Long-term Effects of Exercise on High-density Lipoprotein Cholesterol Levels.

Pauline Renfroe, Rogelio Aguirre, Chris Grant, Benjamin Eaton, Tom Yamaguchi

High Density Lipoprotein Cholesterol● High-density lipoprotein is

one of the five major groups of lipoproteins.

● Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules around the body within the water outside cells.

Role of HDL Cholesterol - “The Good Guy”

Decreasing Risks

At risk Desirable

Men Less than 40 mg/dL (1.0 mmol/L)

60 mg/dL (1.6 mmol/L) or above

women Less than 50 mg/dL (1.3 mmol/L)

60 mg/dL (1.6 mmol/L) or above

The Framingham Heart Study concluded that for every 1 mg/dL rise in HDL-C levels, there was a 3% reduction in cardiovascular risk.

Resistance Training

HDL-C (mmol/l)TrainingBefore 77 mg/dlAfter 77.7 mg/dl

Change0.7 mg/dl1.0%

PopulationSedentary postmenopausal womenage 53-58

Routine8 weeks3 days a week

3 sets of 8 at 80% of 10 rep max

80% of 10 rep max = to 60% of 1 rep max

lat pull down, bench press, leg press, and knee extension.

Study from K J Elliot

Resistance TrainingStudy by E. Morencos

Population Healthy middle aged men and women(18-50)BMI 25-29.9

Study Design

24 Weeks3 days a week

-intensity increased at week 6 from 50% of 15rm to 60% 15rm

-Duration increased at week 15 from 51 min to 64 min.

HDL-C (mg/dl)

MenBefore41.9 + 7.8

After45 + 9.3

change3.1 mg/dl7.4%

WomenBefore59 + 9.6

After59.5 + 12.2

Change0.5 mg/dl0.8%Cardiovascular Risk lowered

9.3% 1.5%

shoulder press, squat, barbell row, lateral split, bench press, front

split, biceps curl, and French press for triceps

Resistance TrainingStudy by Tseng

Population

Sedentary males 18-29BMI > 27

Study12 weeks5 days a week

Weeks 1-4:60 min/day, at 50–60% of 1-repetition maximum (1-RM) for three sets (12–15 repetitions)

Weeks 5-8:60–70% of 1-RM for three sets (10–12 repetitions)

Weeks 9-12: 70–80% of 1-RM for three sets (8–10 repetitions)

military press, leg extension, leg curl, chest press, biceps curl, arm flexion, arm extension, abdominal crunch, twisting oblique, and plantar/dorsiflexion

HDL-C (mg/dl)

Before55.1 + 3.3

After57.9 + 3.3

Change2.8 mg/dl5.6%

Cardiovascular Risk lowered8.4%

Resistance and Aerobic Training

Study by E. Morencos

Same Resistance training

Aerobic trainingintensity increased at week 6 from 50% of HRR to 60% HRR

-Durration increased at week 15 from 51 min to 64 min.

HDL-C (mg/dl)

Men Before47.1 + 7.6After51.1 + 6.7

change4 mg/dl8.5%

WomenBefore62.3 + 8.5After57.4 + 8.9

change-4.9 mg/dl-7.9%

Study by Tseng

Same Resistance Training

Aerobic Training60 min/day, 5 days/week, from 15 min/session at 50–60% of maximal heart rate (HRmax) to 45 min/session at 60–70% of HRmax during Weeks 1–12

HDL-C mg/dl

Before50.1 + 2.4

After55.1 + 2.5

Change5 mg/dl10%

Cardiovascular Risk lowered15%

Cardiovascular Risk lowered12% -14.7%

Mode of Aerobic ExerciseEffects of 4 different exercises on HDL-C levels; M.A. Ferguson et al.

- 11 active men 20-21 years of age.

- 4 separate submaxtreadmill sessions at 800,1,100, 1,300, and 1,500kcals expended at 70% VO2 max.

- Results: An acuteimprovement in HDL-Clevels are seen in sessionsthat expend 1,100 kcal or more. 15-28% improvementin HDL-C levels.

Mode of Aerobic Exercise- An additional cross sectional analysis by Durstine et al. indicates that exercises that

exhibit expenditures of 1200 -2200 kcal/week is associated with 2 to 3 mg/dl increase in HDL-C levels.

- According to Stein et al. acute changes in HDl-C levels can be maintained long term if exercise prescription that caused the acute change is continued 4-5 times a week for 10-14 weeks depending on the individual.

Mode of Aerobic ExerciseContinuous vs. intermittent exercise Hernandez Torres et al.- Continuous defined as constant speed 90 min at 5.8 mph. -Intermittent defined as alternating low and high speed , 22 reps. 4.5 mph for 3 min and 11mph for 1 min. - 15 healthy male long distance runners- Results: HDL-C at the end of IE was 12.6% higher than pre-exercise values. Increase in HDL-C post CE did not reach significance (p=0.052).

Mode of Aerobic ExerciseWalk Run vs. Step Aerobics , Esin Gullu et al.- 10 week study with 30 sedentary

women ages 35-40.

- 2 groups (run walk and step aerobics).Exercised at 75% max HR. Results:

- In the run walk group there was no change in HDL-C levels only a decrease in LDL levels.

- In the step aerobics group there was an increase in HDL-C levels in addition to lowered LDL levels.

Mode of Aerobic ExerciseInterval training vs. Continuous exercise : Adrian Elliot et al. -Interval: brief (1-4 min) intermittenthigh intensity > 85% HR max.- Continuous: moderate intensity30 min < 80% HR max.

-Results: minimal overall differencebetween interval and continuous when it came to HDL-C (p=0.063). Length and intensity seemed to have the greatest effect on HDL-Clevels.

Duration Aerobic Exercise (Session)El-Sayed’s study

-18 normal men divided to high (80% VO2max) and low (30% VO2max) intensity groups-Duration… 20 minutes/session for 12 weeks -Frequency...3 times per week-Exercise ...bicycle ergometer Result No significant changes in HDL-C level

Duration of Aerobic Exercise(Session)

Duration of each session ● Richard A. Stein’s study 49 healthy, sedentary men Age 44±8

(4 groups w/ different intensities, 30 minutes/session, 3 time/weeks, 12 weeks)

Exercise-Cycle ergometer Pre Post 65% 47.0±0.3 45.7±375% 35.8±2 42.6±385% 42±3 47.6±4

Duration of Aerobic Exercise(Session) Kenneth R. Wilund study Study DesignSubjects Healthy sedentary 17 men &22 women(Ave age 57) -Duration -Frequency 3 times per week 40 minutes/session, 6 months -Intensity 70% MHR-Exercise: Ergometer, treadmill walking, ski-Result 7% increased in HDL-C level.

Duration of Aerobic Exercise(Session) Barbara J. Nicklas46 sedentary men (age 46-72) divided into 3 groups based on BMI1, Normal (BMI 22-26)2, Overweight (BMI 27-30)3, Obese (BMI 31-37) -Duration...60 minutes/ session for 9 months -Frequency...3 times per week-Intensity...70-80% HRR -Exercise...Treadmill walking; ski machine Result

Duration of Aerobic Exercise(Session)

-Lean (mg/dl)Pre Post Change 35.96+3.8 40.99+6.9 3.86+3.5

-Moderately obese (mg/dl)Pre Post Change32.87+6.2 35.14+6.9 2.32+3.1

-Obese (mg/dl)Pre Post Change30.12 +5.0 30.88+5.0 0.39+2.7

Duration of Aerobic Exercise(Session)

Richard A. Stein’s study Kenneth R. Wilund study Barbara J. Nicklas Duration 30 minutes/session Duration 40 minutes/session Duration 60 minutes/ session75% 35.8±2 42.6±3 (18%) Intensity 70% MHR 40.9±1.9 43.9±1.9(7%) Intensity 70-80% 85% 42±3 47.6±4 (13%) -Lean (mg/dl) Pre Post Change 35.96+3.8 40.99+6.9 3.86+3.5(13%)

-Moderately obese (mg/dl) Pre Post Change 32.87+6.2 35.14+6.9 2.32+3.1(7%)

-Obese (mg/dl) Pre Post Change 30.12 +5.0 30.88+5.0 0.39+2.7(2%)

Duration (Whole program) James G. Warner Jr’s study to -Subjects533 men (Age 58.9±10.6)& 166 women (Age 57.2)-Intensity70-85% maximum heart rate -Duration and frequency of exercise program 3 days/ week for 5 years -Duration of each exercise 30 to 40 minutes of walking, jogging, or riding a stationary bicycle.

Duration (Whole program) 1st year: Men-10%, Women-7%Overall 5 years: Men-5%, Women 20%

Intensity of Aerobic Exercise-Glen E. Duncan 20034 different modalities of aerobic endurance training (walking/running)

High intensity & high frequencyHigh intensity & low frequency Charles Couillard 2001Moderate intensity & high frequencyModerate intensity & low frequency, and a physician advice group that received current ACSM

recommendation on physical activity(“moderate intensity” 45%-55% HR reserve vs “hard intensity” 65%-75% HR reserve and “low

frequency” 3-4 days/week vs “high frequency” 5-7 days/week)Participants were 492 healthy but sedentary women (n=315) and men (n=177) (1 h/wk of ModI or

greater leisure time physical activity during the prior year) ages 30-60 years old.

results ModI prescriptions adherence rates were significantly greater than HardI prescriptions (65.8% vs 57.8%) no significant difference between low and high frequency. The metabolic equivalent hours per week of exercise by condition were 6.77±1.76 for HardI-HiF 5.02±1.09 for ModI-HiF 4.00±0.92 for HardILowF, 3.64±0.81 for ModI-LowF.changes in HDL-C level depends on the intensity,frequency, and volume of exercise and on the individual’sbaseline level.

intensity STEPHEN F. CROUSE 1997Twenty-six hypercholesterolemic men (mean cholesterol, 258 mg/dl; (134 -190 LDL and HDL of 35-56mg/dl age, 47 yr; weight, 81.9 kg) BMI 25-35 completed 24 wk of cycle ergometer training 3 days/wk, 350 kcal/session High Intensity (n12) 80% of maximal O2 uptake Moderate Intensity (n14) 50% of maximal O2 uptake, results

Volume vs Intensity WILLIAM E. KRAUS November 2002111 participants (only 84 finished the study) sedentary men and women were overweight or mildly obese BMI 25-35 subjects were ask to maintain body weight Data were excluded from the primary analysis for subjects whose weight varied by more than 5 percent from baseline to the end, participants had cholesterol levels of either an LDL cholesterol concentration of 130 to 190 mg per deciliter [3.4 to 4.9 mmol per liter] or an HDL cholesterol concentration below 40 mg per deciliter [1.0 mmol per liter] for men or below 45 mg per decilithigh-amount–high-intensity exercise (23 kcal per kilogram of body weight per week)caloric equivalent of jogging 20 mi per week at 65 to 80 percent of peak oxygen consumptionlow-amount–high-intensity exercise (14 kcal per kilogram per week.)equivalent of jogging 12 mi per week at 65 to 80 percent of peak oxygen consumptionlow amount–moderate-intensity exercise (14 kcal per kilogram per week)equivalent of walking 12 mi per week at 40 to 55 percent of peak oxygen consumption.

results HDL changes in mg/dl from baselinebaseline end of study 44.3±2.9 48.6±3.3 High amount & intensity46.6±3.7 46.9±3.4 Low-amount Hi-intensity40.3±2.2 41.0±2.6 Low amount & intensity42.7±2.7 42.1±2.2 Control Conclusion Intensity of exercise was less important, at leastin the case of the lower amount of exercise studied,than the amount of exercise in terms of lipoproteinresponses.

other studies Cris A. Slentz 2007high-amount/vigorous-intensity exercise, the caloric equivalentof 20 miles of jogging per week for a 90-kg person at 65–80%peak oxygen consumption (V˙ O2); 2) low-amount/vigorous-intensity exercise, the caloric equivalent of 12 miles of jogging per week at 65–80% peak V˙ O2; and 3) low-amount/moderate-intensity exercise, the caloric equivalent of 12 miles of walking per week at 40–55% peak V˙ O2.

low intensity Yoshiyuki Sunarni40 healthy elderly Japanese subjects (20 men and 20 women) participated in the study, age was 67 years training vs control group The exercise intensity for each subject in the training group was set at 50% Vo2max from the estimated ~O2 max. Subjects in the traininggroup exercised for 60 min/d two to four times per week for 5 months on the electric bicycle ergometer

References: 1. Hernández-Torres, R.p., A. Ramos-Jiménez, P.v. Torres-Durán, J. Romero-Gonzalez, D. Mascher,

C. Posadas-Romero, and M.a. Juárez-Oropeza. "Effects of Single Sessions of Low-intensity Continuous and Moderate-intensity Intermittent Exercise on Blood Lipids in the Same Endurance Runners." Journal of Science and Medicine in Sport (2007): 323-31. Print.

2. Elliott, Adrian D., Kanchani Rajopadhyaya, David J. Bentley, John F. Beltrame, and Edoardo C. Aromataris. "Interval Training Versus Continuous Exercise in Patients with Coronary Artery Disease: A Meta-Analysis." Heart, Lung and Circulation (2014): 149-57. Print.