The impact of lifestyle intervention on sedentary time in individuals at high risk of diabetes.

AIMS/HYPOTHESIS: The Diabetes Prevention Program (DPP) lifestyle intervention successfully achieved its goal of increasing leisure physical activity levels. This current study examines whether the lifestyle intervention also changed time spent being sedentary and the impact of sedentary time on diabetes development in this cohort. METHODS: 3,232 DPP participants provided baseline data. Sedentary behaviour was assessed via an interviewer-administered questionnaire and reported as time spent watching television specifically (or combined with sitting at work). Mean change in sedentary time was examined using repeated measures ANCOVA. The relationship between sedentary time and diabetes incidence was determined using Cox proportional hazards models. RESULTS: During the DPP follow-up (mean: 3.2 years), sedentary time declined more in the lifestyle than the metformin or placebo participants (p < 0.05). For the lifestyle group, the decrease in reported mean television watching time (22 [95% CI 26, 17] min/day) was greater than in the metformin or placebo groups (p < 0.001). Combining all participants together, there was a significantly increased risk of developing diabetes with increased television watching (3.4% per hour spent watching television), after controlling for age, sex, treatment arm and leisure physical activity (p < 0.01), which was attenuated when time-dependent weight was added to the model. CONCLUSIONS/INTERPRETATION: In the DPP, the lifestyle intervention was effective at reducing sedentary time, which was not a primary goal. In addition, in all treatment arms, individuals with lower levels of sedentary time had a lower risk of developing diabetes. Future lifestyle intervention programmes should emphasise reducing television watching and other sedentary behaviours in addition to increasing physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT00004992.

Overview of recruitment for the osteoporotic fractures in men study (MrOS).

Large, long term research studies present recruitment challenges that can be met with collaborative approaches to identify and enroll participants. The Osteoporotic Fractures in Men Study (MrOS), a multi-center observational study designed to determine risk factors for osteoporosis, fractures and prostate cancer in older men, recruited 5995 participants over a 25-month period. Enrolling a cohort that represented the race and age distribution of each community, and developing interest in an older male cohort about a condition commonly thought of as a "women's disease," were major recruitment challenges. During the start-up phase, recruitment challenges and strategies were analyzed and collective approaches were developed to address ways to motivate the target population. Key methods included mailings using community and provider contact lists; regional and senior newspaper advertisements; and presentations targeted to seniors. Sites used a centrally developed recruitment brochure. Response to mass mailings at some sites surpassed 10-15% and appointment show rates averaged above 85%. The final number enrolled in MrOS was 5% more than the original recruitment goal of 5700. Minority recruitment was enhanced through the use of the Health Care Financing Administration and other databases that allowed for targeted recruitment. Overall, minority enrollment was approximately 10.56% of the cohort (244 African American, 191 Asian). Men age>80 were enthusiastic and represent about 18% of enrollees. Through a coordinated approach of developing and refining recruitment strategies and materials, sites were able to adapt their original strategies and complete recruitment ahead of schedule.

Restorative yoga and metabolic risk factors: the Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial.

AIMS: Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. METHODS: In 2009-2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-min group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-h glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. RESULTS: 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (-0.35 mmol/L vs. -0.03 mmol/L; p=0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. CONCLUSIONS: Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors.