A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): The long-term effect on physical activity

Abstract

Aim: To examine the effect of a randomized multiple risk factor intervention study for prevention of ischaemic heart disease (IHD) on the development in physical activity over a 36-month period. Methods: Two random samples (high intensity intervention, group A, n=11,708; low intensity intervention, group B, n=1,308) were invited for a health examination, an assessment of absolute risk of developing IHD, and an individualized lifestyle intervention. The participation rate was 52.5%. High-risk persons in group A were also offered diet/physical activity and/or smoking cessation group counselling. High-risk persons in group B were referred to their GP. High-risk persons were re-counselled after 12 and 36 months. The control group (group C, n=5,264, response rate=61.3%) answered a mailed questionnaire. Data were analysed using longitudinal linear regression models with random effects. Main outcome: Change in physical activity from baseline to 12-and 36-month follow-up. Results: In men, the high-intensity (group A) intervention had a beneficial effect at 12-month follow-up, whereas after 36 months both the high-intensity and the low-intensity (group B) intervention had a beneficial effect on the development in physical activity when compared with group C. This was regardless of baseline physical activity level. At 36-month follow-up there was no significant difference between groups A and B. There was no intervention effect among women. Conclusions: Only men seemed to benefit from the intervention.

Keywords

Exercise ischaemic heart disease lifestyle randomized intervention study

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References

World Health Organization. Global strategy on diet, physical activity and health. 2004 .

Danish Heart Foundation and National Institute of Public Health. Heart Statistics. 2004.

Morris JN , Clayton DG , Everitt MG , Semmence AM , Burgess EH Exercise in leisure time: coronary attack and death rates . Br Heart J 1990;63:325-34.

Manson JE , Hu FB , Rich-Edwards JW , Colditz GA , Stampfer MJ , Willett WC , et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women . N Engl J Med 1999;341:650-8.

Schnohr P. , Lange P. , Scharling H. , Skov JJ Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer . The Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil 2006;13:173-9.

Joint WHO/FAO Expert Consultation. Diet, nutrition and the prevention of chronic diseases.

Hu FB , Willett WC Optimal diets for prevention of coronary heart disease . JAMA 2002;288:2569-278.

Doll R. , Peto R. , Wheatley K. , Gray R. , Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors . BMJ 1994;309:901-11.

Knutsen SF , Knutsen R. The Tromso Survey: the Family Intervention study: The effect of intervention on some coronary risk factors and dietary habits, a 6-year follow-up . Prev Med 1991;20:197-212.

10.

Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: Principal results of British family heart study . Family Heart Study Group . BMJ 1994;308[6924]:313-320.

11.

Effectiveness of health checks conducted by nurses in primary care: Final results of the OXCHECK study . Imperial Cancer Research Fund OXCHECK Study Group . BMJ 1995;310:1099-1104.

12.

Hellenius ML , de Faire U. , Berglund B. , Hamsten A. , Krakau I. Diet and exercise are equally effective in reducing risk for cardiovascular disease: Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors . Atherosclerosis 1993;103:81-91. [13] Andersen SA , Haaland A. , Hjermann I. , Urdal P. , Gjesdal K. , Holme I. Oslo Diet and Exercise Study: A one-year randomized intervention trial. Effect on hemostatic variables and other coronary risk factors . Nutr Metab Cardiovasc Dis 1995;5:189-200.

13.

Lindholm LH , Ekbom T. , Dash C. , Eriksson M. , Tibblin G. , Schersten B. The impact of health care advice given in primary care on cardiovascular risk. CELL Study Group . BMJ 1995;310:1105-9.

14.

Steptoe A. , Doherty S. , Rink E. , Kerry S. , Kendrick T. , Hilton S. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: Randomised trial . BMJ 1999;319:943-7.

15.

Harting J. , van Assema P. , van Limpt P. , Gorgels T. , van Ree J. , Ruland E. et al. Cardiovascular prevention in the Hartslag Limburg project: Effects of a high-risk approach on behavioral risk factors in a general practice population . Prev Med 2006;43:372-8.

16.

Jorgensen T. , Borch-Johnsen K. , Thomsen TF , Ibsen H. , Glumer C. , Pisinger C. A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: Baseline results Inter99 . Eur J Cardiovasc Prev Rehabil 2003;10:377-86.

17.

Thomsen TF , Davidsen M. , Ibsen H. , Jorgensen T. , Jensen G. , Borch-Johnsen K. A new method for CHD prediction and prevention based on regional risk scores and randomized clinical trials: PRECARD and the Copenhagen Risk Score . J Cardiovasc Risk 2001;8:291-7.

18.

Miller WR , Rollnick S. Motivational interviewing, preparing people to change addictive behavior . New York: Guilford Press; 1991.

19.

Janz NK , Becker MH The Health Belief Model: A decade later . Health Educ Q 1984;11:1-47.

20.

Bandura A. Social foundation of thoughts and action: A social cognitive theory . New York: Prentice Hall; 1986. [22] Prochaska JO , DiClemente CC , Norcross JC In search of how people change: Application to addictive behaviors. In: Marlatt G , van den Bos H , editors. Addictive behaviors: Readings on etiology, prevention and treatment. Washington, DC: American Psychological Association ; 1997. p 671-96.

21.

Toft UN , Kristoffersen LH , Aadahl M. , von Huth SL , Pisinger C. , Jorgensen T. Diet and exercise intervention in a general population--mediators of participation and adherence: The Inter99 study . Eur J Public Health 2006; doi:10.1093/eurpub/ckl262.

22.

Toft U. , Kristoffersen LH , Lau C. , Borch-Johnsen K. , Jørgensen T. The Dietary Quality Score: Validation and association with cardiovascular risk factors . The Inter99 Study. Eur J Clin Nutr 2006; doi:10.1038/sj.ejcn.1602503.

23.

Hillsdon M. , Foster C. , Thorogood M. Interventions for promoting physical activity . Cochrane Database Syst Rev 2005;(1):CD003180.

24.

Hillsdon M. , Thorogood M. , White I. , Foster C. Advising people to take more exercise is ineffective: A randomized controlled trial of physical activity promotion in primary care . Int J Epidemiol 2002;31:808-15.

25.

Van Sluijs EM , Van Poppel MN , Twisk JW , Chin APM , Calfas KJ , Van Mechelen W. Effect of a tailored physical activity intervention delivered in general practice settings: Results of a randomized controlled trial . Am J Public Health 2005;95:1825-31.

26.

Orsini N. , Bellocco R. , Bottai M. , Pagano M. , Wolk A. Age and temporal trends of total physical activity among Swedish women . Med Sci Sports Exerc 2006;38:240-5.

27.

Norman A. , Bellocco R. , Vaida F. , Wolk A. Age and temporal trends of total physical activity in Swedish men . Med Sci Sports Exerc 2003;35:617-22.

28.

Pan XR , Li GW , Hu YH , Wang JX , Yang WY , An ZX , et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and Diabetes Study . Diabetes Care 1997;20: 537-44.

29.

Tuomilehto J. , Lindstrom J. , Eriksson JG , Valle TT , Hamalainen H. , Ilanne-Parikka P. , et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance . N Engl J Med 2001;344: 1343-50.

30.

Lindstrom J. , Louheranta A. , Mannelin M. , Rastas M. , Salminen V. , Eriksson J. , et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity . Diabetes Care 2003;26:3230-6.

31.

Wareham NJ , Rennie KL

The assessment of physical activity in individuals and populations: Why try to be more precise about how physical activity is assessed?

Int J Obes Relat Metab Disord 1998 ;22(Suppl 2): S30-S38.

32.

Wood AM , White IR , Hillsdon M. , Carpenter J. Comparison of imputation and modelling methods in the analysis of a physical activity trial with missing outcomes . Int J Epidemiol 2005;34:89-99.