6-Week Adaptation to Minimalist Running Shoe Sign Boosts Running Economy, Doubles Improvements in 5k Time-Trial

The study subjects were trained runners, results may differ for noobs.

I openly admit that the focus of my SuppVersity articles has rarely been on endurance exercises like running. I am well aware, though, that many of you are participating in 10k and or marathon runs and will thus be interested in the results of a recent study in the Journal of Science and Medicine in Sport - a study that tried to get to the bottom of the ambiguous results on the performance enhancing effects of minimalist shoe wear, which appears to be divided into studies supporting its efficacy and papers reporting downright performance decrements when runners are transitioned from classic to lightweight minimalist shoes.

If you are an endurance athlete, you have to learn more about bicarbonate at the SuppVersity

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Even if you're not a passionate runner, you will not be surprised to hear that a 2015 review by Fuller et al. confirms that you can hardly overemphasize the importance of choosing the "right" running shoes, because they can and will affect every runner's maximal performance (Fuller 2015). Back in the day, the scientists from the University of South Australia concluded that...

Table 1: Results of a meta-analysis of the effect of footwear on running performance & economy in distance runners (Fuller 2015).

• running shoes with greater shoe cushioning, greater longitudinal shoe stiffness and greater shoe comfort were associated with improved running economy, while
• running in light shoes or running without shoes = barefoot reduced metabolic cost compared with running in heavy shoes but there was no difference in metabolic cost between running in light shoes and running barefoot

Fuller et al. realized, however, that there were "[n]o studies [that had] investigated the effect of footwear on running performance measured using a time-trial or time-to-exhaustion test" (Fuller 2015). Meanwhile, other studies have suggested that wearing minimalist shoes (or racing flats) during running competition should be advantageous for running performance, as well. In fact, Fuller et al. are right to point out in their latest paper that "runners have been doing this for many years" (Fuller 2017).

Should all these runners be wrong? Mislead by ads and the "cult" of barefoot running?

After all, the encouraging data from a pilot trial, Fuller et al. conducted last year (Fuller 2016),
were not confirmed in subsequent controlled trials which found that

"training in minimalist shoes did not improve running economy when (1) runners followed a flexible minimalist shoe training prescription that allowed them to increase minimalist shoe mileage from week 4-10 as they felt was appropriate or (2) prescribed use of minimalist shoes was combined with instructions to use a forefoot footfall pattern and increase stride rate" (Fuller 2017).

With small sample sizes (n≤25), different instructions being provided to runners and, most importantly, the absence of study with standardized training regimen for both the minimalist and control shoe study, the research has yet eventually not gone beyond the pilot stage, anyway.

What is a minimalist shoe and why would you even expect performance enhancing effects from minimalist shoes? According to what could be considered the "official scientific definition of a in Esculier, et al (2015), it is a "[f]ootwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices" (Esculier). According to the shoes individual characteristics, i.e. weight, flexibility, heel to toe drop, stack height and motion control/stability devices, experts can discriminate minimalist from regular sport shoes on a 0-100% scale, on which the Asics Piranha SP4 (mass 138 ± 10 g per shoe; heel stack height: 22 mm; heel drop: 5 mm) from the study at hand ranked 72%.

Fuller et al. explain the expected benefit as follows: Since running in minimalist shoes can increase the tendency to make initial ground contact with the midfoot or forefoot, instead of the rearfoot, allow for an increased stride rate and plantarflexion moments at the ankle, the biomechanics suggest that "these changes will result in a more efficient running gait" (Fuller 2017).

Running theory and biomechanics tell us that the way barefoot and minimalist shoe running promote a forefoot running pattern should have significant performance advantages, though. In the short term, i.e. when scientists had habitual rearfoot runners switch to a forefoot pattern in a single-session trial (e.g. Gruber 2013), though, the enforced change from a rearfoot to forefoot footfall pattern resulted in either similar or poorer running economy. No wonder, after all, runners find it difficult to maintain a forefoot footfall pattern throughout a prolonged run due to fatigue of the ankle plantar-flexor muscles (Jewell 2017). It is thus only logical that Fuller et al. assumed that a study design that would allow their subjects to adapt to the novel requirements of a more forefoot-based running as it is enforced in minimalist shoes would make up for habituation and training and thus realize the previously explained (see red box) beneficial effects on both, running economy (has already been proven on the small scale) and time trial performance (hasn't been investigated, at all).

To this ends, Fuller et al. conducted a randomized parallel intervention trial with 61 trained runners who gradually increased the amount of running performed in either minimalist (n = 31) or conventional (n = 30) shoes during a six-week standardized training program.

Figure 1: Participant flow chart (Fuller 2017) | * Participant excluded as an outlier after running 5-km time-trial 114 seconds slower at completion of the six-week training program.

"Eligible participants were 18-40 years old, ran at least 15-km/week, could run 5-km in <23 minutes, used conventional shoes, had no previous minimalist shoe experience and were habitual rearfoot footfall runners. Footfall pattern eligibility was assessed during five over-ground running trials at preferred running speed in the runners own shoes using a high-speed digital camera filming at 200 Hz. Only runners that landed heel first in all trials were eligible. Runners were excluded if they used orthotics, had a current or recent musculoskeletal injury (<3 months) or history of surgery in the previous year" (Fuller 2017)

Training duration and relative intensity were standardized across participants. The training intensity was prescribed relative to peak heart rate (HRPeak) achieved during baseline 5-km time-trial assessment and involved two interval running sessions at 85-90% HRPeak and two continuous running sessions at 65-80% HRPeak each week. The duration of interval training was increased throughout the program so that a greater percentage of training was completed at high intensity (85-90% HRPeak). Participants were instructed not to perform any additional training.

Figure 2: The scientists chose a gradual increase in running time in the newly assigned shoes as "a safe and realistic target for participants to achieve during the 6-week intervention" (Fuller 2017)

Runners in each group gradually increased the amount of running in their allocated shoes and decreased the amount of running in their usual running shoes. Participants completed ~5% of weekly running in their allocated shoes during Week 1 and this increased to ~35% of weekly running in weeks six. The scientists explain this very moderate approach as follows:

"Increasing minimalist shoe use to 35% of weekly running was chosen as a safe and realistic target for participants to achieve during the 6-week intervention. Participants completed a total of 3.5 hours (40-50 km) of running in their allocated shoes during the intervention. Compliance was calculated by dividing the total duration of training performed in allocated shoes (from training diaries) by the total duration of prescribed allocated shoe use" (Fuller 2017).

It is thus possible that the subjects' adaptation process had thus only begun, when they performed the retests, i.e. a 5-km time trial performance, running economy, ankle plantar-flexor strength, footfall pattern, stride rate and length tests - the same tests all subjects had completed at baseline.
Against that background, I find it all-the-more surprising that Fuller et al. observed a small, but significant improvement in time-trial performance (Effect size (ES): 0.24; 95% confidence interval (CI): 0.01, 0.48; p = 0.046) and a medium, likewise significant improvement on running economy (ES 0.48; 95%CI: 0.22, 0.74; p < 0.001) in the minimalist vs. conventional shoe group.

Figure 3: Training effect (left) as change (*for time-trial and the running economy those would be negative values, but I thought it's easier to read if I reverse that) and effect size for the pre-/post-comparison in the two groups (Fuller 2017).

What the scientists didn't observe, however, were effects on stride rate (ES: 0.04; 95%CI: −0.08, 0.16; p = 0.53) or length (ES: 0.06; 95%CI: −0.06, 0.18; p = 0.35). ankle plantar-flexor concentric (ES: 0.11; 95%CI: −0.18, 0.41; p = 0.45), isometric (ES: 0.23; 95%CI: ‐0.17, 0.64; p = 0.25), or eccentric strength (ES: 0.24; 95%CI: ‐0.17, 0.65; p = 0.24); and even though the minimalist shoes caused large reductions in the ratio of rear-to-forefoot balance, (ES: 1.03; 95%CI: 0.65, 1.40; p < 0.001), only two runners changed to a forefoot footfall.

You will remember from the Short News that that barefoot running triggers instant improvements in running economy, right? | learn more.

So what's the verdict then? I have to revise the practical implications as they are outlined in the original paper a bit, because I think without my italicized additions, they are misleading: (1) Gradually introducing runners (but not switching them completely) to minimalist shoes over a six-week training block improves running economy and time-trial performance more than the introduction of a conventional shoe as an alternative; (2) minimalist shoes cause runners to use a less-pronounced rearfoot footfall, although in the study at hand only two runners used a forefoot footfall; and (3) minimalist shoes do not affect stride rate, stride length, or ankle plantar-flexor strength.

As my additions to points (1) probably already suggest, there's one thing Fuller et al. fail to emphasize enough; and that's the simple fact that their study only proves the benefits of adding a minimalist shoe like the Asics Piranha SP4 over the use of a regular shoe like the Asics Gel Cumulus (while these were the two shoes used in the study, the study was not sponsored by Asics) as a partial replacement in your running program. That's - just in case you didn't realize that already- why there has to be a follow-up study with (1) a control group that keeps running in their regular shoes for the whole 6 weeks and/or (2) a full transition to the new shoe (maybe over 12 weeks), before we can make general statement about the superior- or inferiority of minimalist shoes for trained runners | Comment on Facebook!

References:

• Esculier, Jean-Francois, et al. "A consensus definition and rating scale for minimalist shoes." Journal of foot and ankle research 8.1 (2015): 42.
• Fuller, Joel T., et al. "The effect of footwear on running performance and running economy in distance runners." Sports Medicine 45.3 (2015): 411-422.
• Fuller, Joel T., et al. "Effects of a minimalist shoe on running economy and 5-km running performance." Journal of Sports Sciences 34.18 (2016): 1740-1745.
• Fuller, Joel T., et al. "Six-week transition to minimalist shoes improves running economy and time-trial performance." Journal of Science and Medicine in Sport - Available online 21 April 2017
• Gruber, Allison H., et al. "Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns." Journal of Applied Physiology 115.2 (2013): 194-201.
• Jewell, Carl, Katherine A. Boyer, and Joseph Hamill. "Do footfall patterns in forefoot runners change over an exhaustive run?." Journal of sports sciences 35.1 (2017): 74-80.

Cardio Can BOOST Your Gains?! Do it Before Weights and be Rewarded With 28% Increased Fiber Size & VO2 Gains

It may be important that the subjects cycled, because a recent review of the potential interference of cardio w/ strength training shows that cycling is the least likely to affect your gains (Murach. 2016).

In previous articles at the SuppVersity, I have written about the still ubiquitous concern that cardio training (or aerobic training, in general) could hamper your size and strength gains - a fear that is, unless you overdo it, unwarranted (learn more about HIIT & "regular" cardio training).

Now, a recent study from the Mid Sweden University shows that the opposite could be the case, i.e. that the hypertrophy response to exercise can actually be stimulated by combining resistance training not just with "cardio", but with "cardio" (=continuous cycling) and HIIT - at least if it's done not after, but before resistance training.

Are you looking for muscle builders for the year 2016? Find inspiration in these articles:

Tri- or Multi-Set Training for Body Recomp.?

1, 2, or 5 sets per Exercise? What's "best"?

Pre-Exhaustion Exhausts Your Growth Potential

Full ROM ➯ Full Gains - Form Counts!

Battle the Rope to Get Ripped & Strong

Study Indicates Cut the Volume Make the Gains!

The authors of the study, Zuzanna Kazior, Sarah J. Willis, Marcus Moberg, William Apró, José A. L. Calbet, Hans-Christer Holmberg, andn Eva Blomstrand were (just like you?) unhappy with the contradictory outcomes of existing studies on the effect of endurance exercise on the anabolic response to strength training. Accordingly, they designed a study to "re-investigated this issue, focusing on training effects on indicators of protein synthesis and degradation" (Kazior. 2016).

Figure 1: Overview of the resistance (top) and cardio training (bottom) protocols in the study at hand (Kazior. 2016).

In said study, two groups of previously not regularly trained male subjects performed 7 weeks of resistance exercise alone (R; n = 7) or in combination with preceding endurance exercise, including both continuous and interval cycling (ER; n = 9). You can see the exact protocols in Figure 1, with the resistance training part being on the top and the endurance / HIIT part on the bottom (the number of training sessions in the ER and R group were identical; importantly, the endurance training was performed before the resistance training and included an extra 5-min warm-up + cool-down before and after the E-part.

Did carbohydrates make the difference? Within 20 min after completion of a training session, subjects in the R-group received a protein supplement (Kolozzeum Pure Whey, Stockholm, Sweden), 20 g dissolved in 500 ml of water to enhance muscle recovery. The ER-group were given this same supplement, but with addition of maltodextrin (Fairing Fast Carbs, Järfälla, Sweden) in an amount corresponding to the individual´s calculated energy expenditure during the endurance training - did the maltodextrin make a difference? Based on the results of previous studies, this seems very unlikely. While carbs alone can enhance the protein synthetic response to resistance training (Børsheim. 2004), studies show no benefit of adding it to a sufficient amount of protein that is consumed right after resistance training workouts (Koopmann. 2007). 

Biopsies were taken from the lateral part of m. quadriceps, i.e., the vastus lateralis, both before and after 7 weeks of training. To ensure the results were not messed up, ...

"[t]he subjects were instructed to refrain from training for 2 days prior to the pre-training biopsies and the post-training biopsies were taken approximately 2 to 3 days after the final session in 15 subjects, but in one subject the post-training biopsy was taken 90 hours after the final session. During this period the subjects also refrained from training" (Kazior. 2016).

All data are expressed as means ± SD and were checked for normal distribution before performing parametric statistical analyses. A two-way repeated measures ANOVA (time, group) was applied to evaluate and compare the effect of training in the R and ER groups. When the ANOVA showed a significant main effect or interaction between time and group, Fisher’s LSD post hoc test was applied to identify where the differences occurred. A P-value <0.05 was considered to be statistically significant.

Figure 2: Levels of proteins in the Akt signaling pathway before and after 7 weeks of training. (A) Akt, (B) mTOR and (C) S6K1 in skeletal muscle before (Pre) and after (Post) 7 weeks of strength training only (R) or combined endurance and resistance exercise (ER). Representative immunoblots from two subjects. *P < 0.05 for Post vs. Pre (Kazior. 2016).

While similar increases in leg-press 1 repetition maximum (30%; P<0.05) were observed in both groups, irrespective of the maximal muscle gains - a discrepancy of which the scientists say that it "suggests that the improvement in maximal strength (1RM) observed following our relatively short 7-week period of training is due largely to neuromuscular adaptation" (Kazior. 2016), the scientists observed a striking and highly significant difference between the changes of the subject's maximal oxygen uptake (a marker of cardiovascular fitness) in the two groups. As you may already have expected, the latter was elevated (8%; P<0.05) only in the ER group, while the strength training only group saw no increase in this important fitness marker.

Figure 3: Pre- vs. post changes in fiber are and capillary density in both groups (Kazior. 2016).

And what about the gains? As far as those were concerned, Kazior et al. observed significantly larger increases in the ER training group as well. More specifically, the ER group saw gains in both, the areas of both type I and type II fibers. The R protocol, on the other hand, increased only the area of the type II fibers, which is why it is not exactly surprising that the mean fiber area increased by 28% (P<0.05) in the ER group, whereas no significant increase was observed in the R group - a difference that appears to be in line with the expression of the anabolic proteins Akt and mTOR, which were both enhanced in the ER group, whereas only the level of mTOR was elevated following R training. The scientists further analyses showed that...

"[the t]raining-induced alterations in the levels of both Akt and mTOR [both anabolic] protein were correlated to changes in type I fiber area (r = 0.55–0.61, P<0.05), as well as mean fiber area (r = 0.55–0.61, P<0.05), reflecting the important role played by these proteins in connection with muscle hypertrophy. Both training regimes reduced the level of MAFbx protein (P<0.05) and tended to elevate that of MuRF-1 [both catabolic]" (Kazior. 2016).

In view of these findings, it is only logical that the authors conclude that "the present findings indicate that the larger hypertrophy observed in the ER group is due more to pronounced stimulation of anabolic rather than inhibition of catabolic processes" (Kazio. 2016) - irrespective of the fact that they cannot tell for sure what it was that triggered these practically relevant differences.

Can the increase in IGF1, GH and testosterone as it was observed W/ Cardio first by Rosa et al. (2014) explain the increased size gains?

So what's going on, here? While you may expect that the addition of carbohydrates after the workout in the ER group could have something to do with the increased size gains, the data discussed in the red box shows that this is relatively unlikely (even though it could be the reason why AKT increased only in the ER group).

As far as the reasons for the surprising differences to other studies are concerned, we are thus left with two options: (1) the cardio protocol with steady state + HIIT could be special, or (2) doing cardio before not after strength training could be special. Interestingly enough, I've written about potential anabolic benefits of doing your cardio before weights, before: In a 2014 study, Rosa et al. observed significant increases in the purportedly muscle building hormones GH, IGF1 and testosterone when cardio was done before weights.

Whether it's in fact a pro-anabolic response to reversing the more common order of resistance training > cardio to cardio > resistance training does yet seem questionable - irrespective of the fact that the acute GH response was in fact one out of two parameters of which West et al. have found that it correlates with the actual muscle gains in their seminal 2012 study (discussed here) | Maybe you've got better explanations? If so, leave them in a comment on Facebook!

References:

• Børsheim, Elisabet, et al. "Effect of carbohydrate intake on net muscle protein synthesis during recovery from resistance exercise." Journal of Applied Physiology 96.2 (2004): 674-678.
• Kazior Z, Willis SJ, Moberg M, Apró W, Calbet JAL, Holmberg H-C, et al. "Endurance Exercise Enhances the Effect of Strength Training on Muscle Fiber Size and Protein Expression of Akt and mTOR." PLoS ONE 11.2 (2016) : e0149082. doi:10.1371/journal.pone.0149082
• Koopman, René, et al. "Coingestion of carbohydrate with protein does not further augment postexercise muscle protein synthesis." American Journal of Physiology-Endocrinology and Metabolism 293.3 (2007): E833-E842.
• Murach, Kevin A., and James R. Bagley. "Skeletal Muscle Hypertrophy with Concurrent Exercise Training: Contrary Evidence for an Interference Effect." Sports Medicine (2016): 1-11.
• Rosa C, Vilaça-Alves J, Fernandes HM, Saavedra FJ, Pinto RS, Machado Dos Reis V. "Order effects of combined strength and endurance training on testosterone, cortisol, growth hormone and IGFBP-3 in concurrent-trained men". J Strength Cond Res. (2014): Jul 15 Ahead of Print. 
• West, Daniel WD, and Stuart M. Phillips. "Associations of exercise-induced hormone profiles and gains in strength and hypertrophy in a large cohort after weight training." European journal of applied physiology 112.7 (2012): 2693-2702.

Trying to Shed That Belly? Step Off the Treadmill and Grab Some Weights, Boys & Girls! 19x More Visceral, 1.5x Higher Subcutaneous Fat Loss W/ Resistance Training in Youths

Specifically for teenagers it may be important to work out in both aerobic and anaerobic workouts. So, this would be another reason to favor the combined over the other regimen.

You will probably have overheard the "knowledgeable" trainers at the gym tell their credulous clients, who just told them they "want to lose that belly fat", that the best thing they could do was to "stop spending that much time with weight training" and to do some more (steady state) cardio. Well, in general, there's nothing wrong about steady state cardio - in fact, many studies show that it is superior to resistance training when it comes to "merely" shedding body weight (in the obese). If "weight loss" is still everything you're aspiring, though, you are either new to the SuppVersity or another of the "headline skimmers" who happen to ask questions that are answered not just in the article, but actually in one of the red boxes... ah, I am digressing.

So, what I actually wanted to tell you is that a recent study from the Universities of Ottawa and Calgary (Alberta. 2015), clearly contradicts the average commercial gym chain trainer's recommendation and shows that belly fat loss is better achieved with diet + resistance training.

Are you looking for muscle builders for the year 2015? Find inspiration in these articles:

Tri- or Multi-Set Training for Body Recomp.?

1, 2, or 5 sets per Exercise? What's "best"?

Pre-Exhaustion Exhausts Your Growth Potential

Full ROM ➯ Full Gains - Form Counts!

Battle the Rope to Get Ripped & Strong

Study Indicates Cut the Volume Make the Gains!

The subjects of the study were youngsters, 304 (! the high number of participants is a huge plus of the study) 14-18 year-old overweight and obese teenagers (mean body fat almost 50%!), to be specific, who were randomized to four different treatments for 22 weeks:

Table 1: Training progression in the Aerobic
and Resistance group (Alberga. 2015)

• aerobic training (Aerobic), 
• resistance training (Resistance),
• combined aerobic + resistance training (Combined) or 
• non-exercising control group (Control)

Adolescents,... ok, but unless they're too sarcopenic (=suffer from pronounced age-induced muscle loss) to hit the weights, your overweight clients or you, yourself, should be able to follow the same training programs the adolescents did and see similar results if you fully adhere to the following training prescriptions:

• Resistance: The duration of each session progressed to a maximum of about 45 min. Exercises were primarily performed on weight machines, and when required with dumbbells (lateral raise, shrugs, bicep curls, front raise, preacher curl, dumbbell pullover) or by using one's own body weight as resistance (lunges, sit-ups and abdominal crunches).
  

  

  Table 2: Overview of the individual workouts in the Resistance group (Alberga. 2015).

  Participants alternated among exercises from groups A1, A2, B1 and B2 shown in Table 2. Participants were asked to rest for ~ 2 min between sets and were instructed on proper breathing techniques.
• Aerobic: Participants randomized to the aerobic training group underwent a 22-week program (Table 1, left) wherein the exercise intensity and duration increased progressively to a maximum of 45 min per session. Exercise was performed on a cycle ergometer, elliptical or treadmill and participants were free to vary the machine(s) used. Exercise intensity was standardized using heart rate monitors (Polar Electro Oy, Kempele, Finland).
• Combined: This group performed the full exercise programs done by both the aerobic and resistance training groups (Table 1, left + right) during each session for a total of 4 times per week for a maximum of 90 min per session.

Now for simplicity we assume that you'd actually achieve not just similar, but rather the exact same results as the virtual "average" study participant from Alberta's trial. In this case, I bet that most of you would prefer to lose -22.7 cm² subcutaneous body fat with resistance training than -16.2 cm² or -18.7 cm² with either aerobic or combined training. Specifically in view of the fact that only resistant and combined training triggered measurable reductions in visceral body fat, too.

Figure 1: Changes in subcutaneous (SAT) and visceral (VAT) body fat at different regions; L4L5 represents area between 4th and 5th Lumbar vertebrae; * indicates sign. difference to control; # sign. difference to aerobic (Alberga. 2015).

On the other hand, a closer look at the body fat data in Figure 1 also shows that aerobic training is the only form of training that will reduce the deep subcutaneous fat, significantly. Plus: When it's done in combination with resistance training the reductions in subcutaneous fat at L4L5, which represents the area between 4th and 5th Lumbar vertebrae, are still statistically significant and not significantly smaller than those the subjects in the resistance training only arm of the study achieved. 

Figure 2: Changes in Apo-B and Apo-B/A ratio in the three exercise and the control group (Alberta. 2015).

What may eventually tip the scale in favor of the combined training regimen, though, is not the body composition data, but rather the fact that only the combined training routine triggered statistically significant, heart healthy changes in Apolipoprotein B and the Apolipoprotein A/B ratio. After all, the latter has "repeatedly been shown to be a better marker than lipids, lipoproteins and lipid ratios" (Walldius. 2006) - scoring in the top tertile for the ApoB/A ratio, for example has consistently been associated with 89% increased risk of heart disease (Thompson. 2006) .

Figure 3: In their 2005 trial, Tufts scientists were able to show that dietary adherence, not macronutrient comp. or other diet-specific parameters is the main determinant of weight loss (Dansinger. 2005).

You must never forget, however, ... that (a) the beneficial of all four exercise regimen were achieved in the context of an energy deficit of albeit relatively, but consistent -250 kcal/day, that (b) the study had a 4-week lead-in during which all participants that didn't show at least 80% adherence to the dietary + exercise baseline intervention were kicked out, and that (c) subjects who did not attend an average 2.8 out of 3.0 workouts per week were not included in the analysis the data in Figures 1-2 is based.

This obviously leads back to Energy restriction and adherence - the two usual suspects. Without them, any effort to shed the hated body fat must fail. With them, however, only perseverance and consistency may keep from achieving your fat loss goals.

You don't believe that? Well, check out the data in Figure 3. Dansiger and his colleagues from the Tufts University tried to find out which diet, i.e. Ornish, Zone, Weight Watchers, or Atkins die, would cut the most body weight. What they found, though, was that it's always the diet the subjects could adhere to that worked the best. Against that background, it's no wonder that, in the study at hand, only those participants who had more than the minimal 70% adherence to their (aerobic) workout regimen actually lost significant amounts of deep subcutaneous fat tissue.. speaking of adherence, there were no significant differences in adherence between the three training regimen; only the control treatment on the couch obviously had 100% adherence ;-) | Comment on FB!

References:

• Alberga, A. S., et al. "Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial." International journal of obesity (2005) (2015).
• Dansinger, Michael L., et al. "Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial." Jama 293.1 (2005): 43-53.
• Thompson, A., and J. Danesh. "Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature‐based meta‐analysis of prospective studies." Journal of internal medicine 259.5 (2006): 481-492.
• Walldius, G., and I. Jungner. "The apoB/apoA‐I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid‐lowering therapy–a review of the evidence." Journal of internal medicine 259.5 (2006): 493-519.

Energy Balance and Everyday Activity Explain Weight Loss Success / Failure W/ Exercise in Men, But Not in Women

Bicycling to work is one of these "small things" that may make the difference between lean and obese.

I know this is not what your friends will want to hear, but for 99.9% of them it's not their genes which are to blame for their inability to lose weight. It's much simpler than that: It's their inability or unwillingness to induce a large enough caloric deficit to force their bodies to tap into the fat stores. Don't get me wrong: It's obvious that genes, with their direct and indirect influence on one's basal energy requirements (think of being tall vs. being small, if nothing else), amount of muscle, and even ability to handle glucose and fats, will factor in here. In the end, however, it's everyone's knowledge about the dos and don'ts of dieting, effort and dietary adherence that will make the difference.

That's no news for you? I think the results of a recent study from the University of Kansas Medical Center and the Texas Tech University will still come as a surprise. Usually, we talk about cheating on one's diet, skipping scheduled workouts and eating foods people are not supposed to eat, when we discuss the reasons why people fail. The results of said study, however, suggest that something else may have a much larger impact: Our regular non-exercise physical activity.

No "metabolic damage" here, but here are posts that relate do increased / decreased REE

Orgasm Hormone Increases REE

9 Tricks to Keep You REE Up

High EAA Intake, High REE

You're not a Bomb Calorimeter

Calorie Shifting for Max. Fat Loss

Met. Damage in Big Losers?

If you've read my March 2015 article "It Doesn't Have to be an Exhaustive Workout - Increasing Physical Activity Just as Effective as Strength, Endurance or Combined Exercise to Lose Fat and Build Muscle" (read it now), you will know about the importance of "taking the stairs", standing instead of seating, bicycling to work and other often overlooked low-intensity non-exercise physical activity in our everyday lives. Interestingly enough, it is just this type of low intensity 'non-exercise' of which the so-called "Midwest Exercise Trial 2" indicates that it is what distinguishes the weight loss responders (>5% weight loss) from the non-responders (<5% weight loss) in a relatively tightly controlled "work out five times per week for 10 months to lose weight"-intervention by Herrmann et al. (2015).

Before we are dealing with this surprising result, though, let's first take a look at what exactly the N=141 18-30 year-old men overweight/obesity (BMI 25-40 kg/m²) subjects had to do in this 'exercise for weight loss study' (details can be found in the description the scientists published when they registered their clinical trial | Donelly. 2012):

• 

  Table 1: It is important to note that there were no sign. baseline differences in weight, age, etc. between responders and non-responders among the study participants (Herrmann. 2015).

  the subjects exercised on 5 days of the week - one of the session was "choose the activity you want", the other sessions were performed under supervision walking/jogging on treadmill
• the duration / intensity of all workouts was matched to initially burn 150 kcal; from months for on, 400 and 600 kcal/session (this is in line with the "2008 Physical Activity Guidelines for Americans" | USDA. 2008) 

I see you're looking for the dietary advise? Well, there was none. That may look awkward, but in view of the fact that the scientists wanted to see whether the simple adherence to the USDA "Physical Activity Guidelines for Americans" would make a difference, the subjects were told to stay on their regular (junk food?) diets.

A friendly reminder for the trainers out there: While it may be enough to increase your clients activity level, long-term weight loss can be facilitated only if you attack all weight- and health-relevant aspects of a clients life-style. That's (I) exercise and everyday activity, (II) diet and (III) sleep (circadian rhythm), stress and related aspects of their lifestyle.

As the name of the study or rather the index "2" in the name implies, the "Midwest Exercise Trial 2" is a follow up study. It's a follow up that was supposed to elucidate (a) what distinguishes responders from non-responders and whether (b) the gender differences in weight response Donelly et al. observed in their 2003 predecessor study were coincidental or something we have to keep in mind, whenever we are designing exercise-based weight loss routines for men and women..

Figure 1: Total daily energy expenditure (TDEE), nonexercise energy expenditure (NEEx), and resting metabolic rate (RMR) at baseline and 10 months in responders (RS) and nonresponders (NR) to an aerobic exercise intervention.

What should I say? If you look at the data it would almost seem as if (2) was the case: Men and women appear to respond very differently to this kind of exercise-based weight loss efforts. Yes, the data in Figure 1 shows that there is a trend for non-responders from both sexes to be less active in their free time and thus having a lower non-exercise induced energy expenditure (NEEEx). On the other hand, though, ...

1. 

   Figure 2: Nonexercise physical activity (NEPA) and sedentary time across 10 months in responders (RS) and nonresponders (NR) to an aerobic exercise intervention (Herrmann. 2015).

   only the male non-responders are truly characterized by their tendency to take the five weekly workouts as an excuse to use the elevator and drive the 200m to the next fast-food outlet by car, while 
2. there is no such compensatory effect on NEEEx in the women and even an increase in resting metabolic rate (so no metabolic damage or shut-down) in the female non-responders

This trend for a "compensatory effect" on non-exercise physical activity (NEPA) in male and its absence is in female non-responders becomes even more obvious in Figure 2.

Figure 3: Rel. energy balance in male and female weight loss responders and non-responders in month 10 - data calculated as (total intake / total expenditure - 1)*100 based on data from Herrmann et al. (2015).

If we go back to my initial comment on caloric deficits and do the math that's required to calculate the relative difference between the total reported energy intake and the estimated energy expenditure, we get an excellent explanation for the fact that the male "non-responders" don't lose weight: They simply weren't in caloric deficit (see Figure 3); and that - and this is actually the most interesting finding - not because they ate more (the reported energy intake didn't change much), but because they moved less in their everyday lives!

I don't want to point with a finger to the non-responders, but energy intake underreporting is an issue you cannot ignore with overweight young(er) women (data from Smith. 1994).

So, what to we do with the women? Is there something that makes women resistant to exercise induced weight loss? I am not sure if it is politically to discuss this, but previous studies actually confirm the obvious: Women tend to lie about their food intake, more frequently than men. Particularly in overweight women underreporting (consciously or not - I don't care) is highly prevalent (Klesges. 1995; Smith. 1994). Especially the highly obesogenic snacks people and caloric beverages tend to "inhale" in-between their meals are often "forgotten" (Poppitt. 1998). Next to an overall tendency to underreport their overall energy intake, obese individuals have also been found more likely to overreport their protein intake and "forget" about fats and sugars, in particular (Heitmann. 1995), ... but let's focus on this study.

With the estimated number of calories that are "forgotten" being estimated around ~17% in all women (sign. higher in obese women), the sex difference may have a methodological, not a physical cause. The only problem here is that all women were overweight or obese. We do thus have to assume that the "responders" were underreporting their food intake, as well. So, if the female non-responders don't compensate on either the physical activity or the diet-side of things and the increasing resting energy expenditures of the non-responders (which would by the way still indicate they ate more than they said) excludes that they had a tough time due to being genetically disadvantaged by "having a slow metabolism" or "a thrifty phenotype", further research is necessary to elucidate what exactly it is that makes some women fail, where others succeed.

Luckily we don't need the answer to this question to state at least one very important conclusion: Diet interventions that are targeted towards exercise induced increases in energy expenditure are better suited for men - in particular for those men who are willing to actually increase their overall activity level, instead of compensating for the time they spend working out in the gym, on the track or wherever else by increasing their "couch time" | Comment on Facebook!

References:

• Donnelly, Joseph E., et al. "Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: the Midwest Exercise Trial." Archives of Internal Medicine 163.11 (2003): 1343-1350.
• Donnelly, Joseph E., et al. "A randomized, controlled, supervised, exercise trial in young overweight men and women: the Midwest Exercise Trial II (MET2)." Contemporary clinical trials 33.4 (2012): 804-810.
• Herrmann, Stephen D., et al. "Energy intake, nonexercise physical activity, and weight loss in responders and nonresponders: The Midwest Exercise Trial 2." Obesity 23.8 (2015): 1539-1549.
• Klesges, Robert C., Linda H. Eck, and JoAnne W. Ray. "Who underreports dietary intake in a dietary recall? Evidence from the Second National Health and Nutrition Examination Survey." Journal of consulting and clinical psychology 63.3 (1995): 438.
• USDA, Physical Activity Guidelines Advisory Committee. "Physical activity guidelines for Americans." Washington, DC: US Department of Health and Human Services (2008): 15-34.
• Poppitt, S. D., et al. "Assessment of selective under-reporting of food intake by both obese and non-obese women in a metabolic facility." International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity 22.4 (1998): 303-311.
• Smith, Wayne T., Karen L. Webb, and Peter F. Heywood. "The implications of underreporting in dietary studies." Australian journal of public health 18.3 (1994): 311-314.

It Doesn't Have to be an Exhaustive Workout - Increasing Physical Activity Just as Effective as Strength, Endurance or Combined Exercise to Lose Fat and Build Muscle

Taking the stairs instead of the elevator, using the bike instead of the car and other means to increase your regular daily physical activity are just as effective as three workouts per week for you or overweight clients who cut their energy intake to lose body weight.

What's the reasons your clients' and friends' exercise efforts fail? They are too ambitious. The all-or-nothing approach combined with the expectation that the belly they've build over decades will fade away in weeks is a combination that programs them to fail.

Against that background, the results of a recent study from the Technical University of Madrid are extremely important. After all, the scientists were able to show that a mere increase in daily physical activity is as effective in boosting obese subjects weight loss efforts as "serious" exercise. The aim of the study was simple: To compare the effects of different physical activity programs, in combination with a hypocaloric diet, on anthropometric variables and body composition in obese subjects.

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Breakfast? (Un?) Biased Review

To this ends, the researchers recruited ninety-six (!) obese (men=48; women =48; age range 18-5
years) participants, who took part in a supervised 22 week program. The subjects were randomized into four groups (the details are described further below):

• strength training (S, n=24),
• endurance training (E, n=26),
• combined strength + endurance training (SE, n=24), and as previously hinted at
• physical activity recommendations (C, n=22).

In addition, all groups had to followed the same hypocaloric diet for 22 weeks. The diets contained between 5 028 and 12 570 kJ (1,201.72-3,229kcal | that's a deficit of -32% / -41% / -32% / -35% for the S, E, SE and C groups compared to their previous intakes, which were obviously too high to keep weight stable) and were prescribed individually for all participants by "expert dieticians" at the Department of Nutrition, La Paz University Hospital, Madrid.

"The diet was designed to provide 30% less energy than the baseline total daily energy expenditure (DEE), as measured using a SenseWear Pro Armband accelerometer (Body Media, USA). Some 29-34% of energy came from fat, and 50- 55% from carbohydrates, according to the recommendations of the Spanish Society of Community Nutrition (SENC, according to its Spanish initials, and 20% from protein (beyond that outlined in the above recommendations) in order to achieve the body composition benefits observed in different studies and examined in a recent meta-analysis" (Benito. 2015).

Dietary counselling was given at baseline and at 12 weeks to resolve questions and to motivate participants sufficiently to comply with dietary advice. All subjects were instructed on how to record their dietary intake using a daily log, and given recommended portion sizes and information on possible food swaps. In addition, nutrition education sessions were given by the dieticians. The goal was to equip the participants with the knowledge and skills necessary to achieve gradual but permanent behaviour changes.

Speaking of behavioral changes,...

While diet was one pillar of the weight loss success of the study participants, exercise was another. You already know that there were three groups. What you don't know, though is what exactly the subjects who had been randomly assigned to the previously listed groups actually did (I quote from th paper by Benito et al., 2015):

• The exercise groups (training 3x per week): The S group followed a circuit involving eight exercises: the shoulder press, squats, the barbell row, the lateral split, bench press, front split and biceps curl, and the French press for triceps. Running, cycling or elliptical (self-selected) exercises were the main components of the session for group E, while group SE followed a combination of cycle ergometry, treadmill or elliptical exercises intercalated with squats, rowing machine, bench presses and front split exercises (15 lifts per set or 45 s for the SE endurance phase).
  
  The exercise training programs were designed taking into account each subject’s muscular strength (MS) and heart rate reserve (HRR). MS was measured in the strength program subjects (S, SE) using the 15-repetition maximum (15 RM) testing method every other day during the week before the intervention period. The volume and intensity of the three training programs were equal and increased progressively during the study. In weeks 2-5, exercise was at an intensity of 50% of the 15RM and HRR, and lasted an overall 51 min and 15 s. In weeks 6-14, exercise was performed at an intensity of 60% of 15RM and HRR, again with a duration of 51 min and 15 s. Finally, in weeks 15-22, exercise was performed at an intensity of 60% of 15RM and RR, with a duration of 60 min. 

All groups gained the same amount of lean mass! I find it quite remarkable that all groups gained 5% lean mass - even the endurance and the "control" group which did no prescribed exercise at all, but simply took the stairs and were only "made aware" of the rest of the activity recommendations of the American College of Sports Medicine (ACSM).

• The get active in your everyday lives group: The C subjects followed the hospital’s habitual clinical practice for achieving weight loss: dietary intervention - the same as followed by the exercise training groups -plus being made aware of the general recommendations of the American College of Sports Medicine (ACSM) regarding physical activity.
  
  Thus, the C subjects were advised to undertake at least 200-300 min of moderate-intensity physical activity per week (30–60 min on most, if not all, days of the week). The C subjects were also advised to reduce their sedentary behaviour (e.g., watching television or using the computer) and increase daily activities such as brisk walking or cycling instead of using a car, or climbing stairs instead of using the lift etc.

At baseline and at end of the intervention, dietetic and physical activity variables were assessed using validated questionnaires. Anthropometric variables were recorded along with body composition
variables measured using dual-energy X-ray absorptiometry techniques.

Figure 1: Relative changes in weight, waist and total body fat over the 22-week study period (Benito. 2015).

As the data in Figure 1 indicates, there were significant improvements in all groups: All subjects lost ~9-10kg body mass (S: -9.21±0.83 kg; E: -10.55±0.80 kg; SE: -9.88±0.85 kg; C: -8.69±0.89 kg) and reduced thir total fat mass by ~5kg (S: -5.24±0.55%; E: -5.35±0.55%; SE: -4.85±0.56%; C: -4.89±0.59%). In view of the research question, this is a very important result. After all, the scientists were not able to detect a significant inter-group-difference between the four study groups.

The lack of inter-group differences in body composition is probably a direct consequence of the fact that the total physical activity per week during the intervention increased similarly, but not identically in all groups (S: 976±367 MET-min/week; E: 954±355 MET-min/week; SE: 1 329±345 MET-min/week; C: 763±410 MET-min/week). in view of the lack of statistical difference between th exercise groups which got - on average - more exercise than the control group, it is thus not surprising that the 22-week changes in body composition did not differ, either.

Figure 2. The macronutrient intake (in g/day) in both groups was virtually identical (Benito. 2015).

Overall, the study at hand does thus - just as the scientists say - "shows that, when combined with a hypocaloric diet, exercise training and the following of physical activity recommendations are equally effective at reducing body weight and modifying body composition in the treatment of obesity" (Benito. 2015).

This may be because we are (a) dealing with an increase from basically zero in many obese indiviuals (the relative increase is thus exorbitant) and is may (b) be a consequence of the "higher frequency" of physical activity you can achieve with moving more everyday vs. sitting around for 4 days and working out "like a maniac" (compared to your regular activity level) on 3 days | Comment on Facebook!

References:

• Benito, Pedro J., et al. "Change in weight and body composition in obese subjects following a hypocaloric diet plus different training programs or physical activity recommendations." Journal of Applied Physiology (2015): jap-00928.