Improving Behavioral Counseling for Primary Cardiovascular Disease Prevention

Abstract

The US Preventive Services Task Force (USPSTF) has published an updated recommendation statement on behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease (CVD) prevention in adults without CVD risk factors 1 and an updated evidence report and systematic review. 2 The USPSTF recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity (C recommendation.)As the USPSTF indicated, CVDs, including coronary heart disease and stroke, remain the leading cause of mortality in the US for male and female individuals and most races and ethnicities, including Black, Hispanic, and White adults. 2 Over the past 5 decades, there have been significant declines in physical activity, with corresponding marked increases in obesity and cardiometabolic diseases. 3,4 Certainly, efforts to reverse these trends are desperately needed.In the updated evidence report and systematic review, Patnode et al 2,5 included 113 randomized clinical trials (129 993 participants), 33 of which were published since the 2017 statement. Behavioral interventions improved participants' dietary intake and physical activity levels and provided very modest, but statistically significant, reductions in blood pressure, low-density lipoprotein cholesterol, and adiposity-related indices at 6 to 18 months of follow-up vs control conditions. Limitations of the review included few data on the underlying CVD risk of the populations studied, interventions that were primarily conducted in or applicable to primary care settings, the inability to directly assess the relationship between dietary patterns, physical activity levels, and health outcomes and heterogeneity with respect to clinical and demographic characteristics, counseling interventions, settings, and behavioral outcomes. Scarce studies reported on CVD events and associated changes in quality of life.Although medications are often used as the first-line strategy to stabilize or favorably modify traditional CVD risk factors, lifestyle changes are also associated with impressive mortality reductions, the magnitude of which are similar to or greater than those observed with cardioprotective medications. 6 Moreover, the effects of lifestyle change and drug therapy on CVD risk reduction appear to be independent and additive. 7

Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations

“…Finally, research-based counseling strategies should be used to facilitate healthy behavior change, including initiating and complying with a structured exercise program, increased lifestyle PA, or both [158] , [159] , [160] . These include: assessing patient readiness to change; the 5A's approach to behavior modification [ 158 , 160 ]; motivational interviewing, and overcoming inertia with downscaled goals. Accordingly, patients need to realize that they have the single greatest influence over their destiny relative to wellness and health promotion [161] .…”

L’esercizio fisico nel diabete di tipo 2: come possiamo migliorare l’aderenza?

“…Inoltre, negli adulti senza diabete all'aumentare dei fattori di rischio per lo sviluppo di diabete (età, etnia, fattori socioeconomici, indice di massa corporea) si riduceva l'aderenza a uno stile di vita attivo (7). farsi male, precedenti tentativi senza successo, scarso supporto da familiari o amici (9,12). La mancanza di un sistema di supporto sociale ottimale, l'isolamento sociale, le difficoltà finanziarie, l'incapacità di identificare e affrontare fattori psicologici quali depressione, rabbia, stress cronico, rappresentano ostacoli importanti al perseguimento di uno stile di vita sano e vanno discussi e possibilmente affrontati.…”