January 27, 2022, 9:09 a.m. News Staff — On Jan. 18, the U.S. Preventive Services Task Force posted on its website a draft recommendation statement and draft evidence review on behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without risk factors for CVD.
Based on the available evidence, the task force recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote healthy diet and physical activity. This is a “C” recommendation, and applies to adults age 18 years or older without known risk factors for CVD such as high blood pressure, dyslipidemia and impaired fasting glucose/glucose tolerance, or mixed or multiple risk factors such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater.
“Healthy diet and physical activity are essential to cardiovascular disease prevention, and behavioral counseling to promote healthy lifestyles can help even some people without cardiovascular disease risk factors,” said Lori Pbert, Ph.D., a member of the task force, in a USPSTF bulletin. “We found that people who are interested in making changes to their diet and physical activity are most likely to benefit from counseling, so clinicians are encouraged to talk with their patients and decide together if behavioral counseling is right for them.”
Cardiovascular disease, which includes heart attack and stroke, is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. High blood pressure, high blood cholesterol levels and smoking are among the leading risk factors for CVD, as are diabetes, obesity and physical inactivity.
The draft recommendation statement is consistent with the task force’s 2017 recommendation statement on the topic.
In the 2017 recommendation statement, which also received a “C” grade, the task force recommended that primary care clinicians individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels or diabetes to behavioral counseling to promote a healthful diet and physical activity. The task force also stated that the evidence at that time indicated a positive but small benefit of behavioral counseling for the prevention of CVD in this population, and that people who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling.
The AAFP supported the 2017 statement.
To update the existing recommendation, the task force commissioned a systematic evidence review that evaluated the benefits and harms of behavioral counseling interventions to promote healthy behaviors in adults without CVD risk factors. The review consisted of studies published in Medline, PsycINFO and the Cochrane Central Register of Controlled Trials published through Feb. 3, 2021, with additional surveillance of the literature conducted through May 21, 2021. Studies included in the 2017 evidence review were re-evaluated for potential inclusion. A total of 113 randomized clinical trials were included in the review.
The task force found that behavioral interventions to promote healthy diet, physical activity, or both were modestly associated with increased physical activity levels and some changes in dietary behaviors.
In one analysis of 87 trials, participants of physical activity interventions increased physical activity by about 33 minutes per week, and had 41% higher odds of meeting physical activity recommendations after six to 12 months, compared with control groups.
In another analysis of 45 trials, participants of healthy diet interventions had increased intakes of fruits, vegetables and fiber, and decreased saturated fat intake, compared with control groups.
The task force also found that behavioral counseling interventions for a healthy diet, physical activity, or both were modestly associated with benefits across a variety of health outcomes, including lower blood pressure, reduced LDL cholesterol levels, and decreases in BMI, weight and waist circumference.
The USPSTF found little direct evidence on the effectiveness of behavioral counseling interventions on all-cause mortality, CVD-related mortality, CVD events such as heart attack or stroke, or quality of life.
Evidence on the harms or lack of harms of behavioral counseling was very limited. Overall, harms were rare and without statistically significant differences reported between intervention participants and control groups on any adverse events, musculoskeletal injuries or falls.
While the draft recommendation focuses specifically on reducing CVD risk in adults without known risk factors, the task force stated that behavioral counseling interventions to reduce CVD risk in adults with known modifiable risk factors such as smoking and physical inactivity are addressed in a separate recommendation statement.
The task force also stated that while obesity is a risk factor for CVD, a separate recommendation statement addresses behavioral weight loss interventions to prevent morbidity and mortality in individuals with a BMI of 30 or greater.
The USPSTF also published a consumer guide on behavioral counseling that explains the draft recommendation statement and details how individuals can submit comments to the task force. Additional resources from the Community Preventive Services Task Force, the Department of Health and Human Services and other agencies are listed in the Practice Considerations section of the draft recommendation statement.
All comments will be considered as the task force prepares its final recommendation statement.