OBJECTIVE -We studied the associations of cardiorespiratory fitness with metabolic syndrome in older men and women, because such data are limited in representative population samples. RESEARCH DESIGN AND METHODS -We studied a population sample of 671 men and 676 women aged 57-79 years at baseline of a randomized controlled intervention study. We assessed maximal oxygen uptake (VO 2max ) by respiratory gas analysis during a maximal bicycle exercise test. RESULTS-VO 2max had a strong, inverse, and graded association with the risk of having metabolic syndrome as defined by the National Cholesterol Education Program criteria. Men and women in the lowest third of VO 2max had 10.2-and 10.8-fold higher risks and those in the middle third had 2.9-and 4.7-fold higher risks (P Ͻ 0.001 all) of metabolic syndrome than those with the highest VO 2max after multivariable adjustments. Factor analysis generated a principal factor that was strongly loaded by the main components of metabolic syndrome and VO 2max (Ϫ0.68 in men and Ϫ0.70 in women).CONCLUSIONS -Low cardiorespiratory fitness is associated with metabolic syndrome in older men and women. Our findings suggest that low cardiorespiratory fitness could be considered a feature of metabolic syndrome. Diabetes Care 31:1242-1247, 2008T he epidemic of metabolic syndrome is due in part to sedentary lifestyle, poor cardiorespiratory fitness, unhealthy diet, and increased overweight and obesity (1). Metabolic syndrome is associated with an increased risk of type 2 diabetes, cardiovascular disease (CVD), and premature mortality (2,3). Higher levels of physical activity and cardiorespiratory fitness have been associated with a decreased risk of developing metabolic syndrome (4 -7) and its consequences of type 2 diabetes, CVD, and premature mortality (8 -11).Only a few population-based studies have been published on the association of cardiorespiratory fitness with metabolic syndrome (4,5,7,12,13). Most have included only young and middle-aged individuals or men and have used indirect measurements of maximal oxygen uptake (VO 2max ). We have previously found strong association of a low VO 2max with an increased risk of having or developing metabolic syndrome in middle-aged men (4,12). Based on factor analysis, we have suggested that poor cardiorespiratory fitness could be considered a feature of metabolic syndrome (12).We assessed the association of directly measured VO 2max with metabolic syndrome and impaired glucose metabolism in a large population sample of older men and women. Because metabolic syndrome consists of highly correlated features, factor analysis was used as a complementary statistical approach. The present study extends our knowledge on the association of cardiorespiratory fitness with metabolic syndrome in middleaged men (12) to older men and women, the fastest growing segment of the population. RESEARCH DESIGN AND METHODS -We used the baseline data of the Dose-Responses to ExerciseTraining Study (DR's EXTRA), which is an ongoing 4-year randomized controlled trial o...

Objective: The aim of the study was to examine the adherence to a salt restriction diet and the effect of salt restriction on blood pressure in free living subjects with mildly elevated blood pressure. Design: Subjects with mildly elevated blood pressure participated in a controlled study on the effect of salt restriction on blood pressure. Subjects received oral and written instructions by a clinical nutritionist to reduce sodium chloride intake to ®ve grams per day. A low sodium bread (0.5%) was supplied free of charge for the subjects during the whole low-sodium period (between weeks 4 ± 24). Subjects and methods: Subjects were recruited from previous studies at the Kuopio Research Institute of Exercise Medicine and from local occupational health care services. Twenty-four men and 15 women aged 28 ± 65 y with the mean daytime ambulatory diastolic blood pressure between 90 ± 105 mmHg and of®ce diastolic blood pressure between 95 ± 115 mmHg were included in the study. Salt intake was monitored by 4-d food diaries and 24-h urinary sodium excretion. Results: Twenty percent of the subjects achieved a urinary sodium excretion level of less than 74 mmola24 h corresponding to a salt intake of ®ve grams per day. There was a signi®cant decline (7.1 AE 12.7a4.2 AE 7.5) in systolic and diastolic blood pressure levels during the salt restriction diet. Conclusions: Even moderate salt restriction seems to be effective in the treatment of mildly elevated blood pressure. However, the recommended salt intake level of less than ®ve grams per day is dif®cult to achieve even after intensive counselling and regular use of low salt bread.

The aim of the study was to describe the levels and to create reference values of cardiorespiratory fitness, expressed as maximal oxygen consumption (VO(2max) ), maximal metabolic equivalents (METs) and maximal workload in aging men and women. We measured VO(2max) directly by a breath-by-breath method during a maximal exercise stress test on a bicycle ergometer with a linear workload increase of 20 W/min in a representative population sample of 672 men and 677 women aged 57-78 years. We presented the age and sex-specific categories of cardiorespiratory fitness (very low, low, medium, high and very high) based on variable distribution and non-linear regression models of VO(2max) , maximal METs and maximal workload. The linear age-related decrement of VO(2max) was -0.047 L/min/year (-2.3%) and -0.404 mL/kg/min/year (-1.6%) in men and -0.027 L/min/year (-1.9%) and -0.328 mL/kg/min/year (-1.6%) in women. After exclusion of diseased individuals, the rate of VO(2max) decrement remained similar. The number of chronic diseases (0, 1, 2 or ≥3) was inversely associated with VO(2max) in men (P<0.001) and women (P<0.001). The present study provides clinically useful reference values of cardiorespiratory fitness for primary and secondary prevention purposes in aging people.

OBJECTIVEWe studied the association of maximum oxygen uptake (Vo2max) with the development and resolution of metabolic syndrome (MetS) for 2 years in older individuals.RESEARCH DESIGN AND METHODSSubjects were a population sample of 1,226 men and women aged 57–78 years. We assessed Vo2max directly by respiratory gas analysis during maximum exercise testing and used dichotomous and continuous variables for MetS.RESULTSOne SD increase in baseline Vo2max associated with 44% (95% CI 24–58) decreased risk of developing MetS. Individuals in the highest third of baseline Vo2max were 68% (37–84) less likely to develop MetS than those in the lowest third. One SD increase in Vo2max increased the likelihood to resolve MetS 1.8 (1.2–2.8) times. Individuals in the highest Vo2max third were 3.9 (1.5–9.9) times more likely to resolve MetS than those in the lowest third.CONCLUSIONSHigher levels of cardiorespiratory fitness protect against MetS and may resolve it in older individuals.

Previous studies have suggested a reduced glucose uptake by the athlete's heart at rest. To examine whether there is a compensatory increase in the myocardial fatty acid utilization, we studied nine male endurance-trained athletes (age 26 +/- 2 yr, VO2max 60 +/- 1 ml.kg-1.min-1, mean +/- SEM) and eight sedentary subjects (age 26 +/- 1 yr, VO2max 38 +/- 2 ml.kg-1.min-1) by single photon emission tomography using 123I-heptadecanoic acid (HDA) and mathematical modeling. Magnetic resonance imaging (MRI) and echocardiography were performed for the measurements of cardiac dimensions and left ventricular (LV) mass. No significant differences were found in the myocardial HDA beta-oxidation index (5.2 +/- 2.0 vs 7.4 +/- 1.6 mumol.min-1.100 g-1, P = NS) between endurance-trained and sedentary subjects. Fractional amounts of HDA beta-oxidation, backdiffusion, and esterification were also similar. In MRI study, LV mass was greater in the trained subjects (213 +/- 9 vs 179 +/- 10 g, P < 0.01) and in particular, LV long-axis diameter measured from the mitral valve level to the apex was increased (102 +/- 2 vs 88 +/- 2 mm, P < 0.001, trained vs sedentary subjects). VO2max correlated with LV long-axis diameter (r = 0.77, P < 0.001). In contrast to our hypothesis, myocardial HDA utilization was not enhanced in endurance-trained athletes at rest. Increases in LV mass and especially in LV long-axis diameter were observed in the athletes, indicating LV longitudinal remodeling.