Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors updated systematic review for the U.S. Preventive Services Task Force
CONCLUSIONS: Medium- and high-contact multi-session behavioral counseling interventions to improve diet and increase physical activity provided to people with hypertension, dyslipidemia, or elevated blood pressure and lipid levels are effective in reducing CVD events, blood pressure, total cholester...
| Main Authors: | , , , |
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| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
| Published: |
Rockville, MD
Agency for Healthcare Research and Quality
2020, May 2020
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| Series: | Evidence synthesis
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | CONCLUSIONS: Medium- and high-contact multi-session behavioral counseling interventions to improve diet and increase physical activity provided to people with hypertension, dyslipidemia, or elevated blood pressure and lipid levels are effective in reducing CVD events, blood pressure, total cholesterol, and adiposity-related outcomes, with little to no risk of serious harm Behavioral counseling interventions were associated with a lower risk of cardiovascular events (pooled relative risk [RR]=0.80 [95% confidence interval (CI), 0.73 to 0.87]; 9 randomized controlled trials [RCTs] [n=12,551]; I2=0%), myocardial infarction (MI) (pooled RR=0.85 [95% CI, 0.70 to 1.02]; 6 RCTs [n=10,375]; I2=0%) and stroke (RR=0.52 [95% CI, 0.25 to 1.10]; 4 RCTs [n=9,800]; I2=0%), although the pooled effect was not statistically significant for stroke or MI. Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]) 3.6 percent in the intervention groups experienced a cardiovascular event, compared with 4.4 percent in the control group. In addition, behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, total cholesterol, fasting glucose, and adiposity-related outcomes at 12 to 24 months' followup. Critical appraisal was completed independently by two investigators. Data were extracted from studies by one reviewer and checked by a second. DATA ANALYSIS: Random effects meta-analysis was used to examine outcomes with sufficient evidence to warrant pooled analyses, including all-cause mortality, cardiovascular events, blood pressure, lipids, adiposity-related outcomes, glucose-related outcomes, dietary measures, and physical activity. Subgroup analyses and meta-regression were used to explore effect modification for systolic blood pressure, total cholesterol, and weight. RESULTS: Ninety-four randomized trials were included (N=52,174). Blood pressure in intervention groups was reduced by a greater amount than in control groups--by a mean 1.8/1.2 mm Hg--after 12 to 24 months (pooled systolic blood pressure [SBP]=−1.8 [95% CI, −2.5 to −1.1]; 44 RCTs [n=14,580]; I2=37%; pooled diastolic blood pressure [DBP]=−1.2 [95% CI, −1.6 to −0.8]; 40 RCTs [n=13,098]; I2=32%). Total cholesterol was reduced by 3.5 mg/dL (95% CI, −5.6 to −1.4; 38 RCTs [n=11,414]; I2=66%) and low-density lipoprotein cholesterol was reduced by 2.1 mg/dL (95% CI, −4.1 to −0.2; 32 RCTs [n=8,894]; I2=56%). Intervention groups also showed slightly greater reductions in three adiposity-related measures: pooled body mass index=−0.5 kg/m2 (95% CI, −0.7 to −0.3); 30 RCTs (n=9,909); I2=83%; pooled weight=−1.6 kg (95% CI, −2.1 to −1.1); 37 RCTs (n=16,345); I2=88%; and pooled waist circumference=−1.8 cm (95% CI, −2.4 to −1.1); 23 RCTs (n=11,708); I2=87%. Reporting of diet and physical activity was very heterogeneous, and evidence suggested small mean improvements in dietary intake consistent with the intervention targets but small to no impact on physical activity. Results for blood pressure, lipid, and adiposity-related measures were generally consistent with the previous review despite some modifications to the review scope. LIMITATIONS: Health outcomes were reported in a small proportion of the included trials, and many had very few events. Measurement of behavioral outcomes was extremely heterogeneous, and the clinical importance of measures of a single aspect of participants' diet is limited. OBJECTIVE: To review the benefits and harms of behavioral counseling interventions to improve diet and increase physical activity in adults with cardiovascular risk factors. DATA SOURCES: We performed a search of MEDLINE, PubMed (publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant English-language studies published between January 2013 and September 2019. Additionally, we re-evaluated all studies included in the 2014 USPSTF review and related USPSTF systematic reviews. We conducted ongoing surveillance for relevant literature through July 24, 2020. STUDY SELECTION: Two investigators independently reviewed 14,409 unique citations and 466 full-text articles against a priori inclusion criteria. We included English-language randomized clinical trials of behavioral counseling interventions to help people with elevated blood pressure or lipids improve their diet and increase physical activity. |
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| Physical Description: | 1 PDF file (vii, 8-467 pages) illustrations |