**4. Prescription of resistance training for healthy people, what do we want to achieve?**

The Canadian Physical Activity Guidelines 2011 have recommended aerobic exercise and training as excellent things to do to add health value. This applies to all healthy people aged 18 to 64, even to people over the age of 65. This recommendation states that one person should do at least 150 minutes of exercise in a week (7 days). They recommend moderate to vigorous intensity exercise. They also add that it will be better if a person continues to do RT to maintain muscle and bone strength by exercising groups of major muscles at least twice a week [1].

A systematic review of selected 11 studies with 382,627 participants, from 2009 to 2019, looked for facts by comparing two large groups, the intervention group doing RT and the group that does not do RT. In the group that performed RT, it was recorded and statistically proven that there was a correlation between doing RT and reduction of death for any reason, decrease in the occurrence of cardiovascular disease, and increase in physical functional capacity. The effects related to cognitive function are not yet clear, they must be further proven. Unwanted side effects were not consistently monitored or reported in these studies. However, it is stated that there are no serious or injurious side effects or uncommon side effects. Overall, RT is beneficial in improving the health status of adults and the benefits outweigh the disadvantages [40].

RT can be a fun exercise with a variety of tools with certain weights. RT can also be done simply by relying on one's own body weight with certain movements that resist the force of gravity. In line with the advancement of RT technology, it can be done using machines and even robotic tools that can be programmed and adjusted to one's needs and abilities. If the advance tools are not available, we can make simple tools with simple materials around us. For instance, we can make a load from a used mineral water drinking bottle filled with fine sand. Determine the weight of the tool load we need.

No matter how healthy a person is, try to determine the RT load and the practice prescribing method with an initial test first. This initial data can be used as a reference for a basic or initial program and can be used to evaluate the progress of the program being trained. As one of the suggestions for training and achieving a defined goal, no

*Resistance Training is Medicine: Stay Active and Reap the Reward, Live in your Life! DOI: http://dx.doi.org/10.5772/intechopen.109973*

matter how much your target load is, start by practicing multi-joint involving large muscles and then train by involving a single joint targeting more focused muscles.

Here is the RT reference taken from ACSM:

### See **Table 1.**

To achieve the optimal goal of RT, there are 4 factors that should be considered, namely muscle strength, muscle power, muscle hypertrophy, and local muscle endurance. These four factors can be developed if the RT prescription is tailor-made, determined and carried out according to the needs and capabilities. RT prescription should always consider the load, volume, rest period between sets, and frequency of each exercise.


#### See **Table 2.**

Frequency can be done by considering the reference as follows:



#### **Table 1.**

*American College of Sports Medicine. Copyright © 2013 American College of Sports Medicine. This brochure was created by Michael R. Esco, Ph.D., HFS, CSCS\*D, It is a product of ACSM's Consumer Information Committee. Visit ACSM online at www.acsm.org [41].*


#### **Table 2.**

*American College of Sports Medicine. Copyright © 2013 American College of Sports Medicine. This brochure was created by Michael R. Esco, Ph.D., HFS, CSCS\*D. it is a product of ACSM's consumer information committee. Visit ACSM online at www.acsm.org [41]. Modified by Ernandini*

Beware of overtraining. Overtraining can occur because the interventions carried out are exceeding the capabilities of the individual. Symptoms of overtraining in RT can be severe pain, injuries to muscles, joints, tendons, or heavy fatigue. This can be triggered by exceedingly heavy load, too many muscles being exercised, too many repetitions, or doing RT too often. Injuries also often occur because we misposition our posture with the weight that must be lifted. It is best to do the exercise in tiered, gradual, and continuous manner instead of a sudden increment of loads [41]. Ernandini et al. [42] stated that the most important thing is safety in doing exercise, so do an MCU to find out your fitness level medically first [42].

#### **5. Resistance training as ammunition to combat obesity**

The status of obesity is believed to be increasing along with the improving economy, especially in countries with high per capita income. The incidence of obesity is also undeniably caused due to modern lifestyle. Obesity is also believed and proven to be a contributing to DM and cardiovascular and cancer diseases [43]. In this journal, it is also stated that the role of regulating the amount and type of food and exercise will help calorie deficit. A 5% weight loss can add significant value to the improvement of health status and cardiovascular health function [44, 45].

Some studies look for the answers to whether RT plays a role in preventing obesity status over a long period, as well as RT's usage as an exercise to reduce obesity cases. So far, AE has been accepted to help maintain weight and prevent obesity. A

#### *Resistance Training is Medicine: Stay Active and Reap the Reward, Live in your Life! DOI: http://dx.doi.org/10.5772/intechopen.109973*

systematic review using the prospective cohort study in 2021 involved 11.938 participants [43]. In this study, obesity is defined as BMI results ≥30 kg/m<sup>2</sup> [46], waist circumference (wc) > 102 cm for men and > 88 cm for women [47], and percent body fat (PBF) ≥ 25% and 30% for men and women, respectively. This study included 11,938 adult participants who were not obese and were followed for 6 years. After taking into account several factors that may affect the results of this study such as age, sex, examination year, smoking, alcohol consumption, hypertension, hypercholesterolemia, and DM, the results show that RT will affect at least 20–30% of participants [48] in reducing the risk of becoming obese for the next 6 years [43]. Of course, with a strong commitment to maintaining a healthy lifestyle to maintain BB and ideal body composition to support health.

The main goal of a healthy lifestyle is to maintain good health status. By living a healthy lifestyle, one can get pleasant side effects in the form of balanced body weight and composition. However, in this super comfortable and easy era, it is a challenge for one to keep his body in optimal condition. Until now, it is still believed that the decrease in the amount of visceral fat and subcutaneous fat is very important and can decrease the incidence of metabolic cardiovascular diseases such as DM, heart attacks, and strokes. Obesity can now be considered a threat to the medical world because it is not only esthetically unpleasing but also a risk factor leading to comorbidities as explained above.

Several studies that chose RT as an exercise to combat obesity were collected and analyzed in a systematic review. Electronic data collection from various studies taken till December 2020, recorded 4184 people with obesity and overweight. This study involved participants aged <18 years, >18–35 years, >35–59 years, and ≥ 60 years, which were given exercise as an intervention for at least four weeks. The types of interventions they carried out further differed into RT alone (49.1%), RT + AE (44%), RT + restriction calorie (RC) (5.3%), and RT + AE + RC (7%). The average treatment was 14.6 weeks of exercise, with a frequency of 1 to 5x/week and variety of intensities of RT (low, moderate, and heavy). Outcome measures were the calculation of body fat, fat mass, visceral adipose tissue (VAT), and subcutaneous adipose (SAT), including body weight and BMI as secondary outcomes [49].

The results of RT alone actually already have a significant difference statistically, but the change value is categorized as small to moderate when analyzed statistically. RT alone has a significant enough role to increase muscle mass weight. RT alone can reduce 2.2% of fat or 1.6 kg of fat [49].

SR conducted by Xinhong Liu et al. 2022 involved 15 studies with a total of 669 subjects, observing three types of exercise in RT: own body weight (OBW), resistance bands (RB), and free weight (FW). It is concluded that RB is the most effective tool in RT for fat removal in cases of overweight and obese. RB has a much more flexible form and work than using certain loads. RB is more adjustable and can follow shape of the body. The pull of RB will provide tensile force that will increase along with the elongation of RB. The intensity of this RB tensile force will not be too high, so the body can do its work more slowly with a lower intensity and the body will use aerobic oxidation, which will use glucose and fat as main source of energy [50, 51]. RB is flexible and can follow the direction of the pulling force following a group of muscles used for the movement, and this will greatly help fat burning. However, because the intensity of RB is not high, the stimulation in the muscles will not continue, hence the muscle mass formation will not be optimal. In addition, the light RB will not have a heavy impact, especially on the joints of overweight and obese [50].

When reviewed further, there are more types of exercises and interventions, which also give meaningful results in combating obesity. Multicomplex exercises turned out to have better results since each intervention had its own role. It is necessary to give monitored, implementable, measurable, accountable, and safe prescriptions to achieve optimal results. These results will be even better when RT is complemented by a reduction in the calories. RT + CR exercises will reduce fat by 3.8%. An encouraging result is when RT plus AE exercises, complemented with CR, can result in a reduction of 5.1 kg of fat, or 7.1%. This effect remains consistent for adolescents to the elderly, with the greatest number of meaningful changes in young adulthood. Decrease in VAT and SAT obtained from multicomplex therapy consisting of RT + AE + RC. Meaningful change with a fairly satisfactory value remains consequential at all ages, even postmenopausal women [49].

*Garrow and Sumerbell* predict that a 20–30% reduction in body weight caused by CR alone in adults is not due to a reduction in fat mass. For this reason, more than just CR efforts are needed for overweight and obesity reduction programs [52]. In line with the study, Sardeli et al. [53] stated RT is required to build skeletal muscle as much as 1.8 kg. When skeletal muscles contract, especially during exercises, our body will release myokine, myostatin, interleukin 6 (IL-6), and brain-derived neutrophic factor (BDNF). These substances will provide protection for the body against adipokines proinflammatory in obese bodies. The formation of muscles plays an important role in increasing resting energy expenditure, which leads to a decrement in obesity and overweight status [53].

#### **6. Prescription resistance training for Cardiovascular Disease (CVD)**

Hypertension (HBP) is one of nine risk factors leading to CVD. HBP is estimated to cause >7 million deaths annually, 13% of total deaths worldwide [54]. Meta-analysis by Lewington in 2002 stated that the safe blood pressure to be free from the threat of disease and death from CVD is at 115/75 mmHg [55]. On that basis, adequate blood pressure management must be socialized to the community to become a worldwide self-monitoring. Adequate BP control is closely related to life habits, including weight control, moderate intake of alcohol, a diet of fresh fruits and vegetables, reducing saturated fat, and staying active in daily life and exercise [55, 56]. So far, there have been many studies and writings that recommend aerobic exercise such as: walking, jogging, and cycling for controlling and even lowering BP on HBP. This is the time to consider one type of exercise that has an effect on metabolic health as well as in the preventive efforts of CVD [55, 57].

Several studies collected in a meta-analysis show several things about the effect of RT on BP on subject groups that have undergone RT and non-RT groups. This research was conducted from 1987 to June 2010. Based on the type of contraction, RT is also divided into two more groups: RT dynamic and RT static/isometric. Dynamic RT consists of concentric and eccentric contraction by moving an arm or leg that causes the length and tension of muscles and tendons to change. Meanwhile, static RT is a state of contraction against the load by not moving or not extending or stretching muscles or tendons. After 16 weeks of exercise, the subjects were then evaluated and compared to their initial values. To eliminate bias, the subjects were instructed not to change their lifestyles during this time while carrying out the pre-ordered exercise, which is a dynamic RT or static RT, according to their group. The result was then analyzed and it was found that from the two groups, dynamic RT exercises with

#### *Resistance Training is Medicine: Stay Active and Reap the Reward, Live in your Life! DOI: http://dx.doi.org/10.5772/intechopen.109973*

moderate intensity, as well as low intensity in static RT, had a decreasing BP systole and BP diastole significantly. It was also noted that the dynamic RT group also had a good effect on things that are predictor CVD risk factors, such as increase in VO2pea and decrease in body fat and plasma triglyceride. The results of the analysis in this study can be concluded to have a clinical meaning that a decrease in SBP and DBP in a resting state even though it is only 3 mmHg can reduce the risk of CAD 5%, stroke 8% and other deaths by as much as 4% [54].

The increase in mortality in chronic CVD such as hypertension and diabetes is often associated with arterial stiffness. This stiffness results from the loss of elastic fibers and the accumulation of stiff collagen debris attached to the arterial wall. This stiffness results from the loss of elastic fibers and the accumulation of stiff collagen debris attached to the arterial wall. Many studies have found that this stiffness is strongly related to a person's physical activity. Activities such as walking and running, affect in a positive way to prevent vascular stiffness. The next question will be, whether RT affects arterial stiffness in positive or negative manner? A meta-analysis tried to answer this question, involving 981 participants aged 18 to 88, and they were divided into experimental groups and control groups. The intervention group carried out RT for 8 to 12 weeks with a frequency of 1 to 5 times per week, with intensity ranging from 30 to 90% 1RM. All subjects were measured for their carotid, femoral, tibial, and brachial arterial pulse rates. In conclusion, RT has no effect on the speed of arterial waves. The researchers did not stop there, they carried out a regression analysis to see the involvement of each parameter. After performing a regression analysis, it was found that only the intensity of exercise had a correlation with the change in the speed of the arterial wave rate. Light to moderate intensity significantly reduces the speed of arterial wave beating, while high intensity has no meaningful effect. Then the researchers also continued the regression analysis of age, then found that the barrier was seen meaningfully in subjects with an age of more than 40 years. Researchers then concluded that RT with mild to moderate intensity meaningfully decreases arterial stiffness in groups over 40 and also has a moderate correlation in those under 40 years of age [57].

The increase in the rate of arterial waves of 1 m/s alone will increase the risk factor of CVD by around 12–14% and the mortality rate by 13–15%. Although it is asserted that RT with mild and moderate intensity will have a good impact on the prevention and improvement of arterial stiffness, the exact explanation of it has not been obtained satisfactorily. Researchers made a hypothesis that states that RT with an intensity of 30–70% will activate only a small amount of the sympathetic nervous system, so it will not increase muscle tone. This has a beneficial effect on the blood circulation system by increasing endothelial function [57].

*Haslan et al.* [58] reported that CAD patients with mild hypertension were declared safe doing RT with an intensity of 40–60% 1xRM [58]. Recommendation for safe rehabilitation program for stable CAD patients without complaints starting with 3 months of AE followed by an RT program of 40–60% intensity 1x RM, 1–2 sets, 8–10 repetitions, 2–3 days per week, duration not more than 60 minutes. There is no recurrence of symptoms and it is shown to increase muscular strength and endurance [59]. Especially for postoperative patients with cardiac and postmyocardial infraction (MI) cases, it is recommended to postpone RT by at least 4 to 6 months [60, 61]. RT should be done progressively, starting low and gradually increasing until a certain goal.

If you are going to do isometric RT, do a mild one. Because isometric movement means making the same muscle contraction without moving the joint so that there is no extension of the length of the muscle involved, causing a disproportionate increase in blood pressure [14].

#### **7. Recommendation and effects of RT for intellectual disability of people**

There are not many studies about RT programs for adults with intellectual impairments (ID). They often have intellectual problems as well as emotional problems, although many of them also have adequate gross motor ability. According to American Psychiatric Association, ID is a disorder due to deficit in person's cognition as well as a disorder in the concept of thinking, which certainly has an impact on practical matters in social activity, and this condition is diagnosed before the age of 18 years [61]. Several studies done by Dairo et al. [62] and Harris L et al. [63] reported that IDs are a group of people who are at risk of injury and tend to have a sedentary lifestyle, which increases the risk for cardiovascular disease, hypertension, obesity, and DM [62, 63].

The lower the IQ, the lower the ability to record memory. Their ability to concentrate and communicate can also be seriously lacking, so monitoring by training instructors and caregivers is still very necessary. Safety remains a major issue for individuals with intellectual disability in doing exercise [64].

The guidelines for prescribing RT from ACSM must still be maintained to obtain excellent health quality. RT is still sought to involve at least 6 to 8 large muscle groups, performed by involving both multi joints and single joint. Possibilities have to be considered: how about exercise using muscle contraction (either eccentric and concentric), also isotonic, isometric and isokinetic exercise, and also exercise using equipment.

A systematic review observation consisting of several studies, involving 280 subjects who had an IQ below 70 with an average age of 18.23 years ±2.86 years, wanted to see how the prescribing and effects of RT for IDs. Interventions performed were varying duration of RT with an average of 12 weeks, 2–5 times a week. All the studies involved gave encouraging results by showing the success of reducing body fat mass, increasing fat-free mass, reducing waist circumference size, reducing BMI, and increasing body balance. These studies also successfully recorded immunoglobulin concentrations in saliva, testosterone levels, and the ability to perform ordered tasks [65]. The increments of salivary IgA values are shown to help prevent respiratory infections [66].

Improvement in functional capacity is also achieved by increasing walking speed as well as the results of body balance tests. This is in line with the addition of strength to the leg muscles [67]. An encouraging result was obtained, that by doing exercise, the subjects gained the effect of meaningful thinking ability. That ability to think and act may not be able to achieve normal IQ value, but at least it adds value to short-term memory ability and vocabulary and improves the ability to act and problem-solving [68].

One obstacle that participants with an intellectual disability face is getting distracted easily. The duration of maintaining concentration is also shorter than that of people with normal IQ. This situation greatly affects their motivation to complete the exercise session. In order to produce the desired exercises and their effects, the coaching team must intervene directly to interact with the participants with IDs. Caregiver involvement, as well as family, is very important to provide motivation and real examples of doing these movements. A cheerful atmosphere can be prevented

#### *Resistance Training is Medicine: Stay Active and Reap the Reward, Live in your Life! DOI: http://dx.doi.org/10.5772/intechopen.109973*

by tuning in to the spirit-boosting music. IDs will be encouraged if they are given the expectation of rewards and appreciation, even if the rewards are simple. The coaching team must always be creative to be able to make the exercises as interesting games for them. It should also be realized that most IDs have mood patterns that are easy to change drastically [64].

Stijn et al. reiterated that safety is the priority concern for this group. The equipment used for this exercise has to be safe and not pose any danger, both intentional and unintentional. Basic equipment that was originally used to complement and help IDs in exercise can turn into a dangerous weapon, without them knowing or planning. It is also necessary to avoid sophisticated equipment such as robots. Movements have to be as simple as possible for them to comprehend and do properly and correctly [64, 65]. A simple example that they apparently cannot do is the squatting movement with ball between the back and the wall. They also cannot perform bridge pose. However, some research and observations explain that there is one movement they like and 100% are willing to repeat, and it is the biceps curl movement. There are times when the IDs do not want to make the movements ordered, so it is appropriate that the coaching team accompanies them by providing examples of these movements and opening up good communication.

Some research and observations state that there are also groups that can use simple and harmless RT tools. For example, using a chest press device is considered easier than using a bench press [69].

RT Recommendations for IDs:

