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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)?


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).


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


Number of trials (people)

Effect of behavioural counselling

Cardiovascular events or death

4 trials (3,962 people)

No difference in effect at 6 months to 7 years

Total cholesterol

34 trials

Reduced by 0.12 mmol/L at 1 to 2 years

Low-density lipoprotein cholesterol

47 trials

Reduced by 0.09 mmol/L at 1 to 2 years

High-density lipoprotein cholesterol

19 trials

Reduced by 0.02 mmol/L at 1 to 2 years

Systolic blood pressure

31 trials

Reduced by 2.0 mm Hg at 1 to 2 years

Diastolic blood pressure

24 trials

Reduced by 1.4 mm Hg at 1 to 2 years

Fasting glucose

22 trials

Reduced by 0.12 mmol/L at 1 to 2 years

Diabetes mellitus

8 trials

Reduced by 42% at 1 to 2 years


34 trials

Reduced by a standard mean difference of 0.25 at 1 to 2 years



Control group
A group that receives either no treatment or a standard treatment.
Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

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