Study Selection
Two investigators independently reviewed 13 562 abstracts
and 481 articles against the specified inclusion criteria
(Figure). We included trials with primary care–
relevant counseling on physical activity (for example, aerobic
activities, such as walking, cycling, or swimming, or resistance
training) or healthful diet interventions (for example,
appropriate calorie intake; increased intake of fruits and
vegetables, whole grains, and fiber; balanced intake of fats;
or decreased sodium). We excluded interventions primarily
aimed at weight loss or those that provided controlled diets
or supervised physical activity. Primary care–relevant counseling
included interventions that were conducted in,
judged feasible to be conducted in (such as phone or electronic
interventions), or potentially referable from a primary
care setting. Interventions had to be compared with
usual care, a minimal intervention, or an attention-control
group. We excluded interventions that targeted persons
with known hypertension, hyperlipidemia, diabetes, or cardiovascular
disease and trials in which more than 50% of
the population had known heart disease or any one or a
combination of these risk factors. We required a minimum
follow-up of 6 months after randomization. A priori outcomes
included true health outcomes (morbidity or mortality
related to cardiovascular disease); intermediate outcomes
and physiologic changes associated with health
outcomes (blood pressure, lipid profile, fasting glucose
level and glucose tolerance, and adiposity); and behavioral
outcomes (any self-reported change in physical activity or
dietary intake). We did not include cost-effectiveness or
cost-related outcomes. For harms, we included any observational
studies that reported serious cardiovascular harms,
such as acute cardiac events during or immediately after
physical activity.
Study SelectionTwo investigators independently reviewed 13 562 abstractsand 481 articles against the specified inclusion criteria(Figure). We included trials with primary care–relevant counseling on physical activity (for example, aerobicactivities, such as walking, cycling, or swimming, or resistancetraining) or healthful diet interventions (for example,appropriate calorie intake; increased intake of fruits andvegetables, whole grains, and fiber; balanced intake of fats;or decreased sodium). We excluded interventions primarilyaimed at weight loss or those that provided controlled dietsor supervised physical activity. Primary care–relevant counselingincluded interventions that were conducted in,judged feasible to be conducted in (such as phone or electronicinterventions), or potentially referable from a primarycare setting. Interventions had to be compared withusual care, a minimal intervention, or an attention-controlgroup. We excluded interventions that targeted personswith known hypertension, hyperlipidemia, diabetes, or cardiovasculardisease and trials in which more than 50% ofthe population had known heart disease or any one or acombination of these risk factors. We required a minimumfollow-up of 6 months after randomization. A priori outcomesincluded true health outcomes (morbidity or mortalityrelated to cardiovascular disease); intermediate outcomesand physiologic changes associated with healthoutcomes (blood pressure, lipid profile, fasting glucoselevel and glucose tolerance, and adiposity); and behavioraloutcomes (any self-reported change in physical activity ordietary intake). We did not include cost-effectiveness orcost-related outcomes. For harms, we included any observationalstudies that reported serious cardiovascular harms,such as acute cardiac events during or immediately afterphysical activity.
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