Physical activity, sedentary behaviour and diet in mediterranean elder adults with high cardiovascular risk

Resumen

Metabolic syndrome (MetS) refers to a clinical condition of the presence of multiple metabolic risk factors for cardiovascular disease (CVD) and type 2 diabetes, resulting in premature morbidity and mortality, in addition to increased economic strain on the health systems of most countries. The risk factors include hypertension, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), hyperglycemia and central obesity. Furthermore, CVDs are the first cause of death globally, representing 31% of all global death. Likewise, type 2 diabetes is a fastest growing disease representing the seventh leading cause of death in 2016. MetS is a rising worldwide problem, which relates largely to increasing obesity and sedentary lifestyles. In fact, the prevalence of MetS in Spain is estimated to be 31% of the population, increasing to 46.7% among those aged 60 years or older. Furthermore, nearly 35% of all adults and 50% of those aged 60 years or older are estimated to have Mets in the United States population. The dichotomous criteria for Mets diagnosis (presence/absence) denies that MetSrelated risk exists as a spectrum. In this way, identifying MetS severity among individuals may help to identify those at higher risk, who could receive further preventive treatment. To prevent MetS and the progression to CVD and type 2 diabetes is crucial to improve lifestyle characteristics and to reduce risk factors in the early stage. In this way, there is solid scientific evidence showing that lifestyle interventions can reverse metabolic risk factors. For the aforementioned reasons, the general purpose of this doctoral thesis is to compare physical activity and physical fitness in a population with and without MetS and to assess physical activity, sedentary behaviours and diet in the MetS population according to their MetS severity. The population of the study consists of Mediterranean older adults, male between 55-75 years and women between 55-75 years, without previous CVD. The main findings derived from this dissertation showed low energy expenditure in leisure-time physical activity (LTPA) and low functional fitness in MetS individuals when compared with those participants without MetS. In fact, participants with MetS showed lower percentage of physically active population and lower Mediterranean diet (MD) adherence compared with non-MetS individuals. Besides, MetS individuals showed lower performance in upper-body and lower-body strength, aerobic endurance, upper body flexibility, agility and dynamic balance, speed and static balance, independently of sex and age. In this way, after a systematic review, larger improvements on cardiovascular events have been related with the combination of physical activity and MD, having MD the most beneficial effect when compared with other diets. On the other hand, participants with most severe MetS showed lower moderate and vigorous LTPA levels and higher levels of sedentary time and depression risk compared with participants with the lowest MetS severity. Moreover, those who increased their MetS severity after 1-year of follow-up were associated with a proinflammatory dietary pattern, low LTPA levels, MD adherence, and high sedentary time and depression risk. In conclusion, increasing time spent in physical activity and promoting the adherence to MD would be beneficial in terms of the severity of MetS among old adults at high cardiovascular risk.