FEATURE: EXERCISE, IR AND METABOLIC SYNDROME intake following earlier weight gain. Similarly, not all obese people will have IR, or may be able to manage their insulin levels through careful diet and exercise. Hypertension will be evident in some, and skin changes can be easily identifiable signs. Fasting blood tests will usually reveal a normal blood sugar, but may demonstrate altered glucose tolerance Studies have shown that and raised insulin levels. Blood lipids may the majority of patients be altered and sex hormone binding globulin (SHBG), lowered. Specific will respond to aerobic diagnostics for PCOS include ultrasound examination. Antidepressant and most exercise, resistance oral contraceptives can increase the training and dietary risk of IR, and B-blockers can limit exercise capacity, so it is important modification. to note any medications the patient has been prescribed. Exercise is the mainstay of treatment for IR, and consequently metabolic syndrome, but treatment of specific organ system disease may be required. ABOUT THE AUTHORS Studies have shown that the majority of patients will respond to aerobic Dr Roslyn Carbon is exercise, resistance training and dietary a Sport and Exercise STANCEmodification. Even in those with raisedfasting blood sugar levels, there isgood evidence that lifestyle change,as a secondary prevention treatment,Physician in Perth,having trained in both Australia andthe UK. Former roles include SeniorClinical Lecturer at the Academic DROMEcan delay the onset of frank diabetesfor years. However, there is a cohortof IR patients in whom medication isrequired to normalise insulin sensitivity,Department of Sports Medicine atthe Royal London Hospital, theNational Medical Director of theEnglish Institute of Sport, and MO particularly in established metabolic at six Olympic Games. Roslyn is syndrome. Tailored exercise prescription, currently the Chair of the ACSEP minimisation of health risk with or ‘Exercise as Medicine’ Working Group depression, and alterations in fertility without medication, and close follow-up and is a WAIS accredited physician. manifesting as polycystic ovarian (including serial blood tests) to assess syndrome (PCOS) in women. progress are required. Dr Diana Robinson is a Sydney based Sport and In patients in whom symptoms suggest Patients often face significant barriers Exercise Physician with metabolic syndrome, it is important to in accessing and maintaining an exercise an interest in ‘Exercise correctly diagnose insulin resistance program, as it may be a substantial as Medicine.’ She is an to ensure a properly tailored treatment departure from their usual lifestyle. Associate Editor with the algorithm. A detailed history of the Furthermore, the diagnosis of the clinical BJSM and BMJ Open Sport and contributing organ systems is important, paradigm of metabolic syndrome can Exercise Medicine. Diana sits on the as well as the temporal progression often be missed or delayed in a patient Anti-Doping Rule Violation Panel, of disease over time, often related to with risk factors or chronic disease, the FINA Doping Control Review changes in nutrition, activity and stress. leading to a deteriorating prognosis. Board and is the Chair of the ACSEP Central adiposity (increased waist Timely diagnosis and a comprehensive Curriculum Development and Review circumference) is more relevant than management plan, delivered by an Committee. She received the ACSEP a high BMI alone. Some patients may integrated clinical team across the Distinguished Service Citation not be obese at the time of presentation professions, will reduce the burden in 2016. in response to persistent low energy of disease for many of our patients. VOLUME 36 • ISSUE 2 2018 23 nausiaL nawappoN/segamiytteg