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British Journal of General Practice

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Research Article

A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.

Paul Little, Martina Dorward, Sarah Gralton, Louise Hammerton, John Pillinger, Peter White, Michael Moore, Jim McKenna and Sheila Payne
British Journal of General Practice 2004; 54 (500): 189-195.
Paul Little
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Martina Dorward
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Sarah Gralton
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Louise Hammerton
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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John Pillinger
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Peter White
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Michael Moore
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Jim McKenna
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Sheila Payne
Primary Medical Care, University of Southampton, Aldermoor Health Centre Practice, Southampton. P.Little@soton.ac.uk
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Abstract

BACKGROUND: Physical activity is a major modifiable risk factor for cardiovascular disease, but it is unclear what combination of feasible approaches, using existing resources in primary care, work best to initiate increased physical activity. AIM: To assess three approaches to initiate increased physical activity. DESIGN OF STUDY: Randomised controlled (2 X 2 X 2) factorial trial. SETTING: Four general practices. METHOD: One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were randomised to eight groups defined by three factors: prescription by general practitioners (GPs) for brisk exercise not requiring a leisure facility (for example, walking) 30 minutes per day, 5 days per week; counselling by practice nurses, based on psychological theory to modify intentions and perceived control of behaviour, and using behavioural implementation techniques (for example, contracting, 'rehearsal'); use of the Health Education Authority booklet 'Getting active, feeling fit'. RESULTS: Single interventions had modest effects. There was a trend from the least intensive interventions (control +/- booklet) to the more intensive interventions (prescription and counselling combined +/- booklet) for both increased physical activity and fitness (test for trend, P = 0.02 and P = 0.05, respectively). Only with the most intense intervention (prescription and counselling combined) were there significant increases in both physical activity and fitness from baseline (Godin score = 14.4, 95% confidence interval [CI] = 7.8 to 21, which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m, respectively, 95% CI = 11.1 to 45.8). Counselling only made a difference among those individuals with lower intention at baseline. CONCLUSION: Feasible interventions using available staff, which combine exercise prescription and counselling explicitly based on psychological theory, can probably initiate important increases in physical activity.

Supplementary Material

Supplementary box 1. Types of intervention Supplementary box 1
Supplementary table 1. Baseline measurements for each intervention factor Supplementary table 1
Supplementary table 2. Box 1. Types of intervention Supplementary table 2
Supplementary table 3. Box 1. Types of intervention Supplementary table 3
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British Journal of General Practice: 54 (500)
British Journal of General Practice
Vol. 54, Issue 500
March 2004
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A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.
Paul Little, Martina Dorward, Sarah Gralton, Louise Hammerton, John Pillinger, Peter White, Michael Moore, Jim McKenna, Sheila Payne
British Journal of General Practice 2004; 54 (500): 189-195.

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A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.
Paul Little, Martina Dorward, Sarah Gralton, Louise Hammerton, John Pillinger, Peter White, Michael Moore, Jim McKenna, Sheila Payne
British Journal of General Practice 2004; 54 (500): 189-195.
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