University of Vermont College of Medicine, Burlington, 05482, USA.
J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):289-98. doi: 10.1097/HCR.0b013e3181d6f9a8.
Obesity is an independent risk factor for the development of coronary heart disease (CHD). At entry into cardiac rehabilitation (CR), more than 80% of patients are overweight and more than 50% have the metabolic syndrome. Yet, CR programs do not generally include weight loss programs as a programmatic component and weight loss outcomes in CR have been abysmal. A recently published study outlines a template for weight reduction based on a combination of behavioral weight loss counseling and an approach to exercise that maximized exercise-related caloric expenditure. This approach to exercise optimally includes walking as the primary exercise modality and eventually requires almost daily longer-distance exercise to maximize caloric expenditure. In addition, lifestyle activities such as stair climbing and avoidance of energy-saving devices should be incorporated into the daily routine. Risk factor benefits of weight loss and exercise training in overweight CHD patients are broad and compelling. Improvements in insulin resistance, lipid profiles, blood pressure, clotting abnormalities, endothelial-dependent vasodilatory capacity, and measures of inflammation such as C-reactive protein have all been demonstrated. Cardiac rehabilitation/secondary prevention programs can no longer ignore the challenge of obesity management in CHD patients. Individual programs need to develop clinically effective and culturally sensitive approaches to weight control. Finally, multicenter randomized clinical trials of weight loss in CHD patients with assessment of long-term clinical outcomes need to be performed.
肥胖是冠心病（CHD）发展的独立危险因素。在进入心脏康复（CR）时，超过 80%的患者超重，超过 50%的患者患有代谢综合征。然而，CR 计划通常不包括减肥计划作为计划组成部分，CR 中的减肥效果一直很差。最近发表的一项研究概述了一种基于行为减肥咨询和最大限度地提高与运动相关的热量消耗的运动方法相结合的减肥模板。这种运动方法最优化地包括将步行作为主要运动方式，最终需要几乎每天进行更长距离的运动以最大限度地消耗热量。此外，应将日常活动，如爬楼梯和避免节能设备，纳入日常生活中。超重 CHD 患者的减肥和运动训练的风险因素获益广泛且令人信服。已经证明了胰岛素抵抗、血脂谱、血压、凝血异常、内皮依赖性血管舒张能力以及 C 反应蛋白等炎症标志物的改善。心脏康复/二级预防计划再也不能忽视 CHD 患者肥胖管理的挑战。各个计划需要制定针对体重控制的临床有效和文化敏感的方法。最后，需要进行针对 CHD 患者减肥的多中心随机临床试验，并评估长期临床结局。
