Title : Strategy for reducing cardiovascular risk in patients with obesity through personalized physical training
Abstract:
Relevance: Obesity is a leading modifiable risk factor for cardiovascular diseases (CVD). Despite the recognized role of physical activity (PA) in the treatment of obesity, existing recommendations are general in nature, which reduces their effectiveness and safety. Determining an optimal, individually tolerable and effective regimen of aerobic training is a key element of a personalized strategy for reducing cardiometabolic risk.
Aim: To evaluate the effectiveness of a strategy for reducing cardiovascular risk based on a personalized selection of an aerobic training regimen in patients with obesity.
Materials and methods: A single-center open-label randomized study involving 37 patients (average age 25 years) with alimentary obesity (BMI >30 kg/m²) and without significant cardiovascular pathology. Based on cardiopulmonary exercise testing (CPET) with determination of peak oxygen consumption (VO?peak) and lactate threshold (LT), patients allocated into 3 groups differing in walking training intensity: 1) low intensity (25–30% of VO?peak, n=15), 2) moderate intensity (60% of VO?peak, n=15), 3) high intensity (75–80% of VO?peak, n=7). Training continued for 6 months. Dynamics of cardiometabolic risk markers were assessed: body mass index (BMI), waist circumference (WC), exercise tolerance (ET by VO?peak), walking speed at LT, duration of the predominant fat oxidation phase (RER=0.70–0.75), as well as the frequency of adverse events (AE).
Results: Recruitment into the high-intensity group terminated early due to poor tolerance. After 6 months, group 1 (low-intensity training, 25–30% VO?peak) showed the greatest reduction in cardiometabolic risk markers: BMI decreased by 8% (p<0.05), group 2- 5% (p<0.05), and group 3 - 3% (p>0.05); WC in group 1 decreased by 2.5% (p<0.05), in groups 2 and 3 by 1.7% (p<0.05). The maximum improvement in the functional reserve of the cardiovascular system was noted in group 1 patients: VO?peak increased by +22% (p<0.05), in group 2 VO?peak increased by an average of 15% (p<0.05), while no dynamics in VO?peak were registered in group 3 patients. Walking speed at LT increased in group 1: +41% (p<0.05), in group 2: +39% (p<0.05); in group 3, patients performing high-intensity interval training showed a decrease in walking speed at LT by an average of 28% (p<0.05). A prolongation of the predominant fat oxidation phase (RER=0.7–0.75) by 5 times was recorded, indicating optimization of the metabolic profile. The duration of the RER phase at the level of 0.7–0.75 increased on average from 0.4 min to 2 min (p<0.05) in group 1 and to 1.1 min (p<0.05) in group 2. No similar dynamics were registered in group 3. Group 1 showed no serious AEs and demonstrated the best treatment adherence (100%). Training of moderate and high intensity was associated with a higher frequency of AEs (muscle pain, shortness of breath, exercise intolerance).
Conclusions: 1. Personalized training with intensity at the lactate threshold (25–30% of VO?peak) is the cornerstone of a safe and effective strategy for obesity correction. 2. This strategy demonstrates the best safety and tolerability profile, which is important for long-term adherence; and provides comprehensive reduction of cardiovascular risk through a significant decrease in abdominal obesity, improvement in the functional state of the cardiorespiratory system, and optimization of metabolism towards predominant fat utilization.
