Janice Sangster

A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol

BackgroundMaintaining a healthy weight and undertaking regular physical activity are important for the secondary prevention of cardiovascular disease (CVD). However, many people with CVD are overweight and insufficiently active. In addition, in Australia only 20-30% of people requiring cardiac rehabilitation (CR) for CVD actually attend. To improve outcomes of and access to CR the efficacy, effectiveness and cost-effectiveness of alternative approaches to CR need to be established.This research will determine the efficacy of a telephone-delivered lifestyle intervention, promoting healthy weight and physical activity, in people with CVD in urban and rural settings. The control group will also act as a replication study of a previously proven physical activity intervention, to establish whether those findings can be repeated in different urban and rural locations. The cost-effectiveness and acceptability of the intervention to CR staff and participants will also be determined.Methods/DesignThis study is a randomised controlled trial. People referred for CR at two urban and two rural Australian hospitals will be invited to participate. The intervention (healthy weight) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks. The coaching sessions will be on weight, nutrition and physical activity and will be supported by written materials, a pedometer and two follow-up booster telephone calls. The control (physical activity) group will participate in a six week intervention previously shown to increase physical activity, consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity, supported by written materials, a pedometer and two booster phone calls. Data will be collected at baseline, eight weeks and eight months for the intervention group (baseline, six weeks and six months for the control group). The primary outcome is weight change. Secondary outcomes include physical activity, sedentary time and nutrition habits. Costs will be compared with outcomes to determine the relative cost-effectiveness of the healthy weight and physical activity interventions.DiscussionThis study addresses a significant gap in public health practice by providing evidence for the efficacy and cost-effectiveness of a low cost, low contact, high reach intervention promoting healthy weight and physical activity among people with CVD in rural and urban areas in Australia. The replication arm of the study, undertaken by the control group, will demonstrate whether the findings of the previously proven physical activity intervention can be generalised to new settings. This population-based approach could potentially improve access to and outcomes of secondary prevention programs, particularly for rural or disadvantaged communities.Trial RegistrationACTRN12610000102077

Maternal and paternal periconceptional nutrition as an indicator of offspring metabolic syndrome risk in later life through epigenetic imprinting: A systematic review

AIMS This review examined whether maternal and paternal periconceptional nutrition effects an offsprings likelihood of developing chronic metabolic related conditions due to epigenetic imprinting. METHODS A literature search was conducted in multiple science databases and limited to studies published after 2012, in English language and peer reviewed. The data from selected articles were extracted and a qualitative approach was employed due to heterogeneity of results. RESULTS Newborns from obese fathers showed altered methylation overall and significant hypomethylation at the Insulin-like Growth Factor 2 (IGF2) gene. High maternal pre-pregnancy body mass index (BMI) was associated with altered offspring DNA methylation levels and gestational diabetes mellitus induced significantly increased methylation levels in offspring. Gestational weight gain was not associated with differentially methylated cord blood. Birth weight was higher in offspring exposed to famine in early gestation. Offspring born post maternal bariatric surgery showed a lower percentage of body fat and improved fasting insulin levels compared to siblings born pre-maternal bariatric surgery. CONCLUSIONS The available evidence suggests that poor maternal and paternal periconceptional nutrition can increase the risk of metabolic syndrome in offspring, through epigenetic imprinting. Potential parents should be advised that maintaining a healthy diet and BMI is likely to reduce the risk of metabolic syndrome in offspring.

Effectiveness of a Pedometer-based Telephone Coaching Program on Weight and Physical Activity for People Referred to a Cardiac Rehabilitation Program: a randomised controlled trial.

PURPOSE: To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity. METHODS: A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6-8 weeks), and medium-term (6-8 months). RESULTS: More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m2 had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term. CONCLUSIONS: Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation.

Where you live matters: Challenges and opportunities to address the urban–rural divide through innovative secondary cardiac rehabilitation programs

OBJECTIVE Only one third of clinically eligible patients attend a cardiac rehabilitation (CR) program. Few studies have looked at participation in rural cardiac patients. This paper examines the risk profile and participation in CR of rural and urban residents with cardiac disease who enrolled in a telephone coaching program. DESIGN, SETTING AND PARTICIPANTS Comparison of baseline characteristics of 173 urban and 140 rural Australians referred to CR, and who enrolled in a telephone-based coaching program. MAIN OUTCOME MEASURES Sociodemographic characteristics, health behaviours and participation in CR programs. RESULTS Rural residents were more likely to enrol in a telephone coaching secondary prevention program (44.7% versus 25.5%, P < 0.001) than urban residents. For those enrolling in the telephone-based program, rural participants were more likely to be obese (42.0% rural versus 28.8% urban, P = 0.02), to rate their health as fair or poor (45% versus 24.3%, P < 0.001) and less likely to be sufficiently physically active (35.3% versus 53.2%, P = 0.002), or follow a special diet for their heart (40.0% versus 56.6%, P = 0.003) compared with urban participants. Those who attended a CR program were more likely to be from an urban location and live closer to a CR program. CONCLUSIONS Rural participants in this study had poorer health profiles and attendance at outpatient CR compared with urban participants. This poses challenges for the provision of secondary prevention programs for rural cardiac patients and highlights opportunities to trial innovative delivery models, such as telephone-based programs, to reach people that would otherwise not have access.

A Comparison of the Cost-effectiveness of Two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease

INTRODUCTION Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. METHODS A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. RESULTS The estimated cost of delivering the interventions was

Assessing the availability, price, nutritional value and consumer views about foods and beverages from vending machines across university campuses in regional New South Wales, Australia

201.48 per Healthy Weight participant and

Food provision among food relief agencies in rural Australia, and perceived barriers and enablers to provide healthy food

138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was

A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE trial

1,260 per Healthy Weight participant and

Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation

2,112 per Physical Activity participant, a difference of

Corrigendum to ‘A Comparison of the Cost-effectiveness of two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease’: [Heart, Lung and Circulation (2015) 24, 471–479]

852 in favour of the Healthy Weight intervention. Healthy Weight participants gained an average of 0.007 additional QALYs than did Physical Activity participants. Thus, overall the Healthy Weight intervention dominated the Physical Activity intervention (Healthy Weight intervention was less costly and more effective than the Physical Activity intervention). Subgroup analyses showed the Healthy Weight intervention also dominated the Physical Activity intervention for rural participants and for participants who did not attend CR. CONCLUSIONS The low-contact pedometer-based telephone coaching Healthy Weight intervention is overall both less costly and more effective compared to the Physical Activity intervention, including for rural cardiac patients and patients that do not attend CR.