Understanding the hidden epidemic of metabolic syndrome in people accessing community rehabilitation: a cross-sectional study of physical activity, dietary intake, and health literacy

Purpose: To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome. Materials and methods: A cross-sectional, multi-centre, observational study of adults (n = 193) presenting to rehabilitation with various health complaints. Metabolic syndrome was determined according to the International Diabetes Federation joint consensus worldwide definition. Health literacy was assessed using the Rapid Estimate of Adult literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Physical activity was assessed using accelerometers and dietary intake was assessed using a food frequency questionnaire. Results: One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD −2.10, 95% confidence interval (CI) −3.98 to −0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake. Conclusions: Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitation Almost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome. Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome. A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.