Cardiorespiratory Fitness Is Inversely Associated With Clustering of Metabolic Syndrome Risk Factors: The Ball State Adult Fitness Program Longitudinal Lifestyle Study

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Abstract

Objective

The focus of this study was the association between the metabolic syndrome (MetSyn) and cardiorespiratory fitness (CRF) defined as maximal oxygen uptake (VO _2max). Although previous research has shown a relationship between MetSyn and CRF, most studies are based on less objective measures of CRF and different cardiometabolic risk factor thresholds from earlier guidelines.

Participants and Methods

The metabolic markers included in the present study were central obesity, elevated plasma triglycerides, elevated fasting high-density lipoprotein cholesterol, impaired fasting plasma glucose, hypertension, or pharmacologic treatment for diagnosed hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, or diabetes. A cohort of 3636 adults (1629 women, 2007 men; mean ± SD age, 44.7±12.3 years) completed CRF and metabolic risk factor assessment between January 1, 1971, and November 1, 2016. The CRF was defined as a measured VO _2max from a cardiopulmonary exercise test on a treadmill, with a respiratory exchange ratio value of 1.0 or more.

Results

Prevalence of MetSyn (≥3 factors) was 26% (n=953) in the cohort, with men having a greater likelihood for MetSyn compared with women ( P<.001). The difference in VO _2max between those individuals with MetSyn and those without was approximately 2.3 (2.0-2.5) metabolic equivalents. Logistic regression analyses showed a significant inverse and graded association between quartiles of CRF and MetSyn for the group overall ( P<.001), with odds ratios (95% CI) using the lowest fitness group as the referent group of 0.67 (0.55-0.81), 0.41 (0.34-0.51), and 0.10 (0.07-0.14) for VO _2max ( P<.001). The sex-specific odds ratios were 0.25 (0.18-0.34), 0.05 (0.02-0.10), and 0.02 (0.01-0.09) for women and 0.43 (0.31-0.59), 0.19 (0.14-0.27), and 0.03 (0.02-0.05) for men ( P<.001).

Conclusion

These results with current risk factor thresholds and a large number of women demonstrate that low VO _2max is associated with MetSyn.

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Most cited references 28

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Banting lecture 1988. Role of insulin resistance in human disease.

G M Reaven (1988)

Resistance to insulin-stimulated glucose uptake is present in the majority of patients with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM) and in approximately 25% of nonobese individuals with normal oral glucose tolerance. In these conditions, deterioration of glucose tolerance can only be prevented if the beta-cell is able to increase its insulin secretory response and maintain a state of chronic hyperinsulinemia. When this goal cannot be achieved, gross decompensation of glucose homeostasis occurs. The relationship between insulin resistance, plasma insulin level, and glucose intolerance is mediated to a significant degree by changes in ambient plasma free-fatty acid (FFA) concentration. Patients with NIDDM are also resistant to insulin suppression of plasma FFA concentration, but plasma FFA concentrations can be reduced by relatively small increments in insulin concentration. Consequently, elevations of circulating plasma FFA concentration can be prevented if large amounts of insulin can be secreted. If hyperinsulinemia cannot be maintained, plasma FFA concentration will not be suppressed normally, and the resulting increase in plasma FFA concentration will lead to increased hepatic glucose production. Because these events take place in individuals who are quite resistant to insulin-stimulated glucose uptake, it is apparent that even small increases in hepatic glucose production are likely to lead to significant fasting hyperglycemia under these conditions. Although hyperinsulinemia may prevent frank decompensation of glucose homeostasis in insulin-resistant individuals, this compensatory response of the endocrine pancreas is not without its price. Patients with hypertension, treated or untreated, are insulin resistant, hyperglycemic, and hyperinsulinemic. In addition, a direct relationship between plasma insulin concentration and blood pressure has been noted. Hypertension can also be produced in normal rats when they are fed a fructose-enriched diet, an intervention that also leads to the development of insulin resistance and hyperinsulinemia. The development of hypertension in normal rats by an experimental manipulation known to induce insulin resistance and hyperinsulinemia provides further support for the view that the relationship between the three variables may be a causal one.(ABSTRACT TRUNCATED AT 400 WORDS)

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Lack of exercise is a major cause of chronic diseases.

Frank Booth, Christian K Roberts, Matthew J. Laye (2012)

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. © 2012 American Physiological Society. Compr Physiol 2:1143-1211, 2012.

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Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

Apoor Gami, Brandi Witt, Daniel E. Howard … (2007)

The purpose of this research was to assess the association between the metabolic syndrome (MetSyn) and cardiovascular events and mortality by meta-analyses of longitudinal studies. Controversy exists regarding the cardiovascular risk associated with MetSyn. We searched electronic reference databases through March 2005, studies that referenced Reaven's seminal article, abstracts presented at meetings in 2003 to 2004, and queried experts. Two reviewers independently assessed eligibility. Longitudinal studies reporting associations between MetSyn and cardiovascular events or mortality were eligible. Two reviewers independently used a standardized form to collect data from published reports. Authors were contacted. Study quality was assessed by the control of selection, detection, and attrition biases. We found 37 eligible studies that included 43 cohorts (inception 1971 to 1997) and 172,573 individuals. Random effects meta-analyses showed MetSyn had a relative risk (RR) of cardiovascular events and death of 1.78 (95% confidence interval [CI] 1.58 to 2.00). The association was stronger in women (RR 2.63 vs. 1.98, p = 0.09), in studies enrolling lower risk (<10%) individuals (RR 1.96 vs. 1.43, p = 0.04), and in studies using factor analysis or the World Health Organization definition (RR 2.68 and 2.06 vs. 1.67 for National Cholesterol Education Program definition and 1.35 for other definitions; p = 0.005). The association remained after adjusting for traditional cardiovascular risk factors (RR 1.54, 95% CI 1.32 to 1.79). The best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.

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Author and article information

Contributors

Mitchell H. Whaley

Journal

Journal ID (nlm-ta): Mayo Clin Proc Innov Qual Outcomes

Journal ID (iso-abbrev): Mayo Clin Proc Innov Qual Outcomes

Title: Mayo Clinic Proceedings. Innovations, Quality & Outcomes

Publisher: Elsevier

ISSN (Electronic): 2542-4548

Publication date PMC-release: 08 May 2018

Publication date Collection: June 2018

Publication date (Electronic): 08 May 2018

Volume: 2

Issue: 2

Pages: 155-164

Affiliations

[a ]Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN

[b ]Department of Educational Psychology, Ball State University, Muncie, IN

[c ]Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN

[d ]College of Health, Ball State University, Muncie, IN

Author notes

[∗ ] Correspondence: Address to Mitchell H. Whaley, PhD, College of Health, AT101, Ball State University, Muncie, IN 47306. mwhaley@ 123456bsu.edu

Article

Publisher ID: S2542-4548(18)30023-7

DOI: 10.1016/j.mayocpiqo.2018.03.001

PMC ID: 6124330

PubMed ID: 30225445

SO-VID: 6bbb1abd-8eeb-41d7-9fd1-c2aab810aa72

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Cardiorespiratory Fitness Is Inversely Associated With Clustering of Metabolic Syndrome Risk Factors: The Ball State Adult Fitness Program Longitudinal Lifestyle Study

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Abstract

Objective

Participants and Methods

Results

Conclusion

Related collections

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Most cited references 28

Banting lecture 1988. Role of insulin resistance in human disease.

Lack of exercise is a major cause of chronic diseases.

Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

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