Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program

Abstract

BackgroundPoor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases.MethodsHere we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months.ResultsChanges in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications.ConclusionImplementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.

Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre–post observations in 210 consecutive patients

“…A similar programme run in the USA, the ‘Lifestyle 180 programme’, reported similar improvements in waist and hip circumference, however, body fat was not measured 25. In contrast to our results, they also reported improvements in body weight and BMI 25. The most likely explanation for this difference is that the duration of the ‘Lifestyle 180’ programme was 30 weeks, while the U-Turn programme was only 12 weeks long.…”

“…This occurred although over 70% of participants were using cholesterol-lowering medication and the lipid profiles of the majority of participants were well controlled at the start of the programme. The reduction in total cholesterol, LDL and triglycerides observed is consistent with the Lifestyle 180 study despite the shorter duration of the U-Turn programme 25. However, Lifestyle 180 reports an increase in HDL, which was not observed in our study 25.…”

“…The reduction in total cholesterol, LDL and triglycerides observed is consistent with the Lifestyle 180 study despite the shorter duration of the U-Turn programme 25. However, Lifestyle 180 reports an increase in HDL, which was not observed in our study 25. Another similar programme conducted over 6 months demonstrated a reduction in the total cholesterol/HDL ratio; however, the authors did not report individual total cholesterol, LDL or HDL results 39…”

“…There was no change in fasting glucose concentrations, in contrast to the Lifestyle 180 study which showed a decrease in fasting glucose 25. Indeed, the mean fasting glucose concentrations in the patients in this study indicate that control could be improved.…”

“…While many single-disease (disease-centred) programmes have been described and evaluated,21–24 this programme is, to the best of our knowledge, unique because it (1) has been developed and implemented in the SEM setting using the unique skill set of the SEM physicians, (2) is a patient-centred chronic disease programme, (3) is aimed at patients with active disease status and multiple comorbidities, (4) provides the patient with comprehensive lifestyle interventions (exercise, psychosocial intervention, nutritional intervention, social habit counselling) and (5) included a risk of musculoskeletal injury screening and intervention programme. We are only aware of similar programmes that have been described for patients with risk factors for cardiac and other diseases (hypertension, hypercholesterolaemia and metabolic syndrome), but these programmes did not cater to patients with active cardiac and other diseases,25 and did not include any other elements (1, 2 and 5) listed above.…”