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marylin monroe
Showing posts with label EMS. Show all posts
Showing posts with label EMS. Show all posts

Intensify Your Training, Increase Your Gains W/ Combined EMG + Regular Training For 30% Greater Muscle Size Gains

Voluntary & NMES contractions for Monster Quads?
You are always looking for new ways to improve your training outcome? Scientists from the Department of Physiotherapy at the University Cardenal Herrera-CEU might have something for you, then. In their latest study, V. Benavent-Caballer, P. Rosado-Calatayud, E. Segura-Ortí, J.J. Amer-Cuenca, and J.F. Lisón tried to elucidate, whether conducting low intensity resistance training in conjunction with  neuromuscular electrical stimulation (NMES) would provide not just an additional growth stimulus, but also corresponding increases in physical performance, muscle cross-sectional area (CSA) and the capacity to perform daily tasks 22 in exactly those subjects researchers will resort to, when they're looking for generous funding for studies the outcome of which is not going to pay off in form of scripts for a new patentable drug: Older adults living in a geriatric nursing home.
Want to get stronger, bigger, faster and leaner? Don't neglect periodization techniques!

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What? Yeah... I have to admit, the subjects are not exactly bodybuilders and a regular high intensity control is missing, but even if it wasn't for the necessary fact that you'll belong to the group of "older adults" in 50 years from now, the results of the study at hand would still have a certain relevance for younger trainees. Why? Well, something that makes the elderly grow will certainly do the same in young people. Whether it does so at the same or even higher rates than "regular" strength training will obviously have to be elucidated in future studies.
Table 1: Subject characteristics;  VC = volitional contraction; NMES = neuromuscular electrical stimulation; NMES+ = NMES superimposed onto voluntary contraction. SD = standard deviation (Benavent-Caballer. 2014)
For now, all I can tell you is that the three weekly supervised 30-35 min exercise sessions the 89 participants of the study at hand performed in the course of this 16-week study lead to significantly more pronounced strength and size gains, when the exercise was performed using both voluntary contractions and the forced contractions, the researchers produced by attaching their subjects to the surface electrodes of a portable NMES devices (TensMed S82).
Beware of NMES only training! In as much as a combination of voluntary contractions and NMES  may make sense, you should not fall for the fallacious promises of "couch workout" advocates. Previous studies suggest that the strength increases of EMS are - just like any form of training - stimulus specific, the "incomplete muscle activation after training with electromyostimulation" will thus make your muscle stronger on the couch (during your NMES workouts), but are not necessarily going to translate into the real world (Hortobágyi. 1998).
The four adhesive surface electrodes (5 × 5 cm) were placed on the distal medial and proximal lateral portions of the subject's anterior thigh, when they performed their three sets of knee extensions (15 reps each) in a single-leg fashion with 3-minute rest between sets.
Figure 2: Changes in muscle strength (hand grup) and size (rectus femoris), as well as changes in parameters of physical functioning in response to the three training modalities (Benavent-Caballer. 2014)
The participants were instructed to raise the weight in 1 s (concentric phase), keep a full knee extension for 3 s (isometric phase) and slowly lower the weight in 2 s to the starting position (eccentric phase). Each contraction was followed by a 2-second rest period, and the training intensity was set at 40% of 1RM... and yeas, this sounds pretty much like peak contractions, an intensity technique which may in fact be the reason that the old trainees in the study at hand recorded highly significant increases in muscle size even when the peak contraction or rather the whole movement was not superimposed with NMES which was delivered with a ramp-up time of 1 s increasing intensity as the knee was extended from 90° to full extension that was followed by 3 s keeping the knee in full extension and 2 s of a ramp-down with gradually decreasing intensity (see Figure 2, yellow).
There is evidence from previous studies that a similar NEMS + VC regimen leads to non-significantly higher strength gains in the trained leg and sign. higher cross-education effects in the untrained leg of young men (Bezerra. 2009)
Bottom line: It is, as mentioned before, difficult to predict whether or not the NEMS+ training would produce superior training outcomes in younger athletes, athletes. It is yet almost certain that the combination of NEMS + voluntary contractions would pose a viable tool in the toolbox of any injured athlete who has to cut back on his / her training intensity for health reasons.

Moreover, previous trials in younger subjects confirmed that superimposing NEMS + voluntary contractions is at least on par with classic high intensity resistance training and can promote neural adaptations that lead to increased cross-education effects (strength gains in non-trained leg) in a 2009 study by Bezerra et al. (2009).

Beneficial effects of combining (N)EMS and voluntary contractions (not always superimposed, though) were also reported by Venable et al. (1991) and Dervisevic et al. (2002) for resistance training, Pichon et al. (1995) for swimming, Maffiuletti et al. () for basektball volleyball, Brocherie et al. (2005) for ice-hockey and Herrero et al (2006), Babault et al. (2007) and Paillard et al. (2008) for physical education (vertical jump, strength, etc. tested) | Comment on Facebook!
References:
  • Babault N, Cometti G, Bernardin M, et al. "Effects of electromy ostimulation training on muscle strength and power of elite rugby players." J Strength Cond Res 21 (2007): 431-7.
  • Bezerra, Pedro, et al. "Effects of unilateral electromyostimulation superimposed on voluntary training on strength and cross‐sectional area." Muscle & nerve 40.3 (2009): 430-437.
  • Brocherie F, Babault N, Cometti G, et al. "Electromyostimulation training effects on the physical performance on ice hockey players." Med Sci Sports Exerc 37 (2005): 455-60.
  • Delitto A, Brown M, Strube MJ, et al." Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment." Int J Sports Med 10 (1989): 187-91.
  • Dervisevic E, Bilban M, Valencic V." The influence of low-frequency electrostimulation and isokinetic training on the maximal strength of m. quadriceps femoris." Isokinet Exerc Sci 10 (2002): 203-9. 
  • Hortobágyi, Tibor, Jean Lambert, and Kevin Scott. "Incomplete muscle activation after training with electromyostimulation." Canadian journal of applied physiology 23.3 (1998): 261-270. 
  • Maffiuletti NA, Cometti G, Amiridis IG, et al. "The effects of electromyostimulation training and basket practice on muscle strength and jumping ability. Int J Sports Med 21 (2000): 437-
    43. 
  • Malatesta D, Cattaneo F, Dugnani S, et al. "Effects of electromyostimulation training and volley practice on jumping abilities." J Strength Cond Res 17 (2003): 573-9.
  • Herrero JA, Izquierdo M, Maffiuletti N, et al. "Electromyostimu lation and plyometric training effects on jumping and sprint time." Int J Sports Med 27 (2006): 533-9.
  • Paillard, Thierry, et al. "Effects of two types of neuromuscular electrical stimulation training on vertical jump performance." The Journal of Strength & Conditioning Research 22.4 (2008): 1273-1278.
  • Pichon F, Chatard JC, Martin A, et al. "Electrical stimulation and swimming performance." Med Sci Sports Exerc 27 (1995): 1671-6.
  • Venable MP, Collins MA, O’Bryant HS, et al. "Effect of supplemental electrical stimulation on the development of strength, vertical jump performance and power." J Appl Sport Sci Res 5 (1991): 139-43

Electrical Stimulation Improves Clearance of Lactic Acid After Anaerobic Activity in Collegiate Athletes. EMS Turns Out to Be as Effective as 'Traditional' Massage Therapy.

Image 1: The EU-940 EMS device the
scientists used in their study to activate
the vastus medialis and lateralis (high-
lighted in the image) of their subjects, is
very different from the average EMS based
"abdominal toner" advertised on TV.
Even here, at the SuppVersity, news on ergogenics, i.e. things that improve (athletic) performance, are usually about a pill, a fancy plant extract or another 'superfood'. Today's news, however is about a much more "physical" means to improve anaerobic exercise performance, decrease lactate accumulation and improve regeneration: Electrical Muscle Stimulation (EMS).

EMS? Now, many of you will probably remember those TV spots, where you were told that "Abmaster" & Co would transform your pot-belly into a "six-packed" attractant for the opposite sex, if you did not miss this "unique" opportunity and bought one of those electro-shockers no sane fitness professionals would voluntarily substitute his/her good old sit-ups and leg raises for. Yet, while these battery-powered torture instruments did, or I should say, were intended to electrically stimulate muscles (in fact in many of the obese buyers of these products, the abs were probably covered by a layer of fat that was way too thick for actually "stimulation" of the abdominal muscles to occur), both the devices, as well as the EMS protocol Seo et al. (Seo. 2011) employed in their double-blind randomized controlled trial at the Sports Science Research Laboratory of Kyungwoon University in Korea were a little more sophisticated.
Did you know? The fatigue index is a concept used in the study of fatigue during anaerobic activities. It is the ratio of power decline to the length of the time interval in seconds between peak power and minimum power. This means lower fatigue indexes equate lower declines of exercise intensity per time unit. When looking at the data in figure 1, you may want to keep in mind that higher starting values / greater overall workloads will entail greater declines in anaerobic power per time unit and thus present with higher fatigue indexes
During and after 3 all out intervals on an ergometer (resistance: 0.8 x body weight Nm; active rest between intervals: 10 seconds) verbal feedback on perceived fatigue, fatigue indexes in W/s, mean power/weight, total work and lactic acid values (from serum drawn before, after and at 15 min and 25 min post exercise) were recorded in a group of 24 randomly selected collegiate Taekwando athletes (age: 19.8yrs, height; 177cm; weight: 66kg, training experience: 5yrs; mean values with non-significant differences between groups).
Figure 1: Fatigue index, mean power (primary axis) and total workload (secondary axis) during Wingate ergometer test
(data adapted from Seo. 2011)
Immediately after the exercise bout, eight athletes, each, received one of the following treatments:
    Table 1: Outline of the massage
    protocol the  athletes in the massage
    group received after having performed
    an exhaustive anaerobic Wingate
    ergometer test (according to Lee. 1998)
  • The control group received no regenerative treatment at all. 
  • The massage group was subjected to a massage protocol which had been shown to effectively improve exercise recovery in a previous study by the same authors (Lee. 1998).
  • The EMS group was attached to an interferential current unit (EU-940, ITO CO., LTD, Tokyo, Japan), which applied an interferential current with a carrier frequency of 4kHz and a pulse duration of 125µs via four vacuum electrodes (vacuum pressure: 60ppm) to the vastus medialis and the vastus lateralis of the subjects.*
    * "The current  intensity was set within the range of the minimum visible contraction of the quadriceps femoris muscle", so that the muscle of the quadriceps were maximally stimulated, while the current was not so intense that cross-over effects to neighboring muscle groups would occur.
Seo and his colleagues found "significant differences in the lactic acid concentrations in the blood among the three groups [...] at 15 min and 25 min after exercise".
Figure 2: Relative reduction in lactic acid concentration after a wingate performance test followed by massage or EMS therapy compared to untreated control (data adapted from Seo. 2011)
As the data in figure 1 shows, massage and EMS promote the clearance of lactic acid to a similar degree (+17-18% vs. control). So, if you are a professional athlete you should either make good use of your already existing six pack and attract a significant other who is a massage therapist or save some bucks and get yourself a reasonably professional EMS device, in case you intend to be a gold medalist at the 2012 Olympics in London ;-)

Edit (26 July): The lactate & Lactic acid confusion

After I posted this piece of information an interesting discussion around the physiological role of lactic acid broke lose on Facebook and I do not want to deny you the great information my buddy Sean Casey from CasePerformance brought to the table. So, here is what he had to say:
Lactic Acid is an interesting thing....During the 1970-1980’s various studies found lactic acid impaired strength and contraction velocity in samples of isolated muscle tissue (1). Based off these early findings, many researchers evaluated ...post workout recovery modalities on their ability to remove lactate from muscle tissue post workout. Similarly, coaches and athletes started employing post workout techniques aimed at removing lactate from muscular tissue. For instance, our high school track coach used to have us lie on our backs and rest our legs on an elevated surface w/ respect to our body. Usually we'd lie on the floor next to a wall & place legs on wall. The theory was that acid would “drain” out of our muscle tissue, allowing our legs to be fresher for the following day’s workout. (I know, a very bro-science approach; , but mentally felt good and you'd always get a cool tingly sensation when you set your legs down and the blood rushed back into them!)

Interestingly, it turns out that lactic acid may not be the best form of measurement with respect to evaluating the effectiveness of a PWRM [post workout recovery measures]. As pointed out by Cairns SP, it may have a much smaller effect on muscle fatigue than was previously hypothesized(1). Thanks to advances in technology, scientists are now able to study muscle tissue closer to physiological temperatures (old studies were completed at muscle tissue held at cooler temperatures, 50-68ºF). As shown by Westerblad et al., acid had little effect on contraction velocity when completed on muscle tissue held at 89ºF (2). On the other hand, a 2006 study by Knuth et al. did indicate that lactic acid decreased muscle contractile power even at warmer temperatures(3). 

Although the lactate question is still being debated amongst scientist, athletes must ask themselves if the research is even applicable to their post training recovery protocol. Although lactate may induce muscular fatigue, its quickly metabolized within the body (1/2 life: muscle- 9.5 minutes; blood- 15 minutes), and eliminated from our system 90 minutes after an exercise session has been completed (4)(5). Thus, exercise induced lactic acid from one workout is likely not even present during a subsequent workout depending on when you complete it.

All this being said, don't misinterpret my comments and think that I'm trying to put down the role of EMS. I've had to use one a fair amount due to various issues and have found it to be effective. Anything that can get a muscle contracting and increase blood flow is always a good thing ;-) 

References

1 Cairns SP. Lactic acid and exercise performance: culprit or friend? Sports Med. 2006;36(4):279-91.

2 Westerblad H, Bruton JD, Lännergren J. The effect of intracellular pH on contractile function of intact, single fibres of mouse muscle declines with increasing temperature. J Physiol. 1997 Apr 1;500 ( Pt 1):193-204.

3 Knuth ST, Dave H, Peters JR, Fitts RH. Low cell pH depresses peak power in rat skeletal muscle fibres at both 30 degrees C and 15 degrees C: implications for muscle fatigue. J Physiol. 2006 Sep 15;575(Pt 3):887-99. Epub 2006 Jun 29.

4 Karlsson J, Saltin B. Oxygen deficit and muscle metabolites in intermittent exercise. Acta Physiol Scand 1971; 82: 115-22.

5 Barnett A. Using recovery modalities between training sessions in elite athletes: does it help? Sports Med. 2006;36(9):781-96.
The only thing I would like to add to Sean's insightful dissertation is a criticism of the indiscriminate use of lactate, which is sort of 'recycled' muscle fuel, and lactic acid, which is its ugly 'degraded' relative. With the ever increasing H+ levels as they can be observed in the course of a long distance race, for example, more and more lactate gets degraded into lactic acid and thus works like a buffer similar to the beta-alanine derived intramuscular H+ buffer carnosine. Now it is no wonder that with H+ release being a measure of muscular exertion and lactic acid being a measure of H+ buffering, Faude et al. (Faude. 2009) found in what is one of the most recent reviews on the role of lactate in exercise metabolism that
[t]hirty-two studies evaluated the relationship of LTs with performance in (partly simulated) endurance events. The overwhelming majority of those studies reported strong linear correlations, particularly for running events, suggesting a high percentage of common variance between LT and endurance performance.
And, after all, it does not really matter in how far the established performance increases from massages and EMG therapy are related to their ability to accelerate lactate clearance, or more generally to their ability to increase blood flow and thus nutrient delivery and waste clearance in the respective tissue - does it?

Shock Your Calves to Grow Stronger & Recover Faster: $650 Electromyostimulation Device Works, But Is It Worth It?

You will have heard about "calf shocker" routines, but would you have imagined that it takes electro shocks?
I don't know how often I've been writing about the truth and fallacy of the good old saying "no pain, no gain", here at the SuppVersity. And while it certainly has its merit for the faint-hearted, the notion that "pain" will entail "gain" is fallacious, also because it suggests that allowing for adequate recovery would be inferior to digging a deep black "hole of pain" (suggested read: "The SuppVersity Athlete's Triad Series").

And while I know that you know that this ain't the way to go, I am also honest enough to admit that I often catch myself pondering the incorporation of intensity techniques, additional exercises or some fat burning minutes of HIIT, but rarely thinks about the undeniable benefits of things like the hot baths for pre-regeneration and other means to speed up recovery (learn more) ...

Recovery, ceratinly not the #1 topic for gym-conversations

I am not sure, whether or not today's SuppVersity article on the surprising benefits of electrical muscle stimulation (EMS) during the recovery period is going to change that, but it certainly adds another interesting option to my toolbox. After all, the improvements in strength and the researchers from the Quincy College the University of Texas at San Antonio, the Hospital  of the University of Pennsylvania, the National Strength and Conditioning Association and the University of Florida present in their most recent paper in the April issue of Official Research Journal of the American Society of Exercise Physiologists would suggest that it will not just allow me to return to the gym earlier, but will also make me stronger.
The "Marc Pro(TM)" is not just the $650 device used in the study, it is also one of most frequently used words in the study at hand... what? No, there is no conflict of interest declared, but I believe the Journal of the American Society of Exercise Physiologists does not even require that.
The study of which I'd better tell you in advance that is has a slight smack of "product pimping", because it mentions the specific EMS device, the Marc Pro(TM) not just in the methods section, but also in the title (Westcott. 2013), involved two trials with comparably large groups (n=43 / n=62) of male and female subjects in their best years (mean age: 61.3 / 61.7 years).

10 weeks 2x per week full body + 4x per week EMS

Suggested read: "Fast Paced High-Resistant Explosive Circuit Training Burns More Fat and Builds More Muscle Than Classical Weight Training. Trainees Dropped 1.5% Body Fat and Gained 3 Pounds of Lean Mass in 8 Weeks." - Don't discard the value of a fast paced full body resistance training (read more).
During both 10-week trials all participants trained twice a week for 60 minutes. The training comprised a medium-paced circuit training on 13 Nautilus machines including leg extension, leg curl, leg press, hip abduction/adduction, chest press, seated row, shoulder press, lat pull down, low back extension, abdominal flexion, torso rotation, neck flexion/extension and calf press. Each exercise was performed only once and the weight was progressively increased by 1% whenever the subjects were able to perform more than the prescribed number of 8-12 reps at a well-controlled pace of 3s for both the concentric and eccentric portion of the exercise. In addition to the standard strength workout, the subjects performed ~20 min of recumbent cycling at 70 to 80% of predicted maximum heart rate) and ~5 min of major muscle group stretching exercises towards the end of each workout. 

While all subjects underwent the same supervised workout program, only 50% of them were assigned to the EMS group, and instructed to self-administer 1h of electrical muscle stimulation to the calf muscles of both legs four times a week. With the two obligatory exercise sessions, this allowed for two "recovery sessions" in-between workouts.
Figure 1: Changes (rel. to baseline) in the EMS and control groups after 10-weeks of training (Westcott. 2013)
As the data from the pre- and post strength 3-RM tests and the results of the fatigue questionnaire, a 9-point rating scale with anchors of 1 (never experience feelings of calf muscle fatigue) and 9 (always experience feelings of calf muscle fatigue) in figure 1 goes to show you this routine was surprisingly effective in both increasing the effective gains in calf muscle strength and decreasing the workout induced fatigue.

So what's the mechanism here?

It is not exactly likely that the medium intensity EMS targets the IGF-1 + muscle growth promoting PGC-1 a4 isoform (learn more)
The exact mechanism for the benefits, the researchers observed in both experiments, is not fully understood, they stand in line with previous research mostly by members of the same research group (Parker. 2003; Kemmler. 2010; Wescott. 2012; DiNubile. 2011; Girold. 2012) which suggests that the application of electical muscle stimulation "causes positive cellular responses such as nitric oxide (NO) production, fluid shifts, protein clearance, and angiogenesis" and allow for the hypothesis that additional, isokinetic contractive stimulus has the potential to induce mRNA transcriptional proteins such as PPAR gamma co-activator (PGC)-1 alpha (learn more) and the vascular endothelial growth factor VEGF.

Against that background, the scientists assumption that [...]the enhanced muscle recovery associated with [...] electrical stimulation may be due to increased microcirculation, muscle loading, and angiogenesis." (my emphasis in Westcott. 2013) appears reasonable and would warrant their conclusion that EMS which is hitherto used mainly by professional athletes (esp. football players) "may also be beneficial for less fit individuals who experience  prolonged periods of recovery or uncomfortable levels of muscle fatigue after exercising." (Westcott. 2013)




I openly admit: Hot baths are still not a part or my "pre-recovery" routine, but I like some cheap and effective walking on an incline on the day after a leg workout.
Bottom line: Depite the overall promosing results of the study at hand, I'd still have a few questions as far as (a) the usefulness, (b) the alternatives and (c) the superiority of EMS therapy as a means to accelerate recovery and adaptation actually is. A handful of studies, a shiny website and the argument that it does works in recreational, or as the scientists write "less fit" trainees, as well as in pro-athletes won't make me pay approx. $650 for an "electro shocker".  This is all the more true in view of the fact that regular aerobic exercise and HIIT (learn how to set up a routine) will also promote PGC1-alpha and VEGF and could - appropriately dosed - probably elicit similar effects.

Apropos "effects" you should not forget that the parameters the scientists measured are actually both performance parameters. Regardless of the fact that the latter is called "fatigue", the fatigue after a standardized workout is mainly determined by your central and peripheral conditioning. It is thus obvious that you should be able to reduce the post-workout fatigue by any means of additional exercise that does not overtax the system - this may also involve enhanced recovery, but the enhancement is a function of physiological adaptations and not externally applied electrical stimuli.

Against that background, the only advantage of EMS over "conscious", i.e. brain-controlled contractions such as a 3x3min (x2 for each leg) session of single-legged body-weight calf-raises or even a simple walk in the park with a deliberate emphasis on calf-involvement would produce, appears to be that it would ease the burden on the central nervous system. Whether that's essentially necessary for the average trainee is however questionable; and though I would probably be slightly irritated, if you called me "an average trainee", I for my part will stick to some recuperative walking on an incline to promote calf-recovery.

References:
  • DiNubile N, Westcott W, Reinl G, et al. The Marc  Pro TM device is a novel paradigm shift in muscle conditioning, recovery and performance:  Induction of nitric oxide (NO) dependent enhanced microcirculation coupled with angiogenesis mechanisms. JEPonline. 2011;14(5): 10-19.
  • Girold S, Jalab C, Bernard O, et al. Dry-land strength training vs. electrical stimulation in sprint swimming performance. J Strength Cond Res. 2012;26(2):497-505.
  • Kemmler W, Schliffka R, Mayhew JL, von Stengel S.  Effects of whole-body electromyostimulation on resting metabolic rate, body composition, and maximum strength in postmenopausal women:  The training and electrostimulation  trial. J Strength Cond Res. 2010;24(7):1880-1887.
  • Parker MG, Bennett MJ, Hieb MA, et al. Strength response in human femoris muscle during 2 neuromuscular electrical stimulation programs.  J Orthop Sports PhysTher. 2003:33(12): 719-726.
  • Westcott WL, Chen T, Neric FB, et al.  The Marc Pro TM device improves muscle performance and recovery from concentric and eccentric exercise in duced muscle fatigue in humans: A pilot study.  JEPonline. 2011;14(2):55-67. 
  • Westcott W, Han D, DiNubile N, Neric F, Loud RLR, Whitehead S, Blum K. Effects of Electrical Stimulation Using the Marc Pro(TM) Device during the Recovery Period on Calf Muscle Strength and Fatigue in Adult Fitness Participants. JEPOnline. April 2013; 16(2): 40-49.

Blood Flow Restriction, Where Are We? "Don't Hold Your Breath", the Valsalva Maneuver Revisited. Ageless Growth, It's Never Too Late to Start. Plus: EMS as Recovery Tool & HIIT to Heal a Scarred Heart After Myocardial Infarctions

I guess it is a cultural thing that there is apparently a lot more of persuading to be done in the US and Europe to familiarize trainees with (a) the idea of limiting the blood supply to their musculature and (b) the notion that heavy weights are not all that counts.
After the huge success of the SuppVersity Exercise Science Week (read all posts), I did actually intend to put a greater emphasis on training related news in the future. Unfortunately, the number of pertinent papers that don't look at the benefits obese post-menopausal women can derive from walking on a treadmill in the fat burning zone is very limited (Please don't misunderstand this as an offense against the obese women. I anything it's meant as an offense against "experts" still advising those women to do just that). If you look closely enough, there are still a couple of newsworthy papers that have been published within the last weeks... and let's be honest, in the end it does not really matter, if they are from last week, as long as the information they provide is "news" in terms of not being part of common knowledge, yet - right?

Kaatsu - a review: Blood flow restriction research still work-in-progress

(Pope. 2013) -- Pope, Wilardson and Schoenfield have recently published an ahead-of-print paper that offers a very comprehensive overview of the current scientific perspective on training with cuffs (aka Kaatsu training). As the authors point out, the most intriguing aspect of blood flow restricted training (BFR) is that it is totally juxtaposed with the "traditional [strength training] paradigm, which suggests that lifting only higher intensity loads increases" muscle strength and size.

Figure 1: Concurrent lactate & GH increases support the metabolic accumulation hypothesis, one of the most popular explanations for the effects of BFR  (Inagaki. 2011).
One of the most commonly head explanations of the unexpected efficacy of blood flow restricted strength training at low intensities relates to the accumulation of what you could jovially call "metabolic waste" in the trained muscle. The results of a 2011 EMS study by Inagaki et al. (see figure 1), for example; suggest that the accumulation of lactate in the cuffed muscle went hand in hand with a +200% increase in growth hormone (GH) compared to the control condition. 

As Pope et al. rightly point out, these results do yet conflict with previous findings by Reeves et al. who observed similar increases in GH in trainees who wore a cuff while they were doing biceps curls at 30% of the 1-RM, despite identical lactate levels in the cuffed an not-cuffed condition (Reeves. 2006). Accordingly, alternative or rather synergistic effects such as an increase in reactive hyperemia (excess of blood) have been brought forward to explain the growth response to BFR.

I am not going to reiterate the whole review here, but still want to point out a couple of other interesting points, the Pope, Willardson and Schoenfield make. There would be, for example the increase in type II (fast, glycolytic) muscle fiber recruitment that was observed in some, yet not all studies, an increase phosphorylation of the protein synthesis gauge S6K1 (likewise a type II fiber dominant effect) and the accumulating evidence that BFR may "enhance recruitment of higher threshold motor units". In the end, the latter means that you will see similar activation patterns as you would expect them in "classic" heavy duty resistance training with comparably light loads and a cuff.

Will BFR soon become a common training technique?

"Chicken legs no more!" In a previous study even walking on a treadmill provided a growth stimulus, when the legs were cuffed before the participants hopped on the torture machine (learn more).
Yet while the implication (=similar results) appear obvious, Pope et al. are correct, when they point out that the "precise relationship between BFR and muscle recruitment still has to be elucidated" before definite conclusions wrt to the fundamental mechanism and their relation to the well-established metabolic and endocrine and paracrine responses, which do in fact share some, yet not all of the characteristics of "classic" resistance training (e.g. no increase in testosterone in response to BFR training; cf. Reeves. 2006; Fujita. 2007; Abe. 2012) can be made.

Once we have gained a better understanding of the processes that take place during and after BFR resistance training, researchers will probably also be able to provide more concrete advice how training with reduced blood flow can be successfully incorporated into the resistance training regimen of trainees on both ends of the performance continuum that ranges from the cancer cachetic patient to the elite level athlete.

Until then and in the absence of someone who's actually knowing what he/she to "cuff me up", I for my part will stick to traditional high intensity weight and interval training and would suggest that you do the same ;-)

"Deadlift, bench and squat, but God forbid: Never hold your breath!" - True or false?

(Hacket. 2012) -- I guess you will have heard about the fallacy of holding your breath while you bench squat and deadlift. It's one of those things every "I got 2h of instructions, now I am a trainer"-expert will tell his clients: "Don't hold your breath... breath!" On the other hand you will hear some of the "big dudes" tell you that you simply cannot lift weights as heavy as they do, if you don't resort to the Valsalva maneuver (VM) which is actually pretty much what most of us are doing, when we are "holding our breath", when lifting. If you carefully observe yourself, when you try to deadlift 80%+ of your 1-RM max you will realize that you do in fact hold your breath, but not like an apnoe diver would do it, on the contrary actually it's like breathing out yet with having your airways closed up.

So why are we doing bullsh*t like that 100% unvoluntarily? Well, the opponents of "holding your breath" will tell you that the pressure that's building up in your abdomen will stabilize your spine and protect you from injury. Against that background it seems only logical that we are naturally programmed to perform such a maneuver whenever we have to lift a heavy object from the ground or free ourselves from a tree that's lying right across our chest by benching it away ;-)

Even  when you are training for strength, heavy weights are not everything. A study I covered back in 2011 here at the SuppVersity showed - allegedly to my own surprise - that reducing rest times from week to week is another way to make progress and gain more mass and strength - particularly in the legs (read more)
Unfortunately, we all know that not all the things we are programmed to do - e.g. eating as much sugar as humanly (in the literal sense) possible, whenever we hit onto a honey-pot - is not necessarily conducive to our health. The existing literature on the matter appears to confirm this notion. It does however also tell us that the majority of healthy resistance trainees do not just get away pretty well when they follow their instincts and perform the Valsalva maneuver, but also achieve the desired increase in spine stability.

How effective this type of all-natural spine protection actually is, has yet never been fully elucidated. The same goes for the performance increases which are, as the scientists point out, "likely", but not adequately quantified in well-controlled studies. That there is a non-negligibly increased risk involved, especially for people with pre-existing cerebrovascular disease, cardiovascular disease and hernias, on the other hand, is non-debatable.

Against that background and in view of the fact that the hemodynamic response (=increase in blood pressure, etc.) decreases over years of training, the authors conclude that the deliberate use of the Valsalva maneuver for brief time-periods (<3s) should remain a prerogative of the more experienced trainees. 

Electrical muscle stimulation (EMS) as a recover tool

SuppVersity veterans know: Recovery begins before you even hit the gym. "Pre-covery" would in fact be an appropriate term for the scientifically proven benefits of taking a hot bath 2 days before a particular strenuous workout or competition. Sounds hilarious? Well, if that's what you think, you better go back and read up on the results of the 2012 study by Touchberry et al., then.
(Kibisa. 2013) -- Ever since the huge disappointments with EMS ab-trainers, the electro-myostimulation is pretty much depreciated by the average trainee. If you still got one of those belts lying around (don't be ashamed ;-) you may want to wrap it around your calves, instead of your abs to use it as a recovery tool similar to the obviously way more sophisticated EMS devices the scientists from the Lithuania Kaunas College used in their latest study.

Kibisa et al. had recruited a group of 19 long-distance runners who had then been randomize to two groups who performed either their regular post-training routine or were attached to the said EMS device in order to apply what you may call a "post-workout recovery stimulus". Interestingly this treatment lead to significant increases in a subsequent maximal voluntary contraction (MVC) and work capacity (WC) tests, as well as profound decreases in in the 72h post muscle soreness.

As you probably would have guessed, the scientists ascribe these benefits to an "improved blood flow in the stimulated muscles and an increased venous blood pump". This however is nothing you could not achieve by an extended cool down, as well so that the study at hand won't qualify as an excuse to go and buy an EMS belt for your abs from the shopping channel ;-)

HIIT after infarction reduces scarring of heart tissue

In the unfortunate case you missed the Making HIIT a HIT! Series I highly suggest .you go back and learn about the fundamental and not so fundamental rules of how to HIIT it right. Part I comprises a brief research overview to give you an idea of what you can expect from HIIT workouts. Part II provides some theoretical considerations and a comprehensive list of 10 rules of thumbs to follow, in order to make HIIT a HIT ;-)
(Godfrey. 2013) -- The longstanding paradigm that rest facilitates recovery in the really sick is crumbling. Against that background it's not totally surprising to see that researchers from the School of Sport and Education at the Brunel University in the UK dared publishing a case-report dealing with a 50-year old post-myocardial infarction patient, who participated in 60 weeks of increasingly intense (obviously according to what a post-myocardial infarction patient can tolerate) high-intensity aerobic interval exercise.

The man who had sustained an idiopathic acute myocardial infarction had been diagnosed with 16% myocardial scar tissue early after the event saw successive improvement in the physiology of his hard, with an MRI-confirmed decrease in myocardial scar tissue. As the scientists point out, he is thus living proof for the "high efficacy and low risk" of high intensity aerobic interval training as a means not just to prevent future cardiac complications, but even to reverse existing damage.

Resistance training works *fullstop* - Regardless of age

(Mero. 2013) -- In the March issue of the European Journal of Applied Physiology Mero et al. report that their 21-week progressive resistance training regimen (two full-body workouts per week classic progression from 15 reps at 40-60% to 5-8 reps at 70-80%) yielded significant strength and size gains in old and young previously untrained subjects.
Figure 2: Changes in muscle cross sectional area and strength at the end of the 21-week study period (Mero. 203)
What's certainly surprising is the fact that there were no differences in terms of strength gains at the end of the study period between the young and old trainees. This is particularly interesting, because the "old chaps" obviously caught up, in the 2nd (=higher intensity) phase of the study. After 10.5 weeks, the young trainees had had a statistically significant advantage as far as the concentric strength was concerned. This advantage did yet melt away in the subsequent weeks.

Remember the article on the usefulness of HMB for the older trainees? With its anti-catabolic effect it would leave more of the scarce satellite cells for growth. Plus: It appears to have anti-obesity effects as well (read more)
In a way the presence of strength in the absence of size gains fits in nicely with the high myostatin expression in the older trainees which increased by >50% in the course of the study (read more about the role of myostatin building muscle) and the even more pronounced increase in myogenin, which suggest that the recruitment of satellite cells is slow / non-function in older trainees and further growth would hamper the function of the muscle cells (which is what myostatin is supposed to prevent learn more).

That two training sessions per week did yield statistically significant increases in muscle size and strength and that despite suboptimal energy and protein intake in the older individuals (<1g/kg body weight protein per day for many of the older subjects vs. 1.5g/kg of protein in the young guys; overall significantly lower energy intake than the young guys) is still impressive and goes to show you that it's never to late for you to start lifting weight.



It's never too late! I could hardly imagine a better bottom line to this short potpourri of recent studies and it's unfortunate that for way too many of our fellow men, even an eye-opener like a heart attack is not enough to divert from the well-worn path of a sedentary life... ok, that was more than enough finger wagging for today. After all, the fact that you've found your way to the SuppVersity is evidence tells me that your path probably ain't going to end in the emergency room.

Well, unless you are a post-menopausal woman taking who's determined to take high dose folate supplements for the next 6+ years. In that case, you may well end up in the ER when the tumor in your colon you've been cultivating over the past 72 months bursts. You have now idea, what I am talking about? In that case you probably haven't yet subscribed to the SuppVersity Facebook Channel yet. Certainly a mistake, but as you've learned today, it's never too late and once you've read the respective post, you can still mae up for this lapse ;-)

References:
  • Abe T, Loenneke JP, Fahs CA, Rossow LM, Thiebaud RS, Bemben MG. Exercise intensity and muscle hypertrophy in blood flow-restricted limbs and non-restricted muscles: a brief review. Clin Physiol Funct Imaging. 2012 Jul;32(4):247-52.
  • Fujita S, Abe T, Drummond MJ, Cadenas JG, Dreyer HC, Sato Y, Volpi E, Rasmussen BB. Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol. 2007 Sep;103(3):903-10. Epub 2007 Jun 14.
  • Godfrey R, Theologou T, Dellegrottaglie S, Binukrishnan S, Wright J, Whyte G, Ellison G. The effect of high-intensity aerobic interval training on postinfarction left ventricular remodelling. BMJ Case Rep. 2013 Feb 13;2013.
  • Hackett DA, Chow CM. The Valsalva maneuver: Its effect on IAP and safety issues during resistance exercise. J Strength Cond Res. 2012 Dec 4.
  • Inagaki Y, Madarame H, Neya M, Ishii N. Increase in serum growth hormone induced by electrical stimulation of muscle combined with blood flow restriction. Eur J Appl Physiol. 2011 Nov;111(11):2715-21.
  • Kibiša R, Grūnovas A, Poderys J, Grūnovienė D. Restoration of the work capacity of the skeletal muscle with electrical myostimulation. J Strength Cond Res. 2013 Feb;27(2):449-57. 
  • Mero AA, Hulmi JJ, Salmijärvi H, Katajavuori M, Haverinen M, Holviala J, Ridanpää T, Häkkinen K, Kovanen V, Ahtiainen JP, Selänne H. Resistance training induced increase in muscle fiber size in young and older men. Eur J Appl Physiol. 2013 Mar;113(3):641-50.
  • Pope ZK, Willardson JM, Schoenfeld BJ. A Brief Review: Exercise And Blood Flow Restriction. J Strength Cond Res. 2013 Jan 28.
  • Reeves GV, Kraemer RR, Hollander DB, Clavier J, Thomas C, Francois M, Castracane VD. Comparison of hormone responses following light resistance exercise with partial vascular occlusion and moderately difficult resistance exercise without occlusion. J Appl Physiol. 2006 Dec;101(6):1616-22.