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A large, well-designed, randomised controlled trial found that MOVE IT, a motivational interviewing intervention, did not increase physical activity or lead to weight loss among people at high risk for cardiovascular disease (CVD).1 That means we should give up on motivational interviewing, right?

The trial described in the Heart article by Ismail and colleagues1 provides important information on a known gap in the literature. A recent systematic review found insufficient evidence to make conclusions regarding the utility of motivational interviewing for preventing and/or treating CVD.2 Ismail and colleagues1 found that neither group nor individual MOVE IT improved primary outcomes (physical activity, weight loss), nor did MOVE IT affect other related factors, such as lipids or CVD risk score (secondary outcomes). Further, MOVE IT was not cost-effective compared with usual care.

These findings suggest it may be inefficient to pay for multisession, in-person, low-intensity motivational interviewing-based interventions with the goal of preventing CVD. Unlike many other studies of motivational interviewing interventions,2 3 Ismail and colleagues1 reported therapist training and fidelity measures, noting that therapists were generally proficient. They also reported that most participants set goals that were at least partially achieved. As a result, we know that study therapists provided a form of enhanced motivational interviewing, and that participants engaged in the intervention.

At the same time, there is reason to believe that MOVE IT was not offered to the population most likely to benefit …