The Metabolic Syndrome

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The general concept of the metabolic syndrome, which describes a clustering of metabolic abnormalities associated with increased risk of cardiovascular disease, diabetes, and hypertension, has been recognized for many years.1-4 Despite a definition of syndrome by the World Health Organization (WHO)5, the most commonly used definition is relatively new. In 2002, the National Cholesterol Education Program, in its Adult Treatment Program III (ATP III),6 presented a definition of metabolic syndrome that is commonly accepted in the U.S as a working model of the condition. However, the relative novelty of the condition to the general medical and lay audiences and only recent acceptance of a working definition means that there have been few studies of the prevalence, incidence, and response of metabolic syndrome to commonly available lifestyle interventions, such as exercise training.

Several excellent reviews of metabolic syndrome exist.7-10 Hence, rather than presenting yet again a review of the topic of metabolic syndrome, in this chapter we will discuss several controversies that continue to plague the field and provide compelling lines of evidence that establish the strong relation between the metabolic syndrome, physical activity, and regular exercise. First, we will present evidence from cross-sectional studies that have consistently reported significant, inverse associations between levels of cardiorespiratory fitness or physical activity and the prevalence of metabolic syndrome (as defined in the ATP III report). Second, we will review the only published study of which we are aware that has analyzed (in a post hoc manner) the effect of exercise training on the metabolic syndrome as currently defined.11 Third, we will briefly present evidence of the relationship between exercise and physical activity and each of the five individual components of the metabolic syndrome. In the course of this discussion, several areas of controversy will become apparent. Where possible, we primarily will point to results from meta-analyses (e.g., blood pressure and exercise). Alternatively, we will reference expert review articles when meta-analyses are not available. In some cases we also discuss data from some key individual studies, relying more heavily on data from randomized, controlled trials (RCTs).

The current diagnostic criteria for metabolic syndrome are detailed in Table 4.1. Although the current ATP III definition provides a useful and accessible formula for

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