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©2013 UpToDate ® Print Email American Heart Association (AHA) recommendations for counseling to promote dietary and physical activity changes Cognitive-behavioral strategies for promoting behavior change Class I Design interventions to target dietary and physical activity behaviors with specific, proximal goals. (Level of evidence: A) Provide feedback on progress toward goals. (Level of evidence: A) Provide strategies for self-monitoring. (Level of evidence: A) Establish a plan for frequency and duration of follow-up contacts (eg, in-person, oral, written, electronic) in accordance with individual needs to assess and reinforce progress toward goal achievement. (Level of evidence: A) Utilize motivational interviewing strategies, particularly when an individual is resistant or ambivalent about dietary and physical activity behavior change. (Level of evidence: A) Provide for direct or peer-based long-term support and follow-up, such as referral to ongoing community-based programs, to offset the common occurrence of declining adherence that typically begins at 4-6 months in most behavior change programs. (Level of evidence: B) Incorporate strategies to build self-efficacy into the intervention. (Level of evidence: A) Use a combination of 2 of the above strategies (eg, goal setting, feedback, self-monitoring, follow-up, motivational interviewing, self-efficacy) in an intervention. (Level of evidence: A) Class II Use incentives, modeling, and problem solving strategies. (Level of evidence: B) Intervention processes and/or delivery strategies Class I Use individual- or group-based strategies. (Level of evidence: A) Use individual-oriented sessions to assess where the individual is in relation to behavior change, to jointly identify the goals for risk reduction or improved cardiovascular health, and to develop a personalized plan to achieve it. (Level of evidence: A) Use group sessions with cognitive-behavioral strategies to teach skills to modify the diet and develop a physical activity program, to provide role modeling and positive observational learning, and to maximize the benefits of peer support and group problem solving. (Level of evidence: A) For appropriate target populations, use Internet- and computer-based programs to target dietary and physical activity change; adding a form of electronic-counseling improves outcomes. (Level of evidence: B) Class IIa

Use group sessions with cognitive-behavioral strategies to teach skills to modify the diet and develop a physical activity program, to provide role modeling and positive observational learning, and to maximize the benefits of peer support and group problem solving. (Level of evidence: A) For appropriate target populations, use Internet- and computer-based programs to target dietary and physical activity change; adding a form of electronic-counseling improves outcomes. (Level of evidence: B) Class IIa Use individualized rather than nonindividualized print- or media-only delivery strategies. (Level of evidence: A) Addressing cultural and social context variables that influence behavioral change Class IIa Utilize church, community, work, or clinic settings for delivery of interventions. (Level of evidence: B) Use a multiple-component delivery strategy that includes a group component rather than individual-only or group-only approaches. (Level of evidence: A) Use culturally-adapted strategies, including use of peer or lay health advisors to increase trust; tailor health messages and counseling strategies to be sensitive to the cultural beliefs, values, language, literacy, and customs of the target population. (Level of evidence: A) Use problem solving to address barriers to physical activity and dietary change, such as transportation barriers, poor local safety, and lack of access to affordable healthier foods and physical activity. (Level of evidence: B) PA: physical activity; Class I: evidence of effectiveness; Class II: conflicting evidence; Class IIa: weight of evidence in favor; Level of evidence A: data derived from multiple randomized clinical trials; Level of evidence B: data derived from a single randomized trial or nonrandomized studies; Level of evidence C: expert opinion or case studies. Reprinted with permission from: Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010; 122:406. Copyright © 2010 American Heart Association, Inc.