METABOLIC SYNDROME AND PHYSICAL ACTIVITY

Metabolički sindrom obuhvaća poremećaje u metabolizmu koji se učestalo pojavljuju zajedno, a to su abdominalna pretilost, dislipidemija, hiperglikemija i hipertenzija. Učestalost sindroma je veća meðu ženama i u starijim dobnim skupinama. Glavni rizični čimbenik je pretilost. Zbog porasta broja pretilih osoba, očekuje se rast učestalosti sindroma u budućnosti. Tjelesnu aktivnost definiramo kao bilo koji pokret izveden pomoću skeletnog mišičja pri ćemu se troši energija koja se mjeri u kilokalorijama. Tjelesna aktivnost ima pozitivan utjecaj na zdravlje i važna je metoda u liječenju metaboličkog sindroma. Možemo je podijeliti s obzirom na intenzitet: na laganu, umjerenu i tešku. Osnovni patofiziološki procesi su inzulinska rezistencija i povećana količina visceralnog masnog tkiva. Metabolički sindrom je i proupalno te protrombotsko stanje. Kliničke manifestacije su povišen arterijski tlak, povišene vrijednosti glukoze u krvi, smanjena koncetracija HDL-a, a povišena koncentracija triglicerida u krvi. Oboljeli od metaboličkog sindroma imaju poveæani rizik za razvoj kardiovaskularnih bolesti i šećerne bolesti tip II. Liječenje se započinje promjenama životnog stila koje umanjuju rizične čimbenike za metabolièčki sindrom (pretilost i smanjenu tjelesnu aktivnost). Ako metaboličke abnormalnosti nakon tih promjena perzistiraju, liječenje se usmjerava na terapiju šečerne bolesti tip II i rizične čimbenike kardiovaskularnih bolesti. Vježbanje efikasno reducira sistolièči i dijastolički tlak, a povezuje se i s poboljšanjem profila lipida; smanjujući pri tom koncentraciju apolipoproteina-B i povećavajući razinu HDL-a. Tjelesna aktivnost pozitivno korelira sa inzulinskom osjetljivošću, dovodi do porasta GLUT4 transportera, poboljšava endotelnu funkciju i mikrocirkulaciju. Smanjenje prekomjerne tjelesne težine inducirano vježbanjem smanjuje razinu markera upale; TNF -a, IL-6 i CRP-a. Oba modaliteta vježbanja, trening snage i aerobni trening rezultiraju u smanjenju koncentracije HbA1c što ima za posljedicu i smanjenje rizika smrtnosti. Smanjenje visceralnog masnog tkiva, jedne od komponenata metaboličkog sindroma, postiže se aerobnim treningom, dok trening otpora ne dovodi do značajnije redukcije. U tome se pokazala djelotvorna i aktivnost umjerenog intenziteta čak i odsustvu promjena kalorijskog unosa.Metabolic syndrome includes metabolic disorders that often occur together, such as abdominal obesity, dyslipidemia, hyperglycemia and hypertension. The incidence of the syndrome is higher among women and in the older age groups. The main risk factor is obesity. Due to the increase in the number of obese people is expected to increase the frequency of the syndrome in the future. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure which can be measured in kilocalories. Physical activity has a positive impact on health and it is important method in treatment of metabolic syndrome. It can be divided based on exercise intensity in light, moderate and vigorous. The basic pathophysiological mechanisms are insulin resistance and an increased amount of visceral fat. Metabolic syndrome is a prothrombotic and a proinflammatory state. Clinical manifestations are elevated blood pressure, elevated blood glucose levels, reduced concentrations of HDL and elevated level of triglycerides in the blood. Patients with metabolic syndrome have an increased risk of developing cardiovascular disease and diabetes mellitus type II. The treatment begins with lifestyle changes that reduce risk factors for metabolic syndrome (obesity and reduced physical activity). If metabolic abnormalities persist after these changes, treatment is directed at diabetes mellitus type II and risk factors of cardiovascular disease. Exercise effectively reduces systolic and diastolic blood pressure, and is associated with an improvement of lipid profile; thereby reducing the concentration of apolipoprotein-B and increasing the level of HDL. Physical activity is positively correlated with insulin sensitivity, leads to an increase of GLUT4 transporters, improves endothelial function and microcirculation. Body weight loss induced by exercise reduces levels of markers of inflammation such as TNFá, IL-6 and CRP. Both modalities of exercise, strength training and aerobic training resulted in reducing HbA1c levels which is associated with decreasing the risk of mortality. The reduction of visceral fat, one of the components of metabolic syndrome, is achieved by aerobic training, while resistance training does not lead to a significant reduction. A modest exercise program decreases visceral fat effectively without changes in caloric intake