Gender differences in effectiveness of the Complete Health Improvement Program (CHIP) lifestyle intervention: an Australasian study.

ISSUE ADDRESSED: Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia. METHODS: Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age=56.0±12.5 years; 65.7% women, mean age=54.4±13.5 years) 30 days after program commencement. RESULTS: Significant reductions (P<0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days. CONCLUSIONS: CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes. SO WHAT?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

The American College of Lifestyle Medicine's Offering of a Mental Health and Wellbeing Program (The Lift Project) to its Members - Caring for the Carers.

In the wake of COVID-19, the American College of Lifestyle Medicine offered its members an online 10-week multicomponent mental health and wellbeing program (The Lift Project), and extended the invitation to members from sister organizations associated with the Lifestyle Medicine Global Alliance. A total of 1785 members registered for the program, representing 39 countries. The website hosting the program recorded 9815 total visits over the 10 weeks. In a post-program questionnaire completed by 145 participants, 91% agreed or strongly agreed that the program supported their mental wellbeing, and participants reported their wellbeing as higher after the program as compared to its commencement (X2 = 80.8, P < .01). Ninety-four percent of respondents indicated they would recommend the program to a friend. Thematic analysis of open-ended responses included in the post-program evaluation indicated that the participants liked: the structure of the program and content covered; the style of the video presentations; and the practical application of the program. Some participants indicated they would have liked more time to engage with the program and would have enjoyed the provision of group meetings. In conclusion, healthcare organizations can support their members' mental health and wellbeing by offering large-scale, evidence-based interventions.

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.

A Multimodal Intervention for Improving the Mental Health and Emotional Well-being of College Students.

This study examined the effectiveness of a 10-week multimodal intervention for improving the mental health and emotional well-being of college students when included as a mandatory component of the students' course of study. A total of 67 students (20.9 ± 5.4 years, 30 male/37 female) participated in the intervention that introduced a variety of evidence-based strategies for improving mental health and emotional well-being from the Lifestyle Medicine and Positive Psychology literature. Significant reductions were recorded in symptoms of depression (-28%, P < .05), anxiety (-31%, P < .05), and stress (-28%, P < .01), whereas significant improvements were observed in mental health (18%, P < .01), vitality (14%, P < .01) and overall life satisfaction (8%, P < .05). Effect sizes were larger than those reported by studies that have examined the individual effectiveness of the strategies incorporated into the intervention, suggesting a compounding effect. Stratified analyses indicated that participants with the lowest measures of mental health and emotional well-being at baseline experienced the greatest benefits. The findings of the study suggest that meaningful improvements in the mental health and emotional well-being of college students can be achieved, and potentially magnified, by utilizing a multidisciplinary approach involving evidence-based strategies from Lifestyle Medicine and Positive Psychology.

EMG activity is not elevated during exercise-related transient abdominal pain.

Skeletal muscle cramp has been proposed as the aetiology of exercise-related transient abdominal pain (ETAP). The aim of this study was to determine whether or not localised electromyographic (EMG) activity indicative of skeletal muscle cramp is elevated during ETAP. Surface EMG activity was quantified at the site of ETAP in 14 symptomatic individuals (ETAP group) while the pain was present and after the pain subsided. Additionally, measurements were taken in another 14 subjects (Comparison group) who performed the same experimental procedure but did not experience ETAP. In the ETAP group, localised EMG activity did not increase when the pain was present or decrease when the pain subsided. The level of EMG activity detected while the pain was present was indistinguishable from noise (0.20+/-0.18microV). No difference was observed between the ETAP and Comparison groups in the level of localised EMG activity (p=0.89) at any time. After the pain subsided in the ETAP group, EMG activity was recorded at the site of the pain while the subjects performed a diaphragm-dependent sniff manoeuvre (8.3+/-0.7microV) and a maximum voluntary contraction of the abdominal muscles (17.5+/-0.7microV). It was concluded that ETAP is not associated with elevated EMG activity, suggesting that the pain is not the result of muscle cramping.

HDL subfraction changes with a low-fat, plant-based Complete Health Improvement Program (CHIP).

BACKGROUND AND OBJECTIVES: Low HDL concentrations are considered an important risk factor for cardiovascular disease. Interventions promoting a low-fat, plant-based eating pattern appear to reduce CVD risk while paradoxically also reducing HDL concentrations. Recent studies show HDL to comprise a range of subfractions, but the role these play in ameliorating the risk of CVD is unclear. The purpose of this study was to characterise changes in HDL subfractions in participants where HDL decreased following the CHIP intervention which promotes a low-fat, plant-based diet, with physical activity. METHODS AND STUDY DESIGN: Individuals (n=22; mean age=55.4±16.3 years; 45.5% men, 54.5% women) participating in a CHIP intervention were assessed at baseline and 30 days for changes in BMI, blood pressure, lipid profile, (including large-, intermediate- and small-HDL subfractions) and fasting glucose. RESULTS: HDL significantly decreased (10.6%, p<0.001) together with BMI (2.5%, p=0.028), systolic blood pressure (7.1%, p=-0.005), total cholesterol (9.5%, p=0.002), LDL (11.2%, p=0.007) and fasting glucose (8.2%, p=0.028). Triglycerides (TG) did not significantly change. Physical activity (22.7%, p=0.016) and consumption of whole plant-foods (13.9%, p=0.003) significantly increased, while nonplant (energy and animal) foods decreased (43.1%, p=0.009). Large-, intermediate- and small-HDL decreased (-10.0%, p=0.003; -8.3%, p=0.013 and 22%, p=0.005, respectively). CONCLUSIONS: This paper discusses specific changes in HDL subfractions when overall-HDL decreases as a response to low fat, whole-food, plant-based eating and exercise. Additional research is required to elucidate the reasons through which behavioural therapies remodel the HDL particle and how this impacts the functional properties of HDL and CVD risk.

The Body Mass Index of Adolescents Attending Seventh-Day Adventist Schools in Australia: 2001-2012.

BACKGROUND: We examined the body mass index (BMI) of students attending Seventh-day Adventist (Adventist) schools in Australia in 2001 and 2012. METHODS: A total of 3069 students attending Adventist schools in Australia responded to a health and lifestyle survey in 2001 (N = 1335) and 2012 (N = 1734). The survey captured self-reported height and weight, demographics (age, sex, year level, religion), and select health behaviors. RESULTS: Compared with national norms, lower rates of overweight and obesity were observed in the study cohort, but higher rates of underweight. There was no change in the mean BMI of the students attending Adventist schools in Australia from 2001 to 2012. Regression analyses indicated that a lower BMI was associated with age, sex, more regularly eating breakfast, consuming less soft drink, and having a regular exercise program. The students reported a high consumption of fruits, vegetables, and whole grains compared with Australian national norms, and 29% claimed to be vegetarian. CONCLUSIONS: Students attending Adventist schools appear to have a lower prevalence of overweight and obesity than the secular population, but a higher prevalence of underweight. The mechanisms through which Adventist schools may influence student's BMI warrants further investigation.

Optimizing the Intensity of Lifestyle Medicine Interventions: Similar Outcomes for Half the Sessions.

Lifestyle medicine interventions are typically intensive by design. This study explored the optimal "dosage" of a well-known lifestyle medicine intervention-the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.

Gender differences in effectiveness of the Complete Health Improvement Program (CHIP).

OBJECTIVE: To determine the differential effect of gender on outcomes of the Complete Health Improvement Program, a chronic disease lifestyle intervention program. DESIGN: Thirty-day cohort study. SETTING: One hundred thirty-six venues around North America, 2006 to 2009. PARTICIPANTS: A total of 5,046 participants (33.5% men, aged 57.9 ± 13.0 years; 66.5% women, aged 57.0 ± 12.9 years). INTERVENTION: Diet, exercise, and stress management. MAIN OUTCOME MEASURES: Body mass index, diastolic blood pressure, systolic blood pressure, lipids, and fasting plasma glucose (FPG). ANALYSIS: The researchers used t test and McNemar chi-square test of proportions, at P < .05. RESULTS: Reductions were significantly greater for women for high-density lipoprotein (9.1% vs 7.6%) but greater for men for low-density lipoprotein cholesterol (16.3% vs 11.5%), total cholesterol (TC) (13.2% vs 10.1%), triglycerides (11.4% vs 5.6%), FPG (8.2% vs 5.3%), body mass index (3.5% vs 3%), diastolic blood pressure (5.5% vs 5.1%), and TC/high-density lipoprotein (6.3% vs 1.4%) but not different for systolic blood pressure (6% vs 5%). The greatest reductions were in participants with the highest baseline TC, low-density lipoprotein, triglycerides, and FPG classifications. CONCLUSIONS AND IMPLICATIONS: The Complete Health Improvement Program effectively reduced chronic disease risk factors among both genders, but particularly men, with the largest reductions occurring in individuals at greatest risk. Physiological or behavioral factor explanations, including differences in adiposity and hormones, dietary intake, commitment and social support, are explored. Researchers should consider addressing gender differences in food preferences and eliciting commitment and differential support modes in the development of lifestyle interventions such as the Complete Health Improvement Program.

Factors influencing exercise-related transient abdominal pain.

PURPOSE: Exercise-related transient abdominal pain (ETAP) is a widely experienced but poorly understood problem. This study examined the influence of age, gender, body mass index (BMI), training status, and sporting activity on the experience of ETAP and shoulder tip pain (STP). STP may occur as a result of referred pain from tissues innervated by the phrenic nerve; these tissues are implicated in theories proposed to explain ETAP. METHODS: A total of 965 regular sporting participants were surveyed from six sporting activities: running, swimming, cycling, aerobics, basketball, and horse riding. RESULTS: The prevalence (r = -0.28, P < 0.01) and severity (r = -0.17, P < 0.01) of ETAP decreased with age. Gender, BMI, and training status had no affect on the prevalence or severity of ETAP, but respondents who trained more frequently reported experiencing ETAP less often. Younger respondents were more inclined than the older respondents to report ETAP on the left side of the abdomen (P < 0.05). The prevalence (r = -0.11, P < 0.01) and severity (r = -0.37, P < 0.01) of STP decreased with age. STP was described as more severe (r = 0.23, P < 0.05) by respondents with high BMI values. Gender and training status had no influence on the experience of STP. Controlling for all other factors, ETAP was respectively 10.5 and 9 times more common (P < 0.01) in running and horse riding than cycling. STP was 13 times more common in running than cycling. CONCLUSION: Training status alters the frequency of occurrence of ETAP but has little effect on the incidence or severity of the pain. Further, ETAP and STP decrease with age but are not related to gender or BMI.

The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility study.

AIM: To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States. METHODS: Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9 plus or minus 12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105). RESULTS: In the 30 days of the program, significant overall reductions (p<0.001) were recorded in the participants' body mass (-3.8%; 87.1 plus or minus 22.4 versus 83.9 plus or minus 21.5 kg), systolic blood pressure (-5.6%; 135 plus or minus 19 versus 127 plus or minus 17 mmHg), diastolic blood pressure (-4.6%; 80 plus or minus 12 versus 76 plus or minus 12 mmHg), total cholesterol (-14.7%; 5.17 plus or minus 1.08 versus 4.41 plus or minus 0.96 mmol/L), low-density lipoprotein cholesterol (-17.9%; 3.17 plus or minus 0.95 versus 2.60 plus or minus 0.83 mmol/L), triglycerides (-12.5%; 1.51 plus or minus 0.98 versus 1.32 plus or minus 0.71 mmol/L) and fasting plasma glucose (-5.6%; 5.55 plus or minus 1.49 versus 5.24 plus or minus 1.11 mmol/L). Participants at program entry with the highest classifications of total cholesterol, low-density lipoprotein, triglycerides and fasting plasma glucose experienced over 20% reductions in these measures in 30 days. CONCLUSIONS: Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP intervention and the improvements were comparable to that observed in cohorts from the United States. The results of this feasibility study indicate that lifestyle interventions like CHIP may be useful for combating the burgeoning epidemic of chronic disease and further research is warranted.

Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors.

Lifestyle modification has been demonstrated to effectively reduce the risk factors associated with cardiovascular disease, but there is a perception that it is costly to administer and resource. The present study examined the results achieved by a 30-day lifestyle modification program (Coronary Health Improvement Project) delivered by volunteers in a community setting. Changes in selected biometric measures of 5,070 participants in the Coronary Health Improvement Project programs delivered throughout North America (January 2006 to October 2009), were assessed. Overall, significant reductions (p < 0.001) were recorded in body mass (-3.2%), systolic and diastolic blood pressure (-4.9% and -5.3%, respectively), total cholesterol (-11.0%), low-density lipoprotein cholesterol (-13.0%), triglycerides (-7.7%), and fasting plasma glucose (-6.1%). Stratification of the data revealed more dramatic responses in those presenting with the greatest risk factor levels. Those presenting with cholesterol levels >280 mg/dl recorded an average reduction of 19.8%. A mean decrease of 16.1% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >190 mg/dl. Individuals who presented with triglycerides >500 mg/dl recorded a mean reduction of 44.1%. The Framingham assessment forecast that approximately 70 cardiac events would be averted during the subsequent decade in the cohort because of the program. In conclusion, significant reductions in cardiovascular disease risk factors can be achieved in a 30-day lifestyle intervention delivered by volunteers, providing a cost-effective mode of administering lifestyle medicine.

Heart rate responses and fluid balance of competitive cross-country hang gliding pilots.

PURPOSE: To evaluate the physiological challenges of competitive cross-country hang gliding. METHODS: Seventeen experienced male pilots (age=41+/-9 y; mean+/-SD) were fitted with a monitor that recorded heart rate and altitude at 0.5 Hz throughout a competitive flight. Fluid losses were evaluated by comparing pilot pre- and postflight mass. RESULTS: The pilots' displacement was 88.4+/-43.7 km in 145.5+/-49.4 min. Mean flight altitude was 1902+/-427 m (range=1363-2601 m) with a maximum altitude of 2925+/-682 m (1870-3831 m). The mean in-flight heart rate of the pilots was 112+/-11 bpm (64+/-6% predicted HRmax). For all except one subject, heart rate was highest while launching (165+/-12 bpm, 93+/-7% predicted HRmax), followed by landing (154+/-13 bpm, 87+/-7% predicted HRmax). No statistically significant relationship was observed between heart rate during the launch and reported measures of state anxiety. Heart rate was inversely related (P<.01) to altitude for all pilots except one. Fluid loss during the flight was 1.32+/-0.70 L, which approximated 0.55 L/h, while mean in-flight fluid consumption was 0.39+/-0.44 L. Six pilots consumed no fluid during the flight. CONCLUSIONS: Even among experienced pilots, high heart rates are more a function of state anxiety than physical work demand. Fluid losses during flight are surprisingly moderate but pilots may still benefit from attending to fluid balance.

Influence of posture and body type on the experience of exercise-related transient abdominal pain.

The aim of this study was to evaluate the influence of posture and body type on the experience of exercise-related transient abdominal pain (ETAP). Postural and somatotype assessments were performed on 104 active males and 55 active females aged 18.6+/-0.4 years (mean+/-SD) and were correlated against their self-reported experience of ETAP. Individuals demonstrating kyphosis were more likely to be susceptible to ETAP (p<0.01). Among the individuals susceptible to ETAP, the extent of kyphosis and lordosis influenced the pain severity (p<0.05). There was no relationship between any measure of body type and ETAP. The findings indicate that postural abnormality, particularly in the thoracic region, influences the experience of ETAP.

Spirometry measurements during an episode of exercise-related transient abdominal pain.

PURPOSE: To determine whether changes in lung function are associated with exercise-related transient abdominal pain (ETAP). METHODS: Twenty-eight subjects susceptible to ETAP performed a flow-volume loop before (pre) and after (post) treadmill exercise. Fourteen of the subjects developed symptoms of ETAP during the exercise and completed the flow-volume loop while the pain was present. The remaining 14 subjects reported no symptoms of ETAP. RESULTS: Forced inspiratory vital capacity was essentially unchanged from pre to post in both groups (ETAP group -0.8% +/- 5.1%, comparison group -0.9% +/- 6.5%). Peak inspiratory-flow rate increased in both the ETAP group (12.4% +/- 16.2%) and the comparison group (17.9% +/- 16.6%), but the difference between groups (-4.6%, standardized effect size [EF] = -0.17) was trivial. Forced expiratory vital capacity decreased by approximately 4% in both groups (ETAP group -3.9% +/- 3.3%, comparison group -4.0% +/- 5.1%). Small differences in the mean change from pre to post between groups were recorded for peak expiratory-flow rate (-7.4%, EF = -0.28) and the forced expiratory volume in the first second of the test (-4.4%, EF = -0.44). CONCLUSIONS: ETAP does not appear to be associated with reduced inspiratory performance, suggesting that the diaphragm is not implicated directly in the etiology of ETAP. Expiratory power might be slightly reduced during an episode of ETAP, but the magnitude of this effect is unlikely to compromise exercise performance.