Resistance training needs not strictly be the domain of athletes, body builders, and gym fanatics. Unfortunately, too many people still view resistance training as a hyperstrenuous activity performed only to “bulk up” for sport performance or vanity. Subsequently, resistance training can be intimidating to many, particularly those who could benefit the most (22). In reality, many individuals with disease, after clearance by a physician, could benefit by including resistance training as one component of a healthy lifestyle (23). Health and wellness educators need to educate the public about resistance training as a tool for the management of disease or disability and seek out ways to involve individuals who suffer the debilitating effects of hypokinetic diseases — those diseases associated with a sedentary lifestyle.
Resistance training is a safe activity for most people, even for those with health conditions once thought to preclude such activities, and it may help ease or reverse some of the symptoms associated with various diseases and disabilities. Resistance training can improve the quality of life in two ways: improved overall health and management of current disease symptoms. First, a person with a disease or disability will benefit from resistance training just as an otherwise healthy individual would. Even if one’s current health problems are not obviously related to a sedentary lifestyle, the following resistance training outcomes are almost certain to improve the quality of life and prevent additional disease or disability problems: improved functional abilities, reduced incidence of back pain, enhanced insulin sensitivity, decreased body fat, and increased muscle mass (25). Many health conditions are compounded by weight gain and depression, and thus a downward spiral begins (Figure 1). Second, in some instances, resistance training may affect the severity of a given disease or disability directly, much like medication without any negative side effects. Many of the most prevalent and costly health problems affecting society have been shown to be managed, at least to some degree, through anaerobic activities like resistance training (1,13,16). Resistance training can be valuable to many people, but the benefits must be shared clearly in a manner that relates to the body of literature while still being understandable to the general public. Because most of the studies referenced report on low- to moderate-intensity resistance training, the Table is intended to provide a general idea of what those terms mean in practice.
Although once thought too dangerous for patients recovering from cardiovascular disease (CVD), resistance training has been found more recently to be helpful in the recovery process. Although not studied as thoroughly as aerobic activities, resistance training can be safe for many cardiac patients. After a review of the research, Janssen (12) concluded that moderate resistance training (2 to 3 times per week with 8 to 10 exercises while performing 10 to 15 repetitions) is safe and effective for most patients. Consequently, resistance training exercises are now commonplace in cardiac rehabilitation settings. Low- to moderate-intensity resistance training has the potential to help those currently fighting CVD by improving functionality and psychological state and by reducing body fat percentage and blood pressure (24). Although research protocols varied, most of the studies referenced here generally defined low-intensity resistance training as that which used 40% to 50% of a one repetition max (1RM) or that which could be performed for at least 15 repetitions. For those with other health conditions that are risk factors for CVD such as hypertension and obesity, resistance training may offer some level of protection from developing CVD. In one large-scale study, a 23% reduction in CVD was reported for men who participated in resistance training exercises for a minimum of 30 minutes per week (23).
Hypertension, more commonly referred to as high blood pressure, affects about one in every three adults (8). Resistance training programs ranging from 6 to 30 weeks have been found sufficient for lowering blood pressure significantly in patients diagnosed as having hypertension (14). As is the case with CVD, only moderate-intensity training programs were required for beneficial results (12). When reviewing a number of studies on hypertension and exercise, Hagberg et al. (9) found that 75% of the subjects were able to lower blood pressure through exercise. Many of the studies reviewed consisted of weight training alone or weight training in combination with aerobic training. In a published ACSM Position Stand, on examination of 12 research articles including 1 meta-analysis containing more than 320 subjects, the authors concluded that the findings regarding the effects of resistance training on hypertension were “conflicting” (20). In particular, the referenced meta-analysis indicated that the modest positive changes in both systolic blood pressure and diastolic blood pressure were statistically significant but of questionable importance in a clinical setting (15). Nonetheless, the ACSM Position Statement includes this evidence statement, “Resistance training performed according to ACSM guidelines reduces BP in normotensive and hypertensive adults” (20). Even though more rigorous research certainly is needed on the matter, resistance training seems to have potential for helping people of all ages, ethnicities, and genders lower blood pressure.
TYPE 2 DIABETES
Sometimes referred to as adult-onset diabetes, type 2 diabetes mellitus is a chronic metabolic disorder. The United States and other developed countries have seen an epidemic rise in the prevalence of type 2 diabetes (18). The results from a variety of research studies (5,18) indicate that maintaining moderate levels of physical activity is one important behavior for regulating this disorder. Although most forms of physical activity have been shown to be beneficial, resistance training, specifically, can produce improved health outcomes. Noting that excessive weight is a risk factor for type 2 diabetes, experts examining the evidence concluded that resistance training has been shown to decrease weight and simultaneously increasing insulin sensitivity in subjects diagnosed as having the disorder (17). Church et al. (4) found that a combination of moderate levels of aerobic and anaerobic exercise would reduce waist circumference and lower glycosylated hemoglobin levels, indicating better control of blood glucose levels. In addition to the aerobic training, the participants engaged in 2 days a week of resistance training that included 1 set of each of the 9 basic exercises with a weight they were able to lift 10 to 12 times. Because muscle can account for more than 80% of the disposal of oral glucose, a weight loss strategy that includes the development of muscle mass should be preferred to one that is only aimed at losing fat (10).
MENTAL HEALTH DISORDERS
Sadly, when considering health and wellness, those suffering from mental disorders are often forgotten. The benefits of physical activity also are missing often from discussions of health-enhancing behaviors. On review of the literature, Buckworth and Dishman (3) found strong support for the use of exercise to combat anxiety and depression. In particular, a meta-analysis showed strong support for the efficacy of exercise, both aerobic and anaerobic, in reducing state anxiety (2). Still another in-depth meta-analysis reviewed multiple studies reporting mood enhancement through exercise, leading to improvement in a variety of states including tension, anger, and depression (21). Subjects in anaerobic activity interventions have reported less anxiety and depression (3). At the very least, the mental diversion associated with the act of exercising is often responsible for improvements in mental states. No form of exercise has been shown to treat severe cases of anxiety or depression effectively but, similar to meditation and relaxation techniques, resistance training has been shown to aid effectively in managing mild cases (19). In general, resistance training improves the quality of life in many ways. It has been associated with higher levels of self-confidence, which most will attest can help one function better in many facets of life. By enhancing the overall quality of life, resistance training potentially can improve one’s mental state. In addition, research findings suggest that physical activity, including anaerobic physical activity, results in physiological responses that affect brain function. Very specific biological processes occur, such as the production of endorphins, increased blood flow to the brain, and the production of proteins essential for growth and maintenance of healthy brain cells (6).
BONE AND JOINT DISORDERS
Bone and joint disorders are not as likely to lead to death as heart disease or vascular disease or even diabetes, but a great number of people still suffer from these disorders. Common sense dictates that the pain from bone and joint disorders decreases physical activity levels, which increases the risk for heart disease, diabetes, and other diseases. Musculoskeletal disorders, such as arthritis and back pain, cause more cases of physical disability in the United States than any other single disorder (1). It may seem counterintuitive to suggest that contracting muscles, to apply resistance against weights or gravity or even elastic bands, could be “good” for hurting joints. However, when thoughtfully and carefully done, resistance training seems to offer some benefit for the afflicted (7). On examination of the literature, McCartney and Phillips (17) concluded that resistance training is an “effective therapeutic instrument” for managing pain and discomfort associated with arthritis and osteoporosis. Resistance training has been demonstrated to reduce pain and delay disability related to a variety of bone and joint disorders. The benefits may be derived in part from the psychological boost that comes from exercise. Other, perhaps more important mechanisms are the body’s ability to better disperse stress because of more muscle mass and to better lubricate joints because of movements that improve the range of motion (11).
With few exceptions, almost anyone can derive some benefit from including resistance training as a component of an active lifestyle, including individuals afflicted with some of the most common diseases and disorders. Such health problems have been referred to as lifestyle diseases because a sedentary lifestyle and poor diet are contributing factors. An understanding of the role that physical inactivity plays in the development of many debilitating conditions can be empowering because it alerts individuals to the fact that they have the ability to improve their health by becoming more physically active (Figure 2). In particular, resistance training is one form of physical activity that is particularly valuable in managing complications of some of the diseases and disorders that affect a large portion of our population. Potentially, all of the health conditions discussed here can be affected positively by regular moderate resistance training. In the words of McCartney and Phillips (17):
Beyond the obvious important role that skeletal muscle plays in locomotion, it is also a critically important tissue in maintaining health. Skeletal muscle is active tissue… one can easily appreciate how important it is to maintain a large and metabolically active skeletal muscle mass. Doing so likely decreases the risk for numerous health problems, including obesity, diabetes, and frailty in the elderly (p. 263).
Everyone responsible for training and educating others about health and wellness should make a concerted effort to include the people who are especially high risk for developing debilitating conditions safely. Regular resistance training can be an extremely effective tool to a healthier, more fulfilled life.
Ideally, the information presented is compelling enough to convince professionals as well as the general public that resistance training can be safe and effective for individuals with some of the more common disease states. The goal here is not to provide a specific exercise prescription; however, that may in fact be the next step. In training an individual or group, one certainly would want to follow best practices in exercise prescription, including obtaining clearance from a physician. In addition, a complete exercise program most certainly would include additional components such as aerobic conditioning, flexibility exercises, and diet. Thus, for those choosing to focus on a specific individual or disease state, there are many great resources where position statements and guidelines can be found such as The American College of Sports Medicine, The American Diabetes Association, the American Heart Association, the American Psychiatric Association, and the Arthritis Foundation.
BRIDGING THE GAP
Resistance training can be helpful for individuals with a variety of lifestyle diseases. The latest research indicates that mild to moderate resistance training can help alleviate many of the physical ailments related to cardiovascular disease, hypertension, type 2 diabetes, bone and joint disorders, and mild anxiety and depression. In simple terms, individuals with such diseases should be encouraged to include resistance training as part of a strategy to reduce body fat, improve psychological mood, lower blood pressure, and strengthen joints.
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