title: Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions.
abstract: BACKGROUND
  To develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised.
  
  
  RESULTS
  Of 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies.
  
  
  CONCLUSIONS
  This comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.
authors.affiliation: University of Exeter, Peninsula Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK. Colin.Greaves@pms.ac.uk
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
authors.forename: Kate E
authors.initials: KE
authors.lastname: Sheppard
authors.forename: Charles
authors.initials: C
authors.lastname: Abraham
authors.forename: Wendy
authors.initials: W
authors.lastname: Hardeman
authors.forename: Michael
authors.initials: M
authors.lastname: Roden
authors.forename: Philip H
authors.initials: PH
authors.lastname: Evans
authors.forename: Peter
authors.initials: P
authors.lastname: Schwarz
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009042:Motivation; D040242:Risk Reduction Behavior