C-CHANGE 2022 recommendations on health behaviours for all people
| Source guideline | Recommendation | Grade or strength of recommendation and category or level of evidence*† |
|---|---|---|
| Dietary | ||
| Treatment targets and thresholds | ||
| Dietary (8) | Nutritious foods are the foundation for healthy eating. Vegetables, fruit, whole grains and protein foods should be consumed regularly. Among protein foods, plant-based should be consumed more often. Protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat (including wild game), lower-fat milk, lower-fat yogourts, lower-fat kefir and cheeses lower in fat and sodium. Foods that contain mostly unsaturated fat should replace foods that contain mostly saturated fat. Water should be the beverage of choice. (New recommendation) | Evidence: strong |
| Dietary (8) | Processed or prepared foods and beverages that contribute to excess sodium, free sugars or saturated fat undermine healthy eating and should not be consumed regularly. (New recommendation) | Evidence: strong |
| Hypertension (9) | In healthy adults, abstaining from alcohol or reducing alcohol intake to 2 drinks per day or less is recommended to prevent hypertension. (New recommendation) | Recommendation: grade B |
| Hypertension (9) | To prevent hypertension and reduce blood pressure, adults with hypertension should consider reducing sodium intake toward 2000 mg (5 g of salt or 87 mmol of sodium) per day. | Recommendation: grade A |
| Physical activity and movement behaviours | ||
| Screening and diagnostic strategies | ||
| Stroke (10) | People at risk of stroke and patients who have had a stroke should be assessed for vascular disease risk factors, lifestyle management issues (diet, sodium intake, exercise, weight, alcohol intake, smoking) and use of oral contraceptives or hormone replacement therapy. | Recommendation: grade B |
| Treatment targets and thresholds | ||
| CACPR (11) | The initiation of physical activity in previously inactive or highly sedentary populations should preferably take place within a comprehensive health behaviour change program. To achieve optimal health benefits, a progressive and individualized program with the target energy expenditure of moderate to vigorous physical activity for 30–60 min most days of the week is recommended. The use of practical tools to facilitate physical activity, such as pedometers, smart watches or phones, or time, distance, activity and caloric equivalence charts, may help to improve adherence. (New recommendation) | Recommendation: grade B |
| Obesity (12) | Aerobic physical activity (30–60 min of moderate to vigorous intensity most days of the week) can be considered for adults who want to (new recommendation):
| Recommendation: grade B; evidence: level 2a |
| Recommendation: grade A; evidence: level 1a | |
| Recommendation: grade B; evidence: level 2a | |
| Smoking cessation | ||
| Screening and diagnostic strategies | ||
| CANADAPTT (13) | Tobacco use status of all patients should be updated on a regular basis and health care providers should clearly advise patients to quit smoking. (New recommendation) | Recommendation: grade A; evidence: level 1 |
| CANADAPTT (13) | Health care providers should clearly advise patients or clients to quit. (New recommendation) | Recommendation: grade C; evidence: level 1 |
| Pharmacologic and procedural therapy for risk reduction | ||
| CANADAPTT (13) | Combining counselling and smoking cessation medication is more effective than either alone; therefore, both should be provided to patients or clients trying to stop smoking, where feasible. (New recommendation) | Recommendation: grade A; evidence: level 1 |
Note: CACPR = Canadian Association of Cardiovascular Prevention and Rehabilitation guideline, CANADAPTT = Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-Informed Tobacco Treatment guideline, Dietary = Canada’s Dietary Guidelines for Health Professionals and Policy-Makers (Health Canada), Hypertension = Hypertension Canada guideline, Obesity = Obesity Canada/Canadian Association of Bariatric Physicians & Surgeons guideline, Stroke = Canadian Stroke Best Practice Recommendations (Heart and Stroke Foundation).
↵* Unless otherwise indicated.
↵† See Appendix 2a (available at www.cmaj.ca/lookup/doi/10.1503/cmaj.220138/tab-related-content) for summary of grading for each included guideline and Appendix 2b for comparison of grading schemes.