May 1st 2007
ABSTRACT: In addition to appropriate pharmacotherapy and assistance with smoking cessation, a secondary prevention plan should include counseling about a heart-healthy diet, a structured exercise program and/or increased physical activity, and assessment of psychosocial risk factors, such as depression. Advise patients to reduce their intake of salt, sugars, refined carbohydrates, and saturated and trans fats; incorporate more fruits, vegetables, and fish into their diet; and balance caloric intake and physical activity to achieve and maintain a body mass index between 18.5 and 24.9 kg/m2. Cardiorespiratory fitness is the key to cardioprotection; the threshold for improving it in persons with coronary heart disease is about 70% of the mea-sured maximal heart rate. Encourage patients to engage in multiple short bouts of physical activity daily, such as taking the stairs instead of the elevator or walking the dog. Among previously sedentary persons, this approach has effects on cardiorespiratory fitness, body composition, and coronary risk factors similar to those of a structured exercise program.