High-calorie-expenditure exercise: a new approach to cardiac rehabilitation for overweight coronary patients.
BACKGROUND
More than 80% of patients entering cardiac rehabilitation (CR) are overweight, and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change.


RESULTS
We performed a randomized controlled clinical trial to evaluate the effect of high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) compared with standard CR exercise (7 to 800 kcal/wk) on weight loss and risk factors in 74 overweight patients with coronary heart disease. Both groups were counseled for weight loss and taking evidence-based preventive medications. High-calorie-expenditure exercise resulted in double the weight loss (8.2+/-4 versus 3.7+/-5 kg; P<0.001) and fat mass loss (5.9+/-4 versus 2.8+/-3 kg; P<0.001) and a greater waist reduction (-7+/-5 versus -5+/-5 cm; P=0.02) than standard CR exercise at 5 months. High-calorie-expenditure exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the ratio of total to high-density lipoprotein cholesterol and components of the metabolic syndrome, more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased high-density lipoprotein cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to high-density lipoprotein cholesterol (each P<0.05). Significant weight loss was maintained at 1 year.


CONCLUSIONS
High-calorie-expenditure exercise promotes greater weight loss and more favorable cardiometabolic risk profiles than standard CR for overweight coronary patients.
Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA. Philip.ades@vtmednet.org
Philip A
PA
Ades
Patrick D
PD
Savage
Michael J
MJ
Toth
Jean
J
Harvey-Berino
David J
DJ
Schneider
Janice Y
JY
Bunn
Marie C
MC
Audelin
Maryann
M
Ludlow
D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000517:prevention & control / Q000534:rehabilitation*; D004734:Energy Metabolism / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D050177:Overweight / Q000534:rehabilitation; D012046:Rehabilitation; D055105:Waist Circumference; D015431:Weight Loss / Q000502:physiology*
D008055:Lipids