Concurrent training and interindividual response in women with a high number of metabolic syndrome risk factors

Abstract

The non-responders (NRs) after exercise training have been poorly studied in populations with morbid obesity. The purpose of this study was to determine the NR prevalence after 20 weeks of concurrent training of morbidly obese women with a high or low number of metabolic syndrome (MetS) risk factors. Twenty-eight women with morbid obesity participated in an exercise training intervention and were allocated into two groups distributed based on a high (≥3, n = 11) or low number (<3, n = 17) of MetS risk factors. The main outcomes were waist circumference (WC), fasting plasma glucose (FPG), high-density lipids (HDL-c), triglycerides (Tg), and systolic (SBP) and diastolic (DBP) blood pressure, and secondary outcomes were body composition, anthropometric and physical fitness, determined before and after 20 weeks of concurrent training. NRs were defined as previously used technical error cut-off points for the MetS outcomes. Significantly different (all p < 0.05) prevalences of NRs between the H-MetS vs. L-MetS groups (respectively) in WC (NRs 18.2 % vs. 41.1 %, p < 0.0001), SBP (NRs 72.7 % vs. 47.0 %, p = 0.022), DBP (NRs 54.5 % vs. 76.4 %, p < 0.0001), FPG (NRs 100% vs. 64.8 %, p < 0.0001), and HDL-c (NRs 90.9 % vs. 64.7 %, p = 0.012) were observed. In addition, the H-MetS group evidenced significant changes on ΔSBP (-10.2 ± 11.4 mmHg), ΔFPG (-5.8 ± 8.2 mg/dl), ΔHDL-c (+4.0 ± 5.9 mg/dl), and ΔTg (-8.8 ± 33.8 mg/dl), all p < 0.05. The L-MetS group only showed significant changes in ΔWC (-3.8 ± 5.0 cm, p = 0.009). Comparing H-MetS vs. L-MetS groups, significant differences were observed in ∆FPG (-5.8 ± 8.2 vs. +0.3 ± 3.2 mg/dl, p = 0.027), but not in other MetS outcomes. In conclusion, 20 weeks of concurrent training promotes greater beneficial effects in morbidly obese patients with a high number of MetS risk factors. However, the NR prevalence for improving MetS outcomes was significantly superior in these more-diseased groups in SBP, FPG, and HDL-c, independent of their major training-induced effects.

Keywords: exercise; morbid obesity; physical activity; quality of life; sleep quality.

FIGURE 1

Metabolic syndrome outcomes before and after (A,C,E), and delta changes (B,D,F) between two groups of a different number of risk factors for metabolic syndrome. Groups are described as H-MetS-Pre, high number of metabolic syndrome risk factors groups at pre-test; H-MetS-Post, high number of metabolic syndrome risk factors groups at post-test; L-MetS-Pre, low number of metabolic syndrome risk factors group at pre test; L-MetS-Post, low number of metabolic syndrome risk factors group at post test. Outcomes are described as; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure. (&) Denotes the significantly different versus baseline L-MetS group at p < 0.05. (d) Denotes Cohen d effect size at p < 0.05. (*) Denotes the significant differences between the H-MetS vs. L-MetS group at p < 0.05. (ns) Denotes no significant differences between groups.

FIGURE 2

Metabolic syndrome outcomes before and after (A,C,E), and delta changes (B,D,F) between two groups of a different number of risk factors for metabolic syndrome. Groups are described as H-MetS-Pre, high number of metabolic syndrome risk factors group at pre-test; H-MetS-Post, high number of metabolic syndrome risk factors group at post-test; L-MetS-Pre, low number of metabolic syndrome risk factors group at pre-test; L-MetS-Post, low number of metabolic syndrome risk factors group at post-test. Outcomes are described as; FPG, fasting plasma glucose; HDL-c, high-density lipoprotein cholesterol; Tg, triglycerides. (&) Denotes significantly different versus baseline L-MetS group at p<0.05. (d) Denotes Cohen d effect size at p < 0.05. (*) denotes significant differences between the H-MetS vs. L-MetS group at p < 0.05. (ns) denotes no significant differences between groups. (^#) Denotes the comparison analyzed by the Mann–Whitney non-parametric test.

FIGURE 3

Interindividual changes in metabolic syndrome markers between two groups of a different number of risk factors for the metabolic syndrome. Groups are described as H-MetS, high number of metabolic syndrome risk factors group; L-MetS, low number of metabolic syndrome risk factors group; and L-MetS, low number of metabolic syndrome risk factors group at post test. Outcomes are described as WC (panel A), waist circumference; SBP, systolic blood pressure (panel B); DBP, diastolic blood pressure (panel C); FPG, fasting plasma glucose (panel D); HDL-c, high-density lipoprotein cholesterol (panel E); Tg, triglycerides (panel F); Rs, responders; and (NRs) non-responders for improving MetS outcomes. (NRs zone) Denotes all the gray areas in which participants classified as NRs using the TE parameter. TE, technical error of measurement.

FIGURE 4

Quality of life dimensions before and after (A,C,E), and delta changes (B,D,F) between two groups of a different load of risk factors for metabolic syndrome. Groups are described as H-MetS-Pre, high metabolic syndrome risk factor group at pre test; H-MetS-Post, high metabolic syndrome risk factor group post test; L-MetS-Pre, low-metabolic syndrome risk factor group at pre test; L-MetS-Post, low-metabolic syndrome risk factor group at post test; HRQoL, health-related quality of life scores from the SF-36 instrument. (d) Denotes Cohen d effect size at p < 0.05. (ns) Denotes no significant differences between groups. (^#) Denotes the comparison analyzed by the Mann–Whitney non-parametric test.