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Cardiovascular Risk Factor Reduction in First Responders Resulting From an Individualized Lifestyle and Blood Test Program: A Randomized Controlled Trial.

ABSTRACT: OBJECTIVE:We tested the hypothesis that a lifestyle program would improve risk factors linked to cardiovascular disease (CVD) in first responders. METHODS:A 1-year cluster-randomized controlled clinical trial in 10 cities. Participants were 175 first responders, with increased waist circumference and/or low levels of large (?1) high-density lipoprotein (HDL) particles. The intervention group received personalized online tools and access to telephonic coaching sessions. RESULTS:At 1 year the intervention significantly reduced body weight (P?=?0.004) and waist circumference (P?=?0.002), increased ?1 HDL (P?=?0.01), and decreased triglyceride (P?=?0.005) and insulin concentrations (P?=?0.03). Program adherence was associated with weight loss (P?=?0.0005) and increases in ?1 HDL (P?=?0.03). CONCLUSIONS:In first responders, a personalized lifestyle intervention significantly improved CVD risk factors in proportion to program adherence. Changes in large HDL particles were more sensitive indicators of lifestyle changes than HDL-cholesterol measurement. CLINICAL TRIAL REGISTRATION NUMBER:ClinicalTrials.gov: NCT03322046.

SUBMITTER: Gill R

PROVIDER: S-EPMC6416033 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Cardiovascular Risk Factor Reduction in First Responders Resulting From an Individualized Lifestyle and Blood Test Program: A Randomized Controlled Trial.

Gill Rosalynn R Superko Harold Robert HR McCarthy Megan M MM Jack Kepra K Jones Briana B Ghosh Debanjali D Richards Steve S Gleason Joi A JA Williams Paul T PT Dansinger Michael M

Journal of occupational and environmental medicine 20190301 3

<h4>Objective</h4>We tested the hypothesis that a lifestyle program would improve risk factors linked to cardiovascular disease (CVD) in first responders.<h4>Methods</h4>A 1-year cluster-randomized controlled clinical trial in 10 cities. Participants were 175 first responders, with increased waist circumference and/or low levels of large (α1) high-density lipoprotein (HDL) particles. The intervention group received personalized online tools and access to telephonic coaching sessions.<h4>Results< ...[more]

PMID: 30475306

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Project description:BackgroundA growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.ObjectiveThis study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.MethodsWe conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.ResultsMixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).ConclusionsThe results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Project description:IntroductionFalls are a serious concern for wheelchair and scooter users with multiple sclerosis (MS). Approximately, 75% of the population reports at least one fall in a 6-month period and nearly half report frequent falls. Falls can result in physical injuries and contribute to activity curtailment. Despite the negative consequences, limited evidenced-based fall prevention programs designed specifically for wheelchair and scooter users with MS exist.PurposeRecognizing the threat falls pose to health and well-being and the dearth of fall prevention programs, the purpose of this study is to perform a structured process evaluation and examine the feasibility and efficacy of a community-based intervention specifically designed to reduce fall incidence among wheelchair and scooter users with MS. Secondary aims of the intervention are to improve functional mobility skills associated with fall risk (e.g., transfer and wheelchair skills, balance), increase knowledge of fall risk factors, decrease fear of falling, and enhance quality of life and community participation.MethodsTo evaluate our specific aims, a clinical trial will be performed with 160 wheelchair and scooter users with MS. (ClinicalTrials.gov Identifier: NCT03705364). Participants will be recruited to participate in a small group-style community-based program. The content of the program will be based on factors found to be associated with falls among wheelchair and scooter users with MS. These factors include but are not limited to, wheelchair/scooter related characteristics, transfer activities, impaired seated balance, and environmental factors. A physical or occupational therapist, will implement the intervention, which is comprised of 6 sessions that occur once weekly. The incidence of falls, along with an examination of wheelchair/scooter and transfer skills, seated postural control and knowledge of fall related risk factors will be compared between intervention and control participants, with assessment periods occurring prior to the intervention, 1 to 2 weeks after completion of the 6-week intervention session, and 12 weeks after the intervention period is complete.ConclusionResults from this study will guide the refinement of the intervention program and inform future research among a large and diverse group of wheelchair and scooter users living with MS.

Project description:BackgroundOver 2 million people in Europe are affected by ulcerative colitis, which often severely impacts the quality of life of those concerned. Among other factors, lifestyle and psychosocial factors seem to play an important role in pathogenesis and course of the disease and can be addressed as a complement to pharmacotherapy in comprehensive lifestyle modification programs.MethodsThis qualitative study as part of a mixed methods approach was carried out in the framework of a randomized controlled trial that examined the effect of a comprehensive lifestyle-modification-program (10-week-day clinic program) on quality of life in patients with ulcerative colitis. Qualitative interviews were conducted with 20 out of 47 patients of the intervention group after the program. The aim was to deepen, supplement, and expand the quantitative results of the trial, i.e. to examine individual perceptions of the intervention, including subjective changes and the extent to which elements of the program were integrated into everyday life. Qualitative content analysis techniques utilizing the software MAXQDA were used.ResultsPatients with ulcerative colitis in our sample often experienced multiple negative effects on different levels (physical, psychological, and social) and impaired quality of life because of their disease. They reported generally positively about the program itself, and emphasized perceived positive changes regarding their psychological and physical well-being. The interviews indicated a good implementation of elements learned during the intervention in everyday life.ConclusionsThrough participation in a comprehensive lifestyle modification program in the structure of a day clinic complementary to pharmacotherapy, patients with ulcerative colitis can reduce psychosocial stress and physical symptoms and thereby actively improve their well-being and general quality of life. This patient-centered, holistic approach was rated as useful in countering the complex disease manifestation as well as meeting the individual needs of the patients regarding their disease.Trial registrationclinicaltrials.gov NCT02721823.

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Cardiovascular Risk Factor Reduction in First Responders Resulting From an Individualized Lifestyle and Blood Test Program: A Randomized Controlled Trial.

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Cardiovascular Risk Factor Reduction in First Responders Resulting From an Individualized Lifestyle and Blood Test Program: A Randomized Controlled Trial.

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