Top Things to Know: Dual Science Advisories on Promotion of a Healthy Lifestyle in Clinical Settings
Prepared by Radhika Rajgopal Singh, PhD, Sr VP Science and Medicine
- As overweight and obesity at all life stages are associated with an increased risk of CVD and premature mortality, the statement details how the 5 A framework can be used for lifestyle-related behavior change counseling in patients who have overweight or obesity.
- Evidence-based guidelines for cardiovascular disease (CVD) risk reduction recommend consuming a healthy dietary pattern, engaging in regular physical activity, avoiding exposure to tobacco products, habitually attaining adequate amounts of sleep, and managing stress levels. However, their effective promotion to patients in clinical settings can be challenging.
- Identified as a unifying framework for behavioral counseling in primary care by the United States Preventive Services Task Force (USPSTF), the 5 A Model helps mitigate several barriers that reduce the capacity and feasibility of delivering counseling in clinical settings, including (a) the need to focus on more medically urgent issues; (b) inadequate clinical training, self-confidence, or reimbursement; (c) low perceived patient demand for lifestyle counseling; (d) lack of supportive resources; (e) time constraints; and (f) perceived lack of efficacy.
- In all life stages, social determinants of health and unmet social-related health needs contribute significantly to health inequities and worse health outcomes. The 5 A Model is foundational to patient-centered approaches that utilize team-based care, shared-decision making, and consideration of social determinants.
- Specific considerations for lifestyle-related behavior change counseling in pregnancy, pre-conception through the first 1000 days, childhood and adolescence, and older adults are outlined, representing life stages where lifestyle behaviors significantly impact CVD risk.
- The statement discusses non-medical, health-related social needs and social determinants of health that may be enablers or barriers to lifestyle-related behavior change across the lifespan.
- The statements guide clinicians on how to use the 5As to briefly advise their patients on each individual lifestyle factor, including diet and nutrition, physical activity, sleep, tobacco product use or exposure, psychological health, and well-being, and also include strategies for implementation.
- The two statements focus on how clinicians and other health care professionals can adopt the 5 A Model (i.e., assess, advise, agree, assist, and arrange) to provide lifestyle-related behavior change counseling to decrease CVD risk in their patients. Specific considerations for counseling patients in population groups disproportionately affected by CVD, and in life stages that are critical to CVD prevention efforts, are highlighted.
- To equitably increase cardiovascular health in the U.S., lifestyle-related CVD risk factors must be targeted at every routine health care visit for all patients. Together, the Statements provide pragmatic strategies using the 5 A Model approach to counsel patients on lifestyle-related behaviors strongly linked to CVD risk.
- To facilitate usability and implementation within the constraints and demands of clinical settings, the statements describe each of the "As" and the brief intervention strategies that can be delivered efficiently in a clinic setting (i.e., <15 minutes) and with minimal clinician training or changes to clinical workflows and via telephone-based or video-conference visits.
Citation
Kris-Etherton PM, Petersen KS, Després J-P, Anderson CAM, Deedwania P, Furie KL, Lear S, Lichtenstein AH, Lobelo F, Morris PB, Sacks FM, Ma J; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Stroke Council; Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Hypertension. Strategies for promotion of a healthy lifestyle in clinical settings: pillars of ideal cardiovascular health: a science advisory from the American Heart Association [published online ahead of print October 25, 2021]. Circulation. doi: 10.1161/CIR.0000000000001018
Kris-Etherton PM, Petersen KS, Després J-P, Braun L, de Ferranti SD, Furie KL, Lear SA, Lobelo F, Morris PB, Sacks FM; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Stroke Council; Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Hypertension. Special considerations for healthy lifestyle promotion across the life span in clinical settings: a science advisory from the American Heart Association [published online ahead of print October 25, 2021]. Circulation. doi: 10.1161/CIR.0000000000001014