Abstract
The combination of both sedentary lifestyle and unrestricted food availability increases the prevalence of obesity and type 2 diabetes and therefore the risk of cardiovascular morbidity and mortality due to coronary artery disease. A cardiomyopathy of obesity where the myocardial abnormalities cannot be ascribed to comorbidities is well recognized and its presence is supported both by experimental models and by epidemiological and clinical studies: left ventricular hypertrophy, reduced diastolic and systolic function, chronotropic incompetence are the typical features of the obesity cardiomyopathy. Moreover obese subjects have a high prevalence of diabetes, hypertension, atrial fibrillation, and sleep apnea. Cardiac rehabilitation programs include diet, physical exercise, and behavioral counseling as a strategy to fight obesity and its consequences and can possibly reverse the anomalies in cardiovascular function. The results are encouraging and obesity cardiomyopathy can partially be reversed by means of rehabilitation programs. Unfortunately, the obese often regain weight even after an early success. The adoption of an active lifestyle can have a favorable impact on prognosis in obese patients independently of weight loss. In this chapter, the modifications that occur in cardiac structure and function of obese subjects, the approach to cardiac rehabilitation, and the main results of weight loss and exercise are reviewed.
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References
Achten J, Jeukendrup AE (2004) Optimizing fat oxidation through exercise and diet. Nutrition 20:716–727
Ades PA (2001) Cardiac rehabilitation and secondary prevention of coronary heart disease. New Engl J Med 345:892–902
Ades PA, Savage PD, Harvey-Berino J (2010) The treatment of obesity in cardiac rehabilitation. J Cardiopulm Rehabil Prev 30:289–298
Agapitov AV, Correia ML, Sinkey CA, Dopp JM, Haynes WG (2002) Impaired skeletal muscle and skin microcirculatory function in human obesity. J Hypertens 20:1401–1405
Ahmadi N, Eshaghian S, Huizenga R, Sosnin K, Ebrahimi R, Siegel R (2011) Effects of intense exercise and moderate caloric restriction on cardiovascular risk factors and inflammation. Am J Med 124:978–982
Alauddin A, Meterissian S, Lisbona R, MacLean LD, Forse RA (1990) Assessment of cardiac function in patients who were morbidly obese. Surgery 108:809–818
Alpert MA (2001) Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 321:225–236
Alvarez GE, Davy BM, Ballard TP, Beske SD, Davy KP (2005) Weight loss increases cardiovagal baroreflex function in obese young and older men. Am J Physiol 289:E665–E669
American College of Cardiology Foundation (2012) Health policy statement on patient-centered care in cardiovascular medicine: a report of the American College of Cardiology Foundation Clinical Quality Committee. J Am Coll Cardiol 59:2125–2143
Arnold AM, Newman AB, Cushman M, Ding J, Kritchevsky S (2010) Body weight dynamics and their association with physical function and mortality in older adults: the cardiovascular health study. J Gerontol A Biol Sci Med Sci 65A:63–70
Backholer K, Wong E, Freak-Poli R, Walls HL, Peeters A (2012) Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis. Obes Rev 13:456–468
Bagi Z, Feher A, Cassuto J (2012) Microvascular responsiveness in obesity—implications for therapeutic intervention. Br J Pharmacol 165:544–560
Bays HE (2011) Adiposopathy is “sick fat” a cardiovascular disease? J Am Coll Cardiol 57:2461–2473
Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp CL, English ER, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HS, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363: 2211–2219
Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, van Dam RM, Hu FB, Visscher TL, Menotti A, Thorpe RJ Jr, Jamrozik K, Calling S, Strand BH, Shipley MJ for the BMI-CHD Collaboration Investigators (2007) Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300,000 persons. Arch Intern Med 167:1720–1728
Borlaug BA, Melenovsky V, Russel SD, Kessler K, Pacak K, Becker LC, Kass DA (2006) Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and preserved ejection fraction. Circulation 114:2138–2147
Bray GA, Ryan DH (2012) Medical therapy for the patient with obesity. Circulation 125:1695–1703
Brinkworth GD, Noakes M, Buckley JD, Clifton PM (2006) Weight loss improves heart rate recovery in overweight and obese men with features of the metabolic syndrome. Am Heart J 152(693):e1–e6
Brunani A, Liuzzi A, Titon A, Graci S, Castagna G, Viberti GC, Gondoni LA (2008) Evaluation of rosiglitazone administration on cardiovascular function in severe obesity. Clin Cardiol 31:602–606
Burger JPW, Serne EH, Nolte F, Sumlders EH (2009) Blood pressure response to moderate physical activity in increased in obesity. Neth J Med 67:342–346
Byberg L, Mealhus H, Gedeborg R, Sundström J, Ahlbom A, Zethelius B, Berglund LG, Wolk A, Michaëlsson K (2009) Total mortality after changes in leisure time physical activity in 50 years old men: 35 year follow-up population based cohort. Br J Sports Med 43:482
Capellini VK, Celotto AC, Baldo CF, Olivon VC, Viaro F, Rodrigues AJ, Evora PR (2010) Diabetes and vascular disease: basic concepts of nitric oxide physiology, endothelial dysfunction, oxidative stress and therapeutic possibilities. Curr Vasc Pharmacol 8:526–544
Cheyne J (1818) A case of apoplexy in which the fleshy part of the heart was converted into fat. Dublin Hosp Rep 2:216–223
Clarke PJ, O’Malley PM, Schulenberg JE, Johnston LD (2010) Midlife health and socioeconomic consequences of persistent overweight across early adulthood: findings from a national survey of American adults (1986–2008). Am J Epidemiol 172:540–548
DeCaria JE, Sharp C, Petrella JP (2012) Scoping review report: obesity in older adults. Int J Obes 36:1141–1150
de Ferranti S, Mozaffarian D (2008) The perfect storm: obesity, adipocyte dysfunction, and metabolic consequences. Clin Chem 54:945–955
Dugravot A, Sabia S, Stringhini S, Kivimaki M, Westerlund H, Vahtera J, Guéguen A, Zins M, Goldberg M, Nabi H, Singh-Manoux A (2010) Do socioeconomic factors shape weight and obesity trajectories over the transition from midlife to old age? Results from the French GAZEL cohort study. Am J Clin Nutr 92:16–23
Esler M, Rumantir M, Wiesner G, Kaye D, Hastings J, Lambert G (2001) Sympathetic nervous system and insulin resistance: from obesity to diabetes. Am J Hypertens 14:S304–S309
Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M, ADHERE Scientific Advisory Committee and Investigators (2007) An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the acute decompensated heart failure national registry. Am Heart J 153:74–81
Fornitano LD, Godoy MF (2010) Exercise testing in individuals with morbid obesity. Obes Surg 20:583–588
Gondoni LA, Liuzzi A, Titon AM, Taronna O, Nibbio F, Ferrari P, Leonetti G (2006) A simple tool to predict exercise capacity of obese patients with ischaemic heart disease. Heart 92:899–904
Gondoni LA, Titon AM, Silvestri G, Nibbio F, Taronna O, Ferrari P, Leonetti G (2007) Short term effects of physical exercise and low calorie diet on left ventricular function in obese subjects: a tissue doppler study. Nutr Metab Cardiovasc Dis 17:358–364
Gondoni LA, Titon AM, Nibbio F, Caetani G, Augello G, Mian O, Tuzzi C, Averna E, Parisio C, Liuzzi A (2008) Short term effects of a hypocaloric diet and a physical activity program on weight loss and exercise capacity in obese subjects with chronic ischemic heart disease: an everyday practice study. Acta Cardiol 63:153–159
Gondoni LA, Titon AM, Nibbio F, Augello G, Caetani G, Liuzzi A (2009) Heart rate behavior during exercise stress test in obese patients. Nutr Metab Cardiovasc Dis 19:170–176
Gondoni LA, Nibbio F, Caetani G, Augello G, Titon AM (2010) What are we measuring? Considerations on subjective ratings of perceived exertion in obese patients for exercise prescription in cardiac rehabilitation programs. Int J Cardiol 140:236–257
Goodpaster BH, DeLany JP, Otto AD, Kuller L, Vockley J, South-Paul JE, Thomas SB, Brown J, McTigue K, Hames KC, Lang W, Jakicic JM (2010) Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 304:1795–1802
Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW (2012) Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol 60:120–128
Istituto Superiore di Sanità (ISS) (2008) Cardiologia riabilitativa e prevenzione secondaria delle malattie cardiovascolari. Available at http://www.snlg-iss.it/lgn_cardiologia_riabilitativa
Kim MK, Tanaka K, Kim MJ, Matsuo T, Ajisaka R (2009) Exercise training-induced changes in heart rate recovery in obese men with metabolic syndrome. Metab Syndr Relat Disord 7:469–476
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. J Am Med Assoc 301:2024–2035
Kokkinos P, Myers J (2010) Exercise and physical activity: clinical outcomes and applications. Circulation 122:1637–1648
Lakoski SG, Barolw CE, Farrell SW, Berry JD, Morrow JR, Haskell WL (2011) Impact of body mass index, physical activity, and other clinical factors in cardiorespiratory fitness (from the Cooper Center longitudinal study). Am J Cardiol 108:34–39
Lavie CJ, Milani RV, Ventura HO, Cardenas GA, Mehra MR, Messerli FH (2007) Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol 100:1460–1464
Lee SL, Blair SN, Jackson AS (1999) Cardiorespiratory fitness, body composition, and cardiovascular disease mortality in men. Am J Clin Nutr 69:373–380
McKee M, Britton A, Black N, McPherson K, Sanderson C, Bain C (1999) Methods in health services research. Interpreting the evidence: choosing between randomised and non-randomised studies. Br Med J 319:312–315
Mourot L, Boussuges A, Maunier S, Chopra S, Rivière F, Debussche X, Blanc P (2010) Cardiovascular rehabilitation in patients with diabetes. J Cardiopulm Rehabil Prev 30:157–164
O’Keefe JH, Vogel R, Lavie CJ, Cordain K (2011) Exercise like a hunter-gatherer: a prescription for organic physical fitness. Progr Cardiovasc Dis 53:471–479
Persinger R, Foster C, Gibson M, Fater DCW, Porcari JP (2004) Consistency of the talk test for exercise prescription. Med Sci Sports Exerc 36:1632–1636
Peterson LR, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ, Barzilai B, Dávila-Román VG (2004) Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 43:1399–1404
Pocock SJ, McMurray JJ, Dobson J, Yusuf S, Granger CB, Michelson EL, Ostergren J, Pfeffer MA, Solomon SD, Anker SD, Swedberg KB (2008) Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J 29:2641–2650
Poirier P, Hernandez TL, Weil KM, Shepard TJ, Eckel RH (2003) Impact of diet-induced weight loss on the cardiac autonomic nervous system in severe obesity. Obes Res 11:1040–1047
Racca V, Spezzaferri R, Modica M, Mazzini P, Jonsdottir J, De Maria R, Ferratini M (2010) Functioning and disability in ischaemic heart disease. Disabil Rehabil 32:S42–S49
Rognmo O, Moholdt T, Bakken H, Hole T, Mølstad P, Myhr NE, Grimsmo J, Wisløff U (2012) Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 126:1436–1440
Schrauwen-Hinderling VB, Hesselink MK, Meex R, van der Made S, Schär M, Lamb H, Wildberger JE, Glatz J, Snoep G, Kooi ME, Schrauwen P (2010) Improved ejection fraction after exercise training in obesity is accompanied by reduced cardiac lipid content. J Clin Endocrinol Metab 95:1932–1938
Selim B, Won C, Yaggi HK (2010) Cardiovascular consequences of sleep apnea. Clin Chest Med 31:203–220
Smith JG, Platonov PG, Hedblad B, Engström G, Melander O (2010) Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity. Eur J Epidemiol 25:95–102
Spertus JA (2008) Evolving applications for patient-centered health status measures. Circulation 118:2103–2110
Stefan N, Kntaritzis K, Machann J, Schick F, Thamer C, Rittig K, Balletshofer B, Machicao F, Fritsche A, Häring H (2008) Identification and characterization of metabolically benign obesity in humans. Arch Intern Med 168:1609–1616
Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP, Blair SN (2007) Cardiorespiratory fitness and adiposity as mortality predictors in older adults. J Am Med Assoc 298:2507–2516
Sweeney G (2010) Cardiovascular effects of leptin. Nat Rev Cardiol 7:22–29
Tanasescu M, Leitzmann MF, Rimm EB, Willet WC, Stampfer MJ, Hu FC (2002) Exercise and intensity in relation to coronary heart disease in men. JAMA 288:1994–2000
The Multiple Risk Factor Intervention Trial (MRFIT) (1976) A national study of primary prevention of coronary heart disease. J Am Med Assoc 235:825–827
Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, Napoli N, Qualls C, Shah K (2011) Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med 364:1218–1229
Wang TJ, Parise H, Levy D, D’Agostino RB Sr, Wolf PA, Vasan RS, Benjamin EJ (2004) Obesity and the risk of new-onset atrial fibrillation. J Am Med Assoc 292:2471–2477
Wende AR, Abel ED (2010) Lipotoxicity in the heart. Biochim Biophys Acta 1801:311–319
West RR, Jones DA, Henderson AH (2012) Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart 98:637–644
Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R (2009) Prospective studies collaboration. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096
WHO (2008). The global burden of disease: 2004 update. WHO, Geneva
Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, Sowers MR (2008) The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering. Arch Intern Med 168:1617–1624
Wong C, O’Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH (2004) Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 110:3081–3087
Wong C, O’Moore-Sullivan T, Leano R, Hukins C, Jenkins C, Marwick TH (2006) Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 47:611–616
Wong C, Marwick TH (2007) Obesity cardiomyopathy: diagnosis and therapeutic implications. Nat Clin Pract Cardiovasc Med 4:480–490
Zarich SW, Kowalchuk GJ, McGuire MP, Benotti PN, Mascioli EA, Nesto RW (1991) Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol 68:377–381
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Gondoni, L.A. (2013). Cardiac Rehabilitation. In: Capodaglio, P., Faintuch, J., Liuzzi, A. (eds) Disabling Obesity. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35972-9_7
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