Adherence-related factors associated with weight reduction: clinical outcomes of telerehabilitation in patients with metabolic syndrome
5 affiliations
- 1Department of Preventive Medicine, Albert Szent-Györgyi Medical School, University of Szeged
- 2Department of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged
- 3Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged
- 4Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged
- 5Medical Informatics Research and Development Centre, University of Pannonia
Abstract
Background: Metabolic syndrome (MetS) is a major contributor to cardiovascular morbidity, yet our healthcare system is underdeveloped in terms of effective lifestyle interventions. Telemedicine-based programs may offer a scalable option, but evidence on their effectiveness in MetS populations is limited.
Objective: To evaluate a combined telemedicine-supported lifestyle program compared to non-randomized controls in adults with MetS and identify adherence-related factors associated with weight loss.
Methods: In this prospective, non-randomized controlled intervention study (2021–2023, Hungary), 133 adults with MetS were enrolled and 111 completed a 90-day lifestyle program. All participants received an initial dietetic consultation; the intervention group additionally used smartphone-based dietary logging, remote exercise monitoring, and biweekly teleconsultations with dietitians and physiotherapists. Primary outcome was waist circumference at the standardized day-90 follow-up; secondary outcomes included body weight, body composition, exercise capacity, metabolic parameters, and adherence indicators. Outcomes were analyzed by baseline-, age-, and sex-adjusted ANCOVA with HC3-robust standard errors; the primary model included a group-by-baseline waist circumference interaction, and exploratory adherence analyses assessed linear trends across ordered weight-loss subgroups.
Results: A significant group-by-baseline waist circumference interaction was observed ( p = 0.029), with a greater adjusted intervention–control difference at higher baseline waist circumference. The intervention group also showed descriptive reductions in body weight (–5.23 ± 5.16 kg), BMI, skinfold thicknesses, body fat mass, and visceral fat. HbA1c declined by 0.41 ± 0.60 percentage points ( p < 0.001), and HDL-cholesterol increased significantly, while other laboratory parameters changed modestly. After Benjamini–Hochberg adjustment within the respective outcome families, the adjusted between-group differences in abdominal circumference, HbA1c, and skeletal muscle mass remained statistically significant. Exploratory adherence analyses showed significant trends toward more frequent body-weight logging and lower relative energy intake with greater weight loss, but not for the other adherence measures.
Conclusions: A telemedical lifestyle program was associated with favorable short-term changes in abdominal obesity, body composition, and metabolic control in adults with MetS, although skeletal muscle mass loss was also observed. Regular self-weighing and maintaining a lower relative energy intake were associated with greater weight loss. Telemedicine-supported lifestyle management may represent a promising approach for MetS care.
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BibTeX
@article{abraham2026adherencerelated,
title = {{Adherence-related factors associated with weight reduction: clinical outcomes of telerehabilitation in patients with metabolic syndrome}},
author = {Judit Erzsébet Ábrahám and Anna Vágvölgyi and Éva Máthéné Köteles and Andrea Korom and Mária Barnai and Mónika Szűcs and Brigitta Szálka and András Király and István Vassányi and Attila Nemes and Tamás Várkonyi and Csaba Lengyel and István Kósa},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1804026},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1804026/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adherence-related factors associated with weight reduction: clinical outcomes of telerehabilitation in patients with metabolic syndrome
AU - Judit Erzsébet Ábrahám
AU - Anna Vágvölgyi
AU - Éva Máthéné Köteles
AU - Andrea Korom
AU - Mária Barnai
AU - Mónika Szűcs
AU - Brigitta Szálka
AU - András Király
AU - István Vassányi
AU - Attila Nemes
AU - Tamás Várkonyi
AU - Csaba Lengyel
AU - István Kósa
PY - 2026
DA - 2026/10/26
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1804026
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1804026/full
AB - Background: Metabolic syndrome (MetS) is a major contributor to cardiovascular morbidity, yet our healthcare system is underdeveloped in terms of effective lifestyle interventions. Telemedicine-based programs may offer a scalable option, but evidence on their effectiveness in MetS populations is limited. Objective: To evaluate a combined telemedicine-supported lifestyle program compared to non-randomized controls in adults with MetS and identify adherence-related factors associated with weight loss. Methods: In this prospective, non-randomized controlled intervention study (2021–2023, Hungary), 133 adults with MetS were enrolled and 111 completed a 90-day lifestyle program. All participants received an initial dietetic consultation; the intervention group additionally used smartphone-based dietary logging, remote exercise monitoring, and biweekly teleconsultations with dietitians and physiotherapists. Primary outcome was waist circumference at the standardized day-90 follow-up; secondary outcomes included body weight, body composition, exercise capacity, metabolic parameters, and adherence indicators. Outcomes were analyzed by baseline-, age-, and sex-adjusted ANCOVA with HC3-robust standard errors; the primary model included a group-by-baseline waist circumference interaction, and exploratory adherence analyses assessed linear trends across ordered weight-loss subgroups. Results: A significant group-by-baseline waist circumference interaction was observed ( p = 0.029), with a greater adjusted intervention–control difference at higher baseline waist circumference. The intervention group also showed descriptive reductions in body weight (–5.23 ± 5.16 kg), BMI, skinfold thicknesses, body fat mass, and visceral fat. HbA1c declined by 0.41 ± 0.60 percentage points ( p < 0.001), and HDL-cholesterol increased significantly, while other laboratory parameters changed modestly. After Benjamini–Hochberg adjustment within the respective outcome families, the adjusted between-group differences in abdominal circumference, HbA1c, and skeletal muscle mass remained statistically significant. Exploratory adherence analyses showed significant trends toward more frequent body-weight logging and lower relative energy intake with greater weight loss, but not for the other adherence measures. Conclusions: A telemedical lifestyle program was associated with favorable short-term changes in abdominal obesity, body composition, and metabolic control in adults with MetS, although skeletal muscle mass loss was also observed. Regular self-weighing and maintaining a lower relative energy intake were associated with greater weight loss. Telemedicine-supported lifestyle management may represent a promising approach for MetS care.
SN - 2297-055X
ER -