Quality of Life Research

, Volume 25, Issue 8, pp 1903–1912 | Cite as

Impact of a community-based lifestyle intervention program on health-related quality of life

  • Yvonne L. Eaglehouse
  • Gerald L. Schafer
  • Vincent C. Arena
  • M. Kaye Kramer
  • Rachel G. Miller
  • Andrea M. Kriska



The presence of risk factors for type 2 diabetes and cardiovascular disease, or the conditions themselves, contributes to lower health-related quality of life (HRQoL) among adults. Although community-based lifestyle intervention programs have been shown to be effective for improving risk factors for these diseases, the impact of these interventions on HRQoL has rarely been described.


To examine changes in HRQoL following participation in the Group Lifestyle Balance program, a community translation of the Diabetes Prevention Program lifestyle intervention for adults with prediabetes and/or the metabolic syndrome.


Participants enrolled in the 12-month, 22-session intervention program (N = 223) completed the EuroQol Health Questionnaire (EQ-5D-3L) at baseline, 6, and 12 months. Linear mixed-effects regression models determined change in EQ-5D-visual analog scale (VAS) and Index scores post-intervention.


Mean EQ-5D-VAS was improved by +7.38 (SE = 1.03) at 6 months and by +6.73 (SE = 1.06) at 12 months post-intervention (both; p < 0.0001). Mean changes in EQ-5D index values were +0.00 (SE = 0.01; NS) and +0.01 (SE = 0.01; p < 0.05), respectively. Adjusted for age, baseline score, and achieving intervention goals, mean change in EQ-5D-VAS was +11.83 (SE = 1.61) at 6 months and +11.23 (SE = 1.54) at 12 months (both; p < 0.0001). Adjusted mean change in EQ-5D index value was +0.04 (SE = 0.01) at 6 months and +0.05 (SE = 0.01) at 12 months (both; p < 0.01).


Participation in a community lifestyle intervention program resulted in improved HRQoL among adults with prediabetes and/or the metabolic syndrome. These benefits to HRQoL, together with improved clinical and behavioral outcomes, should increase the appeal of such programs for improving health.


Physical activity Weight Type 2 diabetes prevention 



The authors would like to thank the DPP-GLB participants, community partners, and staff for their time and continued commitment to this project.


This study was funded by the National Institutes of Health through Grant Number PRO10010131; Clinicaltrials.gov number NCT01050205.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Participants provided written and informed consent prior to enrolling in the study.


  1. 1.
    Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238–1245. doi: 10.1001/jama.291.10.1238.CrossRefPubMedGoogle Scholar
  2. 2.
    Brown, D. W., Balluz, L. S., Giles, W. H., Beckles, G. L., Moriarty, D. G., Ford, E. S., et al. (2004). Diabetes mellitus and health-related quality of life among older adults. Findings from the behavioral risk factor surveillance system (BRFSS). Diabetes Research and Clinical Practice, 65(2), 105–115. doi: 10.1016/j.diabres.2003.11.014.CrossRefPubMedGoogle Scholar
  3. 3.
    Solli, O., Stavem, K., & Kristiansen, I. S. (2010). Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health and Quality of Life Outcomes, 8, 18. doi: 10.1186/1477-7525-8-18.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chittleborough, C. R., Baldock, K. L., Taylor, A. W., & Phillips, P. J. (2006). Health status assessed by the SF-36 along the diabetes continuum in an Australian population. Quality of Life Research, 15(4), 687–694. doi: 10.1007/s11136-005-3570-8.CrossRefPubMedGoogle Scholar
  5. 5.
    Ford, E. S., & Li, C. (2008). Metabolic syndrome and health-related quality of life among U.S. adults. Annals of Epidemiology, 18(3), 165–171. doi: 10.1016/j.annepidem.2007.10.009.CrossRefPubMedGoogle Scholar
  6. 6.
    Katano, S., Nakamura, Y., Nakamura, A., Suzukamo, Y., Murakami, Y., Tanaka, T., et al. (2012). Relationship between health-related quality of life and clustering of metabolic syndrome diagnostic components. Quality of Life Research, 21(7), 1165–1170. doi: 10.1007/s11136-011-0029-y.CrossRefPubMedGoogle Scholar
  7. 7.
    Hakkinen, A., Kukka, A., Onatsu, T., Jarvenpaa, S., Heinonen, A., Kyrolainen, H., et al. (2009). Health-related quality of life and physical activity in persons at high risk for type 2 diabetes. Disability and Rehabilitation, 31(10), 799–805. doi: 10.1080/08916930802354930.CrossRefPubMedGoogle Scholar
  8. 8.
    Kriska, A. M., LaPorte, R. E., Pettitt, D. J., Charles, M. A., Nelson, R. G., Kuller, L. H., et al. (1993). The association of physical activity with obesity, fat distribution and glucose intolerance in Pima Indians. Diabetologia, 36(9), 863–869.CrossRefPubMedGoogle Scholar
  9. 9.
    Fletcher, G. F., Balady, G., Blair, S. N., Blumenthal, J., Caspersen, C., Chaitman, B., et al. (1996). Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the committee on exercise and cardiac rehabilitation of the council on clinical cardiology, American heart association. Circulation, 94(4), 857–862.CrossRefPubMedGoogle Scholar
  10. 10.
    Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health (Oxford), 27(2), 156–164. doi: 10.1093/pubmed/fdi025.CrossRefGoogle Scholar
  11. 11.
    Wing, R. R., Hamman, R. F., Bray, G. A., Delahanty, L., Edelstein, S. L., Hill, J. O., et al. (2004). Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obesity Research, 12(9), 1426–1434. doi: 10.1038/oby.2004.179.CrossRefPubMedGoogle Scholar
  12. 12.
    Knowler, W. C., Barnett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. The New England Journal of Medicine, 346(6), 393–403. doi: 10.1056/NEJMoa012512.CrossRefPubMedGoogle Scholar
  13. 13.
    Orchard, T. J., Temprosa, M., Goldberg, R., Haffner, S., Ratner, R., Marcovina, S., et al. (2005). The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The diabetes prevention program randomized trial. Annals of Internal Medicine, 142(8), 611–619.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Florez, H., Pan, Q., Ackermann, R. T., Marrero, D. G., Barrett-Connor, E., Delahanty, L., et al. (2012). Impact of lifestyle intervention and metformin on health-related quality of life: The diabetes prevention program randomized trial. Journal of General Internal Medicine, 27(12), 1594–1601. doi: 10.1007/s11606-012-2122-5.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Marrero, D., Pan, Q., Barrett-Connor, E., de Groot, M., Zhang, P., Percy, C., et al. (2014). Impact of diagnosis of diabetes on health-related quality of life among high risk individuals: The diabetes prevention program outcomes study. Quality of Life Research, 23(1), 75–88. doi: 10.1007/s11136-013-0436-3.CrossRefPubMedGoogle Scholar
  16. 16.
    Whittemore, R. (2011). A systematic review of the translational research on the diabetes prevention program. Translational Behavioral Medicine, 1(3), 480–491.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Jackson, L. (2009). Translating the diabetes prevention program into practice: A reivew of community interventions. The Diabetes Educator, 35(2), 309–320.CrossRefPubMedGoogle Scholar
  18. 18.
    Johnson, M., Jones, R., Freeman, C., et al. (2013). Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence. Diabetic Medicine, 30(1), 3–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Kramer, M. K., McWilliams, J. R., Chen, H. Y., & Siminerio, L. M. (2011). A community-based diabetes prevention program: Evaluation of the group lifestyle balance program delivered by diabetes educators. The Diabetes Educator, 37(5), 659–668. doi: 10.1177/0145721711411930.CrossRefPubMedGoogle Scholar
  20. 20.
    Kramer, M. K., Cepak, Y. P., Venditti, E. M., Semler, L. N., & Kriska, A. M. (2013). Evaluation of the group lifestyle balance programme for diabetes prevention in a Hispanic Women, Infants and Children (WIC) Programme population in the USA. Diversity and Equality in Health and Care, 10, 73–82.Google Scholar
  21. 21.
    Kramer, M. K., Kriska, A. M., Venditti, E. M., Semler, L. N., Miller, R. G., McDonald, T., et al. (2010). A novel approach to diabetes prevention: Evaluation of the group lifestyle balance program delivered via DVD. Diabetes Research and Clinical Practice, 90, e60–e63.CrossRefPubMedGoogle Scholar
  22. 22.
    Eaglehouse, Y. L., Kramer, M. K., Rockette-Wagner, B., Arena, V. C., & Kriska, A. M. (2015). Evaluation of physical activity reporting in community diabetes prevention program lifestyle intervention efforts: A systematic review. Preventive Medicine, 77, 191–199. doi: 10.1016/j.ypmed.2015.05.023.CrossRefPubMedGoogle Scholar
  23. 23.
    Kramer, M. K., Molenaar, D. M., Arena, V. C., Venditti, E. M., Meehan, R. J., Miller, R. G., et al. (2015). Improving employee health: Evaluation of a worksite lifestyle change program to decrease risk factors for diabetes and cardiovascular disease. Journal of Occupational and Environmental Medicine, 57(3), 284–291. doi: 10.1097/jom.0000000000000350.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kramer, M. K., Vanderwood, K., Eaglehouse, Y., Miller, R. G., Arena, V., Venditti, E., et al. (2014). Diabetes prevention efforts in the community are effective for older, at-risk adults. Diabetes, 63(Suppl 1), A1–A102. doi: 10.2337/db14-1-388.Google Scholar
  25. 25.
    Kramer, M. K., Kriska, A. M., Venditti, E. M., Miller, R. G., Brooks, M. M., Burke, L. E., et al. (2009). Translating the diabetes prevention program: A comprehensive model for prevention training and program delivery. American Journal of Preventive Medicine, 37(6), 505–511.CrossRefPubMedGoogle Scholar
  26. 26.
    Centers for Disease Control and Prevention. (2014). National diabetes prevention program. http://www.cdc.gov/diabetes/prevention/recognition/. Accessed 1 Nov 2014.
  27. 27.
    Centers for Disease Control and Prevention. (2011). Centers for disease control and prevention diabetes prevention recognition program: Standards and operating procedures. www.cdc.gov/diabetes/prevention/recognition
  28. 28.
    Taradash, J., Kramer, M., Molenaar, D., Arena, V., Vanderwood, K., & Kriska, A. M. (2015). Recruitment for a diabetes prevention program translation effort in a worksite setting. Contemporary Clinical Trials,. doi: 10.1016/j.cct.2015.01.010.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Vanderwood, K. K., Kramer, M. K., Miller, R. G., Arena, V. C., & Kriska, A. M. (2015). Evaluation of non-invasive screening measures to identify individuals with prediabetes. Diabetes Research and Clinical Practice, 107(1), 194–201. doi: 10.1016/j.diabres.2014.06.003.CrossRefPubMedGoogle Scholar
  30. 30.
    American Diabetes Association. (2015). Classification and diagnosis of diabetes. Diabetes Care, 38(Suppl), S8–S16. doi: 10.2337/dc15-S005.CrossRefGoogle Scholar
  31. 31.
    Grundy, S. M., Brewer, H. B, Jr, Cleeman, J. I., Smith, S. C, Jr, & Lenfant, C. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109(3), 433–438. doi: 10.1161/01.cir.0000111245.75752.c6.CrossRefPubMedGoogle Scholar
  32. 32.
    Venditti, E. M., & Kramer, M. K. (2012). Necessary components for lifestyle modification interventions to reduce diabetes risk. Current Diabetes Reports, 12(2), 138–146.CrossRefPubMedGoogle Scholar
  33. 33.
    EuroQol Group. (1990). EuroQol–a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.CrossRefGoogle Scholar
  34. 34.
    Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13(9), 873–884. doi: 10.1002/hec.866.CrossRefPubMedGoogle Scholar
  35. 35.
    Jia, H., & Lubetkin, E. I. (2008). Estimating EuroQol EQ-5D scores from population healthy days data. Medical Decision Making, 28(4), 491–499. doi: 10.1177/0272989x07312708.CrossRefPubMedGoogle Scholar
  36. 36.
    Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., et al. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskeletal Disorders, 14, 148. doi: 10.1186/1471-2474-14-148.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research, 14(6), 1523–1532.CrossRefPubMedGoogle Scholar
  38. 38.
    Dolan, P., Gudex, C., Kind, P., & Williams, A. (1996). Valuing health states: A comparison of methods. Journal of Health Economics, 15(2), 209–231.CrossRefPubMedGoogle Scholar
  39. 39.
    Ainsworth, B. E., Haskell, W. L., Herrmann, S. D., Meckes, N., Bassett, D. R, Jr, Tudor-Locke, C., et al. (2011). 2011 Compendium of physical activities: A second update of codes and MET values. Medicine and Science in Sports and Exercise, 43(8), 1575–1581. doi: 10.1249/MSS.0b013e31821ece12.CrossRefPubMedGoogle Scholar
  40. 40.
    Pettee Gabriel, K., McClain, J. J., Schmid, K. K., Storti, K. L., & Ainsworth, B. E. (2011). Reliability and convergent validity of the past-week Modifiable Activity Questionnaire. Public Health Nutrition, 14(3), 435–442. doi: 10.1017/s1368980010002612.CrossRefPubMedGoogle Scholar
  41. 41.
    Pettee Gabriel, K., McClain, J. J., Lee, C. D., Swan, P. D., Alvar, B. A., Mitros, M. R., et al. (2009). Evaluation of physical activity measures used in middle-aged women. Medicine and Science in Sports and Exercise, 41(7), 1403–1412. doi: 10.1249/MSS.0b013e31819b2482.CrossRefPubMedGoogle Scholar
  42. 42.
    Momenan, A. A., Delshad, M., Sarbazi, N., Rezaei Ghaleh, N., Ghanbarian, A., & Azizi, F. (2012). Reliability and validity of the Modifiable Activity Questionnaire (MAQ) in an Iranian urban adult population. Archives of Iranian Medicine, 15(5), 279–282. doi:012155/AIM.007.PubMedGoogle Scholar
  43. 43.
    Schulz, L. O., Harper, I. T., Smith, C. J., Kriska, A. M., & Ravussin, E. (1994). Energy intake and physical activity in Pima Indians: Comparison with energy expenditure measured by doubly-labeled water. Obesity Research, 2(6), 541–548.CrossRefPubMedGoogle Scholar
  44. 44.
    Kriska, A. M., Knowler, W. C., LaPorte, R. E., Drash, A. L., Wing, R. R., Blair, S. N., et al. (1990). Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care, 13(4), 401–411.CrossRefPubMedGoogle Scholar
  45. 45.
    Jacobi, D., Charles, M. A., Tafflet, M., Lommez, A., Borys, J. M., & Oppert, J. M. (2009). Relationships of self-reported physical activity domains with accelerometry recordings in French adults. European Journal of Epidemiology, 24(4), 171–179. doi: 10.1007/s10654-009-9329-8.CrossRefPubMedGoogle Scholar
  46. 46.
    Mallinckrodt, C. H., Kaiser, C. J., Watkin, J. G., Molenberghs, G., & Carroll, R. J. (2004). The effect of correlation structure on treatment contrasts estimated from incomplete clinical trial data with likelihood-based repeated measures compared with last observation carried forward ANOVA. Clinical Trials, 1(6), 477–489.CrossRefPubMedGoogle Scholar
  47. 47.
    Eaglehouse, Y. L., Vanderwood, K. K., Kramer, M. K., & Kriska, A. M. (2014). Can a lifestyle program aimed at preventing diabetes increase physical activity levels across diverse settings? Medicine and Science in Sports and Exercise, 46(5S), 101–114. doi: 10.1249/01.mss.0000451113.55137.dd.Google Scholar
  48. 48.
    Pope, J. E., Khanna, D., Norrie, D., & Ouimet, J. M. (2009). The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials. Journal of Rheumatology, 36(2), 254–259. doi: 10.3899/jrheum.080479.CrossRefPubMedGoogle Scholar
  49. 49.
    Pickard, A. S., Neary, M. P., & Cella, D. (2007). Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health and Quality of Life Outcomes, 5, 70. doi: 10.1186/1477-7525-5-70.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Whynes, D. K., McCahon, R. A., Ravenscroft, A., Hodgkinson, V., Evley, R., & Hardman, J. G. (2013). Responsiveness of the EQ-5D health-related quality-of-life instrument in assessing low back pain. Value in Health, 16(1), 124–132. doi: 10.1016/j.jval.2012.09.003.CrossRefPubMedGoogle Scholar
  51. 51.
    Oh, E. G., Bang, S. Y., Hyun, S. S., Kim, S. H., Chu, S. H., Jeon, J. Y., et al. (2010). Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome. Metabolism, 59(7), 1035–1043. doi: 10.1016/j.metabol.2009.10.027.CrossRefPubMedGoogle Scholar
  52. 52.
    Cezaretto, A., Siqueira-Catania, A., de Barros, C. R., Salvador, E. P., & Ferreira, S. R. (2012). Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus. Quality of Life Research, 21(1), 105–113. doi: 10.1007/s11136-011-9919-2.CrossRefPubMedGoogle Scholar
  53. 53.
    Delgado-Rodriguez, M., & Llorca, J. (2004). Bias. Journal of Epidemiology and Community Health, 58(8), 635–641. doi: 10.1136/jech.2003.008466.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Tuomilehto, J., Lindstrom, J., Eriksson, J. G., Valle, T. T., Hamalainen, H., Ilanne-Parikka, P., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344(18), 1343–1350. doi: 10.1056/nejm200105033441801.CrossRefPubMedGoogle Scholar
  55. 55.
    Piatt, G. A., Seidel, M. C., Chen, H. Y., Powell, R. O., & Zgibor, J. C. (2012). Two-year results of translating the diabetes prevention program into an urban, underserved community. The Diabetes Educator, 38(6), 798–804. doi: 10.1177/0145721712458834.CrossRefPubMedGoogle Scholar
  56. 56.
    Ackermann, R. T., Finch, E. A., Brizendine, E., Zhou, H., & Marrero, D. G. (2008). Translating the diabetes prevention program into the community. The DEPLOY pilot study. American Journal of Preventive Medicine, 35(4), 357–363. doi: 10.1016/j.amepre.2008.06.035.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    McTigue, K. M., Conroy, M. B., Bigi, L., Murphy, C., & McNeil, M. (2009). Weight loss through living well: Translating an effective lifestyle intervention into clinical practice. The Diabetes Educator, 35(2), 199–204, 208. doi: 10.1177/0145721709332815.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Department of Health SciencesCarroll CollegeHelenaUSA
  3. 3.Department of BiostatisticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  4. 4.University of Pittsburgh Cancer InstitutePittsburghUSA

Personalised recommendations