Effect of addition of exercise to therapeutic lifestyle changes diet in enabling women and men with coronary heart disease to reach Adult Treatment Panel III low-density lipoprotein cholesterol goal without lowering high-density lipoprotein cholesterol

Abstract

To reduce the risk for coronary heart disease, the Adult Treatment Panel III of the National Cholesterol Education Program has recommended a multifaceted lifestyle approach.1 The Therapeutic Lifestyle Changes (TLC) Diet has replaced the former Step 1 and Step 2 diets and consists of <7% saturated fat and <200 mg cholesterol for all subjects. The Adult Treatment Panel III guidelines recommend that if low-density lipoprotein (LDL) cholesterol is 100 to 129 mg/dl in subjects with coronary heart disease, drug treatment is optional, or if patients are already on drugs, no change in dose is necessary.1 To determine the additive effect of exercise to a TLC diet, we conducted a structured exercise and stress reduction program in subjects with coronary heart disease who were already following a TLC diet. Our hypotheses were: (1) that exercise and weight loss would result in significant reductions in LDL cholesterol and thus obviate the need to add or increase lipid-lowering medications; (2) that exercise and weight loss would result in reductions in triglyceride levels and thus prevent lowering of high-density lipoprotein (HDL) cholesterol in response to the TLC diet in women and men; and (3) that stress reduction and weight loss would have a beneficial effect on blood pressure.