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Effects of resistance training and chromium picolinate

on body composition and skeletal muscle in older men


WAYNE W. CAMPBELL,1 LYNDON J. O. JOSEPH,2 STEPHANIE L. DAVEY,1
DEANNA CYR-CAMPBELL,2 RICHARD A. ANDERSON,3 AND WILLIAM J. EVANS1
1Nutrition, Metabolism, and Exercise Laboratory, Donald W. Reynolds Department of Geriatrics,

University of Arkansas for Medical Sciences, and Veterans Affairs Geriatric Research, Education,
and Clinical Center, Little Rock, Arkansas 72205; 2Noll Physiological Research Center, The
Pennsylvania State University, University Park, Pennsylvania 16802; and 3Beltsville Human
Nutrition Research Center, US Department of Agriculture, Beltsville, Maryland 20705

Campbell, Wayne W., Lyndon J. O. Joseph, Stephanie If chromium picolinate does have ergogenic proper-
L. Davey, Deanna Cyr-Campbell, Richard A. Anderson, ties, older people may especially benefit from the use of
and William J. Evans. Effects of resistance training and this supplement. Aging is associated with marked
chromium picolinate on body composition and skeletal muscle changes in body composition, skeletal muscle size and
in older men. J. Appl. Physiol. 86(1): 29–39, 1999.—The function, and energy metabolism. These changes in-
effects of chromium picolinate (CrPic) supplementation and clude an increase in both FM and percent body fat, a
resistance training (RT) on skeletal muscle size, strength, decrease in FFM (primarily due to a loss of muscle
and power and whole body composition were examined in 18
mass), a decrease in muscle strength and power, and a
men (age range 56–69 yr). The men were randomly assigned
(double-blind) to groups (n 5 9) that consumed either 17.8
decrease in resting metabolic rate (21, 25, 47). These
µmol Cr/day (924 µg Cr/day) as CrPic or a low-Cr placebo for body composition, functional, and metabolic changes
12 wk while participating twice weekly in a high-intensity RT contribute to the development of age-related disorders,
program. CrPic increased urinary Cr excretion ,50-fold (P , including obesity, sarcopenia, impaired physical mobil-
0.001). RT-induced increases in muscle strength (P , 0.001) ity and function, and physical frailty (25, 27). The
were not enhanced by CrPic. Arm-pull muscle power in- promoted benefits of chromium picolinate are largely
creased with RT at 20% (P 5 0.016) but not at 40, 60, or 80% opposite to these age-related body composition, func-
of the one repetition maximum, independent of CrPic. Knee- tional, and metabolic changes.
extension muscle power increased with RT at 20, 40, and 60% The ergogenic effects of chromium picolinate are
(P , 0.001) but not at 80% of one repetition maximum, and thought to be manifest especially when supplementa-
the placebo group gained more muscle power than did the tion is coupled with an exercise program that includes
CrPic group (RT by supplemental interaction, P , 0.05). resistance training (RT) (24). High-intensity progres-
Fat-free mass (P , 0.001), whole body muscle mass (P , sive RT has been shown to decrease FM, increase FFM,
0.001), and vastus lateralis type II fiber area (P , 0.05) increase muscle strength and size, and increase resting
increased with RT in these body-weight-stable men, indepen- metabolic rate and total energy requirements of older
dent of CrPic. In conclusion, high-dose CrPic supplementa- people (17, 30), including frail elderly people (28, 29).
tion did not enhance muscle size, strength, or power develop-
Thus chromium picolinate and RT may provide older
ment or lean body mass accretion in older men during a RT
program, which had significant, independent effects on these
people with safe and effective ways to slow the progres-
measurements. sion of, or to partially reverse, the age-related changes
in body composition, muscle function, and energy me-
exercise; strength training; aging; basal metabolic rate; muscle tabolism and may prevent or treat the associated
power health disorders.
There are no known data on the effect of chromium
picolinate supplementation on body composition, muscle
strength and function, and energy metabolism in older
THE TRACE MINERAL TRIVALENT chromium (Cr31 ) is an
people. Thus the purpose of the present study was to
essential nutrient involved in the regulation of carbohy-
assess the effect of high-dose chromium picolinate
drate, lipid, and protein metabolism via an enhance- supplementation on body composition, including body
ment of insulin action (2, 4, 5). Chromium supplementa- density, whole body muscle mass and muscle fiber area,
tion, in the form of the organic compound chromium muscle strength and power, and resting metabolic rate
picolinate, was reported (24) to have ergogenic proper- of older men during 12 wk of RT. We hypothesized that
ties related to body composition changes in young men. chromium picolinate supplementation would augment
The suggested benefits of chromium picolinate included RT-induced changes in these parameters.
decreased fat mass (FM) and percent body fat, in-
creased fat-free mass (FFM), increased skeletal muscle METHODS
size and strength, and enhanced senses of energy and
Subjects. Twenty-three men volunteered to participate in
vigor. These chromium picolinate-related benefits were
this 13-wk study. Recruitment criteria included the following:
subsequently promoted in the public (23) and research 1) men, age range 50–75 yr; 2) body mass index range of
(36) literature but were not supported by other con- 27–34 kg/m2; 3) nondiabetic; 4) physically able to safely
trolled research studies that used young men and engage in all aspects of the study protocol; and 5) clinically
women as subjects (20, 32, 34, 39, 46). normal cardiac function, blood pressure, liver function, and

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Copyright © 1999 American Physiological Society. All rights reserved.
30 RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN

kidney function. Each man was cleared for the study on the sume in their habitual diets (i.e., the dose of chromium was
basis of a screening evaluation that included a medical not ‘‘nutritional’’) and a dose recently reported to have
history, a physician-administered physical examination, a beneficial effects on carbohydrate metabolism in middle-aged
resting and resistance exercise electrocardiogram, routine and older people with type 2 diabetes (10).
blood and urine chemistries, and a 3-h, 75-g oral glucose RT protocol. All men participated twice weekly for 12 wk in
tolerance test. For the resistance exercise stress test, heart progressive RT of the muscles involved with 1) unilateral
rate, blood pressure, and electrocardiogram recordings were knee extension, 2) unilateral knee flexion, 3) double leg press,
monitored while each prospective subject performed the 4) seated chest press, and 5) seated arm pull (Keiser pneu-
bilateral knee-extension exercise for three sets of eight repeti- matic resistance equipment, Keiser Sports Health Equip-
tions at 70–80% of his maximal strength. After receiving ment, Fresno, CA). Each man’s baseline maximal strength for
complete written and verbal explanations of the study, each each exercise was set as the greater of two one-repetition-
man signed an informed consent agreement. The study maximum (1RM) values obtained during the first two resis-
protocol and informed consent agreement were reviewed and tance exercise sessions. On these days and on all 1RM
approved by the Institutional Review Board of The Pennsylva- assessment days, each man then performed two sets of eight
nia State University (University Park). The protocol was also repetitions at 80% of the 1RM for each exercise. 1RM
reviewed and approved by the General Clinical Research assessments were repeated at study weeks 7 and 13. On the
Center (GCRC) Advisory Committee of The Pennsylvania non-1RM days, the RT consisted of the performance of each
State University (University Park). exercise for three sets at 80% of 1RM. Eight repetitions were
Eighteen of twenty-three men successfully completed the completed for the first two sets, and the third set consisted of
study protocol. The reasons for the five men withdrawing continuing repetitions until voluntary muscular fatigue or
included the following: 1) a request by a subject’s personal until 12 repetitions were completed. If 12 repetitions were
physician to avoid aggravation of a chronic hip injury; 2) an completed for a given exercise, the resistance was increased
irritation of chronic elbow tendonitis, unrelated to resistance by 5% for the next exercise session. All resistance exercise
exercise; 3) a personal family commitment; 4) a resistance sessions were preceded by 10 min of easy cycling (heart rate
exercise-induced aggravation of an existing knee condition; ,100 beats/min) and 10 min of stretching and were followed
and 5) a shoulder injury caused by slipping on ice. by a similar routine. Seventeen men completed 23 RT ses-
Experimental design. The 13-wk study was conducted at a sions (100% compliance), whereas one man completed 22 RT
GCRC located at the Noll Physiological Research Center on sessions.
the University Park campus of The Pennsylvania State Diet. During study weeks 2–6 and 8–12, each man was
University. Throughout the study, each man maintained his asked to maintain his self-provided habitual diet. In an effort
customary lifestyle while living at home, except for when he to control dietary chromium intake for the measurements of
participated in the planned dietary control periods, the urinary chromium excretion and apparent chromium absorp-
scheduled testing, and the RT. Use of all nutritional supple- tion, each man consumed, for 5 days during study weeks 1, 7,
ments, other than the supplements used for the study, was and 13, the same quantity of foods and beverages (except
discontinued 3 wk before and throughout the study. water) prepared and provided by the Metabolic Research
Baseline testing and evaluations were completed during Kitchen at the GCRC. The controlled diet consisted of 2-day
study week 1, at which time each man did not consume a rotating menus: menu A and menu B (Table 1). Both menus
supplement and remained sedentary. This was followed by a were designed to provide 13, 57, and 30% of total energy as
12-wk period of supplementation and RT, with testing and protein, carbohydrate, and fat, respectively. Each man’s total
evaluations repeated at study weeks 7 and 13. energy intake was estimated to be 1.5 times basal energy
Each man was randomly assigned in a double-blind fashion needs as predicted from the sex-specific Harris-Benedict
to either a chromium picolinate group or a placebo group, on equation (33). Total energy intake was calculated by using
the basis of the date they were declared eligible to participate Nutritionist IV software (version 4.0, N-Squared Computing,
in the study. The starting dates of the subjects were staggered First Data Bank, San Bruno, CA), assuming metabolizable
and ranged from June to November 1995. The chromium energy values for protein, carbohydrate, and fat of 16.7, 16.7,
picolinate group consumed twice daily one commercially and 37.7 kJ/g, respectively.
prepared capsule reported to contain 9.62 µmol chromium/ One duplicate composite of menu A and menu B for each
capsule (500 µg chromium/capsule) as chromium picolinate man was collected into 3-liter polypropylene jugs and frozen
(Nutrition 21, San Diego, CA), and the placebo group con- at 220°C. Thawed composites were homogenized in the
sumed one commercially prepared placebo capsule (Nutrition polypropylene jugs by using low-chromium titanium blender
21) twice daily. All of the men were to consume one capsule in blades and analyzed for chromium concentration as previ-
the morning and one capsule in the evening. The capsules ously described (11). Water samples were also collected from
were distributed weekly in 7-day medication dispensers, and seven drinking fountains and faucets in and around the
compliance was monitored by counting any returned capsules University Park campus and the State College, PA area and
and by weekly interviews with the men. The chromium were analyzed for chromium concentration. A mixed diet
picolinate and placebo capsules were analyzed for chromium standard reference material (SRM 8431; National Institute of
by using a graphite furnace atomic absorption spectrophotom- Standards and Technology, Gaithersburg, MD) with a certi-
eter (model HGA 500, Perkin-Elmer, Norwalk, CT), as previ- fied chromium concentration of 102 6 6 ng/g was run with
ously described (11, 32), and were found to contain 8.88 6 each analysis to verify the accuracy of individual assays. A
0.21 µmol chromium/capsule (462 µg chromium/capsule) and mean chromium concentration of 103 6 10 ng/g was deter-
,0.002 µmol chromium/capsule (,0.1 µg chromium/capsule), mined for the standard reference material over all assays. We
respectively. Thus each man in the chromium picolinate assumed that the chromium contents of the composite menus
group consumed 17.8 µmol chromium/day (924 µg chromium/ for each subject were the same as the chromium contents of
day) of supplemental chromium. The rationale for using this the menus provided at study weeks 1, 7, and 13.
high dose of chromium was to provide an opportunity to Muscle power assessments. Maximal arm and leg power
clearly test our hypotheses with a chromium intake distinctly were determined at study weeks 1 and 13 by using the Keiser
different from that which our subjects might normally con- seated arm-pull and leg-extension machines, respectively.

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Copyright © 1999 American Physiological Society. All rights reserved.
RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN 31

Table 1. Composition of a representative controlled 2-day cycle menu


Menu A Menu B

Breakfast, g Peanut-butter-chocolate chip 36 Strawberry cereal bar 37


breakfast bar English muffin 57
Blueberry pastry 54 Canned orange juice 180
Canned orange juice 180 Canned pears in light syrup 241
Canned peaches in light syrup 241 Milk, 1% fat 500
Milk, 1% fat 500 Peanut butter 16
Lunch, g Canned pineapple chunks 240 String cheese 30
Vanilla pudding 114 Graham crackers 42
Ginger ale 365 Almond granola bar 30
American cheese 38 Black bean soup 53 (dry wt)
Meatless patty (texturized vegetable protein) 64 Wheat bread 38
Sandwich roll 53 Butter 5
Apple-cinnamon pastry 43 Lemon-lime soda 365
Dinner, g Four-cheese pizza 198 Fettucini primavera 290
Wheat bread 38 Canned peas 241
Butter 10 Butter 5
Canned mixed vegetables 241 Apple juice 180
Energy, MJ/day 11.39 6 1.08 11.60 6 1.18
Protein, g/day 89 6 7 90 6 9
Carbohydrate, g/day 391 6 40 404 6 41
Fat, g/day 90 6 9 88 6 10
Chromium
µmol/day 1.88 6 0.27 1.09 6 0.12
(µg/day) (98.0 6 14.1) (56.9 6 6.0)
Values for energy, protein, carbohydrate, fat, and chromium content are means 6 SD for n 5 18 men.

Each man was asked to exert maximal pull using both arms dose of deuterium oxide (deuterium, 99.9%; Cambridge Iso-
or push using the dominant leg with the machine resistance tope Laboratories, Woburn, MA) as described (17). Body
set at 20, 40, 60, or 80% of the most recently determined 1RM. density was determined in the fasting state by using hydro-
The test was repeated three times at each percentage of 1RM, static weighing (1), with residual volume measured in the
with ,30 s of rest in between efforts. hydrostatic weighing tank via the nitrogen dilution technique
Urine collections. At study weeks 1, 7, and 13, 24-h urine (49).
collections were made during the last 3 days of controlled Body composition was assessed by using both a two-
menu feedings. A RT session was performed on one of the compartment model (2c; FM and FFM) and a three-compart-
urine collection days at weeks 7 and 13. All 24-h urine ment model (3c; FM, TBW mass, and protein 1 mineral
samples were collected into disposable 4-liter polyethylene mass). Whole body FM and FFM were estimated from body
containers (Fisher Scientific, Pittsburgh, PA). Aliquots of density by using the 2c model equation of Siri (45). Whole
urine for chromium analyses were pipetted by a research body FFM, FM, and protein 1 mineral mass were estimated
technician, wearing powder-free gloves and using disposable from TBW and body density by using the 3c model of Siri (45)
borosilicate glass pipettes, into polypropylene test tubes as described (17). For the 3c model, FFM was calculated as
(Sarstedt, Newton, NC) and were frozen at 220°C. Samples body mass 2 FM, and protein 1 mineral mass was calculated
were analyzed for chromium by using a graphite furnace as FFM 2 TBW mass. For the purpose of presentation, FM
atomic absorption spectrophotometer (model HGA 500, Perkin- and FFM estimates derived by using the 2c model are
Elmer), as described (14). A pooled urine sample, with a gas designated FM2c and FFM2c, respectively, and FM and FFM
chromatography-mass spectrometer-verified concentration of estimates derived by using the 3c model are designated FM3c
0.32 6 0.01 ng/ml, was run with each assay as a quality and FFM3c, respectively.
control. The mean chromium concentration of this control Total body muscle mass was estimated from the mean
urine sample over all assays was 0.33 6 0.02 ng/ml, as creatinine concentration of three consecutive 24-h urine
measured by atomic absorption spectrophotometry. Percent samples, assuming an equivalence of 18.5 kg muscle/g uri-
chromium absorption was estimated by using the following nary creatinine (35). The creatinine concentration of each
formula: %Cr absorption 5 [urinary Cr excretion/(food Cr urine sample was analyzed on a Technicon Autoanalyzer II
intake 1 supplement Cr intake)] 3 100. (Technicon Instrument, Tarrytown, NY) by using the Jaffe
Body composition measurements. Fasting body weight was reaction (15).
measured each weekday during study weeks 1, 7, and 13 and Skinfold thicknesses were measured to the nearest 0.5 mm
twice weekly during the other study weeks. Weights were at eight sites (biceps, triceps, chest, subscapula, mid-axial,
taken to the nearest 0.1 kg with the subject wearing under- abdomen, suprailiac, and thigh) on the right side of the body
wear, socks, T-shirt, and gym shorts. Nude body weight was by using standard techniques (38) and Lange calipers (Cam-
calculated as total body weight 2 weight of socks, T-shirt, and bridge Scientific Industries, Cambridge, MD). The sum of
gym shorts. Body height, without shoes, was measured one these eight skinfold thicknesses is reported. Body circumfer-
morning during week 1, to the nearest 0.1 cm, with a ence measurements were taken at the chest (at the level of
wall-mounted stadiometer and was assumed to remain con- the fourth costosternal joints, in the horizontal plane, at the
stant throughout the study. end of a normal expiration) and midthigh (midway between
Body composition was assessed by using the techniques the inguinal crease and the distal border of the patella).
described below at study weeks 1, 7, and 13. Total body water Muscle biopsy. The needle biopsy technique (26) was used
(TBW) was determined in the fasting state by using a 20.0-g at study weeks 1 and 13 to obtain vastus lateralis samples

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Copyright © 1999 American Physiological Society. All rights reserved.
32 RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN

from the dominant leg of each man (,150 mg muscle/biopsy). The dietary intake, supplement intake, urinary excre-
A piece of each biopsied muscle sample was placed with the tion, and estimated absorption of chromium for menus
fibers arranged in a longitudinal fashion into a gelatin A and B at study weeks 1, 7, and 13 are presented in
capsule filled with optimum cutting temperature embedding Table 2. For the placebo group, the mean urinary
compound (Sakura Finetek, Torrance, CA). The capsule was chromium excretion at baseline was 5.77 6 3.46 nmol/
covered with optimum cutting temperature compound and
quick-frozen for 20 s in isopentane that was precooled to
day (0.30 6 0.18 µg/day) for menu A and 3.85 6 2.88
2160°C by using liquid nitrogen. The muscle sample was nmol/day (0.20 6 0.15 µg/day) for menu B and was
then placed into liquid nitrogen and transported to a 270°C similar at study weeks 7 and 13. In contrast (time 3
freezer for storage. Serial 10-mm muscle sample sections diet interaction, P , 0.001), chromium picolinate supple-
were sliced onto microscope slides by using a cryostat (Cryo- mentation increased urinary chromium excretion ,50-
cut 1800, Leica Instrument, Germany) maintained at 220°C fold, compared with baseline (42- and 48-fold for menu
and were stained for myofibrillar adenosine triphosphatase, A and 66- and 57-fold for menu B at study weeks 7 and
on the basis of published methods (16, 42), by using a pH 4.3 13, respectively). At baseline, the mean absorption of
incubation solution. Types I and II muscle fiber areas were chromium based on urinary chromium excretion ranged
assessed by using the National Institutes of Health Image
Program, version 1.60a, as modified by Scion (Frederick, MD)
with the use of an LG-3 Scientific Frame Grabber PCI card Table 2. Chromium intake, urinary excretion, and
(Scion). Stained muscle sections were viewed by using the estimated absorption of older men before, midway
103 objective of a Nikon Micro Photo-FXA microscope (Tokyo, between, and after 12 wk of resistance training with
Japan) that was calibrated with a micrometer mounted on or without chromium picolinate supplementation
the slide, and an Ikegami 370M model S camera unit (Tsu-
shinki). The mean muscle fiber areas were calculated from a Time Point
mean of 59 type I fibers (range 15–140 fibers) and 73 type II Group Menu Baseline RT 6 RT 12
fibers (range 13–188 fibers).
Resting metabolic rate measurements. Resting metabolic Chromium intake
rate was measured in the fasting state one morning during Food
study weeks 1 and 13. Each man arrived at the GCRC by Placebo A
automobile, was escorted to a room with an indirect calorim- µmol/day 1.85 6 0.26 Same Same
eter, and rested in a semirecumbent position for ,20 min (µg/day) (96.4 6 13.6)
CrPic A
with the lights low. A clear plastic box, part of a ventilated-
µmol/day 1.92 6 0.29 Same Same
hood system, was then placed over the subject’s head while he (µg/day) (99.6 6 15.3)
rested supine for another 15 min. Then the rates of oxygen Placebo B
consumption (l/min) and carbon dioxide production (l/min) µmol/day 1.07 6 0.14 Same Same
were measured and averaged from 15 consecutive 1-min (µg/day) (55.8 6 7.3)
expired air samples. Resting metabolic rate was calculated by CrPic B
multiplying the oxygen consumption rate (l/min) by the µmol/day 1.12 6 0.09 Same Same
kilojoules per liter of oxygen associated with the respiratory (µg/day) (58.0 6 4.6)
exchange ratio of the expired air (40). Supplement
Placebo,
Statistical methods. Values are reported as means 6 SD. µmol/day ,0.1 ,0.1
The difference between the chromium picolinate group and CrPic
placebo group for each of the independent variables reported µmol/day 17.77 6 0.42 17.77 6 0.42
was determined for study week 1 data (baseline) by using (µg/day) (924 6 22) (924 6 22)
Student’s unpaired t-test. The main effects of RT and chro-
Chromium excretion (urine)
mium picolinate supplementation and the interactions among
these dependent variables on each of the independent vari- Placebo A
ables were determined by using two-way repeated-measures nmol/day 5.77 6 3.46 4.42 6 5.38 5.77 6 6.15*†‡
analysis of variance. All calculations were performed by using (µg/day) (0.30 6 0.18) (0.23 6 0.28) (0.30 6 0.32)
CrPic A
PROC TTEST and PROC GLM of SAS version 6.11 (SAS nmol/day 4.62 6 2.50 196 6 67 224 6 100
Institute, Cary, NC). All data processing was performed by (µg/day) (0.24 6 0.13) (10.2 6 3.5) (11.7 6 5.2)
using Microsoft Excel 5.0 (Microsoft, Redmond, WA). Results Placebo B
were considered statistically significant if P , 0.05 (2-sided). nmol/day 3.85 6 2.88 4.62 6 3.27 6.54 6 7.50*†‡
(µg/day) (0.20 6 0.15) (0.24 6 0.17) (0.34 6 0.39)
CrPic B
RESULTS
nmol/day 3.08 6 1.73 202 6 86 176 6 94
(µg/day) (0.16 6 0.09) (10.5 6 4.5) (9.1 6 4.9)
Menus A and B used during the 5-day controlled diet
periods at study weeks 1, 7, and 13 provided a mean Chromium estimated absorption, %
energy intake of 11.4 6 1.1 MJ/day (2,722 6 258 Placebo A 0.31 6 0.19 0.24 6 0.28 0.31 6 0.31*†‡
kcal/day) and 11.6 6 1.2 MJ/day (2,772 6 282 kcal/day), CrPic A 0.25 6 0.15 1.13 6 0.64 1.14 6 0.51
respectively (Table 1). The energy intake of menu A Placebo B 0.37 6 0.29 0.42 6 0.28 0.59 6 0.63*‡
CrPic B 0.28 6 0.15 1.15 6 0.46 0.93 6 0.50
consisted of 13% protein, 57% carbohydrate, and 30%
fat, and the energy intake of menu B consisted of 13% Results are means 6 SD. CrPic, chromium picolinate group, n 5 9
protein, 58% carbohydrate, and 29% fat. The chromium men; Placebo group, n 5 9 men. Time points: RT 6, resistance
training week 6, RT 12, resistance training week 12. Cr estimated
contents of menus A and B were 1.88 6 0.27 µmol/day absorption, % 5 [urinary Cr excretion/(food Cr intake 1 supplement
(98.0 6 14.1 µg/day) and 1.09 6 0.12 µmol/day (56.9 6 Cr intake)] 3 100. Significantly different, P , 0.001 for * time, † diet,
6.0 µg/day), respectively. and ‡ time 3 diet interaction.

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RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN 33

from 0.25 to 0.37% (for both groups consuming either chromium picolinate interactions, the effect of RT was
menu). For the placebo group, the calculated absorp- assessed by using data from men in both groups
tion of chromium at study weeks 7 and 13 remained combined (n 5 18).
similar to baseline (0.24–0.59%). In contrast (time 3 RT increased body density (P 5 0.003; Table 3). By
diet interaction, P , 0.001), chromium picolinate supple- using the body density data in a 2c model, FM2c (P 5
mentation increased the estimated absorption of chro- 0.007) and percent body fat (P 5 0.003) were decreased
mium to a range of 0.93–1.15%. by 2.1 6 2.9 kg and 2.1 6 2.6%, respectively, and FFM2c
Water samples collected from seven different drink- was increased by 2.2 6 2.3 kg (P , 0.001).
ing fountains and faucets contained 0.33 6 0.09 ng TBW was decreased by 3.0 6 2.3 liters with RT (P ,
chromium/ml (range 0.22–0.46 ng chromium/ml). Thus 0.001; Table 3). By using the TBW data and the body
4 l/day (<1 gallon/day) of water intake would provide density data in a 3c model, FM3c (P 5 0.047) and
0.9–1.8 µg chromium/day. percent body fat (P 5 0.026) were increased by 1.5 6 2.9
At baseline, the mean values for all of the indepen- kg and 1.6 6 2.7%, respectively, and FFM3c decreased
dent variables related to body size, body composition, by 1.4 6 2.1 kg (P 5 0.016). The protein 1 mineral mass
muscle size, strength and power, and resting energy compartment (calculated as FFM3c 2 TBW) was in-
expenditure were not different between the men in the creased by 1.6 6 1.1 kg (P , 0.001).
chromium picolinate group and the men in the placebo Whole body muscle mass, assessed from 24-h urinary
group (see Tables 3 and 4 and Figs. 1 and 2). creatinine excretion, increased with RT by 5.1 6 3.8 kg
For all measurements of body composition, statistical (P , 0.001; Table 3). Mean type I muscle fiber area was
analyses established that no RT-by-chromium picoli- unchanged, and mean type II muscle fiber area was
nate interaction or main effect of chromium picolinate increased by 577 6 1.62 µm2 (P 5 0.046) with RT, as
existed (Table 3). These analyses indicate that 1) when assessed from vastus lateralis biopsy samples. The sum
RT resulted in changes in these measurements of body of eight skinfold thicknesses and midthigh circumfer-
composition, these changes were not influenced by ence did not change with RT, and chest circumference
whether the men consumed chromium picolinate or the was decreased by 1.37 6 2.16 cm (P 5 0.018).
placebo, and 2) when data from all of the evaluation The mean resting metabolic rate at study week 13
periods were considered together, there were no differ- was not statistically different from baseline but did
ences between groups. Because there were no RT-by- trend higher [mean change from baseline, 0.016 6

Table 3. Physical characteristics, body composition, and resting metabolic rate of older men before and after
12 wk of resistance training with or without chromium picolinate supplementation
Placebo Chromium Picolinate

Parameter Baseline RT 12 Baseline RT 12 P Value

Age, yr 60 6 3 63 6 4
(range 56–66) (range 59–69)
Height, cm 173.5 6 5.5 178.2 6 7.3
Body weight, kg 90.2 6 8.6 90.6 6 8.6 96.2 6 13.1 96.0 6 11.7 0.807
Body density, g/ml 1.0233 6 0.0112 1.0293 6 0.0079 1.0203 6 0.0123 1.0233 6 0.0094 0.003
Two-compartment model
Body fat, % 33.8 6 5.3 31.0 6 3.7 35.2 6 5.5 33.7 6 4.5 0.003
Fat mass, kg 30.6 6 6.5 28.1 6 4.6 34.1 6 7.9 32.4 6 5.9 0.007
Fat-free mass, kg 59.6 6 6.2 62.5 6 6.4 62.1 6 8.6 63.5 6 8.7 ,0.001
Three-compartment model
Body fat, % 33.4 6 3.6 35.0 6 3.9 33.9 6 6.5 35.5 6 5.2 0.026
Fat mass, kg 30.3 6 5.5 31.9 6 6.0 33.0 6 9.6 34.4 6 8.3 0.047
Fat-free mass, kg 59.9 6 4.8 58.8 6 4.5 63.1 6 7.0 61.5 6 5.8 0.016
Total body water, liters 44.0 6 3.6 40.9 6 3.5 46.8 6 4.6 43.9 6 3.1 ,0.001
Protein 1 mineral mass, kg 15.9 6 2.3 17.8 6 2.6 16.3 6 2.9 17.6 6 3.3 ,0.001
Other body-composition measurements
S 8 Skinfold thicknesses, mm 191 6 53 173 6 45 187 6 55 170 6 28 0.121
Chest circumference, cm 106.0 6 4.9 105.0 6 4.2 108.4 6 6.2 106.6 6 6.4 0.018
Midthigh circumference, cm 53.3 6 2.7 53.2 6 4.3 54.6 6 4.9 53.1 6 3.0 0.361
Muscle mass, kg 30.4 6 3.7 35.9 6 6.7 30.5 6 5.2 35.3 6 6.3 ,0.001
Type I muscle fiber area, µm2 5,973 6 1,639 6,093 6 1,091 4,986 6 1,015 4,658 6 1,408 0.759
Type II muscle fiber area, µm2 4,985 6 1,224 5,706 6 1,055 4,528 6 1,327 4,920 6 1,033 0.046
Energy expenditure
BMR, l O2/min 0.246 6 0.019 0.269 6 0.036 0.269 6 0.040 0.278 6 0.041 0.068
BMR, MJ/day 7.28 6 0.57 7.94 6 1.13 7.97 6 1.18 8.23 6 1.17 0.093
Values are means 6 SD. S, sum of; BMR, basal metabolic rate. P values are for effect of time (n 5 18 subjects). There were no statistically
significant diet effect or time 3 diet interactions for these data.

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34 RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN

0.034 l O2/min (P 5 0.068) and 0.46 6 1.07 MJ/day (P 5


0.093) for n 5 18 subjects combined].
1RM strength increased in all of the muscle groups
trained (P , 0.0001; Table 4). Quantitatively, the
amount of strength gained was similar for men in the
chromium picolinate and placebo groups for the right
knee flexion, left knee flexion, double leg press, chest
press, and arm pull exercises. However, the chromium
picolinate group gained less strength in both the right
and left knee-extension exercises than did the placebo
group (RT-by-chromium picolinate interaction, P 5
0.035 and P 5 0.009, respectively).
The data from the muscle power testing for the arm-
pull and leg-extension exercises are presented in Figs.
1 and 2, respectively. Chromium picolinate supplemen-
tation did not influence the changes in arm muscle
power to RT. After 12 wk of RT, arm-pull muscle power
at 20% of 1RM was increased and at 40, 60 and 80% of
1RM was not different, compared with baseline. Knee-
extension power at 20, 40, and 60% of 1RM increased
less in the chromium picolinate group than in the
placebo group (RT-by-chromium picolinate interaction,
P 5 0.005, P 5 0.024, and P 5 0.069, respectively).
Knee-extension power at 80% of 1RM was not different
at study week 13 than at baseline and was not influ-
enced by chromium picolinate supplementation.
DISCUSSION

In the present study, supplementation of older men


with 17.8 µmol chromium/day as chromium picolinate
for 12 wk did not influence any of the RT-induced
changes in body composition. Chromium picolinate
supplementation did not augment the accretion of FFM Fig. 1. Arm-pull muscle power before (baseline) and after 12 wk of
or muscle mass or enhance the loss of body fat. These resistance training (RT week 12) of older men who consumed either
17.8 µmol chromium/day (924 µg chromium/day) as chromium picoli-
nate (A) or a low-chromium placebo (B) during RT. 1RM, 1 repetition
Table 4. Maximal muscle strength of older men before maximum. Statistical analyses are as follows.
and after 12 wk of resistance training with or without
chromium picolinate supplementation P Value

Placebo Chromium Picolinate Arm-Pull Power Time Diet Time 3 Diet

Parameter Baseline RT 12 Baseline RT 12 20% 1RM 0.016 0.887 0.293


40%1RM 0.305 0.943 0.291
Right knee exten- 60%1RM 0.474 0.878 0.628
sion, Nm 140 6 32 189 6 36 149 6 26 175 6 31*† 80%1RM 0.287 0.759 0.198
D, % 37 6 22 18 6 10
Left knee exten-
sion, Nm 137 6 25 185 6 18 141 6 41 170 6 42*†
D, % 37 6 18 22 6 11 findings are consistent with most (20, 32, 39, 46) but
Right knee not all (24, 36) double-blind, placebo-controlled chro-
flexion, Nm 120 6 29 157 6 32 121 6 27 156 6 30* mium picolinate supplementation trials conducted in
D, % 34 6 25 31 6 17 young men and women (Table 5). The present study
Left knee flexion,
Nm 117 6 31 154 6 25 121 6 25 150 6 35*
expands present knowledge by studying older men, by
D, % 38 6 36 24 6 20 using a much higher dose of chromium picolinate, and
Double leg press, by using a wider variety of methods to quantify body
N 1,4466181 1,6946287 1,4126310 1,629 6 281* composition.
D, % 14 6 9 12 6 9 The original report of Evans (24) and the research by
Chest press, N 551 6 91 627 6 92 553 6 81 613 6 99*
D, % 15 6 12 11 6 5 Kaats et al. (36) are the only two published studies that
Arm pull, N 596 6 63 713 6 103 626 6 110 754 6 145* report chromium picolinate to have ergogenic effects on
D, % 20 6 7 21 6 13 body composition. Several factors severely limit the
Values are means 6 SD; n 5 9 men. D, change in muscle strength
ability to evaluate the quality of the data of Evans (24).
from baseline to RT 12. * Time effect (n 5 18 subjects), P , 0.0001. First, there is no way to evaluate the accuracy or
† Time 3 diet interaction, P , 0.05. precision of these data because neither the within-

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RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN 35

via measurements of the chromium content of the


beverages and urinary chromium excretion; 2) the
large subject dropout rate [65 of the 219 subjects who
started the study (30%)], and 3) artificially enhancing
the actual between-group differences in body composi-
tion change through the use of undocumented calcula-
tions of a ‘‘body composition improvement score.’’
Collectively, the present study and most of the pub-
lished studies (20, 32, 34, 39, 46) do not support the
hypothesis (24) that chromium picolinate supplementa-
tion promotes the accretion of muscle mass and loss of
body fat. The findings that chromium picolinate supple-
mentation did not affect whole body density (assessed
via hydrodensitometry), skinfold thicknesses, body cir-
cumferences, or whole body muscle mass (assessed via
urinary creatinine excretion) support the findings of
previous research studies that also used these tech-
niques (20, 32, 34, 39, 46). The present study expands
present knowledge by showing that chromium picoli-
nate supplementation also did not affect TBW, whole
body protein 1 mineral mass, or type I and II fiber
areas of the vastus lateralis. These studies assessed
whether chromium picolinate augmented body composi-
tion changes in subjects during relatively short-term
periods (6–16 wk) and in conjunction with other inter-
ventions that specifically attempted to alter body com-
position (e.g., RT or aerobic training). If chromium
picolinate does influence body composition, the effects
must be small. Also, the measurement techniques used
not only must be able to precisely quantify small
changes in body composition, but must be able to
quantify differences in the amount of change in body
Fig. 2. Leg-extension muscle power before (baseline) and after 12 wk
composition (i.e., the interaction of chromium picoli-
of RT of older men who consumed either 17.8 µmol chromium/day nate and the other intervention).
(924 µg chromium/day) as chromium picolinate (A) or a low- The findings that FFM3c decreased and FM3c in-
chromium placebo (B) during RT. Statistical analyses are as follows. creased when we used the 3c model, opposite to the
increase in FFM2c and decrease in FM2c observed by
P Value using the 2c model, were surprising and difficult to
explain (Table 3). These changes in FFM3c and FM3c
Leg Extension Power Time Diet Time 3 Diet
were mostly related to the very large decrease in TBW
20%1RM 0.0001 0.670 0.005 having a major impact on the calculation. The mean
40%1RM 0.0001 0.408 0.024 3.0-liter decrease in TBW is largely opposite to a
60%1RM 0.0001 0.334 0.069
80%1RM 0.095 0.212 0.549 1.6-liter increase in TBW observed in older men and
women who completed a similar RT program (17). The
large decrease in TBW is consistent with a change in
group variability of the changes nor the absolute amount hydration status of the men, a possibility that was not
of weight, lean body mass, or FM were reported. tested in the present study. The men were encouraged
Second, the use of a paired t-test to assign statistical to drink a great deal of fluids in conjunction with the
significance to differences between mean values of exercise sessions. Also, the body weights of the men
group changes and differences in changes between remained stable throughout the study, with no indica-
groups may inappropriately enhance the chance of tion of abrupt declines in body weight, consistent with
detecting a difference in response between groups. short-term shifts in TBW. Because the mean body
Third, the assessment of body composition was limited density of these men was .1.000 g/ml at baseline, a
to indirect estimates of lean body mass and FM by decrease in TBW (density 5 0.993 at 37°C) is consistent
using skinfold thicknesses and measurement of biceps with the increase in body density measured by hydro-
and calf circumferences. Strengths of the Kaats et al. static weighing.
(36) data include the large number of subjects studied The significant increase in protein 1 mineral mass is
(n 5 154) and the use of a double-blind study design. fully consistent with a RT-induced improvement in
Weaknesses of the study include the following: 1) not body composition, as was also shown independently by
controlling the amount of formula beverage consumed the increased whole body density, the increased whole
or quantifying that chromium picolinate was consumed body muscle mass, and the increased vastus lateralis

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36 RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN

Table 5. Chromium picolinate supplementation effects on body composition


Chromium Picolinate
Subjects Supplement

Dose, Length, Body Composition


Ref. Study No. Age, yr µmol Cr/day days Measurement Results

Evans (24) 41 men 18–21 3.85 ,40 Skinfold thicknesses Greater FFM gain
Body circumferences Greater FM loss
Hasten et al. (34) 59 men and women 18–36 3.85 ,72 Skinfold thicknesses Greater BW gain for women
only
Clancy et al. (20) 40 men 18–21 3.85 ,56 Skinfold thicknesses No effect
Body circumferences
Hydrodensitometry
Trent and Thieding-Cancel (46) 95 men and women 30 (mean) 7.7 ,112 Body circumferences No effect
Hallmark et al. (32) 16 men 18–35 3.85 ,72 Hydrodensitometry No effect
Skinfold thicknesses
Body circumferences
Lukaski et al. (39) 36 men 19–29 3.3–3.5 ,58 Dual-energy radiography No effect
Skinfold thicknesses
Whole body muscle mass
Kaats et al. (36) 154 men and women 46 (mean) 3.85–7.7 ,72 Underwater displacement Enhanced BW and FM loss
This study 18 men 56–69 17.8 ,72 Hydrodensitometry No effect
Skinfold thicknesses
Body circumferences
Whole body muscle mass
Total body water
Muscle fiber area
All of the studies were conducted by using a double-blind, placebo-controlled design. FFM, fat-free mass; FM, fat mass; BW, body wt.

type II fiber area. We had chosen to use the 3c model for 2 days before and during the 3-day urine collection
based on previous research (17, 18) showing that the periods to minimize exogenous sources of creatine,
estimate of protein 1 mineral mass was sensitive to consistent with standard protocol (35). Whereas uri-
change and that a change in protein 1 mineral mass nary creatinine excretion is known to decrease by 5–8%
was reflective of changes in whole body and muscle within the first 2–3 wk of consuming a meat-free diet
protein breakdown. (Ref. 19 and unpublished observations), the magnitude
Urinary creatinine excretion is considered a reliable, of these dietary-induced changes would be ,5% during
indirect indicator of whole body muscle mass in adult the 5-day meat-free periods and within the daily within-
humans (35), including older people (48). It is also subject variability of the measurements (8.9 and 7.7%
considered sensitive and reflective of RT-induced at weeks 1 and 13, respectively). Alternatively, it is
changes in muscle mass in older people (41). To use possible that the RT-induced gains in FFM were under-
urinary creatinine excretion as an index of muscle estimated by the hydrostatic weighing method. Indeed,
mass, one must assume that the body creatine pool is Siri (45) indicated that, when the 2c model is used, the
almost exclusively found in skeletal muscle, that the assumption is made that a change in body density
conversion of creatine to creatinine occurs irreversibly reflects a change in body FM and that the apparent
and at a constant rate, and that the rate of renal change in body density would be less if muscle mass
excretion of creatinine is constant (35). These assump- were gained at the same time that FM was lost.
tions are not always precisely met. For example, uri- In contrast with the present findings, one previous
nary creatinine excretion occurs in direct proportion to study from our research group (17, 18) reported that RT
the whole body creatine pool size and was documented by older people did not ‘‘improve’’ body composition.
to change to some extent with changes in dietary Both studies utilized the same equipment, protocol,
protein, creatine, and creatinine intakes, independent and duration of RT. Differences between the previous
of changes in lean body mass (22, 35). (17, 18) and present studies, respectively, included
For the present study, the increase in urinary creati- studying both men and women vs. just men and using
nine excretion indicates an increase in whole body controlled diets intermittently vs. continuously. A
muscle mass, a finding supported by the increase in strength of both studies was the use of multiple,
vastus lateralis type II fiber area. However, the mean independent measurements to assess body composi-
5.1-kg increase in muscle mass estimated from this tion. Within each study, the different measurements of
method exceeds the mean 2.2-kg increase in FFM body composition were in general agreement. For ex-
estimated from body density. It is possible that the ample, in the previous research (17, 18), the conclusion
RT-induced gains in muscle mass were overestimated that RT did not improve body composition in older
by the urinary creatinine excretion data, possibly be- people was supported by assessments of body density
cause of changes in whole body creatine pool size via hydrostatic weighing, protein 1 mineral mass from
(unmeasured in the present study) or dietary factors. the 3c model by using body density and TBW, whole
The men were purposefully provided a meat-free diet body muscle mass via 24-h urinary creatinine excre-

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Copyright © 1999 American Physiological Society. All rights reserved.
RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN 37

tion, thigh muscle area via computed tomography these two methods give relatively comparable results
scanning, body cell mass via 40K-potassium scanning, (11, 44). For the present study, the use of controlled
and muscle fiber area via biopsies of the vastus latera- menus of known chromium content during the 24-h
lis. In the present study, the conclusion that RT did urine collection periods enhanced the estimation of the
improve body composition in older men is supported by absorption of chromium. The estimated absorption of
assessments of body density, protein 1 mineral mass, chromium at baseline, ranging from 0.37 to 0.25% at
whole body muscle mass, and vastus lateralis type II dietary intakes of 1.07–1.92 µmol chromium/day (56–
fiber area. Collectively, these data emphasize the impor- 100 µg chromium/day; Table 2), is fully consistent with
tance of using multiple techniques to assess baseline an estimated absorption of #0.5% at intakes of .0.77
and intervention-induced changes in body composition µmol chromium/day (.40 µg chromium/day) (11).
and the inherent difficulties of precisely and accurately The significant increases in urinary chromium excre-
measuring relatively small changes in body composi- tion with chromium picolinate supplementation at RT
tion associated with shorter-term RT protocols. There weeks 6 and 12 for these older men are consistent with
is little doubt that longer-term RT significantly and previous chromium picolinate supplementation studies
beneficially alters whole body composition and muscle in RT young men (32, 39). Hallmark et al. (32) reported
mass in older people (41, 43). These studies also an ,10-fold increase in urinary chromium excretion
demonstrate that much more research is needed to (29.2 vs. 2.9 nmol chromium/day) with a chromium
better understand the factors (e.g., dietary, hormonal, picolinate supplementation of 3.62 µmol chromium/day
exercise, gender) involved with maintaining and en- (188 µg chromium/day). In comparison, chromium pico-
hancing FFM and muscle mass in older people as linate supplementation of 17.8 µmol chromium/day
preventive or therapeutic treatments for sarcopenia. (924 µg chromium/day) in the present study increased
The increase in muscle strength with RT by the older urinary chromium excretion ,50-fold (199 vs. 3.9 nmol
men in the present study is consistent with previous chromium/day; mean of menus A and B at RT week 6 vs.
research in older people (17, 30). Similarly, the finding baseline for chromium picolinate group, Table 2). Pro-
that chromium picolinate did not augment the increase vided that urinary chromium excretion is an index of
in strength is fully consistent with previous research in the estimated absorption of chromium, ,0.93–1.15% of the
young men who resistance trained (20, 32, 34, 39). chromium contained in a chromium picolinate supplement
To our knowledge, this is the first study to assess the was absorbed. This range of estimated percent absorption
effect on isotonic muscle power of RT by older people of supplemental chromium picolinate is greater than that
and to document increased power of the muscles in- reported for dietary chromium (Table 2) (11), a finding
volved with knee extension. Because 1RM increased consistent with previous research in humans (31) and
with RT, the absolute force or torque at a given rats (8). Collectively, these data suggest that increased
percentage of 1RM used for the muscle power testing chromium picolinate supplementation proportionately
was higher also. A lack of change in muscle power increases urinary chromium excretion via a process
implies that, although the subjects were exerting more that is without strict homeostatic control. It is impor-
force or torque, their speed of movement was actually tant to note that this conclusion only relates to increas-
less. Alternatively, where power at a given percentage ing doses of supplemental chromium picolinate and not
of 1RM increased with RT, it cannot be readily deter- to dietary chromium. At dietary chromium intakes
mined how this relates to the speed of movement. The ,0.77 µmol chromium/day (,40 µg chromium/day),
functional significance of these power data was not estimated absorption decreases with increasing chro-
assessed in the present study and requires further mium intake, i.e., estimated chromium absorption is
evaluation. Similarly, the finding that the men in the inversely related to dietary intake at normal intakes
chromium picolinate group gained less strength in the (between 10 and 40 µg chromium/day) (11).
right and left knee-extension exercises and gained less Aerobic exercise has been shown to increase urinary
knee-extension power (at 20, 40, and 60% of 1RM) is of chromium excretion (12, 13) in relation to the acute
interest and requires further research. These data stress of the exercise (9) and the training status of the
must be viewed as preliminary and should not be used subjects (7). In the present study, mean urinary chro-
to condemn the use of chromium picolinate supple- mium excretion of the placebo group was not signifi-
ments, because similar results were not obtained for cantly different from baseline at RT weeks 6 or 12
the other muscle groups tested. (Table 2). These results suggest that, under these
Urinary chromium excretion is suggested to be a experimental conditions, RT did not alter the urinary
‘‘fairly accurate estimation of the amount of chromium excretion or the estimated absorption of chromium.
absorbed’’ (11), because absorbed chromium is excreted These results are in contrast to the recent report that
primarily in the urine, with only minimal losses occur- acute and chronic resistance exercise increased urinary
ring via other routes. To this end, we chose to use the chromium excretion in men aged 53–63 yr, as assessed
term ‘‘estimated absorption’’ to reflect the ratio of by the measurement of urinary losses of a standard oral
urinary chromium excretion to oral chromium intake dose of the stable isotope 53Cr (44). Differences in
from the diet and the supplement. Whereas a direct results of the present study and those of Rubin et al.
comparison between this method of estimating chromium (44), respectively, may relate to 1) measurement of the
absorption and the use of the stable isotope 53Cr has not urinary excretion of total dietary chromium intake vs. a
been published to date, separate assessments that use 5.77-µmol (300-µg) dose of 53Cr as chromium chloride

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Copyright © 1999 American Physiological Society. All rights reserved.
38 RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN

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Sincere thanks go to the dedicated volunteers who made this study 1970, p. 131–152.
possible. We thank the General Clinical Research Center dietary and 17. Campbell, W. W., M. C. Crim, V. R. Young, and W. J. Evans.
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thank Noella Bryden, US Department of Agriculture Human Nutri- with resistance training in older adults. Am. J. Clin. Nutr. 60:
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analyses for this study. We are grateful to Keiser Sports Health 18. Campbell, W. W., M. C. Crim, V. R. Young, L. J. Joseph, and
Equipment (Fresno, CA) for the generous donation of the resistive W. J. Evans. Effects of resistance training and dietary protein
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This study was supported by National Institute on Aging Grants (Endocrinol. Metab. 31): E1143–E1153, 1995.
T32 AG-0048, 1-R29-AG-13409 and RO1-AG-11811, by General Clini- 19. Castaneda, C., J. M. Charnley, W. J. Evans, and M. C. Crim.
cal Research Center Grant MO1-RR-10732, and by an independent Elderly women accommodate to a low-protein diet with losses of
monetary gift from Nutrition 21 (San Diego, CA). body cell mass, muscle function, and immune response. Am. J.
Address for reprint requests: W. W. Campbell, VA Medical Center, Clin. Nutr. 62: 30–39, 1995.
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72114–1706 (E-mail: campbellwaynew@exchange.uams.edu). P. S. Freedson, J. J. Cunningham, and B. Valentine. Effects
Received 6 October 1997; accepted in final form 27 August 1998. of chromium picolinate supplementation on body composition,

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RESISTANCE TRAINING AND CHROMIUM IN OLDER MEN 39

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