Hopp til innhold

Selected items added to basket

Go to basket
Research overview
Systematic review

Effects of more than three months organized follow-up on physical activity and diet for people with increased risk of lifestyle related disease

«Healthy living centres» (frisklivssentraler) are established in Norway to support change of behaviour that affects health. This systematic review will answer questions about effects of organized follow-up to promote change of physical activity and diet.


  • Year: 2014
  • Authors Denison E, Underland V, Berg RC, Vist GE.

Order

Download:

Key message

«Healthy living centres» (frisklivssentraler) are established in Norway to support change of behaviour that affects health. This systematic review will answer questions about effects of organized follow-up to promote change of physical activity and diet. We searched for studies of interventions with a duration of more than three months that resemble those given in healthy living centres. We included 38 studies based on a literature search completed in March 2013. We conclude, based on our review and assessment of the quality of the documentation:

There is great uncertainty regarding if, and to what degree these interventions contribute to increased physical activity or improved diet. This is because the results vary from no effect to large effect, and because of considerably varying quality of the documentation. There is no documentation that indicates that interventions of more than a year give better results than interventions with a duration up to a year, but direct comparisons are lacking.

We have minimal information on cost-effectiveness or adverse events.

This field of research is characterized by considerable methodological challenges, most notably lack of standardization of outcomes and measurement methods for physical activity and diet, and lack of long-term follow up of the results.

Summary

Background

The Norwegian Directorate of Health has supported the development of “healthy living centres” since 2004. These are centres managed by the municipality where persons who are at risk for, or who already have been diagnosed with, disease can get guidance and organised follow-up concerning health behaviours. Healthy living centres offer three months of follow-up as a base, but it is common practice that follow-up is extended up to a year. The directorate of Health has therefore commissioned a systematic review of effects of interventions corresponding to interventions offered in healthy living centres with a duration of more than three months.

Objective

The questions to be answered are: 1) What are the effects of more than three months’ follow-up on physical activity and/or diet in adults with risk-related health behavior or conditions where change of lifestyle may reduce risk of disease, and what is the cost-effectiveness of such interventions?

Method

We searched systematically for literature in eight electronic databases and in reference lists of included studies up to March 2013. We searched for the following study designs: overviews of systematic reviews, systematic reviews, randomized controlled trials, cluster-randomized controlled trials, quasi-randomized controlled trials, controlled before- and after studies, and interrupted time series analyses. Two project workers independently assessed publications for inclusion and assessed risk of bias in the included studies, using check lists. We summarised the results in text and tables. In addition, we presented the results graphically for each comparison using a simplified “forest plot” based on random effects meta-analysis. We assessed the quality of the documentation using the GRADE approach.

Results

The literature search resulted in 4449 unique references. We assessed 127 publications in full text and excluded 73 studies due to inclusion- and exclusion criteria. We included 38 studies (37 randomized controlled trials and one controlled before- and after study) with in all 74,000 participants, where 48,835 were included in one study. We categorized the the interventions to promote physical activity and/or diet as counselling with follow-up to 1 year, or  counselling with follow-up more than 1 year. Reported outcomes were physical activity and diet, both outcomes measured and reported in several different ways.

Based on the results of the included studies and our assessment of the quality of the documentation we can say the following:

There is great uncertainty regarding if, and to what degree these interventions contribute to increased physical activity or improved diet. This is because the results vary from no effect to large effect, and because of considerably varying quality of the documentation. There is no documentation that indicates that interventions of more than a year give better results than interventions with a duration up to a year, but direct comparisons are lacking.

We lack sufficient information about cost outcomes, which were reported in a few studies only. The available information about injury suggests that there were no or small differences between the intervention groups and the control groups, but we only have data from nine of 38 studies.

Discussion

The interventions in the included studies are quite varied, but seen as a whole they correspond to interventions that can be offered in healthy living centres. The results regarding physical activity are in agreement with previous systematic reviews relevant to this subject. There is some predominance of women and persons with European ancestry in the populations. We do not have documentation about long-term follow-up of results after the end of the intervention. There is great variety in the research field concerning choica of outcomes and how these are measured, which has impeded clear conclusions.

Conclusion

There is great uncertainty regarding if, and to what degree these interventions contribute to increased physical activity or improved diet. This is because the results vary from no effect to large effect, and because of considerably varying quality of the documentation. There is no documentation that indicates that interventions of more than a year give better results than interventions with a duration up to a year, but direct comparisons are lacking.

 We have minimal information on cost-effectiveness or adverse events.

Need for further research based on this systematic review:

  • Interventions given in «healthy living» centres still need to be rigorously evaluated, preferably interventions lasting up to a year.
  • The need to standardise outcomes and measurement methods is emphasized, as well as long-term follow-up of results (minimum one year post-intervention).
  • Cost-effectiveness of the interventions needs to be further evaluated.

 

This is a publication from the Norwegian Knowledge Centre for the Health Services. The Knowledge Centre became part of the Norwegian Institute of Public Health 01/01/2016.