Characteristics of the Intervention Trials in the Systematic Reviews

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2.2.1 Target Population

The reviews considered lifestyle interventions that target adult populations on a continuum from healthy people to people with elevated disease risk through to people with established disease.

2.2.2 Intervention Setting

Diet and physical activity interventions were predominantly conducted in health-care settings, although some worksite and other community interventions were also represented in

2.2.4 Purpose of Systematic Reviews

The primary objective for all reviews was to establish the efficacy of the interventions in terms of clinical, behavioral, and/or other outcomes. Typically, a number of comparisons were included, with the main one being a comparison between a single intervention condition and some kind of usual or routine care. A number of reviews also assessed the relative efficacy of different types of interventions (e.g., diet only vs. diet and exercise); different modes of delivery (e.g., physicians vs. nurses; individuals vs. groups); or different intensities or duration of interventions. Often, however, when these latter comparisons were a secondary objective of the review, the data available and sample sizes were insufficient for drawing any definitive conclusions. Except for a few exceptions, the reviews did not evaluate the influence of setting or delivery on outcomes.

Table 62.1 Summary of systematic reviews

Physiological and anthropometric

Quality of life/

Authors

Brief titles

Outcomes Behavior

outcomes

Disease outcomes

cost-effectiveness

Mortality

SRI (Hooper et al.

Dietary salt

N/A

Urinary sodium excretion: —35.5 mmol/1

Cardiovascular

N/A

Deaths inconsistently

2004)

reduction for

Systolic RR: —1.1 mmHg

events

defined/reported

preventing CVD

Diastolic RR: -0.6 mmHg

inconsistently

defined/reported

SR2 (Hooper et al.

Dietary fat reduction N/A

N/A

Cardiovascular

N/A

Cardiovascular

2000)

for preventing

events: —16% for

mortality:

CVD

all studies; -24%

non-significant

for studies with

trend

follow-up > 2

Total mortality: no

years

effect

SR3 (Brunner

Dietary advice for

Fruit/vegetable

Urinary sodium excretion: —44.2 mmol/1

N/A

N/A

N/A

et al, 2007)

reducing

intake: +1.25

Systolic RR: —2.1 mmHg

cardiovascular

servings/day

Diastolic RR: —1.1 mmHg

risk

Fiber intake: +

Total cholesterol: —0.16 mmol/1

6 g/day

LDL cholesterol: —0.18 mmol/1

Total fat intake:

-4.5% E

Saturated fat

intake: -2.4% E

SR4 (Nield et al.

Dietary advice for

N/A

Significant (p<0.05) reductions in BMI,

Incidence of type 2

N/A

N/A

2008)

the prevention of

risk ratio, triglycerides, and

diabetes: —33%

T2DM in adults

improvements in HDL cholesterol.

(6 years) in one

insulin resistance, and glucose

study

tolerance in one study

SR5 (Nield et al.

Dietary advice for

N/A because of

N/A because of heterogeneity/poor

N/A because of het

N/A

N/A because of

2007)

treatment of

heterogeneity/poor

quality of data

erogeneity/poor

heterogeneity/poor

T2DM in adults

quality of data

quality of data

quality of data

SR6 (Thompson

Dietary advice for

N/A

Total cholesterol: —0.25 mmol/1 dietitian

N/A

N/A

N/A

et al, 2003)

cholesterol

versus doctor; ns. dietitian versus

reduction

self-help; N/A dietitian versus nurse

SR7 (Rees et al.

Exercise-based

Exercise duration:

VOjmax: +2.16 ml/kg/min

HRQoL: 7/9 studies

2004b)

rehabilitation for

+2.38 min

Work capacity: +15.1 Watts

found

heart failure

Distance on 6-min

improvements

walk: +40.9 m

Physiological and anthropometric

Quality of life/

Authors

Brief titles

Outcomes Behavior

outcomes

Disease outcomes

cost-effectiveness

Mortality

SR8 (Jolliffe et al.

Exercise-based

Smoking:

All findings from comprehensive

Non-fatal

HRQoL: small

Total cardiac

2001)

rehabilitation for

comprehensive

rehabilitation:

myocardial

improvements or

mortality/all cause

coronary heart

rehabilitation no

Total cholesterol: —0.57 mmol/1

infarction: no

no effect in 11

mortality: exercise

disease

effect

LDL cholesterol: —0.51 mmol/1

effect

studies

only

Triglycerides: —0.29 mmol/1

—31%/—27%;

comprehensive

rehabilitation

-26%/-13%

SR9 (Thomas

Exercise for T2DM

N/A

VOjmax: no effect in two studies

N/A

QoL: no effect in

N/A

et al, 2006)

HbAlc: -0.6%

one study

BMI: no effect

Visceral adipose tissue: —45.4 cm2

Total cholesterol: no effect

Triglycerides: —0.25 mmol/1

Systolic and diastolic RR: no effect

SR10 (Ashworth

Home versus

1-year adherence to

VOjmax: significant improvement in

N/A

HRQoL: no change

N/A

et al, 2005)

center-based

exercise program:

home- and center-based exercise

or small

physical activity

75-79% home

groups at 6 months

improvement in

programs in older

based/53% center

Lipids: no significant changes at 1 year.

three studies; no

adults

based in two studies

no difference between home- versus

differences

Peak walking time:

center-based exercise groups

between home

center-based

BMI: no effect

versus

improved

center-based

significantly more

exercise groups

Smoking: no effect in

one study

SR11 (Orozco

Exercise or exercise

N/A

Weight. BMI. waist circumference:

Incidence of type 2

Cost-effectiveness:

N/A

et al, 2008)

and diet for

improvement in exercise plus diet

diabetes: —37% in

two studies

preventing T2DM

versus control compromised by high

exercise plus diet

concluded to be

statistical heterogeneity

interventions; no

cost-effective

Systolic RR: -4 mmHg

difference

Diastolic RR: -2 mmHg

between diet

Fasting plasma glucose: —0.59 exercise

only/exercise only

plus diet versus control

and control or

2-h GTT: improvement in exercise plus

with each other

diet

Physiological and anthropometric

Quality of life/

Authors

Brief titles

Outcomes Behavior

outcomes

Disease outcomes

cost-effectiveness

Mortality

Total, LDL, and HDL cholesterol:

no effect

Triglycerides: —0.14 mmol/lin

exercise plus diet versus control

SR12 (Norris et al.

Long-term non-

N/A

Weight:

—2.8 kg at one year.

Incidence of type 2

N/A

N/A

2005b)

pharmacological

BMI: -

1.3 kg/m2

diabetes:

weight loss

HbAic:

—0.3~to 0.0%.

significant

interventions for

Systolic and diastolic RR: small

reduction in 3/5

pre-diabetes

decrease in most studies

studies.

adults

Lipids: minor improvements

SR13 (Norris et al.

Long-term non-

N/A

Weight:

— 1.7 kg or 3.1% for any

N/A

N/A

N/A

2005a)

pharmacological

intervention versus control with

weight loss

1—2 year f-u

interventions for

HbAic:

-2.6 to 1.0% in different

adults with T2DM

types

of interventions

SR14 (Rice and

Nursing

Risk ratio for quitting:

N/A

N/A

N/A

N/A

Stead, 2008)

interventions for

overall 1.28; weak

smoking cessation

evidence for lower

intensity

interventions; weak

evidence for

additional telephone

support

SR15 (Stead et al.

Physician advice for

Risk ratio for quitting:

N/A

Lung cancer: no

NNT = 35-120

Total mortality and

2008)

smoking cessation

overall 1.66; intensive

effect at 20 years

coronary disease

versus minimal 1.37;

in one study

mortality: no effect

follow-up versus no

at 20 years in one

follow-up 1.52

study

SR16 (Barth et al.

Psychosocial

Odds ratio (OR) for

N/A

N/A

NNT = 10

N/A

2008)

interventions for

quitting: overall 1.66;

smoking cessation

intensive versus brief

in CHD patients

1.98; behavioral

therapies versus usual

care 1.69; telephone

support versus usual

care 1.58; self-help

versus usual care 1.48

Quality of life/

Physiological and anthropometric

cost-

Authors

Brief titles

Outcomes Behavior

outcomes

Disease outcomes

effectiveness

Mortality

SR17 (Carrand

Interventions for tobacco

OR for tobacco

N/A

N/A

NNT = 33

N/A

Ebbert, 2006)

cessation in dental setting

abstinence rate: 1.44; no difference between those actively seeking versus not seeking treatment

SR18 (Sowden

Community interventions

Smoking prevalence:

N/A

N/A

N/A

N/A

et al, 2003)

for preventing smoking in young people

2/13 studies reported differences between community intervention versus control

SR19 (Ebrahim

Multiple risk factor

OR for reduction in

Systolic RR: —3.6 mmHg. Diastolic

N/A

N/A

CHD mortality: no

et al, 2006)

interventions for

smoking

RR: -2.8 mmHg

effect

primary prevention of

prevalence: 0.80.

Total cholesterol: —0.07 mmol/1

Total mortality: no

CHD

effect

SR20

Interventions to improve

Adherence:

Total cholesterol: 1/4 studies reported

N/A

N/A

N/A

(Schedlbauer

adherence to lipid

significant effect

significant improvement

et al, 2004)

lowering medication

in 3/8 studies

SR21 (Welschen

Self-monitoring of blood

N/A

HbAic: small but significant

N/A

HRQoL: no effect

N/A

et al, 2005)

glucose in patients with T2DM who are not using insulin

improvement in 2/6 studies

in one study

SR22 (Vermeire

Interventions for

Smoking cessation

HbAjc: small but significant

N/A

HRQoL: no effect

N/A

et al, 2005)

improving adherence to treatment recommendations in people with T2DM

incidence: —15% higher in intervention versus comparison in one study

improvement in 10/13 studies with different types of interventions

in one study

Brief titles

Outcomes Behavior

Physiological and anthropometric outcomes

Disease outcomes

Quality of life/ cost-effectiveness

Mortality

SR23 (Deakin et al, 2005)

Group-based training for self-management strategies in people with T2DM

Individual patient education for people with T2DM

SR25 (Rees et al, 2004a)

SR27 (Foster et al, 2007)

Psychological interventions for CHD

Peer support telephone calls for improving health

Self-management education programs by lay leaders for people with chronic conditions

Heterogeneous measures for self-management, exercise, diet, foot care, self-monitoring: modest findings in support of intervention in 5/6 studies

Smoking cessation: weak evidence from two studies

Smoking: mixed findings in eight studies

Smoking : no effect in 1/3

studies Recovery behaviors: no effect in 1/3 studies Exercise: SMD 0.20

Systolic blood pressure: —5 mmHg Total cholesterol: no effect Triglycerides: no effect HbAic: —1.4% at 4-6 months; -0.8% at 12-14 months; -1.0% at 2 years

Fasting blood glucose: — 1.2 mmol/1 BMI: no effect (individual vs. usual care/group) Systolic/diastolic RR: no effect

(individual vs. usual care/group) Total cholesterol: no effect

(individual vs. usual care/group) HbAjc: no overall effect for individual versus usual care; —0.3% among participants with baseline HbAjc > 8%; no difference individual versus group

Total cholesterol: —0.27 mmol/1 LDL, HDL cholesterol: no effect Triglycerides: no effect

BMI, cholesterol, HbAjc: no effect in 1/3 studies

QoL: no significant effect OR for reduced need for diabetes medication: 11.8

(NNT = 5) Cost-effectiveness: $2.12 per point gained in QoL in one study

HRQoL: mixed findings from two studies

OR for reduction in non-fatal reinfarction: 0.78

Anxiety: SMD-0.08

Depression: SMD-0.3 Composite measure for mental health: SMD—0.22 HRQoL: no effect in 2/3 studies

HRQoL: no effect

Cardiac mortality: no effect Total mortality:

no effect N/A

QOL= quality of life; HRQOL= health-related quality of life; HbAjc= glycated hemoglobin; OR = odds ratio; SMD=standardized mean difference

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