Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care.

OBJECTIVE: The epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD. METHODS: A three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40-74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention. RESULTS: At 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI -288.00 to 147.90 and mean difference=7.24 steps, 95% CI -224.01 to 238.50, respectively), reducing weight (mean difference=-0.03 kg, 95% CI -0.49 to 0.44 and mean difference=-0.42 kg, 95% CI -0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds. CONCLUSIONS: Enhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk

Enhanced motivational interviewing for reducing weight and increasing physical activity in adults with high cardiovascular risk: the MOVE IT three-arm RCT.

BACKGROUND: Motivational interviewing (MI) enhanced with behaviour change techniques (BCTs) and deployed by health trainers targeting multiple risk factors for cardiovascular disease (CVD) may be more effective than interventions targeting a single risk factor. OBJECTIVES: The clinical effectiveness and cost-effectiveness of an enhanced lifestyle motivational interviewing intervention for patients at high risk of CVD in group settings versus individual settings and usual care (UC) in reducing weight and increasing physical activity (PA) were tested. DESIGN: This was a three-arm, single-blind, parallel randomised controlled trial. SETTING: A total of 135 general practices across all 12 South London Clinical Commissioning Groups were recruited. PARTICIPANTS: A total of 1742 participants aged 40-74 years with a ≥ 20.0% risk of a CVD event in the following 10 years were randomised. INTERVENTIONS: The intervention was designed to integrate MI and cognitive-behavioural therapy (CBT), delivered by trained healthy lifestyle facilitators in 10 sessions over 1 year, in group or individual format. The control group received UC. RANDOMISATION: Simple randomisation was used with computer-generated randomisation blocks. In each block, 10 participants were randomised to the group, individual or UC arm in a 4 : 3 : 3 ratio. Researchers were blind to the allocation. MAIN OUTCOME MEASURES: The primary outcomes are change in weight (kg) from baseline and change in PA (average number of steps per day over 1 week) from baseline at the 24-month follow-up, with an interim follow-up at 12 months. An economic evaluation estimates the relative cost-effectiveness of each intervention. Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. RESULTS: The mean age of participants was 69.75 years (standard deviation 4.11 years), 85.5% were male and 89.4% were white. At the 24-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA [mean 70.05 steps, 95% confidence interval (CI) -288 to 147.9 steps, and mean 7.24 steps, 95% CI -224.01 to 238.5 steps, respectively] or in reducing weight (mean -0.03 kg, 95% CI -0.49 to 0.44 kg, and mean -0.42 kg, 95% CI -0.93 to 0.09 kg, respectively). At the 12-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA (mean 131.1 steps, 95% CI -85.28 to 347.48 steps, and mean 210.22 steps, 95% CI -19.46 to 439.91 steps, respectively), but there were reductions in weight for the group and individual intervention arms compared with UC (mean -0.52 kg, 95% CI -0.90 to -0.13 kg, and mean -0.55 kg, 95% CI -0.95 to -0.14 kg, respectively). The group intervention arm was not more effective than the individual intervention arm in improving outcomes at either follow-up point. The group and individual interventions were not cost-effective. CONCLUSIONS: Enhanced MI, in group or individual formats, targeted at members of the general population with high CVD risk is not effective in reducing weight or increasing PA compared with UC. Future work should focus on ensuring objective evidence of high competency in BCTs, identifying those with modifiable factors for CVD risk and improving engagement of patients and primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN84864870. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 69. See the NIHR Journals Library website for further project information. This research was part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

Cutting Ties with Pro-Ana: A Narrative Inquiry Concerning the Experiences of Pro-Ana Disengagement from Six Former Site Users.

Websites advocating the benefits of eating disorders (“Pro-Ana”) tend to reinforce and maintain restrictive eating and purging behaviors. Yet remarkably, no study has explored individual accounts of disengagement from these sites and the associated meanings. Using narrative inquiry, this study sought to address this gap. From the interviews of six women, two overarching storylines emerged. The first closely tied disengagement to recovery with varying positions of personal agency claimed: this ranged from enforced and unwelcomed breaks that ignited change, to a personal choice that became viable through the development of alternative social and personal identities. A strong counternarrative to “disengagement as recovery” also emerged. Here, disengagement from Pro-Ana was storied alongside a need to retain an ED lifestyle. With “recovery” being just one reason for withdrawal from Pro-Ana sites, clinicians must remain curious about the meanings individuals ascribe to this act, without assuming it represents a step toward recovery.Peer reviewedFinal Accepted Versio

Diagnostic criteria for initial orthostatic hypotension:a narrative review

Abnormalities in orthostatic blood pressure changes upon active standing are associated with morbidity, mortality, and reduced quality of life. However, over the last decade, several population-based cohort studies have reported a remarkably high prevalence (between 25 and 70%) of initial orthostatic hypotension (IOH) among elderly individuals. This has raised the question as to whether the orthostatic blood pressure patterns in these community-dwelling elderly should truly be considered as pathological. If not, redefining of the systolic cutoff values for IOH (i.e., a value ≥ 40 mmHg in systolic blood pressure in the first 15 s after standing up) might be necessary to differ between normal aging and true pathology. Therefore, in this narrative review, we provide a critical analysis of the current reference values for the changes in systolic BP in the first 60 s after standing up and discuss how these values should be applied to large population studies. We will address factors that influence the magnitude of the systolic blood pressure changes following active standing and the importance of standardization of the stand-up test, which is a prerequisite for quantitative, between-subject comparisons of the postural hemodynamic response

Explaining LSND by a decaying sterile neutrino

We propose an explanation of the LSND evidence for electron antineutrino appearance based on neutrino decay. We introduce a heavy neutrino, which is produced in pion and muon decays because of a small mixing with muon neutrinos, and then decays into a scalar particle and a light neutrino, predominantly of the electron type. We require values of $g m_4\sim$ few eV, $g$ being the neutrino--scalar coupling and $m_4$ the heavy neutrino mass, e.g. $m_4$ in the range from 1 keV to 1 MeV and $g \sim 10^{-6} - 10^{-3}$. Performing a fit to the LSND data as well as all relevant null-result experiments, we show that all data can be explained within this decay scenario. In the minimal version of the decay model, we predict a signal in the upcoming MiniBooNE experiment corresponding to a transition probability of the same order as seen in LSND. In addition, we show that extending our model to two nearly degenerate heavy neutrinos it is possible to introduce CP violation in the decay, which can lead to a suppression of the signal in MiniBooNE running in the neutrino mode. We briefly discuss signals in future neutrino oscillation experiments, we show that our scenario is compatible with bounds from laboratory experiments, and we comment on implications in astrophysics and cosmology.Comment: 23 pages, 5 figures, minor improvements, matches published versio

Detection of siRNA administered to cells and animals by using a fluorescence intensity distribution analysis polarization system

Small interfering RNA (siRNA) has excellent pharmacological features and is expected to be used for therapeutic drug development. To this end, however, new RNA technology needs to be established so that extremely small amounts (less than 1 pmol) of siRNA can be detected in organs of experimental animals and in human blood to facilitate pharmacokinetics studies. An important feature is that this new technology is not dependent on radioisotopes and can detect siRNA molecules identical to those used for drug development in preclinical tests with experimental animals or in clinical tests with humans. We report a convenient method that can detect small amounts of siRNA. The method uses high-power confocal microscopic analysis of fluorescence polarization in DNA probes that are bound to one of the strands of siRNA and directly quantitates the copy number of siRNA molecule after extraction from specimens. A pharmacokinetic study to examine the blood retention time of siRNA/cationic liposomes in mice showed that this straightforward method is consistent with the other reverse transcriptase polymerase chain reaction amplification-based method. We believe that the entire process is simple and applicable for a high-throughput analysis, which provides excellent technical support for fundamental research on RNA interference and development of siRNA drugs

Validity of an isometric mid-thigh pull dynamometer in male youth athletes

The purpose of the present study was to investigate the validity of an isometric mid-thigh pull dynamometer against a criterion measure (i.e., 1,000 Hz force platform) for assessing muscle strength in male youth athletes. Twenty-two male adolescent (age 15.3 ± 0.5 years) rugby league players performed four isometric mid-thigh pull efforts (i.e., two on the dynamometer and two on the force platform) separated by 5 minutes rest in a randomised and counterbalanced order. Mean bias, typical error of estimate (TEE) and Pearson correlation coefficient for peak force (PF) and peak force minus body weight (PFBW) from the force platform were validated against peak force from the dynamometer (DynoPF). When compared to PF and PFBW, mean bias (with 90% Confidence limits) for DynoPF was very large (-32.4 [-34.2 to -30.6] %) and moderate (-10.0 [-12.8 to -7.2] %), respectively. The TEE was moderate for both PF (8.1 [6.3 to 11.2] %) and PFBW (8.9 [7.0 to 12.4]). Correlations between DynoPF and PF (r 0.90 [0.79 to 0.95]) and PFBW (r 0.90 [0.80 to 0.95] were nearly perfect. The isometric mid-thigh pull assessed using a dynamometer underestimated PF and PFBW obtained using a criterion force platform. However, strong correlations between the dynamometer and force platform suggest that a dynamometer provides an appropriate alternative to assess isometric mid-thigh pull strength when a force platform is not available. Therefore, practitioners can use an isometric mid-thigh pull dynamometer to assess strength in the field with youth athletes but should be aware that it underestimates peak force

A three-season comparison of match performances among selected and unselected elite youth rugby league players

This is an author's accepted manuscript of an article published in Journal of Sports Sciences, 28 February 2014, available online: http:www.tandfonline.com/10.1080/02640414.2014.889838This study compared technical actions, movements, heart rates and perceptual responses of selected and unselected youth rugby league players during matches (under-15 to under-17). The players’ movements and heart rates were assessed using 5 Hz Global Positioning Systems (GPS), while their technical actions were analysed using video analysis. The maturity of each player was predicted before each season for statistical control. There were no differences (P > 0.05) between selected and unselected players in the under-15 or the under-17 age groups for any variables. However, in the under-16 group, the selected players (57.1 ± 11.9 min) played for longer than the unselected players (44.1 ± 12.3 min; P = 0.017; ES = 1.08 ± CI = 0.87), and covered more distance (5,181.0 ± 1063.5 m cf. 3942.6 ± 1,108.6m, respectively; P = 0.012; ES = 1.14 ± CI = 0.88) and high intensity distance (1,808.8 ± 369.3 m cf. 1,380.5 ± 367.7 m, respectively; P = 0.011; ES = 1.16 ± CI = 0.88). Although successful carries per minute was higher in the selected under-15 group, there were no other differences (P > 0.05) in match performance relative to playing minutes between groups. Controlling for maturity, the less mature, unselected players from the under-16 group performed more high-intensity running (P < 0.05). Our findings question the use of match- related measurements in differentiating between selected and unselected players, showing that later maturing players were unselected, even when performing greater high-intensity running during matches

Comparing the effectiveness of an enhanced MOtiVational intErviewing InTervention (MOVE IT) with usual care for reducing cardiovascular risk in high risk subjects: study protocol for a randomised controlled trial.

BACKGROUND: Interventions targeting multiple risk factors for cardiovascular disease (CVD), including poor diet and physical inactivity, are more effective than interventions targeting a single risk factor. A motivational interviewing (MI) intervention can provide modest dietary improvements and physical activity increases, while adding cognitive behaviour therapy (CBT) skills may enhance the effects of MI. We designed a randomised controlled trial (RCT) to examine whether specific behaviour change techniques integrating MI and CBT result in favourable changes in weight and physical activity in those at high risk of CVD. A group and individual intervention will be compared to usual care. A group intervention offers potential benefits from social support and may be more cost effective. METHODS/DESIGN: Individuals aged between 40 and 74 years in 11 South London Clinical Commissioning Groups who are at high risk of developing CVD (≥20%) in the next 10 years will be recruited. A sample of 1,704 participants will be randomised to receive the enhanced MI intervention, delivered by trained healthy lifestyle facilitators (HLFs), in group or individual formats, in 10 sessions (plus an introductory session) over one year, or usual care. Randomisation will be conducted by King's College London Clinical Trials Unit and researchers collecting outcome data will be blinded to treatment allocation. At 12-month and 24-month follow-up assessments, primary outcomes will be change in weight and physical activity (average steps per day). Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. Incidence of CVD events since baseline will be recorded. A process evaluation will be conducted to evaluate factors which impact on delivery, adherence and outcome. An economic evaluation will estimate relative cost-effectiveness of each type of intervention delivery. DISCUSSION: This RCT assesses the effectiveness of a healthy lifestyle intervention for people at high risk of CVD. Benefits of the study include the ethnic and socioeconomic diversity of the study population and that, via social support within the group setting and long-term follow-up period, the intervention offers the potential to support maintenance of a healthy lifestyle. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry (identifier: ISRCTN84864870, registered 15 May 2012)