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Exercise effects on cardiac size and left ventricular diastolic function: relationships to changes in fitness, fatness, blood pressure and insulin resistance
Stewart KJ, Ouyang P, Bacher AC, Lima S, Shapiro EP
Heart 2006 Jul;92(7):893-898
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To determine exercise training effects on cardiac size and left ventricular (LV) diastolic function and relationships of exercise induced changes in physiological and body composition parameters with cardiac parameters. DESIGN: Prospective, randomised controlled trial. SUBJECTS: Men and women (63.6 (5.7) years, body mass index 29.5 (4.4) kg/m2) with untreated hypertension (systolic blood pressure (BP) 130 to 159 or diastolic BP 85 to 99 mmHg). MAIN OUTCOME MEASURES: Cardiac size and LV diastolic function, peak oxygen uptake (VO2), muscle strength, general and abdominal fatness, and insulin resistance. INTERVENTIONS: 6 months of exercise training versus usual care. RESULTS: When analysed by group at six months, cardiac size and LV diastolic function did not differ between exercisers (n = 51) and controls (n = 53), whereas exercisers had significantly higher peak VO2 (28 versus 24 ml/kg/min) and strength (383 versus 329 kg), and lower fatness (34% versus 37%), diastolic BP (73 versus 75 mmHg) and insulin resistance (quantitative insulin sensitivity check index 0.35 versus 0.34) versus controls (all p < 0.05). By regression analysis, among six month changes, increased peak VO2 and reduced abdominal fat were associated with increased cardiac size. Increased peak VO2 and reduced abdominal fat, BP and insulin resistance were associated with improved LV diastolic function, r-values ranged from 0.20 to 0.32 (p < 0.05). CONCLUSIONS: When examined by group assignment, exercise had no effect on cardiac size or LV diastolic function. When individual variations in six month changes were examined, participants attaining the greatest increases in fitness and reductions in abdominal fatness, insulin resistance and BP showed a modest trend towards physiological hypertrophy characterised by increased cardiac size and improved LV diastolic function. These results suggest that decreased abdominal fatness may have a role in improving cardiovascular health.
Reproduced with permission from the BMJ Publishing Group.

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