The impact of a single brief intervention versus multiple contact lifestyle intervention on change in body weight and modifiable cardio vascular risk factors in adults who have undertaken cardiovascular risk screening

  • Janice Rowland

Student thesis: Doctoral ThesisDoctor of Philosophy


Obesity is an increasing cause of poor health in Scotland and contributes to many premature deaths. There are a range of preventable conditions for which causal links with obesity have been suggested including; type 2 diabetes, hypertension, hyperlipideamia (which is a major risk factor for ischemic heart disease), cardiovascular diseases (CVD) and certain cancers. CVD relates strongly to lifestyles, and risk factor modifications have been shown to reduce mortality and morbidity. It has become clear that the major contributors to poor cardiovascular health are related to adverse health behaviours namely excess body weight, diet, physical activity and smoking, and that risk assessment and primary prevention of CVD should remain a priority for the Public Health Agenda.

Participants of the TASCFORCE study screening healthy adults over 40yrs for CVD risk were invited to participate in the HF2 randomised comparison study. All participants received the brief intervention at screening, baseline measurements of body mass index (BMI) and lipids. Participants with BMI ≥25kg/m² were eligible for HF2. Questionnaires were mailed after screening to assess general health, diet and activity. On return of the questionnaires participants were randomised to multiple-contact intervention or follow-up only. For 16-weeks the multiple-contact group received monthly information packs and telephone consultations with lifestyle counsellors to help achieve weight-loss goals. Participants were then re-assessed for changes in weight, cardiovascular risk, diet, activity and general health.

The novel components in the HF2 investigation were; a cohort consisting of a middle aged population having undergone CVD risk screening, a fully powered randomised controlled trial of 16 weeks duration with the primary outcome of change in body weight and secondary outcomes to evaluate change in CVD risk factors, using the telephone as the primary mode of delivery. Per Protocol data indicated the multiple-contact group lost significantly more weight than the brief single contact group (between group difference 1.1kg, CI 0.1563 – 2.0585, p=0.023), however, when adjusted using imputed data, the ITT data showed weight loss was no longer significant (between group difference 0.9kg, CI-0.1420 – 1.9180, p=0.090). Although the HF2 intervention was not successful in achieving statistically significant weight loss, there were many positive outcomes. There were significant improvements in anthropometric modifiable risk factors shown in the intervention group notably a reduction in waist circumference, total cholesterol and low density lipoproteins. Both groups were successful in achieving weight loss and significantly improving a number of CVD risk factors, indicating that the HF2 intervention and the brief (usual care) advice were effective at initiating behaviour change. The study was shown to be acceptable with good participation satisfaction feedback for both intervention and control groups, with 94.5% in the intervention group rating the program as “worthwhile or excellent”. This study demonstrates it is feasible to use the screening setting as an opportunity to recruit participants for a lifestyle intervention.
Date of Award2016
Original languageEnglish
SupervisorJill Belch (Supervisor), Annie Anderson (Supervisor), Angela Craigie (Supervisor), Roberta Littleford (Supervisor) & Elaine Bannerman (Supervisor)

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