Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults-Adult

Patient Population Under Consideration

This recommendation applies to adults 18 years or older who are of normal weight or overweight, with a BMI between 18.5 and 30 (calculated as weight in kilograms divided by the square of height in meters). It does not apply to persons who have known CVD risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes) or persons with obesity or who are underweight.

Behavioral Counseling Interventions

The USPSTF reviewed 88 trials with more than 120 distinct interventions focused on promoting a healthful diet, physical activity, or both. Dietary messages documented in the interventions typically focused on general heart-healthy eating patterns (increased consumption of fruits, vegetables, fiber, and whole grains; decreased consumption of salt, fat, and red and processed meats).^{3, 4} This guidance is generally consistent with major dietary recommendations, including the US Department of Health and Human Services' 2015–2020 Dietary Guidelines for Americans.⁵ Similarly, national guidelines suggest that US adults should perform at least 150 minutes of moderate-intensity or at least 75 minutes of vigorous-intensity physical activity per week, or an equivalent combination of moderate- and vigorous-intensity physical activity, and also should perform strengthening activities at least twice per week.⁶ Physical activity messages used in the reviewed interventions emphasized gradually increasing aerobic activities to recommended levels, with many studies emphasizing walking.³

Interventions categorized as low intensity included print- or web-based materials with tailored feedback and tools for behavior change, ranging from 1-time mailings to monthly mailings over 3 years. Medium- and high-intensity interventions commonly included face-to-face individual or group counseling or both, with telephone, email, and text message follow-up. These more intensive interventions ranged in duration from 4 weeks to 6 years, with the active intervention period often lasting for 6 months. Interventions were delivered by primary care clinicians, health educators, behavioral health specialists, nutritionists or dieticians, exercise specialists, and lay coaches. Behavioral change techniques included goal setting and planning, monitoring and feedback, motivational interviewing, addressing barriers to change, increasing social support, and general education and advice. Adherence to all interventions was relatively high; adherence to high-intensity interventions was generally lower than for less-intensive interventions. Overall, there appeared to be a dose-response effect, with higher-intensity interventions demonstrating greater and statistically significant benefits. However, this dose-response effect was not seen for interventions targeting physical activity only, among which some low-intensity interventions demonstrated benefit.³

Additional Approaches to Prevention

The USPSTF recognizes the important contributions of public health approaches to improving diet, increasing physical activity levels, and preventing CVD. The Community Preventive Services Task Force recommends several community-based interventions to promote physical activity, including community-wide campaigns, social support interventions, school-based physical education, and environmental and policy approaches. It also  recommends programs promoting healthful diet and physical activity for persons at increased risk for type 2 diabetes on the basis of strong evidence of the effectiveness of these programs in reducing the incidence of new-onset diabetes.⁷

Useful Resources

The USPSTF has evaluated the evidence on several aspects of CVD prevention in adults with and without common risk factors, including behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention in adults with cardiovascular risk factors,⁸ screening for and management of obesity in adults,⁹ and screening for abnormal blood glucose levels and type 2 diabetes mellitus.¹⁰

In other recommendation statements, the USPSTF had recommended screening for high blood pressure,¹¹ use of statin medications in persons at risk for CVD,¹² screening and counseling for tobacco smoking cessation,¹³ and aspirin use in certain persons for CVD primary prevention.¹⁴

In addition, the US Department of Health and Human Services has published national dietary and physical activity guidelines for Americans.^{5, 6}