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Patnode CD, Redmond N, Iacocca MO, Henninger M. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:375-388. [PMID: 35881116 DOI: 10.1001/jama.2022.7408] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOMES AND MEASURES CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups. CONCLUSIONS AND RELEVANCE Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Kleinke F, Ulbricht S, Dörr M, Penndorf P, Hoffmann W, van den Berg N. A low-threshold intervention to increase physical activity and reduce physical inactivity in a group of healthy elderly people in Germany: Results of the randomized controlled MOVING study. PLoS One 2021; 16:e0257326. [PMID: 34529735 PMCID: PMC8445413 DOI: 10.1371/journal.pone.0257326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lack of physical activity (PA) and a high level of physical inactivity (PI) are associated with a higher risk for mortality and responsible for several non-communicable diseases including cardiovascular disease. Higher age is associated with a decrease of PA and an increasing level of PI. Studies have shown that interventions in the elderly have the potential to increase the amount of PA and to decrease the level of PI. However, most interventions are complex, elaborated, time- and resource-consuming. Here, we examined the effect of individual feedback-letters reporting the measured PA and PI in a sample of elderly people in Germany. Primary outcomes of the study were overall PA and PI after 6 months in the intervention group compared to a control group. METHODS We examined data from the MOVING intervention study (RCT) for people aged ≥ 65 years living in the northeast of Germany. At baseline, 3 and 6-months follow-up, all study participants wore a 3-axis accelerometer over a period of seven consecutive days. After the baseline measurement, the participants were randomized into intervention and control group. Participants in the intervention group received automatically generated, individualized feedback letters reporting their PA and PI by mail after the baseline measurement and after the 3-months follow-up. A Two-Way Mixed ANOVA with repeated measures was calculated with light, moderate and overall PA as well as PI as dependent variables, and group (between subject) and time (inner subject) as factors. The analysis based on retrospective data from the MOVING study (2016-2018). RESULTS N = 258 patients were recruited. N = 166 participants could be included in the analysis, thereof N = 97 women (58.4%). The mean age was 70.8 years (SD 4.8). At baseline, the participants had a mean wearing time of 5,934.5 minutes (SD = 789.5) per week, which corresponds to about 14 hours daily on average. The overall PA in the intervention group at the 6-months follow up was 2488.8 (95% CI 2358.9-2618.2) minutes and 2408.2 (95% CI 2263.0-2553.4) minutes in the control group. There was no statistically significant interaction effect (time*group) between the intervention and control group for the depending variables. Sensitivity analyses showed significant small positive effects of the interaction time*partnership, F(2, 300) = 3.020, p = 0.05, partial η2 = 0.020. DISCUSSION On average, study participants had high levels of PA at baseline and showed a good adherence in wearing the accelerometer. Both is likely due to selection in the convenience study sample. Thus, some ceiling effect reduced the overall intervention effect somewhat. At baseline, the weekly average of PI was 3436.7 minutes, which correspondents to about 8.2 hours per day and about 57% of participants' daily waking time. The average level of PI could be slightly decreased in both study groups. TRIAL REGISTRATION NUMBER DRKS00010410, 17 May 2017.
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Affiliation(s)
- Fabian Kleinke
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Sabina Ulbricht
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Peter Penndorf
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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3
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Cunningham KB, Rogowsky RH, Carstairs SA, Sullivan F, Ozakinci G. Methods of connecting primary care patients with community-based physical activity opportunities: A realist scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1169-1199. [PMID: 33075180 DOI: 10.1111/hsc.13186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Deemed a global public health problem by the World Health Organization, physical inactivity is estimated to be responsible for one in six deaths in the United Kingdom (UK) and to cost the nation's economy £7.4 billion per year. A response to the problem receiving increasing attention is connecting primary care patients with community-based physical activity opportunities. We aimed to explore what is known about the effectiveness of different methods of connecting primary care patients with community-based physical activity opportunities in the United Kingdom by answering three research questions: 1) What methods of connection from primary care to community-based physical activity opportunities have been evaluated?; 2) What processes of physical activity promotion incorporating such methods of connection are (or are not) effective or acceptable, for whom, to what extent and under what circumstances; 3) How and why are (or are not) those processes effective or acceptable? We conducted a realist scoping review in which we searched Cochrane, Medline, PsycNET, Google Advanced Search, National Health Service (NHS) Evidence and NHS Health Scotland from inception until August 2020. We identified that five methods of connection from primary care to community-based physical activity opportunities had been evaluated. These were embedded in 15 processes of physical activity promotion, involving patient identification and behaviour change strategy delivery, as well as connection. In the contexts in which they were implemented, four of those processes had strong positive findings, three had moderately positive findings and eight had negative findings. The underlying theories of change were highly supported for three processes, supported to an extent for four and refuted for eight processes. Comparisons of the processes and their theories of change revealed several indications helpful for future development of effective processes. Our review also highlighted the limited evidence base in the area and the resulting need for well-designed theory-based evaluations.
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Affiliation(s)
- Kathryn B Cunningham
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Rayna H Rogowsky
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Sharon A Carstairs
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Frank Sullivan
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Gozde Ozakinci
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Everett B, Salamonson Y, Koirala B, Zecchin R, Davidson PM. A randomized controlled trial of motivational interviewing as a tool to enhance secondary prevention strategies in cardiovascular disease (MICIS study). Contemp Nurse 2021; 57:80-98. [PMID: 34006176 DOI: 10.1080/10376178.2021.1927774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Physical activity/exercise has consistently been shown to improve objective measures of functional capacity, enhance quality of life, improve coronary risk profile, and reduce mortality for individuals with coronary heart disease. Despite the gains achieved by those who attend cardiac rehabilitation (CR) many individuals fail to maintain lifestyle changes. The aims of this study were to evaluate the effectiveness of motivational interviewing as a strategy for promoting maintenance of cardiac risk factor modification in patients who had participated in standard, 6-week outpatient CR programs. In a randomized controlled trail, participants in usual care and intervention group (Motivational interviewing supplemental to a standard 6-week CR program) were followed up at 6-weeks and 12-months. The primary outcome was distance walked on the six-minute walk test (6MWT), used as both an indicator of functional capacity and habitual physical activity. Secondary outcomes included modifiable coronary risk factors (smoking, self-reported physical activity, waist circumference, body mass index and medication adherence), psychological status (depression, anxiety, stress, perceived cardiac control, perceived social support, exercise self-efficacy) and quality of life. Total 110 patients, usual care (n = 58) and intervention (n = 52), consented to participate in the study. Overall, demographic and clinical characteristics did not differ between groups at baseline. Motivational interviewing was no more likely to promote maintenance of cardiac risk factor modification (both primary and secondary outcomes) than a standard CR program alone. Both intervention and control groups maintained the gains achieved during CR at the 12-month follow-up except for weight loss. Although both groups maintained the gains achieved during CR for physical activity, there was no effect of the intervention on maintenance of cardiac risk factor modification on both primary and secondary outcomes.
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Affiliation(s)
- B Everett
- School of Nursing and Midwifery, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Y Salamonson
- School of Nursing and Midwifery, Western Sydney Local Health District, Sydney, NSW, Australia
| | - B Koirala
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - R Zecchin
- NUM-Area Cardiac Rehabilitation, Western Sydney Local Health District, Australia
| | - P M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Faculty of Health, University of Technology Sydney, Australia
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Mas-Alòs S, Planas-Anzano A, Peirau-Terés X, Real-Gatius J, Galindo-Ortego G. Feasibility Assessment of the Let's Walk Programme (CAMINEM): Exercise Training and Health Promotion in Primary Health-Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063192. [PMID: 33808729 PMCID: PMC8003347 DOI: 10.3390/ijerph18063192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
Exercise is related to many individual health outcomes but impact evaluations of exercise programmes are seldom conducted. The purpose of the study is to evaluate the feasibility of an exercise prescription intervention in primary health-care settings (CAMINEM Programme) located in two socially disadvantaged neighbourhoods. The CAMINEM was a pragmatic-driven intervention with opportunistic recruitment. It followed the 5As framework for health promotion and also the exercise training principles. Feasibility was evaluated using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Patients with non-communicable chronic diseases participated in a 12-month home-based moderate-intensity exercise program, counselled by exercise physiologists. Participants were grouped according to their physical activity behaviour at baseline and 6-month adherence. CAMINEM reached 1.49% (n = 229) of the eligible population (N = 15374) and included a final sample of 178. Health outcomes for adhered participants followed positive patterns. Non-adhered participants visited their practitioner more compared to adhered participants. Thirty-three practitioners (40%) referred patients. Nurses referred four times more than physicians (81% and 19% respectively). The delivery of exercise prescriptions proved to be easy to complete and record by participants as well as easy to monitor and adjust by the exercise physiologists. One out of four participants adhered during the 12-month intervention. This intervention has been feasible in primary care in Catalonia, Spain, to safely prescribe home-based exercise for several conditions.
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Affiliation(s)
- Sebastià Mas-Alòs
- National Institute of Physical Education of Catalonia (INEFC), Lleida Campus, E-25192 Catalonia, Spain; (A.P.-A.); (X.P.-T.)
- Grup de Recerca de Moviment Humà, University of Lleida (UdL), E-25192 Catalonia, Spain
- Correspondence: ; Tel.: +34-973-272022
| | - Antoni Planas-Anzano
- National Institute of Physical Education of Catalonia (INEFC), Lleida Campus, E-25192 Catalonia, Spain; (A.P.-A.); (X.P.-T.)
- Grup de Recerca de Moviment Humà, University of Lleida (UdL), E-25192 Catalonia, Spain
| | - Xavier Peirau-Terés
- National Institute of Physical Education of Catalonia (INEFC), Lleida Campus, E-25192 Catalonia, Spain; (A.P.-A.); (X.P.-T.)
- Grup de Recerca de Moviment Humà, University of Lleida (UdL), E-25192 Catalonia, Spain
| | - Jordi Real-Gatius
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, E-08195 Sant Cugat del Vallés, Spain;
- Unitat de Suport a la Recerca Lleida—Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Lleida, E-25007 Catalonia, Spain
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Sharman MJ, Ball K, Greaves S, Jose KA, Morse M, Blizzard CL, Wells G, Venn AJ, Palmer AJ, Lester D, Williams J, Harpur S, Cleland VJ. trips4health: Protocol of a single-blinded randomised controlled trial incentivising adults to use public transport for physical activity gain. Contemp Clin Trials Commun 2020; 19:100619. [PMID: 32775761 PMCID: PMC7394862 DOI: 10.1016/j.conctc.2020.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 12/03/2022] Open
Abstract
Background Public transport (PT) users typically accumulate more physical activity (PA) than private motor vehicle users yet redressing physical inactivity through transport-related PA (TRPA) interventions has received limited attention. Further, incentive-based strategies can increase leisure-time PA but their impact on TRPA, is unclear. This study's objective is to determine the impact of an incentive-based strategy on TRPA in a regional Australian setting. Methods trips4health is a single-blinded randomised controlled trial with a four-month intervention phase and subsequent six-month maintenance phase. Participants will be randomised to: an incentives-based intervention (bus trip credit for reaching bus trip targets, weekly text messages to support greater bus use, written PA guidelines); or an active control (written PA guidelines only). Three hundred and fifty adults (≥18 years) from southern Tasmania will be recruited through convenience methods, provide informed consent and baseline information, then be randomised. The primary outcome is change in accelerometer measured average daily step count at baseline and four- and ten-months later. Secondary outcomes are changes in: measured and self-reported travel behaviour (e.g. PT use), PA, sedentary behaviour; self-reported and measured (blood pressure, waist circumference, height, weight) health; travel behaviour perspectives (e.g. enablers/barriers); quality of life; and transport-related costs. Linear mixed model regression will determine group differences. Participant and PT provider level process evaluations will be conducted and intervention costs to the provider determined. Discussion trips4health will determine the effectiveness of an incentive-based strategy to increase TRPA by targeting PT use. The findings will enable evidence-informed decisions about the worthwhileness of such strategies. Trial registration ACTRN12619001136190. Universal trial number U1111-1233-8050.
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Affiliation(s)
- M J Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - S Greaves
- Institute of Transport and Logistic Studies, The University of Sydney, Sydney, New South Wales, Australia
| | - K A Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Morse
- Metro Tasmania, Hobart, Tasmania, Australia
| | - C L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - G Wells
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - D Lester
- Local Government Association of Tasmania, Hobart, Tasmania, Australia
| | - J Williams
- Department of Health, Tasmanian Government, Hobart, Tasmania, Australia
| | - S Harpur
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - V J Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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James ML, Christian D, Scott SC, Todd CE, Stratton G, Demmler J, McCoubrey S, Halcox JPJ, Audrey S, Ellins EA, Brophy ST. Active Children Through Individual Vouchers Evaluation: A Mixed-Method RCT. Am J Prev Med 2020; 58:232-243. [PMID: 31859172 PMCID: PMC6955646 DOI: 10.1016/j.amepre.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Physical activity declines in adolescence, especially among those in deprived areas. Research suggests this may result from accessibility barriers (e.g., cost and locality). The Active Children Through Individual Vouchers Evaluation RCT aimed to improve the fitness and heart health of teenagers in Wales with the help of teenagers who co-produced the study. STUDY DESIGN This study was a mixed-method RCT. SETTING/PARTICIPANTS Before data collection, which took place at baseline, 6 months, and 12 months for both arms, 7 schools were randomized by an external statistician (4 intervention schools, n=524; 3 control schools, n=385). INTERVENTION The Active Children Through Individual Vouchers Evaluation intervention included provision of activity vouchers (£20 per month), a peer mentoring scheme, and support worker engagement for 12 months between January and December 2017. Data analysis occurred February-April 2018. MAIN OUTCOME MEASURES Data included measures of cardiovascular fitness, cardiovascular health (blood pressure and pulse wave analysis), motivation, and focus groups. RESULTS The intervention showed a trend to improve the distance ran (primary outcome) and was significant in improving the likelihood of intervention teenagers being fit (OR=1.21, 95% CI=1.07, 1.38, p=0.002). There was a reduction in teenagers classified as having high blood pressure (secondary outcome) in the intervention group (baseline, 5.3% [28/524]; 12 months, 2.7% [14/524]). Data on where teenagers used vouchers and evidence from focus groups showed that teenagers wanted to access more unstructured, informal, and social activities in their local areas. CONCLUSIONS Active Children Through Individual Vouchers Evaluation identified methods that may have a positive impact on cardiovascular fitness, cardiovascular health, and perspectives of activity. Consulting with teenagers, empowering them, and providing more local opportunities for them to take part in activities that are fun, unstructured, and social could positively impact teenage physical activity. TRIAL REGISTRATION ISRCTN, ISRCTN75594310.
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Affiliation(s)
- Michaela L James
- Swansea University Medical School, Swansea University, Swansea, United Kingdom.
| | - Danielle Christian
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
| | - Samantha C Scott
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Charlotte E Todd
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Gareth Stratton
- College of Engineering, Bay Campus, Swansea University, Swansea, United Kingdom
| | - Joanne Demmler
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | | | - Julian P J Halcox
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | | | - Elizabeth A Ellins
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Sinead T Brophy
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Jones M, Bright P, Hansen L, Ihnatsenka O, Carek PJ. Promoting Physical Activity in a Primary Care Practice: Overcoming the Barriers. Am J Lifestyle Med 2019; 15:158-164. [PMID: 33786031 DOI: 10.1177/1559827619867693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/07/2019] [Accepted: 07/15/2019] [Indexed: 01/04/2023] Open
Abstract
Along with proper diet and avoidance of tobacco use, physical activity is extremely important to maintain and improve overall health of the individual and population. Despite evidence for the cost-effectiveness of physical activity counseling in primary care, only one-third of patients report that they received physical activity counseling by their primary care physician (PCP). Both PCPs and patients face numerous barriers to addressing insufficient physical activity. To assist patients in overcoming their barriers to regular physical activity, the PCP should assess and address the patient's specific barriers to physical activity and counsel patients about the most common general barriers, such as lack of time, knowledge, and motivation. Numerous benefits and barriers are present, and the PCP should understand them and use the information to better counsel patients regarding the benefit of and need for regular physical activity. Brief counseling is an efficient, effective, and cost-effective means to increase physical activity and to bring considerable clinical benefits to various patient populations.
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Affiliation(s)
- Mitul Jones
- University of Florida, Gainesville, Florida (MJ, PB, LH, OI).,Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida (PJC)
| | - Philippa Bright
- University of Florida, Gainesville, Florida (MJ, PB, LH, OI).,Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida (PJC)
| | - Lucia Hansen
- University of Florida, Gainesville, Florida (MJ, PB, LH, OI).,Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida (PJC)
| | - Olga Ihnatsenka
- University of Florida, Gainesville, Florida (MJ, PB, LH, OI).,Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida (PJC)
| | - Peter J Carek
- University of Florida, Gainesville, Florida (MJ, PB, LH, OI).,Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida (PJC)
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Heredia NI, Lee M, Hwang KO, Reininger BM, Fernandez ME, McNeill LH. Health coaching to encourage obese adults to enroll in commercially-available weight management programs: The path to health study. Contemp Clin Trials 2019; 83:1-9. [PMID: 31229621 PMCID: PMC6642849 DOI: 10.1016/j.cct.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥4 calls as compared to those who completed <4 calls. We also found significant dose response relationships for PA and FV intake at 3 months. In this study, we found that phone health coaching was successful in increasing obese adults' enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes.
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Affiliation(s)
- Natalia I Heredia
- The University of Texas MD Anderson Cancer Center, Health Disparities Research, 1400 Pressler St, Houston, TX 77030, United States.
| | - MinJae Lee
- McGovern Medical School at The University of Texas Health Science Center at Houston, United States
| | - Kevin O Hwang
- McGovern Medical School at The University of Texas Health Science Center at Houston, United States
| | - Belinda M Reininger
- The University of Texas Health Science Center Houston, School of Public Health in Brownsville, United States
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston, School of Public Health, United States
| | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Health Disparities Research, 1400 Pressler St, Houston, TX 77030, United States
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James M, Christian D, Scott S, Todd C, Stratton G, Demmler J, McCoubrey S, Halcox J, Audrey S, Ellins EA, Irvine E, Brophy S. What works best when implementing a physical activity intervention for teenagers? Reflections from the ACTIVE Project: a qualitative study. BMJ Open 2019; 9:e025618. [PMID: 31079080 PMCID: PMC6530318 DOI: 10.1136/bmjopen-2018-025618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This paper explores what aspects of a multicomponent intervention were deemed strengths and weaknesses by teenagers and the local council when promoting physical activity to young people. DESIGN Qualitative findings at 12 months from a mixed method randomised control trial. METHODS Active Children Through Incentive Vouchers-Evaluation (ACTIVE) gave teenagers £20 of activity enabling vouchers every month for a year. Peer mentors were also trained and a support worker worked with teenagers to improve knowledge of what was available. Semistructured focus groups took place at 12 months to assess strengths and weaknesses of the intervention. Eight focus groups (n=64 participants) took place with teenagers and one additional focus group was dedicated to the local council's sport development team (n=8 participants). Thematic analysis was used to analyse the data. RESULTS Teenagers used the vouchers on three main activities: trampolining, laser tag or the water park. These appeal to both genders, are social, fun and require no prior skill or training. Choice and financial support for teenagers in deprived areas was considered a strength by teenagers and the local council. Teenagers did not engage with a trained peer mentor but the support worker was considered helpful. CONCLUSIONS The ACTIVE Project's delivery had both strengths and weakness that could be used to underpin future physical activity promotion. Future interventions should focus on improving access to low cost, fun, unstructured and social activities rather than structured organised exercise/sport. The lessons learnt from this project can help bridge the gap between what is promoted to teenagers and what they actually want from activity provision. TRIAL REGISTRATION NUMBER ISRCTN75594310.
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Affiliation(s)
| | - Danielle Christian
- Department of Sport and Physical Activity, Edgehill University, Ormskirk, UK
| | | | | | | | | | - Sarah McCoubrey
- Active Young People Department, City and County of Swansea, Swansea, UK
| | - Julian Halcox
- College of Medicine, Swansea University, Swansea, UK
| | - Suzanne Audrey
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Sinead Brophy
- College of Medicine, Swansea University, Swansea, UK
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11
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Howlett N, Trivedi D, Troop NA, Chater AM. Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Transl Behav Med 2019; 9:147-157. [PMID: 29506209 PMCID: PMC6305562 DOI: 10.1093/tbm/iby010] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.
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Affiliation(s)
- Neil Howlett
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts AL, UK
| | - Nicholas A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
| | - Angel Marie Chater
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
- Institute for Sport and Physical Activity Research (ISPAR), School of Sport Science and Physical Activity, Faculty of Education and Sport, University of Bedfordshire, Bedford, UK
- UCL School of Pharmacy, Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London, London, UK
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12
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Ritvo P, Obadia M, Santa Mina D, Alibhai S, Sabiston C, Oh P, Campbell K, McCready D, Auger L, Jones JM. Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e165. [PMID: 28838886 PMCID: PMC5590009 DOI: 10.2196/resprot.6615] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/22/2016] [Accepted: 03/25/2017] [Indexed: 12/12/2022] Open
Abstract
Background Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors. Objective This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT. Methods We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program. Results We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9). Conclusions This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates. Trial Registration ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735)
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Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Maya Obadia
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Daniel Santa Mina
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- General Internal Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine Sabiston
- Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kristin Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - David McCready
- Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Surgery, University of Toronto, Toronto, ON, Canada
| | - Leslie Auger
- Kinesiology Program, University of Guelph-Humber, Toronto, ON, Canada
| | - Jennifer Michelle Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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13
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Thepwongsa I, Muthukumar R, Kessomboon P. Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review. Fam Pract 2017; 34:376-383. [PMID: 28486622 DOI: 10.1093/fampra/cmx045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. METHODS An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. RESULTS Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. CONCLUSIONS Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.
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Affiliation(s)
- Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | | | - Pattapong Kessomboon
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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14
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James M, Christian D, Scott S, Todd C, Stratton G, McCoubrey S, Halcox J, Audrey S, Ellins E, Brophy S. Active children through individual vouchers - evaluation (ACTIVE): protocol for a mixed method randomised control trial to increase physical activity levels in teenagers. BMC Public Health 2017; 18:7. [PMID: 28693484 PMCID: PMC5504609 DOI: 10.1186/s12889-017-4554-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
Background Many teenagers are insufficiently active despite the health benefits of physical activity (PA). There is strong evidence to show that inactivity and low fitness levels increase the risk of non-communicable diseases such as coronary heart disease (CHD), type 2 diabetes and breast and colon cancers (Lee et al. Lancet 380:219–29, 2012). A major barrier facing adolescents is accessibility (e.g. cost and lack of local facilities). The ACTIVE project aims to tackle this barrier through a multi-faceted intervention, giving teenagers vouchers to spend on activities of their choice and empowering young people to improve their fitness and PA levels. Design ACTIVE is a mixed methods randomised control trial in 7 secondary schools in Swansea, South Wales. Quantitative and qualitative measures including PA (cooper run test (CRT), accelerometery over 7 days), cardiovascular (CV) measures (blood pressure, pulse wave analysis) and focus groups will be undertaken at 4 separate time points (baseline, 6 months,12 months and follow-up at 18 months). Intervention schools will receive a multi-component intervention involving 12 months of £20 vouchers to spend on physical activities of their choice, a peer mentor scheme and opportunities to attend advocacy meetings. Control schools are encouraged to continue usual practice. The primary aim is to examine the effect of the intervention in improving cardiovascular fitness. Discussion This paper describes the protocol for the ACTIVE randomised control trial, which aims to increase fitness, physical activity and socialisation of teenagers in Swansea, UK via a voucher scheme combined with peer mentoring. Results can contribute to the evidence base on teenage physical activity and, if effective, the intervention has the potential to inform future physical activity interventions and policy. Trial registration ISRCTN75594310 (Assigned 06/03/2017).
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Affiliation(s)
- Michaela James
- College of Medicine, Swansea University, Data Science Building, Swansea, SA2 8PP, UK.
| | - Danielle Christian
- Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancs, L39 4QP, UK
| | - Samantha Scott
- College of Medicine, Swansea University, Data Science Building, Swansea, SA2 8PP, UK
| | - Charlotte Todd
- College of Medicine, Swansea University, Data Science Building, Swansea, SA2 8PP, UK
| | - Gareth Stratton
- College of Engineering, Bay Campus Swansea University, Fabian Way, Crymlyn Burrows, Skewen, Swansea, SA1 8EN, UK
| | - Sarah McCoubrey
- City and County of Swansea Council, Room 153, Guildhall, Swansea, SA1 4PE, UK
| | - Julian Halcox
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, Bristol, BS8 2PS, UK
| | - Elizabeth Ellins
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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15
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Lamming L, Pears S, Mason D, Morton K, Bijker M, Sutton S, Hardeman W. What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews. Prev Med 2017; 99:152-163. [PMID: 28232098 DOI: 10.1016/j.ypmed.2017.02.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/14/2017] [Accepted: 02/17/2017] [Indexed: 11/15/2022]
Abstract
This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5min or less) that could be delivered in a primary care consultation.
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Affiliation(s)
- Laura Lamming
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom; Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire BD7 1DP, United Kingdom.
| | - Sally Pears
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom.
| | - Dan Mason
- Born in Bradford, Bradford Institute for Health Research, Bradford BD9 6RJ, United Kingdom.
| | - Katie Morton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom.
| | - Maaike Bijker
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom.
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom.
| | - Wendy Hardeman
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, United Kingdom; School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
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16
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Barte JCM, Wendel-Vos GCW. A Systematic Review of Financial Incentives for Physical Activity: The Effects on Physical Activity and Related Outcomes. Behav Med 2017; 43:79-90. [PMID: 26431076 DOI: 10.1080/08964289.2015.1074880] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this review is to give an overview of the available evidence on the effects of financial incentives to stimulate physical activity. Therefore, a systematic literature search was performed for randomized trials that investigate the effects of physical-activity-related financial incentives for individuals. Twelve studies with unconditional incentives (eg, free membership sport facility) and conditional incentives (ie, rewards for reaching physical-activity goals) related to physical activity were selected. Selected outcomes were physical activity, sedentary behavior, fitness, and weight. Results show that unconditional incentives do not affect physical activity or the other selected outcomes. For rewards, some positive effects were found and especially for rewards provided for physical-activity behavior instead of attendance. In conclusion, rewards seem to have positive effects on physical activity, while unconditional incentives seem to have no effect. However, it should be kept in mind that the long-term effects of financial incentives are still unclear.
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Affiliation(s)
- Jeroen C M Barte
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , the Netherlands.,b Behavioural Science Institute , Radboud University , Nijmegen , the Netherlands
| | - G C Wanda Wendel-Vos
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , the Netherlands
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17
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Jerant A, Lichte M, Kravitz RL, Tancredi DJ, Magnan EM, Hudnut A, Franks P. Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators. PATIENT EDUCATION AND COUNSELING 2016; 99:1865-1872. [PMID: 27423177 PMCID: PMC5069145 DOI: 10.1016/j.pec.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore how physician training in self-efficacy enhancing interviewing techniques (SEE IT) affects patient psychological health behavior change mediators (HBCMs). METHODS We analyzed data from 131 patients visiting primary care physicians ≥4 months after the physicians participated in a randomized controlled trial. Experimental arm physicians (N=27) received SEE IT training during three ≤20min standardized patient instructor (SPI) visits. Control physicians (N=23) viewed a diabetes medications video during one SPI visit. Physicians were blinded to patient participation. Outcomes were self-care self-efficacy, readiness, and health locus of control (Internal, Chance, Powerful Others), examined as a summary HBCM score (average of standardized means) and individually. Analyses adjusted for pre-visit values of the dependent variables. RESULTS Patients visiting SEE IT-trained physicians had higher summary HBCM scores (+0.42, 95% CI 0.07-0.77; p=0.021). They also had greater self-care readiness (AOR 3.04, 95% CI 1.02-9.03, p=0.046) and less Chance health locus of control (-0.27 points, 95% CI -0.50-0.04, p=0.023), with no significant differences in other HBCMs versus controls. CONCLUSION Improvement in psychological HBCMs occurred among patients visiting SEE IT-trained physicians, PRACTICE IMPLICATIONS: If further research shows the observed HBCM effects improve health behaviors and outcomes, SEE IT training might be offered widely to physicians.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis, Sacramento, USA.
| | - Melissa Lichte
- Department of Family and Community Medicine, University of California Davis, Sacramento, USA.
| | - Richard L Kravitz
- Department of Internal Medicine, University of California Davis, Sacramento, USA.
| | - Daniel J Tancredi
- Department of Pediatrics and Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA.
| | - Elizabeth M Magnan
- Department of Family and Community Medicine, University of California Davis, Sacramento, USA.
| | | | - Peter Franks
- Department of Family and Community Medicine, University of California Davis, Sacramento, USA.
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19
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Christian D, Todd C, Hill R, Rance J, Mackintosh K, Stratton G, Brophy S. Active children through incentive vouchers - evaluation (ACTIVE): a mixed-method feasibility study. BMC Public Health 2016; 16:890. [PMID: 27566535 PMCID: PMC5002124 DOI: 10.1186/s12889-016-3381-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022] Open
Abstract
Background Adolescents face many barriers to physical activity, demonstrated by the decline in physical activity levels in teenage populations. This study aimed to assess the feasibility of overcoming such barriers via the implementation of an activity-promoting voucher scheme to teenagers in deprived areas. Methods All Year 9 pupils (n = 115; 13.3 ± 0.48 years; 51 % boys) from one secondary school in Wales (UK) participated. Participants received £25 of activity vouchers every month for six months for physical activity or sporting equipment. Focus groups (n = 7), with 43 pupils, and qualitative interviews with teachers (n = 2) were conducted to assess feasibility, in addition to a process evaluation utilising the RE-AIM framework. Quantitative outcomes at baseline, five months (during intervention) and twelve months (follow-up) included: physical activity (accelerometer), aerobic fitness (12 min Cooper run) and self-reported activity (PAQ-A). Motivation to exercise (BREQ-2) was measured three months post-baseline and at follow-up. Results Qualitative findings showed that vouchers encouraged friends to socialise through activity, provided opportunities to access local activities that pupils normally could not afford, and engaged both those interested and disinterested in physical education. Improvements in weekend moderate-to-vigorous physical activity and reductions in sedentary behaviour were observed in both sexes. Boys’ fitness significantly improved during the voucher scheme. ‘Non-active’ pupils (those not meeting recommended guidelines of 60 mins∙day−1) and those with higher motivation to exercise had higher voucher use. Conclusions Adolescents, teachers and activity providers supported the voucher scheme and felt the vouchers enabled deprived adolescents to access more physical activity opportunities. Voucher usage was associated with improved attitudes to physical activity, increased socialisation with friends and improved fitness and physical activity; presenting interesting avenues for further exploration in a larger intervention trial. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3381-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Christian
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK.
| | - Charlotte Todd
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Rebecca Hill
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Jaynie Rance
- College of Health and Human Science, Swansea University, Swansea, SA2 8PP, UK
| | - Kelly Mackintosh
- College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN, UK
| | - Gareth Stratton
- College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN, UK
| | - Sinead Brophy
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
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20
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Losina E, Collins JE, Wright J, Daigle ME, Donnell-Fink LA, Strnad D, Usiskin IM, Yang HY, Lerner V, Katz JN. Postoperative Care Navigation for Total Knee Arthroplasty Patients: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2016; 68:1252-9. [PMID: 26714179 DOI: 10.1002/acr.22829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/20/2015] [Accepted: 12/15/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To establish the efficacy of motivational interviewing-based postoperative care navigation in improving functional status after total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. METHODS We conducted a parallel randomized controlled trial in TKA recipients with 2 arms: postoperative care with frequent followup by a care navigator or usual care. The primary outcome was the difference between the arms in Western Ontario and McMaster Universities Osteoarthritis Index function score change, over 6 months postsurgery. We performed a preplanned subgroup analysis of differential efficacy by obesity and exploratory subgroup analyses on sex and pain catastrophizing. RESULTS We enrolled 308 subjects undergoing TKA for osteoarthritis. Mean ± SD preoperative function score was 41 ± 17 (0-100 scale, where 100 = worst function). At 6 months, subjects in the navigation arm improved by mean ± SD 30 ± 16 points compared to 27 ± 18 points in the usual-care arm (P = 0.148). Participants with moderate to high levels of pain catastrophizing were unlikely to benefit from navigation compared to those with lower levels of pain catastrophizing (P = 0.013 for interaction). CONCLUSION Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from care navigation, as well as by potential differential effects for subjects with moderate to high degrees of pain catastrophizing. Greater focus on developing programs for reducing pain catastrophizing could lead to better functional outcomes following TKA.
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Affiliation(s)
- Elena Losina
- Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Wright
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Doris Strnad
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Heidi Y Yang
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Jeffrey N Katz
- Brigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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21
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Ramseier CA, Suvan JE. Behaviour change counselling for tobacco use cessation and promotion of healthy lifestyles: a systematic review. J Clin Periodontol 2016; 42 Suppl 16:S47-58. [PMID: 25496370 DOI: 10.1111/jcpe.12351] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/27/2022]
Abstract
AIM To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles. MATERIALS AND METHODS Systematic Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews. RESULTS A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non-existent. CONCLUSIONS While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.
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Affiliation(s)
- Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Molema CCM, Wendel-Vos GCW, Puijk L, Jensen JD, Schuit AJ, de Wit GA. A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels? BMC Sports Sci Med Rehabil 2016; 8:15. [PMID: 27274847 PMCID: PMC4893256 DOI: 10.1186/s13102-016-0041-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/28/2016] [Indexed: 12/14/2022]
Abstract
Background According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication. Results Three studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive. Conclusions Based on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive.
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Affiliation(s)
- Claudia C M Molema
- Department of Tranzo, Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000LE Tilburg, The Netherlands ; National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | - G C Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | - Lisanne Puijk
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | | | - A Jantine Schuit
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Institute of Resource Economics and Food Policy, University of Copenhagen, Copenhagen, Denmark
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Hardcastle SJ, Fortier M, Blake N, Hagger MS. Identifying content-based and relational techniques to change behaviour in motivational interviewing. Health Psychol Rev 2016; 11:1-16. [DOI: 10.1080/17437199.2016.1190659] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah J. Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | | | - Nicola Blake
- Health Improvement, Public Health, East Sussex County Council, Lewes, East Sussex, UK
| | - Martin S. Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Copeland RJ, Horspool K, Humphreys L, Scott E. Recruiting to a large-scale physical activity randomised controlled trial - experiences with the gift of hindsight. Trials 2016; 17:104. [PMID: 26908117 PMCID: PMC4765210 DOI: 10.1186/s13063-016-1229-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment issues continue to impact a large number of trials. Sharing recruitment information is vital to supporting researchers to accurately predict recruitment and to manage the risk of poor recruitment during study design and implementation. The purpose of this article is to build on the knowledge available to researchers on recruiting to community-based trials. Methods A critical commentary of the recruitment challenges encountered during the Booster Study, a randomised controlled trial in which researchers investigated the effectiveness of a motivational interviewing style intervention on the maintenance of physical activity. An overview of recruitment is provided, as well as strategies employed to recruit prospective participants and possible barriers to recruitment. Results Two hundred eighty-two people, 47 % of the original target, were recruited through mail-outs, with secondary recruitment pathways yielding no additional participants. The research team encountered problems with recontacting interested participants and providing study materials in non-English languages. A lower response rate to the mail-out and a greater number of non-contactable participants in the full study than in the pilot study resulted in a smaller pool of eligible participants from the brief intervention eligible for recruitment into the randomised controlled trial. Conclusions Despite using widely accepted recruitment strategies and incorporating new recruitment tactics in response to challenges, the Booster Study investigators failed to randomise a sufficient number of participants. Recruitment in trials of community-based behavioural interventions may have different challenges than trials based on clinical or primary care pathways. Specific challenges posed by the complexity of the study design and problems with staffing and resources were exacerbated by the need to revise upwards the number of mailed invitations as a result of the pilot study. Researchers should ensure study design facilitates recruitment and consider the implications of changing recruitment on the operational aspects of the trial. Where possible, the impact of new strategies should be measured, and recruitment successes and challenges should be shared with those planning similar studies. ISRCTN56495859 (registered on 12 February 2009); NCT00836459 (registered on 3 February 2009).
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Affiliation(s)
- Robert J Copeland
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Kimberley Horspool
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Liam Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Emma Scott
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Burtin C, Langer D, van Remoortel H, Demeyer H, Gosselink R, Decramer M, Dobbels F, Janssens W, Troosters T. Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial. PLoS One 2015; 10:e0144989. [PMID: 26697853 PMCID: PMC4689370 DOI: 10.1371/journal.pone.0144989] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/24/2015] [Indexed: 12/19/2022] Open
Abstract
Background Pulmonary rehabilitation programs only modestly enhance daily physical activity levels in patients with chronic obstructive pulmonary disease (COPD). This randomised controlled trial investigates the additional effect of an individual activity counselling program during pulmonary rehabilitation on physical activity levels in patients with moderate to very severe COPD. Methods Eighty patients (66±7 years, 81% male, forced expiratory volume in 1 second 45±16% of predicted) referred for a six‐month multidisciplinary pulmonary rehabilitation program were randomised. The intervention group was offered an additional eight-session activity counselling program. The primary outcomes were daily walking time and time spent in at least moderate intense activities. Results Baseline daily walking time was similar in the intervention and control group (median 33 [interquartile range 16–47] vs 29 [17–44]) whereas daily time spent in at least moderate intensity was somewhat higher in the intervention group (17[4–50] vs 12[2–26] min). No significant intervention*time interaction effects were observed in daily physical activity levels. In the whole group, daily walking time and time spent in at least moderate intense activities did not significantly change over time. Conclusions The present study identified no additional effect of eight individual activity counselling sessions during pulmonary rehabilitation to enhance physical activity levels in patients with COPD. Trial Registration clinicaltrials.gov NCT00948623
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Affiliation(s)
- Chris Burtin
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
- Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Daniel Langer
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Hans van Remoortel
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Rik Gosselink
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Marc Decramer
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
| | - Thierry Troosters
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium
- * E-mail:
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Bóveda-Fontán J, Barragán-Brun N, Campiñez-Navarro M, Pérula-de Torres LÁ, Bosch-Fontcuberta JM, Martín-Álvarez R, Arbonies-Ortiz JC, Novo-Rodríguez JM, Criado-Larumbe M, Fernández-García JA, Martín-Rioboó E. Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial. BMC FAMILY PRACTICE 2015; 16:151. [PMID: 26498221 PMCID: PMC4620004 DOI: 10.1186/s12875-015-0370-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/13/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care. METHODS A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines. RESULTS 107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI: -15.33 at -23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91). CONCLUSION A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise. TRIAL REGISTRATION the trial is registered in ClinicalTrials.gov ( NCT01282190 ; January 21, 2011).
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Affiliation(s)
| | | | | | - Luís Ángel Pérula-de Torres
- Unidad Docente de Medicina Familiar y Comunitaria de Córdoba. Distrito Sanitario Córdoba y Guadalquivir. C/Isla de Lanzarote, Córdoba, Spain.
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain.
| | | | | | | | | | - Margarita Criado-Larumbe
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Jose Angel Fernández-García
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Enrique Martín-Rioboó
- UGC Fuensanta. Teaching Unit of Family and Community Medicine Cordoba. Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba, Córdoba, Spain.
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Skolasky RL, Maggard AM, Li D, Riley LH, Wegener ST. Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part II: patient activation mediates the effects of health behavior change counseling on rehabilitation engagement. Arch Phys Med Rehabil 2015; 96:1208-14. [PMID: 25827656 PMCID: PMC6153440 DOI: 10.1016/j.apmr.2015.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effect of health behavior change counseling (HBCC) on patient activation and the influence of patient activation on rehabilitation engagement, and to identify common barriers to engagement among individuals undergoing surgery for degenerative lumbar spinal stenosis. DESIGN Prospective clinical trial. SETTING Academic medical center. PARTICIPANTS Consecutive lumbar spine surgery patients (N=122) defined in our companion article (Part I) were assigned to a control group (did not receive HBCC, n=59) or HBCC group (received HBCC, n=63). INTERVENTION Brief motivational interviewing-based HBCC versus control (significance, P<.05). MAIN OUTCOME MEASURES We assessed patient activation before and after intervention. Rehabilitation engagement was assessed using the physical therapist-reported Hopkins Rehabilitation Engagement Rating Scale and by a ratio of self-reported physical therapy and home exercise completion. Common barriers to rehabilitation engagement were identified through thematic analysis. RESULTS Patient activation predicted engagement (standardized regression weight, .682; P<.001). Postintervention patient activation was predicted by baseline patient activation (standardized regression weight, .808; P<.001) and receipt of HBCC (standardized regression weight, .444; P<.001). The effect of HBCC on rehabilitation engagement was mediated by patient activation (standardized regression weight, .079; P=.395). One-third of the HBCC group did not show improvement compared with the control group. Thematic analysis identified 3 common barriers to engagement: (1) low self-efficacy because of lack of knowledge and support (62%); (2) anxiety related to fear of movement (57%); and (3) concern about pain management (48%). CONCLUSIONS The influence of HBCC on rehabilitation engagement was mediated by patient activation. Despite improvements in patient activation, one-third of patients reported low rehabilitation engagement. Addressing these barriers should lead to greater improvements in rehabilitation engagement.
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Affiliation(s)
- Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Anica M Maggard
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Li
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lee H Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD
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Rosa JPP, de Souza AAL, de Lima GHO, Rodrigues DF, de Aquino Lemos V, da Silva Alves E, Tufik S, de Mello MT. Motivational and evolutionary aspects of a physical exercise training program: a longitudinal study. Front Psychol 2015; 6:648. [PMID: 26042076 PMCID: PMC4435236 DOI: 10.3389/fpsyg.2015.00648] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 05/03/2015] [Indexed: 11/30/2022] Open
Abstract
Several studies have indicated that motivational level and prior expectations influence one's commitment to physical activity. Moreover, these aspects are not properly described in terms of proximal (SDT, Self Determination Theory) and distal (evolutionary) explanations in the literature. This paper aims to verify if level of motivation (BREQ-2, Behavioral Regulation in Exercise Questionnaire-2) and expectations regarding regular physical exercise (IMPRAF-54) before starting a 1-year exercise program could determine likelihood of completion. Ninety-four volunteers (53 women) included a completed protocol group (CPG; n = 21) and drop-out group (n = 73). The IMPRAF-54 scale was used to assess six different expectations associated with physical activity, and the BREQ-2 inventory was used to assess the level of motivation in five steps (from amotivation to intrinsic motivation). Both questionnaires were assessed before starting a regular exercise program. The CPG group presented higher sociability and lower pleasure scores according to IMPRAF-54 domains. A logistic regression analysis showed that a one-point increment on sociability score increased the chance of completing the program by 10%, and the same one-point increment on pleasure score reduced the chance of completing the protocol by 16%. ROC curves were also calculated to establish IMPRAF-54 cutoffs for adherence (Sociability - 18.5 points - 81% sensibility/50% specificity) and dropout (Pleasure - 25.5 points - 86% sensibility/20% specificity) of the exercise protocol. Our results indicate that an expectation of social interaction was a positive factor in predicting adherence to exercise. Grounded in SDT and its innate needs (competence, autonomy, relatedness), physical exercise is not an end; it is a means to achieve autonomy and self-cohesion. The association of physical activity with social practices, as occurs in hunter-gathering groups, can engage people to be physically active and can provide better results in adherence exercise programs for the general population.
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Affiliation(s)
- João P. P. Rosa
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
- Sport Psychology Laboratory, Universidade Federal de Minas Gerais, Belo HorizonteBrazil
| | - Altay A. L. de Souza
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Center for Communication and Cognitive Science (4C), Escola de Comunicações e Artes, Universidade de São PauloSão Paulo, Brazil
| | | | - Dayane F. Rodrigues
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
| | - Valdir de Aquino Lemos
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
| | - Eduardo da Silva Alves
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
| | - Sergio Tufik
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
| | - Marco T. de Mello
- Department of Psychobiology, Universidade Federal de São PauloSão Paulo, Brazil
- Centro de Estudos em Psicobiologia e ExercícioSão Paulo, Brazil
- Sport Psychology Laboratory, Universidade Federal de Minas Gerais, Belo HorizonteBrazil
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Strohacker K, Galarraga O, Williams DM. The impact of incentives on exercise behavior: a systematic review of randomized controlled trials. Ann Behav Med 2015; 48:92-9. [PMID: 24307474 DOI: 10.1007/s12160-013-9577-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effectiveness of reinforcing exercise behavior with material incentives is unclear. PURPOSE This study aims to conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy. METHODS Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control. RESULTS There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed. CONCLUSIONS The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research.
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Affiliation(s)
- Kelley Strohacker
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, 1914 Andy Holt Ave., 322 HPER Bldg, Knoxville, TN, 37996-2700, USA,
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Skolasky RL, Maggard AM, Li D, Riley LH, Wegener ST. Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes. Arch Phys Med Rehabil 2015; 96:1200-7. [PMID: 25827657 DOI: 10.1016/j.apmr.2015.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. DESIGN Prospective clinical trial. SETTING Academic medical center. PARTICIPANTS From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial. INTERVENTIONS Brief MI-based HBCC versus attention control. MAIN OUTCOME MEASURES Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05). RESULTS Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs .82±.16, respectively; P<.001) and HEP (.65±.23 vs .75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, -12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months. CONCLUSIONS HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
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Affiliation(s)
- Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Anica M Maggard
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Li
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lee H Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD
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Visram S, Bremner AS, Harrington BE, Hawthorne G. Factors affecting uptake of an education and physical activity programme for newly diagnosed type 2 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.97] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Denison E, Vist GE, Underland V, Berg RC. Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect. BMC FAMILY PRACTICE 2014; 15:120. [PMID: 24934215 PMCID: PMC4075600 DOI: 10.1186/1471-2296-15-120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
Background Organised follow-up is a common feature of several strategies at the primary health care level to promote health behaviour change, e.g. to increase physical activity. In Norway, municipal ‘healthy living’ centres run by health care personnel are established to offer counselling and organised follow-up of health behaviour change during a 12-week programme. We report the results of a systematic review commissioned by the Norwegian Directorate of Health concerning organised follow-up to improve physical activity. Methods We searched ten electronic databases up to June 2012, reference lists of included publications, and relevant journals. Study selection and quality risk of bias assessment were carried out independently. Data were synthesised narratively due to heterogeneity of measurements of physical activity. The GRADE approach was used to assess our confidence in the effect estimate for each outcome in each comparison. Results Fourteen randomised controlled trials from seven countries and with a total of 5,002 participants were included in the systematic review. All studies were carried out in primary care or community settings. The interventions comprised referral to supervised group physical activity (2 studies), referral to local resources with follow-up (6 studies), and self-organised physical activity with follow-up (6 studies). The narrative synthesis, comprising a total of 39 comparisons, indicated effects of self-organised physical activity with follow-up (compared to both advice and no treatment) and referral to local resources with follow-up (compared to advice) in some of the comparisons where we rated our confidence in the effect estimates as moderate. However, the results indicated no difference between intervention and control groups for the majority of comparisons. Follow-up in the studies was mainly short-term with the longest follow-up 9 months post-treatment. We rated our confidence in the effect estimates as low or very low in most comparisons, both for positive and neutral results. Conclusions The results of this systematic review indicate considerable uncertainty concerning effects of organised follow-up during 10–14 weeks on physical activity. Major methodological problems concerning the measurement of physical activity are discussed. Trial registration Systematic review registration: PROSPERO CRD42011001598.
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Affiliation(s)
- Eva Denison
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
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Dunhill D, Schmidt S, Klein R. Motivational interviewing interventions in graduate medical education: a systematic review of the evidence. J Grad Med Educ 2014; 6:222-36. [PMID: 24949125 PMCID: PMC4054720 DOI: 10.4300/jgme-d-13-00124.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/21/2013] [Accepted: 11/25/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial. OBJECTIVE To review the current evidence regarding the impact of MI education in graduate medical education. RESULTS Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures. CONCLUSIONS Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.
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Batliner T, Fehringer KA, Tiwari T, Henderson WG, Wilson A, Brega AG, Albino J. Motivational interviewing with American Indian mothers to prevent early childhood caries: study design and methodology of a randomized control trial. Trials 2014; 15:125. [PMID: 24735707 PMCID: PMC4011767 DOI: 10.1186/1745-6215-15-125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/31/2014] [Indexed: 11/20/2022] Open
Abstract
Background This randomized control trial assesses the effectiveness of motivational interviewing (MI) to encourage behavior change in new mothers relating to caries prevention when caring for their newborn American Indian (AI) infants and young AI children. Methods/Design The study is a randomized control trial. We hypothesize that when motivational interviewing is added to enhanced community oral health education services, the new mothers will achieve greater reduction of caries experience in their AI children compared to those who are receiving enhanced community services (ECS) alone. Six hundred mothers or caregivers of AI newborns will be enrolled into the study and randomized to one of the two intervention groups over a two-year period. The children will be followed until the child’s third birthday. A cost analysis of the study is being conducted in tandem with the enhanced community services, motivational interviewing behavioral interventions, and the dental screenings for the length of the study. Discussion The trial is now in the implementation phase and a number of threats to successful completion, such as recruitment and retention challenges in a vast, rural geographic area, have been addressed. The protocol provides a unique model for oral health interventions using principles of community-based participatory research and is currently on schedule to meet study objectives. If the study is successful, motivational interviewing intervention can be applied in AI communities to reduce ECC disparities in this disadvantaged population, with study of further applicability in other populations and settings. Trial registration ClinicalTrials.gov,
NCT01116726.
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Affiliation(s)
- Terrence Batliner
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, 13055 E, 17th Avenue, Aurora, CO 80045, USA.
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Meredith SE, Jarvis BP, Raiff BR, Rojewski AM, Kurti A, Cassidy RN, Erb P, Sy JR, Dallery J. The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. Psychol Res Behav Manag 2014; 7:103-14. [PMID: 24672264 PMCID: PMC3964160 DOI: 10.2147/prbm.s59792] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior.
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Affiliation(s)
- Steven E Meredith
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brantley P Jarvis
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - Alana M Rojewski
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Allison Kurti
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Rachel N Cassidy
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Philip Erb
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Jolene R Sy
- Saint Louis University School of Social work, St Louis, MO, USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Weinstock J, Capizzi J, Weber SM, Pescatello LS, Petry NM. Exercise as an intervention for sedentary hazardous drinking college students: A pilot study. Ment Health Phys Act 2014; 7:55-62. [PMID: 24949085 PMCID: PMC4058428 DOI: 10.1016/j.mhpa.2014.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young adults 18-24 years have the highest rates of problems associated with alcohol use among all age groups, and substance use is inversely related to engagement in substance-free activities. This pilot study investigated the promotion of one specific substance-free activity, exercise, on alcohol use in college students. Thirty-one sedentary college students who engaged in hazardous drinking (Alcohol Use Disorders Identification Test scores ≥ 8) were randomized to one of two conditions: (a) one 50-minute session of motivational enhancement therapy (MET) focused on increasing exercise, or (b) one 50-minute session of MET focused on increasing exercise plus 8 weeks of contingency management (CM) for adhering to specific exercise activities. All participants completed evaluations at baseline and post-treatment (2-months later) assessing exercise participation and alcohol use. Results of the pilot study suggest the interventions were well received by participants, the MET+CM condition showed an increased self-reported frequency of exercise in comparison to the MET alone condition, but other indices of exercise, physical fitness, and alcohol use did not differ between the interventions over time. These results suggest that a larger scale trial could better assess efficacy of this well received combined intervention. Investigation in other clinically relevant populations is also warranted.
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Affiliation(s)
- Jeremiah Weinstock
- Department of Psychology, Saint Louis University, St. Louis, MO 63103
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030-3944
| | - Jeffrey Capizzi
- Department of Kinesiology, Neag School of Education, University of Connecticut, Storrs, CT 06269-1110
| | - Stefanie M. Weber
- Department of Psychology, Saint Louis University, St. Louis, MO 63103
| | - Linda S. Pescatello
- Department of Kinesiology, Neag School of Education, University of Connecticut, Storrs, CT 06269-1110
| | - Nancy M. Petry
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030-3944
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Milkman KL, Minson JA, Volpp KGM. Holding the Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling. MANAGEMENT SCIENCE 2014; 60:283-299. [PMID: 25843979 PMCID: PMC4381662 DOI: 10.1287/mnsc.2013.1784] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We introduce and evaluate the effectiveness of temptation bundling-a method for simultaneously tackling two types of self-control problems by harnessing consumption complementarities. We describe a field experiment measuring the impact of bundling instantly gratifying but guilt-inducing "want" experiences (enjoying page-turner audiobooks) with valuable "should" behaviors providing delayed rewards (exercising). We explore whether such bundles increase should behaviors and whether people would pay to create these restrictive bundles. Participants were randomly assigned to a full treatment condition with gym-only access to tempting audio novels, an intermediate treatment involving encouragement to restrict audiobook enjoyment to the gym, or a control condition. Initially, full and intermediate treatment participants visited the gym 51% and 29% more frequently, respectively, than control participants, but treatment effects declined over time (particularly following Thanksgiving). After the study, 61% of participants opted to pay to have gym-only access to iPods containing tempting audiobooks, suggesting demand for this commitment device.
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Affiliation(s)
- Katherine L Milkman
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania 19104,
| | - Julia A Minson
- The Harvard Kennedy School, Harvard University, Cambridge, Massachusetts 02138,
| | - Kevin G M Volpp
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania 19104,
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Aloia MS, Arnedt JT, Strand M, Millman RP, Borrelli B. Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2013; 36:1655-62. [PMID: 24179298 DOI: 10.5665/sleep.3120] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP. METHOD Two hundred twenty-seven patients with OSA were randomized to standard care (SC), education (ED) and motivational enhancement therapy (MET). Adherence was measured objectively and the first week of adherence (prior to the intervention) was used as an a priori moderator of the effect of the various interventions. Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy. RESULTS Adherence declined over time for all three groups. There was a significant interaction between level of adherence during the first week of treatment and treatment group. Those who had moderate levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had MET; those who had high levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had ED. MET treatment increased the perception of the positive aspects of PAP, but ED did not. CONCLUSIONS Initial adherence to positive airway pressure could help guide subsequent treatment plans. The results also support social cognitive theory in that educational approaches might be best suited for those who are ready for change whereas more motivational approaches might be best for those who are ambivalent about change.
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Affiliation(s)
- Mark S Aloia
- Department of Medicine, National Jewish Health, Denver, CO
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Barkhof E, Meijer CJ, de Sonneville LMJ, Linszen DH, de Haan L. The effect of motivational interviewing on medication adherence and hospitalization rates in nonadherent patients with multi-episode schizophrenia. Schizophr Bull 2013; 39:1242-51. [PMID: 24072808 PMCID: PMC3796095 DOI: 10.1093/schbul/sbt138] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Medication nonadherence in patients with schizophrenia presents a serious clinical problem. Research on interventions incorporating motivational interviewing (MI) to improve adherence have shown mixed results. AIMS Primary aim is to determine the effectiveness of a MI intervention on adherence and hospitalization rates in patients, with multi-episode schizophrenia or schizoaffective disorder, who have experienced a psychotic relapse following medication nonadherence. Secondary aim is to evaluate whether MI is more effective in specific subgroups. METHODS We performed a randomized controlled study including 114 patients who experienced a psychotic relapse due to medication nonadherence in the past year. Participants received an adapted form of MI or an active control intervention, health education (HE). Both interventions consisted of 5-8 sessions, which patients received in adjunction to the care as usual. Patients were assessed at baseline and at 6 and 12 months follow-up. RESULTS Our results show that MI did not improve medication adherence in previously nonadherent patients who experienced a psychotic relapse. Neither were there significant differences in hospitalization rates at follow-up between MI and HE (27% vs 40%, P = .187). However, MI resulted in reduced hospitalization rates for female patients (9% vs 63%, P = .041), non-cannabis users (20% vs 53%, P = .041), younger patients (14% vs 50%, P = .012), and patients with shorter illness duration (14% vs 42%, P = .040). CONCLUSIONS Targeted use of MI may be of benefit for improving medication adherence in certain groups of patients, although this needs further examination.
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Affiliation(s)
- Emile Barkhof
- *To whom correspondence should be addressed; Department of Psychiatry, Academic Medical Centre, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands; tel: 31-20-8913500, fax: 31-20-8913702, e-mail:
| | - Carin J. Meijer
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Leo M. J. de Sonneville
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands
| | - Don H. Linszen
- Department of Psychiatry, Academic Hospital Maastricht, Maastricht, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
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F. Moore G, Raisanen L, Moore L, Ud Din N, Murphy S. Mixed-method process evaluation of the Welsh National Exercise Referral Scheme. HEALTH EDUCATION 2013. [DOI: 10.1108/he-08-2012-0046] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev 2013; 9:CD010395. [PMID: 24085594 PMCID: PMC9674455 DOI: 10.1002/14651858.cd010395.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown. OBJECTIVES To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated. MAIN RESULTS A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not. AUTHORS' CONCLUSIONS We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.
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Affiliation(s)
- Charles Foster
- University of OxfordBritish Heart Foundation Health Promotion Research Group, Nuffield Department of Population HealthOld Road CampusHeadingtonOxfordUKOX3 7LF
| | - Justin Richards
- University of OxfordBritish Heart Foundation Health Promotion Research Group, Nuffield Department of Population HealthOld Road CampusHeadingtonOxfordUKOX3 7LF
| | - Margaret Thorogood
- Division of Health SciencesPublic Health and EpidemiologyWarwick Medical School, University of WarwickGibbet HillCoventryUKCV4 7AL
| | - Melvyn Hillsdon
- University of ExeterSchool of Sport and Health SciencesSt Luke's CampusExeterUKEX1 2LU
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Abstract
BACKGROUND Face-to-face interventions for promoting physical activity (PA) are continuing to be popular but their ability to achieve long term changes are unknown. OBJECTIVES To compare the effectiveness of face-to-face interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control exposed to placebo or no or minimal intervention. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared face-to-face PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using face-to-face methods. To assess behavioural change over time the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the quality of each study and extracted data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios (ORs) and 95% CIs were calculated. MAIN RESULTS A total of 10 studies recruiting 6292 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of interventions on self-reported PA at one year (eight studies; 6725 participants) was positive and moderate with significant heterogeneity (I² = 74%) (SMD 0.19; 95% CI 0.06 to 0.31; moderate quality evidence) but not sustained in three studies at 24 months (4235 participants) (SMD 0.18; 95% CI -0.10 to 0.46). The effect of interventions on cardiovascular fitness at one year (two studies; 349 participants) was positive and moderate with no significant heterogeneity in the observed effects (SMD 0.50; 95% CI 0.28 to 0.71; moderate quality evidence). Three studies (3277 participants) reported a positive effect on increasing PA levels when assessed as a dichotomous measure at 12 months, but this was not statistically significant (OR 1.52; 95% CI 0.88 to 2.61; high quality evidence). Although there were limited data, there was no evidence of an increased risk of adverse events (one study; 149 participants). Risk of bias was assessed as low (four studies; 4822 participants) or moderate (six studies; 1543 participants). Any conclusions drawn from this review require some caution given the significant heterogeneity in the observed effects. Despite this, there was some indication that the most effective interventions were those that offered both individual and group support for changing PA levels using a tailored approach. The long term impact, cost effectiveness and rates of adverse events for these interventions was not established because the majority of studies stopped after 12 months. AUTHORS' CONCLUSIONS Although we found evidence to support the effectiveness of face-to-face interventions for promoting PA, at least at 12 months, the effectiveness of these interventions was not supported by high quality studies. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions, and assess impact on quality of life, adverse events and economic data.
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Richards J, Thorogood M, Hillsdon M, Foster C. Face-to-face versus remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev 2013; 2013:CD010393. [PMID: 24085593 PMCID: PMC8475768 DOI: 10.1002/14651858.cd010393.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Face-to-face interventions for promoting physical activity (PA) are continuing to be popular as remote and web 2.0 approaches rapidly emerge, but we are unsure which approach is more effective at achieving long term sustained change. OBJECTIVES To compare the effectiveness of face-to-face versus remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above). SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. SELECTION CRITERIA Randomised trials that compared face-to-face versus remote and web 2.0 PA interventions for community dwelling adults. We included studies if they compared an intervention that was principally delivered face-to-face to an intervention that had principally remote and web 2.0 methods. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for continuous measures of cardio-respiratory fitness. MAIN RESULTS One study recruiting 225 apparently healthy adults met the inclusion criteria. This study took place in a high-income country. From 27,299 hits, the full texts of 193 papers were retrieved for examination against the inclusion criteria. However, there was only one paper that met the inclusion criteria. This study reported the effect of a PA intervention on cardio-respiratory fitness. There were no reported data for PA, quality of life, or cost effectiveness. The difference between the remote and web 2.0 versus face-to-face arms was not significant (SMD -0.02; 95% CI -0.30 to 0.26; high quality evidence). The risk of bias in the included study was assessed as low, and there was no evidence of an increased risk of adverse events. AUTHORS' CONCLUSIONS There is insufficient evidence to assess whether face-to-face interventions or remote and web 2.0 approaches are more effective at promoting PA.
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Bóveda Fontán J, Pérula de Torres LÁ, Campiñez Navarro M, Bosch Fontcuberta JM, Barragán Brun N, Prados Castillejo JA. [Current evidence on the motivational interview in the approach to health care problems in primary care]. Aten Primaria 2013; 45:486-95. [PMID: 24042074 PMCID: PMC6985504 DOI: 10.1016/j.aprim.2013.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/08/2013] [Accepted: 01/18/2013] [Indexed: 11/30/2022] Open
Abstract
La entrevista motivacional ha sido ampliamente desarrollada como método clínico para promover en los pacientes cambios de conducta, ayudando a resolver su ambivalencia para obtener sus propias motivaciones. En el presente artículo ofrecemos una revisión de los principales metaanálisis y revisiones, tanto sistemáticas como narrativas, sobre la eficacia de la entrevista motivacional, centrándonos en el ámbito de la atención primaria de salud.
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Young TL, Gutierrez D, Hagedorn WB. Does Motivational Interviewing (MI) Work With Nonaddicted Clients? A Controlled Study Measuring the Effects of a Brief Training in MI on Client Outcomes. JOURNAL OF COUNSELING AND DEVELOPMENT 2013. [DOI: 10.1002/j.1556-6676.2013.00099.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Daniel Gutierrez
- Department of Educational and Human Sciences; University of Central Florida
| | - W. Bryce Hagedorn
- Department of Educational and Human Sciences; University of Central Florida
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Drury VB, Saw SM, Finkelstein E, Wong TY, Tay PKC. A New Community-Based Outdoor Intervention to Increase Physical Activity in Singapore Children: Findings from Focus Groups. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n5p225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Myopia is a significant public health problem in Singapore with estimates that more than 50% of the population is affected by it by the time of adulthood. Childhood obesity is also increasing and has been linked to long-term health problems. Recent studies have found that Singaporean children in Primary 1 spend less than 3 hours a day outdoors which is less than children in other countries. Physical activity has been shown to be protective against obesity and recently, there has been some evidence to suggest that time spent outdoors may reduce the prevalence and severity of myopia. This study aims to explore the barriers and enablers to children in Singapore participating in outdoor activities. Materials and Methods: Qualitative data, gathered from focus group discussions was thematically analysed against the PRECEDE component of the PRECEDE-PROCEED model which provided a conceptual framework for examining factors relevant to children participating in an outdoor activity intervention. A total of 31 people participated in 4 focus groups held over a 6-month period. Results: This feasibility study was exploratory in nature but provided valuable information concerning barriers and enablers to participation. Data informed the development of a larger study. Conclusion: Results indicated that families preferred structured activities such as orienteering and a choice of weekend attendance days and times.
Key words: Myopia, Physical activity, Qualitative research, Singapore
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Affiliation(s)
- Vicki B Drury
- Faculty of Health Sciences, School of Nursing and Midwifery University, Australia
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Tien Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter KC Tay
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Maciejewski ML, Yancy WS, Olsen M, Weidenbacher HJ, Abbott D, Weinberger M, Datta S, Kahwati LC. Demand for weight loss counseling after copayment elimination. Prev Chronic Dis 2013; 10:E49. [PMID: 23557640 PMCID: PMC3617989 DOI: 10.5888/pcd10.120163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight loss clinic by veterans. METHODS We examined clinic use by 44,411 new patients seen in a Veterans Affairs (VA) MOVE! weight management clinic before the copayment elimination and clinic use by 64,398 new patients seen in the year after copayment elimination. We examined clinic use via mixed-effects models for patients who were already exempt from copayment and patients who were newly exempt from copayment. We used 2 outcomes before and after copayment elimination: 1) the ratio of number of clinic visits by new users with the mean number of MOVE! clinic visits by all users, and 2) the number of clinic visits by each new user in the 6 months after their first visit. All models were adjusted for patient and clinic factors. RESULTS Among newly exempt patients, the clinic-standardized rate of new use increased by 2.2% after the copayment was eliminated but increased 12% among already exempt veterans. This finding was confirmed in adjusted analyses. Analysis of number of clinic visits adjusted for patient and clinic factors also found that exempt and nonexempt veterans had similar numbers of repeat clinic visits. CONCLUSION We saw an unexpected larger increase in demand among veterans who receive all VA care for free. These results suggest that VA should not assume that copayment reductions for selective preventive services will motivate patient change and achieve intended system-level outcomes.
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Affiliation(s)
- Matthew L Maciejewski
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA.
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Eeckhout C, Francaux M, Philippot P. Mesure des processus de changement vis-à-vis de la pratique d’une activité physique régulière (QPC) : adaptation et validation francophone du questionnaire Exercise processes of change. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vähäsarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Korpi-Hyövälti E, Kujala UM, Moilanen L, Niskanen L, Oksa H, Poskiparta M. Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes: a cross-sectional analysis within a community-based diabetes prevention project FIN-D2D. BMC Public Health 2012; 12:514. [PMID: 22781026 PMCID: PMC3506518 DOI: 10.1186/1471-2458-12-514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals' perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes. METHODS Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis. RESULTS 74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants' perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants. CONCLUSIONS Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.
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Affiliation(s)
- Kati Vähäsarja
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012; 35:318-33. [PMID: 22476812 DOI: 10.1007/s10865-012-9417-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
Little research exists on the impact of behavior change interventions in disadvantaged communities. We conducted a prospective study to explore the effectiveness of motivational interviewing on physical activity change within a deprived community and the social- psychological and motivational predictors of change in physical activity including stage of change, self-efficacy, social support, and variables from self-determination theory and the theory of planned behavior. Five motivational interviewing counsellors recruited 207 patients and offered motivational interviewing sessions to support physical activity behavior change. At 6-months there were significant improvements in physical activity, stage of change, and social support. A dose-response relationship was evident; those who attended 2 or more consultations increased their total physical activity, stage of change and family social support more than those who attended just one. Hierarchical regression analyses indicated that number of sessions and change in stage of change predicted 28.4% of the variance in change in total physical activity and, with social support from friends, 21.0% of the variance in change walking time. Change in perceived behavioral control and attitudes, friend social support, and number of sessions predicted 16.8% of the variance in change in vigorous physical activity. Motivational interviewing is an effective approach for promoting physical activity amongst lower socio-economic status groups in the short term. The study demonstrates good translational efficacy, and contributes to a limited number of physical activity interventions targeting low income groups in the UK.
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