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(CHIP) for Reducing the Risk Factors Associated with Metabolic Syndrome Avondale College ResearchOnline@Avondale Theses PhD Theses 2014 The Effectiveness of a Volunteer-Delivered, Community-Based Lifestyle Modification Program (CHIP) For Reducing the Risk Factors Associated With Metabolic Syndrome Paul Rankin Avondale College of Higher Education, [email protected] Follow this and additional works at: https://research.avondale.edu.au/theses_phd Part of the Dietetics and Clinical Nutrition Commons, Other Medicine and Health Sciences Commons, and the Sports Sciences Commons Recommended Citation Rankin, P. (2014). The effectiveness of a volunteer-delivered, community-based lifestyle modification program (CHIP) for reducing the risk factors associated with metabolic syndrome (Doctoral dissertation, Avondale College of Higher Education, Cooranbong, Australia). Retrieved from https://research.avondale.edu.au/theses_phd/2 This Thesis is brought to you for free and open access by the Theses at ResearchOnline@Avondale. It has been accepted for inclusion in Theses PhD by an authorized administrator of ResearchOnline@Avondale. For more information, please contact [email protected]. Avondale College of Higher Education School of Education The effectiveness of a volunteer-delivered, community-based lifestyle modification program (CHIP) for reducing the risk factors associated with Metabolic Syndrome. A Doctoral Thesis Presented in Fulfillment of the Requirements for the Award of the Degree of Doctor of Philosophy by Paul Rankin BA, MPH 2014 Student Declaration I, Paul Meredith Rankin hereby declare that: • this dissertation is my own work, • all persons consulted, and all assistance rendered are fully acknowledged, • all references used are indicated in the text and accurately reported in the list of references, • the substance of this dissertation has not been presented, in whole, or part by me, to any other institution for a degree. Signature Date 10/10/13 ii Acknowledgements To Sonia, Rebekah, Caleb and Rachel, my family and primary support mechanism, thank you for your support and patience not just with this Ph.D. but as we have pursued so many dreams. Without your love and support none of this would have happened. Darren Morton, thanks mate. Not only have you been an extraordinary supervisor but you became a real friend as we embarked wholeheartedly on the CHIP adventure. The walk across Sydney Harbour Bridge in 2009 truly was a life changing event. Together we have flown! The detailed statistical analysis contained in this dissertation would not have been possible without the support and coaching of Peter Morey who was my co- supervisor. Thank you for your patience and enthusiasm for this project and your encouragement to continue writing. Also to Esther Chang, thank you, for your passion for CHIP, encouragement and continued reminders to “tell the story” and that we are doing this in His service. This project would not have been possible without the founder of CHIP: Hans Diehl. Thank you for your generosity and your passion to make a difference in people’s lives. Thanks also to John Gobbles who collected the CHIP data used in this dissertation and generously made it available for analysis and to Dena Guthrie and Harold Burden for providing permission to utilise the dataset. To Jerry Matthews, Peter Lynch and Graeme Drinkall, at the New Zealand Pacific Union Conference of the Seventh-day Adventist Church, thank you for providing fee assistance and release time from work for the initial three years of this project. Jerry, iii thank you for your passion to see the departmental directors under your supervision pursue further study and encouraging us to make it a priority. To my current boss, Kevin Price, Health Director for the South Pacific Division of the Seventh-day Adventist Church who insisted that I make the completion of this dissertation a priority even when other responsibilities were pressing, thank you. It’s your turn now Kevin. Kevin Jackson, Cathy MacDonald and Christina Hawkins at Sanitarium Health and Wellbeing and the Lifestyle Medicine Institute, thank you for your commitment to the vision of CHIP and your recognition of the importance of quality research in supporting this project. A special thanks to Michelle Down, Richard Anderson and Elaine Lumsdaine the librarians at Avondale College of Higher Education who tracked down countless journal articles and patiently instructed me on how to use Endnote. Also to Dr Don Hanson who proofread this manuscript, I trust that all the apostrophes are now in their correct position. Thank you to all of the CHIP directors and facilitators in both New Zealand and Australia; you have shown me that passionate volunteers really can make a difference in people’s lives. Thanks also to the late Vic Gidley and his wife Jean Ward who brought CHIP to the South Pacific. And above all thank you to my Creator and Saviour. The more I have learnt about the human body the more I have come to realise that we truly are fearfully and wonderfully made. Lord please show me where you want me to serve and give me the courage to follow your directions. iv Abstract In the latter half of the 20th Century increases in the availability of inexpensive, energy-dense foods combined with an estimated 60-70% reduction in daily energy expenditure, created an “obesogenic” environment. The epidemic of obesity that has emerged has been associated with the Metabolic Syndrome (MetS) which is a cluster of risk factors that are precursors to chronic diseases including cardiovascular disease (CVD), type II diabetes (T2D), stroke, and dementia. These chronic diseases are having a significant social and economic impact worldwide with their related morbidity and mortality. Epidemiological and interventional studies have shown that lifestyle interventions based on a low-fat, plant-based diet are effective for the management of MetS and associated chronic diseases. To date, the research has focused on lifestyle interventions delivered by professional facilitators, mostly in clinical settings. The primary aim of this dissertation was to examine the effectiveness of a lifestyle intervention known as the Coronary Health Improvement Program (CHIP), when delivered by volunteer facilitators to free-living participants in their community. The secondary aim of the dissertation was to examine the impact of selected participant factors including age, gender, religious affiliation, marital status, previous history, family history and body mass index on the participants’ responsiveness to the CHIP intervention. This study adopted a pre-test post-test design involving, a large cohort of 5070 individuals who participated in one of 178 community-based CHIP interventions delivered by volunteers between 2006 to 2009 in the United States and Canada. v In 30 days, significant reductions (p < 0.001) were recorded in body mass index (3.2%), total cholesterol (11.0%), low-density lipoprotein cholesterol (13.0%), triglycerides (7.7%), fasting plasma glucose (6.1%) and systolic and diastolic blood pressure (4.9% and 5.3%, respectively). Stratification of the data revealed larger reductions in those participants who presented to the program with the greatest risk factor levels. Regardless of age, gender, marital status, religious affiliation, previous history, family history and body weight, participants in the CHIP intervention achieved significant improvements in the risk factors associated with MetS however these factors influenced the responsiveness of the participants to the program. In general, male participants achieved better results than the females, and males tended to achieve their best outcomes at a younger age than the female participants. Married participants achieved better outcomes than single, divorced or widowed participants. Seventh-day Adventist (SDA) participants had better risk profiles at baseline, however, the non-SDA participants achieved better outcomes during the intervention. Participants who had the highest body mass index (BMI) at baseline achieved the greatest changes in BMI, fasting plasma glucose and blood pressure, however, those participants with a BMI greater than 35 kg/m2 showed significantly less improvement in their lipid profile than those participants with a BMI between 25 and 35 kg/m2. It was concluded that significant reductions in the risk factors associated with MetS can be achieved in 30 days using the CHIP lifestyle intervention when delivered by volunteers to free-living participants in their local community. Significant reductions in risk factors associated with MetS can be achieved regardless of age, gender, marital vi status, religious affiliation or baseline biometrics. Utilising volunteers may therefore provide an effective and cost-efficient mode of delivering lifestyle interventions targeting MetS. vii Table of Contents Student Declaration ..................................................................................................................... ii Acknowledgements ..................................................................................................................... iii Abstract ........................................................................................................................................ v Table of Contents ...................................................................................................................... viii List of Tables ................................................................................................................................ xi List of Figures............................................................................................................................
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