Group sessions are ideal for efficient skill-building (e.g., learning how to read food labels and shop properly) and hands-on practice (e.g., using a pedometer or exercise equipment). The power of the group may also reflect the positive effect of “modeling,” which is described as exposure to others who are making or have made desired changes.

Used alone, standardized books, brochures, and other media designed to encourage self-directed behavior change appear to be less effective than one-on-one or group interventions, although individualizing such materials, such as by matching them to the patient’s background and level of motivation and risk, has been shown to increase their value.

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Special populations

Ethnic minorities—particularly blacks and Hispanics—and economically disadvantaged groups are at high risk of cardiovascular disease. Behavioral interventions for members of these groups should be tailored to their specific needs and mindful of the difficulties they face.

Printed materials and other interventions should be designed with cultural sensitivity, keeping in mind the attitudes, beliefs, and values of the target group. Language barriers must be considered and limitations in education and literacy addressed. Consider using multimedia rather than printed formats.

Behavioral programs may be more accessible and acceptable when offered at worksites, churches, and community facilities rather than at a clinic.

“Research suggests that people are more likely to hear and personalize messages—and to change their attitudes and behaviors accordingly—if they believe the messenger is similar to them and faces the same concerns and pressures,” the authors write. Lay health advisors of similar ethnic background may be more readily trusted and therefore more effective than professionals.

Particular barriers to healthy eating and physical activity faced by disadvantaged groups include lack of access to quality produce, an environment in which snack foods and fast foods are priced low and heavily promoted, poor transportation, safety concerns, and lack of affordable exercise facilities. Behavior-change programs must include strategies to address and overcome these obstacles.

The Preventive Cardiovascular Nurses Association and the Society for Behavioral Medicine have endorsed the AHA scientific statement.

Mr. Sherman is a freelance medical writer in New York City.


1. 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;122:406-441. 

2. Conn VS, Valentine JC, Cooper HM. Interventions to increase physical activity among aging adults: a meta-analysis. Ann Behav Med. 2002;24:190-200.

All electronic documents accessed May 15, 2011.