title: Effects of lifestyle modification programs on cardiac risk factors.
abstract: Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish) and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006). Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors.
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: Moaven
authors.initials: M
authors.lastname: Razavi
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fournier
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: Grant
authors.initials: G
authors.lastname: Ritter
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: Gail K
authors.initials: GK
authors.lastname: Strickler
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, 02454-9110, United States of America.
authors.forename: William B
authors.initials: WB
authors.lastname: Stason
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D003324:Coronary Artery Disease / Q000191:economics / Q000517:prevention & control / Q000534:rehabilitation*; D005081:Exercise Therapy; D018588:Fee-for-Service Plans; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D006278:Medicare; D010353:Patient Education as Topic; D011379:Prognosis; D015397:Program Evaluation; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States; D015431:Weight Loss