Education-based, lifestyle intervention programs with unsupervised exercise improve outcomes in adults with metabolic syndrome. A systematic review and meta-analysis.

To determine whether lifestyle intervention programs comprising dietary intervention and prescribed, unsupervised exercise improve outcomes for people with metabolic syndrome. A systematic review and meta-analysis of randomised controlled trials. Online databases CINAHL, MEDLINE, PubMed and Embase were searched from the earliest date available to October 2020. Post-intervention data were pooled to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) using inverse variance methods and random effects models. Trial methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and overall quality of each meta-analysis was assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Eleven studies from 9 randomised controlled trials with 1,835 participants were included. There was high quality evidence that lifestyle intervention programs with unsupervised exercise reduced waist circumference (MD -2.82 cm, 95%CI -5.64 to 0.00, I2 91%) and blood pressure (systolic: MD -3.89 mmHg, 95%CI -5.19 to -2.58, I2 4%; diastolic: MD -3.16 mmHg, 95%CI -4.83 to -1.49, I2 50%) and increased physical activity levels (SMD 0.47, 95%CI 0.24 to 0.70, I2 45%) when compared to usual care. There was low quality evidence that they improved quality of life (SMD 0.59, 95%CI 0.05 to 1.13, I2 84%). Unsupervised programs had no significant effect on fasting blood glucose (unless > 3 months duration), metabolic syndrome prevalence or cholesterol. Lifestyle intervention programs with prescribed, unsupervised exercise are a practical alternative to supervised programs for people with metabolic syndrome when time, access or resources are limited or when social distancing is required.

Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis.

BACKGROUND: Metabolic syndrome is characterised by a clustering of metabolic risk factors including abdominal obesity, raised triglycerides, lowered HDL cholesterol, hypertension and impaired glucose tolerance. Multifaceted lifestyle interventions including diet and exercise are recommended as the first-line treatment for the metabolic syndrome. OBJECTIVE: To investigate the effects of lifestyle interventions that include both diet interventions and supervised exercise on outcomes for people with metabolic syndrome. METHODS: A systematic review and meta-regression was conducted. PubMed, EMBASE, MEDLINE and CINAHL were searched from the earliest date possible until November 2018 to identify randomised controlled trials examining the effects of lifestyle interventions compared to usual care on patient health outcomes and components of metabolic syndrome. Post-intervention means and standard deviations were pooled using inverse variance methods and random-effects models to calculate mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (CI). RESULTS: Searching identified 2598 articles, of which 15 articles reporting data from 10 trials, with 1160 participants were included in this review. Compared to usual care, supervised lifestyle intervention demonstrated significant improvements in all but one of the components of metabolic syndrome. Reductions were seen in waist circumference (-4.9 cm, 95%CI -8.0 to -1.7), systolic blood pressure (-6.5 mmHg, 95%CI -10.7 to -2.3), diastolic blood pressure (-1.9 mmHg, 95%CI -3.6 to -0.2), triglycerides (SMD -0.46, 95%CI -0.88 to -0.04) and fasting glucose (SMD -0.68, 95%CI -1.20 to -0.15). Prevalence of metabolic syndrome was reduced by 39% in intervention group participants compared to control group participants (Risk Ratio 0.61, 95%CI 0.38 to 0.96). Improvements in quality of life were not statistically significant. CONCLUSION: There is low to moderate quality evidence that supervised multifaceted lifestyle intervention improves multiple risk factors of metabolic syndrome, as well as reducing prevalence of the disease. Health services should consider implementing lifestyle intervention programs for people with metabolic syndrome to improve health outcomes and prevent progression to chronic disease.