Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome

Abstract

Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone treatment of metabolic syndrome (MetS), little is known about the biobehavioral effects of a TLM program for patients in a community. The purpose of this study was to examine the effects of a 6-month TLM program on MetS risk factors and health-related qualities of life (HRQOL) among middle-aged and older women in a community in Korea. Fifty-two women (mean age, 62.7 ± 9.0 years) with MetS were recruited from 3 community health centers and were randomly assigned to the intervention (n = 31) or control (n = 21) groups. The patients in the intervention group participated in supervised TLM sessions for 6 months. The TLM program included health monitoring, counseling, health education, exercise, and dieting. Metabolic risk factors and HRQOL were measured at baseline, during the study (month 3), at completion (month 6), and postcompletion (month 12) of the TLM program. Compared with the control group, the TLM group showed significantly greater reductions in body weight (P < .001) and waist circumference (P < .001); these effects were sustained for 6 months after intervention. With regard to HRQOL, the TLM group showed greater improvements in physical function (P = .017), general health (P < .001), vitality (P = .008), and mental health (P = .027). These improvements, however, were not sustained after the intervention. The results indicate that a nurse-led systematic TLM program may be an effective strategy for managing middle-aged and older women with MetS at a community level.

Introduction

Metabolic syndrome (MetS) is a clinical entity characterized by a constellation of metabolically related abnormalities and cardiovascular risk factors, including obesity, insulin resistance/glucose intolerance, dyslipidemia, and hypertension [1]. People with MetS have an increased risk of cardiovascular disease–related morbidity and mortality, even in the absence of clinically evident cardiovascular disease and/or diabetes mellitus [2], [3].

In Korea, significant socioeconomic and demographic changes have increased the incidence of MetS. The prevalence in the general Korean population increased from 23.6% in 1998 to 28.0% in 2001 [4]. In addition, previous studies reported an increased prevalence of MetS in older women and in rural populations [5], [6], [7]. The 2001 Korea National Health and Nutrition Survey data showed a higher prevalence for MetS in rural areas (29.3%) than in urban areas (22.3%) [8]; therefore, management of MetS among older women living in rural areas needs to be addressed.

Therapeutic lifestyle modification (TLM) has been recommended as a cornerstone therapy for managing patients with MetS [3], [9]. Therapeutic lifestyle modification is a comprehensive approach based on exercise, diet, education, and/or pharmacotherapy. Furthermore, the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) emphasizes the role of health care providers in initiating and maintaining a TLM program for better compliance and cost-effectiveness. Previous studies have reported the positive effects of TLM. However, few studies have applied a comprehensive multicomponent approach to TLM in patients with MetS. In most intervention research with MetS patients, a single component of TLM, such as exercise alone [10], [11], diet alone [12], [13], drug therapy alone [14], [15], or a combination of 2 components, was used [16], [17], [18], [19], [20], [21] in clinical patients. In addition, little is known about the long-term effects of TLM in people with MetS; and the outcomes of TLM are mostly apparent on the physiologic markers of MetS components. Although it is generally believed that health-related quality of life (HRQOL) improves after lifestyle modification, little is known about whether TLM programs offer better HRQOL for MetS patients. Moreover, information or research on the effectiveness of TLM programs in community populations is limited. Because translational research is increasingly considered important for maximizing health benefits and health care delivery, this may allow for the combination of effective and culturally sensitive interventions with supporting environmental changes and may also encourage continuous improvement in evidence-based public policies. This study will also influence the development of strategies and policies for the management of MetS.

The purpose of this study was to examine, on a community level, the effects of a 6-month TLM program on MetS risk factors and HRQOL in middle-aged and older women with MetS. Specifically, this study primarily examined the effects of TLM on changes in body weight and other cardiometabolic factors and secondly assessed TLM's effects on HRQOL variables.