Prevalence of Failed Back Surgery Syndrome Across Hospital Corporation of America Healthcare in the United States, Their Correlation With Mood Disorders and Other Lifestyle-Related Comorbidities.

About 16 million adults present with chronic back pain, the sixth most costly condition in the United States (US). Estimates suggest that about 60% of initial back surgeries have a successful outcome; however, many don't, leaving over 80,000 failed back surgeries per year. Failed Back Surgery Syndrome (FBSS) is defined by the International Association for the Study of Pain as back pain, with or without radiating pain, located in the lower limbs, of unknown origin, which persists or begins after surgical procedures are performed to treat lumbar disc herniations. Psychiatric comorbidities and psychosocial factors have been associated with patients presenting with this syndrome. A retrospective cross-sectional study was performed to identify the prevalence of FBSS in a population of patients during the period of January 2019-December 2020 across Hospital Corporation of America (HCA) Healthcare in the US. With a sample of 28,426 patients who underwent back surgery only 8% had FBSS. Those with FBSS (N = 2434) were mainly females (54.27%) with a mood disorder (61.18%), P-value <.0001. Among those with FBSS, there was a statistically significant relationship between mood disorder and smoking (57.37%) and obesity (54.61%) compared to non-smokers and non-obese. Lifestyle interventions may ameliorate disabling symptoms and improve the well-being of this population.

Development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) Grade-Based Guidelines on the Surgical Treatment of Obesity Using Multimodal Strategies: Design and Methodological Aspects.

Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach.

Cancer Prevention and Treatment Based on Lifestyles.

Cancer morbidity and mortality incidence are rapidly increasing over the period of time. Cancer prevention, alongside innovative therapies and earlier detection, is considered a key strategy for reducing the overall cancer burden. Substantial evidence indicates a clear correlation between lifestyle factors and changes in nutrient metabolism. Approximately 5-10% of all cancer cases are attributed to genetic factors, whereas 90-95% are due to environmental and lifestyle factors, suggesting that lifestyle interventions have significant prospects for preventing various cancers. Healthy lifestyle changes, in particular healthy diets, physical activity, staying at a healthy weight, reduction or elimination of tobacco/alcohol consumption, and avoiding exposure to radiation and other carcinogens, are significant factors to be considered to tackle the challenges associated with cancer in modern society. This chapter aims to provide lifestyle intervention strategies to improve cancer prevention and risk reduction while promoting the health of cancer patients. The therapeutic role of some dietary regimens and supplements, as well as complementary and alternative health approaches, in cancer treatment is also discussed.

Finding Groups in the Portuguese Population Through Lifestyle: A Cross-Sectional Study.

Lifestyle interventions are recognized as essential in the prevention and treatment of noncommunicable diseases, the main causes of multimorbidity. A population-based cross-sectional study was carried out in mainland Portugal. 891 Portuguese patients aged ≥20 years, representative of the population, were personally interviewed. For lifestyle, diet and alcohol consumption, physical activity and sedentarism, use of tobacco and illicit drugs, sleeping habits, screen activities and stress, were studied. The bio-sociodemographic data reported were age, sex, marital status, highest level of education, body mass index and health problems in the last 12 months. This study aimed to apply principal components analysis and clustering to identify distinct groups within the population based on lifestyle. It was possible to identify 3 groups: cardiometabolic, healthy and anxious-depressive. It seems very likely that smoking cessation and other behavioral changes only occur after negative health conditions occur.

Advances in Diet and Physical Activity in Breast Cancer Prevention and Treatment.

There is currently a growing interest in diets and physical activity patterns that may be beneficial in preventing and treating breast cancer (BC). Mounting evidence indicates that indeed, the so-called Mediterranean diet (MedDiet) and regular physical activity likely both help reduce the risk of developing BC. For those who have already received a BC diagnosis, these interventions may decrease the risk of tumor recurrence after treatment and improve quality of life. Studies also show the potential of other dietary interventions, including fasting or modified fasting, calorie restriction, ketogenic diets, and vegan or plant-based diets, to enhance the efficacy of BC therapies. In this review article, we discuss the biological rationale for utilizing these dietary interventions and physical activity in BC prevention and treatment. We highlight published and ongoing clinical studies that have applied these lifestyle interventions to BC patients. This review offers valuable insights into the potential application of these dietary interventions and physical activity as complimentary therapies in BC management.

Diagnostic indicators and lifestyle interventions of metabolic-associated fatty liver disease.

MAFLD has become a major global health problem and is the leading cause of liver disease worldwide. The disease progresses from a simple fatty liver to gradual fibrosis, which progresses to cirrhosis and even hepatocellular liver cancer. However, the methods currently used for diagnosis are invasive and do not facilitate clinical assessment of the condition. As a result, research on markers for the diagnosis of MAFLD is increasing. In addition, there are no clinical medications for the treatment of MAFLD, and lifestyle interventions remain effective in the prevention and treatment of MAFLD. In this review, we attempt to make a summary of the emerging diagnostic indicators and effective lifestyle interventions for MAFLD and to provide new insights into the diagnosis and treatment of MAFLD.

The Impact of Behavioral Lifestyle Intervention on Inflammatory Cytokines in Older Adults Living With Type 2 Diabetes: A Feasibility Study.

OBJECTIVE: This study investigates the effects of a behavioral lifestyle intervention on inflammatory cytokines and frailty in older adults (≥ 65 years) with type 2 diabetes (T2D). METHOD: We conducted a single-arm, 6-month intervention supplemented with diet and activity self-monitoring technology. We assessed frailty using Fried criteria and quantified inflammatory cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFN-γ], tumor necrosis factor [TNF-α]) using a multiplex assay. We used paired t-tests with significance at P < .05. We calculated the Spearman correlation and evaluated the relationship between frailty, BMI, and inflammatory cytokines. RESULTS: Eighteen participants completed the study (mean ± SD: 71.5 ± 5.3 years; BMI: 34 ± 6 kg/m2). At baseline, we had 4 frail, 13 pre-frail, and 1 non-frail participant. At 6 months, we observed the therapeutic effects of the intervention on frailty score, BMI, IL-2, IFN-y, and GM-CSF. DISCUSSION: The study highlights the importance of behavioral lifestyle intervention in improving inflammatory cytokines and frailty in older adults.

Feasibility and outcomes of a community-based, mobile health system-monitored lifestyle intervention in chronic stroke: A pilot study.

BACKGROUND: People with disabilities face challenges in daily life during the COVID-19 pandemic, including limited access to care, exposure to lifestyle-related diseases, and difficulties in regular exercise. Therefore, it is important to establish health safety nets using Information and Communication Technology (ICT) in communities. OBJECTIVE: This study aimed to develop an m-Health-based personalized lifestyle intervention algorithm targeting high-risk groups of lifestyle-related diseases (including hypertension, diabetes, and obesity) among people with hemiplegic disabilities, and to verify its feasibility. METHODS: Six people at a high risk of lifestyle-related diseases participated in an 8-week lifestyle intervention using a wearable device and the S-Health program. The self-health management areas included walking, moderate-intensity exercise, weight, blood pressure, blood sugar, diet, calorie intake, heart rate, sobriety, no smoking. Health, physical, psychological, and social changes were measured before and after the study. RESULTS: The intervention had a positive impact on the participants' health, with statistically significant differences found in fasting blood glucose, highest systolic blood pressure, grip strength, and motor function assessment. Quality of life, health-related quality of life, and self-efficacy improved post-intervention. CONCLUSION: Our findings can be used as preliminary evidence for establishing m-Health-based health safety net systems for people with disabilities who live in communities.

Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels.

BACKGROUND: Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. METHODS: A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged ≥ 18 years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. RESULTS: Our literature search identified 12 180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomes while some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD) = -3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. CONCLUSION: Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.

Sex- and age-specific normative values of lower extremity muscle power in Italian community-dwellers.

BACKGROUND: Muscle power is associated with health-related parameters. Simple equations were validated to estimate lower extremity muscle power measures based on the time to complete the five-repetition sit-to-stand test. The present study was conducted to provide lower extremity muscle power estimates and produce centile values in a large and relatively unselected population across a wide age spectrum. METHODS: Data were from the Longevity Check-up 7+ (Lookup 7+) project, an ongoing initiative conducted in unconventional settings (e.g., exhibitions, shopping centres and health promotion campaigns) across Italy to foster adoption of healthy lifestyles. Absolute, relative, allometric and specific muscle power measures of the lower extremities were estimated using validated formulas. Cross-sectional centile and normative values for muscle power measures from 18 to 81+ years were produced for the two sexes. Smoothed normative curves for men and women were constructed using the lambda-mu-sigma method. RESULTS: From 1 June 2015 to 31 October 2021, 13 515 participants were enrolled of whom 12 864 were eligible for the present study. Mean age was 55.9 years (standard deviation: 14.8 years; range: 18-98 years), and 7217 (56.%) were women. Absolute, relative, allometric and specific muscle power declined significantly with age. Specific patterns of decline were observed according to sex and muscle power parameter. Absolute muscle power peaked at 41-50 and 31-40 years in men and women, respectively. Afterwards, a decline rate of approximately 12% per decade was observed, regardless of sex. Relative muscle power showed the largest reduction with age, such that it was 40.6% and 46.4% smaller in men and women older than 80, respectively, compared with those aged 18-30 years. Age-related changes in allometric and specific muscle power measures were similar between men and women. CONCLUSIONS: Data from the Lookup 7+ project indicate that lower extremity muscle power estimated using simple equations is significantly associated with age. Sex-specific patterns of decline in absolute and relative muscle power were observed with age. Allometric and specific muscle power declined at a similar rate in men and women.

Uncovering the Cardiovascular Threat: A Comprehensive Examination of Liver Fibrosis and Subclinical Atherosclerosis in Non-alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) has emerged as a global epidemic intricately linked to the rising tide of obesity and metabolic syndrome. This comprehensive review delves into the complex web of relationships between NAFLD, liver fibrosis, and subclinical atherosclerosis, shedding light on their interplay, shared risk factors, and clinical implications. NAFLD encompasses a spectrum of liver conditions, from the benign non-alcoholic fatty liver (NAFL) to the more severe non-alcoholic steatohepatitis (NASH), characterized by inflammation and hepatocellular injury. Central to the discussion is the insidious development of liver fibrosis, the ominous harbinger of progressive liver damage, cirrhosis, and hepatocellular carcinoma. The increasing prevalence of NAFLD, now affecting a quarter of the global population, poses a significant public health challenge. Its association with obesity, insulin resistance, and metabolic syndrome highlights the multifactorial nature of this disease. However, NAFLD's repercussions extend beyond the liver. This review unveils a potent connection between NAFLD and subclinical atherosclerosis, the early precursor to cardiovascular disease. Individuals with NAFLD face an elevated risk of atherosclerosis, even without traditional cardiovascular risk factors. The intricate link between these two conditions is illuminated through shared pathophysiological pathways, including systemic inflammation, insulin resistance, and dyslipidemia. Understanding the interplay between liver fibrosis and subclinical atherosclerosis has profound clinical implications. Patients with advanced fibrosis or cirrhosis are not only at risk of liver-related complications but also of cardiovascular events. This necessitates a holistic approach to patient care, with lifestyle modifications and pharmacological interventions simultaneously managing both conditions. Physicians must prioritize early detection and collaborate across disciplines to provide comprehensive care. Looking ahead, the future holds promising avenues of research. Emerging areas include genetics and precision medicine, microbiome research, and epigenetics, which may unveil new therapeutic targets. Innovations in diagnostics and therapeutics, such as non-invasive biomarkers and combination therapies, offer hope for more effective management. Long-term outcomes and survivorship research will provide insights into the lasting impact of interventions. In conclusion, this review underscores the imperative of addressing liver fibrosis and atherosclerosis in the context of NAFLD. It is a call to action for healthcare professionals, researchers, and policymakers to work collaboratively, promote early detection, and advance our understanding of these interconnected conditions. By doing so, we can enhance patient outcomes and chart a course toward a healthier future for those grappling with NAFLD and its intricate web of consequences.

Cancer Metabolism as a Therapeutic Target and Review of Interventions.

Cancer is amenable to low-cost treatments, given that it has a significant metabolic component, which can be affected through diet and lifestyle change at minimal cost. The Warburg hypothesis states that cancer cells have an altered cell metabolism towards anaerobic glycolysis. Given this metabolic reprogramming in cancer cells, it is possible to target cancers metabolically by depriving them of glucose. In addition to dietary and lifestyle modifications which work on tumors metabolically, there are a panoply of nutritional supplements and repurposed drugs associated with cancer prevention and better treatment outcomes. These interventions and their evidentiary basis are covered in the latter half of this review to guide future cancer treatment.

Adipose tissue as a cause of endocrine dysfunction.

Adipose tissue is a large hormonally active organ that secretes several substances (adipokines), and an important site for the synthesis and metabolism of steroid hormones. With energy balance, the secretory and metabolic activity of adipose tissue determines the normal function of many organs, including the endocrine glands. However, in the course of overweight and obesity, adverse changes occur in the structure and function of adipocytes. Obesity-related adipose tissue dysfunction translates into a change in the profile of secreted adipokines, and it impairs steroidogenesis. These phenomena contribute to the development of obesity-related complications, which also affect the major tropic axes regulating the endocrine glands. However, there is increasing evidence that weight reduction is an effective treatment for obesity-related adipose tissue dysfunction, thereby restoring endocrine function. This narrative review presents the impact of adipose tissue on endocrine gland activity both in the physiological state and in obesity-related dysfunction. It also discusses how functional (related to excess adiposity) changes in the endocrine system can be restored with effective treatment of obesity.

Interventions to Address Cardiovascular Risk in Obese Patients: Many Hands Make Light Work.

Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, mediated through different obesity-associated comorbidities. Diet and physical activity are key points in preventing CV disease and reducing CV risk; however, these strategies alone are not always sufficient, so other approaches, such as pharmacological treatments and bariatric surgery, must support them. Moreover, these strategies are associated with improved CV risk factors and effectively reduce the incidence of death and CV events such as myocardial infarction and stroke; consequently, an individualized care plan with a multidisciplinary approach is recommended. More precisely, this review explores several interventions (diet, physical activity, pharmacological and surgical treatments) to address CV risk in obese patients and emphasizes the importance of adherence to treatments.

Identifying the effective behaviour change techniques in nutrition and physical activity interventions for the treatment of overweight/obesity in post-treatment breast cancer survivors: a systematic review.

PURPOSE: Updated evidence for the treatment of obesity in cancer survivors includes behavioural lifestyle interventions underpinning at least one theoretical framework. The aim of this systematic review was to assess the effectiveness of theory-based lifestyle interventions for the treatment of overweight/obesity in breast cancer survivors and to report effective behavioural change techniques (BCTs) and components used in these interventions. METHODS: Four databases were searched for RCTs published between database inception and July 2022. The search strategy included MeSH terms and text words, using the PICO-framework to guide the eligibility criteria. The PRISMA guidelines were followed. Risk-of-bias, TIDier Checklist for interventions' content, and the extent of behaviour change theories and techniques application were assessed. To evaluate the effectiveness of interventions, trials were categorised as "very," "quite," or "non" promising according to their potential to reduce body weight, and BCTs promise ratios were calculated to assess the potential of BCTs within interventions to decrease body weight. RESULTS: Eleven RCTs met the inclusion criteria. Seven trials were classified as "very", three as "quite" and one study was "non" promising. Studies' size, design, and intervention strategies varied greatly, but the weight-loss goal in all studies was ≥ 5% of the initial body weight through a 500-1000 kcal/day energy deficit and a gradually increased exercise goal of ≥ 30 min/day. Social Cognitive Theory was the most commonly used theory (n = 10). BCTs ranged from 10 to 23 in the interventions, but all trials included behaviour goal setting, self-monitoring, instructions on the behaviour, and credible source. The risk-of-bias was "moderate" in eight studies and "high" in three. CONCLUSION: The present systematic review identified the components of theory-based nutrition and physical activity behaviour change interventions that may be beneficial for the treatment of overweight/obesity in breast cancer survivors. The strategies mentioned, in addition to reported behavioural models and BCTs, should be considered when developing weight-loss interventions for breast cancer survivors.

Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness.

People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.

Obesity and Cardiovascular Risk: Systematic Intervention Is the Key for Prevention.

Obesity is a serious public health issue and associated with an increased risk of cardiovascular disease events and mortality. The risk of cardiovascular complications is directly related to excess body fat mass and ectopic fat deposition, but also other obesity-related complications such as pre-type 2 diabetes, obstructive sleep apnoea, and non-alcoholic fatty liver diseases. Body mass index and waist circumference are used to classify a patient as overweight or obese and to stratify cardiovascular risk. Physical activity and diet, despite being key points in preventing adverse events and reducing cardiovascular risk, are not always successful strategies. Pharmacological treatments for weight reduction are promising strategies, but are restricted by possible safety issues and cost. Nonetheless, these treatments are associated with improvements in cardiovascular risk factors, and studies are ongoing to better evaluate cardiovascular outcomes. Bariatric surgery is effective in reducing the incidence of death and cardiovascular events such as myocardial infarction and stroke. Cardiac rehabilitation programs in obese patients improve cardiovascular disease risk factors, quality of life, and exercise capacity. The aim of this review was to critically analyze the current role and future aspects of lifestyle changes, medical and surgical treatments, and cardiac rehabilitation in obese patients, to reduce cardiovascular disease risk and mortality, and to highlight the need for a multidisciplinary approach to improving cardiovascular outcomes.

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies.

BACKGROUND: Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. OBJECTIVE: We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. METHODS: Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. RESULTS: The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. CONCLUSIONS: This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44830.