Using response variation to develop more effective, personalized behavioral medicine?: evidence from the Resist Diabetes study

Abstract

Health behavior interventions have achieved some notable outcomes through generally higher dose interventions with intensive initial phases and longterm, faded contact maintenance phases with attention to mean changes and adherence rates. Interventions may be improved by shifting attention to the very large response variation that is typical for such protocols as exercise with non-, low, moderate, and high responders and even those who show adverse responses. Data from the Resist Diabetes study, which included adults (N=159, ages 50-69 years) with prediabetes who were overweight or obese (BMI 25-39.9 kg/m 2 ) and previously inactive, are presented. The data show a typical pattern of wide variation for changes on a 2-h oral glucose tolerance test (OGTT), defined by blood glucose concentration measured after 2 h following ingestion of 75 g of glucose, lean body mass, fat mass, strength, and blood pressure to the same resistance training protocol within a highly supervised phase and where adherence was high. A personalized behavioral medicine approach could focus on such individual patterns of response variation to tailor and alter additional intervention components, the staging of maintenance interventions, and then determining how to most effectively, and systematically, translate this adaptive intervention approach into practice to potentially achieve more optimal clinical outcomes. Implications Policy: Health behavior, lifestyle change programs are essential for reducing the costs and burdens of preventable diseases, but more optimal clinical outcomes may be achieved with personalized behavioral medicine programs that are designed for tailoring based on individual response patterns. KeywordsResearch: Research within personalized behavioral medicine can focus on how to design health behavior interventions with tailoring and adaptation based on individual response patterns and then translating this new adaptive intervention approach into practice.Practice: The wide variation in response to most treatment protocols such as exercise with non-, low, moderate, and high responders and even those who experience an adverse response is a key to more personalized behavioral medicine and can be a focus when designing initiation and maintenance phases of interventions requiring alteration and tailoring of adaptive interventions based on individual response to achieve optimal clinical outcomes. TBMpage 333 of 338

Prevalence of Non-responders for Glucose Control Markers after 10 Weeks of High-Intensity Interval Training in Adult Women with Higher and Lower Insulin Resistance

“…For example, for glucose control variables, several authors have observed that after 3 months of strength training (2 days/week, 2 strength exercises at maximal effort), the NRs prevalence for improvements in an OGTT in pre-diabetic patients was 44%. In the present study, we found a NRs prevalence of 15 and 25% in the H-IR and L-IR groups, respectively, for decreased fasting glucose, with no significant difference between the groups (to see Table 3 ; Winett et al, 2014 ). Regarding HOMA-IR, the HERITAGE study (Boulé et al, 2005 ) showed that after 20 weeks of endurance training [30–50 min/session, 55–75% maximum oxygen uptake (VO 2 max) for 20 weeks], 42% of subjects were NRs for a decrease in HOMA-IR scores.…”

“…There is limited evidence about interindividual variability in exercise training with regard to the NRs prevalence in subjects with low glucose control, and there are several methodological differences in studies comparing the NRs prevalences observed in previous studies (Boulé et al, 2005 ; Gremeaux et al, 2012 ; Yates et al, 2013 ; Moker et al, 2014 ; Winett et al, 2014 ; Higgins et al, 2015 ). For example, for glucose control variables, several authors have observed that after 3 months of strength training (2 days/week, 2 strength exercises at maximal effort), the NRs prevalence for improvements in an OGTT in pre-diabetic patients was 44%.…”

Resist diabetes: A randomized clinical trial for resistance training maintenance in adults with prediabetes

“…The overall retention rate was 76% ( Fig 1 ). Adherence to the twice weekly RT sessions during the 3-month Initiation Phase was 91% (i.e., 22 of 24 sessions completed) [ 34 ]. Self-reported adherence among those present at assessment sessions, using the time-line follow-back calendars completed at month 9, was 78% and 72% in the SCT and Standard groups, respectively.…”

Update on the effects of physical activity on insulin sensitivity in humans

“…While there is unequivocal evidence for PA improving population and participant group mean values, indicating positive changes in the majority of participants within the data, it is evident that there is considerable variation in the magnitude of response to exercise interventions within the population: with some individuals displaying considerably greater changes in a variety of health-related outcome measures than others, despite adhering to the same exercise regimen. 98 Additionally, the magnitude of change in one factor, such as VO 2 peak , is not necessarily associated with the magnitude of change in another factor. For example, in the HART-D study, a 9-month exercise training intervention for patients with T2DM, 99 57% of participants displayed an increase in their peak oxygen uptake (VO 2 peak ), while the remaining 43% exhibited no change.…”