Strength training for healthier heart and better bones

By Karen Malkin

To the uninitiated, working with weights may conjure visions of cross-fitters lifting tires or 200-pound men handling large barbells, but your patients can reap impressive health benefits with simple muscle-strengthening exercises, especially when it comes to heart health and bone density.

It seems like cardiovascular exercise would be the main go-to for keeping your heart healthy, but studies show that strength training can significantly improve your heart health:

1. Lower cholesterol and triglyceride levels. Cholesterol and triglycerides are fatty substances that can clog arteries, contributing to heart attacks and strokes when their levels get dangerously high. Working out with weights can lower the levels of cholesterol and triglycerides in the bloodstream. In addition, a 2013 study published in the Journal of Applied Physiology showed that, regardless of weight, young men who regularly strength train have better-functioning high-density lipoproteins “good” cholesterol than those who don’t.
2. Improved blood pressure. Moderate-intensity strength training significantly lowers blood pressure, and is superior to cardiovascular exercise for this result, according to research from Appalachian State University in Boone, North Carolina. That’s true both in the short term or immediately after exercise and over time. Strength training increases blood flow during the exercise and recovery phases, but by helping build lean muscle, it gives the cardiovascular system more places to put its blood, equating to reduced pressure on the arterial walls. This blood pressure benefit may be even stronger in hypertensive women than in men.
3. Less visceral fat. Visceral fat or “belly fat” is found in the abdominal cavity in and around the body’s internal organs, including the heart. High levels of visceral fat, as opposed to subcutaneous fat, directly underneath the skin, are most strongly correlated with cardiovascular disease and death. Research published in the Journal of the American College of Cardiology shows that excess visceral fat carries an increased risk of heart disease, no matter your weight. Strength training is extremely effective in reducing visceral fat. In a 2015 study of more than 10,000 men, those who spent 20 minutes per day strength training gained less visceral fat over a period of 12 years compared to those who spent the same amount of time working out with cardio. When you increase your lean body mass through strength training, you also speed up the body’s metabolic rate, which has a secondary effect of decreasing fatty tissue in the midsection and around the heart.

Strong muscles also lead to strong bones, which can help minimize the risk of fracture due to osteoporosis. Numerous studies have shown that strength training can play a role in slowing bone loss, and several show it can even build bone. This is tremendously useful to help offset age-related declines in bone mass, especially in women. Activities that put stress on bones can set bone-forming cells into action. That stress comes from the pushing on bone that occurs during strength training. The result is stronger, denser bones.

Strength training targets the hips, spine, and wrists, which are sites most likely to fracture. Resistance workouts, especially those that include moves emphasizing power and balance, enhance strength and stability. That can boost confidence, encourage your patients to stay active, and reduce fractures another way, by cutting down on falls.

Muscle-strengthening exercises include activities where you move your body, a weight, or some other resistance against gravity. These exercises are also known as resistance exercises. Muscle-strengthening exercises include lifting weights, using elastic exercise bands, using weight machines, or lifting your own body weight. Yoga and Pilates are also considered muscle-strengthening exercises.

Here are three exercises that are particularly helpful for increasing bone density in the hips and spine:

• Squats. You can do squats in many ways, from holding a dumbbell in front of your chest, known as a goblet squat, to using an exercise ball against a wall, to doing a traditional barbell back squat.
• Lunges. Forward lunges, reverse lunges, side lunges, and other types of lunges that require you to engage your hip and leg musculature while balancing on one leg can help improve bone density, especially when weight is added. You can add weight using a barbell, dumbbell, or weighted vest.
• Step-Ups. Like a lunge, a step-up requires a single leg to propel your body weight in the air. You can use a bench, a chair, or a proper stepper you may find in the gym. You can adjust the height of the platform you are stepping on to and the weight you are holding.

One of the most common objections that women have regarding weight training is the fear of getting “bulky.” The bulky look is attributed to muscular hypertrophy, which is the expansion or growth of new muscle tissue. One of the primary hormones regulating muscle hypertrophy is testosterone. Testosterone works as an anabolic hormone, along with insulin, insulin-like growth factors, and human growth hormone (HGH). In addition to having higher baseline levels of testosterone, acute testosterone response of men to weight training is much higher than women. These hormonal differences mean that a very concentrated effort would be required for women to build the kind of “bulk” or muscle thickness they often fear.

Muscular hypertrophy can also be caused by specific training strategies. If a patient wishes to avoid hypertrophy, they should focus on the following techniques:

• Maintain a healthy, well-balanced diet
• Improve muscular endurance (15–20 repetitions; multiple exercises with minimal rest in between)
• Increase strength (1–6 reps; one exercise with 3–5 minutes rest in-between)
• Reduce “hypertrophy training” (Multiple sets of 8–12 reps with 30–60 seconds of rest for specific body parts)
  

Accountability Counts

A big part of strength training success is consistency. Help your patients stick to a strength-training regimens with tracking tools, such as these online examples:

• MyFitnessPal
• Online Fitness Log
• My Fitness Journal

References

Collier, S. (2011). Sex differences in resting hemodynamics and arterial stiffness following 4 weeks of resistance versus aerobic exercise training in individuals with pre-hypertension to stage 1 hypertension. Biology of Sex Differences. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184039/

Collier, S. (2010). Changes in Arterial Distensibility and Flow-Mediated Dilation After Acute Resistance vs. Aerobic Exercise. Journal of Strength and Conditioning Research. Retrieved from: https://journals.lww.com/nsca-jscr/Fulltext/2010/10000/Changes_in_Arterial_Distensibility_and.38.aspx

Faigenbaum, A. (2008). Age- and Sex-Related Differences and Their Implications for Resistance Exercise. In T. Baechle, & R. Earle, Essentials of Strength Training and Conditioning (3rd ed., p. 151). Champaign, IL: Human Kinetics.

Layne, J. (1999). The effects of progressive resistance training on bone density: a review. Medicine and Science in Sports and Exercise. Retrieved from: https://europepmc.org/abstract/MED/9927006

Lee, J. (2016). Association of Changes in Abdominal Fat Quantity and Quality With Incident Cardiovascular Disease Risk Factors. Journal of the American College of Cardiology. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0735109716347805

Liu, Y. (2018). Associations of Resistance Exercise with Cardiovascular Disease Morbidity and Mortality. Medicine & Science in Sports & Exercise. Retrieved from: https://journals.lww.com/acsm-msse/Abstract/publishahead/Associations_of_Resistance_Exercise_with.96766.aspx

Mekary, R. (2014). Weight training, aerobic physical activities, and long‐term waist circumference change in men. Obesity. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20949

Roberts, C. (2013). Untrained young men have dysfunctional HDL compared with strength-trained men irrespective of body weight status. Journal of Applied Physiology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798817/

Weir, J., & Brown, L. (2012). Resistance Training Adaptations. In J. Coburn, & M. Malek, NSCA’s Essentials of Personal Training (2nd ed., p. 77). Champaign, IL: Human Kinetics.