The Treatment of Obesity in Cardiac Rehabilitation

Abstract

Background: Cardiac rehabilitation (CR) programs have evolved from exercise-only programs designed to improve cardiorespiratory fitness to secondary prevention programs with a broader mandate to alter lifestyle-related behaviors that control cardiac risk factors and, thereby, reduce overall cardiovascular risk. As the obesity epidemic has evolved in the late 20th and early 21st centuries, the prevalence of type 2 diabetes mellitus and the metabolic syndrome have soared and blunted the otherwise expected downturn in deaths from coronary heart disease related to better control of risk factors. In that the causes of obesity are behavioral in origin, the most effective treatment strategy requires a comprehensive, behavioral-based approach. Purpose: In this review, we outline optimal lifestyle approaches that can be delivered in the CR setting to assist cardiac patients with their long-term goals of reducing weight and improving cardiac risk factors while concurrently improving cardiorespiratory fitness. We also performed a survey of CR program throughout the United States and found that only 8% currently deliver a behavioral weight programs. Conclusions: Cardiac rehabilitation programs need to take on an important challenge of secondary prevention, which is to develop behavioral weight loss programs to assist cardiac patients to lose weight and, thereby, improve multiple risk factors and long-term prognosis.

Obesity and Cardiovascular Risk: Systematic Intervention Is the Key for Prevention

“…Comprehensive lifestyle interventions, and medical and surgical treatments, improve CV outcomes. Cardiac rehabilitation is essential in CV patients, to better control arterial hypertension, dyslipidemia, and glycemia, and to maintain weight loss, healthy diet, psychological well-being, and exercise capacity [ 11 ]. A comprehensive assessment is needed to choose the most appropriate strategy and to reduce the CV disease risk and mortality.…”

“…Careful assessment should be performed to organize a patient-specific program. BMI and WC are suggested for classifying the obese patient and stratifying the risk [ 11 ]. However, there are limitations to the role of BMI in cardiac rehabilitation patients.…”

“…In addition, cardiac rehabilitation also ensures and a favorable outcome in this setting. This multidisciplinary intervention assists the patient with obesity through CV risk factor control and physical activity counselling, exercise prescription, diet/nutritional counselling, weight control management, psychosocial management, and professional support [ 11 , 12 ].…”

Benefits of the First Pritikin Outpatient Intensive Cardiac Rehabilitation Program

“…Important benefits of ICR in our study were reductions in body weight, BMI, and waist circumference, with fewer patients being categorized as obese at follow-up. The potential clinical implications of these results are supported by a recent review by Ades and Savage, 35 which highlights the importance of treating obesity in CR programs. The improvement in BMI in the ICR group was modest (from 29.0 to 28.5 kg/m 2 ) after ∼9.6 wk.…”

Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation

“…This approach would be consistent with current recommended interventions for psychosocial core components of CR, and because behavioral sleep interventions follow similar principles to other health behavior change interventions already enacted as part of CR, or proposed for inclusion in CR, they may synergize with those other interventions. 5,74 It may also be useful for participants in CR to complete sleep diaries as a form of self-monitoring. Sleep diaries are logs used to record sleep-related information such as sleep-wake times, time to fall asleep, number of awakenings and time awake in the middle of the night, and sleep quality; diaries can also be used to record information on sleep-related experiences such as use of PAP therapy, experience of nightmares, use of sleep aids, or other symptom experiences (eg, pain, nocturia).…”