Physical Activity Energy Expenditure Predicts Progression Toward the Metabolic Syndrome Independently of Aerobic Fitness in Middle-Aged Healthy Caucasians

The Medical Research Council Ely Study

  1. Ulf Ekelund, PHD,
  2. Søren Brage, MPHIL,
  3. Paul W. Franks, PHD,
  4. Susie Hennings, BSC,
  5. Sue Emms, BSC and
  6. Nicholas J. Wareham, MB, PHD
  1. From the Epidemiology Unit, Medical Research Council, Cambridge, U.K
  1. Address correspondence and reprint requests to Ulf Ekelund, PhD, MRC, Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, U.K. E-mail: ue202{at}


OBJECTIVE—To examine over a period of 5.6 years the prospective associations between physical activity energy expenditure (PAEE), aerobic fitness (Vo2max), obesity, and the progression toward the metabolic syndrome in a population-based cohort of middle-aged men and women (n = 605) who were free of the metabolic syndrome at baseline.

RESEARCH DESIGN AND METHODS—PAEE was measured objectively by individually calibrated heart rate against energy expenditure. Vo2max was predicted from a submaximal exercise stress test. Fat mass and fat-free mass were assessed by bio-impedance. A metabolic syndrome score was computed by summing the standardized values for obesity, hypertension, hyperglycemia, insulin resistance, hypertriglyceridemia, and the inverse level of HDL cholesterol and expressed as a continuously distributed outcome. Generalized linear models were used to examine the independent prospective associations between PAEE and Vo2max and the metabolic syndrome score after adjusting for sex, baseline age, smoking, socioeconomic status, follow-up time, and baseline phenotypes.

RESULTS—PAEE predicted progression toward the metabolic syndrome, independent of baseline metabolic syndrome, body fat, Vo2max, and other confounding factors (standardized β = −0.00085, P = 0.046). This association was stronger when excluding the adiposity component from the metabolic syndrome (standardized β = −0.0011, P = 0.035). Vo2max was not an independent predictor of the metabolic syndrome after adjusting for physical activity (standardized β = 0.00011, P = 0.93).

CONCLUSIONS—PAEE predicts progression toward the metabolic syndrome independent of aerobic fitness, obesity, and other confounding factors. This finding underscores the importance of physical activity for metabolic disease prevention even when an improvement in aerobic fitness is absent.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted February 8, 2005.
    • Received December 22, 2004.
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