The Impact of a Web-Based Lifestyle Educational Program (‘Living Better’) Reintervention on Hypertensive Overweight or Obese Patients

Abstract

‘Living Better’, a self-administered web-based intervention, designed to facilitate lifestyle changes, has already shown positive short- and medium-term health benefits in patients with an obesity–hypertension phenotype. The objectives of this study were: (1) to examine the long-term (3-year) evolution of a group of hypertensive overweight or obese patients who had already followed the ‘Living Better’ program; (2) to analyze the effects of completing this program a second time (reintervention) during the COVID-19 pandemic. A quasi-experimental design was used. We recruited 29 individuals from the 105 who had participated in our first study. We assessed and compared their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), eating behavior, and physical activity (PA) level (reported as METs-min/week), at Time 0 (first intervention follow-up), Time 1 (before the reintervention), and Time 2 (post-reintervention). Our results showed significant improvements between Time 1 and Time 2 in SBP (−4.7 (−8.7 to −0.7); p = 0.017), DBP (−3.5 (−6.2 to −0.8); p = 0.009), BMI (−0.7 (−1.0 to −0.4); p < 0.001), emotional eating (−2.8 (−5.1 to −0.5); p = 0.012), external eating (−1.1 (−2.1 to −0.1); p = 0.039), and PA (Time 1: 2308 ± 2266; Time 2: 3203 ± 3314; p = 0.030, Z = −2.17). Statistical analysis showed no significant differences in SPB, DBP, BMI, and eating behavior between Time 0 and Time 1 (p > 0.24). Implementation of the ‘Living Better’ program maintained positive long-term (3-year) health benefits in patients with an obesity–hypertension phenotype. Moreover, a reintervention with this program during the COVID-19 pandemic produced significant improvements in blood pressure, BMI, eating behavior, and PA.

“Own doctor” presence in a web-based lifestyle intervention for adults with obesity and hypertension: A randomized controlled trial

“…Thus, this type of intervention has widely demonstrated its effectiveness in controlling body weight (37-44) and blood pressure figures (45-48) by promoting a healthy lifestyle. In fact, the participants in the experimental group showed greater benefits than those participants in the previous studies implementing the original "Living Better" intervention (17)(18)(19). Perhaps, these differences could be explained by the addition of more multimedia content in this current version of "Living Better.…”

“…The following inclusion criteria were applied to select the study participants: adults aged between 18 and 75 years with hypertension who were overweight (body mass index >24.9 kg/m 2 and <30 kg/m 2 ) or who had type I obesity (body mass index >29.9 kg/m 2 and <35 kg/m 2 ), and who were patients that saw the same physician specialized in hypertension. As previously described ( 18 , 19 ), hypertension was defined as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, or patients taking antihypertensive drugs; in this study all the patients were on antihypertensive treatments. Regarding the exclusion criteria, patients who had not come for at least 1 visit with their specialist in the 5 years prior were excluded from the work.…”

“…More details about the original intervention can be found in Baños et al ( 16 ), Mensorio et al ( 17 ), and Lison et al ( 18 ). Furthermore, considering the suggestions of the participants in these previous studies (mainly to help facilitate usability) and in order to test our current hypothesis, we converted part of the written content into audiovisual materials, as detailed in Múzquiz-Barberá et al ( 19 ). As previously mentioned, the content was identical in both groups, but the doctor who appeared in the audiovisual material differed between the groups.…”

“…Regarding the exclusion criteria, patients who had not come for at least 1 visit with their specialist in the 5 years prior were excluded from the work. In addition, profiles with previous ischemic heart disease, cerebrovascular disease, serious psychiatric disorders, taking more than 3 antihypertensive medications, with physical impairments that could make it difficult to practice exercise, participating in other treatments for weight loss, who had previously participated in our "Living Better" intervention (17)(18)(19), and/or without internet access were also excluded from this current study.…”

“…Considering all the above, the objective of this present study was to analyze the influence exerted by the identity of the main doctor appearing in the audiovisual content of our e-Health intervention on patients with the obesity-hypertension phenotype in terms of the following variables: body mass index, systolic and diastolic blood pressure, number of antihypertensive drugs used, physical activity, quality of life, satisfaction and adherence to the intervention. To do this, after 12 weeks of intervention with our "Living Better" web-based program (16)(17)(18)(19), we compared the results in two groups: the control group in which an "unknown doctor" appeared in the audiovisual content, and the experimental group whose audiovisual content instructions were provided by the patients' own hypertension specialist. We hypothesized that (1) all the participants would achieve improvements in the different variables analyzed after the 12-week intervention, regardless of the identity of the doctor present in the audiovisual content delivered to them and (2), patients who saw their own specialist doctor giving them the indications would attain greater benefits than those in the control group.…”