New US Preventive Services Task Force Recommendations on Diet, Activity Counseling to Prevent Cardiovascular Disease

The US Preventive Services Task Force (USPSTF) has updated their stance on behavioral counseling to improve healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors in a new recommendation statement.

An update to their 2017 recommendation, the USPSTF concluded with moderate certainty that behavioral counseling interventions had a small net benefit on cardiovascular disease risk in adults without cardiovascular disease risk factors and recommends clinicians individualize the decision to offer or refer these patients to counseling to promote a healthy diet and physical activity, which is consistent with the recommendation made by the organization in 2017.

“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, PhD, in a statement from the USPSTF. “It’s important that healthcare 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.”

Published on July 26, the recommendations statement was composed by a Carol Mangione, MD, MSPH, and a team of colleagues to provide clinicians with an update on the latest evidence on the benefits and hearts of behavioral counseling interventions for promoting healthy lifestyle behaviors in adults without cardiovascular disease. The recommendation within the 2022 statement, which received a level C recommendation, is based on a literature review performed by a team of investigators led by Carrie D. Patnode, PhD, MPH, designed to evaluate data on the benefits and harms of behavioral counseling using data from randomized clinical trials of behavioral counseling interventions aimed at improving diet, increasing physical activity, or decreasing sedentary time. This review, which encompassed data from 113 randomized clinical trials with a population of 129,993 participants, concluded diet and physical activity behavioral counseling in adults without known cardiovascular risk factors provided small but statistically significant benefits for multiple important intermediate health outcomes.

Within their statement, authors provide recommendations for effective implementation of these recommendations and point out these should be implemented using personal judgment.

Implementation recommendations:

• Common dietary counseling advice should promote increased consumption of fruits, vegetables, and fiber; reduced consumption of saturated fats, sodium, and sugar-sweetened beverages; or both.
• Physical activity counseling should encourage patients to gradually increase aerobic activity to achieve at least 150 minutes per week of equivalent moderate-intensity activity.
• Interventions can be delivered individually, in a group, or both, with or without follow-up, or delivered remotely through a combination of print materials, telephone calls, technology-based activities, or some combination thereof.
• Typical counseling techniques should include behavioral change techniques such as goal setting, problem solving, and self-monitoring. Approaches including motivational interviewing principles or portions of the “5 A’s” Model (assess, advise, agree, assist, and arrange) are common.
• A wide range of specially trained professionals can deliver these interventions.
• Interaction time with a clinician can vary from 30 minutes to 6 hours over 6 months or longer.

In an editorial published in JAMA Cardiology, Carl Lavie, MD, Barry Franklin, PhD, and Keith Ferdinand, MD, underline the importance of behavioral counseling in prevention of cardiovascular disease event and how optimizing delivery of this counseling could have implications on a population level.

“Although the modulations described by the USPSTF in CVD risk factors were only modest, the improvements in physical activity were more substantial. Considering the role that physical activity, cardiorespiratory fitness, and sedentary behaviors have on health outcomes, improving these prognostic indices even modestly should reduce the incidence of CVD and cancers across populations, which should favorably and disproportionately impact the Black population relative to the incidence/prevalence of unhealthy lifestyles, risk factors, and underlying chronic disease,” wrote the Lavie, Franklin, and Ferdinand.

This statement, “Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors,” was published in JAMA.