Association of Muscular Strength with

Incidence of Metabolic Syndrome in Men

RADIM JURCA, MICHAEL J. LAMONTE, CAROLYN E. BARLOW, JAMES B. KAMPERT, TIMOTHY S. CHURCH,
and STEVEN N. BLAIR
The Cooper Institute, Dallas, TX

ABSTRACT
JURCA, R., M. J. LAMONTE, C. E. BARLOW, J. B. KAMPERT, T. S. CHURCH, and S. N. BLAIR. Association of Muscular
Strength with Incidence of Metabolic Syndrome in Men. Med. Sci. Sports Exerc., Vol. 37, No. 11, pp. 1849 –1855, 2005. Purpose:
To examine the association between muscular strength and incidence of metabolic syndrome. Methods: Participants were 3233 men
(20 – 80 yr) initially free of metabolic syndrome who had two or more clinical examinations between 1980 and 2003, including baseline
muscular strength and cardiorespiratory fitness assessment. Metabolic syndrome was defined according to NCEP-ATP III criteria.
Muscular strength was quantified by combining body weight-adjusted one-repetition maximal measures for leg and bench presses.
Cardiorespiratory fitness was assessed by maximal treadmill test. Results: A total of 480 men developed metabolic syndrome during
a mean follow-up period of 6.7 ⫾ 5.2 yr. In a Cox regression analysis adjusted for age, the hazard ratios (95% confidence intervals)
of metabolic syndrome associated with the incremental categories of muscular strength were 1.00 (referent), 0.88 (0.69 –1.12), 0.77
(0.60 – 0.98), and 0.54 (0.42– 0.71), respectively (linear trend P ⬍ 0.0001). The inverse trend persisted after adjustment for smoking,
alcohol intake, number of baseline metabolic syndrome risk factors, family history of diabetes, hypertension, and premature coronary
disease (P ⫽ 0.004), but was attenuated (P ⫽ 0.06) when further adjusted for cardiorespiratory fitness. Compared with the lowest
strength category, the highest strength category was associated with 44 and 39% lower risk (P ⬍ 0.05 each) of incident metabolic
syndrome among normal weight body mass index (BMI ⬍ 25) and overweight or obese (BMI ⱖ 25) men, respectively. An inverse
association of incident rates was also seen within stratum of age (20 –39 yr, P ⬍ 0.001; 40 – 49 yr, P ⬍ 0.01; and 50⫹ yr, P ⬍ 0.05).
Conclusions: Muscular strength was inversely associated with metabolic syndrome incidence, independent of age and body size.
Potential benefits of greater muscular strength presumably through resistance exercise training should be considered in primary
prevention of metabolic syndrome. Key Words: RESISTANCE EXERCISE, CARDIORESPIRATORY FITNESS, BODY MASS
INDEX, PREVENTION, AGE

T
he importance of resistance exercise in promoting
health and preventing disease has become increas-
ingly recognized (8,26). In addition to improvements
in skeletal muscle strength, endurance, power, and neuro-
muscular function (1), resistance exercise contributes to the
prevention and management of atherosclerotic coronary
heart disease (19), hypertension (25), diabetes (2), and over-
weight and mild obesity (1). Little is known, however,
whether the health benefits of resistance exercise are inde-
pendent of, or additive to, those already established for large
muscle dynamic aerobic activity.
The mechanism through which resistance exercise mod-
ifies chronic disease risk may be mediated by improvements
Address for correspondence: Radim Jurca, Ph.D., The Cooper Institute,
12330 Preston Road, Dallas, TX 75230; E-mail: djurca@cooperinst.org.
Submitted for publication February 2005.
Accepted for publication June 2005.
0195-9131/05/3711-1849/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2005 by the American College of Sports Medicine
DOI: 10.1249/01.mss.0000175865.17614.74
1849
in abdominal body fat (29), plasma concentrations of tri-
glyceride (10) and high-density lipoprotein cholesterol (11),
blood pressure (18), and glycemic control (20). Aerobic
exercise and cardiorespiratory fitness also are strongly as-
sociated with these risk factors (16) and with chronic disease
outcomes (4). Associations between muscular strength, a
measure of the effects of resistance exercise, and disease
risk, therefore, may be detecting the benefits of an active
and fit way of living rather than an independent benefit of
resistance exercise. We have shown, however, that muscular
strength is inversely associated with all-cause mortality in
men and women, independent of cardiorespiratory fitness
levels (6). We also recently reported an inverse association
between muscular strength and the prevalence of metabolic
syndrome in men, independent of cardiorespiratory fitness
(12).
Metabolic syndrome is a condition of coexisting risk factors
that places individuals at high risk for all-cause and cardiovas-
cular mortality (15) and for the development of diabetes (17).
Evidence from prospective epidemiologic studies (5,14), in-
cluding preliminary analyses in our cohort, suggests that higher
levels of activity and fitness protect against developing meta-
bolic syndrome. Based on our cross-sectional observation that
the inverse association between muscular strength and meta-
bolic syndrome prevalence is independent of cardiorespiratory
fitness (12), it is possible that resistance exercise may provide
protection against developing metabolic syndrome beyond
what is seen for physical activity and cardiorespiratory fitness.
Data testing this hypothesis are currently unavailable; there-
fore, we examined the prospective association between mus-
cular strength and metabolic syndrome incidence in a cohort of
men for whom measurements of cardiorespiratory fitness also
were available.
METHODS
Participants. Participants were asymptomatic men
aged 20 – 80 yr who had a baseline preventive medical
examination at the Cooper Clinic in Dallas, Texas between
1980 and 1989, and who are enrolled in the Aerobics Center
Longitudinal Study (ACLS). Strength testing was voluntary
and an adjunct to the standard examination protocol. Inclu-
sion criteria for the current analysis required participants to
have baseline measures of muscular strength, cardiorespi-
ratory fitness, and a comprehensive clinical examination,
and have at least one follow-up clinical examination with
complete measurements for each metabolic syndrome vari-
able (N ⫽ 3922). After excluding participants with meta-
bolic syndrome at baseline (N ⫽ 501), those with a history
or evidence of cancer (N ⫽ 14), stroke (N ⫽ 1), or coronary
heart disease (N ⫽ 16), those who did not achieve at least
85% of their age-predicted maximal heart rate (N ⫽ 19)
during a maximal treadmill test, and those with an abnormal
exercise electrocardiography (N ⫽ 138), 3233 men re-
mained for analysis. The participants were predominantly
non-Hispanic whites (⬎95%), well educated, and employed
in, or retired from, professional or executive positions. The
Cooper Institute institutional review board approved the
study protocol annually, and all participants provided writ-
ten informed consent before data collection.
Outcome measures and clinical examination.
The primary study outcome was the development of meta-
bolic syndrome, defined as meeting three or more of the
following criteria (21): abdominal obesity (waist girth ⬎102
cm [40 inches]), high triglycerides (TG) (ⱖ1.69 mmol·L⫺1
[150 mg·dL⫺1]), low high-density lipoprotein (HDL)-C
(⬍1.04 mmol·L⫺1 [40 mg·dL⫺1]), high blood pressure (BP)
(ⱖ130 mm Hg systolic or ⱖ85 mm Hg diastolic or self-
reported hypertension), and high fasting glucose (ⱖ6.1
mmol·L⫺1 [110 mg·dL⫺1] or self-reported diabetes). All
participants completed a medical history questionnaire,
which included personal and family health history, smoking
habit, and alcohol intake.
Details of the clinical examination and measures of mus-
cular strength and cardiorespiratory fitness have been de-
scribed elsewhere (4,12). Briefly, body mass index (BMI)
was computed from measured height and weight, and
waist girth was measured at the umbilicus with a plastic
1850 Official Journal of the American College of Sports Medicine
anthropometric tape. We measured resting BP by ausculta-
tion with a mercury sphygmomanometer following the
American Heart Association protocol. Following a 12-h
fast, serum TG, HDL-C, and fasting plasma glucose were
assayed with automated techniques. The laboratory partici-
pates in, and meets, the quality control standards of the U.S.
Centers for Disease Control and Prevention Lipid Standard-
ization Program.
We quantified muscular strength from the results of a
standardized strength assessment protocol using variable-
resistance Universal weight machines (Universal Equip-
ment, Cedar Rapids, IA). Upper body strength was assessed
with a one-repetition maximum (1-RM) supine bench press,
and lower body strength was assessed with a 1-RM seated
leg press. Participants were instructed on proper breathing
and lifting form for each movement. Initial loads were 70
and 100% of body weight for the bench and leg press,
respectively. Following a brief rest period, we added incre-
ments of 2.27– 4.54 kg (5–10 lbs) until maximal effort was
achieved for each lift. We calculated a muscular strength
score by combining the 1-RM score for the bench and leg
press expressed as kilograms of weight lifted per kilogram
of body weight. Distributions of the composite strength
score were formed for the following age groups: 20 –29,
30 –39, 40 – 49, 50 –59, and 60⫹ yr. We used quartiles of the
age-specific composite strength score for analysis. In an
earlier report, we presented a strong and direct gradient for
self-reported participation in resistance exercises across
quartiles of muscular strength, which suggests that our mea-
surement of muscular strength is an adequate reflection of
the resistance exercise habits among men in the ACLS (12).
In a subgroup of 246 men in the ACLS who underwent two
muscular strength assessments within a 1-yr period, the
intraclass correlation for 1-RM bench press and leg press
was R ⫽ 0.90 and R ⫽ 0.83, respectively. We believe,
therefore, that the muscular strength variable used in the
present study has acceptable reliability.
Cardiorespiratory fitness was assessed by a maximal
treadmill test using a modified Balke protocol, which has
been described elsewhere (4,12). Participants were given
verbal encouragement to reach a maximal level of exertion,
and the test was terminated when the participant was ex-
hausted or if the physician stopped the test for medical
reasons. In the current analysis, cardiorespiratory fitness
was quantified as maximal exercise duration (min), which is
highly correlated (r ⫽ 0.92) with measured maximal oxygen
uptake (24).
Statistical analyses. Descriptive statistics were com-
puted for each variable. Participants were defined as a case
if they met the metabolic syndrome definition at any clinical
examination following baseline. The number of clinic visits
among participants ranged from 2 to 27 visits (mean and
SD, 4.6 ⫾ 3.5). Among noncases, follow-up time was cal-
culated as the time from the baseline to the last visit.
Because the exact date of metabolic syndrome development
is unknown, we used the midpoint between the date of the
case-finding clinic examination and the date of the previous
http://www.acsm-msse.org
examination where participants were known to be free of TABLE 1. Baseline characteristics by metabolic syndrome status during follow-up.
metabolic syndrome. Follow-up time among cases was then Metabolic Syndrome during Follow-Up
calculated as the time from the baseline visit to the midpoint Present (N ⴝ 480) Absent (N ⴝ 2753)
between the first “incident” visit and the previous visit. Age (yr) 43.7 (8.7) 42.8 (9.3)
Man-years of exposure were computed as the sum of fol- BMI (kg䡠m⫺2) 26.5 (2.9) 24.7 (2.5)
Waist (cm) 95.2 (8.7) 89.8 (7.8)
low-up time among cases and noncases. Systolic blood pressure (mm Hg) 119.7 (11.6) 117.0 (12.2)
Incident rates were computed as the number of metabolic Diastolic blood pressure (mm Hg) 79.8 (8.2) 77.7 (8.4)
Triglyceride (mmol䡠dL⫺1) 1.68 (1.07) 1.13 (0.68)
syndrome cases divided by man-years of exposure for the HDL-cholesterol (mmol䡠dL⫺1) 1.09 (0.26) 1.27 (0.29)
total population sample and within categories of muscular Glucose (mmol䡠dL⫺1) 5.52 (0.50) 5.42 (0.65)
Upper body strength
strength. We used Cox regression to compute hazard ratios Kilograms 70.6 (15.5) 70.8 (17.3)
(HR) and 95% confidence intervals (CI) for incident meta- Kilograms per kilogram of body weight 0.83 (0.17) 0.89 (0.21)
bolic syndrome according to categories of the muscular Lower body strength
Kilograms 140.3 (26.6) 133.0 (24.8)
strength score. Multivariable analyses were adjusted for age, Kilograms per kilogram of body weight 1.64 (0.24) 1.67 (0.27)
baseline examination date, smoking, alcohol intake, cardio- Maximal METs 12.3 (1.8) 12.9 (1.9)
Current smoker (N) (%) 68 (14) 320 (12)
respiratory fitness, number of baseline metabolic syndrome ⱖ5 alcoholic drinks per week (N) (%) 243 (51) 1414 (51)
risk factors, and family history of diabetes, hypertension, Abdominal obesity (N) (%) 85 (18) 135 (5)
High blood pressure (N) (%) 167 (35) 742 (27)
and premature coronary disease. To determine whether the High triglyceride (N) (%) 150 (31) 304 (11)
pattern of association between muscular strength and inci- Low HDL-cholesterol (N) (%) 197 (41) 538 (19)
dent metabolic syndrome varied by weight status and age, High glucose (N) (%) 47 (10) 211 (8)
Number of metabolic syndrome risk factors
we examined the association within BMI-defined categories (N) (%)
of normal weight (BMI ⬍ 25 kg䡠m⫺2) and overweight or 0 75 (16) 1278 (46)
obese (BMI ⱖ 25 kg䡠 m⫺2), and within age groups of 1
2
164 (34)
241 (50)
1020 (37)
455 (17)
20 –39, 40 – 49, and 50⫹ yr. P values are two-sided, with P BMI, body mass index; HDL, high-density lipoprotein; MET, metabolic equivalent
ⱕ 0.05 regarded as statistically significant. estimated from final maximal treadmill speed and grade (3).
Data are mean (SD) unless otherwise indicated.

RESULTS at baseline, and family history of diabetes, hypertension, and

The mean follow-up was 6.7 ⫾ 5.2 yr (range 0.1–22.0 yr).
A total of 480 incident cases of metabolic syndrome occurred
during 21,706 man-years of follow-up. Men who developed
metabolic syndrome were similar in age and had comparable
levels of risk factors and cardiorespiratory fitness when com-
pared with men who remained free of metabolic syndrome
during follow-up (Table 1). With the exception of elevated
glucose, the baseline prevalence of each metabolic syndrome
risk threshold was significantly higher (P ⬍ 0.001) in cases
than in noncases. The prevalence of having two metabolic
syndrome risk factors at baseline was also higher in cases than
in noncases (50 vs 17%). The range of scores for the composite
strength variable, treadmill time, and maximal METs were
1.0 – 4.9 kg lifted per kilogram of body weight, 8.2–38.2 min,
and 7.1–20.2 METs, respectively.
A strong inverse gradient (P ⬍ 0.0001) of metabolic
syndrome incidence rates was observed across categories of
muscular strength (Table 2). Age-adjusted incident rates per
1000 man-years among men in the highest strength category
were 46% lower than in men with low muscular strength.
Hazard ratios and 95% CI were computed to quantify the
strength of association between muscular strength and inci-
dent metabolic syndrome with men in the lowest strength
category as the referent group (Table 2). After adjusting for
age and examination date, we observed a strong inverse
association (P ⬍ 0.0001) between muscular strength and the
risk of incident metabolic syndrome. The association per-
sisted (P ⫽ 0.004) after additional adjustment for smoking,
alcohol intake, number of metabolic syndrome risk factors
STRENGTH AND METABOLIC SYNDROME INCIDENCE
premature coronary disease. Men in the highest strength
category had a 34% (95% CI, 14 –50%, P ⫽ 0.002) lower
risk of developing metabolic syndrome than men in the
lowest strength category. Further adjustment for cardiore-
spiratory fitness attenuated the association between muscu-
lar strength and incident metabolic syndrome to being mar-
ginally not significant (P ⫽ 0.06). In the latter model,
metabolic syndrome risk was 24% (95% CI, 1– 43%, P ⬍
0.05) lower among men with high versus low strength.
We next examined the pattern of association between mus-
cular strength and metabolic syndrome within BMI-defined
categories of normal weight (N ⫽ 1751) (BMI ⬍ 25 kg䡠m⫺2)
and combined overweight (N ⫽ 1348) and obese (N ⫽ 134)
(BMI ⱖ 25 kg䡠m⫺2) (Fig. 1). Age-adjusted incident rates of
metabolic syndrome per 1000 man-years among normal
weight and overweight men were 11.5 and 37.7% (P ⬍
0.0001), respectively. Muscular strength was inversely associ-
ated (P ⬍ 0.05) with metabolic syndrome incidence in both
normal and overweight men. Age-adjusted rates of metabolic
syndrome were 44 and 39% lower in men with high versus low
muscular strength within the normal and overweight categories
(P ⬍ 0.05), respectively.
Figure 2 shows metabolic syndrome incident rates ac-
cording to categories of muscular strength stratified by age.
In all age groups, the general pattern of association was for
incrementally lower rates of metabolic syndrome incidence
across categories of strength. We observed significant linear
trends for ages 20 –39 yr (P ⬍ 0.001), 40 – 49 yr (P ⬍ 0.01),
and 50⫹ yr (P ⬍ 0.05).
Medicine & Science in Sports & Exercise姞 1851
TABLE 2. Metabolic syndrome incident rates and hazard ratios by muscular strength categories in 3233 men in the Aerobics Center Longitudinal Study (1980 –2003).
Muscular Strength P Value
Q1 (Low) Q2 Q3 Q4 (High) for Trend
Participants (N) 808 809 808 808
Man-years of follow-up 5129 5289 5602 5685
Cases (N) 144 130 120 86
Age-adjusted rate per 1000 man-years 28.1 24.6 21.3 15.2 ⬍0.0001
HR (95% CI), Model 1* 1.00 0.88 (0.69–1.12) 0.77 (0.60–0.98) 0.54 (0.42–0.71) ⬍0.0001
HR (95% CI), Model 2† 1.00 0.93 (0.73–1.17) 0.89 (0.70–1.13) 0.66 (0.50–0.86) 0.004
HR (95% CI), Model 3‡ 1.00 0.95 (0.75–1.21) 0.93 (0.73–1.18) 0.76 (0.57–0.99) 0.06
HR, hazard ratio; CI, confidence interval.
* Adjusted for age and examination date.
† Additionally adjusted for smoking, alcohol intake, number of metabolic syndrome risk factors at baseline, and family history of diabetes, hypertension, and premature
coronary disease.
‡ Additionally adjusted for maximal treadmill time.

DISCUSSION ratory fitness. In our participants, muscular strength and

The primary findings of this investigation were 1) mus-
cular strength was inversely associated with incident meta-
bolic syndrome, 2) the association between muscular
strength and metabolic syndrome was significant after ex-
tensive control for potential confounders and was only mar-
ginally not significant with additional adjustment for car-
diorespiratory fitness, and 3) muscular strength was
protective against developing metabolic syndrome in nor-
mal and overweight men and across a broad range of ages.
Although recent studies have reported protective associa-
tions between cardiorespiratory fitness exposures and inci-
dent metabolic syndrome (5,14), we believe the data re-
ported herein are the first to demonstrate that maximal
muscular strength is inversely associated with the develop-
ment of metabolic syndrome.
We recently reported an inverse association between
muscular strength and the prevalence of metabolic syn-
drome in ACLS men (12). The association between muscu-
lar strength and prevalent metabolic syndrome was indepen-
dent of cardiorespiratory fitness and other confounders. Our
current analysis shows that muscular strength is indepen-
dently associated with lower incidence of metabolic syn-
drome and marginally independent of maximal cardiorespi-
cardiorespiratory fitness measures were modestly correlated
(age-adjusted Pearson r ⫽ 0.29). This increases the plausi-
bility that protection against developing metabolic syn-
drome may be conferred by higher levels of skeletal muscle
function through biological pathways that are independent
of cardiorespiratory fitness. To the extent that resistance
exercise determines cardiorespiratory fitness, however, their
joint effects cannot be completely disentangled statistically.
The specific mechanisms through which resistance exercise
and muscular strength mediate the clustering of metabolic
risk factors have yet to be fully elucidated.
The apparent protective effect of muscular strength against
clustering high-risk metabolic phenotypes may not be a func-
tion of maximal muscular strength per se, but may reflect better
metabolic homeostasis resulting from regular participation in
resistance types of physical activities. We also recognize that
genetic transmission contributes to the expression of muscular
strength (27). However, we previously reported, a strong direct
association (P ⬍ 0.001) between the frequency of self-reported
resistance exercise and maximal muscular strength among men
in the ACLS (12). Regular participation in resistance exercise
was reported by 65% of men in the highest strength category,
but by only 25% of men in the lowest strength category. This

FIGURE 1—Age-adjusted metabolic syn-

drome incidence rates across muscular
strength categories by BMI. Incidence rates
per 1000 man-years are shown atop the bars
and the number of cases within the bars. Q1
represents the lowest and Q4 the highest mus-
cular strength category.

1852 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org


observation suggests that our measurements of muscular
strength are a reflection of the resistance exercise training
habits in our cohort. Other investigators have shown that re-
sistance training increases muscle quantity and insulin action
(3,9) and reduces visceral adipose tissue (22). It has been
recently suggested that the improved insulin sensitivity after
resistance training may occur by an attenuation of insulin-
stimulated glucose uptake per unit of skeletal muscle, which
supports the conclusion that the effect of resistance training
cannot be ascribed solely to a mere increase in fat-free mass
(3). Together, existing data on the health benefits of resistance
exercise training and the prospective data reported here suggest
that resistance exercise may be important to include in physical
activity recommendations to prevent risk factor clustering such
as seen with the metabolic syndrome (21).
In our analysis, 50% of men who developed the metabolic
syndrome had two metabolic syndrome risk factors at base-
line compared with only 17% of men who did not become
a case. A ninefold (95% CI, 7.3–12.3, P ⬍ 0.0001) increase
in the age-adjusted risk of metabolic syndrome was ob-
served in men with two metabolic syndrome risk factors at
baseline compared with men who had none (data not
shown). Clearly, individuals with two of three metabolic
syndrome risk factors have underlying homeostatic meta-
bolic dysregulation and are more susceptible for case de-
velopment during follow-up, analogous to the increased risk
for diabetes and hypertension that is seen in individuals who
are prediabetic and prehypertensive, respectively. Even after
controlling for the number of baseline metabolic syndrome
factors, men with high strength had 34% lower risk (95%
CI, 14 –50%, P ⬍ 0.01) of developing metabolic syndrome
as compared with men with low strength. It appears that
higher levels of muscular strength may provide protection
against metabolic syndrome development even in men at
high-risk susceptibility for this condition.
The risk of developing abnormal glucose metabolism,
dyslipidemia, and hypertension is higher among obese ver-
sus normal weight individuals (23). We observed that men
STRENGTH AND METABOLIC SYNDROME INCIDENCE
FIGURE 2—Metabolic syndrome incidence
rates across muscular strength categories by
age groups. Incidence rates per 1000 man-
years are shown atop the bars and the num-
ber of cases within the bars. Q1 represents the
lowest and Q4 the highest muscular strength
category.
with high compared with low muscular strength had signif-
icantly lower metabolic syndrome incidence rates even
when grouped into BMI categories of normal weight (8.7 vs
15.7, P ⬍ 0.05) and overweight (25.9 vs 42.7, P ⬍ 0.01).
These results are consistent with our cross-sectional study
showing an inverse association between muscular strength
and metabolic syndrome prevalence in normal weight, over-
weight, and obese men (12). Obesity is a heterogeneous
disorder for which both healthy and adverse metabolic phe-
notypes have been described (13). It is possible that mea-
sures of maximal muscular strength are sensitive enough to
discriminate individuals for whom skeletal muscle metabo-
lism is efficient and favors maintaining healthy metabolic
risk profiles through mechanisms mediated by activity-
related energy expenditure that are independent of cardio-
respiratory fitness and body composition (28).
National data indicate the prevalence of metabolic syn-
drome increases across decades of age (7). Cross-sectional
data from our cohort of men showed lower prevalence of
metabolic syndrome with higher levels of muscular strength
(12), independent of age. Our current prospective analysis
shows that risk of metabolic syndrome was lower in those
with high muscular strength across the age groups. Our
findings support extant data on the importance of physical
activity, including resistance exercise, in promoting health
and reducing disease risk among younger and older indi-
viduals (8).
Limitations exist to the findings of our study that should be
considered when interpreting and generalizing the data re-
ported herein. All of the participants underwent a comprehen-
sive medical examination, which was used to limit the mus-
cular strength assessment to individuals without cardiovascular
disease and severe obesity. Generalization of our data applies
only to apparently healthy white men with higher socioeco-
nomic affluence. We do not have detailed information on
resistance exercise habits and medication usage in this group of
ACLS men. It is possible that some men were prescribed
medication and, indeed, adhered sufficiently enough to the
Medicine & Science in Sports & Exercise姞 1853
medication regimen during the follow-up period such to bias
the association between strength and incident metabolic syn-
drome away from unity. Because the baseline strength expo-
sure was obtained during the 1980s, which is before the wide-
spread clinical use of medications that have recently been
shown to affect the complex phenotype of metabolic syndrome
(e.g., statins, ace-inhibitors, PPAR-gamma inhibitors), we be-
lieve the potential influence of medications on the associations
reported here would be only marginal. Finally, it is important
to recognize that metabolic syndrome defined by different
criteria might result in diverse findings. Strengths of our find-
ings include objective and standardized measures of muscular
strength in a large cohort of men with extensive follow-up for
incident metabolic syndrome cases. To our knowledge, this is
the first prospective epidemiologic study to examine the asso-
ciation between muscular strength and metabolic syndrome
incidence.
In summary, the present study showed that muscular
strength was independently associated with metabolic syn-
drome incidence in healthy men. Muscular strength may
protect against developing the metabolic syndrome among
REFERENCES
1. AMERICAN COLLEGE OF SPORTS MEDICINE POSITION STAND. The rec-
ommended quantity and quality of exercise for developing and-
maintaining cardiorespiratory and muscular fitness, and flexibility
in healthyadults. Med. Sci. Sports Exerc. 30:975–991, 1998.
2. ALBRIGHT, A., M. FRANZ, G. HORNSBY, et al. American College of
Sports Medicine position stand. Exercise and type 2 diabetes. Med.
Sci. Sports Exerc. 32:1345–1360, 2000.
3. ANDERSEN, J. L., P. SCHJERLING, L. L. ANDERSEN, and F. DELA.
Resistance training and insulin action in humans: effects of de-
training. J. Physiol. 551:1049–1058, 2003.
4. BLAIR, S. N., H. W. KOHL, III, R. S. PAFFENBARGER, JR., D. G.
CLARK, K. H. COOPER, and L. W. GIBBONS. Physical fitness and
all-cause mortality. A prospective study of healthy men and
women. JAMA 262:2395–2401, 1989.
5. CARNETHON, M. R., S. S. GIDDING, R. NEHGME, S. SIDNEY, D. R.
JACOBS, JR., and K. LIU. Cardiorespiratory fitness in young adult-
hood and the development of cardiovascular disease risk factors.
JAMA 290:3092–3100, 2003.
6. FITZGERALD, S. J., C. E. BARLOW, J. B. KAMPERT, J. R. MORROW,
JR., A. W. JACKSON, and S. N. BLAIR. Muscular fitness and all-
cause mortality: prospective observations. Journal of Physical
Activity and Health 1:7–18, 2004.
7. FORD, E. S., W. H. GILES, and W. H. DIETZ. Prevalence of the
metabolic syndrome among US adults: findings from the third
National Health and Nutrition Examination Survey. JAMA 287:
356–359, 2002.
8. GRAVES, J. E., AND B. A. FRANKLIN. Resistance Training for Health
and Rehabilitation. Champaign, IL: Human Kinetics, 2001:181–
405.
9. HOLTEN, M. K., M. ZACHO, M. GASTER, C. JUEL, J. F. WOJTAS-
ZEWSKI, and F. DELA. Strength training increases insulin-mediated
glucose uptake, GLUT4 content, and insulin signaling in skeletal
muscle in patients with type 2 diabetes. Diabetes 53:294–305, 2004.
10. HONKOLA, A., T. FORSEN, and J. ERIKSSON. Resistance training
improves the metabolic profile in individuals with type 2 diabetes.
Acta Diabetol. 34:245–248, 1997.
11. HURLEY, B. F., J. M. HAGBERG, A. P. GOLDBERG, et al. Resistive
training can reduce coronary risk factors without altering V̇O2 max
or percent body fat. Med. Sci. Sports Exerc. 20:150–154, 1988.
12. JURCA, R. M., J. LAMONTE, CHURCH, T. S. et al. Associations of
muscle strength and aerobic fitness with metabolic syndrome in
men. Med. Sci. Sports Exerc. 36:1301–1307, 2004.
13. KARELIS, A. D., D. H. ST PIERRE, F. CONUS, R. RABASA-LHORET, and
1854 Official Journal of the American College of Sports Medicine
men who are normal weight or overweight, younger or
older, and after adjustment for a number of baseline meta-
bolic syndrome variables and maximal cardiorespiratory
fitness. Randomized controlled trials among diverse popu-
lations are needed to examine the possible role of resistance
exercise training in preventing the development of meta-
bolic syndrome and related disease outcomes. Until such
trials are completed, clinicians may wish to consider coun-
seling their patients on the importance of aerobic physical
activity and resistance exercise training for the primary
prevention of metabolic disorders.
We thank Kenneth H. Cooper, M.D, for establishing the Aerobics
Center Longitudinal Study, the physicians and technicians of the
Cooper Clinic for collecting the data, William L. Haskell, Ph.D., for
comments on an earlier draft, Margo Simmons and her staff for data
entry, and Melba Morrow for editorial assistance.
This research was supported by NIH grants AG06945 and
HL62508. Additional support has been provided by the Communi-
ties Foundation of Texas on recommendation of Nancy Ann and Ray
L. Hunt.
There is no conflict of interest for any of the authors.
E. T. POEHLMAN. Metabolic and body composition factors in sub-
groups of obesity: what do we know? J. Clin. Endocrinol. Metab.
89:2569–2575, 2004.
14. LAAKSONEN, D. E., H. M. LAKKA, J. T. SALONEN, L. K. NISKANEN,
R. RAURAMAA, and T. A. LAKKA. Low levels of leisure-time phys-
ical activity and cardiorespiratory fitness predict development of
the metabolic syndrome. Diabetes Care 25:1612–1618, 2002.
15. LAKKA, H. M., D. E. LAAKSONEN, T. A. LAKKA, et al. The metabolic
syndrome and total and cardiovascular disease mortality in mid-
dle-aged men. JAMA 288:2709–2716, 2002.
16. LAMONTE, M. J., P. A. EISENMAN, T. D. ADAMS, B. B. SHULTZ, B.
E. AINSWORTH, and F. G. YANOWITZ. Cardiorespiratory fitness and
coronary heart disease risk factors: the LDS Hospital Fitness
Institute cohort. Circulation 102:1623–1628, 2000.
17. LORENZO, C., M. OKOLOISE, K. WILLIAMS, M. P. STERN, and S. M.
HAFFNER. The metabolic syndrome as predictor of type 2 diabetes:
the San Antonio heart study. Diabetes Care 26:3153–3159, 2003.
18. MARTEL, G. F., D. E. HURLBUT, M. E. LOTT, et al. Strength training
normalizes resting blood pressure in 65- to 73-year-old men and
women with high normal blood pressure. J. Am. Geriatr. Soc.
47:1215–1221, 1999.
19. MCCARTNEY, N. Role of resistance training in heart disease. Med.
Sci. Sports Exerc. 30:S396–S402, 1998.
20. MILLER, W. J., W. M. SHERMAN, and J. L. IVY. Effect of strength
training on glucose tolerance and post-glucose insulin response.
Med. Sci. Sports Exerc. 16:539–543, 1984.
21. NATIONAL CHOLESTEROL EDUCATION PROGRAM. Third Report of the
National Cholesterol Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adults (Adult Treatment Panel III) final report. Circulation
106:3143–3421, 2002.
22. PARK, S. K., J. H. PARK, Y. C. KWON, H. S. KIM, M. S. YOON, and
H. T. PARK. The effect of combined aerobic and resistance exercise
training on abdominal fat in obese middle-aged women. J. Physiol.
Anthropol. Appl. Human Sci. 22:129–135, 2003.
23. PARK, Y. W., S. ZHU, L. PALANIAPPAN, S. HESHKA, M. R. CARNE-
THON, and S. B. HEYMSFIELD. The metabolic syndrome: prevalence
and associated risk factor findings in the US population from the
Third National Health and Nutrition Examination Survey, 1988-
1994. Arch. Intern. Med. 163:427–436, 2003.
24. POLLOCK, M. L., R. L. BOHANNON, K. H. COOPER, et al. A compar-
ative analysis of four protocols for maximal treadmill stress test-
ing. Am. Heart J. 92:39–46, 1976.
http://www.acsm-msse.org
25. POLLOCK, M. L., B. A. FRANKLIN, G. J. BALADY, et al. AHA Science
Advisory. Resistance exercise in individuals with and without
cardiovascular disease: benefits, rationale, safety, and prescrip-
tion: An advisory from the Committee on Exercise, Rehabilitation,
and Prevention, Council on Clinical Cardiology, American Heart
Association; Position paper endorsed by the American College of
Sports Medicine. Circulation 101:828–833, 2000.
26. TANASESCU, M., M. F. LEITZMANN, E. B. RIMM, W. C. WILLETT, M. J.
STAMPFER, and F. B. HU. Exercise type and intensity in relation to
coronary heart disease in men. JAMA 288:1994–2000, 2002.
STRENGTH AND METABOLIC SYNDROME INCIDENCE
27. THOMIS, M. A., G. P. BEUNEN, H. H. MAES, et al. Strength training:
importance of genetic factors. Med. Sci. Sports Exerc. 30:724–
731, 1998.
28. TIKKANEN, H. O., E. HAMALAINEN, S. SARNA, H. ADLERCREUTZ, and
M. HARKONEN. Associations between skeletal muscle properties,
physical fitness, physical activity and coronary heart disease risk
factors in men. Atherosclerosis 137:377–389, 1998.
29. TREUTH, M. S., A. S. RYAN, R. E. PRATLEY, et al. Effects of strength
training on total and regional body composition in older men. J.
Appl. Physiol. 77:614–620, 1994.
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