From Heartwire
Reed Miller
July 14, 2010 (Dallas, Texas) — A program of counseling with extended follow-up in conjunction with self-monitoring and goal-setting is the best approach to affecting sustainable lifestyle changes to reduce cardiovascular risk, according to a new scientific statement from the American Heart Association [1].
The new statement, published online July 12, 2010 in Circulation, was created by the AHA's Prevention Committee of the Council on Cardiovascular Nursing. It is based on analyses of 74 studies of US adults between January 1997 and May 2007, measuring effects of behavioral change on blood pressure, cholesterol levels, physical activity and fitness, and diet, including intake of fat, calories, salt, fiber, and fruits and vegetables.
Council chair Dr Nancy Artinian (Wayne State University, Detroit, MI) told heartwire the key finding of the council's review is that risk-factor mitigation plans that integrate more than one cognitive lifestyle change approach are more likely to be successful than those focused on just one. An example of a cognitive behavior change strategies includes patients setting specific and attainable goals such as a particular weight-loss target. Another is self-monitoring--patients are also more likely to succeed if they monitor their progress by, for example, weighing themselves regularly or keeping a log of what they eat.
Providers can help patients meet their goals by staying in contact and routinely providing feedback. For example, the doctor can encourage patients to stick with their plan by showing them how their weight loss has reduced their blood pressure and pointing out how their symptoms of hypertension have disappeared as a result, Artinian explained.
On the other hand, nonindividualized efforts to influence patient behavior do not usually work, Artinian said. "We've learned that just using brochures or paper information that is not personalized to the individual is probably not going to work . . . unless they can personalize it to their own life, and they're probably going to need some help doing that."
The research summarized in the statement confirms that minorities and individuals of low socioeconomic background are often at more risk for heart disease. Fortunately, "we've also learned there are interventions that do work for all [people], but those interventions or lifestyle change adaptations may need to be culturally adapted for use with a minority group."
The statement doesn't include any specific public-policy recommendations, but "we know we're going to need some healthcare policy changes, within the healthcare system," Artinian said. "We need to make it easier for healthcare providers to focus on prevention and help people work through lifestyle changes, because at the moment, healthcare providers face a lot of barriers. We all live in toxic environments. It's very difficult to stay healthy these days."
As examples of positive public-policy changes, in its release about the new scientific statement, AHA cites provisions in the latest federal healthcare reform legislation that will provide more reimbursement to support prevention services like lifestyle counseling [2]. The organization also commends proposals to improve product packaging and restaurant menus to help individuals make better choices.
"I'm looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk," Artinian said.
Artinian said the impetus to write the statement was the realization "that healthcare providers were very good about telling patients that they need to make lifestyle changes, and there was a great deal of evidence that high-risk factors are going to increase morbidity and mortality, but what we didn't know a lot about, and what healthcare providers needed assistance with, is helping patients translate that behavior into their everyday life. It's very difficult for people to change behavior and maintain it over a lifetime.
"When we started out doing this, we didn't know a thing about anything, and everybody said the studies are so diverse that we're never going to be able to home in and make sense of everything," she recalled. "So the fact that we did weed through all of the studies and work together and come up with recommendations was maybe a little bit surprising. . . . But now we have a consensus."
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