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No difference in lifestyle changes by adding individual counselling to group-based rehabilitation RCT among coronary heart disease patients

Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, thomas.mildestvedt{at}isf.uib.no

Eivind Meland

Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen

Geir Egil Eide

Centre for Clinical Research, Haukeland University Hospital, Bergen and Department of Public Health and Primary Health Care, Section for Epidemiology and Medical Statistics, University of Bergen, Norway

Aims: First, to examine whether autonomy-supportive and self-efficacy-enhancing individual lifestyle counselling was associated with improved maintenance of heart-protective diets and smoking cessation compared with group-based counselling. Second, to investigate to what extent reported motivation was associated with maintenance of dietary changes. Methods: A randomized controlled trial and longitudinal study of predictor variables in a four-week heart rehabilitation setting with two years follow-up. A total of 176 (38 female) patients were included, mainly with coronary heart disease. The main outcome measures were dietary changes and smoking cessation. Motivational factors were tested for predictive power in the three dietary outcomes: daily intake of fruit and vegetables, a low saturated fat diet, and weekly intake of fish dinners. Results: No clinically significant difference in improvement of dietary maintenance was found between the two groups. The between-group difference in smoking status change was statistically insignificant (p=0.12). Both groups showed an improvement in their dietary measures. Self-efficacy predicted an increased frequency of eating fish dinners (p=0.001) and more daily units of fruit and vegetables (p<0.001). Autonomous motivation had a marginal association with increased intake of fruits and vegetables (p=0.08) and was significantly associated with a lower saturated fat diet (p=0.001). Conclusions: Among this highly motivated group of rehabilitation patients, no effect was found of adding autonomy-supportive, individual counselling to group-based interventions. Based on longitudinal documentation, this cardiac rehabilitation programme improves long-term maintenance of dietary changes, and this maintenance is related to autonomous motivation and self-efficacy.

Key Words: Cardiac rehabilitation • coronary heart disease • dietary change • motivation • randomized controlled trial • secondary prevention

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