Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease.

BACKGROUND: Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment. This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris. METHODS AND RESULTS: Patients were recruited after routine coronary angiography for stable angina pectoris; they were randomized to an intervention group (n = 56) and a control group on "usual care" (n = 57). Treatment comprised intensive physical exercise in group training sessions (minimum, 2 hr/wk), daily home exercise periods (20 min/d), and low-fat, low-cholesterol diet (American Heart Association recommendation, phase 3). No lipid-lowering agents were prescribed. After 12 months of participation, repeat coronary angiography was performed; relative and minimal diameter reductions of coronary lesions were measured by digital image processing. Change in myocardial perfusion was assessed by 201Tl scintigraphy. In patients participating in the intervention group, body weight decreased by 5% (p less than 0.001), total cholesterol by 10% (p less than 0.001), and triglycerides by 24% (p less than 0.001); high density lipoproteins increased by 3% (p = NS). Physical work capacity improved by 23% (p less than 0.0001), and myocardial oxygen consumption, as estimated from maximal rate-pressure product, by 10% (p less than 0.05). Stress-induced myocardial ischemia decreased concurrently, indicating improvement of myocardial perfusion. Based on minimal lesion diameter, progression of coronary lesions was noted in nine patients (23%), no change in 18 patients (45%), and regression in 13 patients (32%). In the control group, metabolic and hemodynamic variables remained essentially unchanged, whereas progression of coronary lesions was noted in 25 patients (48%), no change in 18 patients (35%), and regression in nine patients (17%). These changes were significantly different from the intervention group (p less than 0.05). CONCLUSIONS: In patients participating in regular physical exercise and low-fat diet, coronary artery disease progresses at a slower pace compared with a control group on usual care.

Psychotherapy of bulimia nervosa: what is effective? A meta-analysis.

The present paper assesses the state of the art of psychotherapy of bulimia nervosa. Five hundred and fifty publications available up to April 1990 were systematically screened. Included in subsequent analysis were all studies with samples of five or more bulimic patients which used operational diagnostic criteria, and reported results of binging and vomiting or other means of purging quantitatively. Only 18 independent studies with a total of 433 patients in 24 treatments and 61 patients in 6 control groups fulfilled these criteria. Therapy outcome across studies was assessed meta-analytically. Therapy process across studies was assessed through ratings of interventions used (behavioural, cognitive, educational, humanistic, psychodynamic techniques and symptom-, conflict-, and relationship-orientation), setting and dose parameters. Settings were out-patients only, mostly group or individual. Most studies were on short-term therapies and follow-ups. Stepwise regression analysis revealed no definite advantage of one setting or therapeutic approach over another. Thirty-six per cent of variance was explained by the number of treatment sessions in combination with relationship orientation.