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Cited by 919Physical Activity and HealthCardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular Prevention

Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults: A Scientific Statement From the American Heart Association

Open access
Artinian, Nancy T., Fletcher, Gerald F., Mozaffarian, Dariush, Kris-Etherton, Penny, Van Horn, Linda, Lichtenstein, Alice H., Kumanyika, Shiriki, Kraus, William E. +17 more·2010·Circulation
DOI 10.1161/cir.0b013e3181e8edf1PMC PMC6893884
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Abstract

A pproximately 79 400 000 American adults, or 1 in 3, have cardiovascular disease (CVD). 1 CVD accounts for 36.3% or 1 of every 2.8 deaths in the United States and is the leading cause of death among both men and women in the United States, killing an average of 1 American every 37 seconds. 1 Older adults, some ethnic minority populations, and socioeconomically disadvantaged individuals have an increased prevalence of CVD and vascular/metabolic risk factors such as hypertension, dyslipidemia, and diabetes; are more likely to have Ն2 risk factors; and are at increased risk of being sedentary, overweight or obese, and having unhealthy dietary habits.[2][3][4][5][6][7][8][9][10] Black and Hispanic immigrants are initially at lower risk for vascular/metabolic risk factors and CVD than US-born black and Hispanic individuals, 2 but as they adapt to the diet and activity habits of this country, the prevalence of vascular/metabolic risk factors increases.3 Each of these issues emphasizes the importance of interventions to promote physical activity (PA) and healthy diets in all American adults.Even modest sustained lifestyle changes can substantially reduce CVD morbidity and mortality.Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits.Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance.4 Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals.According to the National Center for Health Statistics, life expectancy could increase byThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on May 4, 2010.

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Crossref · 10.1161/cir.0b013e3181e8edf1

Cites

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Statistics

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Claims the paper makes

0 of 354 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Except for standard behavioral weight-loss interventions that provided daily calorie and fat gram goals, most reviewed studies did not target total energy intake.

    “Except for studies using standard behavioral interventions for weight loss, in which daily calorie and fat gram goals are provided, most studies did not target total energy intake.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The majority of reviewed studies assessed changes in body weight and/or specific eating patterns such as fruits and vegetables or dietary fat.

    “The majority of studies assessed changes in body weight and/or specific eating patterns (fruits/vegetables, dietary fat).”
    Quote in the paperNot a substantial claim
  • Findingown data

    At least two or more strategies were incorporated in studies that yielded favorable outcomes.

    “As illustrated in Tables 2 and 3, at least 2 or more strategies were incorporated in studies that yielded favorable outcomes.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    In a weight-loss study, individuals in a combined therapy group who frequently recorded their weight achieved more than twice the weight loss of those who recorded infrequently.

    “In a study testing interventions to promote weight loss, individuals in a combined therapy group who frequently recorded their weight achieved more than twice the weight loss than those who recorded their weight infrequently.28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005; 353: 2111– 2120. 16291981 source

      Not checked in the free run.

  • Findingown data

    Positive dietary or physical activity behavior changes were observed in all but two of the trials that included goal-based strategies.

    “Positive dietary or PA behavior changes were observed in all but 235,46 of the trials.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [35] Micco N, Gold B, Buzzell P, Leonard H, Pintauro S, Harvey-Berino J. Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med. 2007; 33: 49– 56. 17291170 source

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    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

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  • May combine two claims. 68
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingcitation
    § Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults

    Interventions targeting dietary patterns, weight reduction, and new physical activity habits often produce high initial behavior change rates but frequently do not translate into long-term behavioral maintenance.

    “Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance.4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000; 19: 64– 69. 10709949 source

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  • May combine two claims.

    Findingcitation

    Both observational data and clinical trial evidence demonstrate the importance of self-monitoring in achieving behavior change.

    “Both observational data60–64 and evidence from clinical trials26–28,30,36,38,50,52 demonstrate the importance of self-monitoring in achieving behavior change.”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [60] Butryn ML, Phelan S, Hill JO, Wing RR. Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring). 2007; 15: 3091– 3096. 18198319 source

      Not checked in the free run.

    • cites [61] Baker RC, Kirschenbaum DS. Weight control during the holidays: highly consistent self-monitoring as a potentially useful coping mechanism. Health Psychol. 1998; 17: 367– 370. 9697946 source

      Not checked in the free run.

    • cites [62] Burke LE, Sereika SM, Music E, Warziski M, Styn MA, Stone A. Using instrumented paper diaries to document self-monitoring patterns in weight loss. Contemp Clin Trials. 2008; 29: 182– 193. 17702667 PMC2435095 source

      Not checked in the free run.

    • cites [63] Hollis JF, Gullion CM, Stevens VJ, Brantley PJ, Appel LJ, Ard JD, Champagne CM, Dalcin A, Erlinger TP, Funk K, Laferriere D, Lin PH, Loria CM, Samuel-Hodge C, Vollmer WM, Svetkey LP; Weight Loss Maintenance Trial Research Group. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med. 2008; 35: 118– 126. 18617080 PMC2515566 source

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    • cites [64] Tinker LF, Rosal MC, Young AF, Perri MG, Patterson RE, Van Horn L, Assaf AR, Bowen DJ, Ockene J, Hays J, Wu L. Predictors of dietary change and maintenance in the Women’s Health Initiative Dietary Modification Trial. J Am Diet Assoc. 2007; 107: 1155– 1166. 17604744 source

      Not checked in the free run.

    • cites [26] Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR; Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003; 289: 2083– 2093. 12709466

      Not checked in the free run.

    • cites [27] McManus K, Antinoro L, Sacks F. A randomized controlled trial of amoderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults. Int J Obes Relat Metab Disord. 2001; 25: 1503– 1511. 11673773 source

      Not checked in the free run.

    • cites [28] Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005; 353: 2111– 2120. 16291981 source

      Not checked in the free run.

    • cites [30] Burke LE, Dunbar-Jacob J, Orchard TJ, Sereika SM. Improving adherence to a cholesterol-lowering diet: a behavioral intervention study. Patient Educ Couns. 2005; 57: 134– 142. 15797163 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    For the majority of reviewed studies, the between-group effect size was small, ranging from 0.00 to 0.33, except for the preliminary Carels et al study using motivational interviewing, which reported an effect size of 0.84.

    “As shown in Tables 2 and 3, the ES for the between group differences for the majority of studies was small, ranging from 0.00 to 0.33, except for the preliminary study of Carels et al,15 that used motivational interviewing to augment behavioral intervention and reported an ES of 0.84.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Carels RA, Darby L, Cacciapaglia HM, Konrad K, Coit C, Harper J, Kaplar ME, Young K, Baylen CA, Versland A. Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol. 2007; 26: 369– 374. 17500624 source

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  • May combine two claims.

    Findingcitation

    Frequency of self-monitoring, as well as detail and proximity in time to the recorded behavior, can influence the efficacy of self-monitoring.

    “Frequency of self-monitoring, as well as detail and proximity in time to the recorded behavior, can influence efficacy of self-monitoring.62”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Burke LE, Sereika SM, Music E, Warziski M, Styn MA, Stone A. Using instrumented paper diaries to document self-monitoring patterns in weight loss. Contemp Clin Trials. 2008; 29: 182– 193. 17702667 PMC2435095 source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Of the successful trials, all interventions included provision of feedback about initial baseline screening results, and several included further feedback during follow-up assessments.

    “Of the successful trials, all interventions included provision of feedback about the initial baseline screening results, and several included further feedback during follow-up assessments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Six of the 25 trials listed in Table 3 described provision of feedback as part of the intervention, and five of these resulted in positive lifestyle changes.

    “Six of the 25 trials listed in Table 3 described provision of feedback as part of the intervention. Five of these studies resulted in positive lifestyle changes.44,46,52,55,81”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [44] Eakin EG, Bull SS, Riley KM, Reeves MM, McLaughlin P, Gutierrez S. Resources for health: A primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychol. 2007; 26: 392– 400. 17605558 source

      Not checked in the free run.

    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

      Not checked in the free run.

    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Five of the 6 trials with self-monitoring led to positive lifestyle behavior changes, compared with 13 of the 19 trials without self-monitoring.

    “Five of these 6 trials that included self-monitoring42,46,50–52 led to positive lifestyle behavior changes, compared with 13 of the 19 trials that did not include self-monitoring.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [42] Kumanyika SK, Shults J, Fassbender J, Whitt MC, Brake V, Kallan MJ, Iqbal N, Bowman MA. Outpatient weight management in African-Americans: the Healthy Eating and Lifestyle Program (HELP) study. Prev Med. 2005; 41: 488– 502. 15917045 source

      Not checked in the free run.

    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

      Not checked in the free run.

    • cites [50] Mayer-Davis EJ, D’Antonio AM, Smith SM, Kirkner G, Levin Martin S, Parra-Medina D, Schultz R. Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health. 2004; 94: 1736– 1742. 15451743 PMC1448527 source

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    • cites [51] Racette SB, Weiss EP, Obert KA, Kohrt WM, Holloszy JO. Modestlifestyle intervention and glucose tolerance in obese African Americans. Obes Res. 2001; 9: 348– 355. 11399781 source

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    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

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

    Findingcitation

    Tables 2 and 3 describe several studies that included problem solving as part of interventions that led to positive behavior change.

    “Tables 2 and 3 describe several studies that included problem solving as a part of interventions that led to positive behavior change.31,32,39,41,43–45”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [31] Green BB, McAfee T, Hindmarsh M, Madsen L, Caplow M, Buist D. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Am J Prev Med. 2002; 22: 177– 183. 11897462 source

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    • cites [32] Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Prev Med. 2003; 36: 594– 600. 12689805 source

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    • cites [39] Glasgow RE, La Chance PA, Toobert DJ, Brown J, Hampson SE, Riddle MC. Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. Patient Educ Couns. 1997; 32: 175– 184. 9423499 source

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  • May combine two claims.

    Findingcitation

    In the same trial, 6.5% in the simultaneous arm, 5.2% in the sequential arm, and 6.5% in usual care were adherent to at least two target behaviors, with all statistical contrasts P<0.05.

    “whereas 6.5% in the simultaneous arm, 5.2% in the sequential arm, and 6.5% in the usual care arm were adherent to ≥2 target behaviors (all statistical contrasts resulted in P<0.05).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Hyman DJ, Pavlik VN, Taylor WC, Goodrick GK, Moye L. Simultaneous vs sequential counseling for multiple behavior change. Arch Intern Med. 2007; 167: 1152– 1158. 17563023 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a study comparing nonindividualized self-help manuals versus motivationally matched reports and manuals to promote physical activity adoption, both groups showed significant improvement in physical activity at 6 months, but the increase was 50% greater among participants receiving motivationally matched materials.

    “In contrast, in a study comparing the efficacy of nonindividualized self-help manuals versus motivationally matched reports and manuals to promote PA adoption, both groups showed significant improvement in PA at 6 months, but the increase was 50% greater among participants receiving motivationally matched materials.79”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Marcus BH, Bock BC, Pinto BM, Forsyth LH, Roberts MB, Traficante RM. Efficacy of an individualized, motivationally-tailored physical activity intervention. Ann Behav Med. 1998; 20: 174– 180. 9989324 source

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  • May combine two claims.

    Findingcitation

    In the same trial, at 18 months, 20.3% in the simultaneous arm, 16.9% in the sequential arm, and 10.1% in usual care were negative for urinary cotinine; P=0.06 for simultaneous versus usual care and P=0.08 for the overall trend in smoking cessation.

    “At 18 months, 20.3% in the simultaneous, 16.9% in the sequential, and 10.1% in the usual care arms were negative for urinary cotinine (P=0.06 for the simultaneous group versus the usual care group and P=0.08 for the overall trend in smoking cessation)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] Hyman DJ, Pavlik VN, Taylor WC, Goodrick GK, Moye L. Simultaneous vs sequential counseling for multiple behavior change. Arch Intern Med. 2007; 167: 1152– 1158. 17563023 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Group-based approaches are commonly used in randomized clinical trials employing standard behavioral interventions for weight loss, as well as in other trials using diet and physical activity changes to target cardiovascular risk factors such as blood pressure or blood cholesterol.

    “Group-based approaches are commonly used in randomized clinical trials employing standard behavioral interventions for weight loss,24,25,28,29,66,72,109 as well as in other trials using diet and PA changes to target CVD risk factors such as BP or blood cholesterol.23,26,27,56,66,67,113”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [24] Burke LE, Styn MA, Steenkiste AR, Music E, Warziski M, Choo J. Arandomized clinical trial testing treatment preference and two dietary options in behavioral weight management: preliminary results of the impact of diet at 6 months: PREFER study. Obesity (Silver Spring). 2006; 14: 2007– 2017. 17135618 source

      Not checked in the free run.

    • cites [25] Jeffery RW, Wing RR, Thorson C, Burton LR. Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program. J Consult Clin Psychol. 1998; 66: 777– 783. 9803696 source

      Not checked in the free run.

    • cites [28] Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005; 353: 2111– 2120. 16291981 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Interventions may focus on changing only physical activity, only dietary behaviors, or both.

    “Evidence described in Tables 2 and 3 shows that interventions may focus on changing only PA,34,46,69,108,109 only dietary behaviors,17,24,30,32,33,39,47,48,54,68,74–76,80,81,96,110 or both.26–29,35,36,38,43,44,50,51,53,55,57,66,67,111–113”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Napolitano MA, Fotheringham M, Tate D, Sciamanna C, Leslie E, Owen N, Bauman A, Marcus B. Evaluation of an Internet-based physical activity intervention: a preliminary investigation. Ann Behav Med. 2003; 25: 92– 99. 12704010 source

      Not checked in the free run.

    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

      Not checked in the free run.

    • cites [69] Marcus BH, Napolitano MA, King AC, Lewis BA, Whiteley JA, Albrecht A, Parisi A, Bock B, Pinto B, Sciamanna C, Jakicic J, Papandonatos GD. Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE. Health Psychol. 2007; 26: 401– 409. 17605559 source

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  • May combine two claims.

    Findingcitation

    In a study comparing motivationally matched print materials versus motivationally matched telephone counseling, both groups had significantly increased physical activity at 6 months, but participants receiving print materials were more likely to maintain physical activity change at 12 months.

    “In a study comparing the effects of motivationally matched print materials versus motivationally matched telephone counseling, both groups had significantly increased PA at 6 months, but participants receiving the print materials were more likely to maintain PA change at 12 months.69”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Marcus BH, Napolitano MA, King AC, Lewis BA, Whiteley JA, Albrecht A, Parisi A, Bock B, Pinto B, Sciamanna C, Jakicic J, Papandonatos GD. Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE. Health Psychol. 2007; 26: 401– 409. 17605559 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In one trial, at 6 months, the simultaneous strategy was superior for a fat intake intervention and for a subgroup of participants who did not meet physical activity recommendations at baseline.

    “In 1 trial, at 6 months, the simultaneous strategy was superior for a fat intake intervention and for a subgroup of participants who did not meet physical activity recommendations at baseline.115”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [115] Vandelanotte C, De Bourdeaudhuij I, Sallis JF, Spittaels H, Brug J. Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake. Ann Behav Med. 2005; 29: 138– 146. 15823787 source

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  • May combine two claims.

    Findingcitation

    Other studies demonstrated that motivational interviewing increased physical activity among women and/or individuals with diabetes or obesity and black individuals with hypertension.

    “Other studies demonstrated that motivational interviewing increased PA among women and/or individuals with diabetes or obesity15,40,105 and black individuals with hypertension.106”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Carels RA, Darby L, Cacciapaglia HM, Konrad K, Coit C, Harper J, Kaplar ME, Young K, Baylen CA, Versland A. Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol. 2007; 26: 369– 374. 17500624 source

      Not checked in the free run.

    • cites [40] Perry CK, Rosenfeld AG, Bennett JA, Potempa K. Heart-to-Heart: promoting walking in rural women through motivational interviewing and group support. J Cardiovasc Nurs. 2007; 22: 304– 312. 17589283 source

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    • cites [105] Knight KM, McGowan L, Dickens C, Bundy C. A systematic review of motivational interviewing in physical health care settings. Br J Health Psychol. 2006; 11: 319– 332. 16643702 source

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  • May combine two claims.

    Findingcitation

    Few reviewed interventions specifically addressed relapse prevention as a strategy, though others may have indirectly addressed it through social support, problem solving, or reinforcement.

    “Although few interventions reviewed specifically addressed relapse prevention as a strategy,23,30,45 others may have indirectly addressed relapse prevention through the inclusion of social support, 29,35,41,47,53,55,76,80 through problem solving to reduce barriers,31,32,39,41,44 or through a reinforcement program.98”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [23] Carels RA, Darby LA, Cacciapaglia HM, Douglass OM. Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention. J Womens Health (Larchmt). 2004; 13: 412– 426. 15186658 source

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    • cites [30] Burke LE, Dunbar-Jacob J, Orchard TJ, Sereika SM. Improving adherence to a cholesterol-lowering diet: a behavioral intervention study. Patient Educ Couns. 2005; 57: 134– 142. 15797163 source

      Not checked in the free run.

    • cites [45] Jacobs AD, Ammerman AS, Ennett ST, Campbell MK, Tawney KW, Aytur SA, Marshall SW, Will JC, Rosamond WD. Effects of a tailored follow-up intervention on health behaviors, beliefs, and attitudes. J Womens Health (Larchmt). 2004; 13: 557– 568. 15257847 source

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  • May combine two claims.

    Findingcitation

    In a randomized trial of 289 blacks with hypertension, at 6 months, 29.6% in the simultaneous arm, 16.5% in the sequential arm, and 13.4% in usual care reached the urine sodium goal; P=0.01 for simultaneous versus usual care and P<0.05 for simultaneous versus sequential.

    “When examining individual target behaviors at 6 months, 29.6% in the simultaneous, 16.5% in the sequential, and 13.4% in the usual care arms had reached the urine sodium goal (P=0.01 for the simultaneous versus the usual care group and P<0.05 for the simultaneous versus the sequential group).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Hyman DJ, Pavlik VN, Taylor WC, Goodrick GK, Moye L. Simultaneous vs sequential counseling for multiple behavior change. Arch Intern Med. 2007; 167: 1152– 1158. 17563023 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Few interventions described in this review included incentives, and the return on investment from them has not been widely assessed.

    “Few interventions described in this review included incentives,34,57,76 and the return on investment from them has not been widely assessed.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Napolitano MA, Fotheringham M, Tate D, Sciamanna C, Leslie E, Owen N, Bauman A, Marcus B. Evaluation of an Internet-based physical activity intervention: a preliminary investigation. Ann Behav Med. 2003; 25: 92– 99. 12704010 source

      Not checked in the free run.

    • cites [57] Tate DF, Jackvony EH, Wing RR. A randomized trial comparing humane-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006; 166: 1620– 1625. 16908795 source

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    • cites [76] Campbell MK, Demark-Wahnefried W, Symons M, Kalsbeek WD, Dodds J, Cowan A, Jackson B, Motsinger B, Hoben K, Lashley J, Demissie S, McClelland JW. Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project. Am J Public Health. 1999; 89: 1390– 1396. 10474558 PMC1508774 source

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  • May combine two claims.

    Findingcitation

    In a 212-adult trial, commercial-program participants had greater weight reductions at 1 and 2 years than self-help participants, along with improvements in blood pressure, blood lipids, insulin, and glucose.

    “greater weight reductions were observed at both 1 and 2 years in the commercial group compared with the self-help group, with accompanying improvements in BP, blood lipids, insulin, and glucose levels.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [123] Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX. Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA. 2003; 289: 1792– 1798. 12684357 source

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    • cites [124] Heshka S, Greenway F, Anderson JW, Atkinson RL, Hill JO, Phinney SD, Miller-Kovach K, Xavier Pi-Sunyer F. Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study. Am J Med. 2000; 109: 282– 287. 10996578 source

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  • May combine two claims.

    Findingnone given

    No studies were found that tested in-office prompts alone, in-office reminders alone, or in-office dietary and/or physical activity assessment tools alone on diet or physical activity behavior change.

    “No studies were identified that examined the effects of in-office prompts only, in-office reminders only, or in-office dietary and/or PA assessment tools only on diet and/or PA behavior change”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In EUROACTION, more intervention participants and their partners met recommended targets for physical activity and for fruit, vegetable, saturated fat, and oily fish consumption than usual-care participants, and central obesity was reduced.

    “Compared with usual care, more individuals and their partners in the intervention group achieved recommended targets for PA and for fruit, vegetable, saturated fat, and oily fish consumption. Central obesity was also reduced.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [129] Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, Holden A, De Bacquer D, Collier T, De Backer G, Faergeman O; EUROACTION Study Group. Nurse-coordinated mulitidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomized controlled trial. Lancet. 2008; 371: 1999– 2912. 18555911 source

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  • May combine two claims.

    Findingcitation

    In a small trial of 65 people, a physical activity website plus 12 weekly e-mail tip sheets increased total walking minutes but not moderate physical activity at 1 and 3 months compared with control.

    “use of a PA Web site and 12 weekly E-mail tip sheets resulted in increased total minutes of walking, but not time spent in moderate PA at 1 and 3 months, compared with a control group.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Napolitano MA, Fotheringham M, Tate D, Sciamanna C, Leslie E, Owen N, Bauman A, Marcus B. Evaluation of an Internet-based physical activity intervention: a preliminary investigation. Ann Behav Med. 2003; 25: 92– 99. 12704010 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Personal goal setting and self-monitoring through individual telephone counseling improved adherence to a cholesterol-lowering diet and lowered serum cholesterol compared with usual care.

    “the use of personal goal setting and self-monitoring via individual telephone counseling improved adherence to a cholesterol-lowering diet and reduced serum cholesterol compared with usual care.30”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Burke LE, Dunbar-Jacob J, Orchard TJ, Sereika SM. Improving adherence to a cholesterol-lowering diet: a behavioral intervention study. Patient Educ Couns. 2005; 57: 134– 142. 15797163 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a four-year nurse-led intervention for coronary artery disease patients, the intervention group had less progression of coronary atherosclerosis and fewer cardiac hospitalizations than usual care.

    “Compared with usual care, the intervention group had less progression of coronary atherosclerosis and decreased hospitalizations for cardiac events.128”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [128] Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko HR, Williams PT, Johnstone IM, Champagne MA, Krauss RM, Farquhar JW. Effects of intensive multiple risk factor reduction on coronary artherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford Coronary Risk Intervention Project (SCRIP). Circulation. 1994; 89: 975– 990. 8124838

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  • May combine two claims.

    Findingcitation

    Adding friends/social support, home exercise equipment, aerobic or strength training, Internet counselor access, stepped care, or motivational interviewing to group-based weight-loss programs produced improvements in all groups, with only small between-group differences in energy and fat intake or physical activity.

    “The studies found improvements in all groups, with small between-group differences in energy and fat consumption or PA changes”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [29] Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol. 1999; 67: 132– 138. 10028217 source

      Not checked in the free run.

    • cites [109] Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA. 1999; 282: 1554– 1560. 10546695 source

      Not checked in the free run.

    • cites [72] Wadden TA, Vogt RA, Foster GD, Anderson DA. Exercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial. J Consult Clin Psychol. 1998; 66: 429– 433. 9583346 source

      Not checked in the free run.

    • cites [36] Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003; 289: 1833– 1836. 12684363 source

      Not checked in the free run.

    • cites [57] Tate DF, Jackvony EH, Wing RR. A randomized trial comparing humane-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006; 166: 1620– 1625. 16908795 source

      Not checked in the free run.

    • cites [122] Gold BC, Burke S, Pintauro S, Buzzell P, Harvey-Berino J. Weight losson the web: A pilot study comparing a structured behavioral intervention to a commercial program. Obesity (Silver Spring). 2007; 15: 155– 164. 17228043 source

      Not checked in the free run.

    • cites [15] Carels RA, Darby L, Cacciapaglia HM, Konrad K, Coit C, Harper J, Kaplar ME, Young K, Baylen CA, Versland A. Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol. 2007; 26: 369– 374. 17500624 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In hospitalized acute myocardial infarction patients, nurse-initiated interventions for smoking cessation, exercise, diet, and lipid drug therapy with telephone and mail follow-up led to higher functional capacity at 6 months and higher smoking cessation and lower LDL cholesterol at 12 months compared with usual care.

    “Compared with usual care, the intervention group reported higher functional capacity at 6 months and higher smoking cessation rates and lower LDL cholesterol at 12 months.127”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] DeBusk RF, Miller NH, Superko HR, Dennis CA, Thomas RJ, Lew HT, Berger WE 3rd, Heller RS, Rompf J, Gee D, Kraemer HC, Bandura A, Ghandour G, Clark M, Shah RV, Fisher L, Taylor CB. A case management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994; 120: 721– 729. 8147544 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Lay leaders can increase the quantity of healthy-behavior messages and tailor them to the unique needs and culture of the target population.

    “Lay leaders can improve the quantity of messages about healthy behavior and tailor messages to the unique needs and culture of the target population.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L, Alatorre C, Wentzel TM. Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst. 1999; 91: 1491– 1500. 10469751 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Of the 25 reviewed trials, 3 tested lay-led group or individual interventions and 4 tested combined professional and lay educator interventions.

    “Of the 25 trials reviewed (Table 3), 3 tested lay-led group or individual-level interventions,43,48,74 and 4 tested interventions that combined professional and lay educators.52,53,55,76”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [43] McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes. Diabetes Care. 1997; 20: 1518– 1523. 9314627 source

      Not checked in the free run.

    • cites [48] Havas S, Anliker J, Damron D, Langenberg P, Ballesteros M, Feldman R. Final results of the Maryland WIC 5-A-Day Promotion Program. Am J Public Health. 1998; 88: 1161– 1167. 9702141 PMC1508288 source

      Not checked in the free run.

    • cites [74] Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L, Alatorre C, Wentzel TM. Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst. 1999; 91: 1491– 1500. 10469751 source

      Not checked in the free run.

    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

      Not checked in the free run.

    • cites [53] Staten LK, Gregory-Mercado KY, Ranger-Moore J, Will JC, Giuliano AR, Ford ES, Marshall J. Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project. J Womens Health (Larchmt). 2004; 13: 547– 556. 15257846 source

      Not checked in the free run.

    • cites [55] Yanek LR, Becker DM, Moy TF, Gittelsohn J, Koffman DM. ProjectJoy: faith based cardiovascular health promotion for African American women. Public Health Rep. 2001; 116(suppl 1): 68– 81. 11889276 PMC1913665 source

      Not checked in the free run.

    • cites [76] Campbell MK, Demark-Wahnefried W, Symons M, Kalsbeek WD, Dodds J, Cowan A, Jackson B, Motsinger B, Hoben K, Lashley J, Demissie S, McClelland JW. Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project. Am J Public Health. 1999; 89: 1390– 1396. 10474558 PMC1508774 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Trials using both professionals and lay leaders led to positive outcomes in diet, blood cholesterol and blood pressure, physical activity, and hemoglobin A1c at follow-up.

    “The trials using both professionals and lay leaders also further led to positive outcomes in diet,55,76 blood cholesterol and BP,53,55 PA,53 and hemoglobin A1c at follow-up.52”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [55] Yanek LR, Becker DM, Moy TF, Gittelsohn J, Koffman DM. ProjectJoy: faith based cardiovascular health promotion for African American women. Public Health Rep. 2001; 116(suppl 1): 68– 81. 11889276 PMC1913665 source

      Not checked in the free run.

    • cites [76] Campbell MK, Demark-Wahnefried W, Symons M, Kalsbeek WD, Dodds J, Cowan A, Jackson B, Motsinger B, Hoben K, Lashley J, Demissie S, McClelland JW. Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project. Am J Public Health. 1999; 89: 1390– 1396. 10474558 PMC1508774 source

      Not checked in the free run.

    • cites [53] Staten LK, Gregory-Mercado KY, Ranger-Moore J, Will JC, Giuliano AR, Ford ES, Marshall J. Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project. J Womens Health (Larchmt). 2004; 13: 547– 556. 15257846 source

      Not checked in the free run.

    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Low-literacy individuals may have difficulty accessing Internet information because of poor search strategies, unwillingness to click links, sites written at or above a 10th-grade reading level, and perceived high quantity and complexity of information.

    “low-literacy individuals may have difficulty accessing information through the Internet because of suboptimal searching strategies (eg, use of nonspecific search terms), unwillingness to click on links, accessing Web sites written at or above the 10th grade reading level, and perceived higher quantity and complexity of the information.133,134”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [133] Birru MS, Monaco VM, Charles L, Drew H, Njie V, Bierria T, Detlefsen E, Steinman RA. Internet usage by low-literacy adults seeking health information: an observational analysis. J Med Internet Res. 2004; 6: e25. 15471751 PMC1550604 source

      Not checked in the free run.

    • cites [134] Wathen CN, Harris RM. “I try to take care of it myself.” How rural women search for health information. Qual Health Res. 2007; 17: 639– 651. 17478646 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Of the 25 reviewed trials, 18 used culturally sensitive interventions and had mixed results.

    “Of the 25 trials reviewed (Table 3), 18 designed culturally sensitive interventions and had mixed results.43–47,52,55,59,74–76,81,93,96,102,103,110,144”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [43] McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes. Diabetes Care. 1997; 20: 1518– 1523. 9314627 source

      Not checked in the free run.

    • cites [44] Eakin EG, Bull SS, Riley KM, Reeves MM, McLaughlin P, Gutierrez S. Resources for health: A primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychol. 2007; 26: 392– 400. 17605558 source

      Not checked in the free run.

    • cites [45] Jacobs AD, Ammerman AS, Ennett ST, Campbell MK, Tawney KW, Aytur SA, Marshall SW, Will JC, Rosamond WD. Effects of a tailored follow-up intervention on health behaviors, beliefs, and attitudes. J Womens Health (Larchmt). 2004; 13: 557– 568. 15257847 source

      Not checked in the free run.

    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

      Not checked in the free run.

    • cites [47] Coates RJ, Bowen DJ, Kristal AR, Feng Z, Oberman A, Hall WD, George V, Lewis CE, Kestin M, Davis M, Evans M, Grizzle JE, Clifford CK. The Women’s Health Trial Feasibility Study in Minority Populations: changes in dietary intakes. Am J Epidemiol. 1999; 149(12): 1104– 1112. 10369504 source

      Not checked in the free run.

    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

      Not checked in the free run.

    • cites [55] Yanek LR, Becker DM, Moy TF, Gittelsohn J, Koffman DM. ProjectJoy: faith based cardiovascular health promotion for African American women. Public Health Rep. 2001; 116(suppl 1): 68– 81. 11889276 PMC1913665 source

      Not checked in the free run.

    • cites [59] Yancey AK, McCarthy WJ, Harrison GG, Wong WK, Siegel JM, Leslie J. Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. J Womens Health (Larchmt). 2006; 15: 412– 429. 16724889 source

      Not checked in the free run.

    • cites [74] Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L, Alatorre C, Wentzel TM. Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst. 1999; 91: 1491– 1500. 10469751 source

      Not checked in the free run.

    • cites [75] Kumanyika SK, Adams-Campbell L, Van Horn B, Ten Have TR, Treu JA, Askov E, Williams J, Achterberg C, Zaghloul S, Monsegu D, Bright M, Stoy DB, Malone-Jackson M, Mooney D, Deiling S, Caulfield J. Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level. J Am Diet Assoc. 1999; 99: 1380– 1391. 10570675 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Look AHEAD at one year, combined individual and group sessions produced significantly greater weight loss, improved fitness, and lower mean hemoglobin A1c than diabetes support and education through limited group-only meetings.

    “At 1 year, the trial reported significantly greater weight loss, improved fitness, and lower mean hemoglobin A1c in the combined group compared with those who received diabetes support and education through a limited number of group-only meetings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [111] Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, Curtis JM, Espeland MA, Foreyt JP, Graves K, Haffner SM, Harrison B, Hill JO, Horton ES, Jakicic J, Jeffery RW, Johnson KC, Kahn S, Kelley DE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montgomery B, Nathan DM, Patricio J, Peters A, Redmon JB, Reeves RS, Ryan DH, Safford M, Van Dorsten B, Wadden TA, Wagenknecht L, Wesche-Thobaben J, Wing RR, Yanovski SZ. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Diabetes Prevention Program, diabetes and metabolic syndrome incidence were reduced by 58% and 41% in the lifestyle and control groups, respectively.

    “Incidence of diabetes and metabolic syndrome were reduced by 58% and 41% in the lifestyle and control groups, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346: 393– 403. 11832527 PMC1370926 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a personalized medical office-based intervention for type 1 or type 2 diabetes, computerized dietary barrier assessment plus printed feedback, counseling, and self-help materials led at one year to significant decreases in total fat intake and serum cholesterol but not hemoglobin A1c.

    “One year later, significant decreases were observed in total fat intake and serum cholesterol levels, but not hemoglobin A1c levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Glasgow RE, La Chance PA, Toobert DJ, Brown J, Hampson SE, Riddle MC. Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. Patient Educ Couns. 1997; 32: 175– 184. 9423499 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Seven of the 25 reviewed studies used interventions sensitive to literacy levels, and 6 of those produced some positive outcomes.

    “Seven of the 25 studies described in Table 3 used interventions sensitive to literacy levels44,45,47,52,54,74,81; 6 of these44,45,47,52,74,81 resulted in some positive outcomes.”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [44] Eakin EG, Bull SS, Riley KM, Reeves MM, McLaughlin P, Gutierrez S. Resources for health: A primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychol. 2007; 26: 392– 400. 17605558 source

      Not checked in the free run.

    • cites [45] Jacobs AD, Ammerman AS, Ennett ST, Campbell MK, Tawney KW, Aytur SA, Marshall SW, Will JC, Rosamond WD. Effects of a tailored follow-up intervention on health behaviors, beliefs, and attitudes. J Womens Health (Larchmt). 2004; 13: 557– 568. 15257847 source

      Not checked in the free run.

    • cites [47] Coates RJ, Bowen DJ, Kristal AR, Feng Z, Oberman A, Hall WD, George V, Lewis CE, Kestin M, Davis M, Evans M, Grizzle JE, Clifford CK. The Women’s Health Trial Feasibility Study in Minority Populations: changes in dietary intakes. Am J Epidemiol. 1999; 149(12): 1104– 1112. 10369504 source

      Not checked in the free run.

    • cites [52] Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005; 29: 225– 235. 15946117 source

      Not checked in the free run.

    • cites [54] Howard-Pitney B, Winkleby MA, Albright CL, Bruce B, Fortmann SP. The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults. Am J Public Health. 1997; 87: 1971– 1976. 9431286 PMC1381239 source

      Not checked in the free run.

    • cites [74] Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L, Alatorre C, Wentzel TM. Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst. 1999; 91: 1491– 1500. 10469751 source

      Not checked in the free run.

    • cites [81] Fries E, Edinboro P, McClish D, Manion L, Bowen D, Beresford SA, Ripley J. Randomized trial of a low-intensity dietary intervention in rural residents: the Rural Physician Cancer Prevention Project. Am J Prev Med. 2005; 28: 162– 168. 15710271 source

      Not checked in the free run.

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

    Findingcitation

    Women are reported to have better eating habits than men.

    “Women, however, are reported to have better eating habits than men.169–174”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [169] Dynesen AW, Haraldsdóttir J, Holm L, Astrup A. Sociodemographic differences in dietary habits described by food frequency questions: results from Denmark. Eur J Clin Nutr. 2003; 57: 1586– 1597. 14647224 source

      Not checked in the free run.

    • cites [170] Milligan RA, Burke V, Beilin LJ, Dunbar DL, Spencer MJ, Balde E, Gracey MP. Influence of gender and socio-economic status on dietary patterns and nutrient intakes in 18-year-old Australians. Aust N Z J Public Health. 1998; 22: 485– 493. 9659778 source

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    • cites [171] Nasreddine L, Hwalla N, Sibai A, Hamzé M, Parent-Massin D. Food consumption patterns in an adult urban population in Beirut, Lebanon. Public Health Nutr. 2006; 9: 194– 203. 16571173 source

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    • cites [172] Hart A Jr, Tinker L, Bowen DJ, Longton G, Beresford SA. Correlates off at intake behaviors in participants in the eating for a healthy life study. J Am Diet Assoc. 2006; 106: 1605– 1613. 17000193 source

      Not checked in the free run.

    • cites [173] Forshee RA, Storey ML. Demographics, not beverage consumption, is associated with diet quality. Int J Food Sci Nutr. 2006; 57: 494– 511. 17162328 source

      Not checked in the free run.

    • cites [174] Satia JA, Galanko JA, Neuhouser ML. Food nutrition label use is associated with demographic, behavioral, and psychosocial factors and dietary intake among African Americans in North Carolina. J Am Diet Assoc. 2005; 105: 392– 402. 15746826 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Comorbid conditions and depression negatively affect adherence to most lifestyle-change regimens.

    “Presence of comorbid conditions and depression negatively impact adherence to most lifestyle change regimens.180–183”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [180] Haynes R, Taylor D, Sackett D. Compliance in Health Care. Baltimore, Md: Johns Hopkins University Press; 1979.

      Not checked in the free run.

    • cites [181] Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002; 288: 2880– 2883. 12472330 source

      Not checked in the free run.

    • cites [182] Rejeski WJ, Miller ME, King AC, Studenski SA, Katula JA, Fielding RA, Glynn NW, Walkup MP, Ashmore JA; LIFE Investigators. Predictors of adherence to physical activity in the Lifestyle Interventions and Independence for Elders pilot study (LIFE-P). Clin Interv Aging. 2007; 2: 485– 494. 18044198 PMC2685266

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    • cites [183] Ziegelstein RC, Fauerbach JA, Stevens SS, Romanelli J, Richter DP, Bush DE. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000; 160: 1818– 1823. 10871976 source

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  • May combine two claims.

    Findingcitation

    Older age may be associated with more healthful dietary patterns and better adherence, such as higher fruit consumption.

    “Older age may be associated with more healthful dietary patterns and better adherence, such as higher consumption of fruits.159–163”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [159] Margetts BM, Thompson RL, Speller V, McVey D. Factors which influence ‘healthy’ eating patterns: results from the 1993 Health Education Authority health and lifestyle survey in England. Public Health Nutr. 1998; 1: 193– 198. 10933418 source

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    • cites [160] Stables GJ, Subar AF, Patterson BH, Dodd K, Heimendinger J, VanDuyn MA, Nebeling L. Changes in vegetable and fruit consumption and awareness among US adults: results of the 1991 and 1997 5 A Day for Better Health Program surveys. J Am Diet Assoc. 2002; 102: 809– 817. 12067046 source

      Not checked in the free run.

    • cites [161] Wu SJ, Chang YH, Wei IL, Kao MD, Lin YC, Pan WH. Intake levels and major food sources of energy and nutrients in the Taiwanese elderly. Asia Pac J Clin Nutr. 2005; 14: 211– 220. 16169831

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    • cites [162] Steptoe A, Doherty S, Kerry S, Rink E, Hilton S. Sociodemographic and psychological predictors of changes in dietary fat consumption in adults with high blood cholesterol following counseling in primary care. Health Psychol. 2000; 19: 411– 419. 11007149 source

      Not checked in the free run.

    • cites [163] Howarth NC, Huang TT, Roberts SB, Lin BH, McCrory MA. Eating patterns and dietary composition in relation to BMI in younger and older adults. Int J Obes (Lond). 2007; 31: 675– 684. 16953255 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Obesity, higher body mass index, and smoking are associated with lower physical activity levels.

    “Obesity, higher body mass index, and smoking are associated with lower PA levels.175,177–179”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [175] Norman A, Bellocco R, Vaida F, Wolk. Total physical activity in relation to age, body mass, health and other factors in a cohort of Swedish men. Int J Obes Relat Metab Disord. 2002; 26: 670– 675. 12032752 source

      Not checked in the free run.

    • cites [177] Ahmed NU, Smith GL, Flores AM, Pamies RJ, Mason HR, Woods KF, Stain SC. Racial/ethnic disparity and predictors of leisure-time physical activity among U.S. men. Ethn Dis. 2005; 15: 40– 52. 15720048

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    • cites [178] Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992; 47: 1102– 1114. 1329589 source

      Not checked in the free run.

    • cites [179] Schmitz K, French SA, Jeffery RW. Correlates of changes in leisure time physical activity over 2 years: the Healthy Worker Project. Prev Med. 1997; 26: 570– 579. 9245681 source

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  • May combine two claims.

    Findingcitation

    Reported barriers to healthy eating among disadvantaged and/or minority groups include poor dental health, lack of affordable quality produce, inability to find ethnically preferred fruits and vegetables locally, transportation problems, family customs or habits, social and cultural symbolism of foods, and low price and easy access to snack foods.

    “Reported barriers to healthy eating among the disadvantaged and/or minority groups include poor dental health, lack of access to quality produce at affordable prices, inability to find ethnically preferred fruits and vegetables in local markets, transportation problems, family customs/habits, social and cultural symbolism of certain foods, and low price and easy access to snack foods.147–152”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [147] Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health. 2007; 61: 491– 498. 17496257 PMC2465719 source

      Not checked in the free run.

    • cites [148] Johnson CS, Garcia AC. Dietary and activity profiles of selected immigrant older adults in Canada. J Nutr Elder. 2003; 23: 23– 39. 14650551 source

      Not checked in the free run.

    • cites [149] George GC, Milani TJ, Hanss-Nuss H, Freeland-Graves JH. Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum. J Am Diet Assoc. 2005; 105: 916– 926. 15942541 source

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    • cites [150] Dye CJ, Cason KL. Perceptions of older, low-income women about increasing intake of fruits and vegetables. J Nutr Elder. 2005; 25: 21– 41. 16891261 source

      Not checked in the free run.

    • cites [151] van Lenthe FJ, Brug J, Mackenbach JP. Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Soc Sci Med. 2005; 60: 763– 775. 15571894 source

      Not checked in the free run.

    • cites [152] Palmeri D, Auld GW, Taylor T, Kendall P, Anderson J. Multiple perspectives on nutrition education needs of low-income Hispanics. J Community Health. 1998; 23: 301– 316. 9693987 source

      Not checked in the free run.

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

    Findingcitation

    Lower physical activity levels in women than men are generally reported.

    “Lower PA levels in women than men are generally reported.166–168”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [166] Steffen LM, Arnett DK, Blackburn H, Shah G, Armstrong C, Luepker RV, Jacobs DR Jr. Population trends in leisure-time physical activity: Minnesota Heart Survey, 1980–2000. Med Sci Sports Exerc. 2006; 38: 1716– 1723. 17019292 source

      Not checked in the free run.

    • cites [167] Crespo CJ, Ainsworth BE, Keteyian SJ, Heath GW, Smit E. Prevalence of physical inactivity and its relation to social class in U.S. adults: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Med Sci Sports Exerc. 1999; 31: 1821– 1827. 10613434 source

      Not checked in the free run.

    • cites [168] Simons-Morton DG, Hogan P, Dunn AL, Pruitt L, King AC, Levine BD, Miller ST. Characteristics of inactive primary care patients: baseline data from the activity counseling trial. For the Activity Counseling Trial Research Group. Prev Med. 2000; 31: 513– 521. 11071831 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Diabetes Prevention Program, the greatest risk reduction from the lifestyle intervention occurred in the oldest age group, suggesting better adherence and/or efficacy in that group.

    “In the DPP trial, the greatest risk reduction in response to the lifestyle intervention was seen in the oldest age group, suggesting better adherence and/or efficacy in this group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346: 393– 403. 11832527 PMC1370926 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Many other cities have adopted or have legislative efforts underway to require food purveyors to phase out industrially produced trans fats.

    “Many other cities have adopted or have legislative efforts underway to mandate law that food purveyors phase out industrially produced trans fats.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Few of the reviewed studies examined the influence of behavior change on cardiovascular disease events, mortality, hospitalizations, or quality of life, although they examined surrogate endpoints such as lipid or blood pressure changes.

    “Although the studies reviewed examined the influence of behavior change on surrogate end points such as lipid or BP changes, few examined the influence of behavior change on CVD events, mortality, hospitalizations, or quality of life.221,222”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [221] Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007; 334: 885– 888. 17449506 PMC1857760 source

      Not checked in the free run.

    • cites [222] Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998; 280: 2001– 2007. 9863851 source

      Not checked in the free run.

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

    Findingcitation

    As of October 2009, California had passed legislation to limit trans fats, and numerous other states had similar legislation under review.

    “As of October 2009, California passed legislation to limit trans fats, and numerous other states have similar legislation under review”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    Lifestyle interventions often target constructs from social cognitive theory, such as self-efficacy, self-regulation, social support, and observational learning, or from the trans-theoretical model of change, such as stages of motivational readiness.

    “Lifestyle interventions often target constructs based on social cognitive theory (eg, self-efficacy, self-regulation [self-monitoring, goal-setting, feedback], social support, observational learning) or the trans-theoretical model of change (eg, stages of motivational readiness).”
    Quote in the paperNot a substantial claim

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

    Premisenone given

    Setting appropriately ambitious goals is important; goals that are too difficult may not be attempted, while goals viewed as too easy may not be taken seriously or provide satisfaction.

    “Setting appropriately ambitious goals is also important. Goals that are too difficult may not be attempted, whereas those viewed as too easy may not be taken seriously or provide a sense of satisfaction once achieved.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Self-based monitoring allows individuals to assess progress on their own terms and removes barriers such as travel or scheduling constraints associated with structured group programs.

    “Self-based monitoring allows the individual to assess progress with the program on his/her terms, removing barriers such as travel or scheduling constraints associated with structured group programs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    There was considerable variation in the direction and strength of findings within the reviewed studies, and an effect of bias against publication of null results cannot be ruled out.

    “There was considerable variation in the direction and strength of findings within the studies reviewed; however, an effect of bias against publication of studies with null results cannot be ruled out.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults

    Because the beneficial effects of lifestyle changes accumulate over time, long-term adherence maximizes individual and population benefits.

    “Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Goals focused on behavior rather than physiological targets are preferable because behaviors are under more direct control and observable, whereas multiple factors such as genetics influence physiological targets.

    “Goals that focus on behavior (eg, increasing whole grain intake) rather than a physiological target (eg, improving low-density lipoprotein [LDL] cholesterol or glucose levels) are preferable because behaviors are under a person’s more direct control and also observable by the individual, whereas several factors (eg, genetics) can influence physiological targets.16,19,21,22”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Strecher VJ, Seijts GH, Kok GJ, Latham GP, Glasgow R, DeVellis B, Meertens RM, Bulger DW. Goal setting as a strategy for health behavior change. Health Educ Q. 1995; 22: 190– 200. 7622387 source

      Not checked in the free run.

    • cites [19] Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003; 71: 843– 861. 14516234 source

      Not checked in the free run.

    • cites [21] Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998; 13: 623– 649. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults

    Both adoption and maintenance of new cardiovascular risk-reducing behaviors are challenging for many individuals.

    “Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    Despite extensive search efforts, all relevant studies may not have been identified, but the overall studies are representative and capture the state of the field.

    “Despite extensive search efforts, all relevant studies may not have been identified; overall studies are representative and capture the state of the field.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Most findings from the reviewed US studies may be generalizable to other developed nations.

    “nonetheless, most of the findings may be generalizable to other developed nations.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Societal and cultural factors can affect the feasibility and success of particular intervention strategies.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults

    The success of tobacco cessation efforts provides a strong basis for optimism that a concerted evidence-based program of education, policy change, and individual interventions could successfully improve dietary and physical activity habits in the United States.

    “Although work remains in this regard, the success of tobacco cessation efforts provides a strong basis for optimism that a concerted evidence-based program of education, policy change, and individual interventions could successfully improve dietary and PA habits in the United States.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    When possible, a common measure of effect size was used to quantify and compare the success of each intervention.

    “when possible we used a common measure of effect size (ES) to quantify and compare the success of each intervention.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

      Not checked in the free run.

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

    Interpretationnone given

    Electronic monitoring systems have advantages of mobility, decreasing cost, and increasing availability, but a potential limitation is the absence of human interaction.

    “An advantage of electronic monitoring systems is their mobility, decreasing cost, and increasing availability; a potential limitation is the absence of human interaction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Self-monitoring facilitates recognition of progress toward an identified goal and provides direct feedback.

    “Self-monitoring facilitates recognition of progress made toward the identified goal (eg, minutes of PA or number of calories consumed per day), thus providing direct feedback.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Feedback about behavior performance can illuminate consequences of diet and physical activity behavior for an individual, which may motivate continuation or provide direction for adjusting behavior to reach a targeted goal.

    “Feedback about behavior performance can illuminate consequences of diet and PA behavior for an individual, which may motivate individuals to continue a certain behavior or provide direction for adjusting behavior to reach a targeted goal.78”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Grant L, Evans A. Principles of Behavioral Analysis. New York: Harper Collins; 1994.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Verbal persuasion is the weakest source for improving self-efficacy but can be implemented via telephone or other electronic modes.

    “This is the weakest source for improving self-efficacy, but can be implemented via telephone or other electronic modes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Self-efficacy Bandura A. In: Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986: 390– 453.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Feedback based on initial screening can help individuals become aware of the need for behavior change, and feedback during follow-up provides updated information about ongoing behavior change efforts.

    “Feedback based on initial screening can help individuals become aware of the need for behavior change, and feedback during follow-up provides updated information about ongoing behavior change efforts.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Bandura's theory suggests four sources of self-efficacy that can be drawn on and incorporated into intervention strategies to enhance self-efficacy.

    “Bandura’s theory suggests 4 sources of self-efficacy that can be drawn on and incorporated into intervention strategies to enhance self-efficacy.82”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Self-efficacy Bandura A. In: Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986: 390– 453.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The relative merits of simultaneous versus sequential intervention are unresolved, and more studies comparing these intervention modes are needed.

    “Thus, the relative merits of simultaneous versus sequential intervention are unresolved, and more studies comparing these intervention modes are needed.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Cognitive-behavioral strategies may have been included in individual-level interventions and may have improved their efficacy.

    “cognitive-behavioral intervention strategies may also have been incorporated and improved efficacy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Most programs that include the core elements of standard behavioral treatment improve eating and physical activity habits and produce weight loss at least in the short term.

    “most approaches that include the basic elements of standard behavioral treatment will have a positive effect on eating and PA habits and will result in weight loss, at least for the short term.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Because of their cost, commercial weight-loss programs may be less available to socioeconomically disadvantaged populations.

    “due to their cost, commercial programs may be less available to socioeconomically disadvantaged populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Overall, trials of Web-based and computerized materials have mixed results, but in some scenarios these materials appear to improve weight loss and certain dietary behaviors; fewer studies have assessed physical activity.

    “Overall, the results of these trials are mixed, but at least in some scenarios, the use of Web-based and computerized materials appears to improve weight loss and certain dietary behaviors; fewer studies have evaluated PA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Ethnic homophily is important and may affect whether lay advisors or healthcare professionals are more effective.

    “The homophily for ethnicity (ie, the tendency of individuals to associate and bond with similar others) is important and may affect whether lay advisors or healthcare professionals are more effective.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Combining technology-based approaches may be more effective than single interventions; adding E-counseling appeared to improve the efficacy of Internet-based weight-loss programs.

    “Combinations of technology-based approaches may be more effective than single interventions; for example, the addition of E-counseling appeared to improve efficacy of Internet-based programs for weight loss.35”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Micco N, Gold B, Buzzell P, Leonard H, Pintauro S, Harvey-Berino J. Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med. 2007; 33: 49– 56. 17291170 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lay health advisors, peer educators, and community health workers are trusted community members who usually live in the same communities, speak the same language, have similar values and beliefs, and understand the cultural context of the minority target population.

    “Lay health advisors, peer educators, or community health workers are trusted community members and usually live in the same communities, speak the same language, have similar values and beliefs, and understand the cultural context of the minority target population.137,138”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [137] Jackson EJ, Parks CP. Recruitment and training issues from selected lay health advisor programs among African Americans: a 20-year perspective. Health Educ Behav. 1997; 24: 418– 431. 9247822 source

      Not checked in the free run.

    • cites [138] Eng E, Parker E, Harlan C. Lay health advisor intervention strategies: a continuum from natural helping to paraprofessional helping. Health Educ Behav. 1997; 24: 413– 417. 9247821 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The two multicomponent trials that did not improve diet or physical activity may have been limited by insufficient duration or by an ineffective combination of behavior-change strategies.

    “The 2 trials of multicomponent interventions that did not lead to dietary or PA changes46,59 may have been limited by insufficient duration or lack of effective combination of behavior change strategies.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Albright CL, Pruitt L, Castro C, Gonzalez A, Woo S, King AC. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Ann Behav Med. 2005; 30: 191– 200. 16336070 source

      Not checked in the free run.

    • cites [59] Yancey AK, McCarthy WJ, Harrison GG, Wong WK, Siegel JM, Leslie J. Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. J Womens Health (Larchmt). 2006; 15: 412– 429. 16724889 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Cultural sensitivity by itself is not sufficient and must be combined with essential behavior-change strategies to produce positive outcomes.

    “Thus cultural sensitivity alone is not sufficient and needs to be combined with essential behavior change strategies to produce positive outcomes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Interventions designed for one population may be less effective in another, especially when the other group is educationally or economically disadvantaged or differs in cultural health beliefs or practices.

  • May combine two claims.

    Premisecitation

    To start a behavior, people need anticipated benefits to compare favorably with their current situation and need favorable expectancies about future outcomes.

    “For initiating a behavior, persons’ consideration of the anticipated benefits must compare favorably to their current situation, and they need to hold favorable expectancies regarding future outcomes.4,158”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000; 19: 64– 69. 10709949 source

      Not checked in the free run.

    • cites [158] Rothman A, Baldwin A, Hertel A. Self-regulation and behavior change: Disentangling behavioral initiation and behavioral maintenance In: Vohs KD, Baumeister RF, eds. The Handbook of Self-Regulation: Research, Theory, and Applications. New York, NY: Guilford Press; 2004: 130– 148.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The trial with null outcomes lacked other intervention components such as specific behavioral goals, self-monitoring, or feedback, which may have reduced its efficacy.

    “The trial with null outcomes54 lacked other intervention components such as specific behavioral goals, self-monitoring, or feedback that may have lessened the efficacy of the intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Howard-Pitney B, Winkleby MA, Albright CL, Bruce B, Fortmann SP. The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults. Am J Public Health. 1997; 87: 1971– 1976. 9431286 PMC1381239 source

      Not checked in the free run.

    • Rests on an assumption: Without adequate literacy skills, individuals cannot read health-related materials.

  • May combine two claims.

    Interpretationreasoning

    Most people have clear expectations about what a new lifestyle will provide; if their experiences do not meet those expectations, they become dissatisfied and less motivated to maintain the behavior, especially in unsupportive environments.

    “Most individuals have clear expectations about what a new lifestyle will provide; if their experiences do not meet those expectations, they will be dissatisfied and less motivated to maintain it, particularly in environments that are frequently not supportive of healthy choices.”
    Quote in the paperSubstantial claim

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

    Interpretationcitation

    The absence of males in most weight loss trials may reflect reluctance by some investigators to mix sexes.

    “may reflect reluctance of some investigators to mix sexes,29,36,57,109”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [29] Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol. 1999; 67: 132– 138. 10028217 source

      Not checked in the free run.

    • cites [36] Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003; 289: 1833– 1836. 12684363 source

      Not checked in the free run.

    • cites [57] Tate DF, Jackvony EH, Wing RR. A randomized trial comparing humane-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006; 166: 1620– 1625. 16908795 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    Other factors not included in the review will affect whether the recommendations are feasible, improve cardiovascular risk factors, and prevent clinical events.

    “It is important to note that other factors not included in this review will affect whether our evidence-informed recommendations are feasible for implementation, will result in improved levels of cardiovascular risk factors, and will prevent clinical events.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Special efforts by community groups, businesses, and government to increase availability of healthier food and physical activity choices will complement provider interventions for lifestyle change.

    “Special efforts by community groups, businesses, and government to increase the availability of healthier food and PA choices will complement provider interventions to implement lifestyle changes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The results of POUNDS Lost and Look AHEAD add consistent support for recommendations to use state-of-the-art behavior-change strategies to counsel individuals to promote weight loss along with dietary and physical activity changes to maximize cardiovascular risk reduction.

    “The results of these studies add further and consistent support for the recommendations made herein that include state of the art behavior change strategies to counsel individuals in order to promote weight loss as needed along with the dietary and physical activity changes to maximize reduction in CVD risk.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The American Heart Association's 2020 Goals include a concept of cardiovascular health that directly incorporates metrics of lifestyle behaviors, including diet and physical activity habits, as defining health.

    “The AHA’s 2020 Goals include a new concept of cardiovascular health that directly incorporates metrics of lifestyle behaviors, including diet and PA habits, as defining health.225”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [225] Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, VanHorn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation. 2010; 121: 586– 613. 20089546 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Asians, Native Americans, and Arab Americans are also at risk for cardiovascular disease.

    “more studies that target other racial and ethnic minorities such as Asians, Native Americans, or Arab Americans are needed because these groups are also at risk for CVD.219”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [219] US Department of Health and Human Services. Office of Minority Health: Minority populations. Available at: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl1&lvlID7. Accessed November 1, 2009.

      Not checked in the free run.

82 of 82

  • The paper relies on this without support.

    Societal and cultural factors can affect the feasibility and success of particular intervention strategies.

    “Studies were restricted to those conducted in the United States because societal and cultural factors can affect feasibility and success of particular intervention strategies”

  • The paper relies on this without support.

    Training and certification of the interventionist is necessary to achieve optimal results in motivational interviewing.

    “Training and certification of the interventionist is necessary to achieve optimal results.”

  • The paper relies on this without support.

    Many participants in group-based weight-loss programs have difficulty maintaining reduced caloric intake and/or physical activity.

    “many individuals find it challenging to maintain the reduced caloric intake and/or PA plan”

  • The paper relies on this without support.

    Weight regain often occurs by 4 to 6 months in group-based weight-loss programs.

    “weight is often regained by many individuals as early as 4 to 6 months into the program”

  • The paper relies on this without support.

    Interventions designed for one population may be less effective in another, especially when the other group is educationally or economically disadvantaged or differs in cultural health beliefs or practices.

    “Interventions designed to change dietary and/or PA behavior in 1 population group may be less effective in another group, especially when the population is educationally or economically disadvantaged or differs in cultural health beliefs or practices from the population in which the intervention was initially tested.”

  • The paper relies on this without support.

    Without adequate literacy skills, individuals cannot read health-related materials.

    “Without adequate literacy skills, individuals cannot read health-related materials.”

  • The paper relies on this without support.

    Lack of reimbursement for therapies targeting dietary and physical activity lifestyle change is a barrier for healthcare providers.

    “Lack of reimbursement for therapies targeting dietary and PA lifestyle change is a barrier for healthcare providers.”
7 of 7

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?

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.

  • Trial 46 is described as both successful and unsuccessful

    Minor

    The self-monitoring section counts trial 46 among trials with positive lifestyle changes, but the multicomponent section says it produced no dietary or physical-activity changes.

  • Reported significance conflicts with nearly identical adherence rates

    Minor

    For adherence to at least two behaviors, the simultaneous and usual-care arms are both reported at 6.5%, and the sequential arm at 5.2%. The accompanying claim that all statistical contrasts had P<0.05 is inconsistent with those reported rates in a trial of 289 participants.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Patterson R. The new focus: Integrating behavioral science into disease management. In: Patterson R ed. Changing Patient Behavior: Improving Outcomes in Health and Disease Management. San Francisco Calif: Jossey-Bass; 2001: 1–21.
  2. 10.1161/circ.89.3.8124838 · DOI
  3. Hill M Miller N. Adherence to antihypertensive therapy. In: Izzo J Black H eds. Hypertension Primer. 3rd ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2003: 390–393.
  4. ACC/AHA Task Force on Practice Guidelines. Methodology Manual for ACC/AHA Guideline Writing Committees. American College of Cardiology Foundation and American Heart Association; 2006:1–61. Available at: http://circ.ahajournals.org/manual/manual_I.shtml. Accessed June 21 2010.

Cited by

Sorted by citations

Related

Authors
Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., Kumanyika, S., Kraus, W. E., Fleg, J. L., Redeker, N. S., Meininger, J. C., Banks, J., Stuart-Shor, E. M., Fletcher, B. J., Miller, T. D., Hughes, S., Braun, L. T., Kopin, L. A., Berra, K., Hayman, L. L., Ewing, L. J., Ades, P. A., Durstine, J. L., Houston-Miller, N., & Burke, L. E.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-07-27
Volume
122
Issue
4
Pages
406-441
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/cir.0b013e3181e8edf1
PMC
PMC6893884
OpenAlex
W2159524775
Semantic Scholar
82b2c0c875b2d4af1a33f1153122054be98917b3
Cited by
919
References
241
Citations by year
2026: 23 · 2025: 51 · 2024: 40 · 2023: 40 · 2022: 40 · 2021: 57 · 2020: 59 · 2019: 53 · 2018: 64 · 2017: 72 · 2016: 88 · 2015: 75 · 2014: 79 · 2013: 49 · 2012: 62
FWCI
37.48
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL101236, R01HL074388)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
cardiovascular disease prevention, physical activity promotion, cardiovascular risk factors, hypertension, dyslipidemia, diabetes mellitus, sedentary behavior, obesity, weight loss, immigrant health, behavioral adherence, lifestyle intervention
MeSH terms
Adult, American Heart Association, Cardiovascular Diseases, Humans, Life Style, Motor Activity, United States, Exercise

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 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

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