Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
Study Goal
To review the benefits and harms of behavioral counseling interventions aimed at improving diet and physical activity in adults with cardiovascular risk factors.
Results Summary
Behavioral counseling interventions were associated with a lower risk of cardiovascular events, small but significant reductions in blood pressure, LDL cholesterol, fasting glucose, and adiposity, and showed little to no risk of serious harm. Evidence suggested small improvements in diet but mixed findings for physical activity.
Population
Adults with elevated blood pressure or lipid levels.
Effective Dosage
Median of 6 contact hours and 12 sessions over 12 months (varied by low, medium, or high contact time).
Duration
12 to 24 months' follow-up.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
behavioral counseling interventions to improve diet and increase physical activity | decrease | cardiovascular events | people with elevated blood pressure or lipid levels | pooled relative risk, 0.80 [95% CI, 0.73-0.87] | were associated with a lower risk | #1 |
behavioral counseling interventions to improve diet and increase physical activity | decrease | continuous measures of blood pressure | people with elevated blood pressure or lipid levels | small, statistically significant reductions | were associated with small, statistically significant reductions | #2 |
behavioral counseling interventions to improve diet and increase physical activity | decrease | low-density lipoprotein cholesterol levels | people with elevated blood pressure or lipid levels | small, statistically significant reductions | were associated with small, statistically significant reductions | #3 |
behavioral counseling interventions to improve diet and increase physical activity | decrease | fasting glucose levels | people with elevated blood pressure or lipid levels | small, statistically significant reductions | were associated with small, statistically significant reductions | #4 |
behavioral counseling interventions to improve diet and increase physical activity | decrease | adiposity | people with elevated blood pressure or lipid levels | small, statistically significant reductions | were associated with small, statistically significant reductions | #5 |
behavioral counseling interventions to improve diet and increase physical activity | increase | diet | people with elevated blood pressure or lipid levels | small improvements | evidence suggested small improvements | #6 |
behavioral counseling interventions to improve diet and increase physical activity | no change | physical activity | people with elevated blood pressure or lipid levels | mixed findings | mixed findings and a more limited evidence base | #7 |
behavioral counseling interventions to improve diet and increase physical activity | no change | serious adverse events | people with elevated blood pressure or lipid levels | generally no group differences | generally no group differences | #8 |
behavioral counseling interventions to improve diet and increase physical activity | no change | any adverse events | people with elevated blood pressure or lipid levels | generally no group differences | generally no group differences | #9 |
behavioral counseling interventions to improve diet and increase physical activity | no change | hospitalizations | people with elevated blood pressure or lipid levels | generally no group differences | generally no group differences | #10 |
behavioral counseling interventions to improve diet and increase physical activity | no change | musculoskeletal injuries | people with elevated blood pressure or lipid levels | generally no group differences | generally no group differences | #11 |
behavioral counseling interventions to improve diet and increase physical activity | no change | withdrawals due to adverse events | people with elevated blood pressure or lipid levels | generally no group differences | generally no group differences | #12 |
IMPORTANCE: Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE: To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES: MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION: English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS: Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES: Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS: Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE: Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.