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  1. Brinkley, Tina E. PhD
  2. Hsu, Fang-Chi PhD
  3. Bowman, Benita M. BS
  4. Addison, Theresa MS
  5. Kitzman, Dalane W. MD
  6. Houston, Denise K. PhD, RD


Purpose: Cardiac rehabilitation (CR) programs are integral in the treatment of coronary heart disease (CHD). However, most programs do not incorporate structured, evidence-based obesity treatment, potentially limiting efficacy for the large number of CHD patients with overweight/obesity. This pilot study determined the feasibility of adding a behavioral weight loss intervention during standard CR.


Methods: Adults aged >=40 yr with CHD and overweight/obesity were randomized to 6 mo of CR alone or CR plus a behavioral weight loss program incorporating meal replacements and individual dietary counseling (CR + WL). Body weight, adiposity, cardiometabolic risk factors, self-efficacy for eating, and stages and processes of change for weight management (S-Weight, P-Weight) were assessed at baseline and during follow-up.


Results: Thirty-eight participants (64.5 +/- 7.9 yr, 24% female, 16% Black/Hispanic) were enrolled over 18 mo. Retention was high, with 95% of participants completing the 6-mo follow-up visit. Participants attended ~58% of the prescribed exercise sessions, and those in the CR + WL group attended 98% of the prescribed weight loss sessions. The CR + WL group lost significantly more weight than the CR group (6.4 +/- 4.7% vs 1.2 +/- 3.0%, P = .001), and there were significant treatment effects for total/regional adiposity, eating self-efficacy, and P-weight scores (all P values < .05). Overall, greater weight loss was associated with improvements in self-efficacy (P = .014) and P-weight scores for weight consequences evaluation (P = .007) and weight management actions (P = .04).


Conclusions: A behavioral weight loss intervention during CR is feasible and safe, leading to greater weight and fat loss and related improvements in weight maintenance behaviors in overweight/obese adults with CHD.