Blood Lipid and Lipoprotein Adaptations to Exercise A Quantitative Analysis

Transcription

1 REVIEW ARTICLE Sports Med 2001; 31 (15): /01/ /$22.00/0 Adis International Limited. All rights reserved. Blood Lipid and Lipoprotein Adaptations to Exercise A Quantitative Analysis J. Larry Durstine, 1 Peter W. Grandjean, 2 Paul G. Davis, 3 Michael A. Ferguson, 1 Nathan L. Alderson 1 and Katrina D. DuBose 1 1 Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA 2 Department of Health and Human Performance, Auburn University, Auburn, Alabama, USA 3 Department of Exercise and Sport Science, University of North Carolina Greensboro, Greensboro, North Carolina, USA Contents Abstract Cross-Sectional Findings Total Cholesterol (TC) and Low-Density Lipoprotein Cholesterol (LDL-C) Differences Between Active and Sedentary Groups High-Density Lipoprotein Cholesterol (HDL-C) and Triglyceride (TG) Differences Between Active and Sedentary Groups Dose-Response Relationships Between Physical Activity and Blood Lipids Characterising an Exercise Threshold for Modifying Blood Lipids Summary of Cross-Sectional Findings Exercise Training Interventions Changes in TC and LDL-C Levels Characterising an Exercise Dose for Significant TC and LDL-C Changes Factors Influencing TC and LDL-C Changes with Exercise Training Summary of TC and LDL-C Changes with Exercise Training Changes in HDL-C and TG Levels Factors Influencing HDL-C and TG Changes with Exercise Training Quantification of HDL-C and TG Changes with Exercise Training Characterising an Exercise Dose for Significant HDL-C Changes Characterising an Exercise Dose for Significant TG Changes Summary of HDL-C and TG Changes with Exercise Training Conclusion Abstract Dose-response relationships between volume and blood lipid changes suggest that can favourably alter blood lipids at low volumes, although the effects may not be observable until certain thresholds are met. The thresholds established from cross-sectional literature occur at volumes of 24 to 32km (15 to 20 miles) per week of brisk walking or jogging and elicit between 1200 to 2200 kcal/wk. This range of weekly energy expenditure is associated with 2 to 3 mg/dl increases in high-density lipoprotein cholestrol (HDL-C) and triglyceride (TG) reductions of 8 to 20 mg/dl. Evidence

2 1034 Durstine et al. from cross-sectional studies indicates that greater changes in HDL-C levels can be expected with additional increases in volume. HDL-C and TG changes are often observed after regimens requiring energy expenditures similar to those characterised from cross-sectional data. Training programmes that elicit 1200 to 2200 kcal/wk in are often effective at elevating HDL-C levels from 2 to 8 mg/dl, and lowering TG levels by 5 to 38 mg/dl. Exercise seldom alters total cholesterol (TC) and low-density lipoprotein cholesterol (LDL- C). However, this range of weekly energy expenditure is also associated with TC and LDL-C reductions when they are reported. The frequency and extent to which most of these lipid changes are reported are similar in both genders, with the exception of TG. Thus, for most individuals, the positive effects of regular are exerted on blood lipids at low volumes and accrue so that noticeable differences frequently occur with weekly energy expenditures of 1200 to 2200 kcal/wk. It appears that weekly caloric expenditures that meet or exceed the higher end of this range are more likely to produce the desired lipid changes. This amount of physical activity, performed at moderate intensities, is reasonable and attainable for most individuals and is within the American College of Sports Medicine s currently recommended range for healthy adults. There is substantial, consistent and strong evidence that physical activity is a deterrent for developing many forms of cardiovascular disease. [1] Among its many benefits, habitual physical activity is thought to reduce cardiovascular disease risk, at least in part, by its favourable influence on circulating blood lipids and lipoproteins. [2,3] Cross-sectional studies support a significant incremental effect of on blood lipids and lipoproteins in both men and women. However, the varied interventions, experimental designs and participant sample characteristics of longitudinal investigations have hindered efforts to quantify the dose needed to change lipids and lipoprotein levels in various sub of the general population. In addition, some lipids and lipoproteins, such as highdensity lipoprotein cholesterol (HDL-C) and triglyceride (TG), are more amenable to than others. [2,3] Thus, thresholds for an effect on lipids and lipoproteins are hard to identify from the existing literature and at present, remain elusive. In this review, we will address the magnitude and direction of lipid and lipoprotein responses to endurance and attempt to quantify the amount of physical activity that may elicit significant changes in blood lipid and lipoprotein variables. 1. Cross-Sectional Findings 1.1 Total Cholesterol (TC) and Low-Density Lipoprotein Cholesterol (LDL-C) Differences Between Active and Sedentary Groups Reports from cross-sectional studies over the last several decades provide compelling evidence for the positive influence of physical activity and on blood lipid and lipoprotein levels (table I). [2,3] In general, blood lipid and lipoprotein profiles of physically active reflect a reduced risk for the development of cardiovascular disease when compared with their inactive counterparts. [1,4] Nonetheless, there is limited evidence to suggest that those who are physically active exhibit lower levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) than those who are less active. [5-10] In these studies, total and LDL-C values were lower by 14 to 31 mg/dl (7 to 21%) in the physically active, suggesting that regular physical exertion has a dramatic influence on these lipid variables. However, a well-recognised problem with observational studies is that, by design, they do not account for confounding factors, such as group differences in bodyweight and body fat, caloric intake, nutrient composition of diets, Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

3 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Table I. Differences in the levels of lipoprotein lipids reported from selected cross-sectional studies. Data are presented as mean ± standard deviation, unless otherwise stated Study (n) TC TC differences LDL-C LDL-C differences TG TG differences HDL-C HDL-C differences Enger et al. [16] Skiers (220) 231 ± 42 a 64 ± 15 b 9.8 (21%) Controls (269) 255 ± ± 13 Martin et al. [6] Elite runners (20) 175 ± 26 b 14 (7%) 108 ± 25 b 16 (13%) 74 ± 25 b 18 (20%) 56 ± 12 b 7 (14.2%) Good runners (8) 185 ± ± ± 40 b 19 (21%) 52 ± 11 a Non-runners (72) 189 ± ± ± ± 10.5 Wood et al. [5] Male runners (41) 200 ± 22 b 12 (6%) 125 ± 21 b 14 (10%) 70 ± 24 b 76 (52%) 64 ± 13 b 21 (49%) Controls (747) 212 ± ± ± ± 10 Female runners (43) 193 ± 33 b 16 (8%) 113 ± 33 b 11 (9%) 56 ± 19 b 57 (54%) 75 ± 14 b 17 (30%) Controls (932) 209 ± ± ± ± 10 Lehtonen and Viikari [17] Lumberjacks (12) 224 ± 32 a 149 ± 34 a 53 ± 21 a 74.5 ± 10.8 b 19.7 (36%) Electricians (15) 201 ± ± ± ± 12 Lehtonen and Viikari [18] Active men >25 km/wk (23) 191 ± 39 a 52 ± 24 b 29 (36%) 68.5 ± 14.9 b 13.6 (25%) Active men <25 km/wk (10) 174 ± 47 a 58 ± 13 a 56.3 ± 10.8 a Inactive men (15) 201 ± ± ± 12.1 Adner and Castelli [19] Marathoners (50) 191 ± 31 a 111 ± 25 a 85 ± 75 a 54.8 ± 14.1 b Controls (43) 121 ± ± ± (21%) Hartung et al. [7] Marathoners (59) 187 ± 28 c 25 (12%) 107 ± 27 c 30 (22%) 77 ± 29 c 77 (50%) 65 ± 14 b 22 (51%) Joggers (85) 204 ± 44 b 8 (4%) 125 ± 38 b 12 (9%) 106 ± 63 b 48 (31%) 58 ± 18 b 15 (35%) Inactive men (74) 212 ± ± ± ± 14 Rotkis et al. [20] Runners (90) 210 ± 37 a 156 ± 37 a 54 ± 10 b 20 (59%) Non-runners (19) 182 ± ± ± 7 Hagan and Gettman [21] Distance runners (53) 190 ± ± 29 a 63 ± 28 b 50.9 ± 11 b 4.4 (9.5%) Sedentary men (53) 197 ± ± ± ± 10.7 Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1035

4 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Table I. Contd Study (n) TC TC differences LDL-C LDL-C differences TG TG differences HDL-C HDL-C differences Thompson et al. [22] Distance runners (20) 204 ± ± 17 a 66 ± 12 b 20 (43%) Non-runners (14) 198 ± ± ± 10 Herbertetal. [23] Runners (5) 194 ( ) a,d 25 (12%) 69 (55-79) a 65 (50-88) b 24 (58%) Inactive (5) 155 ( ) d 92 (45-129) 41 (37-48) Williams et al. [24] Runners (12) 191 ± 37 b 26 (12%) 116 ± 31 b 31 (21%) 71 ± 35 b 52 (42%) 64.9 ± 12.5 b 15 (30%) Controls (64) 217 ± ± ± ± 8.7 Durstine et al. [25] Elite runners (16) 179 ± 6 a 95 ± 7 a 71 ± 4 a 69 ± 3 b 14 (25%) Good runners (14) 179 ± 10 a 94 ± 8 a 77 ± 4 a 69 ± 4 b 14 (25%) Recreational (14) 165 ± 8 a 91 ± 9 a 76 ± 9 a 59 ± 4 b 4(7%) Sedentary (14) 163 ± 6 92 ± 7 80 ± 6 55 ± 3 Frey et al. [26] <35y-old trained (11) 200 ± 31 a 130 ± 26 a 113 ± 88 a 55 ± 7 a Untrained (14) 212 ± 20 a 142 ± ± ± 7 >50y-old trained (12) 225 ± 31 a 158 ± 27 a 153 ± 69 a 58 ± 11 b 12 (26%) Untrained (14) 229 ± ± ± ± 8 Thompson et al. [27] Endurance athletes (10) 200 ± 45 a 130 ± 38 a 60 ± 18 b 50 (45%) 58 ± 14 b 17 (41%) Sedentary (10) 201 ± ± ± ± 10 Blessing et al. [28] Distance runners (12) 163 ± 19 a 90 ± 18 a 147 ± 52 b 65 (31%) 71 ± 10 b 17 (31%) Controls (8) 176 ± ± ± ± 12 Stevenson et al. [29] Premenopausal active (13) 142 ± 8 a 73 ± 5 a 70 ± 5 a 55 ± 4 a Premenopausal inactive (12) 135 ± 6 67 ± 6 71 ± 7 54 ± 3 Postmenopausal active (14) 183 ± 7 a 93 ± 6 b 93 ± 9 a 72 ± 4 b Postmenopausal inactive (18) 207 ± ± 8 31 (25%) 131 ± ± 4 15 (26%) a Not significant. b Reported significant difference from controls: p < c Reported significant difference from all other : p < d The values in parentheses are the range. HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; n = number of participants; = not reported; TC = total cholesterol; TG = triglyceride Durstine et al.

5 Blood Lipid and Lipoprotein Adaptations to Exercise 1037 alcohol intake, smoking habits and other potentially lipid-altering lifestyle characteristics. When these factors are statistically controlled, the group differences in TC and LDL-C diminish and often are no longer significant. [8,11,12] Moreover, most crosssectional studies indicate smaller, nonsignificant differences in TC and LDL-C levels between -trained and inactive individuals. [3,13] In addition, regression analyses of data from large-scale epidemiological investigations have failed to consistently demonstrate a relationship between physical activity, TC and LDL-C in normo- and hyperlipidaemic. [14,15] 1.2 High-Density Lipoprotein Cholesterol (HDL-C) and Triglyceride (TG) Differences Between Active and Sedentary Groups Observational data provide stronger evidence for lower TG and higher HDL-C levels in physically active individuals. [2,3] TG levels are almost always lower in endurance athletes, aerobically trained, and physically active individuals when compared with sedentary controls. [2,3] Significant TG differences between these range from 18 to 77 mg/dlor19to50%inoverhalfofallcross-sectional studies reviewed. [5-10,12,18,21,24,27,28,30-33] Blood levels of HDL-C are 4 to 24 mg/dl higher in those having physically demanding jobs and individuals engaged in endurance compared with their less active counterparts. [5-7,16-23,26-29,34] The relative differences in HDL-C that exist between rs and their inactive peers range from 9 to 59%. 1.3 Dose-Response Relationships Between Physical Activity and Blood Lipids Several investigators have used cross-sectional designs to quantify dose-response relationships between the volume of and changes in blood lipid levels (table II). [8,10,12,32,33,35,36] Kokkinos et al. [10] compared the blood lipid levels of 2906 middle-aged men who were partitioned into 6 based on their self-reported kilometres run per week. TG levels, HDL-C, and the TC : HDL-C ratio improved incrementally with volume. HDL-C increased ~0.20 mg/dl/km (~0.31 mg/dl/mile) and the relationships between kilometres run per week and improvements in HDL-C, TG and the TC : HDL- C ratio were consistent across activity. These results suggest that, although may have an effect on blood lipid levels at low volumes, lipid and lipoprotein concentration differences between and sedentary become significant in individuals running 11 to 23km (7 to 14 miles) per week (700 to 1500 kcal/wk). The differences between individuals running at this level and the sedentary group were ~3.5 mg/dl and 20 mg/dl for HDL-C and TG levels, respectively, and 0.59 for the TC : HDL-C ratio. Using a similar cross-sectional design, Drygas and colleagues [35] found that significant HDL-C differences between male rs and those in the lowest activity category (~6 mg/dl) occurred with energy expenditures of 1500 to 3000 kcal/wk. Their results also indicated that further increases in volume can impart additional benefits on this lipid fraction, since the HDL-C difference increased by 3.5 mg/dl in those reporting energy expenditures exceeding 3000 kcal/wk. In a subsequent study, these same investigators noted that the threshold for significant HDL-C differences between middle-aged male rs and sedentary controls was 4 mg/dl and occurred at an energy expenditure of 2000 kcal/wk. [36] Reports from the National Runner s Health Study, which included 8283 men [33] and1837women [32] showed patterns that were similar to those reported by Kokkinos et al. [10] In men, HDL-C increased by mg/dl/km (0.218 mg/dl/mile), while TG and the TC : HDL-C ratio decreased by 0.48 mg/dl and per kilometre, respectively. [32] Williams [32,33] observed higher levels of HDL-C and lower TG levels with each 16km (10-mile) increment in weekly runningdistanceinbothmenandwomen.however, in men, differences in HDL-C (+1.5 mg/dl) and TG ( 7 mg/dl) between the least active and next group were somewhat lower than that reported by Kokkinos et al. [10] The relationship between HDL-C and running distance in both pre- and postmenopausal women were strikingly similar to those observed in men; however, TG and the TC : HDL-C ratio were unchanged. [32] In women, each Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

6 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Table II. Cross-sectional evidence for a dose-response relationship between physical activity and blood lipids Study Participants Stratification Evidence for volume Evidence for intensity Lakka and Salonen [8] 2492 M Self-reported total, occupational and leisure-time physical activity a Kokkinos et al. [10] 2906 M Self-reported km run/wk and GXT Those reporting >31 km/wk (>19 miles/wk) had 4% greater HDL-C, 9% lower TG and 4% lower LDL-C than lowest activity group a HDL-C increased (0.20 mg/dl/km/wk (0.308 mg/dl/mile/wk), significantly greater HDL-C, lower LDL-C and TC : HDL-C were observed at11to23km/wk(7to14miles/wk) Williams [33] 8283 M Self-reported km run/wk HDL-C increased mg/dl/km/wk (0.218 mg/dl/mile/wk), TG decreased by 0.47 mg/dl/km/wk (0.766 mg/dl/mile/wk), TC : HDL-C decreased 0.01 per km/wk (0.19 per mile/wk), significantly greater HDL-C was observed for each 16 km/wk (10 miles/wk) increment Drygas et al. [35] 146 M Volume and intensity of self-reported leisure-time physical activity Drygas et al. [36] 224 M Volume and intensity of self-reported leisure-time physical activity Williams [12] 7059 M Self-reported km run/wk and 10km race times Significantly greater HDL-C (6 mg/dl) was observed in those reporting 1500 to 3000 kcal/wk versus low activity group Significantly greater HDL-C (6 mg/dl) was observed in those reporting >2000 kcal/wk vs low activity group HDL-C increased mg/dl/km/wk (0.156 mg/dl/mile/wk), TG increased mg/dl/km/wk (0.284 mg/dl/mile/wk) b Those reporting average leisure-time physical activity intensities >6 METs had 6.6% greater HDL-C, 15.6% lower TG than those reporting lower intensities a >5 kcal/min was suggested as a possible physical activity threshold for reducing CVD risk HDL-C increased 0.68 mg/dl/km/h (1.1 mg/dl/mile/h), TG decreased 5.27 mg/dl/km/h (8.5 mg/dl/mile/h), LDL-C decreased 0.78 mg/dl/km/h (1.25 mg/dl/mile/h) b 1837 F HDL-C increased mg/dl/km/wk (0.185 mg/dl/mile/wk) b TG increased 1.80 mg/dl/km/h (2.9 mg/dl/mile/h) b Williams [32] 1837 F Self-reported km run/wk HDL-C increased mg/dl/km/wk (0.214 mg/dl/mile/wk). No changes in TG and LDL-C across a b Lipid differences reported for leisure-time physical activity only. Relationship between lipid variable and weekly running distance or velocity before adjusting for differences in body mass index. CVD = cardiovascular disease; F = females; GXT = graded testing; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; M = males; METs = metabolic equivalents (1 MET = 3.5 ml/kg/min); TC = total cholesterol; TG = triglyceride Durstine et al.

7 Blood Lipid and Lipoprotein Adaptations to Exercise km (10-mile) increase in weekly running distance was associated with a 2.1 mg/dl increase in HDL-C levels. These findings were supported in separate investigations by Moore et al. [37] and Durstine et al. [25] Moore and colleagues [37] determined that running distance was predictive of greater HDL-C levels in inactive females, recreational joggers and long-distance runners. In their study, the influence of running distance on HDL-C remained significant after adjusting for group differences in body fat. Durstine and co-workers, [25] demonstrated that HDL-C levels were greater in female recreational runners and were even higher in runners classified in the good and elite versus age-matched sedentary controls. The time spent running each week was strongly associated with HDL-C levels, providing additional evidence for a positive relationship between volume and favourable lipid and lipoprotein changes. Interestingly, the studies by Williams, [12,32,33] Kokkinos et al., [9,10] and others [8,11,35] suggest that along with a volume, the intensity of may be related to -induced blood lipid and lipoprotein changes. Kokkinos et al. [9] found significantly better blood lipid and lipoprotein profiles in women who were able to achieve intensities of 6 to 11 metabolic equivalents (1 MET = 3.5 ml/kg/min) versus those exhibiting lower intensity levels (>6 METs). Williams [12] observed predictive relationships between blood lipid and lipoprotein levels and increasing 10km run velocity, which was related to intensity. However, results from these cross-sectional studies indicated that volume, rather than intensity, has the greatest influence on favourable blood lipid changes. This is especially true for -induced changes in HDL-C levels. [8,12] 1.4 Characterising an Exercise Threshold for Modifying Blood Lipids The statistical relationships between and blood lipid and lipoprotein levels occur across activity levels in several of the cross-sectional studies reviewed. These relationships demonstrate that the effects of on lipid and lipoprotein levels can be initiated at low volumes and will continue in a dose-response fashion with increasing volume. With respect to gender and lipid and lipoprotein adaptations to, men and women may respond similarly to, although the sensitivity of the regression slopes for HDL-C and TG imply that women may be more resistant to -induced changes than men. [9,32,33] Arunning volume of 11 to 23km (7 to 14 miles) has been proposed as a possible threshold for observing significant HDL-C and TG concentration differences. [10,38] However, this may be an underestimate of the required volume, since others have reported that significant HDL-C differences occur with energy expenditures between 1500 and 3000 kcal/wk (~24 to 48 km/wk: ~15 to 30 miles/wk). [8,35] More recently, thresholds have been characterised with caloric expenditures of 2000 kcal/wk, which equates to roughly 20 miles/wk of jogging or brisk walking. [8,36] Although Williams [32,33] reported that significant differences in HDL-C and TG levels occur in 16km (10-mile) increments in both men and women, the reporting the lowest amount of physical activity in these studies were already running up to 16 km/wk (10 miles/wk). The next category of runners averaged between 16 to 32 km/wk (10 and 20 miles/wk). Therefore, a 24 to 32 km/wk (15to20mile/wk),1500to2200kcal/wkthreshold for significant HDL-C and TG changes compares favourably with the findings of Williams, [12,32,33] is supported by the current body of cross-sectional data, but is somewhat greater than what has been postulated as the threshold elsewhere. [38] At this point it should be emphasised that walking and running are not the only modes of physical activity in which favourable lipid and lipoprotein changes occur. Many investigators have reported similar relationships between lipid levels and the volume of swimming, cycling and recreational sports participation. [8,35,36] Thus, the volume of physical activity, in which a relatively large muscle mass is employed, relates to caloric expenditure and seems to be the stimulus for altering blood lipids and lipoprotein levels. 1.5 Summary of Cross-Sectional Findings Taken together, the cross-sectional data indicate that most sedentary individuals will experience elevations of 3.5 to 6 mg/dl in HDL-C by Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

8 1040 Durstine et al. increasing their energy expenditure to 1500 to 2200 kcal/wk. Further increases in HDL-C of 1.5 to 3 mg/dl can be expected for each 16 km/wk (10 miles/wk) increment in running volume, which equates to ~1100 kcal/wk of energy expenditure. Differences in TG range from 7 to 20 mg/dl at an energy expenditure of 1500 to 2200 kcal/wk and further reductions of 3 to 8 mg/dl may occur for each 16km (10-mile) increase in volume. There is little support in the cross-sectional literature for significant differences in TC and LDL-C between active and inactive, independent of bodyweight and body fat differences. [8] Causality can not be established from crosssectional data and results from these observational studies may embellish the association between and blood lipid levels. Indeed, the greatest disparities in blood lipids, and most often HDL-C, are generally reported when physiological differences and the volume of physical activity between are extreme. The differences in blood lipids and lipoprotein levels are often diminished or are no longer observed when controlling for group characteristics that influence lipid levels, [8,11,12] and when more heterogeneous are compared. [39-42] Furthermore, blood lipid and lipoprotein level changes associated with are not as frequently observed and are generally more modest than the group differences reported between rs and non-rs. [2,3] Therefore, it is important to examine longitudinal studies in order to determine the efficacy of threshold recommendations from cross-sectional evidence. 2. Exercise Training Interventions 2.1 Changes in TC and LDL-C Levels TC and LDL-C levels infrequently change with in either men or women. [2,3] In fact, lower TC and LDL-C levels result after in just over 25% of the publications reviewed (Appendix I). When has been shown to alter TC levels, the reductions are similar in both men and women and range from 7 to 27 mg/dl, or 4 to 20%. Likewise, lower LDL-C levels ranging from 6 to 28 mg/dl (5 to 19%) have been reported after in both genders. The adaptations reported with are similar to differences observed between rs and sedentary from the cross-sectional literature. However, control were not included in many of these studies, and therefore, the effects of on TC and LDL-C levels may be overstated. [43-51] Indeed, the extent to which lowers these lipid fractions is either somewhatlower(6to13mg/dlor4to7%) [52-56] or no longer significant [57-59] when the effect is adjusted for the TC and LDL-C changes that occur in control over the period. Estimates from a recent meta-analysis of randomised case-control studies suggest that mayonlybeexpectedtolowertcandldl-clevelsby~4mg/dl. [60] Characterising an Exercise Dose for Significant TC and LDL-C Changes Significant changes in TC and LDL-C levels are generally not observed after with a few exceptions. Therefore, there is little evidence to support a threshold for lowering TC and LDL-C levels. When changes have been reported, they are often associated with programmes in which participants expended more than 1200 kcal/wk. [43,44,47,51,52,56,61-65] Endurance programmes producing this level of caloric expenditure are most effective at lowering TC and LDL-C in previously untrained individuals, since trained individuals do not seem to respond, even with extreme increases in volume. [58,66,67] Some investigators have suggested that the different lipid responses to in trained versus untrained individuals may be caused by differences in initial TC and LDL-C levels. They reason that physically inactive individuals who exhibit higher initial TC or LDL-C levels may be expected to show greater -induced changes than those with lower baseline cholesterol levels. [68,69] However, baseline TC and LDL-C levels probably do not exert a significant influence on cholesterol adaptations to, since similar reductions in TC and LDL-C can occur in those with high [43,70] or normal baseline cholesterol levels. [62,65] Furthermore, in a recent meta-analysis of 31 randomised, Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

9 Blood Lipid and Lipoprotein Adaptations to Exercise 1041 controlled studies, Halbert and coworkers [60] did not find a significant relationship between baseline lipid levels and the changes in lipids that occur with Factors Influencing TC and LDL-C Changes with Exercise Training When non-obese men and women are directly compared, there is limited evidence to suggest that women may be more resistant to -induced changes in TC and LDL-C than their male counterparts. [44,45] This seems to be the case when weekly caloric expenditure meets or exceeds 1200 kcal. However, Shephard et al. [61] have reported just the opposite, and Brownell et al. [71] observed no gender differences after low-volume interventions. Others have shown that TC and LDL- C do not change in pre- and postmenopausal women following aerobic ; [72] however, the use of hormone replacement therapy may enhance the lipid and lipoprotein adaptations to in postmenopausal women. [54] Some investigators have suggested that the -induced changes in TC and LDL-C are caused by bodyweight and body fat reductions. [13] This may be true for subsets of the population in which large bodyweight or fat losses are reported, such as in obese women. [50,73-76] However, the present literature does not provide definitive evidence that bodyweight and fat loss are requisite for changing TC or LDL-C. First, there are several studies in which TC and LDL-C were significantly reduced in the absence of bodyweight and/or body fat changes. [45-47,52,62,65,77] Second, TC and LDL-C are often unchanged after programmes in which bodyweight and body fat are significantly lowered. [59,67,78-89] Third, when TC and LDL-C changes are reported after, they are of similar magnitude with and without losses in bodyweight or body fat (Appendix I). However, lower TC and LDL-C levels are more frequently observed when substantial bodyweight loss occurs through a combination of diet and. [59,74-76,90-93] However, it is unclear as to whether the reductions in TC and LDL-C after these interventions are caused by greater caloric deficits and bodyweight loss than what is generally reported after alone, or if a decrease in dietary saturated fat and cholesterol intake are more strongly associated with these lipid changes. A conclusive position on these issues can not be made from the current literature, as Schwartz [86] observed decreases in TC and LDL-C with dietinduced, but not -induced bodyweight loss. Nieman et al. [75] reported similar reductions in TC and LDL-C levels with diet alone or in combination with. On the other hand, Wood et al. [59] andcoonetal. [94] found small, comparable, but nonsignificant reductions in TC and LDL-C levels after bodyweight loss by diet or by. It is difficult to evaluate the effects of intensity on TC and LDL-C changes, since most studies were conducted with intensities >60% of maximum heart rate or maximal oxygen uptake (V. O 2max ). As such, most of the reductions in TC and LDL-C that have been reported with occur at these intensities or greater. Despres and colleagues, [64] however, observed significant reductions in TC and LDL-C with a lowintensity/high-volume regimen. Others have compared the effects of intensities, rangingfrom40to85%ofv. O 2max and did not find an intensity effect on TC and LDL-C. [79,95-98] Stein et al. [99] and Tomiyasu et al. [48] reported greater reductions in TC and LDL-C levels with high- versus moderate-intensity ; however, a failure to control for the volume in both of these studies makes their findings hard to interpret. Resistance does not seem to alter blood lipid and lipoprotein levels. [ ] Some investigators have reported lower TC and/or LDL-C levels after several weeks of resistance. [55,105,106] However, the sample sizes in these studies were small and, other than the results from Hurley et al., [106] these findings have been generally limited to females. [55,105] Resistance, in general, may be less effective than endurance activities for modifying TC and LDL-C levels, since relatively fewer calories are expended with resistance versus aerobic activity. In fact, the work of Blumenthal et al. [101] andsmutoketal. [100] have shown that lipids and lipoproteins changes should not be expected Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

10 1042 Durstine et al. after low-volume interventions of either resistance or aerobic activities Summary of TC and LDL-C Changes with Exercise Training In summary, a careful evaluation of the literature indicates that, more often than not, results in unaltered TC and LDL-C levels. In some instances, regular can produce small changes in TC and LDL-C of 4 to 7% in both men and women. Reductions in these lipid fractions occur with greater frequency in previously sedentary individuals and when caloric expenditure exceeds 1200 kcal/wk. At present, baseline levels of TC and LDL-C, changes in bodyweight and body fat, and intensity do not seem to be determinants for -induced changes in TC and LDL-C levels. 2.2 Changes in HDL-C and TG Levels Based on the frequency of reported changes in HDL-C and TG levels following, these lipid variables are more responsive to regular than TC and LDL-C. Significantly greater HDL-C and lower TG levels have been reported after in over half of the manuscripts reviewed (Appendix I). [2,3] Therefore, regular aerobic is often cited as consistently improving these lipid and lipoprotein levels. HDL-C and TG changes, however, are not always observed after interventions. Suggested reasons for the disparate findings include differences in regimens, baseline characteristics between study cohorts, and the extent to which bodyweight or body fat changes with. Other factors, such as the influence of alcohol, tobacco, lipid altering medications and the level of dietary intervention or control, may affect HDL-C and TG adaptations to. [3,13,68,107] Factors Influencing HDL-C and TG Changes with Exercise Training In a 1983 meta-analysis of longitudinal studies, Tran et al. [69] reported that the changes in HDL-C levels with were inversely related to baseline HDL-C levels. These findings suggested that individuals with the lowest HDL-C levels would exhibit the greatest increases in HDL-C with. However, this notion does not seem to hold true in light of more recent findings. For example, Raz et al. [53] reported that aerobic was ineffective in modifying HDL-C levels in young men with low initial HDL-C values. Williams and colleagues [108] found that increased HDL-C to a lesser extent in men with low versus normal baseline HDL-C levels. Others have demonstrated that HDL-C adapts most favourably to in men with normal initial HDL-C values (>38 mg/dl) and is resistant to change in men with baseline HDL-C values lower than 37 mg/dl. [81,109,110] To our knowledge, analogous studies have not been conducted with women. However, elevations in HDL-C have been observed in women with moderate baseline HDL-C levels [82,111,112] and in those with high preexisting HDL-C levels after large increases in volume. [66,67] Therefore, it appears that may be most effective at elevating HDL-C in those with normal or higher HDL-C levels before undergoing an programme. Present literature does not support the contention that baseline TG values influence TG adaptations to in either gender. [60] Inverse relationships have been established between body mass index (BMI), percentage body fat, regional body fat measured at baseline and the extent to which HDL-C and TG levels change with. [86,94,110] Observations from these studies suggest that -induced changes in HDL-C and TG are smaller in individuals with a greater BMI, body fat or with more central fat distribution. These physical characteristics may be indicative of underlying metabolism that impedes -induced changes in these blood lipids. For example, unique metabolic characteristics related to HDL-C and TG metabolism have been observed in adipocytes of different fat depots and suggest a mechanistic link between body fat, regional fat distribution and HDL-C and TG adaptations to. [ ] Contrary to a commonly held notion, a reduction in bodyweight or body fat is not requisite for Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

11 Blood Lipid and Lipoprotein Adaptations to Exercise 1043 to produce significant changes in HDL-C and TG. In men, favourable changes in these lipids occur with equal frequency when bodyweight and body fat are reduced [53,59,62-64,81,83,86,89,90,116,117] or not altered with. [48,52,99,109, ] In women, TG and HDL-C changes occur most often in the absence of bodyweight and fat loss. [66,67,87,95,111,126] Interestingly, when bodyweight loss is induced by either dietary intervention, alone or in combination with, HDL-C can increase, [76,108,127] however, a majority of studies indicate that HDL-C will decrease [74,75,91] or not change. [92,128] In fact, some investigators have suggested that may prevent a decrease in HDL-C when combined with dietary means of bodyweight or body fat reduction. [75,91] Nevertheless, these studies provide evidence that bodyweight loss and body fat reduction are not necessary for to have a beneficial effect on HDL-C and TG levels, as changes in these physical characteristics do not seem to influence the magnitude or direction of change in these lipid and lipoprotein fractions. Several investigators have demonstrated that can alter HDL-C and TG levels to the same extent in men and women. [49,97,129] However, favourable changes in HDL-C and TG levels are reported less frequently in women (Appendix I). [130] Reasons for less consistent findings in women are not completely clear. Some physiologic and metabolic factors that can influence lipid metabolism, such as smaller muscle and greater fat mass, different fat distribution, menstrual cycle fluctuations, the use of oral contraceptives in premenopausal women, menopausal status, and the use of hormone replacement therapy in postmenopausal women are thought to contribute to a greater variance in the lipid adaptations to in females. [54,72,131] Quantification of HDL-C and TG Changes with Exercise Training When HDL-C levels are significantly elevated after, the increases are similar in both men and women and generally range from 2 to 8 mg/dl, or 4 to 22%. However, increases of 15 to 19 mg/dlhavebeenreportedinbothgenders. [66,120,122] Likewise, significant reductions in TG levels, ranging from 5 to 38 mg/dl or 4 to 37%, have been reported for males after, but less frequently in females. In their recent meta-analysis, Halbert and co-workers [60] suggested that the effects of on HDL-C and TG favoured the more conservative ends of these ranges. These investigators estimated that increased HDL-C levels by 2 mg/dl and reduced TG values by 9 mg/dl. Although these estimates are modest, they may represent a reduction in cardiovascular disease risk of 2 to 4%. [132,133] In both men and women, extreme increases in running volume have been effective at elevating HDL-Cby6to17mg/dl(10to29%). [48,66,67,119,134] In men but not women, TG levels were also reducedby30to38mg/dl,or30to37%. [48,119] Along with greater volumes, the absolute and relative lipid changes are greater in these studies when compared with the rest of the literature, suggesting that there may be a doseresponse effect of on HDL-C and TG levels. However, most individuals would not adopt the volumes or intensities utilised in these studies as part of a permanent lifestyle practice. Moreover, recommending regimens similar to the ones described in these investigations would not be prudent for the general population, as they canleadtoanincreasedrateofinjuryanddrop out. [135] Investigators who have addressed the doseresponse issue with volumes more likely to be accepted by the general public have not found a relationship between increasing frequency, volumes or intensities and changes in HDL-C or TG levels. [48,111,136] In addition, a preponderance of interventions that encompassed only a few weeks are of limited value because the frequency and intensity were not at a level that would produce significant lipid changes. These issues all contribute to the difficulty in quantifying an threshold for modifying HDL-C and TG levels. Thus, threshold stimuli for altering these lipids and lipoproteins can be approximated, but not definitively established from the literature. Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

12 1044 Durstine et al Characterising an Exercise Dose for Significant HDL-C Changes In men, significantly higher HDL-C levels are observed consistently with moderate programmes requiring 1200 kcal/wk. Although exceptions exist, [58,96,129,137,138] this energy expenditure threshold was met in 21 out of the 25 studies showing significant increases in HDL-C levels (Appendix I). Elevations in HDL-C are seldom reported with weekly volumes eliciting less than 1200 kcal. [46,99,116,139] Thus, a volume of 1200 kcal/wk or greater may be necessary to raise HDL-C levels in men. Interestingly, a review of the literature indicated that the threshold for significant changes in HDL-C may be similar in both men and women. Changes in HDL-C are consistently shown in females when the weekly caloric expenditure meets or exceeds 1200 kcal. [45,49,97,111,129] Training volumes that elicit 1000 to 1200 kcal/wk in energy expenditure have also been shown to elevate HDL-C levels in sedentary and moderately fit women. [54,85,87,95,112,126] Yet, more often than not, weekly energy expenditure in the 1000 to 1200 kcal/wk range is not enough to elevate HDL-C levels in females. [51,72,73,101,136,138, ] As with men, volumes that require less than 1000 kcal/wk are not enough to favourably improve HDL-C values. [55,71,78,80,104, ] Currently, there is no evidence from the literature to support an intensity threshold for producing HDL-C level changes. In many instances where intensity was reported to influence HDL-C in males, investigators failed to control for energy expenditure. [48,99,118] As such, it can be argued that energy expenditure or volume, rather than intensity, affected the results. When energy expenditure or volume is controlled, intensity was not shown to influence HDL-C changes in men or women. [79,95,97,98,111] Characterising an Exercise Dose for Significant TG Changes In an early study, Holloszy and colleagues [150] determined that TG reductions attributed to, are in fact an acute response to the last session. Subsequent research examining the effect of one session on lipid metabolism has corroborated this observation. [3] Therefore, the frequency and extent to which TG level changes are reported after may be a function of when the final blood sample was obtained relative to the last session, rather than a cumulative effect of the regimen. If imparts an effect on TGs, independent of the changes that occur from the last session, then the volume threshold necessary for a TG level change may be similar to that necessary for HDL-C. For example, a weekly energy expenditure of 1200 kcal generally produces lower post- TG levels in sedentary and moderately fit men, [48,62,63,90,119, ,151] with few exceptions. [44,58,83,120] Significant reuctions in TG levels have occurred with weekly energy expenditures of 1000 to 1200 kcal; [46,52,53,59,81,116,117,121,152] yet, this energy expenditure does not consistently lower TG levels, as others have reported no change in TG levels at similar volumes. [64,65,79,84,86,94,97,109,129,153,154] Others have demonstrated that TG changes in men should not be expected when energy expenditure is lower than 1000 kcal/wk. [43,47,89,98-100,137,139,155] An threshold for lowering TG levels in women is not evident from the present literature. Many barriers contribute to the difficulty in trying to quantify a threshold stimulus. First, lower TG levels are reported less frequently in women versus men after. [56,73,85,87,117,126,149] Second, when TG reductions occur, they are observed with volumes eliciting 1000 to 3000 kcal/wk and intensities ranging from 50 to 80% of cardiovascular capacity. [73,85,117,126] These interventions are similar in frequencies, volumes and intensities to those producing no change. Third, TGs are not altered when volumes and intensities are increased to extreme levels, [66] indicating that a dose-response relationship between and TG changes may not exist for women. However, it should be emphasised that a lack of evidence for a dose-response relationship between and TGs does not mean that has no effect on blood TG levels in women. Woods and Graham [149] have shown that measur- Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

13 Blood Lipid and Lipoprotein Adaptations to Exercise 1045 able fluctuations in TG levels occur throughout the menstrual cycle, indicating that the menstrual phase in which blood samples were obtained may mask the effects of in premenopausal women. In addition, Binder s group [54] determined that can attenuate the elevations in TG that may accompany hormone replacement therapy in postmenopausal women. Therefore, can beneficially influence TG levels in women, whether or not significant changes are observed with Summary of HDL-C and TG Changes with Exercise Training In summary, regular aerobic can increase HDL-C and TG levels in men and women. The effect of on HDL-C is similar in both males and females; however, TG changes are more commonly reported in males. The effect is strongest in non-obese individuals with normal or elevated HDL-C before the intervention. In contrast, baseline TG levels do not seem to impact TG responses to. In addition, changes in bodyweight or body fat do not appear to be necessary for favourable adaptations in these lipids. Regular can raise HDL-C levels by 2 to 8 mg/dl and lower TGs from 5 to 38 mg/dl in men and women. The volumes that elicit energy expenditures 1200 kcal/wk are most frequently associated with elevations in HDL-C levels in both genders and reduced TG levels in men. At present, a threshold for lowering TGs in women can not be established from the literature. 3. Conclusion Comparisons between sedentary and physically active have been used to establish a positive influence of physical activity on blood lipids. Physically active individuals typically exhibit greater HDL-C and lower TG levels versus their less active counterparts. In some instances, lower TC and LDL-C levels may also be observed in physically active ; however, this is not a consistent finding. Dose-response relationships between the amount of and favourable blood lipid changes suggest that can exert a positive influence on blood lipids at low volumes, although the effects may not be observable until certain thresholds are met. The thresholds established from cross-sectional literature appear to be similar in men and women and occur at volumes of 24 to 32 km/wk (15 to 20 miles/wk) of brisk walking or jogging and elicit between 1200 to 2200 kcal/wk. This range of weekly energy expenditure is associated with 2 to 3 mg/dl increases in HDL-C and TG reductions of 8 to 20 mg/dl. Cross-sectional evidence also suggests that these lipid fractions are enhanced further with additional increases in volume. There is limited support in the cross-sectional or intervention literature for favourable changes in TC and LDL-C with. However, favourable changes in HDL-C and TGs are often observed after regimens requiring energy expenditures similar to those characterised from cross-sectional data. Training programmes that elicit 1200 to 2200 kcal/wk in are often effective at elevating HDL-C levels from 2 to 8 mg/dl and lowering TGs by 5 to 38 mg/dl. This weekly energy expenditure is also associated with TC and LDL-C reductions, when they are reported. The frequency and extent to which most of these lipid changes are reported are similar in both genders, with the exception of TG levels. Thus, for most individuals, the positive effects of regular are exerted on blood lipids at low volumes and accrue so that noticeable differences frequently occur with weekly energy expenditures of 1200 to 2200 kcal/wk. It appears that weekly caloric expenditures that meet or exceed the higher end of this range are more likely to produce the desired lipid changes. This volume threshold is slightly greater than what has been suggested previously for favourably altering blood lipids. However, this amount of physical activity, performed at moderate intensities, is reasonable and attainable for most individuals and is within the American College of Sports Medicine s currently recommended range for healthy adults. Acknowledgements The authors have no conflicts of interest. Adis International Limited. All rights reserved. Sports Med 2001; 31 (15)

14 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Blood lipid and lipoprotein changes from 100 selected - studies in men and women a Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Aellen et al., Effects of 1993 [118] intensity using AT Allison et al., Effects of 1981 [153] duration Altekruse and Effects of Wilmore, 1973 [43] Andersen et al., Effects of diet [74] and diet + lifestyle Baker et al., 1986 [62] Effects of Barr et al., 1991 [58] Effects of progressive endurance Bassett-Frey et al., 1982 [78] Effects of Binder et al., 1996 [54] Effects of + hormone replacement therapy Age 20-30y; 33 M: 16 intensity > AT, 17 intensity < AT, 12 C Age 17-26y; 25 M, 23 F: 22 C; 30-min group; 45- min group Age 17-59y; 39 M Age 21-60y; obese; 38 F: 19 DE, 19 DL Age>50y;34M: 20 Ex (walk/run), 14 C Age 18-22y; 24 M swimmers: 13 HV, 11 NV Age 19-29y; 18 F: 12 IT, 6 CT Age 60-72y; 71 F postmenopausal: 23Ex,16ExH,15 H, 17 C Cycle ergometry; 9 weeks; f = 4/wk; I and < AT; D = 30 min Fitness class, jogging; 8 wk; f = 3/wk; I = 85% HRmax; D = 30 and 45 min Walk/jog/run; 10 weeks; f = 3/wk; I = mod-high; D = 5 to 15 km/wk (2.7-9 miles/wk) Step aerobics; 16wk and 1y follow-up; f=3/wk;i=7-11 METs; D = min ( kcal/session) Walk/run: 20wk; f = 3/wk; I = 65-85% HRR; D = 48 min Swimming; 25wk season; f = daily; I = moderate; D = HV: increased from 22 to 44 km/wk; NV: 22 km/wk (6wk) Cycle ergometry; 10wk; f = 3/wk; I = 70% HRR; D=30min Walk/jog/stair climb; 11mo;f=3-5/wk; I = 60-70% V. O2max; D=30+min TC LDL-C TG HDL-C <AT: ±2 (4%), >AT: NS, M 30-min: 7 ( 12%), M 45-min: 6 ( 10%), F 30-min: 5 ( 8%), F 45- min: 4 ( 7%), 24 ( 11%) NS ±19 (±50%): α lipoprotein % 16wk; DE: 22 ( 11%), DL: 23 ( 9%). 1y follow-up (vs baseline): DE: 5 ( 2%), DL: 7 ( 3%) Ex: 9 ( 4%), C: ±6 (3%) 11( 6%) NS at wk 20: both ; 7 ( 4%) NS at wk 25: both Ex: 13 ( 6%), ExH: 13 ( 6%), H: NS, 16wk; DE: 12 ( 11%), DL: 15 ( 6%). 1y follow-up (vs baseline): DE: NS, DL: NS Ex: 10 ( 5%), C: ±9 (6%) 15 ( 15%) at wk 20: both ; 6 ( 6%) NS at wk 25: both Ex: 9 (7%), ExH: 25 ( 20%), H: 24 ( 17%), 16wk; DE: 24 ( 18%), DL: 18 ( 15%). 1y follow-up (vs baseline): DE: NS, DL: NS Ex: 21 ( 24%), 16wk; DE: 5 ( 9%), DL: 5 ( 10%). 1y follow-up (vs baseline): DE: ±4 (8%), DL: ±2 (5%) Ex: ±6 (±17%), C: 3 ( 8%) bodyweight (% ) %fat V. O2max (% ) 1% 16wk; DE: 10%, DL: 9%. 1y (vs baseline): DE: 8%, DL: 8% Ex: 2%, 16wk; DE: 14%, DL: 19%. 1y (vs baseline): DE:, DL: Ex: 2%, NS NS NS 10% (sum of skinfolds): both ExH: NS, H: ±45 (42%), ExH: ±9 (17%), H: ±9 (17%), Ex: 2%, ExH: 3%, H: NS, 2%: both Ex: 8%, ExH: 6%, H: NS, ±5-10% in M and F, both 30- and 45- min 16wk; DE: ±19%, DL: ±16%. 1y (vs baseline): DE: ±16%, DL: ±24% Ex:±17%, ±16%: both Ex: ±18%, ExH: ±22%, H: NS, 1046 Durstine et al.

15 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Blumenthal et al., 1991 [126] Blumenthal et al., 1988 [95] Blumenthal et al., 1991 [101] Effects of activity intervention Effects of intensity Effects of aerobic and resistance Boyden et al., 1993 [55] Effects of resistance Brownell et al., 1982 [71] Compare responses between genders Buono et al., 1988 [50] Effects of hypocaloric diet and Cauley et al., Effects of 1987 [140] on HDL-C Coon et al., 1989 [94] Effect of vs diet Crouse et al., Effect of 1997 [79] intensity Despres et al., 1988 [63] Effects of heredity and Despres et al., 1990 [64] Effects of Age >60y; M and F: 33 AE, 34 Y, 34 C Cycle ergometry; 14mo; f = 3/wk; I = 50-60% HRR; D=60min AE: NS, Y: NS, Age 28-66y, Walk/jog for 12wk; M, post-mi: 23 at 65-75% V. f=3/wk;i=modvs O2max, 23 at <45% V. low; D = 30 vs 45 min O2max Age 45-57y; 46 F: 22 RE, 24 AE Age 28-39y; 88 F: 46 RE, 42 C Age 20-60y; 24 M, 37 F Age 20-26y; 10 obese F Age 50-62y; 204 F: 100 Ex, 104 C Age 46-73y; 20 obese M: 10 Ex, 10 Dt Age 37-57y; 26 M with high cholesterol: 12 HI, 12 MI 12 adult M: 6 pairs of monozygotic twins Age 22-28y; 5 M Circuit or walk/jog; 12wk; f=3/wk;i=70% HRR (AE); D=35min Resistance ; 5mo; f = 3/wk; I = 70% 1RM; D = 3 sets, 8 reps, 12 s Various aerobic + resistance activities; 10wk; f = 3/wk; I = 70% HRmax; D=15-20min Walking + diet; 42d; f=daily;i=low (HR:>132 beats/min); D = 5 h/d Walking; 2y; f 3/wk; I = low-mod; D = 5 km/session (3 miles/session) Walk/jog/cycle; 9-12mo; f = 3/wk; I = 50 85% HRR; D=40min Cycle ergometry; 24wk; f = 3/wk; I=HI:80%V. O2max, MI: 50% V. O2max; D = 350 kcal /session Cycle ergometry; 22d; f = V. O2max; D = 1000 kcal, total kcal deficit Cycle ergometry; 100d; f = 6/wk; I = low; D = 2 53 min sessions to expend 1000 kcal/d RE: 13 ( 7%), C: 3 ( 2%), NS M: NS, F: NS AE: NS, Y: NS, RE: 14 ( 12%), C: 3 ( 3%) NS AE: 30 (20%), Y: 17 (12%), C: ±20 (±14%) M: 8.5 M: NS, ( 6%), F: NS F: 5.3 ( 5%) AE: ±4 (7.5%), Y: NS, Mod: ±5 (±18%), low: ±6 (±22%) M: NS, F: NS AE: NS, Y: NS, 1%: both M: 1%, F: 1.5% AE: ±18%, Y: ±6%, C: ±7% ±11-14% for both AE: ±18%, RE: NS 1% 31 ( 15%) 25 ( 24%) NS 8% 5% ±19% Ex: 11 NS, Dt: 8 NS 16 ( 6%): both ; significant at 16wk,NSat 24wk 18 ( 11%); NS Ex: 9 NS, Dt: 6 NS 18 ( 16%); NS Ex: 11 NS, Dt: 26 ( 25%) Dt: ±4 (±12%) ; HDL2-C (±82%) HDL3-C ( 13%) Dt: 12% 2%: both Dt: 6% ±8-10% in M and F Ex: ±32%, Dt: NS NS HI: +51%, MI: +25% 32 (32%) ±4.4 (16%) 3% 2.4% ±10% 8 ( 4%) 6 ( 5%) NS ±5 (±12%) 9% 38%: fat mass Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1047

16 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Contd Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Despres et al., Effects of 1991 [51] Duncan et al., Exercise doseresponse for 1991 [111] lipid changes in women Dressendorfer et al., 1982 [119] Effects of a 20d road race el-sayed, 1996 [155] Effects of intensity Farrell and Barboriak, 1980 [141] Effects of Filipovsky et al., Effects of 1991 [70] in hypertensives Franklin et al., Effects of body 1979 [80] fat on lipid response to Fonong et al., Effects of 1996 [137] in older men and women Gaesser and Rich, 1984 [96] Effect of intensity Age 33-50y; 13 obese F Age 20-40y; 59 F: 16 AW, 12 BW, 18 St, 13 C Age 23-60y; 12 M runners 18M,9HI,9LI Age 20-27y; 7 M, 9F Age 26-76y; 77 hypertensives: 60 M, 17 F Age 29-40y; 36 F: 23 obese, 13 N Age 60-75y; 23 M, 14 F Age 20-30y; 16 M: 7HI,9MI Walk/jog/swim/cycle/ aerobic dance; 14mo; f = 4-5/wk; I = 55% V. O2max; D=90min Walking; 24wk; f = 5/wk; I = varied; D=4.8km/d Running: 20d; f = 10 successive days; 70h rest; 8 successive days; I=high;D=28km/d Cycleergometry; 12wk; f = 3/wk; I=HI:80%V. O2max; L: 30% V. O2max; D=20min Walking; 8wk; f = 3-4/wk; I = 70% V. O2max; D=30min Walking/callisthenics/ cycle ergometry; 5wk; f = 2-3/wk; I = 70% HRmax: D = 7-10km walk, 30 min callisthenics + 30 min cycle Walk; 12wk; f=4/wk;i=75% V. O2max; D = min Cycle ergometry; 8wk; f = 3/wk; I = 60-75% V. O2peak; D = kcal /session Cycle ergometry; 18wk; f = 3/wk; I = HI: 80-85% V. O2max, MI: 45% V. O2max; D=HI:25 min, MI: 50 min TC LDL-C TG HDL-C bodyweight (% ) %fat V. O2max (% ) 15 ( 7%) 15 ( 10%) NS NS; HDL2-C: 4% 3.3% ±15% ±3, HDL3-C: 3 AW: NS, BW: NS, St: NS, AW: NS, BW: 10 (8%), St: NS, AW: NS, BW: NS, St: NS, C: 13 (18%) AW: ±3 (±6%), BW: ±2 (±4%), St: ±3 (±6%), AW: NS, BW: NS, St: NS, AW: NS, BW: NS, St: 1.7%, NS 30 ( 30%) ±7.5 (22%) NS NS AW: ±16%, BW: ±9%, St: ±4%, HI: ±15%, LI: NS NS: M and F NS: M and F NS: M and F NS: M and F 1%: M and F ±9%: M and F 43 ( 19%) 32 ( 21%) 64 ( 35%) 5 ( 14%) 1.6: BMI (kg/m 2 ) Obese: NS, N: NS Obese: NS, N: NS Obese: 3%, N: NS Obese: 5%, N: 3% Obese: ±16%, N: ±12% NS NS NS NS NS ±15% HI: NS, MI: NS HI: NS, MI: NS HI: NS, MI: NS HI: NS, MI: NS HI: NS, MI: NS HI: NS, MI: NS HI: ±19%, MI: ±15% 1048 Durstine et al.

17 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Goldberg et al., Effects of 1984 [105] resistance Goodyear et al., 1986 [66] Effects of progressive endurance Grandjean et al., 1996 [57] Grandjean et al., 1998 [72] Effects of Effects of menopausal status on changes in lipids Hardman et al., 1989 [112] Effects of Higuchi et al., Effects of 1984 [120] Hill et al., 1989 [45] Effects of Hinkleman and Nieman, 1993 [142] Effects of Holloszy et al., Effects of 1964 [150] and acute response Houmard et al., 1994 [81] Effects of Age 24-36y; 6 M, 8F Age 20-25y; 10 F: 5 runners, 5 C Age 30-45y; 37 F: 20 Ex, 17 C Age 36-68y; F: 21 PRE, 16 POM Age 37-53y; 44 F: 28 Ex, 16 C Age 28-31y; 5 M Age 25-45y; 8 M, 9F Age 25-45y; 36 F: 18 Ex, 18 C Age 35-55y; M: 27 Ex (15 supervised, 12 unsupervised), 8 C Age 45-50y; 13 M Resistance ; 16wk; f = 3/wk; I = 3-8 reps, 3 sets, 2 min rest; D=8s Running; 8wk; f, I and D = individualised to meet volume: incremental increase from km/wk (37-62 miles/wk) Walk/jog/cycle; 24wk; f = 3/wk; I = 60-70% V. O2max; D = min (1200 kcal/wk) Walk/jog; 12wk; f = 4/wk; I = 50-70% V. O2max; D = kcal Brisk walking; 1y; f = varied; I = 60% predicted V. O2max; D = varied to meet km/wk (10-11 miles/wk) Running; 4 wk; f=5/wk;i=80% V. O2max; D=50min Walk/jog; 10wk; f = 3-4/wk; I = 70% HRmax; D=20-60 min ( kcal/wk) Walk/jog; 15wk; f=5/wk;i=60% V. O2max; D=45min Walk/running + callisthenics; 24wk; f = 3-4/wk; I = modhigh; D = km (2-4 miles) StairMaster ; 14wk; f = 3/wk; I = 70-85% V. O2max; D = min M: NS, F: 21 ( 11%) Ex: 20 ( 10%), C: 20 ( 10%) PRE: NS, POM: NS M: 23 ( 16%) F: 20 ( 19%) Ex: 25 ( 21%) C: 17 ( 14%) PRE: NS, POM: NS M: NS, F: 20 ( 28%) PRE: NS, POM: NS M: NS, F: NS M: NS, F: NS ±17 (±29%) Ex: ±6 (±11%) NS, 3 (5.5%) in combined Ex: ±12 (±27%), PRE: NS, POM: NS M: 20%, skinfold thickness, F: 15%, skinfold thickness PRE: NS, POM: NS ±5% NS NS ±19 (35%) NS NS NS M: 25 ( 13%), F: NS M: NS, F: ±3 (±6%) NS NS NS Ex: 1.5 ( 3%), C: ±7 (±15%) NS Ex: 83 ( 40%): determined to be an acute response, NS: increased cholesterol and phospholipid composition of LDL M: NS, F: NS C: ±2% M: NS, F: NS Ex: +15%, ±16% in combined M: ±18%, F: ±13% NS ±106%, treadmill test time 35 ( 20%) ±2.7 (8.5%) 2% 2% ±21% Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1049

18 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Contd Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Hurley et al., Effects of 1988 [106] resistance Huttunen et al., Effects of 1979 [116] Keins et al., Effects of 1980 [52] King et al., 1995 [97] Effects of intensities and formats in older men and women Kokkinos et al., 1988 [103] Effects of resistance Kokkinos et al., Effects of 1991 [102] resistance Lamarche et al., 1992 [73] Effects of fat loss with in obese women Lapman et al., 1985 [152] Effects of resistance Age 40-55; 21 M: 11 Ex, 10 C Age 40-45y; 100M:50Ex, 50 C Age 35-45y; 40 M: 24 Ex, 13 C Age 50-65y; 149 M, 120 F: 69 HG, 74 HH, 64 LH Age 19-22y; 37 M: 15 L rep, 14 H rep, 8C Age 35-60y; 24 M: 16 Ex, 8 C Age 30-40y; 31 obese F: 20 FL, 11 FG Age 34-58y; 10 hypertriglyceridaemic M Resistance ; 16wk; f = 3-4/wk; I = 8-20 reps, 1 set 15 sec rest between s; D = 14 s Walk/jog/ski/cycle; 16wk; f = 3-4/wk; I = 40-66% V. O2max; D=30min Run/swim/gymnastic games; 12wk; f=3/wk;i=80% V. O2max; D=45min Walk/jog/cycle ergometry; 2y; f = 3-5 /wk; I = HG and HH: 73-88%; LH: 60-73% HRmax; D=30-40min Resistance ; 10wk; f = 3/wk; I = variable resistance sec between sets; D = sets adjusted to meet equal volume Resistance ; 20wk; f= 3/wk; I = reps with adjusted resistance, 90 sec rest, 2 sets; D = 11 s Walk/jog; 24wk; f = 4-5/wk; I = 55% V. O2max; D=90min Jogging; 9wk; f=3/wk;i=85% HRmax; D=30-40min TC LDL-C Ex: 7 ( 5%), Ex: 30 ( 12%), C: 15 ( 6%) Ex: 10 ( 4%), HG:, HH:, LH: L rep: NS, H rep: NS, FL: 16 (8%), FG: NS Ex: 23 ( 12%), C: 10 ( 5%) TG Ex: 25 ( 18%), C: ±15 (±12%) Ex: 29 ( 21%), HG: NS, HH: NS, LH: NS Lrep:NS, H rep: NS, FL: 15 (11%), FG: NS HG: NS, HH: NS, LH: NS L rep: NS, H rep: NS, FL: 30 (18%), FG: NS HDL-C Ex: ±5 (13%), Ex: ±6 (16%), Ex: ±3 (±8%), HG: NS, HH: ±2 (±4.5%), LH: ±4 (±8.5%) Lrep:NS, H rep: NS, FL: NS, (HDL2-C: ±2), (HDL3-C: 2), FG: NS, (HDL2-), (HDL3-C: 5) bodyweight (% ) Ex: 1%, C: <1% HG: NS, BMI, HH: NS, BMI, LH: NS, BMI L rep: NS, H rep: NS, FL: 2%, FG: ±2.5% %fat V. O2max (% ) Ex: ±9%, HG:, HH:, LH: L rep: NS, H rep: NS, FL: 2%, FG:±1.7% Ex: ±11%, HG: ±4%, HH: ±9%, LH: ±8% L rep: NS, H rep: NS, FL: ±13%, FG: ±10% NS NS 77 ( 38%) NS NS ±26% 1050 Durstine et al.

19 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Leon et al., Effects of 1979 [83] Lewis et al., 1976 [82] Effects of physical activity Lopez et al., Effects of 1974 [46] and physical fitness Manning et al., Effects of 1991 [104] resistance Marti et al., Effects of 1990 [139] Milesis et al., 1976 [84] Effects of duration Moll et al., 1979 [77] Effects of Nieman et al., Effects of diet 1990 [75] and Nieman et al., Effects of 1993 [143] physical activity Nye et al., Effects of 1981 [47] Peltonen et al., 1981 [65] Effects of Age 19-31y; 6 obese M Age 30-52y; 22 obese F Age 22y; 13 medical students Age 30-40y; 16 obese F Age 27-50y; 61 M: 39 Ex, 22 C Age 20-35y; 59 M inmates: 14 in 15-min group, 17 in 30-min group, 12 in 45-min group, 16 C Age 22-26y; 14 F Age 35-40y; 21 obese F: 11 DE, 10 Dt Age 67-85y; 32 F: 14 WK, 16 CL Age 30-45y; 16 M Age 26-53y; 27 M: 20 Ex, 7 C Brisk walking; 16wk; f=5/wk;i=>7 METs; D = min, 1100 kcal/session Walk/jog; 17wk; f=2/wk;i=80% HRmax; D=5km(2.5 miles) + 1h of callisthenics Jog/cycle/callisthenics; 7wk;f=4/wk; I=7METs;D=30 min Resistance ; 12wk; f = 3/wk; I = 60-70% 1RM; D = 3 sets, 6-8 reps Jogging; 16wk; f = 2-6/wk; I = 85% of AT; D = varied to meet 120 min/wk Jogging; 12wk; f = 3/wk; I = 80-95% HRmax; D = 15, 30 or 45 min Jogging; 6wk; f=5/wk;i=70% HRmax; D=30-45min Walking; 5wk; f = 5/wk; I = 60% HRR; D=30-40min Walking/callisthenics; 12wk; f = 5/wk; I = 60% HRR (WK); D=30-40min Callisthenics to music; 10wk; f = 2/wk; I = ; D=30-45min Jog /cross-country ski/swim; 15wk; f=3/wk;i=modhigh (HR: bpm); D = min NS NS NS ± 5(±16%) 6% 4.9% NS NS NS ±4.7 (±9%) 5% 5% ±33%, GXT duration 7 ( 4%) 28 ( 17%) 27 ( 24%) ± 46 (±16%): α lipoprotein NS NS NS NS NS NS Ex: ±3 (±6%), NS NS 15-min: NS, 30-min: 2%, 45-min: 1%, 15-min: 1%, 30-min: 1%, 45-min: 1%, Ex: ±6%, estimate from run test, C: ±4%, estimate from run test 15-min: ±9%, 30-min: ±16%, 45-min: ±17%, 10 ( 6%) NS NS ±17%, max treadmill work rate DE: 34 ( 17%), D: 24 ( 12%) DE: 17 ( 14%), D: 17 ( 14%) DE: 42 ( 36%), D: 31 ( 27%) DE: NS, D: 6 ( 11%) DE: 7%, D: 7% DE: 4%, D: 4% 12 ( 5%) 8 ( 5%) NS NS NS NS Ex: 9 ( 4%), Ex: 11 ( 6%), Ex: ±3 (±6%), DE: ±18%, D: 2% WK: ±13%, CL: NS Ex: ±14, work rate at 150 bpm, Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1051

20 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Contd Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Pollock et al., Effects of 1969 [121] frequency Ponjee et al., 1995 [44] Effects of marathon Raz et al., 1988 [53] Effects of in men with low HDL-C Ready et al., Effects of 1995 [56] Ready et al., Effect of 1996 [136] volume Rotkis et al., 1984 [67] Effects of increasing running volume Santiago et al., 1987 [144] Effects of intensity Age 30-47y; 18 M: 5 in 2/wk group, 6 in 4/wk group, 7 C Age 27-49y; sedentary 20 M, 14 F Age 24-26y; 55 M; 28 Ex, 27 C Age 57-67y; 40 postmenopausal F: 24 Ex, 16 C Age 55-67y; 76 postmenopausal F: 19 in 3/wk group, 17 in 5/wk group, 20 C Age 24-37y; 19 run-trained F Age 20-40y; 25 F: 9WK,8J,8C Walk/jog/run/interval; 16wk;f=2or4/wk; I = low-mod; D=30min Jogging/running; 9mo; f = 3-6/wk; I = variable; D = variable; increasing volume and intensity in a marathon programme Jogging/circuit ; 9wk; f = 2/wk; I = 75-85% V. O2max; D=45min Walking; 24wk; f=5/wk;i=54% HRR; D=55min Walking; 24wk; f=3or5/wk;i= 60% V. O2peak; D=60min Running; 15mo; f=5-6/wk; I = variable; D = variable to meet run volume [running volume increased from km/wk (15-63 miles/wk)] Walking/jogging; 20wk; f=3-4/wk; I=WK:70-74% V. O2max; J:85-90% V. O2max; D = 5 km/session (3 miles/session) TC 2/wk group: 22 ( 11%), 4/wk group: 10 ( 5%), C: ±8 (±5%) M: 27 (12%), F: NS Ex: 12 ( 5%), LDL-C M: 19 ( 12%), F: NS Ex: 6 ( 6%), TG 2/wk group: 13 ( 16%), 4/wk group: 13 ( 14%), M: NS, F: NS Ex: 14 ( 14%), Ex: 11 ( 7%), C: ±15 (±10%) HDL-C M: NS, F: NS C: ±3 (±10%) bodyweight (% ) 2/wk group: NS, 4/wk group: 1%, M: 3%, F: NS Ex: <1%, C: ± <1% Ex: 2%, 3/wk group: <1%, 5/wk group: NS, %fat 2/wk group: NS, 4/wk group: 3%, M: 5%, F: 3% 3/wk group: 1%, 5/wk group: 1%, NS ±10 (±16%) NS 3.6% V. O2max (% ) 2/wk group: ±10%, 3.2 km (2-mile) run time, 4/wk group: ±12%, 3.2km run time Ex: ±14%, Ex:±8%, 3/wk group: ±9%, 5/wk group: ±12%, WK: ±21%, J: ±31%, 1052 Durstine et al.

21 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Santiago et al., Effects of 1995 [145] Savage et al., 1986 [98] Effects of intensity Schwartz, Independent 1987 [86] effects of dietary vs bodyweight loss Schwartz et al., 1992 [90] Effects of Seip et al., 1993 [49] Effects of Shephard et al., Effects of an 1979 [61] industrial fitness programme Smutok et al., 1993 [100] Effects of strength vs aerobic Age 22-40y; 27 F: 16 WK, 11 C Age 6-10y, 34-40y; HI: 12 boys and 12 men; LI: 8 boys and 8 men; C: 10 boys and 10 men Age 20-38y; 26 M: 12 Ex, 14 Dt Age 28-68y; 27 M: 12 young, 15 older Age 60-72y; 57 sedentary older M andf:28m,29f Age 24-53y; 98 M, 158 F: 101 HA, 57 LA, 37 C Age 40-60y; 44 M: 14 ST, 13 AT, 10 C Sopko et al., 1983 [127] Effects of diet and in overweight, hypercholesterola emic men Age 43-60y: 23 M: 10 DE, 13 Dt Walking; 40wk; f=4/wk; I = 72% HRmax; D = 5 km/session (3 miles/session) Walk/jog/run; 10wk; f=3/wk; I=HI:75%V. O2max; LI: 40% V. O2max; D = km/session Walk/jog; 12wk; f=3-5/wk; I = 70-85% HRR; D=40min Walk/jog/cycle; 24wk; f=5/wk; I = 50-85% HRR; D=45min Walk/jog/cycle; 9-12mo; f = 3-5/wk; I = 65-85% HRmax; D=45-60min; kcal/wk Jog/rhythm callisthenics; 24wk; f = 3/wk; I = 60-70% V. O2max; D=30min Walk/jog/resistance; 20wk; f = 3/wk; I = AT: 50-85% HRR; ST: reps, 2 sets, 90 sec rest; D=AT:30min; ST: 11 s Walking; 12wk; f=3/wk;i= moderate; D = 60 min ( kcal /session) Dt: 29 ( 16%) Young: NS, older: NS Dt: 33 ( 22%): VLDL-C + LDL-C Young: NS, older: NS Dt: 54 ( 35%) Young: NS, older: 23 ( 20%) Ex: ±3 (±8%), Dt: ±4 (±12%) Young: ±6 (±13%), older: ±6 (±14%) Ex: 3%, Dt: 13% Young: NS, older: 3% Ex: 11% fat mass, Dt: 30% fat mass Young: NS, older: 1.7% WK: ±22%, C: 2% HI: ±3%, LI: NS, Ex: ±19%, Dt: NS Young: ±18%, older: ±22% 8 ( 4%) 6 ( 5%) 26 ( 20%) ±3 (±5%) 3-3.5% 2-3% ±18-22% HA M: NS, HA F: 15 ( 7%) LA M: 9 ( 4%), LA F: NS, C F: 4 ( 2%) NS: all DE: 10 ( 4%) NS, Dt: 6 ( 3%) NS HA M: NS, HA F: 16 ( 14%), LA M: 10 ( 8%), LA F: NS, C F: 13 ( 10%) DE: NS, Dt: NS HA M: NS, HA F: NS, LA M: NS, LA F: NS, CF:NS NS: all DE: NS, Dt: NS HA M: NS, HA F: NS, LA M: NS, LA F: NS, CM: 5 ( 8%), C F: 7 ( 10%) NS: all DE: ±5 (±11%), Dt: NS NS: all DE: 4%, Dt: NS HA M: 1%, HA F: 2%, LA M: NS, LA F: 2%, CF:NS AT: 1.6%, ST: NS, DE: 17% sum of skinfolds, Dt: NS HA M:+9%, HA F:+5%, LA M: +5%, LA F: NS, CF:+3% AT: ±17%, ST: NS, Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1053

22 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Contd Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Stefanick et al., Effects of 1998 [128] NCEP step 2 diet and in men and women Stein et al., Effects of 1990 [99] intensity Stubbe et al., 1983 [154] Effects of Sunami et al., Effects of lowintensity 1999 [129] Suter and Marti, Effects of selfmonitored 1992 [146] Sutherland et al., 1983 [122] Sutherland et al., 1984 [134] Effects of cholesterol levels on response Effects of marathon Svendsen et al., 1994 [156] Effects of after diet intervention Age 30-64y; 190 M, 177 F: 47 M Ex, 43 F Ex, 49 M Dt, 46 F Dt, 48 M DE, 43 F DE, 46 M C, 45 F C Age 36-52y; 49 M: 13 at 65% HRmax,,14 at 75% HRmax, 12at85% HRmax,10 C Age 32-53y; 18 M: 12 HI, 6 MI Age 60-77y; 20 M, 20 F: 10 M Ex, 10 F Ex, 10 M C, 10 FC Age 25-55y; 33 F: 17 Ex, 16 C Age 16-50y; 18 M: 8 HC, 10 NC Walking; 1y; f=3/wk;i=lowmod; D = varied to meet goal of 16 km/wk (10 miles/wk) Cycle ergometry; 12wk; f = 3/wk; I = 65, 75, 85% HRmax; D=30min interval Cycle ergometry; HI: 6wk; MI: 12wk; f=3-5/wk;i=hi: 85% HRmax; MI: 70% HRmax; D=50min Cycle ergometry; 20wk; f = 2-4/wk; I = 50% estimated V. O2max; D=60min Walk/jog; 16wk; f = 2-6/wk; I = moderate; D = variable to meet 2h or 11 km/wk (7 miles/wk) Running/circuit ; 16wk; f = 2-3/wk; I = mod-high; D=60min Age 18-47y; 12 M Running; 18wk; f = variable; I = variable; D = self-monitored marathon (increased 33 km/wk) Age 49-58y; 118 postmenopausal F: 51 Dt, 49 DE, 21 C Walking; 24wk; f = 3/wk; I = 70% V. O2max; D = min; included resistance TC Ex M: NS, Ex F: NS, Dt M: NS, Dt F: NS, DE M: 21 ( 9%), DE F: 18 ( 7%), CF:NS 65%: NS, 75%: NS, 85%: NS, HC: ±55 (±14%), NC: ±20 (±10%) LDL-C Ex M: NS, Ex F: NS, Dt M: NS, Dt F: NS, DE M: 20 ( 13%), DE F: 15 ( 9%), CF:NS 65%: NS, 75%: 17 ( 10%), 85%: NS, HI: NS, MI: 27 ( 17%) HC: ±66 (±22%), NC: ±16 (±11%) TG Ex M: NS, Ex F: NS, Dt M: NS, Dt F: NS, DE M: NS, DE F: NS, CF:NS 65%: NS, 75%: NS, 85%: NS, H, N HDL-C Ex M: NS, Ex F: NS, Dt M: NS, Dt F: NS, DE M: NS, DE F: NS, CF:NS 65%: NS, 75%: ±7 (±19%), 85%: ±6 (±13%), HI: NS, MI: NS Ex: ±5 (±10%), H, N bodyweight (% ) Ex M: NS, Ex F: NS, Dt M: 3%, Dt F: 4%, DE M: 5%, DE F: 4%, CF:NS H, NC: ±3% %fat V. O2max (% ) Ex M: ±5%, Ex F: ±9%, Dt M: NS, Dt F: NS, DE M: ±7%, DE F: ±9%, CF:NS H, N NS NS ±15 (±26%) NS Dt: 25 ( 25%), DE: 27 (27%), C: ±18 (±15%) Dt: ±6 (±9%), DE: ±8 (±12%), Dt: 13%, DE: 13%, Dt: 23% fat mass, DE: 23% fat mass, 65%: ±11%, 75%: ±18%, 85%: ±43%, HI: ±19%, MI: ±18% Ex: ±7%, H, N Dt: NS, DE: NS, C: 13% 1054 Durstine et al.

23 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Szmedra et al., Effects of 1998 [147] Thomas et al., 1984 [138] Effects of interval and continuous Thomas et al., Effects of 1985 [157] interval and continuous Tomiyasu et al., Effect of shortterm 1996 [48] Thompson et al., 1988 [123] Thompson et al., 1997 [124] Effects of Effects of Vermeulen, Effects of 1990 [92] modified fast diet and Van Der Eems and Ismail, 1985 [87] Effects of Age 20-22y; 7 obese F Age 18-32y; 24 M, 35 F: 6.5km (4-mile) run 9 M, 13 F; 3.2km (2-mile) run: 9 M, 12F;IT:10M,11 F; 16 C Age 18-25y; 36 M college students: 11 in 8km (5-mile) run, 8 in 4-min interval, 9 in 2-min interval, 8 C Age 19-30y; 20 M: 13 HI, 7 MI Age20-40y;8M: 6Ex,2C Walk-jog/cycle/row; 6wk; f = 3/wk; I=70%V. O2max; D=30min Walk/jog; 12wk; f=3/wk;i=6.5km (4-mile), 3.2km (2-mile): 75% HRmax; IT:90% HRmax; D = 6.5km: 500 kcal ; 3.2km: 250 kcal ; IT: 500 kcal Running; 11wk; f = 3/wk; I = 5-min: 70-85% HRmax; 4-min, 2-min: % HRmax; D = kcal/session Running; 3wk; f = daily; I = HI: 19 km/h (12 miles/h); MI: 10 km/h (6 miles/h); D = HI: 6.5km (4 miles); MI: 3.2km (2 miles) Cycle ergometry; 48wk; f = 4-5/wk; I=80%HRmax; D=60min Age 30-50y; 17 M Walk/jog/cycle; 1y; f = 4/wk; I = 60-80% HRmax; D=50min Age 42-65y; 46 obese postmenopausal F: 26 DE ( kcal/d diet), 20 C at baseline Age 27-59y; 20 F: 10 PRE, 10 POM Swim/gymnastics; 4wk; f = daily; I = low-moderate; D = 20-min swim, 30-min gymnastics Jog/callisthenics; 8mo; f = 3/wk; I=60-70%HRmax; D=45min NS NS NS NS 2% 4% ±30% HI: 16 ( 9%), MI: 12 ( 6%) NS HI: 38 ( 37%), MI: 33 ( 28%) NS HI: ±6 (±10%), MI: ±6 (±10%) 19 ( 16%) ±5 (±14%) 6.5km: 8%, 3.2km: 8%, IT: 10%, 6.5km: ±4%, 3.2km: ±7%, IT: ±12%, 5-min: NS, 4-min: ±18%, 2-min: NS, ±27% NS NS 11 ( 8%) ±4 (±9%) NS NS ±27% DE: 59 ( 22%), DE: 50 ( 26%), PRE: 23 ( 27%) significant for combined, POM: 14 ( 16%) significant for combined PRE: ±4 (±4%) NS for combined, POM: 2 ( 3%) NS for combined DE: 8kg, NS PRE: 3%, POM: NS Continued over page Blood Lipid and Lipoprotein Adaptations to Exercise 1055

24 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Appendix I. Contd Study characteristics lipid and lipoprotein variables physiological characteristics author purpose n intervention Warner et al., Effects of 1989 [93] dietary fish oil and Weltman et al., Effects of 1980 [91] caloric restriction and Weintraub et al., Effects of 1989 [125] Whitehurst and Menendez, 1991 [85] Effects of Williford et al., 1988 [148] Effects of aerobic dance Williams et al., Effects of 1994 [108] HDL-C levels and weight loss by diet and Age 27-63y; 22 M, 12F:7FE,7FO, 10 CN, 10 C Age 58-47y; 50 M: 23 DE, 11 Dt, 11 Ex, 5 C Age 22-33y; 6 M Age 61-81y; 34 postmenopausal F: 20 Ex; 14 C Age 18-30y; 18 college F: 10 Ex, 8 C Age 30-59y; 130 M: 34 LHDL-C,, 63 MHDL-C, 36 HHDL-C; Ex: 13 LHDL-C, 21 MHDL-C, 12 HHDL-C; Dt: 8 LHDL-C, 20 MHDL-C, 14 HHDL-C; C: 13 LHDL-C, 21 MHDL-C, 8HHDL-C Walk/jog; 12wk; f=3/wk; I=70-85%HRmax; D=45-50min Walking; 10wk; f=4/wk; I=5.6km/h(3.5 miles/h) walking speed; D = min/d [4.2 km/d (2.6 miles/d)] Jogging; 7wk; f=4/wk; I = 80% estimated HRmax; D = 30 min; 25 km/wk (15 miles/wk) Walking; 8wk; f = 3/wk; I = 70-80% HRmax; D=25-40min Aerobic dance class; 10wk; f = 3/wk; I = 60-90% HRR; D=30min Jogging/running; 1y; f = 3-4/wk; I=60-85%HRmax; D=25-40min TC FE: 23 ( 10%), FO: 29 ( 13%), CN: NS, 16 ( 8%) all treatments vs C LDL-C FE: 11 ( 8%), FO: NS, CN: NS, 14 ( 9%) in DE and Ex vs C TG FE: 90 ( 39%), FO: 158 ( 61%), CN: NS, HDL-C FE: NS, F: NS, CN: NS, DE: NS, Dt: 8 ( 16%), bodyweight (% ) %fat FE: 3%, FO: NS, CN: NS, DE: 7%, Ex: 1%, Dt: 7%, DE: 4%, Ex: 1%, Dt: 3%, V. O2max (% ) FE: ±22%, FO: NS, CN: NS, NS NS 11 ( 14%) NS NS ±43% Ex: 5 ( 4%), Ex: ±4 (±7%), Ex LHDL-, Ex MHDL-C: ±4.9 change vs C, Ex HHDL-C: ±7 change vs C, Dt LHDL-C: ±6 change vs C, Dt MHDL-C: ±5 change vs C, Dt HHDL-C: ±5 change vs C Ex: 2%, Ex LHDL-C: 1.1 BMI, Ex MHDL-C: 1.2 BMI, Ex HHDL-C: 1.5 BMI, Dt LHDL-C: 2 BMI, Dt MHDL-C: 2.4 BMI, Dt HHDL-C: 2.3 BMI, CLHDL-, CMHDL-, CHHDL- Ex: 1%, Ex LHDL-C: 2%, Ex MHDL-C: 2%, Ex HHDL-C: 1%, Dt LHDL-C: 3%, Dt MHDL-C: 2%, Dt HHDL-C: 2%, CLHDL-, CMHDL-, CHHDL- Ex: ±5%, improved 1.6km (1-mile) time, Ex: ±12%, 1056 Durstine et al.

25 Adis International Limited. All rights reserved. Sports Med 2001; 31 (15) Wirth et al., 1985 [88] Effects of in hypertriglyceridae mia Age 35-51y; 21 M: 10 Ex, 11 C Woods and Graham, 1986 [149] Effects of menstrual cycle on changes Wood et al., Effects of 1983 [89] Wood et al., 1988 [59] Effects of bodyweight loss by diet and Wood et al., Effects of 1991 [76] NCEP step 1 diet and Wynne et al., Effects 1980 [117] Zmuda et al., Effects of 1998 [109] HDL-C levels on response Age20-25y;8F; no effect of menstrual phase on TC and HDL, TG > at menses onset Age 30-55y; 81 M: 48 Ex, 33 C Age 30-59y; 131 overweight M: 47 Ex, 42 Dt, 42 C Age 25-49y; 231 overweight M and F. DE: 39 M, 42F;Dt:40M,31 F; C: 40 M, 39 F Age 19-30y; 19 F controlled oral contraceptive use: 13 Ex, 6 C Age 26-49y; 17 M: 7LHDL-C, 10NHDL-C Jog/recreational games; 4mo; f=3/wk; I = moderate-high; D=60min Cycle ergometry; 56-77d; f = 3/wk; I = 60% HRR; D=30min Jogging/running; 1y; f = 3-5/wk; I = 70-85% HRmax; D=25min Brisk walking/jogging; 1y; f = 3-5/wk; I = 60-80% HRmax; D = min + increased non physical activity Brisk walking/jogging; 1y; f = 3/wk; I = 60-80% HRmax; D = min Cycle ergometry; 10wk; f = 3/wk; I = 70% HRR; D=30min Walk/jog/cycle; 1y; f = 4/wk; I = 60-80% HRmax; D=50min Ex: 13 ( 5%) NS, C: 5 ( 2%) NS NS 19 ( 22%) measured at onset of menses after 3mo of Ex: 9 ( 4%) NS, Dt: 14 ( 6%) NS, C: 9 ( 4%) NS DE M: NS, DE F: 11 ( 6%), Dt M: NS, Dt F: 15 ( 8%), CF:NS, CM:NS Ex: 5 ( 3%) NS, C: 5 ( 3%) NS Ex: 10 ( 7%), Dt: 12 ( 8%) NS, C: 8 ( 5%) NS DE M: NS, DE F: 11 ( 9%), Dt M: NS, Dt F: 11 ( 9%), CF:NS Ex: 14 ( 11%), Dt: 24 ( 17%), DE M: 41 (33%), DE F: NS, Dt M: NS, Dt F: NS, CF:NS Ex: 21 ( 15%) NS, Ex: 2%, NS NS NS ±6% NS, HDL-C ±4 in M running 12.8 km/wk (8 miles/wk) Ex: ±4 (±10%), Dt: ±5 (±11%), DE M: ±5 (±13%), DE F: NS, Dt M: NS, Dt F: NS, CF:NS LHDL-, NHDL-C: ±5 (±12%) Ex: 2%, C: NS Ex: 4%, Dt: 8%, DE M: 9%, DE F: 7%, Dt M: 5%, Dt F: 5%, CF:NS Ex: 2%, C: NS Ex: 16% fat mass, Dt: 23% fat mass, DE M: 28%, DE F: 20%, Dt M: 16%, Dt F: 15%, CF:NS Ex: 2%, Ex: ±28% max aerobic power, max aerobic power Ex: ±21%, Ex: ±12%, Dt: NS, C: 7% DE M: ±25%, DE F: ±24%, Dt M: NS, Dt F: NS, CF:NS Ex: ±16%, LHDL-C: ±21%, NHDL-C: ±32% a These studies were selected because they are the studies most often cited. AE = aerobic group; AT = aerobic threshold; AW = walkers; BMI = body mass index; BW = brisk walkers; C = controls; CL = callisthenics; CN =cornoil;ct = continuous ; D = duration; DE = diet and ; DL = diet and lifestyle; Dt =diet;ex = rs; ExH = and hormone replacement therapy group; F = females; f = frequency; FE = fish oil and ; FG = fat gain; FL = fat loss; FO =fishoil;gxt = graded testing; H = high; HA = high adherence; HC = high cholesterol; HDL-C = high-density lipoprotein cholesterol; HG = high intensity group; HH = high intensity at home; H HDL-C = high HDL-C; HI = high intensity; HRep= high repetitions; HR max = maximal heart rate; HRR = heart rate reserve; HV = high volume; I = intensity; IT = interval ; J = joggers; L =low;la = low adherence; LC = low cholesterol; LDL = low-density lipoprotein; LDL-C = low-density lipoprotein cholesterol; LH = low intensity at home; L HDL-C = low HDL-C; LRep= low repetitions; M = males; METs = metabolic equivalents (1 MET = 3.5 ml/kg/min); M HDL-C = moderate HDL-C; MI = moderate intensity; N = normal bodyweight; n = number of participants; NC = no change; NCEP = National Cholesterol Education Program; N HDL-C = normal HDL-C; = not reported; NS = not significant; NV = normal volume; POM = postmenopausal; PRE = premenopausal; RE = resistance group; RM = repetition maximum;st= strength ; St= strollers;tc = total cholesterol; TG = triglyceride; VLDL-C+ LDL-C= very low-density lipoprotein-cholesterol + low-density lipoprotein-cholesterol; V. O 2max = maximal oxygen uptake; V. O 2peak = peak oxygen uptake; WK = walkers; Y = yoga group. Blood Lipid and Lipoprotein Adaptations to Exercise 1057

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