Sunday, April 26, 2020

Will You Lose All Your Strength During The Circuit Breaker If You Cannot Lift Weights?

Lunging with a 10 kg bag of rice 
We are currently at the end of week 3 of the circuit breaker (or modified lock down) in Singapore. Most of my patients who strength train are not able to take part in their usual exercises and training regimes. This is true especially for my bodybuilding and avid gym going patients, since gyms and other exercise centers are closed.

Not many of them have an ideal home gym for strength training during this period. So for them, there's a real threat of detraining (loss of strength) for them and other sporting populations. Any loss in muscle strength, power, muscle atrophy may affect future performance, injury risk and self esteem.

A recently published study (Blocquiaux et al 2020) studied older male patients (58-70 years old) during a 12 week whole body resistance training program. The subjects stopped training for 12 weeks and then resumed training for another 12 weeks.

Decent strength gains were made at 8 weeks (22%), and 12 weeks (36%) in leg strength (similar for upper limb).

What was most interesting was that all the strength gains (36%) during the initial 12 weeks were not completely lost during the 12 weeks of no training. 14% was lost during this period.

When the participants resumed training for another 12 weeks, they were stronger at the end of the second 12 week period than the first. It took them 8 weeks or thereabouts to regain what they lost in 12 weeks.

So if we were to compare with our current circuit breaker period (3 weeks and counting), don't be too discouraged. You can probably gain back what you lost. Hopefully it will take less time too looking at that study (Blocquiaux et al 2020) . For those of you who bike, run, row or do other endurance sports, there is a similar pattern observed for cardiovascular fitness too.

Now, lets look at female subjects. Correa et al (2016) studied a group of older women, and this time the period of no training was a whole year. The female participants gain an increase of 75% in strength after an initial 12 week training period. Much of these gains were lost after a year, back to baseline levels. However, after another 12 weeks or training, they gained a lot of this strength back, they were just 15% off their first 12 week training period.

So, another glimmer of hope for those of you who strength train. Though I'm hoping our circuit breaker will not be a year long!

If you make do with whatever you can find at home to strength train to failure albeit with a lighter weight, you will stave off some of the losses. That's what I try to do.

Many people are dealing with all sorts of mental and motivational issues other than physical and financial ones so exercise may be way down on their list of priorities. But if you can still exercise, it will definitely lift your mood Ludyga et al (2020).


Blocquiaux S, Gorski T et al (2020). The Effect Of Resistance Training, Detraining And Retraining On Muscle Strength And Power, Myofibre Size, Satellite Cells And Myonuclei In Older Men. Expt Gerontology. 133: 110860. DOI: 10.1016/j.exger.2020.110860

Correa CS, Cunha G et al (2016). Effects Of Strength Training, Detraining and Retraining In Muscle Strength, Hypertrophy And Functional Tasks In Older Female Adults. Clin Physiol Funct Imaging. 6(4): 306-310. DOI: 10.1111/cpf.12230.

Luduga S, Gerber M et al (2020). Systematic Review And Meta-analysis Investigating Moderators Of Long-term Effects Of Exercise On Cognition In Healthy Individuals. Nat Human Behav. DOI: 10.1038/s41562-020-0851-8

Sunday, April 19, 2020

Does Lactic Acid Affect Your Appetite?

One of our blog's more popular post was regarding lactic acid or lactate. For our new readers, that post came about after a massage therapist asked me if lactic acid in our bodies can form 'crystals' in our muscles with too much running.

A few of his patients who run had gone to this particular massage place and was told by a massage therapist there that 'crystals' left there by the lactic acid/ lactate will affect their running if the 'crystals' are not removed by sports massage.

Yes, lactic acid/ lactate is produced as a by product during intense exercise, but it starts to clear or leave your body once you slow down and especially when you stop your exercise. You do not need help to get rid of it. It certainly won't form 'crystals' in your muscles!

What lactic acid/ lactate does according to recent research is that it can blunt your appetite by altering your appetite hormones (Vanderheyden et al, 2020).

What the researchers in the study did was to have volunteers do an interval workout of 10 x 1 min really hard with 1 min recovery on an exercise bike. They repeated this protocol twice at the same intensity on separate days at least a week apart. For the first time, the participants were given a dose of baking soda and the other time a dose of salt as a placebo.

Baking soda (or sodium bicarbonate) helps to partially counteract rising acidity in your bloodstream during intense exercise (to prevent you from accumulating too much lactic acid in your bloodstream). It is often used as a legitimate and legal performance enhancing drug by some runners (especially middle distance) and track cyclists.

Please note that consuming baking soda can be associated with stomach distress although there was no apparent difference in this particular study.

This allowed the researchers to compare lactate levels in the subjects' bloodstream during and after the 10 x 1 minute intervals since baking soda will decrease lactate levels.

The researchers found that the response of the subjects' appetite hormones were lower when there was more lactic acid/ lactate in the bloodstream.

Ghrelin (which measure hunger levels were lower meaning less hunger) and two appetite suppressing hormones, *GLP-1 and PYY were higher meaning less hunger were indeed different in the two groups during and 90 minutes after the intense exercise.

Previously, when I use to compete and still did really intense training, I definitely do recall that I do not feel like eating after the workout ends. I usually only felt like drinking an ice cold Coke. Well, those were the days .....

What I'm actually wondering is whether changes in our appetite hormones can affect our eating patterns on a long term basis and thus affect weight for serious endurance athletes. If you're training reasonably hard, surely weight isn't gonna be something you worry about.

To conclude, you do not need to flush lactate (lactic acid) out from your body after intense exercise, it starts to dissipate once you stop exercising. Nor do you want to take too much baking soda in a race if you're trying to lower your lactate levels as it can give you stomach distress especially if you haven't tried it in training.


Vanderheyden LWN, McKie GL et al (2020). Greater Lactate Accumulation Following An Acute Bout Of High Intensity Exercise In Males Suppresses Acylated Ghrelin And Appetite Post Exercise. J App Physiol. DOI: 10.1152/japplphysiol.00081.2020.

*GLP -1 glucagon like peptide-1

*PYY - active peptide tyrosine-tyrosine

Monday, April 13, 2020

How Much Treadmill Incline To Use?

Getting tested at the then Racers' Toolbox (now Coached)
My patient who had been running outside contacted me after reading that running outside was more dangerous. After checking the viral article she read, I reminded her that the Belgian engineers chose to bypass all standard publishing protocols so that article wasn't reliable (picture below showing the simulated spread droplets of breathing, coughing and sneezing from people who are walking, running or cycling).
Picture by ANSYS taken from here 
Despite my reassurance, she decided that she would run indoors for now since she had a treadmill at home. She was wondering what incline she should be using while running.

The hills we run or cycle up outdoors are measured as a percentage. The treadmill also displays incline as a percentage. So if you've set the incline on your treadmill to 1.5, it means you are running at a 1.5 percent incline (not level 1.5). Most treadmills allow you to adjust the incline from 0 to 12 percent. Some models even allow for a decline. Good if you want to practice running downhill.

I suggested to my patient that she should set her treadmill at the 1 percent incline as research shows that it will simulate outdoor running as it makes up the lack of wind resistance while running indoors (Jones and Doust, 1996). This is especially so if you're running between 12 to 17 km an hour. Under 12 km an hour no adjustment is necessary as the difference is small, but you can probably still set the incline at 1 percent for an extra challenge. This may also help you transition back to running outside.

I suggested running by effort rather than by than speed alone as this may reduce the risk of fatigue, injury and frustration. This will also help with pacing before she returns to running outside.

If you too have read that viral article, the article suggested staying at least 4-5 meters behind others when walking in a single file, 10 meters while running or cycling slowly and 20 meters while cycling quickly.

I definitely don't have a treadmill and I prefer to run and bike outside. My suggestion is to respect everyone's space. Don't run or pass too close, don't follow behind and don't cut in too quickly. Stay safe.


Jones AM and Doust JU (1996). A 1% Treadmill Grade Most Accurately Reflects The Energetic Cost Of Outdoor Running. J Sports Sci. 14(4): 321-327.

Today's Straits Times 13/4/2020 on page B21 under the Sports Section too mentioned the guidelines laid out in the viral article.

Today paper published it's commentary on that same article on 15/4/2020. You can read it here.

Sunday, April 5, 2020

Let Us Help With An Online/ Video Consultation

I remember doing an video consultation a few years ago with a former patient of mine who left Singapore and relocated to Hong Kong. I treated his shoulder previously and he tore his Anterior Cruciate ligament (ACL) and had the reconstruction done in Hong Kong.

He was frustrated as he was not improving (as you can read from his iMessage to me above) and wanted my advice. I was very hesitant as I wondered how I can assess him physically without being there. I wondered if I could really be of help.

I told him that if I hadn't treated him before I would not have agreed to the video conference. Even though he insisted on paying, I didn't charge him for that video consultation.

In this particular consultation what really helped was that my patient already had his ACL reconstruction done. He was also able to describe his symptoms in detail. So what the patient tells us can perhaps replace the assessment tests we need to do. We can then guide the patient through the session if we need them to do any active movements or tests.

Why am I writing about tele/ video consultations here? Well, these are unprecedented times. On 3rd April 2020, our Prime Minister went on national TV and announced the implementation of a "circuit breaker" to minimize the further spread of COVID-19.

In line with the new policies set out by our government, our clinics will be closed from Tuesday 7th April to 4th May 2020, both dates inclusive. We will reopen as soon as we are able to do so.

We understand and support this temporary closure as it is in the best interest of our community. We all need to do our part to make this work to overcome this pandemic.

We will be available for tele/ video consultations during this period of closure.

If you’re a patient at Physio Solutions, please contact  +65 9297 9641.
If you’re a patient at Sports Solutions, please contact +65 9112 5326. 

Despite my doubts and hesitation wondering whether online/ video consultations will help, my patient thought it was "super helpful" if I may quote him from his message above. Again, he asked me to bill him, but I did not. He actually felt much improvement from what I taught him and subsequently came back to Singapore to see me 3 times for his knee.