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Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care.

Ismail, K; Bayley, A; Twist, K; Stewart, K; Ridge, K; Britneff, E; Greenough, A; Ashworth, M; Rundle, J; Cook, DG; et al. Ismail, K; Bayley, A; Twist, K; Stewart, K; Ridge, K; Britneff, E; Greenough, A; Ashworth, M; Rundle, J; Cook, DG; Whincup, P; Treasure, J; McCrone, P; Winkley, K; Stahl, D (2020) Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care. Heart, 106 (6). pp. 447-454. ISSN 1468-201X https://doi.org/10.1136/heartjnl-2019-315656
SGUL Authors: Whincup, Peter Hynes

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Abstract

OBJECTIVE: The epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD. METHODS: A three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40-74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention. RESULTS: At 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI -288.00 to 147.90 and mean difference=7.24 steps, 95% CI -224.01 to 238.50, respectively), reducing weight (mean difference=-0.03 kg, 95% CI -0.49 to 0.44 and mean difference=-0.42 kg, 95% CI -0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds. CONCLUSIONS: Enhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.

Item Type: Article
Additional Information: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: behaviour change techniques, cardiovascular disease, lifestyle intervention, motivational interviewing, physical activity, primary care, weight loss, Cardiovascular System & Hematology, 1102 Cardiorespiratory Medicine and Haematology
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Heart
ISSN: 1468-201X
Language: eng
Dates:
DateEvent
25 February 2020Published
12 December 2019Published Online
25 October 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
10/62/03National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 31831574
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111527
Publisher's version: https://doi.org/10.1136/heartjnl-2019-315656

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