Top Things to Know: Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions

1. In 2010, the American Heart Association defined its 2020 Strategic Impact Goal of “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%” and identified 7 health metrics for cardiovascular health, including nonsmoking, healthy weight, healthy diet, regular physical activity, and healthy levels of blood pressure, cholesterol, and glucose.i
2. Despite the scientific evidence that supports the benefits of a healthy diet, physical activity, and non-smoking in reducing the risk of cardiovascular disease, very few American adults meet the 7 metrics of ideal cardiovascular health. 13% of US adults meet 5 of the criteria and 5% meet 6 of the criteria.ii
3. Approximately 80% of Americans visit their primary care physician at least once a year; an opportunity for physicians to encourage their patients to adopt healthy lifestyles. However, many medical education programs do not train providers in prevention and management of chronic diseases. Physicians may also experience lack of time, insufficient reimbursement, and other clinical priorities that lead to limited behavioral counseling.
4. The goal of this Scientific Statement is to provide guidance and key learning objectives in medical education and training for future physicians to be proficient in lifestyle medicine. The four main topics include Behavioral Sciences, Nutrition, Physical Activity, and Tobacco Cessation.
5. Physicians with a fundamental understanding of behavioral sciences may have better outcomes with their patients compared to reciting facts to change patient behavior. The “5A’s algorithm” for behavior change is suggested to encourage patients to adopt healthy behaviors:
1. Assess the risk behavior
2. Advise change
3. Agree on goals and an action plan via shared decision making
4. Assist with treatment, and
5. Arrange follow-up. Currently, many healthcare providers are trained to focus on the first two steps to assess the risk and advise changes. This statement provides 8 learning objectives Behavior Sciences in medical education.
6. Less than half of American adults meet the ideal or intermediate health metrics for physical activity and a healthy diet score, respectivelyiii. This statement provides learning objectives for physical activity and nutrition assessment, exercise counseling and prescription, nutrition interventions and monitoring, and highlights the importance of the physician-in-training to model healthy behaviors in their own lives.
7. While the percentage of smokers has declined 30% since 1998, 18.8% of men and 15.5% of women smoke and tobacco smoking remains the second leading risk factor for death in the United Statesiv. Learning objectives for medical training include assessing the use and level of dependence on cigarettes and other tobacco products; understanding effective cessation aids and behavior change techniques; and communication skills to engage patients in a cessation discussion.
8. The learning objectives outlined in this statement provide the foundation of understanding in these key domains to help physicians-in-training engage in conversations with their patients, make assessments, and provide basic advice and encouragement towards a healthier lifestyle, including specific training and expertise for patients who would benefit from additional support (e.g., nutritionists, exercise physiologists, clinical health psychologists, etc.).
9. Regular physical activity, good nutrition, and other healthful behaviors (e.g., quitting smoking) are among the recommended lifestyle goals that can reduce mortality and morbidity, and improve quality of life of all Americans.
10. Achieving AHA 2020 goals will be possible if we invest in healthy lifestyle promotion, education and interventions - from the population to the individual level. Physicians are key stakeholders as they oversee an individual’s care and serve as key advocates for the implementation of policies and public health messages

ⁱ Lloyd-Jones (2010) Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010 Feb 2;121(4):586-613.

ⁱⁱ Mozaffarian (2016) Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association. Circulation. 2015;132:000-000.

ⁱⁱⁱ Mozaffarian (2016) Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association. Circulation. 2015;132:000-000.

^iv Mozaffarian (2016) Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association. Circulation. 2015;132:000-000.