The importance of healthy lifestyle behaviors to cardiovascular health promotion, risk reduction, as well as disease prevention and management is well established. Health behaviors, including patterns of dietary intake, physical activity and inactivity, as well as smoking and alcohol consumption, have been universally emphasized and embraced as a central component of evidence-based guidelines for children, adolescents, and adults from diverse populations. In 2011, the revised guidelines for children and adolescents were published and disseminated in an array of venues.1 Healthy lifestyle behaviors and therapeutic lifestyle change were emphasized and reaffirmed as central to cardiovascular health promotion and risk reduction, respectively. Within the pediatric community of healthcare providers, however, concern continues to be expressed regarding the adequacy of dissemination and uptake as well as use in clinical practice. In a thoughtful review and analysis of the pediatric guidelines, Zachariah and de Ferranti2 comment on both strengths and limitations of the evidence-based recommendations. With the use of an age-appropriate integrated approach, recommendations argue persuasively for the development and maintenance of healthy lifestyle behaviors from early life through adolescence for all children and youth, with the goal of preventing the development of risk factors (ie, dyslipidemias, obesity, hypertension) in the first place.1 Referred to as primordial prevention,3 this is clearly a population-based approach to healthy lifestyle behaviors. However, the guidelines are relatively quiet on advocating for primordial prevention policies focused on creating optimal defaults, environments that enable healthy choices and behaviors for all individuals across the life course.1,2 In addition, in the summary document that is more widely available to healthcare providers than the full report, minimal attention is devoted to sociodemographic and cultural factors known to influence healthy lifestyle behaviors.1,2
More recently, the American Heart Association (AHA) and the American College of Cardiology (ACC), in collaboration with the National Heart, Lung and Blood Institute, reaffirmed the importance of lifestyle management to reduce cardiovascular risk in adults.4 As 1 of the 4 prevention guidelines released (simultaneously) in late 2013, the AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk focused solely on healthy lifestyle behaviors.4 With primary care providers identified as the target audience, recommendations in these evidence-based guidelines focus on healthy patterns of dietary intake and physical activity . Detailed elsewhere,4,5 emphasis is placed on achieving a healthy dietary pattern by following plans such as the Dietary Approaches to Stop Hypertension-type diet, the United States Department of Agriculture food pattern, or the AHA diet.4 Individuals are encouraged to adapt this dietary pattern to appropriate energy requirements, personal and cultural food preferences, as well as nutrition therapy for other medical conditions (including diabetes). The recommended dietary pattern also includes limiting sodium consumption to less than 2400 mg/d; the desirable daily intake suggested is 1500 mg/d.4 Focused on improving the lipid profile and blood pressure, physical activity recommendations encourage adults to engage in aerobic physical activity of moderate/vigorous intensity for 40 minutes per session, 3 to 4 times per week.4
Important to note in this context is the identification of gaps in the evidence and future research needs focused on how lifestyle impacts cardiovascular risk reduction. The writing group identified strategies for effective implementation as a key area for future research with emphasis on how providers, health systems, public health agencies, local and federal government, community organizations, as well as other stakeholders may help patients adopt and sustain these healthy lifestyle behavior patterns.4 In addition, the need for better understanding of the racial, social, and socioeconomic factors that influence these key lifestyle behaviors was emphasized.4
On the basis of a rigorous review and synthesis of the available evidence, the integrated pediatric guidelines1 and the AHA/ACC guidelines on lifestyle management4 emphasize the importance of healthy behavior patterns for optimal cardiovascular health across the life course. Intended for implementation by healthcare providers, both guidelines represent an individual clinical approach. Complementary to and synergistic with this approach, a growing body of evidence clearly indicates that population-based approaches that include and encompass policy and environmental change are central and essential to enable the adoption and maintenance of healthy behaviors.6,7 To that end, with the use of a life course framework, the AHA has developed and disseminated several documents focused on population-based approaches designed to improve healthy lifestyle behaviors.8,9 More recently, the AHA issued a call to action focused on better population health through behavior change.10 Reflecting the need for both individual clinical- and population-level strategies to achieve sustained patterns of healthy behaviors, the community of healthcare providers is strongly encouraged to (1) intervene directly and as members of an interprofessional healthcare team to help individual patients adopt healthy lifestyles as well as (2) advocate for healthcare system and policy improvements to address the behavior change needs of the entire population effectively.10
As cardiovascular nurses functioning in a variety of practice, teaching, research, policy, and advocacy roles, we have numerous opportunities to promote the adoption and maintenance of healthy lifestyle behaviors. On an individual/clinical level, we are encouraged to capture the “teachable moment” as well as integrate patient and family lifestyle counseling in every patient encounter. Across healthcare and community settings including schools, work sites, and faith-based organizations, we are encouraged to operationalize the recommendations for healthy lifestyle behaviors1,4 in our individual lifestyle choices and role modeling as well as in our education, practice, and research initiatives . Importantly, on a population level, we must be advocates for the health of the public by assuming leadership roles in promoting healthcare system and multilevel policy changes necessary for universal adoption and maintenance of healthy behaviors across the life course.
1. National Heart, Lung and Blood Institute. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents : the report of the expert panel. Published 2011. http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm
. Accessed February 13, 2014.
2. Zachariah JP, de Ferranti SD. NHLBI integrated pediatric guidelines: battle for a future free of cardiovascular disease. Future Cardiol. 2013; 9( 1): 13–22. doi:10.2217/fca.12.72.
3. Weintraub WS, Daniels SR, Burke LE, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011; 124: 967–990. doi:10.1161/CIR.0b013e3182285a81.
4. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63( 25): 2960–2984.
5. Himmelfarb CR, Commodore-Mensah Y, Hayman LL. New cardiovascular prevention guidelines offer a new approach and effective strategies. J Cardiovasc Nurs. 2014; 29( 2): 102–104.
6. Koh HK, Blakey CR, Roper AY. Healthy people 2020: a report card on the health of the nation. JAMA. 2014; 311( 24): 2475–2476. Supplemental content at jama.com.
7. Fisher EB, Fitzgibbon ML, Glasgow RE, et al. Behavior matters. Am J Prev Med. 2011; 40( 5): e15–e30. doi:10.1016/j.amepre.2010.12.031.
8. Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation. 2012; 126( 12): 1514–1563.
9. Pearson TA, Palaniappan LP, Artinian NT, et al. American Heart Association guide for improving cardiovascular health at the community level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013; 127: 1730–1753. doi:10.1161/CIR.0b013e31828f8a94.
10. Spring B, Ockene JK, Gidding SS, et al. Better population health through behavior change in adults: a call to action. Circulation. 2013; 128: 2169–2176. doi:10.1161/01.cir.0000435173.25936.e1.