The Concept of CMR
Slides, videos and moreManaging CMR
Managing Cardiometabolic Risk in Abdominally Obese Patients
Physical Activity and Exercise
- 1Key Points (1 page)
- 2Exercise and Cardiometabolic Risk (2 pages)
- 3Exercise and Abdominal Obesity (3 pages)
- 4Exercise and Insulin Resistance (5 pages)
- 5Exercise and Atherogenic Dyslipidemia (4 pages)
- 6Exercise and Elevated Blood Pressure (3 pages)
- 7Exercise and Thrombosis (3 pages)
- 8Exercise and Systemic Inflammation (3 pages)
- 9References (1 page)
Exercise and Cardiometabolic Risk
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A joint statement by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) challenged the concept of the metabolic syndrome and questioned its clinical utility above and beyond individual risk factors (12). The statement also concluded that “the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker” (12). Following the publication of the critical review of the metabolic syndrome, the International Chair on Cardiometabolic Risk (13), the ADA, and the American Heart Association (AHA) introduced the concept of global cardiometabolic risk, which goes beyond the earlier meaning of the metabolic syndrome to encompass a broader cluster of risk factors associated with CVD and type 2 diabetes (14). Cardiometabolic risk includes the features of the metabolic syndrome as well as traditional CVD risk factors (13). Among Canadian adults, physical inactivity is the most prevalent cause of abdominal obesity and the metabolic syndrome (15), and along with smoking is one of the factors that is easiest to target. In addition, physical activity and/or exercise have consistently been recommended for the reduction of many individual cardiometabolic risk factors (9) (10) (16). Prospective studies have shown that increasing physical activity seems to protect against the development of diabetes and CVD in a dose-response manner (17) (18). Exercise’s specific role in reducing abdominal obesity, intra-abdominal (visceral) fat in particular, and improving insulin sensitivity, lipid levels (triglycerides, HDL cholesterol, LDL size), blood pressure, thrombosis, and inflammation is examined below.
Although the terms physical activity and exercise are often used interchangeably, a distinction has been made between them for the purposes of this document. Physical activity is defined as any bodily movement produced by skeletal muscles resulting in increased energy expenditure. It includes both occupational and leisure-time physical activity. Exercise is a component of leisure-time physical activity that is planned, structured, repetitive, and performed for the purpose of improving or maintaining physical fitness. While the evidence presented here mainly addresses the effects of structured and regular exercise, it is well established that increasing physical activity during leisure and non-leisure time yields significant benefits (19).
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