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

TY - JOUR

T1 - Reducing weight and increasing physical activity in people at high risk of cardiovascular disease

T2 - A randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care

AU - Ismail, Khalida

AU - Bayley, Adam

AU - Twist, Katherine

AU - Stewart, Kurtis

AU - Ridge, Katie

AU - Britneff, Emma

AU - Greenough, Anne

AU - Ashworth, Mark

AU - Rundle, Jennifer

AU - Cook, Derek G.

AU - Whincup, Peter

AU - Treasure, Janet

AU - McCrone, Paul

AU - Winkley, Kirsty

AU - Stahl, Daniel

PY - 2019/12/12

Y1 - 2019/12/12

N2 - 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.

AB - 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.

KW - behaviour change techniques

KW - cardiovascular disease

KW - lifestyle intervention

KW - motivational interviewing

KW - physical activity

KW - primary care

KW - weight loss

UR - http://www.scopus.com/inward/record.url?scp=85076601701&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2019-315656

DO - 10.1136/heartjnl-2019-315656

M3 - Article

C2 - 31831574

AN - SCOPUS:85076601701

SN - 1355-6037

JO - Heart

JF - Heart

M1 - 315656

ER -