acceleration training for improvingphysical fitness

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Please cite this article in press as: So R, et al. Acceleration training for improving physical fitness and weight lossin obese women. Obes Res Clin Pract (2013), http://dx.doi.org/10.1016/j.orcp.2013.03.002

ARTICLE IN PRESSORCP-307; No. of Pages11

Obesity Research & Clinical Practice (2013) xxx, xxx.e1xxx.e11

ORIGINAL ARTICLE

Acceleration training for improving

physical fitness and weight loss in

obese women

Rina So a,b,, Miki Eto a, Takehiko Tsujimoto a, Kiyoji Tanaka a

a FacultyofHealth andSport Sciences, UniversityofTsukuba, 1-1-1 Tennodai,

Tsukuba, Ibaraki 305-8574,Japanb Japan Societyforthe Promotion ofScience, Tokyo, Japan

Received 24 September 2012; received in revised form 10 January 2013; accepted 12 March 2013

KEYWORDS

Acceleration training;

Physical fitness;

Visceral adipose tissue;

Obesity

Summary

Background: Reducing body weight and visceral adipose tissue (VAT) are the primarygoals for maintaining health in obese individuals as compared to those of normalweight, but it is also important to maintain physical fitness for a healthy life afterweight-loss. Acceleration training (AT) has recently been indicated as an alterna-tive to resistance training for elite athletes and also as a component of preventive

medicine. However, it is unclear whether combining AT with a weight-loss diet willimprove physical fitness in obese individuals. The present study aimed to deter-mine the synergistic effects of AT on body composition and physical fitness withweight-loss program in overweight and obese women.Methods: Twenty-eight obese, middle-aged women were divided into two groupsas follows: diet and aerobic exercise group (DA; BMI: 29.33.0 kg/m2); and diet,aerobic exercise and acceleration training group (DAA; BMI: 31.24.0 kg/m2). Bothgroups included a 12-week weight-loss program. Body composition, visceral adiposetissue (VAT) area and physical fitness (hand grip, side-to-side steps, single-leg bal-ance with eyes closed, sit-and-reach and maximal oxygen uptake) were measuredbefore and after the program.Result: Body weight, BMI, waist circumference and VAT area decreased significantlyin both groups. Hand grip (2.1 3.0 kg), single-leg balance (11.0 15.4 s) and sit-and-reach (6.54.8 cm) improved significantly only in the DAA group.

Corresponding author at: Graduate School of Comprehensive Human Science, University of Tsukuba, Address: 1-1-1 Tennodai,Tsukuba, 305-8577, Japan. Tel.: +81 29 853 2655; fax: +81 29 838 5883.

E-mail address: [email protected] (R. So).

1871-403X/$ see front matter 2013 Asian Oceanian Association for the Study ofObesity. Published by Elsevier Ltd. All rights reserved.

http://dx.doi.org/10.1016/j.orcp.2013.03.002
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ARTICLE IN PRESSORCP-307; No.of Pages11

xxx.e2 R. So et al.

Conclusions: Our findings indicate that combining AT with classical lifestyle mod-ifications is effective at reducing VAT, and it may enhance muscle strength andperformance in overweight and obese women. 2013 Asian Oceanian Association for the Study ofObesity. Published by Elsevier Ltd.All rights reserved.

Introduction

Obesity is closely associated with many majormetabolic diseases [1,2]. In particular, weight gain,which sometimes progresses to obesity, is a majorhealth concern for women at midlife, and numer-ous studies have pointed out that aging is associatedwith an increased accumulation ofvisceral adiposetissue (VAT) [3,4]. Dietary modification is generallymore effective for weight loss compared with exer-cise alone because it is an easier means ofinducinga marked energy deficit [57]. However, losing

weight through severe dietary restriction alone candramatically reduce muscle mass strength [8,9] andlead to a decline in physical fitness [10].

Some studies have shown that abdominally obeseand overweight people have lower maximal oxy-gen uptake than people ofnormal weight, and thatVAT accumulation is closely related to diminishedphysical fitness [11]. However, both cardiorespira-tory fitness and muscle strength serve as indicatorsof health status, especially for conditions suchas metabolic syndrome [12] and mortality [13].Thus, it is important that obese individuals maintaintheir physical fitness when losing weight. Resis-

tance training as part of an exercise program forincreasing muscle strength and preventing diseasehas been endorsed by the American College ofSports Medicine [14], the American Heart Asso-ciation [15] and the Japanese physical activityguideline [16]. However, obese individuals, withtheir excessive body weight and their typically poorposture, are more prone to injury [16] compared tonon-obese individuals [17]. To address this issue,we formulated a novel resistance-training methodfor obese individuals that preserves muscle strengthand reduces the chance ofinjury.

Increasing attention has been paid to acceler-ation training (AT) and its use as an alternativefor traditional strength training. Several stud-ies have shown that AT does not require heavydumbbells or a pulley system [17], it saves timeand it is a safe and effective intervention forincreasing muscle strength and functional capac-ity [1820]. As a result, although AT was initiallyused by elite athletes to improve their physicalfitness and performance, it is now seen as a ben-eficial training method for general exercise and

sports, and as a tool in rehabilitation and pre-ventive medicine. In sports, AT seems to improveflexibility, increase jumping height and increasemuscle strength. In preventive medicine, there isalready good evidence suggesting AT can improvebalance and muscle strength in the frail andelderly.

Our group also investigated the effects ofincor-porating AT into a daily lifestyle as a meansof decreasing arterial stiffness and consequentlyreducing the risk of cardiovascular disease andmuscle weakness in obese individuals [21]. Fur-thermore, Vissers et al. recently reported thatcombining AT with a weight-loss diet can helpachieve sustained long-term body weight loss of510% over 6 months [22]. They concluded thatAT has a greater potential than aerobic exerciseto reduce VAT in obese adults. Vissers study wasthe first clinical study to report the effect of ATon VAT, but it is unclear whether combining ATwith a weight-loss diet provides sufficient physicalstimulation for improving physical fitness, includ-ing muscle strength, agility, balance, flexibility andmaximal oxygen uptake in obese individuals.

Although the primary goal of a weight loss

program is to reduce weight and VAT, it is alsoimportant to maintain physical fitness for a healthylife after weight-loss. Therefore, the present studywas undertaken to examine whether adding ATtraining to a conventional weight-loss program canpromote additional weight-loss while improving ormaintaining components ofphysical fitness in over-weight and obese women.

Methods

Participants

We recruited 40 premenopausal, sedentary, over-weight and obese women in Japan through localnewspaper advertisements and study flyers, and32 met the following eligibility criteria: (1) aged3060 years, (2) BMI > 25 kg/m2 according to thedomestic obesity guideline [23], and (3) no his-tory ofmusculoskeletal disorders. In present study,we did not include a control group, because ofour subjects participated as volunteer intent on
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Effects ofacceleration training on obesity xxx.e3

improving their health. Therefore, maintaining acontrol group of obese subjects who would notbe able to participate in the program was notnecessary and likely not possible with these volun-teers. Instead, we maintained two groups with thesame lifestyle modifications but with or without AT.This would be a more realistic study design in the

field or when providing general health guidance.To increase adherence to the weight-loss program,personal lifestyle (e.g., occupation and daily sched-ule) was taken into account, and participants wereassigned to a diet with aerobic exercise (DA) group(n =12) or a diet with aerobic exercise and AT (DAA)group (n = 20). One participant in the DAA group wasunable to start the study due to a health problem,and two other participants in the DAA group failedto complete the program successfully for personalreasons. In addition, one participant withdrew dueto lack ofmotivation. Consequently, 12 participantsin the DA group and 16 in the DAA group were

included in the final analysis. All potential risks andprocedures ofthe study were fully explained to theparticipants before they provided written informedconsent to participate in the study. The study con-formed to the principles outlined in the Declarationof Helsinki. The ethical committee ofthe Universityof Tsukuba also reviewed and approved the studyprotocol.

Dietary modification

Both groups received the same dietary program,

which consisted of 90-min, group-based instruc-tional sessions performed weekly for 3 monthsand individual counseling by trained staff. Dietaryhabits were modified according to the Four-Food-Group Point Method [24]. We instructedparticipants to consume a well-balanced 1200-kcaldiet daily. Details ofthe program and methodologyhave been published previously [25].

Aerobic exercise training

Exercise training sessions were conducted nearour facility and supervised by exercise physiolo-gists. The exercise program consisted of a 60-min(DA group) or 30-min (DAA group) aerobic exer-cise session three times per week for 3 months.Aerobic exercise included brisk walking, mild jog-ging, and/or aerobic dancing. Each session waspreceded by 1520 min ofwarm-up activities, suchas stretching and calisthenics and was concludedwith 1520 min of cool-down activities. Exerciseintensity was based on maximum heart rate (HR)percentage measured by short-range telemetry(RS400, Polar, Kempele, Finland). Briefly, walking

intensity commenced at 45% maximum HR, and tar-get exercise intensity was 6580% ofage-predictedHR (220 minus age).

Acceleration training

The DAA group performed the AT session on

the same day as the aerobic exercise session.The DAA group performed upper and lower bodyexercises on the AT platform (Power Plate, Bad-hoevendorp, The Netherlands). Participants in theDAA group performed the AT training protocolfor 30 min 3 times per week with a gradualincrease in frequency (3035 Hz), execution ampli-tude (staticdynamic) and number of exercises(1224). Each interval of acceleration lasted 30 sand was followed by a 30-s rest. The meantotal exercise time per session increased steadily(7.7 min11.5 min13 min) according to the pro-gressive overload principle. A training session

typically included squats, wide-stance squats, deepsquats, lunges, push-ups, triceps dips, and frontplank. Trained staff supervised all training ses-sions to ensure correct execution. Briefly, in thefirst month the program consisted of static exer-cises (30 Hz), and in the second month, the trainingintensity increased by increasing the frequency ofthe acceleration to 35 Hz. In the last month, train-ing intensity increased by switching from static todynamic exercises.

Daily energy intake and expenditure

We assessed total energy intake (TEI; kcal) 2 weeksbefore and at the end of the program (week10) by reviewing 3-day weighed dietary recordsand through dietary recall interviews performedby a skilled interviewer. Participants were alsoinstructed to record their dietary information ontwo days during the week and on one weekendday or holiday. The food data gathered by thesemethods were converted to energy consumed bya registered dietician and analyzed using commer-cially available software (Excel Eiyoukun version4.0, Kenpakusya, Tokyo).

We also assessed total energy expenditure (TEE;kcal) with a validated uniaxial accelerometer(Lifecorder; Suzuken Co. Ltd., Nagoya, Japan). Theaccelerometer was firmly attached to the partic-ipants clothing (belt or waistband), and was tobe worn during all waking hours (except whilebathing). The recording started 2 weeks before the12-week program, to assess expenditure at base-line, and continued throughout the program. Theaccelerometer can determine the level of move-ment intensity every 4 s. It can assess two types


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xxx.e4 R. So et al.

of activity-related energy expenditure. The TEEcan then be calculated from the sum of the basalmetabolic rate, the diet-induced thermogenesisand the two types ofactivity-related energy expen-diture. Detailed descriptions of the accelerometerhave been published elsewhere [26]. Also, thephysical activity variables used in this study were

calculated on a daily basis and then used toestimate weekly activity by taking a weighted aver-age of daily weekday and weekend activity. Datafrom participants who had worn the accelerom-eter for at least 10 h per day for at least 4weekdays and 1 weekend day were consideredvalid.

Anthropometric measurements

All measurements were conducted in the sameorder at baseline and at week 12. Participants wereinstructed not to engage in vigorous physical activ-

ity or alcohol consumption within 24 h prior to themeasurements. Body weight was measured to thenearest 0.1 kg using a digital scale (TBF-551; Tanita,Tokyo, Japan), and height was measured once to thenearest 0.1 cm using a wall-mounted stadiometer(YG-200; Yagami, Nagoya, Japan) with the partic-ipants barefoot and in underwear in the morningafter fasting for at least 8 h. BMI was calculatedas weight (kilograms) divided by height (in meters)squared. Waist circumference (WC) was measuredto the nearest 0.1 cm at the level ofthe umbilicususing a flexible, retractable, fiberglass tape mea-

sure. WC measurements were taken in duplicate tothe nearest 0.1 cm, and the average value was usedfor analysis.

Body composition

We measured body composition by dual energy X-ray absorptiometry (DEXA, QDR 4500A, Hologic,CO) with manufacturer-supplied software (version1.35). Body composition was assumed to consist offat mass (FM) and fat free mass (FFM) as previouslydescribed [25]. A standard soft tissue examina-tion was performed and entailed total body andregional measurements of the trunk, arms andlegs to analyze body composition according to athree-compartment model including FM and FFM.Participants lay in the supine position with theirlegs closed and their arms at their sides during the15-min scan.

Abdominal adipose tissue by MRI

We performed magnetic resonance imaging(MRI) scans at baseline and repeated the same

measurements in the same order on completionof the program. We instructed participants not towear metal objects during the MRI measurementsand to refrain from eating or drinking for 2 hprior to the measurement. Abdominal multiple-slice MRI scans were performed using a 1.5-Tsystem (SIEMENS MAGNETON Avanto syngo MR

B15, Siemens, Erlangen, Germany) at the TsukubaMedical Center Hospital and conducted accordingto our previously described protocol [27]. We usedsingle-slice images at the L4-L5 level to assessVAT and subcutaneous adipose tissue (SAT) areas.The images were retrieved from the scanneraccording to a Digital Imaging and Communicationsin Medicine protocol. After image acquisition,the same experienced technician performed thesegmentation and quantification of SAT and VATusing image analysis software (SLICEOMATIC,Tomovision Inc., Montreal, Canada). The modeland method employed to segment the various

tissues is comprehensively presented elsewhere[28,29].

Physical fitness tests

Participants performed the following physical fit-ness tests as a measure of the respective healthcomponents: hand-grip (muscle strength), side-to-side step (agility), single-leg balance (balance),sit-and-reach test (flexibility) and maximal oxygenuptake (VO2 max) (cardiorespiratory fitness). Hand-

grip strength was assessed in both hands with ahand-dynamometer (TKK, Tokyo, Japan), and themean value of both hands was used for analy-sis. The side-to-side steps test was performed onthe floor and expressed as the number of stepscompleted in 20 s. In the single-leg balance test,participants closed their eyes and balanced onone leg with the opposite knee bent back andheld behind their buttocks with the hand on thatsame side. The sit-and-reach test assessed reach-ing distance (cm) while sitting on the floor withlegs stretched out straight ahead. The participantreached forward along the measuring line as far

as possible. VO2 max was determined by a gradedexercise test using a cycling ergometer (828E,Monark, Stockholm, Sweden). Following a 2-minwarm-up at 15 watts (W), the workload increased by15 W min1 until volitional exhaustion. During thetest, ventilation and expiratory gases were mea-sured using an indirect calorimeter (Oxycon Alpha,Mijnhardt, Breda, The Netherlands). The highestoxygen uptake achieved over 30 s was taken as theVO2 max and then analyzed in accordance with pub-lished criteria [30].


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Effects ofacceleration training on obesity xxx.e5

Biochemical analysis

Trained observers measured systolic and diastolicblood pressure using a standard mercury sphygmo-manometer on the right arm ofseated participants(cuff size: 14 cm47 cm) who had rested forat least 10 min. A blood sample of 10 mL was

drawn from each participant after an overnightfast of at least 8 h. Serum concentrations oftotal cholesterol and triglycerides were determinedenzymatically, and high-density lipoprotein choles-terol was measured by the heparin-manganeseprecipitation method. Serum concentration oflow-density lipoprotein (LDL) was estimated accordingto the method of Friedewald et al. [31]. Bloodplasma glucose and insulin concentrations wereassayed by a glucose oxidase method and radioim-munoassay, respectively. The glucose and insulinconcentrations were used to determine the homeo-stasis model assessment as an index of insulin

resistance (HOMA-IR) according to the equations ofMatthews et al. [32].

Statistical analyses

We used the statistical package SPSS version 13.0for Windows (SPSS, Chicago, IL) to perform statisti-cal calculations. Data are expressed as mean SD.We used a paired-sample t-test to analyze changeswithin groups and a two-way repeated measuresANOVA with time by intervention interaction toanalyze differences in daily energy intake and

expenditure, weight, BMI, body composition, phys-ical fitness and biochemical parameters betweengroups. We also calculated effect sizes with theG*Power 3 analysis program [33]. A scale for effectsizes has been suggested by Cohen [34], with >0.8reflecting a large effect, >0.5 a moderate effectand >0.2 a small effect. Results were consideredsignificant ifp< 0.05.

Results

The average attendance rate was 70.8% (DA group)and 73.7% (DAA group). Values for energy intakeand expenditure at baseline and their changesare shown in Table 1. There were no differ-ences in TEI or macronutrient balance between thegroups at baseline, and the TEI and macronutri-ent balance changed significantly by the end ofthe program in both groups. Furthermore, TEE andphysical activity energy expenditure increased sig-nificantly during the study period in both groups.However, we detected no significant interactions

Table

1

Physicalactivityenergyexpenditureandenergyintakebe

foreandduringlifestyleintervention

.

DA

(n=12)

DAA(n=16)

Group

time

interaction

p-value

Bas

eline

During

change

Baseline

During

change

Totalenergyintake,

kcal/day

19

99

588

1121

274

874

500*

2041

468

1213

219

824

57

6*

0.8

70

Protein,g/day

70

.9

14.3

57.6

16.4

12.4

21.2

*

67.1

23.2

54.6

10.3

13.3

17

.8*

0.9

08

Fat,g/day

73

.4

15.6

38.1

9.7

34.4

31.3

*

68.2

29.1

33.8

9.1

35.5

19

.9*

0.9

15

Carbohydrate,g/day

261

.1

71.1

158.3

46.6

99

60.4

*

262.6

66.5

163.7

19.8

102.8

73

.0*

0.8

85

Totalenergy

expenditure,

kcal/day

18

95

245

2008

198.0

114

165*

1889

165

1974

185.0

84

13

7*

0.6

83

Physicalactivity

energy

expenditure,

kcal/day

1

83

79.5

269

91.6

86

49.0

*

172

68.7

274

93.9

102

82

.0*

0.5

40

Valuesarepresentedasthemean

standarddeviation.

Changes=duringbaseline.

*Significantintragroupdifferen

ceusingpairedt-test.


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xxx.e6 R. So et al.

Table

2

Characteristicsandb

odycompositionofeachinterventiongroup.

DA

(n=12)

Cohensd

DAA(n=16)

Cohensd

Group

time

interaction

p-value

Baseline

Post

Change

Baseline

Post

Change

Age,yr

45.9

6.8

43.3

5.5

Bodyweight,kg

71.9

9.0

65.5

8.9

6.5

2.8

*

0.7

2

78.3

12.9

68.8

10.4

9.4

4.5

*

0.81

0.0

55

BMI,kg/m2

29.3

3.0

26.7

3.1

2.6

1.2

*

0.8

5

31.2

4.0

27.5

3.2

3.8

1.6

*

1.02

0.0

47

Waistcircumference,cm

99.5

9.6

90.5

10.9

9.0

5.0

*

0.8

8

102.6

8.3

91.0

6.7

11.6

4.0

*

1.54

0.1

32

Abdominaladiposetissue

VATarea,cm2

135.7

52.9

107.7

56.9

28.0

24.7

*

0.5

1

134.1

45.5

84.9

24.4

49.1

28.1

*

1.35

0.0

49

SATarea,cm2

317.6

80.3

262.2

88.8

55.5

39.2

*

0.6

6

335.4

99.6

260.2

79.4

75.2

46.9

*

0.84

0.2

49

DXAmeasures

TotalFM,

kg

26.3

5.2

21.1

4.5

5.2

2.4

*

0.7

7

27.9

6.6

21.2

6.3

6.7

5.3

*

1.04

0.0

41

TotalFFM,

kg

44.2

5.4

42.8

5.1

1.4

1.3

0.2

7

48.5

6.5

46.2

6.8

2.2

2.6

0.35

0.4

32

Abbreviations:BMI,bodymassind

ex;VAT,visceraladiposetissue;SAT,subc

utaneousadiposetissue;FM,

fatmass;FF

M,

fatfreemass.

Datavaluesarepresentedasmean

standard

deviation.

*Significantchangewithingroupbytwo-wayrepeatedANOVA.

Significantbetween-groupdiff

erenceforchangedp

acceleration training for improvingphysical fitness

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