REGULAR PHYSICAL EXERCISE AND LOW-FAT DIET - EFFECTS ON PROGRESSION OF CORONARY-ARTERY DISEASE

Background. Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment. This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris. Methods and Results. Patients were recruited after routine coronary angiography for stable angina pectoris; they were randomized to an intervention group (n=56) and a control group on "usual care" (n=57). Treatment comprised intensive physical exercise in group training sessions (minimum, 2 hr/wk), daily home exercise periods (20 min/d), and low-fat, low-cholesterol diet (American Heart Association recommendation, phase 3). No lipid-lowering agents were prescribed. After 12 months of participation, repeat coronary angiography was performed; relative and minimal diameter reductions of coronary lesions were measured by digital image processing. Change in myocardial perfusion was assessed by Tl-201 scintigraphy. In patients participating in the intervention group, body weight decreased by 5% (p<0.001), total cholesterol by 10% (p<0.001), and triglycerides by 24% (p<0.001); high density lipoproteins increased by 3% (p=NS). Physical work capacity improved by 23% (p<0.0001), and myocardial oxygen consumption, as estimated from maximal rate-pressure product, by 10% (p<0.05). Stress-induced myocardial ischemia decreased concurrently, indicating improvement of myocardial perfusion. Based on minimal lesion diameter, progression of coronary lesions was noted in nine patients (23%), no change in 18 patients (45%), and regression in 13 patients (32%). In the control group, metabolic and hemodynamic variables remained essentially unchanged, whereas progression of coronary lesions was noted in 25 patients (48%), no change in 18 patients (35%), and regression in nine patients (17%). These changes were significantly different from the intervention group (p<0.05). Conclusions. In patients participating in regular physical exercise and low-fat diet, coronary artery disease progresses at a slower pace compared with a control group on usual care.