(5min read)
How effective is exercise in managing blood glucose and lipids?
Does race or ethnicity influence these levels of blood glucose and lipids?
Is aerobic or resistance exercise effective in managing blood glucose and lipids? And what is the required intensity, frequency and duration of each exercise to achieve such health benefits?
Evidence suggests that the levels of blood glucose, cholesterol and other lipoprotein carriers (triglycerides, low- and high-density lipoproteins) are excellent markers of an individual’s cardiac health. Cardiovascular disease risk factors which include impaired glucose control, unhealthy levels of lipids (typically referred to as cholesterol or fat), increased blood pressure (aka hypertension) and abdominal obesity, together form the ‘Metabolic Syndrome’. Specifically, this diagnosis is established by the presence of any 3 of the following 5 risk factors (also see Table 1):
- elevated or ↑ waist circumference
- ↑ serum triglycerides
- reduced or ↓ High-Density Lipoprotein Cholesterol (HDL-C), typically known as the ‘good cholesterol’
- ↑ blood pressure
- ↑ fasting glucose
| Table 1. Clinical diagnostic criteria of the Metabolic Syndrome (any 3 out of 5) | |
| Measure | Cut Points |
| Elevated waist circumference* | >=102 cm (40.1 in) (or 90 cm (35.4 in)) in males >=88 cm (34.6 in) (or 80 cm (31.4 in)) in females |
| Elevated triglycerides or related drug treatment | >=175 mg/dL (2.0 mmol/L) |
| Reduced HDL-C or related drug treatment | <40mg/dL (1.0 mmol/L) in males <50mg/dL (1.3 mmol/L) in females |
| Hypertension or related drug treatment | Systolic >=130 and/or diastolic >=85 mm Hg |
| Elevated fasting glucose or related drug treatment | >=100 mg/dL |
| * Waist circumference cut points generally recommended for the United States are >=102 cm in males and >=88 cm in females, but lower cut points (>=90 cm in males and >=80 cm in females) are commonly recommended for other populations. |
Metabolic syndrome is now found in approximately 1/3rd of the entire adult population in the United States and in at least 20-25% of the entire world population. It is considered to be a significant world-wide concern as it increases the risk of future conditions such as heart attack, stroke, other atherosclerotic cardiovascular diseases, type 2 diabetes, all-cause and cardiovascular death.
Race and ethnic factors can significantly influence the blood glucose and lipid levels, and therefore affect, the risk estimations of metabolic syndrome and atherosclerotic cardiovascular conditions. Specifically, people from South Asia, including the individuals from Bangladesh, India, Nepal, Pakistan, and Sri Lanka demonstrate poor glucose and lipid levels thus showing a higher prevalence of metabolic syndrome and other conditions.
What are the major contributors to the development of metabolic syndrome?
Although the exact cause of metabolic syndrome is unknown, following factors are considered to be major contributors in its development:
- Insulin resistance, which in turn results in poor regulation of glucose and lipids within the body
- Urbanization
- Overconsumption of nutrients
- Unhealthy diet
- Sedentary lifestyle
The role of exercise and physical activity in managing the metabolic syndrome and blood glucose and lipid levels:
Physical exercise is not only recommended as a preventative measure but also a primary method of treatment in metabolic syndrome and cardiovascular conditions. Physical exercise improves cardiorespiratory fitness and therefore provides several cardioprotective benefits! Physical exercise can include multiple forms such as aerobic, strengthening and stretching or flexibility type of exercises.
- Aerobic exercises typically include large body motions with arms and legs and are a great source of cardiovascular conditioning as it uses oxygen to meet the energy demands of the exercise via aerobic metabolism. A recent review and meta-analysis determined that aerobic exercises done for >4 weeks can significantly improve the waist circumference (by 3.4 cm), fasting glucose (by 0.15 mmol/L), high-density cholesterol (by 0.05 mmol/L), triglycerides (by 0.29 mmol/L), diastolic blood pressure (by 1.6 mmHg), and cardiorespiratory fitness (by 4.2 ml/kg/min). Evidence also suggests thataerobic exercises progressed to vigorous intensity (see below for examples), and conducted 3 days/week for ≥12 weeks offer larger and more widespread improvements in these cardio-metabolic factors.
- Resistance or strengthening exercises typically include limb or body exercises against some form of resistance such as lifting weights or using a person’s body weight and therefore can result in improving the muscle mass, strength and endurance. These exercises have shown to improve insulin sensitivity, glucose oxidation and reduce the risk of premature death.
- Combined aerobic and resistance training has been shown to decrease the waist circumference, systolic blood pressure, and improve the HDL-C and peak oxygen consumption in individuals with metabolic syndrome. A recent randomized trial suggests that 12 weeks of resistance training when combined with high intensity interval aerobic training (intervals of 3 mins fast walking and 3 mins running ranging from 55–65% to 80–90% of maximum heart rate) results in improved fasting blood glucose and low-density lipids, while 12 weeks of resistance training combined with moderate intensity continuous aerobic training (25 mins of walking at 60-70% of maximum heart rate) results in improved triglycerides.
- The American College of Sports medicine recommends that ALL HEALTHY ADULTS between the ages of 18 and 65 years should participate in:
- Moderate intensity aerobic activity for a minimum of 30 min on five days per week, or Vigorous intensity aerobic activity for a minimum of 20 min on three days per week. See table 2 for some detailed examples of such activities.
- Muscle strengthening activities including all major muscle groups for a minimum of two days per week.
| Moderate intensity activities | Vigorous intensity activities |
| -Includes any activity that causes you to breathe heavily where you can carry out a conversation with some effort. -These activities typically include fast walking, dancing, gardening, carrying/moving moderate loads (<20 kgs) etc. | -Includes any activity that causes you to be breathe more heavily where a conversation will require maximum effort and you can barely speak a sentence. -These activities typically include running, fast cycling, competitive sports, heavy shoveling, carrying/moving moderate loads (>20 kgs) etc. |
The role of diet in managing the metabolic syndrome and blood glucose and lipid levels:
The 2018 AHA/ACC guidelines on cholesterol management emphasize the use of heart-healthy lifestyle in patients with such cardiometabolic risk-factors. Here are some specific dietary recommendations:
- Consume a dietary pattern that emphasizes intake of vegetables, fruits, whole grains, legumes, healthy protein sources (low-fat dairy products, low-fat poultry (without the skin), fish/ seafood, and nuts), and nontropical vegetable oils
- Limit the intake of sweets, sugar-sweetened beverages, and red meats
- NOTE that diet should be adjusted to appropriate calorie requirements, personal and cultural food preferences, and nutritional therapy for other medical conditions including diabetes.
- Typically, caloric intake should be adjusted to avoid weight gain, or encourage weight loss.
In conclusion, diet and exercise play a significant role in the management of cardiometabolic risk factors by improving the control of blood glucose and lipids. Follow these guidelines to develop your own path to a healthy lifestyle!
Hope that you enjoyed reading this article! I highly recommend a link to self-evaluation and learning to improve each of these factors (Find My life check by American Heart Association) in the reference below. Please let us know how we are doing! And like, comment and share this article.
Written by:
Hina Garg PT, MS, PhD
MS PT and Wellness Director, CRC
References:
- Wang HH, Lee DK, Liu M, Portincasa P, Wang DQ. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr. 2020 May;23(3):189-230.
- Wewege MA, Thom JM, Rye KA, Parmenter BJ. Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis. 2018 Jul;274:162-171.
- Da Silva MAR, Baptista LC, Neves RS, De França E, Loureiro H, Lira FS, Caperuto EC, Veríssimo MT, Martins RA. The Effects of Concurrent Training Combining Both Resistance Exercise and High-Intensity Interval Training or Moderate-Intensity Continuous Training on Metabolic Syndrome. Front Physiol. 2020 Jun 11;11:572.
- https://www.acsm.org/read-research/trending-topics-resource-pages/physical-activity-guidelines
- A useful online tool for improving these factors of metabolic syndrome and atherosclerotic disease includes: https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check–lifes-simple-7