Skip to main content

Advertisement

SpringerLink
Log in

Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

An Erratum to this article was published on 18 February 2015

Abstract

Purpose

This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight.

Methods

Seventy-three patients (mean ± SD, 55 ± 12 years) with overweight (body mass index (BMI), 34.5 ± 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 ± 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days.

Results

The experimental group reduced 2.1 kg (±4.6) in weight and 3 cm (±4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups.

Conclusions

The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual’s goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lindberg E, Gislason T (2000) Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 4(5):411–433

    Article  CAS  PubMed  Google Scholar 

  2. Chasens ER, Sereika SM, Houze MP, Strollo PJ (2011) Subjective and objective appraisal of activity in adults with obstructive sleep apnea. J Aging Res. doi:10.4061/2011/751819

    PubMed Central  PubMed  Google Scholar 

  3. Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest 99:861–866

    Article  CAS  PubMed  Google Scholar 

  4. Fisher D, Pillar G, Malhotra A, Peled N, Lavie P (2002) Long-term follow-up of untreated patients with sleep apnoea syndrome. Respir Med 96(5):337–343

    Article  CAS  PubMed  Google Scholar 

  5. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015–3021

    Article  CAS  PubMed  Google Scholar 

  6. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5(2):185–192

    Article  PubMed Central  PubMed  Google Scholar 

  7. Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B (2008) Management of obesity in adults: European clinical practice guidelines. Obes Facts 1:106–116

    Article  PubMed  Google Scholar 

  8. Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults (review). Cochrane Database Syst Rev 19(3), CD001106. doi:10.1002/14651858.CD001106.pub3

    Google Scholar 

  9. Johansson K, Neovius M, Trolle Lagerros Y, Harlid R, Rössner S, Granath F, Hemmingsson E (2009) Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ 339:b4609. doi:10.1136/bmj.b4609

    Article  PubMed Central  PubMed  Google Scholar 

  10. Tuomilehto HPI, Seppä JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JOI, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tuikainen H, Uusitupa M (2009) Lifestyle intervention with weight reduction. First-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327

    Article  PubMed  Google Scholar 

  11. Foster G, Borradaile K, Sanders M, Millman R, Zammit G, Newman A, Wadden T, Kelley D, Wing R, Pi-Sunyer X, Rebossin D, Kuna S (2009) A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes. Arch Intern Med 169(17):1619–1626

    Article  PubMed Central  PubMed  Google Scholar 

  12. Netzer N, Lormes W, Giebelhaus V, Halle M, Keul J, Matthys H, Lehmann M (1997) Physical training of patients with sleep apnea. Pneumologie 51(Suppl 3):779–782

    PubMed  Google Scholar 

  13. Giebelhaus V, Strohl KP, Lormes W, Lehmann M, Netzer N (2000) Physical exercise as an adjunct therapy in sleep apnea—an open trial. Sleep Breath 4(4):173–176

    PubMed  Google Scholar 

  14. Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B (2011) The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath 15(1):49–56

    Article  PubMed  Google Scholar 

  15. Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD (2011) The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 34(12):1631–1640

    PubMed Central  PubMed  Google Scholar 

  16. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093

    Article  PubMed  Google Scholar 

  17. Tudor-Locke C, Schuna JM Jr (2012) Steps to preventing type 2 diabetes: exercise, walk more, or sit less? Front Endocrinol. doi:10.3389/fendo.2012.00142

    Google Scholar 

  18. O’Donovan G, Blazevich AJ, Boreham C, Cooper AR, Crank H, Ekelund U, Fox KR, Gately P, Giles-Corti B, Gill JMR, Hamer M, Mc Dermott I, Murphy M, Mutrie N, Reilly JJ, Saxton JM, Stamatakis E (2010) The ABC of physical activity for health: a consensus statement from the British Association of Sports and Exercise Sciences. J Sports Sci 28(6):573–591

    Article  PubMed  Google Scholar 

  19. Tudor-Locke C, Craig CL, Brown WJ, Clemes SA, de Cocker K, Giles-Corti B, Hatano Y, Inoue S, Matsudo SM, Mutrie N, Oppert J-M, Rowe DA, Schmidt MD, Schofield GM, Spence JC, Teixeira PJ, Tully MA, Blair SN (2011) How many steps/day are enough? For adults. Int J Behav Nutr Phys Act. doi:10.1186/1479-5868-8-79

    Google Scholar 

  20. Enghardt Barbieri H, Lindvall C (2005) Swedish Nutrition recommendations Objectified (SNO)—basis for general advice on food consumption for healthy adults. National Food Administration Report, National Food Agency Stockholm

    Google Scholar 

  21. Geissler C, Powers HJ (2011) Human nutrition, 12th edn. Churchill Livingstone, Edinburgh

    Google Scholar 

  22. Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47(9):1102–1114

    Article  CAS  PubMed  Google Scholar 

  23. Knittle K, de Gucht V, Maes S (2012) Lifestyle- and behaviour-change interventions in musculoskeletal conditions. Best Pract Res Cl Rh 26:293–304

    Article  Google Scholar 

  24. Williams SL, French DP (2011) What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res 26(2):308–322

    Article  CAS  PubMed  Google Scholar 

  25. Michie S, Abraham C, Whittington C, Mc Ateer J (2009) Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol 28(6):690–701

    Article  PubMed  Google Scholar 

  26. The Swedish Council on Technology Assessment in Health Care [SBU] (2007) Methods of promoting physical activity. A systematic review. vol 181. The Swedish Council on Technology Assessment in Health Care [SBU]. Full text in Swedish. Summary and conclusions available in English, Stockholm

  27. Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The ASSM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester, Illinois

    Google Scholar 

  28. Igelström H, Emtner M, Lindberg E, Åsenlöf P (2013) Level of agreement between methods for measuring moderate to vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity. Phys Ther 93:50–59

    Article  PubMed  Google Scholar 

  29. The National Board on Health and Welfare [Socialstyrelsen] (2011) Nationella riktlinjer för sjukdomsförebyggande metoder. Tobaksbruk, riskbruk av alkohol, otillräcklig fysisk aktivitet och ohälsosamma matvanor. Stöd för styrning och ledning. The National Board on Health and Welfare [Socialstyrelsen], Stockholm

  30. van Strien T, Frijters JER, Bergers GPA, Defares PB (1986) The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord 5(2):295–315

    Article  Google Scholar 

  31. Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs

    Google Scholar 

  32. Deci EL, Ryan RM (2008) Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol 49(3):182–185

    Article  Google Scholar 

  33. Sniehotta FF, Schwarzer R, Scholz U, Schüz B (2005) Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J Soc Psychol 35:565–576

    Article  Google Scholar 

  34. Igelström H, Martin C, Emtner M, Lindberg E, Åsenlöf P (2012) Physical activity in sleep apnea and obesity—personal incentives, challenges, and facilitators for success. Behav Sleep Med 10(2):122–137

    Article  PubMed  Google Scholar 

  35. Spörndly-Nees S, Igelström H, Lindberg E, Martin C, Åsenlöf P (2014) Facilitators and barriers for eating behaviour changes in obstructive sleep apnoea and obesity—a qualitative content analysis. Disabil Rehabil 36(1):74-81

    Google Scholar 

  36. Åsenlöf P, Denison E, Lindberg P (2009) Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: a randomized controlled trial in primary care. Eur J Pain 13(10):1080–1088

    Article  Google Scholar 

  37. Jönsson B, Ohrn K, Oscarson N, Lindberg P (2009) The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour in patients with periodontal disease: a blinded randomized-controlled clinical trial (1-year follow-up). J Clin Periodontol 36(12):1025–1034

    Article  PubMed  Google Scholar 

  38. Kreuter MW, Skinner CS (2000) Tailoring: what’s in a name? Health Educ Res 15(1):1–4

    Article  CAS  PubMed  Google Scholar 

  39. Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ, Owen N (2008) Objectively measured sedentary time, physical activity, and metabolic risk. Diabetes Care 31:369–371

    Article  PubMed  Google Scholar 

  40. Elbelt U, Schuetz T, Hoffmann I, Pirlich M, Strasburger CJ, Lochs H (2010) Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity. Clin Nutr 29(6):766–772

    Article  PubMed  Google Scholar 

  41. Harris J, Benedict FA (1919) A biometric study of basal metabolism in man. Carnegie Institute of Washington, Washington D.C.

  42. Barnes MP, Ward AB (2000) Textbook of rehabilitation medicine. Oxford University Press, Oxford

    Google Scholar 

  43. Gollwitzer PM (1999) Implementation intentions. Strong effects of simple plans. Am Psychol 54(7):493–503

    Article  Google Scholar 

  44. Carver CS, Scheier MF (1982) Control theory: a useful conceptual framework for personality—social, clinical, and health psychology. Psychol Bull 92(1):111–135

    Article  CAS  PubMed  Google Scholar 

  45. Haynes SN, Leisen MB, Blaine DD (1997) Design of individualized behavioral treatment programs using functional analytic clinical case models. Psychol Assess 9(4):334–348

    Article  Google Scholar 

  46. Wen CP, Wai JP, Tsai MK, Yang YC, Cheng TY, Lee MC, Chan HT, Tsao CK, Tsai SP, Wu X (2011) Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 378(9798):1244–1253

    Article  PubMed  Google Scholar 

  47. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, New Jersey

    Google Scholar 

  48. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS (2011) 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581

    Article  PubMed  Google Scholar 

  49. Hemmingsson E, Johansson K, Eriksson J, Sundstrom J, Neovius M, Marcus C (2012) Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study. Am J Clin Nutr 96(5):953–961

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Bandura A (1997) Self-efficacy. The exercise of control. W.H Freeman and Company, New York

    Google Scholar 

  51. Gourlan MJ, Trouilloud DO, Sarrazin PG (2011) Interventions promoting physical activity among obese populations: a meta-analysis considering global effect, long-term maintenance, physical activity indicators and dose characteristics. Obes Rev 12(7):e633–e645

    Article  CAS  PubMed  Google Scholar 

  52. Kaleta D, Jegier A (2005) Occupational energy expenditure and leisure-time physical activity. Int J Occup Med Environ Health 18(4):351–356

    PubMed  Google Scholar 

  53. Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC (2005) Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev 1, CD004017. doi:10.1002/14651858.CD004017.pub2

    PubMed  Google Scholar 

  54. Renjilian DA, Perri MG, Nezu AM, McKelvey WF, Shermer RL, Anton SD (2001) Individual versus group therapy for obesity: effects of matching participants to their treatment preferences. J Consult Clin Psychol 69(4):717–721

    Article  CAS  PubMed  Google Scholar 

  55. McDoniel SO, Hammond RS (2010) A comprehensive treatment program for obese adults diagnosed with obstructive sleep apnea. A pilot study. Top Clin Nutr 25(2):172–179

    Article  Google Scholar 

  56. Steingrimsdottir L, Ovesen L, Moreiras O, Jacob S (2002) Selection of relevant dietary indicators for health. Eur J Clin Nutr 56(Suppl 2):S8–S11. doi:10.1038/sj.ejcn.1601423

    Article  PubMed  Google Scholar 

  57. Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R (2001) Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res 9(3):171–178

    Article  CAS  PubMed  Google Scholar 

  58. Scheers T, Philippaerts R, Lefevre J (2012) Assessment of physical activity and inactivity in multiple domains of daily life: a comparison between a computerized questionnaire and the SenseWear Armband complemented with an electronic diary. Int J Behav Nutr Phys Act. doi:10.1186/1479-5868-9-71

    PubMed Central  PubMed  Google Scholar 

  59. Trabulsi J, Schoeller DA (2001) Evaluation of dietary assessment instruments against doubly labeled water, a biomarker of habitual energy intake. Am J Physiol Endocrinol Metab 281(5):e891–e899

    CAS  PubMed  Google Scholar 

  60. Papazoglou D, Augello G, Tagliaferri M, Savia G, Marzullo P, Maltezos E, Liuzzi A (2006) Evaluation of a multisensor armband in estimating energy expenditure in obese individuals. Obesity 14(12):2217–2223

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was financially supported by the Swedish Research Council (Stockholm, Sweden), Caring Sciences Funding at the Faculty of Medicine, Uppsala University (Uppsala, Sweden), Uppsala County Council (Uppsala, Sweden), the Swedish Heart and Lung Association (Stockholm, Sweden), Swedish Sleep Research (Umeå, Sweden), and the Association against Heart and Lung Diseases (Uppsala, Sweden). The authors thank Gunilla Hägg, RN, for excellent assistance with data collection.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, BMC, Uppsala, SE-751 24, Sweden

    Igelström Helena, Emtner Margareta & Åsenlöf Pernilla

  2. Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden

    Emtner Margareta & Lindberg Eva

Authors
  1. Igelström Helena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emtner Margareta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lindberg Eva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Åsenlöf Pernilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Igelström Helena.

Additional information

Trial registration

Clinical Trials NCT01102920

Rights and permissions

Reprints and permissions

About this article

Cite this article

Helena, I., Margareta, E., Eva, L. et al. Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight. Sleep Breath 18, 655–668 (2014). https://doi.org/10.1007/s11325-013-0929-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-013-0929-x

Keywords

Search

Navigation