Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance

Objective. To assess the effects of lifestyle intervention on cardiovascular risk factors in general and especially on fibrinolysis. Design. Randomized clinical study, Subjects, A total of 186 subjects with impaired glucose tolerance and obesity. Interventions. The intervention programme included a low-fat, high-fibre diet and regular physical exercise. Half of the participants (n = 93) took part in a one-month learning and training session using different behavioural modification techniques and conducted in a full-board wellness centre (intense intervention group). The other half (n = 93) was randomized a one-hour counselling session with a specially trained nurse (usual care group). Follow-up was carried out after 12 months. Main outcome measures. Body weight, oxygen consumption, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator (tPA) antigen, fibrinogen and fasting plasma insulin measured at the start of the programme and at follow-up after 1 year. Results. The intense intervention group had a mean weight decline by 1 year of 5.4 kg compared to 0.5 kg in the usual care group. Oxygen consumption in the intense group increased 10% vs. a 1% decline in the usual care group. In the intense group, PAI-I activity decreased 31% (- 10.1 U mL(-1)), which was significantly more than in the usual care group (12%; - 3.0 U mL(-1)). The corresponding reductions in tPA antigen were 14% (- 1.65 mu g L-1) and 6% (- 0.69 mu g L-1). Conclusions. The present randomized study shows that an intense lifestyle programme has sustained beneficial effects on fibrinolysis.