Table 1 The BCPP and MDPP programmes
Timeline | Health care professional | Modality of contact | BCPP | MDPP | |
|---|---|---|---|---|---|
Disease risk information | |||||
Median (range)-6.5 (0 – 63) months | Personalised breast cancer risk information had been received prior to invitation to the lifestyle programmes (10 year and lifetime – derived from the Tyrer-Cuzick model) | Clinician in the high risk clinic (High or above average risk) or Letter (average or below average risk) | Face to face / phone Letter | ✓ | ✓ |
Time 0 | Reminder of personalised breast cancer risk | Research dietitian | Face to face | ✓ | ✓ |
Advice that weight loss of ≥5% and adherence to PA and alcohol recommendations could lead to significant reductions in risk of BC (25%) [21, 22] | Research dietitian | Face to face | ✓ | ✓ | |
General advice that 5% weight loss could reduce their risk of T2D (60%) [23] and CVD (30%) [24] | Research dietitian | Face to face | ✓ | ||
NHS health check tests | Research dietitian/research practitioner | Face to face | ✓ | ||
Personalised feedback of: CVD risk (10-year and lifetime risk and heart age from QRISK2) [19] T2D risk (QDiabetes and measured HbA1c) [20] | Research dietitian | Face to face | ✓ | ||
Personalised estimate of change in CVD risk from predicted reductions in blood pressure and total cholesterol) (i.e. a 1 mm/Hg reduction in systolic blood pressure per 1% weight loss up to a 10% weight loss [25] and a 1% reduction in total cholesterol for every 1% weight loss up to a 15% weight loss) [26]. Personalised estimate of change in Q diabetes risk by entering the target reduced weight in the QDiabetes tool | Research dietitian | Face to face | ✓ | ||
NHS Health Check results sent to general practitioner to allow appropriate follow up and clinical management, e.g. checking abnormal result, consideration of medications for raised cholesterol, blood pressure and HbA1c. | General practitioner | Face to face/phone | ✓ | ||
Lifestyle advice and behavioural support | |||||
Time 0 | Dietary advice to follow an intermittent (5:2) or daily energy restricted Mediterranean diet | Research dietitian | Face to face | ✓ | ✓ |
Physical activity advice (150 mins/moderate intensity CV & 40 mins of resistance exercise /week) [27] tailored to participant’s preferences, abilities and co-morbidities, with referral to local services where appropriatea | Research dietitian | Face to face | ✓ | ✓ | |
Advised to limit alcohol intake to <10 units/week due to its effect on weight and weight independent effects on disease risk | Face to face | ✓ | ✓ | ||
Tutorial for use of the trial website & self-monitoring | Research dietitian | Face to face | ✓ | ✓ | |
Referral to NHS smoking cessation or alcohol services if reporting high-risk alcohol intakes with Alcohol Use Disorders Identification Test (AUDIT) scores >8 [28] | Participants asked to self- refer to relevant services | Face to face | ✓ | ✓ | |
0 – 6 months | Scheduled review calls at weeks 1, 4 and 8 | Research dietitian | Phone | ✓ | ✓ |
Weekly personalised e mails (weeks 2,3,5,6,7,9-26) | Research dietitian | E mail | ✓ | ✓ | |
Monthly trial newsletter | Automated | E mail | ✓ | ✓ | |
3 and 6 month weight review | Research dietitian | Face to face | ✓ | ✓ | |
Self-management using the trial website | Participants | Web | ✓ | ✓ | |
6- 12 months | Automated monthly email from the trial website: Positive feedback for records showing weight loss or weight maintenance Encouraged re-engagement with the programmes if weight had increased by ≥1kg or if no website entries recorded. | Automated | E mail | ✓ | ✓ |
Self -management using the trial website | Participants | Web | ✓ | ✓ |