Document Type : Review Article

Authors

Abstract

Results from meta-analyses focused on patients MetS are not conclusive because of no specifically focusing on the overall metabolic risk and papers published up to 2011. Therefore, this meta-analysis was determined the effect of aerobic training on overall metabolic syndrome z score and its indices MetS patients. RCTs and CTs that investigated the effect of, at least, 4 weeks aerobic training in adults with MetS, published in a peer-reviewed journal up to 2015 were included. Primary outcome measure was MetS z score and the MetS factors were secondary outcomes. Random-and fixed-effect models were used for analyzing the data and the effect size were reported as standard difference in means and between 95% confidence intervals(CIs). Heterogeneity between trial results was tested with a standard Chi-squared(v2) test. A value for I2[50% has been considered to be substantial heterogeneity. Eight trials were included to investigate about primary outcome, involving 561 participants (288 in aerobic training group and 273 in control group). MetS Z score had -0.33 standard deviation from mean. For secondary outcomes, standard deviation from their mean were -0.36 for FBS, 0.03 for HDL, -0.23 for MAP, -0.1 for TG and -0.40 for WC. Mild effect of aerobic training on overall MetS risk and most of the associated cardiovascular risk factors persists on clinical benefits of aerobic training in MetS patients. However, quantifying the effects of the aforementioned factors and other variables such as age, gender, race and training parameters in future meta-analyses could be applicative and useful.

Keywords

Main Subjects

 
1. Zhang J, Li N, Yan Z, Zhang D L, Wang H, Guo Y, et al. Association of genetic variations of prdm16 with metabolic syndrome in a general xinjiang uygur population. Endocrine. 2012; 41(3): 539.
2. Sattelmair J, Pertman J, Ding E L, Kohl H W, Haskell W, Lee I M. Dose response between physical activity and risk of coronary heart disease a meta-analysis. Circulation. 2011; 124(7): 789-95.
3. Yang T, Chu C H, Hsieh P C, Hsu C H, Chou Y C, Yang S H, et al. C-reactive protein concentration as a significant correlate for metabolic syndrome: A chinese population-based study. Endocrine. 2013; 43(2): 351-9.
4. Stefanov T, Blüher M, Vekova A, Bonova I, Tzvetkov S, Kurktschiev D, et al. Circulating chemerin decreases in response to a combined strength and endurance training. Endocrine. 2014; 45(3): 382-91.
5. Tsai C H, Li T C, Lin C C, Tsay H S. Factor analysis of modifiable cardiovascular risk factors and prevalence of metabolic syndrome in adult taiwanese. Endocrine. 2011; 40(2): 256-64.
6. Pattyn N, Cornelissen V A, Eshghi S R T, Vanhees L. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome. Sports Med. 2013; 43(2): 121-33.
7. Bateman L A, Slentz C A, Willis L H, Shields A T, Piner L W, Bales C W, et al. Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the studies of a targeted risk reduction intervention through defined exercise-strride-at/rt). Am J Cardiol. 2011; 108(6): 838-44.
8. Yamaoka K, Tango T. Effects of lifestyle modification on metabolic syndrome: A systematic review and meta-analysis. BMC Med. 2012; 10(1): 138.
9. Whelton S P, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: A meta-analysis of randomized, controlled trials. Ann Intern Med. 2002; 136(7): 493-503.
10. Cornelissen V A, Fagard R H. Effects of endurance training on blood pressure, blood pressure–regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005; 46(4): 667-75.
11. Kelley G A, Kelley K S. Aerobic exercise and lipids and lipoproteins in men: A meta-analysis of randomized controlled trials. J Mens Health Gend. 2006; 3(1): 61-70.
12. Thomas D, Elliott E J, Naughton G A. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006; 3(3).
13. He D, Xi B, Xue J, Huai P, Zhang M, Li J. Association between leisure time physical activity and metabolic syndrome: A meta-analysis of prospective cohort studies. Endocrine. 2014; 46(2): 231-40.
14. Li J, Siegrist J. Physical activity and risk of cardiovascular disease—a meta-analysis of prospective cohort studies. Int J Environ Res Public Health. 2012; 9(2): 391-407.
15. Jeon C Y, Lokken R P, Hu F B, Van Dam R M. Physical activity of moderate intensity and risk of type 2 diabetes a systematic review. Diabetes Care. 2007; 30(3): 744-52.
16. Huai P, Xun H, Reilly K H, Wang Y, Ma W, Xi B. Physical activity and risk of hypertension a meta-analysis of prospective cohort studies. Hypertension. 2013; 62(6): 1021-6.
17. Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen N F, et al. Physical activity and mortality in individuals with diabetes mellitus: A prospective study and meta-analysis. Arch Intern Med. 2012; 172(17): 1285-95.
18. Rossi A, Dikareva A, Bacon S L, Daskalopoulou S S. The impact of physical activity on mortality in patients with high blood pressure: A systematic review. J Hypertens. 2012; 30(7): 1277-88.
19. Lin X, Zhang X, Guo J, Roberts C K, Mckenzie S, Wu W C, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015; 4(7): e002014.
20. Yamaoka K, Tango T. Effects of lifestyle modification on metabolic syndrome: A systematic review and meta-analysis. BMC Medicine. 2012; 10: 138.
21. Moher D, Liberati A, Tetzlaff J, Altman D G. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. Ann Intern Med. 2009; 151(4): 264-9.
22. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care. 2005; 28(12): 2823-31. (In Persian).
23. Watkins L L, Sherwood A, Feinglos M, Hinderliter A, Babyak M, Gullette E, et al. Effects of exercise and weight loss on cardiac risk factors associated with syndrome x. Arch Intern Med. 2003; 163(16): 1889-95.
24. Poppitt S D, Keogh G F, Prentice A M, Williams D E, Sonnemans H M, Valk E E, et al. Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr. 2002; 75(1): 11-20.
25. Ilanne-Parikka P, Laaksonen D E, Eriksson J G, Lakka T A, Lindstr J, Peltonen M, et al. Leisure-time physical activity and the metabolic syndrome in the finnish diabetes prevention study. Diabetes Care. 2010; 33(7): 1610-7.
26. Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, et al. Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. J Gen Intern Med. 2007; 22(12): 1695-703.
27. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial. JAMA. 2004; 292(12): 1440-6.
28. Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González M A, Fitó M, Estruch R, et al. Effect of a mediterranean diet supplemented with nuts on metabolic syndrome status: One-year results of the predimed randomized trial. Arch Intern Med. 2008; 168(22): 2449-58.
29. Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes a meta-analysis of randomized controlled trials. Diabetes Care. 2005; 28(11): 2780-6.
30. De Morton N A. The pedro scale is a valid measure of the methodological quality of clinical trials: A demographic study. Aust J Physiother. 2009; 55(2): 129-33.
31. Azali Alamdari K, Choobineh S. Metabotrophic effects of aerobic training in male patients with metabolic syndrome. Adipobiology. 2015; 7: 21-9. 
32. Azali Alamadari K. Predicting the amount and direction of blood pressure change after aerobic training and detraining in sedentary midlife men. J Know Health. 2015; 10(2): 1-10. (In Persian).
33. Azali Alamdari K, Rohani H. Effects of normobaric and hypobaric endurance training on metabolic risk factors in midlife men. Iran J Endocrin Met. 2015; 17(2): 113-23. (In Persian).
34. Azali Alamdari K, Rohani H. Metabolic and endocrine adaptations of aerobic training in men with generalized stages of metabolic syndrome. Sport Physiol. 2015; 7(27): 149-66. (In Persian).
35. Babaei P, Azali Alamdari K, Soltani Tehrani B, Damirchi A. Effect of six weeks of endurance exercise and following detraining on serum brain derived neurotrophic factor and memory performance in middle aged males with metabolic syndrome. J Sports Med Phys Fitness. 2013; 53(4): 437-43. 
36. Damirchi A, Babaei P, Azali Alamdari K. Effects of aerobic training on metabolic risk factors and BDNF in midlife males. J Sport Biomot Sci. 2011; 3(6): 40-51. (In Persian).
37. Damirchi A, Tehrani B S, Alamdari K A, Babaei P. Influence of aerobic training and detraining on serum BDNF, insulin resistance, and metabolic risk factors in middle-aged men diagnosed with metabolic syndrome. Clin J Sport Med. 2014; 24(6): 513-8. 
38. Earnest C P, Johannsen N M, Swift D L, Lavie C J, Blair S N, Church T S. Dose effect of cardiorespiratory exercise on metabolic syndrome in postmenopausal women. Am J Cardiol. 2013; 111(12): 1805-11.
39. Gates T. Effect of exercise training on metabolic syndrome z-score: The association of c-reactive protein [MSC]. East Carolina University; 2015.
40. Johnson J L, Slentz C A, Houmard J A, Samsa G P, Duscha B D, Aiken L B, et al. Exercise training amount and intensity effects on metabolic syndrome (from studies of a targeted risk reduction intervention through defined exercise). Am J Cardiol. 2007; 100(12): 1759-66.
41. Kemmler W, Von Stengel S, Bebenek M, Kalender W A. Long-term exercise and risk of metabolic and cardiac diseases: The erlangen fitness and prevention study. Evid Based Complement Alternat Med. 2013:768431.
42. Malin S K, Niemi N, Solomon T P, Haus J M, Kelly K R, Filion J, et al. Exercise training with weight loss and either a high-or low-glycemic index diet reduces metabolic syndrome severity in older adults. Ann Nutr Metab. 2012; 61(2): 135-41.
43. Thomas G A, Alvarez-Reeves M, Lu L, Yu H, Irwin M L. Effect of exercise on metabolic syndrome variables in breast cancer survivors. Int J Endocrinol. 2013; 168797.
44. Wang X, Hsu F C, Isom S, Walkup M P, Kritchevsky S B, Goodpaster B H, et al. Effects of a 12-month physical activity intervention on prevalence of metabolic syndrome in elderly men and women. J Gerontol A Biol Sci Med Sci. 2012; 67(4): 417-24.
45. Damirchi A, Azali Alamdari K, Babaei P. Effects of submaximal aerobic training and following detraining on serum BDNF level and memory function in midlife healthy untrained males. Met Exerc. 2012; 2(2): 135-47. (In Persian).
46. Babaei P, Damirchi A, Azali Alamdari K. Effects of endurance training and detraining on serum BDNF and memory performance in middle aged males with metabolic syndrome. Iranian Journal of Endocrinology and Metabolism. 2013; 15(2): 132-42. (In Persian).
47. Gomes V A, Casella-Filho A, Chagas A C, Tanus-Santos J E. Enhanced concentrations of relevant markers of nitric oxide formation after exercise training in patients with metabolic syndrome. Nitric Oxide. 2008; 19(4): 345-50.
48. Dumortier M, Brandou F, Perez-Martin A, Fedou C, Mercier J, Brun J F. Low intensity endurance exercise targeted for lipid oxidation improves body composition and insulin sensitivity in patients with the metabolic syndrome. Diabetes Metab. 2003; 29(5): 509-18.
49. Tjonna A E, Lee S J, Rognmo O, Stolen T O, Bye A, Haram P M, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome a pilot study. Circulation. 2008; 118(4): 346-54.
50. Balducci S, Zanuso S, Nicolucci A, Fernando F, Cavallo S, Cardelli P, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010; 20(8): 608-17.
51. Zimmet P Z, Alberti K G, Shaw J E. Mainstreaming the metabolic syndrome: A definitive definition. Med J Aust. 2005; 183(4): 175-6.
52. Ellis P D. The essential guide to effect sizes: Statistical power, meta-analysis, and the interpretation of research results. Cambridge University Press; 2010.
53. Tan C E, Ma S, Wai D, Chew S K, Tai E S. Can we apply the national cholesterol education program adult treatment panel definition of the metabolic syndrome to asians? Diabetes Care. 2004; 27(5): 1182-6.
54. Kissebah A H, Krakower G R. Regional adiposity and morbidity. Physiol Rev. 1994; 74(4): 761-811.
55. Misra A, Chowbey P, Makkar B M, Vikram N K, Wasir J S, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009; 57(FEV):163-70.
56. Kohrt W M, Obert K A, Holloszy J O. Exercise training improves fat distribution patterns in 60- to 70-year-old men and women. J Gerontol. 1992; 47(4): 99-105.
57. Klancic T, Woodward L, Hofmann S M, Fisher E A. High density lipoprotein and metabolic disease: Potential benefits of restoring its functional properties. Mol Metab. 2016; 5(5): 321-7.
58. Regazzi R, Widmann C. Genetics and molecular biology: Mirnas take the HDL ride. Curr Opin Lipidol. 2012; 23(2): 165-6.
59. Vickers K C, Palmisano B T, Shoucri B M, Shamburek R D, Remaley A T. Micrornas are transported in plasma and delivered to recipient cells by high-density lipoproteins. Nat Cell Biol. 2011; 13(4): 423-33.
60. Group Ta S. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010; 362(17): 1563-74.
61. Murphy A J, Woollard K J. High‐density lipoprotein: A potent inhibitor of inflammation. Clinical and Experimental Pharmacology and Physiology. 2010; 37(7): 710-8.
62. Baker P, Rye K, Gamble J, Vadas M, Barter P. Phospholipid composition of reconstituted high density lipoproteins influences their ability to inhibit endothelial cell adhesion molecule expression. J Lipid Res. 2000; 41(8): 1261-7.
63. Kratzer A, Giral H, Landmesser U. High-density lipoproteins as modulators of endothelial cell functions: Alterations in patients with coronary artery disease. Cardiovasc Res. 2014; 103(3): 350-61.
64. Riwanto M, Rohrer L, Roschitzki B, Besler C, Mocharla P, Mueller M, et al. Altered activation of endothelial anti-and pro-apoptotic pathways by high-density lipoprotein from patients with coronary artery disease: Role of HDL-proteome remodeling. Circulation. 2013; 127(8): 891-904.
65. Lehti M, Donelan E, Abplanalp W, Al-Massadi O, Habegger K, Weber J, et al. High-density lipoprotein maintains skeletal muscle function by modulating cellular respiration in mice. Circulation. 2013; 128(22): 2364-71.
66. Fryirs M A, Barter P J, Appavoo M, Tuch B E, Tabet F, Heather A K, et al. Effects of high-density lipoproteins on pancreatic beta-cell insulin secretion. Arterioscler Thromb Vasc Biol. 2010; 30(8): 1642-8.
67. Serban C, Muntean D, Mikhailids D P, Toth P P, Banach M. Dysfunctional HDL: The journey from savior to slayer. Clin Lipidol. 2014; 9(1): 49-59.
68. Carey A L, Siebel A L, Reddy-Luthmoodoo M, Natoli A K, D’souza W, Meikle P J, et al. Skeletal muscle insulin resistance associated with cholesterol-induced activation of macrophages is prevented by high density lipoprotein. PLos One. 2013; 8(2): 56601.
69. Dalla-Riva J, Stenkula K G, Petrlova J, Lagerstedt J O. Discoidal HDL and apoa-i-derived peptides improve glucose uptake in skeletal muscle. J Lipid Res. 2013; 54(5): 1275.
70. Tohidi M, Hatami M, Hadaegh F, Azizi F. Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in middle eastern women. J Hum Hypertens. 2012; 26(9): 525-32.