Motivational interviewing increases efficacy of exercise intervention

Adding a motivational interviewing component to a community-based exercise intervention increased the efficacy of the workout, data published in Health and Social Care in the Community showed.

“Research shows that from middle age onwards, adults face increasing barriers to physical activity, including developing physical health conditions and low confidence with exercise, and the barriers are increased for those living in rural areas,” Catharine Rose, director of Tiller Research in Worcestershire, England, told Healio Primary Care.

Rose and colleagues assessed the cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) at 5 years, 10 years and 25 years of Active HERE, a 12-week intervention that engaged inactive adults in physical activity. The intervention took place in Herefordshire, “a large, rural English county, with a significantly older and inactive adult population,” the researchers wrote.

There are two versions of the Active HERE intervention. During the study, 427 adults chose to participate in the Active in the Community (AiC) version, during which they talked about exercise-related preferences, possible obstacles to engaging in exercise and other concerns before being guided towards one or more exercises, according to the researchers. The other 478 adults chose to participate in Active Plus (A+), which consisted of the AiC components plus up to three more motivational interviewing sessions lasting up to 1 hour each. During these sessions, participants learned about the physical benefits of exercise and goal-setting exercises. The A+ participants were then assigned to exercises based on information from the motivational interviewing sessions.

Physical activity levels and emotional well-being (the latter through the WHO-5 questionnaire) were also evaluated at the end of the intervention, and, among the A+ participants, again at 26 and 52 weeks. Many of the outcomes were analyzed alongside results from an unmatched comparison group receiving treatment as usual (TAU), according to the researchers.

After 12 weeks, the results showed that physical activity significantly increased among all groups, with the highest increase observed among adults in A+ (69.3%) and the lowest increase observed among adults in TAU (22.6%). There were also greater psychological outcomes among adults in A+ compared with those in TAU, according to the researchers. Well-being improved significantly in the TAU group (P = .003) and the A+ group (P < .001). In addition, longitudinal results showed that the adults in A+ maintained increases in light-intensity physical activity at 52 weeks. Regression analyses indicated baseline self-efficacy foretold a participant’s increased physical activity at 52 weeks, while baseline well-being did not.

“The relationship between self-efficacy and [physical activity] increased successively across time points,” the researchers wrote. “However, magnitude of participants’ increased self-efficacy did not predict [physical activity] at any time point.”

The researchers estimated that both AiC and A+, when conducted in adults aged 61 years and older, were cost effective at about £20,000 ($27,860) per QALY, with a greater than 99% probability. Rose and colleagues projected that the interventions helped prevent certain conditions, including hip fractures, dementia and heart disease.

Modeled projections for QALY-ROI were higher for A+ than AiC and in all instances were “strong,” with greater than 95% probability that a positive ROI would occur.

Catharine Rose

Rose said Active HERE provides a good, financially prudent example of the “guidance and encouragement” adults need to become and remain physically active as they grow older.

“Tailored interventions which provide practical support and guidance to help adults choose accessible, appropriate and enjoyable physical activities are needed to help people make lasting changes in their lives,” she said. “Interventions that are community-based and accessible through self-referral routes remove the stigma of help-seeking and are therefore empowering to those needing support.”