title: A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: pronounced short-term impact but long-term adherence problems.
abstract: OBJECTIVE
  To compare data on cardiovascular risk factor changes in lipids, insulin, proinsulin, fibrinolysis, leptin and C-reactive protein, and on diabetes incidence, in relation to changes in lifestyle.
  
  
  METHODS
  The study was a randomized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000, in 168 individuals with impaired glucose tolerance (IGT) and body mass index above 27 at start. The intensive intervention group (n = 83) was subjected to a 1-month residential lifestyle programme. The usual care group (n = 85) participated in a health examination ending with a single counselling session. Follow-up was conducted at 1, 3 and 5 years.
  
  
  RESULTS
  At 1-year follow-up, an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group, along with a 70% decrease of progress to type 2 diabetes. At 5-year follow-up, most of these beneficial effects had disappeared. Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased, and fasting insulin and proinsulin were lower.
  
  
  CONCLUSIONS
  The intervention affected several important cardio-metabolic risk variables beneficially, and reduced the risk for type 2 diabetes, but the effects persisted only as long as the new lifestyle was maintained. Increased physical activity seemed to be the behaviour that was most easy to preserve.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. bernt.lindahl@medicin.umu.se
authors.forename: Bernt
authors.initials: B
authors.lastname: Lindahl
authors.forename: Torbjörn K
authors.initials: TK
authors.lastname: Nilssön
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Michael E
authors.initials: ME
authors.lastname: Røder
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
authors.forename: Lars
authors.initials: L
authors.lastname: Widman
authors.forename: Owe
authors.initials: O
authors.lastname: Johnson
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Jan-Håkan
authors.initials: JH
authors.lastname: Jansson
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000517:prevention & control; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000150:complications*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors