Sarah J. Hardcastle

Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up

BackgroundIntensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention.MethodsPrimary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion.ResultsIntent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained.ConclusionsThe present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.

Why sprint interval training is inappropriate for a largely sedentary population.

Public health practitioners and researchers in behavioral medicine recognize the need to find effective physical activity interventions and prescriptions to curb the growth in inactivity and prevent chronic illness (Conn et al., 2009; Hagger, 2010; Hardcastle et al., 2012; Katzmarzyk and Lear, 2012). For example, researchers in exercise physiology have focused on the minimal dose of exercise needed to gain favorable physiological adaptations to cardiovascular and metabolic systems (Gibala et al., 2012). Efforts to identify a minimal dose of exercise are linked to the problem of exercise adherence with few people meeting current physical activity guidelines of 30 min per day of moderate intensity exercise. Given that time is the most commonly cited barrier to exercise (Trost et al., 2002; Sequeira et al., 2011), exercise professionals have focused attention on the development of time-efficient exercise interventions (Gibala, 2007). A recent development is the advocacy of Sprint Interval Training (SIT) as a means to attain substantial health benefits with a lower overall exercise volume. SIT is characterized by repeated, brief (4–6 × <30 s), intermittent bursts of all-out exercise, interspersed by periods (approximately 4.5 min) of active or passive recovery (Gibala et al., 2012). Research has consistently demonstrated that participation in SIT results in a host of physiological adaptations including improvements in health and fitness indicators (Burgomaster et al., 2006, 2008; Gibala et al., 2006, 2012; Rossow et al., 2010; Tong et al., 2011). In addition, these improvements have been reported to be equal or superior to traditional continuous aerobic training despite SIT involving a substantially lower total overall training volume (Rossow et al., 2010; Tong et al., 2011; Gibala et al., 2012; Cocks et al., 2013). Consequently, SIT is being advocated as a time-efficient alternative intervention for the achievement of fitness and health benefits through exercise (Gibala, 2007; Whyte et al., 2013).

Patients' Perceptions and Experiences of Familial Hypercholesterolemia, Cascade Genetic Screening and Treatment

BackgroundFamilial hypercholesterolemia (FH) is a serious genetic disorder affecting approximately 1 in every 300 to 500 individuals and is characterised by excessively high low-density lipoprotein (LDL) cholesterol levels, substantially increased risk of early-onset coronary heart disease (CHD) and premature mortality. If FH is untreated, it leads to a greater than 50 % risk of CHD in men by the age of 50 and at least 30 % in women by the age of 60. FH can be diagnosed through genetic screening and effectively managed through pharmacological treatment and lifestyle changes.PurposeFamilial hypercholesterolemia (FH) is a genetic health condition that increases the risk of cardiovascular disease. Although FH can be effectively managed with appropriate pharmacological and dietary interventions, FH detection rate through genetic screening remains low. The present study explored perceptions and experiences of FH patients (N = 18) involved in a genetic cascade screening programme.MethodsFace-to-face interviews were conducted to assess patients’ knowledge and understanding of FH, explore factors linked to adherence to health-protective behaviours and examine perceptions of genetic screening.ResultsThematic analysis of interviews revealed four themes: disease knowledge, severity of FH, lifestyle behavioural change and barriers to cascade screening and treatment. Participants recognised FH as a permanent, genetic condition that increased their risk of CHD and premature mortality. Many participants dismissed the seriousness of FH and the importance of lifestyle changes because they perceived it to be effectively managed through medication. Despite positive attitudes toward screening, many participants reported that relatives were reluctant to attend screening due to their relatives’ ‘fatalistic’ outlook or low motivation. Participants believed that they had insufficient authority or control to persuade family members to attend screening and welcomed greater hospital assistance for contact with relatives.ConclusionsFindings support the adoption of direct methods of recruitment to cascade screening led by medical professionals, who were perceived as having greater authority. Other implications included the need for clinicians to provide clear information, particularly to those who are asymptomatic, related to the seriousness of FH and the necessity for adherence to medication and lifestyle changes.

A minimum price per unit of alcohol: A focus group study to investigate public opinion concerning UK government proposals to introduce new price controls to curb alcohol consumption

BackgroundUK drinkers regularly consume alcohol in excess of guideline limits. One reason for this may be the high availability of low-cost alcoholic beverages. The introduction of a minimum price per unit of alcohol policy has been proposed as a means to reduce UK alcohol consumption. However, there is little in-depth research investigating public attitudes and beliefs regarding a minimum pricing policy. The aim of the present research was to investigate people’s attitudes and beliefs toward the introduction of a minimum price per unit of alcohol policy and their views on how the policy could be made acceptable to the general public.MethodsTwenty-eight focus groups were conducted to gain in-depth data on attitudes, knowledge, and beliefs regarding the introduction of a minimum price per unit of alcohol policy. Participants (total N = 218) were asked to give their opinions about the policy, its possible outcomes, and how its introduction might be made more acceptable. Transcribed focus-group discussions were analysed for emergent themes using inductive thematic content analysis.ResultsAnalysis indicated that participants’ objections to a minimum price had three main themes: (1) scepticism of minimum pricing as an effective means to reduce harmful alcohol consumption; (2) a dislike of the policy for a number of reasons (e.g., it was perceived to ‘punish’ the moderate drinker); and (3) concern that the policy might create or exacerbate existing social problems. There was a general perception that the policy was aimed at ‘problem’ and underage drinkers. Participants expressed some qualified support for the policy but stated that it would only work as part of a wider campaign including other educational elements.ConclusionsThere was little evidence to suggest that people would support the introduction of a minimum price per unit of alcohol policy. Scepticism about the effectiveness of the policy is likely to represent the most significant barrier to public support. Findings also suggest that clearer educational messages are needed to dispel misconceptions regarding the effectiveness of the policy and the introduction of the policy as part of a package of government initiatives to address excess alcohol consumption might be the best way to advance support for the policy.

Motivating the unmotivated: how can health behavior be changed in those unwilling to change?

Author(s): Hardcastle, Sarah J; Hancox, Jennie; Hattar, Anne; Maxwell-Smith, Chloe; Thogersen-Ntoumani, Cecilie; Hagger, Martin S

Feeling of pleasure to high-intensity interval exercise is dependent of the number of work bouts and physical activity status

Objectives To examine the affective responses during a single bout of a low-volume HIIE in active and insufficiently active men. Materials and methods Fifty-eight men (aged 25.3 ± 3.6 years) volunteered to participate in this study: i) active (n = 29) and ii) insufficiently active (n = 29). Each subject undertook i) initial screening and physical evaluation, ii) maximal exercise test, and iii) a single bout of a low-volume HIIE. The HIIE protocol consisted of 10 x 60s work bouts at 90% of maximal treadmill velocity (MTV) interspersed with 60s of active recovery at 30% of MTV. Affective responses (Feeling Scale, -5/+5), rating of perceived exertion (Borg’s RPE, 6–20), and heart rate (HR) were recorded during the last 10s of each work bout. A two-factor mixed-model repeated measures ANOVA, independent-samples t test, and chi-squared test were used to data analysis. Results There were similar positive affective responses to the first three work bouts between insufficiently active and active men (p > 0.05). However, insufficiently active group displayed lower affective responses over time (work bout 4 to 10) than the active group (p < 0.01). Also, the insufficiently active group displayed lower values of mean, lowest, and highest affective response, as well as lower values of affective response at the highest RPE than the active group (p < 0.001). There were no differences in the RPE and HR between the groups (p > 0.05). Conclusions Insufficiently active and active men report feelings of pleasure to few work bouts (i.e., 3–4) during low-volume HIIE, while the affective responses become more unpleasant over time for insufficiently active subjects. Investigations on the effects of low-volume HIIE protocols including a fewer number of work bouts on health status and fitness of less active subjects would be interesting, especially in the first training weeks.

Autonomous and controlled motivational regulations for multiple health-related behaviors: between- and within-participants analyses.

Self-determination theory has been applied to the prediction of a number of health-related behaviors with self-determined or autonomous forms of motivation generally more effective in predicting health behavior than non-self-determined or controlled forms. Research has been confined to examining the motivational predictors in single health behaviors rather than comparing effects across multiple behaviors. The present study addressed this gap in the literature by testing the relative contribution of autonomous and controlling motivation to the prediction of a large number of health-related behaviors, and examining individual differences in self-determined motivation as a moderator of the effects of autonomous and controlling motivation on health behavior. Participants were undergraduate students (N = 140) who completed measures of autonomous and controlled motivational regulations and behavioral intention for 20 health-related behaviors at an initial occasion with follow-up behavioral measures taken four weeks later. Path analysis was used to test a process model for each behavior in which motivational regulations predicted behavior mediated by intentions. Some minor idiosyncratic findings aside, between-participants analyses revealed significant effects for autonomous motivational regulations on intentions and behavior across the 20 behaviors. Effects for controlled motivation on intentions and behavior were relatively modest by comparison. Intentions mediated the effect of autonomous motivation on behavior. Within-participants analyses were used to segregate the sample into individuals who based their intentions on autonomous motivation (autonomy-oriented) and controlled motivation (control-oriented). Replicating the between-participants path analyses for the process model in the autonomy- and control-oriented samples did not alter the relative effects of the motivational orientations on intention and behavior. Results provide evidence for consistent effects of autonomous motivation on intentions and behavior across multiple health-related behaviors with little evidence of moderation by individual differences. Findings have implications for the generalizability of proposed effects in self-determination theory and intentions as a mediator of distal motivational factors on health-related behavior.

Identifying content-based and relational techniques to change behaviour in motivational interviewing

ABSTRACT Motivational interviewing (MI) is a complex intervention comprising multiple techniques aimed at changing health-related motivation and behaviour. However, MI techniques have not been systematically isolated and classified. This study aimed to identify the techniques unique to MI, classify them as content-related or relational, and evaluate the extent to which they overlap with techniques from the behaviour change technique taxonomy version 1 [BCTTv1; Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., … Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95]. Behaviour change experts (n = 3) content-analysed MI techniques based on Miller and Rollnick’s [(2013). Motivational interviewing: Preparing people for change (3rd ed.). New York: Guildford Press] conceptualisation. Each technique was then coded for independence and uniqueness by independent experts (n = 10). The experts also compared each MI technique to those from the BCTTv1. Experts identified 38 distinct MI techniques with high agreement on clarity, uniqueness, preciseness, and distinctiveness ratings. Of the identified techniques, 16 were classified as relational techniques. The remaining 22 techniques were classified as content based. Sixteen of the MI techniques were identified as having substantial overlap with techniques from the BCTTv1. The isolation and classification of MI techniques will provide researchers with the necessary tools to clearly specify MI interventions and test the main and interactive effects of the techniques on health behaviour. The distinction between relational and content-based techniques within MI is also an important advance, recognising that changes in motivation and behaviour in MI is a function of both intervention content and the interpersonal style in which the content is delivered.

Predicting Self-Management Behaviors in Familial Hypercholesterolemia Using an Integrated Theoretical Model: the Impact of Beliefs About Illnesses and Beliefs About Behaviors

PurposePatients with familial hypercholesterolemia (FH) are at markedly increased risk of coronary artery disease. Regular participation in three self-management behaviors, physical activity, healthy eating, and adherence to medication, can significantly reduce this risk in FH patients. We aimed to predict intentions to engage in these self-management behaviors in FH patients using a multi-theory, integrated model that makes the distinction between beliefs about illness and beliefs about self-management behaviors.MethodsUsing a cross-sectional, correlational design, patients (N = 110) diagnosed with FH from a clinic in Perth, Western Australia, self-completed a questionnaire that measured constructs from three health behavior theories: the common sense model of illness representations (serious consequences, timeline, personal control, treatment control, illness coherence, emotional representations); theory of planned behavior (attitudes, subjective norms, perceived behavioral control); and social cognitive theory (self-efficacy).ResultsStructural equation models for each self-management behavior revealed consistent and statistically significant effects of attitudes on intentions across the three behaviors. Subjective norms predicted intentions for health eating only and self-efficacy predicted intentions for physical activity only. There were no effects for the perceived behavioral control and common sense model constructs in any model.ConclusionsAttitudes feature prominently in determining intentions to engage in self-management behaviors in FH patients. The prominence of these attitudinal beliefs about self-management behaviors, as opposed to illness beliefs, suggest that addressing these beliefs may be a priority in the management of FH.

What if it really was an accident? The psychology of unintentional doping

Doping refers to the use of prohibited performance-enhancing substances or methods in sport. It is considered a serious offence in sport that has many negative consequences, including titles being stripped, bans from participating, damage to reputation and ill health. As doping is assumed to be a pre-meditated action, engaging in this behaviour has been predominantly attributed to athletes’ decision-making processes and moral values or obligations.1 An increasing volume of literature has focused on the psychological factors associated with doping or doping intention, such as motivation, sportsmanship, moral disengagement and social-cognitive factors.1 These studies make a central assumption that doping is a consciously controlled and goal-directed behaviour. However athletes may dope unintentionally because they are not aware that food, drinks, supplements, or medications may contain doping substances.2 ,3 Therefore, one of the key antidoping strategies of WADA, apart from doping control, is to enhance athletes’ antidoping awareness and their capacity to avoid unintentional doping. Unintentional doping could lead to adverse analytical findings (AAFs) in doping controls (eg, …