- Email: [email protected]
Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women
+Model
ARTICLE IN PRESS
SCISPO-3066; No. of Pages 8 Science & Sports (2017) xxx, xxx—xxx
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
ORIGINAL ARTICLE
Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women Effet à court terme d’un entraînement en endurance associé ou non à un entraînement en résistance sur la composition corporelle, le profil lipidique et le bien-être psychologique de femmes non ménopausées E. Arslan a,∗, S. Can b, E. Demirkan b a b
Siirt University, School of Physical Education and Sport, Siirt, Turkey Hitit University, School of Physical Education and Sport, C ¸ orum, Turkey
Received 30 June 2016; accepted 23 November 2016
KEYWORDS Depression; Lipids profile; Middle-aged women; Strength training
∗
Summary Purpose. — The purpose of this study was to investigate the effect of short-term (eight weeks) aerobic and combined training program on the body composition, lipids profile and psychological health (depression), and to compare which training method is more effective in middle-aged premenopausal sedentary women. Methods. — Sixty-four women aged 35—45 years (age = 38.8 ± 3.0 years) were divided into three groups: Aerobic training, Combined training and the control group and women exercised during eight weeks. The subjects’ body composition was measured with anthropometric tape and skinfold caliper and also body fat percentage, fat mass and lean body mass were estimated using BIA. Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and also Beck Depression Inventory scores were registered at before and after eight weeks training.
Corresponding author. Tel.: +90 532 545 28 48; fax: +90 0484 254 21 77. E-mail address: [email protected] (E. Arslan).
http://dx.doi.org/10.1016/j.scispo.2016.11.004 0765-1597/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
2
E. Arslan et al. Results. — Aerobic training and combined training showed significant differences in fat percentage (−2.6%, −4.2%, and 0.2%, P = 0.044 respectively) and fat mass (−5.5%, −5.7%, and 1.1%, P = 0.034 respectively) compared to the control group. Considering the waist circumference, there was a significant difference only between the combined training and control group (−1.3%, −2.6%, and 0.5%, P = 0.048 respectively). Aerobic training and combined training groups showed significant differences in total cholesterol (−7.9%, −9.7%, and 0.9%, P = 0.022 respectively), triglyceride (−5.8%, −6.9%, and 2.0%, respectively, P = 0.012), atherogenic index (−13.5%, −16.0%, and 2.3%, P = 0.000 respectively) and Beck Depression Inventory score (−26.2%, −24.7%, and 8.7%, P = 0.047 respectively) compared to the control group. Conclusion. — The results of this study suggest that both training methods could be used for loosing body weight, fat mass and fat percentage for middle-aged women. Although the combined training seems a little more efficient, aerobic training is also practically easier in order to control and maintain in a large scale training groups. © 2017 Elsevier Masson SAS. All rights reserved.
MOTS CLÉS Dépression ; Profil lipidique ; Femmes d’âge moyen ; Entraînement ; Résistance
Résumé But. — Le but de cette étude était d’étudier l’effet à court terme (huit semaines) d’un entraînement en endurance associé ou non à un entraînement en résistance sur le profil lipidique et les index psychométriques de dépression, pour déterminer quelle méthode d’entraînement est plus efficace chez des femmes non-ménopausées sédentaires d’âge moyen. Méthodes. — Soixante-quatre femmes âgées de 35 à 45 ans (âge = 38,8 ± 3,0 ans) ont été divisés en trois groupes : entraînement en endurance, entraînement combiné, et groupe contrôle suivi en parallèle. La composition corporelle des sujets a été mesurée avec un ruban métrique et la mesure des plis de peau, ainsi que le calcul par bio-impédancemétrie du pourcentage de graisse corporelle, de la masse grasse et de la masse maigre. Le cholestérol total, les triglycérides, les lipoprotéines HDL et LDL et les scores de dépression de Beck ont été mesurés avant et après l’entraînement de 8 semaines. Résultats. — L’entraînement en endurance et l’entraînement combiné modifiaient de fac ¸on significative le pourcentage de graisse (—2,6 %, —4,2 %, et 0,2 %, p = 0,044, respectivement) et la masse grasse (—5,5 %, —5,7 %, et 1,1 %, p = 0,034 respectivement) en comparaison avec le groupe contrôle. La variation de tour de taille ne différait qu’entre le groupe de contrôle et le groupe d’entraînement combiné (—1,3 %, —2,6 %, et 0,5 %, p = 0,048 respectivement). L’entraînement en endurance et l’entraînement combiné diminuaient significativement le cholestérol total (—7,9 %, —9,7 %, et 0,9 %, p = 0,022 respectivement), les triglycérides (−5,8 %, —6,9 %, et 2,0 %, respectivement, p = 0,012), l’indice d’athérogénicité (—13,5 %, —16,0 %, et 2,3 %, p = 0,000 respectivement) et le score de dépression de Beck (26,2 %, —24,7 %, et 8,7 %, p = 0,047 respectivement) en comparaison avec le groupe contrôle. Conclusion. — Les Résultats de cette étude suggèrent que les deux méthodes en pourraient être utilisées pour diminuer le poids corporel, la masse grasse et le pourcentage de graisse chez les femmes de cette tranche d’âge. Bien que l’entraînement combiné de 8 semaines semble plus efficace, l’entraînement en endurance, facile à mettre en œuvre, améliore efficacement tous ces paramètres. © 2017 Elsevier Masson SAS. Tous droits r´ eserv´ es.
1. Introduction Regular physical activity has recommended for health enhancement [1] and it has positive effects on body composition, lipid profile and psychological health [2,3], especially in women. Some studies have examined the effects of aerobic training on anthropometric variables and psychological health [4—6], others have investigated the effects of blood lipid profile in sedentary women with the combined training method [3,7]. Aerobic training, improves the maximal oxygen uptake, oxidative capacity and increases the activity of aerobic
enzymes, mitochondrial and capillary densities in the muscles [8], is one of the most common and popular activity among all ages women, improving lipid profile and cardiovascular health [4,9] and reducing total body mass, total body fat [2,3] and also is beneficial for depression symptoms [10,11]. Strength training also appears to be beneficial as it helps to reduce body mass and body fat percentage [1], contributing to an increase in lean body mass [12], thus preventing the development of osteoporosis [13] and low back pain [14] which is quite prevalent in this population. In the light of these facts, there has been increased attention on different training methods that can affect body
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
Training program on body composition and psychological health in premenopausal women composition, lipid profile and psychological health in premenopausal women. However, a few studies have examined the effects of different types of training on body composition, lipid profile and psychological health [4,15]. In this context, although previous studies [2—4] have investigated the body composition, lipid profile components and psychological health across different trainings, sessions durations and genders, no studies have carried out in-depth examinations of the effect of eight weeks (short-term) aerobic and combined training on the body composition, lipids profile and psychological health and to compare which training method is more effective in middle-aged premenopausal sedentary women. We hypothesized that the combined training would be more effective than the aerobic training, changing body composition, blood lipids profile and depression symptom of premenopausal sedentary women after eight weeks training sessions.
2. Materials and methods 2.1. Participants Subjects were sixty-four premenopausal middle-aged sedentary women, aged 35—45 years, and they were not taking medication or hormone therapy and not suffering from infectious, chronic diseases and musculoskeletal disorders before participation. All the women were overweight (body mass index >25.0 kg/m2) according to World Health Organization (WHO) [16], housewife and performed similar activities in their daily lives. None had ever participated in resistance training exercises and had not been involved in aerobic and combined type exercise in the previous a year. Total of eighty-four women who participated in the first meeting and only seventy-eight met all the inclusion/exclusion criteria and agreed to participate in the study protocol. Participants were randomly assigned to one of 3 groups. During 8-weeks of training period, 6 subjects from combined training, 5 subjects from aerobic training and 3 subjects from control group total fourteen women (a dropout rate about 20.0%) who did not comply with the criteria for inclusion in the study were excluded (i.e., injuries, sickness, abandonment). The final sample was composed of sixty-four women: Aerobic training (n = 21), Combined training (n = 20) and Control group (n = 23). All participants were notified of the research procedures, requirements, benefits, and risks before giving informed consent. Written informed consent was obtained from all the participants. This study was approved by the local Ethics Committee, and was conducted in a manner consistent with the institutional ethical requirements for human experimentation in accordance with the Declaration of Helsinki.
2.2. Methods After 2-weeks familiarization period for the participants in the aerobic and strength training, anthropometric, body composition, lipid profile and Beck Depression Inventory (BDI) score measurements were performed at baseline (pre) and after 8-weeks of training (post) at the temperature controlled private room in a public municipal institution. The Aerobic training (At) and Combined training (Ct) took part
3
in training (1-h main exercise sessions 3 times per week for 8-weeks), whereas control group (Cg) had no training or lifestyle changes during the study. All measurements were performed by same researchers after an overnight fast. All measurements were performed at a similar time of the day between 8:00 and 12:00 a.m. in order to have similar chronobiological characteristics [17].
2.3. Anthropometric measurements and body composition Height and weight were taken for each volunteer while they were wearing light clothing and no shoes and socks. Weight was measured to the nearest 0.1 kg using calibrated scales (Seca, Germany) while height was measured to the nearest 0.1 cm using a calibrated stadiometer (Holtain Ltd, England). Gulick anthropometric tape (Holtain) with an accuracy of ±1 mm was used to measure the circumference of the waist, hip, abdominal, thighs and calves. To estimate percent body fat percentage, a three site skinfold thickness technique was used with a scientific skinfold caliper (Holtain, UK) to the nearest 0.1 mm. The anatomical sites used were: abdominal, triceps and suprailiac. Body density was estimated using the equation which was validated for female aged 18—55 years [18]. Body density was used to estimate body fat percentage using the Siri equation: [%Body fat = (495/body density) − 450]. Fat mass was calculated by the transformation of percent body fat values [fat mass = (body mass × %body fat)/100]. Lean body mass was determined by the fractionation of body mass into two components: lean body mass = body mass − fat mass. The body mass index (BMI) of each female was calculated as weight in kg divided by weight in meters squared. Body fat percentage (Fp), body fat mass (Fm), and lean mass (Lm) were obtained using the BIA device (BC-418 8-contact electrode BIA system (Tanita Corp., Tokyo, Japan)). The measurements were made following the guidelines given by the manufacturer. Two measurements were taken for each of these variables, and their average values were used in the statistical analysis.
2.4. The Beck Depression Inventory To assess the mood state (depression), subjects filled out the Beck Depression Inventory which is a 21-item self-report rating inventory and widely used screening tool that measures symptoms and characteristic attitudes of depression. A higher score indicates more depressed mood [19].
2.5. Blood samples After a 12 h fasting, blood samples, including total cholesterol (Tc), triglyceride (Tg), high-density lipoprotein (Hdl-c), and low-density lipoprotein (Ldl-c) were collected into vacutainer tubes, immediately centrifuged and stored at −80 C until analysis. All blood samples were performed by using Olympus 2700 auto-analyzers (Olympus Diagnostics, GmbH, Hamburg, Germany). The atherogenic index (Ai) was calculated by dividing the total cholesterol by the high-density lipoprotein (Tc/Hdl-c).
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
4
E. Arslan et al.
2.6. Aerobic training procedures Exercise session consist of 10 min warm-up, 60 min At and 10 min cool-down respectively. The training was performed 60 min a day, 3 days (Mon, Wed, Fri) a week at 60—70% of maximum heart rate (HRmax ) as identified by the calculation 220—age [20], during 1—4 weeks (side by side, step touch, lunge side, v-step, grapevine, pivot turn, cha cha cha, mambo rock, diamond step, single hamstring walking, heel touch, sit-up, push up) and at 60—70% of HRmax during 5—8 weeks (fast walking, turn round, heel side, knee-up, scissors double, hop and jump, jumping jack, side kick, full turn, double kick). This type of activity involved the major muscle groups in a continuous manner using basic steps and a minimum of three rhythmic variations of popular dance styles and aerobics per session with songs of a rhythmic cadence of 120—160 beats per minute. Polar Analyzer (Polar Elector oy Finland) was used to continuously to maintain 60—70% of HRmax during the aerobic exercise training program.
2.7. Combined training procedures Combined training were performed for 60 min per a day, 3 days (Mon, Wed, Fri) day, with 35 min of At and 25 min of strength training, including 10 min of warm-up and 10 min cool-down in the training session. The strength training program consisted of two progressive phases: phase (1) from 1 to 4 week, 20 repetitions, 60% of 1 maximum repetition (1MR), 3 sets per exercise, 2—3 min between sets; phase (2) from 5 to 8 week, 15 repetitions, 70% of 1-MR, 3 sets per exercise, 2—3 min between sets. The major muscle groups of the upper and lower limbs were exercised with the use free weights (dumbbells). 9 exercises used in the program were: biceps curl, triceps extension, sits up, squat, side elevation, shoulder press, side bends, pectoral fly and upright row. The 1-MR test consisted of a warm-up, followed by the performance of one series of 10 repetitions of each exercise without overload. The load was increased gradually during the test until the participants were no longer able to perform the entire movement, and three attempts were considered to meet the corresponding 1-MR load. For recovery, an interval of 3—5 min between attempts was given [21]. A physical education teacher guided the sessions, controlled the intensity and the volume, and corrected the posture of the participants during the exercises.
2.8. Statistical analysis The data are reported as means and standard deviations. Before using parametric tests, the assumption of normality was verified using the Shapiro—Wilk test. The one-way ANOVA test was used to identify similarity of groups at baseline. Analysis of variance (ANOVA) for repeated measures was used to evaluate the effects of the variables time (baseline and 8-week), group (At, Ct and Cg) and interaction (time × group). Tukey Post Hoc test was applied to make a pairwise comparison among the different levels of within subjects’ factors (time). Effect sizes (2 ) values of <0.20, 0.20—0.60, 0.60—1.2, 1.2—2.0, 2.0—4.0 were considered to represent small, moderate, large, very large and extremely differences, respectively [22]. In addition, the
deltas of change (%) were presented, and were calculated as follows: 100 × (pre − post)/post measurement values. All statistical analyses were performed in SPSS version 20.0 and the level of statistical significance was set at P < 0.05.
3. Results Table 1 shows the physiological characteristics and socioeconomic status of the subjects at the baseline measurement in the three groups studied. There were no differences at the start of the study for any of the physiological and socioeconomic variables. Table 2 demonstrates the changes in the body composition variables comparisons among groups before and after 8-weeks training program. At and Ct groups showed significant differences in Fp (−2.6%, −4.2%, and 0.2%, P = 0.044 respectively) and Fm (−5.5%, −5.7%, and 1.1%, P = 0.034 respectively) compared to the Cg. Considering the Wc, there was a significant difference only in Ct (−1.3%, −2.6%, and 0.5%, P = 0.048 respectively). In addition, Hc and Ac the largest reductions were in the Ct, however no significant difference found (P > 0.05). Table 3 shows the changes in the in blood lipid profile and psychological health (depression) comparisons among groups before and after 8-weeks training program. At and Ct showed significant differences in Tc (−7.9%, −9.7%, and 0.9%, P = 0.022 respectively), Tg (−5.8%, −6.9%, and 2.0%, respectively, P = 0.012), Ai (−13.5%, −16.0%, and 2.3%, P = 0.000 respectively) compared to the Cg. There are some effects of interactions in Tc (f = 3.309; P < 0.043; 2 = 0.098 small effect) and Ai (f = 8.779; P < 0.000; 2 = 0.224 moderate effect). In addition, At and Ct showed significant differences in BDI score (−26.2%, −24.7%, and 8.7%, P = 0.047 respectively) compared to the Cg.
4. Discussion The purpose of this study was to investigate the effect of short-term aerobic and combined training on the body composition, lipids profile and psychological health to compare which training method is more effective in middle-aged premenopausal sedentary women. The main findings of the present study is that the combined training was more efficient for not only changing body composition but also having positive effect on blood lipid profile and psychological health. To our knowledge, this is the first study that has made a thorough examination of the effects of 8-weeks of training with different training methods on middle-aged premenopausal sedentary women. Aerobic training is traditionally considered to be more effective for reducing body weight and fat mass and it is associated with greater energy expenditure than strength training according to previous comparative analysis study results [23]. However, many studies have currently showed that combined training is more efficient for not only increasing lean mass, but also for reducing total body fat and fat percentage [3,4,24]. The results of comparative studies indicated that after 12-weeks and over aerobic or combined training in middle aged women demonstrated healthier anthropometric profiles, with lower total body fat, fat percentage and higher lean mass, compared to a sedentary
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model
ARTICLE IN PRESS
SCISPO-3066; No. of Pages 8
Training program on body composition and psychological health in premenopausal women Table 1
5
Physiological characteristics and socioeconomic status of the subjects.
Variables
At (n = 21)
Ct (n = 20)
Cg (n = 23)
Age (years) Weight (kg) Body mass index (kg/m2 ) Basal metabolic rate (kcal/day) Marital status (f) Single Married Divorced Education levels (f) High School College University Household income (f) <2000 Tl 2000—3000 Tl >3000 Tl
39.0 ± 3.1 68.7 ± 8.1 29.0 ± 3.4 1289.4 ± 77.8
38.7 ± 2.7 69.3 ± 8.4 28.7 ± 3.2 1288.4 ± 78.9
38.9 ± 3.1 66.4 ± 6.5 27.5 ± 2.3 1294.3 ± 79.5
1 18 2
2 15 3
4 18 1
16 3 2
15 4 1
18 1 4
2 17 2
3 14 3
2 15 6
At: aerobic training; Ct: combined training; Cg: control group; Tl: Turkish liras; f: frequency.
Table 2
Changes in body composition variables before and after 8-weeks training program.
Variables
At (n = 21) Pre
Weight (kg) BMI (kg/m2 ) Wc (cm) Hc (cm) W:H Ac (cm) Fp (%) Fm (kg) Lm (kg)
68.7 29.0 84.1 102.4 0.82 91.7 29.5 20.7 46.0
Ct (n = 20) Post
± ± ± ± ± ± ± ± ±
8.1 3.4 10.1 6.5 0.05 10.8 6.1 7.7 4.1
68.1 28.8 83.1 100.8 0.82 90.9 28.7 19.6 46.5
± ± ± ± ± ± ± ± ±
7.9 3.9 9.5 6.1 0.05 10.7 5.9 7.7 4.1
%
Pre
−0.8 −0.8 −1.3 −1.6 −0.3 −0.8 −2.6* −5.5* 1.1
69.3 28.7 81.8 100.4 0.82 92.6 30.1 21.8 45.4
Cg (n = 23) Post
± ± ± ± ± ± ± ± ±
8.4 3.2 10.5 5.8 0.07 11.4 6.5 8.9 4.5
68.5 28.5 79.8 98.5 0.82 90.6 28.9 20.7 45.8
± ± ± ± ± ± ± ± ±
8.1 3.9 9.1 5.7 0.06 10.6 6.1 8.6 4.4
%
Pre
−1.1 −0.8 −2.6¥ −1.9 −0.9 −2.3 −4.2* −5.7* 0.9
66.4 27.5 78.2 98.6 0.79 88.9 28.1 19.7 44.7
Post ± ± ± ± ± ± ± ± ±
6.5 2.3 6.6 6.4 0.04 9.9 5.1 4.9 6.7
66.8 27.7 78.6 98.9 0.79 89.4 28.1 19.9 44.9
% ± ± ± ± ± ± ± ± ±
6.6 3.2 8.9 6.6 0.04 7.7 5.1 4.9 6.8
0.5 0.5 0.5 0.4 0.1 0.5 0.2 1.1 −0.4
BMI: body mass index; Wc: waist circumference; Hc: hip circumference; W:H: waist:hip ratio; Ac: abdominal circumference; Fp: fat percentage; Fm: fat mass; Lm: lean mass; At: aerobic training; Ct: combined training; Cg: control group; %: the deltas of change. ¥ P value <0.05 compared with aerobic and control group. * P value <0.05 compared with control group.
Table 3 Variables
Changes in blood lipid profile and psychological health (depression) before and after 8-weeks training program. At (n = 21) Pre
Ct (n = 20) Post
Tc (mg/dl) 195.7 ± 13.8 181.5 ± 13.6 Ldl-c (mg/dl) 119.6 ± 13.8 114.8 ± 13.5 Hdl-c (mg/dl) 54.2 ± 7.9 57.0 ± 8.0 Tg (mg/dl) 107.9 ± 12.3 102.0 ± 12.1 Ai 3.6 ± 0.4 3.2 ± 0.3 BDI 12.4 ± 4.1 9.8 ± 3.1
%
Pre
Cg (n = 23) Post
−7.9 207.1 ± 18.5 188.8 ± 15.2 −4.4 110.2 ± 13.4 105.3 ± 13.8 4.8 53.1 ± 8.3 56.0 ± 8.7 −5.8* 101.3 ± 14.6 94.8 ± 14.4 −13.5* 3.9 ± 0.5 3.4 ± 0.4 −26.2* 11.8 ± 3.6 9.5 ± 2.7 *
%
Pre
Post
−9.7 200.3 ± 18.9 202.2 ± 19.1 −4.6 112.2 ± 12.9 115.6 ± 13.3 5.3 51.6 ± 8.1 50.8 ± 7.5 −6.9* 103.4 ± 9.1 105.6 ± 8.6 −16.0* 3.9 ± 0.4 4.0 ± 0.5 −24.7* 12.7 ± 4.6 13.9 ± 4.3 *
% 0.9 2.9 −1.4 2.0 2.3 8.7
Tc: total cholesterol; Tg: triglyceride; Ldl-c: low-density lipoprotein; Hdl-c: high-density lipoprotein; Ai: atherogenic index; BDI: Beck Depression Inventory; At: aerobic training; Ct: combined training; Cg: control group; %: the deltas of change. * P value <0.05 compared with control group.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
6
E. Arslan et al.
group [3—5,7,25]. The present study also reported similar results to those of previous studies, but our study had a shorter time (8-weeks) training session. The explanation for these findings is that regular physical activity provides active energy expenditure, resulting in higher energy expenditure and calorie consumption than a sedentary life style. Moreover, the effect of combined training, including aerobic and strength exercises, increases the activity of aerobic enzymes, and mitochondrial and capillary densities in the muscles and motor units during the exercises sessions [8,12]. Guiraudou et al. [26] described as reprogramming of the function of the sedentary muscle and this may not leading to higher spontaneous activity in addition to the protocol, but also changing in eating behavior. Body composition and distribution of the fat tissue have changed over the years [27]. Therefore, the determination of the body composition is an important factor which should not be disregarded, and it may help medical knowledge about premenopausal sedentary women. Waist circumference is the predictor of visceral fat located in the abdominal region [28]. Its measurement is an easy, low-cost and very important in the population-based studies [29] and it has high correlation with the majority of metabolic risk factors [29,30]. In present study, aerobic and combined training group showed significant differences in waist, hip and abdominal circumferences (the largest reductions were in the combined training group) compared to control group. These results are similar to those reported by previous studies of the effects of different training programs [4,31]. It can be inferred that strength training has the effects of tightening the waist region and reducing fat mass. Considering the lipid profile, the experimental groups showed significant changes in total cholesterol, triglyceride and atherogenic index values compared to the control group. Some similar previous studies [3,5,9,31,32] reported that blood lipid profiles (especially cholesterol, triglyceride, high and low density lipoprotein) were decreased in aerobic or combined training sessions in sedentary females. A low level of Hdl cholesterol is a powerful predictor of increased cardiovascular risk factor. However, it is not clear that this association exists for low levels of low-density lipoprotein cholesterol [33]. It is generally known that regular exercise can lead to preferential fat, including visceral fat reduction (even in the absence of weight loss). Aerobic exercise increases hormone-stimulated adipose lipolysis and subsequent circulating fatty acid availability, which when combined the sustained increase in the metabolic rate, resulting in increased uptake and oxidation of fatty acids in a working muscle [34]. This highlights the fact that this mechanism may be the reason for the difference in blood lipid profiles between the experimental groups (aerobic and combined) and the control group (Fig. 1). Beside reducing total body fat and fat percentage, exercise has positive effects on psychological behavior and can help to improve of general mood [35,11]. Some studies have found that physical activity is associated with fewer depressive symptoms than physical inactivity [36]. Geliebter et al. [37] observed that even though subjects who performed aerobic training with diet, or resistance training with diet, did not lose any more weight than only diet group, the participants in both exercise groups showed considerable improvement in their mood. In another study analyzing the
Figure 1 Distribution of the weight loss of the participants according to groups.
effects of aerobic and resistance exercise on depression, it was observed that only the aerobic exercise group showed significant improvement in depressive symptoms [38]. Our study results demonstrate that both the aerobic training and combined training groups showed significant changes in their BDI scores compared to the control group. However, aerobic training resulted in greater reduction in the BDI scores of the middle-aged premenopausal sedentary women. Improvements in mood states and reductions in anxiety and depressive symptoms after exercise are explained by changes in endorphin and monoamine levels, and are associated with a reduction in urine cortisol and epinephrine excretions [6,39]. There are limitations that need to be acknowledged and addressed regarding the present study. One limitation of this study is that the determination of the aerobic training intensity using maximum heart rate (HRmax ) as identified by the calculation 220 − age is an easy and widely using method in the population-based studies. It may be influenced by physical and environmental conditions, but we used temperature controlled private room (participants are accustomed to the these conditions) to avoid the negative influence on the study results that participants are accustomed to the these conditions. Another important limitation of this study is that there was a lack of dietary intake control, which may be variable affecting body composition and blood lipid profiles in this type of research. Further research is needed to investigate the effect of different training models on body composition, blood lipid profiles and psychological health to explain factors affecting different age groups of women. In summary, our hypothesis was that combined exercise training would be more effective than aerobic training at changing body composition, lipid profiles and depressive symptom of premenopausal sedentary women after 8-weeks of training. The results of this study supported our hypothesis and they also demonstrate that both aerobic training and combined training are effective at reducing body fat percentage and fat mass, total cholesterol, triglyceride, the atherogenic index, and depressive symptoms. Moreover, only combined training was effective at reducing the waist circumference of middle-aged premenopausal sedentary women. The results of this study both training methods could be used for loosing body weight, fat mass and fat percentage for middle-aged women. Although the combined training seems a little more efficient, aerobic training is
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
Training program on body composition and psychological health in premenopausal women also practically easier in order to control and maintain in a large scale training groups. Although many studies have been conducted to find the most effective model of training for older and postmenopausal women, these studies generally prescribed 12-weeks or more of training and did not examine the 8-week training effect on body composition, lipid profiles and psychological health of premenopausal women. Therefore, further studies are needed in order to gain more information about the actual effects of the different training programs in a short time.
Disclosure of interest
[11]
[12]
[13]
[14]
The authors declare that they have no competing interest.
References [1] Bouchard DR, Soucy L, Senechal M, Dionne IJ, Brochu M. Impact of resistance training with or without caloric restriction on physical capacity in obese older women. Menopause 2009;16:66—72, http://dx.doi.org/10.1097/gme.0b013e31817dacf7. [2] Diniz TA, Fortaleza ACS, Rossi FE, Neves LM, Campos EZ, Junior IF. Short-term program of aerobic training prescribed using critical velocity is effective to improve metabolic profile in postmenopausal women. Sci Sports 2016;31:95—102, http://dx.doi.org/10.1016/j.scispo.2015.03.006. [3] Rossi FE, Fortaleza AC, Neves LM, Buonani C, Picolo MR, Diniz TA, et al. Combined training (aerobic plus strength) potentiates a reduction in body fat but demonstrates no difference on the lipid profile in postmenopausal women when compared with aerobic training with a similar training load. J Strength Cond Res 2016;30:226—34, http://dx.doi.org/10.1519/JSC.0000000000001020. ¸a RMSC, Júnior Araujo AT, Sousa MSC, Fernan[4] Mendonc des HM. The effects of different exercise programmes on female body composition. J Hum Kinet 2014;43:67—78, http://dx.doi.org/10.2478/hukin-2014-0091. [5] Mohr M, Lindenskov A, Holm PM, Nielsen HP, Mortensen J, Weihe P, et al. Football training improves cardiovascular health profile in sedentary, premenopausal hypertensive women. Scand J Med Sci Sports 2014;24:36—42, http://dx.doi.org/10.1111/sms.12278. [6] Sarsan A, Ardic ¸ F, Özgen M, Topuz O, Sermez Y. The effects of aerobic and resistance exercises in obese women. Clin Rehabil 2006;20:773—82, http://dx.doi.org/10.1177/0269215506070795. [7] Sillanpaa E, Laaksonen DE, Hakkinen A, Karavirta L, Jensen B, Kraemer WJ, et al. Body composition, fitness, and metabolic health during strength and endurance training and their combination in middle-aged and older women. Eur J Appl Physiol 2009;106:285—96, http://dx.doi.org/10.1007/s00421-009-1013-x. [8] Chtara M, Chamari K, Chaouachi M, Chaouachi A, Koubaa D, Feki Y, et al. Effects of intra-session concurrent endurance and strength training sequence on aerobic performance and capacity. Br J Sports Med 2005;39:555—60, http://dx.doi.org/10.1136/bjsm.2004.015248. [9] Hallage T, Krause MP, Haile L, Miculis CP, Nagle EF, Reis RS, et al. The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res 2010;24:2261—6, http://dx.doi.org/10.1519/JSC.0b013e3181ddacc6. [10] Mastura J, Mohd Sofian OF, Bahaman AS, Salleh AR, Muhammad Nazrul S. Effect of low-impact aerobic dance exercise on psychological health (stress) among
[15]
[16]
[17]
[18] [19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
7
sedentary women in Malaysia. Biol Sport 2012;29:63—9, http://dx.doi.org/10.5604/20831862.984944. De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med 2006;42:273—9, http://dx.doi.org/10.1016/j.ypmed.2005.12.002. Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training on older adults. Sports Med 2004;34:329—48, http://dx.doi.org/10.2165/00007256-200434050-00005. Bemben DA, Bemben MG. Dose—response effect of 40 weeks of resistance training on bone mineral density in older adults. Osteoporos Int 2011;22:179—86, http://dx.doi.org/10.1007/s00198-010-1182-9. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J 2004;4:106—15, http://dx.doi.org/10.1016/S1529-9430(03)00174-8. Rech CR, Petroski EL, Silva RCRD, Silva JCND. Anthropometric indicators of fat mass excess among Rev Bras Med Esporte 2006;12:119—24, women. http://dx.doi.org/10.1590/S1517-86922006000300002. World Health Organization. Obesity: prevention and managing the global epidemic: report of a WHO consultation. WHO technical report series 894; 2000. Drust B, Waterhouse J, Atkinson G, Edwards B, Reilly T. Circadian rhythms in sports performance — an update. Chronobiol Int 2005;22:21—44, http://dx.doi.org/10.1081/CBI-200041039. Jackson AS, Pollock ML. Practical assessment of bodycomposition. Phys Sports Med 1985;13:76. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988;8:77. Robergs RA, Landwehr R. The surprising history of the ‘‘HRmax = 220 − age’’ equation. J Exerc Physiol 2002;5: 1—10. Thompson PD, Arena R, Riebe D, Pescatello LS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription. Curr Sports Med Rep 2013;12:215—7. Hopkins WG. Linear models and effect magnitudes for research, clinical and practical applications. Sportscience 2010;14:49—57. Church T. Exercise in obesity, metabolic syndrome, and diabetes. Prog Cardiovasc Dis 2011;53:412—8, http://dx.doi.org/10.1016/j.pcad.2011.03.013. Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. J Obes 2011:1—9, http://dx.doi.org/10.1155/2011/482564. Bravo MF, Paredes FZ, Rodriguez FJR, Montero CC. Occupational physical activity and body composition in adult women: pilot study. Nutr Hosp 2013;28:1060—4, http://dx.doi.org/10.3305/nh.2013.28.4.6552. Guiraudou M, Romain AJ, Mawunu M, Bedjih K, Fedou C, Brun JF. Chronic effects of exercise targeted at the level of maximal lipid oxidation (LIPOXmax) on eating behavior in sedentary obese subjects. Sci Sports 2016;31:13—8, http://dx.doi.org/10.1016/j.scispo.2015.09.001. Colado JC, Triplett NT. Effects of a short-term resistance program using elastic bands versus weight machines for sedentary middle-aged women. J Strength Cond Res 2008;22:1441—8, http://dx.doi.org/10.1519/JSC.0b013e31817ae67a. Keating SE, Machan EA, O’Connor HT, Gerofi JA, Sainsbury A, Caterson ID, et al. Continuous exercise but not high intensity interval training improves fat distribution in overweight adults. J Obes 2014:1—12, http://dx.doi.org/10.1155/2014/834865. Olinto MTA, Nacul LC, Gigante DP, Costa JSD, Menezes AMB, Macedo S. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
8
E. Arslan et al.
[30]
[31]
[32]
[33]
[34]
[35]
population-based study. Public Health Nutr 2004;7:629—35, http://dx.doi.org/10.1079/PHN2003582. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments association with metabolic risk factors in the Framingham Heart Study. Circulation 2007;11:39—48, http://dx.doi.org/10.1161/CIRCULATIONAHA.106.675355. Kerksick C, Thomas A, Campbell B, Taylor L, Wilborn C, Marcello B, et al. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women. Nutr Metab 2009;23:1—17, http://dx.doi.org/10.1186/1743-7075-6-23. Ha CH, Swearingin B, Jeon YK, Lee M. Effects of combined exercise on HOMA-IR, HOMA -cell and atherogenic index in Korean obese female. Sport Sci Health 2015;11:49—55, http://dx.doi.org/10.1007/s11332-014-0208-7. Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007;357:1301—10, http://dx.doi.org/10.1056/NEJMoa064278. Burguera B, Proctor D, Dietz N, Guo Z, Joyner M, Jensen MD. Leg free fatty acid kinetics during exercise in men and women. Am J Physiol Endocrinol Metab 2000;278:113—7. Byrne A, Byrne DG. The effect of exercise on depression, anxiety and other mood states:
[36]
[37]
[38]
[39]
a review. J Psychosom Res 1993;37:565—74, http://dx.doi.org/10.1016/0022-3999(93)90050-P. Azar D, Ball K, Salmon J, Cleland V. The association between physical activity and depressive symptoms in young women: a review. Ment Health Phys Activ 2008;1:82—8, http://dx.doi.org/10.1016/j.mhpa.2008.09.004. Geliebter A, Maher MM, Gerace L, Gutin B, Heymsfield SB, Hashim SA. Effects of strength or aerobic training on body composition, resting metabolic rate, and peak oxygen consumption in obese dieting subjects. Am J Clin Nutr 1997;66:557—63. Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, et al. Exercise and depressive symptoms a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B: Psychol Sci Soc Sci 2002;57:124—32, http://dx.doi.org/10.1093/geronb/57.2.P124. Nabkasorn C, Miyai N, Sootmongkol A, Junprasert S, Yamamoto H, Arita M, et al. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. Eur J Public Health 2006;16:179—84, http://dx.doi.org/10.1093/eurpub/cki159.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
ARTICLE IN PRESS
SCISPO-3066; No. of Pages 8 Science & Sports (2017) xxx, xxx—xxx
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
ORIGINAL ARTICLE
Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women Effet à court terme d’un entraînement en endurance associé ou non à un entraînement en résistance sur la composition corporelle, le profil lipidique et le bien-être psychologique de femmes non ménopausées E. Arslan a,∗, S. Can b, E. Demirkan b a b
Siirt University, School of Physical Education and Sport, Siirt, Turkey Hitit University, School of Physical Education and Sport, C ¸ orum, Turkey
Received 30 June 2016; accepted 23 November 2016
KEYWORDS Depression; Lipids profile; Middle-aged women; Strength training
∗
Summary Purpose. — The purpose of this study was to investigate the effect of short-term (eight weeks) aerobic and combined training program on the body composition, lipids profile and psychological health (depression), and to compare which training method is more effective in middle-aged premenopausal sedentary women. Methods. — Sixty-four women aged 35—45 years (age = 38.8 ± 3.0 years) were divided into three groups: Aerobic training, Combined training and the control group and women exercised during eight weeks. The subjects’ body composition was measured with anthropometric tape and skinfold caliper and also body fat percentage, fat mass and lean body mass were estimated using BIA. Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and also Beck Depression Inventory scores were registered at before and after eight weeks training.
Corresponding author. Tel.: +90 532 545 28 48; fax: +90 0484 254 21 77. E-mail address: [email protected] (E. Arslan).
http://dx.doi.org/10.1016/j.scispo.2016.11.004 0765-1597/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
2
E. Arslan et al. Results. — Aerobic training and combined training showed significant differences in fat percentage (−2.6%, −4.2%, and 0.2%, P = 0.044 respectively) and fat mass (−5.5%, −5.7%, and 1.1%, P = 0.034 respectively) compared to the control group. Considering the waist circumference, there was a significant difference only between the combined training and control group (−1.3%, −2.6%, and 0.5%, P = 0.048 respectively). Aerobic training and combined training groups showed significant differences in total cholesterol (−7.9%, −9.7%, and 0.9%, P = 0.022 respectively), triglyceride (−5.8%, −6.9%, and 2.0%, respectively, P = 0.012), atherogenic index (−13.5%, −16.0%, and 2.3%, P = 0.000 respectively) and Beck Depression Inventory score (−26.2%, −24.7%, and 8.7%, P = 0.047 respectively) compared to the control group. Conclusion. — The results of this study suggest that both training methods could be used for loosing body weight, fat mass and fat percentage for middle-aged women. Although the combined training seems a little more efficient, aerobic training is also practically easier in order to control and maintain in a large scale training groups. © 2017 Elsevier Masson SAS. All rights reserved.
MOTS CLÉS Dépression ; Profil lipidique ; Femmes d’âge moyen ; Entraînement ; Résistance
Résumé But. — Le but de cette étude était d’étudier l’effet à court terme (huit semaines) d’un entraînement en endurance associé ou non à un entraînement en résistance sur le profil lipidique et les index psychométriques de dépression, pour déterminer quelle méthode d’entraînement est plus efficace chez des femmes non-ménopausées sédentaires d’âge moyen. Méthodes. — Soixante-quatre femmes âgées de 35 à 45 ans (âge = 38,8 ± 3,0 ans) ont été divisés en trois groupes : entraînement en endurance, entraînement combiné, et groupe contrôle suivi en parallèle. La composition corporelle des sujets a été mesurée avec un ruban métrique et la mesure des plis de peau, ainsi que le calcul par bio-impédancemétrie du pourcentage de graisse corporelle, de la masse grasse et de la masse maigre. Le cholestérol total, les triglycérides, les lipoprotéines HDL et LDL et les scores de dépression de Beck ont été mesurés avant et après l’entraînement de 8 semaines. Résultats. — L’entraînement en endurance et l’entraînement combiné modifiaient de fac ¸on significative le pourcentage de graisse (—2,6 %, —4,2 %, et 0,2 %, p = 0,044, respectivement) et la masse grasse (—5,5 %, —5,7 %, et 1,1 %, p = 0,034 respectivement) en comparaison avec le groupe contrôle. La variation de tour de taille ne différait qu’entre le groupe de contrôle et le groupe d’entraînement combiné (—1,3 %, —2,6 %, et 0,5 %, p = 0,048 respectivement). L’entraînement en endurance et l’entraînement combiné diminuaient significativement le cholestérol total (—7,9 %, —9,7 %, et 0,9 %, p = 0,022 respectivement), les triglycérides (−5,8 %, —6,9 %, et 2,0 %, respectivement, p = 0,012), l’indice d’athérogénicité (—13,5 %, —16,0 %, et 2,3 %, p = 0,000 respectivement) et le score de dépression de Beck (26,2 %, —24,7 %, et 8,7 %, p = 0,047 respectivement) en comparaison avec le groupe contrôle. Conclusion. — Les Résultats de cette étude suggèrent que les deux méthodes en pourraient être utilisées pour diminuer le poids corporel, la masse grasse et le pourcentage de graisse chez les femmes de cette tranche d’âge. Bien que l’entraînement combiné de 8 semaines semble plus efficace, l’entraînement en endurance, facile à mettre en œuvre, améliore efficacement tous ces paramètres. © 2017 Elsevier Masson SAS. Tous droits r´ eserv´ es.
1. Introduction Regular physical activity has recommended for health enhancement [1] and it has positive effects on body composition, lipid profile and psychological health [2,3], especially in women. Some studies have examined the effects of aerobic training on anthropometric variables and psychological health [4—6], others have investigated the effects of blood lipid profile in sedentary women with the combined training method [3,7]. Aerobic training, improves the maximal oxygen uptake, oxidative capacity and increases the activity of aerobic
enzymes, mitochondrial and capillary densities in the muscles [8], is one of the most common and popular activity among all ages women, improving lipid profile and cardiovascular health [4,9] and reducing total body mass, total body fat [2,3] and also is beneficial for depression symptoms [10,11]. Strength training also appears to be beneficial as it helps to reduce body mass and body fat percentage [1], contributing to an increase in lean body mass [12], thus preventing the development of osteoporosis [13] and low back pain [14] which is quite prevalent in this population. In the light of these facts, there has been increased attention on different training methods that can affect body
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
Training program on body composition and psychological health in premenopausal women composition, lipid profile and psychological health in premenopausal women. However, a few studies have examined the effects of different types of training on body composition, lipid profile and psychological health [4,15]. In this context, although previous studies [2—4] have investigated the body composition, lipid profile components and psychological health across different trainings, sessions durations and genders, no studies have carried out in-depth examinations of the effect of eight weeks (short-term) aerobic and combined training on the body composition, lipids profile and psychological health and to compare which training method is more effective in middle-aged premenopausal sedentary women. We hypothesized that the combined training would be more effective than the aerobic training, changing body composition, blood lipids profile and depression symptom of premenopausal sedentary women after eight weeks training sessions.
2. Materials and methods 2.1. Participants Subjects were sixty-four premenopausal middle-aged sedentary women, aged 35—45 years, and they were not taking medication or hormone therapy and not suffering from infectious, chronic diseases and musculoskeletal disorders before participation. All the women were overweight (body mass index >25.0 kg/m2) according to World Health Organization (WHO) [16], housewife and performed similar activities in their daily lives. None had ever participated in resistance training exercises and had not been involved in aerobic and combined type exercise in the previous a year. Total of eighty-four women who participated in the first meeting and only seventy-eight met all the inclusion/exclusion criteria and agreed to participate in the study protocol. Participants were randomly assigned to one of 3 groups. During 8-weeks of training period, 6 subjects from combined training, 5 subjects from aerobic training and 3 subjects from control group total fourteen women (a dropout rate about 20.0%) who did not comply with the criteria for inclusion in the study were excluded (i.e., injuries, sickness, abandonment). The final sample was composed of sixty-four women: Aerobic training (n = 21), Combined training (n = 20) and Control group (n = 23). All participants were notified of the research procedures, requirements, benefits, and risks before giving informed consent. Written informed consent was obtained from all the participants. This study was approved by the local Ethics Committee, and was conducted in a manner consistent with the institutional ethical requirements for human experimentation in accordance with the Declaration of Helsinki.
2.2. Methods After 2-weeks familiarization period for the participants in the aerobic and strength training, anthropometric, body composition, lipid profile and Beck Depression Inventory (BDI) score measurements were performed at baseline (pre) and after 8-weeks of training (post) at the temperature controlled private room in a public municipal institution. The Aerobic training (At) and Combined training (Ct) took part
3
in training (1-h main exercise sessions 3 times per week for 8-weeks), whereas control group (Cg) had no training or lifestyle changes during the study. All measurements were performed by same researchers after an overnight fast. All measurements were performed at a similar time of the day between 8:00 and 12:00 a.m. in order to have similar chronobiological characteristics [17].
2.3. Anthropometric measurements and body composition Height and weight were taken for each volunteer while they were wearing light clothing and no shoes and socks. Weight was measured to the nearest 0.1 kg using calibrated scales (Seca, Germany) while height was measured to the nearest 0.1 cm using a calibrated stadiometer (Holtain Ltd, England). Gulick anthropometric tape (Holtain) with an accuracy of ±1 mm was used to measure the circumference of the waist, hip, abdominal, thighs and calves. To estimate percent body fat percentage, a three site skinfold thickness technique was used with a scientific skinfold caliper (Holtain, UK) to the nearest 0.1 mm. The anatomical sites used were: abdominal, triceps and suprailiac. Body density was estimated using the equation which was validated for female aged 18—55 years [18]. Body density was used to estimate body fat percentage using the Siri equation: [%Body fat = (495/body density) − 450]. Fat mass was calculated by the transformation of percent body fat values [fat mass = (body mass × %body fat)/100]. Lean body mass was determined by the fractionation of body mass into two components: lean body mass = body mass − fat mass. The body mass index (BMI) of each female was calculated as weight in kg divided by weight in meters squared. Body fat percentage (Fp), body fat mass (Fm), and lean mass (Lm) were obtained using the BIA device (BC-418 8-contact electrode BIA system (Tanita Corp., Tokyo, Japan)). The measurements were made following the guidelines given by the manufacturer. Two measurements were taken for each of these variables, and their average values were used in the statistical analysis.
2.4. The Beck Depression Inventory To assess the mood state (depression), subjects filled out the Beck Depression Inventory which is a 21-item self-report rating inventory and widely used screening tool that measures symptoms and characteristic attitudes of depression. A higher score indicates more depressed mood [19].
2.5. Blood samples After a 12 h fasting, blood samples, including total cholesterol (Tc), triglyceride (Tg), high-density lipoprotein (Hdl-c), and low-density lipoprotein (Ldl-c) were collected into vacutainer tubes, immediately centrifuged and stored at −80 C until analysis. All blood samples were performed by using Olympus 2700 auto-analyzers (Olympus Diagnostics, GmbH, Hamburg, Germany). The atherogenic index (Ai) was calculated by dividing the total cholesterol by the high-density lipoprotein (Tc/Hdl-c).
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
4
E. Arslan et al.
2.6. Aerobic training procedures Exercise session consist of 10 min warm-up, 60 min At and 10 min cool-down respectively. The training was performed 60 min a day, 3 days (Mon, Wed, Fri) a week at 60—70% of maximum heart rate (HRmax ) as identified by the calculation 220—age [20], during 1—4 weeks (side by side, step touch, lunge side, v-step, grapevine, pivot turn, cha cha cha, mambo rock, diamond step, single hamstring walking, heel touch, sit-up, push up) and at 60—70% of HRmax during 5—8 weeks (fast walking, turn round, heel side, knee-up, scissors double, hop and jump, jumping jack, side kick, full turn, double kick). This type of activity involved the major muscle groups in a continuous manner using basic steps and a minimum of three rhythmic variations of popular dance styles and aerobics per session with songs of a rhythmic cadence of 120—160 beats per minute. Polar Analyzer (Polar Elector oy Finland) was used to continuously to maintain 60—70% of HRmax during the aerobic exercise training program.
2.7. Combined training procedures Combined training were performed for 60 min per a day, 3 days (Mon, Wed, Fri) day, with 35 min of At and 25 min of strength training, including 10 min of warm-up and 10 min cool-down in the training session. The strength training program consisted of two progressive phases: phase (1) from 1 to 4 week, 20 repetitions, 60% of 1 maximum repetition (1MR), 3 sets per exercise, 2—3 min between sets; phase (2) from 5 to 8 week, 15 repetitions, 70% of 1-MR, 3 sets per exercise, 2—3 min between sets. The major muscle groups of the upper and lower limbs were exercised with the use free weights (dumbbells). 9 exercises used in the program were: biceps curl, triceps extension, sits up, squat, side elevation, shoulder press, side bends, pectoral fly and upright row. The 1-MR test consisted of a warm-up, followed by the performance of one series of 10 repetitions of each exercise without overload. The load was increased gradually during the test until the participants were no longer able to perform the entire movement, and three attempts were considered to meet the corresponding 1-MR load. For recovery, an interval of 3—5 min between attempts was given [21]. A physical education teacher guided the sessions, controlled the intensity and the volume, and corrected the posture of the participants during the exercises.
2.8. Statistical analysis The data are reported as means and standard deviations. Before using parametric tests, the assumption of normality was verified using the Shapiro—Wilk test. The one-way ANOVA test was used to identify similarity of groups at baseline. Analysis of variance (ANOVA) for repeated measures was used to evaluate the effects of the variables time (baseline and 8-week), group (At, Ct and Cg) and interaction (time × group). Tukey Post Hoc test was applied to make a pairwise comparison among the different levels of within subjects’ factors (time). Effect sizes (2 ) values of <0.20, 0.20—0.60, 0.60—1.2, 1.2—2.0, 2.0—4.0 were considered to represent small, moderate, large, very large and extremely differences, respectively [22]. In addition, the
deltas of change (%) were presented, and were calculated as follows: 100 × (pre − post)/post measurement values. All statistical analyses were performed in SPSS version 20.0 and the level of statistical significance was set at P < 0.05.
3. Results Table 1 shows the physiological characteristics and socioeconomic status of the subjects at the baseline measurement in the three groups studied. There were no differences at the start of the study for any of the physiological and socioeconomic variables. Table 2 demonstrates the changes in the body composition variables comparisons among groups before and after 8-weeks training program. At and Ct groups showed significant differences in Fp (−2.6%, −4.2%, and 0.2%, P = 0.044 respectively) and Fm (−5.5%, −5.7%, and 1.1%, P = 0.034 respectively) compared to the Cg. Considering the Wc, there was a significant difference only in Ct (−1.3%, −2.6%, and 0.5%, P = 0.048 respectively). In addition, Hc and Ac the largest reductions were in the Ct, however no significant difference found (P > 0.05). Table 3 shows the changes in the in blood lipid profile and psychological health (depression) comparisons among groups before and after 8-weeks training program. At and Ct showed significant differences in Tc (−7.9%, −9.7%, and 0.9%, P = 0.022 respectively), Tg (−5.8%, −6.9%, and 2.0%, respectively, P = 0.012), Ai (−13.5%, −16.0%, and 2.3%, P = 0.000 respectively) compared to the Cg. There are some effects of interactions in Tc (f = 3.309; P < 0.043; 2 = 0.098 small effect) and Ai (f = 8.779; P < 0.000; 2 = 0.224 moderate effect). In addition, At and Ct showed significant differences in BDI score (−26.2%, −24.7%, and 8.7%, P = 0.047 respectively) compared to the Cg.
4. Discussion The purpose of this study was to investigate the effect of short-term aerobic and combined training on the body composition, lipids profile and psychological health to compare which training method is more effective in middle-aged premenopausal sedentary women. The main findings of the present study is that the combined training was more efficient for not only changing body composition but also having positive effect on blood lipid profile and psychological health. To our knowledge, this is the first study that has made a thorough examination of the effects of 8-weeks of training with different training methods on middle-aged premenopausal sedentary women. Aerobic training is traditionally considered to be more effective for reducing body weight and fat mass and it is associated with greater energy expenditure than strength training according to previous comparative analysis study results [23]. However, many studies have currently showed that combined training is more efficient for not only increasing lean mass, but also for reducing total body fat and fat percentage [3,4,24]. The results of comparative studies indicated that after 12-weeks and over aerobic or combined training in middle aged women demonstrated healthier anthropometric profiles, with lower total body fat, fat percentage and higher lean mass, compared to a sedentary
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model
ARTICLE IN PRESS
SCISPO-3066; No. of Pages 8
Training program on body composition and psychological health in premenopausal women Table 1
5
Physiological characteristics and socioeconomic status of the subjects.
Variables
At (n = 21)
Ct (n = 20)
Cg (n = 23)
Age (years) Weight (kg) Body mass index (kg/m2 ) Basal metabolic rate (kcal/day) Marital status (f) Single Married Divorced Education levels (f) High School College University Household income (f) <2000 Tl 2000—3000 Tl >3000 Tl
39.0 ± 3.1 68.7 ± 8.1 29.0 ± 3.4 1289.4 ± 77.8
38.7 ± 2.7 69.3 ± 8.4 28.7 ± 3.2 1288.4 ± 78.9
38.9 ± 3.1 66.4 ± 6.5 27.5 ± 2.3 1294.3 ± 79.5
1 18 2
2 15 3
4 18 1
16 3 2
15 4 1
18 1 4
2 17 2
3 14 3
2 15 6
At: aerobic training; Ct: combined training; Cg: control group; Tl: Turkish liras; f: frequency.
Table 2
Changes in body composition variables before and after 8-weeks training program.
Variables
At (n = 21) Pre
Weight (kg) BMI (kg/m2 ) Wc (cm) Hc (cm) W:H Ac (cm) Fp (%) Fm (kg) Lm (kg)
68.7 29.0 84.1 102.4 0.82 91.7 29.5 20.7 46.0
Ct (n = 20) Post
± ± ± ± ± ± ± ± ±
8.1 3.4 10.1 6.5 0.05 10.8 6.1 7.7 4.1
68.1 28.8 83.1 100.8 0.82 90.9 28.7 19.6 46.5
± ± ± ± ± ± ± ± ±
7.9 3.9 9.5 6.1 0.05 10.7 5.9 7.7 4.1
%
Pre
−0.8 −0.8 −1.3 −1.6 −0.3 −0.8 −2.6* −5.5* 1.1
69.3 28.7 81.8 100.4 0.82 92.6 30.1 21.8 45.4
Cg (n = 23) Post
± ± ± ± ± ± ± ± ±
8.4 3.2 10.5 5.8 0.07 11.4 6.5 8.9 4.5
68.5 28.5 79.8 98.5 0.82 90.6 28.9 20.7 45.8
± ± ± ± ± ± ± ± ±
8.1 3.9 9.1 5.7 0.06 10.6 6.1 8.6 4.4
%
Pre
−1.1 −0.8 −2.6¥ −1.9 −0.9 −2.3 −4.2* −5.7* 0.9
66.4 27.5 78.2 98.6 0.79 88.9 28.1 19.7 44.7
Post ± ± ± ± ± ± ± ± ±
6.5 2.3 6.6 6.4 0.04 9.9 5.1 4.9 6.7
66.8 27.7 78.6 98.9 0.79 89.4 28.1 19.9 44.9
% ± ± ± ± ± ± ± ± ±
6.6 3.2 8.9 6.6 0.04 7.7 5.1 4.9 6.8
0.5 0.5 0.5 0.4 0.1 0.5 0.2 1.1 −0.4
BMI: body mass index; Wc: waist circumference; Hc: hip circumference; W:H: waist:hip ratio; Ac: abdominal circumference; Fp: fat percentage; Fm: fat mass; Lm: lean mass; At: aerobic training; Ct: combined training; Cg: control group; %: the deltas of change. ¥ P value <0.05 compared with aerobic and control group. * P value <0.05 compared with control group.
Table 3 Variables
Changes in blood lipid profile and psychological health (depression) before and after 8-weeks training program. At (n = 21) Pre
Ct (n = 20) Post
Tc (mg/dl) 195.7 ± 13.8 181.5 ± 13.6 Ldl-c (mg/dl) 119.6 ± 13.8 114.8 ± 13.5 Hdl-c (mg/dl) 54.2 ± 7.9 57.0 ± 8.0 Tg (mg/dl) 107.9 ± 12.3 102.0 ± 12.1 Ai 3.6 ± 0.4 3.2 ± 0.3 BDI 12.4 ± 4.1 9.8 ± 3.1
%
Pre
Cg (n = 23) Post
−7.9 207.1 ± 18.5 188.8 ± 15.2 −4.4 110.2 ± 13.4 105.3 ± 13.8 4.8 53.1 ± 8.3 56.0 ± 8.7 −5.8* 101.3 ± 14.6 94.8 ± 14.4 −13.5* 3.9 ± 0.5 3.4 ± 0.4 −26.2* 11.8 ± 3.6 9.5 ± 2.7 *
%
Pre
Post
−9.7 200.3 ± 18.9 202.2 ± 19.1 −4.6 112.2 ± 12.9 115.6 ± 13.3 5.3 51.6 ± 8.1 50.8 ± 7.5 −6.9* 103.4 ± 9.1 105.6 ± 8.6 −16.0* 3.9 ± 0.4 4.0 ± 0.5 −24.7* 12.7 ± 4.6 13.9 ± 4.3 *
% 0.9 2.9 −1.4 2.0 2.3 8.7
Tc: total cholesterol; Tg: triglyceride; Ldl-c: low-density lipoprotein; Hdl-c: high-density lipoprotein; Ai: atherogenic index; BDI: Beck Depression Inventory; At: aerobic training; Ct: combined training; Cg: control group; %: the deltas of change. * P value <0.05 compared with control group.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
6
E. Arslan et al.
group [3—5,7,25]. The present study also reported similar results to those of previous studies, but our study had a shorter time (8-weeks) training session. The explanation for these findings is that regular physical activity provides active energy expenditure, resulting in higher energy expenditure and calorie consumption than a sedentary life style. Moreover, the effect of combined training, including aerobic and strength exercises, increases the activity of aerobic enzymes, and mitochondrial and capillary densities in the muscles and motor units during the exercises sessions [8,12]. Guiraudou et al. [26] described as reprogramming of the function of the sedentary muscle and this may not leading to higher spontaneous activity in addition to the protocol, but also changing in eating behavior. Body composition and distribution of the fat tissue have changed over the years [27]. Therefore, the determination of the body composition is an important factor which should not be disregarded, and it may help medical knowledge about premenopausal sedentary women. Waist circumference is the predictor of visceral fat located in the abdominal region [28]. Its measurement is an easy, low-cost and very important in the population-based studies [29] and it has high correlation with the majority of metabolic risk factors [29,30]. In present study, aerobic and combined training group showed significant differences in waist, hip and abdominal circumferences (the largest reductions were in the combined training group) compared to control group. These results are similar to those reported by previous studies of the effects of different training programs [4,31]. It can be inferred that strength training has the effects of tightening the waist region and reducing fat mass. Considering the lipid profile, the experimental groups showed significant changes in total cholesterol, triglyceride and atherogenic index values compared to the control group. Some similar previous studies [3,5,9,31,32] reported that blood lipid profiles (especially cholesterol, triglyceride, high and low density lipoprotein) were decreased in aerobic or combined training sessions in sedentary females. A low level of Hdl cholesterol is a powerful predictor of increased cardiovascular risk factor. However, it is not clear that this association exists for low levels of low-density lipoprotein cholesterol [33]. It is generally known that regular exercise can lead to preferential fat, including visceral fat reduction (even in the absence of weight loss). Aerobic exercise increases hormone-stimulated adipose lipolysis and subsequent circulating fatty acid availability, which when combined the sustained increase in the metabolic rate, resulting in increased uptake and oxidation of fatty acids in a working muscle [34]. This highlights the fact that this mechanism may be the reason for the difference in blood lipid profiles between the experimental groups (aerobic and combined) and the control group (Fig. 1). Beside reducing total body fat and fat percentage, exercise has positive effects on psychological behavior and can help to improve of general mood [35,11]. Some studies have found that physical activity is associated with fewer depressive symptoms than physical inactivity [36]. Geliebter et al. [37] observed that even though subjects who performed aerobic training with diet, or resistance training with diet, did not lose any more weight than only diet group, the participants in both exercise groups showed considerable improvement in their mood. In another study analyzing the
Figure 1 Distribution of the weight loss of the participants according to groups.
effects of aerobic and resistance exercise on depression, it was observed that only the aerobic exercise group showed significant improvement in depressive symptoms [38]. Our study results demonstrate that both the aerobic training and combined training groups showed significant changes in their BDI scores compared to the control group. However, aerobic training resulted in greater reduction in the BDI scores of the middle-aged premenopausal sedentary women. Improvements in mood states and reductions in anxiety and depressive symptoms after exercise are explained by changes in endorphin and monoamine levels, and are associated with a reduction in urine cortisol and epinephrine excretions [6,39]. There are limitations that need to be acknowledged and addressed regarding the present study. One limitation of this study is that the determination of the aerobic training intensity using maximum heart rate (HRmax ) as identified by the calculation 220 − age is an easy and widely using method in the population-based studies. It may be influenced by physical and environmental conditions, but we used temperature controlled private room (participants are accustomed to the these conditions) to avoid the negative influence on the study results that participants are accustomed to the these conditions. Another important limitation of this study is that there was a lack of dietary intake control, which may be variable affecting body composition and blood lipid profiles in this type of research. Further research is needed to investigate the effect of different training models on body composition, blood lipid profiles and psychological health to explain factors affecting different age groups of women. In summary, our hypothesis was that combined exercise training would be more effective than aerobic training at changing body composition, lipid profiles and depressive symptom of premenopausal sedentary women after 8-weeks of training. The results of this study supported our hypothesis and they also demonstrate that both aerobic training and combined training are effective at reducing body fat percentage and fat mass, total cholesterol, triglyceride, the atherogenic index, and depressive symptoms. Moreover, only combined training was effective at reducing the waist circumference of middle-aged premenopausal sedentary women. The results of this study both training methods could be used for loosing body weight, fat mass and fat percentage for middle-aged women. Although the combined training seems a little more efficient, aerobic training is
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
Training program on body composition and psychological health in premenopausal women also practically easier in order to control and maintain in a large scale training groups. Although many studies have been conducted to find the most effective model of training for older and postmenopausal women, these studies generally prescribed 12-weeks or more of training and did not examine the 8-week training effect on body composition, lipid profiles and psychological health of premenopausal women. Therefore, further studies are needed in order to gain more information about the actual effects of the different training programs in a short time.
Disclosure of interest
[11]
[12]
[13]
[14]
The authors declare that they have no competing interest.
References [1] Bouchard DR, Soucy L, Senechal M, Dionne IJ, Brochu M. Impact of resistance training with or without caloric restriction on physical capacity in obese older women. Menopause 2009;16:66—72, http://dx.doi.org/10.1097/gme.0b013e31817dacf7. [2] Diniz TA, Fortaleza ACS, Rossi FE, Neves LM, Campos EZ, Junior IF. Short-term program of aerobic training prescribed using critical velocity is effective to improve metabolic profile in postmenopausal women. Sci Sports 2016;31:95—102, http://dx.doi.org/10.1016/j.scispo.2015.03.006. [3] Rossi FE, Fortaleza AC, Neves LM, Buonani C, Picolo MR, Diniz TA, et al. Combined training (aerobic plus strength) potentiates a reduction in body fat but demonstrates no difference on the lipid profile in postmenopausal women when compared with aerobic training with a similar training load. J Strength Cond Res 2016;30:226—34, http://dx.doi.org/10.1519/JSC.0000000000001020. ¸a RMSC, Júnior Araujo AT, Sousa MSC, Fernan[4] Mendonc des HM. The effects of different exercise programmes on female body composition. J Hum Kinet 2014;43:67—78, http://dx.doi.org/10.2478/hukin-2014-0091. [5] Mohr M, Lindenskov A, Holm PM, Nielsen HP, Mortensen J, Weihe P, et al. Football training improves cardiovascular health profile in sedentary, premenopausal hypertensive women. Scand J Med Sci Sports 2014;24:36—42, http://dx.doi.org/10.1111/sms.12278. [6] Sarsan A, Ardic ¸ F, Özgen M, Topuz O, Sermez Y. The effects of aerobic and resistance exercises in obese women. Clin Rehabil 2006;20:773—82, http://dx.doi.org/10.1177/0269215506070795. [7] Sillanpaa E, Laaksonen DE, Hakkinen A, Karavirta L, Jensen B, Kraemer WJ, et al. Body composition, fitness, and metabolic health during strength and endurance training and their combination in middle-aged and older women. Eur J Appl Physiol 2009;106:285—96, http://dx.doi.org/10.1007/s00421-009-1013-x. [8] Chtara M, Chamari K, Chaouachi M, Chaouachi A, Koubaa D, Feki Y, et al. Effects of intra-session concurrent endurance and strength training sequence on aerobic performance and capacity. Br J Sports Med 2005;39:555—60, http://dx.doi.org/10.1136/bjsm.2004.015248. [9] Hallage T, Krause MP, Haile L, Miculis CP, Nagle EF, Reis RS, et al. The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res 2010;24:2261—6, http://dx.doi.org/10.1519/JSC.0b013e3181ddacc6. [10] Mastura J, Mohd Sofian OF, Bahaman AS, Salleh AR, Muhammad Nazrul S. Effect of low-impact aerobic dance exercise on psychological health (stress) among
[15]
[16]
[17]
[18] [19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
7
sedentary women in Malaysia. Biol Sport 2012;29:63—9, http://dx.doi.org/10.5604/20831862.984944. De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med 2006;42:273—9, http://dx.doi.org/10.1016/j.ypmed.2005.12.002. Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training on older adults. Sports Med 2004;34:329—48, http://dx.doi.org/10.2165/00007256-200434050-00005. Bemben DA, Bemben MG. Dose—response effect of 40 weeks of resistance training on bone mineral density in older adults. Osteoporos Int 2011;22:179—86, http://dx.doi.org/10.1007/s00198-010-1182-9. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J 2004;4:106—15, http://dx.doi.org/10.1016/S1529-9430(03)00174-8. Rech CR, Petroski EL, Silva RCRD, Silva JCND. Anthropometric indicators of fat mass excess among Rev Bras Med Esporte 2006;12:119—24, women. http://dx.doi.org/10.1590/S1517-86922006000300002. World Health Organization. Obesity: prevention and managing the global epidemic: report of a WHO consultation. WHO technical report series 894; 2000. Drust B, Waterhouse J, Atkinson G, Edwards B, Reilly T. Circadian rhythms in sports performance — an update. Chronobiol Int 2005;22:21—44, http://dx.doi.org/10.1081/CBI-200041039. Jackson AS, Pollock ML. Practical assessment of bodycomposition. Phys Sports Med 1985;13:76. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988;8:77. Robergs RA, Landwehr R. The surprising history of the ‘‘HRmax = 220 − age’’ equation. J Exerc Physiol 2002;5: 1—10. Thompson PD, Arena R, Riebe D, Pescatello LS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription. Curr Sports Med Rep 2013;12:215—7. Hopkins WG. Linear models and effect magnitudes for research, clinical and practical applications. Sportscience 2010;14:49—57. Church T. Exercise in obesity, metabolic syndrome, and diabetes. Prog Cardiovasc Dis 2011;53:412—8, http://dx.doi.org/10.1016/j.pcad.2011.03.013. Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. J Obes 2011:1—9, http://dx.doi.org/10.1155/2011/482564. Bravo MF, Paredes FZ, Rodriguez FJR, Montero CC. Occupational physical activity and body composition in adult women: pilot study. Nutr Hosp 2013;28:1060—4, http://dx.doi.org/10.3305/nh.2013.28.4.6552. Guiraudou M, Romain AJ, Mawunu M, Bedjih K, Fedou C, Brun JF. Chronic effects of exercise targeted at the level of maximal lipid oxidation (LIPOXmax) on eating behavior in sedentary obese subjects. Sci Sports 2016;31:13—8, http://dx.doi.org/10.1016/j.scispo.2015.09.001. Colado JC, Triplett NT. Effects of a short-term resistance program using elastic bands versus weight machines for sedentary middle-aged women. J Strength Cond Res 2008;22:1441—8, http://dx.doi.org/10.1519/JSC.0b013e31817ae67a. Keating SE, Machan EA, O’Connor HT, Gerofi JA, Sainsbury A, Caterson ID, et al. Continuous exercise but not high intensity interval training improves fat distribution in overweight adults. J Obes 2014:1—12, http://dx.doi.org/10.1155/2014/834865. Olinto MTA, Nacul LC, Gigante DP, Costa JSD, Menezes AMB, Macedo S. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004
+Model SCISPO-3066; No. of Pages 8
ARTICLE IN PRESS
8
E. Arslan et al.
[30]
[31]
[32]
[33]
[34]
[35]
population-based study. Public Health Nutr 2004;7:629—35, http://dx.doi.org/10.1079/PHN2003582. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments association with metabolic risk factors in the Framingham Heart Study. Circulation 2007;11:39—48, http://dx.doi.org/10.1161/CIRCULATIONAHA.106.675355. Kerksick C, Thomas A, Campbell B, Taylor L, Wilborn C, Marcello B, et al. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women. Nutr Metab 2009;23:1—17, http://dx.doi.org/10.1186/1743-7075-6-23. Ha CH, Swearingin B, Jeon YK, Lee M. Effects of combined exercise on HOMA-IR, HOMA -cell and atherogenic index in Korean obese female. Sport Sci Health 2015;11:49—55, http://dx.doi.org/10.1007/s11332-014-0208-7. Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007;357:1301—10, http://dx.doi.org/10.1056/NEJMoa064278. Burguera B, Proctor D, Dietz N, Guo Z, Joyner M, Jensen MD. Leg free fatty acid kinetics during exercise in men and women. Am J Physiol Endocrinol Metab 2000;278:113—7. Byrne A, Byrne DG. The effect of exercise on depression, anxiety and other mood states:
[36]
[37]
[38]
[39]
a review. J Psychosom Res 1993;37:565—74, http://dx.doi.org/10.1016/0022-3999(93)90050-P. Azar D, Ball K, Salmon J, Cleland V. The association between physical activity and depressive symptoms in young women: a review. Ment Health Phys Activ 2008;1:82—8, http://dx.doi.org/10.1016/j.mhpa.2008.09.004. Geliebter A, Maher MM, Gerace L, Gutin B, Heymsfield SB, Hashim SA. Effects of strength or aerobic training on body composition, resting metabolic rate, and peak oxygen consumption in obese dieting subjects. Am J Clin Nutr 1997;66:557—63. Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, et al. Exercise and depressive symptoms a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B: Psychol Sci Soc Sci 2002;57:124—32, http://dx.doi.org/10.1093/geronb/57.2.P124. Nabkasorn C, Miyai N, Sootmongkol A, Junprasert S, Yamamoto H, Arita M, et al. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. Eur J Public Health 2006;16:179—84, http://dx.doi.org/10.1093/eurpub/cki159.
Please cite this article in press as: Arslan E, et al. Effect of short-term aerobic and combined training program on body composition, lipids profile and psychological health in premenopausal women. Sci sports (2017), http://dx.doi.org/10.1016/j.scispo.2016.11.004