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*Important NOTE: research place publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health-related behavior, or be treated as established information.
In a recent study conducted at the BMC Public Health journal and currently published in the research place* Using preprint servers, the researchers examine the perceptual, behavioral, and anthropometric changes in Coaching on Lifestyle (CooL) participants.
Learn: The combined lifestyle intervention CooL in times of COVID-19: a descriptive case series study. Photo credit: Motortion Films / Shutterstock.com
Support for weight loss in the Netherlands
In 2021, half of the Dutch population aged 18 and over was considered overweight, and almost 14% obese.
In the Netherlands, combined lifestyle interventions (CLIs) were part of primary health insurance for overweight/obese people. CLIs are designed to stimulate weight loss and promote healthier behavior.
CooL is one of six CLIs and will be implemented in two phases consisting of an eight-month behavior change phase and a 16-month behavior maintenance phase.
About the study
In the present study, researchers examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on changes in health perceptions, anthropometry, and behavior in CooL participants during the behavior change phase. Dutch speakers in the Netherlands were recruited between November 2018 and October 2021.
Some participants completed their first phase of CooL before the COVID-19 pandemic started in the Netherlands, while others attended during the period when the COVID-19 restrictions were being enforced. April 1, 2020 was used as the cut-off date to distinguish between participants who were affected by the pandemic and those who were not.
There have been some changes in how CooL was offered to participants during the pandemic, including the addition of COVID-19-related queries to existing outcome measurements. CooL was an open CLI with no strict protocol, allowing trainers to tailor interventions to the target audience.
Researchers used anthropometric measurements and a questionnaire to collect data. Outcome measures were grouped into anthropometry, physical activity, control and support, perceived fitness, attention to diet, smoking and alcohol consumption, stress, and sleep. Data were collected at the start of the study (T0), after 32 weeks (T1) and after 24 months (T2).
T1 represented the completion of the first cool phase, while T2 was the end of the second phase. Data from T2 were not available for analysis in this study.
Demographics, including age, gender, education, occupation, and marital status, were reported by participants at baseline. CooL trainers measured anthropometry using professional equipment.
Perceived support from close people was examined to identify social support. A shortened version of the Pearlin Mastery Scale was used to assess self-control.
A short questionnaire for trainers was used to understand how the CooL interventions differed during the pandemic. To assess physical activity, the team asked about sedentary behavior on the least and most active days and the average minutes/day that participants were physically active.
study results
A total of 1,824 adults participated in the CooL CLI. About 95% of the participants were born in the Netherlands, with 72% of the study cohort identifying as female. Over 70% of the study cohort lived with a partner, two-thirds had intermediate/lower education, and a quarter had no permanent job.
Around 24% of participants provided information on how CooL was offered during the pandemic. Over 80% of attendees launched CooL with physical face-to-face sessions, while 20% joined remotely.
Almost all participants were part of the combined physical and digital sessions. More participants received in-person than digital sessions throughout the study period.
Before April 1, 2020, 120 participants have completed their first phase of the CooL CLI; however, 1,667 completed the first phase after that date. Weight, waist circumference, and body mass index (BMI) decreased at T1 relative to T0, with an average loss of 1.15 BMI points and 3.2% weight loss.
Anthropometric measurements did not differ significantly between those who joined before and during the COVID-19 pandemic. Self-control decreased at T1 compared to baseline; however, support remained unchanged. There were differences in self-control between CooL participation before and during the pandemic, with a much larger effect for pre-COVID-19 participants.
At T1, sedentary time was reduced for the least and most active days. The mean daily physical activity in minutes at T1 was 108 minutes and increased from 94 minutes at T0.
CooL participants enrolled during the COVID-19 period reported a decrease in sedentary time compared to baseline, while pre-COVID-19 participants showed a slight increase.
Over time, participants increased their attention to food consumption, meal composition, and food quantity while reducing alcohol consumption. There were no differences between pre-COVID-19 and COVID-19 participants in diet-related outcomes.
Stress perceptions were significantly reduced in pre-COVID-19 participants compared to those who joined after the onset of the COVID-19 pandemic. There were no differences in sleep between the two groups.
Conclusions
The current study evaluated the changes in outcomes after eight months of the first phase of the CooL CLI and reported positive changes compared to baseline. Importantly, the COVID-19 pandemic had negative effects on self-control, stress, and perceived fitness, but not on diet, social support, sleep, or anthropometric scores.
Taken together, these results suggest that small changes in different lifestyle behaviors can synergistically contribute to better health.
*Important NOTE: research place publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health-related behavior, or be treated as established information.
