Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up

International Journal of Behavioral Nutrition and Physical Activity

Martin S Hagger³  Robert A Harley¹  Martin P Bailey¹  Adrian H Taylor²  Sarah J Hardcastle¹ 

[1] School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK;Sport, Exercise and Health Sciences, University of Exeter, St. Luke’s Campus, Exeter, Exeter EX1 2LU, UK;Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth WA6845, Australia

关键词: Diet;    Physical activity;    Cholesterol;    Blood pressure;    Obesity;    Health promotion;    Motivational interviewing;   

Others  :  810583
DOI  :  10.1186/1479-5868-10-40

 received in 2012-09-06, accepted in 2013-03-18,  发布年份 2013

【 摘 要 】

Background

Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention.

Methods

Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion.

Results

Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained.

Conclusions

The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.

【 授权许可】

   
2013 Hardcastle et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Butland B, Jebb S, Kopelman P: McPherson K, Thomas S, Mardell J, Parry V: Foresight: Tackling Obesities: Future choices- project report. London: Government Office for Science; 2007.
• [2]Jebb S: Tackling the Weight of the Nation. London: MRC Human Nutrition Research; 2004.
• [3]Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, Smith WCS, Jung RT, Campbell MK, Grant AM: Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004, 8:21.
• [4]Espeland M, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Brigh R: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes-One year results of the Look AHEAD trial. Diabetes Care 2007, 30:1374-1383.
• [5]Walker A, Maher J, Coulthard M, Goddard E, Thomas M: Living in Britain: Results from the 2000/01 General Household Survey. London: Office for National Statistics; 2001.
• [6]NICE: Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: National Institute for Health and Clinical Excellence; 2006.
• [7]Shaw K, Rourke P, Del M, Kenardy J: Psychological interventions for overweight and obesity. Coch Db Syst Rev 2005., 2CD003818
• [8]Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Eng J Med 2002, 346:393-403.
• [9]Smith-West DS, Dillo V, Bursac Z, Gore SA, Greene PG: Motivational interviewing improved weight loss in women with type 2 diabetes. Diabetes Care 2007, 30:1081-1087.
• [10]Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, Hill DR: Long-term maintenance of weight loss: current status. Health Psychol 2000, 19:5-16.
• [11]Rothman AJ: Toward a theory-based analysis of behavioural maintenance. Health Psychol 2000, 19:64-69.
• [12]Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichenstein AH, Kumanyika S, Kraus WE, Fleg JL, Burke LE: Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults: A Scientific Statement from the American Heart Association. Circulation 2010, 122:406-441.
• [13]Rubak S, Sandbaek A, Lauritzen T, Christensen B: Motivational interviewing: a systematic review and meta-analysis. Br J Gen Prac 2005, 55:305-312.
• [14]Britt E, Hudson SM, Blampied NM: Motivational interviewing in health settings: a review. Patient Educ Couns 2004, 53:147-155.
• [15]Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J: Motivational interviewing to increase physical activity in long-term cancer survivors. Nurs Res 2007, 56:18-27.
• [16]Carels RA, Darby L, Cacciapaglia HM, Konrad Coit C, Harper J: Using motivational interviewing as a supplement to obesity treatment: A stepped-care approach. Health Psychol 2007, 26:369-374.
• [17]Hardcastle S, Taylor AH, Bailey M, Castle R: A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Educ Couns 2008, 70:31-39.
• [18]Befort CA, Nollen N, Ellerbeck EF, Sullivan DK, Thomas JL, Ahluwalia JS: Motivational interviewing fails to improve outcomes of a behavioural weight-loss program for obese African American women: a pilot randomised trial. J Behav Med 2008, 31:367-377.
• [19]Schwartz RP, Hamre R, Dietz WH, Wasserman RC, Slora EJ, Myers EF: Office-based motivational interviewing to prevent childhood obesity: A feasibility study. Arch Pediat Adol Med 2007, 161:495-501.
• [20]Rollnick S, Mason P, Butler C: Health behaviour change: a guide for practitioners. Edinburgh: Churchill Livingstone; 1999.
• [21]Aharonovich E, Amrhein PC, Bisaga A, Nunes EV, Hasin DS: Cognition, commitment language, and behavioural change among cocaine-dependent patients. Psychol Addict Behav 2008, 22:557-562.
• [22]Lai DTC, Cahill K, Qin Y, Tang J: Motivational interviewing for smoking cessation. Coch Db Syst Rev 2010. CD006936
• [23]Martins RK, McNeil DW: Review of Motivational Interviewing in promoting health behaviours. Clin Psychol Rev 2009, 29:283-293.
• [24]Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR: Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomised controlled trials. Obesity Rev 2011, 12:709-723.
• [25]Eakin E, Reeves M, Winkler E, Lawler S, Owen N: Maintenance of physical activity and dietary change following a telephone-delivered intervention. Health Psychol 2010, 29:566-573.
• [26]Dombrowski SU, Sniehotta FF, Avenell A, Johnston M, MacLennan G, Araújo-Soares A: Identifying active ingredients in complex behavioural interventions for obese adults with additional risk factors: A systematic review. Health Psychol Rev 2012, 6:7-32.
• [27]Michie S, Johnston M: Theories and techniques of behaviour change: Developing a cumulative science of behaviour change. Health Psychol Rev 2012, 6:1-6.
• [28]Burke BL, Arkowitz H, Menchola M: The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. J Consult Clin Psychol 2003, 71:843-861.
• [29]Miller WR, Rollnick S: Motivational interviewing: Preparing people for change. 2nd edition. New York: Guilford Press; 2002.
• [30]Moyers TB, Rollnick S: A Motivational interviewing perspective on resistance in psychotherapy. J Clin Psychol 2002, 58:185-193.
• [31]Miller WR, Rollnick S: Ten things that motivational interviewing is not. Behav Cognit Psychother 2009, 37:129-140.
• [32]Hagger MS: Current issues and new directions in psychology and health: Physical activity research showcasing theory into practice. Psychol Health 2010, 25:1-5.
• [33]Hagger MS: Self-regulation: An important construct in health psychology research and practice. Health Psychol Rev 2010, 4:57-65.
• [34]Deci EL, Ryan RM: The "What" and "Why" of goal pursuits: Human needs and the self-determination of behavior. Psychol Inquiry 2000, 11:227-268.
• [35]Markland D, Ryan RM, Tobin VJ, Rollnick S: Motivational interviewing and self-determination theory. J Soc Clin Psychol 2005, 24:811-831.
• [36]Hagger MS, Chatzisarantis NLD: Causality orientations moderate the undermining effect of rewards on intrinsic motivation. J Exp Soc Psychol 2011, 47:485-489.
• [37]Chatzisarantis NLD, Hagger MS, Biddle SJH, Smith B, Wang CKJ: A meta-analysis of perceived locus of causality in exercise, sport, and physical education contexts. J Sport Exerc Psychol 2003, 25:284-306.
• [38]Hagger MS: Theoretical integration in health psychology: Unifying ideas and complimentary explanations. Br J Health Psychol 2009, 14:189-194.
• [39]Bandura A: Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977, 84:191-215.
• [40]Rohsenow DJ, Monti PM, Martin RA, Colby SM, Myers MG: Motivational enhancement and coping skills training for cocaine abusers: Effects on substance abuse outcomes. Addiction 2004, 99:862-874.
• [41]Hardcastle S, Blake N, Hagger MS: The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012, 35:318-333.
• [42]Prochaska JO, DiClemente CC: Stages of change and process of change of self-change of smoking: Toward an integrative model. J Consult Clin Psychol 1983, 20:390-395.
• [43]Ellliot DL, Goldberg L, Keuhl KS, Moe EL, Breger RKR, Pickering MA: The PHLAME (Promoting Health Lifestyles: Alternative Models' Effects) firefighter study: Outcomes of two models of behavior change. J Occup Environ Med 2007, 49:204-213.
• [44]Kelley GA, Kelley KS, Tran ZV: Walking and resting blood pressure in adults: A meta-analysis. Prev Med 2001, 33:120-127.
• [45]Wilson PM, Rodgers WM, Fraser SN, Murray TC: Relationships between exercise regulations and motivational consequences in university students. Res Q Exerc Sport 2004, 75:81-91.
• [46]Emmons KM, Rollnick S: Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med 2001, 20:68-74.
• [47]Booth ML: Assessment of physical activity: An international perspective. Res Q Sport Exerc 2000, 71:114-120.
• [48]Department of Health: At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London: Department of Health; 2004.
• [49]Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 35:1381-1395.
• [50]Blair SN, Dunn AL, Marcus BH, Carpenter RA, Jaret P: Active living everyday: 20 weeks to lifelong vitality. Champaign, Illinois: Human Kinetics; 2001.
• [51]Roe L, Strong C, Nei A, Mant D: Dietary intervention in primary care: validity of the DINE method for diet assessment. Fam Pr 1994, 11:375-381.
• [52]Department for the Environment Food and Rural Affairs (DEFRA): National food survey 2000: Annual report on food expenditure, consumption and nutrient intakes. London: HMSO; 2001.
• [53]Crawley H: Food portion sizes (MAFF Handbook). 2nd edition. London: HMSO; 1994.
• [54]Ashfield-Watt PAL, Welch AA, Godward S, Bingham SA: Effect of a pilot community intervention on fruit and vegetable intakes: Use of FACET. Pub Health Nutr 2007, 10:671-680.
• [55]Shao J, Zhong B: Last observation carry-forward and last observation analysis. Statistics in Medicine 2003, 22:2429-2441.
• [56]Ketola E, Sipila R, Makela M: Effectiveness of individual lifestyle intervention in reducing cardiovascular disease and risk factors. 2000, 32:239-251.
• [57]Knutsen SF, Knutsen R: The Tromso survey: The family intervention study- the effectiveness of intervention on some coronary risk factors and dietary habits, a 6 year follow-up. 1991, 20:197-212.
• [58]Oxcheck Study Group: Effectiveness of health checks conducted by nurses in primary care: Results of Oxcheck study after one year. 1994, 308:308-312.
• [59]Ockene IS, Herbert JR, Ockene K: Effect of physician-delivered nutrition counselling training and an office support program on saturated fat intake, weight and serum lipid measurements in a hyperlipidemic population. 1999, 159:725-731.
• [60]Mhurchu CN, Margetts BM, Speller V: Randomised controlled trial comparing the effectiveness of two dietary interventions for patients with hyperlipidaemia. Clinical Science 1998, 95:479-487.
• [61]Chapman J, Armitage CJ: Evidence that boosters augment the long-term impact of implementation intentions on fruit and vegetable intake. Psychol Health 2010, 25:365-381.
• [62]Luszczynska A, Haynes C: Changing nutrition, physical activity and body weight among student nurses and midwives: Effects of a planning intervention and self-efficacy beliefs. J Health Psychol 2009, 14:1075-1084.
• [63]Fjeldsoe B, Neuhaus M, Winkler E, Eakin E: Systematic review of maintenance of behaviour change following physical activity and dietary interventions. Health Psychol 2011, 30:99-109.
• [64]Lombard CB, Deeks AA, Teede HJ: A systematic review of interventions aimed at the prevention of weight gain in adults. Pub Health Nutr 2009, 12:2236-2246.
• [65]Trials of Hypertension Prevention Collaborative Research Group: The effect of a nonpharmacolgic intervention on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, phase1. JAMA 1992, 267:1213-1220.
• [66]Greaney ML, Riebe D, Garber CE, Rossi JS, Lees FD, Burbank PA, Clark PG: Long-term effects of a stage-based intervention for changing exercise intentions and behaviour in older adults. Gerontologist 2008, 48:358-367.
• [67]Prochaska JO, Velicer WF, Redding C, Rossi J, Goldstein M, DePue J, Plummer BA: Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Prev Med 2005, 41:406-416.
• [68]De Vet E, Oenema A, Sheeran P, Brug J: Should implementation intentions interventions be implemented in obesity prevention: The impact of if-then plans on daily physical activity in Dutch adults. Int J Behav Nutr Phys Act 2009, 6:11. BioMed Central Full Text
• [69]Jimmy G, Martin BW: Implementation and effectiveness of a primary care based physical activity counselling scheme. Patient Educ Couns 2005, 56:323-331.
• [70]Fries E, Edinboro P, McClish D, Manion L, Bowen D, Beresford SA, Ripley J: Randomised trial of a low intensity dietary intervention in rural residents. Am J Prev Med 2005, 28:162-168.
• [71]Clark M, Hampson SE, Avery L, Simpson R: Effects of a tailored lifestyle self-management intervention in patients with Type 2 diabetes. Br J Health Psychol 2004, 9:365-379.
• [72]Lindsay S, Smith S, Bellaby P, Baker R: The health impact of an online heart disease support group: A comparison of moderated versus unmoderated support. Health Educ Res 2009, 24:646-654.
• [73]Amireault S, Godin G, Vohl M, Perusse L: Moderators of the intention behaviour and perceived behavioural control-behaviour relationships for leisure-time physical activity. Int J Behav Nutr Phys Act 2008, 5:7. BioMed Central Full Text
• [74]Lorentzen C, Ommundsen Y, Jenum AK, Holma I: The "Romsas in Motion" community intervention: Programme exposure and psychosocial mediated relationships to change in stages of change in physical activity. Int J Behav Nutr Phys Act 2007, 4:15. BioMed Central Full Text
• [75]Lewis BA, Forsyth LH, Pinto BM, Bock BC, Roberts M, Marcus BH: Psychosocial mediators of physical activity in a randomized controlled intervention trial. J Sport Exerc Psychol 2006, 28:193-204.
• [76]Hagger MS, Biddle SJH, Chow EW, Stambulova N, Kavussanu M: Physical self-perceptions in adolescence: Generalizability of a hierarchical multidimensional model across three cultures. Journal of cross-cultural Psychology 2003, 34:611-628.
• [77]Parks SE, Housemann RA, Brownson RC: Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. J Epidemiol Community Health 2003, 57:29-35.
• [78]Chatzisarantis NLD, Hagger MS: Effects of an intervention based on self-determination theory on self-reported leisure-time physical activity participation. Psychol Health 2009, 24:29-48.
• [79]Courneya KS, Bobick TM: Integrating the theory of planned behavior with the processes and stages of change in the exercise domain. Psychol Sport Exerc 2000, 1:41-56.
• [80]Hagger MS, Anderson M, Kyriakaki M, Darkings S: Aspects of identity and their influence on intentional behaviour: Comparing effects for three health behaviour. Personality and Individual Differences 2007, 42:355-367.
• [81]Hardcastle S, Hagger MS: “You can’t do it on your own”: Experiences of a motivational interviewing intervention on physical activity and dietary behaviour. Psychol Sport Exerc 2011, 12:314-323.
• [82]Baumeister RF, Gailliot MT, DeWall CN, Oaten M: Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. J Pers 2006, 74:1773-1801.
• [83]Fishbach A, Friedman RS, Kruglanski AW: Leading us not unto temptation: Momentary allurements elicit overriding goal activation. J Pers Soc Psychol 2003, 84:296-309.
• [84]Hagger MS, Wood C, Stiff C, Chatzisarantis NLD: The strength model of self-regulation failure and health-related behavior. Health Psychol Rev 2009, 3:208-238.
• [85]Webber KH, Gabriele JM, Tate DF, Dignan MB: The effect of a motivational intervention on weight loss is moderated by level of baseline controlled motivation. Int J Behav Nutr Phys Act 2010, 7:4. BioMed Central Full Text
• [86]Hagger MS, Chatzisarantis NLD: Assumptions in research in sport and exercise psychology. Psychol Sport Exerc 2009, 10:511-519.
• [87]Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL: A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Res Soc Work Pract 2010, 20:137-160.
• [88]Hettema J, Steel J, Miller W: Motivational interviewing. Ann Rev Clin Psychol 2005, 1:91-111.
• [89]Fjeldsoe BS, Miller YD, Marshall AL: MobileMums: A Randomized Controlled Trial of an SMS-Based Physical Activity Intervention. Ann Behav Med 2010, 39:101-111.
• [90]Lundahl BW, Burke BL: The effectiveness and applicability of motivational interviewing: A practice-friendly review of four meta-analyses. J Clin Psychol 2009, 65:1232-1245.