BACKGROUND: Coronary microvascular function is associated with outcome and is reduced in coronary artery disease (CAD) and obesity. We compared the effect of aerobic interval training (AIT) and weight loss on coronary flow reserve (CFR) and peripheral vascular function in revascularised obese CAD patients. METHODS AND RESULTS: Seventy non-diabetic patients (BMI 28 to 40 kg/m2, age 45 to 75 years) were randomised to 12 weeks' AIT (three weekly sessions lasting 38 min with about 16 min at 85 to 90% of VO2peak) or low energy diet (LED, 800 to 1,000 kcal/day). Per protocol adherence was defined by training-attendance > 60% and weight loss > 5%, respectively. CFR was assessed by Doppler echocardiography of the LAD. Peripheral vascular function was assessed by arterial tonometry as reactive hyperaemia index (RHI) and augmentation index. Most participants had impaired CFR with a mean CFR of 2.38 (SD 0.59). Twenty-six AIT and 24 LED participants completed the study per protocol with valid CFR measurements. AIT resulted in a 10.4% improvement in VO2peak and LED in a 10.6% weight loss (between group differences both p < 0.001). CFR increased by 0.26 (95%CI 0.04 to 0.48) after AIT and by 0.39 (95%CI 0.13 to 0.65) after LED without significant between-group difference (-0.13 (95%CI -0.45 to 0.20)). RHI and augmentation index remained unchanged after both interventions (p > 0.50). Intention-to-treat analyses showed similar results. CONCLUSIONS: 12 weeks' AIT and LED increased CFR by comparable magnitude; thus both interventions might impact prognosis of CAD through improvement of coronary microvascular function. CLINICAL TRIAL REGISTRATION: URL http://www.ClinicalTrials.gov. Unique identifier NCT01724567.

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