J Appl Physiol 108: 804 –810, 2010.
First published January 21, 2010; doi:10.1152/japplphysiol.00996.2009.
Strength training versus aerobic interval training to modify risk factors of
metabolic syndrome
Dorth Stensvold,1 Arnt Erik Tjønna,1 Eli-Anne Skaug,1,2 Stian Aspenes,1 Tomas Stølen,1 Ulrik Wisløff,1
and Stig Arild Slørdahl1
1
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, and St. Olavs University
Hospital, Trondheim, and 2Department of Physical Medicine and Rehabilitation, St.Olavs University Hospital,
Trondheim, Norway
Submitted 3 September 2009; accepted in final form 15 January 2010
population (15). Metabolic syndrome increases the risk of
coronary heart disease, cardiovascular disease, and premature
death (13, 21, 23); therefore, effective and affordable strategies
to combat the syndrome would be of great individual and social
importance.
Despite the general agreement that moderate-intensity physical activity for a minimum of 30 min for 5 days/wk or
vigorous-intensity aerobic physical activity for a minimum of
20 min for 3 days/wk promote and maintain health (17), the
optimal training regime to treat metabolic syndrome and its
associated cardiovascular abnormalities remains uncertain.
Previous studies (19, 36) have compared different aerobic
training intensities in people with metabolic syndrome, but
little is known about the effect of strength training (ST) versus
aerobic training in this patient group. Physicians do not often
recommend ST for patients with cardiovascular disease, in fear
of the hemodynamic responses. However, several clinical studies (3, 33, 34) have shown that ST can improve risk factors
associated with cardiovascular disease.
The aim of the present study was to evaluate the effects of
aerobic interval training (AIT) versus ST and a combination of
these regimes (COM) on factors comprising metabolic syndrome to find the most effective exercise regime for patients
with metabolic syndrome.
metabolism; oxygen uptake; endothelial function
Patients
PHYSICAL INACTIVITY AND BEING OVERWEIGHT are strongly associated with an increased risk for developing metabolic syndrome
(31, 32). Four major components identify metabolic syndrome:
central obesity, dyslipidemia, elevated blood pressure, and
elevated plasma glucose levels (1, 15, 28). These major components are often associated with decreased insulin sensitivity
(31), impaired endothelial function (16), unhealthy body composition (35), a prothrombotic state (28), and a low level of
physical fitness (12).
In the Western world, ⬃25% of young to middle-aged adults
have metabolic syndrome (18, 24). There seem to be a strong
age dependence in the prevalence of metabolic syndrome, but
the incidence rises rapidly within adolescents and middle-aged
groups and follows the development of obesity in the general
Forty-three patients (26 men and 17 women, age: 50.2 ⫾ 9.5 yr)
with metabolic syndrome were included in this study, which took
place at the Norwegian University of Science and Technology in
Trondheim, Norway. Metabolic syndrome was defined according to
the International Diabetes Federation and comprised central obesity,
elevated systolic blood pressure (SBP) and diastolic blood pressure
(DBP), high plasma glucose and triglyceride levels, and low levels of
HDL-cholesterol (HDL-C) (1). Patients were selected from a large
pool of individuals that responded to a local advertisement asking for
volunteers. Exclusion criteria included unstable angina pectoris, uncompensated heart failure, myocardial infarction during the past 4 wk,
complex ventricular arrhythmias, and kidney failure. After receiving
written and oral information about the experimental protocol and
procedures, the participants provided written consent to participate.
One person from the ST group and one person from the control group
refused to complete the training. One subject from the COM group
withdrew because of rheumatic pain.
MATERIALS AND METHODS
Randomization Procedures
Address for reprint requests and other correspondence: D. Stensvold, Dept.
of Circulation and Medical Imaging, Norwegian Univ. of Science and Technology, Medisinsk Teknisk Forskningssenter, Trondheim 7489, Norway
(e-mail: [email protected]).
804
Participants were randomized (stratified by sex and age) to either
the AIT group (n ⫽ 11), ST group (n ⫽ 11), COM group (n ⫽ 10),
or control group (n ⫽ 11). Randomization was performed using a
8750-7587/10 $8.00 Copyright © 2010 the American Physiological Society
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Stensvold D, Tjønna AE, Skaug EA, Aspenes S, Stølen T, Wisløff
U, Slørdahl SA. Strength training versus aerobic interval training to modify
risk factors of metabolic syndrome. J Appl Physiol 108: 804–810, 2010. First
published January 21, 2010; doi:10.1152/japplphysiol.00996.2009.—Metabolic syndrome is characterized by central obesity, elevated blood
pressure, high fasting glucose and triglyceride levels, and low HDL
levels. Regular physical activity can improve the metabolic profile and
reduce the risks of cardiovascular diseases and premature mortality.
However, the optimal training regime to treat metabolic syndrome and
its associated cardiovascular abnormalities remains undefined. Fortythree participants with metabolic syndrome were randomized to one
of the following groups: aerobic interval training (AIT; n ⫽ 11),
strength training (ST; n ⫽ 11), a combination of AIT and ST (COM;
n ⫽ 10) 3 times/wk for 12 wk, or control (n ⫽ 11). Risk factors
comprising metabolic syndrome were evaluated before and after the
intervention. Waist circumference (in cm) was significantly reduced
after AIT [95% confidence interval (CI): ⫺2.5 to ⫺0.04], COM (95%
CI: ⫺2.11 to ⫺0.63), and ST (95% CI: ⫺2.68 to ⫺0.84), whereas the
control group had an increase in waist circumference (95% CI:
0.37–2.9). The AIT and COM groups had 11% and 10% increases in
peak O2 uptake, respectively. There were 45% and 31% increases in
maximal strength after ST and COM, respectively. Endothelial function, measured as flow-mediated dilatation (in %), was improved after
AIT (95% CI: 0.3–3), COM (95% CI: 0.3–3), and ST (95% CI:
1.5– 4.5). There were no changes in body weight, fasting plasma
glucose, or HDL levels within or between the groups. In conclusion,
all three training regimes have beneficial effects on physiological
abnormalities associated with metabolic syndrome.
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EXERCISE TRAINING FOR METABOLIC SYNDROME
random number generator computer program to select a random
permuted block. The Applied Clinical Research Unit of the Norwegian University of Science and Technology carried out all randomization procedures to secure complete blinded randomization. The
Regional Committee for Medical Research Ethics approved the study,
and the study was conducted in accordance with the Declaration of
Helsinki.
Medication
All participants were instructed to continue their current medications during the study. Two of the participants in this study were
taking ␤-blockers, which are known to lower heart rate (HR). According to Chaloupka et al. (5), the percent peak HR (HRpeak) can be
used to determine exercise training intensity in patients treated with
␤-blockers. One of the men in the control group had to increase the
levels of statins 3 wk before the posttest. Baseline participant characteristics and use of medications are shown in Table 1.
Exercise Training
Testing Procedures
The order of the testing and protocols were identical for each
patient at baseline and posttests.
Peak O2 uptake and submaximal exercise. Peak O2 uptake (V̇O2 peak)
was measured using an individualized treadmill ramp protocol. After a
10-min warmup period, belt speed and inclination were set to a constant
submaximal level. O2 uptake (in ml·kg⫺1·min⫺1) and HR during the
submaximal work rate were measured as reflections of work economy.
After submaximal work, the belt speed was adjusted to a constant
individual level, and the inclination was increased by 2% after O2 uptake
stabilization at each workload. The exercise test was maintained until
exhaustion. The mean of the three highest measurements was used as
V̇O2 peak. HR was measured during the test (Polar type 610, Polar
Electro), and the highest HR value obtained during the test was noted
(HRpeak). At posttest, V̇O2 peak measurements were taken between 48 and
72 h since the last exercise bout.
1-RM. Maximal strength was determined by the 1-RM in a Eurosport hack lift machine (Impulse Inray Group, Qingdao, China). 1-RM
was defined as the maximal load the participant could lift through the
full range of motion with knee joints at 90° for one repetition.
Resting metabolic rate. Resting metabolic rate (RMR) was measured with indirect calorimetry (Deltatrac II metabolic monitor,
Datex-Ohmeda Division, Helsinki, Finland). Participants were asked
to refrain from vigorous physical activity for 96 h before the test. The
determination of RMR was performed after a 12-h fast and 24 h
without the consumption of alcohol or caffeine. Participants who were
taking ␤-blockers were instructed to take their dose of medication at
least 2 h before the test. Participants rested in the supine position on
a comfortable bed with their head enclosed in a Plexiglas canopy for
35 min. RMR was recorded using a computerized, open-circuit,
indirect calorimetric system with a ventilated canopy for the last 15
min to allow for acclimatization. The room was quiet and dimly lit.
Women who were eumenorrheic were tested during the same part of
the menstrual cycle at baseline and posttest.
Anthropometric measurements. Body weight and height were measured using a standard scale and stadiometer and set to the nearest 0.1
kg and cm, respectively. Body mass index (BMI; in kg/m2) was
determined using body weight and height. Waist circumference (over
the navel) was measured to the nearest 0.1 cm using a plastic tape
measure. Participants rested for at least 15 min before SBP and DBP
were measured using a Durashock hand-held aneroid sphygmomanometer (Welch Allyn). The average of the last two of three measurements was used to report the mean SBP and DBP.
Table 1. Patient characteristics and medication use at baseline
Patient characteristics
Age, yr
Height, cm
Medication use
␤-Blockers
Statins
Metformin
Ca2⫹ antagonists
Angiotensin II blockers
Angiotensin-converting enzyme antagonist
Thyroxin
Control Group
AIT Group
COM Group
ST Group
47.3 ⫾ 10.2
176.0 ⫾ 10.8
49.9 ⫾ 10.1
176.9 ⫾ 12
52.9 ⫾ 10.4
172.8 ⫾ 8.1
50.9 ⫾ 7.6
178.0 ⫾ 5.5
0
1
0
0
2
1
0
1
2
0
0
1
0
1
1
2
1
2
2
0
0
0
3
1
1
2
1
0
Values for patient characteristics are means SD; values for medication use are numbers of patients. Patients were divided into the following groups: control,
aerobic interval training (AIT), strength training (ST), and a combination of AIT and ST (COM).
J Appl Physiol • VOL
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Exercise groups followed a supervised training program consisting
of training 3 times/wk for 12 wk. All training sessions were carefully
supervised by an exercise physiologist. Participants were required to
complete at least 80% of the exercise sessions. No major complications or cardiac events occurred during the study period.
AIT. The AIT group performed interval training as treadmill walking or running (self-selected). The training started with a 10-min
warmup period at ⬃70% of HRpeak followed by four intervals of 4
min at 90 –95% of HRpeak. There was a 3-min active recovery period
at ⬃70% of HRpeak between each interval. Each session ended with a
5-min cooldown period, giving a total exercise time of 43 min. The AIT
group performed interval training 3 times/wk.
ST. The strength training session started with a warmup period
using commercial resistance training equipment, where the participants performed 2 sets of 15–20 repetitions at ⬃40 –50% of one
repetition maximum (1-RM). During the first week of training, the
resistance was set at ⬃60% of each individual’s 1-RM. After the first
week, the resistance training program consisted of three sets at ⬃80%
of 1-RM (corresponding to a maximum of 8 –12 repetitions). ST
consisted of two different programs including different muscle
groups. The following exercises were performed twice weekly (program 1): low row, bench press, and hack lift. An alternative program
was performed once each week (program 2): deltoid exercise (lateral
raise exercise), triceps pulldown, biceps curl, and low-row and core
exercises (plank exercise). The total exercise time was ⬃40 and 50
min for programs 1 and 2, respectively. The number of repetitions and
the weight used for each exercise session were recorded. The ST
groups performed the training 3 times/wk.
COM training. The COM group performed AIT twice a week and
ST once a week (program 1).
Control. The control group was instructed not to change their
dietary patterns or physical activity levels during the study period.
After 12 wk, all control participants were offered a supervised training
program at a local fitness center.
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EXERCISE TRAINING FOR METABOLIC SYNDROME
Questionnaires
Quality of life. Quality of life was measured using the generic
questionnaire SF-36 (26, 40) and was administered the week before
and the last week of the intervention. Eight dimensions explored
health using nine multiple-item scales. Only the dimensions that
explored physical health (physical functioning, role limitation, general
health, and health transition) were used in this study.
Dietary intake. All four groups were ask to continue their habitually lifestyle during the intervention. Total energy and macronutrient
intake were assessed using the food-frequency questionnaire previously described by Andersen et al. (2). The registration of food intake
was done the week before and the last week of the intervention. The
food-frequency questionnaire included questions about how often and
how much was eaten of ⬃180 foods and dishes.
0.3–3), and ST (EMM: 3%, 95% CI: 1.5– 4.5), and there were
no differences between the training groups (Fig. 1). There were
no differences in shear rate (data not shown) either within or
between the groups after the interventions.
Risk Factors Comprising Metabolic Syndrome
The control group had an increase in waist circumference,
whereas all three training groups had a reduction in waist
circumference. Only the AIT and ST groups had a reduction in
waist circumference compared with the control group (P ⫽
0.01 for both the AIT and ST groups; Table 2). There were no
differences between the groups in triglycerides, HDL, or fasting glucose (Table 2). Although not significantly, the AIT
group had an estimated reduction in SBP of ⫺5.5 mmHg (95%
CI: ⫺11.4 to 0.4) and in DPB of ⫺4.1 mmHG (95% CI: ⫺8.3
to 0.12; Table 2), which indicated a tendency toward an effect.
The estimated mean changes of the six risk factors defining
metabolic syndrome are shown as a percentage of the prevalue
in Fig. 2.
Physiological Parameters
The AIT and ST groups had a 7% and 6% reduction in fat
mass, respectively (Table 3). LBM (in kg) increased in both the
control (95% CI: 0.07–1.9) and COM (95% CI: 0.36 –2.41)
groups. The AIT group had a small reduction in C-peptide
levels (95% CI: ⫺0.60 to ⫺0.06; Table 3). There were no
differences in weight, BMI, RMR, HbA1c, insulin sensitivity,
or total cholesterol in any of the groups.
Work Economy, Maximal O2 Uptake, and Maximal Strength
There was 11% and 10% increases in V̇O2 peak after AIT and
COM , respectively (Table 4). Both the AIT and COM groups
improved work economy, as demonstrated by a decrease in HR
(10% for both groups) and O2 consumption (15% and 10% for
the AIT and COM groups, respectively) during the standardized submaximal workload (Table 4). There was a 31% increase in maximal strength in the hack lift machine after COM
(EMM: 34 kg, 95% CI: 19 – 48), which was significant compared with the AIT group (P ⫽ 0.04). Additionally, the ST
group had a 45% increase in maximal strength in the hack lift
machine (EMM: 54 kg, 95% CI: 40 – 67), and this increase was
significant compared with the change in the AIT and control
groups (P ⬍ 0.01 for both; Table 4).
Statistical Analysis
Results are reported as means ⫾ SD. The mean change in each
group was reported as the estimated margin of the mean (EMM), as
assessed by 95% confidence intervals (CI). Within-group differences
were considered significantly when the 95% CI did not include zero
(14). Covariance analysis, with the Bonferroni adjustment, was used
to test differences between groups, with the difference/⌬-value as the
dependent factor, group variable as the fixed factor, and baseline
values as covariates (37). P values of ⬍0.05 were considered significant. All statistical evaluations were performed using SPSS (version
14.0).
RESULTS
Endothelial Function
Endothelial function measured as FMD was improved after
AIT (EMM: 2%, 95% CI: 0.3–3), COM (EMM: 2%, 95% CI:
J Appl Physiol • VOL
Fig. 1. Endothelial function measured as flow-mediated dilatation (FMD).
Values are means ⫾ SD. AIT, aerobic interval training; ST, strength training;
COM, combination of AIT and ST; Post, posttest. *Significantly different from
baseline (P ⬍ 0.05).
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Dual-energy X-ray absorptiometry. Dual-energy X-ray absorptiometry scanning (HologicDiscovery-A) was used to measure fat mass,
bone mineral content (BMC), and lean body mass (LBM) (29). The
subjects underwent a whole body scan that gave the regional distributions of fat mass, BMC, and LBM.
Blood analysis. The participants were asked to refrain from vigorous exercise the last 48 h before the test. After a 12-h fast, the
participants arrived at the laboratory, and a blood sample was obtained
from an arm vein. Serum triglycerides, glucose, HDL-C, total cholesterol, glycosylated hemoglobin (HbA1c), and C-peptide were measured immediately using standard procedures at St. Olav’s University
Hospital (Trondheim, Norway). The intra-assay coefficient variation
for the different measurement was 4.2% for triglycerides, 2.3% for
glucose, 2.1% for HDL, 2.3% for total cholesterol, 2.1% for HBA1c,
and 7.1% for C-peptide. The laboratory at the hospital is under
Labquality’s quality system; program and quality assurances are
therefore performed frequently. Citrated and EDTA-treated plasma
were centrifuged at 3,000 rpm for 10 min at 4°C. Aliquots of plasma
were stored at ⫺80°C for later analysis. The homeostasis assessment
model (HOMA) was used to estimated the overall insulin sensitivity (39).
Endothelial function. Participants were asked to refrain from vigorous physical activity for 96 h before the test. Endothelial function
was measured as flow-mediated dilatation (FMD) using high-resolution ultrasound (Vivid 7 system, GE Vingmed Ultrasound, Horten,
Norway) according to previously described methods (7, 33). All
measurements were taken at the brachial artery. Artery diameter was
measured every 30 s for 2 min after the cuff release, and peak blood
flow was recorded 10 s after the release. Shear rate was calculated as
blood flow velocity divided by the diameter 1 min after the cuff
release, as previously described (30). Because FMD is influenced by
estrogen levels (11), women were evaluated during the same part of
their menstrual cycle at baseline and posttest. The ultrasound images
were analyzed using EchoPACtm (GE Vingmed Ultrasound).
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EXERCISE TRAINING FOR METABOLIC SYNDROME
Table 2. Risk factors defining metabolic syndrome
Control Group
Pretest
108.7 ⫾ 9.3
Posttest
110.4 ⫾ 9.0*
1.7
0.4–2.9
1.29 ⫾ 0.35
1.27 ⫾ 0.63
⫺0.02
⫺0.19 to 0.16
6.2 ⫾ 2.1
6.1 ⫾ 2.3
⫺0.1
⫺0.68 to 0.43
1.7 ⫾ 0.8
1.7 ⫾ 1.0
⫺0.1
⫺0.6 to 0.5
141.5 ⫾ 12.3 142.1 ⫾ 24.1
0.7
⫺5.5 to 6.9
90.1 ⫾ 7.1
89.5 ⫾ 13.6
⫺0.6
⫺5.0 to 3.9
Pretest
COM Group
Posttest
109.6 ⫾ 10.0
108.3 ⫾ 10.7*†
⫺1.3
⫺2.5 to ⫺0.1
1.17 ⫾ 0.35
1.23 ⫾ 0.40
0.06
⫺0.11 to 0.23
6.0 ⫾ 1.1
5.9 ⫾ 0.8
⫺0.2
⫺0.71 to 0.35
2.3 ⫾ 1.0
1.8 ⫾ 0.8
⫺0.4
⫺0.9 to 0.2
140.0 ⫾ 14.6 134.2 ⫾ 12
⫺5.5
⫺11.4 to 0.4
89.0 ⫾ 8.1
85.0 ⫾ 5.5
⫺4.1
⫺8.3 to 0.1
Pretest
106.2 ⫾ 8.6
Posttest
105.5 ⫾ 8.2*
⫺0.74
⫺2.1 to ⫺0.6
1.38 ⫾ 0.38
1.49 ⫾ 0.64
0.12
⫺0.09 to 0.32
6.0 ⫾ 2.4
5.6 ⫾ 1.8
⫺0.4
⫺1.0 to 0.3
2.6 ⫾ 1.4
2.3 ⫾ 1.1
⫺0.1
⫺0.8 to 0.5
148.6 ⫾ 14
145.1 ⫾ 15.2
⫺4.2
⫺11.9 to 3.5
89 ⫾ 7.1
89.8 ⫾ 6.4
0.8
⫺4.7 to 6.2
ST Group
Pretest
Posttest
111.5 ⫾ 10.8
110.1 ⫾ 11.0*†
⫺1.4
⫺2.7 to ⫺0.8
1.15 ⫾ 0.18
1.23 ⫾ 0.21
0.08
⫺0.10 to 0.26
6.6 ⫾ 2.0
6.6 ⫾ 1.5
0.1
⫺0.5 to 0.6
1.8 ⫾ 0.9
1.9 ⫾ 1.2
⫺0.1
⫺0.6 to 0.5
142.7 ⫾ 14.2 139.9 ⫾ 16.9
⫺2.8
9.0 to 3.3
90.7 ⫾ 10.9
88.9 ⫾ 11.2
⫺1.7
⫺6.2 to 2.8
Values are means ⫾ SD, and results are expressed as estimated margins of the mean (EMM) and 95% confidence intervals (CI). SBP, systolic blood pressure;
DBP, diastolic blood pressure. *Significant change from pretest to posttest (zero not within the 9%% CI); †significantly different from the control group (P ⬍
0.05).
Questionnaires: Quality of Life and Food Registration
Health transition was increased with AIT (95% CI: 6 –25)
and ST (95% CI: 5–21; data not shown). There were no
significant differences in general health, physical function, or
role limitations after the intervention in any of the groups.
Total energy intake (in kcal) and macronutrient intake did not
change during the interventions for any of the groups (data not
shown).
DISCUSSSION
To our knowledge, this is the first clinical study to compare
ST with AIT and a combination between the two training
regimes (COM) in patients with established metabolic syndrome.
Previously, Katzmarzyk et al. (22) showed that aerobic
exercise can be beneficial for patients with metabolic syn-
Fig. 2. Estimated mean change (EMM) of the six risk factors defining
metabolic syndrome. Changes are presented as percentages of the prevalue ⫾
95% confidence intervals (CI).
J Appl Physiol • VOL
drome, but it has been debated whether high-intensity training
(36) or moderate-intensity training (19) is more advantageous.
The results from the present study support the findings of
Tjønna et al. (36), who reported that high-intensity interval
training is effective in improving risk factors related to metabolic syndrome. The present study also showed that ST is
beneficial for people with metabolic syndrome. Furthermore, it
is notable that none of the participants in the ST group
experienced any problems during the training period.
Recently, there has been an increased focus on the accumulation of excess fat in the abdominal region, and it has been
proposed that waist circumference is a better indicator of the
risk of developing cardiovascular diseases than either BMI or
the waist-to-hip ratio (8). Increased waist circumference is
considered the main inclusion criteria for metabolic syndrome
(according to the International Diabetes Federation), and in the
present study, the AIT, ST, and COM groups had a significant
reduction of waist circumference.
The AIT group had a clear tendency toward a reduction in
SBP and DBP; only one person had an increase after the
training period. The estimated mean reduction of ⬃6 mmHg
for SBP and ⬃4 mmHg for DBP in the AIT group are of
clinical importance, as it has been assumed that 10- and
5-mmHg decreases in SBP and DBP, respectively, could decrease the long-term risk of death by ischemic heart diseases by
⬃40% (25).
The changes in HDL-C seen after exercise training are often
associated with a change in body weight and/or fat mass. There
were no changes in HDL-C, total cholesterol, or triglycerides
in any of the groups in the present study, although the AIT and
ST groups had a reduction in total body fat. According to
Durstine et al. (10), almost no change in HDL-C related to
exercise occurs when the exercise training program is shorter
than 12 wk, but when training programs last longer than 12 wk,
increased HDL-C levels are more likely to be reported. One
person in the control group increased the use of statins during
the study. The adjustment of medication in the control group
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Waist circumference, cm
EMM
95% CI
HDL, mmol/l
EMM
95% CI
Glucose, mmol/l
EMM
95% CI
Triglycerides, mmol/l
EMM
95% CI
SBP, mmHg
EMM
95% CI
DBP, mmHg
EMM
95% CI
AIT Group
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EXERCISE TRAINING FOR METABOLIC SYNDROME
Table 3. Physiological parameters measured before (pretest) and after (posttest) 12 wk of physical training
Control Group
Pretest
AIT Group
Posttest
Pretest
COM Group
Posttest
Pretest
Posttest
Pretest
Posttest
103.4 ⫾ 17.1 102.5 ⫾ 17.2
⫺0.7
⫺2.3 to 0.9
32.2 ⫾ 4.2
32.2 ⫾ 4.4
0.1
⫺0.4 to 0.5
32.3 ⫾ 7.0
30.5 ⫾ 5.7*
⫺1.9
⫺3.1 to ⫺0.8
68.2 ⫾ 12.0
69.2 ⫾ 12.8
0.9
⫺0.1 to 1.9
2.85 ⫾ 3.4
2.83 ⫾ 3.8
⫺0.2
⫺0.7 to 0.3
2,050 ⫾ 366 2,001 ⫾ 351
⫺31
⫺99 to 37
6.44 ⫾ 0.95
6.47 ⫾ 1.04
0.03
⫺0.21 to 0.33
1.88 ⫾ 2.37
1.10 ⫾ 0.46
⫺0.29
⫺0.58 to 0.1
38.1 ⫾ 17.4
46.5 ⫾ 24.4
7.5
⫺3.8 to 18.8
5.49 ⫾ 1.21
5.77 ⫾ 1.02
0.13
⫺0.25 to 0.51
Values are means ⫾ SD, and results are expressed as EMM and 95% CI. HOMA, homeostasis assessment model. *Significant mean change from pretest to
posttest (zero not within the 95% CI).
might have influenced the result leading to lower mean levels
of triglycerides and total cholesterol at posttest.
Metabolic syndrome is commonly termed as insulin resistance syndrome, and resistance to insulin-mediated glucose
disposal and compensatory hyperinsulinemia are considered
the central defects of the syndrome (31). The AIT group had a
small estimated mean reduction in C-peptide. The initial level
of C-peptide was normal, and because plasma glucose, HbA1c,
and insulin sensitivity (HOMA2-S) did not change, it cannot be
postulated that AIT had a significant effect on glucose metabolism. It might be that a reduction in body weight is needed to
obtain a change in glucose metabolism, especially when the
volume and length of the training programs is as low as in the
present study (⬃120 min exercise/wk for 12 wk). Our results
Table 4. Aerobic capacity and maximal strength
Control Group
Peak O2 uptake,
ml·kg⫺1·min⫺1
EMM
95% CI
Submaximal exercise,
ml·kg⫺1·min⫺1
EMM
95% CI
Submaximal heart
rate, beats/min
EMM
95% CI
One repetition
maximum, kg
EMM
95% CI
AIT Group
COM Group
ST Group
Pretest
Posttest
Pretest
Posttest
Pretest
Posttest
Pretest
Posttest
34.2 ⫾ 10.2
33.1 ⫾ 9.9
34.2 ⫾ 9.8
38.6 ⫾ 11.3
28.4 ⫾ 6.3
31.5 ⫾ 10.2
31.9 ⫾ 4.6
33.1 ⫾ 4.3
⫺1.1
⫺3.8–1.5
11.3 ⫾ 1.5
10.9 ⫾ 0.6
4.4
1.3–7.6
12.7 ⫾ 2.1
11.1 ⫾ 1.0
3.1
0.3–6.0
12.5 ⫾ 1.9
10.9 ⫾ 1.7
1.4
⫺1.2 to 4.1
11.4 ⫾ 2
11.3 ⫾ 1.8
⫺0.72
⫺1.40 to ⫺0.03
107.4 ⫾ 12.1
105.9 ⫾ 16.8
⫺1.24
⫺2.01 to ⫺0.55
106.8 ⫾ 12.7
96.4 ⫾ 11.7
⫺1.29
⫺2.01 to ⫺0.56
107.5 ⫾ 13.7
97.0 ⫾ 13.3
⫺0.43
⫺1.15 to ⫺0.30
102.1 ⫾ 7.7
103.3 ⫾ 9.3
⫺1.2
⫺7.3 to 4.8
96.7 ⫾ 25.5
109.4 ⫾ 29.0
⫺10.2
⫺15.9 to ⫺3.8
129.3 ⫾ 32.8
129.3 ⫾ 29.4
⫺10.2
⫺16.5 to ⫺3.8
75.8 ⫾ 42.7
110.6 ⫾ 35.8
0.3
⫺5.8 to 6.4
116.7 ⫾ 51.1
170.0 ⫾ 63.1
12.5
⫺0.8 to 25.8
1.1
⫺14.7 to 16.9
33.5
19.3–47.7
53.9
40.4–67.4
Values are means ⫾ SD, and results are expressed as EMM and 95% CI. *Significant change from pretest to posttest (zero not within the 95% CI);
†significantly different from the control group (P ⬍ 0.05).
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Weight, kg
100.9 ⫾ 9.4
101.6 ⫾ 10.2 99.7 ⫾ 18.7 98.3 ⫾ 18.3
91.7 ⫾ 14.7 92.1 ⫾ 14.8
EMM
0.7
⫺1.4
0.4
95% CI
⫺0.9 to 2.2
⫺2.9 to 0.1
⫺1.3 to 2.1
2
Body mass index, kg/m
31.9 ⫾ 4.1
32.0 ⫾ 4.2
31.3 ⫾ 4.3
30.9 ⫾ 4.6
30.3 ⫾ 3.5
30.4 ⫾ 3.6
EMM
0.1
⫺0.4
0.1
95% CI
⫺0.3 to 0.6
⫺0.8 to 0.1
⫺0.3 to 0.6
Fat mass, kg
34.6 ⫾ 8.8
34.2 ⫾ 8.4
33.5 ⫾ 8.6
31.3 ⫾ 9.0*
32.8 ⫾ 4.6
32.0 ⫾ 5.5
EMM
⫺0.3
⫺2.1
⫺0.8
95% CI
⫺1.5 to 0.9
⫺3.2 to ⫺1.0
⫺1.2 to 0.4
Lean body mass, kg
63.6 ⫾ 8.6
64.6 ⫾ 9.4* 63.5 ⫾ 15.2 64.2 ⫾ 15.2
56.3 ⫾ 12.3 57.5 ⫾ 12.1*
EMM
1.0
0.7
1.4
95% CI
0.1–1.9
⫺0.2 to 1.6
0.4–2.4
Bone mineral content, kg
2.8 ⫾ 3.3
2.8 ⫾ 3.1
2.7 ⫾ 5.3
2.7 ⫾ 5.0
2.6 ⫾ 5.6
2.6 ⫾ 5.5
EMM
0.3
⫺0.4
0.2
95% CI
⫺0.3 to 0.8
⫺0.5 to 0.5
⫺0.3 to 0.8
Resting metabolic rate, kcal/24 h 1,861 ⫾ 226 1,865 ⫾ 221 1,933 ⫾ 278 1,936 ⫾ 237 1,633 ⫾ 343 1,677 ⫾ 360
EMM
2
9
19
95% CI
⫺62 to 67
⫺53 to 71
⫺55 to 93
6.12 ⫾ 1.62
6.24 ⫾ 1.40 6.19 ⫾ 0.80 5.95 ⫾ 0.66
6.28 ⫾ 0.78 6.30 ⫾ 0.76
HbA1c, %
EMM
0.10
⫺0.25
0.03
95% CI
⫺0.17 to 0.37
⫺0.51 to 0.01
⫺0.28 to 0.33
C-peptide, nmol/l
1.12 ⫾ 0.26
1.18 ⫾ 0.58 1.11 ⫾ 0.24 1.00 ⫾ 0.42* 1.30 ⫾ 0.68 1.08 ⫾ 0.30
EMM
⫺0.15
⫺0.33
⫺0.27
95% CI
⫺0.44 to ⫺0.14
⫺0.60 to ⫺0.06
⫺0.59 to 0.49
Insulin sensitivity (HOMA), %
41.0 ⫾ 12.8
44.3 ⫾ 20.4 40.4 ⫾ 8.3
48.4 ⫾ 17.1
42.7 ⫾ 24.8 44.9 ⫾ 17.6
EMM
3.5
8.0
3.0
95% CI
⫺7.8 to 14.7
⫺2.7 to 18.8
⫺9.6 to 15.6
Cholesterol, mmol/l
5.72 ⫾ 1.27
5.59 ⫾ 0.95
6.1 ⫾ 0.96 5.64 ⫾ 0.63
6.30 ⫾ 0.88 5.91 ⫾ 0.67
EMM
⫺0.18
⫺0.34
⫺0.33
95% CI
⫺0.55 to 0.20
⫺0.70 to 0.02
⫺0.75 to 0.09
ST Group
EXERCISE TRAINING FOR METABOLIC SYNDROME
Limitations
The number of patients in our study was small; therefore,
larger multicenter studies are encouraged to reinforce our
findings. The variation in age as well as the fact that men and
women were pooled can explain the large variation in some of
the results. The COM and ST groups were on more medications than the other two groups. This difference in medication
use might have influenced the result by making theses groups
more or less susceptible to the adaptation to training. The
progressive nature could not be matched between the groups
J Appl Physiol • VOL
because the number of AIT and ST sessions differs between the
groups. Consequently, the AIT and ST groups performed more
of the specific training form than the COM group. The COM
group performed AIT twice a week and ST once a week; thus, the
strength components of the training was low in this study. This
distribution of aerobic training and ST was believed to be the most
appropriate and advantageous form of combined training when
the total amount per week was three training sessions. Alternatively, we could have changed each week so that the same
numbers of sessions were done for AIT and ST. Metabolic
syndrome is characterized by a cluster of risk factors, but not all
patients have all risk factors. In future studies, it might be informative to group the participants according to their battery of risk
factors.
Summary
The present study showed that ST, AIT, and COM training
have beneficial effects on physiological abnormalities associated with metabolic syndrome. There was a strong tendency
toward a decrease in SBP and DBP after AIT; thus, our data
may indicate that AIT for 12 wk is more effective than both ST
and COM training in improving risk factors defining metabolic
syndrome. The effect of longer training interventions needs to
be studied in the future, especially for combination training
regimes that require both resistance and aerobic adaptations.
ACKNOWLEDGMENTS
The authors thank Ragnhild Røsbjørgen and Trine Skoglund for excellent
technical assistance.
GRANTS
This work was supported by the Liaison Committee between the Central
Norway Regional Health Authority and the Norwegian University of Science
and Technology.
DISCLOSURES
The authors confirm that the manuscript has been read and approved and
that they qualify for authorship. The authors report no conflicts of interest.
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