a detailed description of the design , subjects , and methods applied in the dps has been reported previously ( 14 ) . in brief , the dps was a randomized lifestyle intervention study in 522 middle - aged overweight participants with impaired glucose tolerance , aimed at the prevention of type 2 diabetes . in the present study ,
we included those 486 participants ( 249 in the intervention and 237 in the control group ) who had completed a questionnaire quantifying ltpa at baseline and during yearly follow - up visits ( 11 ) . a subgroup of 137 participants was taking part in supervised resistance training sessions .
the study protocol was approved by the ethics committee of the national public health institute in helsinki , and all subjects gave written informed consent .
the participants in the intervention group were given detailed and individualized dietary and exercise counseling as described elsewhere ( 15 ) .
session for supervised and individually tailored progressive circuit - type resistance training with moderate intensity were recommended twice a week and offered free of charge in three of the five study centers .
the participants in the control group were given general information about healthy food choices , physical activity , and weight loss at baseline , but no individualized counseling was offered .
the validated kuopio ischemic heart disease risk factor study questionnaire ( 11,12 ) was used for the assessment of physical activity .
the participants estimated the frequency , average duration , and intensity of different forms of exercise for individual months during the past 12 months .
based on the reported intensity of different activities and their corresponding metabolic equivalent ( met ) values , the total ltpa was divided to low - intensity and to moderate - to - vigorous intensity ltpa ( 13 ) .
low - intensity ltpa ( < 3.5 mets ) included activities such as gardening , picking berries , casual walking , and bicycling at recreational intensity .
moderate - to - vigorous ltpa ( 3.5 mets ) included activities such as brisk walking , jogging , skiing , swimming , rowing , forest work , gymnastics , resistance training , ball games , snow shoveling , and heavy housework .
the duration of total ltpa and its components were calculated as hours / week from the baseline to the end of the follow - up .
the changes were calculated by subtracting averaged follow - up value from the corresponding baseline value ( 11 ) . the participation in resistance training was recorded electronically when the participants visited the resistance training facilities and was analyzed as sessions / year .
medical history and 3-day food records were collected at baseline and at each annual visit .
average intakes of energy ( kcal / day ) , carbohydrates ( e% ) , total fat ( e% ) , saturated fat ( e% ) , and dietary fiber ( g/1,000 kcal ) were calculated .
the average values from years 13 were used to measure dietary intakes during follow - up ( 11 ) .
serum total and hdl cholesterol and triglyceride levels were determined by enzymatic methods ( boehringer mannheim , germany ) . for the definition of the mets
the data were analyzed using spss statistical software ( version 11.5 ; spss , chicago , il ) .
the baseline values are given as mean  sd , as median with 0.250.75 interquartile range , or as percentages .
the student two - tailed t test , mann - whitney u test ( fasting and 2-h serum insulin , triglycerides , and ltpa ) , and  test were applied to compare the differences at baseline and during the follow - up . for participants who dropped out or developed diabetes during the study , the measurements at the last observation year was used as the end value .
the primary outcome measure was the change in the mets status in the combined intervention and control group from baseline to the end , i.e. , resolution of the mets from baseline , development of mets , or no change with ltpa changes as explanatory variables .
secondary outcome measures were the changes of the mets components . the change of different ltpa was categorized into thirds .
the association with the change in mets status and its components was analyzed with multinominal regression .
the models were adjusted for age , sex , intervention group , and dps study years ( model 1 ) with further adjustments for changes in diet ( intake of total fat , saturated fat , fiber , and energy ) ( model 2 ) and bmi ( model 3 ) .
the change in low - intensity ltpa was also adjusted for the change in moderate - to - vigorous ltpa and vice versa .
the participants in the intervention group were given detailed and individualized dietary and exercise counseling as described elsewhere ( 15 ) .
session for supervised and individually tailored progressive circuit - type resistance training with moderate intensity were recommended twice a week and offered free of charge in three of the five study centers .
the participants in the control group were given general information about healthy food choices , physical activity , and weight loss at baseline , but no individualized counseling was offered .
the validated kuopio ischemic heart disease risk factor study questionnaire ( 11,12 ) was used for the assessment of physical activity .
the participants estimated the frequency , average duration , and intensity of different forms of exercise for individual months during the past 12 months .
based on the reported intensity of different activities and their corresponding metabolic equivalent ( met ) values , the total ltpa was divided to low - intensity and to moderate - to - vigorous intensity ltpa ( 13 ) .
low - intensity ltpa ( < 3.5 mets ) included activities such as gardening , picking berries , casual walking , and bicycling at recreational intensity .
moderate - to - vigorous ltpa ( 3.5 mets ) included activities such as brisk walking , jogging , skiing , swimming , rowing , forest work , gymnastics , resistance training , ball games , snow shoveling , and heavy housework .
the duration of total ltpa and its components were calculated as hours / week from the baseline to the end of the follow - up .
the changes were calculated by subtracting averaged follow - up value from the corresponding baseline value ( 11 ) .
the participation in resistance training was recorded electronically when the participants visited the resistance training facilities and was analyzed as sessions / year .
medical history and 3-day food records were collected at baseline and at each annual visit .
average intakes of energy ( kcal / day ) , carbohydrates ( e% ) , total fat ( e% ) , saturated fat ( e% ) , and dietary fiber ( g/1,000 kcal ) were calculated .
the average values from years 13 were used to measure dietary intakes during follow - up ( 11 ) .
serum total and hdl cholesterol and triglyceride levels were determined by enzymatic methods ( boehringer mannheim , germany ) . for the definition of the mets
the data were analyzed using spss statistical software ( version 11.5 ; spss , chicago , il ) .
the baseline values are given as mean  sd , as median with 0.250.75 interquartile range , or as percentages .
the student two - tailed t test , mann - whitney u test ( fasting and 2-h serum insulin , triglycerides , and ltpa ) , and  test were applied to compare the differences at baseline and during the follow - up . for participants who dropped out or developed diabetes during the study , the measurements at the last observation year was used as the end value .
the primary outcome measure was the change in the mets status in the combined intervention and control group from baseline to the end , i.e. , resolution of the mets from baseline , development of mets , or no change with ltpa changes as explanatory variables .
secondary outcome measures were the changes of the mets components . the change of different ltpa was categorized into thirds .
the association with the change in mets status and its components was analyzed with multinominal regression .
the models were adjusted for age , sex , intervention group , and dps study years ( model 1 ) with further adjustments for changes in diet ( intake of total fat , saturated fat , fiber , and energy ) ( model 2 ) and bmi ( model 3 ) .
the change in low - intensity ltpa was also adjusted for the change in moderate - to - vigorous ltpa and vice versa .
the participants with the mets at baseline had significantly higher bmi , waist circumference , blood pressure , fasting and 2-h glucose , fasting and 2-h insulin , and serum triglyceride levels and lower serum hdl cholesterol levels ( table 1 ) .
baseline characteristics of the participants according the absence ( mets ) or presence ( mets ) of the mets data are means  sd for normally distributed or medians ( interquartile ranges ) for skewed parameters or percentages . in general , men exercised more than women .
women without the mets reported significantly more hours per week spent on total and low - intensity ltpa during the previous 12 months than women with the mets .
the median for total ltpa increased from 7.2 ( 3.610.8 ) at baseline to an average of 7.7 ( 4.811.7 ) hours per week ( p = 0.061 ) in men and from 5.3 ( 2.88.6 ) to 5.8 ( 3.29.0 ) hours per week ( p = 0.016 ) in women during the follow - up .
the median for moderate to vigorous ltpa increased from 2.3 ( 0.94.8 ) to 3.1 ( 1.84.9 ) ( p  0.001 ) hours per week in men and from 1.4 ( 0.33.5 ) to 2.5 ( 1.14.1 ) ( p  0.001 ) hours per week in women .
of the 361 participants meeting the mets criteria at baseline , 20.8% ( n = 75
; 26.6% in the intervention and 14.7% in the control group ; p = 0.005 ) showed resolution during the follow - up .
of the 126 participants not meeting the mets criteria at baseline , 31.2% ( n = 39 ; 30.8% in the intervention and 31.7% in the control group ; p = 0.95 ) developed mets during the follow - up .
the development of the mets was associated with weight gain and less ltpa in both groups .
the change in total ltpa was associated with the change in mets status ( resolution , no change , development ) after adjustment for age , sex , intervention group , and dps study years ( model 1 , fig .
the change in moderate - to - vigorous ltpa was even more strongly associated with the change in mets status in analyses adjusting for the variables in model 1 and changes in low - intensity ltpa .
the resolution of the mets was seen in 29.7 versus 19.1% ( p = 0.004 ) , and the development of mets was seen in 23.5 versus 44.7% ( p = 0.041 ) in the upper versus lower third of change in moderate - to - vigorous ltpa .
the associations remained significant after further adjustments for changes in diet ( model 2 ) and bmi ( model 3 ) ( fig .
changes in low - intensity ltpa were not associated with the change in mets status ( fig .
incidences ( % ) for the development ( for individuals without mets at baseline , n = 125 ) (  ) and the resolution ( for individuals with mets at baseline , n = 361 ) (  ) of the mets according to ltpa change tertiles for total ltpa ( a ) , moderate - to - vigorous ltpa ( b ) , and low - intensity ltpa ( c ) . model 1 : adjustments for age , sex , intervention group , and dps study years
. the change in low - intensity ltpa was also adjusted for change in moderate - to - vigorous ltpa and vice versa .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
the increase in total ltpa was associated with a decrease in the prevalence of hyperglycemia ( p = 0.0200.053 ) , low hdl cholesterol ( p = 0.0180.057 ) , and hypertriglyceridemia ( p = 0.0020.003 ) ( table 2 ) . increased moderate - to - vigorous ltpa decreased the prevalence of elevated fasting glucose ( p = 0.0030.018 ) , but no association with abdominal obesity ( p = 0.0650.181 ) , low hdl cholesterol ( p = 0.0980.232 ) , and high blood pressure ( p = 0.0680.151 ) was found .
in contrast , an increase in low - intensity ltpa was associated with an improvement in hypertriglyceridemia ( p = 0.0060.004 ) , but not any of the other components of the mets
. incidences ( % ) for development and resolution of the mets components according to ltpa change tertiles for total , low - intensity , and moderate - to - vigorous ltpa during the follow - up * model 1 : adjustments for age , sex , intervention group , and dps study years .
the change in low - intensity ltpa was also adjusted for change in moderate - to - vigorous ltpa and vice versa .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
model 3 : model 2 and change in bmi . in the subgroup of 137 individuals taking part in supervised resistance training , the median attendance rate was 27.0 ( 13.442.9 ) sessions / year during the entire study . of the mets status components ,
the resistance training attendance rate was associated , even after adjustment for dietary and bmi changes , with improvements in hyperglycemia ( p = 0.1270.029 ) , hypertriglyceridemia ( p = 0.0460.081 ) , and low hdl cholesterol ( p < 0.0010.002 ) , but not with elevated blood pressure or abdominal obesity ( table 3 ) .
the average resistance training attendance rate per year and the change ( development and resolution ) in the mets components among a subgroup of 137 participants * model 1 : adjustments for age , sex , group , dps study years , averaged low - intensity ltpa , and ltpa other than gymnastics and calisthenics .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
the participants with the mets at baseline had significantly higher bmi , waist circumference , blood pressure , fasting and 2-h glucose , fasting and 2-h insulin , and serum triglyceride levels and lower serum hdl cholesterol levels ( table 1 ) .
baseline characteristics of the participants according the absence ( mets ) or presence ( mets ) of the mets data are means  sd for normally distributed or medians ( interquartile ranges ) for skewed parameters or percentages . in general , men exercised more than women .
women without the mets reported significantly more hours per week spent on total and low - intensity ltpa during the previous 12 months than women with the mets .
the median for total ltpa increased from 7.2 ( 3.610.8 ) at baseline to an average of 7.7 ( 4.811.7 ) hours per week ( p = 0.061 ) in men and from 5.3 ( 2.88.6 ) to 5.8 ( 3.29.0 ) hours per week ( p = 0.016 ) in women during the follow - up .
the median for moderate to vigorous ltpa increased from 2.3 ( 0.94.8 ) to 3.1 ( 1.84.9 ) ( p  0.001 ) hours per week in men and from 1.4 ( 0.33.5 ) to 2.5 ( 1.14.1 ) ( p  0.001 ) hours per week in women .
of the 361 participants meeting the mets criteria at baseline , 20.8% ( n = 75 ; 26.6% in the intervention and 14.7% in the control group ; p = 0.005 ) showed resolution during the follow - up .
of the 126 participants not meeting the mets criteria at baseline , 31.2% ( n = 39 ; 30.8% in the intervention and 31.7% in the control group ; p = 0.95 ) developed mets during the follow - up .
the development of the mets was associated with weight gain and less ltpa in both groups .
the change in total ltpa was associated with the change in mets status ( resolution , no change , development ) after adjustment for age , sex , intervention group , and dps study years ( model 1 , fig .
the change in moderate - to - vigorous ltpa was even more strongly associated with the change in mets status in analyses adjusting for the variables in model 1 and changes in low - intensity ltpa .
the resolution of the mets was seen in 29.7 versus 19.1% ( p = 0.004 ) , and the development of mets was seen in 23.5 versus 44.7% ( p = 0.041 ) in the upper versus lower third of change in moderate - to - vigorous ltpa .
the associations remained significant after further adjustments for changes in diet ( model 2 ) and bmi ( model 3 ) ( fig .
changes in low - intensity ltpa were not associated with the change in mets status ( fig .
incidences ( % ) for the development ( for individuals without mets at baseline , n = 125 ) (  ) and the resolution ( for individuals with mets at baseline , n = 361 ) (  ) of the mets according to ltpa change tertiles for total ltpa ( a ) , moderate - to - vigorous ltpa ( b ) , and low - intensity ltpa ( c ) . model 1 : adjustments for age , sex , intervention group , and dps study years .
the change in low - intensity ltpa was also adjusted for change in moderate - to - vigorous ltpa and vice versa .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
the increase in total ltpa was associated with a decrease in the prevalence of hyperglycemia ( p = 0.0200.053 ) , low hdl cholesterol ( p = 0.0180.057 ) , and hypertriglyceridemia ( p = 0.0020.003 ) ( table 2 ) .
increased moderate - to - vigorous ltpa decreased the prevalence of elevated fasting glucose ( p = 0.0030.018 ) , but no association with abdominal obesity ( p = 0.0650.181 ) , low hdl cholesterol ( p = 0.0980.232 ) , and high blood pressure ( p = 0.0680.151 ) was found .
in contrast , an increase in low - intensity ltpa was associated with an improvement in hypertriglyceridemia ( p = 0.0060.004 ) , but not any of the other components of the mets .
incidences ( % ) for development and resolution of the mets components according to ltpa change tertiles for total , low - intensity , and moderate - to - vigorous ltpa during the follow - up * model 1 : adjustments for age , sex , intervention group , and dps study years .
the change in low - intensity ltpa was also adjusted for change in moderate - to - vigorous ltpa and vice versa .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
in the subgroup of 137 individuals taking part in supervised resistance training , the median attendance rate was 27.0 ( 13.442.9 ) sessions / year during the entire study .
of the mets status components , the resistance training attendance rate was associated , even after adjustment for dietary and bmi changes , with improvements in hyperglycemia ( p = 0.1270.029 ) , hypertriglyceridemia ( p = 0.0460.081 ) , and low hdl cholesterol ( p < 0.0010.002 ) , but not with elevated blood pressure or abdominal obesity ( table 3 ) .
the average resistance training attendance rate per year and the change ( development and resolution ) in the mets components among a subgroup of 137 participants * model 1 : adjustments for age , sex , group , dps study years , averaged low - intensity ltpa , and ltpa other than gymnastics and calisthenics .
model 2 : model 1 and adjustments for change in dietary intakes of total fat , saturated fat , fiber , and energy .
increased moderate - to - vigorous ltpa during the 4.1-year follow - up increased the likelihood for the mets to resolve and decreased the likelihood for the mets to develop , independently of changes in diet and body weight . moreover , increased moderate - to - vigorous ltpa decreased the prevalence of hyperglycemia .
improvements in fasting plasma glucose , serum triglycerides , and hdl cholesterol , independently of changes in diet , lifestyle ltpa , and other types of ltpa , were associated with participation in resistance training .
overall , strong and mostly linear dose - response associations of the change in total ltpa with the development and resolution of the mets were seen .
when breaking down physical activity into moderate - to - vigorous ltpa and low - intensity ltpa , it seems evident that most of the benefit was from moderate- to vigorous - intensity ltpa .
changes in moderate - to - vigorous ltpa were associated with the change in metabolic status , even independently of the changes in bmi , but the association was not linear across categories .
changes in low - intensity ltpa were not associated with the development or resolution of the mets .
why the dose - response association was not apparent for moderate - to - vigorous ltpa is unclear , but it may be related to the difficulty in the precise assessment of ltpa .
overall , however , our findings support efforts to increase or at least maintain ltpa , especially moderate - to - vigorous ltpa , in the prevention and treatment of the mets . in this analysis of the dps ,
, there was a significant difference between the groups in the resolution of the mets . however , there was no difference in the development of mets between groups ; 30% of those without mets at baseline developed mets in both groups during the follow - up
they were individuals at high risk for type 2 diabetes and for the mets . during the follow - up
while the development of mets was associated with weight gain and less ltpa , those subjects who developed the mets appeared to not adhere with our intervention .
the apparent favorable effects of moderate - to - vigorous ltpa on resolution and development of the mets are consistent with the results of the uncontrolled heritage family study ( 16 ) and some prospective cohort studies showing that increased moderate - to - vigorous ltpa was associated with a lower incidence of the mets during follow - up ( 8,12,17 ) . in the dps cohort , increased moderate - to - vigorous ltpa seemed to protect against developing the mets in both men and women .
higher cardiorespiratory fitness , which partly reflects higher levels of moderate - to - vigorous ltpa , has predicted a lower prevalence of the mets independently of major confounding variables also in women in the aerobics center longitudinal study ( 18 ) and in the dose - responses to exercise training study ( 19 ) .
changes in low - intensity ltpa were not associated with changes in the mets status .
these findings are consistent with the results of the kuopio ischemic heart disease study , in which moderate - to - vigorous , but not low - intensity , ltpa was associated with development of the mets ( 12 ) . when examining specific components of the mets , increased moderate - to - vigorous ltpa had the greatest effect on impaired fasting glucose , whereas the benefit on abdominal obesity , low hdl cholesterol , and high blood pressure was not significant .
in contrast , changes in low - intensity ltpa had benefits on hypertriglyceridemia , but not on the other components of the mets , and changes in total ltpa improved impaired fasting glucose and dyslipidemia . in intervention trials , low - intensity ltpa has less consistently improved metabolic outcomes than more intense ltpa ( 8) .
however , we have previously reported that increased low - intensity and moderate - to - vigorous ltpa were similarly associated with a lower risk of type 2 diabetes in the finnish dps , suggesting that total energy expenditure on ltpa was more important than intensity ( 11 ) . in line with that finding , the accumulated daily physical activity as measured with an accelerometer was a major determinant of insulin sensitivity , and time spent on moderate - to - vigorous physical activity did not affect insulin sensitivity independently of total activity in the european relationship between insulin sensitivity and cardiovascular risk study ( 20 ) . the differences may be explained by differences in study populations and specific metabolic outcomes . more information on the long - term metabolic benefits of low - intensity ltpa in different age - groups and risk groups is nonetheless needed .
we found that a higher participation rate in resistance training was associated with benefits on impaired fasting glucose , hypertriglyceridemia , and low hdl cholesterol , but not abdominal obesity or blood pressure . in 3- to 6-month trials ,
resistance training has variably increased muscle mass , decreased fat mass and abdominal obesity , and improved insulin sensitivity in obese adults , hypertensive patients , older men , and older type 2 diabetic patients ( 8,21,22 ) . in individuals with type 2 diabetes , resistance training resulted in similar improvements of glycemic control as aerobic exercise ( 23 ) , although the effect on glucose tolerance in impaired glucose tolerance has been less clear ( 8) .
improvements in insulin sensitivity and metabolic risk factors may be mediated in part by changes in body composition , but strength training may also independently affect steps in insulin signaling and glucose transport ( 24 ) . based on meta - analyses of trials ,
resistance training may decrease blood pressure ( 25 ) , but effects on dyslipidemia have been variable ( 8) .
our findings suggest that there is a graded benefit in the frequency of resistance training in the prevention or treatment of the mets components , with rather substantial benefits for individuals engaging in resistance training on median once a week compared with individuals engaging in resistance training on median less than once a month . in the above - mentioned studies showing an improvement in insulin sensitivity in individuals at risk for type 2 diabetes and in glycemic control in patients with type 2 diabetes , training frequency was generally two to three times per week .
the metabolic benefits of resistance training at a lower frequency may become apparent only after much longer periods of training than in previously published trials , which have usually lasted 36 months .
strengths of the dps include its repeated assessments of ltpa and dietary intake . however , the present analyses are post hoc . furthermore , the intervention had several components .
detailed assessment of the individual lifestyle components allows statistical disentanglement of their individual effects , but residual confounding is possible .
decreases in ltpa may have been related to factors that themselves may be related to the development of the mets .
adherence to resistance training was on average poor . when this study was conducted in the early 1990s , it was uncommon for middle - aged and overweight individuals to attend resistance training facilities , where most of the clientele were young and fit .
some also encountered difficulties with transportation and time schedules . in conclusion , increased participation in moderate - to - vigorous physical activity and regular long - term participation in resistance training improved the mets status among men and women with impaired glucose tolerance in the finnish dps .
physical activity and resistance training also more specifically had benefits with respect to hyperglycemia and dyslipidemia , but improvements in abdominal obesity were not clearly seen .
resolution or prevention of the mets and related features might contribute to the protective effect of physical activity on type 2 diabetes .
 objectiveto assess the effects of leisure - time physical activity ( ltpa ) and resistance training on metabolic syndrome ( mets ) and its components in a post hoc analysis of the finnish diabetes prevention study , a randomized controlled lifestyle counseling trial.research design and methodsa cohort of 486 middle - aged overweight men and women with impaired glucose tolerance were followed for an average of 4.1 years . 
 the intervention and control groups were combined in the analyses . 
 ltpa was assessed by questionnaires , dietary intake by food records , and features of the mets by anthropometric and biochemical measures annually . 
 resistance training sessions were documented for 137 participants.resultsincreased moderate - to - vigorous ltpa , even after adjustments for changes in dietary intakes of total and saturated fat , fiber , and energy , and change in bmi was associated with a greater likelihood for resolution ( 29.7 vs. 19.1% ; p = 0.004 in the upper versus lower third of change ) and a lesser likelihood for development ( 23.5 vs. 44.7% ; p = 0.041 ) of the mets . 
 of the components of the mets , the increase in moderate - to - vigorous ltpa was associated most strongly with improvement of glycemia . among the 137 participants who participated in resistance training , 
 mets components were favorable in individuals who were in the upper third of participation rate ( median 51 times / year ) compared with individuals in the lowest third ( median 8.5 times / year).conclusionsincreased moderate - to - vigorous ltpa was associated with a decreased likelihood of developing the mets and an increased likelihood of its resolution in individuals at high risk for type 2 diabetes . 