title: Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis.
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], 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), and fat mass (MD: -2.20 kg, 95% CI -3.75 to -0.66). 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.
  
  
  BACKGROUND
  PROSPERO CRD42013003906.
authors.affiliation: Faculty of Life Sciences, Department of Nutritional Sciences, University of Vienna, Althanstraße 14 UZA II, A-1090 Vienna, Austria. lukas.schwingshackl@univie.ac.at.
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwingshackl
authors.forename: Sofia
authors.initials: S
authors.lastname: Dias
authors.forename: Georg
authors.initials: G
authors.lastname: Hoffmann
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000178:diet therapy / Q000628:therapy; D050177:Overweight / Q000178:diet therapy / Q000628:therapy*; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*