Exercise Training and Respiratory Muscle Training in Individuals With Metabolic Syndrome(METS)
Condition: Metabolic Syndrome
MeSH terms: Metabolic Syndrome; Syndrome
Study type: Interventional

Summary: 
      The study will be conducted on individuals with Metabolic Syndrome. There are many studies
      showing that aerobic exercise provides significant improvements in waist circumference,
      fasting glucose, high-density lipoprotein cholesterol (HDL-C), Triglyceride (TG), systolic
      and diastolic blood pressure (SBP-DBP), and cardiorespiratory fitness on METS parameters.
      However, although the beneficial effects of physical activity are known, only half of the
      population adheres to the 150 minutes of moderate-intensity physical activity per week
      recommendation. High-intensity interval training (HIIT) is a type of training that uses
      near-maximal intensities in short-term sessions. HIIT has been used to improve compliance
      because it requires less time to treat patients with cardiometabolic disease. Compared to
      continuous aerobic exercise, this type of training has been shown to be an effective
      alternative for improving maximum oxygen consumption (VO2 max), blood pressure, heart
      function, glucose and lipid metabolism, and markers of oxidative stress and inflammation. In
      the literature, HIIT has been studied in patients with METS and has been shown to be
      effective. In addition, a study showed that seven-day respiratory muscle training was also
      effective on METS parameters, but there is no study showing the long-term effects of
      respiratory muscle training in this patient group. Therefore, in our study, researchers aimed
      to show the effects of respiratory muscle training given with HIIT on METS parameters.
    

Detailed description: 
      Metabolic syndrome (METS) is a systemic endocrinopathy characterized by the presence of risk
      factors such as abdominal obesity, glucose intolerance or diabetes mellitus, atherogenic
      dyslipidemia, hypertension, and a persistent proinflammatory profile. According to the
      International Diabetes Federation (IDF) definition of METS, almost 20-25% of the adult world
      population has METS, and people with METS are at risk of heart attack, stroke, type 2
      diabetes (T2D), all-cause and cardiovascular death (approximately three times higher). In
      addition, modifiable risk factors such as physical inactivity, diet, and sedentary behavior
      have all been associated with increased prevalence of METS. Increasing incidence of METS,
      increase in morbidity and mortality necessitated the implementation of preventive strategies
      and the implementation of pharmacological and non-pharmacological treatments.

      Studies in the literature have shown that vagal tone decreases and sympathetic tone increases
      in patients with METS. At the same time, impaired baroreflex sensitivity and decreased heart
      rate variability are observed in these patients. Changes in autonomic modulation cause the
      release of some bioactive molecules by affecting the endocrine and immune systems. In this
      case, increased sympathetic autonomic tone creates a cardiometabolic risk. In adults with
      METS, autonomic dysfunction appears to be more prominent in women than in men. Autonomic
      functions are impaired due to changes such as loss of lean body mass, increase in fat mass,
      increase in body mass, redistribution of fat from the periphery to the middle parts of the
      body, especially in postmenopausal women. As a result, increased blood pressure, impaired
      endothelial function, decreased glucose tolerance, and atherogenic changes in lipid and
      coagulation profiles can be observed. This increases the incidence of METS in postmenopausal
      women. Therefore, strategies to reduce the risk of metabolic syndrome have often been studied
      on women in the literature, and there is a need for studies involving men and new strategies.

      Physical activity and exercise training are recommended as key prescriptions for the
      prevention and treatment of METS and low-grade chronic inflammation . Increase in physical
      exercise has been recommended for the prevention and primary treatment of cardiovascular
      disease (CVD) and METS because of the cardioprotective benefits associated with improved
      cardiorespiratory fitness (CRF). There are many studies showing that aerobic exercise
      provides significant improvements in waist circumference, fasting glucose, high-density
      lipoprotein cholesterol (HDL-C), TG, systolic and diastolic blood pressure (SBP-DBP), and
      cardiorespiratory fitness on METS parameters . However, although the beneficial effects of
      physical activity are known, only half of the population adheres to the 150 minutes of
      moderate-intensity physical activity per week recommendation. It has been shown that one of
      the main barriers to reaping health benefits and being more active is "lack of time".
      High-intensity interval training (HIIT) is a type of training that uses near-maximal
      intensities in short-term sessions. HIIT has been used to improve compliance because it
      requires less time to treat patients with cardiometabolic disease. Compared to continuous
      aerobic exercise, this type of training is an effective alternative to improve maximum oxygen
      consumption (VO2max), blood pressure, heart function, glucose and lipid metabolism, and
      markers of oxidative stress and inflammation . However, it has been seen that there are not
      enough studies on HIIT effectiveness on METS parameters in the literature. Therefore,
      researchers aimed to show the effects of HIIT training applied together with respiratory
      muscle training on METS parameters in patients with METS.

      It has shown the beneficial effects of exercise training as well as inspiratory muscle
      training (IME) on autonomic function in patients with hypertension and heart disease . In a
      study, it was shown that 7-day inspiratory muscle training improved respiratory muscle
      functions and cardiac autonomic functions in postmenopausal women . As a result of this
      study, inspiratory muscle training has been proposed as a nonpharmacological strategy to
      improve autonomic modulation and reduce risk factors in individuals with METS, but further
      studies are required to confirm the long-term effects or effects of inspiratory muscle
      training in addition to classical exercise training protocols such as aerobic, resistance or
      combined training. are needed.

      In a study conducted in healthy and middle-aged men and postmenopausal women in 2021, it was
      proven that high resistance inspiratory muscle strength training can improve blood pressure
      control and vascular endothelial function, and reduce the risk of cardiovascular disease and
      other clinical disorders. In this study, researchers presented the first evidence that
      inspiratory muscle strength training increases NO bioavailability, decreases systemic
      inflammation, and causes potentially beneficial changes in the plasma metabolome by
      increasing endothelial NO synthase activation and decreasing oxidative stress. In conclusion,
      it has been shown that inspiratory muscle strength training can be used as a promising
      lifestyle intervention to improve cardiovascular function and reduce the risk of other
      clinical disorders .

      Since the long-term effects of respiratory muscle training in individuals with METS have not
      been examined in the literature; researchers planned this study to examine the effects of
      inspiratory muscle strength training added to aerobic exercise training (HIIT) on physical
      fitness, respiratory functions and METS parameters in individuals with METS.
    

Intervention name(s): exercise; inspiratory muscle training
Intervention type(s): Other; Device
Intervention description(s): high-intensity interval training will be performed on the treadmill.; Respiratory muscle strength exercise will be performed with the respiratory muscle strengthening device 'POWERbreathe Classic Light Resistance'.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: metabolic syndrome; inspiratory muscle training; high intensity interval training; exercise