BEDEUTUNG VON KORPERKOMPOSITION UND FITNESS IN DER KARDIALEN PRAVENTION UND KURORTMEDIZIN

Despite the known influence of physical activity, physical fitness and body weight on the expression of metabolic cardiovascular risk factors for coronary heart disease, there is currently still a lack of coronary prevention programs in particular on an outpatient basis. In order to demonstrate the importance of such a program even in young clinically healthy individuals we investigated parameters of physical fitness and obesity in over 200 men aged 18 to 45 years and compared these data with a detailed coronary risk profile including distribution of lipoproteins and lipoprotein subfractions, peripheral insulin resistance, hypercoagulability and hypertension. As expected we found a direct correlation between physical fitness expressed as maximal oxygen consumption (VO₂max) and Body Mass Index (r = -0.62; p > 0.0001; VO₂max [ml/kg/min] = -2.25 x BMI + 103.5). Individuals with a BMI > 27.5 kg/m² and low physical fitness (VO₂max) < 36.1 ml/kg/min) had significantly values of higher systolic blood pressure, higher fasting glucose and insulin levels as well as higher serum concentrations of fibrinogen and ferritin. In addition these men had a significantly more unfavourable lipid profile: Triglyceride-rich lipoproteins (VLDL, IDL) and particularly atherogenic small dense LDL particles were significantly elevated. The mean cholesterol concentration of small dense LDL particles was 36 mg/dl and was 140% higher in comparison with the leaner groups. HDL and HDL₂ cholesterol was lower by 30% and 50% respectively in obese subjects (BMI > 27.5 kg/m²). These data demonstrate that men with a BMI > 27.5 kg/m² and low physical fitness express all criteria of the metabolic cardiovascular syndrome. These findings support the importance of physical fitness and body weight on the expression of an atherogenic coronary risk profile even in individuals with only moderately elevated body weight. Therefore, outpatient prevention programs should be organized and carried extensively by using the facilities of rehabilitation clinics, health resorts and sport clubs.