Physical activity counselling : the application of motivational interviewing and brief negotiation.

The Department of Culture Media and Sport (2002) set a national target for sport and physical activity (PA) that 70% of the population be reasonably active by 2020. However, the proportion of the population meeting these levels of activity is currently only 30% (DoH, 2004a). There is now unequivocal evidence that the UK population is becoming increasingly inactive leading to increases in premature mortality and illness and disease. There is also clear evidence that increased PA can assist in both the avoidance and management of hypokinetic disease such as CHD and type II diabetes. Part of the health strategy for the UK includes the use of interventions such as PA referral schemes (PARS). Within such schemes specific techniques such as PA counselling are increasingly popular in both community and clinical settings (Tulloch et al., 2006).The aim of the thesis was to examine the context and efficacy of PARS, the prevalence of PA counselling and the levels of competence and consistency applied within empirical studies, and finally an assessment of the efficacy of behaviour change counselling in PARS settings based on Motivational Interviewing (Miller & Rollnick, 2002).The first study provided a systematic review of PA counselling from 1995 to 2006 and examined whether a theoretical framework was applied to each study reporting a PA counselling component and if so, which theory. Furthermore, it assessed the number of studies that report the use of a treatment fidelity framework in order to ensure internal validity of the intervention as well as an assessment of competence of the interventionist. Results indicated the dominant theory to be the transtheoretical model (TTM) and in particular stages of change (a sub-component of TTM). No studies applied a treatment fidelity framework with only 2 from 25 assessing competence of the PA counselling interventionist.Prior to delivering an MI intervention, the second study followed a treatment fidelity framework and assessed the competence of the investigator in delivering MI. This applied validated tools with regards to levels of MI competency and proficiency. Results indicated that the investigator demonstrated proficiency across MI global ratings of empathy and spirit and used commensurate levels of open to closed questions and complex to simple reflections.Having assessed the competency and consistency of the MI intervention Study 3 examined the impact of MI applied to a randomly allocated patient group referred to a PARS by GP's The results of the intervention, as compared to a control group receiving traditional PARS interventions only, were equivocal. Additional measures such as patient 'readiness to change' and 'exercise motivation' were also recorded and it appears from the current study that 'pure' MI is not appropriate for those patients reporting a high level of readiness.The final study assessed the impact of a 2-day training workshop in MI to an experienced PARS officer with little or no previous counselling training. The assessment of competence was carried out using the same measure as Study 2 for comparison. The impact of the training was assessed by applying a similar design to that of Study 3. Competency tests indicated the 2-day training did not create competence and proficiency across all facets of MI though adaptations were recorded. The impact on the patient adherence rates in the PARS was similarly equivocal to the previous study

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed

Embedding physical activity in the heart of the NHS: the need for a whole-system approach

Solutions to the global challenge of physical inactivity have tended to focus on interventions at an individual level, when evidence shows that wider factors, including the social and physical environment, play a major part in influencing health-related behaviour. A multidisciplinary perspective is needed to rewrite the research agenda on physical activity if population-level public health benefits are to be demonstrated. This article explores the questions that this raises regarding the particular role that the UK National Health Service (NHS) plays in the system. The National Centre for Sport and Exercise Medicine in Sheffield is put forward as a case study to discuss some of the ways in which health systems can work in collaboration with other partners to develop environments and systems that promote active lives for patients and staff

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians:The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics.

Background:Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer’s disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive.Objective:The MedWalk trial’s primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment.Methods:MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60–90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community.<br/

Physical activity counselling : the application of motivational interviewing and brief negotiation

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‘What’s the point when you only lose a pound?’ Reasons for attrition from a multi-component childhood obesity treatment intervention:a qualitative inquiry

This study explored the causes of drop-out from a community-based multi-component childhood obesity treatment intervention (MCTI), considering parent and child perspectives in order to develop future interventions which manage potential attrition more effectively. Semi-structured interviews explored attrition amongst a sample of children (n = 10) and their parents (n = 10) who dropped out of a community-based MCTI. Parents and children highlighted psychological and motivational issues (e.g. misaligned expectations, lack of desire to make behaviour changes and perceived costs of change outweigh the perceived gains) as the driving factor for their attrition alongside attitudinal, environmental, interpersonal and treatment variables. The complexity and interaction of factors associated with attrition identified in this study points to the challenges associated with reducing drop-out in MCTI’s. The views of families’ should be a key consideration in the design and implementation of treatment interventions to harness and sustain commitment to the treatment process

Behaviour change interventions to improve physical activity in adults: a systematic review of economic evaluations

Abstract Background Behaviour change interventions can result in lasting improvements in physical activity (PA). A broad implementation of behaviour change interventions are likely to be associated with considerable additional costs, and the evidence is unclear whether they represent good value for money. The aim of this study was to investigate costs and cost-effectiveness of behaviour change interventions to increase PA in community-dwelling adults. Methods A search for trial-based economic evaluations investigating behaviour change interventions versus usual care or alternative intervention for adults living in the community was conducted (September 2023). Studies that reported intervention costs and incremental cost-effectiveness ratios (ICERs) for PA or quality-adjusted life years (QALYs) were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC-list). A Grading of Recommendations Assessment, Development and Evaluation style approach was used to assess the certainty of evidence (low, moderate or high certainty). Results Sixteen studies were included using a variety of economic perspectives. The behaviour change interventions were heterogeneous with 62% of interventions being informed by a theoretical framework. The median CHEC-list score was 15 (range 11 to 19). Median intervention cost was US$313 per person (range US$83 to US$1,298). In 75% of studies the interventions were reported as cost-effective for changes in PA (moderate certainty of evidence). For cost per QALY/gained, 45% of the interventions were found to be cost-effective (moderate certainty of evidence). No specific type of behaviour change intervention was found to be more effective. Conclusions There is moderate certainty that behaviour change interventions are cost-effective approaches for increasing PA. The heterogeneity in economic perspectives, intervention costs and measurement should be considered when interpreting results. There is a need for increased clarity when reporting the functional components of behaviour change interventions, as well as the costs to implement them