Active Voice: Exercise Training Halts the Increase in Medicine Use that Occurs in Sedentary Individuals with Metabolic Syndrome

By Ricardo Mora-Rodriguez, Ph.D., and Felix Morales-Palomo, M.Sc.

Ricardo Mora-Rodriguez, Ph.D. Felix Morales-Palomo, M.Sc.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM.

Ricardo Mora-Rodriguez, Ph.D., is a professor of exercise physiology in the Department of Sport Sciences at the University of Castilla-La Mancha in Spain. Dr. Mora-Rodriguez’s research is focused on understanding how exercise interacts with habitual medication to improve the health of individuals with metabolic syndrome.

Felix Morales-Palomo is a Ph.D. candidate in the Department of Sport Sciences at the University of Castilla-La Mancha.

Today’s feature commentary relates to the research paper that Dr. Mora-Rodriguez and Mr. Morales-Palomo published with other colleagues. Their paper appears in the October 2018 issue of
Medicine & Science in Sports & Exercise® (MSSE) and is entitled “Exercise periodization over the year improves metabolic syndrome and medication use.”

Abdominal obesity, hypertension, hyperglycemia and dyslipidemia (high blood triglycerides and low HDL-cholesterol) are the five components of metabolic syndrome (MetS). MetS is an increasingly prevalent clinical condition that often develops into Type 2 diabetes and cardiovascular disease. Clinicians treat metabolic syndrome initially with lifestyle modifications that include reduction in calorie intake and participation in exercise training. However, if conditions do not improve, doctors are bound to prescribe medication to lower those risk factors. Thus, diet, exercise training and pharmacological interventions often co-exist, while our knowledge of the interactions between these treatments is scarce.

ACSM’s praiseworthy proposal that Exercise is Medicine® holds promise that, if somebody embraces exercise training, this nonpharmacological medicine should serve to improve status on the MetS components (or at least prevent these from worsening) and reduce the dose of pharmacological medicine required, i.e., drug treatment. However, results from exercise-intervention studies to support this view are not rapidly emerging. Uncertainties on the dose-response relationship between exercise and health improvements, differences in individual responsiveness to the effects of exercise and even confounding factors, such as patients’ habitual medication usage and variations in exercise habits, perhaps are preventing scientists from getting a clear picture.

In our recent study, as reported in the October 2018 issue of MSSE, we followed two groups of individuals during two consecutive years. The groups had similar characteristics (average age 53 years; BMI 33 kg/m2; 32 percent women) and possessed 3.6 out of the five MetS components that comprise the syndrome. One group underwent exercise training for four months every year, while the other group remained sedentary. We used a high-intensity interval training (HIIT) program, since recent findings suggest this is a time-conserving and effective means to achieve the desired health-oriented adaptations. We measured the yearly evolution of the MetS components, as well as medication use in each participant.

All participants in the study were under the supervision of their primary care physicians, and their care was managed using established treatment guidelines. Those guidelines require lifestyle counseling, blood analysis every six months and pharmacological prescription adjusted to blood chemistry, blood pressure values and body weight evolution. Participants brought all prescription medication to their baseline visit, as well as their one- and two-year visits to ensure recording accuracy. Only medicines to control hyperglycemia, hypertension and dyslipidemia (components of MetS) were computed. To account not only for the number of medicines used, but also for the evolution of dosages over the two-year period, a medicine use score was devised. Evaluations also were held after seven months of detraining to test the persistent, rather than the acute, effects of exercise training.

During the two-year follow-up, the sedentary group maintained MetS; this was likely due to an increased medication use. In contrast, the exercise training group improved their status on MetS, mostly due to reductions in blood pressure after the first year. Importantly, this improvement in MetS status took place without increase in medicine prescription. Thus, yearly exercise training halted the increase in medicine use that occurred in the sedentary MetS group.

This last finding highlights that, at least in our group of patients with MetS, exercise is indeed medicine — keeping patients from the progressive filling of their pillbox. The potential implications of maintaining or lowering medicine use by exercise training are enormous. It could reduce health care costs (i.e., doctor visits, blood analysis, pharmacy cost), reduce the side effects associated with polypharmacy and improve quality of life — all of which are worth exploring through further investigation.