Abstract
To the Editor.— In Effects of Stress Management Training and Dietary Changes in Treating Ischemic Heart Disease (1983;249:54), Ornish and colleagues randomly assigned 48 persons with evidence of coronary artery disease to experimental and control groups of equal size. Despite the exclusion of aerobic exercise training from their intervention, they found significant improvement in duration of exercise and amount of total work performed, without alteration of maximum heart rate-systolic BP product attained. The experimental group had lower exercise tolerance than their controls before the intervention period, but their final level was significantly higher. The authors frankly admit their lack of a clear mechanism for this improvement, although they propose several possibilities. I wish to add one more, namely, the possible dissimilarity of intervention and control groups. Despite the investigators' randomization efforts, their two groups were remarkably dissimilar regarding plasma triglyceride and high-density lipoprotein (HDL) levels before the intervention period. The
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