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The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study - a randomized controlled trial.

ABSTRACT: Multi-factorial intervention studies have been found to be successful in the initiation of lifestyle changes. However, little is known about the longer-term maintenance of health behavior improvements. The purpose of this study was to investigate whether improvements in physical activity and dietary habits achieved in a population-based multi-factorial lifestyle intervention of five years duration were maintained five years after intervention activities have ended.The study was a population-based randomized controlled trial, Inter99 (1999-2006), Copenhagen, Denmark. Over five years, all participants in the intervention group (n?=?6,091) received individual lifestyle counseling; participants at high risk of ischemic heart disease - according to pre-specified criteria - were also offered group-based counseling. The control group (n?=?3,324) was followed by questionnaires. Both groups were followed one, three, five, and ten years after baseline. Changes in physical activity and dietary habits (intake of vegetables, fruit, fish, and saturated fat) during and after the intervention were investigated using random-coefficient models.Five years after the intervention, women in the intervention group reported greater improvements in the intake of fruit (M ??=?90.2 g/week, p?=?0.041) and less intake of saturated fat (OR?=?0.30, 95% CI: 0.17-0.54) than the control group. Men in the intervention group reported greater improvements in physical activity (M ??=?19.6 min/week, p?=?0.003) and less intake of saturated fat (OR?=?0.31, 95% CI: 0.17-0.56) than the control group. Improvements in the intake of vegetables and fish achieved during the intervention were not maintained in the longer-term.Screening and lifestyle counseling had sustained effects on physical activity and dietary habits five years after its discontinuation. The patterns of long-term changes in lifestyle differed across behaviors and between men and women.ClinicalTrials.gov ( NCT00289237 ).

SUBMITTER: Baumann S

PROVIDER: S-EPMC4352560 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study - a randomized controlled trial.

Baumann Sophie S Toft Ulla U Aadahl Mette M Jørgensen Torben T Pisinger Charlotta C

The international journal of behavioral nutrition and physical activity 20150306

<h4>Background</h4>Multi-factorial intervention studies have been found to be successful in the initiation of lifestyle changes. However, little is known about the longer-term maintenance of health behavior improvements. The purpose of this study was to investigate whether improvements in physical activity and dietary habits achieved in a population-based multi-factorial lifestyle intervention of five years duration were maintained five years after intervention activities have ended.<h4>Methods< ...[more]

PMID: 25886540

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Project description:BACKGROUND:Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL). METHODS:Women diagnosed with early breast cancer (N?=?143, mean age?=?52?±?10?years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18?weeks (end of chemotherapy), and 26?weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time. RESULTS:Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26?weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26?weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26?weeks. No significant effect of the intervention was found on major macronutrients intake. CONCLUSIONS:A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1?year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients. TRIAL REGISTRATION:The APAD study was prospectively registered on ClinicalTrials.gov (NCT01495650; date of registration: December 20, 2011).

Project description:Specific dietary and other lifestyle behaviors may affect the success of the straightforward-sounding strategy "eat less and exercise more" for preventing long-term weight gain.We performed prospective investigations involving three separate cohorts that included 120,877 U.S. women and men who were free of chronic diseases and not obese at baseline, with follow-up periods from 1986 to 2006, 1991 to 2003, and 1986 to 2006. The relationships between changes in lifestyle factors and weight change were evaluated at 4-year intervals, with multivariable adjustments made for age, baseline body-mass index for each period, and all lifestyle factors simultaneously. Cohort-specific and sex-specific results were similar and were pooled with the use of an inverse-variance-weighted meta-analysis.Within each 4-year period, participants gained an average of 3.35 lb (5th to 95th percentile, -4.1 to 12.4). On the basis of increased daily servings of individual dietary components, 4-year weight change was most strongly associated with the intake of potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed red meats (0.95 lb), and processed meats (0.93 lb) and was inversely associated with the intake of vegetables (-0.22 lb), whole grains (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt (-0.82 lb) (P?0.005 for each comparison). Aggregate dietary changes were associated with substantial differences in weight change (3.93 lb across quintiles of dietary change). Other lifestyle factors were also independently associated with weight change (P<0.001), including physical activity (-1.76 lb across quintiles); alcohol use (0.41 lb per drink per day), smoking (new quitters, 5.17 lb; former smokers, 0.14 lb), sleep (more weight gain with <6 or >8 hours of sleep), and television watching (0.31 lb per hour per day).Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect and implications for strategies to prevent obesity. (Funded by the National Institutes of Health and others.).

Project description:BackgroundFew studies have investigated the specific effect of single intervention components in randomized controlled trials. The purpose was to investigate the effect of adding group-based diet and exercise counselling to individual life-style counselling on long-term changes in dietary habits.MethodsThe study was a randomized controlled intervention study. From a general Danish population, aged 30 to 60 years (n = 61,301), two random sample were drawn (group A, n = 11,708; group B, n = 1,308). Subjects were invited for a health screening program. Participation rate was 52.5%. All participants received individual life-style counselling. Individuals at high risk of ischemic heart disease in group A were furthermore offered group-based life-style counselling. The intervention was repeated for high-risk individuals after one and three years. At five-year follow-up all participants were invited for a health examination. High risk individuals were included in this study (n = 2 356) and changes in dietary intake were analyzed using multilevel linear regression analyses.ResultsAt one-year follow-up group A had significantly increased the unsaturated/saturated fat ratio compared to group B and in men a significantly greater decrease in saturated fat intake was found in group A compared to group B (net change: -1.13 E%; P = 0.003). No differences were found between group A and B at three-year follow-up. At five-year follow-up group A had significantly increased the unsaturated/saturated fat ratio (net change: 0.09; P = 0.01) and the fish intake compared to group B (net change: 5.4 g/day; P = 0.05). Further, in men a non-significant tendency of a greater decrease was found at five year follow-up in group A compared to group B (net change: -0.68 E%; P = 0.10). The intake of fibre and vegetables increased in both groups, however, no significant difference was found between the groups. No differences between groups were found for saturated fat intake in women.ConclusionOffering group-based counselling in addition to individual counselling resulted in small, but significantly improved dietary habits at five-year follow-up and a tendency of better maintenance, compared to individual counselling alone.Trial registrationThe Inter99 study was approved by the local Ethics Committee (KA 98 155) and is registered with ClinicalTrials.gov (registration number: NCT00289237).

Project description:ObjectiveTo investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level.DesignRandomised controlled community based trial.SettingSuburbs of Copenhagen, Denmark.Participants59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987).InterventionThe intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening.Main outcome measuresThe primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality.Results6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58,308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58,940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09).ConclusionA community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.Trial registration Clinical trials NCT00289237.

Project description:The objective of the present study was to evaluate the short- and long-term intervention and mediation effects of a 3-month individualized need-supportive physical activity (PA) counseling intervention on employees' PA and sedentary behavior.Insufficiently active employees (n?=?300; mean age 42?±?9 years; 78% female) were recruited from a large pharmaceutical company in Flanders, Belgium. A quasi-experimental design was used in which the intervention group (N?=?246) was recruited separately from the reference group (N?=?54). Intervention group participants received a 3-month behavioral support intervention, which consisted of two one-hour face-to-face counseling sessions and three follow-up counseling contacts by e-mail or telephone at weeks three, six and nine. PA counseling, delivered by qualified PA counselors, aimed to satisfy participants' basic psychological needs for autonomy, competence, and relatedness. Reference group participants did not receive individualized PA counseling. Outcome measures included objectively assessed and self-reported PA and sedentary time and psychological need satisfaction. Assessments were held at baseline, immediately after the intervention (short-term) and 6 months post-intervention (long-term). Mixed model analyses and bootstrapping analyses were used to determine intervention and mediation effects, respectively.The intervention group increased weekday daily steps both in the short- and long-term, while the reference group showed reductions in daily step count (ES?=?.65 and ES?=?.48 in the short- and long-term, respectively). In the short-term, weekday moderate-to-vigorous PA increased more pronouncedly in the intervention group compared to the reference group (ES?=?.34). Moreover, the intervention group demonstrated reductions in self-reported sitting time during weekends both in the short- and long-term, whereas the reference group reported increased sitting time (ES?=?.44 and ES?=?.32 in the short- and long-term, respectively). Changes in perceived autonomy and competence need satisfaction mediated the long-term intervention effects on daily step count.A 3-month individualized need-supportive PA counseling intervention among employees resulted in significant and sustained improvements in weekday daily step count and in decreased self-reported sitting during weekends. Our findings contribute to the growing evidence of the long-term effectiveness of need-supportive PA counseling.ClinicalTrials.gov NCT01759927 . Registered December 30, 2012.

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The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study - a randomized controlled trial.

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The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study - a randomized controlled trial.

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