Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial.
Heleen Westland, Marieke J Schuurmans, Irene D Bos-Touwen and 5 others
PMID 32375491WHAT IT FOUND
Nurse-led consultations did not improve physical activity more than usual care over 6 months in patients at risk of cardiovascular disease.
Subgroup hints for low baseline activity or low social support were not enough to prove benefit.
Key findings
01The primary outcome, change in moderate to vigorous physical activity at 6 months, did not differ significantly between the nurse-led intervention and usual care.
02Sedentary behaviour, self-efficacy for physical activity, patient activation and health status also showed no significant between-group differences at 6 months.
03Subgroup analyses suggested larger effects in patients with low baseline activity or low perceived social support, but the authors cautioned these analyses lacked power.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial was underpowered: the planned sample was 279 patients, but 195 completed baseline questionnaires. Only 31 of 478 invited general practices participated (6.5%), and the patient recruitment rate was 27.6%. The intervention group had more women, a higher BMI and a slightly higher metabolic risk profile at baseline. The trial was unblinded, and patients were not aware of the study aim until after follow-up. Many patients were already relatively active at baseline, nearly half meeting the Dutch physical activity guideline, leaving little room for improvement. Baseline measurements were mostly taken in summer, when physical activity levels are higher. The dropout rate was 19.4%, higher than the anticipated 15%. Subgroup analyses were not powered, so the apparent benefits in low social support and low baseline activity should be treated as exploratory. The accelerometer could not measure cycling, swimming or strength training properly, and device loss or technical problems caused missing data.
Declared interests
No funding or conflict-of-interest declaration is included in the supplied text; the publication type lists non-U.S. government research support.
The easy way to misread this
Do not read the 15.3% higher activity or the 33.3% versus 23.7% clinically relevant increase as proof the programme works. The primary outcome was not significantly different, and the subgroup findings were underpowered.