From exercise to diet, many are still not doing nearly enough to prevent heart disease or prevent second heart attacks and stroke, a new study finds.

Data on 97,000 men and women from 20 states reveal that only about two-thirds of men and women reported exercising, and two-thirds to three-quarters reported changing their diet.

The sample was made up of a cross-spectrum of people at various levels of risk for heart disease, who participated in the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, according to a report in the June issue of the American Journal of Preventive Medicine.

The data are especially worrying among the 14 percent of men and 12 percent of women who are at the greatest risk because they are diabetics or have a history of heart attack, stroke or heart disease.

Dr. Catherine Kim is an assistant professor in the departments of internal medicine and obstetrics and gynecology at the University of Michigan Medical School. "The reports of people actually dieting and exercising were not as good as they could have been," Kim said.

The CDC's Division of Diabetes Translation found doctors failed to give advice on diet and exercise often enough.

The research team found women were slightly more likely than men to diet and exercise, except among high-risk patients, where men were almost equal to women in exercising.

Even though diet and exercise advice from a doctor has never been shown to affect behavior, "it's cheap advice, it's probably not harmful, and should be brought up in the context of a checkup," Kim said.

In terms of diet and exercise, people aren't doing it. "It is really something that has been shown to lower your risk of disease. Folks need to make major lifestyle changes," Kim said.

"If you don't feel that you can do that, you need to ask for help from your doctor or nutritionist or a weight loss program," she added.

Dr. David L. Katz, an associate clinical professor and director of the Prevention Research Center at Yale University School of Medicine, said "it is remarkably difficult to convince women that heart disease affects them, too."

Even though 10 times as many women die of heart disease as die of breast cancer, "breast cancer remains a far more feared and provocative topic for women than heart disease," he said.

That women make a greater effort with lifestyle -- particularly diet -- is not surprising either, Katz said. "Diet offers many potential benefits, including weight control, and thus this effort may be related to concerns quite distinct from heart disease prevention."

"The challenge is getting the right people to apply the right preventive strategies at the right times for the right reasons," Katz said.

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