Un programme de prévention santé pour les jeunes couples

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A clinical trial testing the effectiveness and efficiency of health prevention efforts focused on physical activity and diet with people living in a relationship for less than two years.

A randomized controlled trial of Australian Dzator and colleagues, published in the Journal of Clinical Epidemiology in 2004, assesses the 12-month efficacy and cost-effectiveness of a primary prevention program combining physical activity and healthy eating on the condition physical, diet, cholesterol levels of people living in a relationship for less than 2 years. The results show a healthier diet, improved physical fitness and cholesterol levels up to 12 months among program participants compared to the control group.

The Study Rationale

Marriage or concubinage can negatively impact the health of people. People in couples for the first time tend to increase their energy intake and decrease their physical activity leading to weight gain. This lifestyle increases risk factors for health such as cardiovascular disease and chronic diabetes. Cardiovascular disease is the leading cause of death in many countries. In Australia, 39% of deaths in 2000 were associated with cardiovascular disease. They are also an economic and social cost. 12% of health spending in Australia in 1993 and 1994 were devoted to the care of cardiovascular diseases, 3.7 billion.

The physical practice is insufficient to provide health benefits in half Australian. Lack of physical activity causes significant costs in terms of morbidity and mortality. Between 1989 and 2000, rates of overweight and obesity increased from 48 to 67% for men and from 34 to 52% for women. Weight gain also increases the risk of type 2 diabetes.

The Question

A health prevention program based on education to a healthier diet and regular physical activity is it advantageous in terms of cost-efficacy?

The Protocol

The randomized controlled Dzator and colleagues, compared the cost-effectiveness of two health prevention actions based on physical activity and diet and adopting a healthier lifestyle. The study covers 81 couples living together for the first time for less than 2 years. Participants were randomly placed into three distinct groups: one group enjoyed the physical activity and nutrition program (high intensity), another group enjoyed the same program but less intense (low intensity) and a control group. Biological measures related systolic and diastolic blood pressure and heart rate. Anthropometric measures included weight, height, waist and hips. A fasting blood sample was performed to determine the total cholesterol and high density lipoprotein (HDL). The measures included the diet of 3 days (Xyris Diet / Fat 1 Software and Short Questionnaire), the level of physical activity (7-day recall questionnaire and 14-day activity recall) and the economic cost of the programs. The measurements were recorded at the beginning of intervention, intervention end at 16 weeks and 12 months of follow-up.

The tested Non-Pharmacological Intervention (NPI)

The program of physical activity and dietary lasted 4 months. The program consisted of a series of six modules on nutrition, physical activity and the benefits of a healthy lifestyle. A professional physical activity and a dietitian trained in primary prevention explained the objective of the couples in the program during the first visit.

intensive program of meetings were mailed alternating with supervised sessions. Each group consisted of 8 couples.

low intensity program: Participants attended an initial meeting of the group. Then the modules were sent by mail every 2 to 3 weeks.

The physical activity program was designed to encourage participants to practice at least 30 minutes of moderate physical activity most days of the week. The themes of health education included the health benefits of exercise, a healthy diet, how to start an exercise program to prevent injuries, recognizing signs of overwork and maintain physical practice time even as a couple.

The nutrition program was designed to encourage the adoption of healthy eating habits, rich in fruits, vegetables, fiber and low in fat and salt. Educational modules addressed the pyramid healthy diet, the types and sources of dietary fats, a healthy diet based on the budget, the specific nutritional requirements and guidelines for the choice of healthy menus at the restaurant.

Main Results

The results show that both health prevention programs are effective in improving the physical and nutritional health of participants compared to the control group. The results also show a greater improvement in cholesterol levels, blood pressure, fat intake and physical practice level in the group with intensive compared to the group receiving the low intensity program. The intensive program has a better cost-effectiveness than the low intensity program at the end of intervention and after one year.

What it means for Patients

The adoption of a deleterious lifestyle health is common in early married life. An awareness campaign on physical activity and dietary 4 months improves physical and psychological health of these young couples and reduce health costs.

What it means for Healthcare Professionals

The results of this trial demonstrate that it is possible to achieve lifestyle changes people in couples at low cost. Prescribe this type of educational program for healthcare to people living in a relationship for less than two years allows to encourage them to adopt a healthier lifestyle and prevent many health spending. An intensive program is preferable to a lightweight program.

What it means for Researchers

This clinical trial evaluated the cost-effectiveness of an intervention for primary prevention aimed at changing the lifestyle of people living in a relationship for less than 12 months. This type of program is effective in changing people’s health behaviors.

What it means for Policymakers

The growing obesity and chronic diseases related to poor lifestyle habits continue to threaten the health of individuals in developed and in developing countries countries. This intervention provides promising benefits on cardiovascular risk factors. The profits could then lead to a substantial reduction in health-related expenses.

The reference

Dzator JA, Hendrie D, Burke V, Gianguilio N, Gillam HF, Beilin LJ, Houghton S (2004). A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost. Journal of Clinical Epidemiology, 57, 610-619.

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To reference this Blog en Sante © article.

Ninot G (2016). A health prevention program for young couples. Blog en Sante, A85.

© Copyright 2016 Grégory Ninot. All rights reserved.