Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial

Abstract

Aims To investigate the effectiveness of a 3-year worksite lifestyle intervention on cardiovascular metrics and to study whether outcomes are influenced by baseline subclinical atherosclerosis (SA) by non-invasive imaging. Methods and results A randomized controlled trial was performed to compare a lifestyle intervention with standard of care in asymptomatic middle-aged subjects, stratified by SA. The intervention consisted of nine motivational interviews during the first year, followed by three further sessions between Years 1 and 3. The primary outcome was the change in a pre-specified adaptation of the Fuster-BEWAT score (Blood pressure, Exercise, Weight, Alimentation, and Tobacco) between baseline and follow-up Years 1–3. A total of 1020 participants (mean age 50 ± 4 years) were enrolled, of whom 510 were randomly assigned to the intervention and 510 to the control group. The baseline adapted Fuster-BEWAT score was 16.2 ± 3.7 points in the intervention group and 16.5 ± 3.5 points in the control group. At Year 1, the score improved significantly in intervention participants compared with controls [estimate 0.83 (95% CI 0.52–1.15) points]. However, intervention effectiveness decreased to non-significant levels at Year 3 [0.24 (95% CI –0.10 to 0.59) points]. Over the 3-year period, the intervention was effective in participants having low baseline SA [0.61 (95% CI 0.30–0.93) points] but not in those with high baseline SA [0.19 (95% CI –0.26 to 0.64) points]. Conclusion In middle-aged asymptomatic adults, a lifestyle intervention was associated with a significant improvement in cardiovascular health and behavioural metrics. The effect attenuated after 1 year as the intensity of the intervention was reduced. Trial registration ClinicalTrials.gov (NCT02561065).

Exploring the Role of Wearable Electronic Medical Devices in Improving Cardiovascular Risk Factors and Outcomes Among Adults: A Systematic Review

“…Increased physical activity is likely the most profound benefit of wearable devices [3,[13][14][15][16]18,22,25,27]. Physical activity is a modifiable risk factor [8].…”

“…Therefore, in instances of professional mentorship toward better cardiac health, while monitoring devices are helpful, they may not necessarily be central and cannot be regarded as a game-changer [ 16 ]. Due to the effect on physical activity, sedentary lifestyles, including occupations that do not demand physical intensity, appear to stand more to gain from these devices [ 3 , 22 , 27 ]. The question then becomes, “what is the main role of these devices on modifiable cardiovascular disease risk factors other than increased physical activity?.”…”

“…Furthermore, the varied forms of physical activity per age group require a degree of individualization of these devices [ 11 ]. While some studies note an increase in physical activity with improvement in metabolic syndrome [ 3 , 22 , 27 ], they fail to give a clear individualized set-point at which device use, by the duration of wearing, or by other measures may be deemed optimal. The idea of adherence to these devices is undefined [ 14 , 18 ] and cannot be delineated from the intense supervision mentioned in the studies.…”

“…If the use of these devices is to be promoted among diverse ethnic groups [ 11 , 18 ], simplicity must be factored into its use. Finally, the evidence for the utility of these devices seems to tilt in favor of those with sedentary lifestyles [ 22 , 24 , 27 ]. There appears to be no additional benefit to acquiring these devices for people who already engage in healthy physical activity beyond better data-gathering and record-keeping [ 11 ].…”

“…They include smoking cessation, physical activity, healthy eating habits, obesity, high blood pressure, and diabetes [ 30 ]. In the majority of records reviewed in this article, physical activity was noted to be the foremost direct beneficiary of the use of wearable electronic devices [ 3 , 11 , 13 - 16 , 18 , 21 - 24 , 27 ]. According to the CDC, adults need at least 150 minutes of moderate physical activity per week, or 75-150 minutes weekly of vigorous-intensity aerobic physical activity, to be considered to have undergone adequate health promotion [ 31 ].…”