Background
Nutritional status plays an important role in disease management in cardiovascular patients. Improvement of body composition can bring several benefits for blood pressure, cholesterol levels, insulin resistance and glucose control in cardiovascular disease (CVD) patients. Hence, optimization of body composition might reduce the risk for metabolic syndrome. Data in kilograms body weight or the body mass index (body weight/body height2), do not distinguish between muscle mass and fat mass, and consequently fail to provide a realistic assessment of persons’ actual body composition. Visceral fat or intraabdominal fat defines stored fat in the abdominal cavity. In contrast to subcutaneous fat, visceral fat releases proinflammatory cytokines and negatively influences fat and carbohydrate metabolism. Excessive visceral fat reduction has shown more noticeable effects than subcutaneous fat reduction. Ideally, weight loss should be derived almost exclusively from the fat mass compartment since this is the main driver of metabolic disease. However, several studies have shown that there is an accompanying loss of mass from the fat-free compartment, especially skeletal muscle mass. To induce targeted fat reduction, particular metabolic stimuli are required. Exercise-based cardiac rehabilitation (EBCR) including dietary management and exercise are considered stimuli to trigger targeted fat reduction. Therefore, the aim of our research project is to investigate the effects of EBCR on body composition.
Methods
Participants will be recruited at the Hochgebirgsklinik Davos to participate in this study. We aim to include 1000 patients to participate after signing a general consent. Body composition analysis, by means of bioimpedance analysis (BIA) will be performed with every patient on admission and discharge of their rehabilitation hospitalization (usually 24±4 days). During their in-patient EBCR, patients will perform EBCR including exercise training, mediterranean diet, risk factor and lifestyle education, smoking cessation if indicated, optimization cardiovascular risk factors. Rehabilitation programs will be performed according to patients’ physical condition and based on cardiologists’ decision and according to current guidelines. The training sessions include approximately 20 sessions per week, including cycle ergometer training, cardiological gymnastics, walking and resistance training.
Relevance of the expected results
There is an urgent need to further elicit aspects on the effectiveness of a in-patient EBCR on body composition, particularly fat distribution in the visceral area and muscle mass. BIA is a rapid, safe, valid, and reliable method to assess these parameters. Moderate weight loss can achieve clinically meaningful reductions in markers of cardiometabolic risk and may offer the opportunity for patients to defer or reduce medication. To target fat reduction effectively, and preserve muscle loss in CVD patients, insights into training adaptations are essential. Possible body composition shifts could give valuable insight into physiological mechanisms triggered by EBCR, and the different sub-components including medication. BIA parameters significantly impact treatment outcomes, quality of life, and disease progression. The therapeutical consequence would comprise individually tailored exercise programs and treatment plans for CVD patients, to reduce morbidity and mortality, and enhance quality of life for patients.
Quiz question
In cardiac rehabilitation weight management interventions to reach a healthy weight (BMI 18.5-25 kg/m2) are guideline recommended. Tick the correct answer regarding weight loss.
Weight loss interventions can increase the lipid profile and insulin sensitivity in cardiovascular disease patients.
Weight loss is not accompanied by loss of tissue from muscle in cardiovascular disease patients.
Weight loss is recomended through energy intake restrictions and high intensity interval training in cardiovascular disease patients.