Multifactorial Lifestyle Interventions in the Primary and Secondary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus—A Systematic Review of Randomized Controlled Trials

Competence Centre of Complementary Medicine and Naturopathy, Technische Universität München, Kaiserstr 9, 80801, Munich, Germany.
Annals of Behavioral Medicine (Impact Factor: 4.2). 08/2010; 40(1):49-64. DOI: 10.1007/s12160-010-9206-4
Source: PubMed


This systematic review aims to summarize the available randomized trials of multifactorial lifestyle interventions in the primary and secondary prevention of coronary heart disease and type 2 diabetes mellitus. Randomized trials investigating the effects of lifestyle interventions including the elements of diet, physical activity, and stress management in people at increased risk for or with manifest coronary heart disease or type 2 diabetes mellitus were searched for in five electronic database and by citation tracking. Quality was assessed using the Cochrane Collaboration's risk of bias tool. Exploratory effect size calculations were performed for a variety of laboratory and clinical outcome measures. Twenty-five trials including a total of 7,703 participants met the inclusion criteria. Fifteen trials were in patients with coronary heart disease, seven in patients with type 2 diabetes mellitus, and three on primary prevention. The interventions varied greatly regarding concept, intensity, and providers. Compared to participants in "usual care" control groups, there were no consistent effects on lipid levels and blood pressure and small effects on body mass index and glycated hemoglobin (HbA1c). Composite cardiac event rates were significantly less in the intervention groups of the few trials reporting these outcomes. Mortality was also lower in the intervention groups, but the difference was not statistically significant, and confidence intervals were wide. The evidence base for multifactorial lifestyle interventions is weak. Effects on surrogate measures seem minor, but there may be clinically relevant effects on major clinical endpoints.

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    • "c o m behaviors on disease progression and development of comorbidities (eg, vascular disease) in patients with type 2 diabetes [5] [6] [7] [8] [9] [10] [11] [12] [13]. However, the benefit of lifestyle changes in reducing all-cause mortality or cardiovascular disease is less clear as the findings from these analyses are inconsistent or the data are inconclusive [5] [6] [7] [8] [9] [10] [11] [12] [13]. To our knowledge, there have been no meta-analyses that evaluated the effect of interventions that result in multiple lifestyle changes on risk factors for cardiovascular disease in patients with type 2 diabetes. "
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    ABSTRACT: Objective: The effect of lifestyle intervention on clinical risk factors in patients with type 2 diabetes is unclear. The aim of this meta-analysis was to evaluate the effects of comprehensive lifestyle change, such as diet, exercise, and education, on clinical markers that are risk-factors for cardiovascular disease in patients with type 2 diabetes. Methods: We searched Medline, Cochrane, EMBASE, and Google Scholar (up to August 31, 2013) for randomized controlled trials that compared standard of care (control group) with treatment regimens that included changes in lifestyle (intervention group). The primary outcome was reduction in risk factors of cardiovascular disease including body mass index (BMI), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Results: A total of 16 studies were included in the meta-analysis. The standardized difference in means of change from baseline significantly favored the intervention compared with the control group in BMI (-0.29; 95% CI, -0.52 to -0.06, P=0.014), HbA1c (-0.37; 95% CI, -0.59 to -0.14, P=0.001), SBP (-0.16: 95% CI, -0.29 to -0.03, P=0.016), DBP (-0.27, 95% CI=-0.41 to -0.12, P<0.001). There was no difference between the intervention and control groups in HDL-c (0.05; 95% CI, -0.10 to 0.21; P=0.503) and LDL-c (-0.14; 95% CI, -0.29 to 0.02; P=0.092). Conclusions: The meta-analysis found that lifestyle intervention showed significant benefit in risk factors that are known to be associated with development of cardiovascular disease in patients with type 2 diabetes.
    Metabolism 10/2014; 64(2). DOI:10.1016/j.metabol.2014.10.018 · 3.89 Impact Factor
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    • "The success of individual-targeted lifestyle interventions depends on realistic goal setting [12, 13], yet current approaches to health education are often provider centred [5, 14, 15]. In their book ‘Sick Societies’ , Stuckler et al. note that ‘societies in which people are born, live, work and age create the individual’s risks for chronic diseases, for which individuals have little choice’ [6]. "
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    ABSTRACT: Background Interventions for prevention of type 2 diabetes ought to be acceptable to target communities. We assessed perceptions about type 2 diabetes and lifestyle change among people afflicted or at high risk of this disease in a low income setting in Iganga Uganda. Methods Twelve focus group discussions (FGDs) of eight participants each were conducted, balancing rural and peri-urban (near the Municipality) residence and gender. The FGDs involved people with suspected type 2 diabetes (based on fasting plasma glucose (FPG), people with suspected pre-diabetes and obese people with normal FPG. Content analysis was conducted. Results Diabetes was perceived to be a very severe disease. Its severity was attributed to its incurability and its numerous health effects. Men were also concerned about reduced sexual performance. However, participants’ strong concerns about the severity of diabetes were not reflected in their perceptions about the risk factors and lifestyles associated with it. While people with diabetes perceive obesity as ‘sickness’, those without diabetes perceive it as a sign of ‘success’. Although participants are willing to change their diet, they mention numerous barriers including poverty, family size, and access to some foods. Because of their good taste, reduction of high risk foods like sugar and fried food is perceived as ‘sacrificing a good life’. Increments in physical activity were said to be feasible, but only in familiar forms like domestic work. An over-arching theme emerged that ‘lifestyle changes are viewed as sacrificing a good life’. Conclusions Health promotion should target both community norms and individual awareness regarding obesity, physical activity and diet, and should address the notion that obesity and unhealthy foods represent a good life. Health educators should plan with clients on how to overcome barriers and misconceptions to lifestyle change, leveraging the pervasive perception of type 2 diabetes as a severe disease to motivate change.
    BMC Public Health 08/2014; 14(1):864. DOI:10.1186/1471-2458-14-864 · 2.26 Impact Factor
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    • "There is clear evidence that physical activity participation [3], and specifically AC, can result in positive health outcomes [20, 21, 23, 25]. Other studies have also highlighted how continued physical activity participation and lifestyle choices can help to manage diabetes [48, 49] or cardiovascular disease [50–52] and help with cancer survivorship [53, 54]. In the current study, those with cardiopulmonary, metabolic and musculoskeletal disease, and depression were more likely to choose the more passive mode of travel, driving. "
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    ABSTRACT: Active commuting (AC) to the workplace is a potential strategy for incorporating physical activity into daily life and is associated with health benefits. This study examined the association between health-related factors and mode of travel to the workplace. Methods. A volunteer convenience sample of employed adults completed an online survey regarding demographics, health-related factors, and the number of times/week walking, biking, driving, and using public transit to work (dichotomized as no walk/bike/drive/PT and walk/bike/drive/PT 1 + x/week). Logistic regression was used to predict the likelihood of each mode of transport and meeting PA recommendations from AC according to demographics and health-related factors. Results. The sample (n = 1175) was aged 43.5 ± 11.4 years and was primarily White (92.7%) and female (67.9%). Respondents reported walking (7.3%), biking (14.4%), taking public transit (20.3%), and driving (78.3%) to work at least one time/week. Among those reporting AC, 9.6% met PA recommendations from AC alone. Mode of travel to work was associated with several demographic and health-related factors, including age, number of chronic diseases, weight status, and AC beliefs. Discussion. Mode of transportation to the workplace and health-related factors such as disease or weight status should be considered in future interventions targeting AC.
    Journal of Environmental and Public Health 02/2013; 2013(7):242383. DOI:10.1155/2013/242383
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