title: The effect of weight loss and exercise training on flow-mediated dilatation in coronary heart disease: a randomized trial.
abstract: BACKGROUND
  More than 80% of patients entering cardiac rehabilitation are overweight, with a high prevalence of associated insulin resistance, diabetes, hypertension, hyperlipidemia, and a prothrombotic state. Because each of these characteristics is associated with abnormalities of endothelial-dependent flow-mediated dilatation (FMD), a predictor of long-term prognosis in patients with coronary heart disease (CHD), we assessed the effect of exercise training and weight reduction on FMD in overweight patients with CHD.
  
  
  METHODS
  All patients (N = 38) participated in behavioral weight loss while taking their usual preventive medications. Subjects were randomized to one of two exercise protocols, which differed by caloric expenditure. The primary outcome was extent (%) of brachial artery FMD measured by ultrasonography before and after the 4-month exercise and weight-loss program.
  
  
  RESULTS
  Both study groups experienced an increase in brachial artery FMD after weight loss and exercise. Patients randomized to the higher-caloric exercise condition (longer-distance walking) lost more weight (8.6 ± 4.1 kg vs 2.3 ± 3.3 kg [P < .001]) and experienced a greater percentage increase in brachial artery FMD (3.6% ± 4.1% vs 1.3% ± 2.1%, P < .05) than did subjects in the lower-caloric-expenditure exercise group who lost less weight. Both groups increased peak aerobic capacity similarly. Increased FMD correlated with changes in body weight more than with measures of abdominal fat, glucose disposal, lipid measure, BP, or measures of physical activity or cardiorespiratory fitness.
  
  
  CONCLUSIONS
  Exercise and weight loss increased FMD in overweight and obese patients with CHD. Greater weight reduction was associated with a greater improvement in FMD; thus, there was a dose effect.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00628277; URL: www.clinicaltrials.gov.
authors.affiliation: Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT. Electronic address: Philip.Ades@vtmednet.org.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades
authors.affiliation: Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Savage
authors.affiliation: Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lischke
authors.affiliation: Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Toth
authors.affiliation: Department of Nutrition, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Jean
authors.initials: J
authors.lastname: Harvey-Berino
authors.affiliation: Department of Biostatistics, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Janice Y
authors.initials: JY
authors.lastname: Bunn
authors.affiliation: Department of Nutrition, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: Maryann
authors.initials: M
authors.lastname: Ludlow
authors.affiliation: Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
authors.forename: David J
authors.initials: DJ
authors.lastname: Schneider
mesh_terms: D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000517:prevention & control / Q000534:rehabilitation*; D018752:Diet, Fat-Restricted; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000517:prevention & control*; D010809:Physical Fitness / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D014463:Ultrasonography; D015431:Weight Loss