Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis

Lukas Schwingshackl*, Sofia Dias, Georg Hoffmann

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

56 Citations (Scopus)
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Abstract

BACKGROUND: The aim of this meta-analysis was to compare the long-term efficacy of diet plus exercise (D + E) vs. diet (D), D + E vs. exercise (E) and D vs. E on anthropometric outcomes and cardiovascular risk factors in overweight and obese participants.

METHODS: Electronic searches were performed in MEDLINE and the Cochrane Central Register of controlled trials. Inclusion criteria were as follows: body mass index >=25 kg/m2 and a minimum intervention period including follow-up of >=12 months. Outcomes of interest were as follows: anthropometric parameters, blood lipids, blood pressure and cardiorespiratory fitness. Pooled effects were calculated using pairwise random effects and Bayesian random effects network meta-analysis. Results of the corresponding fixed effects models were compared in sensitivity analyses.

RESULTS: Overall, 22 trials (24 reports) met the inclusion criteria and 21 (including 3,521 participants) of them were included in the quantitative analysis. As compared with D, D + E resulted in a significantly more pronounced reduction in body weight [mean differences (MD): -1.38 kg, 95% confidence interval (CI) -1.98 to -0.79], waist circumference (MD: -1.68 cm, 95% CI -2.66 to -0.70) and fat mass (MD: -1.65 kg, 95% CI -2.81 to -0.49], respectively. When comparing D + E with E, MD in change of body weight (-4.13 kg, 95% CI -5.62 to -2.64), waist circumference (-3.00 cm, 95% CI -5.81 to -0.20), and fat mass (-3.60 kg, 95% CI -6.15 to -1.05) was in favour of combined diet and exercise, respectively. Comparing E vs. D, diet resulted in a significantly more pronounced decrease in body weight (MD: -2.93 kg, 95% CI -4.18 to -1.68), fat mass (MD: -2.20 kg, 95% CI -3.75 to -0.66) and systolic blood pressure (MD: -2.19 mmHg, 95% CI -4.23 to -0.15). D + E yielded also the greatest reductions with respect to blood lipids and blood pressure when compared to single applications of D and E, respectively. Results from the network meta-analyses confirmed these findings.

CONCLUSIONS: Moderate-quality evidence from the present network meta-analysis suggests that D + E can be highly recommended for long-term obesity management. Furthermore, the evidence suggests a moderate superiority of D over E with respect to anthropometric outcomes.Systematic review registration: PROSPERO CRD42013003906.

Original languageEnglish
Article number130
Number of pages13
JournalSystematic Reviews
Volume3
Issue number1
DOIs
Publication statusPublished - 30 Oct 2014

Keywords

  • Diet
  • Exercise
  • Lifestyle
  • Network meta-analysis
  • Obesity
  • Systematic review

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