Jennifer S. Lin, MD, MCR; Elizabeth O'Connor, PhD; Corinne V. Evans, MPP; Caitlyn A. Senger, MPH; Maya G. Rowland, MPH; Holly C. Groom, MPH
Acknowledgment: The authors thank the medical librarians at Kaiser Permanente Center for Health Research for creating and conducting the literature searches and Kevin Lutz, MFA, for his editorial assistance. They also thank David Brown, PhD; Janet de Jesus, MS, RD; David Hopkins, MD, MPH; Abby King, PhD; Penny Kris-Etherton, PhD, RD; and Laura Svetkey, MD, MHS, who provided expert review of the report. The authors thank Joseph Chin, MD, MS; Lawrence Fine, MD; Linda Kinsinger, MD, MPH; Charlotte Pratt, PhD, RD; Wendy B. Smith, OBSSR, OD; and Catherine Witkop, MD, MPH, who provided additional review of the report. They also thank Robert McNellis, MPH, PA, at the Agency for Healthcare Research and Quality, and Sue Curry, PhD; Mark Ebell, MD, MS; and Michael LeFevre, MD, MSPH, from the USPSTF.
Financial Support: By the Agency for Healthcare Research and Quality (contract HHS-290-2007-10057-I).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0130.
Request for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.ahrq.gov).
Current Author Addresses: Drs. Lin and O'Connor, Ms. Evans, Ms. Senger, Ms. Rowland, and Ms. Groom: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.
Author Contributions: Conception and design: J.S. Lin, E. O'Connor.
Analysis and interpretation of the data: J.S. Lin, E. O'Connor, C.V. Evans, C.A. Senger.
Drafting of the article: J.S. Lin.
Critical revision of the article for important intellectual content: J.S. Lin, E. O'Connor, C.A. Senger, H.C. Groom.
Final approval of the article: J.S. Lin, E. O'Connor, C.V. Evans, C.A. Senger, M.G. Rowland, H.C. Groom.
Statistical expertise: E. O'Connor.
Obtaining of funding: J.S. Lin.
Administrative, technical, or logistic support: C.A. Senger, M.G. Rowland.
Collection and assembly of data: J.S. Lin, C.V. Evans, C.A. Senger, M.G. Rowland, H.C. Groom.
Most Americans do not meet diet and physical activity recommendations despite known health benefits.
To systematically review the benefits and harms of lifestyle counseling interventions in persons with cardiovascular risk factors for the U.S. Preventive Services Task Force.
MEDLINE, PsycINFO, the Database of Abstracts of Reviews of Effects, and the Cochrane Central Register of Controlled Trials (January 2001 to October 2013); experts; and existing systematic reviews.
Two investigators independently reviewed 7218 abstracts and 553 articles against a set of inclusion and quality criteria.
Data from 74 trials were abstracted by one reviewer and checked by a second.
At 12 to 24 months, intensive lifestyle counseling in persons selected for risk factors reduced total cholesterol levels by an average of 0.12 mmol/L (95% CI, 0.16 to 0.07 mmol/L) (4.48 mg/dL [CI, 6.36 to 2.59 mg/dL]), low-density lipoprotein cholesterol levels by 0.09 mmol/L (CI, 0.14 to 0.04 mmol/L) (3.43 mg/dL [CI, 5.37 to 1.49 mg/dL]), systolic blood pressure by 2.03 mm Hg (CI, 2.91 to 1.15 mm Hg), diastolic blood pressure by 1.38 mm Hg (CI, 1.92 to 0.83 mm Hg), fasting glucose levels by 0.12 mmol/L (CI, 0.18 to 0.05 mmol/L) (2.08 mg/dL [CI, 3.29 to 0.88 mg/dL]), diabetes incidence by a relative risk of 0.58 (CI, 0.37 to 0.89), and weight outcomes by a standardized mean difference of 0.25 (CI, 0.35 to 0.16). Behavioral changes in dietary intake and physical activity were generally concordant with changes in physiologic outcomes.
Sparse reporting of patient health outcomes, longer-term follow-up of outcomes, and harms.
Intensive diet and physical activity behavioral counseling in persons with risk factors for cardiovascular disease resulted in consistent improvements across various important intermediate health outcomes up to 2 years.
Agency for Healthcare Research and Quality.
Table 1. Pooled Effect Sizes for Intermediate Cardiovascular Health Outcomes, by Intervention Type
Table 2. Overall Summary of Evidence, by Outcome
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Lin JS, O'Connor E, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral Counseling to Promote a Healthy Lifestyle in Persons With Cardiovascular Risk Factors: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161:568-578. doi: 10.7326/M14-0130
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Published: Ann Intern Med. 2014;161(8):568-578.
Cardiology, Coronary Risk Factors, Prevention/Screening.
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