A recent study on the AAFP's Americans in Motion-Healthy Interventions(www.annfammed.org) (AIM-HI) program showed clinically significant before and after improvements in outcomes for patients in 21 U.S. family medicine practices using the AIM-HI program.
The study's original intent was to compare two methods of implementing AIM-HI tools to see if practices using an "enhanced" AIM-HI program were more successful than practices using a traditional AIM-HI program. In the enhanced program, physicians and office staff used AIM-HI tools to make personal changes and create a healthy environment. In the traditional practice approach, physicians and staff members were trained and asked to use the tools with patients.
Although the study, which appears in the July/August Annals of Family Medicine, was unable to demonstrate that clinician and practice behavior changes translate to changes in patient behavior, the study did show that the AIM-HI program generated clinically significant changes in body mass index (BMI) and fitness level across the entire study population.
"In our direct measurement of BMI and fitness level, 16.2 percent of patients who completed a 10-month visit and 10 percent of all patients enrolled lost 5 percent or more of their body weight," the study authors wrote. "Similarly, 16.7 percent of patients who completed a 10-month visit and 10.3 percent of all patients enrolled had a two-point or greater increase in their fitness level. One hundred ten patients (29.2 percent of those who completed the 10-month visit, 18 percent of all enrollees) had either lost 5 percent or more of their body weight and/or increased their fitness level by two or more points."
Investigators provided all practices with AIM-HI tools(28 page PDF), including a fitness inventory, fitness prescription, and a food and activity journal as part of the fitness intervention. All staff members and clinicians in enhanced practices were trained and encouraged to become familiar with the tools, to use the tools to make their own personal lifestyle changes, and to create a fitness culture within their own practices.
Traditional practices also were trained in the use of the AIM-HI tools and encouraged to use them with patients, but clinicians and staff members were not instructed to initiate practice-level interventions.
Investigators said the one significant difference between the two groups was a decrease in the systolic blood pressure numbers for enhanced-practice patients.
"Both groups showed greater changes at four months than 10 months, though statistically significant improvements were seen in multiple measures at 10 months in each group. Self-reported eating behaviors scores improved consistently from baseline to four months to 10 months in both groups," the authors wrote. "As a whole, enrolled patients showed significant, albeit small, changes in most areas."
Principal investigator, Wilson Pace, M.D., a professor in the family medicine department at the University of Colorado-Denver, said the study indicates that the AIM-HI tools can be successfully integrated into family practices in various ways. "Offering help for behavioral change using the AIM-HI tools to interested patients can result in worthwhile improvements in weight and physical fitness," he said.
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