One of the most talked about and pervasive, yet minimally understood, health conditions today is that which professionals refer to as Metabolic Syndrome, also referred to as Syndrome X.

Identified as recently as a mere two decades ago, this mysterious combination of risk factors seems to be as ubiquitous as the common cold. According to the American Heart Association, 50-75 million Americans currently live with Metabolic Syndrome and the numbers continue to increase along with the age of our current population.

Metabolic Syndrome is defined by having at least 3 of the following 5 risk factors:

  • Large Waiste Size: Men: 40 inches or larger; Women: 35 inches or larger
  • High Triglycerides: 150 mg/dL or higher
  • Low Good Cholesterol (HDL): Men: Less than 40 mg/dL; Women: Less than 50 mg/dL
  • High Blood Pressure: 135/85 mm Hg or greater
  • High Fasting Blood Gucose Level: 100 mg/dL or higher

While the medical community is not exactly clear on why Metabolic Syndrome develops, there is a great deal of data to suggest that abdominal obesity and an unhealthy lifestyle are major contributors to this potentially dangerous condition. Individuals who have been diagnosed with Metabolic Syndrome seem to be at a higher risk for stroke, diabetes, atherosclerosis and, consequently, cardiovascular disease, all of which can be combatted by intensive lifestyle modifications, including dietary changes and a significant increase in physical activity.

Being that atherosclerosis is one of the more serious and life-threatening risks associated with Metabolic Syndrome, it is interesting to review some research that came out in the late 1970s. At that time, several studies suggested that mortality or morbidity caused by atherosclerotic disease was inversely related to the individual’s physical activity status. Although exercise is considered a cornerstone in the treatment of diabetes, a condition strongly related to Metabolic Syndrome, only a handful of scientists have investigated its relationship with cardiovascular disease risk in those individuals already diagnosed with diabetes.

Tracking a sample of 492 diabetic men and women for two years, as part of the National Health and Nutrition Examination Survey, researchers concluded that an inactive lifestyle was significantly associated with higher rates of coronary death. While not surprising in and of itself, this observation was further corroborated by the ATTICA study, an epidemiologic study that evaluated the association between physical activity and the prevalence of the Metabolic Syndrome. This series of experiments resulted in the clear demonstration of how even light-to-moderate physical activity (<7 kcal/min expended during leisure activities) was associated with a considerable reduction in the prevalence of Metabolic Syndrome in 3042 men and women from the general population. Regular, more intensive exercise was associated with an even greater decrease.

Exercise alone cannot account for the sole manner in which an individual can take a proactive role in his or her treatment of Metabolic Syndrome.  The nutritional component must also be addressed, since dyslipidemia (high cholesterol), hypertension, impaired glucose tolerance, compensatory hyperinsulinemia (excess levels of circulating insulin in the body) and excess belly fat are due in large part to one’s diet. Another facet of the aforementioned ATTICA study sought to address how the adoption of a Mediterranean meal plan might impact the typical hallmarks of Metabolic Syndrome.

A Mediterranean diet is one which is largely comprised of olive oil, whole grains, an abundance of vegetables and fruit, nuts and legumes, fish and seafood, and very little red meat and dairy products. ATTICA Study investigators demonstrated that the adoption of the Mediterranean diet by physically active people was associated with greater reduction in the odds of developing Metabolic Syndrome than either diet or exercise alone.

Another study, published in the European Journal of Preventative Cardiology, followed 45 sedentary men and women between the ages of 50 to 66 years who had been diagnosed with Metabolic Syndrome. The subjects were randomly assigned to one of two groups for 12 weeks: those following a lower-calorie, normal protein Mediterranean diet, or those following the same diet with the inclusion of a moderate to high intensity exercise program. A number of tests were conducted to measure quality of life and Metabolic Syndrome risk factors.

The resulting data indicated that those participants in the diet-only group showed improvements in several factors, such as physical function, vitality, general physical health, weight loss, and also improvements in some Metabolic Syndrome characteristics. The group that also followed an exercise program in addition to the diet demonstrated an even greater improvement in health-related quality of life components and, as expected, lost more weight. Since the loss of as little as 5-10% of one’s total body weight can be sufficient to reduce insulin levels and decrease the risk of diabetes, incorporating a Mediterranean-type meal plan along with 30-60 minutes of daily moderate-intensity exercise makes prudent sense in the overall plan to mitigate the deleterious effects of Metabolic Syndrome.

Other risk factors associated with the onset of Metabolic Syndrome may be out of our locus of control, such as genetics, or circulating levels of certain hormones. However, armed with the knowledge of what we are able to control, it seems that once again, careful attention to one’s consumption coupled with a dedicated effort to including exercise as part of leisure-time activities is the winning combination toward the ultimate goal of better health!


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About the Author

Cathleen Kronemer is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for 23 years. Look for her on

She welcomes your feedback and your comments!



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