According to a commentary, an important issue in the interpretation of such life style trials is that prevention and early treatment of people at risk with statins and antihypertensive drugs might now confound lifestyle-intervention effects, since the absolute risk of cardiovascular disease is much lower than 20 years ago. In addition, regular follow-up of might modify outcomes, since participants might change their behaviour because they are being monitored, and they might also have better access to health services than the general population. Those who participate in lifestyle trials may also be more likely to be health conscious and well-motivated.
The commentator suggests that the results of these analyses lend support to the importance of increased physical activity and permanent weight reduction in the prevention of cardiovascular diseases in patients with type 2 diabetes, although some reservations remain because of the post-hoc nature of the analyses and the fact that participants in the trial were very obese. He nevertheless concludes that in line with findings from previous studies in different populations, these results show that adherence to lifestyle changes is mandatory to achieve health benefits in the long term.