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The Cause of Obesity - Part 3

January 29 2012

This is the last post on this topic (Part 1 & Part 2). Lot of people made comments and there were a lot of discussions on a few different blogs and forums. I had a posted in a couple of other forums too. I knew very well that I will get a lot of criticisms, but I am sure these articles will will make a lot of people think twice before they make comments about obesity and obese people.

This a very important topic and I admire all those passionate commenters who took the time to express their concerns and opinions.  In this article, I will be replying to some of the commonly asked questions about the articles

1. This is just a matter of how you view it. Environment is required for obesity. Look at the concentration camps and tell me how many people are obese, Anoop?

This is one question that was raised lot. This is almost a knee-jerk response from people. It is true that environment is required. I don't think anyone will argue against it. The concentration camp is just an example of the “absence” of environment or the “lack” of environment. If we don't give food, nobody will be obese, or for that matter, nobody will be even healthy or normal weight!

What we are concerned is when everyone is given free access to food (or the same environment) why only a few people become obese?  Here is an example I gave to one of the posters. I usually don't try to make analogies because they are often wrong, but I feel this gets the point across.

Imagine you plant Sequoia tree (one of the tallest trees) and other trees in a plot which has the same type of soil (same environment). After a few years, you see the sequoia tree taller than others. Are you going to say the difference in tallness of the trees is because of the soil (environment) or simply because it is the sequoia tree (genetics)? Almost 99% percent of people would simply say it is the sequoia tree. We are not going to sit and argue if it weren't for the soil the tree wouldn't be this tall.  But when it comes to obesity, we just can't see the obvious. 


2. Just like other genetics disorders, obesity will not manifest if there is no environment.

“Every genetic disorder is 100% genes and 100% environment”, by Ken Rothman (one of the epidemiological greats). A classic example quoted is the phenylketonuria (PKU), a genetic disorder which characterized by a mutation in the gene for enzyme rendering it nonfunctional; this is about as 100% genetic as a disease can get!  If it goes untreated, the kids develop mental retardation and brain damage.  Nevertheless if there was no phenylalanine given - a phenylalanine free-diet, there would be no PKU, so one could argue it is 100% environmentally determined.

The huge mistake in comparing PKU (or other genetics diseases) and obesity is that in PhenylKetone Urea (PKU) kids are not “hungry” for phenylalanine.

In obesity, hunger is THE fundamental problem. We used to believe that people became fat because they had a slow metabolism or they spent less energy (Non-exercise activity thermogenisis). Now we clearly know that Leptin, Ghrelin and all other staggering complex of hormones are working at the hypothalamus by increasing or decreasing appetite. When leptin deficient kids who have a voracious appetite are treated with leptin, the first thing to drop is their hunger. Kids with Prader-willi syndrome eat from garbage cans because they feel they will die if they don't eat. Bariatric surgery works so well because it is bunting their appetite for some weird reason. People who lose a lot of weight gain weight back because they are primarily hungry. 

So obesity is not a “passive” genetic problem where the genes are just sitting there in the background silently until they see food. People eat because they are hungry.

3. Obesity is all about people eating more. If obese people eat less and move more, they will not be obese.

Obese people are fat because they eat too much. Everyone knows that. The question is why are these people doing it in the first place? Or why are 70% of the non-obese not doing the same? Is it lack of will power or laziness when both have access to the SAME toxic environment?

If it is not biology then it should be lack of will power or laziness. If that's the case, we have a bigger issue here. Obese people are lazy and are incapable of changing habits and behaviors. This is so earth shattering discovery that is worth the Nobel Prize in the field of psychology.

4.  Ok. Obesity is largely genetics. But there are a lot of people who lose weight and keep it off, right

And this is the problem with anecdotal evidence: looking at a few positives and casually extrapolating to everyone. Nobody wants to write about their tales of weight loss failure or struggles. People only hear (or want to hear) the grandiose tales of weight loss success in magaziines and on TV. And this is just a minority.

The negative hits never get counted or talked about.  In medicine they say, “dead men never tell any tales”. In research, they count the negative hits too. There are people who are struggling very hard, but still cannot lose weight and keep it off. 

Here is one commenter: How interesting! I have struggled with weight all my life. I have gone from a size 16/18 to a size 10/12 without ever going below 65kilos. It is as if my body simply will not release any more weight. Also, I recently lost 5kilos over 4 months or so, without losing any fat percentage whatsoever! Again, it just will not go! At size 10/12 I am still 35% fat, and have only ever been 40% fat at my heaviest at 85 kilos. It feels mad!

Her story will never come on a magazine or a blog. She might very well have a biology which makes it hard to lose weight and keep it off. But they are all lumped into the same category and just crucified for not working hard enough or making bad choices.  This is an example of how research or science helping morality. We are the very same people who back in the days labeled schizophrenics as possessed by demons and people with complex regional pain syndrome as mad! And what helped them? Science or understanding the biology - not more or better anecdotes.

5. Twin studies show heritability of obesity to be around 60-80% (very high). So 60% of your weight is explained by genes and the rest is environment.

No. Heritability can only explain the variation between individuals within an environment. So when they say heritability of height is 90%, it means 90% of the difference between average height and extremes of height can be explained by genes. We cannot say that this percentage of the weight is due to genes or environment.

6. Everyone can get obese if they eat enough food or have access to enough calories. Look around, people now are fatter than they were in the 70's. How do you explain that?

And this is the number one reason why people instinctively question these articles.

And this is another problem with anecdotal evidence. When people say people are getting fat, they have no accurate way of quantifying the gain in weight. They are just eyeballing and making conclusions. Did they gain 10, 20, 50, and 150? Most people are talking about their 5 to 15 lbs weight they gained or saw their friend gain and extrapolating it to the effect of environment on obesity.

There is no question that people gain 10-15 lbs due to environment. You won't call that fat do you? To go from overweight category to Obese (25 BMI to 30 BMI),you have to gain around 35-40lbs. To go from normal weight to obese (20 -30 BMI), you have to gain around 75-80lbs. To go from normal weight to extremely obese (20-35), you have to gain 125lbs. But if you are right below 30, you can gain just 2-3 lbs and be clinically obese!

Do you seriously think people gain this 50-100lbs weight by “accident” if they have food around?

And it is extremely hard for people to get obese. If you think it is easy, check this documentary of people trying hard to get obese. 

7. What about people who gain a lot of weight as shown in NHANES study in US?

This is a good point. For people who are already heavy (around obese), the toxic environment is making them worse. And Karky had commented on this. They are gaining 3-4 times the weight than the normal or underweight people. These are the same people who make the average weight gain on US go up and make the rest of us look fat too.  This is a classic example of gene-envronment interaction.  

8. This kind of gives people a cop out in that it justifies the genetic component, but it’s a bit like saying “Cancer runs in my family, all of the smokers died from it.

There are number of people on Facebook and other blogs that have made similar comments. When did we get so concerned about their health and welfare I ask?  Give them a break for heaven sake.

Most obese people are often depressed, lack self esteem and live a life in an endless cycle of self-blaming. There is no other population that has been discriminated for so long, even in the 21st century. These people have been discriminated and judged everywhere, in schools, workplaces, and even by health care professionals. It is clear in research that even health professionals (also people who treat obesity) associate obese people with being “bad” and “lazy” and “worthless”. This is largely because we still think obesity is all about a personal choices and we are too cuddled up in our cognitive biases to question our assumptions.

And for all the normal people who are crying out loud, why can’t you all get a six pack? After all just like losing weight, getting a six pack is as simple eating less and working more. 

9.  So you are saying just lose 10-15 lbs or 5-7% of the weight?

Losing weight is extremely simple in principle, but extremely hard for the majority and maybe almost impossible for some. And this is what the research says too.  IOM (Institute of Medicine) and the NHLBI (National Heart, Lung, Blood Institute) recommends this too. In fact “success” in weight loss treatments is a weight loss of >=5% of bodyweight maintained for 1 or more years.

This amount of weight loss will not bring many people even close to normal BMI. Then why it is set so conservatively? Because we know that majority of people regain almost all the weight back within 3-5 years. The  IOM summarized the long term findings by saying” those who complete weight loss programs lose approximately 10% of the body weight, only to regain two thirds back within a year and almost all of it back within 5 years”. And this hasn't changed a bit even now.

We have number of studies to show that even moderate looses have significant health benefits. In fact, two of the the large multicenter trials - the DPP and the LOOK AHEAD study- has shown this.

So lose 10-15 and maintain it for 6 months. If it can be maintained without extreme difficulty, try to lose more. I am not going to sit and argue with people who want to lose more. But they should understand what they are dealing with and be better prepared.

9. People could become fatalistic in their approach to weight loss upon reading the article.
 
Does anyone here have a better option? 

What are you goona to tell them when they fail?  And most will. That since it not genetics, it is probably you; so try again. And you thoroughly deserve all the mental agony and suffering you go through and also the stigma associated with obesity?

10. Ok agreed it is largely genetics.  It will not change the treatment of obesity since we cannot change genes.

Finally, everything comes down what we can do about it. I wouldn't have written this series if there were no practical applications. Just understanding the biological basis of obesity, changes everything: It changes the way we treat obesity and treat obese people.

• Obese people will set realistic goals (5-7%). Most people set weight loss goals looking at magazines or they think they have to come down to normal BMI to be called 'healthy'. If it can be maintained without extreme difficulty, try to lose more.
• People will immediately focus more on weight maintenance than weight loss. I always tell my clients that “weight loss is easy, weight maintenance is the hardest part”. People just don’t get this idea because they have no clue about the biological basis of obesity whatsoever. People will think long term, and will think more about how to maintain their weight loss than how fast they can lose the most amount of weight. The typical Before-After picture is an example of weight loss - not weight maintanance. 
• People will finally stop looking for the perfect diet or bothering incessantly about whether it is fructose, crabs, fat and so forth.  They will finally stop blaming their diet for failing them. There will be less tress wasted on diet books. 
• Normal weight and lean people would look at obese from a different perspective - one filled with compassion and empathy. 
• And for the most important part: Obese people will finally understand that it was never their fault. They will finally be free of their endless self-blaming, depression, and lack of self-esteem that they had to endure their ther whole life.
• And this world would be a much better place to live in.

Note: If you want to learn more about this topic, start with this recent presentation about Friedman about the biological basis of obesty. He discovered Leptin. The book Rethinking Thin: The New Science of Weight Loss—and the Myths and Realities of Dieting by Gina Kolata talks about the same too.

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The Cause of Obesity - Part 2

January 14 2012

In the first part, I come to the conclusion that obesity is largely dictated by your genes. I wrote about how your bodyweight is biologically regulated to be stay within a range, say 10-15 lbs. As I expected, and as you can read from the comments, many didn't agree.

There were a lot of comments, but the most sensible counter argument is how can there be an obesity epidemic if it is largely genes? Hence it is rather clear that obesity is largely due to our environment. And this is the argument almost all studies make to counter the biological basis of obesity. Here I am going to drill down further into the data and show exactly what these numbers mean and why is it is largely your genes.

How is obesity defined?

BMI: Obesity is defined by an index known as Body Mass Index (BMI). BMI is a crude measure of body fat based on just your height and weight. As shown in the picture, If you are between 25 & 30, you are overweight, and if you are over 30 - you are obese.

Why is it called an 'epidemic'?

Obesity trends: As shown in the figure above,  if you gain weight to cross the 30BMI mark, you are clinically obese.

In the 1980's and 90's, as shown in the graph from CDC, a lot of people (20-74 yrs) gained weight and moved into the obese and extreme obese category. This is shown as a steep rise in the obese and severely obese lines in the graph. If you calculate, it shows a 33% increase in obesity and a 67% increase in extreme obesity in the 90's compared to the 80's. This sharp increase in the percentages prompted the researchers to call it an epidemic.

This was the same for childhood obesity too. For the  age group of 6-11 there was a 73% increase and a 100% increase for the age group 12-19.

These numbers are huge and gives a picture of people all over in US just gorging on food and lying around doing nothing but getting fat.

How can this be an example to support the argument for genes?

The average weight gain is very modest: Though the percentage increases looks huge, the  average weight gained is very modest. For example, there was a 33% and 66% increase in obese and extremely obese in the 90's compared to the 80's, prompting the term obesity 'epidemic'. But, in fact, the average weight gain was 6-8lbs in a decade! Of course, 6-8 lbs is important, but 6-8lbs pounds increase paints a completely different picture than the 33% and 66% increase which caused the 'epidemic'.

The weight gain is non-uniform and is even smaller for the majority: If it was environment, everyone including normal weight, overweight, obese and severely obese should have gained equally. But this is not at all what we see. What we see is a small increase in weigh for the majority, but very large increases in weight for the obese and severely obese. This can be seen in the graph which is skewed to the right.

It is hard to tell this difference from the frequency curves. They are in fact smoothed (curve smoothing) to give those clean curves. The researchers hence used  mean difference plot technique to look at the  increases in weight based on the BMI levels.  What they saw was less than 6-8lbs (1 BMI) increase for the people in the lower BMI catgeory, while almost 3-4 times this amount for the obese and extremely obese category. This graph for 30-39 year olds men (1976-80 till 1988-94) shows the general trend n the MD plots, though the differences are smaller in certan subgroups. This shows that even the average weight of 6-8 lbs in a decade is is largely due the obese and extremely obese category ganng weight. So people who are at normal or overweight BMI might have increased an average of 4-5 lbs at the most in the 90's.

Ths clearly shows that for folks who are genetically predisposed to obesity, the toxic environment seems to make it worse.  For people who are not genetically predisposed, the very same toxc environment is not making any big difference. Why is that?

Why do the weight gain and the obesity percentages looks so different? This is what happens when you give a cut off value to a continuous variable, like BMI. As you can see from the BMI graph, the majority of people are around the 25-30 BMI, so a small increase in weight will push a large number people from this area over to the obese category. This gives the impression that people are gaining a lot of weight.

What about childhood obesity?

BMI: For childhood (and adoloscent) obesity, the increase in BMI is one-sided (see the skewed curve with no shift). Kids in the normal weight category hasn't budged, whereas the overweightand obese kids have gained a lot of weight. The increase in obesity for children is almost entirely due the heavier kids getting more obese.

How would the graph be if it was largely environment?

Environment: If it was largely environment, everyone would have been equally affected and would have gained a lot of weight. The curve would  have shifted to right a lot with no skewness. This will show that there is no overriding factor for obesity. Everyone will get really fat!

What if we lower the calories and increase physical activity?

If we lower the calories and increase physical activity, the obesity trends will come down. The curve will be shifted to the left and less skewed; there will be less obese people, and obese will be less obese.  But the shape of the curve will remain the exact same as in the 1970. That simply means there will be still obese people and lean people! And why is that? The short answer is 'genes'.

Practical Recommendations

• Exercising and eating healthy have a lot of benefits independent of weight loss.
• Lose 10-15 lbs (5-7%) of your weight. There are a lot of health benefits of losing such a small weight. This is what even the research recommends.
• If you can maintain this loss without gong crazy, you can always try to lose more. At least now you know what you are dealing with.
• Unlike what most people think , environment - whether fructose, carbs, portion size, low activity, or whatever- only causes a modest weight gain in the majority. But when converted to obesity prevalence, this modest number turns into large percentage increases. This gives the wrong impression that everyone is putting a lot of weight.
• Like it or not, genetics play the largest role in obesity.
• There is no other populaton that has suffered such discrmination and bias for all these years, even in this 21st century. All this because of our casual beliefs based on some personal experiences and observations that obesity is largely determnd by lifestyle/environment and lack of willpower or everything except genes. I think it's time that we showed more compassion to these people whose only fault is that they ate because they were hungry - just like me and you.

Reference 1  | Reference 2 | Reference 3 | Reference 4 | Reference 5

NOTE: I first read this from Jeffery Friedman. Friedman discovered leptin which is the greatest discovery in nutrition. He even confrims his hunches about the modest gains of weight (and how these weight gans influenced by the heaviest people) from Kathryn FLegal. And who the heck is Flegal? Flegal is the lead author who publishes all the obseity prevalance data of US. Her papers are the very paers which we uses to show the increase in obesity prevalnce in recent times. I urge everyone to look into this topic closely than base your arguements on personal memmory and observations. 

 

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The Cause of Obesity

December 23 2011

Are obese people fat because they are lazy or because of their life style or their genes?

Now there is more and more evidence to suggest that obesity has a powerful genetic component and the cause of obesity is largely genetic.  Apparently, there is a powerful unconscious biological system that is constantly trying to keep your body weight within a certain range, say with 10-15 lbs.

What is the evidence that obesity is largely genetic?

Animal Studies: Animals which are tube fed, voluntarily eat less. When the tube is taken off, they voluntarily eat more and get back to the previous body weight. Animals that are restricted food, lose weight. But they quickly get back to their previous weight when food is re-introduced. Why?

It appears as if the animals were looking in the mirror and badly wanted to get back to their previous weight.

Adoption Studies: Obesity is said to run in the family. The usual retort for this case is that kids brought up in the same obese family are exposed to the same environment and hence not an example for the genetics for obesity. However, adoption studies clearly show that the adopted children's weight more closely resembles the biological parent than the adopted parent.

Twin Studies: Identical and non-identical twin studies are mainly used to study the genetic contribution for a particular trait like height, cancer, heart disease and so forth. Identical twins (Monozygote) have almost exactly the same genetic make-up. Non-identical twins (Dizygote), on the other hand, share about 50% of the genetic traits. It has been shown from twin studies that percentage of heritability of obesity ranges between 70 % to 80% - the only trait being higher than obesity is your height! See the picture below.

Hormones: The recent discovery of leptin, ghrelin, bombesin and other appetite regulating hormones now offer a mechanistic explanation for how our body weight is so tightly regulated.

• Leptin: The discovery of Leptin is one of the greatest discoveries in the field of nutrition. Leptin is primarily secreted from fat. When you lose weight, leptin levels goes down and signals the hypothalamus to increase appetite and decrease metabolic rate. When you gain weight, leptin levels increase and in turn suppresses appetite. The picture shows leptin defiency treated with leptin administration. 
• Ghrelin: Ghrelin is another hormone secreted mainly from the stomach. Ghrelin is a short term modulator of hunger; food intake decreases ghrelin, while starvation increases ghrelin.
• There are other hormones like CCK, choleskylin, amylin and so forth that are part of a complicated network evolved to maintain the homeostatic control over your body weight.

Leptin Gene: Mutations in leptin gene, leptin receptor have shown to result in massive obesity. Mice with mutations in ob gene (leptin gene)  fail to produce leptin and show a fivefold increase in body fat compared with normal mice.  An as expected, these are remedied with leptin treatment. Unfortunately, majority of obese seems to be resistant to leptin. So injecting leptin to treat obesity didn't live up to the hype.

• Other Genes: Mutations of other genes involved in energy balance has also shown to cause massive obesity.  Leptin receptors are located in the hypothalamus and lesions in these areas have shown to cause massive obesity and thinness in both animals and humans.

Stability of Weight: As most of us have experienced, our body weight tends to be pretty stable throughout the year. According to the laws of thermodynamics, you will stay at the same weight if you match your energy intake to energy expenditure.   That means, you somehow managed to spend exactly a million calories to match the million calories you ate throughout the year! 

Over a decade, people gain 10 pounds or so. This small increase means that you have precisely balanced tons of calorie intake and output to a precision level of 99.6%. This is almost impossible for even the most ardent calorie counter since most calorie count on food labels are off by 10% or more!

Extreme Variations: Environment is always blamed for obesity. If that is the case, why are extreme variations in fatness within the same fattening environment? Are all the lean people who live in the same environment watching their diet throughout their life?

In twin studies, it is very clear that for the same calorie intake and expenditure, people lose different weight. In one study where identical twins ate the same amount of calories in a controlled environment, the variation ranged from 12llb to 28 lb! So it is not always obese people eating more food.

Dieting: It is now pretty clear that 75-90% of the people who lose massive amount of weight (50-100lb) gain most of it back within 1-2 years.  It has been shown that when people lose weight, they not only feel hungry but that they also burn fewer calories than a person who is lean. The more you lose weight, the more the biological drive to gain the weight back.

Bariatric Surgery: Bariatric surgery is the most successful weight loss treatment. Bariatric surgery results in 20-40% initial weight loss; the majority of which is maintained for 15 years. It is now clear that bariatric surgery do not just work by making the stomach smaller. If that was the case, people could easily eat small frequent meals and get back to their weight; but they don't.

It has been now shown that bariatric surgery cures most people of diabetes. This cure happens a few days after surgery and even before they lose substantial amount of weight.  Bariatric surgery seems to change the gut biology to the extent that it somehow resets the homeostatic mechanism that controls body weight.

If it is mainly genetics, why is obesity on the rise?

And this is the main arguement against how obesity is largely genetics. Genes don't change so fast so how can obesity prevalanace increase? So it is mainly the environment - they say.

BMI: Obesity is classified based on Body Mass Index. BMI is measure of body fat based on your height and weight. If you are above 25, you are over-weight; 30 and above,  you are obese. This means that a small shift in bodyweight is enough to push a lot of people over the BMI category of obesity.

In 1999 a 33% increase in obesity was reported compared to the previous decade. In terms of body weight this just means a 3-5 kg increase in body weight. The 3-5 kg increase in bodyweight gives an entirely different picture than when you hear about a 33% increase in obesity!

Also the BMI of people between 15 & 30 hasn't changed much. What is going up is the BMI of people who are around 30BMI & over. The obese people are gettng more fat and making it look like everyone is getting obese, when it is clearly not the case.

What about the role of environment?

Gene-Environment Interactions: There are certain high risk groups such as the pima Indians and Pacific Islanders who have genes that are very susceptible to obesity. Pima Indians have an extremly high rate of obesity. For people who already have the obese genes, environment plays a permissive role. Environment is necessary, but not sufficient for obesity.

Overweight: For people who are moderately overweight like the majority, environment does play a role in the 5-10 lbs they gain over decades.

What about people who lose a lot of weight and keep it off?

These folks are clearly the minority, around 5-10%. It is not exactly clear how they do it. There might be a subset of people whose conscious motivation can override their biological drive in the long run. Majority of the people can’t.

Practical recommendations

1. We should focus more on health than weight or the cosmetic aspects.
2. It is clear than moderate weight loss of 10-15 lbs of weight loss in obese people can have dramatic improvements in their health.
3. It is also very clear that eating healthy and exercising has a beneficial effect on health independent of the change in body weight. 
4. The major cause for obesity is your genes and not the lack of will power or lifestyle.
5. Obesity is not the fault of obese people. So treat them with respect.

Here is part 2: The cause of Obesity- Part 2

 

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Is Exercise the Magic Pill?

December 04 2011

This was the title of the presentation I gave a week back. If you know anyone who doesn't exercise, send this to them please. Everyone kind of vaguely knows that exercise is important, but they got no clue about the breadth and depth of the benefits we are talking about.

Heart Disease:  Heart disease is the leading cause of death in United States. Almost 300,000 people die of heart disease every year.  In short, 1 out of 3 people would die of heart disease.

Exercise Beneifts: Number of observational studies have shown exercise to cut the risk of heart disease and the risk of deaths from heart disease by almsot 50%. Exercise capacity has shown to be a stronger predictor of death than established risk factors such as hypertension, smoking, and diabetes. As shown in the graph, it is now clear that as your physical fitness (exercise capacity) increases, the risk of dying decreases in a dose-response manner in both healthy and people with heart problems(1,2).

Cancer: Cancer is the second leading cause of death in USA. 1 out of 4 people would die of Cancer. 1 out of 8 women will be diagnosed with breast cancer.

Exercise Benefits: There is strong evidence to show that exercise may decrease the risk of colon cancer by almost 50% and breast cancer by about 30% from observational studies. Colon cancer is the most common form cancer in both men & women. And there some evidence to suggest that exercise lowers the risk of endometrial, lung and prostate cancer. Exercise has shown to lowers the risk of cancer recurrence or death in colon, prostate and breast cancer survivors too. It also improves the quality of life and lowers fatigue in cancer patients(3).

Diabetes: Diabetes is the 7th leading cause of death in the states. 1 out of 13 people would die of diabetes. Diabetes is the leading cause of amputations in the country.

Exercise Benefits:  Number of observational studies & experimental studies have shown to cut the risk of diabetes by almost 60%. Exercise is  also beneficial for treating diabetes. The famous study - Diabetes Prevention Trial - showed that exercise and diet cuts the risk of diabetes by almost 60% compared to the most popular diabetic drug- Metformin, whiich showed a 30% reduction(4).

Osteoporosis: Osteoporosis is the loss of bone density which can lead to  bone fractures. 1 out 5 women over the age of 50 will develop osteoporosis. 1 In 5 women over the age of 75 who sustains a hip fracture will die within the next 2 years. Half of the survivors will end up dependent on others.

Exercise Benefits: Exercise, especially weight bearing exercises can be beneficial to prevent and treat osteoporosis bone density. It seems like we need more high quality studies to quantify the effect of exercise on osteoporosis.

Cognition: Cognition is just a big word for mental processes like memory, learning, attention and so forth. Recently, there has been an intense interest in the benefits of exercise on brain cognition.

• Children: There is a growing body of studies that show a positive relationship between exercise and cognition and children.  Exercise has shown to have a positive relation to cognition in 8 cognitive measurement categories (math test, verbal test, memory, academic readiness, perceptual skills, IQ and achievement) except for memory for all age groups.
• Exercise has also shown to improve academic performance. A few studies have shown no change in academic performance with exercise. But none of the studies have shown a decline in academic performance by increasing the time allotted to exercise.  The below graph shows a significant improvement in academic scores with exercise in elementary school children after 3 years compared to a control group. This is ironical considering physcial education is the first to be cut from the curriculum owing to financial constraints.

• Older Adults:  Now there is an overwhelming number of studies to show that exercise is  important for maintaining brain functions with age and also in lowering risk for cognitive decline and dementia.The greatest improvement is seen with executive cognition function which involves tasks such as planning, scheduling, inhibition, and working memory. In fact, executive cognitive processes suffer the most with ageing (5,6,7). 

Depression: 1in 10 adults are affected by depression.  Women are almost 70% more likely than men to suffer depression. Half of the deaths due to suicides is attributed to depression.

Exercise Benefits:There are 2 studies which show that exercise is as effective as anti-depressant drugs in reducing depression in people with mild to severe depression. The study also showed that exercise reduces the chances of the depression returning. After 6 months, only 8% in the exercise group relapsed compared to 30% in the drug group. It is safe to say that evidence is only suggestive and we need better quality studies to show a conclusive evidence of exercise for depression (8,9).

Side Effects: The side effects of exercise are almost zero, if done properly and gradually. It is typical for doctors to carefully evaluate to see if the side effects of the drug exceed the benefits of the drug. Just like exercise, aspirin works well to prevent heart attacks, but the side effect is cerebral bleeding. 

I didn't really talk about the effects of exercise on obesity, treating pain, and preventing the loss of muscle mass since most people are aware of it. I also talked a bit about the minimum exercise required for achieving these benefits. Exercise research is still in its infancy; there will be more and more studies looking at the effect of exercise on other health conditions in the coming years.  

Conclusion

Is there any pill out there which can prevent and/or treat so many major diseases, improve quality of life, has almost zero side effects, and costs almost nothing?

One hand went up in the crowd. A bit perplexed, I asked, “which drug is that?”

She said, 'exercise' - with a smile.

Reference 1 | Reference 2 | Reference 3 | Reference 4 | Reference 5
Reference 6 | Reference 7 | Reference 8 | Reference 9

 

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Why is it Hard to Maintain Your Lost Weight?

November 27 2011

We know that 80% of the obese & overweight people who lose weight, gain most of it back within a few years. Is it because they lack the discipline or is there physiological mechanisms beyond their control that is driving the weight back.

It is now clear your body weight is regulated by your brain.  There are numerous hormones in your body that controls your appetite to keep your body weight within a certain range. 

Leptin:  Leptin - one of the most important hormones- is primarily produced from fat cells and its circulating level is directly proportional to body fat levels.

Ghrelin: Ghrelin is released from the stomach and its primary purpose is it stimulates hunger,

Cholecystokinin(CKK): CKK is another intestinal hormon which suppresses appetite.

Eating less causes profound reductions in energy expenditure,leptin, cholecystokinin and increase in ghrelin and appetite all of which promote weight regain. 

What was the study purpose?

The purpose of the study was to see whether these fluctuations in these appetite regulating hormones persists with prolonged maintenance of reduced weight.If it persists, it maybe be one of the reasons why people gain back weight so easily.

What was the sudy design?

The study involved 50 overweight or obese participants in a 10 week weight loss program. They measured different hormones and appetite levels before the weight loss, after the weight loss (10 weeks), and after 62 weeks of weight maintenance.

What were the results?

The mean weight loss was around 26 lbs after 10 weeks.  There were significant changes in hormones and appetite after weight loss, and all these changes persisted even after 62 weeks. 

The raph shows how hunger and 'desire to eat' were significantly higher after 10 weeks and 62 weeks compared to baseline. In short, it just means that your body is trying to get back to the baseline weight.

Conclusions

There are multiple compensatory mechanisms vigorously resisting weight loss in obese and overweight people.You didn't gain the weight back just because 'life got busy' or you lacked the will power.

Reference 

 

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ACE Fitness Conference 2011 Review

November 13 2011

The American Council of Exercise (ACE Fitness) conference 2011 was held in San Deigo on Nov 2-5. I had ACE certification years back and this was my first ACE symposium. Here are some of the presentations which I thought were interesting.

Thomas Plummer

The keynote presentation titled “Changing lives .. Creating a Fitness Career that matters” by   Thomas Plummer.  He founded the Thomas Plummer Company and the National Fitness Business Alliance (NFBA). Plummer speaks to more than 10,000 people each year through engagements as a keynote speaker, workshop host and private consultant.

This was a good one. He talked about where the fitness industry was, where it is now and where it is heading towards. The topic was very relevant and he communicated his points really well, I thought.  

He talked about the end of traditional training model which was based on the training philosophy of the bodybuilders in the 1980's: the circuit machines and the steroid bodybuilders. It was all about lifting heavy weights, using machines, single joint exercises, crunches, and long cardio sessions, and low fat, high carb diets. The fitness field is moving more towards full body, functional, multi-joint than the one day a body part, single joint exercises bodybuilding model.

I agree with most of what he says. And I have wrote in the past how the majority of what bodybuilders do do not apply to the majority of the people who go the gym.  The recent article I wrote about the lat pulldowns is an example of this.  We are taking a model which may be good for a bodybuilding population and applying to a completely different population whose goals, priorities, motivation levels are completely  different.

And as I always say it always goes back to client goals and preferences.  If someone wants to get muscular, it is always better to focus on multi joint exercises, lifting heavy,  with a few isolation exercises here and there  than just working with ropes, medicine balls,TRX and other functional movement stuff all the time. You can also throw some functional stuff at the end to spice up the workout for your client. You don't have to look at it as an either or situation which is what most people tend to do.

Another good point he talked was the failure of the big box model clubs with lines of circuit machines , ab area, and personal trainers. The new generation club are much smaller,circuit lanes are replaced with functional cable machines, they carry a few dumbells, a few squat racks, a floor area with number of fun tools like kettle bells, medicine balls, bosu balls, ropes, sled pushing, a few treadmills and ellipticals,and group training instead of one- on-one training. This is true and I see these small facilities popping up everywhere. This is basically the Crossfit model which has gained so much popularity  these days.

But I am not sure if this is entirely true because places like Planet Fitness, 24 hour, Lifetime  are just the typical box model types and they are all just growing. For example,  Planet fitness has around 400 to 500 fitness centers in US with around 5K-6K members and almost  95% of them are making profits. Planet fitness does not have contracts and their memberships are around 10-15 dollars.  Compare this to an average gym which makes you sign contracts and makes you pay around $49 a month!.  Now get this, they have machines, and they also have a designated circuit machine workout area with lights to time your circuits!

He talked about some other few points but I forget. And  I am yet to see the presentation slides that the ACE people told they will upload to the website in a few days. Talk about customer service …

Todd Durkin

Todd Durkin, MA, CSCS, is an internationally recognized performance-enhancement coach, personal trainer, massage therapist, author, and speaker who motivates, educates and inspires people worldwide.  He is the founder and creator of Fitness Quest 10 & Todd Durkin Enterprisesin San Diego, CA. He is a 2 Time Personal Trainer of the Year (IDEA & ACE) and has received numerous industry accolades

Todd is an excellent speaker and is very motivating and energetic. He was like a Bull on red bull. Hs presentation was titled the “The business of personal training”. It was just an overview about how to make your personal training business better or in his words - 'world class'. He had a lot of good points about how to motivate your clients and your team, but nothing really that I wasn't aware of. If you are really customer focused, if you really want  to improve, you would come across these. 

I wish the content was a bit more organized, and also he didn't skip content in the slides. Every time when I see presenters skipping content and slides, I just think they didn't care enough to make changes or rehearse it.  He gave a lot of good tips and books to read throughout. But I like to focus on concepts and big picture rather than tips. They are like those typical Muscle & Fitness articles like '5 Tips to lose weight or a stronger bench'.  If you cannot see the underlying concept, you will be like one of those 16 year old's waiting for the magic bench program in the next Muscle & Fitness edition. Todd was nice enough to raffle out free DVD's and books which I thought more presenters should do than just send a paper around to get people's email addresses.
 

Michol Dalcourt

Michol Dalcourt is an educator, author, trainer, inventor, and an industry leader in the areas of human movement and performance training. is currently an Adjunct Professor at the University of San Francisco in the Faculty of Sports Science, Director of the Institute of Motion, and Co-Founder of PTA Global.

The tile of the presentation was “Correcting Dysfunctional Movements”. I know where this was going, but I wanted to say what he had to say and if there is anything new. After 20 min of going an  exercise of finding joints which are primary and secondary, he went to show some slow, one- legged exercises which was suppose to make  your foot pronation right. Somebody who was really smart asked if can we indeed change the foot dysfunctions and as they all say he replied “you can do it, but it will take along time”. Sure if it doesn't work, you didn't do it long enough or you didn't do it right!  He also made sure he had some biomechanical explanations for every little twist and degree change you do with the exercise. And I am guessing he did this for every major joint, but I didn't wait for that long.

People always say research is mumbo jumbo. Research is pretty simple. You take a group with back pain or knee pain, make them do exercises to fix pronation or whatever and show that as their pronation improved, their knee or back pain improved compared to a control group. This is the basis of randomized controlled studies (RCT) in research which is the gold standard of finding if a drug or treatment works.  They don't care about the biomechanical mumbo jumbo or your rationale for doing the exercise. And the whole correcting movement dysfunctions or posture or FMS field is lacking these basic RCT's. Even the shoulder scapular dysfunction studies show decrease in pain with scapular exercise, but the scapular dysfunction remains the same. There are people with scapular dysfunctions who have no pain and people with no dysfunctions have pain. What does that tell you about 'dysfunctions'?

I went to a few more , but it was mainly group fitness ones and activity type classes.    I just wanted to get better at it so that I can train my instructors. You guys wouldn't be too interested in those stuff anyways. ACE fitness conference I felt was more about the 'How' than the 'Why' like at the NSCA conferences. That’s all I have.

 

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Can Circuit Training Increase Strength and Muscle?

October 30 2011

Circuit weight training takes less time compared to traditional weight training, but can it increase strength and muscle similar to a traditional routine?

What is circuit training?

Circuit Training: This type of training involves lifting lighter loads with very short rest periods of time. The lifter moves from one  exercise to the next  in 15 -30 sec (or no rest)  and completes a series of circuits. The weight is usually around 40-60% of 1Rm which equates to 10-20 reps.

What are the advantages of circuit training?

Cardiovascular: There is a moderate  Increase in cardiovascular capacity compared to traditional strength training.

Time: Less time is required since there is little or no rest in between sets.

Fat Loss: There maybe greater fat loss with circuit training compared to traditional training.

What are the drawbacks?

Strength & Muscle: Since the weights used are pretty light, the strength and muscle gains are minimal compared to traditional training.

Bone Mass: This is also true for bone mass since there is less loading.

What was the purpose of the study?

Purpose: The purpose of the study was to study the effect  circuit training with heavier loads ( 6 reps)  on body fat, strength, muscle, cardiovascular response compared to a traditional routine.

What was the training protocol?

Duration: 8 weeks
Participants: The subjects were trained  men.
Rest between sets:  The traditional group did the same number of exercises separated by 3 min rest while the circuit training group rest time was 35 sec.

What were the results?

• Surprisingly, with just 35 sec  rest, circuit training group had similar power, strength  increase compared to the traditional training group.
• There was an a decrease in body fat and an increase in body fat in both groups. The decrease in body fat was only significant in the circuit training group though.
•  Both groups improved in aerobic and anaerobic tests

Practical considerations

• Circuit training with heavier loads can increase strength and muscle similar to traditional routines.
• Circuit training can cut your workout time by almost half.

Reference

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Braden Sowle - Natural Bodybuilder Interview

October 19 2011

I know Braden pretty well. Braden has worked for me for almost 4 years now. We always have a lot of interesting conversations about diet and training.  Braden’s whole life is all about bodybuilding – he eats, sleeps and drinks bodybuilding. Braden is pretty humble and always willing to help anyone who has questions about their training and diet. Braden is currently working on his M.S in Dietitics. 

Age: 25
Competition Weight: 175-185.
Offseason Weight:  205-212.

What is your training program? 

It’s hard to describe since it changes so often… a good program is progression based, is dynamic and changing, involves some heavy lifting for dense muscle as well as some higher volume training for that fullness and roundness. I am between competitions right now so I’m just trying to maintain intensity, prevent injury, increase fullness, and most importantly improve conditioning by burning some fat.

What is your diet like? 

I eat different everyday depending on my activity levels. But overall I eat a wide variety of foods similar to what our ancestors ate avoiding most pre-packaged and processed foods while focusing on quality sources of meat, veggies, fruits and nuts.

Protein sources:  Egg white, whole eggs , turkey, cod (other white fish), salmon, beef(venison  or buffalo) whey protein isolate/conc/hydro
Carbohydrate sources: Sweet potatoes, Brown/white rice, oats, sugar free carbohydrate powder
Fats: olive oil, almond, pecan, walnut, peanuts (technically considered a  legume)
Fruit: blueberries, raspberries, pear, nectarine, peach, cranberries, apples, lemon, pineapple, plum, etc..
Veggies: Broccoli, Asparagus, Green Beans, Spinach, Romaine lettuce, peppers, onions, mushrooms, bok choy, etc…
Dairy: Greek yogurt

Supplements:
(fat burning) - Caffeine, beta alanine, l-carnatine , green tea.
(strength, power, recovery) -  creatine BCAA (recovery), glutamine.
(Increase blood flow) - Arginine.
(Joint lubrication/repair) -  glucosamine(w/msm}+chondroitin.
(promote healthy hormone levels) - Vit D, vit E, Zinc fish oil, flax oil. 

My eating schedule depends on my activity level,  eating more on harder workout days.  Each meal has a significant source of protein, and either complex carbs or veggies depending on the timing, I eat most of my carbs in the two meals before my weight training session.  On my rest days I eat less carbs and calories.

What do you think are the 3 most important things that people who want to get bigger should focus?

Chips, pizza and ice cream ……but that’s if you want your waistline bigger.

If you want the growth to be muscle mass
1. Design a training split with enough recovery for each body part
2. Be patient, Rome wasn’t built in a day!
3. Don’t make excuses! - Anyone can get bigger you just have to eat more and lift more than you are currently.

Do you think there is a difference in training of natural bodybuilders and bodybuilders on drugs?

Natural athletes need more recovery and I believe in using very low and very high rep ranges to shock the muscle into growth. Most steroid using bodybuilders seem to grow using the traditional 8-12 rep range. Let’s say you dead lifting, rather and doing 3 sets of 10 with 315 or 365, I’d recommends doing something like 495x2, and 405x14…

Do you think bodybuilders should worry about strength like power lifters?

Yes they should try to increase their strength, but not by any mean necessary like power lifters. A bodybuilder who wants to build a bigger chest may try to increase their bench, but if they use their delts and triceps instead of their chest to do the work - the wrong muscles will grow.

What do you think about the low volume and high volume approach of training?

I’ve had success with both types of training; I think rotating between high and low volume programs is best. When I diet for a competition I reduce my volume a bit, but I try to keep my strength and intensity as high as possible.

What are your future goals?

I’m a big believer in short and long term goals. My short term goals include finishing school and earning my pro card as a natural bodybuilder. Long term I want to work with professional athletes as a Strength/Nutrition coach.

What are the 3 biggest mistakes people make in the weight room?

Not training with enough intensity, not emphasizing sleep and nutrition enough, keeping form too strict when it comes to getting bigger, “if you ain’t cheatin’ you ain’t tryin”.

If you have any questions for Braden, ask in the comments please. Thanks Braden and good luck with everything. 

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Do Power Balance Bracelets or Bands Work?

October 10 2011

Power balance bracelets have become wildly popular in the last couple of years. There are dozens of professional athletes, celebrities and musicians wearing these, and some even endorsing these bracelets.

So what are Power Balance bracelets?

As the name suggests, these are just ordinary rubber bracelets made in China. What makes it stand out is they have embedded these bracelets with holograms.

They come at an 'affordable' price of $29.99.

What are the Power Balance bracelet claims?

Hologram: The hologram on the power balance band is supposed to interact with your body frequency and it supposedly reacts differently for different people. Also according to the website, “The thin polyester film hologram is programmed through a proprietary process, which is designed to mimic Eastern philosophies that have been around for hundreds of years.”

Performance: Before thy got sued for false and misleading   claims, they advertized power balance to increase strength, power and flexibility by 500% and called it performance technology. Now they cleverly word it as  “maximize their potential and live life to the fullest.”

Testimonials: There are lot of testimonials from professional athletes about how power balance bands has helped improve their performance and they just can't take it off now.

Does Power Balance bracelet work?

Nope.

Then why do people think it works?

There are no scientific studies showing that power bracelet balance works. And there is no earthly science even remotely saying that we can capture frequencies and bottle it in a hologram. Then why do some people feel or think it works?

Placebo Effect: If you believe or expect a procedure or a pill to improve you health or behavior, it will. Apparently, the pill or procedure do not have anything to do with is improvement. Watch this cool video about placebo effect.

Flexibility: Power balance band test involves a flexibility test where you try to stretch and reach as far as you can. And then they are made to repeat the stretch wearing the power balance band. This always works since now you have a goal to go beyond. People always do better the second time than the first one even if they wear a band or not.

Strength: Another test the power bracelet band use to have you stand on one leg and have your arm to the side. The sales guy then pushes down on your hand. Almost everyone falls off balance. After they wear the power band, no one falls off balance.

This is just basic physics being abused.  The first time the sales person pushes down and out of the body which pulls you out off balance. The second time he just pushes down and 'into' your body which is not pulling you out of balance. This is what is shown in the picture.

Practical Applications

• Power balance band or power balance bracelet do not work. Period.
• If you still wear it, you are just openly endorsing your lack of basic critical thinking skills than anything else.

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The Hallmarks of Cancer

October 02 2011

Cancer is different from other diseases because it is not just one disease, but a collection of more than 100 distinct diseases. If so, what are the commonalities shared by different cancers?

Picture: A breast cancer cell

In 2000, the journal Cell published a ground breaking article titled “The Hallmarks of cancer”. This paper has turned out to be the most cited paper in the cancer field. Below are these 6 hallmarks of cancer.

And if you are wondering about the topic, I keep up with most of the health-related topics. This site is not just about bench press and biceps. This topic is also a bit dear to me since my Mom passed away  a year back after battling with cancer for almost 3 years. I have blunted the language a bit so that it makes some sense.

Growing out of control: Or Sustained proliferative signaling. Normal tissues carefully control the production and release of signals which control growth. But cancer cells have developed their own signals . They chose when to replicate and when to grow.

Evading growth suppressors: Just like there are signals to trigger growth, there are signals that suppress growth in normal cells. But cancer cells somehow are resistant or suppress these growth blocking signals.

Blood vessel growth: Or Inducing Angiogenisis. To sustain the growing size of the tumor, cells need a good blood supply to ensure enough oxygen and nutrients. Cancer cells activates the process of making new blood vessels(angiogenesis)  to sustain themselves.

 

Evading Death:  Or Resisting Cell Death. Normal cells are programmed to die or commit suicide  after so many cell cycles or when they get damaged. It is called programmed cell death or apoptosis. It is a fundamental property of normal multi cell tissue. It is just another check to prevent abnormal growth.  But cancer cells earn how to avoid cell death.

Invading other cells:  Or Activating Invasion and metastasis. Most of the deaths from human cancers (90%) are due to cancer cells spreading and establishing colonies in other parts of the body. Cancer cells have learned to migrate to other parts in the body and invade healthy cells.

Unlimited copies: Or Enabling Replicative Immortality. Normal cells can only divide so many times, but cancer cells just keep dividing and making unlimited copies.

Journal nature had an article on how these hallmarks are common to even benign tumors (harmless) and hence cannot be called 'hallmarks'. The only hallmark not common to both benign and harmful cancer is the ability to invade other cells and metastasize.

Very recently, in March 2011, the authors updated the hallmarks by adding two more: 

• Dis-regulating energy systems : Cancer cells come up with their own energy systems to sustain their uncontrolled growth and proliferation.
• Avoiding immune destruction: It is assumed that many potential cancer cells are destroyed by the immune system, but many cancer cells know how to hide from such immune surveillance.

Cancer is a deadly disease, but it is most fascinating to learn and wonder about the intricacies of such an extraordinary disease. 

Reference

 

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Can Participating in Sports Make You Better at Everyday Tasks?

September 25 2011

Can cognitive skills attained through participation in sports transfer to your everyday life?It is clear that expert athletes outperform less skilled athletes in sport specific skills  requiring attention, speed, perception and so forth.

But can these sport specific abilities transfer to every day multitasking activities like driving and talking on your cell phone?

What was the purpose of the study?

Purpose: The purpose of the study was to find if athletes can do everyday tasks better than non-athletes. It is assumed that participating in sports relates to multitasking and increased processesing speed that can carry over to similar tasks in daily life

What was the design?

Participants: The study recruited 18 Division 1 athletes and 18 non-athletes.  The sport the participants played included baseball, gymnastics, swimming, tennis and so forth. Non-athletes were not involved in any university organized sports.

What was the outcome measured?

Street Crossing: A virtual reality street crossing task was used as the test. It involved crossing a virtual intersection while avoiding traffic.

Just to add some fun, they performed  street crossing task under three distraction conditions-no distraction, conversing on a cellular phone with a hands-free device, or listening to music through headphones on an iPod.

The participants were instructed to walk and not run.

What were the results?

Atheletes better: The athletes showed statistically significant higher success rates (75% vs 50%) in crossing the streets reflected by fewer collisions with moving vehicles. This was also true for the distracted conditions too.

Other Studies: Other studies have confirmed that athletes perform better than non-athletes in laboratory testing of cognitive measures which includes processesing speed and tests of attention. As expected, athletes from interceptive sports like basketball, baseball, soccer showed the largest gains.

Practical applications

• Participating in sports may help you become better at real life activities which require multitasking and greater processing speed.
• The study however do not exactly answer the question if these cognitive differences are due to adaptation to training , practice, or just simply better genetics that predispose them to be athletes.
• A neat little study would be to take inactive people, make them participate in a sport, and test if they improve in everyday tasks compared to a control group.

Reference 1

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Understanding & Treating Pain in 5 minutes

September 05 2011

The video tells what 90% of people do not know about pain in less than 5 minutes!

 

 

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The 4-Hour Body by Tim Ferriss Review

September 04 2011

The 4 hour body is a New York Best Seller written by Tim Ferriss.  Before writing this book, he was just another productivity expert with a book called “The 4 hour Work Week” in the New York Best Seller List.

. Here is the 4 hour body review.

What are the claims in 'The 4 Hour Body'?

There are quite a few claims in his book, but I will review about this specific one:  How Tim Ferriss gained 34 pounds of muscle in 28 days in a total of 4 hours in the gym.

Did Tim Ferriss gain 34 pounds of muscle in 28 days?

Muscle  & Water : Before you start thinking about Tim Ferris’ four hour body workout routine and diet review , you need to understand what constitutes 34 pounds of muscle. Tim Ferriss says he used hydrostatic weighing for testing. Hydrostatic weighing is the gold standard of body fat testing. Most body fat and muscle measurements are 2 compartment models - means they only recognize fat and muscle. But the point here is that when it means muscle it counts muscle, bones and water. So when people say they gained 20 lbs of muscle, it not just muscle tissue, it includes water and bones.

Natural bodybuilders gain 15-20 lbs a day after their competition because they eat a ton and put all the water back and more. If we measure them with hydrostatic, it will show that they gained 20 lbs of muscle! Can you believe gaining 15-20 lbs of muscle in a day? And Tim Ferriss is not a newbie when it comes to body fat loss and water manipulation. From his blog”  In 1999, I was a gold medalist at the Sanshou (Chinese kickboxing) national championships in the 165-lb. weight class (here is a video sample of Sanshou). This is perhaps the most controversial accomplishment in the 4HWW, as I make it clear: I arrived the on-site at 187 lbs., weighed in at 165 lbs., and stepped on the platform to compete the next morning weighing 193 lb.

Now tell me how hard is for him to gain 34 lbs in 4 weeks if he can lose 22 lbs of muscle and gain 28 lbs muscle overnight?

Muscle Memory & 4 Hour Body review: This is a physiological phenomena which makes it easier to put back muscle or strength that you lost . It means that if you stopped working out for a few months or a year, you can easily put that same amount of muscle or strength that you had in weeks.  Tim Ferriss writes in the 4 hour body about how he had weighed 197 pounds in 1996 and was easily the strongest he has ever been. Also how he has gained 20 lbs in 4 weeks in aleast 4 occasions.  This is totally different from a beginner trying to gain 34 lbs of muscle in a few weeks. 

High Intensity Training & 4 Hour Body review: What program did he use in the 4 hour body? He basically used an HIT program which has been around for years. I really doubt anybody bothers about HIT anymore besides  a handful of HIT experts.  I am not going to write what exactly HIT is since no one really knows what exactly is HIT. Every HIT expert has their own version and their own science (and philosophy when they run out of  science)to support it. For  example, Arthur Jones prescribed 14-16 exercises solely using machines, Mike Mentzer took it to the extreme with 3-4 exercises for 10-14 days and Ellington Darden - Arthur Jone's  assistant who is currently the modern voice of HIT - reccommends 7-12 exercise per routine, 2 days per week and includes both machines and free weights. Just to show how HIT experts make their own rules, Ellington Darden - the most famous of HIT experts -  now recommends Not To Failure sets (NFT). This is called taking a complete u-turn in your philosophy considering the whole philosophy of HIT is based on 'going to failure' with just one set. Darden also thinks that most HIT enthusiasts have gotten carried away by prescribing very few exercises like 3-4 exercises and very low frequency like once a week. Tim Ferriss' workout uses 3-4 exercises and even goes to recommend once a week frequency further into the program. So who are we supposed to believe? Tim Ferriss who base his 4 hour body book writings on Arthur Jones or Ellington Darden who is the most famous HIT expert second to Arthur Jones?

The Colorado Experiment & 4 hr body review: And how was Tim Ferriss convinced that he could gain 34 lbs of muscle? He read about the infamous Colorado experiment conducted in May 1973 by Arthur Jones with  a bodybuilder named Casey Viator (in picture). The claim is that Casey gained 64 lbs of muscle. Just remember that Casey Viator had almost dropped 33 lbs of muscle due to an accident and allergy, wasn't training for almost a year before the experiment, and was on steroids previously. Nobody has ever been able to replicate that much of muscle mass in a short period of time.  I am sure someone will if they stop training for a year, had used steroids, and dropped almost 35 lbs of muscle before they started the experiment.

Science & 4 hour body: I love how the 4 Hour Body has a Chapter called “spotting Bad Science” at the end of his book. I whole heartedly agree with everything he had to say about the problems with observational studies, lack of control groups, the funders having vested interested and such. But I don’t understand how he couldn't find the reviews (atleast 2) which concludes that multiple sets are better for muscle (& strength) in both trained  and untrained. I thought it was funny how he quoted just one study published in some online journal and writes how the author of the study incorporates '112 sources to answer the question', but then later we have chapters about spotting 'bad science'.in his 4 hour body book

Some of his diet rules like avoid fruit, milk and white flour like plague are just the typical fear mongering and bad science that most diet authors are known for.  He writes that his 4 hour body book is a result of thousands of hours of 'jaw dropping personal experiments'. And I ask what makes his approach so different from other fitness experts and diet gurus? They all think it works for everyone because it worked for them, they all have a before after picture, they all have plenty of anecdotes & philosophy, and they all think that the conventional wisdom about diet and muscle growth is just dead wrong, and guess what they all get results in 4-6 weeks too.

The 4 Hour body book, the incredible claims, and the philosophy is no different from any one of those hundreds of diet and muscle books out there.

 

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Hypothesis Testing & the Casey Anthony Trial

August 13 2011

Hypothesis testing is one of the most important concepts in scientific studies, but most people don't understand it. Atleast I didn't get it when I took my stats and research class.  In this article, I will try to elucidate this concept by comparing it to the recent Casey Anthony trial

What is hypothesis testing?

Hypothesis Testing: Hypothesis testing is a method used to make a decision in scientific studies. It tries to figure out if a hypothesis is true based on probabilities.
  
Imagine you want to test if Drug A is better or not in lowering deaths in cancer patients compared to a Drug B. In hypothesis testing, you first come up with 2 hypotheses.

• There is no difference between the drugs. Or nothing important is happening. This is called the null hypothesis.
• There is a difference between the drugs. Or there is something important happening here. This is called the alternative hypothesis.

But why have two hypotheses to prove a single hypothesis?

This didn't make any sense to me when I was introduced to this concept.

If you want to show a difference, why just start with one hypothesis that there is a difference between the drugs and try to prove it? Why the heck should you come up with a hypothesis that there is no difference and then try to disprove it to show there is a difference? It seems counter intuitive to most people, but there is a good reason as you will see.

Popper's Theory: According to Karl Popper, one of the great philosophers, you cannot prove a theory, you can only disprove it. For example, let's say you want to prove a theory that all swans are white. This will be extremely hard to prove since you will have to go to every nook and corner of the world to make sure all swans are white. But it is extremely easy to disprove thee theory: You just have to find one black swan.  And if you tried really hard and couldn't find a black swan, you support the theory that all swans are white (but , mind you, you didn't prove the theory since there might be a black swan hiding somewhere in the world) .

And hence the reason, you come with a hypothesis and then you try to disprove it. If you disprove it, you accept the second hypothesis or the alternate hypothesis. In hypothesis testing we use probability to disprove the hypothesis. Make sense?

Now what has this got to do with Casey Anthony?

Casey Anthony 's trial is a good example of how people don't understand this concept. For people outside US, Casey Anthony is a Florida woman who was recently acquitted of killing her 2-year old daughter. This was one of those murder trials which took the country by storm. Almost everyone thinks that she killed her daughter and she should have been punished.

The whole hypothesis testing makes a lot of sense when we look at how the American justice system is set up. Just like in hypotheses testing, you come up with 2 hypotheses before the trial.

• The first is the null hypothesis or the default hypothesis that Casey Anthony is not guilty.
• The alternate hypothesis is that Casey is guilty.

US Justice System: Just like in hypothesis testing, the lawyers try to disprove the hypothesis that Casey is not guilty. Instead of using probability, lawyers use evidence in form of DNA, witnesses and so forth.  In the trial, the prosecutors couldn’t disprove the null hypothesis that she is not guilty with the evidence they had. So the jurors had no choice but to accept the null hypothesis that she is not guilty. Just like swan example, this doesn't mean or prove that that she is innocent.

A lot of people in the media were going crazy thinking how on Earth can the jurors think that she is innocent. But the jurors never thought she is innocent.  One of the jurors put it best after the verdict- She said we never said Casey Anthony is innocent. This goes back to the concept of how you cannot prove a theory and we can only disprove a theory with the evidence in hand. The jurors understood this concept very well.

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NSCA National Conference 2011 Review - Part 2

July 31 2011

Here is the second part of my review of the NSCA National Conference. To read the first part, click here

Dr. Dan Bernadot

Dr. Bernadot is a Professor of Nutrition and the Director of the laboratory for Elite Athlete Performance at Georgia University. Dan’s presentation was titled “Within Day energy Balance for Better Weight, Body Composition, and performance”.

Dr. Dan talked about the issue of meal frequency - how many times you have to eat in a day to improve body composition.  From what I have read, eating more frequently do not raise your metabolic rate or improve your body composition, though every fitness magazine swears that eating 6-8 times a day raises your metabolism. So I was very interested in looking at his references.

His first major study was an observational study done on elite gymnasts and runners. The study was based on self reporting and showed that the larger the energy deficit (in both frequency and /or magnitude), the higher the body fat. Keep in mind that this study is based on self reporting, the correlation coefficient was less than .50, and was studied on a population notorious for eating disorders and menstrual problems.  It is hard to conclude anything more than a weak association between the frequency of food intake and body fat from this study.

Now for an experimental study with a control group –at least that’s what I thought from the slide. But the study was just a poster presentation and never got published. And the study did not study the frequency of meals, it only looked to see if a caloric surplus affected body composition in athletes. And, as expected, it did in a positive manner.

In fact, there are a few studies which have showed increase in lean body mass (or decrease in muscle loss) with lower meal frequency compared to a higher frequency. But the studies used BIA to measure body composition.  In short, it seems like we do not have any strong evidence to show that a higher meal frequency helps lose weight or maintain muscle mass better than a lower meal frequency.

The second part of Dan’s presentation involved a dietitian talking about meal plans and recipes and how you can ‘make’ your athletes eat 6 times a day.  Considering how college students have a hard time finding time or motivation to prepare and eat meals, strong recommendations like these need some strong evidence to be justified. If you can control your appetite better with 3 meals a day and hate taking the time to eat 6-8 meals (and most do), there is no convincing data to tell you otherwise.

Dr. Jeffrey Stout

Dr. Stout is an Associate Professor and the Director of Metabolic and Body Composition Laboratory in the University of Oklahoma.  Dr. Stout presentation was titled “Nutritional Supplement Approaches to Male Athletes”.

This was a good presentation: He had all the relevant studies and he narrowed his presentation from acute to long term studies. In the acute studies, he showed how a carb-protein supplement showed lower cortisol levels and lower muscle damage (creatine kinase). He also had some data showing how protein-carb supplement increase endurance performance, time to fatigue and decrease muscle damage. By the way, I am yet to see a endurance athlete talk about post workout nutrition.

For long term benefits, he showed a couple of studies which showed an increase in muscle and strength. He also talked about creatine and how creatine shows an increase in strength and muscle. It wasn’t anything ground breaking, but it was good to see someone lay out the evidence neatly.

I have talked about in the past that only the Cribb study directly supports the pre-post supplementation protocol to increase strength and muscle.  There are two major reasons for this: In most supplement timing studies that I have seen, the participants were tested in the morning under fasted conditions. This is not how majority of people workout unless you are training in the morning on an empty stomach.  Also, if we are studying the timing, the study design should be such that one group consumes the supplement Pre and Post and another group consumes it further apart from their workouts. But most long-term studies which looked at supplement timing used a control group that just had water or a carb solution post workout.

I would love to see a study with the same design as the Cribb study, but with a few changes: A placebo group so that the subjects who are in the pre-post group are not subjected to the placebo effects. In fact, a placebo group is required in drug trials if you are testing the efficacy of a drug. Also, a study performed by authors who have no financial ties to the supplement industry. It pretty clear now that favorable results are more likely in studies where there is a financial conflict of interest.

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NSCA National Conference 2011 Review - Part 1

July 24 2011

National Strength & Conditioning Association (NSCA) is the world’s leading authority in strength & conditioning. They hold an annual conference every year which attracts conditioning & fitness professionals from all over the world. The conference includes presentations from leading fitness & conditioning experts, and was held in Las Vegas from July 6 till July 9, 2011. Here is the part 1 of my little review.

Dr. Stuart Mcgill

Dr. Stuart Mcgill is a professor of spine biomechanics at the University of Waterloo , Canada. His advice is often sought by governments, corporations, legal experts and elite athletes and teams from around the world. Difficult back cases are regularly referred to him for consultation.

Dr. Mcgill presented two topics. I attended the first and many people thought this was one of the best presentations. In the first presentation, he talked a lot of training concepts (titled ‘Lessons learned from the greatest athletes’). He talked about training the speed of contraction and relaxation, spending more time with asymmetric carries, learning to enhance stiffness in the core, avoiding spine flexion movements and so forth. In short, Dr. Stuart Mcgill’s work is basically about increasing performance and preventing low back injuries and pain largely by focusing on the core.

I was a bit concerned about how he makes so many absolute statements without too much evidence. When it comes to performance, I just think we are just over -emphasizing the role of core. Why are we so worried about the core? Has it been shown that just like strength, endurance, vo2 max, vertical jump and other proven variables, core strength is a major determinant of performance? No. Has it been shown that improving core strength can improve performance? No. Is there a general test for reliably measuring the core strength? No. So when Dr. Mcgill says that the great athletes fire this particular core muscle more than the others(or in a particular way) and hence we should all train that way, I would say that’s just another correlation.  I just didn’t see many studies from him to support his statements either.

If we really want to say that this particular observation is really important for performance and it is what makes great athletes great, we need to do an intervention study. Find athletes from different disciplines, put them through his intervention, and show how they increased their time or distance or speed or strength and so forth than the control group.

When it comes to low back pain, I think it is pretty clear that the psychosocial component is very important, and maybe even more important than the biomechanical aspect. I have never heard or read Dr. Mcgill mentioning the psychosocial factors involved in pain. Even American College of Physicians recommend not to scan people with non-specific low back pain because what you find on a scan has very little to do with the onset, severity, prognosis, or duration of low back pain. Considering the bulk of evidence against the biomechanical model of pain, I think it’s a bit perplexing (and bothering) that he doesn’t even bother alluding to it and keeps ignoring it.  Dr. Mcgill’s studies are a good example of studies which measure surrogate measures like EMG, spine models, compressive/shear stress instead of looking at meaningful outcomes to people like pain, performance or strength. There is nothing wrong with these studies, but you have to be careful about extrapolating your conclusions because you might be very well wrong. If you are not sure what I mean by surrogate measures, check my recent post on it.

I couldn’t attend his second presentation, but he seems to have changed his topic of his presentation because the presenter before him talked about how we don’t have much evidence about what causes low back pain or how to treat it.  Unfortunately, it is true, and Dr. Mcgill disagreed to the extent that he felt he should change his presentation. If he had enough studies to show against, he wouldn’t have to talk so loud and so often and talk about so many anecdotal evidences, I thought.

Dr. Chad Kerksick

Dr. Kerksick is an Assistant Professor of Exercise Physiology and Director of the Applied Biochemistry and Molecular Physiology Lab at the University of Oklahoma. Chad talked about Intensity vs volume in muscle growth. Chad spoke like a true researcher - he had data for everything he said and was very careful and hesitant about jumping into conclusions unlilike others.

He introduced his lecture by quoting the size principle and how the Type 2 fibers, which has the greatest potential for muscle growth, gets recruited at the end of a set. Then he talked about the infamous Dr. Phillips study which showed how low load, high volume protocol (30RM) showed greater protein synthesis compared to a high load, low volume (90% RM) protocol. He also showed another study by Wilborn et al., ( 2009) which showed molecular markers and proteins for muscle growth all increased significantly for both 18-20 reps and 8-10 reps. Both these studies lend some credence to the fact that high reps may be valuable for increasing muscle growth.

But, mind you, both these studies are acute studies in beginners and measure surrogate measures not muscle growth. Chad also mentions this and how we have to be careful since this an acute design. I asked him about how this could be muscle-specific since both the studies were done on leg musculature and we have heard plenty of stories about 20 rep squats and how people grow better with high reps for legs.

The second half of the presentation was by Dr. Coil Wilborn about training to failure which I will cover in the next part.

It is very important to draw lines between what we know, what we do not know and what we need to know. Unlike what most people think, things aren’t as black and white and are mostly shades of grey. Anyway, that’s all I have for the first part.

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How To Read a Study - The Pyramid of Outcomes

July 16 2011

The outcome measured in a study is the most important aspect of a study.  But this aspect is the least emphasized when people try to interpret studies. So which outcomes are the most beneficial according to the pyramid?

What does the pyramid say?

Base of the pyramid: The base of the pyramid include studies with outcomes which do not have a direct impact on you. These are called surrogate outcomes. Examples for surrogate measures are protein synthesis, EMG analysis, X-rays, in-vitro models, cholesterol and so forth.

These measures are ‘stand in’ or represent meaningful outcomes higher up in the pyramid. For example, we think that protein synthesis is a stand in for muscle growth. We think x-ray is a stand in for pain outcomes. We think cholesterol levels are a stand in for deaths due to heart disease.

Top of the pyramid: As we go up the pyramid, we get to the patient or meaningful outcomes which are the most important and has a direct effect on you. Examples of these are muscle strength, muscle growth, fat loss, death, pain and so forth.

As we go up the pyramid, the importance of the study and the outcome goes up too.

What about some examples about surrogate measures?

Muscle growth: The most popular surrogate measure for muscle growth is protein synthesis. What people care about is muscle growth. We are not really sure if an increase in protein synthesis will lead to an increase in muscle growth. It may - or it may not. The molecular makers like AKT, MAPK, mTOR are surrogate measures for muscle growth which are way below the pyramid.

Even if synthesis goes up, protein breakdown could go up too. Or the fatigue generated can go up and cause the person to lower the weights or reduce their training. All these can affect muscle growth in a negative manner.

Performance: One of the usual performance measures for an athlete is the increase in squat strength. But can the increase in squats increase how many goals you scored, decrease the time taken to run or make you throw or hit longer? There are a host of factors that can influence performance, and squat strength may or may not be one among them.

Bone density: Bone density is a classic example of surrogate measure. We do not care about bone density. What people care about is does it lower the chance of a hip fracture, the most disabling kind of fracture.

People could fall due to poor vision, lack of strength, balance, their environment and so forth. So an increase in bone density may not always translate to fewer fractures.

Cholesterol: Drug companies usually measure cholesterol levels to show the efficacy of a certain drug. But the question is do they make the person live longer or do they feel better?

Clofibrate, a drug for cholesterol, lowered cholesterol really well, but inexplicably increased the number of deaths. A recent example is the popular diabetic drug -Avandia - for lowering blood glucose. The drug worked really well for lowering glucose levels in diabetes, but people suffered from heart attacks, stroke and even deaths. These are good examples of drugs that got approved from surrogate end point studies.

Core strength: In the fitness field, there are lot of people who quote studies showing increase in EMG, core strength, pig spine models, shear /compressive stress values as evidence for prescribing or not prescribing certain exercises for the core. These are just surrogate end points. Until they can show the intervention can increase performance or prevent injury or decrease low back pain, it is just a beautiful hypothesis.

Exceptions: There are cases where just lowering the symptoms might be really important for you. For example, people in end-stage cancer treatments, improving the quality of life or the symptoms can be very important. There are also surrogate measures which are highly correlated with the end point.

Why do people use surrogate measures?

• Cheap & quick: These surrogate measures only need a small sample size and are relatively short-term studies. For example, to study mortality you will need a study with 100’s of participants for a period 5-10 years.
• Preliminary:  Most studies use these designs as preliminary evidence to justify long-term studies with meaningful outcomes.

Practical Application

• The outcome measure is the most important aspect of a study. Next time, when you read a study or hear someone quoting a study, look to see if it is a surrogate measure or not.
• If it is a surrogate measure, be skeptical about the conclusions.
• If you know about other surrogate measures used to prove a hypothesis, please comment below

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Should I Take a Wide Grip or Close Grip for Lat Pulldowns?

July 01 2011

This is the most common question I get asked when I talk about lat pull downs to a new client. As you will see,  this question also gets to the root of one of the major problems.

Does changing grip width make a difference?

The Magnitude of Effect: In research, they call this the “magnitude of the effect”. If you change your grip from narrow to wide grip, how big of a difference will it make on your physique?  Good researchers worry about the clinical significance than just statistical significance.

Even if you do all the adjustments with the grip, 90% of the people who come to the gym will never come to that single digit body fat level where they could tell these small difference in lats. They should focus or worry about things which will make the biggest difference.

Population: If you are a bodybuilder, you are justified worrying about the grip width and such. You will be getting down to 4-6% body fat levels where the judges can clearly see how well your lats look in the lat spread pose. 

This is one reason why wise men say never copy routines of bodybuilders. Their goals are way different from the majority of the population and their training will reflect them. Their priorities are a lot different than yours. This also one reason why ‘some’ bodybuilders do not make the greatest of trainers.

Other examples: Some other examples where people worry about the minutiae and forget the big picture are:

1. Spending hours doing cardio but have no clue about their food and calorie intake
2.Doing high reps to burn more calories or /and trying to burn calories using weights
3.Focusing on isolation exercises like curls & shoulder raises
4.Doing half an hour of ab exercises
5.Eating a ton of protein , but not getting enough calories in the first place.

I will stop here, but I can just keep going.

So what should I focus on?

Three things: The three most important aspects which will make the biggest difference in your physique are your diet, weight progression, and sleep.

Just pull: As long as you are pulling and getting stronger, you are doing it right.  It doesn’t really matter if you are doing lat pulldowns or chin ups, close grip or narrow grip or whatever.

If you are good with the first 3 points, then you are welcome to worry about little things like how many reps, which grip, and so forth.

But does the grip width make a difference?

• The wide grip pulldowns to the chest showed the greatest activity for the lattisimus dorsi compared to wide grip pull downs behind the neck, closed grip pull-downs (V grip), or a supinated grip. 
• A recent study (2010) concluded that that the width do not really matter, what matters is the wrist position (pronated or supinated). A pronated wrist position ,irrespective of the width, is optimal for maximally activating the lats

Practical Applications

• A comfortable grip width for lat pull downs ,with pronated wrists, pulled to the front is the best position for lat pulldowns
• Focus on your diet, weight progression and sleep. These are the top things which will make the biggest difference in your physique.
• Anytime you start to worry about certain aspects of your workout, ask how big of a difference will it make in your physique?

Reference 1
Reference 2

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The Fall of the Greatest Theory of Muscle Growth - Part 2

May 22 2011

If you haven’t read the first part of the article and is not aware of the debate, please read the The Fall of the Greatest Theory of Muscle Growth. Recently, another study was conducted by a different group of authors and concluded that the acute hormone elevations may help. Now let’s take a closer look at the study titled:Physiological elevation of endogenous hormones results in superior strength training adaptation.
 

What was the design of the study?

• Nine untrained men performed four single joint biceps exercise per week for 11 weeks.
• For two training sessions, 3 leg exercises(leg press, leg extensions and leg curls) were performed before the bicep exercises for one of the arms (hormone Group).
• For the other two training sessions, the same protocol was performed for the other arm without the leg exercise (NO hormone group)
• This type of within-subject design ensures that motivation levels and genetics do not affect the results.

The same design was employed in the previous study too, but the big difference was that the leg exercises were performed after the arm exercises But in the current study the leg exercises were performed before the arm exercises.

What were the results of the study?

• Both group increased muscle CSA, 1RM strength, peak power and muscle volume.
• Only the hormone group obtained significant increase in muscle CSA at the part of the arm with ht e largest cross sectional area.
• Only the hormone group showed a significant improvement in 1RM strength in biceps

My Comments

• One of my concerns is the design of the study. The design of having them do leg exercises before arm exercises is not ideal. The acute increase in catecholamine and the neural drive after leg exercises makes you feel stronger which can be evident especially in smaller muscle exercises.
• The % strength increase for the no hormone group is 14% (12lbs) and 21% (18lbs) for the hormone group. In the previous study, they saw a 24% increase in strength for the no hormone group and they did only 3-4 sets compared to 6 sets in this study.  That is almost twice more than what they got here!
• Though the results are statistically significant, the difference of only 5-6 lbs in 11 weeks in beginners is not really impressive.



• The muscle cross sectional area (CSA) increase was significant in all sections for both the groups except section 8 & 9 (circled in red in the figure) for the no hormone group. But the author for some reason only mentions the significant increase in section 8 of the hormone group in the abstract. In the previous study, all sections in both groups had a significant increase in CSA.
• The CSA increased more in one group, but the muscle volume inexplicably remained the same for both groups.

Practical Applications

• Even after doing 6 sets of biceps exercise after leg exercise for 11 weeks, the increase in biceps strength was only 5-6 lbs in rank beginners in the hormone group. Hence the benefits of such a training protocol for trained individuals is dubious.
• Based on this study, performing just leg exercises and increasing hormones will not make your biceps grow. You have to perform sets of bicep exercises and make sure they are done ‘right’ after the leg exercises.
• Considering that this is the only study which gives a causative role for the hormone theory, the evidence is still weak for a theory which is still the most popular theory of muscle growth.

Reference 1

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Pain Is In Your Brain

May 17 2011

You will only feel pain if the brain thinks that the stimuli is threatening or it is a danger to the body. And this is what I tried to convey in my pain article. Check it out if you haven’t read it. But most people can’t fathom this concept.

In the below presentation by Lorimer Moseley – one of the leading researchers of pain- he talks about the concept of how ‘pain is in the brain’  by giving an example from his own life. The post below talks about this example.

Scenario 1

Scratch from a twig: This was 8 years ago when Moseley was camping in western Australia:  Something touches the left side of his leg when he is walking on the trail through the woods. It activates the nociceptors (pain receptors) 

Brain thinks: This is not dangerous, we have been here a million times, I grew up walking bare foot in a bush. My nick name was scratchy because I used to have to so many scratches on my leg. So the brain says kick of the twig and get back to business. (Remember this evaluation by the brain is outside of your control or awareness. It happens in a split second)

No Pain: Here he feels no pain since the brain do not think it is threatening and you need to be protected.

Result: 3 days later he wakes up in the hospital. He was the first survivor of eastern brown snake (grade 3 bite). The bite works by stimulating the nerves and hence it ‘should’ be extremely painful.

Scenario 2 (6 months later)

Scratch from a twig: 6 months later he was walking down the bush and something scratches the left side of his leg. It activates the nociceptors (pain receptors) as usual.

Brain thinks: This is highly threatening since last time I was in the bush and a twig scratched, I almost died. So this scenario is really threatening and he needs to be protected. (Again, evaluation by the brain is outside of your control or awareness. It happens in a split second)

Extreme Pain: There is extreme pain and he falls down and is holding his leg.

Result: It was just a scratch from a twig and ‘should not’ be painful.

The stimuli is the same in both scenarios. One is extremely painful and the other is not at all painful. What changed? The only thing that changed is how the brain perceives the stimuli, and it really doesn’t matter if the pain receptors are activated or not!

Conclusion

• The point is you will only feel pain when the brain feels it indeed dangerous and you need to be protected.
• This happens at the unconscious level and you cannot control what your brain is thinking in that split second. What your brain thinks depends on your combined input of previous beliefs, social context, attitudes, expectation, sensory cues and such
• So the goal of any pain treatment should be to lower the threat level in your brain. One way to do this is to understand the physiology of pain and the fact that ‘pain is in your brain’.

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The Biggest Loser Show Review

May 14 2011

Since I work in a fitness center, I hear a lot of people talking about how the Biggest Loser contestants can lose so much weight and how they wish they could lose the same or if they had a celebrity trainer. Let us take a closer look at the Biggest Loser show.

What is the biggest loser show?

TV Show: Biggest Loser is a weight-loss contest aired on NBC which has become extremely popular. It is broadcast in different countries with each having their own versions. But the central theme in every show is all about who can lose the most weight in 12 weeks for a cash prize. Contestants lose 100-220 lbs in 12 weeks.

What are the pros of the Biggest Loser show?

Entertaining: The show is entertaining to say the least. The ratings of the show are proof that they got something right about the show.

Inspirational: It is inspirational to see people making an effort and achieving their goals. The message of “If they can do it, I should be able to do it too” is clearly infectious.
 

What are the cons of the Biggest Loser show?

Unrealistic: The show is completely unrealistic. Most people cannot achieve that sort of weight loss in such a short span of a time (and shouldn’t). You can though if you have the following going for you:

• Be in that obese category where you are 100-200 lbs heavier. The heavier you are, the greater the weight loss
• You are ready to quit your job, leave your family and move to a ranch with only one goal in mind.
• You have enough money to hire a trainer to train you everyday and keep you accountable.
• You know millions of people all over the world are watching you on television and judging you on how well you do. How is that for accountability?
• You have thousands of dollars to look forward for achieving your goal.

Weight Maintenance: I have written in the past that losing weight is easy, maintaining it is the hardest. You have to do everything (and more) that you did to lose weight for the rest of your life to maintain the new weight.

The faster you lose and the more you lose, the harder it will be to maintain that weight loss. The Biggest Loser contestants lose around 50-60% of their weight in 12 weeks which is 10-15 lbs per week. The recommended guidelines suggest 5-10% of your body weight at 1-2 lb weight loss per week! How is that for ‘following’ guidelines?

And this is one major reason why most of the contestants gain most of their weight right back after the show. They are now their back to real life where they have jobs, a family to take care, responsibilities, and so forth. And worse yet, for some -along with the weight gain- comes the psychological problems of defeat and failure which triggers a vicious cycle of overeating, depression and guilt.

On the other hand, most contestants who are maintaining most of their weight have turned their life completely upside down.  These people have become fitness experts for a career and they advise and coach people in losing weight and staying healthy. This sort of drastic life change is unrealistic for most of us.

Extreme Workouts: People who weigh 300-400lbs who even have trouble walking and are at high risk for cardiovascular problems are made to run for miles which is outright dangerous and ridiculous.

Some of the technique they use in the weight room are just good examples of how NOT to do those exercises.  Contestants are made to do cardio for hours a day which is above and beyond over-training and is a great way to have long lasting knee and ankle problems.  The concept of intelligent workout programming is missing; it is all about throwing as much stress as you can to the body.

Extreme Water Loss: Some of the contestants in the show have dropped 20-35 lbs in days by dehydrating themselves using extreme measures like working out in rubber suit and not drinking water for 24 hours and such. This isn’t actual weight loss and can mislead people who are unaware of these extremes measures

Practical Considerations

• Lose 5-10% of your weight and try to maintain for 6 months. If you can maintain it, go for more.
• Even losing 10 percent of your total body weight can have significant improvements in blood pressure, blood cholesterol, and blood sugars.
• When you think of making dramatic changes to exercise and diet, ask yourself if it is healthy and if you can maintain it for the rest of your life.
• The Biggest Loser show is inspiring, but clearly has nothing to teach you about healthy weight loss and weight maintenance.

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The ‘Train Low, Compete High’ Protocol for Endurance Training

April 30 2011

Train low: Train low means to perform your training under low glycogen levels.

Compete High: Means competing under high glycogen levels.

Why do you need glycogen?

Energy :  Carbohydrates you eat are broken down into glucose and stored in your muscles as muscle ( and liver) as glycogen. Glycogen is your primary energy source for endurance events like long distance running and such.

Sports nutrition guidelines: Hence current sports nutrition guidelines recommend a high carbohydrate intake for endurance training. This is called the “train high, compete high” approach.

So why train with low glycogen?

If glycogen is required for energy, why train at low glycogen levels? This goes against the conventional training wisdom, right?

Cellular Signal Pathways: The recent discovery of the several molecular pathways activated during endurance training (AMPK, P38, MAPK and so on shown in the figure) shows that these signaling protein are activated to a greater extent when exercising with low muscle glycogen than normal or high glycogen levels. These pathways play a critical role in making new mitochondria and activating other training adaptations.

2005 Study: The 2005 study by Hansen confirmed these suspicions. In this study, seven untrained males undertook a 10-week program of leg knee extensor ‘‘kicking’’ exercise. Interestingly, the study showed a “two fold” increase in time to fatigue in the Low glycogen leg compared to the high glycogen leg which goes completely against the current training philosophy.

The study seems to show that it might be the lack of substrates (glycogen) and not the surplus of substrates which activates the endurance training adaptations.

What about training and performance measures?

But the question is will this concept of Train low, compete high work for trained individuals and translate to increased performance?

Studies: Number of studies was conducted to see if there is an improved performance with low glycogen training. Guess what, none of the studies saw any increase in performance measures besides the increase in these signaling pathways.

This is another classic example of how it is so important to test our hypothesis with meaningful outcomes before jumping to any conclusions, not matter how sensible and beautiful the hypothesis may be.

So why didn’t we see any performance improvements?

• There may not exist a direct relationship between performance and the cellular events measured. So increase in AMPK may not mean a thing when it comes to increasing performance.
• Muscle function is just one factor in determining performance. Performance might be dictated by an integration of several factors such as the nervous system, mechanical efficiency and such
• We lack the tools sensitive enough to detect small increments in performance.
• Training with low glycogen can have negative effects on training intensity and the health of the athlete which might compensate for the positive effects of low glycogen training
• Finally, there might be some complex combination of training and nutrition which we haven’t nailed it yet.

Practical Consideration

• There is no clear advantage of training with low glycogen levels on performance measures, atleast from the current studies
• Elite athletes already might be training with low glycogen levels due to practical reasons. Sessions done after overnight fasting, with low carbohydrate levels, twice a week sessions   can stimulate low glycogen training.
• If low glycogen training is attempted it is better to do it early and away from your competition period.

Reference 1
Reference 2

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Scans for Low Back Pain: Good or Bad

April 19 2011

This was a really interesting post by Neil O’Connell at bodyinmind.org.This is such a relevant post because almost all of us will have some sort of low back pain in our life.

We now clearly know that abnormal findings on the x-ray and MRI ( like disc herniations, bulging disk, degenerating joints and so on) are clearly NOT related to the onset, severity, prognosis, or duration of low back pain.

This is now so well established that the American College of Physicians have come forward with clinical guidelines saying” Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain”

Non-Specific low back pain is defined as low back pain that cannot reliably be attributed to a specific disease or spinal abnormality. 85% of the low back pain is due to non specific effects.

Imaging is only recommended for a minority of people whose low back pain can be attributed to specific pathology like cancer, compression fracture, spinal infection, cauda equina syndrome. progressive n neurological deficits and such.

Though these guidelines exist, physicians routinely get scans for patients. But the question is there any harm? The answer is YES.

I am not going though the design specifics of the study. You can check the link for more info.

• The results showed that no-MRI groups came off disability around 200%  faster than the low-propensity early MRI subgroup!
• Medical costs were also dramatically different and in the same direction.
• The risk of having surgery for the no-MRI groups was reduced to 3% and 10% in comparison with the early MRI group (100%).

This post again emphasizes the powerful role of the psycho-social factors in pain which are still missing in our thinking about pain.

The Llnk to the post: http://bodyinmind.org/spinal-mri-and-back-pain/

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NSCA Personal Trainer’s Conference 2011 Part 2

April 17 2011

This is the second part of the Review. If you want to read the first part, click here.

Chad Kerksick

Dr. Kerksick is an Assistant professor at the University of Oklahoma in the Health & Physical Education Department. Chad’s Title of the presentation was “Split Training”:  A training approach to effectively teach, train and monitor clients”.

Chad was the typical researcher- he had references for everything he said and his slides were just replete with studies.  And he spoke with a dry and unemotional tone like a true researcher. He gave an outline about the various resistance training variables like loading, frequency and such and then talked about split routine. His split routine was the typical 2 days lower, 2 days upper body.

The summary was that split routine is an efficient training model since we can use higher volumes, there is more recovery time and it allows people to train at the recommended frequency and intensity. I was waiting for a study ( or studies) which showed greater increase in strength or muscle with a split body routine compared to a full body routine. But he didn’t have one. If the adaptations are similar , why spend one more day in the gym when you can spend 3 days and get the same benefits? I just felt like he didn’t have a compelling conclusion to why someone should do a split routine.

In one of the slides, he showed a study done by Kramer and how it increased serving velocity and jump height by 13 percent, but the results weren’t statistically significant. He talked about how 13% increase is clinically significant thought it may not be statistically significant. This is one of the concepts many people are unaware of. Mark Young, one of my smart friends, talks about his concept in his new “How To Read Fitness Research Product”.  If we are using p values, we should do a power analysis to find the minimum samples we need to have a clinically significant result to be statistically significant. This is especially important in the exercise field when we are dealing with very few sample sizes.  Unfortunately, not many exercise studies bother to do one.

I asked about power analysis and confidence intervals after the presentation. I also asked him why he thinks in most studies there is a plateau of strength by the 4th or 5th week. He said he has seen the same in his studies too. I also asked him about his view about training to failure. He said he ‘believes’ in going to failure in atleast one your sets. I was looking for a more scientific answer though or any relevant studies. He also talked about the hormone hypothesis which I still think is just an interesting hypothesis lacking causative studies. 

Brad Schoenfeld

Brad is the Associate Editor of the NSCA Strength and Conditioning Journal, an adjunct professor of exercise science, manages a fitness corporation, has a blog (www.workout911.com), and has written a few books. Brad’s presentation title wasThe Functional Fitness Continuum: Training Strategies to Optimize Functional Transfer. Brad lectured for a half an hour and Jay Dawes lead the hands-on session. 

This was one of the best presentations at the conference. It is a very relevant topic which is still misunderstood and misinformed even among fitness professionals all over the world. There is rage in the fitness industry to make everything functional these days

People usually say machines are non-functional and hence they have no purpose. Brad showed a study which showed older individuals who used ‘leg extension machine’ to improve their walking and balance considerably. In fact, 2 of the subjects were able to walk without the assistance of the canes. He also showed how free weight training increased functional strength more than machine training. In short, all modalities can elicit functional improvements, and the greatest transfer is seen with free weights.
 
His next point was unstable training.  You will be hard pressed to find a gym where people don’t use bosu balls or unstable surface training. Atleast, I get to see it 60 hours a week! Most of our movements are done on a stable ground so training on an unstable surface is ‘non-functional’. The more unstable the movements lower the loading on the muscles. And lower the loading on muscles, the less the increase in strength, muscle and such. The funny thing was last year in the same conference there was an hour and a half presentation on unstable training. I asked him if there is any benefit of unstable training on propioreception when you are recovering from an injury.

He talked about how single joint exercises are considered non- functional , but can fill the ‘gaps’. For example, only 50% of the hamstrings are involved in squats compared to glutes and quads. Brad also emphasized the importance of fast repetitions in functional training since movements are velocity specific.

I talked with Brad a couple of times during the conference. At the end of the conference, we went and had dinner. We talked a lot about research and the problems in the fitness field. I was really excited to talk to someone who is very knowledgeable in both research and application. I usually don’t get people of this caliber to talk shop and hence speaking with Brad was one of my conference highlights.  You will see a lot of people who are evidence-based and such, but there is only a handful of people who are really concerned about the profession and wants to bring some credibility to the field of fitness. Brad is one among them and I felt like we both had a lot of things in common. 

There were a few others good ones too. One was by Lee Brown about Speed Training. Lee is an excellent presenter and really brought down the topic so that everyone could understand. Some of the presentations I felt were a bit too heavy on physiology and lacked on the application aspect. Maybe it was the way they presented since most of them were researchers. I also made it a point to network with a lot of trainers at the conference.

Anyway, that’s the end of the review.

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NSCA Personal Trainer’s Conference 2011

April 09 2011

The conference was held in Las Vegas as usual. I had reviewed the 2010 conference here. It was a 2 day conference and each presentation lasted around an hour and a half. They had both hands-on and lecture type presentations.

Marie Spano MS

She is one of the leading sports nutritionists and co-authored the book ‘NSCA’s Guide to Sports Nutrition’.  The title of her presentation was “Analyzing the popular weight loss diets”.

This was a really good presentation. She reviewed popular diets, what is good and bad about these popular diets, really emphasized how important it is to make behavioral changes than focus on diets, avoiding the diet mentality, and so forth. She talked a lot about intuitive eating and how it is a great way of avoiding the diet mentality and the popular food and eating ‘rules’. Everything she said was all about long term adherence, proper nutrition, and a healthy mentality towards food, your body, and eating. And everything you see and hear around you is the exact opposite: quick fixes, no mention about nutrition, and rules like ‘eat this and not that’.

Below are her food rules:

1. Incorporating high volume foods
2. Drinking water before your meals
3. Eat half your plate with fruits/veggies
4. Eat 20 gms of protein with every meal
5. Tune into physiological hunger
6. Eat when you are hungry
7. Work on emotional eating
8. Find out why you eat
9. No food, within reason, is off limits.
10. Learn to like healthy foods,
11. Create what fits into your lifestyle
12. Change your environment
13. No good food, bad food
14. If you bite it, write it

I asked her if she emphasizes fat loss with her clients, how much nutrition you can talk to your clients, and about re-feeding. I just felt she could have mentioned about the “starvation mode” or metabolic drop seen in people with dieting, strategies like re-feeding or cheat meals a bit,  and what is wrong with the popular ‘The Biggest Loser’ show.

Most of our diet advice comes from diet experts who work with bodybuilders and fitness models who need to come down to single digit body fat levels for a few weeks or months. We try to take their advice and apply it to the general population who doesn’t have even half the motivation of a bodybuilder, nor the genetics, they need to look good the whole year, and don’t need to come to insane body fat levels. And that’s the problem.

Just so that you know, it is hard to make all these changes in people’s lives though this maybe the right way. I guess the question is how to make these behavioral changes, will these really help lose weight and keep it off and such. So it is not as black and white.

 

Dr. Len Kravtiz

Len Kravitz, PhD is the Program Coordinator of Exercise Science and researcher at the University of Mexico.

Len did a presentation on Eccentric Training titled” Eccentric Training: Everything you wanted to know and more”.  I don’t think I have seen many presenters who are so enthusiastic and animated. He is one of the rare breed of teachers who can spark the love for the subject in a student. 

He spent around 30 minutes on the physiology of eccentric contraction which I thought was a bit too deep for the audience. He talked about titin, troponin and such, and trainers don’t care about that stuff. But he presented the subject better than anyone I have seen. I remember him walking around the room and animatedly saying, “you become the actin” and talked about how he makes his students act out the muscle contraction. I wish more teachers could watch him.

His presentation was mostly about the mechanisms, theories and lacked a bit on practical-based information I felt. He showed a study about how eccentric contractions increased concentric strength. But this was just an acute study and did not say much about long term adaptations. It is clear that eccentric training increases concentric strength, but concentric contraction are better than eccentric contractions to increase concentric strength in the long term.  It is just the specificity principle in action.

This is the reason why we should look at systematic reviews and meta analysis first. If we don’t have any, then we fall back to single studies.  I had written an article about eccentric contraction based on a meta-analysis here. I am surprised how he missed that met-analysis.  I also felt he could have talked about how eccentric contraction show increased muscle growth than concentric contraction which is one of the most talked about benefit and the reason why most people use it.  He showed a study which showed eccentric contractions burned 8-9% calories post-workout for many hours. And 8-9% is how many calories I was thinking? 10, 25, 50?.

He showed a lot of videos about how to do eccentric contractions. I think two or three would have been fine to show the different ways to overload. He had too many I thought, and people didn’t like the kid in the video who was bent on showing the world how strong and awesome he is. I talked to Dr. Len and even had lunch with him. He seems to be a real nice guy and is very humble and polite.

Conclusion

This is getting too long and I will write more about other speakers in the second part. I felt the presentations were a lot more evidence-based than last year and they made an effort to pick speakers who have PhD’s and do specific work in that particular topic.  I just wished they had more topics about training and nutrition for muscle growth.

That’s all I have for Part 1

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A Revolution in the Understanding of Pain and Treatment of Pain

March 28 2011

This is an article I wrote for another website. This is will change the way you look at your pain forever.

Click the below link to go to the article please.

A Revolution in the Understanding of Pain and Treatment of Pain

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Detox Diets and Cleansing Diets: Do They Work?

March 14 2011

What are detox diets and cleansing diets? Do they really get rid of toxins and chemicals from your body? And do we need to cleanse ourselves every now and then?

What are detox diets and cleansing diets?

Basic Premise: The basic premise of every detox and cleansing diet is that our body is constantly accumulating toxins and chemicals from the food and our environment . And we need to get rid of these toxins every now and then.

Duration: These diets last for a short period of time, usually 4-8 weeks.

Methods: Some of the common methods include one or more of: dieting, using herbs and supplements, consumption of specific foods such as fruits and vegetables, juices or water or avoiding fats, sugars,  fasting,  avoiding caffeine, aclohol, junk food and so on. Some others involve extreme measures such as colon cleansing, liver flushing, chelation, and so on.

What do these diets claim?

Toxin Removal: They claim that these diets or therapies can effectively remove toxins or chemicals trapped in the body through urine or bowel movements .

Benefits: By removing these toxins, they claim that you will have improved energy, clearer and fairer skin, a regular bowel movement, improved metabolism and digestion, increased concentration, and will also prevent diseases.

Now can these diets really remove toxins?

Scientific evidence: There is no scientific evidence to show that you can remove toxins or chemicals using these methods. Chelation, a medically approved procedure, is used to remove heavy metal toxins when people suffer from genuine iron, lead, uranium poisoning. This is only warranted when the levels are dangerously higher than normal.

Pictures: There are pictures on the web of these long algae like substance from bowel movements called mucoid plaque. These are not toxins or chemicals, but they are formed from bentonite and psyllium husk which are most often included in colon cleansers. The bentonite acts like a clay to expand when it mixes with water. The psyllium husk adds bulk and are used as a source of dietary fiber. They are the “toxins” from the very substance which are supposed to clear the toxins.

Foot pads: These foot pads, left on your feet overnight, turns brown in the morning. These pads have powdered wood vinegar which turns brown when it comes in contact with sweat. These pads also peel off the dead cells on your feet which gives them the brown color. It’s funny how toxins are always brown in color and not green or blue.

But what about these chemicals accumulating in the body?

Chemical-Free Life: You cannot lead a chemical-free life because everything is made of chemicals.  For example: an average person has more than a trillion atoms of uranium in their body and that hundreds of these atoms are radioactively disintegrating every day.  All is coming from a perfectly natural source: the food we eat! Many toxic substances occur naturally in foods, e.g., arsenic, but in doses so small to even bother about.

Dose:  The toxicity of a chemical depends on the dosage or the amount received.  Aspirin - a wonder drug- in extreme doses becomes toxic and causes acute renal failure, coma, and heart failure. Botox ,one of the most toxic substance know to man, is safely used in cosmetics because it can be highly localized. There is no chemical that can be automatically labeled as dangerous or safe without the above info. 

Body’s Detox:Our body has its own detox like the gut which prevents entry of toxins, the liver which breakdown harmful chemicals which are then excreted by the kidneys. None of the above processes can be made more efficient by detox or cleansing.

But what about people feeling better?

Increased Energy: This boost in energy is due to fasting. This is one of the body’s survival mechanism to get you moving to locate food during starvation periods.

Weight Loss: If you are on juice and water and other low calorie diets, you will lose weight. Don’t worry, this is just temporary and you will put all of it right back on when you go back to your regular diet.

Feeling Better: You will feel better if you stop using alcohol, caffeine, junk food, stop smoking and such. That is just common wisdom, right.

Other Benefits: The other benefits like clear skin, improved digestion, increased concentration can be easily traced backed to increased water intake, fruits and vegetables, avoiding too much fatty foods and such.

Placebo effect: If you really believe something is good for you and is helping, you will feel it too even if has nothing medicinal in it. Check this short video about placebo effect.

The bottom line is whatever you are feeling on a detox diet or cleansing diet has nothing to do with removing toxins.

Practical Applications

• Detox or cleansing diet cannot clear toxins or chemicals from your body as claimed. The short term benefits has nothing to do with toxins removal.
• We already have an inbuilt detox system in our body namely kidneys and liver.
• If anything is removed with the detox diets, it is your money from your wallet.

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What is Autoregulatory Training?

March 09 2011

What is autoregulatory training? Is it the same as instinctive training and how can you apply it?

What is autoregulatory training?

Autoregulatory training:  It is a training method which makes sure that you are using the maximum weight for a particular repetition, say 6 repetition or 10 repetition. 

Why the heck we need autoregulatory training?

Planned Training: Planned training may not be familiar to bodybuilders or the common folks. But it is pretty much the norm for athletes to plan their workouts months and months ahead. This includes the weight they should use, number of days they train, the reps and sets.  It is called Periodization.

Problem: The problem with this planned training is an athlete due to so many outside variables like sleep, food, stress and such may either find the weights too easy or too hard on a particular day than what was planned months ahead.

Solution:  One solution is to use weights based on how much you can lift that particular day than what was planned. And this weight also gives you the starting weight for the next workout. This is basically called autoregulation training.

What about instinctive training?

Instinctive training:  In instinctive training, you use a weight depending on how you feel that day. You do not test a weight like autoregulatory training from last week to change your weights accordingly.  For example, you didn’t sleep well last night and feel a bit tired and hence you pick a weight which is a bit lower than your last workout.

In autoregulatory training, you lift the weight you did last workout, AND then change the weights for the next sets based on how many reps you got with that weight. Some folks can tell how they feel from their bar speed and how they feel in their warm up sets

Are there any studies on autoregulaton?

There were 2 studies done on autoregulation comparing it a regular linear periodization.

15 week Study: There was a 15 weeks study done on untrained females back in 1996 which showed no significant difference in strength between periodization and autoregulation. In fact, the periodization showed a linear increase throughout the study while the autoregulation group showed a plateau at the later stages of the study.

6 week Study: This was a recent 2010 study done on Division 1 football players which is quoted everywhere as an example of autoregulation. The study has numerous limitations as shown below:

• Retrospective: The study is looking comparing 2 groups . The first group trained in 2004 while the second group trained in 2005. The author looks back at these numbers in 2010. Retrospective studies usually cannot make cause and effect conclusions because there are so many variables that are not controlled.
• Volume and Intensity: The volume and intensity was not equalized and hence says nothing about the autoregulation/periodization.
• Pre-test and Post Test: The pre-test numbers are in fact the post test numbers after the off season. So the numbers might have gone up or gone down in that break period.
• Results: The is a bit sketchy. The results are given in N when the training weights and such given in lbs. The results how that the Autoregulatory group went up by 90 N (20 lbs) in bench while the squat by almost 180 N(40lbs). The bench press periodization group had no increase!

The study is interesting, but only brings in a hypothesis which needs to be tested with a well designed, randomized-controlled study.

Practical Application

• Beginners: In beginners, it is better to stick with traditional sets and reps. You need few years of training before you can really go by feel.  Also, if they go by instincts, most beginners will rather sit at home and watch TV.
• Advanced:  Most advanced lifters use a mix of planned and auto-regulated type of training. They will have a basic template of the sets, exercises and which weeks to go hard and light. The weights, sets and reps will change based on how they feel that day. Some call it cybernetic periodization.
• Length of Training: Autoregulation is best done for periods of 4-6 weeks. In autoregulation, you are training to your maximum weight for that particular rep and hence can easily get overtrained if you don’t have a plan to manage fatigue. And I think the duration of the cycle can be partly attributed to the results of the above studies.

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No Arms, No Legs? No Worries

March 05 2011

If you think you are weak, fat, skinny, ugly, unfortunate, and all the negative things you can think about you and your life, this short video is for you.

This is part of the series of inspirational videos I am putting together under the category “Inspirational”. If you come across any more like these, please send it to me.

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David Goggins: The Man Who Can Run

March 04 2011

Here is an inspirational video about David Goggins. He wakes up at 3.00 am, runs 25 miles, bikes 25 miles back and forth to work. And you think your workout is hard.

He makes you think twice about the limits of human performance.

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How To Make Fitness Goals and Achieve Them

February 28 2011

Use this simple step by step approach to make and achieve fitness goals.

Please click here to read about making fitness goals

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What is the Placebo Effect?

February 23 2011

We all heard about the placebo effect. Here is a nice little video explaining what it is and what it can do for you.

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Making A Strength/Size Routine

February 20 2011

Casey Butt is most popular for his writings about the maximum muscle growth potential for natural trainees. In this article series, he makes a lot of sense about exercise selection, sequence, frequency, reps & sets. 

In the first article , he talks about multi joint exercises like squats and deadlifts making the core of your workout and keeping single joint exercises to the minimum.

In the second part, he talks about sequencing exercises. It is about how you should start with compound exercises before you get into isolation exercises.

In the third article, he talks about the repetition range for muscle growth and strength.

In the forth article, he talks about how often you should train, how many sets you need, volume based on bone structure and such.

In the final one, he writes about training splits and how to decide if you want to use a full body or a split routine.

If you are drug-free and genetically average, these articles are for you.

Making A Strength/Size Routine Part I
Making A Strength/Size Routine Part II
Making A Strength/Size Routine Part III
Making A Strength/Size Routine Part IV

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What’s My Genetic Muscular Potential?

February 20 2011

If you are unaware, Lyle Mcdonald is one of the very few in the industry who takes an evidence-based approach to fitness & nutrition. And Lyle is extremely honest which is a rarity in the fitness field.

In this article, Lyle explains how much muscle you can gain realistically for men and women. And it is very very low than most people think. Here is the table Lyle had in the article. For women, you take half of the below values.

You can read the article here: What’s My Genetic Muscular Potential?

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Does Nitric Oxide (NO) Supplements work?

February 08 2011

Nitric Oxide (NO) supplements are one of the most popular pre-workout supplements. NO explode is one of the top selling pre-workout supplements at bodybuilding.com.

The major claim of nitric oxide supplements is that it increases blood flow the muscle and can bring in more oxygen and amino acids. ( and thereby increase muscle growth). But is it true?

What is Nitric Oxide?

• Vasodilator:  Nitric oxide works as a vasodilator. It means it dilates or expands, especially tubes through which blood flow (blood vessels).
• Arginine: Arginine is an amino acid and produces nitric oxide (NO) in the body, so the supplements which contain L-arginine are essentially nitric oxide supplements.

Why is nitric oxide such a popular supplement?

• Increased Blood Flow: Since nitric oxide expands blood vessels, it is claimes to increase blood flow and oxygen to the muscles during exercise.
• Increased Protein Synthesis: Increased blood flow means increased transport of amino acids and nutrients and thereby greater protein synthesis and muscle growth.

But Can nitric oxide supplements increase blood flow?

• Clinical Population: Number of studies have shown that In conditions where NO production is reduced (common in various conditions such as cardiovascular disease diabetes, hypertension, etc.), arginine supplementation can increase NO production and blood flow.
• Healthy Individuals: In healthy individuals, who have normal NO production, oral arginine supplementation do not further increase nitric oxide and thereby blood flow. This was shown in number of studies.
• In healthy individuals infusion of very high doses of arginine (3-4 times higher than oral dosage) has shown to increase NO and blood flow though.

Can nitric oxide supplements increase protein synthesis with resistance training?

• Protein Synthesis: This was also tested in a recent study in healthy individuals. They found 10 gms of arginine supplements taken before resistance training neither enhances blood flow nor protein synthesis compared to a placebo without exercise.

Practical Application

• If you have cardiovascular diseases, diabetes, burn injury and such, nitric oxide supplementation can increase blood flow.
• For healthy individuals , Nitric oxide supplements do not increase blood flow to the muscle or protein synthesis as claimed by NO supplements

Reference 1
Reference 1

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Does the Shake Weight Work?

January 31 2011

Shake Weight is the new fitness product which is the talking point these days. Of course, the guy and the girl who uses it is ripped. So it should work. Or does shake weight work? Here is my shake weight reviews.

What are the Shake Weight claims?

1. Get toned & firm arms in 6 minutes a day - for women.
2. Build definition, strength & size in 6 minutes a day - for Men.

So does the Shake Weight  work?

Since there is no shake weight study out there, all we need to see is if shake weight goes against the fundamental science of muscle growth and fat loss.

• Body fat: You cannot burn body fat from specific areas of your body by exercising those specific areas. This is called the myth of spot reduction. It is the same reason why millions of Americans who does thousands of crunches at the gym still have no abs. So shake weight fails big time for fat loss.
• What about the calories burned? You might burn 30-50 calories with a 6 minute workout since it only uses small muscles groups, with a small range of motion, and for very short time. To burn a pound of fat, you need to burn 3500 calories!
• Muscle Gain: There might be some increase in muscle in your upper body for a beginner for the first few workouts, but then your muscles adapt.  Since there is no progression in weights with a shake weight, which is the cardinal rule of muscle gain, no shaking will ever get your more muscular.
• Tone: You look toned when you lose fat and gain some muscle. Since shake weight fails to do both, guess how can it make you toned?
• Pump: Most of the shake weight ads show people using it and feeling the burn in your arms and upper body and they think “wow it works”. You can get a regular dumbell and shake it too and you will feel the same. Or get a bottle, fill it half way, and shake it .

Are there any risks with Shake Weight?

• Harm:  It is now well established that vibration exposure can cause harmful effects. According to OSHA (Occupational & Safety Hazard Association), long term exposure to vibration can also cause nausea, impaired vision, hyperventilation, and disorders such as White Finger Disease (Raynaud’s Syndrome), Hand-Arm Vibration Syndrome, & Carpal Tunnel Syndrome.

Practical Applications

• Shake Weight do not work to get toned, gain strength, muscle or burn calories.
• Regular use of shake weight may cause some vibration exposure problems.
• If shake weight helps anything, it teaches you how to market the wrong product the right way.

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Functional Movement Screen: Is it Really a Screen?

January 21 2011

FMS is a battery of 7 movement tests which claims to predict injuries and even prevent injuries. It is becoming very popular among NFL players and other fitness professionals.

From what I have seen, the majority of people who use the screen are personal trainers. I wrote a review about FMS when I attended a 2-day seminar 3 years back here (Functional Movement screen).

Gray Cook, one of the brightest and most eloquent in the industry, in one of his recent podcasts talks about how FMS screen should be used on everyone just like a blood pressure screen. Let us see if FMS can be used as a screen or not.

What is the difference between a diagnosis test and screen?

Diagnosis: People are sick and they “come to you” because they want you to diagonoze why they are sick.

Screening: People are well and healthy and might be coming to you for some unrelated problems, and we are “soliciting them” telling that they will live longer or live better if they let you test them.

So what is the problem with FMS as a screen?

Screen Requirements: When you employ any type of screen, the validity of the screen should be of the highest quality since you are “labeling” people.And hence we should have some very solid proof that people will be better off in the long run. When someone scores less than the cut-off score in the FMS, you tell them that your chance of getting injured is extremely high. This is a great way to get someone move less or have fear of movement or spent their time and money trying to fix it with their trainer.

Injury Prediction: FMS has not been tested on the lay people, and hence we really don’t know if people will get injured if they scored less than the cut-off.

Injury Prevention:If they proved that FMS can indeed predict injury, then they will also have to prove that if you were to fix the movements that it will reduce the chance of getting injured. And FMS has not been shown to prevent injuries.  If you can identify injuries but can’t prevent injuries, then you better not label people or screen them in the first place.

Frequency & Severity: The importance of any screen will depend on the frequency and the severity of the problem. When FMS is used on lay people, you have to ask what is the severity and frequency of injuries. In NFL FMS study, 13 people out of 46 got injured in 4.5 months (28 in 100).  For the lay people, we might get 1-5 injuries out of 100 people in 1-3 years!

False positives & negatives: Every screen or test has false positiives & negatives since no test is 100% accurate. For example, even mammography screening will falsely diagnose of someone having breast cancer, when they don’t have it or falsely diagnose of someone not having breast cancer when someone has the disease. The measure of these are called the sensitivity & specificity of a test

In the FMS study for NFL players, the sensitivity was 46%. That means out of 100 people who will get injured, the test only identified 46 of them correctly, which is less for a screening test. A screening test needs high sensitivity (90%) because we want to identify as many people with the disease because we think this disease is of such importance that people need to be screened for.

Cost Vs Benefit: If we finally “prove that FMS indeed predicts injuries and prevents”, what is the cost vs benefits here? Imagine your client comes to get in shape as most lay people do. You do the FMS, finds dysfunctions, and tell them that their likelihood of getting injured is high. Though that wasn’t their goal or priority, you make them go through the FMS screen fixers for 10-15 minutes for which they have to pay 50-100 dollars an hour. 

So you have to ask yourself, with any screen, does all this time, money, and anxiety people have to go through, will it improve the quality of life in anyway? Will trying to minimize an injury which has the chances of next to nil in years improve her quality of life? Probably not. 

But what about an NFL player? For the NFL players, the benefits are huge. The severity and frequency of the problem is so high, the risk of getting injured is next to losing millions and their career. FMS also shown to predict injuries in NFL in one study. Injury prevention should be their primary goal.

Other: FMS is available, affordable & not that time consuming which is indeed a plus for any screen.

Practical Applications

• For high impact sport athletes, FMS can be a worth while screen though this is not as black and white as most see it. 
• For the lay people or the average joe who goes to gym, FMS cannot be justified as screen
• What I wrote above is an integral part of evidence-based approach, which is not all about research studies as most people think.

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What are your chances of getting cancer?

January 09 2011

Cancer and other cardiovascular diseases are pretty common these days . Usually the chance/risk of you getting /preventing/ treating cancer/other diseases is usually expressed in percentages since we are not certain about their outcome.

But sometimes these percentages can be deceiving.

Which drug will you take to lower the risk of cancer?

• Drug A can lower the risk of dying from cancer by 25%
• Drug B can lower the risk of dying from cancer by 0.1%

Which drug will you take? Obviously, Drug A.

In fact, it doesn’t matter which drug you take: The risk reduction of 25% and 0.1% ,though looks different, is in fact the the same for both the drugs

How can Drug A & B have the same effect ??

It is because the percentages are just expressed differently as in absolute vs relative risk.  Risk or chances of you getting/preventing/treating a disease is usually expressed in absolute or relative risk.  The risk always appear bigger when expressed in relative risk than absolute risk as you can see.

• Drug A (25% reduction) is expressed as Relative Risk
• Drug B (0.1% reduction) is expressed as Absolute risk

For example, consider 1000 women who did not take the drug A/ B and another who did take. Within 10 years,  4 die in the first group an 3 in the second group which did take the drug of cancer as shown in the picture. You can see how we got the absolute and relative risk reduction.

How do people use this information?

• Drug Company: A drug company will always write risk reduction in relative risk to make the benefits look great and the side effects in absolute risks. So you might read an article that Drug A will lower the risk of deaths by 25% and the risks of developing side effects is 1%. That is great drug you will think!
• Caring Doctor: A caring doctor will usually express the risk in absolute terms and avoid percentages. So if the risk is .1% , he will say we will have to treat 1000 people with this drug to prevent one death(shown in the pic). This concept is called Numbers Needed to Treat (NNT).That is not that great as you previously thought!

Practical Application

• Risk/chance can be expressed in relative risk or absolute risk.
• Relative risk is always higher than absolute risks and hence often misread.
• It is better to use absolute risk or the Numbers Needed to Treat (NNT) concept to get the true picture.

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Does It Work?

January 01 2011

Being in the fitness field, the usual questions I get are Does it work? Does P90X or crossfit works? I heard it works, Is it good for you? and so on.

But these question lack three important parts to make it meaningful:

Works for what?: It means is it for strength, muscle growth, fat loss, flexibilty, cardiovascular endurance and so forth. The “what” is important because to optimize each of these goals require a different training or workout program.

For example, crossfit will work for strength endurance since it involves a lot of high rep training, but won’t be the best for maximal strength. Yoga works for flexibility but not good for strength muscle growth, or cardiovascular health. Running works for fat loss but not for building muscle.

Works for who? You have to specify the population you are trying to use it too. The who is important because results can be completely different based on your training level, age, gender and so forth.

The whom depends on the type of question. For injury prevention, the age, the gender, sport played, and the level can have different effects on injury prevention.  For example, females have 4-8 times ACL injury than males, soccer will have more ACL injuries than cycling. A training program to increase strength and muscle for a beginner won’t work for trained individuals.  A drug which works for men may not have the same effect on females too.

Compared to what? When you say the program X it works, what are you comparing it to? 

For example, when you say P90 works, are you saying P90 will increase strength and muscle more than not working out? Of course, it will.  Or are you saying P90 works better than a general 3 sets strength and cardio routine?  Maybe. If you are saying P90works for increasing maximal strength than a powerlifting routine. I will say of course not.

In drug studies, the comparison group gets a placebo ( a drug which has no effect but it looks, smells and feels the same).  The goals of the drug study is to see if the new drug works better than the placebo drug. So the placebo works too, but compared to a real drug, the effects are not great.

Practical Application

• Every time someone asks if a new program or diet or drug works, ask if it works for what, who, and compared to what
• When you read a study, look what are they measuring, in whom they are measuring and what are they comparing it too.
• Happy New Year!

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Is Muscle Soreness A Reliable Indicator of Muscle Growth?

December 28 2010

Is muscle soreness a reliable indicator of muscle growth? Most people think it is. If they get sore, they think they had a great workout and in turn will grow muscle. If they don’t get sore, they feel they didn’t do enough to cause muscle growth.

What is muscle soreness?

Discomfort or pain in the muscle caused by unfamiliar physical activity. It shows within the first day and peaks within 2 days,  and then disappears within 5-7 days.  Hence it is called DOMS or Delayed onset of Muscle Soreness.

What causes muscle soreness?

There are so many theories proposed, but none has conclusively be proven to cause soreness. The current theory tries to explain soreness through a combination of theories.

1. Muscle and connective tissue damage due to high forces, especially eccentric contractions (means lowering the weight).
2. Increased ca leakage from the muscle and inflammations worsen the damage
3. Sensitizes and activates the pain receptors to cause pain and discomfort.

So why Is muscle soreness NOT indicative of muscle growth?

Muscle damage not required: Muscle can grow with just tension and no damage. Most people think that damage is required for muscle growth.

Receptors called integrins can sense mechanical load and activate pathways which are required for protein synthesis and thereby muscle growth (Integrin Mediated signaling). So even if you are not sore, you might be very well growing.

Soreness not indicative of the level of damage: You could have done the same muscle damage, but the pain receptors get less and less sensitive with damage . So you don’t feel the soreness, though the damage is still present and maybe even more than when you had soreness. So soreness is not a reliable indicator of the magnitude of muscle damage either.

More soreness do not mean more growth: It doesn’t matter how hard you hit the muscle or how many sets you do, the protein synthesis levels can only go up so far. So more soreness do not mean more damage and more protein synthesis and hence more growth

More Soreness may mean less muscle growth:  Unlike synthesis, protein breakdown on the other hand, will go up with greater damage. So when you are really sore, it could also mean that you are breaking down more muscle and in turn growing less!

No soreness results in muscle growth: People have experienced muscle growth without soreness.  Low reps hardly ever cause soreness, but powerlifters who does low reps all the time are as big as bodybuilders.

Major soreness results in little muscle growth: People get really sore from endurance training like cycling and running or playing ping pong. But they don’t grow any appreciable muscle compared to lifting.

Practical Applications

• Soreness is not a reliable indicator of muscle growth and soreness is clearly not required for muscle growth.
• Soreness only means you have caused muscle damage which may or may not result in muscle growth.

Reference 1

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Carbs Not Required for Your Workout Protein Shake

December 19 2010

The belief that carbs are required in your post workout protein shake is so established that the debate has been more about whether to take high gi or low gi carbs, if waxy maize is better than dextrose. and so on. But this recent study shows that carbs may not be required in the first place.

Why carbs were needed in your workout protein shake?

Protein break down: Protein breakdown is increased after workouts. Carbs increase insulin levels and can blunt protein breakdown after your workouts. This is the major reason why carbs are added with protein shakes.

Protein Synthesis: Carbs can increase insulin levels and slightly increase protein synthesis.

Glycogen: Restore glycogen in the muscle. Unless you are doing a lot of high reps, glycogen is not really depleted with weight training.

What was the study design?

• 9 recreationally active subjects were randomly assigned to a Protein only group and a protein + carbs group.
• Participants performed 2 trials seperated by 7 days of 4 sets of leg extensions (8-12) for failure after an overnight fast.
• The protein group consumed 25 gms of whey protein while the protein+carbs group consumed the protein with 50 gms of malto dextrin

What were the results of the study?

• As predicted, the glucose and insulin levels was significantly greater for the protein+carbs group
• But, guess what, there was no difference in protein synthesis or protein breakdown between the protein only group and the protein plus carbs group.

Are there other studies to support?

30 gms vs 90 gms: Another recent study looked if 90 gms of carbs +amino acids can decrease protein breakdown compared to 30gms+amino acids after resistance training. But they didn’t find any significant difference between the groups.

Though study lacked a group with only protein to see if there is any difference if only protein was ingested, the results are consistent with this study.

Practical Applications

• There is no reason to add carbs in your post workout shake to decrease protein breakdown or increase protein synthesis.
• The protein itself in the shake is enough to increase insulin levels and decrease protein breakdown to the maximum extent

Reference 1
Reference 2

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Are Low Reps Ideal for Strength?

December 14 2010

Every now and then, you will articles saying bodybuilders should do low reps since that will help them increase their strength. And you will also see training programs for muscle which will have a mix of low and high reps to target both strength and muscle.

But are low reps ideal for strength?

Why is low rep considered ideal for strength?

Powerlifters: Powerlifters are the strongest blokes around, and their training involves a lot of low reps ( 1-6 reps).

Guidelines: According to text books and exercise guidelines, the repetition range for strength is 1-6 reps.

So what is the problem?

Types of strength: There are different types of strength: Maximal strength is the amount of weight you can lift for one repetition. And people are usually refferfing to maximal strength when they say just strength.

On the other hand, strength endurance is the maximum amount of weight you can lift multiple number of reps, say 15-20.

Specificity of strength: According to the theory of specificity, strength is very specific to the repetition range.

So if you want to increase your maximal strength, you do a lot of low reps (1-6). If you want to increase the weight you do for 10 reps, you do a lot of reps around 10 (8-12). If you want to increase your 20 reps, you do a lot of 20 reps ( 18-22).

Example: Consider 3 people A, B, and C with the same genetics, diet, body weight and motivation. A does a lot of bench press in the range of 1-6, B does a lot of bench press in the 8-12 range, and C does a lot in the 20-25 range. Who is stronger?

            A is the strongest in 1-6 reps
            B is the strongest in the 8-12 reps
            C is the strongest in the 20-25 range.
                           

Is there any evidence for this?

The above example was tested in a study. The first figure shows what happens when they were tested for maximal strength. As predicted, A was the strongest.

In the second figure, they were tested for strength endurance. And guess what, A was the weakest!

Practical Applications

• Strength is very specific to the repetition range.. There is no magic to low reps that is missing in high reps in increasing strength
• If you are training for muscle, there is no reason to add low reps to increase “strength” as most people say.

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How to Build and Stretch your Calf Muscle?

December 04 2010

You can emphasize the soleus or the gastroc with different exercise and stretches. Here we use the concept of active and passive insufficiency.

What are the different calf muscles?

Gastrocnemius: Gastroc is the muscle which has two heads and is visible from outside as two diamond heads.  Gatsroc has 2 functions: Bending the knee and raising your heel.

Soleus: Soleus lies beneath the gastroc and is not really visible. The soleus performs just one function of raising the heel as in calf raises.

How to build your soleus and gastroc muscles?

Seated Calf Raises: Seated calf raises target the soleus than the gastroc since gastroc is almost inactive during bent knee exercises.

The gatsroc is already used when the knee is bent and hence it cannot work to raise the heels. This is called the principle of active insufficiency.

Standing Calf Raises: On the other hand, standing calf raises emphasizes both the gastroc and soleus equally well.

How to stretch your soleus and gastroc muscle?

Straight Knee: Straight knee primarily stretches the gastroc.

Bent Knee: Bent Knee stretches target more of the soleus since the gastroc muscle is contracted.

Practical Applications

• Straight leg exercises target both the soleus and gastroc muscles. Seated calf raises only target the soleus muscle.
• Straight knee stretches target the gastroc muscle while bent knee stretches target the soleus

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Can Vitamin C Prevent and Treat Common Cold?

November 28 2010

Should you take vitamin C to prevent and treat colds? Let’see what does this 2010 review add to the topic.

Why look at vitamin C?

• Common cold is the major cause of visits to the doc in western countries and absentism from work and school
• Worse yet, you to miss your workouts too!
• Anitbiotics are ineffective since common colds are caused by viruses
• Vitamin c has been widely sold to treat and prevent common cold

What were the study highlights?

The study is a systematic review. Out of 55 studies, 36 met the inclusion criteria.

• High quality methodology: Studies were accessed for blinding, random allocation , placebo indistinguishabilty, allocation concealment, studiy search done by independent authors and sought intrepretation only when data is questionable.
• Treatment: Orally administered vitamin C of at least 0.2 g daily for a single day or for a period.
• Outcome: Outcome measures were incidence, duration or severity of the common cold.

What were the vitamin C study results

• Prevention (incidence of colds): There is very little benefit of taking vitamin C routinely to prevent colds. In special circumstances, If you physically very active and /or exposed to cold conditions (marathon running, skiers), vitamin C could beneficial to prevent colds. This was consistently shown even with smaller doses.
• Treatments after the onset (therapeutic): No trials have shown it to be effective. But since vitamin C has consistently shown to decrease the severity and duration, it might be worth a try. We need more studies to see if high doses ( 8g/day)  can have a therapeutic effect and if supplementation is more effective in children than adults.
• Dosage: The effective dosage can be from 1 gms to 8 gms.

Practical Applications

• If you live in cold countries and is highly active or prone to colds (athelete or heavy lifting, dieting), supplementing vitamin C during the winter could be beneficial. The dosage could be from 1- 4 gms.
• There is little practical benefit of taking it year round.
• If you already got a cold, try some high doses as soon as you can (4g -  8g). If it doesn’t work, have some chicken soup instead

Reference 1

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Evidence-Based Approach to Fitness/Sports Performance

November 21 2010

From what I have seen, most folks have very little understanding of an evidence-based approach. They think EBP is all about taking the results of a study and just blindly applying it. This is called research utilization  and is clearly NOT evidence-based approach.

So what is the definition of evidence-based approach?

As the figure shows, evidence-based approach involves the integration of the best available evidence with the trainer’s/coach’s expertise and the client values, goals, and circumstances.

Best available evidence from research

• Science of training: This part is the crux of an evidence- based approach and is called the “science of training”. The best evidence is obtained from high quality randomized experimental trials to determine the effectiveness of a particular workout program/supplement/diet and so on.
• Example: For example it is clear from reviews and meta-analysis that multi-sets are better than single sets to increase strength and muscle in intermediate and advanced lifters.  It is clear from studies that supplementing creatine with your workouts helps with muscle growth and strength.

The experience and expertise of the coach/trainer

• Art of training: No evidence can replace the trainer’s/coach’s expertise and experience. This is what they call the “art of coaching or training”.You will never find a study where the subjects are exactly the same as your clients. Ironically , the number one criticism against the evidence based approach is that evidence based approach ignores trainer’s/coach’s expertise and judgment and is just a cookie-cutter approach.
• The client’s age, training history, injury problems, biomechanical constraints,  fitness assessments , stress level, personality , sleep, diet, genetics, skill can all have an influence on the effectiveness of the workout program and hence the evidence needs to be tailored to the individual client. 
• Example: For example, an older client with stressful job will need much lower volume to maximize recovery. Also, the evaluation and correction of the exercise technique is solely dependent on the trainer’s experience and expertise

client concerns, values, circumstances, & preferences

• Client, client, & client: The client goals and preferences are important though the best evidence may not recommend this option . For example,  taking long rest periods in between low reps when the client don’t want to sit around and waste time.  Though the best evidence shows that long rest periods are optimal for low reps, this may not be the optimal decision strategy for that particular client.
• Example: I have come across numerous times when trainer makes the client do a lot of funky functional exercises on the ball when the client just wanted to lose weight. This is where the trainer’s preference is taking precedence over the clients preferences

The above is just a very brief introduction to the topic of evidence based approach.

There is certainly more to it like hierarchy of evidence, grading of evidence, appraising the evidence and so forth, but this article is certainly a good place to start. Unfortunately, in the fitness/performance field the research evidence part is missing and the decision making is solely based on the trainer experience/expertise and client goals and preferences.

Let me know what you think of the article.

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Can Eccentric Training Increase Muscle & Strength?

November 06 2010

The meta-analysis (2009)  looked to see if eccentric training is superior to concentric training for strength & muscle mass.

Why eccentrics are different from concentrics?

Eccentrics involve active lengthening and concentrics involve active shortening of the muscle fibers

Characteristics of eccentric contractions

• They can produce more force than concentrics. So you can use more weight than concentrics.
• They selectively recruit Fast fibers. Fast fibers are bigger and have greater potential for growth than slow fibers
• They recruit less fibers than concentrics and hence accumulate greater damage and greater protein synthesis ( and greater protein breakdown too , mind you).
• The use very little energy and hence has very little metabolic fatigue
• In contrast to concentric, higher velocity generates greater force in eccentrics.

What were the study highlights?

• Meta-analysis: The study combines all the studies comparing eccentric exercise to concentric exercise into one big study.
• High Quality:  As like any quality meta-analysis, the study had an inclusion and exclusion criteria, quality assessment of studies by independent reviewers, subgroup analysis based on contraction mode and speed of contraction and so on.
• Included studies: After reviewing 66 studies, only 20 studies were included based on the inclusion and exclusion criteria.

What were the results of the meta-analysis?

• Strength: Eccentric training is more effective at increasing eccentric strength than concentric training. The greater strength increase was only shown with higher eccentric intensity. But even training with higher eccentric intensity did not increase concentric strength.
• Muscle: Eccentric training appears to be more effective at increasing muscle mass than concentric training. This increase was shown with both higher and comparable eccentric intensities. Some of the conflicting results are speculated to be because of the different methods of measurements used.
• Velocity-Specific: Eccentric strength is highly specific to the velocity of training

Practical Applications

• Adding a few sets of eccentric sets for the weaker body parts can be helpful. You can also add few weeks of eccentrics at the end of your training cycle too.
• Eccentric for every exercise or bodypart will be extremely fatiguing and will negatively affect your recovery.
• If you are into sport performance, training eccentric contraction at the velocity of the sport will be more helpful in improving eccentric strength

Reference 1

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What is Wrong with Testimonials and Results?

October 20 2010

Every trainer and fitness website has a testimonial page with a lot of impressive before and after pictures. And everyone claims it’s all about results. But what is blatantly wrong with these testimonials and results?

And this is the typical strength coach and trainer’s classic line: “I get results and results are all that matters”. Do you?

What is missing in testimonial and results?

Negative results: Have you ever seen a testimonial page with people looking the same in before -after pictures? Or anyone writing about how the program or the supplement didn’t do anything good for them?

For example, the testimonial page shows 10 people who got great results with the diet/workout program. But here might be 9 more people for whom the diet/workout didn’t do anything and 2 more people where the program/diet actually made them worse. These people are never seen of the testimonial page. Do you think the diet/ program still works?

Drop Outs: There are folks who dropped out from a diet or workout program and you will never find their names on a testimonial page. These are the people who usually think the program and supplement didn’t work for them. In drug trials of fatal diseases, like cancer, they usually say “dead men say no tales”.

What about research?

Reporting Bias/Outcome bias: In research this type of under-reporting is called publication bias or/and outcome bias.

In research, you have to report negative results, adverse outcomes, and the study drop outs /attrition rate. The effectiveness of a treatment/supplement is identified by taking into account BOTH the positive and the negative results. If you do not report negative results, you are in violation of the standard code of scientific conduct & ethical behavior and may end up in some legal trouble.

Practical Application

• This is the problem with results/ testimonials. Everyone seem to have results and it is hard to pick one workout/diet over the other based on it.
• Next time when someone talks about results/testimonials, ask them if they ever heard about reporting/outcome bias and send this article to them.
• That’s one more reason to stick with scientific studies.

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Does Glucosamine Chondroitin Help knee and Joint Pain Due to Osteoarthritis?

October 09 2010

Glucosamine Chondroitin is the most popular supplement for joint pain. But does it really help?

What is osteoarthritis?

• Osteoarthritis: Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling
.

Why use Glucosamine & Chondroitin?

• Glucoasmine Basics: Glucoasmine and Chondroitin are the building blocks of your cartilage and hence is believed to make up for the loss of cartilage.
• Dosage: It can come in combination with other supplements (such as chondroitin), or by itself in the form of glucosamine hydrochloride or sulphate.  The usual dose recommended on packages is 1500 mg per day or 500 mg three times a day.

Why study again if it is already being used?

• Benefits: The studies have been conflicting. Studies which shows a benefit used small sample size and had methodological flaws. 
• No Benefits: Larger studies with sound methodology shows no or small benefits.

What were the major study points?

• Meta-analysis: It basically combines the results from a number of studies done on the same topic. It is kind of like a study of studies. So 3 studies of with 10, 50, 100 will be one big study of 160 subjects.
• High Quality: All the studies selected were methodologically superior, large scale and blinded which wasn’t the case of previous reviews. Out of 58 studies, only 10 (3803 subjects) made it to the analysis based on the inclusion criteria. Each study had to have atleast 200 patients.
• Outcomes: The study looked at pain and joint space width (smaller joint space means more cartilage build up).

Trials compared chondroitin sulphate, glucosamine sulphate, glucosamine hydrochloride, or the combination of any two with placebo or head to head.Hence the name network meta-analysis.

Practical Applications?

• Chondroitin, glucosamine, and their combination do not have any beneficial effect on joint pain or on joint space narrowing. Or just basically they don’t work for joint pain due to osteoarthritis.
• The supplement is not harmful and hence people who get some benefits can keep taking it if they have the money.
• The industry-sponsored trials (Rotta brand) showed better results in pain and function than industry-independent trials. Guess why is that?
• These results are consistent with the recent Cochrane Review 2009 on glucosamine and osteoarthritis

Reference 1
Reference 2

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The Top Natural Bodybuilders

October 03 2010

Like the Mr.Olympia, there is no single federation where all the natural bodybuilders compete.So it is hard to pick the best or the biggest natural bodybuilder.

In my opinion, these are the best natural bodybuilders (in no particular order) who have stood out in the recent years. Note that all these natural bodybuilders are currently competing. These are also some of the The biggest natural bodybuilders you will ever find.

Phillip Riccardo

Age: 39
Competition Weight: 180

Kiyoshi Moody

Age: 40
Competition Weight: 195-200

Doug Miller

Age: 33
Competition Weight: 186-192

Jim Cordova

Age: 31
Competition weight: 170-180

Jeff Rodriguez

Age: 27
Competition Weight: 180’s

Who do you think is the biggest natural bodybuilder?

And just to give you some perspective. Here is what drugs can do to you.

Jay Cutler

Mr. Olympia 2010 (Not Natural).
Age: 37
Competition Weight: 270!

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The Top 5 Exercise Journals

September 26 2010

Most folks and even exercise science experts are unaware of how journals are rated and how these rating affect on the quality of the studies published .

Which are the top 5 exercise & sport journals?

1. Journal of Applied Physiology (3.73)
2. Medicine and Science in Sport & Exercise (3.70)
3. American Journal of Sports Medicine(3.60)
4. Exercise & Science Sports Reviews (3.62)
5. Sports Medicine (3.11)

The popular Journal of Strength & Conditioning Research is ranked 34 (1.457)! Their secondary journal Strength & conditioning Journal is ranked 64!
* These are 2009 ranking and subject of category is “sports science”

What are these journal rankings based on?

These ranking are based one the most popular bibliometric indicator called the Journal Impact Factor. The journal Impact Factor was first published in 1961.

• Journal Impact Factor =  The number of times an article in a journal is cited in the past 2 years divided by total number of articles published by that journal in past 2 years

What are the limitations?

There are number of limitations for this ranking system. Some of them are:

• Subject Area: The raking differs a lot based on the subject area. Exercise field’s highest ranked journal has an IF of 4 while basic life science (or fundamental) journals like Nature or Cell has an IF of 40. So comparisons should not be made across subject areas.
• Publication Type: You can easily see that review articles has a lot more citations. Hence journals which only publish review articles will always be rated high.
• Editorials, Letters & Meeting Abstracts: These are included in the numerator but only articles and reviews are included in the denominator. So these letters and editorials can raise the IF of the journal considerably without publishing any major articles.

So why do people still rely on impact factor:

Impact Factor is extremely important in the research circles.

• Scientific Career: Promotion and tenure in most universities depends on how many of your articles you publish are in high IF journals.
• Librarians: With the price of journals on the rise and so many journals to pick from, librarians need a ranking system bases on objective measures.
• Editors: They need to a objective criteria to see if they are meeting the standards.
• Quality articles: This may not be always true, but the journals with the highest Impact factors are very hard to get accepted in and hence the quality of the articles are always top notch.

Usually getting an article published in Nature or Cell is a dream for most researchers. Some of the researchers (atleast the ones I worked with) doesn’t even bother reading articles published in low impact journals.

Practical application

• Next time when you are reading an research article (not just exercise journals), it is a good practice to look up the Impact Factor of the journal in which it is published.
• The quality of research articles in journals with high IF is usually pretty high.
• Journal articles should not solely be judged on the journal in which they are published.

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Is Effort or Weight Lifted Important For Muscle Growth?

September 18 2010

Weight Lifted: Is defined as the amount of weight you can lift.  This is usually denoted as 10 RM or 5 RM.(for ex, 5RM or 5 Repetition Maximum is the maximum amount of weight you can lift for 5 reps.)

Effort: Effort is the degree of difficulty in performing an exercise. This is more subjective and hard to quantify.  The effort required for a 10RM to fatigue can be very similar to 5RM though the weight used is much different.

Is weight lifted or effort Important for Muscle Growth?

Type 2 Fiber Recruitment: Type 2 fibers are the fibers which makes you big. They have greater growth potential and much stronger than Type 1 fibers.

According to the size principle, the greater the effort, the greater the activation of Type 2 fibers. If the weight is heavy ( less than 6 reps), all fibers are recruited from the first rep. For moderate weights (greater than 6 reps), it is the effort in those last few reps that determine Typ2 fiber recruitment .

Protein Synthesis Studies: In line with the Type 2 fiber recruitment,  recent studies have shown that moderate weights taken close to fatigue can stimulate protein synthesis to a similar extent as heavier weights. Occlusion studies clearly shows light weights with greater effort can cause similar muscle growth to using heavy weights.

Anecdotal Evidences: It is common to hear natural bodybuilders say it is the intensity (or effort) that matters not the repetition range and the program.

The same goes with power lifters. Most people think it is not the program but the crazy training intensity at their gym is what makes Westside lifters among the best power lifters in the world.

Practical Recommendation

• It is not required to train with heavy weights ( less than 5 reps) for muscle growth.
• Using Heavier weights (< 5 reps) can cause greater fatigue, and may delay recovery. Also, there is a risk of injury with heavier weights.
• Moderate weight ( between 5 -15 reps) trained with high intensity is ideal for muscle growth for most folks.

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Power Plate: Do Vibration Plates Work?

August 21 2010

Power plates seems to be the latest trend in the fitness indusrty. And there are number of studies done on these vibrating exercising machines. Let’s take a look at what the science say about the power plate.

What is a Power Plate?

Power Plate, one brand of vibration plate,  as the name implies uses whole-body vibrations while you perform exercises on the plate.

What are the power plate performance & health claims?

The power plate company claims that power plate helps:

• increase strength & power even in elite athltes
• improve your golf performance
• prevent age-related muscle loss
• increase bone density
• remove toxins and thereby decrease cellulite

Their most marketed claim is the increase in strength and power and how it is used by elite level athletes in the NBA, NFL, and pro golf players. Here is a qoute from their website:

“For serious athletes, workouts on the Power Plate® machines enhance the results of conventional training and explosive strength training, as well as serve athletes and trainers alike to speed recovery and regeneration times. Because of the extensive academic and independent scientific research, professional sports teams throughout the world use Power Plate® machines as part of their strength and conditioning programs.”

So does power plate help in increasing strength and power?

There are number of long term studies which looked at strength, power and speed changes with vibration training. The power plate website quotes number of studies which show significant increase in strength and power. But almost all of these had serious methodological issues as shown below:

• Passive control Group: The control group in the majority of the studies did not exercise. They just sat on their butt. No wonder they saw large improvements in strength and power compared ot the control.
• Improper Control: The studies which concluded that vibration training is as effective as traditional strength training did not normalize intensity. Since the intensity was not normalized, it just could be that the intensity of exercises in both groups were similar and the vibration had nothing to do per se in the improvements.
• Proper control: Now guess what, the studies which employed a proper control where they did similar exercises without vibration saw no statistically significant difference in strength or power.

Looking at all the studies, we can conclude that:

• Strength and power:  None or only minor additional effects on muscle strength and jump performance as compared with performing the same exercises without vibration.
• Speed: No improvements in speed is observed.
• Bone density: There is evidence to show it increase bone mineral density.
• Other: There is no evidence to show that it will remove toxins and decrease cellulite or improve your golf performance or prevent age related muscle loss

Can vibration training be harmful?

• OSHA: It is now well established that vibration exposure can cause harmful effects. According to OSHA (Occupational & Safety Hazard Association), long term exposure to vibration can also cause nausea, impaired vision, hyperventilation, and disorders such as White Finger Disease (Raynaud’s Syndrome), Hand-Arm Vibration Syndrome, & Carpal Tunnel Syndrome.

Practical Recommendations

• There is no conclusive evidence to recommended power plate as a replacement or addition to the resistance training to improve performance.
• Besides increase in bone density , there no evidence to support the claims made by power plate.

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CPR:  Just Chest Compressions To Save Lives?

August 15 2010

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that involves a combination of rescue breathing (mouth to mouth)  and chest compressions delivered to victims in cardiac arrest.

In my opinion, this is probably the most useful skill you will ever learn in your life.

Why is CPR important?

• An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive.
• CPR allows oxygenated blood to circulate to your vital organs such as the brain and heart and doubles the likelihood of survival for victims of cardiac arrest. Without oxygen, permanent brain damage or death can occur in less than 8 minutes

What are the different methods of CPR?

• Standard CPR: The standard versions of CPR, practiced for more than 50 years,  involves cycles of 30 chest compressions and 2 rescue breaths.
• Continuous Chest compression CPR: In the new chest compression CPR adopted by American Heart Association 2 years back, there is no rescue breathing, only chest compressions (100/min)

Till date, besides animal studies and a few small studies,  there has been no large human studies comparing the effectiveness of these 2 methods on survival.

What does the recent studies suggest?

Two recent large studies (1900 and 1300 hundred people) published in the top clinical journal - New England Journal of Clinical Medicine - suggest that continuous chest compression CPR by bystanders is as effective for survival as the traditional CPR of rescue breaths.

Why is chest compression CPR better?

• People being panicky and being worried about doing CPR wrong were the two top reasons why people don’t attempt CPR.Chest compression CPR procedure is simple to perform and teach and more people are likely to perform it over the standard CPR.( The traditional CPR requires a CPR certification training).
• Most times people do rescue breathing wrong and the breathing the interruption reduces blood flow to the major organs.
• There is no mouth to mouth contact and hence there is no concerns and risks associated with the transmission of infectious diseases
• Chest compression CPR is more effective in certain heart rythms ( ventricular tachycardia or fibrillation).

Should we stop doing rescue breaths?

• No. CPR courses should teach rescue breathing, since it is still preferred in children and adults who suffer cradiac arrest due to respiratory failure by choking, drowning and so on.
• There is certainly a need for rescue breathing after a prolonged period of CPR.We are not sure if we should interrupt compressions for this or not

How do I do Chest compression CPR?

This video only takes 2 minutes.

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Which Is The Best Weight-Loss Diet?

August 09 2010

The best weight loss diet is still intensely debated and there has been very few well conducted studies which looked at this issue. Is a high protein diet better, or high carb or a high fat diet the best weight loss diet?

A recent study looked to find out which is the best weight loss diet and received a lot of good attention.

What were the strengths of the best weight loss diet study?

• Large number of participants: There were 811 participants from diverse backgrounds irrespective of age, income, geography and included a large percentage of men. Obviously the largest RCT related to determine the best weight loss diet.
• High rate of retention: The people who dropped out of the study were low which was a serious problem in other weight loss studies.
• Long Duration: The best weight loss diet study lasted for 2 years which is the longest trial for randomized weight loss trial.
• Compliance accessed: Compliance was assessed by objective markers .For example, urinary nitrogen excretion was used to asses adherence to the protein intake.
• Intense Treatment: Treatment included individual and group instructional sessions to promote adherence.

What was the design of the best weight loss diet study?

Eight hundred and eleven participants were randomly assigned to four different diets:

• 20% fat, 15% protein, and 65% carbs; Low-fat,average-protein
• 20% fat, 25% protein, and 55% carbs; Low-fat, high-protein
• 40% fat, 15% protein, and 45% carbs; High Fat, Average Protein
• 40% fat, 25% protein, and 35% carbs.High Fat High Protein

All of the diets had an average calorie deficit of 750 calories from the patients’ aggregate baseline caloric intake. Participants followed the diets for two years, during which time they were also expected to engage in 90 minutes of moderate exercise each week, keep a daily food diary, fill out a Web-based tool that monitored how closely their intake adhered to their assigned diet, and attend group and individual sessions to promote adherence

What were the results of the best weight loss diet study?

All the diets were equally successful in promoting moderate weight loss and maintaining this loss for over 2 years. Weight loss averaged 3-4 years after 2 years.

Practical Recommendations

• Any diet which emphasizes calorie restriction will work and the specific amount of protein, fat or carbs of the diet does not matter.
• Diets should be tailored to the person based on their individual and cultural preferences than based on nutritional recommendations for long term success.
• Behavioral strategies maybe more important in weight loss diets than their composition.

Reference 1

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Is Single Set or Multiple Sets Better To Build Muscle?

July 31 2010

The question of single set or multiple sets for building muscle has been long standing. A recent study has shed some new insight into this “number sets for muscle” debate.

Why one set to build muscle?

• Intensity: You can put lot more into one set and therefore can use more weight.
• Recovery: If you are doing less sets, you recover better.

Why multiple sets to build muscle?

• Time under Tension: The time under tension on the muscle is greater and hence greater muscle growth potential.
• Trained Lifters: As you the training age increase, ,muscle becomes resistant to training and hence you need multiple sets to gain muscle.

But what do the studies say?

What was the design of the study?

The recent study looked at one set and 3 sets on muscle protein synthesis.

• Participants:  The study had 8 trained participants (atleast one year) .
• Design: The design was within subject design where the subject acted as their own control. This within-subject design minimizes the variables like participant motivation and genetics.
• Training Protocol: The participants after an overnight fast did 3 sets of 70%1RM till failure with 2 min rest in between,  and for the other leg they did 1 set of 70% 1RM.

What were the results of the study?

• At 5h: The results showed that both 1 and 3 sets increased protein synthesis at 5 hours, but the increase was significantly higher for 3 sets.
• After a day: Only the 3 sets groups sustained the protein synthesis even after a day while the single set returned back to fasted levels.

What about long term studies on sets and muscle?

Can this acute results in protein synthesis translate as muscular changes in the long term? Yes, indeed.

• Recent Meta-analysis: The recent meta-analysis confirms with the above acute study and shows that multiple sets are more effective than single sets in building muscle. This was true irrespective of the training status or the training duration.

Practical Recommendations

• Multiple sets are more effective in building muscle than single set.
• 3 sets are more effective in building muscle than one set.6 sets might be more effective that 3 sets, but we are not sure yet

Reference 1
Reference 2

Related articles

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• The Best Workout Program For Muscle Growth?

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The Best Stretch For Your Shoulders

July 24 2010

There are number of shoulder stretching exercises. But which is the most important and why?

Why stretch the shoulder posterior capsule?

• Shoulder Pain: It has been shown in number of studies that posterior shoulder tightness could be one of the risk factors for shoulder problems and pain.



Figure: The figure shows how a tight posterior capsule can cause impingement and shoulder pain when you raise your arm.


• Weight Lifters: It has been consistently shown in number of studies that overhead athletes, recreational weight lifters and bodybuilders have limited internal rotation or a tight posterior capsule.

  The tight posterior capsule in weight lifters could be due the limited internal rotation end-range of motion exercises compared to external rotation exercises.

What are the stretches for the posterior capsusle?

The two most common stretches for posterior capsule are:
1. Sleeper stretch
2. Cross body stretch.

So which is the best shoulder stretch?

Of the two, a recent study showed that the cross body stretch to be more effective for posterior capsule and increasing IR range of motion compared to sleeper stretch

Practical Application

• If you had to pick just one stretch to prevent shoulder pain and problems, pick the cross body stretch.
• If you have the time, do both.

Reference 1
Reference 2

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The Best Scapular Muscle Exercises to Prevent & Treat Shoulder Pain

July 17 2010

There are number of exercises to optimize scapular muscles to prevent and treat shoulder pain. But which are the best scapular muscle exercises?

What are scapular muscles?

Scapular muscles are muscles that connect to the scapula and give both stability and mobility to the scapula, which is unique among other joints . The major scapular muscles are shown in the below picture.

Why scapular muscles are important in shoulder pain?

Scapulothoracic Rythm: The scapula has to move in a well-coordinated manner as shown to bring about arm movements. Any change in the function of scapula muscles can affect the normal functioning of the shoulders.

Correlation: Very recently, number of studies have shown abnormalities in scapular position and motion to be correlated with shoulder pain caused by impingement symptoms, rotator cuff dysfunction, and instability.

Shoulder Rehab protocols: All shoulder rehab protocols now emphasize the importance of scapular muscle training as a component of shoulder rehabilitation.

Which scapular muscles are important ?

Most researchers attribute scapular dysfunction to scapular muscular imbalance rather than absolute strength deficits of the scapular muscles.

In particular,excess activation of the upper trapezius (UT), combined with lower activation of the lower trapezius (LT) and the serratus anterior (SA), has been proposed as contributing to abnormal scapular motion (muscles shown in pic).

Hence the best scapular exercises are those which have high activity of LT & MT and low activity of LT.

So which are the best scapular muscle exercises?

• The study looked at 12 different trapezius strengthening exercises and they found the below exercises to have the highest activity of LT & MT and lowest activity of UT.
• None of the exercises met the criteria for optimal intermuscular balance restoration of serratus anterior (SA) and LT. Push up and push with aplus are normally prescibed exercises for SA.
• The results of this study suggest that the exercises: A, B, and C are optimal for restoration of UT/LT muscle imbalances. A, B, and D are optimal for restoration of UT/MT muscle imbalances.

If you have any questions about these scapular exercises, just ask in the comment section.

Reference 1

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Why Some Grow Muscle Easily While Some Don’t?

May 31 2010

The study shows why some folks grow like a weed while other struggle.

The study recruited 66 subjects.The training included 3 sets of squats, Leg Press and Leg Extensions 3 days/week for 16 weeks.

What were the results?

Based on the muscle fiber size, the participants were divided into three groups independent of age or sex ( using new method called cluster analysis):

Extreme Responders:  58% increase in muscle fiber size
Moderate Responders: 26% increase in muscle fiber size
Non Responders: 0% increase in muscle fiber size.

What are satellite cells and muscle nuclei?

Before you can understand the results of the study, you need to be familiar with some terms. I will keep it simple and short, promise.

Unlike other cells in the body, muscle cells (or muscle fibers) are multinucleated. Considering how a muscle cell is way larger and complex than the rest of the cells in the body, it makes a lot of sense to have more than one nuclei to control the complex tasks in the muscle.

For instance, if your favorite restaurant was a muscle and the cooks the nuclei, it’s pretty safe to say that the number of cooks sets the limit to the size of the restaurant. Similarly (or somewhat), the size of your muscle is ultimately limited by the number of nuclei you have in your muscle.

Simply put, you cannot grow bigger muscles without additional nuclei to take care of the extra muscle.

So where do we get these nuclei from?

Figure: A muscle fiber with nuclei shown in blue and satellite cell shown in red.

These muscle nuclei sprouts from specialized cells around the muscle called satellite cells. So any increase in satellite cells means some of these cells could be “blossoming” into new nuclei.

So how did the extreme responders grow muscle easily?

• The extreme responders had higher satellite cells to begin with. The authors speculate that your muscle growth potential is partly dependent on the availability of satellite cells before training.
• The satellite cell pool increased a remarkable 117%  in the extreme responders during training.
• After training, the Extreme responders had significantly more myonuclei per fiber than Non and Moderate groups .

NOTE: It is interesting to note that 1/4(non-responders) of the subjects experienced no growth. The authors speculate that this might be because of a lack of greater recovery period between workouts and/ or additional weeks of training. Studies with 2 days/week has shown better results in older adults.

Practical Recommendations

• The extreme responders in the study are the genetic freaks who can do whatever and still grow like a weed. So don’t think it is their program as most folks do, and copy it blindly.
• As far as I know, the only natural way to increase satellite cells is by creatine. Creatine has shown to increase satellite cells substantially compared to training without creatine.

Reference 1

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How Graphs Can Fool You

May 17 2010

You can be easily tricked into believing things if you don’t read the actual data and just glance at the graphs. Below are some of the ways how graphs tend to fool you.

Distortion of Scale

Here the units of the graph are distorted to make the differences between groups to look much larger than what it is. The second graph shows the more accurate representation. The difference in strength in Group A is made to appear triple that of Group B though it is only a 10 lb difference.

The score above 70 represents clinical depression. The decline of depression scores over 72 months is only 3.5 scale points but is made to look significant by distorting the units. The second graph is shown in the correct scale.

Distortion of Meaning

The graph shows the difference in tempertaure to be trivial though 98.6 is normal and 102 is significantly elevated. The second graph shows a meaningful representation considering it shows the percentage of people in each group who exceeds the normal temperature of 98.6.

Linearity Distortions

In longitudinal studies, it is usually customary to connect the pre and post test values with a straight line which can distort the true picture.

The graphs shows the changes in weekly income. The first graph shows measure taken only at the start and end dates which misleadingly suggests a steady rise in income. The bottom graph provides the monthly data and the true picture.

       

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The Fall of The Greatest Theory of Muscle Growth

May 09 2010

The recent study was the final nail in the coffin for one of the greatest theories of muscle growth-the hormone theory - proposed by the prominent researcher William J Kramer.

What is the hormone theory of muscle growth?

• Growth & Development: Hormones like testosterone, growth hormone, & IGF-1 are important for growth & development.
• Injection of hormones: Injection of hormone,s especially testosterone has shown increase strength and muscle mass while suppression of testosterone has shown to decrease in muscle mass & strength.
• Acute Increase after exercise: These same hormones are elevated acutely after resistance training. The magnitude of increase depends on rest times between sets, the weight used and so on. For example, the large rises in these hormones are observed after high intensity exercises with short rest periods using big muscle groups (multi-joint exercises).

Based on the above hormone hypothesis , it is assumed that

• Exercise induced muscle growth is primarily due to an acute increase in these hormones.
• Hence workouts should mainly use multi joint exercises with short rest periods to raise the hormone levels.
• Small exercising muscle groups (e.g., biceps), which are incapable of causing large increases in anabolic hormones when used in isolation, should be trained concurrently with large exercising muscle masses like squats or leg press that can elevate testosterone and GH.

The fall of the hormone hypothesis

• Local factors in muscle growth: The recent discovery of local factors like MGF,muscle IGF-1 showed that it is local factors that are mainly responsible for muscle growth and not systemic hormones. The discovery of these local factors, which are found inside the muscle, showed why muscle growth is specific to the exercised muscle. If systemic hormone were indeed responsible, you would have seen an increase in muscle growth in the non-exercised muscle too. 
• No effect of GH administration: Injection of high doses growth hormone to raise resting levels resulted in little increase in muscle growth or strength. So the benefits of these tiny spikes in GH after exercise which do not even change the resting levels are questionable.
• Unilateral exercises: Increase in muscle growth has been observed with unilateral exercises like biceps curl without any increases in systemic hormones. For example, unilateral exercise like biceps curl and leg extensions which do not cause a spike in systemic hormones have shown to increase muscle growth and strength.
• No Increase in protein synthesis: There was no significant increase in protein synthesis due to an acute increase in systemic hormones after the workout.

BUT the question can these spikes in systemic hormones play a small role if not a major role in muscle growth which might have been overlooked in the above studies .  All the above were indirect studies until the recent study.

What was the study design?

• Twelve healthy untrained young men trained their biceps independently for 15 wk on separate days.
• In one training condition, participants performed isolated biceps curl exercise designed to maintain basal hormone levels.
• In the other training condition, participants performed identical biceps curls followed immediately by a high volume of leg resistance exercise to elicit a large increase in these hormones .
• If the hormone hypothesis were true, the biceps curl plus leg pres group should see greater muscle growth & strength, right.

What were the results of the study

Unfortunately, at the end of 15 weeks there was no significant difference between groups in strength, muscle cross sectional area, & Type 1 or Type 2 fiber area.

Simply put, the increase in testosterone, growth hormone or IGF-1after your workout do not help in muscle growth/strength.This study was the final nail in the coffin and clearly drops the curtain on one of the best known theories of muscle growth .

Practical Applications

• Don’t perform multi-joint exercise like deadlifts, squats, 20 resp squats or leg press for the “sake of increasing hormones”.
• Don’t keep rest times short or perform high intensity workouts for the purpose of “raising hormone levels”.
• If your trainer says the program works by increasing hormones, send this article to him

Reference 1

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Is Muscle Mass Important For Power Lifters?

April 28 2010

Powerlifters are usually looked as strong athletes with little muscle compared to bodybuilders. A recent study looked to see what differentiates the weaker lifters from stronger lifters.

What Is Power Lifting?

Three Lifts: Powerfliting involves three basic lifts the Bench Press, Deadlift & Squats. Olympic lifting, on the other hand, involves the clean and jerk and snatch.

 
1RM: It means one repetition /maximum or the maximum amount of weight that you can lift for one rep.

The person who can do the most amount of weight for 1 rep (1RM) wins the competition. Basically, the strongest person wins the competition.
 

Muscle not important for power lifters?

Most people think powerlifting or strength has nothing to do with muscle . A few reason why they think are:

Powerlifters are Fat:  Bodybuilders are muscular and ripped. So people think it is the training that makes them look like that.
 
Heavier Weights: Powerlifters usually train with very low reps (1-3) and hence the weight they lift is almost double what they can do if they did 8-10 reps.

Bodybuilders usually train with high reps (8-12) and the weight they use are much lighter. So people think strength is not really related to muscle.

Nervous system: Strength is all about nervous system adaptations and has little to do with muscle.

A recent study looked to see if muscle mass can predict powerlfiting performance.

What was the study design?

The study compared weaker lifters and stronger powerlifters who had competed in powerlifting competitions. None of the lifters tested positive in drug test in the past 2 years.

Stronger lifters were defined as lifters whose wilks score were greater than 417 here as the weaker group were defined as lifters who had a wilks score of less than 370.

They compared anthropometric characteristics like limb lengths, muscle girths, bone breadth and muscle mass.

  What were the Study Results?

The study showed that the majority of the significant differences were for muscle mass and muscular girths per unit height and the greater muscle mass contributed to the greater strength levels in stronger lifters.

The study recommends powerlifters should spent more time training to the development of muscle mass most relevant to the three lifts.

Practical Applications

• Strength is highly correlated with muscle mass. You cannot magically gain strength without putting on muscle or vice-versa.

• If your strength is climbing, you are definitely gaining muscle too.

Reference 1

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How Much Protein Do You need After Your Workout?

April 18 2010

How much protein do you really need after your workouts? It is pretty common to see folks having a protein shake after their workout. Is more protein better?

Why Do You need Protein after Your Workout?

Increase in Protein Breakdown: Although protein synthesis is higher after resistance exercise, it has been clear that protein breakdown can increase enough to cause a negative net protein balance..

An increase in muscle mass is only possible if net protein balance stays positive.

Studies: Number of studies have confirmed that having protein (amino acids) after your workouts will decrease protein breakdown and shift the net protein balance to a positive state. .

More important,  Increase in strength and muscle mass has also been observed in the long-term studies.

We know there is a dose response relationship of protein intake and protein synthesis in your muscle. Nevertheless, this hasn’t been looked at until this study.

What was the ‘protein after workout’ study design?

This study used 6 trained, fasted young men ( > 4 months to 8 years).

The protocol involved 4 sets of 8-10 of leg press, leg extension and leg curl and then ingested 0, 5, 10, 20 or 40 gm of whole egg protein.

What were the results of the ‘protein after your workout’ study?

The study showed a steady increase in protein synthesis until 20 gms of protein(8.6 gms of EAA), and then a plateau as shown below.

The study showed no significant increase at 40 gms of protein and showed a significant increase in lecuine oxidation ( protein burned off because it cannot be used) at this point.

Practical Applications

• The study participants were around 190 pounds and trained. So 20-25gms will be sufficient protein after your workouts if you are around this weight category .
• If you are above that weight category or doing a higher volume, 25 -30 gms would be more than enough considering the rate of protein synthesis has an upper limit. 
• The study looks at acute adaptations,. The long term adaptations such as strength and muscle mass to such doses are yet to be seen
.

Reference 1

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  Are low reps (1-6) better than high reps (8-12) for muscle growth?

• 

  Should you eat protein every 2-3 hours for muscle growth?

NSCA Personal Trainer’s Conference 2010 Review - Part 2

April 10 2010

Here is the second part of my review of the 2010 NSCA Personal Trainer’s conference held in Las Vegas. you can read the first part here: NSCA Personal Trainer’s Conference 2010 Review - Part 1

Eric Creesey

Eric Creesey is an upcoming and strength & conditioning expert. He is also know to be rehab specialist, especially with baseball players. You can see his articles, books and DVd’s all over the web.

Eric gave 2 presentations. The first one I attended was about Shoulder Rehab in baseball pitchers. This was not good to begin with since it is a personal trainers conference and you don’t get much out of a shoulder rehab lecture for pitchers. And he could have done more to make it more relevant to the audience. He just had one slide up ( a flow chart) and just ran through the exercises and stretches. It was a hands on presentation so maybe that could have been his excuse.

He showed how pitchers tend to have limited ROM in their shoulders ( Internal Rotation)  and showed stretches to improve ROM, exercises for scapular stability, thoracic flexibility and so on. He also talked about how breathing patterns, opposite ankle hip restrictions, poor cervical spine function can cause shoulder problems.  He says he found the greatest improvement in shoulder ROM with improving thoracic flexibility and he has seen some studies; I haven’t see any though.

The second presentation was titled “Inefficiency vs Pathology”. This was interesting because I had gone through the handouts before and saw all those infamous studies which shows disc herniations, tendonitis rotator cuf tears, and all other problems in asymptomatic people (with no pain). I was looking forward to see how he is going to fix the disconnect because the studies basically shows the weak the structure - pain link and everything he talks about his based on structure deviations causing pain.

His argument was that the people who are free of symptoms in those studies haven’t reached the threshold and was a matter of time that they end up in pain or something to that effect.  He continued talking about how you need mobility in your ankles, knees, hips, shoulder & thorax. It is the joint by joint concept by Gray cook( I think Boyle introduced it a T-nation article) where if one joint is weak or tight, the other joint will take the brunt. It is just another hypothesis, mind you.

Shannon Fables

Shannon Fables presented Balance Training “On the Edge”. She was the quintessential cheerful, bubbly group fitness instructor. She talked about how balance is important and showed exercises to improve balance with a BOSU ball and other unstable devices.

Balance training is another one of those areas in fitness which is beaten to death without having a good understanding of the physiological concepts behind it. We have to ask ourselves what aspects of balance are we trying to improve here.  For example, we know that If we are on a unstable surface, the visual and vestibular elements are heigtened since there is less feedback from the propiorecptive components. Since most of the task which require balance are reactive or unpredictable in nature , should we do a lot of steady state, anticipatory balance training? How will your balance change if you had biomechanical constraints like limited ankle mobility and so on.

She talked about how her pain went away after she started going barefoot. And hence she thinks going bare feet is the best and hence we all had to do exercises on bare feet. She also gave some anecodotal examples of how bare feet running is the way to go. The barefeet running is still a hypothesis and we should be more careful when we make these sweeping conclusions, especially to a crowd of 40-50 personal trainers.

Susan Kleiner

She presented Protein and Amino Acid supplementation. Though she didn’t have anything new (atleast to me) , this was the best presentation at the conference I thought.

Her presentation was probably the only presentation which I would say had an evidence-base approach to it. She used phrases like. ” The research is unclear”, ” I don’t know”, ” this is a theory or a hypothesis” , ” haven’t come across any research” and so on which were completely missing in other presentations. And I took the time to tell her this after the presentation.

I wish she could have timed it better so that she had more time to get into some of the interesting topics stuff like protein-carb ratio for post workout shake , protein needs for people and so forth. There were a few occasions where I felt like she was trying a bit too hard to promote certain products which had no research to back them up.

There were a lot of questions asked about creatine, protein and other supplements and I wish NSCA had more speakers on the nutrition aspects of muscle growth.

I went to a few more, but I don’t’ want to keep on writing and make it into a 3 part article .It’s already too long for my liking.

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Are low reps (1-6) better than high reps (8-12) for muscle growth?

April 03 2010

The debate about whether high reps or low reps are better for muscle growth has been going forever. In fact, my thesis was on this exact question and I am yet to see any good evidence to favor either side.

Finally, a recent study which compared high reps and low reps sheds some light to the long- standing question.

Why are high reps (8-12 reps) better?

Bodybuilders: Bodybuilders always use low weight, high reps: 8-12 rep range .Power lifters always use high weight, low reps: 1-3 repetition range.

Growth Hormone Increase: Number of studies show that low weight, high reps (8-12 reps) with short rest increases GH significantly compared to high weight, low reps.

Based on the above evidence low weight, high reps (8-12 reps) is considered the standard recommendation for muscle growth or hypertrophy.

So why is there a debate on low weight, high reps and high weight, low reps?

Muscle Growth Studies: Surprisingly, the studies which looked at low weights, high reps and high weights, low reps show no significant difference in muscle growth.

GH ineffective: The GH hormone hypothesis of muscle growth doesn’t hold water anymore considering number of recent direct and indirect studies showing that exercise-induced increases in growth hormone (systemic hormones)  do not help in muscle growth.

Greater Load: As reps decrease, the weight lifted increases. So theoretically greater the weight (low reps) , greater the potential for growth.

But what about protein synthesis & rep range?

Your muscle increase in size because of an increase in protein synthesis. So the most simple question to ask is does low weight, high reps ( 8-12)  show greater protein synthesis than high weights, low reps?.

Surprisingly, nobody ever bothered to look at protein synthesis and exercise intensity until this latest study.

The study compared different intensities ( 15%, 30% 1RM, 45%1RM, 60% 1RM, 90% 1RM) to see if there is a dose response relationship to weight lifted or reps and protein synthesis. The subjects were beginners and the volume was kept similar in all groups.

What were the results of the high reps & low reps study?

• And guess what, there was no significant difference in protein synthesis for the 60%, 75%, & 90% 1RM! Simply put, there was no significant difference for high reps and low reps.

• The study showed the same results for older individuals but the levels of protein synthesis were depressed which further confirms the above results.
• This study finally shows why studies which looked at outcome measures couldn’t find any significant difference in muscle growth with high reps and low reps.

What about trained lifters?

In trained lifters, the curve may take either one of the shapes as shown below in the graph.

Practical Application

• There no magic in the 8-12 repetition range for muscle growth. If you are using a weight above 60% 1RM, you are getting the maximum level of your protein synthesis.
• There is no increase in protein synthesis as the weight goes up or the reps decrease.  So 5RM (low reps) is no better than a 10RM (high reps) to increase protein synthesis.
• Theoretically, a high rep range (low weight) would work the best for muscle growth considering there is less damage and nervous system fatigue compared to high weight, low reps .

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NSCA Personal Trainer’s Conference 2010 Review - Part 1

March 30 2010

The 2010 NSCA Personal Trainer’s conference was held in Las Vegas on April 7 & 8. For people who are unaware of NSCA, they are the the world’s leading authority in strength & conditioning. In fact, NSCA sets the standards and guidelines in the strength and conditioning field and the rest just follows them like a good dog.

NSCA usually has a number of conferences year round. Their biggest one is usually held in Florida in Summer which is mainly for strength and condition specialists. Anyway, I felt like I should go since I would like to present a topic someday and wanted to meet some of the Trainer’s council members since I happen to be one of them.

So here I am off to Las Vegas.

The conference was for 2 days and went from 8.00 am in the morning to 5.00 pm and each presentation lasted for 90 min. They had 4 presentations each in the morning and evening. All the presentations were repeated several times during the days so that everyone can attend all the lectures.

I will go through each lecturer and a give a synopsis of their presentation..

Anthony Carey

Anthony Carey was the first speaker I attended at the conference. His talk was “ working with clients with musculoskeletal challenges”. He runs a company based on corrective exercises for pain and has a few DVD and books based on it.  It was all about the usual how muscle imbalances, structural misalignments and altered movement patterns, all of which create undo stress on your body, resulting in pain.

I have written in the past about how there is very little causative role for the biomechanical model in pain. I wouldn’t say there is none, but the evidence is certainly nowhere to the level of what all these pain experts try to make you believe. In athletic population, the bio-mechanical model might have greater implications. 

At the question-answer session, I asked him about the posture pain concept. I asked him why the posture-pain link is pretty weak in the scientific literature and if he has come across any studies which atleast shows you can change person’s posture. He said his “18 years of anecdotal experience has taught him..” But to give his due, he admitted there is not a strong link between posture and pain in the literature after all his talk.

Bill Sonnemaker

This was a hands-on presentation titled “movement preparation”. The concept is that the fascia is structured in the body to work globally(and not in isolation) to facilitate movements. So he had a lot of functional-stretching type exercises that supposedly targets the different fascia tissues in a global fashion. This is supposed to better performance, prevent injury and pain.

I don’t think these dynamic stretching sort of movements will make any changes to the fascia considering even the ability of manual therapists to change the plasticity of connective tissues by applying direct pressures is now seriously questioned.

Guido Van Ryssegem

And I thought my name was hard. The presentation was titled ” Return to Training after Shoulder Pain”. This was one of the best presentations at the conference. He talked about a very relevant topic and everything he had on his slides were referenced.

He talked about how all shoulder injuries have certain things in common such as postural dysfunction, scapular dysfunction, lower trap weakness, scapulothoracic weakness. There is some recent interest in scapulae dysfunctions in people with shoulder pain. But the interesting point is that even after the pain is fixed, the scapular dysfunction still prevails( nice example of correlative evidence) .And I asked his if he had come across any studies which showed the postural and scapulae dysfunctions to improve after the pain has resolved. I haven’t seen any and I was almost sure there wasn’t any. And he said he hasn’t seen any either (atleast he is up to date in his field I thought).

He made some comments though which cut right through his scientific approach and raised my eyebrows. One was about how the best test according to him to observe shoulder dysfunctions was to sit on a table and raise yourself by pushing your hands against the table. What about the validity and reliability of the test, sir?

Conclusion

The part that stood out the most about the conference ,even during the first day, was the lack of critical thinking among the trainers. None of them really bothered to question the science behind some of the concepts presented, and NSCA ,mind you,  is all about science.

Anywa, in the next part, I will review Eric Creesey and a few others.

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Monitoring Body Weight : A Proven Method to Prevent Weight Gain

March 22 2010

The best way to lose weight is to prevent weight gain in the first place. Considering the environment, you are bound to put on some weight if you are not bothered about the things that go into your mouth.There are so many approaches to prevent weight gain, but most don’t have any scientific support.

One method that has been told to avoid is monitoring of your body weight. But recent studies shows otherwise.

What is wrong with daily weight monitoring?

It is widely believed that the large fluctuations in daily weight caused by changes in fluid balance can mask real changes in body mass and may discourage people from continuing those behaviors that might cause a loss in weight.

How is daily monitoring a useful method then?

Number of recent studies have shown that monitoring bodyweight to be an effective strategy to prevent weight gain

NWCR Study: One of the several behaviors identified with long term weight loss maintenance in the National Weight control Registry study was frequent monitoring of body weight .To be enrolled in the NWCR, individuals must have successfully lost at least 30 lbs and maintained that weight loss for at least 1 year.

The study showed that 36% of successful weight losers reported weighing themselves at least once a day, and 79% weighed themselves at least weekly.

Freshmen Study: The study showed daily monitoring be an effective technique to help female college freshmen resist gaining weight in an environment that is conducive to weight gain. Unlike the above group, this group represent people of normal weight trying to prevent weight gain.

The graph shows the difference in weight gain of the weight monitoring group and the control group . You can see almost a 6 pound difference between the groups and within the individual.

When interviewed at the end of the trial, the weight monitoring group said that when thy saw the weight increase, they decreased the amount of food they put on their plate, reduced the number of foods they put on the plate, skipped dessert, and even skipped a meal depending on how that change fit into their life style. Interestingly, the study used a simple technique called TMS.  The Tissue Monitoring System (TMS) is an algorithm where the trend in daily body weight (over 7 days) rather than daily body weight is used to estimate body weight changes.

Other Studies: Apart from the studies above, number of other studies have looked at regular body weight monitoring. Overall the studies shows that self-weighing weekly or daily was associated with significantly greater weight loss & weight maintenance compared to infrequent self-weighing.

How does frequent weight monitoring work?

Self-regulation: Specifically, an individual who self-weighs often is believed to stay focused on and sensitive to changes in their weight. This creates more opportunities for self-  encouragement)  of even small weight loss (or weight maintenance) progress.

Also, the individual is able to quickly catch small weight gains before they escalate and make behavior changes accordingly ( diet or exercise) to prevent large weight gains.

The major limitations of the above approach stems from the fact that the studies used weight recalls ( recall biases)  and the population was mostly middle aged american white females.

Practical Application

• Frequent weight monitoring helps in preventing weight regain and weight loss.  Buy a scale if you don’t have one and weigh yourself daily or weekly
• We are not sure if there is a benefit to daily weighing or just weekly monitoring.

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Why Anecdotes/Testimonials Are Unreliable?

March 16 2010

If you are familiar with this website, I always insist on an evidence-based approach and do not put much value in anecdotes or testimonials. Many people just say science is important without fully understanding why evidence-based approach or science evolved.

Here are some of the reasons for why anecdotes/testimonials are considered the lowest form of evidence and why an evidence-based approach evolved.

Confounding variables

There are too many variables like diet, age, trainee level, genetics, sex that can significantly affect the results of the training program. 

“A muscular guy says he does this special program,  so I am going to try his program.”.
The problem with this testimonial is that most muscular guys are just genetically gifted.  They can do just whatever and eat whatever and still be under 8% body fat.

“That exercise program didn’t work for me”
Here is a guy who has given a decent program but didn’t make any progress because his diet was still the same.

“That program just killed me”
Here is example of 40 yr old guy who just copied a workout from a 20 year old who got great results.

In research, these confounding variables are eliminated by random selection from the specific population and randomizing people into groups, restricting, and matching. The randomization eliminates the confounding variables and hence is very important in research.

Hidden Data

In testimonials and anecdotes, you only read about positive results. The people who didn’t gain much never bother to talk about it.

“Program X worked worked for 3 of my friends”. 
Does that mean X works? What if I show you 5 people (hidden data) for who the program X didn’t work or who dropped out?

In research, the negative hit and the number of people who dropped (attrition rate) out are also recorded.

Cognitive Biases

These psychological biases distort reality and judgment and has been extensively studied and confirmed in the psychology field. A few of the biases which can skew reality are memory recall biases, expectancy effect, exposure effect, bandwagon effect and so on. There are over 35 or more of them which becomes relevant depending on the specific context.

“I do high reps with light weights to tone”
This is classic case of bandwagon effect or herd effect where people just follow what others do without analyzing the underlying evidence.

“I know it works. I have been doing this for almost 20 years and there is some research to show it works”
This is an example of the confirmation bias and is one of the most common biases out there. Here people tend to prefer, seek, and interpret information which confirms their hypothesis and neglects the opposing data.This bias is so often seen among fitness guru’s who have a product or idea to sell.

“That diet doesn’t work. I didn’t eat too much ”
According to the social desirability bias, there is a tendency to provide answers which is more socially acceptable /desirable. This type of bias has now been widely accepted in nutritional studies which include dietary recalls.

“I was really excited about the program and it worked great”
This is called the hawthorne effect where just by believing in the program the person was doing all the right things that he never did with other programs.  He is eating all the right foods, getting enough sleep and so on.

In research, these biases are taken into account and eliminated by having a control group and blinded designs. For example, in double blinded trials, neither the researchers nor the participants are aware of who belongs to which group. 

By Chance

Hypothetically, if every bias and confounding variable is taken into account, there is still a possibility that the results were due to mere chance than the program/diet.

In science, the chance is taken care by the p value (p less than .05) as often seen in studies. If the result are statistically significant, it means there is only a 5% chance the results were due to chance or accident.

Subjective Outcome Measures

 
Anecdotal Outcome measures are extremely subjective. For example , judging muscle size by looking in the mirror, waist size, and so on.

“The program worked. I look a lot bigger than I was”
This could be just due to increased glycogen, fat and water accumulation than just actual muscle growth.

“My weight hasn’t changed at all”
They might be losing fat and gaining muscle or just holding water.

This can only be measured with more sensitive & accurate body composition measures.

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Can Gaining Too Much Fat Decrease Muscle Gains?

February 14 2010

It is well known that you have to put some serious weight to add some serious muscle. Bodybuilders often call this the bulking phase where they try to gorge on food and gain as much weight as they can.

The belief is that the greater the weight gain, the greater the calories partitioned to muscle and hence greater the muscle gain. This is why bodybuilders look like fat tubs in the off season.

But it is becoming increasingly clear that higher fat levels can decrease muscle gain.

Is there any evidence to show higher body fat will decrease muscle gain?

Forbe’s Theory: In 1980’s, Forbe’s showed that there is a logarithmic relation between fat gain and lean body mass gain. He showed that the extent of LBM gain or loss depend on the initial body fat in humans and other species.

Basically, lower your body fat, better your muscle gains when you overeat. As you put on more fat, your muscle gain tend to decrease.  Lean people show 30-70% of LBM gain and obese people show 30-40% of LBM gain with overeating.

Anecdotal Evidence: There has always been some anecdotal evidence that natural folks tend to gain the most muscle at 10-15% body fat. Beyond 15%, you tend to gain more fat and less muscle.

What is the mechanism behind the decreased muscle gain with greater fat?

Insulin Resistance: The decrease in muscle mass with increasing fat can largely be attributed to the insulin resistance in the muscle with increasing fat accumulation.

The recent animal study was the first to show that increase fat levels can directly blunt muscle protein synthesis via the insulin pathway. Mice fed a high fat diet and loaded (akin to weight training) for 30 weeks. The mice in high fat group put on 31% more weight than the low fat group.

The results showed a significant decrease in the muscle mass and the activation of key members of the muscle growth pathway in the high fat group. (It’s an animal study so take it with a grain of salt)

Practical Application

• If you are trying to bulk, try to stay below 15% or thereabouts of body fat. The higher you go up in body fat, the lesser the muscle gain
• Some cardio on off days can decrease insulin resistance acutely and may help with muscle gain.

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Weight Loss Goals: How to Set Realistic Weight Loss Goals

January 31 2010

It’s New Year again. And just like every new year, many of us have have made some weight loss goals. Unfortunately, for most, this may not be the first or the last time that you set a weight loss goal.
 
I think we have too many weight loss tips and diet books out there that the fundamental questions about weight loss get lost in the clutter and clamor. In this article, I will try to answer some of the basic weight loss questions which will help you set some realistic goals and understand the weight loss issues better. 

When should I worry about losing weight?

I see a lot of people unnecessarily worrying about their weight. So, when should weight loss be a concern for you?

 
If your BMI >24.6 (overweight)
BMI >30 (obese)
or
If your waist circumference >35 (Women)
waist circumference >40 (Men)

If you are under these values, you are in the risk-free category for obesity-related problems.

As a side note, BMI values are not valid if you are an athlete or have a lot of muscle mass. Click here to find your BMI

I am over-weight. So how much should I lose?

Modest losses of even 5 -10% of your body weight is enough to see significant improvements in your health. Once you have lost the weight and maintained it for 6 months, you can think of losing further. Weight loss of 1-2 lb per week is reasonable and safe.
  

Why just 5-10% weight loss? Why can’t I shoot for larger weight loss?

You can and you will lose weight. But it has been painfully clear that most people who lose a lot of weight gain most of it back withiin 1-5 years. It is not weight loss but weight maintenance that is the greatest challenge we face. If weight loss is hard, maintaining that new lower weight is even harder. .

Why is it hard to maintain weight? Is it because overweight people are lazy?

No. Never. There is a social stigma associated with obesity and people often falsely associate obesity with gluttony and laziness.

Ever since the recent discovery of the hormone Leptin and other complex physiological mechanisms regulating bodyweight, we have come to realize that obesity is largely dictated by your genetics. Dr. Friedman who discovered leptin writes that the drive to eat for someone who lost a lot of weight is “analogous to consciously holding your breath; inevitably, your basic drive to breath dominates your conscious motivation”

Picture 1: The picture shows the complex regulation of feeding by genetics, metabolism, & behavior.
 
Our body weight is genetically predetermined to stay within a narrow range (10 – 20 lbs). The further we move from these values, the more powerful becomes our unconscious biological drive to come back to our set weight. This becomes very true in obese and morbidly obese individuals. Environment does play a role but it doesn’t account for the large proportion of marked individual variations within the same environment.

Of course, there are people who lose a lot of weight and maintain it. But they are highly motivated and are the exceptions as evident from the National Weight Control
Registry study.

What about diet composition? Should I do a high carb or a low carb diet?

As we suspected long back, recent studies have confirmed that diet composition matters the least. Whether it’s Atkins, Ornish or South Beach diet, the weight loss differences are negligible after a year.

A recent study which compared different diets and which received quite a few accolades concludes “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients (carbs, fat or protein) they emphasize”.

I exercise 3-4 times a week. I am still at the same weight. Am I wasting my time?

No. Exercise helps the most in preventing weight gain and has an independent beneficial effect on your cardiovascular and metabolic profile (even without weight loss).

Ok, whatever. Can you just tell me how to lose 10lbs?

Instead of having a numerical goal, let your goal be a realistic behavioral change or a lifestyle intervention. If you make behavioral changes, the numbers can’t help, but follow.

If you want to lose weight ,and more important, maintain that 10lb weight loss, you have to change your food and activity habits. Remember weight loss is temporary, but weight maintenance is permanent. Examples of realistic behavioral goals are “exercising 6-7 days/week for 30 min”, eating more vegetables and fruits, drinking diet instead of regular soda and so on.

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How To Maintain The Weight Lost

January 16 2010

We now know that 70-80% of the people who lose weight gain it all back. That being said,  what are the characteristics of those 20-30% of people who lose weight and maintain the weight lost?.

Why is it hard to maintain the weight lost?

Genetics: 70-80% of your weight is determined by your genes. Though calories in and out is thought to be consciously regulated, there is a powerful,  unconscious biological system that tries to maintain your genetically determined weight.

Interestingly,your height is the only heritable trait that is more dominated by your genes than obesity.

So how can you maintain the weight lost?

If genetics plays such a big role is obesity,  is it really possible to lose weight and keep it off? To answer this question, The National Registry of Weight Control - the largest prospective study of long-term successful weight loss maintenance- has been tracking people who

• Lost at least 30 pounds, and
• Maintained a weight loss of at least 30 pounds for one year or more

So how did the majority of participants maintain the weight lost:

78% eat breakfast every day: Eating breakfast probably helps in preventing having a big meal later in the day or snacking before lunch.
 
75% weigh themselves at least once a week: This is pretty interesting considering how people are often advised not to check their weight and go by dress sizes. And there is a few more studies to support frequent weighing to catch weight gains before they escalate and make changes to prevent additional weight gain.

62% watch less than 10 hours of TV per week:Most people think this to be pretty straightforward. But most people tend to snack when they watch TV.

This is an example of classical conditioning effect: It holds that stimuli repeatedly presented before or simultaneously with a given behavior will become associated with that behavior. For example, after repeatedly eating salty snacks while watching TV, simply turning on the set may trigger a craving for potato chips.

90% exercise about 1 hour per day:This seems to be one big factor since we know exercise plays a big role in preventing weight regain than in weight loss. The most frequently reported form of activity was walking .

Most continuing to maintain a low calorie, low fat diet: The low fat is understandable considering how hard it is to maintain a high fat diet diet and at the same time keep it low calories. Studies do tend to show people who start with a low carb diet moving towards a moderate carb diet as the study progresses.

Limitations

The major limitations of the study are:

• subjects are self selected.
• Observational study.
• The subjects themselves report all data.

So we really don’t know which habit contributes the most or if these habits are even really contributing much. You can read more about the study here: National Weight Control Registry

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Exercises To Correct Forward Head and Shoulder Posture

January 09 2010

A forward head or shoulder posture is the most common posture seen among people. So what causes it, what are the benifts of correcting it, and how to correct it.

Why people have a forward head posture?

Muscle Imbalance: Based on some clinical evidence, tight chest muscles and weak back muscles may lead to a forward head posture. This muscle imbalance could be due to:

• Working Posture: A good example is working on the computer or at your desk with a slouched posture.
• Activities: Repetitive use of the chest muscles more than back muscles, like swimming, too much pushing exercises than pulling exercises in the gym.

Disease: Osteoarthritis and certain congenital diseases can cause structural deformities in your spine which can really screw up your spine.

What are the benefits of correcting a forward head posture?

The major reasons claimed for correcting a forward head posture are:

Prevent/Lower Pain: Correcting a forward head posture may lower the likelihood of shoulder impingement and prevent shoulder pain. It may also lower pain in people with shoulder problems.

Range of motion: By improving a forward head posture, you may increase the range of motion in your shoulder.

Aesthetics: Basically, you will look good with a better posture and this is the best reason in my book to fix posture. 

There is very little evidence, almost none, to lowering/preventing shoulder pain by fixing a forward head posture.

What are the exercises to correct forward head posture?

Forward head posture due to muscle imbalances can be corrected by

• Stretching the tight chest muscles
• Strengthening the weak back muscles.

Stretching Exercises

The single arm wall stretch was found to be the most effective pectoralis minor stretch in a study comparing different pectoralis minor stretches . Do this for 2 sets for 30sec 3 times/week

Strengthening Exercises

Below are the strengthening exercises. Do 2-3 sets each 10-15 reps 3 times/week.

For Scapula retractors

For Lower trapezius

For external rotators

You can use a cable machine if you don’t have thera bands.

I picked the above stretches & exercises because these were the exact exercises used in the study to change posture. And it is the only study which ever showed a change in posture with exercise.

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The Best Triceps Exercise

December 29 2009

There are plenty of triceps exercises, but which is the very best triceps exercise?

What are the different Triceps muscle heads?

As shown in the pic, the triceps Brachii (cep=head) have three heads (medial head lies beneath other heads) :

• Long head
• Medial Head
• Lateral head

What is the function of triceps muscle?

The major function of triceps or all the triceps head is the extension of your elbow (push your elbows away from you)

On the other hand,  triceps long head is a bi-articulate muscle or crosses the elbow and the shoulder joint and hence has the function of shoulder extension (bring the arm to the rear of the body) too.

So which is the best triceps exercise?

• The best tricep exercise will be the one which maximally activates all three heads, especially the triceps long head
• Triceps long head has the greatest volume and length compared to other heads. So you will get the greatest gains if you build your long head than any other triceps heads.
• You can only maximally activate your tricep long head if you keep your arms over head as in overhead extensions & dumbell french press. Triceps exercises which have your arms down like cable pressdowns do not maximally activate the triceps long head muscle.

  

  All the other heads will be activated with just elbow extension; It doesn’t matter whether your arms are over head or not.

Practical Applications

If you had to pick one triceps exercise, the best triceps exercise would be one which bring your arm overhead, like overhead extensions or dumbell french press.

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Creatine Increases Dihydrotestosterone (DHT): Is Creatine Bad For Your Health?

December 18 2009

Is creatine bad for your health? The recent study shows an increase in DHT (dihydrotestosterone) as one of the side effects of creatine and raises some interesting questions about the safety of long-term creatine use.

What is DHT & is it Harmful?

DHT (dihydrotestosterone) is male hormone formed in the hair follicles, testes, prostate and adrenal glands.

Apart from the benefits, DHT is a contributing factor for male pattern baldness and plays a key role in Benign prostate hypertrophy.

Prostate cancer is strongly linked to male hormones, and recently DHT has been associated (not causative) with prostate cancer.

What was the creatine & DHT study design?

The study was well designed to minimize biases and errors.

Double Blinded: The study was double blinded and hence the researchers and the subjects did not know if they were getting creatine or placebo.

Cross over design: As shown in the pic, the study used a cross over design so that every subject receives both creatine and placebo, thereby minimizing the errors and the need for a large group of subjects.

Groups: Subjects loaded with creatine (25 g/day creatine with 25 g/day glucose) or placebo (50 g/day glucose) for 7 days followed by 14 days of maintenance (5 g/day creatine)

What were the results of the creatine & DHT study?

The major findings of the study were:

DHT: The levels of DHT increased by 56% after 7 days of creatine loading and remained 40% above baseline after 14 days maintenance (significant)

Ratio of DHT to T:  The ratio of DHT:T also increased by 36% after 7 days creatine supplementation and remained elevated by 22% after the maintenance dose.

The ratio tells us that the increased DHT levels are not because of a higher testosterone levels but a greater conversion of T to DHT.

So is creatine bad for your health?

• Bad News: For the first time, the study shows a significant increase in DHT levels (at loading & maintanance phase), and as mentioned above DHT is contributing factor for male pattern baldness and is associated with prostrate cancer.
• Almost all the studies done on the safety of creatine were short term. Only a handful of long-term studies exist and they only lasted for a year.  So the long-term safety of consuming creatine for 5-10 years is still not conclusive.
• Good News: There has been a number of studies in humans showing creatine has no adverse effects, barring the gastric upset in a few folks.
               
• People have been using creatine for years and we haven’t heard much about people losing hair and getting prostate cancer.
• A high DHT to testosterone ratio do not always mean that you will get prostate cancer. Like all cancers, the cause of prostate cancer is multi factorial and cannot be pinned down to one factor.
• In research, controversial findings like these need to be replicated in other labs before it can be taken seriously.

Reference 1
Prostate cancer prevention trial

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Can Exercise or Diet Prevent Abdominal Visceral Fat Gain?

December 13 2009

Abdominal visceral fa (as showin the picture) is a strong risk factor for cardiovascular diseases and diabetes than fat deposits in other areas.

Both exercise and diet can prevent weight gain. But can both exercise and diet prevent the dangerous abdominal visceral fat gain?

What was the purpose of the abdominal visceral fat study?

The study was done to find if exercise or diet is better in preventing abdominal visceral fat following weight loss

What was the design of the visceral fat study?

• Subjects lost around 25 lbs before the study
• Then they were divided into 5 groups: Resistance training, Aerobic exercise, Diet only, Non-Aerobic Adheres, Non- Resistance adheres.
• After 1 year of follow up, the visceral fat and other variables were measured.

What was the exercise protocol?

The exercise was very moderate. They exercised 2 days/week

Cardio: 40 min at 80% of HR max
Resistance: 1o exercises – 2 sets of 10 reps

What was the result of the visceral fat study?

Though the weight loss was similar in both groups, exercise group gained no visceral fat compared to the diet only group

Practical Applications

• Though weight loss is all about calories in vs out, we can see how exercise is superior to diet in preventing the harmful abdominal visceral fat gain.
• Following weight loss, even moderate volumes (1-2 days of exercise) are beneficial to prevent large weight gains and direct fat deposit away from abdominal area.

Reference 1

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Healthy & Quick Breakfast Recipes

December 09 2009

Write your favorite breakfast recipes in the comments and I will add those in here with pictures. Deal?

Oatmeal Breakfast with Protein and Fruit - 1

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How to Hit Your Biceps Long Head & Short Head Muscle?

December 05 2009

As shown in the picture, biceps brachii is one set of muscles in your upper arm.

Biceps Brachii consist of two heads: Long head & the Short head

Both these heads can be emphasized differently since the long head is bi-articulate (crosses the 2 joints: shoulder & elbow joint.).

Long Head: The long head (& the short head) can be emphasized with incline dumbbell curls. The nice stretch you feel in your biceps when doing incline curls is in the long head.

Short head: The short head can be emphasized by doing preacher curls. Since the shoulder is flexed (or uuper arm is raised) the long head is de-emphasized.

 

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The Best Ab Exercise for Lower and Upper Abs

November 26 2009

Are crunches the most effective for upper abs? Are there exercises which work the upper and lower abs equally hard? Which is the most effective exercise or the best exercise for upper and lower abs?

A study looked at the most common ab exercises in the gym to answer the above questions. The ab exercises compared in the study were:

Abdominal Crunch

  Sit ups

Reverse Ab Crunch

  Reverse 30 degree Incline Crunch

Power Wheel roll-out

.Hanging Leg Raises with straps

Which was best ab exercise for upper abs?

For upper abs, the Power Wheel roll-out, hanging knee-up with straps,and reverse crunch inclined 30 degrees are much more effective than the crunches, sit ups and flat reverse crunch

Which was the best ab exercise for lower abs?

For lower abs, the Power Wheel roll-out and hanging knee-up with straps
were the most effective compared to the other ab exercises

Chart: The result of EMG analysis for the above ab exercises.

Practical Applications

• The power wheel roll & hanging knee raises are the most effective exercise for both upper and lower abs
• Bent knee sit-up is the least effective among the ab exercises
• Power wheel rollout showed the least stress on low back muscles.

Power wheel roll-out wins!

Reference 1

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How To Make Your Back Exercises More Effective?

November 23 2009

In real life, pulling muscles (back muscles) are less used than pushing muscles and get less attention in the gym since they are not the mirror muscles. Hence, most folks have a hard time feeling the back or getting the technique right when doing back exercises.

One simple tip to feel your back more is to change your grip.

Over Hand, Thumbless Grip: When doing rows or lat pulldowns, or any other back exercises for that mater, take an over hand grip with your thumb over the bar than under.

The benefits of a thumb less grip for back exercises are:

• You can keep the bar closer to the body, especially in bent over rows.
• You feel the back muscles better.

The drawback is you might find it hard to hold on to the bar when t gets heavy. Chalk or straps usually help here. Try it and report back.

 

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Strength Progression: The Key to Muscle Growth

November 21 2009

The reason why I picked strength progression is that it is one of the cardinal rules of lifting and probably the most ignored in the gym. How much have you increased the weight lifted in an exercise in the last 6 months?  If you have no clue, then keep reading.

What is strength progression?

It is simply the gradual process of increasing the amount of weight you lift in each exercise.

Why is strength progression Important?

Your body is designed to be incredibly efficient: It likes to spend the least amount of resources and energy to keep it ticking

If you are using a 10 lb weight, your nervous system, your muscles and your connective tissue has adapted just enough (and not an ounce more) to lift that 10lb weight. It sees no glory whatsoever in increasing your muscle if you are not bothered to increase that 10lb weight.

If you have been using the same weight you did for months, I will give you a 100% money back guarantee that haven’t made any positive changes to your muscle. It’s sad, but true.

Should I progress in reps or weight?

Once you hit 15 reps, the weight gets really low for the muscle to make any appreciable adaptations. So progression generally in strength training means increase in weights lifted.

Is strength increase important for muscle growth?

Your strength is depended on 2 factors: Nervous system adaptation and Muscle growth.

If your strength is climbing, it’s due to one of these factors, usually both. You cannot really control which factor dominates your strength increase. Hence, if your strength is increasing and you are eating well, you can be rest assured that you are gaining muscle.

So how should I progress in strength?

There are different ways to progress in weight:

Option 1: Have a repetition range, like 8-10 reps than just 8 reps or 10 reps. When you get 10 reps with a weight, increase the weight by 5 or 10lbs - and now try to get 8 reps. With just one number like 8 or 10, it becomes hard not to be subjective in deciding when to go up in weights:

Option 2: Start at a low weight and keep adding 5lbs to your upper body exercises and 10lb to your lower body exercises every workout. When you cannot increase the weight for 2 consecutive workouts, change the exercise and repeat.

Option 3: If you have been stuck at the same weight for more than 2 workouts, decrease the weight by 5-10% and take 2-3 weeks to get to the previous weight and then break through the plateau.

This is the most popular method if you do not want to change your exercise. It’s basically called an “Intensity deload”.

Option 4: Start at 12 reps and decrease the reps by 2 every 2-3 weeks. So week 1 & 2: 12 reps, Week 3 & 4: 10 reps, Week 5 & 6: 8 reps and so on.

Practical Tips

• Keep a workout log to chart your progress
• Plan your progression before your workouts: Write down a realistic progression goal for each exercise.
 

 

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Nutritional Tips for Vegetarian Lifters

November 06 2009

Here are some nutritonal tips fore vegetarain lifters:

Low Total Calories in Vegetarian Diets

It has been shown that energy intake is usually lower for vegetarians than non –vegetarians.

Vegetarian lifters should try keeping a count of their total calories and get more energy dense, low fiber foods.

High Carbohydrates in Vegetarian Diets

Almost 50-65% of the total calories came from carbs for vegans and 50-55% for a lacto-ovo vegetarian.

The high carbs are good for endurance athlete but it is not so great if you into lifting. As you will see, the high carbs minimizes the availability of protein in the vegetarian diets.

Low Protein in Vegetarian Diets

Vegetarian diets generally contain less protein than meat diets. Among lacto-ovo and vegan diets, vegans tend to have the lowest protein intake (around 10-12%).

Meal Combing for Proteins

Since plant proteins are incomplete proteins(lacking or insufficient amount of a few amino acids), food combining is recommended to make it a compete protein.

For example, by combing grains & legumes (rice and beans) in the same meal,  you get the missing amino acids and make it a complete protein .

Now it is known that you don’t have to have it in the same meal as long as you have a variety of foods throughout the course of the day.

Low Creatine levels in vegetarians

It has been shown that creatine levels are pretty low in vegetarians.

Supplementing creatine to vegetarian diets has shown increase in muscle and strength significantly. So it won’t be a bad idea to use creatine.

Low Iron Absorption in Vegetarian Diets

Studies have shown vegetarians get ample iron, but iron absorption is impaired.

Consumption of fresh fruits, vegetables and juices rich in vitamin C can enhance Iron absorption in vegetarians.

Low Zinc levels in Vegetarian Diets

Total zinc intake is lower in vegetarians compared to non-vegetarians. Also strenuous exercises increases zinc loss from the body.

Like iron, zinc absorption also seems to be a problem in vegetarians. Soaking beans, grains & seeds increases zinc absorption or bio-availibilty.

Vitamin B12, Riboflavin, D, & Calcium

Vegetarians, especially vegans, are at risk of low intake of these nutrients because the main sources of these are animal products.

Fortified foods like breakfast cereals and soy products are the only source of B12 for vegans.

Reference 1

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Can Workouts Designed To Increase Testosterone Increase Muscle Mass?

October 24 2009

It has been shown that moderate to high volume workouts, using large muscle group exercises & short rest intervals cause an acute spike in testosterone levels.

Theoretically, these acute spikes in testosterone are claimed to increase muscle growth and strength.Let’s see what the evidence says:

Study 1

Injection of testosterone has shown to increase muscle mass & strength.

The increase in muscle & strength was also seen without any weight training exercise whatsoever.These studies clearly show the benefit of testosterone on muscle growth & strength.

Limitations: The studies we are talking about use supraphysiological doses of testosterone which are far greater & incomparable to the exercised-induced tiny spikes in testosterone.

Also exercised-induced testosterone spikes do not change the resting values of testosterone;it only lasts for 45-60 min.

Study 2

Suppression of testosterone has shown to decrease muscle mass & strength in weight training folks

Limitations: The suppressed levels of testosterone in the study reached the levels of hypogonadal individuals.

So the only sensible conclusion we can make from this study is that we need minimum levels of testosterone to maintain/or increase muscle mass & strength.

Study 3

Resistance training increases testosterone receptors

Limitations: That’s well and good, but it is yet to be shown that a workout program designed to increase testosterone is more effective in increasing these steroid receptors compared to a generic weight training workout.

We are also unsure if this increase in receptors contribute to a greater increase in strength and muscle mass.

Study 4

Combined leg & biceps training shows greater isometric strength in biceps compared to just biceps training.

Limitations: This study is some scientific proof to the anecdote of how squats can add inches to your arms. The study showed significant increases in testosterone and isometric strength when leg training was added to the arm training.

However, the study did not measure muscle size, the increase in isometric strength could have been due to neural adaptations, and the mean initial strength was higher in the arm group which skewed the results a bit.

Study 5

Increase in muscle & strength without any exercise- induced increase in testosterone.

Limitations: This study concluded that you only need basal levels of testosterone to promote muscle growth and strength increase.

But it does not reject the possibility that increase in exercise –induced testosterone levels could have increased the muscle growth & strength even further.

Conclusion

What it all means is that we are still not sure if workout routines specifically designed to increase testosterone are effective in increasing muscle and strength than the generic workout routines.

Reference 1
Reference 2
Reference 3
Reference 4
Reference 5

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Can Nervous System/ Neural Adaptations Increase Strength?

October 07 2009

We all know muscle growth will increase strength. But can nervous system adaptations contribute to strength?

Evidence for nervous system adaptations

Beginner’s Strength: It is pretty clear that there is a disproportionate increase in strength during the early phases of training which cannot be explained by just muscle growth. In fact, there is little or no muscle growth during those early stages of a training program (8-10 weeks).

For example, everyone experience pretty big jumps in weight when you started weight training. Or you will see weights going up easily when you try a new exercise. But you will find you are not getting any bigger in that period.

Disuse: As mentioned above, when you stop working out, there is disproportionate decrease in strength which cannot be explained by muscle loss. And this loss of strength is easily recovered with a few days of training.

For example, you will find yourself a lot weaker when you come back to lifting after you take a couple of weeks off . And you might have noticed that you haven’t got any bit smaller or you that haven’t lost any muscle to explain this loss of strength.

Transfer of Strength: It basically means the increases in strength in one task will not necessarily transfer to other tasks which uses the same muscle.

For example, if you use flat bench for your chest and one day if you change it dumbbell chest press, you will find the weights used to be a lot lower than flat bench though they both use similar muscles.

Unilateral Training:  When you perform exercises with one leg, strength increases are seen in the opposite leg. The strength in the untrained leg may increase up to 22%. How cool is that? They call it “cross- education”

All the above give enough evidence to suspect the role of nervous system adaptations in increasing strength. The next article will talk a bit about the mechanisms behind these adaptations.

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Which is the Most Accurate Body Fat Calculator / Measurement Method?

September 08 2009

I get often asked about the most accurate body measurement method/calculator. Here we will look at the common body fat percent measurement methods to find the most accurate one

Body Mass Index (BMI)

Body Mass Index (BMI) is just simply weight (kg) divided by height (msquare) and is often used to classify people into categories based on disease risk. Click here to find your BMI

Problem 1. BMI just assumes your body be a tub of fat. So if you are an athlete or someone who lift weights, it just ignores all that hard-earned muscle and might classify as “overweight or obese”. How unfair is that?

Just to be sure, BMI do not estimate bodyfat. Equations are being developed to estimate bodyfat from BMI but the current equations have large errors (>5%) in estimating bodyfat.

Underwater (Hydrostatic) Weighing

Underwater weighing is considered as the Gold Standard among body fat measurement methods/calculators. It is based on the fact that density of muscle is higher than fat and hence muscle sinks and fat floats.

Problem 1. It is based on a two-component model and hence divides your body into two compartments: Fat Free Mass & Fat Mass. Fat free mainly mass includes bone, muscle, water (also glycogen, soft tissues) apart from body fat as shown below. 

* Figure shows a two-compartment model and how it divides total body mass.

It assumes fat free mass and fat mass to have a constant density. But it is pretty clear that the density of your muscles and bones do change depending on age, illness, activity, and ethnicity.

If you are 18 and lift weights, your bone and muscle density will be a lot different from a 45 year old sedentary individual.

Problem 2. Fat-free mass is made up of proteins, water, & bone minerals. So if you drink a lot of water before measuring, it can’t help but think it is all muscle (lucky you).

Hydrostatic weighing is used as a standard to even validate other bodyfat measurement techniques. Now tell me how screwed up is that?

Skin Calipers

Skin calipers measures the fat under the skin (subcutaneous) in certain areas to estimate bodyfat. It assumes that subcutaneous fat is proportional the fat inside your body.

Problem 1.Body fat distribution & how well it correlates with the fat inside your body varies based on age, fatness levels , physical activity, and genetics. Some might have more on the thighs whereas others on their abs.

Problem 2. It is based on a two compartment model and hence also has all the problems mentioned above.

Problem 3. There are equations which measures skin thickness from 3, 7, & 9 sites. But, generally, as the measurements increases so does the errors.

Bioelectrical Impedance Analysis (BIA)

BIA is based on the fact that muscle is 72% water and hence is less resistant to the flow of current than fat. Usually BIA is measured by attaching electrode to your wrist and feet and passing a current through.

* Picture shows BIA with electrodes connected and the commonly used hand held & scale BIA.

Problem 1. As you might have guessed everything from drinking a lot of water, emptying your bowels, having more salt in your diet, having a high- carb diet can change the water levels, and along with it your bodyfat.

Problem 2. The commonly seen hand held or scales are called segmental body fat analysers -measures one half of the body -and the equations used in these are yet to be validated.

Problem 3. Since they are based on a two-compartment model they suffer from all the problems associated with a two compartment model.

DEXA

DEXA is slowly replacing to be the gold standard for body composition methods. DEXA is based on a three-compartment model than a 2-compartment model. It can measure the density of fat, bone minerals, and water & protein combined.

Problem 1. This is lot more accurate than the two compartment models but still assumes the density of water & protein. It also has a lot more assumptions which are too technical to make any sense.

Conclusions

• As you can see there are lots of errors & assumptions in the body fat methods/calculators we commonly use. So what really matters more than accuracy is reliability. Can the body fat method you use consistently keep track of your body fat changes “accurately”?
• Find a method that is cost effective, reliable, and easily accessible.
• Skin calipers (measured by the same technician) and BIA (measured under similar conditions) are cost effective, consistent, and easily accessible.

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Are Organic Foods More Nutritious Than Conventional Foods?

August 22 2009

There is a widespread belief that organic automatically means more healthy or nutritious. So what do you really mean by organic food and is it really nutritious than conventional food?

What are organic foods?

Type of Production: Organic refers to the way of production which avoids or largely excludes the use of synthetic fertilizers, pesticides, herbicides, hormones, and antibiotics.It relies mainly on crop rotations, natural fertilizers, biological pest control, and better animal husbandry.

USDA Approval:  In order to bear an organic label, the USDA (United States Dept. of Agriculture) has set some strict government guidelines based on how foods are grown, handled and processed.

Process Label: Organic is not a “label” of safety or health or being natural It is just a process label.

Are organic foods more nutritious?

Not More Nutritious:A recent (2009) systematic review – the biggest and most complete review even undertaken in this subject- looked over this issue and found no truth to the claim that organic foods are more nutritious than conventional foods.

And concluded that the differences that were detected in crops (nitrate & phosphorus) were biologically plausible and are unlikely to be of public health relevance.

Are organic foods more safer?

Lack of Evidence: The study above looked at only the nutritional side of the issues. But there is a complete lack of evidence to suggest that organic foods are safer because it contains less pesticides and insecticides.

A review which looked at safety aspect of organic foods conclude,” At our present state of knowledge, other factors rather than safety aspects seem to speak in favor of organic food.”

Conclusions

• If you are willing to paying more for organic foods because you think they are more “nutritious” than conventional foods, save the money.
• Contrary to the claims, there is no evidence to suggest that organic foods are safer and more healthier than conventional foods.
• If you are buying organic foods because you think they are kinder to the environment and taste better, you do have a point.

Reference 1
Reference 2

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Time Magazine Article: Why Exercise Won’t Make You Thin

August 15 2009

If you been an ardent reader of Exercise Biology, you would have been aware of this before your read the controversial article titled “Why Exercise Won’t Make You Thin”  in the August issue of the Time magazine.

I had written an article titled ” Is Exercise or Cardio Exaggerated in Losing Weight” a few months back. And the August issue of the Time magazine talks exactly the same as the article I wrote.

The main points talked about in the article are:

1. People usually compensate for calories burned with exercise by moving less or eating more
2. Muscle burns only 6 -13 calories/kg/day. It’s not 150 kcal as most trainers say!
3. Exercise burns very less calories than what most people believe.

Conclusion

According to the article, it’s what you eat, not how hard you try to work it off, that matters more in losing weight.

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How Do You Know If An Exercise Program/Diet Works or Not?

July 29 2009

The ideal way to test if an exercise program or diet works is to use randomized controlled studies (RCT). But what if there are no studies attempted? How do you pick a diet to lose weight or an exercise program for muscle growth?

You have 3 options:
1. Try it
2. Ask people who tried it
3. Look for biological plausibility

If you rely on the fist option, you will have to quit your job, leave your family, and probably still won’t get enough time to test out everything out there. 

The second option is worse. There are lots of variables that determine the success of a program /diet. For example, the success of an exercise program depends on diet, your previous exercise programs, your training level, genetics, and so on. Unless they have everything leveled out, you will be jumping into some ridiculous conclusions.

This leaves us with the last option which is what I recommend.

So what is biological plausibility?

It basically means that the exercise program or diet should be consistent or agree with what we currently know about muscle growth/weight loss. Simply put, it should make some biological sense.

Example 1

You often see ads of special ab exercise equipment claiming to get you a flat stomach or a six pack if you use their equipment. But it is painfully clear in the literature that spot reduction is not possible or spot reduction is biologically implausible.

You have to burn more calories than you what you spend if you wanna lose weight or see your abs.

Example 2

One common misconception that I hear a lot is about eating rice at night. Folks often complain eating rice (or carbs) for dinner is the reason why they put on weight. But this does not make any biological sense. Losing weight or gaining weight is all about calories; when you have you food or how often you have food matters the least.

Limitation of biological plausibility approach

One limitation of this approach is that it is limited to what we currently know about muscle growth/diet. But, mind you, we know a hell of a lot about muscle growth and weight loss. Or, at least, enough to see if a diet or exercise program will work or not.

Conclusion

Instead of looking at a before-after picture or reading testimonials or checking the author’s qualifications, check to see if the diet/exercise program makes any biological sense.

If you are unsure, ask in the Exercise Biology forum.

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The Best Workout Program For Muscle Growth?

June 04 2009

I am often asked if I have tried this particular exercise program like P90X, MaX-OT, Crossfit, HST & so forth. And I say you don’t have to try each and every program to see if it works. As long as the program is based on the fundamental physiological principles of muscle growth (or fat loss) they all work. Or they should work.

So let’s look at the key elements of an exercise program to increase muscle growth?

Weight Lifted: The load or the weight lifted is one of the most important determinants for muscle growth. It is usually expressed as the number of reps.

For muscle growth, 6-12 reps with proper form is considered optimal. If you are doing 20 reps or higher, it is too less weight to cause any significant damage or stretch to the muscle which is what ultimately kicks starts the process of muscle growth.

I have come across come across a lot of programs revolving around light weights and bodyweight exercises. They do burn a few more calories but is below par for stimulating muscle growth. And it doesn’t matter how good the model look – you can’t just change human physiology.

Volume: Not just the weight or load, but how many times you lift the weight or the “time under tension” matters too. Volume is inversely related and secondary to the weight lifted or the load.

Figure: Graph showing how volume and frequency is inversely related to weight lifted

A good exercise program will ensure the right volume; that is, not too much or not too less. So what is that right volume? It can be anywhere from 1-3 sets per exercise. So if you are doing 3 exercises for chest the total volume comes around 3- 9 sets for chest in a workout.

If you are doing 20-25 sets per bodypart per workout, you better be chemically- assisted or someone with incredible genetics. Most people who do a high volume sacrifice load or weight lifted, which is probably the number one priority for a natural lifter.

Periodization: Periodization is based on the simple fact that nobody can workout at their 100% in every single workout. They will soon get hit by fatigue and overtraining symptoms. The harder you workout, the sooner you will hit by symptoms of overtraining.

Periodization helps us to manage or prepare for this fatigue (both muscular & CNS fatigue). A good program will have some sort of periodization built into to it take care of the fatigue.

Some common periodization strategies include changing the weight used, changing the sets & reps, taking a week off, and so on.

Frequency: How many days should you hit a body part in a week?  There is some anecdotal and scientific evidence to show that twice a week for a body part or a higher frequency is better than the typical once- a -week routine.

That been said, there might be a subset of people who do well exercising one body party a week. The problem with using a higher frequency is that you just cannot go all out in both the workouts. Periodization becomes absolutely necessary with a higher frequency program.

Progressive Overload: This is the cardinal rule in weight lifting. All the above rules matter the least, if you cannot increase the weight you are lifting. It is also the very reason we use “weight” training.

This is probably the most ignored rule in the gym or exercise programs. If you increase the weights you lift, your muscles can’t help but grow.

Conclusion

There are a lot of programs using a lot of unnecessary scientific jargon and fairy tale theories which might need a background in exercise physiology and research to analyze critically. I feel like the more I know about the field, the harder it is to find a decent program or a fitness expert who is more concerned about improving his knowledge than just marketing and profits.

It may not be the best, but a program which sticks to the above elements will not be too far from the best.

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How Does Occlusion Training Work In Increasing muscle?

May 19 2009

Can we use lights weights and still grow big muscles? It seems you can with occlusion training. Now let’s learn more about occlusion training?

What is Occlusion Training?

Occlusion training involves partially restricting (occluding) the blood flow to the muscle when you are lifting weights by using a tourniquet cuff.

Why has Occlusion Training become so popular?

Lighter Weights: For muscle growth, you need to use heavy weights (> 65% of your 1RM). However, occlusion training with lighter weights (20 -50% of 1RM) has shown to achieve muscle & strength gains comparable to conventional training with heavier weights (around 80% 1RM).

Rehabilitation: Heavier weights are not recommended when you are recovering from injury. Occlusion training improves strength and muscle gains with lighter weights which is beneficial for rehabbing injuries.

Studies: Number of scientific studies have confirmed the above results with occlusion training.

So how does Occlusion Training increase muscle growth?

The major factors that could explain muscle growth with occlusion training are:

Recruitment of Type 2 Fibers:  Muscles are made of two types of fibers: Type 2 & Type 1 fibers. Type 2 fibers are the ones which grow easily and make you look big. But Type 2 fibers are only recruited when you go to failure or when you use heavy weights (>80% 1RM).

When lighter loads are combined with occlusion, Type 2 fibers are recruited way early in the set just like when you are doing a heavier weight. So they get naturally bigger.

Increase in Growth Hormone: Lighter loads with occlusion training have shown to increase GH levels more than heavy training. But recent evidences have shown increases in GH not to have much benefit for muscle growth.

Metabolic Accumulation: The accumulation of metabolites like lactic acid, hydrogen in the muscle (causes the burn) due to blood flow restriction ( as in occlusion training) may help in increasing muscle growth. But we are not sure.

Practical Application

The muscle is usually occluded when you are using heavier weights (> 60% of1RM). But you can occlude or reduce blood flow a bit more with some other techniques.

• Not relaxing the muscle throughout the set. Or maintain the tension thought the muscle by doing partial movements and/or contracting them hard.
• Keeping rest time between sets short
• Doing a drop set with lighter weights after your heavy set. When you use heavy weight, you are recruiting ALL your fibers from the very first rep.So a drop set can give you some metabolic build up (the burn) which may help in muscle growth.
• Occluding the muscles for more than 5-10 minutes with tourniquets can cause serious muscle damage.

Reference 1
Reference 2

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Can Antioxidants Prevent Cancer?

May 03 2009

You will find a lot of people taking multivitamin, Vit C, Beta carotene, & Vit E to prevent cancer.But the recent cancer prevention studies paints an entirely different story.

Why use antioxidants to prevent cancer?

Prevent Oxidative Stress: Antioxidants can neutralize free radicals or oxidative stress which may cause damage to cells and cell processes , and thereby increase the risk of cancer.

Studies: A large number of epidemiological studies have shown that a diet high in fruits, vegetables, and plants can lower risk of cancer. This same was shown in animals studies and cell culture studies that antioxidants can prevent or delay the development of cancer.

What are the major antioxidants used to prevent cancer?

The major antioxidants used in studies to prevent cancer are: Vitamin E, Vitamin C, Beta carotene, & Selenium.

And did antioxidants prevent cancer?

The results of the studies- spanning three decades of research - have been extremely disappointing to say the least.  A few of the recent large trials showed no benefit of antioxidants for cancer prevention.

Other Nutrients: Even other vitamins like folic acid, Vit b6, B12, Calcium, Vitamin D which showed tremendous hope have failed to deliver.

SELECT Study: The biggest blow to cancer prevention was the recently concluded SELECT study (Selenium and Vitamin E Cancer Prevention Trial), which is the largest cancer prevention study . Though very promising, the study failed to show any beneficial effect of selenium and Vitamin E for reducing the risk of prostrate cancers and was terminated early.

Can antioxidants increase the risk of cancer?

Surprisingly, a couple of studies of large studies have shown that antioxidants may increase the risk of cancers.

Increase in Lung Cancer: The CARET study (Beta-Carotene and Retinol Efficacy Trial) showed that beta carotene supplements in smokers increase the risk of lung cancer.  The similar results from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study and the high incidence of lung cancer in the participants prompted the researchers to stop the study early.

Increase in Prostrate Cancer: In a recent study (secondary findings), the author concluded that daily supplementation with 1 mg of folic acid was associated with an increased risk of prostate cancer.

Why antioxidant studies failed to prevent cancer?

There has been a lot of explanations. Below are the major ones:

• The epidemiological studies that showed benefits had whole foods, which usually is a complex mix of several nutrients. The antioxidant studies used specific single nutrient isolated from food.
• The effects of specific nutrients depend on the genetic make up of the individual.
• A deficiency of certain antioxidants or nutrient might increase cancer risk. Also an excess of the same nutrient may increase cancer risk. A good example is folate.
• Oxidative stress & free radicals are not evil. They have a beneficial effect too.

Conclusion

• The best way to get antioxidants and maybe prevent cancer is eat a lot of fruits & vegetables. The American Cancer Society recommends eating at least 5 servings of these foods every day.
• We don’t have too much evidence to advocate high doses of single antioxidant to prevent cancer. In some cases, excess may increase the risk of cancer.

Reference 1
Reference 2

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Weight Loss Drugs & Supplements: Do They Work & How?

April 19 2009

Everyone seems to have questions like do weight loss drugs & supplements work, are they safe, and if so, how do they work. Here is the run down:

Do weight-loss drugs & supplements work?

Before you understand if they work or not, you have to understand the difference between weight loss drugs and weight loss supplements :

Weight Loss Drugs: They can be either prescription or Over the counter drugs. These are approved by the Federal Drug Administration (FDA). That means, the safety & efficacy of these drugs are proven in clinical studies. 

These drugs have shown 5-10% of weight loss (of initial body weight), around 2lb/month with lifestyle medications. Examples are Alli, & Meridia as shown in the picture.

Dietary Supplements: These are not approved by the FDA and hence are not tested in clinical trials. So the safety and efficacy carries a big question mark. Simply put, most don’t work and are not safe.

How do these weight-loss drugs & supplements work?

Suppressing Appetite: Most weight loss drugs work by suppressing the appetite and thereby reducing food intake.

An example is Meridia (sibutramine), which is the only drug approved by FDA for long-term use.

Altering food absorption: These reduce weight by preventing the absorption and digestion of fat in foods.

Alli (Orlistat) which prevents fat absorption is the only over- the-counter drug approved by the FDA to treat obesity .

Increasing Energy expenditure: These drugs (called thermogenics) help by increasing your metabolism or energy expenditure. You can expect 2-3% increase in your metabolism (around 100-150 calories/day).

Ephedrine works via the same mechanism and also by suppressing appetite. FDA hasn’t approved ephedrine as a weight loss drug. Mua Hung – a natural source of Ephedrine- can be found in many dietary supplements.

Conclusions

• Even weight loss drugs work by making you eat less or spending more energy. So don’t think you can eat whatever you want and still magically lose weight by taking weigh loss supplements
• FDA approved Weight loss drugs are proven to work and are safe. Dietary supplements are not.
• Weight loss drugs work best when complimented with lifestyle modifications like diet and exercise.
• Weight loss drugs cannot cure weight problems; get off the drug, and you will gain all the weight back.

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Is Exercise or Cardio Exaggerated in Losing Weight?

April 11 2009

We know there are two ways to lose weight:

• Exercise/ Cardio
• Eat Less

But which is better? 99% of the people overestimate the ability of exercise (or cardio) to lose weight or/and underestimate the importance of diet in losing weight.

They have this notion that if they do cardio 3-4 days/week and eat a bit healthy (and of course eat small meals), they should just easily lose weight.

Is Exercise or Cardio Really Exaggerated in Losing Weight?

Exercise Studies: Research has repeatedly shown that exercise or cardio workout does a pretty poor job in losing weight. Believe it or not, most of the exercise studies ranging from six months to a year show a meager 1-12 lb weight loss. This is no where near to the “1-2 lb/week” we often hear about.

Exercise Studies Supporting Exercise: The couple of studies which did show greater weight loss with exercise had some brutal exercise protocol or had the participants restrict and monitor their diet. For example, one study showed 25lb loss in 5 months (around 1lb/week). And how many hours did the particpants have to train for this? An average of 29 hours per week (yes it’s per week)

So Why is Exercise or Cardio Not Great For Losing Weight?

1 lb of fat= 3500 calories

That is, if you want to burn 1 lb of fat in a week, you have to burn 3500 calories with exercise/cardio in a week.

Now let’s take the example of running since it’s a lot more energy intense than biking, elliptical training or swimming. If you can run at a pace of 5-6 miles/hr, you will burn around 500-600 calories ( for 150-160 lb body weight). So if you run for 7 days at this pace, you will burn I lb of fat. And that’s great. But the problem is that this never happens in reality. Why?

Too Intense: At least, 90% of the people who I see exercise at the gym do not even come close to an intensity of 5-6miles/hr pace. And people who can run at this pace, obviously, won’t have a bodyweight problem in the first place. The same applies for biking, elliptical, stepping or whatever cardio workout.

Joint Problems:  Folks who grind their teeth and somehow manage to run 7 days/ week will usually end up with knee pain, especially if they are overweight or obese.

Adherence: It is so hard for someone with a regular job and other priorities in life to exercise 6-7 days/week. Most people drop out soon. And this is clearly shown in exercise studies which show high drop out rates.

Body Compensating: When you lose weight, your body has a nasty habit of compensating by:

• Increasing Hunger: The above weight loss of 1lb/week with running is assuming you are eating the same amount of calories day in and out.Have a small donut (300 - 350calories) - and you wasted 30 - 45min minutes of your running. If you don’t keep an approximate count of calories you eat, it is so easy to overeat and compensate for all the calories you burned with exercise.
• Decreasing Activity: You tend to sit around a lot more than you used to.  In research they call it spontaneous physical activity. So you workout but come home and lie on the couch or watch TV or somehow try to move the least.

However, If you can magically overcome the problems above, you can lose weight with just exercise.

Conclusion

• You can lose a lot of weight with just diet and no exercise/cardio.
• A combination of diet and exercise/cardio is the best for weight loss.
• Exercise/cardio becomes more important in maintaining the lost weight than losing weight.

Reference 1

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Is Back Squat Better Than Front Squat?

March 31 2009

Which is better: Back squat or front squat? Back squat is one of those exercises which has a bad ass reputation of being THE best for overall muscle growth in your legs.

On the other hand, front squat is often sidelined as one of those secondary exercises to isolate or emphasize the quads . Or it is considered to be more more of a shaping exercise.

To see if there is any truth to these long-held beliefs, a recent study compared the back squat to the front squat in men and women who were experienced at doing both the lifts.

The study used 70% of their 1RM (maximum weight that can be lifted for one rep) for both the exercises thereby ensuring that they are comparing exercises of similar intensity.

Results

• Though the back squat used a heavier weight, muscle activity recorded in quads, hamstrings and low back was similar in both exercises.  In other words, both exercises theortically are equally effective in making your legs grow!
• Compressive forces were much lower in front squats than back squats. High and continued compressive forces on the knee can cause loss of cartilage and result in osteoarthritis (usually pain in the knees).
• Glute activity was not measured in the study.

Conclusion

Front squat is equally good as back squat for your quads and hams from EMG results. As well, front squat is lot better on your knees than back squat.

If knee health & muscle activation is a concern, you might want try front squats for a change.

Reference

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