1. Healthcare

Special Populations
The Special Populations Column provides personal
trainers who work with apparently healthy or medically
cleared special populations with scientifically supported
background information.
COLUMN EDITOR: Peter Ronai, MS, RCEP, CSCS*D,
NSCA-CPT
Resistance Training for
Metabolic Syndrome:
Part I
Paul Sorace, MS, RCEP, CSCS*D,1 Peter Ronai, MS, RCEP, CSCS*D, CSPS,2
and James R. Churilla, PhD, MPH, RCEP, CSCS3
1
Hackensack University Medical Center, Hackensack, New Jersey; 2Sacred Heart University, Fairfield, Connecticut;
and 3University of North Florida, Jacksonville, Florida
ABSTRACT
THIS COLUMN WILL FOCUS ON
DISCUSSING THE COMPONENTS
OF METABOLIC SYNDROME (MetS)
AND THE BENEFITS RESISTANCE
TRAINING (RT) MAY HAVE ON
THESE COMPONENTS AND METS
AS A WHOLE.
METABOLIC SYNDROME: AN
OVERVIEW
This column (Part I) will provide an
overview of metabolic syndrome (MetS),
the defining criteria for MetS and discuss
the benefits resistance training (RT) may
have on each component of MetS. The
one on one column (Part II) will provide
evidence-based RT program guidelines
for managing or preventing MetS and
discuss RT modifications / safety precautions for the individual components
of MetS.
Metabolic syndrome is a name for
a group of cardiovascular disease risk
factors that occur together. Having
MetS increases the risk for a number
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of health consequences including coronary artery disease, heart attack and
stroke (2). MetS is identified in a person
by the presence of 3 of 5 criteria including an elevated waist circumference,
blood pressure, blood glucose, or triglycerides and low high-density lipoproteins (HDL). At this time, the criteria
set by the American Heart Association
and National Heart, Lung, and Blood
Institute (AHA/NHLBI) are currently
recommended in the United States
(13). This definition represents an updated version of the National Cholesterol Education Program Adult
Treatment Program III criteria (Table 1).
An individual must have at least 3 of the
defining criteria to be diagnosed by
a physician with MetS.
It is interesting to note that at the present time, there are no universal criteria
for diagnosing MetS (7). Various governing bodies have slightly different
diagnostic criteria. Recently, a harmonized definition or unifying criteria for
MetS has been proposed (1).
VOLUME 35 | NUMBER 4 | AUGUST 2013
Although genetics play a role in the
development of MetS (e.g., family history of type 2 diabetes [T2D] and obesity) (22), lifestyle or environmental
issues such as low physical activity levels, poor diet, and progressive weight
gain contribute significantly to the risk
of developing MetS. Sufficient levels of
physical activity/exercise, including
RT can play a major role in the
prevention and management of MetS
(2,9,24).
RESISTANCE TRAINING EFFECTS
ON METABOLIC SYNDROME
In recent years, there has been
increased attention to the effects RT
has on preventing and managing metabolic diseases. Although aerobic training is not discussed in detail in this
column, it is important to note that
a combination of aerobic and resistance
exercise may be superior compared
with either exercise modality alone,
for improving components of MetS,
such as glycemic control (6). Although
aerobic exercise will always be an integral part of the exercise prescription for
Copyright Ó National Strength and Conditioning Association
RT does contribute to overall caloric
expenditure, it is generally recommended as an adjunct to aerobic or
endurance training in persons with
dyslipidemia (2).
Table 1
Defining criteria for metabolic syndromea
Elevated waist circumference
Men—equal to or greater than 40 in. (102 cm)
PREHYPERTENSION/
HYPERTENSION
Women—equal to or greater than 35 in. (88 cm)
Elevated triglycerides
Equal to or greater than 150 mg/dL or on pharmacotherapyb
Reduced high-density lipoproteins (HDL cholesterol)
Men—less than 40 mg/dL or on pharmacotherapyb
Women—less than 50 mg/dL or on pharmacotherapyb
Elevated blood pressure
Equal to or greater than 130/85 mm Hg or on pharmacotherapyb
Elevated fasting glucose
Equal to or greater than 100 mg/dL or on pharmacotherapyb
Information obtained from Ref. 13.
a
A person must meet at least 3 of these criteria to be diagnosed by a physician with MetS.
b
Defined as taking physician-prescribed medication(s) to treat the health condition.
individuals with cardiovascular disease
risk factors, it is important to understand
the effects and benefits of RT on the
various components of MetS. Recent
evidence shows that RT performed at
least 2 days/wk can reduce the risk and
prevalence of MetS and its individual
components in U.S. adults (8, 9). Resistance training has a clinically significant
effect on MetS risk factors and should
be part of the lifestyle management of
MetS (24).
IMPAIRED FASTING GLUCOSE/
TYPE 2 DIABETES
There is evidence that RT can have
a positive impact in improving glycemic control (4,5,20). A recent study
showed that 10 weeks of resistance
exercise was associated with significantly better glycemic control in adults
with T2D compared with a treadmill
exercise group (4). Additional studies
have shown RT to be effective in
improving glycemic control in older
adults (5) and women (20). Muscle
contraction-mediated glucose uptake
and both increased intramuscular
glucose transport (GLUT4) protein
content and increased lean body mass
have all been identified as mechanisms
for enhanced glycemic control
(11,14,20). Resistance exercise has
been shown to improve ability to perform activities of daily living (18), and
this is important to help increase daily
physical activity, thus helping prevent
or manage impaired fasting glucose,
T2D, and MetS.
DYSLIPIDEMIA
Improvements in total cholesterol, lowdensity lipoproteins (LDL), and triglycerides have been observed from RT
(16,20). The results of studies examining
the effects of RT on various blood lipids
(e.g., increases in HDL) have reported
inconsistent findings, which may be
partly because of varying RT programs
used in the studies (e.g., different volumes of RT) (12,25). A reduction in
abdominal adiposity is a proposed
mechanism for these improvements
observed in both T2D and dyslipidemia
patients after RT (5,11,15,16,20,23).
Healthy weight loss and weight maintenance is generally emphasized for
persons with dyslipidemia. Although
RT has been shown to reduce both
resting and ambulatory blood pressure
in persons with hypertension (19,21).
The effects of RT on resting blood pressure are generally modest (3). A metaanalysis by Kelley and Kelley (17) indicates an approximate 2% reduction in
resting systolic blood pressure and an
approximate 4% reduction in resting
diastolic blood pressure. This analysis
looked at RT programs (circuit-training
and a more conventional format [multiset, longer rest periods]) lasting at least 4
weeks. However, the majority of outcomes in this meta-analysis and a second one (10) were in subjects with
resting blood pressures of ,140/90
mm Hg. More research is needed
regarding the effects of RT on blood
pressure in persons with hypertension.
Recent data indicate that adults performing resistance exercise at least twice
weekly may reduce the risk of developing prehypertension (9).
Regular RT may have other benefits for
persons with prehypertension/hypertension. Activities requiring physical exertion (e.g., physical activities involving
lifting or carrying) may be safer to perform, because hemodynamic responses
(e.g., increases in blood pressure and
heart rate) may be less as a result of
increased muscular strength and
endurance from regular RT. Resistance exercise has been shown to
decrease the blood pressure response
to maximal exercise and improve
heart rate and blood pressure recovery following cardiorespiratory exercise (26).
ABDOMINAL OBESITY
Although aerobic activities should be
emphasized for weight loss and
abdominal fat loss (2), RT has a demonstrated role with this component of
MetS. Resistance training, performed
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65
Special Populations
twice weekly, in the absence of a weight
loss diet, has been shown to improve
insulin sensitivity and fasting glycemia
and decrease central adiposity in older
men with T2D (15). In addition,
a recent meta-analysis showed that
RT could have a significant impact on
reducing abdominal and total adiposity
in individuals with abnormal glucose
metabolism (24). Although RT should
not be the primary mode of exercise for
weight loss and total and abdominal fat
loss, RT does expend calories and can
result in increases in lean body mass,
which can increase resting metabolic
rate. In addition, increased muscular
strength and endurance will likely
enable overweight and obese individuals to be more physically active on
a regular basis, thus expending more
calories to assist with abdominal and
total fat loss and the prevention of
weight regain.
SUMMARY
More research is needed regarding
the specific benefits of RT on the individual components of MetS. However, it is clear that RT, particularly
when combined with aerobic exercise
training, can help prevent and manage
MetS.
Conflicts of Interest and Source of Funding:
The authors report no conflicts of interest
and no source of funding.
Paul Sorace is a clinical exercise physiologist for The Cardiac Prevention and
Rehabilitation Program at Hackensack
University Medical Center in Hackensack, NJ.
Peter Ronai is a clinical associate professor in the exercise science department
at Sacred Heart University in Fairfield,
CT.
James R. Churilla is an Assistant
Professor of clinical exercise physiology
and physical activity and the Graduate
Program Director for the Exercise
Science and Chronic Disease program in
the Brooks College of Health at the
University of North Florida in
Jacksonville, FL.
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