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A 3-year randomized trial of lifestyle intervention for cardiovascular risk reduction in the primary care setting: the Swedish Björknäs study.

Eriksson MK, Franks PW, Eliasson M - PLoS ONE (2009)

Bottom Line: At 36 months post-randomisation, intensive lifestyle modification reduced waist circumference (-2.2 cm: p = 0.001), waist-hip ratio (-0.02: p<0.0001), systolic blood pressure (-4.9 mmHg: p = 0.036), and diastolic blood pressure (-1.6 mmHg: p = 0.005), and improved aerobic fitness (5%; p = 0.038).Changes in lipid or glucose values did not differ statistically between groups.At 36 months, self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group (p<0.001).

View Article: PubMed Central - PubMed

Affiliation: Björknäs Primary Health Care Centre, Boden, Sweden. margareta.Eriksson@nll.se

ABSTRACT

Background: Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility. The objective of this study was to test whether intensive lifestyle modification, shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals, can reduce cardiovascular risk factor levels in the primary care setting.

Methodology / principal findings: The Swedish Björknäs study was a randomized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3, 12, 24 and 36 months. A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were randomly assigned to either an intensive lifestyle intervention (n = 75) or control (n = 76) group. The intervention was based broadly on the protocol of the Diabetes Prevention Program. The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling, followed by regular group meetings during three years. The control group was given general advice about diet and exercise and received standard clinical care. Outcomes were changes in anthropometrics, aerobic fitness, self-reported physical activity, blood pressure, and metabolic traits. At 36 months post-randomisation, intensive lifestyle modification reduced waist circumference (-2.2 cm: p = 0.001), waist-hip ratio (-0.02: p<0.0001), systolic blood pressure (-4.9 mmHg: p = 0.036), and diastolic blood pressure (-1.6 mmHg: p = 0.005), and improved aerobic fitness (5%; p = 0.038). Changes in lipid or glucose values did not differ statistically between groups. At 36 months, self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group (p<0.001).

Conclusion / significance: A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals.

Trial registration: ClinicalTrials.gov NCT00486941.

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Related in: MedlinePlus

(A–D) Changes in clinical characteristics.Data are adjusted means (95% confidence intervals) for each time point derived from generalised linear models with repeated measures. Adjustments are made for the baseline value for the respective outcome variable. Blood pressure values are also adjusted for medication load. Statistical significance at each follow-up time point generated from univariate analysis of variance, * p<0.05, ** p<0.01, *** p<0.001.
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pone-0005195-g003: (A–D) Changes in clinical characteristics.Data are adjusted means (95% confidence intervals) for each time point derived from generalised linear models with repeated measures. Adjustments are made for the baseline value for the respective outcome variable. Blood pressure values are also adjusted for medication load. Statistical significance at each follow-up time point generated from univariate analysis of variance, * p<0.05, ** p<0.01, *** p<0.001.

Mentions: Reductions in systolic (ITT p = 0.03; mixed model p = 0.0062) and diastolic (ITT p = 0.005; mixed model p = 0.0004) blood pressures were greater in the intervention group than in the control group, after adjustments for baseline values and medication load. Systolic blood pressure was significantly lower (−4.9 mmHg) in the intervention compared with the control group after three years (mean 141.7 mmHg; 95% CI 139.0–144.4 mmHg vs. mean 146.8 mmHg; 95%CI 144.2–149.4 mmHg). Diastolic blood pressure was significantly lower in the intervention group at all time points except at three years (Figure 3). During follow-up, the use of blood pressure lowering drugs increased in both groups; this increase did not differ between groups (Table 3).


A 3-year randomized trial of lifestyle intervention for cardiovascular risk reduction in the primary care setting: the Swedish Björknäs study.

Eriksson MK, Franks PW, Eliasson M - PLoS ONE (2009)

(A–D) Changes in clinical characteristics.Data are adjusted means (95% confidence intervals) for each time point derived from generalised linear models with repeated measures. Adjustments are made for the baseline value for the respective outcome variable. Blood pressure values are also adjusted for medication load. Statistical significance at each follow-up time point generated from univariate analysis of variance, * p<0.05, ** p<0.01, *** p<0.001.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664964&req=5

pone-0005195-g003: (A–D) Changes in clinical characteristics.Data are adjusted means (95% confidence intervals) for each time point derived from generalised linear models with repeated measures. Adjustments are made for the baseline value for the respective outcome variable. Blood pressure values are also adjusted for medication load. Statistical significance at each follow-up time point generated from univariate analysis of variance, * p<0.05, ** p<0.01, *** p<0.001.
Mentions: Reductions in systolic (ITT p = 0.03; mixed model p = 0.0062) and diastolic (ITT p = 0.005; mixed model p = 0.0004) blood pressures were greater in the intervention group than in the control group, after adjustments for baseline values and medication load. Systolic blood pressure was significantly lower (−4.9 mmHg) in the intervention compared with the control group after three years (mean 141.7 mmHg; 95% CI 139.0–144.4 mmHg vs. mean 146.8 mmHg; 95%CI 144.2–149.4 mmHg). Diastolic blood pressure was significantly lower in the intervention group at all time points except at three years (Figure 3). During follow-up, the use of blood pressure lowering drugs increased in both groups; this increase did not differ between groups (Table 3).

Bottom Line: At 36 months post-randomisation, intensive lifestyle modification reduced waist circumference (-2.2 cm: p = 0.001), waist-hip ratio (-0.02: p<0.0001), systolic blood pressure (-4.9 mmHg: p = 0.036), and diastolic blood pressure (-1.6 mmHg: p = 0.005), and improved aerobic fitness (5%; p = 0.038).Changes in lipid or glucose values did not differ statistically between groups.At 36 months, self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group (p<0.001).

View Article: PubMed Central - PubMed

Affiliation: Björknäs Primary Health Care Centre, Boden, Sweden. margareta.Eriksson@nll.se

ABSTRACT

Background: Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility. The objective of this study was to test whether intensive lifestyle modification, shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals, can reduce cardiovascular risk factor levels in the primary care setting.

Methodology / principal findings: The Swedish Björknäs study was a randomized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3, 12, 24 and 36 months. A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were randomly assigned to either an intensive lifestyle intervention (n = 75) or control (n = 76) group. The intervention was based broadly on the protocol of the Diabetes Prevention Program. The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling, followed by regular group meetings during three years. The control group was given general advice about diet and exercise and received standard clinical care. Outcomes were changes in anthropometrics, aerobic fitness, self-reported physical activity, blood pressure, and metabolic traits. At 36 months post-randomisation, intensive lifestyle modification reduced waist circumference (-2.2 cm: p = 0.001), waist-hip ratio (-0.02: p<0.0001), systolic blood pressure (-4.9 mmHg: p = 0.036), and diastolic blood pressure (-1.6 mmHg: p = 0.005), and improved aerobic fitness (5%; p = 0.038). Changes in lipid or glucose values did not differ statistically between groups. At 36 months, self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group (p<0.001).

Conclusion / significance: A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals.

Trial registration: ClinicalTrials.gov NCT00486941.

Show MeSH
Related in: MedlinePlus