Effect of Polyglucosamine on Weight Loss and Metabolic Parameters in Overweight and Obesity: A Systematic Review and Meta-Analysis

The use of dietary supplements for weight loss has gained significant momentum. Polyglucosamine, a chitosan derivative, is a dietary supplement increasingly used for weight loss. In this meta-analysis, we systematically summarized and quantified the key findings of four randomized, placebo-controlled clinical trials examining the effects of polyglucosamine supplementation and caloric restriction, and physical activity on body weight, body mass index (BMI), and waist circumference in subjects with overweight and obesity. The control group was set with a physical activity from 6–7 MET-h/week activity and up to 21 MET-h/week activity with caloric restriction. Compliance in the latter trials was reported via a follow-up questionnaire with the individual participants. The analysis included 399 subjects followed for a period ranging from 12 weeks to one year. Subjects’ age ranged from 21–75 years, BMI from 26–45 kg/m2, and all were white European or Caucasian in ethnicity. The meta-analyzed mean differences for random effects showed that polyglucosamine supplementation improves weight loss by −1.78 kg [−2.78, −0.79], BMI by −1.52 kg/m2 [−3.58, 0.54], and improves waist circumference reduction by −1.45 cm [−2.77, −0.12]. In conclusion, the use of polyglucosamine supplementation in conjunction with lifestyle behavioral therapies can be effective for weight reduction. Further studies are needed to examine the long-term effects of polyglucosamine supplementation on weight loss and other metabolic parameters

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A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-01065-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Chandni Maria Jacob ◽

Polly Louise Hardy-Johnson ◽

Hazel M. Inskip ◽

Taylor Morris ◽

Camille M. Parsons ◽

...

Keyword(s):

Physical Activity ◽

Health Education ◽

Meta Analysis ◽

Overweight And Obesity ◽

Risk Of Bias ◽

Control Group ◽

Z Score ◽

School Based ◽

Education Interventions ◽

Health Education Interventions

Abstract Background Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. Methods A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10–19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. Results Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (− 0.06 [95% CI -0.10, − 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. Conclusions Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.

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Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis (Preprint)

10.2196/preprints.17039 ◽

2019 ◽

Author(s):

Md.Mohaimenul Islam ◽

Tahmina Nasrin Poly ◽

Bruno Andres Walther ◽

Yu-Chuan (Jack) Li

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Body Weight ◽

Mobile Phone ◽

Controlled Trial ◽

Meta Analysis ◽

Mobile App ◽

Control Group ◽

Promote Weight Loss ◽

The Impact

BACKGROUND Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. OBJECTIVE The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. METHODS PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RESULTS A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88). CONCLUSIONS The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.

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Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/17039 ◽

2020 ◽

Vol 8 (7) ◽

pp. e17039

Author(s):

Md Mohaimenul Islam ◽

Tahmina Nasrin Poly ◽

Bruno Andres Walther ◽

Yu-Chuan (Jack) Li

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Body Weight ◽

Mobile Phone ◽

Controlled Trial ◽

Meta Analysis ◽

Mobile App ◽

Control Group ◽

Promote Weight Loss ◽

The Impact

Background Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88). Conclusions The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.

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Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials (Preprint)

10.2196/preprints.26699 ◽

2020 ◽

Author(s):

Annette Mönninghoff ◽

Jan Niklas Kramer ◽

Alexander Jan Hess ◽

Kamila Ismailova ◽

Gisbert W Teepe ◽

...

Keyword(s):

Physical Activity ◽

Meta Analysis ◽

Control Group ◽

Long Term Effects ◽

Short Term ◽

Mhealth Intervention ◽

Group Type ◽

Randomized Controlled

BACKGROUND Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. OBJECTIVE The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. METHODS We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. CONCLUSIONS mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.

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Effect of interventions based on regular physical activity on weight management in adolescents: a systematic review and a meta-analysis

Systematic Reviews ◽

10.1186/s13643-021-01602-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Babak Moeini ◽

Forouzan Rezapur-Shahkolai ◽

Saeed Bashirian ◽

Amin Doosti-Irani ◽

Maryam Afshari ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Clinical Trial ◽

Weight Loss ◽

Weight Management ◽

Meta Analysis ◽

Educational Interventions ◽

Regular Physical Activity ◽

Control Group ◽

Significant Finding

Abstract Background Physical inactivity is one of the major risk factors for non-communicable diseases. This systematic review and meta-analysis aimed to assess the effects of educational interventions on promoting regular physical activity in adolescent weight management programs. Methods The relevant studies indexed in Embase, Web of Science, Scopus, and ProQuest databases were searched using keywords namely “Physical Activity, Adolescent, Weight Management, Body Mass Index (BMI), Randomized Controlled Trials, and Clinical Trial.” Up to the end of March 2020, two authors independently screened the papers, extracted data, and assessed the methodological quality of the studies using Effective Public Health Practice Project (EPHPP) tool. Results Out of 12,944 initial studies, 14 met the inclusion criteria after screening the titles, abstracts, and full texts of the papers. The participants in these studies were aged between 6 and 18 years, and 13 studies included participants from both sexes. Moreover, eight of them were performed as a controlled clinical trial. The overall estimate of the difference showed that the interventions improved weight loss which is a statistically significant finding. The participants in the intervention group had a weight loss of 1.02 kg compared to the control group at a 95% confidence interval (− 4.794–0.222). Conclusion Published longitudinal data indicated that physical activity declines over the transition from adolescence to adulthood. Using the results of the study, policy-makers can design educational interventions using educational models and patterns. Systematic review registration PROSPERO registration number: CRD42020173869

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A review and meta-analysis of the effect of weight loss on all-cause mortality risk

Nutrition Research Reviews ◽

10.1017/s0954422409990035 ◽

2009 ◽

Vol 22 (1) ◽

pp. 93-108 ◽

Cited By ~ 138

Author(s):

Mary Harrington ◽

Sigrid Gibson ◽

Richard C. Cottrell

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Mortality Risk ◽

Meta Analysis ◽

Lifestyle Change ◽

Overweight And Obesity ◽

Dietary Quality ◽

Separate Analysis ◽

Intentional Weight Loss ◽

All Cause Mortality

Overweight and obesity are associated with increased morbidity and mortality, although the range of body weights that is optimal for health is controversial. It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m2). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. An electronic search identified twenty-six eligible prospective studies that monitored subsequent mortality risk following weight loss by lifestyle change, published up to 2008. Data were extracted and further analysed by meta-analysis, giving particular attention to the influence of confounders. Moderator variables such as reason for weight loss (intentional, unintentional), baseline health status (healthy, unhealthy), baseline BMI (normal, overweight, obese), method used to estimate weight loss (measured weight loss, reported weight loss) and whether models adjusted for physical activity (adjusted data, unadjusted data) were used to classify subgroups for separate analysis. Intentional weight loss per se had a neutral effect on all-cause mortality (relative risk (RR) 1·01; P = 0·89), while weight loss which was unintentional or ill-defined was associated with excess risk of 22 to 39 %. Intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors) (RR 0·87 (95 % CI 0·77, 0·99); P = 0·028), especially unhealthy obese (RR 0·84 (95 % CI 0·73, 0·97); P = 0·018), but appeared to be associated with slightly increased mortality for healthy individuals (RR 1·11 (95 % CI 1·00, 1·22); P = 0·05), and for those who were overweight but not obese (RR 1·09 (95 % CI 1·02, 1·17); P = 0·008). There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does not support solely advising overweight or obese individuals who are otherwise healthy to lose weight as a means of prolonging life. Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered. However, well-designed intervention studies are needed clearly to disentangle the influence of physical activity, diet strategy and body composition, in order to define appropriate advice to those populations that might be expected to benefit.

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Fad Diets: Dietary Dilemmas, Predicaments, and Recommendations for its Use

Current Nutrition & Food Science ◽

10.2174/1573401316999200407092922 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1362-1380

Author(s):

Jyoti Singh ◽

Prasad Rasane ◽

Vidisha Tomer ◽

Sawinder Kaur ◽

Yogesh Gat ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Health Care Expenditures ◽

Overweight And Obesity ◽

Lifestyle Changes ◽

Health Issues ◽

Lifestyle Modifications ◽

Treatment Measures ◽

Long Time ◽

Extra Weight

The health issues, mainly overweight and obesity are the growing concerns nowadays due to the associated factors and lifestyle changes which significantly have increased the individual’s health care expenditures. Fad diets are promoted as the easiest and simplest way of shedding the extra weight despite the availability of several treatments available. The prevention and treatment measures, including modification in lifestyle, dietary pattern, and physical activity, are the foundation of weight loss. However, the standard treatment measures are not effective for certain populations as they require long time adherence, which leads to the search for other approaches like fad diet. We steered a comprehensive literature review to present the facts related to fad diets to their efficacy and sustainability. Although fad diets have yielded tremendous positive results in weight loss and cardiovascular risk prevention, the studies reported death in long-term interventions and the results and some of them show side effects too. Randomized controlled trials have significantly reported weight loss in comparison with the popular fad diets; however, persisting on the same diet has also reported kidney problems, ketosis, and other metabolic related problems. The conclusion of this critical review reported that gradual weight loss could be attained by the combination of lifestyle modifications, physical activity, and recommended dietary approaches.

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Individual Diet Modification Reduces the Metabolic Syndrome in Patients Before Pharmacological Treatment

Nutrients ◽

10.3390/nu13062102 ◽

2021 ◽

Vol 13 (6) ◽

pp. 2102

Author(s):

Małgorzata Elżbieta Zujko ◽

Marta Rożniata ◽

Kinga Zujko

Keyword(s):

Physical Activity ◽

Metabolic Syndrome ◽

Fatty Acids ◽

Waist Circumference ◽

Nutrition Education ◽

Dietary Habits ◽

Fasting Glucose ◽

Intervention Group ◽

Control Group ◽

The Metabolic Syndrome

Modification of lifestyle, including healthy nutrition, is the primary approach for metabolic syndrome (MetS) therapy. The aim of this study was to estimate how individual nutrition intervention affects the reduction of MetS components. Subjects diagnosed with MetS were recruited in the Lomza Medical Centre. The study group consisted of 90 participants and was divided into one intervention group (individual nutrition education group (INEG)) and one control group (CG). The research was conducted over 3 months. The following measurements were obtained during the first visit and after completion of the 3 months intervention: body mass, waist circumference, body composition, blood pressure, fasting glucose, and blood lipids. Dietary assessments were performed before and post-intervention using 3-day 24-h dietary recalls. Dietary knowledge was evaluated with the KomPAN questionnaire. The total polyphenol content of the diet was calculated. Sociodemographic and lifestyle characteristics were collected from a self-reported questionnaire. The physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ). It was found that the individual nutrition education was an effective method to improve the knowledge, dietary habits, and physical activity of the study participants. The modification of the diet in terms of higher intake of polyphenols (flavonoids and anthocyanins), fiber, polyunsaturated fatty acids (PUFA), PUFA n-3, and lower intake of saturated fatty acids (SFA) had a significant impact on the improvement of some MetS risk factors (waist circumference, fasting glucose, and HDL-cholesterol).

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Effect of workplace physical activity interventions on the cardio-metabolic health of working adults: systematic review and meta-analysis

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-019-0896-0 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Rubina Mulchandani ◽

Ambalam M. Chandrasekaran ◽

Roopa Shivashankar ◽

Dimple Kondal ◽

Anurag Agrawal ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Blood Pressure ◽

Body Weight ◽

Waist Circumference ◽

Meta Analysis ◽

Workplace Interventions ◽

Working Adults ◽

Reduced Body ◽

Physical Activity Interventions

Abstract Background Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults. Methods All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome. Results A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m2, 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant. Conclusions Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.

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Impact of a 12-month web and smartphone-based intervention initiated during spa therapy to improve long-term physical activity of patients with chronic diseases: randomized controlled trial. (Preprint)

10.2196/preprints.29640 ◽

2021 ◽

Author(s):

Florie FILLOL ◽

Ludivine PARIS ◽

Sébastien PASCAL ◽

Aurélien MULLIEZ ◽

Christian-François ROQUES ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Waist Circumference ◽

Controlled Trial ◽

Intervention Group ◽

Group Versus ◽

Control Group ◽

Spa Therapy

BACKGROUND Lack of physical activity (PA) and sedentary behaviors are leading risk factors for non-communicable diseases (NCD). Web-based interventions are effective in increasing PA in older adults and in NCD patients. In many countries a course of spa therapy is commonly prescribed to NCD patients and represents an ideal context to initiating lifestyle changes. OBJECTIVE The main objective of this study was to evaluate in NCD patients the effectiveness of an intervention combining an individual face-to-face coaching during spa therapy and, when returning home, a web- and smartphone-based PA program including a connected wrist pedometer and a connected weighing scale, on the achievement of physical activity guidelines (PAG) 12 months after the end of spa therapy. METHODS This was a 12-month, prospective, parallel-group, randomized controlled trial. Patients were enrolled during spa therapy and randomized 1:1 to intervention or control group who received usual advices about PA. From the end of spa therapy, PA, weight, waist circumference, and quality of life of the participants in both groups, were assessed by phone every 2 months. Primary outcome was meeting PAG (PA≥600 METs) at 12 months after the end of spa therapy. Secondary outcomes were: meeting current PAG at 6 months of follow-up; sedentary time, weight and waist circumference, PA and quality of life, at 6 and 12 months. Objective use data of the web-and smartphone-based PA program were collected. Analytic methods include intention-to-treat and constrained longitudinal data analyses. RESULTS The study sample was 228 patients (female : 77.2% (176/228), mean age: 62.4 years (SD 6.7), retired: 53.9% (123/228), mean BMI = 28.2 kg.m-2 (SD 4.2)). No group differences were found for any baseline variable. At 12 months, the proportion of patients achieving PAG was significantly higher in intervention group versus control group (81% vs 67% respectively, OR = 2.34 (95% CI 1.02- 5.38; P=.045). No difference between intervention and control group was found neither in achieving PAG at 6 months nor for sedentary time, weight and waist circumference, at 6 and 12 months. Regarding quality of life, the physical component subscale score was significantly higher at 12 months in intervention group versus control group (mean difference: 4.1 (95% CI 1.9-6.3; P<.001). The mean duration use of the program was 7.1 months (SD 4.5). Attrition rate during the first 2 months of the program was 20.4% (23/113) whereas 39.8% (45/113) of the participants used the program for at least 10 months. CONCLUSIONS The results showed significantly more participants meeting PAG at one year in the intervention group compared to controls. A course of spa therapy offers the ideal time and setting to implement education in PA. Digital coaching seems to be more efficient than usual coaching for increasing the level of PA and decreasing sedentariness on the long term. CLINICALTRIAL ClinicalTrials.gov NCT02694796; https://clinicaltrials.gov/ct2/show/NCT02694796.

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