Health Benefits and Medical Applications

Resistance Exercise:

Health Benefits and

Medical Applications

Medical Fitness Association 2014

Wayne L. Westcott, Ph.D., CSCS

Resistance Exercise is Medicine: Effects of Strength Training

on Health

Westcott, et al.

ACSM’s

Current Sports Medicine Reports

Vol. 11, No. 4, July/August 2012

Learning Objectives

1. To recognize the cascade of degenerative processes

that proceed from muscle loss to metabolic slowdown

to fat gain, and the relationship to osteopenia,

metabolic syndrome, type 2 diabetes, heart disease,

and all cause mortality.

2. To realize the positive impact of resistance exercise

for reversing these degenerative processes and

reducing the risk of experiencing associated

diseases/infirmities.

3. To apply recent research findings regarding a model

exercise and nutrition program for concurrently

increasing muscle mass and reducing body fat.

Effects of Inactive Aging

Muscle Loss

• Bone Loss

• Metabolic Decline

• Fat Gain

• Diabetes

• Metabolic Syndrome

• Heart Disease

• All-Cause Mortality

Cascade of Degenerative Processes

Muscle Loss ( 6 lbs. / decade)

Metabolic Rate Reduction (3% / decade)

Fat Gain (16 lbs. / decade)

75% Adults over age 60 are overweight or

obese (BMI).

(Flegal, JAMA, 2010)

Muscle

Muscle loss increases to 10 lbs. / decade

after age 50

(Nelson, JAMA, 1994)

Muscle loss increases risk factors for

obesity, diabetes and cardiovascular

disease.

(Strasser, J. Obesity, 2011)

Muscle

Muscle protein breakdown and synthesis

are largely responsible for resting energy

expenditure, which is 5 to 6 calories per

pound per day of untrained muscle tissue.

(Wolfe, Amer. J. Clinical Nutrition, 2006)

Trained muscle tissue may have a resting

energy expenditure of more than

9 calories per pound per day.


Metabolism

Muscle loss is the largest contributor to

age-related decline in resting metabolic

rate, which is approximately 3% / decade

in adults.

(Keys, Metabolism, 1973)

Fat Gain

Resting metabolism accounts for 65% to

75% of daily calorie use among sedentary

men and women. Consequently,

metabolic rate reduction is generally

accompanied by an increase in fat weight.

(Wolfe, Amer. J. Clinical Nutrition, 2006)

Reversing Muscle Loss

Numerous studies have shown that a

basic and brief program of resistance

training (10 to 20 total exercise sets) can

increase muscle mass in adults of all

ages.

(Campbell, Amer. J. Clinical Nutrition, 1994;

Fiatarone, JAMA, 1990; Hunter, J. Applied

Physiology, 2000; Pratley, J. Applied Physiology,

1994, Westcott, Physician and Sportsmedicine,

2009)

Reversing Muscle Loss

Large study (1,644 subjects) using ACSM

strength training guidelines (1 set x 8-12

reps x 12 exercises x 2-3 days per week)

revealed 3.1 lb. lean weight increase after

10 weeks of training.

(Westcott, Physician and Sportsmedicine, 2009)

Recharging Resting Metabolism

Resistance training stimulates increased

muscle protein turnover which has a dual

impact on resting metabolic rate, namely,

a chronic adaptation and an acute

response.

(Evans, Can. J. Applied Physiology, 2001)


Chronic Adaptation: A 3.1 lb. increase in

trained muscle tissue may raise resting

metabolic rate almost 30 calories per day.



Acute Response: Increased energy

requirements for 72 hours after the

microtrauma caused by a standard session of

resistance exercise for remodeling the trained

muscle tissue.

1 or 3 sets of 10 exercises (15 or 35 minutes)

increased resting energy expenditure 5% (100

calories per day) for 3 days after the workout.

(Heden, Eur. J. Applied Physiology, 2011)

Reducing Body Fat

Several studies have shown approximately

3 lbs. muscle gain and 4 lbs. fat loss after

2 to 3 months of strength training.

(Campbell, Amer. J. Clinical Nutrition, 1994;

Hunter, J. Applied Physiology, 2000; Pratley, J.

Applied Physiology, 1994; Westcott, Physician and

Sportsmedicine, 2009)

Reducing Body Fat

Research has revealed that resistance

exercise significantly reduces intra-

abdominal fat in older men and women.

(Hunter, Med. Sci. Sports Exercise, 2002;

Treuth, J. Applied Physiology, 1994 & 1995)

Reducing Body Fat

Three 20-minute circuit strength training

sessions per week may increase energy use

by 5,400 calories per month (1.5 lbs fat).

Exercise Session Expenditure: 200 cal X 12 = 2,400 cal/mo.

Resting Energy Expenditure: 100 cal X 30 = 3,000 cal/mo.

Total Energy Use: = 5,400 cal/mo.

Fat Equivalent = 1.5 lbs/mo.

(Haltom, Med. Sci. Sports Exercise, 1999; Heden, Eur. J.

Applied Physiology, 2011)

Facilitating Physical Function

After 14 weeks of resistance exercise, 89

year old nursing home residents increased

strength by 60%, increased muscle mass

by 4 lbs., and improved FIM (functional

independence) scores by 14%.

(Westcott, J. Active Aging, 2009)

Facilitating Physical Function

Studies support older adult strength

training for enhancing movement control,

functional abilities, physical performance,

and walking speed.

(Barry, J. Gerontology A, 2004; Holviala, J.

Strength Conditioning Research, 2006; Schlicht, J.

Gerontology A, 2001)

Resisting Type 2 Diabetes

By mid-century, one of three adults will

have diabetes

(Boyle, Population Health Metrics, 2010)

Resistance training is an effective

intervention for reducing the risk of type 2

diabetes.

(Flack, J. Aging Research,

2011)

Resisting Type 2 Diab

Resistance exercise improves insulin

sensitivity and glycemic control, as well as

reduces abdominal fat.

(Castaneda, Diabetes Care, 2002; Dunstan,

Diabetes Care, 2002; Holten, Diabetes, 2004;

Kohrt, Diabetes, 1993)


Resistance exercise may be preferable to

aerobic activity for improving insulin

sensitivity and lowering HbA1C.

(Bweir, Diabetes Metabolic

Syndrome, 2009:

Eves, Diabetes Care,

2006)


Resistance training is recommended for

the prevention and management of Type 2

diabetes and metabolic disorders

(Strasser, Sports Medicine, 2010)

ADA recommends resistance exercise for

all major muscles, 3 days/week, up to 3

sets of 8-10 reps, at high intensity.

(ADA, Diabetes Care, 2006)

Improving Cardiovascular Health

“Resistance training is at least as effective

as aerobic endurance training for reducing

some major cardiovascular disease risk

factors.”

(Strasser and Schobersberger

J. Obesity, 2011)


35% American adults have hypertension.

(Ong, Hypertension, 2007)

Resistance exercise reduces resting blood

pressure.

(Hurley, Sports Medicine, 2000; Kelley, J.

Applied Physiology, 1997; Smutok, Metabolism,

1993)


Large study (1,644 subjects) using ACSM

strength training guidelines (1 set x 8-12

reps x 12 exercises x 2-3 days/week)

revealed significant reductions in resting

blood pressure after 10 weeks of training.

*2 days/week -3.2 sys. and -1.4 dias. (mmHg)

*3 days/week -4.6 sys. and -2.2 dias. (mmHg)

(Westcott, Physician and Sportsmedicine, 2009)


Blood pressure reductions with resistance

training comparable to aerobic activity.

* -6.0 mmHg systolic

* -4.7 mmHg diastolic

(Meta-analysis by Cornelissen, Hypertension,

2005)


45% American adults have undesirable

blood lipid profiles.

(Lloyd-Jones, Circulation, 2009)

Resistance exercise improves blood lipid

profiles

(Hagerman, J. Gerontology A, 2000; Kelley,

Preventive Medicine, 2009; Tambalis, Angiology,

2009)


Resistance training has been shown to:

* Increase HDL cholesterol by 8-21%

* Decrease LDL cholesterol by 13-23%

* Reduce triglycerides by 11-18%

(ACSM Position Stand on Exercise and Physical

Activity for Older Adults, 2009)


Resistance training enhances

cardiovascular health

(Braith, Circulation, 2006)

Resistance training reduces risk for

predisposing metabolic syndrome

(High BW, BP, BG, TG; Low HDL)

(Hurley, Sports Medicine, 2011; Jurca, Med. Sci.

Sports Exercise, 2005; Strasser, Sports Medicine,

2010; Magyari, JSCR, 2012)

Increasing Bone Mineral Density

10 million American adults have osteoporosis

35 million American adults have osteopenia

(National Osteoporosis Foundation, 2009)

30% women and 15% men will experience

bone fracture due to osteoporosis

(USDHHS, Bone Health and Osteoporosis: A Report

of the Surgeon General, 2004)


Adults who do not perform resistance

exercise may experience 1-3% reduction

of BMD every year of life.

(Kemmler, Med. Sci. Sports Exercise, 2005;

Nelson, JAMA, 1994; Warren, Med. Sci. Sports

Exercise, 2008)


Several studies have shown significant

increases in BMD after 4 to 24 months of

resistance training

(Kerr, J. Bone Mineral Research, 1996; Lohman, J.

Bone Mineral Research, 1995; Wolfe, Osteoporosis

Int., 1999)

Resistance training increases BMD between

1-3% in pre and postmenopausal women.

(Review by Going, Amer. J. Lifestyle Medicine,

2009)


Two-year study showed a 3.2%

improvement in BMD from resistance

exercise compared to control group.

(Kerr, J. Bone Mineral Research, 2001)

Resistance training has greater impact on

BMD than aerobic and weight-bearing

exercise.

(Gutin, Osteoporosis Int., 1992)

Enhancing Mental Health

Benefits of resistance training for adults

include:

* Reduced symptoms of fatigue, anxiety, and

depression

* Reduced pain associated with osteo-arthritis,

fibromyalgia, and low back issues

* Improved cognitive abilities

* Increased self-esteem

(Review by O’Connor, Amer. J. Lifestyle

Medicine, 2010)


Aerobic activity plus resistance exercise

produced greater cognitive improvement than

aerobic activity alone.

(Colcombe, Psychological Science, 2003)

10 weeks of strength and endurance exercise

significantly improved physical self-concept,

depression, fatigue, positive engagement,

revitalization, tranquility, and tension in adults

and older adults.

(Annesi & Westcott, Perceptual and Motor Skills,

2004 & 2007)


10 weeks of resistance exercise reversed

clinical depression in 80% of elderly

subjects.

(Singh, J. Gerontology A, 1997)

Reversing Aging Factors

6 months of resistance training reversed

mitochondrial gene expression (179 genes

associated with age and exercise) in older

adults (68 years) comparable to that of

younger adults (24 years).

(Melov, PLoS One, 2007)

Conclusions

Resistance training is effective for:

* Increasing lean weight

* Increasing resting energy expenditure

* Decreasing fat weight

* Reducing low back pain

* Reducing arthritic discomfort

* Increasing functional independence

* Enhancing movement control

Conclusions

Resistance training is effective for:

* Increasing insulin sensitivity

* Improving glucose control

* Reducing resting blood pressure

* Improving blood lipid profiles

* Increasing bone mineral density

* Improving cognitive ability

* Enhancing self-esteem

* Reversing aging factors in skeletal muscle

Nutrition and Exercise for Weight Loss Research Study

2013

(W. Westcott, C. Apovian, K. Puhala, et al. Physician and Sporstmedicine, 41: 85-91, 2013)

Nutrition/Exercise for Weight Loss Study

Exercise Protocol 1. Leg Extension 7. Shoulder Press

2. Leg Curl 8. Cycle

3. Leg Press 9. Abdominal Curl

4. Cycle 10. Low Back Extension

5. Chest Press 11. Rotary Torso

6. Pulldown 12. Cycle

*Strength Training: 1 set; 8-12 reps; 3 secs up – 3 secs down *Cardio Training: 5 minutes; 20 secs high – 20 secs low

(Westcott, Physician and Sportsmedicine, 41;3 2013)


Nutrition Guidelines

Moderate Calorie: 1500-1800 men; 1200-1500 women

High Protein: 1.5 grams protein/kg ideal body weight

High Water: unlimited consumption

High Vegetables: unlimited servings

High Fruit: unlimited servings

Nutrition /Exercise for Weight Loss Study

Study Groups (N=121)

1. Exercise Only (N=44)

(No increased protein; No decreased calories)

2. Exercise/Increased Protein (N=32)

(No decreased calories)

3. Exercise/Increased Protein/Decreased Calories (N=45)


Study Results (N=121)

Lean Weight (Muscle)

1. Exercise Only +1.1 lbs.

2. Exercise/Increased Protein +2.7 lbs.*

3. Exercise/Increased Protein/Decreased Cals +1.6 lbs.

*Statistically (p<.05) greater improvement than Group 1



Body Weight

1. Exercise Only -1.2 lbs.

2. Exercise/Increased Protein -1.5 lbs.

3. Exercise/Increased Protein/Decreased Cals -5.5 lbs.*

*Statistically (p<.05) greater improvement than Group 1 and Group 2



Body Mass Index (BMI)

1. Exercise Only -0.49

2. Exercise/Increased Protein -0.31

3. Exercise/Increased Protein/Decreased Cals -1.04*




Percent Body Fat

1. Exercise Only -1.1%

2. Exercise/Increased Protein -1.9%

3. Exercise/Increased Protein/Decreased Cals -2.9%*




Fat Weight

1. Exercise Only -2.4 lbs.

2. Exercise/Increased Protein -3.9 lbs.

3. Exercise/Increased Protein/Decreased Cals -7.1 lbs.*




Waist Circumference

1. Exercise Only -1.1 in.

2. Exercise/Increased Protein -1.0 in.

3. Exercise/Increased Protein/Decreased Cals -1.7 in.*




Systolic Blood Pressure

1. Exercise Only -0.1 mmHg

2. Exercise/Increased Protein -1.7 mmHg

3. Exercise/Increased Protein/Decreased Cals -4.8 mmHg*




Diastolic Blood Pressure

1. Exercise Only -0.2 mmHg

2. Exercise/Increased Protein -4.4 mmHg*

3. Exercise/Increased Protein/Decreased Cals -3.4 mmHg*



Study Conclusions: Exercise/Increased Protein *Effective for increasing muscle mass *Effective for decreasing diastolic blood pressure

Exercise/Increased Protein/Decreased Calories: *Effective for decreasing body weight

*Effective for decreasing body mass index

*Effective for decreasing percent body fat

*Effective for decreasing fat weight

*Effective for decreasing waist circumference

*Effective for decreasing systolic blood pressure

*Effective for decreasing diastolic blood pressure

*Effective for maintaining muscle mass

Contact Information

If you have any questions or concerns regarding this seminar, please contact:

Wayne L. Westcott

Director of Exercise Science and Fitness Research

Quincy College

Quincy, MA

[email protected]

617-984-1716

mailto:[email protected]

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