Lifestyle Modification Program Research Articles

Sociodemographic, Health, and Lifestyle-Related Characteristics Associated With the Commencement and Completion of a Web-Based Lifestyle Educational Program for People With Multiple Sclerosis: Randomized Controlled Trial.

Digital health interventions increase access to multiple sclerosis (MS)-related knowledge for people living with MS; however, our understanding of factors associated with engagement in web-based learning is limited. This study aims to examine associations between participant sociodemographic, health, and lifestyle-related characteristics and the commencement and completion of the Multiple Sclerosis Online Course (MSOC) in a randomized controlled trial (RCT). An intervention course was developed based on the Overcoming MS Program-an evidence-based lifestyle modification program for MS, and a standard care course was developed based on international MS website information. An RCT was conducted to compare the effectiveness of the intervention course versus the standard care course in improving health outcomes in people living with MS. Participant data were collected from a baseline survey. Associations between baseline participant characteristics and MSOC commencement and completion, respectively, were assessed using multivariate log-binomial regression. Overall, 1893 participants enrolled in the RCT, and 45.27% (n=857) completed the baseline survey: 23.5% (n=444) in the intervention course and 21.8% (n=413) in the standard care course. Of these 857 participants, 631 (73.6%) commenced the standard care course or intervention course, and 49.1% (218/444) and 54.2% (224/413) completed the intervention course and standard care course, respectively. University education, partnered relationship status, and higher mental and physical quality of life were associated with 19%, 12%, 20%, and 22% higher rates of course commencement, respectively. Clinically significant fatigue was associated with a 10% reduction in the likelihood of commencement. Strongest associations with intervention course completion included middle and older adulthood, male sex, fatigue, and preexisting adherence to a diet program, with 96%, 27%, 24%, and 19% higher rates of completion observed, respectively, whereas higher self-efficacy was associated with up to 35% lower intervention course completion. Associations with standard care course completion included practicing meditation (20% higher completion), whereas employment was associated with 22% lower completion. Sociodemographic and clinical factors, as well as lifestyle-related factors, were important factors in MSOC commencement and completion. These data may help guide the design and enhancement of digital health interventions tailored for people living with MS. Australian New Zealand Clinical Trials Registry ACTRN12621001605886; https://tinyurl.com/2vyve9p9. RR2-10.1186/s12883-023-03298-0.

Lifestyle Intervention Modulates the CD4+ T Cell Profile in the Blood of Crohn's Disease Patients.

Crohn's disease (CD) significantly affects patients' well-being and is influenced by stress and lifestyle factors, highlighting the importance of improving quality of life in CD management. An imbalance between pro- and anti-inflammatory CD4+ T cell responses is a key factor in CD, and stress has been shown to alter the function of CD4+ T cells. Therefore, this study aimed to evaluate the effect of a mind-body medicine stress management and lifestyle modification (MBM) program on the CD4+ T cell profile in CD patients. Circulating CD4+ T cells from CD patients were analyzed by flow cytometry following the MBM program. Patients were randomly assigned to either a guided intervention group (IG) or a self-guided waitlist control group (CG) over a 9-month trial and compared with healthy blood donors. Lifestyle intervention reduced regulatory T cell (Treg) frequencies in the blood of CD patients. Notably, we observed a significant correlation between the quality of life improvement and Treg frequencies in the IG but not in the CG. Furthermore, differential activation and expression of the gut-homing molecules G protein-coupled receptor 15 and CCR9 on circulating Tregs and CD4+ effector T cells were detected in both the IG and CG. The MBM program, whether guided or self-directed, has the potential to restore the CD4+ T cell profile of CD patients to levels comparable to healthy blood donors. Lifestyle interventions may benefit CD progression, symptoms, and immunological status, but further analysis is needed to substantiate these findings and to fully understand their clinical implications. (ClinicalTrials.gov: NCT05182645).

Re-PROGRAM: The evaluation of a brief intervention program for patients with functional seizures in an outpatient hospital setting.

Functional seizures (FS) account for 20%-25% of referrals to specialist epilepsy clinics. They are associated with major disability, increased mortality, and frequent and costly health care use. Current guidelines emphasize the importance of implementing clinical pathways to coordinate and deliver effective treatment, but there are few targeted evidence-based interventions that reliably improve patient outcomes, and treatment resources are limited. We conducted a retrospective evaluation of Re-PROGRAM, a novel, brief intervention for functional seizure patients, to assess its feasibility in an outpatient setting. Twenty-nine patients with FS undertook Re-PROGRAM between August 2020 and January 2022 at the Alfred Hospital Functional Seizures Clinic, Melbourne, Australia. The intervention comprised five 60-90-min consecutive weekly appointments via telehealth, where psychologists engaged patients in a structured program of seizure management skills, lifestyle modification, and behavioral activation strategies. Following the intervention, patient feedback was collected in routine clinical follow-up as well as with a 24-item self-report pre-/postintervention comparison questionnaire. All 29 patients who enrolled in Re-PROGRAM completed the scheduled sessions. Of those who returned the postintervention questionnaire (n = 16), 15 reported a reduction in seizure frequency. Four patients were lost to follow-up. Of the remaining nine, eight reported seizure frequency reduction during clinical follow-up. Qualitative analysis of the feedback revealed the majority of patients reported reduced seizure duration, intensity, and bothersomeness, and patients felt improvements in their sense of control over seizures, confidence to use seizure control strategies, assertive communication, problem solving, coping skills, relationships with others, and their day-to-day functioning. This retrospective evaluation demonstrates the feasibility and acceptability of Re-PROGRAM as a brief intervention for individuals diagnosed with FS delivered in a clinical outpatient setting and warrants further investigation in larger scale, randomized controlled studies.

Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs.

This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.

Evaluating an acceptance-based lifestyle modification program to address cardiovascular disease risk among adolescent girls with overweight and obesity: Protocol for a randomized controlled trial

BackgroundBehavioral weight loss interventions achieve only limited weight loss in adolescent samples and weight regain is common. This limited intervention success may be attributed, in part, to adolescents' lack of self-regulation skills essential for lifestyle modification and use of a one-size fits-all approach to produce weight loss in boys and girls. Interventions which teach self-regulation skills, such as Acceptance-Based Therapy (ABT), and are tailored to meet gender-specific concerns, are critical to help adolescents adapt to pervasive biological and environmental influences toward weight gain. ObjectiveThis trial tests the effect of an ABT intervention on cardiometabolic health, health-related behaviors, and psychological factors among adolescent girls with overweight or obesity (OW/OB). MethodsGirls 14–19 years (N = 148; ≥ 40% racial/ethnic minorities) with OW/OB (BMI: ≥ 85th percentile) will be enrolled in the study. Participants will be randomized to one of two 6-month interventions, consisting of either 18 sessions of ABT or 9 sessions of a health education control, an augmented version of standard care for adolescent OW/OB, both led by bachelor's level interventionists. ResultsRecruitment is taking place in Philadelphia, USA, from January 2024 to January 2028. Cardiometabolic health markers (adiposity; blood pressure; blood lipids), health-related behaviors (dietary intake; physical activity; sleep), and psychological factors (quality of life; depression; disordered eating; psychological flexibility) will be measured at baseline, mid-treatment, post-treatment, 6-month follow-up, and 12-month follow-up. ConclusionsThis study will provide valuable information on a novel intervention tailored to the needs of adolescent girls with OW/OB to address self-regulation and cardiometabolic health.

Obesity awareness-insight is inversely associated with body composition and physical activity behaviour in women with obesity at the admission to a lifestyle modification program

Abstract Aim This study was conducted to examine obesity awareness-insight in relation to body composition and physical activity behaviour in women with obesity who were admitted to a lifestyle modification program. Subject and methods Eighty-two participants (age = 38.22 ± 12.49 years) were included. Body composition was assessed. The Obesity Awareness and Insight scale (OASIS), Sedentary Behavior Questionnaire (SBQ), and International Physical Activity Questionnaire–Short Form (IPAQ-SF) were applied. Results The OASIS total score was positively correlated with SBQ and body composition. OASIS “negative outcome awareness” score was negatively correlated with IPAQ-SF moderate physical activity (p < 0.05 for all). OASIS total score and “illness awareness” and “awareness of need for treatment” scores were higher in Class 2 and Class 3 obese participants than in Class 1 participants. Conclusion This study demonstrated that increased obesity awareness-insight correlated with deteriorating body composition and increased sedentary behaviour among women with obesity who were admitted to a lifestyle modification program. Furthermore, awareness of obesity-related adverse outcomes revealed an inverse association with physical activity.

The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults

BackgroundThe Single Point Insulin Sensitivity Estimator (SPISE) index is a surrogate marker for insulin sensitivity. Given the emerging role of bone as an active endocrine organ, its associations with non-invasive measures of extra-skeletal functions such as insulin sensitivity warrant investigation.AimsThis study aimed to explore the relationship between the SPISE index and Bone Mineral Density (BMD) in an adult population.MethodsData from a total of 1270 Arab adults (84% females, mean age 56.7 ± 8.1 years) from the Osteoporosis Registry Database of the Chair for Biomarkers of Chronic Diseases in King Saud University, Riyadh, Saudi Arabia was used in this study. T-scores and SPISE were calculated. Regression models were used to determine associations between SPISE and bone health indices.ResultsThe low BMD group (N = 853; T-score <-1.0) had significantly higher SPISE values than those with normal BMD (N = 417; T-score − 1.0 and above) (4.6 ± 1.3 vs. 4.3 ± 1.2, p < 0.001). Multivariate linear regression, adjusted for covariates, confirmed a significant inverse association between SPISE and BMD for all participants (β=-0.22, p < 0.001), as well as both groups [normal BMD (β = -0.10, p = 0.02) and low BMD groups (β = -0.15, p < 0.001)]. SPISE, family history of T2DM, and history of fractures collectively account for 17% of the variances perceived in T-score for all participants (p < 0.001).ConclusionsA significant inverse association between the SPISE index and BMD was observed in adults, suggesting a link between BMD and extra-skeletal health. Underlying mechanisms need to be investigated prospectively using BMD as secondary outcomes in lifestyle modification programs.

Effects of a multicomponent lifestyle modification intervention on liver function, lipid profile, and body composition in adults with elevated hepatic steatosis index

Parallel to the escalating burden of obesity is the steadily increasing prevalence of metabolic dysfunction associated steatotic liver diseases (MASLD), a chronic condition that progresses from simple steatosis to advanced stages of steatohepatitis, fibrosis, and cirrhosis (1-2). MASLD, regarded as the hepatic manifestation of metabolic syndrome is known to be exacerbated by unhealthy lifestyle choices and the presence of comorbidities such as diabetes, dyslipidemia, and obesity (3-4). Therefore, early identification of the general population at risk of MASLD and the development of multicomponent interventions that can prevent the progression of liver damage and mitigate associated adverse cardiometabolic health outcomes are important. Our study aimed to evaluate the effects of a lifestyle modification program on glucose levels, lipid profile, liver function, and body composition measures in community-living adults with elevated hepatic steatosis index in Mumbai, India.Adults (n= 231, mean age 46.1(13.7) years), 58.6% men) were screened for risk of MASLD using a non-invasive screening tool, Hepatic Steatosis Index (HSI) (calculated as (HSI)= 8 x (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus) (5). Eligible participants with HSI &gt;36 (predictive of the presence of MASLD) were randomized to receive either a multicomponent lifestyle intervention (experimental group, EG) comprising weekly sessions of individualized dietary counseling (Participants having BMI &gt;23kg/m2 (n = 36) received hypocaloric diets with 40% carbohydrates, 40% fat and 30% proteins (WLD) and those having BMI &lt;22.9kg/m2 (n= 22) received weight maintenance diet (WMD) plans including 55% carbohydrates, 15% protein and 30% fats) and fortnightly group sessions of structured exercise and nutrition education or a standard of care package (control group, CG, n= 43) including general healthy eating and activity guidelines for the 8- week study duration. Paired t test and independent sample t tests were used to determine within and between group changes in variables from baseline to endline.Trial Registration: This study is registered as CTRI/2022/05/042927.Overall, the prevalence of MASLD was 52.2%, 32.8% were hypertensive, and 26.7% and 15.4% had diabetes and hypertriglyceridemia respectively. The intervention (WLD) resulted in decreased weight (mean (M)= 3.4 kg, standard error (SE) = 1.88 k, p = 0.02), body fat percent (M = 2.2%, SE = 1.1%, p= 0.042), serum triglycerides (M=28.8mg/dL, SE 8.5mg/dL, p&lt;0.001) and AST (M= 3.8 U/L, SE= 2.2U/L, p &lt;0.05) values. The WMD group reported improvements in serum cholesterol levels, and ALT/ AST ratio as compared to CG (p &lt;0.001). In WMD, HDL-C increased from 45.8 mg/dl to 47.2 mg/dl and the mean AST values reduced from 28.8 (10.6) U/L to 25.6 (9.9) U/L, but these changes were not statistically significant.Multicomponent lifestyle modification programs integrating diet, physical activity and education are effective strategies to improve liver outcomes and optimize cardiometabolic health in people with MASLD.

Obesity awareness-insight is inversely associated with body composition and physical activity behaviour in women with obesity at the admission to a lifestyle modification program

Obesity awareness-insight is inversely associated with body composition and physical activity behaviour in women with obesity at the admission to a lifestyle modification program

Oral glucose tolerance test clearance in type 2 diabetes patients who underwent remission following intense lifestyle modification: A quasi-experimental study.

Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and β-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.

High Compliance with the Lifestyle-Modification Program "Change 10 Habits" Is Effective for Obesity Management.

Low compliance (LC) with lifestyle modification is a very common obstacle in obesity management. The purpose of the current study was to investigate the effectiveness of obesity management according to compliance with a lifestyle-modification program. The "Change 10 Habits" program was administered four times over 12 weeks. Eighty-seven participants were divided into LC and high compliance (HC) groups for analysis after intervention. Then, to assess the program's effectiveness based on compliance, we conducted t-tests and linear regression modeling. In week 12, the scores of two dietary habits-specifically, "eat three meals regularly, adequate amount" and "do not eat after 9:00 PM"-were significantly higher in the HC group than in the LC group. Changes in leg and total body fat percentages were significantly improved in the HC group (-0.2%±0.3% vs. 0.9%±0.3%, P<0.05; -0.1%±0.3% vs. 1.1%±0.5%, P<0.05, respectively). The body mass index was also significantly lower in the HC group than in the LC group (26.7±1.8 kg/m2 vs. 27.7±2.1 kg/m2, P<0.05) at final follow-up. Finally, the systolic blood pressure, triglyceride, and very-low-density lipoprotein cholesterol values of the HC group also decreased significantly (from 117.9±12.2 to 114.3±15.0 mmHg, P<0.05; from 121.7±74.9 to 105.7±60.9 mg/dL, P<0.05; and from 24.3±15.0 to 21.1±12.2 mg/dL, P<0.05, respectively). HC with the study program effectively improved the dietary habits, body fat composition, blood pressure, and lipid profile of adults with mild obesity.

A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus.

The aim of the present study was to evaluate the effectiveness of a 12-month early postnatal lifestyle intervention program in women with gestational diabetes in a recent pregnancy. This study was a prospective randomized intervention study conducted at a diabetes center in Hong Kong. Chinese women aged 18-45 years, who developed gestational diabetes mellitus (GDM) in their most recent pregnancy, were invited. Eligible women were randomized in 1:1 ratio at baseline (6-12 weeks postpartum), to standard care or lifestyle intervention (diet and physical activity) groups for 12 months. A standardized biochemistry assessment including oral glucose tolerance test, blood lipids, complete blood count, renal and liver functions, were measured at baseline and at 12-month. Anthropometry assessment and lifestyle questionnaire were performed at various timepoints. A total of 103 women were randomized at baseline and a total of 79 women (standard care, n = 39, intervention, n = 40) completed the assessment. After the 12-month study period, women in the intervention group had significantly lower energy intake (intervention, -497.6 ± 488.3 kcal; standard, -222.0 ± 390.0 kcal, P < 0.01) compared to the standard care group, and a trend towards greater weight reduction (intervention, -0.93 ± 4.68 kg; standard, -0.01 ± 3.12 kg, P = 0.36). The lifestyle intervention implemented within 3 months postpartum appeared to promote postpartum weight loss. The early postnatal lifestyle intervention program may provide an opportunity to reduce the long-term risk of diabetes in this high-risk population.

The efficacy of multi-disciplinary lifestyle modifications in Taiwanese nonalcoholic steatohepatitis patients.

Lifestyle modification is the standard of care for nonalcoholic fatty liver disease (NAFLD) patients. We aimed to investigate the efficacy of a short-term lifestyle modification program in the disease course of Taiwanese nonalcoholic steatohepatitis (NASH) patients with paired biopsies. All patients received a 6-month, strict multidisciplinary program of lifestyle modifications led by physicians, dieticians, and nursing staff. The histopathological and clinical features were assessed. The endpoints were normalization of transaminase levels, metabolic parameters, a decrease in the NAFLD activity score (NAS) ≥1, and a decrease in the fibrosis stage ≥1. We also aimed to elucidate the predictors associated with disease progression. A total of 37 patients with biopsy-proven NASH were enrolled. The normalization of transaminase levels increased from 0% to 13.5%. There were also significantly increased proportions of patients with normal total cholesterol, triglyceride, and hemoglobin A1c levels. Fifteen (40.5%) patients had an increased NAS ≥1, whereas 10 (27.0%) patients had NAS regression. Twelve (32.4%) patients had increased fibrosis ≥1 stage. Only 2 (5.4%) patients experienced fibrosis regression. A high fasting plasma glucose (FPG) level was associated with NAS progression. Older age and higher transaminase and FPG levels were factors associated with fibrosis progression. Seven (18.9%) patients achieved a body weight reduction >3%, and 4 (57.1%) of them experienced NAS regression. No significant effect of weight reduction on the progression of fibrosis was observed. The short-term lifestyle modification program significantly decreased liver enzymes and metabolic parameters in NASH patients. A more precise or intensive program may be needed for fibrosis improvement.

An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023.

Diabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran. Up to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study's level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study's findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis. There were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1-12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6-15.3). Additionally, the prevalence of diabetes was much higher in the 55-64 age group, coming in at 21.7% (95% CI: 17.5-25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%). The prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial

Introduction: Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD). Hypothesis: We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension. Methods: The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR &lt;60 mL/min/1.73 m 2 or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index. Results: Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers. Conclusions: A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.

Structured lifestyle modification as an adjunct to obesity pharmacotherapy: there is much to learn.

We are at the start of an exciting new era of very effective pharmacotherapy for patients with obesity, with the latest generation of drugs approaching the efficacy of obesity surgery. Clinical trials of obesity drugs tend to emphasise the importance of participation in some form of structured lifestyle intervention for all trial participants. This usually consists of advice to reduce calorie intake and increase moderate to vigorous physical activity. There is strong evidence that structured lifestyle modification programmes improve health in patients with obesity and related disorders. However, there is no specific evidence that they improve the response to obesity medications. This is because of the way that drug trials for patients with obesity have traditionally been designed, with participants in the active drug treatment group being compared to participants on placebo drug treatment, but with both groups always receiving the same structured lifestyle intervention. While this approach is entirely reasonable, it makes it impossible to draw any inferences about the efficacy of structured lifestyle modification to augment the response to drug therapy. Given this genuine equipoise, a critical step in ensuring that our treatment of patients with obesity is robustly evidence-based is to determine whether "drug plus lifestyle" offer any advantage over "drug plus placebo" in large, well-designed and adequately powered clinical trials. We also need to determine the cost-effectiveness of these programmes.

Evaluation of a Multimodal Stress Management and Comprehensive Lifestyle Modification Program on Quality of Life and Gastrointestinal Symptoms in Patients with Crohn’s Disease: A Randomized Controlled Pilot Trial with 9-Month Follow-Up

Introduction: Stress and lifestyle factors impact the course of Crohn’s disease (CD). Our primary objective was to assess whether patients with CD benefit from a mind-body-medicine stress management and lifestyle modification (MBM) program. Methods: This 9-month two-arm pilot trial was conducted in Bamberg, Germany (2020–2021). Patients (18–75 years) with mild to moderate activity of CD and stable medication were enrolled and randomly assigned to either a 10-week MBM program (intervention group, IG) or a single 90-min education session (waiting list control group, CG). Primary endpoints were quality of life (IBDQ) and disease activity (HBI). Secondary endpoints were emotional distress, core self-evaluation, and inflammatory biomarkers 3 and 9 months after baseline assessment. Results: We analyzed data from 37 patients (IG: n = 19, mean ± SD age 49.6 ± 13.1 years, 68% female; CG: 18, 46.8 ± 11.4, 67% female). Immediately after the intervention, 79% (IG) and 44% (CG) experienced a clinically relevant improvement (IBDQ score ≥16 points). This was similar after 9 months (63% vs. 44%). There was no difference in disease activity (3 months: p = 0.082, 95% CI −1.3 to 2.6; 9 months: p = 0.251, 95% CI −1.2 to 2.5). Secondary outcomes indicated improvements in emotional distress, core self-evaluation, erythrocyte sedimentation rate after three and in emotional distress, T-cell profiling in the blood, and fecal lactoferrin and calprotectin group after 9 months in the IG. Conclusion: Our study suggested benefits of a multimodal stress management and lifestyle modification program for patients with CD. Larger trials are needed to determine if the program can supplement or at least partially replace pharmacological treatment approaches.

“Mindset Matters”: Perseverance, a balanced approach and structured support as facilitators of whole foods plant-based adoption

Whole foods plant-based diets (WFPBD) show potential for preventing and addressing chronic diseases. However, concerns exist about their acceptability and feasibility. Research on firsthand WFPBD adoption experiences is limited but crucial for promoting dietary change. In a 12-week remotely delivered lifestyle modification program using an ad libitum WFPBD, twenty weight-loss seeking adults (ages 18–75) with overweight or obesity completed self-report surveys and semi-structured interviews via Zoom. The study aimed to explore: (1) experiences with WFPBD adoption; (2) factors that helped or hindered adherence; and (3) perceived salient benefits. Interviews were analyzed inductively through a conventional content analysis, and associations between variables examined with correlational analyses. Participants overall reported WFPBD adoption being a positive, new experience, with an equal number (30%) finding it easy/easier than expected as challenging. Key cited challenges included overwhelm, different eating habits in the household, and meal preparation. Key cited facilitators included adopting an incremental approach to dietary change, persisting after setbacks, and having simple go-to meals. Greater self-compassion and family support, and less sabotage from friends and family corresponded to greater dietary change (rs > 0.45, ps < .05). Participants valued accountability, structure, human support, nutrition psychoeducation and recipes in the program. Three categories emerged regarding perceived benefits of following the WFPBD: physical health benefits, improvements to eating habits, and greater perceived control/agency over health. Results indicate that future interventions should include psychological strategies alongside nutrition education to enhance self-efficacy, address household barriers, and combat feelings of overwhelm through sufficient structure, support, and meal preparation guidance. Messaging around WFPBD may benefit from discussing prevailing positive experiences with adoption, common benefits experienced, and options for an incremental approach given that feasibility and acceptability concerns may deter efforts.

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings.

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings.

ADHERENCE TO LIFESTYLE MODIFICATION AMONG THE POST-PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS IN CARDIOLOGY OPD OF A SELECTED HOSPITAL IN KOLKATA

Background:The prevalence of coronary artery disease is increasing every year in India. As the prevalence of coronary artery disease is increasing, the number of PTCA is also increasing every year. Lifelong adherence to medication and lifestyle modification is required to prevent major adverse effects after PTCA. The purpose of the study was to assess theadherence to lifestyle modification among post-PTCA patients of a selected hospital, Kolkata. Methods:A total of 100 post-PTCA patients attending Cardiology OPD of a tertiary care hospital, Kolkata were surveyed using the purposive sampling technique.Data were collected by using the demographic proforma and structured interview schedule for adherence to lifestyle modification. All the tools were tested for validity and reliability. Results:A Majority(61%) of the patients weremedium adherent to lifestyle modification and 35% and 4% of patients were high adherent and low adherent to lifestyle modification respectively. Adherence to lifestyle modification was significantly associated with education, occupation and monthly per-capita income. Conclusion:To improve health outcomes, in post-PTCA patients, early detection of patients with poor adherence to lifestyle modification and motivational education programmes to improve adherence is important.