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What is the Relationship Between Exercise and Metabolic Abnormalities?

A Review of the Metabolic Syndrome

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Abstract

Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. It is now widely recognised that obesity (especially abdominal fat accumulation), hyperglycaemia, dyslipidaemia and hypertension are common metabolic traits that, concurrently, constitute the distinctive insulin resistance or metabolic syndrome. Cross-sectional and prospective data provide an emerging picture of associations of both physical activity habits and cardiorespiratory fitness with the metabolic syndrome. The metabolic syndrome, is a disorder that requires aggressive multi-factorial intervention. Recent treatment guidelines have emphasised the clinical utility of diagnosis and an important treatment role for ‘therapeutic lifestyle change’, incorporating moderate physical activity. Several previous narrative reviews have considered exercise training as an effective treatment for insulin resistance and other components of the syndrome. However, the evidence cited has been less consistent for exercise training effects on several metabolic syndrome variables, unless combined with appropriate dietary modifications to achieve weight loss.

Recently published randomised controlled trial data concerning the effects of exercise training on separate metabolic syndrome traits are evaluated within this review. Novel systematic review and meta-analysis evidence is presented indicating that supervised, long-term, moderate to moderately vigorous intensity exercise training, in the absence of therapeutic weight loss, improves the dyslipidaemic profile by raising high density lipoprotein-cholesterol and lowering triglycerides in overweight and obese adults with characteristics of the metabolic syndrome. Lifestyle interventions, including exercise and dietary-induced weight loss may improve insulin resistance and glucose tolerance in obesity states and are highly effective in preventing or delaying the onset of type 2 diabetes in individuals with impaired glucose regulation. Randomised controlled trial evidence also indicates that exercise training decreases blood pressure in overweight/obese individuals with high normal blood pressure and hypertension. These evidence-based findings continue to support recommendations that supervised or partially supervised exercise training is an important initial adjunctive step in the treatment of individuals with the metabolic syndrome. Exercise training should be considered an essential part of ‘therapeutic lifestyle change’ and may concurrently improve insulin resistance and the entire cluster of metabolic risk factors.

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References

  1. Grundy SM, Bazzarre T, Cleeman J, et al. Prevention Conference V: beyond secondary prevention. Identifying the high-risk patient for primary prevention: medical office assessment: Writing Group 1. American Heart Association Medical/Scientific Statement. Circulation 2000; 101: 111–6

    Article  PubMed  Google Scholar 

  2. Grundy SM, Brewer Jr HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation 2004; 109: 433–8

    Article  PubMed  Google Scholar 

  3. Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003; 9: 237–52

    PubMed  Google Scholar 

  4. Wilson PWF, Kannel WB, Silbershatz H, et al. Clustering of metabolic factors and coronary heart disease. Arch Intern Med 1999; 159: 1104–9

    Article  PubMed  CAS  Google Scholar 

  5. Garvey WT, Hermayer KL. Clinical implications of the insulin resistance syndrome. Clin Cornerstone 1998; 1: 13–8

    Article  PubMed  CAS  Google Scholar 

  6. Lamarche B, Lewis GF. Atherosclerosis prevention for the next decade: risk assessment beyond low density lipoprotein cholesterol. Can J Cardiol 1998; 14: 841–51

    PubMed  CAS  Google Scholar 

  7. Yki-Jarvinen H. Pathogenesis of non-insulin dependent diabetes mellitus. Lancet 1994; 343: 91–5

    Article  PubMed  CAS  Google Scholar 

  8. De Fronzo RA. The triumvirate: β-cell, muscle and liver: a collusion responsible for NIDDM. Diabetes 1988; 37: 667–87

    Google Scholar 

  9. Smiley T, Oh P, Shane LG. The relationship of insulin resistance measured with reliable indexes to coronary artery disease risk factors and outcomes: a systematic review. Can J Cardiol 2001; 17: 797–805

    PubMed  CAS  Google Scholar 

  10. Ruige JB, Assenfelt WJJ, Dekker JM, et al. Insulin and risk of cardiovascular disease: a meta-analysis. Circulation 1998; 97: 996–1001

    Article  PubMed  CAS  Google Scholar 

  11. Ferrannini E, Haffner SM, Mitchell BD, et al. Hyperinsulinemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 1991; 34: 416–22

    Article  PubMed  CAS  Google Scholar 

  12. Stern MP. Diabetes and cardiovascular disease: the common soil hypothesis. Diabetes 1995; 44: 369–74

    Article  PubMed  CAS  Google Scholar 

  13. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607

    Article  PubMed  CAS  Google Scholar 

  14. De Fronzo RA. Insulin resistance, hyperinsulinemia, and coronary artery disease: a complex metabolic web. J Cardiovasc Pharm 1992; 20Suppl. 11: S1–16

    Article  Google Scholar 

  15. Meigs JB. Epidemiology of the metabolic syndrome. Am J Manag Care 2002; 8Suppl. 11: S283–92

    PubMed  Google Scholar 

  16. Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 2002; 106: 286–8

    Article  PubMed  Google Scholar 

  17. Hansen BC. The metabolic syndrome X. Ann N Y Acad Sci 1999; 18: 1–24

    Article  Google Scholar 

  18. World Health Organisation Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications: report of the World Health Organisation Consultation. Geneva: World Health Organisation, 1999

    Google Scholar 

  19. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary on the third report on the The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–97

    Google Scholar 

  20. The European Group for the Study of Insulin Resistance (EGIR). Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab 2002; 28: 364–76

    Google Scholar 

  21. Westheim A, Os I. Physical activity and the metabolic cardiovascular syndrome. J Cardiovasc Pharmacol 1992; 20Suppl. 8: S49–53

    PubMed  Google Scholar 

  22. Buemann B, Tremblay A. Effects of exercise training on abdominal obesity and related metabolic complications. Sports Med 1996; 21: 191–212

    Article  PubMed  CAS  Google Scholar 

  23. Shahid SK, Schneider SH. Effects of exercise on insulin resistance syndrome. Coron Artery Dis 2000; 11: 103–9

    Article  PubMed  CAS  Google Scholar 

  24. Eriksson J, Taimela S, Koivisto VA. Exercise and the metabolic syndrome. Diabetologia 1997; 40: 125–35

    Article  PubMed  CAS  Google Scholar 

  25. Dela F. Physical training in the treatment of metabolic syndrome. Ugeskr Laeger 2002; 164: 2147–52

    PubMed  Google Scholar 

  26. Stefanick ML. Physical activity for preventing and treating obesity-related dyslipoproteinemias. Med Sci Sports Exerc 1999; 31: S609–18

    Article  PubMed  CAS  Google Scholar 

  27. Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin dependent diabetes mellitus. Sports Med 1997; 24: 321–36

    Article  PubMed  CAS  Google Scholar 

  28. Kelley DE, Goodpaster BH. Effects of physical activity on insulin action and glucose tolerance in obesity. Med Sci Sports Exerc 1999; 31: S619–23

    Article  PubMed  CAS  Google Scholar 

  29. National Heart, Lung and Blood Institute. Obesity Education Initiative Expert Panel: clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the evidence report. Bethesda (MD): National Institutes of Health, 1998 Sep. NIH publication no.98-4083: 1–228

    Google Scholar 

  30. Grundy SM, Blackburn G, Higgins M, et al. Consensus statement physical activity in the prevention and treatment of obesity and its comorbidities. Med Sci Sports Exerc 1999; 31: S502–8

    Article  PubMed  CAS  Google Scholar 

  31. Bouchard C. Physical activity and health: introduction to the dose-response symposium. Med Sci Sports Exerc 2001; 33: S347–50

    Article  PubMed  CAS  Google Scholar 

  32. Groop L. Genetics of the metabolic syndrome. Br J Nutr 2000; 83Suppl. 1: S39–48

    PubMed  CAS  Google Scholar 

  33. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000; 106: 453–8

    Article  PubMed  CAS  Google Scholar 

  34. Timar O, Sestier F, Levy E. Metabolic syndrome X: a review. Can J Cardiol 2000; 16: 779–89

    PubMed  CAS  Google Scholar 

  35. Hayden MR, Tyagi SC. Intimai redox stress: accelerated atherosclerosis in metabolic syndrome and type 2 diabetes. Atheroscleropathy. Cardiovascular Diabetology 2002 [online]. Available from URL: http://www.Cardiab.com/content/1/1/3 [Accessed 2003 Jan]

    Google Scholar 

  36. Reaven GM. Syndrome X: past, present, and future. In: Draznin B, Rizza R, editors. Clinical research in diabetes and obesity. Vol 2. Totowa (NJ): Humana Press Inc., 1997: 357–82

    Chapter  Google Scholar 

  37. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med 1993; 44: 121–31

    Article  PubMed  CAS  Google Scholar 

  38. De Fronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for non-insulin dependent diabetes, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173–94

    Article  Google Scholar 

  39. Ferrannini E. The insulin resistance syndrome. Curr Opin Nephrol Hypertens 1992; 1: 291–8

    Article  PubMed  CAS  Google Scholar 

  40. Kissebah AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54: 254–60

    Article  PubMed  CAS  Google Scholar 

  41. Krotkiewski M, Bjorntorp P, Sjostrom L, et al. Impact of obesity on metabolism in men and women: importance of regional adipose tissue distribution. J Clin Invest 1983; 72: 1150–62

    Article  PubMed  CAS  Google Scholar 

  42. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout and uric calculous disease. Am J Clin Nutr 1956; 4: 20–34

    PubMed  CAS  Google Scholar 

  43. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989; 149: 1514–20

    Article  PubMed  CAS  Google Scholar 

  44. Liese AD, Mayer-Davis EJ, Haffner SM. Development of the multiple metabolic syndrome: an epidemiological perspective. Epidemiol Rev 1998; 20: 157–72

    Article  PubMed  CAS  Google Scholar 

  45. Fagan TC, Deedwania PC. The cardiovascular dysmetabolic syndrome. Am J Med 1998; 105: 77S–82S

    Article  PubMed  CAS  Google Scholar 

  46. Sowers JR. Update on the cardiometabolic syndrome. Clin Cornerstone 2002; 4: 17–22

    Article  Google Scholar 

  47. Groop L, Orho-Melander M. The dysmetabolic syndrome. J Intern Med 2001; 250: 105–20

    Article  PubMed  CAS  Google Scholar 

  48. Haffner SM, Ferrannini E, Hazuda HP, et al. Clustering of cardiovascular risk factors in confirmed prehypertensive individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? Hypertension 1992; 20: 38–45

    Article  PubMed  CAS  Google Scholar 

  49. Haffner SM, Valdez RA, Hazuda HP, et al. Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes 1992; 41: 715–22

    Article  PubMed  CAS  Google Scholar 

  50. Everson SA, Goldberg DE, Helmrich SP, et al. Weight gain and the risk of developing insulin resistance syndrome. Diabetes Care 1998; 21: 1637–43

    Article  PubMed  CAS  Google Scholar 

  51. Mykkanen L, Kuusisto J, Haffner SM, et al. Hyperinsulinemia predicts multiple atherogenic changes in lipoproteins in elderly subjects. Arterioscler Thromb 1994; 14: 518–26

    Article  PubMed  CAS  Google Scholar 

  52. Liese AD, Mayer-Davis EJ, Tyroler HA, et al. Development of the multiple metabolic syndrome in the ARIC cohort: joint contribution of insulin, BMI, and WHR. Ann Epidemiol 1997; 7: 407–16

    Article  PubMed  CAS  Google Scholar 

  53. Salonen JT, Lakka TM, Lakka HM, et al. Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men. Diabetes 1998; 47: 270–5

    Article  PubMed  CAS  Google Scholar 

  54. Meigs JB, D’Agostino RB, Wilson PWF, et al. Risk variable clustering in the insulin-resistance syndrome. The Framingham Offspring Study. Diabetes 1997; 46: 1594–600

    Article  PubMed  CAS  Google Scholar 

  55. Hanson RL, Imperatore G, Bennett PH, et al. Components of the ‘metabolic syndrome’ and incidence of type 2 diabetes. Diabetes 2002; 51: 3120–7

    Article  PubMed  CAS  Google Scholar 

  56. Arya R, Blangero J, Williams K, et al. Factors of insulin resistance syndrome-related phenotypes are linked to genetic locations on chromosomes 6 and 7 in nondiabetic Mexican-Americans. Diabetes 2002; 51: 841–7

    Article  PubMed  CAS  Google Scholar 

  57. Gray RS, Fabsitz RR, Cowan LD, et al. Risk factor clustering in the insulin resistance syndrome: the Strong Heart Study. Am J Epidemiol 1998; 148: 869–78

    Article  PubMed  CAS  Google Scholar 

  58. Donahue RP, Bean JA, Donahue RD, et al. Does insulin resistance unite the separate components of the insulin resistance syndrome?: evidence from the Miami Community Health Study. Arterioscler Thromb Vasc Biol 1997; 17: 2413–7

    Article  PubMed  CAS  Google Scholar 

  59. Anderson PJ, Critchley JAJH, Chan JCN, et al. Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality. Int J Obes Relat Metab Disord 2001; 25: 1782–8

    Article  PubMed  CAS  Google Scholar 

  60. Hanley AJG, Karter AJ, Festa A, et al. Factor analysis of the metabolic syndrome using directly measured insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Diabetes 2002; 51: 2642–7

    Article  PubMed  CAS  Google Scholar 

  61. Meigs JB. Invited commentary: insulin resistance syndrome?. Syndrome X? Multiple metabolic syndrome? A syndrome at all?: factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 2000; 152: 908–11

    Article  PubMed  CAS  Google Scholar 

  62. Zimmet P, Boyko EJ, Collier GR, et al. Etiology of the metabolic syndrome: potential role of insulin resistance, leptin resistance, and other players. Ann N Y Acad Sci 1999; 13: 25–44

    Article  Google Scholar 

  63. Liese AD, Mayer-Davis EJ, Tyroler HA, et al. Familial components of the multiple metabolic syndrome: the ARIC study. Diabetologia 1997; 40: 963–70

    Article  PubMed  CAS  Google Scholar 

  64. Hong Y, Rice T, Gagnon J, et al. Familial clustering of insulin and abdominal visceral fat: the Heritage Family Study. J Clin Endocrinol Metab 1998; 83: 4239–45

    Article  PubMed  CAS  Google Scholar 

  65. Samaras K, Nguyen TV, Jenkins AB, et al. Clustering of insulin resistance, total and central fat: same genes or same environment. Twin Res 1999; 2: 218–25

    PubMed  CAS  Google Scholar 

  66. Mitchell BD, Kammerer CM, Mahaney MC, et al. Genetic analysis of the IRS: pleiotropic effects of genes influencing insulin levels on lipoprotein and obesity measures. Arterioscler Thromb Vasc Biol 1996; 16: 281–8

    Article  PubMed  CAS  Google Scholar 

  67. Nelson TL, Vogler GP, Pedersen NL, et al. Genetic and environmental influences on body fat distribution, fasting insulin levels and CVD: are the influences shared. Twin Res 2000; 3: 43–50

    PubMed  CAS  Google Scholar 

  68. Hong Y, Pedersen NL, Brismar K, et al. Genetic and environmental architecture of the features of the insulin-resistance syndrome. Am J Hum Genet 1997; 60: 143–52

    PubMed  CAS  Google Scholar 

  69. Brunner EJ, Marmot MG, Nanchahal K, et al. Social inequality in coronary disease risk: central obesity and the metabolic syndrome: evidence from the Whitehall II Study. Diabetologia 1997; 40: 1341–9

    Article  PubMed  CAS  Google Scholar 

  70. Imperatore G, Riccardi G, Iovine C, et al. Plasma fibrinogen: a new factor of the metabolic syndrome: a population-based study. Diabetes Care 1998; 21: 649–54

    Article  PubMed  CAS  Google Scholar 

  71. Trevisan M, Liu J, Bahsas FB, et al. Syndrome X and mortality: a population-based study: For the Risk Factor and Life Expectancy Research Group. Am J Epidemiol 1998; 148: 958–66

    Article  PubMed  CAS  Google Scholar 

  72. Valdez R. Epidemiology. Nutr Rev 2000; 58 (3 Pt 2): S4–6

    PubMed  CAS  Google Scholar 

  73. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–9

    Article  PubMed  CAS  Google Scholar 

  74. Hulthe J, Bokemark L, Wikstrand J, et al. The metabolic syndrome, LDL particle size, and atherosclerosis. Arterioscler Thromb Vasc Biol 2000; 20: 2140–7

    Article  PubMed  CAS  Google Scholar 

  75. Okosun IE, Liao Y, Rotimi CN, et al. Abdominal adiposity and clustering of multiple metabolic syndrome components in White, Black and Hispanic Americans. Ann Epidemiol 2000; 10: 263–70

    Article  PubMed  CAS  Google Scholar 

  76. Rantala AO, Kauma H, Lilja M, et al. Prevalence of the metabolic syndrome in drug treated hypertensive patients and control subjects. J Intern Med 1999; 245: 163–74

    Article  PubMed  CAS  Google Scholar 

  77. Whaley MH, Kampert JB, Kohl HW, et al. Physical fitness and clustering of risk factors associated with the metabolic syndrome. Med Sci Sports Exerc 1999; 31: 287–93

    Article  PubMed  CAS  Google Scholar 

  78. Wannamethee SG, Shaper AG, Durrington PN, et al. Hypertension, serum insulin, obesity, and the metabolic syndrome. J Hum Hypertens 1998; 12: 735–41

    Article  PubMed  CAS  Google Scholar 

  79. Yarnell JWG, Patterson CC, Bainton D, et al. Is metabolic syndrome a discrete entity in the general population?: evidence from the Caerphilly and Speedwell population studies. Heart 1998; 79: 248–52

    PubMed  CAS  Google Scholar 

  80. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA 2002; 287: 356–9

    Article  PubMed  Google Scholar 

  81. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709–16

    Article  PubMed  Google Scholar 

  82. Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care 2003; 26: 575–81

    Article  PubMed  Google Scholar 

  83. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-Reactive Protein as a predictor of coronary heart disease and diabetes in the West of Scotland Prevention Study. Circulation 2003; 108: 414–9

    Article  PubMed  CAS  Google Scholar 

  84. Meigs JB, Wilson PWF, Nathan DM, et al. Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 2003; 52: 2160–7

    Article  PubMed  CAS  Google Scholar 

  85. Bonora E, Kiechl S, Willeit J, et al. Metabolic syndrome: epidemiology and more extensive phenotypic description: cross-sectional data from the Bruneck Study. Int J Obes 2003; 27: 1283–9

    Article  CAS  Google Scholar 

  86. Yarborough DE, Barrett-Connor E, Kritz-Silverstein D, et al. Birth weight, adult weight and girth as predictors of the metabolic syndrome in postmenopausal women. Diabetes Care 1998; 21: 1652–8

    Article  Google Scholar 

  87. Ridker PM, Buring JE, Cook NR, et al. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 2003; 107: 391–7

    Article  PubMed  Google Scholar 

  88. Reilly MP, Rader DJ. The metabolic syndrome: more than the sum of its parts? Circulation 2003; 108: 1546–51

    Article  PubMed  Google Scholar 

  89. Hanley AJ, Wagenknecht LE, D’Agostino Jr RB, et al. Identification of subjects with insulin resistance and beta-cell dysfunction using alternative definitions of the metabolic syndrome. Diabetes 2003; 52: 2740–7

    Article  PubMed  CAS  Google Scholar 

  90. World Health Organisation (1998) Obesity. Preventing and managing the global epidemic. Report of the WHO consultation on obesity [WHO/NUT/NCD/981]. Geneva: WHO, 1997 Jun 3–5

    Google Scholar 

  91. Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156: 1070–7

    Article  PubMed  Google Scholar 

  92. Kekalainen P, Sarlund H, Pyorala K, et al. Hyperinsulinemia cluster predicts development of type 2 diabetes independently of family history of diabetes. Diabetes Care 1999; 22: 86–92

    Article  PubMed  CAS  Google Scholar 

  93. Pyorala M, Miettinen H, Halonen P, et al. Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22 year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000; 20: 538–44

    Article  PubMed  CAS  Google Scholar 

  94. Howard BV, Criqui MH, Curb JD, et al. Risk factor clustering in the insulin resistance syndrome and its relationship to cardiovascular disease in postmenopausal White, Black, Hispanic, and Asian/Pacific Islander women. Metabolism 2003; 52: 362–71

    Article  PubMed  CAS  Google Scholar 

  95. Lempiainen P, Mykkanen L, Pyorala K, et al. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 1999; 100: 123–8

    Article  PubMed  CAS  Google Scholar 

  96. Lehto S, Ronnemaa T, Pyorala K, et al. Cardiovascular risk factor clustering with endogenous hyperinsulinemia predict death from coronary heart disease in patients with type II diabetes. Diabetologia 2000; 43: 148–55

    Article  PubMed  CAS  Google Scholar 

  97. Kuusisto J, Lempiainen P, Mykkanen L, et al. Insulin resistance syndrome predicts coronary heart disease events in elderly type 2 diabetic men. Diabetes Care 2001; 24: 1629–33

    Article  PubMed  CAS  Google Scholar 

  98. Girman CJ, Rhodes T, Mercuri M, et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/Tex-CAPS). Am J Cardiol 2004 93(2): 136–41

    Article  PubMed  CAS  Google Scholar 

  99. Bjorntorp P, Rosmond R. The metabolic syndrome: a neuroendocrine disorder? Br J Nutr 2000; 83Suppl. 1: S49–57

    PubMed  CAS  Google Scholar 

  100. Hedman A, Byberg L, Reneland R, et al. Muscle morphology, self-reported physical activity and insulin resistance syndrome. Acta Physiol Scand 2002; 175: 325–32

    Article  PubMed  CAS  Google Scholar 

  101. Goodpaster BH, Kelley DE. Role of muscle in triglyceride metabolism. Curr Opin Lipidol 1998; 9: 231–6

    Article  PubMed  CAS  Google Scholar 

  102. Simoneau J-A, Veerkamp JH, Turcotte LP, et al. Markers of capacity to utilise fatty acids in human skeletal muscle: relation to insulin resistance and obesity and effects of weight loss. FASEB J 1999; 13: 2051–60

    PubMed  CAS  Google Scholar 

  103. Radzuik J, Pye S. The role of the liver in insulin action and resistance. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999: 197–231

    Google Scholar 

  104. Ansell BJ. The metabolic syndrome: an interplay of multiple subtle cardiovascular risk factors: case study and commentary. JCOM 2002 [online]. Available from URL: http://www.turnerwhite.com [Accessed 2003 Oct 1]

  105. Despres J-P. Abdominal obesity as important component of insulin resistance syndrome. Nutrition 1993; 9: 452–9

    PubMed  CAS  Google Scholar 

  106. Juhan-Vague I, Alessi MC, Vague P. Increased plasminogen activator inhibitor 1 levels: a possible link between insulin resistance and atherothrombosis. Diabetologia 1991; 34: 457–62

    Article  PubMed  CAS  Google Scholar 

  107. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 713–8

    Article  PubMed  CAS  Google Scholar 

  108. Corry DB, Tuck ML. Selective aspects of the insulin resistance syndrome. Curr Opin Nephrol Hypertens 2001; 10: 507–14

    Article  PubMed  CAS  Google Scholar 

  109. Bjorntorp P. Visceral obesity: a ‘civilisation syndrome’. Obes Res 1993; 1: 216–22

    Google Scholar 

  110. Bonara E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders. Diabetes 1998; 47: 1643–9

    Article  Google Scholar 

  111. Despres J-P, Lemieux I, Prud’homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2001; 322: 716–20

    Article  PubMed  CAS  Google Scholar 

  112. Abate N. Obesity and cardiovascular disease: pathogenetic role of the metabolic syndrome and therapeutic implications. J Diabet Complications 2000; 14: 154–74

    Article  CAS  Google Scholar 

  113. Verdecchia P, Reboldi G, Schillaci G, et al. Circulating insulin and insulin growth factor-1 are independent determinants of left ventricular mass and geometry in essential hypertension. Circulation 1999; 100: 1802–7

    Article  PubMed  CAS  Google Scholar 

  114. Ferrannini E. Insulin resistance and blood pressure. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999

    Google Scholar 

  115. Landsberg L. Insulin-mediated sympathetic stimulation: role in the pathogenesis of obesity-related hypertension (or how insulin affects blood pressure, and why).) J Hypertens 2001; 19: 523–8

    Article  PubMed  CAS  Google Scholar 

  116. Sundstrom J, Lind L, Nystrom N, et al. Left ventricular concentric remodelling rather than left ventricular hypertrophy is related to the insulin resistance syndrome in elderly men. Circulation 2000; 101: 2595–600

    Article  PubMed  CAS  Google Scholar 

  117. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities-the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334: 374–81

    Article  PubMed  CAS  Google Scholar 

  118. Juhan-Vague I, Alessi MC. PAI-1, obesity, insulin resistance and risk of cardiovascular events. Thromb Haemost 1997; 78: 656–60

    PubMed  CAS  Google Scholar 

  119. Kohler HP, Grant PJ. Plasminogen-activator inhibitor type 1 and coronary artery disease. N Engl J Med 2000; 342: 1792–801

    Article  PubMed  CAS  Google Scholar 

  120. Meigs JB, Mittleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglycaemia, and impaired hemostasis. JAMA 2000; 283: 221–8

    Article  PubMed  CAS  Google Scholar 

  121. Miller GJ. Hyperlipidemia and hypercoagulability. Prog Lipid Res 1993; 32: 61–9

    Article  PubMed  CAS  Google Scholar 

  122. Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuroendocrine and target tissue related causes. Int J Obes Relat Metab Disord 1999; 24Suppl. 2: S50–5

    Google Scholar 

  123. Das UN. Is metabolic syndrome x an inflammatory condition. Exp Biol Med (Maywood) 2002; 227: 989–7

    CAS  Google Scholar 

  124. Festa A, D’Agostino R, Howard G, et al. Inflammation and microalbuminuria in nondiabetic subjects: the Insulin Resistance Atherosclerosis Study. Kidney Int 2000; 58: 1703–10

    Article  PubMed  CAS  Google Scholar 

  125. Frolich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000; 23: 1835–9

    Article  Google Scholar 

  126. Hak AE, Stehouwer CD, Bots ML, et al. Associations of C-reactive protein with measures of obesity, insulin resistance and atherosclerosis in healthy middle-aged women. Arterioscler Thromb Vasc Biol 2000; 19: 1986–91

    Article  Google Scholar 

  127. Hotamisligil GS, Spiegelman BM. Tumor necrosis factor alpha: a key component of the obesity-diabetes link. Diabetes 1994; 43: 1271–8

    Article  PubMed  CAS  Google Scholar 

  128. McLaughlin T, Abbasi F, Lamendola C, et al. Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation 2002; 106: 2908–12

    Article  PubMed  CAS  Google Scholar 

  129. Pinkney JH, Stehouwer CDA, Coppack SW, et al. Endothelial dysfunction: cause of the insulin resistance syndrome. Diabetes 1997; 46Suppl. 2: S9–S13

    PubMed  CAS  Google Scholar 

  130. Tooke JE, Hanneman MM. Adverse endothelial function in the insulin resistance syndrome. J Intern Med 2000; 247: 425–31

    Article  PubMed  CAS  Google Scholar 

  131. Baron AD, Quon MJ. Insulin action and endothelial function. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999: 247–63

    Google Scholar 

  132. Bjorntorp P. Androgens, the metabolic syndrome and non-insulin dependent diabetes. Ann N Y Acad Sci 1993; 676: 242–52

    Article  PubMed  CAS  Google Scholar 

  133. Rantala AO, Kauma H, Lilja M, et al. Gamma-glutamyl transpeptidase and the metabolic syndrome. J Intern Med 2000; 248: 230–8

    Article  PubMed  CAS  Google Scholar 

  134. Reaven GM. The kidney: an unwilling accomplice in syndrome X. Am J Kidney Dis 1997; 30: 928–31

    Article  PubMed  CAS  Google Scholar 

  135. Simoneau J-A, Colberg SR, Thaete FL, et al. Skeletal muscle glycolytic and oxidative enzyme capacities and determinants of insulin sensitivity and muscle composition in obese women. FASEB J 1995; 9: 273–8

    PubMed  CAS  Google Scholar 

  136. Kelley DE, Mandriano LJ. Fuel selection in human skeletal muscle in insulin resistance. Diabetes 2000; 49: 677–83

    Article  PubMed  CAS  Google Scholar 

  137. Pan DA, Lillioja S, Kritetos AD, et al. Skeletal muscle triglyceride levels are inversely related to insulin action in man. Diabetes 1997; 46: 983–8

    Article  PubMed  CAS  Google Scholar 

  138. Lillioja S, Young AA, Cutler CL, et al. Skeletal muscle capillary density and fibre type are possible determinants of in vivo insulin resistance in man. J Clin Invest 1987; 80: 415–24

    Article  PubMed  CAS  Google Scholar 

  139. Vessby B, Tengblad S, Lithell H. The insulin sensitivity is related to the fatty acid composition of the serum lipids and skeletal muscle phospholipids in 70 year old men. Diabetologia 1994; 37: 1044–50

    Article  PubMed  CAS  Google Scholar 

  140. Frayn KN. Insulin resistance, impaired postprandial lipid metabolism and abdominal obesity: a deadly triad. Med Princ Pract 2002; 11Suppl. 2: 31–40

    Article  PubMed  Google Scholar 

  141. Bonora E. Relationship between regional fat distribution and insulin resistance. Int J Obes Relat Metab Disord 2000; 24Suppl. 2: S32–5

    Article  PubMed  CAS  Google Scholar 

  142. Lewis GF, Carpentier A, Khosrow A, et al. Disordered fat storage and mobilisation in the pathogenesis of insulin resistance and type 2 diabetes. Endocrine Rev 2002; 23: 201–29

    Article  CAS  Google Scholar 

  143. de Courten M, Zimmet P, Hodge A, et al. Hyperleptinaemia: the missing link in the metabolic syndrome? Diabetes Med 1997; 14: 200–8

    Article  Google Scholar 

  144. Poppitt SD, Keogh GF, Prentice AM, 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: 11–20

    PubMed  CAS  Google Scholar 

  145. Lehtovirta M, Kaprio J, Forsblom C, et al. Insulin secretion and insulin sensitivity in monozygotic and dizygotic twins. Diabetologia 2000; 43: 285–93

    Article  PubMed  CAS  Google Scholar 

  146. McKeigue PM. Fetal effects on insulin resistance and glucose tolerance. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999

    Google Scholar 

  147. Ruderman N, Chisholm D, Pi-Sunyer X, et al. The metabolically obese, normal weight individual revisited. Diabetes 1998; 47: 699–713

    Article  PubMed  CAS  Google Scholar 

  148. Laaksonen DE, Lakka HM, Lynch J, et al. Cardiorespiratory fitness and vigorous leisure-time physical activity modify the association of small size at birth with the metabolic syndrome. Diabetes Care 2003; 26: 2156–64

    Article  PubMed  Google Scholar 

  149. Martyn CN, Hales CN, Barker DJ, et al. Fetal growth and hyperinsulinemia in adult life. Diabet Med 1998; 15: 688–94

    Article  PubMed  CAS  Google Scholar 

  150. Phillips DI, Barker DJ, Hales CN, et al. Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150–4

    Article  PubMed  CAS  Google Scholar 

  151. Phipps K, Barker DJ, Hales CN, et al. Fetal growth and impaired glucose tolerance in men and women. Diabetologia 1993; 36: 225–8

    Article  PubMed  CAS  Google Scholar 

  152. Davey Smith G, Hart C. Insulin resistance syndrome and childhood social conditions. Lancet 1997; 349: 284–5

    Article  PubMed  CAS  Google Scholar 

  153. Vanhala MJ, Vanhala PT, Keinanen-Kiukaanniemi SM, et al. Relative weight gain and obesity as a child predict metabolic syndrome as an adult. Int J Obes Relat Metab Disord 1999; 23: 656–9

    Article  PubMed  CAS  Google Scholar 

  154. Chen W, Bao W, Begum S, et al. Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of Black and White subjects: the Bolalusa Heart Study. Diabetes 2000; 49: 1042–8

    Article  PubMed  CAS  Google Scholar 

  155. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17: 961–7

    Article  PubMed  CAS  Google Scholar 

  156. Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes in women. Ann Intern Med 1995; 122: 481–6

    PubMed  CAS  Google Scholar 

  157. Mayer-Davis J, Monaco JH, Hoen HM, et al. Dietary fat and insulin sensitivity in a triethnic population: the role of obesitas. The Insulin Resistance Atherosclerosis Study (IRAS). Am J Clin Nutr 1997; 65: 79–87

    PubMed  CAS  Google Scholar 

  158. Tremblay A. Nutritional determinants of the insulin resistance syndrome. Int J Obes Relat Metab Disord 1995; 19Suppl. 1: S60–8

    PubMed  Google Scholar 

  159. Wirfalt E, Hedblad B, Gullberg B, et al. Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer Cohort. Am J Epidemiol 2001; 154: 1150–9

    Article  PubMed  CAS  Google Scholar 

  160. Vessby B. Dietary fat and insulin action in humans. Br J Nutr 2000; 83Suppl. 1: S91–6

    PubMed  CAS  Google Scholar 

  161. Wolever TMS. Dietary carbohydrates and insulin action in humans. Br J Nutr 2000; 83Suppl. 1: S97–102

    PubMed  CAS  Google Scholar 

  162. Zavaroni I, Bonini L, Gasparini P, et al. Cigarette smokers are relatively glucose intolerant, hyperinsulinemic and dyslipidemic. Am J Cardiol 1994; 73: 904–5

    Article  PubMed  CAS  Google Scholar 

  163. Facchini F, Hollenbeck CB, Jeppesen J, et al. Insulin resistance and cigarette smoking. Lancet 1992; 339: 1128–30

    Article  PubMed  CAS  Google Scholar 

  164. Eliasson B, Attvall S, Taskinen MR, et al. The insulin resistance syndrome in smokers is related to smoking habits. Arterioscler Thromb 1994; 14: 1946–50

    Article  PubMed  CAS  Google Scholar 

  165. Rosmond R, Bjorntorp P. Occupational status, cortisol secretory pattern, and visceral obesity in middle-aged men. Obes Res 2000; 8: 445–50

    Article  PubMed  CAS  Google Scholar 

  166. Horsten M, Mittleman MA, Wamala SP, et al. Social relations and the metabolic syndrome in middle-aged Swedish women. J Cardiovasc Risk 1999; 6: 391–7

    PubMed  CAS  Google Scholar 

  167. Raikkonen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metabolism 2002; 51: 1573–7

    Article  PubMed  CAS  Google Scholar 

  168. Raikkonen K, Matthews KA, Kuller LH, et al. Anger, hostility, and visceral adipose tissue in healthy postmenopausal women. Metabolism 1999; 48: 1146–51

    Article  PubMed  CAS  Google Scholar 

  169. Keltikangas-Jarvinen L, Raikkonen K, Hautanen A, et al. Vital exhaustion, anger expression, and pituitary and adrenocortical hormones: implications for the insulin resistance syndrome. Arterioscler Thromb Vasc Biol 1996; 16: 275–80

    Article  PubMed  CAS  Google Scholar 

  170. Keltikangas-Jarvinen L, Ravaja N, Viikari J. Identifying Cloninger’s temperament profiles as related to the early development of the metabolic cardiovascular syndrome in young men. Arterioscler Thromb Vasc Biol 1996; 19: 1998–2006

    Article  Google Scholar 

  171. Lakka TA, Venalainen JM, Rauramaa R, et al. Relation of leisure time physical activity and cardiorespiratory fitness to risk of acute myocardial infarction. N Engl J Med 1994; 330: 1549–54

    Article  PubMed  CAS  Google Scholar 

  172. Folsom AR, Arnett DK, Hutchinson RG, et al. Physical activity and incidence of coronary heart disease in middle-aged women and men. Med Sci Sports Exerc 1997; 29: 901–9

    Article  PubMed  CAS  Google Scholar 

  173. James SA, Jamjoum L, Raghunathan TE, et al. Physical activity and NIDDM in African-Americans: the Pitt County Study. Diabetes Care 1998; 21: 555–62

    Article  PubMed  CAS  Google Scholar 

  174. Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999; 282: 1433–49

    Article  PubMed  CAS  Google Scholar 

  175. Lynch J, Helmrich SP, Lakka TA, et al. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med 1996; 156: 1307–14

    Article  PubMed  CAS  Google Scholar 

  176. Wei M, Gibbons LW, Mitchell TL, et al. The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men. Ann Intern Med 1998; 130: 89–96

    Google Scholar 

  177. Wannamethee SG, Shaper AG, Walker M, et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in British middle-aged men. Arch Intern Med 1998; 158: 2433–40

    Article  PubMed  CAS  Google Scholar 

  178. Kohl HW. Physical activity and cardiovascular disease: evidence for a dose response. Med Sci Sports Exerc 2001; 33: S472–83

    Article  PubMed  Google Scholar 

  179. Kelley DE, Goodpaster BH. The effects of exercise on glucose homeostasis in type 2 diabetes mellitus. Med Sci Sports Exerc 2001; 33: S495–501

    Article  PubMed  CAS  Google Scholar 

  180. Laaksonen DE, Lakka H-M, Salonen JT, et al. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care 2002; 25: 1612–8

    Article  PubMed  Google Scholar 

  181. Zimmet PZ, Collins VR, Dowse GK, et al. The relation of physical activity to cardiovascular disease risk factors in Mauritians. Am J Epidemiol 1991; 134: 862–75

    PubMed  CAS  Google Scholar 

  182. Byberg L, Zethelius B, McKeigue PM, et al. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia 2001; 44: 2134–9

    Article  PubMed  CAS  Google Scholar 

  183. Wannamethee SG, Shaper AG, Alberti KGMM. Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes. Arch Intern Med 2000; 160: 2108–16

    Article  PubMed  CAS  Google Scholar 

  184. Clausen JO, Borch-Johnsen K, Ibsen H, et al. Insulin sensitivity index, acute insulin response, and glucose effectiveness in a population-based sample of 380 young healthy Caucasians: analysis of the impact of gender, body fat, physical fitness, and lifestyle factors. J Clin Invest 1996; 98: 1195–209

    Article  PubMed  CAS  Google Scholar 

  185. Mayer-Davis EJ, D’Agostino Jr R, Karter AJ, et al. For the IRAS Investigators. Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA 1998; 279: 669–74

    Article  PubMed  CAS  Google Scholar 

  186. Siscovick DS, Fried L, Mittlemark M, et al. Exercise intensity and subclinical cardiovascular disease in the elderly: the Cardiovascular Health Study. Am J Epidemiol 1997; 145: 977–86

    Article  PubMed  CAS  Google Scholar 

  187. Mensink GBM, Heerstrass DW, Neppelenbroek SE, et al. Intensity, duration and frequency of physical activity and coronary risk factors. Med Sci Sports Exerc 1997; 29: 1192–8

    Article  PubMed  CAS  Google Scholar 

  188. Thune I, Njolstad I, Lochen M-L, et al. Physical activity improves the metabolic risk profiles in men and women: the Tromso Study. Arch Intern Med 1998; 158: 1633–40

    Article  PubMed  CAS  Google Scholar 

  189. Wareham NJ, Hennings SJ, Byrne CD, et al. A quantitative analysis of the relationship between habitual energy expenditure, fitness and the metabolic cardiovascular syndrome. Br J Nutr 1998; 80: 235–41

    Article  PubMed  CAS  Google Scholar 

  190. Carroll S, Cooke CB, Butterly RJ. Metabolic risk factor clustering, associations of both physical activity and cardiorespiratory fitness in middle-aged men. Med Sci Sports Exerc 2000; 32: 2079–86

    Article  PubMed  CAS  Google Scholar 

  191. Irwin ML, Ainsworth BE, Mayer-Davis EJ, et al. Physical activity and the multiple metabolic syndrome in a tri-ethnic sample of women. Obes Res 2002; 10: 1030–7

    Article  PubMed  Google Scholar 

  192. Kullo IJ, Hensrud DD, Allison TG. Relation of low cardiorespiratory fitness to the metabolic syndrome in middle-aged men. Am J Cardiol 2002; 90: 795–7

    Article  PubMed  Google Scholar 

  193. Lakka TA, Laaksonen DE, Lakka H-M, et al. Sedentary lifestyle, poor cardiorespiratory fitness and the metabolic syndrome. Med Sci Sports Exerc 2003; 35: 1279–86

    Article  PubMed  Google Scholar 

  194. Bevis LC, Blackburn G. The obesity epidemic: prevention and treatment of the metabolic syndrome. Medscape 2002 [online]. Available from URL: http://www.medscape.com [Accessed 2003 Oct 1]

    Google Scholar 

  195. Despres J-P. Visceral obesity, insulin resistance, and dyslipidemia: contribution of endurance exercise training to the treatment of the plurimetabolic syndrome. Exerc Sport Sci Rev 1997; 25: 271–300

    PubMed  CAS  Google Scholar 

  196. Giles T. Reducing the risk of cardiovascular events through weight loss. Medscape 2002 [online]. Available from URL: http://www.medscape.com [Accessed 2003 Jan]

    Google Scholar 

  197. Denke MA, Pasternack RC. Defining and treating the metabolic syndrome: a primer from the Adult Treatment Panel III. Curr Treat Options Cardiovasc Med 2001; 3: 251–3

    Article  PubMed  Google Scholar 

  198. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord 1997; 21: 941–7

    Article  PubMed  CAS  Google Scholar 

  199. Reaven G. Syndrome X. Curr Treat Options Cardiovasc Med 2001; 3: 323–32

    Article  PubMed  Google Scholar 

  200. Pescatello LS, Van Heest JL. Physical activity mediates a healthier body weight in the presence of obesity. Br J Sports Med 2000; 34: 86–93

    Article  PubMed  CAS  Google Scholar 

  201. Smutock MA, Reece PF, Kokkinos PF, et al. Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism 1993; 42: 177–84

    Article  Google Scholar 

  202. Katzel LI, Bleecker ER, Rogus EM, et al. Sequential effects of aerobic exercise training and weight loss on risk factors for coronary disease in healthy, obese middle-aged and older men. Metabolism 1997; 46: 1441–7

    Article  PubMed  CAS  Google Scholar 

  203. Torjesen PA, Birkeland KI, Anderssen SA, et al. Lifestyle changes may reverse development of the insulin resistance syndrome. The Oslo Diet and Exercise Study: a randomized trial. Diabetes Care 1997; 20: 26–31

    CAS  Google Scholar 

  204. Anderssen SA, Holme I, Urdal P, et al. Associations between central obesity and indexes of hemostatic, carbohydrate and lipid metabolism: results of a 1-year intervention from the Oslo Diet and Exercise Study. Scand J Med Sci Sports 1998; 8: 109–15

    Article  PubMed  CAS  Google Scholar 

  205. Dengel DR, Hagberg JM, Pratley RE, et al. Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men. Metabolism 1998; 47: 1075–82

    Article  PubMed  CAS  Google Scholar 

  206. Watkins LL, Sherwood A, Feinglos M, et al. Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med 2003; 163: 1889–95

    Article  PubMed  Google Scholar 

  207. Katzmarzyk PT, Leon AS, Wilmore JH, et al. Targeting the metabolic syndrome with Exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 2003; 35(10): 1703–9

    Article  PubMed  CAS  Google Scholar 

  208. Diabetes Prevention Program Research Group. The effect of intensive lifestyle Intervention (ILS) and metformin (MET) on the incidence of metabolic syndrome among the participants in the Diabetes Prevention Program. American Diabetes Association 63rd Scientific Session. Epidemiology: Predictors of Diabetes; 2003 Jun 16; New Orleans, abstract no. 250-OR

  209. Minehira K, Tappy L. Dietary and lifestyle interventions in the management of the metabolic syndrome: present status and future perspective. Eur J Clin Nutr 2002; 56: 1262–9

    Article  Google Scholar 

  210. Ryan DH, Diabetes Prevention Program Research Group. Diet and exercise in the prevention of diabetes. Int J Clin Pract Suppl 2003; 134: 28–35

    PubMed  Google Scholar 

  211. Goodpaster BH, Kelley DE, Wing RR, et al. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999; 48: 839–47

    Article  PubMed  CAS  Google Scholar 

  212. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med 1999; 20: 1–12

    Article  Google Scholar 

  213. Henriksen EJ. Exercise effects of muscle insulin signalling and action. Invited review: effects of acute exercise and exercise training on insulin resistance. J Appl Physiol 2002; 93: 788–96

    PubMed  CAS  Google Scholar 

  214. Katzel LI, Bleeker ER, Colman EG, et al. Effects of weight loss vs aerobic exercise training on risk factors for coronary artery disease in healthy, obese, middle-aged and older men. JAMA 1995; 274: 1915–21

    Article  PubMed  CAS  Google Scholar 

  215. Ross R, Dagone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after diet-induced weight-loss or exercise induced weight loss. Ann Intern Med 2000; 133: 92–103

    PubMed  CAS  Google Scholar 

  216. Dengel DR, Pratley RE, Hagberg JM, et al. Distinct effects of aerobic exercise training and weight loss on glucose homeostasis in obese sedentary men. J Appl Physiol 1996; 8: 318–25

    Google Scholar 

  217. Davey GJG, Roberts JD, Patel S, et al. Effects of exercise on insulin resistance in South Asians and Europeans. J Exerc Physiol [online] 2000; 3(2). Available from URL: http://www.asep.org/JEPDavey.html [Accessed 2004 Mar 23]

  218. McAuley KA, Williams SM, Mann JI, et al. Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomised controlled trial. Diabetes Care 2002; 25: 445–52

    Article  PubMed  Google Scholar 

  219. Houmard JA, Tanner CJ, Slentz CA, et al. The effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol 2004; 96(1): 101–6

    Article  PubMed  CAS  Google Scholar 

  220. Short KR, Vittone JL, Bigelow ML, et al. Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes 2003; 52: 1888–96

    Article  PubMed  CAS  Google Scholar 

  221. Despres J-P, Marette A. Obesity and insulin resistance: epidemiological, metabolic and molecular aspects. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999

    Google Scholar 

  222. Smith SR, Zachwieja JJ. Visceral adipose tissue: a critical review of intervention strategies. Int J Obes Relat Metab Disord 1999; 23: 329–35

    Article  PubMed  CAS  Google Scholar 

  223. Ross R, Freeman JA, Janssen I. Exercise alone is an effective strategy for reducing obesity and related comorbidities. Exerc Sport Sci Rev 2000; 28: 165–70

    PubMed  CAS  Google Scholar 

  224. Di Pietro L, Seeman TE, Stachenfield NS, et al. Moderate-intensity aerobic exercise training improves glucose tolerance in aging independent of abdominal adiposity. J Am Geriatr Soc 1998; 46: 875–9

    Google Scholar 

  225. Torjesen PA, Birkeland KI, Anderssen SA, et al. The Oslo Diet and Exercise Study: a randomised trial: lifestyle changes may reverse development of the insulin resistance syndrome. Diabetes Care 1997; 20: 26–31

    Article  PubMed  CAS  Google Scholar 

  226. Irwin ML, Yasui Y, Ulrich CM, et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomised controlled trial. JAMA 2003; 289: 323–30

    Article  PubMed  Google Scholar 

  227. Liao D, Asberry PJ, Shofer JB, et al. Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance. Diabetes Care 2002; 25: 1504–10

    Article  PubMed  Google Scholar 

  228. Borch-Johnsen K. The new classification of diabetes mellitus and IGT: a critical approach. Exp Clin Endocrinol Diabetes 2001; 109Suppl. 2: S86–93

    Article  PubMed  CAS  Google Scholar 

  229. Unwin N, Shaw J, Zimmet P, et al. International Diabetes Federation IGT/IFG Consensus Statement. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 2002; 19: 708–23

    Article  PubMed  CAS  Google Scholar 

  230. Davies MJ, Raymond NT, Day JL, et al. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics. Diabet Med 2000; 17: 433–40

    Article  PubMed  CAS  Google Scholar 

  231. Larsson H, Berglund G, Lindgarde F, et al. Comparison of WHO and ADA criteria for diagnosis of diabetes and glucose intolerance. Diabetologia 1998; 41: 1124–5

    Article  PubMed  CAS  Google Scholar 

  232. Rathman W, Giani G, Mielck A. Cardiovascular risk factors in newly diagnosed abnormal glucose tolerance: comparison of 1997 ADA and 1985 WHO criteria. Diabetologia 1999; 42: 1268–9

    Article  Google Scholar 

  233. Hanefeld M, Temelkova-Kurktschiev T, Schaper F, et al. Impaired fasting glucose is not a risk factor for atherosclerosis. Diabet Med 1999; 16: 212–8

    Article  PubMed  CAS  Google Scholar 

  234. DECODE Study Group. Glucose tolerance and mortality: comparison of the WHO and ADA diagnostic criteria. Lancet 1999; 354: 617–21

    Article  Google Scholar 

  235. Potteiger JA, Jacobsen DJ, Donnelly JE. A comparison of methods for analysing glucose and insulin areas under the curve following nine months of exercise in overweight adults. Int J Obes Relat Metab Disord 2002; 26: 87–9

    Article  PubMed  CAS  Google Scholar 

  236. Dengel DR, Galecki AT, Hagberg JM, et al. The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am J Hypertens 1998; 11: 1405–12

    Article  PubMed  CAS  Google Scholar 

  237. Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med 1998; 339: 12–20

    Article  PubMed  CAS  Google Scholar 

  238. Blumenthal JA, Sherwood A, Gullette ECD, et al. Exercise and weight loss reduce blood pressure in men and women with mild hypertension. Arch Intern Med 2000; 160: 1947–58

    Article  PubMed  CAS  Google Scholar 

  239. Hellenius ML, Brismar KE, Berglund BH, et al. Effects on glucose tolerance, insulin secretion, insulin-like growth factor 1 and its binding protein, IGFBP-1, in a randomised controlled diet and exercise study in healthy middle-aged men. J Intern Med 1995; 238: 121–30

    Article  PubMed  CAS  Google Scholar 

  240. Pan X, Li G, Hu Y-H, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT Diabetes Study. Diabetes Care 1997; 20: 537–44

    CAS  Google Scholar 

  241. Li G, Hu Y, Yang W, et al. Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the Da Qing IGT and Diabetes Study. Diabetes Res Clin Pract 2002; 58: 193–200

    Article  PubMed  CAS  Google Scholar 

  242. Toumilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–50

    Article  Google Scholar 

  243. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403

    Article  PubMed  CAS  Google Scholar 

  244. Grundy SM. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am J Cardiol 1998; 81: 18B–25B

    Article  PubMed  CAS  Google Scholar 

  245. Howard BV, Mayer-Davis EJ, Goff D, et al. Relationships between insulin resistance and lipoproteins in nondiabetic African Americans, Hispanics, and non-Hispanic Whites: the Insulin Resistance Atherosclerosis Study. Metabolism 1998; 47: 1174–9

    Article  PubMed  CAS  Google Scholar 

  246. Reaven GM, Chen Y-DI, Jeppesen J, et al. Insulin resistance and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles. J Clin Invest 1993; 92: 141–6

    Article  PubMed  CAS  Google Scholar 

  247. Sattar N, Tan CE, Han TS, et al. Associations of indicies of adiposity with atherogenic lipoprotein subfractions. Int J Obes Relat Metab Disord 1998; 22: 432–9

    Article  PubMed  CAS  Google Scholar 

  248. Abbassi F, McLaughlin T, Lamendola C, et al. Insulin regulation of plasma free fatty acid concentrations is abnormal in healthy subjects with muscle insulin resistance. Metabolism 2000; 49: 151–4

    Article  Google Scholar 

  249. Bjorntorp P. ‘Portal’ adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arterioscler Thromb 1990; 10: 493–6

    Article  CAS  Google Scholar 

  250. Laws A. Insulin resistance and dyslipidemia: implications for coronary heart disease risk. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999

    Google Scholar 

  251. Taskinen MR. Insulin resistance and lipoprotein metabolism. Curr Opin Lipidol 1995; 6: 153–601

    Article  PubMed  CAS  Google Scholar 

  252. Durstine JL, Grandjean PW, Davis PG, et al. Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med 2001; 31: 1033–62

    Article  PubMed  CAS  Google Scholar 

  253. Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc 2001; 33: S502–15

    Article  PubMed  CAS  Google Scholar 

  254. Haibert JA, Silagy CA, Finucane P, et al. Exercise training and blood lipids in hyperlipidemia and normolipidemic adults: a meta-analysis of randomised, controlled trials. Euro J Clin Nutr 1999; 53: 514–22

    Article  Google Scholar 

  255. Gallagher D, Heymsfield SB, Heo M, et al. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000 Sep; 72(3): 694–701

    PubMed  CAS  Google Scholar 

  256. Zhu S, Wang Z, Shen WS, et al. Percentage body fat ranges associated with metabolic syndrome risk: results based on the third National Health and Nutrition Examination Survey (1988–1994). Am J Clin Nutr 2003; 78: 228–35

    PubMed  CAS  Google Scholar 

  257. Kiens B, Jorgensen I, Lewis S, et al. Increased plasma HDL-cholesterol and aop A-1 in sedentary middle-aged men after physical conditioning. Euro J Clin Invest 1980; 10: 203–9

    Article  CAS  Google Scholar 

  258. Juneau M, Rogers F, De Santos V, et al. Effectiveness of self-monitored, home-based, moderate-intensity exercise training in middle-aged men and women. Am J Cardiol 1987; 60: 66–70

    Article  PubMed  CAS  Google Scholar 

  259. Wood PD, Stefanick ML, Dreon DM, et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 1988; 319: 1173–9

    Article  PubMed  CAS  Google Scholar 

  260. King AC, Haskell WL, Taylor B, et al. Group- vs home-based exercise training in healthy older men and women: a community-based clinical trial. JAMA 1991; 266: 1535–42

    Article  PubMed  CAS  Google Scholar 

  261. Nieman DC, Warren BJ, O’Donnell KA, et al. Physical activity and serum lipids in elderly women. J Am Geriatr Soc 1993; 41: 1339–44

    PubMed  CAS  Google Scholar 

  262. Anderssen SA, Haaland A, Hjermann I, et al. Oslo Diet and Exercise Study: a one-year randomised intervention trial: effect on hemostatic and other coronary risk factors. Nutr Metab Cardiovasc Dis 1995; 5: 189–200

    Google Scholar 

  263. Ready EA, Drinkwater D, Ducas J, et al. Walking program reduces elevated cholesterol in women postmenopause. Can J Cardiol 1995; 11: 905–12

    PubMed  CAS  Google Scholar 

  264. Eriksson J, Tuominen J, Valle T, et al. Aerobic endurance exercise or circuit-type resistance training for individuals with impaired glucose tolerance. Horm Metab Res 1998; 30: 37–41

    Article  PubMed  CAS  Google Scholar 

  265. Wing RR, Venditti EV, Jakicic JM, et al. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care 1998; 21: 350–9

    Article  PubMed  CAS  Google Scholar 

  266. Kokkinos PF, Narayan P, Colleran J, et al. Effects of moderate intensity exercise on serum lipids in African-American men with severe systemic hypertension. Am J Cardiol 1998; 81: 732–5

    Article  PubMed  CAS  Google Scholar 

  267. Lavrencic A, Salobir BG, Keber I. Physical training improves flow-mediated dilation in patients with the polymetabolic syndrome. Arterioscler Thromb Vasc Biol 2000; 20: 551–60

    Article  PubMed  CAS  Google Scholar 

  268. Nieman DC, Brock DW, Butterworth D, et al. Reducing diet and/or exercise training decreases the lipid and lipoprotein risk factors of moderately obese women. J Am Coll Nutr 2002; 21: 344–50

    PubMed  CAS  Google Scholar 

  269. Kraus WE, Houmard JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347: 1483–92

    Article  PubMed  CAS  Google Scholar 

  270. Schuit AJ, Schouten EG, Miles TP, et al. The effect of six months training on weight, body fatness and serum lipids in apparently healthy elderly Dutch men and women. Int J Obes Relat Metab Disord 1998; 22: 847–53

    Article  PubMed  CAS  Google Scholar 

  271. Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.2.0 [updated 2003 Mar]. Available from URL: http://www.cochrane.dk/cochrane/handbook/handbook.htm [Accessed 2003 Oct 10]

  272. Sutton AJ, Abrams KR, Jones DR, et al. Methods for meta-analysis in medical research. Chichester: John Wiley & Sons, 2001

    Google Scholar 

  273. Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992; 45: 769–73

    Article  PubMed  CAS  Google Scholar 

  274. Egger M, Davey Smith G. Meta-analysis: potentials and promise. BMJ 1997; 315: 1371–4

    Article  PubMed  CAS  Google Scholar 

  275. Jüni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books, 2001

    Google Scholar 

  276. Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando (FL): Academic Press, 1985

    Google Scholar 

  277. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in healthcare: meta-analysis in context. 2nd ed. London: BMJ Books, 2001: 285–312

    Google Scholar 

  278. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60

    Article  PubMed  Google Scholar 

  279. Sterne JAC, Egger M, Davey Smith G. Meta-analysis: investigating and dealing with publication and other bias. In: Egger M, Davey Smith G, Altman DG, editors: Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books, 2001: 189–210

    Chapter  Google Scholar 

  280. Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001; 54: 1046–55

    Article  PubMed  CAS  Google Scholar 

  281. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34

    Article  PubMed  CAS  Google Scholar 

  282. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–99

    Article  PubMed  CAS  Google Scholar 

  283. Oja P. Dose response between total volume of physical activity and health and fitness. Med Sci Sports Exerc 2001; 33: S428–34

    Article  PubMed  CAS  Google Scholar 

  284. Wing RR. Physical activity in the treatment of adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (11 Suppl.): S547–52

    PubMed  CAS  Google Scholar 

  285. Couillard C, Despres J-P, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health Risk Factors Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol 2001; 21: 1226–32

    Article  PubMed  CAS  Google Scholar 

  286. Williams PT, Krauss RM, Vranizan KM, et al. Changes in lipoprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men. Circulation 1990; 81: 1293–304

    Article  PubMed  CAS  Google Scholar 

  287. Williams PT, Krauss KM, Vranizan KM, et al. Effects of exercise-induced weight loss on LDL subfractions in healthy men. Arteriosclerosis 1989; 9: 623–32

    Article  PubMed  CAS  Google Scholar 

  288. Doria A, Fioretto P, Avogaro A, et al. Insulin resistance is associated with high sodium-lithium countertransport activity in essential hypertension. Am J Physiol 1991; 261: E691–4

    Google Scholar 

  289. Sowers JR, Epstein M, Frolich ED. Diabetes, hypertension and cardiovascular disease: an update. Hypertension 2001; 37: 1053–9

    Article  PubMed  CAS  Google Scholar 

  290. The sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–46

    Google Scholar 

  291. World Health Organisation. International Society of Hypertension Guidelines for the Management of Hypertension: Guidelines Subcommittee. J Hypertens 1999; 17: 151–83

    Google Scholar 

  292. Staessen J, Fagard R, Amery A. The relationship between body weight and blood pressure. J Hypertens 1988; 2: 207–17

    CAS  Google Scholar 

  293. Brand MB, Mulrow CD, Chiquette E, et al. Dieting to reduce body weight for controlling hypertension in adults. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 1. Oxford: Update Software, 2000

    Google Scholar 

  294. Hermansen K. Diet, blood pressure and hypertension. Br J Nutr 2000; 83Suppl. 1: S113–9

    PubMed  CAS  Google Scholar 

  295. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med 2000; 30: 193–206

    Article  PubMed  CAS  Google Scholar 

  296. Fagard RH. Exercise characteristics and blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001; 33: S484–92

    Article  PubMed  CAS  Google Scholar 

  297. Fagard RH. Physical activity in the prevention and treatment of hypertension in the obese. Med Sci Sports Exerc 1999; 31 (11 Suppl.): S624–30

    PubMed  CAS  Google Scholar 

  298. Niedfeldt MW. Managing hypertension in athletes and physically active patients. Am Fam Physician 2002; 66: 445–52

    PubMed  Google Scholar 

  299. Gordon N. Hypertension. In: Durstine JL, Moore GE, editors. ACSM’s exercise management for persons with chronic diseases and disabilities. 2nd ed. American College of Sports Medicine. Champaign (IL): Human Kinetics, 2003: 76–80

    Google Scholar 

  300. Miller ED, Erlinger TP, Young DR, et al. Results of the diet, exercise, and weight loss intervention trial. Hypertension 2002; 40: 612–8

    Article  PubMed  CAS  Google Scholar 

  301. Devereux RB, Roman MJ. Hypertensive cardiac hypertrophy: pathophysiologic and clinical characteristics. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis and management. 2nd ed. New York (NY): Reaven Press Ltd, 1995: 409–24

    Google Scholar 

  302. Rutter MK, Parise H, Benjamin EJ, et al. Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study. Circulation 2003; 107: 448–54

    Article  PubMed  CAS  Google Scholar 

  303. Lind L, Anderssen PE, Andren B, et al. Left ventricular hypertrophy in hypertension is associated with the insulin resistance syndrome. J Hypertens 1995; 13: 433–8

    PubMed  CAS  Google Scholar 

  304. Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res 2002, 98

  305. Kannel WB. Risk stratification in hypertension: new insights from the Framingham study. Am J Hypertens 2000; 13: 3S–10S

    Article  PubMed  CAS  Google Scholar 

  306. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J 2001; 141: 334–41

    Article  PubMed  CAS  Google Scholar 

  307. Weber MA, Smith DH, Neutel JM, et al. The therapeutic implications of left ventricular hypertrophy in the hypertensive patient. Am J Ther 1995; 2: 972–7

    Article  PubMed  Google Scholar 

  308. MacMahon SW, Wilcken DEL, Macdonald GJ. The effect of weight reduction on left ventricular mass: a randomised controlled trial in young overweight hypertensive patients. N Engl J Med 1986; 314: 334–9

    Article  PubMed  CAS  Google Scholar 

  309. Farerberg B, Berglund A, Anderssen OK, et al. Cardiovascular effects of weight reduction versus antihypertensive drug treatment: a comparative, randomised, 1-year study of obese men with mild hypertension. J Hypertens 1991; 9: 431–9

    Article  Google Scholar 

  310. Hiemeno E, Nishino K, Okazaki T, et al. A weight reduction and weight maintenance program with long-lasting improvement in ventricular mass and blood pressure. Am J Hypertens 1999; 12: 682–90

    Article  Google Scholar 

  311. Hinderlitter A, Sherwood A, Gullette ECD, et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med 2002; 162: 1333–9

    Article  Google Scholar 

  312. Lalonde L, Gray-Donald K, Lowensteyn I, et al. Comparing the benefits of diet and exercise in the treatment of dyslipidemia. Prev Med 2002; 35: 16–24

    Article  PubMed  Google Scholar 

  313. Andersen RE, Wadden TA, Bartlett SJ, et al. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomised trial. JAMA 1999; 281: 335–40

    Article  PubMed  CAS  Google Scholar 

  314. Snyder KA, Donnelly JE, Jabobsen DJ, et al. The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females. Int J Obes Relat Metab Disord 1997; 21: 1180–9

    Article  PubMed  CAS  Google Scholar 

  315. Purnell JQ, Brunzell JD. The central role of dietary fat, not carbohydrate, in the insulin resistance syndrome. Curr Opin Lipidol 1997; 8: 17–22

    Article  PubMed  CAS  Google Scholar 

  316. Wolever TM, Mehling C. High carbohydrate-low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. Br J Nutr 2002; 87: 477–87

    Article  PubMed  CAS  Google Scholar 

  317. Dumesnil JG, Turgeon J, Tremblay A, et al. Effect of a low-glycaemic index-low-fat-high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr 2001; 86: 557–68

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors are grateful to the following investigators who supplied unpublished information for the purposes of this review: Dr R. Fagard, Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Drs W.E. Kraus and C.A. Slentz, Division of Cardiology Department of Medicine, Duke University Medical Center, Durham, NC, USA; Drs L.L. Watkins and J.A. Blumenthal, Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Drs K.R. Short and K.S. Nair, Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN, USA; Dr M.L. Irwin, Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA; Dr J. Oldroyd, Department of Epidemiology and Public Health, University of Newcastle, UK.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. School of Leisure and Sports Studies, Beckett Park Campus, Leeds Metropolitan University, Leeds, LS6 3QS, UK

    Sean Carroll

  2. Leeds Sports Development Unit, Leeds Leisure Services, Leeds, UK

    Mike Dudfield

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Carroll, S., Dudfield, M. What is the Relationship Between Exercise and Metabolic Abnormalities?. Sports Med 34, 371–418 (2004). https://doi.org/10.2165/00007256-200434060-00004

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