Recommendation for Lifestyle Modifications in Stages A and B HF: Asymptomatic Patients at Risk for HF or With Structural Heart Disease Recommendation COR LOE Referenced Guideline References Exercise or regular physical activity is beneficial in prevention of cardiovascular disease and HF. I B COR indicates Class of Recommendation; HF, heart failure; and LOE, Level of Evidence. Table 14. Recommendations for Lifestyle Modifications in Stage C HF: Patients With Cardiac Structural Abnormalities or Remodeling With Prior or Current Symptoms of HF, Especially With Clustering Risk or Several Comorbidities at the Same Time Recommendations COR LOE Referenced Guideline References Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate to improve functional status. Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms. Otherwise, there are no specific recommendations for caloric intake or dietary composition. COR indicates Class of Recommendation; HF, heart failure; and LOE, Level of Evidence. Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES 7447 participants to 1 of 3 groups: the Mediterranean diet with extravirgin olive oil, the Mediterranean diet with 30 g of mixed nuts daily, or a control group with low-fat Participants had either type 2 diabetes mellitus or at least 3 major risk factors of smoking, hyperten- sion, increased low-density lipoprotein cholesterol, low high-density lipoprotein levels, overweight/obesity, or a family history of premature coronary heart disease. After a median follow-up of 4.8 years, there was a significant reduction in the primary end point (a composite of MI, stroke, or death resulting from cardiovascular causes) in both Mediterranean diet groups compared with the control group with a low-fat diet. 