Family physician–led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project
Khursheed Jeejeebhoy MBBS PhD, Rupinder Dhaliwal RD, Daren K. Heyland MD […] Doug Klein MD MSc
Abstract
Background
Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS.
Methods
In this longitudinal before–after study, 305 adult patients with MetS were recruited from 3 diverse family medicine teambased organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk.
Results
Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%–24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%–18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6 (95% CI 7.6–11.6) points on a 100-point scale and by 1.4 (95% CI 1.1–1.6) points on a 14-point scale, respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%.
Interpretation
A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.