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What’s more, in addition to losing fat mass and twice the weight, overweight coronary patients on a steady walking regimen apparently can improve their insulin sensitivity to a greater degree than people undergoing standard cardiac rehabilitation, says a new study in Circulation: Journal of the American Heart Association.

In the study, researchers at the University of Vermont randomized 74 overweight cardiac rehab patients whose average age was 64 to either a high-caloric expenditure exercise regimen, aimed at burning 3,000 to 3,500 calories a week by walking almost daily, or to standard therapy, burning 700 to 800 calories a week, exercising three times per week.

Shedding weight on a daily basis called for walking 45-60 minutes at a moderate pace -- a lower speed than standard therapy -- for five to six days per week.

The standard rehab called for walking, biking, or rowing for 25-40 minutes at a brisker pace, but only three times per week.

Five months into the study, the researchers compared the two groups and found that patients doing the daily walking had:

* Significantly greater improvement in 10 heart risk factors, including insulin sensitivity.
* A greater average reduction in weight, 18 pounds compared to 8 pounds in the standard rehab group. Walkers lost 13 pounds in body fat compared to 6 pounds for those in the standard group. And walkers’ waistlines shrunk by 2.7 inches, compared to 2 inches for the standard rehab group.

“Cardiac rehab has essentially remained the same since the 1970s because it has a mortality benefit,” says Philip A. Ades, MD, lead author of the study and a professor of medicine at the University of Vermont College of Medicine. “But it doesn’t burn many calories and things have changed. Eighty percent of our rehabilitation patients are now overweight and many of them are becoming diabetic. It’s a different time in terms of what we need to do in cardiac rehab.”

Being overweight increases the risk of heart attacks and is associated with diabetes, hypertension, and high cholesterol.

Standard rehab has benefits, but the high calorie-burning regimen increases benefits, Ades says, adding that the study’s message is “walk often and walk far.”

But he doesn’t recommend that every heart patient who’s overweight hit the streets -- not until first discussing their plans with their doctors. “We suspect that the general applicability of the high-caloric expenditure exercise programs in cardiac rehabilitation will be broad, although staff and patients will need to be comfortable with performing much of the five- to six-day-per-week exercise program away from the highly monitored rehab facility.”

Most patients continued their exercise programs after five months. A year after the study started, both groups had regained a few pounds from when last weighed. The heavy walkers regained an average of 2.9 pounds, and the lower exercisers regained 2 pounds. But weight and body fat stayed significantly lower in both groups, the researchers say.

A significant finding, and probably the most important one, was the improvement in walking patients’ insulin sensitivity as well as in multiple markers of heart disease risk (other than weight), when compared to the standard rehab participants.

The researchers’ conclusion is unequivocal: “High calorie-expenditure exercise is superior to standard [cardiac rehabilitation] exercise in accomplishing weight loss and favorably altering cardiometabolic risk factors, particularly insulin resistance, in overweight patients with [coronary heart disease].”