Using the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice

Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Telemedicine and e-Health (Impact Factor: 1.54). 11/2009; 15(9):851-8. DOI: 10.1089/tmj.2009.0036
Source: PubMed

ABSTRACT Despite evidence-based recommendations for addressing obesity in the clinical setting, lifestyle interventions are lacking in practice. The objective of this study was to translate an evidence-based lifestyle program into the clinical setting by adapting it for delivery via the Internet. We adapted the Diabetes Prevention Program's lifestyle curriculum to an online format, comprising 16 weekly and 8 monthly lessons, and conducted a before-and-after pilot study of program implementation and feasibility. The program incorporates behavioral tools such as e-mail prompts for online self-monitoring of diet, physical activity, and weight, and automated weekly progress reports. Electronic counseling provides further support. Physician referral, automated progress reports, and as-needed communication with lifestyle coaches integrate the intervention with clinical care. We enrolled 50 patients from a large academic general internal practice into a pilot program between November 16, 2006 and February 11, 2007. Patients with a body mass index (BMI) =25 kg/m2, at least one weight-related cardiovascular risk factor, and Internet access were eligible if referring physicians felt the lifestyle goals were safe and medically appropriate. Participants were primarily female (76%), with an average age of 51.94 (standard deviation [SD] 10.82), and BMI of 36.43 (SD 6.78). At 12 months of enrollment, 50% of participants had logged in within 30 days. On average, completers (n = 45) lost 4.79 (SD 8.55) kg. Systolic blood pressure dropped 7.33 (SD 11.36) mm Hg, and diastolic blood pressure changed minimally (+0.44 mm Hg; SD 9.27). An Internet-based lifestyle intervention may overcome significant barriers to preventive counseling and facilitate the incorporation of evidence-based lifestyle interventions into primary care.

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    • "These technologies (cd-rom software, internet websites, e-mail contacts, sms or mms based systems, telemedicine platforms etc.) have opened potential applications to revolutionize health care in different inpatient and outpatient settings. There is a significant interest in the employment of new technologies and devices in order to obtain better results in weightreduction programs: this literature has grown strongly over recent years (Riva et al., 2001, Riva et al., 2002, Simpson et al., 2002, Jeffery et al., 2003, Riva et al., 2003, Simpson et al., 2003, Castelnuovo et al., 2004, Goulis et al., 2004, Sherwood et al., 2006, Haugen et al., 2007, Joo and Kim, 2007, Wister et al., 2007, Kim and Kim, 2008, Krukowski et al., 2008, Morak et al., 2008, Schiel et al., 2008, Shaikh et al., 2008, McTigue et al., 2009, Park et al., 2009, Castelnuovo, 2010, Castelnuovo et al., 2010). "
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    ABSTRACT: PURPOSE: The translation of an evidence-based lifestyle intervention to an online delivery format has the potential to provide an effective treatment option for obesity in primary care practice. Research is needed, however, to standardize e-counseling procedures to promote the training of health coaches and the dissemination to primary care settings. This article describes the development of an online lifestyle intervention coaching protocol adapted from the Diabetes Prevention Program lifestyle intervention curriculum. CONCLUSIONS: The delivery of patient counseling via the Internet may enable the dissemination of high-quality lifestyle advice to prevent diabetes in patients whose schedules or geographic constraints prohibit their participation in in-person counseling sessions.
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