You Can Get Stronger and Healthier as You Age!
Some of you long-time readers may recall that both my parents passed away a few years back from frailty. My mom was 82, and passed before my dad who was 89. It was deeply saddening to see them deteriorate so rapidly, even more so that I didn’t have a simple strategy to recommend that would slow down their deterioration.
Obviously, there were many factors that contributed to their premature passing, but I sincerely believe frailty and loss of the ability to move freely played a major role. That was a primary motivation for me to avoid the fate of both of my parents through the use of regular exercise.
Your Skeletal Muscle Has Many Functions
Sarcopenia — age-related muscle loss — threatens a healthy lifespan. With society aging worldwide, the prevalence of sarcopenia increases the urgent need to establish prevention and intervention strategies. The U.S. Centers for Disease Control and Prevention now recognizes sarcopenia as an independently reportable medical condition.1
Many don’t realize that skeletal muscle not only manages physical activity, but also plays a major role in metabolism, circulation and cognition, as seen in the following figure.
Skeletal muscle not only functions to generate force and movement, but it is now known that your muscles actually serve an important endocrine function. They secrete special cytokines (i.e. myokines) and transcription factors into the bloodstream, thereby regulating the function of other organs. Furthermore, skeletal muscle is a metabolically active tissue with an important role in the maintenance of metabolic homeostasis.
Skeletal muscle is the most abundant tissue, comprising 40% of your body mass,2 and is the primary sink of insulin-mediated glucose disposal. Muscle is also the major site for insulin-stimulated glucose uptake, as well as the main energy consumer of fat.3 After meals, about 80% of glucose is deposited in your skeletal muscle.4,5
How Sarcopenia Sabotages Your Health
The loss of muscle mass with advancing age is thought to be a primary driver of insulin resistance in older adults.6 The declining muscle strength and progressive mobility impairment with age also likely causes a reduction in daily physical activity which can contribute to metabolic dysfunction.7,8
The loss of resilience as a result of sarcopenia is underappreciated as a major factor in the ability to recover from life’s inevitable challenges. It is clear that elderly with low muscle mass experience delayed recovery,9,10 and have higher rates of complications and infections following surgery,11 greater drug toxicity12 and higher disease-specific and all-cause mortality.13
Sarcopenia also predicts both the risk for community-acquired pneumonia in the elderly,14 as well as 90-day mortality in patients suffering from aspiration pneumonia.15
Muscle is increasingly recognized as an organ with immune regulatory properties. As such, skeletal muscle cells modulate immune function by signaling through different soluble factors, cell surface molecules or cell-to-cell interactions.16 It is also speculated that sarcopenia contributes to immunosenescence — the gradual deterioration of your immune system — which is a leading cause of death in the elderly.17
Additionally, recent reviews found strong evidence that frailty due to sarcopenia18 is a risk factor for adverse outcomes, such as longer hospital stay, functional decline at discharge, and both in-hospital and medium, lower quality of life,19 and long-term mortality.20
My Strategy and Recommendation to Combat Sarcopenia
Now, I am no stranger to exercise. I have been exercising since 1968, which is 52 years. The problem is that the first 43 years were exclusively cardio, and in my case long distance running. I like to compete, so I got relatively decent and was eventually able to run a 2:50 marathon, which was good enough back then to get me on the post-graduate University of Chicago Track Club.
Unfortunately, I didn’t realize that while cardiovascular exercise can lower your risk of heart disease, it is a highly catabolic activity and will actually lower your ability to build muscle. Below is a picture of me taken during my peak running condition. As you can see by the arrow, I had a gigantic 10.5-inch arm circumference.
There are loads of ways to increase your muscle mass but they mostly involve moving, pushing or pulling heavy weights or resistance bands. The problem with this strategy is that if you are not in good shape, and especially if you are elderly, there is a very high likelihood that you will get injured. In most cases, it is not if you will get injured but when.
The answer to this problem is an exercise strategy known as blood flow restriction training or BFR. As the name implies, BFR involves modifying the arterial inflow and venous outflow while you’re working the muscle by placing an inflatable band around the extremity.24
I have done many things in the last 10 years to help build muscle mass, but I believe combining TRE with mTOR activation and BFR is largely responsible for producing the changes you see in my video above.
How BFR Works
BFR’s ability to achieve such remarkable physiological benefits is directly related to slowing venous blood flow from the muscle group being engaged and creating a relatively hypoxic environment or low oxygen pressures in the exercising muscle.
Venous flow moderation is optimally achieved by wrapping the extremity being exercised with an inflatable cuff or band. The band needs to be tight enough to slow venous return to the heart, allowing venous blood to “pool” in the region of the limb that is being exercised, while loose enough to allow arterial blood to flow through.
With very light exercise, and in about 15 to 20 minutes, you get an exhaustive workout that sends a signal to your brain that says, “Hey, I’ve done something really hard here — you better help me recover and adapt to it.”
Your brain then sends out hormonal responses that cause your muscles and blood vessels to grow. Most would think that such light weights would be insufficient to provide any muscle strength improvements, but studies show a 36.2% to 40.1% increase in muscle strength after only 12 weeks, depending on your load and health.25
BFR Mimics Heavy Weight Training Without Any of the Risks
BFR training is frequently misunderstood as simply a conventional resistance training program with the addition of resistance bands. Nothing could be further from the truth.
Because the exercise is done with such low weights, there’s far less muscle fiber trauma and damage; especially relative to conventional strength training. This means you are able to recover much quicker, so you don’t have to dig yourself out of a hole the next few days. In most cases, you can exercise different body parts nearly every day and rapidly attain the metabolic and physical benefits.
High-intensity training such as sprinting or heavy weight training have typically been recommended for increasing muscle size because they activate the fast twitch Type II muscle fibers.
In order to increase muscle mass and strength, it’s important to activate Type II muscle fibers during training, since these fibers have been shown to be more responsive to hypertrophy than Type I fibers26 and are generally much larger.
Weight training done at low weights will not activate Type II fibers — unless it’s done with BFR. The reason for this is because the Type I fibers become exhausted in the hypoxic conditions created by BFR, which then allow the Type II fibers to fire and generate high levels of lactate, which are responsible for much of the metabolic magic.
During BFR training the Type I fibers become highly fatigued during the first set, thus necessitating the recruitment of Type II fibers as the exercise progresses.27 Simply moving light weights with high repetition without BFR will not engage Type II fibers because there is plenty of oxygen for the Type I fibers to work. Hence the fast-twitch Type II fibers just aren’t called into action.
This is the type of training that not only will add solid muscle mass, but also significantly increase your strength and endurance while reducing your body fat. For most people who are not competitive athletes, it’s really the only form of resistance training they need.
Competitive athletes also seem to benefit from BFR, but they would need to combine it with conventional strength training.28 In short, BFR works on a very simple principle: It tricks your body into believing that it’s moving far heavier weights than you’re actually using, and as a result generates compensatory metabolic responses, detailed below.
Local and Systemic Effects of BFR
If you are elderly, what is really amazing is that your muscle growth with BFR is beyond what strength training with heavy weights can do. This is because you need good blood flow to your Type II muscle fiber stem cells, and virtually everyone’s microcirculation decreases with age. So, even if you send the signal to grow by doing conventional strength training, it won’t work as well if there isn’t enough capillary supply to your Type II fiber stem cells.
BFR increases your microcirculation, your capillaries and venules and arterioles that are associated with them (see image below), largely because your muscles are working in a hypoxic (low oxygen) environment.
BFR Increases Microcirculation
This low oxygen tension causes the release of hypoxia-inducible factor-1 alpha (HIF-1 alpha),29 that then increases the hormone vascular endothelial growth factor (VEGF), which is one of the most powerful angiogenic signals in your body. BFR has been shown to raise VEGF levels by 410% in young adults.30
Essentially it acts as “fertilizer” for growing new blood vessels and capillaries to your muscle stem cells. BFR training has been shown to increase muscle stem cells by 300% after eight days of training.31 But it gets even better, as VEGF not only increases microcirculation in your muscle stem cells but also in your brain and heart. In Japan, BFR is frequently used for stroke and cardiac rehab precisely for this purpose.
BFR also increases the production of the important regulatory free radical, nitric oxide (NO), which further contributes to an increase in VEGF.32 NO is an important signaling molecule produced at high levels in muscle by neuronal nitric oxide synthase (nNOS). BFR, by way of increasing NO, has been found to stimulate muscle satellite stem cells and proliferation.33
BFR Is a Powerful Myostatin Inhibitor
But here’s the real winner: BFR also downregulates a hormone called myostatin, which is a negative regulator of muscle growth and mass.34,35,36 In other words when your myostatin levels are high you simply are unable to grow muscle. This is important because the elderly have levels twice as high as the young.37
In the past, lactate was traditionally viewed as a metabolic waste product, but today it is understood that lactate is an important molecule that is responsible for many metabolic processes and results in many structural adaptations. It is even referred to as a pseudo-hormone.38
When you apply the bands and engorge the working muscle, the Type I muscle fibers which require oxygen, glucose and fat to create energy in the mitochondria rapidly give out and your muscle switches to Type II fibers that run on burning glucose without oxygen by the glycolysis pathway illustrated below.
The lactate that your Type II muscle fibers generate during BFR actually down-regulates the production of myostatin and helps improve skeletal muscle loss. Amazingly, BFR can decrease your myostatin levels by 41% to 45%, which has been shown to increase muscle protein synthesis.39,40,41,42
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Article from LewRockwell
