title: Intensive practical lifestyle intervention improves endothelial function in metabolic syndrome independent of weight loss: a randomized controlled trial.
abstract: The objective was to evaluate the metabolic and vascular effects of lifestyle interventions involving a healthy diet and either a moderate- or a high-intensity exercise regimen in nondiabetic subjects with metabolic syndrome. The effects of these interventions on flow-mediated vasodilation (FMD) and risk profiles were compared with a standard low-fat diet and engaging in daily walking (standard of care). Seventy-five healthy adults with metabolic syndrome (30-55 years old) were randomized to a 10,000-steps-a-day exercise program, a 3-times-a-week fitness (>75% peak VO(2)) program, or a 1-hour-walking-a-day program for 12 weeks. The first 2 interventions were combined with an accessible healthy, no-sugar diet; and the third was combined with a tailored low-fat diet. The outcomes, including FMD and risk factors, were examined at 12 weeks and at 1-year reassessment. Significant increase in FMD (mean difference = 1.51%, 95% confidence interval = 1.05%-3.017%, P = .0007) and decrease in arterial pressure (mean difference = 19.3 ± 2.3/-12.6 ± 1.8 mm Hg, P = .0001) were observed in all groups. However, the FMD changed most favorably in the high-intensity, low-sugar group (mean difference = 1.56%, 95% confidence interval = 0.1%-3.02%, P = .036). Significant improvements in body mass index, waist, insulin-like growth factor-1, homeostasis model assessment of insulin resistance, insulin, glucose, urinary albumin excretion, and lipid profiles occurred in all groups. Metabolic syndrome was resolved in 64%. One year later, weight loss (-9.1 ± 2.3 kg, P = .0001) and arterial pressure decrease (-18.5 ± 2.3/-12.3 ± 2.1 mm Hg, P = .0001) were maintained. Practical, health-centered diet combined with high-intensity exercise is associated with enhanced vascular protection. These data suggest that more intense exercise combined with a low-sugar diet modulates endothelium-dependent vasodilation.
authors.affiliation: Internal Medicine Department, Graduate Program in Cardiovascular Sciences, Federal University of Rio Grande do Sul, Divisions of Internal Medicine and Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035903, Brazil. biaseligman@gmail.com
authors.forename: Beatriz G S
authors.initials: BG
authors.lastname: Seligman
authors.forename: Carisi A
authors.initials: CA
authors.lastname: Polanczyk
authors.forename: Angela S B
authors.initials: AS
authors.lastname: Santos
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
authors.forename: Mauricio
authors.initials: M
authors.lastname: Junges
authors.forename: Laisa
authors.initials: L
authors.lastname: Bonzanini
authors.forename: Gabriela
authors.initials: G
authors.lastname: Nicolaidis
authors.forename: Suzi
authors.initials: S
authors.lastname: Camey
authors.forename: André L
authors.initials: AL
authors.lastname: Lopes
authors.forename: Paulo
authors.initials: P
authors.lastname: Sehl
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000652:urine; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D018752:Diet, Fat-Restricted; D004730:Endothelium, Vascular / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000178:diet therapy / Q000503:physiopathology* / Q000534:rehabilitation*; D008875:Middle Aged; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014664:Vasodilation; D055105:Waist Circumference; D016138:Walking; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D007334:Insulin-Like Growth Factor I