title: Short-term effects of a hypocaloric diet and a physical activity programme on weight loss and exercise capacity in obese subjects with chronic ischaemic heart disease: a study in everyday practice.
abstract: OBJECTIVE
  The objective of this paper is to describe the effects of a rehabilitation programme in obese patients affected with chronic ischaemic heart disease; to identify the factors that influence weight loss and improvement in exercise capacity in everyday practice.
  
  
  RESULTS
  We studied 562 white patients (381 men) who followed a 23.3 +/- 3.9 days in-hospital programme. They attended daily sessions of aerobic activity (cycloergometer, walking, and strength exercise); a low-calorie diet was set at approximately 80% of resting energy expenditure. By the end of the programme BMI decreased from 38.0 +/- 4.9 to 36.7 +/- 4.8 kg/m2 (P < 0.001 ). Attained metabolic equivalents (METs) increased from 6.2 +/- 2.5 METs to 7.3 +/- 2.7 (P < 0.001). Age, sex, presence of diabetes and education level were significantly related to the outcomes. Patients who took beta-blockers and statins had less BMI improvement: -1.2 +/- 0.7 kg/m2 vs. -1.4 +/- 0.6 (P = 0.013) and -1.3 +/- 0.6 vs. -1.4 +/- 0.7 (P = 0.023), respectively. Patients that took diuretics and angiotensin receptor blockers (ARB) had less improvement in exercise capacity: 0.9 +/- 1.0 METS vs. 1.3 +/- 1.3 (P < 0.001) and 0.8 +/- 1.3 vs. 1.2 +/- 1.3 (P = 0.011 ), respectively. After a median interval of 358 days, 152 patients were seen at a follow-up visit: their BMI increased by 1.0 +/- 2.4 kg/m2 and only 21% of patients lost weight.
  
  
  CONCLUSIONS
  Rehabilitation improves exercise capacity and induces significant weight loss in obese patients with stable IHD, but women, diabetic, elderly and poorly educated subjects obtained unsatisfactory results. Use of diuretics and ARB seem to worsen the results. At follow-up only a small percentage of patients further improves BMI.
authors.affiliation: Unit of Cardiac Rehabilitation Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Verbania, Italy. gondoni@auxologico.it
authors.forename: Luca Alessandro
authors.initials: LA
authors.lastname: Gondoni
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Titon
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Nibbio
authors.forename: Giulia
authors.initials: G
authors.lastname: Caetani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Augello
authors.forename: Ornella
authors.initials: O
authors.lastname: Mian
authors.forename: Cristina
authors.initials: C
authors.lastname: Tuzzi
authors.forename: Eva
authors.initials: E
authors.lastname: Averna
authors.forename: Cinzia
authors.initials: C
authors.lastname: Parisio
authors.forename: Antonio
authors.initials: A
authors.lastname: Liuzzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D050528:Diet, Carbohydrate-Restricted / Q000379:methods; D018752:Diet, Fat-Restricted / Q000379:methods; D018753:Diet, Protein-Restricted / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D009765:Obesity / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*