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Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial.
Han, CY, Sharma, Y, Yaxley, A, Baldwin, C, Woodman, R, Miller, M
Clinical interventions in aging. 2023;18:809-825
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As the global population ages, the incidence of frailty is expected to increase. Frailty has been associated with higher dependency and an increased risk of death. Research has shown that exercise and nutrition have been shown to be effective at treating and preventing frailty, however this is open to criticism as most of the research has been performed in healthy older adults, and not those who are at risk or suffering from frailty. This pilot randomised control trial aimed to determine the effectiveness of an individualised exercise and nutrition programme on frailty and its complications in 32 individuals with pre frailty and frailty. The nutrition programme focused on ensuring diet quality and that individuals were receiving 100% of their energy requirements, adequate protein, and at an ideal body weight. The exercise programme focused on resistance exercise at least 3 times per week. The results showed that an individualised diet and exercise programme improved the degree of pre-frailty and frailty after 3 and 6 months. Brain function and mood were also improved in individuals on the diet and exercise programme. Interestingly there was an indication that the number of well-nourished individuals was slightly higher in these individuals, however this was not significantly greater than those who were not undergoing the diet and exercise regime. It was concluded that adherence to a self-managed nutrition and exercise programme can slow and even reverse frailty and pre-frailty. This study could be used by healthcare professionals to recommend an individualised diet and exercise programme that focuses on ensuring 100% of daily energy requirements are met, adequate protein levels and resistance exercise to older adults with pre-frailty and frailty.
Abstract
PURPOSE Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults. PATIENTS AND METHODS Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions. RESULTS Participants were 79.2 ±6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6±1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91±13% and 92±21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (-3.0; 95% CI: -4.8 to -3.0) and 6 months (-2.5; 95% CI: -3.8 to -1.0, P<0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, P<0.05 for both), mini-mental state examination (2.6; 95% 0.3-4.8, P=0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2-7.1, P=0.039) and Geriatric Depression Scale, at 6 months (-2.2; 95% CI: -4.1 to -0.30, P=0.026) in the intervention group as compared to control. CONCLUSION This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults.
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Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis.
Candow, DG, Prokopidis, K, Forbes, SC, Rusterholz, F, Campbell, BI, Ostojic, SM
Nutrients. 2023;15(20)
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Increased body fat in young adults is leading to the development of health complications in later life. The use of resistance exercise in combination with creatinine has been shown to decrease body fat in people over the age of 55. However, it is unclear as to whether this combination would have the same result in those under 55 years. This systematic review and meta-analysis of 12 randomised control trials with 266 individuals aimed to review the data on the use of creatinine and resistance exercise in individuals less than 55 years of age. The results showed that compared to resistance exercise alone, creatinine supplementation did not impact absolute fat mass, but did decrease body fat percentage over time. When in combination with resistance exercise individuals had a very small but significant reduction in body fat percentage, but absolute fat mass remained unaffected. It was concluded that in adults under the age of 50, a combination of resistance exercise and creatinine decreased body fat percentage but had no effect on absolute fat mass. This study could be used by healthcare professionals to understand that creatinine and resistance exercise may have a very small benefit on body fat percentage, however the cost of supplementation may outweigh the benefits.
Abstract
The combination of resistance exercise and creatine supplementation has been shown to decrease body fat percentage in adults ≥ 50 years of age. However, the effect on adults < 50 years of age is currently unknown. To address this limitation, we systematically reviewed the literature and performed several meta-analyses comparing studies that included resistance exercise and creatine supplementation to resistance exercise and placebo on fat mass and body fat percentage Twelve studies were included, involving 266 participants. Adults (<50 years of age) who supplemented with creatine and performed resistance exercise experienced a very small, yet significant reduction in body fat percentage (-1.19%, p = 0.006); however, no difference was found in absolute fat mass (-0.18 kg, p = 0.76). Collectively, in adults < 50 years of age, the combination of resistance exercise and creatine supplementation produces a very small reduction in body fat percentage without a corresponding decrease in absolute fat mass.
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Effects of multi-domain intervention on intrinsic capacity in older adults: A systematic review of randomized controlled trials (RCTs).
Liao, X, Shen, J, Li, M
Experimental gerontology. 2023;174:112112
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With the increase of age, the physiological reserve of the elderly decreases, which leads to the increase of physical vulnerability and the decrease of anti-stress ability, showing a series of frailty manifestations. Intrinsic capacity (refers to the comprehensive capacity of all physical and mental capacities of an individual) is central to maintaining function in older adults, and maintaining optimal intrinsic capacity is important to promote healthy aging. The aim of this study was to assess randomised controlled trials of multidomain interventions to further validate their effectiveness in the maintenance and enhancement of function in older adults, and to formulate strategies for preventive care and clinical practice. This study was a systematic review and meta-analysis of twenty-five publications. Results showed that multi-domain interventions can improve indicators of vital domains in older adults and integrate to optimise intrinsic capacity (refers to the comprehensive capacity of all physical and mental capacities of an individual) through potential interaction mechanisms. Authors concluded that because older adults may not be able to receive overly complex interventions due to limitations in their integrative abilities, the involvement of older adults and the sustainability of interventions should be considered before implementing them.
Abstract
Intrinsic capacity is central to the maintenance of function in older adults, and maintaining optimal intrinsic capacity is of great importance to promote healthy aging. The purpose of this systematic review and meta-analysis was to analyze the impact of multi-domain interventions on intrinsic capacity in older adults, intervention components, and potential interactions between components. A total of 6740 published articles were screened until August 2022, and the review included 25 randomized controlled trials that analyzed populations, interventions, control groups, and outcomes. The meta-analysis showed improvements in the primary outcome indicators in the intervention group compared to the control group. These included increased scores on the Mini-Mental State Examination as an indicator of cognitive function, decreased scores on the Geriatric Depression Scale (GDS-15) as an indicator of psychological ability and increased scores on the Short Physical Performance Battery (SPPB) as an indicator of physical performance, with only the SPPB indicator analyzed showing greater heterogeneity. Significant improvements were also seen in the secondary indicators Time-to-Walk Test (TUG), gait speed, Chair Stand Test (CST), grip strength values and BMI. There was insufficient data for the Mini Nutritional Assessment (MNA) as an indicator of vitality to conduct a meta-analysis. Studies were of moderate to high quality. The results of this review indicate that multi-domain interventions can maintain the level of intrinsic capacity in older adults and are equally effective in older adults with declining self-care abilities.
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Effects of dietary supplements on athletic performance in elite soccer players: a systematic review.
Abreu, R, Oliveira, CB, Costa, JA, Brito, J, Teixeira, VH
Journal of the International Society of Sports Nutrition. 2023;20(1):2236060
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Dietary supplements are used by elite soccer players to improve performance and recovery. However, it is unclear as to whether the research can back up the reasons for their use. This systematic review of 18 randomised control trials aimed to determine any effects of dietary supplements on elite, adult soccer players. The results showed that studies on the use of supplementation in soccer players has been completed using caffeine, caffeinated energy drinks, creatine, protein, beverages with carbohydrates and electrolytes, tart cherry juice, nitrate-rich beetroot juice, yohimbine, Resurgex Plus, and sodium and potassium bicarbonate with potassium, magnesium, and calcium citrate. It was concluded that the use of creatine, protein, and caffeine may be of benefit to the performance of elite soccer players. The use of yohimbine was strongly discouraged due to unclear safety data. There was a lack of evidence for the use of any of the other supplements and it was concluded that more studies need to be completed. This study could be used by healthcare professionals to understand that certain supplements may enhance athletic performance in elite soccer players, but more research is encouraged.
Abstract
Dietary supplements are widely used among athletes, and soccer players are no exception. Nevertheless, evidence supporting the use of dietary supplements aiming to enhance performance in soccer is somewhat contradictory, scarce, or even nonexistent. Thus, the present study aimed to systematically review and synthesize the effects of dietary supplements on athletic performance (e.g. distance covered, sprinting, jump performance) in elite soccer players. Studies enrolling highly trained, elite, and world-class soccer players using dietary supplements were searched in MEDLINE/PubMed, Web of Science, Scopus, and EBSCO databases in June 2022. In total, 1043 studies were identified, and 18 met the eligibility criteria. The studies evaluated the impacts on athletic performance of several dietary supplements, including caffeine, creatine, protein, beverages with carbohydrates and electrolytes, tart cherry juice, nitrate-rich beetroot juice, sodium bicarbonate with minerals, yohimbine, and a proprietary nutraceutical blend. Caffeine supplementation in doses between 3 and 6 mg/kg of body mass may improve jump height and sprint ability, particularly in female players, but individual response to caffeine must be considered. Creatine may improve sprint, agility, and in female players, jump performance. Protein supplementation can improve sprint and jump performance between matches, especially if protein ingested from food is not up to recommendations. Beverages containing carbohydrates and electrolytes can be used as part of the strategies to achieve carbohydrate intake during training and match-days but used alone do not benefit athletic performance. Tart cherry juice might be useful for maintaining athletic performance after matches that produce higher force loss and exercise-induced muscle damage, although polyphenols from the diet might attenuate the effects of tart cherry supplementation. Nitrate-rich beetroot concentrate can attenuate performance decrease in the days following matches. Further investigation with sodium bicarbonate alone is necessary, as supplementation protocols with elite players included other substances. Finally, the available data does not support yohimbine supplementation or the use of Resurgex Plus® to improve athletic performance in elite soccer players. Still, more well-designed research with elite soccer players is needed to improve support and advice regarding the use of dietary supplements for athletic performance enhancement.
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Effects of an 18-month community-based, multifaceted, exercise program on patient-reported outcomes in older adults at risk of fracture: secondary analysis of a randomised controlled trial.
Talevski, J, Gianoudis, J, Bailey, CA, Ebeling, PR, Nowson, CA, Hill, KD, Sanders, KM, Daly, RM
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2023;34(5):891-900
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Fragility fractures are associated with both personal and healthcare system burdens. It is well established that bone loss leading to osteopenia or osteoporosis results in increased risk of fractures. Prescription of pharmacological agents is commonly used as first-line treatment. The aim of this study was to evaluate the effect of the Osteo-cise: Strong Bones for Life program on the patient-reported outcomes including health related quality of life (HRQoL), osteoporosis knowledge and osteoporosis attitudes and beliefs. This study is a secondary analysis of an 18-month randomised controlled trial in which participants were randomly allocated to either the community-based Osteo-cise: Strong Bones for Life program (‘Osteo-cise’) or a standard care control group. Results showed that there were no significant effects on HRQoL, osteoporosis knowledge or osteoporosis attitudes and beliefs compared with usual care. However, per protocol analyses revealed that those most adherent to exercise training did experience significant improvements in both HRQoL and osteoporosis knowledge compared with usual care. Authors concluded that their findings highlight the need to identify strategies that promote long-term adherence to multifaceted exercise programs in community-dwelling older adults.
Abstract
UNLABELLED This study identified that an 18-month community-based, multifaceted, exercise program consisting of resistance, weight-bearing impact, and balance/mobility training combined with osteoporosis education and behavioural support can improve health-related quality of life (HRQoL) and osteoporosis knowledge in older adults at risk of fracture, but only for those adherent to the exercise regime. PURPOSE To evaluate the effects of an 18-month community-based exercise, osteoporosis education and behaviour change program (Osteo-cise: Strong Bones for Life) on HRQoL, osteoporosis knowledge and osteoporosis health beliefs. METHODS This was a secondary analysis of an 18-month randomised controlled trial in which 162 older adults aged ≥ 60 years with osteopenia or increased falls/fracture risk were randomized to the Osteo-cise program (n = 81) or control group (n = 81). The program consisted of progressive resistance, weight-bearing impact and balance training (3 days/week); osteoporosis education to facilitate self-management of musculoskeletal health and behavioural support to enhance adherence to exercise. HRQoL, osteoporosis knowledge and osteoporosis health beliefs were assessed using the EuroQoL questionnaire (EQ-5D-3L), Osteoporosis Knowledge Assessment Tool and Osteoporosis Health Belief Scale, respectively. RESULTS Overall, 148 participants (91%) completed the trial. Mean exercise adherence was 55% and mean attendance for the three osteoporosis educational sessions ranged from 63-82%. After 12 and 18 months, there were no significant effects of the Osteo-cise program on HRQoL, osteoporosis knowledge or health beliefs relative to controls. Per protocol analyses (≥ 66% exercise adherence; n = 41) revealed a significant net benefit in EQ-5D-3L utility for the Osteo-cise group relative to controls after 12 months (P = 0.024) and 18 months (P = 0.029) and a significant net improvement in osteoporosis knowledge scores at 18 months (P = 0.014). CONCLUSION This study supports the importance of adherence to exercise regimes, as adherence to the Osteo-cise: Strong Bones for Life program was associated with improvements in HRQoL and osteoporosis knowledge in older adults at increased risk for falls and fractures. TRIAL REGISTRATION NUMBER ACTRN12609000100291.
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Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis.
Learmonth, YC, P Herring, M, Russell, DI, Pilutti, LA, Day, S, Marck, CH, Chan, B, Metse, AP, Motl, RW
Multiple sclerosis (Houndmills, Basingstoke, England). 2023;29(13):1604-1631
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Exercise training represents a rehabilitation-based approach for reversing multiple sclerosis (MS) dysfunction and managing symptoms and should be promoted among persons with MS throughout the disease trajectory. The aim of this study was to quantify the rate of relapse, adverse events (AE) and serious adverse events (SAE) in randomised controlled trials of exercise training in persons with MS. This study was a systematic review and meta-analysis of forty-six exercise interventions. Results showed that in exercise trials with individuals diagnosed with MS, where safety measures were documented, aerobic, strength, or neuromotor exercises conducted under both supervised and unsupervised conditions were deemed safe for those with MS. This conclusion was drawn from two key observations: (1) there were no instances of serious adverse effects reported during exercise sessions, and (2) participants engaging in exercise interventions did not exhibit higher risks of relapse, AE or SAE compared to control participants. Authors concluded that exercise training may be promoted as safe and beneficial to persons with MS.
Abstract
BACKGROUND A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013. OBJECTIVE We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE). METHODS Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study's internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR. RESULTS Forty-six interventions from 40 RCTs (N = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), p-value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), p = 0.82), 1.40 ((0.90, 2.19), p = 0.14) and 1.05 ((0.62, 1.80), p = 0.85), respectively. No significant heterogeneity is observed for any outcome. CONCLUSION In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.
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Effect of Supervised and Unsupervised Exercise Training in Outdoor Gym on the Lifestyle of Elderly People.
Barbosa, WA, Leite, CDFC, Reis, CHO, Machado, AF, Bullo, V, Gobbo, S, Bergamin, M, Lima-Leopoldo, AP, Vancini, RL, Baker, JS, et al
International journal of environmental research and public health. 2023;20(21)
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Lifestyle directly impacts the longevity and quality of life in the elderly population. Therefore, behaviours such as sedentary lifestyle, physical inactivity, and inadequate nutrition are discouraged, primarily due to their association with detrimental effects on health indicators. The aim of this study was to investigate the effects of a 12-week training program, both supervised and unsupervised, using equipment from popular gyms for elderly individuals to measure lifestyle parameters. This study enrolled physically independent elderly people who were randomly distributed into three groups: supervised training (n: 20; ST), unsupervised training (n: 20; UT) and control (n: 20; C). The ST and UT groups completed a 12-week program, with exercises performed three times a week. Results showed that there were no significant differences among the assessed groups in terms of the family domain. However, elderly individuals subjected to physical exercise programs exhibit a better lifestyle compared to inactive elderly individuals. Authors concluded that findings underscore the significance of engaging in physical activity, as it yields numerous beneficial impacts on the health of this population.
Abstract
UNLABELLED The aim of this study was to investigate the effectiveness of supervised and unsupervised physical training programs using outdoor gym equipment on the lifestyles of elderly people. METHODS physically independent elderly people were randomly distributed into three groups: supervised training (n: 20; ST), unsupervised training (n: 20; UT) and control (n: 20; C). The ST and UT groups completed a 12-week program, with exercises performed three times a week. The ST group underwent weekly 30 min sessions consisting of a 5 min warm-up (walking at 60% of HRmax), followed by 20 sets of 30, "monitored by a metronome with 30" of passive recovery between sets and a five-minute cool-down. The following equipment was used: elliptical, rowing, surfing and leg press. The UT group was instructed to freely attend the gym and train spontaneously using the same equipment used by ST. Lifestyle changes were evaluated using a questionnaire containing specific domains. RESULTS no significant differences were identified in the domains for family, physical activity, nutrition, smoking, sleep, behavior, introspection, work and overall score; however, the values corresponding to the alcohol domain for the ST and UT groups were lower (p < 0.05) than the C group, remaining even lower after the 12 weeks of intervention. Time effect (p < 0.05) was found only in the ST group for the physical domains, sleep, behavior and overall score. CONCLUSION elderly people submitted to supervised and unsupervised physical exercise programs using outdoor gym equipment present positive changes in lifestyle parameters compared to physical inactive elderly people.
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Frailty-Preventing Effect of an Intervention Program Using a Novel Complete Nutritional "COMB-FP Meal": A Pilot Randomized Control Trial.
Nakazeko, T, Shobako, N, Shioya, N, Iwama, Y, Hirano, Y, Fujii, S, Nakamura, F, Honda, K
Nutrients. 2023;15(20)
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Frailty is a complex and diverse combination of diseases, including physical dysfunctions and psycho-social problems. The aim of this study was to compare a 12-week programme with an exclusive dietary intervention in determining the impact of meals related to frailty. This study was a 12-week, open-label, randomised controlled trial. A total of 288 participants were recruited: 110 participants were enrolled and randomly assigned to the test (exercise and test food) or control (only exercise) group. Results showed that the 12-week intervention improved multiple outcomes related to frailty. There were significant improvements in both functional ability and cognitive function. Authors concluded that their findings indicate the important role of nutritional intervention in preventing frailty.
Abstract
Frailty is a huge concern for the aging population, and dietary nutrition is considered a key factor in the prevention of aging. To solve the problem of frailty in the aging population, we developed a novel dietary intervention program using a novel COMpletely Balanced for Frailty Prevention (COMB-FP) meal, based on the Dietary Reference Intake for Japanese; in addition, we conducted a pilot randomized control trial comparing an exercise program only (control group) with exercise plus the COMB-FP meal program (test group). We included 110 male and female healthy volunteers with pre-frailty or frailty; the trial lasted for 12 weeks. Two daily meals were replaced with the COMB-FP meals during the trial in the test group. Walking speed and cognitive function were significantly improved in the test group compared with the control group. We observed a similar pattern in other frailty-related outcomes, such as occupancy of the microbiome, World Health Organization well-being index (WHO-5), and oxidative stress. Our study might indicate the importance of a well-balanced intake of nutrients for frailty prevention.
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Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial.
Sartorelli, DS, Crivellenti, LC, Baroni, NF, de Andrade Miranda, DEG, da Silva Santos, I, Carvalho, MR, de Lima, MC, Carreira, NP, Chaves, AVL, Manochio-Pina, MG, et al
European journal of nutrition. 2023;62(1):443-454
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Excessive gestational weight gain exposes the woman and the child to a higher risk of harmful health outcomes in the short and long term. Dietary patterns based on the substitution of meals made with unprocessed or minimally processed foods for the consumption of ultra-processed items can be partly blamed for the exponential global growth in the incidence of obesity. The main aim of this study was to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products. This study is a two-armed parallel randomised controlled trial conducted among overweight, pregnant women receiving prenatal care in seven primary health units. Participants (n=350) were randomly allocated into the intervention group (IG) or control group (CG). The women allocated into the IG, in addition to the usual prenatal care, were invited to participate in three individualised nutritional counselling sessions conducted by trained nutritionists. Results show that even though there were more women in the IG who had increased their daily intake of minimally processed foods and vegetables at lunch time when compared to the CG, this was not statistically significant. Additionally, there weren’t any differences between the groups in relation to physical activity. Authors conclude that their study was unprecedented in demonstrating that a nutritional counselling intervention based on the NOVA food classification system, together with the practice of physical activity, is effective in preventing excessive gestational weight gain in overweight pregnant women.
Abstract
PURPOSE This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).
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Effectiveness of Combined Health Coaching and Self-Monitoring Apps on Weight-Related Outcomes in People With Overweight and Obesity: Systematic Review and Meta-analysis.
Chew, HSJ, Rajasegaran, NN, Chin, YH, Chew, WSN, Kim, KM
Journal of medical Internet research. 2023;25:e42432
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Effective interventions for obesity involve multiple components that combine educational, environmental, and behavioural strategies to promote healthy eating and physical activity. Mobile health (mHealth) technologies, such as smartphone apps and wearable devices, have been used widely as promising strategies to enhance the effectiveness of weight loss interventions. The aim of this study was to evaluate the effectiveness of combining weight management apps with health coaching on clinical outcomes among people with overweight and obesity. This study was a systematic review and meta-analysis of fourteen studies. The included studies represent 2478 participants with a mean age of 39.1 years. Results did not show any evidence of improvement in physical activity related to the use of smartphone apps with or without health coaching. Furthermore, combining smartphone apps with health coaching only yields a significantly greater reduction in waist circumference but not weight loss as compared to using a self-monitoring app alone. Authors conclude that combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app.
Abstract
BACKGROUND Self-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear. OBJECTIVE This study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity. METHODS Relevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1. RESULTS A total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95% CI -3.17 kg to -1.12 kg; P<.001; I2=60.3%), waist circumference by 2.48 cm (95% CI -3.51 cm to -1.44 cm; P<.001; I2=29%), triglyceride by 0.22 mg/dL (95% CI -0.33 mg/dL to 0.11 mg/dL; P=.008; I2=0%), glycated hemoglobin by 0.12% (95% CI -0.21 to -0.02; P=.03; I2=0%), and total calorie consumption per day by 128.30 kcal (95% CI -182.67 kcal to -73.94 kcal; P=.003; I2=0%) kcal, but not BMI, blood pressure, body fat percentage, cholesterol, and physical activity. Combined interventional effectiveness was superior to receiving usual care and apps for waist circumference but only superior to usual care for weight loss. CONCLUSIONS Combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app. TRIAL REGISTRATION PROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay.