A novel approach to increasing community capacity for weight management a volunteer-delivered programme (ActWELL) initiated within breast screening clinics: a randomised controlled trial

Abstract

Background It is estimated that around 30% of breast cancers in post-menopausal women are related to lifestyle. The breast cancer-pooling project demonstrated that sustained weight loss of 2 to 4.5 kg is associated with an 18% lower risk of breast cancer, highlighting the importance of small changes in body weight. Our study aimed to assess the effectiveness a volunteer-delivered, community based, weight management programme (ActWELL) for women with a BMI > 25 kg/m2 attending NHS Scotland Breast Screening clinics. Methods A multicentre, 1:1 parallel group, randomised controlled trial was undertaken in 560 women aged 50 to 70 years with BMI > 25 kg/m2. On completion of baseline measures, all participants received a breast cancer prevention leaflet. Intervention group participants received the ActWELL intervention which focussed on personalised diet advice and pedometer walking plans. The programme was delivered in leisure centres by (the charity) Breast Cancer Now volunteer coaches. Primary outcomes were changes between groups at 12 months in body weight (kg) and physical activity (accelerometer measured step count). Results Two hundred seventy-nine women were allocated to the intervention group and 281 to the comparison group. Twelve-month data were available from 240 (81%) intervention and 227 (85%) comparison group participants. Coaches delivered 523 coaching sessions and 1915 support calls to 279 intervention participants. Mean weight change was − 2.5 kg (95% CI − 3.1 to − 1.9) in the intervention group and − 1.2 kg (− 1.8 to 0.6) in the comparison group. The adjusted mean difference was − 1.3 kg (95% CI − 2.2 to − 0.4, P = 0.003). The odds ratio for losing 5% weight was 2.20 (95% CI 1.4 to 3.4, p = 0.0005) in favour of the intervention. The adjusted mean difference in step counts between groups was 483 steps/day (95% CI − 635 to 1602) (NS). Conclusions A community weight management intervention initiated at breast screening clinics and delivered by volunteer coaches doubled the likelihood of clinically significant weight loss at 12 months (compared with usual care) offering significant potential to decrease breast cancer risk. Trial registration Database of registration: ISCRTN. Registration number:11057518. Date trial registered:21.07.2017. Date of enrolment of first participant: 01.09.2017.

“Whilst you are here…” Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme

“…Existing interventions that have utilized the breast cancer screening programme as a teachable moment have focused on early detection of breast cancer by raising awareness and encouraging early presentation of symptoms 21 or prevention. 22 The current study extends this by considering the early detection of different cancers. The high levels of willingness and acceptability are promising and comparable to previous findings that have looked into willingness to receive lifestyle advice as part of screening programmes.…”

“…Women would prefer such advice to be provided through a leaflet or discussion with the mammographer at the breast cancer screening appointment although some would prefer the information to be provided before the appointment or with their breast screening results. Existing interventions that have utilized the breast cancer screening programme as a teachable moment have focused on early detection of breast cancer by raising awareness and encouraging early presentation of symptoms 21 or prevention 22 . The current study extends this by considering the early detection of different cancers.…”

Effectiveness of physical activity monitors in adults: systematic review and meta-analysis

“…We included 38 studies including results on 5634 participants in the meta-analysis on sedentary time. 13 22 23 64 66 67 70 73 82 87 92 93 94 98 99 103 105 113 114 116 117 119 121 126 127 128 130 143 146 149 152 153 155 157 160 162 163 172 The overall standardised mean difference was −0.12 (−0.25 to 0.01; I 2 =66%), favouring the PAM intervention as the intervention groups were less sedentary. When we transformed the standardised mean difference to a weighted mean difference of daily sedentary minutes using a median standard deviation of 87.2 minutes, the pooled effect equated to 9.9 (−0.8 to 21.8) daily minutes of sedentary time less in the intervention groups.…”

Letter on “Sharing trial results directly with trial participants and other stakeholders after the SARS-CoV-2 pandemic hit the UK – experience from the ActWELL trial”

“…Following this guidance, the ActWELL (ISRCTN11057518) 2 trial team planned to share the trial's results with participants. The ActWELL trial results were published in March 2021 3 .…”