Metabolic Syndrome
Physiological benefits
Which of the following is not a criterion of metabolic syndrome?
a. Waist circumference >102cm for males or >88cm for females
b. Triglycerides ≥ 150mg/dL or on medication
c. Systolic blood pressure ≥ 130mmHg or diastolic blood pressure ≥85mmHg
d. Hematocrit >53% for males and >48% for females
- Improve waist circumference
- Improve fasting blood glucose and BP
- Greater SBP improvement with aerobic training
- Decrease triglycerides, increase HDL-C, reduce BP, and reduce waise circumference below threshold values
- Primary prevention of chronic diseases that Metsyn patients are at high risk for
- Reduce number of Metsyn criteria per patient
- 77% of original group had Metsyn pre-intervention, 15% of exercise group had Metsyn post-intervention
What is the frequency and intensity recommendation for cardiovascular exercise in an individual with metabolic syndrome?
Short Answer:
How does the prevalence of metabolic syndrome change with age?
a. 3 days per week at low intensity
b. 5 days per week at moderate intensity
c. 5 days per week at high intensity
d. 2 days per week at moderate intensity
Important Information
Testing Guidelines
Criteria cutpoints
Exercise Prescription
Review Questions
- Testing not required for low-to-moderate intensity exercise program
- General recommendations with particular consideration for HTN, dyslipidemia, and hyperglycemia (when present)
- Many Metsyn patients are overweight or obese - follow considerations specific to this population
- Low initial exercise capacity requires low initial workload
- Strictly follow BP assessment protocols (testing and during program)
- 2x as likely to develop CVD and 5x as likely for T2DM
- Typically lower initial exercise capacity
- Excuse that exercise is too tiring is greatest barrier - combine aerobic and resistance training to overcome
- Focus: weight control and overall PA
- FITT principle: generally consistent with aerobic, resistance, and flexibility training as healthy adults
- Central Adiposity:
- Waist circumference >102cm in males and >88cm in females
- Insulin Resistance:
- ≥100mg/dL fasting blood glucose or on medication to lower blood glucose
Short Answer:
True or False?
What are the resistance training recommendations for an individual with metabolic syndrome?
Known obstructive left main coronary artery stenosis is an absolute contraindication for exercise in an individual with metabolic syndrome.
Special Considerations
- Give attention to each present risk factor - use most conservative protocols for initial workoad
- 150min/wk or 30min/day most days of week
- Reduce body weight by gradually increasing PA 250-300min/wk or 50-60min/day 5days/wk
- Combinating resistance and aerobic training produces much greater decrease in prevalence
Definition & Criteria Overview
- Minimal PA dose improves health & fitness outcomes (150min/wk or 30min moderate PA most days of week)
- Close attention to each present risk factor/condition - most conservative initial approach
- Moderate intensity initially can reduce impact of Metsyn
- Focus to reduce body weight by increasing PA
- Combining resistance and aerobic training greatly reduces prevalence of Metsyn
- ≥2days/wk reduces risk of increased waist circumference, prehypertension, increased waist circumference, and dyslipidemia
Metabolic syndrome, or "Metsyn" is a clustering of cardiovascular disease, diabetes, and stroke risks (Riebe, 2018)
Special considerations for Metsyn due to likely presence of CVD, DM, and other chronic diseases and health conditions
F: Frequency
Criteria: must have ≥3
- Central Adiposity
- Insulin Resistance/Elevated Glucose
- Dyslipidemia
- Elevated Blood Pressure
Prevalence
- CV: ≥5days/wk moderate or ≥3days/wk vigorous
- RT: each major muscle group 2-3days/wk
- F: >2-3days/wk, but most effective if done daily
- US: between 34% and 39%
- Worldwide: between 20% and 30%
- Prevalence increases with age: ~40% US population >60yr. old (Grundy, 2008)
*CV = cardiovascular; RT = resistance training; F = Flexibility
P: Pattern & Progression
Prescription Guidelines
- CV: continuous, interval, or multile sessions
- Gradually increase duration, frequency, and/or intensity
- RT: rest 2-3min between sets and 48 hours between sessions training same muscle groups
- Gradually increase resistance and/or frequency
- F: 2-4x per stretch
- Warm up with light-to-moderate activity
I: Intensity
References
Exercise programming for people with metabolic syndrome follows recommendations for the general population
*CV = cardiovascular; RT = resistance training; F = Flexibility
Criteria cutpoints cont'd
- CV: moderate and/or vigorous
- Light-t0-moderate for deconditioned
- RT: 60-70% 1-RM for novice to intermediate exercisers
- 40-50% 1-RM for previously sedentary individuals
- F: stretch to point of tightness or slight discomfort
- Dyslipidemia:
- HDL <40mg/dL for males and <50mg/dL for females or on lipid-lowering medication
- triglycerides ≥150mg/dL or on drug treatment
- Elevated Blood Pressure:
- ≥130mmHg systolic blood pressure or ≥85mmHg diastolic blood pressure or on medication
F: Frequency
I: Intensity
T: Time
T: Type
V: Volume
P: Pattern & Progressoin
*CV = cardiovascular; RT = resistance training; F = Flexibility
Grundy, Scott M. (2008). Metabolic Syndrome Pandemic. Retrieved from
https://www.ahajournals.org/doi/full/10.1161/ATVBAHA.107.151092
Gurka, M.J., Filipp, S.L., DeBoer, M.D. (2018). Geographicas variation in the prevalence of
obesity, metabolic syndrome, and diabetes among US adults. Retrieved from https://www.nature.com/articles/s41387-018-0024-2
Katzmarzyk, P.T., Leon, A. S., Wilmore, J.H., Skinner, J. S., Rao, D.C., Rankinen, T.,
Bouchard, C. (2003). Targeting the Metabolic Syndrome with Exercise: Evidence from the HERITAGE Family Study. Retrieved from https://journals.lww.com/acsm-msse/Fulltext/2003/10000/Targeting_the_Metabolic_Syndrome_with_Exercise_.13.aspx
Norizzati, M.I., Sarine, M.Y., Maisarah, S., Raja Nurul Jannat R.H. (2018). Comparison
of Different Exercise Modalities in Improving Metabolic Syndrome Risk Factors Among Obese Females. Retrieved from http://mohejournal.com/index.php/mohe/article/view/193/109
Ognibene, A. (2019). What is Metabolic Syndrome? Jamestown Spine Chiroporactic Center.
Retrieved from https://jamestownspine.com/metabolic-syndrome/.
Oncol, J.C. (2018). Effects of Aerobic and Resistance Exercise on Metabolic Syndrome,
Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858524/
Riebe, D., Ehrman, J.K., Liguori, G., Magal, M. (2018). ACSM’s Guidelines for Exercise
Testing and Prescription. Wolters Kluwer.
Waehner, P., Black, H. (2020). The F.I.T.T. Principle for an Effective Workout. Retrienved
from https://www.verywellfit.com/f-i-t-t-principle-what-you-need-for-great-workouts-1231593
V: Volume
All FITT-VP info from Riebe, 2018
- CV: ≥500-1000MET*min/wk
- Increase pedometer step counts by ≥2,000 steps/day to reach ≥7,000 steps/day
- RT: 2-4 sets of 8-12 reps to improve strength
- F: 60sec total stretching time for each exercise
T: Time
*CV = cardiovascular; RT = resistance training; F = Flexibility
- CV: 30-60min/day moderate or 20-60min/day vigorous
- RT: no specific duration
- F: hold static stretch 10-30sec
T: Type
*CV = cardiovascular; RT = resistance training; F = Flexibility
- CV: regular, purposeful, using major muscle groups in continuous or rhythmic nature
- RT: major muscle groups, multi-joint affecting >1 muscle group
- Or single-joint targeting major muscle groups
- F: Static, dynamic, ballistic, and PNF
*CV = cardiovascular; RT = resistance training; F = Flexibility