Effect of concurrent training on physiological and psychological outcomes for women at risk for metabolic syndrome

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Wadsworth, Ashley Peart, Mynor Rodriguez Hernandez, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7328808/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose : Psychological stress, psychological distress and mental well-being, are related to metabolic syndrome (MetS) risk factors. Exercise is beneficial for both MetS and mental health independently, however concurrent training (combining aerobic and resistance exercise) has been insufficiently studied for its potential to simultaneously address both physical and psychological outcomes. The purpose of this intervention was to examine how a concurrent training intervention consisting of sprint interval training and resistance training impacted MetS outcomes, perceived stress, psychological distress and well-being. Methods : 40 (M Age= 44.59 ± 9.24 years, weight = 197.25 ± 44.07 kg height= 1.65 ± 0.07 m) were recruited to begin a 10-week concurrent training study consisting of resistance training and sprint interval training. Participants were assessed for MetS outcomes (blood pressure, waist circumference, triglycerides, high density lipoprotein, and fasting blood glucose) and psychological outcomes (well-being, perceived stress, anxiety, depression and anger). Results : Waist circumference ( t (36) = 3.18, p = .002), systolic blood pressure ( t (36) = 2.81, p = .004), diastolic blood pressure ( t (36) = 2.85, p = .004) and triglycerides (t(36) = 2.04, p = .024) showed a significant decrease from pre to post-test. A significant increase was noted for psychological well-being ( t( 36) = 2.18, p = .03). Conclusions : These findings support the utility of high-intensity concurrent training in improving both physical and psychological health in individuals with MetS risk factors. Sprint interval training resistance training high intensity exercise psychological well-being perceived stress psychological distress INTRODUCTION Metabolic syndrome (MetS) is a composite term encompassing cardiometabolic risk factors, including abdominal adiposity, hypertension, dyslipidemia, and insulin resistance [ 1 ]. Individuals diagnosed with MetS have approximately three times greater risks of heart attack, stroke, type 2 diabetes, and all-cause mortality. Recent data show that the prevalence of MetS in the U.S. increased from 37.6–41.8% from 2011–2012 to 2017–2018, with consistently higher rates in women than in men [ 2 , 3 ]. Similarly, poor mental health is increasingly prevalent and linked to poor physical health and higher mortality risk [ 4 ]. Women are disproportionately affected, experiencing depression at twice the rate of men and exhibiting higher rates of anxiety disorders [ 5 , 6 ]. Several psychological outcomes, including psychological stress, psychological distress and mental well-being, are related to MetS risk factors. Psychological stress, or the appraisal of life events as threatening or demanding, has been suggested as a risk factor that may prospectively predict MetS [ 7 ]. A review and meta-analysis revealed that waist circumference, serum triglyceride levels and diastolic blood pressure were correlated with perceived stress [ 8 ]. Depression, anxiety, and anger, which we term psychological distress, are also associated with MetS, with meta-analyses of cross-sectional and cohort studies showing that depressed patients are more likely to have MetS than nondepressed patients [ 9 ]. An additional meta-analysis and systematic review revealed an association between MetS and anxiety in cross-sectional studies [ 10 ]. A study examining the impacts of anger and aggression, also known as hostility, on the experience of MetS revealed an association between hostility and waist circumference as well as an association between hostility and MetS [ 11 ]. In addition to decreases in psychological distress, consideration of improved mental wellbeing is also relevant. Mental wellbeing, sometimes called psychological wellbeing, is an understanding of positive mental health that includes positive affect and psychological functioning [ 12 ]. As with stress and psychological distress, some research points to overall lower well-being for women than for men and lower well-being for people with obesity [ 13 , 14 ]. As MetS and poor mental health outcomes appear to have elevated rates in women, interventions that improve outcomes for both are advantageous. Participation in physical activity and exercise has consistently improved MetS outcomes [ 15 , 16 ]. Findings from two meta-analyses assessing the relationship between exercise and MetS concluded that aerobic exercise was effective and was the most frequently used approach to improve MetS and its risk factors, such as waist circumference, blood pressure, fasting glucose, triglycerides, and high- and low-density lipoproteins [ 17 ]. Participation in resistance training is part of the national physical activity recommendations and has also shown positive outcomes for MetS risk factors [ 17 – 19 ]. However, the effects of the combination of aerobic exercise and resistance exercise, termed concurrent training, on MetS outcomes remain understudied. A study by Da Silva et al. (2020) showed promise in concurrent training, with varying intensities of aerobic exercise resulting in improved waist circumference, fasting blood glucose and triglyceride levels over a 12-week randomized trial in women. However, more information is needed. There is evidence that exercise or physical fitness is associated with lower levels of psychological distress, including depression symptoms, anxiety symptoms, and anger or irritability [ 20 – 23 ]. Exercise interventions show effect sizes for reductions in depression (-.43) and anxiety (-42) [ 24 ], which are comparable to the effects observed for pharmacotherapy (SMD range − .22 to − .37) [ 25 – 27 ]. The effects are dependent on the population and characteristics of the exercise studied [ 24 ]. Like research on the effects of exercise and MetS, research on the benefits of physical exercise on psychological distress has focused on aerobic-style activities such as walking and moderate continuous exercise. Findings show that low-intensity regimes such as walking and moderate-intensity continuous training are associated with favorable psychological outcomes, with moderate-intensity training being more effective [ 24 , 28 ]. A meta-analysis specifically examining the impact of high-intensity interval training (HIIT) on physical illness revealed that compared with a sedentary lifestyle, HIIT leads to moderate improvements in well-being, depression and perceived stress [ 29 ]. Additionally, a topical review examined the impact of HIIT on psychological outcomes in people with obesity and reported that overall, compared with moderate-intensity training, HIIT produces similar outcomes; however, there is insufficient evidence for depression and anxiety, as only a few studies have examined distress [ 30 ]. Although participation in resistance training is associated with reductions in anxiety and depression, the findings are not consistent [ 24 ]. Interestingly, a study examining low-intensity exercise consisting of aerobic and resistance-style exercises completed in a chair revealed positive changes in depression and perceived stress but did not reveal changes in MetS outcomes in older adults [ 18 ]. While exercise is beneficial for both MetS and mental health independently, concurrent training (combining aerobic and resistance exercise) has been insufficiently studied for its potential to address both physical and psychological outcomes simultaneously. Furthermore, few studies have examined the impact on MetS risk factors and psychological outcomes within the same intervention, particularly for women. Therefore, the purpose of this intervention was to examine how a concurrent training intervention consisting of sprint interval training and resistance training impacted MetS, perceived stress, psychological distress and well-being. METHODS Participants All procedures described herein were approved by the Institutional Review Board and conformed to the standards set by the latest revision of the 1964 Declaration of Helsinki. This cohort was part of a series of studies that examined the effect of concurrent training on MetS outcomes. Prior to participation, all participants were asked to provide informed consent and complete the Physical Activity Readiness plus Questionnaire (PAR-Q+) [ 31 ]. The female participants were recruited via health fairs, word-of-mouth, e-mail, flyers, and social networks from the local community. The participants were included in the study if they were between the ages of 25 and 55 years, were healthy, as determined by the PAR-Q+ [ 31 ] other than MetS risk factors, not pregnant, agreed and able to complete a 10-week exercise program, and not currently engaged in any structured physical activity program. For this cohort, initially 52 women from the local community were interested in participation and 47 women arrived at the lab and volunteered to participate (5 women did not show for baseline testing). Four women did not meet the inclusion PAR-Q + criteria at the initial assessment and two declined to participate due to time constraints. A total of 41 participants met the criteria, completed baseline measures and were placed in the intervention. The participants were grouped based on time preference/availability at a 1:1 researcher/participant ratio. 2.2. Procedures This intervention consisted of one experimental group, the sprint interval training (SIT) and resistance training (RT) combined group, which received 10 weeks of exercise training for 30 sessions. Prior to baseline testing, the participants arrived at the lab and completed the informed consent and PAR-Q+. Baseline measurements were completed over one week and included height, weight, MetS outcomes, and surveys. Following baseline testing, the participants completed three familiarization sessions to practice the SIT and RT protocols. Upon arrival, each participant completed a walking warm-up on the treadmill followed by completing two to three sprints at their prescribed speed and/or grade. The participants were able to practice starting and ending the sprints and were instructed on hand and foot placement as well as treadmill safety procedures. Next, the participants performed each of the RT exercises. During the third familiarization session, the participants completed a three-repetition max (3-RM) for the bench press and back squat. The participants then attended three exercise training sessions per week over ten weeks, for a total of 30 sessions. In each session, all the subjects completed a SIT and RT protocol. The order in which the SIT and RT exercise portions of the protocol alternated between sessions to avoid potential order effects. After ten weeks of training, the subjects completed all post-intervention assessments. Huffman and Wadsworth used a similar exercise protocol for previous cohorts [ 32 , 33 ]. 2.3. Measures Anthropometrics Height was measured to the nearest 0.25 cm, and weight was assessed via a stadiometer (SECA Model 769, Seca & Co.kg., Hamburg, Germany) to the nearest 0.1 kg. Metabolic Syndrome Outcomes Following an 8-hour overnight fast, capillary blood samples were collected at baseline and at week 11 by a trained phlebotomist using standardized procedures. While seated comfortably in a phlebotomy chair, participants underwent fingerstick sampling with a 28-gauge lancet (Unistick 3 Comfort, Owen Mumford, Marietta, GA), from which a 5 µL blood sample was obtained. Blood was drawn into a lithium heparin-coated capillary tube and analyzed using the Alere Cholestech LDX system (Alere San Diego, Inc., San Diego, CA) for fasting blood glucose (FBG), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Resting blood pressure (BP) was assessed under standardized protocols. Participants were instructed to wear loose clothing, sit quietly with their feet flat on the floor, and relax for several minutes prior to measurement. Systolic (SBP) and diastolic blood pressure (DBP) readings were obtained at both time points using a sphygmomanometer and appropriately sized cuff (Welch Allyn Inc., Skaneateles, NY, USA) placed on the left arm. The cuff was positioned approximately two finger widths above the antecubital fossa and aligned with the brachial artery. For participants taking antihypertensive medications, resting BP was assessed without medication at both baseline and week 11 to more accurately reflect their untreated resting values; these individuals were classified as meeting the MetS criterion for elevated blood pressure. Waist circumference was measured to the nearest 0.1 cm using a Gulick tension-controlled measuring tape, positioned horizontally at the level of the top of the right iliac crest. Care was taken to avoid compressing the skin, and measurements were recorded at the end of a normal expiration while ensuring the tape remained parallel to the floor. Psychological Outcomes The Perceived Stress Scale (PSS) measures the degree to which situations in one's life are appraised as stressful [ 7 ]. The item scores are summed (possible range 0–40); higher scores indicate more stress. The Warwick-Edinburgh Mental Well-being Scale (WEMWB), used with permission, was used to assess subjective well-being and psychological functioning. Scores were summed for a total score (possible range 14–70) [ 13 ]. A higher score is associated with greater well-being. The PROMIS Emotional Distress Scale of Anxiety, Depression, and Anger (ED-ADA) is part of the NIH-funded Patient-Reported Outcomes Measurement Information Systems (PROMIS) and measures the psychological distress aspects of anxiety, depression, and anger [ 34 ]. Each subfactor is summed for the total sum subscale score (possible ranges: anxiety 9–45, depression 9–45, anger 8–40). Intervention The 10-week intervention consisted of 30 sessions, 3 times a week (Monday, Wednesday, and Friday). During each sessions, participants completed a general warm-up for 5 mins, followed by the SIT and RT protocol and ended with flexibility and core protocols. The order of the SIT and RT was counterbalanced between sessions. Each session, including warm-up and cool-down periods, lasted approximately 45 minutes. SIT Protocol Sprint interval training is a type of HIIT training consisting of short bursts of near maximal effort followed by rest periods. Compared with HIIT, SIT consists of short exercise bouts at a greater intensity [ 35 ]. The SIT running protocol consisted of two sets of three 40-second sprints with 20 seconds of passive recovery between each sprint and one minute of additional recovery after each set for the first 5 weeks. During the last 5 weeks, the protocol increased to three sets. For example, participants would sprint for 40 seconds at the beginning of minutes 3, 4, and 5, followed by 20 seconds of passive rest by straddling the treadmill belt. After a full minute of rest (minute 6), the participants completed one to two more sets of sprints. Each sprint session began with a 3-minute warm-up at 3.0 mph. After the sprints, the participants walked on the treadmill at 3.0 mph for a 3-minute cool-down. The SIT program aimed to elicit cardiovascular responses at approximately 95% of the maximal heart rate achieved. An aerobic fitness test using the Bruce protocol determined 95% of the maximum heart rate during baseline testing. This test is commonly used to estimate aerobic (cardiovascular) fitness, with a reported standard error of estimates (SEEs) ranging from ± 2.7 to ± 4.7 mL/kg/min [ 36 ]. During the aerobic fitness test, participants’ heart rates were recorded at the end of each stage, and heart rate and time were recorded upon volitional fatigue. RT Protocol Participants followed an alternating RT schedule that incorporated two distinct protocols, referred to as Protocol A and Protocol B, which were performed on non-consecutive training days. Each session commenced with a dynamic warm-up. Protocol A included compound strength exercises: back squat, bench press, and bent-over rows. Protocol B emphasized functional and multi-joint movements, including squat jumps, walking lunges, standing overhead press, and back extensions. Both sessions concluded with core-focused abdominal exercises and static stretching for cool-down. The RT program followed an undulating periodization model, designed to introduce variable training stimuli and promote neuromuscular adaptation through progressive overload. Periodization over 10-weeks were as follows: two weeks of conditioning, two weeks of hypertrophy training, two weeks of strength training, followed by a second cycle of two weeks of hypertrophy and two weeks of strength training. During the conditioning phase, participants completed three sets of 10 repetitions at 55%, 65%, and 70% of their individually assessed three-repetition maximum (3-RM). Emphasis was placed on correct technique; if form deteriorated before completing the assigned repetitions, the set was terminated at that point, and the participant resumed with the next prescribed set after rest. The hypertrophy phases included three sets of 10 repetitions at 65%, 70%, and 75% of the 3-RM across four exercises: back squat, bench press, bent-over row, and overhead press. The strength training phases consisted of three sets of six repetitions at 75%, 80%, and 85% of 3-RM for the same lifts. This structured progression was designed to elicit adaptations in both muscular hypertrophy and strength while maintaining a focus on safe and technically sound execution. Statistical Analyses All the quantitative analyses were performed with SPSS 26.0. A minimum sample size of 28 participants was determined with G power a priori to achieve .80 power with an alpha level of .05 and an effect size of .30. A paired sample t-test was used to evaluate the effects of the program on the MetS and psychological outcomes. The significance level was set at p < .05. RESULTS All 41 (M Age = 44.59 ± 9.24 years, weight = 197.25 ± 44.07 kg height = 1.65 ± 0.07 m) participants were placed in the intervention after completing the informed consent process. During the intervention, three participants voluntarily dropped out of the study and stopped attending due to time constraints. The resulting sample size was 38. On average, participants completed 26 sessions out of 30, with a range of 17–30. Table 1 displays the mean scores for the pre- and posttests as well as the paired t test results. Waist circumference ( t (36) = 3.18, p = .002), systolic blood pressure ( t (36) = 2.81, p = .004), diastolic blood pressure ( t (36) = 2.85, p = .004) and triglycerides (t(36) = 2.04, p = .024) significantly decreased from pre- to posttest. A significant increase was noted for WEMWB ( t( 36) = 2.18, p = .03). Table 1 Mean scores and statistics for pre and post assessments Variable Pre Post t p 95% CI Effect size (Cohen’s D) PSS 12.81 (5.25) 13.42 (5.67) -0.76 .226 -2.23,1.01 .14 WEMWB 51.63 (6.89) 53.64 (7.81) -2.12 .021* -3.92,-.08 .37 EDADA Anxiety 19.03 (5.47) 17.68 (6.20) 1.63 .056 − .33,3.03 .27 EDADA Depression 13.54 (5.35) 13.03 (5.07) 0.88 .192 − .67,1.69 .14 EDADA Anger 15.32 (4.89) 15.00 (5.71) 0.39 .351 -1.37,2.03 .06 WC (cm) 111.10 (18.17) 107.45 (16.43) 3.18 .002* 1.230,2807 .52 SBP (mmHG) 129.46 (9.42) 125.03 (11.86) 12.97 < .001* -50.21,-36.42 .46 DBP (mmHG) 80.62 (6.90) 78.70 (6.11) 12.39 < .001* -84.27,-60.20 .47 HDL (mgDl) 52.32 (16.50) 51.27 (14.77) 0.42 .338 -4.03,6.14 .07 GLU (mgDL) 89.89 (7.80) 89.59 (7.61) 0.89 .190 -1.66,4.252 .15 TRIG (mgDL) 152.89 (92.24) 117.97 (69.48) 2.04 .024 .231,69.61 .34 * denotes significance at the .05 level; Abbreviations: Perceived stress scale (PSS), Warwick-Edinburgh Mental Well-being Scale (WEMWB), Emotional Distress scales of Anxiety, Depression, and Anger (EDADA(, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoproteins (HDL), fasting plasma glucose (GLU), Triglycerides (TG) Discussion Our results showed that 10 weeks of concurrent training resulted in significant reductions in waist circumference, SBP, DBP, and triglyceride levels as well as improvements in mental well-being. Exercise is a well-established intervention for preventing and managing MetS, with outcomes varying by exercise type, intensity, and duration. High-intensity aerobic training has demonstrated effects comparable to moderate continuous training [ 37 ]. While both aerobic and resistance training yield positive outcomes, few studies have examined the effects of concurrent training on MetS [ 2 , 16 ]. Andrade and colleagues reported that 10 weeks of concurrent training consisting of HIIT with a cycle ergometer and RT three times a week resulted in reductions in waist circumference by 4.2 cm, triglycerides by 10.6 mgdL and FPG by 1.3 mgdL for women aged 40–49 years [ 38 ]. Da Silva et al. reported that both moderate-intensity continuous training and HIIT combined with resistance training resulted in significant reductions in waist circumference in both men and women [ 19 ]. Additional changes were dependent upon group assignment, with the moderate continuous and resistance training groups showing significant reductions in triglycerides and the HIIT and RT groups showing significant changes in low density lipoprotein and glucose. For this study, we showed a significant reduction in waist circumference by ~ 4 cm, with a medium effect, as reported by Andrade et al. [ 38 ]. Although this reduction is clinically significant, the participants’ mean waist circumference was still high and met the criteria for metabolic syndrome at the conclusion of the study. We also observed significant decreases in both systolic and diastolic blood pressure, which differs from the findings of both Andrade et al. (2021) and Da Silvia et al., (2020). A meta-analysis examining the effect of concurrent training on blood pressure revealed that, on average, moderate-intensity concurrent training performed three days a week reduced blood pressure by ~ 3 mmHg compared with that of controls, with a greater effect for those with hypertension [ 39 ]. Our study revealed a reduction in SBP by ~ 4 mmHG and a decrease in diastolic SBP by ~ 2 mmHG, with 10 of our participants meeting hypertension measurements at baseline for either SBP or DBP. Our study also revealed a reduction in triglyceride levels of ~ 34 mg/dL, reducing the mean triglyceride level to below the metabolic syndrome criteria at 10 weeks. In terms of the psychological outcomes, only well-being showed significant findings. In general, physical activity is related to positive well-being. A recent meta-analysis examining the relationship between exercise and well-being revealed that across 980 effect sizes, the overall effect had a Cohen’s d of .360, which closely aligns with our study (Cohen’s d = .37) [ 40 ]. Furthermore, this meta-analysis revealed that the relationship was not related to the intensity of exercise, as previously indicated, and that the initial fitness level did not impact wellbeing. For individuals with risk factors for MetS, positive well-being may be reduced [ 41 ]. As this intervention was associated with positive increases in well-being as well as positive MetS outcomes, exercise interventions should be further explored. The numerical decreases in scores for depression, anger and anxiety were statistically nonsignificant. Many of the prior studies have shown significant effects of exercise interventions on psychological distress in clinical populations [ 42 , 43 ]. In contrast, our sample started with a mean total EDADA score of 47.89, which translates to normal distress [ 44 ]. Nevertheless, the Cohen’s d effect for anxiety was 0.27 (p = .056); our study was underpowered to detect effects lower than .30. Unexpectedly, while statistically nonsignificant, the PSS score numerically increased toward higher stress. Aspects of MetS have been linked to perceived stress, such as waist circumference, blood pressure and triglycerides [ 8 ]. However, this relationship is not clear in women because of a lack of studies. As exercise and MetS outcomes have been linked to perceived stress, further research is necessary to determine the role of exercise in mitigating the impact of perceived stress in those with MetS. CONCLUSIONS This study showed that a 10-week concurrent training program combining SIT and RT led to significant improvements in waist circumference, BP, triglycerides, and psychological well-being among individuals at risk for MetS. These results support the effectiveness of high-intensity concurrent training for improving both physical and psychological health. Although psychological distress outcomes were not statistically significant, effect sizes, particularly for anxiety, suggest potential benefits warranting further research. The unexpected rise in perceived stress underscores the complex relationship between exercise and stress, highlighting the need for continued investigation. Declarations Author Contribution Acknowledgements: No funding was recvied for conducting this study. Portions of the data presented in this article were collected as part of a doctoral dissertation.Disclosures: The authors have no relevant financial or non-financial interests to disclose. Acknowledgements: No funding was recvied for conducting this study. Portions of the data presented in this article were collected as part of a doctoral dissertation. 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Assessment 18:263-283. https://doi.org/10.1177/1073191111411667 Rosenblat MA, Perrotta AS, Thomas SG (2020) Effect of high-intensity interval training versus sprint interval training on time-trial performance: a systematic review and meta-analysis. Sports Med 50:1145-1161. https://doi.org/10.1007/s40279-020-01279-9 Bushman B (2017) ACSM’s complete guide to fitness & health, 2E. Human Kinetics, Champaign, IL. Poon ET-C, Yu CC-W, Chan CY, et al (2024) High-intensity interval training for cardiometabolic health in adults with metabolic syndrome: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 58:1267-1284. https://doi.org/10.1136/bjsports-2023-106909 Andrade DC, de Salles Painelli V, Lira FS, et al (2021) Similar adaptations to 10 weeks concurrent training on metabolic markers and physical performance in young, adult, and older adult women. J Clin Med 10:5582. https://doi.org/10.3390/jcm10235582 Corso LM, Giani A, Cianci A, et al (2016) Is concurrent training efficacious antihypertensive therapy? A meta-analysis. Med Sci Sports Exerc 48:2398-2406. https://doi.org/10.1249/MSS.0000000000001033 Buecker S, Terwiel S, Michalak J, et al (2021) Physical activity and subjective well-being in healthy individuals: a meta-analytic review. Health Psychol Rev 15:574-592. https://doi.org/10.1080/17437199.2021.1894747 Boylan JM, Ryff CD (2015) Psychological well-being and metabolic syndrome: findings from the midlife in the United States national sample. Psychosom Med 77:548-558. https://doi.org/10.1097/PSY.0000000000000180 Gerber M, Holsboer-Trachsler E, Pühse U, et al (2019) Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial. J Psychiatr Res 113:58-64. https://doi.org/10.1016/j.jpsychires.2019.03.021 LeBouthillier DM, Asmundson GJ (2017) The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: a randomized controlled trial. J Anxiety Disord 52:43-52. https://doi.org/10.1016/j.janxdis.2017.09.004 Cella D, Yount S, Rothrock N, et al (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63:1179-1194. https://doi.org/10.1016/j.jclinepi.2010.04.011 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Dec, 2025 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers invited by journal 10 Nov, 2025 Editor assigned by journal 09 Aug, 2025 Submission checks completed at journal 09 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7328808","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547318104,"identity":"2085f47b-fd97-4cb2-ac88-5f2345879606","order_by":0,"name":"Danielle D. Wadsworth","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYHACAwYGNmY5BgYeKP8AkVqMSdeS2EC0FoPjhzd/5imzTu+fkXtMunIHgxzfjQQCWs6klUnznEvPnXEjL03y7BkGY0lCWswO5Jgx57Ydzm24kWMm2djGkLiBoJbzb4w/A7Wky0O11BPWciPHQBqoJcEAqgXIIKDF/sazMuk/59INN555l2zZ2CZhOPPMA/xaJPuTN3+cUWYtL3c89+DNxjYbeb7jBGxBBxKkKR8Fo2AUjIJRgB0AANHtSAtLWsYXAAAAAElFTkSuQmCC","orcid":"","institution":"Auburn University","correspondingAuthor":true,"prefix":"","firstName":"Danielle","middleName":"D.","lastName":"Wadsworth","suffix":""},{"id":547318105,"identity":"87e2b9e9-0edb-4307-b75d-cea3b6283720","order_by":1,"name":"Ashley Peart","email":"","orcid":"","institution":"Auburn University","correspondingAuthor":false,"prefix":"","firstName":"Ashley","middleName":"","lastName":"Peart","suffix":""},{"id":547318106,"identity":"3ab20798-682b-4d9f-9d6a-03bedbbc6c6f","order_by":2,"name":"Mynor Rodriguez 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09:06:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":525871,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7328808/v1/8ae39452-590d-4d88-b7a9-b2ce9b7c3b80.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of concurrent training on physiological and psychological outcomes for women at risk for metabolic syndrome","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMetabolic syndrome (MetS) is a composite term encompassing cardiometabolic risk factors, including abdominal adiposity, hypertension, dyslipidemia, and insulin resistance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Individuals diagnosed with MetS have approximately three times greater risks of heart attack, stroke, type 2 diabetes, and all-cause mortality. Recent data show that the prevalence of MetS in the U.S. increased from 37.6\u0026ndash;41.8% from 2011\u0026ndash;2012 to 2017\u0026ndash;2018, with consistently higher rates in women than in men [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSimilarly, poor mental health is increasingly prevalent and linked to poor physical health and higher mortality risk [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Women are disproportionately affected, experiencing depression at twice the rate of men and exhibiting higher rates of anxiety disorders [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several psychological outcomes, including psychological stress, psychological distress and mental well-being, are related to MetS risk factors. Psychological stress, or the appraisal of life events as threatening or demanding, has been suggested as a risk factor that may prospectively predict MetS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A review and meta-analysis revealed that waist circumference, serum triglyceride levels and diastolic blood pressure were correlated with perceived stress [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Depression, anxiety, and anger, which we term psychological distress, are also associated with MetS, with meta-analyses of cross-sectional and cohort studies showing that depressed patients are more likely to have MetS than nondepressed patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. An additional meta-analysis and systematic review revealed an association between MetS and anxiety in cross-sectional studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A study examining the impacts of anger and aggression, also known as hostility, on the experience of MetS revealed an association between hostility and waist circumference as well as an association between hostility and MetS [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition to decreases in psychological distress, consideration of improved mental wellbeing is also relevant. Mental wellbeing, sometimes called psychological wellbeing, is an understanding of positive mental health that includes positive affect and psychological functioning [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As with stress and psychological distress, some research points to overall lower well-being for women than for men and lower well-being for people with obesity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As MetS and poor mental health outcomes appear to have elevated rates in women, interventions that improve outcomes for both are advantageous.\u003c/p\u003e\u003cp\u003eParticipation in physical activity and exercise has consistently improved MetS outcomes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Findings from two meta-analyses assessing the relationship between exercise and MetS concluded that aerobic exercise was effective and was the most frequently used approach to improve MetS and its risk factors, such as waist circumference, blood pressure, fasting glucose, triglycerides, and high- and low-density lipoproteins [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Participation in resistance training is part of the national physical activity recommendations and has also shown positive outcomes for MetS risk factors [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, the effects of the combination of aerobic exercise and resistance exercise, termed concurrent training, on MetS outcomes remain understudied. A study by Da Silva et al. (2020) showed promise in concurrent training, with varying intensities of aerobic exercise resulting in improved waist circumference, fasting blood glucose and triglyceride levels over a 12-week randomized trial in women. However, more information is needed.\u003c/p\u003e\u003cp\u003eThere is evidence that exercise or physical fitness is associated with lower levels of psychological distress, including depression symptoms, anxiety symptoms, and anger or irritability [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Exercise interventions show effect sizes for reductions in depression (-.43) and anxiety (-42) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which are comparable to the effects observed for pharmacotherapy (SMD range \u0026minus;\u0026thinsp;.22 to \u0026minus;\u0026thinsp;.37) [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The effects are dependent on the population and characteristics of the exercise studied [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Like research on the effects of exercise and MetS, research on the benefits of physical exercise on psychological distress has focused on aerobic-style activities such as walking and moderate continuous exercise. Findings show that low-intensity regimes such as walking and moderate-intensity continuous training are associated with favorable psychological outcomes, with moderate-intensity training being more effective [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A meta-analysis specifically examining the impact of high-intensity interval training (HIIT) on physical illness revealed that compared with a sedentary lifestyle, HIIT leads to moderate improvements in well-being, depression and perceived stress [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, a topical review examined the impact of HIIT on psychological outcomes in people with obesity and reported that overall, compared with moderate-intensity training, HIIT produces similar outcomes; however, there is insufficient evidence for depression and anxiety, as only a few studies have examined distress [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Although participation in resistance training is associated with reductions in anxiety and depression, the findings are not consistent [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Interestingly, a study examining low-intensity exercise consisting of aerobic and resistance-style exercises completed in a chair revealed positive changes in depression and perceived stress but did not reveal changes in MetS outcomes in older adults [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile exercise is beneficial for both MetS and mental health independently, concurrent training (combining aerobic and resistance exercise) has been insufficiently studied for its potential to address both physical and psychological outcomes simultaneously. Furthermore, few studies have examined the impact on MetS risk factors and psychological outcomes within the same intervention, particularly for women. Therefore, the purpose of this intervention was to examine how a concurrent training intervention consisting of sprint interval training and resistance training impacted MetS, perceived stress, psychological distress and well-being.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAll procedures described herein were approved by the Institutional Review Board and conformed to the standards set by the latest revision of the 1964 Declaration of Helsinki. This cohort was part of a series of studies that examined the effect of concurrent training on MetS outcomes. Prior to participation, all participants were asked to provide informed consent and complete the Physical Activity Readiness plus Questionnaire (PAR-Q+) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The female participants were recruited via health fairs, word-of-mouth, e-mail, flyers, and social networks from the local community. The participants were included in the study if they were between the ages of 25 and 55 years, were healthy, as determined by the PAR-Q+ [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] other than MetS risk factors, not pregnant, agreed and able to complete a 10-week exercise program, and not currently engaged in any structured physical activity program.\u003c/p\u003e\u003cp\u003e For this cohort, initially 52 women from the local community were interested in participation and 47 women arrived at the lab and volunteered to participate (5 women did not show for baseline testing). Four women did not meet the inclusion PAR-Q\u0026thinsp;+\u0026thinsp;criteria at the initial assessment and two declined to participate due to time constraints. A total of 41 participants met the criteria, completed baseline measures and were placed in the intervention. The participants were grouped based on time preference/availability at a 1:1 researcher/participant ratio.\u003c/p\u003e\u003cp\u003e\u003cem\u003e2.2. Procedures\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis intervention consisted of one experimental group, the sprint interval training (SIT) and resistance training (RT) combined group, which received 10 weeks of exercise training for 30 sessions. Prior to baseline testing, the participants arrived at the lab and completed the informed consent and PAR-Q+. Baseline measurements were completed over one week and included height, weight, MetS outcomes, and surveys. Following baseline testing, the participants completed three familiarization sessions to practice the SIT and RT protocols. Upon arrival, each participant completed a walking warm-up on the treadmill followed by completing two to three sprints at their prescribed speed and/or grade. The participants were able to practice starting and ending the sprints and were instructed on hand and foot placement as well as treadmill safety procedures. Next, the participants performed each of the RT exercises. During the third familiarization session, the participants completed a three-repetition max (3-RM) for the bench press and back squat. The participants then attended three exercise training sessions per week over ten weeks, for a total of 30 sessions. In each session, all the subjects completed a SIT and RT protocol. The order in which the SIT and RT exercise portions of the protocol alternated between sessions to avoid potential order effects. After ten weeks of training, the subjects completed all post-intervention assessments. Huffman and Wadsworth used a similar exercise protocol for previous cohorts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003e2.3. Measures\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAnthropometrics\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHeight was measured to the nearest 0.25 cm, and weight was assessed via a stadiometer (SECA Model 769, Seca \u0026amp; Co.kg., Hamburg, Germany) to the nearest 0.1 kg.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eMetabolic Syndrome Outcomes\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFollowing an 8-hour overnight fast, capillary blood samples were collected at baseline and at week 11 by a trained phlebotomist using standardized procedures. While seated comfortably in a phlebotomy chair, participants underwent fingerstick sampling with a 28-gauge lancet (Unistick 3 Comfort, Owen Mumford, Marietta, GA), from which a 5 \u0026micro;L blood sample was obtained. Blood was drawn into a lithium heparin-coated capillary tube and analyzed using the Alere Cholestech LDX system (Alere San Diego, Inc., San Diego, CA) for fasting blood glucose (FBG), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG).\u003c/p\u003e\u003cp\u003eResting blood pressure (BP) was assessed under standardized protocols. Participants were instructed to wear loose clothing, sit quietly with their feet flat on the floor, and relax for several minutes prior to measurement. Systolic (SBP) and diastolic blood pressure (DBP) readings were obtained at both time points using a sphygmomanometer and appropriately sized cuff (Welch Allyn Inc., Skaneateles, NY, USA) placed on the left arm. The cuff was positioned approximately two finger widths above the antecubital fossa and aligned with the brachial artery. For participants taking antihypertensive medications, resting BP was assessed without medication at both baseline and week 11 to more accurately reflect their untreated resting values; these individuals were classified as meeting the MetS criterion for elevated blood pressure.\u003c/p\u003e\u003cp\u003eWaist circumference was measured to the nearest 0.1 cm using a Gulick tension-controlled measuring tape, positioned horizontally at the level of the top of the right iliac crest. Care was taken to avoid compressing the skin, and measurements were recorded at the end of a normal expiration while ensuring the tape remained parallel to the floor.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003ePsychological Outcomes\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe Perceived Stress Scale (PSS) measures the degree to which situations in one's life are appraised as stressful [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The item scores are summed (possible range 0\u0026ndash;40); higher scores indicate more stress. The Warwick-Edinburgh Mental Well-being Scale (WEMWB), used with permission, was used to assess subjective well-being and psychological functioning. Scores were summed for a total score (possible range 14\u0026ndash;70) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A higher score is associated with greater well-being. The PROMIS Emotional Distress Scale of Anxiety, Depression, and Anger (ED-ADA) is part of the NIH-funded Patient-Reported Outcomes Measurement Information Systems (PROMIS) and measures the psychological distress aspects of anxiety, depression, and anger [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Each subfactor is summed for the total sum subscale score (possible ranges: anxiety 9\u0026ndash;45, depression 9\u0026ndash;45, anger 8\u0026ndash;40).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe 10-week intervention consisted of 30 sessions, 3 times a week (Monday, Wednesday, and Friday). During each sessions, participants completed a general warm-up for 5 mins, followed by the SIT and RT protocol and ended with flexibility and core protocols. The order of the SIT and RT was counterbalanced between sessions. Each session, including warm-up and cool-down periods, lasted approximately 45 minutes.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSIT Protocol\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSprint interval training is a type of HIIT training consisting of short bursts of near maximal effort followed by rest periods. Compared with HIIT, SIT consists of short exercise bouts at a greater intensity [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The SIT running protocol consisted of two sets of three 40-second sprints with 20 seconds of passive recovery between each sprint and one minute of additional recovery after each set for the first 5 weeks. During the last 5 weeks, the protocol increased to three sets. For example, participants would sprint for 40 seconds at the beginning of minutes 3, 4, and 5, followed by 20 seconds of passive rest by straddling the treadmill belt. After a full minute of rest (minute 6), the participants completed one to two more sets of sprints. Each sprint session began with a 3-minute warm-up at 3.0 mph. After the sprints, the participants walked on the treadmill at 3.0 mph for a 3-minute cool-down. The SIT program aimed to elicit cardiovascular responses at approximately 95% of the maximal heart rate achieved. An aerobic fitness test using the Bruce protocol determined 95% of the maximum heart rate during baseline testing. This test is commonly used to estimate aerobic (cardiovascular) fitness, with a reported standard error of estimates (SEEs) ranging from \u0026plusmn;\u0026thinsp;2.7 to \u0026plusmn;\u0026thinsp;4.7 mL/kg/min [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. During the aerobic fitness test, participants\u0026rsquo; heart rates were recorded at the end of each stage, and heart rate and time were recorded upon volitional fatigue.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRT Protocol\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants followed an alternating RT schedule that incorporated two distinct protocols, referred to as Protocol A and Protocol B, which were performed on non-consecutive training days. Each session commenced with a dynamic warm-up. Protocol A included compound strength exercises: back squat, bench press, and bent-over rows. Protocol B emphasized functional and multi-joint movements, including squat jumps, walking lunges, standing overhead press, and back extensions. Both sessions concluded with core-focused abdominal exercises and static stretching for cool-down. The RT program followed an undulating periodization model, designed to introduce variable training stimuli and promote neuromuscular adaptation through progressive overload. Periodization over 10-weeks were as follows: two weeks of conditioning, two weeks of hypertrophy training, two weeks of strength training, followed by a second cycle of two weeks of hypertrophy and two weeks of strength training. During the conditioning phase, participants completed three sets of 10 repetitions at 55%, 65%, and 70% of their individually assessed three-repetition maximum (3-RM). Emphasis was placed on correct technique; if form deteriorated before completing the assigned repetitions, the set was terminated at that point, and the participant resumed with the next prescribed set after rest. The hypertrophy phases included three sets of 10 repetitions at 65%, 70%, and 75% of the 3-RM across four exercises: back squat, bench press, bent-over row, and overhead press. The strength training phases consisted of three sets of six repetitions at 75%, 80%, and 85% of 3-RM for the same lifts. This structured progression was designed to elicit adaptations in both muscular hypertrophy and strength while maintaining a focus on safe and technically sound execution.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAll the quantitative analyses were performed with SPSS 26.0. A minimum sample size of 28 participants was determined with G power a priori to achieve .80 power with an alpha level of .05 and an effect size of .30. A paired sample t-test was used to evaluate the effects of the program on the MetS and psychological outcomes. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e All 41 (M Age\u0026thinsp;=\u0026thinsp;44.59\u0026thinsp;\u0026plusmn;\u0026thinsp;9.24 years, weight\u0026thinsp;=\u0026thinsp;197.25\u0026thinsp;\u0026plusmn;\u0026thinsp;44.07 kg height\u0026thinsp;=\u0026thinsp;1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07 m) participants were placed in the intervention after completing the informed consent process. During the intervention, three participants voluntarily dropped out of the study and stopped attending due to time constraints. The resulting sample size was 38. On average, participants completed 26 sessions out of 30, with a range of 17\u0026ndash;30.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the mean scores for the pre- and posttests as well as the paired t test results. Waist circumference (\u003cem\u003et\u003c/em\u003e(36)\u0026thinsp;=\u0026thinsp;3.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002), systolic blood pressure (\u003cem\u003et\u003c/em\u003e(36)\u0026thinsp;=\u0026thinsp;2.81, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004), diastolic blood pressure (\u003cem\u003et\u003c/em\u003e(36)\u0026thinsp;=\u0026thinsp;2.85, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004) and triglycerides (t(36)\u0026thinsp;=\u0026thinsp;2.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.024) significantly decreased from pre- to posttest. A significant increase was noted for WEMWB (\u003cem\u003et(\u003c/em\u003e36)\u0026thinsp;=\u0026thinsp;2.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.03).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean scores and statistics for pre and post assessments\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eEffect size (Cohen\u0026rsquo;s D)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.81 (5.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.42 (5.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.23,1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWEMWB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.63 (6.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.64 (7.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.021*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.92,-.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEDADA Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.03 (5.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.68 (6.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.33,3.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEDADA Depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.54 (5.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.03 (5.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.67,1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEDADA Anger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.32 (4.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.00 (5.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.37,2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWC (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111.10 (18.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107.45 (16.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.230,2807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP (mmHG)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129.46 (9.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125.03 (11.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-50.21,-36.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDBP (mmHG)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80.62 (6.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.70 (6.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-84.27,-60.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL (mgDl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.32 (16.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.27 (14.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.03,6.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGLU (mgDL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89.89 (7.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.59 (7.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.66,4.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTRIG (mgDL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152.89 (92.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117.97 (69.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.231,69.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e* denotes significance at the .05 level; Abbreviations: Perceived stress scale (PSS), Warwick-Edinburgh Mental Well-being Scale (WEMWB), Emotional Distress scales of Anxiety, Depression, and Anger (EDADA(, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoproteins (HDL), fasting plasma glucose (GLU), Triglycerides (TG)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eOur results showed that 10 weeks of concurrent training resulted in significant reductions in waist circumference, SBP, DBP, and triglyceride levels as well as improvements in mental well-being.\u003c/p\u003e\u003cp\u003eExercise is a well-established intervention for preventing and managing MetS, with outcomes varying by exercise type, intensity, and duration. High-intensity aerobic training has demonstrated effects comparable to moderate continuous training [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. While both aerobic and resistance training yield positive outcomes, few studies have examined the effects of concurrent training on MetS [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Andrade and colleagues reported that 10 weeks of concurrent training consisting of HIIT with a cycle ergometer and RT three times a week resulted in reductions in waist circumference by 4.2 cm, triglycerides by 10.6 mgdL and FPG by 1.3 mgdL for women aged 40\u0026ndash;49 years [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Da Silva et al. reported that both moderate-intensity continuous training and HIIT combined with resistance training resulted in significant reductions in waist circumference in both men and women [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Additional changes were dependent upon group assignment, with the moderate continuous and resistance training groups showing significant reductions in triglycerides and the HIIT and RT groups showing significant changes in low density lipoprotein and glucose. For this study, we showed a significant reduction in waist circumference by ~\u0026thinsp;4 cm, with a medium effect, as reported by Andrade et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Although this reduction is clinically significant, the participants\u0026rsquo; mean waist circumference was still high and met the criteria for metabolic syndrome at the conclusion of the study. We also observed significant decreases in both systolic and diastolic blood pressure, which differs from the findings of both Andrade et al. (2021) and Da Silvia et al., (2020). A meta-analysis examining the effect of concurrent training on blood pressure revealed that, on average, moderate-intensity concurrent training performed three days a week reduced blood pressure by ~\u0026thinsp;3 mmHg compared with that of controls, with a greater effect for those with hypertension [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Our study revealed a reduction in SBP by ~\u0026thinsp;4 mmHG and a decrease in diastolic SBP by ~\u0026thinsp;2 mmHG, with 10 of our participants meeting hypertension measurements at baseline for either SBP or DBP. Our study also revealed a reduction in triglyceride levels of ~\u0026thinsp;34 mg/dL, reducing the mean triglyceride level to below the metabolic syndrome criteria at 10 weeks.\u003c/p\u003e\u003cp\u003eIn terms of the psychological outcomes, only well-being showed significant findings. In general, physical activity is related to positive well-being. A recent meta-analysis examining the relationship between exercise and well-being revealed that across 980 effect sizes, the overall effect had a Cohen\u0026rsquo;s d of .360, which closely aligns with our study (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;.37) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Furthermore, this meta-analysis revealed that the relationship was not related to the intensity of exercise, as previously indicated, and that the initial fitness level did not impact wellbeing. For individuals with risk factors for MetS, positive well-being may be reduced [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. As this intervention was associated with positive increases in well-being as well as positive MetS outcomes, exercise interventions should be further explored.\u003c/p\u003e\u003cp\u003eThe numerical decreases in scores for depression, anger and anxiety were statistically nonsignificant. Many of the prior studies have shown significant effects of exercise interventions on psychological distress in clinical populations [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In contrast, our sample started with a mean total EDADA score of 47.89, which translates to normal distress [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Nevertheless, the Cohen\u0026rsquo;s d effect for anxiety was 0.27 (p\u0026thinsp;=\u0026thinsp;.056); our study was underpowered to detect effects lower than .30.\u003c/p\u003e\u003cp\u003eUnexpectedly, while statistically nonsignificant, the PSS score numerically increased toward higher stress. Aspects of MetS have been linked to perceived stress, such as waist circumference, blood pressure and triglycerides [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, this relationship is not clear in women because of a lack of studies. As exercise and MetS outcomes have been linked to perceived stress, further research is necessary to determine the role of exercise in mitigating the impact of perceived stress in those with MetS.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study showed that a 10-week concurrent training program combining SIT and RT led to significant improvements in waist circumference, BP, triglycerides, and psychological well-being among individuals at risk for MetS. These results support the effectiveness of high-intensity concurrent training for improving both physical and psychological health. Although psychological distress outcomes were not statistically significant, effect sizes, particularly for anxiety, suggest potential benefits warranting further research. The unexpected rise in perceived stress underscores the complex relationship between exercise and stress, highlighting the need for continued investigation.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAcknowledgements: No funding was recvied for conducting this study. Portions of the data presented in this article were collected as part of a doctoral dissertation.Disclosures: The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\n\u003cp\u003eNo funding was recvied for conducting this study. Portions of the data presented in this article were collected as part of a doctoral dissertation.\u003c/p\u003e\n\u003ch2\u003eDisclosures:\u003c/h2\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640-1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644\u003c/li\u003e\n\u003cli\u003eLiang X, Zhang Y, Wu J, et al (2023) Prevalence of metabolic syndrome in the United States National Health and Nutrition Examination Survey 2011\u0026ndash;18. 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J Cardiopulm Rehabil Prev 23:115-121. https://doi.org/10.1097/00008483-200303000-00006\u003c/li\u003e\n\u003cli\u003eSingh B, Uijtdewilligen L, Twisk JW, et al (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med 57:1203-1209. https://doi.org/10.1136/bjsports-2022-106111\u003c/li\u003e\n\u003cli\u003eCarpenter JK, Andrews LA, Witcraft SM, et al (2018) Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials. Depress Anxiety 35:502-514. https://doi.org/10.1002/da.22728\u003c/li\u003e\n\u003cli\u003eCipriani A, Furukawa TA, Salanti G, et al (2018) Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Focus (Am Psychiatr Publ) 16:420-429. https://doi.org/10.1176/appi.focus.20180007\u003c/li\u003e\n\u003cli\u003eTwomey C, O\u0026rsquo;Reilly G, Byrne M (2015) Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract 32:3-15. https://doi.org/10.1093/fampra/cmu057\u003c/li\u003e\n\u003cli\u003eCatalan-Matamoros D, Moreno-Guerrero AJ, Dorado-Rodr\u0026iacute;guez MI, et al (2016) Exercise improves depressive symptoms in older adults: an umbrella review of systematic reviews and meta-analyses. Psychiatry Res 244:202-209. https://doi.org/10.1016/j.psychres.2016.07.029\u003c/li\u003e\n\u003cli\u003eMartland R, Herring MP, Farmer O, et al (2022) Can high-intensity interval training improve mental health outcomes in the general population and those with physical illnesses? A systematic review and meta-analysis. Br J Sports Med 56:279-291. https://doi.org/10.1136/bjsports-2021-104526\u003c/li\u003e\n\u003cli\u003eBatrakoulis A, Jamurtas AZ, Fatouros IG (2021) High-intensity interval training in metabolic diseases: physiological adaptations. ACSM Health Fit J 25:54-59. https://doi.org/10.1249/FIT.0000000000000644\u003c/li\u003e\n\u003cli\u003eJamnik VK, Warburton DE, Kavanagh T, et al (2011) Enhancing the effectiveness of clearance for physical activity participation: background and overall process. Appl Physiol Nutr Metab 36:S3-S13. https://doi.org/10.1139/H11-001\u003c/li\u003e\n\u003cli\u003eHuffman LS, McNally JS, Cuellar A, et al (2019) Effects of a sprint interval and resistance concurrent exercise training program on aerobic capacity of inactive adult women. 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Sports Med 50:1145-1161. https://doi.org/10.1007/s40279-020-01279-9\u003c/li\u003e\n\u003cli\u003eBushman B (2017) ACSM\u0026rsquo;s complete guide to fitness \u0026amp; health, 2E. Human Kinetics, Champaign, IL.\u003c/li\u003e\n\u003cli\u003ePoon ET-C, Yu CC-W, Chan CY, et al (2024) High-intensity interval training for cardiometabolic health in adults with metabolic syndrome: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 58:1267-1284. https://doi.org/10.1136/bjsports-2023-106909\u003c/li\u003e\n\u003cli\u003eAndrade DC, de Salles Painelli V, Lira FS, et al (2021) Similar adaptations to 10 weeks concurrent training on metabolic markers and physical performance in young, adult, and older adult women. J Clin Med 10:5582. https://doi.org/10.3390/jcm10235582\u003c/li\u003e\n\u003cli\u003eCorso LM, Giani A, Cianci A, et al (2016) Is concurrent training efficacious antihypertensive therapy? A meta-analysis. Med Sci Sports Exerc 48:2398-2406. https://doi.org/10.1249/MSS.0000000000001033\u003c/li\u003e\n\u003cli\u003eBuecker S, Terwiel S, Michalak J, et al (2021) Physical activity and subjective well-being in healthy individuals: a meta-analytic review. Health Psychol Rev 15:574-592. https://doi.org/10.1080/17437199.2021.1894747\u003c/li\u003e\n\u003cli\u003eBoylan JM, Ryff CD (2015) Psychological well-being and metabolic syndrome: findings from the midlife in the United States national sample. Psychosom Med 77:548-558. https://doi.org/10.1097/PSY.0000000000000180\u003c/li\u003e\n\u003cli\u003eGerber M, Holsboer-Trachsler E, P\u0026uuml;hse U, et al (2019) Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial. J Psychiatr Res 113:58-64. https://doi.org/10.1016/j.jpsychires.2019.03.021\u003c/li\u003e\n\u003cli\u003eLeBouthillier DM, Asmundson GJ (2017) The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: a randomized controlled trial. J Anxiety Disord 52:43-52. https://doi.org/10.1016/j.janxdis.2017.09.004\u003c/li\u003e\n\u003cli\u003eCella D, Yount S, Rothrock N, et al (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005\u0026ndash;2008. J Clin Epidemiol 63:1179-1194. https://doi.org/10.1016/j.jclinepi.2010.04.011\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Sprint interval training, resistance training, high intensity exercise, psychological well-being, perceived stress, psychological distress","lastPublishedDoi":"10.21203/rs.3.rs-7328808/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7328808/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Psychological stress, psychological distress and mental well-being, are related to metabolic syndrome (MetS) risk factors. Exercise is beneficial for both MetS and mental health independently, however concurrent training (combining aerobic and resistance exercise) has been insufficiently studied for its potential to simultaneously address both physical and psychological outcomes. The purpose of this intervention was to examine how a concurrent training intervention consisting of sprint interval training and resistance training impacted MetS outcomes, perceived stress, psychological distress and well-being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: 40 (M Age= 44.59 ± 9.24 years, weight = 197.25 ± 44.07 kg height= 1.65 ± 0.07 m) were recruited to begin a 10-week concurrent training study consisting of resistance training and sprint interval training. Participants were assessed for MetS outcomes (blood pressure, waist circumference, triglycerides, high density lipoprotein, and fasting blood glucose) and psychological outcomes (well-being, perceived stress, anxiety, depression and anger).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Waist circumference (\u003cem\u003et\u003c/em\u003e(36) = 3.18, \u003cem\u003ep\u003c/em\u003e = .002), systolic blood pressure (\u003cem\u003et\u003c/em\u003e(36) = 2.81, \u003cem\u003ep\u003c/em\u003e = .004), diastolic blood pressure (\u003cem\u003et\u003c/em\u003e(36) = 2.85, \u003cem\u003ep\u003c/em\u003e = .004) and triglycerides (t(36) = 2.04, \u003cem\u003ep\u003c/em\u003e = .024) showed a significant decrease from pre to post-test. A significant increase was noted for psychological well-being (\u003cem\u003et(\u003c/em\u003e36) = 2.18, \u003cem\u003ep\u003c/em\u003e = .03).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: These findings support the utility of high-intensity concurrent training in improving both physical and psychological health in individuals with MetS risk factors.\u003c/p\u003e","manuscriptTitle":"Effect of concurrent training on physiological and psychological outcomes for women at risk for metabolic syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 13:33:08","doi":"10.21203/rs.3.rs-7328808/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-15T15:14:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T08:38:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204660106532932012424656824131446338657","date":"2025-11-10T18:00:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T17:35:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-09T10:43:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-09T10:43:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2025-08-08T15:38:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"40547587-0abc-4436-a1e6-f6610de0592b","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T11:54:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 13:33:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7328808","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7328808","identity":"rs-7328808","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}