PURPOSE: This study aimed to determine the effects of a 5-yr exercise intervention on metabolic syndrome (MetS) and health-related variables and medication use for MetS management. METHODS: Participants were randomly assigned to an exercise intervention (n = 25, 54 +/- 2 yr, 20% women) or control group (n = 26, 54 +/- 2 yr, 38% women). The intervention lasted 4 months per year and consisted of high-intensity interval training on a cycloergometer thrice a week. Outcomes were MetS z-score and medication use score, MetS-related variables (including blood pressure, blood glucose homeostasis, and lipid profile), and cardiorespiratory fitness (CRF, as determined by maximal oxygen uptake). RESULTS: MetS z-score was similarly reduced over time in both groups (p = 0.244 for group-time interaction). A quasi-significant and significant group-time interaction was found for MetS number of factors (p = 0.004) and CRF (p < 0.001), respectively. Thus, MetS factors tended to decrease over time only in the exercise group with no change in the control group, whereas CRF increased from baseline to 5-yr assessment in the exercise group (by 1.1 MET, p < 0.001) but decreased in the control group (-0.5 MET, p = 0.025). Medicine use score increased twofold from baseline to 5-yr follow-up in the control group (p < 0.001) but did not significantly change (10%, p = 0.52) in the exercise group (p < 0.001 for group-time interaction). The proportion of medicated patients who had to increase antihypertensive (p < 0.001), glucose-lowering (p = 0.036), or total medication (p < 0.0001) over the 5-yr period was lower in the exercise than that in the control group. CONCLUSIONS: Exercise training can attenuate the increase in medication that would be otherwise required to manage MetS over a 5-yr period.

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