Original ArticlesA randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost
Introduction
Changes in lifestyle associated with marriage or cohabitation could have substantial influences on the couple's health and that of their children. Couples who are beginning to cohabit for the first time tend to increase energy intake and decrease physical activity, leading to weight gain [1]. This has implications for an increase in risk factors associated with lifestyle diseases such as cardiovascular disease and diabetes [2].
Cardiovascular disease remains a leading cause of death in many developed countries, and is increasing in many developing countries [3]. In Australia, in 2000, cardiovascular disease accounted for about 39% (49,700) of all deaths [4]. Cardiovascular disease also imposes high economic and social costs on national resources. In 1993–1994, the health and economic costs of cardiovascular disease exceeded the costs associated with any other disease in Australia. It accounted for $3.7 billion or 12% of total health costs [5]. The U.S. Medicare program spends about US$4 billion each year on procedures related to coronary artery bypass graft surgery [6].
Lifestyle, particularly diet and physical activity, influence risk for cardiovascular disease. Clinicians have long recognized the relationship between physical inactivity and morbidity and mortality with increased rates of chronic diseases including diabetes [7], [8] and cardiovascular diseases [9], [10]. Levels of physical activity are inadequate for health benefits among about half of Australian adults [11], leading to substantial costs in terms of morbidity and mortality [12]. Inadequate intake of fruit and vegetables [13] and greater than recommended intake of fat [14] also are a concern. There is an increasing prevalence of obesity among Australians, consistent with world-wide trends. Over the period from 1989 to 2000, rates of overweight or obesity increased from 48 to 67% among Australian men and from 34 to 52% among Australian women [15], [16], with concomitant increases in rates of diabetes. These observations make it important to promote healthy lifestyle choices in relation to diet and physical activity. Early in marriage is a time for re-evaluating lifestyle and accepting that behaviors will change [17], while mutual support between partners may encourage positive health-related behaviors for diet and physical activity [18]. This implies that couples who have been cohabiting for a short period are more likely to be receptive to health promotion messages and also have the opportunity to use the social support of their partner [19].
A previously piloted study that aimed to help couples beginning a shared lifestyle to maintain or adopt positive behaviors relating to nutrition and physical activity achieved a decrease in intake of fat, increased consumption of fruit and vegetables, increased physical activity, and a decrease in blood cholesterol [20]. Because there are some costs associated with each intervention, a randomized controlled trial was undertaken to assess the costs and the effectiveness of the intervention program. We also sought to compare two methods of delivering the program, one using mainly mail-outs (low level) and the second combining mail-outs with interactive group sessions (high level). Empirical evidence on the cost effectiveness of the intervention is relevant to making decisions about the wider implementation of the program.
Section snippets
Study design
Couples were recruited by advertisement in the press, and through publicity on radio and television programs. Inclusion was restricted to Perth couples cohabiting for the first time, not living together for more than 2 years, intending to reside in Perth for the length of the study and not planning a pregnancy during the time of the intervention. There were no inclusion criteria with regard to age. Exclusion criteria included diseases such as heart disease, diabetes, and severe asthma. All
Results
One hundred and thirty-seven couples entered the study; 111 couples completed testing at the end of the program, and 81 attended follow-up after 1 year. Nine couples withdrew before the end of the program in the high-level group, 10 in the low-level group, and 7 in the control group. Reasons for withdrawal were separation (6 couples), pregnancy (5 couples), long-term travel (1 couple), illness (3 couples), and other commitments or lack of interest (11 couples). Thirty couples did not attend the
Discussion
The global obesity epidemic and diet-related diseases [31] continues to be a threat to health in both developed and developing countries. Although health policies have aimed to raise public awareness to prevent obesity, its prevalence implies that solutions have not yet been found. Our study suggests that people who are prepared to volunteer for an intervention program can improve and sustain a healthy lifestyle particularly in the context of mutual support from partners. Newlyweds who are
Limitation
Higher socioeconomic status, based on occupational classification, was over-represented in our study, and was a potential source of bias. However, the proportion of individuals at risk in relation to overweight and sedentary behavior did not differ significantly from surveys of the wider Australian population. These comparisons suggest that, despite their higher socioeconomic status, the participants in our study do not have healthier lifestyles, and in this respect a “healthy volunteer”
Conclusion
We have shown that a program that provides skills for individuals to undertake healthy lifestyle changes with some support from interactive workshops is more cost-effective in improving and sustaining healthy lifestyle in newlyweds at least for 12 months than a mailed program or just creating awareness. This implies that the provision of a behavioral program to encourage a healthy lifestyle represents a desirable use of society's scarce resources.
Acknowledgements
This study was supported by a grant from the West Australian Health Promotion Foundation (Healthway).
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2010, Social Science and MedicineCitation Excerpt :Both processes mutually influencing activity (and each other) would be consistent with reciprocal determinism proposed in social cognitive and ecological theories (Bandura, 1989). That intervention-mediated effects were not found via the social support might appear curious in light of recent findings predicting activity (Barrera et al., 2008; Cerin et al., 2006; Dzator et al., 2004) and the general success of social support interventions (Hogan, Linden, & Najarian, 2002). The PACE intervention did not significantly increase the growth trajectory for social support relative to the control group.
Proposal for a multidisciplinary approach to the patient with morbid obesity: The St. Franciscus Hospital Morbid Obesity Program
2008, European Journal of Internal MedicineCitation Excerpt :Group sessions are held twice weekly for 3 months. Quality of life seems to increase in most patients at this stage (personal observations), and group sessions appear to help as well [29] because patients can share their positive (and negative) results. Moreover, they can stimulate each other to achieve the predefined goals.
Small-scale randomized controlled trials need more powerful methods of mediational analysis than the Baron-Kenny method
2006, Journal of Clinical EpidemiologyCitation Excerpt :To find a statistically significant mediational effect (if any exist), intervention studies must (a) produce sizable changes on the hypothesized mediators and outcomes, (b) be based on a sufficiently large sample size, and (c) make use of statistical methods capable of detecting a mediational effect of a specific magnitude for a given sample size. Exercise-related social support from family and friends is a factor associated with being more likely to be physically active [6,7]. To date, however, only a small number of studies have examined the mediational effect of social support on changes in physical activity behavior, using a randomized controlled trial design.
Introduction
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