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Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise
Niebauer J, Hambrecht R, Velich T, Hauer K, Marburger C, Kalberer B, Weiss C, von Hodenberg E, Schlierf G, Schuler G, Zimmermann R, Kubler W
Circulation 1997 Oct 21;96(8):2534-2541
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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*

BACKGROUND: It was the aim of this study to assess the long-term effects of physical exercise and low-fat diet on the progression of coronary artery disease. At the beginning of the study, 113 male patients 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. METHODS AND 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 < 0.03) and triglyceride levels (1.94 +/- 0.8 versus 1.6 +/- 0.89 mmol/L; p < 0.005) and maintained their initial body mass index (26 +/- 2 versus 27 +/- 2 kg/m2; p = 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 < 0.0001)). In the intervention group, there was a significant 28% increase in physical work capacity (166 +/- 59 versus 212 +/- 89 W; p < 0.001), whereas values remained essentially unchanged in the control group (165 +/- 51 versus 170 +/- 60 W; p = NS; between groups, p < 0.05). In the intervention group, coronary stenoses progressed at a significantly slower rate than in the control group (p < 0.0001). Energy expenditure during exercise was assessed in a subgroup; patients with regression of coronary stenoses spent an average of 1784 +/- 384 kcal/wk (approximately 4 hours of moderate aerobic exercise per week). Multivariate regression analysis identified only physical work capacity as independently contributing to angiographic changes. CONCLUSIONS: 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.
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