The effect of leisure-time physical activity on the presence of metabolic syndrome in patients with manifest arterial disease. The SMART study

Background Physical activity can influence insulin sensitivity and metabolic syndrome (MetS) independent of weight loss. Therefore, we investigated the independent effect of leisure-time physical activity on the prevalence of MetS and insulin resistance in patients with manifest arterial disease and the role of body fat and fat distribution on this relationship. Methods Data were collected from the Second Manifestations of ARTerial disease study, an ongoing prospective cohort study of patients with manifest vascular disease or vascular risk factors at the University Medical Center Utrecht. Data of 1097 patients, mean age 58.3 ± 10.4 years, with clinically manifest arterial disease were used. Information on leisure-time physical activity (sporting or other physical exercise) during the past year was collected using a questionnaire. Patients were classified according to the time spent doing leisure-time physical activities: 0 metabolic equivalent (MET)/h per week (64%), 1.0 to 14.9 MET/h per week (16%), and >15.0 MET/h per week (20%). Results The prevalence of MetS was markedly lower (20%) in physically active patients (>15 MET/h per week active) than in physically inactive patients (36%; odds ratio [OR] 0.50, 95% confidence interval [CI] 0.33-0.75) after adjustment for age, sex, body mass index, and smoking. After adjustment for age, sex, waist circumference, and smoking, the OR of having MetS remained essentially the same (OR 0.59, 95% CI 0.38-0.90). Patients who were active (>15 MET/h per week active) had a considerable lower risk of insulin resistance (homeostasis model assessment determined insulin resistance >2.38) than inactive patients (OR 0.40, 95% CI 0.25-0.64) after adjustment for age, sex, body mass index, and smoking. Conclusions Patients with manifest arterial disease who are physically active are less likely to have MetS and insulin resistance than physically inactive patients, although body weight is comparable between the groups.