Laurey R. Simkin-Silverman

Evaluation of motivationally tailored vs. Standard self-help physical activity interventions at the workplace

Purpose. This study compares the efficacy of a self-help intervention tailored to the individuals stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. Design. Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. Setting. Eleven worksites participating in the Working Healthy Research Trial. Subjects. Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. Intervention. Printed self-help exercise promotion materials either (1) matched to the individuals stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). Measures. Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. Results. Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. Conclusions. This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individuals stage of motivational readiness for exercise adoption.

Lifestyle intervention can prevent weight gain during menopause: Results from a 5-year randomized clinical trial

Context: Menopausal-related weight gain and increased waist circumference have major cardiovascular health implications for older women. The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease (CVD) risk factors from the peri- to postmenopause is unknown.Objective: To report the 54-month results of a lifestyle dietary and physical activity program on weight, body composition, physical activity, diet, and other CVD risk factors.Design: Data are from a 5-year randomized clinical trial known as the Women’s Healthy Lifestyle Project, conducted from 1992 to 1999.Participants: 535 healthy, premenopausal women ages 44 to 50 at study entry enrolled into the trial.Intervention: Participants were randomly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment-only control group. The lifestyle intervention group was given modest weight loss goals (5–15 lb, or approximately 2.3–6.8 kg) to prevent subsequent gain above baseline weight by the end of the trial. To achieve weight loss and lower low-density lipoprotein cholesterol levels, intervention participants followed an eating pattern consisting of 1,300 kcal/day (25% total fat, 7% saturated fat, 100 mg of dietary cholesterol) and increased their physical activity expenditure (1,000–1,500 kcal/week).Main Outcome Measures: Regarding weight gain prevention, 55% (136/246) of intervention participants were at or below baseline weight compared with 26% (68/261) of controls after 4.5 years, χ(2, N = 507) = 45.0, p < .001. The mean weight change in the intervention group was 0.1 kg below baseline (SD = 5.2 kg) compared with an average gain of 2.4 kg (SD = 4.9 kg) observed in the control group. Waist circumference also significantly decreased more in the intervention group compared with controls (M = −2.9 cm, SD = 5.3 vs. M = −0.5 cm, SD = 5.6, p < .001). Moreover, participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls. Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance.Conclusions: In healthy women, weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention.

Women’s Healthy Lifestyle Project: A Randomized Clinical Trial Results at 54 Months

Background—The Women’s Healthy Lifestyle Project Clinical Trial tested the hypothesis that reducing saturated fat and cholesterol consumption and preventing weight gain by decreased caloric and fat intake and increased physical activity would prevent the rise in LDL cholesterol and weight gain in women during perimenopause to postmenopause. Methods and Results—There were 275 premenopausal women randomized into the assessment only group and 260 women into the intervention group. The mean age of participants at baseline was 47 years, and 92% of the women were white. The mean LDL cholesterol was 115 mg/dL at baseline, and mean body mass index was 25 kg/m2. The follow-up through 54 months was excellent. By 54 months, 35% of the women had become postmenopausal. At the 54-month examination, there was a 3.5-mg/dL increase in LDL cholesterol in the intervention group and an 8.9-mg/dL increase in the assessment-only group (P =0.009). Weight decreased 0.2 lb in the intervention and increased 5.2 lb in the assessment-only group (P =0.000). Triglycerides and glucose also increased significantly more in the assessment-only group than in the intervention group. Waist circumference decreased 2.9 cm in the intervention compared with 0.5 cm in the assessment-only group (P =0.000). Conclusions—The trial was successful in reducing the rise in LDL cholesterol during perimenopause to postmenopause but could not completely eliminate the rise in LDL cholesterol. The trial was also successful in preventing the increase in weight from premenopause to perimenopause to postmenopause. The difference in LDL cholesterol between the assessment and intervention groups was most pronounced among postmenopausal women and occurred among hormone users and nonusers.

Using the Internet to translate an evidence-based lifestyle intervention into practice.

Despite evidence-based recommendations for addressing obesity in the clinical setting, lifestyle interventions are lacking in practice. The objective of this study was to translate an evidence-based lifestyle program into the clinical setting by adapting it for delivery via the Internet. We adapted the Diabetes Prevention Programs lifestyle curriculum to an online format, comprising 16 weekly and 8 monthly lessons, and conducted a before-and-after pilot study of program implementation and feasibility. The program incorporates behavioral tools such as e-mail prompts for online self-monitoring of diet, physical activity, and weight, and automated weekly progress reports. Electronic counseling provides further support. Physician referral, automated progress reports, and as-needed communication with lifestyle coaches integrate the intervention with clinical care. We enrolled 50 patients from a large academic general internal practice into a pilot program between November 16, 2006 and February 11, 2007. Patients with a body mass index (BMI) =25 kg/m2, at least one weight-related cardiovascular risk factor, and Internet access were eligible if referring physicians felt the lifestyle goals were safe and medically appropriate. Participants were primarily female (76%), with an average age of 51.94 (standard deviation [SD] 10.82), and BMI of 36.43 (SD 6.78). At 12 months of enrollment, 50% of participants had logged in within 30 days. On average, completers (n = 45) lost 4.79 (SD 8.55) kg. Systolic blood pressure dropped 7.33 (SD 11.36) mm Hg, and diastolic blood pressure changed minimally (+0.44 mm Hg; SD 9.27). An Internet-based lifestyle intervention may overcome significant barriers to preventive counseling and facilitate the incorporation of evidence-based lifestyle interventions into primary care.

The psychological consequences of weight gain prevention in healthy, premenopausal women

OBJECTIVE This study examined the psychological consequences of a modest weight loss in a sample of healthy women aged 44 to 50. METHOD Five hundred and thirty-five women, with body mass indices (BMIs) ranging from 20 to 34, were randomly assigned either to an intensive behavioral lifestyle intervention or to a no-treatment control group. Women in the lifestyle intervention received weight loss goals of 5 to 15 lb, depending on baseline BMI, and attended 20 weekly group meetings during which they received information on lowering dietary fat intake and increasing physical activity levels. Psychological measures administered at baseline and at a 6-month examination assessed perceived stress, mood, dietary restraint, and binge eating behaviors. RESULTS Intervention subjects showed significant decreases in depressive symptoms over time, relative to control subjects, and this effect was observed for normal-weight, as well as heavier, subjects. Binge eating scores for all subjects declined significantly over time, with heavier subjects in the intervention showing the greatest decrease in scores. DISCUSSION The current study found no evidence of negative psychological sequelae of participation in a behavioral lifestyle change program, regardless of weight status. Results further suggest that participation in these types of programs may exert a positive influence on the psychological status of both normal-weight and heavier women.

Weight gain during menopause. Is it inevitable or can it be prevented

PREVIEW Weight gain at menopause increases the risk of high blood pressure, high blood lipid levels, and insulin resistance. Some studies have suggested that increased weight is linked with hormonal changes and might be considered “normal.” Does this mean women face inexorable weight gain at menopause, or are there ways to overcome this problem? In this article, the authors review long-term studies related to changes that occur at menopause and define the factors that can be altered to avoid weight gain and the many problems associated with it.

Urinary markers of estrogen metabolism 2- and 16α-hydroxylation in premenopausal women

Abstract There is considerable scientific interest in whether measurement of the major estrogen metabolites 2- and 16α-hydroxyestrone will shed light on the role of estrogen in the risk of breast cancer. These have been difficult to measure in large numbers because of the need for radiolabeled tracers, but a new assay is able to utilize spot urine samples. The main objective of this study was to assess the reliability of a newly developed enzyme immunoassay (EIA) for the measurement of 2- and 16α-hydroxyestrone in urine samples collected from a large group of healthy premenopausal women enrolled in a clinical trial. A secondary objective was to assess the impact of several factors such as body weight on the urinary estrogen metabolite ratios. The study cohort included 174 women aged 44–50, who were enrolled in the Cardiovascular Risk Factors and Menopause Trial, also referred to as the Womens Healthy Lifestyle Project (WHLP), an ongoing 5-year clinical trial of 535 premenopausal women randomized either to an intensive dietary life-style intervention group or to an assessment-only control group. Measurements of 2- and 16α-hydroxyestrone showed a high intraclass correlation for blind duplicate urine samples ( R = 0.94 and R = 0.80), cross-sectionally and over time ( R = 0.79 and R = 0.62), in this population of healthy premenopausal women. The intervention diet (of 25% of total calories from fat) did not appear to influence the estrogen metabolite ratio. This new estrogen metabolite EIA demonstrates good reliability and thus may be appropriate for use in large epidemiologic studies of estrogen-related diseases. There was no relation between dietary fat reduction, weight loss, and increased exercise and change in the ratio among premenopausal women in this study.

Segment-Specific Effects of Cardiovascular Risk Factors on Carotid Artery Intima-Medial Thickness in Women at Midlife

Objective—We investigated associations between segment-specific carotid intima-medial thickness (IMT) and cardiovascular risk factors collected before menopause for insight into mechanisms of atherosclerosis development. Methods and Results—Participants were 453 healthy women (aged 46 to 58 years) enrolled in a dietary and physical activity randomized clinical trial. Ultrasound scan measures were taken ≈2.7 years after baseline in the common carotid artery (CCA), bifurcation (bulb), and internal carotid artery (ICA) segments. When scanned, 84% remained premenopausal. In linear regression models adjusted for age, menopausal status, and intervention group, measures independently (P<0.05) and positively associated were as follows: baseline weight (&bgr;=0.007 per 5 kg), systolic blood pressure (SBP; &bgr;=0.008 per 10 mm Hg), and age (&bgr;=0.02 per 5 years) with CCA IMT; smoking (&bgr;=0.08), weight (&bgr;=0.009), and SBP (&bgr;=0.02) with bulb IMT; and apoprotein B (&bgr;=0.01 per 0.1 g/L) with ICA IMT. Differential effects in a repeated measures model with all 3 IMT locations showed these risk factors to have segment-specific positive associations. The effect of weight was strongest in the CCA, smoking and SBP were specific to the bulb, and apoprotein B was strongest in the ICA segment. Conclusion—Analyses indicate that cardiovascular risk factors may differentially affect IMT in the CCA, bulb, and ICA segments of healthy middle-aged women.

Lifetime weight cycling and psychological health in normal-weight and overweight women.

OBJECTIVE The relationship between weight cycling history and psychological health was studied in a sample of 429 normal-weight and overweight women. METHOD Participants were from the Healthy Women Study, a longitudinal investigation of biological and psychosocial aspects of menopause. Participants were asked to report retrospectively details on their weight cycling history in terms of the frequency and magnitude of previous weight loss episodes. Data were examined using the total cycle weight lost and the frequency of weight cycles > or = 10 lb. Self-reported measures of depression, stress, anxiety, and anger were used to evaluate psychological health. RESULTS For both normal-weight and overweight women, the analyses revealed no adverse relationships between weight cycling history and the psychological measures. DISCUSSION These findings suggest that a history of weight cycling regardless of weight status does not adversely impact psychological health.

Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention.

BACKGROUND The decision to take hormone replacement therapy (HRT) is a choice many women encounter when entering menopause. The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause. METHODS The Womens Healthy Lifestyle Project is a randomized clinical trial designed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause. Participants (N = 535) completed questionnaires and were interviewed regarding menopausal symptoms, menopausal status, hot flashes, and HRT use at baseline and 54 months. RESULTS The intervention was successful in preventing risk elevation through the 54-month visit. At the final visit, there was no difference between the intervention and control groups in the percentage who had become postmenopausal (32.9% vs 35.0%, respectively), there was no difference between control and intervention with HRT use, with 31.2% reporting use of HRT, and there was no difference between groups with menopausal symptoms. The women started HRT an average of 6 months after they missed a period. Baseline risk factors did not predict HRT use at the 54-month visit. CONCLUSIONS A sizable number of women reported HRT use. The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk, and these women started HRT very early in the peri- to postmenopause. Further, weight loss in the perimenopause did not affect menopausal symptoms.