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Can you Build Muscle without Heavy Lifting? | Dr. Jeremy Loenneke
Episode 119, duration 2 hr 02 mins
Episode 119
Can you Build Muscle without Heavy Lifting? | Dr. Jeremy Loenneke
Join Dr. Gabrielle Lyon as she sits down with Dr. Jeremy Loenneke, an associate professor of exercise science at the University of Mississippi and one of the world’s leading experts in blood flow restriction (BFR) training. They discuss the science behind skeletal muscle adaptation, how BFR can help you get stronger without heavy weights, and why muscle growth and strength aren’t always the same thing.
Dr. Loenneke shares insights on how BFR works—using low loads to trigger muscle adaptation and growth—and the potential benefits for recovery, rehabilitation, and even everyday training for those wanting to avoid joint strain. They also explore some fascinating phenomena like cross-education, where training one side of your body can strengthen the other side.
Key Highlights:
● The basics and benefits of blood flow restriction training
● How to build muscle with low weight loads
● The difference between muscle growth and muscle strength
● Practical applications of BFR in both sports and rehabilitation
Don’t miss out on these expert insights that can transform your approach to exercise and recovery. Let’s take your fitness knowledge to the next level!
Who is Jeremey Loenneke?
Dr. Jeremy Loenneke is an Associate Professor of Exercise Science at The University of Mississippi within the School of Applied Sciences. He received his MS in Nutrition and Exercise Science from Southeast Missouri State University and his PhD in Exercise Physiology from the University of Oklahoma. He is the director of the Kevser Ermin Applied Physiology Laboratory and his research group’s primary focus is on skeletal muscle adaptations to exercise with and without the application of blood flow restriction. His recent work has also focused on addressing whether or not muscle growth contributes to changes in strength with exercise. Dr. Loenneke is
a Fellow of the American College of Sports Medicine and a member of the American Physiological Society. He has authored numerous peer-reviewed articles and is an Associate Editor for PLOS One, Peer J, and Research Quarterly for Exercise and Sport. He also serves on the editorial board for Sports Medicine and Medicine and Science in Sports and Exercise.
In this episode we discuss:
– The basics and benefits of blood flow restriction training
– How to build muscle with low weight loads
– The difference between muscle growth and muscle strength
– Practical applications of BFR in both sports and rehabilitation
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Welcome to the Dr. Gabrielle Lyon show where cutting edge science meets innovation and practical application for everyone. In today’s episode, I sit down with the epic Jeremy Lenake. He’s an associate professor of exercise science at the University of Mississippi. His research group focuses primarily on skeletal muscle adaptations to exercise with and without the application of blood flow restriction. Dr. Lenake is a fellow of the American College of Sports Medicine and a member of the American Physiological Society. He has authored numerous peer-reviewed articles. He’s an associate editor of many top tier journals. Now, there are very few labs in the world that do blood flow restriction and he’s arguably one of the best. Join me in this conversation with Dr. Jeremy.
Are you ready to take control of your health and fitness? Join us for the forever strong six week bootcamp designed specifically for you guessed it, beginners looking to get started with muscle centric living and mastering their macros. This bootcamp is all about support and most importantly, real results. You’ll have access to weekly Q&A calls, weekly workbooks, training videos, and a dynamic community committed to the same goals as you. The feedback from our first round was so amazing. People loved the workouts, the community spirit, the science backed guidance that made fitness and nutrition accessible and fun. To join, of course, click the link in the description below. Please do not miss out on this chance to kickstart your health with a program that is all about real life changing results. Jeremy Lenicki, welcome to the show. I’m so excited to have you. I’ve been really fascinated by your work on blood flow restriction that may or may not be a tongue twister. Really excited to have a chat. Yeah, thanks for having me. It’s wonderful to be here. Now, rumor has it that you were at the University of Illinois, maybe it was for a summer, where you ran into a mutual friend of ours. And the story goes, and that mutual friend is Lane Norton, the story goes that I think you guys were at the gym. And maybe you said something about this blood flow restriction thing, or maybe he said something about it. And then here you are, a pioneer in blood flow restriction. Is it true? It is true. So yeah, before I went to Illinois, I was an undergraduate student. So I was reading the literature, trying to just learn as much as I possibly could. I read a paper on blood flow restriction. So that was before I met Lane.
And it was, you know, kind of talking about restricting blood flow and then beneficial things happening. So for me, I was like, I must just not understand what I’m reading. This doesn’t even make sense. So I never, I didn’t think anything more of it. I went to Illinois. And at the time, the mecca of natural bodybuilding was gold gym champagne. Was it really? It was. You had Lane, a couple other people there, Chris Foz, Gabe Wilson. But I saw these guys in the gym kind of trying to do blood flow restriction with knee wraps in the gym. And I’m like, what are they doing?
And then I was talking with them and I found out that, oh, maybe I was reading that correctly. Maybe there is something to this blood flow restriction. So that’s kind of how I just started reading more and more and more about it. And then I never stopped, essentially. And just to be clear, you are the director and you have your own lab. And this is the Kevzer, Kevzer, Ermine applied physiology lab. And you focus primarily on skeletal muscle adaptation, adaptations to exercise and without via blood flow restriction. Correct. Is that true? Yep. And by the way, you are a fellow of the American College of Sports Medicine. I am. Congratulations. Thank you so much. That’s pretty outstanding. Yeah, I appreciate it. Why muscle? Why did you even carry? Here you are, undergraduate student. You’re in Missouri, right? The first before you got to. Southeast Missouri State. Before I went to WashU. Oh, nice. I did my fellowship there. Why muscle? Yeah. So early in my life, I was a mediocre wrestler. You’re tall for a wrestler. I went to a really powerhouse of Jackson High School, who’s really known for wrestling and mediocre, meaning I would win matches. I shouldn’t win and lose matches. I should dominate. It was really frustrating for my coaches.
And they always told me, it’s like if you could just get into the gym and train, you know, you would be much better, right? Because you have the technique. If you could just match that with a little bit more strength. But I hated working out as a wrestler, you hated working out, which requires a lot of, I hated lifting weights. I liked wrestling. And, you know, I would always tell him that I got the nickname too strong because I was like, coach, I don’t need the tramp too strong, which wasn’t true. But in between my junior year and senior year, I started to really get serious about lifting weights. And my friend would take me to the gym and then we’d go and read these Bodybuilding magazines at Barnes and Noble, Hastings bookstore. And that’s how I kind of got into it. So then I started getting really interested in how to get as big as possible.
Did you win any more matches? I did. Yeah, I did. And I lost some, I shouldn’t have lost too. But yeah, I wrestled through my senior year and then started kind of getting into the Bodybuilding world. That’s how I came across Lane Norton in the first place on the classic bodybuilding.com message boards. The good old days is what you’re saying. It was the good old days for sure.
And you decided that you were going to study. So you went from high school to college in Southern Missouri. Yep. Southeast Missouri state. So initially I thought I wanted to kind of work with athletes. That was kind of what I almost knew for certain now it’s going to do. And nobody could tell me different. But then like a lot of programs, we had to practicum where I was working with Ryan Kleppel, doing some sports performance with kind of youth athletes, variety of ages. But I realized very quickly that’s not what I want to do. I’m like, man, this is not what I thought it was going to be. So I still had a couple of years left and I kind of got a little bit interested in the research. I had a professor who put out these journals, so I would start reading them. I got interested. I was like, maybe I want to do research. And the guy I was working with at sports performance was kind of like, well, you’ll need a PhD for that. I was like, oh, I guess I’ll just do that then. That’s amazing. So that kind of led me to the master’s program, actually led me to Illinois and then master’s program back at Southeast and then PhD at Oklahoma. When you did your master’s program, that was at University of Illinois somewhere else. That was back at Southeast Missouri State. And what was that? Was that in muscle physiology? It was in nutrition and exercise science. Oh, interesting. Did you have any big takeaways during that time? Just out of curiosity from the nutrition side of it, because some aspects of nutrition have really changed, but some have not. Not really. Like I said, Southeast is more of a teaching school. That’s why I was really kind of bummed out that it didn’t work out at Illinois. But they did allow me to do some research. That’s where I did a lot of the early practical blood flow restriction. So applying blood flow restriction with knee wraps and doing some of that early work on that was there. I would say that I had really great professors there. There’s no question. And looking back now, it was probably way more combative than I probably should have been, because when I was at Illinois, I was obviously very familiar with Lane and then all the work that they were doing in Dr. Lehman’s lab. So I was bringing that back. That is funny. I was going hard in the pain. So my professors had to stay on their game, but I had a good relationship with them. Because I was battling all the myths about protein.
We still do that now. Yeah, but it was good. But then it provided all those professors there really provided an avenue for me to go off and do my PhD because they knew that was my ultimate goal. So they really did a lot to make sure I could, you know, because it’s hard to do research at a teaching school, but they made it happen the best that they could. You did your PhD in what?
Exercise physiology, but focus on skeletal muscle. Okay. That took five years, six years. How long does a PhD take now? If you go in with a master’s, it takes four. Okay. So essentially, you fast track. Depending upon who you ask. Yeah. Well, I did a master’s. When you were there, and now you have your own lab, I guess we should go forward to what are you studying now? What is coming out of your lab and why? Yeah, so we’re still doing blood flow restriction. Right now we’re finishing up a dissertation looking at submaximal exercise in combination with blood flow restriction.
But we’re also looking at some of the cross-education effect, trying to better understand what may or may not be driving that with blood flow restriction. Cross-education being if I train my right arm, but I don’t train my left arm under certain circumstances, my left arm can still get stronger. So that’s one of the things that we’re kind of looking at with submaximal exercise. And then we’re getting ready to do some kind of work on blood flow restriction and the cardiovascular response to see if we can really tease out if there are people who are responding much greater than other people to the same type of exercise. It’s a little bit harder to do that methodologically than I think most people kind of realize, but that’s one of the things that we’re starting. So yeah, still doing blood flow restriction. And do you think you’ll always do blood flow restriction? I think so. We generally always have something going on with blood flow restriction. For a couple years there, we kind of got interested in cross-education, even with just traditional exercise. So with the blood flow restriction, that early work, that’s what led us in to start questioning kind of the relationship between changes in muscle size and changes in muscle strength. So we kind of have that as another avenue that we have, you know, been trying to investigate for the past probably five, six years now. Yeah. I mean, you have a wonderful paper which will link because I am very curious. I have my own thoughts and I think that you might even change my mind about muscle mass and strength. I’m fully open to that.
Highlight for us what blood flow restriction is. And by the way, I did blood flow restriction. I have a tendinopathy, a hamstring tendinopathy. And I was one of those people that wrapped my leg in a band assuming that this was blood flow restriction. Just a band, total brow, shout out to Don Saladino at Drive in New York. And I decided we’ve been sending patients for blood flow restriction under the guidance of a PT. A lot of our military operators do it for recovery. I did it and it is very painful when you are doing it appropriately, when you are doing appropriate levels of occlusion. Tell me what is blood flow restriction? Yeah. So essentially, it’s applying a cuff or a wrap at the proximal portion of the muscle that you are looking to affect.
So really the only two places we really put them is at the top of the legs or the top of the arms. So basically right here on the bicep. So the very, very top kind of overlapping this way. And what you are essentially doing is you are inflating it to a pressure that is affecting how much blood flow is going in. And occluding a lot of the blood flow that is leaving. So what it does is it creates kind of a cell volumization effect. So the arm swells. And that might be useful. I think we are not sure. But that is essentially what it is doing. What it does is it makes the muscle work a lot harder than it normally would. So when you are doing submaximal exercise, so training at 20 or 30% away from failure. So using 20 or 30% of the most weight that you can use, staying away from the most amount of repetitions that you can do, it makes that muscle work a lot harder than it would if it didn’t have the restriction on it. And when you do that repeatedly, two of the common things that we commonly focus on is the muscle gets bigger and it gets stronger. And does it get bigger in a statistically significant way? It does. And stronger. It does. The strength will kind of depend upon what load you are using. If you are using around 20 or 30%, you will get stronger. If you get down to 15% or body weight, sometimes that might not elicit strength. There is a specificity component there.
Muscle growth, that will change to levels that you will see with normal exercise. So the growth that you see from training with low loads in combination with blood flow restriction is similar to high load exercise. Strength, a little bit different, a little bit less. But growth is very much the same. Isn’t that… One would not anticipate that. In my mind, you would think, and yes, a lot of the literature says that strength and mass are not the same. One could be stronger without getting any kind of hypertrophy effect. For blood flow restriction for the listener, this could be, I don’t know, 15 pounds. If you can squat or leg press a lot, you could easily get a significant pump or where you’re going to get a pump no matter why, because you’re including blood flow, 15 pounds. Most people may not know they’re one rep max, but just from a perspective standpoint, it’s very low weight. Could someone… It’s just we kind of lay the foundation. Are there variations to how much someone would restrict or occlude blood flow? 80%, 50%, 30% is a diminishing return? Yeah. So what you’re describing is typically how we apply blood flow restriction like a research lab or a clinic. So as a percentage of arterial occlusion pressure. So what that means is, now you can think about it similar to blood pressure.
Whatever cuff you’re going to use, we apply it to the limb that you’re getting ready to exercise. And then we basically slowly inflate that cuff until we get to the lowest pressure of which there is no blood flow. So that would be 100% arterial occlusion. And then we take a percentage of that. So the question is, is there a pressure that’s better? I don’t know that we know that. I think for muscle, I think it’s probably fair to say that there’s a wide range that you can use and still see a lot of benefits of 40% to 90%. We’ve seen very similar changes in muscle size between those two pressures. So other labs, which is important, right? It’s replicatable. Yeah. Now there could be, there’s other adaptations that exist outside of muscle size and strength. So sometimes like changes in the vasculature, like resting in blood flow, that might require higher pressure. So that might require more 80% arterial occlusion. Now, a couple of things. The percentage is just the percentage of arterial occlusion. So if you apply 80%, that just means it’s 80% of the pressure required to cuff blood flow at rest. It doesn’t mean there’s an 80% reduction in blood flow. So it’s not a linear response. Those are different. Yeah. That sounds important. Also, if someone had an unhealthy vascular system, they probably would get greater, I’m just speculating, a greater occlusion at a lower pressure. Would that potentially be right?
I don’t know. I guess I could see it maybe going either way. I mean, I guess the, what a lot of people who are using it in the clinics would say is that if you measure it, you’ll know what their arterial occlusion is. Now, a lot of the clinical work is applying a higher pressure. Now, is that needed? I don’t know. I think it would be pretty ridiculous of me to approach clinicians and go, “You’re at the pressure, it’s too high.” You can use a lower pressure and get similar adaptations because we’ve seen that in my lab. And that’s true. We have, but we’re also doing a lot of exercise. We know what the 1RM is. We know how many repetitions they can do. When you’re in a clinic, you’re usually not 1RM testing someone. So you’re usually the best guess. So maybe a higher pressure might make sense here. It’s not going to be worse. But as you noted, the higher the pressure gets, the more discomforting it is. So that’s a trade-off. Why would someone use blood flow restriction? And again, people, there’s always another hack or hype. And we’ve all seen, what is it, the shake wake and all these other crazy tools. You don’t use that? No, Lane does. Lane definitely does. That’s what I saw him using it, the gym, actually. I know. I know. Is this that? Another hyped up tool?
Is it a hyped up tool? Probably. Yeah. But no, I don’t think it’s not a fad. Blood flow restriction, as we use it, has actually been around for almost 25 years. I’m not good at math, but the first published paper was in 1998, how we use blood flow restriction. So it’s been around for a while. And there’s a lot of research behind it. Do you know where it originated from?
Japan. That’s where a lot of it came from. So a lot of the early work was coming out of there.
Why would someone use it? Yeah. So I think this is a great question. And probably when you get asked all the time. Yeah. And people who are able-bodied, they go, why would I use that? It’s the same benefit as high-load exercise. And my response is, then don’t use it. I don’t care. But it could be a way for someone who cannot lift heavy weights to get the benefits of lifting heavier weights. So you’re getting the muscle to get bigger than it normally would. It’s getting stronger than it normally would at the same load. We’re at a very, very low load. So I think that’s one benefit.
There’s also some suggestion that if you can’t even contract the muscle voluntarily, that if you apply blood flow restriction, inflate and deflate it, that maybe it can slow down the loss of muscle. Now, that’s interesting. That literature is not as solid as the resistance exercise. So I don’t have a lot of confidence in that. There’s some studies going both ways. A lot of the ones that show a lot of benefit are from a long time ago. But there’s a lot of literature behind low lows and combination with resistance exercise. So if you don’t have an injury, some people might go, “Well, why would I use it?” As I said, you don’t have to. But anybody who’s training for long periods of time, it might be useful just to shift things up a little bit, keep you a little bit motivated, trying something new. Or if you go into the gym and you have just a nagging injury that you just don’t want to test it out with a high load, then use blood flow restriction until you can get back to lifting heavier weights. Do you think, and again, I would love for you to mention some of the mechanisms of action as to how or how it is believed to work, because it is going to lead me to my next question of repair. Does it have the potential to repair tendons or increase blood flow to tendons? How does it work from a rehabilitative standpoint for skeletal muscle? Sure. Yeah. So with respect to tendons, there is some work suggesting that it can have an effect on tendons similar to that of high load exercise. Now, how does that work?
And we would define high load exercise as heavy. Like 70, 85% of your 1RM. What you would think of probably what most people might be doing if they’re going to go into the gym. Now, what is the mechanism of action of altering the tendon? That’s a good question. Part of that literature is kind of problematic because on one hand, it’s really, really good because you’re showing low load exercise with blood flow restriction is producing changes in tendon greater than that of non-exercise control. So outside of noise and similar to that of high load exercise. So it’s like, okay, that’s great. But we don’t know what it looks like compared to the same exercise without blood flow restriction. So you kind of lost that important piece. So it’s hard to know what exactly is due to blood flow restriction. Now, we would probably guess that just doing low load exercise without it probably isn’t doing anything, but we don’t know that yet.
But some of the early ideas were that the metabolites to lactate that might stimulate some of these, I don’t know, pathways that are associated with those beneficial changes in those connective tissues. But I don’t know that we know that for certain.
Is it also still believed that the exercising, if you’re using blood flow restriction, that it can decrease some of this, I don’t know, calcium sensitivity. I looked up a couple ways in which potentially would work and it looked like it can weaken actin mycin cross bridging. Is that true? So in other words, trying to explain how you’re getting this augmented muscle activation.
Yeah. So I think a lot of people are just conceptually are starting to believe that muscle growth is going to be largely dictated by how much of that muscle you can activate in a given exercise about for some given amount of time. In other words, if I lift a heavy weight, right? So 80, if the most I can do is a hundred pounds and I’m lifting 80 pounds repeatedly, in order to even move that weight, I’m going to require a high percentage of that muscle to be activated from the very, very beginning. Otherwise it’s not going to move. So if you’ve done 10 repetitions with that, you’ve activated a large portion of your muscle repeatedly with low loads. One of the things that blood flow restriction does is it’s basically pulling all those metabolites.
Now, originally, I thought that the metabolites in and of themselves were important, meaning that if I pull these metabolites that those are signaling muscle to grow in and of themselves, right? There’s not a lot of evidence that that’s the case. And I would say many people also believe that. Yeah. And to be fair, it could be true. There is no evidence for it though.
What I think is potentially more likely is that they’re getting those metabolites are being pulled and they’re basically making that muscle work a lot harder. So in order to still maintain lifting weights, right? If you’re lifting with a low load, you have to start recruiting more and more of those fibers. So that first repetition with a very lightweight, you don’t need a high level of activation, but with blood flow restriction, as it works harder, you start to recruit higher and higher percentage of that muscle. So by the end of the exercise, you’ve activated the same amount of muscle as high load exercise. So that’s important mechanistically because when we think about, and you probably, you probably know this in way more detail than I do, but the mTOR pathway is an important pathway for muscle growth.
Now, turning that pathway on is important. So if you activate more and more fibers, each one of those fibers that’s been activated is now being signaled to grow is the idea. Where does load come into play? For example, you’re talking about high load, which would be again, 70, 80% of one rep max and then low load would be defined as, would that be 20 to 30% of a one rep max? I think that’s how it’s commonly. Would someone who is using blood flow restriction, again, I think that there are incredible benefits to blood flow restriction. Again, I have seen it myself. I’ve seen it in multiple patients who have gotten injured. There’s probably also a place just like you had mentioned for people who can’t lift heavy weights for whatever reason. Maybe it’s fear. Maybe they have an old injury. Maybe they’re concerned because they’re older. Is the load important or is it the energy utilized for, let’s say we’re talking about, I think that we should say both for strength and hypertrophy, because I do want while you’re here, I want to break down.
Why do we care about strength and mass? Because from reading your work, there is a bit of a divergent path between the two. Would you say that’s accurate? Yeah. So I think that especially for strength, load is going to be important. You can get away with it a little bit without even blood flow restriction. It’ll give you this kind of intermediate response. The high load is going to, especially in the task that you’re training is going to dominate it. And I think that would make sense to most people. If I’m repeatedly lifting 80% of my max versus repeatedly lifting 30% of my max, and then I test who can lift weights the best at 100% of their max, the one that’s training at 80% has a lot more practice at that. So I think they’re getting those adaptations that you’re not going to get from lifting very, very lightweight. Now you can argue that how important is it to drive up your one RM for just functional living? And I think that’s a worthwhile conversation to have. And one of the things that you said kind of cued something in me about why people would use this. Some people, and this is something we have investigated recently, and a lot of other people have too, is the pain sensitivity following exercise. So you become less sensitive to pain following blood flow restricted exercise. Because it hurts so much, right? That’s one thought is that pain inhibits pain. We haven’t found that link,
but some people have suggested that clinically this could be useful because if you are limited by your pain and your rehabilitation, that if you can somehow numb that a little bit going into that, maybe you get more out of your rehabilitation. Now I could see that going both ways.
That’s fascinating. Blood flow restriction, when you talk about high load and low load, just in general, there is a lot of literature saying the load doesn’t matter for hypertrophy, right? An individual will, many colleagues that we know have published, you know, numerous papers that the load doesn’t matter. That’s for hypertrophy. But are there other adaptations beyond hypertrophy that maybe personally you think that we should care about? Again, in an everyday life, does someone have to be able to be really strong to train for strength? I mean, I would argue yes. And if we had a conversation where low load training is just equivalent to high load, as long as you’re going to fatigue, are we really training up people to be strong? Yeah. So yeah, I think there’s lots of things that are important in addition to muscle size and strength. I mean, we talk about tendons, bone, which, you know, there’s some suggestion that maybe blood flow restriction might be beneficial for that, but there’s not a lot of long-term data that would show that that’s true or not true. The short-term data looks really good, looking at bone markers and things like that. But bone markers, you know, those have a lot of limitations. But yeah, I think, you know, tendon, bone, cognitive function, pain sensitivity, these are all things that could be important depending upon the situation. Would we get the same benefit with high load training as you would with low load training and blood flow restriction? I think so. I mean, I think one of the things that I’m trying to think about is there something that you can get from low load exercise and blood flow restriction that you cannot get with high load exercise? I wouldn’t think so. And, you know, I think high load exercise is just such an effective way to train. I know. And, you know, one of the messages that I think is I’m always trying to convey is that this is in no way trying to completely dismiss that literature or to say that, why are you training with a high load? You should be doing this instead. I mean, the more options that you have, depending upon what scenario you’re currently working with in your life, the better you are. But yeah, I can’t think of anything that you couldn’t get from just traditional high load exercise. I mean, assuming that you’re doing enough volume, right? So if all I did was one or M training, I could get pretty strong, but I probably not going to get a lot of the muscle mass. Now, does that mean anything? It does from my perspective, from a metabolic perspective, from a sarcopenic perspective. Yeah. I think that mass is really important. Yeah. I think I’d probably agree. Maybe. Yeah. You were maybe agreeing. Yeah. I’m just thinking about strength and function are, I view them as pretty disconnected from just skeleton muscle to a point. Right. And that’s one of the things that, you know, Manini and Clark talked about that for years with dienopenia, about even the loss from baseline. So not even talking about exercises that they’re completely disconnected for a while. Now, of course, at some point you’re going to lose enough muscle mass where it’s going to be, it’s going to be a problem.
But yeah, I think that there’s some utility and, or a lot of utility in maintaining what you have for as long as you possibly can. That’s what I view as being so beneficial about exercise, not necessarily about gaining as much as you possibly can, but maintaining what you have. And, but yeah, I absolutely agree with you. And I will even mention we, I had mentioned that my husband is here. He does research at Baylor. And we had a research meeting yesterday, once a month, it’s the Andrology fellows. And one of the handful of papers that they pulled up was muscle mass in and of itself. And again, these were not randomized control trials. We’re going to do a literature review next to see what’s out there. But muscle mass in and of itself seem to be protected, protective against diabetes, protective for sexual function later on in life. It was crazy. These individuals smoked and had a whole bunch of poor lifestyle habits, but they had high muscle mass. Again, I think, I don’t know what that means yet, but it’s interesting. Again, nothing related to exercise, but just simply this idea of more muscle mass potentially can be protective against the interface with poor lifestyle factors. Yeah. And you also have, you also have those same type of analyses when they include strength sometimes eliminates muscle mass. Now I don’t, I think that that could be related to the fact that it’s a lot easier sometimes to, it’s a lot cleaner to measure strength than it is muscle mass. And if you get a little bit of a noisier measurement that can suppress some of those relationships. So yeah, I think it’s, it’s not as clean cut as a lot of people would make it out to be. So when you add in strength and muscle mass gets eliminated, I don’t think that necessarily means that muscle mass is no longer important. Right. I would agree with that. And strength we know is critical. We know that the more strength you have, if you’re in the lower one third of strength, you have an increase in mortality, all cause mortality from nearly any kind of disease and also even mass. So muscle mass and strength, the lower muscle mass and strength you have, if you are in the lower one third of your cohort cohort age group, you’re in trouble.
Yeah. Blood flow restriction, I think, could be incredibly beneficial when you’re thinking about blood flow restriction in terms of what you think the benefit is from a adaptation standpoint. Would you say that there is one overarching benefit, why someone would potentially include this even from a pre-op standpoint? And what I’m asking really is more of that, is it neurological adaptation? If someone doesn’t have to go under and lift a very heavy load, a squat, which that can be central nervous system, very taxing, could be stressful. Someone could do blood flow restriction and lift a fraction of that heavy weight. Would they, for example, have the same neurological stress? Would it feel as stressful? Are there outcomes that are maybe different? Yeah, that’s a good question.
People always talk about me on these podcasts, we’re like, “He says everything’s a good question.” And a lot of them, they are good questions. But this is a sign of a good, this is why I want the people that are doing the research, this is why I wanted to talk to you so that you can have a voice. Because a fine researcher will think about it the way that you’re thinking about it and express it the way that you’re expressing as opposed to, “Well, this is the way and this is the answer.” If someone says that, then it’s probably not true. When we did some studies in older adults, we didn’t do anything, this is all kind of anecdotal, just conversations. But they really preferred the low-load exercise DFR compared to the higher-load exercise. They didn’t like it. Not that they couldn’t get benefits from it, but even the discomfort associated with it, a lot of them still seem like they kind of preferred it. So not all of them universally, of course, not all of them loved it. But I think that option just to get people active and especially if you, I think about my parents, they can’t necessarily just walk into a gym and start lifting as heavy as possible. But they could do low-load BFR and some of them have in some of the therapy that they’ve been in. So I think that that’s beneficial. Now, the neural adaptation, I don’t think we have a good handle about that. I would probably guess that as far as neural associated with strength, there’s something probably different. But it’s clear that there’s a big physiological response to training with low-loads in combination with blood flow restriction. Now, how much of that central in origin, how does that differ from high-load? I don’t really know that. Could someone potentially, if you were going to take out blood flow restriction and they’re doing low-load training to failure and high-load training to failure, again, a lot of the data would say it doesn’t matter as long as you are putting in the work.
Would you say that there would be an additional benefit from layering on blood flow restriction training to that low-load and or even that high-load training, just the mechanism of implementing blood flow restriction on either high-load or low-load, which would probably be very difficult. But yeah, I’ll answer the last part of that first. High-load exercise does not appear to be augmented with muscle size and strength. There could be other variables, but muscle size and strength with blood flow restriction.
That’s something I’m interested in. I’m interested in trying to figure out ways to utilize that because the aerobic literature, which I’m not as familiar with, they have found the way to utilize that with high force contractions and seeing some benefits in athletes. Richard Ferguson has been doing some really interesting stuff with that during the rest periods and sprint intervals. So that’s actually, I was looking at that earlier. Yeah, phenomenal guy. Seems like there is an augment in performance using blood flow restriction and high intensity interval training on cardiorespiratory fitness. But we have not been able to apply that the same way with resistance exercise. Now, if someone were to do low loads to failure, let’s say 30% of the 1RM with or without blood flow restriction, the adaptations are going to be pretty similar with respect to changes in muscle size and sometimes changes in strength. Now, what people will say the benefit of blood flow restriction is, is that you do that with you get the same effect with a lower volume of work. Meaning that if I’m training with a low load without blood flow restriction, I might be able to do 50 reps. Now, if I do that with blood flow restriction, I can do it with 20 reps and see the same effect. So you can see the same effect with a lower volume of work. Now, I do think that there could be some effects that training the failure doesn’t give you, or at least training to or near failure. Now, this is a finding that needs to be followed up. We have some early work that suggests that change in resting blood flow. We had groups that were training without blood flow restriction doing the same amount of work, didn’t see the same change in blood flow that we saw with a higher pressure. So I don’t know if that’s repeatable or not. And also how you train to failure with low load matters. What do you mean by that? So if we were to give you 30% of your 1RM and do four sets to failure,
I agree. I don’t think there’s going to be a big difference between blood flow restriction and those two variables outside of the fact that you’re doing a lot less work. However, if you would be okay, so it would be time more time efficient, but is it really is it maybe 10 minutes or 20 minutes? I guess that you would you would you could argue that the stress, the overall stress on the joint is less. Now, that’s something that we’ve been interested in. And we’re that’s what we’re kind of currently tackling right now, because it’s a major assumption that you’re making is that if I do 50 and I do 20, it’s the same effect, right? But you do less, but you don’t know that unless this group does the same amount. And does it matter if it’s a compound movement or if it’s a single leg curl or bicep curl versus a deadlift or an additional type of movement isolating individual muscle groups versus a full compound movement? Yeah, it probably does.
To and to finish the other point that I didn’t get to was the went off on the I went off on the other tangent. But I love I love it. If you do if you if you train a failure without blood flow restriction and say I want you to do it like a 30 to 40 RM and we adjust the load for the next set so you can maintain 30 to 40 that you do see growth, but it does look a little bit less than that of high load exercise in our lab at least.
Now that’s a very different physiological stimulus than, you know, just keeping the same load and making that second set really difficult from the very, very beginning. So I think that might get to that differences in activation. Now, what was the one that you just asked me? Compound movements versus, for example, let’s say someone comes in for an upper body injury, you put a cuff on again, there’s only two places in the upper body could put a cuff, right arm, left arm, unless I’m mistaken. Would you do a or would there be different a difference if you are doing a bicep curl versus because now you’re thinking about moving that joint through a range of motion versus upper body cuff and I don’t know if you would then do a lower body cuff and do a deadlift. Does it matter? You also had mentioned this idea of cross-education.
If someone is working their upper body with a single bicep curl, would you expect to see a variation in improvement with blood flow restriction as opposed to a full body movement without blood flow restriction? Yeah, I don’t think we know that. Okay.
But one of the things that we do have a little bit of inkling on is something like a chest press.
And that’s where you start getting adaptations that are proximal to the cuff. Now, that’s fascinating, isn’t it? Yeah. And it could still be related to activation. We don’t really know. Activation of muscle or act. So for example, if you’re applying it here, you think about the chest and triceps being engaged in a chest press. So some people have put forth the idea that if you fatigue the triceps, the chest will pick up the load so you don’t drop it on yourself. So some people have suggested that maybe that’s how it’s working. Other people think that have thrown the idea out that it’s related to the circulating hormones, but I don’t think a lot of people are on board with that anymore. Not anymore. But yeah, so I think that there is some suggestion that if I apply the cuffs here and I do a chest press that I am able to see benefits in the chest, even though it’s not directly under blood flow restriction. Now, is the prescription of exercise different for a compound movement versus a bicep curl? I don’t know. I would guess yes. My guess would be is that it may require a little bit more work to be done. Maybe you could get away with one set if you really, really wanted to on a bicep curl, but on a chest press, there’s a lot more muscles involved. So maybe you do require three to four sets to really maximize that response. I don’t know that we know that. There’s not been a head to head comparison there, but that’s what I would suggest. That’s what I would guess. Now, one of the things that you said or kind of alluded to that I thought was interesting is what if I, and this is one of the things I was thinking about with me in my lab or thinking about recently is
how can we apply this with high load exercise? So some, there is some work on this, but it’s
not really kind of clear what they were doing, but it did appear that they applied cuffs to the legs and did high load upper body exercise and saw some sort of augmentation. Now that hasn’t been consistently observed and there’s been some concerns brought up about that, but that to me is interesting because it would suggest that maybe you’re responding to the pressure applied. Maybe it has nothing to do with the restriction of blood flow for some adaptations that maybe restricting on your legs, you might be able to train with a heavy weight in the upper body. We’re interested in that. There’s not a lot of work on that though. That would be fascinating. Do you know, have you seen any systemic response? There’s the strength and hypertrophy component, which I definitely want to keep going down that road because you did write a wonderful paper about that. And you challenged some of the conventional thoughts about the dogma of strength and mass. Are there systemic and the paper is muscle growth does not contribute to the increases in strength that occur after resistance training? I’m sure you remember that. And this was kind of highlighted the ongoing debate. Are you very proud of that paper? It’s wonderful. I do enjoy the paper. I’ve had some nice discussions back and forth with some of them nice, some of them not so nice, but generally with the people I’m talking about on here have been some good back and forth. I mean, it truly is amazing. I will link it. Everybody should read this paper. We’ll include it in our newsletter. Thank you to ZocDoc for sponsoring this episode of the show. If you have not heard about ZocDoc, I’m about to change your life. As adults, we have to do responsible things like go to the doctor and ZocDoc is a free app and website that allows you to pair an in network doctor with your insurance and location. It has never been easier. Not only that, you can see what other patients have to say about these physicians. So that’s high quality in network doctors. Super easy. You can do it from your phone and we’re talking about over a hundred thousand different healthcare providers across every specialty. So for example, if you need to see someone about dental health or eye health or skin health, you name it, ZocDoc has you covered. Plus ZocDoc appointments, they happen fast, typically within 24 to 72 hours of booking. And sometimes you can even get a same day appointment. This is truly amazing and it’s an amazing feature. Again, this matches your location, your insurance and providers and allows you to get whatever it is that you need done. And again, being an adult isn’t always easy, but ZocDoc definitely makes it easier. Go to ZocDoc.com. That’s Z O C D O C dot com slash Dr. Lion. That’s ZocDoc.com slash a Dr. Lion and you can get instantly booked with a top rated doctor. As you know, I am always looking for various sources of caffeine in various amounts that taste amazing. Enter Mudwater. I’m so grateful that Mudwater has offered to sponsor this episode of the show. Let me tell you about this product. This is a little bit of cacao chai. It’s almost as if it’s an adult hot chocolate coffee alternative. It has functional mushrooms in it. It tastes amazing. It allows me to maintain my energy in a steady way. I’m not getting the buzz of caffeine. It doesn’t affect my sleep. It tastes amazing and it has added benefits. Mudwater has flavonols in them again in the cacao. So these are bioactive compounds that can improve your health as well as functional mushrooms and not the kind you would get pulled over for. Mudwater is hooking up my show with a special offer. If you go to Mudwater.com, that’s mudwater.com slash Dr. Lion. You can get a free frother. You can never have enough of those and $20 off. That’s mudwater.com slash Dr. Lion for you guessed it, your free frother and $20 off mudwater.com slash Dr. Lion. All right, let’s talk about snacks on the go, busy parents, busy anybody. What do you need? You need to make sure that you’ve got your protein dialed in, which is why I love Paleo Valley beef sticks, not just their beef sticks, by the way, which in fact is the only fermented beef stick that I have ever seen. They also have one of my new favorite items and this is chicken buffalo. Friends, if you are looking for a snack, if you are a busy professional, if you have kids, if you are breathing, then you have to try this product. I love Paleo Valley’s beef sticks, chicken buffalo. I’m telling you, you guys, this is my new favorite. You can try yours.
They are offering 15% off. All you have to do is go to paleo Valley.com and use the code Dr. Lion or go to paleo Valley.com slash impressive. Dr. Lion, they will give you 15% off. I guarantee you once you try them, you will never go back. Have you seen systemic responses? Because the people at home are thinking, okay, blood flow restriction sounds really interesting. I might not be as strong as I’d like to be yet, but there’s a potential that I could use blood flow restriction to get the same adaptation as lifting a high load with actually using low load. For example, when I avoles my hamstring, I could not do much with my hamstring injury and I didn’t want it to atrophy. Is there also a systemic response? Do we see, I don’t know, a decrease in HSCRP or a decrease in any kind of inflammatory markers? Do we know if there are systemic responses to the utilization of blood flow restriction? I’m not too familiar with some of that work, but there is some suggestion that it has some metabolic effects. One of the things that we’ve shown in our lab that I was, to be honest, when people were talking about it initially, I didn’t believe it. I had a student who presented on this idea in one of our classes and I’m like, there’s no way that’s a thing. What was it? The hypo-igesic response, the pain response. That’s one of the reasons why it could be potentially useful in the clinic because it is a systemic response. One of the things that, and there might be others out there who are like me, when you start learning about things, when I first started, I really thought the hormonal response was very, very important. And then I learned through Stu- We all did and we really hoped it was. Yeah, through Stu Phillips and things like that. That, okay, maybe it’s not as important or important at all. The acute change at least, obviously the hormone level matters. The acute change in testosterone or IGF-1, which we, I think many people for long periods of time felt that the acute changes due to exercise had some long lasting systemic impact in it. It doesn’t. Yeah, not on those two variables at least. But he started writing a lot of papers when I was coming through school about it’s a local response, local response. So I just kind of got that into my head that everything’s a local response, which is obviously not true.
So muscle growth from exercise does appear to be a local response. Strength is not. Strength can be a systemic response. What do you mean? And that gets at the cross-education, meaning if I train my right arm, and we’ve done this with blood flow restriction, and this was compared to high load exercise, which was surprising to us, isometric hand grip, we saw cross-education only in the blood flow restriction limb. So we have previously shown that high load like dynamic movements lead to cross-education. So we thought that high load isometric would absolutely crush. And it didn’t. It got the strongest in the limb that was training, but the cross-education, so the limb that wasn’t training, the only group that saw cross-education was blood flow restriction. And cross-education is the response to mass, or is it the response to strength? Strength. Okay. So that’s a, you could view that as a systemic response. The pain. Do they know why? Why is there, what is the mechanism of a cross-education response?
So there’s a couple ideas. So my understanding is a couple ideas, right? One of them is, is that when you do this movement, right, you have, you form like an ingram, right, on the opposite side, the opposite hemisphere. So when you go to act, when you go to do the movement on a limb that you haven’t been training. So let’s say I’ve done this three times a week for six weeks. And let’s just say it’s a bicep curl, right? Yeah. Or bicep curl, hand grip, whatever, right? I’ve done it 18 times on this arm, right? And you know, there’s, it’s this right arm is controlled by the opposite hemisphere. So when I go to do it on this limb, even though I haven’t done it, the opposite, yeah, this hemisphere can, can access that ingram, right? That’s one of the ideas. The other ideas, and doesn’t have to be separate, they could be working together, is that when you fire this side, some of it spills over to the other side. So there’s some signal being sent to the entrain arm. So those are two, two ideas. I’m sure there’s a lot more, but those are some of the ideas that have been put forth. Will cross education also maintain mass? Yes. There is some, there is some work on that. And that’s fascinating because it kind of gets at this idea that these mechanisms that regulate baseline size and strength are potentially different than that of exercise. Because we know that if we exercise the right arm, but not the left arm, the left arm might get stronger, but it does not get bigger. Right? But if I immobilize it, and then I train this arm, I can maintain or slow down the muscle loss. Isn’t that wild? It’s mind blowing. I don’t even know what to make of that. But I suppose from a practical aspect, if you are immobilized, if there’s an injury, people will say, you know, you have to train bilaterally.
Yes. But if you can’t, you should be training. Yeah. And you know, the go-to that some people say is, is that, well, that’s explained by neural. And which probably maybe, but I’m like, I don’t, what does that mean? Totally. Yeah. And also, let’s say you stopped training you what you get atrophy in both. One doesn’t, I mean, obviously probably the one that’s immobilized will atrophy first, but well, that’s, that’s, that could be another unique scenario, right? Because these are done people who haven’t been training. So it’s like, if you immobilize it in somebody who hasn’t trained, it’s going to lose. Right? So if I train this arm, it’s protective. Is it still protective if I have a much bigger arm? I don’t, I don’t know that. That would be interesting to know though.
Where does this let, let’s just wander up to your paper where you challenged some of the, this ongoing debate around the role of muscle hypertrophy and strength adaptations. Do we know why and how someone gets stronger? In my opinion, no. Now here’s what I’ll say is, is that I think people know how to get stronger. I think that’s very, I think, I think almost everybody knows that. Or a lot of people know that, that you can go to the gym and you can prescribe, you know how to set a program in order to get stronger. Nobody’s arguing against that. The question is what’s going on inside the body to lead to those changes in strength. So if you look at any textbook from the 1980s to present day outside of Dr. Scott Powers new book, he’s given us some love. I gotta get that. He or a lot of the, a lot of the books will say when you get stronger, that that’s due to neural adaptations first. And then after about five weeks, it’s followed by large contributions from muscle growth. In other words, from three weeks on, muscle growth is going to be explaining a large portion of why you get stronger. Now the paper that’s often cited for that, Moritani didn’t actually measure muscle growth, which is hilarious to me. They inferred it off of something else, but they didn’t actually image the muscle. Now the first paper to really kind of provide some indirect evidence that maybe muscle growth could be doing that is Ukaidan Fukunaga, which is two years before. But really what they did is, is that they had people train. They saw an increase in a proxy of muscle size or muscle size in the Ukaidan Fukunaga’s paper. And then they saw an increase in strength.
So in the discussion, they were going, okay, we saw an increase in muscle size. We see an increase in strength. They must be related. Right. And I don’t think it’s that much of a stretch. I’m not saying it does the idea itself doesn’t make sense. It’s like we think about how a muscle contracts. We have acting in my eyes and interacting, and that’s how muscle contracts to produce force. If you get more of those, it makes sense that you would be stronger. I follow all of the logic. I’m not sure. My concern has been is that we start to see a lot of discrepancies. And that’s when we started to really dive into this literature. What kind of discrepancies? Well, we’ve been talking about low load exercise. And that’s what kind of got it. I mean, on it in the first place is that we start to see when we do low load exercise with blood flow restriction, we do see increases in strength, right? So your maximal strength does increase, assuming you’re lifting around 30% of your max, but it’s usually less than that of a group training with a heavier load. So, but the muscle growth is the same. So that’s what first started doing it. It’s like, man, how is the growth the same, but the strength is different, right? So that in and of itself is not great evidence, but at least gets the wheels turning. Because I would always kind of just try to write it off. And then when you have really good students like I’ve had, who aren’t afraid to talk or hold you accountable for everything that you say, which I’ve had, and you’ve had one of them on here, Dr. Buckner. I had no idea. I didn’t realize he was a wonderful guest. I didn’t realize he was a student. He was. He’s excellent. Yeah, he’s awesome. And I’ve had so many good ones, but there’s only so many times where you can just go, it’s just, this makes sense. Basically what I’m hearing you say is you can lift heavy load, high load, low load, put on mass equally, but strength is different. Right. So then we started looking back through the literature and I, did you have an aha moment? Was there a moment where you were like, you know, this is wrong or well, this is off. You know, I think that people have always assumed my biases to being this guy who’s like, muscle growth doesn’t do anything. It’s all about strength. And it’s like, that’s not my initial bias at all. I came from the bodybuilding community. And I was so fascinated by muscle growth. And I thought muscle growth did everything. Right. So there’s no one more upset than me. Um, that we started to see a tear that we started to, it’s just dusty. I’m not crying.
Um, it’s, basically when we started to have these questions, I was like, well, okay, let’s go back and let’s look to see why do we think this in the first place. So I’m like, let’s go to the textbooks. I’m sure they have lots of papers. Right. And then you go look at all these textbooks and me and Dr. Buckner went to the library and we got textbooks from the early 1900s all the way up to present day. And we went through every single one of them. Oh, that we could get our hands on at least. Right. And what we noticed is, and what was the question you were asking? Where did this story come from? Right. That muscle mass and strength are equal. Or what was the story? Well, the story is, is that neural first followed by hypertrophy. We want to know where’s the evidence for that. Okay. So in our minds, the best place to look for that should be a textbook. Right. So what we ended up finding is, is that what you typically will see is Yikai and Fukunaga or more Tani will be cited or another review paper by Digby Sale, where he highlights this, this hypothetical figure and people have taken that hypothetical figure to basically be gospel. Over repetition created truth when maybe truth wasn’t there. Yeah. So, and I think that people have started to go, okay, if we look at people who are bigger, they tend to be stronger, right? We know that we can modify muscle size and we know that he wouldn’t get stronger. So given this baseline relationship, if we were to increase it even more, it makes sense that those two might be working together. So, um, that’s the, that’s the idea that’s put forth. So we’ve tested that a couple of different ways. What happened to all the books? We went through all of them and we basically came to the conclusion that they all cite the same stuff except for the books before 1980. Right. So when you look at a book in from like 1955 or 1950s Morehouse and Miller, um, they were very skeptical about the role of muscle growth. Um, and they thought it might just be a byproduct of training. And they even said maybe even a noxious one. Now I don’t think getting muscle growth is a noxious stimulus. Um, but they were skeptical. Now I think somebody who’s going to be critical of that would just say, of course they were. There wasn’t a good way to measure muscle growth. Right. But we’re still not really collectively, uh, we should definitely come. Uh, I, we have to touch on imaging, skeletal muscle imaging, whether it’s ultrasound MRI, DEXA, which everyone loves and kind of where some of the discrepancies are potentially. Yeah. So you kind of Fukunaga, they did, um, cross sectional area via ultrasound. So, but even then it’s like, so you saw a change. So what, you know, in order to, to know if, if muscle growth is doing something, you need to know what would you have to ask the, basically the counterfactual, what would have happened to strength had growth not been there. So that’s the, that’s the kind of designs that we started doing. So we started designing studies, do is in very simple movements, such as the bicep curl, try to limit learning and things like that. And we had a group that was just doing the one around. That’s it. That was their training. Um, and we had another group doing traditional exercise. And what we found is like, let’s say high load exercise, like three sets to failure, right? So doing like eight to 10 repetitions.
And what we found is, is that the group doing three sets of eight to 10 or whatever, somewhere around there, um, saw changes in muscle size and changes in strength. But when we looked at a group that was just doing the one RM, they saw the same change in strength.
So it was like the question starts to become, well, what is the growth doing?
It’s not doing the, the whole thesis would predict that strength should be greater.
Now, some have suggested that muscles, more strength. Exactly. Now, some have suggested that while the protocols were slightly different and that might be explaining it, you should do a mediation model instead, statistical mediation, where you can kind of control for some of those things. So we’ve done those three times. We don’t see any evidence at all, even doing that model.
So the next question that people have is, is like, well, it’s because your studies are too short, right? You’re looking at this over six to eight weeks, right? Muscle growth doesn’t become an important mechanism, um, until maybe months down the road. But is that, is that true? It just might not be sensitive enough to, to pick it up if you’re using DEXA, but certainly with a CTR MRI, you could. We can detect muscle growth. It’s there. Um, now whether or not it plays some role down the road, we, I don’t know that answer. I mean, we have, we haven’t, we haven’t looked at what it is at six months or a year. Maybe it does. Uh, but, but that’s not what the hypothesis is. You know, the, the original idea is after the first three to four weeks, there’s a large amount of growth playing a role with strength. Um, but we have not found that to be the case.
Have you thought about what muscle hypertrophy is meaning? Do you feel like it is an adaptation to not necessarily strength, but just repetition under load? Have you thought about why? Yeah. Personally, what do you, what do you think? Yeah, I thought about that. Yeah. 24 hours a day for the last 20 years. Over many whiskeys. Right. It’s just staring off into the woods. Um, because it’s worth asking like, what is it doing or what is going on with, uh, what do you, what are you, what are you adding? Right? So are you actually adding, you know, actin in my eyes and are you actually adding these myosin motors to the muscle? Um, people would say you’re adding math, fibrillar proteins, right? Yeah. That would, that should be what you, that should be what it is. That’s um, so if that’s true, then how come it’s not leading to a change in strength? Now we’ve wrote a hypothesis paper about this. Um, we actually had to, um, I’m gonna forget his name. Um, I think it’s Cameron Mitchell. I cannot remember that. Forgive me. Um, but he was, we’ll be sure to send this to him. He was so helpful because he published a paper on basically the molecular aspects of the myosin motors themselves. Right. So he published a paper and this is one of them, you know, there’s a lot of downsides of social media. One of the positives is that it can connect you to different people. Um, so he published a paper where they show that some of the myosin heads that you have are not actually in the on state. So not all of them are available for forced production. So I just tweeted that, oh, what a fascinating paper. I wonder if this might have something to do with the strength change I got, but I don’t really understand the specifics of the paper. So he sends me a message and let’s say, he said, I would love to, to go over with you in your lab if you’d like. It’s like, we would like that very much. Um, where is he located? Somewhere in the, I think the UK. Okay. Um, but he went over some stuff. We wrote up a hypothesis paper. He actually reviewed it. So it gives us a lot of confidence. But the idea is, is that maybe you are adding those myosin motors, right? The, the mile for Briller portion, but maybe you’re adding them in the off state. So they’re there. They’re, they’re adding to the bulk, but not actually able to contribute, uh, to forced production. So you know, that’s, that’s one of the things. Now, the other component of that is if, if, what else could it be doing? You know, I think one of the things that you said earlier is maybe there’s some metabolic effects there. Um, and maybe there are, right? I think that, um, it’s pretty clear that just contracting the muscle, even just acutely does some sort of metabolic effect, but that doesn’t mean that you couldn’t get more metabolic effects if the muscle was getting bigger or something like that. So I’m interested in that idea. Um, but with respect to what it does with strength, at least in six to eight weeks, I don’t know that it’s doing much. I mean, it’s just so fascinating because we’ve been talking about muscle or humans have been talking about muscle forever to think that we still don’t know, blows my mind. Yeah. When it comes down to strength, you can get stronger without getting bigger. Yeah. Everybody, and nobody disagrees with that, right? Everybody would agree that that’s possible. Where I think the disagreement comes in is do you limit your ability to get maximally strong if you don’t get that muscle growth response? I think that’s a unanswered question. I think the, the short-term evidence that we have is a just doesn’t appear to be, but maybe if you were six months, a year, two years, maybe there comes a point where that does start to matter, but there’s no evidence either way for that. Is there, do you, now I’m going to ask you this question, which I know you’re going to say yes. And then
I’m going to frame it in a way where potentially the strength question, how, how can we think about it? There has to be a cap for how strong one could get, right? Let’s say everything is done perfect. I mean, I don’t know. Yeah. Every, some, someone does everything perfectly. For example, I might never be able to bench. I weigh a hundred and I’m going to weigh 110 pounds.
I might never be able to bench, I don’t know, 250 pounds, right? No matter how much I train for strength, is there a cap or a limit to how strong a human could get? I think so. And I think that, I think that you, you reach your cap for muscle growth as an adult probably faster than you would at your maximal strength. But you know, I, and the reason why I say that is, is that, you know, you can see people in weight class sports for a long periods of time who don’t really change weight classes, but the performance inches up just a little bit sometimes, not, not a lot, not drastically. Only if they’re in wrestling. My dad was a collegiate wrestler by the way. Oh nice. Yeah. I, I think that, I think sometimes I think people, and this is what I always say, you should, you should approach or you should acknowledge that adaptations are finite, right? That they’re not infinite. This can’t go on forever. However, you should approach your training as if they can. Otherwise, how do you stay motivated? Now what’s happening, right? To, to limit that. That’s one of the things that always brings us up in class. And I think it’s awesome. I don’t think they think it’s awesome, but I’m like, you know, we get taller, right? Speak for yourself as we get, as we, as we, as we age, we get to a point and then we stop growing. Why? And it’s like, yeah, your growth plates. I understand it. What happened to just at this point, that’s a really good question. But you know, what’s going on with, with resistance training? And I think one of the things that starts to happen is, and you talked about this earlier, sarcopenia, dienepenia. At some point, as you start to train, you’re getting older, not only your training age, but also physiologically. So at some point you start to compete with the effects of aging. So I don’t know how much of it’s driven by, I just can only get so much stronger from, from just physiologically versus now I’m having the effects of aging as well. So my guess is a combination of both. But I would say, and people do not like this, but I think that most people, most people who are adults who are lifting weights hard, the most change that you see is probably in the first year and then diminishing returns where it’s maybe imperceptible beyond that point.
So you’re going to know what you are very early on, in my opinion. Meaning you’re going to know somewhat of your muscular potential. If you are someone who could gain muscle and maintain muscle, is that kind of what you’re saying? That’s my opinion. Yeah. And not to say that you couldn’t gain some little bit trying different things over time, but I think you are capped. In a meaningful way. We do see that. I’m a geriatrician by training and we always deploy resistance training. I mean, I did it at WashU. I did my geriatrics, my geriatric fellowship at WashU. And one of the things that they, that our group was when I was a fellow is they were very interested in the aging and exercise research. Individuals always got stronger. They were able also to put on muscle mass, not quite at the same rate, but is it significant? Yes. Any increase in muscle mass and strength is meaningful. You might not say so much for mass, but from a geriatric perspective, the more amino acid stores you have, the better we see in survivability, especially in Cacexia or sarcopenia, we know that that’s a reservoir. But it’s not as if they were in their twenties and they were growing. And I mean, again, why people will say, well, it’s not really an aging effect, it’s a deconditioning effect, but there has to be an aging component, just like you’re saying, like growth plates. Yeah. Yeah. I’m so fascinated and just kind of resist this exercise in the older adults. They do other things in this just resist this exercise, but I’m always looking at like, what is the benefit of exercise? What is the benefit of actually training? And we talked about muscle size and strength, but one of the things that I started to kind of just, because you talked about the relationships that you have, like if you lose enough strength, this starts to, you start to get into some danger zones. Right. Yeah. So I started to think about it. What is one of the benefits of resistance training with athletes? And there’s some suggestion that they get hurt less, right? They reduce the risk of injury. So, and that’s one of the performance benefits of resistance training for athletes is that does it matter the actual sport? Is it potentially just better physical adaptation to the environment? Yeah. I don’t know what it is about the training that does it. You know, some of the, the bigger studies are done in like military recruits where they show that, and it’s not even like, it’s not even what I would think of as resistance training. A lot of it’s banded exercise. Don Lehman, we, I worked on some of the early studies of body composition and quote resistance exercise. He cringes when I say this, it was five days a week of walking and two days a week of the resistance exercise was yoga. Yeah. Yeah. Shout out to Don. He hates when I talk about that. But you know, it kind of got me thinking. It’s like, you know what? So that would be an indirect effect on performance because they can, your performance is going to be low if you can’t actually play the sport.
So I was thinking about, I wonder if that’s what’s going on with older adults, because Douglas Patton Jones, he had that really, that cool figure where it’s like you lose a lot. And as you’re, as you’re older, you can regain some of it, but not all of it. So you kind of over time get lower and lower. So I started to think about it is if you get hurt less, maybe you have fewer dips across time. I actually think that’s a genius. Yeah. I think that’s right. So I think that’s one of the, if, so independent of how, how strong you can get or how much muscle mass you can gain, if you can stay active enough to where, you know, you can do your, you know, physical function, your normal activities that did a living repeatedly over time and not get hurt. I think, I think there could be something long-term about that. I absolutely believe that you are correct. And I think that there is, I’ve been talking to my team and Don and a few of my colleagues, and we believe that there is lifespan, health span and muscle span. Yeah. Health span. Yep. And muscle span is the length of time that you live without musculoskeletal injury and with strength and potentially mass. What do you need to do to keep that span, you know, under the conceptual framework of lifespan, but really as muscle span? Yeah. Is there a role in, with blood flow restriction in youth? We think about, and I, I can’t imagine that there’s a lot of data in kids, but I believe, and please correct me where I’m wrong, that the training in youth seems to prime the muscle, the myonuclei, the collagen of tendons, those individuals that train when they start young seem to do better later on in life. Do you think that there is a role for, I mean, we have an increasing sedentary population. Yeah. Is there a role of blood flow restriction in a preventative space? So there is some work in kids. I think they were doing some sort of soccer. I don’t know that. I don’t know it well, but I remember them seeing some sort of benefit with it. So it was able to be safely applied at least in one or two studies. But so yeah, I think you could do it. And I do think there could be some utility in the training that muscle early on in your life to, you know, maybe what you’re gaining early on in your life will be easier to maintain as an adult versus starting later. Like, so if I start training when I’m still developing, do the adaptations that I get from that, are they more permanent than they would be if I started training when I was 25? I think there could be something to that. And there’s some longitudinal data that would suggest that weak kids become weak adults. Absolutely. So this is something that we’ve been, my colleague, I think we talked about this off air, but Takashi Abe, Dr. Abe, he’s retired, but him and his wife still collect a lot of data on kids. We kind of got into this idea of trying to track strength, you know, early on and then measure them and in response to different sports like soccer, baseball, keto, things like that. With the idea that those who are more active and they are stronger, are they going to be better off when they become older? And I think that they could be. I think that there could be something that’s different about situations when you’re developing, that it’s a different environment than when you’re an adult because that might be a time where hormones might be playing an important role. I mean, we certainly believe it from a metabolic standpoint. Why wouldn’t it be applicable to muscle and tendon? You know, with blood flow restriction, you know, I keep thinking about what are the things that take people out as age in their forties? It’s typically a tendon or ligament. They, I don’t know, tear their hamstring, tear their shoulder. Blood flow restriction is often used in rehab. Would that be how it’s mainly utilized now? That’s one of the ways that it’s used. Yeah, there’s a lot of clinicians using it. How else is it typically used? Because in my mind, I’m thinking, could we think about blood flow restriction in the area of prehab, prehab adults before they get injured? The body believes it’s lifting, quote, a high load without tissue, tendon, neurological strain, which we also know that there’s some benefit to that. You need the the impact on the muscle and the tendons and the bone. But is there a role? You said rehab. What are additional roles that someone say, you know what, you’re a good candidate for blood flow restriction because of X, Y, and Z? Yeah. I mean, for the for preabilitation, I completely agree. I mean, if you’re going into, I guess, as a preventative, or if you know you’re going to have surgery, you can try and build up something, you know, especially if you’re already compromised. And that might be a way to do that with these lower lows. I think that makes meaning you could build up strength, potentially mass, right? Even though we’re not sure about that, but build up strength and mass using blood flow restriction before you’re going to surgery. Well, certainly not. Certainly mass. I mean, the strength will come to it. It just might not be the same as a high load. But some of these studies that are done in clinical populations, sometimes the strength is similar to that of high load exercise. And I think that’s because it could be that the high load is just really painful for them to do so they don’t, they can’t quite engage it the same way that they do with that, potentially even that reduction in pain sensitivity with blood flow restriction, maybe they’re able to get more out of it. The pain sensitivity is systemic, right? Basically, you’re saying someone would be able to train without pain or reduces systemic pain.
Well, yeah, so the, I should be clear, chronic pain is something that could be potentially different, almost probably certainly is. But it is used in clinical populations. And I think that could be one of the benefits that it has. Do you mean chronic back pain? Are we talking fibromyalgia? What kind of pain? Yeah. So would it benefit that? I don’t know. In our laboratory, we show that if you do like a late extension, right, that you see reductions of pain even in the upper body. That’s amazing. Prehab also pain. Yeah, so if you have analgesic effect. Yeah. So Cora Coccas has published some ideas on this where he’s saying that, or their group is saying that, for example, if you have like an injury to your left arm, right, maybe I can do or you have an injury to your left leg or whatever, I’ll I will do blood flow restricted exercise on the limb that’s not hurt, because I’m going to get a systemic effect. So when I go to my actual therapy on the limb that’s actually affected, maybe I can get a greater range of motion because I don’t feel the pain as much. Now that’s something where I don’t know if that’s that might depend upon the clinician, whether that’s a good idea or not. Some people may argue that that’s fascinating, that maybe the pain is there for a reason. But that’s something I don’t know. But that is observed. Do we know why? Is there a mechanism of action? Is it neuro? I don’t know. So neuro pain receptors. Yeah, we don’t know. Some have suggested that, you know, it could be related to the discomfort with exercise. So the pain inhibits pain, it doesn’t fit that paradigm perfectly. We’ve not been able to link those two together. We see discomfort and we see a reduction that when we do some sort of mediation analysis, we don’t really see that it’s mediating that. Hughes and Patterson have done some work where they look at kind of the endogenous opioids, and they’ve shown that those are elevated and that might mediate some of those effects. But I don’t think we know for sure. I know I think one of the things that is interesting about blood flow restriction is that we know a lot of the outcomes.
But what is it that blood flow restriction is doing to elicit that outcome is where we don’t quite know as much. Pregnancy and post pregnancy, these are hard times for women. We have to make sure one of the most important things in the scope of fertility and pregnancy and health postpartum is nutrition. And it is very difficult, as we all know, whether you are nauseous or you are not hungry, and you just can’t eat the things that you know you should, you have to have an alternative game plan. And that is one reason why I love needed. Well, the name is needed and it’s a pre and post natal vitamin. They have a whole slew of other products, but I really want to bring your attention to their post natal, pre natal, and post natal multivitamin. It has zinc, selenium, B vitamins, vitamin A, iodine, all the things that you need, nothing that you don’t. And it is an amazing, amazing product to help you with the nutrients that you need both for you during pregnancy and after. Head over to thisisneeded.com and use the code DrLion for 20% off your first order. That’s T-H-I-S-I-S-N-E-E-D-E-D.com and use the code DrLion for 20% off your first order. Really quickly, I’d like to take a moment to thank one of the sponsors and that’s Fatty 15. You’ve heard all about essential fatty acids and Fatty 15 is a new fatty acid, the first one discovered in the last 90 years. And let me tell you, essential fatty acids are critical for health and wellness. We’ve all heard this, of course, but Fatty 15 is unique. So it’s a carbon 15. And by the way, it is going to be helpful for cellular aging. The reality is we’re all getting older, but there are ways and things that we can do to combat the destruction and impact our lifestyle has on our body and our brain and our mood. Fatty 15 is one of those supplements. Fatty 15 is amazing and it’s extremely potent. And by the way, you will not be burping up Fatty 15 because it is tasteless and odorless, which also makes it amazing. Fatty 15 has great research behind it, which again, I think is extremely valuable. So a lot of different supplements on the market. I’m only bringing to you supplements that I love and use myself. Fatty 15 has helped me with energy. I’ll let you know about aging next year, but Fatty 15 is an amazing product. I think that you’re going to love it. Go to fatty15.com slash Dr. Lion. That’s fatty15.com slash Dr. Lion. And no surprise, you will get 15% off on your first 90 day subscription. Who should be doing blood flow restriction? I think one of the things that we’ve seen, any population that we’ve really looked at, we’ve seen benefits, right? And that’s across laboratories. So normal, young, healthy individuals, we see benefits. Older adults, we see benefits. Clinical populations, like ACL repair and doing those other things, we see some beneficial effects there. Now, one of the things that’s, and it’s cool, Johnny Owens has done a lot of work to get it put into a lot of places in the United States, especially in the collegiate world. How are they using it for injury recovery? Yeah, they use it for injury, but some of them are starting to also think about using it as a recovery modality. And like what, what do you mean? So like after exercise, they’ll try and use it to stimulate, I guess, blood flow to the lower body or to the muscle. Now, I’m very interested in that. I don’t know that that does anything, but I don’t know that it doesn’t either. But I think that’s a cool kind of area of future research. Now, the older adults, there’s some unique work. I don’t know if it’s unique, but it’s kind of people have become more interested in the idea of the vasculature. So blood flow and muscle growth, they’re starting to link those two together again. And what do you mean in what way? So I think, I think people are starting to see that, hey, maybe if someone has a compromised vasculature through the age or whatever, if we could find a way to improve their blood flow, maybe we could find a way to make their muscle get bigger to maybe get some sort of benefit from whatever that would mean. Maybe you mean peripheral vascular disease or something like that? That could be one or, you know, even even simpler. Like if I have blood flow to a muscle, right? And if I can improve blood flow to the muscle, maybe I improve nutrient delivery.
And you think about satellite cells and those type of things, if someone’s signaling molecules are located in sometimes proximity to the capillary. So they may start responding to the environment of what’s in the blood. So there’s some connections being made there. I do not think that the evidence is quite as amazing as many people because we’ve got people going now going, oh, well, you know, here’s a paper. I’ll do aerobic exercise and then I’ll to build up the vasculature and then I’ll do resistance training. That’s a cool idea. I’m not exactly convinced that that paper is the end all be all. I think it’s a cool idea that requires future work. But the idea is pretty fascinating where I increase blood flow, I increase capillaries, which does happen in response to resistance training and that that may be linked to ultimate growth. And it, you know, in the same vein, aging decreases capillary perfusion. And some of these other signaling molecules potentially, right? Not saying it is or it isn’t the fountain of youth, but there is definitely a lot of potential for a blood flow restriction. What are some of the limitations to it and who shouldn’t be doing it? Someone is at home listening and they’re thinking, you know what, I’m going to go to the gym and I’m going to tie a band much like I did when I lived in New York and do bicep curls. Is that the most effective protocol?
I think it depends, honestly. I think it depends on who you are. It depends upon how much resources that you have. It depends upon. Some of these are really expensive. Yeah, exactly. And, you know, if you’re just somebody who’s, you know, able bodied, perfectly healthy, and you want to experiment with blood flow restriction in your local gym, you could probably use knee wraps. The limitation is that you don’t really know what pressure is being applied. You might be able to gauge it a little bit because we talked about earlier that there’s some wiggle room there for muscle adaptations. Now, if you’re applying that to somebody else and you’re working in a clinic, I think you should probably invest in something that can know what the pressure is. So the limitation, I think, is, you know, can you get the device or if you’re using knee wraps on yourself, I would only do that if you on yourself and if you are, you know, overtly healthy. But it would also be difficult to replicate the exact pressure. Yeah, you’re going off feeling, but yeah, one thing that you could do is, you know, we’ve done elastic, we had an elastic cuff made where you can pull it to a percentage of your limb circumference. That’s kind of cool. That might be something. We only have resting data. We didn’t, we don’t have any long term data. I don’t know why it would be different, but you’re still limited for sure. As far as who shouldn’t do this, that’s a great question. And I think that that’s often the ones that the question that people usually have. That was the first thing question that I had. It’s like, once I figured out, okay, this is what I thought it was, my how does this make any sense? This doesn’t, this sounds like this could be potentially very bad.
And I think the way to kind of think about this is a couple points. One, we’re only applying blood flow restriction for a short period of time. How long? You know, if you’re, if you’re starting out, I mean, and you’re doing resistance training, I’d probably start with one exercise. So three to four sets of exercise, so maybe what, seven minutes? And then take it off until you get kind of used to that. If you’re walking, maybe you could walk with it. You know, I don’t think that’s quite as effective as resistance exercise. But maybe 20 or 30 minutes, that’s a little bit of a much different stimulus. It’s not as, not as intense. But the other point is, is that it’s not complete occlusion. So there’s blood flow going into the limb always. Right. And you couldn’t 100%. I mean, the machines do 100% occlusion, and then they yeah, they decrease it. You said it’s 80%. Then yeah, I mean, you could do occlusion. I think it’s going to limit how much work you can do. And I don’t think there’s a benefit to doing it. There’s probably a danger over a period of time. How long could one occlude a limb without repercussions? Yeah, 100% occlusion. Yeah, I don’t. Yeah, I don’t think it’s a good idea. Yeah. Would something bad happen in the short amount of time that you’re doing with exercise?
I don’t think I mean, unless you passed out. Which we don’t recommend. Right. But I do think that safety is something that you should think about. And I think one of the ways to think about it is what I just said, but also realize that the question that you have to ask is not whether there’s a risk, but does applying blood flow restriction substantially increase that risk? I mean, we know there’s a risk for lots of things to happen during exercise.
You know, that happens all the time. But we still think exercise is good.
But two of the things that are commonly brought up is muscle damage and blood clots. So in other words, does it increase your risk for muscle damage? And does it increase your risk for blood clotting? The available literature suggests that it doesn’t. So there doesn’t appear to be structural damage at the fiber itself. And why would there be anything different than normal exercise adaptation because of the occlusion? Is that why they would? Yeah, I think they’re saying that that could provide like the reperfusion injury. But those are really extreme protocols that show that. I mean, those are long periods of occlusion. So we don’t see that we do see soreness. But that’s that’s disconnected necessarily from muscle damage. Right. So you can have soreness and muscle damage, where you actually have dysfunction at the fiber, but we don’t necessarily see that. But we do see soreness. There’s no question. But it reduces with repeated bouts of exercise, just like you do with normal exercise. Blood clotting, I think it’s the fact that maybe you slow down blood flow. Luckily, it doesn’t appear to do that. It keeps both of those, the fiber linic and coagulation systems are in balance there. Now, the other component of that, and this is brought up by Marty Springer. He had a concern that I think his first reaction is, what are these guys doing? Are they going to they’re going to kill people? Because his concern was is that he works with populations who hyper respond to metabolites. So they have a hyperactive metabol reflex. So his concern was is that there are some people who may apply this. And when they have that point of metabolites, they’re going to have a an exaggerated metabol reflex, which is going to augment their blood pressure. How does someone know if they are part of the population that has a hyper response to a metabolic byproduct? Yeah. And is that a real thing over? I think it’s a real thing. I think you would know it by taking your blood pressure.
And, you know, my my report to that was, one, I think he’s obviously correct. I think that’s, of course, we have to be really careful with clinical populations. But the blood, because, you know, one of the things that he was pointing out is that blood pressures augmented over the same exercise without blood flow restriction, probably due to the metabol reflex. And we have some interesting data coming out which supports that. But my my thought was, of course, right, they actually you’re exercising with blood flow restriction. Of course, the blood pressure response is elevated. But how is it compared with high load exercise? Because exercise, again, is going to increase blood pressure in the short term anyway. So it’s usually going to be similar to or less than that of traditional high load exercise. Now, his response would still be that fine. And I’m paraphrasing, I’m not actually speaking for him. But I think he would say that you still need to be careful with certain populations. And I think it’s exactly right.
So potentially, if you are someone who has high blood pressure going in, you may not be a candidate for it. But on the other hand, one would say that’s also like saying, I don’t know, high load exercise would not be appropriate. Yeah, I think you just want high blood pressure. What you would do is you would you would work with a professional who would monitor you to know how you’re going to respond and do something, you know, that would be a nice introduction to the exercise. Obviously, measure your blood pressure. And if you see this really alarming response to it, yeah, maybe there’s other exercises that you should be doing other than this. But those are those are kind of the three kind of big ones. Now, I do think that one of the things that we’re going to start to see is a lot of case studies because blood flow restriction is becoming very, very popular. So definitely in the last what five years? Yeah. And one of the things that we are obviously going to start to probably figure out because I think if you look at the studies, they all seem they all demonstrate that yeah, hey, this is largely safe and effective, even in clinical populations, it’s safe and effective. But as you know, way more than I do is that what you don’t pick up in those studies is rare events. So because they’re rare. So when you start applying this to thousands and thousands and thousands of people, you might start to see things that you’re never going to pick up in a study that you should be aware of. So obviously, you have to approach case studies with the limitation that they’re a case study. But I think I think we’re going to learn a lot about what rare things do some people have that maybe they should stay away from blood flow restriction. And then the question would be, would that also translate to just high load training in general? Yeah, exactly. Exactly. And it would probably be again, one would have to check with their physician, but it would probably be few and far between because that would be the same as saying high load activity would be challenging. Yeah. If someone was going to go into a protocol, and there we use, I have done blood flow restriction with my physical therapist. And I will tell you, we started with I think eight minutes, the first 30 seconds, I was doing a leg press for this hamstring, I was doing it for 30 seconds, I would get a 30 second break, and then another, I think 15 seconds or a minute and then another 30 seconds, it was a cadence.
And we did two exercises. Yeah, I probably could have done three, but I had to run. And not actually run because I would hurt myself. I understand. If someone was listening to this, and they wanted to experiment, are there particular starting protocols that is the bare minimum to do? Could someone do this three days a week? Is this the same as resistance training? Or is this a augmentation within a normal training protocol? Yeah, I think there’s a lot of different ways that you could apply it. I don’t think there is one way. And I think it would depend upon what it is that you can already do. I think if you know what your one RM is, I think just a common protocol would be 20 or 30% of your max, using a pressure between, depending on if you want to do muscle adaptation, 40 to 80% probably. And then shooting for, the common, the classic protocol is 30 repetitions followed by three sets of 15. So that’s what it was. It wasn’t 15 seconds. Yeah, followed by, separated by 30 seconds of rest. Now, what we find is, is that especially if people are pretty strong, that they won’t be able to do that. So even though it’s 30%, people who are strong, they won’t be able to get all of those repetitions. But I think you should be getting close to that. So I think if you can’t do that, maybe lower the pressure, lower the load, because some people would go, I don’t know what RM is. So what you could do is you could use workload as some sort of guide. So you could say, set the pressure, put the workload. If you do the first set and you do seven reps, it’s too heavy, or the pressure is too high. Probably if you know the pressure, then you know the load is too high so you can lower it. So that’s how I would probably implement it in practice so you can have some sort of goal repetitions. Now, that’s a good idea. Another way you could do it is to just… And for how many days would one do this? I mean, you could do it. You could say, I’m going to have a low load day where that’s when I’m going to do blood flow restriction, or I’m going to just train normally, but I’m going to finish my workout with maybe a muscle group with blood flow restriction, or I’m only going to train my blood flow restriction. Now, there’s lots of different ways you could do it. Could someone design a program that was a normal program three days a week? I don’t know, 12 to 15 reps and just say, okay, well, I’m going to include blood flow restriction, and that would be their training. It doesn’t have to be a special training cadence necessarily, or should it be this 30 reps, 15, 15, 15? No, I mean, they could do that. But that wouldn’t be really supported by the literature. There needs to be some sort of volume component. Now, we are experimenting currently with ways to do it sub-maximally, to where we know that we’re studying it sub-maximally. But I don’t know… I think that’s more of importance in the research world. I don’t know how important it would be for the average person. Because one of the things that we’re concerned about is, getting back to what we talked about earlier, is if we have people just go to failure, that’s a huge physiological response.
So it’s like, if you saturate the anabolox signal, it would be like looking at muscle protein synthesis and giving 100 grams of protein versus 30. It’s like, well, you’re already getting a lot.
So how much more could you possibly do over 100 or over 30 or whatever? So we started to look at, and one of the first variables that we did was the pain sensitivity stuff, where we said, okay, let’s just have people do blood flow restriction to failure, then take a percentage of what they did to failure with and without it. So we know on the worst day of their life, they can get all the repetitions. So when they do these protocols, it’s very easy. It’s very sub-maximal. And then we start to see some of these effects of blood flow restriction over that of the same exercise without it, because now we’ve matched everything. But I think that’s more of an experimental thing. But in real life, I think having those goal repetitions, shooting for that, and then once you can do that, if you get the load where you can do 30 repetitions, and then the next set, maybe you get close to 15, maybe you’re a little bit less than that. Once you can do that a couple of times, then you can start bumping up the load a little bit. Do you care about the exercise chosen? Whatever you’re interested in. Yeah. Do you want bigger biceps or Universal Chest Day? Yeah, I would say that a lot of the people who are able-bodied who are going to say, “Hey, I want to train my shoulders or my chest. How could I use that?” I’d probably superset it with something with a muscle that’s under restriction. So if I’m doing chest press, I would do a set of chest press, and then I would probably do some tricep extensions. That way, if it really is working through fatiguing the triceps, you’re going to be able to take more advantage of that. And that’s a pretty big pump.
You definitely get a bigger pump when you’re doing blood flow restriction.
Considering you did come out of or spent some time at University of Illinois, have you thought about the nutritional influence at all with blood flow restriction? Are we delivering more nutrients post-release when occlusion is stopped and now you have this blood flow rushing? Is that a way to overcome anabolic resistance? Something like that. Yeah. Some people have done some of that work where they look at the perfusion of blood following deflation versus if you were to do it pharmacologically. So they look at the area under the curve of blood flow. And they didn’t think that that was a real driving mechanism, but the pattern of blood flow, even though the area of the curve was the same, the pattern was completely different. Because when you deflate the cuff, you get a huge reperfusion of blood flow with BFR. But now we have not combined it with nutrition. I do think that some people have thrown around the idea of trying to combine it with something that could also augment blood flow. So combining it with a supplement that can increase blood flow to the working muscle.
I could see that maybe in certain clinical populations where they might have an impaired endothelium, but when you look at the blood flow response to exercise, it’s hard to imagine that you could augment that. I was just thinking the same thing. There has to be a saturation. From a saturation standpoint, how you’re already training, how is restricting blood flow in that way? How much more blood flow do you want? It’s funny because you brought up Illinois. So when I went there, I was not seeing supplements don’t work. There’s not a place for it. I was on every supplement that you could possibly think of. I had a whole room at Illinois dedicated to just supplements. They look like a coke den to be honest because there’s powder everywhere.
One of the studies I participated in there was Chris Fos. He is a good friend of mine, friend of Elaine Norton’s as well. He was looking for resistance trained participants because he’s a bodybuilder himself looking for arginine supplementation because we know that that increases blood flow. So what he was doing is we had a placebo and then we trained and then we came back and we did the arginine and then we trained. We had him our training partners, the natural mecca bodybuilding at the time. Okay, gold. I remember I had been taking that supplement for a long time and I knew for a fact that this was going to be beneficial.
But that was before I knew a lot of the physiological response of blood flow and things like that. I remember sitting there, we were just finished our workout and I was like, “Hey, whatever happened with your master’s thesis?” And he goes, “Oh yeah, I just finished it up.” He goes, “I didn’t find anything.” And I remember going, “What do you mean you didn’t find anything?” And my first thought was, because- I’ve wasted $5,000 on my arginine supplementation. Because I know Elaine gets fired up about this where it’s like, “You got to believe the evidence.” My first response is what most people’s first response is, especially if when you really spend a lot of money on something, I’m like, “You must have done something wrong.” What was wrong with the study? Needless to say, you guys aren’t friends anymore, you guys. No, he ended up saving me a lot of money because he’s like, “Well, it turns out if you don’t have an impaired endothelium, it’s really, really hard to augment it.” And then he was showing me the blood flow responses to exercise. He’s like, “Look at how big this is.” I’m like, “Ah, okay.” Then I started to realize that I was the one that was mistaken. So yeah, I think a normal person, I think it’d be hard to augment it. And with nitric oxide or arginine, maybe, and I was talking to Donna about this, that maybe there’s some variation in literature because if an individual was on a lower protein diet, they would have less arginine. And the only time arginine would potentially work is the variation. If you’re on a lower protein diet, then you could potentially benefit from arginine. But if you’re not and you’re on a protein adequate diet, then maybe there’s no effect. Yeah, I was not on a low protein diet.
What is next for blood flow restriction? Where are we in terms of what you believe we’re going to start to see? Because you’ve been doing… How long have you been doing blood flow restriction research now? Since about 2008. So just last year. Yeah. You’ve seen it probably go through multiple transformations in terms of how it’s being spoken about in the literature. And frankly, there’s not that many labs that are doing blood flow restriction work. Yeah. I think early on, I think people were very skeptical and actually quite negative about it, to be honest. And then it started to see a shift. I would say that the bodybuilding community did a lot for blood flow restriction.
But then I think it started to make its way into different clinics and then started to see some benefits. I think you started seeing multiple different groups starting to see some effects there all over the world. So it’s not just coming out of Japan. It’s not just coming out of Oklahoma. It’s not just coming out of Minini and Clark’s lab. It’s coming out of lots of different places, summer cook. And then you start to get to where we are now. So there’s still some skepticism by some, but now you have some people who are going, “Now blood flow restriction can do everything.” It’s like, “Oh, they can do that.” It’s not magic. But I would say that I think it’s going to continue to be tried out in different avenues of clinical research. I would like to see it tried in some form of it in space. We have had those discussions before and they have some concerns. One of the things that they wanted is like, “I want to make sure that there’s good data on the ground and that it’s safe and that it doesn’t require a lot of power.” So I was like, “Well, I can come up with a way that doesn’t require power at all. We got a lot of data.” And our conversation with them was they basically said, “Well, is it safe in space?” Well, I’m like, “Why don’t we? I don’t know.” Relative to what? You know there’s NASA’s right here. City in a lawn chair on top of a rocket. It’s safe relative to that, which is what you’re essentially doing. So I’m interested in that. We did get funded to do a proof of concept. One of the things that happens if you’ve been in space for any period of time is that when you come back, a lot of them have orthostatic intolerance, meaning that they stand up, their blood pressure drops, and they pass out. So it goes away. I mean, they normalize, but what we got funded to do was if you were to do that, if you were to come back in the space capsule and you needed to… There was an emergency where you needed to evacuate the spacecraft. If you stood up and passed out, that could be dangerous. So we had the idea that what if we were to apply just blood flow restriction just instantly, just on the limb, and then we tilted them up. So we did it without restriction and then different levels of blood flow restriction. So even in normal people, you see when you tilt them up, you see that drop and then a recovery. But with blood flow restriction, we basically maintained the pressure. So we never saw that drop. So that was proof of concept that, hey, maybe this could serve as a way for not only astronauts, but maybe people who have orthostatic intolerance. Now, we didn’t do it in those populations, so we don’t know. But I think that’s an area because civilian space travels is starting to become maybe a popular idea, which I think would… Sounds crazy, but yeah. Yeah, I’m too scared. Me too. I love the idea of it. For me, outside of the clinic, I don’t have anything to do with that. I’m not a clinician. But some of the questions that are interesting for me is related to what we talked about earlier, where can we apply this with high force contractions? So is there something about if I were to apply this using some sort of maybe to a limb that’s not exercising, so I wouldn’t get that negative effect of restriction on the… So basically meaning that if I apply blood flow restriction to a limb that’s working, it’s going to fatigue rapidly. So it’s hard to do any amount of high force work, but that wouldn’t happen if I applied it to my legs because my legs aren’t exercising. But if there’s some sort of systemic effect, some sort of neural signal, maybe I could get some effects. Maybe I wouldn’t get all the effects that you would get from actually applying it to a limb, but maybe I could get that performance effect. But we don’t know that. And it’s related to the other idea of what is it about applying a cuff? So I think that most people, and I don’t think it’s crazy, I say it repeatedly that there’s something related to the restriction of blood flow. It’s in the name, blood flow restriction, which implies that it’s due to the restriction of blood flow that’s driving these beneficial effects. And that might be true. But how do you separate that from sensing the pressure that’s applied to the limb? And it’s a great question. One of the ways that we’ve done it is we’ve tried to do with applying super occlusive pressure. So if you apply 110% and 150%, right? We didn’t do exercise, we were just doing the inflation and deflation. The arterial inflow reduction is the same, theoretically. Well, if they’re both under arterial occlusion, 110 and 150. That makes sense. But we saw slightly different, the discomfort’s different, which means that there’s something going on with the pressure. But is that driving something? I don’t know. I’d be interested to figure out a way to do that with sub occlusive pressures. That’s interesting. Were you surprised what you found? Because again, after 100%, it’s already occluded. Yeah, it would suggest that at least the effects using that protocol are not due specifically to the arterial occlusion. There’s some other effect there.
That’s what’s interesting for me. I think that looking at potential sex differences. I was looking at some of the research. It looks like, I’m sure this person is a colleague of yours, but it looks like there is, I mean, again, this was done in cardiovascular and HIIT training, but there looked like there was a sex difference between male and female response. I don’t know if that’s true. I’m not really giving you good data.
In our work with resistance training, we see sex effects in the sense that the pressures are different, the loads are different because men are typically bigger than women. But when we look at the actual effect, meaning that did the change differ between men and women? With pressure pain threshold, or their strings or something, we never see any difference.
Yeah, and this study was based on blood flow restriction and high intensity interval training.
And they were looking at the differences. The small sample size center of the earth is going to cool or faster Mars before we get it. But yeah, so yeah, it could be I’m not, I’m just not familiar with that. And it wouldn’t make sense that there what there would be based on the mechanism of action that you’re talking about. So you know, we’re getting into this weird spot now because it is Yeah.
McLean blood flow restriction during high intensity interval cycling exacerbates psycho physiological responses to a greater extent in females and males. Okay, so the perceptual response. Yeah. Yeah, I do. I am familiar with that paper, actually.
Yeah, I guess I’d have to I’d have to relook at that. Yeah, there’s certainly not a lot of them. I think there wasn’t actually, and this didn’t show any difference in any of the outcomes that you had mentioned. Yeah, I think that, you know, we’ve always included men and women, I would say traditionally that you included, you know, men, because, you know, and there’s here to recruit, they’ll do it. It’s not true. It’s not true. In our, in our experience, we always have more women than men. So I’ve people will use that argument. I’ve never found it to be true. Any, any place I’ve ever been. I always find that women are more willing to participate. So, but I would say traditionally, and people make the argument, it’s like, I heard this at a conference one time, he’s like, you know, women were first studied here, this is when they were first discovered. You know, but traditionally I would say that most people would say that men were the default and then people are trying to correct that. But the way that they’re correcting it doesn’t make any sense because now they’re going only women and then they’re trying to make claims. So they’re going, okay, we didn’t see this in men. We saw this effect in women. Therefore there’s a sex difference. It’s like, yeah, but you didn’t compare them. So yeah, I would be shocked that there’s a lot of sex differences, but I would say that we probably need a lot more data to know for sure. And who knows, we’re definitely, hopefully we’re not overcompensating one way or the other. Yeah, we need data in both for sure. Yes. Dr. Jeremy Lenike, thank you so much for coming on the show. You’ve answered a ton of my questions. I know that this is going to be very beneficial. Is there anything that I didn’t ask you that you think that I should have or more things that you would like to share with the audience? No, I think we covered a lot of different things. Blood flow restrictions is what we’re really known for in our lab, but have done a lot of work with the growth and strings. So I was happy that we got to touch on that. But no, I think that one of the things I try and always make sure I note is that I’m fortunate to be able to come here and talk with you. But a lot of these ideas come from sitting with my lab, talking over with my students who are back in Mississippi right now, doing a lot of work, even in the summer. So they’re collecting data right now as I’m here having this conversation. So the ideas, a lot of the ideas I’m talking about right now, I only have been able to develop because of them so past and present. So thanks for having me. It was a pleasure. I’d be happy to answer anything else. Thank you so much. And your students are lucky to have you just as much as you are lucky to have them. I think that you’re probably a tremendous mentor to them. Thank you. And one other thing, you did say that this was a much better podcast than lanes. Is that correct? Is that I wasn’t sure? Yeah, definitely. Did you hear that, buddy? Definitely much better than lanes. Thank you so much. Thank you.
