Although exercise has well-documented health benefits on cardiovascular disease (CVD), the benefit of combination exercise on CVD risk factors in individuals with elevated risk has not been fully elucidated. We compared the effects of aerobic, resistance, and a combination of both aerobic and resistance training on CVD risk factors including peripheral and central BP, cardiorespiratory fitness (CRF), muscular strength, body composition, blood glucose and lipids. Sixty-nine adults (58±7 years) with an elevated blood pressure or hypertension, overweight/obesity, and sedentary lifestyle were randomized to one of the three 8-week exercise programs or a non-exercise control group. Participants in all three exercise groups had an equal total exercise time, 3 days/week (aerobic: 60 minutes/session vs. resistance: 60 minutes/session vs. combination: aerobic 30 minutes/session plus resistance 30 minutes/session). Combined training provided significant reductions in peripheral (-4 mmHg) and central diastolic BP (-4 mmHg), increase in CRF (4.9 ml/kg/min), increase in upper (4 kg) and lower (11 kg) body strength, and increase in lean body mass (0.8 kg) (p <0.05). Aerobic training only increased CRF (7.7 ml/kg/min), and reduced body weight (-1.0 kg) and fat mass (-0.9 kg) (p <0.05). Resistance training only increased lower body strength (13 kg) and reduced waist circumference (-1.7 cm) (p 0.05). Furthermore, a composite score of CVD risk factors indicated a greater reduction with combination training compared to the control group. In conclusion, among individuals at an increased risk for CVD, as little as 8-weeks of combined training may provide more comprehensive CVD benefits compared to time-matched aerobic or resistance training alone.

Sarcopenic obesity is the coexistance of sarcopenia and obesity. Modern sarcopenia definition includes low muscle mass, weak muscle strength (handgrip strength) and poor physical function (slow walking), although the clinical definition of each varies worldwide. The cut-points for low muscle mass for men and women using appendicular lean mass divided by height (kg/m2) are ≤7.0 and ≤5.4 in Asians, and ≤7.23 and ≤5.67 in Caucasians, respectively. The cut-points for weak handgrip strength (kg) for men and women are <26 and <18 in Asians, and <30 and <20 in Caucasians, respectively. The cut-point for slow walking is ≤0.8 m/s in men and women. Current data suggest the potential benefits of physical activity and fitness on sarcopenic obesity in older adults. Lay abstract Sarcopenic obesity (SO) is the combination of low muscle mass (sarcopenia) and obesity. The average prevalence of SO is about 5–10%. Older adults with SO have higher risks of mobility disability, cardiometabolic diseases and mortality. The medical problems related to SO are much greater than that in sarcopenia or obesity alone. Current studies suggest the potential benefits of physical activity, fitness and resistance exercise on the prevention and treatment of SO in older adults. This review highlights the importance of the development of effective public health strategies to prevent, delay and treat SO in older people.

Purpose: Resistance exercise (RE) can improve many cardiovascular disease (CVD) risk factors, but specific data on the effects on CVD events and mortality are lacking. We investigated the associations of RE with CVD and all-cause mortality and further examined the mediation effect of body mass index (BMI) between RE and CVD outcomes. Methods: We included 12,591 participants (mean age, 47 yr) who received at least two clinical examinations 1987–2006. RE was assessed by a self-reported medical history questionnaire. Results: During a mean follow-up of 5.4 and 10.5 yr, 205 total CVD events (morbidity and mortality combined) and 276 all-cause deaths occurred, respectively. Compared with no RE, weekly RE frequencies of one, two, three times or total amount of 1–59 min were associated with approximately 40%–70% decreased risk of total CVD events, independent of aerobic exercise (AE) (all P values <0.05). However, there was no significant risk reduction for higher weekly RE of more than four times or ≥60 min. Similar results were observed for CVD morbidity and all-cause mortality. In the stratified analyses by AE, weekly RE of one time or 1–59 min was associated with lower risks of total CVD events and CVD morbidity regardless of meeting the AE guidelines. Our mediation analysis showed that RE was associated with the risk of total CVD events in two ways: RE had a direct U-shaped association with CVD risk (P value for quadratic trend <0.001) and RE indirectly lowered CVD risk by decreasing BMI. Conclusion: Even one time or less than 1 h·wk⁻¹ of RE, independent of AE, is associated with reduced risks of CVD and all-cause mortality. BMI mediates the association of RE with total CVD events.

To determine the comparative efficacy of resistance, aerobic, and combined resistance plus aerobic exercise on cardiovascular disease (CVD) risk profile. This randomized controlled trial enrolled 406 adults aged 35–70 years with overweight or obesity and elevated blood pressure. Participants were randomly assigned to resistance (n = 102), aerobic (n = 101), combined resistance plus aerobic exercise (n = 101), or no-exercise control (n = 102). All exercise participants were prescribed 1 h of time-matched supervised exercise (the combination group with 30 min of each resistance and aerobic exercise) three times per week for 1 year. The primary outcome was the change from baseline to 1 year in the standardized composite Z-score of four well-established CVD risk factors: systolic blood pressure, low-density lipoprotein (LDL) cholesterol, fasting glucose, and per cent body fat. Among 406 participants (53% women), 381 (94%) completed 1-year follow-up. Compared with the control group, the composite Z-score decreased at 1 year, which indicates improved CVD risk profile, in the aerobic {mean difference, −0.15 [95% confidence interval (CI): −0.27 to −0.04]; P = .01} and combination [mean difference, −0.16 (95% CI: −0.27 to −0.04); P = .009] groups, but not in the resistance [mean difference, −0.02 (95% CI: −0.14 to 0.09); P = .69] group. Both aerobic and combination groups had greater reductions in the composite Z-score compared with the resistance group (both P = .03), and there was no difference between the aerobic and combination groups (P = .96). Regarding the four individual CVD risk factors, only per cent body fat decreased in all three exercise groups at 1 year, but systolic blood pressure, LDL cholesterol, and fasting glucose did not decrease in any exercise groups, compared with the control group. In adults with overweight or obesity, aerobic exercise alone or combined resistance plus aerobic exercise, but not resistance exercise alone, improved composite CVD risk profile compared with the control. Effects of 1-year resistance, aerobic, or combined exercise training on cardiovascular disease (CVD) risk profile: the CardioRACE trial. Aerobic exercise alone or combined aerobic plus resistance exercise, but not resistance exercise alone, improved CVD risk profile (composite Z-score) compared with no-exercise control (Z-score values below 0 indicate favourable changes in CVD risk factors). BMI, body mass index; CI, confidence interval; CVD, cardiovascular disease; DBP, diastolic blood pressure; SBP, systolic blood pressure.