Effects of physical exercise on metabolic syndrome in middle-aged and olderadults – a systematic review

Metabolic syndrome (MetS), characterised by abdominal obesity, hypertension, dyslipidemia, and insulin resistance, presents a growing public health concern, especially among middle-aged and older adults. This systematic review evaluates the effects of different physical exercise modalities, including aerobic training, resistance training, high-intensity interval training (HIIT), and combined programs, on MetS-related parameters, inflammation, and cardiometabolic risk factors. A total of 30 studies published between 2000 and 2025 involving participants aged 40 years and older were analysed. All studies reported positive changes in at least one outcome. Notably, reductions in C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and increases in interleukin-10 (IL-10) were reported in 17, 12, 13, and 4 studies, respectively. Improvements in lipid profiles included increased HDL (7 studies), reduced LDL (3 studies), and decreased triglycerides (4 studies). Enhanced aerobic capacity (VO2max/VO2peak) was observed in 4 studies. Blood pressure improvements were found in 5 studies, while waist circumference reduction and better glycemic control (HbA1c, glucose, insulin) were noted in a few studies. Additional anti-inflammatory effects were reflected in reductions of IL-8 (3 studies) and IL-18 (2 studies). Despite these promising outcomes, inconsistencies regarding optimal exercise intensity and volume remain. Limitations such as small sample sizes and methodological variability highlight the need for more standardised and largescale research. This review reinforces the pivotal role of structured physical activity in managing MetS and advocates for personalised exercise interventions to enhance therapeutic efficacy.