Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease (original) (raw)
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The international journal of behavioral nutrition and physical activity, 2007
Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors, psychosocial factors, and the social environment. This report examines the long-term effects of a multiple-risk-factor intervention. Postmenopausal women (N = 279) with type 2 diabetes participated in the Mediterranean Lifestyle Program (MLP), a randomized, comprehensive lifestyle intervention study. The intervention targeted healthful eating, physical activity, stress management, smoking cessation, and social support. Outcomes included lifestyle behaviors (i.e., dietary intake, physical activity, stress management, smoking cessation), psychosocial variables (e.g., social support, problem solving, self-efficacy, depression, quality of life), and cost analyses at baseline, and 6, 12, and 24 months. MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception (there were too few smokers to analyze to...
Health Education Research, 2002
This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle management intervention for 279 postmenopausal women with type 2 diabetes who are at elevated risk for coronary heart disease (CHD). The intervention, called the Mediterranean Lifestyle Trial, is focused on dietary factors, physical activity, social support and stress management. The Mediterranean Lifestyle Trial relies on a synthesis of Social Cognitive Theory and Social Ecologic Theory, as well as goalsystems theory, to explicitly inform the lifestyle intervention and to address maintenance. Thus, the trial should help illuminate the theoretical mechanisms responsible for lifestyle change. Primary outcome variables are dietary, stress management and physical activity behavior change, quality of life, and CHD-related biological risk factors. Hypothesized mediating variables include self-efficacy, coping, and social and environmental support. Following the initial 6-month intervention, participants in the intervention condition are randomized to one of two groups designed to enhance maintenance of effects: either a peer-led support group or a personalized multilevel community resources maintenance condition. Unlike the peer group, the personalized approach focuses on multiple levels of community resources to promote healthful lifestyle change. Because this research focuses on issues of generalization and translation to practice, the RE-AIM evaluation framework is being used to evaluate Reach, Effectiveness, Adoption, Implementation and Maintenance. This framework will help to translate research into practice by directing researchers' attention to important but seldominvestigated strategies for enhancing longerterm maintenance. Specifically, the study tests how long-term maintenance may be improved through the use of existing community resources, an intervention based on multiple environmental factors and multiple lifestyle behaviors, and lay leaders versus personalized professional support.
Diabetes Care, 2003
Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. Multivariate ANCOVAs revealed significantly greater improvements in the MLP...
Multiple-Behavior–Change Interventions for Women With Type 2 Diabetes
2011
As part of comprehensive clinical care for people with diabetes, there is a need for multifaceted interventions that address the primary lifestyle factors that contribute to women's type 2 diabetes and place them at elevated risk for heart disease. The Mediterranean Lifestyle Program (MLP) demonstrated that a multiple-behavior-change intervention focusing on diet, exercise, stress management, and social support had beneficial effects on biological, behavioral, and psychosocial outcomes within the first 2 years of the program. A cultural adaptation of MLP, ¡Viva Bien!, partially replicated those effects when it was extended to Latina women recruited from a large health maintenance organization and a community health center. Both projects indicated that refinements are warranted to increase the sustainability of intervention effects and the feasibility of dissemination.
Seven-Year Follow-up of a Multiple-Health-Behavior Diabetes Intervention
American Journal of Health Behavior, 2010
Objective-To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program. Methods-The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors. Results-Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study (at 6, 12, and 24 months) were partially maintained during the non-treatment phase of the study, through 5 years post-intervention contact for dietary behavior and stress management, and 1 year post-treatment for PA. Conclusions-This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment. Future research should explore innovative methods for sustaining change over the long term. Keywords multiple health behaviors; diabetes; long-term; women; randomized controlled trial Improvements in lifestyle behaviors such as healthful eating and regular exercise are difficult to attain during behavioral interventions, and are even more difficult to maintain after formal intervention activities have ended.1-3 Yet, for individuals with type 2 diabetes, attaining and sustaining a healthful lifestyle over long periods of time are critical for improving risk factors4 and avoiding adverse consequences of illness progression, such as heart disease, blindness, and kidney damage. 5 It is especially important for older adults who have heart disease or CHD risk factors to engage in long-term physical activity (PA) and dietary changes. 6, 7
Physiologic and related behavioral outcomes from the Women’s Lifestyle Heart Trial
Annals of Behavioral Medicine, 2000
The Women's Lifestyle Heart Trial was a small (N = 28) randomized controlled trial to evaluate the effects of a comprehensive lifestyle self-management program (very low-fat vegetarian diet, stress-management training, exercise, group support, and smoking cessation) on reduction of cardiovascular risk factors in postmenopausal women with coronary heart disease (CHD). Women assigned to the treatment condition (Prime Time) participated in a week-long retreat followed by twice-weekly 4-hour meetings. Endpoints were program adherence; changes in lipid profiles, body mass, blood pressure, hypolipidemic and antihypertensive medications; and quality of life. Risk factor and psychosocial evaluations were conducted at baseline and at 4, 12, and 24 months. Repeated measures analyses of covariance revealed that the dietary, stress management, and physical activity changes made by intervention women were dramatic and lasting. There were significantly greater improvements in the Prime Time condition compared to the usual care control group on body mass, angina symptoms, and quality of life, and a tendency for a greater reduction in blood pressure-lowering medications. Similar patterns were seen in lipids, blood pressure, and lipid-lowering medications, but did not reach significance. These results demonstrate that postmenopausal CHD women can make lasting lifestyle changes, and that these changes may reduce the need for cardiac medications and improve CHD risk factors and quality of life.
Objective: In behavioral research directed at the treatment of type 2 diabetes, the challenge is to understand how interventions might facilitate long-term lifestyle changes. The Mediterranean Lifestyle Program (MLP) is an intervention for postmenopausal women diagnosed with type 2 diabetes that has shown promising effects on outcomes that include increased physical activity and reduced fat consumption. The present study extended previous findings by evaluating diet-specific and activity-specific social-ecological resources as possible mediators of intervention effects over a 2-year period. Main Outcome Measures: Percent calories from saturated fat and caloric expenditure per week in all physical activities were assessed with self-report questionnaires. Results: The MLP was successful in increasing participants' use of diet-specific and activity-specific family/friend and neighborhood resources. There was some evidence that changes in those resources mediated intervention effects on saturated fat consumption and physical activity outcomes. Conclusion: The experimental manipulation of mediators and the demonstrated mediational effects provided some support for the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes
Journal of Health Psychology, 2006
A study was conducted to determine if an intervention could change social support and social-ecological resources of post-menopausal women diagnosed with type 2 diabetes, and if those changes mediated the intervention's effects on health behaviors and outcomes. Women (N = 279) were randomly assigned to receive a comprehensive 6-month Mediterranean Lifestyle Program (MLP) or usual care from their physicians (UC). MLP was successful in changing social embeddedness and social-ecological resources, but not a measure of perceived support. Changes in social-ecological resources mediated intervention effects on fat consumption, exercise and glycemic control. The experimental manipulation of mediators and the demonstrated mediation effects support the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes.
Reducing Cardiovascular Risk Factors in Postmenopausal Women through a Lifestyle Change Intervention
Journal of Womens Health, 2004
Background: The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese, sedentary, postmenopausal women was examined. A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction. Methods: Forty-four women were randomly assigned to receive either a lifestyle change or a lifestyle change with self-control skills intervention. Pretreatment and posttreatment weight loss, body composition, physical activity, cardiorespiratory fitness, diet, blood pressure (BP), blood lipids, and psychosocial functioning were assessed. Also, at 1-year posttreatment, weight loss, body composition, self-reported physical activity, and psychosocial functioning were assessed. Results: The women significantly increased their physical activity (؉39.6%) and cardiorespiratory fitness (؉13.5%) and reduced their body weight (؊6.5%), fat mass (؊7.4%), body fat (؊2.4%), BP (SBP ؊6.2%, DBP ؊9.2%), total cholesterol (؊7.4%), triglycerides (؊16.5%), and low-density lipoprotein (LDL) cholesterol (9.1%) and improved their diet (p Ͻ 0.05). At the 1year follow-up, women had regained approximately 63% of their posttreatment weight loss (p Ͻ 0.05), but had maintained their previous increases in physical activity. Additionally, there were no significant changes in fat free mass, body fat, anxiety, or depression between the end of treatment and 1-year posttreatment. The addition of self-control skills training did not significantly improve cardiovascular risk reduction. Conclusions: Lifestyle change interventions may be an effective means for reducing cardiovascular risk in obese, sedentary, postmenopausal women. However, greater attention should be devoted to the maintenance of these positive lifestyle changes.
Nutrients, 2020
Background: The reasons behind low adherence to the Mediterranean diet (Med-diet) are still not entirely known. We aimed to evaluate the effect of biological (i.e., sex-related) and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence. Methods: Baseline Med-diet adherence was measured using a self-administered questionnaire among adults with ischemic heart disease (IHD) from the EVA (Endocrine Vascular Disease Approach) study. A multivariable analysis was performed to estimate the effect of sex- and gender-related factors (i.e., identity, roles, relations, and institutionalized gender) on low adherence. Results: Among 366 participants (66 ± 11 years, 31% women), 81 (22%) adults with low adherence demonstrated higher rates of diabetes, no smoking habit, lower male BSRI (Bem Sex Role Inventory) (median (IQR) 4.8 (4.1 to 5.5) vs. 5.1 (4.5 to 5.6) and p = 0.048), and higher Perceived Stress Scale 10 items (PSS-10) (median (IQR) 19 (11 to 23) vs. 15 (11 to 20) and p...