PURPOSE: to verify the effectiveness of an annual program of endurance and resistance supervised training of physical activity and Mediterranean diet compared to the conventional counselling in nutrition physical activity in improving the glycemic control, the aerobic fitness and reduce the cardiovascular risk in patients with metabolic syndrome. METHODS: 40 subjects, randomized into 2 groups EXE and CON, mean age 58-66 years, BMI 30-34 kg/m2, underwent assessment of VO2 Max, 1 RM tests (of the upper arms and lower limbs), emato-chemical analysis and medical evaluation. The baseline parameters of the two groups were: HbA1c (%) 7.98 (SD 1.6), CRP (mg / l) 3.4 (SD 2.3), VO2max (ml / kg / min) 26.3 (SD 6). The patients in the EXE group were followed with a program of mixed physical activity (aerobic and strength) for 2 times / week, sessions of 70 minutes, for one year. The group EXE was reassessed every 3 months to calibrate the workout. RESULTS: In the EXE group parameters of HbA1 (from 7.98 to 6.85%, p <0.0001), hs-CRP (from 3.36 to 2.22 mg / l, p <0.0001) and VO2max (from 26.3 to 32.5 ml / kg / min, p <0.01) have changed significantly, while in the CON group there was no significant modification. CONCLUSIONS: The results show that only a long term physical exercise program, prescribed on an individual assessment, associated with the nutritional and pharmacological treatment improves the cardio-metabolic risk profile in patients with metabolic syndrome.