Exercise Reduces Medication for Metabolic Syndrome Management

A 5-Year Follow-up Study

Felix Morales-Palomo; Alfonso Moreno-Cabañas; Miguel Ramirez-Jimenez; Laura Alvarez-Jimenez; Pedro L. Valenzuela; Alejandro Lucia; Juan F. Ortega; Ricardo Mora-Rodriguez

Disclosures

Med Sci Sports Exerc. 2021;53(7):1319-1325. 

In This Article

Abstract and Introduction

Abstract

Purpose: This study aimed to determine the effects of a 5-yr exercise intervention on metabolic syndrome (MetS) and health-related variables and medication use for MetS management.

Methods: Participants were randomly assigned to an exercise intervention (n = 25, 54 ± 2 yr, 20% women) or control group (n = 26, 54 ± 2 yr, 38% women). The intervention lasted 4 months per year and consisted of high-intensity interval training on a cycloergometer thrice a week. Outcomes were MetS z-score and medication use score, MetS-related variables (including blood pressure, blood glucose homeostasis, and lipid profile), and cardiorespiratory fitness (CRF, as determined by maximal oxygen uptake).

Results: MetS z-score was similarly reduced over time in both groups (P = 0.244 for group–time interaction). A quasi-significant and significant group–time interaction was found for MetS number of factors (P = 0.004) and CRF (P < 0.001), respectively. Thus, MetS factors tended to decrease over time only in the exercise group with no change in the control group, whereas CRF increased from baseline to 5-yr assessment in the exercise group (by 1.1 MET, P < 0.001) but decreased in the control group (−0.5 MET, P = 0.025). Medicine use score increased twofold from baseline to 5-yr follow-up in the control group (P < 0.001) but did not significantly change (10%, P = 0.52) in the exercise group (P < 0.001 for group–time interaction). The proportion of medicated patients who had to increase antihypertensive (P < 0.001), glucose-lowering (P = 0.036), or total medication (P < 0.0001) over the 5-yr period was lower in the exercise than that in the control group.

Conclusions: Exercise training can attenuate the increase in medication that would be otherwise required to manage MetS over a 5-yr period.

Introduction

Metabolic syndrome (MetS) affects one third of the adult population in the United States.[1] Owing to the multisystemic nature of this disorder, more than 35% of affected people take two or more drugs daily.[2,3] Polypharmacy is defined as routinely taking a minimum of five medicines daily and represents an important medical problem.[4] Indeed, most drugs have adverse effects, and dosage must be frequently increased over the years to maintain the desired effect, with subsequent saturation of metabolizing processes, drug accumulation, and exacerbation of side effects.[5] Polypharmacy also imposes a burden on the public health system.[6] Implementation of lifestyle strategies aiming at reducing medicine use without affecting—and ideally improving—disease management are thus paramount from both an individual and a public health perspective.[7]

A major lifestyle intervention with multisystemic benefits that can mimic—at least partly—drug effects on cardiometabolic conditions is physical exercise.[8–10] Although reductions in medicine use is not a direct aim for the inclusion of exercise into a lifestyle, sometimes it induces that reduction by improving some health risk factor.[11,12] We recently showed that a 4-month exercise intervention implemented twice during two consecutive years prevented the increases in medication that would be otherwise needed to normalize blood glucose levels in patients with MetS.[3] In the present follow-up study, we aimed to determine the effects of maintaining this type of intervention during three more years on MetS and health-related variables, as well as on the use of medication for MetS management.

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