Search Results (105)

Background/Objectives: Physical inactivity and sedentary lifestyles remain leading behavioral risk factors for chronic disease across generations. Mothers with young children face unique barriers to exercise, including time constraints, fatigue, and limited access to supportive environments. Lion Hearts was developed to address these barriers through a family-centered, community-based approach that integrates physical activity, strength training, and health education. This protocol describes the systematic application of the Intervention Mapping (IM) framework to develop Lion Hearts, a multigenerational CrossFit-based program for mothers and children. Methods: Following the first four steps of the IM framework—needs assessment, matrices, intervention design, and program creation—behavioral determinants were identified through literature review, national data, and community input. The resulting 12-week program integrates twice-weekly family CrossFit sessions, monthly cardiovascular health workshops, and weekly home-based challenges delivered through local affiliates using a train-the-trainer model. Results: IM produced a theoretically grounded and evidence-based intervention targeting individual (self-efficacy, outcome expectations), interpersonal (modeling, relatedness), and environmental (access, social support) determinants. The process resulted in detailed logic models, behavior change matrices, and implementation materials, including family handbooks and coach guides. Conclusions:Lion Hearts represents a scalable, multigenerational approach to CVD prevention that leverages existing community fitness infrastructure. By embedding prevention within family systems and CrossFit affiliates, the program offers a sustainable, replicable model to enhance physical activity, strengthen family health behaviors, and reduce intergenerational CVD risk. Full article

Background/Objectives: Type 2 diabetes (T2D) is a growing health epidemic. Innovative approaches such as digital technologies incorporating peer-supported coaching have shown promise in diabetes prevention. This study aimed to examine the feasibility and effect on weight of a digitally-enabled peer support program in inner-regional Sydney. Methods: A pre-post study of a digitally-enabled peer support initiative promoted weight management and lifestyle changes in participants at risk of T2D in inner-regional Sydney. Participants were recruited primarily from general practices and community groups. Participants received initial guidance, educational videos, goal-setting tools, and self-assessment weights, while volunteer peer support facilitators provided ongoing support through action planning and monthly calls. Baseline and follow-up weights at 6 months were collected to determine program effectiveness, while feasibility was evaluated through short exit interviews and analytic website data. Results: Most eligible participants (92.4%) were recruited through general practice. Program completers (n = 35, 43.8%) reported an average weight reduction of 3.7 kg (SD = 3.9, p < 0.001). Those who used the platform to log at least one achievement saw a greater reduction in weight than those who did not log achievements (mean difference = −2.9 kg, 95% CI −5.6 to −0.1, p = 0.049). Exploratory qualitative analysis of exit interviews revealed challenges surrounding technology, website interaction, scheduling conflicts, data collection, and attrition. Conclusions: Preliminary results indicate that this digital program was associated with significant weight reduction among individuals at risk of diabetes in an inner-regional area of Sydney. Recruitment was most effective via general practices, highlighting the potential for such a program to be promoted through this setting. Full article

Hypertension is a major chronic condition affecting older adults in the United States. The condition imposes clinical and economic burdens. Self-efficacy, or confidence in managing health, is crucial for effective self-management of hypertension. This study explored the relationships between socio-demographics, health status, and confidence in following provider recommendations for controlling hypertension among Medicare beneficiaries. The 2021 Medicare Current Beneficiary Survey was analyzed, including responses from 5838 beneficiaries aged ≥65 years with reported hypertension. A three-level categorical dependent variable ((1) very confident/confident, (2) somewhat confident, and (3) not confident (reference group)) based on provider recommendations for lifestyle changes for hypertension control was created. A survey-weighted multinomial logit model examined associations between socio-demographics and self-reported health status and the dependent variable. Among respondents, 70.8%, 21.4%, and 7.8%, respectively, were very confident/confident, somewhat confident, and not confident in following provider recommendations for lifestyle changes to control hypertension. Beneficiaries with obesity, fair/poor general health, and limitations in basic activities of daily living or instrumental activities of daily living were less likely to report being very confident/confident. The findings of this cross-sectional study highlighted the potential need for targeted support (e.g., tailored health coaching, peer mentoring) of lifestyle changes for at-risk older adults to manage hypertension. Full article

Background: Patients with early-stage (I–IIIA) resectable non-small cell lung cancer (NSCLC) often experience reduced physical activity (PA) after surgery. PA telecoaching may support a more active lifestyle, but evidence in this population is limited. Objective: To evaluate acceptability, feasibility, safety, and actual usage of an automated and manual PA telecoaching program following surgery for NSCLC. Methods: In this multicenter, single-blind study, patients received either an eight-week automated coaching program (ACP) with a customized smartphone app or a manual coaching program (MCP) with weekly phone calls from a coach. Both groups used an activity tracker, linked to their smartphone, to monitor steps and receive feedback. Primary outcomes included acceptability, feasibility, safety and usage, assessed via questionnaires and interviews. Secondary outcomes included objectively measured PA (accelerometry), functional exercise capacity (six-minute walk distance) and symptoms (dyspnea, fatigue) and quality of life, evaluated via questionnaires. Results: Nineteen patients (12 males; 68 ± 6 years; baseline daily steps 7820 ± 2799) were included. The majority (18/19) found the intervention enjoyable, and a minority (6/19) reported minor smartphone issues. All patients wore the activity tracker consistently. No adverse events occurred. The ACP required significantly less coach contact time compared to the MCP (25 ± 14 vs. 54 ± 15 min, p = 0.0003). No other differences in primary outcomes were observed between groups. Changes in secondary outcomes were limited in both groups. Conclusion: PA telecoaching is feasible, well accepted, and safe in patients with NSCLC post-surgery, with excellent activity tracker adherence. The ACP required less coach involvement. However, increasing PA remains challenging, and no conclusions can be made about the effectiveness of telecoaching. Future research should explore longer interventions in larger populations to assess efficacy and long-term outcomes. Full article

Background/Objectives: Evidence-based lifestyle coaching programs have been developed to support people with disabilities in adopting healthy behaviors, and to ultimately contribute to enhancing their overall well-being. However, when implementing such programs in new settings, adaptations may be needed to ensure a successful implementation process. This study aimed to explore professionals’ perceptions on an adapted evidence-informed lifestyle coaching program (Healthy Habits Coaching) for people with physical disabilities to inform the implementation of the program in Dutch rehabilitation and/or community settings. Methods: A qualitative study with semi-structured interviews was conducted. The study was performed from a pragmatic perspective using an integrated knowledge translation approach. Ten professionals who had experience with offering, delivering, and/or implementing lifestyle coaching programs were enrolled. Interview questions focused on participants’ perceptions on implementing the Healthy Habits Coaching in Dutch settings. A directed content analysis was used to analyze the data. Results: Participants highlighted the importance of implementing lifestyle coaching tailored to people with physical disabilities. While participants were generally positive about the implementation of Healthy Habits Coaching, they had mixed opinions on its added value alongside existing lifestyle programs and on the core components, particularly the free coaching model and the use of volunteer coaches with lived experience. Participants underlined that for a successful adoption and implementation, the added value, (scientific) foundation, financial basis, and organizational structure of the program should be clearly communicated. Conclusions: The findings provide directions for how, where, and by whom an adapted lifestyle program (Healthy Habits Coaching) for people with physical disabilities could be implemented in Dutch rehabilitation and community settings. This study demonstrates an example of how an evidence-based lifestyle program can be prepared for implementation in a new setting, presenting an efficient and promising strategy to enhance overall well-being among people with disabilities. Full article

Background: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. Methods: The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. Results: The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. Conclusions: If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support. Full article

Background: Obesity in adults is a growing health concern. The principal interventions used in obesity management are lifestyle-change interventions such as diet, exercise, and behavioral therapy. Although they are effective, current treatment options have not succeeded in halting the global rise in the prevalence of obesity or achieving sustained long-term weight maintenance at the population level. E-health and m-health are both integral components of digital health that focus on the use of technology to improve healthcare delivery and outcomes. The use of eHealth/mHealth might improve the management of some of these treatments. Several digital health interventions to manage obesity are currently in clinical trials. Objective: The aim of our systematic review is to evaluate whether digital health interventions (e-Health and m-Health) have effects on changes in anthropometric measures, such as weight, BMI, and waist circumference and behaviors such as energy intake, eating behaviors, and physical activity. Methods: A search was conducted for randomized controlled trials (RCTs) conducted through 4 October 2024 through three databases (Medline, Web of Science, and Scopus). Studies were included if they evaluated digital health interventions (e-Health and m-Health) compared to control groups in overweight or obese adults (BMI ≥ 25 kg/m²) and reported anthropometric or lifestyle behavioral outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool (RoB 2). Meta-analyses were performed using random-effects or fixed-effects models as appropriate, with statistical significance set at p < 0.05. Results: Twenty-two RCTs involving diverse populations (obese adults, overweight individuals, postpartum women, patients with eating disorders) were included. Digital interventions included biofeedback devices, smartphone apps, e-coaching systems, web-based interventions, and mixed approaches. Only waist circumference showed a statistically significant reduction (WMD = −1.77 cm; 95% CI: −3.10 to −0.44; p = 0.009). No significant effects were observed for BMI (WMD = −0.43 kg/m²; p = 0.247), body weight (WMD = 0.42 kg; p = 0.341), or lifestyle behaviors, including physical activity (SMD = −0.01; p = 0.939) and eating behavior (SMD = −0.13; p = 0.341). Body-fat percentage showed a borderline-significant trend toward reduction (WMD = −0.79%; p = 0.068). High heterogeneity was observed across most outcomes (I² > 80%), indicating substantial variability between studies. Quality assessment revealed predominant judgments of “Some Concerns” and “High Risk” across the evaluated domains. Conclusions: Digital health interventions produce modest but significant benefits on waist circumference in overweight and obese adults, without significant effects on other anthropometric or behavioral parameters. The high heterogeneity observed underscores the need for more personalized approaches and future research focused on identifying the most effective components of digital interventions. Digital health interventions should be positioned as valuable adjuncts to, rather than replacements for, established obesity treatments. Their integration within comprehensive care models may enhance traditional interventions through continuous monitoring, real-time feedback, and improved accessibility, but interventions with proven efficacy such as behavioral counseling and clinical oversight should be maintained. Full article

In the United States, at least one in three adults has prediabetes, a condition categorized by blood glucose levels higher than normal but not high enough to be classified as type 2 diabetes. The Centers for Disease Control and Prevention (CDC) recommends a modest weight loss of 5–7%, a reduction in A1C by 0.2%, and at least 150 min of physical activity per week to prevent or delay the onset of type 2 diabetes in individuals with prediabetes. Eat Smart, Move More, Prevent Diabetes (ESMMPD) is a CDC-recognized lifestyle-change program for individuals with prediabetes or at high risk of developing type 2 diabetes. ESMMPD consists of 26 lessons delivered over the course of a year by trained Lifestyle Coaches using Zoom^TM. Participants are taught strategies to implement health-promoting behaviors related to healthy eating, physical activity, and mindfulness into their daily lives. The core components of the program are planning, tracking, and living mindfully. The aim of this article is to provide insights into the development, delivery, and core components of the ESMMPD program for public health practitioners. Full article

The present pilot randomized control study examined the effectiveness of an 8-week stress management and health coaching intervention on perceived stress, healthy routines, sleep quality, self-efficacy, self-esteem and happiness. A total of 38 office employees were randomly assigned to the intervention group (IG, n = 20) or the control group (CG, n = 18) and validated tools were used to assess outcomes. Statistically significant differences in the IG after the 8 weeks were observed in perceived stress (i.e., a decrease in PSS-14 score, p = 0.043), in “Daily Routine”, i.e., an increase in control over the consistent timing of meals and sleep (p = 0.001) and in “Social and Mental Balance”, i.e., an increase in inclination to socialize, balance leisure and personal time and adopt positive thinking or cognitive control over stressors (p = 0.003). These improvements were reflected in an increase in total healthy lifestyle and personal control score (HLPCQ, p = 0.048). Short time and stress management and coaching interventions at workplaces can empower employees to increase control over stressors and to take the first step in adopting healthy behaviors by recognizing bad habits. Furthermore, in building sustainable employment, an empowered employee would participate at an organizational level more actively. Our preliminary results strongly support the idea that primary health care professionals should be educated in health coaching and relaxation techniques. Full article

Background/Objectives: Clinicians are becoming increasingly interested in the use of large language models (LLMs) in obesity services. While most experts agree that LLM integration would increase access to obesity care and its efficiency, many remain skeptical of their scientific accuracy and capacity to convey human empathy. Recent studies have shown that ChatGPT-3 models are capable of emulating human dietitian responses to a range of basic dietary questions. Methods: This study compared responses of two ChatGPT-4o models to those from human dietitians across 10 complex questions (5 broad; 5 narrow) derived from patient–clinician interactions within a real-world medicated digital weight loss service. Results: Investigators found that neither ChatGPT-4o nor Chat GPT-4o1 preview were statistically outperformed (p < 0.05) by human dietitians on any of the study’s 10 questions. The same finding was made when scores were aggregated from the ten questions across the following four individual study criteria: scientific correctness, comprehensibility, empathy/relatability, and actionability. Conclusions: These results provide preliminary evidence that advanced LLMs may be able to play a significant supporting role in medicated obesity services. Research in other obesity contexts is needed before any stronger conclusions are made about LLM lifestyle coaching and whether such initiatives increase care access. Full article

Physical inactivity among university students remains a global health concern, especially in semi-rural settings where unique barriers such as limited facilities, cultural norms, and inadequate transportation persist. This study aimed to identify the primary motivations and barriers to physical activity participation among students at a semi-rural university, providing insights for tailored interventions. A mixed-methods explanatory sequential design was used. In the quantitative phase, 414 questionnaires were distributed across four faculties, with 328 completed responses analysed using t-tests and factor analysis. The qualitative phase involved semi-structured interviews with 23 students, analysed through conventional content analysis. The quantitative findings revealed key motivators for physical activity, which included enjoyment (mean = 4.51, p < 0.001), social interaction (mean = 3.99, p < 0.001), and health benefits (mean = 3.27, p = 0.001). However, for barriers, heavy academic workload reached statistical significance (mean = 3.88, p < 0.001). In contrast, qualitative data uncovered additional barriers such as insufficient facilities and poor communication, which were not captured in the quantitative phase. Factor analysis identified four constructs for motivations (e.g., coaching, social, health, enjoyment) and barriers (e.g., club processes, excuses, external factors, lack of interest). Qualitative data corroborated these findings, highlighting issues such as insufficient visibility of physical activity programs, time barriers, and inconsistent coaching quality. This study underscores the importance of addressing structural barriers, such as upgrading facilities, improving communication strategies, and enhancing coaching quality, to increase physical activity participation. By implementing strategic interventions, universities can foster inclusive environments that better support students’ well-being and engagement, ultimately promoting healthier lifestyles among university populations. Full article

Rationale: The dietary components choline, betaine, and L-carnitine are converted by intestinal microbiota into the molecule trimethylamine (TMA). In the human liver, hepatic flavin-containing monooxygenase 3 oxidizes TMA to trimethylamine-N-oxide (TMAO). TMAO is considered a candidate marker for the risk of cardiovascular disease. Methodology: The Healthy Lifestyle Community Program cohort 3 (HLCP-3) intervention was conducted with participants recruited from the general population in Germany (intervention: n = 99; control: n = 48). The intervention included intensive educational workshops, seminars, and coaching activities. The assessment was conducted using a complete case analysis (CCA) of the participants. The intervention was carried out for a ten-week intensive phase and an alumni phase. The interventional program emphasizes adopting a healthy plant-based diet and reducing meat consumption, as adherence to such a diet may lead to lowering TMAO levels. Additionally, it provides general recommendations about physical activity, stress management, and community support. The control group did not receive any intervention. TMAO was evaluated using stable isotope dilution liquid chromatography, and tandem mass spectrometry was used to measure fasting plasma levels of TMAO. Objectives: The present study aimed to determine the impact of the Healthy Lifestyle Community Program (HLCP-3) on risk profiles for lifestyle-related diseases and TMAO plasma levels. Results: Significant decreases in most risk profile parameters were detected, and a non-significant decrease in plasma TMAO levels was observed in the intervention group (0.37 (−1.33; 0.59) µmol/L). Furthermore, for the intervention group, after a six-month follow-up period, there was a significant negative correlation between higher healthy plant diet index (hPDI) scores and a decrease in plasma TMAO (ß = −0.200, p = 0.027). Additionally, a significant negative correlation was observed between the TMAO level and the scores for adherence to the plant diet index (PDI) (r = −0.195; p = 0.023). Conclusions: HLCP-3 is effective at improving adherence to a plant-based diet and improving risk profile parameters. However, long-term interventions involving stricter dietary programs in the sense of a plant-based diet are recommended if significant decreases in TMAO levels are to be obtained. Full article

Background/Objectives: Lifestyle coaches are integral to delivery of the National Diabetes Prevention Program (DPP); however, few studies have explored the role of the lifestyle coach in relation to participant success. This study aimed to develop a conceptual model of the factors that contribute to lifestyle coach performance and success. Methods: A cross-sectional qualitative study including 82 semi-structured interviews with National DPP staff and participants between June 2020 and February 2022. Results: Based on the analysis of the interviews, the developed model illustrates how central to coach success are the intrinsic qualities they bring to the role, the quality of their training and preparation for the lifestyle coach role, and the mechanization of their qualities and training through their program delivery. Around this focal relationship revolve four other factors that together or independently affect lifestyle coach success: organization influences; external influences; program participants; and evaluation and feedback. Conclusions: Health coaching can be an incredibly powerful tool in behavior change. This model provides insight into how coaching can impact participant outcomes and can be used by other health promotion programs who use the coach model. Full article

Background: Young women spend 50 min daily on social media (SM); thus, SM platforms are promising for health interventions. This study tested the feasibility and preliminary efficacy of the co-designed SM intervention the Daily Health Coach (DHC). The DHC is a 3-month healthy lifestyles intervention programme, targeting eating, physical activity, and social wellbeing behaviours in women aged 18–24, via the dissemination of health and nutrition content on social media platform Instagram. Methods: The programme was tested using an assessor-blinded, two-arm pilot randomised controlled trial with 46 participants over 12 weeks. Engagement was assessed via SM metrics; acceptability via post-programme questionnaires; and feasibility included retention, randomisation, recruitment, and data collection. Secondary outcomes—dietary quality, physical activity, social influence, disordered eating behaviours, body image, and digital health literacy—were assessed using validated surveys. Analyses included t-tests, chi-squared tests, and linear mixed models. The treatment effects were estimated by testing mean score differences from baseline to 3 months for intention-to-treat populations. Results: The DHC scored 83.6% for programme satisfaction. Over time, a significant decrease in body image disturbance was observed (p = 0.013). A significant group-by-time interaction for digital health literacy (p = 0.002) indicated increased ability to discern evidence-based nutrition information (p = 0.006). The waitlist control group showed increased social influence compared to the intervention group (p = 0.034). No other significant changes were observed. Conclusion: The DHC is a feasible and acceptable method for disseminating nutrition information. Larger studies are needed to determine efficacy. Full article

(1) Background: General nutrition knowledge is a fundamental pillar of well-being and healthy lifestyles. This study aimed to measure the general nutrition knowledge questionnaire (GNKQ) scores of overweight and obese participants who joined a pilot randomized controlled trial (RCT) and the association between changes in GNKQ scores and changes in anthropometric measures. (2) Methods: A total of 30 and 25 participants had completed the trial at the 3- and 6-month visits, respectively. All participants enrolled in a randomized controlled trial (RCT) and received a hypocaloric-tailored diet and three online nutrition education sessions over 6 months. The participants were randomly divided into two groups: an intervention group supported with weekly telemonitoring and monthly telehealth coaching vs. a control group. The Arabic-validated GNKQ was used, covering four sections: dietary recommendations; food groups and nutrient sources; healthy food choices; and associations between the diet–disease relationship and weight. (3) Results: The findings show that both the intervention and control groups showed improvements in GNKQ scores over time, with the intervention group demonstrating significant increases in overall nutrition knowledge and specific areas, such as the diet–disease relationship and weight management, at 3 months. In addition, changes in GNKQ scores had a significant negative association with BMI and visceral fat percentage. The findings underline the benefits of supporting dietary weight loss interventions with telemonitoring and telehealth coaching, suggesting that an increase in nutrition knowledge may relate to lower body fat metrics. Nevertheless, the small sample size and high attrition rate of participants were the main limitations of this study, such that large populations are required to confirm the reliability of the obtained findings. Full article