Muscle and cancer - It is not getting old that is the problem, it is getting weaker!

I saw this get picked up in a few places but no one was linking to the actual study.  The takeaway message is that building and maintaining muscle strength is vital to all for overall health and this extends to surviving cancer.  It is not getting old that is the problem, it is getting weaker!

Researchers studied patients with advanced melanoma to understand the illness as it related to muscle strength. They looked at CT scans of the psoas muscle in order to measure core muscle density. The authors then correlated the core muscle density with the risk of metastasis, or spreading of the cancer. 

Patients with higher muscle density were found to have significantly better survival rates and less metastasis.  The authors concluded that decreased muscle density was an important predictor in the outcome of the disease. Furthermore, they stated that “frailty, not age, was associated with decreased disease-free survival.”

Here is theabstract

Sarcopenia as a Prognostic Factor among Patients with Stage III Melanoma.

Abstract

BACKGROUND: Several hypotheses proposed to explain the worse prognosis for older melanoma patients include different tumor biology and diminished host response. If the latter were true, then biologic frailty, and not age, should be an independent prognostic factor in melanoma.

METHODS: Our prospective institutional review board (IRB)-approved database was queried for stage III patients with computed tomography (CT) scans at time of lymph node dissection (LND). Psoas area (PA) and density (PD) were determined in semi-automated fashion. Kaplan-Meier (K-M) survival estimates and Cox proportional-hazard models were used to determine PA and PD impact on survival and surgical complications.

RESULTS: Among 101 stage III patients, PD was significantly associated with both disease-free survival (DFS) (P = 0.04) and distant disease-free survival (DDFS) (P = 0.0002). Cox multivariate modeling incorporating thickness, age, ulceration, and N stage showed highly significant association with PD and both DFS and DDFS. DDFS was significantly associated with Breslow thickness (P = 0.04), number of positive nodes (P = 0.001), ulceration (P = 0.04), and decreasing muscle density (P = 0.01), with hazard ratio of 0.55 [95% confidence interval (CI) 0.35-0.87]. PD also correlated with surgical complications, with odds ratio (OR) of 1.081 [95% CI 1.016-1.150, P = 0.01]. 

CONCLUSIONS: Decreased psoas muscle density on CT, an objective measure of frailty, was as important a predictor of outcome as tumor factors in a cohort of stage III melanoma patients. On multivariate analysis, frailty, not age, was associated with decreased disease-free survival and distant disease-free survival, and higher rate of surgical complications.

Avoid ibuprofen if you want to grow muscle?

Well that heading is just to promote some interest, but to be honest it does have something to do with this post.  I spotted this bit of research reported yesterday, about how muscles get the signal to grow.  Developing and retaining muscle is not just an issue for bodybuilders or athletes, it is essential to health as we grow old.

The story in EurekaAlert explains:

We take it for granted, but the fact that our muscles grow when we work them makes them rather unique. Now, researchers have identified a key ingredient needed for that bulking up to take place. A factor produced in working muscle fibers apparently tells surrounding muscle stem cell "higher ups" that it's time to multiply and join in, according to a study in the January Cell Metabolism, a Cell Press journal.

The research identifies this factor as "serum response factor (Srf)" which  translates the mechanical signal of work into a chemical one.

Srf works through a network of genes, including one known as Cox2. That raises the intriguing possibility that commonly used Cox2 inhibitors—think ibuprofen—might work against muscle growth or recovery, Sotiropoulos notes.

The research is available here:

Srf-Dependent Paracrine Signals Produced by Myofibers Control Satellite Cell-Mediated Skeletal Muscle Hypertrophy

Adult skeletal muscles adapt their fiber size to workload. We show that serum response factor (Srf) is required for satellite cell-mediated hypertrophic muscle growth. Deletion of Srf from myofibers and not satellite cells blunts overload-induced hypertrophy, and impairs satellite cell proliferation and recruitment to pre-existing fibers. We reveal a gene network in which Srf within myofibers modulates interleukin-6 and cyclooxygenase-2/interleukin-4 expressions and therefore exerts a paracrine control of satellite cell functions. In Srf-deleted muscles, in vivo overexpression of interleukin-6 is sufficient to restore satellite cell proliferation but not satellite cell fusion and overall growth. In contrast cyclooxygenase-2/interleukin-4 overexpression rescue satellite cell recruitment and muscle growth without affecting satellite cell proliferation, identifying altered fusion as the limiting cellular event. These findings unravel a role for Srf in the translation of mechanical cues applied to myofibers into paracrine signals, which in turn will modulate satellite cell functions and support muscle growth.

Ok so how do I apply this to get massive?

Muscle Anatomy

I am getting addicted to the Khan Academy.  Their stuff on biology is amazing.

Another reason to build - and maintain - muscle

Muscular heart failure patients may have a better chance at survival

......research found that having more muscle was associated with better nutritional status and lower severity of heart failure, while higher body fat was associated with increased inflammation and reduced exercise capacity. This suggests that in patients with heart failure having more muscle mass and lower fat may be beneficial.


The study also discovered that testing just the body mass index (BMI) of heart failure patients doesn't accurately measure their body fat status. Oreopoulos found 41 per cent of the participants were inaccurately classified by BMI. Many who had a high body weight but not high body fat were mislabelled as obese and others who did not weigh a lot but had a high amount of body fat were mislabelled as normal by BMI.

Podcast with Doug McGuff

Last week I posted an interview that I had done with Doug McGuff, co-author of Body by Science.

A couple of days ago Doug featured in Jimmy Moore's podcast with an interesting interview that covers much of the material that is in the book. There is some good stuff in there.

Strength Training and Skill Training

I have been reflecting more on the interview that I did the other day with Doug McGuff. In particular I've been thinking about this issue of strength training versus skill training.


Here is a quote from Richard Winnett that says something similar to Doug:

Similar arguments can be made concerning 'functional' and 'stability' training. The basic assumptions are that training in a specific way transfers directly to a sport or activity of daily living and training in unstable environments activates more muscle fibers and also will better transfer to unstable 'real life tasks'.

The arguments made for this kind of training fall apart when the research literature is consulted. At best, studies suggest that transfer of training occurs very little or not at all. This is what is meant by these outcomes. Training in a certain way such as very rapid movements or jumping with weights does not enhance rapid movements or jumping, for example, in a sport, any more than conventional training enhances such performance.

The major outcomes of such studies suggest that the goal should be to gain strength in a safe, efficient, and effective way and then learn how to use that strength in a given sport. Trying to mimic the sport in training makes little or no sense.

I am really intrigued by that last statement: gain strength in a safe, efficient, and effective way and then learn how to use that strength in a given sport.

The sort of research he is talking about is here.


I've started to sense a "freedom" about the approach that he is promoting. Sometimes there is a danger - for me at least - of always looking for the next big thing, looking for the secret training approach that will finally sort me out and make me perform better. Doug's approach is straightforward - you need basic strength training then you need to practice the skills for your sport. It isn't complicated - stop looking for the hidden secret.

Interview with Doug McGuff

Here is another interview - this time with Doug McGuff - one of the authors of the recently published Body by Science. (Available from Amazon if you are interested). I've read it and found it a fascinating book, but it left me with some questions. Doug has helpfully answered those questions and clarified some things about which I was a bit confused. Body by Science is a really good book. It is built in the way that I like - it starts with the foundational principles and builds from there. It will get you thinking and challenge some of your assumptions. If you want a flavour of it, check out some of the videos on YouTube.
(The book is also reviewed here)



Doug, normally when I do an interview, the first question gives the interviewee the chance to explain a little bit about themselves and their interest in health and fitness. The Body By Science website has this helpful biography:

Doug McGuff, MD became interested in exercise at the age of 15 when he first read Arthur Jones’ Nautilus Training Bulletin No. 2.
His interest in exercise and biology led him into a career in medicine. In 1989, he graduated from the University of Texas Medical School at San Antonio and went on to train in Emergency Medicine at the University of Arkansas for Medical Sciences at Little Rock where he served as Chief Resident. From there, Dr. McGuff served as Faculty in the Wright State University Emergency Medicine Residency and was a staff Emergency Physician at Wright-Patterson AFB Hospital. 
 
Throughout his career Dr. McGuff maintained his interest in high intensity exercise. Doug realized a lifelong dream when he opened Ultimate Exercise in November, 1997. Over the past 11 years Dr. McGuff and his instructors have continued to explore the limits of exercise through their personal training clients at Ultimate Exercise.

1. Is there anything you would want to add for my readers to give them an insight into you as a trainer and writer?

Yes, I would like to mention that prior to age 15 I was a fat kid. My first attempt at physical improvement was to jog to the end of my street, rest at the stop sign, and then jog back. I was astounded how quickly my condition improved after just a few attempts. This was the beginning of my amazement with the adaptability of the human body.

Later, I was given a Sears Ted Williams home barbell set. I did the workout provided in the manual and was literally amazed at the transformation that occurred. The lifting of weights, combined with the hormonal environment of adolescence had me hooked. The physical improvements made me excel in my sport (BMX) and I tried very hard to keep my weight training secret (until one of my competitors peeked through my garage window while I was working out).

I acquired Arthur Jones’ Bulletin No. 2 from an area Nautilus Gym where I traded Janitorial Services for a membership. Since that time I have always enjoyed working out very hard, and had felt there was something intrinsically valuable about very intense exercise, and that fears of danger were unfounded. I was motivated to study biology and medicine so that I might someday be able to prove what I intrinsically knew as a teenager. Lastly, despite all the HIT rhetoric of “workouts should not be enjoyable”, I can honestly say I have loved every workout I have ever done.

2. You have recently published Body by Science. It is the best book on training I’ve read for a long time. The science is clearly presented and I have learned a lot. I’ve really enjoyed reading it and found the chapters on Global Metabolic Conditioning, The Dose-Response Relationship of Exercise and the Science of Fat Loss fascinating. The book certainly challenged by thinking in several areas and I’d like to clear up some of my confusion.

Thanks so much for the kind words.

So much of the book comes from a theoretical understanding of basic physiology as applied to high intensity exercise. For a long time, there were no studies to substantiate these theories. And let me be clear, I was not the originator of most of what is in this book. You will find these theories and the empirical evidence that produced these theories going way back. There is not a lot of difference between Body by Science and the Rader courses of the 1930’s or the work of Delorme and Watkins.

The concept of Global Metabolic conditioning is just my own answer to the aerobics movement which has so successfully tied itself to cardiovascular conditioning. Questioning the aerobics movement was inspired by the work of Ken Hutchins (developer of SuperSlow-tm and now Renaissance Exercise ). When I looked at the big picture of metabolism, the notion that the aerobic pathway was preferentially linked to the cardiovascular system just seemed silly. Further, the attempt to isolate this component of metabolism sacrificed conditioning in the other components of metabolism that had enormous biologic importance.

3. Your book promotes high intensity strength training – training to failure once a week on a handful of basic exercises - and its many benefits. Who is the book aimed at?

The book is aimed at everyone.

Every person has the skeletal muscle and the supporting subsystems that can benefit from high intensity strength training. I chose a handful of simple exercises that make it easy to focus on the truly important aspect which is intense exertion. Intense exertion sets into motion massive mobilization and emptying of the glycogen stores. By tapping the largest glucose reservoir of the body, you set into motion a process that is the antithesis of the modern metabolic syndrome. By making severe demands on the musculature, you wake up the “active genotype” that is our birthright.

4. I enjoy physical activity – hiking, krav maga, sprint training, weight training. Even if I only need 8 minutes once a week, I do not want to be limited to exercising only once a week. Am I missing something?

Not missing something, just misunderstanding.

The physical activities you enjoy are the by-product of a well-conditioned musculature. I used to try to get my clients to limit their activities outside the gym in order to maximize recovery between workouts. What I found was, that once a client reached a certain level of muscular conditioning, the client almost could not help themselves from partaking in other physical activities, sports, and exertional recreation. I found this in myself. Once I abbreviated my weight workout to the point that I was getting progressively stronger, I had an incredible urge to become more active. I even took up a sport from my youth (BMX) and raced competitively again.

What I now believe, is that the skeletal muscle is the storehouse for our “active genotype”. But realize this…if you dropped the krav maga, and continued your other activities, your conditioning would still be excellent, and you would still remain quite active. The same situation would occur if you dropped any component of your physical activity EXCEPT your strength training. If you dropped your strength training, you would gradually become less energetic and more injury-prone. You would probably first sustain an injury from one of your high-force pursuits such as krav-maga or sprinting. This would either prevent you from hiking, or you would gradually become lethargic and not have the desire to hike.

I feel that there is nothing wrong with lots of physical activity. However, I think the sport and conditioning world needs to understand that proper strength training is the fountainhead for the capability and desire to be this active.

5. You make a clear distinction between skill conditioning and metabolic conditioning. For sports like soccer where there is a lot of sprinting over 10-20 metre distances would you see sprint training as skill conditioning or metabolic conditioning? I suppose I am thinking of the example in the book where you talk about using interval training to train BMX racers. Were the sprints skill training or metabolic conditioning?

It depends on the circumstance. In both sports sprinting is both a skill and a component of conditioning. The reference I made to interval training was to illustrate how SPECIFIC metabolic conditioning is.

Doing intervals that involved 20 second bursts with 10 seconds rest (Tabata Intervals) did not work well for BMX racers because the average BMX race lasts about 35 seconds. So the interval training I was referring to here was for metabolic conditioning. I adjusted the intervals to 35 second bursts and 25 second rests so that the metabolic adjustments would be more precise to the sport. Sprinting (or practicing gate starts) is a very specific skill conditioning that is critical to the sport of BMX. Here the goal is to practice the mechanics of the first component of the race so that maximal power can be transferred to get you in the lead early. Adequate recovery between gate starts is given so energy is available to practice perfect technique. Some conditioning may occur as a side-effect, but that is not the goal of skill practice.

6. One of the big trends in training recently has been “functional training”. The coach Vern Gambetta for example talks about training “movements not muscles”. Is this different from what you mean when you talk (p215) about building “functional strength …..tracking muscle and joint function with the intent of making the athlete stronger”?

I am not familiar with Vern Gambetta or what he means by “training movements not muscles”. When I refer to selecting movements that track muscle and joint function, I am simply referring to using exercises that effectively load resistance onto a muscle so that aggressive fatigue can be brought about, and done so safely.

I do think the notion of truly isolating a muscle group is somewhat specious. I remember how amazed I was during my Gross Anatomy class in medical school by how integrated all of the body’s musculature was. I remember spending HOURS trying to dissect out the separation between the biceps and brachioradialis. There were anatomy graduate students who would spend DAYS meticulously trying to dissect out muscle groups for us to view because they knew most of the class would be unsuccessful. This is why I emphasize basic compound movements that are simple to perform. This involves multiple muscle groups in a manner that is easy to coordinate so that the trainee can focus on what really matters….intense effort.

7. Balance / proprioception. Do you see a role for balance training? For example, lots of old people begin a serious decline following a fall and a fracture. Do you think balance training alone would help or is the key problem a lack of strength which can be built through resistance training?

The vast majority of balance problems in the elderly are due to muscle atrophy and weakness. The stiff gait characteristic of the frail elderly subject is largely due to weakness. They depend on the bone-on-bone tower to stand. As soon as there is any decrease in the joint angle, the force required from the muscles to stay upright is quickly exceeded and they lose balance and fall. All the balance training in the world will not help someone who is too weak to hold themselves up if they “break the lockout” in their knees. Once muscle strength is restored, near normal balance returns. The elderly have some loss of balance due to calcification of the semicircular canals in the inner ear, loss of connective tissue elasticity, and other components that are not improved with balance training. If adequate muscle strength is restored, balance training can produce improvements, but like any other skill, these improvements are very specific.

You can teach someone to walk on a tightrope, but that won’t necessarily make them perform better on a skateboard. I remember watching an episode of MTV where professional skateboarders and BMX vert riders went out to learn to wakeboard with disastrous results. So you won’t find any beach balls or wobble boards in my facility.

8. A related question – is there a role for “skill conditioning for everday life”? The athlete has a skill set at which to excel. Is there a similar skill set that – irrespective of our strength and metabolic conditioning – we need to practice to function well in everyday life? I’m thinking about walking, squatting, balance, bending over etc?

Again, if someone has adequate muscular strength to lead an active life, these “skill sets” will be adequately rehearsed just by the act of living life. But let us be very clear…these skill sets can NEVER BE irrespective of our strength and metabolic conditioning.

9. Do you think that it is possible to train effectively with Calisthenics? If the focus is on intensity of effort – as this review seems to indicate - can “superslow” lunges, pushups, dips, pull-ups and isometrics be sufficient?

Yes, bodyweight exercise can be very effective. Superslow is not a requirement for them to be productive, although in many cases it can be a good intensifier. As long as you use techniques to make the resistance adequate, you don’t need much in the way of equipment. While I love great equipment, low friction, good biomechanics, and perfect cam profiles, I must say that I am tired of the eternal hope that some radical new design in equipment is going to make the marginal difference that is going to make possible degrees of muscular development that were previously not possible. The rate-limiting factor WILL ALWAYS BE the particular person’s genotype.

10. I’ve been reading books about high intensity training / superslow training for years. I’m thinking of John Little’s books, those from Ellington Darden or Slow Burn for example. These have either been illustrated mainly by pictures of steroid fuelled bodybuilders – who have the genetics and drugs to look phenomenal on any training regime - or of very normal looking people who don’t look particularly athletic. Are there examples of people who have built impressive natural physiques using your methods….or am I committing a logical error, ("Fooled by Randomness" style) in looking for “testimonial” physiques?

There are numerous examples of folks that have built impressive physiques using the methods described in Body by Science (or at least HIT principles). David Landau, and Vee Furguson have built competition worthy physiques with once-a-week training. Joshua Trentine has built a pro-level physique using HIT principles.

But you are right, this line of thinking is a logical error. The biggest error that occurs is one of selection bias and survivor bias. Those with the potential for great muscular development tend to have better recovery characteristics and the positive feedback from good results tends to drive them to higher volume. We deliberately steered away from “fitness models” in illustrating the book, so as to not to incite in the readers of Body by Science the exact observational errors that we were trying to dispel in the early chapters.

11. The book mentions that you have learned from Art DeVany. He has inspired a lot of people with his Evolutionary Fitness approach. I’ve noted before that there is often an almost romantic idealism among people who promote a Palaeolithic exercise and dietary regime – I for one am grateful for the comforts of modern life from hygiene to central heating! What do you think we can learn from our hunter gatherer ancestors regarding health and fitness…..and where do we now have the knowledge and technology to improve?---

I think we have to acknowledge that our evolutionary background must be considered when we consider the type of diet and exercise which is best. I would not ever want to do away with agriculture, because it is this ability to plan for the future and store wealth that are the foundation of capitalism which has propelled human life, comfort and longevity so far forward.

However, we must realize that our genome has not had time to adjust to all that is available. We are truly Fred Flintstones living in a George Jetson world. In the realm of diet, the evidence that we should eat within the paradigm of the hunter-gatherer model, and that we should avoid grain-based/agricultural products, is overwhelming. With regard to exercise, we evolved with a requirement for intense intermittent exercise and fairly high activity levels (though not steady state). However, I think a lot of people make the mistake of romantic idealism when it comes to working out…thinking it is intrinsically better to lift a rock, than a barbell, or work out on a well-designed exercise machine. We see this in the movies…Rocky works out with an ox-cart filled with rocks, the evil Russian is on a Nautilus machine. If we understand some of the mechanisms that stimulate muscular improvement and can bring them about in a safer and more efficient way, we should do so. Like I tell my clients…I advocate a Fred Flintstone diet and a George Jetson workout.

12. Your Big 5 Routine is built around the use of machines. I understand that with a properly designed cam there are advantages in terms of delivering variable resistance. However is there any truth to the argument that is often made that machines do not sufficiently stress the synergists and the supporting muscles that would be worked with free weights? Or it is more appropriate to train those muscles as part of “skill conditioning”.---

There is probably some advantage to the involvement of the muscles that must be involved in a static/stabilizing manner to carry out lifting with free weights. However, this must be weighed against safety issues and biomechanical issues.

There are some specificity issues as well. The argument is frequently made that strength that is gained on machines does not translate to barbells. Leg Pressing 1000 pounds on a MedX machine does not mean that you will squat well with 315 pounds. However, what is often forgotten is that this argument works both ways. Squatting with 315 does not mean you will use 1000 pounds on the MedX machine. Building strength involves aggressively loading and fatiguing the musculature. Demonstrating strength will always require skill rehearsal in the modality that you will use to demonstrate strength.

One final point, the “Big 5” is not a magical or optimal routine. I simply have selected 5 movements that are simple to perform and cover the major musculature of the body.

13. What about explosive training? When we see athletes doing box jumps, bounding or Olympic lifting are we seeing skill conditioning or specific metabolic conditioning? Are things like dumbbell snatches a waste of time?---

No, they’re not a waste of time. But you do need to consider the risk-to-benefit ratio, especially when there are alternatives that are safer. In my opinion, explosiveness is a matter of capability, intent, and practice. Capability is largely predicated on your muscular strength. Intent is a function of your neurological efficiency. Practice is marrying your capability and intent to a specific skill in which you wish to be explosive. I do not think there is a lot of evidence to suggest that performing a snatch or cleans is going to help a lineman explode any more than just being appropriately strength-trained and then practicing the specific skill in question.

With regard to safety, I think the dangers may be underestimated because of survivorship bias. Lots of collegiate and professional athletes and coaches advocate this kind of training, but the selective pressure of competition has already identified them as more resilient intrinsically. What we don’t see is what Nassim Taleb calls “the graveyard”- those that have fallen out because of lack of results or injury.

You can only do kipping pull-ups or clapping pushups so long before you tear the labrum of your shoulder or injure your rotator cuff. Further, these injuries are not always acutely evident. You may tear your labrum in your 20’s and “mysteriously” end up with a frozen shoulder in your 50’s.

14. I totally agree that stretching is not conducive to improved athletic performance. However do you see a role for mobility training? There is much talk of mobility training “lubricating the joints”, but I’ve yet to find any research about its benefits. Still I find it enjoyable and something that really “loosens me up”.---

This is definitely in the realm of “Mikey likes it” (the old Life Cereal commercial). There is no data to support this idea, but if Mikey likes it…what the heck.

15. To finish, can I ask for your views on my training? I am a 41 year old office worker. I am fairly physically active and just looking to keep active, healthy and able to keep doing the things I enjoy.

• I do a Krav Maga (self defence) class on a Tuesday – which is generally 15 minutes of warm ups and conditioning exercises (sprints, squats, pushups, agility work) followed by 45 minutes of drilling specific moves – punches, kicks, throws, defences.
• On a Friday at the moment I do some sprint training with some guys at work. One is a competitive sprinter – Scottish over 40 champion of 100m – who does a lunchtime session of 400m intervals. This is tough but enjoyable and a good social event.
• Most weekends I try to get out into the hills for a hike, often in the summer climbing one of Scotland’s many mountains which could be anything from a 2 – 8 hour walk…..
• Somewhere in there I usually do another strength training session – e.g. last week was a 10 minute session of dumbbell rows, dumbbell stiff leg deadlift, pushups and split squats/lunges all superslow style. Other times it may be kettlebell swings or whatever.

How could I improve my health and fitness?---

I don’t think I have a lot to tell you to improve. I would say to make your strength training the foundation of what you do and realize the other things are derivative. It is strength training that will carry you into old age with the ability to continue all of your interests. My rules are basically this…

1)make sure you are progressing and showing improvement.
2) Keep your training frequency such that you experience more days “above baseline” than “below baseline”.
3) Don’t injure yourself.

Thanks for taking the time to answer these questions Doug!

You’re welcome. Thanks for the opportunity to appear on your blog.

UPDATE MARCH 2011 - there is an excellent video of a talk from Doug available HERE   and available for purchase HERE

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Ibuprofen - the latest 'roid for the aged?

This is a weird story that popped up yesterday. Basically, a study has found that

..over-the-counter painkillers may promote muscle growth in older patients during weight training...

In 24 patients with a mean age of 64, recommended daily doses of ibuprofen and acetaminophen were associated with gains of about 50% in muscle volume and strength compared with placebo after 12 weeks of resistance training, Chad Carroll, Ph.D., of Ball State University in Muncie, Ind., and colleagues reported at the Experimental Biology meeting here.

"These results suggest that chronic consumption of ibuprofen or acetaminophen during resistance training induces intramuscular changes that enhance the metabolic response to resistance exercise," said Todd Trappe, Ph.D., also of Ball State.

I really don't know what to make of this one!

Have a look at the full story: OTC Painkillers Also Help Grandpa Get Buff (!)

It is also reported by Eureka here.

Maybe these guys need some?


Talking of older people weight-training, there was a story in the NY Times yesterday about bodybuilders in their 60's and 70's: 60-Plus, Ripped, and Natural Competitors