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ISSN: 2638-6003

Orthopedics and Sports Medicine: Open Access Journal

Review Article(ISSN: 2638-6003)

The Effect of Aerobic Exercise on The Cardiorespiratory Endurance and Skeletal Muscle of Metabolic Syndrome Volume 4 - Issue 5

Wei Y Huang1 and Hsuan Huang2*

  • 1Section Chief of PE, National Taiwan College of Performing Arts, Taiwan
  • 2Department of Occupational Therapy, National Cheng Kung University, Taiwan

Received: December 17, 2020;   Published:January 06, 2021

Corresponding author:Huang Hsuan, Department of Occupational Therapy, National Cheng Kung University, Taiwan

DOI: 10.32474/OSMOAJ.2021.04.000198


Abstract PDF



This study examined the influence of aerobic exercise on the cardiorespiratory endurance and skeletal muscle of metabolic syndrome. An experimental research method was adopted, sampling community health service center people participating in health examination, 15 middle-aged men with waist circumference greater than 90cm (age 49.11±3.32) as subjects. Participants received 60-min aerobic exercise sessions two times a week for 10 weeks (20 sessions in total). The research tool uses a body composition analyzer (In Body) to detect skeletal muscle and basal metabolic rate; a three-minute cardiorespiratory endurance test (Harvard Step Test) is used to understand the subject’s cardiorespiratory endurance index after aerobic training. The results of the study found that weight loss, skeletal muscle rate t = -6.58*, and basal metabolic rate t = -5.77* all improved, and the cardiopulmonary endurance index increased from 52.64 to 58.31, from “poor” to “average” “within. The study concluded that aerobic exercise can consume more deep fat, reduce the risk of suffering from metabolic syndrome, help improve cardiorespiratory endurance and skeletal muscles, and achieve the results of rehabilitation and health improvement.

Keywords: Metabolic Syndrome; Cardiorespiratory Endurance; Aerobic Exercise; Skeletal Muscle Rate; Basal Metabolic Rate


Metabolic syndrome (MS) is a group of metabolic diseases that appear in the same person. Its main metabolic abnormalities include obesity, dyslipidemia, hyperglycemia, hypertension, insulin resistance or glucose intolerance and other risk factors [1-4], one person At the same time, as long as there are more than three risk factors, it can be presumed to be metabolic syndrome [5], that is, MS is not a disease but a warning sign of the body [6,7], it is also a “predisease state” in which the body begins to experience metabolic abnormalities. MS is an aggregation of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). Population aging is accompanied by higher prevalence of MS [8,9]. The prevalence of MS increases with age, with about 40% of people older than 60 years meeting the criteria [10]. Now days MS can no longer be considered a disease of only adult populations. Alarmingly, MS and DM are increasingly prevalent in the pediatric population, again in parallel with a rise in obesity [11]. Most middleaged people have abdominal obesity, and thus constitute a high-risk group for MS. Statistics have indicated that people with visceral obesity have a 50% chance of developing MS [12]. Middle-aged people who belong to the high-risk group of MS can easily lead to chronic diseases such as diabetes, heart disease, and hypertension if they do not control their diet and exercise [13-15].
General body composition is composed of body fat mass, body fat percentage, skeletal muscle rate (SMR) and basal metabolic rate (BMR) [16]. Among them, the MS is closely related to its own BMR [17], and because the BMR is positively correlated with SMR growth and exercise [18]. One of the most critical elements of physical fitness is cardiorespiratory endurance. Relying on the kinetic functions of the heart and lungs, cardiorespiratory endurance refers to the body’s ability to continue supplying energy to the human circulatory system and muscles over extended periods [17]. There had been positive reports [19,21] about how advanced cardiorespiratory endurance not only enables one to engage in aerobic exercises, such as walking and jogging for a longer time. From the above literature, we could see the feasibility of this study. After a long period of aerobic exercise, people with metabolic syndrome and generally healthy people should be able to improve the growth rate of skeletal muscle and improve cardiorespiratory endurance [22,25]. This was also the focus of this research. In addition to dietary control, frequent exercise is the best method for staving off MS, where daily exercise invigorates the body [26]. Evidence has indicated that aerobic exercise is an effective method of improving cardiorespiratory endurance, aerobic exercise can significantly improve health [27,30]. Relevant studies have indicated that starting from 30 years old, lack of exercise is the primary driver of aging-related loss of muscle mass [31,32]. Some other studies have indicated that exercise can enhance bone density, reduce body fat, enhance metabolism, and prevent chronic diseases [33,34]. Aerobic exercise can strengthen the muscles surrounding and supporting the joints can help maintain a good body shape and enhance the integrity of the joints, thereby helping to prevent injuries [35,36]. Aerobic exercise will strengthen the skeletal muscles and help the bones to stay strong. Just like your brain, skeletal muscles need to be exercised to maintain muscle strength [37]. Some MS become obese, muscle strength deteriorates, physical vitality decreases, and even chronic diseases are caused by lack of exercise [38]. MS is a symptom produced by modern society and civilization, and because aerobic exercise has a positive effect on the physical composition of individuals, this study uses middle-aged people with MS as the research object, and uses aerobic exercise to understand the cardiorespiratory endurance and skeletal muscles of MS.

Materials and Methods

Experimental Approach to the Participants

An experimental research method was adopted, in cooperation with the community health service center, and implemented in the school gym. The subjects were people who participated in the health checkup at the community health service center. Middleaged men with a waist circumference greater than 90cm were the sample objects, a total of 15 people were sampled (age = 47.89 ± 6.24 years). Participants received 60-min aerobic exercise training sessions two times a week for 10 weeks (20 sessions in total). All training and testing are performed by the research team. This study did not involve personal privacy and strictly adhered to research ethics. As for the subjects’ psychological symptoms, disease history, family factors and other potential variables, they were listed as control variables. Aerobic training courses are shown in Table 1[39].

Table 1: Aerobic Exercise Program.


Experimental Detection Tools

A body composition analyzer (InBody 230) was used to measure SMR, and BMR. The mechanism underlying the InBody analyzer is the method of bioelectrical impedance analysis, which utilizes the impedance of current flow; specifically, the lower the conductivity of the muscles, blood, body fat, and skin, the higher the impedance is [40]. Take a 3-minute test of cardiorespiratory endurance (Harvard step test) to learn about the subjects’ cardiorespiratory endurance index after aerobic training. Use a 35cm high step, 96 beats per minute metronome, a total of three minutes of operation, after completing the test, measure 1 minute to 1.5 minutes, 2 minutes to 2.5 minutes, 3 minutes to 3.5 minutes, three 30-second wrist pulse rates. The cardiorespiratory endurance index score is then determined by the following equations. Cardiorespiratory Endurance Index = (100 x test duration in seconds) divided by (2 x sum of heart beats in the recovery periods). And consider the male cardiorespiratory endurance index norm [41], as shown in Table 2.

Table 2: The Male Cardiorespiratory Endurance Index Norm.


Statistical Analysis

Pre-test and post-test data were obtained and analyzed in SPSS (version 23.0). Descriptive statistics (specifically, the mean and standard deviation) were used to summarize the participants’ characteristics, and t tests were used to analyze after aerobic training changes in cardiorespiratory endurance (CRE), SMR and BMR.


The results of this study are divided into two parts: First, Descriptive statistics of SMR, BMR, CRE before and after aerobic exercise; Second, Difference analysis of SMR, BMR, CRE before and after aerobic exercise for subjects.

Descriptive Statistics of SMR BMR CRE Before and After Aerobic Exercise

In this study, 15 men (age 49.11±3.32) were the subjects. These subjects were middle-aged men with waist circumference greater than 90 cm. According to the data in Table 3, the weight of the subjects was overweight or obese, and the cardiorespiratory endurance did not reach the standard average value. The data in Table 4 shows that the average weight of the subjects decreased significantly after aerobic exercise training, while the skeletal muscle, basal metabolism, and cardiopulmonary endurance were significantly improved.

Table 3:Descriptive statistics of SMR, BMR, CRE before and after aerobic exercise for subjects.


Pre-test results: The average weight of the subjects was 84.47 kg, the SMR was 29.30%, which was slightly too low, the BMR was 1585 kcal/day, and the cardiorespiratory endurance index was 52.64, which was a poor state.

Post-test results: The average weight of the subjects was 78.67 kg, the SMR was 34.98% above the normal range (32~34% of the normal range), and the BMR was 1623 kcal/day, which was in the normal range (the male is 1400~1700) Card) [42], cardiorespiratory endurance index (cardiorespiratory endurance index) of 58.31 belongs to average state. According to the above data, aerobic exercise can increase the body’s BMR [43,44], and improve the effect of cardiopulmonary endurance [45,46], and the BMR is positively correlated with skeletal muscle [47]. Increasing skeletal muscle can increase the BMR, which not only helps burn calories and avoid weight gain, so the metabolic rate is low, and the risk of weight gain is low higher.

Table 4: Mean and SEM analysis results for pre-test versus post-test SMR, BMR, CRE for subjects.


Difference Analysis of SMR BMR CRE Before and After Aerobic Exercise

Table 5 shows the difference analysis of SMR, BMR, CRE before and after aerobic exercise, all of which have significant differences. In terms of weight: t = 7.89* reached a significant level of .05, which means that after the aerobic exercise course, the average weight dropped from 84.47 kg to 78.67 kg. In terms of skeletal muscle rate: t = -6.58* reached a significant level of .05, and the average skeletal muscle rate increased from 29.30% to 34.98%. In terms of basal metabolic rate: t = -5.77* reached a significant level of .05. The average basal metabolic rate increased from 1585 kcal/day to 1623 kcal/day, with an average daily increase of 38 calories. Cardiorespiratory endurance index (CRE index): t = -18.96* reached a significant level of .05. After the subjects undergo aerobic exercise, the cardiorespiratory endurance index increased from 52.64 to 58.31, that is, from “poor” to “average” range (see Table 2). Based on the above results, the subjects significantly increased their cardiorespiratory endurance index and skeletal muscle rate after ten weeks of aerobic exercise training.

Table 5: Difference analysis of SMR, BMR, CRE before and after aerobic exercise for subjects.



This study focused on improvements to cardiorespiratory endurance, skeletal muscle and basal metabolism from middleaged people with metabolic syndrome of aerobic exercise.

Exercise Can Prevent the Occurrence of Metabolic Syndrome

In general, the public is often interested in studies reporting that certain types of physical activity can lead to weight loss [48]. The present study’s findings revealed the following. In general, aerobic exercise does not immediately affect all middle-aged people with metabolic syndrome. In particular, aerobic exercise effect on skeletal muscle and basal metabolism are relatively weak, thus, a longer aerobic exercise period may be required for improvements in BMR to be notable. This is consistent with findings in the literature. For example, a study noted that although basal metabolic rate gradually decreases with age, an individual can enhance their metabolic function as long as they maintain favorable exercise habits [49]. According to research reports, metabolic syndrome has become a precursor to chronic diseases in middle-aged people (at least 3 of the following: abdominal adiposity, low HDL cholesterol, high triglycerides, hypertension, and impaired fasting glucose) [50]. With the successful conquest of communicable infectious diseases in most of the world, this new non-communicable disease (NCD) has become the major health hazard of modern world [51]. Many studies have confirmed that exercise can prevent the occurrence of metabolic syndrome early, because exercise is a cost-effective intervention to both prevent and reduce the impact of the metabolic syndrome [52,55].

The Effect of Aerobic Exercise on The Changes Of Cardiorespiratory Endurance in Middle-Aged People with Metabolic Syndrome

“Exercise is Medicine, Exercise is the best medicine”, aerobic exercise is an important item for regular exercise. Cardiopulmonary function is the most important fitness in physical fitness, and it is also closely related to cardiovascular disease risk factors. Therefore, in regular exercise, aerobic exercise can be listed as an important item, and it must also improve and maintain good cardiopulmonary function, which can not only promote health and prevent diseases disease and can improve the quality of life. Although aerobic exercise and CRE are often used interchangeably, it is important to recognize that they are different; aerobic exercise is a behavior and CRE is an attribute. CRE is improved by aerobic exercise, but it is influenced by other factors, including genetics. Some studies have reported that a 20‐week supervised aerobic exercise training reduced metabolic syndrome prevalence by 31% [56]. Nevertheless, this experiment most middle-aged people with metabolic syndrome will improve CRE by following the aerobic exercise. A few prospective studies have revealed that aerobic exercise and cardiorespiratory endurance are predictors of metabolic syndrome incidence [57,58]. One clinical intervention studies have shown that regular aerobic exercise clearly improved risk factors for metabolic syndrome in obese people [59,60]. Studies have also shown that confirmed the improvement of metabolic syndrome with increased cardiorespiratory endurance [61,62]. Cardiopulmonary endurance is an objective indicator of aerobic exercise patterns, which is negatively correlated with the incidence of metabolic syndrome [63,64]. Laaksonen, et al [63]. reported that half and two-thirds of adult men had a 47% and 75% reduction in the probability of developing metabolic syndrome in the results of the maximum oxygen uptake experiment.

Influence of Aerobic Exercise on SMR Of Middle-Aged People with Metabolic Syndrome

The skeletal muscle mass comprises approximately 40% of total body mass and is the primary source of insulin-mediated glucose uptake and fatty acid oxidation. The aerobic exercise evokes adaptation in skeletal muscle in a multitude of nerve stimulation, the functional response to which is determined by training volume, mode of training, intensity and frequency. With persistent aerobic exercise exposure, there is mitochondrial biogenesis, fast-toslow fiber-type transformation, changes in substrate metabolism, and angiogenesis. Aerobic exercise brings additional benefits to energy expenditure from its ability to develop and maintain the functions of muscle mass and BMR [65,67]. Because their physiological structures differ, men have greater muscle mass and less body fat [Tomlinson, et al. 2016]. Studies have observed that aerobic exercise training reduced body fat but slightly increased body weight [47,69], because body fat is reduced faster than the proliferation of skeletal muscle, only decreases body weight slightly. Many studies have also confirmed that aerobic exercise training can also increase the proportion of lean muscle mass, strengthen the skeletal muscles, and enhance metabolic capacity [68,70]. Studies have indicated that SMR is positively correlated with BMR and lean muscle mass, which, in turn, are positively associated with calories burnt in a day [71]. In the absence of exercise in adults, muscle mass begins to decline after the age of 30, and bone mass is also lost [72]. Studies have shown that low muscle mass is a risk factor for low bone density, so even low-intensity aerobic exercise will have a positive effect on preventing skeletal muscle loss [73]. On the other hand, although bone and muscle mass will change with weight, some patients with abnormal metabolic function, the increase in weight is not accompanied by the increase in bone and muscle mass, which means that osteopenia type obesity will occur osteosarcopenic obesity [74], and complicating metabolic syndrome [75,76]. Additionally, some studies have confirmed that aerobic training can increase the consumption of deep abdominal fat, which reduces the risks of diabetes and metabolic syndrome [54,68]. The total weight of men measured in this study belongs to the obese group, and the abdomen is larger than 90cm. In order to avoid excessive abdominal fat accumulation, exercise training can be used to increase muscle mass and increase the basal metabolic rate, this finding is consistent with others in the literature [29,79].
The damage caused by metabolic syndrome to the human body should not be underestimated, it worsens one’s health condition in the short term and can even produce chronic diseases. This study confirmed that aerobic exercise training is an effective way to improve the cardiorespiratory endurance and skeletal muscles of middle-aged people with metabolic syndrome. Many people incorrectly believe that they cannot control their own bodily functions, but many studies have confirmed that aerobic exercise can improve cardiorespiratory endurance and skeletal muscle, which means that bodily functions can be controlled. While it is clear that exercise is important, the mechanistic pathways behind exercise-induced benefits on metabolic syndrome are still being identified. Further, aerobic exercise will improve cardiorespiratory endurance and skeletal muscle function of metabolic syndrome which can act in conjunction with exercise programs, and for metabolic syndrome individuals whom are unable or unwilling to exercise to amplify the beneficial effects of exercise. These data together emphasize the importance of aerobic exercise to prevents the development of metabolic syndrome and promotes recovery and improved health in patients with cardiorespiratory endurance and skeletal muscle.


We thank to the participants and professionals involved in this study. The study was designed by H.W-Y., and H.H.; data were collected and analyzed by H.W-Y.; data interpretation and manuscript preparation were undertaken by H.W-Y., and H.H.; literature analysis by H.W-Y.; collection of funds by H.H. All authors have read and agreed to the published version of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


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