Titulo

1.LA
PROMOCI
N DE LA
SALUD
COMO
ESTRATEGIA
PARA EL
FOMENTO
DE ESTILOS
DE VIDA
SALUDABLE
S

2.Eficacia
de un
programa
para el
tratamiento
del
sobrepeso y
la obesidad
no mrbida
en atencin

Abstract
Objetivo: profundizar en el tema de la promocin de
salud como estrategia para el fomento de estilos de vida
saludables. Metodologa: revisin sistemtica de
publicaciones cientficas derivadas de investigaciones y
revisiones detalladas acerca de la promocin de la salud y
los estilos de vida saludables, para lo cual se tomaron
como fuentes bibliogrficas: las publicaciones de la
Biblioteca Virtual de Salud, bases de datos como
Proquest, LILACS, Dialnet, Ovid, Hinary, Medline e ndices
bibliogrficos como Scielo, que fueron publicados entre
los aos 1992-2009. Para determinar su pertinencia, los
artculos y documentos fueron revisados a partir de su
resumen y los libros a partir de su tabla de contenido.
Resultados: se obtuvo una descripcin detallada de la
promocin de la salud como estrategia, sus componentes
y la forma de aplicacin. Respecto a los estilos de vida
saludables, adems de las definiciones se tuvieron en
cuenta los factores tanto internos como externos a las
personas que intervienen para su fomento. Adicional a lo
anterior, se encontr una autora que hall en la
promocin de la salud la base para proponer el "Modelo
de Promocin de la Salud", que dado su aporte a la
profesin de Enfermera, ha sido aplicado en la prctica
profesional y utilizado para la realizacin de trabajos de
investigacin en salud. Conclusin: la promocin de la
salud se constituye como una estrategia encaminada a
desarrollar procesos y actividades individuales o grupales
con el fin de modificar conductas de riesgo y adoptar
estilos de vida saludables. De igual forma la promocin
de la salud apunta a que las personas y colectivos tengan
una mejor calidad de vida, teniendo en cuenta que los
seres humanos son entidades biolgicas y tambin
entidades sociales que requieren ser intervenidas por los
profesionales de la salud como un todo para as conseguir
personas y comunidades saludables.
Introduccin y Objetivos: la modificacin de conductas no
saludables es fundamental para tratar la obesidad. El
objetivo de este estudio fue evaluar los efectos de un
programa basado en dieta, ejercicio y apoyo psicolgico
en la modificacin conductual de pacientes con sobrepeso
y obesidad tratados en Atencin Primaria.
Mtodos: 60 pacientes con sobrepeso grado II y obesidad
grado I-II fueron incluidos en este ensayo piloto. Edad
entre 18-50 aos. Los pacientes recibieron un programa
que combinaba educacin nutricional, actividad fsica y

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primaria y
su
influencia
en la
modificaci
n de estilos
de vida

3.Eficacia
de una
intervenci
n educativa
grupal
sobre
cambios en
los estilos
de vida en
hipertensos
en atencin
primaria: un
ensayo
clnico
aleatorio

apoyo psicolgico. Formato grupal, periodicidad

quincenal. Los principales resultados medidos al inicio y 6
meses fueron parmetros antropomtricos (ndice de
masa corporal, porcentaje de masa grasa, permetro
cintura) y de estilos de vida usando el Cuestionario para
la valoracin de hbitos de vida relacionados con el
sobrepeso y la obesidad. Consta de 5 dimensiones:
contenido calrico de la dieta (CC), alimentacin
saludable (AS), ejercicio fsico (EF), comer por bienestar
psicolgico (BP) y consumo de alcohol (CA). La mayor
puntuacin indica mejores hbitos para CC, AS y EF y
peores para BP y CA.
Resultados: al final de la intervencin mejoraron las
escalas CC (2,60 0,5 vs 3,49 0,7, p<0,001), EF
(2,19 0,9 vs 3,17 1,0, p<0,001) y AS (3,04 0,4 vs
3,43 0,4, p<0,05) del cuestionario; CA (3,98 0,7 vs.
4,25 0,7, p<0,05) y BP (2,82 1,0 vs. 3,34 0,7,
p<0,001) empeoraron.
Conclusin: el programa basado en moderada restriccin
de la dieta, aumento de actividad fsica y apoyo
psicolgico puede mejorar parmetros antropomtricos y
estilos de vida en pacientes obesos tratados en un centro
de Atencin Primaria.
Fundamentos: Los estilos de vida saludables se
relacionan con un menor riesgo de enfermedades
cardiovasculares. El objetivo del estudio es evaluar la
eficacia de una estrategia educativa grupal en la
modificacin de estilos de vida, control de factores de
riesgo y riesgo cardiovascular (RCV) en personas
hipertensas.
Mtodo: Ensayo clnico aleatorio en Atencin Primaria. Se
seleccionaron por muestreo aleatorio 101 personas
hipertensas de 35 a 74 aos, randomizando 51 al grupo
de intervencin (GI)(64,59,7 aos, 56% mujeres) y 50
al control (GC) (65,48,4 aos, 68% mujeres). Se realiz
una evaluacin basal, una intervencin educativa grupal
sobre cambios de estilos de vida (seis sesiones durante
un ao) y una evaluacin final. El efecto de la
intervencin se evalu con RCV (Framingham), presin
arterial(PA), perfil lipdico, permetro de cintura, ndice de
masa corporal(IMC), consumo de nutrientes con encuesta
validada, ejercicio fsico con 7-PAR Day y calidad de vida
con SF-36.
Resultados: PA basal 136,8/82,7 mmHg en GI y
139,3/79,3 mmHg y en GC, RCV:11,1% (GI) y 12,3%
(GC). La PA sistlica descendi 5,619,6 mmHg (p=0,07)

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4.Superaci
n
profesional
en la
Atencin
Primaria de
Salud: una
estrategia
didctica
propiciador
a de estilos
de vida
saludables

5.Intervenci
n
educativa
sobre la
atencin a
nios de
madres

en GI, y 7,116, mmHg (p=0,004) en GC, la diastlica

3,910,8 (p=0,02), y 2,711, mmHg (p=0,10)
respectivamente. El IMC descendi 0,31,6 puntos en
GI(p=0,17), y aument 0,11,5 en GC(p=0,81). El RCV
descendi 0,86,5 puntos en GI y aument 0,26,8 en
GC, el efecto de la intervencin fue un descenso de 1
punto (IC95%:-3,9-1,9) (p=0,48). La ingesta disminuy
en GI: 42,81141,2 Kcal/da(p=0,14), y en GC:
278,91115,9 (p=0,62). El ejercicio (mets/hora/semana)
aument en ambos, 3,619 en GI(p=0,20) y 3,914,9
en GC(p=0,07).
Conclusin: Encontramos mayor descenso del riesgo
cardiovascular en el grupo de intervencin, sin existir
diferencias estadsticamente significativas en los
parmetros evaluados entre ambos grupos.
Se persigue exponer una estrategia didctica general de
superacin profesional de posgrado, formativa y
desarrolladora, a travs del mtodo de investigacinaccin, con la finalidad de propiciar transformaciones
favorables de estilos de vida de la poblacin cubana y se
explica cmo implementarla. Habiendo sido adecuada a
las necesidades formativas de los participantes para
conseguir lo anterior mediante la apropiacin y aplicacin
social de los conocimientos como integradores de
habilidades, se encamina a fomentar actitudes positivas
a travs de convicciones para modificar
comportamientos inadecuados, crear mecanismos para
lograr una salud responsable, formar o consolidar
valores, as como viabilizar el desarrollo intelectual y
social para perfeccionar el modo de actuacin profesional.
Se sustenta en la dinmica de una concepcin didctica
por medio de una intervencin de superacin dirigida a
los profesionales de la atencin primaria para transformar
los estilos de vida de la poblacin que puedan ser
mejorados. Tanto las acciones educativas y
socioculturales como las intervenciones de salud social se
fundamentan en la integracin de elementos planteados
por reconocidos autores, entre los cuales figuran: Rojas,
Fuillerat, Ferrer, Rodrguez Ojea y Castell Florit.
El embarazo en la adolescencia constituye un problema
de salud por su inmadurez en la esfera reproductiva y en
la atencin al nio. Se realiz una intervencin educativa
a 253 madres adolescentes en el Hospital
Ginecoobsttrico de Guanabacoa durante el perodo
2002-2008 para identificar conocimientos y preparacin
de las madres adolescentes para la atencin de sus hijos

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adolescente
s. Hospital
Ginecoobst
trico
Guanabaco
a, 20022008

6.Estrategia
educativa
novedosa
en la
prevencin
de factores
de riesgo
cardiovascu
lar gracias a
la alianza
de
programas
estatales y
la iniciativa
universitari
a

7.Promocin
de la salud
y
prevencin
escolar del
consumo
de drogas
en
contextos
de
vulnerabilid
ad social

y disear un programa educativo a travs tcnicas de

exploracin cualitativa, disendose el programa
educativo aplicado durante los tres primeros aos de vida
de sus hijos. El contenido del programa se bas en:
cuidados generales del neonato, lactancia materna,
crecimiento y desarrollo, nutricin, accidentes,
inmunizaciones, incorporacin estudio y/o trabajo. Las
madres adolescentes presentaron bajos niveles de
conocimiento y falta de habilidades en el cuidado de sus
hijos. La aplicacin del programa educativo contribuy a
la transformacin en estilos de vida ms saludables de la
madre adolescente y una mejor atencin de sus hijos.
El fracaso de las estrategias tradicionales que se basan
en el manejo de guas y educacin mediante charlas en
las unidades de salud, es evidente en diferentes estudios,
en especial en los EUROASPIRE. Por ello, surge la
necesidad de crear nuevas tcticas que sean efectivas
para cambiar los estilos de vida no saludables de las
personas y las comunidades, y disminuir la prevalencia
de los factores de riesgo modificables para aterosclerosis
y bajar la incidencia de eventos cardiovasculares. Aqu se
presenta una experiencia que si bien no mide an el
impacto sobre estos aspectos, fue bien recibida por la
comunidad e involucr aspectos novedosos. Se demostr
la posibilidad de unir esfuerzos entre las polticas y
recursos estatales y los medios acadmicos
universitarios. De este modo, se prob la utilidad del
trabajo interdisciplinario entre acadmicos de diferentes
formaciones y creativos de medios audiovisuales y de la
comunicacin as como una estrategia ldico-educativa
masiva que parece ofrecer grandes posibilidades como
didctica moderna eficiente en la bsqueda de cambios
hacia estilos de vida saludable.
Se presentan los resultados de un programa para la
promocin de estilos de vida saludables y sostenibles, la
prevencin del consumo de drogas que se desarroll en
escuelas de educacin primaria insertas en comunidades
vulnerables en dos provincias argentinas (Buenos Aires y
Santa Fe) entre los aos 2002 y 2009. El objetivo fue
indagar, en nios y nias de 6 a 14 aos que asisten a
escuelas primarias, las variaciones en los conocimientos
sobre s mismos, los cuidados de la salud y las
habilidades sociales, a partir de la implementacin de un
programa de prevencin y cuidado de la salud.
Se utiliz la estrategia de estudio de casos comparativos
sobre una muestra no probabilstica compuesta por 634

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8.Procesos
psicosociale
s en la
educacin
en salud y
en la
prevencin
del cncer

9.The
Communitybased
Healthylifestyle
Intervention
for Rural
Preschools
(CHIRP)
study:
Design and
methods

nios. El abordaje metodolgico se bas en un diseo de

investigacin descriptivo-analtico, longitudinal, cuasi
experimental del tipo: ensayos comunitarios.
Entre las conclusiones se encontr que el programa
tiende a mejorar significativamente el dominio de las
reas en cuestin: conocimientos sobre s mismos (53%
de los estudiantes presenta indicadores de mejora),
cuidados de la salud (un 73%) y habilidades para la vida
(un 74%). Al hacerlo segn gnero se observa que las
mujeres obtienen ms beneficios en el eje conocimiento
de s mismo, mientras que los varones tienen mejores
logros en el eje cuidados de la salud y habilidades para la
vida.
Se realiza una revisin bibliogrfica cuyos objetivos
fueron brindar informacin sobre las categoras
psicosociales que intervienen en el proceso de educacin
en salud y reflexionar sobre la importancia de ellas para
la formulacin y ejecucin de acciones y programas
efectivos dirigidos a la prevencin del cncer en el
espacio de la comunidad. Se analizan aspectos esenciales
de 5 categoras psicosociales para su empleo en la
prevencin y educacin en cncer, utilizando
herramientas que permitan una modificacin de los
estilos de vida no saludables de las personas. Se
muestran ejemplos sencillos de su aplicacin y se
concluye que una educacin en salud de nuevo tipo
requiere un cambio en la metodologa interventiva de los
agentes sanitarios, orientndose involucrar procesos que
propicien la autorregulacin y la adopcin de
precauciones.
The CHIRP study is a two-arm, pilot randomized
controlled trial assessing the effectiveness of a behavioral
family weight management intervention in an important
and at-risk population, overweight young children, 3 to 6
years of age, and their parents from underserved rural
counties. Participants will include 96 parentchild dyads
living in rural counties in north central Florida. Families
will be randomized to one of two conditions: (a)
behavioral family based intervention or (b) a waitlist
control. Child and parent participants will be assessed at
baseline (month 0), post-treatment (month 4), and
follow-up (month 10). Assessments and intervention
sessions will be held at the Cooperative Extension office
in each participating rural county. The primary outcome
measure is change in child body mass index (BMI) zscore. Additional key outcome measures include child

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dietary intake, physical activity, and parent BMI.

10.Correlate
s Among
Healthy
Lifestyle
Cognitive
Beliefs,
Healthy
Lifestyle
Choices,
Social
Support,
and Healthy
Behaviors in
Adolescents
:
Implications
for
Behavioral
Change
Strategies
and Future
Research

11.The
CHANGE
Study: A
HealthyLifestyles

This study is unique because (1) it is one of the few

randomized controlled trails examining a behavioral
family intervention to address healthy habits and
improved weight status in young overweight and obese
children, (2) addresses health promotion in rural settings,
and (3) examines intervention delivery in real world
community settings through the Cooperative Extension
Service offices. If successful, this research has potential
implications for medically underserved rural communities
and preventative health services for young children and
their families.
Introduction
The foundation for healthy lifestyle behaviors begins in
childhood. As such, the relationships among cognitive
beliefs, healthy lifestyle choices, and healthy lifestyle
behaviors in adolescents have been explored. The
purpose of this study was to assess the relationships
among cognitive variables, social support, and healthy
lifestyle behaviors in adolescents.
Method
A descriptive correlational design was used for this study.
Students from two high schools in the Southwest United
States were recruited to participate (N = 404).
Results
Significant correlations existed among cognitive variables,
social support, behavioral skills, and health lifestyle
behaviors.
Discussion
This study demonstrated that cognitive beliefs about
leading a healthy lifestyle, including attitudes and
intended choices, are related to physical activity as well
as the intake of fruits and vegetables. In working with
adolescents on healthy lifestyle behavior change, it is
important to implement strategies to strengthen their
cognitive beliefs about their ability to make healthy
choices and engage in healthy lifestyle behaviors.
Strengthening these beliefs should lessen their perception
that these behaviors are difficult to perform, which
ultimately should result in healthy behaviors.
Background
Despite the high rates of overweight and obesity among
rural children, there have been limited interventions
reported to improve the diet quality of rural, low-income
children in the United States.

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Intervention
to Improve
Rural
Children's
Diet Quality

12.The

Objective
Our aim was to evaluate students' diet quality at baseline
and after implementing the CHANGE (Creating Healthy,
Active and Nurturing Growing-Up Environments) study, a
2-year (2007-2009) randomized, controlled, communityand school-based intervention to prevent unhealthy
weight gain among rural school-aged children.
Design
We used a school and community-based group
randomized, controlled design.
Participants/setting
Data were collected in eight rural communities in
California, Kentucky, Mississippi, and South Carolina (one
elementary school per community). Children in grades 1
to 6 participated in the study (n=432; mean age=8.65
years1.6 years). Students' diets were assessed at
baseline (spring or early fall 2008) and post intervention
(spring 2009) using the Block Food Screener for ages 2 to
17 years.
Statistical analyses
Mixed-model analysis of variance was used to examine
the effect of the CHANGE study intervention on students'
diets. Results were adjusted for corresponding baseline
dietary values, sex, age, grade, race/ethnicity, and state,
with school included as a random effect nested within
condition.
Results
At the end of 1 year, students enrolled in the CHANGE
study intervention schools consumed significantly more
vegetables (0.08 cups/1,000 kcal/day; P=0.03) and
combined fruits and vegetables (0.22 cups/1,000
kcal/day; P<0.05) compared with students in control
schools. Students in the intervention schools also showed
a reduction in the average daily dietary glycemic index
(GI=1.22; P<0.05) and a trend toward more fruit
consumption (0.15 cups/1,000 kcal/day; P=0.07). There
were no significant differences in students' consumption
of whole grains, legumes, dairy, potatoes/potato
products, saturated fat, added sugars, or dietary fiber
consumption.
Conclusions
The CHANGE study enhanced some aspects of rural
students' dietary intake. Implementing similar
interventions in rural America can be promising to
support vegetable consumption.
Background

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Effects of
an Exercise
and
Lifestyle
Intervention
Program on
Cardiovascu
lar,
Metabolic
Factors and
Cognitive
Performanc
e in MiddleAged Adults
with Type II
Diabetes: A
Pilot Study

13.The
Healthy
Lifestyle
Change
Program: A
Pilot of a

Canada is experiencing a rise in type II diabetes mellitus

(T2DM), a known risk factor for accelerated cognitive
decline and dementia. Within the context of an aging
population, this will impose significant individual and
societal burden, making the development of prevention
programs imperative.
Objective
This pilot study examines the effects of the Diabetes
Exercise and Healthy Lifestyle Service, a 24-week
intervention program, on cardiovascular, metabolic
regulation and cognitive function in adults with T2DM.
Methods
Seventeen middle-aged participants provided blood
samples for biological markers, underwent cognitive
testing and a physical stress test pre- and postintervention. Cognitive performance was evaluated using
the California Verbal Learning Test (CVLT), Digit Symbol
Substitution Tasl (DSST) and fluency test.
Results
Adjusted models reveal participants displayed increased
cardiovascular fitness (VO2 peak: Mchange=4.09
mLkgmin-1 SE=1.4), peak heart rate (Mchange= 9.28
beatsmin-1 SE=2.68) and change in heart rate
(Mchange=10.71 SE=1.76) in response to the stress test
(ps<0.05) following the 24-week intervention. A decrease
in body mass index (BMI) (Mchange= 1.03 SE=0.40)
and depressive symptomatology (CES-D: Mchange =
3.62 SE=1.44) was also found (ps<0.05). No change
was found for lipid and glucose levels. Surprisingly,
analyses showed that cognitive performance on the CVLT
immediate recall (M= 4.37 SE=2.21), CVTL short-delay
recall (M= 1.06 SE=0.55), DSST (Mchange= 3
SE=0.53) and category fluency (Mchange= 1.69
SE=0.78) declined following the intervention (ps<0.05);
however, decline on the CVLT was limited to adults with
co-morbid T2DM and hypertension.
Conclusion
Additional research is needed to evaluate the benefit of
an exercise and lifestyle program that targets cognitive
health in those with T2DM.
Background
Although adults with developmental disabilities are at
high risk for obesity and its sequelae, few communitybased lifestyle interventions targeting those with
developmental disabilities exist.
Design

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CommunityBased
Health
Promotion
Intervention
for Adults
with
Developme
ntal
Disabilities

The study was a single group, community-based

demonstration project with prepost test evaluation
conducted from December 2005 to June 2006.
Setting/participants
Eligible participants were 431 community-dwelling adults
with developmental disabilities, aged 1865 years, who
were overweight/obese (BMI 25) with another risk
factor for diabetes or metabolic syndrome or who had a
diagnosis of diabetes, and received services from a
community agency. Eighty-five signed up (20% of those
eligible), 68 participated in an initial class, and 44
completed the program (35% attrition rate).
Intervention
The Healthy Lifestyle Change Program (HLCP) is a
community-based health intervention developed and
implemented using community-based participatory
research methods by members of the developmental
disabilities community, in collaboration with academic
researchers. The HLCP was a 7-month, twice-weekly
education and exercise program to increase knowledge,
skills, and self-efficacy regarding health, nutrition, and
fitness among adults with developmental disabilities. Peer
mentors served as participant leaders and primary
motivators.
Measures
Changes in weight, BMI, abdominal girth, access to care,
and self-reported nutrition, physical activity, and life
satisfaction were each measured.
Results
Two thirds of participants maintained or lost weight, with
a mean weight loss of 2.6 pounds and a median weight
loss of 7 lbs (range: 224 lbs). Average BMI decreased
by 0.5 kg/m2 (p=0.04). Abdominal girth decreased in
74% of participants (mean= 1.9 inches). Sixty-one
percent of participants reported increased physical
activity. Mean exercise frequency increased from 3.2
times to 3.9 times per week (p=0.01). Mean exercise
duration increased from 133 minutes to 206.4 minutes
per week (p=0.02). Significant improvements in
nutritional habits and self-efficacy were reported. Over
half (59%) of participants showed improvements in life
satisfaction. Participants received 206 referrals for
needed medical care. The HLCP and its dissemination
increased participants' and peer mentors' ability to act as
community advocates and partners in research.
Conclusions

14.Predictin
g changes
in lifestyle
and clinical
outcomes in
preventing
diabetes:
The Greater
Green
Triangle
Diabetes
Prevention
Project

15. Impact
of a webbased
intervention
supplement

The HLCP resulted in improved lifestyles, weight loss

success, and increased community capacity, indicating
that a community-based program with significant
participation of those with developmental disabilities is
feasible. This program should be expanded and evaluated
with larger populations with developmental disabilities.
Objectives
To analyse how psychosocial determinants of lifestyle
changes targeted in the Greater Green Triangle Diabetes
Prevention Project conducted in Southeast Australia in
20042006 predict changes in dietary behaviour and
clinical risk factors.
Methods
A longitudinal pre-test and post-test study design was
used. The group program was completed by 237 people
at high risk of type 2 diabetes. Associations between
changes in the variables were examined by structural
equation modelling using a path model in which changes
in psychological determinants for lifestyle predicted
changes in dietary behaviours (fat and fibre intake),
which subsequently predicted changes in waist
circumference and other clinical outcomes. Standardised
regression weights are presented, with = 0.1 and =
0.3 representing small and medium associations,
respectively.
Results
Improvements in coping self-efficacy and planning
predicted improvements in fat ( = 0.15, p < 0.05 and
= 0.32, p < 0.001, respectively) and fibre intake (
= 0.15, p < 0.05 and = 0.23, p < 0.001, respectively)
which in turn predicted improvements in waist
circumference ( = 0.18, p < 0.01 and = 0.16, p <
0.05, respectively). Improvements in waist circumference
predicted improvements in diastolic blood pressure ( =
0.13, p < 0.05), HDL ( = 0.16, p < 0.05),
triglycerides ( = 0.17, p < 0.01), and fasting glucose (
= 0.15, p < 0.05).
Conclusions
Psychological changes predicted behaviour changes,
resulting in 12-month biophysical changes. The findings
support the theoretical basis of the interventions.
Objective
To assess the impact of a web-based intervention
supplemented with text messages to reduce cancer risk
linked with smoking, unhealthy diet, alcohol
consumption, obesity, sedentary lifestyle and sun

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ed with text
messages
to improve
cancer
prevention
behaviors
among
adolescents
: Results
from a
randomized
controlled
trial

16. The
Maternal
Obesity
Managemen
t (MOM)
Trial
Protocol: A
lifestyle
intervention
during
pregnancy
to minimize
downstream
obesity

exposure.
Methods
A total of 2001 voluntary adolescents from Spain and
Mexico were recruited between 2009 and 2012 and
randomly assigned to: one control group (CG) and two
experimental groups, which received exclusively the
online intervention (EG1) or the intervention
supplemented with encouraging text messages (EG2).
The educational intervention was based on both:
successful psychosocial models (i.e. A.S.E. and
Transtheoretical model) and the school curriculum.
Results
After a 9-month follow-up, the prevalence of students
who did not eat fruit was reduced significantly in all
groups: EG1 ( 62.6%), EG2 ( 71.5%) and even the
CG ( 66.8%). Being overweight was only reduced in the
EG2 ( 19.6%). The total cancer behavioral risk (TCBR)
score, which ranged from 0 to 100 points (highest risk),
was significantly reduced in the EG1 ( 3.5 points) and in
the EG2 ( 5.3 points). The text-supplemented online
intervention increased the probability of improving the
post-test TCBR (OR = 1.62).
Conclusion
The web-based intervention supplemented with text
messages had a positive global impact, but it lead to only
minimal changes in risky behaviors. This intervention
appears useful in controlling overweight adolescents.
Clinical trial registration number: ISRCTN27988779.
Abbreviations
TCBR, total cancer behavioral risk
Background
Maternal obesity and/or high gestational weight gain
(GWG) are associated with downstream child obesity.
Pregnancy represents a critical period for prevention as
women are highly motivated and more receptive to
behavior change.
Objective
This pilot study was developed to test the feasibility of
intervening with the mother, specifically keeping her GWG
within the Institute of Medicine (IOM) limits, with the
intended target of preventing obesity in her child
downstream. We are testing the practicality of delivering
a structured physical activity and nutrition intervention to
pregnant women during gestation and then following
mom and baby to 24 months of age.
Study design

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17.Randomi
sed clinical
trial of a
familybased
lifestyle
intervention
for
childhood
obesity
involving
parents as
the
exclusive
agents of
change

18. Stage of
change and

This study is a two-arm, parallel group, randomized

controlled trial being conducted in Ottawa. Pregnant
women, with pregavid BMI > 18.5, between 12 and 20
weeks gestation are randomized to one of two groups:
intervention (n = 30) who receive the MOM trial
Handbook (guide to healthy gestation) plus a structured
physical activity and nutrition program, or a standard
clinical care control group (n = 30). The intervention lasts
2528 weeks (6 months) depending on anticipated
delivery date, with follow-up assessment on mother and
child at 3, 6, 12 and 24 months post-delivery.
Significance
Pregnancy, a critical time of growth, development and
physiological change, provides an opportunity for early
lifestyle intervention. The goal of identifying an effective
lifestyle program for the gestational period that leads to
healthy fetal development and subsequently normal
weight offspring, less likely to develop obesity and its comorbidities, is unique and could possibly attenuate the
inter-generational cycle of obesity.
Parent-centred interventions for childhood obesity aim to
improve parents skills and confidence in managing
childrens dietary and activity patterns, and in promoting
a healthy lifestyle in their family. However, few studies
assess changes in parenting over the course of
treatment. This study describes the evaluation of a
lifestyle-specific parenting program (Group Lifestyle Triple
P) on multiple child and parent outcomes. One-hundredand-one families with overweight and obese 4- to 11year-old children participated in an intervention or waitlist
control condition. The 12-week intervention was
associated with significant reductions in child BMI z score
and weight-related problem behaviour. At the end of the
intervention, parents reported increased confidence in
managing childrens weight-related behaviour, and less
frequent use of inconsistent or coercive parenting
practices. All short-term intervention effects were
maintained at one-year follow-up assessment, with
additional improvements in child body size. The results
support the efficacy of Group Lifestyle Triple P and
suggest that parenting influences treatment outcomes.
Further research is needed to evaluate the long-term
effectiveness of the intervention and to elucidate the
mechanisms of change.
Backgrounds & Aims
Healthy diet and physical activity are the treatment

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motivation
to healthier
lifestyle in
nonalcoholic
fatty liver
disease

19.
Rationale
and design
of FAITH, a
lifestyle
intervention
targeting
blood
pressure

cornerstones of non-alcoholic fatty liver disease (NAFLD);

their effectiveness is however limited by difficulties in
implementing lifestyle changes. We aimed at determining
the stage of change and associated psychological factors
as a prerequisite to refine strategies to implement
behavior changes.
Methods
We studied 138 consecutive NAFLD patients (73% male,
age 1973 years). The diagnosis was confirmed by liver
biopsy in 64 cases (steatohepatitis, 47%). All cases
completed the validated EMME-3 questionnaire,
consisting of two parallel sets of instruments (for diet and
physical activity, respectively) and providing stages of
change according to transtheoretical model. Logistic
regression analysis was used to identify factors
associated with stages making behavioral changes more
demanding.
Results
The individual profiles were variable; for diet, no cases
had precontemplation as prevalent stage of change
(highest score in individual profiles); 36% had
contemplation. For physical activity, 50% were classified
in either precontemplation or contemplation. Minor
differences were recorded in relation to associated
metabolic complications or steatohepatitis. Logistic
regression identified male sex (odds ratio, 4.51; 95%
confidence interval, 1.6912.08) and age (1.70; 1.20
2.43 per decade) as the independent parameters
predicting precontemplation or contemplation for diet. No
predictors were identified for physical activity.
Conclusions
NAFLD cases have scarce readiness to lifestyle changes,
particularly with regard to physical activity. Defining
stages of change and motivation offers the opportunity to
improve clinical care of NAFLD people through individual
programs exploiting the powerful potential of behavioral
counseling, an issue to be tested in longitudinal studies.
Background
Uncontrolled hypertension (HTN) is a significant public
health problem among Blacks in the United States.
Despite the proven efficacy of therapeutic lifestyle change
(TLC) on blood pressure (BP) reduction in clinical trials,
few studies have examined their effectiveness in churchbased settingsan influential institution for health
promotion in Black communities.
Methods

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control
among
Black
church
members

20. The
COPE
healthy
lifestyles
TEEN
randomized
controlled
trial with
culturally
diverse high
school
adolescents
: Baseline
characterist
ics and
methods

Using a cluster-randomized 2-arm trial design, this study

evaluates the effectiveness of a faith-based therapeutic
lifestyle change intervention (TLC) vs. health education
control (HE) on BP reduction among hypertensive Black
adults. The intervention is delivered by trained lay health
advisors (LHAs) through group TLC sessions plus
motivational interviewing (MINT-TLC) in 32 Black
churches. Participants in the intervention group receive
11 weekly TLC sessions targeting weight loss, increasing
physical activity, fruit, vegetable and low-fat dairy intake,
and decreasing fat and sodium intake, plus 3 monthly
individual MINT sessions. Participants in the control group
attend 11 weekly classes on HTN and other health topics
delivered by healthcare experts. The primary outcome is
change in BP from baseline to 6 months. Secondary
outcomes include level of physical activity, percent
change in weight, and fruit and vegetable consumption at
6 months and BP control at 9 months.
Conclusion
If successful, this trial will provide an alternative and
culturally appropriate model for HTN control through
evidence-based lifestyle modification delivered in
churches by LHAs.
Obesity and mental health disorders remain significant
public health problems in adolescents. Substantial health
disparities exist with minority youth experiencing higher
rates of these problems. Schools are an outstanding
venue to provide teens with skills needed to improve
their physical and mental health, and academic
performance. In this paper, the authors describe the
design, intervention, methods and baseline data for a
randomized controlled trial with 779 culturally diverse
high-school adolescents in the southwest United States.
Aims for this prevention study include testing the efficacy
of the COPE TEEN program versus an attention control
program on the adolescents' healthy lifestyle behaviors,
Body Mass Index (BMI) and BMI%, mental health, social
skills and academic performance immediately following
the intervention programs, and at six and 12 months post
interventions. Baseline findings indicate that greater than
40% of the sample is either overweight (n = 148,
19.00%) or obese (n = 182, 23.36%). The predominant
ethnicity represented is Hispanic (n = 526, 67.52%). At
baseline, 15.79% (n = 123) of the students had above
average scores on the Beck Youth Inventory Depression
subscale indicating mildly (n = 52, 6.68%), moderately

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21.
Lifestyleand
behaviourchange
intervention
s in
musculoskel
etal
conditions

22. Sleep
health,
lifestyle and
mental
health in
the
Japanese
elderly:
Ensuring
sleep to
promote a
healthy
brain and
mind

(n = 47, 6.03%), or extremely (n = 24, 3.08%) elevated

scores (see Table 1). Anxiety scores were slightly higher
with 21.56% (n = 168) reporting responses suggesting
mildly (n = 81, 10.40%), moderately (n = 58, 7.45%) or
extremely (n = 29, 3.72%) elevated scores. If the
efficacy of the COPE TEEN program is supported, it will
offer schools a curriculum that can be easily incorporated
into high school health courses to improve adolescent
healthy lifestyle behaviors, psychosocial outcomes and
academic performance.
This review discusses several health behaviours
associated with the progression and impact of
osteoarthritis (OA) and rheumatoid arthritis (RA),
including weight management, physical activity,
medication adherence and smoking. An overview of
current theories of behaviour-change is provided in terms
of principles that can guide medical practice. Finally,
evaluation studies of interventions targeting weight loss,
physical activity and medication adherence in patients
with OA or RA are presented and discussed. Of existing
behaviour-change interventions in this population, few
have taken a comprehensive theory-based approach to
behaviour-change. Practitioners who provide lifestyle or
behavioural advice to patients would do well to adopt a
less prescriptive and more patient-centred approach in
which they, or other health professionals to whom they
refer the patient, assist the patient in formulating
personal change goals, in translating good intentions into
specific action plans and in closely monitoring their
progress towards self-chosen goals.
The Ministry of Health, Labor and Welfare in Japan
proposed a plan called Health Japan 21, which adopted
sleep as one of the specific living habits needing
improvement. This has led to increased interest in mental
health needs at community public health sites. In
addition, it was reported from a recent 2000 survey that
one in five Japanese, and one in three elderly Japanese,
suffer from insomnia. Insomnia is becoming a serious
social problem; so much so that alarm bells are ringing
with insomnia listed as one of the refractory diseases of
the 21st century. Against this background, in January
2001, Japan began a national project called Establishing
a Science of Sleep.
This article is an overview of sleep and health in the
elderly, sleep mechanisms and the characteristics of
insomnia among the elderly. At the same time, it

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23. Effects
of a 14-Day
Healthy
Longevity
Lifestyle
Program on
Cognition
and Brain
Function

introduces the scientific basis for lifestyle guidance that is

effective for ensuring comfortable sleep, an essential
condition for a healthy, energetic old age, with actual
examples from community public health sites. The
present authors reported that a short nap (30 min
between 1300 and 1500 h) and moderate exercise such
as walking in the evening are important in the
maintenance and improvement of sleep quality. The study
was to examine the effects of short nap and exercise on
the sleep quality and mental health of elderly people.
Interventions by short nap after lunch and exercise with
moderate intensity in the evening were carried out for 4
weeks. After the intervention, wake time after sleep
onset significantly decreased and sleep efficiency
significantly increased, showing that sleep quality was
improved. The frequency of nodding in the evening
significantly decreased. As a result, the frequency of
nodding before going to sleep decreased, and the quality
of nocturnal sleep was improved. Present results
demonstrated that the proper awakening maintenance
during evening was effective in improving sleep quality.
After the intervention, mental health also improved with
improving sleep quality. Furthermore, physical health also
improved with improving sleep quality. These results
suggest that this intervention technique is effective for
the quality of life (QOL) and the activity of daily living
(ADL) of elderly people.
Objective
The objective of this study was to determine the effects
of a 14-day healthy longevity lifestyle program on
cognition and cerebral metabolism in people with mild
age-related memory complaints.
Methods
Seventeen nondemented subjects, aged 3569 years
(mean: 53 years, standard deviation: 10) with mild selfreported memory complaints but normal baseline
memory performance scores were randomly assigned to
1) the intervention group (N = 8): a program combining
a brain healthy diet plan, relaxation exercises,
cardiovascular conditioning, and mental exercise (brain
teasers and verbal memory training techniques); or 2)
the control group (N = 9): usual lifestyle routine. Preand postintervention measures included self-assessments
of memory ability, objective tests of cognitive
performance, and determinations of regional cerebral
metabolism during mental rest with [fluorine-

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24.
Changes in
Emerging
Cardiac
Biomarkers
After an
Intensive
Lifestyle
Intervention

18]fluorodeoxyglucose (FDG) positron emission

tomography (PET).
Results
Subjects in the intervention group objectively
demonstrated greater word fluency. Concomitantly, their
FDG-PET scans identified a 5% decrease in activity in the
left dorsolateral prefrontal cortex. The control group
showed no significant change in any of the measures.
Conclusions
A short-term healthy lifestyle program combining mental
and physical exercise, stress reduction, and healthy diet
was associated with significant effects on cognitive
function and brain metabolism. Reduced resting activity
in left dorsolateral prefrontal cortex may reflect greater
cognitive efficiency of a brain region involved in working
memory.
The present study evaluated the changes in emerging
cardiac biomarkers, cognitive function, and social support
measures after a comprehensive lifestyle intervention
that included a low-fat, whole-foods, plant-based diet,
exercise, stress management, and group support
meetings. We conducted a prospective cohort study of
131 participants (59.2% women and 43.1% with diabetes
mellitus), 56 with coronary heart disease (CHD) (37.5%
women and 27.3% diabetes mellitus), and 75 at high risk
with 3 CHD risk factors and/or diabetes mellitus (76%
women and 54.7% diabetes mellitus). The measurements
were taken at baseline and 3 months after the
intervention. Improvement in all targeted health
behaviors was seen in both high-risk and CHD groups (all
p <0.001) at 3 months, with reductions in body mass
index, systolic and diastolic blood pressure, waist/hip
ratio, C-reactive protein, insulin, low-density lipoprotein,
high-density and total cholesterol, apolipoproteins A1 and
B (all p <0.009) were observed. Nuclear magnetic
resonance spectroscopy analysis of lipoprotein subclass
particle concentrations and diameters showed a reduction
in large very-low-density lipoprotein particles, size of the
very-low-density lipoprotein particles, total low-density
lipoprotein particles; total, large, and small high-density
lipoprotein particles (all p <0.009) and small very-lowdensity lipoprotein particles (p <0.02). Increases in
fibrinogen (p <0.03) and B-type natriuretic peptide (p
<0.001) were seen, and these changes correlated
inversely with the changes in the body mass index. The
observed increase in B-type natriuretic peptide can be

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25. The
Influence of
a Physician
and Patient
Intervention
Program on
Dietary
Intake

explained by the metabolic changes related to adipose

tissue lipolysis. The quality of life, cognitive functioning,
and social support measures significantly improved. In
conclusion, lifestyle changes can be followed by favorable
changes in traditional and emerging coronary heart
disease biomarkers, quality of life, social support, and
cognitive function among those with, or at high risk, of
CHD.
Background
Efficient dietary interventions for patients with
hypertension in clinical settings are needed.
Objective
To assess the separate and combined influence of a
physician intervention (MD-I) and a patient intervention
(PT-I) on dietary intakes of patients with hypertension.
Design
A nested 22 design, randomized controlled trial
conducted over 18 months.
Participants
A total of 32 physicians and 574 outpatients with
hypertension.
Intervention
MD-I included training modules addressing the Seventh
Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood
Pressure hypertension management guidelines and
lifestyle modification. PT-I included lifestyle coaching to
adopt the Dietary Approaches to Stop Hypertension
(DASH) eating pattern, reduce sodium intake, manage
weight, increase exercise, and moderate alcohol intake.
Main outcome measures
Dietary intakes were measured by the Block Food
Frequency Questionnaire. Concordance with the DASH
dietary pattern was estimated by a DASH score.
Statistical analyses
The main effects of MD-I and PT-I, and their interaction,
were evaluated using analysis of covariance.
Results
After 6 months of intervention, MD-I participants
significantly increased intakes of potassium, fruits, juices,
and carbohydrate; decreased intake of fat; and improved
overall dietary quality as measured by the Healthy Eating
Index. PT-I intervention resulted in increased intakes of
carbohydrate, protein, fiber, calcium, potassium, fruits
and fruit juices, vegetables, dairy and Healthy Eating
Index score, and decreased intakes in fat, saturated fat,

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26. Lifestyle
physical
activity
intervention
s: History,
short- and
long-term
effects, and
recommend
ations

cholesterol, sodium, sweets, and added fats/oils/sweets.

In addition, PT-I improved overall DASH concordance
score. The change in DASH score was significantly
associated with the changes in blood pressure and weight
at 6 months. At 18 months, most changes reversed back
toward baseline levels, including the DASH score.
Conclusions
Both MD-I and PT-I improved eating patterns at 6 months
with some sustained effects at 18 months. Even though
all dietary changes observed were consistent with the
DASH nutrient targets or food group guidelines, only the
PT-I intervention was effective in improving the overall
DASH concordance score. This finding affirms the role of
medical nutrition therapy in long-term intensive
interventions for hypertension risk reduction and weight
management and underlines the need for development of
maintenance strategies. Furthermore, this study
emphasizes the importance of collaborations among
physicians, registered dietitians and other dietetics
practitioners, and lay health advisors while assisting
patients to make healthy behavior changes.
Introduction: Lifestyle physical activity interventions have
resulted in response to the public health problem of
promoting regular amounts of physical activity to the
majority of U.S. adults who remain inadequately or
completely inactive. These lifestyle interventions allow a
person to individualize his/her physical activity programs
to include a wide variety of activities that are at least of
moderate intensity and to accumulate bouts of these
activities in a manner befitting his/her life circumstances.
Methods: We reviewed the history of lifestyle physical
activity interventions and defined lifestyle physical
activity based on this review. We located 14 studies that
met this definition.
Results: Lifestyle physical activity interventions are
effective at increasing and maintaining levels of physical
activity that meet or exceed public health guidelines for
physical activity in representative samples of previously
sedentary adults and obese children. The majority of
these interventions have been delivered by face-to-face
contact in small groups, which limits their public health
impact. However, a small number of studies demonstrate
that these interventions can be delivered by mail and
telephone, which may enhance their generalizability. Most
of these studies utilized behavior change theories such as
Social Cognitive Theory, the Transtheoretical Model, and

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27. Growing
Right Onto
Wellness
(GROW): A
familycentered,
communitybased
obesity
prevention
randomized
controlled
trial for
preschool
childparent
pairs

Behavior Learning to shape the interventions. Lifestyle

interventions aimed at modifying the environment, such
as signs posted to increase stair climbing, also have been
shown to be effective over the short term.
Conclusions: The major issues concerning lifestyle
physical activity interventions are: (1) testing their ability
to be implemented on a large scale; (2) examining costeffectiveness for different modes of delivery; and (3)
researching the efficacy in populations such as the
elderly, minorities, economically disadvantaged, and
individuals with concurrent disease. More studies aimed
at manipulating the environment to increase physical
activity need to be tested over periods of one year or
longer. It is possible that lifestyle interventions could be
integrated and delivered by new technologies such as
interactive computer-mediated programs, telephone, or
computer web-based formats. All of these recommended
approaches should utilize valid and reliable measures of
physical activity and should examine the health effects,
particularly on a longitudinal basis. Basic dose-response
studies in controlled settings also are needed to help us
understand the health effects of accumulated moderate
intensity activity.
Growing Right Onto Wellness (GROW) is a randomized
controlled trial that tests the efficacy of a familycentered, community-based, behavioral intervention to
prevent childhood obesity among preschool-aged
children. Focusing on parentchild pairs, GROW utilizes a
multi-level framework, which accounts for macro (i.e.,
built-environment) and micro (i.e., genetics) level
systems that contribute to the childhood obesity
epidemic.
Six hundred parentchild pairs will be randomized to a 3year healthy lifestyle intervention or a 3-year school
readiness program. Eligible children are enrolled between
ages 3 and 5, are from minority communities, and are
not obese. The principal site for the GROW intervention is
local community recreation centers and libraries.
The primary outcome is childhood body mass index (BMI)
trajectory at the end of the three-year study period. In
addition to other anthropometric measurements,
mediators and moderators of growth are considered,
including genetics, accelerometry, and diet recall.
GROW is a staged intensity intervention, consisting of
intensive, maintenance, and sustainability phases.
Throughout the study, parents build skills in nutrition,

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28.Multidisc
iplinary
lifestyle
intervention
in the
obese: Its
impact on
patients
perception
of the
disease,
food and
physical
exercise

physical activity, and parenting, concurrently forming new

social networks. Participants are taught goal-setting, selfmonitoring, and problem solving techniques to facilitate
sustainable behavior change. The GROW curriculum uses
low health literacy communication and social media to
communicate key health messages. The control arm is
administered to both control and intervention
participants.
By conducting this trial in public community centers, and
by implementing a family-centered approach to
sustainable healthy childhood growth, we aim to develop
an exportable community-based intervention to address
the expanding public health crisis of pediatric obesity.
Background and aims
To be successful, lifestyle intervention in obesity must
take into account patients views. The aim of the present
study, conducted using a narrative-autobiographical
approach, was to report on the perception of disease,
food and physical exercise in a group of 80 obese
patients during a structured multidisciplinary lifestyle
intervention.
Methods and Results
Patients underwent lifestyle intervention, of three
months duration, structured in the following steps: 1) an
initial medical examination; 2) an interview by a
psychologist; 3) an assessment by a dietician, 4) a
physical examination by a specialist in sports medicine;
5) an individualized program consisting of 24 sessions
(two per week) of structured indoor exercise 6) eight
sessions of group therapeutic education; 7) Nordic
walking activity combined with walking excursions during
weekends. All the narrative autobiographic texts obtained
during the lifestyle intervention were submitted for
content analysis; data were analysed according to the
grounded theory method.
According to patients descriptions at the end of the
intervention, lifestyle intervention resulted in enhanced
self-efficacy and a reduction in their dependency on food
and people; their fear of change was also diminished
because, by undergoing intervention, they had
experienced change.
Conclusion
The findings made in the present qualitative analysis
suggest that whenever multidisciplinary lifestyle
intervention is planned for patients with obesity, it is of
the utmost importance to tailor the approach while taking

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29.Social
marketing
leverage for
heart
health: The
Ekaterinbur
g
experience

30. Inducing
lifestyle
regularity in
recovering
bipolar
disorder
patients:
Results
from the
maintenanc
e therapies
in bipolar
disorder
protocol

the following key aspects into account: motivation,

barriers and/or facilitators in lifestyle change, patients
perceptions of obesity and relationship with food, diet
and exercise.
The Russian Federation has one of the lowest life
expectancies in Europe, as well as having the highest
rates of death and disability due to cardiovascular disease
(CVD). In order to sensitize the professional and publichealth community and the public to the growing
challenge of cardiovascular disease, the World Heart
Federation, in partnership with the Russian Society of
Cardiology and the City Public Health Care Administration
and with the support of Unilever Bestfoods, carried out a
pilot social marketing project in the central Russian city of
Ekaterinburg. The primary objective was to assess the
viability of a cardiovascular disease-focused social
marketing campaign in terms of its diffusion in the
population and its acceptability. The social marketing
campaign itself involved community interventions, a mass
media campaign and training of health care professionals.
Progress towards achieving this and the secondary
objectives were measured by evaluating changes in a set
of predetermined output and outcome indicators. A pretest/post-test control-group quasi-experimental design
was used for examining project outcomes. The results
showed a significant level of acceptability and diffusion,
which need to be further developed for large-scale use.
Because of its short duration, the project cannot be held
to expectations of influencing behavioural risk, but in
terms of meeting its primary objective, it has been
successful.
On the basis of theories we articulated in earlier papers
(Ehlers et al 1988: Arch Gen Psychiatry 45:948952,
1993: Depression 1:285293), we have developed an
adjunctive psychosocial intervention for patients with
bipolar 1 disorder. Central to this intervention is the
establishment of regularity in daily routines. In this
report, we present data from a controlled investigation
comparing this new treatment, interpersonal and social
rhythm therapy (IPSRT), with a conventional medication
clinic approach. Despite comparable changes in
symptomatology over a treatment period lasting up to 52
weeks, subjects assigned to IPSRT (n = 18) show
significantly greater stability (p = .047) of daily routines
with increasing time in treatment, while subjects
assigned to the medication clinic condition (n = 20) show

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essentially no change in their social routines as measured

by Social Rhythm Metric (SRMMonk et al 1990: J Nerv
Ment Dis 178(2): 120126) score. We conclude that
IPSRT is capable of influencing lifestyle regularity in
patients with bipolar 1 disorder, with the possible benefit
of protection against future affective episodes.