TR Concorrente Lipidemia Pos Menopausa

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Journal of Strength and Conditioning Research Publish Ahead of Print

DOI: 10.1519/JSC.0000000000001732
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3 CONCURRENT TRAINING PROMOTED SUSTAINED ANTI-ATHEROGENIC BENEFITS
4 IN THE FASTING PLASMA TRIACYLGLYCEROLEMIA OF POSTMENOPAUSAL
5 WOMEN AT 1-YEAR FOLLOW-UP.
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7 Short-title: Lipid profiles, postmenopausal women and follow-up.
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9 Fabrício E. Rossi1, Tiego A. Diniz1, Ana Claudia S. Fortaleza1, Lucas M. Neves2, Malena R. Picolo3,
10 Paula A. Monteiro1, Camila Buonani4, Fábio S. Lira5, Ismael F. Freitas Jr4.
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12 Institute of Bioscience, University Estadual Paulista, Rio Claro, São Paulo, Brazil.
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14 School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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16 Department of Physiotherapy, University Estadual Paulista, Presidente Prudente, São Paulo, Brazil.
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18 Department of Physical Education, University Estadual Paulista, Presidente Prudente, São Paulo,
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19 Brazil.
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21 Exercise and Immunometabolism Research Group, Department of Physical Education, University
22 Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
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Copyright ª 2016 National Strength and Conditioning Association

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28 Corresponding Author
29 Fabrício E. Rossi. Department of Physical Education. Paulista State University "Júlio Mesquita
30 Filho". Roberto Simonsen Street. nº 305 – Education Center. Presidente Prudente. 19060-900. São
31 Paulo. Brazil. Telephone: 55 18 32295828 Fax. 55 18 3221 4391. e-mail: rossifabricio@yahoo.com.br
32 (This e-mail address can be published).
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34 ABSTRACT
35 The aim of this study was to compare the effects of aerobic and concurrent training (aerobic plus
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36 strength training) on the lipid profiles of normotriacylglycerolemic and hypertriacylglycerolemic
37 postmenopausal women and to verify whether the benefits of aerobic and concurrent training were
38 sustained after 1 year. Total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density
39 lipoprotein cholesterol (LDL-c), Triacylglycerol (TAG) and glucose were assessed in 46

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40 normotriacylglycerolemic (TAG<150 mg/dL) postmenopausal women divided into three groups:
41 Aerobic Training (AT), Concurrent Training (CT) and a Control Group (CG). For CT group,
42 hypertriacylglycerolemic postmenopausal women were recruited (TAG≥150 mg/dL, n=14). Total
43 daily caloric consumption and free-living physical activity were evaluated by dietary
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44 questionnaires and accelerometer respectively and fat mass by DXA. In 16 weeks, CT was
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45 effective in increasing HDL-c (normotriacylglycerolemic: pre=57.1±17.3 mg/dL x post= 64.3±16.1
46 mg/dL; p=0.020 and hypertriacylglycerolemic: pre=44.7±9.6 mg/dL x post=50.3±15.3 mg/dL;

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47 p=0.012) and reducing the atherogenic index in normotriacylglycerolemic (pre= 3.6±0.9 mg/dL x
48 post= 3.0±0.6 mg/dL; p=0.003) and hypertriacylglycerolemic (pre= 5.2±1.1 mg/dL x post= 4.7±1.2
49 mg/dL; p=0.018) postmenopausal women. In addition, the effects were sustained at the 1-year follow-
50 up only among the hypertriacylglycerolemic postmenopausal women. The anti-atherogenic status in
51 normo and hypertriacylglycerolemic postmenopausal women was changed by CT but without
52 significant differences between groups. Furthermore, these benefits are sustained at the 1-year follow-
53 up among the hypertriacylglycerolemic subjects.
54 Keywords: strength training; endurance training; follow-up; menopause.

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55 INTRODUCTION
56 The period of menopause is followed by a decrease in estrogen concentrations (25) and
57 contributes to the development of morbidities such as type 2 diabetes mellitus, hypertension,
58 dyslipidemia, metabolic syndrome (28) and cardiovascular diseases, such as atherosclerosis, which are
59 all leading causes of death worldwide (31). Associated with the menopausal period, physical inactivity
60 can be an aggravating factor, since the reduction in levels of physical activity also results in decreased
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61 fat-free mass, increased fat mass and trunk fat (3), increased risk of cardiovascular disease (12) and
62 postmenopausal breast cancer (21). Moreover, chronic systemic inflammation is associated with
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63 physical inactivity independent of obesity (8), thus, different training models have been used in an
64 attempt to minimize the effects of menopause.
65 While previous meta-analytic research with aerobic exercise has reported significant
66 improvements in lipids and lipoproteins among women (16), the effects of strength training have been
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67 unclear (2). Combined aerobic plus strength training in the same session of training (concurrent
68 training) is an interesting option for regulating lipid profiles, since endurance training has anti-
69 inflammatory effects, and increases cardiovascular fitness and oxidation of lipids in skeletal muscle
70 and the liver, while strength training has anticatabolic effects, and increases the oxidation of
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71 carbohydrates in skeletal muscle and increasing muscle anabolism (19,29).
72 Furthermore, as shown in a systematic review conducted by Tambalis et al. (40) which

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73 compared different kinds of training and different intensities, they emphasized that although
74 concurrent training is proposed for improvements in cardiovascular and functional fitness in older
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75 adults, the influence of concurrent training on blood lipids are restricted, and its effect on the lipid
76 profiles between normotriacylglycerolemic and hypertriacylglycerolemic women may be different. In
77 addition, it is not known whether these positive outcomes acquired after the aerobic and concurrent
78 training program in this high-risk population are maintained for the long-term (beyond 6 months and 1
79 year).
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81 Thus, the objectives of the present study were: 1) to verify whether aerobic and concurrent
82 training promotes different benefits on the lipid profiles of Normotriacylglycerolemic and
83 hypertriacylglycerolemic postmenopausal women and 2) to verify whether the benefits of
84 concurrent training on the lipid profile in Normotriacylglycerolemic and Hypertriacylglycerolemic
85 postmenopausal women are sustained at the 1-year follow-up.
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87 METHODS
88 Subjects
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89 This controlled clinical trial study was carried out from February to July of 2013, with follow-
90 up conducted in January and August of 2014, at the University Estadual Paulista (FCT / UNESP),
91 Presidente Prudente, SP, Brazil. The project was approved by the Ethics Research Group of the
92 University (Protocol 64/2011). Subjects were invited to participate in the study via television and
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93 newspaper advertising. Prospective participants contacted the researchers by phone and an
94 appointment was made in order to conduct a more detailed interview. The inclusion and exclusion
95 criteria were: 1) being in menopause [Menopausal status was based on self-report: had no menstrual
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96 cycle for one or more years] (27) and blood measures taken for Follicle-Stimulating Hormone
97 (FSH≥26.72 mUI/ml) (37); 2) not taking medication for diabetes or dyslipidaemia; 3)

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98 Normotriacylglycerolemic (Triacylglycerol<150 mg/dL) (33); 4) no smoking and alcohol for the past
99 6 months; 5) not having participated in any systematic physical exercise for at least six months prior to
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100 the study; 6) not receiving treatment for hormone replacement; and 7) not presenting any physical
101 limitations or health problems that could prevent the completion of the assessments and exercise
102 interventions.
103 Out of a total of 90 women who participated in the first screening, only 46 met all the
104 inclusion and exclusion criteria and agreed to participate in the study protocol. Participants were
105 randomized into three study groups, using simple randomization techniques for allocation, which
106 ensures that trial participants have an equal chance of being allocated to a treatment group

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107 (39): a concurrent training group (CT, n= 16) and an aerobic training group (AT, n= 15), both of
108 which performed 16-weeks of training, and a control group (CG, n= 15) which went 16-weeks without
109 regular physical exercise. To verify whether aerobic plus strength training would promote the same
110 benefits in Hypertriacylglycerolemic postmenopausal women, we recruited Hypertriacylglycerolemic
111 women (Triacylglycerol≥150 mg/dL, n=14) (33) that complied similar inclusion criteria than
112 Normotriacylglycerolemic women. During the 16-weeks of training, five from the CG group (a
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113 dropout rate of 33.3%) dropped out of the study and two women from the AT group (a dropout rate of
114 13.3%) and were excluded from the final analysis. The reasons for dropouts included personal or
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115 family problems and unspecified reasons. After the intervention, subjects were encouraged to maintain
116 their habits but not having participating in any systematic aerobic and strength training program and
117 the researchers contacted the participants by phone after six months and then 1 year after the end of
118 training. After the six-month and 1 year follow-up the participants were evaluated again:
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119 Normotriacylglycerolemic-CT (n=16), Hypertriacylglycerolemic-CT (n=14) and
120 Normotriacylglycerolemic-AT (n= 8) (Figure 1).
121
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122 Procedures
123 Blood Samples
124 After an overnight fast, venous blood samples were collected to measure total fasting cholesterol
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125 (Chol), high-density lipoprotein cholesterol (HDL-c) and Triacylglycerol (TAG) using the colorimetric
126 technique and dry chemicals, with equipment manufactured by Johnson and Johnson, Vitros 250 model.
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127 The Friedewald et al. (10) formula was used to calculate low-density lipoprotein cholesterol
128 concentration (LDL-c). The atherogenic index was calculated by dividing the total cholesterol by the
129 high-density lipoprotein (Chol/HDL-c). The participants who were above the TAG≥150 mg/dL were
130 classified as Hypertriacylglycerolemic and TAG<150 mg/dL were classified as
131 Normotriacylglycerolemic (33).
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133

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134 Body weight, fat mass, dietary intake and free-living physical activity assessment
135 Body weight was measured using an electronic scale (Filizola PL 50, Filizzola Ltda., Brazil),
136 with a precision of 0.1 kg. Fat mass (Kg) was estimated using a Dual-Energy X-ray Absorptiometry
137 (DXA) scanner, version 4.7 (General Electric Healthcare, Lunar DPX-NT; UK, England). Twenty-
138 four hourly dietary questionnaires were administered on three nonconsecutive days (one weekend and
139 two weekdays). The participants were instructed by a nutritionist as to how to complete the dietary
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140 questionnaires. Data were analyzed by the same nutritionist using NutWin software, version 1.5 (A
141 Program for Assisting Nutrition by the Federal University of São Paulo, Brazil. 2002).
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142 Physical activity level was measured by accelerometers (ActiGraph GT3X. Pensacola. FL)
143 and self-report physical activity [i.e. Have you been doing exercise: aerobic (walking, jogging,
144 cycling, hydroginastic or resistance training, Yes or No?). The raw measurement from the
145 accelerometer was determined in counts (arbitrary measure; the greater the number of counts, the
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146 higher the level of physical activity) and an epoch length of 60 seconds was used. This epoch is
147 related to low intensity and long duration patterns of PA (42), which is the standard for monitoring
148 free-living adults. Accelerometers were placed on the subjects’ waists using an elastic band. The
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149 participants used the equipment for eight days during all waking hours, except when bathing or
150 engaging in aquatic activities, such as swimming, and at the end, each participant accumulated a
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151 minimum of 10 hours of valid activity recordings per day for at least five days, including at
152 least one weekend day (6). ActiLife5 software (ActiGraph, Pensacola, FL) was used to
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153 initialize the accelerometers and process the accelerometer data.
154 The assessment of PA was analyzed as a combination of moderate plus vigorous PA
155 (MVPA). We determined MVPA minutes per week by applying a range of cut-points as
156 provided by Freedson et al. (9) and thresholds were: Light physical activity was defined as
157 <1952 counts/min [<3.00 metabolic equivalents (METs)], moderate physical activity was
158 defined as 1952–5724 counts/min (3.00–5.99 METs), vigorous physical activity was defined
159 as 5725–9498 counts/min (6.00–8.99 METs), and very vigorous physical activity was defined

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160 as ≥9499 counts/min (≥9 METs) counts per minute. Moreover, we categorized the sample
161 according to American College of Sports Medicine physical activity recommendations
162 (physically active women ≥ 150 MVPA minutes) (26).
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164 Aerobic Training procedures
165 The intensities of aerobic training were established using the critical velocity protocol (15).
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166 The studied group traveled three distances (400, 800 and 1200 m) on a running track on separate,
167 nonconsecutive days, and the participants were instructed to cover the distance in the shortest possible
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168 time, which was recorded using a digital stopwatch (model S810i; Polar Electro, Kempele, Finland).
169 The critical velocity was assumed by the angular coefficient of linear regression straight line between
170 the distances (meters) and the respective times (seconds) obtained in each repetition (15, 32). Before
171 the beginning of the training, the participants performed 2 weeks of familiarization. The training
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172 volume was equivalent to 50 minutes/day at 100% of critical velocity. After 4 weeks, the procedures
173 of critical velocity were repeated to determine and adjust the intensities of training (32).
174 Concurrent training procedures

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175 Aerobic plus strength training was performed for about 60 minutes per day, consisting of 30
176 minutes of strength training and 30 minutes of aerobic training, including 10 minutes of warm-up
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177 before each session and stretching at the end of the training session. The strength training program
178 consisted of nine exercises: 45 degree leg press, leg extension, leg curl, bench press, seated row, arm
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179 curl, triceps extension (Ipiranga®, São Paulo/Brazil), side elevation with dumbbells and abdominal
180 exercises. The strength training program consisted of four progressive phases [phase 1 (1st to 4th
181 week, 15 repetitions, three sets per exercise, 60 sec between sets); phase 2 (5th to 8th week, 12
182 repetitions, three sets per exercise, 60 sec between sets); phase 3 (9th to 12th week, 10 repetitions,
183 three sets per exercise, 60 sec between sets) and phase 4 (13th to 16th week, eight repetitions, three
184 sets per exercise, 60 sec between sets)]. The series was executed until momentary exhaustion, (i.e.
185 when the participants performed the training with repetitions varying from 12 to 15 RM, they were

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186 always encouraged to execute at least 12 and no more than 15 repetitions) (32, 36). In the case of the
187 participants executing more repetitions, the load was increased in order to keep in the training zone
188 (32, 36).
189 Statistical Analysis
190 We performed a power analysis of this study based on the observation from a previous
191 study that verified a reduction in trunk fat of 0.9 Kg and standard deviation of 0.6 after 16
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192 weeks of aerobic training and detraining in patients with metabolic syndrome (22). With 80%
193 power and an alpha level of 0.05 and using PS software (ver 3.1.2, Dupont and Plummer,
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194 http://biostat.mc.vanderbilt.edu/wiki/Main/PowerSampleSize), it was estimated that we would
195 need eight subjects per group. Considering a dropout rate of 15-20%, we over-recruited the
196 number of subjects.

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197 The Levene test estimate was used to analyze homogeneity in the data and to identify
198 similarity of groups at baseline, the one-way ANOVA was used. The comparison between groups
199 during the follow-up and between Normotriacylglycerolemic and Hypertriacylglycerolemic was
200 conducted by a two-way repeated measure ANOVA (group x time). When a significant difference was
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201 observed, a Tukey post hoc test was conducted. For all measured variables, the estimated sphericity
202 was verified according to Mauchly’s W test and the Greenhouse–Geisser correction was used when
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203 necessary. Also, a dependent t-test was used (t-test for normo- group and t-test for hyper-
204 group). Statistical significance was set at p<0.05. The data was analyzed using the Statistical Package
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205 for Social Sciences 17.0 (SPSS Inc. Chicago. IL. USA).
206 RESULTS
207 Table 1 presents values in mean±standard deviation of the general characteristics and
208 comparisons between the groups. There were no statistical baseline differences for all the analyzed
209 variables. There was a statistically significantly difference only after 16 weeks of training compared to
210 the baseline in both experimental groups for fat mass (p= 0.016), however, there was no statistical
211 difference between groups (p= 0.285) and in interaction (p=0.772). For lean mass, there was increased

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212 statistically significantly in CT group (p=0.028) but there was no statistical difference between groups
213 (p= 0.992) and interaction (p=0.509). As regards dietary intake were no observed differences across
214 time (p=0.155) and interaction (p=0.111). As regards the free-living physical activity presented in
215 counts per minute, there were no differences across time (p=0.313) or in interaction (p=0.556) and the
216 participants maintained physically active during all study [MVPA= ≥150 min/week: baseline (CT=
217 218.3±125.1 vs AT= 268.2±225.6), post-training (CT= 300.8±113.3 vs AT= 281.0±208.9), after 6
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218 months (CT= 174.7±81.8 vs AT= 236.6±220.9) and 1 year(CT= 219.0±32.5 vs AT= 201.4±125.0)]
219 without difference across time (p=0.321) and no difference between groups (p=0.635)..
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221 **Insert table 1**
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223 Table 2 presents the comparisons between normotriacylglycerolemic subjects before and after
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224 the program. There was a statistically significant increase in the HDL-c and a decrease for the
225 atherogenic index in concurrent training (p<0.05). It can be observed that the CT groups presented a
226 statistically significant HDL-c increase and a reduction for the Chol/HDL with differences compared
227 to the CG. However, there were no statistical differences between the intervention groups for any of
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228 the variables analyzed.
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231
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232 Table 3 presents the comparisons between normotriacylglycerolemic and
233 Hypertriacylglycerolemic subjects before and after the concurrent training program. In both groups,
234 there was a statistically significant increase in the HDL-c and a decrease for the atherogenic index
235 again (p<0.05).
236 Table 4 presents the comparisons of the effects of aerobic and concurrent training on glucose
237 and lipid profiles among normotriacylglycerolemic postmenopausal women at the 6-month and 1-year
238 follow-up.

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239 When performing the comparison of the lipid profile between the aerobic and concurrent
240 training groups after 6 months and 1 year of follow-up, there was an increase in the atherogenic index
241 only for the CT group after one year of ending training, however, there were not differences between
242 the AT and CT groups.
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248 Table 5 presents the comparison between the lipid profiles of
249 normotriacylglycerolemic and Hypertriacylglycerolemic postmenopausal women at the 6-
250 month and 1-year follow-up after the concurrent training program.
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251 There was decreased HDL-c after 6 months and an increased atherogenic index after 1 year
252 among the Hypertriacylglycerolemic women. Although there was not a statistically significant
253 difference between groups, there was a marginal difference in the atherogenic index.
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254

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256
257 DISCUSSION
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258 The main finding of this study is that 16-weeks of concurrent training promoted increased lean
259 mass, HDL-c and reduced the atherogenic index in normotriacylglycerolemic and
260 Hypertriacylglycerolemic postmenopausal women. In addition, the advantage of concurrent training
261 was that the anti-atherogenic status was sustained after the 1-year follow-up in
262 Hypertriacylglycerolemic postmenopausal women. The lean mass was maintained higher after 1
263 year follow-up in CT group when compared to baseline, however without statistic difference,
264 and this increase could be the mechanism by which the anti-atherogenic status was

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265 maintained. While the treatments or strategies used to improve lipid profiles have attempted to
266 encourage improvements in cardiometabolic health, the literature suggests that a healthy diet, weight
267 loss, exercise and physical activity are keys to preventing and treating the development of this disease
268 (4). Moreover, the training adaptations are specific to the type of stimulus.
269 Aerobic training resulted in metabolic and morphological changes, including fast-to-slow
270 fiber-type transformation, mitochondrial biogenesis, as well as increasing the activity of aerobic
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271 enzymes and substrate metabolism and increasing the oxidation of lipids in muscle and liver (7). On
272 the other hand, strength training stimulates synthesis of proteins responsible for muscle hypertrophy
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273 by increasing the recruitment of satellite cells, motor unit activations and high-energy phosphate
274 availability and force muscle (7). Thus, concomitant with this adaptation, the mechanisms are distinct
275 between models. Previous randomized controlled trials addressing the effects of aerobic (5), strength
276 training (20) and combined training (29,35) on lipid and lipoprotein outcomes have reported
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277 conflicting findings as regards to total cholesterol, HDL-c, the ratio of total cholesterol to HDL-c
278 (Chol/HDL-c), LDL-c and TAG. However, the exercise guidelines recommend participation in both
279 aerobic and strength training programs for the greatest benefit to lipid profiles (14).
280 It is known that the period of menopause increases metabolic syndrome risk by a factor of 1.6
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281 (28). The remodeling of adipose tissue that occurs in this population (derived from a high-fat-diet and
282 physical inactivity), results from adipocyte hypertrophy, impairment of vascularization (hypoxia),
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283 infiltration of immune system cells and an increase of pro-inflammatory cytokines (TNF-α. IL-6)
284 (38). High triacylglycerol plasma implies a peripheral insulin resistance due to its accumulation, which
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285 inhibits insulin activation of its cell surface receptor, as well as downstream signaling molecules such
286 as insulin receptor substrate 1 (IRS-1) and Protein Kinase B/Akt (24). This could have an impact on
287 postmenopausal women, who have a greater propensity to develop chronic inflammation and insulin
288 resistance (1).
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290

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291 The British Regional Heart Study reported an inverse relationship between HDL-c and
292 incidence of coronary heart disease. A 1-mg/dL increment in HDL-c was associated with a significant
293 coronary heart disease risk decrement of 2% in men and 3% in women. Furthermore, a 1-mg/dL
294 increment in HDL-c was associated with a significant decrease (3.7% in men and 4.7% in women) in
295 cardiovascular disease mortality rates (11). The reduction in HDL-c and increase in LDL-c increased
296 the risk of developing cardiovascular diseases, since LDL-c is more susceptible to oxidation and
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297 greater accumulation in the arterial wall (17). Exercise increases the activity of lecithin-cholesterol
298 acyltransferase (L-CAT), the enzyme responsible for transferring cholesterol ester to HDL, which
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299 reduces the activity of plasmatic cholesterol ester transfer protein (CETP), the enzyme responsible for
300 transferring the ester of HDL to other lipoproteins (34). Once we verified that concurrent training was
301 effective in increasing HDL-c and reducing the atherogenic index in Normotriacylglycerolemic
302 women, we aimed to verify whether aerobic plus strength training would promote the same benefits in
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303 Hypertriacylglycerolemic postmenopausal women and our results showed that in both groups there
304 was a statistically significant increase in HDL-c and a decrease in the atherogenic index.
305 Petibois et al. (30) had demonstrated that the beneficial outcomes of regular exercise were
306 diminished or disappeared within a few weeks or months after cessation of training. In our study,
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307 when conducting a comparison between aerobic and concurrent training on lipid profiles at the 6-
308 month and 1 year follow-up, there were no differences between AT and CT groups. However, there
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309 was a decrease in HDL-c after 6 months and an increased atherogenic index after 1 year in
310 Normotriacylglycerolemic women.

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311 There are few studies regarding the effects of detraining on blood lipids in postmenopausal
312 women. However, Gupta et al. (13) showed that when compared to sedentary individuals, trained
313 athletes demonstrated enhanced reverse cholesterol transport. More studies are needed to better
314 understand the mechanisms involved in the reverse transport of cholesterol among trained individuals.
315 On the other hand, a significant decrease of 18% in HDL-c after 1 month of detraining has been
316 reported in elderly people who previously participated in a long-term (9-month) aerobic training
317 program (23) and the lipid profile in patients with coronary artery disease indicated a tendency toward

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318 the pre-training values 3 months after the cessation of exercise (41), demonstrating yet again the
319 importance of our training program.
320 The limitations of this study need to be considered when interpreting the finding. The follow-
321 up time may have been insufficient for verifying differences between groups; and there were no
322 Hypertriacylglycerolemic-AT group. On the other hand, no differences were observed during the
323 follow-up as regards body weight, fat mass, dietary intake and free-living physical activity in both
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324 aerobic and concurrent training. In addition, futures studies could use a physical activity
325 questionnaire at all points of data collection (pre, post, 6 months, 1 year) may help give a
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326 better idea of participant's physical activity levels at all phases of data collection, especially 6
327 months and 1 year.
328 In conclusion, the present investigation demonstrated that concurrent training promoted an
329 anti-atherogenic status in Normo- and Hypertriacylglycerolemic postmenopausal women but without
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330 significant differences between those groups that were subjected to only aerobic training. Furthermore,
331 these effects were sustained after 1 year, as determined by the follow-up, only among
332 Hypertriacylglycerolemic women.

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334 PRACTICAL APPLICATIONS

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335 In the present study, our data suggests that concurrent training induces important adaptations
336 to cholesterol metabolism primarily by increasing HDL-c and decreasing the atherogenic index,
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337 resulting in a metabolic adjustment in Hypertriacylglycerolemic postmenopausal women in the long
338 term and concurrent training could be an important non-pharmacological treatment and prevention
339 of disease for these subjects. Although the participants of this study have maintained
340 hypertriacylglycerolemia after 16-weeks of the concurrent training program, there was an increase of
341 5.6 mg/dL in HDL-c (12.5%) and this effect was sustained, unchanged, for 1 year, which was
342 statistically significant as regards the body weight and fat mass during the follow-up.
343

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344 Conflict of interest:
345 The authors declare that they have no conflict of interest.
346
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488 37. Stricker R, Eberhart R, Chevailler MC, Quinn F, Bischof P, Stricker R. Establishment of
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493 38. Suganami, T, and Ogawa, Y. Adipose tissue macrophages: their role in adipose tissue
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496 39. Suresh, K. An overview of randomization techniques: An unbiased assessment of outcome
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499 40. Tambalis, KD, Panagiotakos, DB, Kavouras, SA, and Sidossis, LS. Responses of blood
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501 systematic review of current evidence. Angiology 2008.
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503 41. Tokmakidis, SP, and Volaklis, KA. Training and Detraining Effects of a Combined‐strength
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504 and Aerobic Exercise Program on Blood Lipids in Patients With Coronary Artery
505 Disease. Journal of Cardiopulmonary Rehabilitation and Prevention 23: 193-200, 2003.
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507 42. Trost, SG, McIver, KL, and Pate, RR. Conducting accelerometer-based activity assessments
508 in field-based research. Medicine and science in sports and exercise 37: S531, 2005.
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509
510 FIGURE CAPTIONS

A
511 Figure 1. The trial profile of this study.
512
513 Table 1 – General characteristics and comparison between the groups.
514 Data are express as mean and standard-deviation (SD). a= Tukey’s post-hoc test with p-value< 0.05
515 compared to Pre-moment.
516

21
517 Table 2: Characteristics of the lipid profile in normotriacylglycerolemic subjects before and after
518 training program.
519 Data are express as mean and standard-deviation (SD). *= statistically significant difference (p<0.05).
520 LDL-c (mg/dL) = low-density lipoprotein; HDL-c (mg/dL)= high-density lipoprotein; Chol/HDL
521 (mg/dL)= atherogenic index.
522
D
523 Table 3: Characteristics of the lipid profile in normotriacylglycerolemic and hypertriacylglycerolemic
524 subjects before and after concurrent training.
TE
525 Data are express as mean and standard-deviation (SD). *= statistically significant difference (p<0.05).
526 TAG (mg/dL)= Triacylglycerol; LDL-c (mg/dL) = low-density lipoprotein; HDL-c (mg/dL) = high-
527 density lipoprotein; Chol/HDL (mg/dL) = atherogenic index.

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528
529 Table 4: Comparison of the effects of aerobic and concurrent training on glucose and lipid profiles
530 among normotriacylglycerolemic postmenopausal women at the 6-month and 1-year follow-up.
531
C
532 Data are express as mean and standard-deviation (SD). ∆ in order = post-training minus pre; After 6
533 months minus post-training and after 1 year minus after 6 months. a= Tukey’s post-hoc test with p-
C
534 value< 0.05 compared to post-training. LDL-c (mg/dL) = low-density lipoprotein; HDL-c (mg/dL)=
535 high-density lipoprotein; Chol/HDL (mg/dL)= atherogenic index.

A
536
537 Table 5: Comparison between the lipid profiles of normotriacylglycerolemic and
538 Hypertriacylglycerolemic postmenopausal women at the 6-month and 1-year follow-up after the
539 concurrent training program.
540

22
541 Data are express as mean and standard-deviation (SD). Normotriacylglycerolemic = Triacylglycerol <
542 150 mg/dL; hypertriacylglycerolemic = Triacylglycerol ≥150 mg/dL. ∆ in order = post-training minus
543 pre; After 6 months minus post-training and after 1 year minus after 6 months. a= Tukey’s post-hoc
544 test with p-value< 0.05 compared to post-training. LDL-c (mg/dL) = low-density lipoprotein; HDL-c
545 (mg/dL)= high-density lipoprotein; Chol/HDL (mg/dL)= atherogenic index.
546
D
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EP
C
C
A

Table 1 – General characteristics and comparison between the groups.
CG (n= 10) AT (n= 13) CT (n=16)

Variables
Mean±SD Mean±SD Mean±SD
FSH (mUI/ml) 62.5 ± 19.4 62.6 ± 18.4 69.2 ± 25.6
Age (years) 63.4±7.5 61.8±7.9 61.4±5.0
Body weight (Kg) 64.0±14.7 66.4±7.6 59.7± 6.8
Fat mass (Kg)
D
Pre 28.4±10.9 30.1±5.1 24.0±4.5
Post 29.1±10.6 28.8±4.5 a 23.1±5.3 a
TE
Post 6-month - 29.4±6.7 23.1±4.8
Post 1-year - 28.8±4.7 22.7±5.4
Lean Mass (Kg)
Pre 33.5±4.2 34.0±3.3 33.7±4.0

EP
Post 33.8±4.8 34.4±3.3 34.8±4.0 a
Post 6-month - 34.2±3.0 33.7±4.3
Post 1-year - 34.4±3.1 34.0±3.9
Dietary intake (Kcal)

C
Pre 1922±127 1520±376 1738±455
Post 2007±259 1566±334 1647±454

C
Post 6-month - 1902±560 1737±413
Post 1-year - 1543±320 1850±501
Physical activity level

A
(counts/minute)
Pre 297.2±117.6 455.2±217.3 354.8±96.0
Post 311.7±123.1 439.3±174.5 387.2±127.4
Post 6-month - 424.6±175.0 332.1±79.7
Post 1-year - 396.2±123.9 436.5±313.8
Data are express as mean and standard-deviation (SD). a= Tukey’s post-hoc test with p-value< 0.05
compared to Pre-moment.

Table 2: Characteristics of the lipid profile in normotriacylglycerolemic subjects before
and after training program.
Control Group ∆ Aerobic Training ∆ Concurrent Training
(n= 10) (Change 0-16 (n= 13) (Change 0-16 (n=16) (Ch
weeks) weeks)
Mean±SD Mean±SD Mean±SD
D
Pre Post Pre Post Post Post
6±10.1 91.9±15.3 0.3±8.3 92.5 ± 25.9 88.1 ± 15.7 -4.3±14.0 86.9 ±12.4 86.1 ± 10.4 -0
TE
.0±27.7 120.9±32.7 8.9±24.1 91.0 ± 28.2 107.7 ± 41.0 16.7±27.0 91.3 ± 31.9 85.5 ± 39.7 -5
.1±35.3 195.4±27.0 12.3±30.4 199.4 ± 38.6 194.2 ± 37.6 -5.1±18.1 192.5 ± 29.9 190.1 ± 36.7 -2
.1±8.6 49.0±7.0 -0.1±6.2 57.6 ± 13.3 60.1 ± 13.4 2.5±7.2 57.1 ± 17.3 64.3 ± 16.1* 7
.4±29.8 121.8±23.5 10.4±25.0 123.6 ± 37.3 111.9 ± 31.3 -11.7±20.5 117.2 ± 23.3 106.5 ± 30.1 -1
EP
8±0.7 4.0±0.54 0.24±0.43 3.6 ± 0.9 3.3 ± 0.8 -0.25±0.5 3.6 ± 0.9 3.0 ± 0.6* -0
Data are express as mean and standard-deviation (SD). *= statistically significant difference (p<0.05). a=
Tukey’s post-hoc test with p-value< 0.05 compared to post-training. LDL-c (mg/dL) = low-density
lipoprotein; HDL-c (mg/dL)= high-density lipoprotein; Chol/HDL (mg/dL)= atherogenic index.

C
C
A

Table 3: Characteristics of the lipid profile in normotriacylglycerolemic and
hypertriacylglycerolemic subjects before and after concurrent training.
Concurrent Traininig Concurrent Training

Between
normotriacylglycerolemic ∆ hypertriacylglycerolemic ∆ groups
(TAG<150) (TAG≥150)
Variables (Change 0- (Change 0-16 p-value
(n= 16) 16 weeks) (n=14) weeks)
Mean±SD Mean±SD
D
Pre Post Pre Post
Chol 192.5 ± 29.9 190.1± 36.7 -2.4 ± 30.5 225.6 ± 24.5 222.9 ± 24.7 -2.7 ± 18.3 0.971
TE
HDL-c 57.1 ± 17.3 64.3 ± 16.1* 7.2 ± 11.1 44.7 ± 9.6 50.3 ± 15.3* 5.6 ± 7.2 0.645
LDL-c 117.2 ± 37.3 106.5 ± 31.3 -10.7±26.6 143.4± 28.2 138.1± 25.1 -5.2 ± 19.0 0.528
Chol/HDL 3.6 ± 0.9 3.0 ± 0.6* -0.5 ± 0.6 5.2 ± 1.1 4.7 ± 1.2* -0.5 ± 0.7 0.962
Data are express as mean and standard-deviation (SD). *= statistically significant difference (p<0.05).
EP
TAG (mg/dL)= Triacylglycerol; LDL-c (mg/dL) = low-density lipoprotein; HDL-c (mg/dL) = high-
density lipoprotein; Chol/HDL (mg/dL) = atherogenic index.

C
C
A

Table 4: Comparison of the effects of aerobic and concurrent training on glucose and lipid profiles
among normotriacylglycerolemic postmenopausal women at the 6-month and 1-year follow-up.
Aerobic Training Concurrent Training Time

Moment (n= 8) (n=16) x
Mean±SD Mean±SD Group
Glucose (mg/dL) ∆ ∆
Pre 93.9±31.5 86.9±12.4
Post-training 87.6±20.2 -6.25 ± 11.9 86.13±10.4 -0.75 ± 10.3
D
After 6 months 85.7±11.7 -1.87 ± 9.5 86.88±14.6 0.75 ± 11.6 0.439
After 1 year 81.9±5.3 -6.25 ± 8.4 80.63±7.6 -6.2 ± 9.7
TAG (mg/dL)
TE
Pre 76.6±15.1 91.3±31.9
Post-training 86.1±32.6 9.50 ± 30.6 85.5±39.7 -5.8 ± 30.7
After 6 months 87.2±30.4 1.13 ± 37.9 87.6±33.8 2.1 ± 39.0 0.084
After 1 year 83.0±26.4 -4.2 ± 37.6 75.5±27.4 -12.1 ± 32.8
Chol (mg/dL)
EP
Pre 187.1±31.3 192.5±29.9
Post-training 176.9±28.9 -10.2 ± 14.8 190.1±36.7 -2.4 ± 30.5
After 6 months 176.7±24.6 -0.12 ± 19.6 184.9±28.4 -5.2 ± 18.2 0.880
After 1 year 189.2±28.3 12.5 ± 16.3 193.0±31.4 8.0 ± 18.9
HDL-c (mg/dL)
C
Pre 58.9±11.6 57.1±17.3

Post-training 60.4±13.5 1.5 ± 6.4 64.3±16.1 7.2 ± 11.1
After 6 months 60.1±6.0 -0.25 ± 9.7 59.2±17.9 -5.1 ± 7.6 0.945
C
After 1 year 61.4±12.8 1.2 ± 8.5 60.0±17.2 0.75 ± 8.9

LDL-c (mg/dL)
Pre 112.9±34.4 117.2±23.3
A
Post-training 99.4±27.9 -13.5 ± 19.2 106.5±30.1 -10.7 ± 26.6

After 6 months 99.1±28.9 -0.25 ± 17.4 108.1±16.9 1.62 ± 22.3 0.821
After 1 year 111.4±31.2 12.2 ± 17.3 117.9±22.8 9.7 ± 17.8
Chol/HDL (mg/dL)
Pre 3.3±0.9 3.6±0.9
Post-training 3.0±0.8 -0.23 ± 0.4 3.0±0.6 -0.53 ± 0.6
After 6 months 3.0±0.6 -0.07 ± 0.3 3.3±0.6 0.24 ± 0.5a 0.803
a
After 1 year 3.2±1.0 0.24 ± 0.4 3.4±0.9 0.14 ± 0.6
Data are express as mean and standard-deviation (SD). ∆ in order = post-training minus pre; After 6
months minus post-training and after 1 year minus after 6 months. a= Tukey’s post-hoc test with p-value<

0.05 compared to post-training. LDL-c (mg/dL) = low-density lipoprotein; HDL-c (mg/dL)= high-
density lipoprotein; Chol/HDL (mg/dL)= atherogenic index.
D
TE
EP
C
C
A

Table 5: Comparison between the lipid profiles of normotriacylglycerolemic and
Hypertriacylglycerolemic postmenopausal women at the 6-month and 1-year follow-up after the
concurrent training program.
Normotriacylglycerolemic Hypertriacylglycerolemic Time

Moment (n= 16) (n=14) x
Mean±SD Mean±SD Group
Chol (mg/dL) ∆ ∆
D
Pre 192.5±29.9 225.6±24.5
Post-training 190.1±36.7 -2.4 ± 30.5 222.9±24.7 -2.7± 18.3
After 6 months 184.9±28.4 -5.2 ± 18.2 214.9±29.2 -8.1 ± 24.2 0.079
TE
After 1 year 193.0±31.4 8.1 ± 18.9 207.7±33.1 -7.1 ± 32.9
HDL-c (mg/dL)
Pre 57.1±17.3 44.7±9.6
Post-training 64.3±16.1 7.2 ± 11.1 50.3±15.3 5.6 ± 7.2
a
After 6 months 59.2±17.9 -5.1 ± 7.6 47.8±10.0 -2.5 ± 7.5 0.794
EP
After 1 year 60.0±17.2 0.75 ± 8.9 48.7±10.1 0.93± 7.2
LDL-c (mg/dL)
Pre 117.2±23.3 143.4±28.2
Post-training 106.5±30.1 -10.7 ± 26.6 138.1±25.1 -5.2 ± 19.0
After 6 months 108.1±16.9 1.6 ± 22.3 134.4±30.0 -3.7 ± 21.7 0.098
After 1 year 117.9±22.8 9.7 ± 17.8 127.9±29.8 -6.5 ± 31.2
C
Chol/HDL (mg/dL)
Pre 3.6±0.9 5.2±1.1
Post-training 3.0±0.6 -0.53 ± 0.6 4.7±1.2 -0.52 ± 0.7
C
a
After 6 months 3.3±0.6 0.24 ± 0.5 4.6±1.0 -0.07 ± 0.7 0.064
a
After 1 year 3.4±0.9 0.14 ± 0.6 4.4±1.0 -0.25 ± 0.9
Data are express as mean and standard-deviation (SD). Normotriacylglycerolemic = Triacylglycerol <
A
150 mg/dL; hypertriacylglycerolemic = Triacylglycerol ≥150 mg/dL. ∆ in order = post-training minus
pre; After 6 months minus post-training and after 1 year minus after 6 months. a= Tukey’s post-hoc test
with p-value< 0.05 compared to post-training. LDL-c (mg/dL) = low-density lipoprotein; HDL-c
(mg/dL)= high-density lipoprotein; Chol/HDL (mg/dL)= atherogenic index.

D
TE
EP
C
C
A

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1

Journal of Strength and Conditioning Research Publish Ahead of Print

3 CONCURRENT TRAINING PROMOTED SUSTAINED ANTI-ATHEROGENIC BENEFITS

4 IN THE FASTING PLASMA TRIACYLGLYCEROLEMIA OF POSTMENOPAUSAL

5 WOMEN AT 1-YEAR FOLLOW-UP.

10 Paula A. Monteiro1, Camila Buonani4, Fábio S. Lira5, Ismael F. Freitas Jr4.

22 Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil

Copyright ª 2016 National Strength and Conditioning Association

31 Paulo. Brazil. Telephone: 55 18 32295828 Fax. 55 18 3221 4391. e-mail: rossifabricio@yahoo.com.br

32 (This e-mail address can be published).

39 lipoprotein cholesterol (LDL-c), Triacylglycerol (TAG) and glucose were assessed in 46

42 hypertriacylglycerolemic postmenopausal women were recruited (TAG≥150 mg/dL, n=14). Total

45 effective in increasing HDL-c (normotriacylglycerolemic: pre=57.1±17.3 mg/dL x post= 64.3±16.1

46 mg/dL; p=0.020 and hypertriacylglycerolemic: pre=44.7±9.6 mg/dL x post=50.3±15.3 mg/dL;

50 up only among the hypertriacylglycerolemic postmenopausal women. The anti-atherogenic status in

51 normo and hypertriacylglycerolemic postmenopausal women was changed by CT but without

53 up among the hypertriacylglycerolemic subjects.

54 Keywords: strength training; endurance training; follow-up; menopause.

Copyright ª 2016 National Strength and Conditioning Association

56 The period of menopause is followed by a decrease in estrogen concentrations (25) and

57 contributes to the development of morbidities such as type 2 diabetes mellitus, hypertension,

64 attempt to minimize the effects of menopause.

71 carbohydrates in skeletal muscle and increasing muscle anabolism (19,29).

72 Furthermore, as shown in a systematic review conducted by Tambalis et al. (40) which

76 profiles between normotriacylglycerolemic and hypertriacylglycerolemic women may be different. In

Copyright ª 2016 National Strength and Conditioning Association

82 training promotes different benefits on the lipid profiles of Normotriacylglycerolemic and

83 hypertriacylglycerolemic postmenopausal women and 2) to verify whether the benefits of

84 concurrent training on the lipid profile in Normotriacylglycerolemic and Hypertriacylglycerolemic

85 postmenopausal women are sustained at the 1-year follow-up.

97 (FSH≥26.72 mUI/ml) (37); 2) not taking medication for diabetes or dyslipidaemia; 3)

Copyright ª 2016 National Strength and Conditioning Association

110 benefits in Hypertriacylglycerolemic postmenopausal women, we recruited Hypertriacylglycerolemic

120 Normotriacylglycerolemic-AT (n= 8) (Figure 1).

123 Blood Samples

130 classified as Hypertriacylglycerolemic and TAG<150 mg/dL were classified as

131 Normotriacylglycerolemic (33).

Copyright ª 2016 National Strength and Conditioning Association

153 initialize the accelerometers and process the accelerometer data.

154 The assessment of PA was analyzed as a combination of moderate plus vigorous PA

Copyright ª 2016 National Strength and Conditioning Association

161 according to American College of Sports Medicine physical activity recommendations

162 (physically active women ≥ 150 MVPA minutes) (26).

164 Aerobic Training procedures

174 Concurrent training procedures

Copyright ª 2016 National Strength and Conditioning Association

188 (32, 36).

189 Statistical Analysis

196 number of subjects.

Copyright ª 2016 National Strength and Conditioning Association

221 **Insert table 1**

228 the variables analyzed.

230 **Insert table 2**

232 Table 3 presents the comparisons between normotriacylglycerolemic and

235 again (p<0.05).

Copyright ª 2016 National Strength and Conditioning Association

242 the AT and CT groups.

244 **Insert table 3**

246 **Insert table 4**

248 Table 5 presents the comparison between the lipid profiles of

249 normotriacylglycerolemic and Hypertriacylglycerolemic postmenopausal women at the 6-

255 **Insert table 5**

260 Hypertriacylglycerolemic postmenopausal women. In addition, the advantage of concurrent training

221 Insert table 1

230 Insert table 2

244 Insert table 3

246 Insert table 4

255 Insert table 5