DPP Spring Training 

As the year 2000 begins, more than 500 DPP lifestyle participants have been in the study for 18 months or more.  While some participants have lost weight and maintained the loss, others are struggling and experiencing weight regain.  The average weight losses for all DPP lifestyle participants are gradually diminishing, as shown in the table below.

Weight Change for Lifestyle Participants Based on F01 and F02 (All Clinics)
Data as of December 15, 1999
Month	N	Mean weight change (lbs)	
6	1041	-14.8	
12	829	-14.9	
18	578	-12.6	
24	386	-10.6	
30	207	-8.0	

Similarly, the average physical activity for participants during the core curriculum period was more than 200 minutes and by 18 months is consistently below this number. 

By now most lifestyle participants know what they need to do to reach their weight and activity goals, but they may be bored, frustrated, or overwhelmed with all of it and showing a lower level of commitment.  In addition, many Coaches have come to know their participants so well by this point that individual meetings can easily become focussed on personal issues (although this is understandable and often critically important for retention purposes, it makes it even more difficult to focus on the basics of healthy eating and exercise).  

With all of this in mind, and with the aim to revitalize the lifestyle intervention, we have developed the attached after-core class, DPP Spring Training, designed to be offered during April - July 2000.  Although the class is optional, we strongly encourage all centers to offer this class or a similar one to their lifestyle participants.   We envision that new waves of a similar class may be offered in the Spring of 2001 as well. 

The purpose of the DPP Spring Training is to offer participants a new opportunity for weight loss and exercise in a group format.   We want to position this as a new and different approach within the DPP, with new staff and a different location if at all possible.  (The basic principles of how to lose weight in a healthy manner remain the same, but we are trying to present these principles in a new way.)

The class will include the following key features:

1.	Offered to all lifestyle participants who have completed the core curriculum.  We recommend that centers send a personal invitation to participants from the Principal Investigator (see attached sample letter).

2.	At least eight weeks of weekly group meetings, with the option of an additional four to eight weeks.  
C	We propose a group format because it has been shown to be highly effective in behavioral weight loss programs (the core curriculum was designed to provide individual contacts largely because of the pace of randomization).  However, if your study team feels that a group format will not work at your center, feel free to take parts of the class and use them with individual participants instead.  
C	We propose weekly meetings for eight weeks, a sufficient period of time to allow participants to reengage, develop social support with the other participants in the class, and reach significant weight and exercise goals.  We recommend that each center survey their participants to see what day of the week and time would be most convenient for the most participants to attend (e.g., on a Thursday night or Saturday morning).  You may want to meet twice weekly if weight training is the focus (see below) to allow for ongoing instruction and practice. 
C	At the end of the first eight weeks, the participants are to be invited to continue for another four to eight weeks.  Participants who have not been in the class during the first eight weeks may join the class at this time as well. 
Note:  Each session may be considered an In-Person Contact provided a Coach meets with the participants individually, before or after the class, to collect and comment on self-monitoring records, get weight and physical activity data, and problem solve.  In that case, an L03 form should be completed for each participant who attends. 

3.	A weight loss goal of 1-2 pounds per week.  This is a realistic goal, would help many participants reach the 7% weight loss goal for the study, and would benefit many who have already reached the study goal.  (The goal should be weight maintenance for any participants who reach a BMI of 21--see the Manual of Operations, Section 2.1.1.)  If a participant has already reached the 7% weight loss goal and doesn’t want to lose more, he or she may still want to attend the class to exercise, enhance weight maintenance, and receive group support.

4.	An exercise goal of at least 200 minutes per week.  This is higher than the 150-minute study goal because we thought participants should set their sights a little higher than the minimum goal for a “training” program.  To reach the 200-minute goal, stepwise weekly goals should be set for each participant depending on how much physical activity they are doing when they enter the class.  (If strength training is the class topic, as outlined below, the goal would be to do 150 minutes of aerobic activity plus the strength training assignment for each week.)  (Note:  For the purpose of lifestyle form completion, if participants reach 150 minutes per week during the class, they will still be reaching the study goal.)

5.	Four weeks of structured meal plans for 1200 and 1500 calories (attached), designed to be repeated twice for a total of eight weeks.  The meal plan for the DPP Spring Training is called “DPP Start Now.”  We are providing detailed meal plans because participants often look to structured plans, which eliminate a lot of temptations and decisions about food, to renew their efforts at weight control.  Shopping lists are also provided.  Participants are to be coached to follow the meal plans exactly for at least the first four weeks (see the Coach instructions with the meal plans).  At that point, participants may choose to recommit to the meal plan or develop individualized modifications with their Coach and then attempt to follow the modified meal plans exactly for the additional four weeks.

6.	Each session will include a weigh-in and collection and review of self-monitoring materials.   We strongly recommend that participants use a different method of self-monitoring during the class.  As one option, the Lifestyle Resource Core has ordered each center copies of HealthCheques, a checkbook-style self-monitoring booklet with room for three weeks of recording.  
C	In HealthCheques, the inside cover may be used to record individualized goals for participants in the class.  
C	For recording exercise, there are two options:
a.	In the separate pages for exercise monitoring (these are marked in the lower right hand corner by a graphic of a pair of sneakers and include a place for recording exercise goals and minutes of both aerobic exercise and muscle conditioning; unfortunately, exercise minutes are distinguished from “physical activity,” which most likely refers to lifestyle activity and will need to be explained to participants), or
b.	In the area labeled “Comments” at the bottom of each page for monitoring food intake (this may be easier for participants than flipping to the separate exercise sections). 
We recommend that participants self-monitor measures of their progress during the class, such as waist circumference, perceived rate of exertion after walking a certain distance, and/or the number of reps they are able to complete comfortably doing muscle training exercises.  Depending on who leads the class, you may want to provide an additional form of self-monitoring.  For example, cardiac rehabilitation centers may use a standard note card to record each participant’s exercise prescription and individual progress during each visit. 
C	To record food intake, participants who follow the DPP Start Now eating plan exactly would write “Eating Plan” on the food log pages (or indicate any deviations from the plan).  Participants who do not follow the eating plan could self-monitor fat grams and/or calories in the columns provided or monitor servings from the Food Pyramid in the boxes provided.  
C	You will need to instruct participants to record weight in the comments section at the bottom of each food log page.
Alternative methods for self-monitoring may be arranged for participants with their Lifestyle Coach.

7.	We believe most participants know what to eat and how to exercise, are weary of hearing about these topics, and are more likely to attend a class if they receive new information and group experiences they could not get elsewhere without significant cost.  With this in mind, we recommend the primary content of the class be strength training.  Several centers have noted that strength training classes have attracted a large number of participants, and in general, the feedback has been very positive.
C	We recommend that the class include training with Thera-Bands as well as with other weight lifting equipment, if available, so that participants can use the Thera-Bands at home between sessions to fulfill part of their activity goal.  (All of the DPP centers have already received some Thera-Bands from the Lifestyle Core.  An additional roll of thin resistance (yellow) Thera-Bands will be shipped to each center soon.)
C	Given the potential effectiveness of providing a “fresh face” for participants, centers should brainstorm options for finding a new and/or different individual with exercise expertise who could lead the classes.  Possibilities include an existing staff member who has not been extensively involved with the majority of participants, an exercise physiology student or intern, or a consultant hired on a limited basis.  (A Coach would need to be on hand to weigh participants, help review self-monitoring, and so on.)  
Some centers may want to vary the class topic.  Some alternatives include the following:  a) choose a different exercise as the focus, such as aerobic dance or circuit training;  b) alternate sessions on strength training with low-fat cooking or recipe tasting, or include exercise and nutrition at each session; or c) use the 16-session Learn Manual (the Lifestyle Core has sent this to each center).  

8.	A new location, if possible, that might attract participants.  For example, you may be able to offer the class at a location with weight lifting equipment, or hold the class at a neighborhood community center, recreation center, or church using Thera-bands and free weights.
DPP Spring Training 2000:  How Did It Go?

We want to know what you thought of the DPP Spring Training 2000.

 How helpful were each of the following?   NA = Not Applicable (Not Part of
the Program), 1 = Not at All Helpful, 5 = Very Helpful     							
1. 	The Start Now Eating Plans	NA	1	2	3	4	5	
2. 	Learning to use the Therabands	NA	1	2	3	4	5	
3. 	Meeting as a group with other participants	NA	1	2	3	4	5	
4. 	Exercising as a group with other participants	NA	1	2	3	4	5	
5. 	Group leader:                                         
Group leader:                                         	
Group leader:                                         	NA
NA
NA	1
1
1	2
2
2	3
3
3	4
4
4	5
5
5	
6. 	Using the Health Checques to self-monitor	NA	1	2	3	4	5	
7.		Using another kind of self-monitoring
(specify type used:                                 )	
NA	
1	
2	
3	
4	
5	
8. 	Receiving an invitation from the Principal Investigator	NA	1	2	3	4	5	
9.		The option of coming on different days of the week 	NA	1	2	3	4	5
	
10.	Location:                                              
Location:                                              
Location:                                              	NA
NA
NA	1
1
1	2
2
2	3
3
3	4
4
4	5
5
5	
11.	Other:                                                  	NA	1	2	3	4	5	

Do you have other comments or suggestions?  
If we were to do another Spring Training, would you suggest any changes?

                                                                                                                             

Thank you.