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EXERCISE IS MEDICINE

Resistance Training is Medicine: Effects
of Strength Training on Health
Wayne L. Westcott, PhD

As American lifestyle became more
Abstract
sedentary and heart disease became the
Inactive adults experience a 3% to 8% loss of muscle mass per
leading cause of death, regular exercise
decade, accompanied by resting metabolic rate reduction and fat
was promoted for attaining physical
accumulation. Ten weeks of resistance training may increase lean
fitness, desirable body weight, and car-
weight by 1.4 kg, increase resting metabolic rate by 7%, and reduce fat
diorespiratory health. However, the
weight by 1.8 kg. Benefits of resistance training include improved
overwhelming emphasis was on aerobic
physical performance, movement control, walking speed, functional
activity with little encouragement for
independence, cognitive abilities, and self-esteem. Resistance training
resistance training (29).
may assist prevention and management of type 2 diabetes by decreasing
More recently, attention has been
visceral fat, reducing HbA1c, increasing the density of glucose transporter
given to age-related muscle loss (68,95)
type 4, and improving insulin sensitivity. Resistance training may enhance
and associated physiological problems
cardiovascular health, by reducing resting blood pressure, decreasing
such as bone loss (101), metabolic de-
low-density lipoprotein cholesterol and triglycerides, and increasing
cline (142), fat gain (124), diabetes
high-density lipoprotein cholesterol. Resistance training may promote
(46), metabolic syndrome (125), and
bone development, with studies showing 1% to 3% increase in bone
all-cause mortality (45). Given the
mineral density. Resistance training may be effective for reducing low
serious problem of sarcopenia in an
back pain and easing discomfort associated with arthritis and
increasingly sedentary and aging pop-
fibromyalgia and has been shown to reverse specific aging factors in
ulation (71), and the accumulating evi-
skeletal muscle.
dence that resistance exercise promotes
muscle gains in men and women of all
Introduction ages (144), it is understandable that leading researchers have
Not long ago, the muscle-building activity known as advocated a public health mandate for sensible resistance
weight training generally was considered to be the domain training (109).
of exceptionally strong men who competed in sports such The series of events that seem to be associated with a
as powerlifting, Olympic lifting, bodybuilding, and foot- large number of illnesses, injuries, and infirmities are 1)
ball. It was obvious that these athletes required high levels muscle loss, 2) leading to metabolic rate reduction, 3) fol-
of strength and muscularity to excel in their chosen sport lowed by fat gain that places almost 80% of men and 70%
and that their mesomorphic physiques responded favor- of women 60 years of age and older in the undesirable
ably to heavy resistance training with barbells and dumb- categories of overweight or obese (47). These percentages
bells. Average individuals saw no reason to engage in are based on body mass index calculations that do not
weight training, and participants in other sports typically account for age-related sarcopenia (50). It is therefore
felt that lifting weights actually would hinder their athletic likely that an even higher percentage of the older adult
performance. population has excess body fat (above 22% for males and
above 32% for females) (4).
Muscle mass declines between 3% and 8% each decade
after age 30 (46), averaging approximately 0.2 kg of lean
weight loss per year (49,50). Muscle loss increases to 5% to
Department of Exercise Science, Quincy College, Quincy, MA
10% each decade after age 50 (95), averaging approximately
Address for correspondence: Wayne L. Westcott, PhD, Department of 0.4 kg per year after the fifth decade of life (101). Skeletal
Exercise Science, Quincy College, 1 President’s Place, 1250 Hancock muscle, which represents up to 40% of total body weight,
Street, Quincy, MA 02169; E-mail: wwestcott@quincycollege.edu. influences a variety of metabolic risk factors, including obe-
1537-890X/1104/209Y216
sity, dyslipidemia, type 2 diabetes, and cardiovascular disease
Current Sports Medicine Reports (124). Muscle tissue is the primary site for glucose and tri-
Copyright * 2012 by the American College of Sports Medicine glyceride disposal, so muscle loss specifically increases the

www.acsm-csmr.org Current Sports Medicine Reports 209

Copyright © 2012 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

141.g. (116). gain also reported approximately 1.44. as a chronic response. Increased resting metabolic rate would seem to be a major lowing approximately 3 months of resistance training. which contribute to the development of (38. resulting from resistance training in older women (65. With respect to abdominal adipose tissue.130) as well as only one-third as much Reversing Muscle Loss visceral fat gain in premenopausal women over a 2-year Numerous studies have demonstrated that relatively brief study period (7% resistance trained vs 21% untrained) sessions (e. muscle loss is the greatest con. resting Training frequencies of 2 and 3 dIwkj1 produced similar lean energy expenditure may remain elevated by 100 calIdj1 for weight gains. review article on aging.101. the participants increased rate (approximately 7%) after several weeks of resistance their overall strength by 60%. It is predicted that by the middle of this 3 sets each) or a low-volume resistance workout (10 exercises  century.4 kg fol. improved insulin sensitivity.64. physical performance (61).124). Unauthorized reproduction of this article is prohibited. the workout (58). Flack et al. of daily calorie use among sedentary men and women.risk of glucose intolerance and associated health issues blood pressure. Reducing Body Fat including those demonstrating improvements in insulin Excessive body fat is associated with risk factors such as resistance and glycemic control (24. effects associated with inactive aging.37. twice a week. resistance machine exercises.112.62).4 kg after 10 wk of resistance (50 cal) for recovery processes during the first hour following training incorporating 12 total exercise sets per session (144). Second. With tissue (148). Research has revealed that increase in trained muscle tissue may raise resting metabolic resistance training can reverse some of the debilitating rate by about 20 calIdj1 (124). Resistance training stimulates increased muscle protein turnover (39) and actually has a dual impact on resting Facilitating Physical Function metabolic rate.89.112.25.0-kg activities of daily living (143).8 kg of fat weight loss Because resting metabolism accounts for about 65% to 70% (22. and resting presented in the previous section.141.56. these studies showed lean weight gains of about 1.141). A 1. regular resistance ing may be an effective intervention approach for middle- training may increase energy expenditure at rest by 100 calIdj1 aged and older adults to counteract age-associated declines in or more. This position is supported by numerous research studies. type 2 diabetes and cardiovascular disease (94. one of three adults will have diabetes (15). Consequently.22. more recent and improved their functional independence measure by studies have revealed a similar elevation in resting energy 14% (141). A 20-min circuit resistance training pro- representative large-scale study with more than 1. Furthermore. Muscle protein breakdown and synthesis largely are In their review article. and diabetes diture for 3 d after their respective exercise sessions (60). gram may require approximately 200 cal for every per- ticipants between the ages of 21 and 80 years revealed a formance and may use 25% as many additional calories mean lean weight increase of 1. resistance training. A factor in fat loss. which is concluded that resistance training is recommended in the approximately 11 to 12 calIdj1Ikgj1 of untrained muscle management of obesity and metabolic disorders.53.112.124. circuit resistance training sessions a week. nursing home relatively large amounts of energy for muscle remodeling residents (mean age = 89 years) performed one set of six processes that may persist for 72 h after the training session.146). training (17. several resistance training tributor to the age-related decline in resting metabolic rate studies that showed approximately 1. As elevated plasma cholesterol. Participants who performed a tional abilities (63. resistance training also has 210 Volume 11 & Number 4 & July/August 2012 Resistance Training is Medicine Copyright © 2012 by the American College of Sports Medicine. At Research has shown significant increases in resting metabolic the end of the training period. (46) concluded that resistance train- Based on the findings from these studies. First. and there were no significant differences in muscle remodeling processes (60). Strasser and Schobersberger (124) responsible for energy expenditure in resting muscle.4 kg of lean weight (108).129. for 14 wk.64. .60).137). even in elderly resistance training causes tissue microtrauma that requires individuals (44.7 kg of lean weight.56. prevention. and enhanced can increase muscle mass in adults of all ages through the sympathetic activity as possible means by which resistance 10th decade of life (22. (68) have identified increased resting ance training (two or three nonconsecutive days per week) metabolic rate.74). over the next 72 h. research has reduction of muscle mass and resting metabolic rate may be revealed significant reductions in intra-abdominal fat accompanied by increased fat weight (148). as an acute response. which averages 2% to 3% per decade in adults (83). Assuming two 20-min muscle development among any of the age groups. resistance train.46.40. insulin sensitivity and to prevent the onset of type 2 diabetes. In their 1 set each) averaged a 5% increase in resting energy expen. the associated energy utilization would approximate 5000 calImoj1 (eight Recharging Resting Metabolism workouts  250 cal + 30 d  100 cal). func- resistance training (55.64. Hurley et al. Many of training may decrease intra-abdominal fat stores. In one study. averaged an 8% (trained subjects) to 9% (untrained subjects) increase in resting energy expenditure for 3 d after the exer.144).144). Resisting Type 2 Diabetes cise session (55). Aging is accompanied by a gradual reduction in physical ing results in greater muscle mass that necessitates more function that negatively affects the ability to perform energy at rest for ongoing tissue maintenance.131) and older men (69. added 1.600 par. respect to overall body fat. Other studies support resistance training by expenditure (5% to 9%) for 3 d following a single session of older adults for enhancing movement control (9). Beginning participants who performed As the obesity problem increases so does the prevalence of either a moderate-volume resistance workout (10 exercises  type 2 diabetes. and high volume resistance workout (8 exercises  8 sets each) walking speed (115).. 12 to 20 total exercise sets) of regular resist. However. plasma glucose.

training and aerobic activity produce similar effects on blood According to Phillips and Winett (109). is evidence that combined resistance training and aerobic ted findings related to cardiovascular benefits of resistance activity improves blood lipid profiles better than either training included improved body composition.84).acsm-csmr. as well as qualitative improve. ‘‘resistance training is at least as review by Tambalis et al. while other research reveals (ages 21 to 80 years) who performed 20 min of resistance enhanced vascular conductance and condition with resist- training and 20 min of aerobic activity 2 or 3 dIwkj1 for a ance training (8. with the exception of high- area and lean body mass. training (14.7 mm Hg diastolic and lower-volume and lower-intensity exercise protocols.40) and for lowering HbA1c (21).4 mm Hg. One study reported rest. Vascular condition refers to the ability of arteries to tension. and reduce triglycerides by 11% to 18% (p. which is a major factor in cardiovascular disease accommodate blood flow. but there major cardiovascular disease risk factors’’ (p. After a careful of visceral and subcutaneous abdominal fat. A more recent meta- training programs incorporating higher-volume and higher. insulin resistance seems to be associated with abdominal fat A meta-analysis of randomized controlled trials by Kelley accumulation in aging adults (28. Older Adults (3). resting which resistance training influences blood lipid profiles blood pressure. This were comparable with those associated aerobic activity (31). including increases significantly. improved lipoprotein-lipid profiles. Hur- blood pressure. and HDL cholesterol profiles (41).67. (32. decrease low-density lipoprotein (LDL) cholesterol by 13% tivity (21. recommendation is consistent with the resistance training guidelines of the American Diabetes Association to exercise Blood Lipid Profiles all major muscle groups. Some investigators have found that resistance metabolic disorders (125). Resting Blood Pressure Vascular Condition Approximately one-third of American adults have hyper. Unauthorized reproduction of this article is prohibited. and Kelley (77) concluded that resistance training is effective ature review. to suggest that resistance training may enhance cardiovas- respectively. A study by Kelemen and Effron (75) also dem.42.134. which may be partic. further study is necessary to significantly reduced resting systolic and diastolic blood determine the relevant role of resistance training in vascular pressure readings by 3. In a study with elderly women (70 to 87 years of age). respectively. and insulin-mediated glucose clear.0 mm Hg systolic and j4. there is evidence to suggest that resistance ance. which did not change ments in muscle metabolic properties.135). Medicine position stand on Exercise and Physical Activity for thase content/activity. Subjects who trained twice a week cluded in their literature review. some studies show no effect of resistance training on ing blood pressure changes in more than 1. resistance lipid profiles (13.126. onstrated significant blood pressure reductions from com- ularly important for diabetes prevention.76. The repor.99). Flack et al. (Table). There also is evidence that resistance training may be training may increase HDL cholesterol by 8% to 21%.121).been shown to reduce abdominal fat. blood lipid profiles. A 2009 (124) concluded that. Improving Cardiovascular Health resistance training significantly improved triglyceride. (68) suggested that lipoprotein-lipid responses to hanced glycemic control (124).121). (46) suggested that resistance for reducing resting blood pressure. effects of resistance training on three key physiological fac.79. mobilization exercise performed independently (110). preferable to aerobic exercise for improving insulin sensi. density lipoprotein (HDL) cholesterol.6 and 2. reduced resting review of the research literature and their own studies. 3 dIwkj1. 6). as well as reduce the risk of predisposing www. Those adaptations. Based on their liter. 1519). whereas other studies have cluded that resistance training should be recommended for not demonstrated significant changes in blood lipid levels the prevention and management of type 2 diabetes and (85. there is sufficient evidence and diastolic blood pressure readings by 4. and vascular condition. This section addresses the resistance training likely are to be genotype dependent. cular health (16). (126) revealed resistance training to effective as aerobic endurance training in reducing some be an effective means for reducing LDL cholesterol. The review authors con.56. LDL A 2011 literature review by Strasser and Schobersberger cholesterol. which directly affects blood pres- (106). analysis of randomized controlled trials found that blood intensity protocols may be more effective for improving pressure reductions associated with resistance training aver- insulin resistance and glucose tolerance compared with aged j6.2 and 1. Several studies have shown beneficial decreased glycosylated hemoglobin (HbA1c) in people with effects on lipoprotein-lipid profiles resulting from resistance abnormal glucose metabolism. This is because bined resistance training and endurance exercise. to 23%. Association (91). As Phillips and Winett (109) con- period of 10 wk (144). glycogen syn. ley et al.org Current Sports Medicine Reports 211 Copyright © 2012 by the American College of Sports Medicine. approximately 45% of Americans have A meta-analysis by Strasser et al.113). According to the American College of Sports in the density of glucose transporter type 4.600 participants arterial compliance (93. who trained 3 dIwkj1 significantly reduced resting systolic Based on the research reviewed. Some studies more months of standard resistance training or circuit style indicate that resistance training reduces arterial compliance resistance training (25. A review by Kelley and Kelley (79) training is associated with improved glucose and insulin reported modest improvements in blood lipid profiles homeostasis because of increases in muscle cross-sectional resulting from resistance training. Several studies have demonstrated reduced resting sure. namely.2 mm Hg.121). (125) revealed that undesirable blood lipid profiles that increase their risk for resistance training reduced visceral adipose tissue and cardiovascular disease. progressing to three sets According to a recent report of the American Heart of 8 to 10 repetitions at high intensity (122). Research studies are inconsistent regarding the effects systolic and/or diastolic blood pressure following two or of resistance training on vascular condition. and en.105). . indicating that genetic factors may determine the degree to tors associated with cardiovascular health.

meta-analysis by Wolfe et al. there is evidence that young men may increase BMD by 2.36. legs). Unauthorized reproduction of this article is prohibited. (104). (104). positive effects in post coronary patients. Although much of the research on resistance training Training technique Perform each repetition in a controlled and bone density has been conducted with older women.52.98.98). by physical training than other psychological measures. as a programs prevented or reversed approximately 1% bone loss global concept of one’s perception of himself or herself. Training frequency Train each major muscle group two or three nonconsecutive days per week. potent effect on bone density than other types of physical Resistance training also has been shown to produce activity such as aerobic and weight bearing exercise (54). abdomen. nation of the resistance training program leads to reversal of Training resistance Use a resistance that can be performed BMD gains (139.103.88).72. bones because the musculoskeletal effects of resistance training relatively are site specific (1. a clusion in Layne and Nelson’s (88) review that resistance combination of resistance training and aerobic activity gen. and depression. improvements in cognitive abilities in older adults.139. (133). hips.150). pain allevia- tion in people with osteoarthritis.138. (149) indicated that exercise According to O’Connor et al. (5Y7) have shown 10 wk of combined resist- have identified several possible reasons for the inconsistent ance training and aerobic activity to improve significantly 212 Volume 11 & Number 4 & July/August 2012 Resistance Training is Medicine Copyright © 2012 by the American College of Sports Medicine.102. and low back Increasing Bone Mineral Density issues.73.111. studies show that termi- training for each major muscle group.78). Although resistance The majority of studies in this area support the con- training alone seems to provide cardiovascular benefits. assignments. (82) indicated that resistance training resulted in a 3.90. arthritic discomfort (48. tion and psychological measures.23.92.140). this sec- Department of Health and Human Services estimates that tion will address the effects of resistance training on cogni- 30% of women and 15% of men will experience bone frac.66). Several longitudinal studies have shown sig.Table study results. tures due to osteoporosis (136).7% to 7. Adults who do not perform resistance training featured endurance exercise alone or combined aerobic may experience 1% to 3% reduction in bone mineral density activity and resistance training (104). per year (femoral neck and lumbar spine) in adult and older relatively is stable over time and less likely to be affected adult women. studies by resistance training (26. exercise using only resistance training interventions have shown interventions that promote muscle gain also may be expected significant improvement in cognitive abilities (20. lack of randomized exercise training (4) (p.87).123).114). and almost 35 million others low back pain (59.57). dermilk (51) revealed that resistance training increased BMD Nonetheless. and repetitions for 8 to 12 repetitions.101.S. positive changes in self-esteem as a result of between 1% and 3% (femoral neck and lumbar spine) in resistance training have been reported in older adults premenopausal and postmenopausal women. anxiety.172). However. the mental health benefits of resist- enhancing both self-concept and self-efficacy in cardiac ance training for adults include reduction of symptoms in patients (43. and pain associated with fibromyalgia (12. and calcium and vitamin D supplemen- tation (35. According to the National Osteoporosis Foundation. people with fatigue. .117. Training exercises Perform 8 to 10 multijoint exercise that Other variables that may influence BMD research results address the major muscle groups are growth hormone administration in men (150).11. and different resistance training intensities. women (19). A 2-year study by Kerr et al. and O’Connor et al. intake (30. short intervention American College of Sports Medicine recommendations for resistance periods. aerobic relationship.147). metabolic syndrome (68. replacement therapy in women (52. manner through a full range of motion. However. activity plus resistance training produced significantly nificant increases in BMD after 4 to 24 months of resistance greater cognitive improvement in inactive older adults training (34. and the majority of studies support this In a meta-analysis by Colcombe and Kramer (27). low completion rates.140).101.7% through resistance training (1). studies (BMD) every year of life (80. A more recent review by Going and Lau. have insufficient bone mass or osteopenia (100). self-esteem. Cussler et al. increasing According to a comprehensive research review by muscular strength. and participants of cardiac rehabilitation (10). including small sample sizes. shoulders.2% improvement in BMD compared Training sets Perform two to four sets of resistance with the control group.145). Numerous stud- ies indicate that resistance training is a safe and productive Enhancing Mental Health means for maintaining desirable body weight. A than aerobic activity alone. much of the research has been loss (sarcopenia) is associated with bone loss (osteopenia) conducted with older adults. younger adults (132). improving physical performance. significant increases in BMD following 4 to 32 months of With respect to other psychological measures. training appears to be associated positively with high BMD erally is recommended for healthy adults (16) and for older in both younger and older adults and may have a more adults (3). Research reveals that muscle Concerning cognition. and most of the studies have (2.81.81. hormone (chest. cancer patients Conversely.18. other longitudinal studies have failed to show (33). to increase BMD.96. back.86).82. and improvements in self-esteem.72. The U.125. While there is consider- approximately 10 million American adults (8 million able evidence that appropriate resistance training reduces women) have osteoporosis. The range of Exhale during lifting actions and inhale BMD change is related to different responses in different during lowering actions. Logically.70.128). fibromyalgia. dietary protein arms. (34) Annesi et al.

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