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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–C) Changes in physical activity level.Proportion of participants reporting the level of each variable, total physical activity, leisure time physical activity and exercise and ordered as follows: TPA; sedentary, minimally active, moderately active and very active. LTPA and exercise; ‘none’ = 0, ‘<30 min/day’ = 1, ‘30–60 min/day’ = 2, and ‘>60 min/day’ = 3. P values from general linear model repeated measures analysis.
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pone-0005195-g005: (A–C) Changes in physical activity level.Proportion of participants reporting the level of each variable, total physical activity, leisure time physical activity and exercise and ordered as follows: TPA; sedentary, minimally active, moderately active and very active. LTPA and exercise; ‘none’ = 0, ‘<30 min/day’ = 1, ‘30–60 min/day’ = 2, and ‘>60 min/day’ = 3. P values from general linear model repeated measures analysis.

Mentions: The improvements in VO2max may reflect an effect of increased physical activity levels in participants in the intervention group; those individuals reported more exercise participation (p<0.0001) and greater TPA (p<0.0001) compared with participants in the control group by the end of the trial. At baseline 20% of the lifestyle intervention group was sedentary, whereas only 7% was sedentary at the 3-year examination. At three years about 70% of both groups reported LTPA of at least 30 min/d, but in the intervention group the proportions of those reporting being moderately or very physical active had increased from 42% to 59%, respectively. This contrasted the control group, where physical activity had decreased from 49% to 43%, respectively. Correspondingly, in the intervention group the proportion reporting exercising at least 30 min/d or more increased from 11% to 28% (Figure 5). The results from the mixed-model analyses were consistent with the ITT analyses for both exercise (p<0.001) and TPA (p = 0.0009).


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–C) Changes in physical activity level.Proportion of participants reporting the level of each variable, total physical activity, leisure time physical activity and exercise and ordered as follows: TPA; sedentary, minimally active, moderately active and very active. LTPA and exercise; ‘none’ = 0, ‘<30 min/day’ = 1, ‘30–60 min/day’ = 2, and ‘>60 min/day’ = 3. P values from general linear model repeated measures analysis.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2664964&req=5

pone-0005195-g005: (A–C) Changes in physical activity level.Proportion of participants reporting the level of each variable, total physical activity, leisure time physical activity and exercise and ordered as follows: TPA; sedentary, minimally active, moderately active and very active. LTPA and exercise; ‘none’ = 0, ‘<30 min/day’ = 1, ‘30–60 min/day’ = 2, and ‘>60 min/day’ = 3. P values from general linear model repeated measures analysis.
Mentions: The improvements in VO2max may reflect an effect of increased physical activity levels in participants in the intervention group; those individuals reported more exercise participation (p<0.0001) and greater TPA (p<0.0001) compared with participants in the control group by the end of the trial. At baseline 20% of the lifestyle intervention group was sedentary, whereas only 7% was sedentary at the 3-year examination. At three years about 70% of both groups reported LTPA of at least 30 min/d, but in the intervention group the proportions of those reporting being moderately or very physical active had increased from 42% to 59%, respectively. This contrasted the control group, where physical activity had decreased from 49% to 43%, respectively. Correspondingly, in the intervention group the proportion reporting exercising at least 30 min/d or more increased from 11% to 28% (Figure 5). The results from the mixed-model analyses were consistent with the ITT analyses for both exercise (p<0.001) and TPA (p = 0.0009).

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