Lifestyle counselling programs help people make healthy choices and beneficial changes

The Bottom Line

  • People with high blood pressure, high cholesterol, increased risk of diabetes or who smoke are at greater risk for heart disease.
  • These risk factors can be improved with changes to diet and exercise, but many people are unable to change unhealthy habits on their own.
  • Lifestyle counselling programs can help people make changes that will result in improved health. 

We know what we’re supposed to do: follow a healthy, balanced diet and get regular physical exercise. It sounds simple enough, but for most of us it’s easier said than done. We try to practice good habits – at least most of the time – and limit our indulgences. But far too many people consistently make poor choices, putting themselves at risk for serious health problems, including heart disease (1).

That’s worrisome enough, but what’s even more alarming is that many people are already at increased risk for cardiovascular disease due to high blood pressure, high cholesterol, high risk of diabetes or because they smoke or are significantly overweight (2;3). While these risk factors can be improved with changes to diet and exercise, some people are unable to make or maintain these changes on their own.

For them, the intensive guidance and support offered by behavioural lifestyle counselling programs could be the solution. Research has shown that lifestyle interventions in people at risk for type 2 diabetes may decrease or postpone their risk of progressing to diabetes (4), but what about those at risk for heart disease?

To better determine if such programs benefit people with cardiovascular risk factors, a systematic review analyzed the results of 74 relevant studies conducted between 1990 and 2013. Most involved a combination of diet and exercise counselling, with some focusing on diet or exercise only. Participants (more than 34,000 across the 74 studies) were men and women aged 40 to 71 who had at least one risk factor for heart disease. The programs lasted an average of 12 months, included individualized care plans, and were delivered by dietitians, nutritionists, physiotherapists and exercise professionals (5).

What the research tells us

So do lifestyle counselling programs help? In a word, yes. The studies showed improvements in dietary and physical activity behaviours and reductions in cholesterol levels, blood pressure, weight, glucose levels (5;6) and incidence of diabetes (5). While the reductions were small to moderate, they may still translate into fewer strokes or reduced stroke risk (5;6), and fewer heart attacks (5).

The review points out that although intensive lifestyle counselling programs can be beneficial, they involve resources that may not be available or funded through healthcare systems. Future research might address alternate ways of offering lifestyle counselling support at a lower cost (5).

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Author Details


  1. Centres for Disease Control and Prevention (CDC). Million hearts: strategies to reduce the prevalence of leading cardiovascular disease factors – United States, 2011. MMWR Morb Mortal Wkly Rep. 2011; 60:1248-51.
  2. Yoon SS, Burt V, Louis T, et al. Hypertension among adults in the United States, 2009-2010. NCHS Data Brief. 2012; 1-8.
  3. Kuklinka EV, Carroll MD, Shaw KM, et al. Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States. 1976-2010. NCHS Data Brief. 2013; 1-8.
  4. Howells L, Musaddaq B, McKay AJ, et al. Clinical impact of lifestyle interventions for the prevention of diabetes: An overview of systematic reviews. BMJ open. 2016; 6(1):e013806. doi: 10.1136/bmjopen-2016-013806.  
  5. 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. Preventative Services Task Force. Ann Intern Med. 2014; 161:568-578.
  6. Zhang X, Devlin HN, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis. PLoS One. 2017; 12(5):e0176436. doi: 10.1371/journal.pone.0176436. 

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