Changes in blood lipids consequent to aerobic exercise training related to changes in body fatness and aerobic fitness


Katzmarzyk, P.T.; Leon, A.S.; Rankinen, T.; Gagnon, J.; Skinner, J.S.; Wilmore, J.H.; Rao, D.C.; Bouchard, C.

Metabolism: Clinical and Experimental 50(7): 841-848

2001


The contribution of changes in body fatness and aerobic fitness to changes in blood lipids after aerobic exercise training was investigated. The sample included 295 men (77 black and 218 white) and 355 women (131 black and 224 white), aged 17 to 65 years, from the HERITAGE Family Study. Participants underwent measurements at baseline and after 20 weeks of supervised exercise training on a cycle ergometer. Body fat mass (FM, in kg) was determined by underwater weighing and aerobic fitness (maximal oxygen uptake, V<sub>O</sub><sub>2max</sub>, in ml/min) was assessed by cycle ergometry. Blood lipid measurements included fasting plasma levels of high-density lipoprotein cholesterol (HDL-C), HDL<sub>2</sub>-C, HDL<sub>3</sub>-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol (CHOL), CHOL/HDL, and triacylglycerols (TG). A composite lipid change index (LCI) was derived by subjecting the Delta scores for the individual blood lipids to principal components analysis. The exercise training was accompanied by a mean increase of 17.5% in V<sub>O</sub><sub>2max</sub> and a mean decrease of 3.3% in FM. Partial correlations controlled for age, between absolute changes in V<sub>O</sub><sub>2max</sub> and changes in the blood lipids were consistently low and non-significant. On the other hand, absolute changes in FM were significantly (P<0.05) associated with changes in HDL-C (r=-0.23), HDL<sub>2</sub>-C (r=-0.17), CHOL/HDL (r=0.24) and the LCI (r=-0.27) in men, and with changes in LDL-C (r=0.22), CHOL (r=0.19), CHOL/HDL (r=0.15) and the LCI (r=-0.19) in women. Forward stepwise regression confirmed that the change in FM was a better predictor of changes in blood lipids than the change in V<sub>O</sub><sub>2max</sub>, entering as a predictor in 4 of 8 regressions in both men and women. Change in V<sub>O</sub><sub>2max</sub> did not enter as a significant predictor in any regression. There were no differences in LCI between the upper and lower quartiles of V<sub>O</sub><sub>2max</sub> change. On the other hand, there were significant differences between the low and high quartiles of FM change. No race effects were observed in any of the relationships, except that race was a significant predictor of changes in TG in both men and women. It is concluded that changes in blood lipids associated with aerobic exercise training do not appear to be related to changes in aerobic fitness per se rather, they are weakly to moderately associated with changes in body fatness.

Changes
in
Blood
Lipids
Consequent
to
Aerobic
Exercise
Training
Related
to
Changes
in
Body
Fatness
and
Aerobic
Fitness
Peter
T.
Katzmarzyk,
Arthur
S.
Leon,
Tuomo
Rankinen,
J.
Gagnon,
James
S.
Skinner,
Jack
H.
Wilmore,
D.C.
Rao,
and
Claude
Bouchard
The
contribution
of
changes
in
body
fatness
and
aerobic
fitness
to
changes
in
blood
lipids
after
aerobic
exercise
training
was
investigated.
The
sample
included
295
men
(77
black,
218
white)
and
355
women
(131
black,
224
white),
aged
17
to
65
years,
from
the
HERITAGE
Family
Study.
Participants
underwent
measurements
at
baseline
and
after
20
weeks
of
supervised
exercise
training
on
a
cycle
ergometer.
Body
fat
mass
(FM,
in
kilograms)
was
determined
by
underwater
weighing,
and
aerobic
fitness
(maximal
oxygen
uptake,
Vo
2
,„„„,
in
milliliters
per
minute)
was
assessed
by
cycle
ergometry.
Blood
lipid
measurements
included
fasting
plasma
levels
of
high-density
lipoprotein
cholesterol
(HDL-C),
HDL
2
-C,
HDL
3
-C,
low-density
lipoprotein
cholesterol
(LDL-C),
total
cholesterol
(CHOL),
CHOL/HDL,
and
triglycerides
(TG).
A
composite
lipid
change
index
(LCI)
was
derived
by
subjecting
the
A
scores
for
the
individual
blood
lipids
to
principal
components
analysis.
The
exercise
training
was
accompanied
by
a
mean
increase
of
17.5%
in
Vo
2
,„
ax
and
a
mean
decrease
of
3.3%
in
FM.
Partial
correlations,
controlled
for
age,
between
absolute
changes
in
i/o
2
,„
ax
and
changes
in
the
blood
lipids
were
consistently
low
and
nonsignificant.
On
the
other
hand,
absolute
changes
in
FM
were
significantly
(P
<
.05)
associated
with
changes
in
HDL-C
(r
=
—.23),
HDL
2
-C
(r
=
—.17),
and
CHOL/HDL
(r
=
.24)
and
the
LCI
(r
=
—.27)
in
men
and
with
changes
in
LDL-C
(r
=
.22),
CHOL
(r
=
.19),
and
CHOL/HDL
(r
=
.15)
and
the
LCI
(r
=
—.19)
in
women.
Forward
stepwise
regression
confirmed
that
the
change
in
FM
was
a
better
predictor
of
changes
in
blood
lipids
than
the
change
in
Vo
2
,„„„,
entering
as
a
predictor
in
4
of
8
regressions
in
both
men
and
women.
Change
in
Vo
2
,„
ax
did
not
enter
as
a
significant
predictor
in
any
regression.
Further,
there
were
no
differences
in
LCI
between
the
upper
and
lower
quartiles
of
i/o
2
,„
ax
change.
On
the
other
hand,
there
were
significant
differences
between
the
low
and
high
quartiles
of
FM
change.
No
race
effects
were
observed
in
any
of
the
relationships,
except
that
race
was
a
significant
predictor
of
changes
in
TG
in
both
men
and
women.
In
conclusion,
changes
in
blood
lipids
associated
with
aerobic
exercise
training
do
not
appear
to
be
related
to
changes
in
aerobic
fitness
per
se;
rather,
they
are
weakly
to
moderately
associated
with
changes
in
body
fatness.
Copyright
©
2001
by
W.B.
Saunders
Company
T
HE
TRADITIONAL
exercise
recommendations
of
the
American
College
of
Sports
Medicine
for
the
mainte-
nance
of
aerobic
fitness
call
for
20
to
60
minutes
of
physical
activity
at
an
intensity
of
55%
to
90%
of
maximal
heart
rate
3
to
5
times
a
week.'
On
the
other
hand,
the
current
public
health
recommendations
from
the
Centers
for
Disease
Control
and
Surgeon
General,
targeted
at
the
largely
sedentary
North
Amer-
ican
population,
are
for
30
minutes
of
"moderate"
levels
of
physical
activity
on
most
(preferably
all)
days
of
the
week.
2
Part
of
the
rationale
for
recommending
moderate
levels
of
activity
has
been
the
realization
that
health
benefits
can
accrue
at
levels
of
activity
below
the
threshold
at
which
significant
improvements
in
aerobic
fitness
may
occur.
Coronary
heart
disease
(CHD)
remains
a
major
health
con-
cern
in
North
America.
Major
risk
factors
for
CHD
include
smoking,
dyslipidemia,
hypertension,
obesity,
and
physical
in-
activity,
3
all
of
which
are
potentially
modifiable
through
changes
in
lifestyle.
The
focus
of
the
present
study
is
on
blood
lipids
because
plasma
levels
of
total
cholesterol
(CHOL)
and
the
various
subfractions
are
related
to
risk
of
CHD,
4
ie,
a
poor
lipid
profile
promotes
and
contributes
to
coronary
artery
ath-
erosclerosis,
the
most
common
cause
of
cardiac
ischemia
and
infarction.
5
In
general,
there
is
a
weak
cross-sectional
relationship
be-
tween
aerobic
fitness
and
levels
of
blood
lipids
in
adults.
6
In
particular,
physically
active
individuals
tend
to
have
higher
levels
of
high-density
lipoprotein
cholesterol
(HDL-C)
and
lower
levels
of
triglycerides
(TG)
and
low-density
lipoprotein
cholesterol
(LDL-C)
than
those
who
are
sedentary.
On
the
other
hand,
the
results
of
training
studies
on
changes
in
blood
lipid
levels
are
equivocal.
In
general,
there
is
an
increase
in
HDL-C
or
the
HDL/CHOL
ratio
and
a
decrease in
TG
consequent
to
exercise
training.
However,
few
studies
have
observed
changes
in
LDL-C
levels.
6
The
changes
in
blood
lipids
accompanying
20
weeks
of
supervised
aerobic
training
in
the
HERITAGE
Family
Study
have
recently
been
reported.?
Although
there
were
no
significant
changes
in
CHOL,
LDL-C,
very-low-den-
sity
lipoprotein
(VLDL),
or
apolipoprotein
(apo)
B
after
train-
ing,
there
was
a
significant
increase
in
HDL-C,
particularly
HDL,-C,
with
an
associated
increase
in
apo
A-1.
7
From
the
School
of
Kinesiology
and
Health
Science,
York
Univer-
sity,
North
York,
Ontario;
School
of
Kinesiology
and
Leisure
Studies,
University
of
Minnesota,
Minneapolis,
MN;
Pennington
Biomedical
Research
Center,
Louisiana
State
University,
Baton
Rouge,
LA;
Lab-
oratory
of
Molecular
Endocrinology,
Laval
University,
Ste-Foy,
Que-
bec;
Department
of
Kinesiology,
Indiana
University,
Bloomington,
IN;
Department
of
Health
and
Kinesiology,
Texas
A&M
University,
Col-
lege
Station,
TX;
and
the
Division
of
Biostatistics
and
Departments
of
Genetics
and
Psychiatry,
Washington
University
Medical
School,
St
Louis,
MO.
Submitted
October
26,
2001;
accepted
December
8,
2000.
The
HERITAGE
Family
Study
is
supported
by
the
National
Heart,
Lung,
and
Blood
Institute
through
grants
HL45670
(C.
Bouchard,
PI),
HL47323
(Arthur
S.
Leon,
PI),
HL47317
(D.C.
Rao,
PI),
HL47327
(to
James
S.
Skinner,
PI),
and
HL47321
(Jack
H.
Wilmore,
PI).
Arthur
S.
Leon
is
partially
supported
by
the
Henry
L.
Taylor
endowed
profes-
sorship
in
exercise
science
and
health
enhancement.
Claude
Bouchard
is
supported
in
part
by
the
George
A.
Bray
chair
in
nutrition.
Address
reprint
requests
to
Peter
T.
Katzmarzyk,
PhD,
School
of
Kinesiology
and
Health
Science,
York
University,
4700
Keele
St,
North
York,
Ontario,
Canada
M3J
1P3.
Copyright
©
2001
by
W.B.
Saunders
Company
0026-0495/01/5007-0001835.00/0
doi:10.1053/meta.2001.24190
Metabolism,
Vol
50,
No
7
(July),
2001:
pp
841-848
841
KATZMARZYK
ET
AL
842
It
has
been
suggested
that
the
changes
in
HDL-C
observed
with
training
are
mostly
attributable
to
the
exercise
itself
rather
than
to
changes
in
body
fatness.
8
On
the
other
hand,
a
review
of
several
studies
concluded
that
prolonged
low-
intensity
(-50%
maximal
oxygen
uptake
[Vo
2
,„„„])
exercise
results
in
improvements
in
lipid
profiles
that
are
largely
independent
of
changes
in
cardiorespiratory
fitness.
9
Whether
weight
loss
is
required
for
HDL
to
increase
with
exercise
training
is
controversial.
There
is
some
evidence
that
exercise-induced
weight
loss
is
required,
10-
'
2
and
other
studies
indicate
that
exercise
can
have
an
independent
effect
on
HDL.
13-
'
5
Further
work
is
needed
to
elucidate
the
rela-
tionship
between
changes
in
fitness,
fatness,
and
blood
lipid
levels
that
occur
with
exercise
training.
The
purpose
of
this
study
was
to
examine
changes
in
blood
lipid
levels
in
relation
to
changes
in
both
aerobic
fitness
and
body
fatness
after
20
weeks
of
standardized,
supervised
aerobic
exercise
training.
Directly
measured
Vo
2
,„„„
and
densitometri-
cally
measured
fat
mass
(FM)
were
used
as
the
indicators
of
aerobic
fitness
and
body
fatness,
respectively.
SUBJECTS
AND
METHODS
Sample
The
HERITAGE
Family
Study
was
designed
to
investigate
the
genetics
of
cardiovascular,
metabolic,
and
hormonal
responses
to
aer-
obic
exercise
training
and
the
contribution
of
regular
exercise
to
changes
in
risk
factors
for
cardiovascular
disease
and
type
2
diabetes.
The
aims
and
design
of
the
HERITAGE
Family
Study
have
been
described
in
detail.
116
Briefly,
the
participating
research
centers
con-
sisted
of
4
clinical
centers-Arizona
State
University
(now
Indiana
University),
Laval
University
(now
Pennington
Biomedical
Research
Center),
University
of
Minnesota,
University
of
Texas
at
Austin
(now
Texas
A&M
University)-and
a
data
coordinating
center
at
Washing-
ton
University
(St.
Louis,
MO).
Recruitment
of
participants
was
based
on
extensive
publicity
and
advertisements
at
the
clinical
centers.
The
essential
criteria
for
participation
in
the
HERITAGE
Family
Study
included
age
between
17
and
65
years,
being
healthy
but
sedentary
(no
regular
physical
activity
over
the
previous
6
months),
body
mass
index
(BMI)
usually
under
40
kg/m
2
,
and
systolic/diastolic
blood
pressure
less
than
159/99
mm
Hg.
Individuals
with
confirmed
or
possible
CHD,
hypertension,
chronic
or
recurrent
respiratory
problems,
and
uncon-
trolled
endocrine
and
metabolic
disorders
(including
diabetes
and
use
of
lipid-lowering
drugs)
were
excluded
from
the
study.
The
sample
included
here
consists
of
295
men
(77
black,
218
white)
and
355
women
(131
black,
224
white)
for
whom
measures
of
aerobic
fitness,
body
fatness,
and
blood
lipids
were
available
before
and
after
the
training
program.
The
characteristics
of
the
participants
are
shown
in
Table
1.
Measures
Each
participant
was
examined
on
a
battery
of
measurements
both
before
and
after
a
20-week
standardized
exercise
training
program.
The
study
personnel
were
centrally
trained
on
all
aspects
of
recruitment
and
measurement
protocols
using
a
specially
prepared
manual
of
proce-
dures.
Data
quality
was
assured
through
an
extensive
quality
control
program."
Aerobic
fitness.
Two
progressive
maximal
exercise
tests
were
con-
ducted
on
separate
days
both
before
and
after
training
on
a
cycle
ergometer
(SensorMedics,
Yorba
Linda,
CA)
connected
to
a
Sensor-
Medics
2900
metabolic
cart.
Heart
rate
was
monitored
using
an
elec-
trocardiogram.
Gas
exchange
parameters
(Vo
2
,
Vco
2
,
VE,
and
respi-
Table
1.
Descriptive
Characteristics
of
Sample
at
Baseline
and
Changes
After
20
Weeks
of
Aerobic
Exercise
Training
Variable
Baseline
Change
Mean
SD
Mean
SD
Men
Age
(yr)
35.9
14.4
Vo
2
,..
(Umin)
2.96
0.58
0.44
0.22*
FM
(kg)
20.0
10.6
-0.8
1.7*
HDL-C
(mmol/L)
0.95
0.20
0.03
0.11*
HDL
2
-C
(mmol/L)
0.27
0.13
0.02
0.10*
HDL
3
-C
(mmol/L)
0.68
0.12
0.01
0.09
LDL-C
(mmol/L)
3.05
0.86
-0.03
0.39
CHOL
(mmol/L)
4.51
1.00
-0.004
0.44
CHOUHDL
5.03
1.66
-0.16
0.67*
TG
(mmol/L)
1.44
0.80
-0.02
0.53
Women
Age
(yr)
34.1
12.9
Vo
2
,
0x
(Umin)
1.85
0.36
0.34
0.16*
FM
(kg)
22.7
11.1
-0.6
2.0*
HDL-C
(mmol/L)
1.15
2.26
0.05
0.14*
HDL
2
-C
(mmol/L)
0.42
0.19
0.05
0.14*
HDL
3
-C
(mmol/L)
0.72
0.14
-0.001
0.12
LDL-C
(mmol/L)
2.87
0.76
-0.03
0.38
CHOL
(mmol/L)
4.33
0.87
0.02
0.43
CHOUHDL
3.93
1.06
-0.13
0.49*
TG
(mmol/L)
1.05
0.49
-0.009
0.33
*
Change
significantly
different
from
0
at
P
<
.05.
ratory
exchange
ratio
[RER])
were
recorded
as
rolling
averages
of
three
20-second
intervals.
Two
tests
were
conducted
both
before
and
after
training.
In
the
first
test,
participants
exercised
at
a
power
output
of
50
W
for
3
minutes,
followed
by
increases
of
25
W
each
2
minutes
until
they
reached
volitional
fatigue.
For
older,
smaller,
or
less
fit
individ-
uals,
the
test
was
started
at
40
W,
with
increases
of
10
to
20
W
each
2
minutes
thereafter.
For
the
second
test,
participants
exercised
for
10
to
12
minutes
at
a
power
output
of
50
W,
had
a
rest
period,
and
then
exercised
at
a
relative
power
output
of
60%
Vo
2
xx
for
10
to
12
minutes,
followed
by
3
minutes
at
a
relative
power
output
of
80%
Vo
2
.
Resistance
was
then
increased
to
the
highest
power
output
attained
in
the
first
test.
If
the
participant
was
able
to
pedal
after
2
minutes,
power
output
was
increased
each
2
minutes
thereafter
until
volitional
exhaustion.
The
criteria
for
Vo
2
„,„„
were
RER
>
1.1,
plateau
of
VO
2
(change
<
100
mL/min
in
the
last
three
20-second
intervals),
and
heart
rate
within
10
beats/min
of
predicted
maximal
heart
rate.
All
participants
achieved
V
0
2
,
xx
by
one
of
these
criteria
on
at
least
1
of
the
2
tests
both
before
and
after
training.
The
average
Vo
2
„„„,
expressed
in
milliliters
per
minute,
from
the
2
tests
before
and
after
training
was
taken
as
Vo
2
„„„„
for
each
participant
if
the
2
values
were
within
5%
of
one
another.
If
they
differed
by
more
than
5%,
the
higher
value
was
used.
Reproducibility
of
Vo
2
„,„„
in
these
participants
is
quite
high,
with
an
intraclass
correlation
of
0.97
for
repeated
measures
and
a
coefficient
of
variation
of
5%."
Body
fatness.
FM
was
determined
from
measurements
of
body
density
from
underwater
weighing,
with
a
correction
made
for
residual
lung
volume
by
the
oxygen
dilution
techniqueo
at
3
of
the
clinical
centers
and
by
the
helium
dilution
technique"
at
the
fourth
(Laval
University
Clinical
Center).
A
detailed
explanation
of
the
underwater
weighing
method
is
found
elsewhere?'
Briefly,
relative
body
fat
was
estimated
from
body
density
using
equations
for
white
men,
22
white
women,
23
black
men,
24
and
black
women
25
and
converted
to
abso-
lute
FM.
Blood
lipids.
Fasting
(12
hour)
blood
samples
were
obtained
from
an
antecubital
vein
and
collected
into
vacutainer
tubes
con-
FITNESS,
FATNESS,
AND
BLOOD
LIPIDS
843
taining
ethylenediaminetetraacetic
acid
twice,
at
baseline
and
72
hours
after
the
last
exercise
training
session.
For
women,
samples
were
obtained
in
the
early
follicular
phase
of
the
menstrual
cycle.
The
2
baseline
samples
were
averaged
for
the
purpose
of
this
study.
Plasma
was
ultracentrifuged,
and
the
top
fraction
containing
VLDL
was
quantitatively
recovered.
The
LDL
in
the
ultracentrifuged
bot-
tom
fraction
was
precipitated
with
heparin
and
MgC1
2
,
26,27
and
FIDL
was
obtained
in
the
supernatant.
Selective
precipitation
was
used
to
isolate
FIDL
2
and
HDL
3
subfractions
using
dextran
sulfate.
28
The
concentrations
of
cholestero1
29
in
the
lipoprotein
fractions
were
measured
using
a
Technicon
RA-500
analyzer
(Bayer,
Tarrytown,
NY).
To
adjust
for
potential
plasma
volume
changes
accompanying
the
exercise
training,
plasma
total
proteins
were
analyzed
using
the
Biuret
method
(Roche
Molecular
Biochemicals,
Dallas,
TX)
on
the
baseline
and
posttraining
specimens.
Posttraining
values
were
corrected
based
on
the
correlation
of
pretraining
to
posttraining
plasma
total
protein
levels.
A
,
0.75
0.5
0.25
0
—1
-0.25
-0.5
-0.75
-
1
EV=2
40
34.4%
1
HDL-C
HDL
2
-C
HDL,-C
LDL-C
CHOL/HDL
CHOL
TG
Training
Program
Each
participant
completed
a
20-week
standardized
aerobic
training
program.
The
exercise
training
involved
3
sessions
per
week
of
super-
vised
exercise
on
a
cycle
ergometer
(Universal
Aerocycle,
Cedar
Rap-
ids,
MI).
Participants
started
at
55%
of
their
baseline
Vo
2
„,.„„
for
30
minutes
per
session
and
progressed
in
intensity
or
duration
every
2
weeks
following
a
standardized
protocol
until
they
were
working
at
75%
Vo
2
for
50
minutes
per
session
for
the
final
6
weeks
of
the
program.
Participants
were
counseled
at
baseline
and
midway
through
the
training
program
not
to
alter
their
health
habits
and
to
continue
their
usual
eating
pattern,
physical
activity
outside
of
the
study,
alcohol
and
tobacco
use,
and
oral
contraceptive
or
hormone
replacement
therapy.
More
details
about
the
exercise
training
program
have
been
provided
elsewhere.
30
Statistical
Analyses
Absolute
changes
in
Vo
2
,
FM,
and
blood
lipids
after
training
were
calculated
by
subtracting
posttraining
from
baseline
values
(A
scores).
To
study
the
changes
in
the
blood
lipid
"profile"
in
addition
to
changes
in
the
individual
lipids,
principal
components
analysis
was
used.
Briefly,
the
A
scores
for
the
individual
blood
lipids
were
sub-
jected
to
principal
components
analysis,
and
the
first
principal
compo-
nent
scores
were
saved
and
used
as
a
composite
lipid
change
index
(LCI).
Partial
correlations,
controlled
for
age,
between
changes
in
individual
risk
factors,
LCI,
and
changes
in
aerobic
fitness
and
FM
were
calculated.
Forward
stepwise
regression
was
then
used
to
predict
the
changes
in
blood
lipid
levels
based
on
changes
in
FM,
aerobic
fitness
(Vo
2
„,
mL/min),
and
the
potentially
confounding
effects
of
age,
baseline
level
of
the
blood
lipid,
smoking
status
(0,
no;
1,
yes),
and
race
(0,
black;
1,
white).
Differences
in
LCI
between
the
upper
and
lower
quartiles
of
changes
in
VO
2
and
FM
were
examined
using
analysis
of
covariance,
with
age,
race,
and
smoking
status
included
as
covariates.
All
analyses
were
conducted
using
SAS
procedures
(SAS
Institute,
Cary,
NC)
3'
RESULTS
Table
1
presents
the
baseline
levels
and
mean
changes
in
fitness,
fatness,
and
blood
lipid
levels
after
20
weeks
of
aerobic
training.
Overall,
the
training
was
accompanied
by
a
mean
increase
of
17.5
%
in
Vo
2
,„
and
a
mean
decrease
of
3.3%
in
FM
(both
P
<
.05).
Results
of
the
principal
components
anal-
ysis
of
the
A
scores
is
presented
in
Fig
1.
The
first
principal
component
explained
34.4%
and
35.5%
of
the
variance
in
lipid
A
scores
in
men
and
women,
respectively.
The
factor
loading
B
1
0.75
0.5
0.25
i
5
0
1
-0.25
-0.75
-0.5
I
-
1
HDL-C
HDL
2
-C
HDL,-C
LDL-C
CHOL/HDL
CHOL
TG
Fig
1.
Risk
factor
loadings
on
LCI,
derived
from
principal
compo-
nents
analysis
of
the
risk
factor
change
scores
in
(A)
men
and
(B)
women.
The
eigenvalue
(EV)
and
percentage
of
the
variance
ac-
counted
for
by
the
LCI
(first
principal
component)
are
provided
in
the
inset.
pattern
indicates
that
the
response
to
training
was
similar
in
men
and
women
because
there
are
positive
loadings
for
HDL-C
and
HDL
2
-C
and
negative
loadings
for
CHOL/HDL
and
TG.
The
loading
for
HDL
3
-C
was
low
and
positive
in
men
and
low
and
negative
in
women.
Additionally,
the
loadings
were
stron-
ger
for
LDL-C
and
CHOL
in
women,
suggesting
some
sex
differences
in
the
response
to
exercise
for
blood
lipids.
The
second
and
third
principal
components
explained
successively
less
variance
in
the
response,
and
the
loading
patterns
could
not
be
interpreted
meaningfully.
Thus,
only
the
first
principal
com-
ponent
was
retained
for
further
analysis
(LCI).
Figures
2
and
3
show
the
partial
correlations
between
changes
in
aerobic
fitness,
body
fatness,
and
blood
lipid
levels
in
men
and
women,
controlling
for
age.
The
correlations
be-
tween
changes
in
Vo
2
,„
and
changes
in
the
risk
factors
were
consistently
low
and
nonsignificant.
On
the
other
hand,
changes
in
FM
were
significantly
(P
<
.05)
associated
with
changes
in
HDL-C
(r
=
.23),
HDL
2
-
C
(r
=
—.17),
and
CHOL/HDL
(r
=
.24)
and
the
LCI
(r
=
—.27)
in
men
and
with
changes
in
LDL-C
(r
=
.22),
CHOL
(r
=
.19),
and
CHOL/HDL
(r
=
.15)
and
the
LCI
(r
=
.19)
in
women.
Forward
stepwise
regression
analysis
confirmed
that
FM
was
a
better
predictor
of
changes
in
risk
factors
than
Vo
2
,„„„
be-
EV=2.49
35.5%
HCL-C
I-I:1,-C
HCL,-C
LCL-C
TO
CHOL
CHOL.HEL
LCI
Co
rre
la
t
io
ns
0.2
0.1
0
-0.1
-
0.2
-
0.3
B
0.3
0.2
0.1
D
-
0.1
-0.2
-
0.3
Corre
la
t
ions
844
KATZMARZYK
ET
AL
A
°
- -
HCL,-C
1-ICL
3
-C
La-C
TG
CHOL
CHOUHDL
LCI
Fig
2.
Correlations
between
changes
in
Vo
z
„„„
and
changes
in
risk
factors
after
20
weeks
of
aerobic
exercise
training
in
(A)
men
and
(B)
women.
None
of
the
correlations
are
significant
at
P
<
.05.
cause
changes
in
FM
entered
as
a
predictor
in
4
of
8
regressions
in
both
men
and
women,
whereas
change
in
Vo
2m
did
not
enter
as
a
significant
predictor
in
any
regression
(Table
2).
Figure
4
outlines
the
results
of
the
analyses
of
covariance
between
the
upper
and
lower
quartiles
of
response
in
Vo,„..„,
and
FM
for
differences
in
LCI.
There
were
no
differences
in
LCI
between
the
upper
and
lower
quartiles
of
change
in
however,
participants
in
the
lower
quartile
of
change
in
FM
(lost
more
FM)
had
a
higher
LCI
than
those
in
the
upper
quartile
of
change
in
FM
(lost
less
or
gained
FM).
Race
effects
were
observed
for
changes
in
HDL
3
-C
in
women
and
for
changes
in
TG
in
both
men
and
women
(Table
2).
However,
the
amount
of
variance
accounted
for
by
race
in
these
regressions
was
small,
ranging
from
1.3%
to
4%.
Race
did
not
enter
as
a
significant
predictor
in
any
of
the
other
regressions
in
Table
2.
Correlations
between
changes
in
Vo,„..,„
FM,
and
blood
lipid
levels
followed
a
similar
pattern
when
stratified
by
race,
as
in
the
combined
sample.
Correla-
tions
between
changes
in
Vo
2m
and
LCI
were
uniformly
low
and
nonsignificant
in
all
4
sex-by-race
groups,
and
correlations
between
changes
in
FM
and
LCI
were
moderate
and
significant
in
all
groups
(Table
3).
DISCUSSION
On
average,
the
exercise
training
program
in
the
HERITAGE
Family
Study
resulted
in
significant
mean
increases
in
HDL-C
but
had
no
effect
on
LDL-C
or
CHOL.
7
The
protocol
of
the
HERITAGE
Family
Study
was
designed
to
elicit
increases
in
aerobic
fitness,
and
the
study
was
successful
in
this
endeavor
because
there
was
a
significant
mean
increase
in
Vo
2m
of
17.5%.
However,
the
increases
observed
in
aerobic
fitness
were
not
uniform.
Some
individuals'
fitness
levels
increased
consid-
erably,
and
others
had
no
increase
in
fitness
(range
from
ap-
proximately
0%
to
51%).
Similarly,
although
the
mean
change
in
body
fatness
was
quite
small
(but
significant),
32
the
response
to
training
for
several
indicators
of
adiposity
showed
consid-
erable
interindividual
variability.
33
Thus,
it
is
difficult
to
re-
solve
whether
the
changes
in
blood
lipid
levels
observed
in
this
study
are
primarily
associated
with
changes
in
fitness
or
fatness
based
on
the
mean
changes
that
occurred
because
of
the
great
heterogeneity
in
response.
One
must
consider
individual
re-
sponses
to
the
exercise
protocol
across
the
entire
range
of
variation.
Thus,
in
this
study
we
used
correlation
and
regression
analyses
on
the
individual
scores
in
addition
to
examining
overall
mean
changes
in
the
variables.
The
analyses
in
this
paper
are
based
on
absolute
changes
in
(mL/min)
and
FM
(kg)
rather
than
on
relative
changes
(%).
However,
when
the
data
were
analyzed
using
relative
changes
in
these
variables,
the
results
were
virtually
identical
(results
not
shown).
The
correlations
between
relative
changes
in
Vo
2m
and
the
changes
in
blood
lipid
levels
were
uniformly
low
and
nonsignificant,
whereas
the
relative
changes
in
FM
where
related
to
changes
in
the
same
blood
lipid
fractions
as
were
absolute
changes
in
FM.
Thus,
for
conciseness,
only
the
relationships
with
absolute
changes
in
V0
2
„.„,
and
FM
are
presented
here.
A
0.3
0.2
g
0.1
-
SI-
0
-0.2
-0.3
HDL-C
HDI,C
Ha
s
-C
LDL-C
TG
CHOL
CHOL/HDL
LCI
HDL,C HDL,C
LDL-C
TG
CHOL
CHOUHDL
LCI
Fig
3.
Correlations
between
changes
in
FM
and
changes
in
risk
factors
after
20
weeks
of
aerobic
exercise
training
in
(A)
men
and
(B)
women.
*P
<
.05.
B
0.3
0
1-
=
-
0.1
-
0.2
-0.3
HDL-C
FITNESS,
FATNESS,
AND
BLOOD
LIPIDS
845
Table
2.
Results
of
Forward
Stepwise
Multiple
Regression
Analyses
to
Predict
Changes
in
Blood
Lipid
Levels
After
20
Weeks
of
Aerobic
Exercise
Training
From
Age,
Race,
Smoking
Status,
Baseline
Levels,
Changes
in
Vo
z
„„
x
,
and
Changes
in
FM
Variable
Model
R
2
Predictors
R
2
Variable
Men
A
HDL-C
5.5
5.5
-0.02
A
FM
A
HDL
2
-C
7.3
5.7
-0.16
Baseline
HDL
2
-C
1.6
-0.01
A
FM
A
HDL
3
-C
5.9
5.9
-0.19
Baseline
HDL
3
-C
A
LDL-C
3.5
3.5
-0.09
Baseline
LDL-C
A
CHOL
2.3
2.3
-0.09
Baseline
CHOL
A
CHOUHDL
16.1
12.5
-0.14
Baseline
CHOUHDL
3.6
0.08
A
FM
A
TG
14.0
12.7
-0.39
Baseline
TG
1.3
0.13
Race
LCI
7.1
7.1
0.16
A
FM
Women
A
HDL-C
No
variables
entered
A
HDL
2
-C
4.1
4.1
-0.14
Baseline
HDL
2
-C
A
HDL
3
-C
17.9
16.5
-0.37
Baseline
HDL
3
-C
1.4
0.03
Race
A
LDL-C
13.4
7.2
-0.16
Baseline
LDL-C
4.3
0.04
A
FM
1.9
0.005
Age
A
CHOL
10.3
4.6
-0.14
Baseline
CHOL
3.3
0.04
A
FM
2.4
0.006
Age
A
CHOUHDL
9.1
5.2
-0.12
Baseline
CHOUHDL
2.0
0.006
Age
1.9
0.04
A
FM
A
TG
7.1
3.1
-0.18
Baseline
TG
4.0
0.14
Race
LCI
3.3
3.3
0.09
A
FM
NOTE.
R
2
values
are
expressed
as
percentages
(ie,
x
100).
The
results
of
the
forward
stepwise
multiple
regression
analyses
indicate
that
overall,
changes
in
blood
lipid
levels
associated
with
the
standardized
exercise
training
program
are
only
moderately
predicted
from
the
variables
used
in
this
study
(Table
2).
Only
up
to
18%
of
the
variance
in
changes
in
blood
lipid
levels
was
explained
by
the
regression
models.
The
best
predictors
were
generally
the
baseline
levels
of
the
lipid
fraction
itself,
and
the
negative
beta
weights
suggest
an
inverse
relationship
between
baseline
levels
and
the
direc-
tion
of
change
observed
with
the
exercise
training.
In
gen-
eral,
changes
in
body
fatness
were
better
predictors
of
changes
in
blood
lipid
levels
than
were
changes
in
fitness.
Indeed,
these
results
are
confirmed
in
Fig
4,
which
shows
no
differences
in
LCI
between
the
upper
and
lower
quartiles
of
Vo
2
,„„„
change
but
significant
differences
between
the
upper
and
lower
quartiles
of
FM
change.
The
familial
aggregation
in
the
blood
lipid
response
to
training
in
HERITAGE
has
been
investigated,
and
the
estimated
heritabilities
for
changes
in
HDL,
HDL
2
-C,
HDL
3
-C,
and
TG
range
from
25%
to
32%
in
black
families
and
from
24%
to
64%
in
white
families.
34
These
results
indicate
that
familial
factors
ex-
plain
a
significant
proportion
of
the
variance
in
blood
lipid
levels
in
response
to
training.
The
role
of
genes
has
not
been
fully
investigated;
however,
genetic
factors
appear
more
important
than
changes
in
fitness
or
fatness
in
the
lipid
and
lipoprotein
responses
to
regular
exercise.
There
is
still
no
consensus
on
the
independent
effects
of
weight
(fat)
loss
versus
increases
in
fitness
in
determining
the
lipid
response
to
exercise
training.
This
is
by
far
the
largest
study
to
investigate
this
issue,
and
the
results
support
the
idea
that
changes
in
lipid
levels
are
more
closely
associated
with
fat
loss
than
with
increases
in
fitness.
Two
randomized,
controlled
trials
in
which
men
were
assigned
to
diet,
exercise,
or
control
groups
for
1
year
also
support
the
contention
that
improve-
ments
in
blood
lipid
levels
are
independent
of
increases
in
fitness.
In
both
studies,
the
diet
and
exercise
groups
lost
weight
and
had
improved
blood
lipid
profiles."
,12
In
the
first
study,
there
were
no
differences
between
exercisers
or
dieters
in
the
mean
plasma
lipid
changes,
and
there
were
significant
correla-
tions
between
changes
in
HDL-C,
HDL
2
-C,
and
HDL
3
-C
and
changes
in
FM."
Correlations
between
changes
in
FM
and
LDL,
TG,
and
CHOL
were
in
the
expected
direction,
although
not
statistically
significant.
In
the
second
study,
changes
in
BMI
were
significantly
correlated
with
changes
in
HDL
2
-C,
small
LDL,
and
LDL
peak
flotation
rate
in
both
dieters
and
exercisers.
12
There
were
also
significant
associations
between
changes
in
lipoproteins
and
changes
in
fitness
levels,
but
these
differences
disappeared
when
adjusted
for
the
changes
in
BMI.
846
KATZMARZYK
ET
AL
A
0.6
-
F=0.01,
p=0.93
F=1.15,
p=0.29
0.4
0.2
ri
0
-0.2
-0.4
-0.6
B
06
0.4
0.2
(7)
0-
-0.2
-
-0.4
-0.6
Males
Females
Fig
4.
Comparison
of
LCI
among
participants
in
the
lower
quartile
of
change
(M)
and
the
upper
quartile
of
change
(IA
for
(A)
Vo
z
„„„
and
(B)
FM
after
20
weeks
of
aerobic
exercise
training.
The
results
of
an
earlier
study
from
the
laboratory
of
one
of
the
investigators
(A.S.L.)
indicated
that
both
weight
loss
and
exercise
training
over
12
weeks
result
in
increases
in
HDL-C
and
that
the
effects
are
additive."
Schwartz"
also
reported
that
HDL-C
increased
after
both
diet
and
exercise
in
men,
but
the
changes
in
aerobic
capacity
and
body
composition
were
not
significantly
related
to
the
changes
in
plasma
lipid
concentra-
tions.
However,
the
small
sample
size
in
this
study
may
not
have
provided
sufficient
power
to
detect
meaningful
differ-
ences.
Intervention
studies
involving
exercise
training
and
diet-
induced
weight
loss
in
obese
men
suggest
that
changes
in
blood
lipid
levels
are
more
closely
associated
with
changes
in
FM
than
changes
in
Vo1,
1
5
and
that
an
exercise
intervention
(re-
sulting
in
a
significant
increase
in
Vo
2
,„„„)
did
not
improve
blood
lipid
levels
after
diet-induced
weight
loss.
36
Further,
comparison
of
a
hypocaloric
diet
versus
a
hypocaloric
diet
plus
aerobic
exercise
in
obese
men
showed
no
significant
effect
on
blood
lipid
levels
with
the
addition
of
exercise
to
the
interven-
tion,
despite
a
significant
increase
in
Vo
2
„..
37
Taken
together,
these
studies
highlight
the
importance
of
weight
loss
for
the
improvement
of
blood
lipid
levels
and
the
lipoprotein
profile.
Some
studies
have
shown
mean
increases
in
Vo
2m
in
concert
with
improvements
in
blood
lipid
levels
38,39
;
however,
it
is
difficult
to
determine
associations
when
only
mean
changes
are
considered.
For
example,
Kiens
et
al.
39
reported
significant
mean
changes
in
HDL-C,
TG,
and
CHOL
after
exercise
train-
ing
in
middle-aged men.
There
was
also
a
mean
12%
increase
in
Vo
2
,„„„
but
no
significant
mean
change
in
body
weight.
However,
the
changes
in
Vo,„..„,
ranged
from
0%
to
27%,
and
correlations
between
changes
in
Vo,max
and
variations
in
body
weight
with
changes
in
lipids
were
not
presented.
Similarly,
Thompson
et
al.
38
demonstrated
elevations
in
HDL-C
(13%)
after
an
exercise
program
in
previously
sedentary
men.
There
was
an
average
increase
in
Vol,
of
26%;
however,
the
correlation
between
variations
in
Vo,„..„,
and
changes
in
HDL-C
was
not
significant.
On
the
other
hand,
in
a
study
that
incorporated
long-term
(100
days)
low-intensity
(-55%
Vo,„..„,)
exercise
that
resulted
in
no
increase
in
Vo,„..„,
but
a
significant
decrease
in
FM,
there
were
significant
improve-
ments
in
HDL-C,
LDL-C,
and
the
HDL-C/CHOL
ratio
in
a
small
sample
of
young
men.
40
Based
on
mean
changes,
it
is
thus
difficult
to
determine
whether
the
changes
in
blood
lipid
levels
were
related
to
the
changes
in
Vo,m8x
or
to
changes
in
body
fatness
in
these
studies.
In
addition
to
the
training
studies
discussed
above,
the
results
of
the
present
study
are
in
agreement
with
a
4-year
observa-
tional
study
of
men,
in
which
changes
in
adiposity
were
cor-
related
with
changes
in
CHOL/HDL-C
ratio,
HDL-C,
and
TG.
41
Changes
in
Vo
2
,„„„
were
correlated
with
changes
in
TG,
but
the
use
of
multiple
regression
demonstrated
that
the
effects
of
fitness
on
TG
were
moderated
by
the
changes
in
body
fatness.
It
appears
as
though
both
experimentally
induced
weight
loss
and
natural
changes
in
body
fatness
over
time
are
related
to
changes
in
blood
lipid
levels
more
than
are
changes
in
fitness
per
se.
Current
public
health
recommendations
for
physical
activity
call
for
moderate
levels
of
physical
activity.
It
has
been
sug-
gested
that
heath
benefits
can
accrue
from
physical
activity
that
does
not
result
in
increases
in
aerobic
fitness.
42
Support
for
this
statement
can
be
found
in
the
results
of
a
24-week
randomized
controlled
trial
in
which
there
was
a
dose-response
relationship
for
Vo,„..„,
across
4
groups
of
women
randomized
into
different
walking
speed
programs.
43
In
contrast,
there
was
no
dose-
response
relationship
for
HDL-C
because
both
aerobic
walkers
and
strollers
had
similar
increases.
More
recently,
Spate-Dou-
glas
and
Keyser
44
reported
that
HDL-C
and
HDL,
-C
both
increased
significantly
in
women
after
exercise
training
and
that
high-intensity
exercise
provided
no
additional
benefit
over
moderate-intensity
exercise
in
terms
of
improving
HDL
levels.
Although
the
results
from
the
present
study
certainly
support
the
contention
that
changes
in
aerobic
fitness
are
not
necessary
to
obtain
health
benefits,
these
findings
must
be
interpreted
with
caution.
All
participants
exercised
at
the
same
relative
intensity
throughout
the
exercise
training
program,
beginning
at
55%
Vo,„..„,
and
progressing
to
75%
Vo,„..„,
for
the
final
6
weeks.
Thus,
this
study
did
not
test
for
a
dose-response
relationship
Table
3.
Correlations
Among
Changes
in
Fitness
and
Fatness
and
LCI,
Stratified by
Race
and
Sex
Black
Men
White
Men
Black
Women
White
Women
A
Vo2,r,ox
—0.09
0.01
0.01
0.01
A
FM
0.23*
0.28*
0.29*
0.13*
*
P<
.05.
Males
Females
F=12.61,
p=0.0005
F=11.07,
p=0.001
11.1
7
FITNESS,
FATNESS,
AND
BLOOD
LIPIDS
847
between
physical
activity
and
blood
lipid
levels
because
all
participants
received
the
same
relative
dose
of
activity.
How-
ever,
using
a
standardized
protocol,
some
individuals'
fitness
increased
more
than
others',
and
the
changes
in
blood
lipid
levels
were
unrelated
to
the
changes
in
fitness
in
both
black
and
white
participants.
ACKNOWLEDGMENT
The
authors
thank
all
the
coprincipal
investigators, investigators,
coinvestigators,
local
project
coordinators,
research
assistants,
labora-
tory
technicians,
and
secretaries
who
contributed
to
the
study.
Thanks
are
expressed
to
Drs
Jean
Bergeron
and
Jean-Pierre
Despres,
whose
laboratory
was
responsible
for
the
lipid
and
lipoprotein
assays.
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