Purpose The long-term impact of primary care behavior change programs on health-related quality of life (HRQoL) and physical activity (PA) level is unknown. The aim of this study was to investigate changes in HRQoL and PA among participants after a 3-month behavior change intervention at Norwegian healthy life center (HLCs) and at a 15-month follow-up. Furthermore, we aimed to study associations between changes in PA and HRQoL. Methods We followed 524 adult participants (18–83 years), recruited from 32 HLCs in August 2016–January 2018, who provided data on HRQoL (SF-36) and PA (ActiGraph accelerometers) 12 months after a 3-month behavior change intervention. Changes in HRQoL and PA between baseline, 3-month and 15-month follow-ups, and associations between changes in PA and HRQoL were analyzed by linear mixed models. Results All HRQoL dimensions improved from baseline to 3-month follow-up, and the improvements maintained at 15-month follow-up (mean 3.1–13.1 points, p < 0.001). PA increased from baseline to 3 months (mean 418 steps/day, p < 0.001), but declined from 3 to 15 months (mean − 371 steps/day, p < 0.001). We observed positive associations between changes in PA and HRQoL (0.84–3.23 points per 1000 steps/day, p < 0.023). Conclusions Twelve months after completing a 3-month HLC intervention we found improved HRQoL, but not PA level. Still, there were positive associations between PA and HRQoL over this period, indicating that participants increasing their PA were more likely to improve their HRQoL.

ObjectivesPhysical inactivity is a risk factor for cardiovascular disease (CVD). Cycling as a physical activity holds great potential to prevent CVD. We aimed to determine whether cycling reduces the risk of CVD and CVD risk factors and to investigate potential dose-response relationships.DesignSystematic review and meta-analysis of quantitative studies.Eligibility criteria for selecting studiesWe searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD incidence, mortality or risk factors were reported. Studies were excluded when they reported continuous outcomes or when cycling and walking were combined in them. We pooled adjusted relative risks (RR) and OR. Heterogeneity was investigated using I.ResultsThe search yielded 5174 studies; 21 studies which included 1,069,034 individuals. We found a significantly lower association in combined CVD incidence, mortality and physiological risk factors with total effect estimate 0.78 (95% CI (CI): 0.74–0.82; P<0.001; I2=58%). Separate analyses for CVD incidence, mortality and risk factors showed estimates of RR 0.84 (CI, 0.80 to 0.88; P<0.001; I2=29%), RR 0.83 (CI, 0.76 to 0.90; P<0.001; I2=0%), and OR 0.75 (CI, 0.69 to 0.82; P<0.001; I2=66%), respectively. We found no dose-response relationship or sex-specific difference.ConclusionsAny form of cycling seems to be associated with lower CVD risk, and thus, we recommend cycling as a health-enhancing physical activity.Systematic review registrationProspero CRD42016052421.

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