Browsing by Author "Diehl, Hans A."
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Item Effectiveness of a Volunteer-Delivered Lifestyle Modification Program for Reducing Cardiovascular Disease Risk Factors(2012-01-01) Chang, Esther; Morey, Peter; Gobble, John; Diehl, Hans A.; Morton, Darren; Rankin, PaulLifestyle modification has been demonstrated to effectively reduce the risk factors associated with cardiovascular disease, but there is a perception that it is costly to administer and resource. The present study examined the results achieved by a 30-day lifestyle modification program (Coronary Health Improvement Project) delivered by volunteers in a community setting. Changes in selected biometric measures of 5,070 participants in the Coronary Health Improvement Project programs delivered throughout North America (January 2006 to October 2009), were assessed. Overall, significant reductions (p280 mg/dl recorded an average reduction of 19.8%. A mean decrease of 16.1% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >190 mg/dl. Individuals who presented with triglycerides >500 mg/dl recorded a mean reduction of 44.1%. The Framingham assessment forecast that approximately 70 cardiac events would be averted during the subsequent decade in the cohort because of the program. In conclusion, significant reductions in cardiovascular disease risk factors can be achieved in a 30-day lifestyle intervention delivered by volunteers, providing a cost-effective mode of administering lifestyle medicine.[from publisher's website].
Item Gender Differences in Effectiveness of the Complete Health Improvement Program (CHIP)(2015-01-01) Diehl, Hans A.; Gobble, John; Rankin, Paul; Morton, Darren; Kent, LillianObjective: To determine the differential effect of gender on outcomes of the Complete Health Improvement Program, a chronic disease lifestyle intervention program.
Design: Thirty-day cohort study.
Setting: One hundred thirty-six venues around North America, 2006 to 2009.
Participants: A total of 5,046 participants (33.5% men, aged 57.9 ± 13.0 years; 66.5% women, aged 57.0 ± 12.9 years).
Intervention: Diet, exercise, and stress management.
Main Outcome Measures: Body mass index, diastolic blood pressure, systolic blood pressure, lipids, and fasting plasma glucose (FPG).
Analysis: The researchers used t test and McNemar chi-square test of proportions, at P < .05.
Results: Reductions were significantly greater for women for high-density lipoprotein (9.1% vs 7.6%) but greater for men for low-density lipoprotein cholesterol (16.3% vs 11.5%), total cholesterol (TC) (13.2% vs 10.1%), triglycerides (11.4% vs 5.6%), FPG (8.2% vs 5.3%), body mass index (3.5% vs 3%), diastolic blood pressure (5.5% vs 5.1%), and TC/high-density lipoprotein (6.3% vs 1.4%) but not different for systolic blood pressure (6% vs 5%). The greatest reductions were in participants with the highest baseline TC, low-density lipoprotein, triglycerides, and FPG classifications.
Conclusions and Implications: The Complete Health Improvement Program effectively reduced chronic disease risk factors among both genders, but particularly men, with the largest reductions occurring in individuals at greatest risk. Physiological or behavioral factor explanations, including differences in adiposity and hormones, dietary intake, commitment and social support, are explored. Researchers should consider addressing gender differences in food preferences and eliciting commitment and differential support modes in the development of lifestyle interventions such as the Complete Health Improvement Program.
Item Long-Term Effectiveness of the Community-Based Complete Health Improvement Program (CHIP) Lifestyle Intervention: A Cohort Study(2013-11-20) Diehl, Hans A.; Hanna, Althea; Rankin, Paul; Hurlow, Trevor; Morton, Darren; Kent, LillianObjective: To examine the long-term (three or more years) effectiveness of the volunteer-delivered CHIP intervention.
Design: Cohort study
Setting: Hawera, New Zealand
Participants: Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age = 64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration = 49.2+10.4 months).
Intervention: 30-day lifestyle modification program (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting.
Main outcome measures: Changes in body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG).
Results: After approximately 4 years, participants with elevated biometrics at program entry maintained significantly lowered BMI (-3.2%; 34.8±5.4 versus 33.7±5.3 kg/m2, p=0.02), DBP (-9.4%; 89.1±4.1 versus 80.8±12.6 mmHg, p=0.005), TC (-5.5%; 6.1±0.7 versus 5.8±1.0 mmol/L, p=0.04) and TG (-27.5%; 2.4±0.8 versus 1.7±0.7 mmol/L, p=0.002). SBP, HDL, LDL and FPG were not significantly different from baseline. Participants with elevated baseline biometrics who reported being compliant to the lifestyle principles promoted in the intervention (N=71, 67% of follow-up participants) recorded further reductions in BMI (-4.2%; 34.8±4.5 versus 33.4±4.8 kg/m2, p=0.02), DBP (-13.3%; 88.3±3.2 versus 77.1±12.1 mmHg, p=0.005) and FPG (-10.4%; 7.0±1.5 versus 6.3±1.3 mmol/L, p=0.02).
Conclusions: Individuals who returned for follow-up assessment and entered the CHIP lifestyle intervention with elevated risk factors were able to maintain improvements in most biometrics for more than three years. The results suggest that the community-based CHIP lifestyle intervention can be effective in the longer-term, even when delivered by volunteers.
Item Optimizing the Intensity of Lifestyle Medicine Interventions: Similar Outcomes for Half the Sessions(2017-05-01) Diehl, Hans A.; Gobble, John; Parker, Karina; Mitchell, Brett G.; Rankin, Paul; Kent, Lillian; Morton, DarrenLifestyle medicine interventions are typically intensive by design. This study explored the optimal “dosage” of a well-known lifestyle medicine intervention—the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.
Item Short-Term Effectiveness of a Lifestyle Intervention Program for Reducing Selected Chronic Disease Risk Factors in Individuals Living in Rural Appalachia: A Pilot Cohort Study(2014-01-16) Shubrook, Jay; Morton, Darren; Kostohryz, Tom; Nakazawa, Masato; Diehl, Hans A.; Drozek, DavidMost Western chronic diseases are closely tied to lifestyle behaviors, and many are preventable. Despite the well-distributed knowledge of these detrimental behaviors, effective efforts in disease prevention have been lacking. Many of these chronic diseases are related to obesity and type " diabetes, which have doubled in incidence during the last 35 years. The Complete Health Improvement Program (CHIP) is a community-based, comprehensive lifestyle modification approach to health that has shown success in addressing this problem. This pilot study demonstrates the effectiveness of CHIP in an underserved, rural, and vulnerable Appalachian population. Two hundred fourteen participants in CHIP collectively demonstrated significant reductions in body mass index, systolic and diastolic blood pressure, and fasting blood levels of total cholesterol, low-density lipoprotein, and glucose. If these results can be repeated in other at-risk populations, CHIP has the potential to help reduce the burden of preventable and treatable chronic diseases efficiently and cost-effectively.
Item The Complete Health Improvement Program (CHIP) and Reduction of Chronic Disease Risk Factors in Canada(2014-05-19) Diehl, Hans A.; Gobble, John; Dysinger, Wayne; Sokolies, Rex; Kent, Lillian; Rankin, Paul; Morton, DarrenPurpose: The short-term effectiveness of the nutrition-centred Complete Health Improvement Program (CHIP) lifestyle intervention for improving selected chronic disease risk factors was examined in the Canadian setting.
Methods: A total of 1003 people (aged 56.3 ± 12.1 years, 68% female) were self-selected to participate in one of 27 CHIP interventions hosted in community settings by Seventh-day Adventist churches throughout Canada, between 2005 and 2011. The program centred on the promotion of a whole-food, plant-based eating pattern, and daily physical activity was also encouraged. Biometric measures, including body mass index (BMI), blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS), were determined at program entry and 30 days into the intervention.
Results: Over 30 days, significant overall reductions (P
Conclusions: The CHIP intervention, which centres on a whole-food, plant-based eating pattern, can lead to rapid and meaningful reductions in chronic disease risk factors in the Canadian context.
Item The Complete Health Improvement Program (CHIP) and Reduction of Chronic Disease Risk Factors in the Philippines(2015-06-30) Diehl, Hans A.; Rankin, Paul; Muya, Alma Mae B.; Yabres, Glen D.; Mañez, Suzan Q.; Mañez, Johann T.; Morton, Darren; Kent, LillianLifestyle modification has been demonstrated to effectively reduce the risk factors associated with chronic disease. The Complete Health Improvement Project, a 30-day diet and lifestyle modification program, has been shown to be efficacious in the US, Australasia and Canada. The present study examined the changes in selected biometric measures of 61 participants from six programs delivered in Manila, in the Philippines (May 2013 to November 2014). Overall, significant reductions were recorded in body mass (2.2%, p5.17mmol/l recorded an average reduction of 14.4%. A mean decrease of 17.0% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >3.35 mmol/l. Individuals who presented with triglycerides >2.26 mmol/l recorded a mean reduction of 21.8%. Individuals with systolic blood pressure above 139 mmHg and diastolic blood pressure above 89 mmHg decreased levels by 10.3% and 7.1%, respectively. Finally, fasting plasma glucose decreased on average 24.8% among individuals entering the program with levels above 6.9 mmol/l. In conclusion, significant reductions in chronic disease risk factors can be achieved in a 30-day life style intervention delivered in the Philippines.
Item The Effect of a Low-Fat, Plant-Based Lifestyle Intervention (CHIP) on Serum HDL Levels and the Implications for Metabolic Syndrome Status - A Cohort Study(2013-10-01) Diehl, Hans A.; Gobble, John; Grant, Ross; Ward, Ewan; Rankin, Paul; Morton, Darren; Kent, LillianBackground
Low levels of high-density lipoproteins (HDL) are considered an important risk factor for cardiovascular disease and constitute one of the criteria for the Metabolic Syndrome (MetS). Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk but also HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern.
Methods
Individuals (n = 5,046; mean age = 57.3 ± 12.9 years; 33.5% men, 66.5% women) participating in a in a Complete Health Improvement Program (CHIP) lifestyle intervention within the United States were assessed at baseline and 30 days for changes in body mass index (BMI), blood pressure (BP), lipid profile and fasting plasma glucose (FPG).
Results
HDL levels decreased by 8.7% (p
Conclusions
When people move towards a low-fat, plant-based diet, HDL levels decrease while other indicators of cardiovascular risk improve. This observation raises questions regarding the value of using HDL levels as a predictor of cardiovascular risk in populations who do not consume a typical western diet. As HDL is part of the assemblage of risk factors that constitute MetS, classifying individuals with MetS may not be appropriate in clinical practice or research when applying lifestyle interventions that promote a plant-based eating pattern.[from publisher's website].
Item The Effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for Reducing Selected Chronic Disease Risk Factors: A Feasibility Study(2013-03-01) Diehl, Hans A.; Chang, Esther; Hurlow, Trevor; Kent, Lillian; Morey, Peter; Rankin, Paul; Morton, DarrenAbstract Aim To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States. Methods Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9±12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105). Results In the 30 days of the program, significant overall reductions (pConclusions Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP intervention and the improvements were comparable to that observed in cohorts from the United States. The results of this feasibility study indicate that lifestyle interventions like CHIP may be useful for combating the burgeoning epidemic of chronic disease and further research is warranted.
Item The Influence of Religious Affiliation on Participant Responsiveness to the Complete Health Improvement Program (CHIP) Lifestyle Intervention(2016-10-01) Diehl, Hans A.; Gobble, John; Ferret, Rick; Rankin, Paul; Ward, Ewan; Morton, Darren; Kent, LillianSeventh-day Adventist (SDA) and non-SDA (21.3 and 78.7 %, respectively) individuals (n = 7172) participating in the Complete Health Improvement Program, a 30-day diet and lifestyle intervention, in North America (241 programs, 2006–2012) were assessed for changes in selected chronic disease risk factors: body mass index (BMI), blood pressure (BP), pulse, lipid profile and fasting plasma glucose (FPG). Reductions were greater among the non-SDA for BMI, pulse and blood lipids. Furthermore, the majority of non-SDA in the highest risk classifications for BP, lipids and FPG, but only some lipids among SDA, were able to show improvement by 20 % or more.