Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont College of Medicine, South Burlington, VT.
Chest. 2011 Dec;140(6):1420-1427. doi: 10.1378/chest.10-3289. Epub 2011 Jul 21.
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.
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.
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.
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.
ClinicalTrials.gov; No.: NCT00628277; URL: www.clinicaltrials.gov.
超过 80%进入心脏康复的患者超重，且普遍存在胰岛素抵抗、糖尿病、高血压、高血脂和血栓前状态。由于这些特征中的每一个都与内皮依赖性血流介导的扩张（FMD）异常有关，而后者是冠心病（CHD）患者长期预后的预测因素，因此我们评估了超重 CHD 患者的运动训练和体重减轻对 FMD 的影响。
所有患者（N=38）在服用常规预防药物的同时参与行为性减肥。将受试者随机分为两种运动方案之一，两种方案的区别在于热量消耗。主要结局是超声测量的肱动脉 FMD 在 4 个月运动和减肥计划前后的变化程度（%）。
两组患者在减肥和运动后肱动脉 FMD 均增加。随机分配到高卡路里运动组（长距离步行）的患者体重减轻更多（8.6±4.1kg 比 2.3±3.3kg[P<0.001]），肱动脉 FMD 的增加百分比也更大（3.6%±4.1%比 1.3%±2.1%，P<0.05），而低卡路里运动组患者体重减轻较少。两组的最大有氧能力均增加。FMD 的增加与体重变化相关，而与腹部脂肪、葡萄糖处置、血脂测量、血压或体力活动或心肺适应能力的测量无关。
运动和体重减轻增加了超重和肥胖 CHD 患者的 FMD。体重减轻幅度越大，FMD 的改善越大，存在剂量效应。
ClinicalTrials.gov；编号：NCT00628277；网址：www.clinicaltrials.gov。
