Lifestyle Intervention Program for Former Elite Athletes

NCT ID: NCT03031951

Last Updated: 2021-02-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

94 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-09-30

Study Completion Date

2021-01-31

Brief Summary

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Given the lack of support for lifestyle management in post-career and considering the high rates of physical inactivity and overweight in former elite athletes, the aim of this research project is to analyze the efficacy and effectiveness of a lifestyle intervention in former athletes.

Detailed Description

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The physical preparation of the elite athlete results from a complex and very demanding daily training. In this process high energy expenditure (EE) occur compensated by a proportional energy intake, thus contributing to neutral energy balance and weight maintenance. However, a positive energy balance (and consequently an increase in weight) is expected after the end of the sports career if the energy intake is maintained for lower EE. While clinicians and researchers are concerned with the average individual whose physical activity (PA) level is far below the recommended exercise dose an often overlooked group are the former highly competitive athletes, who have been exposed to higher amounts of vigorous PA during times of training and competition.

It is common that upon retirement energy intake does not match the dramatic decrease in overall energy expenditure leading to a positive energy balance, and consequently weight gain. The change to a lower physical activity level does not induce an equivalent reduction in energy intake. Varying physical activity level from 1.8 to 1.4 over 7 days was not associated with a change of energy intake and there was no tendency for energy intake to drop as the sedentariness progressed.

In fact, elite athletes that became inactive are susceptible to various chronic diseases such as obesity, diabetes and cardiovascular disease. Not only obesity and its comorbidities are a major health problem as an increase in body weight and a higher risk for developing hypertension, type II diabetes and cardiovascular disease has been observed in athletes that retired from the sports career . However, the literature reports that this risk is only present in those retired athletes exposed to a sedentary lifestyle. In fact, the current levels of PA are more protective against the development of cardiovascular disease in former athletes than their past sports history. Although it is expected that the retired elite athlete will be engaged in regular PA throughout life, studies reveal that this assumption does not apply to all former athletes. This concern was addressed in the United States, namely within the National Football League where an obesity prevention program for the retired athletes was implemented. In Portugal \~50% of the former elite athletes are overweight/obese and \~30% are inactive, based on self-reports measures. Indeed no support is provided for maintaining a healthy lifestyle after the end of the sports career. If a healthy lifestyle promotion among post-career elite athletes would contribute to avoid the observed rates of overweight/obesity it is unknown. Considering this actual context, the aim of this research project is to analyze the effect of a lifestyle intervention in former athletes. To accomplish the goals the investigators will perform a 1 year randomized controlled trial with a 4-month lifestyle intervention and an 8-month follow-up in 100 volunteered former overweight (Body Mass index\>25 kg.m-2), inactive elite athletes that represented Portugal in international competitions during 1972-2012, ended their career for at least 2 years prior the study and are able to attend the educational sessions. Participants will be randomly assigned into 2 groups: i) dietary counseling (control group), or ii) behavioral lifestyle intervention, focusing on diet and PA. All participants will be screened at baseline, 4 months, and 12 months. A broad set of parameters will be assayed in each participant, namely: body composition, cardiorespiratory fitness, muscle strength, biochemical parameters, resting metabolic rate, nutritional intake, daily PA, and quality of life. These variables will allow the comprehension of the effects of a lifestyle modification on fatness, fitness and health-related parameters contributing also to further elucidate compensatory mechanisms associated with potential changes in weight and composition. To accomplish the main goal the research team will use established methods in the literature as well as novel procedures, which will enable the research team to overcome some of the limitations of previous studies. At the end of the study the investigators expect to have collected consistent data about whether a lifestyle intervention is or is not able to effectively decrease fatness while improving fitness and health-related markers. The research team believe that these data will help both non-governmental and governmental stakeholders in sports and education to make evidence based decisions, specifically the introduction and implementation of lifestyle programs in the transition to the post-career of elite athletes. The growing number of elite athletes supported by the government along with the recent EU report guidelines on dual careers in high-performance sports (ec.europa.eu/sport/news/2013/20130123-eu-guidelines-dualcareers\_en.htm) requires further studies that test the role of preventive and educational programs for athletes in the areas of healthy living. The past experience of the research team in body composition, physical fitness, and objectively measured PA using cross-sectional and prospective study designs in athletic and non-athletic populations, as well as in the conduction of PA intervention clinical trials, together with the involvement of the Portuguese Olympic Committee as partners, supports the chances of successfully achieving the proposed objectives.

Conditions

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Obesity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Lifestyle Intervention Group

Subjects will attend 12 educational sessions for a healthy lifestyle in groups of 10-15 participants, for approximately 4 months. Sessions will last 90-120 minutes and will include educational content and practical application classroom exercises in the areas of physical activity and exercise, diet and eating behavior, and behavior modification. The inclusion of self-regulation skills, such as pedometer use, recording food regularly and monitoring weight, is also part of the curriculum. Participants will be instructed and motivated to make small but enduring reductions in caloric intake and to increase energy expenditure to induce a daily energy deficit of approximately 300 kcal. Weight will be monitored weekly.

Group Type EXPERIMENTAL

Lifestyle Intervention Group

Intervention Type BEHAVIORAL

The intervention group will start the lifestyle intervention with a 60-minute nutrition appointment given by a certified dietitian. This meeting is intended to provide a well-balanced personalized diet plan, calculated to create a moderate reduction from \~300 to 500kcal/day according to each participant's energy requirements and preferences. Two additional follow-up appointments are also planned to adjust the individual energy requirements throughout the intervention. Subjects will attend 12 educational sessions for a healthy lifestyle in groups of 10-15 participants, for approximately 4 months. Sessions will last 60-90 minutes and will include educational content and practical application classroom exercises in the areas of physical activity and exercise, diet and eating behavior, and behavior modification. The inclusion of self-regulation skills, such as pedometer use, recording food regularly and monitoring weight, is also part of the curriculum. Weight will be monitored weekly.

Control Group - Waiting List

Participants assigned to the control group will have access to the intervention after the 12-month period - waiting list. Meanwhile, participants will receive multimedia health information fortnightly by e-mail over the first 4-month period. The health information covers healthy lifestyle topics.

During the 12 months of study participation, control group participants will be instructed to maintain their baseline level of physical activity. Individuals assigned to the control group will be asked to maintain their current nutritional practices and physical activity patterns.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Lifestyle Intervention Group

The intervention group will start the lifestyle intervention with a 60-minute nutrition appointment given by a certified dietitian. This meeting is intended to provide a well-balanced personalized diet plan, calculated to create a moderate reduction from \~300 to 500kcal/day according to each participant's energy requirements and preferences. Two additional follow-up appointments are also planned to adjust the individual energy requirements throughout the intervention. Subjects will attend 12 educational sessions for a healthy lifestyle in groups of 10-15 participants, for approximately 4 months. Sessions will last 60-90 minutes and will include educational content and practical application classroom exercises in the areas of physical activity and exercise, diet and eating behavior, and behavior modification. The inclusion of self-regulation skills, such as pedometer use, recording food regularly and monitoring weight, is also part of the curriculum. Weight will be monitored weekly.

Intervention Type BEHAVIORAL

Other Intervention Names

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Lifestyle Intervention Programme

Eligibility Criteria

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Inclusion Criteria

* Being a Former high-level athlete;
* Being Physical Inactive (not exercising for \>20 min at least 3 days/week);
* Being Overweight or Obese (BMI exceed≥25 kg/m2);
* Willing to be randomized to either control or intervention groups and follow the protocol to which they have been assigned;
* Willing to participate in the educational sessions performed at Faculdade de Motricidade Humana - Universidade de Lisboa;
* Unwilling to consider using weight loss medications;

Exclusion Criteria

* Failure to complete the run-in for dietary intake and physical activity;
* Lack of support from primary health care provider or family members;
* Being unable or unwilling to give informed consent or communicate with local study staff;
* Current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder;
* Eating disorders;
* Medical conditions such as thyroid disorders;
* Diabetes and cardiovascular disease or other medical condition known to affect energy balance homeostasis;
* Hospitalization for depression in past six months;
* Self-report of alcohol or substance abuse within the past twelve months, current consumption of more than 14 alcoholic drinks per week, and/or current acute treatment or rehabilitation program for these problems;
* Pregnancy or planning to get pregnant within the next 9 month, having been pregnant within the past 6 months or breastfeeding;
* History of weight loss surgery or liposuction procedures;
* Current participation in a weight loss program;
* In the past three months, weight loss exceeding 4.5 kg (such individuals may have difficulty losing additional weight) or successful attempts to lose weight within the past 6-month;
* Current use of medications for weight loss;
* Chronic treatment with systemic corticosteroids;
* Self-reported inability to walk two blocks;
* Inability to complete the study within the designated time frame because of plans to move out of the study area;
* Inability to attend the visits/appointments, evaluation measurements, and attend the intervention sessions at the Faculdade de Motricidade Humana - Universidade de Lisboa;
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Faculdade de Motricidade Humana

OTHER

Sponsor Role lead

Responsible Party

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Analiza Mónica Lopes Almeida Silva

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Analiza Silva

Role: PRINCIPAL_INVESTIGATOR

Faculty of Human Kinetics, University of Lisbon

Locations

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Faculdade de Motricidade Humana

Oeiras, Cruz-Quebrada, Portugal

Site Status

Countries

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Portugal

References

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Stubbs RJ, Hughes DA, Johnstone AM, Horgan GW, King N, Blundell JE. A decrease in physical activity affects appetite, energy, and nutrient balance in lean men feeding ad libitum. Am J Clin Nutr. 2004 Jan;79(1):62-9. doi: 10.1093/ajcn/79.1.62.

Reference Type BACKGROUND
PMID: 14684398 (View on PubMed)

Miller MA, Croft LB, Belanger AR, Romero-Corral A, Somers VK, Roberts AJ, Goldman ME. Prevalence of metabolic syndrome in retired National Football League players. Am J Cardiol. 2008 May 1;101(9):1281-4. doi: 10.1016/j.amjcard.2007.12.029. Epub 2008 Mar 7.

Reference Type BACKGROUND
PMID: 18435958 (View on PubMed)

Pihl E, Jurimae T. Relationships between body weight change and cardiovascular disease risk factors in male former athletes. Int J Obes Relat Metab Disord. 2001 Jul;25(7):1057-62. doi: 10.1038/sj.ijo.0801642.

Reference Type BACKGROUND
PMID: 11443506 (View on PubMed)

Pihl E, Zilmer K, Kullisaar T, Kairane C, Magi A, Zilmer M. Atherogenic inflammatory and oxidative stress markers in relation to overweight values in male former athletes. Int J Obes (Lond). 2006 Jan;30(1):141-6. doi: 10.1038/sj.ijo.0803068.

Reference Type BACKGROUND
PMID: 16158088 (View on PubMed)

Dey SK, Ghosh C, Debray P, Chatterjee M. Coronary artery disease risk factors & their association with physical activity in older athletes. J Cardiovasc Risk. 2002 Dec;9(6):383-92. doi: 10.1097/01.hjr.0000049244.21319.20.

Reference Type BACKGROUND
PMID: 12478209 (View on PubMed)

Kujala UM, Marti P, Kaprio J, Hernelahti M, Tikkanen H, Sarna S. Occurrence of chronic disease in former top-level athletes. Predominance of benefits, risks or selection effects? Sports Med. 2003;33(8):553-61. doi: 10.2165/00007256-200333080-00001.

Reference Type BACKGROUND
PMID: 12797837 (View on PubMed)

Buchwald H, Roberts AJ. The HOPE (heart, obesity, prevention, education) program for former NFL players. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):573-5. doi: 10.1016/j.soard.2014.02.030. Epub 2014 Mar 1. No abstract available.

Reference Type BACKGROUND
PMID: 24958646 (View on PubMed)

Batista C, Soares JM. Are former athletes more prone to asthma? J Asthma. 2013 May;50(4):403-9. doi: 10.3109/02770903.2013.776075. Epub 2013 Apr 8.

Reference Type BACKGROUND
PMID: 23489224 (View on PubMed)

Nunes CL, Jesus F, Rosa GB, Marianito M, Francisco R, Bosy-Westphal A, Minderico CS, Martins P, Sardinha LB, Silva AM. Interindividual variability in energy intake and expenditure during a weight loss intervention. Appetite. 2024 Feb 1;193:107162. doi: 10.1016/j.appet.2023.107162. Epub 2023 Dec 13.

Reference Type DERIVED
PMID: 38101517 (View on PubMed)

Nunes CL, Rosa GB, Jesus F, Heymsfield SB, Minderico CS, Martins P, Sardinha LB, Silva AM. Interindividual variability in metabolic adaptation of non-exercise activity thermogenesis after a 1-year weight loss intervention in former elite athletes. Eur J Sport Sci. 2023 Aug;23(8):1761-1770. doi: 10.1080/17461391.2022.2147020. Epub 2022 Nov 28.

Reference Type DERIVED
PMID: 36377398 (View on PubMed)

Nunes CL, Carraca EV, Jesus F, Finlayson G, Francisco R, Silva MN, Santos I, Bosy-Westphal A, Martins P, Minderico C, Sardinha LB, Silva AM. Changes in food reward and intuitive eating after weight loss and maintenance in former athletes with overweight or obesity. Obesity (Silver Spring). 2022 May;30(5):1004-1014. doi: 10.1002/oby.23407. Epub 2022 Mar 28.

Reference Type DERIVED
PMID: 35347875 (View on PubMed)

Nunes CL, Jesus F, Francisco R, Matias CN, Heo M, Heymsfield SB, Bosy-Westphal A, Sardinha LB, Martins P, Minderico CS, Silva AM. Adaptive thermogenesis after moderate weight loss: magnitude and methodological issues. Eur J Nutr. 2022 Apr;61(3):1405-1416. doi: 10.1007/s00394-021-02742-6. Epub 2021 Nov 27.

Reference Type DERIVED
PMID: 34839398 (View on PubMed)

Silva AM, Nunes CL, Jesus F, Francisco R, Matias CN, Cardoso M, Santos I, Carraca EV, Finlayson G, Silva MN, Dickinson S, Allison D, Minderico CS, Martins P, Sardinha LB. Effectiveness of a lifestyle weight-loss intervention targeting inactive former elite athletes: the Champ4Life randomised controlled trial. Br J Sports Med. 2022 Apr;56(7):394-401. doi: 10.1136/bjsports-2021-104212. Epub 2021 Oct 1.

Reference Type DERIVED
PMID: 34598935 (View on PubMed)

Matias CN, Campa F, Nunes CL, Francisco R, Jesus F, Cardoso M, Valamatos MJ, Homens PM, Sardinha LB, Martins P, Minderico C, Silva AM. Phase Angle Is a Marker of Muscle Quantity and Strength in Overweight/Obese Former Athletes. Int J Environ Res Public Health. 2021 Jun 21;18(12):6649. doi: 10.3390/ijerph18126649.

Reference Type DERIVED
PMID: 34205575 (View on PubMed)

Campa F, Matias CN, Nunes CL, Monteiro CP, Francisco R, Jesus F, Marini E, Sardinha LB, Martins P, Minderico C, Silva AM. Specific Bioelectrical Impedance Vector Analysis Identifies Body Fat Reduction after a Lifestyle Intervention in Former Elite Athletes. Biology (Basel). 2021 Jun 12;10(6):524. doi: 10.3390/biology10060524.

Reference Type DERIVED
PMID: 34204604 (View on PubMed)

Other Identifiers

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16/2016

Identifier Type: -

Identifier Source: org_study_id

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