Cardiac rehabilitation

Abstract

The combination of both sedentary lifestyle and unrestricted food availability increases the prevalence of obesity and type 2 diabetes and therefore the risk of cardiovascular morbidity and mortality due to coronary artery disease. A cardiomyopathy of obesity where the myocardial abnormalities cannot be ascribed to comorbidities is well recognized and its presence is supported both by experimental models and by epidemiological and clinical studies: left ventricular hypertrophy, reduced diastolic and systolic function, chronotropic incompetence are the typical features of the obesity cardiomyopathy. Moreover obese subjects have a high prevalence of diabetes, hypertension, atrial fibrillation, and sleep apnea. Cardiac rehabilitation programs include diet, physical exercise, and behavioral counseling as a strategy to fight obesity and its consequences and can possibly reverse the anomalies in cardiovascular function. The results are encouraging and obesity cardiomyopathy can partially be reversed by means of rehabilitation programs. Unfortunately, the obese often regain weight even after an early success. The adoption of an active lifestyle can have a favorable impact on prognosis in obese patients independently of weight loss. In this chapter, the modifications that occur in cardiac structure and function of obese subjects, the approach to cardiac rehabilitation, and the main results of weight loss and exercise are reviewed.