VCU news

By Mary Kate Brogan
School of Pharmacy

Eating right and exercising are key to staving off the risk of cardiovascular disease, which includes heart disease and stroke and is one of the leading causes of death in the United States. Based on the latest recommendations from medical experts, one doctor says patients might be surprised at how many resources their doctor has available to help with making these lifestyle changes.

In a paper published Tuesday in the Journal of the American Medical Association, a group of experts led by Alex Krist, M.D., a Virginia Commonwealth University professor and chair of the U.S. Preventive Services Task Force, concluded that there is a moderate benefit to recommending behavioral counseling for those who show signs of being at risk for cardiovascular disease, affirming the group’s previous recommendation geared toward helping patients reduce their risk.

The U.S. Preventive Services Task Force is a volunteer panel of national health care experts that provides guidance on which checkups and tests Americans need to stay healthy. Krist, a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine, has served on the task force since January 2015 and was appointed its chair in March 2020. Krist holds additional roles at VCU, leading community-engaged research at the C. Kenneth and Dianne Wright Center for Clinical and Translational Research and conducting research at VCU Massey Cancer Center.

The task force has recommended for years that doctors try to help patients do better with eating right and exercising, particularly if they are at risk for cardiovascular disease. Krist said the task force’s latest recommendation shows that the evidence still shows this advice is correct: Offering options to help patients eat well and exercise has a positive impact on their health.

Krist spoke with VCU News about this recommendation and what it means for patients nationwide.

What are the new recommendations from the U.S. Preventive Services Task Force?

We’re recommending that primary care clinicians offer — for adults who have cardiovascular risk — interventions to help them have a healthier diet and better physical activity. High blood pressure, high cholesterol or smoking would be examples of risk factors. Cardiovascular disease is the No. 1 killer in America, and we know that if we can help people do better with eating right and exercising, we can prevent a lot of cardiovascular disease.

If I'm a patient who has been assessed to be at risk for cardiovascular disease, how might my next visit be different from what I've experienced before as a result of this recommendation?

I actually hope it won’t be too different. We’ve recommended this in the past, so hopefully folks have gotten this before. My hope is that all patients are being asked about healthy diet and exercise and being given help to do better with their diet and exercise. This recommendation was about people who are at cardiovascular risk, and we’re recommending this counseling for patients. For patients with cardiovascular risk, the data shows us that it’s even more important to eat right and exercise, and clinicians helping patients do it has an even greater benefit.

We have another recommendation that says clinicians should counsel all patients, even if you don’t have cardiovascular risks, to eat right and to exercise. That recommendation has a small net benefit, whereas, for people at risk for cardiovascular disease, it has a moderate net benefit. So clinicians should do this for all patients. If a patient hasn’t been asked about their diet and exercise, if they’ve got questions and are wondering if they need to make changes or if they’re looking for help making changes, I would encourage any patient to bring this up with their doctor and talk to them about it because it’s such an important part of health.

It’s easy if we’re feeling stressed to give up exercise and to not eat as healthy, but I think with all the stresses going on in the world today, it’s even more important than ever.

There’s a whole bunch of different interventions that can work. … It’s not just your doctor saying, ‘Hey, you should eat right and exercise.’ There are some interventions, like the Diabetes Prevention Program that’s run out of YMCAs, where they get people into exercise classes, nutrition classes and other things. But interventions can range from motivational interviewing and behavior change techniques that doctors might do with patients — things like problem-solving and how to make changes to improve their health. It might be asking people to self-monitor and to record and document what they’re doing. It might involve nurses, dietitians, nutritionists, physical therapists or exercise specialists. It could involve some education and sharing of information, watching videos, getting links to or looking at things online to learn more and think through how to make changes and what changes may help.

How do you think this recommendation will benefit patients going forward?

We know that eating right and exercising is good for our health; we also know that it’s hard to do this. The more doctors can help patients do this better, the better we’ll help people to be healthy. That would be my main hope with this.

What do you most want people to know about this recommendation in terms of improving their health?

Diet and exercise are the foundations of our health. They have a big impact on cardiovascular disease, but they also have big impacts on cancer and our mental health and just our quality of life and how we’re feeling. … I think for folks who are not doing as well as they could with diet and exercise, there is a lot their doctor can do to help them, and I’d encourage them to talk with their doctor and to think through effective ways to make changes.

For some people, their diet and exercise habits got better during the COVID-19 pandemic, but for many people they got worse. It’s easy if we’re feeling stressed to give up exercise and not eat as healthy, but I think with all the stresses going on in the world today, it’s even more important than ever.