# Exercise as it relates to Disease/American football players not immune to Metabolic Syndrome

This fact sheet will analyse and critique paper about metabolic health in college football players as an assignment for University of Canberra as part of Health Disease and Exercise course.
This is an analysis of the article “Presence of Metabolic Syndrome in Football Linemen” by Beull et al. (2008)

## Background to the Research

Metabolic syndrome is a clustering of disease risk factors related to heart attacks and cardiovascular health. These risk factors such as, fasting blood glucose, and in turn type 2 diabetes, abdominal obesity, high cholesterol, and high blood pressure all contribute to the increased risk of a heart attack or stroke by 3 times and twice as likely die from such event.
The underlying cause of metabolic still remains largely unknown, central obesity and insulin resistance appear to be significant influences on developing metabolic syndrome. Along with central obesity and insulin resistance, genetic factors, physical activity and ageing play a key role, however the amount of influence they have varies depending on ethnicity. The estimated prevalence of metabolic syndrome is 20-25% of the world population.
While Metabolic Syndrome isn’t a disease itself, the risk factors are considered to be the driving force behind two world epidemics, diabetes and cardiovascular disease, gaining an understanding on causes, treatments, and preventative measures is ever more important.

## Where is the Research From?

The research was conducted by Beull et al. from Ohio State University, Columbus OH, The university of Findlay, Findlay OH, and Capital University, Columbus OH. The research was funded by the National Football League Charities. The article was then published in the Journal of Athletic Training by the National Athletic Trainers Association, the peak body for athletic training. The authors haven't declared any conflicts of interest in this study.

## What type of research was this?

The cross sectional descriptive study means the intention was to describe what the prevalence of metabolic syndrome is in a particular population at a particular time snap. In this case, the prevalence of metabolic syndrome in college football linemen at the beginning of preseason. This type of study is good for determining or describing an issue, as well as determining further areas of research. However, this means that its hard to draw conclusions and causations of that particular disease.

## What did the research involve?

The participants in the study were recruited from three different universities, all of the participants were volunteers and were football linemen. These volunteers were asked to give, height, weight, waist circumference, blood pressure, upper body skinfolds. They were also required to supply a blood sample that was then analysed for fasting blood glucose (FBG), which is the amount of glucose is in the blood in a fasted state (6–8 hours), Cholesterol profile that included, total cholesterol, high density lipoprotein, triglycerides, and calculated low density lipoprotein, fasting insulin which indicates the amount of insulin in the blood in a fasted state, and C-reactive protein which is a marker for inflammation, in particular cardiovascular disease. While the blood was being taken, the phlebotomist surveyed the participants to gain an understanding of the dietary habits, family history regarding cardiovascular disease, their exercise history for the past week, and their injury status. All the data was analysed to determine if there were any correlations and relationships between the risk factors. The American heart association/ national heart, lung, and blood institute criteria was used to determine a diagnosis of metabolic syndrome. This criteria can be seen below presence of 3 or more of these risk factors result in a positive diagnosis.
| Risk Factor | Criteria |
| Blood Pressure | Systolic >130mm Hg or Diastolic >85mm Hg |
| Waist Circumference | >102 cm |
| Fasting Blood Glucose | >5.6 mmol/L |
| High Density Lipoproteins | <1.03 mmol/L |
| Triglycerides | >1.7 mmol/L |

## Basic results

The results were 34 of the 70 participants were diagnosed with having metabolic syndrome using the American Heart Association/ National Heart, Lung, and Blood Institute method. Twenty five of the 34 that resulted in a positive diagnoses had three risk factors, eight had four, while just one participant had four risk factors. The most common three measures that resulted in a positive diagnosis were waist circumference, blood pressure, and high density lipoprotein with 18 participants (26%). A hundred percent of the positive diagnosis included waist circumference above 102 centimetres. These results were interpreted by the researchers as needing more of an emphasis on athlete health. Most people assume the health of college football athletes due to the amount of the exercise and training they do, however this study proves that the linemen are not immune to the epidemic of metabolic disease. The combinations that resulted in a positive diagnosis can be seen below.
| No. of Factors | Combination of Factors | No. of Participants |
| 3 | Waist, BP, HDL | 18 |
| 3 | Waist, TG, HDL | 4 |
| 3 | Waist, FBG, HDL | 1 |
| 3 | Waist, BP, FBG | 1 |
| 3 | Waist, BP, TG | 1 |
| 4 | Waist, BP, TG, HDL | 3 |
| 4 | Waist, BP, FBG, HDL | 5 |
| 5 | Waist, BP, FBG, TG, HDL | 1 |
| | Abbreviations: BP= Blood pressure, FBG= fasting blood glucose, HDL= high density lipoprotein, TG= Triglycerides. |

## What conclusions can we take from this research?

The researchers concentrated on the results in terms of how to manage and treat athletes or football linemen, however correlations between resistance exercise, bulking that is required as a linemen and lack of aerobic exercise are apparent. Demonstrating this research aligns with other studies which have concluded resistance training alone is not a reliable method of treating or preventing metabolic syndrome. Braith & Stewart demonstrate resistance training alone wasn't sufficient enough to prevent some of the risk factors associated with metabolic syndrome. Results from this study showed all but 2 subjects had low levels of high density lipoprotein, which aligns with the work of Braith & Stewart that resistance training showed little evidence to change lipoprotein profile.

## Practical applications

While the nature of the study makes it hard to make real world applications and more research in the area needs to be conducted to make final conclusions, this study indicates that resistance training without the addition of aerobic training is not sufficient enough to prevent or treat metabolic syndrome.

## Further Information

Further information regarding metabolic syndrome and its effects can be found at the following resources:
Better Health: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/metabolic-syndrome
International Diabetes Foundation: http://www.idf.org/metabolic-syndrome

## References

* 1 2 3 4 [1. Buell J, Calland D, Hanks F, Johnston B, Pester B, Sweeney R et al. Presence of Metabolic Syndrome in Football Linemen. Journal of Athletic Training. 2008;43(6):608-616.]
* 1 2 3 2. The IDF consensus worldwide definition of the metabolic syndrome. Obes metabol. 2005;(3):47.]
* ↑ [Beltrán-Sánchez H, Harhay M, Harhay M, McElligott S. Prevalence and Trends of Metabolic Syndrome in the Adult U.S. Population, 1999–2010. Journal of the American College of Cardiology. 2013;62(8):697-703.]
* ↑ NEDARC - Descriptive Study [Internet]. Nedarc.org. 2016 [cited 20 September 2016]. Available from: http://www.nedarc.org/statisticalhelp/projectDesign/descriptiveStudy.html.
* ↑ Grundy S. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-2752.
* ↑ Body Size Changes Among National Collegiate Athletic Association New England Division III Football Players, 1956−2014: Comparison With Age-Matched Population Controls. Journal of Athletic Training [Internet]. 2016 [cited 27 September 2016];. Available from: http://dx.doi.org/10.4085/1062-6050-51.5.14
* ↑ Braith R. Resistance Exercise Training: Its Role in the Prevention of Cardiovascular Disease. Circulation [Internet]. 2006 [cited 27 September 2016];113(22):2642-2650. Available from: http://circ.ahajournals.org/content/113/22/2642.full