Exercise, insulin resistance, and hypertension: a complex relationship. 
More than 300,000 deaths occur annually in the United States alone as a result of obesity, poor dietary habits, or physical inactivity.  Obesity is now an increasingly recognized independent risk factor for cardiovascular disease and leads to numerous other comorbidities.  The causal relationships between obesity and both insulin resistance and hypertension have been consistently demonstrated in numerous studies.  The relationships consist of cascading events involving insulin, leptin, adiponectin, and other hormones that often precipitate the development of metabolic syndrome.  As we learn more about the metabolic activity of the adipose tissue, we can better identify the mechanisms that associate weight reduction with a decrease in health risks.  Evidence suggests that exercise produces a positive effect on weight reduction, insulin sensitivity, and blood pressure.  Therefore, weight reduction and therapeutic changes in lifestyle should be encouraged in all overweight and obese patients.  It is imperative to increase the awareness of the obesity epidemic and to emphasize the importance of exercise as both treatment and prevention of metabolic disease.