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. (Strasser, J. Obesity, 2011)
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)
Recharging Resting Metabolism Chronic Adaptation: A 3.1 lb. increase in trained muscle tissue may raise resting metabolic rate almost 30 calories per day. (Strasser, J. Obesity, 2011)
Recharging Resting Metabolism 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 intraabdominal 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)
Resisting Type 2 Diabetes Resistance exercise may be preferable to aerobic activity for improving insulin sensitivity and lowering HbA1C. (Bweir, Diabetes Metabolic Syndrome, 2009: Eves, Diabetes Care, 2006)
Resisting Type 2 Diabetes 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)
Improving Cardiovascular Health 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)
Improving Cardiovascular Health 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)
Improving Cardiovascular Health Blood pressure reductions with resistance training comparable to aerobic activity. * -6.0 mmhg systolic * -4.7 mmhg diastolic (Meta-analysis by Cornelissen, Hypertension, 2005)
Improving Cardiovascular Health 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)
Improving Cardiovascular Health 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)
Improving Cardiovascular Health 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)
Increasing Bone Mineral Density 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)
Increasing Bone Mineral Density 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)
Increasing Bone Mineral Density 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)
Enhancing Mental Health 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)
Enhancing Mental Health 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/Exercise for Weight Loss Study 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)
Nutrition/Exercise for Weight Loss Study 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
Nutrition/Exercise for Weight Loss Study Study Results (N=121) 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
Nutrition/Exercise for Weight Loss Study Study Results (N=121) Body Mass Index (BMI) 1. Exercise Only -0.49 2. Exercise/Increased Protein -0.31 3. Exercise/Increased Protein/Decreased Cals -1.04* *Statistically (p<.05) greater improvement than Group 1 and Group 2
Nutrition/Exercise for Weight Loss Study Study Results (N=121) Percent Body Fat 1. Exercise Only -1.1% 2. Exercise/Increased Protein -1.9% 3. Exercise/Increased Protein/Decreased Cals -2.9%* *Statistically (p<.05) greater improvement than Group 1 and Group 2
Nutrition/Exercise for Weight Loss Study Study Results (N=121) Fat Weight 1. Exercise Only -2.4 lbs. 2. Exercise/Increased Protein -3.9 lbs. 3. Exercise/Increased Protein/Decreased Cals -7.1 lbs.* *Statistically (p<.05) greater improvement than Group 1 and Group 2
Nutrition/Exercise for Weight Loss Study Study Results (N=121) Waist Circumference 1. Exercise Only -1.1 in. 2. Exercise/Increased Protein -1.0 in. 3. Exercise/Increased Protein/Decreased Cals -1.7 in.* *Statistically (p<.05) greater improvement than Group 1 and Group 2
Nutrition/Exercise for Weight Loss Study Study Results (N=121) 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* *Statistically (p<.05) greater improvement than Group 1
Nutrition/Exercise for Weight Loss Study Study Results (N=121) 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* *Statistically (p<.05) greater improvement than Group 1
Nutrition/Exercise for Weight Loss Study 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 wwestcott@quincycollege.edu 617-984-1716