Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: a randomized controlled trial.
BACKGROUND
Overweight (Body Mass Index [BMI] ≥ 25 kg/m²) and obesity (BMI ≥ 30 kg/m²) are associated with increased cardiovascular risk, posing a considerable burden to public health. The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees.


METHODS
Participants were 276 healthy overweight employees (69.2% male; mean age 44.0 years [SD 9.2]; mean BMI 29.7 kg/m² [SD 3.1]). They were randomized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone (phone group) or e-mail (Internet group), or to a control group receiving usual care. Body weight, height, waist circumference, sum of skinfolds, blood pressure, total cholesterol level and predicted aerobic fitness were measured at baseline, at 6 and at 24 months. Regression analyses included the 141 participants with complete data.


RESULTS
At 6 months a significant favorable effect on total cholesterol level (-0.2 mmol/l, 95%CI -0.5 to -0.0) was observed in the phone group and a trend for improved aerobic fitness (1.9 ml/kg/min, 95%CI -0.2 to 3.9) in the Internet group. At two years, favorable trends for body weight (-2.1 kg, 95%CI -4.4 to 0.2) and aerobic fitness (2.3 ml/kg/min, 95%CI -0.2 to 4.8) were observed in the Internet group.


CONCLUSIONS
The intervention effects were independent of the used communication mode. However short-term results were in favor of the phone group and long-term results in favor of the internet group. Thus, we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers.


BACKGROUND
ISRCTN04265725.
EMGO+ Institute and Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. w.vanmechelen@vumc.nl
Johanna C
JC
Dekkers
Marieke F
MF
van Wier
Geertje Am
GA
Ariëns
Ingrid Jm
IJ
Hendriksen
Nico P
NP
Pronk
Tjabe
T
Smid
Willem
W
van Mechelen
D000328:Adult; D015992:Body Mass Index; D001837:Body Weights and Measures / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D002784:Cholesterol / Q000032:analysis; D057186:Comparative Effectiveness Research; D035061:Control Groups; D003376:Counseling; D015444:Exercise / Q000502:physiology; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D012044:Regression Analysis; D012307:Risk Factors
D002784:Cholesterol
Blood Press Monit. 2003 Jun;8(3):127-33
12900590
Obes Rev. 2009 Nov;10(6):627-38
19754634
JAMA. 2003 Apr 9;289(14):1833-6
12684363
Int J Obes Relat Metab Disord. 1995 Jun;19(6):382-7
7550521
Int J Obes (Lond). 2005 Oct;29(10):1153-67
15997250
Best Pract Res Clin Gastroenterol. 2004 Dec;18(6):1125-46
15561643
Am J Prev Med. 2009 Feb;36(2):142-9
19062240
Clin J Sport Med. 2003 Mar;13(2):106-17
12629429
Exerc Sport Sci Rev. 2002 Jul;30(3):122-8
12150571
BMC Public Health. 2009 Jan 09;9:6
19134171
Clin Dermatol. 2004 Jul-Aug;22(4):276-80
15475226
Health Values. 1984 Nov-Dec;8(6):3-9
10268963
Circulation. 2004 Nov 2;110(18):2952-67
15509809
J Am Diet Assoc. 2001 Oct;101(10):1155-62; quiz 1163-4
11678486
JAMA. 2001 Mar 7;285(9):1172-7
11231746
Int J Obes Relat Metab Disord. 2003 Dec;27(12):1584-92
14517547
BMC Public Health. 2006 May 24;6:140
16723021
Int J Sport Nutr Exerc Metab. 2003 Sep;13(3):358-68
14669935
Am J Med. 2007 Mar;120(3 Suppl 1):S12-8
17320517
Am J Prev Med. 2007 Oct;33(4):336-345
17888860
Prev Med. 2003 Jan;36(1):45-54
12473424
Am J Manag Care. 2002 Oct;8(10):847-57
12395953
J Gerontol A Biol Sci Med Sci. 2003 Feb;58(2):181-9
12586858
Prev Chronic Dis. 2004 Oct;1(4):A06
15670437
J Med Internet Res. 2008 Dec 12;10(4):e52
19073541
Ann Behav Med. 2003 Dec;26(3):212-20
14644697
Am J Health Promot. 2005 Sep-Oct;20(1):39-44
16171160
Metabolism. 2003 Jan;52(1):107-15
12524670
Br J Sports Med. 2004 Apr;38(2):197-205
15039259
Am J Prev Med. 2007 May;32(5):419-34
17478269
Int J Public Health. 2007;52(6):348-59
18368998
Eur J Epidemiol. 2008;23(8):499-509
18509729
Cardiovasc Diabetol. 2009 Jul 18;8:36
19615091