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Lifestyle interventions in primary care

Systematic review of randomized controlled trials

Marshall Godwin, MD MSc
Professor of Family Medicine, both at Memorial University of Newfoundland in St John’s

Correspondence: Dr Marshall Godwin, Room 1776, Health Science Centre, 300 Prince Philip Dr, St John’s, NL A1B 3V6; telephone 709 777-8373; fax 709 777-6118; e-mailgodwinm{at}mun.ca

OBJECTIVE To determine whether lifestyle counseling interventions delivered in primary care settings by primary care providers to their low-risk adult patients are effective in changing factors related to cardiovascular risk.

DATA SOURCES MEDLINE (PubMed), EMBASE, and CINAHL were searched from January 1985 to December 2007. The reference lists of all articles collected were checked to ensure that all suitable randomized controlled trials (RCTs) had been included.

STUDY SELECTION We chose RCTs on lifestyle counseling in primary care for primary prevention of cardiovascular disease. The search was limited to English-language articles involving human subjects. Studies had to have been conducted within the context of primary care, and interventions had to have been carried out by primary care providers, such as family physicians or practice nurses. Studies had to have had a control group who were managed with usual care. Outcomes of interest were cardiovascular risk scores, blood pressure, lipid levels, weight or body mass index, and morbidity and mortality.

SYNTHESIS Seven RCTs were included in the review. Only 4 studies showed any significant positive effect on the outcomes of interest, and only 2 of these showed consistent effects across several outcomes. The main effects were on blood pressure and lipid levels, but the size of these effects, while statistically significant, was small. There was no obvious benefit to one provider doing the intervention over another (eg, physician vs nurse), nor of the focus of the intervention (eg, on diet vs on exercise).

CONCLUSION Lifestyle counseling interventions delivered by primary care providers in primary care settings to patients at low risk (primary prevention) appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with existing heart disease or diabetes.