Physical rehabilitation after acute myocardial infarction: focus on body weight

Aim. To study the effectiveness of 1-year exercise training (ET) after acute myocardial infarction (AMI) during outpatient cardiac rehabilitation in patients with different body mass index (BMI).

Material and methods. The study included 312 patients after AMI, who were randomized into four groups depending on BMI: patients who used ET program with BMI <30 kg/m² (group 1 (n=78)) and BMI >30 kg/m² (group 2 (n=78)); patients who did not use ET program with BMI <30 kg/m² (group 3 (n=78)) and BMI >30 kg/m² (group 4 (n=78)). ET of moderate intensity (60% of the threshold value) was carried out 3 times a week for a year.

Results. In patients with obesity, ET was associated with decrease of blood pressure by 3,3/3,6% (p<0,01 for each) and BMI by 7,7% (p<0,001), while there was an increase by 4,2/3,6% (p<0,05 for each) and 2,1% (p<0,05), respectively, in obese patients without ET. In patients without obesity, ET was associated only with BMI decrease by 3,3% (p<0,01), while in patients without obesity and ET it did not change. Daily physical activity after ET increased regardless of BMI, and without ET it decreased in obese patients. ET was associated with the increase of duration and intensity of training in non-obese patients by 39,2% (p<0,001) and 47,1% (p<0,001), respectively; in obese patients — by 23,8% (p<0,001) and 26,5% (p <0,001), respectively. In control groups it has not changed. After ET with any BMI, the levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) decreased, and the high-density lipoprotein-cholesterol (HDL-C) increased. In the control groups, the concentration of TG increased, and with obesity there was also an increase in LDL-C and a decrease in HDL-C. Against the background of ET, the fibrinogen values decreased with any BMI, in contrast to the control groups. After 1-year ET number of cardiovascular events (CVE) significantly decreased in nonobese patients by 37,5% (p<0,05) and in obese ones by 28,6% (p<0,05).

Conclusion. Long-term aerobic ET in patients with any BMI reduced cardiovascular risk factors and the risk of CVE. At the same time, with concomitant obesity, the maximum effect of cardiac rehabilitation was not achieved, which confirms the importance of controlling BMI in patients after AMI.

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