Cleveland Clinic ran a study with their Lifestyle 180 program. Participants had at least one of 8 chronic conditions (obesity, hypertension, hyperlipidemia, diabetes, non-alcoholic fatty liver disease, multiple sclerosis, early stage breast or prostate cancer.
An initial 48 hours of lessons curriculum was taught twice per week, in four-hour sessions each over the first six weeks, called an Immersion Phase. During this period, the first four-hour session of the week was divided into 60 minutes of participant physical activity and 90 minutes of participant cooking and nutrition as well as stress management classes, while during the second session of the week, 60 minutes period was devoted to participant exercise and practice of cooking/nutrition, stress management and biometric one-on-one sessions each. The follow-up phase included three components to help maintain behavioral changes. These included 1) on-site classes at weeks 10, 18 and 30 that followed the same four-hour structure as occurred during the Immersion phase on the second day of the week, 2) a weekly e-mail newsletter and 3) the buddy system. Buddies were assigned within each group during the initial six-week session and were asked to keep in daily contact.
Nutritional aspects of the program most closely align with the Mediterranean diet. The Lifestyle 180 program eliminates trans fats as well as added sugars and syrups, limits saturated fat and substitutes only 100% whole grains/grain products for processed grain foods. Besides complex carbohydrates, Lifestyle 180 nutritional approach promotes an increase in intake of plant foods to provide a spectrum of phytochemicals exerting diverse beneficial biological functions.
The nutritional component of Lifestyle 180 was team-taught, with a chef and a dietitian. First, the chef worked with participants in the teaching kitchen. In an adjoining dining room/classroom, while participants were eating a meal they helped prepare, the dietitian conducted a seminar and guided a discussion about the nutritional aspects of what they had cooked as well as a covered topic of the day. To motivate participants to change how and what they eat, they were engaged into meal preparation in the kitchen. Gaining confidence with the kitchen equipment and different types of foods as well as learning how to manage time during meal preparation were considered important elements of the efforts to increase the likelihood that participants will change their dietary habits.
As part of the nutrition education of participants, one class during the Immersion Phase involved a grocery store experience. In this environment, participants learned how to read nutrition and ingredient labels, what to avoid in packaged foods and how to "shop" a grocery store (i.e. what aisles to avoid, which to frequent).
An exercise instructor led the class in the Lifestyle 180 Fitness Center that included progressive cardiovascular and endurance training as well as resistance training. Patients were encouraged to wear pedometers that were provided at start of the Program, with a goal of 10,000 steps per day and to record their steps on a daily diary sheet.
This component was team-taught, with a restorative yoga therapist and a behavioral health specialist. To sustain healthy lifestyle modifications, behavioral interventions were implemented during the course of the program. Those included goal setting, keeping records of lifestyle practices, social support, cognitive restructuring and problem solving. Patients learned meditation and mindfulness practices and performed simple yoga poses initially sitting or standing and at later stages of the program lying down. Regular elicitation of the "relaxation response", the physiological opposite of the "fight or flight response", may reduce psychological distress and improve medical symptoms in patients with any of a wide array of medical conditions.
Preventable chronic diseases continue to drive health care costs substantially and importantly upward, in part due to a lack of sustainable treatment options. Specific medications, such as cholesterol-lowering and diabetes medications target mostly one chronic disease-associated abnormality of elevated LDL cholesterol or plasma glucose, respectively, rather than the cause of the abnormality.
While surgical interventions successfully treat obesity and a spectrum of associated metabolic changes, they poorly address the behavioral and lifestyle-related factors that led to the development of chronic conditions in the first place. In contrast, comprehensive lifestyle interventions may result in multiple physiological systems changes including behavior modifications that support long-term healthier lifestyle choices.
The researchers report findings that a tri-pronged lifestyle intervention consisting of diet, physical activity and stress management improves disease-associated markers of participants with multiple chronic conditions. All measured biometric and laboratory variables significantly improved after just 6 weeks of intervention. Beneficial changes in blood pressure and glucose were observed in many participants by the second week of the program, thus supporting previously reported observations of the quick onset of measurable benefits that follow a comprehensive lifestyle intervention.
At week 30, HDL cholesterol is significantly higher than at the baseline and the total cholesterol/HDL ratio improves further. Fasting triglyceride level is also significantly reduced at both points in time (week 6 and 30) compared with baseline, reflecting the observations that triglycerides improve after weight loss.
Lifestyle 180 intervention resulted in significantly healthier markers of glucose metabolism and inflammation. Insulin and CRP show large percentage decreases. It is therefore, not surprising that the percent of participants with metabolic syndrome was significantly lower after 6 months of lifestyle interventions (an estimate relative 32 percent lower, from 54% to 37%).
One caveat: less than 25% of participants paid out of their pocket for participation in the program.
Medication changes at 30 weeks
Participation in a comprehensive Lifestyle 180 program resulted in significant and rapid, as well as clinically and biologically relevant improvements in biometric and laboratory outcomes, including reduced need for medications, for adults with multiple chronic conditions.
Bonnie: none of what was accomplished here is difficult to do outside of a hospital setting. Many of us live under these healthy lifestyle parameters each week, including reading our weekly eNewsletters. It just reaffirms that when done properly, dramatic change in health can occur rapidly and definitively.