Four basic principles must be considered in the practice or prescription of physical training to obtain some physiological effect of training, be it the improvement of physical conditioning or the prevention and treatment of diseases. The first is the principle of overload, which advocates that to have a physiological response to physical training, it must be performed in an overload greater than what is used, controlled by the exercise’s intensity, duration, and frequency. Exercise. The second is the principle of specificity, which is characterized by the fact that specific exercise modalities trigger specific adaptations that promote specific physiological responses. The third is the principle of individuality. Each individual’s biological individuality must be respected in the prescription of a certain exercise program, as the same overload and exercise modality will provoke different magnitudes in different individuals. The fourth and last principle is the principle of reversibility, characterized by the physiological adaptations promoted by the performance of physical exercise return to the original pre-training state when the individual returns to a sedentary lifestyle (20).
The performance of at least 30 minutes of physical activity (which can be formal or leisure, continuously or accumulated in sessions of at least 10 minutes), of at least moderate intensity (level 12 on the Borg scale3 – fig. 3 ), performed on most days of the week (preferably all), in which there is a total expenditure of 700 to 1,000 kcal (kilocalories) per week, has been proposed for the maintenance of health and prevention of a wide variety of chronic diseases (6-9).
However, for the health benefits and safety of the regular practice of activity to be maximized, it is necessary to have an exercise prescription that considers the practitioner’s needs, goals, initial abilities, and history (20,67,68). In addition, for treating certain diseases, such as obesity, this amount of exercise is insufficient (16). These factors lead us to believe that individuals with metabolic syndrome, as they present risk factors for cardiovascular disease, will obtain greater benefits from the regular practice of physical activity if it is individually planned, focusing on improving their health status, and considering your health status, risk factors, and physical ability, as well as your history and goals.
The amount of research on the effects of resistance training on metabolism is small compared to aerobic exercise. However, based on current review studies (20,65,66), we propose that a physical activity program focused on preventing and treating metabolic syndrome should include components that improve cardiorespiratory fitness, muscle strength, and endurance.
The performance of these exercises is based on the following reasons:
– Both resistance and aerobic exercise promote substantial benefits in factors related to health and fitness (fig. 4 ), including most risk factors for metabolic syndrome (13,42).
The mechanisms by which resistance and aerobic exercise affect some metabolic syndrome variables, such as insulin resistance, glucose intolerance, and obesity, seem different (14,16,42). There may be a summation of the effects of the two activities.
With aging, there is a decrease in strength and muscle mass, which are associated with a series of dysfunctions, including metabolic dysfunctions (fig. 3 ); resistance exercise performance can prevent or control this condition (42,45).
– Physical conditioning, which is defined as the ability to perform moderate to intense physical activity without excessive fatigue and the ability to maintain this ability throughout life, is an integral part of good quality of life and the performance of resistance and aerobic exercise, together with flexibility exercises, has been widely recommended for the improvement and maintenance of physical conditioning, as well as for the prevention and rehabilitation of cardiovascular diseases, in adults of all ages (6,42,68-71).
Although the minimum dose of exercise needed to achieve many health benefits is known, the optimal dose for the prevention and treatment of most disorders is still unknown.
Regarding aerobic exercises, it has been recommended that they be performed three to six times a week, with an intensity of 40 to 85% of the FCR4(40 to 85% of, or 55 to 90% of HRmax or level 12 to 16 on the Borg scale), and duration of 20 to 60 minutes (7,68). Because higher exercise intensities are associated with higher cardiovascular risk and orthopedic injury and lower adherence to physical activity programs (68), it is recommended that programs aimed at sedentary individuals with risk factors for cardiovascular disease emphasize moderate intensity (50 to 70% of FCR and levels 12 to 13 on the Borg scale) and prolonged duration (30 to 60 minutes) (9.68).
The current recommendation for the practice of resistance exercise is a series of eight to 12 repetitions (10 to 15 for individuals over 50/60 years), the intensity of 50 to 70% of the maximum load5(13 to 15 on the Borg scale), performed with eight to 10 exercises that work all the major muscle groups, two to three times a week (7,67,68). However, this recommendation is based only on improvements in muscle strength and endurance (72). Performing a greater number of sets (two to three) will increase the energy expenditure of the exercise session, which may increase the benefit of the activity for individuals with metabolic syndrome. Therefore, we recommend that individuals with metabolic syndrome start with one set and, after adaptation, increase to two and then three sets.
All physical activity sessions, aerobic and resistance, should include warm-up and cool down, using flexibility exercises at the beginning and end of each session (figure 5 ).
PRECAUTIONS FOR PHYSICAL ACTIVITY PRACTICE
Despite the beneficial Effect of physical activity on the prevention and treatment of diseases, it is known that the relative risk of a cardiovascular event or musculoskeletal injury during the practice of physical exercise is greater than in usual activities (68). Thus, some care must be taken concerning the practice of physical activity by patients with metabolic syndrome.
Before starting a physical activity program, an individual should undergo an evaluation of recent medical history. In individuals with metabolic syndrome, exercise testing is recommended for cardiovascular assessment. If the exercise test does not show abnormalities, no other assessment is necessary, except for individuals with type 2 diabetes. However, suppose the test shows any abnormality. In that case, the individual must perform other tests as needed, and the exercise prescription will be according to the exercise recommendations for individuals with cardiovascular disease (7).
For individuals with type 2 diabetes, in addition to cardiovascular evaluation, it is recommended to assess the presence of peripheral arterial disease (signs and symptoms of intermittent claudication, decreased or absent pulses, atrophy of subcutaneous tissues, etc.), retinopathy, kidney disease, and autonomic neuropathy (51). It is important to emphasize that none of these diseases prevent the patient from participating in physical activity programs. Still, they influence the modality and intensity of the exercise to be prescribed.
During the practice of physical activity, attention should be paid to proper clothing. The use of light and comfortable clothing is recommended (T-shirt, shorts or tactel or cotton pants ). Comfortable shoes with soft soles and good impact absorption are recommended (73). Attention should also be paid to hydration control before starting and during the exercise session, especially in diabetic individuals (20,51).
For diabetic patients, special attention should be paid to the feet and glycemic control. The use of soft insoles and cotton socks to keep the foot dry is important to minimize trauma. Patients should be educated to constantly check for blisters and any other type of injury before and after each exercise session. In patients using insulin or other medication to control blood glucose, attention should be paid to the medication schedule so that the patient does not perform the activity in a hypoglycemic state.
Received on 4/1. 2 the version received on 22/5/04. Accepted on 5/25/04