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experts to depend on meta-analyses or large retrospective data cohorts. Cardiac Rehabilitation and Exercise Training and Obesity
One of the most publicized was undertaken by O’Connor and colleagues Although obesity is a strong risk factor for CHD and HF, many studies have
nearly two decades ago, and studied 22 RCTs involving 4,500 patients been published on an ‘obesity paradox’ among cardiac patients. Numerous
followed for three years after CRET. The study determined reductions in studies have reported a better prognosis and lower mortality in obese
total mortality, cardiovascular mortality, and fatal MI of 20, 22, and 25%, patients as opposed to lean cardiac patients.
Some have even questioned
More recently, Witt and colleagues at the Mayo Clinic the benefits of purposeful weight loss for obese patients with advanced
analyzed nearly 2,000 patients with incident MIs over 20 years in heart disease. At the ACC meeting we also addressed the ‘obesity paradox’
Unlike the dismal participation in CRET across most of in a study of 529 patients following CHD events, since mortality was lower
the US, 55% participated in CRET in Olmsted county, although in the obese patients than the non-obese patients.
women and elderly patients >70 years of age showed 55 and 75% overweight and obese CHD patients, those who were successful with weight
less participation, respectively. Survival over three years was 95% in reduction during CRET showed more marked benefits on obesity indices,
participants versus 64% in non-participants after adjusting for baseline plasma lipids, fasting glucose, and HSCRP compared with overweight and
factors (p<0.001), and the benefit was greater in 1998 than in 1982, obese patients who did not lose weight. Moreover, we demonstrated that
suggesting that the benefits of CRET are actually greater over time. mortality was lowest in the group of overweight and obese patients who
were more successful at losing weight. We concluded that although an
American College of Cardiology 2008 Data ‘obesity paradox’ exists, our results support the safety and potential long-
At the recent American College of Cardiology (ACC) meeting, several term benefits of purposeful weight loss in overweight and obese patients
important CRET data were presented. Probably the most noteworthy who participated in formal CRET following major CHD events.
data came from Suaya and colleagues, who assessed CRET among a
cohort of over 600,000 Medicare participants eligible for CRET.
data demonstrated a 34% reduction in mortality among CRET users over Considerable data reviewed in this manuscript support the marked
one to five years of follow-up, and the benefit was 19% greater in those benefits of formal, phase II CRET programs following major CHD events.
who attended 25 or more CRET sessions than those who had lower Greater effort is needed to ensure routine referral to and high attendance
attendance rates. In addition, patients with heart failure (HF) gained a rates at CRET programs to further enhance the secondary prevention of
much greater benefit from CRET than those without HF. major CHD events. ■
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