Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.
OBJECTIVE
To determine the effects of cardiac rehabilitation and exercise training in obese coronary patients.


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


METHODS
Two large teaching institutions.


METHODS
116 obese (body mass index [BMI] > or = 27.8 kg/m2 for men and > or = 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.


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


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 > or = 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.


CONCLUSIONS
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.
Lavie
C J
CJ
Department of Internal Medicine, Cardiovascular Health Center of Ochsner Heart and Vascular Institute, New Orleans, LA 70121, USA.
Milani
R V
RV
D000273:Adipose Tissue / Q000473:pathology; D000553:Ambulatory Care; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000534:rehabilitation*; D048909:Diabetes Complications; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D002784:Cholesterol