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Within the obese population (without COPD), the observed heterogeneity in prognosis is in part explained by the variability in the risk of developing cardiovascular disease or diabetes (cardiometabolic risk) leading to the description of metabolic syndrome. In obesity alone, high-intensity aerobic training can support healthy weight loss and improve the constituent components of metabolic syndrome. Those with COPD, obesity and\/or metabolic syndrome undergoing PR appear to do as well in traditional outcomes as their normal-weight metabolically healthy peers in terms of improvement of symptoms, health-related quality of life and exercise performance, and should therefore not be excluded. To broaden the benefit of PR, for this complex population, we should learn from the extensive literature examining the effects of exercise in obesity and metabolic syndrome discussed in this review and optimize the exercise strategy to improve these co-morbid conditions. Standard PR outcomes could be expanded to include cardiometabolic risk reduction to lower future morbidity and mortality; to this end exercise may well be the answer.<\/jats:p>","DOI":"10.1177\/1479972317736294","type":"journal-article","created":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T00:59:10Z","timestamp":1510189150000},"page":"173-181","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Obesity and metabolic syndrome in COPD: Is exercise the answer?"],"prefix":"10.1177","volume":"15","author":[{"given":"Benjamin D","family":"James","sequence":"first","affiliation":[{"name":"Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy V","family":"Jones","sequence":"additional","affiliation":[{"name":"National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK"},{"name":"Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth E","family":"Trethewey","sequence":"additional","affiliation":[{"name":"National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK"},{"name":"Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael A","family":"Evans","sequence":"additional","affiliation":[{"name":"National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK"},{"name":"Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"},{"name":"Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK"},{"name":"Health Sciences, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,11,8]]},"reference":[{"key":"bibr1-1479972317736294","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021322"},{"key":"bibr2-1479972317736294","unstructured":"World Health Organization. http:\/\/www.who.int\/mediacentre\/factsheets\/fs311\/en\/index.html#. 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