Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association.

Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.

Preschool- and childcare center-based interventions to increase fruit and vegetable intake in preschool children in the United States: a systematic review of effectiveness and behavior change techniques.

BACKGROUND: Fruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs. METHODS: This systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2-5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs. RESULTS: The search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect. CONCLUSIONS: While several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change.

Effects of weight loss and weight loss maintenance on cardiac autonomic function in obesity: a randomized controlled trial.

NOVELTY: Caloric restriction and exercise exert significant improvements in cardiac autonomic function as measured by HRV in overweight and obesity. Aerobic exercise training, within recommended guidelines coupled with weight loss maintenance, retains cardiac autonomic function benefits from weight loss in previously obese individuals.

Increasing Equity of Physical Activity Promotion for Optimal Cardiovascular Health in Adults: A Scientific Statement From the American Heart Association.

Fewer than 1 in 4 adults achieves the recommended amount of physical activity, with lower activity levels reported among some groups. Addressing low levels of physical activity among underresourced groups provides a modifiable target with the potential to improve equity in cardiovascular health. This article (1) examines physical activity levels across strata of cardiovascular disease risk factors, individual level characteristics, and environmental factors; (2) reviews strategies for increasing physical activity in groups who are underresourced or at risk for poor cardiovascular health; and (3) provides practical suggestions for physical activity promotion to increase equity of risk reduction and to improve cardiovascular health. Physical activity levels are lower among those with elevated cardiovascular disease risk factors, among certain groups (eg, older age, female, Black race, lower socioeconomic status), and in some environments (eg, rural). There are strategies for physical activity promotion that can specifically support underresourced groups such as engaging the target community in designing and implementing interventions, developing culturally appropriate study materials, identifying culturally tailored physical activity options and leaders, building social support, and developing materials for those with low literacy. Although addressing low physical activity levels will not address the underlying structural inequities that deserve attention, promoting physical activity among adults, especially those with both low physical activity levels and poor cardiovascular health, is a promising and underused strategy to reduce cardiovascular health inequalities.

The effect of exercise training level on arterial stiffness after clinically significant weight loss.

Arterial stiffness is improved by weight loss. However, no data exist on the impact of aerobic exercise levels on arterial stiffness during weight maintenance. Adults who were  overweight or with obesity (N = 39) participated in a 10-week weight loss program. Participants who achieved ≥7% weight loss were randomized to aerobic training at the minimum physical activity guidelines (PA-REC, 550 MET min/week) or weight maintenance guidelines (WM-REC, 970 MET min/week) for 18 additional weeks. Arterial stiffness (carotid-to-femoral pulse wave velocity [cfPWV], augmentation index normalized for 75 beats/min [AIX75]) and blood pressure [aortic and brachial]) were assessed at baseline, the end of the weight loss phase (week 10), and follow-up (week 28). There was a reduction in cfPWV in participants who met the weight loss goal (-0.34 m/s, p = .02) and approached significance for the entire sample (p = .051). Similarly, there were reductions in AIX75, brachial blood pressure, and aortic blood pressure (p < .05) in the full sample. In the weight maintenance phase, no differences were observed between the PA-REC and the WM-REC groups for change in arterial stiffness or blood pressure (p > .05). However, changes in cfPWV were independently associated with changes in LDL (r2 : 0.45, p = .004) and exercise intensity (r2 : 0.17, p = .033). Aerobic exercise level at the minimum physical activity guidelines or weight maintenance guidelines does not affect the change in PWV or the change in cfPWV after clinically significant weight loss. However, interventions which limit increases in LDL cholesterol and promote high-intensity aerobic exercise may prevent increases in stiffness during weight maintenance.

Associations of Percent Body Fat and Motor Skill Development in Preschool-Aged Children: National Youth Fitness Survey.

Background: Body composition and motor skill development are important for the engagement in physical activity and healthy development of children. This study examined the associations between body composition and motor skill development in 3- to 5-year-old children. Methods: Data from preschool-aged children (N = 342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. Skinfold measurements (subscapular, calf, and triceps) were taken and percent body fat (%BF) was calculated using sex-specific equations. Lean muscle mass and fat mass were also calculated. Motor skill development was determined by the Test of Gross Motor Development-2nd Edition. Regression analyses were performed to determine the associations among %BF and locomotor skills, object control skills, and overall gross motor quotient (GMQ), controlling for sex, race, and poverty index ratio. Results: Most children were classified as with underweight/healthy weight (69%) and 31% were either with overweight or obesity. Average %BF was 17.02% ± 0.27%. The standard scores for locomotor skills, object control skills, and GMQ were 9.99 ± 0.16, 8.52 ± 0.14, and 95.57 ± 0.68, respectively. These scores were considered average. Regression analyses indicated that neither the %BF nor sum of skinfolds was associated with locomotor skills (ß = -0.07 ± 0.05, p = 0.63; ß = -0.03 ± 0.03, p = 0.22), object control skills (ß = 0.03 ± 0.04, p = 0.55; ß = 0.00 ± 0.02, p = 0.87), or GMQ (ß = -0.13 ± 0.28, p = 0.63; ß = -0.09 ± 0.14, p = 0.52). Furthermore, neither lean muscle mass nor fat mass was related with any motor skill measure (p > 0.05). Conclusions: Using different measures of body composition may provide additional insight into associations between obesity and motor skill development in preschool-aged children. Given the inconsistent findings in the literature, additional research is needed to elucidate these associations.

Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge.

PURPOSE: To investigate the changes in activities and participation, and mental and physical functions for 9 mo after cardiac rehabilitation (CR) among adults with chronic cardiac conditions. METHODS: Twenty-five adults with chronic cardiac conditions scheduled for discharge from CR were assessed at four different times: within 2-wk window of CR discharge date, 1 mo, 3 mo, and 9 mo after CR discharge. Nine assessments according to the International Classification of Functioning, Disability and Health were used to track the changes post-CR. RESULTS: Participants showed significant changes in the Cognitive Instrumental Activities of Daily Living adequacy of Performance Assessment of Self-Care Skills-Clinic (F = 8.10, P = .017) and improvements in the applied cognitive domain of the Activity Measure for Post-Acute Care Outpatient Short Form (F = 4.493, P = .016). Participants also showed significant decline in the CogState Detection test (F = 3.307, P = .045), the Physical Activity and Leisure Motivation Scale (PALMS) (F = 4.749, P = .005), and the affiliation subscale of the PALMS (F = 5.316, P = .002), and improvements in the 6-min walk test (F = 9.000, P = .011). Lastly, participants showed depressive symptoms for 3 mo post-CR. No other significant changes were detected among other outcome measures. CONCLUSIONS: Adults with chronic cardiac conditions discharged from site-based CR maintained their activity and participation level following discharge with little improvement. They also showed depressive symptoms and decreased motivation for physical activity post-CR.

Comparison of Activity and Participation, and Mental and Physical Functions of Immediate Post-Acute and Distant Post-Acute Adults with Chronic Cardiac Conditions.

This study compared activity participation, and mental and physical functions of two different groups of adults with chronic cardiac conditions. Eleven participants were assessed at the immediate post-acute stage and 26 participants were at the distant post-acute stage. Participants at distant post-acute were significantly more physically active (p < .001), more activity-limited in cognition-related activities (p = .035) and reported more depressive symptoms than immediate post-acute (p = .046). No significant difference in participation level was found. More attention to functional cognition and depressive symptoms at immediate post-acute and individualized approaches to remove participation barriers in complex activities at distant post-acute are likely needed for adults with chronic cardiac conditions.

The Effect of Aerobic Training and Increasing Nonexercise Physical Activity on Cardiometabolic Risk Factors.

PURPOSE: Epidemiological studies suggest that sedentary behavior is an independent risk factor for cardiovascular mortality independent of meeting physical activity guidelines. However, limited evidence of this relationship is available from prospective interventions. The purpose of the present study is to evaluate the combined effect of aerobic training and increasing nonexercise physical activity on body composition and cardiometabolic risk factors. METHODS: Obese adults (N = 45) were randomized to 6 months of aerobic training (AERO), aerobic training and increasing nonexercise physical activity (~3000 steps above baseline levels; AERO-PA), or a control (CON) group. The AERO and AERO-PA groups performed supervised aerobic training (3-4 times per week). The AERO-PA group wore Fitbit One accelerometers and received behavioral coaching to increase nonexercise physical activity. RESULTS: There was a larger increase in fitness in the AERO-PA group (0.27 L·min-1; confidence interval (CI), 0.16 to 0.40 L·min-1) compared with the AERO group (0.09 L·min-1; CI, -0.04 to 0.22 L·min-1) and the CON group (0.01; CI, -0.11 to 0.12 L·min-1). Although significant findings were not observed in the entire study sample, when the analysis was restricted to participants compliant to the intervention (n = 33), we observed significant reductions in waist circumference, percent weight loss, body fat, 2-h glucose, and 2-h insulin in comparison to the CON group (P < 0.05), but not the AERO group. Furthermore, linear regression models showed that change in steps was associated with 21% and 26% of the variation in percent weight loss and percent fat loss, respectively. CONCLUSIONS: Increasing nonexercise physical activity with aerobic training may represent a viable strategy to augment the fitness response in comparison to aerobic training alone and has promise for other health indicators.

Prescribed exercise to Reduce Recidivism After Weight Loss-Pilot (PREVAIL-P): Design, methods and rationale.

Clinically significant weight loss is associated with health benefits for overweight and obese adults. Participation in adequate amounts of physical activity is critical for weight maintenance. However, the recommended amount of physical activity needed to promote weight maintenance is based primarily on retrospective studies that quantified physical activity levels through questionnaires which tend to overestimate physical activity levels. In addition, the present literature has provided little data on the impact of these physical activity levels on cardiovascular and diabetes risk factors, which may have equal or more clinical importance than weight changes. The Prescribed Exercise to Reduce Recidivism After Weight Loss-Pilot (PREVAIL-P) study will evaluate the effect of aerobic exercise training amount on weight maintenance following clinically significant weight loss in overweight and obese adults (BMI 25-40 kg/m2) age 30-65 years. Participants (N = 39) will complete a 10-week OPTIFAST® weight loss program with supervised aerobic exercise training. Individuals who achieve ≥7% weight loss from baseline will be subsequently randomized to levels of aerobic training consistent with physical activity recommendations (PA-REC) or weight maintenance recommendations (WM-REC) for 18 additional weeks. The primary outcome of the PREVAIL-P study will be change in weight from the completion of OPTIFAST® program to the end of the study. Notable secondary measures include changes in clinically relevant cardiometabolic risk factors between study groups (e.g. blood lipids concentrations, oral glucose tolerance, arterial stiffness). This pilot study will be used to estimate the effect sizes needed for a randomized controlled trial on this topic.

A Randomized Community-based Exercise Training Trial in African American Men: Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men.

PURPOSE: To examine the impact of a community-based exercise training intervention on cardiometabolic outcomes in African American men who have a family history of type 2 diabetes. METHODS: The Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men (ARTIIS) study randomized participants into either an exercise training intervention or an information only control group for 5 months. The exercise training intervention consisted of 150 min of moderate intensity aerobic activity and 2 d of resistance training per week, consistent with the current federal physical activity guidelines. Participants in the control group received monthly newsletters featuring topics focused heavily on type 2 diabetes education and prevention. Outcome data were analyzed using repeated-measures ANCOVA models and incorporating both intention-to-treat and per-protocol principles. RESULTS: Adherence to the aerobic and resistance training prescriptions were between 77% and 79%. Despite significant within group improvements in glucose and insulin levels (fasting, 2 h, 2 h minus baseline) and Homeostatic Model 2-Insulin Resistance, there were not significant between group differences. There was a marginally significant between group difference for Homeostatic Model 2-Beta (P < 0.06), and significant between group differences in peak cardiorespiratory fitness (P < 0.001) and waist circumference (P = 0.03). CONCLUSIONS: These findings suggest that exercise training in accordance with the current national recommendations is effective in improving some health parameters in middle-age African American men who have a family history of type 2 diabetes, but did not have a significant impact on glycemic status.

Physical activity types and motor skills in 3-5-year old children: National Youth Fitness Survey.

OBJECTIVE: This study examined relationships between specific types of physical activity (PA) and motor skill development in preschool-aged children. DESIGN: This study was completed using a cross-sectional study design. METHODS: Data from children 3-5years old (N=342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. PA was measured using a questionnaire by parent report and motor skill development determined by Test of Gross Motor Development-2nd Edition (TGMD-2). Multiple regression analyses were conducted to examine the relationship between PA type and overall Gross Motor Quotient (GMQ) controlling for age, sex, race, and parental socioeconomic status. RESULTS: Commonly reported activities were running (43%), playing outdoor games (35%), and riding a bike (34%). Based on the standard scores, participants' motor skill development for Locomotor, Object Control, and overall GMQ were considered average. Participation in the following physical activities were positively associated with GMQ: riding a bike (ß (SE)=5.27 (2.02), p=0.02), scooter riding (ß (SE)=9.83 (2.59), p=0.002), swimming (ß (SE)=4.01 (1.17), p=0.004), and jumping on a trampoline (ß (SE)=7.45 (3.09), p=0.03). With the exception of riding a bike, the physical activities positively related to GMQ had a reported range of participation between 7-12%. CONCLUSIONS: Participation in specific physical activities was related to higher GMQ in preschool-aged children. Also, with the exception of riding a bike, the activities that the children participated in the most were not the same as the activities that were positively related to motor skill development.

Evaluation of Step-Counting Interventions Differing on Intensity Messages.

BACKGROUND: Step-counting interventions with discrepant intensity emphases may elicit different effects. METHODS: A total of 120 sedentary/low-active, postmenopausal women were randomly assigned to one of the following 3 groups: (1) 10,000 steps per day (with no emphasis on walking intensity/speed/cadence; basic intervention, 49 completers), (2) 10,000 steps per day and at least 30 minutes in moderate intensity (ie, at a cadence of at least 100 steps per minute; enhanced intervention, 47 completers), or (3) a control group (19 completers). NL-1000-determined steps and active minutes (a device-specific indicator of time at moderate+ intensity) were collected as process variables during the 12-week intervention. Outcome variables included systolic and diastolic blood pressure, anthropometric measurements, fasting blood glucose and insulin, flow-mediated dilation, gait speed, and ActiGraph GT3X+-determined physical activity and sedentary behavior. RESULTS: The "basic group" increased 5173 to 9602 steps per day and 9.2 to 30.2 active minutes per day. The "enhanced group" similarly increased 5061 to 10,508 steps per day and 8.7 to 38.8 active minutes per day. The only significant change over time for clinical variables was body mass index. CONCLUSIONS: Interventions that use simple step-counters can achieve elevated volume and intensity of daily physical activity, regardless of emphasis on intensity. Despite this, few clinical outcomes were apparent in this sample of postmenopausal women with generally normal or controlled hypertension.

High-intensity exercise to promote accelerated improvements in cardiorespiratory fitness (HI-PACE): study protocol for a randomized controlled trial.

BACKGROUND: African Americans have a disproportionate prevalence and incidence of type 2 diabetes compared with Caucasians. Recent evidence indicates that low cardiorespiratory fitness (CRF) level, an independent risk factor for type 2 diabetes, is also more prevalent in African Americans than Caucasians. Numerous studies in Caucasian populations suggest that vigorous exercise intensity may promote greater improvements in CRF and other type 2 diabetes risk factors (e.g., reduction of glucose/insulin levels, pulse wave velocity, and body fat) than moderate intensity. However, current evidence comparing health benefits of different aerobic exercise intensities on type 2 diabetes risk factors in African Americans is negligible. This is clinically important as African Americans have a greater risk for type 2 diabetes and are less likely to meet public health recommendations for physical activity than Caucasians. The purpose of the HI-PACE (High-Intensity exercise to Promote Accelerated improvements in CardiorEspiratory fitness) study is to evaluate whether high-intensity aerobic exercise elicits greater improvements in CRF, insulin action, and arterial stiffness than moderate-intensity exercise in African Americans. METHODS/DESIGN: A randomized controlled trial will be performed on overweight and obese (body mass index of 25-45 kg/m2) African Americans (35-65 years) (n = 60). Participants will be randomly assigned to moderate-intensity (MOD-INT) or high-intensity (HIGH-INT) aerobic exercise training or a non-exercise control group (CON) for 24 weeks. Supervised exercise will be performed at a heart rate associated with 45-55% and 70-80% of VO2 max in the MOD-INT and HIGH-INT groups, respectively, for an exercise dose of 600 metabolic equivalents of task (MET)-minutes per week (consistent with public health recommendations). The primary outcome is change in CRF. Secondary outcomes include change in insulin sensitivity (measured via an intravenous glucose tolerance test), skeletal muscle mitochondrial oxidative capacity (via near-infrared spectroscopy), skeletal muscle measurements (i.e., citrate synthase, COX IV, GLUT-4, CPT-1, and PGC1-α), arterial stiffness (via carotid-femoral pulse wave velocity), body fat, C-reactive protein, and psychological outcomes (quality of life/exercise enjoyment). DISCUSSION: The anticipated results of the HI-PACE study will provide vital information on the health effects of high-intensity exercise in African Americans. This study will advance health disparity research and has the potential to influence future public health guidelines for physical activity. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02892331 . Registered on September 8, 2016.

Telemedicine-Based Health Coaching Is Effective for Inducing Weight Loss and Improving Metabolic Markers.

BACKGROUND: To assess the efficacy of health coaching (HC) delivered through videoconferencing (VC) to favorably change physical activity (PA), weight, and metabolic markers in adults with high body mass index (BMI). MATERIALS AND METHODS: Thirty adults (BMI ≥30 kg/m2) were randomly assigned to one of three groups: VC, in-person (IP), or control group (CG). Participants received wireless watches and weight scales to sync with their personal smartphones; recorded data were wirelessly uploaded to a secure database. Participants assigned to VC and IP received individualized HC by a multidisciplinary team (registered dietitian, exercise physiologist, and medical doctor) based on data uploaded over the 12-week intervention. Steps/day and weight loss were analyzed through analyses of covariance. RESULTS: Within- and between-group changes in weight (kg), glucose, insulin, hemoglobin A1c (HbA1c), and Homeostasis Model Assessment estimate of insulin resistance (HOMA-IR) were analyzed through analyses of variance. Weight loss was greater (p < 0.05) for VC (8.23 ± 4.5 kg; 7.7%) than IP (3.2 ± 2.6 kg; 3.4%) and CG (2.9 ± 3.9 kg; 3.3%), respectively. Steps/day were significantly higher in VC than IP at week 4 and VC was significantly higher than the CG at weeks 6, 8, 9, and 11 (p ≤ 0.05). No within- or between-group differences were found for glucose, insulin, or HbA1C. HOMA-IR decreased for VC only (p ≤ 0.05). CONCLUSIONS: Our innovative, multidisciplinary, telemedicine HC delivered through VC led to more favorable changes in weight loss, PA (steps/day), and HOMA-IR than IP or no HC. VC may be an economical approach to improve health and promote behavior change in obese adults. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT03278951.

The Effects of Exercise and Physical Activity on Weight Loss and Maintenance.

Obesity represents a major health problem in the United States and is associated with increased prevalence of cardiovascular (CV) disease risk factors. Physical activity (PA) and exercise training (ET) are associated with reduced CV risk, improved cardiometabolic risk factors, and facilitated weight loss through creating a negative energy balance. Clinicians need to counsel overweight and obese patients on how much PA/ET is needed to promote weight loss and weight loss maintenance. This will help establish realistic expectations and maximize improvements in CV risk factors. Although the minimum guidelines for aerobic PA (150 min of moderate or 75 min of vigorous physical activity per week) can improve CV health, these levels are generally inadequate for clinically significant weight loss or weight maintenance without caloric restriction. The purpose of this review is to evaluate the role of ET to promote clinically significant weight loss and promote weight maintenance. In particular, we will evaluate the likelihood of weight loss from ET programs composed of aerobic training only, resistance training only and programs that combine diet and ET. We will also explore the role of PA in promoting short-term and long-term weight maintenance.

Effects of aerobic training with and without weight loss on insulin sensitivity and lipids.

PURPOSE: The purpose of this study is to evaluate the effect of exercise training with modest or greater weight loss (≥3%) or not (<3%) on insulin sensitivity, lipoprotein concentrations, and lipoprotein particle size in overweight and obese participants. METHODS: Adults (N = 163, body mass index: 25-37 [kg/m2]) participated in 8 months of exercise training. Insulin sensitivity, lipid concentrations, lipid particle size and other cardiometabolic variables were measured at baseline and follow-up. Participants were categorized by whether they achieved at least modest weight loss (≥ 3%) or not (<3%) following the intervention. RESULTS: A greater improvement in insulin sensitivity was observed in adults performing exercise training with at least modest weight loss (2.2 mU·l-1 ·min -1, CI: 1.5 to 2.8) compared to those who did not (0.8 mU·l-1 ·min -1, CI: 0.5 to 1.2). Similar results were observed for acute insulin response, triglycerides, non-HDL cholesterol concentration, low density lipoprotein (LDL) particle size and high density lipoprotein (HDL) particle size (p<0.05), when all exercise groups were combined. No significant results across weight loss categories were observed for LDL, HDL, glucose, or insulin levels. CONCLUSION: The present study suggests that aerobic exercise combined with at least modest weight loss leads to greater improvements in insulin sensitivity, triglycerides as well as other non-traditional lipid risk factors (non-HDL cholesterol, HDL/LDL particle size). Clinicians should advocate patients who are overweight/obese to exercise and obtain modest weight loss for improved cardiovascular benefits.

Cardiorespiratory Fitness and Exercise Training in African Americans.

African Americans (AAs) have a higher risk for cardiovascular disease (CVD) compared to their Caucasian American (CA) counterparts, which represents a major health disparity. Low cardiorespiratory fitness (CRF) is a well-established independent risk factor for all-cause and CVD mortality, which has been shown across many epidemiological and clinical trials to be lower in AAs compared to CAs. While much attention has been given to traditional health disparity risk factors (e.g. blood pressure, obesity, insulin resistance), the impact of racial differences in CRF on CVD mortality has not been widely considered. Thus, the purpose of this paper is to review the literature on: 1) the magnitude of racial differences in CRF and the potential clinical significance, 2) examine the relationships between CRF and mortality in AAs and CAs, 3) Potential physiological and behavioral etiologies for racial difference in CRF, and 4) the impact of exercise training on CRF and other cardiometabolic risk factors in AAs compared to CAs. Given that both CRF and change in CRF are associated with reduced CVD mortality, advocating aerobic exercise training or moderate to vigorous activities in AAs has the potential to reduce racial cardiovascular health disparities.

Combined Aerobic and Resistance Training Effects on Glucose Homeostasis, Fitness, and Other Major Health Indices: A Review of Current Guidelines.

The combination of aerobic and resistance training (AER + RES) is recommended by almost every major organization to improve health-related risk factors associated with sedentary behavior. Since the release of the Physical Activity Guidelines for Americans in 2008, several large well-controlled trials and ancillary reports have been published that provide further insight into the effects of AER + RES on health-related outcomes. The current manuscript examines the literature on the effects of AER + RES on major clinical outcomes, including glucose homeostasis, cardiorespiratory fitness (CRF), and muscular strength, as well as other important clinical outcomes, including metabolic syndrome, hypertension, dyslipidemia, and quality of life. Collectively, research suggests that AER + RES and AER or RES alone improves glycemic control and insulin sensitivity compared with continued sedentary behavior. Significant changes in CRF are also observed, suggesting a reduction in cardiovascular disease-related mortality risk. Reduced adiposity, especially abdominal adiposity, and increased strength may also interact with CRF to promote additional health benefits associated with AER + RES. While findings from our review support current physical activity guidelines, a paucity of research limits the generalizability of the results.