Our thanks to FreeTheYoke Sponsor Four Pines Physical Therapy and their staff & interns for writing this article


Diabetes, obesity, high cholesterol and high blood pressure are familiar, loaded words. With these words come vague recollections of of high school biology class, or the names of people you know with one of these chronic health conditions. You may know someone who has more than one problem on this list since these diseases often cluster together, one encouraging another, in could be accurately termed a “toxic” relationship. This relationship is diagnosed as metabolic syndrome (sometimes called cardio-metabolic syndrome or even “syndrome X”), and effects 34% of people in the United States1.

So why does this happen? Why do these diseases hang out together? To understand this, we must zoom into the human body’s process of breaking down fat.

When a healthy individual eats, sugars (glucose) float around in the blood until they move into individual cells to be used as energy. Sugar enters a cell wall through a specific “door” (aka GLUT4 transporter). However, the GLUT4 door will only open if the correct key, in this case insulin, is available to unlock it. Without insulin the sugar is “locked out” and will remain in the bloodstream where it unfortunately cannot be harvested for energy very easily instead of stored in the muscles where it is readily available for action.

In type II diabetes, one of metabolic syndrome’s key components, insulin has a hard time opening the door. Like the all-too-common scene of the prototypical horror movie, insulin fumbles around but can’t seem to unlock the glucose doors. Slowly the scene gets more and more tense as insulin bangs away, but just can’t get in…wondering no doubt (if it could wonder) if the locks had all been changed.  It begins to bang on doors but just can’t get in2, 3.  Eventually, as more and more glucose enters the bloodstream from eating, there’s a pile-up in the blood, which can become a toxic scenario damaging blood vessels and nerves, wearing down sensation-fibers to the hands and feet as well as other smaller vessels like those that supply kidneys, eyes, the heart and even the brain4.

**THINK ABOUT IT** All of that harm from a little extra sugar in the bloodstream! As it turns out, the body is such a finely tuned machine that even small changes to body chemistry can cause big problems over time.

So why do obesity and high cholesterol often tag along with type II diabetes?

The answer is lipid (fat) intermediates and it goes something like this:

  • When an individual has obesity or high cholesterol, there are more fats circulating in their blood.
  • As the body processes these extra fats it produces lipid intermediates within each cell. High concentrations of lipid intermediates in the cell have a side effect of slowing down GLUT4 door production5.  So, in an individual with metabolic syndrome, when glucose floats by the cell, there are fewer GLUT4 doors for glucose to enter the cell through.
  • Less doors means less glucose is cleared from the blood and blood sugar levels rise which of course complicates the lock issue from above!

If this sounds like a scary predicament, it’s probably because it is — Heart Disease (the number 1 killer in America for generations) and Diabetes (the number 7 and rapidly rising) are huge societal problems that will impact (statistically) almost every American, either personally or in their family, during their lifetime.


Fortunately, there’s an easy prevention strategy for this situation – EXERCISE.

Reverse the Disease through Exercise

In a single bout of exercise, an individual can drop their glucose levels for the short-term8, which is great. However, most of the benefits of exercise occur with long-term changes in activity level by changing not the glucose, but the lipid intermediates. Long term exercise uses up circulating fats thereby decreasing lipid intermediates and allowing for greater glucose door production5 and consistency is critical.

The American Diabetes Association recommends 30-60 min of moderate to intense aerobic exercise 3-7x/wk for help preventing and controlling metabolic syndrome2, 3.  And there’s good news is…IT WORKS!!

Consistent exercise has been shown to be a very effective in controlling diabetes in conjunction with medical management. In some cases an individual can even eliminate the need for medication altogether5, 6, 7. So if you have metabolic syndrome, are at risk or know someone who is, there is no reason to be trapped in a bad horror movie….there is no reason to let big bad lipid intermediates rule your body.

Make the decision to fight back and win…..find a form of exercise you enjoy, stick with it and FREE THE YOKE!



  1. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of Metabolic Syndrome in the United States. JAMA 2015;313(19):1973-1974.
  2. American Diabetes Association. Diagnosis and classification of diabetes and risk assessment. Diabetes Care 20142;37(suppl.1): S81-S90.
  3. American Diabetes Association. Exercises and type 2 diabetes. Diabetes Care 33(12):e147-e167, 2010.
  4. Cade TA. Diabetes-related microvascular and microvascular diseases in the physical therapy setting. Phys Ther 2008;88:1322-1335.
  5. Hawley JA, Lessard SJ. Exercise training-induced improvements in insulin action. Acts Physiol 2008;192(1):127-35.
  6. Kinney Lapier TL. Exercise and Diabetes Mellitus. Cardiopulm Phys Ther 1999;10(2):51-55.
  7. Kriska AM, Blair SN, Pereira MA. The potential role of physical activity in the prevention of non-insulin-dependent diabetes mellitus: the epidemiological evidence. Exert Sport Sci Rev 1994;22:121-143.

Marmick TH, Horndern MD, Miller T, Chyun DA, et al. Exercise training for Type 2 diabetes mellitus. Circ 2009;119:3244-3262.