Abstract
BackgroundPrevious interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided. In particular, family practice represents an ideal setting for the provision and long-term maintenance of lifestyle interventions for patients at risk (ie high-normal blood pressure or impaired glucose tolerance).Methods/designThe Staged Nutrition and Activity Counseling (SNAC) study is a randomized clustered design clinical trial that will investigate the effectiveness and efficacy of a multi-component lifestyle intervention on cardiovascular disease risk factors and vascular function in patients at risk in primary care. Patients will be randomized by practice to either a standard of care lifestyle intervention or a behaviourally-based, matched prescriptive physical activity and diet change program. The primary goal is to increase physical activity and improve dietary intake according to Canada's Guides to Physical Activity Healthy Eating over 24 months. The primary intention to treat analysis will compare behavioral, physiological and metabolic outcomes at 6, 12 and 24 months post-randomization including estimation of incident hypertension and/or diabetes.DiscussionThe design features of our trial, and the practical problems (and solutions) associated with implementing these design features, particularly those that result in potential delay between recruitment, baseline data collection, randomization, intervention, and assessment will be discussed. Results of the SNAC trial will provide scientific rationale for the implementation of this lifestyle intervention in primary care.Trial registrationISRCTN: ISRCTN:42921300
Highlights
Previous interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided
The design features of our trial, and the practical problems associated with implementing these design features, those that result in potential delay between recruitment, baseline data collection, randomization, intervention, and assessment will be discussed
Elevated blood pressure and elevated blood glucose are prototypic of preventable chronic cardiovascular disease risk factors [2]
Summary
Previous interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided. Efforts to prevent the morbidity and mortality of these chronic diseases as a result of poor lifestyle have focused mainly on the clinical management of individuals with existing disease Such an approach does not address the potential reversible causes of these conditions, primarily poor lifestyles including low levels of physical activity and poor dietary habits. To have maximal impact in preventing further disability, we will target those patients with preclinical risk for cardiovascular morbidity (namely those with high normal blood pressure and/or impaired glucose tolerance). The catalyst for this bench-to-bedside model will be the family physician, who will deliver this research intervention in his/her practice to a representative population of adults at risk
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