The objective of this investigation was to conduct a literature review on the structural adaptations of the heart to physical exercises in the Metabolic Syndrome. The search was conducted in the following electronic databases: PubMed, Web of Sciences, LILLACS and MEDLINE using keywords in English without time restrictions. The metabolic syndrome (MS) is characterized by a group of metabolic risk factors in a person. In Brazil, more than 300.000 people die every year of cardiovascular diseases. According to the Brazilian Ministry of Health, there are currently over 20 million hypertensive and 15 million have diabetes in the country, and this rate is increasing. Physical inactivity, in most individuals, leads to well characterized structural and functional cardiovascular alterations such as myocyte loss with subsequent hypertrophy of the remaining cells and reduction of the arterial complacency. However, the etiology of the cardiovascular alterations is still under investigation. The most likely mechanisms are related to the cumulative harm and several different aggressive factors. Oxidative stress, inflammations, and changes in cardiovascular gene expression seem to influence this system. The benefits of physical exercises have been studied combined with pharmacotherapy offering the opportunity of intervention in the process by using exercises and drugs that can reduce arterial rigidity, cardiac fibrosis, and ventricular hypertrophy.