BUILD MUSCLE, IMPROVE

HEALTH: BENEFITS
ASSOCIATED WITH
RESISTANCE EXERCISE
by Wayne L. Westcott, Ph.D.
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where combustion occurs, where energy is re-

LEARNING OBJECTIVES
• To realize that age-related muscle loss is associated with bone
loss, metabolic rate reduction, fat gain, diabetes, metabolic
syndrome, heart disease, and various problems associated with
physical degeneration/dysfunction.
• To recognize the beneficial effects of resistance exercise for
increasing muscle mass, bone density, metabolic rate, insulin
sensitivity, high-density lipoprotein cholesterol, cognitive ability,
and self-esteem, as well as for decreasing body fat, resting blood
pressure, low-density lipoprotein cholesterol, low-back pain,
arthritic discomfort, and depression.
• To use programs of resistance exercise that provide safe,
progressive, and effective strength training experiences in accor-
dance with the 2014 ACSM strength training recommendations.
Key words:
Strength Training, Resistance Exercise, Sarcopenia, Osteopenia,
Metabolic Rate, Health Risk Factors
leased, where power is produced, and where
movement originates. Muscles have long been
recognized as key factors in physical performance
and athletic achievement. Essentially all serious
sports participants include regular resistance exer-
cise in their training programs. However, recent
research has shown that strength training has
much greater application than improved sports
performance or even enhanced physical fitness.
Clearly, our muscular condition has a major
influence on both our physical and mental health.
It is likely that age-related muscle loss is a
starting point for a cascade of physiological
problems, including bone loss, metabolic rate
reduction, fat gain, diabetes, metabolic syndrome,
heart disease, and all-cause mortality (57). Adults
who do not perform resistance exercise lose almost
5 lbs of muscle every decade before age 50 years
(19) and up to 10 lbs of muscle every decade after
age 50 years (38). With this in mind, let’s examine
the evidence-based benefits of resistance training
for generally healthy individuals as well as for
adults who have common risk factors.

M
ost fitness profes-
sionals can easily
explain the benefi-
cial effects of aerobic activity with
respect to heart health, cardiore-
spiratory function, endurance fit-
ness, and physical well-being.
Certainly, increased aerobic ca-
pacity is a major objective of a
comprehensive conditioning pro-
gram. However, it is important to
realize that muscles are the en-
gines of our bodies. Muscles are
22 ACSM’s HEALTH & FITNESS JOURNALA | www.acsm-healthfitness.org VOL. 19/ NO. 4

Copyright © 2015 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 MUSCLE MASS
Numerous studies have shown that muscle mass may be increased in
adults of all ages (26), including individuals in their 90s (17,56). A
representative research study with more than 1,600 participants
(aged 21 through 80 years), revealed a 3-lb increase in lean (muscle)
weight after 10 weeks of standard strength training (58), and a
follow-up study showed approximately twice as much lean weight
gain after 9 months of resistance exercise (59). Similar increases in
lean weight were attained for strength training frequencies of 2 and
3 days per week and among all of the age groups.
BONE DENSITY
Muscle loss (sarcopenia) is associated with bone loss (osteopenia)
(27), which explains partly why approximately 45 million Amer-
icans suffer from insufficient bone mass (37). Women who do
not engage in resistance exercise may experience a 1% to 3% per
year reduction in bone mineral density (BMD) (55). Fortunately,
several longitudinal studies have shown significant increases in
BMD after participation in progressive strength training pro-
grams (57). Research reviews by Wolff et al. (62) and by Going
and Laudermilk (20) revealed that resistance exercise increased
BMD between 1% and 3% in both premenopausal and post-
menopausal women. In one study, resistance-trained subjects
increased BMD by 1% during a 12-month period (38) and, in
another study, resistance-trained subjects who also consumed
supplemental protein, calcium, and vitamin D increased BMD by
1% during a 9-month period (59). A 2-year study by Kerr et al.
(31) showed more than 3% improvement in BMD compared with
the control group. Although resistance exercise can increase BMD,
the musculoskeletal effects are relatively site specific and termina-
tion of strength training results in reversal of the BMD gains (60).
RESTING METABOLISM
At rest, every pound of untrained muscle uses between 5 and 6
calories per day for protein breakdown and synthesis (61).
However, every pound of resistance-trained muscle uses
approximately 9 calories per day for more extensive protein
breakdown and repair processes (48). Resistance exercise
produces tissue microtrauma that requires relatively large
energy supplies for muscle remodeling. Research reveals that
a single strength training session can increase resting energy
expenditure by 5% to 9% for 3 days after the workout. In a
study by Hackney et al. (21), a high-volume resistance training
session (eight sets of eight exercises) raised resting energy
expenditure an average of 9% in untrained subjects and an
average of 8% in trained subjects during a 72-hour postexercise
period. In a similar study by Heden et al. (22), a low-volume
resistance training session (1 set of 10 exercises) raised resting
energy expenditure an average of 5% in beginning participants
during a 72-hour postexercise period. Many other studies have
shown approximately a 7% increase in resting metabolic rate
after several weeks of resistance training (26).
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Copyright © 2015 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
BODY FAT
Most strength training studies that have shown significant
increases in lean weight (~1.0 lbs/month) also have demon-
strated concurrent decreases in fat weight (almost 1.5 lbs/
month) (26,56,58). Resistance exercise also has been effective
for reducing intra-abdominal fat in older men and women
(51,52).
Some people have questioned how three relatively brief
(20-minute) circuit strength training sessions a week can result
in a 1.5-lb/month fat loss. Assuming approximately 200 calories
used during a 20-minute resistance training circuit, the total
monthly energy expenditure directly caused by resistance
exercise is only 2,400 calories (12 workouts  200 calories
per session). However, assuming the lowest reported in-
crease in resting metabolism associated with strength training
(100 calories/day) (22), the total monthly energy expenditure
indirectly caused by resistance exercise is 3,000 calories (30 days
 100 calories/day), for a total calorie use of 5,400 calories
(2,400 calories plus 3,000 calories), which is equivalent to
1.5 lbs of fat. In their comprehensive review article, ‘‘Evidence
of Resistance Training as a Treatment Therapy in Obesity,’’
Strasser and Schobersberger (48) concluded that strength training
is recommended in the management of obesity and related
metabolic disorders. These include elevated resting blood
pressure, elevated plasma cholesterol, elevated plasma glucose,
and large waist girth V all of which are associated with the
development of Type 2 diabetes and cardiovascular disease (48).
GLYCEMIC CONTROL
Muscle loss and fat gain increase the risk of Type 2 diabetes, a
disease that is predicted to affect one of three adults by the
middle of this century (8). Numerous studies have demonstrated
significant improvements in insulin sensitivity and glycemic
control as a result of resistance exercise (24). As previously
presented, strength training also has been shown to reduce
abdominal fat, which seems to be associated with insulin
resistance in aging adults (32). An extensive research review by
Flack and associates (18) concluded that resistance exercise
ACSM’s HEALTH & FITNESS JOURNALA 23
Health Benefits of Resistance ExerciseBuild Muscle, Improve Health
may be an effective intervention for counteracting age-
associated changes in insulin sensitivity and for preventing
Type 2 diabetes in middle-aged and older adults. A meta-
analysis conducted by Strasser and colleagues (47) likewise
concluded that strength training should be recommended for
both the prevention and management of Type 2 diabetes.
There is evidence that resistance exercise may be preferable to
aerobic activity for improving insulin sensitivity (11) and for lowering
HbA1c (11), and that higher-volume/higher-intensity strength training
protocols may be more effective than lower-volume/lower-intensity
workouts (18). The American Diabetes Association recommends
resistance exercise for all of the major muscle groups, 3 days/week,
progressing to 3 sets of 8 to 10 repetitions each, performed at a
higher level of training intensity (46).
BLOOD PRESSURE
Several studies have shown significant reductions in resting
blood pressure (systolic and diastolic) after two or more months
of regular resistance exercise (circuit and standard strength
training) (28). Combined resistance and endurance exercise also
has demonstrated favorable blood pressure responses (58). In a
large 10-week study, participants who performed 20 minutes of
strength training and 20 minutes of aerobic activity 3 days/
week experienced a significant 4.6-mmHg decrease in rest-
ing systolic blood pressure, and those who performed the
same exercise program 2 days/week experienced a significant
2.3-mmHg decrease in resting systolic blood pressure (58).
Kelley and Kelley (29) conducted a meta-analysis of relevant
research and concluded that resistance exercise is effective for
reducing resting blood pressure. Another meta-analysis of
randomized controlled trials determined that resistance exercise
resulted in similar blood pressure reductions as aerobic activity,
averaging 6.0 mmHg lower systolic pressure and 4.7 mmHg
lower diastolic pressure for the studies reviewed (14). Likewise,
a 2010 review published in ACSM’s Current Sports Medicine
Reports concluded that the effects of resistance training on
resting blood pressure were comparable to those of aerobic
24 ACSM’s HEALTH & FITNESS JOURNALA | www.acsm-healthfitness.org
Copyright © 2015 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
training (41). However, recent guidelines from the American Heart
Association (3) stated that ‘‘Although resistance training could
yield modest reductions in blood pressure, data are insufficient
to support a specific resistance training program’’ (page 916).
Nonetheless, considering that about 35% of Americans have
hypertension, the blood pressure benefits associated with strength
training should not be overlooked (9, 40).
BLOOD LIPIDS
An even larger number of Americans (~45%) have undesirable
blood lipid profiles (35). Some studies have not found an
association between resistance exercise and blood lipid levels
(33), and the American Heart Association does not believe that
the data are sufficient to support a specific resistance training
program (3). However, other research in this area has revealed
improved blood lipid profiles after participation in strength
training programs (30). Fahlman and colleagues (16) found that
resistance training was effective for improving triglyceride
levels, low-density lipoprotein (LDL) cholesterol, and high-
density lipoprotein (HDL) cholesterol in older women. The
American College of Sports Medicine Position Stand on
Exercise and Physical Activity for Older Adults (1) reports
that resistance training has been shown to reduce triglyceride
levels by 11% to 18%, to decrease LDL cholesterol by 13% to
23%, and to increase HDL cholesterol by 8% to 21% (page
1,519). Research indicates that combined strength training and
aerobic activity may have a more favorable impact on blood
lipid profiles than either exercise performed independently (42).
PHYSICAL FUNCTION
Research clearly demonstrates that resistance exercise can reverse
some of the degenerative processes associated with inactive
aging, including muscle loss (50), movement control (5),
functional abilities (25), physical performance (23), and walking
speed (44). The functional benefits of strength training extend to
nonagenarians (17) and the frail elderly (56). In a study of
nursing home residents (mean age, 89 years), 28 relatively brief
sessions of resistance exercise (twice weekly for 14 weeks)
resulted in a nearly 4-lb increase in lean weight, a 3-lb decrease
in fat weight, a 60% increase in overall muscle strength, and a
14% improvement in functional independence (56).
MENTAL HEALTH
Most of the research on exercise and cognition has featured
aerobic activity alone or combined endurance and strength
training (39). A meta-analysis by Colcombe and Kramer (13)
demonstrated that programs of resistance training and aerobic
exercise were more effective than aerobic exercise alone for
improving cognitive function in inactive older adults. However,
studies restricted to only resistance training interventions also
have shown significant improvements in various cognitive
abilities (12).
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 Studies on strength training and psychological measures have
shown enhanced self-esteem among older adults (54), younger
adults (53), women (10), cancer patients (15), and cardiac
rehabilitation participants (6). Annesi and Westcott (4) found
that 10 weeks of combined strength and endurance training
significantly improved physical self-concept, total mood dis-
turbance, depression, fatigue, positive engagement, revitaliza-
tion, tranquility, and tension in adults and older adults. In a
classic study by Singh and colleagues (45), more than 80% of
the previously depressed elderly individuals who performed
standard resistance exercise 3 days/week were no longer
clinically depressed after completing 10 weeks of the strength
training program. Based on the studies presented, it would
seem that resistance training may have a positive influence on
cognitive and psychological components of mental health.
O’Connor and colleagues (39) completed a comprehensive
review of the research on resistance exercise and mental health,
including the effects of strength training on low-back pain,
arthritic discomfort, and fibromyalgia because these debilitating
physical conditions also may have a negative influence on various
psychological factors. Research supports the role of resistance
exercise for reducing low-back pain (43), for decreasing arthritic
discomfort (34), and for easing the symptoms of fibromyalgia (7).
AGING FACTORS
One aspect of aging is a reduction in muscle mitochondrial content
and function. Circuit strength training has been shown to increase
both muscle tissue mitochondrial content and oxidative capacity
(49). A most interesting study by Melov and associates (36)
examined genetic changes in the muscle mitochondria of older
adults after 6 months of standard resistance exercise. The
research participants (mean age, 68 years) experienced favorable
changes in 179 genes associated with age and exercise
performance. After the strength training program, the older
adults’ mitochondrial gene expression was similar to that of
moderately active young adults (mean age, 24 years). The
researchers concluded that specific aging factors in skeletal
muscle may be reversed through progressive resistance exercise.
RECOMMENDATIONS FOR BEGINNING
STRENGTH TRAINERS
Regardless of age, sex, or apparent physical condition, people
who wish to begin a resistance training program should
complete a health-screening questionnaire, such as the one
recommended on page 25 of ACSM’s Guidelines for Exercise
Testing and Prescription, 9th edition (2). Everyone who reveals
two or more of the following risk factors should be required to
obtain medical clearance (and preferably physician’s guide-
lines) for participation in the strength training program (see
Table 2.2 on page 27 of ACSM’s Guidelines for Exercise
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Copyright © 2015 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Testing and Prescription, 9th edition) (2) for detailed defining
criteria of these cardiovascular disease risk factors).
• Age (men, Q45 years; women, Q55 years)
• Family history of heart disease
• Cigarette smoking
• Sedentary lifestyle
• Obesity (body mass index, Q30)
• Hypertension (systolic, Q140 mmHg; diastolic, Q90 mmHg)
• Dislipidemia (LDL cholesterol, Q130; HDL cholesterol, G40)
• Prediabetes
It should be noted that an HDL cholesterol reading of 60 or
higher cancels out one of the risk factors. It also is suggested
that individuals with uncontrolled hypertension obtain physi-
cian recommendations for performing resistance exercise.
The most recent ACSM resistance training recommendations call
for relatively brief workouts that provide two to four sets of 8 to
12 repetitions each for the major muscle groups by performing 8 to
10 multijoint exercises two or three nonconsecutive days per week
(see Table 7.6 on page 185 of ACSM’s Guidelines for Exercise Testing
and Prescription, 9th edition) (2). For example, beginners who
perform one set of the nine machine exercises in the Table would
experience two sets of resistance training for most of their major
muscle groups (quadriceps, hamstrings, pectoralis major, anterior
deltoids, latissimus dorsi, teres major, rhomboids, middle trapezius,
posterior deltoids, triceps, biceps, erector spinae, rectus abdominis).
The key to successful strength training experiences is sensible
progression. A double progressive training protocol begins with a
resistance that can be performed for at least eight repetitions (~80%
of maximum resistance for most exercises). The client continues to
train with this resistance until 12 good (full range, controlled speed)
TABLE: Nine Machine Exercises That
Address Most of the Major Muscle Groups
Exercise Major Muscle Groups Involved
Leg extension Quadriceps
Leg curl Hamstrings
Leg press Quadriceps, hamstrings, gluteus maximus
Chest press Pectoralis major, triceps, anterior deltoids
Seated row Latissimus dorsi, biceps, teres major,
rhomboids, middle trapezius,
posterior deltoids, erector spinae
Incline press Pectoralis major, triceps, anterior
deltoids, upper trapezius
Pulldown Latissimus dorsi, biceps, teres major,
rhomboids, middle trapezius,
posterior deltoids, rectus abdominis
Abdominal Rectus abdominis
Low back Erector spinae
ACSM’s HEALTH & FITNESS JOURNALA 25
Health Benefits of Resistance ExerciseBuild Muscle, Improve Health
repetitions can be completed (~70% of maximum resistance for
most exercises). At this point, progression in repetitions should be
changed to progression in resistance (~5% heavier weight load)
that will reduce the number of repetitions and permit a new
progression in repetitions within the 8 to 12 range.
Various modes of resistance are effective for increasing muscle
mass and strength. For example, free-weight training offers many
multiple joint exercises performed from a standing position that
concurrently activate muscles of the legs, core, upper body, and arms
while incorporating balance, coordination, and movement control.
Medicine ball strength training enables safe and effective power
production with minimal joint stress because the resistance can be
released at the end of each explosive exercise action. Resistance bands
are easy to use and are especially well suited for pressing exercises as
the increasing resistance roughly matches the increasing force output
during band extension in squats, chest presses, and shoulder presses.
Well-designed resistance machines provide supportive structure, proper
movement patterns, and resistance curves that parallel strength curves in
most exercises. Older individuals, people with orthopedic limitations,
and those who have issues with balance, coordination, or flexibility may
be advised to begin strength training with resistance machines. It also is
recommended that older adults do not hold their breath or hold the
resistance in a static position for more than a few seconds because both
of these procedures may cause excessive blood pressure elevation.
SUMMARY
Muscle loss may initiate a cascade of health issues including bone
loss, metabolic rate reduction, fat gain, diabetes, metabolic
syndrome, heart disease, and all-cause mortality. Resistance training
has been shown to add muscle mass, increase bone mineral density,
raise resting metabolic rate, decrease body fat, improve glycemic
control, reduce resting blood pressure, improve blood lipid profiles,
enhance physical function, improve mental health, and reverse
specific aging factors in skeletal muscle. Beginning participants
should be assessed for cardiovascular disease risk factors and should
be trained in accordance with the ACSM recommendations for
performing safe and effective resistance exercise.
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Disclosure: The author declares no conflicts of interest and
does not have any financial disclosures.
Wayne L. Westcott, Ph.D., directs the
exercise programs and the fitness re-
search programs at Quincy College in
Quincy, MA. His research interests in-
clude the variables, acute responses, and
chronic adaptions associated with resis-
tance exercise.
BRIDGING THE GAP
Age-related muscle loss (3% to 8% per decade) initiates a
cascade of undesirable physiological responses, including
bone loss, metabolic slow down, and fat gain that are
associated with many prevalent diseases and disabilities.
Resistance exercise has been shown to be effective for
reversing muscle loss, increasing bone density, recharging
resting metabolism, decreasing body fat, improving glycemic
control, reducing resting blood pressure, improving blood
lipid profiles, facilitating physical function, enhancing mental
health, reversing aging factors, and attenuating low-back
pain and arthritic discomfort. Resistance training health
benefits may be attained by performing 2 or 3 weekly
workouts of 8 to 10 multijoint exercises using loads that
permit 8 to 12 controlled repetitions.
ACSM’s HEALTH & FITNESS JOURNALA 27