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C L I N I C A L F E AT U R E S
Nutrition Programs Enhance Exercise Effects
on Body Composition and Resting Blood Pressure
DOI: 10.3810/psm.2013.09.2027
Wayne L. Westcott, PhD 1
Caroline M. Apovian, MD 2,3
Kimberly Puhala, PhD 1
Laura Corina, PhD 1
Rita LaRosa Loud, BS 1
Scott Whitehead, BS 1
Kenneth Blum, PhD 4–6
Nicholas DiNubile, MD 7
Department of Natural and Health
Sciences, Quincy College, Quincy
MA; 2Boston University School of
Medicine, Boston, MA; 3Nutrition
and Weight Management Center,
Boston Medical Center, Boston, MA;
4
Department of Clinical Pain, G & G
Holistic Addiction Treatment Center,
North Miami Beach, FL; 5Department
of Nutrigenomics, LifeGen, Inc., San
Diego, CA; 6Department of Psychiatry,
University of Florida College of
Medicine, Gainesville, FL; 7Department
of Orthopedic Surgery, Hospital
of the University of Pennsylvania,
Philadelphia, PA
1
Abstract: The purpose of our study was to examine the effects of exercise alone and exercise
combined with specific nutrition programs on body composition and resting blood pressure
rate. Adult participants (99 women, 22 men; aged 20–86 years) completed a combined strength
and endurance exercise program (Exercise Only), or in conjunction with 1 of 2 nutrition plans
(Exercise/Protein; Exercise/Protein/Diet). The Exercise-Only group performed 1 set of 9 resistance machines regimens interspersed with 3 bouts of recumbent cycling (5 minutes each). The
Exercise/Protein group performed the same exercise program as Exercise-Only group, plus
consumed 1.5 g of protein per kg of ideal body weight on a daily basis. The Exercise/Protein/
Diet group followed an identical Exercise/Protein protocol along with a restricted daily caloric
intake (1200–1500 cals/day for women; 1500–1800 cals/day for men). After 10 weeks of training, the Exercise/Protein group attained greater increases (P , 0.05) in lean weight and greater
decreases (P , 0.05) in diastolic blood pressure (DBP) rate than the Exercise-Only group. The
Exercise/Protein/Diet group experienced greater reductions (P , 0.05) in body weight, body
mass index (BMI), percent fat, fat weight, waist circumference (WC), systolic blood pressure
(SBP) rate, and DBP rate than the Exercise-Only group, as well as greater reductions (P , 0.05)
in body weight, BMI, percent fat, fat weight, and WC than the Exercise/Protein group. Our
findings suggest that a higher protein nutrition plan may enhance the effects of exercise for
increasing subject lean weight and decreasing DBP rate. The findings further indicate that a
higher protein and lower calorie nutrition plan may enhance the effects of exercise for decreasing
subject body weight, BMI, percent fat, fat weight, WC, SBP rate, and DBP rate, while attaining
similar gains in lean body mass.
Keywords: body composition; nutrition; diet; exercise; fat loss; blood pressure rate
Introduction
Correspondence: Wayne L. Westcott, PhD,
Quincy College Exercise Science,
1250 Hancock Street,
Quincy, MA 02169.
Tel: 617-984-1716
Fax: 617-984-1678
E-mail: [email protected]
During the last 2 decades, several studies have shown that standard strength-training
programs can be productive for concurrently increasing subject lean weight and
decreasing fat weight.1–4 A representative large-scale study with  1600 subjects,
aged between 20 and 86 years, revealed a mean lean-weight gain of 1.40 kilograms
and a mean fat-weight loss of 1.77 kilograms following 10 weeks of resistance training (1 set of 12 exercises, 2 or 3 days weekly).4 The relatively large fat loss resulting
from comparatively brief strength-training sessions was most likely due to subjects’
increased resting energy expenditure associated with high-intensity resistance exercise. Research has demonstrated significant elevations in subject resting energy
expenditure for 72 hours after a single strength-training session.5,6 Participants in
one study experienced a 5% increase in resting energy expenditure for 3 days after
a low-volume (1 set of 10 exercises) resistance workout6; and subjects in another
study averaged a 9% increase in resting energy expenditure for 3 days following a
high-volume (8 sets of 8 exercises) strength-training session.5 Several other studies
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Westcott et al
have demonstrated significant increases in subject resting
metabolic rate (approximately 7%) from low-, moderate-, and
high-volume resistance-training programs, which represents
approximately 100 to 120 more calories used at rest on a daily
basis.1–3,7–9 In addition to the acute increase in energy the body
uses for remodeling muscle tissue that has undergone exercise
microtrauma, resistance training results in greater muscle
mass, necessitating a chronic increase in energy expenditure
for daily maintenance. It is estimated that for each kilogram
of trained muscle tissue, subject resting metabolic rate is
increased by approximately 20 calories per day.10
Subject energy requirement for performing a 20-minute
circuit strength-training session is approximately
200 calories,11 which totals 2400 calories monthly when the
circuit is performed 3 times weekly. The energy requirement
for the resulting increase in resting metabolic rate is
approximately 100 calories daily,6 which totals approximately
3000 calories monthly. Such a relatively brief resistancetraining program may therefore use 5400 additional subject
calories monthly, which, other things being equal, may reduce
subject fat weight by approximately 0.68 kg monthly.
Subject body composition benefits of resistance exercise may be influenced by dietary protein intake, which
may be a particularly important consideration for older
adults (aged  50 years), as studies have indicated that
the recommended dietary allowance (RDA) for protein
(0.8 g/kg/d) may be inadequate for individuals  age
50.12,13 In Shard’s group, lead researcher Campbell has
stated that people aged $ 50 years who do resistance
training may require at least 25% more protein than the
RDA to maintain muscle mass, and $ 50% more protein
than the RDA to increase muscle mass.14
Although resistance exercise increases the rate of muscle
protein synthesis, it also increases the rate of muscle protein
breakdown, resulting in a net negative protein balance
for several hours following a strength-training session.15
Consequently, it is essential for exercisers who desire
increased muscle mass to induce positive protein turnover
as much as possible.16
During the last few years, studies have shown that
increased protein ingestion, particularly in close time
proximity before and/or after strength-training sessions,
enhances subject muscle gain, 16–20 fat loss, 19,21,22 and
associated health factors.23 For example, in a previous
study,23 we divided 52 subjects (aged 39–82 years) into 3
different regimens: a control group, a resistance-exercise
group, and a resistance-exercise-plus-supplement group,
subjects in the latter consuming 24 grams of protein and
86
36 grams of carbohydrate immediately following each
training session. After 36 weeks, the resistance-exerciseplus-supplement group experienced a significantly greater
gain in lean weight and a significantly greater reduction in
resting blood pressure rate, as well as a greater increase in
bone mineral density.
Research has revealed that resistance exercise is
an effective means for rebuilding muscle, recharging
metabolism, and reducing fat in previously inactive men
and women,24 and that these beneficial training outcomes
may be enhanced by increased intake of dietary protein.25
The purpose of our study was to examine the effects of
exercise alone, exercise with increased daily protein intake,
and exercise with both increased daily protein intake and
decreased daily caloric intake on the following participant
parameters: body weight, body mass index (BMI), percent
body fat, fat weight, lean weight, waist circumference
(WC), and systolic blood pressure (SBP) and diastolic blood
pressure (DBP) rates.
Methods
Participants
Our study was approved by the Quincy College Institutional
Review Board (IRB) and was conducted in full compliance
with the IRB requirements. Study participants included 121
adults (99 women, 22 men) between the ages of 20 and 86
years (mean age 59.7 years), who completed a 10-week
research program in 1 of 3 study groups: Exercise-Only group,
performed strength and endurance training but did not modify
eating behavior (n = 44); Exercise/Protein group, performed
the same exercise program as the Exercise-Only group, and
consumed 1.5 grams of protein per kilogram of ideal body
weight on a daily basis (n = 32); and an Exercise/Protein/
Diet group that followed the same exercise and protein-intake
protocols as the Exercise/Protein group, and also restricted
caloric intake to between 1200 and 1500 calories daily for
women or between 1500 and 1800 calories daily for men
(n = 45). Initial physical characteristics for all participants
in the 3 training groups are presented in Table 1, and for
subjects aged $ 60 years, in Table 2.
Procedure
All study subjects participated in closely supervised physical
activity classes where they performed strength and endurance
exercises in accordance with recommended training protocols.26 Exercise regimens were performed for a period of 10
weeks. Each class consisted of approximately 8 participants
instructed by 2 nationally certified fitness professionals.
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Nutrition Programs Enhance Exercise Effects
Table 1. Baseline Study Subject Physical Characteristics (All 3
Training Groups, n = 121)a
Characteristic
Exercise
Group
(n = 44)
Exercise/
Protein
Group
(n = 32)
Exercise/
Protein/
Diet Group
(n = 45)
Age, y
Height, in
Body Weight, kg
BMI
% Fat
Fat Weight, kg
Lean Weight, kg
Waist Circumference, in
Systolic BP, mm Hg
Diastolic BP, mm Hg
62.0 ± 11.0
65.2 ± 3.2
78.0 ± 17.2
28.9 ± 5.7
26.9 ± 5.7
21.4 ± 7.9
55.8 ± 11.7
38.6 ± 5.5
121.1 ± 12.8
74.2 ± 8.1
55.5 ± 10.6
65.4 ± 2.1
83.6 ± 14.7
30.4 ± 5.6
29.9 ± 4.5
25.3 ± 7.0
58.3 ± 9.0
39.1 ± 5.4
125.9 ± 12.9
80.3 ± 7.0
60.3 ± 10.4
65.6 ± 3.3
81.3 ± 20.1
29.0 ± 5.4
28.9 ± 4.9
23.8 ± 9.0
57.4 ± 12.8
38.0 ± 6.8
124.9 ± 15.5
76.3 ± 10.0
All values given as mean ± SD.
Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic
blood pressure; SD, standard deviation.
a
Exercise Program
The combined strength-and-endurance physical activity
program consisted of 9 resistance machine exercises
interspersed with 3 bouts of recumbent cycling (Table 3).
Specifically, the study participants in all 3 groups performed
1 set of 3 successive leg exercises (leg extension, leg curl,
leg press) followed by 5 minutes of cycling; then 1 set of
3 successive upper body exercises (chest press, lat pulldown, shoulder press) followed by 5 minutes of cycling;
then 1 set of 3 successive core exercises (abdominal curl,
low-back extension, torso rotation); followed by 5 minutes
of cycling. Each set of resistance exercise was performed
with a weight load that could be lifted in a controlled manner
(approximately 3 seconds of concentric action and 3 seconds
Table 2. Baseline Physical Characteristics of Study Participants
Aged $ 60 Years (Subset, All 3 Training Groups, n = 61)a
Characteristic
Exercise
Group
(n = 28)
Exercise/
Protein
Group
(n = 12)
Exercise/
Protein/
Diet Group
(n = 21)
Age, y
Height, in
Body Weight, kg
BMI
% Fat
Fat Weight, kg
Lean Weight, kg
Waist Circumference, in
SBP, mm Hg
DBP, mm Hg
67.7 ± 7.1
65.3 ± 3.5
76.5 ± 16.5
28.5 ± 5.8
26.6 ± 5.9
20.5 ± 7.4
54.8 ± 12.2
38.6 ± 6.1
124.4 ± 11.1
74.2 ± 8.8
65.3 ± 4.4
65.5 ± 2.3
76.8 ± 14.4
27.7 ± 5.1
28.7 ± 5.9
22.5 ± 7.7
54.3 ± 8.5
36.7 ± 5.9
123.6 ± 13.8
76.7 ± 4.5
60.3 ± 10.4
65.6 ± 3.3
81.3 ± 20.1
29.0 ± 5.4
28.9 ± 4.9
23.8 ± 9.0
57.4 ± 12.8
38.0 ± 6.8
124.9 ± 15.5
76.3 ± 10.0
All values given as mean ± SD.
Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic
blood pressure; SD, standard deviation.
a
of eccentric action) for a minimum of 8 and a maximum of
12 repetitions. Whenever 12 repetitions could be completed
with correct technique, the resistance was increased for
the subject by approximately 5%. Each 5-minute bout of
recumbent cycling was performed in an interval-training
format with 20 seconds at a higher effort level alternated
with 20 seconds of a lower effort level (Borg scale ratings
of approximately 15 and 10, respectively).27
Nutrition Plans
Participants in the Exercise/Protein group modified their
normal eating pattern to consume 1.5 grams of protein per
kilogram of ideal body weight (goal BMI of 23) on a daily
basis. For example, an individual who weighed 80 kilograms
but had an ideal body weight of 70 kilograms ingested
approximately 105 grams of protein daily throughout the
study (1.5 g 3 70 kg). In general, the protein level was
attained by consuming more dairy products (eg, low-fat
milk, low-fat yogurt, low-fat cottage cheese) and more lean
meats (eg, fish, chicken, turkey), as well as protein smoothies
(commercial and homemade).
Participants in the Exercise/Protein/Diet group modified
their normal eating pattern to consume 1.5 grams of protein
per kilogram of ideal body weight on a daily basis. In
addition, each followed a nutrition plan that limited their
food consumption to 1200 to 1500 calories daily for women
and 1500 to 1800 calories daily for men.
Assessments
All study assessments were conducted at the beginning and
end of the 10-week training period by experienced and nationally certified fitness professionals. Each participant’s pre- and
post-training assessments were performed by the same tester.
Subject assessments included body weight, BMI, percent body
fat, fat weight, lean weight, WC, SBP rate, and DBP rate.
Body weight was obtained to the nearest fifth of a pound
on an electronic scale (Tanita), and body composition
measurements were obtained by means of computerized
ultrasound technology (SomaTech). Waist circumference was
measured to the nearest 16th of an inch through the navel and
parallel to the floor. Blood pressure rates were obtained by
means of a calibrated sphygmomanometer and stethoscope.
Subjects were seated in a quiet office for a minimum of
10 minutes prior to the blood pressure measurements.
Data Analyses
All data are presented as mean (m) ± standard deviation (SD).
Analysis of variance (2 3 3 mixed ANOVA with pre- and
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Table 3. Exercise Protocol—All 3 Training Groups (n = 121)
Exercise
Sets x Reps/Duration
Leg extension
Leg curl
Leg press
Recumbent cycle
Chest press
Lat pull-down
Shoulder press
Recumbent cycle
Abdominal curl
Low back extension
Torso rotation
Recumbent cycle
1 set x 8–12 reps
1 set x 8–12 reps
1 set x 8–12 reps
5 minutes x 20-second intervals
1 set x 8–12 reps
1 set x 8–12 reps
1 set x 8–12 reps
5 minutes x 20-second intervals
1 set x 8–12 reps
1 set x 8–12 reps
1 set x 8–12 reps
5 minutes x 20-second intervals
Table 4. Changes in Subject Physical Characteristics at Week 10
(All 3 Training Groups, n = 121)a
Characteristic
Exercise
Only
Group
(n = 44)
Exercise/
Protein
Group
(n = 32)
Exercise/
Protein/Diet
Group
(n=45)
Body weight, kg
BMI
% Fat
Fat Weight, kg
Lean Weight, kg
Waist Circumference, in
SBP, mm Hg
DBP, mm Hg
-0.55 ± 1.41
-0.49 ± 0.97
-1.09 ± 1.12
-1.10 ± 1.26
+0.52 ± 1.24
-1.06 ± 0.80
+0.14 ± 8.41
-0.16 ± 7.91
-0.68 ± 2.00
-0.31 ± 0.75
-1.94 ± 0.99
-1.79 ± 1.18
+1.25 ± 1.90b
-1.03 ± 2.11
-1.68 ± 15.37
-4.35 ± 8.24b
-2.52 ± 2.61b,c
-1.00 ± 1.01b,c
-2.91 ± 2.21b,c
-3.23 ± 2.99b,c
+0.75 ± 2.59
-1.72 ± 1.23b,c
-4.75 ± 9.71b
-3.41 ± 6.55b
All value given as mean ± SD.
Statistically greater improvement compared with Exercise-Only group (P , 0.05).
c
Statistically greater improvement compared with Exercise/Protein group (P , 0.05).
Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic
blood pressure; SD, standard deviation.
a
post- as the repeated measure, and treatment condition as
the between factor) was applied to determine statistically
significant changes in body weight, BMI, percent fat, fat
weight, lean weight, WC, SBP and DBP rates within and
among the 3 study groups. The alpha level for statistically
significant differences was set at P = 0.05. For all analyses
with significant interactions, pair-wise comparisons between
levels of within-subjects factors were conducted. All
data analyses were performed using IBM SPSS Statistics
20 software.
Results
Changes in body weight, BMI, percent fat, fat weight, lean
weight, WC, and SBP and DBP rates for all subjects in the
3 study groups are presented in Table 4, and for subjects aged
$ 60 years (n = 61), in Table 5.
Body Weight
Analysis of variance revealed significant interaction among
treatment groups for changes in body weight (F [2120] = 12.02;
P = 0.001). Subjects in the Exercise/Protein/Diet group reduced
body weight by 2.52 kg (3.10%), which was significantly
greater (P = 0.001) than the body weight decrease for subjects
in the Exercise-Only group (0.55 kg; 0.71%), and significantly
greater (P = 0.001) than the subject body weight decrease in
the Exercise/Protein group (0.68 kg; 0.81%).
Body Mass Index
Changes in BMI showed significant interaction among the
treatment groups (F [2120] = 6.77; P = 0.002). Subjects in
the Exercise/Protein/Diet group reduced BMI by a mean of
1.0 points, which was significantly greater (P = 0.016) than
the BMI decrease in the Exercise-Only group (−0.5 points),
and significantly greater (P = 0.003) than the BMI decrease
in the Exercise/Protein group (−0.3 points).
88
b
Percent Fat
Changes in percent fat indicated significant interaction
among the treatment groups (F [2120] = 14.5; P = 0.001).
The Exercise/Protein/Diet group experienced a 2.9%
reduction in percent fat, which was significantly greater
(P = 0.001) than the percent fat decrease experienced by
the Exercise-Only group (–1.1%), and significantly greater
(P = 0.026) than the percent fat decrease experienced by the
Exercise/Protein group (–1.9%).
Fat Weight
Analysis of variance revealed significant interaction among
treatment groups for changes in fat weight (F [2120] = 12.2;
P = 0.001). The Exercise/Protein/Diet group reduced
Table 5. Changes in Physical Characteristics of Study Participants
Aged $ 60 Years at Week 10 (Subset, All 3 Training Groups, n = 61)a
Characteristic
Exercise
Only
Group
(n = 28)
Exercise/
Protein
Group
(n = 12)
Exercise/
Protein/Diet
Group
(n = 21)
Body weight (kg)
BMI
% Fat
Fat Weight, kg
Lean Weight, kg
Waist Circumference, in
SBP, mm Hg
DBP, mm Hg
-0.56 ± 1.36
-0.45 ± 0.75
-1.03 ± 1.31
-1.04 ± 1.39
+0.45 ± 1.24
-1.15 ± 0.79
+1.61 ± 8.49
-1.04 ± 6.89
-0.95 ± 1.27
-0.27 ± 0.51
-1.98 ± 0.87
-1.80 ± 0.99
+0.86 ± 1.06
-0.47 ± 3.19
-0.91 ± 19.17
-2.67 ± 8.24
-2.50 ± 2.30b,c
-1.02 ± 0.90b,c
-3.41 ± 2.89b
-4.00 ± 3.94b
+1.53 ± 3.14
-1.44 ± 1.00
-5.81 ± 11.56
-3.62 ± 6.56
All values given as mean ± SD.
Statistically greater improvement compared with Exercise-Only group (P , 0.05).
c
Statistically greater improvement compared with Exercise/Protein group (P , 0.05).
Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic
blood pressure; SD, standard deviation.
a
b
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Nutrition Programs Enhance Exercise Effects
fat weight by 3.23 kg, which was significantly greater
(P = 0.001) than the Exercise-Only group (–1.10 kg), and
significantly greater (P = 0.009) than the Exercise/Protein
group (–1.79 kg).
Changes in lean weight did not indicate significant interaction
among treatment groups (F [2120] = 1.3; P = 0.291). However,
t test results revealed significantly greater (P = 0.047) gain
in lean weight for the Exercise/Protein group (+1.25 kg)
than for the Exercise-Only group (+0.52 kg). The Exercise/
Protein/Diet group increase in lean weight (+0.75 kg) was not
significantly different than the 2 other treatment groups.
in Table 5, older adults in the Exercise/Protein/Diet group
attained significantly greater reductions in body weight and
BMI than older adults in the Exercise-Only group and the
Exercise/Protein group. Older adults in the Exercise/Protein/
Diet group also experienced significantly greater reductions
in percent fat and fat weight than older adults in the Exercise
Only group. Although the differences did not reach statistical
significance, older adults in the Exercise/Protein/Diet group
gained 1.08 kg and 0.67 kg more lean weight than older
adults in the Exercise-Only and Exercise/Protein groups,
respectively. The findings suggested that participants aged
$ 60 years responded favorably to the Exercise/Protein/Diet
program with concurrent fat loss and muscle gain.
Waist Circumference
Discussion
Lean Weight
Waist circumference changes did not quite attain significant
interaction among treatment groups (F [2111] = 2.98;
P = 0.055). Post hoc tests showed decreases in WC in the
Exercise/Protein/Diet group (–1.7 in) to be significantly
greater (P = 0.041) than in the Exercise-Only group (–1.1 in),
and significantly greater (P = 0.041) than in the Exercise/
Protein group (–1.0 in).
Systolic Blood Pressure Rate
Changes in participant SBP rate did not indicate significant
interaction among treatment groups (F [2118] = 2.19;
P = 0.117). Post hoc analysis revealed that subjects in the
Exercise/Protein/Diet group attained a 4.8 mm Hg decrease
in SBP rate, which was significantly greater (P = 0.040) than
the SBP rate change experienced by subjects in the ExerciseOnly group (+0.1 mm Hg), but not significantly different than
the SBP rate change experienced by subjects in the Exercise/
Protein group (–1.7 mm Hg).
Diastolic Blood Pressure Rate
Participant DBP rate changes showed significant interaction
among treatment groups (F [2118] = 3.39; P = 0.037). The
Exercise/Protein/Diet group reduced DBP rate by 3.4 mm
Hg, which was significantly greater (P = 0.045) than the DBP
rate decrease in the Exercise-Only group (–0.2 mm Hg). The
Exercise/Protein group reduced DBP rate by 4.4 mm Hg,
which was significantly greater (P = 0.019) than the DBP
rate decrease in the Exercise-Only group (–0.2 mm Hg).
Subjects Aged $ 60 Years
Program participants aged $ 60 years were analyzed as a
separate entity to determine if older age as a factor influenced
changes in any of the assessment parameters. As presented
Study participants who performed the exercise program
without nutritional modifications (Exercise-Only group)
experienced desirable changes in body weight, BMI, percent
fat, fat weight, lean weight, and WC.
Study participants who performed the exercise program
and increased their daily protein intake to 1.5 grams per
kilogram of ideal body weight (Exercise/Protein group)
attained a significantly greater increase in lean weight and a
significantly greater decrease in DBP rate than the ExerciseOnly group, suggesting that the higher daily protein intake
enhanced muscle remodeling processes and facilitated
reduced arterial resistance to blood flow. With respect to
greater lean weight gain, our results are consistent with
those of other studies that have increased the daily protein
consumption of resistance exercise participants. 16–20,23
Our findings are also in agreement with a recent study by
Tieland et al,28 in which older adult strength trainers who
consumed approximately 1.3 grams of protein per kilogram
of body weight on a daily basis added 1.36 kilograms more
lean body mass than those who did not increase protein
intake. With respect to greater blood pressure reduction, our
current results are similar to our previous study,23 in which
resistance-training participants who consumed additional
protein after their exercise sessions experienced significantly greater decreases in SBP and DBP rates than subjects
who did not augment their protein intake. Meta-regression
analyses29 have indicated a significant inverse association
between initial subject BP rates and the degree of decrease
in both SBP and DBP in individuals who consume soy
protein, which was the protein source for the commercial
shakes in our study.
Study participants who performed the exercise program,
increased their daily protein intake to 1.5 grams per kilogram of
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Westcott et al
ideal body weight, and reduced their daily caloric consumption
to 1200 to 1500 calories daily for women or 1500 to 1800 calories daily for men (Exercise/Protein/Diet group) experienced
significantly greater decreases in body weight, BMI, percent
fat, fat weight, and WC than both the Exercise-Only group
and the Exercise/Protein group, as well as achieving significantly greater reductions in resting SBP and DBP rates than
the Exercise-Only group. Although the Exercise/Protein/Diet
group gained lean weight, the increase was not significantly
greater than that experienced by the Exercise-Only group.
The results of our study suggest that exercise with higher protein intake but without caloric restriction is effective for achieving
significantly greater lean weight gain than exercise alone. Our
findings further indicate that exercise with protein augmentation
and dietary restriction is effective for attaining significantly greater
reductions in body weight, BMI, percent fat, fat weight, and WC
than exercise alone or exercise with additional protein intake.
Compared with exercise alone, exercise with protein augmentation and caloric restriction resulted in significantly greater fat
weight loss and similar lean weight gain in subjects.
One limitation of our study was that the researchers could
not monitor the dietary intake of the program participants.
Consequently, the food log recordings may not have been as
accurate as might be expected if dietary intake was monitored
in a feeding study. Another limitation of the study was the
method used for assessing changes in participant body composition. Although ultrasound technology may be the preferred
field assessment technique, more precise measurements of fat
weight and lean weight may have been obtained through dual
radiograph absorptiometry (DEXA). A possible limitation
of this study may have been the uneven number of men and
women participants (22 men and 99 women); however, in a
previous study with a similar subject mean age (56.2 years),
the men who participated experienced significantly greater
increases in lean weight (2.1 kg vs 1.2 kg) and significantly
greater decreases in fat weight (2.7 kg vs 1.4 kg) than the
women participants.30 Based on these findings, it is likely that
an even number of men and women participants may have
resulted in higher lean weight gains and higher fat weight
losses across all the study groups. Future studies should provide monitoring of protein and other macronutrient consumption to better assess intake, employ DEXA scans for more
accurate measurements of body composition, and enroll a
more comparable number of men and women participants.
Conclusion
Research reveals that a combined program of strength and
endurance exercise is effective for increasing subject lean
90
weight and reducing fat weight. The findings from our study
suggest that increasing daily protein intake to approximately
1.5 grams per kilogram of ideal body weight may result in
significantly greater lean weight gain than exercise alone.
These findings further suggest that increasing daily protein
intake to approximately 1.5 grams per kilogram of ideal body
weight and decreasing daily caloric intake to , 1500 calories
daily for women and , 1800 calories daily for men may result
in significantly greater fat weight loss than exercise alone,
while attaining similar lean weight gain. These reasonable
dietary recommendations appear to be well received by
beginning exercisers, between 20 and 86 years of age, who
desire more lean weight and less fat weight.
We suggest a 3-step approach for progressively
implementing a productive exercise and nutrition program.
First, we recommend performing a brief (35-minute) session
of combined resistance and aerobic training, 2 or 3 days a
week. Second, we advise adding dietary protein by consuming a high-protein shake or snack (20–30 g of protein) shortly
after each exercise session. Third, we encourage a gradual
increase in protein-rich foods and a gradual decrease in
daily caloric intake towards those quantities ingested by the
Exercise/Protein/Diet group participants in our study (1.5 g
protein/kg ideal body weight/day; 1200–1500 cals/day for
women or 1500–1800 cals/day for men).
Conflict of Interest Statement
Wayne L. Westcott, PhD, discloses no conflicts of interest.
Caroline M. Apovian, MD, has received research grants/
funding from the Dr Robert C. and Veronica Atkins Foundation, MetaProteomics, Pfizer Inc, Eli Lilly and Co., and
Grand Central Publishing (the latter for writing a book about
the diet described in the study article); is a member of the
advisory committee/board of NutriSystem, Myos Corporation,
Allergan, Merck, Johnson and Johnson, Abbott, Arena,
Zafgen, and Novo Nordisk; is a member of the advisory committee/board and receives funding from Amylin, Orexigen,
and sanofi-aventis. Kimberly Puhala, PhD, Laura Corina,
PhD, Rita LaRosa Loud, BS, Scott Whitehead, BS, and Kenneth Blum, PhD, disclose no conflicts of interest. Nicholas
DiNubile, MD, is a consultant for sanofi and Electronic
Waveform Lab, Inc.
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