Semisupervised Physical Exercise and Lifestyle Counseling in Cardiometabolic Risk Management in Sedentary Adults: Controlled Randomized Trial (BELLUGAT)

in Journal of Physical Activity and Health
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Background: The purpose of this study was to evaluate the feasibility and effectiveness of a high-intensity semisupervised exercise program alongside lifestyle counseling as an intervention for managing cardiometabolic risk in sedentary adults. Methods: A 40-week 3-arm randomized controlled clinical trial (16-wk intervention and 24-wk follow-up) was used. Seventy-five sedentary adults (34–55 y) with at least 1 cardiometabolic risk factor were randomized into one of the following arms: (1) aerobic interval training (AIT) plus lifestyle counseling (n = 25), (2) low- to moderate-intensity continuous training plus lifestyle counseling (traditional continuous training, TCT) (n = 27), or (3) lifestyle counseling alone (COU) (n = 23). Metabolic syndrome severity scores, accelerometer-based physical activity, and self-reported dietary habits were assessed at baseline, after the intervention, and at follow-up. Results: AIT was well accepted with high enjoyment scores. All groups showed similar improvements in metabolic syndrome severity scores (standardized effect size = 0.46) and dietary habits (standardized effect size = 0.30). Moderate to vigorous physical activity increased in all study groups, with the number of responders higher in AIT and TCT groups (50%) than in COU group (21%). Both AIT and TCT had a greater impact on sedentary behavior than COU (63.5% vs 30.4% responders). Conclusions: AIT appears to be a feasible and effective strategy in sedentary individuals with cardiometabolic risk factors. AIT could be included in intervention programs tackling unhealthy lifestyles.

Ensenyat and Machado-Da-Silva are with the Complex Systems and Sport Research Group, National Institute of Physical Education of Catalonia—Lleida Campus, Lleida, Spain. Espigares-Tribo, Sinfreu-Bergués, and Blanco are with the National Institute of Physical Education of Catalonia—Lleida Campus, Lleida, Spain.

Ensenyat (aensenat@inefc.udl.cat) is corresponding author.
  • 1.

    Knaeps S, Bourgois J, Charlier R, Mertens E, Lefevre J, Wijndaele K. Ten-year change in sedentary behaviour, moderate-to-vigorous physical activity, cardiorespiratory fitness and cardiometabolic risk: independent associations and mediation analysis. Br J Sports Med. 2018;52(16):10631068. PubMed ID: 27491779 doi:10.1136/bjsports-2016-096083

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Marcuello C, Calle-Pascual A, Fuentes M, et al. Prevalence of the metabolic syndrome in Spain using regional cutoff points for waist circumference; the di@bet.es study. Acta Diabetol. 2013;50(4):615623. PubMed ID: 23512475 doi:10.1007/s00592-013-0468-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Pattyn N, Cornelissen V, Eshghi RT, Vanhees L. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome. Sports Med. 2013;43(2):121133. PubMed ID: 23329606 doi:10.1007/s40279-012-0003-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Pedersen BK, Saltin B. Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(suppl 3):172. doi:10.1111/sms.12581

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    World Health Organization. Physical Activity Strategy for the WHO European Region 2016–2025. 2015. http://www.euro.who.int/en/publications/abstracts/physical-activity-strategy-for-the-who-european-region-20162025. Accessed June 3, 2019.

    • Search Google Scholar
    • Export Citation
  • 6.

    Powell K, King A, Buchner D, et al. The scientific foundation for Physical Activity Guidelines for Americans, 2nd edition. J Phys Act Health. 2019;16(1):111. doi:10.1123/jpah.2018-0618

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Rankin A, Rankin A, MacIntyre P, Hillis W. Walk or run? Is high-intensity exercise more effective than moderate intensity exercise at reducing cardiovascular risk? Scott Med J. 2012;57(2):99102. PubMed ID: 22194404 doi:10.1258/smj.2011.011284

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Arena R, Myers J, Forman D, Lavie C, Guazzi M. Should high-intensity interval training become the clinical standard in heart failure? Heart Fail Rev. 2013;18(1):95105. PubMed ID: 22791516 doi:10.1007/s10741-012-9333-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Helgerud J, Hoydal K, Wang E, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665671. PubMed ID: 17414804 doi:10.1249/mss.0b013e3180304570

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Rognmo O, Hetland E, Helgerud J, Hoff J, Slordahl SA. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2004;11(3):216222. PubMed ID: 15179103 doi:10.1097/01.hjr.0000131677.96762.0c

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115(24):30863094. PubMed ID: 17548726 doi:10.1161/CIRCULATIONAHA.106.675041

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Weston K, Wisloff U, Coombes J. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(1227):1234. doi:10.1007/s40279-014-0180-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    European Comission. Special Eurobarometer 412—Sport and Physical Activity. Brussels, Belgium: European Comission; 2014. Report No.: 2014.3314. doi:10.2766/73002. https://data.europa.eu/euodp/en/data/dataset/S1116_80_2_412. Accessed June 26, 2019.

    • Search Google Scholar
    • Export Citation
  • 14.

    Biddle S, Batterham A. High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head? Int J Behav Nutr Phys Act. 2015;12(1):95. PubMed ID: 26187579 doi:10.1186/s12966-015-0254-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J. 2009;158(6):10311037. PubMed ID: 19958872 doi:10.1016/j.ahj.2009.10.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Barlett J, Close G, MacLaren D, Gregson W, Drust B, Morton JP. High-intensity interval running is perceived as more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence. J Sports Sci. 2011;29(6):547553. doi:10-1080/026-40414.2010.545427

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Reljic D, Wittmann F, Fisher J. Effect of low-volume high-intensity training in a community setting: a pilot study. Eur J Appl Physiol. 2018;118(6):11531167. doi:10.1007/s00421-018-3845-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Ekkekakis P, Parfitt G, Petruzzello S. The pleasure and displeasure people feel when they exercise at different intensities. Sports Med. 2011;41(8):641671. PubMed ID: 21780850 doi:10.2165/11590680-000000000-00000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Scott SE, Breckon JD, Copeland RJ, Hutchinson A. Determinants and strategies for physical maintenance in chronic health conditions: a qualitative study. J Phys Act Health. 2015;12(5):733740. PubMed ID: 24905976 doi:10.1123/jpah.2013-0286

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Biddle S, Mutrie N, Gorely T. Psychology of Physical Activity: Determinants, Well-Being and Interventions. 3rd ed. Abingdon, UK: Routledge; 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    World Medical Association. Declaration of Helsinki—ethical principles for medical research involving human subjects. 2013. http://www.wma.net/en/30publications/10policies/b3/index.html. Accessed May 5, 2019.

    • PubMed
    • Export Citation
  • 22.

    Schulz K, Altman D, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Ann Intern Med. 2010;152(11):726732. doi:10.7326/0003-4819-152-11-201006010-00232

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Pettee Gabriel K, Morrow J, Woolsey A. Framework for physical activity as a complex and multidimensional behavior. J Phys Act Health. 2012;9(suppl 1):S11S18. doi:10.1123/jpah.9.s1.s11

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390395. PubMed ID: 6863699 doi:10.1037/0022-006X.51.3.390

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Miller W, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press; 2013.

  • 26.

    Ensenyat A, Espigares-Tribo G, Machado L, et al. Metabolic risk management, physical exercise and lifestyle counselling in low-active adults: controlled randomized trial (BELLUGAT). BMC Public Health. 2017;17(1):257272. PubMed ID: 28292282 doi:10.1186/s12889-017-4144-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Espigares G, Ensenyat A. Guia per a la Promoció d’un estil de Vida Saludable (Guide for the Promotion of a Healthy Style). Lleida, Spain: Espigares; 2015.

    • Search Google Scholar
    • Export Citation
  • 28.

    Kendzierski D, DeCarlo K. Physical activity enjoyment scale: two validation studies. J Sport Exerc Psychol. 1991;13(1):5064. doi:10.1123/jsep.13.1.50

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Wiley J, Carrington M. A metabolic syndrome severity score: a tool to quantify cardio-metabolic risk factors. Prev Med. 2016;88:189195. PubMed ID: 27095322 doi:10.1016/j.ypmed.2016.04.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    World Health Organization. Waist Circumference and Waist-to-Hip Ratio: Report of a WHO Expert Consultation. Geneva, Switzerland: World Health Organization; 2008. https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/. Accessed September 3, 2019.

    • Search Google Scholar
    • Export Citation
  • 31.

    Herrmann S, Barrerira T, Kang M, Ainsworth BE. Impact of accelerometer wear time on physical activity data: a NHANES semi simulation data approach. Br J Sports Med. 2014;48(3):278282. PubMed ID: 22936409 doi:10.1136/bjsports-2012-091410

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Meredith-Jones K, Williams S, Galland B, Kennedy G, Taylor R. 24-h Accelerometry: impact of sleep-screening methods on estimates of sedentary behaviour and physical activity while awake. J Sports Sci. 2016;34(7):679685. PubMed ID: 26194337 doi:10.1080/02640414.2015.1068438

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Troiano R, Berrigan D, Dodd K, Masse L, Tilert T, McDowel M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181188. PubMed ID: 18091006 doi:10.1249/mss.0b013e31815a51b3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Basiotis PP, Carlson A, Gerrior SA, Juan WY, Lino M. The Healthy Eating Index: 1999–2000. Washington, DC: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion; 2002. Report No.: CNPP-12. www.cnpp.usda.gov. Accessed April 2, 2018.

    • Search Google Scholar
    • Export Citation
  • 35.

    U.S Department of Agriculture, U.S Department of Health and Human Services. Dietary Guidelines for Americans. 7th ed. Washington, US: Government Printing Office; 2010. https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2010. Accessed April 30, 2019.

    • Search Google Scholar
    • Export Citation
  • 36.

    Guenther PM, Kirkpatrick SI, Reedy J, et al. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 dietary guidelines for Americans. J Nutr. 2014;144(3):399407. PubMed ID: 24453128 doi:10.3945/jn.113.183079

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Cohen J. A power primer. Psychol Bull. 1992;112(1):155159. PubMed ID: 19565683 doi:10.1037/0033-2909.112.1.155

  • 38.

    Boucher S. High-intensity intermittent exercise and fat loss. J Obes. 2011;868305. doi:10.1155/2011/868305

  • 39.

    Tjonna AE, Stolen TO, Bye A, et al. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci. 2009;116(4):317326. doi:10.1042/CS20080249

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Tjonna AE, Lee SJ, Rognmo O, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118(4):346354. PubMed ID: 18606913 doi:10.1161/CIRCULATIONAHA.108.772822

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Morales-Palomo F, Ramirez-Jimenez M, Ortega J, Mora-Rodriguez R. Effectiveness of aerobic exercise programs for health promotion in metabolic syndrome. Med Sci Sports Exerc. 2019;51(9):18761883. PubMed ID: 31415443 doi:10.1249/MSS.0000000000001983

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Castro EM, Regenmortel TV, Vanhaecht K, Sermeus W, Hecke AV. Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient Educ Couns. 2016;99(12):19231939. PubMed ID: 27450481 doi:10.1016/j.pec.2016.07.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Kim CJ, Schlenk EA, Kang SW, Park JB. Effects of an internet-based lifestyle intervention on cardio-metabolic risks and stress in Korean workers with metabolic syndrome: a controlled trial. Patient Educ Couns. 2015;98(1):111119. PubMed ID: 25468401 doi:10.1016/j.pec.2014.10.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Biddle S, Brehm W, Verheijden M, Hopman-Rock M. Population physical activity behaviour change: a review for the European College of Sport Science. Eur J Sport Sci. 2012;12(4):367383. doi:10.1080/17461391.2011.635700

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Braithwaite J. Changing how we think about healthcare improvement. BMJ. 2018;361:k2014. doi:10.1136/bmj.k2014

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