Efficacy of a theory-based behavioural intervention to increase physical activity in an at-risk group in primary care (ProActive UK): A randomised trial

General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
The Lancet (Impact Factor: 45.22). 02/2008; 371(9606):41-8. DOI: 10.1016/S0140-6736(08)60070-7
Source: PubMed


Declining physical activity is associated with a rising burden of global disease. Efforts to reverse this trend have not been successful. We aimed to assess the efficacy of a facilitated behavioural intervention to increase the physical activity of sedentary individuals at familial risk of diabetes.
We enrolled 365 sedentary adults who had a parental history of type 2 diabetes. They were recruited from either diabetes or family history registers at 20 general practice clinics in the UK. Eligible participants were randomly assigned to one of two intervention groups, or to a comparison group. All participants were posted a brief advice leaflet. One intervention group was offered a 1-year behaviour-change programme, to be delivered by trained facilitators in participants' homes, and the other the same programme by telephone. The programme was designed to alter behavioural determinants, as defined by the theory of planned behaviour, and to teach behaviour-change strategies. The principal outcome at 1 year was daytime physical activity, which was objectively measured as a ratio to resting energy expenditure. Analysis was by intention to treat. This study is registered as ISRCTN61323766.
Of 365 patients, we analysed primary endpoints for 321 (88%) for whom we had data after 1 year of follow-up. At 1 year, the physical-activity ratio of participants who received the intervention, by either delivery route, did not differ from the ratio in those who were given a brief advice leaflet. The mean difference in daytime physical-activity ratio, adjusted for baseline, was -0.04 (95% CI -0.16 to 0.08). The physical-activity ratio did not differ between participants who were delivered the intervention face-to-face or by telephone (mean difference -0.05; 95% CI -0.19 to 0.10).
A facilitated theory-based behavioural intervention was no more effective than an advice leaflet for promotion of physical activity in an at-risk group; therefore health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services.

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    • "Individual−level SES x intention effect size Griffin 2011 Watkinson 2010 Kinmonth 2008 Godino 2012 Marteau 2012 478 544 365 569 633 0.15 [ –0.24 , 0.54 ] –0.14 [ –0.43 , 0.15 ] –0.28 [ –0.75 , 0.20 ] 0.06 [ –0.16 , 0.27 ] –0.01 [ –0.26 , 0.23 ] –0.01 [ –0.14 , 0.11 ] "
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    ABSTRACT: Objectives Unhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self-report measures of three behaviours, both individual- and area-level indices of socio-economic status, and pooling data from five studies. DesignSecondary data analysis. Methods Multiple linear regressions and meta-analyses of data on physical activity,diet, and medication adherence in smoking cessation from 2,511 participants. ResultsAcross five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self-report measures of behaviour. Using objectively measured behaviour and area-level deprivation, meta-analyses suggested that the gap between self-efficacy and behaviour was greater amongst the more deprived (B=.17 [95% CI=0.02, 0.31]). Conclusions We find no compelling evidence to support the hypothesis that the intention-behaviour gap is greater amongst the more deprived.
    Full-text · Article · Aug 2015 · British Journal of Health Psychology
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    • "However, while intensive lifestyle intervention may prevent the progression from pre-diabetes to diabetes, once a patient is diagnosed with type 2 diabetes, interventions such as diet, exercise, and weight loss do not appear to be effective in reducing cardiovascular morbidity and mortality (Look AHEAD Research Group, 2013). Additionally, the most effective behavioral intervention techniques aimed at increasing physical activity among Type 2 diabetics have yet to be elucidated (Kinmonth et al., 2008). Nonetheless, early lifestyle intervention in those with pre-diabetes may represent a window of opportunity for health improvement before the irreversible effects of diabetes set in. "
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    ABSTRACT: The prevalence of pre-diabetes (PD) among US adults has increased substantially over the past two decades. By current estimates, over 34% of US adults fall in the PD category, 84% of whom meet the American Diabetes Association's criteria for impaired fasting glucose (IFG). Low physical activity (PA) and/or sedentary behavior are key drivers of hyperglycemia. We examined the relationship between PD and objectively measured PA in NHANES 2003-2006 of 20,470 individuals, including 7,501 individuals between 20 and 65 yrs.We excluded all participants without IFG measures or adequate accelerometry data (final N = 1,317). Participants were identified as PD if FPG was 100-125 mg/dL (5.6-6.9 mmol/L). Moderate and vigorous PA in minutes/day individuals were summed to create the exposure variable "moderate-vigorous PA" (MVPA). The analysis sample included 884 normoglycemic persons and 433 with PD. There were significantly fewer PD subjects in the middle (30.3%) and highest (24.6%) tertiles of PA compared to the lowest tertile (35.5%). After adjusting for BMI, participants were 0.77 times as likely to be PD if they were in the highest tertile compared to the lowest PA tertile (p < 0.001). However, these results were no longer significant when age and BMI were held constant. Univariate analysis revealed that physical activity was associated with decreased fasting glucose of 0.5 mg/dL per minute of MVPA, but multivariate analysis adjusting for age and BMI was not significant. Overall, our data suggest a negative association between measures of PA and the prevalence of PD in middle-aged US adults independent of adiposity, but with significant confounding influence from measures of BMI and age.
    Full-text · Article · Aug 2014 · PeerJ
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    • "[44] or 12 months e.g. [45]. We did not, however, come across studies that evaluated interventions that corresponded to the flexibility offered in healthy lifestyle centres. "
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    ABSTRACT: 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. 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. 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. 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.
    Full-text · Article · Jun 2014 · BMC Family Practice
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