Barbell Shrugged - Blood Flow Restriction Training w/Dr. Jeremy Loenneke, Anders Varner, Doug Larson, and Travis Mash #780

Episode Date: January 8, 2025

Dr. Jeremy Loenneke received his Ph.D. in Exercise Physiology from the University of Oklahoma, where he was mentored by Dr. Michael Bemben. Dr. Loenneke previously received his Master’s degree in Nutrition and Exercise Science from Southeast Missouri State University, where he was mentored by Dr. Joe Pujol. Dr. Loenneke is a member of the American Physiological Society and the American College of Sports Medicine. He also serves on the editorial boards of many publications, including Sports Medicine, AGE, Medicine and Science in Sports and Exercise, and the Journal of Applied Physiology. Dr. Loenneke’s study focuses on the adaptations of skeletal muscles to exercise in the presence of blood flow limitations. His latest study has provided answers to numerous critical methodological and safety problems about the use of blood flow restriction. Loenneke is the director of the Laboratory of Applied Physiology Kevser Ermin and his research group focuses on skeletal muscle adaptations to exercise with and without blood flow restriction. He is a member of the American Physiological Society and a Fellow of the American College of Sports Medicine. Work with RAPID Health Optimization Links: Jeremy P Loenneke on Instagram Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram

Shrug family, this week on Barbell Shrug, Dr. Jeremy Leneke is coming in. He is from Ole Miss, and today on Barbell Shrug, we're gonna be talking about blood flow restriction, maybe even a little bit of skeletal muscle. He is a professor, and one thing cool about blood flow restriction is it's been around a little while,

and every time I hear it, I'm like, man, that seems a little far-fetched. I know there's a little bit of benefit to it. How much of a benefit? Can't really tell you, but today's show, we're going to answer all of those questions. And as always, friends, make sure you get over to rapidhealthreport.com. That is where you can check out all things lab, lifestyle, and performance, and the things that we're going to be working with you on inside Rapid Health Optimization. So make sure you get over to rapidhealthreport.com. Friends,

let's get into the show. Welcome to Barbell Shrugged. I'm Anders Varner, Doug Larson, Dr. Jeremy Lineke. Welcome to the show today. Thanks for having me. Today on Barbell Shrugged, we're going to be talking about something that I don't really know that much about, blood flow restriction. Here's the framework of which blood flow restriction shows up in my life. Lots of people talk about it. And then I go, wait a second. When I was a young buck trying to be as strong as I possibly could be, nobody ever talked about this. And now all of a sudden it's like this new cool thing,

which means I might potentially roll my eyes every time someone brings it up. That's why we brought you on today though. Cause I actually, I, it's one of those things. I know there's some benefit, but i don't really know much about it so um before we dig in i would love to you have all the old miss gear how long you been professor research kind of all those all those pieces of your history yeah i've been in old miss i guess this is year 11 so as i told you earlier getting ready for the spring semester uh trying to update the lectures, make sure I know what I'm talking about for the spring. Before that, grad students will know. They keep you on your toes. But yeah, so I've been here for 11 years, studying skeletal muscle, focusing on blood flow

restriction. We do other things with resistance training, but that is a large focus. Before that, I was at the University of Oklahoma, where I did my PhD. Before that, Southeast Missouri State, where I did my undergrad and my master's. There you go. Awesome. Let's dig in. Blood flow restriction. I'd love to hear just kind of where this interest sparked. And then we can talk about how useful, or not how useful, but what are the best practices and how people can start to implement it. Yeah, I first came across it when I was just reading journal articles as an undergraduate. And I was reading studies where it's like we're restricting blood flow. Good things are happening. People are getting bigger. People are getting stronger. And I just remember thinking, I just must not understand what I'm reading because that doesn't make any sense. We know

blood flow is good. There's no way that restricting it would be good. So I had it in my head, but then I was like, well, you know, maybe it's likely that I just, I'm an undergrad and I just don't know what the heck I'm talking about. So I went to University of Illinois for an internship. And while I was up there, I kind of met with Lane Norton and some other people in the gym. And they were kind of talking about this idea of blood flow restriction and trying to implement it as well. So I was like, well, i i actually was reading that correctly and then from there it just kind of snowballed into

studying it and trying to learn as much as i i possibly could about it uh because it seemed like just a unique way to train and i've kind of got it on the kind of the front end of it i was at a good place at the right time yeah yeah it does sound counterint it on the kind of the front end of it. I was at a good place at the right time. Yeah. Yeah. It does sound counterintuitive on the face of it. Like what, what really is, is the mechanism that provides the benefit? Yeah.

Good question. I think, you know, when you talk about mechanisms, it's very difficult to pinpoint. This is the mechanism, you know, I think it's, it, that's something that's difficult for people to, to grasp sometimes because it's like, how you guys don't know anything about what you're talking about. You know, it's always, we just need more, but it's like, we know the outcomes pretty well. We know that if we do this, we will get this, We will get an increase in muscle size. We will get an increase in strength, an increase in local and muscular endurance. Why that occurs or how that occurs, that's really difficult to pinpoint. I don't know that the mechanisms of growth are all that different

from traditional exercise. For a while, I thought there could be some reason to believe that, and there still might be, but there's no evidence that there's anything different between them. But it is counterintuitive, and I think the thing that explains it is the fact that we are only restricting blood flow for short periods of time, and it's a partial restriction. So blood flow is always going into the limb. So even when we're exercising, blood flow, we're not completely cutting it off. Blood flow is going in.

It's not a tourniquet. Correct. You could probably use one, but as long as you don't restrict blood flow completely. Put that on my Christmas wish list there, Doug. Tourniquet next Christmas. I need one. Yeah. So, and the key point is, is that it's applied for minutes right if you were to restrict blood flow for three days well that's probably not a good thing yeah so blood

continues to flow into the muscle but it can't come out of the muscle so you get like you get this like um very exaggerated pump i'd imagine with that um why why is that again beneficial to have blood only going into the muscle but not not exiting the muscle yeah so when you're contracting there's probably still some flow being pumped out of the muscle just based on the skeletal muscle pump but yeah there is some thought that that cell volumization might actually be an important trigger for growth now there's not a not a lot of great evidence that that is the trigger, but you could connect the dots that, you know, I get the cell volumization. Some of that fluid

goes into those muscle cells. Those muscle cells swell. They turn on some of these signaling cascades, and that may provide one part of the reason why muscle might be stimulated to grow or to have some beneficial effect there. The other part of that is you pull those metabolites. So when you actually are contracting the muscle, you know, you have byproducts of metabolism, which are generally pumped out through circulation. But if you're impeding that circulation, then those metabolites are sometimes trapped around the fibers. And that might provide some reason why we increase rapidly muscle activation. So not only do we recruit those lower threshold, we start to recruit those higher threshold motor neurons. And that might explain why we see large changes in muscle growth, because we're able to

tax those higher threshold motor units. Yeah, I was kind of assumed the metabolic buildup was was a big factor there. I didn't actually think about the the like the pressure of within the cell to have a commanding role there. I've not thought of that before. Yeah, that's one thought. The metabolites are a big thought as well. And for a long time, you know, there was some thought that, and there still is this thought, that those metabolites in and of themselves might actually be beneficial. So just having the metabolites could do some signaling.

There's not a lot of evidence for that, but, you know, it's really difficult to study those type of things. But I think a lot of people do agree that those metabolites do help with fatiguing those fibers and that could expedite some of that recruitment. But they may also have some signaling independent of that, but that's harder to test. Yeah. With hypertrophy in general, it seems hard to tease out whether it's metabolic buildup versus mechanical tension. As an example, all these things are happening at the same time, but with blood flow restriction, oftentimes the loads

typically are lower. Like you can do, you can do higher volume sets, higher rep sets, and still get a very good hypertrophy response, which by definition, if the mechanical 10, sorry, if the, um, reps per set is higher, the mechanical tension on the muscle is typically lower. You're just doing lower weights in general. So I always kind of assume the, the, the metabolite or the metabolic, uh, buildup, uh, had to be a big factor there. Yeah, it definitely is. I think that the mechanical depends upon how you want to, how you want to look at that. Some people would look at it as if you're activating those higher threshold motor motor units where you activate all of those fibers, that that has a mechanical

aspect from those metabolites. But yeah, you're, you're definitely right. The load is substantially lower than traditional exercise. Yeah. Yeah. I was going to say where, um, anytime, uh, this kind of gets brought up, there's always like somebody in the back chirping about the dangers of, um,

restricting blood flow. And, um, like they're being like a sweet spot of what is too tight, not tight enough. Um, how can you kind of, uh,

explain that to people in their own training? Like what, what does that pressure feel like? Um, and actually for, for implementing it. Yeah. And yeah, this, the safety is, is always goes back to kind of what we talked about kind of earlier. Are you partially restricting blood flow for short periods of time? If you do both of those things, it appears to be a relatively safe stimulus. Now, the way that I always try to discuss it is there's always a risk. There's a risk to just normal exercise. When you apply blood flow restriction, how much does it increase that risk? It appears to be really minimal in

most people, assuming you're doing it correctly. And to your point, well, what is the correct pressure? I think if you have a pressurized device where you can actually set the pressure, in other words, the way that we set the pressure in research is we put the cuff at the top of the limb. So whatever limb you're looking to exercise, if it's your bicep, we put it at the top of your arm. If it's your legs, very top of your leg. And we slowly inflate the pressure until we get to the lowest pressure of which there is no pulse. And that's what we call the limb occlusion pressure. It's essentially the systolic pressure of the limb. And we take a percentage of that and that ensures that blood flow is always going in. So we typically use anywhere between 40 and 80% of that pressure.

And for muscle adaptations, there's quite a ways of wiggle room there. For vascular, maybe you need a little bit of a higher pressure. I don't think we have a real definitive answer there, but you can see benefits between 40% and 80%. Now, what about people who don't have pressurized devices, right? So what about people who are trying to do this with, let's say, knee wraps in the gym? I think, one, it's going to be much more challenging to do that. But I think there are some things that you can use. I think you can use kind of how many repetitions you're able to do during an exercise as some sort of gauge for the restriction of blood flow.

So I think one of the things that you can do is try to have some goal repetitions. So say in the first set, I'm going to shoot for 30 repetitions. And in the next three, I'm going to shoot for 15. Now the load, we want to set it around 20 or 30% of our max, right? So if you have the load there and you apply the wrap to your limb and we, you can apply it snugly. You don't want to, if you're in pain before you start an exercise, it's way too tight. But one of the things that you can do is, how many repetitions can I get in that first set? If it's 50 repetitions, and you know the load is low at around 30%, then it's probably not tight enough, right?

If you do 10 repetitionsitions that means the reps are too or the the wraps are too tight or the load is too high so i think you know you might not get it exactly but you can get close to those especially on the first couple sets i think that can kind of give you a gauge of am i in the ballpark for this pressure? Yeah. Is there a frequency where you kind of, it's too much versus, you know, a standard training session is like a once a week thing, once per body part.

Is there any worry about going, doing too much of it? I don't think there's a worry about doing too much depending upon what your goal is. I think if your goal is, um, I want to be as strong as possible. I want to go compete in powerlifting and all you're doing is low load exercise, the blood flow restriction, then you're not setting yourself up for the, your best success, right? You need to have some frequency of higher load training. I think that's quite clear. But I think the frequency and how to implement this, it's really, really difficult to give answers to this

because when you get into real life, there's a lot of other factors. Like how many, you know, you could implement the lots of different ways but what are you normally doing with your training already right if you do a couple days of normal training per body part and you add a third day of this are you really going to be getting that much more probably not uh maybe you could replace parts of what you're currently doing or maybe you could add it at the very end um but i I think if you had somebody who was already training, my suggestion would be to replace one of those training sessions with just lower load blood flow restriction, if that's something you wanted to try. But I wouldn't say I'm going to

stick to my normal training and then add two more days of blood flow. I think you're really going to start hurting your recovery. So is this really kind of siloed to biceps, triceps, maybe, maybe leg extensions, hamstring curls, like some leg exercises, but like it's pretty much limbs only, right? You're not going to be able to do this with, with pecs, lats, abs, obviously. Like what are the, what are the best use cases here? Yeah, the restriction is always going to be on the limbs, but you can see some sort of benefit on muscles that are proximal to that cuff, right? So there's not a lot of evidence behind this, but there are some studies that do exist that suggest that if we apply it where we would

normally on the arms and we do bench press exercise, that you're able to augment some of those adaptations and muscle size and strength over the same exercise without that. Now, what is the reason why? It's not under direct restriction. It could have something to do with I fatigue those muscles that are under restriction and the muscles that are proximal to that have to pick up the load and they're stressed to a greater extent than what they normally would be. That's kind of the token answer to that, but I don't think we really know. But there is data that suggests that you can apply it with bench press, you can apply it with squats and see some benefits, even to muscles that are proximal to that. But I do think it's fair that the majority of the work is completed on the limbs.

In other words, distal to where that restriction is applied. So I think you can apply it with almost any exercise. I think if you're going to do it with something proximal to the cuff, let's say you're going to do shoulders. It might make sense to kind of superset it with something that is under restriction. So maybe do triceps and then shoulder press. Do those kind of together. That might be one way to maximize that in a trained person, but that's just me kind of giving my best guess.

What does the research actually say as far as like kind of an apples to apples comparison of one group does you know three sets of tricep extensions x days a week without blood flow restriction and the other group does the exact same thing with blood flow restriction there's a control group and they do the exact exact same workouts over six weeks or whatever it is on hypertrophy strength muscular endurance or any other relevant variable there yeah so um if we look at if let's say we have three groups in your example you have uh control low load exercise and low load exercise with blood flow and we're the only thing that differs is restriction, even though that's kind of harder to do in practice. But when you look at those outcomes, blood flow restriction is usually better than low load exercise. So it produces more growth. Strength is sometimes better,

not always better, but usually better. And endurance is usually better as well. And then it's usually going to be greater than that of a non-exercise control, suggesting that it's not just noise. So in general, when you compare blood flow restriction to just the same repetitions without blood flow restriction, there is a treatment effect almost always, meaning that you do see greater changes in muscle size and greater changes in muscle strength. Now, if you compare that to, let's say, traditional high load exercise, the story changes slightly. The muscle growth is still about the same. Endurance still probably about the same. Maybe depending upon how you're testing it,

it may still be better with blood flow restriction but it's probably going to be comparable um and if we look at maximal strength blood flow restriction will increase it but it's usually going to be less than that of high load exercise and that just gets to you know the principle of specificity uh meaning that people who lift heavy weights are better at lifting heavy weights than people who spend almost no time doing that. But yeah, I think there's a lot of data that suggests that there is a treatment effect, which is comparable to high load exercise in most variables. Maximal strength being an exception. So as an example, if you are someone like a power lifter or somewhere maximum strength is a factor, on your high load exercises, you would not do this.

You do your heavy bench press for triples and whatever else. And then on your hypertrophy work, where you're doing higher rep sets, maybe you'd apply this there for hypertrophy benefits, but for maximal strength, you you'd apply this there for hypertrophy benefits, but for maximal strength, you would not use this. Yeah, I wouldn't. If your primary goal is maximal strength, then you could implement it on some of that accessory work, but I would still make sure that I'm spending a fair amount of time training heavy. Now, don't get me wrong. Maximal strength does increase with low load exercise in combination with blood flow restriction. But it's going to be less than what you see with traditional high-load exercise.

You know, another way that a powerlifter could use it is if, you know, they, for whatever reason, you know, we kind of talked about this before I started recording it. You go to the gym, you have a scheduled high load day, and you just physically can't, you're not right or mentally not right to do it that day. Well, maybe blood flow restriction is something you could do, uh, at that time and then save your heavy day for when you're a little bit better. Uh, that might be one way to, to, to think about it as well, but yeah, it's going to increase strength, but not to the same extent as high load exercise. Yeah. That's a, that's something that box. Yeah, exactly. Keep moving. And, and without, without having to put all of the weight on your back that day. Um, another thing that, uh, I read in your bio was, uh, kind of a, uh, research on skeletal muscle. Does blood flow restriction have any,

are those connected in any way? Did like one lead to the other in your research? For me? Yeah. So like my interest in it or? Well, we've talked about the muscle tissue kind of on the hypertrophy and strength side of things, but, um, does it play into like, did, did studying blood flow

restriction, uh, impact anything on the skeletal side of things like improve bone mineral density, et cetera. I see. Yeah. So yeah, I, I, when I had that in the bio, that meant more, more so just the muscle tissue. Um, there has been, um, you know, we've done a little bit of work. Um, the lab that I came from in Oklahoma on, on bone, uh, typically bone markers of metabolism that are, are, are thought to give you some information about long-term changes in bone. All of that work suggests that low-load exercise with blood flow restriction might be beneficial for bone long-term. That's such a good scientist answer right there. But there's not a lot of good evidence. I mean, you know, I am not,

my mentality and mindset is not set up to study bone. I need to, I need some adaptations that I can measure in short periods of time. I want to know, is this working or not working? You know, whereas bone takes a long time. Yeah. Especially in young, healthy people, it's going to be really hard. We can change muscle. It's harder to change bone. Gotcha. What about other soft tissue items here? Is there any research on blood flow restriction with respect to injury recovery and or prevention, tendon strength, ligament strength, etc.? Yeah, there's some recent work on tendons.

Some of the original work didn't really progress the blood flow-restricted exercise, and they didn't see a whole lot of benefit. Some more recent work looking at tendon stiffness and tendon cross-sectional area has suggested that blood flow restriction produces tendon adaptation similar to that of high-load exercise. So that's a little bit counter to what I would have expected. But, you know, there's several. So that's a little bit counter to what I would have expected. Um, but you know, there's several studies showing that at this point, um, our lab hasn't focused on tendon too much. We're, we're starting to try to change that. Um, but we haven't done any work currently. Uh, but there is some work, um, that does show that it does have some benefits, even

the tendons, which I think for a long time, that wasn't thought that that was going to happen. They said, well, you may increase muscle size, but tendons require a load. So maybe that narrative might have to change if this becomes a consistent finding. Well, it seems like from a rehabilitation standpoint, if you're able to get similar hypertrophy benefits with lighter loads, then as you're coming back from injury and you're not wanting to use heavy loads because you're not fully rehabbed yet, could blood flow restriction help in that sense where you're able to keep or have an even stronger training stimulus while keeping the loads low as you're recovering

from an injury, maybe like late stage recovery of an injury? Yeah, I definitely think so. And I'll be upfront that I'm not a clinician. But there are a lot of clinicians that are implementing this out in practice for that very reason. And I think if you look at a lot of the D1 programs, division one, uh, programs in the United States, a lot of them are influencing blood flow restriction in the rehabilitation. I know Ole Miss is, I know lots of professional teams are even in the premier league over in Europe. So I think a lot of people see a lot of clinical benefit to it. There is some data behind that.

None of it's for me. I'm again, I'm not a clinician, but I think a lot of people are starting to say, okay, this is working in healthy people. What about these clinical populations? And there's some work in pretty good journals that suggest that, yeah, it works for the reasons that you said, that they can't necessarily apply the heaviest load. So let's apply it with this lower loads that they may be able to use early on in the recovery process and kind of maximize kind of that benefit yeah uh speaking of of europe and primarily and all that i talked to the guys at hydro a while back they they create uh i haven't actually tried uh any other products here but uh they create shirts

and and shorts that have blood flow restriction like woven into the material so you're not just putting a cuff on your arm it's like a part of the shirt or a part of the um of like the workout compression shorts or what have you so uh and i believe with those as well they have like some type of markings where you can consistently apply the same pressure each time if you just use knee wraps you're kind of just guessing it's similar to last time looser tighter you're not really sure but i believe they had some way to quantify how tight they were they're making their straps and from what i could tell just in the brief amount of time that i spoke with those guys that they had really high quality stuff

um what are the what are the what's the lay of the land rather for products similar to to that where it's specifically made for blood flow restriction training where you actually know how tight you're making it in a consistent way across many weeks yeah i think the method that they're probably utilizing and i have seen the i actually have some they sent me some stuff it's pretty slick i think that you know we did a study several years ago where we pulled kind of an elastic band. So one that wasn't pressurized as a percentage of your arm circumference. So I think that's kind of what, you know, they're probably utilizing is I'm going to apply it here. And we show that that produces a pretty comparable reduction in blood flow to that of pressurized devices, at least at rest. We don't know about during exercise, but I don't know why it would be

different. But yeah, that is one company that's done a lot or come out with some really interesting products. I think it's pulling it as a percentage of the circumference that that is sound. It makes sense to me. There's lots of devices though, that I I've, I've lost complete track to be honest. The, we use a very simple device, pressurized device,

one that's not that all that portable for our research purposes. But I think that the, the main point is if you're whatever device that you're looking to use, if it's pressurized, if you're going to spend money to get one that you can try to know what the pressure is, I would try and at least get one that you can make sure you can cut off blood flow. So there are some cuffs that are multi-chamber that it's impossible to completely cut off blood flow. So it's never really able to standardize it to the limb. Um, it's all based on how that pressure is applied. But I think as long as you use the principles of we want more restriction of blood flow,

um, I think almost any of the devices would probably be good. Some of them might just be more convenient than others, but there's, there's so many devices. I wouldn't even know where to begin. Yeah. It seems like there's an opportunity here to create some type of a cuff that has that links to an app that actually tells you your real time systolic and diastolic blood pressure. Yeah. I, I don't know the name of the company.

Um, there are, I think Ole Miss just got, uh the name of the company. There are, I think Ole Miss just got one of these devices in the athletic department where they have unlimited budgets. But I don't know. I'm not familiar with the device really, but I did see that it was connected to some phone. But so, yeah, who knows? It could be made better. there's definitely a sensor out there somewhere doug don't worry i'm surely behind the times on this yeah well i feel like the uh it was something i was actually thinking about the first time that i saw or it was kelly starrett when he was like invented those not maybe not invented but it was like the basically like a bike tire for mobility for people that were like, he was using them on like power lifters at Westside,

basically to like get their knees and whatnot, um, that are just so tight. And the tendons are so tight. The only way to actually get some, um, additional range of motion in there. And he talked about one of the big benefits being of all the blood rushing back into the into the connective tissue and into the joint and kind of like feeding it this brand new healthy oxygenated blood and then some trainers maybe me got over carried away and there was a lot of people with you know hyper mobile joints that were now getting wrapped up without really fully understanding is there any kind of drawback to people that have excess range of motion? Uh, I think as it's kind of like stronger people that are interested in muscle building, we probably don't have

as much hypermobility. Um, but are there any, uh, drawbacks to that? With respect to blood flow restriction, wouldn't think so yeah um i think there are some you know things to think about before you apply blood flow restriction so if you if you have you know because this is one of the common questions that i get is is it safe for me to use blood flow restriction and that's kind of a loaded question. I don't, most of the time I'm like, I don't, I don't know you.

Generally, generally sure. Generally. Exactly. I do think that there are some people who, for whatever reason, have conditions that put them at risk for blood clots. They're at a higher risk in general.

If you have that, could you safely use blood flow restriction? Probably, but maybe you just don't. I think another one could be if you have the sickle cell trait. So is it, that one's a little bit more iffy on because that might be an extreme hypoxic environment, which you're probably not necessarily getting. But even in my example, that all of those, all of that pressure was always put like closer to the knee versus closer to the hip so that it wouldn't even run into any of those scenarios. So you're limiting the risk big time by having it closer to the larger joints to

begin with yeah where you have a little bit more tissue where you're applying the the pressure yeah well it sounds like we know quite a bit about blood flow restriction training but you're a researcher like what is the future of research like what are like the the open-ended questions that still have yet to be answered yeah i, I think one of the ones that I'm most interested in, and this might sound bizarre, but is blood flow restriction, the effects of it, is it driven by the restriction of blood flow? So in other words, is it, does it matter how much blood flow is restricted or is it due to the pressure that is applied to the limb that just happens to also restrict blood flow so that might

be more of an academic type question but it is it might be an important one that leads into my other interest which is can we use this somehow to maximize high load exercise, high load contractions? So typically when we talk about using blood flow restriction, we say, use it with low loads. There's no reason to use it with high loads. And I still believe that that's true. Anytime it's compared, it's really, you don't see anything extra from applying it with high load exercise because high load exercise is already a pretty maximal stimulus and it's actually pretty discomforting to do that. So with resistance training, but there could be ways that you could use it. So for example, if I'm doing the bench press, is there any utility into applying

maybe pressure to the legs? Does that do something? Am I able to sense some sort of pressure, which may have some augmenting effect? Now, the answer is probably it probably doesn't work, but that's something that I'm interested in is, is there a way to use it? Because normally when it's used, it's used on the limbs that are exercising. And when you do that, it's really discomforting during a high-load exercise. So that's going to, if you were going to even see a benefit, you may not be able to because you can't sustain the exercise long enough to see any benefit. Because it's so discomforting. But if we can apply it to a muscle that's not exercising, like the legs in that example, then that might be a way to use it.

I don't want people to leave this podcast and go, Dr. Lineke said that we should be using this and that this can augment high load exercise. I have not said that. It's something I'm interested in and investigating. And I think it's tied to that first question because if it has nothing to do with restriction of blood flow and just the pressure, then maybe we can apply it to other limbs and see benefits on limbs that are exercising with a high load. There's a lot of ifs, but that's something that I'm personally interested in. I'm also interested in what role, and this is something that we've done a lot of work on in the last probably five, six years, is what role does muscle growth play with muscle strength? And we have the controversial view that it doesn't play a whole lot of role, the change in that,

but it needs a lot more exploration for sure. So I think all of those things I find exciting. Yeah. Wait, dig into that. You said you have the the controversial view like what about bigger muscles contributes to strength and what about bigger muscles does not does not contribute to being stronger all show and no go buddy well i i think it's pretty clear and pretty safe to say that if we were to line up a group of people that those who are bigger tend to be stronger there i don't think there's any doubt about that and that's true and train people and that's true and untrained people at the group level for sure sure where my kind of interest comes in is when people train so when adults

start lifting weights and they see muscle growth, does that change in muscle size contribute to changes in maximal strength? Um, because the evidence for that is almost non-existent. Um, and you would never know that by reading any paper written on the topic ever. Um, and it's because people go to that kind of first line of reasoning that people who are bigger are stronger. I don't disagree with that. My contention is, or my argument is, but what about when that big person becomes a little bit bigger? Does that really contribute to changes in maximal strength? I don't think it does and if it and if it does it's probably pretty small um compared to

what you would see from just training as heavy as possible what about what about contributions to submaximal strength you know your 10 rep max as an example yeah i i think it would all depend upon what i think it would come down to what is the program that you're doing. If you have one group that's more in line with submaximal, I think they're going to outperform it regardless of whether or not they saw growth or not. I just think that so much of that performance is, not to say that it couldn't contribute. I think that would be wrong. But if it does contribute, it's probably so small compared to what you see from just trying to practice lifting heavy weights or practice lifting in that 10 RM or whatever. Right.

I think so much of that, that I call it debate conversation really comes down. And this is only because I've been doing it for so long. It's like, it just comes down to movement. Like, are you efficient at moving weights is a massive amount of how strong you are.

Like you can see giant human beings that just don't lift that much. Mostly because their body just doesn't trust the moving big weights, which is their brain. Just talking to their feet. If you're squatting heavy weights, you're there's no trust there. And it makes you, it's not that there isn't a strength potential with the increased size, but there's certain neurological factors that just get in the way that won't allow you to move that weight. So it's probably a very hard thing to study

and actually put hard data to because adding five pounds of body mass it may make you stronger just because the weight sits on you different but as far as like pure strength um i feel like a lot of that just comes down to almost like athleticism and the ability to move efficiently move move well. Yeah. And I can't even remember his name. I think it was maybe Eric Lillibridge. I believe that was his name. This is a long time ago,

but he would upload these training videos on YouTube where he was just, sometimes he would do like a triple, but it was almost always just singles. And I just remember being intrigued by that because that's something so counter to everything that I would expect someone that strong to be doing. And I remember him. I just called him up. What a freak. 10,000 plus pound squat.

It's like the first video. He was incredible. What in the world? And I remember asking him, um, or maybe I didn't ask him. Maybe I, I mean,

we did do a, we did do a powerlifting meet in Chicago, me lane. And, and he was competing in that as well. Um, but his point was, is like,

well, I'm only trying to get good at lifting heavy things one time. And that really kind of stuck with me. I'm like, wow, there must be something to this specificity component. Not to say that there couldn't be some utility to doing other things, but I think you get a big bang for your buck just trying to practice the thing that you're doing. But I think that most people know this. I think that's why people who are interested in being as strong as possible spend quite a bit of time lifting as heavy as possible because it's required.

Yeah, it's not just about getting bigger or else like the biggest bodybuilders would be also be the strongest people. And all these Olympic weightlifters that weigh 130 pounds and fucking snatch 300 pounds, they wouldn't exist. Amen. Everybody knows this. Yeah, there's got to be some correlation there where in general, even people like Olympic weightlifters or powerlifters, they're usually trying to still gain some muscle,

but they're also in a weight class sport and they know they can't just keep gaining muscle forever. I think rate of force development and like the neural side of things matters a lot. All the times that I've trained only using low repetitions, even on my quote unquote like assistance exercises, I got a lot stronger without getting bigger. That's definitely happened more than once in my life. So they're not perfectly correlated at all, even if there's there's I still think there's likely some crossover there. But if you're doing sets of 30 tempo weights your mat your one rm is probably not

going to go up like even even if you do gain a few pounds it's just not going to happen yeah and you know what assuming you're trained and your one rep max is already pretty good right yeah and what i would tell people is almost people almost always disagree with my my take on the growth and strength which is fine. I honestly don't care, but I think most people want to know like something practical from it, even if they do disagree. Um, and what I would tell them is, is like, look, if you're an athlete or if you're a coach and you're working with athletes and you think that muscle growth is in a place, even a smallest portion and could benefit your athlete, then for sure do

that. I'm not, that would be dumb if you really thought it did something and you go, well, but Jeremy said it doesn't, you know, but it, what you could take from it though, is, is that there's almost no evidence that it does. And if, if it does anything at all, it's probably pretty small. So what you could take that and what you could use that information for is you could go, well, if I'm interested in maximal strength, then I've spent a lot of my training for muscle growth. Maybe I could cut that a little bit and either replace it with heavy training or replace it with just some recovery. And maybe that's how I could utilize that information if I still think there could be something to it.

But maybe I kind of get the idea that if it does do anything, it's probably pretty small. So maybe I can still do a little bit, but not as much as I normally did. We need to get our kids on DEXA scans at like 12. That way we can track muscle growth for like 30 years on them and then we can like weighted average the testosterone years and then see how much they're keeping at like 33 to 40 40 to 60 but that would be like the the an actual way to see it because the numbers would consistently go up until up until a point. And that's likely to be where like the, the maximum muscle that you're

going to actually grow in your life is going to hit. And then the maintenance of that maximum amount of muscle is really then the end goal. Basically what I just said is where I'm at right now. How do I keep this stuff as long as possible and continue to try to be as athletic and kind of explosive as with the muscle that I have built? But I don't think I ever go to the gym anymore and think intentionally like I'm trying to build muscle. That might be like a tape that plays in my head, but it's never like the actual reality that I think I'm going in and like getting, you know, going to add two pounds of muscle every year for the rest of my life. It's

just, it's not possible. Yeah. I think maintenance is a perfectly acceptable kind of fitness goal that most people, I mean, if we look at how we prescribe exercise or even the outcomes of it, it's like, are you, are you incrementally increasing? Are you incrementally increasing as if we can just infinitely increase all adaptations, you know, for the rest of our lives. So it's, it's kind of, we almost set people up for, for failure because it's like, well, have you been gaining? It's like, well, you're not going to infinitely gain and all of these adaptations, you know, performance to a point I could see where you can still incrementally kind of creep up, creep up, creep up, but muscle mass, there's, there's just no way. I mean, otherwise, I mean, and we, you could look around a gym and know

that's the case. Um, but yeah, I think that you bring up something really interesting where it's like, what about during development when you have a kid who's growing? Does it matter then? Does it matter if we were to maximize it then? Maybe. I mean, that's a really kind of fascinating area. Yeah. I think that, I mean, and then you could look at the, I almost think the testosterone from the ages of like 17, 16 to, you know, 20, 28, something along those, those, that, that age range, that decade and change. It's like, how much does alcohol or some, or like poor lifestyle choices when you're up and hanging out and partying and doing things that people of

that age do, how much does that affect the amount of muscle growth? And I would say over a lifetime, it probably, like probably doesn't have that much of an impact. It may on a day to day basis or effectiveness of workouts, but you're going to just get to a point where it's the most amount of lean tissue that your body wants to carry genetically. And then you look at the these super freaks that are at Olympia. And even if you took all of the pharmaceuticals out of them, they're still the biggest person you've ever seen in your life. And they're the most shredded. Like we had Phil Heath on and there was a picture in his recent documentary where he was a basketball player and then was like, then the next day was a bodybuilder.

But he was the most yoked like basketball player you'd ever seen. I've seen that picture. It was very clear. He was going to win Olympia within a decade if he just started lifting real weights and then took the necessary pharmaceuticals to get him to the point he needed to be like, the guy was a monster, but your body's just going to get to a natural level where you go, you got enough. This is the, this is the end limit. And we want

to start chasing separate goals. Now that you have this base of muscle that you have an ability and, and call it physical freedom or the structural freedom to go play life. Yeah. I think maintaining that as an adult for as long as you possibly can. Yeah. To me, that's the goal. Uh, because you're, you're starting to go up against the effects of aging. Yeah. I'm actually not interested in my own life of doing that, but seeing how that kind of plays out over – I was talking to Boyle on Twitter today, and it was kind of funny because we were sort of discussing this

and how you train, the ways that you're training, the intensity you're training at and um there was another uh thing that i saw him sharing or writing about of like what was the what was the age of feeling a real drop off in your own life and then compared to when you see non-trained people and that muscle, like you can extend the runway so far by getting us close to maximum muscle mass in the really good training years that I feel like that, that is the cheat code. Like how long can you keep it? How long can you just maintain all of that hard work and like the savings bank? Yeah. And depending upon how you're training, I think that there's something to resistance training that makes you more of a robust human being anyway, to where if you get

hurt less, because there's data in older adults that shows this, there's data in athletes that suggest this, that people who lift weights, you know, they tend to be more robust human beings than people who don't. So, um, maybe they spend less time getting hurt. They less spend less time falling. And when you spend less time falling and getting hurt, then that's more times that you're able to be functionally, you know, active. But, you know, I think, I don't know if that applies to us or the listeners of this podcast because lifting weights has hurt me many times. Um, sure. But I think that we're all sharing the same laugh.

We know, I think it might have more to do with maybe a little ego in there. Yeah. The goals of the training. Well, it wasn't maintenance. You're going to get to maximum muscle mass. You have to also push the limits as hard as't maintenance. If you're going to get to maximum muscle mass, you have to also push the limits

as hard as you can. There's repercussions at times when chasing those limits. Doug, when are you getting your first DEXA scans set up for Riley? Not right now. We've got a couple years. Not for that one.

Jeremy, this is fantastic, man. Where can people find you, your research? All of them. I'm on Instagram and Twitter, at JPLinike, so at J-P-L-O-E, and then E-K-E. I share, anytime we have something come out, I share it on there. So I'm not as interactive as I used to be,

but I still, I will respond most likely to Twitter depending upon how you're looking to have a conversation that's the most fun place Doug Larson that's where all the arguing happens, on Twitter I'm on Instagram, not as much arguing on Instagram, and also like you, not on there

as much as I used to be, but I will respond eventually if you send me a message, Douglas E. Larson on Instagram. Dr. Lineke, appreciate you coming on. Enjoy the conversation. Thank you guys so much. This has been great. I'm Anders Varner at Anders Varner, and we are Barbell Shrugged, Barbell underscore Shrugged.

And make sure you get over to RapidHealthReport.com where you can check out all things labs, lifestyle, performance, and how we can help you inside Rapid Health Optimization. And you can access all of that over at rapidhealthreport.com. Friends, we'll see you guys next week.