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Cited by 380Health Promotion and Cardiovascular PreventionCardiovascular Health and Risk FactorsPhysical Activity and Health

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Open access
Patnode, Carrie D., Evans, Corrine V., Senger, Caitlyn A., Redmond, Nadia, Lin, Jennifer S.·2017·JAMA
DOI 10.1001/jama.2017.3303PMC PMC13292382
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Abstract

IMPORTANCE: Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE: To systematically review the evidence on the benefits and harms of behavioral counseling for the primary prevention of cardiovascular disease in adults without known cardiovascular risk factors to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for studies published in the English language between January 1, 2013, and May 25, 2016, and ongoing surveillance in targeted publications through March 24, 2017. Studies included in the previous review were reevaluated for inclusion. STUDY SELECTION: Randomized clinical trials of behavioral interventions targeting improved diet, increased physical activity, decreased sedentary time, or a combination of these among adults without known hypertension, dyslipidemia, diabetes, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS: Independent critical appraisal and data abstraction by 2 reviewers. MAIN OUTCOMES AND MEASURES: Cardiometabolic health and intermediate outcomes, behavioral outcomes, and harms related to interventions. RESULTS: Eighty-eight studies (N = 121 190) in 145 publications were included. There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials [n = 51 356]) or health-related quality of life (10 trials [n = 52 423]). There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (-1.26 mm Hg [95% CI, -1.77 to -0.75]; 22 trials [n = 57 953]), diastolic blood pressure (-0.49 mm Hg [95% CI, -0.82 to -0.16]; 23 trials [n = 58 022]), low-density lipoprotein cholesterol level (-2.58 mg/dL [95% CI, -4.30 to -0.85]; 13 trials [n = 5554]), total cholesterol level (-2.85 mg/dL [95% CI, -4.95 to -0.75]; 19 trials [n = 9325]), and body mass index (-0.41 [95% CI, -0.62 to -0.19]; 20 trials [n = 55 059]) at 6 to 12 months as well as small-to-modest associations with dietary and physical activity behaviors. There was no evidence of greater incidence of serious adverse events, injuries, or falls in intervention vs control participants. CONCLUSIONS AND RELEVANCE: Diet and physical activity behavioral interventions for adults not at high risk for cardiovascular disease result in consistent modest benefits across a variety of important intermediate health outcomes across 6 to 12 months, including blood pressure, low-density lipoprotein and total cholesterol levels, and adiposity, with evidence of a dose-response effect, with higher-intensity interventions conferring greater improvements. There is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions.

AI snapshot

Written from the paper’s full text.

TL;DR

This updated systematic review for the USPSTF found that behavioral counseling interventions promoting healthful diet and physical activity in adults without known cardiovascular disease risk factors produce small, statistically significant improvements in intermediate cardiometabolic outcomes at 6 to 12 months, with a dose-response effect by intervention intensity. Evidence on mortality, cardiovascular morbidity, quality of life, longer-term outcomes, and harms was limited or inconsistent.

Key findings

  • Across 88 studies (N=121,190) in 145 publications, there was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials, N=51,356) or health-related quality of life (10 trials, N=52,423).
  • Pooled between-group mean differences at 6 to 12 months favored intervention for systolic blood pressure (−1.26 mm Hg [95% CI, −1.77 to −0.75]; 22 trials, N=57,953), diastolic blood pressure (−0.49 mm Hg [95% CI, −0.82 to −0.16]; 23 trials, N=58,022), LDL cholesterol (−2.58 mg/dL [95% CI, −4.30 to −0.85]; 13 trials, N=5,554), total cholesterol (−2.85 mg/dL [95% CI, −4.95 to −0.75]; 19 trials, N=9,325), and BMI (−0.41 kg/m2 [95% CI, −0.62 to −0.19]; 20 trials, N=55,059).
  • Physical activity interventions were associated with a 35-minute increase in physical activity per week versus controls (95% CI, 22.0 to 47.0; 27 trials) and an odds ratio of 1.32 for meeting physical activity recommendations (95% CI, 1.12 to 1.56; 16 trials); dietary effects were variable.
  • There was no evidence of greater incidence of serious adverse events, injuries, or falls in intervention versus control participants, and higher-intensity interventions were associated with greater improvements in intermediate outcomes.

Methods

  • Systematic review for the US Preventive Services Task Force; searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for English-language studies published January 1, 2013 to May 25, 2016, with ongoing surveillance through January 20, 2017; studies from the previous review were re-evaluated.
  • Included randomized clinical trials of primary care-relevant behavioral interventions targeting improved diet, increased physical activity, decreased sedentary time, or a combination among adults without known hypertension, dyslipidemia, diabetes, or impaired fasting glucose; 88 studies (N=121,190) in 145 publications were included.
  • Two reviewers independently appraised and abstracted data; random-effects meta-analyses using the DerSimonian and Laird method were run for intermediate and behavioral outcomes, while health outcomes and adverse events were summarized descriptively; intervention intensity was categorized as low (≤30 minutes), medium (31–360 minutes), or high (>360 minutes).

Limitations

  • The paper states that complex interventions are difficult to describe and synthesize, that better reporting is needed (e.g., TIDieR, RE-AIM, PRECIS), that message-focus analyses were highly confounded by intervention intensity, that only one study targeted sedentary behavior as the main focus and only three reported sedentary outcomes, and that few studies explored subpopulation effects.
  • The paper states that most trials relied on self-reported dietary and physical activity measures with variable reliability and validity, and that heterogeneous studies were intentionally pooled, so interpreting 95% confidence intervals rather than the summary estimate helps inform the true magnitude of effects.
  • Evident from the text: evidence on longer-term (>12 months) intermediate and health outcomes was very limited, and harms were sparsely and inconsistently reported, with no serious adverse events found but limited data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jama.2017.3303

Cites

399 of 399 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Abstract

    Eighty-eight studies (N=121190) in 145 publications were included in the review.

    “Eighty-eight studies (N=121190) in 145 publications were included.”
    • Also stated in: § RESULTS · plain
      “A total of 10045 titles and abstracts and 351 articles were reviewed to determine if they met the pre-specified inclusion criteria and 88 trials (87 RCTs [n = 121106] and 1 nonrandomized clinical trial [n=84]) reported in 145 publications were included”
    Quote in the paperSubstantial claim
  • Findingown data
    § RESULTS

    There was no consistent benefit of the interventions on health-related quality of life (10 trials, N=52423).

    “Ten trials reported quality of life outcomes and reported modest improvements at 6 and 12 months among intervention participants, but no consistent benefit of the intervention compared with control conditions.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract

    There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials, N=51356).

    “There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials, N=51356)”
    Quote in the paperSubstantial claim
  • Findingown data
    § RESULTS

    Interventions were associated with improvements in weight (MD, −1.04 kg [95% CI, −1.56 to −0.51]).

    “weight (MD, −1.04 kg [95% CI, −1.56 to −0.51])”
    Quote in the paperSubstantial claim
  • Findingnone given
    § Abstract

    There is very limited evidence on longer-term intermediate and health outcomes, or harmful effects of these interventions.

    “There is very limited evidence on longer-term intermediate and health outcomes, or harmful effects of these interventions.”
    • Also stated in: § Conclusions · plain
      “There is very limited evidence on longer-term intermediate and health outcomes, or harmful effects of these interventions.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 11
  • Classified as probably not a substantial claim. 13
  • May combine two claims. 15

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    There was evidence of small, statistically significant between-group mean differences for diastolic blood pressure (−0.49 mm Hg [95% CI, −0.82 to −0.16], 23 trials, N=58022) at 6 to 12 months.

    “−0.49 mm Hg (95% CI, −0.82 to −0.16) for DBP”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    There was evidence of small, statistically significant between-group mean differences for total cholesterol level (−2.85 mg/dL [95% CI, −4.95 to −0.75], 19 trials, N=9325) at 6 to 12 months.

    “−2.85 mg/dL (95% CI, −4.95 to −0.75) for total cholesterol”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § Abstract

    There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (−1.26 mm Hg [95% CI, −1.77 to −0.75], 22 trials, N=57953) at 6 to 12 months.

    “There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (−1.26 mm Hg [95% confidence interval (CI), −1.77 to −0.75], 22 trials, N=57953)”
    • Also stated in: § RESULTS · plain
      “Pooled between-group mean differences (MD) were: −1.26 mm Hg (95% CI, −1.77 to −0.75) for SBP”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    There was evidence of small, statistically significant between-group mean differences for low-density lipoprotein cholesterol level (−2.58 mg/dL [95% CI, −4.30 to −0.85], 13 trials, N=5554) at 6 to 12 months.

    “−2.58 mg/dL (95% CI, −4.30 to −0.85) for LDL cholesterol”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § RESULTS

    Twelve of the 88 included trials reported health outcomes.

    “Twelve of the 88 included trials reported health outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Overall, few deaths were reported and no differences were observed between treatment and control groups over 3 to 15 years followup.

    “Overall, few deaths were reported and no differences were observed between treatment and control groups over 3 to 15 years followup.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation
    § RESULTS

    Four trials (n = 51356) reported all-cause or CVD-related mortality, of which 3 also reported cardiovascular events.

    “Four trials (n = 51356) reported all-cause or CVD-related mortality83,147,148,152 of which 3 also reported cardiovascular events.147,148,152”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Thirty-four of the included trials (n = 75793) reported the effects of behavioral interventions on at least 1 intermediate outcome; nearly half of the trials were of good quality.

    “Thirty-four of the included trials (n = 75793) reported the effects of behavioral interventions on at least 1 intermediate outcome (i.e., blood pressure, lipid levels, glucose levels, or adiposity measures); nearly half of the trials were of good quality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning
    § RESULTS

    The 3 trials that reported cardiovascular events or composite CVD outcomes showed some beneficial results, although results were mixed.

    “The 3 trials that reported cardiovascular events or composite CVD outcomes showed some beneficial results, although results were mixed.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    There was considerable statistical heterogeneity (I2>90%) in all adiposity analyses.

    “with considerable statistical heterogeneity (I2>90%) in all analyses”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § METHODS

    The last surveillance was conducted on January 20, 2017, and identified no new studies.

    “The last surveillance was conducted on January 20, 2017, and identified no new studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Medium-intensity interventions were less consistent and generally showed no benefit on intermediate outcomes, with the exception of weight.

    “The associations between medium-intensity interventions (5 to 9 trials per outcome) and intermediate outcomes were less consistent and generally showed no benefit, with the exception of the outcome of weight.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Very few trials reported longer-term effects (>12 months) on intermediate outcomes, and there was no consistent pattern in effects over time among those that did.

    “Very few trials reported longer-term effects (i.e., greater than 12 months follow-up) on intermediate outcomes and there was no consistent pattern in the effects over time among those that did.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Harms of included interventions were sparsely reported and inconsistently defined.

    “Harms of included interventions were sparsely reported and were inconsistently defined.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § DISCUSSION

    The pooled estimates in this updated systematic review were generally consistent in magnitude with the 2010 review and slightly lower in magnitude compared with the 2014 review among persons at high risk for CVD.

    “The pooled estimates found in this updated systematic review were generally consistent in magnitude with the 2010 review on this topic,15 and slightly lower in magnitude compared with the associations seen in the 2014 review among persons at high risk for CVD14 (eTable 3 in the Supplement).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [15] Lin JS, O'Connor E, Whitlock EP, et al. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: update of the evidence for the U.S. Preventive Services Task Force. Evidence Synthesis No. 79. AHRQ Publication No. 11–05149-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; Dec 2010. [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [14] Lin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral counseling to promote a healthy lifestyle for cardiovascular disease prevention in persons with cardiovascular risk factors: an updated systematic evidence review for the U.S. Preventive Services Task Force. Evidence Report No. 113. AHRQ Publication No. 13–05179-EF-1. Rockville MD: Agency for Healthcare Research and Quality; 2014. [PubMed] [Google Scholar]

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in diastolic blood pressure of -0.49 mm Hg (95% CI, -0.82 to -0.16) at 6-12 months (k=23).

    “DBP, mm Hg −0.49 (−0.82, −0.16) 23 37.9”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in systolic blood pressure of -1.26 mm Hg (95% CI, -1.77 to -0.75) at 6-12 months (k=22).

    “SBP, mm Hg −1.26 (−1.77, −0.75) 22 44.5”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § RESULTS

    Data on physical activity outcomes beyond 12 months was sparsely reported.

    “Data on physical activity outcomes beyond 12 months was sparsely reported.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § RESULTS

    Only 9 trials reported dietary outcomes at greater than 12 months follow-up, with a lack of effect or slightly attenuated effect over time.

    “Only 9 trials reported the effects of the interventions on dietary outcomes at greater than 12 months follow-up (i.e., 1.5 to 6 years follow-up) with a lack of effect or slightly attenuated effect being seen over time.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in LDL cholesterol of -2.58 mg/dL (95% CI, -4.30 to -0.85) at 6-12 months (k=13).

    “Low-density lipoprotein cholesterol, mg/dL a −2.58 (−4.30, −0.85) 13 19.6”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in total cholesterol of -2.85 mg/dL (95% CI, -4.95 to -0.75) at 6-12 months (k=19).

    “Total cholesterol, mg/dL a −2.85 (−4.95, −0.75) 19 50.8”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in BMI of -0.41 kg/m2 (95% CI, -0.62 to -0.19) at 6-12 months (k=20).

    “BMI, kg/m2 −0.41 (−0.62, −0.19) 20 95.8”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § DISCUSSION

    Only one of the included studies targeted reductions in sedentary behavior as the main focus of the trial, and only three trials reported the outcomes of sedentary behavior.

    “Also, only one of the included studies targeted reductions in sedentary behavior (i.e., sitting time) as the main focus of the trial and only three trials reported the outcomes of sedentary behavior.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § RESULTS

    Interventions were associated with a mean difference in waist circumference of -1.19 cm (95% CI, -1.79 to -0.59) at 6-12 months (k=17).

    “Waist circumference, cm e −1.19 (−1.79, −0.59) 17 91.8”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § DISCUSSION

    This review found no evidence of a difference in effects by the focus of the message, but analyses were highly confounded by the intensity of interventions.

    “This review found no evidence of a difference in effects by the focus of the message, but analyses were highly confounded by the intensity of interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § METHODS

    One reviewer completed primary data abstraction and a second reviewer checked all data for accuracy and completeness.

    “One reviewer completed primary data abstraction and a second reviewer checked all data for accuracy and completeness.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § METHODS

    Studies were rated as poor quality and excluded if they had several important major risks of bias, including very high attrition, differential attrition, lack of baseline comparability, or other issues judged to considerably bias results.

    “Studies were rated as poor quality and excluded if they had several important major risks of bias, including: very high attrition at 6–12 months (e.g., greater than 40%), differential attrition between intervention groups (e.g., greater than 20%), lack of baseline comparability between groups without adjustment for those variables, or other issues in the conduct, analysis, or reporting of results”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § METHODS

    Two reviewers independently assessed the methodological quality of all eligible studies by using criteria outlined by the USPSTF.

    “Two reviewers independently assessed the methodological quality of all eligible studies, by using criteria outlined by the USPSTF”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § METHODS

    Statistical heterogeneity among the pooled studies was examined using standard χ2 tests and the I2 statistic.

    “Statistical heterogeneity among the pooled studies was examined using standard χ2 tests and the proportion of total variability in point estimates was approximated using the I2 statistic.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § METHODS

    Two reviewers independently reviewed all identified titles and abstracts and relevant full-text articles against pre-specified inclusion and exclusion criteria.

    “Two reviewers independently reviewed all identified titles and abstracts and relevant full-text articles against pre-specified inclusion and exclusion criteria”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § METHODS

    The data on health outcomes (KQ1) and adverse events (KQ4) did not allow for pooled analyses, so were summarized descriptively.

    “The data on health outcomes (KQ1) and adverse events (KQ4) did not allow for pooled analyses, so were summarized descriptively.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § METHODS

    In order to evaluate small-study effects, funnel plots, and the Egger test (for continuous outcomes) or Peters test (for dichotomous outcomes) were examined.

    “In order to evaluate small-study effects, funnel plots, and the Egger test19 (for continuous outcomes) or Peters test20 (for dichotomous outcomes) were examined.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § METHODS

    The strength of the overall body of evidence for each key question was graded as high, moderate, low, or insufficient based on established methods and addressed consistency, precision, reporting bias, study quality, and dose-response related to each outcome.

    “The strength of the overall body of evidence for each key question was graded as high, moderate, low, or insufficient based on established methods21 and addressed the consistency, precision, reporting bias, study quality, and dose-response related to each outcome.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § DISCUSSION

    Consistent rules were used to estimate the total minutes of contact and to categorize each intervention group by intensity.

    “Consistent rules were used to estimate the total minutes of contact and to categorize each intervention group by intensity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § DISCUSSION

    Each of these methods can be prone to bias.

    “Each of these methods can be prone to bias.177”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med. 1999;17(3):211–229. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data
    § DISCUSSION

    For most outcomes, the statistical heterogeneity of pooled analyses was unimportant (I2<40%) or moderate (I2=30% to 60%) and therefore still reasonable to allow for interpreting of pooled estimates.

    “For most outcomes, the statistical heterogeneity of pooled analyses was unimportant (I2<40%) or moderate (I2=30% to 60%) and therefore still reasonable to allow for interpreting of pooled estimates.”
    Quote in the paperSubstantial claim
36 of 36

  • The paper relies on this without support.

    The absence of reported serious adverse events in the trials that reported harms indicates that serious harms are unlikely across all included interventions.

    “Harms of included interventions were sparsely reported and were inconsistently defined.”
    “there is moderate confidence that there are no serious harms related to behavioral counseling interventions for healthful diet and physical activity.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Structured lifestyle interventions are effective in increasing physical activity participation and reducing the progression of chronic diseases.

    “The use of structured lifestyle interventions is reported to be effective in increasing physical activity participation and reducing the progression of chronic diseases [10-12].”

    From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [11]

    The Results (page not provided) report increased physical activity with behavioral interventions, including 35 more minutes per week than controls at 6–12 months. The Discussion (page not provided) says evidence for effects on longer-term health outcomes was sparse and inconsistent, so the claim that these interventions reduce the progression of chronic diseases is not established by this paper. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • We also found a significantly decreased waist circumference with the same magnitude (−1.19 cm; 95% CI: [−1.79, −0.59] cm) as found in another published meta-analysis in which the effect of physical activity and dietary interventions on waist circumference was evaluated.

    “We also found a significantly decreased waist circumference with the same magnitude (− 1.19 cm; 95% CI: [− 1.79, − 0.59] cm) as found in another published meta-analysis in which the effect of physical activity and dietery interventions on waist circumference was evaluated [11].”

    From Can consumer wearable activity tracker-based interventions improve physical activity and cardiometabolic health in patients with chronic diseases? A systematic review and meta-analysis of randomised controlled trials (2020) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Weight estimate is not centered in its reported confidence interval

    Minor

    For the low-intensity weight result, the midpoint of the reported confidence interval is −0.58 kg, not the reported mean difference of −0.23 kg. This is inconsistent with the symmetric confidence intervals used for the mean differences in the table.

    Reported -0.23 · recomputed -0.58

  • Two different upper confidence limits for the physical-activity odds ratio

    Minor

    The narrative gives an upper 95% confidence limit of 1.56 for the odds of meeting physical activity recommendations, while Table 3 gives 1.64 for the same odds ratio and lower limit.

  • Sedentary-behavior trial count changes from four to three

    Minor

    The results state that four trials reported sedentary-behavior measures, whereas the limitations section says only three trials reported sedentary-behavior outcomes.

3 of 3

Cites

3 retracted

Flagged first, then by citations

5 of the 404 references couldn’t be matched to a known paper.

Research works printed but not linked: 10

  1. [1]U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. Washington DC: U.S. Department of Health and Human Services; Dec 2015. [Google Scholar]
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Cited by

Sorted by citations

Related

Authors
Patnode, C. D., Evans, C. V., Senger, C. A., Redmond, N., & Lin, J. S.
Affiliations
  • Kaiser Permanente (US)
  • Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
Corresponding author
Patnode, Carrie D.
ORCID
Lin, Jennifer S.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2017-07-11
Volume
318
Issue
2
Pages
175
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2017.3303
PMC
PMC13292382
OpenAlex
W2734860524
Cited by
380
References
404
Citations by year
2026: 7 · 2025: 25 · 2024: 31 · 2023: 33 · 2022: 49 · 2021: 61 · 2020: 108 · 2019: 39 · 2018: 21 · 2017: 6
FWCI
44.61
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
behavioral counseling, cardiovascular disease prevention, primary prevention, healthy eating, physical activity, sedentary time, cardiometabolic health, systolic blood pressure, LDL cholesterol, total cholesterol, body mass index, health-related quality of life, cardiovascular mortality, cardiovascular morbidity, harms of interventions, USPSTF recommendations, physical activity counseling, smoking cessation
MeSH terms
Diet, Healthy, Counseling, Humans, Preventive Health Services, Risk Factors, United States, Health Behavior, Exercise, Randomized Controlled Trials as Topic, Advisory Committees

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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