Week 7: metabolic syndrome - Ex management Flashcards
What are the primary interventions recommended by the International Diabetes Federation (IDF) for managing Metabolic Syndrome?
The IDF recommends a moderate calorie restriction to achieve a 5-10% weight loss in the first year, a moderate increase in physical activity, and changes in dietary composition to reduce cardiovascular disease (CVD) and type 2 diabetes risk.
Why is visceral obesity considered central to the pathophysiology of Metabolic Syndrome?
Visceral obesity contributes to insulin resistance, which is one of the main underlying factors leading to the development of Metabolic Syndrome. This condition increases the risk of cardiovascular diseases and type 2 diabetes.
Describe the effect of resistance training on blood pressure management for individuals with hypertension.
Resistance training can reduce systolic blood pressure (SBP) by 3.50 mmHg and diastolic blood pressure (DBP) by 2.09 mmHg. It is particularly effective for those with hypertension but has minimal effect on individuals taking blood pressure-lowering medication.
How do statins function in the management of dyslipidemia, and what is their effect on exercise performance?
Statins primarily lower LDL cholesterol with a small effect on HDL. They do not affect heart rate (HR), blood pressure (BP), or exercise capacity. However, a major side effect is myopathy or myalgia, which can present as muscle pain, cramps, heaviness, or stiffness during exercise.
How does exercise impact insulin resistance in individuals with Metabolic Syndrome, and what is the significance of the HOMA-IR model?
Exercise leads to small improvements in insulin resistance, with reductions in fasting glucose and insulin levels. The HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) model measures insulin resistance, and a value above 2 suggests insulin resistance. Exercise can help reduce HOMA-IR scores in the medium term.
Compare the effectiveness of lifestyle interventions (exercise and/or diet) versus pharmacological interventions in reducing the risk of developing type 2 diabetes in adults with Metabolic Syndrome.
Lifestyle interventions result in a 49% reduction in the risk of developing type 2 diabetes, with exercise alone yielding a 51% reduction. Pharmacological interventions achieve a 30% reduction, with Orlistat showing a similar effect to exercise at a 56% reduction.
What are the absolute contraindications for exercise in individuals with hypertension according to the document?
Absolute contraindications include resting SBP ≥180 mmHg or DBP ≥110 mmHg, and these individuals should be referred to a GP before initiating an exercise program.
How does isometric exercise influence blood pressure management in hypertensive individuals, and what are the common protocols used in studies?
Isometric exercise can reduce SBP by approximately 5.65 mmHg and DBP by 4.00 mmHg. Common protocols involve 4 x 2-minute contractions at varying intensities (8-40% MVC), and these exercises are effective in managing blood pressure, especially in those with high baseline SBP.
Why might the effects of exercise be attenuated in individuals taking blood pressure-lowering medications?
Blood pressure-lowering medications can blunt exercise-induced heart rate and blood pressure responses, leading to a reduced ability to achieve maximum power output during exercise, thereby diminishing the effectiveness of exercise interventions in lowering blood pressure.
How does the combination of different exercise modalities compare in lowering systolic blood pressure (SBP) in individuals with metabolic syndrome, and why might these effects vary?
Combination exercise modalities (endurance, resistance, and isometric) can achieve a mean reduction in SBP of around 6.49 mmHg, which is more effective than endurance or resistance training alone. The variation in effects may be due to differences in vascular adaptations, muscle mass activation, and overall cardiovascular stress induced by combining these exercise types.
What role does exercise play in the management of PCOS, and how does it compare to other interventions?
Exercise can improve components of Metabolic Syndrome in PCOS, such as reducing waist circumference and improving insulin sensitivity, but it has no significant impact on the hormonal profile. It is effective for improving metabolic health when combined with dietary changes but is less effective than pharmacological interventions in managing hyperandrogenism or menstrual irregularities.
Explain the pathophysiological mechanism by which angiotensin II receptor blockers (ARBs) help manage hypertension, and their potential impact on exercise response.
ARBs block the action of angiotensin II at its receptor, reducing vasoconstriction and blood volume, thereby lowering blood pressure. During exercise, this can lead to a more pronounced decrease in vascular resistance, which might limit the blood pressure rise typically seen during physical activity, potentially affecting exercise tolerance and performance.
Discuss the role of beta-blockers in modulating exercise-induced cardiovascular responses in individuals with metabolic syndrome and the implications for exercise prescription.
Beta-blockers reduce heart rate and contractility by blocking adrenaline’s action, leading to reduced maximal heart rate and exercise capacity. This necessitates using perceived exertion (RPE) instead of heart rate for intensity monitoring. Additionally, their use may increase the risk of post-exercise hypotension, requiring gradual cool-down protocols.
How do lifestyle interventions affect the lipid profile in metabolic syndrome, and why might these changes be less significant compared to pharmacological treatments?
Lifestyle interventions, including exercise and diet, have minimal effects on lowering LDL cholesterol and triglycerides but can modestly increase HDL levels. These effects are less pronounced than pharmacological treatments like statins because lifestyle changes may not induce the same degree of hepatic cholesterol synthesis inhibition or LDL receptor upregulation as medications.
Critically evaluate why resistance training might be more effective than aerobic training for specific populations with metabolic syndrome, particularly in terms of its impact on hypertension.
Resistance training might be more effective for hypertensive individuals due to its potential to induce greater peripheral arterial adaptations and improve muscular strength, leading to enhanced arterial compliance. This adaptation may reduce resting and exercise-induced SBP more significantly than aerobic training, particularly in those with pre-existing high blood pressure.
