Why Consider Separate Adherence Domains? Data From a 12‐Week Workplace Lifestyle Program in Taiwan: A Single‐Arm Real‐World Cohort Study
Hao Hsu, Wenling Hsu, Wan‐Ming Chen, Chun‐Sheng Ho, Yi‐Chiun Yang, Szu‐Yuan WuABSTRACT
Background
Workplace lifestyle programs are increasingly used for early cardiovascular–kidney–metabolic prevention but are commonly evaluated as whole packages. Whether distinct adherence domains within a multimodal program are associated with different short‐term health responses remains unclear.
Methods
We conducted a single‐arm, retrospective, real‐world cohort study of the Enhancing Lifestyles and Nutritional Domains Intervention Activation (ELANDIA) 12‐Week Life Challenge in a hospital‐based community in Taiwan. Adults with complete paired baseline and 12‐week assessments were included. The intervention integrated five lifestyle pillars: healthy diet, physical activity, stress management, restorative sleep, and social connection. Adherence was quantified as 8000‐step goal adherence, curriculum participation, and daily task completion. Primary outcomes were body weight, lifestyle medicine assessment (LMA) total score, and hospital anxiety and depression scale (HADS) total score. Adjusted within‐participant changes were estimated using linear mixed‐effects models; time‐by‐adherence interactions explored adherence‐domain differentiation.
Findings
Among 151 participants, mean age was 38.93 years (standard deviation [SD] 8.54), 25 (16.6%) were male, and 103 (68.2%) were hospital employees. At 12 weeks, body weight decreased by 3.51 kg (95% confidence interval [CI] −4.06 to −2.95), body mass index (BMI) by 1.34 kg/m 2 (−1.53 to −1.15), and waist circumference by 3.42 cm (−3.94 to −2.90). LMA total score increased by 6.83 points (5.71–7.96), and HADS total score decreased by 4.59 points (−5.33 to −3.85; all p < 0.001). Exploratory analyses showed that step‐goal adherence was associated with changes in seven of eight adiposity outcomes, whereas curriculum participation and task completion were selectively associated with diastolic blood pressure reduction and LMA improvement.
Interpretation
In this hospital‐based workplace cohort, multiple outcomes improved during the 12‐week program, with exploratory differences across adherence domains. High‐resolution adherence tracking may identify candidate engagement patterns for prospective evaluation. Controlled studies with longer follow‐up are needed to assess durability and causal effects.