Chest
Volume 109, Issue 1, January 1996, Pages 52-56
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Clinical Investigations: Cardiology/Exercise
Effects of Cardiac Rehabilitation and Exercise Training in Obese Patients With Coronary Artery Disease

https://doi.org/10.1378/chest.109.1.52Get rights and content

Study objective

To determine the effects of cardiac rehabilitation and exercise training in obese coronary patients.

Design

We compared data before and after cardiac rehabilitation between obese and nonobese patients.

Setting

Two large teaching institutions.

Patients

116 obese (body mass index [BMI] ≥27.8 kg/m2 for men and ≥27.3 kg/m2 for women; mean, 31.2±3.2 kg/m2] and 198 (mean BMI, 24.6±2.1 kg/m2) nonobese patients with recent cardiac events.

Interventions

A 3-month (36-session) formal, outpatient phase 2 cardiac rehabilitation and supervised exercise training program.

Measurements and results

At baseline, obese patients had higher levels of total cholesterol (p<0.01), low-density lipoprotein-cholesterol (LDL-C [p<0.01]), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (p<0.01), percentage body fat (p<0.02), and a higher prevalence of hypertension (p<0.05) than the nonobese patients, but the prevalence of diabetes mellitus and of other coronary risk factors was similar. After cardiac rehabilitation, there were modest reductions in the prevalence of obesity (116 patients [37%] vs 104 patients [33%]) and severe obesity (BMI≥35 kg/m2 [3.5 vs 2.5%]), although these improvements were not statistically significant. The obese patients had improvements in exercise capacity (+24%; p<0.001), BMI (–3%;p<0.0001), LDL-C (–4%;p=0.07), HDL-C (+6%; p<0.001), and LDL-C/HDL-C ratio (–10%;p<0.01). Although reduction in BMI was greater in the obese patients (-3 vs 0%; p<0.0001), improvement in exercise capacity was greater in the nonobese (+36 vs +24%; p<0.01); improvements in lipid fractions and percentage body fat were statistically similar between the groups.

Conclusion

Modest reductions in BMI, obesity, and severe obesity occur after cardiac rehabilitation. In addition, obese patients demonstrate significant improvements in most coronary risk factors after rehabilitation, although improvements in exercise capacity are greater in nonobese patients. Potentially, more significant improvements in exercise capacity and lipid values may occur by specifically targeting obese patients for further weight reduction and exercise training after major cardiac events.

Section snippets

Patients

We reviewed data in 314 consecutive patients (160 from Massachusetts General Hospital and 154 from Ochsner Medical Institutions) who were referred to, attended, and completed outpatient phase 2 cardiac rehabilitation and exercise training programs. A subgroup of 116 patients were classified as obese by body mass index (BMI) criteria (BMI ≥27.8 kg/m2 in men and ≥27.3 kg/m2 in women) as previously described.23 These obese patients were compared with the 198 patients not classified as obese. All

RESULTS

The effects of cardiac rehabilitation and exercise training in the entire cohort are demonstrated in Table 1. Following cardiac rehabilitation, significant improvements were noted in triglycerides (–11%; p<0.0001), HDL-C (+7%; pcO.OOOl), LDL-C/HDL-C ratio (-9%; pcO.OOOl), BMI (-1.5%; p<0.0001), body fat (–6%; p<0.0001), and exercise capacity (+31%; pcO.OOOl). Improvements in total cholesterol (-2%; p=0.05), LDL-C (-3%; p=0.07), and weight (-1%; p<0.07) were of borderline statistical

DISCUSSION

Limited data are available regarding the effects of cardiac rehabilitation and exercise training in obese patients with CHD. The present report demonstrates modest but significant improvements in obesity indices, plasma lipids, and exercise capacity in a large cohort of obese coronary patients. However, although obese patients had statistically greater relative improvement in indices of obesity following cardiac rehabilitation programs than nonobese patients, they had significantly less

ACKNOWLEDGMENTS

The authors greatly appreciate the technical expertise of Barbara Broussard and Lauren Oddo, who prepared and edited the submitted manuscript, as well as the medical staffs of the cardiac rehabilitation programs at both Massachusetts General Hospital and Ochsner Medical Institutions.

REFERENCES (36)

  • LavieCJ et al.

    Left ventricular hypertrophy-its relationship to obesity and hypertension

    Postgrad Med

    (1992)
  • LavieCJ et al.

    Regression of increased left ventricular mass by antihypertensives

    Drugs

    (1991)
  • LawsA et al.

    Insulin resistance, hyperinsulinemia, dyslipidemia and cardiovascular disease

  • HubertHB et al.

    Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart study

    Circulation

    (1983)
  • MansonSE et al.

    A prospective study of obesity and risk of coronary heart disease in women

    N Engl J Med

    (1990)
  • WoodPD et al.

    Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise

    N Engl J Med

    (1988)
  • WilliamsPT et al.

    Changes in lipoprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men

    Circulation

    (1990)
  • ThompsonPD

    What do muscles have to do with lipoproteins?

    Circulation

    (1990)
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