A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors

Abstract 

Objective

The aim of the study was to determine if multiple patient-centred lifestyle counselling sessions would be of interest to patients at risk of coronary heart disease (CHD), in a primary care setting, and if such sessions would result in changes in physical activity and diet, and health status. A randomised trial was conducted to compare the counselling intervention with usual care (health promotion leaflet), among 334 mostly obese patients.

Methods

Patients were randomised into an intervention group that received standard exercise and nutrition information plus up to five face-to-face counselling sessions with a Physical Activity Specialist (PAS) and Registered Dietitian (RD) over a 6-month period or to a control group that only received the standard information.

Results

Of those invited, patients randomised tended to be more obese, older and female. The mean (S.D.) sessions attended was 2.0 (1.6) with 50% attending at least 3. At 6 months, the counselling group were more active, particularly with respect to walking, and had reduced weight, blood pressure and cholesterol, but had not changed their diet, compared with the control group. Furthermore, those who did more sessions had greater increases in activity and reductions in weight, blood pressure and cholesterol.

Conclusion

Attending multiple sessions of client-centred counselling in primary care was of interest to patients, and generally reduced CHD risk factors.

Practice implications

The primary care setting can be used effectively to promote particularly walking, using physical activity specialists and dietitians trained to use an adapted motivational interviewing (MI) counselling style.

Keywords: Motivational interviewing, Exercise, Health promotion, Obesity, Blood pressure, Lipids, Cholesterol, Walking