Cost-Effectiveness and Cost-Benefit of a Lifestyle Intervention for Workers in the Construction Industry at Risk for Cardiovascular Disease Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: a randomized controlled trial Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program An Individually Based Lifestyle Intervention for Workers at Risk for Cardiovascular Disease: A Process Evaluation The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Lifestyle intervention, behavioral changes, and improvement in cardiovascular risk profiles in the California WISEWOMAN project. A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: feasibility and outcomes of a randomized controlled trial. A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High Cardiovascular Risk (SimCard Trial) in Rural Tibet, China, and Haryana, India Community Outreach and Cardiovascular Health (COACH) Trial: A Randomized, Controlled Trial of Nurse Practitioner/Community Health Worker Cardiovascular Disease Risk Reduction in Urban Community Health Centers An Economic Evaluation of Four Work Site Based Cardiovascular Risk Factor Interventions A hypertension control program tailored to unskilled and minority workers. Improving Employee Health: Evaluation of a Worksite Lifestyle Change Program to Decrease Risk Factors for Diabetes and Cardiovascular Disease The long-term effectiveness of a lifestyle intervention in severely obese individuals. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: results of a randomized controlled trial. A Comprehensive Lifestyle Intervention to Prevent Type 2 Diabetes and Cardiovascular Diseases: the German CHIP Trial The Extensive Lifestyle Management Intervention (ELMI) after cardiac rehabilitation: a 4-year randomized controlled trial. Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial. Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention. The Effects of Single Long and Accumulated Short Bouts of Exercise on Cardiovascular Risks in Male Japanese Workers: A Randomized Controlled Study Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: A randomized controlled trial A cluster-randomized controlled trial to evaluate the effects of a simplified cardiovascular management program in Tibet, China and Haryana, India: study design and rationale
Objective : To investigate the cost-effectiveness and cost – benefit of a lifestyle intervention for construction workers with an elevated risk of cardiovascular disease . Methods : In this r and omized controlled trial , usual care was compared to a 6-month individual-based lifestyle intervention . At 6 and 12 months , weight , absenteeism , health care use , and lifestyle-related expenses were determined . Missing data were imputed . A cost-effectiveness analysis was performed from a societal perspective . Uncertainty around the incremental cost-effectiveness ratio ( ICER ) was estimated by bootstrapped cost – effect pairs . A cost – benefit analysis was performed from an employer 's perspective , subtracting the incremental costs from the incremental benefits . Results : The ICER was & OV0556;145/kg weight loss . The difference between intervention and control group in net employer costs was & OV0556;254 ( 95 % CI : −1070 to 1536 ) . Conclusion : Implementation of this important and effective intervention depends on the societal and employer 's willingness to pay Background Of all workers in Dutch construction industry , 20 % has an elevated risk of cardiovascular disease ( CVD ) . A major risk factor for CVD risk is an unhealthy lifestyle . The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk , and to evaluate its ( cost- ) effectiveness . Methods / Design In a RCT , 692 participants will be r and omised to either the control or the intervention group . The control group will receive usual care . For the intervention group , a lifestyle intervention has been design ed based on interviews and current literature . The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts , consisting of individual counselling aim ed at increasing daily physical activity ( PA ) and improving dietary behaviour , and /or smoking cessation . Counselling will take place at the Occupational Health Service ( OHS ) , and will be done according to motivational interviewing ( MI ) . Additional written information about healthy lifestyle will also be provided to those in the intervention group . At baseline , after 6 and after 12 months , measurements will take place . Primary outcome variables will be the lifestyle behaviours of concern , i.e. daily PA , dietary intake , and smoking status . Secondary outcome variables will be body mass index ( BMI ) , systolic and diastolic blood pressure , total and HDL blood cholesterol , Hba1c and cardio-respiratory fitness ( CRF ) . Sickness absenteeism and cost-effectiveness will be assessed as well . Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group . Discussion By improving lifestyle , CVD risk may be lowered , yielding benefits for both employee and employer . If proven effective , this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry . Trial registration Current Controlled Trials IS RCT Background The prevalence of overweight and elevated cardiovascular disease ( CVD ) risk among workers in the construction industry is relatively high . Improving lifestyle lowers CVD risk and may have work-related benefits . The purpose of the study was to evaluate the effects on physical activity ( PA ) , diet , and smoking  of a lifestyle intervention consisting of individual counseling among male workers in the construction industry with an elevated risk of cardiovascular disease ( CVD ) . Methods In a r and omized controlled trial including 816 male blue- and white-collar workers in the construction industry with an elevated risk of CVD , usual care was compared to a 6-month lifestyle intervention . The intervention consisted of individual counseling using motivational interviewing techniques , and was delivered by an occupational physician or occupational nurse . In three face to face and four telephone contacts , the participant 's risk profile , personal determinants , and barriers for behavior change were discussed , and personal goals were set . Participants chose to aim at either  diet and PA  , or smoking . Data were collected at baseline and after six and 12 months , by means of a question naire . To analyse the data , linear and logistic regression analyses were performed . Results The intervention had a statistically significant beneficial effect on snack intake ( β-1.9 , 95%CI -3.7 ; -0.02 ) and fruit intake ( β 1.7 , 95%CI 0.6 ; 2.9 ) at 6 months . The effect on snack intake was sustained until 12 months ; 6 months after the intervention had ended ( β -1.9 , 95%CI -3.6 ; -0.2 ) . The intervention effects on leisure time PA and metabolic equivalent-minutes were not statistically significant . The beneficial effect on smoking was statistically significant at 6 ( OR smoking 0.3 , 95%CI 0.1;0.7 ) , but not at 12 months ( OR 0.8 , 95%CI 0.4 ; 1.6 ) . Conclusions Beneficial effects on smoking , fruit , and snack intake can be achieved by an individual-based lifestyle intervention among male construction workers with an elevated risk of CVD . Future research should be done on strategies to improve leisure time PA and on determinants of maintenance of changed behavior . Considering the rising prevalence of unhealthy lifestyle and CVD , especially in the aging population , implementation of this intervention in the occupational health care setting is recommended . Trial registration Current Controlled Trials IS RCT Background Obesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors . Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss . There has been limited implementation and evaluation of these strategies , particularly the added benefit of community-based intervention , in low-income Latino population s. Design The Vivamos Activos Fair Oaks project is a r and omized clinical trial design ed to evaluate the clinical and cost-effectiveness of two obesity reduction lifestyle interventions : clinic-based intensive lifestyle counseling , either alone ( n = 80 ) or combined with community health worker support ( n = 80 ) , in comparison to usual primary care ( n = 40 ) . Clinic-based counseling consists of 15 group and four individual lifestyle counseling sessions provided by health educators targeting behavior change in physical activity and dietary practice s. Community health worker support includes seven home visits aim ed at practical implementation of weight loss strategies within the person 's home and neighborhood . The interventions use a framework based on Social Cognitive Theory , the Transtheoretical Model of behavior change , and techniques from previously tested lifestyle interventions . Application of the framework was culturally tailored based on past interventions in the same community and elsewhere , as well as a community needs and assets assessment . The interventions include a 12-month intensive phase followed by a 12-month maintenance phase . Participants are obese Spanish-speaking adults with at least one cardiovascular risk factor recruited from a community health center in a low-income neighborhood of San Mateo County , California . Follow-up assessment s occur at 6 , 12 , and 24 months for the primary outcome of percent change in body mass index at 24 months . Secondary outcomes include specific cardiovascular risk factors , particularly blood pressure and fasting glucose levels . Discussion and Conclusions If successful , this study will provide evidence for broad implementation of obesity interventions in minority population s and guidance about the selection of strategies involving clinic-based case management and community-based community health worker support . Clinical Trial Registration Clinical Trials.gov : Purpose . Evaluate counselors ' adherence to an intervention protocol , counselors ' competence , and the associations between three process indicators and body weight at follow-up in a 6-month individually based lifestyle intervention for construction workers . Design . Process evaluation with qualitative and quantitative data . Setting . Occupational health service . Subjects . A total of 408 male construction workers with an elevated risk of cardiovascular disease received the intervention , and 27 occupational health professionals delivered the intervention . Intervention . Seven counseling sessions , the first during which four prescribed items had to be discussed .  Motivational interviewing ( MI ) was used as a counseling technique . Measures and Analysis . The number of sessions and the items discussed were registered by the counselors . Adherence to MI  was determined by expert scoring of transcripts of r and om segments of 19 counseling sessions . Counselors ' competence was rated by participants and counselors separately . Associations between three process indicators and body weight at follow-up were determined by linear and logistic regression analyses . Results . Two-thirds of all participants attended five or more sessions , and 38.5 % attended all seven sessions . In 90.2 % of all cases , the counselor discussed all obligatory items in the first session . MI adherence was reached in one audiotaped fragment . Most ( 86.3 % ) of all participants agreed with the counselor being competent . Neither counselors ' competence nor number of sessions or items discussed was significantly associated with body weight loss . Conclusions . Performing five sessions and discussing four prescribed items was feasible for the counselors , whereas performing MI was not . Still , participants were positive about the counselors ' competence and willing to attend the intervention sessions . Investigators are encouraged to report the evaluation of their intervention process to improve future lifestyle interventions in research or in practice The prevalence of type 2 diabetes continues to increase in minority and underserved patients , who are also more likely to have poorer control of diabetes and related risk factors for complications . Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention  , translating such findings into accessible programs is a major public health challenge . The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study ( LIFT Diabetes ) . The overall goal is to test the impact of a community-based lifestyle weight loss ( LWL ) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients . Secondary outcomes include body weight , physical activity , medication use , cost , re source utilization , and safety . The primary hypothesis being tested is that the  LWL  will result in 10 % relative reduction in CVD risk compared to the DSM . We have r and omized 260 overweight or obese adults with diabetes one of two 12-month interventions : a LWL condition delivered by community health workers or a diabetes self-management ( DSM ) education condition . The baseline demographic characteristics indicate that our sample is predominantly female , obese , low income , and ethnic minority . Translating evidence -based , lifestyle strategies , and targeting minority and underserved patients , will yield , if successful , a model for addressing the burden of diabetes and may favorably impact health disparities BACKGROUND The Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) program in California ( Heart of the Family ) implements lifestyle interventions to improve health behaviors while reducing cardiovascular disease ( CVD ) risk factors among low income , uninsured , or underinsured Hispanic women aged 40 - 64 who participate in the Cancer Detection Programs : Every Woman Counts ( CDP : EWC ) . This study reports the first-year results of the California WISEWOMAN program . METHODS Heart of the Family is a within-site r and omized controlled study with an enhanced intervention group ( EIG ) and a usual care group ( UCG ) . The study was conducted between January 2006 and June 2007 at four community health centers in Los Angeles and San Diego counties .  Lifestyle counseling focusing on health behaviors was provided by bilingual , bicultural ( Spanish and English ) community health workers . The study examines two outcome measures : changes in health behaviors ; and changes in the CVD risk profile , as measured by the 10-year probability of having a coronary heart disease ( CHD ) event . RESULTS Women in the EIG group ( n = 433 ) , compared to those in the UCG group ( n = 436 ) , experienced more improvements in health behaviors , both eating habits and physical activity . The improvement in the 10-year CHD risk was greater for EIG than UCG women . Multiple regression results indicate that this improvement was significantly greater when the women 's CHD risk levels were in the upper quartile at baseline . CONCLUSIONS Compared with UCG women , women in the EIG were more likely to improve their health behaviors . The CVD risk profile , as measured by the 10-year CHD risk , improved in women with the highest baseline risk BACKGROUND Low-income Latinas ( Hispanics ) face risk for cardiovascular disease due to high rates of overweight/obesity , sedentary lifestyle , and other factors . Limited access to health care and language barriers may prevent delivery of health promotion messages . Targeted approaches , including the integration of community health workers , may be required to promote healthy lifestyle and prevent chronic disease in underserved ethnic minority groups . The term commonly used to refer to female community health workers in Latino communities is " promotora(s ) . " OBJECTIVES This study evaluates the outcomes and feasibility of a promotora-led lifestyle behavior intervention for overweight , immigrant Latinas . METHODS A community prevention model was employed in planning and implementing this study . A r and omized controlled trial design was used . A Community Advisory Board provided expertise in evaluating feasibility of study implementation in the community and other important guidance . The sample was comprised of 223 women aged 35 - 64 years , predominantly with low income and ≤8th grade education . The culturally tailored Lifestyle Behavior Intervention included group education ( 8 classes based upon Su Corazon , Su Vida ) , followed by 4 months of individual teaching and coaching ( home visits and telephone calls ) . The control group received a comparable length educational program and follow-up contacts . Evaluations were conducted at baseline and at 6 and 9 months using a dietary habits question naire , accelerometer readings of physical activity , and clinical measures ( body mass index , weight , waist circumference , blood pressure , lipids , blood glucose ) . Data were collected between January 2010 and August 2012 . RESULTS Women in the intervention group improved significantly in dietary habits , waist circumference , and physical activity in comparison to those in the control group . A treatment dosage effect was observed for weight and waist circumference . Knowledge about heart disease increased . High attendance at classes and participation in the individual teaching and counseling sessions and high retention rates support the feasibility and acceptability of the promotora-led lifestyle behavior intervention . CONCLUSIONS Our findings demonstrate that lifestyle behaviors and other risk factors of overweight Latina women may be improved through a promotora-led lifestyle behavior intervention . Feasibility of implementing this intervention in community setting s and engaging promotoras as facilitators is supported Background — In rural areas in China and India , the cardiovascular disease burden is high but economic and healthcare re sources are limited . This study ( the Simplified Cardiovascular Management Study [ SimCard ] ) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system . Methods and Results — The SimCard study was a yearlong cluster-r and omized , controlled trial conducted in 47 villages ( 27 in China and 20 in India ) . Recruited for the study were 2086 individuals with high cardiovascular risk ( aged ≥40 years with self-reported history of coronary heart disease , stroke , diabetes mellitus , and /or measured systolic blood pressure ≥160 mm Hg ) . Participants in the intervention villages were managed by community health workers through an And roid-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications . In comparison with the control group , the intervention group had a 25.5 % ( P<0.001 ) higher net increase in the primary outcome of the proportion of patient-reported antihypertensive medication use pre- and post-intervention . There were also significant differences in certain secondary outcomes : aspirin use ( net difference : 17.1 % ; P<0.001 ) and systolic blood pressure ( –2.7 mm Hg ; P=0.04 ) . However , no significant changes were observed in the lifestyle factors . The intervention was culturally tailored , and country-specific results revealed important differences between the regions . Conclusions — The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in re source -poor setting s in China and India . Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01503814 Background —Despite well-publicized guidelines on the appropriate management of cardiovascular disease and type 2 diabetes , the implementation of risk-reducing practice s remains poor . This report describes the results of a r and omized , controlled clinical trial evaluating the effectiveness of a comprehensive program of cardiovascular disease risk reduction delivered by nurse practitioner /community health worker ( NP/CHW ) teams versus enhanced usual care ( EUC ) to improve lipids , blood pressure , glycated hemoglobin ( HbA1c ) , and patient perceptions of the quality of their chronic illness care in patients in urban community health centers . Methods and Results —A total of 525 patients with documented cardiovascular disease , type 2 diabetes , hypercholesterolemia , or hypertension and levels of LDL cholesterol , blood pressure , or HbA1c that exceeded goals established by national guidelines were r and omly assigned to NP/CHW ( n=261 ) or EUC ( n=264 ) groups . The NP/CHW intervention included aggressive pharmacological management and tailored educational and behavioral counseling for lifestyle modification and problem solving to address barriers to adherence and control . Compared with EUC , patients in the NP/CHW group had significantly greater 12-month improvement in total cholesterol ( difference , 19.7 mg/dL ) , LDL cholesterol ( difference,15.9 mg/dL ) , triglycerides ( difference , 16.3 mg/dL ) , systolic blood pressure ( difference , 6.2 mm Hg ) , diastolic blood pressure ( difference , 3.1 mm Hg ) , HbA1c ( difference , 0.5 % ) , and perceptions of the quality of their chronic illness care ( difference , 1.2 points ) . Conclusions —An intervention delivered by an NP/CHW team using individualized treatment regimens based on treat-to-target algorithms can be an effective approach to improve risk factor status and perceptions of chronic illness care in high-risk patients . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00241904 We used outcome data from a r and omized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease ( CVD ) risk reduction programs : health risk assessment ( HRA ) , risk factor education ( RFE ) , behavioral counseling ( BC ) , and behavioral counseling plus incentives ( BCI ) . Composite CVD risk scores were derived from measures of serum total cholesterol , blood pressure , number of cigarettes smoked , body mass index , and aerobic capacity . The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions , and a sensitivity analysis examined some of the relevant cost variations . At the 6-month follow-up ( i.e. , the " action " or initiation stage of lifestyle change ) , the RFE , BC , and BCI interventions produced a significant reduction in cardiovascular risk . Incremental analyses demonstrated RFE to be more cost-effective , but not as clinical ly effective as BC ; BC was more cost-effective than RFE when assessment costs were included , and BCI was judged to be the least cost-effective . At the 12-month follow-up ( i.e. , the " maintenance " stage of lifestyle of change ) , BC was the only program found to produce a significant reduction in CVD risk .  Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction PURPOSE A comprehensive worksite health promotion program design ed to reduce risk factors for cardiovascular disease among 4000 city of Birmingham employees was used to develop and implement a tailored antihypertensive educational intervention .  The mean age of the underlying population was 36 years , 89 % were blue-collar or unskilled workers , 50 % were African Americans and 20 % were female . METHODS First , we identified barriers to hypertension control : low literacy , difficulty underst and ing the need for treatment of asymptomatic disease , and wide variability of health beliefs and priorities . We then tailored an educational program , which offered employees health education sessions on a variety of different topics , including heart disease , cancer , sleep disorders and back injury . All program material s focused on lifestyle changes and the need to seek medical care . This program was offered to all hypertensive workers ; 130 chose to enroll , and 81 completed the program . These 81 participants were matched by age , sex , race and baseline BP with nonparticipating hypertensive workers ( controls ) .  Changes in SBP and DBP from before to after the educational program were used to evaluate the program . RESULTS Overall , intervention participants had a decrease of 4.5 mm Hg in mean SBP ( different from zero , [ p = 0.03 ] ) . African American participants showed a significant decrease ( 7.4 mm Hg , [ p = 0.004 ] ) , as did unskilled intervention participants ( SBP changes = 7.7 mm Hg , [ p = 0.004 ] ) . Although not statistically significant , controls showed decreases in BP in the same direction . CONCLUSION An educational intervention tailored to the specific health perceptions and working conditions of a low literacy population is feasible , and may have a significant effect on hypertension control Objective : To determine whether an evidence -based , behavioral lifestyle intervention program delivered at a worksite setting is effective in improving type 2 diabetes and cardiovascular disease risk factors .  Methods : A r and omized 6-month delayed control design was utilized , with two thirds of the participants assigned to begin intervention immediately , and one third beginning 6 months later . The year-long program ( weekly for 3 months transitioning to monthly ) focused on weight loss and increasing physical activity . Results : The immediate intervention group had greater mean weight loss ( −10.4 lb , 5.1 % , vs −2.3 lb , 1 % ; P = 0.0001 ) than the delayed control group at 6 months and relatively greater improvements in activity , HbA1c , and other risk factors . The delayed group experienced similar improvements after completing the intervention program . Conclusions : A worksite behavioral lifestyle intervention is feasible and effective in significantly improving risk factors for type 2 diabetes and cardiovascular disease OBJECTIVE Severe obesity ( body mass index [ BMI ] ≥40 kg/m(2 ) ) is a serious public health concern . Although bariatric surgery is an efficacious treatment approach , it is limited in reach ; thus , nonsurgical treatment alternatives are needed . We examined the 4-year effects of an intensive lifestyle intervention  on body weight and cardiovascular disease risk factors among severely obese , compared with overweight ( 25 ≤ BMI < 30 ) , class I ( 30 ≤ BMI < 35 ) , and class II obese ( 35 ≤ BMI < 40 ) participants . METHODS There were 5145 individuals with type 2 diabetes ( 45 - 76 years , BMI ≥25 kg/m(2 ) ) r and omized to an intensive lifestyle intervention or diabetes support and education .  The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings , a ≥10 % weight loss goal , calorie restriction , and increased physical activity . Diabetes support and education received a less intense educational intervention . Four-year changes in body weight and cardiovascular disease risk factors were assessed . RESULTS Across BMI categories , 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( Ps < .05 ) . At year 4 , severely obese lifestyle participants lost 4.9%±8.5 % , which was similar to class I ( 4.8%±7.2 % ) and class II obese participants ( 4.4%±7.6 % ) , and significantly greater than overweight participants ( 3.4%±7.0 % ; P < .05 ) . Four-year changes in low-density-lipoprotein cholesterol , triglycerides , diastolic blood pressure , HbA(1c ) , and blood glucose were similar across BMI categories in lifestyle participants ; however , the severely obese had less favorable improvements in high-density-lipoprotein cholesterol ( 3.1±0.4 mg/dL ) and systolic blood pressure ( -1.4±0.7 mm Hg ) compared with the less obese ( Ps < .05 ) . CONCLUSION Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals An economic evaluation was conducted alongside a r and omised controlled trial of two lifestyle interventions and a routine care ( control ) group to assess the cost-effectiveness of a general practice -based lifestyle change program for patients with risk factors for cardiovascular disease . Routine care was the base case comparator because it represents ' current therapy ' for cardiovascular disease ( CVD ) . A ' no care ' control group was not considered a clinical ly acceptable alternative to lifestyle interventions . The interventions consisted of an education guide and video for GPs to assess individual patient risk factors and plan a program for risk factor behavior change . Each patient received a risk factor assessment , education material s , a series of videos to watch on lifestyle behaviors and some patients received a self-help booklet .  Eighty-two general practitioners were r and omised from 75 general practice s in Sydney 's Western Metropolitan Region to ( i ) routine care ( n = 25 ) , ( ii ) video group ( n = 29 ) or ( iii ) video + self help group ( n = 28 ) . GPs enrolled patients into the trial who met selection criteria for being at risk of CVD . There were 255 patients in the routine care ( control ) group , 270 in the video ( intervention ) group and 232 in the video + self help ( intervention ) group enrolled in the trial . Outcome measures included patient risk factor status : blood pressure , body mass index , cholesterol and smoking status at entry to trial and after 1 year . Changes in risk factors were used to estimate quality adjusted life years ( QALYs ) gained . One hundred and thirty patients in the routine care group , 199 in the video group and 155 in the video + self help group remained in the trial at the 12-month review and had complete data . The cost per QALY for males ranged from $ AUD152,000 to 204,000 . Further analysis suggests that a program targeted at ' high risk ' males would cost approximately $ 30,000 per QALY . The lifestyle interventions had no significant effect on cardiovascular risk factors when compared to routine patient care . There remains insufficient evidence that lifestyle programs conducted in general practice s are effective . Re sources for general practice -based lifestyle programs may be better spent on high risk patients who are contemplating changes in risk factor behaviours OBJECTIVE To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease ( CVD ) . METHODS In a r and omized controlled trial performed in the Netherl and s between 2007 and 2009 , usual care was compared to 6 months of individual counseling using motivational interviewing techniques , delivered face to face and by telephone . Participants aim ed at improving energy balance-related behavior or smoking cessation . Linear regression analyses were performed to determine the effects . RESULTS Body weight had significantly decreased at 6 ( β=-1.9 , 95 % CI -2.6 ; -1.2 ) and 12 months ( β=-1.8 , 95%CI -2.8 ; -1.1 ) . The intervention effects were also significant for diastolic blood pressure at 6 months ( β=-1.7 , 95 % CI -3.3 ; -0.1 ) . Among participants who had aim ed at energy balance , the intervention had a significant favorable effect on body weight at 6 ( β=-2.1 , 95 % CI -2.9 ; -1.3 ) and 12 months ( β=-2.2 , 95 % CI -3.1 ; -1.3 ) and at HDL cholesterol ( β=0.05 , 95 % CI 0.01 ; 0.10 ) and HbA1c ( β=-0.06 , 95%CI -0.12 ; -0.001 ) at 12 months , although there was no intervention effect on these variables over time . CONCLUSION Individual-based counseling result ed in significant beneficial long-term effects on body weight . This is an important finding for occupational health , considering the rising prevalence of obesity and CVD The prevalence of type 2 diabetes is continuously increasing . This chronic metabolic disorder is difficult to treat and imposes a considerable economic burden on the healthcare system . In view of the fact that type 2 diabetes is primarily caused by behavioral factors , effective preventive strategies are urgently needed . We examined the effects of a holistic lifestyle intervention on clinical and laboratory parameters as well as on the long-term diabetes risk in patients at risk to develop diabetes . We conducted a r and omized controlled trial in a primary care setting in Hannover , Germany , with 83 patients diagnosed as (pre)diabetic or at risk for diabetes . CHIP Germany is a 40-hour coaching lifestyle intervention program for the primary and secondary prevention of type 2 diabetes and cardiovascular diseases . The intervention included a comprehensive nutrition and health educational program based on the American CHIP approach . The primary outcome parameter was the body mass index ( BMI ) . Secondary outcome parameters included body weight , blood pressure , fasting glucose , HbA1c , blood lipids , and the FINDRISK score , which assesses long-term diabetes risk . At the final measurement after 12 months , in the intervention group the BMI was reduced by 1.4 versus 0.2 kg/m2 in controls ( p = .119 ) . The mean sustained weight loss after 12 months was −4.1 kg in the intervention group versus −0.8 kg in controls . Furthermore , we found a trend toward a stronger reduction in blood pressure , fasting glucose , and HbA1c as well as an improved FINDRISK score in the intervention group , compared to controls . Although failing to reach statistical significance at the final assessment , this comprehensive lifestyle intervention showed a noticeable reduction in several cardiometabolic risk factors which may facilitate the prevention of diabetes BACKGROUND Previous reports indicate risk factors and lifestyle behaviors may deteriorate early after completion of a cardiac rehabilitation program ( CRP ) . We hypothesized that a modest risk factor and lifestyle management intervention after a CRP would significantly reduce overall cardiovascular risk using the Framingham risk score compared with usual care after 4 years . METHODS Patients with ischemic heart disease ( n = 302 ) were r and omized after a CRP to either usual care or intervention ( exercise sessions , telephone follow-ups , counseling sessions , and reports to the participants ' family physicians ) . The Framingham risk score , risk factors , and lifestyle behaviors were compared after 4 years . RESULTS Data were available for 130 intervention and 119 usual care participants . The intervention result ed in 15.5 hours of direct participant contact . Framingham score , total cholesterol , low-density lipoprotein cholesterol , and systolic blood pressure were significantly improved in the intervention group after adjusting for baseline factors . There were no significant differences with respect to lifestyle factors between the groups . CONCLUSIONS A modest risk factor and lifestyle management intervention result ed in a significant reduction to global risk compared with usual care and should be considered after CRP IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921 BACKGROUND The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese , sedentary , postmenopausal women was examined . A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction . METHODS Forty-four women were r and omly assigned to receive either a lifestyle change or a lifestyle change with self-control skills intervention . Pretreatment and posttreatment weight loss , body composition , physical activity , cardiorespiratory fitness , diet , blood pressure ( BP ) , blood lipids , and psychosocial functioning were assessed . Also , at 1-year posttreatment , weight loss , body composition , self-reported physical activity , and psychosocial functioning were assessed . RESULTS The women significantly increased their physical activity ( + 39.6 % ) and cardiorespiratory fitness ( + 13.5 % ) and reduced their body weight ( -6.5 % ) , fat mass ( -7.4 % ) , body fat ( -2.4 % ) , BP ( SBP -6.2 % , DBP -9.2 % ) , total cholesterol ( -7.4 % ) , triglycerides ( -16.5 % ) , and low-density lipoprotein ( LDL ) cholesterol ( 9.1 % ) and improved their diet ( p < 0.05 ) . At the 1-year follow-up , women had regained approximately 63 % of their posttreatment weight loss ( p < 0.05 ) , but had maintained their previous increases in physical activity . Additionally , there were no significant changes in fat free mass , body fat , anxiety , or depression between the end of treatment and 1-year posttreatment . The addition of self-control skills training did not significantly improve cardiovascular risk reduction . CONCLUSIONS Lifestyle change interventions may be an effective means for reducing cardiovascular risk in obese , sedentary , postmenopausal women . However , greater attention should be devoted to the maintenance of these positive lifestyle changes The aim of this study was to determine whether accumulated short bouts of exercise can achieve the same cardiovascular benefits as a single long bout of exercise in sedentary male Japanese workers and to compare the programs ’ relative effects on oxidative stress . Twenty-three sedentary male workers were r and omly assigned into 2 different exercise programs : a Long-bout group , which performed a single period of continuous exercise ( Long-bout group : 30 min × 1 ) 3 d per week , and a Short-bouts group , which performed 3 short bouts of exercise ( Short-bouts group : 10 min × 3 ) 3 d per week . Cardiovascular risk factors , including the plasma thiobarbituric acid-reactive substances ( TBARS ) level , were examined at baseline and after both 10 and 20 wk . In the Long-bout group , waist circumference and maximum oxygen uptake ( VO2max ) significantly improved after 20 wk . The Short-bouts group demonstrated significant increases in VO2max after 10 weeks and in HDL-C after 20 wk . Plasma TBARS significantly decreased after 20 weeks in the Long-bout group and tended to decrease ( but not significantly ) in the Short-bouts group . These results indicate that accumulated short bouts of exercise are an effective option , especially for busy workers , for incorporating exercise into one ’s lifestyle Background Overweight ( Body Mass Index [ BMI ] ≥ 25 kg/m2 ) and obesity ( BMI ≥ 30 kg/m2 ) are associated with increased cardiovascular risk , posing a considerable burden to public health . The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees . Methods Participants were 276 healthy overweight employees ( 69.2 % male ; mean age 44.0 years [ SD 9.2 ] ; mean BMI 29.7 kg/m2 [ SD 3.1 ] ) . They were r and omized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone ( phone group ) or e-mail ( Internet group ) , or to a control group receiving usual care .  Body weight , height , waist circumference , sum of skinfolds , blood pressure , total cholesterol level and predicted aerobic fitness were measured at baseline , at 6 and at 24 months . Regression analyses included the 141 participants with complete data . Results At 6 months a significant favorable effect on total cholesterol level ( -0.2 mmol/l , 95%CI -0.5 to -0.0 ) was observed in the phone group and a trend for improved aerobic fitness ( 1.9 ml/kg/min , 95%CI -0.2 to 3.9 ) in the Internet group . At two years , favorable trends for body weight ( -2.1 kg , 95%CI -4.4 to 0.2 ) and aerobic fitness ( 2.3 ml/kg/min , 95%CI -0.2 to 4.8 ) were observed in the Internet group . Conclusions The intervention effects were independent of the used communication mode . However short-term results were in favor of the phone group and long-term results in favor of the internet group . Thus , we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers . Trial registration IS RCT Background In re source -poor areas of China and India , the cardiovascular disease burden is high , but availability of and access to quality healthcare is limited . Establishing a management scheme that utilizes the local infrastructure and builds healthcare capacity is essential for cardiovascular disease prevention and management . The study aims to develop , implement , and evaluate the feasibility and effectiveness of a simplified , evidence -based cardiovascular management program delivered by community healthcare workers in re source -constrained areas in Tibet , China and Haryana , India . Methods / design This yearlong cluster-r and omized controlled trial will be conducted in 20 villages in Tibet and 20 villages in Haryana . R and omization of villages to usual care or intervention will be stratified by country . High cardiovascular disease risk individuals ( aged 40 years or older , history of heart disease , stroke , diabetes , or measured systolic blood pressure of 160 mmHg or higher ) will be screened at baseline . Community health workers in the intervention villages will be trained to manage and follow up high-risk patients on a monthly basis following a simplified ‘ 2 + 2 ’ intervention model involving two lifestyle recommendations and the appropriate prescription of two medications . A customized electronic decision support system based on the intervention strategy will be developed to assist the community health workers with patient management . Baseline and follow-up surveys will be conducted in a st and ardized fashion in all villages . The primary outcome will be the net difference between-group in the proportion of high-risk patients taking antihypertensive medication pre- and post-intervention . Secondary outcomes will include the proportion of patients taking aspirin and changes in blood pressure . Process and economic evaluations will also be conducted . Discussion To our knowledge , this will be the first study to evaluate the effect of a simplified management program delivered by community health workers with the help of electronic decision support system on improving the health of high cardiovascular disease risk patients . If effective , this intervention strategy can serve as a model that can be implemented , where applicable , in rural China , India , and other re source -constrained areas .Trial registration The trial was registered in the clinical trials.gov data base on 30 December , 2011 and the registration number is NCT01503814
There was no statistically significant publication bias , except for systolic blood pressure .
This study examined the effect of lifestyle interventions on  cardiovascular disease risk factors among workers .