Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial

Objective To measure the effect of behaviourally oriented counselling in ge neral practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease. Design Cluster randomised controlled trial. Participants 883 men and women selected for die presence of one or more mod ifiable risk factors: regular cigarette smoking, high serum cholesterol con centration (6.5-9.0 mmol/l), and high body mass index (25-35) combined with low physical activity Intervention Brief behavioural counselling, on the basis of the stage of ch ange model, carried out by practice nurses to reduce smoking and dietary fa t intake and to increase regular: physical activity Main outcome measures Questionnaire measures of diet exercise, and smoking habits, and blood pressure, serum total cholesterol concentration, weight, body mass index, and smoking cessation (with biochemical validation) at 4 a nd 12 months. Results Favourable differences were recorded in the intervention group for dietary fat intake, regular-exercise, and cigarettes smoked per day at 4 an d 12 months. Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months. No differences were found be tween groups in changes in total serum cholesterol concentration, weight, b ody mass index, diastolic pressure, or smoking cessation. Conclusions Brief behavioural counselling by practice nurses led to improve ments in healthy behaviour. More extended counselling to help patients sust ain and build on behaviour changes may be required before differences in bi ological risk factors emerge.