1. Metabolic syndrome is a cluster of risk factors

Metabolic syndrome is the name given to a combination of specific risk factors that commonly occur together to raise the risk of chronic disease.

Diagnosis of metabolic syndrome is based on an individual having at least three of five metabolic risk factors: central obesity, raised blood pressure (or on antihypertensive medication), raised triglycerides, lowered high-density lipoprotein cholesterol (or on cholesterol-altering medications) and raised fasting glucose (Alberti et al 2009).

These risk factors are commonly present in individuals but are particularly dangerous when they occur in combination.

The causes of metabolic syndrome are complex; it is thought to primarily result from an imbalance between calorie intake and energy expenditure, but it is also impacted by genetic and epigenetic factors.

2. Metabolic syndrome increases risk of morbidity and mortality

People with metabolic syndrome are twice as likely to develop cardiovascular disease and stroke (Mottillo et al 2010) and three to six times more likely to develop diabetes (Meigs et al 2007, Grundy et al 2016).

Metabolic syndrome is also associated with an increased risk of a number of common cancers including liver and colorectal cancer (Esposito et al 2012).

People with metabolic syndrome have a 1.5-fold increase in all-cause mortality (Mottillo et al 2010) and have double the healthcare utilisation and costs of people without metabolic syndrome (Boudreau et al 2009).

The diagnosis of metabolic syndrome provides a unique opportunity to identify people most at risk of developing chronic disease.

This way, we can intervene early before these conditions emerge to prevent chronic disease and improve health and wellbeing.

3. Metabolic syndrome is a hidden condition—many of your clients may have it

Many of your clients who you see for other conditions probably have metabolic syndrome. One-third of all Australian adults have metabolic syndrome and these rates are even higher in people with osteoarthritis, older adults and people with obesity.

This means that many of your day-to-day clients will have metabolic syndrome (and probably don’t know it).

Physiotherapists in the community are ideally placed to implement preventative lifestyle interventions but may be limited by the fact that metabolic syndrome is under-recognised and under-diagnosed.

Physiotherapists are also ideally placed to detect the condition early in otherwise healthy individuals presenting for treatment.

By taking a thorough history, you will be able to quickly identify the presence of metabolic syndrome in your clients so that you can intervene (or refer) before it’s too late.

Lifestyle modification is the first line of intervention to manage metabolic syndrome, as improvements in diet and exercise are effective in the management of the individual factors that contribute to metabolic syndrome and in reversing the root causes of metabolic syndrome (poor diet, sedentary lifestyle and overweight/ obesity).

A recent systematic review (van Namen et al 2019) of 10 randomised controlled trials found that lifestyle intervention programs comprising diet and exercise reduce the prevalence of metabolic syndrome by 40 per cent; reduce waist circumference, blood pressure, cholesterol and fasting glucose; and increase fitness.

Effective interventions included the basic building blocks of group-based, supervised exercise programs and education or behavioural counselling on healthy eating.

Longer term studies have shown that lifestyle intervention programs which improve immediate outcomes also lead to reduced risk of future disease.

5. Supervised, combined exercise programs appear to be best

Exercise programs that are supervised by healthcare professionals and comprise both aerobic and strengthening exercises (eg, circuit class exercise) appear to be most effective at reversing metabolic syndrome.

Although moderate-intensity walking is beneficial to improve health and reduce mortality in the general population, and does have a positive impact on metabolic risk factors, current evidence suggests combined aerobic and resistance training may be superior for people with metabolic syndrome and other related conditions such as diabetes and obesity (Schwingshackl et al 2013, Schwingshackl et al 2014).

Physiotherapists are well placed and adequately skilled to deliver such interventions to people with metabolic syndrome in the community, and there is evidence to suggest that exercise alone can cause sufficient benefit.

However, physiotherapists could work collaboratively with accredited practising dietitians to deliver multifaceted interventions to optimally improve the health and wellbeing of people living with metabolic syndrome to prevent chronic disease.

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Dr Casey Peiris is a senior lecturer at La Trobe University whose research focuses on physical activity and chronic disease in at-risk populations. Casey has investigated physical activity levels in rehabilitation, people with disability, older adults and people with metabolic syndrome. She is a member of the Physiotherapists for Physical Activity group: physiosforpa.com and @PhysiosforPA