Association of Resistance Exercise With the Incidence of Hypercholesterolemia in Men

Abstract

Objective: To examine the associations of resistance exercise, independent of and combined with aerobic exercise, with the risk of development of hypercholesterolemia in men.

Patients and methods: This study used data from the Aerobics Center Longitudinal Study, which is a cohort examining the associations of clinical and lifestyle factors with the development of chronic diseases and mortality. Participants received extensive preventive medical examinations at the Cooper Clinic in Dallas, Texas, between January 1, 1987, and December 31, 2006. A total of 7317 men aged 18 to 83 years (mean age, 46 years) without hypercholesterolemia at baseline were included. Frequency (times per week) and total amount (min/wk) of resistance and aerobic exercise were determined by self-report. Hypercholesterolemia was defined as a total cholesterol level of 240 mg/dL or higher or physician diagnosis.

Results: During a median (interquartile range) follow-up of 4 (2 to 7) years, hypercholesterolemia developed in 1430 of the 7317 men (20%). Individuals meeting the resistance exercise guidelines (≥2 d/wk) had a 13% lower risk of development of hypercholesterolemia (hazard ratio [HR], 0.87; 95% CI, 0.76-0.99; P=.04) after adjustment for general characteristics, lifestyle factors, and aerobic exercise. In addition, less than 1 h/wk and 2 sessions per week of resistance exercise were associated with 32% and 31% lower risks of hypercholesterolemia (HR, 0.68; 95% CI, 0.54-0.86; P=.001; and HR, 0.69; 95% CI, 0.54-0.88; P=.003), respectively, compared with no resistance exercise. Higher levels of resistance exercise did not provide benefits. Meeting both resistance and aerobic exercise guidelines (≥500 metabolic equivalent task min/wk) lowered the risk of development of hypercholesterolemia by 21% (HR, 0.79; 95% CI, 0.68-0.91; P=.002). compared with meeting none of the guidelines.

Conclusion: Compared with no resistance exercise, less than 1 h/wk of resistance exercise, independent of aerobic exercise, is associated with a significantly lower risk of development of hypercholesterolemia in men (P=.001). However, the lowest risk of hypercholesterolemia was found at 58 min/wk of resistance exercise. This finding suggests that resistance exercise should be encouraged to prevent hypercholesterolemia in men. However, future studies with a more rigorous analysis including major potential confounders (eg, diet, medications) are warranted.

Figure 1

Hazard ratios of hypercholesterolemia by the combination of weekly frequency (1–2 vs. ≥3 times/week) and minutes of resistance exercise (0, 1–59, 60–119, and ≥120 min/week). The dots indicate hazard ratios and the bars indicate 95% confidence intervals. The model was adjusted for age, examination year, body mass index, current smoking, heavy alcohol drinking, abnormal electrocardiography, systolic and diastolic blood pressure, parental history of hypercholesterolemia, and aerobic exercise.

Figure 2

Hazard ratios of hypercholesterolemia by meeting the 2008 US Physical Activity Guidelines for resistance (≥2 days/week) and aerobic activities (≥500 MET-minutes/week). The dots present hazard ratios and the bars 95% confidence intervals. The hazard ratio (95% CI) was 0.89 (95% CI, 0.79–1.01) for only meeting the aerobic exercise guidelines, 0.82 (95% CI, 0.62–1.09) for only meeting the resistance exercise guidelines, and 0.79 (95% CI, 0.68–0.91) for meeting both guidelines. The model was adjusted for age, examination year, body mass index, current smoking, heavy alcohol drinking, abnormal electrocardiography, systolic and diastolic blood pressure, and parental history of hypercholesterolemia.

Figure 3

The dose-response relationship between resistance exercise (minutes/week) and the risk of hypercholesterolemia. Dotted lines represent 95% confidence intervals for the trend obtained from restricted cubic spline regression (5 knots at 25, 60, 90, 135 and 270 minutes/week). The model included the following covariates: age, examination year, body mass index, current smoking, heavy alcohol drinking, abnormal electrocardiography, systolic and diastolic blood pressure, parental history of hypercholesterolemia, and aerobic exercise. P=.13 for a nonlinear relationship.