Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Telemed J E Health. 2009 Nov;15(9):851-8. doi: 10.1089/tmj.2009.0036.
Despite evidence-based recommendations for addressing obesity in the clinical setting, lifestyle interventions are lacking in practice. The objective of this study was to translate an evidence-based lifestyle program into the clinical setting by adapting it for delivery via the Internet. We adapted the Diabetes Prevention Program's lifestyle curriculum to an online format, comprising 16 weekly and 8 monthly lessons, and conducted a before-and-after pilot study of program implementation and feasibility. The program incorporates behavioral tools such as e-mail prompts for online self-monitoring of diet, physical activity, and weight, and automated weekly progress reports. Electronic counseling provides further support. Physician referral, automated progress reports, and as-needed communication with lifestyle coaches integrate the intervention with clinical care. We enrolled 50 patients from a large academic general internal practice into a pilot program between November 16, 2006 and February 11, 2007. Patients with a body mass index (BMI) =25 kg/m2, at least one weight-related cardiovascular risk factor, and Internet access were eligible if referring physicians felt the lifestyle goals were safe and medically appropriate. Participants were primarily female (76%), with an average age of 51.94 (standard deviation [SD] 10.82), and BMI of 36.43 (SD 6.78). At 12 months of enrollment, 50% of participants had logged in within 30 days. On average, completers (n = 45) lost 4.79 (SD 8.55) kg. Systolic blood pressure dropped 7.33 (SD 11.36) mm Hg, and diastolic blood pressure changed minimally (+0.44 mm Hg; SD 9.27). An Internet-based lifestyle intervention may overcome significant barriers to preventive counseling and facilitate the incorporation of evidence-based lifestyle interventions into primary care.
尽管在临床实践中有循证推荐来解决肥胖问题，但生活方式干预措施实际上却缺乏。本研究的目的是通过将其改编为互联网提供的方式，将基于证据的生活方式计划转化为临床环境。我们将糖尿病预防计划的生活方式课程改编为在线格式，包括 16 周和 8 个月的课程，并对计划的实施和可行性进行了前后试点研究。该计划结合了行为工具，例如通过电子邮件提示在线自我监测饮食、体育活动和体重，并自动每周报告进度。电子咨询提供了进一步的支持。医生推荐、自动进度报告和根据需要与生活方式教练沟通，将干预措施与临床护理相结合。我们于 2006 年 11 月 16 日至 2007 年 2 月 11 日期间，从一家大型学术普通内科诊所招募了 50 名患者参加了一项试点计划。如果转诊医生认为生活方式目标是安全且医学上合适的，则符合条件的患者为 BMI = 25 kg/m2，至少有一种与体重相关的心血管危险因素，并且可以使用互联网。参与者主要为女性（76％），平均年龄为 51.94（标准差[SD] 10.82），BMI 为 36.43（SD 6.78）。在入组的 12 个月时，有 50％的参与者在 30 天内登录。平均而言，完成者（n = 45）减轻了 4.79（SD 8.55）kg。收缩压下降了 7.33（SD 11.36）mmHg，舒张压变化不大（+ 0.44 mmHg；SD 9.27）。基于互联网的生活方式干预措施可能会克服预防性咨询的重大障碍，并促进将基于证据的生活方式干预措施纳入初级保健。
