Somers, Virends

Objective We studied the effect of a lifestyle therapy program using the resources already available in a cardiac rehabilitation setting for patients at risk for metabolic syndrome (MetS). Methods We created a six-week cardiometabolic program (CMP) using facilities and resources of a cardiac rehabilitation setting. The CMP included a minimum of 6 once-a-week 60 min sessions consisting of exercise training and nutrition instruction, in addition to 6 once-a-week 60 min group behavioral modification classes following the LEARN program. We also assessed the outcomes in 239 patients (pts) who had at either obesity or hyperglycemia: 58 pts had enrolled and completed the CMP, 58 pts had signed up for the CMP but either never attended or dropped out early (Control 1) and had follow-up data, and 123 pts had not signed up for the CMP but had been seen in the outpatient preventive cardiology practice at the Mayo Clinic (Control 2). We compared changes in components of the MetS from baseline to six weeks (for the CMP group) and at 6 months for all pts. Results Of 187 people who signed up for the CMP, only 62 completed the program and from those, 58 gave authorization to use their clinical data in research. Of the 125 that never attended or dropped out early, 58 had follow-up data. Clinical characteristics of the CMP, Control 1, and Control 2 groups and improvement in each of the outcome measures are shown in the Table. In the CMP group, there was a significant improvement at 6 weeks in waist circumference, weight, diastolic blood pressure and total cholesterol. At 6 months the fasting glucose had also significantly improved. In contrast, improvements in Control 1 and Control 2 were modest at best. See Table. When comparing the 6 month changes in the CMP and Control 1, those in the CMP had more pronounced weight loss (-4.5±5 kg vs -0.14±6 kg, p<0.001); decrease in systolic blood pressure (-1.1±17 mmHg vs +9.6±20 mmHg, p=0.004); and decrease in diastolic blood pressure (-4.6±11 mmHg vs +3.4±15 mmHg, p=0.0017). Similarly, comparing CMP vs Control 2, a significantly greater drop in body weight (-4.5±5 kg vs -0.9±3 kg, p<0.001) and in diastolic blood pressure (-4.6±11 mmHg vs -0.7±9 mmHg, p=0.0202) was noted in the CMP. The change in the number of MetS components per patient dropped significantly, favoring the CMP group compared with the control groups. Conclusion A lifestyle therapy program for patients at risk for MetS can be implemented using existing resources of a cardiac rehabilitation program, although enrollment and completion rates are low. Such a program, however, is effective at improving cardiometabolic outcomes in individuals at risk for MetS.