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Using clinical prediction models to personalise lifestyle interventions for cardiovascular disease prevention: A systematic literature review. Prev Med Rep 2022; 25:101672. [PMID: 35127352 PMCID: PMC8800044 DOI: 10.1016/j.pmedr.2021.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/23/2022] Open
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Jorvand R, Ghofranipour F, HaeriMehrizi A, Tavousi M. Evaluating the impact of HBM-based education on exercise among health care workers: the usage of mobile applications in Iran. BMC Public Health 2020; 20:546. [PMID: 32321484 PMCID: PMC7178600 DOI: 10.1186/s12889-020-08668-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mechanical life made us witness the growing increase of chronic diseases despite the prominent scientific developments in the field of health, treatment and control. The aim of this study was to evaluate the impact of educational intervention based on Health Belief Model (HBM) using mobile applications (Telegram messenger) on doing exercise among the health care workers of Ilam university of medical sciences in 2017. METHODS In this interventional study, 114 people working in Ilam University of medical sciences participated in two groups of intervention and control (employed at two different cities) after providing the informed consent form. HBM-ISCS questionnaire was used to collect the required data and its reliability was approved using Cronbach's alpha. Descriptive statistics, chi square, t test, repeated measures ANOVA (RMANOVA) and structural equation model (SEM) were used. RESULTS Half of the participants were men, 58.77% of them were undergraduate. The mean and SD of their age was 37.61 ± 4.88 years. Based on the results of the repeated measures analysis of variance test (before and after the intervention) in the intervention group, there were significant difference in all of the HBM constructs (perceived barriers was excepted), daily and weekly exercises, blood biochemical markers of the participants (P > 0.05). The above changes were not significant in the control group (P ≥ 0.05). CONCLUSION Exercise is closely related to the beliefs of people, so implementing educational interventions based on Telegram messenger with emphasis on health beliefs and using HBM can lead to have exercise. Therefore, this application can be a suitable tool to deliver trainings, especially when holding in-person classes is difficult.
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Affiliation(s)
- Reza Jorvand
- grid.411528.b0000 0004 0611 9352Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Fazlollah Ghofranipour
- grid.412266.50000 0001 1781 3962Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - AliAsghar HaeriMehrizi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Mahmoud Tavousi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Alageel S, Gulliford MC, McDermott L, Wright AJ. Multiple health behaviour change interventions for primary prevention of cardiovascular disease in primary care: systematic review and meta-analysis. BMJ Open 2017; 7:e015375. [PMID: 28619779 PMCID: PMC5734412 DOI: 10.1136/bmjopen-2016-015375] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness. METHODS The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects. RESULTS We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was -1.86 (95% CI -3.17 to -0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), -1.53 (-2.43 to -0.62; p=0.001) mm Hg; body mass index (14 trials), -0.13 (-0.26 to -0.01; p=0.04) kg/m2; serum total cholesterol (14 trials), -0.13 (-0.19 to -0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes. CONCLUSIONS MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions' rationale, content and delivery is essential to understanding their effectiveness.
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Affiliation(s)
- Samah Alageel
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
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O'Brien N, McDonald S, Araújo-Soares V, Lara J, Errington L, Godfrey A, Meyer TD, Rochester L, Mathers JC, White M, Sniehotta FF. The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55-70 years: a systematic review and meta-analysis. Health Psychol Rev 2015; 9:417-33. [PMID: 25689096 DOI: 10.1080/17437199.2015.1012177] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Content, delivery and effects of physical activity (PA) interventions are heterogeneous. There is a need to identify intervention features (content and delivery) related to long-term effectiveness. Behaviour change techniques (BCTs) and modes of intervention delivery were coded in 19 randomised controlled trials included in a systematic review of PA interventions for adults aged 55-70 years, published between 2000 and 2010, with PA outcomes ≥ 12 months after randomisation; protocol registration: PROSPERO CRD42011001459. Meta-analysis, moderator analyses and meta-regression were conducted. Meta-analysis revealed that interventions were effective in promoting PA compared with no/minimal intervention comparators [d = 0.29, 95% CI = 0.19-0.40, I(2) = 79.8%, Q-value = 89.16 (df = 18, p < 0.01)]. Intervention features often concurred and goal setting was the most commonly used BCT. Subgroup analyses suggested that interventions using the BCT feedback may be more effective, whilst interventions using printed materials or the BCTs information on where and when to perform the behaviour and information on consequences of behaviour to the individual may be less effective. Meta-regression revealed that neither the number of BCTs nor self-regulatory BCTs significantly related to effect size. Feedback appears to be a potentially effective candidate BCT for future interventions promoting long-term PA. Considering concurrence of intervention features alongside moderator analyses is important.
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Affiliation(s)
- Nicola O'Brien
- a Institute of Health & Society, Newcastle University , Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX , UK
| | - Suzanne McDonald
- a Institute of Health & Society, Newcastle University , Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX , UK
| | - Vera Araújo-Soares
- a Institute of Health & Society, Newcastle University , Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX , UK
| | - Jose Lara
- b Human Nutrition Research Centre, Institute for Ageing and Health , Newcastle University , Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL , UK
| | - Linda Errington
- c Walton Library , Newcastle University , Newcastle upon Tyne NE2 4HH , UK
| | - Alan Godfrey
- d Clinical Ageing Research Unit , Newcastle University , Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL , UK
| | - Thomas D Meyer
- e Department of Psychiatry and Behavioral Sciences , University of Texas at Houston , 1941 East Road, BBSB 3118, Houston , TX 77054 , USA
| | - Lynn Rochester
- d Clinical Ageing Research Unit , Newcastle University , Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL , UK
| | - John C Mathers
- b Human Nutrition Research Centre, Institute for Ageing and Health , Newcastle University , Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL , UK
| | - Martin White
- f Fuse, UKCRC Centre for Translational Research in Public Health , Institute of Health & Society, Newcastle University , Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX , UK
| | - Falko F Sniehotta
- f Fuse, UKCRC Centre for Translational Research in Public Health , Institute of Health & Society, Newcastle University , Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX , UK
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Hobbs N, Godfrey A, Lara J, Errington L, Meyer TD, Rochester L, White M, Mathers JC, Sniehotta FF. Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med 2013; 11:75. [PMID: 23506544 PMCID: PMC3681560 DOI: 10.1186/1741-7015-11-75] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/19/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Retirement represents a major transitional life stage in middle to older age. Changes in physical activity typically accompany this transition, which has significant consequences for health and well-being. The aim of this systematic review was to evaluate the evidence for the effect of interventions to promote physical activity in adults aged 55 to 70 years, focusing on studies that reported long-term effectiveness. This systematic review adheres to a registered protocol (PROSPERO CRD42011001459). METHODS Randomized controlled trials of interventions to promote physical activity behavior with a mean/median sample age of 55 to 70 years, published between 2000 and 2010, were identified. Only trials reporting the long-term effect (≥ 12 months) on objective or self-reported physical activity behavior were included. Trials reporting physiological proxy measures of physical activity were excluded. Meta-analyses were conducted when trials provided sufficient data and sensitivity analyses were conducted to identify potential confounding effects of trials of poor methodological quality or with attrition rates ≥ 30%. RESULTS Of 17,859 publications identified, 32 were included which reported on 21 individual trials. The majority of interventions were multimodal and provided physical activity and lifestyle counselling. Interventions to promote physical activity were effective at 12 months (standardized mean difference (SMD) = 1.08, 95% confidence interval (CI) = 0.16 to 1.99, pedometer step-count, approximating to an increase of 2,197 steps per day; SMD = 0.19, 95% CI = 0.10 to 0.28, self-reported physical activity duration outcome), but not at 24 months based on a small subset of trials. There was no evidence for a relationship between intervention effectiveness and mode of delivery or number of intervention contacts; however, interventions which involved individually tailoring with personalized activity goals or provision of information about local opportunities in the environment may be more effective. CONCLUSIONS Interventions in adults aged 55 to 70 years led to long term improvements in physical activity at 12 months; however, maintenance beyond this is unclear. Identified physical activity improvements are likely to have substantial health benefits in reducing the risk of age-related illnesses. These findings have important implications for community-based public health interventions in and around the retirement transition.
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Affiliation(s)
- Nicola Hobbs
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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Santos JDPD, Silveira DV, Oliveira DFD, Caiaffa WT. [Instruments used to evaluate smoking habits: a systematic review]. CIENCIA & SAUDE COLETIVA 2012; 16:4707-20. [PMID: 22124912 DOI: 10.1590/s1413-81232011001300020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 02/12/2010] [Indexed: 11/22/2022] Open
Abstract
Smoking is one of the most important causes of illness in the world, responsible for one out of every eight deaths. To know the instruments that characterize the use of tobacco is the first step to develop reliable and comparable research to tackle this challenge. The objective was to identify and compare instruments and domains used in population-based studies over the past five years aiming to determine smoking patterns. A systematic review was conducted on articles published from September 2002 to September 2007. The terms used were: (*Smok or tobacco) AND (Questionnaire or scale or score or instrument or assessment or form) AND (*cultural* or translat* or valid* or reproduc* or psychomet*). Out of 2,236 references, 186 articles were selected, of which only 91 informed the instruments used. From the 91 manuscripts, 49 distinct instruments were identified. The main topics were profile and prevalence (38%), dependence (24%) and motivation (10.8%). The researchers used standard instruments in 96% of studies of addiction. The majority of articles about profile and prevalence (79%) used self-developed questionnaires. The transparency and standardization of instruments and the preference for the use of validated questionnaires are crucial areas for quality and reproducibility of research on smoking.
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van Limpt PM, Harting J, van Assema P, Ruland E, Kester A, Gorgels T, Knottnerus JA, van Ree JW, Stoffers HE. Effects of a brief cardiovascular prevention program by a health advisor in primary care; the 'Hartslag Limburg' project, a cluster randomized trial. Prev Med 2011; 53:395-401. [PMID: 21925203 DOI: 10.1016/j.ypmed.2011.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine in primary care patients at high risk for a cardiovascular event, the effects on biomedical risk factors for and incidence of cardiovascular events, of a brief cardiovascular prevention program executed by a health advisor. DESIGN cluster randomized controlled trial with 1275 patients (24 general practices) in and around Maastricht, the Netherlands (1999-2004). INTERVENTION health advisors were to complete computerized cardiovascular risk profiles, provide multi-factorial tailored health education and advice, and communicate with GP's to optimize treatment. OUTCOME differences in changes in risk factors between baseline and follow up at 6, 18, and 36 months and incidence of cardiovascular events at 36 months. PROCESS Because of logistic reasons risk profiles were put on paper instead of in the computerized patient files. On average patients attended 2.3 counseling sessions. Interaction with GPs was less productive than expected. OUTCOME Effect after six months on BMI (-0.20 kg/m(2) (95% CI -0.38 to -0.01, p=0.039), Cohen's d: -0.18), and after 18 months on HDL-cholesterol (+0.05 mmol/l (95% CI +0.01 to +0.09, p=0.014), Cohen's d: 0.14). No other (subgroup) effects were found. CONCLUSION Given the lack of clinically meaningful effects, implementation of this intervention in its present form is not justified.
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Affiliation(s)
- Patrick M van Limpt
- Department of General Practice, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands.
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Adherence to a guideline on cardiovascular prevention: a comparison between general practitioners and practice nurses. Int J Nurs Stud 2010; 48:798-807. [PMID: 21176903 DOI: 10.1016/j.ijnurstu.2010.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 11/25/2010] [Accepted: 11/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient non-compliance with prescribed treatment is an important factor in the lack of success in cardiovascular prevention. Another important cause is non-adherence of caregivers to the guidelines. It is not known how doctors and nurses differ in the application of guidelines. Patient compliance to treatment may vary according to the type of caregiver. OBJECTIVE To compare adherence to cardiovascular prevention delivered by practice nurses and by general practitioners. SETTING Six primary health care centres in the Netherlands (25 general practitioners, six practice nurses). METHODS 701 high risk patients were included in a randomised trial. Half of the patients received nurse-delivered care and half received care by general practitioners. For 91% of the patients treatment concerned secondary prevention. The Dutch guideline on cardiovascular prevention was used as protocol. A structured self-administered questionnaire was sent by post to patients. Data were extracted from the practice database and the questionnaire. RESULTS Intervention was received by 77% of respondents who visited the practice nurse compared to 57% from the general practitioner group (OR = 2.56, p < 0.01). More lifestyle intervention was given by the practice nurse; 46% of patients received at least one lifestyle intervention (weight, diet, exercise, and smoking) compared to 13% in general practitioner group (OR = 3.24, p < 0.001). In addition, after one year more patients from the practice nurse group used cardiovascular drugs (OR = 1.9, p = 0.03). Nurses inquired more frequently about patient compliance to medical treatment (OR = 2.1, p < 0.01). Regarding patient compliance, no statistical difference between study groups in this trial was found. CONCLUSION Practice nurses adhered better to the Dutch guideline on cardiovascular prevention than general practitioners did. Lifestyle intervention advice was more frequently given by practice nurses. Improvement of cardiovascular prevention is still necessary. Both caregivers should inquire about patient adherence on a regular basis.
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Effectiveness of nurse-delivered cardiovascular risk management in primary care: a randomised trial. Br J Gen Pract 2010; 60:40-6. [PMID: 20040167 DOI: 10.3399/bjgp10x482095] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses. AIM To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up. DESIGN OF STUDY Prospective pragmatic randomised trial. SETTING Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated. METHOD A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire. RESULTS A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided). CONCLUSION Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care.
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Wendel-Vos GCW, Dutman AE, Verschuren WMM, Ronckers ET, Ament A, van Assema P, van Ree J, Ruland EC, Schuit AJ. Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention. Am J Prev Med 2009; 37:50-6. [PMID: 19524144 DOI: 10.1016/j.amepre.2009.03.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 02/05/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease-prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998-2003). METHODS In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa. RESULTS In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p<or=0.05) for energy intake (-0.2 megajoule per day among both women and those with a low educational level); fat intake (-2.5 grams per day [g/d] among women and -3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level). CONCLUSIONS The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.
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Affiliation(s)
- G C Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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von Huth Smith L, Ladelund S, Borch-Johnsen K, Jørgensen T. A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): the long-term effect on physical activity. Scand J Public Health 2008; 36:380-8. [PMID: 18539692 DOI: 10.1177/1403494807085313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To examine the effect of a randomized multiple risk factor intervention study for prevention of ischaemic heart disease (IHD) on the development in physical activity over a 36-month period. METHODS Two random samples (high intensity intervention, group A, n=11,708; low intensity intervention, group B, n=1,308) were invited for a health examination, an assessment of absolute risk of developing IHD, and an individualized lifestyle intervention. The participation rate was 52.5%. High-risk persons in group A were also offered diet/physical activity and/or smoking cessation group counselling. High-risk persons in group B were referred to their GP. High-risk persons were re-counselled after 12 and 36 months. The control group (group C, n=5,264, response rate=61.3%) answered a mailed questionnaire. Data were analysed using longitudinal linear regression models with random effects. MAIN OUTCOME Change in physical activity from baseline to 12-and 36-month follow-up. RESULTS In men, the high-intensity (group A) intervention had a beneficial effect at 12-month follow-up, whereas after 36 months both the high-intensity and the low-intensity (group B) intervention had a beneficial effect on the development in physical activity when compared with group C. This was regardless of baseline physical activity level. At 36-month follow-up there was no significant difference between groups A and B. There was no intervention effect among women. CONCLUSIONS Only men seemed to benefit from the intervention.
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Lakerveld J, Bot SDM, Chinapaw MJ, van Tulder MW, van Oppen P, Dekker JM, Nijpels G. Primary prevention of diabetes mellitus type 2 and cardiovascular diseases using a cognitive behavior program aimed at lifestyle changes in people at risk: Design of a randomized controlled trial. BMC Endocr Disord 2008; 8:6. [PMID: 18573221 PMCID: PMC2446389 DOI: 10.1186/1472-6823-8-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/24/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people with cardiovascular disease (CVD) and diabetes mellitus type 2 (T2DM) is growing rapidly. To a large extend, this increase is due to lifestyle-dependent risk factors, such as overweight, reduced physical activity, and an unhealthy diet. Changing these risk factors has the potential to postpone or prevent the development of T2DM and CVD. It is hypothesized that a cognitive behavioral program (CBP), focused in particular on motivation and self-management in persons who are at high risk for CVD and/or T2DM, will improve their lifestyle behavior and, as a result, will reduce their risk of developing T2DM and CVD. METHODS 12,000 inhabitants, 30-50 years of age living in several municipalities in the semi-rural region of West-Friesland will receive an invitation from their general practitioner (n = 13) to measure their own waist circumference with a tape measure. People with abdominal obesity (male waist >/= 102 cm, female waist >or= 88 cm) will be invited to participate in the second step of the screening which includes blood pressure, a blood sample and anthropometric measurements. T2DM and CVD risk scores will then be calculated according to the ARIC and the SCORE formulae, respectively. People with a score that indicates a high risk of developing T2DM and/or CVD will then be randomly assigned to the intervention group (n = 300) or the control group (n = 300).Participants in the intervention group will follow a CBP aimed at modifying their dietary behavior, physical activity, and smoking behavior. The counseling methods that will be used are motivational interviewing (MI) and problem solving treatment (PST), which focus in particular on intrinsic motivation for change and self-management of problems of the participants. The CBP will be provided by trained nurse practitioners in the participant's general practice, and will consists of a maximum of six individual sessions of 30 minutes, followed by 3-monthly booster sessions by phone. Participants in the control group will receive brochures containing health guidelines regarding physical activity and diet, and how to stop smoking. The primary outcome measures will be changes in T2DM and CVD risk scores. Secondary outcome measures will be changes in lifestyle behavior and cost-effectiveness and cost-utility ratios. All relevant direct and indirect costs will be measured, and there will be a follow-up of 24 months. DISCUSSION Changing behaviors is difficult, requires time, considerable effort and motivation. Combining the two counseling methods MI and PST, followed by booster sessions may result in sustained behavioral change. TRIAL REGISTRATION Current Controlled Trials ISRCTN59358434.
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Affiliation(s)
- Jeroen Lakerveld
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Center, v.d. Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Sandra DM Bot
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Center, v.d. Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Marijke J Chinapaw
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Health Sciences, Faculty of Earth & Life Sciences, VU University Amsterdam, The Netherlands
| | - Patricia van Oppen
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Center, v.d. Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Giel Nijpels
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Center, v.d. Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Affiliation(s)
- Alfredo Morabia
- Center for the Biology of Natural Systems, Queens College-CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA.
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