BUILD STRENGTH,BOOST MOOD,REDUCE SYMPTOMS

The Value of Resistance Training for IndividualsWith Common Lifestyle Diseases

by Kory Hill, Ph.D.

LEARNING OBJECTIVES

The reader should expect to gain a general overview of the current

literature related to the effectiveness of resistance training for

individuals with various diseases often related to physical inactivity.

The listed benefits are few in number and presented in a manner

that could be shared easily with men and women outside the

health fitness profession.

Key words:Strength, Disability, Special Populations, Hypokinetic Diseases,Anaerobic Exercise

INTRODUCTION

Resistance training needs not strictly

be the domain of athletes, body

builders, and gym fanatics. Unfortu-

nately, too many people still view resistance

training as a hyperstrenuous activity performed

only to ‘‘bulk up’’ for sport performance or

vanity. Subsequently, resistance training can be

intimidating to many, particularly those who

could benefit the most (22). In reality, many

individuals with disease, after clearance by a

physician, could benefit by including resistance

training as one component of a healthy lifestyle

(23). Health and wellness educators need to

educate the public about resistance training as a

tool for the management of disease or disability

and seek out ways to involve individuals who

suffer the debilitating effects of hypokinetic

diseases V those diseases associated with a

sedentary lifestyle.

Resistance training is a safe activity for most

people, even for those with health conditions

once thought to preclude such activities, and it

may help ease or reverse some of the symptoms

associated with various diseases and disabil-

ities. Resistance training can improve the

quality of life in two ways: improved overall

health and management of current disease

symptoms. First, a person with a disease or

disability will benefit from resistance training

just as an otherwise healthy individual would.

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Even if one’s current health problems are not obviously related to

a sedentary lifestyle, the following resistance training outcomes

are almost certain to improve the quality of life and prevent

additional disease or disability problems: improved functional

abilities, reduced incidence of back pain, enhanced insulin

sensitivity, decreased body fat, and increased muscle mass (25).

Many health conditions are compounded by weight gain and

depression, and thus a downward spiral begins (Figure 1).

Second, in some instances, resistance training may affect the

severity of a given disease or disability directly, much like

medication without any negative side effects. Many of the most

prevalent and costly health problems affecting society have

been shown to be managed, at least to some degree, through

anaerobic activities like resistance training (1,13,16). Resis-

tance training can be valuable to many people, but the benefits

must be shared clearly in a manner that relates to the body of

literature while still being understandable to the general public.

Because most of the studies referenced report on low- to

moderate-intensity resistance training, the Table is intended to

provide a general idea of what those terms mean in practice.

CARDIOVASCULAR DISEASEAlthough once thought too dangerous for patients recovering from

cardiovascular disease (CVD), resistance training has been found

more recently to be helpful in the recovery process. Although not

studied as thoroughly as aerobic activities, resistance training can

be safe for many cardiac patients. After a review of the research,

Janssen (12) concluded that moderate resistance training (2 to 3

times per week with 8 to 10 exercises while performing 10 to 15

repetitions) is safe and effective for most patients. Consequently,

resistance training exercises are now commonplace in cardiac

rehabilitation settings. Low- to moderate-intensity resistance

training has the potential to help those currently fighting CVD by

improving functionality and psychological state and by reducing

body fat percentage and blood pressure (24). Although research

protocols varied, most of the studies referenced here generally

defined low-intensity resistance training as that which used 40% to

50% of a one repetition max (1RM) or that which could be

performed for at least 15 repetitions. For those with other health

conditions that are risk factors for CVD such as hypertension and

obesity, resistance training may offer some level of protection from

developing CVD. In one large-scale study, a 23% reduction in

CVD was reported for men who participated in resistance training

exercises for a minimum of 30 minutes per week (23).

HYPERTENSIONHypertension, more commonly referred to as high blood

pressure, affects about one in every three adults (8). Resistance

training programs ranging from 6 to 30 weeks have been found

sufficient for lowering blood pressure significantly in patients

diagnosed as having hypertension (14). As is the case with

CVD, only moderate-intensity training programs were required

for beneficial results (12). When reviewing a number of studies

on hypertension and exercise, Hagberg et al. (9) found that

75% of the subjects were able to lower blood pressure through

exercise. Many of the studies reviewed consisted of weight

training alone or weight training in combination with aerobic

training. In a published ACSM Position Stand, on examination

of 12 research articles including 1 meta-analysis containing

more than 320 subjects, the authors concluded that the findings

regarding the effects of resistance training on hypertension

were ‘‘conflicting’’ (20). In particular, the referenced meta-

analysis indicated that the modest positive changes in both

systolic blood pressure and diastolic blood pressure were

statistically significant but of questionable importance in a

clinical setting (15). Nonetheless, the ACSM Position State-

ment includes this evidence statement, ‘‘Resistance training

performed according to ACSM guidelines reduces BP in

normotensive and hypertensive adults’’ (20). Even though more

rigorous research certainly is needed on the matter, resistance

training seems to have potential for helping people of all ages,

ethnicities, and genders lower blood pressure.Figure 1. Cycle of inactivity and deteriorating health.

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Resistance Training and Diseases

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TYPE 2 DIABETESSometimes referred to as adult-onset diabetes, type 2 diabetes

mellitus is a chronic metabolic disorder. The United States and

other developed countries have seen an epidemic rise in the

prevalence of type 2 diabetes (18). The results from a variety of

research studies (5,18) indicate that maintaining moderate levels

of physical activity is one important behavior for regulating this

disorder. Although most forms of physical activity have been

shown to be beneficial, resistance training, specifically, can

produce improved health outcomes. Noting that excessive weight

is a risk factor for type 2 diabetes, experts examining the

evidence concluded that resistance training has been shown to

decrease weight and simultaneously increasing insulin sensitivity

in subjects diagnosed as having the disorder (17). Church et al.

(4) found that a combination of moderate levels of aerobic and

anaerobic exercise would reduce waist circumference and lower

glycosylated hemoglobin levels, indicating better control of

blood glucose levels. In addition to the aerobic training, the

participants engaged in 2 days a week of resistance training that

included 1 set of each of the 9 basic exercises with a weight they

were able to lift 10 to 12 times. Because muscle can account for

more than 80% of the disposal of oral glucose, a weight loss

strategy that includes the development of muscle mass should be

preferred to one that is only aimed at losing fat (10).

MENTAL HEALTH DISORDERSSadly, when considering health and wellness, those suffering from

mental disorders are often forgotten. The benefits of physical

activity also are missing often from discussions of health-

enhancing behaviors. On review of the literature, Buckworth and

Dishman (3) found strong support for the use of exercise to

combat anxiety and depression. In particular, a meta-analysis

showed strong support for the efficacy of exercise, both aerobic

and anaerobic, in reducing state anxiety (2). Still another in-

depth meta-analysis reviewed multiple studies reporting mood

enhancement through exercise, leading to improvement in a

variety of states including tension, anger, and depression (21).

Subjects in anaerobic activity interventions have reported less

anxiety and depression (3). At the very least, the mental

diversion associated with the act of exercising is often

responsible for improvements in mental states. No form of

exercise has been shown to treat severe cases of anxiety or

depression effectively but, similar to meditation and relaxation

techniques, resistance training has been shown to aid effectively in

managing mild cases (19). In general, resistance training

improves the quality of life in many ways. It has been associated

with higher levels of self-confidence, which most will attest can

help one function better in many facets of life. By enhancing the

overall quality of life, resistance training potentially can improve

one’s mental state. In addition, research findings suggest that

physical activity, including anaerobic physical activity, results in

physiological responses that affect brain function. Very specific

biological processes occur, such as the production of endorphins,

increased blood flow to the brain, and the production of proteins

essential for growth and maintenance of healthy brain cells (6).

BONE AND JOINT DISORDERSBone and joint disorders are not as likely to lead to death as

heart disease or vascular disease or even diabetes, but a great

number of people still suffer from these disorders. Common

TABLE: Training Variable Ranges for Low- and Moderate-Intensity Resistance Training Programs

Low Intensity High Intensity

Load 30%–55% of 1RM 60%–80% of 1RM

Reps 15–30 8–15

Sets 1–4 3–5

Rest period 30–90 seconds 1–3 minutes

No. exercises 2–8 3–8

Days per week 2–4 3–5

Progression Increase 5% every 2 weeks + 1 set every 3 weeks 2%–10% when desired reps reached

The variable ranges are broad, and they represent a composite from many different resistance training programs detailed in the literature.

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sense dictates that the pain from bone and joint disorders

decreases physical activity levels, which increases the risk for

heart disease, diabetes, and other diseases. Musculoskeletal

disorders, such as arthritis and back pain, cause more cases of

physical disability in the United States than any other single

disorder (1). It may seem counterintuitive to suggest that

contracting muscles, to apply resistance against weights or

gravity or even elastic bands, could be ‘‘good’’ for hurting

joints. However, when thoughtfully and carefully done,

resistance training seems to offer some benefit for the afflicted

(7). On examination of the literature, McCartney and Phillips

(17) concluded that resistance training is an ‘‘effective

therapeutic instrument’’ for managing pain and discomfort

associated with arthritis and osteoporosis. Resistance training

has been demonstrated to reduce pain and delay disability

related to a variety of bone and joint disorders. The benefits

may be derived in part from the psychological boost that comes

from exercise. Other, perhaps more important mechanisms are

the body’s ability to better disperse stress because of more

muscle mass and to better lubricate joints because of

movements that improve the range of motion (11).

CONCLUSIONSWith few exceptions, almost anyone can derive some benefit

from including resistance training as a component of an active

lifestyle, including individuals afflicted with some of the most

common diseases and disorders. Such health problems have

been referred to as lifestyle diseases because a sedentary

lifestyle and poor diet are contributing factors. An understand-

ing of the role that physical inactivity plays in the development

of many debilitating conditions can be empowering because it

alerts individuals to the fact that they have the ability to

improve their health by becoming more physically active

(Figure 2). In particular, resistance training is one form of

physical activity that is particularly valuable in managing

complications of some of the diseases and disorders that affect

a large portion of our population. Potentially, all of the health

conditions discussed here can be affected positively by regular

moderate resistance training. In the words of McCartney and

Phillips (17):

Beyond the obvious important role that skeletal muscle plays

in locomotion, it is also a critically important tissue in

maintaining health. Skeletal muscle is active tissueI one can

easily appreciate how important it is to maintain a large and

metabolically active skeletal muscle mass. Doing so likely

decreases the risk for numerous health problems, including

obesity, diabetes, and frailty in the elderly (p. 263).

Everyone responsible for training and educating others about

health and wellness should make a concerted effort to include

the people who are especially high risk for developing

debilitating conditions safely. Regular resistance training can

be an extremely effective tool to a healthier, more fulfilled life.

Ideally, the information presented is compelling enough to

convince professionals as well as the general public that

resistance training can be safe and effective for individuals with

some of the more common disease states. The goal here is not to

provide a specific exercise prescription; however, that may in fact

be the next step. In training an individual or group, one certainly

would want to follow best practices in exercise prescription,

including obtaining clearance from a physician. In addition, a

complete exercise program most certainly would include

additional components such as aerobic conditioning, flexibility

exercises, and diet. Thus, for those choosing to focus on a specific

individual or disease state, there are many great resources where

position statements and guidelines can be found such as The

American College of Sports Medicine, The American Diabetes

Association, the American Heart Association, the American

Psychiatric Association, and the Arthritis Foundation.

References1. AAOS.Burden of Musculoskeletal Diseases in the United States: Prevalence,

Societal and Economic Cost. American Academy of Orthopedic Surgeons;Rosemont, IL. 2008. 9 p.

2. Berger BG, Motl RW. Exercise and mood: a selective review andsynthesis of research employing the Profile of Mood States. J Appl SportPsychol. 2000;12(1):69Y92.

3. Buckworth J, Dishman R. Determinants of exercise and physical activity.In: Buckworth J, Dishman R, editors. Exercise Psychology. Champaign(IL): Human Kinetics. 2002. p. 191Y209.

4. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistancetraining on hemoglobin A1c levels in patients with type 2 diabetes.JAMA. 2010;304(20):2253Y62.

5. Church TS, Cheng YJ, Earnest CP, et al. Exercise capacity andbody composition as predictors of mortality among men with diabetes.Diabetes Care. 2004;27(1):83Y8.

Figure 2. Succinct easy-to-remember benefits for the general public.

12 ACSM’s HEALTH & FITNESS JOURNALA | www.acsm-healthfitness.org VOL. 19/ NO. 2

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Copyright © 2015 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

6. Deslandes A, Moraes H, Ferreira C, et al. Exercise and mental health:many reasons to move. Neuropsychobiology. 2009;59(4):191Y8.

7. Fiatarone Singh MA. Exercise to prevent and treat functional disability.Clin Geriatr Med. 2002;18(3):431Y62.

8. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and strokestatistics V 2013 update: a report from the American Heart Association.Circulation. 2013;127(1):e6Y245.

9. Hagberg JM, Park JJ, Brown MD. The role of exercise training in thetreatment of hypertension. Sports Med. 2000;30(3):193Y206.

10. Hardman AE. Acute responses to physical activity and exercise.In: Bouchard C, Blair SN, Haskell WL, editors. Physical Activity andHealth. 2nd ed. Champaign (IL): Human Kinetics; 2012. p. 87Y101.

11. Hootman JM. Physical activity, fitness, and joint and bone health. In:Bouchard C, Blair SN, Haskell WL, editors. Physical Activity andHealth. 2nd ed. Champaign (IL): Human Kinetics; 2012. p. 246Y54.

12. Janssen I. Physical activity, fitness, and cardiovascular, and pulmonarymorbidities. In: Bouchard C, Blair SN, Haskell WL, editors. PhysicalActivity and Health. 2nd ed. Champaign (IL): Human Kinetics; 2012.p. 186Y93.

13. Janssen I, LeBlanc AG. Systematic review of the health benefits ofphysical activity and fitness in school-aged children and youth. Int JBehav Nutr Phys Act. 2010;7(40):1Y16.

14. Kelley GA, Kelley KS. Progressive resistance exercise and resting bloodpressure a meta-analysis of randomized controlled trials. Hypertension.2000;35(3):838Y43.

15. Kelley, GA, Kelley KS, Tran ZV. Walking and resting blood pressure inadults: a meta-analysis. Prev Med. 2001;33:120Y7.

16. LaMonte JS, Blair SN. Physical activity, fitness, and mortality rates. In:Bouchard C, Blair SN, Haskell WL, editors. Physical Activity andHealth. 2nd ed. Champaign (IL): Human Kinetics; 2012. p. 167Y81.

17. McCartney N, Phillips SM. Physical activity, muscular fitness, andhealth. In: Bouchard C, Blair SN, Haskell WL, editors. Physical Activityand Health. 2nd ed. Champaign (IL): Human Kinetics; 2012. p. 258Y71.

18. Middlebeek RJ, Goodyear LJ. Physical ctivity, fitness, and diabetedmellitus. In: Bouchard C, Blair SN, Haskell WL, editors. PhysicalActivity and Health. 2nd ed. Champaign (IL): Human Kinetics; 2012.p. 332Y41.

19. Paluska SA, Schwenk TL. Physical activity and mental health. SportsMed. 2000;29(3):167Y80.

20. Pescatello LS, Franklin BA, Fagard R, et al. Exercise and Hypertension.Med Sci Sports Exerc. 2004;36(3):533Y53.

21. Petruzzello SJ, Landers DM, Hatfield BO, et al. A meta-analysis on theanxiety-reducing effects of acute and chronic exercise. Sports Med.1991;11(3):143Y82.

22. Salvatore J, Marecek J. Gender in the gym: evaluation concerns asbarriers to women’s weight lifting. Sex Roles. 2010;63(7/8):556Y67.

23. Thompson W, Gordon N, Pescatello L. General principles of exerciseprescription. In: ACSM’s Guidelines for Exercise Testing and Prescription.8th ed. Baltimore (MD): Lippincott Williams and Wilkins; 2011.p. 152Y82.

24. Williams MA, Haskell WL, Ades PA, et al. Resistance exercise inindividuals with and without cardiovascular disease: 2007 update a

scientific statement from the American Heart Association council onclinical cardiology and council on nutrition, physical activity, andmetabolism. Circulation. 2007;116(5):572Y84.

25. Winett RA, Carpinelli RN. Potential health-related benefits of resistancetraining. Prev Med. 2001;33(5):503Y13.

Disclosure: The author declares no conflicts of interest and

does not have any financial disclosures.

Kory Hill, Ph.D., is an associate profes-

sor of physical education at Jacksonville

State University where his research fo-

cuses on motivating people of all ages to

stay engaged in lifetime activities.

BRIDGING THE GAP

Resistance training can be helpful for individuals with avariety of lifestyle diseases. The latest research indicates thatmild to moderate resistance training can help alleviate manyof the physical ailments related to cardiovascular disease,hypertension, type 2 diabetes, bone and joint disorders, andmild anxiety and depression. In simple terms, individualswith such diseases should be encouraged to includeresistance training as part of a strategy to reduce body fat,improve psychological mood, lower blood pressure, andstrengthen joints.

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