LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change—study protocol
Authors: van Dijk Marlinde L. , te Loo Leonie M. , Vrijsen Joyce , van den Akker-Scheek Inge , Westerveld Sanne , Annema Marjan , van Beek André , van den Berg Jip , Boerboom Alexander L. , Bouma Adrie , de Bruijne Martine , Crasborn Jeroen , van Dongen Johanna M. , Driessen Anouk , Eijkelenkamp Karin , Goelema Nies , Holla Jasmijn , de Jong Johan , de Joode Anoek , Kievit Arthur , Klooster Josine van’t , Kruizenga Hinke , van der Leeden Marike , Linders Lilian , Marks-Vieveen Jenny , Mulder Douwe Johannes , Muller Femmy , van Nassau Femke , Nauta Joske , Oostvogels Suzanne , Oude Sogtoen Jessica , van der Ploeg Hidde P. , Rijnbeek Patrick , Schouten Linda , Schuling Rhoda , Serné Erik H. , Smuling Simone , Soeters Maarten R. , Verhagen Evert A. L. M. , Zwerver Johannes , Dekker Rienk , van Mechelen Willem , Jelsma Judith G. M. 
Published: February 2023

Abstract
Background
A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO.

Methods
Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up.

Discussion
This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle.

Trial registration
ISRCTN ISRCTN13046877. Registered 21 April 2022.