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The full report is titled “Behavioral Counseling Interventions to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 4 September 2012 issue of Annals of Internal Medicine (volume 157, pages 367-372). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.
; Counseling to Promote Healthy Lifestyle and Prevent Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2012;157:I-28. doi: 10.7326/0003-4819-157-5-201209040-00494
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Published: Ann Intern Med. 2012;157(5):I-28.
The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.
Cardiovascular disease (heart attack and stroke) is a leading cause of death in the United States. Adults who eat a healthy diet and exercise regularly are at lower risk for cardiovascular disease than those who do not. National guidelines recommend that adults eat more vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood and eat less salt, saturated fat, trans fat, cholesterol, added sugar, and refined grains. Recommendations advise people to exercise at a moderate level (for example, walking) for at least 30 minutes at least 5 days per week or at a vigorous level (for example, running) for at least 20 minutes at least 3 days per week. Most Americans unfortunately do not follow these recommendations. One way to encourage healthy diet and exercise is for doctors and nurses to talk with patients about these behaviors in routine health care. Together they can decide whether patients will benefit from a more intensive counseling program on diet and exercise done by health educators, counselors, dietitians, or others. The USPSTF considered the evidence showing that such programs improve these behaviors and health outcomes.
The USPSTF considered an extensive review of published literature when developing these recommendations. The review included studies that examined the benefits and harms of counseling about healthy diet and exercise during primary care visits. The review considered studies of counseling in people without known high blood pressure, diabetes, cholesterol problems, or cardiovascular disease.
There is a strong relationship among healthy diet, exercise, and heart disease. However, available studies suggest that the benefit of intensive counseling about these behaviors is small for adults without known high blood pressure, diabetes, cholesterol problems, or heart disease. The USPSTF found that counseling has little to no potential harm. However, the time and resources devoted to counseling could take time away from other, more effective preventive care.
The USPSTF does not recommend incorporating counseling about healthy diet and physical activity into routine primary care for all adults in the general population without known diabetes, high blood pressure, unhealthy cholesterol levels, or heart disease. Health care providers may choose counseling about healthy diet and physical activity to prevent cardiovascular disease for some patients. Things to consider when deciding whether to provide such counseling include the patient's other risk factors for heart disease, readiness for change, social supports and community resources to support change, and other health problems.
These recommendations do not mean that the benefits of healthy diet and exercise are uncertain: These lifestyle habits improve health. Patients and health care providers will need to determine whether more intensive counseling about diet and exercise will be beneficial for patients who have less risk for heart disease.
This article was published at www.annals.org on 26 June 2012.
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