Analysis of the efficacy of an internet-based self-administered intervention (“Living Better”) to promote healthy habits in a population with obesity and hypertension: An exploratory randomized controlled trial

Does digital infrastructure improve public Health? A quasi-natural experiment based on China's Broadband policy

This study proposed a scheme for improving people's health from the perspective of digital infrastructure construction. We used the China Family Panel Studies conducted between 2010 and 2020 and the digital infrastructure construction marked by the Broadband China policy between 2014 and 2016 as a quasi-natural experiment. We adopted the multi-time difference-in-differences method to identify the causal relationship between digital infrastructure and people's health. We found that digital infrastructure construction significantly improved people's health, and the effect was more prominent among young and middle-aged residents and those with less than a university education. Moreover, digital infrastructure construction improved the utilization of medical services, helped residents develop healthy lifestyles, and increased people's health investments. Additionally, digital infrastructure reduced health inequality among people and promoted health equity. The findings could guide future policies to improve people's health and well-being.

Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs

This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges' g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001). Heterogeneity was moderate. Scalable mind-body IMIs hold promise as interventions for managing anxiety and depression symptoms in adults with chronic physical conditions without differences seen with age or intervention length. While modest, the effect sizes are comparable to those seen with pharmacological therapy. The field would benefit from detailed reporting of participant demographics including those related to technological proficiency, as well as further evaluation of non-CBT interventions. Registration: The study is registered with PROSPERO ID #CRD42022375606.

How the Presence of a Doctor Known to Patients Impacts a Web-Based Intervention to Promote Physical Activity and Healthy Eating Behaviour in Individuals with an Overweight/Obesity–Hypertension Phenotype: A Randomised Clinical Trial

(1) Background: The ‘Living Better’ web-based programme has shown short- and long-term benefits for body composition and psychological variables in obese patients with hypertension by promoting a healthier lifestyle. To further explore the potential of this programme, in this work we aimed to explore the possible effect of the patient’s ‘own doctor’ appearing in the video content of the Living Better intervention. (2) Methods: A total of 132 patients were randomly assigned either to the experimental (EG, n = 70) or control (CG, n = 62) group (with a doctor the patient knew as ‘their own’ or an ‘unknown doctor’, respectively). The body mass index (BMI), motivation towards physical activity (PA), PA levels, motivation to change one’s eating habits, adherence to the Mediterranean diet, and eating behaviour were all assessed and compared at baseline and post-intervention (12 weeks). (3) Results: The results of this study confirmed the positive effects of the Living Better programme on BMI and external eating style, with significant improvements in these variables in both groups. In addition, in the EG there was higher intrinsic motivation to change eating behaviour (mean difference of 0.9, 95% CI [0.1, 1.6], p = 0.032) and lower amotivation (mean difference of −0.6, 95% CI [−1.2, −0.1], p = 0.027) compared to the CG. (4) Conclusions: This study suggests that the presence of the patients’ own doctor in the audiovisual content of the Living Better intervention did not have significant additional benefits in terms of BMI or external eating style. However, their presence did improve intrinsic motivation and amotivation related to eating habits.

"Own doctor" presence in a web-based lifestyle intervention for adults with obesity and hypertension: A randomized controlled trial

Introduction

Online interventions have long been shown to be an effective means to promote a healthy lifestyle, thereby helping to control body weight and blood pressure figures. Likewise, using video modeling is also considered an effective way to guide patients through behavioral interventions. Nonetheless, to the best of our knowledge, this study is the first to analyze how the presence of patients' "own doctor" in the audiovisual content of a web-based lifestyle program ("Living Better") aimed at promoting regular physical exercise and healthy eating behavior, compared with an "unknown doctor," influences the outcomes of adults with obesity and hypertension.

Materials and methods

A total of 132 patients were randomly assigned either to the experimental (n = 70) or control (n = 62) group ("own doctor" or "unknown doctor", respectively). The body mass index, systolic and diastolic blood pressure, number of antihypertensive drugs used, physical activity level, and quality of life was assessed and compared at baseline and post-intervention (12 weeks).

Results

The intention-to-treat analysis showed intragroup significant improvements in both groups in terms of the body mass index (control group: mean difference -0.3, 95% CI [-0.5, -0.1], p = 0.002; experimental group: -0.4 [-0.6, -0.2], p < 0.001) and systolic blood pressure (control group: -2.3 [-4.4, -0.2], p = 0.029; experimental group: -3.6 [-5.5, -1.6], p< 0.001). In addition, there were also significant improvements in the experimental group for the diastolic blood pressure (-2.5 [-3.7, -1.2], p < 0.001), physical activity (479 [9, 949], p = 0.046), and quality of life (5.2 [2.3, 8.2], p = 0.001). However, when comparing the experimental with the control group, no between-group significant differences were found in these variables.

Conclusions

This study suggests that the presence of patients' "own doctor" in the audiovisual content of a web-based intervention, aimed at promoting a healthy lifestyle among adults with obesity and hypertension, do not show significant additional benefits over the efficacy of e-counseling.

Trial registration

ClinicalTrials.gov NCT04426877. First Posted: 11/06/2020. https://clinicaltrials.gov/ct2/show/NCT04426877.

Effectiveness of Mindfulness and Positive Strengthening mHealth Interventions for the Promotion of Subjective Emotional Wellbeing and Management of Self-Efficacy for Chronic Cardiac Diseases

Intervention in health prevention and treatment via mobile phones is becoming a key element on health promotion. Testing the efficacy of these mobile health (mHealth) psychological interventions for cardiovascular health is necessary as it is a chronic pathology, and it can influence the affective and cognitive states of patients. This research aimed to analyze the effectiveness of two brief psychological interventions-mindfulness and positive strengthening-to promote subjective emotional wellbeing and disease management self-efficacy using mHealth. This was a three-arm intervention and feasibility study, with a pre-post design and three follow-up measures with 105 patients (93 completed all phases) with cardiovascular diseases. Group 1 and 2 received the mindfulness or strengthening intervention, and Group 3 was the control group. The positive-negative affect and management self-efficacy for chronic and cardiovascular diseases were analyzed over time, while anxiety and depression levels were assessed at the beginning of the study. The results showed that mindfulness and positive strengthening interventions both had a positive effect on participants' affective state and management self-efficacy for the disease in comparison with the control group over time, even after controlling for baseline anxiety and depression levels. Positive strengthening seems to be more effective for improving cardiac self-efficacy, while mindfulness practice was significantly more effective at reducing negative affect at the first face-to-face evaluation.

Evaluation of an Interactive Web-Based Health Program for Weight Loss-A Randomized Controlled Trial

Personal behavior patterns, such as unhealthy diet and lack of physical activity, lead to the development of overweight and obesity. These are associated with other comorbidities, reduced quality of life, premature frailty and increased mortality. Personalized web-based interventions are promising in inducing behavioral change leading to effective reductions in body weight at relatively low costs. However, the long-term effects have not been thoroughly investigated. This work evaluates the effectiveness of web-based interactive weight loss coaching and compares it to a non-interactive web-based health program. Therefore, a randomized controlled trial (RCT) was implemented, measuring primary and secondary outcomes at four time points (program start; end of the 12-week-program; 6 months after program end, 12 months after program end). The net sample covered 1499 subjects in the intervention group and 1492 in the control group. On average, the IG was 43 years old (±13.6), 80.1% male, and had 86.4 kg body weight (±16.1) at baseline. The CG was 42.7 years old (±13.9), 79.5% male and had a mean body weight of 86.1 (±15.7). Multilevel analyses with fixed effects were carried out both from the perspective of an intention-to-treat (ITT) and a complete cases approach (CCA). In sum, our adjusted models suggest a weight loss of 0.4 kg per time point. At the end of the program, significant differences in weight loss in % to baseline (delta M = 1.8 in the CCA) were observed in favor of the intervention group. From a long-term perspective, no superiority of the intervention group in comparison to the control group could be found. More intensive use of the program was not statistically associated with higher weight loss.

Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials

BACKGROUND

Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined.

METHODS

Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified.

RESULTS

A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05).

LIMITATIONS

Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected.

CONCLUSION

The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.

The Impact of a Web-Based Lifestyle Educational Program ('Living Better') Reintervention on Hypertensive Overweight or Obese Patients

‘Living Better’, a self-administered web-based intervention, designed to facilitate lifestyle changes, has already shown positive short- and medium-term health benefits in patients with an obesity−hypertension phenotype. The objectives of this study were: (1) to examine the long-term (3-year) evolution of a group of hypertensive overweight or obese patients who had already followed the ‘Living Better’ program; (2) to analyze the effects of completing this program a second time (reintervention) during the COVID-19 pandemic. A quasi-experimental design was used. We recruited 29 individuals from the 105 who had participated in our first study. We assessed and compared their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), eating behavior, and physical activity (PA) level (reported as METs-min/week), at Time 0 (first intervention follow-up), Time 1 (before the reintervention), and Time 2 (post-reintervention). Our results showed significant improvements between Time 1 and Time 2 in SBP (−4.7 (−8.7 to −0.7); p = 0.017), DBP (−3.5 (−6.2 to −0.8); p = 0.009), BMI (−0.7 (−1.0 to −0.4); p < 0.001), emotional eating (−2.8 (−5.1 to −0.5); p = 0.012), external eating (−1.1 (−2.1 to −0.1); p = 0.039), and PA (Time 1: 2308 ± 2266; Time 2: 3203 ± 3314; p = 0.030, Z = −2.17). Statistical analysis showed no significant differences in SPB, DBP, BMI, and eating behavior between Time 0 and Time 1 (p > 0.24). Implementation of the ‘Living Better’ program maintained positive long-term (3-year) health benefits in patients with an obesity−hypertension phenotype. Moreover, a reintervention with this program during the COVID-19 pandemic produced significant improvements in blood pressure, BMI, eating behavior, and PA.

The Impact of the COVID-19 Pandemic on the Lifestyles and Levels of Anxiety and Depression of Patients with Schizophrenia: A Retrospective Observational Study

The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X² = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.

Patient empowerment and self-management behaviour of chronic disease patients: A moderated mediation model of self-efficacy and health locus of control

AIMS

To explore the role of self-efficacy (SE) in the effect of patient empowerment on self-management behaviours among patients with chronic illness and to investigate the moderating effect of three types of health locus of control (HLC) in this moderated mediation model.

DESIGN

Cross-sectional design.

METHODS

Data were collected in a general tertiary hospital, and a sample of 254 patients was recruited between August and October 2020. The effect of moderation and mediation was tested by the PROCESS macro (Model 4 and Model 8) for SPSS 25.0 by Hayes using 5000 bootstrap samples.

RESULTS

Self-efficacy significantly mediated the relationship between patient empowerment and self-management behaviour with a 95% confidence interval excluding zero. The chance HLC demonstrated a moderating effect, and the interaction effect on SE and self-management behaviour was significant.

CONCLUSION

Patient empowerment may improve confidence and adherence to self-management among people with chronic illness, and such benefits were conditional on the HLC of patients.

IMPACT

This study addresses the relationship between patient empowerment and self-management behaviour in patients with different personality characteristics. This result indicated that classifying the type of HLC may enable the identification of subgroups of patients who may subsequently benefit from patient empowerment. In a patient-centred programme, nurses and other healthcare professionals correctly identifying patients' HLC type and understanding the implications and then providing appropriate health care plans for patients with different health beliefs may be useful to tailor the decision-making process.

Impact of the COVID-19 Pandemic on the Lifestyles and Quality of Life of Women With Fertility Problems: A Cross-Sectional Study

Background: The COVID-19 pandemic has implied worldwide the imposition of confinement measures and mobility restrictions, to a greater or lesser extent. It has also meant the closure of some public medical services such as reproductive care. This situation may have impacted the health-related behaviour and quality of life of women with fertility problems.

Objective: The objective of this study was to analyse the effects of confinement and the suspension of reproductive medical care on the lifestyle (diet, physical exercise, and smoking habits), anxiety and depression, and quality of life of infertile women by comparing their pre- and post-confinement situations.

Methods: We carried out a cross-sectional, internet-based study. Information was collected on these women's adherence to the Mediterranean diet (MEDAS questionnaire), physical exercise (IPAQ-SF), anxiety and depression (HADS), and quality of life related to fertility (FertiQol) before, during, and after confinement. The survey was conducted between 1 September and 28 October 2020.

Results: A total of 85 women participated. There had been a significant increase in anxiety and depression levels (P < 0.001) and an increase in tobacco consumption among female smokers during confinement vs. pre-confinement (62.5% had increased their consumption). The participants had also increased the mean number of hours they spent sitting (P < 0.001). There had also been an increase in vigorous and moderate exercise levels by 40 and 30%, respectively (P = 0.004). However, no differences were observed in these patients' eating habits as a result of confinement (P = 0.416). When the reproduction service was resumed, the participants showed higher anxiety level scores (P = 0.001) with respect to the pre-confinement situation as well as lower mean FertiQol scale score (P = 0.008).

Conclusions: Confinement had increased anxiety and depression levels among these infertile women as well as tobacco use among the participants who were smokers. The prolonged closure of reproductive care units decreased the quality of life of the participants of this study. These results suggest the need to implement online programs to improve healthy habits and quality of life of this population group.

The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis

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CBT-based intervention has a positive effect on health outcomes in patients with hypertension.

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CBT-based intervention might be more effective for blood pressure management in hypertension patients when it is group-based, long term, and cognitive therapy based.

Recently, the benefits of cognitive behavioral therapy (CBT)-based interventions for patients with hypertension have been recognized, but there has been no systematic review that has comprehensively analyzed the efficacy of CBT on health outcomes in this population. We aimed to explore the therapeutic effect of CBT-based interventions on hypertension patients through a meta-analysis.

Relevant randomized controlled trials (RCTs) were obtained by searching electronic databases. The primary outcomes were physiological indicators (blood pressure, blood lipid profile). Secondary outcomes were psychological indicators (anxiety, depression), and the quality of sleep. Stata version 15.0 software was used to analyze the results.

A total of 15 RCTs were included. The main analysis revealed that CBT-based interventions reduced systolic pressure: −8.67 (95% CI: −10.67 to −6.67, P = 0.000); diastolic pressure: −5.82 (95% CI: −7.82 to −3.81, P = 0.000); total cholesterol levels: −0.43 (95% CI: −0.76 to −0.10, P = 0.010); depressive symptoms: −3.13 (95% CI: −4.02 to −2.24, P = 0.000); anxiety symptoms: −3.63 (95% CI: −4.40 to −2.87, P = 0.000); and improved quality of sleep: −2.93 (95% CI: −4.40 to −1.47, P = 0.000). Additionally, the results of subgroup analysis indicated that long-term group-based CBT-based interventions were particularly beneficial for blood pressure management in hypertension patients.

CBT-based interventions are effective in reducing systolic pressure, diastolic pressure, total cholesterol levels, anxiety symptoms, depressive symptoms, and improving quality of sleep in hypertension patients.

Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis

Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face-to-face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty-two RCTs were included. Meta-regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self-monitoring of behavior (adjusted R² 's = 0.15-0.51). One BCT showed significant moderator effects on PA in face-to-face interventions, behavioral practice and rehearsal (adjusted R²  = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face-to-face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self-monitoring of behavior. In face-to-face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.

Lifestyle medicine for depression: A meta-analysis of randomized controlled trials

BACKGROUND

The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined.

METHODS

We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons.

RESULTS

Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected.

LIMITATIONS

Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured.

CONCLUSION

Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.

Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review

Background

Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario.

Objective

In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity–related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities.

Methods

This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included.

Results

Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention–related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies.

Conclusions

We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension.

Efficacy of an Internet-Based Intervention to Promote a Healthy Lifestyle on the Reproductive Parameters of Overweight and Obese Women: Study Protocol for a Randomised Controlled Trial

Background: Infertility is estimated to affect 15% of couples of reproductive age. Weight management problems (being obese or overweight) are among the problems that produce infertility, both in women seeking spontaneous pregnancy and in those undergoing assisted reproduction techniques. Over the last few decades, the prevalence of obesity has increased alarmingly in our society and is now considered one of the most important public health problems. The combination of diet and exercise to achieve weight loss are currently considered an effective intervention for the improvement of reproductive parameters in overweight or obese infertile women. In other population groups, it has been shown that Internet-based interventions are just as effective as traditional ones, and these cover a larger population with a good cost–benefit ratio. However, to the best of our knowledge, no studies so far have analysed any specific online interventions for this group of infertile women. Thus, the objective of this project will be to evaluate the effectiveness of an online program to promote a healthy lifestyle among women who are overweight or obese who also have a diagnosis of infertility and are on the waiting list for in vitro fertilisation treatment. Methods: This will be a randomised controlled clinical trial conducted in 94 women which will compare a self-administered Internet-based intervention promoting a healthy lifestyle in terms of diet and exercise (n = 47) to a control group that will receive standard medical care. The online program will comprise nine modules, will last for 3 months, and will be monitored every 3 months after the intervention until the final follow-up at 12 months. The main outcome will be the spontaneous pregnancy rate. Secondary outcomes will include changes in body composition, dietary and physical exercise habits, glycaemic profiles, lipid profiles, hormonal profiles, and patient quality of life related to their fertility problems. The data analysis will be done on an intention-to-treat basis. Discussion: The aim of this study is to increase our knowledge of the effectiveness of online interventions specifically adapted to infertile women who are overweight or obese in the promotion of healthy lifestyles.

Patients' compliance behavior in a personalized mobile patient education system (PMPES) setting: Rational, social, or personal choices?

OBJECTIVE

With the advancement of mobile technologies, patients can access medical and patient educational information anytime and anywhere. Computer-aided patient education has been advocated as a key means of interventions for improving patient knowledge and compliance (i.e., adherence). However, evidence of the efficacy of computer-aided patient education remains relatively limited. For example, little is known about how the latest mobile technologies influence patients' compliance intention and their actual compliance behavior. The objective of this study is to investigate patients' compliance intention and behavior using a personalized mobile patient education system (PMPES) as a novel technological intervention for patients based on rational choice theory (RCT) and the theory of planned behavior (TPB).

MATERIALS AND METHODS

We conducted a field survey with 125 actual patients in U.S. who obtained their patient education through PMPES while seeking medical treatment advice from their doctors. We used partial least squares (PLS) regression path modeling to test our model.

RESULTS

We found that, based on RCT, the benefits of compliance and cost/threat of noncompliance positively influenced intention toward treatment compliance; in contrast, costs of compliance negatively influenced intention toward treatment compliance. However, the benefits of noncompliance had no effect on intention toward treatment compliance. The results also indicated that intention toward treatment compliance, response efficacy, and self-efficacy related to TPB jointly influenced the degree of actual compliance behaviors. Social influence factors including subjective norms and descriptive norms had no influence on patients' actual treatment compliance behavior.

CONCLUSION

Overall, the research model explains 69.2 % of the variance in patients' actual compliance behavior. We find our model robust in using RCT as a key theoretical lens for the assessment of patients' compliance intention to follow medical recommendations enabled by the PMPES and delivered to mobile devices. The factors associated with RCT and TPB jointly influence patients' actual compliance behavior. Future mobile patient education programs should consider patients' age groups, mixed-gender groups, different medical settings, and cross-cultural contexts.

Analysis of the Impact of the Confinement Resulting from COVID-19 on the Lifestyle and Psychological Wellbeing of Spanish Pregnant Women: An Internet-Based Cross-Sectional Survey

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18–31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.

Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial

Background

Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement.

Objective

This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers.

Methods

From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis.

Results

After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045).

Conclusions

This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation.

Trial Registration

Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md

Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: Systematic review and meta-analysis

Though many studies have explored the association between single-risk lifestyle interventions and depression, unhealthy lifestyle factors often co-occur, with adults engaging in two or more risk behaviours. To date, little is known about the effectiveness of universal multiple-risk lifestyle interventions to reduce depressive symptoms. We conducted a SR/MA to assess the effectiveness of universal multiple-risk lifestyle interventions (by promoting a healthy diet, physical activity and/or smoking cessation) to reduce depressive symptoms in adults. We searched MEDLINE, Scopus, CENTRAL, PsycINFO, WOS, OpenGrey, the ICTRP and other sources from inception to 16 September 2019. We selected only randomized controlled trials, with no restrictions on language or setting. Our outcome was the reduction of depressive symptoms. We calculated the standardized mean difference using random-effect models. Sensitivity, sub-group and meta-regression analyses were performed. Of the 9386 abstracts reviewed, 311 were selected for full-text review. Of these, 23 RCTs met the inclusion criteria, including 7558 patients from four continents. Twenty RCTs provided valid data for inclusion in the meta-analysis. The pooled SMD was -0.184 (95% CI, -0.311 to -0.057; p = 0.005). We found no publication bias, but heterogeneity was substantial (I² = 72%; 95% CI: 56% to 82%). The effectiveness disappeared when only studies with a low risk of bias were included. The quality of evidence according GRADE was low. Although a small preventive effect was found, the substantial heterogeneity and RCTs with lower risk of bias suggested no effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms in a varied adult population. Further evidence is required.

Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial

Background

Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients’ average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN).

Objective

The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN.

Methods

A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up).

Results

A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference −0.4, 95% CI −0.1 to −0.6; P=.005), BFM (mean difference −2.4, 95% CI −1.1 to −3.6; P<.001), DBP (mean difference −1.8, 95% CI −0.2 to −3.3; P=.03), and blood glucose (mean difference −2, 95% CI 0 to −4; P=.04).

Conclusions

Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN.

Trial Registration

ClinicalTrials.gov NCT03396302; https://clinicaltrials.gov/ct2/show/NCT03396302

Healthy Dads, Healthy Kids UK, a weight management programme for fathers: feasibility RCT

OBJECTIVE

To assess (1) the feasibility of delivering a culturally adapted weight management programme, Healthy Dads, Healthy Kids United Kingdom (HDHK-UK), for fathers with overweight or obesity and their primary school-aged children, and (2) the feasibility of conducting a definitive randomised controlled trial (RCT).

DESIGN

A two-arm, randomised feasibility trial with a mixed-methods process evaluation.

SETTING

Socioeconomically disadvantaged, ethnically diverse localities in West Midlands, UK.

PARTICIPANTS

Fathers with overweight or obesity and their children aged 4-11 years.

INTERVENTION

Participants were randomised in a 1:2 ratio to control (family voucher for a leisure centre) or intervention comprising 9 weekly healthy lifestyle group sessions.

OUTCOMES

Feasibility of the intervention and RCT was assessed according to prespecified progression criteria: study recruitment, consent and follow-up, ability to deliver intervention, intervention fidelity, adherence and acceptability, weight loss, using questionnaires and measurements at baseline, 3 and 6 months, and through qualitative interviews.

RESULTS

The study recruited 43 men, 48% of the target sample size; the mean body mass index was 30.2 kg/m2 (SD 5.1); 61% were from a minority ethnic group; and 54% were from communities in the most disadvantaged quintile for socioeconomic deprivation. Recruitment was challenging. Retention at follow-up of 3 and 6 months was 63%. Identifying delivery sites and appropriately skilled and trained programme facilitators proved difficult. Four programmes were delivered in leisure centres and community venues. Of the 29 intervention participants, 20 (69%) attended the intervention at least once, of whom 75% attended ≥5 sessions. Sessions were delivered with high fidelity. Participants rated sessions as 'good/very good' and reported lifestyle behavioural change. Weight loss at 6 months in the intervention group (n=17) was 2.9 kg (95% CI -5.1 to -0.6).

CONCLUSIONS

The intervention was well received, but there were significant challenges in recruitment, programme delivery and follow-up. The HDHK-UK study was not considered feasible for progression to a full RCT based on prespecified stop-go criteria.

TRIAL REGISTRATION NUMBER

ISRCTN16724454.

Effect of a Combined Exercise and Dietary Intervention on Self-Control in Obese Adolescents

OBJECTIVE

The aim of this study was to determine whether a combined exercise and dietary intervention improved cognitive and physical self-control and whether pre-to-post interventional changes in self-control were mediated by changes in body mass index (BMI) and maximal grip strength (MGS), in a sample of obese adolescents.

METHODS

Forty-four obese adolescents were randomly assigned to a combined exercise and dietary program or to a waitlist control group; the data from 36 participants (n = 18 for each group) were analyzed. The combined exercise and dietary program was performed over 6 weeks and was supervised by qualified trainers in a closed boot camp. The exercise consisted primarily of typical aerobic training, sports, outdoor training, yoga, and resistance training. Participants were placed on moderate dietary restriction according to individual target body weight (30 kcal/kg × target weight). The primary outcomes of this study were metrics based on cognitive and physical self-control, assessed by the Stroop task and a handgrip task, respectively. Secondary outcomes included BMI and MGS.

RESULTS

The combined exercise and dietary intervention significantly improved both cognitive and physical self-control. Similar positive effects were also found for reduced BMI and enhanced MGS. Correlation analyses showed that the reduced BMI and enhanced MGS were significantly closely associated with improved cognitive and physical self-control. The mediation analyses revealed that the pre-to-post intervention changes in BMI and MGS significantly mediated physical self-control, but did not mediate cognitive self-control.

CONCLUSION

Our combined exercise and dietary intervention is an effective approach to improve multiple aspects of self-control, reduce BMI, and strengthen MGS among obese adolescents. These findings also suggest that reduced BMI and enhanced MGS mediate specific aspects of self-control.