The 'midlife study': Mindfulness as an intervention to change health behaviors in midlife women

The purpose of this paper is to describe a pilot study designed to determine whether mindfulness based stress reduction (MBSR) as a component of a program of research designed to change health behaviors could be an effective intervention to increase adoption of and adherence to heart health related behavior change. Forty nurses, aged 39–57 yrs, with a BMI ≥ 23 but ≤ 41 were recruited and enrolled in the study, stratified by BMI, and randomized into the MBSR (experimental) intervention or the perimenopausal education (active control) intervention. After recruitment and randomization, the 20 women enrolled in the experimental arm of the study completed a MBSR course and then participated in an eight-week program of diet and exercise. Women (n=20) in the active control arm attended educational classes on midlife health issues followed by the same eight week program of diet and exercise in which both groups participated together. Baseline measures of weight, height, body mass index, blood pressure, pulse, waist/hip ratio, glucose, low density lipoprotein, high density lipoprotein, trigylcerides, total cholesterol, highly sensitive C-reactive protein, cortisol, and instruments that measured sleep, depression, psychosocial stress and mindfulness were obtained. Immediately following eight weeks of health education classes or an MBSR course, psychosocial assessment and weight were repeated. Participants then participated together in an eight week program of a pedometer-based exercise program and lowered calorie DASH diet. Measurements of adherence to diet and exercise, changes in heart health-related physiological measures, and associated weight loss outcomes were assessed in both groups again immediately post study at 16 weeks.;There was a 95% combined completion rate for the program. Upon completion of the program women in the control arm had lost from Baseline to Week 16, an average of 2.77 pounds. Women in the intervention arm had lost from Baseline to Week 16, an average of 2.61 pounds. This means that on average, the women in the control arm lost .16 pounds more than women in the intervention arm. A spline linear mixed model was constructed to test the hypothesis that mindfulness based stress reduction would improve adherence and result in greater changes in weight, BMI, depressive symptoms, anxiety, perceived psychosocial stress, sleep quality, and mindfulness at 16 weeks.;In terms of satisfaction, 95% completion rate reflected success. The outcome of the hypothesis testing based on spline linear mixed model for weight, BMI and psychosocial variables revealed there were not statistically significant differences between arms at 16 Weeks. However, both groups had improvement on all of the variables tested. There was a reduction from Baseline to Week 16 on weight, BMI, perceived stress, depressive symptoms, anxiety, and improvements in sleep quality and mindfulness. The main difference between the two groups was the pattern of change in these variables over time. The women in the MBSR arm experienced a linear decline which suggested an improvement in perceived stress, depressive symptoms, and symptoms of anxiety that started while enrolled in the MBSR course. Sleep quality and mindfulness improved during this time period as well. The women in the control group had a similar linear decline in all measures from Week 8 to Week 16 (not from Baseline to Week 8), during the time period in the study when a focus on healthy eating and exercise began. Women in both arms commented that they had started changing the way they ate, how they dealt with stress and that they paid more attention to exercise as an outcome of being enrolled in this study.;This program was shown to be feasible, but several recommendations are made for future research. The program could be tested combining simultaneous engagement in mindfulness (or health education) and the diet and exercise portion for an eight-week program. Follow-up could be more intensive in the ensuing weeks after program termination. In the future, weekly individual or small group interaction about diet and exercise that is woven into the health education or mindfulness may have greater impact and relevance in aid of adopting healthy lifestyle behaviors and weight management. Clearly further research is needed. The program was safe and feasible and may be implemented in practice with diet and exercise program combined with health education and stress management. However, until the content and protocol processes are refined with data to support their efficacy, it is recommended that the outcomes are closely evaluated. (Abstract shortened by UMI.).