Therapeutic Lifestyle Intervention Research Articles

Effects of a therapeutic lifestyle modification intervention on cardiometabolic health, sexual functioning and health-related quality of life in perimenopausal Chinese women: protocol for a randomised controlled trial

IntroductionPerimenopause is a critical transitional period in reproductive ageing. A set of physiological and psychological changes can affect perimenopausal women’s quality of life and further threaten their older adult health...

The Impact of Caregiver/Care-Receiver Co-Treatment in a Therapeutic Lifestyle Intervention for Chronic Spinal Cord Injury: A Comparative Case Series.

This study is a prospective comparative case series analysing the differential impacts of a therapeutic lifestyle intervention (TLI) on individuals with spinal cord injury (SCI) and their caregivers. The primary objective was to assess changes across several health metrics predictive of cardio metabolic disease (CMD), fitness, and quality of life, in dyadic partners and between 2 separate cases. SCI participants and their respective caregivers, forming 10 dyads, were included in the study. Dyads were randomly assigned to two distinct case scenarios: Case 1, where both dyadic partners received TLI; and Case 2, where only the SCI partner received the intervention. Each case series comprised five dyads. TLI constituted a rigorous 6-month program consisting of exercise, adherence to a Mediterranean diet, and behavioural support. Across cases, notable improvements were observed in body mass, and strength among SCI partners; and reductions in body mass and fasting glucose, and improved mental well-being was observed in caregiver partners. Dyadic interaction analysis found that insulin, HOMA, HDL, and mental health improvements in SCI were strongly linked to improvements in caregiver when both dyadic partners received TLI. We conclude that TLI co-treatment for dyadic partners, including exercise, nutrition, and behaviour modification, improves health outcomes related to CMD risks and quality of life in both populations. ClinicalTrials.gov, ID: NCT02853149 Registered August 2, 2016.

THU485 The Impact Of Cured, Fried Bacon On The Reemergence From Breast Cancer Dormancy

Abstract Disclosure: C.P. Schane: None. A. Nelczyk: None. C. Chen: None. H. Vidana Gamage: None. M. Kadiri: None. M.T. McHenry: None. S. Bendre: None. N. Krawczynska: None. M.A. Henn: None. D.C. Castro: None. J. Chen: None. R.I. Tejeda: None. S. Hsiao: None. N.J. Engeseth: None. J.V. Sweedler: None. M.K. Wendt: None. T. Fan: None. W.G. Helferich: None. E.R. Nelson: None. One in eight women will develop breast cancer in her lifetime, with metastasis being the leading cause of mortality. Once the cells colonize the metastatic site, they do not always immediately begin to proliferate, but remain dormant. These dormant cells reside in the tissue, until mechanisms, which remain unknown, awaken the dormant cells and they resume malignant proliferation. Due to the large and growing population of breast cancer survivors at risk of metastatic recurrence, there is an urgent need to elucidate the mechanisms of dormancy and develop therapeutics to prevent reemergence. Elevated levels of circulating cholesterol are a risk factor for breast cancer recurrence. Preclinical work has demonstrated that oxysterol cholesterol metabolites such as 27-hydroxycholesterol (27HC) can promote tumor metastasis. Here, we show that exogenous 27HC lead to a more rapid reemergence from dormancy, using the syngeneic mouse D2.0R model of mammary cancer dormancy. Since it would be expected that cooking high cholesterol foods, such as bacon, under oxidative conditions, such as pan-frying, would produce fat containing cancer-promoting cholesterol metabolites, we hypothesized that consumption of such cooked foods would also promote reemergence from dormancy. Interestingly, consumption of cured, fried bacon fat (cfBF), but not uncured fried bacon fat (ufBF) resulted in reemergence. When metastatic tissues were assessed, it was found that consumption of cfBF dramatically reduced mast cell numbers. Since mast cells (MC) are major contributors to local histamine production, we next tested whether various anti-histamines could alter dormancy. This led to the striking finding that H2 antagonists promoted the breaking of dormancy. Our ongoing work is aimed at further elucidating this novel metastatic axis: Diet - MC - H2 - Dormancy, with the ultimate goal of leveraging it to develop novel therapeutic targets or lifestyle interventions. Therefore, our results are expected to provide the foundation for dietary and medical approaches to reduce the risk of recurrence among breast cancer survivors. This work was supported by the American Institute for Cancer Research grant (713063), the National Cancer Institute (R01CA234025) and Department of Defense Breast Cancer Research Program Era of Hope Scholar Award (BC200206). Further support awarded to ATN from a National Institutes of Environment Health Sciences and Research Training in Toxicology and Environmental Health (T32) Fellowship (ES007326). Presentation: Thursday, June 15, 2023

Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial.

Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population. This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to 'behavioral support' or 'control condition'. Dyadic couples comprise individuals with SCI (18-65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18-65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden. This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation. ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016.

Efficacy observation of pushing Qiaogong point with different intensities for treating stage I essential hypertension

ObjectiveTo observe the clinical efficacy of pushing Qiaogong point with varying intensities for treating stage I essential hypertension.MethodsA total of 72 patients diagnosed with stage I essential hypertension were enrolled in this study. They were divided into three groups using the random number table method, including a control group, a gentle pushing group, and a heavy pushing group, with 24 patients in each group. All three groups received the same therapeutic lifestyle interventions. The control group received no additional interventions, the gentle pushing group received additional pushing Qiaogong point with gentle strength, and the heavy pushing group received additional pushing Qiaogong point with heavy strength. The treatment duration was 4 weeks, followed by a 4-week follow-up period, during which blood pressure changes were observed and analyzed in all three groups.ResultsAfter treatment, the blood pressure levels in all three groups showed a significant decrease (P<0.05). The effective rate in the control group was 43.5%, in the gentle pushing group was 78.3%, and in the heavy pushing group was 33.3%. The reduction in blood pressure levels in the gentle pushing group was significantly superior to that in both the control group and the heavy pushing group, indicating inter-group statistical significance (P<0.01). The efficacy of the heavy pushing group was comparable to that of the control group, indicating no statistical significance (P>0.05). During the follow-up period, compared with the end of the treatment within the same group, the blood pressure levels remained stable in both the control group and the gentle pushing group, indicating no intra-group statistical significance (P>0.05). The heavy pushing group showed a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) compared with the end of the treatment, indicating intra-group statistical significance (P<0.05). During the follow-up, the gentle pushing group had lower systolic blood pressure (SBP) and MBP compared with both the heavy pushing group and the control group, indicating inter-group statistical significance (P<0.01), while there was no inter-group statistical significance in comparing the DBP (P>0.05). There was no statistical significance in comparing the SBP, DBP, and MBP between the heavy pushing group and the control group (P>0.05).ConclusionPushing Qiaogong point with gentle strength combined with lifestyle interventions showed a higher effective rate and long-term blood pressure stability in the treatment of stage I essential hypertension. Pushing Qiaogong point with varying intensities showed varying effects on patients with stage I essential hypertension.

Effects of a Multicomponent Exercise and Therapeutic Lifestyle (CERgAS) Intervention on Gait Function in Lower-Income Urban-Dwelling Older Adults: A Cluster Randomized Controlled Trial.

This study aims to determine the effectiveness of a multicomponent exercise and therapeutic lifestyle (CERgAS) intervention at improving gait speed among older people in an urban poor setting in Malaysia. A total of 249 participants were divided into the intervention (n = 163) and control (n = 86) groups. The mean (SD) age of participants was 67.83 (6.37) and consisted of 88 (35.3%) males and 161 (64.7%) females. A generalized estimating equation with an intention-to-treat analysis was used to measure gait speed at four time points, baseline (T0), 6weeks (T1), 3months postintervention (T2), and 6months postintervention (T3). The results showed significant changes for time between T0 and T3 (mean difference = 0.0882, p = .001), whereas no significant association were found for group (p = .650) and interaction (p = .348) effects. A 6-week intervention is inadequate to improve gait speed. Future efforts should introduce physical activity monitoring and increase exercise duration, frequency, and intensity.

Sarcopenia and type 2 diabetes: Pathophysiology and potential therapeutic lifestyle interventions

AimsSarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity. Methods and Results: Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise. Conclusions: The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D.

A Randomized, Placebo-Controlled Crossover Study to Evaluate Postprandial Glucometabolic Effects of Mulberry Leaf Extract, VitaminD, Chromium, and Fiber in People with Type2 Diabetes.

Reducing postprandial (PP) hyperglycemia and PP glucose excursions is important for overall glycemic management. Although most therapeutic lifestyle interventions that reduce caloric intake would affect this, there is no particular nutritional intervention favored. We evaluated the effects of a novel natural food adjuvant combining mulberry leaf extract (MLE) with other bioactive ingredients, in people with type2 diabetes (T2D) originating from Asia, on improving PP glucometabolic response in a randomized controlled exploratory crossover, two-center study (USA, Singapore). A 2-g blend of 250mg MLE [containing 12.5mg of 1-deoxynojirimycin (DNJ)], fiber (1.75g), vitamin D3 (0.75μg), and chromium (75μg), compared with a similar blend without the MLE, was sprinkled over a 350-kcal breakfast meal (55.4g carbs) and PP blood glucose (primary exploratory endpoint), insulin, and incretin hormones (GLP-1, GIP) were evaluated in blood samples over 3h. Changes in incremental areas under the concentration curve (iAUC) and maximum concentrations (Cmax) were compared. Thirty individuals (12 women, mean age 59years, HbA1c 7.1%, BMI 26.5kg/m2) were enrolled and the MLE-based blend relative to the blend without MLE significantly reduced glucose iAUC at 1h (- 20%, p < 0.0001), 2h (- 17%, p = 0.0001), and 3h (- 15%, p = 0.0032) and Cmax [mean (95% CI) difference - 0.8 (- 1.2, - 0.3) mmol/L, p = 0.0006]. A statistically significant reduction in 1h insulin iAUC (- 24%, p = 0.0236) was observed, but this reduction was no longer present at either 2h or 3h. No difference in GLP-1 was seen, but GIP response (iAUC and Cmax) was less with the MLE-based blend. The observation of a significant glucose reduction paralleled with a significant lower insulin response supports a reduced gastrointestinal glucose absorption. These results support the use of a 2-g natural blend of MLE, fiber, vitaminD, and chromium in T2D as a convenient dietary adjuvant to improve PP glucometabolic response. gov identifier NCT04877366.

Cardiovascular risk in bipolar disorder – A case for the hypothalamus-pituitary-adrenal axis?

BackgroundUnipolar major depressive disorder (MDD) and bipolar disorder (BD) are associated with elevated mortality risk secondary to natural causes. Cardiovascular disease (CVD) constitutes the most prevalent underlying condition. Patients with BD display higher CVD-associated excess mortality than MDD patients. Epicardial adipose tissue (EAT) volume, a known predictor of premature CV morbidity and adrenal gland (AG) volume, an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation, were compared in BD and MDD patients. MethodsMagnetic resonance imaging was performed to assess EAT and AG volume in age-, gender-, and body mass index (BMI)-matched MDD (N = 27) and BD (N = 27) patients. Ten-year CV mortality risk and diabetes risk were assessed by PROCAM, ESC-SCORE, and FINDRISK, respectively; metabolic syndrome (MetS) was determined following NCEP/ATP III criteria. ResultsCardiometabolic risk scores and frequency of MetS were comparable, and scores of cardiometabolic risk indices did not significantly differ in both groups. After adjustment for age, BMI, and physical activity, EAT and AG volumes were significantly higher in BD compared to MDD. Partial correlation analyses showed a significant positive association of EAT and AG volumes in BD but not in the MDD. LimitationsThe modest sample size warrants confirmation in a larger cohort and the cross-sectional design does not allow for temporal or causal inferences. ConclusionOur study indicates increased EAT accumulation in BD patients. This was associated with HPA axis dysregulation. Therapeutic lifestyle interventions that reduce EAT volume should be considered in clinical BD management.

Defining Opportunities For Achieving Health Equity In Heart Failure Prevention And Treatment: The Role Of The Heart Failure Society Of America

Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity and gender. Age-adjusted HF-related HF hospitalization rates are highest for Black patients, particularly among young Black men and women compared to their White counterparts. The consequence of longstanding residential segregation is that Black and Latinx patients are more likely to reside in neighborhoods with limited opportunities for therapeutic lifestyle interventions to prevent the onset of HF. Growing income inequality in the United States also puts Black and Latinx patients, and women at higher risk of having limited access to healthcare and novel therapeutics. Limited conclusions can be made about populations including "Asians", because of an overall lack of data, and inappropriate grouping of a people with a heterogeneous risk of CVD (i.e. East Asians vs. South Asians). Moreover, recent data confirm that bias reduction training and diversification of the cardiovascular workforce will improve the quality of care for an increasingly diverse patient population. We propose a session to defining the most pressing needs to achieve health equity in HF prevention and treatment, and to delineate the role the HFSA has in promoting diversity within the society and the cardiovascular workforce at large. Learning Objective(s):• To redefine concepts related to definitions of race and ethnicity in research and clinical care.• To describe the importance of social determinants of health as a root cause for the growing burden of Stage A-B HF, and difficulty in treating Stage C-D HF• To define the role of HFSA in achieving health equity for patients with or at risk for HF

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions.

Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen's d .1-.2). Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal.

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

Metabolic syndrome among individuals living with hypertension in Accra, Ghana.

Metabolic syndrome (MetS) is a major risk factor to cardiovascular diseases. In this study, we investigate the prevalence and associated risky behaviour of MetS in resource-poor urban communities in Accra, Ghana. We analysed data on 111 persons with hypertension, screened and recruited for a therapeutic lifestyle intervention program in August 2015. MetS was measured using the International Diabetes Federation (IDF) and the World Health Organization definitions. The prevalence of MetS was 58.4% and 16.8% by the IDF and WHO definitions respectively. More women (61.8%) compared to men (31.8%) had MetS (p = 0.011). Approximately 31% of the hypertensive patients were engaged in moderate-intensity physical activity; 9.0% were current smokers, 42.0% consumed excess alcohol over the past month prior to the interview and 41.0% discontinued taking their antihypertensive medications without consulting with a doctor. About 42.0% and 37.0% of respondents always consumed fruits and vegetables respectively at least two times a day. The binary logistic regression showed that compared to women, men had lower odds of consuming two or more servings of vegetable in a day (OR: 0.2; 95% CI; 0.1, 0.8). Increase in age was associated with higher odds of consuming fruits at least twice a day (1.0; 1.0, 1.1) but with lower odds of engaging in moderate intensity physical activity (0.9; 0.8, 1.0). Being married was associated with higher odds of engaging in moderate physical activity (2.8; 1.0, 8.2). Therapeutic methods essential for the management of patients with hypertension and MetS should include non-pharmacological remedies targeting the promotion of medication adherence, Dietary Approaches to Stop Hypertension (DASH) and physical activities; these are vital to changing unhealthy lifestyle which worsens the underlying pathology.

Probiotic characterization and cholesterol assimilation ability of Pichia kudriavzevii isolated from the gut of the edible freshwater snail “Pila globosa”.

Excess cholesterol is one of the main causes of various metabolic diseases. Currently available therapeutic measures, lifestyle, and dietary interventions, as well as pharmaceutical agents, are inadequate for the regulation of cholesterol levels. Probiotic microorganisms have demonstrated the potential to lower cholesterol levels through various mechanisms, including the activity of bile salt hydrolase, production of enzyme-inhibiting compounds such as 3-hydroxy-3-methylglutaryl coenzyme A, and assimilation of cholesterol. In the present investigation a yeast culture designated as S-I, isolated from freshwater snail’s gut (Pila globosa), fulfilled probiotic attributes. The culture was found to be non-hemolytic and could tolerate a bile concentration up to 1.2%, pH 1.5–10; and temperature 42oC respectively. Additionally, 73.57% and 36.24% of S-I culture survived when exposed to the gastric environment for 90 and 180 min respectively, while 53% survived after 240 min incubation under the intestinal environment. The S-I culture could auto-aggregate (93.01%), as well as co-aggregate (77.89%) with gastrointestinal pathogens, an important property required for the probiotics to control the pathogens. The culture also inhibited C. albicans NCIM3557, E. coli NCIM3099, E. faecalis NCIM3040, S. aureus NCIM2408and P. aeruginosa NCIM2036 in-vitro. Other probiotic properties such as hydrophobicity (81%), bile salt hydrolase activity (86.30%), and tolerance to 8% NaCl (27.38%), as well as antibiotics, were found to be in favor of the S-I culture. Most importantly, S-I culture was found to assimilate 20.29% of cholesterol. Molecular characterization of this culture performed by 18S rRNA sequencing revealed that the S-I culture was Pichia kudriavzevii species with 97% similarity.

Metabolic Dysfunction and Asthma: Current Perspectives.

The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions have been shown to be independently related to asthma. Novel insights have also recently been brought by metabolomics in this filed. The purpose of this review is to discuss current perspectives regarding metabolic dysfunction in asthma, from obesity-related asthma to other metabolic conditions and the role of current pharmacological therapeutic strategies and lifestyle interventions. Obesity is a well-recognized risk factor for asthma across the lifespan, which is generally associated with poorer response to current available treatments, rendering a more severe, refractory disease status. Besides the epidemiological and clinical link, untargeted metabolomics studies have recently supported the obesity-associated asthma phenotype at the molecular level. Not only obesity-related, but also other aspects of metabolic dysregulation can be independently linked to asthma. These include hyperinsulinemia, dyslipidemia and hypertension, which need to be taken into account, even in the non-obese patient. Untargeted metabolomics studies have further highlighted several other metabolic pathways that can be altered in asthma, namely regarding oxidative stress and systemic inflammation, and also suggesting the importance of microbiota in asthma pathogenesis. Considering the reduced response to corticosteroids, other pharmacologic treatments have been shown to be effective regardless of body mass index. Non-pharmacologic treatments (namely weight reduction and dietary changes) may bring substantial benefit to the asthmatic patient. Taken together, this evidence points towards the need to improve our knowledge in this filed and, in particular, to address the influence of environmental factors in metabolic dysfunction and asthma development. Personalized medicine is definitely needed to optimize treatment, including a holistic view of the asthmatic patient in order to set accurate pharmacologic therapy together with dietary, physical exercise and lifestyle interventions.

Therapeutic lifestyle change intervention improved metabolic syndrome criteria and is complementary to amlodipine/atorvastatin

AimsTo examine whether addition of amlodipine (5 mg)/atorvastatin (10 mg) A/A to Therapeutic Lifestyle change intervention (TLC) would beneficially modulate Metabolic Syndrome (MetS) and oxidized low-density lipoprotein (Ox-LDL) levels. MethodsPatients with MetS (n = 53) were randomized to TLC + placebo or TLC + A/A for 12 months. Anthropometric measurements, blood pressure (BP), lipid profile, plasma Ox-LDL, and area under the curve of free fatty acid (AUCFFA) during oral glucose tolerance test, a marker of adipose tissue health, were assessed before and after the intervention. ResultsTwenty-six patients completed the study with an overall improvement of MetS (p = 0.02). TLC + placebo was beneficial in reversing MetS comparable to TLC + A/A (54% vs. 39%; p = 0.08). Both treatments decreased systolic BP (p ≤ 0.01). TLC + A/A also decreased diastolic BP and triglyceride levels. The changes in Ox-LDL levels directly correlated with changes in weight in the TLC-placebo group (r = 0.64; p = 0.04). AUCFFA determined the loss of fat mass (r = 0.472, p = 0.03). Conclusions1) Addition of A/A has the advantage of improving the lipid profile and BP; but TLC alone was comparable to TLC + A/A in improving MetS; 2) weight change determines the TLC-associated change in Ox-LDL levels; and 3) AT metabolic health is a significant predictor of TLC-associated loss of body fat mass.

Factors Determining the Success of Therapeutic Lifestyle Interventions in Diabetes - Role of Partner and Family Support.

Background and aims: Knowledge of therapeutic lifestyle interventions is one of the most important pillars of diabetes care; however, its incorporation in real-world settings is poor. This review evaluates the role of partner and family support in diabetes management. Methods: Literature searches were performed in PubMed, Medline and Embase for articles published before July 2018, using the terms “therapeutic lifestyle intervention” [MeSH Terms], OR “diet changes” [All Fields], OR “spousal participation” [All Fields], OR “lifestyle interventions” [All Fields], “lifestyle changes” [All Fields] AND “diabetes” [All Fields]. The search was not restricted to English-language literature; literature in Spanish, French and German were also evaluated. Results: A total of 66 of articles were reviewed, which included 33 original work, 21 review articles, and 12 systematic reviews and meta-analyses. Studies and meta-analyses have showed that if one partner has type-2 diabetes this increases the risk in other by 5–26%. Partner and family have similar diet, lifestyle, and micro- and macro-environments which could explain the similar increased risk of diabetes and non-communicable diseases. Studies have consistently shown that spousal and family support plays a key role in overcoming negative behaviours and optimising behaviours in diabetes control. Partner support has major role in prevention and control of diabetes distress, associated depression, and medication non-compliance which have an adverse impact in glycaemic outcomes. These data are predominantly available from observational studies. There is paucity of data from interventional trials evaluating effects of family and spousal participation on health, glycaemic control and quality of life. Conclusion: The support of family and spouse/partner is beneficial to improve adherence to the lifestyle interventions and pharmacotherapy required to achieve optimum glycaemic control and avoid associated complications.

MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial.

BackgroundThe ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia.MethodsThis cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up.DiscussionFindings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults.Trial registrationISRCTN22749696.

Erratum

Erratum to “The Effect of a Brief Low-intensity Therapeutic Lifestyle Counselling Intervention on Weight Loss Among Overweight Patients in Primary Care: A Pilot Randomised Controlled Trial” Figure 1 of Ng LB, Yang Y, Koh GC-H. The effect of a brief low-intensity therapeutic lifestyle counselling intervention on weight loss among overweight patients in primary care: a pilot randomised controlled trial. Proc Singapore Healthc 2014;23(2):118–25, is incorrect. The corrected figure is given below.

The Effect of a Brief Low-Intensity Therapeutic Lifestyle Counselling Intervention on Weight Loss among Overweight Patients in Primary Care: A Pilot Randomised Controlled Trial

Introduction: To preliminarily assess the effectiveness of a simple low intensity therapeutic lifestyle counselling intervention on weight reduction in overweight patients in primary care. Methods: We piloted a six-month randomised controlled trial on 200 primary care clinic patients aged between 21 to 75 years with body mass index (BMI) &gt;23 kg/m2 who were randomised into two groups. The intervention group received a structured intervention consisting of a 15-minute education session on calorie content of common local food items, healthy food choices, exercise frequency, intensity, type, and time duration, and weight reduction goal setting; the control group received usual care. The primary outcome measure was change in body mass index (BMI) from recruitment to 6 months. Results: Five hundred and seventeen out of the 1,304 patients assessed were eligible for the study. Of these, 317 declined to participate (61.3%). Among the 200 who participated, 88 were assigned to usual care and 112 were assigned to intervention. Only 62 participants completed the six-month follow-up (24 in control and 38 in intervention group). The mean BMI decline was greater in the intervention than control group [0.71 (SD=1.17) and 0.08 (SD=0.90) kg/m2 respectively, p=0.021], and remained statistically significant after adjusting for age, gender and baseline BMI (p=0.041). Conclusion: Our pilot study found that a simple six-month low-intensity therapeutic lifestyle counselling intervention resulted in statistically significant but small reductions in BMI in overweight patients in primary care. These results should be interpreted with caution due to high participation refusal and lost-to-follow-up rates, and lack of objective process measures.