Under Pressure: What's New on BFR & Compression Gear? Of Swollen Legs, Arterial Stiffness & Improved Bone Health

Is it all about pressure? Compression stocking and BFR cuffs revisited.

You will remember that I've covered the use of #BFR, i.e. blood-flow restriction in several articles over the past years. The number of posts on #compression stockings, on the other hand, is limited with only one dealing with the acute anti-heavy-leg effect of 'oma's socks' in the evening.

Today's special will address both, the latest research in everything tight... ;-) Ok, before the ambiguity gets out of hand, let's check out some of the latest studies:

BFR and Hypoxia Training are different from training w/ compression garments

BFR, Cortisol & GH Responses

BFR - Where are we now?

BFR as Add-On to Classic Lifts

BFR for Injured Athletes

BFR B4 Workouts = WIN!?

BFR + Cardio = GainZ?

• In healthy young women, compression stockings may have acute beneficial effects on lower leg swelling and muscle stiffness (Sugahara 2018): While previous trials have often yielded ambiguous results, the latest paper by scientists from Japan Women's University claims to "suggest that even for a short period of application, compression stockings have some positive effects against lower leg swelling" (ibid)... but there's more than the problem with the absence of a real control group of which the scientists say that "it is highly unlikely that the lack of control condition seriously affects the significance of our findings" (ibid) and claim:

  

  Prolonged standing may be as problematic as sitting | more.

  "Rather, the study design did not take into account the preventive effect of wearing compression stockings on leg fluid accumulation that could be induced by even a 20–30 min of sitting, although this was not the primary concern of this study" (Sugahara 2018).

  If that was actually the case, wearing some 'sexy' compression stockings at work may help you ameliorate the circulatory problems triggered by prolonged sitting (and as recently demonstrated even standing).
  
  Before we make further assumptions, though, let's briefly see what those "acute benefits" the Japanese researchers observed actually were.
  
  

  

  Figure 1: Volumes of foot (a), calf (b) and total lower leg (c) measured before and after an application of compression stockings. In each panel, small grey circles = individual data, whereas a large black circle = the group mean. The right panel shows the percent change expressed as mean and SD (n = 20 | Sugahara 2018).

  As previously pointed out, the study involved healthy young women. The N=20 ladies in the age of 18–23 years wore below‐knee graduated compression stockings after returning home in the evening. They were not allowed to lie down, but rested in a seated position for 30 min.
  
  Before and after the application of stockings, maximum calf, volume, circumference, extracellular water resistance (RECW) and muscle stiffness of the right lower leg were determined by tape measure, water displacement volumetry, segmental bioelectrical impedance spectroscopy and ultrasound shear‐wave elastography, respectively.
  
  Unlike the foot volume, the calf volume, and the total lower leg volume, as well as the muscular stiffness of the medial gastrocnemius muscle which only tended to decrease, the maximum calf circumference (vs. volume) decreased significantly (but probably not visibly | -0.35 cm) after the application of the stockings.
  
  In conjunction with the reciprocal of RECW (an index of extracellular fluid volume), it thus seems likely that compression stockings can a least partially reverse the accumulation of fluids in the legs that will occur not just in heart-diseased subjects, but also in healthy individuals.
  
  Obviously, the study at hand cannot provide hard evidence (=real-world outcomes) in terms of the downstream effects on our CVD risk. So, does that even matter?
  
  In view of the small (-1.0% or 0.35cm) reduction in calf circumference, the absence of significant effects on the total lower leg volume, and the lack of correlation between changes in the different parameters the scientists measured, the authors themselves cannot exclude that the stockings simply "pressed" the lower legs into a new shape:

  "More specifically, a brief application of compression stockings on swollen legs may result in greater compression pressure on more swollen part of the leg, affecting the fluid distribution within the lower leg before accelerating the fluid shift from the lower leg to the thigh. This possibility is particularly relevant to our experimental protocol, e.g. participants wore below‐knee stockings and rested in a seated position during the 30‐min application" (Sugahara 2018).

  If that was actually the case, though, we must, unfortunately, assume that using the sexy "compression lingerie" at the end of a workday for only 30 minutes will probably do very little for your risk for common circulatory disorders or other CVD risk factors. What it may help with, however, are tightly wound calf-muscles in the evening... and, we shouldn't forget that wearing them preventively at work may be the more relevant intervention, anyway.

This image from my article about the post-set application of BFR (learn more) shows how reliable BFR cuffs can look like - fundamentally different from the blood pressure cuffs at the doctor's office. You can learn more about BFR in the SuppVersity archives - please klick on "older articles" at the bottom to dig deeper into the archives.

BFR cuffs - The broader the better? Ok, that was not exactly the research question Mouser et al. (2018) tried to answer, but, I guess, you'll still get the idea. In their study, the scientists from the The University of Mississippi tested the effects of cuffs with a width of 10 and 12 cm, respectively, in 17 male and 14 female subjects on two separate occasions using ultrasound measures of blood flow, mean blood velocity, peak blood velocity and artery diameter from the posterior tibial artery at rest and during the application of 10% increments of the aortic pressure.

The results were quite unequivocal: "As long as relative pressures are applied, cuff width appears to have little to no effect on the blood flow stimulus during blood flow restriction at rest" (Mouser 2018). That doesn't mean, though, that you can achieve the same effect with parcel strings or the small and fragile cuffs docs use to get your blood for the lab.

Why 10 and 12 cm? I guess that's what you're asking yourself now. Well, it's worth mentioning that the scientists have already published a paper on the effects of cuff width in 2012 -  a paper with an IMHO practically more relevant comparison of 13.5cm and 5cm cuffs (Loenecke 2012). And while 5cm is still much wider than the previously mentioned cuffs at the doctor's office the scientists did find a significant difference due to the 8.5 cm difference - namely that broader cuffs can achieve the same reduction of arterial blood flow at much lower inflation pressures... for further details on choosing the optimal cuff width and material, pressure, arm circumference, sex, etc, I suggest you read Loenecke's free 2013 paper in Frontiers in Physiology and a 2016 follow-up study that was published in Sports Medicine (Jessee 2016).

• Small arteries stay stiff for a longer period following vibration exercises in combination with  blood flow restriction (Karabulut 2018): Aortic stiffness is, according to a 2012 paper in the Journal of Cardiovascular Translational Research (Tomiyama 2012), a potential trigger and perpetuator of (pre-)hypertension. What is particularly nasty is that the increased blood pressure will only worsen arterial stiffness and the consequent vicous cycle can lead you from
  'pre- to post-hypertension' (=death due to pressure-induced CVD).
  
  In view of the association of arterial stiffness with the onset and progression of hypertension, the study at hand sounds like bad news for you or your clients who use similar blood flow restricted vibration training regimen.
  
  The latter, i.e. using BFR as an adjunct to vibration training was exactly what the eight male subjects did in the study at hand: They performed static upper body (UB) and lower body (LB) exercises on a vibration platform with and without BFR. During the BFR sessions, BFR cuffs were placed on the arms or legs and inflated to a target pressure. Exercises consisted of eight 45‐s sets for UB, and ten 1‐min sets for LB. Arterial elasticity and hemodynamic variables were assessed before, at 10 min and 40 min postexercise. Repeated measures ANOVA was used to test the mean differences in related variables.
  

  

  Figure 2: Changes in large arterial elasticity values following (a) lower and (b) upper body static exercises. Values reported as Mean ± SE (Karabulut 2018)

  As previously hinted at,  the scientists found a significant difference between the BFR versus no‐BFR trials for the subjects' small arterial elasticity (P<0·05). As Figure 2 goes to show you, the result differed slightly for lower and upper body but a significant reduction in small artery elasticity was observed in both body parts.

Kaatsu, the Japanese version of BFR, with a rich tradition has an excellent safety profile (Nakajima 2018).

What about the general safety of #BFR? As Nakajima et al. point out in their 2006 review, blood flow restriction in form of the Japanese KAATSU training doesn't just have a long tradition but is still applied to all generations - from very young (<20 years old) to very old (>80 years old).

That alone does yet not warrant the conclusion that it's safe and side-effect free. Accordingly, the scientists questioned the "KAATSU leaders" or instructors in a total of 105 out of 195 facilities where KAATSU training has been adopted.

Based on survey results, 12,642 persons had received KAATSU training (male 45.4%, female 54.6%). Interestingly enough, the most popular purpose of KAATSU training in the study was to strengthen muscle in athletes and to promote the health of subjects, including the elderly. Approximately 80% of the facilities are satisfied with the results of KAATSU training with only small numbers of complications reported.

The incidence of side effects was as follows; venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%) - see Figure. "These results indicate that the KAATSU training is a safe and promising method for training athletes and healthy persons, and can also be applied to persons with various physical conditions," Nakajima et al. (2006) conclude.

• The obvious question now is: How bad is the impaired restoration of the blood flow in the small arteries? And the answer will hopefully calm you down: Probably not too bad. After all, the systemic effects (not shown in Figure 2) were not affected by BFR and, after plummeting at the 10-minute mark, returned to normal at the 40-minute mark in both the BFR and control trial - a delayed recovery you can see in Figure 2 for the small arteries was absent.
  
  Moreover, we cannot exclude the possible occurrence of an augmentation of the training effects and corresponding (positive) adaptations of the vasculature due to the increased physical demand of combined training (the scientists observed a significantly higher heart rate in the BFR trial. Needless to say that this does not apply for pre-existing vascular disease. They are probably better off if the stay away from BFR and/or perform it only under medical supervision.
• Logical, but also true? Intense exercise, especially weight-bearing exercise, has been shown to be a potent bone builder. BFR has been shown to augment the adaptive response to light(er) exercise. Does this mean BFR training can also build bone? Scientists from the Federal University of Paraíba tried to figure that out in their recent review of the literature (Bittar 2018) - albeit with moderate success.
  
  Bittar et al. searched for studies that analyzed the effect of low‐intensity (LI) exercises with blood flow restriction (BFR) on bone metabolism and compared it to the proven benefits of high‐intensity (HI) exercises without BFR. Two researchers, independently and blindly, selected the studies based on established inclusion and exclusion criteria.
  
  

  

  There are all sorts of different BFR regimen. In this study from the SuppVersity archives, the cuffs were applied before (3x5 minutes), not during the exercise and still: the increase in the putative marker of muscle damage, creatine kinase, was significantly ameliorated.

  While the initial electronic and manual searches had located 170 articles published in English, only four studies survived the screening process. The good news is that they seem to support the initially proposed rationale "that BFR training increases the expression of bone formation markers (e.g. bone‐specific alkaline phosphatase) and decreases bone resorption markers (e.g. the amino‐terminal telopeptides of type I collagen)" not just in response to strength training, but also "after both aerobic [...] exercise across several populations". Still, in the absence of methodological standardization of the samples, exercise type, intervention frequency or duration - more research will be necessary to quantify the effect size in a meta-analysis.

Meta-analysis suggests: Gymgoers may benefit most from wearing compression garments.

Bottom line: While the research investigating the health and performance effects of #compressionGarments and #stockings is still more-or-less in its infancy, the number of studies which probe the efficacy and safety of different types of #bloodFlowRestriction has increased rapidly over the past decade.

In that, one has to be careful, though, to avoid getting too excited about the pro-anabolic effects of blood flow restricted (low intensity) training and/or getting too anxious over the previously discussed transient ill effects on arterial stiffness.

Needless to say that the same applies to the performance and or health effects compression garments, too. For them, the latest meta-analysis concludes that "LLCGs [lower-limb compression garments is] not associated with improved performance in VJ [vertical jump], VO2max, VO2submax, Lactate, or RPE during high-intensity exercise" (da Silva 2018). This result clearly relativizes the measured, bu often small benefits in individual studies and reminds me to refer you to a more comprehensive review I blogged about last year - a review that seems to suggests that gymrats not endurance athletes, who made up the majority of the subjects in the studies reviewed by da Silva et al., may benefit most from the strategically timed use of compression garments | Comment!

References:

• Bittar, S. T., Pfeiffer, P. S., Santos, H. H. and Cirilo‐Sousa, M. S. "Effects of blood flow restriction exercises on bone metabolism: a systematic review." Clin Physiol Funct Imaging, 38 (2018): 930-935. doi:10.1111/cpf.12512
• da Silva, César Augusto, et al. "Association of Lower Limb Compression Garments During High-Intensity Exercise with Performance and Physiological Responses: A Systematic Review and Meta-analysis." Sports Medicine (2018): 1-15.
• Jessee, Matthew B., et al. "The influence of cuff width, sex, and race on arterial occlusion: implications for blood flow restriction research." Sports Medicine 46.6 (2016): 913-921.
• Loenneke, Jeremy P., et al. "Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise." European journal of applied physiology 112.8 (2012): 2903-2912.
• Loenneke, Jeremy P., et al. "Blood flow restriction pressure recommendations: a tale of two cuffs." Frontiers in physiology 4 (2013): 249.
• Mouser, J. G., Dankel, S. J., Mattocks, K. T., Jessee, M. B., Buckner, S. L., Abe, T. and Loenneke, J. P. "Blood flow restriction and cuff width: effect on blood flow in the legs." Clin Physiol Funct Imaging, 38 (2018): 944-948. doi:10.1111/cpf.12504
• Reed, Katharine E., et al. "The effects of lower-body compression garments on walking performance and perceived exertion in adults with CVD risk factors." Journal of science and medicine in sport 20.4 (2017): 386-390.
• Sugahara, I. , Doi, M. , Nakayama, R. and Sasaki, K. "Acute effect of wearing compression stockings on lower leg swelling and muscle stiffness in healthy young women." Clin Physiol Funct Imaging, 38 (2018): 1046-1053. doi:10.1111/cpf.12527
• Tomiyama, Hirofumi, and Akira Yamashina. "Arterial stiffness in prehypertension: a possible vicious cycle." Journal of cardiovascular translational research 5.3 (2012): 280-286.
• Vlachopoulos, Charalambos, Konstantinos Aznaouridis, and Christodoulos Stefanadis. "Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis." Journal of the American College of Cardiology 55.13 (2010): 1318-1327.

Diabetes, Heart Disease, Cancer - Three Good Reasons not to Join the Masses of Dumb "D(e)ad Body" Worshipers

This is one of the "dad body" models currently displayed on the net who are already beyond "normal-weight" obesity.

If you look at the characteristics of the recently hyped "dad body" it's hard to ignore that - from a medical point of view - many of the alleged "mommies" and "daddies" would be classified as a normal weight obese individuals, i.e. someone who's BMI is in the normal zone, but whose body fat percentage exceeds  ≥25. 4 % (for women this would be ≥31.4 %).

And while it may be debatable whether a beer-bellied beanpole is sexy or not, there's no question that having a "dad body" is associated with a significantly increased risk of several potentially fatal health problems.

Learn more about the effects of your diet on your health at the SuppVersity

Only Whey, Not Soy Works for Wheytloss

Taste Matters - Role of the Taste Receptors

Dairy Protein Satiety - Casein vs. Whey

How Much Carbs Before Fat is Unhealthy?

5 Tips to Improve & Maintain Insulin Sensitivity

Carbohydrate Shortage in Paleo Land

• The dad body is a reliable indicator of metabolic syndrome - As sexy as some people obviously believe it was, the belly your "dad" is carrying is a sign of his high risk of suffering from the five main features of the metabolic syndrome.
  

  

  Figure 1: Prevalence of the 6 features of the metabolic syndrome in normal weight subjects according to the amont of body fat they are carrying around (Oliveros. 2014).

  And as the data in Figure 1 tells you, the same goes for your pot-bellied normal-weight "mum", as well. I both population groups the prevalence of metabolic syndrome is significantly increased (Oliveros. 2014). 

• 

  Retinol (Vitamin A) - A Re-Discovered Weapon in the Battle Against Atherosclerosis: Reduced Progression in Patients, Protection For Healthy Subjects From 25,000IU/Day Retinol | more

  The dad body is associated with increased risk of subclinical atherosclerosis - Compared with dads and non-dads without bellies, the gut-bellied dad who is now proud of his "dad body" has 7% more sclerotic plaque and a 46% elevated risk of developing soft plaques, as well as a 7.1% increased risk of developing full-blown atherosclerosis  (Kim. 2015).
  
  Needless to say that  Kim et al. also observed those with a particularly "daddy" belly and thus a high visceral to subcutaneous fat ratio were at the highest risk of clogged-up arteries.
  
  Unsurprisingly, the same group of patients was identified by Polish scientists to suffer from subclinical disturbances of left-ventricular function a harbinger of heart attacks (Kosmala. 2012). Similar data comes from a 2012 study by Shea et al. who were able to confirm that those "with elevated [DEXA determined] %BF are at increased risk of developing cardiometabolic disease despite having a normal BMI" (Shea. 2012).
• The female pendant to the dad body is associated with a high risk of dying from cardiovascular disease - An analysis of the data from the US NHANES dataset revealed that men and women with dad and mom bodies (>23.1% body fat in men and >33.3% in women; both fat, but with a normal BMI) didn't just have a four-fold higher risk of developing metabolic syndrome (16.6 vs. 4.8%, P < 0.0001), they also had a had higher prevalence of dyslipidaemia, hypertension (men), and cardiovascular disease (women).
  

  

  Figure 2: Increase in cardiovascular death risk in men and women with mean (18.65–23.15% in men an 28.9–33.3% in women) and high body fat (>23.15% in men and  >33.3% in women) on a normal-weight frame; data adjusted for age, race, smoking status, waist , dyslipidaemia, hypertension, diabetes, and CV disease (Romero-Corral. 2009).

  It is thus no wonder that even after adjustment for confounding factors, women with a "mom body" showed a significant 2.2-fold increased risk for cardiovscular mortality (HR = 2.2; 95% CI, 1.03–4.67) in comparison to "normal bods" group. In men a risk increase of only 17% was observed - after adjustment for age, race, smoking status, waist circumference, dyslipidaemia, hypertension, diabetes, and CV disease, obviously. Similar evidence comes from a previous study from Switzerland (Marques-Vidal. 2010), where normal-weight obesity is sign. less prevalent than in the US.
• All the negative effects of having a "dad body" may come back to chronic metabolic stress and its vicious consequences- Data from a 2010 study from the University of Rome "clearly indicates that NWO [normal weight obese people], besides being in early inflammatory status, are contextually exposed to an oxidative stress related to metabolic abnormalities occurring in obesity" (Di Renzo. 2010).
  

  

  Figure 3: A significant reduction in insulin sensitivity is only one of the consequences of the pro-inflammatory effects of a "dad belly"; it's also the trigger for a cascade of events that will (often) end with the transition from normal-weight to regular obesity or the transition from the marital to the hospital bed (Romero-Corral. 2009).

  Put simply: Despite not having to wear an XXL or XXXL shirt, the inflammatory status of normal-weight obese men and women is similar to the one of their significantly overweight peers and the health-consequences are (almost) identical, too.
  
  It is thus hardly surprising that the cancer risk of "mom and dad body"-worshipers or rather those who are being worshiped for their "mom and dad bodies" is going to be significantly increased. After all, metabolic stress is among the primary triggers of all forms of cancer (Jin. 2007)

So you're eating "healthy"? Sure? Find out in this SV Classic.

Ok, I have to admit: Not every "dad body" would qualify as "normal-weight obese" according to the official definitions (this is mostly, because the guys who have a "dad body" are also overweight according to the BMI definition, which obviously makes things worse, not better), but if we actually tell people that it's fine to let their waists go, what do you think is going to happen. Is this going to help decrease the prevalence of people who's weight is ok, but whose organs are drowning in visceral fat? I don't think so, do you? | Comment on Facebook!

References:

• Kim, Sohee, et al. "Normal-weight obesity is associated with increased risk of subclinical atherosclerosis." Cardiovascular Diabetology 14.1 (2015): 58.
• Kosmala, Wojciech, et al. "Left ventricular function impairment in patients with normal-weight obesity contribution of abdominal fat deposition, profibrotic state, reduced insulin sensitivity, and proinflammatory activation." Circulation: Cardiovascular Imaging 5.3 (2012): 349-356.
• Marques-Vidal, Pedro, et al. "Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation." Nutrition, Metabolism and Cardiovascular Diseases 20.9 (2010): 669-675.
• Jin, Shengkan, and Eileen White. "Role of autophagy in cancer: management of metabolic stress." Autophagy 3.1 (2007): 28-31.
• Oliveros, Estefania, et al. "The concept of normal weight obesity." Progress in cardiovascular diseases 56.4 (2014): 426-433.
• Romero-Corral, Abel, et al. "Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality." European Heart Journal (2009): ehp487.
• Shea, J. L., et al. "Body fat percentage is associated with cardiometabolic dysregulation in BMI-defined normal weight subjects." Nutrition, Metabolism and Cardiovascular Diseases 22.9 (2012): 741-747.

Foam Rolling For Cardiovascular Health. Propolis For Muscle Protection. Melatonin For Insulin Sensitivity. Plus: Bananas, Pineapples, Oranges & Beer to Boost Your Melatonin Levels!

Among 18-35 year-old Canadians 80% present with premature hardening of the arteries that could potentially lead to an ischaemic event (LLSA).

Despite the fact that it ain't Saturday, yet, I decided to compile a couple of short news for you, also to make sure you re-appreciate the value of melatonin as a prerequisite to be and stay healthy and beautiful. It should therefore not come as a surprise to you that the SuppVersity Figure of the Week comes from the exact same context.

The exact serum value is 51.5 pg/ml melatonin and it is the cut-off point for decreased nocturnal melatonin as a significant marker of an increased risk of stroke (Atanassova. 2009). Accordingly, every 1.0 pg/ml  decrease in melatonin would be associated with a >2% increase in stroke risk with a 50% risk suffering from an ischaemic stroke for people of all ages with a 3 a.m. value for melatonin of approx. 25pg/ml.

 Foam roll yourself towards a healthier cardiovascular system

Who would have thought that: Foam rolling is good for something beside making fun of it! And if the results of the recent study from Nippon Sports University are applicable to everyone, it could be something as vital as the function of our arteries that will benefit from foam rolling the the adductor, hamstrings, quadriceps, iliotibial band and trapezius.

The Japanese scientists had a group of  seven men and three women (age, 19.9 ± 0.3 y; height, 162.7 ± 8.1 cm; weight, 60.6 ± 11.2 kg, means ± SD), all healthy and free of any overt chronic disease performed the self-myofascial release (SMR) with a 15 × 91-cm (diameter × length) uniform polystyrene roller.

Figure 1: Acute brachial-ankle pulse wave velocity and plasma NO concentration in healthy individuals before and after foam rolling aka self-myofascial release (Okamuto. 2013)

The upper and lower extremities and the trunk were moved across the roller, pressure (direct force) was directed at the lower sacrum, mid thoracic spine and posterior head.

"Pressure was adjusted by applying body weight to the roller and using the hands and feet to offset weight as required. The roller was placed under the target tissue area and the body was moved back and forth across the roller. Briefly, to accomplish SMR of the adductor, the thigh is extended and the roller is placed in the groin region with body prone on the floor. For SMR of the hamstrings, the lower extremities are extended and the roller is placed on the hamstrings with the hips unsupported.

For SMR of the quadriceps, the thigh is extended and the roller is placed on the quadriceps with the body prone on the floor. For SMR of the iliotibial band, the roller is placed on the iliotibial band with the body lateral on the floor.

You don't feel comfortable foam rolling? It's awkward? Yes, it is, but that's probably something you will get used to.

For SMR of the upper back, the hands are placed behind the head and the roller is positioned on the trapezius with the hips unsupported. The head is maintained in a neutral position with the ears and shoulders aligned. The bottom leg is raised slightly off floor. The hips are raised until they are unsupported and the head is stabilized in the neutral position.

The SMR proceeded in the order of adductors, hamstrings, quadriceps, iliotibial band and trapezius.

Each participant practiced two or three times to learn the correct foam rolling technique with the guidance of a trainer and performed 20 SMR repetitions on each muscle group at 1-min intervals." (Okamuto. 2013)

As you can see this protocol is a pretty time-consuming undertaking, which was however rewarded with significant

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Bottom line: With this being the first study to examine the effects of foam rolling or to say it the sexy way "Self-Myofascial Release" we cannot tell whether or not the benficial effects on brachial-ankle pulse wave velocity and plasma NO concentration are (a) replicable in sick and old people who would certainly benefit to a greater extent than the healthy young adults in the study at hand, and whether these changes would (b) persist / reoccur, if you practiced foam-rolling on a regular basis. Therefore Oakmuto et al. may be right that their results suggest that "repeated long-term SMR might decrease baseline arterial stiffness" (Okamuto. 2013), but if you had the choice of taking a walk and foam rolling for 30min, I bet the former will be WAY superior to waddling around with higgledy-piggledy 100% paleo incompatible polystyrene ;-)

More evidence that propolis could promote muscle gain - at least in the elderly

With all the rage about protein anabolism we often tend to overlook that pumping air into a balloon with hundreds of holes in it is not the wisest thing to do... or to say it in plain English, we tend to underestimate the importance of anti-catabolic substances. And while this is particularly true for elderly individuals, in whom the catabolic side effects of exercise tend to eat away their gains, even younger folks could benefit from a reduction in the as of now exclusively detrimental effects of TNF-alpha.

Learn more about inflammation and skeletal muscle hypertrophy

A recent study from nowhere else than the Department of Chinese Martial Arts at the Chinese Culture University did now elucidate that the provision of 5 and 10 mg/kg of caffeic acid phenethyl ester (CAPE, HED 50-150mg per day), a phenolic compound isolated from propolis (the honey beehive propolis, not the fungus) effectively blunts the inflammatory assault in response to downhill running and could thus "protect [...] against eccentric exercise-induced skeletal muscle damage" and avert (a) over exertion and (b) potential atrophy (Shen. 2013).

It is however problematic that the TNF-alpha decline goes hand in hand with concomittant declines in OX2, iNOS, and production of IL-1β and MCP-1, all of which have been implicated as an integral part of the beneficial adaptive response to exercise. Genetic ablation of the MCP-1 gene for example lead to persistent macrophage accumulation in association with residual necrotic tissue and impaired muscle regeneration (Shireman. 2007).

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Bottom line: As mentioned before a propolis supplement is probably more beneficial for older people or other trainees with health conditions that make them more susceptible to skeletal muscle catabolism. Whether this will be beneficial in young people is yet about as questionable as the whole COX-inhibitor for or against muscle growth conundrum, of which Trappe et al. wrote in a very recent review that they probably won't hamper muscular adaption in young and middle aged individuals and showed some promise in promoting the adaptation process in the older guys and gals (Trappe. 2013). For both "regular" COX inhibitors like aspirin, but also "exotic" supplements like propolis extracts it may thus depend on both timing & dosage  and age / baseline inflammation & ability to cope with it  - whether or not supplementing with respective compounds makes sense.

Melatonin supplementation doubles insulin sensitivity in old obese rodents

I know another rodent study, but if you look at the sleep problems your own older relatives have and the way similar patterns have become prevalent in ever-increasing parts of the younger generation, as well, even the mere possibility that the 2.1x increase in insulin sensitivity researchers fro the Department of Physiology and Biophysics at the Institute of Biomedical Sciences of the University of São Paulo describe in their soon-to-be published paper would warrant an N=1 experiment with melatonin (Zanuto. 2013). mesenchymal stem cells from oxidative damage and can be temporarily doubled by simply consuming tropical fruits even (pineapple < orange < banana, see figure 2; Sae-Teaw. 2012)

Figure 2: KITT–Glucose disappearance rate (%/min), weight change from week 0, periepididimal fat weight (left; Zanuto. 2013); effect of fruit extract from 1kg pineapples, 1kg oranges or two ripe bananas on serum melatonin in 12 healthy male healthy volunteers (left; Sae-Teaw. 2012)

This is all the more true, in view of the fact that the pineal hormone, of which you do find 60-170µg/l in beer (with higher values in beers with high alcohol content; cf. Garcia-Moreno ), has also been shown to protect rodents from ischaemic heart disease (at high doses of ~1.5mg/kg ; cf. Sehirli. 2013) and to be inversely associated with the incidence of stroke in humans (Atanassova. 2009).

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Bottom line: Don't discount the value of natural and supplemental melatonin. If it was patentable it would maybe be the #1 prescription drug in the stressful an restless world of the 21st century. You think that's an exaggeration? Maybe, but if you just check out the few SuppVersity news on the matter, you will realize that it's only a minor exaggeration.

And in case you don't want to supplement. A decent amount of sleep, some testosterone boosting high alcohol beer as a "Post Workout Booze" (not really recommended) and the insulin sensitizing "6x Bananas à Day Protocol" you can also boost it the natural way ;-)

References:

• Atanassova PA, Terzieva DD, Dimitrov BD. Impaired nocturnal melatonin in acute phase of ischaemic stroke: cross-sectional matched case-control analysis. J Neuroendocrinol. 2009 Jul;21(7):657-63.
• Garcia-Moreno H, Calvo J, Maldonado M. High levels of melatonin generated during the brewing process. J Pineal Res. 2012 Aug 1.
• LLSA - Stroke at a Young Ag. < http://www.lifelinescreening.com/health-updates/healthy-you/stroke/stroke-at-a-young-age.aspx > retrieved April 12, 2013.
• Liu X, Gong Y, Xiong K, Ye Y, Xiong Y, Zhuang Z, Luo Y, Jiang Q, He F. Melatonin mediates protective effects on inflammatory response induced by interleukin-1 beta in human mesenchymal stem cells. J Pineal Res. 2013 Jan 30.
• Okamoto T, Masuhara M, Ikuta K. Self-Myofascial Release and Arterial Function. Journal of Strength and Conditioning Research. April 2013 [ahead of print]
• Sae-Teaw M, Johns J, Johns NP, Subongkot S. Serum melatonin levels and antioxidant capacities after consumption of pineapple, orange, or banana by healthy male volunteers. J Pineal Res. 2012 Oct 5.
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L-Citrulline Against Arterial Stiffness

You probably know it from the ingredient list of your pre-workout or amino acid product, l-citrulline. Being a possible precursor of l-arginine it is included in those formulas to increase nitric oxide levels and deliver those "skin bursting pumps" the advertisements brag about.

In a recent study, scientists from Japan (Ochiai. 2010) found that 1 week of l-citrulline supplementation at 5.6g/day effectively reduced arterial stiffness in 15 healthy males:

Compared with the placebo group, baPWV [index of arterial stiffness] was significantly reduced in the l-citrulline group (p<0.01). No significant differences in blood pressure (BP) were found between the two groups, and no correlation was observed between BP and baPWV. The serum nitrogen oxide (NOx, the sum of nitrite plus nitrate) and NO metabolic products were significantly increased only in the l-citrulline group (p<0.05). Plasma citrulline, arginine and the ratio of arginine/asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase (arginine/ADMA ratio) were significantly increased in the l-citrulline group compared with the placebo group (p<0.05, p<0.01, p<0.05, respectively). Moreover, there was a correlation between the increase of plasma arginine and the reduction of baPWV (r=-0.553, p<0.05).

Beyond the reduction in arterial stiffness, these results confirm the hypothesis that l-citrulline effectively increases NO metabolism (probably even more than l-arginine) AND, what's even more important, reduces an endogenous inhibitor of NO synthase, so that more nitric oxide may be produced.