Nutrition Programs Enhance Exercise Effects on Body Composition and Resting Blood Pressure

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1 All rights reserved: reproduction in whole or prt not permitted. All permission requests to reproduce or dpt published mteril must be directed to the journl office in Conshohocken, PA, no other persons or offices re uthorized to ct on our behlf. Reprints: CLINICAL FEATURES Nutrition Progrms Enhnce Effects on Body Composition nd Resting Blood Pressure DOI: /psm Wyne L. Westcott, PhD 1 Croline M. Apovin, MD 2,3 Kimberly Puhl, PhD 1 Lur Corin, PhD 1 Rit LRos Loud, BS 1 Scott Whitehed, BS 1 Kenneth Blum, PhD 4 6 Nichols DiNubile, MD 7 1 Deprtment of Nturl nd Helth Sciences, Quincy College, Quincy MA; 2 Boston University School of Medicine, Boston, MA; 3 Nutrition nd Weight Mngement Center, Boston Medicl Center, Boston, MA; 4 Deprtment of Clinicl Pin, G & G Holistic Addiction Tretment Center, North Mimi Bech, FL; 5 Deprtment of Nutrigenomics, LifeGen, Inc., Sn Diego, CA; 6 Deprtment of Psychitry, University of Florid College of Medicine, Ginesville, FL; 7 Deprtment of Orthopedic Surgery, Hospitl of the University of Pennsylvni, Phildelphi, PA Abstrct: The purpose of our study ws to exmine the effects of exercise lone nd exercise combined with specific nutrition progrms on body composition nd resting blood pressure rte. Adult prticipnts (99 women, 22 men; ged yers) completed combined strength nd endurnce exercise progrm ( Only), or in conjunction with 1 of 2 nutrition plns (; /Diet). The -Only group performed 1 set of 9 resistnce mchines regimens interspersed with 3 bouts of recumbent cycling (5 minutes ech). The group performed the sme exercise progrm s -Only group, plus consumed 1.5 g of protein per kg of idel body weight on dily bsis. The / Diet group followed n identicl protocol long with restricted dily cloric intke ( cls/dy for women; cls/dy for men). After 10 weeks of trining, the group ttined greter increses (P, 0.05) in len weight nd greter decreses (P, 0.05) in distolic blood pressure (DBP) rte thn the -Only group. The /Diet group experienced greter reductions (P, 0.05) in body weight, body mss index (BMI), percent ft, ft weight, wist circumference (WC), systolic blood pressure (SBP) rte, nd DBP rte thn the -Only group, s well s greter reductions (P, 0.05) in body weight, BMI, percent ft, ft weight, nd WC thn the group. Our findings suggest tht higher protein nutrition pln my enhnce the effects of exercise for incresing subject len weight nd decresing DBP rte. The findings further indicte tht higher protein nd lower clorie nutrition pln my enhnce the effects of exercise for decresing subject body weight, BMI, percent ft, ft weight, WC, SBP rte, nd DBP rte, while ttining similr gins in len body mss. Keywords: body composition; nutrition; diet; exercise; ft loss; blood pressure rte Correspondence: Wyne L. Westcott, PhD, Quincy College Science, 1250 Hncock Street, Quincy, MA Tel: Fx: E-mil: wwestcott@quincycollege.edu Introduction During the lst 2 decdes, severl studies hve shown tht stndrd strength-trining progrms cn be productive for concurrently incresing subject len weight nd decresing ft weight. 1 4 A representtive lrge-scle study with 1600 subjects, ged between 20 nd 86 yers, reveled men len-weight gin of 1.40 kilogrms nd men ft-weight loss of 1.77 kilogrms following 10 weeks of resistnce trining (1 set of 12 exercises, 2 or 3 dys weekly). 4 The reltively lrge ft loss resulting from comprtively brief strength-trining sessions ws most likely due to subjects incresed resting energy expenditure ssocited with high-intensity resistnce exercise. Reserch hs demonstrted significnt elevtions in subject resting energy expenditure for 72 hours fter single strength-trining session. 5,6 Prticipnts in one study experienced 5% increse in resting energy expenditure for 3 dys fter low-volume (1 set of 10 exercises) resistnce workout 6 ; nd subjects in nother study verged 9% increse in resting energy expenditure for 3 dys following high-volume (8 sets of 8 exercises) strength-trining session. 5 Severl other studies The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

2 Westcott et l hve demonstrted significnt increses in subject resting metbolic rte (pproximtely 7%) from low-, moderte-, nd high-volume resistnce-trining progrms, which represents pproximtely 100 to 120 more clories used t rest on dily bsis. 1 3,7 9 In ddition to the cute increse in energy the body uses for remodeling muscle tissue tht hs undergone exercise microtrum, resistnce trining results in greter muscle mss, necessitting chronic increse in energy expenditure for dily mintennce. It is estimted tht for ech kilogrm of trined muscle tissue, subject resting metbolic rte is incresed by pproximtely 20 clories per dy. 10 Subject energy requirement for performing 20-minute circuit strength-trining session is pproximtely 200 clories, 11 which totls 2400 clories monthly when the circuit is performed 3 times weekly. The energy requirement for the resulting increse in resting metbolic rte is pproximtely 100 clories dily, 6 which totls pproximtely 3000 clories monthly. Such reltively brief resistncetrining progrm my therefore use 5400 dditionl subject clories monthly, which, other things being equl, my reduce subject ft weight by pproximtely 0.68 kg monthly. Subject body composition benefits of resistnce exercise my be influenced by dietry protein intke, which my be prticulrly importnt considertion for older dults (ged 50 yers), s studies hve indicted tht the recommended dietry llownce (RDA) for protein (0.8 g/kg/d) my be indequte for individuls ge ,13 In Shrd s group, led resercher Cmpbell hs stted tht people ged $ 50 yers who do resistnce trining my require t lest 25% more protein thn the RDA to mintin muscle mss, nd $ 50% more protein thn the RDA to increse muscle mss. 14 Although resistnce exercise increses the rte of muscle protein synthesis, it lso increses the rte of muscle protein brekdown, resulting in net negtive protein blnce for severl hours following strength-trining session. 15 Consequently, it is essentil for exercisers who desire incresed muscle mss to induce positive protein turnover s much s possible. 16 During the lst few yers, studies hve shown tht incresed protein ingestion, prticulrly in close time proximity before nd/or fter strength-trining sessions, enhnces subject muscle gin, ft loss, 19,21,22 nd ssocited helth fctors. 23 For exmple, in previous study, 23 we divided 52 subjects (ged yers) into 3 different regimens: control group, resistnce-exercise group, nd resistnce-exercise-plus-supplement group, subjects in the ltter consuming 24 grms of protein nd 36 grms of crbohydrte immeditely following ech trining session. After 36 weeks, the resistnce-exerciseplus-supplement group experienced significntly greter gin in len weight nd significntly greter reduction in resting blood pressure rte, s well s greter increse in bone minerl density. Reserch hs reveled tht resistnce exercise is n effective mens for rebuilding muscle, rechrging metbolism, nd reducing ft in previously inctive men nd women, 24 nd tht these beneficil trining outcomes my be enhnced by incresed intke of dietry protein. 25 The purpose of our study ws to exmine the effects of exercise lone, exercise with incresed dily protein intke, nd exercise with both incresed dily protein intke nd decresed dily cloric intke on the following prticipnt prmeters: body weight, body mss index (BMI), percent body ft, ft weight, len weight, wist circumference (WC), nd systolic blood pressure (SBP) nd distolic blood pressure (DBP) rtes. Methods Prticipnts Our study ws pproved by the Quincy College Institutionl Review Bord (IRB) nd ws conducted in full complince with the IRB requirements. Study prticipnts included 121 dults (99 women, 22 men) between the ges of 20 nd 86 yers (men ge 59.7 yers), who completed 10-week reserch progrm in 1 of 3 study groups: -Only group, performed strength nd endurnce trining but did not modify eting behvior (n = 44); group, performed the sme exercise progrm s the -Only group, nd consumed 1.5 grms of protein per kilogrm of idel body weight on dily bsis (n = 32); nd n / Diet group tht followed the sme exercise nd protein-intke protocols s the group, nd lso restricted cloric intke to between 1200 nd 1500 clories dily for women or between 1500 nd 1800 clories dily for men (n = 45). Initil physicl chrcteristics for ll prticipnts in the 3 trining groups re presented in Tble 1, nd for subjects ged $ 60 yers, in Tble 2. Procedure All study subjects prticipted in closely supervised physicl ctivity clsses where they performed strength nd endurnce exercises in ccordnce with recommended trining protocols. 26 regimens were performed for period of 10 weeks. Ech clss consisted of pproximtely 8 prticipnts instructed by 2 ntionlly certified fitness professionls. 86 The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

3 Nutrition Progrms Enhnce Effects Tble 1. Bseline Study Subject Physicl Chrcteristics (All 3 Trining s, n = 121) Chrcteristic (n = 44) (n = 32) / Diet (n = 45) Age, y 62.0 ± ± ± 10.4 Height, in 65.2 ± ± ± 3.3 Body Weight, kg 78.0 ± ± ± 20.1 BMI 28.9 ± ± ± 5.4 % Ft 26.9 ± ± ± 4.9 Ft Weight, kg 21.4 ± ± ± 9.0 Len Weight, kg 55.8 ± ± ± 12.8 Wist Circumference, in 38.6 ± ± ± 6.8 Systolic BP, mm Hg ± ± ± 15.5 Distolic BP, mm Hg 74.2 ± ± ± 10.0 All vlues given s men ± SD. Abbrevitions: BMI, body mss index; DBP, distolic blood pressure; SBP, systolic blood pressure; SD, stndrd devition. Progrm The combined strength-nd-endurnce physicl ctivity progrm consisted of 9 resistnce mchine exercises interspersed with 3 bouts of recumbent cycling (Tble 3). Specificlly, the study prticipnts in ll 3 groups performed 1 set of 3 successive leg exercises (leg extension, leg curl, leg press) followed by 5 minutes of cycling; then 1 set of 3 successive upper body exercises (chest press, lt pulldown, shoulder press) followed by 5 minutes of cycling; then 1 set of 3 successive core exercises (bdominl curl, low-bck extension, torso rottion); followed by 5 minutes of cycling. Ech set of resistnce exercise ws performed with weight lod tht could be lifted in controlled mnner (pproximtely 3 seconds of concentric ction nd 3 seconds Tble 2. Bseline Physicl Chrcteristics of Study Prticipnts Aged $ 60 Yers (Subset, All 3 Trining s, n = 61) Chrcteristic (n = 28) (n = 12) / Diet (n = 21) Age, y 67.7 ± ± ± 10.4 Height, in 65.3 ± ± ± 3.3 Body Weight, kg 76.5 ± ± ± 20.1 BMI 28.5 ± ± ± 5.4 % Ft 26.6 ± ± ± 4.9 Ft Weight, kg 20.5 ± ± ± 9.0 Len Weight, kg 54.8 ± ± ± 12.8 Wist Circumference, in 38.6 ± ± ± 6.8 SBP, mm Hg ± ± ± 15.5 DBP, mm Hg 74.2 ± ± ± 10.0 All vlues given s men ± SD. Abbrevitions: BMI, body mss index; DBP, distolic blood pressure; SBP, systolic blood pressure; SD, stndrd devition. of eccentric ction) for minimum of 8 nd mximum of 12 repetitions. Whenever 12 repetitions could be completed with correct technique, the resistnce ws incresed for the subject by pproximtely 5%. Ech 5-minute bout of recumbent cycling ws performed in n intervl-trining formt with 20 seconds t higher effort level lternted with 20 seconds of lower effort level (Borg scle rtings of pproximtely 15 nd 10, respectively). 27 Nutrition Plns Prticipnts in the group modified their norml eting pttern to consume 1.5 grms of protein per kilogrm of idel body weight (gol BMI of 23) on dily bsis. For exmple, n individul who weighed 80 kilogrms but hd n idel body weight of 70 kilogrms ingested pproximtely 105 grms of protein dily throughout the study (1.5 g 3 70 kg). In generl, the protein level ws ttined by consuming more diry products (eg, low-ft milk, low-ft yogurt, low-ft cottge cheese) nd more len mets (eg, fish, chicken, turkey), s well s protein smoothies (commercil nd homemde). Prticipnts in the /Diet group modified their norml eting pttern to consume 1.5 grms of protein per kilogrm of idel body weight on dily bsis. In ddition, ech followed nutrition pln tht limited their food consumption to 1200 to 1500 clories dily for women nd 1500 to 1800 clories dily for men. Assessments All study ssessments were conducted t the beginning nd end of the 10-week trining period by experienced nd ntionlly certified fitness professionls. Ech prticipnt s pre- nd post-trining ssessments were performed by the sme tester. Subject ssessments included body weight, BMI, percent body ft, ft weight, len weight, WC, SBP rte, nd DBP rte. Body weight ws obtined to the nerest fifth of pound on n electronic scle (Tnit), nd body composition mesurements were obtined by mens of computerized ultrsound technology (SomTech). Wist circumference ws mesured to the nerest 16th of n inch through the nvel nd prllel to the floor. Blood pressure rtes were obtined by mens of clibrted sphygmomnometer nd stethoscope. Subjects were seted in quiet office for minimum of 10 minutes prior to the blood pressure mesurements. Dt Anlyses All dt re presented s men (m) ± stndrd devition (SD). Anlysis of vrince (2 3 3 mixed ANOVA with pre- nd The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

4 Westcott et l Tble 3. Protocol All 3 Trining s (n = 121) Leg extension Leg curl Leg press Recumbent cycle Chest press Lt pull-down Shoulder press Recumbent cycle Abdominl curl Low bck extension Torso rottion Recumbent cycle Sets x Reps/Durtion 5 minutes x 20-second intervls 5 minutes x 20-second intervls 5 minutes x 20-second intervls post- s the repeted mesure, nd tretment condition s the between fctor) ws pplied to determine sttisticlly significnt chnges in body weight, BMI, percent ft, ft weight, len weight, WC, SBP nd DBP rtes within nd mong the 3 study groups. The lph level for sttisticlly significnt differences ws set t P = For ll nlyses with significnt interctions, pir-wise comprisons between levels of within-subjects fctors were conducted. All dt nlyses were performed using IBM SPSS Sttistics 20 softwre. Results Chnges in body weight, BMI, percent ft, ft weight, len weight, WC, nd SBP nd DBP rtes for ll subjects in the 3 study groups re presented in Tble 4, nd for subjects ged $ 60 yers (n = 61), in Tble 5. Body Weight Anlysis of vrince reveled significnt interction mong tretment groups for chnges in body weight (F [2120] = 12.02; P = 0.001). Subjects in the /Diet group reduced body weight by 2.52 kg (3.10%), which ws significntly greter (P = 0.001) thn the body weight decrese for subjects in the -Only group (0.55 kg; 0.71%), nd significntly greter (P = 0.001) thn the subject body weight decrese in the group (0.68 kg; 0.81%). Body Mss Index Chnges in BMI showed significnt interction mong the tretment groups (F [2120] = 6.77; P = 0.002). Subjects in the /Diet group reduced BMI by men of 1.0 points, which ws significntly greter (P = 0.016) thn the BMI decrese in the -Only group ( 0.5 points), nd significntly greter (P = 0.003) thn the BMI decrese in the group ( 0.3 points). Tble 4. Chnges in Subject Physicl Chrcteristics t Week 10 (All 3 Trining s, n = 121) Chrcteristic Only (n = 44) (n = 32) /Diet (n=45) Body weight, kg ± ± ± 2.61 b,c BMI ± ± ± 1.01 b,c % Ft ± ± ± 2.21 b,c Ft Weight, kg ± ± ± 2.99 b,c Len Weight, kg ± ± 1.90 b ± 2.59 Wist Circumference, in ± ± ± 1.23 b,c SBP, mm Hg ± ± ± 9.71 b DBP, mm Hg ± ± 8.24 b ± 6.55 b All vlue given s men ± SD. b Sttisticlly greter improvement compred with -Only group (P, 0.05). c Sttisticlly greter improvement compred with group (P, 0.05). Abbrevitions: BMI, body mss index; DBP, distolic blood pressure; SBP, systolic blood pressure; SD, stndrd devition. Percent Ft Chnges in percent ft indicted significnt interction mong the tretment groups (F [2120] = 14.5; P = 0.001). The /Diet group experienced 2.9% reduction in percent ft, which ws significntly greter (P = 0.001) thn the percent ft decrese experienced by the -Only group ( 1.1%), nd significntly greter (P = 0.026) thn the percent ft decrese experienced by the group ( 1.9%). Ft Weight Anlysis of vrince reveled significnt interction mong tretment groups for chnges in ft weight (F [2120] = 12.2; P = 0.001). The /Diet group reduced Tble 5. Chnges in Physicl Chrcteristics of Study Prticipnts Aged $ 60 Yers t Week 10 (Subset, All 3 Trining s, n = 61) Chrcteristic Only (n = 28) (n = 12) /Diet (n = 21) Body weight (kg) ± ± ± 2.30 b,c BMI ± ± ± 0.90 b,c % Ft ± ± ± 2.89 b Ft Weight, kg ± ± ± 3.94 b Len Weight, kg ± ± ± 3.14 Wist Circumference, in ± ± ± 1.00 SBP, mm Hg ± ± ± DBP, mm Hg ± ± ± 6.56 All vlues given s men ± SD. b Sttisticlly greter improvement compred with -Only group (P, 0.05). c Sttisticlly greter improvement compred with group (P, 0.05). Abbrevitions: BMI, body mss index; DBP, distolic blood pressure; SBP, systolic blood pressure; SD, stndrd devition. 88 The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

5 Nutrition Progrms Enhnce Effects ft weight by 3.23 kg, which ws significntly greter (P = 0.001) thn the -Only group ( 1.10 kg), nd significntly greter (P = 0.009) thn the group ( 1.79 kg). Len Weight Chnges in len weight did not indicte significnt interction mong tretment groups (F [2120] = 1.3; P = 0.291). However, t test results reveled significntly greter (P = 0.047) gin in len weight for the group (+1.25 kg) thn for the -Only group (+0.52 kg). The /Diet group increse in len weight (+0.75 kg) ws not significntly different thn the 2 other tretment groups. Wist Circumference Wist circumference chnges did not quite ttin significnt interction mong tretment groups (F [2111] = 2.98; P = 0.055). Post hoc tests showed decreses in WC in the /Diet group ( 1.7 in) to be significntly greter (P = 0.041) thn in the -Only group ( 1.1 in), nd significntly greter (P = 0.041) thn in the group ( 1.0 in). Systolic Blood Pressure Rte Chnges in prticipnt SBP rte did not indicte significnt interction mong tretment groups (F [2118] = 2.19; P = 0.117). Post hoc nlysis reveled tht subjects in the /Diet group ttined 4.8 mm Hg decrese in SBP rte, which ws significntly greter (P = 0.040) thn the SBP rte chnge experienced by subjects in the - Only group (+0.1 mm Hg), but not significntly different thn the SBP rte chnge experienced by subjects in the group ( 1.7 mm Hg). Distolic Blood Pressure Rte Prticipnt DBP rte chnges showed significnt interction mong tretment groups (F [2118] = 3.39; P = 0.037). The /Diet group reduced DBP rte by 3.4 mm Hg, which ws significntly greter (P = 0.045) thn the DBP rte decrese in the -Only group ( 0.2 mm Hg). The group reduced DBP rte by 4.4 mm Hg, which ws significntly greter (P = 0.019) thn the DBP rte decrese in the -Only group ( 0.2 mm Hg). Subjects Aged $ 60 Yers Progrm prticipnts ged $ 60 yers were nlyzed s seprte entity to determine if older ge s fctor influenced chnges in ny of the ssessment prmeters. As presented in Tble 5, older dults in the /Diet group ttined significntly greter reductions in body weight nd BMI thn older dults in the -Only group nd the group. Older dults in the / Diet group lso experienced significntly greter reductions in percent ft nd ft weight thn older dults in the Only group. Although the differences did not rech sttisticl significnce, older dults in the /Diet group gined 1.08 kg nd 0.67 kg more len weight thn older dults in the -Only nd groups, respectively. The findings suggested tht prticipnts ged $ 60 yers responded fvorbly to the /Diet progrm with concurrent ft loss nd muscle gin. Discussion Study prticipnts who performed the exercise progrm without nutritionl modifictions (-Only group) experienced desirble chnges in body weight, BMI, percent ft, ft weight, len weight, nd WC. Study prticipnts who performed the exercise progrm nd incresed their dily protein intke to 1.5 grms per kilogrm of idel body weight ( group) ttined significntly greter increse in len weight nd significntly greter decrese in DBP rte thn the - Only group, suggesting tht the higher dily protein intke enhnced muscle remodeling processes nd fcilitted reduced rteril resistnce to blood flow. With respect to greter len weight gin, our results re consistent with those of other studies tht hve incresed the dily protein consumption of resistnce exercise prticipnts ,23 Our findings re lso in greement with recent study by Tielnd et l, 28 in which older dult strength triners who consumed pproximtely 1.3 grms of protein per kilogrm of body weight on dily bsis dded 1.36 kilogrms more len body mss thn those who did not increse protein intke. With respect to greter blood pressure reduction, our current results re similr to our previous study, 23 in which resistnce-trining prticipnts who consumed dditionl protein fter their exercise sessions experienced significntly greter decreses in SBP nd DBP rtes thn subjects who did not ugment their protein intke. Met-regression nlyses 29 hve indicted significnt inverse ssocition between initil subject BP rtes nd the degree of decrese in both SBP nd DBP in individuls who consume soy protein, which ws the protein source for the commercil shkes in our study. Study prticipnts who performed the exercise progrm, incresed their dily protein intke to 1.5 grms per kilogrm of The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

6 Westcott et l idel body weight, nd reduced their dily cloric consumption to 1200 to 1500 clories dily for women or 1500 to 1800 clories dily for men (/Diet group) experienced significntly greter decreses in body weight, BMI, percent ft, ft weight, nd WC thn both the -Only group nd the group, s well s chieving significntly greter reductions in resting SBP nd DBP rtes thn the -Only group. Although the /Diet group gined len weight, the increse ws not significntly greter thn tht experienced by the -Only group. The results of our study suggest tht exercise with higher protein intke but without cloric restriction is effective for chieving significntly greter len weight gin thn exercise lone. Our findings further indicte tht exercise with protein ugmenttion nd dietry restriction is effective for ttining significntly greter reductions in body weight, BMI, percent ft, ft weight, nd WC thn exercise lone or exercise with dditionl protein intke. Compred with exercise lone, exercise with protein ugmenttion nd cloric restriction resulted in significntly greter ft weight loss nd similr len weight gin in subjects. One limittion of our study ws tht the reserchers could not monitor the dietry intke of the progrm prticipnts. Consequently, the food log recordings my not hve been s ccurte s might be expected if dietry intke ws monitored in feeding study. Another limittion of the study ws the method used for ssessing chnges in prticipnt body composition. Although ultrsound technology my be the preferred field ssessment technique, more precise mesurements of ft weight nd len weight my hve been obtined through dul rdiogrph bsorptiometry (DEXA). A possible limittion of this study my hve been the uneven number of men nd women prticipnts (22 men nd 99 women); however, in previous study with similr subject men ge (56.2 yers), the men who prticipted experienced significntly greter increses in len weight (2.1 kg vs 1.2 kg) nd significntly greter decreses in ft weight (2.7 kg vs 1.4 kg) thn the women prticipnts. 30 Bsed on these findings, it is likely tht n even number of men nd women prticipnts my hve resulted in higher len weight gins nd higher ft weight losses cross ll the study groups. Future studies should provide monitoring of protein nd other mcronutrient consumption to better ssess intke, employ DEXA scns for more ccurte mesurements of body composition, nd enroll more comprble number of men nd women prticipnts. Conclusion Reserch revels tht combined progrm of strength nd endurnce exercise is effective for incresing subject len weight nd reducing ft weight. The findings from our study suggest tht incresing dily protein intke to pproximtely 1.5 grms per kilogrm of idel body weight my result in significntly greter len weight gin thn exercise lone. These findings further suggest tht incresing dily protein intke to pproximtely 1.5 grms per kilogrm of idel body weight nd decresing dily cloric intke to, 1500 clories dily for women nd, 1800 clories dily for men my result in significntly greter ft weight loss thn exercise lone, while ttining similr len weight gin. These resonble dietry recommendtions pper to be well received by beginning exercisers, between 20 nd 86 yers of ge, who desire more len weight nd less ft weight. We suggest 3-step pproch for progressively implementing productive exercise nd nutrition progrm. First, we recommend performing brief (35-minute) session of combined resistnce nd erobic trining, 2 or 3 dys week. Second, we dvise dding dietry protein by consuming high-protein shke or snck (20 30 g of protein) shortly fter ech exercise session. Third, we encourge grdul increse in protein-rich foods nd grdul decrese in dily cloric intke towrds those quntities ingested by the /Diet group prticipnts in our study (1.5 g protein/kg idel body weight/dy; cls/dy for women or cls/dy for men). Conflict of Interest Sttement Wyne L. Westcott, PhD, discloses no conflicts of interest. Croline M. Apovin, MD, hs received reserch grnts/ funding from the Dr Robert C. nd Veronic Atkins Foundtion, MetProteomics, Pfizer Inc, Eli Lilly nd Co., nd Grnd Centrl Publishing (the ltter for writing book bout the diet described in the study rticle); is member of the dvisory committee/bord of NutriSystem, Myos Corportion, Allergn, Merck, Johnson nd Johnson, Abbott, Aren, Zfgen, nd Novo Nordisk; is member of the dvisory committee/bord nd receives funding from Amylin, Orexigen, nd snofi-ventis. Kimberly Puhl, PhD, Lur Corin, PhD, Rit LRos Loud, BS, Scott Whitehed, BS, nd Kenneth Blum, PhD, disclose no conflicts of interest. Nichols DiNubile, MD, is consultnt for snofi nd Electronic Wveform Lb, Inc. References 1. Cmpbell WW, Crim MC, Young VR, Evns WJ. Incresed energy requirements nd chnges in body composition with resistnce trining in older dults. Am J Clin Nutr. 1994;60(2): Hunter GR, Wetzstein CJ, Fields DA, Brown A, Bmmn MM. Resistnce trining increses totl energy expenditure nd free-living physicl ctivity in older dults. J Appl Physiol. 2000;89(3): The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN

7 Nutrition Progrms Enhnce Effects 3. Prtley R, Nickls B, Rubin M, et l. Strength trining increses resting metbolic rte nd norepinephrine levels in helthy 50-to-65-yr-old men. J Appl Physiol. 1994;76(1): Westcott WL, Winett RA, Annesi JJ, Wojcik JR, Anderson ES, Mdden PJ. Prescribing physicl ctivity: pplying the ACSM protocols for exercise type, intensity, nd durtion cross 3 trining frequencies. Phys Sportsmed. 2009;37(2): Hckney KJ, Engels HJ, Gretebeck RJ. Resting energy expenditure nd delyed-onset muscle soreness fter full-body resistnce trining with n eccentric concentrtion. J Strength Cond Res. 2008;22(5): Heden T, Lox C, Rose P, Reid S, Kirk EP. One-set resistnce trining elevtes energy expenditure for 72 h similr to three sets. Eur J App Physiol. 2011;111(3): Broeder CE, Burrhus KA, Svnevik LS, Wilmore JH. The effects of either high-intensity resistnce or endurnce trining on resting metbolic rte. Am J Clin Nutr. 1992;55(4): Lemmer J, Ivey F, Ryn A, et l. Effect of strength trining on resting metbolic rte nd physicl ctivity. Med Sci Sports Exerc. 2001;33(4): Vn Etten LM, Westerterp KR, Verstppen FT, Boon BJ, Sris WH. Effect of n 18-wk weight-trining progrm on energy expenditure nd physicl ctivity. J Appl Physiol. 1997;82(1): Strsser B, Schobersberger W. Evidence for resistnce trining s tretment therpy in obesity. J Obes. 2011;2011: Hltom RW, Kremer RR, Slon RA, Hebert EP, Frnk K, Tryniecki JL. Circuit weight trining nd its effects on excess post-exercise oxygen consumption. Med Sci Sports Exerc. 1999;31(11): Cmpbell W, Trppe T, Wolfe R, Evns W. The recommended dietry llownce for protein my not be dequte for older people to mintin skeletl muscle. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M373 M Cmpbell W, Trppe T, Jozsi A, Kruskll LJ, Wolfe RR, Evns WJ. Dietry protein dequcy nd lower body versus whole body resistive trining in older humns. J Physiol. 2002;542(prt 2): Shrdt D. Sving muscle: How to sty strong nd helthy s you ge. Nutr Action Helth Lett (April);34(3): Biolo G, Mggi SP, Willims BD, Tipton KD, Wolfe RR. Incresed rtes of muscle protein turnover nd mino cid trnsport fter resistnce exercise in humns. Am J Physiol. 1995;268(3 pt 1):E514 E Poole C, Wilborn, C Tylor L, Kerksick C. The role of post-exercise nutrient dministrtion on muscle protein syntheses nd glycogen syntheses. J Sports Sci Med. 2010;9: Anderson L, Tufekovic G, Zebis M. The effects of resistnce trining combined with timed ingestion of protein on muscle fiber size nd muscle strength. Metbol. 2005;54: Cribb P, Hyes A. Effect of supplement timing on skeletl muscle hypertrophy. Med Sci Sports Exerc. 2006;38(11): Josse AR, Tng JE, Trnopolsky MA, Phillips SM. Body composition nd strength chnges in women with milk nd resistnce exercise. Med Sci Sports Exerc. 2009;42(6): Phillips S, Hrtmn J, Wilkinson S. Dietry protein to support nbolism with resistnce exercise in young men. J Am Coll Nutr 2005;24(2):134S 139S. 21. Hrtmn JW, Tng, JE, Wilkinson SB, et l. Consumption of ft-free fluid milk fter resistnce exercise promotes greter len mss ccretion thn does consumption of soy or crbohydrte in young, novice, mle weightlifters. Am J Clin Nutr. 2007;86(2): Westcott W, Mrtin W, L Ros Loud R, Stoddrd S. supplementtion nd body composition chnges. Fitness Mnge. 2008; 24(5): Westcott, Vrghese J, DiNubile N, et l. nd nutrition more effective thn exercise lone for incresing len weight nd reducing resting blood pressure. J Exerc Physiol. 2011;14(4): Westcott WL. ACSM strength trining guidelines: role in body composition nd helth enhncement. ACSM s Helth Fitness J. 2009;13(4): Westcott WL, L Ros Loud R. Enhncing resistnce trining results with protein/crbohydrte supplementtion. ACSM s Helth Fitness J. 2013;17(2): Americn College of Sports Medicine. ACSM s Guidelines for Testing nd Prescription. 7th ed. Phildelphi, PA: Lippincott, Willims nd Wilkins; Borg, G. Borg s Perceived Exertion nd Pin Scles. Chmpign, IL: Humn Kinetics; Tielnd M, Dirks ML, vn der Zwluw N, et l. supplementtion increses muscle mss gin during prolonged resistnce-type exercise trining in fril elderly people: rndomized, double-blind, plcebocontrolled tril. J Am Med Dir Assoc. 2012;13(8): Dong JY, Tong X, Wu ZW, Xun PC, He K, Qin LQ. Effect of soy protein on blood pressure: met-nlysis of rndomized controlled trils. Br J Nutr. 2011;106(3): Westcott WL, Winett RA. Applying the ACSM guidelines. Fitness Mnge. 2006;22(1): The Physicin nd Sportsmedicine, Volume 41, Issue 3, September 2013, ISSN