Lifestyle changes guidance
Regarding lifestyle interventions, participants received 90-minute sessions at the workplace, combining nutritional and physical activity guidance from a multidisciplinary team, including physicians, clinical dietitians, and fitness instructors. All lifestyle educational programs were provided at the same intensity to all three groups, These sessions occurred weekly during the first month, monthly over the next five months, and every other month until the 18th month. Simultaneously, the exercise program involved a gradual increase in aerobic training, starting at 20 minutes and 65% of the maximum heart rate, progressing to 45-60 minutes at 80% of the maximum heart rate, performed 3-4 times per week. Resistance training began with a single set of weights at 60% of the maximum weight and eventually advanced to two sets at 80% of the maximum weight. These resistance exercises included leg extensions, leg curls, squats, lateral pull-downs, push-ups, shoulder presses, elbow flexions, triceps extensions, and bent leg sit-ups. These adjustments aimed to enhance both aerobic and strength components of the workout program. To maintain motivation, participants received timely text messages with relevant information based on their intervention group, and a website provided access to specific nutritional and physical activity information for each assigned intervention group.