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Research Article| Volume 103, ISSUE 1, P81-91, October 1993

Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors

DOI:https://doi.org/10.1016/0021-9150(93)90042-S
Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors
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      Abstract

      To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors, 157 healthy men aged 35–60 years (mean ± S.D.; 46.2 ± 5.0) with slightly to moderately raised cardiovascular risk factors, were randomized to 4 groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C, n = 39)), and investigated at baseline and after 6 months. BMI was significantly reduced in Groups E and DE (mean difference and 95% confidence intervals (CI), -0.3 (-0.5, -0.01) and -0.6 (-0.9, -0.3) kg/m2, respectively). Waist circumference was reduced in all 3 intervention groups (D, E, and DE), −1.3 (−2.5, −0.1), −2.2 (−3.2, −1.3) and −3.0 (-3.9, -2.0) cm, but not in the control group. Blood pressure (BP) was reduced in all 3 intervention groups, systolic BP 4–7 mmHg and diastolic BP 2–6 mmHg. Serum cholesterol was reduced in Group DE, -0.45 (-0.77, -0.13) mmol/l. VLDL-cholesterol was reduced in Groups E and DE, -0.14 (-0.26, -0.03) and -0.09 (-0.18, -0.01) mmol/l, whereas LDL-cholesterol was reduced in Groups D and DE -0.30 (-0.54, -0.06) and -0.35 (-0.64, -0.05) mmol/I. In contrast, neither HDL-cholesterol nor serum triglycerides were influenced by the interventions. According to the coronary risk profile derived from the Framingham study, all 3 intervention groups (D, E, and DE) significantly reduced their estimated 10-year risk (-13, -12, and -14%, respectively). We conclude that even with rather moderate changes in diet and exercise, several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk.

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      References

        • Keys A.
        • Menotti A.
        • Karvonen M.J.
        • et al.
        The diet and 15 year death rate in the Seven Countries Study.
        Am. J. Epidemiol. 1986; 124: 903
        • Shekelle R.B.
        • Stamler J.
        Dietary cholesterol and ischaemic heart disease.
        Lancet. 1989; i: 1177
        • Powell K.E.
        • Thompson P.D.
        • Caspersen C.J.
        • Kendrick J.S.
        Physical activity and the incidence of coronary heart disease.
        Annu. Rev. Public Health. 1987; 8: 253
        • Berlin J.A.
        • Colditz G.A.
        A meta-analysis of physical activity irl the prevention of coronary heart disease.
        Am. J. Epidemiol. 1990; 132: 612
        • Dayton S.
        • Pearce M.L.
        • Goldman H.
        • et al.
        Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications.
        Lancet. 1968; ii: 1060
        • Singh R.B.
        • Rastogi S.S.
        • Verma R.
        • et al.
        Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up.
        Br. Med. J. 1992; 304: 1015
        • Hjermann L.
        • Holme I.
        • Velve B.K.
        • Leren P.
        Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men.
        Lancet. 1981; ii: 1303
        • Ornish D.
        • Brown S.E.
        • Scherwitz L.W.
        • et al.
        Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.
        Lancet. 1990; 336: 129
        • Watts G.F.
        • Lewis B.
        • Brunt J.N.H.
        • et al.
        Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas Atherosclerosis Regression Study (STARS).
        Lancet. 1992; 339: 563
        • Schuler G.
        • Hambrecht R.
        • Schlierf G.
        • et al.
        Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease.
        Circulation. 1992; 86: 1
        • WHO Expert Committee
        Prevention of Coronary Heart Disease, Report of a WHO Expert Committee.
        in: Technical Report Series 678. World Health Organization, Geneva1982
        • Grundy S.M.
        • Arky R.
        • Bray G.A.
        • et al.
        Coronary risk factor statement for the American Public/A Statement of the Nutrition Committee/American Heart Association.
        Circulation. 1985; 72: 1135
        • Study Group, European Atherosclerosis Society
        Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society.
        Eur. Heart J. 1987; 8: 77
        • The Expert Panel of the National Cholesterol Education Program
        Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treat ment of high blood cholesterol in adults.
        Arch. Intern. Med. 1988; 148: 36
        • WHO Study Group
        Diet, Nutrition and the Prevention of Chronic Diseases, Report of a WHO Study Group.
        in: WHO Technical Report Series 797. World Health Organization, Geneva1990
        • Helle´nius M.L.
        • de Faire U.
        • Krakau I.
        • Berglund B.
        Prevention of cardiovascular disease within the primary health care system - feasibility of a prevention programme within the Sollentuna primary health care catchment area.
        Scand. J. Prim. Health Care. 1993; 11: 69
        • Ulbricht T.L.V.
        • Southgate D.A.T.
        Coronary heart disease: seven dietary factors.
        Lancet. 1991; 338: 985
        • Wood P.D.
        • Stefanick M.L.
        • Williams P.T.
        • Haskell W.L.
        The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women.
        New Engl. J. Med. 1991; 325: 461
        • Becker W.
        The Swedish household survey.
        in: Presented at the Sixth European Nutrition Conference, 1991, Athens, Greece1989 (Abstract in Nutritional Science, New Developments of Consumer Concern)
        • Borg G.
        Perceived exertion as an indicator of somatic stress.
        Scand. J. Rehabil. Med. 1970; 23: 92
        • Carlson K.
        Lipoprotein fractionation.
        J. Clin. Pathol. 1973; 26: 32
        • Zlatkis A.
        • Zak B.
        • Boyle A.J.
        A new method for direct determination of serum cholesterol.
        J. Lab. Clin. Med. 1953; 41: 486
        • Fletcher M.J.
        A colorimetric method for estimating serum triglycerides.
        Clin. Chim. Acta. 1968; 22: 393
        • Gordon N.F.
        • Scott C.B.
        • Wilkinson W.J.
        • Duncan J.J.
        • Blair S.N.
        Exercise and mild essential hypertension. Recommendations for adults.
        Sports Med. 1990; 10: 390
        • Anderson K.M.
        • Wilson P.W.F.
        • Odeil P.M.
        • Kannel W.B.
        An updated coronary risk profile. A statement for health professionals.
        Circulation. 1991; 83: 356
        • Sjo¨stro¨m L.V.
        Morbidity of severely obese subjects.
        Am. J. Clin. Nutr. 1992; 55: 508
        • Margetts B.M.
        • Beilin L.J.
        • Vandongen R.
        • Armstrong B.K.
        Vegetarian diet in mild hypertension: a randomised controlled trial.
        Br. Med. J. 1986; 293: 1468
        • Filipovsky J.
        • Simon J.
        • Chrastek J.
        • Rosolova H.
        • Haman P.
        • Petrikova V.
        Changes of blood pressure and lipid pattern during a physical training course in hypertensive subjects.
        Cardiology. 1991; 78: 31
        • The Treatment of Mild Hypertension Research Group, The Treatment of Mild Hypertension Study
        A randomized, placebo controlled trial of nutritional-hygienic regimen along with various drug monotherapies.
        Arch. Intern. Med. 1991; 151: 1413
        • Collins R.
        • Peto R.
        • MacMahon S.
        • et al.
        Blood pressure, stroke, and coronary heart disease. Part 2, shortterm reductions in blood pressure: overview of randomis ed drug trials in their epidemiological context.
        Lancet. 1990; 335: 827
        • Blumenthal J.A.
        • Siegel W.C.
        • Appelbaum M.
        Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of a randomized controlled trial.
        J. Am. Med. Assoc. 1991; 266: 2098
        • Jungner L.
        • Walldius G.
        • Holme I.
        • Kolar W.
        • Steiner E.
        Apolipoprotein B and A-I in relation to serum cholesterol and triglycerides in 43 000 Swedish males and females.
        Int. J. Clin. Lab, Res. 1992; 21: 247
        • Bloemberg B.P.M.
        • Kromhout D.
        • Goddijn H.E.
        • Jansen A.
        • Obermann-de Boer G.L.
        The impact of the guidelines for a healthy diet of the Netherlands Nutri tion Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men.
        Am. J. Epidemiol. 1991; 134: 39
        • Boberg J.
        • Gustafsson I.B.
        • Karlstro¨m B.
        • Litheil H.
        • Vessby B.
        • Werner I.
        Treatment of hyperlipoproteinemia with `Type Specific' diets under metabolic ward conditions.
        Ann. Nutr. Metab. 1981; 25: 320
        • Ehnholm C.
        • Huttunen J.K.
        • Pietinen P.
        • et al.
        Effect of diet on serum lipoproteins in a population with a high risk of coronary heart disease.
        N. Engl. J. Med. 1982; 307: 850
        • Bae C.Y.
        • Keenan J.M.
        • Wenz J.
        • McCaffrey D.J.
        A clinical trial of the American Heart Association Step One Diet for treatment of hypercholesterolemia.
        J. Fam. Pract. 1991; 33: 249
        • Kiens B.
        • Jo¨rgensen L.
        • Lewis S.
        • et al.
        Increased plasma HDL-cholesterol and apo A-I in sedentary middle-aged men after physical conditioning.
        Eur. J. Clin. Invest. 1980; 10: 203
        • Peltonen P.
        • Marniemi J.
        • Hietanen E.
        • Vuori I.
        • Ehnholm C.
        Changes in serum lipids, lipoproteins, and heparin releasable lipolytic enzymes during moderate physical training in man: a longitudinal study.
        Metabolism. 1981; 30: 518
        • Wood P.D.
        • Stefanick M.L.
        • Dreon D.M.
        • et al.
        Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise.
        N. Engl. J. Med. 1988; 319: 1173
        • Barr S.I.
        • Costill D.L.
        • Fink W.J.
        • Thomas R.
        Effect of increased training volume on blood lipids and lipoproteins in male collegiate swimmers.
        Med. Sci. Sports Exerc. 1991; 23: 795
        • Ekstedt B.
        • Jo¨nsson E.
        • Johnson O.
        Influence of dietary fat, cholesterol and energy on serum lipids at vigorous physical exercise.
        Scand. J. Clin. Lab. Invest. 1991; 51: 437
        • Wood P.D.
        • Haskell W.L.
        • Blair S.N.
        • et al.
        Increased exercise level and plasma lipoprotein concentrations: a one-year, randomized, controlled study in sedentary, middle-aged men.
        Metabolism. 1983; 32: 31
        • Barnard R.J.
        Effects of life-style modification on serum lipids.
        Arch. Intern. Med. 1991; 151: 1389
        • Agheli N.
        • Cloarec M.
        • Jacotot B.
        Effect of dietary treatment on the lipid, lipoprotein and fatty acid compositions in Type IV Familial Hypertriglyceridemia.
        Ann. Nutr. Metab. 1991; 35: 261

      Article info

      Publication history

      Accepted: June 7, 1993
      Received in revised form: May 25, 1993
      Received: March 5, 1993

      Footnotes

      Partly presented at the XlVth Congress of the European Society of Cardiology, 30 August–3 September 1992, Barcelona, Spain.

      Identification

      DOI: https://doi.org/10.1016/0021-9150(93)90042-S

      Copyright

      © 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. Published by Elsevier Inc.

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