CHAPTER 11 METABOLIC SYNDROME

Diagnosis of the metabolic syndrome requires the presence of three or more of the following risk factors

(1) elevated waist circumference, (2) elevated triglycerides, (3) reduced HDL cholesterol, (4) elevated blood pressure, and (5) elevated fasting glucose.

Metabolic syndrome exercise testing

-Appropriate risk stratification for patients diagnosed with metabolic syndrome should be based on the presence of dyslipidemia, hypertension, and hyperglycemia. -Standardized treadmill protocols that use relatively small workload increases are recommended and are often well tolerated by those with obesity and metabolic syndrome.

Scope of Metabolic Syndrome

-Prevalence of the metabolic syndrome almost 35% based on NHANES 2011-2012 data and ATP III criteria (adults ≥20 yr). -Current statistics do not indicate a tapering of metabolic syndrome prevalence in the United States. -Evidence from NHANES III has indicated that approximately two- thirds of adolescents aged 12 to 19 yr present with one or more metabolic abnormalities. -Cumulative annual costs of medical care of (~$316 billion) for the metabolic syndrome.

Metabolic syndrome range of motion exercise

-ROM exercise is an adjunct modality to supplement cardiorespiratory and resistance exercise. -It should be performed at least 2 or 3 d/wk following a warm-up or workout, when muscles are warm. -Static, dynamic, or proprioceptive neuromuscular facilitation (PNF) activities are suggested for all major muscles and joints of the body. -Static stretching—recommendations are that each stretch be completed for at least four repetitions and held for 15 to 60 s.

Metabolic syndrome

Collection of interrelated cardiometabolic risk factors that are present in a given individual more frequently than may be expected with a chance combination • Usually presence of overweight or obesity • Greater risk for developing atherosclerotic cardiovascular disease

Metabolic Syndrome signs and symptoms

Elevated glucose Hypertension Elevated triglyceride levels Low high-density lipoprotein cholesterol level Abdominal obesity Microalbuminuria Hyperuricemia Fatty liver disease High levels of PAI-1 and fibrinogen (i.e., prothrombotic state) Elevated high-sensitivity C-reactive protein (hsCRP) (i.e., proinflammatory state) Cholesterol gallstones Polycystic ovary syndrome Disordered sleeping (e.g., sleep apnea)

Patients with the metabolic syndrome are usually

overweight or obese and have significantly greater risk for developing CVD, insulin resistance, and type 2 diabetes, as well as early mortality.

Metabolic syndrome Medical Exam and Physical History

• Identify the core risk components of metabolic syndrome. • Monitor abdominal obesity. • Obtain a clinical measure of waist circumference.

Metabolic syndrome cardiovascular exercise

• Individuals are encouraged to accumulate 150 to 300 min of moderate-intensity PA per week, an energy equivalent of 1,200 to 2,000 kcal. -Perform continuous or intermittent low intensity (40%-60% VO2 or HRR) to moderate intensity (50%-75% VO2 or HRR). -Sessions should be 30 to 60 min in duration (minimum of 10 min for intermittent cardiorespiratory exercise). -Gradual progression in duration and intensity may be effective for chronic weight maintenance.

Metabolic syndrome treatment

• Interventions to promote weight loss (e.g., caloric restriction, increased physical activity, pharmacological agents, and even surgical procedures when necessary) • Behavioral modifications • Improvements in diet quality • Participation in physical activity • Smoking cessation

Metabolic Syndrome pathology

• The etiology of metabolic syndrome is widely debated. • Possible contributors include: • Obesity and ectopic adiposity • Insulin resistance • Mitochondrial dysfunction

Metabolic syndrome resistance training

• There are no recommendations pertaining to resistance exercise for the metabolic syndrome. • Current minimum recommendations call for resistance exercise training to supplement cardiorespiratory exercise. • Performed 2 (preferably 3) nonconsecutive days per week • Single set of 5 to 10 resistance exercises for the whole body • Moderate level of intensity that allows 10 to 15 repetitions