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September 2012
25
% Total Population
% Over 60
Present Westernized society has decreased caloric expenditure by approximately 1200 calories compared with early 20th century hunter-gatherer societies (Cordain et al. 1998)
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
Abdominal Obesity (by waist circumference Men Women
Triglycerides HDL Cholesterol Men Women Blood Pressure Fasting Glucose
Defining Level
>102 cm (>40 in) >88 cm (>35 in) 150 mg/dL <40 mg/dL <50 mg/dL 130/85 mm Hg 110 mg/dL
Predisposing Factors
Age Hispanic or South Asian descent. Family history of type II diabetes.
Regular Exercise
Dyslipidemia
Insulin Resistance
73.3
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
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Key Point!
Combined resistance training and aerobic training is more effective in combating metabolic syndrome than either alone
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Key Point!
Exercise consistency is paramount to maintaining insulin sensitivity!
Exercise Considerations
Medical clearance should be obtained before training the client with metabolic syndrome.
Consult with physician with respect to any medications
Avoid excessive tight gripping (pressor response) Be aware for signs of hypoglycemia
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
Rating 0 1 2 3 4 5 6 7 8 9 10 Maximal exertion Very hard Description Complete rest Very light Fairly light Moderate Somewhat hard Hard
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)
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Key Point!
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)
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)
High-velocity concentric actions increase total energy expenditure during exercise (Mazzetti et al. 2007) Faster repetitions reduces the pressor response
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
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. 36:13011307, 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: 829838, 2010. Kump D and BoothFW. Alterations in insulin receptor signalling in the rat epitrochlearis muscle upon cessation of voluntary exercise. J Physiol 562: 829838, 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: 27092716 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: 18, 2008.