title: Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients.
abstract: OBJECTIVE
  To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years.
  
  
  METHODS
  The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables.
  
  
  RESULTS
  Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05).
  
  
  CONCLUSIONS
  These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.
authors.affiliation: Preventive Medicine Research Institute, Sausalito, California, USA.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Pischke
authors.forename: Larry
authors.initials: L
authors.lastname: Scherwitz
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
authors.forename: Dean
authors.initials: D
authors.lastname: Ornish
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology*; D003376:Counseling; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011584:Psychology; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors