Kinmonth Ann-Louise, Wareham Nicholas J, Hardeman Wendy, Sutton Stephen, Prevost A Toby, Fanshawe Tom, Williams Kate M, Ekelund Ulf, Spiegelhalter David, Griffin Simon J
General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
Lancet. 2008 Jan 5;371(9606):41-8. doi: 10.1016/S0140-6736(08)60070-7.
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.
身体活动减少与全球疾病负担增加相关。扭转这一趋势的努力尚未成功。我们旨在评估一种促进性的行为干预措施对增加有糖尿病家族风险的久坐不动个体身体活动的效果。
我们招募了365名有2型糖尿病家族病史的久坐不动的成年人。他们是从英国20家全科诊所的糖尿病或家族病史登记册中招募的。符合条件的参与者被随机分配到两个干预组之一，或一个对照组。所有参与者都收到了一份简短的建议传单。一个干预组接受为期1年的行为改变计划，由经过培训的促进者在参与者家中实施，另一个干预组通过电话接受相同的计划。该计划旨在改变由计划行为理论定义的行为决定因素，并教授行为改变策略。1年时的主要结局是白天的身体活动，通过与静息能量消耗的比值进行客观测量。分析采用意向性分析。本研究已注册为ISRCTN61323766。
在365名患者中，我们分析了321名（88%）患者的主要终点，这些患者在随访1年后有数据。1年时，通过任何一种实施途径接受干预的参与者的身体活动比值与收到简短建议传单的参与者的比值没有差异。调整基线后的白天身体活动比值的平均差异为-0.04（95%置信区间-0.16至0.08）。面对面或通过电话接受干预的参与者之间的身体活动比值没有差异（平均差异-0.05；95%置信区间-0.19至0.10）。
基于理论的促进性行为干预在促进高危人群身体活动方面并不比建议传单更有效；因此，医疗保健提供者在将行为计划纳入个体预防性医疗保健服务时应保持谨慎。
