exercise and progression of cardiovascular disease

From: Doug Skrecky (oberon@vcn.bc.ca)
Date: Thu Nov 19 1998 - 22:37:27 MST


Authors
  Hambrecht R. Niebauer J. Marburger C. Grunze M. Kalberer B. Hauer K.
  Schlierf G. Kubler W. Schuler G.
Institution
  Department of Cardiology, Medizinische Universitatsklinik, Heidelberg,
  Germany.
Title
  Various intensities of leisure time physical activity in patients with
  coronary artery disease: effects on cardiorespiratory
  fitness and progression of coronary atherosclerotic lesions
  [see comments].
Comments
  Comment in: J Am Coll Cardiol 1993 Aug;22(2):478-9
Source
  Journal of the American College of Cardiology. 22(2):468-77, 1993 Aug.
Abstract
  OBJECTIVES. This study was designed to define the effect of different levels
  of leisure time physical activity on cardiorespiratory
  fitness and progression of coronary atherosclerotic lesions
  in unselected patients with coronary artery disease. BACKGROUND. It has been
  shown in various studies that regression of coronary atherosclerotic lesions
  can be achieved by means of lipid-lowering drugs, reduction of fat
  consumption and physical exercise. METHODS. Patients were prospectively
  randomized either to an intervention group (n = 29) participating in regular
  physical exercise or to a control group (n = 33) receiving usual care. Energy
  expenditure in leisure time physical activity was estimated from standardized
  questionnaires and from participation in group exercise sessions. After 12
  months of participation, repeat coronary angiography was performed; coronary
  lesions were measured by digital image processing. RESULTS. After 1 year,
  patients in the intervention group achieved an increase in oxygen uptake at a
  ventilatory threshold of 7% (p < 0.001) and peak exercise of 14% (p < 0.05),
  whereas a significant decrease was observed in patients in the control group.
  To achieve significant improvement in cardiorespiratory
  fitness, approximately 1,400 kcal/week had to be expended in
  the form of leisure time physical activity (p < 0.001). The mean energy
  expended in such activity was 1,876 +/- 163 kcal/week in the intervention
  group and 1,187 +/- 97 kcal/week in the control group (p < 0.001). In the
  intervention group, regression of coronary artery disease was noted in 8
  patients (28%), progression of disease in 3 (10%) and no change in coronary
  morphology in 18 (62%). In contrast, coronary artery disease progressed at a
  significantly faster rate in patients in the control group (progression in
  45%, no change in 49% and regression in 6%) (p < 0.001 vs. intervention).
  When the two groups were combined, the lowest level of leisure time physical
  activity was noted in patients with progression of disease (1,022 +/- 142
  kcal/week) as opposed to patients with no change (1,533 +/- 122 kcal/week) or
  regression of disease (2,204 +/- 237 kcal/week) (p < 0.005). CONCLUSIONS.
  Measurable improvement in cardiorespiratory
  fitness requires approximately 1,400 kcal/week of leisure
  time physical activity; higher work loads are necessary to halt progression
  of coronary atherosclerotic lesions (1,533 +/- 122 kcal/week), whereas
  regression of coronary lesions is observed only in patients expending an
  average of 2,200 kcal/week in leisure time physical activity, amounting to
  approximately 5 to 6 h/week of regular physical exercise.



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