Walking reduces risks in heart patients

An exercise program that burns a lot of calories reduced cardiac risk factors better than standard cardiac rehabilitation in overweight coronary patients, researchers report in Circulation: Journal of the American Heart Association.

“The higher-caloric exercise, consisting of almost daily long-distance walking, resulted in double the weight loss and a greater fat mass loss than standard cardiac rehabilitation exercise,” said Philip A. Ades, M.D., lead author of the study and professor of medicine and director of cardiac rehabilitation and prevention at the University of Vermont College of Medicine in Burlington. “And probably most importantly, these patients improved their insulin sensitivity to a greater degree.”

The high-calorie expenditure regime was not more intensive than rehabilitation, but longer duration at lower intensity on more days.

In a first-of-its-kind study, researchers randomized 74 overweight cardiac rehabilitation patients (average age 64, 20 percent women) to either a high-caloric expenditure exercise regimen intended to burn 3,000 to 3,500 calories a week or a standard rehab therapy burning 700 to 800 calories weekly.

After five months, compared to the group doing traditional rehabilitation, patients in the high-calorie-burning group had:

? significantly greater improvement in 10 heart risk factors, including insulin sensitivity (a hallmark of the metabolic syndrome), total cholesterol and the total cholesterol/good cholesterol ratio, blood pressure, and cardio-respiratory fitness; and

? a greater average reduction in weight (18 vs. 8 pounds), body fat, (13 vs. 6 pounds) and waistlines (2.7 vs. 2 inches).

Researchers said all of these changes were statistically significant.

“Cardiac rehab has essentially remained the same since the 1970s because it has a mortality benefit,” Ades said. “But it doesn’t burn many calories and things have changed. Eighty percent of our rehabilitation patients are now overweight and many of them are becoming diabetic. It’s a different time in terms of what we need to do in cardiac rehab.”

Excessive weight increases the risk of heart attacks and is associated with an increase in other heart risks factors, including high cholesterol, hypertension and diabetes.

High-calorie-expenditure exercise consisted of walking for 45 to 60 minutes a day at a moderate pace ? a lower speed than standard therapy ? for five to six days a week. Standard rehabilitation involved walking, biking or rowing for 25 to 40 minutes at a brisker pace three times a week.

While standard rehabilitation has benefit, the high-calorie-burning exercise increased the benefit, which is crucial with the increasing prevalence of obesity, researchers noted.

Source: American Heart Association, USA

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