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.

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!

References:

• 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.

Yes, Men Can Have Low Bone Mineral Density, Too | But Can Jump Training Really Keep up W/ Resistance Training as a Bone Builder For Rel. Young Men W/ Low BMD?

In view of the fact that there are women in the photos, it should be obvious that these are not the study subjects ;-)

Rope skipping is probably not exactly the exercise you'd be thinking of when it comes to bigger or I should say stronger bones, right? You'd think of squats, of deadlifts of farmers' walks - all the exercises where you can and have to move large amounts of weight - weight bearing exercises that is, those exercises of which studies in post-menopausal women of whom you'd expect them to have low bone mass show that they are effective bone builders (Bassey. 1995; Etherington. 1996; Dalsky. 1998).

Well, I have to admit that I was similarly surprised when I read that jumping had a similar beneficial effect on the bones as resistance training in relatively young (25-60 year-old) male subjects in a recent study from the University of Missouri (Horton. 2015).

No, high protein intakes won't make your bones brittle. Here's why!

Protein Timing DOES Matter!

5x More Than the FDA Allows!

Protein requ. of athletes

High EAA protein for fat loss

Fast vs. slow protein

Whey vs. Pea Protein

As a cursory glance at the abstract reveals, the "jumping training" the subjects did 3 times per week consisted of jumps with progressing intensity (e.g. jump off box more “intense” than squat jump) and complexity of the movement (e.g., single-leg jump more intense than double-leg jump).

• Weeks 1–2 were comprised of low-intensity jumps (10 repetitions of squat jump, forward hop, split squat and lateral box push-off jumps); 
• Weeks 3–4 also included moderate-intensity jumps (10 repetitions of 6–8 different jumps, which included bounding, lateral bounding, box jump, lateral hurdle, zig-zag jumps, or single-leg lateral hurdle and 2 randomly selected low-intensity jumps);
• Weeks 5-6 also included high-intensity jumps like depth jumps and jumps off a box (10 repetitions of 10–12 different jumps, which included depth jumps and jumps off a box and 8–10 randomly selected low- and moderate-intensity jumps). 
• Week 7 was a rest week after wards the cycle was repeated for 8 cycles.

Those of the participants who had been randomly assigned to the resistance training group (RT) trained only twice a week.

" The RT intervention included exercises that load the hip and spine: squats, bent-over-row, modified dead lift, military press, lunges, and calf raises. To minimize risk of injury and to account for strength adaptations as a result of strength training improvements, the RT intervention also used a progressive intensity design based on a 6-week cycle followed by a rest week; a total of 8 cycles were completed" (Hinton. 2015).

As it was the case for the JUMP group, the intensity increased gradually over a 6-week cycle based on new 1-RM tests that were made every 2nd week. In that,...

"[...] weeks 1–2 were light intensity, consisting of one warm-up set of 10 repetitions at 20% 1RM and 3 sets of 10 repetitions at 50% 1RM; weeks 3–4 were moderate intensity with one warm-up set of 10 repetitions at 20% 1RM, two sets of 10 repetitions at 60% 1RM, and one set of 6–8 repetitions at 70–75% 1RM; and weeks 5–6 were high-intensity, starting with one warm-up set of 10 repetitions at 20% 1RM, followed by 2 sets of 10 repetitions at 60% 1RM, and one set of 3–5 repetitions at 80–90% 1RM" (Hinton. 2015)" 

The participants were instructed to perform the eccentric phase of each lift in 2–3 seconds and to perform the concentric contraction "explosively."

Figure 1: Despite significantly increased activity levels in almost all subjects, there were no beneficial changes in body composition and accordingly no inter-group differences (Hinton. 2015).

Now, you should be able to see that both groups underwent at best minimal changes in body composition, which is not surprising considering the fact that the total physical activity of the 44 ± 2 year-old (25-60y) subjects who were not inactive and/or obese and didn't even know about their low bone mineral density before they volunteered for a study that included a free bone mineral density (BMD) scan.

Figure 2:1-RM strength from week 0-12; rel. change to baseline in % above the bars (Hinton. 2015).

What did improve and that even highly significantly are the preformance markers. The average subjeft in the RT group almost doubled his / her squat weight. In comparison, the "gains" the JUMP group made (8% in vertical jump height) look pretty pathetic.

The lack of impressive performance gains in the JUMP group does not negate that osteocalcin and OCX, one increases, the other decreases the bone mass improves significantly in subjects in both groups. It does however stand in line with the lack of impressive improvements in bone mass. Improvements that reached statistical significance only in the RT group.

Whole body bone mineral density in physically active (≥ 4 h/wk) men with osteopenia of the hip or spine at baseline and after 6 and 12 months of resistance training or jump training 

So what? If you can strength train, do it! It's good for bone and muscle and you need both now and as you age.

I originally wanted to write that you'd need bones and muscle "even more so as you age", but technically that's not correct. On the other hand, you'll have a much harder time maintaining and maybe even increasing the bone and muscle mass you have as you age. I am not saying it's impossible, but I am saying the difference we see between the actual effects on bone mineral density when comparing weight bearing = resistance training exercise with jumps is to large to be ignored.

References:

• Bassey, E. J., and S. J. Ramsdale. "Weight-bearing exercise and ground reaction forces: a 12-month randomized controlled trial of effects on bone mineral density in healthy postmenopausal women." Bone 16.4 (1995): 469-476.
• Dalsky, Gail P., et al. "Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women." Annals of internal medicine 108.6 (1988): 824-828.
• Etherington, J., et al. "The effect of weight‐bearing exercise on bone mineral density: a study of female ex‐elite athletes and the general population." Journal of Bone and Mineral Research 11.9 (1996): 1333-1338.
• Hinton, Pamela S., Peggy Nigh, and John Thyfault. "Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical trial." Bone (2015).

Oxytocin - The "Orgasm Hormone" with Multiple Health Benefits: Increased REE, Decreased Total and Visceral Body Fat, Reduced Appetite and Preserved Bone & Muscle Mass

Oxytocin as fat loss adjuvant? We are not there, yet, but maybe in 5 years.

Classically, oxytocin has been regarded as a polypeptide hormone, produced by the posterior lobe of the pituitary gland, that stimulates contraction of the smooth muscle of the uterus. In fact, oxytocin is yet far more, the mammalian neurohypophysial hormone that is produced in the supraoptic and paraventricular nuclei of the hypothalamus by nerve axons, and stored in the posterior pituitary gland, acts as an important neuromodulator in the brain and plays an important role in the neuroanatomy of intimacy, specifically in sexual reproduction of both sexes.

Over the last decades scientists have begun to investigate oxytocin's role in various behaviors, including orgasm, social recognition, pair bonding, anxiety, and maternal behaviors, the direct effects of oxytocin on muscle, bone, adipose tissue and metabolism, on the other hand, have been discovered only recently.

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In a recent study from the University Nice-Sophia Antipolis in Nice, France, for example, injected orchidectomized male mice with 1 mg/kg of OT for 8 weeks to analyze its effect on male steoporosis.

Figure 4: Effects of OT on body weight, muscle weight and fat mass in ORX mice. Sham and ORX mice were submitted to daily injections of OT or Ve for 8 weeks starting 2 weeks after surgery. A) Body and B) muscle weights were measured at the end of treatment. C) The volume of white adipose tissue between lumbar vertebra 1 (L1) and the caudal vertebra 4 (C4) was measured using micro-computed tomography. D, E). Intra-abdominal and sub-cutaneous adipose tissue areas were measured on one section at the L4/L5 (lumbar vertebra 4 and 5) junction level (Beranger. 2015).

The same protocol had previously been used in female mice with success to reverse the bone phenotype (Beranger. 2014), but the analysis of the treated mice demonstrated that OT did not restore the bone loss and muscle atrophy in orchidectomized male mice.

Oxytocin is also necessary for muscle maintenance and regeneration! Why? Well, oxytocin decreases with age and this decrease doesn't just go hand in hand with a decline in muscle mass. As Elabd et al. were able to show it may actually be triggered by the decline in OT, which improves muscle stem cell proliferation in vivo after injury, rejuvenates muscle stem cell function in injured tissue and improves myogenic progenitor cell proliferation via activation of the MAPK/ERK pathway. And despite the fact that Elabd et al. were also able to show that in mice lacking oxytocin  muscle regeneration is impaired, I cannot tell for sure that "supplementation" or having sex will accelerate muscle recovery in young individuals.

What the provision of oxytocin did do, though, was to reverse the ovariectomy-induced fat mass gain that had also been observed in female mice before. In fact, the provision of 1mg/kg of OT for 8 weeks

• reversed the 50% increase in fat volume due to "castration" (that's only important for "manopause" or men with hypogonadism who are afraid of TRT),
• led to additional decreases in fat mass in sham operated mice (that's important because it would imply that normal men would benefit, as well - not just eunuchs) and
• improved the ratio of subcutenous (="benign") to visceral body fat (that's important for everyone, because a reduced visceral to subcutaneous fat mass ratio is associated with reduced diabetes and CVD risks at the same level of total body fat)

to a similar extend as it was previously observed in female mice. Specifically in view of its ability to decrease the fat mass in sham operated ale mice, as well as its recently reported ability of oxytocin to "reduces caloric intake in men," (Lawson. 2015) and it's correlation with resting energy expenditures in women (Lawson. 2014), the "orgasm" hormone may in fact be a promising fat loss adjuvant for men and women.

Figure 2: Oxytocin correlates with resting energy expenditure in women (left | Lawson. 2015) and suppresses energy (middle) and more specifically fat intake in men (right | Lawson. 2015)

As a bone builder, however, oxytocin at a human equivalent dose of 0.08mg/kg body weight appears to works only in females. And while its bone preserving effects may be age-specific, its effects on muscle may depend on age and the age-induced decline in basal oxytocin production; a non-specific recommendation to take "supplemental" oxytocin does thus appear unwarranted.

What may appear warranted, though, is to suggest oxytocin treatments for children and adults with autism. In this population abnormal OT levels are the rule (Modahl. 1998) which is why it is hardly surprising that studies have repeatedly OT to promote social behavior (Andari. 2010), increase retention of social cognition (Hollander. 2007) and improve "mind reading", i.e. the ability to understand what others think and how they feel (Domes. 2007)

Figure 3: Rodent studies indicate that the anti-obesity effects (see reduction in body weight, bottom, right) of oxytocin are rooted in (a) its ability to boost both resting (REE) and activity induced (NREE) energy expenditure (top) and (b) its appetite suppressive effects and the down-stream effects on food intake (bottom, left | Noble. 2014). Human studies to confirm the interactive influence of these two motors of body fat loss in the long(er) term are still missing, though.

Does having more sex do the same? I wish I could say "yes!", but I don't have the data to back my assumption that having more sex would be an even better weight loss solution. I mean, the energy expenditure during sexual intercourse is clearly overstated in the popular media, but the oxytocin shower and the mere fact that you are (a) not sitting your ass flat and (b) not stuffing yourself with junk while having sex would help 90% of the average Joes and Janes lose weight ;-) What appears to be undebatable, though, is that oxytocin promotes satiety and acutely elevates energy expenditure and spontaneous activity when it actually reaches the brain.

Speaking of "reaching the brain", I would like to emphasis that next to direct injections into the brain which are obviously not feasible, the intranasal administration of oxytocin which was also used in the human studies by Lawson et al. (2014 & 2015) is probably the best way to up your levels (MacDonald. 2011) if you cannot or do not want to take the "natural" route to elevated levels of the orgasm hormone | Comment on Facebook!

References:

• Andari, Elissar, et al. "Promoting social behavior with oxytocin in high-functioning autism spectrum disorders." Proceedings of the National Academy of Sciences 107.9 (2010): 4389-4394.
• Beranger, Guillaume E., et al. "Oxytocin reverses ovariectomy-induced osteopenia and body fat gain." Endocrinology 155.4 (2014): 1340-1352.
• Beranger, Guillaume E., et al. "Oxytocin reverses osteoporosis in a sex dependent manner." Name: Frontiers in Endocrinology 6 (2015): 81.
• Domes, Gregor, et al. "Oxytocin improves “mind-reading” in humans." Biological psychiatry 61.6 (2007): 731-733.
• Elabd, Christian, et al. "Oxytocin is an age-specific circulating hormone that is necessary for muscle maintenance and regeneration." Nature communications 5 (2014).
• Hollander, Eric, et al. "Oxytocin increases retention of social cognition in autism." Biological psychiatry 61.4 (2007): 498-503.
• Lawson, Elizabeth A., et al. "Oxytocin secretion is related to measures of energy homeostasis in young amenorrheic athletes." The Journal of Clinical Endocrinology & Metabolism 99.5 (2014): E881-E885.
• Lawson, Elizabeth A., et al. "Oxytocin reduces caloric intake in men." Obesity (2015).
• MacDonald, Elayne, et al. "A review of safety, side-effects and subjective reactions to intranasal oxytocin in human research." Psychoneuroendocrinology 36.8 (2011): 1114-1126.
• Noble, Emily E., et al. "Oxytocin in the ventromedial hypothalamic nucleus reduces feeding and acutely increases energy expenditure." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 307.6 (2014): R737-R745.

News Quickie: Regular Eating Patterns May Boost Weight Loss | Protein Increases Satiety, Influence on Food Intake is Limited, Though | Sugar Reduction ≠ Weight Loss | More

So you're eating "healthy"? Sure?

Time to clean my "may be worth an article" folder by putting out another installment of the SuppVersity short news. Today with a colorful potpourri of studies and experiments that were presented at the Summer Meeting of the Nutrition Society and are now subsequently published in the corresponding Proceedings of the Nutrition Society. 

Studies that are mostly, but not exclusively related to weight loss (or its prevention). Studies on protein, meal timing, appetite, eating for bone health and sugar reduction.

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• Potassium and magnesium (not calcium alone) are necessary to keep your bones strong - In a random sample of 4000 individuals from the approximately 25,000 participants in the EPIC-Norfolk cohort scientists from the University of East Anglia were observed that combined dietary magnesium and potassium intake are positively associated with a quantitative measure of bone density (Hayhoe. 2015).

  

  Table 1: The higher the BUA (ultrasound attenuation), the stronger the bone. The higher the potassium and magnesium intake, the higher the BUA - it's as easy as that (Hayhoe. 2015).

  As the scientists point out, these results complement the limited literature studying other populations (Tucker. 1999; New. 2000; Rondanelli. 2013); and while the various beneficial effects of magnesium are widely appreciated (and on the web often totally overblown), the ones of potassium are still largely ignored (learn more about the low potassium epidemia).
• Reduction of simple sugars alone is not enough to lose weight - In view of the fact that simple sugars are blamed to be driving the obesity epidemic, the appearance of tons of "sugar free" products of the market did not yet reverse the ever-increasing mean weights of the average Westerner, it appeared to be a smart move to examine the impact of an 8-week sugar reformulated product exchange on energy intake, energy expenditure (EE) and most importantly energy balance (EB), in a double-blind, randomised, controlled, crossover design Markey. 2015).
  
  

  

  Things look different in overweight individuals who consume artificially sweetened products | learn more

  For the study that was conducted by researchers from the University of Reading, forty five healthy, non-dieting, non-obese volunteers (14 male, 31 female; age: 32·0 (SD 9·8) years; BMI: 23·5 (SD 3·0) kg/m²) were randomly assigned to consume either regular sugar or sugar-reformulated food and drink products including confectionary, pasta sauces, baked beans, muesli, condiments and sugar-sweetened beverages for a 56 d period, with a 28 d washout period. The minimum target difference in dietary NMES intake between the regular and reformulated product exchange was 38 g/d (152 kcal). Weighed food diaries (4 d) and accelerometer data (7 d) were used to assess EI, EE and EB at baseline and following each dietary exchange period.
  
  In contrast to what the "bad sugar myth" would suggest, there was no significant effect of the intervention on body weight, EI, EE or EB; and that despite the fact that (1) the scientists had predicted a weight loss of at least 2.5kg body weight and irrespective of (2) the fact subjects actually reduced both their sugar and total carbohydrate intakes. Since much of the reduction in energy intake was compensated for "partly through increased voluntary fat intake", a blinded "sugar reduced diet" will not have significant effects on energy balance and thus body weight in either men or women.
• Scientists confirm and quantify the satiety bonus of high protein breakfasts - "The fundamental contributing factor to the current obesity epidemic is energy imbalance," (Tolan. 2015) and I wish there were not a couple of dozen gurus who are debating that, but that's a different topic, so let's not lose sight of the context in which Tolan & Drummond wrote this statement.
  
  The researchers from the Queen Margaret University investigated if normal protein (NP; 15% energy), moderate protein (MP; 25% energy) and high protein (HP; 35% energy) quantities at breakfast proportionately increase subjective satiety and decrease within day energy intake. In the corresponding single blind three way crossover study, 12 healthy subjects (4 male, 8 female) (BMI = 23·9 ± 0·65 kg/m²) aged 21–31 years consumed three isocaloric breakfasts containing approximately 15%, 25% and 35% energy from protein, one week apart. Appetite parameters were measured via Visual Analogue Scale ratings before and after each breakfast and hourly thereafter.

  

  Figure 1: Macronutrient composition (g, left) and 8h fullness, hunger and desire to eat ratings  (Tolan .2015)

  The results in Figure 1 (right) clearly indicate a reduction in hunger and desire to eat and an increase in fullness that was however not linear. It is thus not surprising that there was only a trend in for a reduced mean energy intake between breakfast conditions. Only if this trend woul persist in the long run "this may prove to be a beneficial strategy within the multidisciplinary prevention or treatment of obesity" (Tolan. 2015).
• Regular eating patterns may boost your weight loss efforts! And in this case regular does not mean "more frequently" it does simply mean that you stick to a plan like having breakfast at 6:00, lunch at 12:00 and dinner at 18:00.
  
  

  

  A recent study on "Breakfast Skipping" which found: "Whether Skipping Breakfast Increases Insulin, Hunger and Blood Lipids Depends on One's Breakfast Habits" seems to corroborate the results of the study at hand. After all, the findings suggest that breakfast skipping could increase your obesity risk only if you are not used to skipping it, i.e. if you lack a regular meal pattern.

  In a recent study from the University of Nottingham (Alhussain. 2015), 11 healthy weight women (18–40 years) were studied in a randomised crossover trial with two phases of 2 weeks each. In Phase 1, participants consumed either a regular meal pattern (6meals/day) or an irregular meal pattern (varying from 3 to 9meals/day). In Phase 2, participants followed the alternative meal pattern to that followed in Phase 1, after a 2-weeks washout period.
  
  In the two phases, identical foods were provided to a participant in amounts designed to keep body weight constant. Participants came to the laboratory after an overnight fast at the start and end of each phase. Resting metabolic rate (RMR) was measured by indirect calorimetry, in the overnight fasted state and during the 3 h period after consumption of a milkshake, test drink.
  
  In view of the short study period you cannot expect to see changes in body weight, but there was a significant difference in total postprandial energy expenditure (measured for 3 h) by visit (P = 0·04). More specifically, the postprandial energy expenditure after the regular meal pattern was significantly higher than at baseline (25·8 ± 6·8 and 17·5 ± 8·9 kcal respectively; P = 0·002) or than after the irregular meal pattern (14·8 ± 11·7 kcal; P = 0·04). Practically speaking this could, as the scientists point out, "contribute to weight loss and obesity management, but further studies are needed in obese participants" (Alhussain. 2015) - ah, since all subjects were women, it would be interesting to see if that's the same for men, because men are usually less susceptible to the effects of "fasting", so maybe they are also less susceptible to the effects of not getting their meal "in time".

Overfeeding 101: Get an Overview of the Consequences of Short- & Long-Term Overfeeding | read more

Bottom line: Weight loss requires a caloric deficit and that's not automatically induced by either reducing sugar intake or eating more protein - even if the latter may make you feel more satiated. This is by the way now scientifically proven, because Till et al. (2015) have recently been able to demonstrate that"appetite is not a reliable predictor of energy intake" (Till. 2015). In their review appetite and actual food intake were linked in only 19% of the 442 papers they assessed. This does also mean that in 81% the measured appetite scores had no significance in terms of the actual food intake.

In a similar vein, it is not yet clear if the increase in postprandial energy expenditure Alhussain et al. (2015) report in their paper is of real-world significance. In view of the fact that "irregularity" is one important characteristic of obesogenic eating habits, it would yet be foolish to negate it without longterm studies that disprove this hypothesis | Comment on Facebook!

References:

• Alhussain, M, M. A. Taylor and I. A. Macdonald. "Influence of the constancy of daily meal pattern on postprandial energy expenditure in healthy weight women". Proceedings of the Nutrition Society, 74, E141 (2015): doi:10.1017/S0029665115001561. 
• Hayhoe, et al. "Combined dietary magnesium and potassium intake is associated with greater bone density in women in the EPIC-Norfolk cohort". Proceedings of the Nutrition Society, 74, E120 (2015): doi:10.1017/S0029665115001354. 
• Markey, O. and J. A. Lovegrove. "Dietary energy compensation in response to reduced sugar diet in non-obese men and women". Proceedings of the Nutrition Society, 74, E121 (2015): doi:10.1017/S0029665115001366. 
• New, Susan A., et al. "Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health?." The American journal of clinical nutrition 71.1 (2000): 142-151.
• Rondanelli, Mariangela, et al. "Update on nutrients involved in maintaining healthy bone." Endocrinología y Nutrición 60.4 (2013): 197-210.
• Till, S, C. J. Harden, V. A. Grant and B. M. Corfe. "Appetite is not a reliable predictor of energy intake: interim reporting of a systematic literature review". Proceedings of the Nutrition Society, 74, E150 (2015): doi:10.1017/S0029665115001652. 
• Tolan E. and S. Drummond. "An investigation into the satiating effects of differing quantities of protein consumed at breakfast." Proceedings of the Nutrition Society, 74, E130 (2015): doi:10.1017/S0029665115001457. 
• Tucker, Katherine L., et al. "Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women." The American journal of clinical nutrition 69.4 (1999): 727-736.