Tailored Exercise Intervention in Metabolic Syndrome: Cardiometabolic Improvements Beyond Weight Loss and Diet—A Prospective Observational Study

<b>Background</b>: Metabolic syndrome (MS) is a cluster of cardiovascular and metabolic risk factors that increase the likelihood of both acute events and chronic conditions. While exercise has been shown to improve individual risk factors associated with MS; research on its effects on MS as an integrated condition remains limited. This study aims to evaluate the effectiveness of a 6-month Adapted Personalized Motor Activity (AMPA) program for improving the health outcomes of individuals with MS. <b>Methods</b>: Seventy-one sedentary participants with MS (mean age: 63 ± 9.4 years, 46.5% female) completed a 6-month intervention, incorporating moderate-intensity aerobic and resistance training. Each participant received a personalized exercise plan prescribed by a sports medicine physician. The training was monitored via telemetry to ensure safety. No dietary recommendations were provided during the intervention. Baseline and post-intervention assessments included Cardiopulmonary Exercise Testing (CPET), anthropometric measurements, blood pressure, heart rate, lipid profile (total cholesterol, HDL, LDL, and triglycerides), fasting glucose, and HbA1c. <b>Results</b>: Significant improvements were observed in fasting glucose (-10.6%, <i>p</i> < 0.001), HbA1c (-3.88%, <i>p</i> < 0.001), HDL cholesterol (+20.8%, <i>p</i> < 0.001), LDL cholesterol (-25.1%, <i>p</i> < 0.001), and VO₂max (+8.6%, <i>p</i> < 0.001). Systolic and diastolic blood pressure also decreased significantly, with reductions of -12% (<i>p</i> < 0.001) and -5.9% (<i>p</i> < 0.001), respectively. Reductions in weight and waist circumference were statistically significant but modest and clinically irrelevant, showing no correlation with improvements in cardio-metabolic parameters. Logistic regression and correlation matrix analyses were performed to identify key predictors of changes in individual risk factors. <b>Conclusions</b>: While personalized exercise alone may not fully control individual risk factors of metabolic syndrome, its overall effect is comparable to low-intensity pharmacological polytherapy with minimal adverse effects. These benefits appear to be independent of dietary habits, gender, and both baseline and post-intervention physical performance and anthropometric measures.