USPSTF Final Recommendation
Tailored Behavioral Counseling Recommended to Prevent CVD
August 24, 2022, 8:40 a.m. News Staff — Talking about diet and exercise with your patients who do not have cardiovascular disease risk factors might help prevent outcomes such as heart attack and stroke, according to an updated recommendation from the U.S. Preventive Services Task Force.
The AAFP is reviewing the task force’s final recommendation statement, final evidence review and evidence summary, which were posted on July 26.
The update — a “C” recommendation — is consistent with the task force’s 2017 recommendation on the topic.
“Behavioral counseling interventions to promote a healthy lifestyle can help prevent heart attacks and strokes for some people without cardiovascular disease risk factors,” said Task Force member Lori Pbert, Ph.D., in a USPSTF bulletin. “It’s important that health care professionals and patients have a conversation that is guided by professional judgment and patient preferences such as a person’s interest in making changes to their diet and physical activity to decide together if counseling interventions may be right for them.”
The recommendation applies to adults who do not have any known risk factors for CVD such as hypertension, unhealthy cholesterol levels or high blood glucose levels. It does not apply to people with obesity; interventions for adults with risk factors are addressed in a different recommendation.
Story Highlights
Findings of Note
The task force found that overall, behavioral counseling interventions for a healthy diet, physical activity or both were associated with modest increases in physical activity levels and some improvements in dietary health behaviors.
Individuals who took part in physical activity interventions, for example, increased their physical activity by about 33 minutes per week and were more likely to meet physical activity recommendations after six to 12 months compared with control patients.
Those who participated in healthy diet interventions, meanwhile, increased their intake of fruit and vegetables by more than a serving per day and their intake of fiber by almost one-quarter of a serving per day, and also decreased their daily intake of saturated fat, compared with controls.
The task force also found sufficient evidence to show that behavioral counseling interventions, whether for a healthy diet, physical activity or both, were associated with positive changes in intermediate health outcomes such as decreased blood pressure levels and reductions in BMI, weight and waist circumference after six to 12 months. Generally, participation in high-intensity interventions of six or more hours per week produced greater changes in intermediate outcomes.
Finally, the task force found little direct evidence to show the effectiveness of behavioral counseling interventions on outcomes such as all-cause mortality, CVD-related mortality, CVD events or quality of life.
Response to Public Comment
The task force responded to public comment on a draft of the recommendation statement, with changes such as calls for further research into clinician training, and noted that decisions should be based on professional judgement and patient preference.
What’s Next
The AAFP’s Commission on Health of the Public and Science is reviewing the task force’s final recommendation statement, final evidence summary and evidence review, and will then determine the Academy’s stance on the recommendation.