Translational Behavioral Medicine: a pathway to better health

Spring, Bonnie

doi:10.1007/s13142-011-0029-z

Cited by 15 publications

(18 citation statements)

References 19 publications

(26 reference statements)

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“…The cost of lifestyle interventions has traditionally been singled out as the primary implementation challenge, but this is likely the case because lifestyle interventions are one of very few efficacious health services that are not reimbursed by public and commercial health insurance companies. In the inaugural issue of Translational Behavioral Medicine, Spring eloquently discusses the double standard that currently exists in the investment in treatment versus prevention, with far higher standards on rapid return on investment for the latter [29]. Until this health care philosophy shifts, cost will be the burden of either the institution or the patient, neither of which can easily afford it.…”

Section: Progress and The Next Horizonmentioning

confidence: 99%

The current state of lifestyle intervention implementation research: where do we go next?

Pagoto

2011

Behav. Med. Pract. Policy Res.

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In the USA, the prevalence of obesity is 33.8% [1] and type 2 diabetes is 27% [2]. The landmark Diabetes Prevention Program (DPP) showed that a lifestyle intervention facilitating a 7% weight loss had a significantly greater impact on diabetes risk than placebo or metformin with a risk reduction of 58% over 3 years [3]. Similar findings were reported in diabetes prevention studies in Finland and China [4,5]. The impact of lifestyle interventions appears to be long term [3,4]. In the 10-year follow-up of the DPP, the incidence of diabetes in the placebo and metformin groups (who had been offered the lifestyle intervention following the initial intervention period) fell to equal that of the lifestyle group; however, the cumulative incidence of diabetes remained lowest in the lifestyle group [6]. The China Da Qing Study revealed reduced incidence of diabetes from a lifestyle intervention at 20-year follow-up [5]. Widespread availability of lifestyle interventions could have a tremendous impact on public health.In 2003, the United States Preventive Services Task Force assigned intensive lifestyle weight loss interventions, a B grade based on a review of the literature, with fair to good evidence for modest, sustained weight loss [7]. In spite of the evidence, intensive lifestyle interventions have not become a part of standard health care practice and are not a third party reimbursable service, with only a few exceptions. A significant barrier to large-scale adoption is the feasibility of translating intensive lifestyle intervention into real world settings. The DPP lifestyle intervention cost US $2,780 per person over 3 years and required 135 visit hours [8]. Although the cost was not significantly higher than the metformin group, visit time was 3.5 times higher. The amount of visit time is high relative to most services available in the current health care environment. To impact public health, research is needed to inform the process of translation and implementation of intensive lifestyle interventions into affordable, feasible, and sustainable programs not just in healthcare settings but also in community settings such as community centers, worksites, schools, and churches. To catalyze translational research efforts, in 2006, the National Institute for Diabetes and Digestive and Kidney Diseases sponsored a funding initiative for translational research in diabetes prevention and management. Since then, translational work across myriad settings has been forthcoming. In 2009, a systematic review was performed of the seven studies testing translation into community settings of lifestyle interventions specifically based on the DPP [9]. All reported significant weight loss; however, weight loss achieved (2.6-6%) was typically less than that in the DPP (6.9%). Only three examined 1-year outcomes, but all three had significant weight loss at 1 year. I recently surveyed the authors of these seven programs and found that only two were confirmed to be ongoing, one in a hospital setting [10] and the other in the Young Men's...

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Section: Progress and The Next Horizonmentioning

confidence: 99%

The current state of lifestyle intervention implementation research: where do we go next?

Pagoto

2011

Behav. Med. Pract. Policy Res.

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“…Help can quickly be provided for problematic barriers. It then may be feasible for this approach to continue over extended periods, if not, indefinitely, matching what would be expected for continual medical care for any chronic disease or condition [1].…”

Section: Original Researchmentioning

confidence: 99%

“…Maintenance-Treating chronic health conditions through lifestyle changes often requires evidencebased, initially intensive interventions to establish new health behaviors through successive mastery experiences and self-regulation skills so that conditions are abetted or reversed and the behaviors are potentially sustainable [1]. Intensive, evidence-based interventions are costly but potentially can be justified by future disease management offsets, future earnings and tax revenues, and improved health-related quality of life [2].…”

Section: Introductionmentioning

confidence: 99%

Theory-based approach for maintaining resistance training in older adults with prediabetes: adherence, barriers, self-regulation strategies, treatment fidelity, costs

Winett

Davy

Savla

et al. 2015

Behav. Med. Pract. Policy Res.

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Effectively preventing and treating chronic diseases through health behavior changes often require intensive theory-and evidence-based intervention including longterm maintenance components. We assessed the efficacy of theory-based maintenance approaches varying by dose for persistently performing resistance training (RT) with the hypothesis that a higher-dose social cognitive theory (SCT) approach would produce greater RT adherence than lower-dose Standard. The Resist-Diabetes study first established 2×/week resistance training (RT) in a 3-month supervised intervention in older (50-69 years, N=170), overweight to obese (BMI 25-39.9 kg/m 2 ) previously inactive adults who fit prediabetes criteria (fasting glucose concentration=95-125 mg/dl; oral glucose tolerance test 2-h glucose concentration=140-199 mg/dl or both). After the supervised phase, participants (N=159) were then randomly assigned to one of two conditions for transition (3 weeks) and then RT alone in community settings for extended contact, maintenance (6 months), and then no contact (6 months). SCT featured continued tailored, interactive personal, and web-based check-ups focused on RT, self-regulation, and a barrier/strategies approach. Standard involved low-dose, generic personal, and web-based check-ups within the same theoretical approach. SCT and Standard both resulted in similar RT, 2×/week adherence during maintenance (74.4 %) and nocontact phases (53.1 %). Cost analysis indicated the Standard intervention for transition and maintenance was inexpensive ($160). Standard can be translated into practice with the potential for continuous contact and persistence in RT beyond the typical program maintenance phase.

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“…Management of chronic health problems through lifestyle changes often requires evidence-based, intensive interventions to set up new health behaviors through successive self-regulation skills so that conditions are reversed and the behaviors are sustained [26]. Asthma care based on guideline recommendations leads to well-controlled asthma in the majority of patients.…”

Section: Introductionmentioning

confidence: 99%

Development and Implementation of an Evidence-based Self-regulation Intervention: Effect on Knowledge and Perceived Control Among Adult Patients with Asthma

Bayoumy¹,

Osman²

2015

Int J Nurs Clin Pract

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Background: Most chronic diseases are variable and an individual must exercise a significant degree of judgment regarding management. Self management therefore requires that the person understands the illness and actively participate in the treatment process. According to self regulation (SR) theory, individuals are required to set personally important goals that guide their behaviors through goalguidance process. Since, very few or almost no available data to assess self-regulation interventions focused on improving asthma knowledge and control, the current study aimed at evaluating the efficacy of asthma-self-regulation intervention among targeted patients. Methods/Design: A pre/post-test study design was used to compare a six-session asthma-self regulation intervention on participants' outcome. Intervention program was based on the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of participants. Thirty asthmatic patients were recruited for the study.Researchers assessed the effect of the intervention on patients' knowledge gains and control of asthma symptoms. Data were collected at baseline, immediately and two months after the program. Keywords:Asthma, Chronic disease self management, Selfregulation, Knowledge, Asthma control Research Article Open Access IntroductionAsthma is a major public health problem and one of the most common chronic conditions in the world. According to the Global Burden of Disease Study, asthma caused more than 345,000 deaths worldwide in 2010 [1]. In Europe alone, asthma affects 30 million people and the cost of asthma care in Europe is estimated at £18 billion per year; lost productivity accounts for almost £10 billion of this [1]. The second half of the 20 th century was marked by a disturbing increase in frequency of allergic diseases, affecting approximately 20 percent of the global population, and the rate of bronchial asthma amongst adults is 5.4 percent (4.9% in men and 5.8% in women) [2]. Epidemiological studies in Saudi Arabia revealed an increasing prevalence of asthma in the past three decades, which may be attributed to the rapid lifestyle changes related to the modernization of Saudi society, changes in dietary habits, and exposure to environmental factors such as indoor allergens, dust, sand storms, and tobacco [3]. Asthma, a common chronic disorder of the airways in Saudi Arabia affecting more than 2 million Saudis, ranks19 th in terms of disability-adjusted life years [4].Asthma had an enormous impact on patient's wellbeing [5], despite the availability of effective treatments and evidencebased management guidelines [6]. Asthma can result in physical, emotional, and social limitations that can impair patients' quality oflife [7]. There is a growing burden of asthma in terms of morbidity,

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Translational Behavioral Medicine: a pathway to better health

Cited by 15 publications

References 19 publications

The current state of lifestyle intervention implementation research: where do we go next?

The current state of lifestyle intervention implementation research: where do we go next?

Theory-based approach for maintaining resistance training in older adults with prediabetes: adherence, barriers, self-regulation strategies, treatment fidelity, costs

Development and Implementation of an Evidence-based Self-regulation Intervention: Effect on Knowledge and Perceived Control Among Adult Patients with Asthma

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