Lifestyle counselling programs to change diet and physical activity help people improve their risk factors for cardiovascular disease

Lin JS, O’Connor E, Evans CV, et al. 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 Aug 26. [Epub ahead of print].

Review question

What are the benefits and harms of behavioural lifestyle counselling programs to change diet and increase physical activity in people who have risk factors for cardiovascular diseases (e.g., coronary heart disease, stroke, peripheral artery disease)?

Background

People with high blood pressure, high cholesterol, increased risk of diabetes, and who smoke have a higher risk of cardiovascular disease. These risk factors can be improved with changes to diet and exercise, which are often difficult for people to make and to maintain. Intensive behavioural counselling programs have been designed to help people make these lifestyle changes.

How the review was done

The researchers did a systematic review, searching for studies published from 1990 to October 2013. They found 74 randomized controlled trials or controlled trials. The trials included

• adults who had at least 1 risk factor for cardiovascular disease (high blood pressure, high cholesterol, risk of diabetes, or smoking) but who did not have diabetes, coronary artery disease, cerebrovascular disease, peripheral artery disease, or severe chronic kidney disease; and
• behavioural-based counselling programs to promote a healthy diet or physical activity compared with a control group (usual care, a minimal intervention, or attention control) for at least 6 months.

What the researchers found

49 trials combined counselling on diet and physical activity, 18 focused on diet only, and 10 focused on physical activity only.

At 6 months to 7 years, groups did not differ for cardiovascular events including death.

At 1 to 2 years, behavioral counselling reduced cardiovascular risk factors by small amounts compared with the control group (see Table).

Conclusion

Behavioural lifestyle counselling programs to change diet and physical activity help people improve their risk factors for cardiovascular disease a little but do not affect cardiovascular events or death.

Behavioural counselling programs vs control to improve risk factors for cardiovascular disease