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Clinician Article

Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: a systematic review for the U.S. Preventive Services Task Force.



  • Lin JS
  • O'Connor E
  • Evans CV
  • Senger CA
  • Rowland MG
  • Groom HC
Ann Intern Med. 2014 Oct 21;161(8):568-78. doi: 10.7326/M14-0130. (Review)
PMID: 25155549
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Public Health
    Relevance - 6/7
    Newsworthiness - 4/7
  • Special Interest - Obesity -- Physician
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

BACKGROUND: Most Americans do not meet diet and physical activity recommendations despite known health benefits.

PURPOSE: To systematically review the benefits and harms of lifestyle counseling interventions in persons with cardiovascular risk factors for the U.S. Preventive Services Task Force.

DATA SOURCES: MEDLINE, PsycINFO, the Database of Abstracts of Reviews of Effects, and the Cochrane Central Register of Controlled Trials (January 2001 to October 2013); experts; and existing systematic reviews.

STUDY SELECTION: Two investigators independently reviewed 7218 abstracts and 553 articles against a set of inclusion and quality criteria.

DATA EXTRACTION: Data from 74 trials were abstracted by one reviewer and checked by a second.

DATA SYNTHESIS: At 12 to 24 months, intensive lifestyle counseling in persons selected for risk factors reduced total cholesterol levels by an average of 0.12 mmol/L (95% CI, 0.16 to 0.07 mmol/L) (4.48 mg/dL [CI, 6.36 to 2.59 mg/dL]), low-density lipoprotein cholesterol levels by 0.09 mmol/L (CI, 0.14 to 0.04 mmol/L) (3.43 mg/dL [CI, 5.37 to 1.49 mg/dL]), systolic blood pressure by 2.03 mm Hg (CI, 2.91 to 1.15 mm Hg), diastolic blood pressure by 1.38 mm Hg (CI, 1.92 to 0.83 mm Hg), fasting glucose levels by 0.12 mmol/L (CI, 0.18 to 0.05 mmol/L) (2.08 mg/dL [CI, 3.29 to 0.88 mg/dL]), diabetes incidence by a relative risk of 0.58 (CI, 0.37 to 0.89), and weight outcomes by a standardized mean difference of 0.25 (CI, 0.35 to 0.16). Behavioral changes in dietary intake and physical activity were generally concordant with changes in physiologic outcomes.

LIMITATION: Sparse reporting of patient health outcomes, longer-term follow-up of outcomes, and harms.

CONCLUSION: Intensive diet and physical activity behavioral counseling in persons with risk factors for cardiovascular disease resulted in consistent improvements across various important intermediate health outcomes up to 2 years.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Very important but the crucial part is how to do this. A concern is that "high-intensity interventions seemed to explain some statistical heterogeneity for effects".

General Internal Medicine-Primary Care(US)

Challenging to show improved patient outcomes from healthy lifestyle counseling as it is a complex intervention with complex downstream results. I will continue to give patients healthy living advice. If done often and consistently, I`m convinced it leads to better choices that improve quality of life, if not health outcomes.

Public Health

As a Internist, I feel it is very important to discuss life style modifications with patients. Behavioral counselling makes an impact and it is proven by many studies. The article was well done systematically and proved the point well. It was well written and summarized. This article proves the point that rather than just discussing with patients, a systematic approach with counselling and follow up has significant improvement in patient outcome. This aspect of behavioral intervention strategy is not practiced routinely by Physicians or considered by patients and families. It is an important article and even though most practitioners know this, it's not implemented in practice.

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