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Weight Loss and Its Predictors During Participation in Cardiac Rehabilitation

      We aimed to assess the prevalence and magnitude of clinically meaningful weight loss among cardiac rehabilitation (CR) participants who were overweight or obese and identify its predictors. We analyzed subjects with body mass index (BMI) ≥25 who were enrolled in a 12-week CR outpatient program from January 1, 2015, to December 31, 2019, and had paired pre- and post-CR weight data. Patients who lost 3% or more of their body weight by the end of the program were compared with the remaining participants. Multivariable logistic regression was used to determine predictors of weight loss. Overall, 129 of 485 subjects (27%) with overweight or obesity reduced their weight by at least 3% (average percent weight change: −5.0% ± 1.8% vs −0.02% ± 2.2%, average weight change: −10.9 ± 5.0 vs −0.1 ± 4.4 pounds, and average BMI change: −1.7 ± 0.7 vs −0.02 ± 0.7 kg/m2). Compared with the remaining 356 patients, those who achieved the defined weight loss were younger (p = 0.016) and had higher baseline weight (p = 0.002) and BMI (p <0.001). The weight loss group tended to be enrolled more likely for an acute myocardial infarction or percutaneous coronary intervention (p <0.001) and less likely for coronary artery bypass grafting (p = 0.001) or a heart valve procedure (p = 0.05). By the end of the CR program, the weight loss group demonstrated a greater increase in Rate Your Plate – Heart score (7 [3, 11] vs 4 [1, 8]; p <0.001) and a greater decrease in triglycerides (−20 ± 45 vs −7 ± 55 mg/dL; p = 0.026) and glycated hemoglobin (−0.1 [−0.5, 0.1] vs 0.1 [−0.3, 0.4] %; p = 0.05, among patients with diabetes or prediabetes). In a multivariable logistic regression model, baseline predictors of clinically meaningful weight loss included higher BMI and not being enrolled for a surgical CR indication (p = 0.001). In conclusion, throughout 12 weeks of CR participation, 129 of 485 subjects (27%) with BMI ≥25 had a 3% or more reduction in body weight. Patients with higher baseline BMI and participants without a surgical enrollment diagnosis were more likely to achieve the defined weight loss. Efforts to improve CR referral and enrollment for eligible patients with overweight and obesity should be encouraged, and suitable and efficient weight reduction interventions in CR settings need to be further studied.

      Abbreviations:

      AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation), BMI (Body Mass Index), CR (Cardiac Rehabilitation), CVD (Cardiovascular Diseases), ACC (American College of Cardiology)
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      References

        • Ades PA
        • Savage PD
        Obesity in coronary heart disease: an unaddressed behavioral risk factor.
        Prev Med. 2017; 104: 117-119
        • Atti V
        • Devarakonda PK
        • Raina S
        Differential effects of cardiac rehabilitation in obese and non-obese population.
        Cureus. 2021; 13: 18-22
        • Gomadam PS
        • Douglas CJ
        • Sacrinty MT
        • Brady MM
        • Paladenech CC
        • Robinson KC
        Degree and direction of change of body weight in cardiac rehabilitation and impact on exercise capacity and cardiac risk factors.
        Am J Cardiol. 2016; 117: 580-584
        • Guh DP
        • Zhang W
        • Bansback N
        • Amarsi Z
        • Birmingham CL
        • Anis AH
        The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.
        BMC Public Health. 2009; 9: 88
        • Lavie CJ
        • Milani RV
        Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.
        Am J Cardiol. 1997; 79: 397-401
        • Wilkinson JA
        • Harrison AS
        • Doherty P
        Obese patients’ characteristics and weight loss outcomes in cardiac rehabilitation: an observational study of registry data.
        Int J Cardiol. 2021; 337: 16-20
        • Wilson PW
        • D’Agostino RB
        • Sullivan L
        • Parise H
        • Kannel WB
        Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.
        Arch Intern Med. 2002; 162: 1867-1872
        • Ades PA
        • Savage PD
        The treatment of obesity in cardiac rehabilitation: a review and practical recommendations.
        J Cardiopulm Rehabil Prev. 2021; 41: 295-301
        • Ades PA
        • Savage PD
        • Lischke S
        • Toth MJ
        • Harvey-Berino J
        • Bunn JY
        • Ludlow M
        • Schneider DJ
        The effect of weight loss and exercise training on flow-mediated dilatation in coronary heart disease: a randomized trial.
        Chest. 2011; 140: 1420-1427
        • Barrett KV
        • Savage PD
        • Ades PA
        The effects of behavioral weight loss and weight loss goal setting in cardiac rehabilitation.
        J Cardiopulm Rehabil Prev. 2020; 40: 383-387
        • Savage PD
        • Lakoski SG
        • Ades PA
        Course of body weight from hospitalization to exit from cardiac rehabilitation.
        J Cardiopulm Rehabil Prev. 2013; 33: 274-280
        • Schindler TH
        • Cardenas J
        • Prior JO
        • Facta AD
        • Kreissl MC
        • Zhang XL
        • Sayre J
        • Dahlbom M
        • Licinio J
        • Schelbert HR
        Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function.
        J Am Coll Cardiol. 2006; 47: 1188-1195
        • Bader DS
        • Maguire TE
        • Spahn CM
        • O’Malley CJ
        • Balady GJ
        Clinical profile and outcomes of obese patients in cardiac rehabilitation stratified according to National Heart, Lung, and Blood Institute criteria.
        J Cardiopulm Rehabil Prev. 2001; 21: 210-217
        • Barnason S
        • Zimmerman L
        • Schulz P
        • Pullen C
        • Schuelke S
        Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: a randomised trial.
        J Clin Nurs. 2019; 28: 1808-1818
        • Flegal KM
        • Carroll MD
        • Kit BK
        • Ogden CL
        Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010.
        JAMA. 2012; 307: 491-497
        • Jones F
        • Harris P
        • Waller H
        • Coggins A
        Adherence to an exercise prescription scheme: the role of expectations, self-efficacy, stage of change and psychological well-being.
        Br J Health Psychol. 2005; 10: 359-378
        • Mandic S
        • Hodge C
        • Stevens E
        • Walker R
        • Nye ER
        • Body D
        • Barclay L
        • Williams MJ
        Effects of community-based cardiac rehabilitation on body composition and physical function in individuals with stable coronary artery disease: 1.6-year followup.
        Biomed Res Int. 2013; 2013903604
        • Shubair MM
        • Kodis J
        • McKelvie RS
        • Arthur HM
        • Sharma AM
        Metabolic profile and exercise capacity outcomes: their relationship to overweight and obesity in a Canadian cardiac rehabilitation setting.
        J Cardiopulm Rehabil Prev. 2004; 24: 405-413
        • Tuah NA
        • Amiel C
        • Qureshi S
        • Car J
        • Kaur B
        • Majeed A
        Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults.
        Cochrane Database Syst Rev. 2011; 10CD008066
        • Kroenke K
        • Spitzer RL
        • Williams JB
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer RL
        • Kroenke K
        • Williams JB
        • Löwe B
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Eaton T
        • Young P
        • Fergusson W
        • Garrett JE
        • Kolbe J
        The Dartmouth COOP Charts: a simple, reliable, valid and responsive quality of life tool for chronic obstructive pulmonary disease.
        Qual Life Res. 2005; 14: 575-585
        • Gans KM
        • Hixson ML
        • Eaton CB
        • Lasater TM
        Rate Your Plate: a dietary assessment and educational tool for blood cholesterol control.
        Nutr Clin Care. 2000; 3: 163-169
        • Jensen MD
        • Ryan DH
        • Apovian CM
        • Ard JD
        • Comuzzie AG
        • Donato KA
        • Hu FB
        • Hubbard VS
        • Jakicic JM
        • Kushner RF
        • Loria CM
        • Millen BE
        • Nonas CA
        • Pi-Sunyer FX
        • Stevens J
        • Stevens VJ
        • Wadden TA
        • Wolfe BM
        • Yanovski SZ
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society.
        J Am Coll Cardiol. 2014; 63: 2985-3023
        • Aspry K
        • Dunsiger S
        • Breault C
        • Stabile L
        • DeAngelis J
        • Wu WC
        Effect of case management with goal-setting on diet scores and weight loss in cardiac rehabilitation patients.
        J Cardiopulm Rehabil Prev. 2018; 38: 380-387
        • Brochu M
        • Poehlman ET
        • Savage P
        • Ross S
        • Ades PA
        Coronary risk profiles in men with coronary artery disease: effects of body composition, fat distribution, age and fitness.
        Coron Artery Dis. 2000; 11: 137-144
        • Savage PD
        • Lee M
        • Harvey-Berino J
        • Brochu M
        • Ades PA
        Weight reduction in the cardiac rehabilitation setting.
        J Cardiopulm Rehabil Prev. 2002; 22: 154-160
        • Fabricatore AN
        • Wadden TA
        • Moore RH
        • Butryn ML
        • Heymsfield SB
        • Nguyen AM
        Predictors of attrition and weight loss success: results from a randomized controlled trial.
        Behav Res Ther. 2009; 47: 685-691
        • Karlsen TI
        • Søhagen M
        • Hjelmesæth J
        Predictors of weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study.
        Health Qual Life Outcomes. 2013; 11: 165-173