Jennifer S. Lin, MD, MCR; Elizabeth O'Connor, PhD; Evelyn P. Whitlock, MD, MPH; Tracy L. Beil, MS
Poor diet and lack of physical activity can worsen cardiovascular health, yet most Americans do not meet diet and physical activity recommendations.
To assist the U.S. Preventive Services Task Force in updating its previous recommendations by systematically reviewing trials of physical activity or dietary counseling to prevent cardiovascular disease.
MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (2001 to January 2010), experts, and existing systematic reviews.
Two investigators independently reviewed 13 562 abstracts and 481 articles against a set of a priori inclusion criteria and critically appraised each study by using design-specific quality criteria.
Data from 73 studies (109 articles) were abstracted by one reviewer and checked by a second reviewer. Random-effects meta-analyses were conducted for multiple intermediate health and behavioral outcomes.
Long-term observational follow-up of intensive sodium reduction counseling showed a decrease in the incidence of cardiovascular disease; however, other direct evidence for reduction in disease morbidity is lacking. High-intensity dietary counseling, with or without physical activity counseling, resulted in changes of −0.3 to −0.7 kg/m2 in body mass index (adiposity), −1.5 mm Hg (95% CI, −0.9 to −2.1 mm Hg) in systolic blood pressure, −0.7 mm Hg (CI, −0.6 to −0.9 mm Hg) in diastolic pressure, −0.17 mmol/L (CI, −0.09 to −0.25 mmol/L) (−6.56 mg/dL [CI, −3.47 to −9.65 mg/dL]) in total cholesterol level, and −0.13 mmol/L (CI, −0.06 to −0.21 mmol/L) (−5.02 mg/dL [CI, −2.32 to −8.11 mg/dL]) in low-density lipoprotein cholesterol level. Medium- and high-intensity counseling resulted in moderate to large changes in self-reported dietary and physical activity behaviors.
Meta-analyses for some outcomes had large statistical heterogeneity or evidence for publication bias. Only 11 trials followed outcomes beyond 12 months.
Counseling to improve diet or increase physical activity changed health behaviors and was associated with small improvements in adiposity, blood pressure, and lipid levels.
Agency for Healthcare Research and Quality.
CVD = cardiovascular disease; KQ = key question.
KQ = key question.
* We excluded 28 articles for different reasons in different areas; 7 were excluded for 1 area and included for another.
† We included 8 studies in more than 1 area.
‡ Additional studies identified for harms (not including trials included for KQs 1 to 3).
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Jennifer S. Lin, Elizabeth O'Connor, Evelyn P. Whitlock, Tracy L. Beil. Behavioral Counseling to Promote Physical Activity and a Healthful Diet to Prevent Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:736–750. doi: 10.7326/0003-4819-153-11-201012070-00007
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Published: Ann Intern Med. 2010;153(11):736-750.
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