What is Metabolic Syndrome? How can an Accredited Exercise Physiologist help manage metabolic syndrome?
Accredited Exercise Physiologists regularly see patients with metabolic syndrome or be at risk of developing metabolic syndrome. However, despite being a very serious condition, and a condition that is on the rise, few people have actually heard of it.
So, what exactly is Metabolic Syndrome?..
What is Metabolic Syndrome?
Metabolic syndrome (also called syndrome X or insulin resistance syndrome) is not a single disease but instead refers to a combination of interrelated cardiometabolic risk factors. These risk factors currently affect 20-30% of Australian adults and unfortunately with advances in technology causing people to sit more and move less, it is becoming more and more prevalent.
Metabolic syndrome is initially diagnosed by the presence of excess accumulation of fat in the abdominal area also known as central obesity (waist circumference: men >102cm, women >88cm), followed by a combination of two or more of the following risk factors:
- Hypertension (blood pressure: >130/ >85 mmHg)
- Hyperglycaemia (>15 mmol/L)
- Decreased high-density lipoprotein (HDL: men <1.0 mmol/L, women <1.3 mmol/L)
- And increased triglycerides (TG: > 1.7mmol/L)
When diagnosed with one of the above risk factors it can often cause health problems on its own, so when they are combined it can greatly increase your risk of heart disease, diabetes and stroke along with other serious and long-term health complications.
What are the risk factors for metabolic syndrome?
The root cause of most metabolic syndrome cases can be traced back to inadequate dietary and eating habits, being overweight and obese and living a sedentary lifestyle. Some cases occur in those already diagnosed with hypertension and uncontrolled or poorly managed diabetes. Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome. Women also have a higher risk of developing the syndrome when compared to men due accumulating greater central adipose tissue levels and having lower HDL (high-density lipoprotein – the ‘good’ cholesterol) levels and elevated triglyceride levels in the blood stream post menopause.
How is metabolic syndrome treated?
When treating or managing metabolic syndrome, the main aim is to reduce the risk of cardiovascular disease and type 2 diabetes by improving any abnormalities in body weight, blood pressure, blood fats and blood sugar levels. The cornerstone of treatment for metabolic syndrome is lifestyle changes including increasing levels of physical activity and looking for opportunities to be more active throughout the day, eating a balanced and healthy diet, and reducing weight and waist circumference. If lifestyle changes alone are insufficient or ineffective in treating metabolic syndrome your medical practitioner may prescribe medications to help treat and control risk factors (including those that can improve blood lipids, lower blood pressure and blood sugar).
How does regular exercise help manage metabolic syndrome?
Evidence shows that the key most important lifestyle changes for the prevention of many chronic diseases is exercise and diet.
The benefits of regular exercise include:
- Improved blood sugar levels as the body utilises its glucose stores
- Lower blood pressure
- Decrease blood triglyceride levels (‘bad fats’) and modestly increase HDL-cholesterol (‘good cholesterol’)
- Reduce body weight and waist circumference
Aerobic and resistance-based exercise (weights) has been found reverse metabolic syndrome. Aerobic exercise (such as brisk walking, cycling, swimming, jogging, dancing and team sport) refers to activity creating stress on the cardiovascular system (i.e., heart and lungs) whilst resistance-based exercise (such as weightlifting, body weight exercises, resistance band exercises and circuit training) focuses on building muscle mass, which facilities greater glucose uptake into the muscular tissue.
Lifestyle interventions involving exercise can significantly reduce the risk of progression to Type 2 diabetes in adults with metabolic syndrome abnormalities, which may exceed the benefits of insulin sensitising medication. The combination of both aerobic and resistance-based exercise can assist with improving the action of insulin in the process of glucose removal, and in turn assist with improved control of blood glucose levels.
What exercise is best for people with metabolic syndrome?
There is not one single type of recommended exercise to help treat metabolic syndrome. However, guidelines will often take into consideration all 5 potential risk factors, as well as any resulting related health conditions.
Undertaking a combination of regular aerobic exercise and progressive resistance training can reduce the risk of progressing to type 2 diabetes.
Individuals should aim to achieve greater than or equal to 30 minutes of moderate-intensity exercise, such as brisk walking, on most, and preferably all, days of the week. A simple rule of thumb is to exercise at a level that increases your breathing and heart rate but still allows you to maintain a conversation (talk test). To promote weight loss or weight-loss maintenance completing sixty minutes or more of continuous or intermittent aerobic activity every day of the week is preferable. Preference is given to 60 minutes of moderate-intensity brisk walking to be supplemented by other activities. The latter include multiple short (10- to 15-minute) bouts of activity (walking breaks at work, gardening, or household work), using simple exercise equipment (e.g., treadmills), jogging, swimming, biking, golfing, team sports, and engaging in resistance training, resistance training is critical (it increases glucose sensitivity, raises the metabolic rate for hours post exercise meaning your body is still burning energy and most importantly helps stimulate and build lean tissue). It is also advised to avoid common sedentary activities including watching television and playing computer games. To complement aerobic exercise, individuals should also aim to complete two to three resistance training sessions on non-consecutive days per week involving 2–3 sets of 8–10 different exercises, at a load that can be performed for 8–15 repetitions for each exercise (depending on your goals). Exercise that has been demonstrated to be effective and can be tailored to the individual include squats, calf raises, lunges, leg press, chest press, seated row, shoulder press, biceps curl and triceps extension (just to name a few). Individuals diagnosed with metabolic syndrome may also be at an increased risk of falling and therefore regular resistance exercise can help to reduce the risk of falling and associated injuries.
How can an Accredited Exercise Physiologist help you manage Metabolic syndrome?
An Accredited Exercise Physiologist would be able to prescribe and deliver an appropriate exercise intervention to assist with managing any presenting risk factors prior to an official metabolic syndrome, or once a diagnosis has been made. The treatment plan and exercise plan will be created based on what is most suitable for you, focusing not only on the medical conditions you have presented with, but also your current functional abilities, your goals and what you are wanting to achieve. They will also be able to provide ongoing exercise advice for you. You may also choose to engage them regularly for one on one sessions.
With Metabolic syndrome appearing to be on the rise we need to raise awareness how to prevent it but also how to best treat it. Exercise is a medicine in its own right and should be prescribed as such in order to effectively manage those diagnosed with Metabolic Syndrome. As a medical intervention the prescription for exercise should be specifically based on the individuals’ capabilities and needs. If you have been diagnosed with metabolic syndrome or are wanting to prevent it from occurring, it is worthwhile seeing an Exercise Physiologist and getting and assessment and plan to put you on the right track moving forward.
References
Australia, H. 2019, Metabolic Syndrome, Health Direct, viewed 21March 2022, https://www.healthdirect.gov.au/metabolic-syndrome.
Australian Family Physician 2013, RACGP – The metabolic syndrome, RACGP, viewed 21 March 2022, https:/ /www.racgp.org.au/afp/2013/august/the-metabolic-syndrome/.
Grundy, S.M., Cleeman, J.I., Daniels, S.R., Donato, K.A., Eckel, R.H., Franklin, B.A., Gordon, D.J., Krauss, R.M., Savage, P.J., Smith, S.C., Spertus, J.A. and Costa, F. 2005, “Diagnosis and Management of the Metabolic Syndrome”, Circulation, vol. 112, no. 17, pp. 2735-2752.
Mayoclinic.org. 2019, Metabolic Syndrome, Mayo Clinic, viewed 21 March 2022, https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/diagnosis-treatment/drc-20351921.
Paley, C.A., Johnson, M.I 2018, “Abdominal obesity and metabolic syndrome: exercise as medicine?”, BMC Sports Sci Med Rehabilitation, vol. 10, no. 7.