Skeletal muscle mass in competitive physique-based athletes (bodybuilding, 212 bodybuilding, bikini, and physique divisions): A case series.

OBJECTIVES: (1) To examine the muscle thickness of various muscle groups of the body to estimate the absolute and relative skeletal muscle mass (SM) in competitive physique-based athletes (Bodybuilding, 212 Bodybuilding, Bikini, and Physique divisions) and (2) to compare values across various divisions of competition and to resistance trained and non-resistance trained individuals. METHODS: Eight competitive physique-based athletes (2 M and 6 F), two recreationally resistance trained (1 M and 1 F) and two non-resistance trained (1 M and 1 F) participants had muscle thickness measured by ultrasound at nine sites on the anterior and posterior aspects of the body. SM was estimated from an ultrasound-derived prediction equation and SM index was used to adjust for the influence of standing height (i.e., divided by height squared). RESULTS: SM values ranged from 19.6 to 60.4 kg in the eight competitive physique-based athletes and 16.1 to 32.6 kg in the four recreationally resistance trained and non-resistance trained participants. SM index ranged from 7.2 to 17.9 kg/m2 in the eight competitive physique-based athletes and 5.8 to 9.3 kg/m2 in the four recreationally resistance trained and non-resistance trained participants. CONCLUSION: Overall, varying magnitudes of SM and SM index were present across competitors and their respective divisions of bodybuilding. The Men's Open Bodybuilder in the present study had greater values of total SM and SM index compared to previously published values in the literature. Our data provides insight into the extent of SM present in this population and further extends the discussion regarding SM accumulation in humans.

Muscular Adaptations Between Very Low Load Resistance Training With Pulsed Direct Current Stimulation (Neubie) and Traditional High Load Training.

OBJECTIVES: This study compared muscle growth in response to very low load resistance training with direct pulsed current (DPC) stimulation and traditional high load training. METHODS: Twenty-six resistance trained individuals had each leg assigned to one of two unilateral knee extension protocols: 1) 4 sets of 20 repetitions at ~10% one-repetition maximum (1RM) and inter-set rest periods of 30 s (DPC) and 2) 4 sets to muscular failure at ~70% 1RM (TRAD). Muscle thickness (MTH), 1RM strength, and local muscular endurance (LME) were measured before and after 8-weeks of training. An alpha level of 0.05 was used for all comparisons. RESULTS: MTH increased similarly between TRAD and DPC at the 50% (0.24 cm, 95%CI: 0.11-0.36), and the 60% anterior sites (0.25 cm, 95%CI: 0.10-.040), as well as the lateral (0.25 cm, 95%CI: 0.10-.040) and medial sites (0.21 cm, 95%CI: 0.10-0.31), but was greater for TRAD at the 40% anterior site (0.3 cm, 95%CI: 0.16-0.43). Changes in 1RM were greater for TRAD (10.2 kg, 95%CI: 5.8-14.4). LME increased similarly between protocols (5 repetitions, 95%CI: 3-7). CONCLUSIONS: The current data suggest that very low load knee extension resistance training with DPC could be a viable training strategy for promoting skeletal muscle growth and local muscular endurance.

Skeletal Muscle Adaptations to High-Load Resistance Training With Pre-Exercise Blood Flow Restriction.

ABSTRACT: Hammert, WB, Moreno, EN, Martin, CC, Jessee, MB, and Buckner, SL. Skeletal muscle adaptations to high-load resistance training with pre-exercise blood flow restriction. J Strength Cond Res 37(12): 2381-2388, 2023-This study aimed to determine if blood flow restriction (BFR) could augment adaptations to a high-load training protocol that was inadequate for muscle growth. Forty nontrained individuals had each arm assigned to 1 of 3 elbow flexion protocols: (a) high-load resistance training [TRAD; 4 sets to muscular failure at 70% 1 repetition maximum (1RM)], (b) low repetition high-load resistance training with pre-exercise BFR (PreBFR; 4 sets of 3 repetitions at 70% 1RM + 3 min of pre-exercise BFR), and (c) low repetition high-load resistance training (LRTRAD); 4 sets of 3 repetitions at 70% 1RM). Muscle thickness (MT), 1RM strength, and local muscular endurance (LME) of the elbow flexors were measured before and after 8 weeks. An alpha level of 0.05 was used for all comparisons. For the 50% site, MT increased for TRAD (0.211 cm, 95% confidence interval [95% CI]: 0.143-0.280), PreBFR (0.105 cm, 95% CI: 0.034-0.175), and LRTRAD (0.073 cm, 95% CI: 0.000-0.146). The change for TRAD was greater than PreBFR and LRTRAD. For the 60% site, MT increased for TRAD (0.235 cm, 95% CI: 0.153-0.317), PreBFR (0.097 cm, 95% CI: 0.014-0.180), and LRTRAD (0.082 cm, 95% CI: 0.000-0.164). The change for TRAD was greater than PreBFR and LRTRAD. For the 70% site MT increased for TRAD (0.308 cm, 95% CI: 0.247-0.369), PreBFR (0.103 cm, 95% CI: 0.041-0.166), and LRTRAD (0.070 cm, 95% CI: 0.004-0.137). The change for TRAD was greater than PreBFR and LRTRAD. One repetition maximum and LME significantly increased for each condition, with no differences between conditions. Collapsed across conditions 1RM strength increased 2.094 kg (95% CI: 1.771-2.416) and LME increased 7.0 repetitions (95% CI: 5.7-8.3). In conclusion, the application of BFR to low-repetition, high-load training did not enhance the adaptative response.

The acute muscular response following a novel form of pulsed direct current stimulation (Neubie) or traditional resistance exercise.

OBJECTIVES: To examine changes in muscle thickness (MT), soreness (SOR), and isometric torque (ISO) following exercise with pulsed direct current (Neubie) or traditional high-load (TRAD) exercise. METHODS: Thirty-two participants had SOR, MT, and ISO measured before, immediately after, and 24 and 48h following TRAD and Neubie. Rating of perceived exertion (RPE) and discomfort were also measured. Results are displayed as means(SD). RESULTS: For MT, there was a condition x time interaction (p<0.001). For Neubie, MT increased pre [3.7(0.7)cm] to post [3.9(0.8) cm, p<0.001] and remained elevated at 24h. For TRAD, MT increased pre [3.7(0.6)cm] to post [4.0 (0.7)cm, p<0.001] and remained up to 48h. Greater values were observed for TRAD post-exercise. For ISO, both conditions decreased up to 48h. TRAD demonstrated a greater change post exercise (p<0.001). For SOR, both conditions increased up to 48h. Neubie demonstrated greater SOR at 48h (p=0.007). RPE was higher for all sets in TRAD [Mean across sets=16.0(1.9) vs. 13.5(2), p<0.001]. Discomfort was higher in all sets for Neubie [Mean across sets=5.8(1.5)vs. 4.5(2.0), p<0.05]. CONCLUSIONS: Both conditions showed increased SOR, and decreased ISO for up to 48h, with MT increased for up to 24h. MT remained elevated in TRAD at 48h. Neubie training might be effective for individuals who are looking to experience lower RPE responses during exercise.

Muscle growth adaptations to high-load training and low-load training with blood flow restriction in calf muscles.

PURPOSE: To compare muscle growth adaptations between traditional high-load training and low-load training with blood flow restriction (BFR) in the calf muscles over 6 weeks. METHODS: 27 trained individuals performed calf exercise in both legs for 6 weeks. Each leg was randomly assigned to one of the two conditions: (1) Traditional (70% of 1RM) training (TRAD); and (2) Low-load (30% of 1RM) training with BFR. In addition, subjects performed standing calf raises with or without BFR. Measures were taken pre- and post-intervention. RESULTS: For the posterior muscle site, there was no condition (BFR vs. TRAD) × time (pre vs. post) interaction (p = 0.15). In addition, there was no main effect for condition (p = 0.83) or time (p = 0.20). For the lateral muscle site, there was no condition × time interaction (p = 0.47). In addition, there was no main effect for condition (p = 0.10) or time (p = 0.57). For the medial muscle site, there was no condition × time interaction (p = 0.60). In addition, there was no main effect for condition (p = 0.44) or time (p = 0.72). For RPE, there was no condition × time interaction. However, there was a main effect for condition (p < 0.05) with BFR having higher RPE. For discomfort, there was no condition × time interaction. However, there was a main effect for condition (p < 0.001) with the BFR condition displaying higher discomfort. CONCLUSION: No muscle growth was detected in the calf musculature. BFR was not more effective at eliciting muscle hypertrophy compared to traditional training. However, it was accompanied with higher exertion and discomfort.

The Impact of Ultrasound Probe Tilt on Muscle Thickness and Echo-Intensity: A Cross-Sectional Study.

INTRODUCTION/BACKGROUND: To determine the influence of ultrasound probe tilt on reliability and overall changes in muscle thickness and echo-intensity. MATERIALS AND METHODS: Thirty-six individuals had a total of 15 images taken on both the biceps brachii and tibialis anterior muscles. These images were taken in 2° increments with the probe tilted either upward (U) or downward (D) from perpendicular (0°) to the muscle (U6°, U4°, U2°, 0°, D2°, D4°, and D6°). All images were then saved, stored, and analyzed using Image-J software for echo-intensity and muscle thickness measures. Mean values (2-3 measurements within each probe angle) were compared across each probe angle, and reliability was assessed as if the first measure was taken perpendicular to the muscle, but the second measure was taken with the probe tilted to a different angle (to assume unintentional adjustments in reliability from probe tilt). RESULTS: Tilting the probe as little as 2° produced a significant 4.7%, and 10.5% decrease in echo-intensity of the tibialis anterior and biceps brachii muscles, respectively, while changes in muscle thickness were negligible (<1%) at all probe angles. The reliability for muscle thickness was greater than that of echo-intensity when the probe was held perpendicular at both measurements (∼1% vs 3%), and the impact that probe tilt had on reliability was exacerbated for echo-intensity measurements (max coefficient of variation: 24.5%) compared to muscle thickness (max coefficient of variation: 1.5%). CONCLUSION: While muscle thickness is less sensitive to ultrasound probe tilt, caution should be taken to ensure minimal probe tilt is present when taking echo-intensity measurements as this will alter mean values and reduce reliability. Echo-intensity values should be interpreted cautiously, particularly when comparing values across technicians/studies where greater alterations in probe tilt is likely.

Does resistance training increase aponeurosis width? The current results and future tasks.

PURPOSE: The aponeurosis, a sheet of fibrous tissue, is the deep and superficial fascia where muscle fibers attach in pennate muscles. It is quite possible that the aponeurosis size increases in response to resistance training-induced fiber hypertrophy due to an increase in connection area. As a result, it leads to an increase in anatomical muscle cross-sectional area. However, attention has not been paid to aponeurosis area changes. This review sought to determine whether muscle hypertrophy changes aponeurosis width following short-term resistance training using an equation we modified [post/pre changes in aponeurosis width (AWpost/pre) = post/pre changes in anatomical cross-sectional area (CSApost/pre) ÷ post/pre changes in pennation angle (PApost/pre) ÷ post/pre changes in fascicle length (FLpost/pre)]. METHODS: A search using two electronic databases (PubMed and Google Scholar) was conducted. Nine studies measured CSApost/pre, PApost/pre, and FLpost/pre of the vastus lateralis muscle by ultrasound and magnetic resonance imaging. RESULTS: There was a statistically significant 2.73 [95% CI 1.11, 4.36; p = 0.009] cm2 increase in CSApost/pre along with a statistically significant 1.21° [95% CI 0.44, 1.97; p = 0.002] increase in PApost/pre and a statistically significant 0.36 cm [95% CI 0.19, 0.54; p = 0.0002] increase in FLpost/pre. These results yield an estimated 1% reduction in aponeurosis width. CONCLUSION: Our results suggest that while muscle CSA, pennation angle, and fascicle length all increase following short-term resistance training, the aponeurosis width is not altered.

Validity of the Handheld Doppler to Determine Lower-Limb Blood Flow Restriction Pressure for Exercise Protocols.

Laurentino, GC, Loenneke, JP, Mouser, JG, Buckner, SL, Counts, BR, Dankel, SJ, Jessee, MB, Mattocks, KT, Iared, W, Tavares, LD, Teixeira, EL, and Tricoli, V. Validity of the handheld Doppler to determine lower-limb blood flow restriction pressure for exercise protocols. J Strength Cond Res 34(9): 2693-2696, 2020-Handheld (HH) Doppler is frequently used for determining the arterial occlusion pressure during blood flow restriction exercises; however, it is unknown whether the blood flow is occluded when the auscultatory signal is no longer present. The purpose of this study was to assess the validity between the HH Doppler and the Doppler ultrasound (US) measurements for determining the arterial occlusion pressure in healthy men. Thirty-five participants underwent 2 arterial occlusion pressure measurements. In the first measure, a pressure cuff (17.5 cm wide) was placed at the most proximal region of the thigh and the pulse of posterior tibial artery was detected using an HH Doppler probe. The cuff was inflated until the auscultatory pulse was no longer detected. After 10 minutes of rest, the procedure was repeated with the Doppler US probe placed on the superficial femoral artery. The cuff was inflated up to the point at which the femoral arterial blood flow was interrupted. The point at which the auscultatory pulse and blood flow were no longer detected was deemed the arterial occlusion pressure. There were no significant differences in arterial occlusion pressure level between the HH Doppler and the Doppler US (133 [±18] vs. 135 [±17] mm Hg, p = 0.168). There was a significant correlation (r = 0.938, p = 0.168), reasonable agreement, and a total error of the estimate of 6.0 mm Hg between measurements. Arterial occlusion pressure level determined by the HH Doppler and the Doppler US was similar, providing evidence that the HH Doppler is a valid and practical method.

A method to standardize the blood flow restriction pressure by an elastic cuff.

Blood flow restriction training using a practical (non-pneumatic) elastic cuff has recently increased in popularity. However, a criticism of this method is that the pressure applied and the amount of blood flow restriction induced is unknown. The aim was to quantify blood flow following the application of an elastic cuff and compare that to what is observed using a more traditional pressurized nylon cuff. Thirty-five young participants (16 men and 19 women) visited the laboratory once for testing. In a randomized order (one condition per arm), an elastic cuff (5 cm wide) was applied to one arm and blood flow was measured following the cuff being pulled to two distinct lengths; 10% and 20% of the resting length based on arm circumference. The other arm would follow a similar protocol but use a pressurized nylon cuff (5 cm wide) and be inflated to 40% and 80% of the individuals resting arterial occlusion pressure. There was a main effect of pressure for blood flow with it decreasing in a pressure-dependent manner (High < Low, P < 0.001). The mean difference (95% CI) in blood flow between cuffs was -5.9 (-18.9, 7.0) % for the lower pressure and -4.0 (-13.2, 5.1) % for the higher pressure. When the relative changes for each cuff were separated by sex, there were no differences in the changes from Pre (P ≥ 0.509). The application of a pressure relative to the initial belt length, which is largely dependent upon arm circumference, appears to provide one method to standardize the practical blood flow restriction pressure for future research.

Perceptual changes to progressive resistance training with and without blood flow restriction.

The purpose was to examine changes in the perceptual responses to lifting a very low load (15% one repetition maximum (1RM)) with and without (15/0) different pressures [40% (15/40) and 80% (15/80) arterial occlusion pressure] and compare that to traditional high load (70/0) resistance exercise. Ratings of perceived exertion (RPE) and discomfort were measured following each set of exercise. In addition, resting arterial occlusion pressure was measured prior to exercise. Assessments were made in training sessions 1, 9, and 16 for the upper and lower body. Data are presented as means and 95% CI. There were changes in RPE in the upper body with condition 15/40 [-2.1 (-3.4, -0.850)] and 15/80 [-2.4 (-3.6, -1.1)] decreasing by the end of training. In the lower body, RPE decreased in condition 15/40 [-1.4 (-2.3, -0.431)] by the end of the training study. There was a main effect of time in the upper body with all conditions decreasing discomfort. In the lower body, all conditions decreased except for 15/80. For arterial occlusion pressure, there were differences across time in the 15/40 condition and the 15/80 condition in the upper body. Repeated exposure to blood flow restriction may dampen the perceptual responses over time.

Skeletal muscle mass in human athletes: What is the upper limit?

OBJECTIVES: To examine the amount of absolute and relative skeletal muscle mass (SM) in large sized athletes to investigate the potential upper limit of whole body muscle mass accumulation in the human body. METHODS: Ninety-five large-sized male athletes and 48 recreationally active males (control) had muscle thickness measured by ultrasound at nine sites on the anterior and posterior aspects of the body. SM was estimated from an ultrasound-derived prediction equation. Body density was estimated by hydrostatic weighing technique, and then body fat percentage and fat-free mass (FFM) were calculated. We used the SM index and FFM index to adjust for the influence of standing height (ie, divided by height squared). RESULTS: Ten of the athletes had more than 100 kg of FFM, including the largest who had 120.2 kg, while seven of the athletes had more than 50 kg of SM, including the largest who had 59.3 kg. FFM index and SM index were higher in athletes compared to controls and the percentage differences between the two groups were 44% and 56%, respectively. The FFM index increased linearly up to 90 kg of body mass, and then the values leveled off in those of increasing body mass. Similarly, the SM index increased in a parabolic fashion reaching a plateau (approximately 17 kg/m2 ) beyond 120 kg body mass. CONCLUSIONS: SM index may be a valuable indicator for determining skeletal muscle mass in athletes. A SM index of approximately 17 kg/m2 may serve as the potential upper limit in humans.

Moderately heavy exercise produces lower cardiovascular, RPE, and discomfort compared to lower load exercise with and without blood flow restriction.

PURPOSE: To determine the acute cardiovascular and perceptual responses of low-load exercise with or without blood flow restriction and compare those responses to that of moderately heavy exercise. METHODS: Twenty-two participants completed unilateral elbow flexion exercise with a moderately heavy-load- [70% one-repetition maximum (1RM); 70/0] and with three low-load conditions (15% 1RM) in combination with 0% (15/0), 40%, (15/40) and 80% (15/80) arterial occlusion pressure. Participants exercised until failure (or until 90 repetitions per set). The cardiovascular response (arterial occlusion) was measured pre and post exercise and the perceptual responses [ratings of perceived exertion (RPE) and discomfort] were determined before and after each set of exercise. RESULTS: For arterial occlusion pressure, the lower-load conditions had greater change from pre to post compared to 70/00 (e.g., 15/80: 44 vs. 70/0: 34 mmHg). RPE was highest across the sets for the 15/80 condition with the other conditions having similar RPE (e.g., set 4: median rating of 17.2 for 15/80 vs. ~ 15.5 for other conditions). Ratings of discomfort were also greatest for the 15/80 condition (15/80 > 15/40 > 15/0 > 70/0). Exercise volume within the 15/0 and 15/40 conditions were similar but were significantly greater than that observed with the 15/80 and 70/0 conditions. CONCLUSION: Low-load exercise to volitional failure results in a greater cardiovascular response to that of moderately heavy-load exercise. When high pressure is applied to low load exercise, there is a reduction in exercise volume but an elevated perceptual response that may be an important consideration when applying this stimulus in practice.

A critical review of the current evidence examining whether resistance training improves time trial performance.

A number of reviews have concluded that resistance training is beneficial for improving sports performance despite the inclusion of studies which do not actually measure a performance outcome (i.e. a timed trial). The purpose of this review was to examine only those studies which would allow us to infer the benefits of resistance training on improving time trial performance. Of the nine studies meeting all inclusion criteria only three demonstrated an additive effect of adding resistance training to the current activity-specific training being performed. These three studies demonstrated improvements in either 5 or 10 km time trial among recreationally skilled athletes (i.e. non-elite level time). Previous reviews have included studies which did not include: (1) performance outcomes; (2) control groups; and/or (3) equal volumes of activity-specific exercise among the resistance training and control groups. Presently, there is little evidence that adding resistance exercise to a sport-specific training program will augment time trial performance. While it is difficult to perform such long-term studies assessing the effects of resistance training among time trial athletes, the statement that resistance training is efficacious for improving time trial performance should be tempered until sufficient evidence is presented to support such claims.

The Application of Blood Flow Restriction: Lessons From the Laboratory.

Blood flow restriction by itself or in combination with exercise has been shown to produce beneficial adaptations to skeletal muscle. These adaptations have been observed across a range of populations, and this technique has become an attractive possibility for use in rehabilitation. Although there are concerns that applying blood flow restriction during exercise makes exercise inherently more dangerous, these concerns appear largely unfounded. Nevertheless, we have advocated that practitioners could minimize many of the risks associated with blood flow-restricted exercise by accounting for methodological factors, such as cuff width, cuff type, and the individual to which blood flow restriction is being applied. The purpose of this article is to provide an overview of these methodological factors and provide evidence-based recommendations for how to apply blood flow restriction. We also provide some discussion on how blood flow restriction may serve as an effective treatment in a clinical setting.

Muscle adaptations following 21 consecutive days of strength test familiarization compared with traditional training.

INTRODUCTION: Large increases in 1-repetition maximum (1RM) strength have been demonstrated from repeated testing, but it is unknown whether these increases can be augmented by resistance training. METHODS: Five trained individuals performed a 1RM test and maximal voluntary isometric contraction (MVC) for unilateral elbow flexion exercise on 1 arm (testing arm), while the other arm performed a 1RM test and MVC, in addition to 3 sets of exercise (70% 1RM) (training arm), for 21 straight days. RESULTS: Although only the training arm had increased muscle thickness [mean 0.28 cm, 95% confidence interval (CI) 0.22-0.33 cm], 1RM strength increased similarly in the training (2.2 kg, 95% CI 0.9-3.4 kg; P = 0.008) and testing (1.9 kg, 95% CI 0.5-3.2 kg; P = 0.019) arms. CONCLUSION: Increases in 1RM strength from resistance training are related to the specificity of exercise and are likely driven by mechanisms other than muscle growth. Muscle Nerve 56: 307-314, 2017.

What does individual strength say about resistance training status?

The point at which an individual becomes resistance "trained" is not well defined in the literature. Some studies have defined training status as having engaged in consistent resistance training activities for a given period of time, whereas others base inclusion criteria on strength levels alone, or levels of strength in combination with training age/time. If the primary focus of a study is to examine adaptations in individuals with high levels of strength, then it may be appropriate to exclude the individuals who do not meet strength requirements. However, given the heterogeneity of the strength response to resistance training, strength cannot separate those who are "trained" from those who are "untrained." We suggest that, when determining resistance training status, training age (time) and the modality of training (specificity) should be the primary criteria considered. Muscle Nerve 55: 455-457, 2017.

Muscle growth: To infinity and beyond?

Strength increases following training are thought to be influenced first by neural adaptions and second by large contributions from muscle growth. This is based largely on the idea that muscle growth is a slow process and that a plateau in muscle growth would substantially hinder long-term increases in strength. This Review examines the literature to determine the time course of skeletal muscle growth in the upper and lower body and to determine whether and when muscle growth plateaus. Studies were included if they had at least 3 muscle size time points, involved participants 18 years or older, and used a resistance training protocol. Muscle growth occurs sooner than had once been hypothesized, and this adaptation is specific to the muscle group. Furthermore, the available studies indicate that the muscle growth response will plateau, and additional growth is not likely to occur appreciably beyond this initial plateau. However, the current study durations are a limitation. Muscle Nerve 56: 1022-1030, 2017.

Post-exercise blood flow restriction attenuates hyperemia similarly in males and females.

PURPOSE: Our laboratory recently demonstrated that post-exercise blood flow restriction attenuated muscle hypertrophy only in females, which we hypothesized may be due to alterations in post-exercise blood flow. The aim of this study is to test our previous hypothesis that sex differences in blood flow would exist when employing the same protocol. METHODS: Twenty-two untrained individuals (12 females; 10 males) performed two exercise sessions, each involving one set of elbow flexion exercise to volitional failure on the right arm. The experimental condition had blood flow restriction applied for a 3 min post-exercise period, whereas the control condition did not. Blood flow was measured using an ultrasound at the brachial artery and was taken 1 and 4 min post-exercise. This corresponded to 1 min post inflation and 1 min post deflation in the experimental condition. RESULTS: There were no differences in the alterations in blood flow between the control and experimental conditions when examined across sex. Increases in blood flow [mean (standard deviation)] were as follows: males 1 min [control 764 (577) %; experimental 113 (108) %], males 4 min [control 346 (313) %; experimental 449 (371) %], females 1 min [control 558 (367) %; experimental 87 (105) %], and females 4 min [control 191 (183) %; experimental 328 (223) %]. CONCLUSION: It does not appear that the sex-specific attenuation of muscle hypertrophy we observed previously can be attributed to different alterations in post-exercise blood flow. Future studies may wish to replicate our previous training study, or examine alternative mechanisms which may be sex specific.

Do metabolites that are produced during resistance exercise enhance muscle hypertrophy?

Many reviews conclude that metabolites play an important role with respect to muscle hypertrophy during resistance exercise, but their actual physiologic contribution remains unknown. Some have suggested that metabolites may work independently of muscle contraction, while others have suggested that metabolites may play a secondary role in their ability to augment muscle activation via inducing fatigue. Interestingly, the studies used as support for an anabolic role of metabolites use protocols that are not actually designed to test the importance of metabolites independent of muscle contraction. While there is some evidence in vitro that metabolites may induce muscle hypertrophy, the only study attempting to answer this question in humans found no added benefit of pooling metabolites within the muscle post-exercise. As load-induced muscle hypertrophy is thought to work via mechanotransduction (as opposed to being metabolically driven), it seems likely that metabolites simply augment muscle activation and cause the mechanotransduction cascade in a larger proportion of muscle fibers, thereby producing greater muscle growth. A sufficient time under tension also appears necessary, as measurable muscle growth is not observed after repeated maximal testing. Based on current evidence, it is our opinion that metabolites produced during resistance exercise do not have anabolic properties per se, but may be anabolic in their ability to augment muscle activation. Future studies are needed to compare protocols which produce similar levels of muscle activation, but differ in the magnitude of metabolites produced, or duration in which the exercised muscles are exposed to metabolites.

A tale of three cuffs: the hemodynamics of blood flow restriction.

INTRODUCTION: The blood flow response to relative levels of blood flow restriction (BFR) across varying cuff widths is not well documented. With the variety of cuff widths and pressures reported in the literature, the effects of different cuffs and pressures on blood flow require investigation. PURPOSE: To measure blood pressure using three commonly used BFR cuffs, examine possible venous/arterial restriction pressures, and measure hemodynamic responses to relative levels of BFR using these same cuffs. METHODS: 43 participants (Experiment 1, brachial artery blood pressure assessed) and 38 participants (Experiment 2, brachial artery blood flow assessed using ultrasound, cuff placed at proximal portion of arm) volunteered for this study. RESULTS: Blood pressure measurement was higher in the 5 cm cuff than in the 10 and 12 cm cuffs. Sub-diastolic relative pressures appear to occur predominantly at <60% of arterial occlusion pressure (AOP). Blood flow under relative levels of restriction decreases in a non-linear fashion, with minimal differences between cuffs [resting: 50.3 (44.2) ml min-1; 10% AOP: 42.0 (36.8); 20%: 33.6 (28.6); 30%: 23.6 (20.4); 40%: 17.1 (15.9); 50%: 12.5 (9.4); 60%: 11.5 (8.1); 70%: 11.4 (7.0); 80%: 10.3 (6.3); 90%: 7.9 (4.8); 100%: 1.5 (2.9)]. Peak blood velocity remains relatively constant until higher levels (>70% of AOP) are surpassed. Calculated mean shear rate decreases in a similar fashion as blood flow. CONCLUSIONS: Under relative levels of restriction, pressures from 40 to 90% of AOP appear to decrease blood flow to a similar degree in these three cuffs. Relative pressures appear to elicit a similar blood flow stimulus when accounting for cuff width and participant characteristics.