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Why are standardized lifestyle interventions for the metabolic syndrome not successful? Experiences from two RCTs and one mixed-methods study.

Thulesius H - Scand J Prim Health Care (2015)

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Affiliation: Department of Clinical Sciences, Malmö, Family Medicine, Lund University , Sweden.

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One paper by Hrafnkelsson et al. presented a cluster randomized controlled trial (RCT) of an exercise and nutrition intervention in Icelandic schoolchildren... A third paper reported a mixed-methods study where Miettola & Viljanen identified groups of middle-aged Finnish men and women who, based on their Sense of Coherence (SOC) profile and metabolic syndrome statuses, were or were not suitable for possible lifestyle interventions... While both RCTs by Hrafnkelsson et al. and Liira and et al. failed to show significant improvements in main outcome measures such as blood pressure and metabolic blood markers, the third exploratory study by Miettola & Viljanen gave a potential answer to why they failed... Obviously not every person who would benefit from a lifestyle change will eventually change habits and therefore lifestyle interventions probably will need very cleverly tailored designs to succeed... Miettola & Viljanen suggested individualized interventions built on assessments of personal potentials based on needs, attitudes, and motivation, which they call “a salutogenic approach to intervention”... My own anecdotal clinical experience with exercise prescriptions is limited to patients with mainly psychological disturbances for whom they seem to have been useful... However, the hard evidence for the benefit of exercise prescriptions in this group is not striking either... The reasons for this lack of effect from standardized lifestyle interventions are doubtless manifold... Miettola & Viljanen have come up with a few suggestive answers on how to improve metabolic syndrome status by lifestyle interventions based on their sequential mixed-methods study... In summary, three papers in the December 2014 issue of our journal investigated the same topic: lifestyle interventions against the metabolic syndrome showing a recently stagnating yet considerable growth in the number of MEDLINE publications, while publications with negative results have started to emerge (Figure 1)... Two RCT-designed interventions failed to show significant effects, whereas a third mixed-methods paper suggested a tailored person-centred intervention.

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Number of MEDLINE publications with “lifestyle intervention metabolic syndrome” in the article text 1992–2013.
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Figure 1: Number of MEDLINE publications with “lifestyle intervention metabolic syndrome” in the article text 1992–2013.

Mentions: In summary, three papers in the December 2014 issue of our journal investigated the same topic: lifestyle interventions against the metabolic syndrome showing a recently stagnating yet considerable growth in the number of MEDLINE publications, while publications with negative results have started to emerge (Figure 1). Two RCT-designed interventions failed to show significant effects, whereas a third mixed-methods paper suggested a tailored person-centred intervention [1–3].


Why are standardized lifestyle interventions for the metabolic syndrome not successful? Experiences from two RCTs and one mixed-methods study.

Thulesius H - Scand J Prim Health Care (2015)

Number of MEDLINE publications with “lifestyle intervention metabolic syndrome” in the article text 1992–2013.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834503&req=5

Figure 1: Number of MEDLINE publications with “lifestyle intervention metabolic syndrome” in the article text 1992–2013.
Mentions: In summary, three papers in the December 2014 issue of our journal investigated the same topic: lifestyle interventions against the metabolic syndrome showing a recently stagnating yet considerable growth in the number of MEDLINE publications, while publications with negative results have started to emerge (Figure 1). Two RCT-designed interventions failed to show significant effects, whereas a third mixed-methods paper suggested a tailored person-centred intervention [1–3].

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Malmö, Family Medicine, Lund University , Sweden.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

One paper by Hrafnkelsson et al. presented a cluster randomized controlled trial (RCT) of an exercise and nutrition intervention in Icelandic schoolchildren... A third paper reported a mixed-methods study where Miettola & Viljanen identified groups of middle-aged Finnish men and women who, based on their Sense of Coherence (SOC) profile and metabolic syndrome statuses, were or were not suitable for possible lifestyle interventions... While both RCTs by Hrafnkelsson et al. and Liira and et al. failed to show significant improvements in main outcome measures such as blood pressure and metabolic blood markers, the third exploratory study by Miettola & Viljanen gave a potential answer to why they failed... Obviously not every person who would benefit from a lifestyle change will eventually change habits and therefore lifestyle interventions probably will need very cleverly tailored designs to succeed... Miettola & Viljanen suggested individualized interventions built on assessments of personal potentials based on needs, attitudes, and motivation, which they call “a salutogenic approach to intervention”... My own anecdotal clinical experience with exercise prescriptions is limited to patients with mainly psychological disturbances for whom they seem to have been useful... However, the hard evidence for the benefit of exercise prescriptions in this group is not striking either... The reasons for this lack of effect from standardized lifestyle interventions are doubtless manifold... Miettola & Viljanen have come up with a few suggestive answers on how to improve metabolic syndrome status by lifestyle interventions based on their sequential mixed-methods study... In summary, three papers in the December 2014 issue of our journal investigated the same topic: lifestyle interventions against the metabolic syndrome showing a recently stagnating yet considerable growth in the number of MEDLINE publications, while publications with negative results have started to emerge (Figure 1)... Two RCT-designed interventions failed to show significant effects, whereas a third mixed-methods paper suggested a tailored person-centred intervention.

Show MeSH