Metabolic Syndrome

What is the reasonable weight loss goal in the first year?

2-10%

The primary goal of treatment is to reduce the risk of _______ and ________

CVD; type II diabetes

Ectopic obesity, such as IMAT, appears to independently contribute to impaired glucose metabolism and ______ insulin sensitivity

decreased

Metabolic disease is considered a ______

disease

Ectopic obesity

fat accruing in different locations

Most people with MS will be stratified as _________ or ______ which might prompt for additional screening and specific decisions about the prescribed intensity of testing and exercise

moderate; high risk

Signs and symptoms tend to overlap, but the S&S of ______ and diabetes are often prevelant

obesity

Exercise testing is not used for diagnostic purposes, but rather _____ purposes

prescriptive

Since the syndrome represents a confluence of many factors, there is no _______ etiological explanation for its development

singular

This can be accomplished via:

1. PA and EX 2. Surgery 3. Drugs

Modes of exercise prescription for MS patients

1. Aerobic 2. Resistance 3. Flexibility

These abnormal findings include:

1. Elevated waist circumference 2. Reduced HDL's 3. Elevated fasting glucose 4. Elevated blood pressure

Omega 3-fatty acids

Class an Primary Effects: Fish Oil Exercise Effects: None

Telmisartan, irbesartan, valsaratan

Class and Primary Effects: ANG II receptor blocker/ Blood pressure Exercise Effects: Decreased exercise blood pressure

Genfibrozil, fenofibrate

Class and Primary Effects: Fibrates/ Lipid Lowering Exercise Effects: Increase arrythmias and angina in patients with prior MI

Niacin

Class and Primary Effects: Nicotinic Acid/ Increase in HDL Exercise Effects: Possibly decrease in BP

Metformin

Class and Primary Effects: Oral antihyperglycemic Exercise Effects: None

Rimonabant

Class and Primary Effects: Selective CBI/ weight reduction

Lovastatin, Simvastatin, Pravastatin, Rosuvastain

Class and Primary Effects: Statins/ Lipid Lowering Exercise Effects: No effect

Resistance Training

Mode: 8-10 exercises for major muscle groups Freq: 2 days/week Intensity: 12-15 RM Duration: One Set

Flexibility

Mode: Static Stretching Freq: Postexercise Intensity: N/A Duration: 10-30s per exercise of each major muscle group

Aerobic exercise

Mode: Walking, cycling, swimming Freq: 5-7 days/weel Intensity: 50-75% VO2 max Duration: 45-60 minutes

___________________ (TNF-alpha, II-6) formation and secretion is increased by ectopic obesity, which leads to increased triglycerides, cholesterol, ROS, CRP and decreased HDL's

Pro-inflammatory cytokines

______________ (PAI-1, fibrinogen) are also linked to MS, but cause-effect vs. association has yet to be well established

Pro-thrombic

_____________ obesity appears to be a significant contributor to MS

abdominal

All five risk components of metabolic syndrome are modifiable, but ________ is the main driver, so treatment should focus on reducing this first

abdominal obesity

Decreases in ______ density, size, and function may also contribute to the severity of metabolic syndrone

mitochondrial

The new harmonized definition of metabolic syndrome recommends that diagnosis includes ___________ or more abnormal findings

three

Low intensity ______ and _____ protocols are often well tolerated by patients with obesity and MS

treadmill; bike