AHA Effect On Dietary and Activity Change?Monday, July 26, 2010
There is little doubt that changes in diet and physical activity can seriously reduce risk for cardiovascular disease (and countless other conditions from arthritis to cancer).
But changing diet and activity levels both at individual and population levels remains a major challenge. Not that these changes are not possible (they are), but rather that practitioners don’t know where to start and often default to well-meaning but useless advise (eat less – move more).
Last week, the American Heart Association (AHA) Prevention Committee of the Council on Cardiovascular Nursing released a comprehensive collation of the current evidence regarding interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults.
Although the document does not specifically address weight management, the principles and learnings from this document certainly apply as much to managing excess weight as they do to dealing with other chronic conditions like hypertension, dyslipidemia or diabetes.
The following intervention strategies and principles meet the highest levels of evidence (Level A or B):
Cognitive-behavioral strategies for promoting behavior change:
- Design interventions to target dietary and PA behaviors with specific, proximal goals/goal setting (Level of evidence: A)
- Provide feedback on progress toward goals. (Level of evidence: A)
- Provide strategies for self-monitoring. (Level of evidence: A)
- Establish a plan for frequency and duration of follow-up contacts (eg, in-person, oral, written, electronic) in accordance with individual needs to assess and reinforce progress toward goal achievement. (Level ofevidence: A)
- Utilize motivational interviewing strategies, particularly when an individual is resistant or ambivalent about dietary and PA behavior change. (Level of evidence: A)
- Provide for direct or peer-based long-term support and follow-up, such as referral to ongoing community-based programs, to offset the common occurrence of declining adherence that typically begins at 4–6 months in most behavior change programs. (Level of evidence: B)
- Incorporate strategies to build self-efficacy into the intervention. (Level of evidence: A)
- Use a combination of the above strategies (eg, goal setting, feedback, self-monitoring, follow-up, motivational interviewing, self-efficacy) in an intervention. (Level of evidence: A)
- Use incentives, modeling, and problem solving strategies. (Level of evidence: B)
Intervention processes and/or delivery strategies:
- Use individual- or group-based strategies. (Level of evidence: A)
- Use individual-oriented sessions to assess where the individual is in relation to behavior change, to jointly identify the goals for risk reduction or improved cardiovascular health, and to develop a personalized plan to achieve it. (Level of evidence: A)
- Use group sessions with cognitive-behavioral strategies to teach skills to modify the diet and develop a PA program, to provide role modeling and positive observational learning, and to maximize the benefits of peer support and group problem solving. (Level of evidence: A)
- For appropriate target populations, use Internet- and computer-based programs to target dietary and PA change; evidence is less for targeting PA alone; adding a form of E-counseling improves outcomes. (Level of evidence: B)
- Use individualized rather than nonindividualized print- or media-only delivery strategies. (Level of evidence: A)
Addressing cultural and social context variables that influence behavioral change:
- Utilize church, community, work, or clinic settings for delivery of interventions. (Level of evidence: B)
- Use a multiple-component delivery strategy that includes a group component rather than individual-only or group-only approaches. (Level of evidence: A)
- Use culturally adapted strategies, including use of peer or lay health advisors to increase trust; tailor health messages and counseling strategies to be sensitive to the cultural beliefs, values, language, literacy, and customs of the target population. (Level of evidence: A)
- Use problem solving to address barriers to PA and dietary change, such as lack of access to affordable healthier foods, lack of resources for PA, transportation barriers, and poor local safety. (Level of evidence: B)
- Nothing revolutionary here or in fact very different from the way most evidence-based weight management programs already work (scams excluded). In fact this list of recommendations provides a valuable checklist to make sure your program is hitting all the relevant buttons
Good to know that there is actually strong scientific evidence to support most of what we do at WeightWise.
Hat tip to Sebely for pointing me to this article
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Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE, & on behalf of the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing (2010). Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults. A Scientific Statement From the American Heart Association. Circulation PMID: 20625115