Physical rehabilitation of the persons with metabolic syndrome

Metabolic syndrome is one of the fastest growing disorder threats to the health of industrialized populations. According to different estimates the prevalence of metabolic syndrome in the adult population of the world is about 25% and the number continues to grow. Moreover, there is increasing concern about metabolic syndrome occurring in youth and adolescents that has grown from 4,2 % to 6,4 % during the period from 1994 till 2000 [4].

Metabolic syndrome is an integrative interrelationship of hormonal and metabolic disorders that includes: abdominal obesity, glucose intolerance, dyslipidaemia, and hypertension. Patients with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls and type 2 diabetes. Futhermore, it is an independent risk factor that is associated with a 10 % increase in total mortality of the population [1].

The increasing number of people who have this condition is linked to the rise in obesity rates among adults. The root cause of most cases of metabolic syndrome can be traced back to poor eating habits and a sedentary lifestyle. That‘s why metabolic syndrome isn‘t just medical problem but also a serious social one [2].
Methods of the research: theoretical analysis and generalization of data from the scientific literature sources.

Results and their discussion. The clustering of cardiovascular disease risk factors with type 2 diabetes, hyperlipidaemia, hypertension and obesity was first noted in the 1960s-1970s. The concept of the metabolic syndrome was proposed in 1988, when Reaven published a landmark paper describing syndrome X.
Subsequently, the name metabolic syndrome was coined to reflect the range of metabolic features involved [1].

The metabolic syndrome is characterized by a group of metabolic risk factors in one person that include: abdominal obesity (excessive fat tissue in and around the abdomen), atherogenic dyslipidaemia (blood fat disorders — high triglycerides, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol – that foster plaque buildups in artery walls), elevated blood pressure, insulin resistance or glucose intolerance [2, 3].

All of the factors associated with metabolic syndrome are interrelated. Obesity and lack of exercise tend to lead to insulin resistance. Insulin resistance has a negative effect on lipid production, increasing very low-density lipoprotein, low-density lipoprotein, and triglyceride levels in the bloodstream and decreasing high-density lipoprotein. This can lead to fatty plaque deposits in the arteries which, over time, can lead to coronary heart disease and strokes. Insulin resistance also leads to increased insulin and glucose levels in the blood. Excess insulin increases sodium retention by the kidneys, which increases blood pressure and can lead to hypertension. Chronically elevated glucose levels in turn damage blood vessels andorgans, such as the kidneys [1, 3].

The dominant underlying risk factors for metabolic syndrome appear to be abdominal obesity and insulin resistance. According to the current studies metabolic syndrome is closely associated with coronary heart disease and other diseases related to atherosclerosis. Data obtained from the international studies show that metabolic syndrome increases death risk from the cardiovascular diseases in 3 times. The main causes of the death of patients with metabolic syndrome are such complications as ischemic heart disease, heart attack, stroke [1]. It‘s very important that metabolic syndrome is a reversible condition, i.e. with proper treatment and rehabilitation it‘s possible to delay risk factors and prevent serious complications.

The main principle of clinical management of the metabolic syndrome is correction of its changeable factors. Then the first-line therapy should be directed on:
 weight loss to achieve a desirable weight (body mass index less than 25 kg/m2);
 decreasing of blood pressure levels;
 increasing insulin sensitivity;
 improving dyslipidaemia [3].

It‘s well-known that adequate physical activity favors to the normalization of lipid and carbohydrate metabolism and blood pressure rate, decreases body mass index, has positive effect on the total state of the patients with cardiovascular diseases and prevent cardiovascular complications. Lifestyle modifications that include increased daily physical activity, regular physical training and healthy eating habits are the first-line interventions to reduce the metabolic risk factors.

Although numerous domestic and foreign studies are devoted to the problem of the metabolic syndrome just few of them investigates the peculiarities of physical rehabilitation program for patients with this serious condition. Many aspects of the effects of physical training (such as the efficiency of different exercise intensities, training regimens, duration and necessary amount of exercise) on the components of metabolic syndrome need to be addressed [3, 5].

Conclusion. Metabolic syndrome is a serious health condition that affects about 25 % of adults and places them at higher risk of diabetes, coronary heart disease, stroke and other diseases related to atherosclerosis. The chance of developing metabolic syndrome is closely linked to a lack of physical activity. It's possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. High prevalence of metabolic syndrome and its significant role in the development and complications of cardiovascular diseases determine the necessity of combined rehabilitation program working out for persons with metabolic syndrome and its application in practice.

1. Бритов А. Н. Метаболический синдром (риск сердечно-сосудистых заболеваний) / А.Н. Бритов, М.А. Уметов – М.: Здоровье, 2005. – 63 с.
2. Грицай Л. Диагностические критерии метаболического синдрома: что нужно знать врачу? /Л. Грицай // Medicine Review. Кардиология. – 2010. – No1 (10). – С. 46 – 49.
3. Митченко Е. И. Метаболический синдром, диабет и сердечнососудистые заболевания / Е. И. Митченко // Руководство по кардиологии / [ред.Коваленко В. Н.] – К.: Морион, 2008. – С.228 – 241.
4. Сергеев В. Метаболический синдром: причины, лечение и профилактика / В. Сергеев // Врач. – 2009. – No 2. – С. 18 – 21.
5. Hawley J. A. Physical activity and Type 2 Diabetes / J. A. Hawley, J. R. Zierath. – Human Kinetics, 2008. – 218 р.

M. S. Balazh