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In Reply: Dr McCarthy and colleagues suggest that our physical activity goal of 30 min/d or more, while a substantial increase for our participants, may nonetheless have been insufficient to achieve and maintain weight loss. Based on available literature, we designed the physical activity component of our interventions to accomplish BP reduction. Testing the feasibility and efficacy of a longer physical activity goal as a means to control weight seems worthwhile, given the encouraging preliminary data cited by McCarthy et al. They also raise the possibility that, with continued intervention, fruit and vegetable intake may have increased over time. If true, this pattern would be distinctly different from other lifestyle behaviors in which recidivism rather than enhancement generally occurs over the long term.

We agree with Dr Blumenthal and colleagues that PREMIER did not test a "DASH-only intervention." We also agree that it is difficult to interpret the BP reduction . . . [Full Text of this Article]

Lawrence J. Appel, MD; Deborah Young, PhD; David Harsha, PhD; Eva Obarzanek, PhD; Vic Stevens, PhD; Laura Svetkey, MD; Patricia Elmer, PhD for the PREMIER Collaborative Research Group

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