Top

Diabetology & Metabolic Syndrome

Published in:

Open Access 01-12-2023 | Research

Physical activity has a more beneficial effect on the risk of all-cause mortality in patients with metabolic syndrome than in those without

Authors: Chang-Hoon Lee, Kyung-Do Han, Min-Sun Kwak

Published in: Diabetology & Metabolic Syndrome | Issue 1/2023

Abstract

Background

It has not been clarified whether physical activity (PA) has more benefit in terms of health outcomes, including mortality risk, among those with metabolic syndrome (MS) compared to those without. Therefore, the aim of this study is to elucidate whether regular PA has interaction with MS on health outcomes.

Methods

Participants with no underlying cardiovascular diseases who underwent national health screening in 2009 were included. According to the metabolic equivalent (MET)-minutes/week, the amount of PA among the participants was grouped as follows: Group 1 (0 MET-minutes/week), Group 2 (1–499), Group 3 (500–999), Group 4 (1000–1499), and Group 5 (≥ 1500). Multivariable Cox proportional hazard models were applied to evaluate the impacts of the amount of PA on health outcomes among those with and without MS. Health outcomes included all-cause mortality and incident cardiovascular diseases (CVDs).

Results

Of 9,628,109 total participants, 335,970 deaths occurred during a median 8.3-year follow-up. After adjustment for age, sex, smoking status, alcohol consumption, and body mass index, the higher the PA amount was, the lower the risk of all-cause mortality in both those with MS [adjusted hazard ratio (aHR) compared with Group 1, 0.86 (95% CI 0.85, 0.87) in Group 2; 0.82 (95% CI 0.81, 0.83) in Group 3; 0.75 (95% CI 0.74, 0.77) in Group 4; and 0.78 (95% CI 0.76, 0.80) in Group 5; P for trend < 0.001] and those without MS [aHR compared with Group 1, 0.87 (95% CI 0.86, 0.88) in Group 2; 0.84 (95% CI 0.83, 0.85) in Group 3, 0.79 (95% CI 0.78, 0.80) in Group 4, and 0.82 (95% CI 0.81, 0.84) in Group 5; P for trend < 0.001]. The beneficial effects of the amount of PA on all-cause mortality were larger among those with MS than among those without MS in a multiplicative interaction (P for interaction < 0.001). The results were similar in the analysis of the relationship between the PA amount and incident CVD.

Conclusions

More PA was associated with a lower risk of all-cause mortality, which was more prominent in those with MS than in those without MS. Physicians should emphasize more the importance of PA in patients with MS.

Available only for authorised users

Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986;314(10):605–13. https://doi.org/10.1056/NEJM198603063141003.CrossRefPubMed

Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: the Finnish twin cohort. JAMA. 1998;279(6):440–4. https://doi.org/10.1001/jama.279.6.440.CrossRefPubMed

Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175(6):959–67. https://doi.org/10.1001/jamainternmed.2015.0533.CrossRefPubMedPubMedCentral

Ozemek C, Lavie CJ, Rognmo O. Global physical activity levels—need for intervention. Prog Cardiovasc Dis. 2019;62(2):102–7. https://doi.org/10.1016/j.pcad.2019.02.004.CrossRefPubMed

Vasankari V, Husu P, Vaha-Ypya H, et al. Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers. BMJ Open Sport Exerc Med. 2018;4(1):e000363. https://doi.org/10.1136/bmjsem-2018-000363.CrossRefPubMedPubMedCentral

Bankoski A, Harris TB, McClain JJ, et al. Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes Care. 2011;34(2):497–503. https://doi.org/10.2337/dc10-0987.CrossRefPubMedPubMedCentral

Jeong SW, Kim SH, Kang SH, et al. Mortality reduction with physical activity in patients with and without cardiovascular disease. Eur Heart J. 2019;40(43):3547–55. https://doi.org/10.1093/eurheartj/ehz564.CrossRefPubMedPubMedCentral

Lee CH, Han KD, Yoo J, Kwak MS. Synergistic harmful interaction between sustained physical inactivity and hypertension/diabetes mellitus on the risk of all-cause mortality: a retrospective observational cohort study. J Hypertens. 2021;39(10):2058–66. https://doi.org/10.1097/HJH.0000000000002905.CrossRefPubMed

Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12. https://doi.org/10.1007/s11906-018-0812-z.CrossRefPubMedPubMedCentral

10.

Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the united states, national health and nutrition examination survey, 1988–2012. Prev Chronic Dis. 2017;14:E24. https://doi.org/10.5888/pcd14.160287.CrossRefPubMedPubMedCentral

11.

Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB.CrossRefPubMed

12.

Kwon S, Lee HJ, Han KD, et al. Association of physical activity with all-cause and cardiovascular mortality in 7666 adults with hypertrophic cardiomyopathy (HCM): more physical activity is better. Br J Sports Med. 2021;55(18):1034–40. https://doi.org/10.1136/bjsports-2020-101987.CrossRefPubMed

13.

Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81. https://doi.org/10.1249/MSS.0b013e31821ece12.CrossRefPubMed

14.

Kwak MS, Kim D, Chung GE, Kim W, Kim JS. The preventive effect of sustained physical activity on incident nonalcoholic fatty liver disease. Liver Int. 2017;37(6):919–26. https://doi.org/10.1111/liv.13332.CrossRefPubMed

15.

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):1640–5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644.CrossRefPubMed

16.

Park S, Han K, Lee S, et al. Association between moderate-to-vigorous physical activity and the risk of major adverse cardiovascular events or mortality in people with various metabolic syndrome status: a nationwide population-based cohort study including 6 million people. J Am Heart Assoc. 2020;9(22):e016806. https://doi.org/10.1161/JAHA.120.016806.CrossRefPubMedPubMedCentral

17.

Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32. https://doi.org/10.1016/j.jacc.2010.05.034.CrossRefPubMed

18.

Samson SL, Garber AJ. Metabolic syndrome. Endocrinol Metab Clin North Am. 2014;43(1):1–23. https://doi.org/10.1016/j.ecl.2013.09.009.CrossRefPubMed

19.

Ostman C, Smart NA, Morcos D, Duller A, Ridley W, Jewiss D. The effect of exercise training on clinical outcomes in patients with the metabolic syndrome: a systematic review and meta-analysis. Cardiovasc Diabetol. 2017;16(1):110. https://doi.org/10.1186/s12933-017-0590-y.CrossRefPubMedPubMedCentral

20.

Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I. Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging. 2017;12:835–45. https://doi.org/10.2147/CIA.S132940.CrossRefPubMedPubMedCentral

21.

Nishikawa H, Asai A, Fukunishi S, Nishiguchi S, Higuchi K. Metabolic syndrome and sarcopenia. Nutrients. 2021. https://doi.org/10.3390/nu13103519.CrossRefPubMedPubMedCentral

22.

Marzetti E, Calvani R, Tosato M, et al. Physical activity and exercise as countermeasures to physical frailty and sarcopenia. Aging Clin Exp Res. 2017;29(1):35–42. https://doi.org/10.1007/s40520-016-0705-4.CrossRefPubMed

23.

Beaudart C, Dawson A, Shaw SC, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. 2017;28(6):1817–33. https://doi.org/10.1007/s00198-017-3980-9.CrossRefPubMedPubMedCentral

24.

Gratas-Delamarche A, Derbre F, Vincent S, Cillard J. Physical inactivity, insulin resistance, and the oxidative-inflammatory loop. Free Radic Res. 2014;48(1):93–108. https://doi.org/10.3109/10715762.2013.847528.CrossRefPubMed

25.

Grandl G, Wolfrum C. Hemostasis, endothelial stress, inflammation, and the metabolic syndrome. Semin Immunopathol. 2018;40(2):215–24. https://doi.org/10.1007/s00281-017-0666-5.CrossRefPubMed

26.

Zubin Maslov P, Schulman A, Lavie CJ, Narula J. Personalized exercise dose prescription. Eur Heart J. 2018;39(25):2346–55. https://doi.org/10.1093/eurheartj/ehx686.CrossRefPubMed

27.

Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014;64(5):472–81. https://doi.org/10.1016/j.jacc.2014.04.058.CrossRefPubMedPubMedCentral

28.

Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244–53. https://doi.org/10.1016/S0140-6736(11)60749-6.CrossRefPubMed

29.

Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65(5):411–9. https://doi.org/10.1016/j.jacc.2014.11.023.CrossRefPubMed

30.

Schnohr P, O’Keefe JH, Lavie CJ, et al. U-Shaped association between duration of sports activities and mortality: Copenhagen city heart study. Mayo Clin Proc. 2021;96(12):3012–20. https://doi.org/10.1016/j.mayocp.2021.05.028.CrossRefPubMed

Title: Physical activity has a more beneficial effect on the risk of all-cause mortality in patients with metabolic syndrome than in those without
Authors: Chang-Hoon Lee
Kyung-Do Han
Min-Sun Kwak
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: Diabetology & Metabolic Syndrome / Issue 1/2023
Electronic ISSN: 1758-5996
DOI: https://doi.org/10.1186/s13098-023-01227-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Mediterranean diet lowers all-cause and cardiovascular mortality for patients with metabolic syndrome

Autonomic neuropathic symptoms in patients with diabetes: practical tools for screening in daily routine

Brain-derived neurotrophic factor associated with kidney function

Empagliflozin ameliorates diabetic cardiomyopathy via regulated branched-chain amino acid metabolism and mTOR/p-ULK1 signaling pathway-mediated autophagy

Leveraging IgG N-glycosylation to infer the causality between T2D and hypertension

Vitamin D improves the antidiabetic effectiveness of aerobic training via modulation of Akt, PEPCK, and G6Pase expression

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials