Telephone-based motivational interviewing versus usual care in primary care to increase physical activity: a randomized pilot study

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

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Efficacy of Using Physical Activity Mentors to Increase the Daily Steps of Older Adults in the Primary Care Setting: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2012-0120 ◽

2014 ◽

Vol 22 (1) ◽

pp. 16-24 ◽

Cited By ~ 5

Author(s):

Karen A. Croteau ◽

Vijiayurani Suresh ◽

Elanna Farnham

Keyword(s):

Physical Activity ◽

Older Adults ◽

Primary Care ◽

Pilot Study ◽

Repeated Measures ◽

Care Setting ◽

Primary Care Setting ◽

Chronic Illnesses ◽

Main Effects

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n= 14) or a MIM+ mentor group (n= 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps,F(2.324, 59.104) = 4.168,p= .015, but no main effects for group,F(1, 25) = 2.988,p= .096, or time-by-group interaction,F(2.324, 59.104) = 0.905,p= .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

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Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care

Health Technology Assessment ◽

10.3310/hta18490 ◽

2014 ◽

Vol 18 (49) ◽

pp. 1-106 ◽

Cited By ~ 49

Author(s):

Steve Iliffe ◽

Denise Kendrick ◽

Richard Morris ◽

Tahir Masud ◽

Heather Gage ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Usual Care ◽

Primary Outcome ◽

Health Technology ◽

Exercise Programme ◽

Cluster Randomised ◽

Home Based ◽

General Practices ◽

Secondary Outcomes

BackgroundRegular physical activity (PA) reduces the risk of falls and hip fractures, and mortality from all causes. However, PA levels are low in the older population and previous intervention studies have demonstrated only modest, short-term improvements.ObjectiveTo evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years.DesignThe ProAct65+ study was a pragmatic, three-arm parallel design, cluster randomised controlled trial of class-based exercise [Falls Management Exercise (FaME) programme], home-based exercise [Otago Exercise Programme (OEP)] and usual care among older people (aged ≥ 65 years) in primary care.SettingForty-three UK-based general practices in London and Nottingham/Derby.ParticipantsA total of 1256 people ≥ 65 years were recruited through their general practices to take part in the trial.InterventionsThe FaME programme and OEP. FaME included weekly classes plus home exercises for 24 weeks and encouraged walking. OEP included home exercises supported by peer mentors (PMs) for 24 weeks, and encouraged walking.Main outcome measuresThe primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity (MVPA) per week, 12 months after cessation of the intervention. Secondary outcomes included functional assessments of balance and falls risk, the incidence of falls, fear of falling, quality of life, social networks and self-efficacy. An economic evaluation including participant and NHS costs was embedded in the clinical trial.ResultsIn total, 20,507 patients from 43 general practices were invited to participate. Expressions of interest were received from 2752 (13%) and 1256 (6%) consented to join the trial; 387 were allocated to the FaME arm, 411 to the OEP arm and 458 to usual care. Primary outcome data were available at 12 months after the end of the intervention period for 830 (66%) of the study participants.The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40% to 49% in the FaME arm, from 41% to 43% in the OEP arm and from 37.5% to 38.0% in the usual-care arm. A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [adjusted odds ratio (AOR) 1.78, 95% confidence interval (CI) 1.11 to 2.87;p = 0.02]. There was no significant difference in MVPA between OEP and usual care (AOR 1.17, 95% CI 0.72 to 1.92;p = 0.52). Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level. In the 12 months after the close of the intervention phase, there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm (incidence rate ratio 0.74, 95% CI 0.55 to 0.99;p = 0.042). Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care, as did perceptions of benefits from exercise. Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm. There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes, including quality-adjusted life-years. FaME is more expensive than OEP delivered with PMs (£269 vs. £88 per participant in London; £218 vs. £117 in Nottingham). The cost per extra person exercising at, or above, target was £1919.64 in London and £1560.21 in Nottingham (mean £1739.93).ConclusionThe FaME intervention increased self-reported PA levels among community-dwelling older adults 12 months after the intervention, and significantly reduced falls. Both the FaME and OEP interventions appeared to be safe, with no significant differences in adverse reactions between study arms.Trial registrationThis trial is registered as ISRCTN43453770.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 49. See the NIHR Journals Library website for further project information.

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Reducing paediatric overweight and obesity through motivational interviewing: study protocol for a randomised controlled trial in the AAP PROS research network

BMJ Open ◽

10.1136/bmjopen-2019-035720 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035720

Author(s):

Margaret E Wright ◽

Emerson Delacroix ◽

Kendrin R Sonneville ◽

Shannon Considine ◽

Tim Proctor ◽

...

Keyword(s):

Primary Care ◽

Motivational Interviewing ◽

Usual Care ◽

Controlled Trial ◽

Intervention Group ◽

Behavioural Therapy ◽

Overweight And Obesity ◽

Research Network ◽

Care Practices ◽

Child Bmi

IntroductionPrimary care remains an underused venue for prevention and management of paediatric overweight and obesity. A prior trial demonstrated a significant impact of paediatrician/nurse practitioner (Ped/NP)-and registered dietitian (RD)-delivered motivational interviewing (MI) on child body mass index (BMI). The study described here will test the effectiveness of an enhanced version of this primary care-based MI counselling intervention on child BMI.Methods and analysisThis cluster randomised effectiveness trial includes 24 Ped/NPs from 18 paediatric primary care practices that belong to the American Academy of Pediatrics (AAP) national Pediatric Research in Office Settings (PROS) practice-based research network. To date, practices have been randomised (nine to intervention and nine to usual care). Intervention Ped/NPs have been trained in MI, behavioural therapy, billing/coding for weight management and study procedures. Usual care Ped/NPs received training in billing/coding and study procedures only. Children 3– 11 years old with BMI >the 85th percentile were identified via electronic health records (EHRs). Parents from intervention practices have been recruited and enrolled. Over about 2 years, these parents are offered approximately 10 MI-based counselling sessions (about four in person sessions with their child’s Ped/NP and up to six telephonic sessions with a trained RD). The primary outcome is change in child BMI (defined as per cent from median BMI for age and sex) over the study period. The primary comparison is between eligible children in intervention practices whose parents enrol in the study and all eligible children in usual care practices. Data sources will include EHRs, billing records, surveys and counselling call notes.Ethics and disseminationInstitutional Review Board approval was obtained from the AAP. All Ped/NPs provided written informed consent, and intervention group parents provided consent and Health Insurance Portability and Accountability Act (HIPAA) authorisation. Findings will be disseminated through peer-reviewed publications, conference presentations and appropriate AAP channels.Trial registration numberNCT03177148; Pre-results.

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Project LIFE: A Partnership to Increase Physical Activity in Elders with Multiple Chronic Illnesses

Journal of Aging and Physical Activity ◽

10.1123/japa.14.3.324 ◽

2006 ◽

Vol 14 (3) ◽

pp. 324-343 ◽

Cited By ~ 11

Author(s):

Miriam C. Morey ◽

Carola Ekelund ◽

Megan Pearson ◽

Gail Crowley ◽

Matthew Peterson ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Usual Care ◽

High Intensity ◽

Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Significant Group ◽

Physical Activity Counseling ◽

Activity Counseling

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group × Time interaction (p= .041) for physical activity frequency and a similar effect for caloric expenditure (p= .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

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The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

10.31236/osf.io/gq78r ◽

2020 ◽

Author(s):

Matthew Wade ◽

Nicola Brown ◽

James Steele ◽

Steven Mann ◽

Bernadette Dancy ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Motivational Interviewing ◽

Social Action ◽

Multilevel Models ◽

Physical Activity Intervention ◽

Mental Wellbeing ◽

Community Based ◽

The Impact ◽

Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

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Movement as medicine for cardiovascular disease prevention: A pilot feasibility study of a physical activity promotion intervention for at-risk patients in primary care (Preprint)

10.2196/preprints.29035 ◽

2021 ◽

Author(s):

Keegan Knittle ◽

Sarah J Charman ◽

Sophie O'Connell ◽

Leah Avery ◽

Michael Catt ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Primary Care ◽

Motivational Interviewing ◽

Self Efficacy ◽

Healthcare Professionals ◽

Online Course ◽

Cvd Risk ◽

Activity Promotion ◽

Cvd Prevention

BACKGROUND Physical activity (PA) can reduce cardiovascular disease (CVD) risk factors, and while primary care settings offer a large reach to promote PA and reduce cardiovascular disease risk, primary healthcare professionals may lack self-efficacy and tools to effectively promote PA in practice. Movement as Medicine for CVD Prevention is a suite of two theory-based online behavioural interventions – one for healthcare professionals and one for patients – that may offer a pathway for promoting PA and reducing CVD risk in primary care. OBJECTIVE To examine the feasibility and possible effects of Movement as Medicine for CVD Prevention. METHODS This non-randomized pilot recruited participants from primary care organisations in Northeast England. Enrolled healthcare professionals followed a theory-based online course in PA counselling and motivational interviewing techniques. After the course, healthcare professionals delivered behaviour change consultations based on motivational interviewing to inactive individuals with >20% risk of developing CVD within 10 years. Patients were then given access to a website based on self-determination and self-regulation theories which targeted increased levels of PA. Outcomes were assessed at baseline and 3 months. RESULTS Recruitment rates of primary care organisations fell below expectations. Eleven healthcare professionals from three enrolled primary care organisations completed the online course and reported increases in important theoretical determinants of PA promotion in practice (e.g. self-efficacy (d=1.24; 95%CI: 0.67-1.80) and planning (d=0.85; 95%CI: -0.01-1.69)). Eighty-three patients enrolled in the study, and 58 (70%) completed both baseline and three-month assessments. From baseline to 3 months, patients reported significant increases in objective (d=0.26; 95%CI: 0.04-0.48) and subjective (d=0.31; 95%CI: 0.04-0.58) moderate-to-vigorous PA, and in the PA determinants intention, action planning, action control and knowledge of CVD prevention (effect sizes ranged from d=0.26 to d=0.47). CONCLUSIONS Recruitment rates of primary care organisations would need to increase for Movement as Medicine for CVD Prevention to be feasible as a primary care PA promotion pathway. However, the program seems to have effects on important determinants of healthcare professional’s PA promotion and on patient PA behaviours. CLINICALTRIAL ISRCTN, ISRCTN14582348. Registered 3 October 2012.http://www.isrctn.com/ISRCTN14582348

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Excellent multi-stakeholder acceptability and reimbursable costs in a pilot pragmatic trial of an evidence-based physical activity counseling intervention for patients with type 2 diabetes

10.21203/rs.2.21819/v1 ◽

2020 ◽

Author(s):

Amy G. Huebschmann ◽

Russell E Glasgow ◽

Ian M Leavitt ◽

Kristi Chapman ◽

John D Rice ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

Usual Care ◽

Physical Function ◽

Pragmatic Trial ◽

Implementation Strategies ◽

Evidence Based ◽

Multi Level

Abstract Background: Physical activity (PA) improves important health outcomes for patients with type 2 diabetes mellitus (T2D), including physical function. We iteratively adapted the implementation strategies of pragmatic and evidence-based PA counseling programs to meet primary care stakeholders’ needs, resulting in the “Be ACTIVE” program. In a pilot randomized pragmatic trial, we evaluated the feasibility, acceptability and effectiveness of Be ACTIVE. Methods: Formative activities involved engaging multi-level stakeholders (patients, clinicians, coaches) to tailor implementation strategies for Be ACTIVE to the primary care context, while taking care to preserve the core “functions” of Be ACTIVE. Be ACTIVE included: a PA tracker (FitBit©), six theory-informed PA counseling phone calls, and three in-person clinician visits. Sedentary patients with T2D from two academic primary care clinics were randomized to Be ACTIVE vs. enhanced usual care. We used mixed methods to assess implementation outcomes of feasibility and acceptability among multi-level stakeholders, including costs. Objective effectiveness outcomes included PA (primary outcome, steps/week), physical function (secondary outcomes, including Short Physical Performance Battery (SPPB)), and behavioral PA predictors. Results: Multi-level stakeholders were engaged in formative activities to design a feasible pragmatic intervention. Fifty patients were randomized to Be ACTIVE or enhanced usual care. Acceptability was >90% for patients and clinic staff. In-person visits were fully reimbursed, and counseling costs of ~$90/patient would be reimbursable by Medicare. Pre-post PA increased by ~11% absolute in the Be ACTIVE group and by ~6% in controls (group difference: 1574 ± 4391 steps/week, p = 0.72) — less than the clinically important threshold of 4200 steps/week. Be ACTIVE participants’ physical function improved more than controls (SPPB: +0.9 ± 0.3 versus -0.1 ± 0.3, p = 0.01, changes >0.5 points are clinically important for preventing falls), and for PA predictors of self-efficacy (p=0.02) and social-environmental support (p<0.01). Conclusions: In this pilot trial, Be ACTIVE was feasible and highly acceptable to stakeholders and yielded significant improvements in objective physical function consistent with lower fall risk, while changes in PA were less than anticipated. Be ACTIVE may need adaptation or longer duration to clinically improve PA outcomes. Further optimizing the implementation strategies for sustainability is also needed.

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HealthCall: Technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients – a pilot study

AIDS Care ◽

10.1080/09540121.2012.663882 ◽

2012 ◽

Vol 24 (12) ◽

pp. 1461-1469 ◽

Cited By ~ 23

Author(s):

Efrat Aharonovich ◽

Eliana Greenstein ◽

Ann O'Leary ◽

Barbara Johnston ◽

Simone G. Seol ◽

...

Keyword(s):

Primary Care ◽

Pilot Study ◽

Drug Use ◽

Motivational Interviewing ◽

Injection Drug Use ◽

Injection Drug ◽

Hiv Primary Care ◽

Primary Care Patients

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Participants’ experiences of facilitated physical activity for the management of depression in primary care

Journal of Health Psychology ◽

10.1177/1359105313493648 ◽

2013 ◽

Vol 19 (11) ◽

pp. 1430-1442 ◽

Cited By ~ 13

Author(s):

Aidan Searle ◽

Anne M Haase ◽

Melanie Chalder ◽

Kenneth R Fox ◽

Adrian H Taylor ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Grounded Theory ◽

Qualitative Study ◽

Motivational Interviewing ◽

Randomised Trial ◽

Self Determination Theory ◽

Self Determination ◽

Supportive Environment ◽

Future Plans

A qualitative study was conducted within a randomised trial of facilitated physical activity for depression based on Self-Determination Theory and motivational interviewing. Interviews were held with 19 participants at 4 months, and 12 participants were re-interviewed 8 months later. The interviews were analysed in accordance with Grounded Theory using framework. Themes consisted of the following: relationship with the physical activity facilitators, mode of facilitation, impact of contact with physical activity facilitator/assimilation and future plans, change in activity, and effectiveness of physical activity facilitator techniques. Engagement in physical activity was enhanced within an autonomy-supportive environment.

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