Patients are most likely to make the lifestyle changes necessary for reducing cardiovascular disease risks if they receive a combination of behavioral interventions, including counseling, extended follow-up with a health care provider, and tools for self-monitoring of diet and exercise, according to a scientific statement from the American Heart Association.
The statement urges clinicians to move beyond simply telling patients they are at risk for cardiovascular disease and recommending appropriate lifestyle changes, to encouraging the particular interventions likely to promote change.
Specifically, clinicians can best promote effective change by using motivational interviewing techniques to encourage healthier lifestyle choices, by counseling patients that setbacks are normal, and by scheduling regular follow-up sessions, lead author Nancy T. Artinian, Ph.D., of Wayne State University, Detroit, and her colleagues wrote on behalf of the AHA Prevention Committee of the Council on Cardiovascular Nursing (Circulation 2010 July 12 [doi:10.1161/CIR.0b013e3181e8edf1]).
Among other interventions recommended are providing for direct or peer-based long-term support and follow-up (through community-based programs, for example); using incentives, modeling, and problem-solving strategies; and using group sessions with cognitive-behavioral strategies to teach skills to modify the diet and develop a fitness program, provide role modeling and positive observational learning, and maximize the benefits of peer support and group problem solving.
The statement is based on an extensive review of 74 peer-reviewed scientific studies conducted in the United States during January 1997 through May 2007. The studies looked at the effects of behavioral programs on blood pressure, cholesterol levels, activity levels and fitness, and diet.
Evidence-based and expert opinion–based recommendations on designing and implementing interventions—with specific advice for culturally diverse and socioeconomically disadvantaged patients—are included in the statement, and are graded based on the type and strength of the evidence. For example, class I, level A evidence exists for the recommendation that clinicians combine strategies such as motivational interviewing and regular follow-up to best promote change.
The statement also provides recommendations on policy changes that will help make it more feasible for clinicians to follow the recommendations. Currently, clinicians face numerous barriers, including limited resources for counseling and sustained follow-up support, time restraints, and lack of financial incentives and reimbursement, the authors noted.
Indeed, current health care policies should be modified to encourage the interventions identified during the development of the statement as being effective for promoting behavioral change, the authors argued.
In a press statement from the AHA, Dr. Artinian expressed the hope that federal health reform legislation along with the policy changes recommended in the scientific statement will lead to “a health care system that gives more weight to the importance of prevention and changing lifestyle behavior to help people stay healthy and reduce cardiovascular risk.”
Disclosures: Dr. Artinian reported having no relevant financial ties to disclose, but several authors of the statement reported disclosures including receiving research support from, serving on the speakers bureau or as a consultant for, or having an ownership or other interest in one or more companies or organizations. The complete list of disclosures is included in the AHA statement.