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Grogg KA, Giacobbi PR, Blair EK, Haggerty TS, Lilly CL, Winters CS, Kelley GA. Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review. Am J Health Promot 2022; 36:714-737. [PMID: 35224998 DOI: 10.1177/08901171211051840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States. DATA SOURCES A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019. INCLUSION AND EXCLUSION CRITERIA Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature. DATA EXTRACTION Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders. DATA SYNTHESIS Data were synthesized using qualitative and descriptive methods. RESULTS Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions. CONCLUSION The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.
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Affiliation(s)
- Kristin A Grogg
- West Virginia Clinical and Translational Science Institute, 5631West Virginia University School of Medicine and Honors College, Morgantown, WV, USA
| | - Peter R Giacobbi
- Department of Sport Sciences, Joint Appointment in Department of Social & Behavioral Sciences, 5631West Virginia University College of Physical Activity & Sport Sciences, School of Public Health, Morgantown, WV, USA
| | - Emma K Blair
- Department of Exercise Physiology, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Treah S Haggerty
- Department of Family Medicine, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Carena S Winters
- Department of Kinesiology, 4121Jacksonville University, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville, FL, USA
| | - George A Kelley
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
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Canuto R, Garcez A, de Souza RV, Kac G, Olinto MTA. Nutritional intervention strategies for the management of overweight and obesity in primary health care: A systematic review with meta-analysis. Obes Rev 2021; 22:e13143. [PMID: 33006421 DOI: 10.1111/obr.13143] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 12/29/2022]
Abstract
A systematic review with meta-analysis (MA) was conducted to synthesize the effectiveness of nutrition intervention strategies for managing overweight and obesity in the adult population attending primary health care. Relevant articles were searched in the PubMed, Embase, Web of Science, Cochrane and LILACS databases from inception to January 2020. Seventy studies were identified: 45 randomized controlled trials (RCTs) and 25 uncontrolled before-after studies (UBAs). The MA of nutritional intervention revealed a reduced average estimate of the effect on weight in RCTs (weighted mean differences [WMD] = -1.80 kg, 95% confidence interval [CI], -2.40 to -1.19), BMI (WMD = -0.80 kg/m2 , 95% CI, -1.11 to -0.49), and WC (WMD = -2.28 cm, 95% CI, -3.06 to -1.49); and for UBAs showed reductions in weight (WMD = -4.17 kg; 95% CI, -5.18 to -1.70), BMI (WMD = -1.26 kg/m2 ; 95% CI, -1.81 to -0.72) and (WMD = -2.90 cm; 95%CI, -4.21 to -1.59). There was no association between treatment effect and follow-up for both designs. Nutritional interventions alone yielded a higher but nonsignificant average reduction on weight when compared with combined components intervention. Interventions delivered through individual or group sessions showed a similar positive effect on weight decrease. The dietary prescription approach yielded a greater effect on weight loss than did the behavioural approaches but only in UBA studies.
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Affiliation(s)
- Raquel Canuto
- Postgraduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Graduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Anderson Garcez
- Postgraduate Graduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil
| | | | - Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Rio Grande do Sul, Brazil
| | - Maria Teresa Anselmo Olinto
- Postgraduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil
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Navas-Carretero S, Holst C, Saris WH, van Baak MA, Jebb SA, Kafatos A, Papadaki A, Pfeiffer AFH, Handjieva-Darlenska T, Hlavaty P, Stender S, Larsen TM, Astrup A, Martinez JA. The Impact of Gender and Protein Intake on the Success of Weight Maintenance and Associated Cardiovascular Risk Benefits, Independent of the Mode of Food Provision: The DiOGenes Randomized Trial. J Am Coll Nutr 2015; 35:20-30. [PMID: 25826291 DOI: 10.1080/07315724.2014.948642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Maintenance of weight loss and associated cardiovascular benefits after following energy-restricted diets is still a challenging field, and thorough investigation is needed. The present research aimed to determine the role of protein and gender in relation to two different intervention models related to food supply, in a weight maintenance trial. SUBJECTS AND METHODS The DiOGenes trial was a long-term, multicenter, randomized, dietary intervention study, conducted in eight European countries (Clinical Trials.gov, NCT00390637), focusing on assessing the effectiveness of weight maintenance over 6 months. This secondary analysis intended to evaluate the different benefits for weight maintenance and cardiometabolic markers of two dietary advice delivery models: "shop + instruction intervention" vs "instruction-alone intervention," which were further categorized for gender and macronutrient intake. RESULTS The weight maintenance intervention based on different macronutrient intake showed, independently of the advice delivery model, in both sexes that higher protein consumption was more effective for weight stability, showing better results in obese women (low protein: 1.65 kg in males and 0.73 Kg in females vs high protein: 1.45 kg in males and -0.93 Kg in females) . Measurements concerning cardiovascular risk markers from subjects on both structured models produced similar trends in the subsequent follow-up period, with a lower rebound in women for most of the markers analyzed. CONCLUSION The reported dietary benefits for weight sustainability should be ascribed to the macronutrient distribution (higher protein diets) rather than to the structured mode of delivery. Higher weight regain in males was noted, as well as a metabolic divergence attributable to the sex, with a better biochemical outcome in women.
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Affiliation(s)
- Santiago Navas-Carretero
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
| | - Claus Holst
- e University of Copenhagen , Copenhagen , DENMARK.,f Institute of Preventive Medicine, Copenhagen University Hospital , Copenhagen , DENMARK
| | - Wim H Saris
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Marleen A van Baak
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Susan A Jebb
- h The Medical Research Council, Human Nutrition Research, Elsie Widdowson Laboratory , Cambridge , UNITED KINGDOM
| | - Anthony Kafatos
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE
| | - Angeliki Papadaki
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE.,j Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol , Bristol , UNITED KINGDOM
| | - Andreas F H Pfeiffer
- k Department of Clinical Nutrition , German Institute of Human Nutrition Potsdam-Rehbrücke , Nuthetal , GERMANY.,l Department of Endocrinology, Diabetes, and Nutrition , Charité Universitätsmedizin Berlin , Berlin , GERMANY
| | - Teodora Handjieva-Darlenska
- m Department of Human Nutrition, Dietetics and Metabolic Diseases , National Transport Hospital , Sofia , BULGARIA
| | - Petr Hlavaty
- n Obesity Management Center, Institute of Endocrinology , Prague , CZECH REPUBLIC
| | - Steen Stender
- d Department of Clinical Biochemistry, Gentofte Hospital , University of Copenhagen , Copenhagen , DENMARK
| | - Thomas M Larsen
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - Arne Astrup
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - J Alfredo Martinez
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
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Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev 2014:CD008066. [PMID: 24500864 PMCID: PMC10088065 DOI: 10.1002/14651858.cd008066.pub3] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably. OBJECTIVES To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults. SEARCH METHODS Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013. SELECTION CRITERIA Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review. MAIN RESULTS A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments. AUTHORS' CONCLUSIONS The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes.
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Affiliation(s)
- Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, St Dunstans Road, London, Hammersmith, UK, W6 8RP
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