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Moderators of Resistance Training Effects in Overweight and Obese Adults: A Systematic Review and Meta-analysis
Abstract
Purpose:
To analyse whether the effects of resistance exercise on whole-body fat and lean mass are moderated by exercise dosage (i.e., duration, volume, and intensity), age, body mass index, baseline values, assessment methods and prescription of aerobic exercise and caloric restriction in overweight/obese adults.
Methods:
A systematic search was undertaken in eleven databases from inception to December 2020, with an updated search undertaken in April 2022. Eligible randomized controlled trials examined the effects of resistance-based exercise programs on whole-body fat mass and lean mass in adults who were overweight or obese. Meta-analysis was undertaken with a random-effects model. Associations between mean differences and potential moderators were tested by meta-regression models.
Results:
Sixty-seven articles describing 65 trials (n = 2,537) were included. Resistance-based exercise programs resulted in a significant change of -1.6 kg (95% CI: -1.9 to -1.3 kg, P < 0.001) in whole-body fat mass and + 0.8 kg (95% CI: 0.6 to 0.9 kg, P < 0.001) in lean mass. Male participants experienced greater effects than females (P < 0.001), while those presenting with higher levels of fat mass at baseline experienced greater reductions in this outcome (P = 0.084). For lean mass, younger adults experienced greater improvements compared to older participants (P = 0.009), while programs comprising resistance exercise and caloric restriction resulted in significant reductions in lean mass (P = 0.035). Resistance exercise dosage or prescription of aerobic exercise was not associated with change in these outcomes.
Conclusions:
Resistance-based programs improve body composition regardless of the resistance exercise dosage or aerobic component prescribed in adults who are overweight or obese. Additionally, subgroups based on demographic characteristics, baseline levels and presence of caloric restriction may present with more favourable responses in body composition.
... The results found in the present study may be due to the fact that it included middle-aged adults and not only older adults. Some research has shown different effects according to age, with significant changes observed in the body composition of middle-aged adults, while older adults did not show significant changes in body composition [34], or a larger effect size in middle-aged adults than in older adults [35], suggesting that OFE training may improve body composition in middle-aged adults and slow age-associated changes in body composition in older adults. ...
... Most of the research examining the effect of resistance training programs on body composition has been focused on middle-aged adults [36], older adults [37], overweight and obese people [35], people with sarcopenia [6], people with sarcopenia and obesity [38], or postmenopausal women [34]. Although all of them have shown improvements in most of the variables related to body composition, some of them do not show improvements in lean mass [6]. ...
... However, it appears that muscle mass improvements can be achieved with loads greater than 30% 1RM, indicating that there is no ideal zone from a practical point of view [44]. In contrast, in relation to the effect on fat mass, there seems to be more evidence about the need for low to moderate intensity and high volumes [35]. A possible explanation could be the relationship between lipolysis with low intensity training and some volume because the optimal intensity for fat oxidation has been described as around 60% [45]. ...
This study examined the effect of outdoor-fitness-equipment-based resistance training on the health parameters of middle-aged and older adults, as well as analyzing the effect of age on the results found. A total of 149 volunteers were randomly assigned to the training (TG) and control (CG) groups. The TG performed two weekly sessions of resistance training for 8 weeks using outdoor fitness equipment, while the CG continued with their regular daily activities. Body composition was measured using DXA, and the maximal isometric voluntary contraction in knee extension, elbow flexion, and hand grip were assessed, along with the 4 m walk test, the Timed Up and Go Test, and the Short Form 36 Health Survey Questionnaire. The TG showed a significant increase in the lean mass index (p = 0.002) and maximal isometric voluntary contraction in both legs (p < 0.001) and arms (p < 0.001), as well as in physical functioning (p < 0.001) and the role physical dimension (p = 0.006) of the Short Form 36 Health Survey Questionnaire, compared to the CG, which showed a decrease in all these variables. In addition, the TG showed a greater decrease in fat mass (p < 0.001), fat mass index (p = 0.003), and the Timed Up and Go Test (p < 0.001) than the CG. Age conditioned the evolution of most of the variables analyzed (p < 0.05). In conclusion, resistance training with outdoor fitness equipment may be useful for improving the health of middle-aged and older adults, although age is a factor that could influence the adaptations found.
... For example, we included only nonobese young healthy women, whereas Hagstrom et al. (27) included young and middle-aged women regardless of body mass. We previously observed that resistance-based exercise programs result in smaller adaptations in middle-aged compared with young adults (46,48). In addition, we used a three-level metaanalysis, whereas a two-level meta-analysis was used by Hagstrom et al. (27). ...
... Regarding fat mass, we observed a modest reduction (i.e., SMD # 0.5) in body fat percentage after resistance training programs but not whole-body fat mass. Our inclusion criteria may partially explain this result because only nonobese healthy women were included (median BMI of 22.2 kg·m 2 2 ; median body fat percentage of 26.5%), and higher baseline levels of whole-body fat mass are associated with greater reductions after resistance-based exercise programs (46). Also, the very low-to-low GRADE indicates that the extent of benefit may be limited and not certain in young women. ...
... Attention to aspects of randomization and allocation (9) as well as utilization of more precise and reliable body composition assessment methods (e.g., dual-energy X-ray absorptiometry) is necessary to confirm this result in future studies. Regarding the meta-regression results, we did not (46) and healthy adults (81). Therefore, for women with relatively lower BMI or body fat percentage levels, a moderate-intensity resistance training program of ;72 weekly sets may be necessary to achieve greater reductions in body fat percentage because of greater improvements in lean mass/muscle hypertrophy. ...
To systematically review and analyze the effects of resistance-based exercise programs and potential moderators of change in body fat percentage, whole-body fat and lean mass, muscle hypertrophy, muscle strength, and muscle power/rapid force in healthy young women (between 18 and 35 years). A systematic search was undertaken in 7 databases from inception to May 2022. Eligible randomized controlled trials examined the effects of resistance-based exercise programs on outcomes of interest in healthy young women. Meta-analysis was undertaken with a 3-level mixed-effects model. Associations between standardized mean difference (SMD) and potential mod-erators (number of sessions, weekly volume, and intensity) were tested by meta-regression models. Statistical significance was set at an a level of 0.05, whereas an a level of 0.05-0.10 was also considered for potential moderators of resistance training effects. Forty articles (n = 1,312) were included. Resistance-based exercise programs resulted in a significant improvement of 0.4 SMD (95% confidence intervals [95% CI]: 0.2 to 0.5, p < 0.001) in lean mass/muscle hypertrophy and 1.2 SMD (95% CI: 0.9 to 1.5, p < 0.001) in muscle strength. A higher number of sessions was associated with changes in lean mass/muscle hypertrophy (b = 0.01 ± 0.00, p = 0.009), whereas a higher weekly volume approached statistical significance to moderate changes in muscle strength (b = 0.01 ± 0.01, p = 0.053). Body fat percentage (-0.4 SMD, 95% CI: -0.6 to -0.1, p = 0.006) and muscle power/rapid force (0.6 SMD, 95% CI: 0.2 to 1.1, p = 0.011) were significantly improved. In conclusion, a higher resistance training volume was associated with greater improvements in lean mass/muscle hypertrophy, muscle strength, and body fat percentage, whereas muscle power/ rapid force improvements were observed irrespective of prescription characteristics. These findings may help in designing resistance training programs for muscle hypertrophy, strength and power, and body fat percentage in healthy women.
... Interestingly, adopting a low volume resistance training program with ~ 30 full-body weekly sets (or ~ 12 lower-limb weekly sets) led to slightly superior benefits and was the only program to result in continuous improvements over the medium-tolong term. Furthermore, the relatively modest effects and lack of continuous improvement in these outcomes were observed in previous studies [18,219,220] and seem to be associated with anabolic resistance [18,219,220], as we previously observed [221], and the diminishing returns principle, respectively. Nonetheless, low-volume resistance training may be an interesting strategy to help participants stay motivated, build on compliance and achieve their goals, especially considering the challenges of long-term adherence to resistance training and dropouts in participation in physical activity programs over time. ...
Background
The optimal prescription and precise recommendations of resistance training volume for older adults is unclear in the current literature. In addition, the interactions between resistance training volume and program duration as well as physical health status remain to be determined when assessing physical function, muscle size and hypertrophy and muscle strength adaptations in older adults.
Objectives
This study aimed to determine which resistance training volume is the most effective in improving physical function, lean body mass, lower-limb muscle hypertrophy and strength in older adults. Additionally, we examined whether effects were moderated by intervention duration (i.e. short term, < 20 weeks; medium-to-long term, ≥ 20 weeks) and physical health status (i.e. physically healthy, physically impaired, mixed physically healthy and physically impaired; PROSPERO identifier: CRD42023413209).
Methods
CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to April 2023. Eligible randomised trials examined the effects of supervised resistance training in older adults (i.e. ≥ 60 years). Resistance training programs were categorised as low (LVRT), moderate (MVRT) and high volume (HVRT) on the basis of terciles of prescribed weekly resistance training volume (i.e. product of frequency, number of exercises and number of sets) for full- and lower-body training. The primary outcomes for this review were physical function measured by fast walking speed, timed up and go and 6-min walking tests; lean body mass and lower-body muscle hypertrophy; and lower-body muscle strength measured by knee extension and leg press one-repetition maximum (1-RM), isometric muscle strength and isokinetic torque. A random-effects network meta-analysis was undertaken to examine the effects of different resistance training volumes on the outcomes of interest.
Results
We included a total of 161 articles describing 151 trials (n = 6306). LVRT was the most effective for improving timed up and go [− 1.20 standardised mean difference (SMD), 95% confidence interval (95% CI): − 1.57 to − 0.82], 6-min walk test (1.03 SMD, 95% CI: 0.33–1.73), lean body mass (0.25 SMD, 95% CI: 0.10–0.40) and muscle hypertrophy (0.40 SMD, 95% CI: 0.25–0.54). Both MVRT and HVRT were the most effective for improving lower-limb strength, while only HVRT was effective in increasing fast walking speed (0.40 SMD, 95% CI: − 0.57 to 0.14). Regarding the moderators, our results were independent of program duration and mainly observed for healthy older adults, while evidence was limited for those who were physically impaired.
Conclusions
A low resistance training volume can substantially improve healthy older adults’ physical function and benefits lean mass and muscle size independently of program duration, while a higher volume seems to be necessary for achieving greater improvements in muscle strength. A low volume of resistance training should be recommended in future exercise guidelines, particularly for physically healthy older adults targeting healthy ageing.
... Es esencial adaptar los programas a las necesidades individuales para maximizar los beneficios y minimizar riesgos. La correcta prescripción del ejercicio, basada en la evidencia, puede ayudar a integrar estas intervenciones en entornos clínicos y comunitarios, ofreciendo beneficios significativos a largo plazo para los pacientes con cáncer (Geidl et al., 2020;Anderson et al., 2016;Caruso et al., 2016;Li Z et al., 2023;Lopez et al., 2022;Lacio et al., 2021;Campos et al., 2020;Stone et al., 2022;Fang et al., 2020;Cheng et al., 2017;Turner et al., 2018). ...
Objetivos: El objetivo de esta revisión es examinar y sintetizar la evidencia científica disponible sobre la eficacia de los programas de entrenamiento de fuerza en pacientes con cáncer. Se busca identificar las mejores prácticas y estrategias de intervención que optimicen los resultados en términos de calidad de vida, capacidad funcional y salud general de estos. Métodos: Se realizó una búsqueda exhaustiva en Embase, Redalyc, Web of Science, Google Scholar, PubMed, Cochrane Library y Scopus, utilizando términos de búsqueda específicos y criterios de inclusión predefinidos para estudios entre 2018 y 2024. Resultados: De 13 estudios con 1395 mujeres sobrevivientes de cáncer de mama (edad promedio de 54,14 años), se encontró que el entrenamiento de fuerza ofrece beneficios significativos para la salud. Las intervenciones mejoraron la fuerza muscular y la calidad de vida, reduciendo la fatiga y la depresión. También se observaron efectos positivos en el sistema inmune, la capacidad cardiorrespiratoria (Vo2máx) y la movilidad, además de una reducción en el linfedema. Conclusión: se estima que la dosificación optima se encuentra con una frecuencia: Entre 2 y 3 veces por semana. La frecuencia debe ser suficiente para permitir la adaptación sin causar fatiga excesiva o riesgo de lesiones. Intensidad para el entrenamiento de fuerza entre un 60-80% (1RM), realizando 2-3 series de 8-12 repeticiones por ejercicio. Para la resistencia una intensidad moderada a alta, donde el 60-80% de la Fcmax. durante 20-60 minutos por sesión. Palabras claves: Cáncer de mama, rehabilitación postoperatoria, ejercicio de fuerza, calidad de vida, funcionalidad física, Abstract. Objectives: The objective of this review is to examine and synthesize the available scientific evidence on the effectiveness of strength training programs in cancer patients. It aims to identify the best practices and intervention strategies that optimize outcomes in terms of quality of life, functional capacity, and overall health. Methods: An extensive search was conducted in Embase, Redalyc, Web of Science, Google Scholar, PubMed, Cochrane Library, and Scopus using specific search terms and predefined inclusion criteria for studies from 2018 to 2024. Results: From 13 studies involving 1,395 breast cancer survivors (average age of 54.14 years), it was found that strength training provides significant health benefits. Interventions improved muscle strength and quality of life, reducing fatigue and depression. Positive effects were also observed on the immune system, cardiorespiratory capacity (Vo2max), and mobility, in addition to a reduction in lymphedema. Conclusion: Strength and resistance training is an effective strategy for improving quality of life, energy levels, and mitigating treatment side effects in cancer patients. It is recommended to perform 2 to 3 sessions per week of 30 to 60 minutes each. Although protocols vary in intensity, sets, repetitions, and rest periods, tailoring the exercise program to individual needs is crucial for optimizing results and ensuring effective recovery. Keywords: Breast cancer, postoperative rehabilitation, strength exercise, quality of life, physical function.
... Explorations into acute bouts of resistance (RT) training on postexercise metabolism however are limited, and improving our understanding of EPOC is crucial to understanding how RT can be used to improve body composition. It is plausible that the energy expended during and postexercise (5,16,39,45), coupled with elevated fat oxidation postexercise (5,16,44,45) and suppression of appetite (4,10,21,31,32), could explain the improvements in body composition seen with RT (26,33,34). ...
Grisebach, D, Bornath, DPD, McCarthy, SF, Jarosz, C, and Hazell, TJ. Low-load and high-load resistance exercise completed to volitional fatigue induce increases in post-exercise metabolic responses with more prolonged responses with the low-load protocol. J Strength Cond Res XX(X): 000–000, 2024—Comparisons of high-load with low-load resistance training (RT) exercise have demonstrated no differences in postexercise metabolism when volume is matched. This important limitation of matching or equating volume diminishes benefits of the low-load RT protocol. Therefore, the purpose of this study was to determine the effects of acute low-load high volume and high-load low volume RT protocols completed to volitional fatigue on postexercise metabolism. Eleven recreationally active resistance-trained male subjects (24 ± 2 years; BMI: 25.3 ± 1.5 kg·m ⁻² ) completed 3 experimental sessions: (a) no-exercise control (CTRL); (b) RT at 30% 1 repetition maximum (1RM; 30% 1RM); and (c) RT at 90% 1RM (90% 1RM) with oxygen consumption (V̇ o 2 ) measurements 2 hours postexercise. The RT sessions consisted of 3 sets of back squats, bench press, straight-leg deadlift, military press, and bent-over rows to volitional fatigue completed sequentially with 90 seconds of rest between sets and exercises. Changes were considered important if p < 0.100 with a ≥medium effect size. V̇ o 2 1 hour postexercise was elevated following 30% 1RM (25%; p = 0.003, d = 1.40) and 90% 1RM (14%; p = 0.010, d = 1.15) vs. CTRL and remained elevated 2 hours postexercise following 30% 1RM (16%; p = 0.010, d = 1.15) vs. CTRL. Total O 2 consumed postexercise increased following 30% 1RM and 90% 1RM (∼17%; p < 0.044, d > 0.91) vs. CTRL. Fat oxidation was elevated 1 hour postexercise following 30% 1RM and 90% 1RM (∼155%; p < 0.001, d > 2.97) and remained elevated 2 hours postexercise following 30% 1RM compared with CTRL and 90% 1RM (∼69%; p < 0.030, d > 1.03). These data demonstrate beneficial changes to postexercise metabolism following high- and low-load RT sessions, with more prolonged effects following the low-load RT protocol completed to volitional fatigue.
... Por lo tanto, los hallazgos de esta revisión sistemática podrían romper con el pensamiento de que el entrenamiento aeróbico tradicional es el principal medio para perder peso [76], especialmente para la población con sobrepeso y obesidad. Después de todo, el entrenamiento de fuerza puede aumentar la masa magra corporal y la masa muscular además de reducir el %GC [77,78,79,80], mejorando así la composición corporal. Por tal motivo, este hallazgo brinda un fuerte apoyo al entrenamiento de fuerza como una futura forma efectiva de combatir la obesidad, perder grasa y ganar músculo. ...
Introducción: La obesidad sigue siendo uno de los problemas más grandes de salud pública en todo el mundo. Se conoce que está asociada con una gran variedad de enfermedades; en mujeres obesas, aún se desconoce la forma idónea para realizar una adecuada prescripción física. Objetivo: revisar los tipos de entrenamientos físicos de ensayos controlados aleatorizados publicados en la base de datos PubMed entre los años 2015 a 2022 sobre los cambios en la composición corporal en mujeres adultas de 18 a 65 años con obesidad. Metodología: se utilizó a modo de filtro la "Herramienta de Evaluación de Calidad Validada para Estudios Cuantitativos". Resultados: la búsqueda arrojó 586 artículos, de los cuales el 93.85% fueron eliminados; 6.14% pasaron por un filtro que dejó un total de 1.7%. Conclusión: en mujeres adultas con obesidad, se ha demostrado que todos los tipos de entrena-miento físico sirven para generar cambios en la composición corporal.
Introduction: Obesity continues to be one of the biggest public health problems worldwide. It is known to be associated with a wide variety of diseases; in obese women, the ideal way to carry out an adequate physical prescription is still unknown. Objective: to review the types of physical training in randomized controlled trials published in the PubMed database between 2015 and 2022 on changes in body composition in adult women aged 18 to 65 with obesity. Methodology: the "Validated Quality Assessment Tool for Quantitative Studies" was used as a filter. Outcomes: the search yielded 586 articles, of which 93.85% were eliminated; 6.14% went through a filter that left a total of 1.7%. Conclusion: in adult women with obesity, it has been shown that all types of physical training serve to generate changes in body composition.
... However, there is no clinically significant difference between RT and AT in lowering hemoglobin A 1c or other T2D-relevant health outcomes (23). Indeed, a recent meta-analysis has shown that RT is effective in reducing fat mass in overweight/ obese older adults (24). Also, low-moderate-intensity resistance www.acsm-esm.org ...
Objetivos: Desarrollar un protocolo de entrenamiento de la fuerza basado en la cinética del lactato en poblaciones con factores de riesgo. Materiales y Métodos: A través de muestreo probabilístico, 15 participantes, edad 35±53 años, estatura 1.78±0.09. peso 72± 15 kg. grasa 23±19%, masa muscular 41±47% y consumo de oxígeno máximo Vo2max 50±80 ml/kg/min. Realizaron dos pruebas de fuerza en sentadilla media, la primera progresiva hasta el umbral anaeróbico, de la cual se obtuvo la carga media de los resultados que se utilizó en la segunda prueba, donde se realizaron 15 series de 15 repeticiones con descansos de 1 minutos entre cada serie. La toma de la muestra de lactato fue en la serie 1, 3, 5, 7, 9, 11, 13, 15. Resultados; Los resultados de la prueba de carga constante describen un comportamiento con poca variabilidad entre las variables frecuencia cardiaca y lactato. media Fc; 133.27/2.36, lactato 3.01/0.19. Pearson (R) de 0.719. p<0.001. El análisis de varianza (ANOVA) no reveló diferencias estadísticamente significativas en las medias de los grupos en relación con las variables de lactato p<0.358 F1.110. y Frecuencia cardíaca. p<0.221 F 1.299. Conclusiones: Estos hallazgos subrayan la relación significativa entre lactato y frecuencia cardíaca durante el ejercicio. Los tamaños de efecto estimados indican que estas variables tienen un impacto moderado en las diferencias observadas entre los grupos. y respaldan la utilidad de estas variables, principalmente el lactato como método de entrenamiento. Palabras claves: Salud, condición física, fuerza muscular, adulto. Abstract. Objectives: To develop a strength training protocol based on lactate kinetics in populations with risk factors. Materials and Methods: Through probabilistic sampling, 15 participants (age 35±53 years, height 1.78±0.09 m, weight 72±15 kg, body fat 23±19%, muscle mass 41±47%, and maximum oxygen consumption Vo2max 50±80 ml/kg/min) performed two strength tests in the half squat. The first test was progressive until the anaerobic threshold, from which the average load was obtained and used in the second test, where 15 sets of 15 repetitions were performed with 1-minute rests between each set. Lactate samples were taken during sets 1, 3, 5, 7, 9, 11, 13, and 15. Results: The results of the constant load test describe behavior with little variability between the variables heart rate and lactate. Mean HR: 133.27 ± 2.36, lactate: 3.01 ± 0.19. Pearson (R) of 0.719, p < 0.001. The analysis of variance (ANOVA) did not reveal statistically significant differences in group means concerning lactate variables (p < 0.358, F = 1.110) and heart rate (p < 0.221, F = 1.299). Conclusions: These findings highlight the significant relationship between lactate and heart rate during exercise. The estimated effect sizes indicate that these variables have a moderate impact on the observed differences between groups and support the utility of these variables, primarily lactate, as a training method. Keywords: Health, physical condition, muscle strength, adult.
Introducción; La forma tradicional de medir la fuerza es a través del 1Rm es una dinámica poco eficaz en pacientes en rehabilitación cardiaca. Objetivos; El objetivo de este estudio fue valorar la fuerza a través del lactato y determinar una carga especifica que permita desarrollar la fuerza en una zona aeróbica de moderada a baja intensidad en pacientes en riesgo cardiovascular. Materiales y Métodos; A través de muestreo no probabilístico intencional, 5 participantes hombres. Edad 48.80 ± 4.49. peso 95.40 ± 5.54. estatura 1.74 ± 0.06 cm. % grasa 37.58 ± 2.68 %. masa muscular 38.62 ± 1.52. Vo2/kg 38.00 ± 2.73 min. Realizaron dos pruebas de fuerza en sentadilla media, la primera progresiva hasta el umbral anaeróbico, de la cual se obtuvo la carga media de los resultados que se utilizó en la segunda prueba, donde se realizaron 15 series de 15 repeticiones con descansos de 1 minutos entre cada serie. La toma de la muestra de lactato fue en la serie 1, 3, 5, 7, 9, 11, 13, 15. Resultados; Los resultados del análisis Anova no mostraron diferencias significativas entre los diferentes grupos en lactato F (4, 17.1) =0.524, p=0.720. Frecuencia cardiaca F (4, 16.4) =0.457, p=0.766. Los análisis post hoc la prueba de Tukey no mostraron diferencias entre las variables grupales. Frecuencia cardíaca (FC) media durante el ejercicio de fuerza de carga constante. 133.9/5.48 (Ppm). p=0.000. Concentraciones de lactato en sangre durante el ejercicio de Media 2.52/0.28. (Mmol/l). p=0.000. Carga constante 30/00 (kg) Los resultados indican que estas variables metabólicas y cardiacas se mantuvieron parcialmente estables en rangos energéticos aeróbicos. Dentro de la medición de las series 1, 3, 5, 7, 9, 11, 13, 15. Concluciones; Los valores obtenidos del test de carga constante muestran que las variables metabólicas y cardiorrespiratorias se mantienen estables en un metabolismo predominantemente aeróbico, esto podría sugerir que medir la fuerza a través del lactato es efectivo para entrenar la fuerza en pacientes con factores de riesgo cardiovascularODUCCIÓN Palabras claves: Salud, Condición Física, Pronostico, fuerza muscular, adulto. Abstract. Introduction: The traditional way of measuring strength through 1RM is an inefficient dynamic in patients undergoing cardiac rehabilitation. Objectives: The aim of this study was to assess strength through lactate levels and determine a specific load that would allow for strength development in a moderate to low intensity aerobic zone in patients at cardiovascular risk. Materials and Methods: Through intentional non-probabilistic sampling, 5 male participants. Age 48.80 ± 4.49. weight 95.40 ± 5.54 height. 1.74 ± 0.06. % fat 37.58 ± 2.68 %. muscle mass 38.62 ± 1.52. Vo2/kg 38.00 ± 2.73. min. They performed two strength tests in the average squat, the first progressive to the anaerobic threshold, from which the average load of the results was obtained that was used in the second test, where 15 series of 15 repetitions were performed with 1 minute rests between. each series. The lactate sample was taken in series 1, 3, 5, 7, 9, 11, 13, 15. Results: The results of the ANOVA analysis showed no significant differences between the different groups in lactate F (4, 17.1) = 0.524, p = 0.720. Heart rate F (4, 16.4) = 0.457, p = 0.766. Post hoc analyses using the Tukey test showed no differences between group variables. Mean heart rate during constant load strength exercise: 133.9/5.48 (bpm), p = 0.000. Blood lactate concentrations during exercise: Mean 2.52/0.28 (mmol/l), p = 0.000. Constant load: 30/00 (kg). The results indicate that these metabolic and cardiac variables remained partially stable within aerobic energy ranges during the measurement of sets 1, 3, 5, 7, 9, 11, 13, and 15. Conclusions: The values obtained from the constant load test show that metabolic and cardiorespiratory variables remain stable in a predominantly aerobic metabolism. This could suggest that measuring strength through lactate is effective for strength training in patients with cardiovascular risk factors. Keywords: Health, Physical condition, Prognosis, Muscle strength, Adult.
This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15–24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.
Objetivos; Evaluar la cinética del lactato a través de la fuerza y determinar la correlación con la prueba de VO2max y frecuencia cardiaca en sujetos con factores de riesgo. Métodos; 15 participantes con una media de edad 35.5/4.1. Estatura 1.78/0.09. Peso 72.1/12.9. Realizaron una prueba de fuerza máxima en sentadilla y prueba maximal de consumo de oxígeno. en ambos casos se analizaron muestras de lactato sanguíneo. Resultados; Las variables de fuerza y resistencia exhiben una relación significativa, indicando una conexión directa con el metabolismo energético y los parámetros de entrenamiento aplicables. Se evidenció una fuerte asociación entre la frecuencia cardíaca máxima (FC max) en resistencia y fuerza, con un coeficiente de determinación (R²) de 0.981 (p < 0.001). Además, la relación entre los niveles de lactato en resistencia y fuerza fue notable, con un R² de 0.971 (p < 0.001). La carga (en kg) y la velocidad (en K/h) demostraron una correlación perfecta, con un R² de 1.000 y p < 0.001. La prueba de Anova de medias repetidas arrojó un valor significativo de p<0.005. Estos hallazgos respaldan de manera consistente la influencia interrelacionada de las variables medidas, proporcionando una comprensión más profunda de su conexión y relevancia en el contexto del entrenamiento. Conclusiones; El lactato se muestra como un marcador clave en la evaluación de la respuesta fisiológica durante las pruebas de fuerza. puede servir como un indicador útil para evaluar la respuesta metabólica y la demanda energética durante las pruebas de fuerza. Además, considerando su relación con la carga y la velocidad, el lactato puede contribuir a establecer zonas de entrenamiento específicas. Palabras claves: Salud, Condición Física. Fuerza muscular. Adulto. Abstract. Purpose; To evaluate lactate kinetics through strength and determine the correlation with the VO2max test and heart rate in subjects with risk factors. Methods; 15 participants with an average age of 35.5/4.1. Height 1.78/0.09. Weight 72.1/12.9. They performed a maximum squat strength test and a maximum oxygen consumption test. In both cases blood lactate samples were analyzed. Results; The strength and endurance variables exhibit a significant relationship, indicating a direct connection with the energetic metabolism and applicable training parameters. A strong association was observed between maximum heart rate (FC max) in endurance and strength, with a coefficient of determination (R²) of 0.981 (p < 0.001). Furthermore, the relationship between lactate levels in endurance and strength was notable, with an R² of 0.971 (p < 0.001). The load (in kg) and speed (in K/h) demonstrated a perfect correlation, with an R² of 1.000 and p < 0.001. The repeated measures Anova test yielded a significant value of p < 0.005. These findings consistently support the interconnected influence of the measured variables, providing a deeper understanding of their connection and relevance in the training context. Conclusions; Lactate is shown to be a key marker in the evaluation of the physiological response during strength tests. can serve as a useful indicator to evaluate metabolic response and energy demand during strength tests. Additionally, considering its relationship with load and speed, lactate can help establish specific training zones. Keywords: Health, Physical Condition. Muscular strength. Adult.
Introducción: La fuerza se considera un parámetro crítico para la salud y el rendimiento físico, y existen diversas metodologías para su desarrollo. Sin embargo, hasta la fecha, no se han descrito protocolos asociados al umbral anaeróbico y sus efectos agudos. Objetivos: El estudio tiene como objetivo determinar los efectos agudos de un programa de fuerza consistente en la realización de cuatro ejercicios durante 8 semanas a nivel del umbral anaeróbico en el fitness cardiorrespiratorio, fuerza muscular y metabolismo energético. Materiales y Métodos: Quince participantes, con edad promedio de 35.5±4 años, estatura de 1.78±0.09 metros y peso de 72.1±12.9 kg, fueron seleccionados a través de muestreo probabilístico. Se realizaron 3 evaluaciones, incluyendo Vo2máx, antropometría y una prueba de fuerza hasta el umbral anaeróbico en cuatro ejercicios, con toma de muestra de lactato en cada intento. La carga asociada al umbral anaerobio se utilizó como intensidad específica para implementar un programa de entrenamiento de tres días por ocho semanas. Resultados: Los resultados indican que el programa de entrenamiento en el umbral anaeróbico no solo mejora la fuerza muscular, sino que también tiene un impacto positivo en la salud cardiovascular, la composición corporal y los marcadores metabólicos, respaldando su eficacia como estrategia integral para mejorar la salud y el rendimiento físico. Conclusiones: Este estudio resalta la efectividad del programa de entrenamiento de 8 semanas basado en el umbral anaeróbico en mejorar la salud general y el rendimiento físico de los participantes. Palabras clave: Salud, Condición Física, Pronóstico, Fuerza Muscular, Adulto. Abstract. Introduction: Strength is considered a critical parameter for health and physical performance, and there are various methodologies for its development. However, to date, protocols associated with the anaerobic threshold and its acute effects have not been described. Objectives: The study aims to determine the acute effects of a strength program consisting of performing four exercises for 8 weeks at the anaerobic threshold level on cardiorespiratory fitness, muscular strength, and energy metabolism. Materials and Methods: Fifteen participants, with an average age of 35.5±4 years, height of 1.78±0.09 meters, and weight of 72.1±12.9 kg, were selected through probabilistic sampling. Three evaluations were conducted, including Vo2max, anthropometry, and a strength test to the anaerobic threshold in four exercises, with lactate sampling at each attempt. The load associated with the anaerobic threshold was used as specific intensity to implement a three-day training program for eight weeks. Results: The results indicate that the training program at the anaerobic threshold not only improves muscular strength but also has a positive impact on cardiovascular health, body composition, and metabolic markers, supporting its effectiveness as a comprehensive strategy to improve health and physical performance. Conclusions: This study highlights the effectiveness of the 8-week training program based on the anaerobic threshold in improving the overall health and physical performance of participants. Keywords: Health, Physical Fitness, Forecasting, Muscular Strength, Adult.
Background
Obesity has been recognized as a risk factor in the development and recurrence of breast cancer and is also associated with poor prognostic outcomes. This systematic review and network meta‐analysis aimed to identify the most effective exercise, physical activity, and dietary interventions to reduce fat mass, body fat percentage and body weight as well as potentially increase lean mass in women diagnosed with or at high risk of breast cancer.
Methods
A systematic search of databases was performed up to May 2022. Eligible randomized controlled trials examined the effects of exercise, physical activity and/or dietary interventions on fat mass and lean mass in women diagnosed with or at high risk of breast cancer. A random‐effects network meta‐analysis was conducted to determine the effects of different interventions across outcomes when sufficient studies were available.
Results
Eighty‐four studies (n = 6428) were included in this review. Caloric restriction and combined exercise + caloric restriction significantly reduced fat mass (range, –3.9 to –3.7 kg) and body weight (range, –5.3 to –4.7 kg), whereas physical activity + caloric restriction significantly reduced body fat percentage (–2.4%; 95% confidence interval [CI], –3.4% to –13%) and body mass index (–2.2 kg × m–2; 95% CI, –3.0 to –1.4 kg × m–2) in breast cancer patients. Resistance exercise was the most effective intervention to increase lean mass (0.7 kg; 95% CI, 0.5–1.0 kg) in breast cancer patients.
Conclusion
Multimodal exercise and diet programs were the most effective interventions to reduce fat mass, body fat percentage, and body weight and increase and/or preserve lean mass.
The main aim of the current study was to explore the effects of a 1-year recreational Kung Fu protocol on bone health parameters (bone mineral content (BMC), bone mineral density (BMD), femoral neck geometry and composite indices of femoral neck strength) in a group of healthy inactive young men. 54 young inactive men voluntarily participated in this study, but only 51 of them completed it. The participants were assigned to 2 different groups: control group (n=31) and Kung Fu group (n=20). The Kung Fu group performed two sessions of recreational Kung Fu per week; the duration of each session was 45 minutes. The current study has demonstrated that whole body (WB) BMC, ultra-distal (UD) radius BMD, 1/3 radius BMD, total radius BMD, total forearm BMD, maximal strength, maximum oxygen consumption and jumping performance increased in the Kung Fu group but not in the control group. The percentages of variations in WB BMC, forearm BMD and physical performance parameters were significantly different between the two groups. In conclusion, this study suggests that recreational Kung Fu is an effective method to improve WB BMC, forearm BMD and physical performance parameters in young inactive men.
To systematically review and analyze the effects of resistance-based exercise programs on body composition, regional adiposity, and body weight in individuals with overweight/obesity across the lifespan. Using PRISMA guidelines, randomized controlled trials were searched in nine electronic databases up to December 2020. Meta-analyses were performed using random-effects model. One-hundred sixteen articles describing 114 trials (n = 4184 participants) were included. Interventions involving resistance training and caloric restriction were the most effective for reducing body fat percentage (ES = -3.8%, 95% CI: -4.7 to -2.9%, p < 0.001) and whole-body fat mass (ES = -5.3 kg, 95% CI: -7.2 to -3.5 kg, p < 0.001) compared with groups without intervention. Significant results were also observed following combined resistance and aerobic exercise (ES = -2.3% and -1.4 kg, p < 0.001) and resistance training alone (ES = -1.6% and -1.0 kg, p < 0.001) compared with no training controls. Resistance training alone was the most effective for increasing lean mass compared with no training controls (ES = 0.8 kg, 95% CI: 0.6 to 1.0 kg, p < 0.001), whereas lean mass was maintained following interventions involving resistance training and caloric restriction (ES = ~-0.3 kg, p = 0.550-0.727). Results were consistently observed across age and sex groups (p = 0.001-0.011). Reductions in regional adiposity and body weight measures were also observed following combined resistance and aerobic exercise and programs including caloric restriction (p < 0.001). In conclusion, this study provides evidence that resistance-based exercise programs are effective and should be considered within any multicomponent therapy program when caloric restriction is utilized in individuals with overweight or obesity.
Background
Neuregulin 4 (Nrg4) is an adipokine that is sensitive to energy expenditure and with a potential role in metabolic homeostasis and obesity. This study examined the effects of 12 weeks of three different exercise training protocols on Nrg4 levels, cardiometabolic risk factors, and body composition parameters in men with obesity.
Methods
Sixty adult men with obesity (Mean ± SD; age: 27.60 ± 8.4 yrs.; height: 168.4 ± 2.6 cm; weight: 96.7 ± 7.2 kg) were randomly allocated into four equal (n = 15) groups: High- Intensity Interval Training (HIIT), Circuit Resistance Training (CRT), Moderate Intensity Continuous Training (MICT) or a control group. The HIIT protocol involved six bouts of 3-min high-intensity exercise (90% VO2peak) followed by 3-min low-intensity exercise (50% VO2peak). The CRT group performed three circuits of resistance training, where each circuit included 11 exercises at 20% of one-repetition maximum (1RM) and 70% of VO2peak, and with a work-to-rest ratio of 2:1 (40-s exercise and 20-s rest) and 60-s recovery between circuits. The MICT group performed 36 min of exercise at 70% of VO2peak. All measurements were taken 72 h before and after the first and last training sessions.
Results
There were significant differences between the groups in fat-free mass (FFM), (effect size (ES): 0.78), fat mass (ES: 0.86), VO2peak (ES: 0.59), high-density lipoprotein cholesterol (HDL-C) (ES: 0.83), low-density lipoprotein (LDL-C) (ES: 0.79), total cholesterol (TC) (ES: 0.90), triglyceride (TG) (ES: 0.52) glucose (ES: 0.39), insulin (ES: 0.61), HOM-IR (ES: 0.91) and Nrg4 (ES: 0.98) (p < 0.05). There were no significant changes in very-low-density lipoprotein cholesterol (VLDL-C) (ES: 0.13) levels, or body weights (ES: 0.51) (p > 0.05). Levels of Nrg4 were negatively correlated with LDL-C, TC, TG, VLDL-C, glucose, insulin, HOMA-IR (p < 0.05) and positively with HDL-C (p < 0.05).
Conclusion
Our results suggest that HIIT and CRT protocols have greater effects than MICT protocol on Nrg4 levels, metabolic and cardiovascular risk factors, and body composition variables in men with obesity.
Purpose:
Menopause tends to be associated with an increased risk of obesity and abdominal fat mass (FM) and is associated with lower intestinal species diversity. The aim of this study was to determine the effects of a high-intensity interval training and resistance training (HIIT + RT) program on body composition and intestinal microbiota composition in overweight or obese postmenopausal women.
Methods:
Participants (n = 17) were randomized in two groups: HIIT + RT group (3 × / week, 12 weeks) and control group without any training. Dual-energy X-ray absorptiometry was used to measure whole-body and abdominal/visceral FM and fat-free mass. Intestinal microbiota composition was determined by 16S rRNA gene sequencing at baseline and at the study end, and the diet controlled.
Results:
Compared with sedentary controls, physical fitness (Maximal Oxygen Consumption, Peak Power Output) increased, total abdominal and visceral FM decreased, and segmental muscle mass increased in the training group. Although the HIIT + RT protocol did not modify α-diversity and taxonomy, it significantly influenced microbiota composition. Moreover, various intestinal microbiota members were correlated with HIIT + RT-induced body composition changes, and baseline microbiota composition predicted the response to the HIIT + RT program.
Conclusions:
HIIT + RT is an effective modality to reduce abdominal/visceral FM and improve physical capacity in non-dieting overweight or obese postmenopausal women. Training modified intestinal microbiota composition and the response to training seems to depend on the initial microbiota profile. More studies are needed to determine whether microbiota composition could predict the individual training response.
Background
Resistance training is the gold standard exercise mode for accrual of lean muscle mass, but the isolated effect of resistance training on body fat is unknown.Objectives
This systematic review and meta-analysis evaluated resistance training for body composition outcomes in healthy adults. Our primary outcome was body fat percentage; secondary outcomes were body fat mass and visceral fat.DesignSystematic review with meta-analysis.Data SourcesWe searched five electronic databases up to January 2021.Eligibility CriteriaWe included randomised trials that compared full-body resistance training for at least 4 weeks to no-exercise control in healthy adults.AnalysisWe assessed study quality with the TESTEX tool and conducted a random-effects meta-analysis, with a subgroup analysis based on measurement type (scan or non-scan) and sex (male or female), and a meta-regression for volume of resistance training and training components.ResultsFrom 11,981 records, we included 58 studies in the review, with 54 providing data for a meta-analysis. Mean study quality was 9/15 (range 6–15). Compared to the control, resistance training reduced body fat percentage by − 1.46% (95% confidence interval − 1.78 to − 1.14, p < 0.0001), body fat mass by − 0.55 kg (95% confidence interval − 0.75 to − 0.34, p < 0.0001) and visceral fat by a standardised mean difference of − 0.49 (95% confidence interval − 0.87 to − 0.11, p = 0.0114). Measurement type was a significant moderator in body fat percentage and body fat mass, but sex was not. Training volume and training components were not associated with effect size.Summary/Conclusions
Resistance training reduces body fat percentage, body fat mass and visceral fat in healthy adults.Study Registrationosf.io/hsk32.
Understanding the mechanisms involved in the higher energy cost of walking (NCw: the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 year; BMI: 42.7 ± 4.6 kg m–2) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NCw. A motion analysis system and instrumented treadmill were combined to assess total mechanical work (Wtot). Mechanical efficiency (Wtot NCw–1) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P < 0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass‐normalized NCw was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (−6.2 ± 2.7%) and post 1 (−8.1 ± 1.9%; P ≤ 0.007). No difference was found in mass‐normalized Wtot during follow‐up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P ≥ 0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NCw by making their muscles work more efficiently. image
Key points
A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals.
Understanding the mechanisms (i.e. mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals.
We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking.
Individuals with obesity may reorganize their walking pattern into a gait more similar to that of adults of normal body mass, thus decreasing their energy cost of walking by making their muscles work more efficiently.
There is a need for updated practice recommendations on exercise in the management of overweight and obesity in adults. We summarize the evidence provided by a series of seven systematic literature reviews performed by a group of experts from across Europe. The following recommendations with highest strength (Grade A) were derived. For loss in body weight, total fat, visceral fat, intra-hepatic fat, and for improvement in blood pressure, an exercise training program based on aerobic exercise at moderate intensity is preferentially advised. Expected weight loss is however on average not more than 2 to 3 kg. For preservation of lean mass during weight loss, an exercise training program based on resistance training at moderate-to-high intensity is advised. For improvement in insulin sensitivity and for increasing cardiorespiratory fitness, any type of exercise training (aerobic, resistance, and combined aerobic or resistance) or high-intensity interval training (after thorough assessment of cardiovascular risk and under supervision) can be advised. For increasing muscular fitness, an exercise training program based preferentially on resistance training alone or combined with aerobic training is advised. Other recommendations deal with the beneficial effects of exercise training programs on energy intake and appetite control, bariatric surgery outcomes, and quality of life and psychological outcomes in management of overweight and obesity.
This overview of reviews aimed to summarize the effects of exercise training programs on weight loss, changes in body composition, and weight maintenance in adults with overweight or obesity. A systematic search of systematic reviews and meta‐analyses (SR‐MAs) published between 2010 and December 2019 was performed. Only SR‐MAs of controlled trials were included. The mean difference (MD) or standardized MD (SMD) were extracted from SR‐MAs. Twelve SR‐MAs (149 studies) were included. Exercise led to a significant weight loss (4 SR‐MAs, MDs ranging from −1.5 to −3.5 kg), fat loss (4 SR‐MAs, MDs ranging from −1.3 to −2.6 kg) and visceral fat loss (3 SR‐MAs, SMDs ranging from −0.33 to −0.56). No difference in weight, fat, and visceral loss was found between aerobic and high‐intensity interval training as long as energy expenditure was equal. Resistance training reduced lean mass loss during weight loss (1 SR‐MA, MD: 0.8 [95%CI: 0.4–1.3] kg). No significant effect of exercise was found on weight maintenance (1 SR‐MA). These findings show favorable effects of exercise training on weight loss and body composition changes in adults with overweight or obesity. Visceral fat loss may lead to benefits for cardiometabolic health. More research is needed to identify training modalities that promote weight maintenance.
Sarcopenia and frailty are age-related syndromes with negative effects on the quality of life of older people and on public health costs. Although extensive research has been carried out on the effects of physical exercise and physical syndromes, there is a knowledge gap when it comes to the effect of resistance training on muscular strength, physical performance, and body composition at early (prevention) and late (treatment) stages in both syndromes combined. We conducted this systematic review and meta-analysis (CRD42019138253) to gather the evidence of randomized controlled trials examining the effects of resistance training programs lasting ≥ 8 weeks on strength, physical function, and body composition of adults ≥65 years old diagnosed with pre-sarcopenia, sarcopenia, pre-frailty, or frailty. A search from the earliest record up to and including December 2020 was carried out using the PubMed, Scopus, Web of Science, and Cochrane Library databases. A total of 25 studies (n = 2267 participants) were included. Meta-analysis showed significant changes in favour of resistance training for handgrip (ES = 0.51, p = 0.001) and lower-limb strength (ES = 0.93, p < 0.001), agility (ES = 0.78, p = 0.003), gait speed (ES = 0.75, p < 0.001), postural stability (ES = 0.68, p = 0.007), functional performance (ES = 0.76, p < 0.001), fat mass (ES = 0.41, p = 0.001), and muscle mass (ES = 0.29, p = 0.002). Resistance training during early stages had positive effects in all variables during early stages (ES > 0.12), being particularly effective in improving gait speed (ES = 0.63, p = 0.016) and functional strength (ES = 0.53, p = 0.011). Based on these results, resistance training should be considered as a highly effective preventive strategy to delay and attenuate the negative effects of sarcopenia and frailty in both early and late stages.
This study compared the capacity of linear‐(LP) and non‐linear periodized (NLP) resistance training to improve select myokines and metabolic parameters in overweight sedentary women. An additional purpose was to compare these variables between the overweight and lean women. Fitness‐ and age‐matched overweight women between 28 and 43 years old were randomly allocated to LP (body fat [BF]% = 38.7 ± 2.6, n = 10), NLP (BF% = 39.3 ± 2.4, n = 9) and control (BF% = 39.8 ± 2.6, n = 9) groups. Lean women (BF% = 29.1 ± 2.3, n = 16) matched for age and fitness were also included for baseline comparison. Resistance training programmes (12 weeks, 3 d.wk ⁻¹ , 9 exercises, 60–90% of 1‐repetition maximum [1RM]) were performed with different periodization schemes. Glucose, insulin, interleukin (IL)−7, IL‐15, and insulin‐like growth factor (IGF)−1 levels were measured at baseline and after training. Overweight subjects had significantly lower IL‐15, IGF‐1 and higher insulin, glucose, and insulin resistance (homeostasis model assessment, HOMA‐IR) than lean subjects at baseline (all, P < .05). IL‐15 and VO 2 max increased significantly after NLP compared with CON, which was accompanied by a significant decrease in HOMA‐IR (all, P < .03). Muscular endurance improved significantly in both models after training compared to CON (all, P < .01), but it increased more in NLP than in LP ( P = .01). Both training protocols were equally effective at reducing BF% and increasing IGF‐1, IL‐7, muscle mass and bench press 1RM ( P < .01). It appears that LP and NLP are both effective strategies for improving health markers in overweight women, but LP is not as effective as NLP to improve IL‐15, HOMA‐IR and aerobic capacity.
Highlights
Overweight women had a significantly lower IL‐15 and IGF‐1 compared to lean encounters, but no significant difference was noted for maximal strength, aerobic capacity, muscle mass, IL‐7 and neutrophil/lymphocyte ratio.
Twelve weeks of either linear or flexible non‐linear periodized resistance training resulted in reduction in BF% and neutrophil/lymphocyte ratio, and increased IGF‐1, IL‐7, muscle mass and bench press 1RM, with no difference between the two training protocols.
Linear protocol is not as effective as non‐linear protocol to improve IL‐15, HOMA‐IR and aerobic capacity.
A randomized control trial was conducted to investigate the effects of combined concurrent training and Eri silkworm pupae ingestion on resting and exercise fat oxidation (FAO), as well as energy expenditure, and cardiometabolic risk markers in obese adults. Thirty-six sedentary, obese participants were divided into three groups: 1) placebo control group (CON, n=12), 2) Eri silkworm pupae ingestion group (ERI, n=12), and 3) combined concurrent training and Eri silkworm pupae ingestion group (CBT-ERI, n=12). Participants in the ERI and the CBT-ERI consumed 5g Eri silkworm pupae/day (approximately 2.5g linolenic acid). The concurrent training program comprised of supervised aerobic and resistance training: three 1-hr sessions/week for 8 weeks. Body composition, energy expenditure and FAO at rest and during exercise, heart rate variability, and blood chemistry were measured before and after the 8-week interventions. Following the interventions, resting FAO, the natural logarithm of very low-frequency power (lnVLF), and high-sensitive C-reactive protein concentration significantly improved in both the ERI and the CBT-ERI. Only the CBT-ERI improved resting energy expenditure, FAO during exercise, trunk and gynoid fat mass, total cholesterol concentration, the standard deviation of normal R-R intervals (SDNN), and the percentage difference between adjacent normal R-R intervals >50 ms. Furthermore, there were significant correlations between resting energy expenditure and FAO, lnVLF and SDNN in the CBT-ERI. In conclusion, this study demonstrates that concurrent training together with dietary Eri silkworm pupae leads to increased energy expenditure through a significant increase in FAO at rest and during exercise, as well as reduced fat mass.
Current international guidelines recommend people living with obesity should be prescribed a minimum of 300 min of moderately intense activity per week for weight loss. However, the most efficacious exercise prescription to improve anthropometry, cardiorespiratory fitness (CRF) and metabolic health in this population remains unknown. Thus, this network meta-analysis was conducted to assess and rank comparative efficacy of different exercise interventions on anthropometry, CRF and other metabolic risk factors. Five electronic databases were searched for randomized controlled trials (RCTs) that compared different exercise modalities to improve anthropometry, CRF and/or metabolic health in adults living with obesity. RCTs were evaluated using the Cochrane risk of bias tool. A random effects network meta-analysis was performed within a frequentist framework. Of the 6663 articles retrieved, 45 studies with a total 3566 participants were included. Results reveal that while any type of exercise intervention is more effective than control, weight loss induced is modest. Interventions that combine high-intensity aerobic and high-load resistance training exert beneficial effects that are superior to any other exercise modality at decreasing abdominal adiposity, improving lean body mass and increasing CRF. Clinicians should consider this evidence when prescribing exercise for adults living with obesity, to ensure optimal effectiveness.
PurposeWeight loss can result in the loss of muscle mass and bone mineral density. Resistance exercise is commonly prescribed to attenuate these effects. However, the anabolic endocrine response to resistance exercise during caloric restriction has not been characterized.Methods
Participants underwent 3-day conditions of caloric restriction (15 kcal kg FFM−1) with post-exercise carbohydrate (CRC) and with post-exercise protein (CRP), and an energy balance control (40 kcal kg FFM−1) with post-exercise carbohydrate (CON). Serial blood draws were taken following five sets of five repetitions of the barbell back squat exercise on day 3 of each condition.ResultsIn CRC and CRP, respectively, growth hormone peaked at 2.6 ± 0.4 and 2.5 ± 0.9 times the peak concentrations observed during CON. Despite this, insulin-like growth factor-1 concentrations declined 18.3 ± 3.4% in CRC and 27.2 ± 3.8% in CRP, which was greater than the 7.6 ± 3.6% decline in CON, over the subsequent 24 h. Sclerostin increased over the first 2 days of each intervention by 19.2 ± 5.6% in CRC, 21.8 ± 6.2% in CRP and 13.4 ± 5.9% in CON, but following the resistance exercise bout, these increases were attenuated and no longer significant.Conclusion
During caloric restriction, there is considerable endocrine anabolic resistance to a single bout of resistance exercise which persists in the presence of post-exercise whey protein supplementation. Alternative strategies to restore the sensitivity of insulin-like growth factor-1 to growth hormone need to be explored.
Purpose:
Aging lowers brain functionality, and obesity accelerates this process. Resistance exercise can help reverse aging; however, studies examining how it affects brain function and body mass are limited. Thus, this study aimed to investigate the effect of resistance exercise on inflammation and neurotrophic factors in elderly women with obesity.
Methods:
Twenty-six elderly women with obesity were selected for this study and randomly assigned into a control group (CG, n = 13) and an experimental group (EG, n = 13). The EG performed resistance training thrice weekly for 12 weeks using elastic bands, while the CG did not exercise. Serum lipid profile (total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)) and nuclear factor Kappa B (NF-κB), interferon-gamma (IFN-γ), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and eotaxin-1 levels were analyzed before and after the intervention. Body composition (soft lean mass (SLM), skeletal muscle mass (SMM), body fat mass (BFM), percent body fat (PBF), waist-hip-ratio (WHR), basal metabolic rates (BMR)) measurements and blood tests were performed.
Results:
Among the body composition variables, SLM, SMM, and BMR in the EG were significantly increased after intervention (p < 0.05). Serum lipid profile was not significantly different after intervention (p > 0.05). After intervention, the levels of NF-κB, IFN-γ, and eotaxin-1 were significantly lower and BDNF and VEGF were significantly higher in the EG than in the CG (p < 0.05 for all).
Conclusions:
These results imply that regular resistance training in elderly women with obesity can increase muscle mass, reduce inflammation, and stimulate neurotrophic factors.
Background
Progranulin (PGRN) is implicated in obesity and insulin resistance (IR). The aim of this study was to evaluate the effects of 8 weeks of circuit resistance training (CRT) on plasma PGRN, IR and body composition in obese men.
Materials and methods
Twenty-eight healthy obese men [age: 36 ± 7.7 years, body weight (BW): 96.4 ± 15.6 kg, body mass index (BMI): 32.4 ± 4.5 kg/m ² ] completed the study. Subjects were randomly assigned to two groups of control and training. Subjects in the training group underwent training for 8 weeks, 3 times a week. Blood samples and anthropometric characteristics were taken before the commencement of the exercise protocol and 72 h after the last training session. The homeostatic model assessment of insulin resistance (HOMA-IR) was used to measure IR.
Results
BW, BF%, BMI, waist-hip ratio (WHR), HOMA-IR and plasma PGRN levels except lean body mass (LBM) were significantly reduced in the training group (p < 0.05). Additionally, except for LBM, subjects in the training group had significantly decreased BW, BF%, BMI, WHR, HOMA-IR and plasma PGRN levels compared to changes in those in the control group (p < 0.05). Significant correlations were found between the changes in plasma PGRN and the changes in insulin, HOMA-IR and BMI (p < 0.05).
Conclusions
The findings showed that 8 weeks of CRT improved body composition and IR which were accompanied by reduced plasma PGRN levels. This study suggests that CRT has the potential for obese individuals to counteract obesity-associated health impairments.
We assessed differences in mitochondrial function in gluteal (gSAT) and abdominal subcutaneous adipose tissue (aSAT) at baseline and in response to 12-weeks of exercise training; and examined depot-specific associations with body fat distribution and insulin sensitivity (SI). Obese, black South African women (n = 45) were randomized into exercise (n = 23) or control (n = 22) groups. Exercise group completed 12-weeks of aerobic and resistance training (n = 20), while the control group (n = 15) continued usual behaviours. Mitochondrial function (high-resolution respirometry and fluorometry) in gSAT and aSAT, SI (frequently sampled intravenous glucose tolerance test), body composition (dual-energy X-ray absorptiometry), and ectopic fat (MRI) were assessed pre- and post-intervention. At baseline, gSAT had higher mitochondrial respiratory capacity and hydrogen peroxide (H2O2) production than aSAT (p < 0.05). Higher gSAT respiration was associated with higher gynoid fat (p < 0.05). Higher gSAT H2O2 production and lower aSAT mitochondrial respiration were independently associated with lower SI (p < 0.05). In response to training, SI improved and gynoid fat decreased (p < 0.05), while H2O2 production reduced in both depots, and mtDNA decreased in gSAT (p < 0.05). Mitochondrial respiration increased in aSAT and correlated with a decrease in body fat and an increase in soleus and hepatic fat content (p < 0.05). This study highlights the importance of understanding the differences in mitochondrial function in multiple SAT depots when investigating the pathophysiology of insulin resistance and associated risk factors such as body fat distribution and ectopic lipid deposition. Furthermore, we highlight the benefits of exercise training in stimulating positive adaptations in mitochondrial function in gluteal and abdominal SAT depots.
The present study examined the effect of a 12-week combined resistance and aerobic exercise training program on cardiometabolic biomarkers and red blood cell (RBC) hemorheological function in 20 obese older men (mean age: 68.8 ± 0.9 years). Subjects were randomly divided into two groups (exercise intervention [EXP; n = 10] and control [CON; n = 10]). The EXP subjects performed resistance and aerobic exercise training program three times per week for 12 weeks, and the CON subjects maintained their regular lifestyle during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Cardiometabolic biomarkers (glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), HOMA β-cell function, and leptin) and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed. Percent body fat decreased significantly in the EXP group during the intervention period but increased significantly in the CON group. Insulin increased significantly in the CON group over the 12-week period and both insulin and HOMA-IR were significantly higher in the CON group than in the EXP group at post-test. RBC deformability (RBC EI_3Pa) and aggregation (RBC AI_3Pa) improved significantly only in the EXP group. The present study suggests that combined exercise training can be useful for improving cardiometabolic biomarkers and RBC hemorheological parameters in obese older men and may help prevent metabolic syndrome and cardiovascular diseases.
Introduction and hypothesis
The effect of exercise in relation to overweight and overactive bladder (OAB) in young women has not been sufficiently supported by studies. The objective of our study was to reduce symptoms of OAB through a 3-month exercise programme in young overweight women with OAB. The sample consisted of 70 women (mean age 26.7 ± 4.8 years), 36 being treated and 34 in the control group.
Methods
We used a body composition analyser with the assessment of skeletal muscle mass (SMM) (kg), body fat mass (BFM) (kg), body fat percentage (BFP) (%), visceral fat area (VFA) (cm²/level) and the waist/hip circumference index (WHR). OAB symptoms were evaluated using a voiding diary, the overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a programme for the reduction of abdominal fat (PRAF), with elements of aerobic training, strengthening of the abdominal muscles and stretching.
Results
In the OAB symptoms assessed through the voiding diary (number of voidings per 24 h, nocturia, mean voided volume) as well as in the OAB-q and PPIUS scales after training, significant differences were reported in favour of the treatment group [number of voidings per 24 h: treatment vs. control group, baseline 9.1 ± 0.3 vs. 8.6 ± 0.3, final 6.9 ± 0.2 vs. 8.1 ± 0.2, p < 0.0001; mean voided volume per 24 h (ml): treatment vs. control group, baseline 154.2 ± 9.1 vs. 162.2 ± 9.3, final 201.3 ± 9.3 vs. 164.1 ± 9.6, p < 0.0001] with a large effect size (ES). In the body composition analysis after training, significant differences were also reported in favour of the treatment group in the reduction of body mass index (BMI), BFP and VFA (p < 0.0001), with a large ES.
Conclusions
Body composition analysis confirmed a reduction of BMI, body weight, body fat percentage, visceral abdominal fat, the WHR index and waist circumference in favour of the treatment group after the 12-week PRAF exercise programme. A reduction in OAB symptoms was also objectively confirmed following the PRAF exercise programme.
Objective
To investigate the effect of muscle strength exercise training (MSET) on lean mass (LM) gain and muscle hypertrophy in older patients with lower extremity osteoarthritis (OA).
Methods
A comprehensive search of online databases was performed on April 20, 2019. Randomized controlled trials (RCTs) that reported the effects of MSET on LM, muscle thickness, and cross‐sectional area (CSA) in older patients with OA were identified. A risk of bias assessment and meta‐analysis were performed for the included RCTs.
Results
We included 19 RCTs with a median Physiotherapy Evidence Database score of 6 of 10 (range 3–7). In total, data from 1,195 patients (65% women, 85% with knee OA) with a mean age of 62.1 years (range 40–86 years) were analyzed. MSET resulted in significantly higher LM gain (standardized mean difference [SMD] 0.49 [95% confidence interval (95% CI) 0.28, 0.71], P < 0.00001) than did the nonexercise controls. Meta‐analysis results revealed significantly positive effects of MSET on muscle thickness (SMD 0.82 [95% CI 0.20, 1.43], P = 0.009) and CSA (SMD 0.80 [95% CI 0.25, 1.35], P = 0.004) compared with nonexercise controls. No significant effects in favor of MSET were observed for any muscle outcome compared with exercise controls. Five RCTs reported nonsevere adverse events in response to MSET, whereas no RCTs reported severe events.
Conclusion
MSET is effective in increasing LM and muscle size in older adults with OA. Clinicians should incorporate MSET into their management of patients at risk of low muscle mass to maximize health status, particularly for older individuals with OA.
The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review.
The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions.
This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet.
Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
Overweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence‐based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) “Stratum A” nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight‐related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long‐term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m2 when all non‐surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence‐based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.
Aims:
Central adiposity is associated with increased cardiovascular disease (CVD) risk, even among people with normal body mass index (BMI). We tested the hypothesis that regional body fat deposits (trunk or leg fat) are associated with altered risk of CVD among postmenopausal women with normal BMI.
Methods and results:
We included 2683 postmenopausal women with normal BMI (18.5 to <25 kg/m2) who participated in the Women's Health Initiative and had no known CVD at baseline. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017. During a median 17.9 years of follow-up, 291 incident CVD cases occurred. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD [highest vs. lowest quartile hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.33-2.74; P-trend <0.001], whereas higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR = 0.62, 95% CI 0.43-0.89; P-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups = 3.33, 95% CI 1.46-7.62).
Conclusion:
Among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD.
This study examined the effects of a 20‐week concurrent training (CT, ie, resistance plus endurance training) intervention on cardiovascular risk factors, such as body composition, blood pressure, and lipid profile among adult women with hyperglycemia. A secondary aim was to report prevalence of non‐responders for the different study outcomes. Physically inactive overweight/obese and hyperglycemic adult women (42 ± 6 years; BMI = 30.9 ± 4.8 kg/m²) were randomly assigned to a 20‐week CT intervention group or a control (non‐exercise) group (CG) (n = 14/group). Cardiovascular risk factors for body composition (body mass, waist circumference [WC], fat mass, and lean mass), blood pressure, and lipid profile (total, LDL cholesterol and HDL cholesterol, triglycerides, and fasting glucose) were assessed before and after the 20‐week intervention. Our results show that a CT intervention results in a reduction of comorbidities in terms of abdominal obesity and cardiovascular risk in adult women with hyperglycemia by decreasing WC and improving lipid profile in “mean” terms. At the individual level, after CT, some subjects changed their status from a “high” to a “low” cardiovascular risk in terms of WC, while others changed from hypertension to either high blood pressure or normotension, or from high blood pressure to normotension, and others changed from hypercholesterolemia/dyslipidemia to normocholesterolemia. Overall, there were ~30%, 50%, and 20% of individuals in the CT exercise group who showed no change/adverse response for body composition, blood pressure, and lipid profile, respectively, after the 20‐week CT intervention.
Background:
It has been recognized that alternate day calorie restriction (ADCR) or exercise has positive effects on cardio-metabolic risk factors. It is unclear whether the combined effect of ADCR and exercise (aerobic + resistance training) influences risk. We investigated effects of an 8-week ADCR and exercise program (aerobic + resistance training) on cardio-metabolic risk factors in overweight and obese adults.
Methods:
This study randomized 45 overweight or obese but healthy adults (F = 26, M = 19; aged about 32 to 40 years) into 4 groups: ADCR (n = 13), exercise (n = 10), exercise plus ADCR (n = 12), and control (n = 10) for 8 weeks. Body composition, blood lipids profile, and insulin resistance were measured. The intention to treat (ITT) method was used to analyze all participants that were randomized.
Results:
A total of 35 participants completed the trial (78%). Body weight, body mass index, waist circumference, fat mass and percent body fat were reduced in the exercise plus ADCR group (- 3.3 ± 2.4 kg, p < 0.01; - 1.3 ± 1.0 kg/m2, p < 0.01; - 4.1 ± 3.9 cm, p < 0.01; - 2.7 ± 2.0 kg, p < 0.01; - 2. 5 ± 2.2%, p < 0.01). Insulin, glucose, homeostasis model assessment insulin resistance and triglyceride (- 2.9 ± 4.1 μIU/ml, p < 0.05; - 10.9 ± 16.9 mg/dl, p < 0.05; - 0.9 ± 1.3, p < 0.05; - 43.8 ± 41.9 mg/dl, p < 0.01) decreased in the exercise plus ADCR group only.
Conclusions:
ADCR and exercise both proved to be beneficial, but the combined intervention was most effective at inducing beneficial changes in body weight, body composition, glucose, insulin, insulin resistance and triglyceride in overweight and obese adults.
Trial registration:
ClinicalTrials.gov: NCT03652532 , Registered August 28, 2018, 'retrospectively registered'.
Aims:
The PREVIEW lifestyle intervention study (ClinicalTrials.gov Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women.
Materials and methods:
All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI ≥ 25 kg/m2 ) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score.
Results:
In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia.
Conclusions:
An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.
The purpose of this study was to investigate the effect of a 12-week circuit training program on health-related physical fitness and metabolic syndrome risk factors in obese female college students. Twenty subjects with over 30% of accumulated body fat voluntarily participated and were randomly allocated to the control group (n=10) or circuit training group (n=10). The circuit training program consisted of 10 types of resistance and aerobic exercise and was performed 3 times per week for 12 weeks. Health-related physical fitness and metabolic syndrome risk factors were analyzed to elucidate the effect of the circuit training. Significant differences between groups were determined with two-way repeated analysis of variance and paired t-test. As a result of this study, body weight, % body fat, and body mass index in the circuit training group was significantly decreased compared to the control group. All health-related physical fitness indicators such as back strength, sit-up, sit-and-reach, and 1,600 m running time showed relative effects between groups or over time. Among the metabolic syndrome risk factors, waist measurement, triglyceride, and total cholesterol were significantly decreased but blood glucose, high-density lipo-protein cholesterol and low-density lipoprotein cholesterol did not show any significant difference. Therefore, the present data suggested that circuit training for 12 weeks may be effective in improving physical fitness and preventing metabolic diseases.
Background: Phase angle (PhA) is a viable indicator of cellular health, with higher values reflecting better cellularity, cell membrane integrity, and cell function. Adaptive responses to resistance training (RT) on PhA may be important in obese older people Aims: The main purpose of the present study was to investigate the effects of 8 weeks of resistance training (RT) on phase angle (PhA) in obese older women. Methods: Thirty-three obese older women (68.1 ± 5.7 years, 71.6 ± 10.1 kg, 154.5 ± 6.7 cm, 30.0 ± 4.1 kg/m², and 45.0 ± 6.0% body fat) were randomly allocated into one of two groups: a training group that performed the RT program (TG, n = 18) or a non-exercise control group (CG, n = 15). The whole-body RT consisted of an 8-week RT program involving 8 exercises performed for three sets of 8-12 repetitions three times a week. Anthropometric, body fat and fat-free mass, PhA, total body water (TBW), intracellular water (ICW) and extracellular water (ECW) compartments were performed at pre- and post-training. Results: After the intervention period, the TG presented greater increases (P < 0.05) than CG for fat-free mass (TG = +1.3%, CG = -0.3%), TBW (TG = +2.0%, CG = -1.7%), ICW (TG = +3.1%, CG = -1.9%), and PhA (TG = +3.4%, CG = -1.4%), and lower values for percentage of body fat (TG = -1.3%, CG = +0.9%) and bioimpedance resistance (TG = -4.6%, CG = +2.3%). Conclusion: Our results suggest that 8 weeks of RT improve PhA – a cellular health parameter – in obese older women.
Purpose of review:
Skeletal muscle mass with aging, during critical care, and following critical care is a determinant of quality of life and survival. In this review, we discuss the mechanisms that underpin skeletal muscle atrophy and recommendations to offset skeletal muscle atrophy with aging and during, as well as following, critical care.
Recent findings:
Anabolic resistance is responsible, in part, for skeletal muscle atrophy with aging, muscle disuse, and during disease states. Anabolic resistance describes the reduced stimulation of muscle protein synthesis to a given dose of protein/amino acids and contributes to declines in skeletal muscle mass. Physical inactivity induces: anabolic resistance (that is likely exacerbated with aging), insulin resistance, systemic inflammation, decreased satellite cell content, and decreased capillary density. Critical illness results in rapid skeletal muscle atrophy that is a result of both anabolic resistance and enhanced skeletal muscle breakdown.
Summary:
Insofar as atrophic loss of skeletal muscle mass is concerned, anabolic resistance is a principal determinant of age-induced losses and appears to be a contributor to critical illness-induced skeletal muscle atrophy. Older individuals should perform exercise using both heavy and light loads three times per week, ingest at least 1.2 g of protein/kg/day, evenly distribute their meals into protein boluses of 0.40 g/kg, and consume protein within 2 h of retiring for sleep. During critical care, early, frequent, and multimodal physical therapies in combination with early, enteral, hypocaloric energy (∼10-15 kcal/kg/day), and high-protein (>1.2 g/kg/day) provision is recommended.
Aim:
Exercise is one of the most important components in frailty prevention and treatment. Therefore, we systematically reviewed the effect of resistance training (RT) alone or combined with multimodal exercise intervention on muscle hypertrophy, maximal strength, power output, functional performance, and falls incidence in physically frail elderly.
Methods:
MEDLINE, Cochrane CENTRAL, PEDro, and SPORTDiscus databases were searched from 2005 to 2017. Studies must have mentioned the effects of RT (i.e., included or not in multimodal training) on at least one of the following parameters: muscle mass, muscle strength, muscle power, functional capacity, and risk of falls in frail elderly.
Results:
The initial search identified 371 studies and 16 were used for qualitative analysis for describing the effect of strength training performed alone or in a multimodal exercise intervention. We observed that RT alone or in a multimodal training may induce increases of 6.6-37% in maximal strength; 3.4-7.5% in muscle mass, 8.2% in muscle power, 4.7-58.1% in functional capacity and risk of falls, although some studies did not show enhancements.
Conclusion:
Frequency of 1-6 sessions per week, training volume of 1-3 sets of 6-15 repetitions and intensity of 30-70%1-RM promoted significant enhancements on muscle strength, muscle power, and functional outcomes. Therefore, in agreement with previous studies, we suggest that supervised and controlled RT represents an effective intervention in frailty treatment.
The purpose of this study was to determine the effects of resistance training only (RT n=10), dietary intervention only (DIET n=10), resistance training plus diet (RT+DIET n=10) and control (CON n=10) on body composition and resting metabolic rate (RMR) in a cohort of 40 premenopausal female volunteers. Subjects in DIET and RT+DIET were provided with daily macronutrient and calorie goals based on DXA and RMR tests, with protein maintained at 1.4 g/kg/day. Subjects in the RT and RT+DIET groups performed a supervised progressive RT program consisting of exercises for all the major muscle groups of the body. Results showed a significant month-by-group interaction for change in fat mass with no significant linear trend for control. The three treatment groups all showed significant linear decreases in fat mass, but the slope of the decrease became progressively steeper from the RT, to DIET, to RT+DIET. A significant linear increase for lean mass was seen for resistance training-only. There was a non-significant increase in RMR in all groups from Month 0 to Month 4 but no significant month by group interaction. In conclusion, significant reductions in fat mass were achieved by all experimental groups, but results were maximized by RT+DIET. Only the RT group showed significant increases in lean mass.
Objective
We performed a systematic review, meta-analysis and meta-regression to determine if dietary protein supplementation augments resistance exercise training (RET)-induced gains in muscle mass and strength.
Data sources
A systematic search of Medline, Embase, CINAHL and SportDiscus.
Eligibility criteria
Only randomised controlled trials with RET ≥6 weeks in duration and dietary protein supplementation.
Design
Random-effects meta-analyses and meta-regressions with four a priori determined covariates. Two-phase break point analysis was used to determine the relationship between total protein intake and changes in fat-free mass (FFM).
Results
Data from 49 studies with 1863 participants showed that dietary protein supplementation significantly (all p<0.05) increased changes (means (95% CI)) in: strength—one-repetition-maximum (2.49 kg (0.64, 4.33)), FFM (0.30 kg (0.09, 0.52)) and muscle size—muscle fibre cross-sectional area (CSA; 310 µm² (51, 570)) and mid-femur CSA (7.2 mm² (0.20, 14.30)) during periods of prolonged RET. The impact of protein supplementation on gains in FFM was reduced with increasing age (−0.01 kg (−0.02,–0.00), p=0.002) and was more effective in resistance-trained individuals (0.75 kg (0.09, 1.40), p=0.03). Protein supplementation beyond total protein intakes of 1.62 g/kg/day resulted in no further RET-induced gains in FFM.
Summary/conclusion
Dietary protein supplementation significantly enhanced changes in muscle strength and size during prolonged RET in healthy adults. Increasing age reduces and training experience increases the efficacy of protein supplementation during RET. With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM.
Background
Sarcopenia is associated with loss of muscle mass and an increased risk of physical disability in elderly people. However, the prevalence of sarcopenia has increased in obese elderly populations. The purpose of this study was to identify the clinical efficacy of elastic resistance exercise training (RET) in patients with sarcopenic obesity.
Methods
This study was conducted at the rehabilitation center of a university-based teaching hospital and was designed as a prospective and randomized controlled trial with an intention-to-treat analysis. A total of 46 women aged 67.3 (5.2) years were randomly assigned to an experimental group (EG) and control group (CG). The EG underwent elastic RET for 12 weeks, and the CG received no RET intervention. All outcome measures were assessed at the baseline and posttest, including body composition measured using dual-energy X-ray absorptiometry, muscle quality (MQ) defined as a ratio of muscular strength to muscle mass, and physical capacity assessed using functional mobility tests. One-way analysis of covariance and Pearson correlation were used to compare outcomes between the 2 groups and to identify the relationship between changes in body composition and physical outcomes, respectively. A chi-square test was performed to identify differences in qualitative data between the 2 groups.
Results
At the posttest, a significant between-group difference was observed in fat-free mass, MQ, and physical capacity (all P < .05); and a significant correlation was found between leg-lean-mass change and gait speed (r = 0.36; P < .05). After 12 weeks of elastic RET intervention, the EG had significantly fewer patients exhibiting sarcopenia (P < .05) and experiencing physical difficulty (P < .001) than the CG.
Conclusion
The present data suggest that elastic resistance exercise exerted benefits on the body composition, MQ, and physical function in patients with sarcopenic obesity. Regular exercise incorporating elastic RET should be used to attenuate muscle mass loss and prevent physical difficulty in obese older adults with sarcopenia on reconditioning therapy.
Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15006069.
This study examined the capacity of nonlinear resistance training (NRT) to alter some cytokines and markers of insulin resistance in men who are obese. An additional aim was to compare these variables between obese and lean men. Age- and fitness-matched obese men were randomly allocated to NRT (n=12) and control (CON, n=10) groups. An age- and fitness-matched control group of lean men (n=11) were also recruited for baseline comparison. The NRT (12 weeks, 3 d/wk, 5-11 exercises) performed at different intensities (40-95% of IRM) with flexible periodization. Serum insulin, glucose, interleukin (IL)-6, IL-10, IL-17A and IL-20 levels were measured at baseline and after training. Obese men had significantly lower IL-20 and higher glucose, insulin, insulin resistance (homeostasis model assessment, HOMA-IR), IL-10 and IL-6 than lean participants at baseline (all, P < 0.05). There were significant negative correlations between IL-10 with anthropometric markers and HOMA-IR at baseline, while these variables were inversely correlated with IL-20. After training, VO2peak and 1-repetition maximum for bench press and knee extension of the NRT increased significantly compared with CON, which was accompanied by significant reductions in anthropometric markers, insulin and HOMA-IR. IL-6 and IL-17A did not change significantly in response to training, but IL-10 and IL-20 increased significantly when compared to the baseline. An inverse relationship between the percent IL-20 increase and the percent waist circumference decrease suggests that adipocytes, or other metabolic factors such as glucose etc., may exert a lowering-effect on IL-20.
Background
Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia.
Methods
In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). The primary outcome was the change in Physical Performance Test score from baseline to 6 months (scores range from 0 to 36 points; higher scores indicate better performance). Secondary outcomes included changes in other frailty measures, body composition, bone mineral density, and physical functions.
Results
A total of 141 participants completed the study. The Physical Performance Test score increased more in the combination group than in the aerobic and resistance groups (27.9 to 33.4 points [21% increase] vs. 29.3 to 33.2 points [14% increase] and 28.8 to 32.7 points [14% increase], respectively; P=0.01 and P=0.02 after Bonferroni correction); the scores increased more in all exercise groups than in the control group (P<0.001 for between-group comparisons). Peak oxygen consumption (milliliters per kilogram of body weight per minute) increased more in the combination and aerobic groups (17.2 to 20.3 [17% increase] and 17.6 to 20.9 [18% increase], respectively) than in the resistance group (17.0 to 18.3 [8% increase]) (P<0.001 for both comparisons). Strength increased more in the combination and resistance groups (272 to 320 kg [18% increase] and 288 to 337 kg [19% increase], respectively) than in the aerobic group (265 to 270 kg [4% increase]) (P<0.001 for both comparisons). Body weight decreased by 9% in all exercise groups but did not change significantly in the control group. Lean mass decreased less in the combination and resistance groups than in the aerobic group (56.5 to 54.8 kg [3% decrease] and 58.1 to 57.1 kg [2% decrease], respectively, vs. 55.0 to 52.3 kg [5% decrease]), as did bone mineral density at the total hip (grams per square centimeter; 1.010 to 0.996 [1% decrease] and 1.047 to 1.041 [0.5% decrease], respectively, vs. 1.018 to 0.991 [3% decrease]) (P<0.05 for all comparisons). Exercise-related adverse events included musculoskeletal injuries.
Conclusions
Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Funded by the National Institutes of Health; LITOE ClinicalTrials.gov number, NCT01065636.)
Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.
Metabolic syndrome (MetS) is classified as a combination of risk factors for cardiovascular disease (CVD), and postmenopausal women are specifically at an increased risk for MetS, in part due to the hormonal and metabolic changes that occur at the menopause transition. It is crucial to combat the components of MetS with appropriate lifestyle interventions in this population, such as exercise. This study aimed to examine the effects of a resistance band exercise training program in obese postmenopausal women with MetS. A total 35 postmenopausal women were randomly assigned to either a control group (CON, n = 17) or a resistance band exercise training group (EX, n = 18). Participants in the EX group trained 3days/week. Levels of blood glucose, insulin, homeostatic model of insulin resistance (HOMA-IR), blood lipid profile, anthropometrics, and blood pressure (BP) were measured at baseline and after the exercise intervention. There were significant group by time interactions (p < 0.05) for blood glucose (Δ-4.5 mg/dl), insulin (Δ -1.3 μU/ml), HOMA-IR (Δ -0.6), triglycerides (Δ -9.4 mg/dl), low-density lipoprotein cholesterol(Δ -10.8 mg/dl), systolic BP(Δ -3.4 mmHg), body fat percentage (Δ -3.0 %), and waist circumference (Δ -3.4 cm), which significantly decreased (p < 0.05), and lean body mass (Δ 0.7 kg) and high-density lipoprotein cholesterol (Δ 5.1 mg/dl), which significantly increased (p < 0.05) after EX compared to no change in CON. The present study indicates that resistance band exercise training may be an effective therapeutic intervention to combat the components of MetS in this population, potentially reducing the risk for the development of CVD.
(Abstracted from Int Urogynecol J 2020;31:895–902)
Overactive bladder (OAB) occurs in 5% to 10% of young women aged 18 to 35 years. Well-known associations include being overweight and obesity.
As studies examining the hypertrophic effects of resistance training (RT) at the cellular level have produced inconsistent results, we performed a systematic review and meta-analysis to investigate muscle fiber size before and after a structured RT intervention in older adults. A random-effects model was used to calculate mean effect size (ES) and 95% confidence intervals (CI). Thirty-five studies were included (age range: 59.0-88.5 years), and 44 and 30 effects were used to estimate RT impact on myosin heavy chain (MHC) I and II fiber size. RT produced moderate-to-large increases in MHC I (ES=+0.51, 95%CI +0.31 to +0.71; p<0.001) and II (ES=+0.81, 95%CI +0.56 to +1.05; p<0.001) fiber size, with men and women having a similar response. Age was negatively associated with change in muscle fiber size for both fiber types (MHC I: R ² =0.11, β=-0.33, p=0.002; MHC II: R ² =0.10, β=-0.32, p=0.04), indicating a less robust hypertrophic response as age increases in older adults. Unexpectedly, a higher training intensity (defined as percentage of one-repetition maximum) was associated with a smaller increase in MHC II fiber size (R ² =15.09%, β=-0.39, p=0.01). Notably, MHC II fiber subtypes (IIA, IIX, IIAX) were examined less frequently, but RT improved their size. Overall, our findings indicate that RT induces cellular hypertrophy in older adults, although the effect is attenuated with increasing age. In addition, hypertrophy of MHC II fibers was reduced with higher training intensity, which may suggest a failure of muscle fibers to hypertrophy in response to high loads in older adults.
Objectives:
To generate a comprehensive bank of systematic review (SR) reporting items to inform an update of the PRISMA 2009 statement.
Methods:
We searched the EQUATOR Network library in May 2019 to identify all reporting guidelines for SRs that were published after 2009, regardless of the scope of the guideline. We also conducted a selective review of four guidance manuals for SRs, three tools for assessing risk of bias in SRs, six meta-research studies evaluating the reporting quality of SRs using a tailored checklist, and five reporting guidelines for other study designs. One author screened and selected sources for inclusion, extracted reporting guidance from sources, and mapped guidance against the PRISMA 2009 checklist items.
Results:
We included 60 sources providing guidance on reporting of SRs and meta-analyses. From these, we collated a list of 221 unique reporting items. Items were categorised into title (four items), abstract (10 items), introduction (12 items), methods (111 items), results (61 items), discussion (12 items), funding and conflicts of interest (4 items), administrative information (3 items), and data availability (4 items). This exercise generated 175 reporting items that could be added to the guidance in the PRISMA 2009 statement.
Conclusions:
Generation of a comprehensive item bank through review and mapping of the literature facilitates identification of missing items, and those needing modification, which may not otherwise be identified by the guideline development team or from other activities commonly used to develop reporting guidelines.
Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention. The most commonly used tool for randomised trials is the Cochrane risk-of-bias tool. We updated the tool to respond to developments in understanding how bias arises in randomised trials, and to address user feedback on and limitations of the original tool.
The present study examined the effects of a 12-week low-intensity resistance exercise training (LIRET) regimen on heart rate variability, strength, and body composition in obese postmenopausal women. Participants were randomly assigned to 12 weeks of either LIRET (n = 10) or nonexercising control group (n = 10). Heart rate variability, leg muscle strength, and body composition were measured before and after 12 weeks. There were significant decreases ( p < .05) in sympathovagal balance (LnLF/LnHF) and sympathetic tone (nLF), as well as significant increases ( p < .05) in parasympathetic tone (nHF) and strength following LIRET compared with no changes after control. There were no significant changes in body composition after LIRET or control. LIRET may be an effective therapeutic intervention for improving sympathovagal balance and strength in obese postmenopausal women. As obese postmenopausal women are at increased risk of developing cardiovascular diseases and physical disability, they could potentially benefit from LIRET.
Background and purpose:
The objective of this pilot randomized controlled trial was to investigate the effect of alternate day fasting (ADF) and exercise on serum sterol signatures, which are surrogate markers of cholesterol absorption and biosynthesis.
Methods:
We randomly assigned 112 overweight or obese participants to four groups: 1) ADF and exercise (E-ADF); 2) ADF; 3) exercise; and 4) control. We studied 31 completers in this exploratory analysis and measured their serum sterol signatures using gas chromatography-mass spectrometry.
Results:
After intervention, most serum sterol signatures that correspond to cholesterol metabolism were significantly different between groups (p < 0.05 by analysis of covariance [ANCOVA]). We found no differences in plant sterols, which are markers of cholesterol absorption. In the exercise group, desmosterol, cholesteryl esters, and oxysterols decreased significantly. Furthermore, only changes in physical activity levels negatively correlated with changes in the metabolic ratios of desmosterol and 7-dehydrocholesterol to cholesterol, which reflect cholesterol biosynthesis (r = -0.411; p = 0.030, and r = -0.540; p = 0.003, respectively).
Conclusion:
These findings suggest that exercise with or without ADF improves cholesterol metabolism as measured by serum sterol signatures, and increased physical activity has a greater effect on cholesterol biosynthesis than weight reduction or calorie restriction.
Background: Vaspin, nesfatin-1 and high-sensitivity C-reactive protein (hs-CRP) act as main risk factors of inflammation and cardiovascular health. There are contradictory results about the effects of exercise training on these obesity-related factors. Therefore, the purpose of present study was to elucidate the effect of exercise training type on plasma levels of vaspin, hs-CRP, and nesfatin-1 in overweight and obese women. Methods: Thirty-four overweight and obese women (age 22.29 ± 2.49 years) were randomly assigned to the endurance, resistance and sedentary control groups. The 8-week endurance and resistance exercise trainings were conducted at 65–80% of maximal heart rate and one repetition maximum, respectively. Fasting blood samples were taken before and 48-hr after the last exercise training session. The serum concentrations of vaspin, nesfatin-1 and hs-CRP were measured using commercially available ELISA kit. The intra- and inter-group comparisons were performed by t-test and one-way ANOVA at a significant level of P < 0.05, respectively. Results: Both of exercise trainings caused a significant reduction in plasma levels of vaspin (P = 0.001 and P = 0.005 for endurance and resistance exercise trainings, respectively) and hs-CRP (P = 0.008 and P = 0.007 for endurance and resistance exercise trainings, respectively). In contrast, a significant increase in plasma levels of nesfatin-1 (P = 0.001 for both of endurance and resistance exercise trainings) and maximal oxygen consumption (P = 0.001 and P = 0.003 for endurance and resistance exercise trainings, respectively) were obtained. Conclusions: Both of endurance and resistance exercise training protocols promote the cardiovascular health of overweight and obese women by improving obesity-related factors.
Aim This study compared the effect of different resistance training (RT) frequencies on total, android, gynoid and trunk body fat in overweight/obese older women.
Methods Fifty-seven overweight/obese older women (66.9±5.3 years and 39.9±4.9% body fat) were randomly assigned to one of three groups: a group performing RT twice a week (G2X), a group performing RT three times a week (G3X), or a non-exercise control group (CG). Both training groups performed the same 12-week RT program consisting of 8 exercises that trained all major muscle groups. Dual-energy X-ray absorptiometry was used to assess body composition.
Results After the intervention period, both G2X and G3X demonstrated significant (P<0.05) reductions in adiposity compared to the CG for total body fat (G2X=–1.7%, G3X=–2.7%, CG=+2.1%), android fat (G2X=–6.2%, G3X=–7.0%, CG=+8.6%), gynoid fat (G2X=–2.5%, G3X=–2.9%, CG=+1.0%), and trunk fat (G2X=–2.5%, G3X=–3.0%, CG=+2.9%), with no significant differences between training groups.
Conclusion These results demonstrate that a low-volume 12-week RT program performed two or three times per week causes decreases in total and regional fat deposition with the greatest reductions occurring in the android region.
Methods:
This study was a randomized controlled trial with pre- and postintervention measures. Participants included OOW, aged 60-85 years, with no medical history of disease that would preclude them from engaging in physical exercise. Participants were randomly divided into the following groups: elastic tubes with handles group (ETG; n = 22), traditional elastic bands group ( n = 21), and control group (CG; n = 20). Exercise groups (EGs) performed the following supervised RTP: 8 weeks, twice weekly, six overall body exercises, and 3-4 sets of 10 repetitions at a rate of perceived exertion (RPE) of 7-9 on the OMNI-Resistance Exercise Scale of perceived exertion. The controls did not change their usual lifestyle. Outcome measures included body composition (BC; total and regional percentage of fat mass [FM] and fat-free mass [FFM]) and physical performance (PP; dynamic and isometric strength, flexibility, agility/dynamic balance, and endurance).
Results:
Both EGs exhibited significantly reduced FM in the upper limbs (ULs) and trunk and increased FFM in the UL, while the ETG exhibited a significantly increased trunk FFM. Both EGs improved in PP, and there were no intergroup differences. Trunk FM and FFM and meters walked differed significantly between the ETG and CG. The CG did not exhibit any significant changes.
Conclusion:
Training with elastic devices at a moderate-high RPE produces short-term improvements in BC and PP in OOW.
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
Background: Overweight and obese older people face a high risk of muscle loss and impaired physical function, which may contribute to sarcopenic obesity. Resistance exercise training (RET) has a beneficial effect on muscle protein synthesis and can be augmented by protein supplementation (PS). However, whether body weight affects the augmentation of muscular and functional performance in response to PS in older people undergoing RET remains unclear.
Objective: This study was conducted to identify the effects of PS on the body composition and physical function of older people undergoing RET.
Design: We performed a comprehensive search of online databases to identify randomized controlled trials (RCTs) reporting the efficacy of PS for lean mass gain, strength gain, and physical mobility improvements in older people undergoing RET.
Results: We included 17 RCTs; the overall mean ± SD age and body mass index (BMI; in kg/m²) in these RCTs were 73.4 ± 8.1 y and 29.7 ± 5.5, respectively. The participants had substantially greater lean mass and leg strength gains when PS and RET were used than with RET alone, with the standard mean differences (SMDs) being 0.58 (95% CI: 0.32, 0.84) and 0.69 (95% CI: 0.39, 0.98), respectively. The subgroup of studies with a mean BMI ≥30 exhibited substantially greater lean mass (SMD: 0.53; 95% CI: 0.19, 0.87) and leg strength (SMD: 0.88; 95% CI: 0.42, 1.34) gains in response to PS. The subgroup of studies with a mean BMI <30 also exhibited relevant gains in response to PS.
Conclusions: Compared with RET alone, PS combined with RET may have a stronger effect in preventing aging-related muscle mass attenuation and leg strength loss in older people, which was found in studies with a mean BMI ≥30 and in studies with a mean BMI <30. Clinicians could use nutrition supplement and exercise strategies, especially PS plus RET, to effectively improve the physical activity and health status of all older patients.