Dietary weight loss and exercise interventions effects on quality of life in overweight/obese postmenopausal women: A randomized controlled trial

Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA, USA. .
International Journal of Behavioral Nutrition and Physical Activity (Impact Factor: 4.11). 10/2011; 8(1):118. DOI: 10.1186/1479-5868-8-118
Source: PubMed


Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior, few studies have compared individual and combined effects of diet and/or exercise interventions on health-related quality of life (HRQOL). In addition, the mechanisms of how these lifestyle interventions affect HRQOL are unknown. The primary aim of this study was to examine the individual and combined effects of dietary weight loss and/or exercise interventions on HRQOL and psychosocial factors (depression, anxiety, stress, social support). The secondary aim was to investigate predictors of changes in HRQOL.
This study was a randomized controlled trial. Overweight/obese postmenopausal women were randomly assigned to 12 months of dietary weight loss (n = 118), moderate-to-vigorous aerobic exercise (225 minutes/week, n = 117), combined diet and exercise (n = 117), or control (n = 87). Demographic, health and anthropometric information, aerobic fitness, HRQOL (SF-36), stress (Perceived Stress Scale), depression [Brief Symptom Inventory (BSI)-18], anxiety (BSI-18) and social support (Medical Outcome Study Social Support Survey) were assessed at baseline and 12 months. The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance, adjusting for baseline scores. Multiple regression was used to assess predictors of changes in HRQOL.
Twelve-month changes in HRQOL and psychosocial factors differed by intervention group. The combined diet + exercise group improved 4 aspects of HRQOL (physical functioning, role-physical, vitality, and mental health), and stress (p ≤ 0.01 vs. controls). The diet group increased vitality score (p < 0.01 vs. control), while HRQOL did not change differently in the exercise group compared with controls. However, regardless of intervention group, weight loss predicted increased physical functioning, role-physical, vitality, and mental health, while increased aerobic fitness predicted improved physical functioning. Positive changes in depression, stress, and social support were independently associated with increased HRQOL, after adjusting for changes in weight and aerobic fitness.
A combined diet and exercise intervention has positive effects on HRQOL and psychological health, which may be greater than that from exercise or diet alone. Improvements in weight, aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.

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    • "e to a specific dietary pattern could have a positive or negative influence on HRQoL in the general population . The large majority of studies regarding nutrition and quality of life have been performed in a clinical setting ( Katcher et al . , 2010 ; Cash et al . , 2012 ) and the SF - 36 was the most widely used measurement tool in this setting ( Imayama et al . , 2011 ; Villareal et al . , 2011 ; Xu et al . , 2012 ) ."
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    ABSTRACT: The increase of non-communicable diseases at all ages has fostered the general concern for sustaining population health worldwide. Unhealthy lifestyles and dietary habits impacting physical and psycho-social health are well known risk factors for developing life threatening diseases. Identifying the determinants of quality of life is an important task from a Public Health perspective. Consumer-Reported Outcome measures of health-related quality of life (HRQoL) are becoming increasingly necessary and relevant in the field of nutrition. However, quality of life questionnaires are seldom used in the nutrition field. We conducted a scientific literature search to find out the questionnaires used to determine the association between dietary habits and quality of life. A total of 13 studies were eligible for inclusion. Across these studies the short form-36, a generic (non-disease specific) HRQoL measurement instrument was the most widely used. However, generic measures may have limited content validity in the context of dietary habits interventions. We recommend additional contextual diet-specific HRQoL measures are also needed for evaluating the impact of diet habits on daily life functioning and well-being.
    Frontiers in Pharmacology 05/2015; 6. DOI:10.3389/fphar.2015.00101 · 3.80 Impact Factor
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    • "Evidence suggests that lifestyle interventions, which include support for exercise and dietary behaviour change, may improve depressive symptoms by improving mood, enhancing self-efficacy expectations, reducing intrusive thoughts about breast cancer and future morbidity/mortality and buffering self-concept perceptions [27,29]. Reductions in body weight and/or body fat and improvements in cardiopulmonary fitness (as observed in the intervention participants [17]) could also have a positive impact on depression scores [30,31]. In addition, biological mechanisms, including the release of monoamine neurotransmitters (that is, serotonin, dopamine and norepinephrine) and endorphins during exercise have been proposed to account for improvements in depressive symptoms in physically active individuals [32]. "
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    ABSTRACT: Many women experience emotional distress, depression and anxiety after a diagnosis of breast cancer. Psychological stress and depression have been associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation that may adversely affect immune system functioning and impact upon survival. This study investigated the effects of a lifestyle intervention on indices of psychological health status, HPA axis regulation and immune function in overweight women recovering from early-stage breast cancer treatment. A total of 85 women treated for breast cancer 3 to 18 months previously were randomly allocated to a 6-month exercise and hypocaloric healthy eating program plus usual care or usual care alone (control group). Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice, supplemented by weekly nutrition seminars. Depressive symptoms (Beck Depression Inventory version II: BDI-II), perceived stress (Perceived Stress Scale: PSS), salivary diurnal cortisol rhythms; inflammatory cytokines (IL-6 and Tumor necrosis factor-alpha), leukocyte phenotype counts, natural killer (NK) cell cytotoxicity and lymphocyte proliferation following mitogenic stimulation were assessed at baseline and 6-month follow up. Compared with the control group, the intervention group exhibited a reduction in depressive symptoms (adjusted mean difference, 95 % confidence intervals (95 % CI): -3.12, -1.03 to -5.26; P = 0.004) at the 6-month follow-up but no significant decrease in PSS scores (-2.07, -4.96 to 0.82; P = 0.16). The lifestyle intervention also had a significant impact on diurnal salivary cortisol rhythm compared with usual care alone, as evidenced by an increase in morning salivary cortisol at the 6-month follow-up (P <0.04), indicating a change in HPA axis regulation. Women in the control group had higher total leukocyte, neutrophil and lymphocyte counts in comparison to the intervention group at the 6-month follow-up (P <=0.05), whereas there was no difference in NK cell counts (P = 0.46), NK cell cytotoxicity (P = 0.85) or lymphocyte proliferation responses (P = 0.11) between the two groups. Our results show that the lifestyle intervention resulted in a reduction in depressive symptoms and a normalisation of HPA axis regulation. Such changes could have important implications for long-term survival in women recovering from early-breast cancer treatment.Trial registration: Current Controlled Trials: ISRCTN08045231.
    Breast cancer research: BCR 04/2014; 16(2):R39. DOI:10.1186/bcr3643 · 5.49 Impact Factor
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    • "In a large military cohort, those who exercised at least 20 min of vigorous activity two times a week were >40% less likely to develop new onset PTSD over >3 year period (Leardmann et al., 2011). Among those experiencing difficulties with stress, aerobic and resistance exercise has been effective in reducing stress-induced cardiac reactivity (King et al., 2002; Faulk and Bartholomew, 2012) and perceived stress (Wilcox et al., 2008), particularly when paired with healthy dietary changes (Imayama et al., 2011) and behavioral modification programming (Atlantis et al., 2004). Given the strong association between stress and CVD, is it possible that part of the health-enhancing power of exercise stems from its ability to mitigate the effects of stress (Milani and Lavie, 2009)? "

    Frontiers in Physiology 11/2013; 4:346. DOI:10.3389/fphys.2013.00346 · 3.53 Impact Factor
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