According to the in-depth survey report on the 2005 Korea national Health and Nutrition Examination Survey, the overall prevalence rate of the metabolic syndrome tends to increase with older ages by comparison of the gender and ages, the male group with the age of 50-59 years old reaches the highest point of 44.7% of the assumed prevalence rate of the metabolic syndrome and the female group with older than 70 years old marks the highest point of 55.1% due to the increase in the prevalence rate of the metabolic syndrome with older ages. In particular, the prevalence rate of the metabolic syndrome for the female with the age of 60-69 and over 70 years old is significantly higher than the male group and it is indicated that it is required to manage the metabolic syndrome for the elderly female group [1]. In particular, the women in the menopause are exposed to the danger of the metabolic diseases due to various harmful side effects of the menopause and the prevalence rate is also high [2]. However, only 39.1% of the senior perform regular exercise (more than 150 minute per week) even though they should perform physical activities to manage such metabolic diseases [3].

The aerobics, one of the various exercises performed in the metabolic syndrome, is good to reduce the abdominal fat but it is reported that the resistance exercise increases the metabolic syndrome by upgrading the muscle quantity and the effect of the aerobics [4]. The effects of the combined exercise are proven by Kim et al. [5] who showed the improvement in the metabolic syndrome indicators, decrease in the blood sugar level and insulin level and increase in the physical fitness by performing the combined exercise of aerobic and resistance exercise for middle-aged women with the metabolic syndrome and Ban et al. [6] who showed effects in the body composition, metabolic syndrome indicator and physical fitness through the combined exercise for obese middle-aged women. In particular, the combined exercise is recommended as people claim burden and boredom in time due to aerobic and muscular strength exercise [7]. However, the aquatic exercise which may reduce the burden on the joints may be a useful alternative by utilizing physical features of the medium including static water pressure and temperature, buoyancy and muscular strength exercise using the elastic resistance for the senior due to injury or damage from excessive physical activities. Considering the elements of the physical fitness in the senior, the fitness using relatively safe elastic band is widely used and the aqua aerobic is used for certain disease groups with burden on the joints but it is confirmed effective in the physical fitness, physical composition and metabolic syndrome indicators [8].

Various exercise methods have been applied based on such positive effects of the exercise but in many cases, one exercise with aerobic or resistance exercise is performed or mainly based on the aerobic exercise on the ground or in the water. First, the studies on comparing the ground and underwater sports include Kim et al. [9] reporting that the aerobic on the ground and in the water is more effective than the ground aerobic in the metabolic syndrome indicators for metabolic syndrome patients and Kim [10] reports that the ground and underwater exercise shows significant difference in the CRP and Fibrinogen and the underwater exercise is more effective than the ground exercise. The positive effects in the ground and underwater exercise are different for the metabolic syndrome. The studies on walking on the ground and underwater improve the cardiovascular prediction indicators for healthy people [11]. There are rare prior studies on the ground and underwater exercise simultaneously but it is reported that the chronic hemiplegic patients with ground and underwater exercise show positive effect on the physical fitness for daily activities and range of motion than only with the underwater exercise [12].

Most prior studies cover the exercise program for 60 minutes with the warm-up, cool-down, aerobic and resistance exercise in a program. The study compares the effect of combined exercise with the ground band exercise (once a week) and aqua aerobic exercise (twice a week) on the metabolic syndrome indicators for female women with the metabolic syndrome to a single exercise and is used as the basic data to form effective health promotion program.

The study is performed to investigate the impact on the metabolic syndrome indicators after performing the muscle strengthening exercise using elastic thera-band, aqua aerobic exercise and combined exercise (muscular strength and aqua aerobic exercise) for 12 weeks for the elderly women with the metabolic syndrome.

The result of the metabolic syndrome indicators for the subject before the intervention shows that the prevalence rate for each risk factor is 25.9% of impaired fasting glucose, 57.4% of hyperlipidemia, 85.2% of hypertension and 92.6% of the abdominal obesity, covering almost all the elderly women except 4 for the abdominal obesity. 17 subjects (31.5%) show 4 risk factors 2 subjects (3.7%) show all the 5 factors. Compared to 18.95% for 4 risk factors and 2.35% for all the 5 factors in the study of Im et al. [19], the study shows the risk factors in the metabolic syndrome are higher, meaning that it is required to manage the health for the elderly women.

In particular, the ACSM [20] reports that the exercise program for the elderly women should include the muscular resistance exercise in the aerobic exercise due to weaker muscular strength and endurance than the elderly men, raising the requirement for the combined exercise. Laaksonen et al. [21] report that the people with weak physical fitness or sedentary lifestyle have high possibility for the metabolic syndrome and the exercise for more than 3 hours a week, rather than intensive exercise for 60 minutes a week reduces more risk factors in the metabolic syndrome. The authors focus on the lifestyle changes after the 12-week exercise program for the elderly women with the metabolic syndrome.

The study shows no significant difference between the fasting blood sugar, systolic blood pressure and diastolic blood pressure but each exercise group shows decrease. The metabolic syndrome indicators for the exercise type among obese youth shows interaction for all the indicators except the diastolic blood pressure in the aerobic exercise and resistance exercise in the study and the aerobic exercise and resistance exercise are effective compared to the control group [22] different from the study. It is judged that each group does not show significant difference considering the fact that no abrupt changes are found in the senior and the diabetic or hypertension patients well regulate their blood pressure by the medication based on the characteristics of the subjects. Also, the reason why no significant result is found out is that the current fasting blood sugar, systolic blood pressure and diastolic blood pressure levels are not included in the range of high blood sugar level and hypertension.

Meanwhile, the triglyceride and HDL-C show interaction according to the group and time and show the highest effect in the combined exercise group. This shows that the HDL-C increases by 4.6% and the triglyceride decreases by 3.7% for the exercise longer than 12 weeks, meaning that the continual exercise may decrease the blood lipid [23]. The HDL-C shows no difference in the muscular strength exercise and aquatic exercise among the groups except the combined exercise group, the triglyceride and HDL-C show interaction according to the groups and time and the combined exercise shows significant trend compared to other groups. It is remarkable in the study that the combined exercise group shows better achievement than the muscle strengthening exercise using elastic thera-band group or the aqua aerobic exercise group for the triglyceride and HDL-C.

The waist circumference shows significant difference in 3 groups, interaction according to the group and time and the combined exercise shows significant decrease compared to other groups. Most of the subjects show abdominal obesity based on the measurement of the waist circumference. In particular, increasing the abdominal obesity is known as an independent risk factor in the cardiovascular system [24,25]. Decreasing the waist circumference affect the decrease in the metabolic syndrome indicators and it is required to continuously implement the combined exercise with the most positive effect.

The result of the triglyceride, HDL-C and waist circumference in the study seems to reflect the advantage of the combined exercise compared to other exercises based on the study [26] that the combined exercise with the aerobic exercise and resistance exercise cause the synergy and the study [27] with significant result in the metabolic syndrome indicators for the circulation exercise with the aerobic exercise.

In conclusion, the conditions before and after each exercise program are effective for the subjects with the metabolic syndrome but the positive effect of the combined exercise may be confirmed with significant difference in the blood lipid and waist circumference of the metabolic syndrome indicators in the combined exercise compared to other groups.

However, the limitations in the study are as follows. First, the study covers the elderly women with the metabolic syndrome in a single region and is limited to generalize the result to all elderly with metabolic syndrome. Second, the subjects are the senior with large individual difference compared to other age groups and that is why the study performs the homogeneity test but it may not be said that their physical fitness is not the same and it is difficult to conclude that the momentum for all the subject is the same. Therefore, repetitive studies on the comparison of the exercise types is required under control.

A lot of health promotion programs provided by healthcare centers only focus on single exercise program with walking, health gymnastics, yoga and muscular strength exercise or aquatic exercise. Therefore, the effective health promotion program would be developed to prevent from the contraction of a disease by forming the program with combined exercise (ground and aquatic exercise) rather than the single exercise program to avoid the sameness and boredom and increase the participation rate and satisfaction.