The Impact Of Structured Exercise Programs On Metabolic Syndrome And Its Components: A Systematic Review

Using Cluster Analysis to Identify Metabolic Syndrome Components and Physical Fitness in Patients with Metabolic Syndrome

Background: Metabolic syndrome (MetS) comprises a cluster of cardiovascular risk factors. Physical inactivity and reduced physical fitness are associated with one or more components of MetS. However, MetS has many components, and the unclear relationship between the components and physical fitness parameters can provide a plain and straightforward understanding of the clustering method. Aim: To identify the relationship between physical fitness parameters, physical activity levels, and components of MetS using hierarchical cluster analysis. Methods: One hundred twenty-one patients (mean age = 51.4 ± 7.1/years, F:90, M:31) who were diagnosed as having MetS according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria were included in the study. Fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) were analyzed. Systolic and diastolic blood pressures, (SBP and DBP), were evaluated. Body composition (waist and hip circumference, (WC and HC), waist-to-hip ratio (WHR), body mass index (BMI), percent body fat, and visceral fat), upper and lower extremity muscle strength (dynamometer), and functional exercise capacity [6-minute walk test (6MWT)] were assessed as physical fitness parameters. Physical activity levels were assessed using a pedometer and number of steps (NS) was determined. Results: Of the patients, 45.5% were diagnosed as having MetS based on four components. The dendrogram consisted of two main clusters and four subclusters. The main cluster I composed of BMI, HC, WC, visceral fat, HDL-C, percent fat, SBP, DBP, and percent quadriceps. The main cluster II comprised FPG, TG, WHR, handgrip strength, 6MWT, and NS. Conclusion: MetS components clustered with different physical fitness parameters. The clusters in the dendrogram can provide substantial implications for heterogeneous MetS components and physical fitness parameters. Future studies are needed to elucidate the effectiveness of dendrogram-derived exercise programs in MetS.

Physical activity in metabolic syndrome

Obesity has become one of the global epidemics, contributing to the burden of disease in society, increasing the risk of diabetes, cardiovascular and liver diseases. Inadequate energy balance resulting from excessive energy intake and insufficient physical activity (PA) is one of the main factors contributing to the incidence of obesity and the development of metabolic syndrome (MetS). Treatment options for obesity include lifestyle modifications, pharmacotherapy and bariatric surgery, with the latter being the most effective treatment. Lifestyle interventions involving increased PA and reduced caloric intake improve metabolic outcomes. Early implementation of exercise leads to improved physical fitness, better glycemic control and lipid profile. Undertaking systematic PA is associated with better quality of life, improves insulin sensitivity, causes additional weight loss, reduces its adverse effects on bone mass and results in better body composition. In this narrative review we summarized the current state of knowledge on the impact of PA on the components of MetS and the latest recommendations for PA in patients with MetS.

The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial

PURPOSE

The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy.

DESIGN

A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted.

METHODS

Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis.

FINDINGS

Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group.

CONCLUSION

The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise.

CLINICAL RELEVANCE

The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.

Nutrients, Physical Activity, and Mitochondrial Dysfunction in the Setting of Metabolic Syndrome

Metabolic syndrome (MetS) is a cluster of metabolic risk factors for diabetes, coronary heart disease, non-alcoholic fatty liver disease, and some tumors. It includes insulin resistance, visceral adiposity, hypertension, and dyslipidemia. MetS is primarily linked to lipotoxicity, with ectopic fat deposition from fat storage exhaustion, more than obesity per se. Excessive intake of long-chain saturated fatty acid and sugar closely relates to lipotoxicity and MetS through several pathways, including toll-like receptor 4 activation, peroxisome proliferator-activated receptor-gamma regulation (PPARγ), sphingolipids remodeling, and protein kinase C activation. These mechanisms prompt mitochondrial dysfunction, which plays a key role in disrupting the metabolism of fatty acids and proteins and in developing insulin resistance. By contrast, the intake of monounsaturated, polyunsaturated, and medium-chain saturated (low-dose) fatty acids, as well as plant-based proteins and whey protein, favors an improvement in sphingolipid composition and metabolic profile. Along with dietary modification, regular exercises including aerobic, resistance, or combined training can target sphingolipid metabolism and improve mitochondrial function and MetS components. This review aimed to summarize the main dietary and biochemical aspects related to the physiopathology of MetS and its implications for mitochondrial machinery while discussing the potential role of diet and exercise in counteracting this complex clustering of metabolic dysfunctions.

Association between Functional Fitness and Health-Related Quality of Life in the Balearic Islands' Old Adults with Metabolic Syndrome

Research assessing the relationship between functional fitness (FF) and health-related quality of life (HRQoL) is still scarce. The objective of this research is to assess the association between FF and HRQoL in older adults with metabolic syndrome (MetS) from Balearic Islands (Spain). The design is a cross-sectional, descriptive, and comparative study involving 209 participants (42.2% women). The sociodemographic data and medical history of the participants were collected. Physical activity was evaluated using the Spanish version of the Rapid Assessment of Physical Activity Questionnaire. Anthropometrics and blood pressure were measured. Glucose, total cholesterol, high-density lipoprotein cholesterol, and triglyceride plasma levels were measured. A battery of functional fitness tests was applied. HRQoL was measured with the Spanish version of the SF-36 questionnaire. Adherence to the Mediterranean dietary pattern was assessed. In older subjects with MetS, a higher FF score and, within it, endurance, lower body strength, one-leg balance, and agility are positively associated with lower physical function (p < 0.001; d = 0.56), better general health (p = 0.019; d = 0.35), and better summary physical component of HRQoL (p < 0.001; d = 0.57). The FF score and HRQoL physical component are both positively associated with high levels of physical activity (ORadj = 10.3, IC 4.19−28.2, p < 0.001; ORadj = 3.25, IC 1.44−7.72, p < 0.005). Older adults with MetS should consider practicing physical activity above the general recommendations to improve their functional fitness and health status and quality of life.

Summary of the best evidence of diet and physical activity management in patients with metabolic syndrome

To evaluate and summarize the evidence of diet and physical activity management in patients with metabolic syndrome (MS). BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) database, Agency for Healthcare Research and Quality (AHRQ) network, National Institute for Health and Clinical Excellence (NICE) network, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Medlive, Registered Nurses' Association of Ontario (RNAO) network, American Diabetes Association (ADA) network, New Zealand Guideline Group (NZGG) network, Canadian medical association clinical practice guidelines network, PubMed, EmBase, Web of Science, CINAHL, Cochrane Library, CNKI, China Science and Technology Journal Database, Wanfang Knowledge Data Service Platform and Chinese biomedical database were searched systematically to obtain guidelines, evidence summary, expert consensus, best practice information book, clinical decision-making, recommended practice, and systematic review on diet and physical activity management in patients with MS. The retrieval period is from the establishment of database to November 2021. Two researchers with evidence-based medicine background evaluated the quality and evidence level of the included literature. A total of 36 articles met the criteria, including 3 guidelines, 5 expert consensus, 1 clinical decision and 27 systematic reviews. We summarized 49 pieces of evidence related to diet and physical activity in patients with MS, involving 15 aspects, namely diet goals, diet patterns, diet time, carbohydrate intake, fat intake, fiber intake, salt intake, fruits, vegetables and grains intake, coffee intake, effects of diet, principle of physical activity, intensity, form, time of physical activity, effects of physical activity, physical activity prescription of patients with MS and cardiovascular disease, and the joint effects of diet and physical activity. Diet and physical activity management can effectively improve the health outcomes of patients with MS. Health professionals should choose and apply the best evidence with consideration of the clinical situation and patient preference.

Impact of a Pilot Structured Mobile Technology Based Lifestyle Intervention for Patients with Nonalcoholic Fatty Liver Disease

BACKGROUND AND AIMS

Lifestyle modification is the main treatment for nonalcoholic fatty liver disease (NAFLD), but remains challenging to implement. The aim of this pilot was to assess the acceptability and feasibility of a mobile-technology based lifestyle program for NAFLD patients.

METHODS

We enrolled adult patients with NAFLD in a 6-month mobile-technology based program where participants received a FitBit with weekly tailored step count goals and nutritional assessments. Anthropometrics, hepatic and metabolic parameters, Fibroscan, physical function and activity, and health-related quality of life measures were obtained at enrollment and month 6. Semi-structured exit interviews were conducted to assess patient's experience with the program.

RESULTS

40 (63%) eligible patients were enrolled. Median age was 52.5 with 53% males, 93% whites, 43% with diabetes and median BMI 33.9. On baseline Fibroscan, 59% had F0-2 fibrosis and 70% had moderate-severe steatosis. 33 patients completed the study. Median percentage of days with valid FitBit data collection was 91. 4 patients increased and maintained, 19 maintained, and 8 increased but subsequently returned to baseline weekly step count. 59% of patients reported Fitbit was easy to use and 66% felt step count feedback motivated them to increase their activity. Roughly 50% of patients had reduction in weight, triglycerides and Fibroscan liver stiffness, and 75% had improvement in controlled attenuation parameter and physical function.

CONCLUSIONS

A 6-month mobile-technology based pilot lifestyle intervention was feasible and acceptable to NAFLD patients. The program promoted physical activity and was associated with improvement in clinical parameters in some patients.

Effect of voluntary exercise upon the metabolic syndrome and gut microbiome composition in mice

The metabolic syndrome is a cluster of conditions that increase an individual's risk of developing diseases. Being physically active throughout life is known to reduce the prevalence and onset of some aspects of the metabolic syndrome. Furthermore, previous studies have demonstrated that an individual's gut microbiome composition has a large influence on several aspects of the metabolic syndrome. However, the mechanism(s) by which physical activity may improve metabolic health are not well understood. We sought to determine if endurance exercise is sufficient to prevent or ameliorate the development of the metabolic syndrome and its associated diseases. We also analyzed the impact of physical activity under metabolic syndrome progression upon the gut microbiome composition. Utilizing whole-body low-density lipoprotein receptor (LDLR) knockout mice on a "Western Diet," we show that long-term exercise acts favorably upon glucose tolerance, adiposity, and liver lipids. Exercise increased mitochondrial abundance in skeletal muscle but did not reduce liver fibrosis, aortic lesion area, or plasma lipids. Lastly, we observed several changes in gut bacteria and their novel associations with metabolic parameters of clinical importance. Altogether, our results indicate that exercise can ameliorate some aspects of the metabolic syndrome progression and alter the gut microbiome composition.

Prevalence and Correlates of Muscle-Strengthening Activity Participation in Croatia: A Cross-Sectional Study in a National Representative Sample of 4561 Adults

The World Health Organization recommends adults to engage in muscle-strengthening activity (MSA) at least two times per week. The aim of this study was to determine the prevalence and correlates of MSA in Croatian adults. We analysed self-reported data collected among 4561 Croatians aged ≥18 years within the European Health Interview Survey (EHIS wave 2). We calculated the weighted prevalence of meeting the MSA guidelines, and odds ratios for different population groups, adjusted for a range of sociodemographic and lifestyle variables in a multivariable logistic regression analysis. The prevalence of meeting the MSA guidelines was 8.0% (95% CI: 7.2, 8.8) in the overall sample, 5.4% (95% CI: 4.5, 6.4) among females, and 10.9% (95% CI: 9.6, 12.3) among males. We found significantly lower odds of meeting the MSA guidelines for females, older age groups, inhabitants of sparsely populated areas, those with a low education level, obese individuals, and those who did not rate their health as “very good” (p < 0.05 for all). The vast majority of Croatian adults do not meet the MSA guidelines. Public health initiatives to promote MSA in Croatia should focus on females, seniors, sparsely populated areas, people with low education, obese individuals, and those with impaired health.

Effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome: A systematic review

OBJECTIVES

This systematic review evaluated the effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome (MetS).

METHODS

Randomized controlled trials (RCTs) were searched in 10 databases. Data were statistically pooled for meta-analysis.

RESULTS

Twenty RCTs were included. One study involved adults with MetS, and the other 19 studies involved adults with at least one risk factor for MetS. Tai Chi was found to reduce waist circumference and increase high-density lipoprotein cholesterol in obese adults. Tai Chi also reduces waist circumference, body mass index, blood glucose level, insulin resistance, and increases the quality of life (QoL) in adults with elevated blood glucose/type 2 diabetes (T2DM). Among participants with hypertension, Tai Chi improves blood pressure, lipid profiles, anxiety, depression, and physical QoL.

CONCLUSIONS

Tai Chi may be effective for enhancing the physiological and psychosocial wellbeing of community-dwelling adults at risk of MetS. Further RCTs are needed to examine its effects in adults with MetS and identify optimal regimes.

Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to 17 March 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13-0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58-0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81-0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77-1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.

PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. J Med Libr Assoc 2021;109:174-200. [PMID: 34285662 PMCID: PMC8270366 DOI: 10.5195/jmla.2021.962]

BACKGROUND

Literature searches underlie the foundations of systematic reviews and related review types. Yet, the literature searching component of systematic reviews and related review types is often poorly reported. Guidance for literature search reporting has been diverse and, in many cases, does not offer enough detail to authors who need more specific information about reporting search methods and information sources in a clear, reproducible way. This document presents the PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) checklist, and explanation and elaboration.

METHODS

The checklist was developed using a three-stage Delphi survey process, followed by a consensus conference and public review process.

RESULTS

The final checklist includes sixteen reporting items, each of which is detailed with exemplar reporting and rationale.

CONCLUSIONS

The intent of PRISMA-S is to complement the PRISMA Statement and its extensions by providing a checklist that could be used by interdisciplinary authors, editors, and peer reviewers to verify that each component of a search is completely reported and, therefore, reproducible.

PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews

BACKGROUND

Literature searches underlie the foundations of systematic reviews and related review types. Yet, the literature searching component of systematic reviews and related review types is often poorly reported. Guidance for literature search reporting has been diverse, and, in many cases, does not offer enough detail to authors who need more specific information about reporting search methods and information sources in a clear, reproducible way. This document presents the PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) checklist, and explanation and elaboration.

METHODS

The checklist was developed using a 3-stage Delphi survey process, followed by a consensus conference and public review process.

RESULTS

The final checklist includes 16 reporting items, each of which is detailed with exemplar reporting and rationale.

CONCLUSIONS

The intent of PRISMA-S is to complement the PRISMA Statement and its extensions by providing a checklist that could be used by interdisciplinary authors, editors, and peer reviewers to verify that each component of a search is completely reported and therefore reproducible.

Effects of a short health education intervention on physical activity, arterial stiffness and cardiac autonomic function in individuals with moderate-to-high cardiovascular risk

OBJECTIVE

This study evaluated the effects of a short health education and counseling intervention program, in a primary healthcare setting, on daily physical activity (PA), arterial stiffness, and cardiac autonomic function in individuals with moderate-to-high risk of cardiovascular disease.

METHODS

This was a parallel-group study with a 4-month-long intervention, plus 8 months of follow-up. 164 individuals with moderate-to-high cardiovascular risk were allocated to either an intervention (n = 87) or a control group (n = 77). The intervention consisted of 3 walking and face-to-face group sessions plus text messages. Primary outcome was daily PA (sedentary time, light and moderate-to-vigorous PA, all in min/day); secondary outcomes were arterial stiffness i.e., carotid-femoral pulse wave velocity (cfPWV, m/s)] and cardiac autonomic function [(i.e., standard deviation of all N-N intervals (SDNN, ms) and absolute high frequency (HF, ms²)].

RESULTS

There were not significant group*time interactions for sedentary time [-7.4 (7.6); p = 0.331)], light PA [4.4 (6.4); p = 0.491] or moderate-to-vigorous PA [0.1 (2.6); p = 0.938]. Considering secondary outcomes, there were not significant group*time interactions for cfPWV [0.09 (0.18); p = 0.592], Ln_SDNN [0.09 (0.06); p = 0.148], or Ln_HF [0.16 (0.14); p = 0.263].

CONCLUSION

The program did not improve daily PA, arterial stiffness, or the autonomic cardiac function.

PRACTICE IMPLICATIONS

Primary care staff should consider longer or other types of intervention to improve daily PA.

Dietary Patterns Are Associated with Risk of Prostate Cancer in a Population-Based Case-Control Study in Montreal, Canada

This study describes the association between dietary patterns and prostate cancer (PCa) risk in a population-based case-control study conducted in Montreal, Canada (2005-2012). Cases (n = 1919) were histologically confirmed, aged ≤75 years. Concomitantly, controls (n = 1991) were randomly selected from the electoral list and frequency-matched to cases by age (±5 years). During face-to-face interviews, a 63-item food frequency questionnaire focusing on the two years before diagnosis/interview was administered. Three dietary patterns were identified from principal component analysis. Unconditional logistic regression estimated the association between dietary patterns and PCa, adjusting for age, ethnicity, education, family history, and timing of last PCa screening. When comparing scores in the highest vs. lowest quartiles, the Healthy Eating pattern was associated with a decreased risk of overall PCa (Odds ratio (OR) = 0.76, 95% confidence interval (CI) = 0.61, 0.93); this association was stronger for high-grade cancers (OR = 0.66, 95% CI = 0.48, 0.89). By contrast, the Western Sweet and Beverages pattern was associated with an elevated risk of overall PCa (OR = 1.35, 95% CI = 1.10, 1.66). The Western Salty and Alcohol pattern was not associated with PCa risk. These findings suggest that some dietary patterns influence PCa development.