Effect of a 12-week Bungy Pump Training on cardiorespiratory fitness, metabolic syndrome factors and body composition in postmenopausal women

Effect of a 12-week Bungy Pump Training on cardiorespiratory fitness, metabolic syndrome factors and body composition in postmenopausal women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effect of a 12-week Bungy Pump Training on cardiorespiratory fitness, metabolic syndrome factors and body composition in postmenopausal women Yiantao Niu, Łukasz Radzimiński, Guoping Qian, Andrzej Szwarc, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6108479/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract (Y.N.). The study examined the effect of a 12-week Bungy Pump Training (BPT) program on cardiorespiratory fitness (CRF), metabolic syndrome (MetS) factors and body composition in postmenopausal women (PW). Fifty-six participants were assigned to the BPT group (n=30) and Daily Activity (DA) group (n=26). The BPT group completed 60-minute sessions 3 times a week, and the DA group performed daily activities. Body composition, maximum oxygen uptake (VO 2max), heart rate (HR), blood pressure (BP), glucose and lipids were assessed at baseline and post-intervention. In the CRF and MetS factors, significant improvements (p < 0.05) were observed on VO 2max , BP, total cholesterol, high-density lipoprotein cholesterol (HDL-C), Non-HDL-C, and low-density lipoprotein cholesterol in the BPT group. In the body composition, significant improvements (p < 0.05) were observed on body weight, BMI, basal metabolic rate, percent body fat, visceral fat area, skeletal muscle mass, body fat mass, and fat-free mass in the BPT group. The 12-week BPT performed 3 times a week was more significant on CRF, MetS factors and body composition in PW. This finding could be applied to intervention programs for PW in non-pharmacological interventions. Trial registration: Clinical Trials NCT06781541 on 17/01/2025. Health sciences/Diseases/Cardiovascular diseases Health sciences/Health care Health sciences/Health care/Disease prevention Health sciences/Health care/Geriatrics Nordic walking Bungy Pump Training cardiorespiratory fitness metabolic syndrome factors body composition postmenopausal women Figures Figure 1 Figure 2 Figure 3 Introduction By 2040, global female life expectancy is projected to increase by 4.4 years (2.1–6.4 years) to 79.7 years (77.4–81.8 years) 1 . Aging is accompanied by metabolic risks associated with worsening cardiovascular disease (CVD), such as high blood pressure, high body mass index (BMI), and high fasting glucose 1 . CVD is the leading cause of death globally 1,2 , with total incidence increasing from 271 million cases (257–285) in 1990 to 523 million cases (497–550) in 2019 2 . Postmenopausal women (PW) experience a decline in estrogen levels 3 and an increased risk of CVD with age 4 , potentially exceeding that of men 5 . The American Heart Association (AHA) found that 70% of PW will develop CVD 6 , experiencing a low level of cardiorespiratory fitness (CRF) 7,8 , an increased risk of metabolic syndrome (MetS) 9,10 and an adverse body composition 11,12 . Adverse CRF changes are mainly characterized by decreased maximum oxygen uptake (VO 2max ) and increased resting heart rate (HR) 7,13 . MetS factors are reflected in unfavourable changes on blood pressure (BP), glucose, and lipid metabolic indices 14–16 . Body composition is mainly an increase on body weight (BW) 17 , and body fat 18 and a decrease on lean body mass 19 , and basal metabolic rate (BMR) 20 . Therefore, improving CRF, MetS factors, and body composition in PW is important to prevent CVD and reduction in mortality risk. Physical exercise such as aerobic exercise, muscle strengthening, flexibility, and balance 21 may prevent CVD for the elderly by favourably improving blood lipids, BW and hypertension 14,22 . The results of emerging physical exercise modes were similar, such as High-Intensity Interval Training, Pilates, tai chi and yoga 22 . For PW, inappropriate physical activities may worsen their musculoskeletal and cardiovascular health 22 . Compared to walking, Nordic Walking (NW) is a safe and popular physical exercise among the elderly with proven health benefits 23,24 . The NW technique with poles involves circular, repetitive and alternative movements of the whole body 25 . In PW, NW has been shown to be effective in improving CRF (VO 2max 23 , HR 23 ), MetS factors (BP 23 , basic lipid 15,26 , fasting blood glucose 26 , and body composition (BW 23 , fat mass 23 ). To improve the effects of NW, a new form of NW has been produced by combining aerobic and strength training - Bungy Pump Training (BPT) 27 . BPT is performed using a modified pole that contains a built-in resistance shock absorber. The elastic band between the two permanent elements in the poles allows for additional resistance, increasing the intensity of training and calorie consumption 27 . The study shows that an 8-week BPT program led to improvements on the femur strength index and VO 2max but not BP in PW 28,29 . A 12-week BPT program induced improvements on cognitive functions and physical performance in the elderly. In contrast, no glucose homeostasis or lipid profile changes were found 30 . Compared with NW, the 8-week BPT resulted in greater improvements in carbohydrate and lipid metabolic indices and cardiorespiratory efficiency in PW 28,31 . In short, BPT improves physical performance in PW but appears to differ in glucose homeostasis or lipid profile. Most BPT studies have been limited by small sample sizes, short trial durations and lack of a control group. In addition, CRF strongly predicts the risk of developing CVD 32 and MetS factors have been linked to elevated risk of CVD 16 , but little has been done regarding CRF and MetS in PW. Given the growing popularity of BPT among the elderly in Europe 33 , further studies are warranted to evaluate its impact on CRF, MetS, and body composition in this population. Therefore, the study aimed to examine the effects of BPT on CRF, MetS factors, and body composition in untrained PW with no previous experience of this sport. We hypothesised that the participants' CRF, MetS factors, and body composition would improve after the intervention. Materials and Methods Study design The study was registered with ClinicalTrals.gov (NCT06781541 on 17/01/2025). The study was a non-randomised controlled trial divided into two parallel groups: a BPT group and a daily activity (DA) group, with an allocation ratio of nearly 1:1. The original allocation ratio of 1:1 was slightly adjusted. Two participants in the control group preferred BPT. Secondly, the study hypothesised that BPT might have a positive effect and the adjustment might maximise the health effect for the participants. The adjusted numbers of both the experimental and control groups satisfied the sample size calculation numbers. This research combined pretest & posttest with a repeated measures design component to capture within-subject changes over time with a quasi-experimental study to assess between-group differences. Participants underwent the same baseline and post-intervention assessments in the laboratory, including body composition, CRF, and MetS factors. Participants underwent a 12-week intervention and were fitted with training monitors for the duration. The study design is detailed in Fig. 1 . Participants Members of the project sent out invitations to participate in the study at the University of the Third Age (UTA) in Gdansk and Gdynia. Recruitment was also carried out in clinics, churches and on local bulletin boards. Each participant underwent a comprehensive medical assessment prior to enrolment in the study. Although an assessment of cognitive function was not used as an eligibility criterion, participants were asked to answer questions independently in a face-to-face interview without external assistance. Untrained PW aged 61–88 years and in menopause for at least 12 months were invited to participate in this study. Exclusion criteria included uncontrolled hypertension, rheumatoid arthritis, type 2 diabetes, current or previous antibiotic and/or antifungal therapy within the past 4 weeks, and contraindications to physical exercise. This study received approval from the Bioethics Committee of the District Medical Chamber in Gdańsk in compliance with the Declaration of Helsinki under procedure number KB-5/22. All the participants were informed about the intervention and possible adverse events before the commencement of the trial and signed an informed consent form. Sample size calculation A power calculation was conducted to estimate the sample size using G * Power (Version 3.1). A recommended appropriate power in this type of research is 0.9. Thus, based on an effect size from previous research 23 . A sample size of at least 18 participants per group was estimated to provide 0.9 statistical power at p < 0.05. Intervention The training program was based on the principles of the health-related training process and the American College of Sport Medicine 21 guidelines for elderly in good health conditions and lasted 12 weeks (3 weekly 60-minute for 36 sessions). Each training session was performed in the following order: 10-minute warm-up, 40-minute BPT, and 10-minute cool-down. Participants in the BPT group participated in training sessions using built-in resistance shock absorber of 4 kg (Slimline Bungy Pump, Sports Progress International AB, Sweden), Participants in the BPT group were trained by a Bungy Pump trainer (Polish Nordic Walking Federation-qualified) and at least two assistants. BPT emphasis was placed on performing correct Bungy Pump techniques. Each training was performed at 75–85% maximal heart rate (HR max ). The maximum heart rate calculation method: HR max = 206 − 0.88 × age 34 . The intensity of sessions during training was monitored using Polar V-800 sports testers (Polar Electro Oy, Finland). Participants performed two 60-minute sessions of correct marching technique before the start of the training. At the beginning of each training session, the participants warmed up for approximately 10 minutes including a versatile exercise with the Bungy Pump pole. The 40-minute BPT consists of approximately 10 minutes of marching alternating with approximately 5 minutes of strength and balance training. Strength and balance training was based on the elastic resistance of the Bungy Pump pole for 8–12 repetitions of each movement. The approximately 10-minute cool-down was completed by static and dynamic flexibility exercises using the Bungy Pump pole. The DA group performed daily activities without additional intervention. Participants in the DA group were involved in normal daily activities appropriate to their age range. Measures and outcomes All the participants were evaluated at baseline and after intervention. The evaluations were performed on two separate days. On the first day, blood samples were collected and preliminary analyses of body composition and dietary records were conducted. On the second day, physical and psychological tests were performed at the Sports Exercise Laboratory in the Gdansk University of Physical Education and Sport. Biological materials were frozen and subsequently tested by contractors at the Sports Genetics Laboratory of Gdansk University of Physical Education and Sport. Given the independence of the intervention and evaluation, the evaluator used a blinded test during the evaluation. Primary outcome Blood samples: Blood samples were collected after a minimum 12-hour overnight fasting 35 . MetS factors: glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT). Heart rate and blood pressure: resting HR, SBP and DBP were assessed after the participant had rested for 15 minutes in a supine position in a temperature-controlled and quiet room by the Omron HEM-907XL device 36 (Omron Healthcare, Inc., IL, USA). VO 2max was estimated using the EKBLOM-BAK test in a laboratory environment. The test method was performed in accordance with standard procedures 37 . The EKBLOM-BAK test is a submaximal cycle ergometry test designed to estimate VO 2max . The testing procedure begins with the calibration of the ergometry cycle according to standard procedures, followed by verifying that the participant has adhered to the pre-test conditions, such as avoiding heavy meals, alcohol, smoking, and intense physical activity for at least 3 hours before the test. Prior to starting the test, the seat and handlebars of the cycle should be properly adjusted, and the participant should be introduced to the Borg's Rating of Perceived Exertion (RPE) scale. In the first phase of the test, the participant begins pedaling for 4 minutes at a standard workload (60 rpm), previously selected to achieve a heart rate of 110–140 bpm. After the 4-minute period, the average heart rate is measured based on four time points (3:15, 3:30, 3:45, and 4:00), and the results are averaged. The resistance is then increased to a higher workload, chosen to allow the participant to further elevate their heart rate and reach the target range. After 2 minutes at the higher workload, the participant is asked to rate their perceived exertion using the RPE scale. If the RPE is less than 10, the resistance is increased by 1 kp, and the RPE is measured again. If the RPE is between 10–11, the resistance is increased by 0.5 kp. If the RPE is between 12–16, the resistance remains unchanged, and the test continues at the same intensity. If the RPE exceeds 17, the test is stopped, and the participant rests for 20 minutes before attempting the test again at a lower intensity. After completing the test, the average heart rate during the 4 minutes at the higher intensity is measured again, and the participant is asked to rate their overall exertion using the RPE scale. Based on the data collected during the test, VO 2max is estimated using a mathematical formula, which differs for men and women. Alternatively, an online application is available to calculate VO 2max based on the test results. The test is designed for individuals aged 20 to 86 years and provides a reliable estimation of VO 2max . Secondary outcome Height was assessed with the participant standing upright barefoot. BW, PBF, VFA, and different parts of Lean Mass, et al. were assessed by the Octapole Bioimpedance InBody 720 analyzer (Biospace, Seoul, South Korea) following standard protocols. Participants wore light clothing without shoes during the measurements. It employs eight contact electrodes on the hands and feet to independently analyze five body segments (left and right upper limbs, trunk, and left and right lower limbs) at multiple frequencies (1, 5, 50, 250, 500, and 1,000 kHz). BMI is calculated as weight/height 2 (kg/m 2 ). Statistical Analyses Data was expressed as mean ± standard deviation (SD) and 95% confidence intervals (95% CI) or median and interquartile range, and data were analysed using SPSS (SPSS Version 27.0, IBM, Chicago, USA). GraphPad Prism 9 (GraphPad Software, San Diego, CA) was used for figure making. Data normality was examined using the Shapiro-Wilk test and visual histogram. Descriptive statistics were used to describe the characteristics of the participants. The t-test and Mann-Whitney U test were used to assess the significance of differences between groups of participants. The t-test and Wilcoxon test were used to test for differences before and after training. A 2 × 2 (group × time) repeated-measures ANOVA was used to assess the effect of training type on time-assessed body composition, CRF, and MetS factors. For interaction effects (“time × group”) and main effects (“time” and “group”), p ≤ 0.05 was statistically significant. Eta-squared (η 2 ) was used to determine effect sizes, with values of 0.02, 0.13 and 0.26 and above considered small, medium and large effect sizes 38 . Results Study population A total of 56 volunteers were selected from an initial pool of 121 women who expressed interest in participating in the study. 56 participants were assigned to the BPT group and the DA group. For personal and other reasons, 3 participants in the BPT group and 2 participants in the DA group dropped out (Figure. 2). Table 1 summarizes the characteristics of all participants. 51 participants (age 69.59 ± 4.80 years, height 159.20 ± 6.31 cm, BW 70.44 ± 11.46 kg and BMI 27.78 ± 4.09) were assessed at baseline. No significant differences were found between the groups in terms of the variables assessed at baseline (Table 1). Table 1. Participants characteristics (n=51) Characteristics BPT Group (n = 27) DA group (n = 24) Age (years) 69.44 ± 5.91 (67.11, 71.78) 69.75 ± 3.26 (68.37, 71.13) Height (cm) 158.26 ± 5.83 (155.95,160.56) 160.25 ± 6.78 (157.39, 163.11) BW (kg) 69.26 ± 10.00 (65.30, 73.21) 71.77 ± 13.00 (66.28, 77.26) BMI 27.60 ± 3.30 (26.30, 28.90) 27.98 ± 4.91 (25.91, 30.05) BMR (kcal/day) 1285.58 ± 99.00 (1246.42,1324.74) 1306.36 ± 97.41 (1265.23, 1347.50) VFA (cm 2 ) 106.53 ± 25.71 (96.36, 116.71) 115.86 ± 38.29 (99.69, 132.03) PBF (%) 38.29 ± 5.91 (35.96, 40.63) 38.46 ± 8.92 (34.69, 42.23) SMM (kg) 22.96 ± 2.75 (21.87, 24.05) 23.43 ± 2.66 (22.31, 24.56) BFM (kg) 26.94 ± 7.16 (24.11, 29.78) 28.40 ± 10.85 (23.82, 32.98) FFM (kg) 42.43 ± 4.57 (40.62, 44.24) 43.28 ± 4.52 (41.37, 45.19) SLM (kg) 39.94 ± 4.38 (38.20, 41.67) 40.91 ± 4.26 (39.11, 42.71) VO 2max (L/min) 2.24 ± 0.24 (2.15, 2.34) 2.32 ± 0.26 (2.21, 2.43) VO 2max (mL/kg/min) 32.68 ± 3.96 (31.12, 34.25) 32.65 ± 5.09 (30.50, 34.80) HR (bpm) 73.61 ± 9.31 (69.93, 77.29) 77.09 ± 11.13 (72.39, 81.79) SBP (mmHg) 128.52 ± 14.35 (122.85, 134.20) 136.86 ± 18.68 (128.97, 144.74) DBP (mmHg) 80.14 ± 8.21 (76.90, 83.39) 80.90 ± 11.75 (75.94, 85.87) Abbreviations—BPT: Bungy Pump Training; DA: Daily Activity; BW: body weight; BMI: body-mass index; BMR: basal metabolic rate; VFA: visceral fat area; PBF: percent body fat; SMM: skeletal muscle mass; BFM: body fat mass; FFM: fat free mass; SLM: skeletal lean mass; VO 2max : maximal oxygen uptake; HR: resting heart rate; SBP: resting systolic blood pressure; DBP: resting diastolic blood pressure. Training Sessions During the training sessions, the distance marched was gradually increased from 2.8 to 3.6km and the average heart rate (HR mean ) for the intensity of the exercise was 114 ± 14 bpm, corresponding to 79% HR max . Primary outcome No significant differences were found on CRF between groups at baseline. A group x time effect (interaction) was observed for VO 2max (L/min), and VO 2max (mL/kg/min). After completing the training program, PW in the BPT group increased VO 2max (L/min) ( p = 0.0001), and VO 2max (mL/kg/min) ( p = 0.0001) by 7.24 ± 6.34% and 9.42 ± 6.45% respectively. A time effect was observed for VO 2max (L/min), and VO 2max (mL/kg/min), and HR. PW in the DA group reduced HR ( p = 0.008) by 4.87 ± 8.45% (Table 2 and Figure 3). No significant differences were found on MetS factors between groups at baseline except ALT and AST. A time effect was observed for SBP, DBP, TC, HDL-C, Non-HDL-C, and LDL-C. PW in BPT group increased HDL-C ( p = 0.009) by 7.39 ± 13.16% and reduced SBP ( p = 0.0001), DBP ( p = 0.0001), TC ( p = 0.005), Non-HDL-C ( p = 0.006), and LDL-C ( p = 0.014) by 6.95 ± 7.43%, 6.92 ± 6.72%, 8.41 ± 17.59%, 8.12 ± 19.57%, and 7.66 ± 23.24% respectively. A group effect was observed for SBP, HDL-C, ALT, and AST. Independent samples t-test showed no significant difference in the values of changes on ALT ( p > 0.05) and AST ( p > 0.05). At the end of the training program, the BPT group showed significant improvement on SBP ( p = 0.009), and HDL-C ( p = 0.016) than the DA group (Table 2 and Figure 3). Secondary outcome No significant differences were found on body composition between groups at baseline. An interaction effect was observed for BMR, VFA, PBF, and BFM. After completing the training program, PW in BPT group increased BMR ( p = 0.006) by 2.16 ± 3.82% and reduced VFA ( p = 0.006), PBF ( p = 0.0001), and BFM ( p = 0.0001) by 7.04 ± 5.00%, 5.26 ± 4.70%, and 6.74 ± 5.89% respectively. PW in DA group reduced VFA ( p = 0.007), PBF ( p = 0.045), and BFM ( p = 0.046) by 2.91 ± 7.81%, 1.55 ± 5.58%, and 1.7 ± 6.99% respectively. A time effect was observed for BW, BMI, BMR, VFA, PBF, SMM, BFM, FFM, SLM, RLLM, and LLLM. PW in BPT group increased SMM ( p = 0.01), FFM ( p = 0.014), SLM ( p = 0.01), RLLM ( p = 0.002), and LLLM ( p = 0.001) by 1.95 ± 3.46%, 1.73 ± 3.22%, 1.65 ± 2.90%, 3.91 ± 5.43%, and 3.76 ± 4.91% and reduced BW, and BMI by 1.98 ± 2.38%, and 1.98 ± 2.37% respectively (Table 2 and Figure 3). Table 2. Body composition, cardiorespiratory fitness, and metabolic syndrome factors at baseline and after 12 weeks of BPT or DA in postmenopausal women (n = 51) BPT Group (n = 27) DA group (n = 24) Two-way ANOVA baseline (95% CI) 12 weeks (95% CI) Change (95% CI) baseline (95% CI) 12 weeks (95% CI) Change (95% CI) Time Group Interaction p (η 2 ) p (η 2 ) p (η 2 ) Body composition BW (kg) 69.26 ± 10.00 (65.30, 73.21) 67.80 ± 9.19* (64.16, 71.43) -1.46 ± 1.95 (-2.23, -0.69) 71.77 ± 13.00 (66.28, 77.26) 71.40 ± 12.95 (65.93, 76.87) -0.37 ± 2.34 (-1.36, 0.62) 0.004 (0.159) 0.337 (0.019) 0.076 (0.063) BMI 27.60 ± 3.30 (26.30, 28.90) 27.02 ± 2.95* (25.85, 28.19) -0.58 ± 0.78 (-0.89, -0.27) 27.98 ± 4.91 (25.91, 30.05) 27.80 ± 4.72 (25.81, 29.80) -0.18 ± 0.85 (-0.54, 0.18) 0.002 (0.184) 0.734 (0.005) 0.083 (0.060) BMR (kcal) 1285.58 ± 99.00 (1246.42, 1324.74) 1312.58 ± 102.95* (1271.85, 1353.30) 27.00 ± 47.10 (8.36, 45.63) 1306.36 ± 97.41 (1265.23, 1347.50) 1309.81 ± 101.36 (1267.01, 1352.61) 3.45 ± 29.16 (-8.86, 15.77) 0.009 (0.132) 0.745 (0.002) 0.040 (0.084) VFA (cm 2 ) 106.53 ± 25.71 (96.36, 116.71) 98.83 ± 23.27* (89.63, 108.04) -7.7 ± 5.96 (-10.06, -5.35) 115.86 ± 38.29 (99.69, 132.03) 111.91 ± 36.29* (96.59, 127.23) -3.95 ± 6.51 (-6.70, -1.2) 0.001 (0.476) 0.183 (0.033) 0.037 (0.086) PBF (%) 38.29 ± 5.91 (35.96, 40.63) 36.21 ± 5.47* (34.05, 38.38) -2.08 ± 1.78 (-2.78, -1.38) 38.46 ± 8.92 (34.69, 42.23) 37.74 ± 8.58* (34.07, 41.40) -0.72 ± 1.67 (-1.43, -0.02) 0.001 (0.405) 0.798 (0.003) 0.007 (0.138) SMM (kg) 22.96 ± 2.75 (21.87, 24.05) 23.38 ± 2.67* (22.32, 24.43) 0.42 ± 0.78 (0.11, 0.73) 23.43 ± 2.66 (22.31, 24.56) 23.58 ± 2.98 (22.33, 24.84) 0.15 ± 1.10 (-0.32, 0.61) 0.037 (0.086) 0.657 (0.004) 0.314 (0.021) BFM (kg) 26.94 ± 7.16 (24.11, 29.78) 25.07 ± 6.60* (22.45, 27.68) -1.88 ± 1.74 (-2.57, -1.19) 28.40 ± 10.85 (23.82, 32.98) 27.76 ± 10.50* (23.33, 32.19) -0.64 ± 1.49 (-1.27, -0.01) 0.001 (0.382) 0.463 (0.014) 0.009 (0.130) FFM (kg) 42.43 ± 4.57 (40.62, 44.24) 43.13 ± 4.58* (41.32, 44.95) 0.70 ± 1.38 (0.16, 1.25) 43.28 ± 4.52 (41.37, 45.19) 43.65 ± 4.72 (41.66, 45.64) 0.37 ± 1.33 (-0.19, 0.93) 0.007 (0.140) 0.596 (0.006) 0.390 (0.015) SLM (kg) 39.94 ± 4.38 (38.20, 41.67) 40.56 ± 4.32* (38.85, 42.27) 0.63 ± 1.17 (0.16, 1.09) 40.91 ± 4.26 (39.11, 42.71) 41.01 ± 5.54 (39.10, 42.93) 0.11 ± 1.23 (-0.41, 0.62) 0.034 (0.089) 0.562 (0.007) 0.128 (0.047) RALM (kg) 2.21 ± 0.36 (2.07, 2.36) 2.20 ± 0.35 (2.07, 2.34) -0.01 ± 0.10 (-0.05, 0.03) 2.34 ± 0.36 (2.20, 2.49) 2.30 ± 0.35 (2.15, 2.45) -0.04 ± 0.12 (-0.09, 0.01) 0.103 (0.053) 0.256 (0.026) 0.340 (0.019) LALM (kg) 2.18 ± 0.37 (2.03, 2.33) 2.17 ± 0.35 (2.03, 2.31) -0.01 ± 0.11 (-0.05, 0.03) 2.29 ± 0.34 (2.14, 2.43) 2.25 ± 0.36 (2.10, 2.40) -0.04 ± 0.12 (-0.09, 0.01) 0.154 (0.041) 0.345 (0.018) 0.403 (0.014) TLM (kg) 19.33 ± 2.21 (18.46, 20.21) 19.18 ± 2.24 (18.29, 20.07) -0.16 ± 0.60 (-0.39, 0.08) 20.00 ± 2.26 (19.04, 20.95) 19.86 ± 2.43 (18.83, 20.88) -0.14 ± 0.68 (-0.43, 0.15) 0.106 (0.052) 0.296 (0.022) 0.931 (0.001) RLLM (kg) 6.20 ± 0.87 (5.86, 6.55) 6.43 ± 0.88* (6.09, 6.78) 0.23 ± 0.34 (0.10, 0.36) 6.35 ± 0.93 (5.96, 6.74) 6.46 ± 1.02 (6.03, 6.89) 0.11 ± 0.25 (0.01, 0.22) 0.001 (0.252) 0.732 (0.002) 0.162 (0.039) LLLM (kg) 6.24 ± 0.87 (5.90, 6.59) 6.47 ± 0.88* (6.12, 6.82) 0.22 ± 0.31 (0.10, 0.25) 6.37 ± 0.95 (5.98, 6.77) 6.53 ± 1.09 (6.07, 6.98) 0.15 ± 0.34 (0.01, 0.29) 0.001 (0.259) 0.719 (0.003) 0.421 (0.013) Cardiorespiratory fitness VO 2max (L/min) 2.24 ± 0.24 (2.15, 2.34) 2.40 ± 0.24* (2.31, 2.49) 0.16 ± 0.14 (0.10, 0.21) 2.32 ± 0.26 (2.21, 2.43) 2.35 ± 0.24 (2.25, 2.45) 0.03 ± 0.19 (-0.05, 0.12) 0.001 (0.253) 0.861 (0.001) 0.012 (0.121) VO 2max (mL/kg/min) 32.68 ± 3.96 (31.12, 34.25) 35.67 ± 4.11* (34.04, 37.30) 2.99 ± 2.14 (2.14, 3.83) 32.65 ± 5.09 (30.50, 34.80) 33.51 ± 5.65 (31.12, 35.89) 0.86 ± 2.97 (-0.40, 2.11) 0.001 (0.369) 0.393 (0.015) 0.005 (0.152) HR (bpm) 73.61 ± 9.31 (69.93, 77.29) 71.85 ± 7.94 (68.71, 74.98) -1.76 ± 6.98 (-4.53, 1.00) 77.09 ± 11.13 (72.39, 81.79) 72.90 ± 9.38 (68.94, 76.86) -4.19 ± 7.01* (-7.15, -1.23) 0.004 (0.158) 0.362 (0.017) 0.222 (0.030) Metabolic syndrome factors SBP (mmHg) 128.52 ± 14.35 (122.85, 134.20) 119.28 ± 13.79* (113.83, 124.73) -9.24 ± 9.66 (-13.06, -5.42) 136.86 ± 18.68 (128.97, 144.74) 130.58 ± 15.93 # (123.84, 137.31) -6.28 ± 16.51 (-13.25, 0.69) 0.001 (0.260) 0.018 (0.110) 0.432 (0.013) DBP (mmHg) 80.14 ± 8.21 (76.90, 83.39) 74.43 ± 8.00* (71.27, 77.60) -5.71 ± 5.67 (-7.95, -3.47) 80.90 ± 11.75 (75.94, 85.87) 78.62 ± 11.30 (73.85, 83.39) -2.28 ± 11.08 (-6.96, 2.40) 0.002 (0.181) 0.353 (0.020) 0.164 (0.039) glucose (mg/dL) 97.00(91.00-107.00) 97.89 ± 10.06 (93.91, 101.87) 0.86 ± 10.15 (-3.16, 4.87) 93.50 (86.50-100.75) 97.50 ± 9.27 (93.59, 101.41) 3.12 ± 9.31 (-0.81, 7.05) 0.153 (0.041) 0.553 (0.007) 0.413 (0.014) TC mg/dL 232.26 ± 63.43 (207.17, 257.35) 205.30 ± 41.47* (188.98, 221.70) -26.96 ± 45.40 (-44.92, -9.00) 218.58 ± 41.46 (201.08, 236.09) 210.50 ± 36.25 (195.19, 225.81) -8.08, 29.85 (-20.69, 4.52) 0.002 (0.174) 0.728 (0.002) 0.090 (0.058) TG (mg/dL) 96.45 ± 26.59 (85.93, 106.96) 88.89 ± 32.26 (76.13, 101.65) -7.56 ± 19.65 (-15.33, 0.22) 98.66 ± 38.81 (82.27, 115.05) 102.83 ± 40.86 (85.58, 120.09) 4.17 ± 29.88 (-8.44, 16.79) 0.631 (0.005) 0.429 (0.016) 0.101 (0.054) HDL-C (mg/dL) 67.72 ± 12.25 (62.87, 72.56) 72.39 ± 13.43* (67.08, 77.70) 4.67 ± 8.61 (1.26, 8.08) 62.08 ± 11.63 (57.16, 66.99) 63.85 ± 10.50 # (59.41, 68.27) 1.77 ± 5.73 (-0.65,4.19) 0.003 (0.164) 0.032 (0.090) 0.169 (0.038) Non-HDL-C (mg/dL) 163.13 ± 56.00 (140.98, 185.28) 144.36 ± 45.71* (126.27, 162.44) -18.78 ± 32.85 (-31.77, -5.78) 156.39 ± 39.15 (139.86, 172.92) 154.23 ± 34.80 (139.54, 168.92) -2.16 ± 29.50 (-14.62, 10.30) 0.021 (0.104) 0.896 (0.001) 0.065 (0.068) LDL-C mg/dL 143.61 ± 52.76 (122.74, 164.48) 125.85 ± 42.34* (109.10, 142.60) -17.76 ± 35.04 (-31.62, -3.90) 134.21 ± 37.93 (118.19, 150.22) 131.54 ± 32.50 (117.82, 145.26) -2.67 ± 28.56 (-14.73, 9.39) 0.028 (0.095) 0.867 (0.001) 0.101 (0.054) ALT (U/L) 22.31 ± 5.71 (20.05, 24.57) 21.78 ± 6.39 (19.25, 24.31) -0.53 ± 4.48 (-2.30, 1.24) 18.33 ± 5.23 # (16.12, 20.54) 18.04 ± 5.21 # (15.84, 20.24) -0.29 ± 4.52 (-2.20, 1.62) 0.518 (0.009) 0.011 (0.124) 0.851 (0.001) AST (U/L) 26.47 ± 4.48 (24.70, 28.24) 26.07 ± 3.70 (24.61, 27.54) -0.39 ± 2.88 (-1.53, 0.75) 19.16 ± 3.25 # (17.79, 20.53) 19.17 ± 4.07 # (17.44, 20.89) 0.01 ± 3.48 (-1.46, 1.48) 0.667 (0.004) 0.001 (0.506) 0.655 (0.004) Abbreviations—BPT: Bungy Pump Training; DA: Daily Activity; BW: body weight; BMI: body-mass index; BMR: basal metabolic rate; VFA: visceral fat area; PBF: percent body fat; SMM: skeletal muscle mass; BFM: body fat mass; FFM: fat free mass; SLM: skeletal lean mass; RALM: right arm lean mass; LALM: left arm lean mass; TLM: trunk lean mass; RLLM: right leg lean mass; LLLM: left leg lean mass; VO 2max : maximal oxygen uptake; HR: heart rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; Non-HDL-C: non-high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; ALT: Alanine Aminotransferas; AST: Aspartate Aminotransferase. * Significantly different from baseline ( p ≤0.05) # Significantly different from the BPT group ( p ≤0.05) Adherence The adherence of participants to the 12-week BPT program was closely monitored to ensure compliance with the protocol and the reliability of the intervention. Of the initial 56 postmenopausal women enrolled in the study, 51 completed the program, resulting in an adherence rate of 91%. 9% of participants discontinued due to unrelated health issues (n=5). Attendance records showed an average participation rate at a satisfactory level. Adverse events No adverse effects were recorded in participants during the program. Participants were required to wear sportswear and were instructed to use Special poles with an elastic resistance of 4 kg, which may have contributed to this result. Discussion The main objective of this study was to examine the effects of a 12-week BPT on CRF, MetS factors, and body composition to assess whether the training can be beneficial to PW. The present study found that 12-week BPT significantly improves VO 2max in CRF, BP, TC, HDL-C, Non-HDL-C, and LDL-C in MetS factors, BW, BMI, BMR, VFA, PBF, SMM, BFM, FFM, SLM, RLLM, and LLLM in body composition among PW. Favourable changes on CRF reduce CVD risk factors and CVD morbidity and mortality 39 . The effect of VO 2max in the present study showed a significant improvement in PW in the BPT group by 7.24% and 9.42% after the intervention, but not in the DA group. A study of 6 months of walking and NW performed 3 times a week conducted by Muollo et al. showed an increase on VO 2max in the elderly with overweight and obesity by 3.14% and 3.91% separately 40 . The metabolism of working muscles of BPT is dominated by a greater proportion of oxygen metabolism compared to NW. Increased mitochondrial content and desaturation of myoglobin on skeletal muscle tissue after exercise increases the oxidative capacity of skeletal muscle and leads to an increase on VO 2max 31,41,42 . In addition, an increase in VO 2max may also be associated with positive changes in cardiac morphology and physiology as well 43 . The result of the present study was superior to the observation of Domaszewska et al 31 . The present study found an increase on VO 2max by 2.99 ± 2.14 in PW, and Domaszewska et al. found an increase in BPT performed twice a week for 8 weeks by 2.40 ± 3.87 31 . It could be seen that increasing training frequency and duration of training may be more effective in increasing VO 2max in PW. Several studies have shown that both walking and NW can significantly reduce HR in PW 44,45 . In the present study, HR was reduced in both groups. DA significantly reduced HR, but the results of BPT were consistent with those of another NW 24 . A decrease in HR may be an indication of improved cardiac regulation. The HR values of the BPT group were less than the DA group’s at baseline, which may explain why there was only a time effect without any significant improvement. CRF is strongly inversely related to MetS 46 . CRF is a key predictor of CVD mortality and Mets is also a protective factor against CVD 47,48 . The present study showed a significant decrease on SBP and DBP by 7.19% and 7.13% separately in the BPT group. Witkowska et al. found that after 3-time NW for 12 weeks, SBP decreased by 0.39%, and DBP increased by 0.8% in women over 55 years of age 24 . It seemed like the BPT was better at improving BP. BPT as a combined exercise, Montelemy et al. also found beneficial effects on arterial stiffness and blood pressure in combined exercise 49 . Secondly, increased sympathetic nerve excitability induces an increase on HR, which increases cardiac output. The present study showed that BPT decreased the HR of PW, which may also contribute to the decrease in BP. The results of meta-analysis by Xi et al. indicate that combined aerobic and resistance exercise can significantly reduce BP in PW 50 . The results of the present study are consistent with those of Xi et al. The present results showed that the SBP of PW in the BPT group was significantly better than that in the DA group after intervention. Exercise intensity is closely related to blood pressure regulation, with moderate intensity exercise effectively affecting SBP 51 . Overall, 12 weeks of BPT was effective in improving BP in PW. However, our fundings indicated no significant improvement on glucose with BPT. Our results are consistent with the results of Rodziewicz-Flis et al. 30 . The improvement in glucose depends largely on the improvement in insulin sensitivity 52 . A study by van Gemert et al. showed that participation in a year-long intervention program of aerobic and strength exercise did not lead to improvements in insulin sensitivity in healthy postmenopausal women 53 . The present study performed 12 weeks of BPT and may require a longer duration to improve blood glucose. In addition, exercise has a more pronounced effect on glucose in diabetics 54 . In contrast, most PW have normal glucose at baseline, which may have a relatively weak effect on the healthy population. After the intervention, the present study found that TC, HDL-C, Non-HDL-C and LDL-C were beneficial in the BPT. Comparing our results with those of another author, 12 weeks of MW (3 training sessions per week for 60 minutes each) also showed improvement on lipids. While some of these parameters were not significant, HDL-C was significantly different between groups 55 . This is consistent with the results of the present study. The effects of exercise may be produced by modifying the activity of enzymes involved in the synthesis, transport and breakdown of lipoproteins 56 . This enhances lipoprotein metabolism to increase cholesterol uptake. TG is affected by various factors such as blood glucose and insulin resistance, which did not change significantly in the present study 57 . BPT, as a combination of aerobic and resistance exercise, involves more muscle groups and increases cardiovascular load than daily activities and may contribute more to HDL-C. Liang et al. concluded that a combination of aerobic and low-resistance exercise maximises HDL-C benefits 58 . More muscle groups are involved in BPT, increasing the load on the upper body, which may stimulate more lipoprotein metabolism and promote improved lipids. In the present study, ALT and AST were found to be within the normal physiological range in the BPT group, although there was no significant change 59 . A similar study found that combined training did not have significant changes in ALT and AST 60 . The 12-month multi-component exercise program improved body composition in PW 61 and reduced the incidence of CVD 62 . The present study also found that BPT could significantly improve BW, BMI, BMR, fat mass and lean mass, except for RALM, LALM and TLM. Several authors examined the effects of 2 weekly BPT for 8 weeks on body composition in postmenopausal women. Huta-Osiecka et al. reported significant improvements on BM, BMI, Fat mass, and PFM following the intervention 28 . Similarly, Domaszewska et al.observed significant reductions in BM and BMI after the intervention, but not on PBM, VFA, FFM, SMM 31 . In contrast, Wochna et al. found no significant improvement on BMI, PBM, lean body mass and BFM after the intervention 63 . This is inconsistent with some of the results of the present study, and it is possible that increasing the duration and frequency of training is more conducive to improvements on body composition. NW training mainly burns fatty acids as a source of muscle ATP and reduces adipose tissue levels when physical exercise is increased 26 . A meta-analysis showed that aerobic training was effective for fat loss, whereas resistance training was effective for muscle gain 3 . BPT provides additional resistance during marching and improves muscle strength through increased muscle activation 27 , which could be considered a viable strategy to improve body composition in PW. BPT, although BPT did not significantly improve RALM, LALM and TLM, resulted in a slower loss of lean body mass than DA. In addition, Grgic et al. found that the gains in muscle strength in the early phase of training in older adults resulted primarily from neural adaptations, whereas muscle hypertrophy or muscle fibre hypertrophy became significant in the later phase 64 . Based on previous trials, BPT seems to be particularly favourable in PW as it is safe and feasible. Adherence to exercise protocol is a major issue in exercise intervention trials. The high rate of adherence in this trial may be largely attributed to the high level of interest in participating in the exercise intervention. BPT, as a new form of NW efficiently improves CRF and Mets factors in PW. With the increasing acceptance and life expectancy of BPT in PW, we believe that further research on BPT is important for different populations for CVD prevention. Strengths of the current study include that taking PW as subjects is important to prevent cardiovascular diseases and maintain their health. BPT, as a modified form of NW, provides a reference for the study of the effects of different exercise forms in PW. The results involve a rather basic but covering the main health parameters of physiological, biochemical and body composition measurements, providing a comprehensive analysis of the health status of PW. The trial has several limitations. The use of randomization based on geographical location also had some limitations. First, although the distances between the cities were relatively small, this method does not fully eliminate the risk of uneven distribution of other variables, such as education level or access to healthcare, which may differ between cities. Additionally, geographical location may introduce some biases related to differences in health habits among residents of different regions, which could affect the overall representativeness of the sample. Despite these limitations, the use of geographical location-based division allowed for controlling environmental variables, which increased the internal validity of the study by minimizing the risk of systematic differences between groups. One of the limitations is that the included population contains both obese and normal-weight PW. However, the weight status of postmenopausal women in real life is diverse. Therefore, the results of the study may be informative in a wider population. The third limitation is the lack of dietary control. However, participants were asked not to change their diet during the training program. Conclusions The present study showed that the 12-week BPT completed 60-minute sessions 3 times a week had a significant effect on CRF, MetS factors and body composition in PW. BPT induced significant increases in VO 2max , HDL-C, BMR, SMM, FFM, SLM, RLLM and LLLM. Moreover, BPT effectively reduced BP, TC, Non-HDL-C, LDL-C, BW, BMI, VFA, PBF and BFM. These results could provide important guidelines for PW to focus more on BPT when undertaking non-pharmacological interventions, especially in improving CRF and MetS in PW without experience of this sport. Abbreviations The following abbreviations are used in this manuscript: ALT Alanine aminotransferase AST Aspartate aminotransferase BMR Basal metabolic rate BP Blood pressure BFM Body fat mass BW Body weight BMI Body-mass index BPT Bungy Bump Training CRF Cardiorespiratory fitness CVD Cardiovascular disease DA Daily Activity DBP Diastolic blood pressure FFM Fat-free mass HR Heart rate HR max maximal heart rate HR mean average heart rate HDL-C High-density lipoprotein cholesterol LALM Left arm lean mass LLLM Left leg lean mass LDL-C Low-density lipoprotein cholesterol VO 2max Maximum oxygen uptake MetS Metabolic syndrome Non-HDL-C Non-high-density lipoprotein cholesterol NW Nordic Walking PBF Percent body fat PW Postmenopausal women RALM Right arm lean mass RLLM Right leg lean mass SLM Skeletal lean mass SMM Skeletal muscle mass SBP Systolic blood pressure TC Total cholesterol TG Triglyceride TLM Trunk lean mass VFA Visceral fat area Declarations Ethical Approval The study was conducted in accordance with the Declaration of Helsinki, and approved by the Bioethics Committee of the District Medical Chamber in Gdansk (protocol code KB-5/22). Informed Consent Statement : Written informed consent has been obtained from the patient(s) to publish this paper. Registration number of the clinical trial: NCT06781541. Competing Interest: The authors declare no competing interest. Funding This research received no external funding. Author Contribution Conceptualization, Y.N. and Z.O.; methodology, Y.N. and Z.O.; formal analysis, Y.N.; investigation, Y.N., L.R., G.Q., and Z.O.; resources, Z.O.; data curation, Y.N. and Z.O.; writing—original draft preparation, Y.N.; writing—review and editing, Y.N., G.Q. and Z.O.; supervision, G.Q., A.S. and Z.O.; project administration, Z.O. Acknowledgement We would like to thank the staff of Gdansk University of Physical Education and Sport for their help in organizing the study. Data Availability Data from this study are provided in the manuscript and can also be obtained by contacting the authors. References Foreman, K. J. et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet 392 , 2052–2090 (2018). Roth, G. A. et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019. Journal of the American College of Cardiology 76 , 2982–3021 (2020). Khalafi, M. et al. The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 14 , 1183765 (2023). Stojanovska, L., Apostolopoulos, V., Polman, R. & Borkoles, E. To exercise, or, not to exercise, during menopause and beyond. Maturitas 77 , 318–323 (2014). Wang, X., Han, Y., Li, H., Wang, X. & Wang, G. Impact of a Precision Intervention for Vascular Health in Middle-Aged and Older Postmenopausal Women Using Polar Heart Rate Sensors: A 24-Week RCT Study Based on the New Compilation of Tai Chi (Bafa Wubu). Sensors (Basel) 24 , 5832 (2024). Lobo, R. A. et al. Metabolic and cardiovascular effects of TX-001HR in menopausal women with vasomotor symptoms. Climacteric 22 , 610–616 (2019). Chodzko-Zajko, W. J. et al. Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise 41 , 1510 (2009). Jo, E.-A. et al. Effects of exergaming in postmenopausal women with high cardiovascular risk: A randomized controlled trial. Clin Cardiol 43 , 363–370 (2020). Carr, M. C. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88 , 2404–2411 (2003). Torréns, J. I. et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: study of Women’s Health Across the Nation. Menopause 16 , 257–264 (2009). Friedenreich, C. M. et al. Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial. Int J Obes (Lond) 35 , 427–435 (2011). Irwin, M. L. et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. JAMA 289 , 323–330 (2003). Hsia, J. et al. Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study. BMJ 338 , b219 (2009). Chrysant, S. G. The cardiometabolic benefits of exercise in postmenopausal women. J Clin Hypertens (Greenwich) 22 , 1691–1693 (2020). Hagner-Derengowska, M. et al. The influence of a ten-week Nordic walking training-rehabilitation program on the level of lipids in blood in overweight and obese postmenopausal women. J Phys Ther Sci 27 , 3039–3044 (2015). Tune, J. D., Goodwill, A. G., Sassoon, D. J. & Mather, K. J. Cardiovascular Consequences of Metabolic Syndrome. Transl Res 183 , 57–70 (2017). Abdulnour, J. et al. The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study. Menopause 19 , 760–767 (2012). Santosa, S. & Jensen, M. D. Adipocyte Fatty Acid Storage Factors Enhance Subcutaneous Fat Storage in Postmenopausal Women. Diabetes 62 , 775–782 (2013). Abildgaard, J. et al. Menopause is associated with decreased whole body fat oxidation during exercise. American Journal of Physiology-Endocrinology and Metabolism 304 , E1227–E1236 (2013). Elliott, K. J., Sale, C. & Cable, N. T. Effects of resistance training and detraining on muscle strength and blood lipid profiles in postmenopausal women. Br J Sports Med 36 , 340–344 (2002). Nelson, M. E. et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39 , 1435–1445 (2007). Mendoza, N. et al. Benefits of physical exercise in postmenopausal women. Maturitas 93 , 83–88 (2016). Cebula, A. et al. Physiological response and cardiorespiratory adaptation after a 6-week Nordic Walking training targeted at lipid oxidation in a group of post-menopausal women. PLoS One 15 , e0230917 (2020). Witkowska, A., Grabara, M., Kopeć, D. & Nowak, Z. The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age. J Phys Act Health 18 , 669–676 (2021). Marciniak, K., Maciaszek, J., Cyma-Wejchenig, M., Szeklicki, R. & Stemplewski, R. The Effect of Nordic Walking Training with Poles with an Integrated Resistance Shock Absorber on the Body Balance of Women over the Age of 60. Healthcare (Basel) 9 , 267 (2021). Pilch, W. B. et al. The influence of a 12-week program of physical activity on changes in body composition and lipid and carbohydrate status in postmenopausal women. Prz Menopauzalny 14 , 231–237 (2015). Marciniak, K. et al. The Effect of Nordic Walking Training with Poles with an Integrated Resistance Shock Absorber on the Functional Fitness of Women over the Age of 60. Int J Environ Res Public Health 17 , 2197 (2020). Huta-Osiecka, A. et al. Influence of Nordic walking with poles with an integrated resistance shock absorber on carbohydrate and lipid metabolic indices and white blood cell subpopulations in postmenopausal women. PeerJ 10 , e13643 (2022). Sobczak, K., Nowinka, P., Wochna, K. & Domaszewska, K. The Effects of Nordic Walking with Poles with an Integrated Resistance Shock Absorber on Red Blood Cell Distribution and Cardiorespiratory Efficiency in Postmenopausal Women-A Randomized Controlled Trial. Biology (Basel) 12 , 179 (2023). Rodziewicz-Flis, E. et al. Nordic Walking training in BungyPump form improves cognitive functions and physical performance and induces changes in amino acids and kynurenine profiles in older adults. Front Endocrinol (Lausanne) 14 , 1151184 (2023). Domaszewska, K. et al. The Effects of Nordic Walking With Poles With an Integrated Resistance Shock Absorber on Cognitive Abilities and Cardiopulmonary Efficiency in Postmenopausal Women. Front Aging Neurosci 12 , 586286 (2020). Kodama, S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301 , 2024–2035 (2009). Skórkowska-Telichowska, K. et al. Nordic walking in the second half of life. Aging Clinical and Experimental Research 28 , (2016). Mansur, A. J. & Nunes, R. A. B. Heart rate response and chronotropic incompetence in exercise stress testing of asymptomatic women. Womens Health (Lond) 6 , 785–787 (2010). Liu, Y. et al. Relationship between physical activity and abdominal obesity and metabolic markers in postmenopausal women. Sci Rep 14 , 26496 (2024). Mancia, G. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31 , 1281–1357 (2013). Ekblom-Bak, E., Björkman, F., Hellenius, M.-L. & Ekblom, B. A new submaximal cycle ergometer test for prediction of VO2max. Scand J Med Sci Sports 24 , 319–326 (2014). Boutcher, Y. N., Boutcher, S. H., Yoo, H. Y. & Meerkin, J. D. The Effect of Sprint Interval Training on Body Composition of Postmenopausal Women. Med Sci Sports Exerc 51 , 1413–1419 (2019). Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T. & Blair, S. N. Sedentary Behavior, Exercise, and Cardiovascular Health. Circ Res 124 , 799–815 (2019). Muollo, V. et al. Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial. Nutrition, Metabolism and Cardiovascular Diseases 31 , 1247–1256 (2021). Harber, M. P. et al. Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009. Prog Cardiovasc Dis 60 , 11–20 (2017). Pinckard, K., Baskin, K. K. & Stanford, K. I. Effects of Exercise to Improve Cardiovascular Health. Front Cardiovasc Med 6 , 69 (2019). Lavie, C. J. et al. Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes. Circ Res 117 , 207–219 (2015). Pilch, W. et al. Effects of 6-week Nordic walking training on changes in 25(OH)D blood concentration in women after 55 years of age. The Journal of sports medicine and physical fitness 57 , (2016). Güzel, Y., Atakan, M. M., Turnagöl, H. H. & Koşar, Ş. N. Effects of 10 weeks of walking-based exercise training on resting substrate oxidation in postmenopausal women with obesity. Eur J Clin Nutr 1–9 (2024) doi:10.1038/s41430-024-01546-1. Earnest, C. P. et al. Maximal Estimated Cardiorespiratory Fitness, Cardiometabolic Risk Factors, and Metabolic Syndrome in the Aerobics Center Longitudinal Study. Mayo Clinic Proceedings 88 , 259–270 (2013). Singh, B. et al. Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations. J Sport Health Sci 14 , 100986 (2024). Wu, Z. et al. The causal relationship between metabolic syndrome and its components and cardiovascular disease: A mendelian randomization study. Diabetes Research and Clinical Practice 211 , 111679 (2024). Montero, D., Vinet, A. & Roberts, C. K. Effect of combined aerobic and resistance training versus aerobic training on arterial stiffness. Int J Cardiol 178 , 69–76 (2015). Xi, H. et al. Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Experimental Gerontology 155 , 111560 (2021). Ross, R., Hudson, R., Stotz, P. J. & Lam, M. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: a randomized trial. Ann Intern Med 162 , 325–334 (2015). Czech, M. P. Insulin action and resistance in obesity and type 2 diabetes. Nat Med 23 , 804–814 (2017). van Gemert, W. A., Monninkhof, E. M., May, A. M., Peeters, P. H. & Schuit, A. J. Effect of Exercise on Insulin Sensitivity in Healthy Postmenopausal Women: The SHAPE Study. Cancer Epidemiology, Biomarkers & Prevention 24 , 81–87 (2015). Arsenault, B. J. & Després, J.-P. Physical Activity for Type 2 Diabetes Prevention: Some Is Better Than None, More Is Better, and Earliest Is Best. Diabetes Care 46 , 1132–1134 (2023). Pospieszna, B. et al. Influence of 12-week Nordic Walking training on biomarkers of endothelial function in healthy postmenopausal women. J Sports Med Phys Fitness 57 , 1178–1185 (2017). Muscella, A., Stefàno, E. & Marsigliante, S. The effects of exercise training on lipid metabolism and coronary heart disease. American Journal of Physiology-Heart and Circulatory Physiology 319 , H76–H88 (2020). Justesen, J. M. et al. Increasing insulin resistance accentuates the effect of triglyceride-associated loci on serum triglycerides during 5 years. J Lipid Res 57 , 2193–2199 (2016). Liang, M., Pan, Y., Zhong, T., Zeng, Y. & Cheng, A. S. K. Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. Rev Cardiovasc Med 22 , 1523–1533 (2021). Clayton-Chubb, D. et al. Serum Transaminases and Older Adults: Distribution and Associations With All-Cause Mortality. J Gerontol A Biol Sci Med Sci 79 , glae203 (2024). Hejazi, K. & Hackett, D. Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 12 , 3011 (2023). Aragão, F. R. et al. Effects of a 12-month multi-component exercise program on the body composition of postmenopausal women. Climacteric 17 , 155–163 (2014). Srikanthan, P., Horwich, T. B. & Tseng, C. H. Relation of Muscle Mass and Fat Mass to Cardiovascular Disease Mortality. Am J Cardiol 117 , 1355–1360 (2016). Wochna, K. et al. Nordic walking with an integrated resistance shock absorber affects the femur strength and muscles torques in postmenopausal women. Sci Rep 12 , 20089 (2022). Grgic, J. et al. Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 50 , 1983–1999 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 24 Jun, 2025 Reviews received at journal 23 Jun, 2025 Reviews received at journal 22 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 10 Jun, 2025 Editor invited by journal 19 Mar, 2025 Submission checks completed at journal 17 Mar, 2025 First submitted to journal 25 Feb, 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-6108479","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":470771517,"identity":"92080d69-0eb1-467b-8c81-7e7e9c281225","order_by":0,"name":"Yiantao Niu","email":"","orcid":"","institution":"Gdansk University of Physical Education and Sport","correspondingAuthor":false,"prefix":"","firstName":"Yiantao","middleName":"","lastName":"Niu","suffix":""},{"id":470771518,"identity":"15831b91-4fb9-4865-aed8-9355e5b16c6d","order_by":1,"name":"Łukasz Radzimiński","email":"","orcid":"","institution":"Gdansk University of Physical Education and Sport","correspondingAuthor":false,"prefix":"","firstName":"Łukasz","middleName":"","lastName":"Radzimiński","suffix":""},{"id":470771519,"identity":"a724e82e-3ed7-406b-ab7d-e0f58a4ebfbd","order_by":2,"name":"Guoping Qian","email":"","orcid":"","institution":"Gdansk University of Physical Education and Sport","correspondingAuthor":false,"prefix":"","firstName":"Guoping","middleName":"","lastName":"Qian","suffix":""},{"id":470771520,"identity":"f7b982d5-eb36-43e4-9079-5ce1a9f633d8","order_by":3,"name":"Andrzej Szwarc","email":"","orcid":"","institution":"Gdansk University of Physical Education and Sport","correspondingAuthor":false,"prefix":"","firstName":"Andrzej","middleName":"","lastName":"Szwarc","suffix":""},{"id":470771521,"identity":"b4c00aa8-2d7c-439c-9759-aec08968fd65","order_by":4,"name":"Zbigniew Ossowski","email":"data:image/png;base64,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","orcid":"","institution":"Gdansk University of Physical Education and Sport","correspondingAuthor":true,"prefix":"","firstName":"Zbigniew","middleName":"","lastName":"Ossowski","suffix":""}],"badges":[],"createdAt":"2025-02-25 23:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6108479/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6108479/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-25909-1","type":"published","date":"2025-11-25T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84809638,"identity":"b1949b3a-391d-41ac-bc07-d099ad64bda8","added_by":"auto","created_at":"2025-06-17 14:42:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144818,"visible":true,"origin":"","legend":"\u003cp\u003eStudy design\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6108479/v1/02bfec87f03dfe62d43335fa.png"},{"id":84809637,"identity":"13374626-4eb6-4778-8f2b-49556572fa26","added_by":"auto","created_at":"2025-06-17 14:42:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71002,"visible":true,"origin":"","legend":"\u003cp\u003eTREND diagram of the study procedures\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6108479/v1/d9124da955592a8b247c493b.png"},{"id":84809642,"identity":"6eadd3c6-d66f-4aee-85f9-393fbfc91dac","added_by":"auto","created_at":"2025-06-17 14:42:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10264051,"visible":true,"origin":"","legend":"\u003cp\u003eBody composition, cardiorespiratory fitness, and metabolic syndrome factors at baseline and after 12 weeks of BPT or DA in postmenopausal women. \u003cstrong\u003eA-1\u003c/strong\u003e:body weight; \u003cstrong\u003eA-2\u003c/strong\u003e: body-mass index; \u003cstrong\u003eA-3\u003c/strong\u003e: basal metabolic rate; \u003cstrong\u003eA-4\u003c/strong\u003e: visceral fat area; \u003cstrong\u003eA-5\u003c/strong\u003e: percent body fat; \u003cstrong\u003eA-6\u003c/strong\u003e: skeletal muscle mass; \u003cstrong\u003eA-7:\u003c/strong\u003e body fat mass; \u003cstrong\u003eA-8\u003c/strong\u003e: fat-free mass; \u003cstrong\u003eA-9\u003c/strong\u003e: skeletal lean mass; \u003cstrong\u003eA-10\u003c/strong\u003e: right arm lean mass; \u003cstrong\u003eA-11\u003c/strong\u003e: left arm lean mass; \u003cstrong\u003eA-12\u003c/strong\u003e: trunk lean mass; \u003cstrong\u003eA-13\u003c/strong\u003e: right leg lean mass; \u003cstrong\u003eA-14\u003c/strong\u003e: left leg lean mass; \u003cstrong\u003eB-1\u003c/strong\u003e: maximal oxygen uptake(L/min); \u003cstrong\u003eB-2\u003c/strong\u003e: maximal oxygen uptake (mL/kg/min); \u003cstrong\u003eB-3\u003c/strong\u003e: heart rate; \u003cstrong\u003eC-1\u003c/strong\u003e: systolic blood pressure; \u003cstrong\u003eC-2\u003c/strong\u003e: diastolic blood pressure; \u003cstrong\u003eC-3\u003c/strong\u003e: glucose; \u003cstrong\u003eC-4\u003c/strong\u003e: total cholesterol; \u003cstrong\u003eC-5\u003c/strong\u003e: triglyceride; \u003cstrong\u003eC-6\u003c/strong\u003e: high-density lipoprotein cholesterol; \u003cstrong\u003eC-7\u003c/strong\u003e: non-high-density lipoprotein cholesterol; \u003cstrong\u003eC-8\u003c/strong\u003e: low-density lipoprotein cholesterol; \u003cstrong\u003eC-9\u003c/strong\u003e: Alanine Aminotransferas; \u003cstrong\u003eC-10\u003c/strong\u003e: Aspartate Aminotransferase.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6108479/v1/4cc894b1c87100cf5fea1db8.png"},{"id":97178799,"identity":"555fce74-aee2-4f4e-9be4-018804ab3506","added_by":"auto","created_at":"2025-12-01 16:13:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":10490619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6108479/v1/67a29e64-47a3-4bf6-b0fd-15606664d2be.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of a 12-week Bungy Pump Training on cardiorespiratory fitness, metabolic syndrome factors and body composition in postmenopausal women","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eBy 2040, global female life expectancy is projected to increase by 4.4 years (2.1\u0026ndash;6.4 years) to 79.7 years (77.4\u0026ndash;81.8 years)\u003csup\u003e1\u003c/sup\u003e. Aging is accompanied by metabolic risks associated with worsening cardiovascular disease (CVD), such as high blood pressure, high body mass index (BMI), and high fasting glucose\u003csup\u003e1\u003c/sup\u003e. CVD is the leading cause of death globally\u003csup\u003e1,2\u003c/sup\u003e, with total incidence increasing from 271\u0026nbsp;million cases (257\u0026ndash;285) in 1990 to 523\u0026nbsp;million cases (497\u0026ndash;550) in 2019\u003csup\u003e2\u003c/sup\u003e. Postmenopausal women (PW) experience a decline in estrogen levels\u003csup\u003e3\u003c/sup\u003e and an increased risk of CVD with age\u003csup\u003e4\u003c/sup\u003e, potentially exceeding that of men\u003csup\u003e5\u003c/sup\u003e. The American Heart Association (AHA) found that 70% of PW will develop CVD\u003csup\u003e6\u003c/sup\u003e, experiencing a low level of cardiorespiratory fitness (CRF)\u003csup\u003e7,8\u003c/sup\u003e, an increased risk of metabolic syndrome (MetS)\u003csup\u003e9,10\u003c/sup\u003e and an adverse body composition\u003csup\u003e11,12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdverse CRF changes are mainly characterized by decreased maximum oxygen uptake (VO\u003csub\u003e2max\u003c/sub\u003e) and increased resting heart rate (HR)\u003csup\u003e7,13\u003c/sup\u003e. MetS factors are reflected in unfavourable changes on blood pressure (BP), glucose, and lipid metabolic indices\u003csup\u003e14\u0026ndash;16\u003c/sup\u003e. Body composition is mainly an increase on body weight (BW)\u003csup\u003e17\u003c/sup\u003e, and body fat\u003csup\u003e18\u003c/sup\u003e and a decrease on lean body mass\u003csup\u003e19\u003c/sup\u003e, and basal metabolic rate (BMR)\u003csup\u003e20\u003c/sup\u003e. Therefore, improving CRF, MetS factors, and body composition in PW is important to prevent CVD and reduction in mortality risk.\u003c/p\u003e \u003cp\u003ePhysical exercise such as aerobic exercise, muscle strengthening, flexibility, and balance\u003csup\u003e21\u003c/sup\u003e may prevent CVD for the elderly by favourably improving blood lipids, BW and hypertension\u003csup\u003e14,22\u003c/sup\u003e. The results of emerging physical exercise modes were similar, such as High-Intensity Interval Training, Pilates, tai chi and yoga\u003csup\u003e22\u003c/sup\u003e. For PW, inappropriate physical activities may worsen their musculoskeletal and cardiovascular health\u003csup\u003e22\u003c/sup\u003e. Compared to walking, Nordic Walking (NW) is a safe and popular physical exercise among the elderly with proven health benefits\u003csup\u003e23,24\u003c/sup\u003e. The NW technique with poles involves circular, repetitive and alternative movements of the whole body\u003csup\u003e25\u003c/sup\u003e. In PW, NW has been shown to be effective in improving CRF (VO\u003csub\u003e2max\u003c/sub\u003e\u003csup\u003e23\u003c/sup\u003e, HR\u003csup\u003e23\u003c/sup\u003e), MetS factors (BP\u003csup\u003e23\u003c/sup\u003e, basic lipid\u003csup\u003e15,26\u003c/sup\u003e, fasting blood glucose\u003csup\u003e26\u003c/sup\u003e, and body composition (BW\u003csup\u003e23\u003c/sup\u003e, fat mass\u003csup\u003e23\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eTo improve the effects of NW, a new form of NW has been produced by combining aerobic and strength training - Bungy Pump Training (BPT)\u003csup\u003e27\u003c/sup\u003e. BPT is performed using a modified pole that contains a built-in resistance shock absorber. The elastic band between the two permanent elements in the poles allows for additional resistance, increasing the intensity of training and calorie consumption\u003csup\u003e27\u003c/sup\u003e. The study shows that an 8-week BPT program led to improvements on the femur strength index and VO\u003csub\u003e2max\u003c/sub\u003e but not BP in PW\u003csup\u003e28,29\u003c/sup\u003e. A 12-week BPT program induced improvements on cognitive functions and physical performance in the elderly. In contrast, no glucose homeostasis or lipid profile changes were found\u003csup\u003e30\u003c/sup\u003e. Compared with NW, the 8-week BPT resulted in greater improvements in carbohydrate and lipid metabolic indices and cardiorespiratory efficiency in PW\u003csup\u003e28,31\u003c/sup\u003e. In short, BPT improves physical performance in PW but appears to differ in glucose homeostasis or lipid profile. Most BPT studies have been limited by small sample sizes, short trial durations and lack of a control group. In addition, CRF strongly predicts the risk of developing CVD\u003csup\u003e32\u003c/sup\u003e and MetS factors have been linked to elevated risk of CVD\u003csup\u003e16\u003c/sup\u003e, but little has been done regarding CRF and MetS in PW. Given the growing popularity of BPT among the elderly in Europe\u003csup\u003e33\u003c/sup\u003e, further studies are warranted to evaluate its impact on CRF, MetS, and body composition in this population.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eTherefore, the study aimed to examine the effects of BPT on CRF, MetS factors, and body composition in untrained PW with no previous experience of this sport. We hypothesised that the participants' CRF, MetS factors, and body composition would improve after the intervention.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe study was registered with ClinicalTrals.gov (NCT06781541 on 17/01/2025). The study was a non-randomised controlled trial divided into two parallel groups: a BPT group and a daily activity (DA) group, with an allocation ratio of nearly 1:1. The original allocation ratio of 1:1 was slightly adjusted. Two participants in the control group preferred BPT. Secondly, the study hypothesised that BPT might have a positive effect and the adjustment might maximise the health effect for the participants. The adjusted numbers of both the experimental and control groups satisfied the sample size calculation numbers. This research combined pretest \u0026amp; posttest with a repeated measures design component to capture within-subject changes over time with a quasi-experimental study to assess between-group differences. Participants underwent the same baseline and post-intervention assessments in the laboratory, including body composition, CRF, and MetS factors. Participants underwent a 12-week intervention and were fitted with training monitors for the duration. The study design is detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e Members of the project sent out invitations to participate in the study at the University of the Third Age (UTA) in Gdansk and Gdynia. Recruitment was also carried out in clinics, churches and on local bulletin boards. Each participant underwent a comprehensive medical assessment prior to enrolment in the study. Although an assessment of cognitive function was not used as an eligibility criterion, participants were asked to answer questions independently in a face-to-face interview without external assistance. Untrained PW aged 61\u0026ndash;88 years and in menopause for at least 12 months were invited to participate in this study. Exclusion criteria included uncontrolled hypertension, rheumatoid arthritis, type 2 diabetes, current or previous antibiotic and/or antifungal therapy within the past 4 weeks, and contraindications to physical exercise.\u003c/p\u003e\u003cp\u003e This study received approval from the Bioethics Committee of the District Medical Chamber in Gdańsk in compliance with the Declaration of Helsinki under procedure number KB-5/22. All the participants were informed about the intervention and possible adverse events before the commencement of the trial and signed an informed consent form.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA power calculation was conducted to estimate the sample size using G * Power (Version 3.1). A recommended appropriate power in this type of research is 0.9. Thus, based on an effect size from previous research\u003csup\u003e23\u003c/sup\u003e. A sample size of at least 18 participants per group was estimated to provide 0.9 statistical power at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe training program was based on the principles of the health-related training process and the American College of Sport Medicine\u003csup\u003e21\u003c/sup\u003e guidelines for elderly in good health conditions and lasted 12 weeks (3 weekly 60-minute for 36 sessions). Each training session was performed in the following order: 10-minute warm-up, 40-minute BPT, and 10-minute cool-down. Participants in the BPT group participated in training sessions using built-in resistance shock absorber of 4 kg (Slimline Bungy Pump, Sports Progress International AB, Sweden), Participants in the BPT group were trained by a Bungy Pump trainer (Polish Nordic Walking Federation-qualified) and at least two assistants. BPT emphasis was placed on performing correct Bungy Pump techniques. Each training was performed at 75\u0026ndash;85% maximal heart rate (HR\u003csub\u003emax\u003c/sub\u003e). The maximum heart rate calculation method: HR\u003csub\u003emax\u003c/sub\u003e= 206\u0026thinsp;\u0026minus;\u0026thinsp;0.88 \u0026times; age\u003csup\u003e34\u003c/sup\u003e. The intensity of sessions during training was monitored using Polar V-800 sports testers (Polar Electro Oy, Finland).\u003c/p\u003e\u003cp\u003eParticipants performed two 60-minute sessions of correct marching technique before the start of the training. At the beginning of each training session, the participants warmed up for approximately 10 minutes including a versatile exercise with the Bungy Pump pole. The 40-minute BPT consists of approximately 10 minutes of marching alternating with approximately 5 minutes of strength and balance training. Strength and balance training was based on the elastic resistance of the Bungy Pump pole for 8\u0026ndash;12 repetitions of each movement. The approximately 10-minute cool-down was completed by static and dynamic flexibility exercises using the Bungy Pump pole.\u003c/p\u003e\u003cp\u003eThe DA group performed daily activities without additional intervention. Participants in the DA group were involved in normal daily activities appropriate to their age range.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eMeasures and outcomes\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAll the participants were evaluated at baseline and after intervention. The evaluations were performed on two separate days. On the first day, blood samples were collected and preliminary analyses of body composition and dietary records were conducted. On the second day, physical and psychological tests were performed at the Sports Exercise Laboratory in the Gdansk University of Physical Education and Sport. Biological materials were frozen and subsequently tested by contractors at the Sports Genetics Laboratory of Gdansk University of Physical Education and Sport. Given the independence of the intervention and evaluation, the evaluator used a blinded test during the evaluation.\u003c/p\u003e \u003cp\u003ePrimary outcome\u003c/p\u003e \u003cp\u003eBlood samples: Blood samples were collected after a minimum 12-hour overnight fasting\u003csup\u003e35\u003c/sup\u003e. MetS factors: glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT).\u003c/p\u003e \u003cp\u003eHeart rate and blood pressure: resting HR, SBP and DBP were assessed after the participant had rested for 15 minutes in a supine position in a temperature-controlled and quiet room by the Omron HEM-907XL device\u003csup\u003e36\u003c/sup\u003e (Omron Healthcare, Inc., IL, USA).\u003c/p\u003e \u003cp\u003eVO\u003csub\u003e2max\u003c/sub\u003e was estimated using the EKBLOM-BAK test in a laboratory environment. The test method was performed in accordance with standard procedures\u003csup\u003e37\u003c/sup\u003e. The EKBLOM-BAK test is a submaximal cycle ergometry test designed to estimate VO\u003csub\u003e2max\u003c/sub\u003e. The testing procedure begins with the calibration of the ergometry cycle according to standard procedures, followed by verifying that the participant has adhered to the pre-test conditions, such as avoiding heavy meals, alcohol, smoking, and intense physical activity for at least 3 hours before the test. Prior to starting the test, the seat and handlebars of the cycle should be properly adjusted, and the participant should be introduced to the Borg's Rating of Perceived Exertion (RPE) scale.\u003c/p\u003e \u003cp\u003eIn the first phase of the test, the participant begins pedaling for 4 minutes at a standard workload (60 rpm), previously selected to achieve a heart rate of 110\u0026ndash;140 bpm. After the 4-minute period, the average heart rate is measured based on four time points (3:15, 3:30, 3:45, and 4:00), and the results are averaged. The resistance is then increased to a higher workload, chosen to allow the participant to further elevate their heart rate and reach the target range. After 2 minutes at the higher workload, the participant is asked to rate their perceived exertion using the RPE scale. If the RPE is less than 10, the resistance is increased by 1 kp, and the RPE is measured again. If the RPE is between 10\u0026ndash;11, the resistance is increased by 0.5 kp. If the RPE is between 12\u0026ndash;16, the resistance remains unchanged, and the test continues at the same intensity. If the RPE exceeds 17, the test is stopped, and the participant rests for 20 minutes before attempting the test again at a lower intensity.\u003c/p\u003e \u003cp\u003eAfter completing the test, the average heart rate during the 4 minutes at the higher intensity is measured again, and the participant is asked to rate their overall exertion using the RPE scale. Based on the data collected during the test, VO\u003csub\u003e2max\u003c/sub\u003e is estimated using a mathematical formula, which differs for men and women. Alternatively, an online application is available to calculate VO\u003csub\u003e2max\u003c/sub\u003e based on the test results.\u003c/p\u003e \u003cp\u003eThe test is designed for individuals aged 20 to 86 years and provides a reliable estimation of VO\u003csub\u003e2max\u003c/sub\u003e.\u003c/p\u003e \u003cp\u003eSecondary outcome\u003c/p\u003e \u003cp\u003eHeight was assessed with the participant standing upright barefoot. BW, PBF, VFA, and different parts of Lean Mass, et al. were assessed by the Octapole Bioimpedance InBody 720 analyzer (Biospace, Seoul, South Korea) following standard protocols. Participants wore light clothing without shoes during the measurements. It employs eight contact electrodes on the hands and feet to independently analyze five body segments (left and right upper limbs, trunk, and left and right lower limbs) at multiple frequencies (1, 5, 50, 250, 500, and 1,000 kHz). BMI is calculated as weight/height\u003csup\u003e2\u003c/sup\u003e (kg/m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eData was expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and 95% confidence intervals (95% CI) or median and interquartile range, and data were analysed using SPSS (SPSS Version 27.0, IBM, Chicago, USA). GraphPad Prism 9 (GraphPad Software, San Diego, CA) was used for figure making. Data normality was examined using the Shapiro-Wilk test and visual histogram. Descriptive statistics were used to describe the characteristics of the participants. The t-test and Mann-Whitney U test were used to assess the significance of differences between groups of participants. The t-test and Wilcoxon test were used to test for differences before and after training. A 2 \u0026times; 2 (group \u0026times; time) repeated-measures ANOVA was used to assess the effect of training type on time-assessed body composition, CRF, and MetS factors. For interaction effects (\u0026ldquo;time \u0026times; group\u0026rdquo;) and main effects (\u0026ldquo;time\u0026rdquo; and \u0026ldquo;group\u0026rdquo;), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05 was statistically significant. Eta-squared (η\u003csup\u003e2\u003c/sup\u003e) was used to determine effect sizes, with values of 0.02, 0.13 and 0.26 and above considered small, medium and large effect sizes\u003csup\u003e38\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eStudy population\u003c/p\u003e\n\u003cp\u003eA total of 56 volunteers were selected from an initial pool of 121 women who expressed interest in participating in the study. 56 participants were assigned to the BPT group and the DA group. For personal and other reasons, 3 participants in the BPT group and 2 participants in the DA group dropped out (Figure. 2). Table 1 summarizes the characteristics of all participants. 51 participants (age 69.59\u0026nbsp;\u0026plusmn; 4.80\u0026nbsp;years, height 159.20 \u0026plusmn; 6.31 cm, BW 70.44 \u0026plusmn; 11.46 kg and BMI 27.78 \u0026plusmn; 4.09) were\u0026nbsp;assessed at baseline. No significant differences were found between the groups in terms of the variables assessed at baseline (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eParticipants characteristics (n=51)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eBPT Group (n = 27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eDA group (n = 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e69.44 \u0026plusmn;\u0026nbsp;5.91 (67.11, 71.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e69.75 \u0026plusmn; 3.26 (68.37, 71.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e158.26 \u0026plusmn; 5.83 (155.95,160.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e160.25 \u0026plusmn; 6.78 (157.39, 163.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eBW (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e69.26 \u0026plusmn; 10.00 (65.30, 73.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e71.77 \u0026plusmn; 13.00 (66.28, 77.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e27.60 \u0026plusmn; 3.30 (26.30, 28.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e27.98 \u0026plusmn; 4.91 (25.91, 30.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eBMR (kcal/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e1285.58 \u0026plusmn; 99.00 (1246.42,1324.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e1306.36 \u0026plusmn; 97.41 (1265.23, 1347.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eVFA (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e106.53 \u0026plusmn; 25.71 (96.36, 116.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e115.86 \u0026plusmn; 38.29 (99.69, 132.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003ePBF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e38.29 \u0026plusmn; 5.91 (35.96, 40.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e38.46 \u0026plusmn; 8.92 (34.69, 42.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSMM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e22.96 \u0026plusmn; 2.75 (21.87, 24.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e23.43 \u0026plusmn; 2.66 (22.31, 24.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eBFM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e26.94 \u0026plusmn; 7.16 (24.11, 29.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e28.40 \u0026plusmn; 10.85 (23.82, 32.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eFFM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e42.43 \u0026plusmn; 4.57 (40.62, 44.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e43.28 \u0026plusmn; 4.52 (41.37, 45.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSLM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e39.94 \u0026plusmn; 4.38 (38.20, 41.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e40.91 \u0026plusmn; 4.26 (39.11, 42.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eVO\u003csub\u003e2max\u0026nbsp;\u003c/sub\u003e(L/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e2.24 \u0026plusmn; 0.24 (2.15, 2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e2.32 \u0026plusmn; 0.26 (2.21, 2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eVO\u003csub\u003e2max\u0026nbsp;\u003c/sub\u003e(mL/kg/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e32.68 \u0026plusmn; 3.96 (31.12, 34.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e32.65 \u0026plusmn; 5.09 (30.50, 34.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eHR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e73.61 \u0026plusmn; 9.31 (69.93, 77.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e77.09 \u0026plusmn; 11.13 (72.39, 81.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e128.52 \u0026plusmn; 14.35 (122.85, 134.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e136.86 \u0026plusmn; 18.68 (128.97, 144.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eDBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e80.14 \u0026plusmn; 8.21 (76.90, 83.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e80.90 \u0026plusmn; 11.75 (75.94, 85.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations\u0026mdash;BPT: Bungy Pump Training; DA: Daily Activity; BW: body weight; BMI: body-mass index; BMR: basal metabolic rate; VFA: visceral fat area; PBF: percent body fat; SMM: skeletal muscle mass; BFM: body fat mass; FFM: fat free mass; SLM: skeletal lean mass; VO\u003csub\u003e2max\u003c/sub\u003e: maximal oxygen uptake; HR: resting heart rate; SBP: resting systolic blood pressure; DBP: resting diastolic blood pressure.\u003c/p\u003e\n\u003cp\u003eTraining Sessions\u003c/p\u003e\n\u003cp\u003eDuring the training sessions, the distance marched was gradually increased from 2.8 to 3.6km and the average heart rate (HR\u003csub\u003emean\u003c/sub\u003e) for the intensity of the exercise was 114 \u0026plusmn; 14 bpm, corresponding to 79% HR\u003csub\u003emax\u003c/sub\u003e.\u003c/p\u003e\n\u003cp\u003ePrimary outcome\u003c/p\u003e\n\u003cp\u003eNo significant differences were found on CRF between groups at baseline. A group x time effect (interaction) was observed for VO\u003csub\u003e2max\u003c/sub\u003e (L/min), and VO\u003csub\u003e2max\u003c/sub\u003e (mL/kg/min). After completing the training program, PW in the BPT group increased VO\u003csub\u003e2max\u003c/sub\u003e (L/min) (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001), and VO\u003csub\u003e2max\u003c/sub\u003e (mL/kg/min) (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001) by 7.24 \u0026plusmn; 6.34% and 9.42 \u0026plusmn; 6.45% respectively. A time effect was observed for VO\u003csub\u003e2max\u003c/sub\u003e (L/min), and VO\u003csub\u003e2max\u003c/sub\u003e (mL/kg/min), and HR. PW in the DA group reduced HR (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.008) by 4.87 \u0026plusmn; 8.45% (Table 2 and Figure 3).\u003c/p\u003e\n\u003cp\u003eNo significant differences were found on MetS factors between groups at baseline except ALT and AST. A time effect was observed for SBP, DBP, TC, HDL-C, Non-HDL-C, and LDL-C. PW in BPT group increased HDL-C (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.009) by 7.39 \u0026plusmn; 13.16% and reduced SBP (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001), DBP (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001), TC (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.005), Non-HDL-C (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.006), and LDL-C (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.014) by 6.95 \u0026plusmn; 7.43%, 6.92 \u0026plusmn; 6.72%, 8.41 \u0026plusmn; 17.59%, 8.12 \u0026plusmn; 19.57%, and 7.66 \u0026plusmn; 23.24% respectively. A group effect was observed for SBP, HDL-C, ALT, and AST. Independent samples t-test showed no significant difference in the values of changes on ALT (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05) and AST (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). At the end of the training program, the BPT group showed significant improvement on SBP (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.009), and HDL-C (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.016) than the DA group (Table 2 and Figure 3).\u003c/p\u003e\n\u003cp\u003eSecondary outcome\u003c/p\u003e\n\u003cp\u003eNo significant differences were found on body composition between groups at baseline. An interaction effect was observed for BMR, VFA, PBF, and BFM. After completing the training program, PW in BPT group increased BMR (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.006) by 2.16 \u0026plusmn; 3.82% and reduced VFA (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.006), PBF (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001), and BFM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0001) by 7.04 \u0026plusmn; 5.00%, 5.26 \u0026plusmn; 4.70%, and 6.74 \u0026plusmn; 5.89% respectively. PW in DA group reduced VFA (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.007), PBF (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.045), and BFM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.046) by 2.91 \u0026plusmn; 7.81%, 1.55 \u0026plusmn; 5.58%, and 1.7 \u0026plusmn; 6.99% respectively. A time effect was observed for BW, BMI, BMR, VFA, PBF, SMM, BFM, FFM, SLM, RLLM, and LLLM. PW in BPT group increased SMM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.01), FFM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.014), SLM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.01), RLLM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.002), and LLLM (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.001) by 1.95 \u0026plusmn; 3.46%, 1.73 \u0026plusmn; 3.22%, 1.65 \u0026plusmn; 2.90%, 3.91 \u0026plusmn; 5.43%, and 3.76 \u0026plusmn; 4.91% and reduced BW, and BMI by 1.98 \u0026plusmn; 2.38%, and 1.98 \u0026plusmn; 2.37% respectively (Table 2 and Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eBody composition, cardiorespiratory fitness, and metabolic syndrome factors at baseline and after 12 weeks of BPT or DA in postmenopausal women (n = 51)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"1021\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 373px;\"\u003e\n \u003cp\u003eBPT Group (n = 27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 364px;\"\u003e\n \u003cp\u003eDA group (n = 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTwo-way ANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003ebaseline\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003eChange\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 128px;\"\u003e\n \u003cp\u003ebaseline\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eChange\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eInteraction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e (\u0026eta;\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e (\u0026eta;\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e (\u0026eta;\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" style=\"width: 1021px;\"\u003e\n \u003cp\u003eBody composition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBW\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e69.26\u0026nbsp;\u0026plusmn; 10.00\u003c/p\u003e\n \u003cp\u003e(65.30, 73.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e67.80 \u0026plusmn; 9.19*\u003c/p\u003e\n \u003cp\u003e(64.16, 71.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-1.46 \u0026plusmn; 1.95\u003c/p\u003e\n \u003cp\u003e(-2.23, -0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e71.77 \u0026plusmn; 13.00\u003c/p\u003e\n \u003cp\u003e(66.28, 77.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e71.40 \u0026plusmn; 12.95\u003c/p\u003e\n \u003cp\u003e(65.93, 76.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.37 \u0026plusmn; 2.34\u003c/p\u003e\n \u003cp\u003e(-1.36, 0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.159)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.337\u003c/p\u003e\n \u003cp\u003e(0.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003cp\u003e(0.063)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e27.60 \u0026plusmn; 3.30\u003c/p\u003e\n \u003cp\u003e(26.30, 28.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e27.02 \u0026plusmn; 2.95*\u003c/p\u003e\n \u003cp\u003e(25.85, 28.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.58 \u0026plusmn; 0.78\u003c/p\u003e\n \u003cp\u003e(-0.89, -0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e27.98 \u0026plusmn; 4.91\u003c/p\u003e\n \u003cp\u003e(25.91, 30.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e27.80 \u0026plusmn; 4.72\u003c/p\u003e\n \u003cp\u003e(25.81, 29.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.18 \u0026plusmn; 0.85\u003c/p\u003e\n \u003cp\u003e(-0.54, 0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.184)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003cp\u003e(0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003cp\u003e(0.060)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBMR\u003c/p\u003e\n \u003cp\u003e(kcal)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1285.58 \u0026plusmn; 99.00\u003c/p\u003e\n \u003cp\u003e(1246.42, 1324.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1312.58 \u0026plusmn; 102.95*\u003c/p\u003e\n \u003cp\u003e(1271.85, 1353.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e27.00 \u0026plusmn; 47.10\u003c/p\u003e\n \u003cp\u003e(8.36, 45.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1306.36 \u0026plusmn; 97.41\u003c/p\u003e\n \u003cp\u003e(1265.23, 1347.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1309.81 \u0026plusmn; 101.36\u003c/p\u003e\n \u003cp\u003e(1267.01, 1352.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3.45 \u0026plusmn; 29.16\u003c/p\u003e\n \u003cp\u003e(-8.86, 15.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.132)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003cp\u003e(0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.084)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eVFA\u003c/p\u003e\n \u003cp\u003e(cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e106.53 \u0026plusmn; 25.71\u003c/p\u003e\n \u003cp\u003e(96.36, 116.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e98.83 \u0026plusmn; 23.27*\u003c/p\u003e\n \u003cp\u003e(89.63, 108.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-7.7 \u0026plusmn; 5.96\u003c/p\u003e\n \u003cp\u003e(-10.06, -5.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e115.86 \u0026plusmn; 38.29\u003c/p\u003e\n \u003cp\u003e(99.69, 132.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e111.91 \u0026plusmn; 36.29*\u003c/p\u003e\n \u003cp\u003e(96.59, 127.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-3.95 \u0026plusmn; 6.51\u003c/p\u003e\n \u003cp\u003e(-6.70, -1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.476)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003cp\u003e(0.033)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.086)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePBF\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e38.29 \u0026plusmn; 5.91\u003c/p\u003e\n \u003cp\u003e(35.96, 40.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e36.21 \u0026plusmn; 5.47*\u003c/p\u003e\n \u003cp\u003e(34.05, 38.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-2.08 \u0026plusmn; 1.78\u003c/p\u003e\n \u003cp\u003e(-2.78, -1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e38.46 \u0026plusmn; 8.92\u003c/p\u003e\n \u003cp\u003e(34.69, 42.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e37.74 \u0026plusmn; 8.58*\u003c/p\u003e\n \u003cp\u003e(34.07, 41.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.72 \u0026plusmn; 1.67\u003c/p\u003e\n \u003cp\u003e(-1.43, -0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.405)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003cp\u003e(0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eSMM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e22.96 \u0026plusmn; 2.75\u003c/p\u003e\n \u003cp\u003e(21.87, 24.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e23.38 \u0026plusmn; 2.67*\u003c/p\u003e\n \u003cp\u003e(22.32, 24.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.42 \u0026plusmn; 0.78\u003c/p\u003e\n \u003cp\u003e(0.11, 0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e23.43 \u0026plusmn; 2.66\u003c/p\u003e\n \u003cp\u003e(22.31, 24.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e23.58 \u0026plusmn; 2.98\u003c/p\u003e\n \u003cp\u003e(22.33, 24.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.15 \u0026plusmn; 1.10\u003c/p\u003e\n \u003cp\u003e(-0.32, 0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.086)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003cp\u003e(0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003cp\u003e(0.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBFM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e26.94 \u0026plusmn; 7.16\u003c/p\u003e\n \u003cp\u003e(24.11, 29.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e25.07 \u0026plusmn; 6.60*\u003c/p\u003e\n \u003cp\u003e(22.45, 27.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-1.88 \u0026plusmn; 1.74\u003c/p\u003e\n \u003cp\u003e(-2.57, -1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e28.40 \u0026plusmn; 10.85\u003c/p\u003e\n \u003cp\u003e(23.82, 32.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e27.76 \u0026plusmn; 10.50*\u003c/p\u003e\n \u003cp\u003e(23.33, 32.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.64 \u0026plusmn; 1.49\u003c/p\u003e\n \u003cp\u003e(-1.27, -0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.382)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003cp\u003e(0.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.130)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eFFM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e42.43 \u0026plusmn; 4.57\u003c/p\u003e\n \u003cp\u003e(40.62, 44.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e43.13 \u0026plusmn; 4.58*\u003c/p\u003e\n \u003cp\u003e(41.32, 44.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.70 \u0026plusmn; 1.38\u003c/p\u003e\n \u003cp\u003e(0.16, 1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e43.28 \u0026plusmn; 4.52\u003c/p\u003e\n \u003cp\u003e(41.37, 45.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e43.65 \u0026plusmn; 4.72\u003c/p\u003e\n \u003cp\u003e(41.66, 45.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.37 \u0026plusmn; 1.33\u003c/p\u003e\n \u003cp\u003e(-0.19, 0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.140)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003cp\u003e(0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003cp\u003e(0.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eSLM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e39.94 \u0026plusmn; 4.38\u003c/p\u003e\n \u003cp\u003e(38.20, 41.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e40.56 \u0026plusmn; 4.32*\u003c/p\u003e\n \u003cp\u003e(38.85, 42.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.63 \u0026plusmn; 1.17\u003c/p\u003e\n \u003cp\u003e(0.16, 1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e40.91 \u0026plusmn; 4.26\u003c/p\u003e\n \u003cp\u003e(39.11, 42.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e41.01 \u0026plusmn; 5.54\u003c/p\u003e\n \u003cp\u003e(39.10, 42.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 1.23\u003c/p\u003e\n \u003cp\u003e(-0.41, 0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.089)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003cp\u003e(0.007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003cp\u003e(0.047)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eRALM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.21 \u0026plusmn; 0.36\u003c/p\u003e\n \u003cp\u003e(2.07, 2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.20 \u0026plusmn; 0.35\u003c/p\u003e\n \u003cp\u003e(2.07, 2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.01 \u0026plusmn; 0.10\u003c/p\u003e\n \u003cp\u003e(-0.05, 0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.34 \u0026plusmn; 0.36\u003c/p\u003e\n \u003cp\u003e(2.20, 2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.30 \u0026plusmn; 0.35\u003c/p\u003e\n \u003cp\u003e(2.15, 2.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.04 \u0026plusmn; 0.12\u003c/p\u003e\n \u003cp\u003e(-0.09, 0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003cp\u003e(0.053)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003cp\u003e(0.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003cp\u003e(0.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eLALM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.18 \u0026plusmn; 0.37\u003c/p\u003e\n \u003cp\u003e(2.03, 2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.17 \u0026plusmn; 0.35\u003c/p\u003e\n \u003cp\u003e(2.03, 2.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.01 \u0026plusmn; 0.11\u003c/p\u003e\n \u003cp\u003e(-0.05, 0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.29 \u0026plusmn; 0.34\u003c/p\u003e\n \u003cp\u003e(2.14, 2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.25 \u0026plusmn; 0.36\u003c/p\u003e\n \u003cp\u003e(2.10, 2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.04 \u0026plusmn; 0.12\u003c/p\u003e\n \u003cp\u003e(-0.09, 0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003cp\u003e(0.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003cp\u003e(0.018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003cp\u003e(0.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eTLM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19.33 \u0026plusmn; 2.21\u003c/p\u003e\n \u003cp\u003e(18.46, 20.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19.18 \u0026plusmn; 2.24\u003c/p\u003e\n \u003cp\u003e(18.29, 20.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.16 \u0026plusmn; 0.60\u003c/p\u003e\n \u003cp\u003e(-0.39, 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e20.00 \u0026plusmn; 2.26\u003c/p\u003e\n \u003cp\u003e(19.04, 20.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19.86 \u0026plusmn; 2.43\u003c/p\u003e\n \u003cp\u003e(18.83, 20.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.14 \u0026plusmn; 0.68\u003c/p\u003e\n \u003cp\u003e(-0.43, 0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003cp\u003e(0.052)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003cp\u003e(0.022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.931\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eRLLM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.20 \u0026plusmn; 0.87\u003c/p\u003e\n \u003cp\u003e(5.86, 6.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.43 \u0026plusmn; 0.88*\u003c/p\u003e\n \u003cp\u003e(6.09, 6.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.23 \u0026plusmn; 0.34\u003c/p\u003e\n \u003cp\u003e(0.10, 0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e6.35 \u0026plusmn; 0.93\u003c/p\u003e\n \u003cp\u003e(5.96, 6.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.46 \u0026plusmn; 1.02\u003c/p\u003e\n \u003cp\u003e(6.03, 6.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 0.25\u003c/p\u003e\n \u003cp\u003e(0.01, 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.252)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003cp\u003e(0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003cp\u003e(0.039)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eLLLM\u003c/p\u003e\n \u003cp\u003e(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.24 \u0026plusmn; 0.87\u003c/p\u003e\n \u003cp\u003e(5.90, 6.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.47 \u0026plusmn; 0.88*\u003c/p\u003e\n \u003cp\u003e(6.12, 6.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.22 \u0026plusmn; 0.31\u003c/p\u003e\n \u003cp\u003e(0.10, 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e6.37 \u0026plusmn; 0.95\u003c/p\u003e\n \u003cp\u003e(5.98, 6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6.53 \u0026plusmn; 1.09\u003c/p\u003e\n \u003cp\u003e(6.07, 6.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.15 \u0026plusmn; 0.34\u003c/p\u003e\n \u003cp\u003e(0.01, 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.259)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003cp\u003e(0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003cp\u003e(0.013)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" style=\"width: 1021px;\"\u003e\n \u003cp\u003eCardiorespiratory fitness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eVO\u003csub\u003e2max\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003e(L/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.24 \u0026plusmn; 0.24\u003c/p\u003e\n \u003cp\u003e(2.15, 2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.40 \u0026plusmn; 0.24*\u003c/p\u003e\n \u003cp\u003e(2.31, 2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.16 \u0026plusmn; 0.14\u003c/p\u003e\n \u003cp\u003e(0.10, 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.32 \u0026plusmn; 0.26\u003c/p\u003e\n \u003cp\u003e(2.21, 2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.35 \u0026plusmn; 0.24\u003c/p\u003e\n \u003cp\u003e(2.25, 2.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.03 \u0026plusmn; 0.19\u003c/p\u003e\n \u003cp\u003e(-0.05, 0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.253)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.121)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eVO\u003csub\u003e2max\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003e(mL/kg/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32.68 \u0026plusmn; 3.96\u003c/p\u003e\n \u003cp\u003e(31.12, 34.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e35.67 \u0026plusmn; 4.11*\u003c/p\u003e\n \u003cp\u003e(34.04, 37.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.99 \u0026plusmn; 2.14\u003c/p\u003e\n \u003cp\u003e(2.14, 3.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e32.65 \u0026plusmn; 5.09\u003c/p\u003e\n \u003cp\u003e(30.50, 34.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e33.51 \u0026plusmn; 5.65\u003c/p\u003e\n \u003cp\u003e(31.12, 35.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.86 \u0026plusmn; 2.97\u003c/p\u003e\n \u003cp\u003e(-0.40, 2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.369)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003cp\u003e(0.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.152)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003cp\u003e(bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e73.61 \u0026plusmn; 9.31\u003c/p\u003e\n \u003cp\u003e(69.93, 77.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e71.85 \u0026plusmn; 7.94\u003c/p\u003e\n \u003cp\u003e(68.71, 74.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-1.76 \u0026plusmn; 6.98\u003c/p\u003e\n \u003cp\u003e(-4.53, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e77.09 \u0026plusmn; 11.13\u003c/p\u003e\n \u003cp\u003e(72.39, 81.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e72.90 \u0026plusmn; 9.38\u003c/p\u003e\n \u003cp\u003e(68.94, 76.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-4.19 \u0026plusmn; 7.01*\u003c/p\u003e\n \u003cp\u003e(-7.15, -1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.158)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003cp\u003e(0.017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003cp\u003e(0.030)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" style=\"width: 1021px;\"\u003e\n \u003cp\u003eMetabolic syndrome factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003cp\u003e(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e128.52 \u0026plusmn; 14.35\u003c/p\u003e\n \u003cp\u003e(122.85, 134.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e119.28 \u0026plusmn; 13.79*\u003c/p\u003e\n \u003cp\u003e(113.83, 124.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-9.24 \u0026plusmn; 9.66\u003c/p\u003e\n \u003cp\u003e(-13.06, -5.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e136.86 \u0026plusmn; 18.68\u003c/p\u003e\n \u003cp\u003e(128.97, 144.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e130.58 \u0026plusmn; 15.93\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(123.84, 137.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-6.28 \u0026plusmn; 16.51\u003c/p\u003e\n \u003cp\u003e(-13.25, 0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.260)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.110)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003cp\u003e(0.013)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003cp\u003e(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e80.14 \u0026plusmn; 8.21\u003c/p\u003e\n \u003cp\u003e(76.90, 83.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e74.43 \u0026plusmn; 8.00*\u003c/p\u003e\n \u003cp\u003e(71.27, 77.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-5.71 \u0026plusmn; 5.67\u003c/p\u003e\n \u003cp\u003e(-7.95, -3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.90 \u0026plusmn; 11.75\u003c/p\u003e\n \u003cp\u003e(75.94, 85.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e78.62 \u0026plusmn; 11.30\u003c/p\u003e\n \u003cp\u003e(73.85, 83.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-2.28 \u0026plusmn; 11.08\u003c/p\u003e\n \u003cp\u003e(-6.96, 2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.181)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003cp\u003e(0.020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003cp\u003e(0.039)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eglucose\u003c/p\u003e\n \u003cp\u003e(mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e97.00(91.00-107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e97.89 \u0026plusmn; 10.06\u003c/p\u003e\n \u003cp\u003e(93.91, 101.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.86 \u0026plusmn; 10.15\u003c/p\u003e\n \u003cp\u003e(-3.16, 4.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e93.50\u003c/p\u003e\n \u003cp\u003e(86.50-100.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e97.50 \u0026plusmn; 9.27\u003c/p\u003e\n \u003cp\u003e(93.59, 101.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3.12 \u0026plusmn; 9.31\u003c/p\u003e\n \u003cp\u003e(-0.81, 7.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003cp\u003e(0.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003cp\u003e(0.007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003cp\u003e(0.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003cp\u003emg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e232.26 \u0026plusmn; 63.43\u003c/p\u003e\n \u003cp\u003e(207.17, 257.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e205.30 \u0026plusmn; 41.47*\u003c/p\u003e\n \u003cp\u003e(188.98, 221.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-26.96 \u0026plusmn; 45.40\u003c/p\u003e\n \u003cp\u003e(-44.92, -9.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e218.58 \u0026plusmn; 41.46\u003c/p\u003e\n \u003cp\u003e(201.08, 236.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e210.50 \u0026plusmn; 36.25\u003c/p\u003e\n \u003cp\u003e(195.19, 225.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-8.08, 29.85\u003c/p\u003e\n \u003cp\u003e(-20.69, 4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.174)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003cp\u003e(0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003cp\u003e(0.058)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003cp\u003e(mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e96.45 \u0026plusmn; 26.59\u003c/p\u003e\n \u003cp\u003e(85.93, 106.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e88.89 \u0026plusmn; 32.26\u003c/p\u003e\n \u003cp\u003e(76.13, 101.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-7.56 \u0026plusmn; 19.65\u003c/p\u003e\n \u003cp\u003e(-15.33, 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e98.66 \u0026plusmn; 38.81\u003c/p\u003e\n \u003cp\u003e(82.27, 115.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e102.83 \u0026plusmn; 40.86\u003c/p\u003e\n \u003cp\u003e(85.58, 120.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4.17 \u0026plusmn; 29.88\u003c/p\u003e\n \u003cp\u003e(-8.44, 16.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003cp\u003e(0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003cp\u003e(0.016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003cp\u003e(0.054)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eHDL-C\u003c/p\u003e\n \u003cp\u003e(mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e67.72 \u0026plusmn; 12.25\u003c/p\u003e\n \u003cp\u003e(62.87, 72.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e72.39 \u0026plusmn; 13.43*\u003c/p\u003e\n \u003cp\u003e(67.08, 77.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4.67 \u0026plusmn; 8.61\u003c/p\u003e\n \u003cp\u003e(1.26, 8.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e62.08 \u0026plusmn; 11.63\u003c/p\u003e\n \u003cp\u003e(57.16, 66.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e63.85 \u0026plusmn; 10.50\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(59.41, 68.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1.77 \u0026plusmn; 5.73\u003c/p\u003e\n \u003cp\u003e(-0.65,4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.164)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.090)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003cp\u003e(0.038)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eNon-HDL-C\u003c/p\u003e\n \u003cp\u003e(mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e163.13 \u0026plusmn; 56.00\u003c/p\u003e\n \u003cp\u003e(140.98, 185.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e144.36 \u0026plusmn; 45.71*\u003c/p\u003e\n \u003cp\u003e(126.27, 162.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-18.78 \u0026plusmn; 32.85\u003c/p\u003e\n \u003cp\u003e(-31.77, -5.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e156.39 \u0026plusmn; 39.15\u003c/p\u003e\n \u003cp\u003e(139.86, 172.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e154.23 \u0026plusmn; 34.80\u003c/p\u003e\n \u003cp\u003e(139.54, 168.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-2.16 \u0026plusmn; 29.50\u003c/p\u003e\n \u003cp\u003e(-14.62, 10.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.104)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003cp\u003e(0.068)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eLDL-C\u003c/p\u003e\n \u003cp\u003emg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e143.61 \u0026plusmn; 52.76\u003c/p\u003e\n \u003cp\u003e(122.74, 164.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e125.85 \u0026plusmn; 42.34*\u003c/p\u003e\n \u003cp\u003e(109.10, 142.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-17.76 \u0026plusmn; 35.04\u003c/p\u003e\n \u003cp\u003e(-31.62, -3.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e134.21 \u0026plusmn; 37.93\u003c/p\u003e\n \u003cp\u003e(118.19, 150.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e131.54 \u0026plusmn; 32.50\u003c/p\u003e\n \u003cp\u003e(117.82, 145.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-2.67 \u0026plusmn; 28.56\u003c/p\u003e\n \u003cp\u003e(-14.73, 9.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.095)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003cp\u003e(0.054)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003cp\u003e(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e22.31 \u0026plusmn; 5.71\u003c/p\u003e\n \u003cp\u003e(20.05, 24.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e21.78 \u0026plusmn; 6.39\u003c/p\u003e\n \u003cp\u003e(19.25, 24.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.53 \u0026plusmn; 4.48\u003c/p\u003e\n \u003cp\u003e(-2.30, 1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e18.33 \u0026plusmn; 5.23\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(16.12, 20.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e18.04 \u0026plusmn; 5.21\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(15.84, 20.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.29 \u0026plusmn; 4.52\u003c/p\u003e\n \u003cp\u003e(-2.20, 1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003cp\u003e(0.009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.124)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003cp\u003e(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e26.47 \u0026plusmn; 4.48\u003c/p\u003e\n \u003cp\u003e(24.70, 28.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e26.07 \u0026plusmn; 3.70\u003c/p\u003e\n \u003cp\u003e(24.61, 27.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-0.39 \u0026plusmn; 2.88\u003c/p\u003e\n \u003cp\u003e(-1.53, 0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e19.16 \u0026plusmn; 3.25\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(17.79, 20.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19.17 \u0026plusmn; 4.07\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(17.44, 20.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.01 \u0026plusmn; 3.48\u003c/p\u003e\n \u003cp\u003e(-1.46, 1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003cp\u003e(0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.506)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003cp\u003e(0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations\u0026mdash;BPT: Bungy Pump Training; DA: Daily Activity; BW: body weight; BMI: body-mass index; BMR: basal metabolic rate; VFA: visceral fat area; PBF: percent body fat; SMM: skeletal muscle mass; BFM: body fat mass; FFM: fat free mass; SLM: skeletal lean mass; RALM: right arm lean mass; LALM: left arm lean mass; TLM: trunk lean mass; RLLM: right leg lean mass; LLLM: left leg lean mass; VO\u003csub\u003e2max\u003c/sub\u003e: maximal oxygen uptake; HR: heart rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride;\u0026nbsp;HDL-C: high-density lipoprotein cholesterol; Non-HDL-C: non-high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; ALT: Alanine Aminotransferas; AST: Aspartate Aminotransferase.\u003c/p\u003e\n\u003cp\u003e* Significantly different from baseline (\u003cem\u003ep\u003c/em\u003e\u0026le;0.05)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003e Significantly different from the BPT group (\u003cem\u003ep\u003c/em\u003e\u0026le;0.05)\u003c/p\u003e\n\u003cp\u003eAdherence\u003c/p\u003e\n\u003cp\u003eThe adherence of participants to the 12-week BPT program was closely monitored to ensure compliance with the protocol and the reliability of the intervention. Of the initial 56 postmenopausal women enrolled in the study, 51 completed the program, resulting in an adherence rate of 91%. 9% of participants discontinued due to unrelated health issues (n=5). Attendance records showed an average participation rate at a satisfactory level.\u003c/p\u003e\n\u003cp\u003eAdverse events\u003c/p\u003e\n\u003cp\u003eNo adverse effects were recorded in participants during the program. Participants were required to wear sportswear and were instructed to use Special poles with an elastic resistance of 4 kg, which may have contributed to this result.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main objective of this study was to examine the effects of a 12-week BPT on CRF, MetS factors, and body composition to assess whether the training can be beneficial to PW.\u0026nbsp;The present study found that\u0026nbsp;12-week BPT significantly improves VO\u003csub\u003e2max\u003c/sub\u003e in CRF, BP, TC, HDL-C, Non-HDL-C, and LDL-C in MetS factors, BW, BMI, BMR, VFA, PBF, SMM, BFM, FFM, SLM, RLLM, and LLLM in body composition among PW.\u003c/p\u003e\n\u003cp\u003eFavourable changes on CRF reduce CVD risk factors and CVD morbidity and mortality\u003csup\u003e39\u003c/sup\u003e. The effect of VO\u003csub\u003e2max\u003c/sub\u003e in the present study showed a significant improvement in PW in the BPT group by 7.24% and 9.42% after the intervention, but not in the DA group. A study of 6 months of walking and NW performed 3 times a week conducted by Muollo et al. showed an increase on VO\u003csub\u003e2max\u003c/sub\u003e in the elderly with overweight and obesity by 3.14% and 3.91% separately\u003csup\u003e40\u003c/sup\u003e. The metabolism of working muscles of BPT is dominated by a greater proportion of oxygen metabolism compared to NW. Increased mitochondrial content and desaturation of myoglobin on skeletal muscle tissue after exercise increases the oxidative capacity of skeletal muscle and leads to an increase on VO\u003csub\u003e2max\u003c/sub\u003e\u003csup\u003e31,41,42\u003c/sup\u003e. In addition, an increase in VO\u003csub\u003e2max\u003c/sub\u003e may also be associated with positive changes in cardiac morphology and physiology as well\u003csup\u003e43\u003c/sup\u003e. The result of the present study was superior to the observation of Domaszewska et al\u003csup\u003e31\u003c/sup\u003e. The present study found an increase on VO\u003csub\u003e2max\u003c/sub\u003e by 2.99 \u0026plusmn; 2.14 in PW, and Domaszewska et al. found an increase in BPT performed twice a week for 8 weeks by 2.40 \u0026plusmn; 3.87\u003csup\u003e31\u003c/sup\u003e. It could be seen that increasing training frequency and duration of training may be more effective in increasing VO\u003csub\u003e2max\u003c/sub\u003e in PW.\u003c/p\u003e\n\u003cp\u003eSeveral studies have shown that both walking and NW can significantly reduce HR in PW\u003csup\u003e44,45\u003c/sup\u003e. In the present study, HR was reduced in both groups. DA significantly reduced HR, but the results of BPT were consistent with those of another NW\u003csup\u003e24\u003c/sup\u003e. A decrease in HR may be an indication of improved cardiac regulation. The HR values of the BPT group were less than the DA group\u0026rsquo;s at baseline, which may explain why there was only a time effect without any significant improvement.\u003c/p\u003e\n\u003cp\u003eCRF is strongly inversely related to MetS\u003csup\u003e46\u003c/sup\u003e. CRF is a key predictor of CVD mortality and Mets is also a protective factor against CVD\u003csup\u003e47,48\u003c/sup\u003e. The present study showed a significant decrease on SBP and DBP by 7.19% and 7.13% separately in the BPT group. Witkowska et al. found that after 3-time NW for 12 weeks, SBP decreased by 0.39%, and DBP increased by 0.8% in women over 55 years of age\u003csup\u003e24\u003c/sup\u003e. It seemed like the BPT was better at improving BP. BPT as a combined exercise, Montelemy et al. also found beneficial effects on arterial stiffness and blood pressure in combined exercise\u003csup\u003e49\u003c/sup\u003e. Secondly, increased sympathetic nerve excitability induces an increase on HR, which increases cardiac output. The present study showed that BPT decreased the HR of PW, which may also contribute to the decrease in BP. The results of meta-analysis by Xi et al. indicate that combined aerobic and resistance exercise can significantly reduce BP in PW\u003csup\u003e50\u003c/sup\u003e. The results of the present study are consistent with those of Xi et al. The present results showed that the SBP of PW in the BPT group was significantly better than that in the DA group after intervention. Exercise intensity is closely related to blood pressure regulation, with moderate intensity exercise effectively affecting SBP\u003csup\u003e51\u003c/sup\u003e. Overall, 12 weeks of BPT was effective in improving BP in PW.\u003c/p\u003e\n\u003cp\u003eHowever, our fundings indicated no significant improvement on glucose with BPT. Our results are consistent with the results of Rodziewicz-Flis et al.\u003csup\u003e30\u003c/sup\u003e. The improvement in glucose depends largely on the improvement in insulin sensitivity\u003csup\u003e52\u003c/sup\u003e. A study by van Gemert et al. showed that participation in a year-long intervention program of aerobic and strength exercise did not lead to improvements in insulin sensitivity in healthy postmenopausal women\u003csup\u003e53\u003c/sup\u003e. The present study performed 12 weeks of BPT and may require a longer duration to improve blood glucose. In addition, exercise has a more pronounced effect on glucose in diabetics\u003csup\u003e54\u003c/sup\u003e. In contrast, most PW have normal glucose at baseline, which may have a relatively weak effect on the healthy population.\u003c/p\u003e\n\u003cp\u003eAfter the intervention, the present study found that TC, HDL-C, Non-HDL-C and LDL-C were beneficial in the BPT. Comparing our results with those of another author, 12 weeks of MW (3 training sessions per week for 60 minutes each) also showed improvement on lipids. While some of these parameters were not significant, HDL-C was significantly different between groups\u003csup\u003e55\u003c/sup\u003e. This is consistent with the results of the present study. The effects of exercise may be produced by modifying the activity of enzymes involved in the synthesis, transport and breakdown of lipoproteins\u003csup\u003e56\u003c/sup\u003e. This enhances lipoprotein metabolism to increase cholesterol uptake. TG is affected by various factors such as blood glucose and insulin resistance, which did not change significantly in the present study\u003csup\u003e57\u003c/sup\u003e. BPT, as a combination of aerobic and resistance exercise, involves more muscle groups and increases cardiovascular load than daily activities and may contribute more to HDL-C. Liang et al. concluded that a combination of aerobic and low-resistance exercise maximises HDL-C benefits\u003csup\u003e58\u003c/sup\u003e. More muscle groups are involved in BPT, increasing the load on the upper body, which may stimulate more lipoprotein metabolism and promote improved lipids. In the present study, ALT and AST were found to be within the normal physiological range in the BPT group, although there was no significant change\u003csup\u003e59\u003c/sup\u003e. A similar study found that combined training did not have significant changes in ALT and AST\u003csup\u003e60\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe 12-month multi-component exercise program improved body composition in PW\u003csup\u003e61\u003c/sup\u003e and reduced the incidence of CVD\u003csup\u003e62\u003c/sup\u003e. The present study also found that BPT could significantly improve BW, BMI, BMR, fat mass and lean mass, except for RALM, LALM and TLM. Several authors examined the effects of 2 weekly BPT for 8 weeks on body composition in postmenopausal women. Huta-Osiecka et al. reported significant improvements on BM, BMI, Fat mass, and PFM following the intervention\u003csup\u003e28\u003c/sup\u003e. Similarly, Domaszewska et al.observed significant reductions in BM and BMI after the intervention, but not on PBM, VFA, FFM, SMM\u003csup\u003e31\u003c/sup\u003e. In contrast, Wochna et al. found no significant improvement on BMI, PBM, lean body mass and BFM after the intervention\u003csup\u003e63\u003c/sup\u003e. This is inconsistent with some of the results of the present study, and it is possible that increasing the duration and frequency of training is more conducive to improvements on body composition. NW training mainly burns fatty acids as a source of muscle ATP and reduces adipose tissue levels when physical exercise is increased\u003csup\u003e26\u003c/sup\u003e. A meta-analysis showed that aerobic training was effective for fat loss, whereas resistance training was effective for muscle gain\u003csup\u003e3\u003c/sup\u003e. BPT provides additional resistance during marching and improves muscle strength through increased muscle activation\u003csup\u003e27\u003c/sup\u003e, which could be considered a viable strategy to improve body composition in PW. BPT, although BPT did not significantly improve RALM, LALM and TLM, resulted in a slower loss of lean body mass than DA. In addition, Grgic et al. found that the gains in muscle strength in the early phase of training in older adults resulted primarily from neural adaptations, whereas muscle hypertrophy or muscle fibre hypertrophy became significant in the later phase\u003csup\u003e64\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBased on previous trials, BPT seems to be particularly favourable in PW as it is safe and feasible. Adherence to exercise protocol is a major issue in exercise intervention trials. The high rate of adherence in this trial may be largely attributed to the high level of interest in participating in the exercise intervention.\u003c/p\u003e\n\u003cp\u003eBPT, as a new form of NW efficiently improves CRF and Mets factors in PW. With the increasing acceptance and life expectancy of BPT in PW, we believe that further research on BPT is important for different populations for CVD prevention.\u003c/p\u003e\n\u003cp\u003eStrengths of the current study include that taking PW as subjects is important to prevent cardiovascular diseases and maintain their health. BPT, as a modified form of NW, provides a reference for the study of the effects of different exercise forms in PW. The results involve a rather basic but covering the main health parameters of physiological, biochemical and body composition measurements, providing a comprehensive analysis of the health status of PW.\u003c/p\u003e\n\u003cp\u003eThe trial has several limitations. The use of randomization based on geographical location also had some limitations. First, although the distances between the cities were relatively small, this method does not fully eliminate the risk of uneven distribution of other variables, such as education level or access to healthcare, which may differ between cities. Additionally, geographical location may introduce some biases related to differences in health habits among residents of different regions, which could affect the overall representativeness of the sample. Despite these limitations, the use of geographical location-based division allowed for controlling environmental variables, which increased the internal validity of the study by minimizing the risk of systematic differences between groups. One of the limitations is that the included population contains both obese and normal-weight PW. However, the weight status of postmenopausal women in real life is diverse. Therefore, the results of the study may be informative in a wider population. The third limitation is the lack of dietary control. However, participants were asked not to change their diet during the training program.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study showed that the 12-week BPT completed 60-minute sessions 3 times a week had a significant effect on CRF, MetS factors and body composition in PW. BPT induced significant increases in VO\u003csub\u003e2max\u003c/sub\u003e, HDL-C, BMR, SMM, FFM, SLM, RLLM and LLLM. Moreover, BPT effectively reduced BP, TC, Non-HDL-C, LDL-C, BW, BMI, VFA, PBF and BFM.\u003c/p\u003e\n\u003cp\u003eThese results could provide important guidelines for PW to focus more on BPT when undertaking non-pharmacological interventions, especially in improving CRF and MetS in PW without experience of this sport.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eAlanine aminotransferase\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eAspartate aminotransferase\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBasal metabolic rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBlood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBFM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBody fat mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBody weight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBody-mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eBPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eBungy Bump Training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eCRF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eCardiorespiratory fitness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eCVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eDaily Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eDiastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eFFM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eFat-free mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eHeart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eHR\u003csub\u003emax\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003emaximal heart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eHR\u003csub\u003emean\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eaverage heart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eHDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eHigh-density lipoprotein cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eLALM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eLeft arm lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eLLLM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eLeft leg lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eLDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eLow-density lipoprotein cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eVO\u003csub\u003e2max\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eMaximum oxygen uptake\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eMetS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eMetabolic syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eNon-HDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eNon-high-density lipoprotein cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eNW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eNordic Walking\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003ePBF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003ePercent body fat\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003ePW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003ePostmenopausal women\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eRALM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eRight arm lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eRLLM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eRight leg lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eSLM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eSkeletal lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eSMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eSkeletal muscle mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eTotal cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eTriglyceride\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eTLM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eTrunk lean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eVFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 442px;\"\u003e\n \u003cp\u003eVisceral fat area\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki, and approved by the Bioethics Committee of the District Medical Chamber in Gdansk (protocol code KB-5/22).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInformed Consent Statement\u003c/b\u003e: Written informed consent has been obtained from the patient(s) to publish this paper. Registration number of the clinical trial: NCT06781541.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interest:\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, Y.N. and Z.O.; methodology, Y.N. and Z.O.; formal analysis, Y.N.; investigation, Y.N., L.R., G.Q., and Z.O.; resources, Z.O.; data curation, Y.N. and Z.O.; writing\u0026mdash;original draft preparation, Y.N.; writing\u0026mdash;review and editing, Y.N., G.Q. and Z.O.; supervision, G.Q., A.S. and Z.O.; project administration, Z.O.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank the staff of Gdansk University of Physical Education and Sport for their help in organizing the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData from this study are provided in the manuscript and can also be obtained by contacting the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eForeman, K. J. \u003cem\u003eet al.\u003c/em\u003e Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016\u0026ndash;40 for 195 countries and territories. \u003cem\u003eThe Lancet\u003c/em\u003e \u003cstrong\u003e392\u003c/strong\u003e, 2052\u0026ndash;2090 (2018).\u003c/li\u003e\n\u003cli\u003eRoth, G. A. \u003cem\u003eet al.\u003c/em\u003e Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u0026ndash;2019. \u003cem\u003eJournal of the American College of Cardiology\u003c/em\u003e \u003cstrong\u003e76\u003c/strong\u003e, 2982\u0026ndash;3021 (2020).\u003c/li\u003e\n\u003cli\u003eKhalafi, M. \u003cem\u003eet al.\u003c/em\u003e The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. \u003cem\u003eFront Endocrinol (Lausanne)\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 1183765 (2023).\u003c/li\u003e\n\u003cli\u003eStojanovska, L., Apostolopoulos, V., Polman, R. \u0026amp; Borkoles, E. To exercise, or, not to exercise, during menopause and beyond. \u003cem\u003eMaturitas\u003c/em\u003e \u003cstrong\u003e77\u003c/strong\u003e, 318\u0026ndash;323 (2014).\u003c/li\u003e\n\u003cli\u003eWang, X., Han, Y., Li, H., Wang, X. \u0026amp; Wang, G. Impact of a Precision Intervention for Vascular Health in Middle-Aged and Older Postmenopausal Women Using Polar Heart Rate Sensors: A 24-Week RCT Study Based on the New Compilation of Tai Chi (Bafa Wubu). \u003cem\u003eSensors (Basel)\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 5832 (2024).\u003c/li\u003e\n\u003cli\u003eLobo, R. A. \u003cem\u003eet al.\u003c/em\u003e Metabolic and cardiovascular effects of TX-001HR in menopausal women with vasomotor symptoms. \u003cem\u003eClimacteric\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 610\u0026ndash;616 (2019).\u003c/li\u003e\n\u003cli\u003eChodzko-Zajko, W. J. \u003cem\u003eet al.\u003c/em\u003e Exercise and Physical Activity for Older Adults. \u003cem\u003eMedicine \u0026amp; Science in Sports \u0026amp; Exercise\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 1510 (2009).\u003c/li\u003e\n\u003cli\u003eJo, E.-A. \u003cem\u003eet al.\u003c/em\u003e Effects of exergaming in postmenopausal women with high cardiovascular risk: A randomized controlled trial. \u003cem\u003eClin Cardiol\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 363\u0026ndash;370 (2020).\u003c/li\u003e\n\u003cli\u003eCarr, M. C. The emergence of the metabolic syndrome with menopause. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e \u003cstrong\u003e88\u003c/strong\u003e, 2404\u0026ndash;2411 (2003).\u003c/li\u003e\n\u003cli\u003eTorr\u0026eacute;ns, J. I. \u003cem\u003eet al.\u003c/em\u003e Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: study of Women\u0026rsquo;s Health Across the Nation. \u003cem\u003eMenopause\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 257\u0026ndash;264 (2009).\u003c/li\u003e\n\u003cli\u003eFriedenreich, C. M. \u003cem\u003eet al.\u003c/em\u003e Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial. \u003cem\u003eInt J Obes (Lond)\u003c/em\u003e \u003cstrong\u003e35\u003c/strong\u003e, 427\u0026ndash;435 (2011).\u003c/li\u003e\n\u003cli\u003eIrwin, M. L. \u003cem\u003eet al.\u003c/em\u003e Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. \u003cem\u003eJAMA\u003c/em\u003e \u003cstrong\u003e289\u003c/strong\u003e, 323\u0026ndash;330 (2003).\u003c/li\u003e\n\u003cli\u003eHsia, J. \u003cem\u003eet al.\u003c/em\u003e Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study. \u003cem\u003eBMJ\u003c/em\u003e \u003cstrong\u003e338\u003c/strong\u003e, b219 (2009).\u003c/li\u003e\n\u003cli\u003eChrysant, S. G. The cardiometabolic benefits of exercise in postmenopausal women. \u003cem\u003eJ Clin Hypertens (Greenwich)\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 1691\u0026ndash;1693 (2020).\u003c/li\u003e\n\u003cli\u003eHagner-Derengowska, M. \u003cem\u003eet al.\u003c/em\u003e The influence of a ten-week Nordic walking training-rehabilitation program on the level of lipids in blood in overweight and obese postmenopausal women. \u003cem\u003eJ Phys Ther Sci\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 3039\u0026ndash;3044 (2015).\u003c/li\u003e\n\u003cli\u003eTune, J. D., Goodwill, A. G., Sassoon, D. J. \u0026amp; Mather, K. J. Cardiovascular Consequences of Metabolic Syndrome. \u003cem\u003eTransl Res\u003c/em\u003e \u003cstrong\u003e183\u003c/strong\u003e, 57\u0026ndash;70 (2017).\u003c/li\u003e\n\u003cli\u003eAbdulnour, J. \u003cem\u003eet al.\u003c/em\u003e The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study. \u003cem\u003eMenopause\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 760\u0026ndash;767 (2012).\u003c/li\u003e\n\u003cli\u003eSantosa, S. \u0026amp; Jensen, M. D. Adipocyte Fatty Acid Storage Factors Enhance Subcutaneous Fat Storage in Postmenopausal Women. \u003cem\u003eDiabetes\u003c/em\u003e \u003cstrong\u003e62\u003c/strong\u003e, 775\u0026ndash;782 (2013).\u003c/li\u003e\n\u003cli\u003eAbildgaard, J. \u003cem\u003eet al.\u003c/em\u003e Menopause is associated with decreased whole body fat oxidation during exercise. \u003cem\u003eAmerican Journal of Physiology-Endocrinology and Metabolism\u003c/em\u003e \u003cstrong\u003e304\u003c/strong\u003e, E1227\u0026ndash;E1236 (2013).\u003c/li\u003e\n\u003cli\u003eElliott, K. J., Sale, C. \u0026amp; Cable, N. T. Effects of resistance training and detraining on muscle strength and blood lipid profiles in postmenopausal women. \u003cem\u003eBr J Sports Med\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 340\u0026ndash;344 (2002).\u003c/li\u003e\n\u003cli\u003eNelson, M. E. \u003cem\u003eet al.\u003c/em\u003e Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. \u003cem\u003eMed Sci Sports Exerc\u003c/em\u003e \u003cstrong\u003e39\u003c/strong\u003e, 1435\u0026ndash;1445 (2007).\u003c/li\u003e\n\u003cli\u003eMendoza, N. \u003cem\u003eet al.\u003c/em\u003e Benefits of physical exercise in postmenopausal women. \u003cem\u003eMaturitas\u003c/em\u003e \u003cstrong\u003e93\u003c/strong\u003e, 83\u0026ndash;88 (2016).\u003c/li\u003e\n\u003cli\u003eCebula, A. \u003cem\u003eet al.\u003c/em\u003e Physiological response and cardiorespiratory adaptation after a 6-week Nordic Walking training targeted at lipid oxidation in a group of post-menopausal women. \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, e0230917 (2020).\u003c/li\u003e\n\u003cli\u003eWitkowska, A., Grabara, M., Kopeć, D. \u0026amp; Nowak, Z. The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age. \u003cem\u003eJ Phys Act Health\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 669\u0026ndash;676 (2021).\u003c/li\u003e\n\u003cli\u003eMarciniak, K., Maciaszek, J., Cyma-Wejchenig, M., Szeklicki, R. \u0026amp; Stemplewski, R. The Effect of Nordic Walking Training with Poles with an Integrated Resistance Shock Absorber on the Body Balance of Women over the Age of 60. \u003cem\u003eHealthcare (Basel)\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 267 (2021).\u003c/li\u003e\n\u003cli\u003ePilch, W. B. \u003cem\u003eet al.\u003c/em\u003e The influence of a 12-week program of physical activity on changes in body composition and lipid and carbohydrate status in postmenopausal women. \u003cem\u003ePrz Menopauzalny\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 231\u0026ndash;237 (2015).\u003c/li\u003e\n\u003cli\u003eMarciniak, K. \u003cem\u003eet al.\u003c/em\u003e The Effect of Nordic Walking Training with Poles with an Integrated Resistance Shock Absorber on the Functional Fitness of Women over the Age of 60. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 2197 (2020).\u003c/li\u003e\n\u003cli\u003eHuta-Osiecka, A. \u003cem\u003eet al.\u003c/em\u003e Influence of Nordic walking with poles with an integrated resistance shock absorber on carbohydrate and lipid metabolic indices and white blood cell subpopulations in postmenopausal women. \u003cem\u003ePeerJ\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, e13643 (2022).\u003c/li\u003e\n\u003cli\u003eSobczak, K., Nowinka, P., Wochna, K. \u0026amp; Domaszewska, K. The Effects of Nordic Walking with Poles with an Integrated Resistance Shock Absorber on Red Blood Cell Distribution and Cardiorespiratory Efficiency in Postmenopausal Women-A Randomized Controlled Trial. \u003cem\u003eBiology (Basel)\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 179 (2023).\u003c/li\u003e\n\u003cli\u003eRodziewicz-Flis, E. \u003cem\u003eet al.\u003c/em\u003e Nordic Walking training in BungyPump form improves cognitive functions and physical performance and induces changes in amino acids and kynurenine profiles in older adults. \u003cem\u003eFront Endocrinol (Lausanne)\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 1151184 (2023).\u003c/li\u003e\n\u003cli\u003eDomaszewska, K. \u003cem\u003eet al.\u003c/em\u003e The Effects of Nordic Walking With Poles With an Integrated Resistance Shock Absorber on Cognitive Abilities and Cardiopulmonary Efficiency in Postmenopausal Women. \u003cem\u003eFront Aging Neurosci\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 586286 (2020).\u003c/li\u003e\n\u003cli\u003eKodama, S. \u003cem\u003eet al.\u003c/em\u003e Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. \u003cem\u003eJAMA\u003c/em\u003e \u003cstrong\u003e301\u003c/strong\u003e, 2024\u0026ndash;2035 (2009).\u003c/li\u003e\n\u003cli\u003eSk\u0026oacute;rkowska-Telichowska, K. \u003cem\u003eet al.\u003c/em\u003e Nordic walking in the second half of life. \u003cem\u003eAging Clinical and Experimental Research\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, (2016).\u003c/li\u003e\n\u003cli\u003eMansur, A. J. \u0026amp; Nunes, R. A. B. Heart rate response and chronotropic incompetence in exercise stress testing of asymptomatic women. \u003cem\u003eWomens Health (Lond)\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 785\u0026ndash;787 (2010).\u003c/li\u003e\n\u003cli\u003eLiu, Y. \u003cem\u003eet al.\u003c/em\u003e Relationship between physical activity and abdominal obesity and metabolic markers in postmenopausal women. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 26496 (2024).\u003c/li\u003e\n\u003cli\u003eMancia, G. \u003cem\u003eet al.\u003c/em\u003e 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). \u003cem\u003eJ Hypertens\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 1281\u0026ndash;1357 (2013).\u003c/li\u003e\n\u003cli\u003eEkblom-Bak, E., Bj\u0026ouml;rkman, F., Hellenius, M.-L. \u0026amp; Ekblom, B. A new submaximal cycle ergometer test for prediction of VO2max. \u003cem\u003eScand J Med Sci Sports\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 319\u0026ndash;326 (2014).\u003c/li\u003e\n\u003cli\u003eBoutcher, Y. N., Boutcher, S. H., Yoo, H. Y. \u0026amp; Meerkin, J. D. The Effect of Sprint Interval Training on Body Composition of Postmenopausal Women. \u003cem\u003eMed Sci Sports Exerc\u003c/em\u003e \u003cstrong\u003e51\u003c/strong\u003e, 1413\u0026ndash;1419 (2019).\u003c/li\u003e\n\u003cli\u003eLavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T. \u0026amp; Blair, S. N. Sedentary Behavior, Exercise, and Cardiovascular Health. \u003cem\u003eCirc Res\u003c/em\u003e \u003cstrong\u003e124\u003c/strong\u003e, 799\u0026ndash;815 (2019).\u003c/li\u003e\n\u003cli\u003eMuollo, V. \u003cem\u003eet al.\u003c/em\u003e Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial. \u003cem\u003eNutrition, Metabolism and Cardiovascular Diseases\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 1247\u0026ndash;1256 (2021).\u003c/li\u003e\n\u003cli\u003eHarber, M. P. \u003cem\u003eet al.\u003c/em\u003e Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009. \u003cem\u003eProg Cardiovasc Dis\u003c/em\u003e \u003cstrong\u003e60\u003c/strong\u003e, 11\u0026ndash;20 (2017).\u003c/li\u003e\n\u003cli\u003ePinckard, K., Baskin, K. K. \u0026amp; Stanford, K. I. Effects of Exercise to Improve Cardiovascular Health. \u003cem\u003eFront Cardiovasc Med\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 69 (2019).\u003c/li\u003e\n\u003cli\u003eLavie, C. J. \u003cem\u003eet al.\u003c/em\u003e Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes. \u003cem\u003eCirc Res\u003c/em\u003e \u003cstrong\u003e117\u003c/strong\u003e, 207\u0026ndash;219 (2015).\u003c/li\u003e\n\u003cli\u003ePilch, W. \u003cem\u003eet al.\u003c/em\u003e Effects of 6-week Nordic walking training on changes in 25(OH)D blood concentration in women after 55 years of age. \u003cem\u003eThe Journal of sports medicine and physical fitness\u003c/em\u003e \u003cstrong\u003e57\u003c/strong\u003e, (2016).\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;zel, Y., Atakan, M. M., Turnag\u0026ouml;l, H. H. \u0026amp; Koşar, Ş. N. Effects of 10 weeks of walking-based exercise training on resting substrate oxidation in postmenopausal women with obesity. \u003cem\u003eEur J Clin Nutr\u003c/em\u003e 1\u0026ndash;9 (2024) doi:10.1038/s41430-024-01546-1.\u003c/li\u003e\n\u003cli\u003eEarnest, C. P. \u003cem\u003eet al.\u003c/em\u003e Maximal Estimated Cardiorespiratory Fitness, Cardiometabolic Risk Factors, and Metabolic Syndrome in the Aerobics Center Longitudinal Study. \u003cem\u003eMayo Clinic Proceedings\u003c/em\u003e \u003cstrong\u003e88\u003c/strong\u003e, 259\u0026ndash;270 (2013).\u003c/li\u003e\n\u003cli\u003eSingh, B. \u003cem\u003eet al.\u003c/em\u003e Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations. \u003cem\u003eJ Sport Health Sci\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 100986 (2024).\u003c/li\u003e\n\u003cli\u003eWu, Z. \u003cem\u003eet al.\u003c/em\u003e The causal relationship between metabolic syndrome and its components and cardiovascular disease: A mendelian randomization study. \u003cem\u003eDiabetes Research and Clinical Practice\u003c/em\u003e \u003cstrong\u003e211\u003c/strong\u003e, 111679 (2024).\u003c/li\u003e\n\u003cli\u003eMontero, D., Vinet, A. \u0026amp; Roberts, C. K. Effect of combined aerobic and resistance training versus aerobic training on arterial stiffness. \u003cem\u003eInt J Cardiol\u003c/em\u003e \u003cstrong\u003e178\u003c/strong\u003e, 69\u0026ndash;76 (2015).\u003c/li\u003e\n\u003cli\u003eXi, H. \u003cem\u003eet al.\u003c/em\u003e Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eExperimental Gerontology\u003c/em\u003e \u003cstrong\u003e155\u003c/strong\u003e, 111560 (2021).\u003c/li\u003e\n\u003cli\u003eRoss, R., Hudson, R., Stotz, P. J. \u0026amp; Lam, M. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: a randomized trial. \u003cem\u003eAnn Intern Med\u003c/em\u003e \u003cstrong\u003e162\u003c/strong\u003e, 325\u0026ndash;334 (2015).\u003c/li\u003e\n\u003cli\u003eCzech, M. P. Insulin action and resistance in obesity and type 2 diabetes. \u003cem\u003eNat Med\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 804\u0026ndash;814 (2017).\u003c/li\u003e\n\u003cli\u003evan Gemert, W. A., Monninkhof, E. M., May, A. M., Peeters, P. H. \u0026amp; Schuit, A. J. Effect of Exercise on Insulin Sensitivity in Healthy Postmenopausal Women: The SHAPE Study. \u003cem\u003eCancer Epidemiology, Biomarkers \u0026amp; Prevention\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 81\u0026ndash;87 (2015).\u003c/li\u003e\n\u003cli\u003eArsenault, B. J. \u0026amp; Despr\u0026eacute;s, J.-P. Physical Activity for Type 2 Diabetes Prevention: Some Is Better Than None, More Is Better, and Earliest Is Best. \u003cem\u003eDiabetes Care\u003c/em\u003e \u003cstrong\u003e46\u003c/strong\u003e, 1132\u0026ndash;1134 (2023).\u003c/li\u003e\n\u003cli\u003ePospieszna, B. \u003cem\u003eet al.\u003c/em\u003e Influence of 12-week Nordic Walking training on biomarkers of endothelial function in healthy postmenopausal women. \u003cem\u003eJ Sports Med Phys Fitness\u003c/em\u003e \u003cstrong\u003e57\u003c/strong\u003e, 1178\u0026ndash;1185 (2017).\u003c/li\u003e\n\u003cli\u003eMuscella, A., Stef\u0026agrave;no, E. \u0026amp; Marsigliante, S. The effects of exercise training on lipid metabolism and coronary heart disease. \u003cem\u003eAmerican Journal of Physiology-Heart and Circulatory Physiology\u003c/em\u003e \u003cstrong\u003e319\u003c/strong\u003e, H76\u0026ndash;H88 (2020).\u003c/li\u003e\n\u003cli\u003eJustesen, J. M. \u003cem\u003eet al.\u003c/em\u003e Increasing insulin resistance accentuates the effect of triglyceride-associated loci on serum triglycerides during 5 years. \u003cem\u003eJ Lipid Res\u003c/em\u003e \u003cstrong\u003e57\u003c/strong\u003e, 2193\u0026ndash;2199 (2016).\u003c/li\u003e\n\u003cli\u003eLiang, M., Pan, Y., Zhong, T., Zeng, Y. \u0026amp; Cheng, A. S. K. Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. \u003cem\u003eRev Cardiovasc Med\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 1523\u0026ndash;1533 (2021).\u003c/li\u003e\n\u003cli\u003eClayton-Chubb, D. \u003cem\u003eet al.\u003c/em\u003e Serum Transaminases and Older Adults: Distribution and Associations With All-Cause Mortality. \u003cem\u003eJ Gerontol A Biol Sci Med Sci\u003c/em\u003e \u003cstrong\u003e79\u003c/strong\u003e, glae203 (2024).\u003c/li\u003e\n\u003cli\u003eHejazi, K. \u0026amp; Hackett, D. Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. \u003cem\u003eJ Clin Med\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 3011 (2023).\u003c/li\u003e\n\u003cli\u003eArag\u0026atilde;o, F. R. \u003cem\u003eet al.\u003c/em\u003e Effects of a 12-month multi-component exercise program on the body composition of postmenopausal women. \u003cem\u003eClimacteric\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 155\u0026ndash;163 (2014).\u003c/li\u003e\n\u003cli\u003eSrikanthan, P., Horwich, T. B. \u0026amp; Tseng, C. H. Relation of Muscle Mass and Fat Mass to Cardiovascular Disease Mortality. \u003cem\u003eAm J Cardiol\u003c/em\u003e \u003cstrong\u003e117\u003c/strong\u003e, 1355\u0026ndash;1360 (2016).\u003c/li\u003e\n\u003cli\u003eWochna, K. \u003cem\u003eet al.\u003c/em\u003e Nordic walking with an integrated resistance shock absorber affects the femur strength and muscles torques in postmenopausal women. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 20089 (2022).\u003c/li\u003e\n\u003cli\u003eGrgic, J. \u003cem\u003eet al.\u003c/em\u003e Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. \u003cem\u003eSports Med\u003c/em\u003e \u003cstrong\u003e50\u003c/strong\u003e, 1983\u0026ndash;1999 (2020).\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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nordic walking, Bungy Pump Training, cardiorespiratory fitness, metabolic syndrome factors, body composition, postmenopausal women","lastPublishedDoi":"10.21203/rs.3.rs-6108479/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6108479/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"(Y.N.). The study examined the effect of a 12-week Bungy Pump Training (BPT) program on cardiorespiratory fitness (CRF), metabolic syndrome (MetS) factors and body composition in postmenopausal women (PW). Fifty-six participants were assigned to the BPT group (n=30) and Daily Activity (DA) group (n=26). The BPT group completed 60-minute sessions 3 times a week, and the DA group performed daily activities. Body composition, maximum oxygen uptake (VO 2max), heart rate (HR), blood pressure (BP), glucose and lipids were assessed at baseline and post-intervention. In the CRF and MetS factors, significant improvements (p \u003c 0.05) were observed on VO 2max , BP, total cholesterol, high-density lipoprotein cholesterol (HDL-C), Non-HDL-C, and low-density lipoprotein cholesterol in the BPT group. In the body composition, significant improvements (p \u003c 0.05) were observed on body weight, BMI, basal metabolic rate, percent body fat, visceral fat area, skeletal muscle mass, body fat mass, and fat-free mass in the BPT group. The 12-week BPT performed 3 times a week was more significant on CRF, MetS factors and body composition in PW. This finding could be applied to intervention programs for PW in non-pharmacological interventions. Trial registration: Clinical Trials NCT06781541 on 17/01/2025.","manuscriptTitle":"Effect of a 12-week Bungy Pump Training on cardiorespiratory fitness, metabolic syndrome factors and body composition in postmenopausal women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 14:42:48","doi":"10.21203/rs.3.rs-6108479/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-24T06:28:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-23T07:53:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T22:52:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73726291224092857437940468076997664307","date":"2025-06-13T07:47:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29358549789656959274635082125419307294","date":"2025-06-12T10:59:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236128609659559334323995987239320594761","date":"2025-06-12T10:32:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T10:12:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-10T12:49:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-19T04:07:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-17T09:44:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-02-25T23:13:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ce343dd-daf5-4d61-af7f-c5928a9292d6","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":49994839,"name":"Health sciences/Diseases/Cardiovascular diseases"},{"id":49994840,"name":"Health sciences/Health care"},{"id":49994841,"name":"Health sciences/Health care/Disease prevention"},{"id":49994842,"name":"Health sciences/Health care/Geriatrics"}],"tags":[],"updatedAt":"2025-12-01T16:07:23+00:00","versionOfRecord":{"articleIdentity":"rs-6108479","link":"https://doi.org/10.1038/s41598-025-25909-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-11-25 15:58:13","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-06-17 14:42:48","video":"","vorDoi":"10.1038/s41598-025-25909-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-25909-1","workflowStages":[]},"version":"v1","identity":"rs-6108479","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6108479","identity":"rs-6108479","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}