Weight loss was greater in the intervention group than in the control group throughout the study (8.6% versus 0.7% at 1 year; 6.0% versus 3.5% at study end). The intensive lifestyle intervention produced greater reductions in glycated he- moglobin and greater initial improvements in fitness and all cardiovascular risk factors except for low-density-lipo- protein cholesterol levels but did not have a significant impact on cardiovascular events308 310 (Table 13). Does Multifactorial Lifestyle Modification Improve Outcomes in Patients With Established HF? There are few data on the application of a lifestyle modification program in the HF population. A small pilot study (n=20) randomized patients with HFrEF (EF <50%) and the metabolic syndrome to a lifestyle modification program modeled after the Look-AHEAD trial.240 months, the lifestyle group had not lost significantly more weight than the control group ( 0.56 3.7 kg for the control group versus 1.2 4.1 kg for the lifestyle group; P=0.71). Thus, there were no significant altera- tions in metabolic or functional parameters and biomark- ers. Importantly, the intervention, which included a hypo- caloric diet with meal replacement products and a home walking program, was not associated with adverse events related to weight loss or exercise. Current approaches for lifestyle modifications for a HF patient include a variety of approaches such as losing or maintaining normal weight, tracking daily fluid intake, avoiding alcohol, avoiding or limiting caffeine, eating a heart-healthy diet, being physically active, exercising, managing stress, keeping track of and monitoring BP, getting adequate rest, developing support, avoiding flu and pneumonia with vaccinations, and implementing other dietary interventions8 (Table 14). Given their im- portance in lifestyle modification, in the next sections, we focus on specific dietary interventions and exercise regimen. 