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.

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.

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.

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.