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Two new science advisories from the American Heart Association (AHA) provide clinicians with strategies and special considerations for the promotion of a healthy lifestyle in everyday clinical practice.

Penny Kris-Etherton

“It is clear that healthy lifestyle practices can have a big impact on reducing cardiovascular disease (CVD) risk. However, many Americans fall short in meeting Life’s Simple 7 recommendations,” Penny Kris-Etherton, PhD, RD, chair of the writing groups, told theheart.org | Medscape Cardiology.

The AHA’s “Life’s Simple 7” factors for cardiovascular health are not smoking, getting regular physical activity, maintaining a healthy diet and body weight, and controlling cholesterol, cheap aldactone blood pressure, and blood glucose levels.

“The two advisories provide clinicians with straightforward strategies to help their patients across the lifespan adopt healthy lifestyle practices for CVD risk reduction,” said Kris-Etherton, Department of Nutritional Sciences, Penn State University, University Park, Pennsylvania.

The Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health and Special Considerations for Healthy Lifestyle Promotion Across the Life Span in Clinical Settings were published online October 25 in Circulation.

The 5A Model

Using the “5A Model” (assess, advise, agree, assist, and arrange), the strategies writing group provides “best communication” practices for clinicians to provide patient-centered care for healthy lifestyle change at every visit.

Assess: Seek to understand what the patient knows about a lifestyle behavior(s), why it matters to their health, and their intention to change their behavior. 

The writing group suggests that clinicians take advantage of data collected from screening tools integrated into electronic health record systems; have patients enter lifestyle information in patient portals before their clinic visit; and use the OARS approach (ask open-ended questions, affirm what the patient says, reflect what the patient says, summarize) during the visit.

Advise: Discuss health risks and benefits of behavior change, including offering information that corrects patient’s misunderstanding and gaps in knowledge without being judgmental or confrontational.

The group recommends using the ask-tell-ask approach: Ask for permission to offer advice (first ask); give clear advice and address any information gaps/misconceptions (tell); once a shared understanding of the personal health risk has been established, ask questions to determine what action the patient wishes to take to change the health behavior (final ask).

Agree: Collaboratively set goals for behavior change.

A shared decision-making approach gives the patient the best chance of achieving their goals. Discuss with the patient and agree on “SMART” goals that are specific, measurable, achievable, realistic, and timed.

Assist: Encourage patient-selected solutions and action steps for addressing personal barriers to behavior change.

The group recommends that clinicians help patients develop a positive way to think about the challenges to changing a health behavior and guide them through a five-step problem-solving process (identify barriers, brainstorm solutions, analyze pros/cons of solutions, chose a solution, and develop an action plan).

Arrange: Specify the next step (visit, call, reminder) to follow-up on progress.

Health behavior change is an ongoing, iterative process, and arranging follow-up support is important to produce meaningful and lasting behavior change. To assist in brief patient-centered counselling for health behavior change, the group suggests that clinicians leverage health technologies, such as health/wellness smartphone apps and step counters.

Special Considerations

The companion “special considerations” science advisory highlights the fact that certain groups are disproportionately affected by CVD and deserve special attention.

Across the lifespan, social determinants of health, as well as unmet social-related health needs, excess weight, and obesity, all of which affect risk for CVD, should be considered, the writing group says.

They also outline considerations for lifestyle-related behavior change counselling during pregnancy, childhood and adolescence, and older adulthood, the life stages during which lifestyle behaviors significantly affect heart disease risk.

Physicians are viewed by the public as a credible source of health information and mounting evidence shows that clinicians are well positioned to influence the lifestyle practices of their patients, the writing group notes.

“Clinicians need to discuss healthy lifestyle practices with their patients at every visit and provide assistance to them in making these changes. Even small changes can have significant CV benefits,” Kris-Etherton told theheart.org | Medscape Cardiology.

The advisories were prepared on behalf of the AHA 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.

This research had no commercial funding. A complete list of disclosures for the writing groups is available with the original articles.

Circulation. Published online October 25, 2021. Special considerations full text, Strategies full text

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