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Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males

Year 2024, Volume: 9 Issue: 2, 244 - 258, 30.06.2024
https://doi.org/10.25307/jssr.1477466

Abstract

The purpose of this study was to examine the effects of 12 weeks of resistance exercise training on body weight (BW), body mass index (BMI), total fat mass (FM), trunk, arm, and leg fat mass, and total lean body mass (LBM), arm, and leg lean mass of sedentary overweight healthy males. Twenty-nine sedentary overweight healthy males, aged 18-30 years, with a BMI ≥ 25, were enrolled in the study. The subjects were randomly assigned to either a resistance exercise group (REG, n=15) or an aerobic exercise group (AEG, n=14). Randomized subjects followed resistance (3 sessions/wk 60 min 2 sets × 12 repetitions of 5–7 exercises at 65% 1 repetition maximum in 1-4 weeks, 3 sets × 10 repetitions of 5–7 exercises at 75% 1 repetition maximum in 5-8 weeks, and 4 sets × 8 repetitions of 5–7 exercises at 85% 1 repetition maximum in 9-12 weeks,) and aerobic exercise programs (3 sessions/wk 60 min aerobic exercises at 40-50% heart rate reserve in 1-6 weeks and 70%–75% maximal heart rate in 5-8 weeks). At baseline and after the intervention session, total and regional body composition measurements were assessed using the Jawon make body composition analyzer (model IOI-353 Yuseong, South Korea). After the intervention study, there were significant differences observed between the groups regarding the investigated variables (BW, BMI, LBM, trunk, arm, leg lean mass, and arm fat mass p< .05). Both REG and AEG were significantly decreased the amount of total FM, BF, trunk fat mass, arm fat mass, and leg fat mass (p< .05). Trunk and arm lean mass were significantly improved only in the REG (p< .05). In conclusion, resistance exercise training is an efficient training protocol, which produced a better improvement in regional lean mass.

Ethical Statement

Ethical Approval Board Name: Uşak University Non-Interventional Clinical Research Ethics Committee Date: 21.09.2023 Decision number: 171-171-04

References

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  • Alexander, L., Christensen, S.M., Richardson, L., Ingersoll, A.B., Burridge, K., Golden, A., ... & Bays, H.E. (2022). Nutrition and physical activity: An obesity medicine association (OMA) clinical practice statement 2022. Obesity Pillars, 1, Article 100005. https://doi.org/10.1016/j.obpill.2021.100005
  • Akbarpour Beni, M., & Alishirazi, M. (2021). The effects of TRX and traditional resistance training on some of cardiovascular risk factors in sedentary women. Journal of Vessels and Circulation, 2(2), 85-92. http://dx.doi.org/10.32598/JVC.2.2.91.1.2
  • Aneis, Y.M., El Refaye, G.E., Taha, M. M., Aldhahi, M.I., & Elsisi, H.F. (2023). Concurrent aerobic and strength training with caloric restriction reduces ınsulin resistance in obese premenopausal women: A randomized controlled trial. Medicana, 59(7), Article 1193. https://doi.org/10.3390/medicina59071193
  • Benito, P.J., Cupeiro, R., Ramos-Campo, D.J., Alcaraz, P. E., & Rubio-Arias, J.A. (2020). A systematic review with meta-analysis of the effect of resistance training on whole-body muscle growth in healthy adult males. International Journal of Environmental Research and Public Health, 17(4), Article 1285. https://doi.org/10.3390/ijerph17041285
  • Brzycki, M. (1998). A Practical approach to strength training. Master Press.
  • Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., Buman, M.P., Cardon, G., ... & Willumsen, J.F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955
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  • Chin, S.H., Kahathuduwa, C.N., & Binks, M. (2016). Physical activity and obesity: What we know and what we need to know. Obesity Reviews, 17(12), 1226-1244. https://doi.org/10.1111/obr.12460
  • Davis, M.E., Blake, C., Perrotta, C., Cunningham, C., & O’Donoghue, G. (2022). Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta‐analysis. Obesity, 30(2), 300-319. https://doi.org/10.1002/oby.23305
  • Donges, C.E., & Duffield, R. (2012). Effects of resistance or aerobic exercise training on total and regional body composition in sedentary overweight middle-aged adults. Applied Physiology, Nutrition, and Metabolism, 37(3), 499-509. https://doi.org/10.1139/h2012-006
  • Donnelly, J.E., Greene, J.L., Gibson, C.A., Smith, B.K., Washburn, R.A., Sullivan, D.K., ... & Williams, S.L. (2009). Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine, 49(4), 336-341. https://doi.org/10.1016/j.ypmed.2009.07.022
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  • Khalafi, M., Malandish, A., Rosenkranz, S.K., & Ravasi, A.A. (2021). Effect of resistance training with and without caloric restriction on visceral fat: A systemic review and meta‐analysis. Obesity Reviews, 22(9), Article e13275. https://doi.org/10.1111/obr.13275
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  • Lopez, P., Taaffe, D. R., Galvão, D. A., Newton, R.U., Nonemacher, E.R., Wendt, V.M., ... & Rech, A. (2022). Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta‐analysis. Obesity Reviews, 23(5), Article e13428. https://doi.org/10.1111/obr.13428
  • Miller, T., Mull, S., Aragon, A.A., Krieger, J., & Schoenfeld, B.J. (2018). Resistance training combined with diet decreases body fat while preserving lean mass independent of resting metabolic rate: A randomized trial. International Journal of Sport Nutrition and Exercise Metabolism, 28(1), 46-54. https://doi.org/10.1123/ijsnem.2017-0221
  • Mohammadi, H.R., Khoshnam, M.S., & Khoshnam, E. (2018). Effects of different modes of exercise training on body composition and risk factors for cardiovascular disease in middle-aged men. International Journal of Preventive Medicine, 9(9), 1-7. https://doi.org/10.4103/ijpvm.IJPVM_209_16
  • Nana, A., Slater, G. J., Stewart, A. D., & Burke, L. M. (2015). Methodology review: Using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. International Journal of Sport Nutrition and Exercise Metabolism, 25(2), 198-215. https://doi.org/10.1123/ijsnem.2013-0228
  • Oh, M., Kim, S., An, K.Y., Min, J., Yang, H.I., Lee, J., ... & Jeon, J.Y. (2018). Effects of alternate day calorie restriction and exercise on cardio-metabolic risk factors in overweight and obese adults: an exploratory randomized controlled study. BMC Public Health, 18(1), 1-10. https://doi.org/10.1186/s12889-018-6009-1
  • Oppert, J. ., Ciangura, C., & Bellicha, A. (2023). Physical activity and exercise for weight loss and maintenance in people living with obesity. Reviews in Endocrine and Metabolic Disorders, 24(5), 937-949. https://doi.org/10.1007/s11154-023-09805-5
  • Orange, S.T., Marshall, P., Madden, L.A., & Vince, R.V. (2020). Effect of home‐based resistance training performed with or without a high‐speed component in adults with severe obesity. Translational Sports Medicine, 3(1), 34-45. https://doi.org/10.1002/tsm2.115
  • Phelps, N.H., Singleton, R.K., Zhou, B., Heap, R.A., Mishra, A., Bennett, J. E., ... & Barbagallo, C.M. (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet, 403(16), 1027-1050. https://doi.org/10.1016/ S0140-6736(23)02750-2
  • Pieczynska, A., Zasadzka, E., Trzmiel, T., Pyda, M., & Pawlaczyk, M. (2021). The effect of a mixed circuit of aerobic and resistance training on body composition in older adults -retrospective study. International Journal of Environmental Research and Public Health, 18(11), 5608-5619. https://doi.org/10.3390/ijerph18115608
  • Rejeki, P.S., Pranoto, A., Rahmanto, I., Izzatunnisa, N., Yosika, G.F., Hernaningsih, Y., ... & Halim, S. (2023). The positive effect of four-week combined aerobic–resistance training on body composition and adipokine levels in obese females. Sports, 11(4), Article 90. https://doi.org/10.3390/sports11040090
  • Ribeiro, A.S., Quintilhano, K., Kassiano, W., Nunes, J. P., Avelar, A., Trindade, M.C., ... & Cyrino, E.S. (2023). The effects of carbohydrate intake on body composition and muscular strength in trained men undergoing a progressive resistance training. International Journal of Exercise Science, 16(2), 267-280.
  • Rodriguez‐Lopez, C., Alcazar, J., Sanchez‐Martin, C., Baltasar‐Fernandez, I., Ara, I., Csapo, R., & Alegre, L.M. (2022). Neuromuscular adaptations after 12 weeks of light‐vs. heavy‐load power‐oriented resistance training in older adults. Scandinavian Journal of Medicine & Science in Sports, 32(2), 324-337. https://doi.org/10.1111/sms.14073
  • Roh, H.T., Cho, S.Y., & So, W.Y. (2020). A cross-sectional study evaluating the effects of resistance exercise on inflammation and neurotrophic factors in elderly women with obesity. Journal of Clinical Medicine, 9(3), 842-852. https://doi.org/10.3390/jcm9030842
  • Saremi, A., Asghari, M., & Ghorbani, A. (2010). Effects of aerobic training on serum omentin-1 and cardiometabolic risk factors in overweight and obese men. Journal of Sports Sciences, 28(9), 993-998. https://doi.org/10.1080/02640414.2010.484070
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Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males

Year 2024, Volume: 9 Issue: 2, 244 - 258, 30.06.2024
https://doi.org/10.25307/jssr.1477466

Abstract

The purpose of this study was to examine the effects of 12 weeks of resistance exercise training on body weight (BW), body mass index (BMI), total fat mass (FM), trunk, arm, and leg fat mass, and total lean body mass (LBM), arm, and leg lean mass of sedentary overweight healthy males. Twenty-nine sedentary overweight healthy males, aged 18-30 years, with a BMI ≥ 25, were enrolled in the study. The subjects were randomly assigned to either a resistance exercise group (REG, n=15) or an aerobic exercise group (AEG, n=14). Randomized subjects followed resistance (3 sessions/wk 60 min 2 sets × 12 repetitions of 5–7 exercises at 65% 1 repetition maximum in 1-4 weeks, 3 sets × 10 repetitions of 5–7 exercises at 75% 1 repetition maximum in 5-8 weeks, and 4 sets × 8 repetitions of 5–7 exercises at 85% 1 repetition maximum in 9-12 weeks,) and aerobic exercise programs (3 sessions/wk 60 min aerobic exercises at 40-50% heart rate reserve in 1-6 weeks and 70%–75% maximal heart rate in 5-8 weeks). At baseline and after the intervention session, total and regional body composition measurements were assessed using the Jawon make body composition analyzer (model IOI-353 Yuseong, South Korea). After the intervention study, there were significant differences observed between the groups regarding the investigated variables (BW, BMI, LBM, trunk, arm, leg lean mass, and arm fat mass p< .05). Both REG and AEG were significantly decreased the amount of total FM, BF, trunk fat mass, arm fat mass, and leg fat mass (p< .05). Trunk and arm lean mass were significantly improved only in the REG (p< .05). In conclusion, resistance exercise training is an efficient training protocol, which produced a better improvement in regional lean mass.

References

  • Adıgüzel, N.S., & Canlı, U. (2019). Examination the effects of aerobic and resistance exercise on body compositions of sedentary male individuals. Journal of Education and Training Studies, 7(3S), 30-36. https://doi.org/10.11114/jets.v7i3S.4007
  • Alexander, L., Christensen, S.M., Richardson, L., Ingersoll, A.B., Burridge, K., Golden, A., ... & Bays, H.E. (2022). Nutrition and physical activity: An obesity medicine association (OMA) clinical practice statement 2022. Obesity Pillars, 1, Article 100005. https://doi.org/10.1016/j.obpill.2021.100005
  • Akbarpour Beni, M., & Alishirazi, M. (2021). The effects of TRX and traditional resistance training on some of cardiovascular risk factors in sedentary women. Journal of Vessels and Circulation, 2(2), 85-92. http://dx.doi.org/10.32598/JVC.2.2.91.1.2
  • Aneis, Y.M., El Refaye, G.E., Taha, M. M., Aldhahi, M.I., & Elsisi, H.F. (2023). Concurrent aerobic and strength training with caloric restriction reduces ınsulin resistance in obese premenopausal women: A randomized controlled trial. Medicana, 59(7), Article 1193. https://doi.org/10.3390/medicina59071193
  • Benito, P.J., Cupeiro, R., Ramos-Campo, D.J., Alcaraz, P. E., & Rubio-Arias, J.A. (2020). A systematic review with meta-analysis of the effect of resistance training on whole-body muscle growth in healthy adult males. International Journal of Environmental Research and Public Health, 17(4), Article 1285. https://doi.org/10.3390/ijerph17041285
  • Brzycki, M. (1998). A Practical approach to strength training. Master Press.
  • Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., Buman, M.P., Cardon, G., ... & Willumsen, J.F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955
  • Chih-Hui Chiu, C.H., Ko, M.C., Wu, L.S., Yeh, D.P., Kan, N.W., Lee, P.F., ... & Ho, C.C. (2017). Benefits of different intensity of aerobic exercise in modulating body composition among obese young adults: A pilot randomized controlled trial. Health and Quality of Life Outcomes, 15(8), 1-9. https://doi.org/10.1186/s12955-017-0743-4
  • Chin, S.H., Kahathuduwa, C.N., & Binks, M. (2016). Physical activity and obesity: What we know and what we need to know. Obesity Reviews, 17(12), 1226-1244. https://doi.org/10.1111/obr.12460
  • Davis, M.E., Blake, C., Perrotta, C., Cunningham, C., & O’Donoghue, G. (2022). Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta‐analysis. Obesity, 30(2), 300-319. https://doi.org/10.1002/oby.23305
  • Donges, C.E., & Duffield, R. (2012). Effects of resistance or aerobic exercise training on total and regional body composition in sedentary overweight middle-aged adults. Applied Physiology, Nutrition, and Metabolism, 37(3), 499-509. https://doi.org/10.1139/h2012-006
  • Donnelly, J.E., Greene, J.L., Gibson, C.A., Smith, B.K., Washburn, R.A., Sullivan, D.K., ... & Williams, S.L. (2009). Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine, 49(4), 336-341. https://doi.org/10.1016/j.ypmed.2009.07.022
  • Gert-Jan van der Heijden, G.J., Wang, Z.J., Chu, Z.D., Sauer, P.J., Haymond, M.W., Rodriguez, L.M., & Sunehag, A.L. (2010). A 12‐week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity, 18(2), 384-390. https://doi.org/10.1038/oby.2009.274
  • Guelfi, K.J., Donges, C.E., & Duffield, R. (2013). Beneficial effects of 12 weeks of aerobic compared with resistance exercise training on perceived appetite in previously sedentary overweight and obese men. Metabolism, 62(2), 235-243. https://doi.org/10.1016/j.metabol.2012.08.002
  • Khalafi, M., Malandish, A., Rosenkranz, S.K., & Ravasi, A.A. (2021). Effect of resistance training with and without caloric restriction on visceral fat: A systemic review and meta‐analysis. Obesity Reviews, 22(9), Article e13275. https://doi.org/10.1111/obr.13275
  • Lam, B.C.C., Lim, A.Y.L., Chan, S.L., Yum, M.P.S., Koh, N.S.Y., & Finkelstein, E.A. (2023). The impact of obesity: A narrative review. Singapore Medical Journal, 64(3), 163-171. https://doi.org/10.4103/singaporemedj.SMJ-2022-232
  • Lee, S., Bacha, F., Hannon, T., Kuk, J.L., Boesch, C., & Arslanian, S. (2012). Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: A randomized, controlled trial. Diabetes, 61(11), 2787-2795. https://doi.org/10.2337/db12-0214
  • Lopez, P., Taaffe, D. R., Galvão, D. A., Newton, R.U., Nonemacher, E.R., Wendt, V.M., ... & Rech, A. (2022). Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta‐analysis. Obesity Reviews, 23(5), Article e13428. https://doi.org/10.1111/obr.13428
  • Miller, T., Mull, S., Aragon, A.A., Krieger, J., & Schoenfeld, B.J. (2018). Resistance training combined with diet decreases body fat while preserving lean mass independent of resting metabolic rate: A randomized trial. International Journal of Sport Nutrition and Exercise Metabolism, 28(1), 46-54. https://doi.org/10.1123/ijsnem.2017-0221
  • Mohammadi, H.R., Khoshnam, M.S., & Khoshnam, E. (2018). Effects of different modes of exercise training on body composition and risk factors for cardiovascular disease in middle-aged men. International Journal of Preventive Medicine, 9(9), 1-7. https://doi.org/10.4103/ijpvm.IJPVM_209_16
  • Nana, A., Slater, G. J., Stewart, A. D., & Burke, L. M. (2015). Methodology review: Using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. International Journal of Sport Nutrition and Exercise Metabolism, 25(2), 198-215. https://doi.org/10.1123/ijsnem.2013-0228
  • Oh, M., Kim, S., An, K.Y., Min, J., Yang, H.I., Lee, J., ... & Jeon, J.Y. (2018). Effects of alternate day calorie restriction and exercise on cardio-metabolic risk factors in overweight and obese adults: an exploratory randomized controlled study. BMC Public Health, 18(1), 1-10. https://doi.org/10.1186/s12889-018-6009-1
  • Oppert, J. ., Ciangura, C., & Bellicha, A. (2023). Physical activity and exercise for weight loss and maintenance in people living with obesity. Reviews in Endocrine and Metabolic Disorders, 24(5), 937-949. https://doi.org/10.1007/s11154-023-09805-5
  • Orange, S.T., Marshall, P., Madden, L.A., & Vince, R.V. (2020). Effect of home‐based resistance training performed with or without a high‐speed component in adults with severe obesity. Translational Sports Medicine, 3(1), 34-45. https://doi.org/10.1002/tsm2.115
  • Phelps, N.H., Singleton, R.K., Zhou, B., Heap, R.A., Mishra, A., Bennett, J. E., ... & Barbagallo, C.M. (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet, 403(16), 1027-1050. https://doi.org/10.1016/ S0140-6736(23)02750-2
  • Pieczynska, A., Zasadzka, E., Trzmiel, T., Pyda, M., & Pawlaczyk, M. (2021). The effect of a mixed circuit of aerobic and resistance training on body composition in older adults -retrospective study. International Journal of Environmental Research and Public Health, 18(11), 5608-5619. https://doi.org/10.3390/ijerph18115608
  • Rejeki, P.S., Pranoto, A., Rahmanto, I., Izzatunnisa, N., Yosika, G.F., Hernaningsih, Y., ... & Halim, S. (2023). The positive effect of four-week combined aerobic–resistance training on body composition and adipokine levels in obese females. Sports, 11(4), Article 90. https://doi.org/10.3390/sports11040090
  • Ribeiro, A.S., Quintilhano, K., Kassiano, W., Nunes, J. P., Avelar, A., Trindade, M.C., ... & Cyrino, E.S. (2023). The effects of carbohydrate intake on body composition and muscular strength in trained men undergoing a progressive resistance training. International Journal of Exercise Science, 16(2), 267-280.
  • Rodriguez‐Lopez, C., Alcazar, J., Sanchez‐Martin, C., Baltasar‐Fernandez, I., Ara, I., Csapo, R., & Alegre, L.M. (2022). Neuromuscular adaptations after 12 weeks of light‐vs. heavy‐load power‐oriented resistance training in older adults. Scandinavian Journal of Medicine & Science in Sports, 32(2), 324-337. https://doi.org/10.1111/sms.14073
  • Roh, H.T., Cho, S.Y., & So, W.Y. (2020). A cross-sectional study evaluating the effects of resistance exercise on inflammation and neurotrophic factors in elderly women with obesity. Journal of Clinical Medicine, 9(3), 842-852. https://doi.org/10.3390/jcm9030842
  • Saremi, A., Asghari, M., & Ghorbani, A. (2010). Effects of aerobic training on serum omentin-1 and cardiometabolic risk factors in overweight and obese men. Journal of Sports Sciences, 28(9), 993-998. https://doi.org/10.1080/02640414.2010.484070
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There are 45 citations in total.

Details

Primary Language English
Subjects Sports Training, Sports Science and Exercise (Other)
Journal Section Original Article
Authors

Bahar Ateş 0000-0002-6339-3564

Halil Tanır 0000-0001-5626-8362

Jorge Mota 0000-0001-7571-9181

Lucimere Bohn 0000-0001-7988-968X

Early Pub Date June 30, 2024
Publication Date June 30, 2024
Submission Date May 3, 2024
Acceptance Date June 28, 2024
Published in Issue Year 2024 Volume: 9 Issue: 2

Cite

APA Ateş, B., Tanır, H., Mota, J., Bohn, L. (2024). Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males. Spor Bilimleri Araştırmaları Dergisi, 9(2), 244-258. https://doi.org/10.25307/jssr.1477466
AMA Ateş B, Tanır H, Mota J, Bohn L. Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males. JSSR. June 2024;9(2):244-258. doi:10.25307/jssr.1477466
Chicago Ateş, Bahar, Halil Tanır, Jorge Mota, and Lucimere Bohn. “Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males”. Spor Bilimleri Araştırmaları Dergisi 9, no. 2 (June 2024): 244-58. https://doi.org/10.25307/jssr.1477466.
EndNote Ateş B, Tanır H, Mota J, Bohn L (June 1, 2024) Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males. Spor Bilimleri Araştırmaları Dergisi 9 2 244–258.
IEEE B. Ateş, H. Tanır, J. Mota, and L. Bohn, “Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males”, JSSR, vol. 9, no. 2, pp. 244–258, 2024, doi: 10.25307/jssr.1477466.
ISNAD Ateş, Bahar et al. “Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males”. Spor Bilimleri Araştırmaları Dergisi 9/2 (June 2024), 244-258. https://doi.org/10.25307/jssr.1477466.
JAMA Ateş B, Tanır H, Mota J, Bohn L. Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males. JSSR. 2024;9:244–258.
MLA Ateş, Bahar et al. “Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males”. Spor Bilimleri Araştırmaları Dergisi, vol. 9, no. 2, 2024, pp. 244-58, doi:10.25307/jssr.1477466.
Vancouver Ateş B, Tanır H, Mota J, Bohn L. Effects of Resistance Exercise on Total and Regional Body Composition in Overweight Sedentary Males. JSSR. 2024;9(2):244-58.

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