Effects of amount, intensity, and mode of exercise training on the metabolic syndrome: A narrative review.
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2025-09
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Abstract
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The purpose of this narrative review is to: 1) summarize findings from the three Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials regarding the differential effects of exercise amount, intensity, and mode on metabolic syndrome (MetS); and 2) compare the STRRIDE findings with other published randomized exercise trials related to changes in MetS.Methods
A literature review was performed to investigate the effects of exercise on composite measures of MetS. PubMed was searched between October 2023 and December 2023. To be included in this review, studies must have employed a randomized study design, whereby exercise amount, intensity, or mode was varied.Results
Findings from the STRRIDE trials and other randomized exercise trials suggest: 1) there is a relationship between exercise energy expenditure (ExEE) and improvements in composite measures of MetS; 2) there may be an asymptotic effect for ExEE beyond which further improvements in MetS are negligible or counterproductive; 3) improvements in composite measures of MetS are closely linked to insulin sensitivity; and 4) without controlling for total ExEE, combined aerobic and resistance training interventions offer the most robust improvements for composite MetS outcomes compared to either mode alone.Conclusion
Additional, large-scale, randomized exercise trials should be designed to investigate the potential asymptotic effect and associated threshold for ExEE, the interaction between exercise intensity and baseline insulin sensitivity, and the independent effects of exercise mode on MetS.Type
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Moseley, Garrett A, Katherine A Collins-Bennett, William E Kraus and Leanna M Ross (2025). Effects of amount, intensity, and mode of exercise training on the metabolic syndrome: A narrative review. Sports medicine and health science, 7(5). pp. 393–403. 10.1016/j.smhs.2025.03.006 Retrieved from https://hdl.handle.net/10161/33847.
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Scholars@Duke
Katherine Collins-Bennett
Katherine A. Collins-Bennett, PhD, NBC-HWC, is an Assistant Professor in the Department of Population Health Sciences and affiliated with the Duke Molecular Physiology Institute at Duke University School of Medicine, and is a board-certified health and wellness coach. She studies barriers and predictors of health-promoting behavior change. The ultimate goal of her translational research is to design trials to optimize health-promoting behaviors for those at risk for "relapse" or cessation of behavioral modification, in order to improve long-term health and well-being.
William Erle Kraus
My training, expertise and research interests range from human integrative physiology and genetics to animal exercise models to cell culture models of skeletal muscle adaptation to mechanical stretch. I am trained clinically as an internist and preventive cardiologist, with particular expertise in preventive cardiology and cardiac rehabilitation. My research training spans molecular biology and cell culture, molecular genetics, and integrative human exercise physiology and metabolism. I practice as a preventive cardiologist with a focus on cardiometabolic risk and exercise physiology for older athletes. My research space has both a basic wet laboratory component and a human integrative physiology one.
One focus of our work is an integrative physiologic examination of exercise effects in human subjects in clinical studies of exercise training in normal individuals, in individuals at risk of disease (such as pre-diabetes and metabolic syndrome; STRRIDE), and in individuals with disease (such as coronary heart disease, congestive heart failure and cancer).
A second focus of my research group is exploration of genetic determinates of disease risk in human subjects. We conduct studies of early onset cardiovascular disease (GENECARD; CATHGEN), congestive heart failure (HF-ACTION), peripheral arterial disease (AMNESTI), and metabolic syndrome. We are exploring analytic models of predicting disease risk using established and innovative statistical methodology.
A third focus of my group’s work is to understand the cellular signaling mechanisms underlying the normal adaptive responses of skeletal muscle to physiologic stimuli, such as occur in exercise conditioning, and to understand the abnormal maladaptive responses that occur in response to pathophysiologic stimuli, such as occur in congestive heart failure, aging and prolonged exposure to microgravity.
Recently we have begun to investigate interactions of genes and lifestyle interventions on cardiometabolic outcomes. We have experience with clinical lifestyle intervention studies, particularly the contributions of genetic variants to interventions responses. We call this Lifestyle Medicopharmacogenetics.
KEY WORDS:
exercise, skeletal muscle, energy metabolism, cell signaling, gene expression, cell stretch, heart failure, aging, spaceflight, human genetics, early onset cardiovascular disease, lifestyle medicine
Leanna Ross
Dr. Ross's research focuses on understanding the mechanisms by which exercise interventions elicit short- and long-term cardiometabolic health benefits. As cardiometabolic disease remains the leading cause of morbidity and mortality in the United States, the goal of her translational research is to enhance the development of evidence-based, precision exercise interventions that optimally prevent and treat disease.
Areas of Research Interest
Exercise dose-response and cardiometabolic health
Insulin action and glucose homeostasis
Legacy health benefits of exercise
Heterogeneity of response to exercise intervention
Precision lifestyle medicine
Epidemiology of physical activity and cardiorespiratory fitness
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