Saturday, January 28, 2017

Each +30 Min/d of Physical Activity Reduce HbA1c by 11%, Protein + CHO Maintain Bone Mass, Overlooked Benefits of BFR, New Marker of Overtraining - Jan '17 Science Update

  This is what the Jan '17 Science Update has to offer? -11% HbA1c reduction per 30 minutes activity, new benefits of blood flow restricted tr., the bone protective effect of immediate post-workout whey plus carb ingestion, and a new overtraining gauge...

It's almost, February... almost and that's why today's SuppVersity article still qualifies as a January '17 research update. One that is based on the latest (ahead of print) papers from the peer-reviewed journal "Medicine & Science in Sports & Exercise" - papers about the large impact of short bouts of moderate-to-vigorous physical activity (MVPA) on the messed up glucose management of people with an increased T2DM risk, the bone-preserving effects of a mix of whey and dextrose and how this effect depends on timing, the belated and thus overlooked beneficial effects of blood flow restriction on muscular rapid force development and, last but not least, a potential new marker of overreaching and -training that could also explain the dichotomous role of IL-6 in the adaptive and maladaptive response to exercise.
Learn more about blood flow restriction at the SuppVersity

BFR for VO2 & Strength Gains

Using BFR in Periodization

BFR Precondi-tioning = Useless

Benefits of Cuffs After sets?!

No Extra-Gains W/ BFR vs. HIT

Hormonal Re-sponse to BFR
  • Scientists find new marker of overreaching and potentially -training: You know that exercise will increase the levels of the allegedly "bad" cytokine IL-6. Now, as a SuppVersity reader, you will yet also know that this "cytokine" is, in fact, a "myokine" if it is released in response to muscle contractions and that it appears to figure in the hormetic response to exercise stress... or, in other words, without it, you're not going to get the adaptational response in form of strength and size gains you're training for. With that being said, studies also show that significantly elevated levels of IL-6 can also occur with overtraining and are - in this situation - a sign of dysfunctional adaptation.

    Recent research does now suggest that the "dichotomous nature of IL-6 signalling appears to be determined by the respective concentration of its receptors (both membrane-bound (IL-6R) and soluble (sIL-6R) forms)" (Cullen. 2017) - measuring these concentrations could thus provide important information about whether the circulating IL-6 is going to trigger a hormetic response or not. Accordingly, Cullen et al. conducted a study that investigated the response of sIL-6R to long-term training, and the relationship between sIL-6R, self-reported measures of wellbeing, and upper respiratory illness symptoms (URS) in highly-trained endurance athletes.
    Figure 1: Unlike cortisol, which has a long history as a suspected, but rarely useful overtraining gauge, sIL-6R doesn't have a circadian rhythm (see explanation in green box). This doesn't mean it's an accurate marker of overtraining, but it does mean that it is less complicated and more convenient to use, because with overtraining the circadian rhythm can be so messed up that simply measuring at the same time won't suffice to get comparable and thus useful results to gauge your training status.
    Their results are quite conclusive: Firstly, they confirmed that sIL-6R is responsive to prolonged periods of exercise training. And second- and more importantly, the subjects' sIL-6R levels varied according to the individual training volume and could be linked to common symptoms of overreaching such as high levels of stress, and/or depressed mood.

    This is obviously not enough to use sIL-6R as an overtraining gauge. With future studies that determine the level of sIL-6R in overreaching and overtraining athletes, it may thus be possible to distinguish between these states (and regular training) and to use this information to optimize athletes and gymrats workout routines. 
  • Rapid Force Capacity (RFC) increases sign. with blood flow restriction, but study shows: Adaptation takes time: This observation Nielsen, et al. (2017) made in their recent study is an important one, because it implies that previous studies on the effects of blood flow restriction + low-intensity training may simply have missed the beneficial effects when they measured (just as Nielsen, et al. did it, too), the adaptational response only 5 days after having subjects participate in a series of standardized workouts.

    In the study at hand, this series constituted of twenty-three training sessions which were performed within 19 days. In all 10 male subjects (22.8+/-2.3 years) who performed four sets of knee extensor exercise (20%1RM) to concentric failure during concurrent BFR of the thigh (100mmHg), and the eight work-matched controls (21.9+/-3.0 years) who trained without BFR (CON), the scientists tested the maximal slow and fast knee joint velocity muscle strength and rapid force capacity (e.g. RTD) as well as evoked twitch contractile parameters before and after the study.
    Figure 2: Changes in rate of force development (left) and mean muscle fibre area (right | Nielsen. 2017).
    Now, that's nothing new. What was new, however, is that they tested before (Pre) and 5 and 12 days after training (Post5, Post12). In conjunction with the data from the biopsies, Nielsen et al. were thus able to detect the improved rate of torque development for the first time. The sign. difference in muscle fiber area (Figure 2, right), on the other hand, is - interesting as it may be - no news: after all, we're comparing light load with BFR to light load w/out BFR and not, as many other studies did, light load BFR to regular high load training, where time and again the regular training group saw the greater muscle increases.
  • Each extra 30 minutes of daily moderate to vigorous physical activity improve HbA1c of subjects at increased T2DM risk by 11%: MVPA aka "moderate to vigorous physical activity" is the buzzword of the fitness tracker generation. Now, a three-year study confirms what the medals your fitness tracker software will award to you already suggested: each minute spend moving at moderate to vigorous intensity is an investment into your health and well-being.

    How Accurate Are Activity Trackers? EE Data From Omron, Fitbit, Jawbone & Other Devices Reveals 10% Error & More | read the full SV article
    The above is the result of a recent study that correlated longitudinal (three-year follow-up) activity tracker data with changes of the long-term glucose marker HbA1c in a sample of 489 men and women at high risk of developing type II diabetes, participants (mean age 64.2 +/- 7.3 years, BMI 31.7 +/- 5.1, 63.4% male). And it's a result based on which the authors, Mathew McCarthy, and colleagues, rightly conclude that "[i]ncreases in MVPA and body weight were associated with a reduction and increase in HbA1c respectively, particularly in those with dysglycemia" (McCarthy. 2017).
  • Immediate Protein + CHO post-workout nutrition protect your bone from the bone resorption in the hours after exhaustive running: Next to its important result, there are two things which make a recent study by Rebecca Townsend et al. particularly interesting. Firstly: The subjects were young, healthy men, not post-menopausal women as in so many other bone health studies; and second- and not less importantly, the study tested both the efficacy of a mix of 1.5g/kg dextrose + 0.5g/kg whey as a means to reduce bone resorption (=calcium leeching) markers and the effects of timing.
    Figure 3: Overview of the study design, note that active treatment or PLA were administered at three different time points with two servings of placebo ensuring that the subjects could not differentiate between the immediate supplementation, the 2h-post and 4h-post supplementation trial (Townsend. 2017).
    And guess what. The study, in the course of which the dextrose + whey drinks were administered either before or after a placebo drink immediately or 2h after the run (see Figure 3) did not just confirm that the nutrient mix can ameliorate and shorten the exercise-induced (75% VO2Max run to exhaustion) increase in the bone resorption markers β-CTX and P1NP, it also found that this effect is time-dependent with the administration of the dextrose + whey mix right after the workout having more beneficial effects than taking it 2h post. With the immediate consumption reducing the levels below pre-exercise levels (-22% to -61%) within 1h, while it remained elevated with the placebo drink and/or in the DF group in which the supplement was consumed 2h after the workout. Now all that could well be a mere time-shift in the bone anabolic response. The scientists' observation that "[t]he overall β-CTX response was significantly lower in the IF trial than the DF trial (P=0.019, d=0.37) and the PLA trial (P≤0.001, d=0.84)" (Townsend. 2017) does however clearly suggest a definite benefit of immediate (IF) vs. postponed (DF and PLA) nutrient consumption after exhaustive workouts.

    In this context, however, it is important to realize that that, eventually, i.e. 3-4h after the run, the level of β-CTX decreased to similar below pre-test levels in all groups. Practically speaking this means that the net effect of a single session of exhaustive exercise on the young men's bone was almost certainly positive, irrespective of whether and when they ingested the supplement.
What's the take away of the studies in this Science Update: For me personally, the most important lesson comes from the MVPA study by McCarthy et al. (2017). A mere 30 minutes of "exercise" (even fast walking would qualify) is after all an easily manageable workload of that will contribute to statistically and, more importantly, clinically significant improvements in blood glucose management.

Drop the weights, grab the shake! Timing matters for advanced trainees.
Sort of surprising was the time-dependence of the beneficial effects of a dextrose + whey mix on bone resorption after exhaustive running in young male subjects. As I hinted at in the discussion of the study, however, we got to be careful not to mistake a timeshift in the response for an actual improvement.

Imho, future (best longitudinal studies) should investigate the net effect on bone mass to avoid a similar confusion as we've had them for protein supplements of which the majority of studies refutes that their ingestion in the immediate vicinity of the workout would improve your gains.

Last but not least, there's Nielsen's BFR study, which doesn't just prove another hitherto overlooked benefit of blood flow restricted low-intensity training, but also constitutes a lesson in study design, which reminds us that the timing of a retest will often determine if you find an effect or not. Apropos timing, while the latter may matter less for sIL-6R data than it does for cortisol, there's still a lot of research necessary to confirm the validity of this new marker of overreaching and -training and develop reliable tests for athletes and gymrats | Comment on Facebook!
  • Cullen, Tom; Thomas, Andrew W.; Webb, Richard; Phillips, Thom; Hughes, Michael G. "sIL-6R Is Related to Weekly Training Mileage and Psychological Well-being in Athletes." Medicine & Science in Sports & Exercise: Post Acceptance: January 24, 2017.
  • McCarthy, Matthew; Edwardson, Charlotte L; Davies, Melanie J; Henson, Joseph; Gray, Laura; Khunti, Kamlesh; Yates, Thomas. "Change in Sedentary Time, Physical Activity, Bodyweight, and Hba1c in High-Risk Adults." Medicine & Science in Sports & Exercise: Post Acceptance: January 24, 2017.
  • Nielsen, Jakob Lindberg; Frandsen, Ulrik; Prokhorova, Tatyana; Bech, Rune Dueholm; Nygaard, Tobias; Suetta, Charlotte; Aagaard, Per. "Delayed Effect of Blood-Flow-Restricted Resistance Training on Rapid Force Capacity." Medicine & Science in Sports & Exercise: Post Acceptance: January 23, 2017. 
  • Townsend, Rebecca; Elliott-Sale, Kirsty J.; Currell, Kevin; Tang, Jonathan; Fraser, William D.; Sale, Craig. "The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism." Medicine & Science in Sports & Exercise: Post Acceptance: January 24, 2017.