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In the wake of COVID-19, the American College of Lifestyle Medicine offered its members an online 10-week multicomponent mental health and wellbeing program (The Lift Project), and extended the invitation to members from sister organizations associated with the Lifestyle Medicine Global Alliance. A total of 1785 members registered for the program, representing 39 countries. The website hosting the program recorded 9815 total visits over the 10 weeks. In a post-program questionnaire completed by 145 participants, 91% agreed or strongly agreed that the program supported their mental wellbeing, and participants reported their wellbeing as higher after the program as compared to its commencement (X2 = 80.8, P <.01). Ninety-four percent of respondents indicated they would recommend the program to a friend. Thematic analysis of open-ended responses included in the post-program evaluation indicated that the participants liked: the structure of the program and content covered; the style of the video presentations; and the practical application of the program. Some participants indicated they would have liked more time to engage with the program and would have enjoyed the provision of group meetings. In conclusion, healthcare organizations can support their members' mental health and wellbeing by offering large-scale, evidence-based interventions. [ABSTRACT FROM AUTHOR]

BackgroundDigital mental health promotion interventions (MHPIs) present a scalable opportunity to attenuate the risk of mental health distress among nonclinical cohorts. However, adherence is frequently suboptimal, and little is known about participants’ perspectives concerning facilitators and barriers to adherence in community-based settings. ObjectiveThis study aimed to examine participants’ perceptions of facilitators and barriers to adherence in a web- and mobile app–based MHPI for a nonclinical cohort. MethodsThis qualitative study used inductive, reflexive thematic analysis to explore free-text responses in a postintervention evaluation of a 10-week digital MHPI. The intervention was administered using a web and mobile app from September to December 2018. Participants (N=320) were Australian and New Zealand members of a faith-based organization who self-selected into the study, owned a mobile phone with messaging capability, had an email address and internet access, were fluent in English, provided informed consent, and gave permission for their data to be used for research. The postintervention questionnaire elicited participants’ perceptions of facilitators and barriers to adherence during the intervention period. ResultsKey factors that facilitated adherence were engaging content, time availability and management, ease of accessibility, easy or enjoyable practical challenges, high perceived value, and personal motivation to complete the intervention. The primary perceived barrier to adherence was the participants’ lack of time. Other barriers included completing and recording practical activities, length of video content, technical difficulties, and a combination of personal factors. ConclusionsTime scarcity was the foremost issue for the nonclinical cohort engaged in this digital MHPI. Program developers should streamline digital interventions to minimize the time investment for participants. This may include condensed content, optimization of intuitive web and app design, simplified recording of activities, and greater participant autonomy in choosing optional features. Nonetheless, participants identified a multiplicity of other interindividual factors that facilitated or inhibited adherence.

Background: We examined the body mass index (BMI) of students attending Seventh-day Adventist (Adventist) schools in Australia in 2001 and 2012. Methods: A total of 3069 students attending Adventist schools in Australia responded to a health and lifestyle survey in 2001 (N = 1335) and 2012 (N = 1734). The survey captured self-reported height and weight, demographics (age, sex, year level, religion), and select health behaviors. Results: Compared with national norms, lower rates of overweight and obesity were observed in the study cohort, but higher rates of underweight. There was no change in the mean BMI of the students attending Adventist schools in Australia from 2001 to 2012. Regression analyses indicated that a lower BMI was associated with age, sex, more regularly eating breakfast, consuming less soft drink, and having a regular exercise program. The students reported a high consumption of fruits, vegetables, and whole grains compared with Australian national norms, and 29% claimed to be vegetarian. Conclusions: Students attending Adventist schools appear to have a lower prevalence of overweight and obesity than the secular population, but a higher prevalence of underweight. The mechanisms through which Adventist schools may influence student's BMI warrants further investigation.

BackgroundThe escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app–based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. ObjectiveThis study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. MethodsSubjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). ResultsInterested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). ConclusionsEarly dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx

BackgroundThe rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app–based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. ObjectiveThis study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app–based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. MethodsParticipants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard—fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the “mental health” and “vitality” subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. ResultsOf 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. ConclusionsA Web- and mobile app–based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx

This study examined the effectiveness of a 10-week multimodal intervention for improving the mental health and emotional well-being of college students when included as a mandatory component of the students' course of study. A total of 67 students (20.9 ± 5.4 years, 30 male/37 female) participated in the intervention that introduced a variety of evidence-based strategies for improving mental health and emotional well-being from the Lifestyle Medicine and Positive Psychology literature. Significant reductions were recorded in symptoms of depression (−28%, P <.05), anxiety (−31%, P <.05), and stress (−28%, P <.01), whereas significant improvements were observed in mental health (18%, P <.01), vitality (14%, P <.01) and overall life satisfaction (8%, P <.05). Effect sizes were larger than those reported by studies that have examined the individual effectiveness of the strategies incorporated into the intervention, suggesting a compounding effect. Stratified analyses indicated that participants with the lowest measures of mental health and emotional well-being at baseline experienced the greatest benefits. The findings of the study suggest that meaningful improvements in the mental health and emotional well-being of college students can be achieved, and potentially magnified, by utilizing a multidisciplinary approach involving evidence-based strategies from Lifestyle Medicine and Positive Psychology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the physiological challenges of competitive cross-country hang gliding. Methods: Seventeen experienced male pilots (age = 41 ± 9 y; mean ± SD) were fitted with a monitor that recorded heart rate and altitude at 0.5 Hz throughout a competitive flight. Fluid losses were evaluated by comparing pilot pre- and postflight mass. Results: The pilots' displacement was 88.4 ± 43.7 km in 145.5 ± 49.4 min. Mean flight altitude was 1902 ± 427 m (range = 1363-2601 m) with a maximum altitude of 2925 ± 682 m (1870-3831 m). The mean in-flight heart rate of the pilots was 112 ± 11 bpm (64 ± 6% predicted HRmax). For all except one subject, heart rate was highest while launching (165 ± 12 bpm, 93 ± 7% predicted HRmax), followed by landing (154 ± 13 bpm, 87 ± 7% predicted HRmax). No statistically significant relationship was observed between heart rate during the launch and reported measures of state anxiety. Heart rate was inversely related (P < .01) to altitude for all pilots except one. Fluid loss during the flight was 1.32 ± 0.70 L, which approximated 0.55 L/h, while mean in-flight fluid consumption was 0.39 ± 0.44 L. Six pilots consumed no fluid during the flight. Conclusions: Even among experienced pilots, high heart rates are more a function of state anxiety than physical work demand. Fluid losses during flight are surprisingly moderate but pilots may still benefit from attending to fluid balance. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether changes in lung function are associated with exercise-related transient abdominal pain (ETAP), Methods: Twenty-eight subjects susceptible to ETAP performed a flow-volume loop before (pre) and after (post) treadmill exercise. Fourteen of the subjects developed symptoms of ETAP during the exercise and completed the flow-volume loop while the pain was present. The remaining 14 subjects reported no symptoms of ETAP. Results: Forced inspiratory vital capacity was essentially unchanged from pre to post in both groups (ETAP group -0.8% ± 5.1%, comparison group -0.9% ± 6.5%). Peak inspiratory-flow rate increased in both the ETAP group ( 12.4% ± 16.2%) and the comparison group (17.9% ± 16.6%), but the difference between groups (4.6%, standardized effect size [EF] = -0.17) was trivial. Forced expiratory vital capacity decreased by approximately 4% in both groups (ETAP group -3.9% ± 3.3%, comparison group -4.0% ± 5.1%). Small differences in the mean change from pre to post between groups were recorded for peak expiratory-flow rote ( 7.4%, EF = -0.28) and the forced expiratory volume in the first second of the test (-4.4%, EF = -0.44). Conclusions: ETAP does not appear to be associated with reduced inspiratory performance, suggesting that the diaphragm is not implicated directly in the etiology of ETAP. Expiratory power might be slightly reduced during an episode of ETAP, but the magnitude of this effect is unlikely to compromise exercise performance. [ABSTRACT FROM AUTHOR]

Lifestyle medicine interventions are typically intensive by design. This study explored the optimal “dosage” of a well-known lifestyle medicine intervention—the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective. [ABSTRACT FROM AUTHOR]