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Systematic Review
The objective of this report is to synthesise the evidence on the benefits and harms of behavioural counseling on healthy diet and physical activity among adults without CVD risk factors. It aimed to answer four key questions:
1. Do primary care–relevant behavioral counseling interventions to improve diet, increase physical activity, and reduce sedentary behavior improve cardiovascular disease (CVD) and related health outcomes (e.g., morbidity and mortality) in adults without known CVD risk factors?
2. Do primary care–relevant behavioral counseling interventions to improve diet, increase physical activity, and reduce sedentary behavior improve intermediate outcomes associated with CVD (g., blood pressure, lipid levels, blood glucose levels, and body mass index) in adults without known CVD risk factors?
3. Do primary care–relevant behavioral counseling interventions to improve diet, increase physical activity, and reduce sedentary behavior improve intermediate behavioral outcomes (e.g., diet, physical activity, and sedentary behavior) in adults without known CVD risk factors?
4. What are the harms of primary care–relevant behavioral counseling interventions to improve diet, increase physical activity, and reduce sedentary behavior in adults without known CVD risk factors?
Of the 113 included studies, 15 trials reported health outcomes (KQ 1) (e.g., CVD events, self-reported quality of life), 43 trials reported intermediate health outcomes (KQ 2) (e.g., lipid, blood pressure, and glucose levels; weight measures), and 109 trials reported behavioral outcomes (KQ 3) (objective or self-reported measures of diet, physical activity, or sedentary time). Twenty three trials explicitly reported on harms (or the lack thereof) of a counseling intervention (KQ 4).
found that healthy diet and physical activity behavioral interventions in persons without CVD risk factors were associated with very modest reductions in continuous measures of blood pressure, LDL cholesterol, and adiposity at approximately 6 to 12 months of followup compared with control conditions. Given the consistency in the effect estimates and precision in those estimates over time for each intermediate outcome, we are moderately confident that our pooled estimates lie close to the true effects, although the body of evidence is still fairly small (~20 trials for most outcomes) and there is considerable variation in the interventions. Most pooled analyses resulted in moderate or substantial statistical heterogeneity, reflecting the clinical heterogeneity across studies. There was evidence of a dose-response relationship, with increasing intervention intensity being associated with larger improvements in some intermediate outcomes. Most of the interventions of higher intensity—for which we saw a benefit on intermediate outcomes—included healthy diet messages, with or without physical activity messages, and recruited persons outside of the primary care setting.
Access the full review for more details.
The authors state:
"The results of this systematic review update are consistent with the 2017 review on this topic. Healthy diet and physical activity behavioral interventions for persons without a known risk of CVD were associated with very small but statistically significant benefits across a variety of important intermediate health outcomes and small-to-moderate effects on dietary and physical activity behaviors. Very limited evidence exists regarding the health outcomes or harmful effects of these interventions."