How to Train Through Injuries

Don't assume that medical practitioners will tell you everything you need to do to recover. Recovery is your responsibility. Spend your downtime focusing on the basics and dialing in movement patterns. All recovery is aerobic in nature. Do aerobic conditioning to speed recovery. Move every day, even the injured area if possible. Work around specific injuries. Upper body injuries are the easiest to train around. Taking a month off from squats and deadlifts isn't a bad idea. If you concentrate on posterior chain and core work, you'll hit new PR's when you resume squatting and deadlifting. Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength.

The most important element of training through any injury is mindset. You have two options:

Wallow in self pity and allow yourself to regress while you slowly recover to your new, lower baseline. See the injury as an opportunity and challenge to correct weaknesses and recover as quickly as possible. I suggest number two. Your mindset will dictate how successful your recovery is.

Recovery is Your Responsibility
Don't assume that the medical practitioners you're working with will be instructing you on everything you can do to recover as quickly as possible. This isn't a knock on doctors or physical therapists. Most of them spend an extremely limited amount of time with patients and can hardly get them to do the minimum amount of rehab.

In fact, studies have shown that most people are so apathetic that they won't even take life-saving drugs more than 50% of the time, let alone do anything that involves more than stuffing a pill in their mouth.

Having a successful and speedy recovery is your responsibility, no one else's.

How Injuries Affect Training
Your immune system is intricately tied into your body's response to exercise. When you lift a heavy weight or smoke a conditioning workout, cellular damage occurs. This causes a cascade of other responses that end with you becoming bigger, faster, or stronger. This dynamic interaction means that your body's response to the same stimulus is constantly changing.

Any injury that causes a large systemic immune response will disrupt your body's response to training and ability to tolerate stress. You need to modify your training to account for how stressed your immune system is throughout the recovery process. Exercise beyond your body's ability to recover is a "pathogenic" stressor and slows recovery instead of stimulating it.

Basics of Recovery
ouch
Work on your weaknesses
Training what you suck at, well, sucks. But take this as an opportunity to improve. If you're like 99% of lifters, you need better aerobic capacity, movement, and breathing. In addition to that, you'd likely benefit from spending some time focusing on the basics and dialing in movement patterns again.

If you don't know what you suck at, just ask yourself what you dread training the most. Better yet, ask a training partner or friend who isn't afraid to hurt your feelings about what your weaknesses are.

Figure out weaknesses and attack them. Common weaknesses include:

• Conditioning
• Movement
• Breathing
• Exercise Technique
• Don't ignore conditioning

All recovery is aerobic in nature. Blood flowing around an injured site as well as throughout the body promotes exchange of waste and the rebuilding of cells and speeds recovery.

Aerobic conditioning also develops the fat oxidation capacity of your liver, which allows it to clear out immune system waste products more quickly. In addition, aerobic conditioning allows for greater parasympathetic tone, which promotes rest and recovery.

I can hear the excuses now. "I'm trying to gain muscle." "I don't want to get weak." These bullshit excuses are the plaintive cries of mediocrity. Unless you're an elite-level power lifter, Olympic lifter, or bodybuilder, you have no excuse to be deconditioned.

Let's clarify what I mean by "elite" because that's a term that gets bandied about almost as ridiculously as "warrior" lately. Nobody who deadlifts twice their own bodyweight is strong. A double bodyweight deadlift just means that you aren't weak. At my gym the strength standard for endurance athletes is a double bodyweight deadlift.

Similarly, no one who weighs 200 pounds is too heavy to have a decent aerobic capacity. I work with multiple athletes that weigh 200-220 pounds who regularly place well in endurance events (triathlons, marathons). You have no excuse. Get to work.

So, do your aerobic conditioning. Work up to 2-3 times per week for 60-90 minutes. Circuits of various low threshold movements can be a substitute for steady state aerobic work.

Movement is nutrition
Whenever you injure a soft tissue (muscle, ligament, tendon), movement is your best friend. As long as you use common sense and stay within the range of motion and loads your medical practitioners outline, you'll be doing your body a favor. Movement stimulates increased blood flow around the injured site, thus feeding nutrients and getting rid of waste byproducts.

Movement is also a stress (a positive one when you listen to your body) and it stimulates scar tissue formation. This is important because scar tissue develops in specific formations to handle the stress that it's placed under.

If you don't stress the injured site during recovery, you won't develop scar tissue that can handle the movements and types of stress that it'll be under when you're healthy and return to full speed. Known movements, performed at a low intensity for reasonable volume, speed up recovery.

Within the context of your specific limitations, move every day, even the injured area if possible.

Breathing matters

Breathing stimulates the lymphatic system, digestion, blood flow (oxygenation of tissues), immune system, and helps "clean" the organs. All of this stimulates faster recovery.

Opioid intake (pain killers), pain, and anxiety due to injury or surgery all have significant effects on your autonomic nervous system, which disrupts breathing patterns. If not addressed, this disruption can compromise recovery due to suboptimal acid-base balance in the body and the cascade of ensuing negative effects.

Most of the immune cells in your body are created by the bone marrow in the heads of the ribs. Proper breathing stimulates blood and lymph flow around the ribs, supporting optimal immune cell production. Non-optimal breathing also affects cognitive function. This impairs your ability to make good decisions and changes your perception of everything.

Learn how to breathe properly and practice every day.

Working Around Specific Injuries
Here are some basics for working around injuries. Apply these within the context of your specific situation. Be smart and do what works for you. These strategies are suggestions, not instructions. Don't do something just because it's listed here.

Shoulder, Hand, Wrist, and Elbow Injuries
Upper body injuries are the easiest to train around. You still have your lower body, core and one unaffected arm to train.

Train the other arm. Just because one of your arms is injured doesn't mean the other one can't be trained.

Try:

• Single Arm Dumbbell Rows
• Single Arm Dumbbell Bench Presses
• Single Arm Dumbbell or Kettlebell Overhead Presses
• Single Arm Pulldowns

Give your spine a break. Taking a month or two off from squats and deadlifts isn't necessarily a bad idea. I did that following my most recent shoulder surgery and after a few months of hip lifts, belt squats, and lots of posterior chain and core work, I returned to squatting and deadlift. I was hitting PR's a few months later because I fixed my weaknesses. My back also thanked me. Spine deload exercises include:

Rear-Foot Elevated Split Squat (weight in one hand + weighted vest)
Lunge Variations (weight in one hand + weighted vest)
Hip Thrust

Incorporating dynamic work is a great way to overload the lower body without having a lot of weight on the spine. Examples of dynamic exercises:

• Box Jumps
• Hurdle Jumps
• Depth Jumps
• Split Squat Jumps
• Squat Jumps
• Knee, Ankle, and Foot Injuries

Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength throughout your recovery period.

Train the Upper body. This may seem obvious, but most people think any injury means no training. You can still train the upper body with very few modifications and a good training partner.

Train the uninjured leg. Some options:

• Single Leg Squats
• Single Leg Hip Lifts
• Single Leg Deadlifts

Core Training. A lot of core training involves the lower extremity and without one leg, finding core exercises to do can be difficult. Some of my favorite core exercises for clients with a lower body injury:

• Dead Bugs
• Leg Lowering Exercises
• Straight Leg Sit Ups
• Hanging Unilateral Leg Raises

Lower Back, Hip, and Abdomen Injuries
Injuries around the middle of the body are the hardest to train around. However, that doesn't mean that you can't continue to train.

Train the Upper Body
When I have clients with lower back and abdominal injuries we start with a lot of low intensity upper-body work that doesn't stress the injured area. This usually means simple exercises such as floor presses and chest supported rows. Experiment with supported variations that require less core involvement until you find something that works for you.

Replace intensity with volume and density. It's unlikely you can lift heavy while recovering from this type of injury, so instead focus on doing a lot of high quality, low intensity work in short periods of time. The formula outlined below stimulates blood flow and parasympathetic (rest and recovery) activation.

Movement Work – Light-Weight Lunges, Squats, Deadlifts
Breathing exercises between sets
Here's an example of a circuit combining these different principles:

Kettlebell Romanian Deadlifts (very light with slow lowering phase)
Dumbbell One-Arm Bench Presses
Half-Kneeling Cable Rows (hold at top for 3 seconds)
Deep Breathing Squats
Four sets of 5 reps of all exercises. No rest between exercises; the breathing exercise is the rest between sets.

Stages of Recovery
Initial
The initial recovery period will range in length from weeks to months depending on the severity of the injury. During this time your body is in a constant state of systemic inflammation and recovery. The goal during this period should be to feed the recovery process and correct weaknesses without doing too much and inhibiting recovery.

Use the following guidelines to craft a training plan:

Perform aerobic activities at least 2-3 days per week.
Do some type of movement (squats, hip hinges, rows, presses) every day, but keep the intensity and volume fairly low.
Perform breathing exercises daily.
Focus on correcting weaknesses.
Eat a clean diet. Gut health contributes to sleep quality, immune response, and your overall internal health.
Perform soft tissue work daily over the entire body including around the injured site.
Sleep a lot.
Move throughout the day. My favorites are going on five minute walks or performing short sets of 20-25 air squats, light kettlebell swings, push-ups, and pull-ups every one or two hours (or whatever movements I can do).
Avoid heavy lifting, anaerobic conditioning, or crushing yourself in any other way during a training session.
Middle
The middle stage of recovery begins when you're off all pain meds and are able to start more aggressive physical therapy or training without feeling awful for several days. The systemic hormone response from these days should actually speed the recovery process. Aerobic and other low intensity work should be performed on all "off" days.

Use the following guidelines for the middle part of your recovery:

Alternate between moderately difficult and easy training days.
Easy training days should consist of movement and aerobic work.
Hard training days should follow the set/rep/intensity/rest scheme outlined below because it stimulates a large GH and testosterone response but won't crush your nervous system:

Perform variations of the big lifts: squats, deadlifts, presses, rows, pull-ups.
Do full body workouts, 3-5 main exercises, 3-5 sets per exercise, sets of 5-10 reps.
Perform supersets of 2-4 exercises allowing full recovery between sets.
Use moderate intensity. Leave at least 2-3 reps in the tank and focus on perfect technique.
Light sprints (10-15 seconds) can be performed 1-2 times per week. These are not "all out" days but more like 80-90% effort.
You shouldn't accumulate fatigue over the course of the week. You should feel close to 100% before you perform another strength session.
Back to Normal
dip
The final 10-20% of recovery is always the most frustrating. Working with skilled practitioners can help restore movement and function much faster than if you decide to go at it alone. Key tactics of the final stage of recovery:

Slowly return to full intensity workouts.
Focus on restoring proper mechanics and movement up and down the chain from the site of the injury.
Listen to your body and have training partners critique form or record form on all big lifts to ensure proper movement.
Have a long-term mindset. One training session or season is meaningless in the context of a lifetime. Don't take unnecessary risks in the name of short-term satisfaction.
Now, these are just recommendations and are far from comprehensive. Develop a relationship with the team of people you're working with and make a plan that works for you. It's your body and it's your responsibility to make the best of the situation. Be creative, listen to your body, and most importantly, buy in to the fact that you're in control of how you recover from an injury.

Combating hair loss

In the study, 416 men with male pattern hair loss ages 21 to 45 years old, were randomized to receive dutasteride 0.05, 0.1, 0.5 or 2.5 mg, Finasteride 5 mg, or placebo daily for 24 weeks. The results of the study showed that dutasteride increased hair counts in a dose-dependent fashion and dutasteride 2.5 mg was superior to finasteride 5mg at 12 and 24 weeks.

Although testosterone is the major circulating androgen, to be maximally active in scalp hair follicles it must first be converted to dihydrotestosterone (DHT) by the enzyme 5α-reductase. The importance of DHT as a causative factor in male pattern hair loss is shown by the absence of this MPHL in men with a congenital deficiency of the type 2 5α-reductase enzyme. A type 1 5α-reductase, which also metabolizes testosterone to DHT, differs in its location and amount in different tissues. In the skin, type 1 5α-reductase is the principal isoenzyme in sebaceous and sweat glands. There is no recognized genetic deficiency of type 1 5α-reductase in humans to assess its role in male pattern hair loss.

Dutasteride (Avodart) inhibits both type 1 and type 2 5α-reductase and is approved at the 0.5-mg dose for treatment of symptomatic benign prostatic hyperplasia (BPH). It is about 3 times as potent as finasteride at inhibiting type 2 5α-reductase and more than 100 times as potent at inhibiting the type 1 5α-reductase enzyme.
Dutasteride caused scalp and serum dihydrotestosterone levels to decrease and testosterone levels to increase in a dose-dependent fashion. Whereas 5-mg finasteride decreases serum DHT by about 70%, dutasteride can decrease serum DHT by more than 90%.

Results

In this phase II, dose-ranging study, 2.5-mg dutasteride was superior to 5-mg finasteride in improving scalp hair growth in men between ages 21 and 45 years with male pattern hair loss as judged by target area hair counts, expert panel assessment, and investigator assessment at 12 and 24 weeks.

Dutasteride 2.5mg vs. 0.5mg

The 2.5-mg dutasteride dose was consistently superior to 0.5-mg dutasteride in promoting scalp hair growth. The 2.5-mg dose was also better than the 0.5-mg dose at suppressing scalp DHT (79% vs. 51%), whereas it was only marginally better at suppressing serum DHT (96% vs. 92%). This difference in the dose-response of serum and scalp DHT to inhibition with dutasteride is likely to be due to the greater contribution of type 1 5α-reductase to scalp DHT concentrations.
Finasteride 5mg vs. Dutasteride 0.1mg

5 mg finasteride suppressed scalp DHT to a similar degree as 0.1 mg dutasteride group (41% and 32%, respectively). Many of the clinical effects (hair count changes, global panel assessment, and investigator assessment) were also similar in these two groups, supporting the similarity in scalp suppression between 5-mg finasteride and 0.1-mg dutasteride.

Adverse Effects

Both Dutasteride and Finasteride were well tolerated in this phase II study, and no new safety concerns have arisen in any of the phase II and phase III studies of Dutasteride given at doses up to 5 mg daily (the 5-mg dose was used in a phase II study for BPH).

There were no significant differences in side effects, serious adverse events, or withdrawals due to adverse events among any of the treatment groups, including placebo. In total, 11 subjects withdrew because of adverse events: 3 were in the placebo group (irritable bowel syndrome and impotency), 7 in the Dutasteride 0.1 mg group (decreased libido, malaise and fatigue, mood disorders, skin disorders, injuries caused by trauma, and gastrointestinal- and neurology-related complaints) and 1 in the Dutasteride 0.5 mg group (gastrointestinal discomfort and pain).

Decreased libido was noted in:

2 subjects in the placebo group
2 subjects in each of the 0.05-mg and 0.1-mg Dutasteride groups
1 subject in the 0.5-mg Dutasteride group
9 subjects in the 2.5 mg Dutasteride group
3 subjects in the Finasteride group

Of the 9 subjects with decreased libido in the 2.5-mg Dutasteride group:

4 resolved while receiving therapy
1 resolved within 3 weeks
1 resolved within 8 weeks of stopping drug therapy
1 subject, decreased libido continued after therapy had been stopped and was presumed by the subject to be unrelated to the trial or drug therapy

Concerning possible sexual adverse events, there was no evidence in the present study that either Dutasteride or Finasteride was associated with impotence. However, 9 men in the 2.5-mg dutasteride group complained of decreased libido, compared with 1 man in the 0.5-mg dutasteride group and 3 men in the Finasteride group. As with previous studies with finasteride, this adverse event was characterized as either mild or moderate in severity and often resolved with continuation of the medication. In the 4-year follow-up of the phase III trials in BPH, dutasteride (0.5 mg) was well tolerated and the incidence of the most common sexual adverse events was low and tended to decrease over time. The only subject to develop gynecomastia was in the placebo group.

Duration of Effects

The serum half-life of Finasteride is 6 to 8 hours. Dutasteride has a serum half-life of approximately 4 weeks, and this long half-life was evident in the persistent suppression of DHT with the 0.5-mg and 2.5-mg doses after Dutasteride treatment was stopped. Because of this long half-life, men being treated with Dutasteride should not donate blood until at least 6 months past their last dose to prevent administration to a pregnant female transfusion recipient.

Who should avoid using Clenbuterol?

Performance enhancing drugs such as Clenbuterol should be used sensibly and collecting as much qualified information as possible is the key to optimizing and reaping complete benefits of Clenbuterol, which is also known as Clen.

Clenbuterol is not to be used by those having a sensitivity to the medication or any of its substances or those experiencing hyperthyroidism, tachycardia, tachyarrhythmia, heart or thyroid diseases, high blood pressure, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention, glaucoma, ischemic heart disease, myocardial infarction (acute period), and hypertrophic obstructive cardiomyopathy. Long-term use of this medication can decrease stamina stages to a considerable level. The medication is also not suggested for expecting and breast feeding females and kids. People with diabetic issues should seek healthcare guidance before starting use of this steroid.

Moreover, Clenbuterol should not be taken by those who are using cardiac glycosides, beta-blockers, sugar lowering drugs, insulin, CNS stimulants, MAO inhibitors, and sympathomimetic agents. It should not be taken by those already administered with or using terbutaline, oxytocin, propanolol and other beta-blockers, digoxin, dinoprost (Lutalyse, Prostamate), monoamine oxidase inhibitors, or inhaled anesthetics.  Under no situation, Clenbuterol should be used or taken through recycled or distributed needles as such a practice increases the chances of injection site pain and sexually-transmitted diseases such as HIV and AIDS. Most of these adverse reactions are extremely rare and most subside by themselves in over seven to ten days.

Deca-Durabolin Weakens Tendons and Collagen

Is it just a coincidence that bodybuilders are more likely to suffer injuries because of heavy training, or does the use of anabolic steroids have any impact on tendon/collagen strength? The research is very preliminary, as only a few studies have examined the effects of anabolic steroids on tendon and collagen strength. It was shown that anabolic steroids alter the biomechanical properties of tendons and reduce tendon flexibility.

Some interesting theories have been suggested as why heavy anabolic steroid use can cause tendon injury, which is based around cortisol production and anabolic steroids. Researches have demonstrated that anabolic steroids combined with tension overload reduced MMP2 activity (MMP2 is a gene responsible for collagen production) and increased serum values of cortisol. During cortisol treatment, the serum levels of genes responsible for collagen production decrease, suggesting that cortisol suppresses the synthesis of collagen production. The reduction in genes for collagen and tendons have been speculated as to why anabolic steroids makes bodybuilders susceptible to injuries. New research links the use of high doses of anabolic steroids to tendon and collagen dysfunction, which may make a bodybuilder think twice about training heavily while using anabolics.

Researchers examined how heavy use of the anabolic steroid Deca-Durabolin affected collagen strength in rats. The rats were separated into two groups: natural training and training with heavy anabolic steroid use. The dose the researchers administered to the rats was considered supra-physiological – Deca-Durabolin (nandrolone decanoate) 5mg/kg of bodyweight.

The rats were cleverly forced to perform resistance exercise, but you can’t just tell a rat to start benching – so the researchers attached weights to the rats’ backs. They dropped the rats into a tank of water and the rats immediately jumped out of the water as soon as they were dunked. Every week, the researchers gradually made the weight on the rats’ backs heavier and heavier until at the end of seven weeks the weight was 80 percent of their bodyweight. The researchers dropped the rats in the tank so that they performed this for 4 sets x 10 repetitions of “jumps” with 30-second rest periods. After that, they rats were sacrificed and the rats’ tendons and collagen were examined for gene expression.

There were some very interesting findings after seven weeks of training with anabolic steroids, compared with the natty (natural) group of rats. The natty group did not have any biochemical changes in the rat tendon/collagen properties, while the anabolic steroid group had major changes. The Deca-Durabolin group had reduced biochemical properties of genes involving tendon and collagen strength.

It is interesting to note that anabolic steroids administration reduced the accumulation of IGF-1 mRNA levels in some tendon regions, compared to the non-treated, trained group. This decrease of IGF-1 mRNA levels induced by AAS administration may be related to the observed decreases collagen expression when considering the possible connection between IGF-1 and collagen synthesis. The anabolic steroids treatment also decreased the MMP-2 mRNA expression (this gene encodes an enzyme for collagen).

The above study is similar to another recently published study, which showed that nandrolone impaired the healing of rotator cuffs of rabbits. In the latter study, male rabbits underwent an incision in the rotator cuff and were divided into groups with anabolic steroids (nandrolone decanoate, 10mg/kg) and natural recovery. Groups that did not receive anabolic steroids showed better healing and more tendon strength compared to groups that received anabolic steroids. Microscopic examination of specimens from the groups with anabolic steroid use showed focal fibroblastic reaction and inflammation, suggesting an impaired healing response.

The key point is that many of these studies were using supraphysiological dosages of steroids that could be like the typical Olympia stack – but the new research suggests that a high-volume approach to training with less weight may be a better approach to use for a bodybuilder than a high-intensity, heavy weight program that puts more stress on the tendons and makes them more susceptible to injury.

Memories have lasting emotional impact on Alzheimer’s patients

Alzheimer’s disease is marked by an inability to recall certain memories, but new research shows that patients diagnosed with the condition can still remember how those memories made them feel.

In a study researchers showed 17 Alzheimer’s patients and 17 healthy patients clips from happy and sad movies.

During the films, all of the study participants expressed signs of sorrow, like crying, and happiness, like laughter. Five minutes later, the individuals with Alzheimer’s couldn’t remember the movies, but they still experienced prolonged feelings of happiness and sadness.

Researchers say the findings are significant because they could impact how caregivers treat Alzheimer’s patients.

“Frequent visits and social interactions, exercise, music, dance, jokes, and serving patients their favorite foods are all simple things that can have a lasting emotional impact on a patient’s quality of life and subjective well-being,” Edmarie Guzmán-Vélez, lead author and a doctoral student in clinical psychology, said in a news release.

Experts predict that Alzheimer’s will impact nearly 16 million Americans by 2050 and cost an estimated $1.2 trillion.

Lifting Weights Reduces Lymphedema Symptoms Following Breast Cancer Surgery

Breast cancer survivors who lift weights are less likely than their non-weightlifting peers to experience worsening symptoms of lymphedema, the arm- and hand-swelling condition that plagues many women following surgery for their disease, according to new University of Pennsylvania School of Medicine research.

The findings challenge the advice commonly given to lymphedema sufferers, who may worry that weight training or even carrying children or bags of groceries will exacerbate their symptoms. "Our study challenges the historical medical recommendations for women who get lymphedema after breast cancer, and is another example of well-meaning medical advice turning out to be misguided," says lead author Kathryn Schmitz, PhD, MPH, an associate professor of Epidemiology and Biostatistics and a member of Penn's Abramson Cancer Center. "For instance, we used to tell those who had back pain to rest, but we know now that in many cases, inactivity can actually make a bad back worse. Too many women have missed out on the health and fitness benefits that weight lifting provides, including building bone density. Our study shows that breast cancer survivors can safely participate in slowly progressive weight lifting and gain those benefits without any increase in their lymphedema symptoms. In fact, this type of exercise may actually help them feel better."

In the largest study to date to examine the impact of weight training on this sometimes debilitating, incurable condition, Schmitz's team enrolled 141 breast cancer survivors with a current diagnosis of lymphedema. Half were assigned to a weight-lifting group that participated in small- group, twice-weekly, 90-minute exercise classes for 13 weeks. During that time, with guidance from trained fitness instructors in community fitness centers in Pennsylvania, New Jersey and Delaware, the women worked up to greater resistance and more sets of weightlifting exercise. For the next 39 weeks, the women continued twice-weekly unsupervised exercise, with trainers calling to check in on women who missed more than one session per week. The women wore a custom-fitted compression garment on their affected arm during their workouts, and each week were asked about changes in symptoms. Their arms were measured monthly to ensure any changes were noted as soon as they occurred. The 70 control group participants, meanwhile, were asked not to change their exercise level during study participation.

During the course of the study, women in the weightlifting group experienced fewer exacerbations of their condition, and a reduction in symptoms compared to the women who did not lift weights. There were 19 women in the control group who experienced lymphedema exacerbations that required treatment from a physical therapist, compared to 9 in the treatment group. The proportion of women who experienced an increase of five percent or more in their limb swelling was similar in both groups -- 11 percent of the weight-lifting group and 12 percent in the control group. The researchers theorize that a controlled weightlifting program may have protective benefits, by boosting strength in affected limbs enough to ward off injuries from everyday activities that can aggravate lymphedema symptoms.

"Our study shows that participating in a safe, structured weight-lifting routine can help women with lymphedema take control of their symptoms and reap the many rewards that resistance training has on their overall health as they begin life as a cancer survivor," Schmitz says. "We did the intervention in community fitness centers deliberately, in the hope that positive results seen in our study would continue to be available to breast cancer survivors long beyond the end of the research study."

It is recommended that women start with a slowly progressive program, supervised by a certified fitness professional, in order to learn how to do these types of exercises properly. Women with lymphedema should also wear a well-fitting compression garment during all exercise sessions. The new research was conducted in partnership with YMCAs in Philadelphia, Montgomery and Delaware Counties in Pennsylvania and in Burlington County in New Jersey, as well as Sisters-In-Shape Fitness in Philadelphia. Staff at the Edison-Metuchen YMCA in New Jersey have also been trained to deliver this intervention.

The research was supported by grants from the National Cancer Institute and the National Center for Research Resources.

Testosterone Muscle Hypertrophy. IGF-1 and Testosterone

Hormones, such as human growth hormone (GH) and testosterone, have been shown to play a role in muscle hypertrophy and strength gains. Men suffering from GH or testosterone deficiency have increased fat mass, reduced muscle mass, and reduced muscle force production. The anabolic effects of testosterone on muscle mass are dose- and concentration-dependent. An earlier study demonstrated that supraphysiological doses of testosterone can induce increases in muscle size and strength in younger men without exercise. Testosterone-induced increase in muscle mass is associated with a dose-dependent increase in cross-sectional areas of both type I and type II muscle fibers. However, the mechanisms by which testosterone increases muscle mass are not well understood.

The prevalent dogma for the past 50 years has been that testosterone increases muscle mass by stimulating fractional muscle protein synthesis. Testosterone administration primes skeletal muscle for growth by increasing net protein synthesis, even in the fasted state. The logical extrapolation of a continued increase in net protein synthesis is that it results in increased lean body mass and strength. Additionally, testosterone stimulates many other pathways besides just increasing protein synthesis rates, to stimulate muscle hypertrophy.

Testosterone administration also results in increases in GH secretion, androgen receptor number, satellite cell activity, and increased IGF-1 expression in skeletal muscle. It has also been demonstrated that the increase in muscle anabolism is associated with an increase in the expression of intramuscular mRNA IGF-1. High-intensity resistance exercise has been shown to increase anabolic hormones, but there is confusion as to how important the acute increases in anabolic hormones are.

There has been recent debate as to how effective the acute increases in testosterone concentrations are for increasing muscle mass. A couple of studies have suggested that acute increases in testosterone are not necessary for increases in muscle growth; this has led to confusion as to how to train.

Researchers at the Exercise Metabolism Group at McMaster University reported that muscle hypertrophy took place without acute increases in anabolic hormone concentrations.10 Ten healthy, young male subjects performed unilateral resistance training for eight weeks (three days per week). Unilateral resistance exercise is where you train only one arm or in this case, leg (as opposed to both arms or legs), while the other arm or leg is used as a ‘control’ or untrained muscle. Exercises used in the study were knee extensions and leg presses, performed at 80-90 percent of the subject’s single-repetition maximum (1-RM). Blood samples were collected before, immediately after, 30, 60, 90, and 120 minutes post-exercise.

Total testosterone, free testosterone, GH, and insulin-like growth factor-1, along with other hormones, were analyzed for the first training bout and following the last training bout. Thigh muscle cross-sectional area (CSA) and muscle fiber CSA by biopsy (vastus lateralis) were also measured pre- and post-training. No acute changes in GH, testosterone, or IGF-1 concentrations were observed in the 90 minutes following exercise, and there was no influence of training on the anabolic hormones measured. GH did show a moderate increase 30 minutes post-exercise, but returned to baseline values by 90 minutes. Training-induced increases were observed in type IIb and IIa muscle fiber CSA. No changes were observed in fiber CSA in the untrained leg. Whole-muscle CSA increased by in the trained leg and remained unchanged in the untrained leg.

In conclusion, unilateral training induced local muscle hypertrophy in the exercised limb only, which occurred in the absence of testosterone, GH, or IGF-1 circulating levels. So I guess acute increases in anabolic hormones are a waste of time… well, not so fast. A new study was published which really emphasizes the importance of acute anabolic hormones during resistance exercise.

Bill Kraemer, one of the pioneers in GH research, told the American College of Sports Medicine, “GH and testosterone responses to acute resistance exercise are essential and more importantly, the anabolic hormone response that occurs with resistance exercise is like a symphony and GH and testosterone are an important part of that symphony along with IGF-1, MGF, and other anabolic hormones.”

High-intensity exercise has long been shown to increase testosterone and GH levels, but researchers recently published something in the Journal of Steroid Biochemistry and Molecular Biology that emphasizes the need for high-intensity exercise and backs up what Dr. Kramer has been saying for years.

Those who say that acute increases in testosterone are not necessary are missing an important point: acute increases in resistance exercise-induced elevations in circulating T potentiate gains in muscle strength followinglong-term training. Researchers wanted to know if acute increases in exercise-induced testosterone had any effect on the androgen receptor, which has been shown to influence muscle hypertrophy.

Researchers designed this really cool study to investigate the situation:

• Group A: Young male subjects performed heavy leg extensions only, and immediately had a thigh muscle biopsy.
• Group B: Young men performed high-intensity heavy resistance exercise with both upper- and lower-body work. They performed bench presses, bent rows, and overhead presses. Afterward, the group performed heavy leg extensions followed by a muscle biopsy from the thigh. The researchers had the subjects perform an upper-body exercise with lower-body exercise to elicit a large increase in anabolic hormones.

While both groups had a muscle biopsy taken from the thigh after heavy leg extensions, the only difference was that one group did some upper-body work, which enhanced testosterone production.

The group that performed high-intensity, upper-body exercise and lower-body exercises had larger increases in testosterone than the group that only performed a lower-body exercise (i.e., leg extensions), but here is the really cool part. The group that performed bench presses, bent rows, and shoulder presses had a larger increase in androgen receptor function in their legs! I am not advocating a whole-body workout, but what the study shows is that the greater the increases in testosterone, the greater the increases in androgen receptors… even in different body parts (i.e., legs).

So now you have a study showing that you can increase androgen receptors to a larger extent by the acute increases in testosterone.12 This means you could possibly see some growth in your arms, chest, and back by sticking to exercises that generate large increases in testosterone.

I remember reading an article where a bodybuilder swore that doing heavy squats increased his arm size. Based on the current study, this all makes sense. In the study, the acute increases in testosterone were enhanced in the legs by doing high-intensity, upper-body exercise.