1. Long-­term Effects of Exercise on High-­density Lipoprotein
Cholesterol Levels
Rogelio Aguirre, Tom Yamuguchi, Chris Grant, Benjamin Eaton, Pauline Renfroe
Overview and Introduction:
Low levels of high-­density lipoprotein (average as low as 45 mg/dl for men, and less than
60 mg/dl for women) are a great risk factor for coronary heart disease, and show correlations
with a sedentary lifestyle [1]. Though there are many risk factors for CHD, this article will only
briefly mention age and diet while keeping the focus on increasing HDL levels through exercise
because of the great protection factor high HDL levels (>60 mg/dl) seem to provide against
CHD.
Ballantyne [1] states that “Males and females who have a regular habit of exercising have
lower fasting concentrations of total triglyceride and cholesterol in very low and low density
lipoproteins (VLDL and LDL), but higher cholesterol concentrations in high-­density lipoproteins
(HDL).” He goes on to explain that the increase in HDL levels is explained by the increase in
HDL2 subfractions and the increase in the apoA-­1 which is the main protein found in HDL
cholesterol [1,2,4]. To find the most effective exercise to raise HDL levels this review article will
discuss the type (resistance and/or aerobic), mode, intensity (low, moderate, or high), and the
duration of exercise and their effects on HDL cholesterol levels.
Age and Diet:
The age range in this review article does not include those under 18 due to the fact that
long-­term effects of exercise on cholesterol cannot accurately be measured before such a young
age, when poor cholesterol levels and CHD are not yet a true risk factor to focus on.
Also, this article does not want to disregard the fact that there is nothing that can replace
the outstanding benefits, and long-­term effects, of a healthy diet [3]. It is understood that a
life-­long healthy diet is a great protection and influence on cholesterol levels;; however, diet has
the ability to influence LDL cholesterol levels whereas it is exercise, independent of diet, that
has the ability to increase HDL levels [5].

2. Literature
Citation
Participants/
Groups
Mode Length Intensity/Frequency/D
uration
HDL level changes
(pre and post)
Seip R.L. (20) 57 (29 women and
28 men) average age
61-­67
walking,
jogging,and/
or cycle
ergometry
9-­12 months Exercise intensity
gradually increased from
65% of maximal heart
rate initially to 80% to
85%
pre training
52.8+13.9 post
training 55.3±15.5
Duncan G.E (21) 492 healthy but
sedentary women
(n=315) and men
(n=177),age 30-­69
years. PA
comparison group or
to 1 of the 4
exercise-­counseling
conditions:
ModI–low frequency
(LowF),
ModI-­HiF, hard
intensity
(HardI)–LowF, or
HardI-­HiF.
walking or
jogging
6-­ 24 months 45% to 55% HRres in
the ModI;; 65% to 75%
Hrres in the HardI LowF
conditions
were asked to walk 3 to
4 d/wk, while those in
the HiF conditions
were asked to walk 5 to
7 d/wk.30 minutes per
day
Baseline HI I&F
52.13 ± 12.21
Change 1.83 ±
6.11†‡§
mo-­I Hi F 54.49 ±
14.93 Change
0.54 ± 6.43
Hard I low F 53.47
± 11.49 Change
−0.09 ± 5.55
Mod I Low F 54.49
± 4.93 Change
1.44 ± 6.87
PA 55.43 ± 13.44
Change 0.03 ± 5.23
Kraus W.E. (22) 111 sedentary,
overweight men
and women three
exercise groups age
52.3±7.8
walking or
jogging
6-­8 months 0. control
1.high-­amount–high-­inte
nsity exercise, the caloric
equivalent
of jogging approximately
20 mi (32.0 km) per
week for a pers per week
at 65 to 80 percent of
peak oxygen
consumption;; 2.
low-­amount–high-­intensi
ty exercise, the caloric
equivalent of jogging
approximately 12 mi
(19.2 km) per week
at 65 to 80 percent of
peak oxygen
consumption;; and 3.
low-­amount–
moderate-­intensity
exercise, the caloric
equivalent of walking
approximately
12 mi per week at 40 to
55 percent of peak
HDL cholesterol
(mg/dl) (0) 42.7±2.7
42.1±2.2 (3)
42.0±1.9 43.1±2.5
(2) 48.1±3.8
48.9±3.7 (1)
42.1±2.3 45.9±2.6

3. oxygen
consumption.
Crouse S.F. (23) 27 men average age
27 moderate vs high
intensity
cycle
ergometer
3 months [Mod;; 50% maximal O2
uptake (V˙ O2max)] or
high intensity
(Hi;; 80% V ˙ O2max)
exercise training three
times per
week set to burn 350
Kcals per session
no significant
change in HDL
Slentz C.A (24) Sedentary,
overweight subjects
(n
240)
high-­amount/vigorou
s-­intensity exercise;;
2) low-­amount/
vigorous-­intensity
exercise;; or 3)
low-­amount/moderat
e-­intensity exercise.
treadmill,
elliptical
trainer, and
stationary
bicycle
6 months 1)
high-­amount/vigorous-­in
tensity exercise, the
caloric equivalent
of 20 miles of jogging
per week at 65–80%
peak oxygen
consumption (V˙ O2);; 2)
low-­amount/vigorous-­int
ensity
exercise, the caloric
equivalent of 12 miles
of jogging per week at
65–80% peak V˙ O2;;
and 3)
low-­amount/moderate-­in
tensity exercise,
the caloric equivalent of
12 miles of walking per
week at 40–55%
peak V˙ O2.
there was a
significant increase
of ~3.5 mg/dl HDL
high-­amount/vigoro
us-­intensity exercise
Paoli A pacelli (25) Fifty-­eight
participants (ages
61±3.3 yrs three
exercise treatment
groups: HICT, LICT
and ET
cycle
ergometer
3 months 3 times a week 50 min
per session ET: these
participants trained on
cycloergometer.
Intensity was maintained
at 50% of HRR.LICT:
the participants trained
by alternating 8’ of
endurance on
cycloergometer at 50%
of HRR. HICT: the
participants trained by
alternating 8’ of
endurance on
cycloergometer
(performed for 3’ at
HICT present a
significant change
51±0.6) (56±1.2)
mg/dl HDL

4. 50% and 1’ at 75% of
HRR
Sunami Y (19) training group 10
men and 10 women
aged 67 -­+ 4 years
control group (n =
20, 10 men and 10
women ag.ed 68 -­+ 4
years)
bicycle
ergometer
5 months 50% estimated maximal
oxygen consumption
(Vozmax) for 60 minutes
two to four times
per week
training pre;; 51.3_+
11.3 post 56.2_+
13.97 control;; pre
49.7_+ 10.8 post
48,1 _+ 11.1
Ballantyne et al (1) Men ages 51-­54
+/-­6yrs who
survived myocardial
infarction
19 men to exercise
group
23 men to control
group
Canadian Air
force 5BX
(stretching,
sit-­up, back
extension,
push-­up,
running)
6 months N/A / 10 days then 1 day
rest/ 11-­15 minute
routine
Exercise group:
Pre: 49 +/-­9 Post:
56 +/-­13
Control group:
Pre: 51+/-­9
Post: 51+/-­9
Ghanbari-­Niaki
et al (2)
20 female students
Groups:
40 % VO2 max
60%VO2 max
80%VO2 max
Circuit
resistance
training
1 session 40%, 60%, and 80%
VO2 max/single session
of circuit resistance
training (9 exercises, 25
sec per exercise, 3 sets of
3 non stop circuits, and 1
minute rest between sets)
No significant
changes in HDL
levels, but increases
in PBL ABCA1
expression.
Gomez-­Huelgas et
al (3)
601 subjects with
metabolic syndrome
lifestyle intervention
n= 298
control group n=303
Walking 3 years N/A / 150 minutes per
week
Treatment group:
Pre:47+/-­12
Post:49+/-­12
Control group:
Pre:45+/-­12
Post:49+/-­12
Tseng Sedentary males
18-­29 BMI > 27
Resistance
Training and
Aerobic
training
12 weeks Weeks 1-4:
60 min/day, at
50–60% of
1-repetition maximum
(1-RM) for three sets
(12–15 repetitions)
Weeks 5-8:
60–70% of 1-RM for
three sets (10–12
repetitions)
Weeks 9-12:
70–80% of 1-RM for
three sets (8–10
repetitions)
military press, leg
extension, leg curl,
HDL-C (mg/dl)
Before
55.1 ​+​ 3.3
After
57.9 ​+​ 3.3
Change
2.8 mg/dl
5.6%

5. chest press, biceps
curl, arm flexion, arm
extension, abdominal
crunch, twisting
oblique, and
plantar/dorsiflexion
Casella-­Filho et al
(4)
Male and female
21-­70 years with
metabolic syndrome
cycle
ergometer
3 months 45 minutes/ 3 times per
week
Exercise group:
Pre: 36+/-­5
Post:37+/-­6
Control group:
Pre: 52+/-­8
Post: 52+/-­8
KJ Elliot, CJ Sale Postmenopausal
sedentary women
average age of 58.
Low
intensity
resistance
training
8 weeks 3 days a week Pre: 1.99 mmol/l
Post: 2.10 mmol/l
​E. Morencos​1​
, B.
Romero
46 men and 73
women age 18-­53
BMI 25-­29.9
Low
intensity
resistance
training and
low intensity
cardio
23 weeks
El-­sayed et al(13)
18 normal men Group
1 80% VO2 max
Group 2 30% VO2
max (age, train or
untrain not listed)
bicycle
ergometer 12 weeks
1, 80%VO2 max 2, 30%
VO2 max 3 times per
week
No significant
changes in HDL
levels
Stein RA et al(14)
49 healthy sedentary
men (age 44±8) Group
1, 65%MHR,2,
75%MHR, 85%MHR,
control
bicycle
ergometer 12 weeks
65%, 75% and 85% MHR
3 times per week
Pre Post 65%
47.0±0.3 45.7±3 75%
35.8±2 42.6±3 85%
42±3 47.6±4
Kenneth R. Wilund
et al(15)
Healthy sedentary 17
men and 22 women
(Ave age 57)
Ergometer,
treadmill
walking, ski
machine 6 months
70% MHR, 3 times per
week 40.9±1.9 43.9±1.9
Barbara J. Nicklas et
al(16)
46 sedentary men (age
46-­72) group 1 normal
BMI(22-­26) Group 2
overweight
BMI(27-­30), group 3
obese BMI (31-­37)
Treadmill
walking and
ski machine 9 months
70-­80% HRR 3 times per
week
Normal 35.96±3.8
40.99±6.9 overweight
32.87±6.2 35.1±6.9
Obese 30.12 ±5.0
30.88±5.0
Abby C. King et
al(17)
149 men and 120
postmenopausal
Group 1
walking-­joggin 2 years
Group 1 and 2, 73% to
88% of the peak heart rate
Group 1 men
50.27±12.8 change

6. women 50 to 65 years
of age who were
sedentary and free of
cardiovascular
disease. Group 1 High
intensity group based,
Group 2 High
intensity home based,
Group 3, low intensity
home based
g, with some
use of
stationary
cycles and
treadmills.
Group 2 and 3
did home
based
endurance
training
Group 3 heart rate 60% to
73% 3 times per week
0.38±12.4 women
59.3±15.4 change
2.4±16.2 Group 2
men 46.7±12.4
change 1.9±12.4
Women 59.9±17.4
change 2.7±17.4
Group 3 men
45.6±8.9 change
4.3±9.3 women
55.3±14.3 change
3.9±14.3
James G. Warner Jr
et al(18)
533 men (Age
58.9±10.6)& 166
women (Age 57.2)
Cardiac Rehabilitation
Patients
walking,
jogging, or
riding a
stationary
bicycle 5 years
70-­80% MHR, 3 times per
week
Men 36.7±0.3 38.5
±0.9 Women
46.7±0.5 56.1±2.0
Bharathi
Prabhakaran (28) age
27 Twenty four women
resistance
training 14 weeks
(85% of one repetition
maximum (1-­RM) 45–50
minute resistance training
sessions 3 times per week
no significant change
in HDL
Charles Couillard
(29)
200 men younger
than 65 Years old (1)
low TG and high HDL
cholesterol
(normolipidemia), (2)
low TG and low HDL
cholesterol (isolated
low HDL cholesterol),
(3) high TG and high
HDL cholesterol
(isolated high TGs),
and (4) high TGs and
low HDL cholesterol
(high TG/low HDL
cholesterol).
cycle
ergometer 20 week
55% increasing by the
14th week to 75%
base line of ~ 29
mg/dl men with high
TG/low HDL
cholesterol showed a
significant increase in
HDL cholesterol
levels (4.9%)
Barbara J.
Nicklas(30)
Healthy middle-­aged
and older (57 -­+ 2
years)
lean (n = 16;; body
mass index [BMI1, 22
to 26 kg/m2),
moderately obese (n =
15;; BMI, 27 to 30
kg/m2),
treadmills,
cycle
ergometers 9 months
[HRR. 50%-­ 80%] 3 day
per week 45 -­ 50 minutes
significant increase
on lean group (14%
3.8mg d/l) and
moderate obese 7% or
2.3 mg/dl
Long-­term effects of Resistance training on HDL levels:

7.
It is generally accepted in the world of exercise physiology that exercise can improve the
blood lipid profile and more specifically raise HDL levels. The question stands, what is the best
method of exercise for favorable changes to blood HDL cholesterol content;; this article will first
look into the effects of resistance training.
In the article “​Effects of resistance training and detraining on muscle strength and blood
lipid profiles in postmenopausal women,” low intensity weight training was performed to find
out if there was a favorable change in blood lipid profile. The women in the study were all
postmenopausal with an average age of 53. For the experiment women performed ​three sets of
eight repetitions of leg press, bench press, knee extension, knee flexion, and lat pull-­down, three
days a week at 80% of 10RM for 8 weeks [6]. This training procedure was ineffective in
significantly altering HDL levels or any other positive alteration of the blood lipid profile. In the
discussion, references were made to other studies of a similar nature that were found to be
effective but the difference was that those studies lasted 16 and 14 weeks respectively [6]. The
ineffectiveness of this routine to alter HDL levels was hypothesized to be because of duration not
method.
In another study titled “Effects of dietary restriction combined with different exercise
programs or physical activity recommendations on blood lipids in overweight adults,” different
forms of exercise were compared to each other;; the focus will remain on the groups that
performed resistance training. Men and women between the ages of 18-­50 followed a circuit
involving the following eight exercises: shoulder press, squat, barbell row, lateral split, bench
press, front split, biceps curl, and French press for triceps. The intensity of exercise was
gradually increased over the study period. Week 2-­5 exercises were performed at an intensity of
50% of the 15RM and HRR, and lasted an overall of 51 min and 15 s (twice around the circuit,
lasting 7 min 45 s each lap). Weeks 6-­14 exercises were performed at an intensity of 60% of
15RM and HRR, with a duration of 51 min and 15 s (again, twice around the circuit). Finally,
weeks 15-­23 exercises were performed at an intensity of 60% of 15RM and HRR, with a
duration of 64 minutes (three times around the circuit). The recovery period between circuits was
set at 5 min. Participants performed 15 repetitions (45 s) of each exercise with a rest period of 15
seconds between them [7]. This study may prove the hypothesis from the former study that
duration was the reason why the previous study did not succeed in raising HDL levels. This
study being 23 weeks was longer than the referenced studies presented by the former. An
important detail to note is that the intensity of this study was also less than the prior study
presented, beings o performed at a percentage of a 15 rep max, while the former a percentage of
a 10 rep max, but the duration was much longer. The Men in the group saw a significant increase
in HDL at 7.1% increase but the women saw no change.
The next study, “A Simple Method for Increasing Levels of High-­Density Lipoprotein
Cholesterol: A Pilot Study of Combination Aerobic-­ and Resistance-­Exercise Training,” utilized

8. higher intensity. The overweight men in this study (BMI >27), ages 18 to 29 years of age,
performed 60 min/day, at 50–60% of 1-­repetition maximum (1-­RM) for three sets (12–15
repetitions) during Weeks 1–4, 60–70% of 1-­RM for three sets (10–12 repetitions) during Weeks
5–8, and 70–80% of 1-­RM for three sets (8–10 repetitions) during Weeks 9–12, performing
military press, leg extension, leg curl, chest press, biceps curl, arm flexion, arm extension,
abdominal crunch, twisting oblique, and plantar/dorsiflexion [8]. This was performed 5 days a
week for the 12 weeks. It was discovered that HDL levels were significantly improved by about
2.8 ml/dl (2.8 ​+​ 0.1). Seeing that this experiment was able to effectively raise HDL levels with
only 12 week, duration of resistance training may play a factor in raising HDL levels but is not
the only factor as was proposed in the first study. We see that the intensity was much higher in
this study than the previous two, which may make the difference.
Both the study titled, “Effects of dietary restriction combined with different exercise
programs or physical activity recommendations on blood lipids in overweight adults,” and the
study titled, “A Simple Method for Increasing Levels of High-­Density Lipoprotein Cholesterol:
A Pilot Study of Combination Aerobic-­ and Resistance-­Exercise Training”, also involved a mix
aerobic and resistance study group. “Effects of dietary..,” performed the same resistance training
prescription as the resistance only group but also performed endurance training on treadmills and
cross trainer machines for the same allotted times at the same percentages on heart rate reserve.
There was again only significant change found in the HDL of the men at 12% increase, showing
a greater increase than did the men doing resistance training alone [7]. The article, “A Simple
Method....,” also used the same resistance training procedure and did the resistance training only
group but only performed resistance training 3 days a week on odd weeks and 2 days a week on
even weeks. The aerobic-­training group performed 60 min/day, 5 days/week, from 15
min/session at 50–60% of maximal heart rate (HRmax) to 45 min/session at 60–70% of HRmax
during weeks 1–12, determining VO2 max by using a walking treadmill exercise test. This
procedure was completed on opposing days from resistance training. The HDL cholesterol rise in
this study was significant;; significantly higher than resistance training alone. The increase in
HDL was about 5.0 ml/dl. (5.0 ​+​ 0.1), A 15% increase. When checked with a multiple regression
analysis it showed that the significant increase in HDL was correlated with the endurance
exercise (β=0.52) rather than the resistance training (β=-­3.65) [8].
These findings show that even though resistance training, when performed in a specific
way and at a certain level of intensity, may be effective in raising HDL levels, aerobic training is
much more effective at improving HDL levels.
Exercise Mode and its effect on HDL Levels:
There are various types of exercise that have potential to increase HDL levels, so it is
advantageous to know if there is one that is more beneficial than the other.

9. A study by Michael A. Ferguson shows four different single exercise sessions performed
by 11 healthy males who were randomly assigned submaximal treadmill sessions at 70%
maximal O2 consumption. ​During each session 800, 1,100, 1,300, or 1,500 kcal were expended.
Compared with immediately before exercise, high-­density lipoprotein cholesterol concentration
was significantly elevated 24 hr after exercise (​P​ < 0.05) in the 1,100-­, 1,300-­, and 1,500-­kcal
sessions. HDL concentration was also elevated (​P​ < 0.05) immediately after and 48 hr after
exercise in the 1,500-­kcal session [10]. The data indicates that in healthy, trained men 1,100 kcal
of energy expenditure is necessary to elicit increased HDL-­C concentrations after only one
exercise session. Therefore, it can be concluded that as long as the mode of exercise expends at
least 1,100 kcal of energy there will be significant increases in HDL levels. ​Although this study
was done on acute HDL levels after only one exercise session, according to an analysis by Stein
et al., acute changes in HDL-­ C levels can be maintained long term if the exercise prescription
that caused the acute change is continued 4-­5 times a week for 10-­14 week depending on the
individual [26]. Based on the data from this article, data dealing with acute HDL-­C levels can be
extrapolated to long term HDL-­ C levels.
An additional study was performed comparing different types of exercise effects on HDL
levels in the same population. This study was mainly focused at gauging the acute response of
continuous exercise on HDL levels compared to the effects of intermittent exercise on subjects
with high levels of aerobic training (male long distance runners) and determining if those
responses would then be carried into a long term increase in HDL levels. The concentration of
blood lipids was evaluated in this study at the end of continuous exercise and intermittent
exercise as well as post 24 hours after these exercises. The continuous exercise was defined as
running for 90 min on a treadmill at 5.8 mph and intermittent exercise was defined as alternating
low and high speeds on a treadmill between 4.5 mph for 3 min to 11 mph for 1 min. 22
repetitions of this alternating was done and this created an equivalent workload for both groups.
The O2 uptake and CO2 production were recorded, and blood lactate and blood lipid levels were
measured. The results showed that triacylglycerols were not modified by any kind of exercise.
Total cholesterol was increased at the end of both exercises: 7.04% for the continuous exercise
group (p < 0.001) and 4.23% for the intermittent exercise group (p = 0.001). High-­density
lipoprotein cholesterol was increased at the end of the intermittent exercise group from 40.4
mg/dl to 45.5 mg/dl, a 11.38% increase (p = 0.03). The continuous exercise group had no
significant increase in HDL-­C but did have an increase in low-­density lipoprotein cholesterol
from 108.7 mg/dl to 116.8 mg/dl, a 7.45% (p = 0.006). From the data, it can be concluded that
intermittent exercise performed by highly trained athletes increased blood TC and HDL
cholesterol, whereas the continuous exercise group only saw significant increases in blood
LDL-­C [11]. A vital discovery of this study is that the intermittent exercise group saw
significant increase in HDL-­C levels but if we look at the bigger picture, the mode of exercise is
not necessarily the chief factor in increasing HDL levels, but intensity of the exercise is what
influences increases in HDl levels the most. Though intensity is what mostly affects lipid profile,

10. when intensity is controlled energy expenditure and duration are the main factors impacting the
acute changes of lipids and lipoproteins in the blood;; this would then correlate into a long term
improvement in HDL levels and overall blood lipid profile.
Furthermore, in a meta analysis by Adrian Elliot et al. various articles were researched
comparing interval training to continuous training. Interval training was described as brief (1-­4
min) intermittent bouts of high-­intensity (>85% HR peak or equivalent) rhythmic exercise such
as cycling, jogging, or walking, interspersed by periods of (30-­60 sec.) active recovery such as
walking at a comfortable pace. Continuous exercise was defined as at least 30 minutes of
rhythmic aerobic exercise,such as cycling, walking, running or swimming, performed at a
moderate-­intensity (<80% HR peak or equivalent) that is sustainable for the duration of the
session [9]. The data from this meta analysis concluded that although there was an increase in
aerobic capacity for interval training there was no significant difference in HDL levels for either
continuous exercise or interval training.
An additional study by Esin Gullu et al. looked at differences in types of aerobic
exercises and their benefit on HDL levels. In this study 30 sedentary women were divided into 2
groups that either would walk/run or do step aerobics for 45 minutes 4 days a week for 10 weeks
at 75% HRmax. After the 10 weeks the walk/ run group had no change in HDL but there was
lower LDL levels which would still improve overall blood lipid profile. The step aerobics group
saw improvements in HDL levels and also lowered LDL levels so the step aerobics group greatly
improved the overall blood lipid profile and HDL cholesterol levels [24]. Even though aerobic
exercises such as running and walking are beneficial for blood lipid profile the most
improvement in blood lipid profile and HDL cholesterol levels was step aerobic exercises. From
this data it can be concluded that there can be benefits seen in HDL levels doing aerobic
exercises, but the highest improvement in HDL levels occurs in exercises that are aerobic but
that also have a resistance or anaerobic type of component included which would in most cases
increase intensity.
In conclusion nearly any aerobic exercise will show a benefit in HDL levels with the
greatest benefit coming from an exercise that has some kind of anaerobic exercise coupled with
the aerobic exercise. Although mode is important, it is not necessarily the largest issue when it
comes to the effectiveness of improving HDL levels;; what is most influential in improving HDL
levels is the intensity and duration of the exercise. The sum of the data about mode of exercise
concludes that as long as an exercise burns at least 1,100 kcal of energy an improvement in HDL
levels will be seen, with intense anaerobic coupled aerobic exercise being the most beneficial for
overall blood lipid profile.
Duration:
According to Satou Komada et al [12], exercise duration per session is one of the most
important elements of an exercise prescription. The analysis showed that aerobic exercise

11. duration is a strong influence to increase HDL-­C level. First, we will introduce the study that
explains exactly how many minutes of aerobic exercise for each session is beneficial to improve
HDL-­C level.
Komada’s study [12] has mentioned that each 10 minute increase in aerobic exercise
duration corresponds to approximately 1.4 mg/dl net increase in HDL-­C level range from 23
minutes to 74 minutes per session. Aerobic exercise duration of 30 minutes per session may be
recommended to maintain good health, however in order to improve HDL-­C levels more than 30
minutes per session is necessary.
El-­Sayed’s et al study [13] in 1996 showed the effect of 20 minutes aerobic exercise on
18 normal (No age or trained or untrained mentioned) men divided into 2 groups with the first
group performed low intensity exercise (30% VO2 max) and the second group performed high
intensity(80% VO2 max) aerobic exercise. The result showed no significant increase in subjects
HDL-­C level.
According to Richard A. Stein's et al study [14], 3 groups (age 44 plus minus 8) of
different intensities exercised for 30 minutes, 3 times per week. One group that had 75% of
MHR showed an increase in HDL-­C level by 18% however the 60% MHR group showed no
increase. This shows that 30 minutes of aerobic exercise can be long enough to increase the level
of HDL if the intensity is high enough. Kenneth R. Wilund et al [15] conducted a study where 39
sedentary participants who had an average age of 57 years, exercised (ergometer;; treadmill
walking;;ski) 3 times per week for 6 months. Initially, they started with 20 minutes of exercise at
50% of heart rate reserve. Exercise duration was increased by 5 minutes and intensity was
increased by 5% each week until the duration reached 40 minutes and intensity reached 70%.
After 6 months, their HDL-­C level was increased by 10%. Barbara J. Nicklas’s et al study[16]
showed the effect of 60 minutes aerobic exercise on 46 men who were divided into 3 groups
based on their BMI. The first group had a BMI of 22-­26, the second group ranged from 27-­30,
and the final group ranged from 31-­37. Subjects performed treadmill walking and ski machine
exercise for 3 times per week with intensity of 70-­80% HRR for 60 minutes for 9 months. Based
on these studies [12,13, 14, 15,16] 40-­60 minutes of aerobic exercise is necessary to improve
HDL-­C level and the duration can be 30 minutes if the intensity is more than 75% MHR.
Next, we would address the duration of the whole exercise program. The study completed
by Abby C. King et al [17] showed the effect of 24 months of exercise on HDL-­C levels.
Participants between the ages of 50-­65 were divided into 3 groups, based on the different
exercise intensity. The high intensity group led by an exercise instructor performed endurance
training such as walking-­jogging, with some use of stationary cycles and treadmills for 40
minutes with 73%-­88% (7-­7.5 METs) peak heart rate 3 times per week for 2 years. Likewise, the
high intensity group that participated in home based training performed 40 minutes of endurance
training with 73-­88% of peak heart rate for the same frequency. Participants were provided
written information and activity logs, and staff members called subjects the following week to
check on progress. The low intensity home based training group performed endurance exercise

12. with 60%-­73% heart rate (4-­4.5 METs) for 30 minutes 5 times per week. Instructions for
exercise and method of follow-­up were the same as for subjects in the higher-­intensity
home-­based training group. During the first year, both high intensity group’s HDL-­C levels
increased less than 1% while the low intensity group's HDL increased about 3%. After the
second year, the high intensity group’s HDL levels were increased by 2.6% from the first year.
High intensity Home based group's HDL was increased by 4.3% (p = 0.01 and low intensity
group's HDL levels were increased by 8.5% (p = 0.002).
Another study done by James G. Warner Jr et al [18] showed the effect of exercise on
HDL-­C levels in 553 men and 166 women for 5 years. They performed 30 to 40 minutes of
walking, jogging, or riding a stationary bicycle with intensity of 70% to 85% heart rate. During
the first year, men increased 10% HDL-­C level and women 7%. However, men’s HDL-­C levels
stopped increasing after the first year leaving the increase over the 5 years at only 5%. In
contrast, HDL-­C levels in women continued to increase during the 5 years and ended with a 20%
increase from baseline levels. The point of this study is to show that the rate of HDL-­C level
increases differ between men and women;; Men’s levels may increase at a faster rate than
women, but women’s levels have the potential for a greater overall increase.
Based on theses studies [13, 14,15,16,17,18], in order to improve an individual’s HDL-­C
level, exercise duration of 40 to 60 minutes per session is recommended and the individual
should see continual increase in HDL-­C level. Men should adjust their exercise’s intensity,
duration or frequency to produce more work to improve their HDL-­C level after 2 years of
exercise. For women, they they should adjust their exercise after 5 years to have continuous
increase in HDL-­C level.
Exercise Intensity
Intensity is a crucial element of endurance physical activity. Intensity combined with
duration and frequency helps determine the volume of endurance physical activity [17,20,]. A
study conducted by Glen E. Duncan et al [21] analyzed four different modalities of aerobic
endurance training which varied in intensity, “moderate” 45%-­55% HR reserve vs “hard”
65%-­75% HR reserve, and frequency “low” 3-­4 days/week vs “high” 5-­7 days/week. These are
the groups that were created based off the different intensities and frequency: high intensity/high
frequency, moderate intensity/high frequency, high intensity/low frequency, moderate
intensity/low frequency, and a control group that received counsel on current ACSM
recommendations for physical activity. Participants were sedentary men and women ages 30-­60
years old.After 6 months changes in HDL levels were seen, but only the changes in high
frequency & high intensity were significant (HDL-­C, mg/dL Baseline 52.13 ± 12.21 Change
1.83 ± 6.11*).
The role of intensity and frequency when duration is fixed is crucial, in the study
mentioned above [21] the significant changes were attributed to difference in metabolic volume.

13. The metabolic equivalent hours per week of exercise by condition were 6.77±1.76 for hard
intensity/high frequency, 5.02±1.09 for moderate intensity/high frequency, 4.00±0.92 for hard
intensity/low frequency, and 3.64±0.81 for moderate intensity/low frequency. All 4 conditions
differed significantly from each other with respect to volume of exercise [19].
In a similar study conducted by Crouse Stephen F. et al [23] intensity was also tested as a
mean to improve HDL levels. In this case participants were not entirely healthy, but rather
subjects were hyperlipidemic (TC concentrations 200 mg/dl) and sedentary (no regular aerobic
exercise in the past 3 months) males between the ages 37-­58 years old. Subjects were divided
into two groups: moderate intensity (50% of Vo2 max) and high intensity (80% VO2max). What
set this study apart was that they calculated time not just as an arbitrary number, but training time
required to burn 350 Kcal. Based on this model, those training at a lower VO2 max were set to
exercise (stationary bicycle and treadmill) for a longer period of time than those at a higher
intensity;; setting a relatively even training volume across all participants. The study found that
there was a significant change in HDL2-­C levels between high intensity and moderate intensity
participants: high intensity -­ pre 6.3mg/dl (+-­) 4.2 post 13.2mg/dl (+-­) 9.0, moderate intensity -­
pre 5.9 mg/dl (+-­3.7) post 9.3 mg/dl (+-­ 5.5). Even though HDL sub-­fractions showed significant
increases no significant changes were seen in total HDL-­C levels. This study serves to show that
with equal volume, both high intensity and moderate intensity can achieve significant changes in
HDL2-­C levels. The lack of changes in total HDL levels was hypothesised to be a result of
hyperlipidemia;; this might require a higher volume and duration (longer than six months) to see
significant changes. This hypothesis was proven true by a Paoli et al [25] who followed similar
procedures (controlled volume at different intensities) as Crouse in a healthy male population
and saw significant increases in total HDL in High intensity interval training pre (51 mg/dl ±0.6)
(56 mg/dl±1.2) [8].
The amount of physical activity (endurance) and intensity can greatly shape magnitude in
changes in HDL levels [21, 19, 20]. The study conducted by William E. Kraus et al [22] tested
two variables: intensity and amount of physical activity. A high amount of activity was defined
as the caloric equivalent of running 20 miles, a low physical amount of activity as running 12
miles, and moderate intensity at 40-­55% peak oxygen consumption. From this, the study created
a group of high amount and high intensity, low amount and high intensity, low amount and
moderate intensity, and a control group with no physical activity. The study found significant
total HDL changes in only the high amount/high intensity group (pre 44.3 mg/dl ±2.9 post mg/dl
48.6±3.3). It is noteworthy that even though the other two groups presented no significant
differences they actually prevented the worsening of lipoprotein profile in comparison to the
control group.
Currently most of the studies presented [17,19,20,21,24] favor higher intensity to produce
greater positive changes;; theoretically, a more favorable change in HDL levels can be expected
with higher intensity, frequency, duration, and amount of work. Higher intensity also helps
maintain more consistent positive changes in HDL levels after the conclusion of training. More

14. evidence of this was found in a study completed by Cris A. Slentz et al [24] in which after six
months of high-­amount/vigorous-­intensity exercise training (the caloric equivalent of 20 miles of
jogging per week for a 90-­kg person at 65–80% peak oxygen consumption), high intensity and
amount not only experienced the most significant change in HDL levels ( 3 mg/dl after 24 hr of
training), but was also able to maintain a constant 2 mg/dl increase in HDL-­C levels for up to 14
days after the last training session. With this information, high intensity produces the best results
in regards to HDL levels in endurance training. One key point worth mentioning from the last
three studies [21,22,24] is the report of having a significant difference of compliance between
subjects in a moderate intensity group and subjects in a high intensity group, with subjects
favoring the moderate intensity. Those three studies also had a relatively short time frame in
which moderate intensity might not have had enough volume and/or time to reach its full
potential in improving the blood lipid profile. A study done by Yoshiyuki Sunami et al [19]
shows that when individuals, especially older adults (60+ yrs.), train at 50% VO2max, for 60
minutes (almost twice that of reported in [23,22,21]), 2-­4 times per week for 5 months reports
significant changes in HDL levels (pre 51.3 mg/dl (-­+) 11.3 post 56.2 mg/dl (-­+) 13.97). In the
last couple of studies even though greater intensity provided wider range of changes, moderate
and low intensity either showed significant changes in HDL levels or prevented HDL levels from
deteriorating. Lower and moderate intensity showed higher adherence rates [20,25,23,22,21] and
in one of the studies a significant portion of the group kept performing the low-­moderate
endurance physical activity even after the study was complete [19].
Over all the best training program in regards to intensity is found in hybrid programs, in
which there is a gradual progression from low to high intensity. As an example there are studies
such as that of Richard L. Seip et al [20] that show a gradual increase from 65% VO2max to
85% VO2max over a period of one year;; the study showed significant increases of +2.6 mg/dl
±6.2. Also, the 2 year study done by Abby C. King et al [17] that had 2 groups: 3 high intensity,
40-­minute, endurance training sessions per week were prescribed at 73% to 88% of peak
treadmill heart rate, and 5 lower-­intensity, 30-­minute endurance training sessions per week were
prescribed at 60% to 73% of peak treadmill heart rate. In the end, all groups had equally
significant changes in HDL levels (males’ high intensity mmol/L 0.01 ±0.32, females’ high
intensity mmol/L0.06±0.42, males moderate intensity mmol/0.05±0.32, females moderate
intensity mmol/L0.07±0.45) [17]. It can be concluded that though intensity is only a portion of
what determines rises in HDL levels, it is a crucial part to the equation.
In Conclusion:
Through the study and research of many articles, and the utilization of a selected few, it is
proposed that the most effective factor of exercise in order to increase HDL-­C cholesterol levels
is not a matter of whether it is aerobic or resistance[8]. Rather it is the amount of energy
expended in a given duration of time (40 -­60 minutes yielding the best results, with 30 minutes

15. being sufficient given the right amount intensity level) while performing at a high enough
intensity with an appropriate amount of volume. Raising HDL cholesterol levels is not as simple
as performing either strength or aerobic exercise, but it is the combination of different factors of
exercise working together, each factor as important as the other, in order to produce the perfect
mixture of volume, intensity, and duration.
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