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.

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health.

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.

Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy.

BACKGROUND & AIMS: Screening colonoscopy can prevent cancer by removal of adenomatous polyps. Recent evidence suggests that insufficient time for inspection during overly rapid colonoscope withdrawal may compromise adenoma detection. We conducted a study of the effect of a minimum prespecified time for instrument withdrawal and careful inspection on adenoma detection rates during screening colonoscopy. METHODS: Baseline data consisted of neoplasia detection rates during 2053 screening colonoscopies performed without a specified withdrawal protocol. During a subsequent 13-month period we performed 2325 screening colonoscopies using dedicated inspection techniques and a minimum 8-minute withdrawal time. With colonoscopists comprising the study population, we compared overall and individual rates of neoplasia detection in postintervention procedures with those in baseline examinations. RESULTS: As compared with baseline subjects, postintervention subjects had higher rates of any neoplasia (34.7% vs 23.5%, P < .0001) and of advanced neoplastic lesions per patient screened (0.080 +/- 0.358 vs 0.055 +/- 0.241, P < .01). Twenty-five percent of advanced neoplastic lesions detected in postintervention examinations were 9 mm or less in diameter, versus 10% in baseline examinations (P < .001). Endoscopists with mean withdrawal times of 8 minutes or longer had higher rates of detection of any neoplasia (37.8% vs 23.3%, P < .0001) and of advanced neoplasia (6.6% vs 4.5%, P = .13) compared with those with mean withdrawal times of less than 8 minutes. CONCLUSIONS: After implementing a protocol of careful inspection during a minimum of 8 minutes to withdraw the colonoscope, we observed significantly greater rates of overall and advanced neoplasia detection during screening colonoscopy.

C-reactive protein levels according to physical activity and body weight for participants in the coronary health improvement project.

OBJECTIVES: To identify whether the Coronary Health Improvement Project (CHIP), an intervention designed to increase physical activity and improve diet, lowers serum C-reactive protein (CRP). The study will also assess whether changes in CRP over the study period are associated with baseline levels of and changes in selected coronary risk factors. METHODS: A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a 4-week period, beginning March 2003, in Rockford, IL, USA. RESULTS: The intervention significantly increased physical activity and decreased BMI, weight, percent body fat, and saturated fat (P<0.0001). However, the intervention was not significantly associated with a decrease in CRP. Participants in both the intervention and control groups combined showed a decrease in high CRP (>3 mg/L), from 46% at baseline to 38% at 6 weeks and 41% at 6 months. Those with higher BMI at baseline showed a greater increase in CRP over time (P<0.0001), whereas those with higher CRP at baseline showed a greater decrease in CRP over time (P<0.0001). CONCLUSIONS: Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. However, the percentage with high CRP did fall, more so for those with lower BMI and higher CRP at baseline. BMI may mediate the influence of physical activity on CRP.

Can newly acquired healthy behaviors persist? An analysis of health behavior decay.

INTRODUCTION: We evaluated data from the Coronary Health Improvement Project (CHIP) to determine whether improved health behaviors associated with this intervention persisted or decayed during 18 months of follow-up. METHODS: Participants were 348 volunteers aged 24 to 81 years from the Rockford, Illinois, metropolitan area enrolled in CHIP, a 4-week educational course delivered as lectures. The intervention taught the importance of making better lifestyle choices and improving dietary and physical activity behaviors. Physical activity and dietary behaviors were assessed at baseline, and changes in behaviors were assessed at 6 weeks and 18 months. Changes were evaluated according to quartile groupings of each variable at baseline. RESULTS: No baseline differences were found between participants who dropped out and participants who provided data through 18 months. Mean changes significantly improved through 6 weeks for each of the 21 selected physical activity and dietary behavior variables except percentage of daily calories from carbohydrates. Mean changes significantly improved through 18 months for each of the 21 variables except calories from protein, alcohol, and whole grain servings. The percentage of participants who improved their physical or dietary behavior at 6 weeks ranged from 49% for percentage of daily calories from carbohydrates (64% at 18 months) to 91% for intake of dietary cholesterol per day (84% at 18 months). The level of change through 18 months for all variables was significantly influenced by quartile groupings at baseline. Physical activity improved significantly through 18 months only for participants in the lowest two quartiles of physical activity at baseline. Exercise decreased significantly through 18 months for participants in the highest quartile of physical activity at baseline. CONCLUSION: During an 18-month period, participants' physical activity and dietary behaviors improved significantly. Even though behavior improvement tended to be greater at 6 weeks, most healthy behaviors did not return to baseline levels after 18 months.

A video-based lifestyle intervention and changes in coronary risk.

If population-wide improvements in nutrition and physical activity behavior are to be made, behavior change interventions must use a variety of media. This study examines whether participation in a facilitator-based video version of the Coronary Health Improvement Project could significantly reduce coronary risk. A total of 28 video classes conducted in worksite, medical and community settings were used to teach 763 middle-aged adults, ages 30-79 years, about healthy lifestyles. Four to 8 weeks after baseline, follow-up measures were taken. Demographic and biometric data [body weight, body mass index (BMI), blood lipids, blood pressure and fasting blood glucose] were gathered. The class participants were evaluated in aggregate and showed significant improvements in body weight, BMI, resting heart rate, total cholesterol, low-density lipoprotein, triglycerides and fasting blood glucose. Males demonstrated greater improvement than females, and individuals with higher baseline health risks experienced the greatest reductions in risk. This video lifestyle change program appears to help participants make important lifestyle changes. For individuals empowered to make better choices regarding diet and exercise, significant improvements occurred in most coronary risk factors in as little as 4-6 weeks.

The effect of a community-based coronary risk reduction: the Rockford CHIP.

OBJECTIVE: The aim of this study was to assess the clinical effects of a community-based lifestyle intervention program in reducing coronary risk, especially in a high risk group. METHOD: The 40-hour educational curriculum of the Coronary Health Improvement Project (CHIP) delivered over a 30-day period with clinical and nutritional assessments before and after was offered in the spring and fall of 2000 to 2002 through the Center for Complementary Medicine of the Swedish American Health System in Rockford, Illinois to its employees and the general public. The participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 min/day). RESULTS: The data of the 5 CHIP programs were pooled and analyzed. 544 men and 973 women (almost all Caucasian; mean age 55 years) were eligible for analysis. At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk. CONCLUSION: Well-designed community-based intervention programs can improve lifestyle choices and health habits. They can also markedly and rather quickly reduce the level of coronary risk factors in a non-randomized population.

Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.

BACKGROUND: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas and the amount of time taken to withdraw the colonoscope among endoscopists in a large community-based practice. METHODS: During a 15-month period, 12 experienced gastroenterologists performed 7882 colonoscopies, of which 2053 were screening examinations in subjects who had not previously undergone colonoscopy. We recorded the numbers, sizes, and histologic features of the neoplastic lesions detected during screening, as well as the duration of insertion and of withdrawal of the colonoscope during the procedure. We compared rates of detection of neoplastic lesions among gastroenterologists who had mean colonoscopic withdrawal times of less than 6 minutes with the rates of those who had mean withdrawal times of 6 minutes or more. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. RESULTS: Neoplastic lesions (mostly adenomatous polyps) were detected in 23.5% of screened subjects. There were large differences among gastroenterologists in the rates of detection of adenomas (range of the mean number of lesions per subject screened, 0.10 to 1.05; range of the percentage of subjects with adenomas, 9.4 to 32.7%) and in their times of withdrawal of the colonoscope from the cecum to the anus (range, 3.1 to 16.8 minutes for procedures during which no polyps were removed). As compared with colonoscopists with mean withdrawal times of less than 6 minutes, those with mean withdrawal times of 6 minutes or more had higher rates of detection of any neoplasia (28.3% vs. 11.8%, P<0.001) and of advanced neoplasia (6.4% vs. 2.6%, P=0.005). CONCLUSIONS: In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.

The behavioral and clinical effects of therapeutic lifestyle change on middle-aged adults.

INTRODUCTION: Chronic diseases such as cancer, cardiovascular disease, stroke, and diabetes are responsible for most deaths in the United States. Lifestyle factors--poor nutrition, sedentary living, and tobacco use--appear to play a prominent role in the development of many chronic diseases. This study determined the behavioral and clinical impact of a therapeutic lifestyle-modification intervention on a group of community volunteers. METHODS: Participants included 348 volunteers aged 24 to 81 years from the Rockford, Ill, metropolitan area who participated in a randomized clinical trial. The intervention group attended a 40-hour educational course delivered as lectures during a 4-week period. Participants learned the importance of making better lifestyle choices and how to make improvements in nutrition and physical activity. Changes in nutrition, physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 months. RESULTS: Intervention participants showed significant 6-month improvement in all nutrition and physical activity measures except calories from protein and whole-grain servings and all clinical measures except blood glucose, total cholesterol, triglycerides, and high-sensitivity C-reactive protein. Total cholesterol and low-density lipoprotein cholesterol were worse after 6 months in both groups but only significantly worse in the control group. The control group experienced small but significant improvements in systolic and diastolic blood pressure and high-density lipoproteins. Change-score comparisons between the intervention and control groups were significant for all nutrition and physical activity variables except total steps per week and daily sodium intake and were also significant for the clinical measures of weight, body fat, and body mass index. CONCLUSION: This therapeutic lifestyle-modification program can significantly improve nutrition and physical activity behavior and can reduce many of the risk factors associated with common chronic diseases.

The effects of a worksite chronic disease prevention program.

OBJECTIVE: This study determined the behavioral and clinical impact of a worksite chronic disease prevention program. METHODS: Working adults participated in randomized clinical trial of an intensive lifestyle intervention. Nutrition and physical activity behavior and several chronic disease risk factors were assessed at baseline, 6 weeks, and 6 months. RESULTS: Cognitive understanding of the requirements for a healthy lifestyle increased at the end of the program. Program participants significantly improved their cognitive understanding of good nutrition and physical activity and had significantly better nutrition and physical activity behavior at both 6 weeks and 6 months. Participants had significantly lower body fat, blood pressure, and cholesterol. CONCLUSIONS: This worksite chronic disease prevention program can significantly increase health knowledge, can improve nutrition and physical activity, and can improve many employee health risks in the short term.

Effects of an intensive diet and physical activity modification program on the health risks of adults.

BACKGROUND: This study assessed the clinical impact of lifestyle change education on chronic disease risk factors within a community. DESIGN: Randomized clinical trial. SETTING/PARTICIPANTS: Participants included 337 volunteers age 43 to 81 years from the Rockford, IL, metropolitan area. INTERVENTION: The intervention group attended a 40-hour educational course delivered over a 4-week period. Participants learned the importance of making healthful lifestyle choices and how to make improvements in nutrition and physical activity. MAIN OUTCOME MEASURES: Changes in health knowledge, nutrition, and physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 weeks. RESULTS: Beneficial mean changes in scores tended to be significant for the intervention group but not for the control group. Variables with improved scores included health knowledge, percent body fat, total steps per week, and most nutrition variables. Clinical improvements were seen in resting heart rate, total cholesterol, low-density lipoprotein cholesterol, and systolic and diastolic blood pressure. The control group experienced comparatively small but significant improvements in health knowledge, systolic and diastolic blood pressure, glucose, and in some nutrition variables. For almost all variables, the intervention group showed significantly greater improvements. CONCLUSIONS: This lifestyle modification program is an efficacious nutrition and physical activity intervention in the short term and has the potential to dramatically reduce the risks associated with common chronic diseases in the long term.

Rationale and design of the Rockford CHIP, a community-based coronary risk reduction program: results of a pilot phase.

PURPOSE: While residential lifestyle intervention programs have demonstrated coronary risk reduction through education, diet, and exercise, this pilot study was designed to assess the feasibility of a community-based lifestyle intervention program that is both affordable and effective in facilitating better lifestyle choices and health habits and thus effecting indicators of better clinical outcomes. MATERIALS AND METHODS: A 40-h educational curriculum, delivered over a 30-day period with clinical and nutritional assessments before and after, was offered through the SwedishAmerican Center for Complementary Medicine to the general public. The participants were instructed to exercise 30 min/day and to embrace a more optimal diet (ad libitum) of largely unrefined plant foods high in complex carbohydrates and fiber, yet quite low in fat (<15%), animal protein, sugar, and salt, and virtually free of cholesterol. RESULTS: Of the 250 enrollees, 242 "graduated" (78 men and 164 women; almost all Caucasian; mean age 54 +/- 12 years). They had coronary artery disease (CAD) (12%), diabetes (16%), hypertension (55%), most were overweight (88%), and the majority (79%) had low-density lipoprotein (LDL) levels >or=100 mg%. At 4 weeks, stratified analyses of total cholesterol (TC), LDL, triglycerides (TG), blood glucose, blood pressure, and weight showed that those at highest risk also had the greatest improvements. Depending on baseline levels, TC means dropped 10-23% in men and 6-13% in women. At the same time, LDL means declined 5-30% in men and 6-14% in women. In TG, the biggest drop (48%) was found in men who at baseline were in the highest risk category (in women, the biggest TG drop was 32%). CONCLUSION: Community-based intervention strategies can be successfully and affordably utilized to lower coronary risk factor levels in a self-selected, free-living population. The true test, however, will be to what extent social infrastructures can be modified and alumni activities sustained to facilitate long-term adherence and sustained benefits.