V O L U ME 6 , ISS U E 2 FEBRUA RY 2 0 2 2

MASS
M ONTHLY A PPL ICATIO N S IN
STRE N G TH SPO R T

E R I C H E LMS | G R E G N UCK O LS | MIC HAEL ZO URDO S | ERIC T REXL E R

 The Reviewers
Eric Helms
Eric Helms is a coach, athlete, author, and educator. He is a coach for drug-free strength and physique
competitors at all levels as a part of team 3D Muscle Journey where he is also the Chief Science
Officer. Eric regularly publishes peer-reviewed articles in exercise science and nutrition journals on
physique and strength sport, in addition to contributing to the 3DMJ blog. He’s taught undergraduate-
and graduate-level nutrition and exercise science and speaks internationally at academic and
commercial conferences. He has a B.S. in fitness and wellness, an M.S. in exercise science, a second
Master’s in sports nutrition, a Ph.D. in strength and conditioning, and is a research fellow for the Sports
Performance Research Institute New Zealand at Auckland University of Technology. Eric earned pro
status as a natural bodybuilder with the PNBA in 2011 and competes in numerous strength sports.

Greg Nuckols
Greg Nuckols has over a decade of experience under the bar and a B.S. in exercise and sports
science. Greg earned his M.A. in exercise and sport science from the University of North Carolina
at Chapel Hill. He’s held three all-time world records in powerlifting in the 220lb and 242lb classes.
He’s trained hundreds of athletes and regular folks, both online and in-person. He’s written for many
of the major magazines and websites in the fitness industry, including Men’s Health, Men’s Fitness,
Muscle & Fitness, Bodybuilding.com, T-Nation, and Schwarzenegger.com. Furthermore, he’s had the
opportunity to work with and learn from numerous record holders, champion athletes, and collegiate
and professional strength and conditioning coaches through his previous job as Chief Content
Director for Juggernaut Training Systems and current full-time work on StrongerByScience.com.

Michael C. Zourdos
Michael (Mike) C. Zourdos, Ph.D., CSCS, has specializations in strength and conditioning and skeletal
muscle physiology.  He earned his Ph.D. in exercise physiology from The Florida State University (FSU)
in 2012 under the guidance of Dr. Jeong-Su Kim. Prior to attending FSU, Mike received his B.S. in
exercise science from Marietta College and M.S. in applied health physiology from Salisbury University.
Mike served as the head powerlifting coach of FSU’s 2011 and 2012 state championship teams. He
also competes as a powerlifter in the USAPL, and among his best competition lifts is a 230kg (507lbs)
raw squat at a body weight of 76kg. Mike owns the company Training Revolution, LLC., where he has
coached more than 100 lifters, including a USAPL open division national champion.

Eric Trexler
Eric Trexler is a pro natural bodybuilder and a sports nutrition researcher. Eric has a PhD in Human
Movement Science from UNC Chapel Hill, and has published dozens of peer-reviewed research
papers on various exercise and nutrition strategies for getting bigger, stronger, and leaner. In
addition, Eric has several years of University-level teaching experience, and has been involved in
coaching since 2009. Eric is the Director of Education at Stronger By Science.
 Table of Contents

6
BY GR EG NUCKOL S

Resistance Training is Similarly Effective for Both Sexes

Many people believe that since male lifters have more testosterone than female
lifters, males respond much more robustly to resistance training. A recent study (and
an enormous body of literature) demonstrates that this belief is incorrect. Relative
increases in muscle strength and size are similar between the sexes following
resistance training.

20
BY MI CHAEL C. ZOUR DOS

Are You Experiencing Fatigue, Muscle Damage, and

Performance Impairment? If So, Try Not Training to Failure
We have established in MASS that training to failure leads to more acute fatigue and
a longer recovery time course than non-failure training. The reviewed meta-analysis
provides further confirmation and assesses the effect of training status, volume, and
load on this response.

37
BY ER I C HEL MS

Pre-Training Meals, Finally Satisfied

This is the third study I’ve reviewed from a group examining the effects of pre-training
carbohydrate intake on resistance training volume performance. In this study, we learn
that, at least for low to moderate volume training, the energetic content of the meal
may be less important than how filling it is.

49
BY ER I C T R EXL ER

Slow and Steady Wins the Race, but Does It Optimize Your
Physique?
In the early 2010s, high-intensity interval training took the bodybuilding world by
storm, with promises of efficient fat loss and superior muscle retention. This month, a
very thorough meta-analysis puts those claims to the test.

62
BY MI CHAEL C. ZOUR DOS

Hot Water Immersion to Ignite Your Recovery

It’s pretty well-known by now that regular ice baths may blunt hypertrophy, but how
about hot water baths? This article breaks down a new study showing that post-
training hot water immersion speeds up recovery.
77
BY ER I C T R EXL ER

Exercise and Appetite Regulation: Hungry For Gains, or

Hungry From Training?
Does exercise make you hungry? Anecdotal experiences vary markedly, which usually
means we need to dig deeper to identify contextual factors influencing the relationship
between exercise and appetite. That’s exactly what this article aims to do.

90
BY GR EG NUCKOL S & ER IC TREX LER

Research Briefs
In the Research Briefs section, Greg Nuckols and Eric Trexler share quick
summaries of recent studies. Briefs are short and sweet, skimmable, and focused
on the need-to-know information from each study.

133
BY MI CHAEL C. ZOUR DOS

Mental Fatigue Part 2

Recent literature has demonstrated that mental fatigue builds over time in elite
athletes. This video examines how coaches and lifters may mitigate and cope with
mental fatigue, which manifests over time.

135
BY ER I C HEL MS

VIDEO: Supplement Series Part 4: Fat Burners

In part 4 of the “Supplement Series,” Dr. Helms discusses “fat burners.” These are
a common class of supplements, which despite often including well-researched
ingredients like caffeine, actually don’t have a solid basis of evidence proving their
efficacy. In the fourth installment, we cover the latest research on combined fat
burner products, as well as some of the more common, specific ingredients used
in a stand-alone fashion.
Letter From the Reviewers

W
elcome to the February 2022 issue of MASS, which is Volume 6 Issue 2 but
number one in your hearts. We’ll help you navigate the issue.
First, the short but essential research briefs cover a wide array of topics
this month. This issue contains a total of nine briefs covering: ATP supplementation,
exercising with a hangover, energy compensation, animal versus plant protein,
wearable technology, determinants of squat strength, sex differences in the bench press,
tapering for powerlifters, and weightlifting training in athletes.
Down the hall, the pair of Erics have made it another stellar month in the nutrition
department. Dr. Helms reviews a study examining the impact of pre-training nutrition
on performance. Specifically, Dr. Helms discusses whether consuming a carbohydrate,
semi-solid, or liquid breakfast affects squat and bench press performance. Dr. Trexler
breaks down a recent study examining if exercise plays a role in regulating hunger.
Dr. Trexler also entered the training literature fray by covering a recent meta-analysis
comparing interval training and moderate intensity cardio for changes in body
composition.
In one of the corner offices, the video department steps up to the plate with a couple of
continuing series. Leading off is Dr. Helms with part 4 of his supplement series, taking
on fat burners. Mike finishes up his two-part series on mental fatigue with a look at the
research surrounding the long term build of mental fatigue in elite athletes.
In the other corner office, Greg and Mike knocked it out of the park with their trio of
written articles. First, Greg reviews a study comparing the absolute and relative rate
of strength gains between men and women over time. Mike checks in with reviews on
post-training hot water immersion for recovery and an in-depth look at a meta-analysis
comparing the acute fatigue of failure and non-failure training.
As always, be sure to check out the audio roundtables and join us in the Facebook
group. Lastly, the unsung CEU department has continuing education for NSCA,
ACSM, NASM, and ACE.
We hope you have a great month, and thank you for being a part of MASS.

Thanks,
The MASS Team
Eric Helms, Greg Nuckols, Mike Zourdos, and Eric Trexler

5
Study Reviewed: Resistance Training Induces Similar Adaptations of Upper and Lower-Body
Muscles Between Sexes. Kojić et al. (2021)

Resistance Training is Similarly

Effective for Both Sexes
BY GREG NUCKOLS

Many people believe that since male lifters have more testosterone
than female lifters, males respond much more robustly to resistance
training. A recent study (and an enormous body of literature)
demonstrates that this belief is incorrect. Relative increases in
muscle strength and size are similar between the sexes following
resistance training.

6
 KEY POINTS
1. Untrained male and female lifters completed seven weeks of squat and biceps curl
training. Researchers assessed squat strength, curl strength, quad cross-sectional
area, and biceps thickness before and after training.
2. When expressed on both an absolute (kilos on the bar, or centimeters of muscle
growth) and a relative (percentage increase from baseline) basis, gains in strength
and muscle size did not significantly differ between sexes. However, some of the null
findings may have been influenced by the researchers’ statistical approach.
3. The results of this study broadly conform with the vast body of research on this
topic: in general, absolute increases in muscle size and strength tend to be larger
in male lifters, but relative increases are similar between the sexes (and, if anything,
relative strength gains may be a bit larger in female lifters).

A
lthough lifting is historically a
male-dominated pursuit, more and
more female lifters are falling in
love with the iron game each year. Just to use
powerlifting participation as a rough proxy,
OpenPowerlifting data shows that only about
17% of competitors were female (1727 out
of 10,011) in 2000 versus about 33% in 2019
(10,120 out of 30,474).
When people get into lifting, it’s normal to
ponder, “what sort of results can I expect for
my efforts?” If you do a bit of Googling, it’s
not hard to find a lot of content on the sub-
ject. As someone who has written about this
before, I can tell you that articles exploring
aspects of this topic – typical rates of hyper-
trophy and strength gains, strength standards,
“genetics limits” of muscularity, etc. – typ-
ically get a lot of traffic. However, you’ll
probably find that most of the content is writ-
ten with a male audience in mind. It’s harder
to find information pertaining to the rate at
which female lifters can expect to build mus-
cle size and strength, likely due to the fact
that there’s less data on the topic.
I suspect most people assume that typical
rates of muscle growth and strength gains
are lower in females than males (potentially
due to differences in testosterone levels), but
don’t put much thought into actually quan-
tifying the differences. However, in spite of
the fact that research on female lifters is still
lagging behind research on male lifters, com-
parisons between the sexes are plentiful.
The presently reviewed study (1) is the latest
study in a rich body of literature comparing
rates of muscle growth and strength gains in
male and female lifters. For seven weeks, un-
trained males and females trained the squat
and biceps curl. Before and after training, re-
searchers assessed 1RM squat strength, 1RM
curl strength, cross-sectional areas of all heads
of the quads, and biceps thickness. They also
analyzed changes in radial displacement and
contraction time of the biceps and vastus lat-
eralis using tensiomyography (which will be
explained in the methods sections). When

7
expressed on both an absolute (kilos on the
bar, or centimeters of muscle growth) and a
relative (percentage increase from baseline)
basis, gains in strength and muscle size didn’t
significantly differ between sexes, nor did ten-
siomyographic variables. This article will dig
deeper into the study results, discuss how the
researchers’ statistical choices could have in-
fluenced the slate of null findings, and situate
these findings in the broader body of literature.
Purpose and Hypotheses
Purpose
The purpose of this study was to examine the
effects of squat and biceps curl training on
strength gains, hypertrophy, and tensiomyog-
raphy (which will be explained in the meth-
ods section) in males and females.
Hypotheses
The authors hypothesized that squat training
would target different heads of the quads in
males and females, that relative gains in bi-
ceps curl strength would be larger in females,
and that radial displacement (a tensiomyog-
raphy-related variable) would differ between
sexes.
Experimental Design
This study employed a standard longitudi-
nal, parallel-groups, pre-post design. Group
allocation was determined by sex (obvious-
ly), rather than by randomization. The study
started with a two-week familiarization pe-
riod. The training performed during this fa-
miliarization period wasn’t described, but the
authors believe it was sufficient for the sub-
jects to have achieved the “rapid increase in
strength…during the initial 2-4 weeks of re-
sistance training” that is “primarily mediated
by neural adaptation.”
Following the familiarization period, sub-
jects completed seven weeks of training,
which consisted of squats and biceps curls.
Subjects trained twice per week; it’s unclear
whether they performed both lifts in every
session or if they performed squats in one
session, and curls in the other. I think they
performed one lift per session (my reasoning
for this supposition is explained in Footnote
2). During the first three weeks of training,
subjects performed three sets of each exer-

Subjects and Methods

Subjects
18 subjects completed this study (nine males
and nine females). The subjects were either
untrained or detrained (none had participated
in resistance training in the preceding eight
months), but they were moderately active and
generally healthy. You can see more details
about the subjects in Table 1.

8
cise to failure with 60% of their pre-training
1RMs with two minutes of rest between sets.
During the final four weeks of training, sub-
jects performed four sets of each exercise to
failure with 70% of their pre-training 1RMs
with two minutes of rest between sets.
Testing occurred at three time points: prior
to the familiarization period, after the famil-
iarization period (before the start of the sev-
en-week training intervention), and after the
training intervention.
During the first testing session – before the
familiarization period – researchers assessed
anthropometric (height, weight, and body
composition) and tensiomyographic vari-
ables. Tensiomyography involves stimulat-
ing a target muscle via electrodes in order to
induce a maximal muscle contraction. Once
you find the electrical impulse that elicits a
maximal contraction (the point at which fur-
ther increases in impulse fail to cause a stron-
ger contraction), sensors measure the radial
displacement of the stimulated muscle. A
larger radial displacement implies less muscle
stiffness, while a smaller radial displacement
implies more muscle stiffness. It’s thought
that a decrease in radial displacement with
training may be related to changes in muscle
architecture (increased muscle thickness and
pennation angles – both positive adaptations
for strength development) and improvements
in muscle contractile properties (3). Further-
more, tensiomyography can assess muscle
contraction time (the period between the on-
set of the electrical stimulus and the occur-
rence of maximum radial displacement). A
shorter contraction time seems to be indica-
tive of a larger proportion of type II (“fast-
twitch”) muscle fibers. If you want to get
into the weeds regarding tensiomyography, I
highly recommend a 2018 review paper on
the subject by Macgregor and colleagues (4).
Following the two-week familiarization period,
researchers assessed the subjects’ 1RM squat
and biceps curl, and measured the thicknesses
of the biceps, rectus femoris, vastus lateralis,
vastus medialis, and vastus intermedius via ul-
trasound. All biceps curls were performed us-
ing a preacher curl bench and a “curling bar” (an
EZ-curl bar, I assume). Squats were performed
using a standard barbell with a high-bar posi-
tion. The researchers used standard “parallel
squat” depth (subjects were required to squat
until their femurs were parallel to the floor) for
both training and testing sessions. This squat
depth is likely a bit deeper than you’d typically
see from lifters in commercial gyms, but it’s
probably about 2-4 inches above legal depth
for a powerlifting competition.
Following the seven-week training interven-
tion, the researchers re-assessed all strength,
muscle thickness, and tensiomyographic
measures (radial displacement and contrac-
tion time for the biceps, rectus femoris, and
vastus lateralis).
The researchers compared outcomes between
groups using two different sets of statistical
tests. Differences in absolute changes over
time were assessed with analyses of covari-
ance (ANCOVAs) on the change scores for
each measurement (post-training value mi-
nus pre-training value), using the baseline
measurement for each variable as a covari-
ate. Differences in relative changes over time
were assessed with ANCOVAs on the percent
9
change for each measurement (post-train- muscle thicknesses significantly differed be-
ing value minus pre-training value, divided tween sexes. At first, that seems paradoxical.
by the pre-training value), using the baseline The male lifters were considerably stronger
measurement for each variable as a covari- and more muscular than the female lifters,
ate. I’ll discuss the importance of the authors’ so if absolute increases were similar between
choice of statistical tests in the criticisms and the sexes, you’d expect that relative increas-
statistical musings section. es would be significantly larger in the female
lifters. Conversely, if relative increases were
Findings similar between the sexes, you’d expect that
absolute increases would be significantly
Pre-training, muscle thicknesses and 1RMs larger in male lifters. So, what’s going on
were significantly greater in males compared here?
to females. However, tensiomyographic vari-
ables (radial displacement and contraction
time) were similar between sexes for all mus-
cles assessed.
Neither absolute nor relative strength gains
significantly differed between sexes for either
squat or biceps curl 1RM (Figure 1, Table
3). Neither absolute nor relative hypertrophy
significantly differed between sexes for any
muscle assessed (Tables 2 and 3). Similarly,
changes in radial displacement and contrac-
tion time did not significantly differ between
sexes for all muscles assessed (Table 3).
Overall, training-induced adaptations in both
sexes followed the patterns you’d expect:
1RM squat and biceps curl strength increased,
muscle thicknesses increased, and radial dis-
placement decreased. Contraction time didn’t
significantly change over time for any of the
muscles assessed.

Criticisms and Statistical

Musings
You may be surprised to read that neither ab-
solute nor relative increases in strength and

10
I think the slate of null findings for both ab-
solute and relative outcomes was driven by
the researchers’ choice of statistical tests;
they analyzed their data using ANCOVAs
with baseline measurements as covariates.
ANCOVAs tell you whether two (or more)
things differ, after accounting for a pre-spec-
ified covariate. For example, let’s say you
want to see whether linear periodization or
daily undulating periodization produces larg-
er strength gains, and your “subjects” are a
class of college students in a weight train-
ing course. You instruct half of the class to
train with linear periodization and the other
11
half with daily undulating periodization for
the semester. However, since the resistance
training backgrounds likely vary between
students, you also ask about their level of
training experience at the start of the course.
At the end of the semester, you could choose
to compare the strength gains in these two
groups using either an Analysis of Variance
(ANOVA), or an Analysis of Covariance
(ANCOVA) using prior training experience
as a covariate. The ANOVA would simply
tell you which group of students gained more
strength (and, by extension, which program
produced larger strength gains). However, if
you assume that training experience affect-
ed your results – you’d expect to see larger
strength gains in the subjects with less train-
ing experience, regardless of which period-
ization approach they used. An ANCOVA,
using baseline training experience as a co-
variate, would tell you which group experi-
enced larger strength gains when account-
ing for differences in training experience.
Your ANOVA might tell you that strength
gains weren’t significantly different between
groups. However, the group using daily un-
dulating periodization may have simply in-
cluded more students with a lot of training
experience. If that was the case, the ANCO-
VA might suggest that, after accounting for
differences in training experience, the class
using daily undulating periodization actually
achieved significantly larger strength gains.
ANCOVAs are great statistical tests for a
lot of applications in exercise science. Since
sample sizes in our field are often fairly
small, it’s not uncommon for randomiza-
tion to produce groups that still differ a bit
(or more than a bit) at baseline. In this very
common situation, ANCOVAs are explicitly
better than the more commonly used ANO-
VAs, leading to less statistical bias, greater
power, and enhanced precision (5). However,
they’re not always the best statistical test for
a parallel-groups pre-post design.
In the presently reviewed study, I think the
researchers’ decision to use ANCOVAs sim-
ply sacrificed statistical power (thus obscur-
ing “true” differences that may have existed),
due to specific considerations that arise when
studying sex differences in strength and hy-
pertrophy.
Remember, when you run an ANCOVA,
you’re essentially asking, “when accounting
for the covariate, did changes differ between
groups?” In this case, baseline measurements
were used as the covariate for each test. So,
for example, when analyzing changes in bi-
ceps curl 1RM, you’re asking, “when ac-
counting for differences in baseline biceps
curl strength, do strength gains in the biceps
curl differ between sexes?”
This may initially seem like a logical statis-
tical approach, but it runs into a pretty big
snag: strength (and muscularity) are strong-
ly sexually dimorphic. In other words, males
tend to be quite a bit stronger and more mus-
cular than females. As you can see in Figure
1A, the male subjects curled about twice as
much as the female subjects at baseline. Just
eyeballing the standard deviation bars on the
graph (since individual subject data wasn’t
provided), it’s entirely possible that every
single male subject curled more than every
single female subject.
12
That presents us with a problem if we want
to analyze this data using ANCOVAs with
baseline values as covariates. Due to the sex-
ual dimorphism of strength and muscularity,
asking “do strength gains in the biceps curl
differ between sexes when accounting for
differences in baseline biceps curl strength?”
is very similar to asking “do strength gains
in the biceps curl differ between sexes when
accounting for differences in sex?” Phrased
differently, “if we assume that these groups
don’t differ, are there differences between
these groups?”
This may seem a bit abstract, so let’s look at
a concrete example to demonstrate this point.
In my thesis study (6, 7), I measured bench
press 1RM and arm lean mass (via DEXA) in
male and female subjects.
Bench press 1RM clearly differed between
sexes (Figure 2; p < 0.001).
Furthermore, arm lean mass was strongly as-
sociated with bench press 1RM (Figure 3; r =
0.904; p < 0.001).
So, what happens when I run an ANCOVA to
see if bench press 1RM differs between sexes
when accounting for arm lean mass? Take a
look at Table 4.

13
As you can see, the effect of the covariate
(arm lean mass) is statistically significant,
but the difference between sexes is no lon-
ger significant (p = 0.619). However, that ab-
solutely doesn’t mean that the male subjects
didn’t bench significantly more than the fe-
male subjects in my study. It just tells us that
the male subjects generally had a lot more
arm lean mass than the female subjects, so
the difference between sexes was no longer
statistically significant after adjusting for arm
lean mass. But again, since arm lean mass also
differed between sexes, this is tantamount to
saying, “after accounting for sex differences,
we found no significant sex differences.”
If you want to dig a bit more into the tech-
nical reasons why this is a problem, it’s
worth reading up on multicollinearity (and,
for more general information about adjusting
for baseline differences, it may be worth do-
ing a bit of reading on Lord’s paradox). In
this particular study (1), the covariate (base-
line strength or baseline muscle thickness) is
strongly associated with the grouping vari-
able (sex, in this case). Thus, you can run into
issues when including both variables in the
same model. The net result is that the ANCO-
VAs more-or-less ensured that there wouldn’t
be any significant differences between sexes
for any of the strength or hypertrophy-related
outcomes. In general, this type of ANCOVA
is more useful when groups are supposed to
be similar at baseline (i.e. when you recruit
a pool of subjects and randomize them into
groups), than when groups are supposed to
be different at baseline (as was the case in the
present study).
Thankfully, none of this matters all that much
when we zoom out a bit. We might be in trou-
ble if we needed to derive firm conclusions
from this one study, but there’s a larger body
of literature investigating sex differences in
strength gains and hypertrophy, so we can
situate these results within the proper context.
In other words, it ultimately doesn’t matter
which individual outcomes were statistically
significant or not in this one study, since the
findings align with the rest of the research on
the topic.
Interpretation
Based on my comments in the Criticisms and
Statistical Musings section, you might think
I have a pretty low opinion of the present
study (1), but nothing could be further from
the truth. In fact, I thought this was a truly
excellent study in terms of design and meth-
odology – my only quibbles were with the
authors’ statistical approach. So, let’s discuss
the results of the present study, and situate
THIS STUDY FOUND
THAT HYPERTROPHY
AND STRENGTH
GAINS WERE PRETTY
SIMILAR BETWEEN
THE SEXES.
14
them within the broader body of literature.
In general, this study found that hypertro-
phy and strength gains were pretty similar
between the sexes. With a different statisti-
cal approach, I suspect that absolute gains in
squat strength would have been significantly
larger in the male subjects, and that relative
gains in biceps curl strength and biceps thick-
ness were greater in the female subjects. But
overall, relative strength gains and hypertro-
phy were pretty similar between sexes.
The results of the present study are in line
with the rest of the literature. A few years
ago, I meta-analyzed the research investigat-
ing sex differences in relative strength gains
and hypertrophy in a Stronger By Science ar-
ticle. I found that relative muscle growth and
strength gains were pretty similar between the
sexes (although relative strength gains, spe-
cifically for measures of upper body strength,
tended to be larger in young females). After
writing that article, I partnered with Bran-
don Roberts and James Kreiger to formally
publish part of that analysis (the bit on young
subjects) as a peer-reviewed meta-analysis
(8). A few months later, Jones and colleagues
published a similar meta-analysis, examining
the research in older lifters (9). This body of
literature is comprised of 70+ studies, span-
ning nearly 50 years, and it painted a pretty
consistent picture: on an absolute basis (i.e.
measured in terms of pounds on the bar, mil-
limeters of muscle thickness, or kilograms of
fat-free mass), male lifters tend to gain more
strength and build more muscle than female
lifters. However, when expressed in relative
terms (i.e. percentage improvement relative
to one’s starting point), muscle growth and
strength gains are very similar between the
sexes, with females potentially experiencing
slightly larger relative strength gains than
males. While most of the research in this area
– including the present study (1) – is in un-
trained subjects, the strength findings hold
up when looking at powerlifting meet results.
Absolute strength gains from meet to meet
tend to be larger in male lifters, while rela-
tive strength gains tend to be larger in female
lifters (10).
While this is a deep and rich area of re-
search, the presently reviewed study is an
exceptionally good addition to the literature
(1). Though the familiarization period could
have been described in more detail, the mere
presence of a two-week familiarization pe-
riod is an important step to ensure that the
reported strength gains were representative
of “true” strength gains (rather than being
artifacts of poor pre-training strength per-
formances). Furthermore, the study included
measures of both upper and lower body mus-
cle growth and strength gains (many studies
just use a single lift, or investigate a single
muscle group), direct measures of muscle hy-
pertrophy (many studies only assess indirect
measures of hypertrophy, such as changes
in lean body mass), and tensiomyographic
measures. Changes in the tensiomyographic
measures didn’t differ between sexes, but it’s
possible that adaptations to strength training
differ between sexes in ways that wouldn’t
be detectable via a 1RM test or an ultrasound
scan. The fact that changes in contraction
time and radial displacement were similar
between sexes provides further evidence that
relative adaptations to resistance training are
15
truly comparable between sexes. In short,
this study didn’t find any exciting new dif-
ferences, but it does provide a very thorough
and methodologically rigorous confirmation
STUDIES THAT
of prior findings. As the sciences grapple
with the replication crisis, studies that solid-
SOLIDIFY WHAT WE
ify what we (think we) already know may be
even more valuable than studies that (seem
(THINK WE) ALREADY
to) break new ground. KNOW MAY BE EVEN
MORE VALUABLE
Just to tie up one final loose end: you may be
wondering why the authors hypothesized that

THAN STUDIES THAT

the pattern of quadriceps hypertrophy would
differ between the sexes. In the introduction,

(SEEM TO) BREAK

they cited studies showing that rectus femoris
electromyographic (EMG) activity is higher

in females than males during single-leg squats
and knee extensions (11, 12, 13), and a study
suggesting that male rowers may experience
proportionally greater vastus lateralis growth,
while female rowers may experience propor-
tionally greater vastus medialis growth (14).
As reported, the results of the present study
(1) were not in line with the authors’ hypoth-
esis (since absolute and relative hypertrophy
of all four heads of the quads didn’t signifi-
cantly differ between sexes). However, given
the small sample size and choice of statistical
tests, it may be worth entertaining the notion
that the results tentatively support the authors’
hypothesis. The nominal differences all lean
in the directions that would be implied by the
EMG studies and the study on rowers: rela-
tive rectus femoris (8.6% for females vs. 3.5%
for males) and vastus medialis growth (6.0%
for females vs. 3.0% for males) tended to be
greater in the female subjects than the male
subjects, while vastus lateralis growth tended
to be greater in the male subjects (4.0% for
NEW GROUND.
males vs. 3.6% for females). Furthermore,
relative rectus femoris and vastus media-
lis growth tended to be greater than relative
vastus lateralis growth in the females (8.6%
and 6.0% vs. 3.6%), while the opposite was
true for the male subjects (4.0% vs. 3.5% and
3.0%). To be clear, this is nowhere near suf-
ficient evidence to confidently conclude that
squat training preferentially targets different
heads of the quads in males and females. Not
even close. However, I do find it interesting,
and I’d love to see follow-up research.
To wrap things up, I’d just like to discuss
why I wanted to cover the present study in
MASS. First, I realized that, though this topic
is a particular interest of mine, I hadn’t ac-
tually directly covered it before in MASS. I
discussed the relative similarities in strength

16
 APPLICATION AND TAKEAWAYS
While absolute rates of muscle growth and strength gains tend to be larger in male
lifters, relative rates of strength development and muscle growth are similar between
the sexes. Furthermore, when exposed to the same training stimulus, male and female
lifters respond similarly. Therefore, when designing training programs, the lifter’s sex
likely isn’t a variable you need to directly account for – differences in individual goals
and general responsiveness to training are much larger factors.

gains and hypertrophy between the sexes as
sub-points in two prior articles (one, two),
but I hadn’t reviewed a study that addressed
the subject head-on. So, I figured this was an
important article to “enter into the record.”
Second, and more importantly, the present
study – and this entire body of literature – in-
directly addresses a common question in the
fitness world: should male and female lifters
train differently for strength and hypertro-
phy-related goals? We don’t have a robust
body of literature examining whether male
or female lifters respond particularly well to
different training styles, but we do have an
enormous body of literature showing that
when male and female lifters follow the same
training program, they achieve very similar
relative increases in strength and muscular-
ity. To me, that suggests that, even if some
small differences exist, on average, effective
training is effective training regardless of the
trainee’s sex. Training approaches that re-
liably produce muscle growth and strength
gains for female lifters will likely reliably
produce muscle growth and strength gains
for male lifters, and vice versa.
Next Steps
When I did a deep dive on this topic back
in 2018, I was only able to find five studies
comparing rates of hypertrophy or strength
gains in trained male and female lifters (out
of 70+ total studies), so that’s clearly an area
where the research is lacking. Furthermore, of
those five studies, only one reported any di-
rect measures of hypertrophy. For strength,
the rich dataset from OpenPowerlifting allows
us to examine ongoing rates of strength gains
in male and female lifters, but we need more
studies investigating hypertrophy differences
(or similarities) in trained males and females.
WHEN MALE AND
FEMALE LIFTERS FOLLOW
THE SAME TRAINING
PROGRAM, THEY ACHIEVE
VERY SIMILAR RELATIVE
INCREASES IN STRENGTH
AND MUSCULARITY.

17
References
1. Kojić F, Mandić D, Ilić V. Resistance training induces similar adaptations of upper and
lower-body muscles between sexes. Sci Rep. 2021 Dec 6;11(1):23449. doi: 10.1038/
s41598-021-02867-y. PMID: 34873221; PMCID: PMC8648816.
2. Volume loads were reported for both sexes during the first and fourth weeks of training
for both exercises. For the first week of training, the average volume load for biceps curls
was around 850kg for males and 400kg for females. The males averaged 77kg of body
mass, with an average 1RM biceps curl that was 0.46-times body mass (about 35kg).
The females averaged 62kg of body mass, with an average 1RM biceps curl that was
0.27-times body mass (about 17kg). The training prescription in week 1 was three sets to
failure at 60% of 1RM. So, during the first week of training, the male lifters completed
about 40 reps of biceps curls [850/(35×0.6)], and the female lifters completed about
39 reps [400/(17×0.6)]. Averaging 39-40 total reps across three sets of 60% of 1RM
is perfectly reasonable to expect (consistent with training biceps curls in one weekly
session), but you’d expect subjects to complete considerably more reps across six sets
(which would be consistent with training biceps curls in both weekly sessions). Because
of this, I suspect that the subjects trained each lift just once per week.
3. Wilson MT, Ryan AMF, Vallance SR, Dias-Dougan A, Dugdale JH, Hunter AM,
Hamilton DL, Macgregor LJ. Tensiomyography Derived Parameters Reflect Skeletal
Muscle Architectural Adaptations Following 6-Weeks of Lower Body Resistance
Training. Front Physiol. 2019 Dec 10;10:1493. doi: 10.3389/fphys.2019.01493. PMID:
31920699; PMCID: PMC6914863.
4. Macgregor LJ, Hunter AM, Orizio C, Fairweather MM, Ditroilo M. Assessment
of Skeletal Muscle Contractile Properties by Radial Displacement: The Case for
Tensiomyography. Sports Med. 2018 Jul;48(7):1607-1620. doi: 10.1007/s40279-018-
0912-6. PMID: 29605838; PMCID: PMC5999145.
5. Egbewale BE, Lewis M, Sim J. Bias, precision and statistical power of analysis of
covariance in the analysis of randomized trials with baseline imbalance: a simulation
study. BMC Med Res Methodol. 2014 Apr 9;14:49. doi: 10.1186/1471-2288-14-49.
PMID: 24712304; PMCID: PMC3986434.
6. Nuckols G. THE EFFECTS OF BIOLOGICAL SEX ON FATIGUE DURING AND
RECOVERY FROM RESISTANCE EXERCISE. Thesis, University of North Carolina at
Chapel Hill (2019).
7. If you’re wondering why I have such strong feelings about the use of ANCOVAs
in a situation like this, there’s a fun little easter egg on page 44 of my thesis. Before
collecting and analyzing my data, I actually planned to use an ANCOVA to answer a

18
 similar research question. After collecting my data and learning a bit more about stats, I
realized that the ANCOVA I wanted to run wasn’t appropriate for my research question.
However, since I believe strongly in pre-specifying a data analysis plan to reduce the
risk of p-hacking (and sticking to that pre-specified plan), I still presented the results and
called myself out for choosing an inappropriate statistical test.
8. Roberts BM, Nuckols G, Krieger JW. Sex Differences in Resistance Training: A
Systematic Review and Meta-Analysis. J Strength Cond Res. 2020 May;34(5):1448-
1460. doi: 10.1519/JSC.0000000000003521. PMID: 32218059.
9. Jones MD, Wewege MA, Hackett DA, Keogh JWL, Hagstrom AD. Sex Differences in
Adaptations in Muscle Strength and Size Following Resistance Training in Older Adults:
A Systematic Review and Meta-analysis. Sports Med. 2021 Mar;51(3):503-517. doi:
10.1007/s40279-020-01388-4. PMID: 33332016.
10. Solberg PA, Hopkins WG, Paulsen G, Haugen TA. Peak Age and Performance
Progression in World-Class Weightlifting and Powerlifting Athletes. Int J Sports
Physiol Perform. 2019 Nov 1;14(10):1357-1363. doi: 10.1123/ijspp.2019-0093. PMID:
30958059.
11. Flaxman TE, Smith AJ, Benoit DL. Sex-related differences in neuromuscular control:
Implications for injury mechanisms or healthy stabilisation strategies? J Orthop Res.
2014 Feb;32(2):310-7. doi: 10.1002/jor.22510. Epub 2013 Oct 26. PMID: 24167087.
12. Dwyer MK, Boudreau SN, Mattacola CG, Uhl TL, Lattermann C. Comparison of lower
extremity kinematics and hip muscle activation during rehabilitation tasks between sexes.
J Athl Train. 2010 Mar-Apr;45(2):181-90. doi: 10.4085/1062-6050-45.2.181. PMID:
20210622; PMCID: PMC2838470.
13. Zeller BL, McCrory JL, Kibler WB, Uhl TL. Differences in kinematics and
electromyographic activity between men and women during the single-legged squat.
Am J Sports Med. 2003 May-Jun;31(3):449-56. doi: 10.1177/03635465030310032101.
PMID: 12750142.
14. Ema R, Wakahara T, Hirayama K, Kawakami Y. Effect of knee alignment on the
quadriceps femoris muscularity: Cross-sectional comparison of trained versus untrained
individuals in both sexes. PLoS One. 2017 Aug 14;12(8):e0183148. doi: 10.1371/journal.
pone.0183148. PMID: 28806771; PMCID: PMC5555710.

19
 Study Reviewed: Effects of Resistance Training to Muscle Failure on Acute Fatigue: A
Systematic Review and Meta-Analysis. Vieira et al. (2021)

Are You Experiencing Fatigue, Muscle

Damage, and Performance Impairment?
If So, Try Not Training to Failure
BY MICHAEL C. ZOURDOS

We have established in MASS that training to failure leads to

more acute fatigue and a longer recovery time course than non-
failure training. The reviewed meta-analysis provides further
confirmation and assesses the effect of training status, volume,
and load on this response.

20
 KEY POINTS
1. Researchers conducted a systematic review and meta-analysis comparing
performance impairment, metabolic responses, muscle damage, and session
ratings of perceived exertion following failure and non-failure resistance training.
2. Findings showed that, compared to non-failure training, failure training led to
significantly greater performance impairments and more muscle damage within
the subsequent 48 hours. Failure training also elicited a greater acute metabolic
response and higher sRPE.
3. This study also found that failure training led to greater fatigue than non-
failure in both trained and untrained lifters, independent of the load used, and
(usually) regardless of whether volume was equated between training styles.
While training to failure can be used, lifters should be careful about strategically
placing failure training within a week, so that the resulting fatigue doesn’t impair
weekly volume and frequency.

W
e’ve written about recovery dif-
ferences with failure training
versus non-failure before (one,
two, three), including last month. Our gen-
eral conclusion has been that, on average,
failure training delays recovery compared to
non-failure training, which may impair week-
ly volume and training frequency. However,
this result may be moderated by other factors
such as training status, the specific fatigue
measurement (i.e., performance or muscle
damage), the load used, and the training vol-
ume. This systematic review and meta-analy-
sis from Vieira et al (1) concluded that, with-
in 48 hours post-exercise, training to failure
impaired performance and increased blood
lactate, creatine kinase, and session rating
of perceived exertion (sRPE) significant-
ly more than non-failure training. Further,
when training volume was equalized between
groups, creatine kinase was still greater fol-
lowing failure training; however, sRPE was
not significantly different between training
strategies. Lastly, failure training led to more
fatigue and muscle damage than non-failure
training regardless of training status. Since
MASS has previously discussed the effect
of failure training on fatigue, this article will
focus on the results of the modifying factors
such as volume, load, training status, and ex-
ercise selection. This article will aim to:
1. Provide a brief overview of the present
findings
2. Examine the influence of training status,
volume, and load used on recovery from
failure and non-failure training.
3. Evaluate how exercise selection may af-
fect the recovery time course with failure
training
4. Discuss failure and non-failure training
for recovery in a non-binary fashion.
5. Discuss how the repeated bout effect may
ameliorate differences in failure versus
non-failure recovery over the long term.

21
Purpose and Hypotheses
searching databases using specific criteria to
identify all studies that address a particular
Purpose research question. The findings of those stud-
ies are then pooled for analysis. Vieira et al
The purpose of the presently reviewed study
(1) appropriately conducted the meta-analy-
was to compare the magnitude of fatigue
sis following the Preferred Reporting Items
(performance, metabolic response, and mus-
cle damage) between failure and non-failure for Systematic Reviews and Meta-Analyses
resistance training. Further, the meta-anal- (PRISMA) guidelines. The following da-
ysis examined whether certain variables tabases were searched using various terms
(e.g., training status, total volume, and load related to resistance training and training to
used) influenced the outcomes and at what failure: PubMed, SPORTDiscus, Scopus,
time point (immediately, 24, or 48 hours Web of Science, Nursing and Allied Health,
post-training) fatigue was the greatest. Cochrane Library, and Excerpta Medica da-
tabase (EMBASE). The preset criteria for in-
Hypotheses   clusion in the meta-analysis are in Table 1.
The researchers hypothesized that training to
The studies in the systematic review included
failure would lead to greater fatigue and mus-
a total of 218 participants, and the studies in
cle damage than non-failure training.
the meta-analysis included 179 participants.
11 studies in the systematic review and nine
Methods
This paper from Vieira et al (1) was both a
systematic review and meta-analysis. 20 pub-
lished papers (2,  3,  4,  5,  6,  7,  8,  9,  10,  11, 
12, 13, 14, 15, 16, 17, 18, 19, 20, 21) were
included in the systematic review, but only
12 made the cut for the meta-analysis; five of
the papers identified included duplicate data,
while three papers did not report sufficient
data. The good news is that, though they were
not included in the analysis, these studies
only bolster our confidence in the findings.
This article’s “findings” section will present
the meta-analysis results, while the “inter-
pretation” section will discuss the additional
studies included in the systematic review.
As we know, the process for conducting
a meta-analysis involves systematically

22
in the meta-analysis used trained participants.
The researchers performed four primary
analyses to compare failure and non-failure
training for the following fatigue outcomes:
performance, metabolic response, creatine
kinase (an indirect marker of muscle dam-
age), and sRPE. Cohen’s d effect sizes were
calculated to compare the outcomes between
failure and non-failure training. For some
variables, such as creatine kinase, pre- and
post-training measurements were reported in
the individual studies; thus, the researchers
calculated a d-value using the change score.
If only one time point (i.e., post-training) was
available, as was the case for sRPE, the re-
searchers calculated a d-value using the val-
ues at that individual time point.
After the primary analyses, the researchers
performed sub-analyses to examine if factors
such as training status, time point (immediately
post, 24, or 48 hours post-training), load lifted,
or total volume performed moderated the out-
come measures. Sub-analyses were conduct-
ed for performance (vertical jump, velocity,
isometric strength, and power) and metabolic
(blood lactate and ammonia) measures.
Findings
The bottom line is that failure training elicit-
ed significantly greater fatigue in all outcome
measures compared to non-failure training.
Further, every individual study in the me-
ta-analysis leaned in favor of more fatigue
with failure training (Figures 1-3). The spe-
cifics for each outcome are below.
Performance Measures
Performance measures were impaired sig-
nificantly more following failure training
versus non-failure training (d = 0.96; p <
0.001). Eight studies were included in the
performance analysis. The d  values from
those studies, along with the 95% confidence
intervals and relative weights in the analy-
sis, are shown in a forest plot (Figure 1). The
sub-analyses indicated that training status,
time point, load, and volume were not sig-
23
nificant moderators of the results (Table 2).
In other words, failure training impaired per-
formance to a greater extent than non-failure
training, irrespective of training status, at all
time points assessed, at all loads used, and
regardless of whether volume was equated.
However, bench press velocity was impaired
significantly more compared to the other per-
formance metrics (p < 0.001).
Creatine Kinase
The primary analysis (Figure 2) showed that
creatine kinase increased significantly more
with failure than non-failure training. The
sub-analysis (Table 3) showed that creatine
kinase was higher with failure than non-fail-
ure training 48 hours post-exercise, but was
not significantly different between training
styles 24 hours or immediately post-training.
sRPE and Metabolic Response
The main analysis (Figure 3) showed high-
er sRPE with failure compared to non-failure
training. The sub-analysis (Table 4) found
that sRPE was significantly higher with fail-
ure training when the failure group performed
24

more total volume (p = 0.001), but sRPE was
not significantly different (p = 0.16) between
groups when volume was equated. Both
blood lactate (p < 0.001) and ammonia (p <
0.001) concentrations significantly increased
to a greater extent following failure compared
to non-failure training, whether volume was
equal (p < 0.001) or unequal (p < 0.001) be-
tween training styles.
Criticisms and Statistical
Musings
The main findings of the meta-analysis show
that failure training leads to more fatigue and
muscle damage than non-failure training for
at least up to 48 hours. I think we can be con-
fident in these findings because, as seen in the
forest plots (Figures 1-3), every single study
at least leaned in favor of greater fatigue or
25
muscle damage with failure training.
Despite the logical findings, the researchers
appropriately conducted a GRADE  (Grad-
ing of Recommendations, Assessment, De-
velopment, and Evaluations) analysis (22)
to examine the “certainty of evidence.” As
all analyses included <100 subjects, the re-
searchers concluded that there was the poten-
tial for “imprecision” regarding the findings.
Further, in the analysis of performance, met-
abolic response, and sRPE, the researchers
noted “serious” inconsistency, as heteroge-
neity values (denoted by I2) were 53.44%,
70.00%, and 83.72%, respectively. On the
other hand, the I2 for the creatine kinase anal-
ysis was low (22.58%). The I2 statistic notes
the magnitude of heterogeneity (variation in
an outcome between studies) that is not due
to sampling error. An I2 <25% is low, 25-
75% is moderate, and >75% is high. Overall,
the researchers concluded a “low” certainty
of evidence for the performance, metabolic,
and sRPE findings, and a “moderate” certain-
ty of evidence for the creatine kinase find-
ings. I do feel quite confident stating that
26
failure training generally causes more fatigue
than non-failure training in the subsequent 48
hours. However, the small sample sizes and
variation between studies may explain why
some of the sub-analyses did not quite reach
the threshold for statistical significance (see
Tables 3 and 4).
Interpretation
The bottom line is that lifters recover faster,
on average, when training shy of failure ver-
sus taking all sets to failure. Since we have
covered this topic before, I’ll focus on the
potential moderating factors (training status,
training volume, and load) examined in this
meta-analysis. Then we’ll wrap up with some
quick hits on related topics and discuss future
research directions in this area.
Examining the Moderating Factors
In addition to covering the moderating fac-
tors, we should also look at the researchers’
LIFTERS RECOVER
FASTER, ON AVERAGE,
WHEN TRAINING
SHY OF FAILURE
VERSUS TAKING ALL
SETS TO FAILURE.
GRADE analysis to determine the degree of
confidence we can have in these findings. To
do this, we need to expand our scope outside
the meta-analysis to the systematic review. I
also want to zero in on the studies most rel-
evant to MASS readers, which means focus-
ing on those that used trained subjects. I was
able to locate full texts for all 11 studies with
trained subjects, and I have summarized the
study designs and results in Table 5. I in-
cluded results related to all of the moderat-
ing factors (equated volume, load used, and
time point) when available for each study.
Table 5 actually includes 12 studies, as I add-
ed a study from Mangine et al reviewed in
MASS last month. This additional study (23)
was published too recently to be included in
the present meta-analysis, but it would not
have fit the inclusion criteria, as it compared
five sets to failure versus four submaximal
sets plus one set to failure. However, there
was enough disparity regarding the degree
of failure training between conditions to en-
hance our knowledge of this topic.
First, every study in Table 5 shows more
fatigue with failure training compared to
non-failure training for at least one outcome
measure. Therefore, while the researchers’
“low certainty” GRADE scores are import-
ant, we can be confident in the overarching
message that failure training leads to more
acute fatigue and a longer recovery time
course than non-failure training. Next, to ad-
dress the “uncertain” grades, eight of the 11
systematic review studies in Table 5 assessed
resistance training performance of some kind
(squat or bench press velocity or isometric
leg extension strength) as a recovery metric.
27
All eight (3, 4, 5, 14, 15, 16, 19, 20) studies
found that failure training impaired perfor-
mance to a greater degree during the recovery
period than non-failure training. As I pointed
out last month, assessing submaximal veloci-
ty or isometric strength is not as high-quality
evidence as assessing volume performance
or 1RM strength during the recovery peri-
od. However, submaximal performance and
isometric strength tests are more realistic for
researchers to perform in a recovery time
course study.
28
The subanalysis I’m most interested in is (12) performed five sets of six reps at 75%
the effect of volume on sRPE. Although the 1RM, five sets of squats and bench press to
meta-analysis reported that sRPE was sig- failure at 75% 1RM, or five sets of squats
nificantly higher with failure training, I was and bench press to failure at 90% of 1RM.
surprised to read that sRPE scores were not Martorelli reported greater sRPE and blood
statistically different (p = 0.16) between lactate in both failure conditions compared to
training styles when volume was equated. the 5 x 6 condition. Blood lactate was higher
However, this finding was only based on in the 75%1RM failure condition than the
data from two studies. Overall, five studies 90%1RM failure condition, but there was no
in Table 5 examined sRPE, two with equated significant difference in sRPE between fail-
volumes and three with greater volume in the ure conditions. Overall, all of these factors
failure condition. All five studies reported play a role in the acute perception of fatigue,
significantly higher sRPE with failure train- but any way you slice it, training to failure is
ing. The two studies with equated volume a key moderator of the perceptual response.
are from Fonseca et al (3) and Shibata et al
We should also feel confident that training
(20). Fonseca reported that, on a 0-10 scale,
to failure drives sRPE because longitudinal
sRPE was significantly higher (p = 0.01) in
studies comparing failure versus non-fail-
the failure condition (4.0 ± 1.0) than in the
ure training have found lower sRPE scores
non-failure condition (3.5 ± 0.6). Despite the
with non-failure training (24,  25). I often
statistically significant findings, a 0.5 differ-
ence is not a huge magnitude. However, Fon-
seca equated volume by having the non-fail-
ure condition perform double the number of
squat sets (eight) than the failure condition LONGITUDINAL
(four). Shibata reported an average sRPE fol-
lowing failure training (8.3 ± 1.2) that was STUDIES COMPARING
double the sRPE following non-failure train-
ing (4.1 ± 1.4 ), even though subjects per- FAILURE VERSUS
formed half the number of sets in the failure
condition. Thus, despite the “low certainty”
NON-FAILURE
for this analysis, I feel confident that training
to failure increases sRPE even when volume
TRAINING HAVE
is equated. Total volume, reps per set, and the
acute metabolic response also seem to affect
FOUND LOWER SRPE
sRPE. In Table 5, we see that Shibata et al
(20) reported greater sRPE and blood lactate
SCORES WITH NON-
following three sets of failure training com-
pared to volume-equated non-failure train-
FAILURE TRAINING.
ing. Subjects in a study from Martorelli et al

29
point out that the studies examining recov-
ery time courses between the training styles
are no longer than one week. This means
that it’s possible recovery time courses for
performance and muscle damage may be at-
tenuated over time to the point where there
isn’t much difference between failure and
non-failure training. That longitudinal atten-
uation of performance impairment or muscle
damage may or may not be the case; howev-
er, we have evidence to suggest that is not the
case with sRPE. Specifically, Laseviscius et
al (24 - MASS Review) found that subjects
reported an average sRPE of 9.1 ± 0.9 with
failure training compared to a sRPE of 7.0 ±
0.8 with volume-equated non-failure train-
ing following the first training session of an
8-week study. Following the 16th and final
training session, subjects still reported sig-
nificantly lower sRPE values with non-fail-
ure training despite performing double the
number of sets than subjects in the failure
condition (failure: 9.6 ± 0.4; non-failure: 6.7
± 1.9). I still suspect that objective markers
of performance or fatigue may be attenuat-
ed over time with consistent failure training.
However, if lifters still perceive it to be more
difficult, that may  still lead to lower enjoy-
ment, a lack of long-term adherence, and a
diminished capacity to add more volume.
Load did not seem to influence the meta-anal-
ysis or systematic review outcomes. Five of
the studies in trained individuals in Table 5
used more than one load. All five of those
studies reported that failure training elicited
greater fatigue in some respect compared to
non-failure training at all loads tested. This
doesn’t mean that the specific load doesn’t
affect fatigue following failure training. For
example, as discussed earlier, acute increases
in blood lactate were greater in Martorelli’s
study (12) when subjects performed five sets
to failure at 75% of 1RM on the squat and
bench press compared to set-equated failure
training at 90% of 1RM. This is likely be-
cause a byproduct of a lower load is more
reps per set. Additionally, Pareja-Blanco et al
(15 – MASS Review) used loads spanning a
4RM to a 12RM. In this study, squat veloci-
ty and creatine kinase took at least 48 hours
to recover in most failure conditions, while
these metrics tended to recover by 24 hours
in the non-failure conditions. However, re-
covery did tend to take longer when subjects
performed sets of 12 reps to failure compared
to sets of four or six reps to failure. Again,
this suggests that while failure does lead to a
longer recovery time course, failure coupled
with more reps per set can further delay re-
covery. One study in this systematic review
did compare a moderate load failure condition
(70% of 1RM) to a low load failure condition
(40% of 1RM) and reported no difference in
sRPE (9). However, other data (26 - MASS
Review) show that lifters have higher sRPE,
discomfort and displeasure when performing
bench press, hack squat, and lat-pulldown
sets to a 25-30RM compared to an 8-12RM.
Overall, load in and of itself may not affect
recovery time, and loads that are close to each
other (i.e., 70% and 75% of 1RM) may not
lead to different recovery rates when taken to
failure. However, a byproduct of lower loads
taken to failure is more reps per set and po-
tentially more metabolic fatigue. Therefore,
when there is enough disparity between loads
(e.g., 60% versus 90% of 1RM) and both
30
loads are performed to failure, the lower load
may lead to a higher sRPE and potentially a
longer recovery time course.
Quick Hits and Review
Notably, this meta-analysis and systematic re-
view only included studies with male partici-
pants. I’d imagine that failure training would
also lead to greater acute fatigue and a longer
recovery time course than non-failure train-
ing in women. Indeed, a study Greg reviewed
last month (27) found that barbell velocity at
80% of 1RM on squats did not decrease at all
following a non-failure 5 × 5 at 80% of 1RM
protocol in trained women. However, barbell
velocity significantly decreased immediate-
ly following training and maintained about
a 5% decline 24 hours post-training. Still, it
must be noted that women were not included
in the present analysis.
All studies in Table 5 used some combination
of the squat and bench press. I do think that
at least acute fatigue (i.e., sRPE and strength
loss) would be greater on almost any exercise
with failure versus non-failure training. How-
ever, it’s important to note that the recovery
time course is exercise-specific; thus, train-
ing shy of failure on some exercises doesn’t
automatically mean a quick recovery. Spe-
cifically, exercises that train through longer
muscle lengths, such as RDLs and flys, will
probably lead to some degree of muscle sore-
ness. Therefore, whether these exercises are
performed to failure or not, they should prob-
ably be avoided for 48 hours before training
the same muscle group again.
Another consideration is that the literature
addresses failure training in a binary fashion.
Consequently, there is a lack of data examin-
ing acute fatigue and recovery time courses
with taking some sets to failure (i.e., two fail-
ure sets and two non-failure sets). The pri-
mary study examining this was from Mang-
ine et al (23), which I reviewed last month
(and is also in Table 5). As a quick review,
Mangine et al compared recovery of bench
press velocity over three reps at 80% of 1RM
and creatine kinase following either five sets
to failure or four sets to a 1-3 RIR plus one
set to failure at 80% of 1RM. Mangine found
that bench press velocity was not impaired
in either condition, but that creatine kinase
was elevated +49% 24 hours and +33% 48
hours post-training with more sets to failure.
In short, these results suggest that taking only
20% of your bench press sets to failure leads
to a quicker recovery than taking all sets to
failure. However, more research is needed
to identify the effect of taking some sets to
failure with other exercises on recovery. Fur-
ther, research should examine potential dif-
ferences in sRPE and performance recovery
between various submaximal sets at different
proximities to failure (i.e., 1-2 RIR versus
4-5 RIR).
Next Steps
First and foremost, there needs to be more
studies comparing failure versus non-failure
training on recovery in women. In addition,
I’d like to see studies tackling the suggestions
at the end of the previous section – specifical-
ly, is there a difference in acute fatigue and
recovery time between different submaximal
proximities to failure? A crossover design
study examining post-training sRPE along
31
with velocity recovery and creatine kinase
24 and 48 hours following squat and bench
press training to a 1-2 RIR versus a 4-5 RIR
would be helpful. Ideally, this study could
be carried out over four weeks, with volume
performance tests 24 and 48 hours following
each training condition. There are a few ways
to conduct this study, and I have laid out one
option in Table 6.

32
 APPLICATION AND TAKEAWAYS
1. Unsurprisingly, this meta-analysis from Vieira et al (1) found that failure training led
to greater fatigue and muscle damage than non-failure training.
2. Research mostly looks at failure and non-failure training in a binary fashion.
Therefore, we need more data to determine the magnitude of fatigue from taking
only some sets to failure. Research is also needed comparing the magnitude
of fatigue and muscle damage between non-failure sets taken to different
proximities to failure.
3. Coupling failure training with higher rep sets and higher training volumes
exacerbates fatigue. Therefore, you should use failure training appropriately
within a week to ensure that excess fatigue does not bleed into the next training
session, potentially compromising performance.

33
References
1. Vieira JG, Sardeli AV, Dias MR, Campos Y, Sant’Ana L, Leitão L, Reis V, Wilk M,
Novaes J, Vianna J. Effects of Resistance Training to Muscle Failure on Acute Fatigue: A
Systematic Review and Meta-Analysis. Sports Medicine. 2021 Dec 9:1-23.
2. Arent SM, Landers DM, Matt KS, Etnier JL. Dose-response and mechanistic issues in
the resistance training and affect relationship. Journal of Sport and Exercise Psychology.
2005 Mar 1;27(1):92-110.
3. Fonseca FS, Costa BD, Ferreira ME, Paes S, de Lima-Junior D, Kassiano W, Cyrino ES,
Gantois P, Fortes LS. Acute effects of equated volume-load resistance training leading to
muscular failure versus non-failure on neuromuscular performance. Journal of Exercise
Science & Fitness. 2020 May 1;18(2):94-100.
4. González-Badillo JJ, Rodríguez-Rosell D, Sánchez-Medina L, Ribas J, López-López C,
Mora-Custodio R, Yañez-García JM, Pareja-Blanco F. Short-term recovery following
resistance exercise leading or not to failure. International journal of sports medicine. 2016
Apr;37(04):295-304.
5. González-Hernández JM, García-Ramos A, Colomer-Poveda D, Tvarijonaviciute A,
Cerón J, Jiménez-Reyes P, Márquez G. Resistance Training to Failure vs. Not to Failure:
Acute and Delayed Markers of Mechanical, Neuromuscular, and Biochemical Fatigue.
The Journal of Strength & Conditioning Research. 2021 Apr 1;35(4):886-93.
6. Gorostiaga EM, Navarro-Amézqueta I, Calbet JA, Sánchez-Medina L, Cusso R, Guerrero
M, Granados C, González-Izal M, Ibáñez J, Izquierdo M. Blood ammonia and lactate
as markers of muscle metabolites during leg press exercise. The Journal of Strength &
Conditioning Research. 2014 Oct 1;28(10):2775-85.
7. Gorostiaga EM, Navarro-Amézqueta I, Calbet JA, Hellsten Y, Cusso R, Guerrero
M, Granados C, González-Izal M, Ibañez J, Izquierdo M. Energy metabolism during
repeated sets of leg press exercise leading to failure or not. PloS one. 2012 Jul
13;7(7):e40621.
8. Gorostiaga EM, Navarro-Amezqueta I, Cusso R, Hellsten Y, Calbet JA, Guerrero M,
Granados C, Gonzalez-Izal M, Ibanez J, Izquierdo M. Anaerobic energy expenditure
and mechanical efficiency during exhaustive leg press exercise. PloS one. 2010 Oct
19;5(10):e13486.
9. Hiscock DJ, Dawson B, Peeling P. Perceived exertion responses to changing resistance
training programming variables. The Journal of Strength & Conditioning Research. 2015
Jun 1;29(6):1564-9.

34
10. Linnamo V, Häkkinen K, Komi PV. Neuromuscular fatigue and recovery in maximal
compared to explosive strength loading. European journal of applied physiology and
occupational physiology. 1997 Dec;77(1):176-81.
11. Linnamo V, Pakarinen A, Komi PV, Kraemer WJ, Häkkinen K. Acute hormonal
responses to submaximal and maximal heavy resistance and explosive exercises in men
and women. Journal of strength and conditioning research. 2005 Aug 1;19(3):566.
12. Martorelli AS, De Lima FD, Vieira A, Tufano JJ, Ernesto C, Boullosa D, Bottaro M.
The interplay between internal and external load parameters during different strength
training sessions in resistance-trained men. European journal of sport science. 2021 Jan
2;21(1):16-25.
13. McGuigan MR, Egan AD, Foster C. Salivary cortisol responses and perceived exertion
during high intensity and low intensity bouts of resistance exercise. Journal of sports
science & medicine. 2004 Mar;3(1):8.
14. Morán-Navarro R, Pérez CE, Mora-Rodríguez R, de la Cruz-Sánchez E, González-
Badillo JJ, Sanchez-Medina L, Pallarés JG. Time course of recovery following resistance
training leading or not to failure. European journal of applied physiology. 2017
Dec;117(12):2387-99.
15. Pareja-Blanco F, Rodríguez-Rosell D, Aagaard P, Sánchez-Medina L, Ribas-Serna J,
Mora-Custodio R, Otero-Esquina C, Yáñez-García JM, González-Badillo JJ. Time course
of recovery from resistance exercise with different set configurations. The Journal of
Strength & Conditioning Research. 2020 Oct 1;34(10):2867-76.
16. Pareja-Blanco F, Rodriguez-Rosell D, Gonzalez-Badillo JJ. Time course of recovery
from resistance exercise before and after a training program. The Journal of sports
medicine and physical fitness. 2019 Feb 5;59(9):1458-65.
17. Pareja-Blanco F, Rodríguez-Rosell D, Sánchez-Medina L, Ribas-Serna J, López-López
C, Mora-Custodio R, Yáñez-García JM, González-Badillo JJ. Acute and delayed response
to resistance exercise leading or not leading to muscle failure. Clinical physiology and
functional imaging. 2017 Nov;37(6):630-9.
18. Raastad T, Bjøro T, Hallen J. Hormonal responses to high-and moderate-intensity
strength exercise. European journal of applied physiology. 2000 May;82(1):121-8.
19. Sanchez-Medina L, González-Badillo JJ. Velocity loss as an indicator of neuromuscular
fatigue during resistance training. Medicine and science in sports and exercise. 2011 Sep
1;43(9):1725-34.
20. Shibata K, Takizawa K, Tomabechi N, Nosaka K, Mizuno M. Comparison between
two volume-matched squat exercises with and without momentary failure for changes
in hormones, maximal voluntary isometric contraction strength, and perceived muscle

35
 soreness. Journal of strength and conditioning research. 2021 Nov 1;35(11):3063-8.
21. Vasquez LM, McBride JM, Paul JA, Alley JR, Carson LT, Goodman CL. Effect of
resistance exercise performed to volitional failure on ratings of perceived exertion.
Perceptual and motor skills. 2013 Dec;117(3):881-91.
22. GRADE Working Group. Grading quality of evidence and strength of recommendations.
Bmj. 2004 Jun 19;328(7454):1490.
23. Mangine GT, Serafini PR, Stratton MT, Olmos AA, VanDusseldorp TA, Feito Y. Effect
of the Repetitions-In-Reserve Resistance Training Strategy on Bench Press Performance,
Perceived Effort, and Recovery in Trained Men. The Journal of Strength & Conditioning
Research. 2022 Jan 1;36(1):1-9.
24. Lasevicius T, Schoenfeld BJ, Silva-Batista C, Barros TD, Aihara AY, Brendon H,
Longo AR, Tricoli V, Peres BA, Teixeira EL. Muscle Failure Promotes Greater Muscle
Hypertrophy in Low-Load but Not in High-Load Resistance Training. Journal of strength
and conditioning research. 2019 Dec 27.
25. Lacerda LT, Marra-Lopes RO, Diniz RC, Lima FV, Rodrigues SA, Martins-Costa HC,
Bemben MG, Chagas MH. Is performing repetitions to failure less important than volume
for muscle hypertrophy and strength?. The Journal of Strength & Conditioning Research.
2020 May 1;34(5):1237-48.
26. Ribeiro AS, Dos Santos ED, Nunes JP, Schoenfeld BJ. Acute effects of different training
loads on affective responses in resistance-trained Men. International journal of sports
medicine. 2019 Dec;40(13):850-5.
27. Amdi CH, Cleather DJ, Tallent J. Impact of Training Protocols on Lifting Velocity
Recovery in Resistance Trained Males and Females. Sports. 2021 Nov;9(11):157.

36
Study Reviewed: Starving Your Performance? Reduced Preexercise Hunger Increases
Resistance Exercise Performance. Naharudin et al. (2021)

Pre-Training Meals,
Finally Satisfied
BY ERIC HELMS

This is the third study I’ve reviewed from a group examining the
effects of pre-training carbohydrate intake on resistance training
volume performance. In this study, we learn that, at least for low to
moderate volume training, the energetic content of the meal may
be less important than how filling it is.

37
 KEY POINTS
1. In a crossover design (1), two hours after consuming a 1) liquid or 2) semi-solid,
carbohydrate-equated breakfast, 16 resistance-trained men completed four
sets of squat and bench press to failure with 90% of their 10RM.
2. Total back squat repetitions were ~12% higher following the semi-solid
compared to the liquid breakfast. Bench press performance was not
significantly different between trials. Hunger and plasma insulin and glucose
were higher during the liquid breakfast, while hunger was lower and fullness
was higher during the semi-solid trial.
3. This group previously observed (2) similar performance and similar effects
on hunger and fullness following very low-energy placebo breakfasts and
carbohydrate-based breakfasts with similar viscosities. In combination with
the present study’s findings, these data provide strong evidence (at least for
low to moderate training volumes) to support the importance of a satisfying
performance-supporting pre-training meal that doesn’t leave you too hungry.

T
his study (1) is the third installment in
a series from the same research group
examining the effects of pre-training
meals on resistance training volume perfor-
mance. Back in Volume 3 of MASS, I re-
viewed the first of these studies, in which a
food-based, carbohydrate-dominant break-
fast condition outperformed a water-only
breakfast condition (3). However, as it was
a comparison between an actual breakfast
and just water in participants who habitual-
ly consumed breakfast, I couldn’t be sure of
the mechanism by which performance was
enhanced. Specifically, it might have been
the placebo effect of consuming breakfast
or the nocebo effect of consuming water,
rather than a direct effect of carbohydrate.
In Volume 4 of MASS, I reviewed the sec-
ond investigation in this series (2), in which
the authors replicated the first study design,
but compared three conditions: a carbohy-
drate-based semi-solid breakfast (kind of
like an orange flavored mush), a texture- and
flavor-matched very-low energy semi-solid
placebo breakfast, and water-only. This time
the placebo and carbohydrate-based break-
fasts both outperformed the water condition,
without any significant differences between
one another, suggesting that, rather than fuel
availability, a hunger or psychological factor
may have enhanced performance.
In the present study (1), the authors sought
to determine the mechanism more specifical-
ly, and once again replicated the crossover
design. However, this time they compared
a viscous semi-solid carbohydrate breakfast
to a carbohydrate-matched liquid breakfast,
knowing that the former would be more fill-
ing. Two hours after consuming the breakfast,
the participants performed four sets to fail-
ure on the squat and bench press with 90%
of their 10RM. They performed significantly
more total squat repetitions after consuming

38

the semi-solid breakfast, but there were no
significant differences in bench press per-
formance between conditions. While hunger
hormones did not significantly differ between
conditions, subjective fullness was elevated
and hunger was suppressed to a significant-
ly greater degree in the semi-solid breakfast
condition. Further, plasma insulin and glucose
were significantly elevated to a greater de-
gree in the liquid breakfast condition. There-
fore, perhaps you can prevent a decrease in
volume performance following an overnight
fast, at least when performing a low to mod-
erate number of sets, as long as you ensure
you don’t feel too hungry. In this article I’ll
unpack the findings, put them in context with
the rest of the available literature on carbo-
hydrate feeding for resistance training perfor-
mance, and conclude with up-to-date recom-
mendations for pre-training fueling.
Purpose and Research
Subjects and Methods
Subjects
16 resistance-trained men (age: 27 ± 3 years,
body mass: 71.6 ± 9.2 kg, height: 1.73 ± 0.05
m, and body mass index: 23 ± 4 kg/m2) par-
ticipated in this study. Prior to the study, all
participants were habitually consuming a
solid breakfast on most days and performing
resistance training regularly with the back
squat and bench press. Specifically, the par-
ticipants had 5 ± 1 years of resistance training
experience, consumed breakfast 6 ± 1 days
per week, and were performing 4 ± 1 training
sessions per week (2 ± 1 of which included
both squats and bench press).
Study Design and Assessments
As this was a crossover study, all volunteers
participated in each condition in a random-
ized order. The participants visited the lab
on four separate occasions: first to test their

Questions
squat and bench press 10RM, then for famil-
iarization with all experimental procedures,
Purpose
The authors stated that “the purpose of this
study was to examine whether hunger influ-
ences resistance exercise performance by pro-
viding pre-exercise carbohydrate-containing
meals of different viscosities to elicit differ-
ences in subjective hunger before exercise.”
Hypothesis
The authors “hypothesized that the semi-sol-
id meal would suppress hunger and increase
performance.”

39
and once for each condition. Their habitual
diets and physical activity levels were record-
ed. They were instructed to replicate these
habitual diets, while refraining from physical
activity or alcohol consumption, for two days
prior to each trial. The participants consumed
1.5g/kg bodyweight of maltodextrin with or-
ange flavoring and water in both conditions.
In the liquid breakfast condition, the partic-
ipants simply drank this mixture. However,
in the semi-solid condition, xanthan gum
was added to thicken the mixture, which the
participants consumed with a spoon out of a
bowl. The nutritional content of these meals
are shown in Table 1.
Two hours after breakfast, the participants
performed a standardized warm-up, followed
by four sets of squats and bench press to fail-
ure with 90% of their 10RMs, with three-min-
ute rest periods. Breakfasts were consumed
by each participant at their habitual breakfast
time after a 10-13 hour fast. Immediately after
breakfast, the participants rated pleasantness
and hunger/fullness using a visual analogue
scale (a 100mm horizontal line). Finally,
blood samples were taken to measure serum
glucose, insulin (markers of energy/carbohy-
drate metabolism), total peptide tyrosine-ty-
rosine (PYY), and ghrelin. PYY and ghrelin
are hormonal markers for satiety and for hun-
ger, respectively. All variables were collected
pre-breakfast. The subjective ratings were tak-
en 10, 45, 60, and 105 minutes after breakfast,
while blood glucose samples were taken 15,
30, 45, 60, and 105 minutes after breakfast.
Insulin, ghrelin, and PYY samples were taken
45 and 105 minutes after breakfast.
40
Findings
creased serum glucose relative to baseline;
however, the magnitude of this increase was
Performance significantly higher 45 minutes post-meal
during the liquid condition compared to the
The participants performed significantly
semi-solid condition (Figure 3, Panel B).
more total back squat reps (and significantly
Likewise, insulin rose significantly relative
more reps [p < 0.5] in each of the four sets)
to baseline in both breakfast conditions, but
following the semi-solid breakfast condi-
tion compared to the liquid breakfast condi- was significantly higher in the liquid condi-
tion (57 ± 9 vs 51 ± 7; p < 0.01; 11.6% more tion 45 and 105 minutes post meal (Figure 3,
reps). However, there were no significant dif- Panel A).
ferences (p = 0.62) in total bench press reps As shown in Figure 4, ghrelin and PYY sig-
between the semi-solid breakfast condition nificantly increased relative to baseline in
(48 ± 11) and the liquid breakfast condition
(48 ± 10), or in reps performed between con-
ditions during any of the four sets (p = 0.69).
Figure 1 displays the total reps and the reps
performed per set for both lifts, with lines in-
dicating individual differences.
Perceptions
The participants found the semi-solid break-
fast significantly less pleasant than the liquid
meal (35 ± 22 mm vs 70 ± 11 mm; p < 0.001);
however, they found it (albeit non-significant-
ly) more filling (78 ± 13 mm vs 69 ± 22 mm; p
= 0.092) immediately after consumption.
Time courses and differences between con-
ditions for hunger and fullness are shown in
Figure 2. While both conditions modified
hunger and fullness relative to baseline, the
semi-solid breakfast did so to a greater mag-
nitude, producing significantly lower hunger
scores and significantly higher fullness scores
compared to the liquid breakfast condition at
most time points (Figure 2).
Blood Measurements
Both breakfast conditions significantly in-

41
both conditions, there were no significant
differences between conditions for either
hormone.
Criticisms and Statistical
Musings
While the primary statistical analyses were
appropriate, the authors used Cohen’s dz
effect sizes to present the magnitude of the
effects. They also used this approach in the
previous study (2), and, as I explained in that
review, this effect size calculation uses the
standard deviation of the differences between
conditions as the divisor. Unlike Cohen’s d
effect size (which uses the pooled baseline
standard deviations of the compared condi-
tions as the divisor), Cohen’s dz calculations
don’t reflect the overall size of the effect.
Rather, Cohen’s dz represents the magnitude
of individual variability in the effect, relative
to the group response (4). Thus, in the Find-
ings section, I simply reported the percentage
differences between trials, which provides a
42
more intuitive interpretation of the magni-
tude of mean differences between conditions.
For those who want to understand this dis-
tinction between effect sizes, and its impor-
tance, check out the Criticisms and Statistical
Musings section of this article (and the article
links in that section) by Dr. Zourdos.
Finally, I think conclusions of this study
would be stronger if they had run correla-
tions between the differences in satiety and
the differences in performance between con-
ditions (assuming they had hypothesized the
relationship). It’s one thing to observe that the
semi-solid breakfast condition produced better
performance while also promoting more full-
ness and less hunger at the group level. But,
if you’re claiming that the effect on perfor-
mance is caused by fullness and hunger, they
should at least be correlated, and showing this
correlation would provide a stronger argument
for that as an explanatory mechanism.
Interpretation
This group’s prior study (2) showed that re-
sistance training performance was similar fol-
lowing a very low-energy placebo breakfast
and a carbohydrate-containing breakfast, both
of which outperformed water. But, important-
ly, that study didn’t tell us why. Was perfor-
mance enhanced due to the placebo effect of
eating, regardless of carbohydrate content? Or
was performance degraded due to the nocebo
effect of not eating in the water-only condi-
tion? Was the nature of this effect psycholog-
ical, or a centrally mediated effect on perfor-
mance due to satiety? The present study (1)
attempts to address these questions.
While the aforementioned study (2) manip-
ulated carbohydrate content while keeping
viscosity matched between breakfasts (and
blinded the participants as to which breakfast
they consumed), the present study (1) matched
carbohydrate content while manipulating vis-
cosity, and the participants knew they were
consuming carbohydrates in both conditions.
Subsequently, the participants were signifi-
cantly fuller, less hungry, and performed
~12% more total repetitions of the back squat
during the semi-solid condition than during
the liquid condition. Given the participants
knew they were consuming a carbohydrate
containing breakfast in both conditions, this
suggests the effect was likely mediated by sa-
tiety, rather than a placebo effect of consum-
ing an energy-containing meal. Further, the
effect of consuming a semi-solid meal com-
pared to a liquid-meal on performance (~12%
more squat repetitions) was similar to the ef-
fect of consuming either a placebo or carbo-
hydrate-based breakfast in the previous study
compared to water (~15% more squat repe-
titions). Thus, if a hypothetical fourth study
was conducted comparing the liquid carbo-
hydrate breakfast from the present study to
a water-only breakfast, you could reasonably
expect similar performance between the two
conditions. This indicates that, at least when
performing a moderate volume (8 sets) after
an overnight fast, it is more important to con-
struct a pre-training meal that prevents exces-
sive hunger, as opposed to focusing on the
carbohydrate content of the meal.
As a side note, you might be wondering
why only back squat performance differed
between conditions. While I’m not sure, I
43

AT LEAST WHEN
PERFORMING A MODERATE
VOLUME (8 SETS) AFTER
AN OVERNIGHT FAST, IT
IS MORE IMPORTANT TO
CONSTRUCT A PRE-TRAINING
MEAL THAT PREVENTS
EXCESSIVE HUNGER, AS
OPPOSED TO FOCUSING
ON THE CARBOHYDRATE
CONTENT OF THE MEAL.
suspect this comes down to the order of the
exercises. The pre-training meals were con-
sumed two hours before the training sessions,
so it might just be that the effect of the meal
dwindled by the time the participants got to
the bench press. A future study that manip-
ulated exercise order would clarify this. Fur-
ther, some readers might speculate that the
differences in blood glucose between condi-
tions in the present study could be the mech-
anistic explanation for performance enhance-
ment, rather than differences in hunger and
fullness. Blood glucose levels were higher in
the liquid condition and indeed, there is some
limited evidence suggesting that slower, less
pronounced rises in blood glucose might be
superior to faster, more pronounced rises in
blood glucose for endurance training perfor-
mance (5). However, the highest blood glu-
cose differences between conditions at any
time point were relatively small (less than
1nmol/L; ~6.2nmol/L in the semi-solid con-
dition versus ~7nmol/L in the liquid condi-
tion), and a previous study reported no signif-
icant difference in resistance training volume
performance when comparing training in a
more pronounced state of acute hypergly-
cemia (~7-9nmol/L) to lower (5-6nmol/L)
blood glucose levels (6). Therefore, out of
the proposed mechanisms, a satiety-mediated
effect seems most plausible.
With that said, we can’t assume this would
also be the only mechanism at play during
resistance training protocols with volumes in
excess of what was performed in the present
study. It is not unreasonable to speculate that
fuel availability becomes more of a concern
during longer, higher volume sessions. In-
deed, while the body of literature on the er-
gogenic effect of pre-resistance training car-
bohydrate intake is mixed, there are trends
that emerge to support this concept. First,
it’s clear that pre-training carbohydrate in-
take doesn’t have a meaningful impact on
one-off expressions of maximal strength or
force (7, 8, 9). Secondly, while the data on
volume performance (i.e. total isokinetic
work or total repetitions to failure) is mixed,
studies with longer duration, higher training
volume protocols demonstrate a positive ef-
fect of carbohydrate feeding on volume per-
formance more often (10, 11, 12, 13) than
not (14). Ultimately, if you were to perform
a low to moderate volume session, along the
lines of 8 sets of 8-15 reps to failure in total,
44
I’m confident that simply consuming a sati-
ating pre-training meal would be sufficient,
regardless of its carbohydrate content. How- IT IS NOT UNREASONABLE
ever, we don’t yet have the data to be sure
that the presence of carbohydrates is incon- TO SPECULATE THAT FUEL
sequential prior to performing high volume
sessions of 15-20+ high-effort sets.
AVAILABILITY BECOMES
MORE OF A CONCERN
Next Steps DURING LONGER, HIGHER
As I alluded to in the final paragraph of my
interpretation, we can’t extrapolate the pres-
VOLUME SESSIONS.
ent study’s findings to resistance training
protocols that differ substantially from the
study protocol. Specifically, who’s to say see this study replicated in a group that did
that a higher volume protocol wouldn’t ben- not habitually eat breakfast, or in individuals
efit from both the effect of satiety and the who aren’t typically hungry in the morning.
effect of carbohydrate as a fuel substrate? It might be that if you simply aren’t hungry,
To get clarity, you’d need to replicate the having a meal before a low to moderate ses-
present study with two additional exercis- sion isn’t necessary.
es (to double the set-volume) and include a
semi-solid very-low energy placebo break-
fast group. With this design you could ex-
amine the independent effects of a satiating
carbohydrate-containing breakfast, a non-sa-
tiating carbohydrate-containing breakfast,
and a satiating very low-energy breakfast on
performance during a high-volume protocol.
Further, as I briefly alluded to earlier in this
article, I’d also like to see similarly designed
studies that manipulate exercise order and/or
have the participants consume a portion of
their pre-training carbohydrates mid-session.
This would help us determine if the benefit
of consuming a pre-training meal diminishes
over time (possibly why only the squat ben-
efitted in the present study), and if consum-
ing something mid-session would prevent
this from occurring. Finally, I’d also like to

45
 APPLICATION AND TAKEAWAYS
Pre-training meals, especially after an overnight fast, are likely to have a positive
effect on volume performance, but only if they are sufficiently satiating. Specifically,
you want to consume either a solid, or semi-solid meal rather than exclusively liquid
(i.e., a banana and a scoop of whey in water would probably do the trick). As long
as it’s satiating, the macronutrient and energy content of your pre-training meal
probably doesn’t matter much, at least when performing low to moderate volume
sessions (6-10 high-effort sets). Finally, satiated isn’t the same thing as stuffed. Don’t
take this too far and eat a giant meal, as that could potentially negatively impact your
performance. Individualize your intake so that you simply eat enough to ensure you
aren’t hungry.

46
References
1. Naharudin, M. N., Yusof, A., Clayton, D. J., & James, L. J. (2021). Starving Your
Performance? Reduced Preexercise Hunger Increases Resistance Exercise Performance.
International journal of sports physiology and performance, 1–7. Advance online
publication.
2. Naharudin, M. N., Adams, J., Richardson, H., Thomson, T., Oxinou, C., Marshall, C., et
al. (2020). Viscous placebo and carbohydrate breakfasts similarly decrease appetite and
increase resistance exercise performance compared with a control breakfast in trained
males. The British journal of nutrition, 1–9. Advance online publication.
3. Bin Naharudin, M. N., Yusof, A., Shaw, H., Stockton, M., Clayton, D. J., & James, L.
J. (2019). Breakfast Omission Reduces Subsequent Resistance Exercise Performance.
Journal of strength and conditioning research, 33(7), 1766–1772.
4. Lakens D. (2013). Calculating and reporting effect sizes to facilitate cumulative science:
a practical primer for t-tests and ANOVAs. Frontiers in psychology, 4, 863.
5. Heung-Sang Wong, S., Sun, F. H., Chen, Y. J., Li, C., Zhang, Y. J., & Ya-Jun Huang,
W. (2017). Effect of pre-exercise carbohydrate diets with high vs low glycemic index on
exercise performance: a meta-analysis. Nutrition reviews, 75(5), 327–338.
6. Lime-Ma, F., Cotter, J. A., & Schick, E. E. (2017). The Effect of Acute Hyperglycemia
on Muscular Strength, Power and Endurance. International journal of exercise science,
10(3), 390–396.
7. Fairchild, T. J., Dillon, P., Curtis, C., & Dempsey, A. R. (2016). Glucose Ingestion Does
Not Improve Maximal Isokinetic Force. Journal of strength and conditioning research,
30(1), 194–199.
8. Haff, G. G., Koch, A. J., Potteiger, J. A., Kuphal, K. E., Magee, L. M., Green, S. B.,
et al. (2000). Carbohydrate supplementation attenuates muscle glycogen loss during
acute bouts of resistance exercise. International journal of sport nutrition and exercise
metabolism, 10(3), 326–339.
9. Aoki, M. S., Pontes Jr, F. L., Navarro, F., Uchida, M. C., & Bacurau, R. F. P. (2003).
Carbohydrate supplementation fails to revert the deleterious effects of endurance exercise
upon subsequent strength performance. Revista Brasileira de Medicina do Esporte, 9,
282-287.
10. Laurenson, D. M., & Dubé, D. J. (2014). Effects of carbohydrate and protein
supplementation during resistance exercise on respiratory exchange ratio, blood glucose,
and performance. Journal of clinical & translational endocrinology, 2(1), 1–5.

47
11. Haff, G. G., Schroeder, C. A., Koch, A. J., Kuphal, K. E., Comeau, M. J., & Potteiger, J.
A. (2001). The effects of supplemental carbohydrate ingestion on intermittent isokinetic
leg exercise. The Journal of sports medicine and physical fitness, 41(2), 216–222.
12. Haff, G. G., Stone, M. H., Warren, B. J., Keith, R., Johnson, R. L., Nieman, D. C., et al.
(1999). The Effect of Carbohydrate Supplementation on Multiple Sessions and Bouts of
Resistance Exercise. The Journal of Strength & Conditioning Research, 13(2), 111-117.
13. Lambert, C. P., Flynn, M. G., Boone Jr, J. B., Michaud, T. J., & Rodriguez-Zayas, J.
(1991). Effects of carbohydrate feeding on multiple-bout resistance exercise. The Journal
of Strength & Conditioning Research, 5(4), 192-197.
14. Smith, J. W., Krings, B. M., Shepherd, B. D., Waldman, H. S., Basham, S. A., &
McAllister, M. J. (2018). Effects of carbohydrate and branched-chain amino acid
beverage ingestion during acute upper body resistance exercise on performance and
postexercise hormone response. Applied physiology, nutrition, and metabolism, 43(5),
504–509.

48
 Study Reviewed: Slow and Steady, or Hard and Fast? A Systematic Review and Meta-
Analysis of Studies Comparing Body Composition Changes between Interval Training and
Moderate Intensity Continuous Training. Steele et al. (2021)

Slow and Steady Wins the Race, but

Does It Optimize Your Physique?
BY ERIC TREXLER

In the early 2010s, high-intensity interval training took the

bodybuilding world by storm, with promises of efficient fat loss
and superior muscle retention. This month, a very thorough
meta-analysis puts those claims to the test.

49
 KEY POINTS
1. The presently reviewed meta-analysis compared the effects of high-intensity
interval exercise and moderate-intensity continuous exercise on changes in fat
mass and fat-free mass.
2. Neither form of cardio led to substantially better (or worse) body composition
changes, and both forms of cardio led to relatively modest changes in body
composition.
3. When it comes to interval versus continuous exercise, let your preference guide
the decision. Neither form of exercise alone will induce precipitous weight loss,
but both can be quite helpful for attenuating weight gain, along with numerous
additional benefits.

E
ndurance training is pretty straight-
forward when it’s performance-ori-
ented – you’re seeking a very specific
set of physiological adaptations to facilitate
your athletic endeavors, and you adjust your
training habits to stress the pertinent physio-
logical systems accordingly. However, when
endurance training becomes cardio (that is,
when the focus shifts away from cultivating
specific athletic capabilities and capacities),
the public consensus regarding the “right
way” to do it becomes very susceptible to
trends that fall in and out of fashion. In the
last 15 years or so, which is a relatively short
time span, the cardio pendulum has swung
aggressively.
At first, people were fixated on the “fat
burning zone,” and the predominant form of
cardio in the bodybuilding world was long,
tedious bouts of incline treadmill walking.
This fixation was largely based on the cross-
over concept, which acknowledges that the
percentage of fuel coming from fat decreas-
es (and the percentage of fuel coming from
carbohydrate increases) as exercise intensity
gets progressively higher. While that state-
ment is true in isolation, it ignores the im-
pact of total energy expenditure for a given
bout of exercise, and ultimately has minimal
relevance to long-term changes in body com-
position. Since then, other trends have come
and gone. There have been periods of time
in which the fashionable perspective in the
bodybuilding world was to minimize cardio
altogether, but also times in which interval
training was the favored form of cardio. In
the early 2010s, it was hard to tell if some-
one was preparing for a natural bodybuilding
show or the track cycling world champion-
ship. Largely fueled by the conclusions of
one particular meta-analysis (2), sprint inter-
val training on stationary bikes became pop-
ular among the evidence-based bodybuilding
crowd due to the low-impact, time-efficient,
power-intensive nature of the approach. Pop-
ularity of the ultra-high-intensity interval ap-
proach has dropped off a bit over the last de-
cade (in the bodybuilding world, at least), but
the cardio debate rages on: if you’re focused
on physique-oriented outcomes, should you

50
be doing high-intensity intervals or lower-in-
tensity, continuous exercise?
I suppose we could make a flashy Instagram
post to answer this question by comparing the
quads of a marathon runner and a sprinter, but
please – for the love of all that is good and in-
tellectually rigorous – let’s not. Instead, let’s
dive into the presently reviewed meta-anal-
ysis by Steele et al (1), which compared the
effects of interval training (with high or max-
imal intensity) and moderate-intensity con-
tinuous training on longitudinal changes in fat
mass and fat-free mass. The highlights of the
results are that neither form of cardio led to
substantially better (or worse) body composi-
tion changes, and both forms of cardio led to
relatively modest changes in body composi-
tion. However, this was a very thorough and
nuanced meta-analysis, so we have a lot to
dig into. This article aims to summarize the
findings of this meta-analysis in a way that
yields practical guidance for making cardio
choices that are compatible with your goals
and preferences.
Purpose and Hypotheses
Purpose
The primary purpose of the presently re-
viewed paper was “to conduct a systematic
review and multilevel meta-analysis of the
current literature as to the effects of [interval
training versus moderate intensity continuous
training] on measures of body composition.”
The secondary purpose was “to determine if
intensity of effort influences exercise adher-
ence and/or adverse events, as well as whether
inter-individual response to [interval training]
and [moderate intensity continuous training]
influences changes in body composition.”
Hypotheses
The researchers did not state a hypothesis,
and did not actually perform hypothesis test-
ing. When you see p-values in a paper, those
p-values generally relate to the decision to re-
ject (or fail to reject) a specific hypothesis. In
this meta-analysis, no p-values are presented.
Rather, the researchers simply aimed to esti-
mate pooled effect sizes, quantify the preci-
sion of those estimates, and explore potential
heterogeneity within each statistical model.
While these decisions aren’t reflective of the
“standard” approach to meta-analysis in ex-
ercise science, they are definitely appropriate
and defensible.
Methods
As is necessarily true of all systematic re-
views, this project began with a systematic
search of major research databases to gath-
er all of the studies directly related to the re-
search question. Studies were included in this
meta-analysis if they:
1. Were randomized controlled trials com-
paring the effects of interval training and
continuous training on body composition
using a validated body composition mea-
sure in healthy participants;
2. Required participants to complete the des-
ignated exercise intervention at least once
per week for a minimum of four weeks;
3. Were published in a peer reviewed journal
or were posted to a pre-print server and
written in the English language.
51
Studies were excluded if participants had
medical conditions that might have inter-
fered with study outcomes, or if there was
an imbalanced implementation of resistance
exercise (in other words, if one of the cardio
groups also completed resistance training).
After completing the search and excluding
studies that did not meet the inclusion criteria,
the researchers were left with 54 studies for the
pooled, quantitative meta-analysis. As you’d
expect, there were some differing character-
istics among the studies. For example, some
studies controlled nutrition, and others did
not; some implemented work-matched exer-
cise protocols, and others did not. There were
also differences in the type of interval exercise
completed – “sprint interval training” refers
to maximal intensity intervals interspersed
with rest (or lower-intensity) intervals, where-
as “high-intensity interval training” refers to
high intensity intervals (generally >80% peak
heart rate or aerobic capacity, but not quite
maximal) interspersed with rest (or lower-in-
tensity) intervals. The study characteristics are
presented in Table 1 (note that some studies
involved multiple experimental groups, which
is why there are 54 studies but 60 groups rep-
resented in the table).
The presently reviewed meta-analysis fea-
tured a pretty comprehensive set of statistical
analyses. First, there were the primary mod-
els of interest: the effects of interval and con-
tinuous exercise on fat mass and fat-free mass
were compared using standardized effect siz-
es (Hedges’ g, which is similar to Cohen’s
d, with positive values reflecting a more fa-
vorable effect of interval exercise compared
to continuous exercise), and corresponding

52
heterogeneity statistics were calculated. This
is the primary analysis we’d typically expect
to see in this type of meta-analysis, with the
biggest divergence being that the researchers
opted to report the pooled effect size and 95%
confidence interval without an accompany-
ing p-value. In a previous MASS review, I
mentioned that many meta-analyses would be
improved by utilizing multi-level models that
incorporate random effects. The presently re-
viewed paper utilized this approach very ef-
fectively, which was really nice to see. They
also used the “GRADE approach” to assess
the certainty of the evidence obtained from
this body of literature.
These primary analyses were supplement-
ed with a number of secondary analyses.
First, the researchers replicated the primary
models of interest, but used relative changes
(percentage of body mass) and the raw units
of measurement rather than standardized ef-
fect sizes. They also examined “within-con-
dition” effects by comparing each individu-
al type of exercise to the control group from
the same study. After that, they conducted
some exploratory subgroup and moderation
analyses to determine if any specific vari-
ables (such as sex, age, BMI, total weekly
training minutes, and the number of inter-
vals performed per training session, among
others) were meaningfully impacting the re-
sults of the primary analyses. The research-
ers also conducted analyses to compare the
adherence rate, number of dropouts, and
frequency of adverse events among the dif-
ferent intervention groups. Finally, the re-
searchers conducted some nuanced analyses
to examine the likelihood of “true” inter-in-
dividual variation in responses to the exer-
cise interventions.
Findings
The primary model for fat mass indicated
that differences between interval and con-
tinuous exercise were trivial; the pooled ef-
fect size was -0.02 (95% confidence interval
[95%CI]: -0.07 to 0.04) and the observed het-
erogeneity was moderate (I2 = 36%). All of
the effect sizes and confidence intervals from
each individual study are presented in Figure
1, along with the pooled effect estimate.
The primary model for fat-free mass also in-
dicated that differences between interval and
continuous exercise were trivial; the pooled
effect size was -0.0004 (95%CI: -0.05 to
0.05) and the observed heterogeneity was
negligible (I2 = 16%). All of the effect sizes
and confidence intervals from each individu-
al study are presented in Figure 2, along with
the pooled effect estimate.
Based on GRADE criteria, the researchers
concluded that there was “high” certainty of
evidence for both fat mass and fat-free mass
outcomes. Results were not meaningfully im-
pacted by using raw unit values or relative
(percent) changes rather than standardized
effect sizes, so these alternative results are
not reported.
When looking at within-group effects, in-
terval exercise led to small reductions in fat
mass (Hedges’ g = -0.22 [95%CI: -0.36 to
-0.08], or -0.20 kilograms [95%CI: -0.34 to
-0.06]) and trivial increases in fat-free mass
(Hedges’ g = 0.13 [95%CI: 0.04 to 0.22], or
0.11 kilograms [95%CI: -0.04 to 0.26]). Con-
53
tinuous exercise also led to small reductions
in fat mass (Hedges’ g = -0.20 [95%CI: -0.36
to -0.04], or -0.25 kilograms [95%CI: -0.39 to
-0.11]) and trivial increases in fat-free mass
(Hedges’ g = 0.07 [95%CI: -0.01 to 0.16], or
0.07 kilograms [95%CI: -0.02 to 0.15]).
Due to negligible heterogeneity for the pri-
mary model, subgroup and moderation analy-
ses were not conducted for fat-free mass. For
fat mass, the only variables that seemed to
make a notable impact were sex (β = 0.0015
[95%CI: 0.00 to 0.0029]) and the number of
intervals performed per training session (β =
-0.0032 [95%CI: -0.0052 to -0.0013]), but
both effects were probably too small to get
worked up about.
When comparing continuous and interval ex-
ercise in terms of adherence, dropouts, and
adverse events, differences were minimal.
The adherence rate was 89.1% for interval
exercise and 89.2% for continuous exercise.
The dropout rate was 16.1% for interval exer-
cise and 20.1% for continuous exercise. Ad-
verse events were quantified as the number of
events per 1000 training sessions performed,
and were not meaningfully different between
groups (1.15 for interval exercise, and 1.07
for continuous exercise). Finally, there was
no clear statistical evidence of “true” in-
ter-individual variation in responses to either
exercise intervention.
Criticisms and Statistical
Musings
This certainly isn’t a criticism, but it proba-
bly counts as a “musing.” I mentioned previ-
ously that these researchers opted for a sta-
tistical approach that deviates from the norm
and may seem a bit unconventional; this pa-
per doesn’t report p-values or anything at all
54
within the realm of “statistical significance.”
When reading research, it’s common to de-
velop a mental shortcut in which you skip to
the good stuff, look for the p-value, and form
a knee-jerk conclusion: if p < 0.05, the find-
ing is important because it’s statistically sig-
nificant. Of course, this perspective is over-
simplified to the point of being incorrect, but
the persistent presence of p-hacking and pub-
lication bias in the scientific literature sug-
gests that the research world just can’t kick
its fixation on that 0.05 threshold (3).
There are several downsides to the wide-
spread tendency to focus on whether or not
p-values are below or above a particular
threshold. For starters, this focus fuels pub-
lication bias and leads to a lot of false posi-
tives and exaggerated effect sizes (4). Some
argue that we should just use lower thresh-
olds (below 0.05), but that seems to inflate
effect sizes even more (4), and would prob-
ably just shift the p-hacking goalposts. Even
if we could get past these issues, there are
bigger problems: the literal interpretation of
a p-value is rather unintuitive, the decision
to set thresholds is arbitrary in nature, and a
p-value can’t tell us if an intervention is prac-
tically useful or worthwhile. As such, large
groups of researchers have suggested that the
standard approach of using p-value thresh-
olds to categorize a finding as statistically
“significant” or “non-significant” should be
abandoned (5), in favor of approaches like
the one used in the presently reviewed me-
ta-analysis. To stop myself from embarking
on a long, meandering, theoretical detour, I’ll
get to the point: these researchers did an ex-
cellent job with their statistical analysis, and
if their decision to avoid reporting p-values
or indicators of statistical significance both-
ers you, you might want to brace for more of
it in the future.
Interpretation
While some people have enthusiastically
picked a side and engaged in divisive argu-
ments about the superiority of interval cardio
versus continuous cardio (or vice versa), the
presently reviewed meta-analysis suggests
they’re probably overthinking it. Pooled ef-
fect sizes were quite similar for both forms
of cardio, and based on the width of the con-
fidence intervals, lack of substantial inter-in-
dividual variability, and “high certainty” out-
come using the GRADE criteria, we can be
fairly confident in this conclusion.
This shouldn’t catch us entirely by surprise
– as we’ve learned from the battle between
low-carb and low-fat diets, changes in fat
mass come down to cumulative energy bal-
ance, and there are many ways to introduce
a deficit. Whether you’re leaning on carb
reduction, fat reduction, interval cardio, or
continuous cardio, establishing a negative
energy balance is key to promoting a net re-
duction in stored fat mass. Both cardio ap-
proaches led to similar changes in fat-free
mass as well, which shouldn’t be a huge
shock. Back when high-intensity interval
training was taking the natural bodybuilding
world by storm, a lot of people embraced the
idea that high-intensity cardio was providing
a potent stimulus for hypertrophy, whereas
longer-duration, lower-intensity continuous
cardio was inducing tremendous amounts of
atrophy (this was when the old “sprinter ver-
55
sus marathoner” picture comparisons were
regrettably making the rounds). The reality is
that both forms of cardio provide a minor hy-
pertrophic stimulus to previously sedentary
folks (after all, they both involve an increase
in forceful muscle activity when compared to
no movement whatsoever), but not much to
write home about. Based on the within-group
changes in the present meta-analysis, we’re
talking about a gain of around 70g of fat-free
mass from continuous exercise, and around
110g of fat-free mass from interval exercise.
You could suggest that hypertrophy would
be greater than this pooled effect size un-
der certain specific conditions (for exam-
ple, short, maximal-intensity cycling sprints
against some external resistance), but we’re
still talking about a fairly negligible amount
of fat-free mass accretion when compared to
something like full-body resistance exercise.
That brings me to one of the most notewor-
thy limitations of this meta-analysis: only
one intervention included a resistance train-
ing component. That’s not necessarily a
shortcoming of the paper, but rather a caveat
that could theoretically threaten our ability
to generalize these findings to the majority
of MASS readers (who tend to be quite fond
of lifting heavy things). Fortunately, I’m not
super concerned about that, and I think lift-
ers can still lean on the results of this me-
ta-analysis with a high degree of confidence.
I mentioned that the bodybuilding world got
really excited about high-intensity interval
training (more specifically, maximal-intensi-
ty cycling sprints) after the publication of a
meta-analysis in 2012 (2). In that paper, the
authors suggested that lifters should gravitate
toward styles of cardio that involve high lev-
els of muscular force and power output, and
avoid long-duration cardio and running. The
idea was that running induces an unfavorable
amount of muscle damage, while a high-in-
tensity, short-duration bout of sprints would
be most similar to the physiological demands
of resistance training. As such, based largely
on ideas related to avoiding the interference
effect of concurrent training, it was theorized
that high-intensity cycling sprints would
minimize unfavorable impacts of cardio on
strength and hypertrophy.
That all sounds logical, but more recent me-
ta-analyses have gravitated toward a consen-
sus that the interference effect of concurrent
training isn’t as scary as commonly suggest-
ed for strength (and especially for hypertro-
phy), except for when the dose of cardio is
extremely high. I won’t belabor that point too
much because Greg and Dr. Zourdos have
done an excellent job covering concurrent
training and the interference effect in recent
issues of MASS. To be clear, the argument
is not that the interference effect is non-exis-
tent, but rather that the doses (with regards to
volume, frequency, and intensity) of cardio
that most lifters might feasibly add into their
routine aren’t extreme enough to markedly
blunt strength or hypertrophy. So, for lifters
who are primarily interested in strength or hy-
pertrophy (but not power or explosiveness),
the exact modality, intensity, and duration of
cardio probably aren’t particularly import-
ant, as long as they keep their overall cardio
volume and intensity within a manageable
range, and separate their lifting and cardio
sessions when possible. Along with similar
56

WHILE MANY EVIDENCE-
BASED LIFTERS USED TO
FEEL OBLIGATED TO PICK
FROM A VERY SHORT
LIST OF SPECIFIC CARDIO
MODALITIES, INTENSITIES,
AND DURATIONS, WE CAN
DRAMATICALLY EXPAND THAT
MENU WITHOUT SACRIFICING
ANY GAINS IN THE PROCESS.
outcomes related to training adaptations, the
presently reviewed meta-analysis did not find
meaningful differences between interval and
continuous exercise in terms of adherence or
injury rates, which means neither option is
universally more tolerable or more injurious
than the other.
This is fantastic, because it empowers lifters
to tailor their cardio choices to their prefer-
ences, which gives them a better chance of
finding a cardio option that they love (or, at
minimum, can tolerate). It’s not unusual for
lifters to seek out a little bit of extra cardio
for a variety of reasons, such as building up a
better aerobic base for their resistance train-
ing endeavors, changing their body composi-
tion, or taking a more active role in the man-
agement of their cardiometabolic health and
wellness. Lifters can achieve these endpoints
using a virtually limitless number of physical
activities that elevate their cardiac output and
energy expenditure, ranging from leisurely
hiking or kayaking to extremely intense cy-
cling, running, or rowing. You always want
to have more options rather than fewer, and,
while many evidence-based lifters used to
feel obligated to pick from a very short list
of specific cardio modalities, intensities, and
durations, we can dramatically expand that
menu without sacrificing any gains in the
process.
To clarify, I’m saying that various cardio
intensities and modalities are interchange-
able, but not identical. Different approaches
to cardio have their own pros and cons. For
example, if you have a really tight schedule,
high-intensity interval training is a fantastic
option due to its remarkable time efficien-
cy. Similarly, if long, continuous cardio ses-
sions bore you to tears, high-intensity inter-
val training provides a great way to get your
cardio over with while keeping it short and
engaging. On the other hand, some people
feel completely wiped out when they do a
lot of high-intensity (or maximal-intensity)
intervals. If you’ve made this observation in
your own training, continuous options with
lower intensities might be preferable. There
are many options on the table, all with dis-
tinct characteristics and advantages, but they
ultimately lead to similar body composition
outcomes.
Before I wrap things up, there’s one more
finding from this meta-analysis that deserves
some attention and discussion: in terms of ab-
solute changes, cardio doesn’t independently
57
cause dramatic weight loss or fat loss. When
compared to control groups, both interval ex-
ercise and continuous exercise led to small
reductions in fat mass (-0.20 kilograms and
-0.25 kilograms, respectively). It’s not noth-
ing, but it’s not much to write home about,
and this finding is pretty consistent with the
broader literature on cardio and weight loss.
Studies generally find that dietary modifica-
tions, alone or in combination with exercise,
are what really drive short-term weight loss,
whereas exercise alone doesn’t move the
needle much (6). That’s a bit disappointing,
but fairly intuitive – it takes a huge amount of
cardio to induce a large caloric deficit, which
could be achieved more feasibly with dietary
restriction. In addition, as your physical ac-
tivity level goes up, you increasingly have
to deal with compensatory adjustments that
chip away at your exercise-induced deficit.
So, when it comes to getting the most bang
for your buck, cardio is not the most direct,
time-efficient, or effort-efficient route to dra-
matic fat loss.
Having said that, all is not lost – despite un-
derwhelming effects on weight loss, exercise
appears to be a powerful tool for weight main-
tenance and the prevention of weight gain (6).
For example, as mentioned in previous MASS
articles, physical activity is associated with
the maintenance of long-term weight loss in
members of the National Weight Loss Regis-
try (7), and physical activity led to more suc-
cessful maintenance of long-term weight loss
in the Biggest Loser Study (8). A more recent
study investigating a weight loss drug called
liraglutide (9) put participants on an 8-week
low-calorie diet to induce weight loss before
assigning them to one of four groups: place-
bo plus usual activity, placebo plus exercise,
liraglutide plus usual activity, or liraglutide
plus exercise. The placebo plus usual activity
group regained 6.1kg of weight over the one-
year intervention, whereas the placebo plus
exercise group regained only 2.0kg, which
was a statistically significant difference be-
tween the two groups. Over that one-year
period, the placebo plus exercise group also
experienced a 1.8-point reduction in body-fat
percentage, which was slightly better than the
weight loss drug alone, and significantly bet-
ter than the placebo group with usual activity,
which experienced a small increase in body-
fat percentage over the same time period.
So, cardio isn’t going to radically transform
your body composition, but it can have some
modest positive impacts. In addition, physi-
cal activity seems to be a really effective way
PHYSICAL ACTIVITY SEEMS
TO BE A REALLY EFFECTIVE
WAY TO FACILITATE
WEIGHT MAINTENANCE
AND PREVENT WEIGHT
GAIN, EVEN IF IT DOESN’T
INDEPENDENTLY INDUCE
SUBSTANTIAL FAT LOSS.
58
to facilitate weight maintenance and prevent
weight gain, even if it doesn’t independent-
ly induce substantial fat loss. Beyond that,
physical activity delivers an enormous col-
lection of benefits that don’t have anything to
do with weight loss, and don’t require weight
loss in order to make a profoundly positive
impact. Whether you’re interested in build-
ing up your aerobic capacity, reducing sys-
temic inflammation, improving your blood
lipid profile, promoting better glycemic con-
trol, enhancing vascular function, bolstering
heart health, reducing fatigue in activities of
daily living, getting better sleep, improving
cognitive function, or generally extending
your healthspan and lifespan (10), exercise
is a beautiful thing, with or without weight
loss. That’s a long list of benefits, and the list
of viable ways to obtain them is even longer.
So, if you’re interested in adding a little bit
of extra physical activity or structured cardio
to the mix, choose an activity that suits your
preferences. As the results of the presently
reviewed meta-analysis suggest, it doesn’t
make too much sense to stress about finding
the perfect modality, intensity, and duration
for your cardio.
or relatively neutral energy balance will al-
ways translate to conditions of negative en-
ergy balance. When lean dieters push to get
even leaner, we see all the classic signs of in-
sufficient energy availability, such as a low ra-
tio of anabolic to catabolic hormones, fatigue,
and (in many cases) losses of fat-free mass.
In this state, dieters are relatively primed for
muscle loss, strength loss, and limited recov-
ery capacity. I’d be curious to see if cardio
exacerbates the loss of strength or lean mass
in these conditions, and if certain modalities
or intensities are better or worse than others. I
don’t suspect that the findings would be radi-
cally different from the results of the present-
ly reviewed meta-analysis, but I’d love some
more direct evidence to lean on.

Next Steps
We’ve got a decent amount of research eval-
uating the impact of various cardio inter-
ventions, both with and without resistance
training, on changes in strength and body
composition. However, I’d love to see more
work of this nature in dieters (and, more spe-
cifically, dieting bodybuilders). As one of my
research briefs from this month reinforces, we
can’t always assume that findings in positive

59
 APPLICATION AND TAKEAWAYS
Adding some extra physical activity or structured cardio to your routine can potentially
confer a long list of health benefits, and may also enhance performance if aerobic
capacity is holding you back in the gym. Exercise alone doesn’t have a huge impact
on weight loss, but many of its health benefits are obtained independently of weight
loss, and exercise can be very helpful in preventing weight gain. If you’re interested
in adding some cardio, but worried about it interfering with your pursuit of strength
and hypertrophy, finding a suitable form of cardio might not be as hard as you think.
Research is increasingly suggesting that adding some cardio to your resistance training
program generally has a minimal impact on changes in strength and hypertrophy.
Further, diverse forms of cardio (in terms of modality, intensity, and duration) seem
to have pretty similar effects on outcomes of interest. As such, the most pragmatic
approach is to select a form of cardio that suits your preferences and is most enjoyable
for you (or, at minimum, most tolerable).

60
References
1. Steele J, Plotkin D, Van Every D, Rosa A, Zambrano H, Mendelovits B, et al. Slow
and Steady, or Hard and Fast? A Systematic Review and Meta-Analysis of Studies
Comparing Body Composition Changes between Interval Training and Moderate
Intensity Continuous Training. Sports. 2021 Nov 18;9(11):155.
2. Wilson JM, Marin PJ, Rhea MR, Wilson SMC, Loenneke JP, Anderson JC. Concurrent
training: a meta-analysis examining interference of aerobic and resistance exercises. J
Strength Cond Res. 2012 Aug;26(8):2293–307.
3. Head ML, Holman L, Lanfear R, Kahn AT, Jennions MD. The Extent and Consequences
of P-Hacking in Science. PLoS Biol. 2015 Mar 13;13(3):e1002106.
4. Van Calster B, Steyerberg EW, Collins GS, Smits T. Consequences of relying on
statistical significance: Some illustrations. Eur J Clin Invest. 2018 May;48(5):e12912.
5. Amrhein V, Greenland S, McShane B. Scientists rise up against statistical significance.
Nature. 2019 Mar;567(7748):305–7.
6. Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The Role of Exercise
and Physical Activity in Weight Loss and Maintenance. Prog Cardiovasc Dis. 2014
Feb;56(4):441.
7. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10
years in the National Weight Control Registry. Am J Prev Med. 2014 Jan;46(1):17–23.
8. Kerns JC, Guo J, Fothergill E, Howard L, Knuth ND, Brychta R, et al. Increased physical
activity was associated with less weight regain six years after “The Biggest Loser”
competition. Obesity. 2017 Nov;25(11):1838–43.
9. Lundgren JR, Janus C, Jensen SBK, Juhl CR, Olsen LM, Christensen RM, et al. Healthy
Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. N Engl J Med.
2021 May 6;384(18):1719–30.
10. Gremeaux V, Gayda M, Lepers R, Sosner P, Juneau M, Nigam A. Exercise and
longevity. Maturitas. 2012 Dec;73(4):312–7.

61
Study Reviewed: Short Term Effects of Two Different Recovery Strategies on Muscle Contractile
Properties in Active Men: A Randomised Crossover Study. Mur-Gimeno et al. (2021)

Hot Water Immersion to Ignite

Your Recovery
BY MICHAEL C. ZOURDOS

It’s pretty well-known by now that regular ice baths may blunt
hypertrophy, but how about hot water baths? This article breaks
down a new study showing that post-training hot water immersion
speeds up recovery.

62
 KEY POINTS
1. Researchers compared the effects of hot and cold water immersion and
passive resting for recovery from resistance training in a crossover design.
Recovery was assessed using tensiomyography, which measures muscle belly
displacement, contraction velocity, and contraction time following electrical
stimulation of the muscle.
2. The researchers found that contraction velocity tended to recover more quickly
after 15 minutes of hot water immersion than after cold water immersion or rest.
3. This study suggests that heating the muscle following resistance training
is more effective than cooling the muscle to promote recovery. However, it
remains to be seen if more practical methods of post-exercise heating can
speed up recovery.

R
esearch has shown cold water im-
mersion to be a double-edged sword.
Some studies report that cold water
immersion attenuates inflammation (2) and
generally speeds up recovery following ex-
ercise (3). However, other studies have con-
sistently found that cold water immersion
attenuates the increase in anabolic protein
expression (4,  5). Additionally, Fyfe et al
(6 - MASS Review) reported that lifters who
sat in an ice bath post-exercise three times
per week for 15 minutes experienced signifi-
cantly less vastus lateralis hypertrophy than
the participants who just lifted (i.e., no re-
covery intervention). In light of the potential
downside of cold water immersion, studies
have investigated the effects of hot water im-
mersion on recovery. There is some evidence
to suggest that hot water immersion actually
increases the expression of anabolic proteins
in animal models and promotes faster recov-
ery of isometric squat performance and cre-
atine kinase in humans following resistance
training (7). The presently reviewed study
from Mur-Gimeno et al (1) pitted cold and
hot water directly against each other to as-
sess recovery following resistance training.
15 men performed five sets of eight reps at
an eight repetition maximum (RM) load in
three conditions. For 15 minutes post-exer-
cise, subjects either sat in an ice bath, sat in
hot water, or passively rested. Tensiomyog-
raphy (electrical stimulus sent to vastus me-
dialis) measures were assessed before train-
ing, immediately after training, immediately
after the 15-minute recovery intervention,
and 15, 30, 45, and 60 minutes post-recov-
ery. The tensiomyography tests provided the
researchers with assessments of muscle belly
displacement, contraction velocity, and con-
traction time (more details on these outcomes
later). The main finding was that muscle
contraction velocity tended to recover more
quickly following hot water immersion com-
pared to both other conditions. These results
suggest that muscle heating may improve re-
covery. Hot water immersion is a new top-
ic for MASS; thus, there is much to discuss.

63
This article will aim to:
1. Review the present study’s findings and
the literature on hot water immersion.
2. Discuss the underlying mechanisms of
hot water immersion.
3. Examine the potential effects of hot water
immersion on anabolic protein expression
and performance recovery from resistance
training.
4. Examine the applicability of both pre- and
post-training hot water immersion.
5. Discuss the practicality of hot water immer-
sion and other potential heating therapies.
Purpose and Hypotheses
Purpose
The purpose of the reviewed study was to
compare rates of recovery from resistance
training after post-training cold water immer-
sion, hot water immersion, or passive rest.
Hypotheses  
The researchers hypothesized faster recov-
ery of contraction velocity in the hot water
immersion condition than in the cold water
immersion and passive rest conditions.
Subjects and Methods
Subjects
28 “healthy active” men (28 ± 5 years old;
body mass index 23.2 ± 1.12 kg/m2) complet-
ed the study. Subjects were excluded if they
had sustained a limb injury in the previous
six months. Subjects were instructed to re-
frain from excessive exercise and consump-
tion of stimulants for 48 hours prior to each
laboratory visit.
Study Protocol
Each subject completed this crossover de-
sign study over four laboratory visits. Sub-
jects completed a leg extension 8RM test
during the first visit and each experimental
condition (hot water immersion, cold water
immersion, passive rest) in three subsequent
sessions separated by exactly one week.
In each condition, tensiomyography (de-
tails below) was assessed at baseline, and
then subjects performed 5 (sets) × 8 (reps) at
their previously established 8RM load. Ten-
siomyography was reassessed immediately
post-training. Next, the condition-specific re-
covery modality was performed. In the cold
water immersion condition, subjects sat in an
ice bath with a temperature of 10 ± 1°C for 15
minutes. Hot water immersion consisted of 15
64
minutes in a bathtub with a water temperature
of 42 ± 2°C. In both the hot and cold water
immersion conditions, the bathtub was filled
with 250 L of water. In the passive rest con-
dition, subjects sat on a bench for 15 minutes.
Researchers reassessed tensiomyography im-
mediately post-recovery and 15, 30, 45, and
60 minutes post-recovery. The complete study
procedures can be seen in Figure 1.
Tensiomyography
To measure tensiomyography, the research-
ers had subjects lie down on their backs with
their dominant leg bent 30 degrees at the
knee. An electrical stimulus was sent to the
vastus medialis muscle to elicit a muscle con-
traction. The researchers assessed three out-
comes from the resulting contraction: 1) radi-
al muscle belly displacement, 2) contraction by contraction time. In other words, contrac-
time, and 3) contraction velocity. tion velocity is the rate of contraction from
What exactly is radial muscle belly displace- 10 to 90% of the muscle belly displacement.
ment? Radial displacement can be described Essentially, a shorter muscle belly displace-
as moving away from the middle of an object. ment (decreased displacement) is observed in
In other words, radial displacement (mm), re- a fatigued state and is acutely associated with
fers to how far the muscle belly moves away a slower contraction velocity (8, 9). Conse-
from its center starting point. Tensiomyog- quently, contraction time often remains the
raphy is often referred to as assessing “mus- same or even increases even though the mus-
cle contractile properties.” This is because cle belly is moving a shorter distance.
decreased displacement is associated with The bottom line is that, when a muscle is elec-
increased muscle stiffness, while increased trically stimulated in a fatigued state, it tends
displacement is associated with decreased to have a lower muscle belly displacement (it
muscle stiffness (8). Increased displacement moves a shorter distance), which results in an
is indicative of acute recovery.
acutely decreased contraction velocity and
Muscle contraction time and contraction ve- a weaker contraction. In the present study,
locity were also recorded during the tensiom- when comparing cold water immersion, hot
yography assessments. Contraction time is the water immersion, and passive rest, the re-
time from 10-90% of radial displacement, and searchers aimed to identify the condition in
contraction velocity is displacement divided which tensiomyography parameters returned

65
to baseline the fastest. Figure 2 summarizes
the three outcomes derived from tensiomyog-
raphy in the present study.

Findings
Table 1 shows that hot water immersion led
to faster recovery of tensiomyography pa-
rameters at various time points compared
to cold water immersion or the passive rest
condition. Specifically, muscle displacement
recovered significantly faster (p < 0.001) im-
mediately post-intervention with hot (-4.2%
from baseline) than with cold (-16.6% from significantly faster with hot water immersion
baseline) water immersion. Contraction ve- than with passive rest (hot: +4.1%; passive
locity also recovered significantly faster with rest: -7.9%) 45 minutes post-intervention
hot water immersion immediately post-in- Further, contraction velocity declined sig-
tervention (hot: -3.1%; cold: -25.3%), 15 nificantly (p = 0.005) more with cold water
minutes (hot: -11.3%; cold: -25.3%), and 45 immersion (-25.3% from baseline) than with
minutes (hot: +4.1%; cold: -6.9%) post-in- passive rest (-12.4% from baseline) immedi-
tervention. Contraction velocity recovered ately post-intervention. Contraction time was

66
not significantly different (p > 0.05) between
conditions at any time point. Figures 3 and 4
show the time course recovery in muscle dis-
placement and contraction velocity.
Interpretation
The reviewed study from Mur-Gimeno et al
(1) suggests that cooling the muscle delays re-
covery and heating the muscle speeds recov-
ery, at least for the first hour post-training. Im-
portantly, this study showed that recovery of
contraction velocity was faster with hot water
than with cold water immersion, but hot water
also outperformed passive rest. That said, the
literature on hot water immersion and heating
techniques reports mixed results. Before we
dive into hot water immersion, let’s briefly
discuss the state of the literature for the more
commonly used cold water immersion.
Cold water immersion, as we’ve discussed be-
fore (one, two) appears to help recovery (2, 3)
and leads to quicker relief from muscle sore-
ness than cryotherapy (10). However, when
used regularly, cold water immersion consis-
tently blunts anabolic protein expression (4,
6, 11, 12), the acute response of testosterone
and various cytokines (13), muscle protein
synthesis (14), and type II fiber hypertrophy
(6). Despite the negative effect of cold water
immersion on muscle growth over the long
term, is it still viable to use every once in a
while to accelerate short term recovery?
Wilson et al (15) recently found that cold
water immersion failed to speed recovery of
muscle soreness and inflammation compared
to passive rest following resistance training.
67
Additionally, the presently reviewed study
(1) suggests that cold water immersion may
impair recovery of contraction velocity with-
in the first hour following the immersion
compared to passive rest. Further, a recent
meta-analysis from Malta et al (16) found
that regular ice baths attenuate long term
1RM strength. Despite the potential benefit
of cold water immersion for acute recovery,
the long term attenuation of both hypertrophy
and strength makes it difficult to recommend
post-training ice baths on any level. Cold wa-
ter immersion is also not a practical strategy;
thus, it makes little sense to spend the time
and effort to engage in a practice that may
have a marginal benefit and potentially harm-
ful effect. I’m not opposed to trying a strat-
egy that might have a marginal benefit, but
it would have to be cheap and practical with
little downside (i.e. foam rolling).
Hot water immersion falls under the umbrel-
la of heat therapy, which also includes sauna,
heat sheets, a heated environmental chamber,
and microwave diathermy (electromagnetic
waves of heat emitted to the skin). The gen-
eral rationale for heating is to increase blood
flow to the muscle, possibly leading to a myr-
iad of positive recovery responses. Studies
in animal models have found hot water im-
mersion (17, 18) and environmental chamber
heating (19) to enhance satellite cell expres-
sion following muscle injury or trauma. In hu-
mans, there are both null (20, 21) and positive
(22, 23) findings for the effect of heat on re-
covery. Vaile et al (22) found that, compared
to passive rest, 14 minutes of hot water im-
mersion attenuated the decrease in isometric
squat performance and the increase in cre-
atine kinase in the days following a bout of 7
(sets) × 10 (reps) on the eccentric leg press.
Another study reported that post-training hot
water immersion improved cycling time trial
performance (23). Nonetheless, other studies
have failed to show a benefit of hot water im-
mersion on recovery following rowing (21) or
of a heating pad following five sets of leg ex-
tensions (20). Further, Fuchs et al (24) found
that hot water immersion failed to augment
post-training muscle protein synthesis com-
pared with immersing the exercised muscle in
thermoneutral water (the water temperature at
which body temperature is maintained).
There are a handful of relevant longitu-
dinal studies on heating and performance
(25, 26, 27, 28, 29, 30, 31). These studies have
mixed results. Two studies implemented in-
tra-session (during training) heating, two used
heating post-training, and the other two im-
plemented longitudinal heating interventions
with no resistance training. Importantly, al-
though there are mixed results, only one study
(a conference abstract) suggests that heating
causes the sorts of deleterious longitudinal ef-
fects associated with muscle cooling.
Let’s start with the intra-session heating
studies. Goto et al (25) had subjects perform
3 (sets) × 30 (reps) of curls four times per
week for 10 weeks. One arm was placed on a
“heat sheet” for 60 consecutive minutes. The
curls were performed during the last 30 min-
utes of the heat sheet application. Findings
showed that skin temperature of the heated
arm acutely increased 2°C (to a temperature
of 38°C) during each session. Over the 10
weeks, the heated arm increased isometric
torque by 6.9% more than the unheated arm.
68
Perhaps most impressive, subjects increased
biceps cross-sectional area of the heated arm,
on average, by 7.5 ± 5.5% but only by 0.3 ±
4.8% in the unheated arm. One caveat is that
the heat in this study was only applied to the
non-dominant arm; thus, the non-dominant
arm could have had more room to grow.
Similarly, Nakamura et al (26) found that a
heating pad applied to the triceps during a
six-week training program also enhanced
muscle growth. In a within-subjects design,
30 untrained men trained three days per
week; one arm performed lying dumbbell tri-
ceps extensions with a heating pad while the
other arm performed triceps extensions with-
out heat. The authors reported 7.6% (estimat-
ed from WebPlotDigitizer) greater triceps
growth in the heating condition. The findings
from the Goto and Nakamura papers are pret-
ty impressive. While I’m still not sold that
this finding would hold up, it’s possible that
it is specific to low loads. Admittedly, I was
also not aware of these papers before writing
this article; thus, I’m still wrapping my head
around the reportedly large benefit of heating
for muscle growth.
In another study from Stadnyk et al (27), 10
men and women who had not lifted in the
prior six months performed 4 × 8 unilateral
leg extensions at 70% of 1RM with load pro-
gressing over 12 weeks. Subjects performed
30 total sessions. A heating pad was applied
to one leg to increase skin temperature to
38°C; the authors aimed for the same target
skin temperature as Goto et al. The other leg
performed leg extensions with no heat. The
authors reported no significant differences
between groups for gains in 3RM strength
and quadriceps lean mass over the 12 weeks.
Meline et al 2021 (28) recently compared
the use of post-exercise hot water immersion
once per week o a control condition of pas-
sive rest in a crossover design (10-day wash-
out). This 4-week study employed a mixed-
sex population of elite speed skaters. Meline
did not directly examine recovery; rather, the
authors reported pre- to post-study changes
in performance markers. Meline found that
quad and hamstring cross-sectional areas sig-
nificantly increased in the passive rest condi-
tion but not in the hot water condition. How-
ever, the within-condition effect size for both
the hot water and passive rest conditions was
trivial, and the difference in muscle growth
between conditions was only 0.3 (quad) and
0.9 cm2 (hamstring). Meline also found that
skaters significantly decreased time to com-
plete one lap around the ice in the passive rest
condition but not in the hot water condition.
However, lap time improved by 0.2 seconds
in the passive rest condition versus 0.1 sec-
onds in the hot water condition; thus, we can-
not conclude a detrimental effect of hot water
immersion. Lastly, Meline reported a signif-
icant but small increase in isometric leg ex-
tension strength for hot water immersion and
a significant but small decrease in the pas-
sive rest condition. The difference between
conditions for strength was also significant;
however, the magnitude was again minimal,
and the superiority of either condition cannot
be confidently stated.
A conference abstract from Peake et al (29)
found that lifters who used post-exercise hot
water immersion for 10 minutes twice per
week for 10 weeks experienced significantly
69
lower relative increases in leg muscle mass
measured via DXA. Further, Peake report-
ed that hot water immersion did not enhance
long term leg press, leg extension, or leg curl
strength gains compared to passive rest.
A study from Kim et al (30) and another one
from Goto et al (31) examined heat thera-
py versus a control condition for long term
muscle performance, but neither condition
performed exercise training of any kind.
Kim used a within-subject design in which
the participants wore a heating garment on
one leg that circulated water at 52°C for 90
minutes while the other leg was not exposed
to heat. After eight weeks, neither leg expe-
rienced significant muscle growth. The heat-
ed leg experienced 4% greater gains in iso-
metric leg extension strength; however, this
group difference was non-significant. Goto
also used a within-subject design and applied
a heat sheet to the quads on one leg four days
per week for eight hours per day over 10
weeks while the other leg received no treat-
ment. In this study, leg extension torque and
cross-sectional area of quadriceps muscles
significantly increased in the heating condi-
tion but not in the control condition.
Typically, muscle heating aims to raise skin
temperature to around 38-40°C. Hot baths or
saunas are usually administered for about 15
minutes. All these methods aim to increase
blood flow to the muscle, which is a quintes-
sential aspect of improving recovery. How-
ever, there are not many applicable human
trials related to heating, and the ones that
do exist are underdeveloped. Animal trials
have consistently shown greater expression
of muscle protein content following induced
atrophy or stress (17, 18), and increased mus-
cle mass during ‘reloading” following a week
of immobilization (32). Thus, at the moment,
there’s more evidence for heating to regener-
ate muscle following trauma or atrophy rath-
er than for recovery or long term growth.
Since neither post-exercise cooling nor heat-
ing seems to be a slam dunk, I don’t think
it’s worth harping too much on the unsurpris-
ingly equivocal findings related to contrast
water therapy (a mix of cooling and heating).
A 2017 meta-analysis (33) on contrast water
therapy concluded that it did not statistically
improve recovery or perception of soreness
compared to passive rest in team sport ath-
letes, but that the findings were ultimately
equivocal. A recent review (34) also noted
equivocal findings for contrast water therapy
and recovery. Importantly, in the cases where
contrast water therapy has aided recovery, it
is primarily for indirect markers of muscle
damage (33) and not resistance training per-
formance. There is also a great deal of be-
tween-study variation in contrast water ther-
apy prescription, which may in part account
for the ambiguous body of literature. How-
ever, if you were to engage in contrast water
therapy, the suggested protocol is about 15
minutes total with a 1:1 alternating ratio of
hot and cold therapies (35).
Lastly, there are, of course, many recovery
options to consider. Most lifters train a mus-
cle group 2-3 times per week and train once
per training day. There are exceptions, but
that schedule would include the majority of
people. When considering that setup, some-
body should first ensure that their training is
structured appropriately before even consid-
70
ering the need for a recovery modality. The
point is, if you feel that you always need a
recovery strategy to be ready for your next
training session, then you probably need to
restructure your training. Once training is
laid out in a fashion that allows for suffi-
cient recovery from session to session, then
it might be worth exploring recovery options.
In my opinion, a useful recovery strategy will
fit the following criteria: 1) it isn’t detrimen-
tal in some way, 2) it is practical, 3) it isn’t
too time-consuming, and 4) it is cheap or free
of monetary cost. Even if hot or cold baths
were consistently effective with no down-
side, it’s unlikely that everyone would start
using them due to the impracticality. On the
other hand, modalities such as foam rolling
and low intensity cycling/walking do fit the
criteria. Other modalities such as compres-
sion garments and massage aren’t too im-
practical either. As noted previously, I don’t
think foam rolling is that effective (see my
video series: Part 1, Part 2), but post-exercise
foam rolling doesn’t really have a downside.
I’d wager that many more people engage in
foam rolling than most other recovery met-
rics simply because it doesn’t harm them
and it’s practical. With that said, even if re-
searchers suddenly churn out a large number
of beneficial hot water immersion studies, I
don’t see the practice catching fire outside
of collegiate and professional teams with the
time and resources to continuously engage in
the practice.
Next Steps
We need more longitudinal studies on heat ap-
plication. The good news is that I think a lon-
gitudinal study could also capture acute and
practical components. I’d have two groups of
lifters train three times per week (i.e., M, W,
F) for eight weeks (or some other long term
time frame). Both groups would perform the
same training program, but one group would
apply heat pads to the trained muscles after
each session while the other group passively
rested. I’d make the first session of the week
high volume training with some sets taken to
failure to cause sufficient muscle damage and
fatigue. Then I would assess indirect muscle
damage and perceived readiness just before
the next training session (48 hours later).
During the next session, I would include some
sort of volume test, such as 5 sets at 70%, with
each set taken to a 2 RIR. The assessments of
indirect muscle damage markers, motivation
to train, and volume performance at 48 hours
would serve as outcomes each week for the
time course of recovery between heating the
muscle and passive resting. Additionally,
pre- and post-study strength and hypertrophy
measurements would be taken for the longi-
tudinal outcomes.
71
 APPLICATION AND TAKEAWAYS
1. Mur-Gimeno et al (1) reported that recovery following resistance training,
assessed by tensiomyography parameters, tended to be faster when subjects sat
in a hot water bath compared to cold water immersion or passive rest.
2. Over the long term, cold water immersion seems to attenuate hypertrophy and
strength adaptations.
3. Hot water immersion may have some efficacy for recovery within the first 60
minutes following training. However, there is currently insufficient evidence to
support the use of consistent hot water baths for recovery. Additionally, a hot
water bath immediately post-training is not a practical strategy for most lifters.
Thus, other recovery modalities (i.e., foam rolling, massage, low intensity exercise)
may be a better choice for regular use.

72
References
1. Mur-Gimeno E, Sebio-Garcia R, Solé J, Lleida A, Moras G. Short-term effects of two
different recovery strategies on muscle contractile properties in healthy active men: A
randomised cross-over study. Journal of Sports Sciences. 2021 Dec 3:1-9.
2. Peake JM, Roberts LA, Figueiredo VC, Egner I, Krog S, Aas SN, Suzuki K, Markworth
JF, Coombes JS, Cameron-Smith D, Raastad T. The effects of cold water immersion
and active recovery on inflammation and cell stress responses in human skeletal mus-
cle after resistance exercise. The Journal of physiology. 2017 Feb 1;595(3):695-711.
3. Poppendieck W, Faude O, Wegmann M, Meyer T. Cooling and performance recov-
ery of trained athletes: a meta-analytical review. International journal of sports phys-
iology and performance. 2013 May 1;8(3):227-42.
4. Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, Camer-
on-Smith D, Coombes JS, Peake JM. Post-exercise cold water immersion attenuates
acute anabolic signalling and long-term adaptations in muscle to strength training. J
Physiol. 2015 Sep 15;593(18):4285-301.
5. Yamane M, Ohnishi N, Matsumoto T. Does Regular Post-exercise Cold Application
Attenuate Trained Muscle Adaptation? Int J Sports Med. 2015 Jul;36(8):647-53.
6. Fyfe JJ, Broatch JR, Trewin AJ, Hanson ED, Argus CK, Garnham AP, Halson SL,
Polman RC, Bishop DJ, Petersen AC. Cold water immersion attenuates anabolic sig-
naling and skeletal muscle fiber hypertrophy, but not strength gain, following whole-
body resistance training. Journal of Applied Physiology. 2019 Nov 1;127(5):1403-18.
7. McGorm H, Roberts LA, Coombes JS, Peake JM. Turning up the heat: an evaluation
of the evidence for heating to promote exercise recovery, muscle rehabilitation and
adaptation. Sports medicine. 2018 Jun;48(6):1311-28.
8. Macgregor LJ, Hunter AM, Orizio C, Fairweather MM, Ditroilo M. Assessment of
skeletal muscle contractile properties by radial displacement: the case for tensiomy-
ography. Sports Medicine. 2018 Jul;48(7):1607-20.
9. García-García O, Cuba-Dorado A, Álvarez-Yates T, Carballo-López J, Igle-
sias-Caamaño M. Clinical utility of tensiomyography for muscle function analysis in
athletes. Open access journal of sports medicine. 2019;10:49.

73
10. Abaïdia AE, Lamblin J, Delecroix B, Leduc C, McCall A, Nédélec M, Dawson B,
Baquet G, Dupont G. Recovery from exercise-induced muscle damage: cold-water
immersion versus whole-body cryotherapy. International journal of sports physiology
and performance. 2017 Mar 1;12(3):402-9.
11. Hyldahl RD, Peake JM. Combining cooling or heating applications with exercise
training to enhance performance and muscle adaptations. Journal of Applied Physiol-
ogy. 2020 Aug 1;129(2):353-65.
12. Yamane M, Ohnishi N, Matsumoto T. Does Regular Post-exercise Cold Application
Attenuate Trained Muscle Adaptation? Int J Sports Med. 2015 Jul;36(8):647-53.
13. Earp JE, Hatfield DL, Sherman A, Lee EC, Kraemer WJ. Cold-water immersion
blunts and delays increases in circulating testosterone and cytokines post-resistance
exercise. European Journal of Applied Physiology. 2019 Aug;119(8):1901-7.
14. Fuchs CJ, Kouw IW, Churchward-Venne TA, Smeets JS, Senden JM, Lichtenbelt
WD, Verdijk LB, van Loon LJ. Postexercise cooling impairs muscle protein synthesis
rates in recreational athletes. The Journal of physiology. 2020 Feb;598(4):755-72.
15. Wilson LJ, Dimitriou L, Hills FA, Gondek MB, Cockburn E. Whole body cryothera-
py, cold water immersion, or a placebo following resistance exercise: a case of mind
over matter?. European journal of applied physiology. 2019 Jan;119(1):135-47.
16. Malta ES, Dutra YM, Broatch JR, Bishop DJ, Zagatto AM. The effects of regu-
lar cold-water immersion use on training-induced changes in strength and endur-
ance performance: a systematic review with meta-analysis. Sports Medicine. 2021
Jan;51(1):161-74.
17. Takeuchi K, Hatade T, Wakamiya S, Fujita N, Arakawa T, Miki A. Heat stress pro-
motes skeletal muscle regeneration after crush injury in rats. Acta histochemica. 2014
Mar 1;116(2):327-34.
18. Shibaguchi T, Sugiura T, Fujitsu T, Nomura T, Yoshihara T, Naito H, Yoshioka T,
Ogura A, Ohira Y. Effects of icing or heat stress on the induction of fibrosis and/
or regeneration of injured rat soleus muscle. The Journal of Physiological Sciences.
2016 Jul;66(4):345-57.
19. Naito H, Powers SK, Demirel HA, Sugiura T, Dodd SL, Aoki J. Heat stress attenuates
skeletal muscle atrophy in hindlimb-unweighted rats. Journal of Applied Physiology.

74
 2000 Jan 1;88(1):359-63.
20. Jayaraman RC, Reid RW, Foley JM, Prior BM, Dudley GA, Weingand KW, Meyer
RA. MRI evaluation of topical heat and static stretching as therapeutic modalities
for the treatment of eccentric exercise-induced muscle damage. European journal of
applied physiology. 2004 Oct;93(1):30-8.
21. Pournot H, Bieuzen F, Duffield R, Lepretre PM, Cozzolino C, Hausswirth C. Short
term effects of various water immersions on recovery from exhaustive intermittent
exercise. European journal of applied physiology. 2011 Jul;111(7):1287-95.
22. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on the signs and symp-
toms of delayed onset muscle soreness. European journal of applied physiology. 2008
Mar;102(4):447-55.
23. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on recovery from fa-
tigue. International journal of sports medicine. 2008 Jul;29(07):539-44.
24. Fuchs CJ, Smeets JS, Senden JM, Zorenc AH, Goessens JP, van Marken Lichtenbelt
WD, Verdijk LB, van Loon LJ. Hot-water immersion does not increase postprandi-
al muscle protein synthesis rates during recovery from resistance-type exercise in
healthy, young males. Journal of Applied Physiology. 2020 Apr 1;128(4):1012-22.
25. Goto K, Oda H, Morioka S, Naito T, Akema T, Kato H, Fujiya H, Nakajima Y, Su-
giura T, Ohira Y, Yoshioka T. Skeletal muscle hypertrophy induced by low-intensi-
ty exercise with heat-stress in healthy human subjects. Jpn J Aerosp Environ Med.
2007;44(1):13-8.
26. Nakamura M, Yoshida T, Kiyono R, Sato S, Takahashi N. The effect of low-intensity
resistance training after heat stress on muscle size and strength of triceps brachii: a
randomized controlled trial. BMC musculoskeletal disorders. 2019 Dec;20(1):1-6.
27. Stadnyk AM, Rehrer NJ, Handcock PJ, Meredith-Jones KA, Cotter JD. No clear ben-
efit of muscle heating on hypertrophy and strength with resistance training. Tempera-
ture. 2018 Apr 3;5(2):175-83.
28. Méline T, Solsona R, Antonietti JP, Borrani F, Candau R, Sanchez AM. Influence of
post-exercise hot-water therapy on adaptations to training over 4 weeks in elite short-
track speed skaters. Journal of Exercise Science & Fitness. 2021 Apr 1;19(2):134-42.
29. Peake J, McGorm H, Roberts L, Coombes J, Cameron-Smith D, Raastad T. Chronic

75
 and Acute Effects of Hot Water Immersion on Strength, Recovery and Hypertrophy.
The FASEB Journal. 2017 Apr;31:lb735.
30. Kim K, Reid BA, Casey CA, Bender BE, Ro B, Song Q, Trewin AJ, Petersen AC,
Kuang S, Gavin TP, Roseguini BT. Effects of repeated local heat therapy on skeletal
muscle structure and function in humans. Journal of Applied Physiology. 2020 Mar
1;128(3):483-92.
31. Goto K, Oda H, Kondo H, Igaki M, Suzuki A, Tsuchiya S, Murase T, Hase T, Fujiya H,
Matsumoto I, Naito H. Responses of muscle mass, strength and gene transcripts to long-
term heat stress in healthy human subjects. European journal of applied physiology. 2011
Jan;111(1):17-27.
32. Selsby JT, Rother S, Tsuda S, Pracash O, Quindry J, Dodd SL. Intermittent hyperthermia
enhances skeletal muscle regrowth and attenuates oxidative damage following reloading.
Journal of applied physiology. 2007 Apr;102(4):1702-7.
33. Higgins TR, Greene DA, Baker MK. Effects of cold water immersion and contrast water
therapy for recovery from team sport: a systematic review and meta-analysis. The Journal
of Strength & Conditioning Research. 2017 May 1;31(5):1443-60.
34. Greenhalgh O, Alexander J, Richards J, Selfe J, McCarthy C. The use of contrast therapy
in soft tissue injury management and post-exercise recovery: a scoping review. Physical
Therapy Reviews. 2021 Jan 2;26(1):64-72.
35. Versey NG, Halson SL, Dawson BT. Water immersion recovery for athletes: effect
on exercise performance and practical recommendations. Sports medicine. 2013
Nov;43(11):1101-30.

76
 Study Reviewed: The effects of Acute Exercise on Appetite and Energy Intake in Men and
Women. Tobin et al. (2021)

Exercise and Appetite Regulation:

Hungry For Gains, or Hungry From
Training?
BY ERIC TREXLER

Does exercise make you hungry? Anecdotal experiences vary

markedly, which usually means we need to dig deeper to identify
contextual factors influencing the relationship between exercise
and appetite. That’s exactly what this article aims to do.

77
 KEY POINTS
1. The presently reviewed study evaluated the impact of biological sex and exercise
modality on acute appetite responses to exercise.
2. The effect of exercise modality was not statistically significant. Female participants
generally reported lower hunger and prospective food consumption, but didn’t
consume fewer calories (relative to their energy needs) in a subsequent test meal.
3. Increasing physical activity seems to tighten the relationship between energy
expenditure and energy intake by influencing appetite regulation. The effect of
activity level adjustments on appetite may differ from context-to-context and
person-to-person, but there is insufficient evidence to suggest that sex or exercise
modality significantly influences this relationship.

W
ithin the few social media com-
munities I regularly inhabit, I’ve
recently seen a couple of really
interesting discussions about if (and how) ex-
ercise impacts appetite. One aspect of these
conversations that really grabs my attention
is the apparent heterogeneity of responses,
and the anecdotal experiences that appear –
on the surface – to be fully contradictory. It’s
fairly common to see people ask why their
recent uptick in total exercise volume is mak-
ing them so ravenously hungry, only for ut-
terly baffled posters to respond that exercise
completely extinguishes their appetite. Of
course, contradictory anecdotes can some-
times be attributed to erroneous observations
or skewed perspectives, but there seems to be
more to the exercise and appetite discussion
than meets the eye.
I was quite pleased to see that a new study (1)
investigated the relationship between acute
exercise and appetite responses, specifically
focusing on biological sex and exercise type
as variables that may influence the relation-
ship. In the presently reviewed study, 24 par-
ticipants (12 males and 12 females) visited
the laboratory three times: they completed a
45-minute aerobic exercise protocol in one
visit, a ~45-minute resistance exercise proto-
col in another visit, and rested for 45 minutes
in the third (control) visit. They consumed a
standardized diet the day prior to each visit,
which was customized to provide the appro-
priate amount of total energy for each indi-
vidual. Measurements related to appetite, ap-
petite-related biomarkers, and cravings were
assessed over the course of 180-minutes.
Participants consumed a standardized break-
fast after the baseline measurements and per-
formed the assigned exercise bout (or rest)
following the 30-minute measurements. Af-
ter the final measurements were taken at 180
minutes, participants were placed in a private
room for 30 minutes to consume as an ad li-
bitum test meal.
Female participants generally reported lower
hunger than males, although this was more
pronounced during the aerobic exercise and

78
resting visits than the resistance exercise
visit. These lower subjective hunger ratings
did not correspond with any significant dif-
ferences in hunger-related blood biomarkers,
nor did they lead to lower relative energy
intake (scaled to estimated energy require-
ments) during the ad libitum meal. There’s
clearly some nuance surrounding this topic
that needs to be explored, which is exactly
what this article aims to do.
Purpose and Hypotheses
Purpose
The purpose of the presently reviewed study
was “to compare the effects of an acute bout
of [resistance exercise], [aerobic exercise],
and a sedentary control condition on hormon-
al and behavioral indices of appetite regula-
tion and [energy intake] in men and women
with [overweight/obesity].” Sorry for all the
brackets – they used a lot of abbreviations.
Hypotheses
The hypotheses were not clearly stated for
each study outcome, but it seems like they
generally anticipated a greater degree of ap-
petite stimulation from exercise in females
compared to males.
Subjects and Methods
Subjects
24 participants (12 males and 12 females with
similar age and BMI characteristics) com-
pleted the study. Five of the female partici-
pants (41.7%) were using hormonal contra-
ceptives during the study. Participants were
healthy, weight stable (had not gained or lost
more than 5% of their body weight in the six
months preceding the study), and physically
inactive (performed less than 150 minutes per
week of moderate-intensity activity and few-
er than two resistance exercise sessions per
week). Female participants were excluded
if they were pregnant, lactating, peri-meno-
pausal, post-menopausal, oligomenorrheic,
amenorrheic, or had given birth within six
months prior to the study. Characteristics of
all 24 participants are presented in Table 1.
79
Methods
The presently reviewed paper (1) is a sec-
ondary analysis of a previously published
study (2). Prior to the three experimental vis-
its, participants reported for a baseline body
composition assessment and to complete the
Three-Factor Eating Questionnaire (which
assesses dietary restraint, disinhibition, and
hedonic hunger). Then participants com-
pleted four familiarization sessions. In two
visits, they completed the aerobic exercise
condition, which consisted of a five-minute
warmup, 35 minutes of walking at 65-70%
of age-predicted maximal heart rate, and a
five-minute cooldown. In the other two, they
completed the full-body resistance exercise
condition, which consisted of one set of 12
different exercises to “failure” (12-15 reps
with an RPE of 9-10 on a 10-point scale),
with 3 minutes of rest between each exercise.
After the familiarization sessions, partici-
pants completed the three experimental vis-
its (resistance exercise, aerobic exercise, or
rest) in a randomized order. Participants con-
sumed an individualized diet (yielding 20%
protein, 30% fat, and 50% carbohydrate) the
day prior to each testing visit, which was
provided by the research team. On the day of
testing visits, participants arrived at the lab
in a fasted state (at least 10 hours). Baseline
tests included a blood draw and completion
of visual analogue scales to assess hunger,
satiety, and prospective food consumption
(how much people thought they could eat).
Then participants consumed a standardized
breakfast that was individualized to provide
25% of their daily energy requirements with
the same macronutrient breakdown as the
previous day’s diet. Blood draws and appe-
tite assessments were repeated 30, 90, 120,
150, and 180 minutes after consumption
of the standardized breakfast. Participants
performed the exercise bout (or rest, in the
control condition) after the 30-minute mea-
surements, and completed the Food Craving
Inventory questionnaire after the 90-min-
ute measurements. Finally, following the
180-minute measurements, participants were
taken to a private room and given 30 minutes
of access to an ad libitum test meal consisting
of lasagna, pound cake, and a bunch of other
side dishes.
Outcomes of interest included blood biomark-
ers related to hunger and satiety (ghrelin, pep-
tide YY, and glucagon-like peptide-1 [GLP-
1]), the subjective questionnaire and visual
analogue scale responses related to hunger
and cravings, and actual energy intake during
the ad libitum test meal. While 24 participants
completed the study, there were some missing
data to acknowledge: it appears that baseline
body composition data were available for 19
participants, ghrelin and peptide YY data were
available for 21 participants, and GLP-1 data
were available for 17 participants.
Findings
There were no significant sex (male or fe-
male) × condition (aerobic exericse, resis-
tance exercise, or control) interactions, nor
were there any significant differences in hor-
mone concentrations between sexes over the
duration of the experimental visits. Area-un-
der-curve values are presented for each hor-
mone (ghrelin, peptide YY, and GLP-1) in
Table 2.
80
Results for hunger, satiety, prospective food
consumption, and relative energy intake
during the ad libitum test meal are present-
ed in Table 3. The researchers did not report
a p-value for the sex × condition interaction
effect for hunger responses, so I’m assuming
it was not statistically significant. Nonethe-
less, the researchers did report a main effect
of sex; post-hoc analyses indicated that males
had significantly greater hunger levels than
females in the aerobic exercise and control
conditions, while the difference between sex-
es was smaller (and non-significant) in the
resistance exercise condition. For satiety re-
sponses, the sex × condition interaction effect
was not statistically significant, nor were the
main effects of sex or condition. For prospec-
tive food consumption, the sex × condition
interaction effect was not reported, which
I once again assume to reflect non-signifi-
cance. The researchers did report a main ef-
fect that was close to the significance thresh-
old (p = 0.06) – they didn’t clearly state if it
was the main effect of sex or condition, but I
believe they’re referring to the effect of sex.
Much like the hunger results, post-hoc tests
revealed that prospective food consumption
values were significantly higher in males
than females in the aerobic exercise and con-
trol conditions, while the difference between
sexes was smaller (and non-significant) in
the resistance exercise condition.
As for the scores from the Food Craving
Inventory questionnaire, the results aren’t
reported very clearly. The researchers men-
tioned that “there were no statistical differ-
ences between men and women in [Food
Craving Inventory] scores across conditions”
and that “within each sex, there was no statis-
tical difference across conditions in … [Food
Craving Inventory] scores.” Rather than pro-
viding the p-values for interaction effects or
main effects, they appeared to jump right into
what would typically be post-hoc compari-
sons, but it seems like there’s generally noth-
ing noteworthy to report for craving scores.
During the ad libitum test meal, men con-
sumed more total calories, with between-sex
comparisons yielding p-values mostly in the
0.06-0.07 range. This is to be expected, as the
male participants had higher energy needs
81
than the female participants (in absolute
terms). However, in relative terms (scaled to
estimated energy requirements), energy in-
take was not significantly different between
the male and female participants (Table 3).
Criticisms and Statistical
Musings
As this study used the typical frequentist two-
way ANOVA approach, the first objective
when reporting the results is to clearly iden-
tify, at minimum, the decisions related to the
three hypothesis tests built into the statistical
model: the sex × condition interaction effect,
the main effect of sex, and the main effect
of condition. Within this statistical paradigm,
you would reject or fail to reject the null hy-
pothesis corresponding to each effect based
on the calculated p-value for each. If the sex
× condition interaction effect was statistical-
ly significant, you’d typically follow up by
performing specific pairwise comparisons
that assess the impact of one variable across
levels of the other variable (for example, you
might compare males versus females at each
level of the “condition” variable [control,
aerobic exercise, and resistance exercise], or
you might compare the different conditions
[control, aerobic exercise, and resistance ex-
ercise] within males only and females only).
On the other hand, if a main effect was sig-
nificant (and the interaction effect was not),
you’d further explore that main effect by
comparing the levels of that variable while
controlling for the other variable. For exam-
ple, if there was a main effect of sex, you’d
control for the effect of condition (control,
aerobic exercise, and resistance exercise) and
make a single, general comparison of male
values versus female values for the outcome
of interest. Alternatively, if there was a main
effect of condition, you’d compare the three
conditions for the whole sample of partici-
pants, while controlling for the impact of sex.
In the presently reviewed study, some of the
decisions and p-values related to interaction
effects and main effects were not explicitly
reported, and it appears that significant main
effects were further explored using post-hoc
procedures that would typically be used only
for the exploration of significant interaction
82
effects. To be clear, I’m not saying that the
standard guidelines I’ve described for this
statistical approach represent the best or only
way to make inferences about data. I’m sim-
ply noting that researchers inevitably commit
to a particular paradigm for their data analysis
– each of which comes with its own expecta-
tions – and there was a slight disconnect be-
tween how these analyses were completed and
the way you’d expect them to be reported.
I don’t want to nitpick for the sake of being
critical – it appears that this is one of the first
papers published by this lead author, and it’s
certainly much better than any of my earli-
est attempts at publication. It’s also possible
that this approach to statistical reporting was
intentionally chosen to avoid republishing
findings from a previous paper from the same
dataset (2). Nonetheless, I wanted to acknowl-
edge that the reporting for this study was a bit
unclear to me for one specific, self-serving
reason: readers with advanced knowledge
of statistics might wonder why I presented
the results in such a disjointed way, and dis-
cussed post-hoc comparisons that weren’t re-
ally compatible with the results of the initial
ANOVA. They might be wondering why I
provided some values and comparisons but
not others. Ultimately, I’m playing the cards
I was dealt, and trying to provide the most
informative summary possible with the re-
sults reported in the paper. They might not be
100% comprehensive and “by the book,” but
they give us plenty of useful information to
fuel practical conclusions and applications,
which is what MASS is all about. So, I’m ap-
preciative of the researchers’ efforts (and the
data that those efforts yielded), and I’m hap-
py to adopt a pragmatic perspective and look
past some minor statistical quibbles.
Interpretation
Before we dig into the details, we should op-
erationally define what constitutes one’s “ap-
petite.” I think Beaulieu et al did this excep-
tionally well in their 2017 review paper (3)
that Dr. Helms previously covered in MASS,
so I will paraphrase their conceptual model.
Appetite is ultimately influenced by a com-
bination of psychological and physiological
factors related to hunger (which drives feed-
ing), satiation (which terminates feeding), and
satiety (which is the post-meal suppression of
hunger). Appetite and energy intake are influ-
enced by episodic signals (with meal-to-meal
and diurnal fluctuations throughout the day
that impact meal initiation, termination, and
satiety) and tonic signals (which stem from
body tissues and cells that convey informa-
tion about cumulative, long-term aspects of
energy availability).
While physiological factors are very import-
ant, psychological and behavioral factors are
also highly influential. Examples include the
hedonic drive to eat for the enjoyment of great
food, behavioral traits or habits that impact
our feeding behaviors, obesogenic feeding
environments, and potential links between
emotional responses and feeding behaviors.
In summary, appetite and energy intake are
impacted by a combination of homeostatic
mechanisms (largely driven by physiological
factors) and non-homeostatic mechanisms
(largely driven by psychological and behav-
ioral factors).
83
We’re generally interested in appetite be-
cause of an assumed link between appetite
and energy intake. If we look at the first paper
published from this dataset (2), we can see
there were no differences among conditions
(resistance exercise, aerobic exercise, or con-
trol) in terms of ad libitum energy intake or
appetite ratings. While this appears to reflect
no appetite suppression despite completion
of an energy-consuming exercise bout, you
could argue (as the authors did) that, given
the calories burned during exercise were not
replaced or compensated for, similar appe-
tite and energy intake reflects some relative
degree of appetite reduction. In the present-
ly reviewed paper, females generally report-
ed lower subjective hunger and prospective
food intake than males, but did not consume
fewer calories (relative to their energy needs)
in the ad libitum meal. This uncoupling of
subjective hunger and energy intake seems
paradoxical, but it appears to be a somewhat
common observation. As reviewed by King
et al (4) and Dorling et al (5), there is consid-
erable experimental support for the idea that
exercise acutely suppresses appetite as long
as exercise intensity is sufficiently high, but
this appetite suppression doesn’t consistently
alter energy intake in meals consumed fol-
lowing the exercise bout.
There could be a large number of plausible
explanations for this discrepancy, but I sus-
pect that ad libitum test meals in laboratories
are simply less representative of real-world
eating conditions than researchers would
like. For example, the spread of foods offered
appears to be quite impactful; as the offer-
ings become more heterogeneous, the typical
variation in energy intake from meal-to-meal
increases from around 9-12% to around 19%
(4). This variation is likely linked to the fact
that, when food diversity is high, the caloric
content of your meal will be largely reflective
of the energy density of the foods you select
(and the degree to which you enjoy them),
rather than physiological hunger per se. Also,
as described at the beginning of this Inter-
pretation section, energy intake is influenced
by both homeostatic and non-homeostatic
factors, and the psychological and behavior-
al aspects of eating can be quite important.
It goes without saying that being isolated in
a room with a bunch of food, all under the
watchful eye of researchers, isn’t particu-
larly representative of a typical meal (or the
psychological state that accompanies a more
typical, unsupervised eating experience). As
such, I’m not entirely surprised to see a dis-
crepancy between subjective hunger ratings
and ad libitum intake in laboratory settings.
While it’s interesting to note that energy in-
take in laboratory conditions might not be
totally reflective of real-world intakes, we
probably shouldn’t get too hung up on the
details of acute post-exercise appetite and en-
ergy intake responses anyway. There is some
utility in understanding them, but the most
important applications of appetite and energy
intake responses are related to cumulative en-
ergy balance over time. Suppressing your ap-
petite for 30-60 minutes won’t matter much
if you quickly become habituated to this re-
sponse or compensate at subsequent meals, so
the chronic effects of exercise on appetite are
much more impactful than any acute effects.
For example, will regular exercise cause pro-
84
nounced weight loss by simultaneously sup-
pressing appetite while increasing energy ex-
penditure? Will an endurance athlete have a
chronically suppressed appetite, such that it’s
difficult to properly fuel for training?
As discussed in my other article this month,
the independent effect of exercise on weight
loss is pretty underwhelming. This might
seem surprising, based on observations that
exercise increases total daily energy expen-
diture and generally appears to acutely exert
either a downward or neutral effect on appe-
tite ratings and energy intake. Nonetheless,
longitudinal studies suggest that compensa-
tory adjustments start to kick in, which leads
to less weight loss than we would expect. As
Dr. Helms has previously covered, some of
these adjustments relate to downregulation of
non-exercise components of energy expendi-
ture, but compensatory increases in appetite
and energy intake have also been reported
(6). As you read this, some skepticism might
be growing – why would exercise lead to un-
EXERCISE DOESN’T
NECESSARILY INCREASE
OR DECREASE APPETITE
RESPONSES. RATHER, IT
RE-COUPLES HUNGER
AND SATIETY CUES TO
ENERGY EXPENDITURE.
impressive weight loss results due (in part)
to compensatory increases in energy intake,
when multiple MASS articles (one, two,
three) have acknowledged that exercise has
a substantial positive effect on maintaining
a stable body weight and preventing weight
regain after weight loss?
The answer goes back to an observation high-
lighted by Dr. Helms in Volume 2 of MASS:
exercise doesn’t necessarily increase or de-
crease appetite responses. Rather, it re-couples
hunger and satiety cues to energy expenditure,
such that homeostatic factors have a stronger
influence on energy intake. In other words, a
sedentary person may be more prone to pos-
itive energy balance, because they exist in a
“non-regulated” zone in which appetite is dis-
proportionately influenced by non-homeostat-
ic factors related to psychological, behavioral,
and hedonic drives to eat. As they increase
their activity level, they are more likely to drift
toward neutral energy balance, as homeostat-
ic factors related to energy expenditure and
body composition take over a relatively larger
portion of appetite regulation. This relation-
ship is summarized in Figure 1, which you’ve
seen before in Dr. Helms’ review of a study by
Beaulieu et al (3).
In the Introduction section, I mentioned that
anecdotal accounts of the relationship be-
tween exercise habits and hunger vary dra-
matically. I suspect a major reason for this
variation in anecdotes and experiences relates
to the fact that exercise seems to re-couple
energy intake and appetite to energy expen-
diture, rather than universally increasing or
decreasing hunger. So, for someone who is
quite sedentary and in a positive energy bal-
85
ance, an increase in exercise could passive-
ly nudge them toward reductions in energy
intake and greater satiety levels after meals.
Conversely, for someone who is already
quite active and in a neutral energy balance,
we would expect an increase in physical ac-
tivity or exercise volume to increase hunger;
their appetite and energy intake are already
quite tightly linked to energy expenditure,
and the additional activity is pushing energy
expenditure even higher. In this context, ex-
ercise is a driver (rather than a suppressor)
of energy intake. If you’re actively pursuing
weight loss and hoping to attenuate your ap-
petite, more activity might not be the answer;
homeostatic factors – even if tightly coupled
to appetite – will probably nudge more in the
direction of hunger than fullness when you’re
in a negative energy balance. However, if
you’re trying to maintain a reduced body
weight after weight loss, but have low phys-
ical activity levels, some extra activity might
nudge you closer to the “regulated” zone that
is largely influenced by homeostatic factors
reflecting energy balance, which could fa-
cilitate better appetite regulation and more
successful weight maintenance in a neutral
energy balance.
This might make it seem like we know ev-
erything we need to know about exercise and
appetite regulation, but that’s really not the
case. Researchers generally agree that appe-
tite and energy intake responses to exercise
appear to vary from person-to-person, but
there’s uncertainty about what’s driving this
variability. This has understandably fueled
interest in determining which characteristics
might be predictive of an individual’s appe-
titive response to exercise. In the presently
reviewed study, the researchers assessed the
impact of biological sex and exercise modal-
ity; while females generally reported lower
hunger ratings, neither variable seemed to
significantly alter the relationship between
86

APPETITE AND ENERGY
INTAKE RESPONSES TO
EXERCISE APPEAR TO VARY
FROM PERSON-TO-PERSON,
BUT THERE’S UNCERTAINTY
ABOUT WHAT’S DRIVING
THIS VARIABILITY.
exercise and appetite or energy intake. This is
in line with a fairly recent review by Dorling
et al (5); as our understanding of the topic
currently stands, habitual activity levels (and
by extension, training status) appear to tight-
en the relationship between energy expen-
diture and appetite, but there is insufficient
evidence to conclude that the relationship be-
tween exercise and appetite is meaningfully
altered by the demographic characteristics
that have been investigated to date, including
sex and body-fat level.
We’ll need a lot more research to answer
some of the lingering questions surrounding
exercise and appetite. There’s still uncertain-
ty regarding how much of the inter-individ-
ual variability observed in previous studies
represents normal day-to-day fluctuation or
statistical “noise” and how much represents
true differences among individuals. Some re-
searchers say the true magnitude is small (4),
and others say it is large (5), but it seems like
there’s general agreement that the magnitude
is non-negligible. Beyond that, we aren’t en-
tirely certain which factors might be driving
any “true” differences among individuals.
It seems that habitual physical activity lev-
el is one influential factor, but we need more
research to further explore how outcomes
might be impacted by things like energy bal-
ance, characteristics of the exercise bout, and
characteristics of the individual. The present-
ly reviewed study (and others like it) have
not convincingly demonstrated that biologi-
cal sex or exercise modality are particularly
influential factors, but we certainly have a lot
more to learn. For now, the best we can do is
understand that the relationship between en-
ergy expenditure and appetite becomes tight-
er as physical activity level increases, use
this knowledge to set our context-dependent
expectations for how an increase or decrease
in exercise might affect appetite, and pre-
pare for the possibility that some individuals
might respond quite differently than others.
Next Steps
When it comes to the impact of exercise on
appetite and energy intake, there are many
questions that remain insufficiently an-
swered. First, we need more studies to em-
ploy nuanced statistical approaches so we
can achieve a scientific consensus regarding
how much of the inter-individual variability
is “real,” and how much is attributable to nor-
mal day-to-day variability. After establishing
how much “true” inter-individual variability
exists, the next step would be to determine
which characteristics appear to be driving the
variability. It seems that training intensity,
training status, and habitual physical activity
87
 APPLICATION AND TAKEAWAYS
Exercise tends to acutely and transiently suppress appetite, as long as the intensity
level is sufficiently high. More importantly, regular physical activity (which includes,
but is not limited to structured exercise) influences hunger and satiety regulation, such
that appetite and energy intake are more closely linked to energy expenditure. As a
result, the impact of a change in activity level on appetite is context-dependent; you
might notice an unintentional reduction in energy intake when you transition from very
sedentary to somewhat active, but an unintentional increase in energy intake when you
transition from active to very active. In addition, it appears that the effect of exercise
on appetite is subject to a non-negligible degree of inter-individual variation, but
researchers have not conclusively identified the exact characteristics and contextual
factors driving this apparent variation.

level impact the relationship between exer-

cise and appetite, but a lot more research is
needed to explore how this relationship is in-
fluenced by energy balance, along with a va-
riety of characteristics related to the exercise
bout and the individual completing it.

88
References
1. Tobin SY, Cornier M-A, White MH, Hild AK, Simonsen SE, Melanson EL, et al. The
effects of acute exercise on appetite and energy intake in men and women. Physiol
Behav. 2021 Nov 1;241:113562.
2. Halliday TM, White MH, Hild AK, Conroy MB, Melanson EL, Cornier M-A. Appetite
and Energy Intake Regulation in Response to Acute Exercise. Med Sci Sports Exerc.
2021 Oct 1;53(10):2173–81.
3. Beaulieu K, Hopkins M, Blundell J, Finlayson G. Homeostatic and non-homeostatic
appetite control along the spectrum of physical activity levels: An updated perspective.
Physiol Behav. 2018 Aug 1;192:23–9.
4. King JA, Deighton K, Broom DR, Wasse LK, Douglas JA, Burns SF, et al. Individual
Variation in Hunger, Energy Intake, and Ghrelin Responses to Acute Exercise. Med Sci
Sports Exerc. 2017 Jun;49(6):1219–28.
5. Dorling J, Broom DR, Burns SF, Clayton DJ, Deighton K, James LJ, et al. Acute and
Chronic Effects of Exercise on Appetite, Energy Intake, and Appetite-Related Hormones:
The Modulating Effect of Adiposity, Sex, and Habitual Physical Activity. Nutrients. 2018
Aug 22;10(9):1140.
6. Martin CK, Johnson WD, Myers CA, Apolzan JW, Earnest CP, Thomas DM, et al. Effect
of different doses of supervised exercise on food intake, metabolism, and non-exercise
physical activity: The E-MECHANIC randomized controlled trial. Am J Clin Nutr. 2019
Sep;110(3):583.

89
 Research Briefs
BY GREG NUCKOLS & ERIC TREXLER

In the Research Briefs section, Greg Nuckols and Eric

Trexler share quick summaries of recent studies. Briefs are
short and sweet, skimmable, and focused on the need-to-
know information from each study.

91 ATP Supplementation: More Evidence, Less

Clarity

95 More Evidence that the Hip Extensors are

Particularly Important for Deep Squats

99 Do Hangovers Hinder Performance?

103 The Bench Press May Target Different

Muscles in Male and Female Lifters

108 Adding Another Layer to the Energy

Compensation Discussion

113 How do Powerlifters Taper for Competitions?

119
Replacing Animal Proteins With Plant
Proteins: Are There Any Downsides?

The Combination of Weightlifting Training &

124 Traditional Resistance Training May be Better
for Athletes than Either Modality in Isolation

128 Is Everything That's Measured Worth

Managing?

90
 Study Reviewed: Dose Response of Acute ATP Supplementation on Strength Training
Performance. dos Santos Nunes de Moura et al. (2021)
ATP Supplementation: More Evidence, Less Clarity
BY ERIC TREXLER
Back in Volume 4 of MASS, Dr. Helms did a
deep dive into the ATP supplementation liter-
ature. I won’t try to recreate all of that magic,
but I’ll hit the most pertinent highlights here,
as they will facilitate our brief examination
of a new study on the topic. In short, every
biology class in the world calls ATP the “en-
ergy currency” of the cell. While we typically
think of our energy consumption in terms of
calories and macronutrients, we’re ultimately
converting that energy from food into ATP
before our cells actually make use of it.
In terms of research on ATP supplementa-
tion, the road has been tumultuous, to say
the least. As reviewed by Dr. Helms, the first
study on the topic (2) found that oral ATP
supplementation led to no significant benefits
compared to a placebo when dosed at 225mg
or 150mg, and also found no significant
changes in blood ATP levels. There were a
few significant within-group changes, but the
groups were small (n = 9 subjects per group),
strength outcomes were measured with low
precision due to equipment limitations, and
there were a few obvious outliers (I’m not
aware of any single-dose supplement that can
actually add 28.6kg to your chest press). Giv-
en that the supplement didn’t increase blood
ATP levels and there were no between-group
differences, these findings were not strong.
Nonetheless, Herda et al took another look at
a purported ATP-boosting supplement a few
years later (3). Once again, supplementation
did not lead to any exciting or significant be-
tween-group effects.
Here’s where it gets interesting. Wilson
and colleagues published a couple of indus-
try-funded ATP studies that reported some
pretty extraordinary results. One paper by
Lowery et al (4), which included a combi-
nation of ATP and HMB supplementation,
received considerable interest because the re-
ported effects were comparable in magnitude
to anabolic steroid use. As you would expect,
a published letter to the editor raised serious
questions about this paper and two others
from the Wilson lab (5).
Helms’ recap of the literature concluded with
a review of a study by de Freitas et al (6). They
found that subjects taking oral ATP supple-
mentation (400mg) completed significantly
greater volume load across four sets of half-
91
squats compared to a placebo treatment group.
After considering the totality of the (very
mixed) literature, Dr. Helms concluded that
ATP supplementation could possibly enhance
performance, but specifically in conditions of
multiple sets taken to failure (or multiple sets
with short rest periods), due to a potential fa-
tigue-attenuating effect of one or more metab-
olites of ATP. However, given the relatively
inconsistent findings in this literature and the
uncertainty surrounding the actual mechanism
of action, Dr. Helms advised readers to hold
off on ATP supplementation until more con-
clusive research became available.
That leads us to this follow-up study (1) with
the same senior author as the ATP study re-
viewed previously by Dr. Helms, whose lab
group has also published most of the lift-
ing-related capsaicin research. However,
there’s a new cast of co-authors this time
around; four of the six authors on the pres-
ently reviewed ATP paper were also co-au-
thors on the HMB-ATP paper by Lowery
et al that prompted some scrutiny in the ac-
ademic world. The similarities don’t end
there; the presently reviewed paper also used
the same ATP supplement and received re-
search funding from the same company that
owns the product (more or less – the study by
Lowery et al received funding and donated
materials from Metabolic Technologies, Inc.
and TSI, Inc., but TSI eventually acquired
Metabolic Technologies, and the sole spon-
sor of the presently reviewed study is TSI).
For the presently reviewed paper, four of the
six authors reported financial relationships in
the form of employment or consulting fees
with these companies (Metabolic Technolo-
gies, Inc. and TSI, Inc.). To be clear, there is
nothing inherently wrong with the existence
of conflicts of interest in research. Transpar-
ent disclosure of financial conflicts is a good
thing, and the presence of such conflicts is
not grounds for automatically disregarding a
study. I report these details so that they may
merely inform our interpretation of the re-
sults; no more, no less.
Now, for the details. Twenty recreational-
ly trained male participants (age 28.6 ± 1.0
years, body mass 81.2 ± 2.0 kg, height 175.2
± 1.4 cm, 1RM 141.5 ± 5.0 kg) completed the
presently reviewed study (1). It was a cross-
over design, meaning each subject complet-
ed all four study conditions: 100mg of ATP,
200mg of ATP, 400mg of ATP, or a place-
bo, all ingested 30 minutes prior to exercise
testing. The exercise test consisted of four
sets of barbell half-squats (approximately
90 degrees of knee flexion at the bottom of
the squat) using a load equivalent to 80% of
1RM, with two minutes of rest between sets.
The researchers reported that the 400mg
ATP dose significantly increased the num-
ber of reps performed in set 1 when com-
pared to placebo (11.1 ± 0.4 vs. 12.3 ± 0.4
reps, +13%, p = 0.04). The lower doses only
increased reps by around 3-4%, which was
not statistically significant (p = 0.47 and p =
0.63). None of the ATP doses led to signifi-
cantly significant increases in total reps or
total weight lifted across the four sets. The
p-values for the interaction effects were not
reported in the text, but I have done my best
to recreate the figure that presents the results
for total repetitions (Figure 1). It was kind of
difficult to recreate, because the original fig-
92
ure used 3-dimensional bars that were a little
hard to gauge relative to the y-axis, and there
were formatting issues that led to inconsis-
tent error bar placement. I also expanded the
y-axis, as the original axis scaling made the
effect seem larger than it was; the 400mg dose
did increase total repetitions by about 6%,
but this effect was not statistically significant
when compared to placebo (p = 0.19). The
researchers also reported that 100mg ATP
and 400mg ATP led to about 4% reductions
in rating of perceived exertion values when
compared to placebo and 200mg conditions
(these comparisons were statistically signif-
icant for 100mg, but not for 400mg, despite
similar percent change values).
My first quibble with this paper is that the title
refers to a “dose-response” effect of ATP sup-
plementation. You’d want to see some pret-
ty consistent and clear-cut evidence of that
dose-response relationship to unambiguously
refer to it in the title of a paper, and I’m just
not seeing it. There isn’t enough separation
between the 100mg and 200mg conditions to
conclusively suggest that 200mg led to better
set 1 performance than 100mg. Additionally,
the 100mg dose actually had more positive
effects on total repetitions and ratings of per-
ceived exertion when compared to 200mg.
You could potentially suggest that the 100mg
and 200mg doses were insufficient, but it’s
hard to defend a clear and consistent dose-re-
sponse relationship in these data.
My other quibble with these findings is that
they add even more inconsistency to the lit-
erature. Dr. Helms tentatively concluded that
ATP should have a bigger impact on multi-
ple-set performance rather than single-set
performance, but the presently reviewed
study found more evidence to support a sin-
gle-set (or first-set) effect than a cumulative
effect across multiple sets. To add to the un-
certainty and ambiguity, we still don’t have
a rock-solid understanding of how oral ATP
supplementation would actually enhance per-
formance. It appears to have very poor oral
bioavailability, and the only metabolite that
seems to meaningfully increase in system-
93

ic circulation is uric acid. Without question,
there are multiple possible mechanisms by
which ATP supplementation could potential-
ly enhance various types of exercise perfor-
mance, but I’m not prepared to elevate any
specific mechanism from possible to proba-
ble, and the more applied empirical evidence
is way too heterogeneous to hang your hat
on. As a result, I’m going to pass on ATP
supplementation until I see more convincing
evidence to nudge me toward a more opti-
mistic position.
References
1. Dos Santos Nunes de Moura HP, Jäger
R, Purpura M, Rathmacher JA, Fuller JC,
Rossi FE. Dose Response of Acute ATP
Supplementation on Strength Training
Performance. Front Sports Act Living.
2021;3:780459.
2. Jordan AN, Jurca R, Abraham EH,
Salikhova A, Mann JK, Morss GM, et
al. Effects of oral ATP supplementation
on anaerobic power and muscular
strength. Med Sci Sports Exerc. 2004
Jun;36(6):983–90.
3. Herda TJ, Ryan ED, Stout JR, Cramer
JT. Effects of a supplement designed to
increase ATP levels on muscle strength,
power output, and endurance. J Int Soc
Sports Nutr. 2008;5:3.
4. Lowery RP, Joy JM, Rathmacher JA,
Baier SM, Fuller JCJ, Shelley MCI, et
al. Interaction of Beta-Hydroxy-Beta-
Methylbutyrate Free Acid and Adenosine
Triphosphate on Muscle Mass, Strength,
and Power in Resistance Trained
Individuals. J Strength Cond Res. 2016
Jul;30(7):1843–54.
5. Gentles JA, Phillips SM. Discrepancies in
publications related to HMB-FA and ATP
supplementation. Nutr Metab. 2017 Jul
4;14:42.
6. Freitas MC, Cholewa JM, Gerosa-Neto
J, Gonçalves DC, Caperuto EC, Lira
FS, et al. A Single Dose of Oral ATP
Supplementation Improves Performance
and Physiological Response During Lower
Body Resistance Exercise in Recreational
Resistance-Trained Males. J Strength Cond
Res. 2019 Dec;33(12):3345–52.
94
 Study Reviewed: Quadriceps Femoris Cross-Sectional Area and Specific Leg Strength:
Relationship Between Different Muscle and Squat Variations. Kojic et al. (2021)

More Evidence that the Hip Extensors are

Particularly Important for Deep Squats
BY GREG NUCKOLS

The paper reviewed in this research brief (1)
seems to come from the same study as the pa-
per I reviewed in my main article this month
(2; the authors are the same, and the subject
characteristics are incredibly similar). More
importantly, it’s relevant to one of my favor-
ite topics: determinants of squat strength.
Following a two-week familiarization peri-
od, sixteen untrained subjects (9 males and 7
females) completed 1RM parallel squats and
deep squats. As noted in my main article this
month, the “parallel squat” depth was likely
a couple inches above standard powerlifting
depth. The deep squats, on the other hand,
were deep squats – subjects squatted down un-
til they achieved a 45° knee angle (i.e., 135°
of knee flexion). Depth was monitored us-
ing an elastic band, which would contact the
subjects’ hindquarters once they achieved an
appropriate depth on each rep. It’s worth not-
ing that the researchers included the weight of
each subject’s head, trunk, arms, and thighs
when recording their 1RMs. In other words, if
someone weighed 80kg (excluding their lower
legs and feet), and they squatted 100kg, their
1RM was recorded as 180kg.
Cross-sectional area of each head of the quad-
riceps, along with the cross-sectional area of
the entire quadriceps group, was assessed via
ultrasound. Furthermore, leg skeletal muscle
mass was estimated via bioelectrical imped-
ance (BIA). Of note, the BIA device used in
this study (InBody 720) certainly isn’t as ac-
curate or reliable as a DEXA scan for esti-
mating segmental lean mass, but it was still
a research-grade BIA device that’s consider-
ably more accurate than the consumer-grade
BIA scales or hand-held BIA devices you
may have seen in commercial gyms.
The researchers assessed the strength of the
associations between quadriceps cross-sec-
tional area and squat strength. They also as-
sessed the strength of the association between
leg skeletal muscle mass and squat strength,
after controlling for quadriceps cross-sec-
tional area via multiple linear regression.
Unsurprisingly, subjects’ parallel squat 1RMs
exceeded their deep squat 1RMs. Further-
more, the male subjects squatted more than
the female subjects. Cross-sectional areas of
all heads of the quadriceps (r = 0.509-0.754),
with the exception of the rectus femoris (r

95
= 0.315-0.408; p > 0.11), were significantly
associated with 1RM parallel squat and deep
squat strength (Table 1; Figure 1). Interest-
ingly, in all cases, the correlation between
quadriceps size and squat strength was stron-
ger for the parallel squat than the deep squat
in nominal terms: r = 0.408-0.754 for paral-
lel squats; r = 0.315-0.706 for deep squats.
Finally, when controlling for quadriceps
cross-sectional area, leg skeletal muscle mass
was still significantly associated with deep
squat strength (r = 0.641; p = 0.026), but not
parallel squat strength (r = 0.530; p = 0.076).
Overall, the results suggest that quad strength
is more strongly associated with parallel squat
strength than deep squat strength, and that the
hip extensors may play a larger role in the
deep squat. The fact that, after controlling for
quadriceps cross-sectional area, leg skeletal
muscle mass wasn’t significantly associated
with parallel squat strength, but was still sig-
nificantly associated with deep squat strength,
suggests that other lower body musculature –
likely the hamstrings, adductors, and glutes
– contributed more to deep squatting perfor-
mance than parallel squatting performance.
To be clear, this is a very tentative conclusion,
because the association between quadriceps
cross-sectional area and squat strength wasn’t
that much stronger for the parallel squat than
the deep squat (the difference in r-values was
< 0.10). Similarly, the association between leg
muscle mass and squat strength after controlling
for quadriceps cross-sectional area wasn’t that
much stronger for the deep squat than the par-
allel squat (the difference in r-values was just
0.111). However, other research can bolster our
confidence in this tentative conclusion.
Specifically, a longitudinal study by Kubo
and colleagues (3) investigated the effects of
half squats (squatting to 90° of knee flexion
– likely a bit higher than the parallel squat
testing in the present study) and full squats
(squatting to 140° of knee flexion – very sim-
ilar to the deep squat testing in the present
study) on lower body muscle hypertrophy.
These researchers found that half squats and
deep squats resulted in similar quad growth,
but that deep squats produced considerably
more adductor and glute growth (Figure 2).
Neither squat depth produced much ham-
strings growth. These results suggest that the
hip extensors (the adductors – specifically
the adductor magnus – play a major role in
96
97

hip extension) contribute more to deep squats
than shallower squats, as long as you’re will-
ing to assume that muscle growth is a decent
indicator of a muscle’s relative contribution
to a given exercise.
I doubt many MASS readers will be overly
surprised by this conclusion, but it’s a surpris-
ingly controversial opinion within the broad-
er fitness community. Many people argue
that if you squat much below parallel, your
hip extensors will go “slack,” and therefore
contribute less to the squat. Others point to
a particular electromyographic (EMG) study
(4), suggesting that glute activation may be
lower in a deep (isometric) squat position
than in a half squat position. However, the
Kubo study provides the best direct evidence
on the topic, in my opinion, as a longitudi-
nal study that actually assessed differences
in muscle growth over time. Furthermore,
modeling research suggests that the relative
muscular effort of the hip extensors is at its
peak at the very bottom of a below-parallel
squat (5; Figure 3). Thus, while the present
study doesn’t independently provide partic-
ularly strong evidence that the hip extensors
contribute more to deep squats than parallel
squats, it meshes well with other lines of re-
search that paint a similar picture.
So, just to wrap things up: if you’re primari-
ly squatting for the purpose of building your
quads, you probably don’t NEED to squat
to maximal depth. Squatting to parallel (or
potentially even a bit above parallel) seems
to be perfectly fine. However, if you’d also
like to use the squat to build your glutes and
adductors, it likely behooves you to squat as
deep as you (comfortably and safely) can.
References
1. Kojic F, Ðurić S, Ranisavljev I, Stojiljkovic
S, Ilic V. Quadriceps femoris cross-
sectional area and specific leg strength:
relationship between different muscles
and squat variations. PeerJ. 2021 Nov
26;9:e12435. doi: 10.7717/peerj.12435.
PMID: 34900415; PMCID: PMC8628634.
2. Kojić F, Mandić D, Ilić V. Resistance
training induces similar adaptations of
upper and lower-body muscles between
sexes. Sci Rep. 2021 Dec 6;11(1):23449.
doi: 10.1038/s41598-021-02867-y. PMID:
34873221; PMCID: PMC8648816.
3. Kubo K, Ikebukuro T, Yata H. Effects
of squat training with different depths on
lower limb muscle volumes. Eur J Appl
Physiol. 2019 Sep;119(9):1933-1942. doi:
10.1007/s00421-019-04181-y. Epub 2019
Jun 22. PMID: 31230110.
4. Marchetti PH, Jarbas da Silva J, Jon
Schoenfeld B, Nardi PS, Pecoraro
SL, D’Andréa Greve JM, Hartigan E.
Muscle Activation Differs between Three
Different Knee Joint-Angle Positions
during a Maximal Isometric Back
Squat Exercise. J Sports Med (Hindawi
Publ Corp). 2016;2016:3846123. doi:
10.1155/2016/3846123. Epub 2016 Jul 18.
PMID: 27504484; PMCID: PMC4967668.
5. Bryanton MA, Kennedy MD, Carey
JP, Chiu LZ. Effect of squat depth and
barbell load on relative muscular effort
in squatting. J Strength Cond Res.
2012 Oct;26(10):2820-8. doi: 10.1519/
JSC.0b013e31826791a7. PMID: 22797000.
98
 Study Reviewed: Effect of Previous-Day Alcohol Ingestion on Muscle Function and
Performance of Severe-Intensity Exercise. Shaw et al. (2022)
Do Hangovers Hinder Performance
BY ERIC TREXLER
This issue of MASS is slated for a February
1st publication date, which is exactly one
month after hangover prevalence reaches its
annual peak. So, we might be a little late with
this topic, but the presently reviewed study
(1) investigated the impact of previous-day
alcohol ingestion on exercise performance.
This was a crossover trial in which 12 rec-
reationally active individuals (6 male and 6
female) completed exercise testing under two
experimental conditions: one testing session
occurred the morning after alcohol ingestion,
while the other occurred the morning after
placebo ingestion.
Alcohol was delivered in the form of an arti-
ficially sweetened beverage containing vodka
at an individualized dose of 1.09g of ethanol
per kilogram of fat-free mass. The placebo
condition was a similarly flavored beverage
and the rim of the cup was blotted with vodka
to mimic the flavor and smell of the alcoholic
beverage. Female participants consumed an
average of 44 ± 2g of ethanol, and male par-
ticipants consumed an average of 60 ± 4g of
ethanol, with participants averaging an etha-
nol dose of 0.70g per kilogram of total body
mass. For context, a “standard drink” is gen-
erally around 10-14g of ethanol, with some
variation from country to country. This led to
an average peak blood alcohol concentration
of 0.09 ± 0.02 g/dL (range: 0.06 - 0.12 g/dL),
which is generally considered a little too high
to legally operate a vehicle.
For the beverage consumption visits, par-
ticipants arrived between noon and 2:30pm,
drank their assigned drink, and remained in
the lab for at least 6.5 hours while snacking on
some Papa John’s pizza. Honestly, not a bad
way to spend an afternoon. For safety reasons,
they all arranged for a ride home afterward,
and returned between 8:00am and 10:00am
the following morning for exercise testing.
The researchers measured urine specific grav-
ity upon arrival, and participants with insuf-
ficient hydration levels were provided water
until they were sufficiently hydrated to initiate
testing. Tests included a hangover symptom
questionnaire, a vertical jump test, isometric
midthigh pulls, isokinetic biceps curls, and a
cycling test to exhaustion.
Unsurprisingly, the alcoholic beverage led
to significantly greater hangover symptoms;
99

7/12 participants reported having a hangover,
11/12 reported being tired, and 10/12 reported
having a headache the morning after consum-
ing the alcohol. As shown in Figure 1, alco-
hol also had a negative impact on the cycling
test; participants reached exhaustion at 203 ±
34 seconds in the placebo condition, but only
lasted 181 ± 39 seconds in the alcohol condi-
tion. However, as presented in Table 1, alco-
hol did not significantly affect vertical jump,
isometric midthigh pull, or isokinetic biceps
curl performance.
This is alcohol’s third appearance in the pag-
es of MASS; I covered a systematic review
(2) on the effects of alcohol on recovery in
Volume 3, and a longitudinal study (3) on al-
cohol intake in Volume 4. The results of the
presently reviewed study aren’t particularly
earth-shattering, but they reinforce some of
my speculations from the Volume 3 article
and can help us paint a more complete pic-
ture of the impact of alcohol on fitness-relat-
ed outcomes. The previously reviewed study
by Lakicevic reported that alcohol had sur-
prisingly minimal effects on recovery and
next-day performance, but I noted that many
of the exercise tests involved fairly simple,
unskilled tasks that weren’t particularly in-
tense or metabolically demanding.
I speculated that: “If you’re really hungov-
er going into a workout, you’re probably not
going to have a good time, and you probably
won’t perform well on skillful or physically
demanding tasks.” The presently reviewed
study seems to generally confirm that spec-
ulation; these participants had more than a
100
couple drinks (but not necessarily a ton, rela- the typical fitness enthusiast, and infrequent
tive to some of the more extreme protocols in instances of moderate alcohol consumption
this literature), experienced some hangover will not necessarily disrupt your next-day
symptoms, and were generally able to pull it training, depending on the characteristics of
together for tasks like the vertical jump and your program. However, the decision to con-
biceps curls. However, for a metabolically sume or abstain from alcohol is multifaceted,
demanding task like cycling to exhaustion, and all relevant outcomes should be consid-
the hangover came back to haunt them. ered when weighing the pros and cons.
Questions about alcohol are extremely com-
mon in the fitness space, and while we don’t
have a ton of applied literature related to al-
cohol consumption, I think we have enough
to confidently draw some tentative conclu-
sions. The consumption of 1-2 alcoholic bev-
erages seems to be fairly negligible in terms
of performance (3) and body composition (4)
outcomes. If you’re drinking around 0.5-0.7g
of ethanol per kilogram of total body mass,
you might notice some performance decre-
ments when completing exercise tasks that
are metabolically intensive or require a great
deal of skill and coordination. Doses of 1g/
kg and beyond are increasingly likely to neg-
atively impact even fairly modest next-day
exercise tasks. So, when it comes to acute
performance, small doses seem fine, moder-
ate doses seem moderately fine, and frequent
intake of high doses is inadvisable.
Of course, next-day performance is far from
the only consideration when it comes to al-
cohol-related decisions. There’s no question
that acute high-dose alcohol consumption
can be dangerous, and that chronic high-dose
alcohol intake is associated with a variety of
serious medical conditions, in addition to un-
favorable effects on muscle protein synthe-
sis, sleep quality, and a number of important
hormones. Low-dose alcohol will not derail

101
References
1. Shaw AG, Chae S, Levitt DE, Nicholson
JL, Vingren JL, Hill DW. Effect of
Previous-Day Alcohol Ingestion on Muscle
Function and Performance of Severe-
Intensity Exercise. Int J Sports Physiol
Perform. 2022 Jan 1;17(1):44-49.
2. Lakićević N. The Effects of Alcohol
Consumption on Recovery Following
Resistance Exercise: A Systematic
Review. J Funct Morphol Kinesiol. 2019
Sep;4(3):41.
3. Molina-Hidalgo C, De-la-O A, Dote-
Montero M, Amaro-Gahete FJ, Castillo
MJ. Influence of daily beer or ethanol
consumption on physical fitness in
response to a high-intensity interval
training program. The BEER-HIIT study. J
Int Soc Sports Nutr. 2020 May 27;17(1):29.
4. Molina-Hidalgo C, De-la-O A, Jurado-
Fasoli L, Amaro-Gahete FJ, Castillo
MJ. Beer or Ethanol Effects on the Body
Composition Response to High-Intensity
Interval Training. The BEER-HIIT Study.
Nutrients. 2019 Apr 23;11(4):909.

102
 Study Reviewed: Understanding Bench Press Biomechanics – Training Expertise and Sex
Affect Lifting Technique and Net Joint Moments. Mausehund and Krosshaug (2021)
The Bench Press May Target Different Muscles in
Male and Female Lifters
BY GREG NUCKOLS
In Volume 2 of MASS, I reviewed a study by
Gołaś and colleagues investigating sex differ-
ences in pec, triceps, and front delt electro-
myographic (EMG) amplitudes in the bench
press, with loads ranging from 55% to 100%
of 1RM (2). It was a valuable contribution to
the literature, because the vast majority of prior
bench press EMG studies had used exclusive-
ly male subjects, and the studies with mixed-
sex cohorts didn’t perform separate statistical
analyses for the male and female subjects (3).
However, the Gołaś study had a couple nota-
ble drawbacks. First, it had a very small sam-
ple – just five male and five female subjects.
Second, it used an EMG normalization pro-
cedure that was sufficient for analyzing how
EMG changed as loads increased, but didn’t
allow for an actual apples-to-apples compar-
ison between the sexes. However, even with
those drawbacks, the results of this study were
interesting: it found that, as loads increased,
pec EMG increased to a greater extent in the
female subjects, while triceps EMG increased
to a greater extent in the male subjects (2). That
led me to tentatively conclude that bench press
may be a slightly more pec-dominant lift for
female lifters than male lifters, and a slightly
more triceps-dominant lift for male lifters than
female lifters, on average. At first glance, the
study reviewed in the present research brief
(1) would seem to contradict that conclusion.
However, the results of these two studies can
actually coexist nicely.
In this study by Mausehund and Krosshaug
(1), 22 recreationally trained lifters (13 males
and 9 females) and 12 competitive powerlift-
ers (6 males and 6 females) completed a 6-8
RM set of bench press. All subjects used a
medium grip width (approximately 160% of
biacromial breadth). During the set, joint and
limb positions were tracked in three dimen-
sions using a camera system in order to calcu-
late net joint moments, and EMG amplitudes
of the pecs (sternal and clavicular heads),
triceps (long head and lateral head), and an-
terior deltoids were recorded using surface
electrodes. EMG amplitudes obtained during
the bench press were normalized against
maximal EMG amplitudes obtained during
single-joint maximum voluntary contraction
(MVC) testing. The MVCs were performed
on an isokinetic dynamometer at a low angu-
lar velocity (60° per second); triceps MVC
103
EMG was assessed during isolated elbow ex-
tensions, and pec and anterior deltoid MVC
EMG was assessed during isolated shoulder
horizontal adduction.
The powerlifters and recreationally trained
lifters adopted different bar paths; the verti-
cal range of motion was longer for the recre-
ationally trained lifters, while the horizontal
range of motion was greater for the power-
lifters (i.e. the powerlifters touched the bar-
bell lower on their chests). Shoulder moment
arms were pretty similar between sexes for
the recreationally trained lifters, but tended
to be longer for the male powerlifters than
the female powerlifters. Conversely, elbow
moment arms were longer for female recre-
ational lifters and powerlifters than for male
104
recreational lifters and powerlifters. Accord-
ingly, the ratio of elbow net joint moments to
shoulder net joint moments diverged between
sexes – it was larger for female recreational
lifters than male recreational lifters, and for
female powerlifters than male powerlifters.
In fact, the difference between the male and
female powerlifters was larger than the dif-
ference between the male and female recre-
ational lifters (Figure 1).
Normalized EMG for both heads of the pecs
was greater for the male lifters than the female
lifters (for both recreational lifters and power-
lifters). Conversely, normalized EMG of the
long head of the triceps was greater for the
female lifters than the male lifters (Figure 2).
These EMG results match up nicely with the
reported moment arms and net joint moments.
As I mentioned previously, these results ini-
tially appear to conflict with those of the pre-
vious study we reviewed in MASS investigat-
ing sex differences in bench press EMG (2).
105
However, these two studies asked slightly
different research questions. The prior study
investigated differences in EMG as loads in-
creased, while the present study investigated
differences in EMG at a fixed load (1). In
the present study, the bench press appears
to be a more triceps-dominant lift for female
lifters, and a more pec-dominant lift for the
male lifters with heavy (but submaximal)
loads. In the prior study, pec EMG increased
to a greater extent in female lifters as they
approached 1RM loads, while triceps EMG
increased to a greater extent in male lifters as
they approached 1RM loads (Figure 3).
Thus, when taken together, these studies sug-
gest that the bench press may be a bit more
triceps-dominant for female lifters with sub-
maximal loads, but that female lifters are still
capable of ramping up pec recruitment as they
approach 1RM loads. Conversely, the bench
press may be a bit more pec-dominant for
male lifters with submaximal loads, but male
lifters are still capable of ramping up triceps
recruitment as they approach 1RM loads. In
other words, there are slight differences in the
muscles primarily used for “normal” efforts,
versus the muscles that function as a “strength
reserve” as lifters approach maximal effort.
Now, this was an EMG study, so all stan-
dard caveats apply. Namely, we don’t know
whether acute EMG differences are predictive
of long-term differences in training adapta-
tions (4). However, we don’t need to solely
rely on the EMG results. The joint moment
results of this study suggest that female lift-
ers may actually experience relatively larg-
er increases in triceps strength with training,
while male lifters experience relatively larger
increases in pec strength. The ratio of elbow
to shoulder net joint moments diverged to a
106

greater extent in the powerlifters than in the
recreationally trained subjects, which may be
suggestive of different adaptations resulting
from training. In other words, female lifters
may utilize their triceps more when benching,
build more triceps strength, and thus adopt a
more triceps-dominant bench technique as
training status increases, resulting in a larger
ratio of elbow to shoulder net joint moments.
Conversely, male lifters may utilize their pecs
more when benching, build more pec strength,
and thus adopt a more pec-dominant bench
technique as training status increases, result-
ing in a smaller ratio of elbow to shoulder
net joint moments. Of course, since this was
a cross-sectional study, we can’t rule out the
possibility that these results were influenced
by body segment length (i.e. humerus-to-fore-
arm length ratios) differences between groups,
unrelated to training adaptations.
If I were to offer a very tentative takeaway,
I would suggest that, on average, female
lifters may benefit a bit more from pec-fo-
cused accessory work than male lifters, while
male lifters may benefit a bit more from tri-
ceps-focused accessory work than female
lifters. This tentative takeaway is predicated
on the assumption that female lifters are tru-
ly (slightly) under-utilizing their pecs during
submaximal bench press training, and male
lifters are truly (slightly) under-utilizing their
triceps during submaximal bench press train-
ing. Of course, more work is needed to under-
stand if and why this specific neuromuscular
difference exists, if similar differences exist
for other exercises, and whether or not these
differences functionally influence bench
press performance or training adaptations.
References
1. Mausehund L, Krosshaug T. Understanding
Bench Press Biomechanics—Training
Expertise and Sex Affect Lifting Technique
and Net Joint Moments. Journal of Strength
and Conditioning Research. 2021. doi:
10.1519/JSC.0000000000004191
2. Gołaś A, Maszczyk A, Pietraszewski P,
Wilk M, Stastny P, Strońska K, Studencki
M, Zając A. Muscular activity patterns of
female and male athletes during the flat
bench press. Biol Sport. 2018;35(2):175–
179
3. Stastny P, Gołaś A, Blazek D, Maszczyk
A, Wilk M, Pietraszewski P, Petr M, Uhlir
P, Zając A. A systematic review of surface
electromyography analyses of the bench
press movement task. PLoS One. 2017 Feb
7;12(2):e0171632. doi: 10.1371/journal.
pone.0171632. PMID: 28170449; PMCID:
PMC5295722.
4. Vigotsky AD, Beardsley C, Contreras B,
Steele J, Ogborn D, Phillips SM. Greater
electromyographic responses do not
imply greater motor unit recruitment and
‘hypertrophic potential’ cannot be inferred.
J Strength Cond Res. 2017 Jan;31(1):e1-e4.
doi: 10.1519/JSC.0000000000001249.
Epub 2015 Dec 11. Erratum in: J Strength
Cond Res. 2017 Feb;31(2):e66. PMID:
26670996.
107
 Study Reviewed: Physical Activity and Total Daily Energy Expenditure in Older US Adults:
Constrained versus Additive Models. Willis et al. (2022)
Adding Another Layer to the Energy Compensation
Discussion
BY ERIC TREXLER
The constrained total energy expenditure
model isn’t new, but it’s definitely a hot topic
at the moment. Pontzer et al published a very
thorough overview of the concept back in
2016 (2), but a few newer papers have made
quite a splash over the past year or so. A pa-
per by Careau et al (3) reported (in a huge
sample of free-living individuals) that people
tend to compensate for increased physical
activity by reducing basal energy expendi-
ture. There was also the paper by Broskey et
al (4), which Dr. Helms reviewed in MASS,
that also identified compensatory reductions
in non-exercise components of energy expen-
diture, ultimately resulting in lower-than-pre-
dicted weight loss over the course of an ex-
ercise intervention. More recently, Dr. Kevin
Hall revisited the data from the Biggest Loser
Study (reviewed here) to present an updated
perspective, suggesting that the observation
of large, sustained, unexpected suppression
of resting metabolic rate could be related to
compensatory adjustments in response to
high levels of physical activity (5).
As the constrained energy expenditure model
picks up steam, it’s informative to frame (and
assess) it relative to the alternative model –
the additive energy expenditure model. The
additive model is certainly the most parsimo-
nious; it contends that when we add 100kcals
worth of exercise to our daily routine, total
daily energy expenditure increases by rough-
ly 100kcals. The constrained model argues
that things are a bit more complicated – when
baseline physical activity level is on the low-
er end of the spectrum, the constrained model
and additive model essentially agree that to-
tal daily energy expenditure increases fairly
proportionally to the amount of extra exer-
cise that is added to the mix. However, the
models diverge at higher levels of physical
activity; the additive model assumes that the
increases in energy expenditure keep ramping
up, whereas the constrained model assumes
that our bodies make adaptive adjustments
to constrain total daily energy expenditure
within a working range. In other words, as
we start pushing total daily energy expendi-
ture up to potentially unsustainable levels by
engaging in extremely high levels of physical
activity, our body aims to become more ener-
gy efficient, cutting unnecessary energy ex-
penditure from other processes taking place
108
at rest. These models are concisely described American adults (between the ages of 50-74
in the following figure, adapted from a paper years, with BMI values between 18.5-40 kg/
by Pontzer et al (2). m2), total energy expenditure was measured
using doubly labeled water, and physical
One important aspect of Figure 1 is that en-
activity was measured using accelerome-
ergy compensation in the constrained model
try. The 12-month study timeline included a
is incomplete. In other words, as you move
complicated staggering of assessments, but
from low physical activity levels to high lev-
the important highlights are that total ener-
els, there is still a general increase in total en-
gy expenditure was measured over a 14-day
ergy expenditure. Physical activity increas-
period, physical activity was measured over
es total energy expenditure, but not quite as
a 7-day period, and energy status was cate-
much as you’d expect, particularly at higher
gorized based on average weight change over
levels of activity. Many people misinterpret
a six-month period. Positive energy balance
the constrained model and suggest that ex-
was defined as gaining more than 3% of body
ercise is totally useless for increasing total
weight, negative energy balance was defined
energy expenditure. However, based on the
as losing more than 3% of body weight, and
assumption of partial energy compensation, a
neutral energy balance was defined as staying
more accurate interpretation of the proposed
within ±3% of baseline weight. The simpli-
model is that exercise causes smaller increas-
fied version of the results is very straightfor-
es in total energy expenditure than you would
ward: for people in neutral or positive energy
mathematically anticipate.
balance, the additive model did just fine – as
The presently reviewed study (1) put the con- physical activity went up, total energy expen-
strained model to the test by directly compar- diture went up to a fairly proportional degree.
ing it to the additive model. In 584 free-living However, the constrained model held true for

109

people in negative energy balance; total en-
ergy expenditure was fairly stable across the
full range of activity levels. These relation-
ships are presented in Figure 2.
This is pretty cool. In a recent MASS arti-
cle, we saw how the constrained model can
help us understand the adaptations common-
ly attributed to negative energy balance. In
this paper, we see how negative energy bal-
ance can help us understand the constrained
model. As a result, we have even more evi-
dence supporting the idea that these two top-
ics (metabolic adaptation and the constrained
model) are inherently linked under the um-
brella of topics related to energy availabili-
ty. Of course, we should always hesitate to
get overly excited about a singular research
finding (pending further verification and rep-
lication), but these results might fill a pretty
important gap in our understanding of energy
compensation. Overly simplistic interpreta-
tions of the constrained energy expenditure
concept have always bothered me, because
they don’t seem to pass some very superficial,
unscientific sanity checks. We never want to
get too attached to our anecdotal observations
(as they are susceptible to considerable sub-
jectivity and misinterpretation), but we also
don’t want to ignore our experience and ob-
servations. Overly simplistic interpretations
of the constrained model just don’t seem to
match up with reality.
When people suggest that energy expenditure
is maintained within an extremely tight range
to compensate for physical activity, they of-
ten lean on studies showing surprisingly sim-
ilar total daily energy expenditure in people
with sedentary lifestyles in more industrial-
ized areas compared to people who perform
energy-intensive physical work in less indus-
trialized areas (2). However, it is difficult to
reconcile this with the research reporting that
energy expenditure fluctuations across the
adult lifespan seem mostly tied to changes in
110
physical activity or the research (6) indicating
that total daily energy expenditure in free-liv-
ing athletes tends to be markedly higher than
in free-living non-athletes.
Beyond that, I tend to be pretty curious about
physiology, and I’ve spent most of my life
hanging around a mixture of people with
athletic goals and body composition goals.
I’ve long been frustrated by an apparent dis-
crepancy: I’ve known plenty of endurance
athletes who seem to perpetually achieve as-
tonishingly high caloric intakes to fuel their
training, but I’ve simultaneously known plen-
ty of chronic dieters who seem to require sur-
prisingly low caloric intakes to promote fur-
ther weight loss, despite pretty eye-popping
amounts of daily cardio. I’ve never really
resisted the concept of energy compensation,
but I’ve long suspected that compensation is
relatively incomplete in the majority of con-
texts, and that the relationship between phys-
ical activity level and the degree of compen-
sation contains multiple layers of complexity.
Thanks to the hard work of many researchers,
we are continuing to develop a more nuanced
understanding of those layers of complexi-
ty. For starters, the relative degree of phys-
ical activity should influence the magnitude
of compensation – it’s literally built into the
model (see Figure 1), which assumes that
more severe compensation doesn’t kick in
until physical activity levels get pretty high.
In addition, there appears to be considerable
variability between individuals; in the study
by Careau et al (3), higher fat mass was pre-
dictive of greater energy compensation. To
quantify this relationship in practical terms,
they reported that leaner individuals at the
10th BMI percentile compensated for 29.7%
of the calories burned during physical activi-
ty, whereas individuals at the 90th BMI per-
centile compensated for 45.7%. It’s unclear
if compensation leads to greater BMI or if
greater BMI leads to more compensation (or
if a more complicated relationship explains
the link between BMI and compensation),
but there appears to be significant inter-in-
dividual variability that correlates with BMI
(and more specifically, fat mass).
To add to the complexity, the presently re-
viewed study suggests that compensation is
also impacted by the energy status of the in-
dividual. This may help us understand why
total energy expenditure could be similar
when we compare people in more active, less
industrialized areas (where excess energy
consumption is less likely) to people in less
active, more industrialized areas (where ex-
cess energy consumption is more likely). It
may also help us understand why the chronic
dieter appears to experience so much energy
expenditure compensation for their countless
hours on the treadmill, while we observe con-
sistently high energy expenditure values in
endurance athletes who are actively striving
to adequately fuel their training efforts.
As this line of research pushes forward at an
impressive pace, it has delivered some pret-
ty useful observations. We can’t treat cardio
as a one-size-fits-all method for increasing
energy expenditure, and we should be open
to the idea that some individuals will experi-
ence more or less compensation, depending
on the circumstances. Aside from variability
that is inherent to the individual (which may
correlate with higher fat mass), individuals
111

might experience greater degrees of com-
pensation as they reach fairly high levels of
physical activity or achieve fairly low levels
of energy availability. So, exercise can ab-
solutely be part of a well-constructed weight
loss program (in addition to countless oth-
er benefits), but the relative efficiency with
which exercise boosts total daily energy ex-
penditure is context-dependent.
References
1. Willis EA, Creasy SA, Saint-Maurice
PF, Keadle SK, Pontzer H, Schoeller D,
et al. Physical Activity and Total Daily
Energy Expenditure in Older US Adults:
Constrained versus Additive Models. Med
Sci Sports Exerc. 2022 Jan 1;54(1):98–105.
2. Pontzer H, Durazo-Arvizu R, Dugas L,
Plange-Rhule J, Bovet P, Forrester TE, et
al. Constrained Total Energy Expenditure
and Metabolic Adaptation to Physical
Activity in Adult Humans. Curr Biol. 2016
Feb 8;26(3):410.
3. Careau V, Halsey LG, Pontzer H,
Ainslie PN, Andersen LF, Anderson
LJ, et al. Energy compensation and
adiposity in humans. Curr Biol. 2021 Oct
25;31(20):4659-4666.e2.
4. Broskey NT, Martin CK, Burton JH,
Church TS, Ravussin E, Redman LM.
Effect of Aerobic Exercise-induced Weight
Loss on the Components of Daily Energy
Expenditure. Med Sci Sports Exerc. 2021
Oct;53(10):2164–72.
5. Hall KD. Energy compensation and
metabolic adaptation: “The Biggest
Loser” study reinterpreted. Obesity. 2022
Jan;30(1):11-13.
6. Westerterp KR. Exercise, energy
expenditure and energy balance, as
measured with doubly labelled water. Proc
Nutr Soc. 2018 Feb;77(1):4–10.
112
 Study Reviewed: Characterizing the Tapering Practices of United States and Canadian Raw
Powerlifters. Travis et al. (2021)

How do Powerlifters Taper for Competitions?

BY GREG NUCKOLS

We’ve covered tapering several times in
MASS (one, two, three, four, five), including
an excellent concept review by Dr. Hayden
Pritchard, and a review of a study investigat-
ing the tapering practices of elite Croatian
powerlifters (2). The study reviewed in this
research brief adds to that body of literature
by documenting the tapering practices of a
large sample of American and Canadian raw
powerlifters (1). The prior study on Croatian
lifters had just 10 subjects, while the present-
ly reviewed study included 364 subjects, thus
giving us a better understanding of common-
ly used tapering practices.
The subjects were identified using the Open-
Powerlifting database (since the researchers
wanted to survey people who had recently
competed in sanctioned USAPL, CPU, or
IPF competitions) and contacted via social
media. The participants completed an online
survey about their training and tapering prac-
tices. For purposes of analysis, subjects were
split by sex and competition level (regional/
provincial, national, and international).
There were a lot of outcomes. I will present
the tables from the study, but, in the interest
of keeping this within the length of a typical
research brief, I’ll only comment on the out-
comes I personally found interesting.
It appears that general training variables (total
training sessions per week, training frequen-
cy for each lift, and overall training duration)
were pretty similar across all levels of com-
petition (Table 1). The only slight difference
is that international-level powerlifters tended
to have longer training sessions than nation-
al- and regional-level competitors (57% of
international-level lifters reported that a typ-
ical training session lasted 2+ hours, versus
28% of regional-level lifters and 34% of na-
tional-level lifters). Over 80% of lifters of all
skill levels averaged 1-3 hours in the gym per
session; session duration for the internation-
al-level lifters just skewed slightly longer.
Step and linear tapers were the most popular
tapering models for powerlifters at all levels.
Tapers generally lasted <10 days. Most lift-
ers decreased their volume during their taper,
but they took varied approaches when ma-
nipulating intensity. Most lifters (79%) either
increased or decreased their training intensity
during their taper; decreasing intensity was

113
slightly more common than increasing inten-
sity for lifters at all levels, but a hefty mi-
nority of lifters (31-36% across all compet-
itive levels) increased intensity during their
taper period. The biggest difference between
the international-level lifters and the region-
al- and national-level lifters is that the vast
majority of international-level lifters (84%)
decreased training duration during their ta-
per. Approximately half of the regional- and
national-level lifters decreased training dura-
tion during their taper, while approximately
half maintained their typical training duration
(Table 2).
During the tapering period, a plurality of lift-
ers at all competitive levels completed their
final heavy (>85% of 1RM) back squat and
deadlift sessions 7-10 days out from the meet,
while a majority completed their final heavy
bench press session within 7 days of the meet.
Similarly, it appears that lifters of all com-
petitive levels completed their last squat and
bench press workouts (generally with lighter
loads) about four days out from the meet, on
average, and their final deadlift session about
six days out from the meet (Table 3).
In addition to training changes, lifters en-
gaged in a number of other practices during
114
115
the taper period that might influence recovery
or competition performance. Sleep and medi-
tation, foam rolling, mobility work, nutrition-
al changes (likely for the purpose of making
weight), massage, visualization work, and
static stretching were all pretty popular; these
strategies were employed by ~30-60% of lift-
ers (Figure 1).
Finally, the authors provided a figure sum-
marizing their findings. Figure 2 illustrates
the typical tapering approach used by Ameri-
can and Canadian raw powerlifters.
The biggest thing that jumped out at me was
that lifters across all levels of competition
approached training and tapering very simi-
larly. Of course, overall training frequency,
training duration, per-lift frequencies, styles
of tapers, etc. varied between individuals,
116
but the mean differences between the re-
gional-level lifters, the national-level lifters,
and the international-level lifters were pret-
ty small. That could suggest that the optimal
approaches to powerlifting training are being
discovered and disseminated across all lev-
els of competition, or it could merely sug-
gest that there’s a bit of groupthink at work
(I think it’s likely a bit of both). Importantly,
I think this finding partially dispels the myth
that international-level lifters are particularly
successful because they employ some special
mix of training variables that dramatically
improves their results. This study suggests
that, on average, international-level lifters
may train a bit more (in terms of average
session duration) than other people, but their
general approach to training doesn’t mean-
ingfully differ from the norm.
The other thing that jumped out to me is that
a plurality of lifters decreased training inten-
sity during their tapers (particularly the inter-
national-level lifters). If you’ve spent much
time in powerlifting, this shouldn’t be a sur-
prising finding. However, it conflicts with the
“standard” tapering advice in the literature:
it’s commonly recommended that athletes
should maintain or increase intensity (% of
1RM for their training loads) during a taper,
while decreasing volume (3). I’ve long be-
lieved that this piece of advice doesn’t really
apply to powerlifting. It’s primarily derived
from studies on endurance athletes or studies
using fairly simple strength tests. I don’t have
a hard time believing that you can produce
a ton of isometric knee extension torque 2-3
days after some high-intensity knee exten-
sions, but I don’t think you’ll have your best
performance on the powerlifting platform 2-3
days after near-max deadlifts. Of course, the
present study was a cross-sectional design,
rather than an experimental study (1); there-
fore, it can’t conclusively establish that de-
creasing intensity during a powerlifting taper
is superior to increasing or maintaining in-
tensity throughout a taper. However, I’m per-
sonally comfortable with assuming that we’re
seeing a bit of the “wisdom of crowds.” If
decreasing intensity during a taper produced
worse results on the platform, I don’t think it
would be as popular among competitors – es-
pecially international-level competitors. It’s
also possible that I’m falling prey to a bit of
groupthink on this topic (but I don’t think I
am).
Finally, it’s worth noting that the present
study merely presents the typical approach
to tapering used by American and Canadi-
an powerlifters. It doesn’t establish that the
typical approach to tapering is actually the
optimal approach. It’s certainly possible that
we’ve been misled by tradition, and we’re
collectively missing out on superior strate-
gies that either haven’t been tried or haven’t
been popularized. I don’t think it’s ludicrous
to assume that the typical approaches work
well enough for most people, most of the time
(otherwise, people would gravitate to other
strategies), but it would be presumptuous to
confidently conclude that the most common
tapering approaches are the best approaches.
117
References
1. Travis SK, Pritchard HJ, Mujika I,
Gentles JA, Stone MH, Bazyler CD.
Characterizing the Tapering Practices
of United States and Canadian Raw
Powerlifters. J Strength Cond Res.
2021 Dec 1;35(Suppl 2):S26-S35. doi:
10.1519/JSC.0000000000004177. PMID:
34846328.
2. Grgic J, Mikulic P. Tapering Practices
of Croatian Open-Class Powerlifting
Champions. J Strength Cond Res. 2017
Sep;31(9):2371-2378. doi: 10.1519/
JSC.0000000000001699. PMID:
27806009.
3. Bosquet L, Montpetit J, Arvisais D, Mujika
I. Effects of tapering on performance:
a meta-analysis. Med Sci Sports Exerc.
2007 Aug;39(8):1358-65. doi: 10.1249/
mss.0b013e31806010e0. PMID: 17762369.

118
 Study Reviewed: Replacing dietary animal-source proteins with plant-source proteins
changes dietary intake and status of vitamins and minerals in healthy adults: a 12-week
randomized controlled trial. Pellinen et al. (2021)

Replacing Animal Proteins With Plant Proteins: Are

There Any Downsides?
BY ERIC TREXLER

Plant-based diets have received a pretty sub-
stantial amount of attention in MASS over
the last year or two, and for good reason –
recent studies have prompted a fairly signifi-
cant re-evaluation of how plant-based protein
sources might impact our aspirations to build
strength and muscle mass (one, two, three).
Of course, “plant-based” can be viewed in
relative terms; while some might choose to
exclude all animal products from their diet,
others might adopt an ovo-vegetarian, lac-
to-vegetarian, pescatarian, or flexitarian diet,
or simply aim to replace some animal foods
in their diet with plant-based options. Re-
cent reviews in MASS have suggested that
even fully vegan diets can adequately support
muscle protein synthesis (2), strength (3),
and hypertrophy (3) outcomes under the right
conditions, but there’s (arguably) more to life
than getting bigger and stronger. Protein-rich
foods contain not only protein, but also a wide
variety of micronutrients; as such, swapping
one protein source for another is likely to in-
fluence your daily micronutrient intakes. So,
will replacing animal-based protein sources
with plant-based protein sources meaningful-
ly influence your micronutrient status? That’s
exactly what the presently reviewed study (1)
sought to find out.
136 adults (107 female, 29 male) aged 20-
69 years volunteered for this study, which
randomly assigned participants to one of
three groups. The animal protein group was
instructed to consume 70% of their protein
from animal sources, the 50/50 group was
instructed to consume 50% of their protein
from animal sources, and the plant group
was instructed to consume 30% of their pro-
tein from animal sources. Animal protein
(red meat, poultry, dairy, etc.) in the 50/50
and plant diets were partially replaced by
plant-based protein sources (such as cereal
products, peas, lentils, chickpeas, tofu, fava
beans, nuts, almonds, seeds, and plant-based
dairy substitutes). The researchers provid-
ed food items that made up about 80% of
the daily energy intake; the other 20% or so
was obtained from self-selected food sourc-
es. All diets were designed to provide about
17% of total energy intake from protein, and
four-day food records were completed prior
to the start and during the final week of the
12-week intervention. The researchers were

119
primarily interested in assessing intakes of
vitamin B12, iodine, iron, folate, and zinc,
along with several closely related blood or
urine biomarkers representing nutrient status.
Results indicated that the groups did not con-
sume significantly different amounts of total
energy, carbohydrate, or fat. The plant group
ended up eating significantly less protein
(15.2% of energy) than the 50/50 and animal
groups (16.9% and 18.2% of energy, respec-
tively), but also ended up eating significantly
more fiber than both. There were significant
differences among groups for vitamin B12
intake (plant < 50/50 < animal), iodine intake
(plant and 50/50 < animal), folate intake (an-
imal < plant), zinc intake (plant < animal), to-
tal iron intake (animal < plant), plant-derived
iron intake (animal < 50/50 < plant), and an-
imal-derived iron intake (plant < 50/50 < an-
imal). Intakes of vitamin B12 and iodine are
presented in Figure 1.
Despite this relatively large number of be-
tween-group differences for dietary intakes,
levels of only two biomarkers were signifi-
cantly different among groups at the end of
the intervention. Serum holotranscobalamin
II (representative of vitamin B12 levels) was
significantly lower in the plant group com-
pared to the 50/50 and animal groups, with
three participants (all in the plant or 50/50
groups) dropping below the threshold for vi-
tamin B12 deficiency. In addition, urinary io-
dine was significantly lower in the plant and
50/50 groups compared to the animal group.
Group averages were all within the recom-
mended ranges for adults who are not preg-
nant or nursing, but there were more instanc-
es of iodine deficiency observed in the 50/50
and plant groups than in the animal group.
In summary, it would appear that there are
some key micronutrients of elevated interest
if you’re transitioning to a more plant-based
120
diet (of course, you already knew that from
Dr. Helms’ two-part video series on “Per-
fecting a Plant-Based Diet for Bodybuild-
ing”). It’s also worth noting that these find-
ings were observed with diets consisting of
only 50-70% of protein coming from plants,
so these results might underestimate the im-
pact of adopting a fully vegan diet. The pres-
ently reviewed study provided direct support
for the idea that vegans, vegetarians, and
even flexitarians might want to proactively
seek out additional vitamin B12 and iodine,
which shouldn’t be hard to do – vitamin B12
is widely available in supplements and for-
tified foods and beverages, and iodine can
readily be found in many multivitamin for-
mulations and in iodized salt (or iodized salt
substitutes). Other micronutrients of interest
that Helms listed include vitamin D, iron,
zinc, and calcium.
The presently reviewed study did not focus on
vitamin D, but a previously reviewed study
found that vegans had significantly lower vi-
tamin D levels than omnivores at the time of
enrollment. Iron levels weren’t significantly
impacted in the presently reviewed study, but
it’s also possible that the study was too short
to reveal notable differences among groups;
in the previously mentioned study comparing
vegans and omnivores, blood ferritin levels
were non-significantly lower in vegans (140
± 83 196 ± 121; p = 0.10). The presently re-
viewed study noted that zinc intake was low-
est in the plant group, but they were unable
to measure a valid biomarker to compare nu-
trient status among groups. This could poten-
tially be important, as the authors note that
strict vegetarians might have a higher daily
requirement for dietary zinc due to bioavail-
ability considerations. Finally, eliminating
dairy obviously takes some great calcium
sources off the table, but there are plenty of
vegan calcium sources with adequate bio-
availability (4), and plant-based diets appear
to be fine for bone health as long as some
pretty feasible steps are taken to ensure ade-
quate calcium and vitamin D levels (5).
I always encourage people to seek out micro-
nutrients from whole food sources when it’s
feasible to do so. This recommendation isn’t
driven by the old appeal to nature fallacy, but
rather by the awareness that, in addition to
micronutrients, whole foods provide various
combinations of essential amino acids, essen-
tial fatty acids, macronutrients, and several
bioactive compounds that we’re only begin-
ning to understand. For example, we might
think of coffee as nature’s caffeine supple-
ment, but it contains hundreds of potential-
ly bioactive phytochemicals that make it so
much more.
Having said all that, I do believe that multi-
vitamin supplementation can be a viable and
feasible strategy to provide some supplemen-
tary micronutrient coverage (rather than re-
placing the need to seek out nutrient-dense
foods). Of course, targeted supplementation
with singular micronutrients would also be
a viable approach, but it’s not my go-to rec-
ommendation; on the whole, it doesn’t seem
to be substantially more cost-effective than a
broad-spectrum multivitamin approach, and
it won’t actually be a more targeted and pre-
cise intervention without repeated (and po-
tentially costly) blood testing to inform dos-
ing. People also have a tendency to go a bit
121
overboard with singular micronutrient sup-
plementation strategies, which may lead to
excessive dosages with the potential for acute
or chronic toxicity risk.
The most common arguments against mul-
tivitamin supplementation usually center
around two points: 1) the literature reports
few clear, clinically relevant benefits of mul-
tivitamin supplementation, and 2) multivita-
mins are a huge waste of money. As for point
number one, that’s true, and it’s a good thing.
There are many studies reporting null effects
of multivitamin supplementation in popula-
tions in which micronutrient deficiencies are
uncommon, which is exactly what you’d an-
ticipate – most people in these studies don’t
actually need a multivitamin, so adding a mul-
tivitamin to the mix isn’t a huge, statistically
significant game changer in terms of clinical
outcomes or mortality. However, multivita-
min trials conducted in populations with fair-
ly common micronutrient deficiencies often
report quite positive, clinically relevant ef-
fects of supplementation. As such, in 2018
an expert panel (6) concluded that, “Given
the relatively low cost and established safety
of [multivitamin/multimineral supplements],
as well as the essentiality of adequate micro-
nutrient status for human biology and good
health, [health care professionals] should
assess their patients’ dietary needs and risk
of micronutrient inadequacies and consider
intervening with [multivitamin/multimineral
supplements] for their at-risk patients.”
Now, when it comes to point number two
(that multivitamins are a huge waste of mon-
ey), that’s ultimately a judgment call. Sci-
entists can’t (and, in my opinion, shouldn’t)
universally agree on what a “large” effect
size is, so there’s no chance of settling on
a monetary value for a given effect. I was a
college student for ten straight years, so I’m
generally sensitive to the costs of any exer-
cise or nutrition strategy, and not prone to
downplay the financial impact of adding new
costs to the mix. However, as of writing this
article, I currently pay less than four cents per
day for my multivitamin supplement, which
offers pretty comprehensive micronutrient
coverage. That’s like paying $14.40 USD for
an annual “micronutrient insurance plan,”
which isn’t too bad.
One might suggest that you should just or-
der some micronutrient testing to check your
blood levels before supplementation. I don’t
necessarily disagree, as more information
tends to be better than less information. How-
ever, when you consider an intervention that
costs four cents per day and has an extremely
low risk of adverse events, it seems kind of
counterintuitive to pay for testing that might
(depending on your healthcare situation) cost
the equivalent of several years worth of mul-
tivitamins. Imagine you could spend several
hundred dollars to test if you’re a responder
(or non-responder) to creatine. It would be
cool to know, but it’d be way cheaper to just
try creatine for a year and see if you like it,
not to mention it’s an extremely low-risk ex-
periment for a healthy person with no under-
lying medical conditions.
In conclusion, a 12-week stint of replacing an-
imal-based proteins with plant-based proteins
won’t necessarily yield a long list of clinical-
ly significant micronutrient deficiencies, but
there are some key micronutrients to keep an
122

eye on if you’re transitioning to a more plant-
based diet. The most noteworthy micronutri-
ents of interest are iron, vitamin B12, vitamin
D, iodine, zinc, and calcium. In many cases,
adequate intakes can be achieved with a mix-
ture of carefully selected conventional and
fortified foods, but supplementation is also
a viable option. You could pursue a target-
ed supplementation approach with individual
micronutrients, but my personal preference is
to lean on a basic multivitamin supplement.
Plant-based diets with adequate micronutri-
ent coverage, sufficient total protein intake
(and comprehensive essential amino acids)
can support the goals of lifters and athletes
to the same extent as omnivorous diets with a
higher proportion of animal-based products.
References
1. Pellinen T, Päivärinta E, Isotalo J,
Lehtovirta M, Itkonen ST, Korkalo L, et al.
Replacing dietary animal-source proteins
with plant-source proteins changes dietary
intake and status of vitamins and minerals
in healthy adults: a 12-week randomized
controlled trial. Eur J Nutr. 2021 Nov 27;
ePub ahead of print.
2. Monteyne AJ, Dunlop MV, Machin DJ,
Coelho MO, Pavis GF, Porter C, et al. A
mycoprotein based high-protein vegan
diet supports equivalent daily myofibrillar
protein synthesis rates compared with an
isonitrogenous omnivorous diet in older
adults: a randomized controlled trial. Br J
Nutr. 2020 Nov 11;1–35.
3. Hevia-Larraín V, Gualano B, Longobardi
I, Gil S, Fernandes AL, Costa LAR, et
al. High-Protein Plant-Based Diet Versus
a Protein-Matched Omnivorous Diet to
Support Resistance Training Adaptations:
A Comparison Between Habitual Vegans
and Omnivores. Sports Med. 2021
Jun;51(6):1317-1330.
4. Mangels AR. Bone nutrients for
vegetarians. Am J Clin Nutr. 2014 Jul;100
Suppl 1:469S-75S.
5. Hsu E. Plant-based diets and bone health:
sorting through the evidence. Curr
Opin Endocrinol Diabetes Obes. 2020
Aug;27(4):248–52.
6. Blumberg JB, Cena H, Barr SI, Biesalski
HK, Dagach RU, Delaney B, et al.
The Use of Multivitamin/Multimineral
Supplements: A Modified Delphi
Consensus Panel Report. Clin Ther. 2018
Apr;40(4):640–57.
123
 Study Reviewed: Effect of Weightlifting Training on Jumping Ability, Sprinting Performance
and Squat Strength: A Systematic Review and Meta-Analysis. García-Valverde et al. (2021)

The Combination of Weightlifting Training and

Traditional Resistance Training May be Better for
Athletes than Either Modality in Isolation
BY GREG NUCKOLS

We’ve discussed research related to weight-
lifting a few times in MASS (one, two, three,
four), but it doesn’t receive quite as much at-
tention as research that is directly relevant to
other strength sports. There are a couple rea-
sons for that: fewer weightlifters than pow-
erlifters read MASS, and there are way more
studies that investigate methods of improving
maximal force output than studies investigat-
ing weightlifting performance. However, I’m a
big fan of weightlifting, and I actually trained
more weightlifters than powerlifters when I
was cutting my teeth as a coach. I think the
Research Briefs will give me an opportunity to
discuss weightlifting research more frequently.
Before we get rolling on this brief, let’s take a
quick detour to discuss terminology. Weight-
lifting is the actual name of the sport that
consists of the snatch and the clean and jerk.
It’s often referred to as “Olympic weightlift-
ing” or (if you come from a CrossFit back-
ground) “Oly,” but the name of the sport is
just “weightlifting.” Weightlifting is also not
to be confused with “weight lifting,” which is
a catch-all term for any pursuit that involves
lifting weights.
A recent meta-analysis (1) investigated the im-
pact of weightlifting training, “traditional train-
ing,” and a combination of both modalities on
squat jump, countermovement jump, sprinting
(up to 40m), and squat performance. For the
purposes of this meta-analysis, weightlifting
training included the classical lifts (full snatch-
es and full clean and jerks) and variations of the
classical lifts (hang cleans and snatches, power
cleans and snatches, cleans without jerks, etc.),
and “traditional training” included…just about
everything else. For the most part, the “tradi-
tional training” in the included studies consist-
ed of standard barbell (squat, half squat, bench
press, split squat, etc.) and machine (leg press,
leg curls, knee extensions, etc.) exercises, or
jumping-based interventions.
The researchers searched databases for all
studies that a) included healthy subjects, b)
compared a weightlifting-based training in-
tervention to some other training interven-
tion, and c) assessed changes in squat jump,
countermovement jump, sprinting, and/or
squat performance. Then they identified the
groups in each study that performed a) entire-
ly or primarily weightlifting-style training, b)

124
a combination of weightlifting-style training
and traditional training, and c) exclusive-
ly traditional training. After separating the
duced generally positive mean effects. How-
groups into these three categories, they used
ever, the effects weren’t always statistically
a series of standard random-effects models
significant for traditional training (counter-
to calculate the effect size for each outcome
movement jump, sprint, and squat perfor-
(standardized mean difference; SMD) result-
mance; 2) or weightlifting training (counter-
ing from each training style.
movement jump and sprint performance).
For all four outcomes, weightlifting train- Conversely, a combination of weightlifting
ing, traditional training, and a combination of training and traditional training produced sta-
weightlifting and traditional training all pro- tistically significant effects for all four out-

125
comes, with small effect sizes for jumping
(Figures 1 and 2) and sprinting outcomes (Fig-
ure 3; SMD = 0.30-0.46), and a large effect
size for squat strength (Figure 4; SMD = 0.86).
The major takeaway from this meta-analysis
is that a combination of weightlifting train-
ing and traditional training seems to be pretty
effective for improving lower-body strength,
speed, and power. Combining both modali-
ties seems to produce more consistently pos-
itive results across more measures of lower
body strength/power performance than ei-
ther modality in isolation. I’m sure this isn’t
a mindblowing conclusion, but a combina-
tion of weightlifting variations, conventional
strength-focused exercises, and jump training
seems to pretty reliably make athletes stron-
ger, faster, and more powerful. However, any
single modality in isolation may leave you
with gaps in your lower body strength and
power development.
Finally, just as a word of caution to end with:
I’d encourage you to take the results of the
present meta-analysis seriously, but not too
literally. Each comparison included differ-
ent studies within the “weightlifting,” “tradi-
tional,” and “combined” groupings, different
subjects, different training interventions, etc.
In other words, this meta-analysis is informa-
tive about whether or not each training style
126

is generally effective for improving each out-
come, but we can’t make direct apples-to-ap-
ples comparisons between training styles.
For example, the mean effect size for im-
provements in squat performance was larger
following combined training than traditional
training, but we can’t directly interpret that to
mean that a combination of squats and cleans
will improve your 1RM squat to a greater ex-
tent than just doing more squat training.
References
1. García-Valverde A, Manresa-Rocamora
A, Hernández-Davó JL, Sabido R. Effect
of weightlifting training on jumping
ability, sprinting performance and squat
strength: A systematic review and meta-
analysis. International Journal of Sports
Science & Coaching. December 2021.
doi:10.1177/17479541211061695
2. It’s worth noting that the lack of significant
increases in squat strength following
traditional training is probably just due
to lack of studies. All four studies in this
grouping reported a positive effect size, but
statistical power was low since there were
only four studies in this grouping.
127
 Study Reviewed: Wrist-Worn Devices for the Measurement of Heart Rate and Energy
Expenditure: A Validation Study for the Apple Watch 6, Polar Vantage V and Fitbit Sense.
Hajj-Boutros et al. (2021)
Is Everything That’s Measured Worth Managing?
BY ERIC TREXLER
You may have heard the old adage, “What
gets measured gets managed.” This might
be used as a justification for the increasingly
common desire to utilize wearable technol-
ogy in order to attain fitness goals. Howev-
er, you might be surprised to learn that the
adage listed above is actually incomplete.
The full quote, delivered in the context of
business management guidance (although
there’s disagreement regarding who actually
said it first), reads: “What gets measured gets
managed – even when it’s pointless to mea-
sure and manage it, and even if it harms the
purpose of the organization to do so.” There
would of course be considerable advantages
conferred from valid, reliable, real-time mea-
surement of energy expenditure data. How-
ever, whether or not such tracking is “point-
less” or “harms our purpose” comes down to
the validity, reliability, and utility of those
measurements. If they’re terrible, the act of
tracking energy expenditure with wearable
devices is pointless at best. If we’re making
significant adjustments guided by erroneous
data, it might even harm our purpose.
The presently reviewed study (1) sought to
evaluate the accuracy of three wrist-worn de-
vices: the Apple Watch 6, the Polar Vantage
V, and the Fitbit Sense. 60 young and healthy
individuals (30 males and 30 females; age:
24.9 ± 3.0 years, BMI: 23.1 ± 2.7 kg/m2)
completed five different activities (sitting,
walking, running, resistance exercise, and
cycling) for ten minutes each while wearing
each of the devices. Heart rate and energy ex-
penditure were continuously measured using
the Polar H10 chest strap and MetaMax 3B;
these were the criterion (reference) measure-
ments to which the wearable devices were
compared.
The researchers performed a number of anal-
yses to facilitate device comparison, includ-
ing Pearson correlations between each device
and the criterion measure, standardized typ-
ical error of the estimate for each device (a
standardized version of “the typical amount
by which the estimate is wrong for any given
subject”), the coefficient of variation for each
device (standard deviation / mean × 100), and
Bland-Altman plots for each device (which as-
sess the agreement between devices by plotting
the difference between two devices against the
128
average value of both). Pearson correlations
were interpreted as ≥ 0.995: excellent; 0.95-
0.994: very good; 0.85-0.94: good; 0.70- 0.84:
poor; 0.45-0.69: very poor; < 0.45: impracti-
cal. Standardized typical error of the estimate
values were interpreted as >2.0: impractical;
1.0-2.0: very large; 0.6-1.0: large; 0.3-0.6:
moderate; 0.1-0.3: small; <0.1: trivial. Coeffi-
cients of variation were interpreted as > 10%:
poor accuracy; 5-10%: acceptable accuracy; <
5%: high accuracy. So, just to be clear: a high
value would be good for a Pearson correlation,
but a high value would be bad for a standard-
ized typical error of the estimate or coefficient
of variation.
Unfortunately, the researchers found that
these wearable devices were pretty disap-
pointing when it comes to estimating energy
expenditure. Given all of the different ways
they quantified device agreement and differ-
ent types of errors, we could drown in a sea
of numbers here. However, the quantitative
interpretation of these numbers isn’t partic-
ularly intuitive, and I don’t want us to miss
the forest for the trees. So, I have adapted a
table to concisely summarize the energy ex-
penditure results using the authors’ own cat-
egorized criteria for interpreting the values
(Table 1).
129
As can be seen in Table 1, all three devic-
es did quite poorly when aiming to estimate
energy expenditure during various types of
activity. The researchers also constructed a
number of Bland-Altman plots; it would be
a bit excessive to include them all here, so I
will summarize them. It was fairly common
to see mean bias values relatively far from
zero (indicating that there is general dis-
agreement between methods, on average),
very wide limits of agreement (reflecting
high variability in the magnitude of disagree-
ment), some very big outliers (suggesting that
estimates were very, very bad for some spe-
cific individuals), and some instances of pro-
portional bias (indicating that disagreement
systematically differed among people with
lower-than-average energy expenditure and
people with higher-than-average energy ex-
penditure). In short, the estimates were pretty
bad, but not in a way that would be easily
predictable. If a device consistently overes-
timates everyone’s energy expenditure by
100kcal/day, it’s technically wrong, but still
quite useful. However, when you’re looking
at large errors with a great deal of variability
and some fairly substantial outliers, it’s hard
for an individual user to confidently act upon
the estimate they receive.
I assume that many people view their energy
expenditure estimates from wearable tech-
nologies as somewhat imperfect estimates
that should be interpreted with some degree
of caution, but these data reflect much more
than a functionally negligible rounding error
or a consistent magnitude and direction of er-
ror that can be easily adjusted for. As such,
the researchers stated: “Collectively, based on
these findings, we would suggest that evalu-
ating energy expenditure using these 3 wrist-
worn devices does not provide an acceptable
surrogate method for the estimation of ener-
gy expenditure in research studies.” Based
on the data, it’s hard to argue with them, and
they’re certainly not the first group to reach
this type of conclusion – previous systemat-
ic reviews by Fuller et al (2) and Evenson et
al (3) concluded that commercially available
wearable devices estimated energy expendi-
ture with insufficient validity.
Having said that, all is not lost. I know Dr.
Helms gets upset when we mention any type
of exercise that is not lifting, but there are
plenty of folks who do various types of en-
durance exercise and find heart rate data to be
quite helpful. The presently reviewed study
found that the Apple Watch 6 did a pretty
good job of tracking heart rate, whereas the
heart rate accuracy of the other two devices
varied depending on the type of activity be-
ing performed. So, if you were interested in
using a wearable device to track your heart
rate during endurance exercise (or incorpo-
rate heart rate-based exercise prescriptions),
the Apple Watch 6 would probably get the
job done. In line with this finding, previous
systematic reviews by Fuller et al (2) and
Evenson et al (3) have reported that certain
wearable devices (but not all) are pretty ef-
fective for heart rate tracking.
In addition, we have previously discussed
the many benefits of striving for higher dai-
ly step counts, and these systematic reviews
also reported that certain wearable devices do
a pretty nice job tracking step counts (2, 3).
So, getting back to the old adage at the begin-
130
ning of this research brief: the point is not that
wearable devices are “pointless,” but they may
“harm our purpose” if we place too much con-
fidence in their energy expenditure estimates.
If you’re altering your calorie intake in direct
response to estimates from a wearable device
with questionable validity, you might be chas-
ing an inaccurate number that could be leading
you astray. The available research suggests
that many wearable devices tend to do a pretty
poor job of estimating energy expenditure and
sleep metrics (3), but some may be pretty valid
when it comes to measuring heart rate and step
counts. I say “may” because the relative valid-
ity and reliability of each specific device must
be assessed independently, with some models
performing substantially better than others (2).
Rather than using a wearable device to obtain
an estimate of your daily energy expenditure,
you might be better off with an approach that
focuses on patiently and consistently observ-
ing your daily energy intake and fluctuations
in body weight. Body mass changes reflect
changes in the total metabolizable energy con-
tent of the body, which draws a direct math-
ematical link between body composition and
energy balance. As I previously wrote else-
where, “All you need to do is accurately track
your body weight every morning and your dai-
ly energy intake, and you can identify the calo-
rie target required to meet your goal. If you’re
trying to maintain body weight, then you’re
trying to find the calorie target that keeps your
weight stable.” Of course, if you’re trying
to achieve a particular rate of weight gain or
weight loss, the same principle applies.
The primary downside to this approach is
that changes in sodium intake, carbohydrate
intake, hydration status, and the bulk of food
in our gastrointestinal tract can cause some
day-to-day fluctuations in body weight that
can make it hard to determine which weight
fluctuations are “signal” and which are
“noise.” You could keep yourself very busy
developing spreadsheets or algorithms that
use different smoothing, weighting, and ad-
justment techniques to sort out this variabil-
ity and tighten up your estimates (see here),
but the level of precision you wish to pursue
is all up to you.
When writing about scientific topics, my gen-
eral aim is to share robust conclusions that are
likely to stand the test of time, with no bias
related to “wanting” any specific outcome.
However, this particular topic is an exception
– I hope (and expect) that wearable devices
will eventually get better at energy expendi-
ture estimation, so studies describing their cur-
rent estimation errors are sure to be outdated
in the near future. It remains to be seen if these
devices will become valid and reliable enough
to independently inform dietary intake (in the
absence of additional adjustments or algorith-
mic inputs). For now, the commercially avail-
able wearables that have been tested in the
peer reviewed literature come up short. Wear-
ables can be great for measuring and tracking
other physiological metrics (such as heart rate
and step counts), but patient and consistent
tracking of changes in energy intake and body
composition is currently our best option for
making inferences about energy expenditure
and energy balance.
131
References
1. Hajj-Boutros G, Landry-Duval M-A,
Comtois AS, Gouspillou G, Karelis AD.
Wrist-Worn Devices for the Measurement
of Heart Rate and Energy Expenditure: A
Validation Study for the Apple Watch 6,
Polar Vantage V and Fitbit Sense. Eur J
Sport Sci. 2021 Dec 27;1–36.
2. Fuller D, Colwell E, Low J, Orychock K,
Tobin MA, Simango B, et al. Reliability
and Validity of Commercially Available
Wearable Devices for Measuring Steps,
Energy Expenditure, and Heart Rate:
Systematic Review. JMIR MHealth
UHealth. 2020 Sep 8;8(9):e18694.
3. Evenson KR, Goto MM, Furberg RD.
Systematic review of the validity and
reliability of consumer-wearable activity
trackers. Int J Behav Nutr Phys Act. 2015
Dec 18;12:159.

132
 VIDEO: Mental Fatigue Part 2
BY MICHAEL C. ZOURDOS

Recent literature has demonstrated that mental fatigue builds over time in
elite athletes. This video examines how coaches and lifters may mitigate and
cope with mental fatigue, which manifests over time.
Click to watch Michael's presentation.

133
Relevant MASS Videos and Articles
1. Is Your Brain Getting in the Way Volume 4 Issue 12.
2. Put That Phone Down, Now! Volume 5 Issue 7.
3. Mental Fatigue Part 1. Volume 6 Issue 1.

References
1. Russell S, Jenkins D, Smith M, Halson S, Kelly V. The application of mental fatigue research to
elite team sport performance: New perspectives. Journal of science and medicine in sport. 2019
Jun 1;22(6):723-8.
2. Habay J, Van Cutsem J, Verschueren J, De Bock S, Proost M, De Wachter J, Tassignon B,
Meeusen R, Roelands B. Mental Fatigue and Sport-Specific Psychomotor Performance: A
Systematic Review. Sports Medicine. 2021 Mar 12:1-22.
3. Schiphof-Godart L, Roelands B, Hettinga FJ. Drive in sports: How mental fatigue affects
endurance performance. Frontiers in psychology. 2018 Aug 17;9:1383.
4. Russell S, Jenkins DG, Halson SL, Kelly VG. Mental fatigue increases across a 16-week pre-
season in elite female athletes. Journal of Science and Medicine in Sport. 2021 Dec 15.
5. Russell S, Jenkins DG, Halson SL, Juliff LE, Connick MJ, Kelly VG. Mental Fatigue Over
2 Elite Netball Seasons: A Case for Mental Fatigue to be Included in Athlete Self-Report
Measures. International journal of sports physiology and performance. 2021 Sep 27;1(aop):1-0.
6. Russell S, Jenkins D, Rynne S, Halson SL, Kelly V. What is mental fatigue in elite
sport? Perceptions from athletes and staff. European journal of sport science. 2019 Nov
26;19(10):1367-76.
7. Russell S, Jenkins DG, Halson SL, Juliff LE, Kelly VG. How do elite female team sport
athletes experience mental fatigue? Comparison between international competition, training and
preparation camps. European Journal of Sport Science. 2021 Mar 24:1-1.
8. Igorov M, Predoiu R, Predoiu A, Igorov A. Creativity, resistance to mental fatigue and
coping strategies in junior women handball players. The European Proceedings of Social and
Behavioural Sciences EpSBS. 2016;11:286-92.

134
 VIDEO: Supplement Series
Part 4: Fat Burners
BY ERIC HELMS

In part 4 of the “Supplement Series,” Dr. Helms discusses “fat burners.”

These are a common class of supplements, which despite often including
well-researched ingredients like caffeine, actually don’t have a solid basis of
evidence proving their efficacy. In the fourth installment, we cover the latest
research on combined fat burner products, as well as some of the more
common, specific ingredients used in a stand-alone fashion.
Click to watch Eric's presentation.

135
Relevant MASS Videos and Articles
1. Is Caffeine an Effective Appetite Suppressant?? Volume 2, Issue 10.

References
1. Pillitteri, J. L., Shiffman, S., Rohay, J. M., Harkins, A. M., Burton, S. L., & Wadden, T. A.
(2008). Use of dietary supplements for weight loss in the United States: results of a national
survey. Obesity (Silver Spring, Md.), 16(4), 790–796.
2. Machado, E. C., Silveira, M. F., & Silveira, V. M. (2012). Prevalence of weight-loss strategies
and use of substances for weight-loss among adults: a population study. Cadernos de saude
publica, 28(8), 1439–1449.
3. Clark, J. E., & Welch, S. (2021). Comparing effectiveness of fat burners and thermogenic
supplements to diet and exercise for weight loss and cardiometabolic health: Systematic review
and meta-analysis. Nutrition and health, 27(4), 445–459.
4. Panek-Shirley, L. M., DeNysschen, C., O’Brien, E., & Temple, J. L. (2018). Caffeine
Transiently Affects Food Intake at Breakfast. Journal of the Academy of Nutrition and Dietetics,
118(10), 1832–1843.
5. Tabrizi, R., Saneei, P., Lankarani, K. B., Akbari, M., Kolahdooz, F., Esmaillzadeh, A., et al.
(2019). The effects of caffeine intake on weight loss: a systematic review and dos-response
meta-analysis of randomized controlled trials. Critical reviews in food science and nutrition,
59(16), 2688–2696.
6. Ludy, M. J., Moore, G. E., & Mattes, R. D. (2012). The effects of capsaicin and capsiate on
energy balance: critical review and meta-analyses of studies in humans. Chemical senses, 37(2),
103–121.
7. Golzarand, M., Toolabi, K., & Aghasi, M. (2018). Effect of green tea, caffeine and capsaicin
supplements on the anthropometric indices: A meta-analysis of randomized clinical trials.
Journal of Functional Foods, 46, 320-328.

136
 Just Missed the Cut
Every month, we consider hundreds of new papers, and they can’t all be included in MASS.
Therefore, we’re happy to share a few pieces of research that just missed the cut. It’s our
hope that with the knowledge gained from reading MASS, along with our interpreting research
guide, you’ll be able to tackle these on your own. If you want to peruse our full journal sweep,
you can find it here, and you can find our historical archive here.

1. Morel et al. A Bioassay-Guided Fractionation of Rosemary Leaf Extract Identifies Carnosol

as a Major Hypertrophy Inducer in Human Skeletal Muscle Cells
2. Davids et al. Acute cellular and molecular responses and chronic adaptations to low-load
blood flow restriction and high-load resistance exercise in trained individuals
3. Markov et al. Acute Effects of Aerobic Exercise on Muscle Strength and Power in Trained
Male Individuals: A Systematic Review with Meta-analysis
4. Anderson et al. Acute fetal response to high-intensity interval training in the second and
third trimesters of pregnancy
5. Sargent et al. An Individualized Intervention Increases Sleep Duration in Professional
Athletes
6. Medeiros et al. Association of Vitamin D Supplementation in Cardiorespiratory Fitness
and Muscle Strength in Adult Twins: A Randomized Controlled Trial
7. Nagao and Ishii. Characteristics of the Shrug Motion and Trapezius Muscle Activity During
the Power Clean
8. Marchetti et al. Different Knee and Ankle Positions Affect Force and Muscle Activation
During Prone Leg Curl in Trained Subjects
9. Knaier et al. Diurnal Variation in Maximum Endurance and Maximum Strength Performance:
A Systematic Review and Meta-analysis
10. Pichardo et al. Effects of Combined Resistance Training and Weightlifting on Injury Risk
Factors and Resistance Training Skill of Adolescent Males
11. Liu et al. Effects of different resistance exercise forms on body composition and muscle
strength in overweight and/or obese individuals -a systematic review and meta-analysis
12. Đurić et al. Effects of Resistance Training With Constant, Inertial, and Combined Loads on
Muscle Power and Strength Output
13. Hamarsland et al. Equal-Volume Strength Training With Different Training Frequencies
Induces Similar Muscle Hypertrophy and Strength Improvement in Trained Participants
14. Duran and Öz. Examination of the association of muscle dysmorphia (bigorexia) and social
physique anxiety in the male bodybuilders
15. Dougherty et al. Five–year changes in objectively measured cardiorespiratory fitness,
physical activity, and sedentary time in mid-to-late adulthood

137
16. Draganidis et al. Low-Grade Systemic Inflammation Interferes with Anabolic and Catabolic
Characteristics of the Aged Human Skeletal Muscle
17. Fyfe et al. Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and
Function: A Narrative Review of Current Evidence and Practical Considerations
18. Fecchio et al. Post-dynamic Resistance Exercise Hypotension: Exploring Individual
Responses and Predictors
19. Tranaeus et al. Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A
Mixed-Studies Systematic Review
20. Patterson et al. The influence of hip extensor and lumbar spine extensor strength on lumbar
spine loading during a squat lift
21. Finlay et al. Upper-Body Post-activation Performance Enhancement for Athletic Performance:
A Systematic Review with Meta-analysis and Recommendations for Future Research
22. Wikander et al. Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional
Survey

138
 Thanks for
reading MASS.
The next issue will be released to
subscribers on March 1, 2022.

Copy editing by Lauren Colenso-Semple

Graphics and layout by Kat Whitfield

139