Adherence
Large-scale lifestyle interventions (diet and exercise) significantly reduce the risk of disease progression and microvascular complications in high-risk populations, but fail to significantly reduce macrovascular complications or mortality compared to usual care, primarily due to low adherence.
Lifestyle changes (diet and exercise) are highly effective at preventing diabetes progression and improving heart failure outcomes, but they often fail to extend life or prevent heart attacks in large groups because people struggle to stick with them long-term. To succeed, prioritize consistency and adherence over intensity, as the benefits are 'overwhelming' when you actually follow the plan.
Results in prediabetes have revealed a significant preventative effect (58% risk reduction) by lifestyle intervention on the progression of disease to clinical diabetes... a positive effect on the development of microvascular complications... and a reduction of recurrent hospitalization in HFrEF... However, effects in these large trials were significantly less than expected from the results of smaller pilot studies, and failed to show an expected reduction of macrovascular complications or mortality... These less-than-expected effects can be readily explained by low adherence to intervention programmes of weight reduction and/or increment of physical activity.
Why this rating
Based on three large, high-quality randomized controlled trials (DPP, Look AHEAD, HF-ACTION) with thousands of participants.
Source
Research in preventive cardiology: Quo vadis?
Martin Halle · European Journal of Preventive Cardiology · 2020
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