Behavioral Counseling to Promote Physical Activity and a Healthful Diet to Prevent Cardiovascular Disease in Adult

Behavioral Counseling to Promote Physical Activity and a Healthful Diet to Prevent Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force

Annals of Internal Medicine
December 6, 2010 vol. 153 no. 11 736-750

1. Jennifer S. Lin, MD, MCR; Elizabeth O'Connor, PhD Evelyn P. Whitlock, MD, MPH; andTracy L. Beil, MS

Author Affiliations

1. From the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.

Abstract

Background: Poor diet and lack of physical activity can worsen cardiovascular health, yet most Americans do not meet diet and physical activity recommendations.

Purpose: To assist the U.S. Preventive Services Task Force in updating its previous recommendations by systematically reviewing trials of physical activity or dietary counseling to prevent cardiovascular disease.
Data Sources: MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (2001 to January 2010), experts, and existing systematic reviews.

Study Selection: Two investigators independently reviewed 13 562 abstracts and 481 articles against a set of a priori inclusion criteria and critically appraised each study by using design-specific quality criteria.
Data Extraction and Analysis: Data from 73 studies (109 articles) were abstracted by one reviewer and checked by a second reviewer. Random-effects meta-analyses were conducted for multiple intermediate health and behavioral outcomes.

Data Synthesis: Long-term observational follow-up of intensive sodium reduction counseling showed a decrease in the incidence of cardiovascular disease; however, other direct evidence for reduction in disease morbidity is lacking.

High-intensity dietary counseling, with or without physical activity counseling, resulted in changes of −0.3 to −0.7 kg/m2 in body mass index (adiposity), −1.5 mm Hg (95% CI, −0.9 to −2.1 mm Hg) in systolic blood pressure, −0.7 mm Hg (CI, −0.6 to −0.9 mm Hg) in diastolic pressure, −0.17 mmol/L (CI, −0.09 to −0.25 mmol/L) (−6.56 mg/dL [CI, −3.47 to −9.65 mg/dL]) in total cholesterol level, and −0.13 mmol/L (CI, −0.06 to −0.21 mmol/L) (−5.02 mg/dL [CI, −2.32 to −8.11 mg/dL]) in low-density lipoprotein cholesterol level. Medium- and high-intensity counseling resulted in moderate to large changes in self-reported dietary and physical activity behaviors.

Limitations: Meta-analyses for some outcomes had large statistical heterogeneity or evidence for publication bias. Only 11 trials followed outcomes beyond 12 months.

Conclusion: Counseling to improve diet or increase physical activity changed health behaviors and was associated with small improvements in adiposity, blood pressure, and lipid levels.

Primary Funding Source: Agency for Healthcare Research and Quality.
Article and Author Information

• Acknowledgment: The authors thank Daphne Plaut, MLS, for conducting the literature searches; Kevin Lutz, MFA, for editorial support; Sarah Zuber, MSW, and Leslie Perdue, MPH, for assistance in conducting the evidence review; and Caitlyn Senger, MPH, for assistance in preparing the manuscript. They also thank the Agency for Healthcare Research and Quality and the USPSTF, as well as the expert reviewers (Miriam C. Morey, PhD; Michele M. Doucette, PhD; Charlotte A. Pratt, PhD, RD; Janet M. de Jesus, MS, RD; Brian Martinson, PhD; Stephen P. Fortmann, MD; David R. Brown, PhD; and David P. Hopkins, MD, MPH), for their contribution to this evidence review.

• Grant Support: By the Agency for Healthcare Research and Quality, Rockville, Maryland (contract HHS-290-2007-10057-I, task order 3).

• Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1648.

• Requests for Single Reprints: Copies of the full report on which this article is based are available at www.uspreventiveservicestaskforce.org/.

• Current Author Addresses: Drs. Lin, O'Connor, and Whitlock and Ms. Beil: Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227.

• Author Contributions: Conception and design: J.S. Lin, E. O'Connor, E.P. Whitlock, T.L. Beil.

• Analysis and interpretation of the data: J.S. Lin, E. O'Connor, E.P. Whitlock.

• Drafting of the article: J.S. Lin, E. O'Connor.

• Critical revision of the article for important intellectual content: J.S. Lin, E.P. Whitlock.

• Final approval of the article: J.S. Lin, E. O'Connor, T.L. Beil.

• Provision of study materials or patients: T.L. Beil.

• Statistical expertise: E. O'Connor.

• Obtaining of funding: E.P. Whitlock.

• Administrative, technical, or logistic support: T.L. Beil.

• Collection and assembly of data: J.S. Lin, E. O'Connor, T.L. Beil.

Featured Angina| Acute Coronary Syndrome and Heart Disease Interviews

Author Interview: Claes Held MD Associate professor at Uppsala Clinical Research Center and the Cardiology department at Uppsala University Hospital in Sweden Publication: Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432 2012 doi:10.1093/eurheartj/ehr432 Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf What are the main findings of the study? The main findings are he following: It is well known that physical inactivity is a risk factor for developing cardiovascular disease. Our study shows that being physically active reduces the risk of having a heart attack. Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries. We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %. We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.     Were any of the findings unexpected? We looked at the relationship between physical activity both at work and during leisure time. A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did. What should clinicians and patients take away from this study? The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines. This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away. All PA does a good job for the heart as compared to not doing anything at all!   What recommendations do you have for cardiology health care providers as a result of your study? It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true. More Author Interview from Angina.com More on Exercise and Heart Disease More on Heart Attack Studies   3M Littmann Master Classic II Stethoscope

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