Lifestyle Intervention Program for Former Elite Athletes
Condition: Obesity
Study type: Interventional

Summary: 
      Given the lack of support for lifestyle management in post-career and considering the high
      rates of physical inactivity and overweight in former elite athletes, the aim of this
      research project is to analyze the efficacy and effectiveness of a lifestyle intervention in
      former athletes.
    

Detailed description: 
      The physical preparation of the elite athlete results from a complex and very demanding daily
      training. In this process high energy expenditure (EE) occur compensated by a proportional
      energy intake, thus contributing to neutral energy balance and weight maintenance. However, a
      positive energy balance (and consequently an increase in weight) is expected after the end of
      the sports career if the energy intake is maintained for lower EE. While clinicians and
      researchers are concerned with the average individual whose physical activity (PA) level is
      far below the recommended exercise dose an often overlooked group are the former highly
      competitive athletes, who have been exposed to higher amounts of vigorous PA during times of
      training and competition.

      It is common that upon retirement energy intake does not match the dramatic decrease in
      overall energy expenditure leading to a positive energy balance, and consequently weight
      gain. The change to a lower physical activity level does not induce an equivalent reduction
      in energy intake. Varying physical activity level from 1.8 to 1.4 over 7 days was not
      associated with a change of energy intake and there was no tendency for energy intake to drop
      as the sedentariness progressed.

      In fact, elite athletes that became inactive are susceptible to various chronic diseases such
      as obesity, diabetes and cardiovascular disease. Not only obesity and its comorbidities are a
      major health problem as an increase in body weight and a higher risk for developing
      hypertension, type II diabetes and cardiovascular disease has been observed in athletes that
      retired from the sports career . However, the literature reports that this risk is only
      present in those retired athletes exposed to a sedentary lifestyle. In fact, the current
      levels of PA are more protective against the development of cardiovascular disease in former
      athletes than their past sports history. Although it is expected that the retired elite
      athlete will be engaged in regular PA throughout life, studies reveal that this assumption
      does not apply to all former athletes. This concern was addressed in the United States,
      namely within the National Football League where an obesity prevention program for the
      retired athletes was implemented. In Portugal ~50% of the former elite athletes are
      overweight/obese and ~30% are inactive, based on self-reports measures. Indeed no support is
      provided for maintaining a healthy lifestyle after the end of the sports career. If a healthy
      lifestyle promotion among post-career elite athletes would contribute to avoid the observed
      rates of overweight/obesity it is unknown. Considering this actual context, the aim of this
      research project is to analyze the effect of a lifestyle intervention in former athletes. To
      accomplish the goals the investigators will perform a 1 year randomized controlled trial with
      a 4-month lifestyle intervention and an 8-month follow-up in 100 volunteered former
      overweight (Body Mass index>25 kg.m-2), inactive elite athletes that represented Portugal in
      international competitions during 1972-2012, ended their career for at least 2 years prior
      the study and are able to attend the educational sessions. Participants will be randomly
      assigned into 2 groups: i) dietary counseling (control group), or ii) behavioral lifestyle
      intervention, focusing on diet and PA. All participants will be screened at baseline, 4
      months, and 12 months. A broad set of parameters will be assayed in each participant, namely:
      body composition, cardiorespiratory fitness, muscle strength, biochemical parameters, resting
      metabolic rate, nutritional intake, daily PA, and quality of life. These variables will allow
      the comprehension of the effects of a lifestyle modification on fatness, fitness and
      health-related parameters contributing also to further elucidate compensatory mechanisms
      associated with potential changes in weight and composition. To accomplish the main goal the
      research team will use established methods in the literature as well as novel procedures,
      which will enable the research team to overcome some of the limitations of previous studies.
      At the end of the study the investigators expect to have collected consistent data about
      whether a lifestyle intervention is or is not able to effectively decrease fatness while
      improving fitness and health-related markers. The research team believe that these data will
      help both non-governmental and governmental stakeholders in sports and education to make
      evidence based decisions, specifically the introduction and implementation of lifestyle
      programs in the transition to the post-career of elite athletes. The growing number of elite
      athletes supported by the government along with the recent EU report guidelines on dual
      careers in high-performance sports
      (ec.europa.eu/sport/news/2013/20130123-eu-guidelines-dualcareers_en.htm) requires further
      studies that test the role of preventive and educational programs for athletes in the areas
      of healthy living. The past experience of the research team in body composition, physical
      fitness, and objectively measured PA using cross-sectional and prospective study designs in
      athletic and non-athletic populations, as well as in the conduction of PA intervention
      clinical trials, together with the involvement of the Portuguese Olympic Committee as
      partners, supports the chances of successfully achieving the proposed objectives.
    

Intervention name(s): Lifestyle Intervention Group
Intervention type(s): Behavioral
Intervention description(s): The intervention group will start the lifestyle intervention with a 60-minute nutrition appointment given by a certified dietitian. This meeting is intended to provide a well-balanced personalized diet plan, calculated to create a moderate reduction from ~300 to 500kcal/day according to each participant's energy requirements and preferences. Two additional follow-up appointments are also planned to adjust the individual energy requirements throughout the intervention. Subjects will attend 12 educational sessions for a healthy lifestyle in groups of 10-15 participants, for approximately 4 months. Sessions will last 60-90 minutes and will include educational content and practical application classroom exercises in the areas of physical activity and exercise, diet and eating behavior, and behavior modification. The inclusion of self-regulation skills, such as pedometer use, recording food regularly and monitoring weight, is also part of the curriculum. Weight will be monitored weekly.
Other intervention name(s): Lifestyle Intervention Programme
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Former athletes; Body composition; Adaptive thermogenesis; Physical activity; Energy expenditure; Sedentary behavior; Fat mass; Abdominal fat mass; Nutrition; Behavior modification