Short-term effects of a hypocaloric diet and a physical activity programme on weight loss and exercise capacity in obese subjects with chronic ischaemic heart disease: A study in everyday practice

Objective - The objective of this paper is to describe the effects of a rehabilitation programme in obese patients affected with chronic ischaemic heart disease; to identify the factors that influence weight loss and improvement in exercise capacity in everyday practice. Methods and results - We studied 562 white patients (381 men) who followed a 23.3 ± 3.9 days in-hospital programme. They attended daily sessions of aerobic activity (cycloergometer, walking, and strength exercise); a low-calorie diet was set at approximately 80% of resting energy expenditure. By the end of the programme BMI decreased from 38.0 ± 4.9 to 36.7 ± 4.8 kg/m² (P <0.001). Attained metabolic equivalents (METs) increased from 6.2 ± 2.5 METs to 7.3 ± 2.7 (P <0.001). Age, sex, presence of diabetes and education level were significantly related to the outcomes. Patients who took beta-blockers and statins had less BMI improvement: -1.2 ± 0.7 kg/m² vs.-1.4 ± 0.6 (P = 0.013) and -1.3 ± 0.6 vs. -1.4 ± 0.7 (P = 0.023), respectively. Patients that took diuretics and angiotensin receptor blockers (ARB) had less improvement in exercise capacity: 0.9 ± 1.0 METS vs. 1.3 ± 1.3 (P <0.001) and 0.8 ± 1.3 vs. 1.2 ± 1.3 (P = 0.011), respectively. After a median interval of 358 days, 152 patients were seen at a follow-up visit: their BMI increased by 1.0 ± 2.4 kg/m ² and only 21% of patients lost weight. Conclusions - Rehabilitation improves exercise capacity and induces significant weight loss in obese patients with stable IHD, but women, diabetic, elderly and poorly educated subjects obtained unsatisfactory results. Use of diuretics and ARB seem to worsen the results. At follow-up only a small percentage of patients further improves BMI.