Exercise Round-Up: HIIT Prevents Angina; Stretching Reduces IGF-1 & Strength Gains; Cardio + Weights Lower TNF-Alpha; Protein Doesn't Works W/ Glucose Depletion; Polarization More Effective Than Threshold Training

That's (hopefully) not the way you want to "kick off" your year 2013, is it? So keep the booze at bay and party away, tonight ;-)

There are three things of which I would hope that they are on the top ranks in the things you are planning to do in 2013. And aside from proposing to your girlfriend, becoming a parent, graduating from whatever you are currently studying and keeping or, in the unfortunate case you don't have one, getting a job no other goals should be ranked in this must to in 2013 category: Work out, eat health and sleep deep and sufficiently. Against that background today's exercise round-up, which comprises all the few newsworthy papers that have been published during or shortly before the holiday season can actually be regarded as a means of orientation as far as practical realization of your best intentions for 2013 are concerned.

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• HIIT in the evening will keeps the heart attack away (Morikowa. 2012) -- Having a mild angina (coronary spasm was documented and no severe organic lesions were found) is not just no excuse for not working out, the 26 patients in a recent study that was conducted by a team of researchers from Kashiwara City, Japan, clearly shows that the number of spasms (=perceived heart attacks) was reduced from 2 to ZERO (average numbers) per 5 days in the men and women who performed an aerobic interval exercise training in the afternoon.
  
  

  

  Figure 1: Selected significantly improved health markers before and after the 3x workout short-term intervention involving 19 male and 7 suffering from angina (Morikawa. 2012)

  The protocol was performed on three consecutive days. After warming up thoroughly (10min), all subjects performed four sets of 3 min intervals at 75-85% of their heart rate reserve. The work to rest ratio was 1:1. In other words each of the intervals was followed by a phase of 3 minutes of active recovery. The whole session was concluded by a 5-10 minutes cool down.
  
  In conjunction with the initially mentioned benefits in terms of the recurrence of angina attacks the data in figure 1 should actually suffice to motivate you and lazy relatives to invest this small amount of time into the length and quality of your life- don't you think so?

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  Figure 2: The group of recreational trained young men (~29 years) that did no stretching at all had slightly, but significantly elevated IGF-1 levels (µg/L) after the workout (Borges. 2012).

  Stretching blunts acute IGF-1 response and 10 week strength gains (8RM test) (Borges. 2012) -- Now, hormonal responses to exercise are certainly not everything, the fact that the non-stretchers (OST) did yet also gain significantly more strength on the bench (19% vs. 7% and 5% in the static stretching during warm-up (SBST) and the stretching before each set (SDST) groups, respectively), the leg press, leg extensions and leg curls should yet call your attention, Mr. and Mrs. "I am so freaking professional that I stretch in between every set" maniacs - after 10 weeks of training the guy next to you who sticks to a handful of warm-up sets for injury prevention is going to outperform you.
  
  Remember this is not about not warming up and making sure that you don't hurt yourself, it's just even more more evidence that the die-hard belief that static stretches are beneficial (which was btw. also the research hypothesis of the Portuguese and Brazilian scientists) is dated text book knowledge.

• Again: Not strength or, but strength and aerobics is the way to go (Ho. 2012) -- While the medical establishment is still reluctant to accept the notion that strength and aerobic training must go hand in hand and many muscle heads still plead, they would lose muscle or hamper their gains, when they hopped onto a treadmill from time to time. The evidence is clear: The advantages are simply non-negligible - for the gymbro trying to look muscular (which requires a low body fat percentage if you don't want to look simply ludicrous), and the average Australian (pre-)obese in a recently published study by Ho, Dhaliwal, Hills, and Pal who found that ...
  

  "Twelve weeks of moderate-intensity aerobic, resistance, but mainly combination exercise training decreased TNF-α in overweight and obese individuals compared to no exercise. Therefore, combination exercise training may be physiologically relevant in decreasing the risk of developing chronic diseases." (Ho. 2012)

  The exercise interventions were either 30 min of aerobic exercise on a treadmill (60 % heart rate reserve; HRR estimated using the Karvonen equation: 220 - age - resting heart rate), 30 min of resistance exercise (four sets of 8–12 repetitions at 10-RMlevel of leg press, leg curl, leg extension, bench press, and rear deltoid row, with each set completed in approximately 30 s with 1-min rest) or a combination of 15 min of aerobic exercise and 15 min of resistance exercise (two sets of the above exercises).
  

  

  Figure 3: The combined training did not only result in a maximal suppression of TNF-alpha, the latter was also highly correlated with the reduction in body fat (esp. in the belly area; cf. Ho. 2012)

  "Starting workload levels for each piece of equipment were tested by participants and if more than 10 repetitions were achieved, the weight was increased and after a short rest participants tried again. Likewise, if less than eight repetitions were achieved, the weight was decreased and after a short rest participants tried again. Participants reported to the Curtin Fitness Centre 3 days a week to complete the required exercise and either exercised at home the other 2 days or at the fitness center.
  
  If exercises were completed at home, dumbbells (adjustable weight 1.5–10.5 kg) were provided for resistance exercises (three sets of 10 repetitions for biceps curls, lunges, dumbbell raise, calf lift, and triceps extension for resistance group while the combination group did two sets of biceps curls and lunges and one set for dumbbell raise, calf lift, and triceps extension; back extension, push ups, and sit ups exercises were also included). Treadmills were equipped with heart rate sensors and participants were instructed to increase weight loads by 2.5-kg increments when they could complete more than 12 repetitions." (Ho. 2012)

  Maybe not the perfect program for you, but I bet you know someone who "wants" to make room for 30 min of exercise in 2013, don't you? Ah,... don't tell them that 67-74% compliance was enough to elicit a 30%+ decrease in TNF-alpha and finally allow the participants to drop body fat, though ;-)

• You can have your peri-workout protein even if you want to exploit the AMPK & PGC-1 bonus of training glycogen depleted (Taylor. 2012) -- Actually I have discussed that in the Intermittent Thoughts more than a year ago, but since the debate just goes on forever, I thought it may be worth posting the results of a recent study pertaining to the issue of peri-workout protein ingestion and its purported (yet non-existent!) negative side effects on the beneficial AMPK response to glycogen depleting exercises (note: that's not the AMPK that's increased in your brain, when you starve yourself for longer time periods, the "bad" one that will make you ravenously hungry, induce overeating and shut down your metabolism).
  

  

  As long as you remain glycogen depleted protein has no effect on the beneficial part of the exercise induced AMPK expression (read more)

  "After performing a glycogen-depleting protocol the evening before, the subsequent morning ten active men performed 45 min steady-state cycling at 50 % of peak power output (PPO) followed by an exercise capacity test (1-min intervals at 80 % PPO interspersed with 1-min periods at 40 % PPO).
  
  In a repeated measures design, subjects consumed 20 g of a casein hydrolysate solution (PRO) 45 min before exercise, 10 g during and a further 20 g immediately post-exercise, or an equivalent volume of a non-calorie taste matched placebo (PLA)." (Taylor. 2012)

  In view of the fact that the post-exercise muscle glycogen was not different between the protein supplementation and the "on empty" trial, it is not exactly surprising that the p-AMPK levels increased threefold and the PGC-1mRNA increased sixfold in the 3h after the workout. And even the blunted increase in eEF2 activation is probably only a sign that the muscle started taking up protein right away and thus did not have ask for more after the workout - That said,Taylor et al. are right to point out that
  

  "athletes who deliberately incorporate training phases with reduced muscle glycogen into their training programmes may consume protein before, during and after exercise without negating signalling through the AMPK cascade." (Taylor. 2012)

  Ah, don't overlook the words "training phases" - remember what I wrote about training glycogen depleted in the context of the PGC-1 a-4 post and doing cardio before a workout? It's an intensity technique and not a necessity for everyone on every training day in 2013. Plus, glycogen depletion does require repletion! Running around 24/7/365 is not an option for 2013.

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  Aside "polarization" your cycling performance can also benefit from baking soda & beta alanine (read more)

  Polarize your training and optimize your gains (Neall. 2012) -- What makes HIIT so effective? The cyclicity of high and low intensity, right! It's the same cycle of ups and downs you find everywhere in nature. Against that background it should actually not surprise you that Neal et al. have now found male cyclist record greater training improvements on a polarised model exercise regimen (6.4/hrs per week; 80%, 0%, 20% of training time in low, moderate and high intensity zones) than on a threshold model (7.5hrs per week; 57%, 43%, 0% training intensity distribution).
  
  According to the researchers from the University of Stirling, both groups recorded performance improvements, yet those in the group that followed the polarized regimen saw 5% greater increases in peak power output, 7% greater increases in lactate threshold, and 48% greater increases in high-intensity exercise capacity.

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Thats it for today and in fact for the year 2012. The last one of 365 new posts here at the SuppVersity and probably twice or thrice as many on the SuppVersity Facebook Wall (it would be ~5-6x more on Facebook, if I had started posting short news on Facebook in January already)... Apropos, if you want some additional news before the turn of the year you should make sure to visit www.facebook.com/SuppVersity, today, to read and learn more about.

• A brief history of anti-hangover cures: The ancient Assyrians swore by Ground birds' beaks and myrrh. Raw eel and bitter almonds is a recipe from Europe that was popular during the Middle Ages. The Mongolians were more into  sheep's eyes, while the Chinese must have listened to Thursday's installment of On Short Notice and went with green tea. Us Germans like it traditional (not me though) and eat "Tom's breakfast" (Katerfrühstück), a postbinge breakfast with Bismark Herring, pickles, rollmops and/or sauerkraut (this stuff does work, by the way, 'cause it helps replenish the lost electrolytes).
  Harvard Health Letters headline: "The new medicine: muscle strength. It's not just for bodybuilders. Strength training is critical for all of us." (read more)
• Creatine reduces total antioxidant defenses? Scientists confirm for the 1012532x that creatine works and to make sure somebody even reads their study they overemphasis an increase in uric acid and decreases in TAS in the creatine supplementation group - a reason for concern? (read more)
• Case report: Type I diabetes remission without insulin therapy on gluten-free diet in a 6-year old boy with type 1 diabetes mellitus. (read more)
• Got Acne? Insulin resistance makes men break out. You better don't rely on fasted values, but get an OGGT ASAP(!) cause it turned out to be the most accurate independent predictor of acne at multivariate analysis. (read more)

I guess the one thing that remains to be said now is:  

HAPPY NEW YEAR everyone! 

Don't party too wild, and if you do, drink your green tea before the binge - this is (contrary to the historical advice in the box above) indicated by the latest science you should remember from Thursday's Science Round Up on Super Human Radio ;-)

References:

• Borges Bastos CL, Miranda H, Gomes de Souza Vale R, de Nazaré Dias Portal M, Gomes TM, da Silva Novaes J, Winchester JB. Chronic Effect Of Static Stretching On Strength Performance And Basal Serum Igf-1 Levels. J Strength Cond Res. 2012 Dec 18.
• Ho SS, Dhaliwal SS, Hills AP, Pal S. Effects of Chronic Exercise Training on Inflammatory Markers in Australian Overweight and Obese Individuals in a Randomized Controlled Trial. Inflammation. 2012 Dec 19.
• Morikawa Y, Mizuno Y, Harada E, Katoh D, Kashiwagi Y, Morita S, Yoshimura M, Uemura S, Saito Y, Yasue H. Aerobic interval exercise training in the afternoon reduces attacks of coronary spastic angina in conjunction with improvement in endothelial function, oxidative stress, and inflammation. Coron Artery Dis. 2012 Dec 14.
• Neal CM, Hunter AM, Brennan L, O'Sullivan A, Hamilton DL, De Vito G, Galloway SD. Six Weeks Of A Polarised Training Intensity Distribution Leads To Greater Physiological And Performance Adaptations Than A Threshold Model In Trained Cyclists. J Appl Physiol. 2012 Dec 20.
• Taylor C, Bartlett JD, van de Graaf CS, Louhelainen J, Coyne V, Iqbal Z, Maclaren DP, Gregson W, Close GL, Morton JP. Protein ingestion does not impair exercise-induced AMPK signalling when in a glycogen-depleted state: implications for train-low compete-high. Eur J Appl Physiol. 2012 Dec 23.

Reduced Exertion High Intensity Training - A Minimalist 2x20s HIIT Protocol For The Male Convenience Generation.

Image 1: Looks like humans are not the only lazy creatures, in these days of unhealthy convenience.

Laziness, it seems, is utterly human. If you look around, these days, it appears as if we were genetically programmed to be bone idle. And, from an evolutionary perspective, we may actually be. After all, moving around, hunting and gathering was an obligatory part of our lives in 99% of the human history. It was thus only consistent that our genes would tell us to sit down at the fireplace and relax, once we had found enough to eat on a given day... (un-)fortunately things have changed since those early days. Not only have we moved out of our caves, we have also found ways to radically reverse the ratio of activity to inactivity in our lives.

"Convenience" is the buzzword of the modern western civilization and the obesity epidemic is its unwanted consequence.

A consequence, which is yet by no means inevitable. After all, we all know that getting our behinds off our couches and into the gym, and setting the dietary recommendations of the (fast-)food industry, ahh... pardon, the government at naught would solve the problem, if ... yeah, if there was not this aforementioned genetically programmed laziness that makes the couch so much more appealing to us than the hard benches in the gym...

Sacrifice 30min per week of your TV-time and live to see your grandchildren graduate

A recent study from scientists from the United Kingdom does yet show that you could still spend more than enough time in front of your beloved television set, if you just performed what what Richard S. Metcalfe and his colleagues from the United Kingdom call the "minimal amount of exercise for improving metabolic health" (Metcalfe. 2011) - a 3x per week 10min exercise regimen with no more than two (yes, only 2x!) all-out sprints.

Figure 1: Outline of the training protocol, the black bars indicate all-out sprints at a breaking force equivalent to 7.5% of the individuals body weight (directly adapted from Metcalfe. 2011. Fig. 1)

As you can see in the outline of the experimental protocol, the 29 healthy and normal-weight, but sedentary young (~23y) men (n=13) and women (n=16) did not even have to start with 2x20s sprints. They rather built up to it, by starting out with a single 10s all-out cycle-ergometer sprint at a braking force equivalent to 7.5% of their body weight in the first week of the 6-week study period and built their exercise capacity from there.

Image 2: "Cardio" does not have to be steady state.

Note: If you have not read my previous blogposts on HIIT, you may have missed the information that interval training (not necessarily at the maximal intensity, though) is suitable for everyone - even heart disease patients (cf. Interval, not Steady State Aerobics is the Way to Go - Even for Patients with Myocardial Infarctions!). This has been confirmed only recently by Neil A. Smart et al. who found that "[i]ntermittent exercise may improve functional capacity [of congestive heart failure patients] to a greater extent than continuous exercise" (Smart. 2011) - and that despite the fact that both continuous (30min), as well as interval training (60min, 1 min cycling, 1 min rest) were performed at the same low intensity.

The rest of the 10-min exercise sessions, the subjects were pedaling along at 60W, which is about as much as it takes so that you do not fall off the bike, because of the lack of resistance that is required to stabilize yourself on the bike. The latter would have been tragic, at least if you are a man, because that would have counteracted the surprisingly (not for who has read about the magic of HIIT here at the SuppVersity before) profound effects this regimen, for which the scientists coined the name "reduced exertion high intensity training" (REHIT), had on the glucose homeostasis of the male subjects.

Figure 2: Changes in VO2Max, glucose and insulin area under the cure in response to oral glucose tolerance test in men and women after 6 week of "reduced exertion high intensity training" (data calculated based on Metcalfe. 2011)

As the data in figure 2 shows, the statistically more than significant decreases in the area under the glucose (-12%) and insulin (-39%) curve (AUC) measured during an oral glucose tolerance test was exclusive to the 13 male participants - and that despite the fact that both, male as well as female study participants exhibited similar improvements in their individual VO2Max (+15% in men; +12% in women).

(RE)HIIT only for men?

As far as the underlying reasons for these gender differences are concerned, the scientists are pretty much at a loss, stating that this could be due to "the low statistical power of our study, with only eight female subjects performing the REHIT", " differences in metabolic perturbations during the brief high-intensity cycle sprints",  and the 3-day delay after the last HIIT session before the glucose tolerance test was done (as a SuppVersity reader you will be familiar with the notion that the "anabolic barn door" is wide open for 24-48h), so that "insulin sensitivity was improved in female subjects at an earlier time-point". Now, I do not want to sound like a himbo, but I would say that another observation the scientists made, provides a much better explanation:

[...] we observed that some of the female volunteers struggled with the transition from 60 W to the all-out sprints, and were unable to substantially increase their pedal frequency, and thus their power output during the sprints. This may have increased the aerobic contribution to energy supply and reduced glycogen depletion.

In other words, what was supposed to be a sprint turned out to be a sluggish ordeal. The slightly, but statistically significantly higher rates of perceived exertion (+10%) in the female study participants corroborates the assumption that the women simply did not burn enough glycogen. If we do now also consider the results of a 2008 study by Hagobia et al. who report that

[...] in women, exercise altered energy-regulating hormones in a direction expected to stimulate energy intake, regardless of energy status. In men, the response to exercise was abolished when energy balance was maintained.

It appears obvious that an increase in pedaling frequency by adapting the resistance to the individual fitness levels and dietary controls may be necessary to render this minimalist "REHIT" protocol productive for the fairer sex.

Figure 2: Comparison of changes in VO2Max, glucose and insulin area under the cure in response to oral glucose tolerance test subsequent to 6 weeks of REHIT, or 10 months of "classic cardio" exercise, or dietary intervention (data calculated based on Metcalfe. 2011 and Dengel. 1996)

The comparison of this 6 week exercise program with the results of a 10 months intervention program in likewise healthy sedentary, but older men (45y) who exercised 3x a week for 40min (steady state) at 75-85% of their maximal heart rate, goes to show that it would well be worth making the REHIT protocol work for women, as well (Dengel. 1996). After all, the steady state endurance protocol in the Dengel study was not only four times more time-consuming (plus, the intervention period was 6.6x longer) than the modified HIIT protocol in the Metcalfe study, it also failed to improve the glucose response to the oral glucose tolerance test and produced less pronounced improvements in insulin sensitivity (cf. insulin AUC in figure 3). The mild caloric reduction (-300-500kcal/day) that was imposed on another group of the study participants, on the other hand, yielded similar reductions in glucose and insulin AUCs as the REHIT protocol in the Metcalfe study that was accompanied by a body weight reduction of ~10%, a reduction in body-fat of -5.8% and essentially no loss in fat free mass!

Note: Unfortunately, Metcalfe et al. did not measure the body composition of the study participants. In view of the results of the Whyte study (Whyte. 2010), I cited in the Intermittent Thoughts on Healthy Weight Loss, where the participants lost -2.4cm of their allegedly obese bellies within no more than 2 weeks of doing HIIT, as well as the well-established correlation between insulin resistance and the size of your beer-belly, it is very well possible that the male participants in the Metcalfe study will have lost some body fat doing no more than 8.67 minutes of all out cycling spread across 18 training sessions in 6 weeks... and if they didn't their diet probably was still too convenient ;-)

The (in-)convenient truth about your future

Taken together the results of these studies suggest that a) steady state aerobic exercise is pretty pointless, b) even a minimalist HIIT regimen goes a long way, as long as c) you really hit it hard and d) adhere to your regular (hopefully non-convenient) diet, or even better e) introduce a slight calorie deficit. In other words, without at least some "inconveniences" as far as nutrition and exercise are concerned, chances are that YOU will either remain or become one of the 34,004,946 obese human beings that are now populating a planet where the US alone spend 1,550,566$ per day on the detrimental health consequences of the"convenience" of its citizens (data from Obesity Statistics).

Endurance Athletes Bath in Cortisol: Dose-Dependent Elevations in Hair Cortisol of Triathletes and Runners.

Image 1: There are two types of endurance exercise - the one that is healthy for obese diabetics and the one that chronically stresses and, in the worst case, eventually kills healthy but overambitious hobby athletes; the photo shows a collapsed runner at the 2007 London Marathon, where 22 of his comrades died
(source thisislondon.co.uk)

In view of the fact, that the series of blogposts on High Intensity Interval Training (HIIT) I made in the course of the last weeks were pretty popular, I thought it may also be of interest that there are interesting new results on the effects of resistance training which goes beyond the common "we took 12 obese sedentary post-menopausal women and had them ride a stationary bike for 45min three times a week" approaches, as well. One of these studies happens to come from a group of German scientists from the Universities of Dresden, Marburg and Hamburg (Kirschbaum. 2011); and the results underline my previous comments on the difference between endurance exercise as it is understood by the medical orthodoxy (and as I described it in the previous sentence) and endurance exercise as many hobby athletes and fitness enthusiasts define it. While the former is unquestionably beneficial for obese diabetics or anyone else who would otherwise sit on the couch watch TV and stuff himself with potato chips and ice-cream, 3x45 min of riding a bike probably won't improve the physical condition of a reasonable conditioned hobby athlete. Now, the Kirschbaum study shows quite convincingly that the opposite extreme, i.e. jogging / running and training loads way beyond 40km per week, comes with another certainly more annoying sting in the tail: chronic stress.

In their study, Clemens Kirschbaum et al. analyzed the hair samples of 304 amateur endurance athletes (long-distance runners, triathletes and cyclists; 190 females, 114 males,  mean age ~38 years) and 70  active control subjects (all recruited at local sport events or from friends and family of the authors ;-) and found on average +42% higher hair cortisol concentrations in the endurance athletes.

Figure 1: Relative increase in hair cortisol levels in endurance athletes compared to controls (Kirschbaum. 2011)

As figure 1 goes to show the increase and, more specifically, it's statistical significance largely depended on the type and the duration of exercise. While both cycling and 10k runs increased cortisol levels by about +36%, in this group there were too many "outlayers", i.e. persons with either much higher or much lower cortisol levels, for this increase to reach statistical significance (as defined by a p-value of p<0.05, meaning that chances that this observation happens to be mere coincidence are <5%). In the study participants who stated that they were running half-marathons, triathlons and marathons, on the other hand, the increases in cortisol (+36%, +48% and +66%) were statistically significant, and in case of the marathon runners even dead (consider this a "forerunner" of what may befall marathon junkies) certain.

Figure 2: Relative increase in hair cortisol levels of endurance runners in relation to average weekly training load in kilometers (calculation based on a regression with r=0.32, indicating a below average precision; Kirschbaum. 2011))

If we disregard any reservations concerning the general validity of hair analysis as long-term marker of cortisol levels (recent studies like Manenschijn. 2011 a.o. would suggest that they are valid), Kirschbaum et al. are thusly right to conclude that their data suggests ...

that repeated physical stress of intensive training and competitive races among endurance athletes is associated with elevated cortisol exposure over prolonged periods of time.

Even more important is their advice that, due to the possibly important implications of these findings, it would be necessary to study potentially detrimental effects on the somatic and mental health of the athletes in the future! Well, I probably don't have to tell you that the SuppVersity is going to be the place, where you will read about those studies first ;-)

Before, After or In-Between? Study Puts Another '?' Behind the Widely Accepted 'Cardio After Weights' Paradigm.

Image 1 (rippedfitness.com): As of late everyone picks on gals who believe they would get bulky, when they train with weights... I wonder, when people finally start picking on big, but chubby guys who still try to justify their laziness with the "conditioning work induces muscle loss" myth, when they are guzzling their sugary weight gainers.

I know that I am probably one of the few people with a bias towards lifting weight and high intensity interval training who does not discard the merits of steady state aerobics (LISS) as a third pillar of the exercise part of physical culture. In that I am however well aware that we all have only so much time to spare for exercise - although I believe each and everyone of us would be able to carve out another hour everyday, if we just streamlined our schedules and threw out some useless Internet surfing or TV watching, but this is another issue... it may thus be necessary or at least desirable for many of us, if we could combine strength and LISS sessions into a single session. Personally, I have been doing that for years and after some initial experimentation I have, for the most time, relied on the broscientific recommendation to do LISS after workouts (when I could not do it separately).

Cardio? Ok... but when? Before, after or in-between?

The recent publication of a study on the post-exercise response to concurrent endurance and resistance training published in the Journal of Sports Science and Medicine does yet make me question if there may not be better ways to combine weight lifting and light intensity steady state cardio training. To elicit whether you'd better walk on the treadmill at 60% of your HRmax before or after your weight lifting workout and whether there may not be an even better third protocol that would involve jumping back ond forth from the treadmill to the bench Andrea Di Blasio and her colleagues from the G. d’Annunzio University of Chieti-Pescara in Italy recruited 13 young previously untrained women (mean age 24.40y; BMI 21.28 kg/m²).

Figure 1: Outline of the 3 training protocols that were performed by all subjects (Di Blasio. 2012)

On three different occasions, each of the participants, who underwent an extensive initial fitness test and had been required to follow identical nutrition protocols before each of the three testing sessions, performed all three of the endurance / resistance training protocols, i.e.

• ERT - 30 min endurance training, first + 3x resistance training circuit*, 2nd
• RET - 3x resistance training circuit, first + 30min endurance training, 2nd
• AERT - [10min endurance training + 1x resistance training circuit] x3

note: the circuit training was performed in sissy mode, i.e. at 55% of the 1RM because "it allows working for 30-second consecutively" (Di Blasio. 2012)

...in random order. Resting energy expenditure, VO2, ventialtion, respiratory frequency, proportion of oxygen in the expired air were collected for 30 minutes via continuous indirect calorimetry (FitMate Pro, Cosmed, Roma, Italy) with the subjects in total rest and in a reclined position in a standardized and quiet room (please keep that in mind! We are NOT looking at intra-exercise energy expenditure, but what happens, when you head home or shower!) according to a standardized experimentally validated protocol (Compher. 2006).

Conventional wisdom fails, both alternatives useful - pick whatever suits your goals

The results, of this trial were - to say the least - more than surprising. Or ... well, honestly they were not. If you take a closer look at the plotted data in figure 2, you will realize that the RPE value, i.e. the rate of perceived exertion, Di Blasio et al. had elucidated visual analogue scale questionnaires, as well as the cardiovascular turned out to be the crucial parameters:

Figure 2: Resting energy expenditure (total and rel. to RPE, left) and changes in oxgyen consumption (VO2), ventilation and oxygen fraction in exhaled air relative to mean changes after ERT, RET and AERT training (based on Di Blasio. 2012)

Interestingly, the long-stading"resistance training first" principle (RET) turned out to be the least useful protocol current experimental setting (see implications, below). Rather, the study found

"[...] that AERT, compared with the other protocols, induced a higher metabolic rate by in- creasing EE, VO2, Ve and RPE during recovery from training, and independently of their pre-test values." (Di Blasio. 2012)

This is an interesting result, because it suggests that the hitherto certainly unappreciated alternation of strength and LISS training within one exercise session appears to elicit those post-exercise increases in EE, VO2 and ventilation, that are necessary to support the re-synthesis of adenosine triphosphate (ATP) / creatine phosphate (PCr), to replenish glycogen and oxygen stores, to propel lactate removal and circulation (Børsheim. 2003).

It stands do reason that all these processes are energy intensive. To (1) quantify all of them in kcal (I wonder how long you could survive if you ate kcal instead of foods and how your mitochondria would function if they burned kcal instead of nutrients) and (2) subsume them under the misleading term  "excess post-exercise oxygen consumption" (EPOC) and judge the "optimal" training regimen by its effect on EPOC is yet short-sighted, not just because "EPOC comprises only 6-15% of the net total oxygen cost of the exercise" (LaForgia. 2006), but also because this practice implies that the total or relative (as fat) amount of energy you expend in the immediate vicinity of  a workout was the main determinant of its effects on your metabolic health and physique.

F*** EPOC, the fat burning zone and the calories in vs. calories out hypothesis!

Figure 3: Figure 3: Changes of key enzymes envolved in the phosphorylation of key enzymes in the protein synthetic cascade in response to endurance (E) and combined endurance and resistance (E+R) training (calculated based on Sahlin. 2011; originally posted in "Resistance After Endurance Training Increases Mitochondrial Biogenesis & Protein Synthesis and Ramps Up Fat Metabolism").

That the results of the study at hand do yet still speak in favor of the mixed-mode AERT protocol - at least as long as your main intention is to perform a relatively light full-body conditioning workout at least 3x times a week - is thus not that it yielded the highest post-exercise energy expenditure, but that it did that at the (relatively) lowest rate of perceived exertion (see figure 2, left) and provided the greatest VO2 stimulus to initiate those beneficial metabolic adaptation which won't just reduce the huffing and puffing on subsequent training sessions, but will also help you build a bigger metabolic engine, that's going to keep you lean and help you shed more fat in the future. Apropos "metabolic engine", those of you who have been around for more than a couple of weeks, should actually remember my a post from November 15, 2011, in which I already discussed that adding strength to endurance training can turn even a 60-min cycling workout into a tree-trunk leg builder (see figure 3).

In conjunction with the study at hand, which is the first I know of that compared "cardio first", "cardio second" and "cardio in-between", directly, the results of the 2011 Sahlin study, which employed a true hypertrophy specific pyramid-style leg training after 60min of cycling (without a "hypertrophy first" control, though) do suggest that it may be about time to re-evaluate the bro-scientific standard protocol of "strength, first", "cardio, second" without the long overcome mantra of "you got to work out in the fat burning zone" in the back of your head.

Interestingly, enough, Yardley et al. have only recently reported that "doing cardio first" can make type I diabetics go hypo (Yardley. 2012). Though this may sound scary at first, it would suggest that, in healthy people, the expression of the energy sensor AMPK, as well as the the mitochondria building, fat browning protein PGC-alpha (cf. "If a High Fat Diet was a Pill, the Lay Press Would Celebrate it as Exercise in a Pill!") is probably higher and all the beneficial downstream effects on metabolic health and body composition more pronounced (as always you can of course also argue otherwise - if you want to get hightened leptin levels down, you'd better do it the exact other way around; cf. "Greater Reduction in Leptin With Cardio After Weights").

Suggestion for combining strength and cardio training in one session for,...

• strength - 15 min LISS before*
• hypertrophy - max. 25 min LISS before*
• fat loss (classic) - max. 40min LISS before
• fat loss (alternative) - 10min HIIT + 5min LISS + body part 1, 10min HIIT + 5min LISS + body part 2

* if you feel like it add a 10min HIIT session to the end

You may certainly argue that you would gain more strength without doing any cardio... still, the average O-lifting heavy weight look is probably not what many of you are training for, right? And when you think about it from a physiological perspective it would only appear logical that you better do your cardio first, lift second and add a ~5min cool-down to leave the gym before your protein synthesis peaks / begins to decline, than experience just that during a 45min LISS session after your workouts.

In this respect, even the "equipment hopping" of the AERT sessions, may have it's merit for advanced trainees. While it may certainly not be optimal to "bulk", switching back and forth from cardio to strength training could be a viable alternative for people whose main goal is to maintain the muscle mass while improving their conditioning - particularly when it is combined with short HIIT sessions 5-10min, followed by a short cool-down done twice before say chest and arms (e.g. HIIT > Chest > HIIT > Arms).

References:

• Børsheim E, Bahr R. Effect of exercise intensity, duration and mode on post-exercise oxygen consumption. Sports Med. 2003;33(14):1037-60.
• Compher C, Frankenfield D, Keim N, Roth-Yousey L; Evidence Analysis Working Group. Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006 Jun;106(6):881-903.
• Di Blasio A, Gemello E, Di Iorio A, Di Giacinto G, Celso T, Di Renzo D, Sablone A., Ripari P. Order effects of concurrent endurance and resistance training on post-exercise response of non-trained women. Journal of Sports Science and Medicine. 2012 Aug; 11:393-39.
• LaForgia J, Withers RT, Gore CJ. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. J Sports Sci. 2006 Dec;24(12):1247-64. 

Up Your Coffee Intake & The Temperature of Your Baths to Get in Shape; Up Your Mood W/ Self-Paced Aerobics; Up Your Vitamin D in Time; Up Both Fat & Sugar For Diabesity

Ice cold baths are retarded. A cosy hot tub and a cup of coffee make a way better peak conditioning strategy.

+38% that's the SuppVersity Figure of the Week and it is the fat liberating advantage of the ingestion of 3mg/kg caffeine (in water) before sitting for 30 min in a hot bath (42°C; up to the navel) - yeah, you read me right:  The latest study from the Graduate School at the Department of Health Care of the Soonchunhyang University in the Republic of Korea is about the thermogenic effects of HOT (not cold) baths.

Even in the absence of additional caffeine ingestion the latter increases the amount of circulating free fatty acids by 52% (80% with caffeine) with the ~200-300mg of caffeine before the bath it almost doubles the amount of free fatty acids and increases the circulating leptin levels by 28% (vs. 5.6% w/out caffeine).

Whether the significantly more pronounced reduction in waist circumference (8.9mm vs 6.7mm) Tae-Wook Kim & Jeong-Beom Lee observed in their 9 male subjects (age ~26y; BF% 20%; no habitual caffeine consumers) is yet a result of real fat loss, remains highly questionable. However, even if that's not the case  sitting in a hot tub after having a large cup of coffee would still qualify as a potentially valuable peak-conditioning technique before a contest or photo shoot - or, for the less ambitious, before the high school reunion or the a first date ;-)

Aerobic workouts for a better mood

(Buscombe. 2013) You know these drill instructor classes, where the mostly female participants get their more or less over- and under-sized butts kicked ending up either severely overtrained or chit-chatting with the lady next to them? Yeah, I see - you know exactly what I am talking about ;-)

I guess Richard M. Buscombe and Helen Inskip from the University of London won't like my prelude to their study and there is in fact nothing bad about doing aerobic session like the ones in the Buscombe study, but both, the effects on body composition are about as intensity dependent as the affective changes, Buscome & Inskip measured in their study.

Figure 1: Psychological and physiological effect of 40 min or aerobics at different intensity (Buscombe. 2013)

As you can see in figure 1 the absolute affective change from pre- to post was clearly intensity dependent. Yet despite the fact that the intense workouts had the most significant (beneficial) effect on the feeling scales, the researchers are probably right, when they highlight that

"there was a positive pretest-to-posttest shift in the FS scores, irrespective of the intensity of exercise [and that this] finding supports existing literature advocating the role exercise plays in contributing to positive affective change" (Buscombe. 2013)

Still, in this group of 15 women (medium age 35.08) who think of themselves that they are "fit" or "highly fit", the high intensity (complete routine performed matched to a music with a 140bpm speed) has the greatest reward effect (pre- vs. post).

You have no idea, why I am mentioning the speed of the music here? Read up on the "Accustic Gear" post from 2011 (read more) and the corresponding research overview from April 2013 (learn more) to understand why the rhythm and tempo of the music matters.

In view of the significantly highly rate of perceived exertion and the frustration during the workouts, it does yet stand out of question that the "self-paced" routine, in the course of which

"[t]he participants were instructed that they could add or take away levels from their 'Step' aerobics box, as appropriate [and were allowed] alter the intensity of their session at any stage throughout the course" (Buscombe. 2013)

would be the preferable way to exercise on a regular basis - also, or rather especially because it does not entail the same risk of overtraining as the "push yourself to the limits" high intensity pattern.

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One thing to keep in mind, though, is the fact that not everyone is as willing and able to push him-/herself, when he or she is told that it was not necessary. For less ambitious individuals, the "self-paced" workout may thus well end up mirroring the low intensity routine, in the course of which the participants used only small body movements and minimized any lifting or propulsion actions, performing their workout in sync with a 125 bpm music.

Detrimental effects of vitamin D deficiency on the heart accumulate with time 

(Assalin. 2013) I know that I am already notorious for being the "anti vitamin D guy", but that is about as overgeneralized as the notion that everyone must be taking at least 4k of vitamin D per day. People who have been following the SuppVersity for some time now will be aware that I have always maintained that you go and check your vitamin D levels, supplement, if necessary and re-check after 3-4 months. After all, we all know how detrimental it is to be in a state of full-blown deficiency....

What we did not know - at least up to a couple of days ago, was how "fast" the detrimental effects of vitamin D deficiency can become potentially life-threatening. At least for rodents a recent study from the  São Paulo State University in Botucatu, Brazil, fills this important knowledge gap.

Figure 2: Effects of short (2 months; D2) and long (4 months; D4) on vitamin D deficient diet in the absence UV light on inflammatory markers, anti-oxidant status and heart morphology; data relative to levels after 2 months on the standard diet with 1,000IU vitamin D/kg chow (Assalin. 2013)

The scientists put a group of weanling Wistar rats under non-UV lights on diets containind either 1,000IU VD/kg of chow (C2 and C4) or a vitamin D deficient, but otherwise identical diet for two (D2) and four months (D4), respectively and observed:

• lower beta-hydroxyacyl coenzyme-A dehydrogenase activity and higher lactate dehydrogenase (LDH) activity, as well as 
• increased cytokines release, oxidative stress, apoptosis and fibrosis and 
• left ventricular (LV) hypertrophy and lower fractional shortening and ejection fraction 

in all vitamin D deficient animals. The differences in LDH activity, LV weight, right ventricle weight, and LV mass did yet not achieve statistical significance before the rodents had been kept on the vitamin D deficient diet for four months.

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Bottom line: Given the fact that the animals in the study did not consume any vitamin D and were - due to being exposed to evanescent (non-UV) light unable to produce even minimal amounts of vitamin D, the study results confirm that you can survive without supplements for a couple of weeks. On the other hand, they underline the importance of getting your vitamin D levels checked regularly. After all, we do as of yet have no idea to predict, where you as an individual are on the 25OHD spectrum ranging from deficient to over the tops - for some it may suffice to get regular sun exposure in the summer, for others 5,000IU of D + sunlight may still not suffice to keep their levels in the normal range: Don't be cheap! Get your levels checked.

What's the best diet to induce metabolic syndrome? The SAD diet!

(Pranpawit. 2013) The research design of the latest study from the Institute of Food, Nutrition and Human Health at the Massey University looks like Araya Pranprawit, Frances M. Wolber, Julian A. Heyes, Abdul L. Molan and Marlena C. Kruger wanted to participate in a competition, where those researchers win whose rodents gain the maximal amount of weight in the minimal amount of time. I mean, if you put the little critter on either

• control: 23% protein, 12% fat, 55% starch, 11% sugar
• high sugar (HS): 22% protein, 18% fat, 60% sugar
• high fat (HF): 16% protein, 60% fat, 20% starch, 4% sugar
• high fat + high sugar (HFHS): 19% pro, 40% fat, 41% sugar

the question that remains is not: "Are the rodents going to develop diabesity"?, but rather "Which group of rodents will die from the consequences of it first?" ... well, guess what, in the end this was more or less what the scientists wanted to find out.

Image  from NYC Dept. of Health & Mental Hygiene: The words on this poster from a 2009 campaign in the NY subway must be taken literally (learn why)!

Since published data with regards to diet‐induced metabolic syndrome in the SD rat model remain inconsistent, it is hypothesized that different types and amounts of diet as well as the period of time the animals are exposed to the experimental diet may significantly affect metabolic parameters in SD rats. Therefore, the objective of the present study was to compare the effects of consuming diets high in saturated fat, high in sucrose, and the combination of high saturated fat plus high sucrose, for a short time (4 weeks) and a long time (8 weeks), on selected markers related to metabolic syndrome in order to identify the optimal diet and experimental period for establishing metabolic disorder in the SD rat model (Pranpawit. 2013)

While the rodents in the HFHS and the HS diets consumed about the same amount of fat, those who had been randomized to the high fat (only; HF) diet obviously did not really enjoy their chow. At least weight-wise these rodents consumed significantly less food than their peers and still gained (due to the high energetic density of the chow) significantly more weight than the rodents in the "pure sugar" (HS) diet (see figure 3).

Figure 3: Weight and fat gain, as well as changes in Homa-IR (insulin resistance) and serum cholesterol; * indicates expressed in reference to control group at 2 weeks (Pranpawit. 2013)

As you can see the actual fat gain was slightly more pronounced in the high fat + high sugar diet (no this does not stand in contrast to yesterday's post on insulin not increasing fat storage, because we are not dealing with insulin sensitive critters here, but with severely obese pre-diabetics with elevated FFA levels, which do not require prior conversion to fat to be stashed away).

SAD, but true: "Human Study Shows: Three Days on "High Fat" Standard American Diet Produce Heart Healthier LDL Particle Profile Than NCEP  Approved Low Fat Diet" (read more).

"In all groups, fasting glucose, insulin concentrations (and insulin resistance (HOMA‐IR index) significantly increased between the 4 week and 8 week time points (p = 0.05; data not shown), indicating that these parameters increase with age regardless of diet. At 4 weeks, test diets had no effect on fasting glucose compared to CONT. HS, HF, and HSHF slightly elevated insulin and HOMA‐IR (Fig. 1). At 8 weeks, glucose was slightly elevated in test groups compared to CONT. HS had no measurable effect on insulin or HOMA‐IR, while HF slightly increased and HFHS strongly increased these parameters, although this did not reach statistical significance." (Pranpawit. 2013)

Somewhat surprisingly, none of the test groups differed from CONT as far as the weights of liver, kidney, pancreas, or caecum (data not shown) are concerned. The only, yet statistically non-significant difference was a "tendency for an increase in pancreas size with body weight" (Pranpawit. 2013). Moreover, rats on fat‐containing diets had markedly heavier abdominal white adipose tissues compared to CONT and this effect was unsurprisingly greater after 8 weeks on the diet compared to 4 weeks.

What's certainly interesting and an observation that flys right in the face of the generally held believe that it was the dietary fat that would precipitate to a messed up cholesterol metabolism is the fact that the rodents in the HS group showed elevated circulating cholesterol levels, as well. The often touted effect of sugar on the elevation of triglycerides, on the other hand, was absent unless the rodents received additional fat in their so that the combination of exogenous and endogenously produced (by fatty acid synthesis) fat reached a level that could not be compensated for by an increase in fat storage and/or oxidation.

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Suggested read: "Standard Am. Diet Has 'Optimal' Fatty Acid Ratio to Induce Diabesity. Plus: Doubling SFA Would Yield More Benefits Than Halving Them" (read more)

Bottom line: While we have to be careful about direct extrapolation of conclusions pertaining to the corresponding effect in human beings, it is still interesting to see that (a) the high sugar diet with literally no fat produces a "skinny, but sick" (remember those rodents were not fat) phenotype that is characterized by a messed up glucose and cholesterol metabolism in the absence of obesity and insulin resistance, that (b) taking fasting or postprandial glucose levels as a means to judge the insulin sensitivity is not generally accurate and overestimated the de facto non-existent insulin resistance in the high sugar group (HS), that (c) it's rather the rise in free fatty acids than the carbs that are responsible for both the developing insulin resistance (in the HF group in the presence of low fasting glucose; cf. (b)) and last, but most intriguingly that "the starch‐based control diet may also gradually cause impaired glucose tolerance" and is thus not exactly healthier for the glucose metabolism of the rodents than the high fat or even the high fat + high sugar diets.

If we had to pick a "winner" to be awarded the grand prize for the most metabolically damaging diet it would thus (without question) be the high fat + high sugar diet, which does - not much to your surprise as I would get - actually show a high resemblance to the SAD diet with a relatively high content of saturated and omega-6 fatty acids (from lard, in the case of the study at hand) and tons of simple sugar. The high fat (only) diet and the high sugar (only) diet, on the other hand lead to obesity and insulin resistance, respectively - both did thus fail to induce the key features of the metabolic syndrome, the presence both.

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That's it for today and aside from the obligatory information that you can find addition real short (and I mean "short" as in few words) short news on www.facebook.com/SuppVersity, e.g.

• 

  Most nuts deliver way less energy than the label or calorie tables tell you - for almonds, for example it's ~35%  less (learn more)

  More direct evidence for the free fatty acid - muscular glucose uptake connection: Reducing the amount of free fatty acids in the blood has immediate effects on the ability of the muscle (esp. of diabetics) to take up glucose (read more)
• The verdict on nuts: Not only are nuts not fattening, a recent meta review suggests that incorporating them into your diet may even yield reductions in BMI and more important waist circumference (read more)
• Stupid fools! "Reduced fat" labels are a signal to overeat... well, sort of at least the average customer is more likely to overeat, when the label tells him/her "this food is not as bad as the real deal" (read more)

there is just one thing left to do for me, which is to wish all of you a great Saturday morning, noon, afternoon and evening (whatever your clock may tell you it is now and will be in a few hours :-)

References:

• Assalin HB, Rafacho BP, Dos Santos PP, Ardisson LP, Roscani MG, Chiuso-Minicucci F, Barbisan LF, Fernandes AA, Azevedo PS, Minicucci MF, Zornoff LA, Rupp de Paiva SA. Impact of the Length of Vitamin D Deficiency on Cardiac Remodeling. Circ Heart Fail. 2013 May 24.
• Buscombe RM, Inskip H. Affective change as a function of exercise intensity in a group aerobics class. Journal of Exercise, Science & Fitness. 2013 [epub ahead of print]
• Pranprawit A, Wolber FM, Heyes JA, Molan AL, Kruger MC. Short-term and long-term effects of excessive consumption of saturated fats and/or sucrose on metabolic variables in Sprague Dawley rats: A pilot study. J Sci Food Agric. 2013 May 24.