Effects of exercise timing on metabolic health

The increasing prevalence of metabolic syndrome is associated with major health and socioeconomic consequences. Currently, physical exercise, together with dietary interventions, is the mainstay of the treatment of obesity and related metabolic complications. Although exercise training includes different modalities, with variable intensity, duration, volume, or frequency, which may have a distinct impact on several characteristics related to metabolic syndrome, the potential effects of exercise timing on metabolic health are yet to be fully elucidated. Remarkably, promising results with regard to this topic have been reported in the last few years. Similar to other time-based interventions, including nutritional therapy or drug administration, time-of-day-based exercise may become a useful approach for the management of metabolic disorders. In this article, we review the role of exercise timing in metabolic health and discuss the potential mechanisms that could drive the metabolic-related benefits of physical exercise performed in a time-dependent manner.     

Comparison of ventilatory threshold and exercise habits between Japanese men with and without metabolic syndrome

OBJECTIVE: We compared the levels of ventilatory threshold (VT) and exercise habits in subjects with metabolic syndrome with those in age, sex-matched subjects without metabolic syndrome. METHODS: We used data of 155 Japanese men (47.1+/-9.2 years) with metabolic syndrome; the diagnosis was given by the definition and the diagnostic standard for metabolic syndrome in Japan. The influence of metabolic syndrome on oxygen uptake, work rate and heart rate at VT, and exercise habits were evaluated. RESULTS: Oxygen uptake and work rate at VT in subjects with metabolic syndrome were significantly lower than those in subjects without metabolic syndrome even after adjusting for body mass index (BMI). The number of subjects with exercise habits was significantly lower in metabolic syndrome. The subjects with exercise habits were significantly older than that in subjects without exercise habits. Furthermore, oxygen uptake and work rate at VT were significantly higher in subjects with exercise habits than those in subjects without exercise habits. CONCLUSION: Lower level of VT was characteristic in subjects with metabolic syndrome. Promotion of exercise habits is necessary for preventing and improving metabolic syndrome in Japanese men.     

交感神经系统与代谢综合征

代谢综合征的患病率在逐年上升。过去20年的研究证实,代谢综合征的大多组分都与交感神经系统的过度激活密切相关。生活方式的改变,即饮食控制和适当的体力活动,是代谢综合征患者最重要的干预措施之一;基于交感神经激活与代谢综合征的研究,抑制交感神经的活性应该成为代谢综合征治疗的最主要目标。现就交感神经系统与代谢综合征的关系,以及代谢综合征去肾脏神经治疗的研究进展等方面做一综述。     

Exercise for prevention and treatment of cardiovascular disease,type 2 diabetes,and metabolic syndrome

A considerable number of observational and intervention studies support the role of exercise as a cornerstone in prevention and treatment of cardiovascular disease (CVD), type 2 diabetes (T2D), and the metabolic syndrome. Physical activity and cardiorespiratory fitness are also associated with reduced mortality rates among persons with CVD, T2D, and metabolic syndrome. Exercise has definite acute effects on a number of risk markers for CVD and T2D, in addition to more substantial benefits with chronic training. Both aerobic and resistance exercise have therapeutic value, largely independent of weight loss, and should be included in exercise programs.     

Current treatment options for the metabolic syndrome

Optional statement The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests that the first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity). The treatment should be based on two major components: behavioral change to reduce caloric intake and an increase in physical activity. A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months. The general dietary recommendations include low intake of saturated fats, trans fats and cholesterol, and diets with low glycemic index. Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia. Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome. Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes. An equal balance between aerobic exercise and strength training is advised. Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals. There is no single best therapy and the treatment should consist of treatment of individual component(s). Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe. Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category. Some evidence suggests that angiotensin-converting enzyme inhibitors and β blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome. Patients with metabolic syndrome also have elevations in fibrinogen and other coagulation factors leading to prothrombotic state and aspirin may be beneficial for primary prevention in these patients. The new developments in the treatment of metabolic syndrome with drugs, such as peroxisome proliferator-activated receptor agonists, will broaden the horizons of the current treatment options in metabolic syndrome.     

The effects of exercise on C-reactive protein, insulin, leptin and some cardiometabolic risk factors in Egyptian children with or without metabolic syndrome

ABSTRACT: BACKGROUND: The prevalence and magnitude of obesity in the children and the adolescents have increased dramatically in the developing countries over the last 20-30 years. The prevalence of metabolic syndrome (MS) in children is increasing. Aim: This study aimed to investigate the changes of C-reactive protein (CRP), leptin, insulin, and blood lipids before and after the exercise therapy in normal and obese children (with or without metabolic syndrome). METHODS: The study covered 49 normal children (control), 32 obese children without metabolic syndrome and 12 obese children with metabolic syndrome. We examined the influence of exercise (3 times/week) for 12 weeks on the levels of serum CRP, leptin, insulin, homeostatic model assessment insulin resistance (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDLC) in all groups. RESULTS: There were significant correlations between HOMA-IR and the individual components of the metabolic syndrome. After 12 weeks of exercise, both of the obese children groups, with and without metabolic syndrome, showed reduced body weight, body mass index (BMI), and CRP level, and increased HDL-C level. The percentage of metabolic syndrome decreased from 12.9 % before the exercise training to 7.5 % after training. Also, there was a significant reduction in BMI (from 47.3 to 32.6 %), in systolic blood pressure (from 18.3 to 15.1 %) and in HDL-C level (from 18.3 to 9.7 %). CONCLUSION: Overweight children have multiple risk factors associated with the metabolic syndrome. 12- week exercise may have a positive effect on reducing risk factors for the metabolic syndrome.     

Effect of short-term Pritikin diet therapy on the metabolic syndrome

The Pritikin Program (Aventura, FL) involves the use of a very-low-fat, low-sodium, high-fiber diet and exercise to decrease the risk of coronary heart disease (CHD). This study evaluated the effect of short-term Pritikin therapy on the metabolic risk factors for CHD in patients with the metabolic syndrome. Sixty-seven subjects who had the metabolic syndrome and attended the Pritikin Longevity Center & Spa for 12-15 days were studied. Short-term Pritikin therapy improved most CHD risk factors: body mass index decreased by 3% (P<.001); systolic and diastolic blood pressure, and serum glucose and low-density lipoprotein cholesterol concentrations decreased by 10%-15% (P<.001); serum triglyceride concentration decreased by 36% (P<.001); and 37% of subjects no longer met National Cholesterol Education Program criteria for the metabolic syndrome. Serum high-density lipoprotein cholesterol, however, decreased by 3% (P<.05). These data demonstrate that brief treatment with a very-low-fat, low-sodium, high-fiber diet and regular exercise simultaneously improves multiple CHD risk factors in patients with the metabolic syndrome.     

Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study

It is not known whether the metabolic syndrome is associated with poor exercise capacity among patients who have established coronary heart disease. We evaluated the association of the metabolic syndrome with treadmill exercise capacity and heart rate recovery among patients who had coronary heart disease. We measured treadmill exercise capacity (METs) and heart rate recovery (beats per minute) in 943 subjects who had known coronary heart disease. Of these, 377 (40%) had the metabolic syndrome as defined by criteria of the National Cholesterol Education Program. Participants who had the metabolic syndrome were more likely to have poor exercise capacity (METs <5, 33% vs 18%, p <0.0001) and poor heart rate recovery (相似文献   

Exercise Training and Cardiometabolic Diseases: Focus on the Vascular System

The regular practice of physical activity is a well-recommended strategy for the prevention and treatment of several cardiovascular and metabolic diseases. Physical exercise prevents the progression of vascular diseases and reduces cardiovascular morbidity and mortality. Exercise training also ameliorates vascular changes including endothelial dysfunction and arterial remodeling and stiffness, usually present in type 2 diabetes, obesity, hypertension and metabolic syndrome. Common to these diseases is excessive oxidative stress, which plays an important role in the processes underlying vascular changes. At the vascular level, exercise training improves the redox state and consequently NO availability. Moreover, growing evidence indicates that other mediators such as prostanoids might be involved in the beneficial effects of exercise. The purpose of this review is to update recent findings describing the adaptation response induced by exercise in cardiovascular and metabolic diseases, focusing more specifically on the beneficial effects of exercise in the vasculature and the underlying mechanisms.     

辛伐他汀联合运动训练治疗稳定期慢阻肺合并代谢综合征疗效及检查指标1657

目的：观察分析辛伐他汀联合运动训练治疗稳定期慢性阻塞性肺疾病合并代谢综合征的临床疗效。方法选取2013年2月-2014年8月来我院就诊治疗的84例稳定期慢阻肺合并代谢综合征患者,随机分为对照组和观察组,对照组患者采用常规治疗,观察组患者在常规治疗基础上加用辛伐他汀及运动训练治疗,均持续治疗半年,比较两组患者治疗前、后的肺功能、CAT得分、外周血炎症水平及治疗后胰岛素抵抗及6 min步行距离情况。结果两组患者的一般情况及治疗前、后的肺功能指标无统计学差异,P>0．05；观察组患者治疗后CAT得分(23．7±1．3分)、胰岛素抵抗指数(2．5±0．7)、6min步行距离(361．4±38．7m)较对照组患者治疗后CAT得分(24．8±1．6分)、胰岛素抵抗指数(4．2±0．8)、6min步行距离(279．9±56．3m)具有明显优势,P<0．05；观察组患者治疗后的IL-6、IL-8等炎症因子水平均明显低于对照组患者,P<0．05。结论辛伐他汀联合运动训练治疗稳定期慢阻肺合并代谢综合征虽不能改善患者肺功能,但其可有效降低患者外周血炎症因子水平,提高运动能力和CAT评分,降低患者的胰岛素抵抗,提高患者的生命质量。     

Epidemiology of the metabolic syndrome

The clustering of cardiovascular risk factors, known as the metabolic syndrome, greatly increases the risk of developing diabetes, kidney disease, and cardiovascular disease. Individuals with the metabolic syndrome are also at increased risk for premature death from cardiovascular disease or all-cause mortality. Cross-sectional and longitudinal epidemiologic studies provide prevalence data on the syndrome based on criteria proposed by the World Health Organization and the National Cholesterol Education Program Adult Treatment Panel III. Owing to differences in the criteria, estimates of the prevalence of the syndrome vary according to the criteria used. Generally, the syndrome is more common in older people and in the United States and it is more prevalent among Mexican Americans. Obesity and sedentary lifestyles are major contributing factors to the syndrome and provide opportunities for interventions. Recent data from a randomized controlled trial indicate that a weight loss and exercise intervention reduced the incidence of the metabolic syndrome by 41% among individuals with impaired glucose tolerance. Pharmacologic treatment of the individual components of the metabolic syndrome provides an alternate strategy for managing the syndrome. The rising global epidemics of overweight and obesity will likely lead to increases in the prevalence of the metabolic syndrome posing a serious burden for clinicians and public health officials.     

Effects of angiotensin-converting enzyme inhibitor therapy on levels of inflammatory markers in response to exercise-induced stress: studies in the metabolic syndrome

The authors sought to determine whether the angiotensin-converting enzyme (ACE) inhibitor perindopril has beneficial effects on vascular markers of inflammation in patients with the metabolic syndrome when exposed to exercise-induced stress. Thirty patients with the metabolic syndrome were randomized to perindopril (4 mg/d) or placebo in a double-blind fashion for 4 weeks. Prior to treatment, the patients underwent an exercise treadmill study to a level of 8 metabolic equivalents. Circulating monocyte CD11b expression, levels of soluble interleukin 6 (sIL-6), and levels of vascular cell adhesion molecule-1 (VCAM-1) were measured. After the treatment period, exercise treadmill study and measurement of markers were repeated. Treatment with perindopril reduced sIL-6 levels at pre-exercise by 22% and at 1 and 30 minutes by 30% and 33%, respectively (P<.005). Levels of soluble VCAM-1 in perindopril-treated patients were reduced at pre-exercise by 25% and at 1 and 30 minutes by 31% and 37%, respectively. Treatment with perindopril reduced monocyte CD11b expression by 25%. In response to exercise-induced physical stress, the addition of an ACE inhibitor differentially regulates markers of inflammation, thereby providing potential vascular protection in the metabolic syndrome.     

Defining the level of physical activity for a diabetic who is obese

Physical activity plays an important role in the treatment of metabolic syndrome and/or type 2 diabetes or obesity. Less than 20% of the adult population does physical exercise at least twice a week. The effectiveness of physical exercise depends on paying attention to the following parameters: the frequency, the intensity and the duration. The most difficult parameter to set for patients with obesity or metabolic syndrome is the optimum intensity of exercise. The most common means of measuring the intensity of physical activity is heart rate or pulse rate. With patients who take medicines that affect their heart rate, the Borg scale is used to give a subjective rating of perceived exertion. To set optimal intensity it is necessary to use exertion tests with these patients. The most accurate setting is a suitable combination of spiroergometry and a CHR (clamped heart rate) test. In practice, though, it is usually enough to combine ergometry together with the Borg scale. Tracking exertion parameters during exercise improves patient compliance and also the results of exercise.     

The metabolic syndrome: what to treat, how to treat, what are the goals?

Metabolic syndrome is a cluster of risk factors for cardiovascular disease that include obesity, atherogenic dyslipidemia, raised blood pressure, and insulin resistance. The growing trend of obesity is associated with increased prevalence of metabolic syndrome. Optimizing diet and exercise are still the leading therapy for controlling the metabolic syndrome. Based on the current evidence, further emphasis should be placed on aggressive management of other metabolic risk factors such as high blood pressure and dyslipidemia.     

Arterielle Hypertonie und metabolisches Syndrom

BACKGROUND AND THERAPY: The metabolic syndrome comprises a virulent and lethal group of atherosclerotic risk factors, including dyslipidemia, obesity, systemic hypertension and insulin resistance. The prevalence of the metabolic syndrome has continuously grown in industrialized and developing countries during the last decades, and affects tens of millions of people in Germany and Europe. Particularly prominent as a risk factor for the development of insulin resistance is central obesity, which is causally involved in the pathogenesis of insulin resistance in addition to genetic predisposition. The metabolic syndrome can easily be diagnosed in clinical practice (guidelines of the WHO and ATP III panel), and immediate treatment of the metabolic syndrome is mandatory because those patients are at increased risk to develop overt diabetes mellitus, coronary artery disease and stroke. The high risk for cardiovascular diseases is supported by findings that the risk for myocardial infarction in patients with insulin resistance is as high as the risk of patients after their first myocardial infarction. Intentional weight reduction reduces abdominal obesity and beneficially modulates all features of the metabolic syndrome, while the benefits of aerobic exercise training are discussed controversially. Thus, weight reduction causally undoes essential features of the metabolic syndrome, but effects are often not enduring. Therefore, the treatment of cardiovascular risk factors such as hypertension and dislipidemia is essential. Of note, antihypertensive treatment is more effective than tight glucose control to reduce cardiovascular events. Diuretics, ACE-inhibitors and angiotensin II type 1 receptor antagonists are suggested as first line therapeutics. However, at least two antihypertensives are usually necessary to achieve the suggested goals of blood pressure reduction. In conclusion, the prevalence of the metabolic syndrome is continuously growing. Due to its adverse impact on cardiovascular disease, early detection and aggressive treatment is mandatory to ensure longlasting benefits for affected patients.     

Cardiovascular risk: prevention and treatment of the metabolic syndrome

The metabolic syndrome is a cluster of metabolic abnormalities, including impaired glucose metabolism, hypertension, dyslipidemia and abdominal obesity. It is a precursor to type 2 diabetes and a powerful independent risk factor for cardiovascular disease. Lifestyle changes, such as a diet high in saturated fats and a lack of physical exercise, have contributed to a worldwide increase in the prevalence of the metabolic syndrome and its associated complications. Identification and effective management of patients with the metabolic syndrome is important to reduce their risk of subsequent disease. Lifestyle modifications are an essential first step, and lipid-lowering therapy may also be required to achieve the lipid goals set out in current treatment guidelines. Statins are the most effective class of lipid-lowering drugs. Recent studies in patients with type 2 diabetes or the metabolic syndrome have shown that rosuvastatin was more effective than atorvastatin, simvastatin or pravastatin in reducing low-density lipoprotein cholesterol and enabling patients to reach lipid goals.     

Kidney disease and the metabolic syndrome

The epidemic of metabolic syndrome contributes to the rapid growth of cardiovascular and renal diseases. Hyper-hemodynamics, impaired pressure natriuresis, excess excretory load, insulin resistance, endothelial dysfunction, chronic inflammation, and prothrombotic status individually and interdependently initiate renal injury in metabolic syndrome. The prevention and treatment of kidney disease require a multifactorial approach. Weight loss through diet control and exercise can reverse many pathophysiologic processes. Pharmacologic intervention includes insulin sensitizers, tight glycemic and lipid control, blockage of renin angiotensin aldosterone system, and anti-inflammatory and antithrombotic therapies. Each peroxisome proliferator-activated receptor isoform plays a distinct role in metabolic syndrome, and their agonists may prevent or reverse the early renal injuries.     

Metabolic syndrome from the point of view of a cardiologist: diagnosis,non drug and drug treatment

Timely diagnosis and treatment of metabolic syndrome is important because of high prevalence of this pathology in population. For the elaboration of approaches to complex treatment of this syndrome it is necessary to understand pathogenetic mechanisms of development of hypertension and metabolic changes as well as acquire an array of non drug and drug methods of influence on elevated blood pressure and disordered carbohydrate, lipid and purine metabolism. Phenylalkylamine calcium antagonists should be used as drugs of choice for treatment of hypertension. These agents exert slowing of heart rate, coronarolytic and antiatherogenic effects, the latter being especially important in this group of patients. Resistance of hypertension to treatment developing on the background of insulin resistance of peripheral tissues dictates necessity of the use of combinations of antihypertensive drugs with consideration of their metabolic effects. For correction of metabolic changes metformin is used in addition to non drug methods which include diet and exercise. Treatment with metformin allows to decrease insulin resistance and thus severity of derangements of metabolism.     

Cardiac Rehabilitation Programs Improve Metabolic Parameters in Patients With the Metabolic Syndrome and Coronary Heart Disease

J Clin Hypertens (Greenwich). This study was performed to determine the effectiveness of a cardiac rehabilitation and exercise training program on metabolic parameters and coronary risk factors in patients with the metabolic syndrome and coronary heart disease. The study involved 642 patients with coronary heart disease. Of them, 171 (26.7%) fulfilled criteria for the metabolic syndrome. Clinical data, laboratory tests, and exercise testing were performed before and after the program, which lasted 2 to 3 months. Except for waist circumference, there were no significant differences between groups; blood pressure, high-density lipoprotein cholesterol, triglycerides, and fasting glucose improvements during the follow-up were higher in patients with the metabolic syndrome (all P<.001). At study end, in patients with the metabolic syndrome, functional capacity increased by 26.45% ( P<.001), as measured by metabolic equivalents, with a slight increase of 1.25% ( P=not significant) in the double product. Patients with the metabolic syndrome who took part in this secondary prevention program reported improvements in cardiovascular risk profile and functional capacity.     

Have guidelines addressing physical activity been established in nonalcoholic fatty liver disease?

The purpose of this review was to highlight, in relation to the currently accepted pathophysiology of non-alcoholic fatty liver disease (NAFLD), the known exercise habits of patients with NAFLD and to detail the benefits of lifestyle modification with exercise (and/or physical activity) on parameters of metabolic syndrome. More rigorous, controlled studies of longer duration and defined histopathological end-points comparing exercise alone and other treatment are needed before better, evidence-based physical activity modification guidelines can be established, since several questions remain unanswered.