Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial

Jeroen Lakerveld (j.lakerveld@vumc.nl)
Sandra D Bot (s.bot@vumc.nl)
Mai J Chinapaw (m.chinapaw@vumc.nl)
Maurits W van Tulder (maurits.van.tulder@falw.vu.nl)
Piet J Kostense (pj.kostense@vumc.nl)
Jacqueline M Dekker (jm.dekker@vumc.nl)
Giel Nijpels (g.nijpels@vumc.nl)


Abstract
Background
Intensive lifestyle interventions in well-controlled settings are effective in lowering the risk
of chronic diseases such as type 2 diabetes (T2DM) and cardiovascular diseases (CVD), but
there are still no effective lifestyle interventions for everyday practice. In the Hoorn
Prevention Study we aimed to assess the effectiveness of a primary care based lifestyle
intervention to reduce the estimated risk of developing T2DM and for CVD mortality, and to
motivate changes in lifestyle behaviors.
Methods
The Hoorn Prevention Study is a parallel group randomized controlled trial, implemented in
the region of West-Friesland, the Netherlands. 622 adults with ≥10% estimated risk of T2DM
and/or CVD mortality were randomly assigned and monitored over a period of 12 months.
The intervention group (n=314) received a theory-based lifestyle intervention based on an
innovative combination of motivational interviewing and problem solving treatment,
provided by trained practice nurses in 12 general practices. The control group (n=308)
received existing health brochures. Primary outcomes was the estimated diabetes risk
according to the formula of the Atherosclerosis Risk In Communities (ARIC) Study, and the
estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation
(SCORE) formula. Secondary outcomes included lifestyle behavior (diet, physical activity
and smoking). The research assistants, the principal investigator and the general practitioners
were blinded to group assignment. Linear and logistic regression analysis was applied to
examine the between-group differences in each outcome measure, adjusted for baseline
values.
Results
536 (86.2%) of the 622 participants (age 43.5 years) completed the 6-month follow-up, and
502 (81.2%) completed the 12-month follow-up. The mean baseline T2DM risk was 18.9%
(SD 8.2) and the mean CVD mortality risk was 3.8% (SD 3.0). The intervention group
participated in a median of 2 sessions. Intention-to-treat analyses showed no significant
differences in outcomes between the two groups at 6 or 12-months follow-up.
Conclusions
The lifestyle intervention was not more effective than health brochures in reducing risk
scores for T2DM and CVD or improving lifestyle behavior in an at-risk population.
Trial registration
Current Controlled Trials: ISRCTN59358434



http://www.ijbnpa.org/content/pdf/1479-5868-10-47.pdf

High-Intensity Interval Resistance Training (HIRT) influences resting energy expenditure and respiratory ratio in non-dieting individuals

Antonio Paoli,¹ Tatiana Moro,¹ Giuseppe Marcolin,¹ Marco Neri,² Antonino Bianco,³ Antonio Palma,³ and Keith Grimaldi⁴

Abstract

Background

The benefits of exercise are well established but one major barrier for many is time. It has been proposed that short period resistance training (RT) could play a role in weight control by increasing resting energy expenditure (REE) but the effects of different kinds of RT has not been widely reported.

Methods

We tested the acute effects of high-intensity interval resistance training (HIRT) vs. traditional resistance training (TT) on REE and respiratory ratio (RR) at 22hours post-exercise. In two separate sessions, seventeen trained males carried out HIRT and TT protocols. The HIRT technique consists of: 6 repetitions, 20seconds rest, 2/3 repetitions, 20 secs rest, 2/3 repetitions with 2^′30″ rest between sets, three exercises for a total of 7 sets. TT consisted of eight exercises of 4 sets of 8–12 repetitions with one/two minutes rest with a total amount of 32 sets. We measured basal REE and RR (TT₀ and HIRT₀) and 22hours after the training session (TT₂₂ and HIRT₂₂).

Results

HIRT showed a greater significant increase (p<0.001) in REE at 22hours compared to TT (HIRT₂₂2362±118 Kcal/d vs TT₂₂ 1999±88 Kcal/d). RR at HIRT₂₂ was significantly lower (0.798±0.010) compared to both HIRT₀ (0.827±0.006) and TT₂₂ (0.822±0.008).

Conclusions

Our data suggest that shorter HIRT sessions may increase REE after exercise to a greater extent than TT and may reduce RR hence improving fat oxidation. The shorter exercise time commitment may help to reduce one major barrier to exercise.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551736/?tool=pmcentrez&rendertype=abstract

The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review

1. M. D. Klok, 
2. S. Jakobsdottir, 
3. M. L. Drent

Summary

Leptin and ghrelin are two hormones that have been recognized to have a major influence on energy balance. Leptin is a mediator of long-term regulation of energy balance, suppressing food intake and thereby inducing weight loss. Ghrelin on the other hand is a fast-acting hormone, seemingly playing a role in meal initiation. As a growing number of people suffer from obesity, understanding the mechanisms by which various hormones and neurotransmitters have influence on energy balance has been a subject of intensive research. In obese subjects the circulating level of the anorexigenic hormone leptin is increased, whereas surprisingly, the level of the orexigenic hormone ghrelin is decreased. It is now established that obese patients are leptin-resistant. However, the manner in which both the leptin and ghrelin systems contribute to the development or maintenance of obesity is as yet not clear. The purpose of this review is to provide background information on the leptin and ghrelin hormones, their role in food intake and body weight in humans, and their mechanism of action. Possible abnormalities in the leptin and ghrelin systems that may contribute to the development of obesity will be mentioned. In addition, the potentials of leptin and ghrelin as drug targets will be discussed. Finally, the influence of the diet on leptin and ghrelin secretion and functioning will be described.

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2006.00270.x/abstract;jsessionid=C2EE821034A976B4DEF422E730A72358.d03t04

Myths, Presumptions, and Facts about Obesity

Krista Casazza, Ph.D., R.D., Kevin R. Fontaine, Ph.D., Arne Astrup, M.D., Ph.D., Leann L. Birch, Ph.D., Andrew W. Brown, Ph.D., Michelle M. Bohan Brown, Ph.D., Nefertiti Durant, M.D., M.P.H., Gareth Dutton, Ph.D., E. Michael Foster, Ph.D., Steven B. Heymsfield, M.D., Kerry McIver, M.S., Tapan Mehta, M.S., Nir Menachemi, Ph.D., P.K. Newby, Sc.D., M.P.H., Russell Pate, Ph.D., Barbara J. Rolls, Ph.D., Bisakha Sen, Ph.D., Daniel L. Smith, Jr., Ph.D., Diana M. Thomas, Ph.D., and David B. Allison, Ph.D.

BACKGROUND

Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.

METHODS

Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.

RESULTS

We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.

CONCLUSIONS

False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.)

Myths, Presumptions, and Facts about Obesity — NEJM

Treatment of obesity: need to focus on high risk abdominally obese patients

Jean-Pierre Després, professor,^a Isabelle Lemieux, PhD student,^b and Denis Prud'homme, professor

Summary points

• A simple measurement such as waist circumference can indicate accumulation of abdominal fat
• Viscerally obese men are characterised by an atherogenic plasma lipoprotein profile
• A triad of non-traditional markers for coronary heart disease found in viscerally obese middle aged men (hyperinsulinaemia, raised apolipoprotein B concentration, and small LDL particles) increases the risk of coronary heart disease 20-fold
• Four out of five middle aged men with a waist measurement 90 cm and triglyceride concentrations 2 mmol/l are characterised by this triad
• Even in the absence of hypercholesterolaemia, hyperglycaemia, or hypertension, obese patients could be at high risk of coronary heart disease if they have this “hypertriglyceridaemic waist” phenotype

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119905/

Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults

DONNELLY, JOSEPH E. Ed.D (Chair); BLAIR, STEVEN N. PED; JAKICIC, JOHN M. Ph.D.; MANORE, MELINDA M. Ph.D., R.D.; RANKIN, JANET W. Ph.D.; SMITH, BRYAN K. Ph.D

Abstract

Overweight and obesity affects more than 66% of the adult population and is associated with a variety of chronic diseases. Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies. Guidelines of the National Heart, Lung, and Blood Institute (NHLBI) encourage a 10% reduction in weight, although considerable literature indicates reduction in health risk with 3% to 5% reduction in weight. Physical activity (PA) is recommended as a component of weight management for prevention of weight gain, for weight loss, and for prevention of weight regain after weight loss. In 2001, the American College of Sports Medicine (ACSM) published a Position Stand that recommended a minimum of 150 min·wk^-1 of moderate-intensity PA for overweight and obese adults to improve health; however, 200-300 min·wk^-1 was recommended for long-term weight loss. More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss. To this end, we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain, for weight loss, and prevention of weight regain. Evidence supports moderate-intensity PA between 150 and 250 min·wk^-1 to be effective to prevent weight gain. Moderate-intensity PA between 150 and 250 min·wk^-1 will provide only modest weight loss. Greater amounts of PA (>250 min·wk^-1) have been associated with clinically significant weight loss. Moderate-intensity PA between 150 and 250 min·wk^-1 will improve weight loss in studies that use moderate diet restriction but not severe diet restriction. Cross-sectional and prospective studies indicate that after weight loss, weight maintenance is improved with PA >250 min·wk^-1. However, no evidence from well-designed randomized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss. Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk. Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk. There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain.

http://journals.lww.com/acsm-msse/Fulltext/2009/02000/Appropriate_Physical_Activity_Intervention.26.aspx

Exercise as a Management Strategy for the Overweight and Obese: Where Does Resistance Exercise Fit in?

Sword, David O. PT, DPT, CSCS

Abstract

SUMMARY: EXCESS BODYWEIGHT, SPECIFICALLY EXCESS FAT WEIGHT, INCREASES THE RISK OF CHRONIC DISEASE AND PREMATURE DEATH. INCREASED PHYSICAL ACTIVITY/EXERCISE IS A RECOMMENDED STRATEGY FOR THOSE SEEKING TO EFFECTIVELY REDUCE AND MANAGE BODYWEIGHT. TRADITIONALLY, WEIGHT MANAGEMENT EXERCISE RECOMMENDATIONS HAVE FOCUSED ON AEROBIC-TYPE ACTIVITIES, SUCH AS WALKING, BIKING, SWIMMING, AND THE LIKE, WHICH TEND TO RESULT IN A SIGNIFICANT CALORIC EXPENDITURE DURING THE EXERCISE SESSION. STUDIES SUGGEST THAT RESISTANCE EXERCISE CAN ALSO PLAY AN IMPORTANT ROLE IN A LONG-TERM WEIGHT MANAGEMENT PROGRAM, ALBEIT THROUGH DIFFERENT MECHANISMS. THIS ARTICLE EXPLORES CURRENT ACTIVITY/EXERCISE RECOMMENDATIONS FOR WEIGHT LOSS/MANAGEMENT AND DISCUSSES THE POTENTIAL ROLE OF RESISTANCE EXERCISE.

http://journals.lww.com/nsca-scj/Fulltext/2012/10000/Exercise_as_a_Management_Strategy_for_the.7.aspx?WT.mc_id=EMxj18x20121112xL12

Resistance Training Reduces Subclinical Inflammation in Obese, Postmenopausal Women

PHILLIPS, MELODY D.¹; PATRIZI, ROBERT M.¹; CHEEK, DENNIS J.²; WOOTEN, JOSHUA S.³; BARBEE, JAMES J.⁴; MITCHELL, JOEL B.¹

Abstract

Purpose: Aerobic exercise is frequently prescribed to reduce inflammatory-related disease (cardiovascular disease and diabetes) risk. Resistance training (RT), however, may be key to maximizing anti-inflammatory benefits of consistent exercise. We examined the influence of RT on inflammatory biomarkers in obese, postmenopausal women.

Methods: Twenty-three women (65.6 ± 2.6 yr; body mass index, 33 kg·m⁻²) underwent 12 wk of RT (3 sets, 10 exercises, 3× per week, 8–12 repetition maximum (RM), resistance exercise (EX), N = 11) or social interaction intervention (SI, stretching, knitting, health lectures, 2× per week, control group (CON), N = 12). Both before (BT) and after (AT) RT or SI, blood was collected before (PR), immediately (PO), 2 h (2H), and 24 h (24H) after a single resistance exercise bout (RE) in EX and at the same time points in nonexercise, resting CON. For all time points, blood was analyzed for IL-6, leptin, and lipopolysaccharide (LPS)-stimulated tumor necrosis factor-α (TNF-α) (LPS-TNF) and IL-10 (LPS-IL10). PR samples were also examined for C-reactive protein, TNF-α, and adiponectin, and mRNA expression of toll-like receptor 4 (TLR4) and MC1R. Subcutaneous adipose tissue was extracted BT and AT and analyzed for mRNA expression of monocyte chemotactic protein-1, leptin, CD68, and TLR4.

Results: RT improved strength (44%) and reduced circulating C-reactive protein (−33%), leptin (−18%) and TNF-α (−29%) with no change in body composition. IL-6 decreased after SI in CON (−17%). LPS-TNF increased after SI or RT (CON +26%, EX +67%, respectively), whereas LPS-IL10 decreased in CON (−28%) but increased in EX (+20%). RT did not influence inflammatory biomarker gene expression in whole blood or subcutaneous adipose tissue. A single RE bout augmented LPS-TNF and LPS-IL10 at 24H in EX, particularly AT.

Conclusion: RT reduced markers of subclinical inflammation in circulation in obese, postmenopausal women in the absence of changes in body composition. Chronic RT also enhanced response to endotoxin challenge both at rest (PR) and 24 h after an acute RE bout (24H).

http://journals.lww.com/acsm-msse/Fulltext/2012/11000/Resistance_Training_Reduces_Subclinical.8.aspx?WT.mc_id=EMxj18x20121226ACSMHTxL6