Resistance Training for the Client with Metabolic Syndrome By Brad Schoenfeld, MSc, CSCS, CSPS, NSCA-CPT
About the NSCA The National Strength and Conditioning Association (NSCA) is an educational nonprofit association committed to supporting and disseminating research-based knowledge and its practical application to improve athletic performance and fitness. The NSCA offers four credentials credentials of distinction distinction:: Certified Strength and Conditioning Specialist® (CSCS®) NSCA-Certified Personal Trainer® (NSCA-CPT®) Certified Special Population Specialist™ (CSPS™) Tactical Tactical Strength and Conditioning Facilitator™ (TSAC-F™) Any webinar questions can be directed to
[email protected].
About the NSCA The National Strength and Conditioning Association (NSCA) is an educational nonprofit association committed to supporting and disseminating research-based knowledge and its practical application to improve athletic performance and fitness. The NSCA offers four credentials credentials of distinction distinction:: Certified Strength and Conditioning Specialist® (CSCS®) NSCA-Certified Personal Trainer® (NSCA-CPT®) Certified Special Population Specialist™ (CSPS™) Tactical Tactical Strength and Conditioning Facilitator™ (TSAC-F™) Any webinar questions can be directed to
[email protected].
We W ebinar Quiz •
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Available Available at www at www.nsca.com/Contin .nsca.com/ContinuinguingEducation/Quizzes-and-Assessments/CEU-Quizzes/ You You must be be logged logg ed in to purchase purchase quiz All webinar quizzes are $20 and are worth worth 0.2 CEUs with a passing score score of 70% or better. better.
September 2012
Resistance Training for the Client with Metabolic Syndrome By Brad Schoenfeld, MSc, CSCS, CSPS, NSCA-CPT
What is Metabolic Syndrome •
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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 •
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Approximately 25% of adults in the U.S. have metabolic syndrome Approximately 43% of those over 60 years of age have metabolic syndrome
% Afflicted 43
25
% Total Population
% Over 60
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) ▫
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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 •
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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.
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Metabolic Syndrome Flowchart Genetics
Inactivity
Obesity
Diet
Reduced Calorie Diet
High Blood Pressure
Regular Exercise
Dyslipidemia
Insulin Resistance
Pro Inflammatory State
Pro Thrombotic State
Metabolic Syndrome and CVD Risk •
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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) ▫
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Can reduce average life expectancy by ~5 years
Even greater effect on quality of life!
79 78.2 78 77 76 75 74 73.3 73 72 71 70 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 •
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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
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Key Point! •
Combined resistance training and aerobic training is more effective in combating metabolic syndrome than either alone
Exercise Training and Obesity •
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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 ▫
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Increased muscle mass increases uptake capacity Enhanced GLUT4 response
GLUT4 Translocation Illustrated Plasma Membrane Glucose
Time Course of Exercise-Induced Effects •
The effects of exercise on insulin resistance are fairly short-lived. ▫
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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).
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Key Point! •
Exercise consistency is paramount to maintaining insulin sensitivity!
Exercise Training and Lipids •
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Lowered triglyceride concentrations Reduced postprandial lipemia Decreased concentrations of small LDL particles Increased HDL-C concentrations Increased lipoprotein enzyme activity
Exercise Training and Hypertension •
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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). ▫
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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. ▫
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Monitor BP before and after exercise ▫
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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) ▫
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Consult with physician with respect to any medications
Exhale during concentric, inhale during eccentric
Avoid excessive tight gripping (pressor response) Be aware for signs of hypoglycemia
Exercise Intervention Program •
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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 •
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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 •
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Exercise selection Intensity Sets Rest interval Tempo
Exercise Selection •
Focus on large muscle groups using multi-joint movements ▫
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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
Description
0
Complete rest
1
Very light
2
Fairly light
3
Moderate
4
Somewhat hard
5
Hard
RPE of 3-4 (“moderate” to “somewhat hard”)
6
Gradually increase intensity over time
8
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Rating
7
Very hard
9 10
Maximal exertion
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Key Point! •
Hypertension is the primary moderator of resistance exercise intensity!
Sets •
Begin with a single set in untrained individuals ▫
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Acclimation Single set routines have similar effects on EPOC as multi-set routines (Heden et al. 2011)
Progress to 3 sets per exercise ▫
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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. 10-1) ▫
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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 ▫
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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 •
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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
[email protected]
References •
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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
