Effects of a weight reduction program with and without aerobic exercise in the metabolic syndrome

Background: In the setting of a rural, primary care practice, evidence for the efficacy of intentional weight loss with or without aerobic exercise training (AET) in hypertensive patients with the metabolic syndrome remains controversial. Design of study, methods: We analysed data of 52 hypertensives with the metabolic syndrome, who attended a weight management program with or without AET (diet/exercise group, n=18; diet group, n=20) for 36 months. Patients with a similar risk profile, who declined antihypertensive therapy beyond ACE inhibition, served as controls (n=14). Results: Body mass index (BMI) was significantly reduced over time in the diet and diet/exercise group (ΔBMI: −7.2±1.1 and−6.6±1.5 kg/m2) vs. the control group (ΔBMI: +0.4±1.3 kg/m2; p<0.001 at 36 m). While systolic and diastolic blood pressures (BPs) did not change over time in controls (175±5/89±7 mm Hg), BPs were significantly reduced in the diet group (151±8/75±10 mm Hg) and in the diet/exercise group (139±12/71±8 mm Hg; p<0.001 vs. diet group). Metabolic abnormalities were significantly improved over time in the diet group vs. controls, while AET did not add further benefits. However, heart rate recovery after acute exercise was improved and body cell mass (BCM) was increased in the diet/exercise group vs. patients without AET (p<0.001 vs. others). Conclusions: Weight management significantly improves the lipid and nonlipid abnormalities of the metabolic syndrome, which is associated with reduced blood pressure. Addition of AET does not add further benefits on metabolic parameters, but improves blood pressure regulation. Effective lifestyle modifications are feasible even in the setting of a rural practice.