Abstract
Metabolic syndrome and its various features (obesity, hypertension, dyslipidemia, diabetes, and nonalcoholic fatty liver disease) are increasing worldwide and constitute a severe risk for the sustainability of the present universal Italian health care system. Lifestyle interventions should be the first therapeutic strategy to prevent/treat metabolic diseases, far before pharmacologic treatment. The role of diet and weight loss has been fully ascertained, whereas the role of physical activity is frequently overlooked both by physicians and by patients. Physical activity has favorable effects on all components of the metabolic syndrome and on the resulting cardiovascular risk, the cornerstone in the development of cardiometabolic diseases. The quantity and the frequency of physical activity necessary to produce beneficial effects has not been defined as yet, but brisk walking is considered particularly appropriate, as it can be practiced by a large number of individuals, without any additional cost, and has a low rate of injury. The effects of exercise and leisure time physical activity extend from prevention to treatment of the various components of the metabolic syndrome, as well as to mood and quality of life. Any effort should be done to favor adherence to protocols of physical activity in the community.
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Averna M, Noto D (2012) Clinical utility of novel biomarkers for cardiovascular disease risk stratification. Intern Emerg Med 7(Suppl 3):263–270
Dagogo-Jack S, Egbuonu N, Edeoga C (2010) Principles and practice of nonpharmacological interventions to reduce cardiometabolic risk. Med Princ Pract 19:167–175
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952
Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309:71–82
World Health Organization (2000) Preventing and managing the global epidemic: Report of a WHO consultation. Report No.: 894. World Health Organization, Geneva
Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R et al (2011) Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med 364:1218–1229
Foster-Schubert KE, Alfano CM, Duggan CR, Xiao L, Campbell KL, Kong A et al (2012) Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity (Silver Spring) 20:1628–1638
Chobanian AV (2009) Shattuck Lecture. The hypertension paradox—more uncontrolled disease despite improved therapy. N Engl J Med 361:878–887
Sharp AS, Tapp RJ, Thom SA, Francis DP, Hughes AD, Stanton AV et al (2010) Tissue Doppler E/E’ ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J 31:747–752
National Institutes of Health (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6(Suppl 2):51S–209S
Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV et al (2006) Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 24:215–233
Karanja N, Lancaster KJ, Vollmer WM, Lin PH, Most MM, Ard JD et al (2007) Acceptability of sodium-reduced research diets, including the dietary approaches to stop hypertension diet, among adults with prehypertension and stage 1 hypertension. J Am Diet Assoc 107:1530–1538
Maruthur NM, Wang NY, Appel LJ (2009) Lifestyle interventions reduce coronary heart disease risk: results from the PREMIER Trial. Circulation 119:2026–2031
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA (2004) American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 36:533–553
Fagard RH, Conelissen V (2005) Physical activity, exercise, fitness and blood pressure. In: Battagay EJ, Lip GHY, Bakris GL (eds) Hypertension: principles and practice. Taylor & Francis, Boca Raton
Mora S, Redberg RF, Cui Y, Whiteman MK, Flaws JA, Sharrett AR et al (2003) Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA 290:1600–1607
Church TS, Earnest CP, Skinner JS, Blair SN (2007) Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. JAMA 297:2081–2091
Lee LL, Watson MC, Mulvaney CA, Tsai CC, Lo SF (2010) The effect of walking intervention on blood pressure control: a systematic review. Int J Nurs Stud 47:1545–1561
Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R et al (2007) Using pedometers to increase physical activity and improve health: a systematic review. JAMA 298:2296–2304
Sohn AJ, Hasnain M, Sinacore JM (2007) Impact of exercise (walking) on blood pressure levels in African American adults with newly diagnosed hypertension. Ethn Dis 17:503–507
Fossum E, Gleim GW, Kjeldsen SE, Kizer JR, Julius S, Devereux RB et al (2007) The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. J Intern Med 262:439–448
Smith PJ, Blumenthal JA, Babyak MA, Craighead L, Welsh-Bohmer KA, Browndyke JN et al (2010) Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure. Hypertension 55:1331–1338
Christmas C, Andersen RA (2000) Exercise and older patients: guidelines for the clinician. J Am Geriatr Soc 48:318–324
Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS (2009) Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia. Diabetes Care 32:1531–1535
Cocco G, Pandolfi S (2011) Physical exercise with weight reduction lowers blood pressure and improves abnormal left ventricular relaxation in pharmacologically treated hypertensive patients. J Clin Hypertens (Greenwich) 13:23–29
Lee LL, Arthur A, Avis M (2007) Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial. Prev Med 44:160–166
The National Cholesterol Education Program (NCEP) (2002) Expert panel on detection evaluation and treatment of high blood cholesterol in adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:314–3421
Lee CD, Blair SN, Jackson AS (1999) Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 69:373–380
Lakka TA, Laaksonen DE, Lakka HM, Mannikko N, Niskanen LK, Rauramaa R et al (2003) Sedentary lifestyle, poor cardiorespiratory fitness, and the metabolic syndrome. Med Sci Sports Exerc 35:1279–1286
Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS et al (2002) Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 347:1483–1492
Kelley GA, Kelley KS, Tran ZV (2004) Walking, lipids, and lipoproteins: a meta-analysis of randomized controlled trials. Prev Med 38:651–661
Leon AS, Sanchez OA (2001) Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc 33:S502–S515 (discussion S528-509)
Duncan GE, Anton SD, Sydeman SJ, Newton RL Jr, Corsica JA, Durning PE et al (2005) Prescribing exercise at varied levels of intensity and frequency: a randomized trial. Arch Intern Med 165:2362–2369
Slentz CA, Houmard JA, Johnson JL, Bateman LA, Tanner CJ, McCartney JS et al (2007) Inactivity, exercise training and detraining, and plasma lipoproteins. STRRIDE: a randomized, controlled study of exercise intensity and amount. J Appl Physiol 103:432–442
Walldius G, Jungner I (2007) Is there a better marker of cardiovascular risk than LDL cholesterol? Apolipoproteins B and A-I—new risk factors and targets for therapy. Nutr Metab Cardiovasc Dis 17:565–571
Mora S, Lee IM, Buring JE, Ridker PM (2006) Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 295:1412–1419
Holme I, Hostmark AT, Anderssen SA (2007) ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from the 1-year randomized Oslo Diet and Exercise Study. J Intern Med 262:235–243
Behre C, Bergstrom G, Schmidt C (2010) Moderate physical activity is associated with lower ApoB/ApoA-I ratios independently of other risk factors in healthy, middle-aged men. Angiology 61:775–779
Henson J, Yates T, Biddle SJ, Edwardson CL, Khunti K, Wilmot EG et al (2013) Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia 56:1012–1020
Cicero AF, D’Addato S, Santi F, Ferroni A, Borghi C (2012) Leisure-time physical activity and cardiovascular disease mortality: the Brisighella Heart Study. J Cardiovasc Med (Hagerstown) 13:559–564
Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC et al (1999) Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 282:1433–1439
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49:289–297
Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20:537–544
Orchard TJ, Temprosa M, Barrett-Connor E, Fowler SE, Goldberg RB, Mather KJ et al (2013) Long-term effects of the diabetes prevention program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Med 30:46–55
Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q et al (2008) The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 371:1783–1789
Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K et al (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679
Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT et al (2009) 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374:1677–1686
Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG et al (2013) Translating the diabetes prevention program lifestyle intervention for weight loss into primary care: a randomized trial. Arch Intern Med 173:113–121
Chae JS, Kang R, Kwak JH, Paik JK, Kim OY, Kim M et al (2012) Supervised exercise program, BMI, and risk of type 2 diabetes in subjects with normal or impaired fasting glucose. Diabetes Care 35:1680–1685
The InterAct Consortium (2012) Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC-InterAct Study. Diabetologia 55:1944–1952
Hallal PC, Bauman AE, Heath GW, Kohl HW 3rd, Lee IM, Pratt M (2012) Physical activity: more of the same is not enough. Lancet 380:190–191
Jakicic JM, Jaramillo SA, Balasubramanyam A, Bancroft B, Curtis JM, Mathews A et al (2009) Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study. Int J Obes (Lond) 33:305–316
Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 170:1566–1575
Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J et al (2012) Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA 308:2489–2496
Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N et al (2005) Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care 28:1295–1302
Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N et al (2003) Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care 26:404–408
Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P et al (2010) Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med 170:1794–1803
Balducci S, Zanuso S, Cardelli P, Salvi L, Mazzitelli G, Bazuro A et al (2012) Changes in physical fitness predict improvements in modifiable cardiovascular risk factors independently of body weight loss in subjects with type 2 diabetes participating in the Italian Diabetes and Exercise Study (IDES). Diabetes Care 35:1347–1354
Balducci S, Zanuso S, Cardelli P, Salvi L, Bazuro A, Pugliese L et al (2012) Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS ONE 7:e49297
Bacchi E, Negri C, Zanolin ME, Milanese C, Faccioli N, Trombetta M et al (2012) Metabolic effects of aerobic training and resistance training in type 2 diabetic subjects: a randomized controlled trial (the RAED2 study). Diabetes Care 35:676–682
Balducci S, Zanuso S, Cardelli P, Salerno G, Fallucca S, Nicolucci A et al (2012) Supervised exercise training counterbalances the adverse effects of insulin therapy in overweight/obese subjects with type 2 diabetes. Diabetes Care 35:39–41
Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G (2010) A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 53:372–384
Della Corte C, Alisi A, Saccari A, De Vito R, Vania A, Nobili V (2012) Nonalcoholic fatty liver in children and adolescents: an overview. J Adolesc Health 51:305–312
Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R et al (2003) Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 37:917–923
Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bugianesi E, McCullough AJ et al (1999) Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 107:450–455
Del Ben M, Baratta F, Polimeni L, Angelico F (2012) Non-alcoholic fatty liver disease and cardiovascular disease: epidemiological, clinical and pathophysiological evidences. Intern Emerg Med 7(suppl 3):S291–S296
Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E et al (2008) Risk of severe liver disease in NAFLD with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology 48:792–798
Targher G, Day CP, Bonora E (2010) Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 363:1341–1350
Calori G, Lattuada G, Ragogna F, Garancini MP, Crosignani P, Villa M et al (2011) Fatty liver index and mortality: the Cremona study in the 15th year of follow-up. Hepatology 54:145–152
Carulli L, Ballestri S, Lonardo A, Lami F, Violi E, Losi L et al (2011) Is nonalcoholic steatohepatitis associated with a high-though-normal thyroid stimulating hormone level and lower cholesterol levels? Intern Emerg Med. doi:10.1007/s11739-011-0609-4
Marchesini G, Moscatiello S, Agostini F, Villanova N, Festi D (2011) Treatment of non-alcoholic fatty liver disease with focus on emerging drugs. Expert Opin Emerg Drugs 16:121–136
Bae JC, Rhee EJ, Lee WY, Park SE, Park CY, Oh KW et al (2011) Combined effect of nonalcoholic fatty liver disease and impaired fasting glucose on the development of type 2 diabetes: a 4-year retrospective longitudinal study. Diabetes Care 34:727–729
Johnson NA, Sachinwalla T, Walton DW, Smith K, Armstrong A, Thompson MW et al (2009) Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology 50:1105–1112
Fealy CE, Haus JM, Solomon TP, Pagadala M, Flask CA, McCullough AJ et al (2012) Short-term exercise reduces markers of hepatocyte apoptosis in nonalcoholic fatty liver disease. J Appl Physiol 113:1–6
Sullivan S, Kirk EP, Mittendorfer B, Patterson BW, Klein S (2012) Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology 55:1738–1745
Sreenivasa Baba C, Alexander G, Kalyani B, Pandey R, Rastogi S, Pandey A et al (2006) Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J Gastroenterol Hepatol 21:191–198
Johnson NA, Keating SE, George J (2012) Exercise and the liver: implications for therapy in fatty liver disorders. Semin Liver Dis 32:65–79
St George A, Bauman A, Johnston A, Farrell G, Chey T, George J (2009) Independent effects of physical activity in patients with nonalcoholic fatty liver disease. Hepatology 50:68–76
Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR et al (2010) Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 51:121–129
van der Heijden GJ, Wang ZJ, Chu ZD, Sauer PJ, Haymond MW, Rodriguez LM et al (2010) A 12-week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity (Silver Spring) 18:384–390
Keating SE, Hackett DA, George J, Johnson NA (2012) Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol 57:157–166
Kistler KD, Brunt EM, Clark JM, Diehl AM, Sallis JF, Schwimmer JB (2011) Physical activity recommendations, exercise intensity, and histological severity of nonalcoholic fatty liver disease. Am J Gastroenterol 106:460–468 (quiz 469)
Zelber-Sagi S, Ratziu V, Oren R (2011) Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence. World J Gastroenterol 17:3377–3389
Centis E, Moscatiello S, Bugianesi E, Bellentani S, Fracanzani AL, Calugi S et al (2013) Stage of change and motivation to healthier lifestyle in nonalcoholic fatty liver disease. J Hepatol 58:771–777
Gerber L, Otgonsuren M, Mishra A, Escheik C, Birerdinc A, Stepanova M et al (2012) Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study. Aliment Pharmacol Ther 36:772–781
Krasnoff JB, Painter PL, Wallace JP, Bass NM, Merriman RB (2008) Health-related fitness and physical activity in patients with nonalcoholic fatty liver disease. Hepatology 47:1158–1166
Newton JL, Jones DE, Henderson E, Kane L, Wilton K, Burt AD et al (2008) Fatigue in non-alcoholic fatty liver disease (NAFLD) is significant and associates with inactivity and excessive daytime sleepiness but not with liver disease severity or insulin resistance. Gut 57:807–813
Church TS, Kuk JL, Ross R, Priest EL, Biltoft E, Blair SN (2006) Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology 130:2023–2030
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM et al (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359
Frith J, Day CP, Robinson L, Elliott C, Jones DE, Newton JL (2010) Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease. J Hepatol 52:112–116
Moscatiello S, Di Luzio R, Bugianesi E, Suppini A, Hickman I, Di Domizio S et al (2011) Cognitive-behavioral treatment of non-alcoholic fatty liver disease: a propensity score-adjusted observational study. Obesity (Silver Spring) 19:763–770
Marchesini G, Trovati M (2003) Type 2 diabetes and the Naaman syndrome. Diabetes Care 26:3195
Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S et al (2012) Evidence-based intervention in physical activity: lessons from around the world. Lancet 380:272–281
Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48
Dalle Grave R, Calugi S, Centis E, El Ghoch M, Marchesini G (2011) Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. J Obes 2011:348293
Peterson JA (2007) Get moving! Physical activity counseling in primary care. J Am Acad Nurse Pract 19:349–357
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Montesi, L., Moscatiello, S., Malavolti, M. et al. Physical activity for the prevention and treatment of metabolic disorders. Intern Emerg Med 8, 655–666 (2013). https://doi.org/10.1007/s11739-013-0953-7
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DOI: https://doi.org/10.1007/s11739-013-0953-7