Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial   Commentary: Treatment allocation by the method of minimisation

Abstract

Objective To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease. Design Cluster randomised controlled trial. Participants 883 men and women selected for the presence of one or more modifiable risk factors: regular cigarette smoking, high serum cholesterol concentration (6.5-9.0 mmol/l), and high body mass index (25-35) combined with low physical activity. Intervention Brief behavioural counselling, on the basis of the stage of change model, carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity. Main outcome measures Questionnaire measures of diet, exercise, and smoking habits, and blood pressure, serum total cholesterol concentration, weight, body mass index, and smoking cessation (with biochemical validation) at 4 and 12 months. Results Favourable differences were recorded in the intervention group for dietary fat intake, regular exercise, and cigarettes smoked per day at 4 and 12 months. Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months. No differences were found between groups in changes in total serum cholesterol concentration, weight, body mass index, diastolic pressure, or smoking cessation. Conclusions Brief behavioural counselling by practice nurses led to improvements in healthy behaviour. More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge.

The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease

“…11 The power of the study was insufficient to detect differences in smoking cessation, although the self-reported reduction in the number of cigarettes smoked was greater in the behavioral intervention group. The present results corroborate these differences in behavioral response by demonstrating that the likelihood of attaining the target stage of change in fat intake and physical activity was greater for the behavioral intervention group than for the control group at both 4 months and 12 months.…”

“…[8][9][10] The behavioral and biological risk factor results of this study, which have been described elsewhere, show greater reductions in fat intake and the number of cigarettes smoked and greater increases in physical activity in the behavioral intervention group than in the control group at 4 and 12 months. 11 In this article, we present stage of change outcomes in the study and address (1) whether behavioral intervention was more effective than normal practice in achieving the target stage (action/maintenance), (2) whether the likelihood of achieving the target stage for each behavior varied with initial stage, and (3) whether any advantage of behavioral intervention was equally evident for patients at different stages of readiness at baseline.…”

Potentials and pitfalls for nutrition counselling in general practice

“…Tailoring nutrition counselling to the stages of change has been suggested to increase programme effectiveness (Ashworth, 1997;Kristal et al, 1999;Steptoe et al, 1999Steptoe et al, , 2001. Although some studies have shown favourable results of stage-matched nutrition counselling (Campbell et al, 1994;Steptoe et al, 1999Steptoe et al, , 2001Tilley et al, 1999;Van der Veen et al, 2002), the principle of stage-matched approaches in nutrition counselling is not undisputed.…”

Efficacy of multifactorial lifestyle interventions in patients with established cardiovascular diseases and high risk groups

“…In a short (two or three counseling sessions) lifestyle intervention in England in almost 900 men and women 25 , after 12 months, lifestyle was still improved (dietary fat intake, regular exercise and cigarettes smoked per day) but there was no difference in levels of biological risk factors (blood pressure, body weight and serum cholesterol) between the intervention group and control group.…”