Table 3.

Intervention details.

Author and year	Study purposes	Study design	Sample characteristics	Interventions	Primary outcomes	Secondary outcomes	Assessment time	Main findings
Berger et al. (2018)	1) To investigate if AL is higher in patients with SCZ and FEP and associated with clinical relevant outcomes; 2) To examine the temporal dynamics of AL in response to treatment with second-generation anti-psychotics.	Longitudinal study design	28 patients with SCZ (32% female, average age of 40 yrs), 28 patients with FEP (46% female, average age of 33 yrs), and 53 HC (32% female, average age of 36 yrs).	One of the second-generation antipsychotics (risperidone, olanzapine and quetiapine) were given to patients after baseline assessment.	AL	NA	Baseline and 6 and 12 weeks	Adjusting for age, sex and smoking, positive SCZ symptoms were positively correlated with AL (adjusted R = 0.510 (95%CI 0.247–0.715), p < .001). Psychosocial functioning was negatively correlated with AL (adjusted R = −0.224 (95% CI −0.441–0.016), p = .103). In patients with SCZ or and FEP, AL decreased significantly after treatment (between baseline and 6 and 12-week follow-up assessments; p < .001).
Carroll et al. (2015)	To compare the efficacy of CBT, TCC, and SS controls to improve sleep quality and reduce AL in older adults with insomnia.	Secondary analysis of data from a Randomized controlled comparative efficacy trial	47 older adults with insomnia in CBT (79% female, average age of 65 yrs, 87% White), 39 in TCC (64% female, average age of 67 yrs, 84% White), and 23 SS controls (70% female, average age of 66 yrs, 86% White).	CBT taught behavioral strategies to improve mood and cognitive activity, TCC taught slow-paced movements designed to control physical function and arousal, and SS taught sleep hygiene and factors contributing to sleep issues. All groups received 120-minutes classes each week for 4 months.	Sleep quality measure by the PSQI	AL	Baseline, after intervention at 4-months, 1 year after intervention completion, and at 16-months.	Both TCC (p = .04) and CBT (p = .001) had significantly lower AL scores than SS at 16-months. CBT reduced risk of being in the high risk AL group at 4-months (odds ratio [OR] = .21 [95% CI, .03—1.47], p < .10) and at 16-months (OR = .06 [95% CI, .005—.669]; p<.01). TCC reduced the risk at 16-months (OR = .10 [95% CI, .008—1.29]; p<.05) but not at 4 months. For participants with high risk AL scores at baseline, sleep quality improvements decreased the likelihood of being in the high risk group at 16-months, OR = .08 (95% CI, .008—.78); p = .01.
McClain et al. (2018)	To test the longitudinal effect of FI on AL and to examine the moderation by SNAP participation.	Secondary analysis of data from a longitudinal cohort study	733 Puerto Rican adults: aged 45 to 75 yrs, 71% female	Federal program that provides nutrition benefits to low-income individuals and families were used to purchase food for the household. EBT cards were distributed to participants to purchase food at stores.	AL	NA	Baseline, 2 years, and 5 years.	Adjusting for covariates, FI was not associated with AL (OR = 1.07 [0.70–1.64]). However, AL was associated with high neuroendocrine/inflammation scores (1.71 [1.25–2.36]), but not metabolic/cardiovascular scores (0.82 [0.48–1.40]). SNAP participation moderated the relationship between FI and neuroendocrine/ inflammation scores (p = .06). FI participants who had never received SNAP had higher neuroendocrine/inflammation scores than food-secure participants not in SNAP or FI participants in SNAP.
Nuño et al. (2019)	To examine the efficacy of osteopathic manipulative treatment (OMT) on graduate student’s overall health through an objective index of representative AL biomarkers	Within-Subject Study design	One man (age 22 years) and one woman (age 23). Both participants were enrolled in a Masters of Science in Medical Health Sciences program at Touro University California College of Osteopathic Medicine (TUCOM).	The intervention involved four visits scheduled every 2–4 weeks. Baseline data collection included perceived stress, blood pressure, blood and urine samples and anthropometric measures. Participants then received the OMT following the ABC protocol (autonomics, biomechanics, circulation, screening) for 30 minutes. The OMT was repeated at each of the four visits.	AL and Perceived stress via the Trier Inventory for Chronic Stress (TICS)	N/A	Baseline and at the end of the intervention after 7 weeks	AL score decreased from 7 to 4 for the male participant, and from 9 to 7 for the female participant. TICS scores lowered after 7 weeks from 18 to 15 for the male participant and from 40 to 13 for the female participant.
Soltani et al. (2018)	To examine the effects of a DGA-based diet on chronic stress load.	Secondary analysis of data from a double-blind RCT	Obese women, ages 20–64; 22 in DGA and 22 in TAD	Over 8 weeks, both TAD and DGA received daily food delivery with meal checklist with foods to document amount and time consumed; and confirm that no other foods or medications were consumed. They were also instructed on managing social situations and the value of honesty over perfection.	AL; perceived stress measured by the PSS-10	NA	Baseline and at the end of intervention at 8 weeks.	Perceived stress did not differ after 8 weeks between the diet groups (p = 0.45), and neither did AL (p = 0.79). There were inverse associations between change in stress and diet quality (lower sodium and higher vegetable consumption). Increased sodium consumption was significantly associated with decreased AL across after 8 weeks (ß = −0.21 ± 0.07; p = 0.007). Increased vegetable consumption was significantly associated with a decreased perceived stress after 8 weeks in both diet groups (ß = −1.45 ± 0.66; p = 0.034). As HEI (healthy eating index) increased, AL decreased.
Ye et al. (2017)	To test the effects of the BRBC on resilience, QoL, emotional and physical distress (AL), and longevity among women with MBC.	RCT	226 women with MBC, aged ≥ 40 yrs; 113 in BRBC and 113 controls. No significant demographic differences between groups except for income (P > 0.0254).	Over 12 months, weekly 120-minute face-to-face group sessions, including 45 minutes of education on breast cancer topics and 45–75 minutes of group discussion. Discussion time began with mentors sharing their experiences and continued with participant discussions regarding life changes since diagnosis.	3- and 5-year cancer-specific survival	anxiety and depression measured by HADS, QoL measured by QLQ-C30, resilience measured by CD-RISC-10, and AL	Survival data were collected every 1–2 months till the end of the study. Secondary outcomes were only collected at baseline, 2 months, 6 months, and 12 months.	At baseline, the two groups did not show any significant difference in AL (P = 0.1817). After 2 months, AL had improved, but the ES was not significant (ES = 0.45, P = 0.1345). After 12 months, the effect size increased significantly (from 0.75 to 0.90).

Note. AL: allostatic load; SCZ: schizophrenia; FEP: first-episode psychosis; HC: healthy controls; NA: not applicable/not available; CBT: cognitive behavioral therapy; TCC: tai chi chih, SS: sleep seminar; PSQI: Pittsburgh Sleep Quality Index; FI: food insecurity; SNAP: Supplemental Nutrition Assistance Program; EBT: Electronic Benefit Transfer; DGA: Dietary Guidelines for Americans; TAD: Typical American Diet; RCT: randomized controlled trial; PSS-10 : Perceived Stress Scale-10; BRBC: Be Resilient to Breast Cancer; QoL: quality of life; MBC: metastatic breast cancer; HADS: Hospital Anxiety and Depression Scale; CD-RISC-10 : Conner-Davison Resilience Scale.