Search Strategy and Selection Criteria

We identified and conducted a review of systematic reviews of behavioral intervention trials targeting lifestyle risk factors related to the prevention and/or management of circulatory and related conditions. Suitable reviews were identified by conducting an electronic search with the Database of Systematic Reviews of the Cochrane Library (Issue 3, 2009) and by crossing the keywords 'diet,' 'eating,' 'physical activity,' 'exercise,' 'smoking,' 'nutrition,' 'lifestyle,' 'behavior,' 'change,' 'smoking,' 'obesity,' 'overweight,' and 'adiposity.' These were crossed separately with 'cardiovascular,' 'heart disease,' 'coronary,' 'metabolic syndrome,' 'type 2 diabetes,' 'pre-diabetes,' and 'chronic disease.' Last, the search was combined with 'intervention' or 'trial.' We identified 165 reviews published between 1997 and 2009. We selected only reviews that were published in English and related to adults aged 18 or above. Reviews were excluded if they were: (1) related to medical conditions other than circulatory and associated conditions (e.g., psychiatric disorders, pregnancy, HIV/AIDS, cancer); (2) pharmacological interventions and did not incorporate any explicit lifestyle or behavioral change strategies; (3) primarily focused on interventions to treat biological mechanisms; (4) focused primarily on determinants of health behaviors rather than health behavior change per se; and (5) primarily narrative or qualitative reviews. We identified 27 reviews that met these inclusion criteria and these reviews form the basis of our evaluation of the effectiveness of lifestyle interventions for this chapter. Additionally, we conducted a search that also included other databases (PSYCINFO, MEDLINE) in order to identify non-systematic and narrative reviews that considered other relevant issues that are not usually well addressed by systematic reviews. These other issues are discussed in more detail in the final section of this chapter.

Among the 27 systematic reviews included from the Cochrane Library, there were six on nutrition and diet (Table 62.1, SR1-6), four on exercise (SR7-10), three on both diet and exercise (SR11-13), five on smoking (SR14-18), and one on multiple risk factors (SR19). Another eight reviews evaluated interventions targeting different aspects of disease management (SR20-27).

the reviews. Smoking intervention settings were more varied and included other community settings and delivery systems, including the use of mass media. Disease management interventions were most often delivered via health-care or related settings.

2.2.3 Mode of Delivery

Channels of delivery were varied and diverse, although face-to-face delivery - either individually or in groups - was the most common approach utilized. Other approaches included delivery via telephone, internet, mail, and mass media. Most interventions were delivered by health professionals. Many different kinds of professionals were involved in delivery of smoking interventions including counselors, psychotherapists, teachers, and pharmacists, in addition to nurses and physicians. There were two systematic reviews of intervention delivery by peers.

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