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  1. Sthira, you'll love this one [1] posted by Al Pater (thanks Al!) to the CR email list. It compared various group lifestyle interventions, including yoga, walking, Mediterranean diet and group smoking cessation classes for their effect over the following 10 years on risk of cardiovascular disease. It found: [Y]oga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). Of course, the effectiveness of a treatment is dependent on subject compliance and treatment efficacy. That's why smoking cessation treatments were almost completely ineffective - almost nobody quits for very long. The authors acknowledge this, saying: We have presented a rank order of strategies that do not include taking any pills or medication. As such, non-adherence with lifestyle change and other health behaviors, including pill-taking, is of concern and may dilute intervention effects. Our calculations are based on intention to-treat rates from the clinical trials, which incorporate non-adherence. For a current smoker, successfully quitting smoking is the most effective lifestyle change. Smoking cessation is, however, difficult to achieve and group therapy for stopping smoking has only a small probability of success. From an intention-to-treat perspective, if yoga is as effective as reported in currently published meta-analyses, then yoga could be considered among the strongest lifestyle interventions for reducing CVD risk. Too bad they didn't include a dance intervention group. Based on the benefits of dance discussed here, I bet it might have done best of all! --Dean ---------- [1] Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction. Chu P, Pandya A, Salomon JA, Goldie SJ, Hunink MG. J Am Heart Assoc. 2016 Mar 29;5(3). pii: e002737. doi: 10.1161/JAHA.115.002737. PMID: 27025969 Free Article http://jaha.ahajournals.org/content/5/3/e002737.full http://jaha.ahajournals.org/content/5/3/e002737.full.pdf+html Abstract BACKGROUND: Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. METHODS AND RESULTS: We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. CONCLUSIONS: This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures. KEYWORDS: cardiovascular risk reduction; comparative effectiveness; lifestyle modification
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