Effectiveness and cost-effectiveness of 'BeweegKuur', a combined lifestyle intervention in the Netherlands: Rationale, design and methods of a randomized controlled trial

Abstract

BackgroundImproving the lifestyle of overweight and obese adults is of increasing interest in view of its role in several chronic diseases. Interventions aiming at overweight or weight-related chronic diseases suffer from high drop-out rates. It has been suggested that Motivational Interviewing and more frequent and more patient-specific coaching could decrease the drop-out rate. 'BeweegKuur' is a multidisciplinary lifestyle intervention which offers three programmes for overweight persons. The effectiveness and the cost-effectiveness of intensively guided programmes, such as the 'supervised exercise programme' of 'BeweegKuur', for patients with high weight-related health risk, remain to be assessed. Our randomized controlled trial compares the expenses and effects of the 'supervised exercise programme' with those of the less intensively supervised 'start-up exercise programme'.Methods/DesignThe one-year intervention period involves coaching by a lifestyle advisor, a physiotherapist and a dietician, coordinated by general practitioners (GPs). The participating GP practices have been allocated to the interventions, which differ only in terms of the amount of coaching offered by the physiotherapist. Whereas the 'start-up exercise programme' includes several consultations with physiotherapists to identify barriers hampering independent exercising, the 'supervised exercise programme' includes more sessions with a physiotherapist, involving exercise under supervision. The main goal is transfer to local exercise facilities. The main outcome of the study will be the participants' physical activity at the end of the one-year intervention period and after one year of follow-up. Secondary outcomes are dietary habits, health risk, physical fitness and functional capacity. The economic evaluation will consist of a cost-effectiveness analysis and a cost-utility analysis. The primary outcome measures for the economic evaluation will be the physical activity and the number of quality-adjusted life years. Costs will be assessed from a societal perspective with a time horizon of two years. Additionally, a process evaluation will be used to evaluate the performance of the intervention and the participants' evaluation of the intervention.DiscussionThis study is expected to provide information regarding the additional costs and effects of the 'supervised exercise programme' in adults with very high weight-related health risk.Trial registration numberISRCTN: ISRCTN46574304

Implementation of the ‘BeweegKuur’ in practice: utilization of care of a lifestyle intervention in the Netherlands

“…Programs are similar in lifestyle advice and dietician's care, but the amount of support by physiotherapists differs. Patients with a body mass index (BMI) of 25-35 kg m 22 without comorbidities are offered an independent exercise program and patients with a BMI of 25 -35 kg m 22 with comorbidities or a BMI of 35 -40 kg m 22 are offered the start-up exercise program or the supervised exercise program (Berendsen et al 2011).…”

“…If necessary, the physiotherapist could extend the supervised exercise program with one individual session and eight group-training sessions. More information on the intervention can be found elsewhere (Berendsen et al 2011).…”

“…This 1-year intervention, called 'BeweegKuur', promotes physical activity and a healthy diet, and is guided by the general practitioner, lifestyle advisor, physical therapist, and dietician (Berendsen et al 2011). Participants were referred to a lifestyle advisor by one of the health care providers.…”

Prevention and treatment of obesity

“…Weight change is commonly seen as a clear outcome variable and useful for comparing different interventions. However, just as in earlier CLIs like the BeweegKuur [34], weight loss is not the primary goal of the CooL intervention. Lifestyle coaches encourage the participants to identify challenging but achievable action steps for each of the lifestyle behaviours, in order to set feasible and sustainable goals that will improve their longterm health.…”

“…However, in 2007 the Ministry of Health, Welfare and Sports initiated the development of a programme called BeweegKuur. BeweegKuur is a combined lifestyle intervention (CLI; see the paragraph about CLIs later in this introduction) for people with overweight or obesity, supported by a general practitioner, a lifestyle advisor, a physiotherapist and a dietician [34]. In 2009, the ministry planned to include CLIs in the basic compulsory health insurance coverage [35].…”