Review Article

Systematic Review of the Effect of Diet and Exercise Lifestyle Interventions in the Secondary Prevention of Coronary Heart Disease

Table 4

Impact of interventions on lifestyle risk factors.

SourceDietExerciseSmoking

Exercise
Astengo et al. [16] (2010)NRMaximum workload: 𝑃 = . 0 2 . Self-reported training (days/week): 𝑃 value for difference between groups <.001.
Self reported training (minutes/session): 𝑃 < .001.
Maximum heart rate: NS.
NR

Dietary
% calories consumed: NR NR
Total lipids: 𝑃 = . 0 0 2 .
Saturated fats: 𝑃 = . 0 0 0 1 .
Polyunsaturated fats: 𝑃 = . 0 0 0 1 .
Oleic: 𝑃 = . 0 0 0 1 .
De Lorgeril et al. [32] (1996).Linoleic: 𝑃 = . 0 0 0 1 .
Linolenic: 𝑃 = . 0 0 0 1 .
Alcohol: NS.
Proteins: NS.
Fibre: 𝑃 = . 0 0 4 .
Cholesterol: 𝑃 = . 0 0 0 1 .

Psychological
Lewin et al. [29] (2002) NRSeattle Angina Questionnaire: physical limitations score for I group reduced; for C group increased: 𝑃 < . 0 0 1 .NR

Diet knowledge index: 𝑃 < . 0 0 0 5 .PA frequency: 𝑃 < . 0 2 5 .
Maximum workload: 𝑃 < . 0 0 2 5 .
Chest pain ratings during exercise tests: 𝑃 < . 0 2 5 .
Self rated smokers 𝑃 < . 0 1 .
Lisspers et al. [26] (1999).Self rated dietary habits: 𝑃 < . 0 0 0 5 .
Lisspers et al. [27] (2005) calculated overall lifestyle scores incorporating diet, PA, smoking, and stress: I group significantly higher score than C group at 12, 24, 36, and 60 months. 𝑃 values not given for individual components of score.

Salminen et al. [25] (2005)Type of milk/type of fat consumed: NS (data not reported).PA frequency: NS (data not reported).NS (data not reported).

Educational
Carlsson et al. [42, 43] (1997, 1998).A: NRA: work capacity: NS (AMI patients: 𝑃 = . 0 8 ; CABG patients: 𝑃 = . 7 5 ) . B: NR.A: NR
B: NRC: PA: frequency: NS. StoppedB: NR
C: Concern about food habits: 𝑃 = . 0 0 8 physical training: 𝑃 = . 4 3 ; started physical training: 𝑃 = 0 . 5 0 .C: smoking cessation: NS.

Cupples and McKnight [22] (1994).Intake of poultry ( 𝑃 = . 0 2 ) , green vegetables ( 𝑃 = . 0 0 2 ) , high fibre food ( 𝑃 = . 0 1 ) , red meat ( 𝑃 = . 0 0 5 ) , fried food ( 𝑃 = . 0 4 5 ) , biscuits and sweets ( 𝑃 = . 0 0 0 1 ) , saturated fat ( 𝑃 = . 0 1 3 ) .PA frequency: 𝑃 < . 0 0 0 1 .Smoking cessation rate: NS ( 𝑃 = . 8 2 ) .

Cupples and McKnight [23] (1999)Diet score: difference between groups: NSPA frequency: 𝑃 < . 0 5 .Smoking cessation rate: difference between groups: NS.

Heller et al. [44] (1993)Mean fat score: 𝑃 = . 0 0 2 .Proportion exercising 3 times weekly: difference between groups NS.Current smoker: difference in proportions between groups: NS

Southard et al. [31] (2003)MEDFICTS dietary score: NSCanadian Angina Grade, Duke Activity Status Score: NS.
PA duration: NS.
NR

Multifactorial
1 year:MET, hr/wk ≥6
1 year: 𝑃 = . 0 2 .
NR
Fat: 𝑃 = . 0 0 9 ;
Allen et al. [30] (2002).Saturated fat: 𝑃 = . 0 0 4 ;
Cholesterol: 𝑃 = . 0 0 6 ;
Fibre: NS.

Campbell et al. [34] (1998) ALow fat diet: effect size: OR 1.47, CI 1.10 to 1.96, 𝑃 = . 0 0 9 .Moderate PA: effect size: OR 1.67, CI 1.23 to 2.26, 𝑃 = . 0 0 1 .Proportion of non-smokers: OR 0.78, 𝑃 = . 3 2 2 .

Giallauria et al. [18] (2009). NR V O 2 p e a k (increase in oxygen at peak exercise): NR
3, 12, and 24 months: 𝑃 < . 0 0 1 .
V O 2 A T (anaerobic threshold): 3, 12 and 24 months: 𝑃 < . 0 0 1 .
W a t t m a x : 3, 12 and 24 months: 𝑃 < . 0 0 1 .

Gianuzzi et al. [21] (2008)Dietary score 3.9% higher in I group ( 𝑃 < . 0 0 1 ) ; maintained throughout study.Mean score:
6 months: 𝑃 < . 0 1 ; maintained throughout study.
At 6 months: 𝑃 = . 0 2 .
3 years: NS ( 𝑃 = . 6 0 ) .

NR Frequency of PA and work capacity: NS (data not reported).No. cigarettes smoked/day:
1 year: NS;
Hamalainen et al. [45] (1995).2 years: 𝑃 = . 0 2 ;
3 years: 𝑃 = . 0 0 2 ;
Years 6 and 10: NS.

Murchie et al. [36] (2003) ANS
I group improvements sustained in all areas but at 4 years C group improved and differences no longer significant.
NS NS

Murphy et al. [17] (2009).DINE fibre: NS ( 𝑃 = . 0 6 )
DINE fat: NS ( 𝑃 = . 8 6 ) .
Godin exercise score: NS ( 𝑃 = 0 . 6 7 ) .Self reported smoker: NS ( 𝑃 = . 2 3 ) .

  Fat intake, g per day:Adherence to exercise: NR
1 year: 𝑃 < . 0 0 1 .
5 years: 𝑃 < . 0 0 1 .
Ornish et al. [41] (1998).Fat intake, % of energy intake:
1 year: 𝑃 < . 0 0 1 .1 year: NS.
5 years: 𝑃 < . 0 0 1 .
Dietary cholesterol:
1 year: 𝑃 < . 0 0 1 .
   5 years: 𝑃 = . 0 0 2 .5 years: NS.
Energy intake:
1 year: 𝑃 = . 6 4 .
5 years: 𝑃 = . 8 6 .

Redfern et al. [19] (2008) A Baseline to 3 monthsNRMETS/kg/min: 𝑃 = . 0 1 .Smokers: 𝑃 < 0 . 0 1 .

Redfern et al. [20] (2009) BNRMETS/kg/min, 𝑃 = . 0 0 1 .NR

Vestfold [28] (2003).6 months: I patients significantly lower intake saturated and monounsaturated fat, sugar, and cholesterol, higher fibre than C.PA frequency:
6 months: 𝑃 < . 0 0 1 .
6 months: 𝑃 < . 0 5 .
2 years: 𝑃 < . 0 5 .
2 years: I group significantly lower total fat intake, saturated fat and monounsaturated, significantly higher fibre, lower sugar and cholesterol.2 years: 𝑃 < . 0 1 .

Total fat: 𝑃 = . 0 0 1 ;Kcal/day: 𝑃 = . 0 0 1 . NR
SFA: 𝑃 = . 0 5 ;
MUFA: 𝑃 = . 0 4 ;
Carbohydrate: 𝑃 = . 0 0 1 ;
Wallner et al. [39] (1999).Fibre: 𝑃 = . 0 0 6 ;
Cholesterol: 𝑃 = . 0 3 ;
Vitamin C: 𝑃 = . 0 0 6 ;
Energy intake (kcal), PUFA, protein, vitamin E: NS.

Organisational
Jolly et al. [40] (1999) NRFitness test (distance walked in 6 minutes, metres): NS.Quit rate (proportion who stopped smoking): NS.

Munoz et al. [24] (2007) NRPA (amount of exercise): both groups increased but difference between groups NS. NR

NR: not reported; NS: not significant; I: intervention; C: control.