Lavie C J, Milani R V
Department of Internal Medicine, Cardiovascular Health Center of Ochsner Heart and Vascular Institute, New Orleans, LA 70121, USA.
Chest. 1996 Jan;109(1):52-6. doi: 10.1378/chest.109.1.52.
To determine the effects of cardiac rehabilitation and exercise training in obese coronary patients.
We compared data before and after cardiac rehabilitation between obese and nonobese patients.
Two large teaching institutions.
116 obese (body mass index [BMI] > or = 27.8 kg/m2 for men and > or = 27.3 kg/m2 for women; mean, 31.2 +/- 3.2 kg/m2] and 198 (mean BMI, 24.6 +/- 2.1 kg/m2) nonobese patients with recent cardiac events.
A 3-month (36-session) formal, outpatient phase 2 cardiac rehabilitation and supervised exercise training program.
At baseline, obese patients had higher levels of total cholesterol (p < 0.01), low-density lipoprotein-cholesterol (LDL-C [p < 0.01]), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (p < 0.01), percentage body fat (p < 0.02), and a higher prevalence of hypertension (p < 0.05) than the nonobese patients, but the prevalence of diabetes mellitus and of other coronary risk factors was similar. After cardiac rehabilitation, there were modest reductions in the prevalence of obesity (116 patients [37%] vs 104 patients [33%]) and severe obesity (BMI > or = 35 kg/m2 [3.5 vs 2.5%]), although these improvements were not statistically significant. The obese patients had improvements in exercise capacity (+24%; p < 0.001), BMI (-3%; p < 0.0001), LDL-C (-4%; p = 0.07), HDL-C (+6%; p < 0.001), and LDL-C/HDL-C ratio (-10%; p < 0.01). Although reduction in BMI was greater in the obese patients (-3 vs 0%; p < 0.0001), improvement in exercise capacity was greater in the nonobese (+36 vs +24%; p < 0.01); improvements in lipid fractions and percentage body fat were statistically similar between the groups.
Modest reductions in BMI, obesity, and severe obesity occur after cardiac rehabilitation. In addition, obese patients demonstrate significant improvements in most coronary risk factors after rehabilitation, although improvements in exercise capacity are greater in nonobese patients. Potentially, more significant improvements in exercise capacity and lipid values may occur by specifically targeting obese patients for further weight reduction and exercise training after major cardiac events.
确定心脏康复和运动训练对肥胖冠心病患者的影响。
我们比较了肥胖和非肥胖患者心脏康复前后的数据。
两家大型教学机构。
116名肥胖患者（男性体重指数[BMI]≥27.8kg/m²，女性≥27.3kg/m²；平均31.2±3.2kg/m²）和198名非肥胖患者（平均BMI 24.6±2.1kg/m²），均有近期心脏事件。
为期3个月（36节课程）的正规门诊二期心脏康复及有监督的运动训练项目。
基线时，肥胖患者的总胆固醇水平（p<0.01）、低密度脂蛋白胆固醇（LDL-C[p<0.01]）、LDL-C/高密度脂蛋白胆固醇（HDL-C）比值（p<0.01）、体脂百分比（p<0.02）以及高血压患病率（p<0.05）均高于非肥胖患者，但糖尿病及其他冠心病危险因素的患病率相似。心脏康复后，肥胖患病率（116例患者[37%]对104例患者[33%]）和重度肥胖患病率（BMI≥35kg/m²[3.5%对2.5%]）有适度降低，尽管这些改善无统计学意义。肥胖患者的运动能力提高（+24%；p<0.001）、BMI降低（-3%；p<0.0001）、LDL-C降低（-4%；p=0.07）、HDL-C升高（+6%；p<0.001）以及LDL-C/HDL-C比值降低（-10%；p<0.01）。虽然肥胖患者的BMI降低幅度更大（-3%对0%；p<0.0001），但非肥胖患者的运动能力提高幅度更大（+36%对+24%；p<0.01）；两组间血脂成分和体脂百分比的改善在统计学上相似。
心脏康复后BMI、肥胖及重度肥胖有适度降低。此外，肥胖患者康复后多数冠心病危险因素有显著改善，尽管非肥胖患者的运动能力改善更大。在重大心脏事件后，通过专门针对肥胖患者进一步减重和运动训练，运动能力和血脂值可能会有更显著改善。
