Weight change and quality of life in a community-based population

*Objectives:* This study investigates the longitudinal association between 5-year weight change and quality of life (QoL) in Dutch men and women.

*Design:* A prospective cohort study (1998, 2000, 2003) in a population based sample. Subjects: 2,414 men and women from the Maastricht region of the Netherlands.

*Measurements:* QoL outcomes were measured by the RAND-36 (eight subscales and two overall composite scores, physical and mental health (PCS and MCS)). Weight was measured on a scale. Weight change was calculated as change in weight between 1998 and 2003. In addition, 5-year weight change was also categorized in three groups: weight losers, weight maintainers, and weight gainers. All analyses were stratified for gender.

*Results:* A total of 598 men (50%) and 646 women (54%) maintained their weight, 177 men (15%) and 163 women (14%) lost more than 2.5 kg, and 410 men (35%) and 379 women (32%) gained more than 2.5 kg. Associations between 5-year weight change and QoL were found for MCS ([beta] = 0.13, 95% CI: 0.02|0.24) in women, and PCS ([beta] = -0.09, 95% CI: -0.17|-0.00; [beta] = -0.10, 95% CI: -0.19|-0.01) in men and women respectively. Moreover, associations between weight change and QoL were most pronounced for women of normal weight and obese men. Furthermore, in both genders, weight gainers showed a greater reduction on all physical components of QoL compared with weight maintainers. However, after 5-years weight gainers and weight losers did not significantly differ from weight maintainers in the mean change of MCS and PCS.

*Conclusion:* Weight gain was inversely associated with the physical domains of QoL in women and obese men. Conversely, in women, weight gain was positively associated with the mental domains of QoL. No differences between weight losers and weight gainers were found in mean change of QoL compared with weight maintainers

Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty:modelling the results of a randomized controlled trial

Background: Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty. Methods: Intervention participants (N= 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print delivered versus Web based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET) hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5 year, 10 year and lifetime horizons) in terms of health effects and quality-adjusted life years (OALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated. Results: For all extrapolated time horizons, the printed and the Web based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of 20,000/QALY, on a lifetime horizon the printed (ICER =E7,500/QALY) as well as the Web based interventions (ICER = E10,100/QALY) were cost-eftective. On a 5-year time horizon, the Web based intervention was preferred over the printed intervention. On a 10 year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness. Conclusion: A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50

Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors.

BACKGROUND: A widely advocated strategy in public health is community-based health promotion. The aim of this study was to investigate the net effect of a cardiovascular disease prevention program (Hartslag Limburg) on cardiovascular risk factors after 5 years of intervention. DESIGN: Cohort study comparing 5-year mean change in risk factors between the intervention and reference area. The statistical analyses for the study were performed in 2005. SETTING/PARTICIPANTS: In 1998, 3000 subjects (aged 25 to 70) from the intervention area and 895 subjects from a reference area participated in the baseline measurement. Of these, 2414 intervention subjects and 758 reference subjects completed the follow-up measurement in 2003. INTERVENTION: Hartslag Limburg is an integrative community-based cardiovascular disease prevention program promoting a healthy lifestyle. MAIN OUTCOME MEASURES: Body mass index (BMI), waist circumference, blood pressure, serum glucose (nonfasting), and serum total and high-density lipoprotein (HDL) cholesterol. RESULTS: During the 5-year follow-up, risk factors changed unfavorably in the reference group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in risk factors between intervention and reference group was significant (p<0.05) for BMI: -0.36 kg/m(2) in men and -0.25 kg/m(2) in women; waist circumference -2.9 cm in men and -2.1 cm in women; systolic blood pressure: -7.8 mmHg in men and -5.5 mmHg in women; total cholesterol 0.11 mmol/L in women and finally serum glucose -0.23 mmol/L in women. CONCLUSIONS: Hartslag Limburg succeeded in reducing-and in some cases, preventing-age- and time-related increase in BMI, waist circumference, blood pressure, and, in women, nonfasting glucose concentration