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Applying the ACSM Guidelines

Research shows that the ACSM exercise guidelines are effective for improving body composition and blood pressure in previously sedentary adults.

DURING THE LAST two decades, numerous studies have examined the effects of strength training on various health indicators in adults. Resistance exercise has produced beneficial outcomes for bone mineral density,27 glucose utilization,26 back pain,31 arthritis,24 gastrointestinal transit,20 blood pressure,17 blood lipids,7 post coronary performance,14 depression,32 resting metabolism29 and body composition.11 Comprehensive reviews12,34 have noted the potential of strength training for producing a myriad of health benefits, and recent studies have shown that regular resistance exercise reduces the risk for metabolic syndrome19 and premature all-cause mortality.18

While all of the reported studies showed favorable outcomes for improving strength and body composition, there was little consensus regarding a standard training protocol. For example, important strength-training studies conducted at Tufts University typically featured five or fewer exercises, performed two or three days a week, for three sets of eight repetitions each.9,13,21,11 On the other hand, equally important studies conducted by University of Maryland investigators29,28,25,23 typically featured seven to 14 exercises, performed three days per week, for one to two sets of 15 repetitions each.

During this same time period, researchers at the University of Florida examined the comparative effects of various strength-training protocols, especially the number of exercise sets30,15,33 and the number of weekly training sessions.30,8,16,22

ACSM guidelines

As reported by Faigenbaum and Pollock,10 the findings from these and other studies on resistance-training protocols were instrumental in the development of the strength-training recommendations published in the 1995 American College of Sports Medicine Guidelines for Exercise Testing and Prescription, 5th edition.2

The 1995 ACSM exercise guidelines essentially restated and reinforced the 1990 ACSM Position Stand3 with respect to the recommended training protocols for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Both of these ACSM publications advised previously sedentary but otherwise healthy men and women to perform one set (eight to 12 repetitions) of eight to 10 resistance exercises for the major muscle groups at least two days a week. These guidelines also recommended a minimum of 20 minutes of aerobic activity, three days a week, at sufficient intensity to attain 60 to 90 percent of maximum heart rate.

The South Shore YMCA, Quincy, Mass., decided to apply the 1995 ACSM minimum requirement exercise guidelines to previously sedentary adults who enrolled in a 10-week introductory fitness program for the primary purposes of improving body composition and reducing resting blood pressure. Because exercise class participants typically perform both muscular strength and cardiovascular endurance activities during the same session, we offered a two-time-per-week training program (consistent with ACSM's minimum strength-training guidelines), and a three-times-per-week training program (consistent with ACSM's minimum endurance exercise guidelines).

Exercise classes were scheduled mornings, afternoons and evenings on a Tuesday/Thursday sequence (twice per week) and on a Monday/Wednesday/Friday sequence (three times a week). All training sessions were completed within one-hour class periods, and included approximately 20 minutes of resistance exercise and 20 minutes of aerobic activity. Participants with low initial fitness levels required more time to complete the strength-training circuit, and began with shorter bouts of aerobic activity. All exercise classes were carefully instructed and closely supervised (maximum of six participants with two instructors) to ensure compliance with the ACSM exercise guidelines.

To provide a controlled training environment, a separate exercise facility was outfitted with 10 standard weightstack machines (leg extension, leg curl, double chest, pullover, lateral raise, biceps curl, triceps extension, abdominal curl, low-back extension and neck flexion/extension) and three common cardiovascular tools (two treadmills and a recumbent cycle).

Program protocol

Body weight, body composition and resting blood pressure were assessed during the first and the last week of the 10-week training program. The order of exercise was randomly assigned during the first training day, so that three participants performed resistance training followed by aerobic training, and three participants performed aerobic training followed by resistance training.

Strength training consisted of one set of each resistance exercise, from larger to smaller muscle groups, with a weightload that could be lifted between eight and 12 repetitions. When a trainee completed 12 repetitions, the resistance was increased by 5 percent (or less). Each exercise repetition was performed in approximately six seconds, with about two seconds for the concentric muscle action and about four seconds for the eccentric muscle action.

Aerobic training bouts began and ended with three-minute warm-up and cool-down periods, during which participants performed the same aerobic activity at a lower training intensity (slower treadmill speed or reduced cycle resistance). The steady-state aerobic training segment was performed at an exercise heart rate approximately 70 to 80 percent of the participant's age-predicted maximum. However, participants were not allowed to train above level 15 (hard effort) on the Borg (6 to 20) rating scale of perceived physical exertion,5 regardless of their exercise heart rate.

Participants also performed a 20-second static stretch for the prime-mover muscle group immediately following each resistance-training exercise. For example, upon completing the leg extension exercise, participants performed a 20-second quadriceps stretch; after completing the leg curl exercise, they performed a 20-second hamstrings stretch, and so on, for all 10 strength exercises.

Program participants

Participants in the 10-week introductory fitness program were 1,644 adults between the ages of 21 and 80 years old from the greater Boston area. Each participant completed a medical history questionnaire, and anyone with possible exercise contraindications was required to provide written physician permission before beginning the program. The mean age for the 892 participants who trained twice a week was 56.2 years, and the mean age for the 752 participants who trained three times a week was 51 years.

Program results

Pre-training and post-training assessment data were collected over an eight-year period from 1996 through 2004, including nine spring, eight summer, eight fall and eight winter exercise sessions of 10 weeks in duration. Ninety-two percent of the previously sedentary adults who enrolled in the exercise program completed all 10 weeks of training. Data for these 1,644 introductory exercise program participants were analyzed by training frequency, gender and age. Beginning values for body weight, body composition and blood pressure are presented in Table 1.

Training frequency. The mean exercise adherence rates (percentage of scheduled training sessions attended) were 83.2 percent for twice-per-week trainees and 79.6 percent for three-times-per-week trainees. Both training frequencies were effective for improving body composition and resting blood pressure in previously sedentary adults (Table 2). Participants who trained three times per week had significantly greater decreases in percent fat (­2.2 vs. ­1.9 percent) and fat weight (­4.4 vs. ­3.2 pounds) than those who trained twice a week, which makes sense because three-day trainees performed 50 percent more exercise. However, both training frequencies produced identical increases in lean weight (+3.1 pounds), indicating that two weekly resistance workouts may be as effective as three weekly strength-training sessions for stimulating muscle development in beginning exercisers. Reductions in resting systolic and diastolic blood pressure were statistically similar for participants who trained three times a week and twice a week.

Based on these findings, it would appear that three exercise sessions a week may be more beneficial overall, but two weekly workouts are effective for improving body composition and reducing resting blood pressure in previously sedentary adults.

Gender. Our program participants included 1,258 women and 386 men, showing a stronger response from women than men to supervised exercise classes (3:1 ratio). The men experienced significantly greater decreases in percent fat (­2.8 vs. ­1.8 percent) and fat weight (­5.9 vs. ­3.0 pounds) than the women. Men also added significantly more lean weight (+4.6 vs. + 2.6 pounds) than women (Table 3). The greater changes in body composition components attained by the men may be due in part to their higher bodyweight (204.7 vs. 171.9 pounds) and lean weight (156.1 vs. 119.2 pounds), compared to the women. Men and women trainees had statistically similar reductions in resting systolic and diastolic blood pressure.

Age. The data were also divided into age groups: 1) 21 to 30 years; 2) 31 to 50 years; 3) 51 to 65 years; and 4) 66 to 80 years. The analyses showed no significant differences among the four age groups in body weight, body composition or blood pressure changes. These findings indicate that the ACSM minimum requirement exercise guidelines produce similar improvements in these health/fitness factors for young, middle-aged and older adults.

Summary and practical application

Based on the results attained by 1,644 adults who completed our 10-week introductory exercise program, the 1995 ACSM minimum requirement exercise guidelines are effective for improving body composition and resting blood pressure in previously sedentary men and women between 21 and 80 years of age. On average, 10 weeks of combined strength and endurance training produced a 2 percent reduction in percent fat, a 3.7-pound loss in fat weight, a 3.1-pound gain in lean weight, a 3.8 mmHg-decrease in resting systolic blood pressure and a 1.8 mmHg-decrease in resting diastolic blood pressure (see sidebar).

The basic and brief 1995 ACSM exercise protocol was apparently well-received by these formerly inactive adults. More than 90 percent of those who enrolled in the fitness program completed it, attending more than 80 percent of their scheduled classes. According to written, anonymous questionnaires administered at the completion of each 10-week training session, more than 95 percent of the participants reported high levels of satisfaction with the overall exercise program, and committed to continuing their training.

Research indicates that both genetic and psychological factors can influence tolerance for and responsiveness to physical training.6,4 In addition, it would appear that relatively simple and time-efficient exercise protocols may be advantageous for previously inactive adults from an acceptance and compliance perspective. Based on our experiences with beginning exercisers, the 1995 ACSM basic strength and endurance training guidelines provide both a practical and effective approach for improving body composition and resting blood pressure in previously sedentary adults.

Finally, the recently released 7th edition of ACSM's Guidelines for Exercise Testing and Prescription1 presents essentially the same strength-training recommendations used in this study. The key resistance exercise guidelines in the latest ACSM certification textbook call for the following:

* Eight to 10 exercises for the major muscles.
* One set of each exercise.
* Eight to 12 repetitions per exercise set.
* Two to three nonconsecutive training days per week.
* Moderate movement speed: approximately six seconds per repetition.

* Full range of pain-free movement.

Clearly, these guidelines are consistent with our research findings, and we agree that new exercisers should begin strength training in this manner. FM

1. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. Lippincott, Williams and Wilkins: Philadelphia, Pa., 2006 (7th ed.).
2. American College of Sports Medicine. Guidelines for Graded Exercise Testing and Exercise Prescription. Lea & Febiger: Philadelphia, Pa., 1995 (5th ed.).
3. American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Medicine & Science in Sports & Exercise 22: 265-274, 1990.
4. Annesi, J., W. Westcott and S. Gann. Preliminary evaluation of a 10-week resistance and cardiovascular exercise protocol on physiological and psychological measures for a sample of older women. Perceptual Motor Skills 98: 163-170, 2004.
5. Borg, G.A. Psychological assessment of physiological exertion. Medicine & Science in Sports & Exercise 14: 377-383, 1982.
6. Bouchard, C., R.M. Malina and L. Perusse. Genetics of Fitness and Physical Performance. Human Kinetics: Champaign, Ill., 1997.
7. Boyden, T., R. Pamenter, S. Going, T. Lohman, M. Hall, L. Houtkooper, J. Bunt, C. Ritenbaugh and R. Aickin. Resistance exercise training is associated with decreases in serum low-density lipoprotein cholesterol levels in premenopausal women. Archives of Internal Medicine 153: 97-100, 1993.
8. Braith, R.W., J.E. Graves and M.L. Pollock. Comparison of two vs. three days/week of variable resistance training during 10- and 18-week programs. International Journal of Sports Medicine 10: 450-454, 1989.
9. Campbell, W.W., M.C. Crim, V.R. Young and W.J. Evans. Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition 60: 167-175, 1994.
10. Faigenbaum, M.S., and M.L. Pollock. Prescription of resistance training for health and disease. Medicine & Science in Sports & Exercise 31: 38-45, 1999.
11. Fiatarone, M.A., E.F. O'Neill, N.D. Ryan, K.M. Clements, G.R. Solares, M.E. Nelson, S.B. Roberts, J.J. Kehayias, L.A. Lipsitz and W.J. Evans. Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 330: 1769-1775, 1994.
12. FitzGerald, S.J., C.E. Barlow, J.B. Kampert, J.R. Morrow, A.W. Jackson and S.N. Blair. Muscular fitness and all-cause mortality; prospective observations. Journal of Physical Activity and Health 1: 7-18, 2004.
13. Frontera, W., C. Meredith, K. O'Reill, H. Knuttgen and W. Evans. Strength conditioning in older men: Skeletal muscle hypertrophy and improved function. Journal of Applied Physiology. 64: 1038-1044, 1988.
14. Ghiladucci, L., R. Holly and E. Amsterdam. Effects of high resistance training in coronary heart disease. American Journal of Cardiology 64: 866-870, 1989.
15. Graves, J.E., B.L. Holmes and S.H. Leggett. Single versus multiple set dynamic and isometric lumbar extension training. Proceedings, Book III, World Confederation for Physical Therapy, 11th International Congress, London, 1340-1342, 1991. Medicine & Science in Sports & Exercise 28: 1311-1320, 1996.
16. Graves, J.E., M.L. Pollock and D. Foster. Effects of training frequency and specificity on isometric lumbar extension strength. Spine 15: 504-509, 1990.
17. Harris, K., and R. Holly. Physiological response to circuit weight training in borderline hypertensive subjects. Medicine & Science in Sports & Exercise 246-252, 1987.
18. Hurley, B.F,. and S.M. Roth. Strength training in the elderly: Effects on risk factors for age-related diseases. Sports Medicine 30: 249-265, 2000.
19. Jurca, R., M.J. LaMonte, T.S. Church, C.P. Earnest, S.J. Fitzgerald, C.E. Barlow, A.N. Jordan, J.B. Kampert and S.N. Blair. Associations with muscle strength and aerobic fitness with metabolic syndrome in men. Medicine & Science in Sports & Exercise 36: 1301-1307, 2004.
20. Koffler, K.H., A. Menkes, R.A. Redmond, W.E. Whitehead, R.E. Pratley and B.F. Hurley. Strength training accelerates gastrointestinal transit in middle-aged and older men. Medicine & Science in Sports & Exercise 24: 415-419, 1992.
21. Layne, J.E., and M.E. Nelson. The effects of progressive resistance training on bone density: A review. Medicine & Science in Sports & Exercise 31: 25-30, 1999.
22. Leggett, S.H., J.E. Graves and M.L. Pollock. Quantitative assessment and training of isometric cervical extension strength. American Journal of Sports Medicine 19: 653-659, 1991.
23. Lemmer, J.T., F.M. Ivey, A.S. Ryan, G.F. Martel, D.E. Hurlbut, J.E. Metter, J.L. Fozard, J.L. Fleg and B.F. Hurley. Effect of strength training on resting metabolic rate and physical activity: age and gender comparisons. Medicine & Science in Sports & Exercise 33: 532-541, 2001.
24. Marks, R. The effect of isometric quadriceps strength training in mid-range for osteo-arthritis of the knee. Arthritis Care Research 6: 52-56, 1993.
25. Martel, G.F., D.E. Hurlbut, M.E. Lott, J.T. Lemmer, F.M. Ivey, S.M. Roth, M.A. Rogers, J.L. Fleg and B.F. Hurley. Strength training normalizes blood pressure in 65- to 73-year-old men and women with high normal blood pressure. Journal of the American Geriatric Society 47: 1215-1221, 1999.
26. Miller, J.P., R.E. Pratley, A.P. Goldberg, P. Gordon, M. Rubin, M.S. Treuth, A.S. Ryan and B.F. Hurley. Strength training increases insulin action in healthy 50- to 65-year-old men. Journal of Applied Physiology 77: 1122-1127, 1994.
27. Nelson, M.E., M.A. Fiatarone, C.M. Morganti, I. Trice, R.A. Greenberg and W.J. Evans. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. Journal of the American Medical Association 272: 1909-1914, 1994.
28. Nicklas, B.J., A.J. Ryan, M.S. Treuth, S.M. Harman, M.R. Blackman, B.F. Hurley and M.A. Rogers. Testosterone, growth hormone and IGF-I responses to acute and chronic resistive exercise in men aged 55-70 years. International Journal of Sports Medicine 16: 445-450, 1995.
29. Pratley, R.B., M. Nicklas, J. Rubin, A. Miller, M. Smith, B. Smith, B.F. Hurley and A. Goldberg. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-year-old men. Journal of Applied Physiology 76: 133-137, 1994.
30. Pollock, M.L., J.E. Graves and M.M. Bamman. Frequency and volume of resistance training: effect of cervical extension strength. Archive of the American Journal of Physical Medicine & Rehabilitation 74: 1080-1086, 1993.
31. Risch, S., N. Nowell, M. Pollock, E. Risch, H. Langer, M. Fulton, J. Graves and S. Leggett. Lumbar strengthening in chronic low-back pain patients. Spine 18: 232-238, 1993.
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South Shore YMCA Fitness Program

* 10 weeks of training (1,644 subjects)
* 2 percent reduction in percent fat
* 3.7-pound fat loss
* 3.1-pound lean (muscle) gain
* 3.8 mmHg systolic blood pressure decrease
* 1.8 mmHg diastolic blood pressure decrease
* More than 90 percent completion rate
* More than 80 percent attendance rate
* More than 95 percent satisfaction rate

TABLE 1. Pre-Exercise Body Measurements

Beginning means for body weight, body composition and resting blood pressure for 1,644 exercise program participants (386 men, 1,258 women).

Men Women
Body weight (lbs.) 204.7 171.9
Percent fat
(percent) 22.6 29.9
Fat weight (lbs.) 48.5 52.2
Lean weight (lbs.) 156.1 119.2
Systolic blood
pressure (mmHg) 131.7 127.3
Diastolic blood
pressure (mmHg) 78.4 76.6

Table 2. Body Changes Over 10-Week Program

Changes in body weight, body composition and resting blood pressure over a 10-week training period by exercise frequency (1,644 subjects).

Two/week Three/week All
Body weight (lbs.) ­0.1 ­1.3 ­0.6
Percent fat (percent) ­1.9* ­2.2* ­2.0*
Fat weight (lbs.) ­3.2* ­4.4* ­3.7*
Lean weight (lbs.) +3.1* +3.1* +3.1*
Systolic blood
pressure (mmHg) ­3.1* ­4.6* ­3.8*
Diastolic blood
pressure (mmHg) ­1.4* ­2.2* ­1.8*

* Statistically significant change from beginning value (p< 0.05).

Table 3. Body Composition Changes Over 10-Week Program

Body composition changes for men and women participants in a 10-week training program (1,644 subjects).

Women Men
Percent fat
(percent) ­1.8* ­2.8*
Fat weight (lbs.) ­3.0* ­5.9*
Lean weight (lbs.) +2.6* +4.6*

*Statistically significant change from beginning value ( p<0.05).

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