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Effects of Aerobic Physical Exercise on Inflammation and Atherosclerosis in Men: The DNASCO Study: A Six-Year Randomized, Controlled Trial

Rainer Rauramaa, MD, PhD; Pirjo Halonen, MSc; Sari B. Väisänen, PhD; Timo A. Lakka, MD, PhD; Arno Schmidt-Trucksäss, MD, PhD; Aloys Berg, MD, PhD; Ilkka M. Penttilä, MD, PhD; Tuomo Rankinen, PhD; and Claude Bouchard, PhD
[+] Article and Author Information

From Kuopio Research Institute of Exercise Medicine, University of Kuopio, and Kuopio University Hospital, Kuopio, Finland; University of Freiburg, Freiburg, Germany; and Louisiana State University, Baton Rouge, Louisiana.


Grant Support: By the Ministry of Education in Finland (322/722/94, 80/722/95, 176/722/96, 42/722/97, 84/722/98, 138/722/99, 112/722/2000); Academy of Finland (68103/1999, 72401/2000); City of Kuopio; Finnish Heart Association; Juho Vainio Foundation; Freiburg University Hospital, Center for Clinical Research (Project C3, ZKF II); and Centre de Recherche et d'Information Nutritionnelles de Paris, France. Dr. Bouchard is partially funded by the George A. Bray Chair in Nutrition.

Potential Financial Conflicts of Interest:Employment: C. Bouchard (Louisiana State University, Pennington Biomedical Research Center); Consultancies: C. Bouchard (Almond Board of California, Baylor Children's Nutrition and Research Center, Boston Obesity and Nutrition Research Center, Bristol-Myers Squibb, Institutes for Pharmaceutical Discovery, Mars, Inc., Pennington Management of Clinical Trials, Sanofi-Synthelabo, Cooper Institute for Aerobic Research, Weight Watchers International); Honoraria: C. Bouchard; Grants received: C. Bouchard (Bristol-Myers Squibb).

Requests for Single Reprints: Dr. Rauramaa: Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, FIN-70100 Kuopio, Finland; e-mail, rainer.rauramaa@uku.fi.

Current Author Addresses: Drs. Rauramaa, Väisänen, and Penttilä: Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, FIN-70100 Kuopio, Finland.

Ms. Halonen: IT Service Centre, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland.

Drs. Lakka, Rankinen, and Bouchard: Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808-4124.

Drs. Schmidt-Trucksäss and Berg: Department of Rehabilitative and Preventative Sports Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany.

Author Contributions: Conception and design: R. Rauramaa, S.B. Väisänen, A. Berg, T. Rankinen, C. Bouchard.

Analysis and interpretation of the data: R. Rauramaa, P. Halonen, S.B. Väisänen, T.A. Lakka, A. Schmidt-Trucksäss, I.M. Penttilä, T. Rankinen.

Drafting of the article: R. Rauramaa, S.B. Väisänen, T.A. Lakka.

Critical revision of the article for important intellectual content: R. Rauramaa, P. Halonen, S.B. Väisänen, T.A. Lakka, A. Schmidt-Trucksäss, A. Berg, I.M. Penttilä, T. Rankinen, C. Bouchard.

Final approval of the article: R. Rauramaa, P. Halonen, S.B. Väisänen, T.A. Lakka, A. Schmidt-Trucksäss, A. Berg, I.M. Penttilä, C. Bouchard.

Provision of study materials or patients: R. Rauramaa, A. Schmidt-Trucksäss.

Statistical expertise: P. Halonen.

Obtaining of funding: R. Rauramaa, A. Berg, I.M. Penttilä.

Administrative, technical, or logistic support: R. Rauramaa, S.B. Väisänen, I.M. Penttilä.

Collection and assembly of data: R. Rauramaa, T. Rankinen.


Ann Intern Med. 2004;140(12):1007-1014. doi:10.7326/0003-4819-140-12-200406150-00010
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The main finding of this 6-year randomized, controlled trial is that regular physical exercise at low to moderate intensity did not slow the progression of carotid atherosclerosis, except in the subgroup of men who were not taking statins. These subgroup findings, if applicable to the coronary circulation, support the data from observational studies of an inverse relationship between physical activity and the risk for coronary heart disease (1, 3, 67, 2829) and provide evidence for the antiatherosclerotic effects of an increase in regular physical exercise in some men.

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Figures

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Figure 1.
Flow of participants through the study.
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Figure 2.
Mean ventilatory aerobic threshold in the exercise and control groups during the intervention.

P < 0.001 (repeated-measures analysis of variance based on intention-to-treat analysis for 140 patients with covariates).

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Figure 3.
Mean high-sensitivity C-reactive protein level in the exercise and control groups during the intervention.

P > 0.2 (repeated-measures analysis of variance based on intention-to-treat analysis for 140 patients with covariates). To convert mg/L to nmol/L, multiply by 8.45.

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Figure 4.
Mean intima–media thickness during the intervention in all participants (top) and excluding men taking statins (bottom).

In the top panel, P > 0.2; in the bottom panel, P = 0.02 (repeated-measures analysis of variance based on intention-to-treat analysis for 140 patients with covariates).

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Comments

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Misleading Conclusions
Posted on June 19, 2004
Vernon C Jones
none
Conflict of Interest: None Declared

How many of the 140 men were in the subgroup that were taking statins? Exercise clearly indicated a 40% advantage in the normal man, that is, not taking statins. This study is an example of faulty reporting. Many will see the conclusion that states that physical exercise did not attenuate the progression of atherosclerosis and without thought will accept this as fact. How can the truth be brought to the public when the pharmaceutical industry pays for and controls how reports are presented? This is a financial conflict of interest pure and simple. The American public is becomming wise to people such as C. Bouchard of LSU receiving honoraria and or grants from the likes of Bristol-Myers Squibb while representing what should be an unbiased and objective, easy to interpret, report of a "randomized" controlled trial.

Conflict of Interest:

None declared

Effects of aerobic physical exercise and atherosclerosis in men
Posted on August 16, 2004
Th. F.M. Fennis
Atrium Medical Centre
Conflict of Interest: None Declared

23 July 2004

To the editor:

Rauramaa and colleagues (1) report that physical exercise slows progression of atherosclerosis in men not taking statins. Their way of measuring the progression of atherosclerosis is, however, invalid. They report having used an ultrasound device with a high-resolution 10 MHz transducer to measure the intima-media thickness in the carotid bifurcation. The velocity of sound in tissue is 1540 m/sec. Wavelength is calculated by dividing this velocity through frequency, thus wavelength equals 0,154 mm. It is commonly accepted that the standard measurement error is 2 to 3 times this wavelength. The difference noted in the article in the subgroup analysis of men not taking statins is 0,08 mm in favor of the exercise group. This difference falls well within the measurement error. Furthermore, because it is smaller than the wavelength it is, by definition, not reliable.

Th F.M. Fennis, MD and J.W. Vredeveld, MD, Ph.D. Atrium Medical Centre

Heerlen

The Netherlands

1. Rauramaa R, Halonen P, Vaisanen SB, Lakka TA, Schmidt-Trucksass A, Berg A, Penttila IM, Rankinen T, Bouchard C. Effects of aerobic physical exercise on inflammation and atherosclerosis in men: the DNASCO Study: a six-year, randomized, controlled trial. Ann Int Med. 2004;140:1007-14. [PMID: 15197018]

Conflict of Interest:

None declared

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Summary for Patients

Does Aerobic Exercise Slow Progression of Atherosclerosis?

The summary below is from the full report titled “Effects of Aerobic Physical Exercise on Inflammation and Atherosclerosis in Men: The DNASCO Study. A Six-Year Randomized, Controlled Trial.” It is in the 15 June 2004 issue of Annals of Internal Medicine (volume 140, pages 1007-1014). The authors are R. Rauramaa, P. Halonen, S.B. Väisänen, T.A. Lakka, A. Schmidt-Trucksäss, A. Berg, I.M. Penttilä, T. Rankinen, and C. Bouchard.

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