Home-based lifestyle intervention for rural adults improves metabolic syndrome parameters and cardiovascular risk factors: A randomised controlled trial

Effect of the national lifestyle guidance intervention for metabolic syndrome among middle-aged people in Japan

Background

Japan has implemented a national lifestyle guidance intervention programme for potential metabolic syndrome among adults aged 40-74 years; however, there is limited evidence regarding the causal impact of this intervention. The study aims to determine the causal effect of this intervention on health outcomes and health care utilisation.

Methods

We performed a regression discontinuity design study. A total of 46 975 adults with ≥1 cardiovascular risk factor in 2015 were included in the study. A two-stage evaluation process (stage 1: waist circumference ≥85 cm for men or ≥90 cm for women and ≥1 cardiovascular risk factor; stage 2: body mass index (BMI)≥25 kg/m2 and ≥2 cardiovascular risk factors) was applied. Changes in obesity, cardiovascular outcomes, and health care utilisation were evaluated in a one-year follow-up in the fiscal year 2016.

Results

Participants who received lifestyle guidance intervention based on the waist circumference had a statistically significant reduction in obesity outcomes (Δ weight: -0.30 kg, 95% CI = -0.46 to -0.11; Δ waist circumference: -0.26 cm, 95% CI = -0.53 to -0.02; Δ BMI = -0.09 kg/m2, 95% CI = -0.17 to -0.04) but not in other cardiovascular risk factors and health care utilisation. Analyses based on BMI and results according to demographic subgroups did not reveal significant findings.

Conclusions

The provision of this intervention had a limited effect on health improvement and a decrease in health care costs, health care visits, and length of stay. A more intensive intervention delivery could potentially improve the efficacy of this intervention programme.

Delivery of Allied Health Therapies to People with Parkinson's Disease in Africa

Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson's disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context.

Lifestyle Interventions for the Prevention of Parkinson Disease: A Recipe for Action

The prevalence of Parkinson disease (PD) is growing fast, amplifying the quest for disease-modifying therapies in early disease phases where pathology is still limited. Lifestyle interventions offer a promising avenue for preventing progression from prodromal to manifest PD. We illustrate this primarily for 1 specific lifestyle intervention, namely aerobic exercise because the case for the other main lifestyle factor (dietary interventions) to modify the course of prodromal PD is currently less persuasive. Various observations have hinted at the disease-modifying potential of exercise. First, studies in rodents with experimental parkinsonism showed that exercise elicits adaptive neuroplasticity in basal ganglia circuitries. Second, exercise is associated with a reduced risk of developing PD, suggesting a disease-modifying potential. Third, 2 large trials in persons with manifest PD indicate that exercise can help to stabilize motor parkinsonism, although this could also reflect a symptomatic effect. In addition, exercise seems to be a feasible intervention, given its minimal risk of side effects. Theoretical risks include an increase in fall incidents and cardiovascular complications, but these concerns seem to be acceptably low. Innovative approaches using gamification elements indicate that adequate long-term compliance with regular exercise programs can be achieved, although more work remains necessary to demonstrate enduring adherence for multiple years. Advances in digital technology can be used to deliver the exercise intervention in the participant's own living environment and also to measure the outcomes remotely, which will help to further boost long-term compliance. When delivering exercise to prodromal participants, outcome measures should focus not just on phenoconversion to manifest PD (which may well take many years to occur) but also on measurable intermediate outcomes, such as physical fitness or prodromal nonmotor symptoms. Taken together, there seems to be sufficient evidence to advocate the first judicious attempt of investigating exercise as a disease-modifying treatment in prodromal PD.

A systematic review and meta-analysis of weight loss in control group participants of lifestyle randomized trials

Randomized clinical trials (RCTs) of lifestyle modification have reported beneficial effects of interventions, compared to control. Whether participation in the control group has benefits is unknown. To determine whether control group participants experience weight loss during the course of RCTs. After prospective registration (PROSPERO CRD42021233070), we conducted searches in Medline, Scopus, Web of Science, Cochrane library and Clinicaltrials.gov databases from inception to May 2021 without language restriction to capture RCTs on dietary advice or physical activity interventions in adults with overweight, obesity or metabolic syndrome. Data extraction and study quality assessment was performed by two independent reviewers. Weight loss in the control group, i.e., the difference between baseline and post-intervention, was pooled using random effects model generating mean difference and 95% confidence interval (CI). Heterogeneity was assessed using the I² statistical test. Subgroup meta-analysis was performed stratifying by follow-up period, type of control group protocols and high-quality studies. Among the 22 included studies (4032 participants), the risk of bias was low in 9 (40%) studies. Overall, the controls groups experienced weight loss of − 0.41 kg (95% CI − 0.53 to − 0.28; I² = 73.5% p < 0.001). To identify a result that is an outlier, we inspected the forest plot for spread of the point estimates and the confidence intervals. The magnitude of the benefit was related to the duration of follow-up (− 0.51 kg, 95% CI − 0.68, − 0.3, for 1–4 months follow-up; − 0.32 kg, 95% CI − 0.58, − 0.07, 5–12 months; − 0.20 kg, 95% CI − 0.49, 0.10, ≥ 12 months). In high-quality studies we found an overall weight loss mean difference of − 0.16 (95% CI − 0.39, 0.09) with a considerable heterogeneity (I² = 74%; p < 0.000). Among studies including control group in waiting lists and combining standard care, advice and material, no heterogeneity was found (I² = 0%, p = 0.589) and (I² = 0%, p = 0.438); and the mean difference was − 0.84 kg (95% CI − 2.47, 0.80) and − 0.65 kg (95% CI − 1.03, − 0.27) respectively. Participation in control groups of RCTs of lifestyle interventions had a benefit in terms of weight loss in meta-analysis with heterogeneity. These results should be used to interpret the benefits observed with respect to intervention effect in trials. That control groups accrue benefits should be included in patient information sheets to encourage participation in future trials among patients with overweight and obesity.

Home-based exercise for adults with overweight or obesity: A rapid review

The COVID-19 pandemic has impacted the ability of people globally to consistently engage in their typical physical activity and exercise behaviour, contributing to the rising number of people living with overweight and obesity. The imposed government lockdowns and quarantine periods saw an increase in social media influencers delivering their own home-based exercise programmes, but these are unlikely to be an evidence-based, efficacious, long-term solution to tackle sedentary behaviour and increase physical activity. This rapid review aims to conceptualise home-based exercise and physical activity programmes, by extracting relevant programme characteristics regarding the availability of evidence and effectiveness of home-based exercise programmes. Fifteen studies met the inclusion criteria, of which there were varied reports of significant positive effects of the exercise programme on weight management and related outcomes. The two most common measures were Body Mass Index and body mass, as of which almost all reported a trend of post intervention reduction. Some programmes reported qualitative data, identifying barriers to physical activity and preferred programme components, highlighting a need to consider factors outside of physiological measures. The findings provide guidance and direction for the development of future home-based physical activity and exercise programmes for adults living with overweight and obesity.

Effects of the Participatory Action Research on Reducing the Risk of Metabolic Syndrome in Adult Women

This study aimed to evaluate the effects of a participatory action research (PAR) on reducing the metabolic syndrome risk factors among the Koran adult women. The effectiveness of the PAR intervention was examined using a one-group pretest-post-test design. The data were collected from 58 adult women living in a community health center in Ulsan, Korea, between May and November 2016. The psychosocial factors (empowerment, social support, and quality of life), metabolic-related indices, and health behaviors were collected to measure the intervention’s efficiency. After applying it, the participants’ empowerment, social support, and health-related quality of life increased significantly, as compared to the pre-test. Furthermore, their metabolic-related indices improved significantly in the post-test, as compared to the pre-test. Therefore, the PAR intervention was found to be effective in enhancing the psychosocial factors, metabolic-related indices, and health behaviors in the aforementioned population and could be applied to other community health centers.

Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care

Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet^© was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach’s α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett’s test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser’s Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with “Positive” and “Negative” tone model. The overall Cronbach’s α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.

Service provider perspectives on implementing the NSW Get Healthy at Work program

Purpose: One approach increasingly used by governments to deliver on public initiatives is to partner with private enterprise through public–private partnerships. This study is a qualitative process evaluation of an Australian state-wide workplace health programme “Get Healthy at Work” from the currently under-researched perspective of the private service providers. Methods: Semi-structured interviews were conducted with nine service providers. Interviews were transcribed and analysed inductively. Results: Service providers reported an alignment of motives and skills between the programme and their organizations as a benefit of the partnership. However, they also described misalignments: between the potential and realized value of the programme to businesses and service providers; the programme cycle and business operational processes; and the capacity building approach and businesses’ expectations of the service.Conclusions: Although several hallmarks of a well-functioning private–public partnership were evident, misalignments of process and expectations challenged sustained partnership involvement by providers. Careful consideration must be given to the ongoing management functioning of cross-sector engagement and partnering in health promotion practice in order to ensure public health goals are being met, but also that the model is mutually sustainable.

Nurse co-ordinated health and lifestyle modification for reducing multiple cardio-metabolic risk factors in regional adults: outcomes from the MODERN randomized controlled trial

BACKGROUND 

Nurse-led health and lifestyle modification programmes can prevent cardio-metabolic diseases and be advantageous where health disparities exist.

AIMS 

To assess the effectiveness of a nurse-driven health and lifestyle modification programme in improving cardio-metabolic risk parameters for higher-risk regional residing adults.

METHODS 

We conducted an open, parallel-group randomized controlled trial in two sites. Participants were aged 40-70 years with no prior cardiovascular disease who had any three or more of; central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure (BP) and dysglycaemia. Intervention participants received individual face-to-face and telephone coaching for improving cardio-metabolic risk. Control group participants received standard care and general information about risk factor management. The primary endpoint was the percentage of participants who achieved the target risk factor thresholds or clinically significant minimum changes for any three or more cardio-metabolic risk factors during 24 months of follow-up.

RESULTS 

Participant average age was 57.6 (SD 7.6) years, 61% were female and 71% were employed. The primary endpoint was achieved by 76% intervention (97 of 127) and 71% usual care (92 of 129) participants [adjusted risk ratio (RR): 1.08; 95% CI 0.94, 1.24; P = 0.298]. Improved BP in the intervention group was more likely than in the control group (84% vs. 65%) (adj. RR: 1.28; 95% CI 1.11, 1.48; P = 0.001) but no other cardio-metabolic component.

CONCLUSION 

Nurse intervention to modify cardio-metabolic risk parameters had no enhanced effectiveness compared with usual care. However, participation was associated with improvements in cardio-metabolic abnormalities, with particular emphasis on BP.

TRIAL REGISTRATION

Registered with the Australian New Zealand Clinical Trial Registry (ACTRN12616000229471).

A Combined Multidisciplinary Intervention for Health Promotion in the Workplace: A Pilot Study

The aim of this study was to assess the effects of a joint health promotion intervention on a cohort of healthcare workers (HCWs) who had at least one cardiovascular risk factor. The HCWs were assessed at three different times, i.e., time zero (T0), after 6 months (T6), and after 12 months (T12). The following parameters were measured at a medical examination: physical activity, blood pressure, waist circumference, body mass index (BMI), routine laboratory tests, plicometric analysis, work ability index (WAI), and body image dissatisfaction (BID). Among the 447 HCWs, 38 HCWs were included in the study; 45% (n = 17) were male. At T12, the average blood pressure, waist/hip ratio (WHR) index, BMI, total cholesterol, triglyceride level, and blood glucose values were reduced. The levels of physical activity and adherence to the Mediterranean diet had progressively increased. The WAI showed a significant shift from low to good work performance at T12, as well as BID score. This is the first study that has analyzed work performance in relation to a workplace health promotion through a multidisciplinary approach. This health promotion intervention that combined diet and sport activity has led to a significant change in HCWs’ lifestyles and body perceptions, as well as their ability to work. This project highlights the importance of using a multidisciplinary approach and the workplace setting in health promotion programs.

Effectiveness of a Singaporean Community-Based Physical Activity and Nutrition Intervention: A Cluster Randomized Controlled Trial

This study examined the effectiveness of a 6-month intervention to improve the health behaviors and outcomes among women aged 50 years and older. A sample of 580 (intervention n = 295; control n = 285) women was recruited from 26 recreational centers. Only the intervention group participated in the Singapore Physical Activity (PA) and Nutrition Study (SPANS), received health resources (calendar, recipe, and booklets) and motivational support from program ambassadors. The intervention group showed significant improvements in moderate-intensity PA, vigorous-intensity PA, and total PA (P < .001), increased intake frequency of fruit and vegetables (P = .049), a reduction in salt and sugary beverage intake (P ≤ .042), and reductions in systolic blood pressure (BP; -3.68 mm Hg), diastolic BP (-3.54 mm Hg), and percentage body fat (-2.13%; P ≤ .020) when compared with the control group. The SPANS appeared to be efficacious in improving PA and dietary behaviors, reducing BP and percentage body fat among Singaporean women.

Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality.

OBJECTIVE

To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors.

DATA SOURCES

MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020.

STUDY SELECTION

English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity.

DATA EXTRACTION AND SYNTHESIS

Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used.

MAIN OUTCOMES AND MEASURES

Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes).

RESULTS

Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events.

CONCLUSIONS AND RELEVANCE

Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.

The Effect of Different Interventions for Lifestyle Modifications on the Number of Diagnostic Criteria and Clinical Aspects of Metabolic Syndrome

Background: Lifestyle intervention programs comprise the first-choice therapy to reduce the cardiovascular risk factors in metabolic syndrome (MetS). Our aim was to compare the effects of three lifestyle modification programs on the number of diagnostic criteria and clinical parameters of MetS. Methods: Twelve-week clinical trial, including 125 adults who presented at least three of the criteria defined by the revised NCEP ATP III (National Cholesterol Education Program Adult Panel III) for MetS. Individuals were randomized into three multidisciplinary intervention groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). Results: Seventy-one individuals, aged 34-59 years, concluded the study: SI: 20, GI: 25, and II: 26. The GI and II groups presented a significant decrease of body mass index, abdominal circumference, diastolic and systolic arterial pressure after intervention. The number of diagnostic criteria for MetS decreased significantly. Within the GI and II groups, 16.0% and 15.4% of the individuals, respectively, did not meet the criteria for the clinical condition studied at the end of the interventions. In the II group, the percentage of individuals with five criteria reduced 83.5%. In the GI group, the percentage of individuals with five criteria remained the same, but the number of individuals with four criteria presented a 50.0% reduction. Conclusions: Results reinforce that nonpharmacological strategies for changing lifestyle affect the reduction of cardiovascular risk factors existing in MetS. They are also able to remove the population from this clinical condition by decreasing the diagnostic criteria. II or GI lead to a successful treatment of MetS, especially when conducted by multidisciplinary team. Brazilian Registry of Clinical Trials-ReBEC number: RBR-9wz5fc.

Long-term sustainability of a physical activity and nutrition intervention for rural adults with or at risk of metabolic syndrome

OBJECTIVE

To determine longer-term (18-month) sustainability of a six-month physical activity and nutrition intervention for 50-69-year-olds with or at risk of metabolic syndrome residing in a rural Australian community.

METHODS

Participants (n=151) were followed-up at 12 and 18 months post-intervention. Changes in nutrition behaviours (fat and fibre barometer); physical activity behaviours (IPAQ); anthropometry (waist-hip ratio, weight, BMI), blood pressure, blood parameters (triglycerides, glucose, LDL-, HDL-, non-HDL, total-cholesterol) were analysed using t-tests and repeated measures ANOVA.

RESULTS

Across three time points (6, 12 and 18 months) marginal decrease was observed for waist circumference (p=0.001), a modest increase was observed for diastolic blood pressure (p=0.010) and other outcome measures remained stable.

CONCLUSION

Maintenance and ongoing improvement of health behaviours in the longer-term is challenging. Future studies must look for ways to embed interventions into communities so they are sustainable and investigate new approaches to reduce the risk of chronic disease. Implications for public health: Metabolic syndrome is a major health issue in Australia and worldwide. Early identification and management are required to prevent the progression to chronic disease. This 18-month follow-up showed that outcomes measures remained relatively stable; however, there is a need to investigate opportunities for embedded community interventions to support long-term health behaviour change.

Skeletal muscle - A bystander or influencer of metabolic syndrome?

BACKGROUND AND AIMS

Metabolic syndrome is the concurrent presentation of multiple cardiovascular risk factors, including obesity, insulin resistance, hyperglycemia, dyslipidemia and hypertension. It has been suggested that some of these risk factors can have detrimental effects on the skeletal muscle while others can be a direct result of skeletal muscle abnormalities, showing a two-way directionality in the pathogenesis of the condition. This review aims to explore this bidirectional correlation by discussing the impact of metabolic syndrome on skeletal muscle tissue in general and will also discuss ways in which skeletal muscle alterations may contribute to the pathogenesis of metabolic syndrome.

METHODS

Literature searches were conducted with key words (e.g. metabolic syndrome, skeletal muscle, hyperglycemia) using PubMed, EBSCOhost, Science Direct and Google Scholar. All article types were included in the search.

RESULTS

The pathological mechanisms associated with metabolic syndrome, such as hyperglycemia and inflammation, have been associated with changes in skeletal muscle fiber composition, metabolism, insulin sensitivity, mitochondrial function, and strength. Additionally, some skeletal muscle alterations, particularly mitochondrial dysfunction and insulin resistance, are suggested to contribute to the development of metabolic syndrome. For example, the suggested underlying mechanisms of sarcopenia development are also contributors to metabolic syndrome pathogenesis.

CONCLUSION

Whilst numerous studies have identified a relationship between metabolic syndrome and skeletal muscle abnormalities, further investigation into the underlying mechanisms is needed to elucidate the best prevention and management strategies for these conditions.

Limited dietary interventions in rural Australian communities: A systematic review

AIM

This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia.

METHODS

Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data.

RESULTS

In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia.

CONCLUSION

Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.

Metabolic syndrome in rural Australia: An opportunity for primary health care

OBJECTIVE

To measure the impact of a 6-month home-based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas.

DESIGN

A two-arm randomised controlled trial of rural adults.

SETTING

The rural town of Albany in the Great Southern region of Western Australia.

PARTICIPANTS

Participants (n = 401) aged 50-69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group.

INTERVENTIONS

A 6-month intervention program incorporating goal setting, self-monitoring and feedback, with motivational interviewing was conducted.

MAIN OUTCOME MEASURES

Change in metabolic syndrome status and cardiovascular risk.

RESULTS

Significant improvements in metabolic syndrome status and cardiovascular disease risk score (-0.82) were observed for the intervention group relative to control group from baseline to post-test.

CONCLUSION

This home-based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long-term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered.

Effect of PolyGlycopleX (PGX) Consumption on Blood Lipid Profiles in Healthy, Low CVD Risk Overweight Adults

Raised blood lipid levels are associated with a risk of a cardiovascular disease (CVD). Moderate reductions in several CVD factors such as total, low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (non-HDL) cholesterol concentrations may be more effective in reducing overall risk than a major reduction in just one. A blind, randomised controlled trial was conducted with 120 healthy overweight (BMI 25⁻30) adults aged 25⁻70 years who were non-smokers, not diabetic and of low risk of cardiovascular disease, as assessed by the Framingham risk equation. Participants consumed 4.5 g PolyGlycopleX (PGX) as softgel capsules (PGXS) or 5 g PGX granules (PGXG) or 5 g rice flour (RF) with meals three times a day for 12 weeks. Total, LDL and non-HDL cholesterol were all significantly reduced (-6%, -5% and -3.5%, respectively) post the PGX granule treatment; however, PGX in softgel capsule form did not affect blood lipid profiles. Daily consumption of PGX granules in overweight low CVD risk adults produced lipid changes indicating a CVD preventative benefit.

Combined Before-and-After Workplace Intervention to Promote Healthy Lifestyles in Healthcare Workers (STI-VI Study): Short-Term Assessment

Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI ‘before-and-after’ study, with assessments scheduled at 6 and 12 months, was to improve the lifestyle of HCWs with at least one cardiovascular risk factor. A tailored motivational counseling intervention, focusing on dietary habits and physical activity (PA) was administered to 167 HCWs (53 males; 114 females). BMI, waist circumference, blood pressure, and cholesterol, triglyceride, and blood glucose levels were measured before and after the intervention. The 6-month results (total sample and by gender) showed a marked effect on lifestyle: PA improved (+121.2 MET, p = 0.01), and diets became more similar to the Mediterranean model (+0.8, p < 0.001). BMI dropped (−0.2, p < 0.03), and waist circumference improved even more (−2.5 cm; p < 0.001). Other variables improved significantly: total and LDL cholesterol (−12.8 and −9.4 mg/dL, p < 0.001); systolic and diastolic blood pressure (−4.4 and −2.5 mmHg, p < 0.001); blood glucose (−1.5 mg/dL, p = 0.05); and triglycerides (significant only in women), (−8.7 mg/dL, p = 0.008); but HDL cholesterol levels dropped too. If consolidated at 12 months, these results indicate that our intervention can help HCWs maintain a healthy lifestyle and work ability.

Prediction of the development of metabolic syndrome by the Markov model based on a longitudinal study in Dalian City

Background

Metabolic syndrome (MetS) increases the incidence of cardiovascular disease and diabetes mellitus. It is essential to study the natural progression of MetS in the interest of prevention. Information on the dynamic changes in MetS in developing countries is limited. This study aimed to simulate the progression of each component of MetS and explore the potential role of these components in early prevention and intervention.

Methods

This study involved 5881 individuals, aged 20 to 60 at study entry, who underwent at least two consecutive years of health check-ups in the seven-year study period at our institution’s health check-up center. Participants were divided into four groups by age (a 20- to- 40-year-old group and a 40- to 60-year-old group) and gender. A Markov model containing 7 stages (no components, isolated hypertension, isolated obesity, isolated hyperglycemia, isolated dyslipidemia, a 2-component state, and the MetS state) was constructed for each group.

Results

In women and young men (20- to 40-year-old men), dyslipidemia and obesity were the two most probable states for individuals who were transitioning from no components to one of the other six states. Among those who had no components and were 30 years old at study entry, MetS was estimated to develop within 10 years in 11.42% of men and 3.04% of women. Among those who had no components and were 50 years old at study entry, MetS was estimated to develop within 10 years in 25.04% of men and 7.09% of women. The estimated prevalence of MetS over the next 10 years was higher in individuals starting with the obesity component than in individuals starting with any other isolated component. In a comparison of interventions targeting single components, simulations showed that the obesity intervention produced the largest relative reduction in the prevalence of MetS.

Conclusion

Markov models are suitable for describing and predicting the dynamic development of MetS. The occurrence of MetS most frequently began with dyslipidemia or obesity. Obesity played a predominant role in the development of MetS. Early obesity intervention was extremely important for MetS prevention.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5599-y) contains supplementary material, which is available to authorized users.

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

Evaluation of the physical activity level, nutrition quality, and depression in patients with metabolic syndrome: Comparative study

Metabolic syndrome (MetS) is a complex problem that contains risk factors related with obesity, cardiovascular diseases, and type-II diabetes. The incidence of MetS is increasing every year throughout the world.The aim of this study was to evaluate and compare physical activity levels, nutrition quality, and depression status of the individuals who are diagnosed with and without MetS.International Physical Activity Questionnaire (IPAQ), Mediterranean Diet Adherence Screener (MEDAS), Beck Depression Inventory (BDI) was used. In addition, biochemical analysis and anthropometric measurements were also taken.According to IPAQ, 81.1% of the MetS group is inactive, 6.8% is active, and 5.1% is highly active, whereas 22.3% of the non-MetS group is inactive, 46.2% is active, and 31.5% is highly active. MEDAS was found to be lower in the MetS group. BDI levels were also determined high in the MetS group.Sedentary lifestyle, depression, and unhealthy nutrition habits are among the significant factors for the development of MetS. The knowledge levels of the people should be increased by developing national physical activity and nutrition guidelines.

Developing a Third-Party Analytics Application Using Australia's National Personal Health Records System: Case Study

BACKGROUND

My Health Record (MyHR) is Australia's national electronic health record (EHR) system. Poor usability and functionality have resulted in low utility, affecting enrollment and participation rates by both patients and clinicians alike. Similar to apps on mobile phone app stores, innovative third-party applications of MyHR platform data can enhance the usefulness of the platform, but there is a paucity of research into the processes involved in developing third-party applications that integrate and use data from EHR systems.

OBJECTIVE

The research describes the challenges involved in pioneering the development of a patient and clinician Web-based software application for MyHR and insights resulting from this experience.

METHODS

This research uses a case study approach, investigating the development and implementation of Actionable Intime Insights (AI²), a third-party application for MyHR, which translates Medicare claims records stored in MyHR into a clinically meaningful timeline visualization of health data for both patients and clinicians. This case study identifies the challenges encountered by the Personal Health Informatics team from Flinders University in the MyHR third-party application development environment.

RESULTS

The study presents a nuanced understanding of different data types and quality of data in MyHR and the complexities associated with developing secondary-use applications. Regulatory requirements associated with utilization of MyHR data, restrictions on visualizations of data, and processes of testing third-party applications were encountered during the development of the application.

CONCLUSIONS

This study identified several processes, technical and regulatory barriers which, if addressed, can make MyHR a thriving ecosystem of health applications. It clearly identifies opportunities and considerations for the Australian Digital Health Agency and other national bodies wishing to encourage the development of new and innovative use cases for national EHRs.

Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults

Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.

Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial

BACKGROUND

Metabolic syndrome (MetS) and its subclinical diseases are now public health problems in Vietnam. This study aimed at determining the effectiveness of a physical activity and nutrition program for reducing MetS proportion and its components among adults with MetS in Hanam province, Vietnam.

METHODS

A total of 417 volunteers aged 50-65 years with MetS were recruited from 10 communes. The communes were randomly allocated to an intervention group (five communes, n = 214) and a control group (five communes, n = 203). The participants in the intervention group received a nutrition and physical activity program for 6 months, whereas participants in the control group received standard diet and physical activity advice on only one occasion. Anthropometry, lipid profiles, glycemic status, and blood pressure were measured at baseline and at 6 months to evaluate program effectiveness.

RESULTS

In total, 175 intervention (81.8%) and 162 control (79.8%) participants completed the post-program evaluation. After controlling for the effects of clustering and confounding factors, the intervention group showed significant improvements in high-density lipoprotein cholesterol (+0.42 mM, P < 0.001), waist circumference (-1.63 cm, P < 0.001), waist-to-hip ratio (-0.024, P < 0.001), weight (-1.44 kg, P < 0.001), and body mass index (-0.59 kg/m², P < 0.001) when compared with the control group. A reduction in the MetS proportion was found in both intervention and control groups (P < 0.001), decreasing to 56.0% and 75.9%, respectively, but the post-program proportion was significantly lower among the intervention participants (P < 0.001). Furthermore, the mean number of MetS components exhibited by individuals decreased significantly in the intervention group (P < 0.001).

CONCLUSIONS

The community-based physical activity and nutrition program reduced MetS proportion, with significant improvements in several metabolic and anthropometric parameters for Vietnamese adults with MetS.

Investigating the differences of body mass index and waist circumference in the follow-up assessment of patients to cardiac rehabilitation with acute coronary syndrome

Obesity management is a key point during cardiac rehabilitation. The effect of new index, waist circumference (WC), in the obesity management of cardiac rehabilitation is not clear yet. Therefore, our study compared the WC index to the body mass index (BMI) in the evaluation of obesity management for the patients with acute coronary syndrome (ACS) in a well-designed cardiac rehabilitation program (CRP). Totally 61 patients were enrolled into our study between October 2013 and January 2014 in our hospital. All these patients were requested to participate in the CRP actively for 6 months. We collected the BMI, WC, vital signs, fasting blood levels, the results from a sub-maximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) through a follow-up visit conducted every 1, 3, and 6 months. We used two-tailed Pearson's test and linear regression to analyze the data from our experiment. Our results show that the grouping of obese individuals based on the WC results in the WC being significantly associated with high-density lipoprotein cholesterol (HDL_C), inter-ventricular septal thickness at diastole (IVSd) and left ventricular posterior wall at diastole (LVPwd) after 1 and 3 months of the CRP (HDL_C after1 month of CRP: r = -0.292, P = 0.022; HDL_C after 3 months of CRP: r = -0.289, P = 0.024; IVSd after1 month of CRP: r = 0.451, P = 0.004; IVSd after 3 months of CRP: r = 0.304, P = 0.035; LVPwd after1 month of CRP: r = 0.468, P = 0.002; LVPwd after 3 months of CRP: r = 0.290, P = 0.045). However, no similar regular associations were found when obesity was stratified using the BMI. In other words, WC could be better than the BMI for reflecting the cardiac status. In conclusion, obesity management using WC can benefit the clinical evaluation, diagnosis, treatment, prevention, and prognosis of obese individuals of ACS when participating in the CRP.