LiSM10! (Lifestyle Modification program 10!)

In Japan, 17.2% of males have metabolic syndrome, a condition that increases risk for heart disease, diabetes, and stroke. Metabolic syndrome is diagnosed when at least three of these five metabolic factors are present: a large waistline, high triglyceride level, low HDL cholesterol level, high blood pressure, and high fasting blood sugar. Obesity increases the risk of having metabolic syndrome as well as other negative health outcomes (e.g., respiratory problems, osteoarthritis, various cancers). In Japan, 27.3% of males are overweight and 5.8% are obese. Interventions that target lifestyle change by increasing physical activity and nutrition may help improve metabolic parameters and reduce the risk of obesity and its associated outcomes.
 

LiSM10! (Lifestyle Modification program 10!) is a 6-month worksite-based nutrition and physical activity program that promotes health among white-collar, middle-aged Japanese men who work in office settings and are at high risk for having metabolic syndrome. Based on the social cognitive theory and stages of change, LiSM10! aims to increase the intake of healthy food, decrease the intake of unhealthy food, and increase physical activity to ultimately improve metabolic parameters.

The LiSM10! program consists of four face-to-face sessions and one email session providing physical activity and nutrition counseling. Facilitated by trained health counselors (a dietician and a physical trainer), the sessions include the following:

-- Session 1: Face-to-face goal-setting counseling session (approximately 30 minutes). The participant engages in a self-assessment of his or her current nutrition and physical activity habits, selects and documents goals, and learns how to eat healthier by increasing intake of 5 groups of healthy foods (e.g., fish, soybeans, green/deep-yellow vegetables) and decreasing intake of 11 groups of unhealthy foods (e.g., confectionaries, fatty meats, fried dishes, alcoholic drinks). The dietician tailors recommendations on changes in intake on the basis of the participant's stage of change and self-efficacy, with more aggressive changes recommended to participants with a more advanced stage of change and greater self-efficacy. Between sessions 1 and 2, and between subsequent sessions, participants record their walking steps, dietary intake, and body weight.

-- Sessions 2 and 3: Face-to-face review counseling sessions (approximately 20 minutes each). The participant talks about his or her achievements toward goals, makes necessary modifications to goals, and discusses any potential problems or concerns.

-- Session 4: Email-based review counseling session (conducted via a website during the study). The participant verifies achievement of goals, informs the counselors of progress and challenges, and receives guidance from the counselors to help maintain progress.

-- Session 5: Face-to-face final counseling session (approximately 20 minutes). The counselors review the progress completed toward goals based on the participant's completion of a post-counseling lifestyle assessment and measures of diet and exercise, and the counselors and participant discuss future health goals.
 

-- Time to attend the counselor training session, to prepare for goal-setting counseling sessions, and to prepare program documents and arrange participant information.

-- 1.5 to 2 hours to complete the five counseling sessions.

LiSM10! targets white-collar Japanese males aged 30 to 59 years who work in office settings and are at risk of developing metabolic syndrome.

LiSM10! can be implemented in urban and suburban workplace settings.

Required resources to implement the program include the following:
-- LiSM10! Participant Manual
-- Lifestyle Assessment
-- Pedometer Check Sheet
-- Number of Steps Self-Check Sheet (baseline)
-- Number of Steps Self-Check Sheet (at the end)
-- Self-Monitoring Sheet
-- Check Your Dietary Habits Sheet (baseline)
-- Check Your Dietary Habits Sheet Group A (at the end)
-- Check Your Dietary Habits Sheet Group B (at the end)
-- Commitment Sheet
-- LiSM10! Program Overview
-- Nutritional Counseling Manual
-- Physical Activity Counseling Manual
-- Guide on Using the "Check Your Dietary Habits" Sheets
-- Goal Setting and Review Counseling Check List
-- Final Counseling Check List
-- LiSM10! Manual for Office Staff
-- Using Coaching Skills During Counseling Slides
-- Basic Knowledge Required for Nutrition Counseling Slides
-- Healthy Guidance To Support Sustainable Behavior Modification Slides

For costs associated with this program, please contact the developer, Ai Moriyasu. (See products page on the EBCCP website for developer contact information.)
 

A randomized controlled trial compared the effects of LiSM10! with those of a comparison condition. After medical examinations, intervention group participants received LiSM10, and comparison group participants received written feedback about the results of their medical examinations, printed materials, and recommendations from an occupational nurse on exercise and diet.

Participants were recruited from a health insurance company in Tokyo and the surrounding area. The study recruited male Japanese office workers aged 30 to 59 years at risk of developing metabolic syndrome. A participant was considered at risk of developing metabolic syndrome if he had one or more test results outside the normal range for serum lipids, glucose levels, or blood pressure, coupled with visceral obesity (umbilical circumference of 85 cm or more) and/or body mass index (BMI) of 25 kg/m² or higher. Participants were excluded if they were under medical treatment for hypertension, dyslipidemia, diabetes, and/or arteriosclerotic disease. Of the 800 employees informed about the study, 115 enrolled. Of those, 14 were not eligible on the basis of their medical treatment, leaving 101 study participants who were randomized into the intervention group (n=52) or the comparison group (n=49) using computer software.

The average age of intervention participants was 43.1, average height was 171.1 cm (67.36 in.), average weight was 75.4 kg (166.23 lbs.), and average BMI was 25.7 kg/m². The average age of comparison group participants was 35.5, average height was 171.3 cm (67.44 in.), average weight was 75.8 kg (167.11 lbs.), and average BMI was 25.8 kg/m².

The main outcomes were consumption of healthy and unhealthy foods and number of walking steps, with secondary outcomes being weight, BMI, and umbilical circumference; diastolic and systolic blood pressure; and biochemical measures such as aspartate aminotransferase, fasting glucose, fasting insulin, HOMA-IR (homeostasis model assessment of insulin resistance), total and LDL cholesterol, uric acid, and others. All were assessed at baseline and 6 months later at the Tokyo Health Service Association (Shinjuku-ku, Tokyo) except food intake, walking steps, and weight, which were recorded over the course of the study by participants.

Food intake was reported weekly on a website using a questionnaire, the Dietary Assessment. Each week, participants completed the online Dietary Assessment to measure servings of healthy foods (Group A foods) and those of unhealthy foods (Group B foods). Five items assessed Group A food intake on a scale of 1 to 5. For example, for fish, respondents indicated their servings/week by answering with 1 (never/rarely), 2 (1-2 servings), 3 (3-4 servings), 4 (5-6 servings), or 5 (7 or more servings). The total score for Group A ranged from 5 to 25, with a greater score indicating greater healthy food intake. Eleven items assessed Group B food intake on a scale of 5 to 1. For example, for fatty meats, respondents indicated their servings/week by answering with 5 (never/rarely), 4 (1-2 servings), 3 (3-4 servings), 2 (5-6 servings), or 1 (7 or more servings). The total score for Group B ranged from 11 to 55, with a greater score indicating less unhealthy food intake. Participants also provided their weekly steps (measured with a pedometer) and weekly weight through the website.

BMI was calculated using height and weight [weight (kg)/height (m)²], and umbilical circumference was measured in a standing position during late exhalation. Blood pressure was measured with an automatic blood pressure manometer while participants were seated. Biochemical measures were taken from blinded fasting blood samples.

• From baseline to 6-month follow-up, the intervention group had a significant increase in healthy food intake (reflected in a greater increase in the mean Dietary Assessment score) relative to the comparison group (p=.00).

• From baseline to 6-month follow-up, the intervention group had a significant decrease in unhealthy food intake (reflected in a greater increase in the mean Dietary Assessment score) relative to the comparison group (p=.00).

Additional Findings

• From baseline to follow-up, the intervention group had significantly greater decreases than the comparison group in both weight (2.14 vs. 0.80 kg; p=.01) and BMI (0.74 vs. 0.26 kg/m², p=.01).

• From baseline to follow-up, the intervention group also had significantly better outcomes than the comparison group across some biochemical measures: aspartate aminotransferase (p=.03), glucose (p=.02), insulin (p=.04), and HOMA-IR (p=.00).

• From baseline to follow-up, no significant between-group differences were found for walking steps, umbilical circumference, diastolic and systolic blood pressure, and the remaining biochemical measures.