Lifestyle medicine (Hoboken, N.J.)最新文献

Introduction

Lifestyle interventions combining caloric restriction with resistance exercise have the potential to preserve lean mass during weight loss. Additional protein intake can further improve lean mass. However, it is unclear whether these effects are sustained after completion of the intervention. This study aimed to evaluate the long-term effect of a 3-month lifestyle intervention, with or without supplementation of a protein drink, to preserve lean mass in older adults with obesity and type 2 diabetes at 6 months post-intervention.

Methods

Adults (n = 123) aged ≥55 years with obesity and type 2 diabetes were enrolled in a 3-month intensive lifestyle intervention including a hypocaloric diet, resistance exercise and high-intensity interval training. Participants were randomized to either receive a leucine and vitamin D-enriched protein drink or an isocaloric control drink. The 3-month intervention was followed by a 6-month phase without intervention. At baseline, 3 and 9 months (follow-up) body composition, physical functioning, physical activity and quality of life were assessed. Statistical analyses were performed using linear mixed models.

Results

Body weight loss was largely sustained at follow-up (−2.1 kg compared to baseline, 95% CI [−2.8, −1.5]) and comprised a sustained loss of fat mass (−2.6 kg, 95% CI [−3.2, −2.0]) with a simultaneous gain of lean mass (+0.7 kg, 95% CI [+0.2, +1.2]). Improvements in 400 m walk speed (+0.05 m/s, 95% CI [+0.03, +0.08]) and chair stand test time (−1.5 s, 95% CI [−1.9, −1.1]) were sustained at follow-up. There were no differences in these changes between the protein supplementation group and the control group at follow-up.

Conclusions

Older adults with obesity and type 2 diabetes preserved their lean mass, their loss of fat mass and their improvements in physical functioning at 6 months post-intervention. Protein supplementation during intervention did not affect outcomes at follow-up.

Background

Adopting a healthy lifestyle and improvements in medical care have led to an increase in life expectancy. Thus, the development and implementation of techniques for assessing healthy lifestyles have garnered more attention recently. Finding and evaluating healthy lifestyle assessment tools across all demographics is the goal of this systematic review.

Method

Using online databases PubMed, Scopus, Web of Science, and APA PsycINFO, a systematic literature review was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses. Registration DOI https://doi.org/10.17605/OSF.IO/ZD9XK for the review has been set on Open Science Framework (OSF). Using the quality standards proposed for measuring features of health status surveys, two independent reviewers evaluated the methodological quality ratings of the eligible studies.

Results

From 7480 studies, 47 eligible instruments were identified and included in the review. Most of the studies followed the World Health Organization's definition of healthy lifestyle to develop the scales. The instruments are categorized into those used to assess general lifestyle or healthy lifestyle in general as well as in the clinical population. Physical activity, nutrition, tobacco use, alcohol use, and stress management were the most assessed modules of healthy lifestyle. Furthermore, validity, reliability, responsiveness, floor and ceiling effects, and interpretability were among the psychometric qualities that were frequently assessed.

Conclusion

Lifestyle questionnaires can be used to identify specific risk factors in a variety of populations, as well as to plan community-based intervention programs, by acting as a predictive diagnostic tool and preventive measure. The majority of the assessments of healthy lifestyles that are currently accessible require improvements.

Introduction

This reflective essay explores a medical student's evolving understanding of the relative roles of technical and interpersonal skills in shaping the patient experience.

Methods

The author's personal reflections on the relative roles of technical and interpersonal skills are supplemented with discussion of relevant literature.

Results and Discussion

Initially focused on the technical aspects of medicine, the author's perspective shifts upon entering clinical practice. The essay begins by emphasising the importance of interpersonal skills in patient satisfaction, drawing on personal experiences from general practice and supporting literature. However, a pivotal experience on a respiratory ward reveals the profound impact of interpersonal skills on both patient satisfaction and clinical outcomes. With further reflection incorporating relevant literature, it becomes clear that this case in-fact underscores the interplay between technical knowledge and interpersonal skills.

Conclusion

The reflective exploration concludes with the insight that these skillsets are not independent but interdependent and synergistic. The essay thus advocates for an integrated approach (combining technical expertise with strong interpersonal communication) to foster patient partnerships and enhance the overall patient experience.

Introduction

Loneliness can have a negative impact on people's physical and psychological well-being; building social capital is a potential means of addressing this connection. Community initiatives (e.g. groups, clubs, neighbourhood activities) may be a route that enables people to build social capital to tackle loneliness. Understanding what is known, and where gaps in knowledge exist, is important for advancing research on this topic.

Methods

A scoping review was undertaken to explore the question – What community initiatives, with a focus on well-being, have been evaluated in the United Kingdom that include information about social capital and loneliness? Four databases (Medline, CINAHL, ASSIA and Embase) were searched for relevant research papers. References were screened by two researchers to identify if they met the review's inclusion criteria. Data were summarised as a narrative and in tables.

Results

Five papers met the review's inclusion criteria. They all used qualitative methods. Findings suggested that social capital could be developed through creating a sense of trust, group cohesion and reciprocity among participants in the community initiatives. This connection enabled people to experience a sense of belonging and to feel they had a meaningful relationship with others, which appeared to alleviate feelings of loneliness.

Conclusion

More research is warranted on the review topic, including studies that have employed quantitative or mixed methods. Clarity around definitions of social capital and loneliness in future research is required. Engagement with community initiatives can provide a formalised route to help people develop connections and counteract limitations in their social networks. However, individuals may be wary about attending community initiatives, needing support and encouragement to do so. Social prescribing link workers are one means of motivating people to access groups, events or organisations that could improve their well-being.

Introduction

The behaviour change technique taxonomy version 1 was developed to identify the smallest active ingredients of a lifestyle intervention, that is, behaviour change techniques (BCTs) based on a written description. By participation and direct observation of an intervention, we intend to not only identify BCTs but also assess exposure time for each BCT. Adding the dimension of exposure time should enable us to make quantitative comparisons between the different BCTs employed. We intend to demonstrate this by studying the hypotheses that exposure to information-related BCTs is similar for all targeted lifestyle modalities but decreases in the course of the intervention.

Methods

During 5-week intensive multimodal lifestyle interventions at a Swedish clinic for lifestyle medicine, we identified BCTs according to behaviour change technique taxonomy version 1 and noted exposure times to BCTs in all mandatory parts of the behaviour change intervention.

Results

Two hundred thirty-one independent intervention components were evaluated. BCTs 8.1 Behavioural practice/rehearsal (126 h), 4.1 Instruction on how to perform the behaviour (98 h) and 6.1 Demonstration of the behaviour (65 h) were the most common in terms of exposure time. Relative exposure to BCTs with an informative nature was similar for the different treatment phases (33%−37%−28%; p = 0.09) but higher for physical activity compared to food habits, stress management and unspecific lifestyle medicine (63%−25%−22%−25%; p < 0.001).

Conclusions

The behaviour change technique taxonomy version 1 can be extended by adding exposure time for different BCTs. The resulting BCT–exposure profile can be used for assessing the relative importance of different behaviour change strategies.

Introduction

With the rapid growth of urbanization globally and in the UK, increasing attention is now being directed towards urban green spaces (UGS). The appeal of UGS to policymakers lies in their capacity to address multiple policy objectives, including improving physical and mental wellbeing, mitigating noncommunicable diseases (NCDs), combating climate change through carbon sequestration, providing climate adaptation measures, and enhancing biodiversity.

Method

This narrative review gives an overview of the current literature and UK policy relating to urban green and blue spaces, with a particular focus on the use of UGS to increase physical activity levels.

Results

UGS have a profound impact on public health, with evidence indicating their positive effect on both physical and psychological health. Thirty-eight percent of adults in the UK do not live within 15 minutes of UGS, so policy makers at national and international level are aiming to address this gap. One reason for the health benefits of UGS is associated increased physical activity, a vital component needed to address the burden of non-communicable disease. To effectively harness UGS to promote physical activity various factors must be considered; proximity and diversity of urban green spaces, and the presence of suitable infrastructure features. Tailoring UGS to meet the needs and preferences of different population demographics is essential, as is ensuring safety, and addressing barriers to access particularly for lower socio-economic groups. The careful planning of UGS must avoid potential gentrification effects and displacement of vulnerable communities, whilst utilising the equigenic nature of UGS.

Conclusions

To create a brighter future and capitalize on the potential of UGS, a collaborative approach is needed, involving communities, local governments, and national authorities. Primary-care professionals, represented by organizations like the Royal College of General Practitioners (RCGP), can play a crucial role in advocating for UGS and physical activity, promoting their use, and providing guidance and support.

Aims

To determine the impact of a multi-component exercise intervention on the cure rate of urinary incontinence (UI) among older women living in the community.

Method

A systematic search was conducted of five databases (Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Academic Search Complete, PubMed and Web of Science), grey literature and reference lists of relevant studies in December 2021– January 2022 and again between January 2023 and February 2023 when no additional new studies were identified. Key inclusion criteria were studies with female older adults above the age of 60, with any type of UI, residing in the community, addressing the effects of a multi-component exercise intervention combining pelvic floor muscle training (PFMT), strength and balance exercises. The primary outcome of interest was the cure rate of UI in community-dwelling older women (%).

Studies underwent quality appraisal using the RevMan Risk of Bias tool and the Evidence-based Librarianship tool, identifying significant biases. A narrative synthesis presents results for all outcomes; a meta-analysis was also performed for secondary outcomes.

Results

Following the PRISMA 2020 guidelines, a total of 596 records were identified from the systematic search. Five studies met the inclusion criteria. Participants receiving the intervention had a statistically significant mean cure rate of 44.0% (p < 0.05), which decreased at follow-up, except for participants with stress UI. Participants receiving the intervention had significantly decreased frequency of UI episodes (p < 0.00001) and increased maximum walking speed (p < 0.0003) at a 3-month follow-up.

Conclusion

A multi-component exercise, combining PFMT, strength and balance exercises, is effective in improving and curing UI, especially stress UI, in community-dwelling older women.