The Complete Health Improvement Program (CHIP) and reduction of chronic disease risk factors in Canada

Effects of a vegetarian diet combined with aerobic exercise on glycemic control, insulin resistance, and body composition: a systematic review and meta-analysis

BACKGROUND

Vegetarian diets and aerobic exercise are increasingly accepted as a common way to improve lifestyle. Several studies have shown that vegetarian diets combined with aerobic exercise interventions have a significant effect on preventing and reducing the risk of metabolic diseases.

METHODS

A search of the PubMed, EBSCO, Embase, CENTRAL, and Web of Science databases was conducted for comparative studies of pre- and post-vegetarian diet adoption combined with aerobic exercise interventions on glycemic control and body composition. Qualitative reviews and meta-analyses of fixed and random effects were conducted to pool available data. The results were validated by sensitivity analysis.

RESULTS

A total of 27 studies were selected for meta-analysis. Combining the studies included in the meta-analysis showed a mean difference for homeostasis model assessment of insulin resistance of - 0.75 (- 1.08 to - 0.42), fasting plasma glucose of - 0.27(- 0.30 to - 0.23), waist circumference of - 1.10 (- 5.06 to 2.86) and body mass index of - 0.70 (- 1.38 to - 0.01).

CONCLUSION

In summary, our findings suggest that participants who adopted a vegetarian diet combined with aerobic exercise intervention had significantly lower fasting plasma glucose and insulin levels and improved body composition compared to preintervention participants.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

The Effect of Healthy Lifestyle Changes on Work Ability and Mental Health Symptoms: A Randomized Controlled Trial

OBJECTIVE

The effects of lifestyle interventions on the prevention of a decline in work ability and mental health are not well known. The aim of this randomized controlled trial was to examine the effects of healthy lifestyle changes on work ability, sleep, and mental health.

METHODS

Workers aged 18-65 years, who were free from cardiovascular diseases, diabetes, and malignant diseases, and did not use medication for obesity or lipids were included (N = 319). Based on their cholesterol balance, participants were classified into medium-risk and high-risk groups and were randomized into four arms: group lifestyle coaching (N = 107), individual lifestyle coaching (N = 53), the control group for group coaching (N = 106), and the control group for individual coaching (N = 53). The intervention groups received eight sessions of mostly remote coaching for 8 weeks about healthy diet, physical activity, other lifestyle habits, and sources/management of stress and sleep problems, and the control groups received no intervention. In individual coaching, the coach focused more on individual problem solving and the possibilities for motivation and change. The intention-to-treat principle was applied, and missing data on the outcomes were imputed using multiple imputation.

RESULTS

After the completion of the intervention, the risk of depressive symptoms was lower by 53% (95% CI 1-77%) in participants who received individual lifestyle coaching compared with the control group. The intervention had no beneficial effects on anxiety, work ability, sleep duration, or daily stress. In subgroup analyses, group lifestyle coaching had beneficial effects on depressive symptoms and work ability in participants with less tight schedules or less stretching work, whereas individual lifestyle coaching lowered the risk of depressive symptoms in those with fewer overlapping jobs, less tight schedules, or less stretching work.

CONCLUSION

Short but intensive remote lifestyle coaching can reduce depressive symptoms and improve work ability, and time-related resources at work may improve mental health in the context of individual lifestyle intervention. However, further randomized controlled trials are needed to confirm the findings.

Effects of a vegetarian diet combined with exercise on lipid profiles and blood pressure: A systematic review and meta-analysis

We aimed to evaluate the combined effects of a vegetarian diet (VD) and exercise on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters. A literature search was conducted in electronic databases from build to February 27, 2022. Data were synthesized using random effects model and were expressed as standardized mean difference (SMD)/weighted mean difference (WMD) and 95% confidence interval (CI). Overall, 27 trials with 9,251 participants were included. Pooled results indicated that the combination of a VD and exercise significantly reduced TC (SMD: -0.524; 95% CI: -0.602, -0.446; p < 0.001), LDL-C (SMD: -0.379; 95% CI: -0.471, -0.287; p < 0.001), HDL-C (SMD: -0.213; 95% CI: -0.299, -0.126; p < 0.001), TG (SMD: -0.090; 95% CI: -0.160, -0.020; p = 0.012), SBP (WMD: -7.664 mm Hg; 95% CI: -9.219, -6.109 mm Hg; p < 0.001), and DBP (WMD: -4.347 mm Hg; 95% CI: -5.099, -3.596 mm Hg; p < 0.001). These parameters were reduced more following a low-fat VD, or a mixed high-frequency exercise, especially under strict supervision. Surprisingly, the decreased HDL-C due to VD was observed to recover with the prolongation of exercise.

Jumpstarting Health With a 15-Day Whole-Food Plant-Based Program

The 15-day Jumpstart was developed as an evidence-based, affordable, standardized, replicable, and scalable program, designed to demonstrate quickly to patients that changing what they eat can improve their health. The program was designed using the principles of the self-determination theory of motivation and personality. Patients were instructed to eat an Esselstyn-compliant, whole-food plant-based diet consisting of vegetables, fruits, whole grains, and legumes. Of the 389 participants in the program from September 2018 to February 2020, average weight loss was 5.8 pounds (7.3 for those whose body mass index was >30), average systolic blood pressure drop was 6.8 points (16.8 points for those with systolic blood pressure >140), average drop in cholesterol was 26 points (44 points for those with a cholesterol >200), average drop in low-density lipoprotein was 19 points (33 points for those with a low-density lipoprotein >100), and average drop in fasting blood sugar was 5.1 points (28.4 points for those starting in the diabetic range); P value was <.005 for fasting blood sugar and <.001 for all other comparisons. A 15-day program that helps patients adopt an Esselstyn-style whole-food plant-based diet, through education, individualized medical feedback, social support, and facilitated small group work, rapidly improves health.

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

PURPOSE

Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States.

DESIGN

Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012.

SETTING

Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012.

SUBJECTS

Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years).

MEASURES

Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose.

ANALYSIS

Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes.

RESULTS

The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen's d .1-.2).

CONCLUSIONS

Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

Effectiveness of the Complete Health Improvement Program in a Geriatric Population

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level ( P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables ( P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.

Understanding patient experiences in a motivational interviewing intervention to improve whole-person lifestyle among individuals with hypertension or type 2 diabetes: a qualitative focus group study

Purpose

This qualitative focus group study aimed to determine how participants responded to a motivational interviewing intervention and to further explore how it impacted whole-person lifestyle of participants with hypertension or type 2 diabetes.

Methods

Twenty participants attended one of five focus groups. A trained researcher led the one-hour focus groups using a semi-structured question guide. Responses were coded using thematic analysis and were then aggregated into six themes.

Results

The following six themes emerged most consistently: (1) the importance of a coach who can connect meaningfully with participants; (2) appreciation of the whole-person approach; (3) the power of “choice” in making health behaviour changes; (4) the effectiveness of goal setting and accountability; (5) the desire for increased contact and follow-up; (6) overall positive experience with mixed clinical results.

Conclusion

Focus group themes highlighted that this intervention may empower individuals to feel confident in their choices and attain their goals during their health and wellness journey.

Addressing the COVID-19 Mental Health Crisis: A Perspective on Using Interdisciplinary Universal Interventions

Mental health is reaching a crisis point due to the ramifications of COVID-19. In an attempt to curb the spread of the virus and circumvent health systems from being overwhelmed, governments have imposed regulations such as lockdown restrictions and home confinement. These restrictions, while effective for infection control, have contributed to poorer lifestyle behaviors. Currently, Positive Psychology and Lifestyle Medicine are two distinct but complimentary disciplines that offer an array of evidence-based approaches for promoting mental health and well-being across a universal population. However, these strategies for improving mental health are typically used in isolation. This perspective calls for a new paradigm shift to create and rollout well-designed interdisciplinary universal multicomponent mental health interventions that integrates the benefits of both disciplines, and uses innovative digital mental health solutions to achieve scalability and accessibility within the limitations and beyond the COVID-19 lockdown and restrictions.

A Randomized Controlled Trial of a Motivational Interviewing Intervention to Improve Whole-Person Lifestyle

The purpose of this randomized controlled trial was to examine the effects of a motivational interviewing intervention to improve whole-person lifestyle and reduce cardiovascular disease risk profile. A sample of 111 adults with type 2 diabetes and/or hypertension was recruited from a primary care physician practice. The intervention was facilitated by a program specialist trained in motivational interviewing. Outcomes included body mass index, cholesterol, hemoglobin A1c, blood pressure, waist circumference, wellness scores, and substance use. Differences in the changes in body mass index and waist circumference existed between the intervention and control groups after 6 months. In the intervention group, the proportion of high wellness scores increased after the program. A whole-person lifestyle intervention with motivational interviewing for patients with metabolic syndrome can improve one’s health in terms of components in the cardiovascular disease risk profile, as well as overall wellness. Efforts to improve the health of these patients may incorporate motivational interviewing to guide goal setting and address mental and spiritual health in addition to physical health.

The Global Influence of the Seventh-Day Adventist Church on Diet

The emphasis on health ministry within the Seventh-day Adventist (SDA) movement led to the development of sanitariums in mid-nineteenth century America. These facilities, the most notable being in Battle Creek, Michigan, initiated the development of vegetarian foods, such as breakfast cereals and analogue meats. The SDA Church still operates a handful of food production facilities around the world. The first Battle Creek Sanitarium dietitian was co-founder of the American Dietetics Association which ultimately advocated a vegetarian diet. The SDA Church established hundreds of hospitals, colleges, and secondary schools and tens of thousands of churches around the world, all promoting a vegetarian diet. As part of the ‘health message,’ diet continues to be an important aspect of the church’s evangelistic efforts. In addition to promoting a vegetarian diet and abstinence from alcohol, the SDA church has also invested resources in demonstrating the health benefits of these practices through research. Much of that research has been conducted at Loma Linda University in southern California, where there have been three prospective cohort studies conducted over 50 years. The present study, Adventist Health Study-2, enrolled 96,194 Adventists throughout North America in 2003–2004 with funding from the National Institutes of Health. Adventist Health Studies have demonstrated that a vegetarian diet is associated with longer life and better health.

'Live more': Study protocol for a community-based lifestyle education program addressing non-communicable diseases in low-literacy areas of the South Pacific

Background

Non-communicable diseases (NCDs) have reached epidemic proportions in Pacific Island countries. Unhealthy lifestyle is one of the major risk factors and lifestyle interventions have been shown to be efficacious for primary, secondary and early tertiary prevention. However, there is a paucity of evidence regarding effective community-based lifestyle interventions in the Pacific Islands. The Complete Health Improvement Program for high-income countries was contextualised for rural communities with relatively low-literacy rates in low-income countries using the REFLECT delivery approach. This study will assess the effect of this ‘Live More’ program to reduce participant’s NCD risk factors and improve lifestyle behaviours associated with health and wellbeing, in low-literacy communities in countries of the South Pacific.

Methods/Design

This study is a 6-month cluster-randomised controlled trial of 288 adults (equal proportions of men and women aged 18 years and over) with waist circumference of ≥92 cm for men and ≥80 cm for women in four rural villages in each of Fiji, Vanuatu and Solomon Islands. Participants will permanently reside in their village and be able to prepare their own meals. Two villages will be randomised to the ‘Live More’ intervention (n = 24) or to control receiving only country specific Ministry of Health literature (n = 24). Intervention participants will meet three times a week in the first month, then once a week for the next two months and once a month for the last three months. Themes covered include: NCDs and their causes; and the benefits of positive lifestyle choices, positive psychology, stress management, forgiveness and self-worth, and how these influence long-term health habits. Outcome assessments at baseline, 30-days, 3-months and 6-months include body mass index, waist circumference, blood lipids, blood pressure and blood glucose. Secondary outcomes include changes in medication and substance use, diet, physical activity, emotional health and supportive relationships, collected by lifestyle questionnaire at the same time points.

Discussion

This is the first lifestyle intervention using the Reflect approach to target NCDs. The findings from the study will be used to guide broader delivery of a lifestyle intervention to improve health and wellbeing across the South Pacific.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12614001206617.

The Complete Health Improvement Program (CHIP): History, Evaluation, and Outcomes

The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.