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Evidence for Resistance Training as a Treatment Therapy in Obesity

Wiley
Journal of Obesity
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  • Private University for Health Sciences and HealthTechnology GmbH

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Over the last decade, investigators have paid increasing attention to the effects of resistance training (RT) on several metabolic syndrome variables. Evidence suggests that skeletal muscle is responsible for up to 40% of individuals' total body weight and may be influential in modifying metabolic risk factors via muscle mass development. Due to the metabolic consequences of reduced muscle mass, it is understood that normal aging and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. The purpose of this review is to (1) evaluate the potential clinical effectiveness and biological mechanisms of RT in the treatment of obesity and (2) provide up-to-date evidence relating to the impact of RT in reducing major cardiovascular disease risk factors (including dyslipidaemia and type 2 diabetes). A further aim of this paper is to provide clinicians with recommendations for facilitating the use of RT as therapy in obesity and obesity-related metabolic disorders.
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Hindawi Publishing Corporation
Journal of Obesity
Volume 2011, Article ID 482564, 9pages
doi:10.1155/2011/482564
Review Article
Evidence for Resistance Training as a Treatment
Therapy in Obesity
Barbara Strasser and Wolfgang Schobersberger
Institute for Sports Medicine, Alpine Medicine and Health Tourism, University for Health Sciences,
Medical Informatics and Technology, 6060 Hall in Tirol, Austria
Correspondence should be addressed to Barbara Strasser, barbara.strasser@umit.at
Received 14 May 2010; Accepted 16 June 2010
Academic Editor: Eric Doucet
Copyright © 2011 B. Strasser and W. Schobersberger. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Over the last decade, investigators have paid increasing attention to the eects of resistance training (RT) on several metabolic
syndrome variables. Evidence suggests that skeletal muscle is responsible for up to 40% of individuals’ total body weight and may
be influential in modifying metabolic risk factors via muscle mass development. Due to the metabolic consequences of reduced
muscle mass, it is understood that normal aging and/or decreased physical activity may lead to a higher prevalence of metabolic
disorders. The purpose of this review is to (1) evaluate the potential clinical eectiveness and biological mechanisms of RT in the
treatment of obesity and (2) provide up-to-date evidence relating to the impact of RT in reducing major cardiovascular disease risk
factors (including dyslipidaemia and type 2 diabetes). A further aim of this paper is to provide clinicians with recommendations
for facilitating the use of RT as therapy in obesity and obesity-related metabolic disorders.
1. Introduction
The inclusion of resistance training (RT) as an integral part
of an exercise therapy program has been endorsed by the
American Heart Association [1], the American College of
Sports Medicine [2], and the American Diabetes Association
[3]. While these recommendations are primarily based on the
eects of RT on muscle strength, cross-sectional studies have
shown that muscle mass is inversely associated with all-cause
mortality [4] and the prevalence of the metabolic syndrome
[5], independent of cardiorespiratory fitness levels.
Aging is associated with a loss of both muscle mass
and the metabolic quality of skeletal muscle. Sarcopenia,
the loss of muscle mass associated with aging, is a main
cause of muscle weakness in old age and leads consequently
to an increased risk for development of obesity-associated
insulin resistance and type 2 diabetes mellitus [6]. Research
supports the use of RT to prevent an age-related decline
in skeletal muscle mass (which is approximately 0.46 kg of
muscle per annum from the fifth decade on). Strong evidence
indicates that muscle maintains its plasticity and capacity
to hypertrophy, even into the 10th decade of life [79].
However, there is some evidence to suggest that muscle
strength and its eect on body composition and metabolic
risk factors may be more important than muscle mass [10].
Accordingly, the term of “dynapenia” to qualify the loss of
muscle strength with normal aging has been proposed [11].
A number of neural factors may be implicated in the age-
associated loss of muscle strength, but also alterations in
contractile properties are discussed.
Skeletal muscle is the primary metabolic target organ
for glucose and triglyceride disposal and is an important
determinant of resting metabolic rate. The potential con-
sequences of age-related reduction in skeletal muscle mass
are diverse, including reduced muscle strength and power,
reduced resting metabolic rate, reduced capacity for lipid
oxidation, and increased abdominal adiposity. With increas-
ing adiposity, the insulin-mediated glucose uptake in skeletal
muscle of elderly patients is reduced [12]. Evidence suggests
that the maintenance of a large muscle mass may reduce
metabolic risk factors—namely, obesity, dyslipidaemia, and
type 2 diabetes mellitus—associated with cardiovascular
2Journal of Obesity
disease [1315]. Despite the fact that a high muscle mass
is associated with a favourable metabolic profile, one study
reported that a higher muscle mass can be associated with
metabolic disturbances in obese women [16]. The possible
mechanisms may include increased concentrations of free
androgens due to diminished levels of SHBG, a protein-
sparing eect due to increased lipid metabolism, and changes
in muscle capillarization and fiber composition due to
visceral adiposity.
For the most part, recommendations to treat or prevent
overweight and obesity via physical activity have focused
on aerobic endurance training (AET). Data suggest that
RT may be an eective alternative for modifying metabolic
risk factors. From this backdrop, the purpose of this review
is to (1) evaluate the potential clinical eectiveness and
biological mechanisms of RT in the treatment of obesity
and (2) provide-up-to-date evidence on the impact of RT in
reducing cardiovascular disease (CVD) risk factors, namely,
dyslipidaemia and type 2 diabetes.
2. Metabolic Effects of Resistance Training
2.1. Weight Control. Both resting and activity-related energy
expenditure declines with age [17]; decreased energy expen-
diture can have a major adverse eect on weight maintenance
[18]. Studies on the usefulness of RT in the context of weight
loss have demonstrated mixed results. Although it is clear
that AET is associated with much greater energy expenditure
during the exercise session than RT, some studies have shown
that regular RT is eective in promoting weight loss in obese
persons [19,20]. A significant number of studies have shown
that RT is associated with a decrease in fat mass (FM) and a
concomitant increase in lean body mass (LBM) and thus has
little or no eectivechangeintotalbodyweight[2127]. RT
increased muscle mass by a minimum of 1 to 2 kg in studies
of sucient duration.
The implementation of RT within a dietary intake restric-
tion programme has been studied, along with a combined
dietary restriction and AET programme [2832]. In terms of
relative eects, the addition of RT has been found to prevent
the loss of LBM, secondary to dietary restriction [33,34].
One study demonstrated that twice-weekly RT could prevent
age-associated loss of LBM, as well as associated resting
metabolic rate (RMR) which is closely correlated to losses in
LBM [35]. RT contributes to elevations of RMR as a result
of a greater muscle protein turnover [36]. Theoretically, a
gain of 1 kg in muscle mass should result in an RMR increase
of approximately 21 kcal/kg of new muscle. Thus, RT, when
sustained over years or decades, translates into clinically
important dierences in daily energy expenditure and age-
associated fat gains. For example, a dierence of 5 kg in LBM
translates to a dierence in energy expenditure of 100 kcal
per day (equivalent to 4.7 kg FM per year) [37]. However, a
number of studies have shown that RT will increase RMR, at
least if the training is intense enough to induce an increase in
LBM [3840].
In a randomized control trial [41], 35 overweight men
were randomized to either a control group, a diet-only
group, a diet group that performed AET, or a diet group
that performed both AET and RT. After 12 weeks, the
weight loss in the three intervention groups was similar and
significant, of which 69%, 78%, and 97%, respectively, were
accounted for by fat loss. This study highlights the potential
for RT to provide a unique stimulus to spare catabolism
of body protein, thus altering the relationship between the
LBM and FM. Exercise provided no additional stimulus for
greater weight loss compared with that obtained from dietary
restriction alone. The diet-only group also demonstrated a
significant reduction in LBM.
Another study randomly assigned 29 obese men to one of
three 16-week treatments, which consisted of a hypocaloric
diet alone or in combination with RT (at 80% of 1-RM)
or AET [19]. Whereas reduction in weight (12.4 kg) and
total adipose tissue (9.7 kg) were not significantly dierent
between the three groups, LBM was only preserved after the
exercise training (independent of the mode), compared with
the diet-only group (2.5 kg). The principal finding of this
study was that dietary restriction combined with either AET
or RT increased the influence of diet alone on insulin levels
in obese men.
A further trial assessed whether increases in LBM and
decreases in FM from 15 weeks of twice weekly supervised
RT (at 80% of 1-RM) could be maintained over 6 months
of unsupervised exercise [25]. Over the total 39 weeks of RT,
the treatment group gained 0.89 kg more in LBM, lost 0.98 kg
more in FM, and lost 1.63% more in percent body fat when
compared to the control group. Findings demonstrated that
twice weekly RT did not result in any significant weight loss,
but potentially could prevent age-associated fat gains over
a period of years. Cited as feasible, was the likelihood that
the positive body composition changes associated with RT
could be maintained in an unsupervised exercise program
after completion of the supervised exercise regime.
In a more recent study [42], an 8-week regime of RT
delivered 3 times weekly (at 60% of 1-RM) significantly
changed participants’ body mass (+0.58%), percentage of
body fat (13.05%), LBM (+5.05%), and FM (12.11%)
when compared to the control group. This study supported
a relationship between RT and body mass index (BMI),
demonstrated by an increase in BMI. Therefore, the use of
BMI in ascribing CVD risk should be used with caution
in those individuals with an increased LBM (as would be
expected following RT).
More recently, the eects of a 6-month RT program (at
50% to 80% of 1-RM) were analysed in relation to exercise-
induced oxidative stress and homocysteine and cholesterol in
normal-weight and overweight older adults [43]. Oxidative
stress is suggested to be a potential contributor in the
early and advanced stages of CVD [44]. In the study,
49 older adults were stratified by BMI and randomly
assigned to either a control nonexercise group or an RT
group. Findings demonstrated that lipid hydroperoxides
(PEROXs) and homocysteine levels were lower in both the
overweight and normal weight RT groups compared with
control groups. Change in muscle strength was associated
with homocysteine at 6 months, whereas the change in
PEROXs was associated with the change in body fat. This
Journal of Obesity 3
study showed that RT reduces exercise-induced oxidative
stress and homocysteine, regardless of adiposity. Such a
result indicates that this protection can be aorded in
an older, overweight/obese population as eectively as in
healthy older adults, which might indicate protection against
oxidative insults (i.e., ischemia). A potential mechanism
for RT-induced reduction of oxidative stress could include
contraction-induced antioxidant enzyme up-regulation [45].
2.2. Visceral Adipose Tissue. Adipose tissue is a major
endocrine organ, secreting substances such as adiponectin,
leptin, resistin, tumor necrosis factor α, interleukin 6, and
plasminogen activator inhibitor-1 that may play a critical
role in the pathogenesis of the metabolic syndrome [46].
Excessive central obesity and especially visceral adipose tissue
have been linked with the development of dyslipidaemia,
hypertension, insulin resistance, type 2 diabetes, and CVD
[8,12]. A relative increase in body fat is linked with a decline
in insulin sensitivity in both obese and elderly individuals
[47,48].
Several studies have demonstrated decreases in visceral
adipose tissue after RT programs [24,2628,49,50]. Treuth
et al. observed significant decreases in visceral fat in older
men and women after 16 weeks of RT [26,27]. In two
studies, Ross et al. measured regional fat losses after 16
weeks of exercise combined with dietary interventions in
middle-aged obese men [28,49]. In their first study [49],
testsofbothdietplusAETanddietplusRT(at70%
to 80% of 1-RM) elicited similar losses of visceral fat,
which were greater than losses of whole-body subcutaneous
fat. In a follow-up study [28], they isolated the eects of
AET and RT (at 70% to 80% of 1-RM) by comparing
the responses to diet alone. All 3 groups lost significant
amounts of total body fat, and all 3 groups experienced a
significantly greater visceral fat loss compared with whole-
body subcutaneous fat loss. The changes amounted to a
40% reduction in visceral fat in the diet plus RT group,
39% in the diet plus AET group, and a 32% reduction
in the diet-only group. One study raised the possibility of
gender specificity in visceral fat reduction response to RT
[24]. Hunter et al. studied older women and men after 25
weeks of RT (at 65% to 80% of 1-RM). Results demonstrated
that both genders significantly increased muscle mass and
decreased whole-body fat mass. However, women also lost
a significant amount of subcutaneous and visceral adipose
tissue (6% and 11%, resp.), whereas the men did
not.
Although more research is needed to clarify these
possible gender-specific responses, the overall available body
of literature supports the use of RT, with or without AET,
and with or without diet modification, as an eective
intervention in the reduction of abdominal obesity. It seems
that RT has the potential to reduce visceral fat deposits
through both immediate eects (e.g., during weight loss
or weight maintenance) and delayed eects (during weight
regain). The results of the two Ross et al. studies [28,49]
suggest a potential for low volume, high-intensity RT to
achieve reductions in total and regional adipose tissue when
used in conjunction with a calorie-restriction diet. However,
this observation requires confirmation by additional studies.
Overall, strong evidence supports the notion that regular
RT can eectively alter body composition in obese men and
women, independently from dietary restriction. It has been
shown that RT increases LBM, muscular strength, and resting
metabolic rate, and mobilizes the visceral and subcutaneous
adipose tissue in the abdominal region. Further, RT lowers
exercise-induced oxidative stress and homocysteine levels in
overweight and obese older adults, associated with CVD.
Considering the benefits of RT on body composition in
obese men and women, the question is are there any studies
that have investigated the eects of RT in obese adolescents?
The majority of RT research with children to date has
focused on preadolescents and the safety and ecacy of this
type of training rather than the potential metabolic health
benefits. There is only a small amount of evidence that
children and adolescents may derive metabolic health-related
adaptations from supervised RT. However, methodological
limitations within the body of this literature make it dicult
to determine the optimal RT prescription for metabolic
fitness in children and adolescents, and the extent and
duration of such benefits. More robustly designed single
modality randomized controlled trials utilizing standardized
reporting and precise outcome assessments are required to
determine the extent of health outcomes attributable solely
to RT and to enable the development of evidence-based
obesity prevention and treatment strategies in this cohort.
Furthermore, further studies with postintervention follow-
ups of at least six months are required in order to assess
whether RT prescriptions can be maintained as part of a
regular lifestyle, and whether improved body composition
can be maintained over longer periods.
2.3. Metabolic Risk Reduction. Epidemiologic studies show
a strong association for obesity with CVD [51]andtype2
diabetes (T2D) [52]. Obesity-induced risk factors such as
plasma cholesterol, elevated plasma glucose, and elevated
blood pressure increase the risk for CVD and have thus
been called the “metabolic complications” of obesity [53].
Published evidence indicates that the risk for CVD associated
with the metabolic syndrome is greater than the sum of
its individual risk factors [54]. Apparent is that improved
glycemic control, decreased fat mass, improved blood lipid
profiles, and decreased blood pressure are important factors
in reducing coronary heart disease (CHD) in people with
metabolic risk.
2.3.1. Dyslipidaemia. At present, a small amount of conflict-
ing data exists on the eects of RT on blood lipid levels in
healthy elderly people, and in patients with dyslipidaemia.
In a recent trial, 131 subjects were randomly assigned to
an RT group, an AET group, a combined RT and AET
group, or a nonexercising control group [55]. Findings
demonstrated that exercise mode did not impact upon
blood lipids. In contrast, total cholesterol (TC), low-density
lipoprotein cholesterol (LDL), and plasma triglyceride (TG)
were significantly lower in all groups. These data are
4Journal of Obesity
comparable with another study that investigated the eects
of RT and AET on metabolic parameters in 60 obese women
[56]. After 20 weeks of training without diet, significant
decreases in TG and TC levels were noted in each of the study
groups. Fahlman et al. demonstrated that both AET and
RT groups experienced increased high-density lipoprotein
cholesterol (HDL-C) and decreased TG at the end of a 10-
week training period in 45 healthy elderly women [57]. The
RT group (at 80% of 1-RM) also had significantly lower LDL-
C and TC compared with controls. These favourable changes
occurred without concurrent changes in weight or diet.
None of the above studies included patients with abnor-
mal lipid profiles. Unfortunately, no information is available
on the eects of RT on subjects with dyslipidaemia. Several
earlier studies examined the relationship between RT and
plasma lipoprotein levels, with mixed results. In one study,
premenopausal women were randomly assigned to an RT
program or a control group for 5 months [58]. The RT
group showed a significant decrease in TC and LDL-C, while
no significant changes were noted in serum HDL-C or TG
levels in either group. Changes in body composition showed
no significant correlations with changes in TC or LDL-C.
Another study determined the eects of 20 weeks of RT
on lipid profiles in sixteen untrained males with abnormal
lipoprotein-lipid levels and at least two other risk factors for
CHD [59]. The training program resulted in no significant
changes in plasma concentrations of TG, TC, and HDL-C.
These results are in agreement with those that determined
the eects of 12 weeks of RT (at 60% to 70% of 1-RM)
on lipoprotein-lipid levels in sixteen sedentary obese women
[60]. In contrast, another study examined the eects of 16
weeks of high-intensity RT on risk factors for CHD in eleven
healthy, untrained males [13]. The RT program resulted in
a 13% increase in HDL-C, a 5% reduction in LDL-C, and
an 8% decrease in the TC/HDL-C ratio, despite not showing
changes in body weight or percent body fat.
These findings indicate that RT has the potential to lower
risk factors for CHD, independent of changes in body weight
or body composition. The results of a prospective study
that focused on lipid and lipoprotein levels in previously
sedentary men and women undergoing 16 weeks of RT
were similar [61]. Women participants demonstrated a 9.5%
reduction of TC, a 17.9% decrease in LDL-C, and a 28.3%
lowering of TG. Among the men, LDL-C was reduced by
16.2%, while the ratios of TC and LDL-C versus HDL-C
were lowered by 21.6% and 28.9%, respectively. Thus, RT
may result in favourable changes in lipid and lipoprotein
levels in previously sedentary men and women. However,
limitations exist; only one of the above-mentioned studies
was conducted with subjects with dyslipidaemia, and no
information is available about the eect of RT on patients
with dyslipidaemia alone.
2.3.2. Type 2 Diabetes. Most available studies relate to AET in
the treatment of insulin resistance (IR) and type 2 diabetes
(T2D). Several systematic reviews focused on the relation-
ship between exercise and/or physical activity and glycemic
control in patients with T2D [6264]. Results indicated that
physical training significantly improves glycemic control and
reduces visceral adipose tissue and plasma TG in people with
T2D, even without weight loss.
RT has been shown to improve insulin-stimulated glu-
cose uptake in patients with impaired glucose tolerance or
manifest T2D [48]. RT, and subsequent increases in muscle
mass, may improve glucose and insulin responses to a glucose
load in healthy individuals [65,66] and in diabetic men
and women [67,68] and improves insulin sensitivity in
diabetic or insulin-resistant middle-aged and older men and
women [6871]. In addition, high-intensity RT has been
found to decrease glycosylated haemoglobin (HbA1c) levels
in diabetic men and women, regardless of age [21,22,72
76].
A recent meta-analysis of 27 randomized controlled trials
examined the eects of dierent modes of exercise on glucose
control, and risk factors for complications in patients with
T2D [77]. Results demonstrated that dierences among the
eects of AET, RT, and combined training on HbA1c were
minor. For training lasting 12 weeks, the overall eect was
a small beneficial reduction (HbA1c 0.8% ±0.3%). Aerobic
and combined exercise had small or moderate eects on
blood pressure (BP). All three modes of exercise produced
trivial or unclear eects on blood lipids. The eects of
RT on glycemic control and risk factors associated with
CVD in T2D were small (HbA1c), unclear (BP), or trivial
(blood lipids). Findings supported the notion that combined
training was generally superior to RT alone.
The clinical significance of a 0.5% decrease in HbA1c
can be gauged by examining large prospective intervention
studies investigating morbidity and mortality outcomes in
people with T2D [78]. Data suggests that a 1% rise in HbA1c
represents a 21% increase in risk for any diabetes-related
death, a 14% increased risk for myocardial infarction, and
a 37% increased risk for microvascular complications. The
impact of a decrease of 0.5% HbA1c equates to a 50%
improvement towards a target value of 7% HbA1c, and a
25% improvement towards a normal value of 6% HbA1c, for
a person diagnosed with 8% HbA1c.
It is unclear whether an improvement in glycemic control
can be maintained in the longer term. For example, in the
6-month postintervention follow-up period reported by one
author [79], participants continuing with supervised RT
(at 70% to 80% of 1-RM) maintained the improvement in
glycemic control, whilst in a 6-month home-based follow-up
group, the improvements were lost [80]. The hypothesized
reason for this dierence is the diculty of motivating people
with T2D to maintain RT prescriptions as part of a regular
lifestyle.
In another study [22], the combination of RT (at
70% to 80% of 1-RM) and moderate dietary restriction
was associated with a threefold greater decrease in HbA1c
levels after 6 months compared with moderate weight loss
without RT. This result was not mediated by concomitant
reductions in body weight, waist circumference, and FM.
It is apparent that an increase in LBM after RT may be
an important mediator in improved glycemic control. One
study specifically discussed the eects of an increase in the
number of GLUT4 transporters [48], because the transporter
Journal of Obesity 5
protein GLUT4 expression at the plasma membrane is related
to fibre volume in human skeletal muscle fibres [81]. A
further study found that the improvement in LBM after a 10-
week moderate RT-program had a greater impact on HbA1c
levels than the reduction in FM, suggesting that increases in
muscle mass improved glycemic control [72]. Furthermore,
RT-induced changes in HbA1c have been inversely correlated
with changes in the quadriceps cross-sectional area [71]. It
has been proposed that hyperglycemia has a direct adverse
eect on muscle contractile function and force generation
[82].
A recent meta-analysis sought to investigate the existence
of a dose-response relationship between intensity, duration,
and frequency of RT and the metabolic clustering in patients
with T2D [83]. Findings demonstrated that RT significantly
reduced glycated hemoglobin by 0.48% HbA1c (95% CI: 0.76
to 0.21, P=.0005), fat mass by 2.33 kg (95% CI: 4.71
to 0.04, P=.05), and systolic BP by 6.19 mmHg (95% CI:
1.00 to 11.38, P=.02). There was no statistically significant
eect of RT on TC, HDL-C, LDL-C, TG, and diastolic BP.
It appears that RT regimes of longer duration are most
beneficial, whilst higher intensity more likely has a harmful
eect on glycemic control. The meta-analysis confirmed the
notion that RT does not increase BP (as was once thought),
and that RT may even benefit resting BP. The BP-lowering
eect of RT seems to be independent of weight loss and is
believed to be mediated via reduced sympathetically induced
vasoconstriction in the trained state [84,85]. It should be
noted that a decrease of approximately 6.2mmHg for resting
systolic BP is significant, since a reduction of as little as
3 mmHg in systolic BP has been estimated to reduce CHD
by 5–9%, stroke by 8–14%, and all-cause mortality by 4%
[86]. Progressively higher volumes of RT may reduce resting
systolic BP, and more significantly, diastolic BP. Interpretive
caution is warranted, due to the fact that the above analyses
were based on a limited number of study groups.
3. Prescription of Resistance Training
It is well understood that when performed regularly and
with sucient intensity, RT stimulates skeletal muscle to
synthesize new muscle proteins (hypertrophy). However,
the eective amount of RT to promote muscle growth in
relatively sedentary diseased or aged individuals is an area in
need of further investigation. It is believed that 1 to 2 sets
of 8 to 12 repetitions per set with an intensity greater that
60% of 1-repetition maximum (1RM—the maximum load
that can be lifted once only throughout a complete range of
motion), with 8 to 10 exercises per session and 2 to 3 sessions
per week, are likely to be beneficial for maximising the health
eects of increased skeletal muscle mass [87]. A recent study
examining the eects of systematic RT in the elderly (76.2±
3.2 years) demonstrated that RT consisting of two training
sessions per week was at least as ecient as RT involving
three trainings sessions per week, provided that the number
of sets performed was equal [88]. These findings contradict
results of a previous study reporting that RT three days per
week elicits superior strength gains when compared with RT
two days per week [89]. However, the latter study was low
volume: higher frequency produced better results. A more
recent review demonstrated that there was no dierence in
mean rates of increase in the whole muscle cross-sectional
area between two and three RT sessions per week for longer
periods of training [90]. But, caution is urged on the fact
that the methods (machines, dynamometer) of measuring
muscle strength and expressing it (absolute, relative to body
weight or muscle mass) are not standardized. Thus, the true
increases in muscle strength are dicult to determine in
research protocols. Therefore, to compare results of dierent
studies, muscle strength should be determined in kilo pound
(kp) or Newton (N; SI unit).
Systematic reviews comparing RT frequencies in patients
with metabolic or cardiovascular risk revealed no apparent
association between RT frequencies and changes in risk
factors for CVD [91,92]. However, it should be noted
that only a few studies were conducted with subjects with
metabolic risk, and most of the included RT studies had
a training frequency of three days per week. Regression-
based analyses from recently performed meta-analysis by
Strasser et al. suggest there is no apparent association
between RT frequency and glycemic control, but indicate a
trend to a negative correlation for some outcomes of lipid
profile in patients with abnormal glucose regulation [83].
The eect of RT on resting systolic BP and diastolic BP
seems to be dose-dependent, since decreases in resting BP
were more pronounced when the RT program was of high
volume. Apparent was that relatively modest increases in
RT frequency had hypotensive eects, since resting BP was
reduced to a greater extent when exercising three times per
week compared to twice a week [83].
On the basis of a combination of literature findings and
in-house laboratory results [21,79,88,9395], some basic
recommendations for the design of programmes for elderly
adults with metabolic risk based are provided.
(i) During the first two weeks of exercise, the weights
should be kept to a minimal level so that patients
learn the exercise techniques. A minimal weight
allows muscles to adapt to the training and prevents
muscle soreness.
(ii) From the third week, the objective of the training
is hypertrophy. Participants should start with three
sets per muscle group per week, on 3 nonconsecutive
days of the week. One set should consist of 10–
15 repetitions, without interruption, until severe
fatigue occurs and completion of further repetitions
is impossible.
(iii) The training load should be systematically increased
to keep the maximum possible repetitions between
10 to 15 per set. A repetition maximum of 10 to 15
repetitions corresponds with 60–70% 1-RM [15].
(iv) The number of sets for each muscle per week should
be increased progressively every four weeks by one set
to a maximum of 10 sets per week on (Table 1).
6Journal of Obesity
Tab le 1: Systematic adjustment of the weekly RT volume in sets per
muscle group per week (S/MG/W) for improvement in maximum
strength in rehabilitation, health, and leisure sports.
Stage S/MG/W Frequency
11 1-2
22 2
33 2
44 2
56 2-3
68 2-3
710 2-3
BG: Blood glucose
HbA1c: Glycated hemoglobin
TC: Total cholesterol
HDL-C: High-density lipoprotein cholesterol
LDL-C: Low-density lipoprotein cholesterol
TG: Plasma triglyceride
40
30
20
10
0
10
20 BG HbA1C TC HDL-C TGLDL-C
28
15
0.4
4.6
11.3
11
.6
10.5
2.4
11.9
5.4
34.5
0.4
Figure 1: Percent change in metabolic parameters after 4 months
RT (black) or AET (white) in patients with T2D. Whiskers represent
standard deviation [18].
(v) The RT program should consist of exercises for all
major muscle groups. Exercises to strengthen the
upper body could include bench press (pectoralis),
chest cross (horizontal flexion of the shoulder joint),
shoulder press (trapezius), pull downs (latissimus
dorsi), bicep curls, tricep extensions, and exercises for
abdominal muscles (sit-ups). Lower body exercises
could include leg press (quadriceps femoris).
4. Conclusions
Based on this review of the literature, there is a strong
support for the notion that RT is at least as eective as AET
in reducing some major cardiovascular disease risk factors
(Figure 1). Findings demonstrate that RT may be an eective
alternative to improve body composition and maintain
reduced FM in obese patients after exercise training or energy
intake restriction. Furthermore, it has been shown that
RT preferentially mobilizes the visceral and subcutaneous
adipose tissue in the abdominal region. There is now sub-
stantial support for RT decreasing glycosylated hemoglobin
levels in people with an abnormal glucose metabolism and
improves tendency lipoprotein-lipid profiles. Decreased fat
mass, improved glycemic control and blood lipid profiles
are important for reducing microvascular and macrovascular
complications in people with metabolic risk. On this basis,
RT is considered a potential adjunct in the treatment of
metabolic disorders by decreasing known major risk factors
for metabolic syndromes. As such, RT is recommended in the
management of obesity and metabolic disorders.
Conflict of Interests
The authors have no conflict of interests that are directly
relevant to the content of this original research paper.
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... Because of increased muscle mass, research has shown that resistance training can also increase the resting metabolic rate [3]. Some studies have indicated that resistance training is as effective as aerobic endurance training in reducing major cardiovascular disease risk factors [4]. Furthermore, resistance training research has produced evidence about reversing aging factors. ...
... With the significant increases in muscle mass that accompany regular strength training, the mean energy intake required for body weight and tissue maintenance can increase by 15% [2]. Some suggest that a 1.0 kg increase in trained muscle tissue may raise the resting metabolic rate by about 20 kilocalories per day [4]. With more energy at rest required for tissue maintenance, resistance training tends to stimulate muscle protein turnover [40,41] and increase arterialized plasma norepinephrine levels [42]. ...
Article
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Telomere length is an index of cellular aging. Healthy lifestyles are associated with reduced oxidative stress and longer telomeres, whereas unhealthy behaviors are related to shorter telomeres and greater biological aging. This investigation was designed to determine if strength training accounted for differences in telomere length in a random sample of 4814 US adults. Data from the National Health and Nutrition Examination Survey (NHANES) were employed to answer the research questions using a cross-sectional design. Time spent strength training was calculated by multiplying days of strength training per week by minutes per session. Participation in other forms of physical activity was also calculated based on reported involvement in 47 other activities. Weighted multiple regression and partial correlation were used to calculate the mean differences in telomere length across levels of strength training, adjusting for differences in potential confounders. With the demographic covariates controlled, strength training and telomere length were linearly related (F = 14.7, p = 0.0006). Likewise, after adjusting for all the covariates, the linear association remained strong and significant (F = 14.7, p = 0.0006). In this national sample, 90 min per week of strength training was associated with 3.9 years less biological aging, on average. Regular strength training was strongly related to longer telomeres and less biological aging in 4814 US adults.
... Developing the strength and size of muscles after WT is a consequence of muscle satellite cell recruitment initiated in order to support adult muscle fiber hypertrophy (Hunter et al., 2004). Other beneficial effects of WT include the improvement of bone density and insulin sensitivity and the decrease in the risk of being overweight and the incidence of obesity-related diseases (Strasser and Schobersberger, 2011;Csapo and Alegre, 2016;Socha et al., 2016). Recent research (Nilsson et al., 2023) has shown that the implementation of a 15-week WT regimen in postmenopausal women can help counteract the abdominal fat redistribution associated with the menopausal transition. ...
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Background: The lack of physical activity, stress, and unhealthy eating habits contribute to body mass disorders, which form the basis of most civilization diseases. Mature women are increasingly turning to fitness clubs to improve their physique and protect themselves from diseases and the progressive aging process. The multitude of training systems proposed to women by fitness clubs leads to the search for solutions that will bring positive health results. The response to an exercise stimulus may depend on the menopausal status. Methods: This quasi-experimental study aimed to determine the effects of 6, 12, and 18 weeks of circuit hydraulic weight interval training (CHWIT) on anthropometric indices, body composition estimated by the bioelectrical impedance analysis (BIA), and muscle performance in inactive pre- and post-menopausal women from an urban population. A total of 100 women aged between 35 and 69 (mean 51.5 ± 9.61) years with a mean body mass index (BMI) of 27.3 (±5.4 kg/m2) were divided by menopausal status and assigned to the training CHWIT group (25 pre- and 25 postmenopausal women) and the control group (25 pre- and 25 postmenopausal women). Each participant from the CHWIT group took part in a total of 54 training sessions, developed for the Mrs.Sporty network, under the constant supervision of a qualified trainer. Results: After 18 weeks of training in both intervention groups, ANCOVA demonstrated statistically significant (p < 0.05) decreased body fat (%), reduced thigh and arm circumference, and increased muscle component (kg) as the main part of fat-free body mass. Additionally, premenopausal women decreased their body mass, BMI, and waist and hip circumferences. A significant increase in the muscle component was noticed after 6 weeks of CHWIT in pre-menopausal women and only after 18 weeks in postmenopausal women. Significant progression of resistance (amount of repetitions on hydraulic machines) was observed after 6 weeks and at each subsequent stage of CHWIT in both intervention groups (p < 0.001). No significant differences were found in the controls. Conclusion: CHWIT is an effective form of training, improving body composition and physical functions in inactive pre- and postmenopausal women. Changes in the muscle component require a longer intervention of physical effort in women after menopause.
... Changes in strength can be observed when the appropriate levels of stress are applied to skeletal muscles, usually achieved through external resistance (Dorgo et al., 2009). Some benefits of RT include the management of obesity and other metabolic disorder (Strasser and Schobersberger, 2011) and the possible reduction of insulin resistance or insulin action (Hurley et al., 2011). ...
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Manual Resistance Training (MRT) is a mode of Resistance Training (RT) primarily used as a training method for improving muscular strength and body composition. MRT is a form of training that requires minimal equipment due to the use of a partner who provides external resistance. The purposes of this study were 1) to investigate the effects of an 8-week MRT intervention on body composition and muscular strength, and 2) to compare the changes observed in MRT to a traditional Weight Resistance Training (WRT) and control groups. Thirty young adults (n = 30) were randomly assigned to either a MRT (n = 10), WRT (n = 10) or control (n = 10) group. The MRT and WRT groups engaged in twice-a-week training for 1 hour with 2 circuits composed of 3 exercises per circuit while the control group was instructed not to engage in any exercise for 8 weeks. Body composition was measured via Dual-energy X-ray Absorptiometry and Muscular Strength was measured via Isokinetic Knee Extension/Flexion, Isometric Bench Press, Isometric Mid-thigh Pull, One-Repetition Maximum (1RM) Bench Press (1RMBP), and 1RM Leg Press (1RMLP) before and after the intervention. The MRT and WRT groups showed no change in body composition from pre to post-testing. However, an increase in Strength was seen in MRT through 1RMLP (p < 0.01) and in WRT through 1RMBP (p < 0.01) and 1RMLP (p < 0.01) from pre to post-testing. No changes in the control group were observed for any of the variables of interest (p > 0.05). An 8week MRT or WRT intervention increases muscle strength without changes in body composition.
... Overall, the results of this study suggest that individuals with DO have a remarkable capacity to adapt to prescribed exercises, and that amino acid supplementation may not provide additional benefits compared to RT alone. Our study did not include a group that performed only RT, and the existing literature demonstrates that RT alone can lead to substantial benefits on muscle strength and physical performance [41,42]. Therefore, we can only hypothesize that an intense RT regimen may be sufficient on its own to drive significant improvements. ...
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Background/Objectives: Exercise and nutrition may be useful strategies in dynapenic and sarcopenic obesity management, but the identification of treatment modalities aimed at improving this condition is still lacking. We compared the effect of a five-month hypocaloric diet plus resistance training (RT) with and without essential amino acids (EAAs) on body composition, physical performance, and muscle strength among older adults with dynapenic obesity (DO). Methods: Older individuals (n = 48) with DO [(BMI ≥ 30 kg/m2 and/or high waist circumference and low handgrip strength (HGS)] were randomized into two double-blind groups (RT without EAAs vs. RT+EAAs). All participants followed a hypocaloric diet (1 g of proteins/kg spread over three meals) and RT for five months. Pre- and post-intervention assessments included the body composition (DXA), Short Physical Performance Battery (SPPB), HGS, one-repetition maximum (1-RM), and maximal isometric torque with an isokinetic dynamometer. Results: Both groups reduced body mass (RT: −4.66 kg; RT+EAAs: −4.02 kg), waist circumference (RT: −4.66 cm; RT+EAAs: −2.2 cm), total fat mass (RT: −3.81 kg; RT+EAAs: −3.72 kg), and compartmental fat mass with no between-group differences. Both groups improved 1-RM strength (33–47%), isometric torque for body mass (RT: 14.5%; RT+EAAs: 10.6%), and functional performance (chair stand (RT: −3.24 s; RT+EAAs: −1.5 s) and HGS (RT: −2.7 kg; RT+EAAs: 2.9 kg)) with no between-group differences. Conclusions: A moderate hypocaloric diet combined with RT improves body composition and physical function in DO participants, but EAA supplementation did not provide additional benefits.
... By manipulating DNA methylation patterns, it may be possible to enhance muscle growth and function in individuals suffering from these conditions [10]. Additionally, aerobic and resistance training-induced epigenetic changes could be harnessed to improve metabolic health, offering new strategies for managing obesity, type 2 diabetes, and other metabolic disorders [18,20,21]. This knowledge also emphasizes the importance of incorporating resistance training into rehabilitation programs for older adults and patients recovering from chronic illnesses, to promote muscle strength, functional independence, and overall health. ...
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Introduction: The skeletal muscle tissue has a remarkable degree of plasticity. In the case of exercise training, the skeletal muscle adapts to match the specific stress imposed by the training modality. Aerobic exercise training promotes oxidative metabolism, angiogenesis, and fiber type switching from type IIb to IIa. Conversely, resistance exercise training promotes muscle protein synthesis and a hypertrophic response of the skeletal muscle. Regardless of training modality, the tissular adaptation of the skeletal muscle is a consequence of underlying changes in gene expression. Changes in promoter DNA methylation regulate genes' activation, or silencing, by influencing euchromatin and heterochromatin organization, respectively, ultimately determining chromatin accessibility to transcriptional machinery. It surmises that dynamic DNA methylation mechanisms would regulate acute exercise-responsive genes in skeletal muscle. In the context of exercise training, alterations in DNA methylation of gene promoters could support long-term changes in gene expression or restrict the responsiveness of acute exercise genes. Methods: This literature review will involve a comprehensive search of peer-reviewed articles published after the year 2000 in databases including UBC Library, PubMed, Google Scholar, and Web of Science. Articles selected for inclusion were screened based on relevance to the topic and quality of evidence. Data extraction was focused on identifying key findings related to DNA methylation changes in skeletal muscle following exercise interventions. Results: Resistance training alters DNA methylation in skeletal muscle, enhancing genes for muscle growth and strength. Aerobic training reduces DNA methylation, boosting genes for mitochondrial biogenesis, glucose metabolism, and muscle endurance. Discussion: The discussion highlights that both aerobic and resistance training induce long-term epigenetic modifications in skeletal muscle, creating a "memory" that enhances muscle adaptability and performance in future exercises. These findings suggest potential therapeutic applications for muscle-wasting diseases and metabolic disorders, emphasizing the need for personalized exercise regimens to maximize health benefits. Conclusion: This literature review emphasizes the pivotal role of DNA methylation in skeletal muscle adaptation to exercise, highlighting the distinct epigenetic modifications induced by aerobic and resistance training that enhance muscle function and metabolic health.
... For individuals aiming to decrease body fat, incorporating aerobic exercises such as long-distance running may be more effective, on the other hand, those looking to increase muscle mass and strength should consider resistance training. This study supports the notion that a combination of both training modalities may provide a balanced approach to achieving optimal body composition[19].Despite the insights provided by this study, several limitations should be noted. Factors such as diet, training intensity, and duration were not accounted for and could have influenced the results. ...
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Background: Body composition, including body fat percentage and lean body mass, significantly impacts athletic performance and overall health. Long-distance running and weightlifting athletes leads to distinct physiological adaptations. This study aims to elucidate the disparities in body fat percentage and lean body mass between these two groups, providing insights that are essential for tailoring sport-specific training and health management strategies. Objective: The study aimed to examine the body fat percentage and lean body mass of athletes who engage in weightlifting and longdistance running. Study Design: This research utilized an observational cross-sectional design. Material and Methods: In this study, 60 university-level male sports persons were selected as subjects with long-distance runners (n = 30) and weightlifting athletes (n = 30). To achieve the purpose of the study, Body composition analyser GS6.5B Body Building Weight Test System (Version 1.0) was used to analyze the body fat percentage and lean body mass of the subjects. Results: This study found that there exists a significant difference in body fat percentage and lean body mass among weightlifting athletes and long-distance runners. The t-value with regards to the variable body fat percentage was 3.70 and p-value was 0.0005 and was found to be statistically significant at 0.05 level of significance p<.05. The t-value with regards to lean body mass was 8.392 and p-value was 0.0001 and was found to be statistically significant at 0.05 level of significance p<.05. Conclusion: The findings of the investigation demonstrated considerable dissimilarity in the percentage of body fat and lean body mass between long-distance runners and weightlifting athletes. In particular, weightlifting athletes exhibited a higher body fat percentage and greater lean body mass than those in the long-distance running group.
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Obesity is one of the greatest public health challenges of the 21st century. In India, about 30-65% of urban adults are obese. The aim of this study was to investigate neuromuscular electrical stimulation (NMES) markers as a therapeutic tool in diagnosing the effectiveness of exercise intervention in obesity at different levels in obese Class I and Class II male subjects. This randomized controlled study was conducted in the physiotherapy outpatient department of Madha Hospital, Kovur, Chennai. The study duration was 12 weeks. The sample of 30 men was divided into the class I obese men group, 15 nos, and the class II obese men group, 15 numbers. The subjects of age between 18-50 years were included in the study. The Class III Obese men associated with co-morbidities were excluded in this study. The data of Randomized controlled study include anthropometric measurements like height, weight, BMI, Hip circumference, Waist circumference, Thigh circumference, Waist to Height ratio, Waist to Hip ratio, Waist to Thigh ratio, Sagittal abdominal diameter, Abdominal Skin fold thickness, Thigh skin fold thickness and NMES markers. Paired t-test analysis was done. SPSS 20 version was used to analyze the collected data. The result was presented as mean and standard deviation. There was a significant difference in mean values at P?0.005 between different levels of study duration Class I and Class II obese men with neuromuscular electrical stimulator markers (NMES) as a Diagnostic tool. Thus, this study concludes that the NMES marker can be used as a therapeutic tool to analyze obesity.
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Obesity is a public health crisis, with prevalence rates tripling over the past 60 y. Although lifestyle modifications, such as diet and physical activity, remain the first-line treatments, recent anti-obesity medications (AOMs) have been shown to achieve greater reductions in body weight and fat mass. However, AOMs also reduce fat-free mass, including skeletal muscle, which has been demonstrated to account for 20% to 50% of total weight loss. This can equate to ∼6 kg or 10% of total lean mass after 12–18 mo, a loss comparable to a decade of human aging. Despite questions surrounding the clinical relevance of weight loss-induced muscle loss, the importance of adopting lifestyle behaviors such as eating a protein-rich diet and incorporating regular resistance training to support skeletal muscle health, long-term weight loss maintenance, and overall well-being among AOM users should be encouraged. Herein, we provide a rationale for the clinical significance of minimizing weight-loss-induced lean mass loss and emphasize the integration of diet and physical activity into AOM clinical care. Owing to a lack of published findings on diet and physical activity supporting skeletal muscle health with AOMs, specifically, we lean on findings from large-scale clinical weight loss and diet and exercise trials to draw evidence-based recommendations for strategies to protect skeletal muscle. We conclude by identifying gaps in the literature and emphasizing the need for future experimental research to optimize skeletal muscle and whole-body health through a balance of pharmacotherapy and healthy habits.
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This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 ± 6.8 kg at Week 24, which decreased to 15.1 ± 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood.
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Obesity has reached epidemic proportions in the United States: more than 20% of adults are clinically obese as defined by a body mass index of 30 kg/m 2 or higher, and an additional 30% are overweight. Environmental, behavioral, and genetic factors have been shown to contribute to the development of obesity. Elevated body mass index, particularly caused by abdominal or upper-body obesity, has been associated with a number of diseases and metabolic abnormalities, many of which have high morbidity and mortality. These include hyperinsulinemia, insulin resistance, type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. This underscores the importance of identifying people at risk for obesity and its related disease states.
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Strength training (ST) is considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure that is associated with advanced age. This reversal is thought to result in improvements in functional abilities and health status in the elderly by increasing muscle mass, strength and power and by increasing bone mineral density (BMD). In the past couple of decades, many studies have examined the effects of ST on risk factors for age-related diseases or disabilities. Collectively, these studies indicate that ST in the elderly: (i) is an effective intervention against sarcopenia because it produces substantial increases in the strength, mass, power and quality of skeletal muscle; (ii) can increase endurance performance; (iii) normalises blood pressure in those with high normal values; (iv) reduces insulin resistance; (v) decreases both total and intra-abdominal fat; (vi) increases resting metabolic rate in older men; (vii) prevents the loss of BMD with age; (viii) reduces risk factors for falls; and (ix) may reduce pain and improve function in those with osteoarthritis in the knee region. However, contrary to popular belief, ST does not increase maximal oxygen uptake beyond normal variations, improve lipoprotein or lipid profiles, or improve flexibility in the elderly.
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Context Exercise is widely perceived to be beneficial for glycemic control and weight loss in patients with type 2 diabetes. However, clinical trials on the effects of exercise in patients with type 2 diabetes have had small sample sizes and conflicting results.Objective To systematically review and quantify the effect of exercise on glycosylated hemoglobin (HbA1c) and body mass in patients with type 2 diabetes.Data Sources Database searches of MEDLINE, EMBASE, Sport Discuss, Health Star, Dissertation Abstracts, and the Cochrane Controlled Trials Register for the period up to and including December 2000. Additional data sources included bibliographies of textbooks and articles identified by the database searches.Study Selection We selected studies that evaluated the effects of exercise interventions (duration ≥8 weeks) in adults with type 2 diabetes. Fourteen (11 randomized and 3 nonrandomized) controlled trials were included. Studies that included drug cointerventions were excluded.Data Extraction Two reviewers independently extracted baseline and postintervention means and SDs for the intervention and control groups. The characteristics of the exercise interventions and the methodological quality of the trials were also extracted.Data Synthesis Twelve aerobic training studies (mean [SD], 3.4 [0.9] times/week for 18 [15] weeks) and 2 resistance training studies (mean [SD], 10 [0.7] exercises, 2.5 [0.7] sets, 13 [0.7] repetitions, 2.5 [0.4] times/week for 15 [10] weeks) were included in the analyses. The weighted mean postintervention HbA1c was lower in the exercise groups compared with the control groups (7.65% vs 8.31%; weighted mean difference, −0.66%; P<.001). The difference in postintervention body mass between exercise groups and control groups was not significant (83.02 kg vs 82.48 kg; weighted mean difference, 0.54; P = .76).Conclusion Exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications, but no significantly greater change in body mass was found when exercise groups were compared with control groups.
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Background: Aerobic exercise training is associated with reduced serum concentrations of triglycerides, increased concentrations of high-density lipoprotein cholesterol, and minimal changes in serum levels of total cholesterol or low-density lipoprotein cholesterol. There are few data on the effects of resistance exercise on blood lipid levels.Methods: Premenopausal women were randomly assigned to a supervised resistance exercise training program (n=46) or a control group (n=42) for 5 months. Serum was analyzed for levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Body composition and dietary intake were also measured.Results: The exercise group showed a 0.33±0.03-mmol/L (mean ± SE) decrease in total cholesterol level and a 0.36±0.001-mmol/L decrease in low-density lipoprotein cholesterol level that was significantly different from the control group. No significant changes were noted in serum high-density lipoprotein cholesterol or triglyceride levels in either group. Changes in body composition showed no significant correlations with changes in total cholesterol or low-density lipoprotein cholesterol. There were no significant differences in nutrient intake between the groups.Conclusion: In healthy, premenopausal women, with normal baseline lipid profiles, 5 months of resistance exercise training was associated with significant decreases in serum total cholesterol and low-density lipoprotein cholesterol concentrations.(Arch Intern Med. 1993;153:97-100)