A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden

Figures & data

Table 1. Educational and practical components of the lifestyle intervention.

Educational components of the lifestyle intervention
Meetings every other week for 20 weeks (sessions 1–10) and 8 follow-up meetings once a month (exercise and diet recommendations every session)
Health education for 20 weeks	Health discussions for the whole 52-week intervention (exercise and diet recommendations every session)
The ADHD diagnosis (guest lecture)	Group discussion on the strengths and weaknesses of individuals with ADHD and the advantages of ADHD
Physical exercise recommendations (guest lecture)	Group discussion on how to be physically active
Diet recommendations	Group discussion on how to achieve a healthy diet; diet recommendations from the social board, for example, carbohydrates, protein, vitamins, fats, different diets
Physical health and how to handle and prevent symptoms of physical illness	Group discussion on how and what should be included in physical health and how to be healthy, as well as on comorbidity and treatments (asthma, stomach disorders, pain)
Mental health and how to handle and prevent symptoms of mental illness (guest lecture on burnout)	Group discussion on what should be included in mental health and how to stay healthy as well as on psychiatric comorbidity (depression, anxiety, autism, suicide) and how manage symptoms, for example, breathing techniques, relaxing exercises
Cognitive impairments and how to cope with them	Group discussion on cognitive impairments and how to manage them, for example, schedules, reminders
Lifestyle disorders and how to prevent them	Group discussion on sleep problems, stress, metabolic syndrome, type 2 diabetes, and risky living habits, such as use of alcohol/drugs, smoking, and sedentary behaviour
Working life and sick leave; financial support (guest lecture)	Group discussion on support and how adapt, tips, information and strategies
Social relationships	Group discussion on how to support social relationships, loneliness and structure and strategies in everyday life
Risky living habits, such as use of alcohol/drugs and smoking	Group discussion on how to handle risky living habits and about sexual life
Practical components of the lifestyle intervention
Practical exercises	Activities
Different relaxation techniques tested during the group meetings	Training for each participant in relaxation and strategies for everyday life
Tactile massage	Tactile massage including hand and back massage
Physical exercises (walking, gymnastic exercises, gym, yoga, swimming)	Taking part in physical exercises with the purpose of doing activities together and alone and finding something useful for each individual; exercises were done with the group leaders
Individual lifestyle habit changes between the meetings	Working on individual goals for lifestyle habits changes supported by the group leaders.
Relationships	Eating dinner/lunch together
Information booklets	A summary of health education content
Activity diaries	Records of lifestyle habit changes as well as nursing prescriptions and follow up
Pedometers	Used to measure how many steps participants took in a day and as a motivational tool
Individual nursing prescriptions	Individual nursing prescriptions according to the lifestyle habit goals to achieve before the next meeting
Individual support for healthy lifestyle habit changes between meetings	Individual support from group leaders; cognitive support with schedules, phone calls, reminders, etc.; Motivational interviewing techniques for behaviour and strategies to develop individual capability for lifestyle habits changes.
Group education	Group support for lifestyle changes and follow up of individual nursing prescriptions

Follow-ups meetings (8) included the three main components interpersonal relationships, health education and cognitive support. The health education was adapted to the groups wishes and was focused on: vitamin D, sexual relationship, healthy cooking, working life, suicide, medications, mental health and living with ADHD in daily life.

Table 2. Demographics, socioeconomic and clinical data of participants from baseline (T1), after 20 weeks (T2) and post-intervention after 52 weeks (T3).

Demographic characteristic	T1 (n = 48)	T2 (n = 35)	T3 (n = 25)	p-Value
Age, Mean SD (years of age)	36 (11)	37 (11)	35 (11)	1.000
Sex (female/male, n [%])	29 (60)/19 (40)	21 (60)/14 (40)	14 (58)/10 (42)	0.881
Civil status (n [%])
Cohabiting/married	22 (46)	14 (40)	11 (44)
Single	26 (54)	21 (60)	14 (56)
Socioeconomic characteristic
Education (n [%])				0.881
University	13 (27)	12 (34)	7 (28)
High school	28 (58)	19 (54)	14 (56)
Elementary school	7 (15)	4 (12)	4 (16)
Employment (n [%])				0.939
Work (100%)	11 (23)	9 (26)	5 (20)
Work (75%)	6 (13)	4 (11)	4 (16)
Work (50%)	5 (10)	3 (9)	4 (16)
Sick leave (100%)	14 (29)	7 (20)	6 (24)
Unemployed/studying	12 (25)	12 (34)	6 (24)
Clinical characteristic
Years with ADHD (n [%])			14 (56)	0.204
1–5 years	20 (42)	16 (46)	4 (16)
6–10 years	13 (27)	6 (17)	0 (0)
>10 years	3 (6)	3 (9)	7 (28)
No answer	12 (25)	10 (29)
Pharmacological treatment (n [%])				0.371
In treatment	41 (85)	25 (71)	18 (72)
No treatment	7 (15)	10 (29)	7 (28)
Body Mass Index (BMI) (n [%])				0.747
Normal weight (BMI 18.5–24.9)	15 (31)	11 (31)	10 (40)
Pre-obesity (BMI 25.0–29.9)	15 (31)	9 (26)	4 (16)
Obesity class I, II, III (BMI > 30)	18 (38)	15 (43)	11 (44)
Waist circumference				0.070
>102 (men)/>88 (women)	20 (42)	16 (46)	9 (36)
<102 (men)/<88 (women)	28 (58)	18 (51)	14 (56)

Internal losses: waist circumference 2 in (T3).

Table 3. Results of lifestyle habits measures from baseline (T1), after 20 weeks (T2) and post-intervention after 52 weeks (T3), n = 25.

Lifestyle-Performance-Health Questionnaire (LIV)	T1	T2	T3	p-Value
Sedentary habits (n [%])	n = 24	n = 24	n = 25	0.531
All time	4 (16)	2 (8)	2 (8)
3/4 of time	6 (24)	10 (40)	10 (40)
1/2 of time	10 (40)	9 (36)	10 (40)
1/4 of time	3 (12)	2 (8)	2 (8)
No time	1 (4)	1 (4)	1 (4)
Weekly physical activity (n [%])	n = 24	n = 24	n = 25
0 min	11 (44)	0 (0)	0 (0)	0.014^2
<30 min	2 (8)	2 (8)	2 (8)
30-60 min	4 (16)	4 (16)	4 (16)
60-90 min	4 (16)	6 (24)	1 (4)
90-120 min	1 (4)	2 (8)	3 (12)
>120 min	2 (8)	10 (40)	15 (60)
Tobacco use (n [%])	n = 25	n = 25	n = 25
Smoking	8 (32)	7 (28)	8 (32)	0.368
No smoking	17 (68)	18 (72)	17 (68)
Snuff	10 (40)	10 (40)	9 (36)	0.651
No snuff	15 (60)	15 (60)	16 (64)
Eating habits (n [%])
Fruit daily	6 (24)	9 (36)	9 (36)	0.091
No fruit daily	19 (76)	16 (64)	16 (64)
Vegetables	5 (20)	7 (28)	8 (32)	0.500
No vegetables	15 (60)	14 (56)	13(52)

Notes. p ≤ 0.05, Placement of significance are presented as following: ¹difference between T1 and T2, ²T1–T3, and ³T2–T3.

Internal losses: ADHD participants missing value for sedentary behaviour 1 missing, weekly physical activity 1 missing, vegetables missing values 5; 4; 4.

Table 4. Results of health and wellbeing measures from baseline (T1) to after 20 weeks (T2) and post-intervention after 52 weeks (T3).

	T1	T2	T3	p-Value
ASRS, Adult ADHD Self-Report Scale (median, range)
Inattention	25.5 (20)	24.5 (32)	25 (32)	0.326
Hyperactivity-impulsivity	18 (14)	18(12)	17(15)	0.916
AAQoL, Self-reported quality of life scale (median, range)
Quality of life, total points	44 (80)	45 (61)	46 (58)	0.568
Life productivity	41 (66)	41 (80)	51 (82)	0.001^2
Psychological health	44 (71)	42 (75)	46 (75)	0.542
Life outlook	39 (61)	39 (57)	36 (54)	0.827
Relationships	58 (70)	60 (75)	42 (85)	0.046^3
Lifestyle-Performance-Health Questionnaire
General health (n [%])				0.025^1
Good	3 (12)	7 (28)	7 (28)
In-between	11 (44)	9 (36)	11 (44)
Bad	11 (44)	8 (32)	5 (20)
Physical health (n [%])				0.148
Good	11 (44)	10 (40)	15 (60)
Bad	14 (56)	14 (56)	10 (40)
Mental health (n [%])				0.368
Good general mental health	16 (60)	14 (56)	13 (52)
Bad general mental health	9 (40)	10 (40)	12 (48)
HADS, Hospital Anxiety and Depression Scale (median, Range)
Anxiety	12 (18)	13 (15)	12(18)	0.985
Depressive symptoms	10 (14)	8 (18)	8 (14)	0.014^2
Lifestyle-Performance-Health Questionnaire
Sleep problems (n [%])				0.664
Sleep problems	7 (28)	10 (40)	10 (40)
No sleep problems	17 (68)	14 (56)	14 (56)
Fatigue (median, range)				0.220
Fatigue (index, 5–20)	14 (14)	12 (14)	12 (11)
VO2 max, Aerobic fitness VO2 Max Test				0.740
Physical fitness (VO2max mL/kg min) (mean, sd)	37 (10)	39 (8)	39 (9)

Notes. p ≤ 0.05. Placement of significance are presented as following: ¹difference between T1 and T2, ²T1–T3, and ³T2–T3.

Internal losses: ADHD participants missing value for quality of life ‒ 2 missing, general health ‒ 2 missing, physical health ‒ 1 missing, sleep problems ‒ 1 missing, V02max ‒ 1 missing, ARS ‒ 2 missing, mental health ‒ 1 missing, HADS ‒ 3 missing.

Figure 1. Flowchart of the lifestyle intervention.