Alterations in anthropometric, physiological and biochemical parameters during a complex exercise and dietary treatment program for obese patients with controlled hypertension

Objective: Obesity and hypertension are considered as major risk factors of for cardiovascular diseases. Besides unfavorable metabolic processes, altered levels of pro-inflammatory factors and adipokines produced by the white adipose tissue have various role in atherogenesis. In our study, we aimed to investigate the impact of exercise and dietary therapies on these unfavorable processes in obese, controlled hypertensive patients. Design and method: Forty-two obese subjects with controlled hypertension were enrolled in our six-week self-controlled clinical trial. The load capacity was assessed by ergospirometry and the maximum VO2 uptake (VO2max), respiratory anaerobic threshold (V-slope) and maximum metabolic equivalent (MET) were determined. Body composition analysis and six- minute walking test (6MWT) were also performed. We also investigated serum lipid parameters, high-sensitivity C-reactive protein (hsCRP) levels, oxidized low-density lipoprotein (oxLDL) concentrations, paraoxonase (PON1) activities and calculated the homeostatic model assessment (HOMA)-insulin resistance (HOMA-IR). Serum adipokine levels including leptin, adiponectin, tumor necrosis factor (TNF)-alfa, chemerin, resistin, lipocalin-2 concentrations were also measured. All of our tests were repeated at the end of the six-week program, during which, the patients received 3 x 50 minutes of exercise training. Dietotherapy was also provided twice a week. Results: Each patient completed the program (age: 58.12 ± 10.4 years, M/F: 9/33, initial mean body mass index /BMI/: 44.24 ± 7.22 kg/m2, mean blood pressure /BP/: 132,21 ± 5,74 mmHg). At the end of the program, BMI and BP were significantly reduced (p < 0.00001, p < 0.01, respectively), with improvement in all functional tests (p < 0.0001), VO2max (p < 0.000002) and in V-slope (p = 0.001). LDL-cholesterol and oxLDL concentrations decreased significantly (p = 0.0005, p = 0.0009, respectively), while high-density lipoprotein (HDL)-cholesterol levels showed a significant increase (p = 0.0028). HOMA-IR also improved significantly (p = 0.006) and the percentage of body fat mass was reduced significantly (p = 0.000036). Among the adipokines, only the circulating concentrations of lipocalin-2 and leptin were significantly decreased (p = 0.036, p < 0.000001, respectively). HsCRP concentration and PON activity were also found to be significantly reduced (p < 0.00001, p = 0.0032, respectively). Conclusions: Besides its beneficial physiological effects, an aerobic exercise program combined with dietotherapy improves pro-atherogenic, pro-inflammatory and metabolic factors in obese patients with controlled hypertension.