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CARROLL, S., C. B. COOKE and R. J. BUTTERLY. Metabolic clustering, physical activity and fitness in nonsmoking, middle-aged men. Med. Sci. Sports Exerc., Vol. 32, No. 12, 2000, pp. 2079–2086. The relationship of both physical activity and predicted maximum oxygen consumption (V̇O2max) with the clustering of metabolic risk factors associated with the metabolic syndrome (MS) was examined within 711 employed middle-aged (46.9 ± 7.8 yr) men. Metabolic markers included fasting glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure, and BMI, defined by highest risk quintiles or clinically relevant risk thresholds. The prevalence and age-adjusted odds ratios of all MS clusters were inversely graded across both higher physical activity index (PAI) and cardiorespiratory fitness (CRF) categories. The age-adjusted odds ratio for the clustering of clinically relevant metabolic markers was 0.60 (95% CI 0.22–1.22) for subjects in the occasional/light PAI, 0.32 (95% CI 0.12–0.82) for the moderate/moderately vigorous PAI, and 0.13 (95% CI 0.02–1.02) for the vigorous PAI when compared with subjects in the sedentary PAI (P < 0.05 for trend). The corresponding age-adjusted odds ratio was 0.28 (95% CI 0.14–0.57) for subjects in the moderate fitness category and 0.12 (95% CI 0.05–0.32) for the highest fitness category compared with those in the lowest fitness category (P < 0.001 for trend). Higher levels of physical activity or CRF were also associated with significantly lower age-adjusted odds ratios for the MS after exclusion of obesity in the MS definition. Overall, these cross-sectional results suggest that higher physical activity and predicted V̇O2max levels are associated with a decreased clustering of risk factors associated with the MS in middle-aged men of higher social class.