Change in Metabolic Syndrome and Cardiorespiratory Fitness Following Exercise Training - The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST)

Brittany E Smith, James E Peterman, Matthew P Harber, Mary T Imboden, Bradley S Fleenor, Leonard A Kaminsky, Mitchell H Whaley, Brittany E Smith, James E Peterman, Matthew P Harber, Mary T Imboden, Bradley S Fleenor, Leonard A Kaminsky, Mitchell H Whaley

Abstract

Purpose: To evaluate how the changes in directly measured cardiorespiratory fitness (CRF) relate to the changes in metabolic syndrome (MetS) status following 4-6 months of exercise training.

Methods: Maximal cardiopulmonary exercise (CPX) tests and MetS risk factors were analyzed prospectively from 336 adults (46% women) aged 45.8 ± 10.9 years. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria, as updated by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Pearson correlations, chi-squares, and dependent 2-tail t-tests were used to assess the relationship between the change in CRF and the change in MetS risk factors, overall number of MetS risk factors, and a MetS severity score following 4-6 months of participation in a self-referred, community-based exercise program.

Results: Overall prevalence of MetS decreased from 23% to 14% following the exercise program (P < 0.05), while CRF improved 15% (4.7 ± 8.4 mL/kg/min, P < 0.05). Following exercise training, the number of positive risk factors declined from 1.4 ± 1.3 to 1.2 ± 1.2 in the overall cohort (P < 0.05). The change in CRF was inversely related to the change in the overall number of MetS risk factors (r = -0.22; P < 0.05) and the MetS severity score (r = -0.28; p < 0.05).

Conclusion: This observational cohort study indicates an inverse relationship between the change in CRF and the change in MetS severity following exercise training. These results suggest that participation in a community-based exercise program yields significant improvements in CRF, MetS risk factors, the prevalence of the binary MetS, and the MetS severity score. Improvement in CRF through exercise training should be a primary prevention strategy for MetS.

Keywords: abdominal obesity; cardiorespiratory fitness; exercise training; metabolic syndrome.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2022 Smith et al.

Figures

Figure 1
Figure 1
Scatter plots of change in CRF and change in MetS risk factors and MetS severity score. *Denotes a significant correlation coefficient.

References

    1. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–1645. doi:10.1161/CIRCULATIONAHA.109.192644
    1. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–1607. doi:10.2337/diab.37.12.1595
    1. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA. 2015;313(19):1973–1974. doi:10.1001/jama.2015.4260
    1. Ades PA, Savage PD. The treatment of obesity in cardiac rehabilitation: a review and practical recommendations. J Cardiopulm Rehabil Prev. 2021;41(5):295–301. doi:10.1097/HCR.0000000000000637
    1. Brage S, Wedderkopp N, Ekelund U, et al. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care. 2004;27(9):2141–2148. doi:10.2337/diacare.27.9.2141
    1. Franks PW, Ekelund U, Brage S, Wong MY, Wareham NJ. Does the association of habitual physical activity with the metabolic syndrome differ by level of cardiorespiratory fitness? Diabetes Care. 2004;27(5):1187–1193. doi:10.2337/diacare.27.5.1187
    1. Earnest CP, Artero EG, Sui X, Lee DC, Church TS, Blair SN. Maximal estimated cardiorespiratory fitness, cardiometabolic risk factors, and metabolic syndrome in the aerobics center longitudinal study. Mayo Clin Proc. 2013;88(3):259–270. doi:10.1016/j.mayocp.2012.11.006
    1. Johnson JL, Slentz CA, Houmard JA, et al. Exercise training amount and intensity effects on metabolic syndrome (from studies of a targeted risk reduction intervention through defined exercise). Am J Cardiol. 2007;100(12):1759–1766. doi:10.1016/j.amjcard.2007.07.027
    1. Wijndaele K, Duvigneaud N, Matton L, et al. Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults. Eur J Clin Nutr. 2009;63(3):421–429. doi:10.1038/sj.ejcn.1602944
    1. Vishnu A, Gurka MJ, DeBoer MD. The severity of the metabolic syndrome increases over time within individuals, independent of baseline metabolic syndrome status and medication use: the Atherosclerosis Risk in Communities Study. Atherosclerosis. 2015;243(1):278–285. doi:10.1016/j.atherosclerosis.2015.09.025
    1. DeBoer MD, Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes Metab Syndr Obes. 2017;10:65–72. doi:10.2147/DMSO.S101624
    1. American College of Sports Medicine. Position stand: exercise and type 2 diabetes. Med Sci Sports Exerc. 2000;32(7):1345–1360. doi:10.1097/00005768-200007000-00024
    1. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA; American College of Sports Medicine. Position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–553. doi:10.1249/01.MSS.0000115224.88514.3A
    1. Jakicic JM, Clark K, Coleman E; American College of Sports Medicine. Position stand: appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2001;33(12):2145–2156. doi:10.1097/00005768-200112000-00026
    1. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359. doi:10.1249/MSS.0b013e318213fefb
    1. Myers J, Kokkinos P, Nyelin E. Physical activity, cardiorespiratory fitness, and the metabolic syndrome. Nutrients. 2019;11(7):1652. doi:10.3390/nu11071652
    1. Ekblom O, Ekblom-Bak E, Rosengren A, Hallsten M, Bergstrom G, Borjesson M. Cardiorespiratory fitness, sedentary behaviour and physical activity are independently associated with the metabolic syndrome, results from the SCAPIS Pilot Study. PLoS One. 2015;10(6):e0131586. doi:10.1371/journal.pone.0131586
    1. Ekelund U, Brage S, Franks PW, Hennings S, Emms S, Wareham NJ. Physical activity energy expenditure predicts progression toward the metabolic syndrome independently of aerobic fitness in middle-aged healthy Caucasians: the Medical Research Council Ely Study. Diabetes Care. 2005;28(5):1195–1200. doi:10.2337/diacare.28.5.1195
    1. Greer AE, Sui X, Maslow AL, Greer BK, Blair SN. The effects of sedentary behavior on metabolic syndrome independent of physical activity and cardiorespiratory fitness. J Phys Act Health. 2015;12(1):68–73. doi:10.1123/jpah.2013-0186
    1. Lakka TA, Laaksonen DE, Lakka HM, et al. Sedentary lifestyle, poor cardiorespiratory fitness, and the metabolic syndrome. Med Sci Sports Exerc. 2003;35(8):1279–1286. doi:10.1249/01.MSS.0000079076.74931.9A
    1. Whaley MH, Kampert JB, Kohl HWI, Blair SN. Physical fitness and clustering of risk factors associated with the metabolic syndrome. Med Sci Sports Exerc. 1999;31(2):287–293. doi:10.1097/00005768-199902000-00013
    1. Carroll S, Cooke CB, Butterly RJ. Metabolic clustering, physical activity and fitness in nonsmoking, middle-aged men. Med Sci Sports Exerc. 2000;32(12):2079–2086. doi:10.1097/00005768-200012000-00018
    1. LaMonte MJ, Barlow CE, Jurca R, Kampert JB, Church TS, Blair SN. Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Circulation. 2005;112(4):505–512. doi:10.1161/circulationaha.104.503805
    1. Hassinen M, Lakka TA, Hakola L, et al. Cardiorespiratory fitness and metabolic syndrome in older men and women: the dose responses to exercise training (DR’s EXTRA) study. Diabetes Care. 2010;33(7):1655–1657. doi:10.2337/dc10-0124
    1. Kelley E, Imboden MT, Harber MP, Finch H, Kaminsky LA, Whaley MH. Cardiorespiratory fitness is inversely associated with clustering of metabolic syndrome risk factors: the ball state adult fitness program longitudinal lifestyle study. Mayo Clin Proc. 2018;2(2):155–164. doi:10.1016/j.mayocpiqo.2018.03.001
    1. Katzmarzyk PT, Leon AS, Wilmore JH, et al. Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc. 2003;35(10):1703–1709. doi:10.1249/01.MSS.0000089337.73244.9B
    1. Dalleck LC, Van Guilder GP, Quinn EM, Bredle DL. Primary prevention of metabolic syndrome in the community using an evidence-based exercise program. Prev Med. 2013;57(4):392–395. doi:10.1016/j.ypmed.2013.06.002
    1. Morales-Palomo F, Ramirez-Jimenez M, Ortega JF, Mora-Rodriguez R. Effectiveness of aerobic exercise programs for health promotion in metabolic syndrome. Med Sci Sports Exerc. 2019;51(9):1876–1883. doi:10.1249/MSS.0000000000001983
    1. Stewart KJ, Bacher AC, Turner K, et al. Exercise and risk factors associated with metabolic syndrome in older adults. Am J Prev Med. 2005;28(1):9–18. doi:10.1016/j.amepre.2004.09.006
    1. Whaley MH, Kaminsky LA, Dwyer GB, Getchell LH. Failure of predicted VO2peak to discriminate physical fitness in epidemiological studies. Med Sci Sports Exerc. 1995;27(1):85–91. doi:10.1249/00005768-199501000-00016
    1. Whaley MH, Kaminksy LA, Getchell LH, Kelly MD, Treloar JH. Changes in total cholesterol following endurance training: a function of initial values. J Cardiopulm Rehabil. 1992;12:42–50. doi:10.1097/00008483-199201000-00008
    1. Harber MP, Metz M, Peterman JE, Whaley MH, Fleenor BS, Kaminsky LA. Trends in cardiorespiratory fitness among apparently healthy adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST) cohort from 1970–2019. PLoS One. 2020;15(12):e0242995. doi:10.1371/journal.pone.0242995
    1. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: executive summary. Crit Pathw Cardiol. 2005;4(4):198–203. doi:10.1097/00132577-200512000-00018
    1. Bruce RA, Blackmon JR, Jones JW, Strait G. Exercising testing in adult normal subjects and cardiac patients. Pediatrics. 1963;32(4):742–756. doi:10.1542/peds.32.4.742
    1. Kaminsky LA, Whaley MH. Evaluation of a new standardized ramp protocol: the BSU/Bruce Ramp protocol. J Cardiopulm Rehab. 1998;18(6):438–444. doi:10.1097/00008483-199811000-00006
    1. Pollock ML, Foster C, Schmidt D, Hellman C, Linnerud AC, Ward A. Comparative analysis of physiologic responses to three different maximal graded exercise test protocols in healthy women. Am Heart J. 1982;103:363–373. doi:10.1016/0002-8703(82)90275-7
    1. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. Baltimore: Wolters Kluwer/Lippincott Williams & Wilkins; 2013.
    1. Getchell LH, Moore JC. Physical training: comparative responses of middle-aged adults. Arch Phys Med Rehabil. 1975;56:250–254.
    1. Kaminsky LA, Arena R, Myers J. Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: data from the fitness registry and the importance of exercise national database. Mayo Clin Proc. 2015;90(11):1515–1523. doi:10.1016/j.mayocp.2015.07.026
    1. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–359. doi:10.1001/jama.287.3.356
    1. Park S, Lee S, Kim Y, et al. Altered risk for cardiovascular events with changes in the metabolic syndrome status: a nationwide population-based study of approximately 10 million persons. Ann Intern Med. 2019;171(12):875–884. doi:10.7326/M19-0563
    1. Carbone S, Kirkman DL, Garten RS, et al. Muscular strength and cardiovascular disease: an updated state-of-the-art narrative review. J Cardiopulm Rehabil Prev. 2020;40(5):302–309. doi:10.1097/HCR.0000000000000525

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