Copyright © 2010 American College of Sports Medicine Metabolic Syndrome.

Copyright © 2010 American College of Sports Medicine

Metabolic SyndromeMetabolic Syndrome

Metabolic SyndromeMetabolic Syndrome• Also referred to as syndrome X or the insulin resistance

syndrome, describes a condition in which several coronary heart disease (CHD) risk factors are clustered together.

– CHD risk factors may include: dyslipidemia, insulin resistance, elevated blood pressure, etc.

– Increases risk of Type 2 Diabetes, CVD and liver disease.

– Risk factors for MetS are undertreated. Is reversible.

MET Syndrome - 3 or more – From table 10.3MET Syndrome - 3 or more – From table 10.3• SBP > 130 or DBP > 85 mm Hg.

• Fasting glucose > 110

• Fasting HDL < 40 for men

• Fasting HDL < 50 for women

• Fasting Triglycerides > 150 mg/dL

• Waist circumference > 102 cms for men

• Waist circumference > 88 cms for women

FactsFacts• WHO guidelines = 25.1% of the USA have MetS

• Mexican Americans – highest prevalence

• Primarily seen in overweight people and deconditioned individuals.

• By 2020 as many as 40% of the population will have MetS.

• Main components are the development of insulin resistance in the presence of central or visceral adiposity.


Metabolic Syndrome (cont.)Metabolic Syndrome (cont.)

Table 10-3



Table 10-3



Table 10-3


Metabolic Syndrome: Exercise PrescriptionMetabolic Syndrome: Exercise Prescription• The minimal Frequency, Intensity, Time (duration) or FIT

framework is consistent with the recommendations for healthy adults regarding aerobic, resistance, and flexibility exercise.

• Similarly, the minimal dose of physical activity to improve health/fitness outcomes is consistent with the consensus public health recommendations of 150 min·wk-1 or 30 minutes of physical activity on most days of the week.

TreatmentTreatment• Weight loss is the primary intervention

• Decrease 7-10% form baseline total weight over 6-12 months.

• Maintenance of weight loss.

• Exercise prescription that of an obese person or low to moderate intensity.

• Don’t overlook cardiovascular risks when considering resistance training and flexibility exercises.

• Resistance training is inversely related to MetS. Use 40-60% of client’s estimated 1 RM. Circuit training recommended with 30-45 seconds of rest between stations.


Pulmonary DiseasesPulmonary Diseases• Pulmonary diseases typically result in dyspnea or shortness

of breath with exertion.

• As a result of dyspnea, patients with pulmonary disease limit physical activity and deconditioning results.

• Consequently, patients with pulmonary disease experience dyspnea even at low levels of physical exertion.


Pulmonary Diseases (cont.)Pulmonary Diseases (cont.)• This adverse cycle can lead to eventual functional

impairment and disability.

• Exercise is an effective intervention that lessens the development of functional impairment and disability in patients with pulmonary disease.

• Chronic bronchitis, emphysema, and cystic fibrosis are classified as chronic obstructive pulmonary diseases (COPDs), resulting in a permanent diminution of airflow, whereas asthma has a reversible component to airway obstruction.

• Emphysema

DefinitionsDefinitions

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indoor/outdoor pollutionindoor/outdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD


Pulmonary Diseases: Exercise TestingPulmonary Diseases: Exercise Testing• Assessment of physiologic function should include

cardiopulmonary capacity, pulmonary function, and determination of arterial blood gases or arterial oxygen saturation (SaO2) via direct or indirect methods.

• Modifications of traditional protocols (e.g., extended stages, smaller increments, and slower progression) may be warranted depending on functional limitations and the early onset of dyspnea. For example, in patients with severe COPD, the Naughton protocol may be modified such that only the speed but not the grade increases every 2 minutes instead of 3 minutes.


Pulmonary Diseases: Exercise Testing (cont.)Pulmonary Diseases: Exercise Testing (cont.)• Persons with pulmonary disease may have ventilatory

limitations to exercise; thus, prediction of peak VO2 based on age-predicted HRmax may not be appropriate.

• In recent years, the 6-minute walk test has become popular for assessing functional exercise capacity in persons with more severe pulmonary disease and in settings that lack exercise testing equipment.

• In addition to standard termination criteria, exercise testing may be terminated because of severe arterial oxygen desaturation (i.e., SaO2 ≤80%).

.


Pulmonary Diseases: Exercise Testing (cont.)Pulmonary Diseases: Exercise Testing (cont.)

• The exercise testing mode is typically walking or stationary cycling.

• Walking protocols may be more suitable for persons with severe disease who may lack the muscle strength to overcome the increasing resistance of cycle ergometers.

• If arm ergometry is used, upper extremity aerobic exercise may result in increased dyspnea that may limit the intensity and duration of the activity.


Pulmonary Diseases: Exercise PrescriptionPulmonary Diseases: Exercise PrescriptionFor individuals with well-controlled asthma or mild COPD, the following exercise prescription for cardiovascular fitness is recommended.

• Frequency: at least 3 to 5 d·wk-1

• Intensity: presently there is no consensus as to the “optimal” exercise intensity for patients with pulmonary disease.


Pulmonary Diseases: Exercise PrescriptionPulmonary Diseases: Exercise Prescription

• Time: 20 to 60 min·d-1 of continuous or intermittent physical activity

• Type: walking is strongly recommended because it is involved in most activities of daily living. Stationary cycling may be used as an alternate type of training. Additionally, resistance training and flexibility exercises should be incorporated into the exercise prescription.


Pulmonary Diseases: Exercise PrescriptionPulmonary Diseases: Exercise PrescriptionFor individuals with moderate to severe COPD, the following exercise prescription for cardiovascular fitness is recommended.

• Frequency: at least 3 to 5 d·wk-1


Pulmonary Diseases: Exercise PrescriptionPulmonary Diseases: Exercise Prescription• Intensity: for those patients with severe COPD whose

exercise tolerance may be ventilatory limited, exercise intensities as high as 60% to 80% of peak work rates are suggested. Intensity may also be based on dyspnea ratings determined from the graded exercise test with ratings between 3 (moderate shortness of breath) and 5 (strong or hard breathing) on a scale of 0 to 10 corresponding to the desired exercise intensity that can be tolerated.


Pulmonary Diseases: Exercise Prescription Pulmonary Diseases: Exercise Prescription • Time: persons with moderate or severe COPD may be able to

exercise only at a specified intensity for a few minutes at the start of the training program. Intermittent exercise may also be utilized for the initial training sessions until the patient tolerates exercise at sustained higher intensities and durations of activity.

• Type: walking and/or cycling. Additionally, resistance training and flexibility exercises should be incorporated into the exercise prescription.

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