Clinical Research Directory

Supporting Preventive Practices in Primary Care: Amplifying the Potential of Opportunistic Interventions

In France, as worldwide, the prevalence of chronic conditions is increasing, with high burden on populations and healthcare systems. Behaviour is a key risk factor, and needs to be tackled within the social and environmental context in which it occurs. For example in 2017, the French eat too much processed food and salt, not enough fibers, 34% are overweight and 17% obese, and 80% present excessive sedentary time. In parallel, in France 5.4% of all cancers were attributable to sub-optimal nutrition (especially low fruits consumption and dietary fibers, and high processed meats consumption), and 6.3% to overweight/obesity or insufficient physical activity. Governments and health systems, including in France, have therefore considered a priority to intervene preventively on health behaviours throughout the lifespan. For a populational approach to prevention via behaviour change, primary care professionals are best placed to intervene, due to the long-term relationship that can be established with healthcare users in their everyday life environments, and the many opportunities for brief interventions which can be delivered and followed up depending on individual needs. Research suggests that brief interventions can be effective in producing small but important changes in behaviour (Keyworth 2020) particularly if the intervention is based on a theoretical model of behaviour change (e.g., Prochaska's transtheoretical model or Bandura's cognitive social theory). One such Public Health program is Making Every Contact Count (MECC), a program developed in England and deployed since 2007 and more recently implemented in Wales and Ireland as well. The development and implementation have been supported by epidemiological, behaviour change and implementation science research and continues to adapt to current challenges in preventive healthcare needs and provision. The "Healthy Conversation Skills" is a training program for healthcare professionals within the MECC program that focuses on how they can assess and support their patients' goals to improve behaviours such as physical activity and diet. It has been delivered since 2015 and shown effective (Adam 2020). In France, 98% of general practitioners (GPs) consider prevention as part of their professional roles. However, initial and continuous training for primary care professionals focuses mainly on healthcare rather than prevention, and the latter is only addressed through physiological and epidemiological perspective but not on behaviour determinants and change techniques. Actually, there is at the moment limited training on assessing and supporting health behaviour change in primary care professionals in France, which limits the opportunities and effectiveness of a preventive approach to behavioural risk factors in chronic conditions. However, a direct transfer of the "Healthy Conversation Skills" program to the French context is unlikely to achieve optimal benefit, as differences in culture and health system organisation are considerable in behavioural care (de Bruin 2018). Collaborative approaches to developing and implementing training programs are recommended. The investigators therefore propose to co-construct a training program tailored to the context of GP practice in France, and study its effectiveness and implementation in supporting changes in diet, physical activity and sedentary time in adult patients from the general population consulting in routine care.

HIIT vs. MICT Training Study

The purpose of this study is to compare the impact of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on human health outcomes in healthy sedentary subjects, over 12 weeks of exercise training. The investigators will compare several health parameters, such as changes in multiomics profile, cardiorespiratory fitness, muscle strength, and body composition, before and after 12-week interventions of either HIIT or MICT.

Interaction Between Inorganic Nitrate Supplementation and Metformin in Individuals With Prediabetes

This study is examining whether short-term supplementation with inorganic nitrate, in the form of beetroot juice, can enhance blood vessel health, insulin sensitivity, and exercise capacity in individuals with prediabetes. We will be comparing the responses in individuals who are taking metformin to those who are naive to metformin. The results from this study may help identify non-pharmacological interventions in prediabetes.

Mediterranean-DASH Intervention for Neurodegenerative Delay and High-Intensity Interval Training in Adults With Hypertension

This pilot study examines whether a 4-week diet and exercise intervention can improve blood pressure, heart health, and sleep in physically inactive individuals with high blood pressure and overweight or obesity.

The Effects of Vitamin C on Acute-Exercise in Postmenopausal Females

This study is looking at whether vitamin C can help improve oxidative stress and blood vessel health in females after menopause. We will see if taking different amounts of vitamin C for a few days changes how the body handles stress from exercise. This could lead to safer ways to protect females from heart disease without using hormone therapy.

Effects of Inspiratory Muscle Fatigue and Warm-up on Respiratory Variables, Handgrip Strength, and Walking Capacity in Sedentary Older Adults

Respiratory muscle training represents an effective method increasingly utilized in both sports and healthcare domains, employing various devices, among which threshold devices are prominent. The aim of this study is to determine the relationship between inspiratory muscle fatigue or warm-up and muscular strength in upper and lower limbs, in sedentary older adults, as well as the association between such fatigue and other variables, including maximal inspiratory pressure, diaphragmatic ultrasonography, functionality and handgrip strength. According to our hypothesis, the execution of a protocol inducing inspiratory muscle fatigue or activation in sedentary older adults could influence muscular strength, respiratory function and exercise capacity. In this study, subjects will be divided into three groups: the fatigue group , the activation group and the control group. Measurements of variables, such as maximal inspiratory pressure, diaphragmatic strength (ultrasound image) and functional capacity, will be conducted.

Acute Effects of Intermittent Hypoxia-Hyperoxia in Older Adults

The supply of oxygen is essential for energy production, recovery from efforts, and human life. Intermittent Hypoxia-Hyperoxia Exposure (IHHE) is a novel technique in which the subject is exposed to a respiratory environment with reduced oxygen fraction, controlled through a specific software, using a facial mask and a hypoxic generation device. The objective of this study is to determine if there is a relationship between intermittent hypoxia-hyperoxia exposure and cardiorespiratory condition, blood pressure, and arterial oxygen saturation. According to our hypothesis, acute IHHE in elderly adults may influence cardiorespiratory condition, blood pressure, and arterial oxygen saturation. The study will be conducted as a randomized clinical trial. The subjects will be divided into two groups: the experimental group will undergo an IHHE session, breathing air with an oxygen concentration (FiO2) ranging from 10-14% for 1-5 minutes, with 1-3 minutes of rest in hyperoxia (FiO2 30-40%) for a total of 4-8 cycles, based on their acute response to hypoxia. The placebo group will undergo a 5-cycle protocol with an FiO2 of 21%.