Effect of a One-Year Combined Exercise Training Program on Body Composition in Men With Coronary Artery Disease Helena Santa-Clara, Bo Fernhall, Fa ´ tima Baptista, Miguel Mendes, and Luı ´s Bettencourt Sardinha Increased fat mass, particularly abdominal fat mass, is associated with poor metabolic profiles and an increase in cardiovas- cular risk factors. The purpose of this study was to evaluate the effect of a 1-year combined aerobic and strength training regimen, compared to aerobic training only, on body composition in patients with coronary artery disease (CAD). Thirty-six males with CAD were assigned to 3 groups: 13 to weight training plus aerobic training (combined training group [CT]), 13 to aerobic training only (aerobic training group [AT]), and 10 to a control group (no exercise [CG]). Body composition was determined by dual-energy x-ray absorptiometry (DEXA). Differences were observed between groups at the end of the study, controlling for prevalues. The total and trunk percent fat mass (%FM) were lower in CT compared with AT and CG (P < .05). The total %FM in AT was significantly (P < .05) lower than in CG, but the %FM of the trunk did not differ between the 2 groups. Fat-free mass (FFM) was significantly higher in CT than in AT and CG (P < .05). The results suggest that a long-term CT program is more effective than an AT program alone in producing changes in body composition. The percentage changes in total and trunk fat mass were higher in CT (11% and 12%, respectively) than in AT (2.4% and 0.7%, respectively). Future studies need to investigate the specific health effects of trunkal fat mass loss in patients with CAD. © 2003 Elsevier Inc. All rights reserved. M OST PATIENTS entering cardiac rehabilitation pro- grams are obese, with a high prevalence of upper body obesity. 1 The pattern of body fat distribution is a critical factor in the relationship between obesity and metabolic abnormali- ties. 2 Increased fat mass, particularly abdominal fat mass, is associated with poor metabolic profiles and an increase in cardiovascular risk factors, independent of the level of obesity. 3 For example, abdominal fat has been correlated with alterations in lipoproteins such as higher low-density lipoprotein (LDL)- cholesterol and lower high-density lipoprotein (HDL)-choles- terol, 4 hyperinsulinemia, 5 hypertension, 2,3 and lower peak aer- obic capacity 6 ; in addition, abdominal fat can be considered as an independent risk factor for coronary artery disease (CAD). 7 Fat-free mass (FFM) is important for maintaining skeletal integrity for the prevention of osteoporosis. 8 Osteoporosis is common among older men, and almost 20% of men above 50 years of age have osteoporosis. 9 Body weight, and particularly FFM, is a significant positive predictor of bone mineral mass in both men and women. 10-13 Exercise is important in preventing fractures due to bone loss and for enhancing both FFM and bone mineral density (BMD). 14 Cardiac rehabilitation programs may elicit small changes in body composition, but improvements in FFM are not always observed. 2,15 High-intensity strength training may 16 or may not 17 improve body composition, but most cardiac rehabilita- tion programs typically utilize lower training intensities. 18 While such programs consistently show significant improve- ments in strength, 18 they rarely affect body composition. 19-21 However, most prior studies have used short-term training programs (8 to 10 weeks). 18 Six months of training may im- prove percent body fat, but only in patients who performed both aerobic and resistance training. A nonsignificant decrease in trunkal body fat has been observed, 22 but the training load was not equalized between groups, body composition was only measured in a small subset of patients, and no control group was included. It is unclear if adding low-intensity weight training to aero- bic training will affect body composition and trunkal fat in cardiac patients in a long-term (1-year) intervention program. Therefore, the purpose of the current study was to evaluate the effect of a 1-year combined aerobic and strength training re- gime compared to aerobic training only on overall and trunkal fat mass, FFM, and bone density in patients with CAD. MATERIALS AND METHODS Sample Forty male patients who had completed phase II cardiac rehabilita- tion were initially recruited for this study. Four withdrew because of the time commitment required. Thirty-six men between the ages of 45 and 68 years completed the study. After pre-evaluation, they were assigned to 3 groups: 13 to the weight training plus aerobic training group (combined training group [CT]), 13 to the aerobic training group (AT), and 10 to a control group (no exercise [CG]). Logistical concerns prevented random group assignments; the subjects were assigned based on residential proximity to the exercise locations in order to maximize exercise compliance, but patients did not choose group assignments. To be eligible patients had to be male, and diagnosed with one or more of the following: stable angina pectoris, myocardial infarction (MI), per- cutaneous transluminal coronary angioplasty (PTCA), or coronary ar- tery bypass (CABG). None of the subjects smoked at the time of recruitment, and they were free of other major disease states including diabetes mellitus, hypertension, and any condition precluding regular exercise. All subjects provided written informed consent prior to par- ticipation. The study was approved by the University Institutional Review Board. Patients in the 3 groups had comparable histories of CABG (CT, n = 7; AT, n = 6; CG, n = 7) and there were more patients in the CT group who had MI (CT, n = 10; AT, n = 7; CG, n = 6) and previous PTCA (CT, n = 6; AT, n = 5; CG, n = 3) than in CG. The patients were taking more than 1 medication (beta blockers, nitrates, calcium channel blockers, platelet inhibitors, and angiotensin- converting enzyme) with similar use between the 3 groups, and there From the Exercise and Health Department, Faculty of Human Move- ment–Technical University of Lisbon; and the Heart Institute, Lisbon, Portugal. Submitted January 6, 2003; accepted June 16, 2003. Address reprint requests to Helena Santa-Clara, PhD, Faculdade de Motricidade Humana, Estrada da Costa 1495-688 Cruz-Quebrada, Portugal. Email santaclar@tmh.utl.pt. © 2003 Elsevier Inc. All rights reserved. 0026-0495/03/5211-0011$30.00/0 doi:10.1016/S0026-0495(03)00320-2 1413 Metabolism, Vol 52, No 11 (November), 2003: pp 1413-1417