Multimodal Lifestyle Research Articles

Mediterranean diet for the management of metabolic dysfunction-associated steatotic liver disease in non-Mediterranean, Western countries: What's known and what's needed?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, affecting 30% of the population in Western countries. MASLD is considered the hepatic manifestation of the metabolic syndrome, pathophysiologically underpinned by insulin resistance and frequently co-exists with hypertension, central obesity and dyslipidaemia. Currently, safe and effective pharmacotherapies for MASLD are limited, making weight loss with lifestyle changes the mainstay therapy. A Mediterranean diet (MedDiet) has emerged as an effective dietary pattern for preventing and managing MASLD, but most studies have been conducted in Mediterranean countries, necessitating further investigation into its benefits in Western populations. Additionally, the effect of holistic multimodal lifestyle interventions, including physical activity combined with the MedDiet, is not well established. Finally, MASLD's widespread prevalence and rapid growth require improved accessibility to interventions. Digital health delivery platforms, designed for remote access, could be a promising approach to providing timely support to individuals with MASLD. This narrative review summarises the current evidence related to the effects of the MedDiet in Western, multicultural populations with MASLD. This includes a detailed description of the composition, prescription and adherence to dietary interventions in terms of how they have been designed and applied. The evidence related to the role of physical activity or exercise interventions prescribed in combination with the MedDiet for MASLD will also be reviewed. Finally, recommendations for the design and delivery of dietary and physical activity or exercise interventions to inform the design of future randomised controlled trials to facilitate the optimal management of MASLD are outlined.

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model.

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.

Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program.

Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.

A multimodal precision-prevention approach combining lifestyle intervention with metformin repurposing to prevent cognitive impairment and disability: the MET-FINGER randomised controlled trial protocol

BackgroundCombining multimodal lifestyle interventions and disease-modifying drugs (novel or repurposed) could provide novel precision approaches to prevent cognitive impairment. Metformin is a promising candidate in view of the well-established link between type 2 diabetes (T2D) and Alzheimer’s Disease and emerging evidence of its potential neuro-protective effects (e.g. vascular, metabolic, anti-senescence).MET-FINGER aims to test a FINGER 2.0 multimodal intervention, combining an updated FINGER multidomain lifestyle intervention with metformin, where appropriate, in an APOE ε4-enriched population of older adults (60–79 years) at increased risk of dementia.MethodsMET-FINGER is an international randomised, controlled, parallel-group, phase-IIb proof-of-concept clinical trial, where metformin is included through a trial-within-trial design. 600 participants will be recruited at three sites (UK, Finland, Sweden). Participants at increased risk of dementia based on vascular risk factors and cognitive screening, will be first randomised to the FINGER 2.0 intervention (lifestyle + metformin if eligible; active arm) or to receive regular health advice (control arm). Participants allocated to the FINGER 2.0 intervention group at risk indicators of T2D will be additionally randomised to receive metformin (2000 mg/day or 1000 mg/day) or placebo. The study duration is 2 years. The changes in global cognition (primary outcome, using a Neuropsychological Test Battery), memory, executive function, and processing speed cognitive domains; functional status; lifestyle, vascular, metabolic, and other dementia-related risk factors (secondary outcomes), will be compared between the FINGER 2.0 intervention and the control arm. The feasibility, potential interaction (between-groups differences in healthy lifestyle changes), and disease-modifying effects of the lifestyle-metformin combination will be exploratory outcomes.The lifestyle intervention is adapted from the original FINGER trial (diet, physical activity, cognitive training, monitoring of cardiovascular/metabolic risk factors, social interaction) to be consistently delivered in three countries. Metformin is administered as Glucophage®XR/SR 500, (500 mg oral tablets). The metformin/placebo treatment will be double blinded.ConclusionMET-FINGER is the first trial combining a multimodal lifestyle intervention with a putative repurposed disease-modifying drug for cognitive impairment prevention. Although preliminary, its findings will provide crucial information for innovative precision prevention strategies and form the basis for a larger phase-III trial design and future research in this field.Trial registrationClinicalTrials.gov (NCT05109169).

Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective

Chronic pain is the most prevalent disease worldwide, leading to substantial disability and socioeconomic burden. Therefore, it can be regarded as a public health disease and major challenge to scientists, clinicians and affected individuals. Behavioral lifestyle factors, such as, physical (in)activity, stress, poor sleep and an unhealthy diet are increasingly recognized as perpetuating factors for chronic pain. Yet, current management options for patients with chronic pain often do not address lifestyle factors in a personalized multimodal fashion. This state-of-the-art clinical perspective aims to address this gap by discussing how clinicians can simultaneously incorporate various lifestyle factors into a personalized multimodal lifestyle intervention for individuals with chronic pain. To do so the available evidence on (multimodal) lifestyle interventions targeting physical (in)activity, stress, sleep and nutritional factors, specifically, was reviewed and synthetized from a clinical point of view. First, advise is provided on how to design a personalized multimodal lifestyle approach for a specific patient. Subsequently, best-evidence recommendations on how to integrate physical (in)activity, stress, sleep and nutritional factors as treatment targets into a personalized multimodal lifestyle approach are outlined. Evidence supporting such a personalized multimodal lifestyle approach is growing, but further studies are needed.

The behaviour change technique: Profile of a multimodal lifestyle intervention

AbstractIntroductionThe behaviour change technique taxonomy version 1 was developed to identify the smallest active ingredients of a lifestyle intervention, that is, behaviour change techniques (BCTs) based on a written description. By participation and direct observation of an intervention, we intend to not only identify BCTs but also assess exposure time for each BCT. Adding the dimension of exposure time should enable us to make quantitative comparisons between the different BCTs employed. We intend to demonstrate this by studying the hypotheses that exposure to information‐related BCTs is similar for all targeted lifestyle modalities but decreases in the course of the intervention.MethodsDuring 5‐week intensive multimodal lifestyle interventions at a Swedish clinic for lifestyle medicine, we identified BCTs according to behaviour change technique taxonomy version 1 and noted exposure times to BCTs in all mandatory parts of the behaviour change intervention.ResultsTwo hundred thirty‐one independent intervention components were evaluated. BCTs 8.1 Behavioural practice/rehearsal (126 h), 4.1 Instruction on how to perform the behaviour (98 h) and 6.1 Demonstration of the behaviour (65 h) were the most common in terms of exposure time. Relative exposure to BCTs with an informative nature was similar for the different treatment phases (33%−37%−28%; p = 0.09) but higher for physical activity compared to food habits, stress management and unspecific lifestyle medicine (63%−25%−22%−25%; p < 0.001).ConclusionsThe behaviour change technique taxonomy version 1 can be extended by adding exposure time for different BCTs. The resulting BCT–exposure profile can be used for assessing the relative importance of different behaviour change strategies.

Exercise therapy as a digital therapeutic for chronic disease management: consideration for clinical product development.

Digital exercise therapies (DET) have the potential to bridge existing care gaps for people living with chronic conditions. Acting as either a standalone, embedded within multi-modal lifestyle therapy, or adjunct to pharmacotherapy or surgery, evidence-based DETs can favorably impact the health of a rapidly growing population. Given the nascent nature of digital therapeutics, the regulatory landscape has yet to mature. As such, in the absence of clear guidelines clinical digital product developers are responsible for ensuring the DET adheres to fundamental principles such as patient risk management and clinical effectiveness. The purpose of this narrative review paper is to discuss key considerations for clinical digital product developers who are striving to build novel digital therapeutic (DTx) solutions and thus contribute towards standardization of product development. We herein draw upon DET as an example, highlighting the need for adherence to existing clinical guidelines, human-centered design and an intervention approach that leverages the Chronic Care Model. Specific topics and recommendations related to the development of innovative and scalable products are discussed which ultimately allow for differentiation from a basic wellness tool and integration to clinical workflows. By embodying a code of ethics, clinical digital product developers can adequately address patients' needs and optimize their own future digital health technology assessments including appropriate evidence of safety and efficacy.

Multimodal lifestyle engagement patterns support cognitive stability beyond neuropathological burden

BackgroundModifiable lifestyle behaviors account for a large proportion of dementia risk. However, the combined contributions of multidomain lifestyle patterns to cognitive aging are poorly understood, as most studies have examined individual lifestyle behaviors in isolation and without neuropathological characterization. This study examined data-driven patterns of lifestyle behaviors across multiple domains among older adults and tested their associations with disease-specific neuropathological burden and cognitive decline.MethodsParticipants included 2059 older adults enrolled in the longitudinal Memory and Aging Project (MAP) at the Rush Alzheimer’s Disease Center; none of whom had dementia at baseline (73% no cognitive impairment (NCI), 27% mild cognitive impairment [MCI]). All participants completed cognitive testing annually. Lifestyle factors were measured during at least one visit and included (1) actigraphy-measured physical activity, as well as self-reported (2) sleep quality, (3) life space, (4) cognitive activities, (5) social activities, and (6) social network. A subset of participants (n = 791) had autopsy data for which burden of Alzheimer’s disease (AD), cerebrovascular disease (CVD), Lewy body disease, and hippocampal sclerosis/TDP-43 was measured. Latent profile analysis across all 2059 participants identified distinct subgroups (i.e., classes) of lifestyle patterns. Linear mixed-effects models examined relationships between lifestyle classes and global cognitive trajectories, with and without covarying for all neuropathologies. Classes were also compared on rates of incident MCI/dementia.ResultsFive classes were identified: Class 1Low Life Space (lowest lifestyle engagement), Class 2PA (high physical activity), Class 3Low Avg (low to average lifestyle engagement), Class 4Balanced (high average lifestyle engagement), and Class 5Social (large social network). Classes 4Balanced and 5Social had the lowest AD burden, and Class 2PA had the lowest CVD burden. Classes 2–5 had significantly less steep global cognitive decline compared to Class 1Low Life Space, with comparable effect sizes before and after covarying for neuropathological burden. Classes 4Balanced and 5Social exhibited the lowest rates of incident MCI/dementia.ConclusionsLifestyle behavior patterns among older adults account for differential rates of cognitive decline and clinical progression. Those with at least average engagement across all lifestyle domains exhibit greater cognitive stability after adjustment for neuropathology, highlighting the importance of engagement in multiple healthy lifestyle behaviors for later life cognitive health.

Prevention of Alzheimer’s by a Multimodal Lifestyle Protocol – Working‐mechanisms for Memory Gains: Mouse‐PAW

AbstractBackgroundThe approach of changing multiple lifestyle factors simultaneously targeting different risk factors is expected to have the greatest potential in preventing or delaying the progression of dementia. Nevertheless, it is largely unidentified what are the biological working mechanism underlying the positive findings from clinical trials of multimodal lifestyle interventions.MethodWe have set up a novel protocol to study multimodal lifestyle intervention in mice. The protocol was developed to recapitulate the FINGER (NCT01041989) and MIND‐AD (NCT03249688) clinical trials. In the lifestyle Prevention of Alzheimer’s Working‐mechanisms (PAW) group, mice were given access to running wheels (voluntary exercise), Fortasyn Connect (healthy diet), and they were subjected to cognitive training in an IntelliCage (IC) environment. To separately investigate the effects of an intervention resembling vascular monitoring, a group of mice was given Atorvastatin and Enalapril mixed in the diet. Control mice were housed in normal conditions. We included 12 wild‐type female C57BL/J6 mice six‐months‐of‐age per group. The full intervention lasted for 8 weeks.ResultThe study aimed to evaluate the feasibility of this innovative housing setup that provides a lifestyle intervention for the mice. The housing setup furthermore provides diverse data for individual mice on their learning and physical activity. Definite strengths of the protocol are the minimal need for mouse handling, the possibility of group housing, and that the intervention runs fully in a homecage environment. During the intervention, the PAW group undergoes cognitive training in the form of learning the location (corner) of a bottle from which they receive water (positive reinforcement). Regardless of individual variation in learning different cognitive training paradigms, PAW mice on a group level were able to reduce the error rates (incorrect corner visits) by approximately 25% in all paradigms.ConclusionWe constructed a way of performing multimodal lifestyle intervention in mice in a homecage environment, which provides a platform for detailed mechanistic studies. Moreover, our protocol minimizes stress due to handling and provides quantitative data for both cognitive training and exercise. The future steps involve studying animal models of cognitive decline, Alzheimer’s disease and vascular/metabolic dysfunction to assess mechanisms impacted by lifestyle change.

The LEISURE Study: A Longitudinal Randomized Controlled Trial Protocol for a Multi-Modal Lifestyle Intervention Study to Reduce Dementia Risk in Healthy Older Adults.

Dementia is understood to arise from a mixed etiology, enveloping chronic inflammatory and vascular impacts on the brain, driven by a constellation of modifiable risk factors which are largely mediated by lifestyle-related behaviors. These risk factors manifest over a prolonged preclinical period and account for up to 40% of the population attributable risk for dementia, representing viable targets for early interventions aimed at abating disease onset and progression. Here we outline the protocol for a 12-week randomized control trial (RCT) of a multimodal Lifestyle Intervention Study for Dementia Risk Reduction (LEISURE), with longitudinal follow-up at 6-months and 24-months post-intervention. This trial integrates exercise, diet, sleep, and mindfulness to simultaneously target multiple different etiopathogenetic mechanisms and their interplay in a healthy older adult population (aged 50-85 years), and assesses dementia risk reduction as the primary endpoint. The LEISURE study is located in the Sunshine Coast region of Australia, which has one of the nation's highest proportions of adults aged over 50 years (36.4%), and corresponding dementia prevalence. This trial is novel in its inclusion of mindfulness and sleep as multidomain lifestyle targets, and in its comprehensive suite of secondary outcomes (based on psychological, physical health, sleep activity, and cognitive data) as well as exploratory neuroimaging (magnetic resonance imaging and electroencephalography) and molecular biology measures. These measures will provide greater insights into the brain-behavioral underpinnings of dementia prevention, as well as the predictors and impacts of the proposed lifestyle intervention. The LEISURE study was prospectively registered (ACTRN12620000054910) on 19 January 2020.

Results of a tailored multimodal lifestyle follow-up care program focusing on physical activity, nutritional behavior and psychological processes in adolescent and young adult cancer survivors: The CARE for CAYA multicenter, randomized clinical trial.

12002 Background: The aim of the CARE for CAYA-program (CFC-P) was to implement a multimodal lifestyle program in addition to medical follow-up care for child, adolescents and young adult cancer survivors (CAYAs). Methods: The CFC-P was a multicenter program with an initial randomized clinical trial (RCT) comparing need-based modular interventions to usual care for CAYAs aged between 15 and 39. A comprehensive assessment (questionnaires and medical examination) was conducted to determine individual needs regarding nutrition, physical activity and psycho-oncology. If “high need” was identified, CAYAs could take part in up to three modules over 12 months. In the intervention group (IG), each module included five consultations plus newsletters. The control group (CG) included one baseline counseling in each module. The primary outcome was defined as the rate of CAYAs with “high need(s)” after 12 months of intervention. Secondary outcomes included feasibility, cost-effectiveness, modular-specific endpoints, quality of life (QoL) and fatigue. Results: 791 CAYAs were included at 14 German CAYA survivorship clinics from December 2017 to March 2021. Most common tumor types were lymphoma 26.8% (n = 211), sarcoma 13.2% (n = 104) and leukemia 10.0% (n = 79). 58.0% (n = 457) were female, median age was 23.9 years, time since end of tumor specific therapy was < 5 years in 54.4%, > 5 years in 21.2%, > 10 years in 11.5% and > 15 years in 12.9% of patients (median: 57.0 months). 86.2% (n = 679) reported an initial “high need” in at least one module. After 52 weeks, 83.9% (n = 396 of 472 evaluable participants) continued to report or developed a “high need”: 59.3% (n = 235) in IG and non-randomized cohort, 28.8% (n = 114) in CG and 12.7% (n = 47) with no initial “high need”. 357 participants were evaluable in the RCT (63% (n = 226) female, median age 25.0 years). 26.2% (n = 94) reported a “high need” in one, 35.7% (n = 128) in two and 37.6% (n = 135) in three modules. 271 patients could be analyzed at 52 weeks, 87.0% of IG (n = 120 of 138) and 86.5% of CG (n = 115 of 133) continued to have at least one “high need”. The primary outcome did not differ significantly between groups (p = .905). However, both showed an increase of QoL and a reduction of fatigue. Conclusions: In the CFC-P, the feasibility of a large trial to regularly assess lifestyle habits and the psychosocial situation and determine the efficacy of a need based multimodal interventions in CAYAs was demonstrated. Although a high need for support was revealed in this population, no significant changes with the applied interventions were noted after 12 months. The obtained data will guide the development and implementation of multimodal interventions in long term follow up of CAYAs. Clinical trial information: DRKS00012504 .

Musical Activity During Life Is Associated With Multi-Domain Cognitive and Brain Benefits in Older Adults.

Regular musical activity as a complex multimodal lifestyle activity is proposed to be protective against age-related cognitive decline and Alzheimer’s disease. This cross-sectional study investigated the association and interplay between musical instrument playing during life, multi-domain cognitive abilities and brain morphology in older adults (OA) from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study. Participants reporting having played a musical instrument across three life periods (n = 70) were compared to controls without a history of musical instrument playing (n = 70), well-matched for reserve proxies of education, intelligence, socioeconomic status and physical activity. Participants with musical activity outperformed controls in global cognition, working memory, executive functions, language, and visuospatial abilities, with no effects seen for learning and memory. The musically active group had greater gray matter volume in the somatosensory area, but did not differ from controls in higher-order frontal, temporal, or hippocampal volumes. However, the association between gray matter volume in distributed frontal-to-temporal regions and cognitive abilities was enhanced in participants with musical activity compared to controls. We show that playing a musical instrument during life relates to better late-life cognitive abilities and greater brain capacities in OA. Musical activity may serve as a multimodal enrichment strategy that could help preserve cognitive and brain health in late life. Longitudinal and interventional studies are needed to support this notion.

Breast Cancer Diet "BCD": A Review of Healthy Dietary Patterns to Prevent Breast Cancer Recurrence and Reduce Mortality.

Breast cancer (BC) represents the most common cancer in women, while overweight and obesity are the second preventable cause of cancer. Weight gain and fat accumulation are common after BC diagnosis; moreover, weight gain during the treatment decreases the survival rate and increases the risk of recurrence in breast cancer survivors (BCS). To reduce the risk of second primary cancer or BC recurrence, and all-cause mortality in BCS, multiple interventions have been investigated to obtain reduction in weight, BMI and/or waist circumference. The aim of this narrative review is to analyze evidence on BCS for their risk of recurrence or mortality related to increased weight or fat deposition, and the effects of interventions with healthy dietary patterns to achieve a proper weight and to reduce fat-related risk. The primary focus was on dietary patterns instead of single nutrients and supplements, as the purpose was to investigate on secondary prevention in women free from disease at the end of their cancer treatment. In addition, BC relation with insulin resistance, dietary carbohydrate, and glycemic index/glycemic load is discussed. In conclusion, obesity and overweight, low rates of physical activity, and hormone receptor-status are associated with poorer BC-treatment outcomes. To date, there is a lack of evidence to suggest which dietary pattern is the best approach for weight management in BCS. In the future, multimodal lifestyle interventions with dietary, physical activity and psychological support after BC diagnosis should be studied with the aim of reducing the risk of BC recurrence or mortality.

The Coaching for Cognition in Alzheimer's (COCOA) trial: Study design.

Comprehensive treatment of Alzheimer's disease (AD) requires not only pharmacologic treatment but also management of existing medical conditions and lifestyle modifications including diet, cognitive training, and exercise. We present the design and methodology for the Coaching for Cognition in Alzheimer's (COCOA) trial. AD and other dementias result from the interplay of multiple interacting dysfunctional biological systems. Monotherapies have had limited success. More interventional studies are needed to test the effectiveness of multimodal multi‐domain therapies for dementia prevention and treatment. Multimodal therapies use multiple interventions to address multiple systemic causes and potentiators of cognitive decline and functional loss; they can be personalized, as different sets of etiologies and systems responsive to therapy may be present in different individuals. COCOA is designed to test the hypothesis that coached multimodal interventions beneficially alter the trajectory of cognitive decline for individuals on the spectrum of AD and related dementias (ADRD). COCOA is a two‐arm prospective randomized controlled trial (RCT). COCOA collects psychometric, clinical, lifestyle, genomic, proteomic, metabolomic, and microbiome data at multiple timepoints across 2 years for each participant. These data enable systems biology analyses. One arm receives standard of care and generic healthy aging recommendations. The other arm receives standard of care and personalized data‐driven remote coaching. The primary outcome measure is the Memory Performance Index (MPI), a measure of cognition. The MPI is a summary statistic of the MCI Screen (MCIS). Secondary outcome measures include the Functional Assessment Staging Test (FAST), a measure of function. COCOA began enrollment in January 2018. We hypothesize that multimodal interventions will ameliorate cognitive decline and that data‐driven health coaching will increase compliance, assist in personalizing multimodal interventions, and improve outcomes for patients, particularly for those in the early stages of the AD spectrum.Highlights The Coaching for Cognition in Alzheimer's (COCOA) trial tests personalized multimodal lifestyle interventions for Alzheimer's disease and related dementias.Dense longitudinal molecular data will be useful for future studies.Increased use of Hill's criteria in analyses may advance knowledge generation.Remote coaching may be an effective intervention.Because lifestyle interventions are inexpensive, they may be particularly valuable in reducing global socioeconomic disparities in dementia care.

My Healthy Brain: a multimodal lifestyle program to promote brain health

Background Promoting brain health depends on sustaining healthy behaviors across the lifespan. Yet, public adoption of lifestyle behaviors and knowledge of cognitive decline (CD) prevention remains poor. Our multidisciplinary team developed My Healthy Brain (MHB) to promote a healthy lifestyle (e.g. diet, exercise, alcohol, sleep) and build cognitive reserve (e.g. memory compensatory strategies). Our objective was to demonstrate early proof-of-concept for MHB by exploring the feasibility, acceptability, and improvement in primary lifestyle outcomes as well as secondary outcomes of self-determination and subjective wellbeing. Materials and Methods Older adults with subjective (self-report only) or objective (confirmed by cognitive testing) CD, referred by neurologists to modify lifestyle risk factors (e.g. sedentary), participated in a non-randomized open pilot of MHB (N = 24). Participants completed the 8-week MHB group (90 min each) and pre-post outcome measures. Results MHB met all a-priori set benchmarks, including good feasibility of recruitment (71% of patients screened) and enrollment (75% completed baseline), and good acceptability of treatment (75% completed 6 of 8 sessions and post-testing). Program satisfaction was excellent (100% of participants) and no adverse events were reported. We also observed improvements in primary lifestyle outcomes as well as secondary outcomes of self-determination and subjective well-being. Discussion While MHB demonstrated preliminary feasibility and the potential to modify lifestyle risk factors for CD, the program can be improved. Future work will explore the integration of mindfulness skills with behavioral principles to bolster multidomain lifestyle change, and the live video delivery format to bypass barriers to participation.

Gustatory Function Can Improve after Multimodal Lifestyle Intervention: A Longitudinal Observational Study in Pediatric Patients with Obesity.

Introduction: Obesity is a major health burden in children and adolescents. One influential factor is the choice of food, which is partly determined by gustatory perception. Cross-sectional studies have provided evidence that gustatory function is reduced in patients with obesity compared to individuals with normal weight. This longitudinal study was aimed at investigating potential effects of a multimodal lifestyle intervention program on gustatory function in pediatric patients with obesity. Methods: Gustatory perception of five different taste qualities (sweet, sour, salty, bitter, and umami) was assessed in n = 102 patients (age 6-18) with obesity (BMI >97th percentile). Testing was performed before (T0) and after (T1) a residential multimodal weight reduction program between June and December 2015 using well-established taste strips. Results: Overall, identification performance increased between T0 and T1. Patients were most successful at identifying the taste quality sweet at both time points and reached higher scores at identifying umami and bitter at T1 compared to T0. Moreover, patients rated the highest concentration of sweet significantly sweeter at T1 compared to T0. Conclusion: Gustatory function can improve after a multimodal lifestyle intervention program in pediatric patients with obesity. This may lead to a modified choice of food, possibly resulting in a long-term therapeutic success. Therefore, these findings underline the importance of professional nutritional counseling as part of treatment for obesity.

Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial.

Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown. To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep. This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65-85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality. There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT -CON]: 1.18%; 95% CI [-0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: -1.39; 95% CI [-2.72, -0.06]) compared to CON. Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.

Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION)

BackgroundUnhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking.MethodsThis multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients’ cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures.ResultsGeneral multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were − 0.15 cm (95%CI: − 2.49; 2.19) after six and − 1.03 cm (95%CI: − 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients’ readiness to change dietary behaviour.ConclusionA multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients.Trial registrationDutch Trial Registry, www.trialregister.nl, NTR3765, 21 December 2012.

Cognitive Reserve Over the Lifespan: Neurocognitive Implications for Aging With HIV.

Approximately 59% of adults living with HIV experience HIV-associated neurocognitive disorder, a collection of symptoms and cognitive deficits in various cognitive domains. As the HIV population ages, the prevalence and severity of such cognitive deficits are expected to grow. Understanding how these cognitive deficits manifest is important for nurses and health care providers. This article provides an overview of cognitive reserve and evidence of how it is compromised by HIV, aging, and individual characteristics. Within this context of cognitive reserve, the role of neuroinflammation, neurotoxicity, substance use, comorbidities, depression and anxiety, social isolation, and sedentary lifestyle is reviewed. From this, strategies used to address cognitive deficits are provided, including topics such as psychostimulants, cognitive training, multimodal lifestyle interventions, and compensation strategies. Scenarios of successful and unsuccessful cognitive aging are presented to provide a lifespan perspective of cognitive reserve. Implications for clinical practice and research are provided, as it relates to aging.

Estilo de vida saludable: un factor de protección minusvalorado frente a la depresión

Depression rates have increased in recent decades in the developed world. According to the WHO report published in 2012, approximately 5% of the population refer to having experienced a depressive episode at some point in their life. In the last few years, the factors responsible for reducing the quality of diet, sleeping hours, physical activity, exposure to ambient lighting, or social environment are being investigated. All of these factors increase the vulnerability to depression to the point that, like diabetes or cardiovascular disease, depression is considered as a “modern disease”, referring to the changes we make in our lifestyles that may predispose to the appearance of these diseases. Consequently, helping patients to improve their lifestyles could have a positive impact on their depressive symptoms, as is being demonstrated. Current available treatments, such as drugs or psychotherapy, do not always prove to be fully effective, and there are estimates that only about 50% of patients treated for depression have total remission without requiring other interventions. In this paper, we describe a multimodal lifestyle program for patients with depression that addresses the above factors and has been labelled as the “Mediterranean lifestyle” program. It is concluded that healthy lifestyle (a regressive lifestyle in many parts of the world), is a protective factor against depression, and many patients can recover from it with specific help.