I think it is important to point out that this person very well might be on hypertensive medication, cholesterol medication and who knows might be pre-diabetic. I say this as the treatment approach recommended by the National Cholesterol Education Program (NCEP) includes, weight control, physical activity and pharmacotherapy.
Designing an exercise program for an individual with multiple clinical conditions is indeed complex and requires more than knowing the correct intensity and duration of exercise. Clinical exercise testing MUST be utilized to know how to write the exercise prescription.
I am moved to question whether the personal trainer understands how a diseased body responds to exercise? What exercise tests are they performing for the person presenting with more than one clinical condition who is clearly high risk? Why high risk? If this is a male according to the question the person is over 45, presents with abdominal adiposity, dyslipidemia and hypertension and impaired fasting glucose and we don’t know whether there is a family history of disease. Even if the doctor gives clearance the question still exists does the fitness professional understand the exercise response in someone with diagnosed clinical conditions.
Professionally, I have never heard of “a little bit of metabolic syndrome.” There are clear clinical criteria for the diagnosis of metabolic syndrome.
I would first learn what is metabolic syndrome and ask myself whether I am adequately qualified to design a fitness program with health outcomes as the objective (raising HDL levels, lowering BP, decreasing body fat percentage as well as improved fasting glucose levels.
If the approach is solely to lose visceral fat, then it might be a good idea to refer this client to someone experience in designing and training individuals with clinical conditions.