Table 5 Non-pharmacological interventions recommended by the included CPGs for CVDs

Physical Activity

Aim for moderate intensity aerobic physical activity 150–300 min/week, or vigorous intensity aerobic activity 75-150 min/week, or a mix of both that provides an equivalent level of exercise

Form: moderate or vigorous intensity aerobic PA

Duration/Frequency: 150–300 min or 75–150 min/week

I/A

ESC Guidelines Classification Scheme

ESC CVD (2021)

Physical Activity

For adults who are unable to engage in the moderate-intensity physical activity for 150 min/week, it is recommended to remain as active as their physical capabilities and health status permit

Form: NR

Duration/Frequency: NR

I/B

ESC Guidelines Classification Scheme

ESC CVD (2021)

Physical Activity

To minimize sedentary time, engaging in at least light activity during the day.

Form: light activity

Duration/Frequency: NR

I/B

ESC Guidelines Classification Scheme

ESC CVD (2021)

Physical Activity

Recommend resistance exercise, in addition to aerobic activity for at least 2 days/week for reducing all-cause mortality.

Form: resistance exercise, in addition to aerobic activity

Duration/Frequency: more than 2 days per week

I/B

ESC Guidelines Classification Scheme

ESC CVD (2021)

Physical Activity

Recommend moderate-intensity PA for the whole population unless contraindicated. Enhancing activity levels can be achieved by adjusting the intensity, duration, or frequency of the activity. Individuals should minimize sedentary time, particularly over extended periods.

Form: Moderate-intensity PA, minimize sedentary time

Duration/Frequency: NR

R/2 +  + , 2 + 

SIGN criteria

SIGN 149 CVD (2017)

Physical Activity

Recommend PA including occupational and/or leisure-time activities, such as brisk walking.

Form: occupational and/or leisure-time activities

Duration/Frequency: NR

R/2 +  + , 2 + 

SIGN criteria

SIGN 149 CVD (2017)

Physical Activity

Encourage individuals who are moderately active and capable of boosting their physical activity to do so by making adjustments to the intensity, duration, or frequency of their activities

Form: NR

Duration/Frequency: NR

R/2 +  + , 2 + 

SIGN criteria

SIGN 149 CVD (2017)

Physical Activity

Individuals should minimize sedentary time, particularly over extended periods.

Form: NR

Duration/Frequency: NR

R/2 +  + , 2 + 

SIGN criteria

SIGN 149 CVD (2017)

Physical Activity

Encourage all patients to increase activity levels gradually, regardless of their current health, fitness, or activity level.

Form: NR

Duration/Frequency: NR

✔/4

SIGN criteria

SIGN 149 CVD (2017)

Physical Activity

Recommend exercise with moderate intensity for at least 150 min/week or more intense exercise for 75 min/week to reduce cardiovascular risk.

Form: moderate intensity exercise or more intense exercise

Duration/Frequency: at least 150 min/week or 75 min/week

I/A

Brazilian Society of Cardiology (SBC) criteria

Brazilian CVD (2019)

Physical Activity

Doing moderate intensity exercise < 150 min/week or more intense exercise < 75 min/week still reduces cardiovascular risk.

Form: moderate intensity exercise or more intense exercise

Duration/Frequency: less than 150 min/week or 75 min/week

IIa/B

SBC criteria

Brazilian CVD (2019)

Physical Activity

The suggested amount of PA for healthy adults, regardless of age, is moderate-intensity exercise 150 min/week, or vigorous-intensity exercise 75 min/week. Alternatively, they can opt for a combination of both. Additionally, it is advisable to incorporate resistance exercises on more than two days/ week and flexibility exercises on 2–3 days/ week, whenever feasible or required.

Form: moderate intensity, vigorous intensity, resistance exercise, flexibility exercise

Duration/Frequency: at least 150 min/week, 75 min/week, 2 days/week, 2–3 days/week

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Smoking cessation

All tobacco use should be stopped, as it is a strong and independent cause of ASCVD.

I/A

ESC Guidelines Classification Scheme

ESC CVD (2021)

Smoking cessation

Regardless of weight gain, it is advisable to quit smoking since the advantages of cessation for ASCVD remain unaffected by weight fluctuations.

I/B

ESC Guidelines Classification Scheme

ESC CVD (2021)

Smoking cessation

Advise all smokers to stop and offersupport to minimize cardiovascular and general health risks.

R/2 +  + , 2 + , 4

SIGN criteria

SIGN 149 CVD (2017)

Smoking cessation

Exposure to passive smoking should be minimized, as it increases cardiovascular risk.

R/2 +  + , 2 + 

SIGN criteria

SIGN 149 CVD (2017)

Smoking cessation

Recommend smoking cessation for all adults to decrease cardiovascular risk.

I/B

SBC criteria

Brazilian CVD (2019)

Smoking cessation

Complete cessation: a combination of physiological and psychological intervention. Avoid exposure to second-hand tobacco smoke.

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Smoking cessation

E-cigarettes and shisha use are not recommended.

III/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Weight management

Overweight and obese individuals should aim to reduce weight to improve their cardiovascular health. Form: Healthy diet

I/A

ESC Guidelines Classification Scheme

ESC CVD (2021)

Weight management

Weight reduction interventions should aim for at least a 3 kg weight loss and maintenance.

R/2 +  + , 2 + , 1 +  + , 1 + 

SIGN criteria

SIGN 149 CVD (2017)

Weight management

Weight should be measured annually.

✔/ gpp

SIGN criteria

SIGN 149 CVD (2017)

Weight management

Overweight and obese individuals should aim for weight loss to improve their cardiovascular risk profile.

I/B

SBC criteria

Brazilian CVD (2019)

Weight management

Overweight and obese individuals should receive counseling and interventions aimed at achieving and maintaining weight loss, including caloric restriction and lifestyle modifications.

I/B

SBC criteria

Brazilian CVD (2019)

Weight management

The goals of weight management therapy are to achieve 5–10% weight loss and maintain it for 1–2 years before attempting further weight loss.

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Weight management

Recommended waist circumference thresholds for evaluating abdominal obesity are as follows: Less than 90 cm for men and less than 80 cm for women.

I/A

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Weight management

Recommended Dietary Weight-Loss Strategies: Practical initial target for weight loss is a negative deficit of 500 cal per day, with greater weight loss requiring a calorie restriction of 1200 to 1500 kcal per day achieved through meal replacement or calorie counting.

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Weight management

Recommended PA Weight-Loss Strategies: For unfit individuals, PA should be started slowly and gradually increased each week, such as starting at 60 min per week and slowly increasing to 150 min per week.

To achieve weight loss, it is recommended to do moderate-intensity PA 250-450 min/week, which should also include strength training sessions of 2 to 3 times/ week.

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)

Weight management

Recommended Behavioral Weight-Loss Strategies: Various behavioral strategies, such as self-monitoring of dietary patterns and PA, are necessary to maintain weight loss, but this method may yield only small reductions in body weiht in primary care settings.

I/B

ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme

Malaysian CVD (2017)