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Abstract

BACKGROUND:

Obesity and physical inactivity increase the risk for cardiovascular disease, Type 2 diabetes mellitus, hypertension, dyslipidemia and certain cancers. Exercise training and increased fitness promote positive changes in body composition and improve insulin sensitivity.

OBJECTIVE:

To investigate the effect of sequence order of combined strength and endurance training on new adiposity indices: visceral adiposity index (VAI), body adiposity index (BAI) and waist to hip ratio (WHtR) in overweight elderly women.

METHODS:

Forty overweight elderly women (age range: 60.34 $\pm$ 0.82 years old) were selected purposefully and randomly assigned into four groups: endurance, then strength (E $-$ $>$ S) ( $n=9$ ), strength, then endurance (S $=>$ E) ( $n=10$ ), alternative concurrent training (ACT) ( $n=12$ ), and control ( $n=9$ ) groups. Training was performed three times per week for eight weeks. Endurance training performed on a cycle ergometer (intensity: 60–88% MHR) and strength training included several selected exercises targeting upper and lower body (intensity: 40–75 1RM, 8–18 repeat).

RESULTS:

The results showed that the amount of weight, BMI, body fat percentage, BAI and WHtR have significantly decreased in E $+$ S, S $+$ E and ACT experimental groups ( $P<$ 0.05). No significant differences were found in VAI variable and triglyceride with sequence order of E $+$ S and S $+$ E, but after sequence order of ACT a significant decrease was seen in both variables ( $P\geqslant$ 0.05). There were no statistically significant differences between the three combined training groups for the mentioned variables ( $P\geqslant$ 0.05).

CONCLUSION:

Sequence does not seem to play a role in the positive effect on current adiposity indices of the investigated training programs.

Keywords

Combined training VAI BAI WHtR overweight elderly women

1. Introduction

Increasing prevalence of obesity and its relationship with chronic diseases such as diabetes, cardiovascular diseases, cancer and mortality put this disorder still on the top of health problems [1]. The first step to health programming is screening for and identification of obesity with easy and precise methods. Obesity which is said to the excess body fat can be identified precisely and reliably using imaging techniques such as magnetic resonance imaging (MRI), CT scan and dual-energy X-ray absorptiometry (DEXA), but in addition to be costly and time consuming, these techniques require skill in measuring and cannot be used for a large population. In contrast, anthropometric measures including waist circumference (WC), body mass index (BMI), and waist-to-hip ratio (WHR) are the most commonly used means to identify general and abdominal obesity [2].

BMI has been recommended as an international reference and standard for defining overweight and obesity [3]. Although a large number of health professionals are familiar with BMI index and use it in health care centers, BMI has some limitations: BMI is the index of total body fat but it gives no information about abdominal fat which is localized and has more to do with metabolic diseases. The other problem is that BMI does not differentiate between muscle body mass and body fat mass. Therefore, it is essential to replace BMI with accurate indexes which have fewer limitations [4].

Recently, it has been reported that these new indices including visceral adiposity index (VAI) and body adiposity index (BAI) make a reliable prediction of systemic diseases such as cardiovascular and metabolic disorder [5, 6].

VAI has been known as the fat distribution index showing metabolic risks indirectly. Moreover, VAI has been known as a useful tool for early detection of cardiac risk factors before metabolic syndrome develops. VAI is a simple mathematical relation based on gender-specific anthropometric models (WC, BMI) and functional parameters (triglyceride and HDL cholesterol) which shows body fat distribution and its function [7].

In an analysis conducted on 1518 Peruvian adults using a variety of actions to investigate obesity, VAI, WC and WHtR were the best predictors for metabolic syndrome. Especially, VAI has a good prediction power to show the risk of visceral obesity and high blood pressure [8].

In a large study, high VAI was associated with increased risk of coronary heart disease in Chinese men and women [9], however, there are also some conflicting results. A Canadian study showed non-superiority of VAI in predicting adipose tissue changes in postmenopausal women with low calorie diet in comparison to BMI and WC. These contradictory results have increased the need to prospective studies on VAI compared to other simple anthropometric ones [10]. Furthermore, research has shown that BAI can be used to show the body fat of adults, men, women and different ethnic groups without numerical modification. In another study, body fat was estimated using X-ray (DXA) and it was reported that hip circumference and height were highly correlated with body fat.

On the other hand, aging process leads to many adverse changes in body composition, muscular strength, aerobic capacity, health status and finally the practical capacity of persons [11]. Several studies have shown that endurance activity can reduce fat mass and increase muscles resistance to fatigue and increase in the maximum oxygen uptake (VO ${}_{\rm 2max}$ ), while strength training in aging can increase strength, fat-free mass and skeletal muscle power [12, 13, 14]. Strength and endurance training enhances function and health status by changing body composition. Therefore, both strength and endurance training prescription is recommended to improve functional capacity and body composition in elderly people [15].

Concurrent endurance-strength training in regular training program is called combined training. Various adaptation during combined strength and endurance training has been reported in the classic research conducted by Hickson and studies following that [16]. Due to the specificity of training effects, the combination of both endurance and strength training has been recommended for optimal physical performance and health in the elderly people [15]. We propose that combining strength and endurance training in elderly people to improve physical fitness, body composition and metabolic status is more effective than each of the training methods alone. Kitamura et al. after 12 weeks of combined endurance and strength training in 14 elderly men aged 65–73, observed an improvement in insulin function and a significant reduction in body fat percentage in both strength and combined groups [17]. In contrast, after 14 weeks of combined training in 12 middle-aged women, Fleck et al. found no significant changes in the total body fat tissue and all regional measures of fat tissue and body fat percentage [19].

The sequence order of training, that is, the sequence of performing strength and endurance training may affect training induced adaptations as well. However, about improvement in adiposity indices, only a few studies have reported on whether strength training should be done before or after endurance training in a training session [20]. Following 10 weeks of combined endurance-resistance training in sedentary postmenopausal women, Taleghani et al. observed a significant change in all anthropometric indices including body mass, abdominal circumference, waist circumference, waist – hip ratio (WHR), BMI, and body fat percentage [21]. Also, Tibana et al. investigated the effect of eight weeks of resistance training in overweight women. They found no significant changes in WHtR and BAI [22]. To the best of our knowledge, no comprehensive research has yet been conducted on the effect of combined strength and endurance training on new adiposity indices. Therefore, considering the importance of new adiposity indices in metabolic syndrome and some chronic disease, the current research aimed to investigating the effect of sequence order of combined strength and endurance training on new adiposity indices (VAI, BAI, and WHtR) in overweight elderly women.

2. Method

2.1 Subjects

Forty elderly healthy women (age: 60.34 $\pm$ 0.82 years old, height: 155 $\pm$ 0.1 cm, weight: 71.72 $\pm$ 1.89 kg and BMI: 29.45 $\pm$ 0.63) were recruited from a retirement center in Shahrekord city, Iran. The present study was approved by the Human Research Committee of Shahrekord University Faculty of Human Sciences with Clinical Trial Registry Number: IRCT2014123019995N3. All subjects signed an informed consent for protection of human subjects. The subjects filled medical history questionnaire. They were assured that all questions contained would be kept confidential and their anthropometric characteristics were evaluated. The participants were required to be sedentary, defined as not having exercised for more than 20 minutes a week over the previous 6 months. Women taking any medication with chronic diseases or an orthopedic limitation that might have produced interference effects on their participation in an exercise program or laboratory test results were excluded.

2.2 Group assignment

After baseline assessments the participants were randomly assigned into 4 groups of 12 people. After the beginning of the experimental period, eight participants withdrew from the study due to personal reasons. At the end of the training period, the participants decreased to control group (N $=$ 9), strength after endurance training (E $+$ S, N $=$ 9), strength prior to endurance training (S $+$ E, N $=$ 10) and alternative concurrent training (ACT, N $=$ 12).

2.3 Anthropometric measures

2.3.1 Fat percentage

Body fat percentage was calculated using 3-site skin fold test (triceps, thigh and suprailiac) value, measured with a Lafayette Skinfold Caliper II. The suprailiac, thigh, and triceps sites were selected, since they are included in the 3-Site model for women developed by Pollock et al. [24]. Sites were measured on a rotation basis. Each site was measured three times and the mean of these three measurements was calculated. The three measures were at a distance of 2 mm from each other.

Density: 1.0994921 $-$ 0.0009929(x) $+$ 0.0000023(x ${}^{2}$ ) $-$ 0.0001392(y);

Fat percentage $=$ (4.95 $\div$ Density $-$ 4.5) $\times$ 100;

x $=$ Total skinfold thicknesses;

y $=$ age;

BMI $=$ weight/height ${}^{2}$ (kg/m ${}^{2}$ );

Weight $=$ weight in Kg, Height $=$ height in meter;

WHtR $=$ waist (cm)/height (cm);

Waist $=$ waist circumference in cm.

In order to estimate VAI, the following women specific formula was used:

VAI $=$ (WC/36.58 $+$ (1.89 $\times$ BMI)) $\times$ (TG/0.81) $\times$ (1.52/HDL);

WC: waist circumference in cm;

TG: Triglycerides in millimoles per liter (mmol/L);

HDL: High-density lipoprotein in millimoles per liter (mmol/L);

BAI was estimated using the following formula [25]:

BAI $=$ (HC/height ${}^{\text{1.5}}$ ) $-$ 18;

HC $=$ hip circumference in cm.

2.3.2 Biochemical indices measurement

After 12 hours of overnight fasting, subjects attended the specialized laboratory at 9:00 AM and the initial 5 ml blood sample was drawn by laboratory expert from their antecubital vein. Then centrifuged blood sample and its serum sample were separated and stored frozen at $-$ 70 ${}^{\circ}$ C for analysis. After collecting initial data, the 8-week training program at the gym began the next day. After training was completed, 24 hours following the last training session, anthropometric and laboratory measurements were performed again under initial testing conditions and time using the same tool by the researcher and laboratory expert. Triglycerides and high-density lipoprotein (HDL) were measured by enzymatic method using specialized kits (Pars Azmoon Co. Iran).

Table 1
Complete strength and endurance training periodization

Endurance training		Strength training
Intensity	Volume	Intensity	Repetitions	Sets	Sessions	Week
60%HRmax	16 min	40%1RM	16-18RM	2	3	1
66%HRmax	16 min	45%1RM	16-18RM	2	3	2
70%HRmax	20 min	50%1RM	12-14RM	2	3	3
74% HRmax	20 min	55%1RM	12-14RM	2	3	4
77%HRmax	25 min	60% 1RM	10-12RM	3	3	5
80%HRmax	25 min	65% 1RM	10-12RM	3	3	6
85%HRmax	30 min	70%1RM	8-10RM	3	3	7
88%HRmax	30 min	75%1RM	8-10RM	3	3	8

2.3.3 Maximal oxygen consumption

Modified Bruce protocol treadmill test was used to estimate maximal oxygen consumption of subjects. In this test, the subjects ran with a speed of 1.7 mph and a gradient of 0%. At three minute intervals the incline of the treadmill and the speed. The test continued until exhaustion. Testing time was measured and recorded. Estimated VO ${}_{\rm 2max}$ score was calculated using the following formulas [26].

VO ${}_{\rm 2max}$ $=$ 2.94 $\times$ time $+$ 3.74.

2.4 Muscle strength

Prior to the beginning of the muscle strength assessment, two familiarization sessions were performed with the following exercises: bench press, leg press, bent over lateral pull down, and bilateral biceps curl and bilateral triceps push down. During these two sessions, volunteers were expected to perform two series of ten sub-maximal repetitions, with 60 seconds of interval between series and exercises. Muscle strength was measured with the maximum repetition test (1-RM). The 1-RM leg press test used to measure the lower limb strength capabilities and upper limb strength was measured using 1-RM bench press test [27].

Maximal strength was calculated by using Berezicki equation [28]:

One Repetition Maximum (1RM) $=$ moved weight (kg) $\div$ 1.278 $-$ 0.0278 (number of repetition till exhaustion)

In order to use this equation and evaluate the maximal strength, replacement of weight was repeated to maximal amount in leg press and bench press until getting fatigued and then, it was evaluated through placing amount of weight and number of repeats in Berezicki equation. It must be mentioned that Berezicki equation is used for repeats under maximal amount that would be less than 10. Previous studies have examined the validity of these tests and have shown a high reliability for older people [28].

2.4.1 Concurrent training protocols

After the preliminary tests, the exercise intervention consisted of eight weeks of combined (strength plus endurance) training. Experimental groups performed three training sessions per week. Each session consisted of 10 minutes for general warm up and 50 minutes exercise training, and 10 minutes for the cooling-down processes. All participants performed a familiarization session for becoming familiar with training procedures, intensity and equipment. The training program for strength-endurance (S $-$ $>$ E) and endurance-strength (E $-$ $>$ S) groups was determined by the similar order of exercises. Sixteen Minute endurance training was performed at 45% VO ${}_{\rm 2max}$ on a cycling ergometer for the first two weeks and continued for 30 minutes until the eighth week (Table 1). Two minutes after the endurance training, the resistance training was performed as follows: bench press, leg press, bent over lateral pull down, and bilateral biceps curl and bilateral triceps push down the strength training was performed 8–18 repeat at 40% of 1-RM for first week and increased to 75% of 1RM until the eighth week. ACT protocol was characterized by five minutes of warm-up on the ergometer followed by one-third of time duration of endurance exercise alternated with one-third of volume of resistance training and this combination was repeated three times (Fig. 1). Each endurance phase was separated from each resistance phase by two minutes of recovery.

Figure 1.

Experimental training protocols. E $+$ S $=$ concurrent endurance-strength training; S $+$ E $=$ concurrent strength-endurance training; ACT $=$ alternating concurrent training.

Table 2

Changes in outcome variables within groups and between groups

Variables	Stage	E $+$ S	S $+$ E	ACT	Control	Between groups
						p value
Weight (kg)	Pre-test	74.66 $\pm$ 4.68	70.80 $\pm$ 3.90	66.41 $\pm$ 2.69	76.88 $\pm$ 3.78	0.017*
	Post-test	72.77 $\pm$ 4.67	68.60 $\pm$ 3.86	64.41 $\pm$ 2.44	76.66 $\pm$ 4.05
	Within group p	0.005*	0.003*	0.001*	0.51
Body mass index (BMI) (kg/m2)	Pre-test	29.89 $\pm$ 1.20	29.23 $\pm$ 1.71	27.57 $\pm$ 0.92	31.75 $\pm$ 0.91	0.023*
	Post-test	29.12 $\pm$ 1.21	28.30 $\pm$ 1.56	26.76 $\pm$ 0.86	31.63 $\pm$ 1.01
	Within group p	0.005*	0.003*	0.001*	0.42
Fat percentage (%)	Pre-test	30.49 $\pm$ 1.0	31.66 $\pm$ 1.35	30.65 $\pm$ 1.05	28.50 $\pm$ 0.92	0.08
	Post-test	26.90 $\pm$ 1.47	27.77 $\pm$ 1.30	27.88 $\pm$ 0.95	27.50 $\pm$ 1.0
	Within group p	0.001*	0.001*	0.001*	0.08
Waist circumference (cm)	Pre-test	3.08 $\pm$ 98.33	3.08 $\pm$ 95.40	2.64 $\pm$ 93.50	4.36 $\pm$ 97.44	0.006*
	Post-test	3.03 $\pm$ 93.44	3.18 $\pm$ 92.50	3.08 $\pm$ 90.25	4.53 $\pm$ 97.00
	Within group p	0.001*	0.008*	0.003*	0.22
Hip circumference (cm)	Pre-test	2.92 $\pm$ 107.66	0.01 $\pm$ 108.00	1.88 $\pm$ 100.83	2.63 $\pm$ 109.77	0.17
	Post-test	3.46 $\pm$ 104.33	3.40 $\pm$ 105.00	1.73 $\pm$ 98.25	2.74 $\pm$ 109.11
	Within group p	0.026*	0.009*	0.002*	0.31
Waist-to-hip ratio (WHR)	Pre-test	0.91 $\pm$ 0.01	0.88 $\pm$ 0.01	0.92 $\pm$ 0.01	0.88 $\pm$ 0.02	0.55
	Post-test	0.89 $\pm$ 0.01	0.88 $\pm$ 0.01	0.91 $\pm$ 0.02	0.88 $\pm$ 0.02
	Within group p	0.17	0.8	0.32	0.83
VAI	Pre-test	0.63 $\pm$ 1.62	0.39 $\pm$ 1.21	0.44 $\pm$ 1.58	0.86 $\pm$ 1.85	0.12
	Post-test	0.41 $\pm$ 1.58	0.35 $\pm$ 1.10	0.46 $\pm$ 1.02	1.00 $\pm$ 1.64
	Within group p	0.84	0.37	0.007*	0.35
BAI	Pre-test	3.34 $\pm$ 36.57	6.40 $\pm$ 37.68/	4.11 $\pm$ 34.32	3.73 $\pm$ 38.79	0.202
	Post-test	2.87 $\pm$ 34.77	6.29 $\pm$ 36.09	3.90 $\pm$ 32.98	3.37 $\pm$ 38.41
	Within group p	0.034*	0.009*	0.003*	0.287
WHtR	Pre-test	0.038 $\pm$ 0.62	0.058 $\pm$ 0.61	.0069 $\pm$ 0.60	0.078 $\pm$ 0.62	0.006*
	Post-test	0.037 $\pm$ 0.59	0.063 $\pm$ 0.59	0.077 $\pm$ 0.58	0.079 $\pm$ 0.62
	Within group p	0.001*	0.007*	0.003*	0.214
Triglyceride (mmol/L)	Pre-test	0.58 $\pm$ 1.66	0.34 $\pm$ 1.22	0.56 $\pm$ 1.58	0.76 $\pm$ 1.96	0.091
	Post-test	0.47 $\pm$ 1.69	0.36 $\pm$ 1.12	0.53 $\pm$ 1.02	0.37 $\pm$ 1.70
	Within group p	0.82	0.42	004/0*	34/0
HDL (mmol/L)	Pre-test	0.28 $\pm$ 2.07	0.19 $\pm$ 1.99	0.30 $\pm$ 1.97	0.17 $\pm$ 2.06	0.482
	Post-test	0.26 $\pm$ 2.03	0.14 $\pm$ 1.96	0.60 $\pm$ 1.74	0.26 $\pm$ 1.94
	Within group p	0.55	0.64	0.18	0.089
VO ${}_{\rm 2max}$ (ml/kg/min)	Pre-test	29.07 $\pm$ 1.88	24.60 $\pm$ 1.35	23.70 $\pm$ 1.78	24.77 $\pm$ 3.03	0.029*
	Post-test	34.01 $\pm$ 2.05	31.81 $\pm$ 1.05	27.93 $\pm$ 2.18	24.25 $\pm$ 3.01
	Within group p	0.003*	0.003*	0.024*	0.43

Significance level at $P\leqslant 0.05$ *.

Figure 1 shows the experimental training protocols.

This intervention was registered in Iranian Registry of Clinical Trials (IRCT) coded as IRCT2014123019995N3 and approved in the Research Deputy of Shahrekord University coded as 311254 3114 on May 25, 2014.

2.5 Statistical analysis

The SPSS statistical software package was used to analyze all data. Results are reported as mean $\pm$ SD. Statistical comparisons in the control period (from week 0 to week 8) were performed by using Students paired t-tests. The training-related effects were assessed using a two-way ANOVA with repeated measures (group x time). When a significant F value was achieved, Bonferroni post-hoc procedures were used to detect the pairwise differences between means. Selected relative changes between groups were compared via 1-way ANOVA. Significance was accepted when $p<$ 0.05.

3. Results

The obtained results by the research showed a significant decrease in the weight, BMI, body fat percentage, and WHtR in experimental groups E $-$ $>$ S, S $-$ $>$ E, and ACT ( $P<$ 0.05). In addition, it was found that the VO ${}_{\rm 2max}$ of the experimental group increased significantly in experimental groups ( $P<$ 0.05). However, no significant changes was observed in VAI variable and triglyceride in the sequence order of E $+$ S and S $+$ E, but after the ACT sequence order a significant decrease was seen in both variables ( $P<$ 0.05). An eight-week combined training with three different orders caused no significant changes in HDL ( $P\geqslant 0.05$ ). The results of one-way ANOVA analysis yielded a significant difference between the 4 groups in the weight, BMI, WHtR, and VO ${}_{\rm 2max}$ variables ( $P<$ 0.05) (Table 2). The results of post-hoc Tukey test to determine between group differences showed that S $+$ E and control groups, and ACT and control groups differed significantly in weight variable, and S $+$ E and control groups differed significantly in BMI variable at $P<$ 0.05. in addition, the E $+$ S group was significantly different from control group in WHtR variable, and S $+$ E group significantly varied with control group in VO ${}_{\rm 2max}$ variable ( $P<$ 0.05).

4. Discussion

The results of the current research indicated a significant decrease in BMI, body fat percentage, BAI, and WHtR among all 3 training groups, and no difference was observed between training sequence orders in reducing mentioned variables. Endurance training and strength training help with improvement of body composition by decreasing and increasing body fat mass, respectively. Training volume is a key factor in changing body composition. As training volume in combined training group is approximately 2 times of strength and endurance training volume alone, probably subjects enjoy the positive benefits of both types of training. Glowacki et al. observed the significant reduction of body fat percentage only in combined training groups [29]. Several studies demonstrated that performing combined training in a session leads to increased consumption of body fat. In this vein, Hu et al. investigated the effect of 12 weeks of aerobic, strength and combined trainings on risk of cardiovascular disease among overweight adult men and women. They found that combined training caused a significant reduction in BMI, weight and fat mass of subjects in comparison to other training methods. They ascribed this to the interactive effects of two training methods. Therefore, combined training can effectively influence persons’ body composition compared to other training methods alone [2]. Tan et al. reported that performing six months of combined training (aerobic and resistance) improved body composition and significantly reduced BMI and waist-to-hip ratio in elderly persons [30]. In addition, the results of the current research are in line with the results obtained by researchers who observed improvement of body composition indices after performing combined training in sedentary people [31].

Therefore, we suggest that combined training is an effective and efficient method for reducing body fat percentage and improving body composition, and the sequence order of training may have no effect on reducing the body fat percentage. Cadore et al. investigated the effect of sequence order of combined training in elderly men. The body fat percentage reduced in their research without any difference in sequence order of training [32]. Moreover, Alves et al. stated that the sequence order of training did not interfere with energy expenditure during combined training [33].

Glowacki et al., Cadore et al. and Shaw et al. observed a slight increase or no significant change in the body mass after combined training [29, 34, 35]. The result obtained by them is in contrast with the current research results. As the aim of resistance training program used in this research was not to create maximum hypertrophy, the intensities used in the current research may cause very little muscle hypertrophy or no hypertrophy in elderly persons. In the other studies a greater increase in muscle mass was observed by resistance and endurance combined training in a session [36, 37]. The increase of body mass may be due to different methods designed to change body composition. However, the results of the current research are the same as those obtained by Nindl et al., Gergley et al. and Dolezal et al. indicating the significant reduction of body mass after combined training [38, 39, 40].

When combined training is performed in a session, fat mass reduction and a slight increase or no change in fat-free mass causes body composition to change and eventually body mass to reduce. In this regard, it has been shown that in comparison to aerobic training, combined training enhances more the continuous growth of muscle mass and therefore, can help reduce fat mass by increasing the basal metabolic rate. In a recently conducted meta-analysis, Marzolini et al. reported that combined training is more effective than aerobic training alone in improving lean body mass, body fat percentage, and body fat mass in individuals with coronary artery disease [41].

In another study, following 10 weeks of combined resistance endurance training, Taleghani et al. observed a significant change in all anthropometric indices such as body mass, abdominal circumference, waist circumference, WHR, BMI, and body fat percentage [21]. These were in agreement with changes observed in our research exprimental groups. In addition, the results of several other studies are consistent with those of our research i.e. training leads to significant reduction in body mass and body fat percentage [34, 42]. But some of the studies did not show the efficiency of combined training [43]. The results of the current research are inconsistent with those obtained by Campos et al. [44]. They observed that combined training yielded no significant effects on body composition of elderly women. These inconsistencies may be due to the subjects’ age, gender and physical condition, the severity and duration of training, and methods of measuring variables in research.

The results of the current research indicate a significant reduction in BAI and WHtR in all 3 training methods. Considering the significant reduction of waist circumference in all 3 training methods, the reason for WHtR reduction can be attributed to the reduction of waist circumference. Moreover, the significant reduction of BAI is logical with regard to the significant reduction of hip circumference following combined training. In addition to VAI, the amount of triglyceride and HDL underwent no significant change after sequence order of E $+$ S and S $+$ E. According to Celik et al., the reason for no change in VAI can be attributed to triglyceride and HDL which remained unchanged. After one month fasting, Celik et al. observed no significant changes in the amount of VAI and triglyceride in healthy men. However, following alternative concurrent training (ACT) the amount of VAI and triglyceride had been reduced significantly. The reduction of VAI and triglyceride following alternative concurrent training may be due to more training diversity in this type of training, and subjects might have performed more training in this sequence due to training diversity and this has led to significant changes.

As for the possible limitations of the present study, we concede the lack of sizeable enough strength and endurance training groups. This resulted from difficulty in recruitment of a sufficient number of participants that met with the inclusion criteria. Another limitation refers to the age of the subjects which e.g. under N. American or West European, and certainly Japanese, standards may not be considered as representative of elderly population. However, in terms of the local populace, they are but some care should be taken when extrapolating the findings into other parallel cohorts.

5. Conclusions

The current research indicate no significant differences among sequences of strength and endurance training for adiposity indices; all three training types seem to have the same efficiency in reducing new and old adiposity indices of elderly women. Consequently all protocols may be effective in promoting health of overweight elderly women.

Footnotes

Conflict of interest

None to report.

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Effect of sequence order of combined strength and endurance training on new adiposity indices in overweight elderly women

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Method

2.1 Subjects

2.2 Group assignment

2.3 Anthropometric measures

2.3.1 Fat percentage

2.3.2 Biochemical indices measurement

Table 1 Complete strength and endurance training periodization

2.4 Muscle strength

2.4.1 Concurrent training protocols

3. Results

4. Discussion

5. Conclusions

Footnotes

Conflict of interest

References

Table 1
Complete strength and endurance training periodization