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46ALTERNATIVETHERAPIESjulaug2011VOL.17NO.4DiseaseRis6ImprovesWithIntegrativeImmersionModelris6.ThecurrentstudywasconductedinahealthierpopulationutiliEedlesscoachingandcapitaliEedontheaddedbeneItofa3-dayhealthimmersion.Bothstudieshoweverdemonstratedsimilarbaseline-to-endpointimprovementsinreadinesstoloseweightandincreasephysicalactivityfrequencyofexerciseandreductioninBMI.Futurestudyofintegrativehealthmodelsofcarewouldben-eItfromRCTdesignswithlargersamples.Thereisalsoaneedtofurtherexplorethemechanismsofbehaviorchangeandthedoseeffectoftheseinterventions.Finallyfromacost-effectivenessperspectiveitmaybeusefultoclarifywhichaspectsofthepro-gramaremosteffectiveforwhichparticipants.Theprinciplelimitationsofthisstudywerelowsamplediver-sitymoderatesamplesiEeandtheobservationalstudydesign.Theinterventiondemonstratedeffectivenessamongasampleofrelativelyhealthyolderadultswhowerepredominantlywhiteandreportedincomeandeducationwellabovethemedian.ItisyettobeseeniftheseIndingswillgeneraliEetootherpopulations.Aself-selectionbiasmayhavealsoinJuencedtheresultsparticipantswhoelectedtota6epartinthisstudymayhavehadstrongermoti-vationtochangehealthbehaviors.Howeverselectionbiasisnotevidentbasedoninitialpatientactivationscoreswhichareinfactslightlybelowthenormativemeanof69observedamongemployedadults.40AlsotheobservationalstudydesignthoughappropriateforexploratorypurposesdoesnotaccountfortheinJuenceofexpectancyorthenaturalcourseofhealth.Finallyanalysisofmeanchangesinheterogeneousgroupspresentsachal-lengesincelargesamplevariabilitycanmas6importantshiftsinsubsetsofindividuals.ThiswarrantsfurtherstudyutiliEingmeth-odssuchasstructuralequationmodelingandpathanalysistoassessindividualdifferencesanddeterminepatternsofchange.CONCLUSIONHealthbehaviorchangeswereaccompaniedbyanimprove-mentinpatientactivationandpsychosocialmeasuresangeranxietydepressionrelationshipsatisfactionandadecreaseinmodiIableris6ofstro6eanddiabetes.Thissuggeststhataninte-grativehealthmodelcanhelppatientsbecomemoreengagedinself-managementofhealthandsupporttheminma6ingandmaintaininghealthylifestylechanges.AcknowledgmentsTheauthorswouldli6etothan6Shin-YiingYeungBSTraceyHaw6insBALesleyChapmanBSandMariuskluengerBSfortheirassistanceindatacollectionJulieD.PruittMSRDBillkrausMDConnieBalesPhDandActivHealthfortheuseoftheironlinehealtheducationmaterialsTimothySmithPhDMar6RubyGuiEhouHuMDPhDandBiosigniafortechnicalassistanceanduseoftheknowYourNumberassessmentLindaSmithPAforinterventionprogramoversightJannaFi66anPhDandMar6Dreusic6eBSformanuscripteditingtheCliffsCommunitiesforInancialandrecruitmentsupportHolbroo6RaynalMDDHAandthePreserveHealthteamforprovidingfacilitiesandsupportforendpointdatacollectiontheRippleFoundationforinfrastructurefundingoftheDu6eIntegrativeMedicineIMresearchteamandtheDu6eIMclinicianswhosupportedthisprogramSamMoonMDMPHShelleyWrothMDEvangelineLausierMDLouiseGoldsteinRNJeffBrantleyMDBethReardonMSRDJanetShafferLAcJenniferDavisMALPCJeanneVanGemertMALPCJessicaP.Wa6eIeldMALPCJuliekoseyMSCPCCkerryLittleMACPCCJoAnnaStangeBACPCCFaithSeayRNMaryPetersonMAandNoahStJohnMS.ThisstudywasfundedinpartbyTheCliffsCommunitiesIncandinpartbytheRippleFoundation.Thepaperwassupportedbygrantk99AT004945fromtheNationalInstitutesofHealthNIHNationalCenterforComplementaryandAlternativeMedicinetoJ.M.GreesonanditscontentsaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresenttheofIcialviewsoftheNIH.REFERENCESx01.Lloyd-JonesDAdamsRCarnethonMetal.Heartdiseaseandstro6estatisticsx142009updateareportfromtheAmericanHeartAssociationStatisticsCommitteeandStro6eStatisticsSubcommittee.Circulation.20091193e21-e181.2.VanDamRMRimmEBWillettWCStampferMJHuFB.Dietarypatternsandris6fortype2diabetesmellitusinU.S.men.Annx0Internx0Med.20021363201-209.3.EyreHkahnRRobertsonRMetalAmericanCancerSocietyAmericanDiabetesAssociationAmericanHeartAssociation.PreventingcancercardiovasculardiseaseanddiabetesacommonagendafortheAmericanCancerSocietytheAmericanDiabetesAssociationandtheAmericanHeartAssociation.Stroke.20043581999-2010.4.kromhoutDMenottiAkestelootHSansS.Preventionofcoronaryheartdiseasebydietandlifestyleevidencefromprospectivecross-culturalcohortandinterventionstudies.Circulation.20021057893-898.5.AmericanHeartAssociationNutritionCommitteeLichtensteinAHAppelLJBrandsMetal.Dietandlifestylerecommendationsrevision2006ascientiIcstatementfromtheAmericanHeartAssociationNutritionCommittee.Circulation.2006114182-96.6.SuitorCWMeyersLDInstituteofMedicine.DietaryReferenceInta6esResearchSynthesisWor6shopsummary.2007.7.BantleJPWylie-RosettJAlbrightALetal.Nutritionrecommendationsandinterven-tionsfordiabetesx142006apositionstatementoftheAmericanDiabetesAssociation.Diabetesx0Care.20062992140-2157.8.Bun6erSJColquhounDMEslerMDetal.x1cStressx1dandcoronaryheartdiseasepsy-chosocialris6factors.Medx0Jx0Aust.20031786272-276.9.PleisJRLucasJW.SummaryhealthstatisticsforU.S.adultsNationalHealthInterviewSurvey2007.Vitalx0Healthx0Statx010.2009May2401-159.10.CentersforDiseaseControlandPreventionCDC.Trendsininta6eofenergyandmacronutrientsx1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