Stress management in obesity during a thermal spa residential programme (ObesiStress): protocol for a randomised controlled trial study

Frédéric Dutheil, Elodie Chaplais, Audrey Vilmant, Daniel Courteix, Pascale Duche, Armand Abergel, Daniela M Pfabigan, Shihui Han, Laurie Mobdillon, Guillaume T Vallet, Martial Mermillod, Gil Boudet, Philippe Obert, Omar Izem, Magalie Miolanne-Debouit, Nicolas Farigon, Bruno Pereira, Yves Boirie, Frédéric Dutheil, Elodie Chaplais, Audrey Vilmant, Daniel Courteix, Pascale Duche, Armand Abergel, Daniela M Pfabigan, Shihui Han, Laurie Mobdillon, Guillaume T Vallet, Martial Mermillod, Gil Boudet, Philippe Obert, Omar Izem, Magalie Miolanne-Debouit, Nicolas Farigon, Bruno Pereira, Yves Boirie

Abstract

Introduction: Stress and obesity are two public health issues. The relationship between obesity and stress is biological through the actions of stress on the major hormones that regulate appetite (leptin and ghrelin). Many spa resorts in France specialise in the treatment of obesity, but no thermal spa currently proposes a specific programme to manage stress in obesity. The ObesiStress protocol has been designed to offer a new residential stress management programme. This thermal spa treatment of obesity implements stress management strategies as suggested by international recommendations.

Methods and analysis: 140 overweight or obese participants with a Body Mass Index of >25 kg/m2 and aged over 18 years will be recruited. Participants will be randomised into two groups: a control group of usual practice (restrictive diet, physical activity and thermal spa treatment) and an intervention group with stress management in addition to the usual practice. In the present protocol, parameters will be measured on five occasions (at inclusion, at the beginning of the spa (day 0), at the end of the spa (day 21), and at 6 and 12 months). The study will assess the participants' heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometric profile, body composition, psychology and quality of life via the use of questionnaires and bone parameters.

Ethics and dissemination: The ObesiStress protocol complies with the ethics guidelines for Clinical Research and has been approved by the ethics committee (CPP Sud-Est VI, Clermont-Ferrand - ANSM: 2016-A01774-47). This study aimed to highlight the efficacy of a 21-day thermal spa residential programme of stress management in obesity through objective measurements of well-being and cardiovascular morbidity. Results will be disseminated during several research conferences and articles published in peer-reviewed journals.

Trial registration number: NCT03578757.

Keywords: heart rate variability; obesity; prevention; spa bath; stress.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The ObesiStress protocol. M month, D day.

References

    1. Quine L. Workplace bullying in NHS community trust: staff questionnaire survey. BMJ 1999;318:228–32. 10.1136/bmj.318.7178.228
    1. Dutheil F, Lac G, Lesourd B, et al. . Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE* randomized trial. Int J Cardiol 2013;168:3634–42. 10.1016/j.ijcard.2013.05.012
    1. Foss B, Dyrstad SM. Stress in obesity: cause or consequence? Med Hypotheses 2011;77:7–10. 10.1016/j.mehy.2011.03.011
    1. Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry 2013;73:827–35. 10.1016/j.biopsych.2013.01.032
    1. Robinson E, Hunger JM, Daly M. Perceived weight status and risk of weight gain across life in US and UK adults. Int J Obes 2015;39:1721–6. 10.1038/ijo.2015.143
    1. Haleem DJ. Investigations into the involvement of leptin in responses to stress. Behav Pharmacol 2014;25:384–97.
    1. Schellekens H, Finger BC, Dinan TG, et al. . Ghrelin signalling and obesity: at the interface of stress, mood and food reward. Pharmacol Ther 2012;135:316–26. 10.1016/j.pharmthera.2012.06.004
    1. Isasi CR, Parrinello CM, Jung MM, et al. . Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults. Ann Epidemiol 2015;25:84–9. 10.1016/j.annepidem.2014.11.002
    1. Backé E-M, Seidler A, Latza U, et al. . The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Arch Occup Environ Health 2012;85:67–79. 10.1007/s00420-011-0643-6
    1. Dutheil F, Boudet G, Perrier C, et al. . JOBSTRESS study: comparison of heart rate variability in emergency physicians working a 24-hour shift or a 14-hour night shift — a randomized trial. Int J Cardiol 2012;158:322–5. 10.1016/j.ijcard.2012.04.141
    1. Karason K, Mølgaard H, Wikstrand J, et al. . Heart rate variability in obesity and the effect of weight loss. Am J Cardiol 1999;83:1242–7. 10.1016/S0002-9149(99)00066-1
    1. Chintala KK, Krishna BH, MR N. Heart rate variability in overweight health care students: correlation with visceral fat. JCDR 2015;9 10.7860/JCDR/2015/12145.5434
    1. Tsuji H, Larson MG, Venditti FJ, et al. . Impact of reduced heart rate variability on risk for cardiac events. The Framingham heart study. Circulation 1996;94:2850–5. 10.1161/01.cir.94.11.2850
    1. Boudet G, Walther G, Courteix D, et al. . Paradoxical dissociation between heart rate and heart rate variability following different modalities of exercise in individuals with metabolic syndrome: the resolve study. Eur J Prev Cardiol 2017;24:281–96. 10.1177/2047487316679523
    1. Hufnagel C, Chambres P, Bertrand PR, et al. . The need for objective measures of stress in autism. Front Psychol 2017;8 10.3389/fpsyg.2017.00064
    1. Proietti R, Mapelli D, Volpe B, et al. . Mental stress and ischemic heart disease: evolving awareness of a complex association. Future Cardiol 2011;7:425–37. 10.2217/fca.11.13
    1. Elenkov IJ, Iezzoni DG, Daly A, et al. . Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation 2005;12:255–69. 10.1159/000087104
    1. Dutheil F, Lesourd B, Courteix D, et al. . Blood lipids and adipokines concentrations during a 6-month nutritional and physical activity intervention for metabolic syndrome treatment. Lipids Health Dis 2010;9:148 10.1186/1476-511X-9-148
    1. Bloom L, Shelton B, Bengough M, et al. . Psychosocial outcomes of a non-dieting based positive body image community program for overweight adults: a pilot study. J Eat Disord 2013;1 10.1186/2050-2974-1-44
    1. Waysfeld B. Psychological approaches to the obese]. Presse Med 2000;29:556–63.
    1. van der Klink JJ, Blonk RW, Schene AH, et al. . The benefits of interventions for work-related stress. American Journal of Public Health 2001;91:270–6.
    1. Banz WJ, Maher MA, Thompson WG, et al. . Effects of resistance versus aerobic training on coronary artery disease risk factors. Exp Biol Med 2003;228:434–40. 10.1177/153537020322800414
    1. Brinkborg H, Michanek J, Hesser H, et al. . Acceptance and commitment therapy for the treatment of stress among social workers: a randomized controlled trial. Behav Res Ther 2011;49:389–98. 10.1016/j.brat.2011.03.009
    1. Davies WR. Mindful meditation: healing burnout in critical care nursing. Holist Nurs Pract 2008;22:32–6.
    1. Cohen-Katz J, Wiley SD, Capuano T, et al. . The effects of mindfulness-based stress reduction on nurse stress and burnout: a quantitative and qualitative study. Holist Nurs Pract 2004;18:302–8.
    1. Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med 2014;44:81–121. 10.1007/s40279-013-0090-5
    1. Hansen Åse Marie, Blangsted AK, Hansen EA, et al. . Physical activity, job demand–control, perceived stress–energy, and salivary cortisol in white-collar workers. Int Arch Occup Environ Health 2010;83:143–53. 10.1007/s00420-009-0440-7
    1. Stress K-GJK. Food, and inflammation: psychoneuroimmunology and nutrition at the cutting edge. Psychosomatic medicine 2010;72:365.
    1. Bhui KS, Dinos S, Stansfeld SA, et al. . A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism. J Environ Public Health 2012;2012:1–21. 10.1155/2012/515874
    1. Elghozi J-L, Girard A, Laude D. Effects of drugs on the autonomic control of short-term heart rate variability. Autonomic Neuroscience 2001;90:116–21. 10.1016/S1566-0702(01)00276-4
    1. Bond FW, Bunce D. The role of acceptance and job control in mental health, job satisfaction, and work performance. J Appl Psychol 2003;88:1057–67. 10.1037/0021-9010.88.6.1057
    1. Tochikubo O, Ikeda A, Miyajima E, et al. . Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 1996;27:1318–24. 10.1161/01.HYP.27.6.1318
    1. Khalfa N, Bertrand PR, Boudet G, et al. . Heart rate regulation processed through wavelet analysis and change detection: some case studies. Acta Biotheor 2012;60:109–29. 10.1007/s10441-012-9154-4
    1. Report of a WHO consultation Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser 2000;894:1–253.
    1. Courteix D, Valente-dos-Santos J, Ferry B, et al. . Multilevel approach of a 1-year program of dietary and exercise interventions on bone mineral content and density in metabolic syndrome – the resolve randomized controlled trial. PLoS One 2015;10:e0136491 10.1371/journal.pone.0136491
    1. Pateyjohns IR, Brinkworth GD, Buckley JD, et al. . Comparison of three bioelectrical impedance methods with DXA in overweight and obese Men*. Obesity 2006;14:2064–70. 10.1038/oby.2006.241
    1. Dutheil F, Chambres P, Hufnagel C, et al. . 'Do well B.': design of well being monitoring systems. A study protocol for the application in autism. BMJ Open 2015;5:e007716 10.1136/bmjopen-2015-007716
    1. Lang RM, Badano LP, Mor-Avi V, et al. . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 2015;28:1–39. 10.1016/j.echo.2014.10.003
    1. Mor-Avi V, Lang RM, Badano LP, et al. . Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications. Journal of the American Society of Echocardiography 2011;24:277–313. 10.1016/j.echo.2011.01.015
    1. Nagueh SF, Smiseth OA, Appleton CP, et al. . Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321–60. 10.1093/ehjci/jew082
    1. Buss J, Havel PJ, Epel E, et al. . Associations of ghrelin with eating behaviors, stress, metabolic factors, and telomere length among overweight and obese women: preliminary evidence of attenuated ghrelin effects in obesity? Appetite 2014;76:84–94. 10.1016/j.appet.2014.01.011
    1. Karege F, Perret G, Bondolfi G, et al. . Decreased serum brain-derived neurotrophic factor levels in major depressed patients. Psychiatry Res 2002;109:143–8. 10.1016/S0165-1781(02)00005-7
    1. Karege F, Bondolfi G, Gervasoni N, et al. . Low brain-derived neurotrophic factor (BDNF) levels in serum of depressed patients probably results from lowered platelet BDNF release unrelated to platelet reactivity. Biol Psychiatry 2005;57:1068–72. 10.1016/j.biopsych.2005.01.008
    1. Shimizu E, Hashimoto K, Okamura N, et al. . Alterations of serum levels of brain-derived neurotrophic factor (BDNF) in depressed patients with or without antidepressants. Biol Psychiatry 2003;54:70–5. 10.1016/S0006-3223(03)00181-1
    1. Krystal JH, Neumeister A. Noradrenergic and serotonergic mechanisms in the neurobiology of posttraumatic stress disorder and resilience. Brain Res 2009;1293:13–23. 10.1016/j.brainres.2009.03.044
    1. Lac G, Dutheil F, Brousse G, et al. . Saliva DHEAS changes in patients suffering from psychopathological disorders arising from bullying at work. Brain Cogn 2012;80:277–81. 10.1016/j.bandc.2012.07.007
    1. Danhof-Pont MB, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. J Psychosom Res 2011;70:505–24. 10.1016/j.jpsychores.2010.10.012
    1. Montgomery H, Clarkson P, Barnard M, et al. . Angiotensin-Converting-Enzyme gene insertion/deletion polymorphism and response to physical training. The Lancet 1999;353:541–5. 10.1016/S0140-6736(98)07131-1
    1. Henrion D, Benessiano J, Philip I, et al. . The deletion genotype of the angiotensin I-converting enzyme is associated with an increased vascular reactivity in vivo and in vitro. J Am Coll Cardiol 1999;34:830–6. 10.1016/S0735-1097(99)00299-5
    1. Gard PR. The role of angiotensin II in cognition and behaviour. Eur J Pharmacol 2002;438:1–14. 10.1016/S0014-2999(02)01283-9
    1. Thayer JF, Merritt MM, Sollers JJ, et al. . Effect of angiotensin-converting enzyme insertion/deletion polymorphism DD genotype on high-frequency heart rate variability in African Americans. Am J Cardiol 2003;92:1487–90. 10.1016/j.amjcard.2003.08.069
    1. Hariri AR, Drabant EM, Weinberger DR. Imaging genetics: perspectives from studies of genetically driven variation in serotonin function and corticolimbic affective processing. Biol Psychiatry 2006;59:888–97. 10.1016/j.biopsych.2005.11.005
    1. Hariri AR, Weinberger DR. Functional neuroimaging of genetic variation in serotonergic neurotransmission. Genes Brain Behav 2003;2:341–9. 10.1046/j.1601-1848.2003.00048.x
    1. McCaffery JM, Bleil M, Pogue-Geile MF, et al. . Allelic variation in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and cardiovascular reactivity in young adult male and female twins of European-American descent. Psychosom Med 2003;65:721–8. 10.1097/01.PSY.0000088585.67365.1D
    1. Epel ES, Blackburn EH, Lin J, et al. . Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A 2004;101:17312–5. 10.1073/pnas.0407162101
    1. Choron G, Dutheil F, Lesage FX. Are nurses burned out? Int J Nurs Stud 2016;58:80–1. 10.1016/j.ijnurstu.2016.02.002
    1. Hung C-I, Liu C-Y, Wang S-J, et al. . The cut-off points of the depression and somatic symptoms scale and the hospital anxiety and depression scale in detecting non-full remission and a current major depressive episode. Int J Psychiatry Clin Pract 2012;16:33–40. 10.3109/13651501.2011.617456
    1. Julian LJ. Measures of anxiety: State-Trait anxiety inventory (STAI), Beck anxiety inventory (BAI), and hospital anxiety and depression Scale-Anxiety (HADS-A). Arthritis Care Res 2011;63:S467–72. 10.1002/acr.20561
    1. Spiess K, Sachs G, Moser G, et al. . Psychological moderator variables and metabolic control in recent onset type 1 diabetic patients—a two year longitudinal study. J Psychosom Res 1994;38:249–58. 10.1016/0022-3999(94)90120-1
    1. Endler NS, Parker JD. Multidimensional assessment of coping: a critical evaluation. J Pers Soc Psychol 1990;58:844–54. 10.1037/0022-3514.58.5.844
    1. Ioannidis CA, Siegling AB. Criterion and incremental validity of the emotion regulation questionnaire. Front Psychol 2015;6:247 10.3389/fpsyg.2015.00247
    1. Lesage F-X, Choron G, Dutheil F. Multifaceted program to reduce job strain in ICU nurses. JAMA 2019;321:1410–1. 10.1001/jama.2019.0570
    1. Trousselard M, Dutheil F, Naughton G, et al. . Stress among nurses working in emergency, anesthesiology and intensive care units depends on qualification: a job Demand-Control survey. Int Arch Occup Environ Health 2016;89:221–9. 10.1007/s00420-015-1065-7
    1. Luszczynska A, Scholz U, Schwarzer R. The general self-efficacy scale: multicultural validation studies. J Psychol 2005;139:439–57. 10.3200/JRLP.139.5.439-457
    1. Li S, Zhang B, Guo Y, et al. . The association between alexithymia as assessed by the 20-item Toronto Alexithymia scale and depression: a meta-analysis. Psychiatry Res 2015;227:1–9. 10.1016/j.psychres.2015.02.006
    1. Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale—I. item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23–32. 10.1016/0022-3999(94)90005-1
    1. Bagby RM, Taylor GJ, Parker JDA. The twenty-item Toronto Alexithymia scale—II. convergent, discriminant, and concurrent validity. J Psychosom Res 1994;38:33–40. 10.1016/0022-3999(94)90006-X
    1. Broadbent E, Petrie KJ, Main J, et al. . The brief illness perception questionnaire. J Psychosom Res 2006;60:631–7. 10.1016/j.jpsychores.2005.10.020
    1. Broadbent E, Wilkes C, Koschwanez H, et al. . A systematic review and meta-analysis of the brief illness perception questionnaire. Psychol Health 2015;30:1361–85. 10.1080/08870446.2015.1070851
    1. Wells A, Cartwright-Hatton S. A short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther 2004;42:385–96. 10.1016/S0005-7967(03)00147-5
    1. Amiel R, Lebigre F. A new rapid test for the evaluation of mental health. its use for early detections Its importance in health surveys]. Ann Med Psychol 1970;1:565–80.
    1. Golubic R, May AM, Benjaminsen Borch K, et al. . Validity of electronically administered recent physical activity questionnaire (RPAQ) in ten European countries. PLoS One 2014;9:e92829 10.1371/journal.pone.0092829
    1. Sornay-Rendu E, Boutroy S, Munoz F, et al. . Cortical and trabecular architecture are altered in postmenopausal women with fractures. Osteoporos Int 2009;20:1291–7. 10.1007/s00198-009-1008-9
    1. Boutroy S, Bouxsein ML, Munoz F, et al. . In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 2005;90:6508–15. 10.1210/jc.2005-1258
    1. Stein EM, Liu XS, Nickolas TL, et al. . Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res 2010;25:2572–81. 10.1002/jbmr.152
    1. Kullback S. Information theory and statistics. New York: John Wiley & Sons, 1959.
    1. Steiger JH. Tests for comparing elements of a correlation matrix. Psychol Bull 1980;87:245–51. 10.1037/0033-2909.87.2.245
    1. Vickers AJ, Altman DG. Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ 2001;323:1123–4. 10.1136/bmj.323.7321.1123
    1. Damilakis J, Adams JE, Guglielmi G, et al. . Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol 2010;20:2707–14. 10.1007/s00330-010-1845-0
    1. Fappa E, Yannakoulia M, Pitsavos C, et al. . Lifestyle intervention in the management of metabolic syndrome: could we improve adherence issues? Nutrition 2008;24:286–91. 10.1016/j.nut.2007.11.008
    1. Elefteriou F, Ahn JD, Takeda S, et al. . Leptin regulation of bone resorption by the sympathetic nervous system and CART. Nature 2005;434:514–20. 10.1038/nature03398
    1. Puissant C, Abraham P, Durand S, et al. . Reproducibility of non-invasive assessment of skin endothelial function using laser Doppler flowmetry and laser speckle contrast imaging. PLoS One 2013;8:e61320 10.1371/journal.pone.0061320
    1. Souza EG, De Lorenzo A, Huguenin G, et al. . Impairment of systemic microvascular endothelial and smooth muscle function in individuals with early-onset coronary artery disease. Coron Artery Dis 2014;25:23–8. 10.1097/MCA.0000000000000055
    1. Wu C, Glüer C, Lu Y, et al. . Ultrasound characterization of bone Demineralization. Calcif Tissue Int 1998;62:133–9. 10.1007/s002239900406
    1. Büssing A, Fischer J, Haller A, et al. . Validation of the brief multidimensional life satisfaction scale in patients with chronic diseases. Eur J Med Res 2009;14:171–7. 10.1186/2047-783X-14-4-171
    1. Büssing A, Edelhäuser F, Weisskircher A, et al. . Inner correspondence and Peacefulness with practices among participants in Eurythmy therapy and yoga: a validation study. Evidence-Based Complementary and Alternative Medicine 2011;2011:1–9. 10.1155/2011/329023

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться