Using the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice
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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ABSTRACT: Background: In the United States, 86 million adults have pre-diabetes. Evidence-based interventions that are both cost effective and widely scalable are needed to prevent diabetes.
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ABSTRACT: To evaluate 3- and 6-month weight loss outcomes achieved when physicians refer overweight/obese patients to an automated 3-month Internet-based behavioral weight loss intervention. A total of 154 patients age 18-70 years with a BMI between 25 and 45 kg/m(2) and access to a personal computer and the Internet were randomly assigned to 3 months of Internet behavioral intervention (IBI; n = 77) with 12 weekly videos teaching behavioral weight loss skills, a platform for submitting self-monitored data, and automated feedback or an education-only Internet-delivered eating and activity control group (IDEA; n = 77). Outcome measures were weight loss after 3 months (primary outcome) and 6 months and changes in weight-control behaviors (secondary outcomes). In intent-to-treat analyses with baseline weight carried forward for missing data, IBI produced significantly larger mean (SD) weight losses than IDEA at 3 months (5.5 kg [4.4] vs. 1.3 kg [2.1]) and 6 months (5.4 kg [5.6] vs. 1.3 kg [4.1]) (P < 0.001). Participants in IBI compared with IDEA were also more likely to achieve a clinically significant weight loss of 5% of initial body weight at 3 months (53.3 vs. 9.1%) and 6 months (48.1 vs. 15.6%) (P < 0.001) and reported more frequent use of weight control-related strategies. Physician referral to an Internet-based behavioral weight loss intervention produced clinically significant weight loss for over half of the patients studied. Further research is needed to determine the effectiveness of implementing this intervention more broadly within diverse healthcare settings. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.Diabetes Care 11/2014; 38(1). DOI:10.2337/dc14-1474 · 8.57 Impact Factor
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ABSTRACT: In this paper we present studies on biological and health effects of electromagnetic fields emphasizing the aspects related with measurement of the aggressing electromagnetic fields. A brief review of literature on electromagnetic environment is presented, together with some methods aiming to control and eliminate the electromagnetic interferences on medical instrumentation used in the acquisition of the biological signals (electroencephalography – EEG, electrocardiography – ECG). We performed analysis of electromagnetic fields in order to determine the induced current/field and the specific absorption rate in models of human body and also to correlate the exposure fields with some alterations of the biological signals acquired from a subject laid in various electromagnetic environments. The main goal of this research is to design a method for accurate identification and characterization of the aggressing electromagnetic fields on biological signals and human health.Pervasive and Mobile Sensing and Computing for Healthcare, 2013 edited by Mukhopadhyay S.C., Postolache A.O., 04/2013: chapter Acquisition and Analysis of Biomedical Signals in Case of Peoples Exposed to Electromagnetic Fields: pages 269-296; Springer-Verlag Berlin Heidelberg., ISBN: 978-3-642-32537-3