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Objective. To assess the effects of lifestyle intervention on cardiovascular risk factors in general and especially on fibrinolysis.

Design. Randomized clinical study.

Subjects. A total of 186 subjects with impaired glucose tolerance and obesity.

Interventions. The intervention programme included a low-fat, high-fibre diet and regular physical exercise. Half of the participants (n = 93) took part in a one-month learning and training session using different behavioural modification techniques and conducted in a full-board wellness centre (intense intervention group). The other half (n = 93) was randomized a one-hour counselling session with a specially trained nurse (usual care group). Follow-up was carried out after 12 months.

Main outcome measures. Body weight, oxygen consumption, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator (tPA) antigen, fibrinogen and fasting plasma insulin measured at the start of the programme and at follow-up after 1 year.

Results. The intense intervention group had a mean weight decline by 1 year of 5.4 kg compared to 0.5 kg in the usual care group. Oxygen consumption in the intense group increased 10% vs. a 1% decline in the usual care group. In the intense group, PAI-1 activity decreased 31% (- 10.1 U mL-1), which was significantly more than in the usual care group (12%; - 3.0 U mL-1). The corresponding reductions in tPA antigen were 14% (-1.65 [mu]g L-1) and 6% (-0.69 [mu]g L-1).

Conclusions. The present randomized study shows that an intense lifestyle programme has sustained beneficial effects on fibrinolysis.

(C) 1999 Blackwell Science Ltd.