The Transtheoretical Model of behavior change is based on stages of change. The theory relies on the obser- vation that many individuals traverse 5 distinct temporal processes in achieving permanent change. These in- clude precontemplation, contemplation, preparation, ac- tion, and maintenance. Application of this model of change entails categorizing an individual s progress in the process of change and recognizing that cycling through phases is common in the process of achieving The interventions described above should be provided within a medical environment that provides coordinated, team-based care. Data accumulating from interventions that incorporate principles of the chronic care model,479 such as the patient-centered medical home, have demonstrated bene- ficial effects not only on intermediate outcomes such as glycemic and BP but also on cost, utilization, and mortality rate.480,481 This approach depends on the active participation of an engaged, informed patient, which in turn relies on the patient s understanding of his or her condition, ability to adhere safely to complex medical therapies, and willingness to communicate on a regular basis with the healthcare team. In addition to counseling about the approach to management of SIHD and risk reduction, patients often seek information about other aspects of their health, particularly issues that are often not directly addressed by healthcare providers. One such topic that commonly arises is possible restric- tions on sexual activity. Regrettably, there are relatively limited scientific data on the cardiovascular demands and potential risks of sexual activity in patients with heart disease, some of it dating back 3 or 4 decades and nearly all of it dealing with men. 