To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme.
Methods:
Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified ‘high risk’ (≥20% CVD risk) at baseline.
Results:
At baseline, 33.6% of participants were classified as ‘high CVD risk’ and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In ‘high-risk’ participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change.
Conclusions:
Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.
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: The Stationery Office, 2004
2.
NICE (National Institute for Health and Clinical Excellence). NICE Public Health Guidance 25: Prevention of Cardiovascular Disease. London: NICE, 2010
3.
WanlessD.Securing Good Health for the Whole Population: Final Report. London: Department of Health, 2004
4.
GlanzKLankenauBFoersterSTempleSMullisRSchmidT.Environmental and policy approaches to cardiovascular disease prevention through nutrition: opportunities for state and local action. Health Education Quarterly1995; 22: 512–27
5.
SallisJFBaumanAPrattM.Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine1998; 15: 379–97
6.
KingACStokolsDTalenEBrassingtonGSKillingsworthR.Theoretical Approaches to the Promotion of Physical Activity: Forging a Transdisciplinary Paradigm. New York: Elsevier, 2002
7.
AndersonJWKonzECFrederichRCWoodCL.Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition2001; 74: 579–84
8.
ShawKGennatHO’RourkePDel MarC.Exercise for overweight or obesity. Cochrane Database of Systematic Reviews2006; 4: CD003817.
9.
CurioniCCLourencoPM.Long-term weight loss after diet and exercise: a systematic review. International Journal of Obesity and Related Metabolic Disorders2005; 29: 1168–74
10.
DouketisJDMacieCThabaneLWilliamsonDF.Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. International Journal of Obesity and Related Metabolic Disorders2005; 29: 1153–67
11.
MatyasEJeitlerKHorvathK. Benefit assessment of salt reduction in patients with hypertension: systematic overview. Journal of Hypertension2011; 29: 821–8
12.
WheltonSPChinAXinXHeJ.Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Annals of Internal Medicine2002; 136: 493–503
13.
KatzmarzykPTLearSA.Physical activity for obese individuals: a systematic review of effects on chronic disease risk factors. Obesity Reviews2012; 13: 95–105
14.
TuomilehtoJLindstromJErikssonJG. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine2001; 344: 1343–50
15.
UpchurchSL.Review: lifestyle or pharmacological interventions prevent or delay type 2 diabetes in people with impaired glucose tolerance. Evidence Based Nursing2007; 10: 78. doi:10.1136/ebn.10.3.78
16.
Diabetes Prevention Program. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine2002; 346: 393–403
17.
LaatikainenTDunbarJChapmanA. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health2007; 7: 249. doi: 10.1186/1471-2458-7-249
18.
GidlowCMurphyR.Physical activity interventions in primary health care. In DugdillLCroneDMurphyR (eds) Physical Activity and Health Promotion. Oxford: Blackwell Publishing, 2009
19.
Hippisley-CoxJVinogradovaY.Final Report to the NHS Information Centre and Department of Health. Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009: Analysis of the QResearch® Database. London: NHS Information Centre for Health and Social Care, 2009
20.
StathiAMcKennaJFoxKR.The experiences of older people participating in exercise referral schemes. Journal of the Royal Society for the Promotion of Health2003; 123: 18–23
21.
EatonCBMenardLM.A systematic review of physical activity promotion in primary care office settings. British Journal of Sports Medicine1998; 32: 11–16
22.
Department of Health. Choosing Health? Choosing Activity: A Consultation on How to Increase Physical Activity. London: The Stationery Office, 2004
23.
GouldMMThorogoodMIliffeSMorrisJN.Promoting physical activity in primary care: measuring the knowledge gap. Health Education Journal1995; 54: 304–11
24.
HillsdonM.Promoting physical activity: issues in primary health care. International Journal of Obesity1998; 22(Suppl 2): S52–4
25.
DugdillLGrahamRCMcNairF.Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation. Ergonomics2005; 48: 1390–410
26.
PaveyTGTaylorAHFoxKR. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. British Medical Journal2011; 343. doi: http://dx.doi.org/10.1136/bmj.d6462
27.
MichieSRumseyNFussellS. Improving Health: Changing Behaviour – NHS Health Trainer Handbook. London: Department of Health and British Psychological Society, 2006
28.
SloaneBCZimmerCG.The power of peer health education. Journal of American College Health1993; 41: 241–5
29.
CarrSMLhussierMForsterN. An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, costeffectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment2011; 15(9): iii–iv, 1–284. doi: 10.3310/hta15090.
30.
ScorerC.Health Trainers implementing a new public health role. The Journal of the Royal Society for the Promotion of Health2007; 127: 258–9
NICE (National Institute for Health and Clinical Excellence). Four Commonly Used Methods to Increase Physical Activity: Brief Interventions in Primary Care, Exercise Referral Schemes, Pedometers and Community-Based Exercise Programmes for Walking and Cycling. NICE, 2006
33.
Department of Health. Exercise Referral Systems: A National Quality Assurance Framework. London: The Stationery Office, 2001
34.
AttreePClaytonSKarunanithiSNayakSPopayJReadD.NHS health trainers: a review of emerging evaluation evidence. Critical Public Health2011; 1–14
35.
House of Lords Science and Technology Select Committee. Behaviour Change. London: The Stationery Office, 2011
36.
National Health Service. Health Trainers DCRS National Report. Birmingham: Birmingham Primary Care Shared Services Agency, 2011
37.
GardnerBCaneJRumseyNMichieS.Behaviour change among overweight and socially disadvantaged adults: a longitudinal study of the NHS Health Trainer Service. Psychology & Health2012; 27: 1178–93
38.
van LimptPMHartingJvan AssemaP. Effects of a brief cardiovascular prevention program by a health advisor in primary care: the ‘Hartslag Limburg’ project, a cluster randomized trial. Preventive Medicine2011; 53: 395–401
39.
BartonGRGoodallMBowerPWoolfSCapewellSGabbayMB.Increasing heart-health lifestyles in deprived communities: economic evaluation of lay health trainers. Journal of Evaluation in Clinical Practice2012; 18: 835–40.
40.
DaveyRCochraneTIqbalZ. Randomised controlled trial of additional lifestyle support for the reduction of cardiovascular disease risk through primary care in Stoke-on-Trent, UK. Contemporary Clinical Trials2010; 31: 345–54
41.
CochraneTDaveyRIqbalZ. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction. BMC Public Health2012; 12: 944.
42.
Communities and Local Government. The English Indices of Deprivation 2010. London: Department for Communities and Local Government, 2010
43.
NHS Stoke-on-Trent. Health and Behaviour in Stoke-on-Trent: Director of Public Health Annual Report 2010. >Stoke-on-Trent: NHS, 2010
Stoke-on-Trent City Council, Stoke-on-Trent Primary Care Trust. Floor Target Action Plan for Physical Activity: Final Report. Stoke-on-Trent: NHS, 2008
47.
Department of Health. Putting Prevention First – NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance. London: Department of Health, 2009
48.
British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association. JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart2005; 91(suppl 5): v1–52
49.
DaltonARHBottleAOkoroCMajeedAMillettC. Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study. Journal of Public Health2011; 33: 422–9
50.
WilliamsNHHendryMFranceBLewisRWilkinsonC.Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. British Journal of General Practice2007; 57: 979–86
51.
GidlowCJohnstonLHCroneD. Socio-demographic patterning of referral, uptake and attendance in Physical Activity Referral Schemes. Journal of Public Health2007; 29: 107–13
SallisJFJohnsonMFCalfasKJCaparosaSNicholsJF.Assessing perceived physical environmental variables that may influence physical activity. Research Quarterly for Exercise and Sport1997; 68: 345–51
54.
EstabrooksPALeeREGyurcsikNC.Resources for physical acitivity participation: does availability and accessibility differ by neighorhood socioeconomic status?Annals of Behavioral Medicine2003; 25: 100–4
55.
BrazierJUsherwoodTHarperRThomasK.Deriving a preference-based single index from the UK SF-36 Health Survey. Journal of Clinical Epidemiology1998; 51: 1115–28
