New Zealand rugby-inspired program tackles obesity

Obesity has been continuously increasing across the globe at an alarming rate. In New Zealand (NZ), around 31% of adults are obese, and 35% are overweight, with the prevalence of overweight men significantly greater than women. Notably, Māori and Pasifika men are more obese than non-Māori and non-Pasifika men. Therefore, there is a need for effective and sustainable means of intervention to address issues related to being overweight and obese among NZ men.

Study: Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs. Image Credit: Peopleimages.com – Yuri A / Shutterstock.com

Background

Men are mostly underrepresented in the majority of weight loss programs. Based on the reports of fourteen randomized controlled trials (RCTs) linked to men-only weight loss and maintenance programs, a combined intervention of exercise, dietary, and behavior change techniques was found to be most effective.

Motivated by the positive results of a previously developed Football Fans in Training (FFIT) program in Scotland, a similar program was designed in NZ. This new program was developed to support obese or overweight NZ men through professional rugby clubs.

A pilot RCT of Rugby Fans in Training-NZ (RUFIT-NZ) was conducted using 96 participants. Notably, this study documented a weight loss of around 2.5 kg among the participants after 12 weeks of intervention.

In addition to the weight loss, these participants exhibited a decrease in resting heart rate, waist circumference, and diastolic blood pressure. An overall improvement in fitness level was also observed.

Importantly, all participants who completed the program strongly recommended this program to their friends, thereby indicating the possibility of broader acceptance of RUFIT-NZ. Thus, a large-scale RCT was required to assess its sustained effect.

A recent International Journal of Behavioral Nutrition and Physical Activity study determines the efficacy and cost-effectiveness of RUFIT-NZ on lifestyle change, fitness, weight loss, blood pressure, and health-related quality of life (HRQoL).

About the study

A two-arm, multi-center, and parallel RCT was conducted in NZ between January 21, 2019, and October 22 22, 2020. RUFIT-NZ was delivered to participants by professional rugby franchises in a 12-session program.

This study cohort included overweight men between 30 and 65 years of age. These study participants were initially screened through the Physical Activity Readiness Questionnaire (PAR-Q). Any participants who were already associated with other healthy lifestyle programs were excluded. 

Weight changes, the primary outcome, were recorded after 52 weeks of intervention. In addition, secondary outcomes such as changes in waist circumference, cardiorespiratory and musculoskeletal fitness, blood pressure, lifestyle behaviors, and HRQoL were evaluated at 12 and 52 weeks.

A total of 308 participants were recruited and randomly divided into two arms, each comprising 154 men. Notably, the study cohort constituted 150 Māori participants.

A wait-list control approach was adopted for the control group, in which participants randomly assigned to this group were asked to continue with their routine lifestyle for 52 weeks. Following this, they were offered RUFIT-NZ intervention at the end of the 12-month follow-up period.

Each RUFIT-NZ intervention session included workshop-based education where the participants learned about the importance of nutrition, sleep, physical activity, and sedentary behavior for about one hour. The following session included one hour of exercise training for the treatment group. Although this was a group-based session, each participant’s exercise was tailored to their individual needs.

Study findings

RUFIT-NZ interventions had overall sustained changes in weight, physical fitness, waist circumference, self-reported physical activity, alcohol consumption, and HRQoL in the treated group. However, no significant change was observed in blood pressure or sleep post-RUFIT-NZ intervention.

Taken together, 200 participants completed the RUFIT-NZ intervention before the implementation of coronavirus disease 2019 (COVID-19) restrictions. The intervention group reported higher consumption of fruits and vegetables at 12 weeks.

At 52 weeks, this group revealed a weight loss of around 2.77 kg. In addition, waist circumference reduction, high physical activity levels, and HRQoL were reduced at 12 and 52 weeks.

The effectiveness of this intervention was also analyzed based on cost per quality-adjusted life year (QALY). Incremental cost-effective ratios of $259 per kg lost or $40,269 per QALY were obtained. A marginal gain in QALY was attributed to the short testing period. 

Conclusions

One of the critical limitations of the present trial was related to the lockdowns and restrictions implemented during the COVID-19 pandemic. Due to these restrictions, the RUFIT-NZ intervention could not be delivered to some participants. However, based on the advice of the trial steering committee, data were analyzed for participants from the first two waves.

Another limitation of this study was the absence of blinded outcome assessments. 

Despite these limitations, the overall positive primary and secondary outcomes emphasized the efficacy of this intervention in preventing the possible adverse events of morbidity and mortality due to obesity.