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Behavioral Intervention Can Lead to Sustained Lifestyle Changes

Achieving modest lifestyle changes among adults with hypertension or prehypertension took almost three dozen counseling sessions over 18 months.

Behavioral interventions can produce short-term changes in diet, physical activity, lipid levels, and blood pressure, but can these changes be sustained? Researchers reported the 18-month results of a multicenter trial, in which 810 adults with prehypertension or stage 1 hypertension were randomized to one of three interventions:

• two 30-minute advice sessions
  
• 33 counseling sessions with specific goals related to weight loss, physical activity, and sodium and alcohol intake
  
• counseling and goals as above, plus recommendations to adhere to the DASH (Dietary Approaches to Stop Hypertension) diet with regard to fruit, vegetable, and fat intake
  

At 18 months, fat intake was reduced significantly in both counseling groups compared with the advice group, and the DASH group had the largest increase in fruit and vegetable intake. Changes in fitness levels and self-reported energy expenditure did not differ significantly among the groups. Mean weight loss was significantly greater (by 2–3 kg) in the counseling groups than in the advice group. Hypertension at follow-up was significantly less common in the DASH group than in the advice group (odds ratio, 0.77). The prevalence of hypertension at follow-up among initially hypertensive subjects was significantly lower in the DASH and other counseling group than in the advice group (38%, 40%, and 63%, respectively).

Comment: In this study, behavioral counseling led to some sustained lifestyle changes, weight loss, and lower blood pressure. However, achieving these modest changes took almost three dozen counseling sessions during 18 months, and we do not know yet whether the changes will persist after counseling stops. Although behavioral counseling certainly is worth pursuing to achieve lifestyle change, more potent and efficient interventions clearly are needed.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine April 18, 2006

Citation(s):

Elmer PJ et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006 Apr 4; 144:485-95.

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