Savage Patrick D, Brochu Martin, Poehlman Eric T, Ades Philip A
Division of Cardiology, University of Vermont College of Medicine, Burlington, Vt, USA.
Am Heart J. 2003 Aug;146(2):317-23. doi: 10.1016/S0002-8703(02)94706-X.
The majority of patients with coronary heart disease (CHD) are overweight. However, little weight loss occurs with participation in a standard cardiac rehabilitation (CR) program.
Fifteen overweight patients (average body mass index of 31.0 kg/m2) with CHD completed a 4-month exercise training program in a CR program. The exercise program consisted primarily of walking long duration (60-90 minutes per session) 5 to 7 days per week at a relatively low intensity of 50% to 60% of peak VO2. Measures of body composition by dual-energy x-ray absorptiometry, body fat distribution by computed tomography, plasma lipid-lipoprotein, glucose and insulin concentrations, and peak VO2 were obtained before and after the exercise intervention. Patients maintained an isocaloric diet throughout the study.
Patients had reductions in total body weight (-4.6 kg), fat mass (-3.6 kg), percent body fat (-2.9%), and waist circumference (-5.6 cm) (all P <.001) while maintaining fat-free mass. Subcutaneous adipose tissue was reduced by 12% (P <.001) and visceral adipose tissue was lowered by 14% (P <.001). There were favorable changes in the lipid-metabolic profile with reductions in triglyceride levels (-23.7%), total cholesterol/HDL-C ratio (-14.3%), and fasting insulin levels (-22.3%) (all P <.05). Peak VO2 increased by 21.2% (P <.001).
The present pilot study results suggest that a high caloric training exercise training program in the CR setting may be effective in promoting weight loss and improving coronary risk factors in overweight coronary patients. Although additional research with randomized control patients is needed, this alternative to traditional CR may be considered to maximize weight loss as part of a secondary prevention program.
大多数冠心病（CHD）患者超重。然而，参与标准心脏康复（CR）计划后体重减轻很少。
15名超重的冠心病患者（平均体重指数为31.0kg/m²）在CR计划中完成了一项为期4个月的运动训练计划。运动计划主要包括每周5至7天进行长时间步行（每次60 - 90分钟），强度相对较低，为峰值VO₂的50%至60%。在运动干预前后，通过双能X线吸收法测量身体成分，通过计算机断层扫描测量体脂分布，测量血浆脂质 - 脂蛋白、葡萄糖和胰岛素浓度以及峰值VO₂。患者在整个研究过程中保持等热量饮食。
患者总体重减轻（-4.6kg）、脂肪量减轻（-3.6kg）、体脂百分比降低（-2.9%）和腰围减小（-5.6cm）（所有P <.001），同时保持去脂体重。皮下脂肪组织减少了12%（P <.001），内脏脂肪组织减少了14%（P <.001）。脂质代谢谱有良好变化，甘油三酯水平降低（-23.7%）、总胆固醇/高密度脂蛋白胆固醇比值降低（-14.3%）和空腹胰岛素水平降低（-22.3%）（所有P <.05）。峰值VO₂增加了21.2%（P <.001）。
本初步研究结果表明，在CR环境中进行的高热量训练运动训练计划可能有效地促进超重冠心病患者的体重减轻并改善冠心病危险因素。尽管需要对随机对照患者进行更多研究，但作为二级预防计划的一部分，这种替代传统CR的方法可能被认为可最大限度地减轻体重。
