Resistance Training for the Client with Metabolic Syndrome

By Brad Schoenfeld, MSc, CSCS, CSPS, NSCA-CPT

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September 2012

Resistance Training for the Client with Metabolic Syndrome

By Brad Schoenfeld, MSc, CSCS, CSPS, NSCA-CPT

What is Metabolic Syndrome

• Lifestyle disease directly linked

to obesity.

• Primary clinical outcome is

cardiovascular disease.

• Predisposes to other conditions

including polycystic ovary

syndrome, fatty liver, cholesterol

gallstones, asthma, sleep

disturbances, and some forms

of cancer.

Metabolic Syndrome Stats

• Approximately 25% of

adults in the U.S. have

metabolic syndrome

• Approximately 43% of

those over 60 years of age

have metabolic syndrome

25

43

% Total Population % Over 60

% Afflicted

Then vs. Now…

• In early-hunter gatherer populations,

men hunted 1-4 nonconsecutive days

per week and women gathered food

every 2-3 days (Eaton et al. 2002)

▫ Estimated steps per day: 20,000

• Present Westernized society has

decreased caloric expenditure by

approximately 1200 calories

compared with early 20th century

hunter-gatherer societies (Cordain et

al. 1998)

Effects of Lifestyle on Health

• The prevalence of Type 2 diabetes in

present hunter-gatherer, rudimentary

horticultural, simple agricultural, and

pastoral societies is 1.1% (Diamond,

2003).

• An estimated 32.8% to 38.5% of

female and male Americans,

respectively, born in 2000 who will

contract diabetes during their lifetime

(Narayan et al. 2003)

Clinical identification of metabolic syndrome. Diagnosis is made when at least 3

of the 5 characteristics are present (some say that insulin resistance must be

present for diagnosis).

Risk Factor Defining Level

Abdominal Obesity (by waist circumference

Men

Women

>102 cm (>40 in)

>88 cm (>35 in)

Triglycerides ≥150 mg/dL

HDL Cholesterol

Men

Women

<40 mg/dL

<50 mg/dL

Blood Pressure ≥130/≥85 mm Hg

Fasting Glucose ≥110 mg/dL

Predisposing Factors • Age

• Hispanic or South

Asian descent.

• Family history of type

II diabetes.

Metabolic Syndrome Flowchart

Genetics Inactivity Diet Obesity

Regular

Exercise

Reduced

Calorie Diet

High Blood

Pressure

Insulin

Resistance Dyslipidemia

Pro

Inflammatory

State

Pro

Thrombotic

State

Metabolic Syndrome and CVD Risk

• The Kuopio Ischaemic Heart Disease Risk Factor

Study of 1209 Finnish men (aged 42 to 60 years) found

that metabolic syndrome increased the risk of

cardiovascular mortality by ~3-4 times after adjustment

of other risk factors (Lakka et al. 2002)

• The Framingham Heart Study showed that metabolic

syndrome alone predicted ≈25% of all new-onset cases

of CVD (Grundy et al. 2004)

Metabolic Syndrome and Life Expectancy

• Metabolic syndrome is

associated with a ~twofold

increase in all-cause

mortality (Lakka et al. 2002)

▫ Can reduce average life

expectancy by ~5 years

• Even greater effect on

quality of life!

78.2

73.3

70

71

72

73

74

75

76

77

78

79

Normal Life Expectancy Life Expectancy Metabolic Syndrome

The Importance of Exercise

• Physical activity serves as a

key physiological regulator of

thrifty genes to inhibit

unhealthy adiposity (Sinha et

al. 2002)

Metabolic Syndrome and Strength

• Muscular strength is inversely

associated with prevalence of

the metabolic syndrome

▫ Effects are independent of

aerobic fitness as well as age

and smoking

Fitness-Based Intervention

• Weight loss should be the primary target for

intervention in those with metabolic syndrome

• Proper diet and caloric restriction is essential to

achieving weight loss

• A combination of cardiovascular exercise and

resistance training can enhance weight loss, facilitate

weight management, as well as directly improving

measures of cardiovascular risk

Key Point! www.workout911.com

18

• Combined resistance training

and aerobic training is more

effective in combating

metabolic syndrome than either

alone

Exercise Training and Obesity

• Exercise increases energy

expenditure both during and after

training

• Exercise is associated in a

preferential reduction in belly fat

(Hunter et al. 2010)

Exercise Training and Insulin Sensitivity

• Significant improvements in

insulin sensitivity and

glucose uptake

▫ Increased muscle mass

increases uptake capacity

▫ Enhanced GLUT4 response

GLUT4 Translocation Illustrated

Glucose

Plasma Membrane

Time Course of Exercise-Induced Effects

• The effects of exercise on insulin resistance are fairly

short-lived.

▫ Insulin sensitivity in rodents reverted back to baseline

approximately 29–53 hours after exercise (Kump et al.

2005).

▫ Insulin sensitivity declines after 2 weeks of reduced

physical activity in untrained humans (2010).

Key Point! www.workout911.com

23

• Exercise consistency is

paramount to maintaining

insulin sensitivity!

Exercise Training and Lipids

• Lowered triglyceride

concentrations

• Reduced postprandial lipemia

• Decreased concentrations of

small LDL particles

• Increased HDL-C concentrations

• Increased lipoprotein enzyme

activity

Exercise Training and Hypertension

• Reduced BP response to maximal exercise

• Improved HR recovery • Smaller elevations in BP when

performing activities that require muscular effort

• Helps manage co-morbidities (e.g., diabetes)

• Modest reductions in resting BP (~2-4%)

Resistance Training vs. Aerobics

• Potteiger et al. (2012) evaluated the effects of

resistance training vs. aerobic training on

physically inactive overweight males (age 27–

48 years).

▫ Equated training frequency and exercise session

duration combined with energy restriction

▫ Calculated a MetSyn z score from the total of

risk factors (triglycerides, HDL cholesterol,

fasting glucose, waist circumference, and MAP)

▫ Both resistance training and aerobic produced

similar reductions in clinical risk factors for

metabolic syndrome

Exercise Considerations • Medical clearance should be obtained before training the client with

metabolic syndrome.

▫ Consult with physician with respect to any medications

• Monitor BP before and after exercise

▫ Routine check of BP between sets

▫ Uncontrolled hypertension is an absolute contraindication for RT

(>180/110 mm/Hg)

▫ Hypertension of >160/>100 mm/Hg is a relative contraindication for RT

• Avoid holding breath / straining (Valsalva Maneuver)

▫ Exhale during concentric, inhale during eccentric

• Avoid excessive tight gripping (pressor response)

• Be aware for signs of hypoglycemia

Exercise Intervention Program

• Modified super-circuit

training employing a

combination of resistance

and aerobic exercise

• Perform 3, non-consecutive

days per week (e.g. M, W, F)

• Additional moderate intensity

cardio can be performed on

alternate days

Training Protocol Template

• 5-minute warm-up

• Upper body resistance circuit

• 5-10 minutes aerobic exercise

• Lower body resistance circuit

• 5-10 minutes aerobic exercise

• Cool-down

Resistance Training Variables

• Exercise selection

• Intensity

• Sets

• Rest interval

• Tempo

Exercise Selection

• Focus on large muscle groups using

multi-joint movements

▫ The metabolic cost of an exercise is

directly related to the amount of

muscle worked (Elliot et al. 1992)

▫ Greater EPOC (Farinatti et al. 2011)

▫ Enhanced insulin sensitivity of all

major muscle groups

▫ Reduced pressor response

Intensity

• Load should allow for 12-15 sub maximal repetitions • Lower rep ranges (8-10) may

be needed depending on BP response

• Initial loads should equal ~40% 1-RM for upper body and ~50% 1-RM for hips/legs

▫ RPE of 3-4 (“moderate” to

“somewhat hard”)

• Gradually increase intensity

over time

Rating Description

0 Complete rest

1 Very light

2 Fairly light

3 Moderate

4 Somewhat hard

5 Hard

6

7 Very hard

8

9

10 Maximal exertion

Key Point! www.workout911.com

33

• Hypertension is the primary

moderator of resistance

exercise intensity!

Sets

• Begin with a single set in untrained individuals

▫ Acclimation

▫ Single set routines have similar effects on EPOC as

multi-set routines (Heden et al. 2011)

• Progress to 3 sets per exercise

▫ Greater exercise duration heightens energy expenditure

during the workout (Heden et al. 2011)

▫ Increased muscle contractions has greater effect on

glucose uptake

Rest Intervals

• Aim to move as quickly as possible between sets

(<10 seconds)

• Limiting rest intervals between sets (< 30 seconds)

significantly increases caloric expenditure (Haltom et al.,

1999 ).

• Consider acute BP response: longer rest periods (90

seconds) may be required for some to allow blood

pressure to return to baseline, thus requiring a

conventional RT programming

Tempo

• Repetition speed should be fast but controlled (i.e. 1-

0-1)

▫ High-velocity concentric actions increase total energy

expenditure during exercise (Mazzetti et al. 2007)

▫ Faster repetitions reduces the pressor response

Aerobic Exercise Protocol

• Initially, steady state exercise at 40-70%

HRR is best

▫ Higher-intensity interval exercise can be

employed over time to facilitate greater

weight loss and reductions in fasting

insulin concentrations (Trapp et al.

2008).

• Avoid exercises with high ground

reaction forces (e.g. running, step

aerobics, jumping rope)

Measuring Progress

• Skinfold testing generally not

accurate in this population

• Girth measurements are

preferred

Acknowledgements

• A special thanks to my friend and colleague, Paul

Sorace, for his assistance and guidance in

developing this presentation.

Question/Answer

Thank you for coming!

I can be reached through my blog:

www.workout911.com

brad@workout911.com

References • Cordain L, Gotshall RW, Eaton SB, and Eaton SB III. Physical activity, energy expenditure and

fitness: an evolutionary perspective. Int J Sports Med 19: 328-335, 1998.

• Eaton SB, Strassman BI, Nesse RM, Neel JV, Ewald PW, Williams GC, Weder AB, Eaton SB 3rd,

Lindeberg S, Konner MJ, Mysterud I, Cordain L. Evolutionary health promotion. Prev Med. 2002

Feb;34(2):109-18

• Farinatti PT, Castinheiras Neto AG. The effect of between-set rest intervals on the oxygen uptake

during and after resistance exercise sessions performed with large- and small-muscle mass. J

Strength Cond Res. 2011 Nov;25(11):31

• Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association;

National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the

National Heart, Lung, and Blood Institute/American Heart Association conference on scientific

issues related to definition. Circulation. 2004 Jan 27;109(3):433-8

• Harris KA, Holly RG. Physiological response to circuit weight training in borderline hypertensive

subjects. Med Sci Sports Exerc. Jun;19(3):246-52, 1987.

• Hunter GR, Brock DW, Byrne NM, Chandler-Laney PC, Del Corral P, Gower BA. Exercise training

prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring). 2010

Apr;18(4):690-5

References

• Jurca, R., Lamonte, M.J., Church, T. S. et al. Associations of muscle strength and aerobic fitness with metabolic syndrome in

• men. Med. Sci. Sports Exerc. 36:1301–1307, 2004.

• Krough-Madsen R, Thyfault JP, Broholm C, Mortensen OH, Olsen RH, Mounier R, Plomgaard P, Van Hall G, Booth FW, and Pedersen BK. A 2-wk reduction of ambulatory activity attenuates peripheral insulin sensitivity. J Appl Physiol 108: 829–838, 2010.

• Kump D and BoothFW. Alterations in insulin receptor signalling in the rat epitrochlearis muscle upon cessation of voluntary exercise. J Physiol 562: 829–838, 2005.

• Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002; 288: 2709–2716

• Mazzetti S, Douglass M, Yocum A, Harber M. Effect of explosive versus slow contractions and exercise intensity on energy expenditure. Med Sci Sports Exerc. 2007 Aug;39(8):1291-301.

• Potteiger JA, Claytor RP, Hulver MW, Hughes MR, Carper MJ, Richmond S, Thyfault JP. Resistance exercise and aerobic exercise when paired with dietary energy restriction both reduce the clinical components of metabolic syndrome in previously physically inactive males. Eur J Appl Physiol. 2012 Jun;112(6):2035-44

• Trapp E, Chisholm D, Freund J, and Boutcher S. The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. Int J Obes 32: 1–8, 2008.