title: A randomized trial comparing the effect of weight loss and exercise training on insulin sensitivity and glucose metabolism in coronary artery disease.
abstract: OBJECTIVE
  The majority of patients with coronary artery disease (CAD) exhibit abnormal glucose metabolism, which is associated with mortality even at non-diabetic glucose levels. This trial aims to compare the effects of a considerable weight loss and exercise with limited weight loss on glucose metabolism in prediabetic, CAD patients.
  
  
  RESULTS
  Seventy non-diabetic participants with CAD, BMI 28-40 kg/m(2), age 45-75 years were randomized to 12 weeks' aerobic interval training (AIT) at 90% peak heart rate three times weekly or a low energy diet (LED, 800-1,000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. Glucose tolerance, insulin action, β-cell function and suppression of lipolysis were assessed using a 3-h oral glucose tolerance test. ISI-composite and ISI-HOMA (=1/HOMA-IR) were calculated as surrogate measures of whole-body and hepatic insulin sensitivity, respectively. Magnetic resonance imaging estimated abdominal adipose tissue. Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. LED increased ISI-composite by 55% and ISI-HOMA by 70% (p<0.01) while AIT did not change insulin sensitivity (p>0.7) revealing a significant difference between the groups (p<0.05). No concurrent significant changes in lipolysis, β-cell responsiveness or insulin clearance were seen. Changes in ISI-HOMA and ISI-composite were associated with reduced visceral abdominal fat, waist circumference and body weight. Intention-to-treat analyses (n=64) yielded similar results.
  
  
  CONCLUSIONS
  LED is superior to AIT in improving insulin sensitivity in prediabetic CAD patients. Changes in insulin sensitivity are associated with decreased visceral abdominal fat, waist circumference and body weight.
authors: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: lrpedersen@gmail.com.
authors: Lene Rørholm
authors: LR
authors: Pedersen
authors: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Rasmus Huan
authors: RH
authors: Olsen
authors: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Anders
authors: A
authors: Jürs
authors: Department of Internal Medicine, Amager Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Christian
authors: C
authors: Anholm
authors: Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Mogens
authors: M
authors: Fenger
authors: Department of Internal Medicine, Amager Hospital, University of Copenhagen, Copenhagen, Denmark; The Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen Denmark.
authors: Steen Bendix
authors: SB
authors: Haugaard
authors: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Eva
authors: E
authors: Prescott
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001823:Body Composition / Q000502:physiology; D031204:Caloric Restriction; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs
chemical_list: D001786:Blood Glucose
keywords: Coronary artery disease; Exercise; Insulin resistance; Weight loss