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Excerpt
Purpose. To assess the long-term effects of physical exercise and low-fat diet on the progression of coronary artery disease.
Methods. One hundred thirteen men with coronary artery disease were randomized to an intervention group (n = 56) or a control group (n = 57); 90 patients (80%) could be reevaluated after 6 years.
Results. Patients in the intervention group (n = 40) showed a reduction in total serum cholesterol (6.03 + 1.03 versus 5.67 + 1.01 mmol/L; P < .03) and triglyceride levels (1.94 + 0.8 versus 1.6 + 0.89 mmol/L; P < .005) and maintained their initial body mass index (26 + 2 versus 27 + 2 kg/m2; P = not significant [NS]), but results were not statistically different from the control group (n = 50) (total serum cholesterol, 6.05 + 1.02 versus 5.79 + 0.88 mmol/L; triglycerides, 2.25 + 1.28 versus 1.85 + 0.96 mmol/L [both P = NS]; body mass index, 26 + 2 versus 28 + 3 kg/m2 [P < .0001]). In the intervention group, there was a significant 28% increase in physical work capacity (166 + 59 versus 212 + 89 W; P < .001), whereas values remained essentially unchanged in the control group (165 + 51 versus 170 + 60 W; P = NS; between groups, P < .05). In the intervention group, coronary stenoses progressed at a significantly slower rate than in the control group (P < .0001). Energy expenditure during exercise was assessed in a subgroup; patients with regression of coronary stenoses spent an average of 1784 + 384 kcal/wk (4 hours of moderate aerobic exercise per week). Multivariate regression analysis identified only physical work capacity as independently contributing to angiographic changes.
Conclusion. After 6 years of multifactorial risk intervention, there is significant and persistent improvement in lipoprotein levels and physical work capacity, which results in a significant retardation of disease progression. These beneficial effects appear to be largely due to chronic physical exercise.
Comment. The body of evidence showing that coronary artery disease progression can be retarded and even regressed through diet, exercise, and pharmacologic intervention is growing. These investigators from Germany are the only group that has followed patients for an extended period. This is probably the first intervention trial that provides evidence of an independent beneficial effect of regular exercise on the atherosclerotic process.
