High-Calorie Exercise in Cardiac Rehabilitation?Tuesday, June 16, 2009
Despite the fact that obesity is a well-established risk factor for coronary artery disease (CAD), traditional cardiac rehabilitation programs (highly recommended to anyone with significant CAD) pay lip service to weight control. In contrast much emphasis is placed on exercise and controlling other risk factors like smoking, LDL-cholesterol, blood pressure and diabetes. Thus, few people lose weight in cardiac rehab and those who do, quickly put it back on.
A recent paper, just published in CIRCULATION, now takes a new look at weight loss during cardiac rehab.
In this study, Philip Ades and colleagues from the University of Vermont, Burlington, VT, randomised 74 overweight patients with CAD to either high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) versus standard CR exercise (7 to 800 kcal/wk).
During the course of the study (5 months), high-calorie-expenditure exercise resulted in double the weight loss (8.2 vs. 3.7 kg) and fat mass loss (5.9 vs. 2.8 kg) and a greater waist reduction (-7 vs. -5 cm) than standard CR exercise.
High-calorie-expenditure exercise also had a greater effect on insulin resistance, high-density lipoprotein cholesterol and other components of the metabolic syndrome.
Not surprisingly, fat mass loss was the best predictor of improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%.
Significant weight loss was maintained at 1 year.
Clearly, the higher exercise dose had a greater beneficial effect than usual exercise.
Nevertheless, exercising with CAD is not without risk and it is strongly recommended that anyone with significant CAD does this only after consultation with their physician and even then, best under close professional supervision.