Lifestyle modification: weight control, exercise, and smoking cessation.

Cigarette smoking, obesity, and sedentary lifestyle are known to increase risk of coronary and other vascular disease. Yet eliminating, or reducing, these risk factors through lifestyle modifications is a significant challenge to patients and their physicians. To help meet this challenge in patients with coronary and other vascular disease, physicians should use an approach similar to that followed in other treatment plans: First, help the patient understand the value of the therapy; second, discuss the way in which treatment will evolve and set appropriate goals; third, follow up by monitoring and encouraging the patient's progress and identifying any barriers or adverse effects. When applying this paradigm to exercise, physicians can motivate patients by making them aware of the benefit of even moderate levels of activity, outlining a specific exercise program and setting appropriate goals, and following up on their patients' progress. Studies show that physicians can have a major positive impact on smoking cessation merely by asking patients whether they smoke and advising smokers to quit. Physicians can further assist smokers by providing educational materials, referring patients to counseling groups when needed, and prescribing nicotine replacement therapy when appropriate. Again, follow-up is essential. Dietary intervention should be tailored to individual patients, their food preferences and ethnic backgrounds. Individuals should be encouraged to try a wide variety of nonfat and low-fat foods and incorporate those they find acceptable into their diet in place of higher-fat alternatives. Educational materials are helpful in motivating patients to modify their eating habits and in providing additional ideas for food substitutions.