Observation of the long-term effects of lifestyle intervention during balneotherapy in metabolic syndrome

Social Networks in French Balneotherapy: A Focus on Spa Doctors

Spa therapy is a medical treatment based on the use of natural mineral water. In France, spa therapy is delivered in spa care facilities (SCF) involving the intervention of several actors (stakeholders). Spa doctors are key stakeholders as they prescribe the treatments, follow spa patients and assess spa therapy with scientific studies. This study aimed to analyze the spa doctors' relationships in order to highlight their role in transferring information to other stakeholders, particularly to spa managers. For that purpose, we used the social network analysis (SNA) method by means of snowball data collection. We sent a questionnaire to all the spa therapy categories of actors. In total, 80 persons answered and declared 397 relationships. Our results, based on the categorization of respondents and of their relationships and on quantitative indicators (density, response rate), show that spa doctors demonstrate a very acceptable density of relations with spa managers and elected local authorities. However, they appear to be poorly involved in relations concerning the strategy and management of SCF, although they are essential actors in ensuring the medical relevance and sustainability of spa therapy. This research is of interest to patients' care as it recommends deeper involvement of spa doctors in the management of SCF in order to optimize access to informational resources, specifically regarding the evolution of treatments in accordance with scientific progress. Our data are of international scope because the organizational model of balneotherapy, based on the cooperation between spa doctors and SCF, is universal.

Possible Impact of a 12-Month Web- and Smartphone-Based Program to Improve Long-term Physical Activity in Patients Attending Spa Therapy: Randomized Controlled Trial

Background

Lack of physical activity (PA) and sedentary behaviors are leading risk factors for noncommunicable diseases (NCDs). Web- and smartphone-based interventions are effective in increasing PA in older adults and in patients with NCD. In many countries, spa therapy, commonly prescribed to patients with NCD, represents an ideal context to initiating lifestyle changes.

Objective

This study aimed to evaluate, in patients attending spa therapy, the effectiveness of an intervention combining a face-to-face coaching and, when returning home, a web- and smartphone-based PA program on the achievement of PA guidelines (PAG) 12 months after the end of spa therapy.

Methods

This was a 12-month, prospective, parallel-group randomized controlled trial. Patients were enrolled during spa therapy and randomized 1:1 to intervention or control group who received PA usual advice. From the end of spa therapy, PA, weight, waist circumference, and quality of life of the participants were assessed by phone every 2 months. Primary outcome was meeting PAG (PA ≥600 metabolic equivalent of task) at 12 months. Secondary outcomes were meeting current PAG at 6 months; sedentary time, weight, waist circumference, PA, and quality of life at 6 and 12 months. Objective use data of the web- and smartphone-based PA program were collected. Analytic methods included intention to treat and constrained longitudinal data analyses.

Results

The study sample included 228 participants (n=176, 77.2% females) with a mean age of 62.4 (SD 6.7) years and a mean BMI of 28.2 (SD 4.2) kg/m². Approximately 53.9% (123/228) of the participants were retired. No group differences were found for any baseline variable. At 12 months, the proportion of patients achieving PAG was significantly higher in intervention group than in the control group (81% vs 67% respectively, odds ratio 2.34, 95% CI 1.02-5.38; P=.045). No difference between intervention and control group was found neither in achieving PAG at 6 months nor for sedentary time, weight, and waist circumference at 6 and 12 months. Regarding quality of life, the physical component subscale score was significantly higher at 12 months in the intervention group than in the control group (mean difference: 4.1, 95% CI 1.9-6.3; P<.001). The mean duration use of the program was 7.1 (SD 4.5) months. Attrition rate during the first 2 months was 20.4% (23/113) whereas 39.8% (45/113) of the participants used the program for at least 10 months.

Conclusions

PA increased in both the intervention group and the control group. However, at 12 months, more participants met PAG in the intervention group compared with the controls. This indicates that the web- and smartphone-based program could have maintained PA in the intervention group. In addition, a spa therapy seems to be an ideal time and framework to implement PA education.

Trial Registration

ClinicalTrials.gov NCT02694796; https://clinicaltrials.gov/ct2/show/NCT02694796

[Balneotherapy and modification of risk factors in cardiovascular disease prevention programs]

Cardiovascular disease (CVD) is the leading cause of death in the Russian Federation, as in many other countries. Taking into consideration the observed increase in the spread of risk factors, modern demographic trends (an increase in the proportion of elderly people), and a high economic burden of circulatory system diseases, the search for new forms and effective strategies of prevention is becoming relevant. OBJECTIVE: To provide the data available in the scientific literature on the effectiveness of the measures to modify risk factors and lifestyle, which are implemented during balneotherapy under both resort and in non-resort conditions, and to define areas for further investigators in this field. Investigations evaluating the effectiveness of these measures were sought in the Embase, PubMed, PEDro, Web of Science, eLIBRARY databases in January 2012 to August 2018. The analysis included seven trials that showed an improvement of estimated endpoints (blood pressure, body mass index, lipid profile, physical activity, and morbidity and mortality rates). The generalization of results of the analyzed trials was limited by the high heterogeneity of their protocols and methodological quality, which does not allow for a final conclusion on the effectiveness of preventive measures implemented during balneotherapy. Future research should provide more evidence of the benefits of this approach. The analysis will be able to take into account the existing experience and to develop a strategy to enhance the effectiveness of cardiovascular disease prevention programs based on high-quality randomized clinical trials.

A review and critique of published real-world weight management program studies

BACKGROUND

Beyond the essential but somewhat artificial conditions that typify formal clinical studies, real-world evidence (RWE) of weight loss program effectiveness is paramount for an accurate assessment of such programs and refinement of best practices.

OBJECTIVES

To evaluate the current state of RWE studies and publications on weight loss, identify the range of weight loss components being used in RWE programs, and to provide a general overview of the consistency or lack of consistency with regard to measuring and reporting outcomes.

METHODS

A structured search of PubMed was performed to identify relevant English-language publications from 2006 to December 2017 that reported real-world studies of weight loss among adults. Duplicates, non-relevant publications, articles on weight loss surgery, pediatric studies, randomized controlled trials, studies with self-reported weight loss, no objective weight measures, or that failed to include weight loss results were excluded.

RESULTS

This review included 62 RWE publications. Forty-nine studies included dietary intervention, 37 included exercise, 29 included motivational counseling, and 5 contained some patients who had pharmacologic treatment as part of their weight loss regimen. The numbers of participants per study ranged from 10 to more than 3 million. The interventions reported in the publications included diet, exercise, counseling to promote diet and/or exercise, motivational counseling, and pharmacotherapy, and various combinations of these.

CONCLUSIONS

Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies.

Physical Education in a Thermal Spa Resort to Maintain an Active Lifestyle at Home: A One-Year Self-Controlled Follow-Up Pilot Study

The self-controlled follow-up pilot study was set up to examine the maintenance of engagement in physical activity by a group of older adults in a thermal spa resort, as a consequence of the inclusion of additional physical education sessions within their usual care offers. A cohort of 42 participants (70.4 ± 4.5 years) underwent three weeks of thermal treatment with additional physical education (PE) sessions. Measurements were established during the intervention in 2 periods (baseline and final thermal treatment evaluation) and 4 periods of measurements in the follow-up (+15 days, +2 months, +6 months, and +1 year). Physical measures (anthropometrics, flexibility, and 6-minute walk test) and intrapersonal and psychosocial factors as well as health-related quality of life (HQOL) and physical activity (PA) were self-reported by participants. Only HQOL and PA were assessed during the follow-up. One year after a 3-week PE session combined with the usual thermal care, 64% of the participants exhibited a higher volume of PA than at baseline. The components of the HQOL changed during the follow-up. This strategy to maintain PA engagement appears to be feasible in a population of thermal care older adults. This work demonstrates the feasibility of a study conducted to maintain physical activity engagement after a thermal treatment.

Health resort medicine in non-musculoskeletal disorders: is there evidence of its effectiveness?

Health resort medicine (HRM; in German: Kurortmedizin) is a field of medicine with long-lasting tradition in several European countries. A number of systematic reviews have shown the effectiveness of HRM in musculoskeletal conditions. Reviews focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare. This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions, to summarize evidence for its effectiveness and to assess the quality of published studies. MEDLINE, Web of Knowledge and Embase were searched for articles published between January 2002 and December 2013. We used a broad search strategy in order to find studies investigating the effects of HRM in non-musculoskeletal disorders. Two authors independently extracted data and assessed quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP-QAT). Forty-one studies (19 of them with control group) from eight countries examining the efficacy of various forms of spa treatment for 12 disease groups were included. The studies are markedly heterogeneous regarding study design, population and treatment. HRM treatment is associated with clinical improvement in diseases of the skin, respiratory, circulatory, digestive and nervous system among others. However, small samples, the lack of control groups and an insufficient follow-up often limit the generated evidence. The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of HRM. The challenge for the future will be to carry out thoroughly designed studies in larger patient populations to corroborate the impact of HRM treatment on non-musculoskeletal disorders.