PURPOSE: This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight.
METHODS: Seventy-three patients (mean ± SD, 55 ± 12 years) with overweight (body mass index (BMI), 34.5 ± 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 ± 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days.
RESULTS: The experimental group reduced 2.1 kg (±4.6) in weight and 3 cm (±4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups.
CONCLUSIONS: The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual's goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.
BACKGROUND: There is a paucity of data describing the sustained benefits of lifestyle interventions on health behaviors and blood pressure (BP).
METHODS: We examined the persistence of changes in health habits and BP in the ENCORE study, a trial in which 144 overweight individuals with above-normal BP were randomized to one of the following 16-week interventions: Dietary Approaches to Stop Hypertension (DASH) diet alone (DASH-A), DASH diet plus a behavioral weight management intervention (DASH-WM), or Usual Care. Follow-up assessments were conducted 8 months after the end of treatment.
RESULTS: At 16 weeks, systolic BP was reduced by 16.1 (95% confidence interval (CI) = 13.0-19.2) mm Hg in the DASH-WM group, 11.2 (95% CI = 8.1-14.3) mm Hg in the DASH-A group, and 3.4 (95% CI = 0.4-6.4) mm Hg in the Usual Care group. A decrease in BP persisted for 8 months, with systolic BP lower than baseline by 11.7 (95% CI = 8.1-15.3) mm Hg in the DASH-WM group, 9.5 (95% CI = 6.7-12.1) mm Hg in the DASH-A group, and 3.9 (95% CI = 0.5-7.3) mm Hg in the Usual Care group (P < 0.001 for active treatments vs. Usual Care). DASH-WM subjects lost 8.7 kg during the intervention and remained 6.3 kg lighter on follow-up examination. Changes in diet content were sustained in both DASH intervention groups. Among those who participated in DASH-WM, however, caloric intake was no longer lower, and only 21% reported still exercising regularly 8 months after completing the intervention.
CONCLUSIONS: Changes in dietary habits, weight, and BP persisted for 8 months after completion of the 16-week ENCORE program, with some attenuation of the benefits. Additional research is needed to identify effective methods to promote long-term maintenance of the benefits of lifestyle modification programs.
CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00571844.
OBJECTIVE: The objective was to determine whether adding a self-regulatory intervention (SRI) focused on self-monitoring of spontaneous physical activity (SPA) and sedentary behavior to a standard weight loss intervention improved maintenance of lost weight.
METHODS: Older (65-79 years), obese (BMI = 30-40 kg/m(2) ) adults (n = 48) were randomized to a 5-month weight loss intervention involving a hypocaloric diet (DIET) and aerobic exercise (EX) with or without the SRI to promote SPA and decrease sedentary behavior (SRI + DIET + EX compared with DIET + EX). Following the weight loss phase, both groups transitioned to self-selected diet and exercise behavior during a 5-month follow-up. Throughout the 10-months, the SRI + DIET + EX group utilized real-time accelerometer feedback for self-monitoring.
RESULTS: There was an overall group by time effect of the SRI (P < 0.01); DIET + EX lost less weight and regained more weight than SRI + DIET + EX. The average weight regain during follow-up was 1.3 kg less in the SRI + DIET + EX group. Individuals in this group maintained approximately 10% lower weight than baseline compared with those in the DIET + EX group whom maintained approximately 5% lower weight than baseline.
CONCLUSIONS: Addition of a SRI, designed to increase SPA and decrease sedentary behavior, to a standard weight loss intervention enhanced successful maintenance of lost weight.
BACKGROUND: Obese men are more likely to have poor dietary patterns compared to women, increasing diet-related chronic disease risk. The impact of a male-only weight loss intervention on dietary intakes is under-evaluated. The aim was to determine whether overweight/obese men randomised to self-help paper-based resources with or without online support, achieved greater improvements in diet compared with Wait-list controls at 3 and 6 months following a gender tailored weight-loss intervention.
METHODS: Dietary intake was assessed using a 120-item semi-quantitative food frequency questionnaire (FFQ), in a secondary analysis of a three-arm weight loss RCT grounded in Social Cognitive Theory; (1) RESOURCES: gender-tailored weight loss resources (DVD, handbooks, pedometer, tape measure); (2) Online: resources plus website and efeedback, (3) Wait-list control.
RESULTS: Energy, total fat, saturated fat, and carbohydrate intakes decreased in the online group, which differed significantly from controls at 3- and 6-month follow-up (P<0.05). There was a significant reduction in energy, fat and carbohydrate intakes in the Resource group at 3 and 6 months, but no difference from controls (P>0.05). In the online group there was an increase in %energy from core foods and decrease in %energy from energy-dense nutrient-poor foods (P<0.05) that was significantly different compared to controls at 3 and 6 months (P<0.05).
CONCLUSION: Results suggest that men randomised to the SHED-IT intervention arms were able to implement key dietary messages up to 6 months compared to controls. Future interventions should include targeted and gender-tailored messages as a strategy to improve men's dietary intake within weight loss interventions.
OBJECTIVE: To evaluate the effectiveness of a telephone-delivered behavioral weight loss and physical activity intervention targeting Australian primary care patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS: Pragmatic randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151). Reported here are 18-month (end-of-intervention) and 24-month (maintenance) primary outcomes of weight, moderate-to-vigorous-intensity physical activity (MVPA; via accelerometer), and HbA1c level. Secondary outcomes include dietary energy intake and diet quality, waist circumference, lipid levels, and blood pressure. Data were analyzed via adjusted linear mixed models with multiple imputation of missing data.
RESULTS: Relative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements in weight loss (relative rate [RR] -1.42% of baseline body weight [95% CI -2.54 to -0.30% of baseline body weight]), MVPA (RR 1.42 [95% CI 1.06-1.90]), diet quality (2.72 [95% CI 0.55-4.89]), and waist circumference (-1.84 cm [95% CI -3.16 to -0.51 cm]), but not in HbA1c level (RR 0.99 [95% CI 0.96-1.02]), or other cardio-metabolic markers. None of the outcomes showed a significant change/deterioration over the maintenance period. However, only the intervention effect for MVPA remained statistically significant at 24 months.
CONCLUSIONS: The modest improvements in weight loss and behavior change, but the lack of changes in cardio-metabolic markers, may limit the utility, scalability, and sustainability of such an approach.
BACKGROUND: Sedentary behavior may independently contribute to morbidity and mortality among survivors of colorectal cancer. In the current study, the authors assessed whether a telephone-delivered multiple health behavior change intervention had an effect on the sedentary behavior of recently diagnosed colorectal cancer survivors.
METHODS: A total of 410 participants were recruited through the Queensland Cancer Registry and randomized to the health coaching (intervention) or usual-care (control) group. Eleven health coaching sessions addressing multiple health behaviors, including sedentary behavior, were delivered over a period of 6 months. Data were collected at baseline (before randomization), at 6 months, and at 12 months via a telephone interview.
RESULTS: At 12 months, there was a significant decrease noted in the hours per day of sedentary time in both the health coaching (-1.21; 95% confidence interval [95% CI], -1.71 to -0.70) and usual-care groups (-0.55; 95% CI, -1.06 to -0.05), but the between-group difference was not found to be statistically significant (-0.65; 95% CI, -1.37 to 0.06 [P = .07]). In stratified subgroup analyses, the multiple health behavior change intervention was found to have a significant effect on total sedentary time (hours/day) at 12 months in survivors of colorectal cancer who were aged > 60 years (-0.90; 95% CI, -1.80 to -0.01 [P = .05]), male (-1.33; 95% CI, -2.44 to -0.21 [P = .02]), and nonobese (-1.10; 95% CI, -1.96 to -0.25; [P = .01]).
CONCLUSIONS: Incorporating simple messages about limiting sedentary behaviors into a multiple health behavior change intervention was found to have modest effects on sedentary behavior. A sedentary behavior-specific intervention strategy may be required to achieve substantial changes in sedentary behavior among colorectal cancer survivors.
AIMS/HYPOTHESIS: The aim of this study was to assess whether or not a theory-based behaviour change intervention delivered by trained and quality-assured lifestyle facilitators can achieve and maintain improvements in physical activity, dietary change, medication adherence and smoking cessation in people with recently diagnosed type 2 diabetes.
METHODS: An explanatory randomised controlled trial was conducted in 34 general practices in Eastern England (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care-Plus [ADDITION-Plus]). In all, 478 patients meeting eligibility criteria (age 40 to 69 years with recently diagnosed screen or clinically detected diabetes) were individually randomised to receive either intensive treatment (n = 239) or intensive treatment plus a theory-based behaviour change intervention led by a facilitator external to the general practice team (n = 239). Randomisation was central and independent using a partial minimisation procedure to balance stratifiers between treatment arms. Facilitators taught patients skills to facilitate change in and maintenance of key health behaviours, including goal setting, self-monitoring and building habits. Primary outcomes included physical activity energy expenditure (individually calibrated heart rate monitoring and movement sensing), change in objectively measured fruit and vegetable intake (plasma vitamin C), medication adherence (plasma drug levels) and smoking status (plasma cotinine levels) at 1 year. Measurements, data entry and laboratory analysis were conducted with staff unaware of participants' study group allocation.
RESULTS: Of 475 participants still alive, 444 (93%; intervention group 95%, comparison group 92%) attended 1-year follow-up. There were no significant differences between groups in physical activity (difference: +1.50 kJ kg(-1) day(-1); 95% CI -1.74, 4.74), plasma vitamin C (difference: -3.84 μmol/l; 95% CI -8.07, 0.38), smoking (OR 1.37; 95% CI 0.77, 2.43) and plasma drug levels (difference in metformin levels: -119.5 μmol/l; 95% CI -335.0, 95.9). Cardiovascular risk factors and self-reported behaviour improved in both groups with no significant differences between groups.
CONCLUSIONS/INTERPRETATION: For patients with recently diagnosed type 2 diabetes receiving intensive treatment in UK primary care, a facilitator-led individually tailored behaviour change intervention did not improve objectively measured health behaviours or cardiovascular risk factors over 1 year.
TRIAL REGISTRATION: ISRCTN99175498 FUNDING: The trial is supported by the Medical Research Council, the Wellcome Trust, National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and National Institute of Health Research under its Programme Grants for Applied Research scheme. The Primary Care Unit is supported by NIHR Research funds. Bio-Rad provided equipment for HbA1c testing during the screening phase.
Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues, improving eating regulation and dietary patterns, reducing symptoms of depression and anxiety, and promoting weight loss. Diabetes self-management education (DSME), which addresses knowledge, self-efficacy, and outcome expectations for improving food choices, also may be an effective intervention for diabetes self-care. Yet few studies have compared the impact of mindful eating to a DSME-based treatment approach on patient outcomes. Adults 35 to 65 years old with type 2 diabetes for ≥ 1 year not requiring insulin therapy were recruited from the community and randomly assigned to treatment group. The impact of a group-based 3-month mindful eating intervention (MB-EAT-D; <i>n</i> = 27) to a group-based 3-month DSME “Smart Choices” (SC) intervention (<i>n</i> = 25) postintervention and at 3-month follow-up was evaluated. Repeated-measures ANOVA with contrast analysis compared change in outcomes across time. There was no significant difference between groups in weight change. Significant improvement in depressive symptoms, outcome expectations, nutrition and eating-related self-efficacy, and cognitive control and disinhibition of control regarding eating behaviors occurred for both groups (all <i>p</i> < .0125) at 3-month follow-up. The SC group had greater increase in nutrition knowledge and self-efficacy than the MB-EAT-D group (all <i>p</i> < .05) at 3-month follow-up. MB-EAT-D had significant increase in mindfulness, whereas the SC group had significant increase in fruit and vegetable consumption at study end (all <i>p</i> < .0125). Both SC and MB-EAT-D were effective treatments for diabetes self-management. The availability of mindful eating and DSME-based approaches offers patients greater choices in meeting their self-care needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
OBJECTIVE: To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities.
DESIGN: Multicentre, parallel group, randomised controlled trial.
SETTING: Four Scottish National Health Service health boards.
PARTICIPANTS: 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control.
INTERVENTION: Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change.
MAIN OUTCOME MEASURES: The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption.
RESULTS: At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation.
CONCLUSIONS: Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN53033856.
This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight.
METHODS:
Seventy-three patients (mean ± SD, 55 ± 12 years) with overweight (body mass index (BMI), 34.5 ± 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 ± 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days.
RESULTS:
The experimental group reduced 2.1 kg (±4.6) in weight and 3 cm (±4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups.
CONCLUSIONS:
The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual's goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.
