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Overview of Metabolic Syndrome

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Metabolic syndrome is a collection of factors associated with central obesity. Central obesity is indicated by waist circumferences of ≥94 cm for men and >80 cm for women. Metabolic syndrome is further determined by any two of the following: raised triglycerides, reduced high-density lipoprotein cholesterol, raised blood pressure, and raised fasting plasma glucose levels or type 2 diabetes.1,2 Clinical management of this syndrome is focused on controlling its risk factors, especially atherosclerosis. Clients with metabolic syndrome have impaired endurance, primarily related to a sedentary lifestyle. Endurance impairments are exacerbated by the development of cardiovascular disease and complications related to type 2 diabetes. Clients using medications for prevention and treatment of cardiovascular disease or type 2 diabetes will need regular evaluation for the effectiveness of these medications.

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Clinical Management Goals for Management of Metabolic Syndrome

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Prevent cardiovascular disease Prevention/treatment of type 2 diabetes
Increase physical activities Reduce intake of saturated fats and cholesterol
Reduce low-density lipoprotein cholesterol levels Reduce elevated blood pressure levels

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Comorbidities to Consider

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  • Clients with metabolic syndrome have a higher risk for cardiovascular disease and type 2 diabetes.

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Client Examination

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Keys to Examination of Clients

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  • Clients need regular examinations to assess blood pressure, fasting blood glucose level, and lipid levels.

  • Discuss with these clients their previous experiences, beliefs, and other conditions that will make them reluctant to begin an exercise program.

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Recommended Baseline Testing of Fitness Levels

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  • Assess endurance with a half-mile walk, 6-minute walk, or 10-meter walk, depending on the client's functional status.3

  • Determine body mass index and waist circumference to assess body composition.3

  • Client's heart rate, blood pressure, and perceived exertion levels should be regularly assessed at beginning of exercise program.

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Exercise Prescription

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Type: Walking, aquatic exercise, weight training

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Intensity: 40%–70% of maximum capacity3,4

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Duration: Start at 15–20 minutes, progress to 60 minutes

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Frequency: 5–7 days per week

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Getting Started

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Walking is the easiest form of exercise to begin and maintain. Clients may benefit from using a pedometer to assess their daily activity levels and to encourage them to walk throughout the day to increase their caloric output. Multiple forms of aerobic exercise are recommended for these clients to improve adherence and to avoid overuse conditions. Clients with morbid obesity may best start an exercise program using aquatic activities. Resistive exercise training is also recommended for these clients, as it improves insulin sensitivity and may enhance metabolism of adipose tissue in the abdominal region.5 A goal of 150 to 250 minutes of total physical activity per week or 1500 ...

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