For patients who continue to have an elevated non HDL-C while on adequate statin therapy, niacin or fibratei therapy32,35,41 (Level of Evidence: B) or fish oil (Level of Evidence: C) may be reasonable. 3. For all patients, it may be reasonable to recommend omega-3 fatty acids from fish or fish oil capsules (1 g/d) for cardiovascular disease risk reduction.44 46 (Level of Evidence: B) Physical activity Class I Goal: At least 30 minutes, 7 days per week (minimum 5 days per week) 1. For all patients, the clinician should encourage 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, at least 5 days and preferably 7 days per week, supplemented by an increase in daily lifestyle activities (eg, walking breaks at work, gardening, household work) to improve cardiorespiratory fitness and move patients out of the least fit, least active high-risk cohort (bottom 20%).54,55,58 (Level of Evidence: B) 2. For all patients, risk assessment with a physical activity history and/or an exercise test is recommended to guide prognosis and prescription.47 52,58 (Level of Evidence: B) 3. The clinician should counsel patients to report and be evaluated for symptoms related to exercise. (Level of Evidence: C) Class IIa 1. It is reasonable for the clinician to recommend complementary resistance training at least 2 days per week.59 (Level of Evidence: C) Weight management Class I Goals: Body mass index: 18.5 to Waist circumference: women ,35 inches (,89 cm), men 1. Body mass index and/or waist circumference should be assessed at every visit, and the clinician should consistently encourage weight maintenance/reduction through an appropriate balance of lifestyle physical activity, structured exercise, caloric intake, and formal behavioral programs when indicated to maintain/achieve a body mass index .60 62,65 70 (Level of Evidence: B) 2. 