This study sought to determine whether aerobic exercise training without diet restriction had a favourable impact on ventricular epicardial fat thickness and whether changes in intra-abdominal (visceral) fat were associated with changes in epicardial fat thickness during exercise training in middle-aged obese men (n=24). Each participant underwent the 12-week supervised exercise training program (60-70% of the maximal heart rate, 60 minutes/day, 3 days/week) and a transthoracic echocardiography to determine the epicardial fat thickness. Intra-abdominal (visceral) and subcutaneous fat area was determined by computed tomography. Epicardial fat thickness was significantly reduced after the exercise training program along with waist circumference, body mass index, body weight, and abdominal fat areas (intra-abdominal and subcutaneous). There was a significant association between changes in epicardial fat thickness and changes in intra-abdominal fat (r=0.525, p=0.008). In a multiple regression analysis, changes in intra-abdominal fat, changes in systolic blood pressure, and changes in insulin sensitivity were independently related to changes in epicardial fat thickness. These results stress the critical role played by exercise training in improving ectopic fat depots. This paper was accompanied by an editorial, which explained that epicardial adipose tissue is currently receiving so much research attention because of the features it shares with intra-abdominal (visceral) adipose tissue. Each depot has the same intra-abdominal embryological derivation, each depot’s mass increases in obesity, the increase in size of one correlates with the increase in size of the other, and their increases are significantly associated with established cardiovascular disease risk factors. Sacks recognized that the study by Kim et al. added to the literature by showing that increased energy expenditure without calorie restriction is associated with reduction in epicardial fat thickness. Because of the limitations of echocardiography, it was proposed that future human studies to assess whether epicardial adipose tissue is a coronary artery disease risk factor or contributes to coronary artery disease should use more sophisticated imaging technologies such as computed tomography or magnetic resonance imaging in conjunction with coronary angiography, intra-vascular ultrasound, or even magnetic resonance angiography.
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