Jeroen C.M. Barte

Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review

Lifestyle interventions can reduce body weight, but weight regain is common and may particularly occur with higher initial weight loss. If so, one may argue whether the 10% weight loss in clinical guidelines is preferable above a lower weight loss. This systematic review explores the relation between weight loss during an intervention and weight maintenance after at least 1 year of unsupervised follow‐up. Twenty‐two interventions (during at least 1 month) in healthy overweight Caucasians were selected and the mean percentages of weight loss and maintenance were calculated in a standardized way. In addition, within four intervention groups (n > 80) maintenance was calculated stratified by initial weight loss (0–5%, 5–10%, >10%). Overall, mean percentage maintenance was 54%. Weight loss during the intervention was not significantly associated with percentage maintenance (r = −0.26; P = 0.13). Percentage maintenance also not differed significantly between interventions with a weight loss of 5–10% vs. >10%. Consequently, net weight loss after follow‐up differed between these categories (3.7 vs. 7.0%, respectively; P < 0.01). The analyses within the four interventions confirmed these findings. In conclusion, percentage maintenance does not clearly depend on initial weight loss. From this perspective, 10% or more weight loss can indeed be encouraged and favoured above lower weight loss goals.

Maintenance of lifestyle changes : 3-Year results of the Groningen Overweight and Lifestyle study

OBJECTIVE This study aims to evaluate the three-year effect of lifestyle counseling by a nurse practitioner (NP) on physical activity (PA) and dietary intake compared with usual care by a general practitioner (GP). METHODS At baseline, subjects were randomly allocated to the NP group (n = 225) or to the GP group (n = 232). The NP group received a low-intensive lifestyle intervention for three years by the NP and the GP group received one consultation by the GP and thereafter usual care. PA and dietary intake were assessed with questionnaires at baseline, 1 year follow-up and 3 year follow-up. RESULTS After three years, leisure-time activity increased and favorable improvements towards a healthy diet were made for both groups. These three-year changes in PA and diet did not differ significantly between groups. Changes in PA and dietary habits after one year were practically maintained after 3 years, because only small relapses were found. CONCLUSION After three years, subjects were more physically active and had a healthier diet compared to baseline. Lifestyle counseling by NP resulted in similar lifestyle changes compared to GP consultation. PRACTICE IMPLICATIONS NPs could also advice patients at cardiovascular risk by lifestyle counseling, to possibly reduce GP barriers.

Process Evaluation of a Lifestyle Intervention in Primary Care: Implementation Issues and the Participants' Satisfaction of the GOAL Study

The Groningen Overweight and Lifestyle (GOAL) intervention effectively prevents weight gain. The present study describes a process evaluation in which 214 participants in the intervention group received a structured questionnaire within 7 months (a median of 5 months) after the end of the intervention. The authors investigated the content of the intervention (on basis of the participants’ recall), the participants’ satisfaction of the intervention, the participants’ satisfaction with the nurse practitioners (NPs), and the determinants of the participants’ satisfaction. In general, the results show that the content corresponded well with the protocol for the intervention, except for the number of telephone calls and the percentage of participants with individualized goals for a healthy lifestyle. The overall satisfaction of the participants was high, and success and perceived success and a low educational level were important determinants for a higher overall satisfaction grade. Furthermore, the NP was considered to be an expert and motivational to learning and keeping up a healthy lifestyle. The authors therefore conclude that the GOAL study is feasible and indicates that the NP is well equipped to treat these patients. However, it is recommended to reinforce the advice given and the lifestyle goals after the first contact sessions.

Fatigue experiences in competitive soccer: Development during matches and the impact of general performance capacity

ABSTRACT Background: Fatigue as a result of prolonged activity may increase injury risk and decrease performance. Purpose: To provide insight in the development of fatigue experiences during soccer matches and the extent to which general performance capacity (i.e. overall physical fitness, psychological fitness, and recovery) contributes to these fatigue experiences. Methods: 450 Soccer players from the highest divisions in the Netherlands completed a questionnaire to assess (a) fatigue experiences (feeling tired, physically exhausted, not fit, weak, and mentally exhausted: not at all [1] – very much [7]) during a typical match; and (b) subjective indices of general performance capacity (i.e. general capacity to handle workload). Results: On average, fatigue levels were reported to be moderate. Fatigue increased primarily during the second half of the match and only a small decrease in fatigue was observed during half time. Generally, higher intensity fatigue experiences were reported by attackers than defenders. Regression analyses showed that players’ general performance capacity explained a substantial part of fatigue at the start of a match and also predicted the development of fatigue experiences during a match, with low performance capacity being associated with higher baseline levels of fatigue and a steeper increase in fatigue over time. Conclusions: The observed association between players’ general performance capacity and their fatigue levels during matches suggests that periodic screening of general performance capacity can be informative with regard to the employability of players across different stages of match-play and as such, aid in reducing injury risk and increasing performance.

Implementation of the 'BeweegKuur' in practice: Utilization of care of a lifestyle intervention in the Netherlands

This study investigates the delivered care in a multidisciplinary lifestyle intervention by dieticians and physiotherapists compared to the protocol of this intervention. Participants with a body mass index (BMI) between 25 and 40 kg m− 2 were divided over three different programs depending on their BMI and comorbidities. All these programs consisted of individual and group sessions with the dietician, while care by the physiotherapist differed by program. The dieticians and physiotherapists of 30 locations were contacted to provide data about health care use within the intervention from their health records. Data of 379 participants were available and showed that group sessions by dieticians were often not attended. Care by the physiotherapist was delivered according to the protocol to a larger extent. An average of 43–93% of the sessions was attended. The level of attendance is comparable to other interventions, but especially attendance at group sessions with dieticians should be improved.

Effects of fatigue on interception decisions in soccer

In competitive soccer, match-induced fatigue is a common phenomenon that may negatively influence performance. Focusing on decision-making, the current study experimentally tested the impact of fatigue on players’ interception decisions and, in doing so, also took into account potential effects on physical capacity and motivation. Using a counterbalanced pretest–posttest design, 30 well-trained amateur soccer players were tested in a fatigued state vs. a non-fatigued control state (i.e. after performing a simulated soccer match and after watching soccer on television). Before and after both protocols, players performed a sprint test and an interception test in which they were instructed to either intercept or not intercept passes of different speeds. Dependent variables included physical capacity (i.e. maximal sprint capacity), motivation to intercept, decisions to intercept, and success rate of interceptions. Results showed that motivation to intercept but not sprint capacity was negatively affected by fatigue. Despite changes in motivation, fatigue did not significantly affect the number of interception attempts or the success rate of interceptions. In conclusion, findings suggest that match-induced fatigue reduces players’ self-reported motivation to engage in effortful actions (i.e. interception attempts) but does not necessarily affect objective (maximal) physical capacity and decision-making.

De GOAL-studie: een leefstijlinterventie voor patiënten met overgewicht en obesitas ter voorkoming van verdere gewichtsstijging

SamenvattingIn de GOAL-studie zijn de effecten van leefbegeleiding door praktijkondersteuners bij ruim vierhonderd patiënten met overgewicht en obesitas in Nederland onderzocht. In deze bijdrage worden de effecten na één en drie jaar, evenals de tevredenheid van de deelnemers over hun eigen gewicht, hun eigen gezondheid, de interventie(componenten) en de praktijkondersteuner als uitvoerder van de interventie onderzocht. Na drie jaar bleek de interventie bij ruim 60% van de mensen gewichtstoename te hebben voorkomen. Het (ervaren) succes was een belangrijke voorspeller voor de tevredenheid van de patiënt. Patiënten met gewichtsverlies vonden ook dat de adviezen over gezonde leefstijl meer kennis toevoegden dan patiënten met een gewichtsstijging. Na afloop waren de deelnemers over het algemeen tevreden over de inhoud van de interventie(componenten) en over de praktijkondersteuner als uitvoerder ervan. Leefstijladvisering in de eerste lijn kan dus heel goed worden uitgevoerd door de praktijkondersteuner.