{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:55:25Z","timestamp":1793346925681,"version":"4.5.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Med"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) have a substantially increased risk for major cardiovascular events and mortality. Increasing physical activity and improving a healthy diet may effectively reduce cardiovascular risk factors; however, the effects are often transient. In a multicenter, 1:1 randomized controlled trial including 502 patients with combined CHD and T2DM (68\u2009\u00b1\u20098\u2009years; 84% men), we assessed the effects of a home-based telemedicine-supported lifestyle intervention (exercise training, nutritional recommendations and health literacy training) with regular individualized feedback versus usual care. The study met its primary endpoint of reduced glycated hemoglobin after 6\u2009months in favor of the lifestyle intervention group (mean between-group difference in the complete-case analysis (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009197 and\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009193), \u22120.13% (95% confidence interval, \u22120.25 to \u22120.01),\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.04). When individualized feedback and health literacy training were discontinued after 6\u2009months (while other telemedicine tools were maintained), no statistically significant between-group differences were observed at 12\u2009months. At 12\u2009months, 31 patients (6.2%) had a major adverse cardiovascular event (lifestyle intervention,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200920 (8.0%); usual care,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200911 (4.4%);\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.15), with the main reason being hospitalization for angina or revascularization (lifestyle intervention,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200915; usual care,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20098). There were five deaths (lifestyle intervention,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092; usual care,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093), none of which were categorized as related to the intervention. However, three events that resulted in hospitalization were categorized as potentially related to the intervention (decompensation of heart failure, vertebral disc prolapse and inguinal hernia). In conclusion, a home-based lifestyle intervention with telemedicine support showed modest effects in patients with CHD and T2DM. ClinicalTrials.gov registration:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03835923\" ext-link-type=\"uri\">NCT03835923<\/jats:ext-link>\n                    .\n                  <\/jats:p>","DOI":"10.1038\/s41591-025-03498-w","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T05:02:44Z","timestamp":1738904564000},"page":"1203-1213","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Telemedicine-supported lifestyle intervention for glycemic control in patients with CHD and T2DM: multicenter, randomized controlled trial"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4890-3981","authenticated-orcid":false,"given":"Stephan","family":"Mueller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2897-4291","authenticated-orcid":false,"given":"Sophia M. T.","family":"Dinges","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4366-5390","authenticated-orcid":false,"given":"Felix","family":"Gass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Fegers-Wustrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Treitschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"von Korn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8344-2476","authenticated-orcid":false,"given":"Alessandra","family":"Boscheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janosch","family":"Krotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6132-8913","authenticated-orcid":false,"given":"Felix","family":"Freigang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Dubois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ephraim B.","family":"Winzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Linke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Edelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Feuerstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Wolfram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3361-3722","authenticated-orcid":false,"given":"Marlo","family":"Verket","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Wolfarth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"D\u00f6rr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2231-2200","authenticated-orcid":false,"given":"Rolf","family":"Wachter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Hackenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Rust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Nebling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Amelung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3065-530X","authenticated-orcid":false,"given":"Martin","family":"Halle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"3498_CR1","doi-asserted-by":"publisher","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","volume":"80","author":"M Vaduganathan","year":"2022","unstructured":"Vaduganathan, M. et al. The global burden of cardiovascular diseases and risk: a compass for future health. J. Am. Coll. Cardiol. 80, 2361\u20132371 (2022).","journal-title":"J. Am. Coll. Cardiol."},{"key":"3498_CR2","doi-asserted-by":"publisher","DOI":"10.1177\/1479164120973676","volume":"17","author":"V Ritsinger","year":"2020","unstructured":"Ritsinger, V. et al. Diabetes, metformin and glucose lowering therapies after myocardial infarction: Insights from the SWEDEHEART registry. Diab. Vasc. Dis. Res. 17, 1479164120973676 (2020).","journal-title":"Diab. Vasc. Dis. Res."},{"key":"3498_CR3","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.jval.2015.07.003","volume":"18","author":"M Laxy","year":"2015","unstructured":"Laxy, M. et al. The burden of diabetes mellitus in patients with coronary heart disease: a methodological approach to assess quality-adjusted life-years based on individual-level longitudinal survey data. Value Health. 18, 969\u2013976 (2015).","journal-title":"Value Health."},{"key":"3498_CR4","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/eurheartj\/ehz486","volume":"41","author":"F Cosentino","year":"2020","unstructured":"Cosentino, F. et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 41, 255\u2013323 (2020).","journal-title":"Eur. Heart J."},{"key":"3498_CR5","doi-asserted-by":"publisher","first-page":"4043","DOI":"10.1093\/eurheartj\/ehad192","volume":"44","author":"N Marx","year":"2023","unstructured":"Marx, N. et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes: developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). Eur. Heart J. 44, 4043\u20134140 (2023).","journal-title":"Eur. Heart J."},{"key":"3498_CR6","doi-asserted-by":"publisher","first-page":"e779","DOI":"10.1161\/CIR.0000000000000766","volume":"141","author":"SV Arnold","year":"2020","unstructured":"Arnold, S. V. et al. Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation 141, e779\u2013e806 (2020).","journal-title":"Circulation"},{"key":"3498_CR7","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1016\/j.mayocp.2014.04.033","volume":"89","author":"QR Pack","year":"2014","unstructured":"Pack, Q. R. et al. The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis. Mayo Clin. Proc. 89, 1368\u20131377 (2014).","journal-title":"Mayo Clin. Proc."},{"key":"3498_CR8","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1093\/eurheartj\/ehac747","volume":"44","author":"GO Dibben","year":"2023","unstructured":"Dibben, G. O. et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur. Heart J. 44, 452\u2013469 (2023).","journal-title":"Eur. Heart J."},{"key":"3498_CR9","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1001\/jama.2011.576","volume":"305","author":"D Umpierre","year":"2011","unstructured":"Umpierre, D. et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305, 1790\u20131799 (2011).","journal-title":"JAMA"},{"key":"3498_CR10","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1007\/s00394-019-02147-6","volume":"59","author":"L Garc\u00eda-Molina","year":"2020","unstructured":"Garc\u00eda-Molina, L. et al. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur. J. Nutr. 59, 1313\u20131328 (2020).","journal-title":"Eur. J. Nutr."},{"key":"3498_CR11","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1056\/NEJMoa1212914","volume":"369","author":"The Look AHEAD Research Group.","year":"2013","unstructured":"The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New Engl. J. Med. 369, 145\u2013154 (2013).","journal-title":"New Engl. J. Med."},{"key":"3498_CR12","doi-asserted-by":"publisher","first-page":"2548","DOI":"10.2337\/dc14-0093","volume":"37","author":"MA Espeland","year":"2014","unstructured":"Espeland, M. A. et al. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care 37, 2548\u20132556 (2014).","journal-title":"Diabetes Care"},{"key":"3498_CR13","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","volume":"41","author":"J Knuuti","year":"2019","unstructured":"Knuuti, J. et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes: the task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur. Heart J. 41, 407\u2013477 (2019).","journal-title":"Eur. Heart J."},{"key":"3498_CR14","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1093\/eurheartj\/ehp398","volume":"31","author":"S Sixt","year":"2010","unstructured":"Sixt, S. et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur. Heart J. 31, 112\u2013119 (2010).","journal-title":"Eur. Heart J."},{"key":"3498_CR15","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1177\/1479164115590552","volume":"12","author":"R Byrkjeland","year":"2015","unstructured":"Byrkjeland, R. et al. Effects of exercise training on HbA1c and VO2 peak in patients with type 2 diabetes and coronary artery disease: a randomised clinical trial. Diab. Vasc. Dis. Res. 12, 325\u2013333 (2015).","journal-title":"Diab. Vasc. Dis. Res."},{"key":"3498_CR16","doi-asserted-by":"publisher","first-page":"706","DOI":"10.2337\/dc14-2216","volume":"38","author":"JJ Karjalainen","year":"2015","unstructured":"Karjalainen, J. J. et al. Effects of physical activity and exercise training on cardiovascular risk in coronary artery disease patients with and without type 2 diabetes. Diabetes Care 38, 706\u2013715 (2015).","journal-title":"Diabetes Care"},{"key":"3498_CR17","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1177\/2047487320939671","volume":"28","author":"M Scherrenberg","year":"2020","unstructured":"Scherrenberg, M. et al. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur. J. Prev. Cardiol. 28, 524\u2013540 (2020).","journal-title":"Eur. J. Prev. Cardiol."},{"key":"3498_CR18","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1177\/1474515119826510","volume":"18","author":"K Jin","year":"2019","unstructured":"Jin, K. et al. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review and meta-analysis. Eur. J. Cardiovasc. Nurs. 18, 260\u2013271 (2019).","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"3498_CR19","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1136\/bjsports-2021-105261","volume":"56","author":"F D\u2019Ascenzi","year":"2022","unstructured":"D\u2019Ascenzi, F. et al. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br. J. Sports Med. 56, 1180\u20131187 (2022).","journal-title":"Br. J. Sports Med."},{"key":"3498_CR20","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1177\/2047487318820420","volume":"26","author":"H Kemps","year":"2020","unstructured":"Kemps, H. et al. Exercise training for patients with type 2 diabetes and cardiovascular disease: what to pursue and how to do it. A position paper of the European Association of Preventive Cardiology (EAPC). Eur. J. Prev. Cardiol. 26, 709\u2013727 (2020).","journal-title":"Eur. J. Prev. Cardiol."},{"key":"3498_CR21","unstructured":"European Medicines Agency. Guideline on clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus, CPMP\/EWP\/1080\/00 Rev. 2. www.ema.europa.eu\/en\/documents\/scientific-guideline\/draft-guideline-clinical-investigation-medicinal-products-treatment-prevention-diabetes-mellitus_en.pdf (accessed 11 November 2021)."},{"key":"3498_CR22","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1007\/s00125-014-3303-z","volume":"57","author":"L Schwingshackl","year":"2014","unstructured":"Schwingshackl, L. et al. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia 57, 1789\u20131797 (2014).","journal-title":"Diabetologia"},{"key":"3498_CR23","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.2196\/jmir.5425","volume":"18","author":"C Arambepola","year":"2016","unstructured":"Arambepola, C. et al. The impact of automated brief messages promoting lifestyle changes delivered via mobile devices to people with type 2 diabetes: a systematic literature review and meta-analysis of controlled trials. J. Med. Internet Res. 18, e86 (2016).","journal-title":"J. Med. Internet Res."},{"key":"3498_CR24","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.diabres.2019.02.022","volume":"150","author":"R Haider","year":"2019","unstructured":"Haider, R. et al. Mobile phone text messaging in improving glycaemic control for patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 150, 27\u201337 (2019).","journal-title":"Diabetes Res. Clin. Pract."},{"key":"3498_CR25","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1089\/tmj.2019.0319","volume":"27","author":"TL Michaud","year":"2020","unstructured":"Michaud, T. L. et al. Assessing the impact of telemonitoring-facilitated lifestyle modifications on diabetes outcomes: a systematic review and meta-analysis. Telemed. J. E Health 27, 124\u2013136 (2020).","journal-title":"Telemed. J. E Health"},{"key":"3498_CR26","doi-asserted-by":"publisher","first-page":"841","DOI":"10.3390\/jcm12030841","volume":"12","author":"J Ja\u00e9n-Extremera","year":"2023","unstructured":"Ja\u00e9n-Extremera, J. et al. Effectiveness of telemedicine for reducing cardiovascular risk: a systematic review and meta-analysis. J. Clin. Med. 12, 841 (2023).","journal-title":"J. Clin. Med."},{"key":"3498_CR27","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005805","volume":"12","author":"X Huo","year":"2019","unstructured":"Huo, X. et al. Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus. Circ. Cardiovasc. Qual. Outcomes 12, e005805 (2019).","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"3498_CR28","doi-asserted-by":"publisher","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","volume":"42","author":"FLJ Visseren","year":"2021","unstructured":"Visseren, F. L. J. et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 42, 3227\u20133337 (2021).","journal-title":"Eur. Heart J."},{"key":"3498_CR29","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1001\/jama.2012.67929","volume":"308","author":"EW Gregg","year":"2012","unstructured":"Gregg, E. W. et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA 308, 2489\u20132496 (2012).","journal-title":"JAMA"},{"key":"3498_CR30","doi-asserted-by":"publisher","first-page":"726","DOI":"10.2337\/dc19-2165","volume":"43","author":"G Ferrannini","year":"2020","unstructured":"Ferrannini, G. et al. Screening for glucose perturbations and risk factor management in dysglycemic patients with coronary artery disease\u2014a persistent challenge in need of substantial improvement: a report from ESC EORP EUROASPIRE V. Diabetes Care 43, 726\u2013733 (2020).","journal-title":"Diabetes Care"},{"key":"3498_CR31","doi-asserted-by":"publisher","DOI":"10.1177\/14791641221113781","volume":"19","author":"SM Dinges","year":"2022","unstructured":"Dinges, S. M. et al. Cardiovascular risk factors, exercise capacity and health literacy in patients with chronic ischaemic heart disease and type 2 diabetes mellitus in Germany: baseline characteristics of the lifestyle intervention in chronic ischaemic heart disease and type 2 diabetes study. Diab. Vasc. Dis. Res. 19, 14791641221113781 (2022).","journal-title":"Diab. Vasc. Dis. Res."},{"key":"3498_CR32","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","volume":"37","author":"MF Piepoli","year":"2016","unstructured":"Piepoli, M. F. et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 37, 2315\u20132381 (2016).","journal-title":"Eur. Heart J."},{"key":"3498_CR33","volume":"8","author":"F Gass","year":"2022","unstructured":"Gass, F. et al. Telemedicine acceptance and efficacy in the context of preventive cardiology interventions: a systematic review. Digit. Health 8, 20552076221114186 (2022).","journal-title":"Digit. Health"},{"key":"3498_CR34","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1002\/jcsm.13409","volume":"15","author":"X Cai","year":"2024","unstructured":"Cai, X. et al. Cardiovascular effects of weight loss in old adults with overweight\/obesity according to change in skeletal muscle mass. J. Cachexia Sarcopenia Muscle 15, 342\u2013351 (2024).","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"3498_CR35","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1161\/CIRCULATIONAHA.119.043594","volume":"141","author":"X Jin","year":"2020","unstructured":"Jin, X. et al. Women\u2019s participation in cardiovascular clinical trials from 2010 to 2017. Circulation 141, 540\u2013548 (2020).","journal-title":"Circulation"},{"key":"3498_CR36","first-page":"58","volume":"67","author":"S Gl\u00e4ser","year":"2013","unstructured":"Gl\u00e4ser, S. et al. The Study of Health in Pomerania (SHIP) reference values for cardiopulmonary exercise testing. Pneumologie 67, 58\u201363 (2013).","journal-title":"Pneumologie"},{"key":"3498_CR37","doi-asserted-by":"publisher","first-page":"e042818","DOI":"10.1136\/bmjopen-2020-042818","volume":"11","author":"P von Korn","year":"2021","unstructured":"von Korn, P. et al. Lifestyle intervention in chronic ischaemic heart disease and type 2 diabetes (the LeIKD study): study protocol of a prospective, multicentre, randomised, controlled trial. BMJ Open 11, e042818 (2021).","journal-title":"BMJ Open"},{"key":"3498_CR38","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/HCR.0000000000000426","volume":"40","author":"JW Christle","year":"2020","unstructured":"Christle, J. W. et al. Interval endurance and resistance training as part of a community-based secondary prevention program for patients with diabetes mellitus and coronary artery disease. J. Cardiopulm. Rehabil. Prev. 40, 17\u201323 (2020).","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"3498_CR39","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1161\/CIRCULATIONAHA.116.022924","volume":"135","author":"\u00d8 Ellingsen","year":"2017","unstructured":"Ellingsen, \u00d8. et al. High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation 135, 839\u2013849 (2017).","journal-title":"Circulation"},{"key":"3498_CR40","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1001\/jama.2020.26812","volume":"325","author":"S Mueller","year":"2021","unstructured":"Mueller, S. et al. Effect of high-intensity interval training, moderate continuous training, or guideline-based physical activity advice on peak oxygen consumption in patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 325, 542\u2013551 (2021).","journal-title":"JAMA"},{"key":"3498_CR41","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1038\/s41591-024-03342-7","volume":"31","author":"F Edelmann","year":"2025","unstructured":"Edelmann, F. et al. Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: a randomized controlled trial. Nat. Med. 31, 306\u2013314 (2025).","journal-title":"Nat. Med."},{"key":"3498_CR42","unstructured":"American College of Sports Medicine. ACSM\u2019s Guidelines for Exercise Testing and Prescription, Eighth Edition (Wolters Kluwer\/Lippincott Williams & Wilkins, 2009)."},{"key":"3498_CR43","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1123\/jpah.8.6.794","volume":"8","author":"R Fuchs","year":"2011","unstructured":"Fuchs, R. et al. Long-term effects of a psychological group intervention on physical exercise and health: the MoVo concept. J. Phys. Act. Health 8, 794\u2013803 (2011).","journal-title":"J. Phys. Act. Health"},{"key":"3498_CR44","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s00394-010-0143-6","volume":"50","author":"V Schusdziarra","year":"2011","unstructured":"Schusdziarra, V. et al. Successful weight loss and maintenance in everyday clinical practice with an individually tailored change of eating habits on the basis of food energy density. Eur. J. Nutr. 50, 351\u2013361 (2011).","journal-title":"Eur. J. Nutr."},{"key":"3498_CR45","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","volume":"46","author":"S Michie","year":"2013","unstructured":"Michie, S. et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann. Behav. Med. 46, 81\u201395 (2013).","journal-title":"Ann. Behav. Med."},{"key":"3498_CR46","doi-asserted-by":"publisher","first-page":"620383","DOI":"10.3389\/fdgth.2021.620383","volume":"3","author":"J Mart\u00edn-Mart\u00edn","year":"2021","unstructured":"Mart\u00edn-Mart\u00edn, J. et al. Behavior change techniques and the effects associated with digital behavior change interventions in sedentary behavior in the clinical population: a systematic review. Front. Digit. Health 3, 620383 (2021).","journal-title":"Front. Digit. Health"},{"key":"3498_CR47","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.jand.2012.05.008","volume":"112","author":"MA Sevick","year":"2012","unstructured":"Sevick, M. A. et al. Biophysiologic outcomes of the enhancing adherence in type 2 diabetes (ENHANCE) trial. J. Acad. Nutr. Diet. 112, 1147\u20131157 (2012).","journal-title":"J. Acad. Nutr. Diet."},{"key":"3498_CR48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","volume":"45","author":"S Van Buuren","year":"2011","unstructured":"Van Buuren, S. & Groothuis-Oudshoorn, K. mice: multivariate imputation by chained equations in R. J. Stat. Softw. 45, 1\u201367 (2011).","journal-title":"J. Stat. Softw."}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03498-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03498-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03498-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T14:02:11Z","timestamp":1744812131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03498-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,7]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["3498"],"URL":"https:\/\/doi.org\/10.1038\/s41591-025-03498-w","relation":{},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,7]]},"assertion":[{"value":"13 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"S.M. reported personal fees from Bristol-Myers Squibb (consulting services) outside the submitted work. E.B.W. reported grants from Boehringer Ingelheim and personal fees from Amarin, Amgen, AstraZeneca, Daiichi Sankyo, Bayer, Boehringer Ingelheim, CVRx and Novartis outside the submitted work. A.L. reported personal fees from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, AstraZeneca, Novartis, Pfizer, Abiomed, Bayer and Boehringer Ingelheim outside the submitted work. F.E. reported personal fees from AstraZeneca, Bayer, Berlin Chemie, Boehringer Ingelheim, CVRx, Medtronic, Merck, MSD, Novartis, Pfizer, PharmaCosmos, Resmed, Servier and Vifor Pharma; nonfinancial support from Novartis and grants from AstraZeneca, Boehringer Ingelheim, Servier and Thermo Fischer Scientific outside the submitted work. R.W. reported personal fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, CVRx, Daiichi, Medtronic, Novartis, Pfizer, Pharmacosmos and Servier and research support from Boehringer Ingelheim, Bundesministerium f\u00fcr Bildung und Forschung, Deutsche Forschungsgemeinschaft and European Union and Medtronic outside the submitted work. V.A. reported personal fees from MSD, Berlin Chemie, Janssen, Coloplast and Novo Nordisk (consulting fees and honoraria for lectures) and is the president of the German Managed Care Association (2007\u20132022) outside the submitted work. M.H. reported honoraria for lectures from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Lilly, Medi, Novartis, Pfizer and Roche; consulting fees from Medical Park and is the past president of the European Association of Preventive Cardiology (presidency 2020\u20132022) outside the submitted work. All other authors declare no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}