how can we reduce central obesity during a cardiac rehabilitation program? noeleen fallon cnm 2...
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How can we reduce How can we reduce central obesity during a central obesity during a
cardiac rehabilitation cardiac rehabilitation program?program?
Noeleen FallonNoeleen Fallon
CNM 2 Cardiac Rehabilitation Department, CNM 2 Cardiac Rehabilitation Department, AMNCHAMNCH
MSc Cardiac RehabilitationMSc Cardiac RehabilitationTrinity College DublinTrinity College Dublin
Noeleen Fallon MSc TCD 2
Definition of ObesityDefinition of ObesityUnhealthy excess accumulation of
body fat with multiple organ-specific pathological consequences (Haslam, 2006).
Obesity is:a major public health problem with
associated morbidity and mortalityclassified as an independent risk
factor for cardiovascular disease and diabetes
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Obesity is an escalating problem that is expected to become the most common health problem of the 21st century
Obesity is highly prevalent within cardiac rehabilitation populations (Brochu 2000, Ades 2001, Shubair 2004, Savage 2006).
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Aim of the studyAim of the study
To examine if additional dietary education and exercise would reduce central obesity in a cardiac rehabilitation population.
Study ParticipantsStudy Participants80 participants
over a 6 month period
8 dropped out
49 study participants
22 in the intervention group
60 patients eligible (CAD and overweight)
29 in the control group
57 agreed
Baseline parameters for both groupsBaseline parameters for both groupsIntervention Control
Gender Male / Female 68% (15) 32% ( 7) 74% (20) 26% ( 7)
Age 59.86 ± 6.94 SD 59.85 ± 9.57 SD
Diagnosis STEMI
NSTEMI
CABG
PCI
ANGINA
1
1
8
9
5
2
1
8
13
3
Smoking Yes
No
Ex
2
16
4
3
15
9
Alcohol > 21 units
< 21 units
Nil
1
14
7
2
20
5
SBP (mmHg) 135 ± 17.89 SD 132 ± 19.96 SD
Weight 85.0 ± 12.48 SD 83.4 ± 14.01 SD
BMI 30.23 ± 3.38 SD 29.32 ± 3.50 SD
WC 100.14 ± 9.33 SD 99.41 ± 10.66 SD
Base line parameters for both groups Base line parameters for both groups (cont.)(cont.)
WHR 0.95 ± 0.06 SD 0.95 ± 0.05 SD
Fat Mass (kg) 26.85 ± 6.15 SD 25.30 ± 6.22 SD
Fat % body weight 31.77 ± 6.56 SD 30.50 ± 6.16 SD
Lipid Profile TC
LDL
HDL
Trigs
4.05 ± 1.10 SD
2.29 ± 0.98 SD
1.08 ± 0.29 SD
1.50 ± 0.61 SD
4.29 ± 1.02 SD
2.35 ± 0.99 SD
1.09 ± 0.20 SD
1.77 ± 1.13 SD
BSL 5.81 ± 1.18 SD 5.55 ± 0.80 SD
Shuttle walk Distance
VO2
METS
403.64 ± 139.54 SD
14.06 ± 4.12 SD
3.64 ± 0.93 SD
403.33 ± 174.82 SD
14.23 ± 4.36 SD
3.69 ± 1.14 SD
HADS Anxiety
Depression
6.41 +/- 4.84 SD
3.59 +/- 2.77 SD
6.22 ± 3.60
3.85 ± 2.52
IPAQ METS min/week
PA low / mod / high
1352.25 ± 1297.63 SD
8 / 13 / 1
1081.19 ± 1071.16 SD
10 / 17 / 0
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MethodologyMethodologyIntervention group:• Walk for one hour in addition to the routine
phase III exercise program • Completed exercise diary’s and wore polar
watches• Individual dietary advice following analysis of
3 day food diary • Additional educational talk and discussion
focusing on exercise, diet and motivation• Daily contact with researcher
Control group Attended phase III routine CR program.
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Results from the studyResults from the study
Data was analysed using SPSS version 14
Analyses using descriptive statistics gave parameters of mean median SD minimum and maximum of all variables
Analyses of variance (ANOVA) parametric test was performed to examine the mean differences at baseline between the intervention and control group and analyse the response to intervention to see if there was a statistically significant difference between the two groups.
A p value of <0.05 was utilised as a level of significance
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Results from studyResults from study
There was no significant difference in any of the anthropometric measurements or fitness level parameters between the two groups
WeightWeightWeight Amongst Groups
75
80
85
90
95
100
Intervention Control
Mas
s (K
g)
Pre
Post
Waist CircumferenceWaist CircumferenceWaist Circumference
90
92
94
96
98
100
102
104
106
108
110
112
Intervention Control
Cir
cu
mfe
ren
ce
(c
m)
pre
post
Shuttle Walk Test DistanceShuttle Walk Test Distance
Shuttle Walk Distance
0
100
200
300
400
500
600
700
800
Intervention control
Dis
tan
ce (
m)
pre
post
METS calculated from Shuttle METS calculated from Shuttle Walk TestWalk TestMETS Calculated From Shuttle Walk Test
0
1
2
3
4
5
6
Intervention control
ME
TS pre
post
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Results from studyResults from study
Parameters of both control and intervention groups (N = 49) were examined using paired t tests pre and post program to evaluate the effect of the program
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Results from studyResults from studyPre Post Sig
Body weight 84.14 83.29 (p = 0.021)
BMI 29.73 29.43 (p = 0.029)
WC 99.73 98.22 (p = 0.003)
TC 4.18 3.78 (p = 0.039)
LDL 2.32 1.93 (p = 0.02)
SBP 133.24 127.27 (p = 0.021)
Distance Mets shuttle walk
402.47 523.04 (p<0.0001)
IPAQ Mets/mins per week
1202.89 4958.65 (p<0.0001)
Shuttle walk distanceShuttle walk distance
0
100
200
300
400
500
600
DistanceIn Meters
Pre Post
P<0.0001
IPAQ Mets/min per weekIPAQ Mets/min per week
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Mets/min
Pre Post post -CR
IPAQ Mets Minute
P <0.0001
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DiscussionDiscussion
• Results demonstrate the clear benefit of the program itself
• Fitness parameters improved as demonstrated by the shuttle walk test and IPAQ results
• Antropometric measurements improved as demonstrated by Body weight, WC and BMI
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Why was there no significant difference in parameters between the intervention and the control groups?????
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AnswersAnswers• Small study sample• Short time frame of program • No target weight loss program• 2-3 weeks to become familiar with
program• Intervention group may not have adhered
to additional exercise or dietary advice• Both groups overlapped for education so
shared information • Control group adhered to program and
lost weight and reduced BMI• Control group may have exercised more
than recommended (30 x 5)
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RecommendationsRecommendations• Recommended that overweight / obese
patients will exercise for 60 min/day, increasing time and intensity gradually.
• Exercise diaries to encourage self report and monitoring of exercise.
• Body fat analyses will continue and liaison with the dieticians
• Definite weight loss program during cardiac rehabilitation phase III with input from psychology towards behaviour change
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ConclusionConclusion• Obesity remains a significant health
problem for cardiac rehabilitation patients (Shubair 2004).
• Targeted interventions toward weight management in cardiac rehabilitation programs are important (Bader, 2001).
• Intervention in obesity, in addition to the well established risk factors, appears to be an advisable goal in prevention of cardiovascular disease and diabetes (McGill 2002).