The Influence Of Regular Exercise At Different Times Of Day On Blood Lipids And Inflammatory Markers In Sedentary Patients With Coronary Artery Disease

Objective:The incidences of cardiovascular events reveal circadian rhythms. However, which times of day to exercise could achieve the greatest improvements in patients with coronary artery disease (CAD) remains unclear. The purpose of this study was to examine the influence of exercise at different times of day on lipids and inflammatory markers in sedentary patients with CAD.Methods:A total of330patients recruited from the First Affiliated Hospital of Nanjing Medical University between September2011and November2012were randomly assigned to a control group (n=110), morning exercise group (n=110) or evening exercise group (n=110). Both the exercise groups were asked to walk at the speed of4-6.8km/h for30min/day or more on at least5days/week either in the morning or evening for12weeks. All patients included were given20mg atorvastatin per day during the intervention period. Lipids and inflammatory markers were measured before and after exercise intervention.Results:Both the exercise groups significantly increased their duration, distance, frequency and total time of walking. Compared with baseline, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were improved in all groups, while fibrinogen, high sensitivity C-reactive protein (hs-CRP), triglycerides (TG) were improved in both exercise groups. After12weeks intervention, significances were seen in fibrinogen, white blood cell (WBC) count, platelet count, TC, TG and hs-CRP among the groups. After adjusting for baseline values, significances were shown in the changes of fibrinogen, hs-CRP, WBC count, TC, TG, LDL-C, lipoprotein(a). The evening exercise group had a larger decrease in fibrinogen (0.16±0.19g/L, P<0.001), hs-CRP (1.16±1.07mg/L, P<0.001), WBC count (0.76±1.53109/L, P=0.004) and LDL-C (0.34±0.31mmol/L, P<0.001) than the other two groups.Conclusions:Our exercise program successfully resulted in a favorable change in lipids and inflammatory markers. In the circumstance of similar exercise volume, patients in the evening exercise group gained more benefits than those in the morning exercise group.