Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Heart. 2020 Mar;106(6):447-454. doi: 10.1136/heartjnl-2019-315656. Epub 2019 Dec 12.
The epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD.
A three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40-74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention.
At 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI -288.00 to 147.90 and mean difference=7.24 steps, 95% CI -224.01 to 238.50, respectively), reducing weight (mean difference=-0.03 kg, 95% CI -0.49 to 0.44 and mean difference=-0.42 kg, 95% CI -0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds.
Enhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.
肥胖症的流行导致心血管疾病（CVD）高危人群的患病率不断上升，抵消了降低 CVD 死亡率的医学进步。我们比较了强化生活方式干预的临床和成本效益，该干预措施包括增强动机访谈，以降低体重和增加心血管疾病高危患者的身体活动。
在伦敦南部的同意参与的初级保健中心进行了一项三臂、单盲、平行组随机对照试验。我们招募了 QRisk2 评分≥20.0%的 40-74 岁患者，该评分表示未来 10 年内发生 CVD 事件的概率。干预措施是增强动机访谈，包括额外的行为改变技术，并由健康教练在 1 年内进行 10 次，分为团体（n=697）或个人（n=523）形式。第三组接受常规护理（UC；n=522）。主要结局是身体活动（平均每日步数）和体重（kg）。次要结局是低密度脂蛋白胆固醇和 CVD 风险评分的变化。我们估计了每种干预措施的相对成本效益。
在 24 个月时，与 UC 相比，团体和个人干预措施在增加身体活动方面并没有更有效（平均差异=70.05 步，95%置信区间-288.00 至 147.90；平均差异=7.24 步，95%置信区间-224.01 至 238.50），减轻体重（平均差异=-0.03kg，95%置信区间-0.49 至 0.44；平均差异=-0.42kg，95%置信区间-0.93 至 0.09）或改善任何次要结局。在常规阈值下，团体和个人干预措施均不具有成本效益。
在心血管疾病高危人群中，增强动机访谈并辅以额外的行为改变技术并没有有效地减轻体重或增加身体活动。
