Table 5 —

Effect of self-management training on cardiovascular disease risk factors and cardiovascular disease

Referencen, F/U interval, and mean ageInterventionsOutcomesComments
1. Didactic, knowledge, and information interventions
34n = 345; F/U immediate; 58 yearsI: Nine multimedia education classes over 1.5 years C: Usual careNSD BP, weight, lipidsNo mention blinding assessor Low participation rate; nonparticipants older, more male
47n = 51; F/U 12 months from BL; 53 yearsI: Three weekly didactic, small group sessions q4 months + q2 months visit with doctor C: Visit with doctor q2 monthsDecreased weight 2 kg in I vs. C, P < 0.05 NSD cholesterol, triglycerides between groupsI more visits than C No information on participation rates
65,109n = 1,139; F/U 5 years; 46 yearsI-1: Didactic individual and group sessions q3 months; focus on diet, PA, smoking, BP and BS control I-2: I-1 + clofibric acid C: Usual care at DM clinics; q3–4 monthsNSD myocardial infarctions, ischemic heart disease, mortality; NSD BMI Increased cholesterol in all groups, NSD between groupsNo mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded
2. Collaborative, knowledge, and information interventions
27,28n = 532; F/U 12–14; 57 yearsI: Average 2.4 sessions × 1.5 h over 2 months + home visit, TC F/U, contracting, skill exercises, goal-setting; over 26 months C: Usual careDecreased SBP, DBP, between group difference, P < 0.05 Decreased weight I, between group difference 2.8 lb, P < 0.05I more contact than C Attrition 51%, differences dropouts  and completers No blinding assessor Low participation rate
29n = 238; F/U 3, 6, 12 months from BL; 56 yearsI-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + two individual sessions I-3: Six or more individual sessions based on cognitive behavior theory, TC F/U over 12 months C: 2 × 1-h group educationNSD SBP, total cholesterol and BMI Decreased DBP I-3 vs. C at 12  months, P < 0.01BL differences: I-2 better educated;  I-1 longer duration DM I more visits than C Dropouts longer duration DM than completers Unclear if study population represents target population
30n = 46; F/U immediate, 6 months; 66 yearsI: 8 × 2-h small group sessions over 3 months; problem- and participant-focusedNSD serum lipids or weight at 6 monthsI more visits than C More C excluded due to poor control No mention blinding assessor
C: One-day didactic teachingNonparticipants older and heavier
48n = 82; F/U 6 months from BL; 56 yearsI-1: 11 × 2-h weekly didactic course + one individual sessionDecreased cholesterol all three groups at 3 months, maintained at 6 monthsNo BL statistics comparing groups I more visits than C
I-2: 11-week course + three individual sessions: barriers and supportDecreased weight at 3 months all three groups, P < 0.01, maintained at 6 monthsAttrition 40%, no comparison dropouts to completers Volunteer study population
C: Usual careNSD between groups; average loss 10 lb at 6 months
59n = 60; F/U 3 months from BL; 55 yearsI: Three-day group education, with F/U of four TC and one home visit; reinforce knowledge and skillsNSD weight between groupsI more contact than C Unclear if study population represents target population
C: Three-day group education
87n = 247; F/U 12 months from BL; 54 yearsI: 12 weekly sessions over 3 months: Spanish videos, followed by 14 group support sessions in 9 m; by lay HCW C: Wait listed for the interventionDecreased weight at 6 months (4 lb in I); back to BL at 12 monthsNo BL comparison I more contact than C No information on attrition No mention blinding assessor; no statistics
96n = 156; F/U ? immediate; 58 yearsI-1: Patient selects behavior for improvement;NSD weight between I and CNo information on attrition Volunteer study population;
I-2: Behavioral strategies to increase complianceF/U interval unclear Number of patient contacts unclear
I-3: Behavioral strategies + instruction on behavioral analysis
C: Routine care with consistent F/U by RN I-1,2,3 based on social cognitive theory; I over 13 months
98n = 22; F/U 32 weeks from BL; 61 yearsI: Weekly to biweekly home visits; nutrition, exercise, foot care, SMBG; by nursing students C: Usual careNSD weight between groupsAttrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population
99n = 56; F/U 6 months; 64 yearsI: Monthly ×6 group sessions: behavior modification (contracts, feedback), general knowledge C: Usual careDecreased LDL, total cholesterol at immediate F/U, P < 0.05; NSD 6 months Decreased weight at 6-month I (−8 lb), P = 0.02; NSD between groupsI more contact than C Attrition 32%, no comparison dropouts to completers Participation rate 37%, no comparison participants to nonparticipants
3. Lifestyle interventions
31n = 40; F/U 6 months from BL; 35 yearsI-1: Lunch demonstrations I-2: Videotape education C: Dietitian instruction and written information Three visits total for all groups over 6 monthsNSD BMINo mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”)
36n = 87; F/U 12 months from BL; 56 yearsI: Five group sessions over 6 months, focus on weight loss C: Individual education on weight loss by dietitian; 3 or more visits in 12 monthsDecreased weight I (5.5 kg) and C (3 kg) at 1 year, between group difference, P < 0.05
38n = 32; F/U immediate, 1 year; 53 yearsI: Two sessions: dietician and CAI C: 2 × 30-min sessions: dietitian only Teaching for both over  approximately 1 monthDecreased weight I (4.6 lb, P < 0.005), maintained at 1 year, NSD CNo BL statistics Unclear if blinding assessor Type of DM uncertain
39n = 105; F/U immediate, 12 months; 45 yearsI: Interactive computer program on diet, 90 min/month over 6 months C: Wait listed for I Both groups received 5 days teachingNSD weightI more contact than C Attrition appears to be 76% at 12 months F/U, no comparison dropouts to completers No mention blinding assessor No information on patient recruitment Crossover design
49n = 41; F/U 6 months; 61 yearsI: Psychologist-led group sessions on PA and dietNSD % overweightDropouts (22%) higher mean BS; equal number dropouts I and C
C: Didactic lectures on diet and DM Both groups 10 × 1-h sessions over  6 monthsLow participation rate, no information on nonparticipants
66n = 148; F/U 6 months from BL; 55 yearsI: Advice to decrease fat <30% total calorie intakeObese patients decreased weight I > C, P < 0.05
C: Advice to decrease CHO to <40% total calorie intakeDecreased cholesterol in both groups I > C, P < 0.001
Both I and C received individual counseling by dietitian, three home visitsNSD HDL or triglycerides
67,68,104n = 206; F/U 12 months from BL; 62 yearsI: Single visit: focus on diet, goal-setting, interactive video on barriers; F/U q3 months C: Usual care q3 monthsDecreased cholesterol for I vs. C at 12 months, P = 0.002 NSD BMIUnclear if food record reviewers were blinded Low participation rate; participants differ from nonparticipants
69,82,89,103n = 86; F/U 15, 27 months from BL; 53 yearsI: Six individual visits at 2-month intervals: intensive therapy for weight, BS control, diet, PA; then q3 months visits C: Usual care q2–3 months Both groups 3 visits/3 months basic  education before randomizationIncreased HDL I at 15 months, P < 0.001, NSD 27 months Weight loss I (3.1 kg) > C at 15 months, P = 0.022; NSD from BL at 27 months NSD BP 15 monthsI more visits than C No mention blinding assessor No information on nonparticipants
70n = 75; F/U 12 months from BL; 61 yearsI: Educational videos, personal and family support q2 weeks for 6 months + 3 h counseling by dietitianNSD weight, BP, cholesterolI more contact than C
C: Review session × 3
71n = 60; F/U 12 weeks from BL; 55 yearsI: Individualized advice on low glycemic index foods C: Standard, individualized diet adviceNSD weight either group Decreased cholesterol I vs. C, P < 0.05No mention blinding assessor Unclear how much intervention time
72n = 78; F/U 2 months; 42–75 yearsI-1: 5 × 2-h weekly education: calories, fat, fiberDecreased weight for I-2 at 2 months, P < 0.05No BL information I more visits than C
I-2: I-1+ goal setting, problem-solving, feedbackMore attrition in C, no comparison dropouts to completers
C: Wait listed for IUnclear if assessor blinded Unclear how study population recruited
73n = 70; F/U, immediate, 6 months; 42 yearsI: Monthly (or more) meetings: diet and PA prescription, feedback, behavior modification C: Usual care; wait listed for INSD weight F/U immediate or 6 months NSD BP Increased Vo2max at 6 monthsIncomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population Cross-over design Type of DM uncertain (“IDDM”)
74n = 102; F/U 3, 6 months from BL; 67 yearsI: 10 weekly sessions: problem-solving, increased self efficacy, diet, and PA focus C: Wait listed for IDecreased weight for I at 3 months (6 lb), maintained at 6 months (4.5 lb, P < 0.002)Randomization blocked by medication I more visits than C Volunteer study population
75n = 66; F/U 4 months; 30–86 yearsI: 5 × 90-min weekly sessions by nurse: diet, PA, barriers, social and group supportNSD BMINo BL statistics Volunteer study population Number of visits uncertain
C: No information on care received
76n = 64; F/U 3, 6 months from BL; 62 yearsI: 12 × 1.5-h weekly didactic sessions, then 6 × 1-h biweekly participatory sessions; based on social action theoryDecreased weight I at 3 and 6 months (−1.3 kg), P < 0.01 NSD SBP; decreased DBP 6 months, P < 0.05I more visits than C More C dropouts, no comparison  dropouts to completers Volunteer study population
C: One didactic class and two mailingsNSD lipids
77n = 53; F/U 16 weeks, 16 months from BL; 55 yearsI-1: 16 weekly sessions: behavioral modification, calorie logs, group PA, monetary incentivesDecreased weight I-1 at 16 weeks (−6.3 kg), between group, P < 0.01I more visits than C Volunteer study population
I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessionsDecreased weight all groups at 16 months, average change −2.8 kg, NSD between groups
78,97n = 79; F/U immediate; 68 yearsI-1: 10 × 60-min diet education sessions over 4 months; adapted for elderlyDecreased weight I-2 at 8 weeks (5.5 lb, P < 0.05), NS gain to 16 weeks, NSD between groupsRandomized by site; no BL comparisons or attrition information
I-2: I-1 + peer support: group sessions, modeling, reinforcement C: Usual careI more visits than C Community recruitment; volunteer study population
79,100,101n = 76; F/U 3, 6, 18 months from BL; 54 yearsI-1: Diet focus: goal-setting, modify environment I-2: PA focus with participation I-3: Diet + PA C: Didactic teaching All groups: 10 × 2-h weekly sessions; I based on behavior and cognitive modification strategiesDecreased weight I-1 at 3 months (between group difference 3.9 kg, P < 0.03), and 6 months (4.5 kg, P < 0.02); NSD from BL at 18 months Decreased LDL I-1, P < 0.05 and I-3, P < 0.01 vs. C at 6 months Increased HDL I-1 vs. other groups, P < 0.05 at 3 months; NSD 6 monthsRandomized by group meeting attended Volunteer study population
80n = 40; F/U 2, 5 months from BL; 59 yearsI: 3 × 1.5-h individual learning activity packages with diet information, goals, activities C: 3 × 1.5-h didactic lecturesDecreased % ideal body weight for I at 5 months, P < 0.05Attrition 23%; no comparison dropouts to completers Volunteer study population from DM education program
81,102n = 247; F/U 6 months from BL; 57 yearsI: Three or more individual visits with dietitian, over 6 weeks, following practice guidelines C-1: One visit producing nutrition care plan C-2: Nonrandomized comparison group; no interventionDecreased total cholesterol I at 6 months, P < 0.05; NSD C NSD HDL or LDL I or C Decreased weight I and C, P < 0.01Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if dropouts equal completers at BL Volunteer study population or physician-referred
83n = 596; F/U immediate, 6 months; 51 yearsI: More nutrition content, follow food pyramidNSD BMI between group with choice and no choiceRandomized into choice/no choice of program, then I and C
C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessionsDecreased cholesterol in I, between group difference, P = 0.04Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers
84n = 163; F/U immediate, 6 months; 64 yearsI: Six monthly sessions on diet C: Usual care; wait listedDecreased weight females at immediate F/U, P = 0.0061 (amount of loss uncertain)No BL statistics I more visits than C Attrition 47%, but dropouts equivalent to completers at BL No information on patient recruitment Type of DM unclear
88n = 80; F/U 12 months from BL; 56 yearsI: Six individual sessions on diet, by nurseDecreased weight both groups, NSD between groupsNo BL statistics
C: Physician gave handout at initial  visit on weight loss Both I and C 6 visits/12 monthsNSD lipids or BP
91n = 120; F/U 7, 11 months from BL; 54 yearsI-1: Six monthly small-group meetings, diet and PA; audiovisual materials culturally sensitiveDecreased weight I-1 at 7 months, (1 kg) P < 0.05, not sustained at 11 monthsI more visits than C Attrition 32% at 11 months, NSD dropouts to completers
I-2: 1-h didactic + five monthly discussions on BS controlNSD triglycerides or cholesterol
C: 1-h didactic only
92n = 40; F/U immediate, 6 weeks; 54 yearsI: Behavioral group: 6 × 1.5-h weekly meetings; cues for eating, daily record C: Individual diet counseling, total 1.25 hDecreased weight C > I at 6 weeks, P < 0.01 Decreased triglycerides C at 12 weeks, P < 0.05 NSD LDL and HDLI more visits than C Unclear how patients selected
93n = 70; F/U 6 months from BL; 58 yearsI: 22 h over 11 weeks, interactive teaching based on cognitive motivational theory C: Didactic teaching, 14 h over 3 days Focus for both I and C: diet and foot careDecreased BMI both groups; NSD between groups Decreased cholesterol I at 6 months, between group, P = 0.003I more contact than C
94n = 23; F/U 6 months from BL; 33–70 yearsI: Self-management skills (stimulus control, monitoring, reinforcement); five classes/day for 5 days; diet focusDecreased % overweight I vs. C at 6 months, P < 0.01Randomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians
C: Conventional teaching 1 h/day × 5 Both groups: 5-days IP admission F/U q2 weeks for 2 months, then 3 and  6 months
95n = 120; 12 months from BL; 61 yearsI: Group education (diet, PA, BS control) q3 months × 4 C: Usual careDecreased weight, BMI I and C; NSD between groupsI more contact than C Unclear if study population represents target population
107n = 152; F/U 10, 14 weeks from BL; 61 yearsI: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No interventionDecreased weight I and C males at 14 weeks (2 kg)No BL comparisons I more visits than C Attrition 30.2%, no information on dropouts No information on blinding assessor Volunteer study population
4. Skills teaching interventions
61n = 20; F/U 1 year from end 16-week I; 53 yearsI: Information on how to use BS measures by adjusting diet and PA C: Self-monitoring of BS; no feedback Both groups: 13 sessions over 16 weeks, then 9 in 6 months; didactic and participatory; focus on weight controlDecreased weight both I and C (6.0 kg end course, 3.7 kg at 1 y); NSD between groupsNo mention blinding assessor Volunteer study population
64n = 203; F/U 13 months I, 9 months C; ?ageI: 1-h didactic group education on foot careNSD mortalityRandomized on SSN No information on dropouts
C: No educationNo mention blinding assessor
No information on nonparticipants Type of DM unclear
90n = 50; F/U 1 year from BL; 54 yearsI: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss program Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control programDecreased weight I and C at 1 year (6.1 kg), NSD between groups Decreased SBP both I and C at 1 year; NSD between groups NSD cholesterol and HDL; decreased triglycerides both I and CVolunteer study population
5. Coping skills and interventions
105n = 55; F/U 3, 6, 12, 18 months from BL; 53 yearsI-1: Behavior modification: focus on self-control procedures; records of diet and exerciseDecreased weight (8 lb in men, 0.1 in women) at 18 months, I-1 > I-2,3 and C
I-2: Cognitive modification: focus on cognitions: self-statements; goal setting
I-3: Cognitive-behavior modification: combined I-1 and I-2
C: Relaxation training to cope with stress All groups got nine weekly sessions of 1.5 h
  • BL, baseline; BS, blood sugar; BP, blood pressure; C, C-1, C-2, control groups; CAI, computer-assisted instruction; CHO, carbohydrate; D/SBP, diastolic/systolic blood pressure; DM, diabetes mellitus; DM2, type 2 diabetes; FBS, fasting blood sugar; F/U, follow-up; HCW, health-care worker; I, I-1, I-2, I-3, intervention groups; IP, inpatient; NSD, no significant difference; OP, outpatient; PA, physical activity; q, every; RN, registered nurse; SD, significant difference; TC, telephone call.