Therapeutic lifestyle and disease-management interventions: pushing the scientific envelope

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

PURPOSE

Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States.

DESIGN

Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012.

SETTING

Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012.

SUBJECTS

Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years).

MEASURES

Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose.

ANALYSIS

Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes.

RESULTS

The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen's d .1-.2).

CONCLUSIONS

Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus

BACKGROUND

Although inaccurate, non-reproducible blood pressure values can result from non-standardized assessments, recommended approaches to standardize blood pressure measurement are often not followed in research studies.

METHODS

An expert consensus of national and international health and scientific organizations developed recommended minimum standards for assessing blood pressure in research subjects where: 1) blood pressure or hypertension is a major endpoint, or 2) blood pressure is likely a major mediator of the research outcome.

RESULTS

Minimum research standards are presented for training of observers, technical aspects of assessing blood pressure, and equipment for both adults and children.

LIMITATIONS

The standards are based on prior recommendations some of which did not conform to the current evidence based methods.

CONCLUSIONS

All new research should require adherence to these minimum standards on the patient populations described above. Readers need to use caution in interpreting studies if the standards are not met in the defined populations.

Recommended Standards for Assessing Blood Pressure in Human Research Where Blood Pressure or Hypertension Is a Major Focus

Introduction

Although inaccurate, nonreproducible blood pressure values can result from nonstandardized assessments, recommended approaches to standardize blood pressure measurement are often not followed in research studies.

Methods

An expert consensus of national and international health and scientific organizations developed recommended minimum standards for assessing blood pressure in research subjects where: (i) blood pressure or hypertension is a major endpoint, or (ii) blood pressure is likely a major mediator of the research outcome.

Results

Minimum research standards are presented for training of observers, technical aspects of assessing blood pressure, and equipment for both adults and children.

Discussion

The standards are based on prior recommendations, some of which did not conform to current evidence-based methods. All new research should require adherence to these minimum standards on the patient populations described above. Readers need to use caution in interpreting studies if the standards are not met in the defined populations.