Metabolic Rehab in Primary Care: Evaluating the CHANGE Protocol
Bibliographic record
Abstract
Context: Metabolic syndrome (MetS) refers to a combination of factors (dyslipidemia, elevated glucose and triglycerides, high blood pressure, and high abdominal fat distribution) that increase the risk for cardiovascular disease (CVD) and diabetes (DM), among other diseases. In Canada, 20% of adults have MetS. MetS is of great importance as it precedes DM and CVD by several years. Progression of MetS to DM and CVD can be significantly reduced by dietary modification and exercise. Objective: The primary purpose of this trial was to test the effectiveness of Metabolic Rehab to increase physical activity, improve diets, reduce obesity and reverse MetS among adult patients when implemented in typical primary care settings within Alberta. Design: A cluster randomized control trial (cRCT) of 16 PCNs within Alberta (pre/post design). Participants: N= 750 participants were screened into the RCT; N=674 participated in the RCT in either intervention (n=354) or control n=(320). Intervention: Metabolic Rehab is an evidence-based lifestyle intervention protocol (the CHANGE Protocol) delivered in primary care for patients with MetS. This protocol is a personalized approach to nutrition and exercise modification supported by an interprofessional team. The protocol’s principles are: 1) individualized, graded nutrition and exercise intervention; 2) supervision and implementation of the program in a collaborative fashion between health professionals. Outcome Measures: The primary outcome is reversal of metabolic syndrome (binary – yes/no) and the secondary outcome is Cardiovascular Risk (as measured by the PROCAM). Results: Patients had a 23% chance of reversing MetS, depending on the severity of their initial MetS based on Multivariate Logistic Regression. Physical activity levels increased in both total amount and intensity in the intervention group; the same pattern was not observed in the control group. Patients reported that they enjoyed the program and liked the depth of information that was provided in their sessions; the individualized nature of the program was helpful. Patients and health professionals also reported that the intervention led to increased health, along with additional unexpected positive benefits. Conclusions: Metabolic Rehab is an effective lifestyle intervention that reverses MetS; greater integration of Metabolic Rehab into primary care can proactively treat the symptoms that later manifest in CVD, DM, and other chronic health conditions.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.101 | 0.109 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.004 | 0.004 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.027 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".