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Effects of the addition of a resistance trainingprogramme to a caloric restriction weight lossintervention on psychosocial factors in overweight andobese post-menopausal women: A Montreal OttawaNew Emerging Team studyVirginie Messier a , Rémi Rabasa-Lhoret a , Eric Doucet b , Martin Brochu c , Jean-MarcLavoie d , Antony Karelis a , Denis Prud'homme b & Irene Strychar aa Department of Nutrition , University of Montreal , Montreal, Quebecb School of Human Kinetics, University of Ottawa , Ottawa, Ontarioc Faculty of Physical Education and Sports , University of Sherbrooke , Sherbrooke, Quebecd Department of Kinesiology , University of Montreal , Montreal, Quebec, CanadaPublished online: 23 Dec 2009.
To cite this article: Virginie Messier , Rémi Rabasa-Lhoret , Eric Doucet , Martin Brochu , Jean-Marc Lavoie , Antony Karelis ,Denis Prud'homme & Irene Strychar (2010) Effects of the addition of a resistance training programme to a caloric restrictionweight loss intervention on psychosocial factors in overweight and obese post-menopausal women: A Montreal Ottawa NewEmerging Team study, Journal of Sports Sciences, 28:1, 83-92, DOI: 10.1080/02640410903390105
To link to this article: http://dx.doi.org/10.1080/02640410903390105
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Effects of the addition of a resistance training programme to a caloricrestriction weight loss intervention on psychosocial factors inoverweight and obese post-menopausal women: A Montreal OttawaNew Emerging Team study
VIRGINIE MESSIER1, REMI RABASA-LHORET1, ERIC DOUCET2, MARTIN BROCHU3,
JEAN-MARC LAVOIE4, ANTONY KARELIS1, DENIS PRUD’HOMME2, &
IRENE STRYCHAR1
1Department of Nutrition, University of Montreal, Montreal, Quebec, 2School of Human Kinetics, University of Ottawa,
Ottawa, Ontario, 3Faculty of Physical Education and Sports, University of Sherbrooke, Sherbrooke, Quebec and 4Department
of Kinesiology, University of Montreal, Montreal, Quebec, Canada
(Accepted 6 October 2009)
AbstractThe aim of this study was to examine the effects of the addition of a resistance training programme to a caloric restrictionweight loss intervention on psychosocial profile. The study sample consisted of 137 overweight and obese post-menopausalwomen. Participants were randomized to a caloric restriction group and caloric restrictionþ resistance training group.Psychosocial, anthropometric, and metabolic variables were measured before and after the 6-month weight loss intervention.Both groups presented similar weight loss and there were no significant differences between the caloric restriction group andcaloric restrictionþ resistance training group for changes in psychosocial profile. Thereafter, all participants were classifiedinto quintiles based on the amount of weight loss. In all quintiles, women markedly improved body esteem and self-esteem,and decreased hunger and perceived risk for diabetes mellitus (P5 0.05). However, significant increases in dietary restraintwere observed in quintiles 2–5 (�2.4 % body weight loss), decreases in disinhibition in quintiles 3–5 (�4.9 %), increases inself-efficacy in quintiles 3–5 (�4.9 %), and increases in health perceptions in quintile 5 (�11.1%). The results of this studydo not support the hypothesis that the addition of a resistance training programme to a caloric restriction weight lossintervention has additional benefits on psychosocial profile. Overall, the significant improvements in the psychosocial profileobserved were mostly accounted for by the degree of weight loss.
Keywords: Weight loss, body esteem, obesity, quality of life, physical activity
Introduction
Classical strategies used in weight loss treatments
include calorie-restricted diets, aerobic physical
activity regimens, and cognitive behavioural thera-
pies. Systematic reviews of diet and exercise trials
have shown a mean weight loss of approximately
5–9% of body weight (Lau et al., 2007). Moreover,
lifestyle interventions combining diet and exercise
regimens are important strategies for long-term
weight loss maintenance (Galani & Schneider,
2007). Similarly, the addition of behavioural thera-
pies has positive benefits on weight loss in the short
(Galani & Schneider, 2007) and possibly long term
(Franz et al., 2007). The health benefits of modest
weight loss (5–10% body weight) include a de-
creased risk for diabetes, an improved lipid profile,
and lowered blood pressure (Douketis, Macie,
Thabane, & Williamson, 2005; Franz et al., 2007;
Lau et al., 2007).
Weight loss interventions are associated with
improved psychological well-being, mental health,
self-esteem, body image, and quality of life (Blaine,
Rodman, & Newman, 2007; Dent, Habib, Soucy, &
Bissada, 2007; Hays, Bathalon, Roubenoff,
McCrory, & Roberts, 2006; Kaukua, Pekkarinen,
Sane, & Mustajoki, 2003). Psychosocial factors
associated with weight loss and weight loss main-
tenance include increased dietary restraint, reduced
disinhibition and hunger, and increased self-efficacy,
Correspondence: V. Messier, Department of Nutrition, University of Montreal, 110 Avenue des Pins Ouest, Montreal, Quebec H2W 1R7, Canada.
E-mail: [email protected]
Journal of Sports Sciences, January 1st 2010; 28(1): 83–92
ISSN 0264-0414 print/ISSN 1466-447X online � 2010 Taylor & Francis
DOI: 10.1080/02640410903390105
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although the results are contradictory (Niemeier,
Phelan, Fava, & Wing, 2007; Teixeira et al., 2002,
2006; Teixeira, Going, Sardinha, & Lohman, 2005;
Wing & Phelan 2005). When pre-treatment pre-
dictors of weight loss were examined in a review of
29 studies, none of these psychosocial factors were
associated with weight outcomes (Teixeira et al.,
2005).
Studies that specifically assessed the addition of
aerobic exercise to caloric restriction have shown
improvements in psychosocial factors (Fontaine
et al., 1999; Gallagher, Jakicic, Napolitano, &
Marcus, 2006; Lemoine et al., 2007; Teixeira
et al., 2006), including physical functioning,
role functioning, general health and mental health
(Fontaine et al., 1999), as well as dietary restraint,
disinhibition, and susceptibility to hunger (Lemoine
et al., 2007). Although the effects of diet and aerobic
exercise programmes on weight loss as well as
on psychosocial factors have been widely studied
(Fontaine et al., 1999; Gallagher et al., 2006;
Lemoine et al., 2007; Teixeira et al., 2006), few
researchers have addressed the impact of resistance
training on changes in psychosocial factors. For
example, in healthy older adults, resistance training
was found to be associated with improvements in
perceived psychosocial well-being, self-efficacy, and
social interactions thought to be the underlying
mechanism explaining this link (Dionigi, 2007).
The association between resistance training and
improved well-being may also be due to the effects
of resistance training on preservation of muscle
mass and increases in muscle strength (Winett &
Carpinelli, 2001), leading to improvements in func-
tional outcomes (Brandon, Boyette, Gaasch, &
Lloyd, 2000; Hurley & Roth, 2000; Singh, 1998)
and quality of life (Inaba, Obuchi, Arai, Satake, &
Takahira, 2008). Although some investigators have
reported improvements in quality of life with resis-
tance training (Rejeski et al., 2002), others have not
(Perrig-Chiello, Perrig, Ehrsam, Staehelin, & Krings,
1998). Thus, this area of study needs to be addressed
because: (1) there are limited and contradictory data
on the effect of resistance training combined with
caloric restriction on individuals’ psychosocial pro-
file; (2) resistance training-strength activities are
part of current physical activity recommendations
(Haskell et al., 2007); and (3) psychosocial correlates
may differ for cardiorespiratory fitness, as related to
aerobic activities, compared with muscle strength, as
related to resistance training (Karelis et al., 2008).
The main aim of this study was to investigate the
effects of the addition of a resistance training
programme to a caloric restriction weight loss
intervention on psychosocial factors in overweight
and obese post-menopausal women. We hypothe-
sized that the addition of a resistance training
programme would have a more beneficial effect on
psychosocial parameters than caloric restriction
alone. A secondary aim was to examine changes in
the psychosocial profile according to the amount of
weight loss.
Methods
Montreal Ottawa New Emerging Team project
The Montreal Ottawa New Emerging Team project
is designed to investigate, using a randomized
controlled design, the impact of resistance training
during weight loss (6 months) and weight main-
tenance (12 months) on detailed, metabolic, inflam-
matory and hormonal profile, body composition,
energy expenditure, psychosocial profiles, and in-
sulin sensitivity in overweight and obese post-
menopausal women. This article presents results on
the psychosocial profile for the weight loss phase.
Participants
This prospective study included sedentary, over-
weight, and obese post-menopausal women, partici-
pating in a 6-month randomized caloric restriction
trial with or without a resistance training weight loss
intervention. Participants were recruited by news-
paper advertisements. The study was approved by
the University of Montreal’s Faculty of Medicine
Ethics Committee. We certify that all applicable
institutional and governmental regulations concern-
ing the ethical use of human volunteers were
followed during this research. Data were collected
from 2003 (initiation of recruitment) to 2006 (end of
the intervention) in the Department of Nutrition at
the University of Montreal. After reading and signing
a consent form, each participant was invited to the
Metabolic Unit for a series of tests. Women were
included in the study if they met the following
criteria: (1) body mass index� 27 kg � m72; (2)
menstruation had ceased for at least 1 year and
follicle-stimulating hormone concentration�30
U � l71; and (3) free of known inflammatory disease.
On physical examination or biological testing, all
participants had no history or evidence of: (a)
cardiovascular disease, peripheral vascular disease
or stroke; (b) diabetes (fasting glucose5 7.0
mmol � l71 and 2 h after a 75 g oral glucose
tolerance test5 11.0 mmol � l71); (c) medications
affecting cardiovascular function and/or metabolism.
A total of 1079 women responded to the news-
paper advertisements, of whom 936 were reachable
by telephone, 252 were eligible for testing, and 137
accepted and met study inclusion/exclusion criteria
(Figure 1). Twice as many women were randomized
to the caloric restriction group (n¼ 89) as the caloric
84 V. Messier et al.
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restrictionþ resistance training group (n¼ 48), be-
cause women who completed the 6-month caloric
restriction intervention were asked to participate in a
12-month follow-up with or without resistance
training.
Caloric restriction intervention
Women entered into a medically supervised weight
loss programme for 6 months aimed at reducing
body weight by 10%. To determine the level of
caloric restriction, 500–800 kcal were subtracted
from baseline resting metabolic rate (determined by
indirect calorimetry) multiplied by a physical activity
factor of 1.4, corresponding to a sedentary state
(Tremblay, Pelletier, Doucet, & Imbeault, 2004).
Macronutrient diet composition was standardized:
55%, 30%, and 15% of energy intake from carbohy-
drates, fat, and protein, respectively. Each partici-
pant met with the study dietitian to receive the diet
prescription. Also, participants in both study groups
were invited to meet bi-monthly with the dietitian for
nutrition classes of 1–1.5 h duration. Themes
discussed during the group sessions included: food
groups and their caloric/nutrient content as well as
portion sizes, self-evaluation of dietary intake and
macronutrient distribution, dietary fats and portion
size, fibre and ways to meet an intake of
25 g � day71, protein and its effect on satiety,
desserts (necessity and nutrient/caloric values),
identification of physiological and emotional cues
to hunger, stage of readiness to lose weight, fad diets
and weight loss products. All participants in the
caloric restriction group were instructed to maintain
their habitual physical activities during the weight
loss protocol.
Resistance training intervention
Each training session included a warm-up of low-
intensity walking on a treadmill for 10 min. The
6-month resistance training programme consisted of
four progressive phases and was performed weekly
on three non-consecutive days [phase 1: introduction
to training (3 weeks, 15 repetitions, 2–3 sets per
exercise, 90–120 s between sets); phase 2 (5 weeks,
12 repetitions, 2–3 sets per exercise, 90 s between
sets); phase 3 (9 weeks, 8–10 repetitions, 2–4 sets
per exercise, 120–180 s between sets); and phase 4
(8 weeks, 10–12 repetitions, 3–4 sets per exercise,
Figure 1. Trial profile of the 6-month study. CR¼ caloric restriction; RT¼ resistance training.
Resistance training and psychosocial profile 85
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60–90 s between sets)]. The resistance training
programme consisted of the following exercises: (1)
leg press, (2) chest press, (3) lateral pull downs, (4)
shoulder press, (5) arm curls, and (6) triceps
extensions. These exercises provide a whole-body
resistance training programme for all of the major
muscle groups of the body. Each exercise session was
individually monitored by qualified personal trainers.
Body composition
Body weight and fat mass were measured using dual-
energy X-ray absorptiometry (General Electric Lu-
nar Corporation, version 6.10.019, Madison, WI,
USA). Standing height was measured using a wall
stadiometer (Perspective Enterprises, Portage, MI,
USA). Body mass index [BMI¼ body weight/height
(kg � m72)] was calculated.
Cardiorespiratory fitness
The participants performed a graded exercise test on
a cycle ergometer (Ergoline 900, Bitz, Germany) to
voluntary exhaustion. During the test, power output
was increased by 25 W every 2 min. Peak oxygen
consumption ( _V O2peak; litres � min71) was consid-
ered to be the highest value obtained during the test.
Expired gases were analysed during the exercise
protocol using an Ergocard (software version 6,
MediSoft, Dinant, Belgium) cardiopulmonary ex-
ercise test station. Standard 12-lead electrocardio-
grams were performed at the end of every 2-min
stage. Three of the following criteria were required
for a successful test: a respiratory exchange ratio
above 1.1; heart rate within 10 beats � min71 of
maximum predicted heart rate (2207 age); voli-
tional cessation of exercise; and a plateau in oxygen
consumption for 60 s.
Physical activity
Total energy expenditure was determined from
doubly labelled water (DLW) over a 10-day period
(Schoeller & van Santen, 1982). The doubly labelled
water experiments generated five urine samples per
individual: a baseline pre-dose sample, two samples
(16–24 h later) obtained after the 2H218O dose had
initially equilibrated in the body, plus two further
samples collected 10 days later. All samples were
measured in triplicate for 18O-water and 2H-water.
An Isoprime Stable Isotope Ratio Mass Spectro-
meter connected to a Multiflow-Bio module for
Isoprime and a Gilson 222XL Autosampler (GV
Instruments, Manchester, UK) were used for daily
energy expenditure measurements. Data processing
was performed with MassLynx 3.6 software. The
stability tests performed each day before testing gave
a standard deviation of 0.026% for deuterium and
0.004% for 18O. In addition, resting metabolic rate
was measured by indirect calorimetry as previously
described (Conus et al., 2004). Physical activity
levels were calculated from the following equation:
total energy expenditure/resting metabolic rate.
Muscle strength
Lower body strength was assessed using leg press
weight training equipment from Atlantis Precision
Series (Atlantis Inc., Laval, Canada). The partici-
pants were aligned with the ball of their feet on the
footplate of the machine at shoulder width so that
their knee angle approximated 908 of flexion.
Keeping their back flat against the chair, they were
assisted to the starting position, which consisted of
extending their legs outward. A complete repetition
consisted of flexing the knees and slowly returning to
a complete extension of the legs stopping before full
knee extension. The participants were asked to start
their session with a light walk on a treadmill for
10 min. Muscle strength was measured using a one-
repetition maximum (1-RM) technique. The first set
was used as a warm-up of 10 repetitions with a light
initial load set by the training supervisor. Thereafter,
the load was increased until maximal effort was
achieved. The 1-RM was typically determined within
five trials with a 4-min rest between trials. Failure
was defined as a lift falling short of the full range of
motion. If none of the trials yielded a 1-RM, the
Wathan equation (Wathan, 1994) was used to
extrapolate the 1-RM.
Psychosocial factors
The psychosocial factors (body esteem, self-esteem,
stress, dietary restraint, disinhibition, hunger, quality
of life, self-efficacy, perceived benefits, perceived
risks) were evaluated using a self-administered
questionnaire. Body esteem was assessed using
Mendelson and colleagues’ Body-Esteem Scale
(Mendelson, Mendelson, & White, 2001), a 23-item
measure that includes three subscales: appearance
(10 items), attribution (i.e. how a woman perceives
other people’s evaluation of her body appearance: 5
items), and weight (8 items). Mean scores, ranging
from 0 to 4, were calculated for total body esteem
and each subscale, with higher scores reflecting
greater body esteem. Self-esteem was assessed using
Rosenberg’s Self-Esteem Scale (Rosenberg, 1965);
mean scores, ranging from 1 to 4, were calculated for
this 10-item measure, with lower scores reflecting
higher self-esteem. Perceived stress was assessed
using Cohen and colleagues’ Perceived Stress Scale
(Cohen, Kamarck, & Mermelstein, 1983). Scores on
this 14-item measure were summed (each response
86 V. Messier et al.
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ranges from 0 to 4) for a total score ranging from 0 to
56; higher scores indicate greater stress. Dietary
restraint, disinhibition, and hunger were assessed
using Stunkard and Messick’s (1985) Three-Factor
Eating Questionnaire. Dietary restraint reflects con-
scious mechanisms for restraining food intake (21
items, scores range from 0 to 21), disinhibition
reflects overeating in response to emotional and
situational cues (16 items, scores range from 0 to
16), and hunger reflects susceptibility to hunger (11
items, scores range from 0 to 14). Higher scores
indicate greater dietary restraint, disinhibition, and
hunger. Quality of life was measured using the
Medical Outcomes Study General Health Survey
(20 items), with scores being transformed to a scale
of 0–100% (McDowell & Newell, 1996; Stewart
et al., 1989); higher scores indicate greater quality of
life. Mean scores were calculated for the total score
and each subscale: physical functioning (6 items),
mental health (5 items), health perceptions (5 items),
role functioning (2 items), social functioning (1
item), and pain (1 item). Self-efficacy was assessed
using a measure developed for this study according
to social cognitive theory (Baranowski, Perry, &
Parcel, 2003): it measures confidence in being able
to control one’s weight (6 items). Perceived benefits
assess the benefits of controlling one’s weight (4
items) and perceived risks of developing heart disease
(1 item) and diabetes (1 item), according to the
Health Belief Model (Janz, Champion, & Strecher,
2003). Mean scores (ranging from 1 to 4) were
calculated, with higher scores indicating greater self-
efficacy, benefits, and perceived risk. The Cronbach
alpha coefficient (Ghiselli, Campbell, & Zedeck,
1981), a measure of internal consistency reliability,
was calculated for each measure with more than one
item and varied between 0.62 and 0.91.
Statistical analyses
The statistical analyses were conducted using the
SPSS program. The data are expressed as means+standard deviations (s). A repeated-measures analysis
of variance (ANOVA) was performed to observe
changes in the psychosocial profile following the
intervention within each group and between groups
(time6 group interaction); the Bonferroni correc-
tion was applied. Moreover, Pearson’s correlations
were calculated to determine the relationship be-
tween changes in psychosocial variables, weight,
muscle strength, and _V O2peak. In addition, the
participants were divided into quintiles based on
percent weight loss and the changes in psychosocial
factors were detected using a one-way ANOVA.
When significant differences were found, a Tukey
post hoc test was performed to identify group
differences. Finally, a stepwise regression analysis
was performed to determine the predictors of
changes in psychosocial factors. Based on correlation
analyses, the independent variables considered in the
final model for changes in psychosocial factors were
weight change, fat mass change, change in _V O2peak,
and lower-body muscle strength. Statistical signifi-
cance was set at P5 0.05.
Results
During the study, 30 of the 137 participants dropped
out of the weight loss programme, yielding an overall
dropout rate of 22% (Figure 1). There we no
significant differences in dropout rates between study
groups. Reasons for dropout included: health pro-
blems not related to training (n¼ 5), minor injury
related to resistance training (n¼ 3), refusal to
undertake 6-month post-testing (n¼ 3), conflicting
time schedules (n¼ 4), personal/family problems
(n¼ 2), weight loss too slow (n¼ 3), travel distance
to the research unit (n¼ 3), and other unspecified
reasons (n¼ 7) (Brochu et al., 2009). The baseline
physical and psychosocial characteristics of dropouts
were not different from those of participants who
completed the study. Thus, 107 women (71 in the
caloric restriction group and 36 in the caloric
restrictionþ resistance training group) completed
pre- and 6-month post-testing procedures and were
included in the analyses reported here.
Pre- and post-intervention values for anthropo-
metric and metabolic characteristics of the partici-
pants in the two study groups are shown in Table I.
Both groups experienced significant changes in body
weight, body mass index, and _V O2peak. Mean
percent body weight loss was similar in the two
groups (76.0+ 5.0% in the caloric restriction group
and77.1+ 5.4% in the caloric restrictionþ resis-
tance training group; P¼N.S.). However, at the end
of the 6-month intervention, only the caloric
restrictionþ resistance training group significantly
increased lower-body muscle strength (27.6+23.6%, P5 0.05).
Pre- and post-intervention values for psychosocial
factors are presented in Table II. In both groups,
scores improved for total body esteem, body esteem
subscales for appearance and weight, self-esteem,
dietary restraint, disinhibition, hunger, quality of life
subscale for health perceptions, and self-efficacy
(P5 0.05). No differences in psychosocial profile
were observed between the two groups.
Since there were no additional effects of resistance
training on weight or on psychosocial factors,
participants in both groups were pooled for correla-
tion analyses. Percent weight loss was significantly
associated with increases in scores for the body
esteem weight subscale (r¼70.33, P¼ 0.006)
and health perceptions (r¼70.39, P¼ 0.001). In
Resistance training and psychosocial profile 87
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addition, there was a significant relationship between
percent weight loss and change in dietary restraint
(r¼70.49, P¼ 0.0001), as shown in Figure 2.
Moreover, Figure 3 shows the positive and signifi-
cant association between change in body weight and
change in self-efficacy (r¼70.49, P¼ 0.0001).
Furthermore, weight loss was associated with de-
creases in disinhibition (r¼ 0.36, P¼ 0.003), stress
(r¼ 0.31, P¼ 0.010), and hunger (r¼ 0.26,
P¼ 0.039). No significant correlations between
changes in psychosocial factors and changes in
muscle strength or _V O2peak were observed, except
that increased strength was associated with increased
self-esteem (r¼70.586, P¼ 0.028).
Changes in psychosocial profile from pre- to post-
intervention were also examined according to the
amount of weight loss (Table III) categorized into
quintiles as follows (mean+ s): first,þ 0.9+ 2.2%
(range:þ 5.3 to 72.3%); second, 73.7+ 0.8%
(72.4 to 74.8%); third, 76.6+ 1.4% (74.9 to
78.3%); fourth, 79.2+ 0.8% (78.4 to711.0%);
and fifth, 713.5+ 2.2% (711.1 to 718.1%). By
Table I. Physical and metabolic characteristics of overweight and obese post-menopausal women before and after the intervention
(mean+ s).
CR only (n¼71) CRþRT (n¼ 36)
Variables Before After Before After
Age (years) 58.0+ 4.7 – 57.2+5.0 –
Body weight (kg) 83.6+ 14.4 78.4+13.5a 84.1+15.0 78.3+ 16.1a
BMI (kg � m72) 32.2+ 4.6 30.2+4.4a 32.6+4.9 30.4+ 5.3a
Fat-free mass (kg) 45.4+ 7.2 44.4+6.1a 44.6+6.0 44.1+ 5.4a
Fat mass (kg) 37.6+ 8.6 33.7+9.0a 39.5+10.5 34.2+ 11.9a
VO2 peak (L/min) 1.5+ 0.3 1.4+0.3a 1.5+0.3 1.4+ 0.3a
Muscle strength (kg) 147.4+ 39.4 143.8+36.8 155.9+38.8 197.0+ 54.4a,b
Physical activity level 1.9+ 0.3 1.9+0.3 1.9+0.3 2.0+ 0.3
CR¼ caloric restriction; CRþRT¼ caloric restrictionþ resistance training; BMI¼ body mass index.aSignificantly different from pre-intervention values (P5 0.05).bSignificantly different from caloric restriction only group (P5 0.05).
Table II. Psychosocial profile of overweight and obese post-menopausal women before and after the intervention (mean+ s).
CR only (n¼71) CRþRT (n¼36)
Psychosocial variables* Before After Before After
Total body esteem (0–4) 1.4+ 0.5 1.7+ 0.6a 1.5+0.4 1.8+0.5a
Body esteem subscales for:
Appearance 1.5+ 0.7 1.8+ 0.7a 1.5+0.5 1.9+0.6a
Attribution 1.8+ 0.5 2.0+ 0.6 2.0+0.5 2.0+0.5
Weight 1.1+ 0.5 1.5+ 0.7a 0.9+0.4 1.4+0.6a
Self-esteem (1–4) 1.6+ 0.4 1.5+ 0.4a 1.5+0.3 1.3+0.3a
Perceived stress (0–56) 18.1+ 8.6 17.0+ 7.5 18.0+6.8 17.2+8.6
Dietary restraint (0–21) 11.4+ 3.7 15.0+ 3.3a 9.3+3.4 14.2+4.8a
Disinhibition (0–16) 8.0+ 3.3 7.1+ 3.1a 8.7+3.6 6.8+3.3a
Hunger (0–14) 5.3+ 3.2 4.1+ 2.8a 5.4+3.0 3.9+3.1a
Total quality of life (0–100%) 81.7+ 11.4 82.5+ 11.9 78.1+12.8 81.5+11.8
Quality of life subscales for:
Physical functioning 86.0+ 21.4 86.3+ 22.1 82.6+21.7 87.8+16.1
Pain 64.3+ 28.4 65.8+ 26.9 56.3+28.8 54.2+32.7
Social functioning 98.8+ 4.9 96.7+ 15.1 92.5+17.5 96.7+7.6
Role functioning 90.3+ 21.5 88.8+ 23.4 91.3+19.4 93.5+18.8
Mental health 70.6+ 14.8 73.8+ 14.1 71.8+15.7 73.5+15.4
Health perceptions 82.0+ 16.3 85.9+ 12.6a 74.8+19.2 82.8+19.5a
Self-efficacy (1–4) 2.7+ 0.6 2.9+ 0.6a 2.7+0.5 2.9+0.5a
Perceived benefits (1–4) 3.6+ 0.5 3.6+ 0.5 3.7+0.3 3.7+0.3
Perceived risks for heart disease (1–4) 2.8+ 0.9 2.6+ 0.8 2.7+1.0 2.5+1.0
Perceived risks for diabetes (1–4) 2.6+ 0.9 2.3+ 1.0 2.7+1.0 2.6+1.0
CR¼ caloric restriction; CRþRT¼ caloric restrictionþ resistance training.
*Higher scores indicate higher body esteem, lower self-esteem, greater stress, greater dietary restraint, greater disinhibition, greater hunger,
greater quality of life, greater self-efficacy, greater perceived benefits, and greater perceived risk.aSignificantly different from pre-intervention values (P5 0.05).
88 V. Messier et al.
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design, weight change was significantly different
among quintiles (P5 0.05). Changes in body es-
teem, self-esteem, hunger, and perceived risk for
diabetes were observed in all quintiles (P5 0.05).
However, significant increases in scores for dietary
restraint were observed only in quintiles 2–5 (body
weight loss� 2.4%) (P5 0.05). In addition, signifi-
cantly higher self-efficacy scores and lower disinhibi-
tion scores were observed only in quintiles 3, 4, and
5 (body weight loss� 4.9%) (P5 0.05). Further-
more, significant improvements in quality of life
subscale scores for health perceptions were observed
only in quintile 5 (body weight loss� 11.1%)
(P5 0.05).
Finally, we performed a stepwise regression analy-
sis to examine the independent predictors (changes in
weight, in fat mass, in _V O2peak, and in lower-body
muscle strength) of changes in psychosocial factors.
The caloric restriction and caloric restrictionþ
resistance training groups were pooled for the
regression analysis, since weight loss was similar in
the two groups. Table IV indicates the significant
predictors of changes in psychosocial factors. Results
show that the change in weight, by way of a caloric
restriction with or without resistance training, was an
independent predictor of changes in self-efficacy,
perceived stress, mental health, disinhibition, and
quality of life subscale for physical functioning. In
addition, the change in muscle strength was an
independent predictor of changes in self-esteem.
Discussion
The purpose of this study was to assess the effects of
the addition of a resistance training programme to a
caloric restriction weight loss intervention on psy-
chosocial factors among post-menopausal women.
Results show that both groups underwent a similar
body weight loss, while the caloric restrictionþ re-
sistance training group displayed a significant in-
crease of muscle strength in the lower body
compared with the caloric restriction group. More-
over, improvements in both study groups (caloric
restriction and caloric restrictionþ resistance train-
ing) were observed for body esteem, self-esteem,
dietary restraint, health perceptions, self-efficacy,
and decreases in disinhibition and hunger. Similar
findings have been reported elsewhere (Fontaine
et al., 1999; Foster et al., 1998; Kaukua et al., 2003;
Lemoine et al., 2007; Teixeira et al., 2006). Thus,
our findings show that within the context of similar
weight loss, both groups improved their psychosocial
profile, but no significant additional improvements
were observed with the addition of a resistance
training programme to a caloric restriction interven-
tion. Despite our findings of increased muscle
strength in the resistance training group, there were
no improvements in the quality of life subscale for
physical functioning, as might be expected with
greater muscle strength (Ghiselli et al., 1981).
Levinger (2007) observed that 10 weeks of resistance
training without caloric restriction increased per-
ceived physical and mental health, physical function,
general health, and social function. It is possible that
in our group of overweight and obese post-meno-
pausal women without other chronic diseases, the
benefits of resistance training on psychosocial factors
may have been overshadowed by those induced by
caloric restriction alone.
When pooling participants from both study
groups, percent body weight loss was significantly
correlated with increases in body esteem, self-
esteem, dietary restraint, health perceptions, self-
efficacy, and decreases in disinhibition, hunger, and
stress. This was as anticipated, since both groups in
our study benefited from the caloric restriction
Figure 2. Relationship between change in dietary restraint and
change in body weight.
Figure 3. Relationship between change in self-efficacy and change
in body weight.
Resistance training and psychosocial profile 89
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Tab
leII
I.P
sych
oso
cial
fact
ors
of
ove
rwei
gh
tan
do
bes
ep
ost
-men
op
ausa
lw
om
end
ivid
edin
qu
inti
les
bas
edon
per
cen
tb
od
yw
eigh
tlo
ss(m
ean+
s).
Quin
tile
1
wei
gh
tch
ange:
þ5
.3to
72
.3%
(n¼
17
)
Quin
tile
2
wei
gh
tch
ange:
72
.4to
74
.8%
(n¼
13
)
Quin
tile
3
wei
gh
tch
ange:
74
.9to
78
.3%
(n¼
15
)
Quin
tile
4
wei
gh
tch
ange:
78.4
to7
11
.0%
(n¼
14
)
Quin
tile
5
wei
gh
tch
ange:
711
.1to
71
8.1
%
(n¼
15
)
Var
iab
les
Bef
ore
Aft
erB
efo
reA
fter
Bef
ore
Aft
erB
efo
reA
fter
Bef
ore
Aft
er
To
tal
bo
dy
este
em1
.5+
0.5
1.6+
0.6
a1
.1+
0.3
1.3
+0
.5a
1.5+
0.6
1.9+
0.6
a1
.5+
0.5
2.0+
0.6
a1
.4+
0.3
1.8
+0
.4a
Bo
dy
este
emsu
bsc
ales
for:
Ap
pea
ran
ce1
.7+
0.6
1.7+
0.8
1.4+
0.5
1.7
+0
.7a
1.7+
0.8
2.0+
0.6
a1
.5+
0.6
2.1+
0.6
a1
.4+
0.4
1.7
+0
.5a
Att
rib
uti
on
1.9+
0.5
2.1+
0.4
a1
.6+
0.5
1.8
+0
.4a
1.9+
0.6
2.1+
0.6
a1
.9+
0.6
2.1+
0.7
a1
.8+
0.7
1.7
+0
.6a
Wei
gh
t1
.1+
0.6
1.2+
0.6
0.9+
0.5
1.2
+0
.6a
1.1+
0.5
1.7+
0.7
a1
.0+
0.6
1.8+
0.8
a0
.9+
0.3
1.5
+0
.6a
Sel
f-es
teem
1.7+
0.4
1.5+
0.5
a1
.6+
0.5
1.5
+0
.6a
1.5+
0.3
1.4+
0.2
a1
.6+
0.4
1.4+
0.3
a1
.3+
0.3
1.2
+0
.2a
Str
ess
15
.3+
8.9
17
.7+
9.6
19
.3+
8.9
17.5
+9
.71
8.5+
7.8
15
.7+
5.5
19
.5+
8.4
17
.5+
6.0
18
.6+
6.2
16.8
+8
.1
Die
tary
rest
rain
t1
2.1+
4.8
12
.5+
4.6
9.3+
1.8
13.6
+2
.1a
10
.8+
3.2
15
.6+
3.5
a1
0.8+
2.7
16
.6+
4.3
a9
.6+
4.1
15.6
+1
.9a
Dis
inh
ibit
ion
8.6+
3.2
8.5+
3.2
8.1+
3.4
8.2
+3
.28
.0+
3.9
6.5+
2.6
a7
.5+
3.1
4.8+
2.3
a9
.0+
3.8
6.9
+3
.2a
Hu
nger
5.3+
3.6
4.6+
3.2
a5
.5+
3.4
4.8
+3
.1a
5.2+
2.9
4.0+
2.5
a4
.7+
2.9
2.9+
2.3
a6
.0+
3.1
3.7
+3
.4a
To
tal
qu
alit
yo
flife
78
.5+
11
.17
8.5+
12
.38
3.5+
15
.98
2.2
+1
6.9
79
.1+
12
.88
1.7+
10
.27
9.8+
13
.18
5.6+
10
.08
1.8+
6.4
83.8
+8
.4
Qu
alit
yo
flife
sub
scal
esfo
r:
Ph
ysic
alfu
nct
ion
ing
73
.0+
30
.48
0.4+
26
.38
9.1+
15
.78
5.9
+2
3.4
81
.4+
23
.18
7.8+
20
.09
1.0+
14
.68
9.7+
14
.99
2.2+
9.2
91.7
+1
2.2
Pai
n5
8.8+
26
.45
7.4+
30
.36
3.5+
36
.35
9.6
+3
7.6
63
.3+
31
.26
5.0+
24
.65
7.7+
31
.37
3.1+
25
.96
5.0+
20
.75
6.7
+2
7.5
So
cial
fun
ctio
nin
g9
8.8+
5.0
97
.5+
6.8
98
.5+
5.5
95.4
+8
.89
8.7+
5.2
98
.7+
5.2
90
.8+
22
.59
2.3+
27
.79
6.0+
8.3
98.7
+5
.2
Ro
lefu
nct
ion
ing
85
.3+
28
.08
3.8+
27
.99
6.2+
13
.91
00.0
+0
.08
5.0+
22
.88
5.0+
26
.49
2.3+
21
.49
4.2+
20
.89
6.4+
9.1
91.1
+1
8.6
Men
tal
hea
lth
74
.4+
17
.67
0.6+
16
.17
3.5+
19
.47
3.2
+1
9.2
70
.4+
11
.67
6.0+
11
.26
8.0+
13
.87
4.8+
11
.26
8.0+
11
.77
2.9
+1
4.2
Hea
lth
per
cep
tio
ns
84
.1+
11
.88
2.9+
12
.58
0.4+
25
.07
8.8
+2
5.8
80
.7+
17
.88
5.3+
11
.47
9.2+
18
.18
9.2+
11
.57
3.2+
14
.58
8.6
+9
.7a
Sel
f-ef
fica
cy2
.7+
0.5
2.4+
0.5
a2
.6+
0.7
2.7
+0
.72
.7+
0.5
3.0+
0.4
a2
.8+
0.5
3.2+
0.4
a2
.5+
0.6
3.0
+0
.5a
Per
ceiv
edb
enefi
ts3
.5+
0.6
3.6+
0.6
3.6+
0.3
3.5
+0
.43
.7+
0.3
3.6+
0.4
3.8+
0.4
3.8+
0.4
3.6+
0.5
3.8
+0
.3
Per
ceiv
edri
skfo
rh
eart
dis
ease
2.4+
1.1
2.3+
0.9
3.1+
0.9
2.8
+0
.92
.9+
0.6
2.7+
0.7
2.6+
1.0
2.2+
0.8
2.9+
0.9
2.7
+1
.0
Per
ceiv
edri
skfo
rd
iab
etes
2.2
4+
1.1
52
.18+
1.0
7a
3.0
8+
0.7
92
.67+
0.9
8a
2.7
3+
0.7
02
.40+
0.9
1a
2.6
2+
1.0
42
.31+
0.8
5a
2.7
3+
0.8
82
.60+
1.1
2a
aS
ign
ifica
ntl
yd
iffe
ren
tfr
om
pre
-in
terv
enti
on
valu
es(P
50
.05
).
90 V. Messier et al.
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intervention, which included diet prescription to-
gether with group sessions that addressed cognitive
and behavioural strategies for weight loss.
Changes in psychosocial profile, following our
weight loss intervention, varied as a function of the
amount of weight loss. When body weight loss
approximated 3%, we observed an increase in dietary
restraint and body esteem regarding appearance and
weight; a loss over 5% was associated with significant
improvements in disinhibition and self-efficacy; and
a loss over 11% improved perceptions about the
women’s health. Kaukua et al. (2003) reported that a
body weight loss over 10% was associated with
improved perceptions of general health. If indeed
changes in psychosocial profile after weight loss
interventions are a function of the magnitude of
weight loss, as we have shown in our study, this
could explain inconsistencies between studies re-
garding which psychosocial factors are associated
with weight loss (Lemoine et al., 2007; Niemeier
et al., 2007). Furthermore, the absence of significant
differences in psychosocial factors between the two
groups in the present study could be due to the fact
that the caloric restrictionþ resistance training group
did not present a greater weight loss than the caloric
restriction group. Overall, our results suggest that the
dominant psychosocial changes associated with
greater weight loss include changes in disinhibition,
dietary restraint, and self-efficacy. As such, we
suggest that weight loss interventions targeting
post-menopausal women should address issues
related to controlling the amount of food eaten in
response to emotional and situational cues.
Stepwise regression analysis showed that weight
change accounted for the greatest source of unique
variance for several of the psychosocial factors in our
cohort. For example, weight loss change explained
35.7% of the unique variance of perceived stress.
Furthermore, one could also ask whether changes in
the psychosocial profile after weight loss could be
explained by factors other than weight loss itself,
including exercise-related changes in _V O2peak, fat
mass, and lower-body muscle strength. Based on our
regression analysis, we can conclude that muscle
strength was an independent predictor of changes in
self-esteem, explaining 34.3% of the variance.
It should be noted that our findings are limited to a
population of otherwise apparently ‘‘healthy’’, non-
diabetic, overweight and obese post-menopausal
women who volunteered to participate in a weight
loss intervention protocol. Moreover, we did not
assess adherence to the diet or monitor appetite.
However, our results are strengthened by examining
a relatively large sample size of well-characterized
overweight and obese post-menopausal women.
In conclusion, in a cohort of overweight and obese
post-menopausal women, following a weight loss
intervention by caloric restriction with or without
resistance training, we observed significant improve-
ments in psychosocial profile (increases in body
esteem, self-esteem, dietary restraint, health percep-
tions, and decreases in hunger and disinhibition) that
varied according to the amount of weight loss. No
differences in psychosocial factors were observed
with the addition of a resistance training programme
to a caloric restriction weight loss intervention.
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