Skip to main content
Top
Published in: Sports Medicine 2/2013

Open Access 01-02-2013 | Systematic Review

The Effect of Exercise on the Cardiovascular Risk Factors Constituting the Metabolic Syndrome

A Meta-Analysis of Controlled Trials

Authors: Nele Pattyn, Véronique A. Cornelissen, Saeed R. Toghi Eshghi, Luc Vanhees

Published in: Sports Medicine | Issue 2/2013

Login to get access

Abstract

Background

Numerous meta-analyses have investigated the effect of exercise in different populations and for single cardiovascular risk factors, but none have specifically focused on the metabolic syndrome (MetS) patients and the concomitant effect of exercise on all associated cardiovascular risk factors.

Objective

The aim of this article was to perform a systematic review with a meta-analysis of randomized and clinical controlled trials (RCTs, CTs) investigating the effect of exercise on cardiovascular risk factors in patients with the MetS.

Methods

RCTs and CTs ≥4 weeks investigating the effect of exercise in healthy adults with the MetS and published in a peer-reviewed journal up to November 2011 were included. Primary outcome measures were changes in waist circumference (WC), systolic and diastolic blood pressure, high-density lipoprotein cholesterol (HDL-C), triglycerides and fasting plasma glucose. Peak oxygen uptake (\( {\dot{{V}}\text{O}}_{{ 2 {\text{peak}}}} \)) was a secondary outcome. Random and fixed-effect models were used for analyses and data are reported as means and 95% confidence intervals (CIs).

Results

Seven trials were included, involving nine study groups and 206 participants (128 in exercise group and 78 in control group). Significant mean reductions in WC −3.4 (95% CI −4.9, −1.8) cm, blood pressure −7.1 (95% CI −9.03, −5.2)/−5.2 (95% CI −6.2, −4.1) mmHg and a significant mean increase in HDL-C +0.06 (95% CI +0.03, +0.09) mmol/L were observed after dynamic endurance training. Mean plasma glucose levels −0.31 (95% CI −0.64, 0.01; p = 0.06) mmol/L and triglycerides −0.05 (95% CI −0.20, 0.09; p = 0.47) mmol/L remained statistically unaltered. In addition, a significant mean improvement in \( {\dot{{V}}\text{O}}_{{ 2 {\text{peak}}}} \) of +5.9 (95% CI +3.03, +8.7) mL/kg/min or 19.3% was found.

Conclusions

Our results suggest that dynamic endurance training has a favourable effect on most of the cardiovascular risk factors associated with the MetS. However, in the search for training programmes that optimally improve total cardiovascular risk, further research is warranted, including studies on the effects of resistance training and combined resistance and endurance training.
Literature
1.
go back to reference 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. Circulation. 2005;112(17):2735–52.PubMedCrossRef 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. Circulation. 2005;112(17):2735–52.PubMedCrossRef
2.
go back to reference Gami AS, Witt BJ, Howard DE, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403–14.PubMedCrossRef Gami AS, Witt BJ, Howard DE, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403–14.PubMedCrossRef
3.
4.
go back to reference Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503.PubMedCrossRef Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503.PubMedCrossRef
5.
go back to reference Cornelissen VA, Fagard RH. Effects of dynamic aerobic endurance training on blood pressure, blood pressure-regulating mechanisms and cardiovascular risk factors. Hypertension. 2005;46(4):667–75.PubMedCrossRef Cornelissen VA, Fagard RH. Effects of dynamic aerobic endurance training on blood pressure, blood pressure-regulating mechanisms and cardiovascular risk factors. Hypertension. 2005;46(4):667–75.PubMedCrossRef
6.
go back to reference Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: a meta-analysis of randomized controlled trials. J Mens Health Gend. 2006;3(1):61–70.PubMed Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: a meta-analysis of randomized controlled trials. J Mens Health Gend. 2006;3(1):61–70.PubMed
7.
go back to reference Thomas D, Elliot EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;3:CD002968. Thomas D, Elliot EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;3:CD002968.
8.
go back to reference Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications: part 1. Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.PubMedCrossRef Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications: part 1. Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.PubMedCrossRef
9.
go back to reference National Cholesterol Education Program (NCEP). Expert Panel on detection evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Final report. Circulation. 2002;106(25):3143–421. National Cholesterol Education Program (NCEP). Expert Panel on detection evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Final report. Circulation. 2002;106(25):3143–421.
10.
go back to reference Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005;366(9491):1059–62.PubMedCrossRef Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005;366(9491):1059–62.PubMedCrossRef
12.
go back to reference De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129–33.PubMedCrossRef De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129–33.PubMedCrossRef
13.
go back to reference Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.PubMed Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.PubMed
14.
go back to reference Dumortier M, Brandou F, Perez-Martin A, et al. Low intensity endurance exercise targeted for lipid oxidation improves body composition and insulin sensitivity in patients with the metabolic syndrome. Diabetes Metab. 2003;29(5):509–18.PubMedCrossRef Dumortier M, Brandou F, Perez-Martin A, et al. Low intensity endurance exercise targeted for lipid oxidation improves body composition and insulin sensitivity in patients with the metabolic syndrome. Diabetes Metab. 2003;29(5):509–18.PubMedCrossRef
15.
go back to reference Watkins LL, Sherwood A, Feinglos M, et al. Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med. 2003;163(16):1889–95.PubMedCrossRef Watkins LL, Sherwood A, Feinglos M, et al. Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med. 2003;163(16):1889–95.PubMedCrossRef
16.
go back to reference Gomes VA, Casella-Filho A, Chagas ACP, et al. Enhanced concentrations of relevant markers of nitric oxide formation after exercise training in patients with metabolic syndrome. Nitric Oxide. 2008;19(4):345–50.PubMedCrossRef Gomes VA, Casella-Filho A, Chagas ACP, et al. Enhanced concentrations of relevant markers of nitric oxide formation after exercise training in patients with metabolic syndrome. Nitric Oxide. 2008;19(4):345–50.PubMedCrossRef
17.
go back to reference Irving BA, Davis CK, Brock DW, et al. Effect of exercise training intensity on abdominal visceral fat and body composition. Med Sci Sports Exerc. 2008;40(11):1863–72.PubMedCrossRef Irving BA, Davis CK, Brock DW, et al. Effect of exercise training intensity on abdominal visceral fat and body composition. Med Sci Sports Exerc. 2008;40(11):1863–72.PubMedCrossRef
18.
go back to reference Tjønna AE, Lee SJ, Rognmo Ø, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118(4):346–54.PubMedCrossRef Tjønna AE, Lee SJ, Rognmo Ø, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118(4):346–54.PubMedCrossRef
19.
go back to reference Irving BA, Weltman JY, Patrie JT, et al. Effect of exercise training intensity on nocturnal growth hormone secretion in obese adults with the metabolic syndrome. J Clin Endocrinol Metab. 2009;94(6):1979–86.PubMedCrossRef Irving BA, Weltman JY, Patrie JT, et al. Effect of exercise training intensity on nocturnal growth hormone secretion in obese adults with the metabolic syndrome. J Clin Endocrinol Metab. 2009;94(6):1979–86.PubMedCrossRef
20.
go back to reference Balducci S, Zanuso S, Nicolucci A, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010;20(8):608–17.PubMedCrossRef Balducci S, Zanuso S, Nicolucci A, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010;20(8):608–17.PubMedCrossRef
21.
go back to reference Stensvold D, Tjønna AE, Skaug EA, et al. Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. J Appl Physiol. 2010;108(4):804–10.PubMedCrossRef Stensvold D, Tjønna AE, Skaug EA, et al. Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. J Appl Physiol. 2010;108(4):804–10.PubMedCrossRef
22.
go back to reference Tjønna AE, Rognmo Ø, Bye A, et al. Time course of endothelial adaptation after acute and chronic exercise in patients with metabolic syndrome. J Strength Cond Res. 2011;25(9):2552–8.PubMedCrossRef Tjønna AE, Rognmo Ø, Bye A, et al. Time course of endothelial adaptation after acute and chronic exercise in patients with metabolic syndrome. J Strength Cond Res. 2011;25(9):2552–8.PubMedCrossRef
23.
go back to reference Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56(2):320–8.PubMed Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56(2):320–8.PubMed
24.
go back to reference Rashid S, Genest J. Effect of obesity on high-density lipoprotein metabolism. Obesity (Silver Spring). 2007;15(12):2875–88.CrossRef Rashid S, Genest J. Effect of obesity on high-density lipoprotein metabolism. Obesity (Silver Spring). 2007;15(12):2875–88.CrossRef
25.
go back to reference Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: a meta-analysis. Prev Cardiol. 2005;8(4):206–14.PubMedCrossRef Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: a meta-analysis. Prev Cardiol. 2005;8(4):206–14.PubMedCrossRef
26.
go back to reference Wilson PW, Abbott RD, Castelli WP. High density lipoprotein cholesterol and mortality: the Framingham Heart Study. Arteriosclerosis. 1988;8(6):737–41.PubMedCrossRef Wilson PW, Abbott RD, Castelli WP. High density lipoprotein cholesterol and mortality: the Framingham Heart Study. Arteriosclerosis. 1988;8(6):737–41.PubMedCrossRef
27.
go back to reference Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients. Diabetes Care. 2006;29(11):2518–27.PubMedCrossRef Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients. Diabetes Care. 2006;29(11):2518–27.PubMedCrossRef
28.
go back to reference Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.PubMedCrossRef Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.PubMedCrossRef
29.
go back to reference 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):1703–9.PubMedCrossRef 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):1703–9.PubMedCrossRef
30.
go back to reference Anderssen SA, Carroll S, Urdal P, et al. Combined diet and exercise intervention reverses the metabolic syndrome in middle-aged males: results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports. 2007;17(6):687–95.PubMedCrossRef Anderssen SA, Carroll S, Urdal P, et al. Combined diet and exercise intervention reverses the metabolic syndrome in middle-aged males: results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports. 2007;17(6):687–95.PubMedCrossRef
31.
go back to reference Sassen B, Cornelissen VA, Kiers H, et al. Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors. Eur J Cardiovasc Prev Rehabil. 2009;16(6):677–83.PubMedCrossRef Sassen B, Cornelissen VA, Kiers H, et al. Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors. Eur J Cardiovasc Prev Rehabil. 2009;16(6):677–83.PubMedCrossRef
32.
go back to reference Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.PubMedCrossRef Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.PubMedCrossRef
33.
go back to reference Laukkanen JA, Rauramaa R, Salonen JT, et al. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262(2):263–72.PubMedCrossRef Laukkanen JA, Rauramaa R, Salonen JT, et al. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262(2):263–72.PubMedCrossRef
34.
go back to reference Banz WJ, Maher MA, Thompson WG, et al. Effects of resistance versus aerobic training on coronary artery disease risk factors. Exp Biol Med. 2003;228(4):434–40. Banz WJ, Maher MA, Thompson WG, et al. Effects of resistance versus aerobic training on coronary artery disease risk factors. Exp Biol Med. 2003;228(4):434–40.
35.
go back to reference Smutok MA, Reece C, Kokkinos PF, et al. Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism. 1993;42(2):177–84.PubMedCrossRef Smutok MA, Reece C, Kokkinos PF, et al. Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism. 1993;42(2):177–84.PubMedCrossRef
36.
go back to reference Cornelissen VA, Fagard RH, Coeckelberghs E, et al. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58(5):950–8.PubMedCrossRef Cornelissen VA, Fagard RH, Coeckelberghs E, et al. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58(5):950–8.PubMedCrossRef
37.
go back to reference Vanhees L, Geladas N, Hansen D, et al., on behalf of the writing group of the EACPR. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (part II). Eur J Cardiovasc Prev Rehabil (epub 30 Nov 2011). Vanhees L, Geladas N, Hansen D, et al., on behalf of the writing group of the EACPR. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (part II). Eur J Cardiovasc Prev Rehabil (epub 30 Nov 2011).
Metadata
Title
The Effect of Exercise on the Cardiovascular Risk Factors Constituting the Metabolic Syndrome
A Meta-Analysis of Controlled Trials
Authors
Nele Pattyn
Véronique A. Cornelissen
Saeed R. Toghi Eshghi
Luc Vanhees
Publication date
01-02-2013
Publisher
Springer International Publishing AG
Published in
Sports Medicine / Issue 2/2013
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-012-0003-z

Other articles of this Issue 2/2013

Sports Medicine 2/2013 Go to the issue

Review Article

Exercise Addiction