https://orcid.org/0000-0002-2575-1236
Abstract
Purpose
To determine the relationship between self-reported physical activity and the components of premorbid metabolic syndrome in patients treated in primary care according to sex.
Methods
Cross-sectional descriptive study conducted on a sample of 2,359 patients without cardiovascular disease or diabetes, included in the cohort of the IBERICAN study. Using ANOVA models and adjusting for age, economic status, employment situation, level of education, adherence to a Mediterranean diet, tobacco use and alcohol consumption, we estimated the association of the variables blood pressure, triglycerides, HDL cholesterol, blood glucose and waist circumference with the self-reported level of physical activity (sedentary, moderate, high, very high). The analyses were performed stratifying by sex.
Results
A total of 854 men and 1,505 women with no identified diseases were included. Women were more sedentary than men (p<0.004; OR = 1,35; IC95% = 1,10–1,65) and presented lower values in all the components of the metabolic syndrome, except for HDL-cholesterol, which was higher (p<0.001). The adjusted ANOVA model shows that diastolic blood pressure, triglycerides, fasting blood glucose, and waist circumference were significantly lower the higher the level of physical activity in both men and women (p<0.05).
Conclusions
Patients served in primary care clinics without diabetes or cardiovascular disease and with high levels of physical activity showed better metabolic syndrome profiles. Given that women are more sedentary, gender approaches are needed in the promotion of physical activity to prevent metabolic syndrome and cardiovascular disease.
Figures
Citation: Micó-Pérez RM, Hernández Segura N, Martín-Sánchez V, Barquilla-García A, Velilla-Zancada SM, Polo-García J, et al. (2025) Physical activity and metabolic syndrome in primary care patients in Spain. PLoS ONE 20(1): e0317593. https://doi.org/10.1371/journal.pone.0317593
Editor: Mohammad Arfat Ganiyani, Miami Cancer Institute, Baptist Health South Florida, UNITED STATES OF AMERICA
Received: May 8, 2024; Accepted: January 1, 2025; Published: January 24, 2025
Copyright: © 2025 Micó-Pérez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files. More details are available from Cinza-Sanjurjo et al. Medicina de Familia SEMERGEN. 2020;46(1):4-15 and https://drive.google.com/drive/folders/1seALW3CX5Xlmq0dephH250-HCrN5Nwrv?usp=drive_link.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
1. Introduction
Metabolic syndrome (MetS) is a global health concern, encompassing key cardiovascular risk factors such as diabetes, prediabetes, abdominal obesity, dyslipidemia, and high blood pressure. It is a significant precursor to cardiovascular diseases (CVD) and other chronic conditions [1,2]. Premorbid MetS is defined by the presence of three out of five diagnostic criteria: increased waist circumference, elevated blood pressure, high triglycerides, elevated blood glucose, and reduced high-density lipoprotein cholesterol (HDL-c) [3]. In Spain, the incidence of metabolic syndrome continues to with approximately more than 90,000 new cases diagnosed each year, partly due to sedentary lifestyles [4].
Physical inactivity is one of the main risk factors for mortality from non-communicable diseases, contributing to 830,000 deaths and 15.75 million disability-adjusted life years worldwide in 2019 [5]. It has been shown that people with an insufficient level of physical activity (PA) have a 20% to 30% higher risk of death compared to people who get a sufficient level of PA [6]. However, populations adhering to healthier lifestyles exhibit higher life expectancy and quality of life, with reduced morbidity and mortality [7]. Despite this, recent surveys indicate a decline in PA levels in Western societies compared to previous generations with a prevalence of sedentary behavior of 25.7% in Spain [1,8,9]. The World Health Organization (WHO) recommends at least 150 minutes of moderate-intensity PA or 75 minutes of vigorous-intensity PA per week for adults [10,11]. Non-compliance with these recommendations is linked to increased risks of coronary heart disease, cancer, diabetes, anxiety, depression, cognitive impairment, and reduced life expectancy [12,13].
Primary Care (PC) plays a crucial role in disease prevention and health promotion by encouraging healthy lifestyles [14]. The potential impact of promoting PA from PC is substantial, with estimates suggesting that 20% of deaths could be prevented if individuals met minimum PA recommendations [15,16]. Despite this, the incorporation of PA into MetS prevention strategies remains underutilized [1].
The prevalence of MetS increases with age, is higher in men than women, and varies by race and ethnicity. There is an inverse relationship between PA and MetS, more pronounced in men, and it is known that a physically active lifestyle can prevent or delay the onset of MetS in young adults [17–20]. Recent evidence underscores the importance of a sex-specific approach to promote PA more effectively and to deepen our understanding of sex-based differences in the development and impact of MetS and cardiovascular disease (CVD). Such an approach could lead to improved health outcomes and more tailored healthcare strategies [21,22].
In the IBERICAN study (Identification of the Spanish Population at Cardiovascular and Renal Risk), carried out on Spanish adult population served in PC to identify the Spanish adult population at cardiovascular and renal risk, one of the secondary objectives was to determine the impact of healthy lifestyles, specifically PA, on CVD [23,24]. In this study, we aim to study the effect of self-reported PA on the components of MetS and, consequently, on the prevention of CVD, according to sex. We analyzed this relationship in patients without diabetes mellitus (DM) or CVD included in the cohort of the IBERICAN study, differentiating by sex and other sociodemographic factors.
2. Material and methods
2.1. Study design
The IBERICAN study is an epidemiological, multicenter, observational, prospective study that is being carried out in PC in Spain in patients of the National Healthcare System, and whose design and characterization of the population have already been published [25]. Fieldwork for this sub-study was conducted between June 2014 and December 2018. A total of 519 family physicians participated in the study, who used consecutive sampling to select at least 10 patients who met the following inclusion criteria: (1) be between 18 and 85 years old, (2) be a user of the Spanish National Health System and attend a PC centre and (3) be resident in Spain within the last 5 years.
The study was classified by the Spanish Agency for Medicines and Health Products (AEMPS) as a Non-Post-Authorization Observational Study (Non-PAS) on January 23, 2013. It was approved by the Clinical Research Ethics Committee (CREC) of Hospital Clínico San Carlos in Madrid on February 21, 2013 (CP IBERICAN-CI13/047-E) and is registered at https://clinicaltrials.gov under number NCT02261441. The results provided in this paper correspond to a cross-sectional analysis of the subjects included in the study up to December 15, 2018.
2.2. Data collection
The subjects included in the study underwent a conventional examination of clinical and analytical parameters according to standard clinical practice. Analytical determinations were considered valid if they had been performed up to six months before the patient’s inclusion in the study or if they were conducted at the time of inclusion.
The data collection process from the case report forms (CRF) was carried out using remote capture: e-clinical. This process refines the data entry techniques by filtering CRF variables, thereby reducing errors and reducing the time between data collection processes and the publication of study results. The researcher accessed a public Uniform Resource Locator (URL) on the Internet, which required him to identify himself as a member of the research community of SEMERGEN (Spanish Society of Primary Care Physicians) with a username and password. Once validated, he accessed an implemented data collection system. All collected information can be consulted in the study by Cinza Sanjurjo et al. [25].
2.3. Study variables
The exposure variable was categorized into four categories (sedentary, moderate, high, and very high) based on the PA practice reported by the patients in the baseline questionnaire. Those who reported not exercising at all were classified as sedentary. People who actively exercised between 30 and 60 minutes a day were classified into the moderate group. Those who actively exercised for at least 60 minutes a day were assigned to the high moderate group. Finally, the subjects who indicated that they regularly practiced sports were classified into the very high group.
Systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured in mmHg, as well as HDL cholesterol, triglyceride and fasting blood glucose concentrations in mg/dl and waist circumference in cm were used as outcome variables.
2.4. Statistical analysis
First, a descriptive study of the sample of 2359 patients without CVD and DM was carried out (S1 Fig). To analyze differences between men and women, the chi-squared test was used for qualitative variables, and the Wilcoxon test for quantitative variables, due to the lack of normality in the data. To analyze differences between sexes based on the level of physical activity, a logistic regression was conducted.
Next, two models of ANOVA analysis of variance were created: model I, adjusting for age, socioeconomic status, employment situation and level of education; and model II, adjusting for age, socioeconomic status, employment situation, level of education, adherence to a Mediterranean diet, tobacco use, family history of cardiovascular event, and alcohol consumption. These two models were used to evaluate whether there were differences based on the level of PA (sedentary, moderate, high and very high) in SBP, DBP, as well as in triglycerides, HDL cholesterol, blood glucose and waist circumference stratified by sex. Statistically significant interactions were explored and nominal p values and their 95% confidence intervals (95% CI) were reported. P-values < 0.05 were considered statistically significant. The Stata version 16 statistical software was used, as well as version R 3.6 for graphs and statistical calculations.
3. Results
The study included 2359 patients, 854 men and 1505 women, whose characteristics are presented in Table 1. The proportion of women who did not do PA was 25.65% compared to 20.37% of men (p<0.004; OR = 1.35; IC95% = 1.10–1.65). On the other hand, 20.02% of men had a very high level of PA compared to 8,97% of women (p<0.001; OR = 2.54; IC95% = 1.99–3.24). No significant differences were found between men and women in employment situation, level of education, adherence to a Mediterranean diet and family history of cardiovascular events (p>0.05). On the contrary, in addition to the level of PA, statistically significant differences were found according to sex in economic level, tobacco use, alcohol consumption, BMI, age, SBP, DBP, triglycerides, HDL cholesterol, blood glucose levels and waist circumference (p<0.05).
Table 2 and Fig 1 show that in women, a statistically significant trend towards lower SBP and DBP, lower triglyceride and glucose levels, as well as lower waist circumference, was observed with higher self-reported physical activity levels. Specifically, women with very high levels of physical activity had an average SBP of 114.78 mmHg and an average DBP of 70.18 mmHg, compared to 119.88 mmHg (p = 0.001) and 73.25 mmHg (p = 0.017), respectively, in sedentary women. Additionally, triglyceride and glucose levels in women with very high physical activity were 85.58 mg/dL and 86.41 mg/dL, respectively, compared to 101.61 mg/dL (p < 0.001) and 89.66 mg/dL (p = 0.027) in sedentary women. Waist circumference was also lower in athletic women (82.31 cm) compared to sedentary women (88.68 cm, p < 0.001).
Model adjusted for age, socioeconomic status, employment situation, level of education, physical activity, Mediterranean diet, tobacco use, alcohol consumption, and family history of cardiovascular event. * p<0.05.
In men, a statistically significant trend towards lower DBP, triglyceride, and glucose levels, as well as lower waist circumference and higher HDL cholesterol level, was observed with higher self-reported physical activity levels. Men with very high levels of physical activity showed an average DBP of 75.71 mmHg, triglyceride levels of 99.94 mg/dL, and glucose levels of 90.75 mg/dL, compared to 77.84 mmHg (p = 0.033), 123.23 mg/dL (p = 0.005), and 94.45 mg/dL (p = 0.025), respectively, in sedentary men. Waist circumference in men with very high physical activity was 90.07 cm, while in sedentary men it was 97.51 cm (p < 0.001). Additionally, HDL cholesterol levels were higher in men with very high physical activity (55.48 mg/dL) compared to sedentary men (50.73 mg/dL, p < 0.001).
4. Discussion
Our study showed that patients, both men and women, who report more PA have better profiles in the components of MetS, such as better blood pressure, blood glucose, waist circumference and triglyceride or HDL-cholesterol levels.
Physical inactivity represents a significant and modifiable risk factor that is more prevalent and severe in the female population globally for all age groups. The gender gap in PA begins early in life and leads to considerable short- and long-term adverse effects on health outcomes, especially CV health [26]. Our study also shows that women are more sedentary than men (OR = 1.35; 95% CI = 1.10–1.65), so they could particularly benefit from increasing their PA levels.
As regards PA and sport, male subjects seem to be more active than female subjects [26]. The results of several studies show that men’s attitudes are more positive than women’s, with significant differences [27]. In the 2022 Survey of Sports Habits in Spain [28], sports practice continues to be higher among men, regardless of frequency, standing at 63.1% and 51.8% respectively in annual terms. The gap, 11.3 percentage points, is lower than that recorded in 2015, 12.3 percentage points, and similar to that recorded in our study (11.1%) whose data were collected between 2014 and 2018.
Regular PA reduces sympathetic activity and plasma catecholamine concentration at rest, and modifies renal homeostasis with a decrease in vascular resistance, contributing to a reduction in blood pressure [29]. High blood pressure is the main independent cardiovascular risk factor [30]. PA reduces SBP by an average of 6.9 mmHg in people with hypertension [31]. Cordero et al. [29] speak of an average reduction of 6–7 mmHg in SBP and DBP in hypertensive patients compared to 3 mmHg in normotensive patients. Cornelissen et al. [32], in a systematic review with healthy adults, found a significant reduction in DBP in patients who received a training program, regardless of the type of training; but they found no reduction in SBP in patients who received combined strength and endurance training. In terms of sex, they found that men with a training program achieved more than twice this reduction in SBP and DBP than women. Our results also show differences in terms of sex, but in this case women show a greater reduction in blood pressure than men.
Regarding the lipid profile, we also found evidence that PA improves it. The literature consulted mainly shows an increase in HDL values and a decrease in triglycerides in patients who practice PA [33–37]. In women, there is greater lipolytic activity in response to exercise [38]. Our results are in line with these studies, showing a statistically significant decrease in triglyceride levels in both sexes, but only a statistically significant increase in HDL cholesterol in the case of men. Therefore, it would be advisable to continue this line of research to verify whether the PA manages to improve the lipid profile in healthy individuals.
One of the direct effects of PA is to decrease insulin resistance, since muscle tissue increases glucose uptake. Regular PA decreases the risk of type 2 diabetes mellitus (T2DM) and observational studies suggest that in patients with T2DM, women may require greater frequency and intensity of PA than men to reduce CV events [39]. In this sense, aerobic PA leads to an increase in the biological efficacy of insulin, and it has been reported that, even after training, sensitivity and the number of insulin receptors increase by 36% [40]. In our study on healthy patients, a reduction in blood glucose levels was observed, and unlike other studies consulted, our data showed significant differences. Significant differences between men and women were only observed in the lowest PA levels, while other studies reported no difference between sexes [36,41].
On the other hand, the results obtained show a reduction in waist circumference as the PA level increases, in this case more marked in men than in women, in line with the existing literature [36]. The regular practice of PA is effective in the prevention of overweight and in the treatment of obesity-related comorbidities [42], and thus PA improves CVR due to body weight regulation.
Among the possible limitations of our study, it should be noted that the collection of data on PA levels comes from a self-reported questionnaire in which the type and intensity of activity performed are not specified, although according to Obling et al. [43] the use of a single item to measure PA levels is a cost-effective strategy. Another limitation of the database is the lack of information on aspects related to sleep quality, emotional health, environmental pollution or maximum oxygen consumption (VO2max). It is also worth noting that the data were collected between 2014 and 2018. However, a database with 2,359 patients from all over Spain, as well as socioeconomic variables that provide robustness to the models used, can be highlighted as strengths.
5. Conclusions
In the IBERICAN study, we find better frequencies of the components of the MetS in patients without CVD or DM and with a high level of PA, both in men and women. In addition, women present a better metabolic profile of MetS because they have higher levels of HDL cholesterol and lower levels of triglycerides, fasting glucose, SBP, DBP, and waist circumference, regardless of their level of PA and stratifying by PA. Therefore, the promotion of PA needs to be approached differently in men and in women.
We need to educate and prescribe people to practice regular PA as early as possible to prevent the risk of developing MetS and CVD, although more studies are needed to see which type of PA may have the greatest benefits. PA is one of the best investments in public health for the prevention of CVD, although a gender approach is necessary with special attention needed in promoting PA among women, who are more sedentary.
Supporting information
S1 Fig. Flow chart of patients included in the study.
https://doi.org/10.1371/journal.pone.0317593.s001
(DOCX)
Acknowledgments
To Fundación SEMERGEN. To the investigators who have actively participated in the recruitment of patients. And to patients for their participation.
List of investigators
Scientific Committee:
Alfonso Barquilla García; Ángel Díaz Rodríguez; Carlos Escobar Cervantes; Francisco Javier Alonso Moreno; Jesús Vergara Martín; José. Luis Llisterri Caro; Juan José Badimón; José Polo García; Luis Rodríguez Padial; Miguel Ángel Prieto; Rafael Vidal Pérez; Sergio Cinza Sanjurjo; Sonia Miravet Jiménez; Sonsoles Velilla Zancada, José Ramón Banegas, Vicente Martín Sánchez y Rafael Manuel Micó Pérez
Andalucía:
Antonio López Téllez, Jesus Vergara Martin, Maria De Los Angeles Ortega Osuna, Cristóbal Prieto Cid, Ma José Hidalgo Fajardo, Jose Lorente Serna, Ángel Domínguez Requena, Ricardo Alberola Cañizares, Manuel Ruiz Peña, Filomena Herrero Collado, Marcela Montes Vázquez, Rafael Ángel Carrascal Garrido, Maria Reyes Herrera Lozano, Beatriz Ortiz Oliva, Francisco José Anguita, Carmen Pérez Ibáñez, Carlos Alberto Cabrera Rodríguez, Maria Jose Cruz Rodríguez, Sandra Bonilla Ruiz, Rocio Reina Gonzalez, Salome Abad Sanchez, Inmaculada Santana Martinez, Rafael Sanchez Jordán, Juan Ma Ramos Navas-Parejo, Jose Manuel Ramirez Torres, Jose Maria Beltran Poveda, Maria Adoración De Cruz Benayas, Carmen Fernandez Gil, Jon Iñaki Esturo Alcaine, Antonio Mora Quintero, Fernando Leiva Cepas, José Luis Carrasco Martín, Emilio Garcia Criado, Mercedes Vazquez Blanco, Isabel Mora Ortiz, Leovigildo Ginel Mendoza, Juan Carlos Aguirre Rodriguez, Esperanza María Romero Rodríguez, Jose Acevedo Vazquez, Juan Gabriel García Ballesteros, María De La Paz Fernández Lara, Patricia Agüera Moreno, Eduardo Paños Maturana, Juan Manuel Ignacio Expósito, Noelia Carrillo Peñas, Carmen María Abad Faya, Ana Marina Almagro Duque, Rubén Torrescusa Camisón, Paloma Menéndez Polo, Marina Peña García, Cristina Lopez Fernández, Ascensión Estepa Torres, Miguel Gutiérrez Jansen, Esperanza Loizaga González, Lisardo Garcia Matarin, Enrique José Gamero De Luna, Javier Benítez Rivero, Maria Jose Gomez Gonzalez, Carmen Gómez Montes.
Aragón
Eva Trillo Calvo, Concepción Bayod Calvo, Susana Larripa De La Natividad, German Grasa Lambea, Emilio Jimenez Marin, Ana Cristina Navarro Gonzalvo, Antonio Pablo Martinez Barseló, Irene Peña León.
Cantabria
E. Lidia Gutiérrez Fernández, Fernando Andrés Mantecón, Ana Belen Garcia Garrido, Asuncion Velez Escalante, Luisa Alonso Rentería, Jesús Sainz Jiménez, Guillermo Pombo Alles.
Castilla La Mancha
Juan Antonio Divison Garrote, Pedro Martinez Sotodosos, Juan Antonio Vivancos Fuster, María García Palencia, José Ambrosio Torres Moraleda, Sara González Ballesteros, Ana Carmen Gil Adrados, Antonio González Cabrera, Miguel Angel Babiano Fernandez, Guillermo Rico García, Juan Jose Criado-Alvarez, Pilar Torres Moreno, Francisco Javier Arribas Aguirregaviria, Alicia Sahuquillo Martinez, Lourdes Maria Santos Bejar, Miguel Laborda Peralta, Raul Piedra Castro, Carlos Santos Altozano, Lucia Gonzalez-Tarrio Polo, Pedro Valiente Maresca, Reinilda Mota Santana, Noemi Elizabeth Terrero Ledesma, Noelia Garrido Espada, Francisco Javier Alonso Moreno, Gabriela Delia Rosa Zambrana Calvi.
Castilla y León
Juan Lorenzo Gutierrez Montero, Juan Ignacio López Gil, Maria Dolores Fernández Ortega, Miren Elizari Roncal, María Ascensión López Serrano, Nuria Esther Adrian De La Fuente, Belén Angulo Fdez. De Larrea, Naiara Cubelos Fernández, Guiomar Luz Ferreiro Gómez, Diana Gomez Rodriguez, Sonia Maria Andres Tuñon, María Ajenjo González, Serafin De Abajo Olea, Juan Jose Leon Regueras, César Manuel Gallego Nieto, Delio Vazquez Mallada, Maria De La O Gutierrez Garcia, Pablo Baz Rodriguez, José Ignacio Ferradal García, Blanca Delia De Román Martínez, Ana Arconada Perez, Omar Mahmoud Atoui, Álvaro Morán Bayón, María Teresa Armenteros Del Olmo, Fco Javier Garcia-Norro Herreros, Enrique Méndez Rodríguez, Diana María Narganes Pineda, Angel Diaz Rodriguez, Verónica Ortiz Ainaga, Milagros Sonlei Sánchez Guevara, Laura Villota Ferreiro, M Teresa Grande Grande, Francisco Vicente Martínez Gracía.
Cataluña
Maria Dolores Moriano Garcia, Beatriz Jiménez Muñoz, Gemma Rovira Marcelino, Diana Elizabeth Fernandez Valverde, Roser Rodó Bernadó, Maria Teresa Ortiz Lupiañez, Najlaa Najih, Jose Maria Dieguez Parra, Ma Rosa Benedicto Acebo, Mari Luz Bravo Vicien, Alberto Ramón León Estella, Juan Antonio Muñoz Gómez, Alicia Mostazo Muntané, Isabel Ortega Abarca, Anna Gasol Fargas, Brenda Elizabeth Riesgo Escudero, Susana Elizabeth Riesgo, Edgar Zaballos Castellvi, Celia Cols Sagarra, Marta Herranz Fernández, Josep Alins Presas, Idaira Damas Pérez, Rosa M Alcolea Garcia, Ines Monte Collado, Roberto Genique Martínez, María José Guasch Villanueva, Sònia Miravet Jiménez, Teresa Rama Martinez, Lucio Pinto Pena, Josefa Maria Panisello Royo, Ines Gil Gil.
Comunidad de Madrid
Alberto Calderon Montero, María Del Mar Zamora Gómez, Elena Alarcón Cebrián, Ma Jose Piñero Acin, Celia Pecharroman Sacristan, M Soledad Mayayo Vicente, Ma Paz Pérez Unanua, Nuria Marañon Henrich, Saray Gómez Monreal, Sonia Redondo De Pedro, Blanca Sanz Pozo, Irene Moreno Martinez, Beatriz Lopez Uriarte, Carmelina Sanz Velasco, Amaya Gárriz Aguirre, Montserrat Rivera Teijido, German Reviriego Jaen, Jose Ignacio Aza Pascual-Salcedo, Josefa Vázquez Gallego, Julia Caballer Rodilla, Aida Herrera, Ezequiel Arranz Martínez, Ana María Gómez Calvo, Paula Morán Oliva, Ma Milagros González Béjar, Julio Antonio Heras Hitos, Olga Garcia Vallejo, Manuel De Jesús Frías Vargas, Maria Jesus Castillejo Boguerin, Aurora Garcia Lerin, Miguel Angel María Tablado, Elena Concepción García García, Leticia De Miguel Acero, Carmen Zárate Oñate, Aránzazu Barranco Apoita, María Ester Montes Belloso, Ana Maria Huertas Velasco, Rafael Sáez Jiménez, Julia Natividad Garcia Pascual, María Clemencia Zuluaga Zuluaga, Ma Cruz Díez Perez, Antonio Ruiz García, Cristina Murillo Jelsbak, Virginia Lasso Oria, Amelia Gonzalez Gamarra.
Comunidad Valenciana
Vicente Pascual Fuster, Ma Dolores Aicart Bort, Natividad Vázquez Gómez, Carlos Lluna Gasco, Teresa Amoros Barber, Pedro Antonio Medina Cano, Miguel Monteagudo Moncho, Ma Jesús Larré Muñoz, Raquel Navarro Hernández, Francisco Jose Martinez Egea, Antonio Tramontano, Marta Ferrer Royo, Belén Persiva Saura, Juan A. Contreras Torres, José Ma Tirado Moliner, Alejandro Salanova Penalba, Ariadna Cucó Alberola, Fernando Maria Navarro I Ros, Enrique Beltran Llicer, Ana Seoane Novás, Inmaculada Martín Valls, Gracia Verdú Mahiques, Enrique Peña Forcada, Nieves Aguilar Gómez, Francisco Javier Sanz García, M Dolores Paradís Bueso, María Eugenia Alegre Romero, Antonio Francés Camus, María Amparo Anton Peinado, Rosa Latorre Santos, Ma Asuncion Palomar Marin, Maria Carmen Botella Garcia, Eva Sánchez Fresquet, Pedro Sala Paños, Tomás Sánchez Ruiz, Rosa Ana Valero Valero, Maria Seoane Vicente, Magdalena Martin Llinares, Antonio Masiá Alegre, José Luis Llisterri Caro, Irene Lluch Verdu, Vicente Pallares Carratala, Francisco Valls Roca, Rafael Manuel Micó Pérez.
Extremadura
Jacinto Espinosa García, Jose Ignacio Prieto Romo, Leandro Fernandez Fernández, Javier Sierratapia, Nieves Moreno Regidor, Francisco Javier Zaballos Sanchez, Ana Moreno Moreno, Francisco Carramiñana Barrera, Juan Jose Torres Vazquez, Maria José Gamero Samino, Miguel Angel De Santiago Rodriguez, Pablo Rafael Gómez Martínez, Antonio Carlos Elias Becerra, Javier Soto Olivera, Víctor Cambero, Julián Domínguez Ávila, Andrés Simón Fuentes, Jorge Manuel De Nicolas Jimenez, Dimas Igual Fraile, Guadalupe Nieto Barco, Ignacio Araujo Ramos, Ma Luz Serrano Berrocal, Francisco Buitrago Ramírez, Minerva Gallego Marcos, Felix Suarez Gonzalez, Victoriano Chavero Carrasco, José Polo García, Francisco Guerra Peguero, Francisco Javier Sanchez Vega, Manuel Tejero Mas, Alba Palmerín Donoso, Miguel Turégano Yedro, María Beatriz Esteban Rojas, Fátima Cabezudo Moreno, Nawson Elver Quevedo Saldaña, Maria Del Mar García Fenés, Alfonso Barquilla Garcia, Timotea Garrote Florencio, Jose Maria Fernandez Toro.
Galicia
Alejandra Rey Rañal, Elena García Del Río, Enrique Nieto Pol, Julio Álvarez Fernández, Pilar Alonso Álvarez, Ma Luisa Jorge Gómez, Antonio Calvo Guerrero, Isabel Celemín Colomina, Lucia Barreiro Casal, Juana Fernandez Moreno, Ma Angelines Carballal Martinez, Nabor Diaz Rodriguez, Carlos Moral Paredes, Dolores Recarey García, Fco Javier Iglesias Mato, Antonio Fouz Ulloa, Amparo Fidalgo Gonzalez, Noelia Dios Parada, Patricia Conde Sabarís, Ana Isabel Rodriguez Pérez, Ana Inés García Palacio, Victor Julio Quesada Varela, Lidia Romero Iglesias, Ángel Lado Llerena, Carmen Lires Rodríguez, Maria Luisa Carretero Diaz, José Carreira Arias, Jose Luís Vázquez Camino, Maria Del Carmen Torreiro Penas, Sandra Yáñez Freire, Sergio Cinza Sanjurjo, Daniel Rey Aldana, Carlos Piñeiro Díaz.
Illes Balears
Fernando García Romanos, Antonia Moreno Gonzalez, Maria Lara Amengual Sastre, Susana Martinez Palli, Jose Alfonso Ramon Bauza, Jose Ortiz Bolinches, Carmen Fernandez Fernández, Maria Isabel Orlandis Vázquez, Ana Sanchis Mezquita, Fernando Unceta Aramburu, Juan Fernando Peiró Morant, Ana Moyá Amengual.
Islas Canarias
Isidro Godoy Garcia, Fernando Rubio Sevillano, María Isabel González González, Marta Perez Souto, Raquel De León Contreras, Sara Isabel Almeida González, Irene Almería Diez, Virginia Maria Mirabal Sánchez, Francisco Jose Escobar Lavado, Yoel Anta Pérez, Nayra Sánchez Hernández, Juan Luis Alonso Jerez, Ricardo Koch, Nayra Ramirez Mendoza, Héctor Suárez Hernández, Francisco Jesús Morales Escobar.
La Rioja
Sonsoles María Velilla Zancada, Rafael Crespo Sabarís, Oscar Fernando Isaula Jimenez.
Melilla
Jesus Manuel Gonzalez Puga, Jorge Antonio Benaín Ávila, óscar Del Toro González.
Navarra:
Laura Sánchez Iñigo, Ines Sanz Perez
País Vasco
Jose Felix Zuazagoitia Nubla, Ana Echebarría Ituiño, Gregorio Mediavilla Tris, María Carmen Noriega Bosch, Esther Gonzalez, Maria Luisa Ruiz Macho, Ruth Sendino Del Olmo, Asunción Olagorta De Prado, Ana López De Viñaspre Muguerza, Jesus Iturralde Iriso.
Principado de Asturias
María José Pérez Martínez, Ana Piera Carbonell, Margarita Alonso Fernández, María Montserrat Rueda Cuadrado, Rodrigo Abad Rodríguez, José Miguel Alvarez Cabo, Rubén Sánchez Rodríguez, Eva Maria Cano Cabo, Anny Romero Secin, Miguel Ángel Prieto Diaz, Juan Jesús García Fernández.
Región de Murcia
Vicente Llorca Bueno, Ana María Ballesteros Pérez, Domingo J. Rubira López, Ma Dolores Esteve Franco, Elena Sánchez Pablo, Maria Teresa Palacios Lopez, Juan Castillo Meroño, José Maria Lobo Martinez, Isabel Maria Peral Martinez, J. Eduardo Carrasco Carrasco, Armando Santo Gonzalez.
References
- 1. Myers J, Kokkinos P, Nyelin E. Physical activity, cardiorespiratory fitness, and the metabolic syndrome. Nutrients. MDPI AG; 2019. pmid:31331009
- 2.
Metabolic Syndrome. MDPI; 2021. https://doi.org/10.3390/books978-3-03943-990-4
- 3. Simmons RK, Alberti KGMM, Gale EAM, Colagiuri S, Tuomilehto J, Qiao Q, et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010;53: 600–605. pmid:20012011
- 4. Cuesta M, Fuentes M, Rubio M, Bordiu E, Barabash A, Garcia de la Torre N, et al. Incidence and regression of metabolic syndrome in a representative sample of the Spanish population: results of the cohort di@bet.es study. BMJ Open Diabetes Res Care. 2020;8: e001715. pmid:33051280
- 5. Ammar A, Trabelsi K, Hermassi S, Kolahi AA, Mansournia MA, Jahrami H, et al. Global disease burden attributed to low physical activity in 204 countries and territories from 1990 to 2019: Insights from the Global Burden of Disease 2019 Study. Biol Sport. 2023;40: 835–855. pmid:37398951
- 6. Warburton DER, Bredin SSD. Health benefits of physical activity: A strengths-based approach. Journal of Clinical Medicine. MDPI; 2019. pmid:31766502
- 7. Hancock T. Lalonde and beyond: Looking back at “A New Perspective on the Health of Canadians.” Health Promot Int. 1986;1: 93–100. pmid:10286856
- 8. Sperling LS, Mechanick JI, Neeland IJ, Herrick CJ, Després JP, Ndumele CE, et al. The CardioMetabolic Health Alliance Working Toward a New Care Model for the Metabolic Syndrome. J Am Coll Cardiol. 2015;66: 1050–1067. pmid:26314534
- 9. Instituto Nacional de Estadística (INE).Encuesta de Condiciones de Vida 2022. 2022.
- 10.
World Health Organization. WHO Guidelines on physical activity and sedentary behaviour. Geneva; 2020.
- 11. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. BMJ Publishing Group; 2020. pp. 1451–1462. pmid:33239350
- 12. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine Jan 1, 2009 p. 1. Available: http://bjsm.bmj.com/content/43/1/1.abstract pmid:19136507
- 13. Pedersen BK, Saltin B. Exercise as medicine—Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25: 1–72. pmid:26606383
- 14. Gutiérrez M, Ruvalcaba Ledezma JC. Health and its determinants, health promotion and health education. 2020;5: 81–90.
- 15. Grandes G, García-Alvarez A, Ansorena M, Sánchez-Pinilla RO, Torcal J, Arietaleanizbeaskoa MS, et al. Any increment in physical activity reduces mortality risk of physically inactive patients: prospective cohort study in primary care. British Journal of General Practice. 2023;73: E52–E58. pmid:36316160
- 16. Feng H, Yang L, Liang YY, Ai S, Liu Y, Liu Y, et al. Associations of timing of physical activity with all-cause and cause-specific mortality in a prospective cohort study. Nat Commun. 2023;14: 930. pmid:36805455
- 17. Yang X, Telama R, Hirvensalo M, Mattsson N, Viikari JSA, Raitakari OT. The longitudinal effects of physical activity history on metabolic syndrome. Med Sci Sports Exerc. 2008;40: 1424–1431. pmid:18614950
- 18. Pucci G, Alcidi R, Tap L, Battista F, Mattace-Raso F, Schillaci G. Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: A review of the literature. Pharmacological Research. Academic Press; 2017. pp. 34–42. pmid:28300617
- 19. Grandes G, Garcia-Alvarez A, Ansorena M, Ortega Sanchez-Pinilla R, Torcal J, Arietaleanizbeaskoa MS, et al. Any increment in physical activity reduces mortality of primary care inactive patients. British Journal of General Practice. 2022; BJGP.2022.0118. pmid:36316160
- 20. Salonen MK, Wasenius N, Kajantie E, Lano A, Lahti J, Heinonen K, et al. Physical Activity, Body Composition and Metabolic Syndrome in Young Adults. PLoS One. 2015;10: e0126737. pmid:25992848
- 21. Ji H, Gulati M, Huang TY, Kwan AC, Ouyang D, Ebinger JE, et al. Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. J Am Coll Cardiol. 2024;83: 783–793. pmid:38383092
- 22. Regitz-Zagrosek V, Gebhard C. Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nature Reviews Cardiology. Nature Research; 2023. pp. 236–247. pmid:36316574
- 23. Cinza-Sanjurjo S, Micó-Pérez RM, Velilla-Zancada S, Prieto-Díaz MA, Rodríguez-Roca GC, Barquilla García A, et al. Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos. Medicina de Familia SEMERGEN. 2020;46: 368–378. pmid:32873502
- 24. Cinza Sanjurjo S, Prieto Díaz MÁ, Llisterri Caro JL, Pallarés Carratalá V, Barquilla García A, Rodríguez Padial L, et al. Características basales y manejo clínico de los primeros 3.000 pacientes incluidos en el estudio IBERICAN (Identificación de la población española de riesgo cardiovascular y renal). SEMERGEN—Medicina de Familia. 2017;43: 493–500. pmid:27567214
- 25. Cinza Sanjurjo S, Llisterri Caro JL, Barquilla García A, Polo García J, Velilla Zancada S, Rodríguez Roca GC, et al. Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk(IBERICAN). Medicina de Familia SEMERGEN. 2020;46: 4–15. pmid:31870705
- 26. Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review. J Clin Med. 2023;12: 4347. pmid:37445383
- 27. Tereza Araújo A, Dosil J. Relaciones entre actitudes y práctica de actividad física y deporte en hombres y mujeres. Cuadernos de Psicología del Deporte. 2016;16: 67–72.
- 28.
Ministerio de Cultura y Deporte. Anuario de estadísticas deportivas 2023. Síntesis de indicadores estadísticos deportivos. Secretaría General Técnica, editor. 2023.
- 29. Cordero A, Masiá MD, Galve E. Ejercicio físico y salud. Rev Esp Cardiol. 2014;67: 748–753.
- 30. Gallardo-Alfaro L, Bibiloni M del M, Bouzas C, Mascaró CM, Martínez-González MÁ, Salas-Salvadó J, et al. Physical activity and metabolic syndrome severity among older adults at cardiovascular risk: 1-Year trends. Nutrition, Metabolism and Cardiovascular Diseases. 2021;31: 2870–2886. pmid:34366176
- 31. Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. European Journal of Cardiovascular Prevention & Rehabilitation. 2007;14: 12–17. pmid:17301622
- 32. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. Journal of the American Heart Association. 2013. pmid:23525435
- 33. Byberg L, Zethelius B, McKeigue PM, Lithell HO. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia. 2001;44: 2134–2139. pmid:11793014
- 34. Muscella A, Stefà E, Marsigliante S. The effects of exercise training on lipid metabolism and coronary heart disease. REVIEW Energetics and Metabolism Am J Physiol Heart Circ Physiol. 2020;319: 76–88. pmid:32442027
- 35. da Silva RC, Diniz M de FHS, Alvim S, Vidigal PG, Fedeli LMG, Barreto SM. Physical activity and lipid profile in the ELSA-Brasil study. Arq Bras Cardiol. 2016;107: 10–18. pmid:27355470
- 36. Remsberg KE, Rogers NL, Demerath EW, Czerwinski SA, Choh AC, Lee M, et al. Sex differences in young adulthood metabolic syndrome and physical activity: Thefels longitudinal study. American Journal of Human Biology. 2007;19: 544–550. pmid:17546618
- 37. Alkahtani S, Elkilany A, Alhariri M. Association between sedentary and physical activity patterns and risk factors of metabolic syndrome in Saudi men: A cross-sectional study. BMC Public Health. 2015;15: 1234. pmid:26655021
- 38. Sims ST, Kerksick CM, Smith-Ryan AE, Janse de Jonge XAK, Hirsch KR, Arent SM, et al. International society of sports nutrition position stand: nutritional concerns of the female athlete. J Int Soc Sports Nutr. 2023;20. pmid:37221858
- 39. García M. Factores de riesgo cardiovascular desde la perspectiva de sexo y género. Revista Colombiana de Cardiología. 2018;25: 8–12.
- 40. Woudberg NJ, Mendham AE, Katz AA, Goedecke JH, Lecour S. Exercise intervention alters HDL subclass distribution and function in obese women. Lipids Health Dis. 2018;17. pmid:30301473
- 41. Jung WS, Park HY, Kim SW, Lim K. Sex-specific energy intakes and physical activity levels according to the presence of metabolic syndrome in korean elderly people: Korean national health and nutrition examination survey 2016–2018. Int J Environ Res Public Health. 2020;17: 1–12. pmid:32731363
- 42. Dipietro L, Zhang Y, Mavredes M, Simmens SJ, Whiteley JA, Hayman LL, et al. Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity. Med Sci Sports Exerc. 2020;52: 1050–1056. pmid:31764468
- 43. Obling KH, Hansen ALS, Overgaard K, Normann K, Sandbaek A, Maindal HT. Association between self-reported and objectively measured physical fitness level in a middle-aged population in primary care. Prev Med Rep. 2015;2: 462–466. pmid:26844103
