Nursing & Health

Issue addressed: Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia.

Methods: Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age = 56.0 ± 12.5 years; 65.7% women, mean age = 54.4 ± 13.5 years) 30 days after program commencement.

Results: Significant reductions (P < 0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days.

Conclusions: CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes.

So what?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

Objective: 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.

Objective: 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.

Background

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].

In the wake of COVID-19, the American College of Lifestyle Medicine offered its members an online 10-week multicomponent mental health and wellbeing program (The Lift Project), and extended the invitation to members from sister organizations associated with the Lifestyle Medicine Global Alliance. A total of 1785 members registered for the program, representing 39 countries. The website hosting the program recorded 9815 total visits over the 10 weeks. In a post-program questionnaire completed by 145 participants, 91% agreed or strongly agreed that the program supported their mental wellbeing, and participants reported their wellbeing as higher after the program as compared to its commencement (X2 = 80.8, P < .01). Ninety-four percent of respondents indicated they would recommend the program to a friend. Thematic analysis of open-ended responses included in the post-program evaluation indicated that the participants liked: the structure of the program and content covered; the style of the video presentations; and the practical application of the program. Some participants indicated they would have liked more time to engage with the program and would have enjoyed the provision of group meetings. In conclusion, healthcare organizations can support their members’ mental health and wellbeing by offering large-scale, evidence-based interventions.

The mental health and wellbeing of health care workers has been uniquely challenged by the COVID-19 pandemic. Health care organizations may support the mental health of their members by offering tailored, evidence-based interventions and initiatives. METHODS: The American College of Lifestyle Medicine offered its members an online, 10-week, multicomponent mental health and well-being program (The Lift Project) for free, and extended the invitation to members from sister organizations associated with the Lifestyle Medicine Global Alliance. Individuals (n=1785) representing 39 countries registered for the program. Website meta-data was used to explore participant’ engagement with the program. One hundred forty-five participants responded to a post-program questionnaire that included Likert items and open-ended questions. RESULTS: The website hosting the program recorded 9,815 total visits over 10 weeks. Ninety-one percent of the respondents agreed or strongly agreed that the program supported their mental wellbeing, and there was a significant increase (X2=80.8, p< 0.01) in the proportion of respondents who rated their wellbeing higher after the program compared to at the start of the program. Ninety percent of respondents indicated that the program would have a long-term positive influence on their mental wellbeing, and 94% indicated they would recommend the program to a friend. Dominant themes from the open-ended questions in the post-program evaluation included: the participants liked the style of the video presentations, the structure of the program, content covered and the practical application of the content; the participants would have liked more time to engage with the program and would have enjoyed the provision of group meetings. CONCLUSION: Health care organizations may play an important role in supporting their members’ mental health and wellbeing by offering large-scale, evidence-based interventions. To optimize efficacy, the interventions should be well-designed, engaging, and potentially provide the opportunity for group connection and interaction.

Background: Affective disorders are becoming more pervasive worldwide, including in Southern Africa, where treating patients with these conditions is challenging due to social and financial constraints. A variety of non-pharmacological approaches including lifestyle medicine (e.g., exercise, nutrition, sleep) and positive psychology practices (e.g., gratitude, service), are effective for treating mental health (MH) conditions.

Methods: Twenty-six individuals from South Africa with a diagnosed MH condition participated in a 10-week multimodal intervention incorporating a diverse range of non-pharmacological strategies for improving MH. MH metrics were assessed pre-and post-intervention, including general MH, vitality/energy (VIT), depression, anxiety, stress, and satisfaction with life. MH and VIT were also measured weekly.

Results: Improvements were observed in all mental metrics from pre-to post-intervention: MH (59%, p < 0.001, Cohen’s D = 1.36), VIT (110%, p < 0.001, Cohen’s D = 1.71), depression (−46%, p < 0.001, Cohen’s D = −1.06), anxiety (−48%, p < 0.001, Cohen’s D = −1.21), stress (−36%, p < 0.001, Cohen’s D = −1.08) and life satisfaction (23%, p < 0.001, Cohen’s D = 0.66). Significant improvements in MH and VIT were observed after only 1 week of the intervention and progressively increased until the seventh week, after which further improvements were not statistically significant.

Conclusion: The findings of this cohort study indicate that a multimodal intervention that incorporates lifestyle and positive psychology practices may benefit individuals living with an affective disorder. Non-pharmacological, multimodal interventions might offer a stigma-free way of providing MH promotion and treatment at a population level.

Simon Matthews (Wellcoaches Australia) and Darren Morton (Avondale University) introduce the passionate people making a difference in the pioneering field of lifestyle medicine. In this episode Simon Matthews (Wellcoaches Australia) and Darren Morton (Avondale University) speak with Stephan Herzog, a professional whose passionate about chronic disease reversal in corporate, medical and community settings.

Simon Matthews (Wellcoaches Australia) and Darren Morton (Avondale University) introduce the passionate people making a difference in the pioneering field of lifestyle medicine. In this episode Simon Matthews (Wellcoaches Australia) and Darren Morton (Avondale University) introduce Liana Lianov as a passionate person leading the movement to promote the science of positive psychology and health in health care.