Running head: EXERCISE INTERVENTIONS 1

Integrative Review: Exercise Interventions

Suzanna H. Goode

Bon Secours Memorial College of Nursing

Arlene Holowaychuk

Nursing Research 4122

10/25/17

“I pledge honor code”

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Abstract

The goal of this integrative review is to examine the literature available on the effects of

resistance versus combined aerobic and resistance exercises on weight loss and body

composition changes in overweight and obese adults. With the obesity epidemic continuing to

worsen, researchers must make haste to discover what modalities will be most effective to

decrease rates of obesity worldwide. EBSCO Discovery Services, an online database, was used

to locate the articles related to the research question. The narrowed search returned with 253 of

articles, five of which addressed aspects of the writer’s PICO question. Each of the five article

concluded with similar results that combined methods proved to be the most effective for weight

loss and body composition change. Limitations to this review include the writer’s lack of

experience researching larger quantities of information at one time and limited the time

constraint allotted to the review. The studies provide implications for practice such as teaching

the obese and overweight population to utilize resistance and aerobic exercise training methods

for weight loss and fat loss success. Future research should aim to study larger sample size

groups to confirm these findings.

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An Integrative Review: Exercise Interventions

The purpose of this integrative review is to examine research related to exercise

interventions for the adult overweight/obese population and their effects on weight loss and body

composition changes. Obesity continues to be a rising epidemic across national borders. This

crisis has inspired researchers to investigate interventions that will be the most effective and

beneficial for weight loss. Weight loss is proven to be rewarding in regards to comorbidities and

other disease processes correlated with obesity including decreased insulin sensitivity and

metabolic functions (Glynn et al., 2015). All exercise interventions are already known to have

positive effects on weight loss, especially in conjunction with diet changes. The effects of

aerobic exercise alone has been readily researched. However, there is limited analysis

comparing resistance exercise to combined aerobic-resistance interventions. This paper will seek

to answer the writer’s PICO question does resistance exercise influence weight loss over

combined aerobic and resistance training in overweight/obese persons?

Design and Search Methods

Five research articles were selected as the focus for this integrative review. The EBSCO

Discovery Services database was utilized to search and locate the chosen articles related to the

writer’s research question. Searched terms and keywords included: ‘aerobic exercise’,

‘resistance exercise’, ‘weight loss’, ‘fat loss’, ‘overweight’, ‘obese’, and ‘adults.’ EBSCO

Discovery Services located 576 articles that included one or more of these key terms. The

results were first filtered to search articles published between 2012 and 2017. Then, the search

was narrowed to present articles that were peer-reviewed and written or published in English.

The 253 remaining articles were reviewed by the writer in order to select literature containing

pertinent information to the writer’s PICO question, stated in the previous section above. The
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five articles discussed in this review were chosen based on inclusion/exclusion criteria. From the

search results, articles were selected based on pertinence to the PICO question and rejected when

research questions were not closely related to the writer’s.

Findings and Results

The findings and results of the five reviewed articles clearly indicated that neither aerobic

or resistance training alone would be most effective for weight loss. Overall, results showed that

combined resistance and aerobic exercise methods achieved the best results in the overweight

population, including weight loss and beneficial body composition changes such as fat loss and

preservation of muscle mass (Contrò et al., 2017; Glynn et al., 2015; Ho, Dhaliwal, Hills & Pal,

2012; Kim et al., 2016; Villareal et al., 2017). The combined approach is considered to be the

best method to suggest to the adult overweight and obese population for the goal of weight loss

and other health advantages. The articles were summarized by the writer and this information is

located in Table 1. The writer organized this review according to the following categories:

exercise intervention strategies and tools for analysis.

Exercise Intervention Strategies

All five articles implemented exercise interventions within their study, but the methods

chosen to conduct each exercise intervention were differing between each article (Contrò et al.,

2017; Glynn et al., 2015; Ho, Dhaliwal, Hills & Pal, 2012; Kim et al., 2016; Villareal et al.,

2017). In one randomized quantitative trial study, researchers Ho, Dhaliwal, Hills & Pal (2012)

sought to determine what types of exercise would improve the cardiovascular risk profiles or be

the most effective for overweight and obese persons. The researchers assigned 16 members to

the control group which had no exercise interventions at all. Exercise interventions for each

group were to be completed five times per week over 12 weeks. The aerobic group of 15
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individuals completed 30 minutes of aerobic activity by means of walking on the treadmill. The

resistance exercise group, comprised of 16 members, completed 30 minutes of resistance

exercise using the gym’s weighted machines. Lastly, the combined group completed 15 minutes

of aerobic and 15 minutes of resistance exercise in each workout. Researchers measured many

other values, but weight in kg, BMI, fat in kg, and body fat percentage at baseline, 8 weeks, and

12 weeks was most pertinent to the PICOT question. Results showed decreases in body weight,

BMI, and total body fat for the combined exercise intervention in comparison to aerobic,

resistance, and control group. The researchers concluded that 12-weeks of mixed aerobic and

resistance exercise will achieve significant positive effects for cardiovascular disease risk factors

in this population (Ho, Dhaliwal, Hills & Pal, 2012).

Another randomized quantitative study conducted by Contrò et al. (2017) was set up with

similar experimental groups, but added the component of circuit training. Researchers sought to

compare different circuit training protocols to observe which was best for weight loss in this

population since there had been hazy research on this topic in the past. The authors examined 45

adult females who were sedentary and overweight. Subjects were randomly assigned to one of

three circuit groups: aerobic-tone-aerobic (ATA), aerobic-circuit-aerobic (ACA), and mini-

trampoline circuit (MTC). The control group completed classical circuit weight training (CWT).

Exercise protocol for each group was performed in “circuit”, meaning subjects completed

multiple sets of exercises of medium to high repetitions with little to no breaks in between. The

participants worked out 3 times per week for 1 hour duration over 12 weeks. Each 60 minute

session included a warm up, cool down, and 5 minutes of stretching. The ATA group exercised

aerobically (cardio) and anaerobically (resistance) by alternating from the treadmill to five

exercise stations. On the treadmill, participants worked up to a heart rate max of 70%. The
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exercise stations included exercises such as push-ups, lateral shoulder raise, abdominal crunches,

and squats (Contrò et al., 2017). The ACA group combined body weight aerobic exercises such

as jumping jacks or mountain climbers with resistance exercises with the subject’s choice of

free-weights or strength machines for the resistance piece of this second combined intervention.

The MTC group completed aerobic exercise only using a mini trampoline. Lastly, the CWT

group performed major muscle group resistance training. Participants in the CWT group

completed 2 sets of 10 exercises (15 repetitions per exercise). Data collected at baseline and

after 12 weeks included BMI, weight in kg, and cholesterol/triglyceride levels. Each method

resulted in total body mass and body fat reduction; however the ATA method of combined

resistance and aerobic exercise decreased these variable more than the other groups. ACA

method achieved statistically significant results with decreased total body mass (P=0.013) as

well as reduced body fat (P<0.001). In addition, MTC was the most effective at improving

participants lipid profiles (Contrò et al., 2017).

In 2016, Kim et al. conducted a pilot study which aimed to investigate how aerobic and

resistance exercise training might affect serum irisin levels, a therapeutic myokine triggered by

exercise, and body composition. This quantitative study measured values at baseline and after 8

weeks including body weight in kg, body fat mass and percentage, BMI, and circulating irisin

levels. Forty-eight overweight or obese adults from 19 to 35 years old were recruited via email

from Seoul National University in Korea. They were assigned to one of three groups: control,

resistance, or aerobic. The exercise strategy used for this study was for subjects to complete 60

minute workouts at the university gym, 5 days a week, for a total of 8 weeks. The aerobic

program consisted of whole body exercise like running on the treadmill and or cycling. Whereas,

the resistance program consisted of upper body exercises on Mondays and Wednesdays and
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lower body exercises on Tuesdays and Thursdays. On Fridays, participants completed combined

upper and lower body resistance training. After 8 weeks of training in both exercise groups, body

composition (BMI, fat percentage, and body weight) changes were significant. Presence of irisin

circulating in the blood was associated with obesity and had a positive correlation with BMI.

Positive body composition changes are closely related to changes of circulating irisin after

exercise in the overweight/obese person (Kim et al., 2016).

A North Carolina quantitative study sought to investigate the effects of exercise

interventions on branched-chain amino acid (BCAA) metabolism and insulin sensitivity (IS) in

overweight individuals (Glynn et al., 2015). Researchers hypothesized that the combined group

would be the most successful and beneficial. Although the researcher’s study aim differs from

this writer’s PICO question, researchers measure variables that are relevant including BMI, body

mass, and fat mass percentage at baseline and after 6 months. Researchers investigated variables

including protein turnover, hyperinsulinemic clamp, plasma and breath analyses, and

muscle/urine analyses. However, the exercise training variable is the focus of this review.

Twenty-three individuals took part in the study and 4 did not complete it. Overweight

participants were assigned to participate in aerobic exercise 3 to 4 times a week as well as whole-

body resistance training utilizing eight weight machines. The results supported that these

interventions lead to weight loss, decreased body fat percentage, and had a positive correlation

with insulin sensitivity (Glynn et al., 2015). IS improvements were predicted by the molar sum

of circulating BCAA’s. The combined resistance and aerobic exercise increased the sum of

circulating BCAA’s (Glynn et al., 2015) .

The fifth study reviewed also explored obese individuals over a 6-month time-frame.

Villareal et al. (2017) conducted research to consider effects of aerobic, resistance, or

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combination exercise on the reduction of muscle and bone mass and frailty induced by weight

loss in older adults. 140 obese older adults 65 years old or greater were randomized into groups:

control, aerobic, resistance, or combined. Researchers measured BMI, lean mass, and fat mass at

baseline and after 26 weeks in addition to measuring frailty/functionality of the obese older

adult. Each experimental group was asked to attend weight management program in conjunction

with their exercise program. The control group was asked not to do this; however there were

opportunities for this group to receive educational information regarding healthy diet at each

monthly visit. The aerobic group participated in 60 minute sessions 3 times per week including

10 minutes of stretching, 40 minutes of aerobic exercise, and 10 minutes of balance exercises.

The resistance group followed the same formula, 60 minute sessions, but the 40 minutes were

allotted to resistance exercise using upper and lower body weight machines; one to two sets of 8

to 12 repetitions per machine. The combined group exercised for 75 to 90 minutes, with 30-40

minutes spent on aerobic and resistance each (Villareal et al., 2017). The aerobic, resistance, and

combined groups all experienced weight loss, but lean mass decreased much less in the

combined group. The combined resistance and aerobic exercise decreased frailty, increased

physical functioning, and preserved lean mass of obese older adults than just aerobic or

resistance exercise alone (Villareal et al., 2017).

Tools for Analysis

All five research articles used quantitative variables to analyze their data. For example,

Body Mass Index (BMI) was measured in every study through the standardized body mass index

calculation. Weight or body mass was measured via electronic scales and recorded in kg’s in

each article as well (Contrò et al., 2017; Glynn et al., 2015; Ho, Dhaliwal, Hills & Pal, 2012;

Kim et al., 2016; Villareal et al., 2017). Only one out of the five articles used DXA (dual energy
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X-ray absorptiometry) scan to measure body fat percentage (2012), which is the most accurate

way to measure this variable. However, two articles used BIA (bioelectrical impedance analysis)

to measure body composition such as body fat percentage (2016). One article made no mention

of which tool was used to measure and analyze body composition (2016). Lunar DPX was

another tool used to measure fat mass, lean mass, and bone density in one study (Villareal et al.,

2017). In this same article, survey methods were used to measure quality of life. The survey was

entitled “Short Form Health Survey” and consisted of questions regarding activities of daily

living and life satisfaction (Villareal et al., 2017). This same study measured frailty through a

Physical Performance Test (PPT) which scored individuals on a scale, with higher numbers

meaning better performance with daily functioning. Although each study measured additional

variables through other tools, all tools pertinent to the PICO question are mentioned above.

There was much overlap in the tools used for analysis since the five research articles measured

many of the same variables to determine weight loss and body composition changes.

Discussion and Implications

The results of the research reviewed all suggest that combined aerobic and resistance

exercise interventions were most beneficial for weight loss and body composition changes like

body fat reduction, especially if performed in circuit (Contrò et al., 2017; Glynn et al., 2015; Ho,

Dhaliwal, Hills & Pal, 2012; Kim et al., 2016; Villareal et al., 2017). These findings support the

PICO enquiry of the writer, which aimed to discover whether resistance or combined

aerobic/resistance exercise would increase weight loss more than the other. The evidence

supports the use of combined exercise interventions to combat the obesity epidemic and increase

an overweight person’s chances of weight loss and fat loss success. Other benefits of combined

aerobic and resistance exercise include: decreased frailty in older adults, improved CVD risk
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profiles, improved insulin sensitivity, and improved metabolism (Contrò et al., 2017; Glynn et

al., 2015; Ho, Dhaliwal, Hills & Pal, 2012; Kim et al., 2016; Villareal et al., 2017). All five

articles recommended combined exercise as the most effective means of weight loss and body

composition improvement. One study even suggested performing combined aerobic and

resistance training in circuit to achieve the best results in the overweight population. This

information should be included in the education provided for patients. All articles mentioned the

need for more research to continue to solidify their findings. Specifically, they want to study

more male participants.

Limitations and Conclusions

Each article listed limitations to their study. Four out of five article included small sample

size as a limitation that could have affected the studies’ accuracy in reflecting the population

examined (Glynn et al., 2015; Ho, Dhaliwal, Hills & Pal, 2012; Kim et al., 2016; Villareal et al.,

2017). In the study conducted by Villareal et al. (2017), those who were physically able to

participate may not have been an accurate representation of the standard older obese population.

The sample size was not large enough to look at differences between sexes. However, authors

came to the conclusion that aerobic plus resistance exercise was the best intervention to reduce

frailty and improve physical functioning of older obese adults (2015). In the study conducted by

Kim et al. (2016), there was a lack of consideration for gender differences such as differences in

metabolism. Other limitations include a high dropout rate and analysis of body composition by

BIA, which produces less conclusive results compared to DEXA (2016). Authors concluded

their research in stating they presented new insight into the increase of circulating irisin levels in

overweight/obese with resistance/aerobic exercise training. Although the association between

exercise induced irisin and body composition changes were evident, the specific causal
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relationship remains unclear, presenting opportunity for future research (2016). The study

conducted by Contrò et al. (2017) did not state limitations, but researchers concluded that circuit

training protocol exercise methods lead to the most beneficial body composition changes like

weight loss and fat loss. The research from Glynn et al. (2015) addressed the diet factor as it

easily could have affected individual’s results, but in summary, BCAA’s were the best predictor

of improvement in IS induced by resistance and aerobic combine exercise strategy. Ho,

Dhaliwal, Hills & Pal’s (2012) study had limitations including: majority of participants were

female, seasonal changes, decreased reported energy intake contributing to body weight changes,

discrepancies in monitored exercise intensity and frequency, and high reliance on participant

honesty and self-reporting. However, the authors acknowledge their successful interventions

may not be successful for all individuals.

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References

Contrò, V., Bianco, A., Cooper, J., Sacco, A., Macchiarella, A., Traina, M., & Proia, P.

(2017). Effects of different circuit training protocols on body mass, fat mass and blood

parameters in overweight adults. Journal Of Biological Research - Bollettino Della

Società Italiana Di Biologia Sperimentale, 90(1). http://dx.doi.org/10.4081/jbr.2017.6279

Glynn, E., Piner, L., Huffman, K., Slentz, C., Elliot-Penry, L., & AbouAssi, H. et al. (2015).

Impact of combined resistance and aerobic exercise training on branched-chain amino

acid turnover, glycine metabolism and insulin sensitivity in overweight humans.

Diabetologia, 58(10), 2324-2335. http://dx.doi.org/10.1007/s00125-015-3705-6

Ho, S., Dhaliwal, S., Hills, A., & Pal, S. (2012). The effect of 12 weeks of aerobic, resistance or

combination exercise training on cardiovascular risk factors in the overweight and obese

in a randomized trial. BMC Public Health, 12(1). http://dx.doi.org/10.1186/1471-2458-

12-704

Kim, H., Lee, H., So, B., Son, J., Yoon, D., & Song, W. (2016). Effect of aerobic training

and resistance training on circulating irisin level and their association with change of

body composition in overweight/obese adults: a pilot study. Physiological Research.

Villareal, D., Aguirre, L., Gurney, A., Walters, D., Sinacore, D., & Colombo, E. et al.

(2017). Exercise Type in Dieting Obese Older Adults. New England Journal Of

Medicine, 377(6), 598-600. http://dx.doi.org/10.1056/nejmc1708176

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Table 1 : Quantitative Summary

First Author A1: Suleen S Ho (2012) - No qualifications were identified
(Year)/Qualifications within the article.

Background/Problem A1:
Statement ● Evidence already supports CVD risk factors
improve through exercise.
● There is a recommendation for the general public of
30 minutes of physical activity a day for improving
general health, but there is not much research out
there on what types of exercise will improve
cardiovascular profiles or be the most effective in
overweight/obese persons.
● Within other studies, researchers looked into how
aerobic exercise affected CVD (cardiovascular
disease) profiles, but did not address other forms
such as resistance training.
● Researchers seek to examine “whether 12 weeks of
moderate-intensity aerobic, resistance, or combined
exercise training would induce and sustain
improvements in cardiovascular risk profile, weight,
and fat loss in overweight and obese adults
compared to no exercise” (Ho, Dhaliwal, Hills &
Pal, 2012).

Conceptual/theoretical A1: No clearly identified theoretical framework was used

Framework to formulate this study.

Design/ A1: Quantitative, randomized parallel design trial; 12 week

Method/Philosophical study
Underpinnings

Sample/ Setting/Ethical A1:

Considerations ● Sample: 16 overweight/obese men and 81
overweight/obese women; total sample size of 97
participants; age 44-66 years; recruited from general
population; sedentary/inactive/participating in less
than 1hr of exercise per week.
● Setting: Australia
● Ethical Considerations: Study was registered with
Australian New Zealand Clinical Trials Registry;
informed consent received from participants (which
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means it would be IRB approved in US); study was

approved by Curtin University Ethics Committee;
participation was voluntary;
confidentiality/autonomy/safety was maintained.

Major Variables Studied A1:

(and their definition), if
appropriate
● Variables: 1 control group, 3 experimental groups
(aerobic, resistance, and combined)
● Control group (G1): 16 members; no exercise
interventions
● Aerobic group (G2): 15 members; 30 mins aerobic
activity 5x/week (treadmill walking)
● Resistance group (G3): 16 members; 30 mins
resistance exercise 5x/week using weight resistance
machines
● Combined group (G4): 17 members; 15 mins of
aerobic + 15 mins of resistance exercise 5x/week

Measurement Tool/Data A1: Body mass index equation to calculate BMI, weight
Collection Method measured through electronic scales, total body fat
percentages measured by DXA at baseline and 12 weeks;
other values measured, but not applicable to PICOT
question.

Data Analysis A1: General linear model used for analysis, after adjusting
for group and baseline values, paired t-test analyzed the
within-group data.
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Findings/Discussion A1:
● Researchers measured many other values, but
weight in kg, BMI, fat in kg, and body fat
percentage at baseline, 8 weeks, and 12 weeks was
all that was pertinent to the PICOT question; the
values listed by researchers are mean values.
● In the combination group there were significant
decreases in body weight, BMI, and total body fat in
comparison to the aerobic and resistance groups.
● The researchers concluded that 12-weeks of mixed
aerobic and resistance exercise will achieve
significant positive effects for CVD risk factors in
this population.

Appraisal/Worth to A1:
practice ● Well researched article, study well-conducted
● Authors state their limitations: participant stress,
anxiety, and time since last exercise session; mainly
female participants; seasonal change factors, issues
monitoring exercise intensity and frequency,
reliance on participant honesty/accuracy with self-
reported information of ⅖ exercises per week - all
could have affected results.
● Authors did not clearly state strengths, but did
suggest generalizing study results to national
borders (may be inappropriate w sample size <100
individuals)
● Overall, great worth to practice, recommend
combination exercise to this population, especially
females

First Author A2: Hee-Jae Kim (2016) - No qualifications specifically

(Year)/Qualifications identified, but study was conducted through Health and
Science Laboratory, Institute of Sport Science, Seoul
National University, Seoul, Korea, Institute on Aging, and
Seoul National University; supported by National Research
Foundation of Korea; funded by Ministry of Science, ICT
and Future Planning, and Ministry of Education - assuming
authors are qualified with all this support.
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Background/Problem A2:
Statement · Irisin is a myokine that is triggered by exercise and is
therapeutic for obese individuals or those with type II DM.
· Although irisin’s therapeutic role in obesity is known,
there was a need for research regarding circulating irisin
levels in correlation with different types of exercise and
body composition for obese persons. This was the
motivation of the study.
· “The objective of this study is to reveal the effects of
aerobic training and
resistance training on circulating irisin levels and their
associations with
change in body composition in overweight/obese adults”
(Kim et al., 2016).

Conceptual/theoretical A2: No clearly identifiable theoretical framework

Framework mentioned to be used in this study.

Design/ A2:
Method/Philosophical · Quantitative
Underpinnings · Pilot study
· 8 week study

Sample/ Setting/Ethical A2:

Considerations · Sample: 48 total overweight/obese adults between ages
of 19 and 35 years; l recruited from email responders via
Seoul National University.
· Setting: Seoul, Korea
· Ethical Considerations: Study was approved by Seoul
National University Ethics Committee and informed
consent was received from participants.
· Confidentiality/autonomy/safety maintained
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Major Variables Studied A2:

(and their definition), if · Variables: 1 control group, 2 experimental groups
appropriate (resistance and aerobic); assigned randomly
· 1 control group (10), 1 aerobic group (19), 1 resistance
group (19)
· Exercise protocol: 5 days/week throughout 8 weeks at
the dormitory gym
· Aerobic program: 60 mins of whole body exercise
(treadmill or treadmill + cycling)
· Resistance program: 60 mins of upper (mon/wed) or lower
body exercises (tues/thurs) or combined (fri)

Measurement Tool/Data A2: Body mass index equation used to calculate BMI, study
Collection Method used “BIA” for body fat percentage measurements, body
weight calculated via scales in kg. Other values were
measured, such as irisin levels, but these values were not
pertinent to the PICOT question.

Data Analysis A2: Results were expressed as mean values, One-way

analysis of variance (ANOVA) used to calculate
homogeneity of participants among three groups baseline,
significant difference was indicated through the adjusted P
value of less than 0.5

Findings/Discussion A2:
· The average attendance for exercise sessions was only
87/4%
· After 8 weeks of training in both exercise groups, body
composition (BMI, fat percentage, and body weight)
changes were significant
· Presence of irisin circulating in blood is associated with
obesity and had a positive correlation with BMI
· Positive body composition changes are closely related to
changes of circulating irisin after exercise in the
overweight/obese person.
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Appraisal/Worth to A2:
practice · Well researched article, study well-conducted overall
· Authors state their limitations: small sample size, no
consideration for gender differences, high dropout rate,
analysis of body composition by BIA vs the more accurate
DXA, specific strengths not listed
· Good worth to practice, supports any recommendation of
exercise to obese/overweight individuals
· Highlights need for future research on effects of various
exercise programs in relation to body composition in
obese/overweight

First Author A3: Erin L. Glynn (2015) - Erin is an independent

(Year)/Qualifications researcher with a PhD and expertise in nutrition and
dietetics, diabetology, and clinical trials. Study supported
by grant from National Institutes of Health, National
Institute of Diabetes and Digestive and Kidney Disease as
well as other organizations.

Background/Problem A3:
Statement · Exercise is known to improve metabolic dysfunction.
· “Skeletal muscle is a major site of insulin action, and thus,
a practice target or therapeutic interventions to improve
insulin sensitivity” (Glynn et al., 2015).
·“The purpose of this study was to investigate the
relationship between BCAA metabolism and IS in
overweight individuals during exercise intervention”
(Glynn et al., 2015).
· Researchers wanted to test the impact of different exercise
regimes and hypothesized that the combined group would
be the most successful/beneficial.

Conceptual/theoretical A3: No clearly identifiable theoretical framework utilized

Framework for this study.
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Design/ A3:
Method/Philosophical · Quantitative; Experimental design; Randomized
Underpinnings · 6 month study

Sample/ Setting/Ethical A3:

Considerations · Sample: 23 overweight individuals, 4 did not complete
· Setting: North Carolina
· Ethical Considerations: Study was approved by the
Institutional Review Board at Duke University Medical
Center (which was in compliance with the Declaration of
Helsinki and revised 1983) (IRB approval); written
informed consent prior to enrollment was given to
participants
· Confidentiality/autonomy/safety maintained

Major Variables Studied A3:

(and their definition), if · Many variables measured
appropriate · Variables applicable to writer’s PICO question: exercise
modalities (aerobic, resistance) and control group
· 6 month training regime
· Aerobic group: exercise 3-4x/ week
· Resistance group: whole-body resistance exercise on 8
different weight machines
· Adherence goal: 80%

Measurement Tool/Data A3: Body mass index calculated BMI formula, weight
Collection Method measured in kg via scales, body fat composition tool not
mentioned; many other serum levels measured (BCAA’s
and amino acid turnover, glycerin metabolism, insulin
sensitivity for example)

Data Analysis A3: *OW = overweight; mean values, unpaired t-test

compared OW groups to control groups, paired t-test
compared OW-trained and untrained, two-sided P values
unadjusted when multiple comparisons were necessary; p
less than or equal to 0.01was significant, statistical analyses
performed using SAS version 9.3.
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Findings/Discussion A3:
· Positive body composition changes related to combined
resistance and aerobic exercise
program
· Combined methods also increase endurance (time to
exhaustion)
· Positive body composition changes (weight loss,
decreased body fat percentage, etc.)
had positive correlation with improvements in insulin
sensitivity
· Improvements in insulin sensitivity were predicted by
increases in molar sum of circulating BCAA’s (branched-
chain amino acids).
· Combined resistance and aerobic exercise increased molar
sum of circulating BCAA’s.

Appraisal/Worth to A3:
practice · Well conducted and researched, highly
professional/scientific study
· Authors state their limitations: small sample size; “while it
is known that exercise has acute effects on measures of IS
and protein turnover, the participants were exercising 3
days/week...24-36 hours after an exercise session represents
their ‘new normal’ metabolic state on days they were not
exercising and represents a combination of chronic and
acute exercise effects” (Glynn et al., 2015); participants
were not asked to change their diet, which could affect
individuals’ results
· Of worth to practice - researchers measure various
metabolism variables in overweight population
· Use information to brainstorm new interventions for this
population specific to improving metabolic qualities in
obese individuals

First Author A4: Dennis T. Villareal MD (2017); remaining authors are

(Year)/Qualifications qualified (MD, PhD, etc.)
EXERCISE INTERVENTIONS 21

Background/Problem A4:
Statement · Researchers recognize obesity can cause older adults to
become frailer, but also know
weight loss can contribute to age-related muscle and bone
mass loss.
· Researchers sought to investigate “the effectiveness of
several exercise modes in reversing frailty and preventing
reduction in muscle and bone mass induced by
weight loss” (Villareal et al., 2017).

Conceptual/theoretical A4: No clearly identifiable theoretical framework

Framework mentioned in the study.

Design/ A4:
Method/Philosophical · Quantitative
Underpinnings · Experimental design
· Randomized
· 26 week study

Sample/ Setting/Ethical A4:

Considerations · Sample size: 160 obese older adults, 140 actually
completed study, 65 y/o or
greater, recruited via advertisements
· Setting: New Mexico
· Ethical Considerations: informed consent provided, IRB
approved, monitored by independent data and safety
monitoring board, all researchers vouched for
integrity/accuracy, no commercial support received
· Participants all completed thorough medical screenings
prior to acceptance to participate in study for safety reasons

Major Variables Studied A4:

(and their definition), if · Age of population (65 +)
appropriate · Exercise modalities
o Control
(no exercise), resistance, aerobic, combined
· Frailty and functionality
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Measurement Tool/Data
Collection Method A4: Physical Performance Test measured frailty on a scale
18-31 on modified version (higher scores means better
performance), functional status questionnaire, Lunar DPX
measured fat mass, lean mass, and bone mineral density,
quality of life (Short-Form Health Survey)

Data Analysis A4: Sample size of 40 given 80% power to detect a mean
difference, SAS software version 9.4, baseline
characteristics used analysis of variance/Fisher’s extract
test, Bonferroni correction adjusted for comparisons,
Dunnett’s test, Fisher Hayter test.

Findings/Discussion A4:
· Aerobic, resistance, and combined all experienced weight
loss, lean mass decreased much less in combined group.
· Overall, combined resistance and aerobic exercise
decreased frailty, increased physical functioning, and
preserved lean mass of obese older adults than just aerobic
or resistance exercise alone.

Appraisal/Worth to A4:
practice · Well conducted, well organized and
clear/understandable/concise in statements
· Authors state limitations and strengths in separate
paragraphs, clearly state new findings/suggestions of their
research, and make recommendations for future research
· Excellent worth to practice.

First Author A5: Valentina Contro (2017): qualifications not found listed
(Year)/Qualifications in article

Background/Problem A5:
Statement ● In the past, there has been “hazy” research regarding
aerobic vs resistance exercise for fat loss and
changes in body composition.
● Researchers sought to compare different circuit
training protocols to observe which is best for
EXERCISE INTERVENTIONS 23

weight loss.

Conceptual/theoretical A5: No clearly identifiable theoretical framework

Framework mentioned in the study.

Design/ A5:
Method/Philosophical ● Quantitative
Underpinnings ● Randomized
● 12 week study

Sample/Setting/Ethical A5:
Considerations ● Sample: 45 sedentary overweight females
● Setting: Italy
● Ethical Considerations: no mention of ethical
considerations in this article…

Major Variables Studied A5:

(and their definition), if
appropriate
● Overweight adult females
● Exercise modalities
○ Control (no exercise), weight training
(resistance), aerobic, & aerobic circuit
training (aerobic+body weight joint
resistance)

Measurement Tool/Data A5: Weight was measured using electronic scales in kg,
Collection Method body composition assessed by BIA (non-invasive), &
venous blood samples

Data Analysis
A5: Multivariate analysis of variance (MANOVA) to
compare difference in measures of weight, BMI, and lipid
profiles across groups; post-hoc Tukey-Kramer test for
pairwise comparisons, alpha comparison significance level
set at 5%, statistica software version 8.0 used for analysis.
EXERCISE INTERVENTIONS 24

Findings/Discussion A5:
● Circuit training (combined aerobic and resistance)
was seen to be the most effective intervention in
reduction of body weight and fat loss in the obese
female population.
● Oddly, decreased body fat mass did not correlate
with decrease in triglycerides or cholesterol

Appraisal/Worth to A5:
practice ● Well conducted, well organized and concise
● Translated Italian → English made it a more
challenging read
● Authors state few limitations
● Authors do not state strengths
● Clearly state their new research findings
● Excellent worth to practice