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Mental Health Benefits of Strength Training in Adults

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Abstract

This review summarizes evidence from randomized controlled trials to examine whether strength training influences anxiety, chronic pain, cognition, depression, fatigue symptoms, self-esteem, and sleep. The weight of the available evidence supported the conclusion that strength training is associated with reductions in anxiety symptoms among healthy adults (5 trials); reductions in pain intensity among patients with low back pain (5 trials), osteoarthritis (8 trials), and fibromyalgia (4 trials); improvements in cognition among older adults (7 trials); improvements in sleep quality among depressed older adults (2 trials); reductions in symptoms of depression among patients with diagnosed depression (4 trials) and fibromyalgia (2 trials); reductions in fatigue symptoms (10 trials); and improvements in self-esteem (6 trials). The evidence indicates that larger trials with a greater range of patient samples are needed to better estimate the magnitude and the consistency of the relationship between strength training and these mental health outcomes. Plausible social, psychological, and neural mechanisms by which strength training could influence these outcomes rarely have been explored. This review revealed the high-priority research need for animal and human research aimed at better understanding the brain mechanisms underlying mental health changes with strength training.
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DOI: 10.1177/1559827610368771
2010 4: 377 originally published online 7 May 2010AMERICAN JOURNAL OF LIFESTYLE MEDICINE
Patrick J. O'Connor, Matthew P. Herring and Amanda Caravalho
Mental Health Benefits of Strength Training in Adults
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American Journal of Lifestyle Medicinevol. 4 • no. 5
377
Mental Health Bene ts of
Strength Training in Adults
Patrick J. O’Connor, PhD,
Matthew P. Herring, MS, and
Amanda Caravalho
DOI: 10.1177/1559827610368771. Manuscript received July 29, 2009; revised October 19, 2009; accepted November 19, 2009. From the Department of Kinesiology
(PJO, MPH) and the Department of Psychology (AC), University of Georgia, Athens. Address correspondence to Patrick J. O’Connor, PhD, University of Georgia, 115-L
Ramsey Center, 330 River Road, Athens, GA 30602-6554; e-mail: poconnor@uga.edu.
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Copyright © 2010 The Author(s)
There is a need for effective behavior
change interventions targeted at
increasing the prevalence of
resistance exercise behaviors.
Abstract: This review summarizes
evidence from randomized controlled
trials to examine whether strength
training influences anxiety, chronic
pain, cognition, depression, fatigue
symptoms, self-esteem, and sleep. The
weight of the available evidence sup-
ported the conclusion that strength
training is associated with reductions
in anxiety symptoms among healthy
adults (5 trials); reductions in pain
intensity among patients with low back
pain (5 trials), osteoarthritis (8 trials),
and fibromyalgia (4 trials); improve-
ments in cognition among older adults
(7 trials); improvements in sleep quality
among depressed older adults (2 trials);
reductions in symptoms of depression
among patients with diagnosed depres-
sion (4 trials) and fibromyalgia
(2 trials); reductions in fatigue symp-
toms (10 trials); and improvements in
self-esteem (6 trials). The evidence indi-
cates that larger trials with a greater
range of patient samples are needed to
better estimate the magnitude and the
consistency of the relationship between
strength training and these mental
health outcomes. Plausible social, psy-
chological, and neural mechanisms by
which strength training could influ-
ence these outcomes rarely have been
explored. This review revealed the
high-priority research need for animal
and human research aimed at better
understanding the brain mechanisms
underlying mental health changes with
strength training.
Keywords: anxiety; cognition; depres-
sion; fatigue; pain; resistance training;
self-esteem; sleep; weight training
A
fter providing some background
information about muscle strength-
ening activities, this review sum-
marizes empirical evidence about the
effects of strength training on several key
aspects of mental health. This is
followed by a discussion of plausible
mechanisms for the effects and suggested
methods for better understanding the
potential mechanisms.
What Are Muscle-
Strengthening Activities?
Muscle-strengthening activities are
repeated muscle actions against a
resistance greater than those typically
encountered during activities of daily
living.
1
Muscle strengthening activities
often are performed as part of a progres-
sive strength training program conducted
with free weights, resistance training
equipment, or elastic bands. Examples of
other physical activities that may require
a high resistance, depending on individ-
ual differences such as a person’s age,
body size, strength, and state of training,
include gardening (eg, shoveling), carry-
ing loads (eg, weighted stair climbing
2
),
water-based exercises,
3
and activities that
use body weight for resistance such as
pull-ups and push-ups.
How Prevalent Is Muscle-
Strengthening Activity?
Results from National Health
Interview Surveys indicate that 25%
of adults in the United States report
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American Journal of Lifestyle Medicine Sep • Oct 2010
engagement in any leisure-time activ-
ities designed to strengthen muscles,
such as weight lifting or calisthenics.”
4
The prevalence of participation in leisure-
time muscle-strengthening activity
declines with age (see Figure 1). The
prevalence is lower among Hispanics/
Latinos (16%) compared with other eth-
nic or racial groups, including Asians
(23%), blacks (22%), whites (25%), and
those with a mixed ethnic/racial her-
itage (31%). The prevalence is lower
among those near or below the poverty
level (16%) compared with those with
incomes that are 2 to 3.9 times (24%)
or 4 or more times the poverty level
(35%). The prevalence is lower among
those who did not graduate from high
school (12%) compared with high school
graduates (19%), those with some col-
lege (28%), those with a college degree
(35%), and those with an advanced
degree (39%). The prevalence of any
leisure-time muscle-strengthening activ-
ity is lower among women (21%) than
men (28%), but an increased rate of
participation among women has been
reported. The percentage of women
meeting the strength levels (2 or more
times per week) recommended by the
US Department of Health and Human
Services
5
increased from 14.4% to
17.5% from 1998 to 2004.
6
Despite the
increase, the percentage of men (22%)
and women (17.5%) who strength train
2 or more times per week is lower than
the 2010 US national target of 30%.
5
There is a need for effective behav-
ior change interventions targeted at
increasing the prevalence of resis-
tance exercise behaviors. These might
include mass media campaigns pro-
moting strength training, environments
built that encourage resistance exercise,
financial incentives for participating in
strength training such as reduced health
insurance premiums, and education
about the benefits of strength training.
7
Health care practitioners are potentially
instrumental in assisting people in mak-
ing the decision to adopt and maintain
strength training as part of a healthy
lifestyle, but these professionals often
lack knowledge about strength train-
ing. One national survey found nearly
twice as many primary care physicians
reported that a lack of knowledge was
a barrier in counseling patients about
strength training compared with aero-
bic exercise counseling (27% vs 16%).
8
The consequence of this lack of knowl-
edge appears to be reduced counseling
of patients about strength training (see
Figure 2).
Figure 1.
Percentage of US adults reporting some type of leisure-time muscle-strengthening
activity as a function of sex and age. Adapted from Adams and Schoenborn.
4
0
5
10
15
20
25
30
35
40
45
50
18-24 25-44 45-64 65-74 75 and
over
% of US adults
Men
Women
0
20
40
60
80
100
0 to 20% > 20%
% of patients counseled
% of physicians
Aerobic training
Strength training
Figure 2.
Percentage of patients counseled about aerobic and strength training by primary
care physicians. Adapted from Abramson et al.
8
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What Elements Should
a Strength Training
Program Entail?
The characteristics of a well-designed
strength training program are context
dependent and take into consideration
individual differences in a variety of
factors such as age, goals for fitness or
health outcomes, fitness level, health
status, access to equipment, and experi-
ence with weight lifting. Science-based
recommendations on how to effectively
structure strength training programs are
beyond the scope of this article, and
details are available elsewhere.
9-13
The US Department of Health and
Human Services recommends that adults
perform at least 1 set of 8 to 12 repeti-
tions of muscle-strengthening activities
of the major muscle groups (legs, hips,
back, chest, shoulders, arms, abdominals)
at least 2 days per week for health.
1
It
has been suggested that a program of this
nature, which can take less than 30 min-
utes per week, will convey most of the
health benefits of strength training.
1,14
A more rigorous program recom-
mended for improving muscle strength
and size among healthy adults has been
suggested by the American College of
Sports Medicine.
9
The program would
involve the use of both free weights
and machines to perform multiple-joint
(eg, squats, bench press, leg press, shoul-
der press) and single-joint (eg, leg exten-
sion, calf raise, arm curl) exercises of the
entire body. The program would involve
slow- to moderate-velocity actions
(eg, 2 seconds each for both the concen-
tric and eccentric exercise phases) for 2
to 3 sets per exercise at an intensity that
starts low (when individuals are learn-
ing technique) and increases to 60% to
80% of 1–repetition maximum (1-RM) for
8 to 12 repetitions. The program would
include 1 to 3 minutes of rest between
sets and occur at a frequency of 2 to
3 days per week. Each session in a pro-
gram of this nature could be completed
in approximately 40 to 80 minutes. This
type of strength training program, per-
formed for 8 to 52 weeks, which we term
typical strength training, is characteristic
of many of the research studies included
in our review.
What Are Some of the
Key Health Benefits of
Strength Training?
Muscle-strengthening activities con-
fer several health benefits, perhaps most
notably for older adults, who often are
characterized by inadequate muscle mass,
strength, and physical functional abili-
ties.
13
Evidence supports strength training
effects on increased muscular strength
15
and power,
16
bone density,
17
and physi-
cal functional abilities such as improved
balance and a reduction in the number
of injurious falls among older adults.
18,19
Strength training can prevent sarcope-
nia and increase the ability to maintain
muscle mass during a weight loss pro-
gram.
20
Strength training positively influ-
ences risk factors for diabetes and heart
disease by improving glycemic control
and insulin resistance
21
as well as by low-
ering blood pressure.
22
Muscular strength
also is inversely associated with all-cause
mortality in men, even after adjusting for
potential confounders such as cardiore-
spiratory fitness.
23
The mental health con-
sequences of strength training are often
touted, but they are less frequently stud-
ied and consequently less well under-
stood than the psychological effects of
aerobic training.
Purpose, Scope,
and Methods
One purpose for the remainder of this
article is to summarize what is known
about the influence of strength training
performed by adults on the following
important aspects of mental health: anx-
iety, chronic pain, cognition, depression,
fatigue symptoms, self-esteem, and sleep.
This review emphasizes results from ran-
domized controlled trials that investigated
the effects of strength training alone.
Selected information about these studies
is presented in Table 1. We estimate that
strength training alone has been used in
~3% to ~11% of randomized controlled
trials that have examined the influence
of exercise training on mental health out-
comes (see Figure 3). We did not include
studies of children because there are too
few randomized trials of strength train-
ing alone performed by children to draw
meaningful conclusions about effects on
mental health.
1,24-26
Studies with quasi-
experimental designs (eg, no control
group, no random assignment) were
excluded because of the widely rec-
ognized limitations to drawing causal-
ity with designs of this type. Also, most
epidemiological investigations of associ-
ations between physical activity and men-
tal health have rarely included adequate
questions or analyses regarding muscle-
strengthening exercises; consequently,
information from population-based stud-
ies was not included.
We searched PubMed and Google
Scholar databases using the phrases
strength training, resistance training, and
weight training combined with the men-
tal health outcome key words (anxiety,
pain, cognition, depression, fatigue, self-
esteem, and sleep). Also searched were
the reference lists of identified review
and data-based articles. In the sections on
anxiety, chronic pain, cognition, depres-
sion, fatigue symptoms, self-esteem, and
sleep, a synopsis of the research evi-
dence regarding the effect of aerobic
training also is provided to put the infor-
mation from the strength training inves-
tigations in the greater context of the
relevant scientific literature. When pos-
sible, we describe the magnitude of psy-
chological changes with strength training
using a standardized effect size. This is
useful in part because raw scores from
psychometric questionnaires often do
not have the intrinsic meaning to readers
that an objective physical measure such
as body weight does. In some instances,
we reported this effect size as it was pre-
sented in a paper, and in other cases, we
calculated the effect size. A commonly
used effect size is Cohen d, which is
defined as the difference between 2
means divided by the pooled standard
deviation (SD). A common convention
is that Cohen d values of .50 and >.80
SD represent moderate and large effects,
respectively.
(text continues on page 384)
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Table 1.
Selected Characteristics of Randomized Trials of Effect of Strength Training on Mental Health Outcomes
Reference #
Country of
Origin
Mental Health
Outcomes
Sample
Size EX
Sample Size
CONT Sex
%
Female Age
Program
Duration, wk
Session
Duration, min
Frequency,
Sessions per Week
36 Brazil Anxiety,
depression,
self-esteem
19 23 Men 0 68 24 60 3
37 United
States
Anxiety,
depression,
fatigue, sleep
33 29 Women 100 68 8 45 2
38 United
States
Anxiety,
depression,
fatigue
107 108 Men and
women
76 75 24 35 3
39 Finland Anxiety 55 35 Men and
women
73 46 15 6 5
40 United
States
Anxiety,
cognition,
fatigue, self-
esteem
12 12 Women 100 69 12 NP 3
41 Canada Anxiety,
depression,
self-esteem
82 82 Women 100 49 17 NP 3
42 United
States
Anxiety,
depression,
OA pain
108 72 Men and
women
66 62 26 10 5
48 Finland Back pain 30 24 Men and
women
37 40 12 90 2
49 Denmark Back pain 27 32 Men and
women
NP 45 12 NP 2-3
50 Australia Back pain 29 28 Men and
women
59 41 4 NP 2
(conitnued)
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Table 1. (continued)
Reference #
Country of
Origin
Mental Health
Outcomes
Sample
Size EX
Sample Size
CONT Sex
%
Female Age
Program
Duration, wk
Session
Duration, min
Frequency,
Sessions per Week
51 United
States
Back pain 31 23 Men and
women
38 45 10 NP 1-2
52 Germany Back pain 30 30 Men and
women
50 52 12 10 2
62 United
States
OA pain 23 23 Men and
women
78 68 16 NP 3
63 United
States
OA pain 146 149 Men and
women
71 69 72 60 3
64 Australia OA pain 83 43 Men and
women
73 66 8 60 2
65 United
States
OA pain 35 35 Men and
women
72 63 16 50 3
66 Netherlands OA pain 93 98 Men and
women
78 68 11 ~30 1-3
67 Taiwan OA pain 36 36 Men and
women
69 62 8 ~30 3
68 United
States
Depression,
OA pain
146 144 Men and
women
70 69 60 60 3
75 Finland FM pain,
depression,
fatigue
11 10 Women 100 38 21 NP 2
76 United
States
FM pain 15 14 Women 100 46 12 30 2
77 United
States
FM pain,
depression,
fatigue
28 28 Women 100 48 12 60 2
(conitnued)
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American Journal of Lifestyle Medicine Sep • Oct 2010
Table 1. (continued)
Reference #
Country of
Origin
Mental Health
Outcomes
Sample
Size EX
Sample Size
CONT Sex
%
Female Age
Program
Duration, wk
Session
Duration, min
Frequency,
Sessions per Week
78 Finland FM pain 13 13 Women 100 62 21 NP 2
86 Brazil Cognition 14 17 Men and
women
74 72 36 60 2
87 United
States
Cognition 102 108 Men and
women
NP 75 24 35 3
88 United
States
Cognition 10 10 Men and
women
63 69 16 45 5
89 United
States
Cognition 20 12 Men and
women
53 73 24 30 3
90 Switzerland Cognition 23 23 Men and
women
39 73 8 NP 1
99 United
States
Depression 20 20 Women 100 29 48 20 3
100 United
States
Depression,
fatigue
15 13 Men and
women
63 71 10 45 3
101 United
States
Depression,
self-esteem
15 14 Men and
women
63 71 20 NP 2-3
102 Australia Depression,
fatigue, sleep
20 low &
20 high
20 Men and
women
55 69 8 60 3
103 United
States
Depression 39 40 Women 100 53 26 NP NP
104 Finland Depression 24 28 Women 100 83 10 90 2
105 Netherlands Depression,
fatigue
41 35 Men and
women
79 81 24 NP 2
106 Australia Depression 14 18 Men and
women
66 74 10 NP 3
(conitnued)
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Table 1. (continued)
Reference #
Country of
Origin
Mental Health
Outcomes
Sample
Size EX
Sample Size
CONT Sex
%
Female Age
Program
Duration, wk
Session
Duration, min
Frequency,
Sessions per Week
107 United
States
Depression 14 15 Men 0 33 16 20 3
108 Canada Depression 21 13 Men and
women
NP 39 36 105 2
112 Canada Fatigue 82 73 Men 0 68 12 NP 3
113 Canada Fatigue 40 41 Men 0 66 24 45 3
120 United
States
Self-esteem 43 42 Women 100 22, 44 12 60 3
121 United
States
Depression 20 20 Women 100 29 48 20 3
122 United
States
Self-esteem 13 10 Women 100 ~20 16 NP NP
136 United
States
Depression,
sleep
15 13 Men and
women
61 71 10 60 3
NP, information not provided; OA, osteoarthritis; FB, fibromyalgia.
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What Is the Effect of
Strength Training on
Anxiety Symptoms?
Anxiety is a common mental health
problem. Approximately 15% of the US
population reports frequently experienc-
ing anxiety (eg, symptoms on more than
15 of 30 days during the prior month),
and those with frequent anxiety symptoms
are more likely to report poor health,
poor sleep, mental distress, pain, and
activity limitations.
27
Reviewers have concluded that aerobic
exercise training is associated with moder-
ate reductions in anxiety symptoms among
both adults with a chronic medical illness
28
and healthy adults.
29-34
Two studies show
large improvements in anxiety symptoms
after aerobic exercise training performed
by patients with an anxiety disorder,
34,35
although in 1 study, the effect was judged
to be less effective than treatment with clo-
mipramine.
34
Reviewers have not previ-
ously summarized the influence of strength
training on symptoms of anxiety.
At least 7 randomized controlled trials
have investigated the effects of strength
training and included an outcome mea-
sure of anxiety symptoms. Five stud-
ies involved healthy adults,
36-40
and 2
involved medical patients.
41,42
In these
7 studies, strength training resulted in a
small mean anxiety reduction of 0.19 SD.
The effect was larger for the 5 studies of
healthy adults (0.54 SD).
Two of these investigations compared
the effects of moderate- versus high-
intensity strength training on anxiety
symptoms among healthy older adults.
36,40
The improvement in anxiety symptoms
was best after moderate intensity training
(1.00 SD effect when the intensity was
50%-60% of 1-RM) compared with the
higher intensity training (0.71 SD when
the intensity was 80% 1-RM).
The evidence supports the conclusion
that strength training alone consistently
reduces anxiety symptoms among healthy
adults. Researchers have yet to document
either the effects of strength training on
anxiety symptoms among people with an
anxiety disorder or comparisons between
strength training and other treatments for
anxiety disorders.
What Is the Effect
of Strength Training
on Chronic Pain?
Chronic pain is a major public health
problem. Common types of chronic pain
disorders include headaches, osteoarthri-
tis, low back pain, other musculoskeletal
pains such as fibromyalgia, and neu-
ropathic pain that results from medical
conditions such as cancer, diabetes, and
strokes. The prevalence of chronic pain
is high. For example, about one third of
adults in community samples report low
back pain during the prior month, and
as many as two thirds will report an epi-
sode of low back pain during the prior
year.
43
The economic cost of lost time
at work from common pain conditions
for the US workforce is estimated at $61
billion annually.
44
Exercise training has
been found to be useful in treating sev-
eral types of chronic pain, including
low back, osteoarthritis, and fibromyal-
gia pain.
Low Back Pain
Large randomized trials and systematic
quantitative reviews of more than 3 dozen
trials reveal that exercise training of all
types is more effective than usual care
in reducing pain and improving physi-
cal function among people suffering from
chronic (>3 months) low back pain.
45-47
The magnitude of the effect on pain is
clinically meaningful and moderate, and
it ranges from 6 to 10 points on a 100-
point pain intensity scale. The efficacy
of strength training per se for reduced
pain cannot be determined from most of
these studies because strength training
was included as but one component in
multidimensional rehabilitation programs
designed to treat back pain.
The efficacy of strength training alone
on back pain has been examined in at
least 5 randomized controlled trials.
48-52
A quantitative review that included a
meta-regression analysis found that
strength training alone not only reduced
pain to a moderate amount and to a
magnitude that was equivalent to aero-
bic training but also was the best type of
exercise for improving physical function
among those with chronic back pain.
46
The reviewers emphasized that strength
training programs yield the largest effects
when delivered in supervised health care
settings.
46
It is noteworthy that strength train-
ing is a popular form of therapy for low
back pain. A survey of a random sample
of 419 therapists found that advice and
0
2
4
6
8
10
12
Anxiety Cognition Depression Fatigue
Percentage of reviewed studies that
used strength training alone
Figure 3.
Percentage of studies that investigated the effects of strength training alone on a
mental health outcome. Adapted from meta-analyses of exercise training effects on
anxiety,
28
cognition,
85
depression,
98
and fatigue.
111
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385
exercise, respectively, were the treat-
ments most frequently used for chronic
low back pain, with strength training
being the most frequently used exercise
type.
53
The available evidence supports the
conclusion that strength training alone
is effective in reducing pain intensity
among people suffering from low back
pain.
46,47
Osteoarthritis
Several quantitative reviews of random-
ized trials showed that exercise training of
all types significantly reduces pain associ-
ated with knee and hip osteoarthritis.
54-58
These analyses indicate that the magni-
tude of the pain reduction following exer-
cise training ranges from 0.33 to 0.50 SD.
The evidence is strong enough that exer-
cise is recommended as an osteoarthri-
tis treatment by the American College of
Rheumatology,
59
the American Geriatric
Society,
60
and the Centers for Disease
Control and Prevention.
61
The efficacy of strength training alone
on osteoarthritis has been examined in at
least 8 randomized controlled trials.
42,62-68
Some trials show effects as large as
1.39 SD.
67
Other trials show an extra
benefit of strength training when it
is combined with nonsteroidal anti-
inflammatory medication therapy.
69
Quantitative reviews of this literature
show a moderate-sized, positive effect
of strength training for reducing pain.
70-72
The effect of lower limb muscle strength
training alone on improved pain scores
exceeded other types of exercise to a
small degree, although the effect was
not statistically different than aerobic
(walking) training (see Figure 4).
The evidence supports the conclusion
that strength training alone is effective
in reducing pain intensity among people
suffering from osteoarthritis.
73
Fibromyalgia
Physical function is reduced among
fibromyalgia patients. More than 60%
report difficulty going up 1 flight of stairs,
walking one-half mile, or lifting 10 lb,
and those with lower function report
higher pain intensity.
74
More than a
dozen randomized trials show that aero-
bic training reduces pain among patients
with fibromyalgia.
54
Four randomized trials have examined
the effects of strength training alone
on pain among fibromyalgia patients.
One trial found a large reduction (>2.0
SD) in pain,
75
whereas the other trials
showed moderate reductions (<0.80 SD)
in pain.
76-78
Two trials compared the effects
of strength to aerobic training and found
that both types of exercise were similarly
effective in improving pain.
79,80
Another
investigation compared the effects of
strength to flexibility training and found
that the magnitude of improvement in
total muscle pain scores favored strength
training over flexibility training (effect
size of 0.75 vs 0.49, respectively).
77
The evidence supports the conclusion
that strength training alone is effective
in reducing pain intensity among fibro-
myalgia patients. Consequently, strength
training is viewed favorably by clinicians
for the management of fibromyalgia.
81,82
What Is the Effect
of Strength Training
on Cognition?
Cognition refers to nervous system
processes in which sensory informa-
tion is transformed, reduced, elaborated,
stored, recovered, and used.
83
Although
there are hundreds of tests of cognitive
function, most of which involve multi-
ple aspects of information processing,
tests of cognition are often categorized
according to the process that appears to
dominate the test (eg, sustained atten-
tion, short-term memory). Some tasks
are complex and thought to more greatly
involve the frontal lobe and “executive
function.” Executive function involves
abilities such as mental set shifting and
the inhibition of prepotent responses.
Executive function is inferred from tests
such as the Wisconsin Card Sorting test
and dual tasks in which 2 tasks are com-
pleted simultaneously.
A high percentage of studies examining
the effects of exercise training on cognition
have been conducted with older adults.
This is logical because exercise training
is perceived as having a greater potential
effect on the brains of older adults, who
more frequently are characterized by phys-
ical inactivity, brain neuronal dysfunc-
tion or loss, reduced vascular health, and
declines in cognitive function. Cognitively
impaired older adults often can participate
in strength training, and when they do,
they obtain increases in muscular strength
and endurance that are similar to those
who are cognitively intact.
84
0
0.1
0.2
0.3
0.4
0.5
0.6
Aerobic Strength Combined Other
Improvement in pain
(standardized effect size)
Figure 4.
Average magnitude of improvement in osteoarthritis pain based on results of
randomized trials involving aerobic walking (4 studies, 351 participants), lower limb
muscle strengthening (9 studies, 1383 participants), the combination of aerobic plus
strength training (9 studies, 998 participants), and other types of exercise training
(7 studies, 565 participants). Adapted from Fransen and McConnell.
70
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*References 36-38, 41, 42, 68, 75, 77, 99-108.
Evidence from randomized controlled
trials, primarily of aerobic training alone
or aerobic combined with strength train-
ing, indicates that exercise training
improves cognitive function in healthy
older adults and reduces symptoms of
dementia among people with cognitive
impairments.
1,85
The positive effect of aerobic exercise
training on cognition among older adults
appears to be largest for complex cogni-
tive tasks categorized as involving execu-
tive function. Moreover, and as illustrated
in Figure 5, results from 18 randomized
trial experiments of exercise training per-
formed by sedentary older adults found
significantly larger improvements in cog-
nitive function when aerobic training was
combined with strength training com-
pared with aerobic training alone.
85
Left
uncertain was whether strength training
alone improves cognition.
At least 7 randomized controlled trials
have examined the influence of strength
training alone on various aspects of cog-
nition among healthy older adults.
36,40,86-90
All 7 studies show positive, small to mod-
erate effects on some aspect of cognition.
Although the effects were statistically non-
significant in 3 studies, these investigations
had relatively small samples (8-17 per
group) and therefore may have lacked sta-
tistical power to detect potentially mean-
ingful small to moderate effects.
40,88,89
Four
of the studies found statistically significant
improvements in memory after strength
training.
36,86,87,90
Other studies that exam-
ined the influence of strength training in
combination with balance or flexibility
training also have reported small to mod-
erate positive effects on cognitive function
among older adults.
91-95
The evidence supports the conclusion
that strength training alone is associated
with small to moderate improvements in
cognition among healthy older adults.
96
To date, the largest effects of strength
training alone have been found for
memory tasks.
What Is the Effect
of Strength Training
on Depression
and Symptoms of
Depression?
Depression is an important mental health
problem that causes substantial morbidity
and costs the United States more than
$50 billion annually.
97
Depression often
can be treated effectively with drugs and
psychological therapies, but these treat-
ments are costly and often have adverse
side effects. Exercise is an attractive
alternative because of the low cost, the
largely positive side effects, and the evi-
dence for its effectiveness.
Twenty-five randomized trials indicate
that exercise training of all types reduces
symptoms of depression among peo -
ple diagnosed as depressed.
98
At least
4 studies with depressed patients have
involved strength training alone.
99-102
Uniformly positive results were reported,
and the average improvement in depres-
sion symptoms is large (see Figure 6).
At least 42 trials show that exercise
training of all types improved depres-
sion symptoms among healthy adults and
medical patients.
1
At least 18 trials have
examined the effects of strength training
alone on symptoms of depression,* and
of these, 10 focused on older adults, and
2 each were conducted with fibromyal-
gia and breast cancer patients. The results
for older adults have been mixed, with
some showing a reduction in depression
symptoms
36,100,104
and others showing lit-
tle change.
37,38,68,105,106
Strength training has
consistently reduced symptoms of depres-
sion among patients with fibromyalgia.
75,77
No significant improvement in depression
symptoms has been realized after strength
training alone in cancer patients.
41,103
Improvements in depression symptoms
after strength training also have been real-
ized in college students,
99
osteoarthritis
patients,
42
law enforcement personnel,
107
and patients with spinal cord injuries.
108
The evidence supports the conclusion
that strength training alone is associated
with both large reductions in symptoms
of depression among depressed patients
and moderate reductions in depres-
sion symptoms among patients with
fibromyalgia.
What Is the Effect of
Strength Training on
Symptoms of Fatigue?
Approximately 1% of the population
suffers from chronic fatigue syndrome,
and ~25% report persistent fatigue
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Aerobic Aerobic plus
strength
Improvement in cognition
(standardized effect size)
Figure 5.
Average magnitude of improvement in cognitive function across all types of
cognitive tasks based on results of randomized trials involving aerobic exercise
training alone (average of 52 effect sizes) and exercise training that combined both
aerobic and strength training (average of 49 effect sizes). Adapted from Colcombe
and Kramer.
85
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387
symptoms.
109
The prevalence of fatigue
symptoms is even higher among peo-
ple with a variety of chronic medical
illnesses, especially those with psychi-
atric disorders.
110
Fatigue is a common
reason for medical visits, and it is so
common that the symptom typically does
not aid in differential diagnosis.
The results of a quantitative review
showed that exercise training of all types
improved symptoms of fatigue in 94% of
70 randomized trials. The overall aver-
age effect of 0.37 standard deviations was
judged to be clinically meaningful and
was larger than effects on fatigue found
in trials of cognitive-behavioral or drug
treatments.
111
Most of the studies (77%)
involved sedentary medical patients and
used aerobic exercise alone or a combi-
nation of exercise modes.
Strength training alone resulted in the
largest improvements in fatigue (see
Figure 7). Positive effects of strength
training alone were found for several
patient groups, including those with can-
cer
112
and fibromyalgia.
75
More recent tri-
als also consistently show improvements
in fatigue symptoms after strength train-
ing alone.
36,102,105
The evidence from at least 10 trials
supports the conclusion that strength
training alone is associated with
improvements in symptoms of fatigue.
What Is the Effect
of Strength Training
on Self-Esteem?
Self-esteem refers to how an individ-
ual feels about himself or herself. High
self-esteem is widely accepted as advan-
tageous, and it is positively associated
with better physical and mental health,
including greater happiness and overall
well-being.
114,115
Exercise training investigations that mea-
sured self-esteem have focused on overall
(global) self-esteem. Self-esteem is thought
to be hierarchical such that overall self-
esteem is linked to, and can potentially be
influenced by, several more narrow aspects
of the self, including how one feels about
his or her relationships with significant oth-
ers.
116
Narrow aspects of the self are more
easily changed than global self-esteem,
and exercise training plausibly has the
best chance to influence aspects of physi-
cal self-esteem such as feelings about phys-
ical appearance or muscular strength.
117,118
Potent changes in physical self-esteem ulti-
mately could plausibly cause changes in
overall self-esteem. Overall self-esteem,
however, is relatively stable and theoretically
References 37, 38, 40, 75, 77, 100, 102, 104, 112, 113.
Figure 6.
Average magnitude of improvement in symptoms of depression among depressed
samples after aerobic, strength, and aerobic and strength combined (mixed) types
of exercise. Based on 25 randomized trials involving exercise training of depressed
patients. Adapted from Mead et al.
98
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Aerobic Strength Mixed
Improvement in depression
symptoms (standardized effect size)
Figure 7.
Average magnitude of improvement in symptoms of energy and fatigue based on
randomized trials involving aerobic exercise training alone (average of 44 effect
sizes), strength training alone (average of 7 effects), and exercise training that
combined both aerobic and strength training (average of 21 effect sizes). Adapted
from Puetz et al.
111
0
0.1
0.2
0.3
0.4
0.5
0.6
Aerobic Strength Combined
Improvement in symptoms
of energy and fatigue
(standardized effect size)
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less subject to large change, especially from
minor or nontraumatic events of daily
living, including typical exercise training.
A meta-analysis of 113 published and
unpublished studies involving 7724 adult
participants found that exercise training of
all types resulted in small improvements in
global self-esteem.
119
The small mean effect
for strength training studies (0.26 SD) was
similar to that found for aerobic train-
ing studies (0.25 SD) and those studies
in which aerobic exercise was combined
with a second form of training (0.22 SD).
Among randomized trials, a posi-
tive effect of strength training alone on
overall self-esteem has been observed
in younger and older healthy adults as
well as patient groups, including those
with cancer and depression.
40,41,101,120-122
Improvements in overall self-esteem also
have accrued when strength training was
added to outpatient rehabilitation per-
formed by cardiac patients.
123
The evidence from at least 6 randomized
trials supports the conclusion that strength
training alone is associated with improve-
ments in overall self-esteem. Theory as
well as cross-sectional and related lon-
gitudinal exercise studies that were not
focused on strength training alone suggests
that changes in overall self-esteem and
other aspects of quality of life and mental
health, including depression symptoms,
may be mediated by changes in more
narrow aspects of the self such as physical
self-efficacy or physical self-worth.
124,125
What Is the Effect
of Strength Training
on Sleep?
Although we spend ~30% of our
lives sleeping, the purpose of sleep
remains unclear. Inadequate sleep is
problematic, and interventions that
enhance sleep could have a major impact
on improving public health. The most
prevalent sleep disorders are insomnia
and obstructive sleep apnea.
126
Chronic
insomnia (eg, sleep <6 hours) is associ-
ated with daytime sleepiness, motor
vehicle accidents, and an increased risk
of cognitive impairment,
127
hyperten-
sion,
128
obesity,
129
and mental illness.
130
Obstructive sleep apnea also is associated
with hypertension, obesity, cardiovascu-
lar disease, stroke, daytime sleepiness,
motor vehicle accidents, and a dimin-
ished quality of life.
131
The idea that daytime exercise
improves sleep is widespread.
132
More
than a dozen population-based studies
show that physically active people con-
sistently report better sleep than inac-
tive people,
133
and 1 analysis calculated a
27% reduced odds of poor sleep among
physically active compared with seden-
tary adults.
1
Two epidemiological studies
found that physically active adults have a
lower risk of sleep apnea.
134,135
Three randomized trials have examined
the influence of strength training alone on
self-reported sleep among older adults.
No effect was found for the trial that stud-
ied mentally healthy older adults who
were normal sleepers,
37
but 2 studies of
depressed patients have shown positive
strength training effects on sleep. Older
adults (n = 32) with a diagnosis of major
or minor depression or dysthymia were
randomly assigned to a 3 times per week
strength training or an attention control
condition for 10 weeks. Prior month sleep
quality was measured before and after
training with a well-validated question-
naire. After strength training, symptoms of
poor sleep were improved by 30%, and
the number of poor sleepers was reduced
from 66% to 26%; these effects were not
observed in the control group.
136
A subse-
quent study compared the effects of
8 weeks of low-intensity (20% 1-RM with-
out progression in the resistance used)
versus high-intensity (80% 1-RM with pro-
gression) strength training on sleep qual-
ity among community-dwelling, depressed
older adults (n = 60). Improvements in
sleep quality were significantly larger
for the high-intensity group compared
with both the low-intensity and control
groups.
102
Improved sleep also has been
reported after exercise training programs
that measured sleep polysomnographi-
cally, including those in which strength
training was combined with other types
of exercise.
137,138
The weight of evidence supports the
conclusion that strength training alone
performed by depressed older adults
improves sleep quality.
By What Mechanisms
Could Strength Training
Plausibly Influence
Mental Health?
The neural mechanisms that under-
lie and regulate several of the men-
tal health outcomes reviewed here, such
as those for anxiety
139
and sleep,
140
are
largely discrete. Nevertheless, many of the
outcomes, such as anxiety and depres-
sion, also are recognized as co-occurring
and having shared biological influences.
Although it is unlikely that exercise train-
ing influences all the mental health out-
comes reviewed here through a single
biological, psychological, or social mech-
anism, the possibility cannot yet be ruled
out. Indeed, a common mechanism is
suggested by some of the proposed social
and psychological explanations for men-
tal health improvements after exercise
training. The mental health benefits of
exercise training may stem from social
interactions that typically occur during
exercise of all types or from psycholog-
ical processes such as expectations for
improved mental states (placebo effect)
that can be present with both strength
and aerobic training.
141-143
As more has
been learned about “psychosocial” phe-
nomena such as the placebo effect, there
is increased evidence that the effects are
rooted in brain neurobiology.
144
Our understanding of the neural mech-
anisms that underlie physical inactiv-
ity and aerobic exercise training effects
on the brain has increased substantially
in recent years.
145-148
Neural mechanisms
for strength training effects on the brain,
however, rarely have been investigated
with humans or other animals. Ultimately,
it will be useful to learn whether the
neurophysiological adaptations to
strength training that underlie mental
health outcomes differ from those that
accrue from aerobic training.
Humans
Because aerobic and resistance exer-
cise modes do not stimulate the neuro-
muscular system in identical ways, it is
possible that neurophysiological adapta-
tions will differ between these 2 exercise
modes. Some of the ways in which
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resistance and aerobic exercise often
differ include (1) the specific nerves and
muscles activated (eg, upper body mus-
cle groups are activated to a greater
extent with typical strength training), (2)
the load on muscles relative to capac-
ity is often higher with resistance exercise
(and many physiological responses and
adaptations to exercise are determined by
the relative intensity), (3) the total time
under tension is often less during typical
strength training compared with aerobic
training of an equal workout time, (4) the
velocity of muscle actions is often slower
during typical strength training (resulting
in different afferent and efferent activation
patterns), (5) the rest periods are greater
during typical strength training, (6) the
range of motion often is greater with typ-
ical strength training, and (7) the achieve-
ment of volitional fatigue is reached more
often during typical strength training.
Exercise training might improve the
central nervous system through indirect
mechanisms that help to maintain good
brain function such as by enhancing vas-
cular health. Aerobic training is associ-
ated with reduced risk for chronic health
problems that can adversely influence the
brain, including coronary heart disease,
hypertension, dyslipidemia, metabolic
syndrome, type 2 diabetes, and obesity.
The scientific evidence that strength train-
ing reduces these risks among humans is
less compelling than for aerobic training.
1
However, if strength training does reduce
these risks, and there is evidence that it
does,
22,149-152
then brain neural function
and mental health, especially among mid-
dle-aged and older adults, could indirectly
benefit. For example, it is plausible that
strength training performed by older type
2 diabetic individuals results in improved
glycemic control, which could improve
cognitive function (or attenuate expected
age-related cognitive declines) by revers-
ing molecular and cellular impairments
induced by poor glucose regulation.
152
Strength training also could improve
mental health because it directly causes
neurophysiological adaptations in cir-
cuitry that controls or influences mental
health. Several lines of indirect evidence
from human studies indicate that por-
tions of the nervous system do adapt to
strength training, and the best evidence
from human studies concerns neurol-
ogy underlying motor control of muscle
strength.
153
Key observations include the
following: (1) large increases in strength
are realized shortly after adopting a
strength training regimen in the absence
of large increases in muscle mass,
154
(2) strength is reduced with detraining or
disuse prior to loss of muscle mass,
155
(3) increased strength on one task does
not always result in increased strength
on a different task that involves the same
muscle,
156,157
and (4) strength can increase
in an untrained limb contralateral to a
limb that undergoes strength training.
158
Also, motor imagery training, which has
no effect on skeletal muscle but does
activate many of the same brain regions
as actual movement, though to a smaller
degree,
159,160
can increase maximal volun-
tary strength.
161
Much of what is known about human
neural adaptations to strength training is
based on the training of small muscles of
the hand or distal upper limb during the
performance of a task that is dissimilar
from tasks performed in typical strength
training programs, which involve large,
proximal muscles (isometric finger task vs
dynamic shoulder press). Research using
twitch interpolation, transcranial mag-
netic, and transcranial electrical stimula-
tion, as well as data from Hoffmann reflex
and motor unit synchronization stud-
ies, suggests that strength training alters
the ability to voluntarily activate mus-
cles by more efficiently activating cortico-
spinal cells or by altering the functional
properties of spinal cord neural circuits
rather than by increasing motor cortex
output.
162-166
The degree to which these
motor-related adaptations influence spe-
cific neural circuitry involved in affective
(anxiety, depression, fatigue), behavioral
(sleep), or cognitive processes currently
is unknown; however, such effects are
not implausible.
167,168
It is expected that
the effect of strength training on adapta-
tions in the human brain and whether the
adaptations account for variations in men-
tal health will be more vigorously investi-
gated in the future. Research with animal
models also could provide useful insight
into this type of inquiry.
Animals
Studies comparing physically inac-
tive rodents to those that are more
active, typically by providing or prevent-
ing access to a running wheel for 3 to
12 weeks, suggest that activity-induced
increases in neurotransmitters (eg, nor-
epinephrine, serotonin), neuromodula-
tors (eg, galanin), and growth factors,
including nerve growth factor, vascu-
lar endothelial-derived growth factor
(VEGF), insulin-like growth factor
(IGF-1), VGF, and brain-derived neu-
rotrophic factor (BDNF), can result in
angiogenesis and neurogenesis as well
as contribute to cellular and molecular
adaptations that enhance learning
and attenuate signs of anxiety and
depression.
146,169-177
It is unknown
whether these effects occur with strength
training. Important contributions to our
understanding of the mechanisms by
which exercise training improves men-
tal health could be made by conduct-
ing research that directly examines the
brains of animals after strength training.
Several rat models of strength train-
ing have been developed,
178
and the
approaches include direct electrical stim-
ulation of the muscle while the rodent
is anesthetized,
179
climbing with weights
added to the back of a rodent,
180
and leg
squats performed in a rodent squat exer-
cise apparatus.
181-184
These and other
rodent models use operant conditioning
to motivate the animals to perform the
resistance exercise and typically involve
either tail shock avoidance or food
reward in hungry animals.
185-188
For exam-
ple, food deprived Long-Evans rats were
trained to reach for a single strand of
pasta and then progressively larger bun-
dles of pasta across 30 days of training.
189
The potential for stress effects of hunger
or shock to confound effects of strength
training per se is a crucial research
design concern in studies where brain
neurochemistry or mental health inferred
from behavior is the primary outcome.
One rodent strength training model
has been proposed as a method for min-
imizing some of the potential confound-
ing effects of hunger or tail shock.
190
Rats were motivated to perform 10
weeks of strength training using electrical
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American Journal of Lifestyle Medicine Sep • Oct 2010
stimulation of the brain as a reward.
After recovery from a brain surgical pro-
cedure, animals received electrical stim-
ulation in the midbrain tegmental area
when they lifted their arms to press a bar.
Weight was attached to their backs, and
the amount of weight attached increased
from 30 to 190 g over a 10-week training
period.
190
The authors concluded that this
intracranial self-stimulation model was
relatively easy to implement and did not
produce any apparent physical or men-
tal trauma in the animals. Nevertheless,
whether the effects of strength training
alone could be separated from potentially
confounding effects of direct tegmental
brain stimulation on other brain regions
remains uncertain.
Nonhuman primate models would be
potentially advantageous because the
brains and weight-lifting behaviors of
monkeys are more similar to humans
than other animals, including cats
191
and rats.
192
Observational studies have
been conducted with capuchin mon-
keys who daily lift stones weighing from
33% to 77% of body weight and throw
them to break open nuts for food.
193
The
weight of the stones could be manipu-
lated experimentally to achieve progres-
sive increases in muscle strength. The
biomechanics of the capuchins’ style of
weight lifting resembles human dead-
lifts and power pulls.
193
Researchers also
have used acute weight-lifting exercise
performed by rhesus monkeys to bet-
ter understand central nervous system
control over cardiovascular responses to
weight lifting.
194-197
For example, in
1 experiment, 4 monkeys learned to use
1 arm to raise and lower a weight of
12 kg a distance of 4.5 cm at least once
every 6 seconds for ~1.5 to ~2.5 minutes
to avoid a tail shock.
194
Simultaneous
electrical stimulation of various brain
regions was performed during the exer-
cise to better understand brain mech-
anisms that underlie cardiovascular
responses to exercise.
Although animal models of weight lift-
ing have been developed, few investiga-
tors have used them to explore central
nervous system adaptations to strength
training.
198
Several currently available ani-
mal models of strength training could be
usefully combined with animal models of
psychological processes, such as canine
199
and rodent
200
models of executive func-
tion, or mental health problems, such
as anxiety
201-204
and depression,
176,205,206
to enhance our understanding of the
brain benefits of strength training. High-
resistance physical activities, although not
strength training per se, could be incorpo-
rated in other model animal systems, such
as the zebra fish and the fruit fly, to better
understand genetic and molecular mecha-
nisms underlying brain neural adaptations
of high-resistance muscular activities.
207-210
Summary
There are relatively few studies, espe-
cially randomized controlled trials, of
the effects of strength training on mental
health outcomes, and many of the stud-
ies are small or were not designed specif-
ically to answer a question about mental
health. Thus, the scientific evidence
regarding the effect of strength training
on mental health outcomes is generally
characterized by a number of limitations.
Nevertheless, the small body of evidence
is largely positive, and the weight of the
available evidence supported the conclu-
sions that strength training is associated
with (1) reductions in anxiety symp-
toms among healthy adults; (2) reduc-
tions in pain intensity among patients
with low back pain, osteoarthritis, and
fibromyalgia; (3) improvements in cogni-
tion among older adults; (4) reductions in
symptoms of depression among patients
with diagnosed depression or fibromy-
algia; (5) reductions in fatigue symptoms;
(6) improvements in self-esteem; and (7)
improvements in sleep quality among
depressed older adults.
It is not uncommon for the effects of
strength training to be compared with aer-
obic training, often to learn whether the
benefit of one mode of exercise equals or
exceeds that of the other.
For example,
1 trial focused on prostate cancer patients
who were randomly assigned to 24 weeks
of resistance or aerobic exercise or usual
care. The authors found that fatigue
scores were reduced to a similar extent
in the short term for both training modes,
but strength training produced longer last-
ing improvements in fatigue.
113
Because
the 2 exercise modes were not matched
on all the characteristics of the exercise
stimulus, it is not possible to conclude
that one mode is better than the other for
mental health. Typically, only the total
exercise duration is matched when aer-
obic and strength training programs are
compared. Because there are more rest
periods in the typical strength training
program, significantly more work is per-
formed in a typical aerobic training pro-
gram of the same duration. Thus, it seems
likely that the effects of strength training
on mental health outcomes are underesti-
mated when comparisons are made to the
effects of aerobic training.
It is also important to consider that
some patients prefer strength training
to aerobic training and that preference
can influence mental health outcomes. A
somewhat greater preference for strength
than aerobic training was found in a study
of 242 breast cancer patients in which
participants were randomly assigned to
either strength or aerobic training (see
Figure 8). Patients with a preference for
strength training improved their qual-
ity of life only if they were assigned to
strength training,
211
and the effect was
explained by expected benefits, enjoy-
ment, and difficulty and the support for
performing each type of exercise during
chemotherapy.
212
This review indicates that a small body
of randomized controlled trials shows
that strength training has positive effects
on a host of important mental health
outcomes. Needed now are studies that
determine the variables that mediate and
moderate the influence of strength train-
ing on mental health. Studies with larger
samples, a greater range of strength
training exercise dose, and a greater
range of patient samples, especially the
poor, the less well educated, Hispanics,
and women and older adults, also are
needed to better estimate the relation-
ship between strength training and men-
tal health outcomes. Plausible social,
psychological, and neural mechanisms
by which strength training potentially
influences these outcomes have not
yet been explored. Thus, there is also
a pressing need for animal and human
References 68, 77, 79, 80, 104, 113.
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research aimed at better understand-
ing brain mechanisms underlying mental
health changes with strength training.
Acknowledgments
We thank Al Ray III for assisting
in the literature search. We thank
anonymous reviewers for helpful com-
ments that improved the presentation of
the information in the article. This work
was supported in part by a grant from
the National Institutes of Health (RO1
NR008131).
AJLM
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... Whether or not improvements in outcomes are mediated by improved strength (ie, the target of strength/resistance training interventions) or by other mechanisms is unclear. Apart from improving strength, exercise may exert effects through psychological mediators, 3,18,36,44 such as improving kinesiophobia, 10 pain catastrophizing, pain self-efficacy, or anxiety. 29,31 We recently published the results of a randomized clinical trial that compared foot orthoses to hip exercises in 218 individuals with patellofemoral pain. ...
... In addition to improving the force-generating capacity of muscles, resistance exercises are associated with psychological benefits. 3,18,36,44 Individuals with patellofemoral pain have higher levels of anxiety, kinesiophobia, and pain catastrophizing 29,31 than individuals who do not have patellofemoral pain, which is important for treating patellofemoral pain. 10,26,29,30,37,42 Our mediation analysis did not detect any mediation of these psychological features. ...
Article
Objective: To determine whether the effect of hip exercise on patellofemoral pain is mediated through changes in hip muscle strength or psychological factors. Design: Secondary mediation analysis of a randomized clinical trial, in which 218 participants with patellofemoral pain were randomly assigned to receive foot orthoses or hip exercises. Methods: Pain (Knee injury and Osteoarthritis Outcome Score pain subscale) and number of pain-free squats at 12 weeks were the outcomes for this mediation analysis, as they are pathognomonic of patellofemoral pain. Hip strength dynamometry (abduction, adduction, and external rotation) and psychological characteristics (pain catastrophizing, kinesiophobia, and anxiety) measured at 6 weeks were considered as potential mediators. We used mediation analysis to decompose the total effect of treatment on the outcome into (1) the "indirect effect" (ie, the portion acting through the mediator) and (2) the "direct effect." Results: The effect of hip exercise on pain and squats was not mediated by any of the strength or psychological mediators analyzed. All indirect effects were small and showed wide 95% confidence intervals (CIs) that contained zero (eg, for pain-free squats: abduction strength, -0.13; 95% CI: -0.49, 0.23; Tampa Scale of Kinesiophobia, -0.17; 95% CI: -0.64, 0.30). Conclusion: Hip strength improved after hip exercise, yet strength did not mediate improvements in pain and pain-free squats, and alternative psychological mediators were not implicated. J Orthop Sports Phys Ther 2021;51(12):602-610. doi:10.2519/jospt.2021.10674.
... It resulted in an increase in hydrogen ions, lactate, inorganic phosphate, ammonia, and ADP; and a decrease in ATP, phospho-Creatine, and pH in active muscle cells during intense or supramaximal exercise [14]. Furthermore, anaerobic training, inducing fatigue, has well-established effects on anxiety that are comparable to other empirically-supported treatments [15]. This type of training may be relevant for training in team sports as it can induce small to large improvements in power, speed, repeated-sprint ability and endurance [16]. ...
Article
The study aimed to investigate the effects of repeated sprint (RS) training on somatic anxiety (SA), cognitive anxiety (CA), self-confidence (SC), rating of perceived exertion (RPE) and repeated sprint ability (RSA) indicators in elite young soccer players. Thirty elite soccer players in the first football league (age: 17.8 ± 0.9 years) volunteered to participate in this study. They were randomly assigned to one of two groups: a repeated sprint training group (RST-G; n = 15) and a control group (CON-G; n = 15). RST-G participated in 6 weeks of intensive training based on RS (6 × (20 + 20 m) runs, with 20 s passive recovery interval between sprints, 3 times/week). Before and after the 6-week intervention, all participants performed a RSA test and completed a Competitive Scale Anxiety Inventory (CSAI-2) and the RPE. After training RST-G showed a very significant (p < 0.000) increase in RSA total time performance relative to controls. Despite the faster sprint pace, the RPE also decreased significantly (p < 0.005) in RST-G, and their self confidence was significantly greater (p < 0.01), while the cognitive (p < 0.01) and somatic (p < 0.000) components of their anxiety state decreased. When practiced regularly, short bouts of sprint exercises improve anaerobic performance associated with a reduction in anxiety state and an increase in SC which may probably boost competitive performance.
... The beneficial effects of resistance training (RT) on muscular strength, power, speed, endurance, balance, coordination, and hypertrophy are widely recognised (Suchomel, Nimphius & Stone, 2016;Suchomel et al., 2018). In addition, RT is often used for injury prevention and rehabilitation purposes and has an important role in general well-being due to numerous beneficial effects on health and quality of life (O'Connor, Herring & Caravalho, 2010;Feigenbaum & Pollock, 1999). However, adaptations to RT may differ depending upon several factors such as the choice and order of the exercises, training intensity, volume, frequency, rest interval duration, set structure, and velocity of the repetitions Grgic et al., 2018aGrgic et al., , 2018bPareja-Blanco et al., 2014;Jukic et al., 2020Jukic et al., , 2021. ...
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Background The purpose of this study was to compare the effects of cluster (CS), rest redistribution (RR) and traditional (TS) set configurations on acute neuromuscular performance, and to determine the viability of using CS and RR as alternatives to training prescription based on velocity loss (VL). Methods Thirty-one resistance-trained men performed, in a randomised order, three experimental sessions consisting of the squat (SQ) and bench press (BP) exercises performed against the 10-repetition maximum load using CS (three sets of six repetitions; 30 s of intra-set rest every two repetitions; 3 min of inter-set rest), RR (9 sets of two repetitions; 45 s of inter-set rest), and TS (3 sets of 6 repetitions; 3 min of inter-set rest), set configurations. Results Linear mixed-effects model analysis revealed that participants had significantly lower VL ( p = 0.0005) during CS and RR than TS. Generalised mixed-effects model analysis yielded significant main effects of set structure ( p < 0.0001; RR > CS > TS), exercise ( p < 0.0001; SQ > BP), and set number ( p = 0.0006; Set 1 > Set 2 > Set 3) for maintaining repetition velocity above a 20% VL threshold. Conclusions These findings suggest that CS and RR are effective at reducing the overall fatigue-included decrease in velocity compared to TS and allow the majority of repetitions to be completed with less than 20% VL. Therefore, both CS and RR can be used to manage fatigue during resistance training, and as alternatives to training prescription method based on 20% VL threshold.
... Scientific evidence has pointed out many possible health benefits of strength training to different population groups at various stages of life. Among these effects are increase resting metabolic rate and a decrease of low-density lipoprotein [3], post--exercise hypotension [4], benefits in the neuromuscular system [5,6] along cognitive and mental health aspects [7]. ...
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How to cite: Cantieri FP, Arruda GA, Coledam DHC, Gomes AC, Aranha ACM, Barros MVG, et al. Strength training: the agreement between methodological standards and prescription by fitness professionals. Rev Bras Fisiol Exerc 2022;21(1):15-25. https://doi. ABSTRACT Introduction: The scientific advances have resulted in proposed methodologic standards to assist the prescription of physical exercise, but it is not clear whether there is a practical application of these standards by fitness professionals. Objective: To analyze the agreement between the methodologic standard for strength training and the methodology used by the fitness professionals. Methods: 461 professionals (men = 68.1%), aged 31.3 (± 6.8) years old, from the city of Londrina/PR and São Paulo/SP participated in the study, who filled out a questionaire containing 16 objective questions about strength training methodology. The Binomial test (cutoffs: 50% and 70%) was used for statistical analysis (p < 0.05). Results: Agreement significantly greater than 70% was obtained for 37.5% of the questions when considering agreement greater than 50%, plus 12.5% of the questtions were added. Agreements significantly less than 50% were identified for the number of repetitions for local muscle endurance (33.5%), load percentage for muscle power (39.5%), as well as for the rest interval for local muscle endurance (19.3%), hypertrophy (33.8%) and muscle power (20.3%). Conclusion: In general, the prescriptions indicated by fitness professionals had low agreement with the analyzed methodologic standards. RESUMO Introdução: Avanços científicos resultaram em padrões metodológicos propostos para auxiliar na prescri-ção do exercício físico, porém ainda não está claro se há aplicação prática de tais padrões por profissionais do fitness. Objetivo: Analisar a concordância entre padrões metodológicos para treinamento de força muscular e a metodologia utilizada por profissionais que atuam na área do fitness. Métodos: Participa-ram do estudo 461 profissionais (homens = 68,1%) com média de 31,3 (± 6,8) anos da cidade de Londrina/ PR e São Paulo/SP, que preencheram um questionário contendo 16 questões objetivas sobre metodologia do treinamento de força. O teste Binomial (cutoffs: 50% e 70%) foi utilizado para as análises estatísticas (p < 0,05). Resultados: Concordância significativamente maior que 70% foi obtida para 37,5% das questões. Ao considerar concordância maior que 50% mais 12,5% das questões foram adicionadas. Concordâncias significativamente inferiores a 50% foram identificadas para o número de repetições para a resistência muscular localizada (33,5%), percentual de carga para potência (39,5%), bem como para o intervalo de re-cuperação para resistência muscular localizada (19,3%), hipertrofia (33,8%) e potência (20,3%). Conclusão: A prescrição apontada pelos profissionais que atuam com fitness em geral apresentou baixa concordância com os padrões metodológicos analisados. Palavras-chave: treinamento resistido; exercício; diretrizes práticas; aptidão física; saúde.
... Finally, no significant relationships were found between muscular fitness and psychosocial problems. This result contrasts with findings in older adults where higher levels of muscular fitness were significantly related to reduced levels of psychosocial problems (O'Connor et al., 2010). The observed inverse relationship between muscular fitness and psychosocial problems in older adults is not surprising, considering how strength training improves daily functioning and facilitates social interactions, which in turn would benefit psychosocial health (Granacher et al., 2013). ...
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Adolescence is characterized by profound changes in body and behavior, and not surprisingly during this developmental phase the risk of developing psychosocial problems increases dramatically. The purpose of the current study was to examine the relationship of both physical fitness and body composition with psychosocial health in adolescents (Dishman and O'Connor, 2009, Anderson and Shivakumar, 2013, Dinas et al., 2011, Mücke et al., 2018). Data were collected in 2019-2020 in a representative sample of 361 Dutch adolescents (46.3% boys, age=13.44±0.43 years). Physical fitness and body composition were assessed by subtests of the Eurofit test battery assessing cardiorespiratory fitness (20m Shuttle Run Test), muscular fitness (Broad Jump and Sit-Ups), speed-agility (10x5-m Shuttle Run Test and Fast Tapping Test), and body composition (Body Mass Index). Psychosocial health was assessed in four domains: self-concept (Competence Experience Scale for Adolescents), symptoms of depression (Child Depression Inventory), anxiety (State and Trait Anxiety Inventory) and ADHD (Strengths and Weaknesses of ADHD Symptoms). Multilevel regression analyses were performed in MLwin. Results showed that better cardiorespiratory fitness was related to better self-concept (β=0.225; p<0.001), less symptoms of depression (β=-0.263; p=0.003), and lower levels of state (β=-0.239; p=0.008) and trait anxiety (β=-232; p=0.008). Furthermore, higher BMI was related to lower self-concept (β=-0.075; p=0.019). Taken together, the results suggest that better cardiorespiratory fitness and lean body composition have a positive relationship with self-concept and that better cardiorespiratory fitness is related to less symptoms of depression and anxiety.
... Previous studies also found that strength training significantly reduced anxiety symptoms [46,47]. There are several studies that consistently show that exercise leads to greater happiness in both the short and long term, and that increasing physical activity can even improve the mood of people with bipolar disorder the day after exercise, which produces serotonin and makes them feel good [48,49]. Studies have also shown that the increase in body temperature during exercise increases blood circulation in the brain and affects the HPA axis (hypothalamic-pituitary-adrenal axis) in the brain, which helps improve mood [50]. ...
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Senile dementia, also known as dementia, is the mental deterioration which is associated with aging. It is characterized by a decrease in cognitive abilities, inability to concentrate, and especially the loss of higher cerebral cortex function, including memory, judgment, abstract thinking, and other loss of personality, even behavior changes. As a matter of fact, dementia is the deterioration of mental and intellectual functions caused by brain diseases in adults when they are mature, which affects the comprehensive performance of life and work ability. Most dementia cases are caused by Alzheimer’s disease (AD) and multiple infarct dementia (vascular dementia, multi-infarct dementia). Alzheimer’s disease is characterized by atrophy, shedding, and degenerative alterations in brain cells, and its occurrence is linked to age. The fraction of the population with dementia is smaller before the age of 65, and it increases after the age of 65. Since women live longer than men, the proportion of women with Alzheimer’s disease is higher. Multiple infarct dementia is caused by a cerebral infarction, which disrupts blood supply in multiple locations and impairs cerebral cortex function. Researchers worldwide are investigating ways to prevent Alzheimer’s disease; however, currently, there are no definitive answers for Alzheimer’s prevention. Even so, research has shown that we can take steps to reduce the risk of developing it. Prospective studies have found that even light to moderate physical activity can lower the risk of dementia and Alzheimer’s disease. Exercise has been proposed as a potential lifestyle intervention to help reduce the occurrence of dementia and Alzheimer’s disease. Various workout modes will be introduced based on various physical conditions. In general, frequent exercise for 6–8 weeks lessens the risk of dementia development.
... There is a wealth of empirical evidence supporting the association between strength-based training and positive mental health outcomes (Billington et al., 2010). A systematic review of 136 studies of this approach conducted by O'Connor et al. (2010) demonstrated that strength-based interventions are associated with reduced anxiety symptoms among healthy adults, reduced depression symptoms among patients with diagnosed depression, reduced pain intensity among patients with lower back pain, and reduced fatigue symptoms among older adults. It was also associated with improvements in cognition among older adults, better sleep quality among depressed older adults, and higher self-esteem. ...
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The importance of complete mental health in school context has recently begun to attract a lot of attention. Positive psychology interventions are often associated with improvement in mental health outcomes, but few studies have examined whether story reading is an intervention that is linked with indicators of complete mental health. This study investigated the effects of story reading interventions on both positive and negative indicators of mental health over time for a group of Turkish grade 10 high school students (n = 53). These included 33 students in a story reading group and 20 in a control group for comparison. The results showed that story reading led to improvement in students’ mindfulness, optimism, happiness, and positive emotions, and also caused reduction in depression, anxiety, pessimism, and other negative emotions over a 5-week period, with a small to large effect sizes. The obtained results are discussed in the context of their implications for potential psychological interventions in high school settings.
Article
This study investigated the objectivity, reliability, and the validity of the Basketball Throw Test (BTT) as an upper-body muscular strength measure. Participants (33 boys and 32 girls; mean age = 8.75 ± 1.47) performed the BTT on 2 occasions (1-week apart), and the hand-grip test as criterion measure. The objectivity and reliability were estimated using an intraclass correlation coefficient (ICC2,1) and graphically examined according to the Bland-Altman approach. Pearson correlation coefficient and the known-differences method was employed to determine validity. The BTT demonstrated high objectivity ICC2,1 = 0.90 (95% CI, 0.84–0.94), reliability ICC2,1 = 0.91 (95% CI, 0.86–0.95) and validity (r = 0.77, p <.001). The Bland–Altman method graphically confirmed intraclass correlation data. The significant difference in the BTT scores between 6-year-old children (1.61 ± 0.23) and 10-year-old children (t = −12.64, p < .001) provided additional support of validity. The BTT test is a feasible measure of upper-body muscular strength in school-aged children.