V O L U ME 3 , ISS U E 10 OC T O BE R 2 0 1 9

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

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

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

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

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

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

2
 Letter from
the Reviewers

W
elcome to the October 2019 issue of MASS.
The issue kicks off with a discussion of cluster sets and “intraset rest” strategies.
Next, Mike breaks down the first study comparing velocity and RPE for esti-
mating distance from failure. Eric Helms analyzes a study investigating whether diet soda
helps people consume fewer calories, and Eric Trexler digs into the fat-free mass index
research.
In the back half of the issue, Greg digs into the first study analyzing whether anthro-
pometric characteristics can predict if you’re best-suited for the sumo or conventional
deadlift, and Mike reviews a systematic review on the effects of intra-session cooling. Eric
Trexler examines some research suggesting that males and females may have different
responses to nitrate supplementation, and we finish the written content with a systematic
review on the placebo effect in exercise research.
For the videos this month, Mike discusses concurrent training for marathon runners,
and Eric Helms begins a series on energy intake for optimizing lean mass. Most people
don’t know this, but Mike has actually ran a few marathons, and I know quite a few MASS
readers are also serious about trying to maintain their size and strength while improving
endurance performance, so we think you’ll find that video enjoyable and informative.
Enjoy!

The MASS Team

Eric Helms, Greg Nuckols, Mike Zourdos, and Eric Trexler

3
 Table of Contents

6
BY G R EG NUCKOL S

Twice the Sets, Half the Reps? The Devil is in the Details
In this article, I reviewed another study looking at the effects of training to failure versus stopping
shy of failure. That study gave me an excuse to dig into the cluster set and intra-set rest literature.
If you’re interested in cluster sets and intra-set rest training, you’ll enjoy this article.

18
BY M I CHAEL C. ZOUR DOS

Intraset RPE and Velocity Provide Similar Estimates of Reps Performed

It is generally accepted that velocity gives you a better gauge of intraset proximity to failure than
RPE, but do we really know this? Although the reviewed study leaves a lot to be desired, it is
actually the first to explore this topic.

30
BY E RI C HEL MS

Diet Sodas and Adherence: Helpful or Counterproductive?

Do “diet” sodas actually help you diet, or do they make it harder? Does the calorie-free flavor
curb your sweet tooth, or set you up for failure by causing cravings? As you’ve probably learned
by now from reading MASS, the answer depends on the context – both the situation, and the
individual.

40
BY E R I C T R EXL ER

Using Fat-Free Mass Index to Forecast Long-Term Gains for Males and
Females
At some point in their lifting career, just about every lifter wonders, “Exactly how big can I get?”
While fat-free mass index (FFMI) isn’t going to tell you the exact limit to your potential, or perfectly
weed out steroid-users from drug-free lifters, it’s still a helpful metric for approximating muscularity
and understanding how big most people can get. Read this article to figure out how big male
and female lifters tend to get, and what this means for your natural potential for muscle growth.

53
BY G R EG NUCKOL S

Can We Predict if You’re Better off Deadlifting Conventional vs. Sumo?

There are a lot of recommendations floating around concerning whether you should deadlift sumo
or conventional based on how you’re built. In spite of the numerous recommendations, there was
no actual research on the topic. That changed with the study reviewed in this article.

4
62
BY M ICHAEL C. ZOUR DOS

Be Cool … Literally
Sitting in a vest with crushed ice and drinking a below-0 degree Celsius beverage has been
investigated as a method to improve exercise performance. Does it actually work? A new meta-
analysis provides us with answers.

73
BY E R I C T R EXL ER

Do the Performance Effects of Beetroot Juice and Dietary Nitrate Differ

Between Males and Females?
Supplements that promote nitric oxide are in just about every pre-workout supplement on the
market. Nitrate, a primary component of beetroot juice, is a notable nitric oxide promoter that
is also found in a variety of fruits and vegetables. Several studies have reported performance
benefits of dietary nitrate for males, but there’s a considerable lack of research in females. Read
this article to find out if nitrate actually improves performance, and if this effect is similar for both
males and females.

85
BY G R EG NUCKOL S

The Placebo Effect Impacts Performance More Than You Might Expect
The placebo effect is a well-known psychological phenomenon, but we often forget about it
in exercise research. We focus on how much a supplement, device, or treatment improves
performance relative to a placebo, but a lot of the “real-world” improvements in performance
may actually be attributable to placebo effects.

95
BY M I CHAEL C. ZOUR DOS

VIDEO: Concurrent Training for a Marathon

You may know that running long distance isn’t the ideal form of cross-training to maximize your
strength. However, maybe you don’t care, and you want to run a marathon anyway. I think this
is cool, as once upon a time I didn’t care and ran some, despite knowing the negative effects on
strength and size. Therefore, this video shows you how to accomplish completing a marathon
while affecting strength as little as possible.

97
BY E RI C HEL MS

VIDEO: Energy Intake to Optimize Lean Mass, Part 1

“You must be in a surplus to build muscle”– An oft-repeated adage in the evidence-based
community, but perhaps an overly simplified statement. In part 1 of this series, we draw on
multiple reviews published in the last 20 years, and mechanistic primary research to explore
how energy intake influences hypertrophy, and when and why a surplus might or might not be
necessary to grow muscle.

5
 Study Reviewed: Impact of Two High-Volume Set Configuration Workouts on
Resistance Training Outcomes in Recreationally Trained Men. Karsten et al. (2019)

Twice the Sets, Half the Reps?

The Devil is in the Details
BY G RE G NUC KO LS

In this article, I reviewed another study looking at the effects of training

to failure versus stopping shy of failure. That study gave me an excuse to
dig into the cluster set and intra-set rest literature. If you’re interested in
cluster sets and intra-set rest training, you’ll enjoy this article.

6
 KEY POINTS
1. In a recent study, two groups of trained young men either performed 4 sets of
10 to failure for all exercises, or 8 sets of 5 for all exercises, aiming to only get
halfway to failure on all sets.
2. Both groups had similar increases in squat and bench press strength, and
experienced similar biceps and anterior deltoid hypertrophy.
3. The group training to failure experienced greater quad growth.
4. There were some methodological issues with this particular study, but it serves
as a good launching off point to discuss cluster sets and intra-set rest training.

B
uilding off of the study by Car-
roll et al (2) that I reviewed last
month, I dug into another study
investigating the effects of training to
failure versus stopping each set shy of
failure. In the presently reviewed study
(1), one group of trained men trained
for six weeks, performing all exercises
for 4 sets of 10 reps to failure, while an-
other group performed all exercises for
8 sets of 5 with loads they should be able
to lift for 10 reps. Strength gains in the
squat and bench press were similar be-
tween groups, as were biceps and anteri-
or deltoid hypertrophy. However, vastus
medialis (inner quads) hypertrophy was
significantly greater in the group train-
ing to failure.
The main study I’m reviewing had a
couple major issues that are discussed
in the interpretation section. However,
this study gave me an excuse to dig into
the cluster set and intra-set rest litera-
ture. Cluster sets and intra-set rest ac-
complish the same basic purpose: allow-
ing you to do the same total amount of
reps with the same load, while staying
further from failure and maintaining a
higher average rep velocity and pow-
er output. With cluster sets, this is ac-
complished by taking short rests within
each set, while with intra-set rest, this
is accomplished by doubling the num-
ber of sets, halving the reps per set, and
shortening the rest intervals between
sets. Although cluster sets are popular,
the longitudinal evidence in their favor
is lacking. However, when training with
lower loads (below ~80% of 1RM), in-
tra-set rest training seems to be a prom-
ising option that may improve strength
gains.
Purpose and
Hypotheses
Purpose
The purpose of this study was to com-

7
 Table 1 Subject characteristics

Failure group (n=9) Nonfailure group (n=9)

Body mass (kg) 78.4 ± 24.3 76.0 ± 13.8

Fat mass (%) 23.4 ± 11.7 15.1 ± 8.4

Fat mass (kg) 18.6 ± 15.4 11.8 ± 8.0

Fat-free mass (%) 76.6 ± 11.7 84.9 ± 8.4

Fat-free mass (kg) 58.8 ± 13.6 64.2 ± 11.5

1RM bench press (kg) 71.0 ± 26.8 90.0 ± 29.1

1RM squat (kg) 87.2 ± 25.3 102.2 ± 28.5

pare the effects of two training programs

differing only in proximity to failure for
each set: One group trained to failure
on each set, while the other group did
half as many reps per set at the same in-
tensity, but did twice as many sets. Out-
comes of interest were body composi-
tion, squat and bench press strength,
upper- and lower-body power, and var-
ious measures of hypertrophy.
Hypotheses
The authors hypothesized that gains in
upper and lower body power would be
greater when not training to failure, hy-
pertrophy would be greater when train-
ing to failure, and both groups would
improve squat and bench press strength
to similar degrees.
Subjects and Methods
Subjects
18 young males participated in this
study. They all had at least 2 years and
at most 5 years of prior training experi-
ence, and none of the subjects competed
in any strength or physique sports. Un-
fortunately, the groups may have wound
up differing in meaningful ways at base-
line. While body mass was similar be-
tween groups, the subjects in the group
not training to failure tended to be lean-
er, have more fat-free mass, and have
greater bench press and squat strength
(though these differences weren’t statis-
tically significant, likely due to high het-
erogeneity within both groups).

8
 Table 2 Exercises performed in the 2 training routines
Training program 1
Bench press
Chest press
Barbell curl
Seated dumbbell curl
Dumbbell deltoid raise
Barbell shoulder press
Barbell shoulder front raise
Experimental Design
To ensure that the results of the study
would not be unduly influenced by
learning effects, the subjects all started
with one week of familiarization with
the squat and bench press. After this
familiarization week, the subjects un-
derwent body composition testing us-
ing a Bod Pod, the circumferences of
their arms and thighs were measured,
and muscle thicknesses of their vas-
tus medialis (a quad muscle), triceps,
and anterior deltoids were assessed us-
Training program 2
(back, arm extensors, and lower body)
Lateral pull-down
Barbell pull-over
Barbell lying arm extension
Barbell close grip press on bench
Parallel squat
Deadlift
Machine leg curl
ing ultrasound. Strength performance
was assessed via 1RM bench press and
squat, and power performance was as-
sessed via vertical jump height and
bench press power at 50% of 1RM. All
of these tests were repeated after the
end of the training intervention.
Training took place two days per
week for six weeks. Both groups per-
formed the same exercises, seen in Ta-
ble 2. Training frequency for each mus-
cle group was just once per week. The
groups were also matched for rep vol-
9
 Figure 1 Changes in muscle thickness between groups

9 *
7
muscle thickness
Changes (mm) in

5
failure
3

1 nonfailure

9
Vastus medialis Elbow flexor Anterior delt
thickness thickness thickness

* = a significant difference between groups (p<0.05)

ume and (theoretically) intensity, but The other group performed 8 sets
differed in terms of the number of sets of 5 reps not to failure for all exer-
performed and proximity to failure. cises, with 1 minute of rest between
One group performed 4 sets of 10 sets (in order to match the routines
reps to failure for all exercises, with 2 for work-to-rest ratios). They start-
minutes of rest between sets. Failure ed with their self-estimated 10RM,
was defined as the subjects self-deter- and adjusted loads based on their ef-
mined rep max (in other words, they fort-based (not reps-in-reserve-based)
didn’t fail the last rep, but they pushed RPE. They were recommended to start
each set to RPE 10, when they didn’t each set with an effort-based RPE of
think they could complete another 5, and to not allow their effort-based
rep). If the description of the methods RPE at the end of a set to exceed 7. If
is correct, the subject did not decrease their final effort-based RPE for a set
their training weights if they were un- exceeded 7, the load was decreased by
able to complete all 10 reps in a set, 2.5kg for the next set. This isn’t spelled
but rather they were allowed an extra out in the methods, but I believe their
30 seconds of rest between sets. If they loads were increased by 2.5kg if their
felt like they could do more than 10 effort-based RPE at the start of a set
reps in a set, the load was increased by was 4 or below.
2.5kg.

10
 Figure 2 Changes in 1RM strength between groups in bench press and squat
14
12
Changes (kg) in
10
1RM strength
6
4 failure
2
0
Bench press 1RM
Findings
Of all of the variables measured, the
only change that was significantly dif-
ferent between groups was for vastus
medialis thickness (p = 0.026). That was
actually a pretty large difference, with
the group training to failure seeing an
increase of ~6%, while the group training
further from failure only increased vas-
tus medialis thickness by 0.6% (which
wasn’t even a significant within-group
change). In the discussion of the paper,
the authors also tried to spin the chang-
es in body composition as favoring the
group training to failure, and the change
in bench press power as favoring the
group staying further from failure, but
none of those between-group compar-
isons were particularly close to signifi-
cant (p > 0.16 for all), and none of the
differences were practically meaningful
either (d < 0.10).
nonfailure
Squat 1RM
Interpretation
I discussed the effects of training at
different proximities to failure in the last
issue of MASS, and I recently wrote a
huge article about it for my own web-
site, so I actually don’t want to discuss
this article in the context of failure ver-
sus non-failure training. Rather, I want
to discuss them in the context of cluster
sets, which is a subject we haven’t touched
on in MASS recently (Mike covered
an acute study [3] several months ago,
but we haven’t yet reviewed a longitudi-
nal training study). This wasn’t exactly a
cluster set study, but it was pretty similar.
First, however, I’d like to express a bit
of skepticism about the way the authors
of this study standardized intensity. The
authors don’t report relative volume loads
(sets x reps x %1RM) or mean training
intensities, even though those factors
were supposed to be equated. I’m con-
11
cerned that intensity may not have been
equated. Specifically, I think the group
training further from failure was train-
ing with lower intensities. Loads were
lowered when their effort-based RPE
increased above 7 by the end of a set.
In research on the squat (4) and bench
press (5) using this same effort-based
RPE scale, subjects reached an RPE of
about 7 (7.6 for squat and 6.8 for bench)
with just a 10% decrease in velocity
when training with 70-80% 1RM loads.
In those same studies, velocity dropped
off by more than 50% in the squat (0.53
m/s to 0.26 m/s) and nearly 70% in the
bench press (0.49 m/s to 0.15 m/s) be-
tween the fastest rep and the rep before
failure. Since velocity decreases basically
linearly as one approaches failure, if the
subjects in the non-failure group were
actually going halfway to failure (as was
the authors’ intention), they would have
needed a ~25% velocity drop for each set
of squats, and a ~35% velocity drop for
each set of bench press. However, if ef-
fort-based RPE is already around 7 with
just a 10% velocity loss, it likely exceeds
7 well before someone is actually halfway
to failure when training with ~10RM
loads. Thus, especially for squats (which
were already given an effort-based RPE
of 7.6 with just a 10% velocity loss), I
strongly suspect the subjects ended up
training with loads well below 75% of
1RM, and did not actually go halfway to
failure on each set. Instead of leaving 5
reps in the tank on all sets, I wouldn’t be
surprised if the subjects had something
more like 7-8+ reps in the tank, especial-
ly for squats.
Thus, if anything, I’m surprised by
how well the non-failure group did in
this study. They were likely training at
lower intensities than the failure group,
and considerably further from failure
than virtually anyone would recommend
for strength or hypertrophy. However,
strength gains were still similar between
groups, and upper body hypertrophy (bi-
ceps and front delt thicknesses) was sim-
ilar as well, in spite of the fact that the
non-failure group was exclusively doing
training that many people would think
of as “junk volume.” And if I’m correct
that the non-failure group was training
super far from failure, the lack of quad
growth with just eight sets of squats per
week is pretty unsurprising.
One thing that was weird about this
study is how drastically volumes differed
for the exercises and muscles tested.
Squats were trained just once per week,
and there were no other quad-dominant
exercises (the only other lower body lifts
were deadlift and leg curls). Bench, on
the other hand, effectively had a fre-
quency of twice per week, and was pretty
directly trained with three different ex-
ercises (bench press and chest press on
day 1, and close grip bench on day 2).
The front delts would have been stim-
ulated directly by 5 different exercis-
es across two days (bench press, chest
press, shoulder press, front delt raises,
and close grip bench), the biceps by
12
 Figure 3 Examples of traditional, cluster set, and intra-set rest protocols

Traditional training

6 reps 2 minutes rest 6 reps 2 minutes rest 6 reps

Cluster sets

30s 30s 30s 30s 30s 30s

rest rest rest rest rest rest

2 reps 2 reps 2 reps 2 minutes rest 2 reps 2 reps 2 reps 2 minutes rest 2 reps 2 reps 2 reps

Intra-set rest

3 reps 1 minute 3 reps 1 minute 3 reps 1 minute 3 reps 1 minute 3 reps 1 minute 3 reps
rest rest rest rest rest

four different exercises across two days Like I said, though, I want to primarily
(barbell curl, dumbbell curl, reverse grip focus on cluster sets in this interpretation
bent over rows, and pull-downs), and section. Traditionally, cluster sets are de-
the quads by just one exercise on one day fined as sets of an exercise interspersed
(squats; I guess you could also make an with short rest intervals, with each mini-
argument for deadlifts, but I wouldn’t be set not taken to failure (thus distinguish-
very receptive to it). With that in mind, ing it from rest-pause training). So, for
this study suggests that going close to example, instead of doing sets of 6 reps
failure doesn’t matter much for strength with 2 minutes between sets, you might
(within the context of this study, with do 3 mini-sets of 2 reps, with 20 seconds
short-term non-periodized training), between each mini-set, and 2 minutes of
and it only matters much for hypertro- rest after 3 mini-sets (thus accomplish-
phy when volume is low. There was a big ing 6 reps during the cluster). The point
difference in quad hypertrophy between of cluster sets is to better maintain rep
4 sets to failure and 8 sets far from fail- speed and quality throughout a set, since
ure, but not much of a difference in bi- the brief rest intervals decrease metabo-
ceps and front delt hypertrophy between lite buildup and keep you further from
16-20 sets to failure and 32-40 sets far failure. It is thought that doing so will
from failure. enhance gains in strength or power, de-
pending on how the cluster training is

13
implemented. The strategy used in the
current study is reminiscent enough to
cluster sets in both purpose and execu-
tion that it’s functionally similar - doing
twice as many sets, with fewer reps per
set, but shorter rest periods between sets.
Though the terminology wasn’t used in
the present study, this strategy has been
previously termed “intra-set rest.”
There are a few longitudinal studies
that are comparable to the present study
that use either cluster sets or intra-set
rest. For the most part, the theory be-
hind cluster sets hasn’t really worked out
in practice. Hansen et al (6) and Nich-
olson et al (7) both compared cluster
loading to traditional high-load training
(80-95% 1RM). In Hansen et al, tradi-
tional heavy training led to significantly
(p < 0.05) larger strength gains in the
squat than cluster training (18.3% vs.
14.6%). In Nicholson et al, traditional
heavy training (4 sets of 6 at 85%) and
two different cluster set arrangements (4
cluster sets of 6 reps with 1 rep in each
mini-set with either 85% or 90% 1RM)
led to similar increases in squat strength
(15.28kg for traditional, 15.83kg for
clusters at 85%, and 17.22kg for clusters
at 90%). Moving on to studies investi-
gating intra-set rest, Lawton et al (8)
compared traditional training (4x6 with
about 4 minutes between sets) against
intra-set rest training (8x3 with about
2 minutes between sets) with relative
loads equated, and found that traditional
training led to larger increases in bench
press strength (9.7% vs. 4.9%). Finally,
a study by Oliver et al (9) is a bit of an
oddball. It compared traditional training
(4x10 with 2 minutes between sets) to
intra-set rest training (8x5 with 1 min-
ute of rest between sets), and found that
intra-set rest training led to larger gains
in both squat and bench press strength
(63.8 vs. 48.5kg for squat, and 15.1kg vs.
9.1kg for bench press).
When we add the present study (1)
into the mix, we see two studies (Karsten
and Nicholson) where traditional train-
ing and either cluster training or in-
tra-set rest training led to similar gains
in strength, two studies (Hansen and
Lawton) where traditional training
proved superior, and one (Oliver) where
intraset rest training led to larger gains
in strength.
If there’s anything resembling a trend
in these three studies, it’s that cluster
or intra-set rest strategies may produce
similar or greater strength gains when
training with lower loads (both Karsten
and Oliver based training on 10RM
loads, with most or all of the training
performed with loads below 10RM
loads, or ~75% 1RM), but may be det-
rimental with higher loads (both studies
where traditional training led to larger
strength gains – Hansen and Lawton
– mostly used loads in excess of 80%
of 1RM). There may be a logical expla-
nation for that. With higher loads, any
training you do will be heavy enough to
strongly stimulate the non-hypertrophic
14
 APPLICATION AND TAKEAWAYS
For the time being, the research is still murky, but you may make better strength gains
by doing intra-set rest training during the offseason when you’re training with loads
below 80% 1RM. Cluster sets, especially with heavier loads, don’t seem to boost
strength gains. It’s still unclear how cluster sets and intraset rest training influence
hypertrophy.

mechanisms of strength gains, and in-
troducing additional rest just serves to
reduce the overall stress and difficulty
of the training. With lower loads, how-
ever, going closer to failure leads to fa-
tigue, drops force output, and makes the
training slightly less specific for strength
gains, while introducing more rest peri-
ods helps keep force output higher, en-
hancing specificity.
The prior study that’s the most com-
parable to the present study is the one
by Oliver et al, where intraset rest train-
ing led to larger strength gains. I think
it’s worth examining the differences
between the two studies to understand
why the intraset rest protocol in Oli-
ver et al enhanced strength gains, while
the intraset rest protocol in the present
study failed to enhance strength gains.
I think the biggest factor is that inten-
sity was more tightly controlled in the
Oliver study. For both groups, training
was organized into three four-week
blocks. During weeks 1-3, intensity in-
creased from 65% to 75% 1RM, while
the fourth week was a deload and test-
ing week. During weeks 5-7, loads again
increased by 65% to 75% 1RM, based
on the new 1RMs established during
week 4, and week 8 was a deload and
testing week. Week 9-12 followed the
same pattern. The weakness of this de-
sign was that loads weren’t autoregulat-
ed for each subject as they were in the
present study, but a strength is that you
knew all subjects were actually training
with the same intensity, as opposed to
the approach used in the present study
where the non-failure group was likely
training at considerably lower intensities
than the failure group. The Oliver study
also had better ecological validity, as the
accessory lifts were the same for both
groups and resembled how people tend
to train accessory lifts (3 sets of 10, likely
to failure), as opposed to the presently
reviewed study where the accessory lifts
were trained the same way as the prima-
ry lifts (who would ever do 8 sets of 5 in-
credibly submaximal front delt raises?).
Ultimately, I think cluster sets are nice
in theory, but probably don’t pan out very
well in practice (at least for the power
lifts; I could see its utility for weight-
lifters, track and field athletes, and team
sport athletes). Once weights get above
80% of 1RM, you probably don’t need to

15
do anything too fancy for your training
to have a robust effect on strength. How- Next Steps
ever, during periods when you’re training I’d honestly just love to see a direct rep-
with lower loads, it may make sense to lication of the Oliver study. I’d also like
use an intra-set rest approach. You still to see an intraset rest study where ter-
get the benefits of training with lower mination of each exercise was based on
loads (namely, giving your body a break reps in reserve. For example, one group
for incessant heavy loading), you may could do sets of 10 at 70% 1RM until
be able to keep gaining strength (if you they reach 2 RIR, and one group could
generally just maintain strength during do sets of 5 at 70% 1RM with shorter
the “offseason”) or increase strength at rest intervals until they reach 2 RIR. I’d
a faster rate, and as long as you’re still be interested in acute fatigue and recov-
doing “normal” accessories fairly close ery after both training designs, as well as
to failure, I doubt you’re missing out on longitudinal strength gains and hyper-
much (if any) hypertrophy, especially if trophy.
you terminate an exercise at the same
overall proximity to failure. For exam-
ple, instead of doing sets of 10 with 2
minutes between sets until you have 2
reps left in the tank, you could do sets
of 5 with the same load with 60 seconds
between sets until you have 2 reps left
in the tank; since you’re terminating the
session after reaching the same overall
level of straining, I think recovery time
would be similar between these two set-
ups as well. I think intra-set rest training
might be good for adherence for some
lifters as well. Powerlifters, as a species,
generally hate doing blocks of 8-12 reps,
but if you can still get a lot of the same
benefits while just doing more sets of
4-6 reps instead, I think a lot of lifters
would find that more palatable.

16
References

1. Karsten B, Fu YL, Larumbe-Zabala E, Seijo M, Naclerio F. Impact of Two High-Volume

Set Configuration Workouts on Resistance Training Outcomes in Recreationally Trained
Men. J Strength Cond Res. 2019 Jul 29.
2. Carroll KM, Bazyler CD, Bernards JR, Taber CB, Stuart CA, DeWeese BH, Sato K, Stone
MH. Skeletal Muscle Fiber Adaptations Following Resistance Training Using Repetition
Maximums or Relative Intensity. Sports (Basel). 2019 Jul 11;7(7).
3. Tufano JJ, Halaj M, Kampmiller T, Novosad A, Buzgo G. Cluster sets vs. traditional sets:
Levelling out the playing field using a power-based threshold. PLoS One. 2018 Nov
26;13(11):e0208035.
4. Chapman M, Larumbe-Zabala E, Gosss-Sampson M, Colpus M, Triplett NT, Naclerio F.
Perceptual, Mechanical, and Electromyographic Responses to Different Relative Loads in
the Parallel Squat. J Strength Cond Res. 2019 Jan;33(1):8-16.
5. Chapman M, Larumbe-Zabala E, Gosss-Sampson M, Triplett NT, Naclerio F. Using Per-
ceptual and Neuromuscular Responses to Estimate Mechanical Changes During Continu-
ous Sets in the Bench Press. J Strength Cond Res. 2018 Feb 22.
6. Hansen KT, Cronin JB, Pickering SL, Newton MJ. Does cluster loading enhance lower body
power development in preseason preparation of elite rugby union players? J Strength Cond
Res. 2011 Aug;25(8):2118-26.
7. Nicholson G, Ispoglou T, Bissas A. The impact of repetition mechanics on the adaptations re-
sulting from strength-, hypertrophy- and cluster-type resistance training. Eur J Appl Physiol.
2016 Oct;116(10):1875-88.
8. Lawton T, Cronin J, Drinkwater E, Lindsell R, Pyne D. The effect of continuous repetition
training and intra-set rest training on bench press strength and power. J Sports Med Phys
Fitness. 2004 Dec;44(4):361-7.
9. Oliver JM, Jagim AR, Sanchez AC, Mardock MA, Kelly KA, Meredith HJ, Smith GL,
Greenwood M, Parker JL, Riechman SE, Fluckey JD, Crouse SF, Kreider RB. Greater gains
in strength and power with intraset rest intervals in hypertrophic training. J Strength Cond
Res. 2013 Nov;27(11):3116-31.

17
 Study Reviewed: Rating of Perceived Exertion and Velocity Loss as Variables for
Controlling the Level of Effort in the Bench Press Exercise. Varela-Olalla et al. (2019)

Intraset RPE and Velocity

Provide Similar Estimates of
Reps Performed
BY MIC HAE L C . ZO URD O S

It is generally accepted that velocity gives you a better gauge of intraset proximity
to failure than RPE, but do we really know this? Although the reviewed study leaves
a lot to be desired, it is actually the first to explore this topic.

18
 KEY POINTS
1. This study examined the relationship between intraset Borg rating of perceived
exertion (RPE; not repetitions in reserve-based RPE) and velocity loss during sets
to failure at low and moderate loads with reps performed at various points in a set
of the Smith machine bench press.
2. Both RPE and velocity loss were highly correlated with reps performed, with
perhaps a slight edge for velocity loss.
3. Importantly, the traditional Borg RPE scale was used to assess intraset RPE instead
of reps in reserve-based RPE, which severely limits the application. However, this
article does discuss the usefulness of both velocity loss and absolute velocities to
assess proximity to failure.

O
n a mood state scale of “I’m out
of caffeine” to “I just hit a dead-
lift PR,” I trend toward the caf-
feine-less state when scientific literature
states that using velocity to predict repe-
titions in reserve (RIR) is more accurate
than using rating of perceived exertion
(RPE). That contention may be true, but
my annoyance stems from the fact that
there is no experimental evidence actu-
ally showing this. We shouldn’t perpet-
uate opinions as fact if they are unsup-
ported in the scientific literature. This
study (1) examined the ability of RPE
and velocity loss during sets to failure
on the Smith machine bench press to
predict reps performed. Over three
different days, seven men performed
Smith machine bench press sets to fail-
ure at loads corresponding to 1.0 m/s,
0.70 m/s, and 0.50 m/s, and were asked
to provide a Borg RPE after every 5, 3,
and 2 reps, respectively. The velocity loss
between each interval (i.e. every 5 reps
on the 1.0 m/s set) was also calculated.
The authors then performed regression
equations with velocity and RPE indi-
vidually and together to examine how
strongly these methods correlated with
the amount of reps performed in a set
up to that point. The correlations be-
tween both RPE and velocity loss with
percentage of reps completed were very
strong (r2 > 0.90), and unsurprisingly,
incorporating both RPE and velocity
loss improved the ability of a regression
equation to predict reps performed. Al-
though intraset RPE and velocity loss
both had high correlations with reps
performed, this study is a bit frustrat-
ing, as it used Borg RPE instead of reps
in reserve (RIR) based RPE. Further,
this study didn’t actually show a predic-
tion of RIR from RPE or velocity loss;
rather, it correlated each metric, taken
at different points during a set, with the
percentage of reps completed at that
point. Despite these frustrations, there

19
 Table 1 Subject characteristics
Number Age (years)
7 men 22 ± 1.9
Data are mean ± SD
Subject characteristics are from Valera-Olalla et al. 2019 (1)
is some benefit from examining these
data, so I’ll do my best to provide some
actionable takeaways in this article.
Purpose and
Hypotheses
Purpose
The purpose of this study was to exam-
ine the strength of the relationships be-
tween the percentage of reps performed
during sets to failure and both intraset
RPE and velocity loss, and to investi-
gate if including both RPE and veloc-
ity loss together in the same regression
equation improved the strength of the
correlation.
Hypotheses
The authors predicted that both RPE
and velocity loss would be similarly cor-
related with the percentage of reps per-
formed during sets to failure, and that
including RPE and velocity loss in the
same regression equation would im-
prove the strength of the relationship.
Smith machine
Body mass (kg) Height (cm) Training experience
bench 1RM (kg)
77.8 ± 11.7 176 ± 68 83.6 ± 16.4 > 1 year
Subjects and Methods
Subjects
Seven men with a training experience
of at least one year participated. The par-
ticipants, however, were not very well-
trained, as their Smith machine bench
press one-repetition maximum (1RM)
was only slightly greater than their body
mass, on average. Specific subject details
are in Table 1.
Study Design
The methods in the paper were not de-
scribed particularly clearly, so I’ve done
my best to interpret and explain them
as clearly as possible. This study con-
sisted of two familiarization sessions
and three experimental sessions. During
the first familiarization session, subjects
had anthropometrics (height and body
mass) assessed, then performed a Smith
machine bench press 1RM. During the
second familiarization session, subjects
performed one set to failure at a load
they could initially press at 0.70 m/s to
familiarize the subjects with what a true
10RPE set felt like.
During each of the three experimen-
20
tal visits, subjects performed a modified
1RM test before performing one set to
failure with a load that corresponded to
an initial average concentric velocity of
1.0, 0.70, or 0.50 m/s. The loads used for
the set to failure were determined during
the modified 1RM test. Subjects with a
1RM greater than 80kg performed two
reps at 60kg after performing a single at
80kg, rather than working up to a true
1RM. I’m not sure why this modifica-
tion was implemented, but this is the
reason for calling it a “modified” 1RM
test.
Assessing RPE and Velocity Loss
During the sets to failure with the 1.0
m/s load, the subjects were asked for an
RPE on the 1-10 Borg scale after ev-
ery 5 reps, and velocity loss was calcu-
lated between every 5 reps as well. This
scale can be seen in Table 2 here. Im-
portantly, the Borg RPE scale (2) simply
gauges effort and not RIR, which limits
the applicability of this study (more on
that later). During the set to failure with
0.70 m/s, RPE and velocity loss were
assessed during every 3-rep increment,
and the same was done during every
2-rep increment during the set to fail-
ure with the 0.50 m/s load. Regression
equations were then used with RPE and
velocity both individually and together
to examine their relationships with the
percentage of reps performed in the set.
Bland-Altman plots – graphical repre-
sentations of agreement between two
models – examined the agreement be-
tween actual reps performed and RPE
and velocity loss predictions of reps per-
formed.
Findings
Reps Performed, Velocity Load, Load
Used
First, let’s report simple observations.
Table 1 shows how many reps were per-
formed at each load lifted, the best rep
(often the first rep) and last rep velocity
at each load, and the percentage veloci-
ty loss from the best rep to the last rep.
The 1.0, 0.70, and 0.50 m/s loads cor-
responded to 43.5%, 63.7%, and 77.3%
of 1RM, respectively. As you would ex-
pect, more reps were performed with the
1.0 m/s load compared to 0.70 m/s load,
which in turn yielded more reps than the
0.50 m/s load. Velocity loss was similar
between the 1.0 (~80%) and 0.70 m/s
(~80%) loads, but both of these loads
had greater velocity loss from the fastest
to last rep compared to 0.50 m/s load.
RPE and Velocity Loss Prediction of Reps
Performed
Both RPE (r2 = 0.89) and velocity loss
(r2 = 0.91) were highly correlated with
reps performed. These correlations sim-
ply show that RPEs were rated higher
and the magnitude of velocity loss was
greater as more reps were performed,
which is obviously to be expected. Fur-
21
 Table 2 Descriptive velocity data, load used, and reps performed
Load 1 ( 1.00 m/s)
Variables Mean ± SD (range)
AV Best (m/s) 1.00 ± 0.05 (0.91 - 1.06)#
AV Last (m/s) 0.20 ± 0.08 (0.11 - 0.31)
VL (%) 80.20 ± 9.0 (67.1 - 88.9)
Load (kg) 36.4 ± 5.8 (30.0 - 45.0)#
Repetitions 41.4 ± 15.8 (24.0 - 74.0)#
Data are mean ± SD
From Valera-Olalla et al. 2019 (1)
AVbest = Average velocity of the best rep in the set; AVlast = Average velocity of the last rep in the set; VL = Velocity loss
* = Significantly different than the 1.00 m/s load; # = Significantly different than the 0.70 m/s load
^ = Significantly different than both the 1.00 and 0.70 m/s loads
ther, Figures 1A and 1B show that both
RPE and velocity loss predicted the
amount of reps left with similar accuracy.
Specifically, the percentage of reps actu-
ally completed is on the x-axis in Figure
2, and on the y-axis is the percentage
of reps which either RPE (Figure 1A)
or velocity (Figure 1B) predicted had
been completed at that point in the set.
RPE had a standard error of estimate of
9.24%, while velocity had a standard er-
ror of estimate of 8.52%.
Agreement of RPE and Velocity Loss with
Reps Performed
The authors also used Bland-Altman
plots, which visually display the level of
agreement between the two methods.
Although two methods may highly cor-
relate (as seen above), that does not mean
Load 2 ( 0.70 m/s) Load ( 0.50 m/s)
Mean ± SD (range) Mean ± SD (range)
0.71 ± 0.03 (0.68 - 0.76)* 0.51 ± 0.03 (0.47 - 0.55)*^
0.15 ± 0.03 (0.10 - 0.19) 0.15 ± 0.03 (0.11 - 0.18)
79.0 ± 4.1 (75.1 - 85.4) 69.3 ± 6.5 (61.7 - 78.3)*^
53.2 ± 8.6 (40.0 - 65.0)* 64.6 ± 9.9 (52.5 - 77.5)*
19.3 ± 4.1 (13.0 - 25.0)* 9.6 ± 1.4 (8-12)*^
that they necessarily agree (3); thus, a
Bland-Altman plot is necessary to de-
termine agreement. The main takeaway
from the Bland-Altman plots (Figure
2AB) is that they suggest some degree
of inaccuracy of both RPE and velocity
loss to predict reps performed, which is
not surprising as it is more difficult to
“agree” than to “correlate.” Further, the
plots do not definitively show one meth-
od (RPE or velocity loss) to be better
than the other. The plots presented by
the authors, however, appear to have a
few issues. First, the dashed lines on the
top and bottom represent the limits of
agreement and should reflect the range
of the confidence intervals listed on the
top of the graph; however, the range of
the lines is slightly different from the
confidence intervals. Additionally, even
22
 Figure 1 RPE and velocity loss predictions of reps performed
though a Bland-Altman is a graphical
representation of agreement, some au-
thors have recommended against using A RPE
100
them for repeated measures data (which y = 0.89x + 6.62
r = 0.94 (0.92 - 0.96)
90
is what these data are) (4). In short, SEE: 9.24%
identity line
80
while there are issues with the plots, I 70
think we can be confident that neither

%REP predicted
60
intraset RPE or velocity loss were truly 50
excellent predictors of the percentage of 40

reps performed in a set. 30

20

Interpretation
10

0
0 10 20 30 40 50 60 70 80 90 100

These data are both interesting and %REP actual

frustrating. They are interesting, because

they show that RPE and velocity loss B
VL
provide pretty similar estimates of how 100
y = 0.91x + 5.44
many reps had been performed at var- 90
r = 0.95 (0.93 - 0.97)
SEE: 8.52%

ious points throughout a set. However, 80

identity line

the data are frustrating for various rea- 70

%REP predicted

sons: 1) Borg RPE was used despite the 60

authors being aware of the RIR-based 50

40
RPE scale, 2) they included RPE and
30
velocity predictions in the regression
20
equations when really far from failure
10
(~36 reps), which is not used in a prac- 0
tical setting, 3) a Smith machine bench 0 10 20 30 40 50 60 70 80 90 100

press was used instead of free weights,
and 4) relatively novice subjects were
used. So, before providing actionable
%REP actual
From Valera-Olalla et al. (1)
RPE = Rating of Perceived Exertion; VL = Velocity Loss.
These figures show the percentage of reps actually completed plotted against the percentage
of reps which RPE (Figure 1A) and velocity loss (Figure 1B) predicted were completed when

takeaways from this study, we must first an RPE was called or velocity loss was assessed during the repetition intervals. The dashed
line is the “identity” line. The identity line is exactly at a 45-degree angle, which indicated a 1:1
relationship, or a perfect prediction. The regression line for both RPE (1A) and velocity loss (1B)
offer some critiques and limitations of is tightly conformed to the identity line.

this study. To do this, I’m going to kick

us off with some whining. RIR-based RPE scale in the introduc-
tion of the paper, yet still used the Borg
Critiques and Limitations RPE scale. My first thought is “why”?
The authors cited the utility of the Hackett and colleagues showed in sepa-

23
 Figure 2 Bland-Altman plots
rate studies in 2012 (5) on the squat and
bench press and in 2016 (6) on the chest
press, leg extension, and leg press that RPE
r2 = 0.031
gauging intraset RIR was more accurate A 95% Cl: -19.19 - 19.13
Systematic bias ± random error: -0.003 ± 9.78%

for predicting proximity to failure and 40

levels of effort than using Borg RPE. In

Difference actual-predicted %REP

30

+1.96 SD
fact, in the Hackett studies, it was com- 20

monplace for subjects to report moder- 10

ate RPEs on the Borg scale even when 0

bias

reaching failure. This prompted further -10

studies to use the RIR-based RPE scale -20

-1.96 SD

to assess intraset proximity to failure (7). -30

The authors did not refer to any of these -40

data, so it is possible they aren’t aware of 0 10 20 30 40 50

mean actual-predicted %REP

60 70 80 90 100

it; however, I doubt that is the case. In

the presently reviewed study, the authors
“anchored” RPE by having subjects per- B
VL
r2 = 0.023
form a set to failure during the famil- 95% Cl: -17.49 - 17.39
Systematic bias ± random error: -0.053 ± 8.89%

iarization to practice what a 10RPE felt

40
Difference actual-predicted %REP

like. However, it is likely that this an-

30

+1.96 SD
choring didn’t completely negate any is- 20

sues using Borg RPE, as the effort-level

10

bias

descriptors at submaximal RPEs were 0

still ambiguous. The authors stated

-10

-1.96 SD
that one of the purposes of the study
-20

was to examine if the “goodness of fit”

-30

(i.e., the r2) to predict the percentage of

-40
0 10 20 30 40 50 60 70 80 90 100

reps performed during a set would be mean actual-predicted %REP

improved if RPE was included in the

same multiple regression with veloci-
From Valera-Olalla et al. (1)
RPE = Rating of Perceived Exertion
These figures examine the agreement between the percentage of reps predicted by RPE (A) and velocity loss (B)

ty loss compared to a linear regression

with the actual percentage reps performed

with velocity loss as the sole predictor.

In that sense, sure, Borg RPE would be
novel, but we already know it’s inferior
for determining intraset proximity to
failure to the RIR-based scale, and the
stated purpose itself is not very sound.
When you run a multiple regression (as
done in this study), adding another vari-
able – no matter what it is (you could
include subject’s shoe size) – will virtu-
ally always increase the r2 value to some
degree. Also, it’s not helpful to include
two metrics in the same regression that

24

RPE AND VELOCITY LOSS
PROVIDE PRETTY SIMILAR
ESTIMATES OF HOW MANY
REPS HAD BEEN PERFORMED
AT VARIOUS POINTS
THROUGHOUT A SET.
are so highly correlated with each other.
In fact, this is called “multicollinearity,”
and it’s something you’re taught to avoid
on day 1 of learning about multiple re-
gression. Rather, you should see if those
two methods agree with each other with
agreement statistics such as Bland-Alt-
man and Mountain Plots (Folded Cu-
mulative Empirical Distribution Plots).
I can see a rationale for Borg RPE to
generally gauge fatigue during extreme-
ly high-rep sets. In this study, about
~41 reps were performed at the 1.0 m/s
load (43.5% of 1RM), which meant that
when an RPE was called for after 5 reps,
there was, on average, an RIR of 36. Ob-
viously, it’s difficult to accurately predict
RIR when about 10 reps from failure, so
accurately predicting 36 RIR is nearly
impossible. Therefore, a general gauge of
effort (i.e. Borg RPE) is OK early in such
a high-rep set; however, in practice, most
people aren’t doing 40-rep sets. From a
design perspective, using the RIR-based
RPE scale during more normal rep sets
(i.e. <20) would have been far preferable
for actually comparing the accuracy of
intraset RPE and velocity loss to predict
RIR. In other words, this study doesn’t
provide us with the comparison that we
really need.
Furthermore, as we know from the pre-
viously referenced Hackett studies (5, 6),
Borg RPE is an especially poor estimate
of effort at close proximities to failure,
which is where RIR-based RPE shines
(7). As stated above, the anchoring in
this study may have helped the estimates
in this study closer to failure, but it cer-
tainly didn’t fully negate the inaccuracy.
Unfortunately, the authors only ran the
regressions with all data points included
and not an additional regression to ex-
amine the accuracy of RPE and veloci-
ty loss when closer to failure. This could
have been done by conducting a sepa-
rate analysis on only RPEs and velocity
loss after the set was close to completion
(i.e. 75% of reps had been completed).
However, we can infer some results for
how RPE and velocity loss fared later in
the set in Figure 1. Although the r-val-
ues are similar between RPE (0.94) and
velocity loss (0.95) in Figure 1AB, by
simply looking at the scatter plots, we
see that on the bottom left hand corner
of the plots (i.e. toward the beginning
of the set and far from failure), the in-
dividual data points for RPE (panel A)
25
are pretty tightly conformed to the iden-
tity line (dashed line), but these points
get farther away from the identity line
at the opposite end, which suggests the
OFTENTIMES, INDIVIDUALS
relationship between RPE and reps per- CAN MAINTAIN THE SAME
formed is worse when closer to failure.
The opposite is true for velocity loss, in VELOCITY FOR A FEW REPS
that more data points are tightly con-
formed to the identity line closer to fail- DURING MODERATE- TO
ure. This shouldn’t be surprising, as the
aforementioned Hackett studies (5, 6)
HIGH-REPETITION SETS;
showed lifters to underrate Borg RPE
on various exercises (squat, bench, chest
THUS, VELOCITY LOSS WILL
press, leg extension, and leg press) when BE VERY MINIMAL ON THE
close to failure (within three reps), and
even recorded submaximal Borg RPE FIRST FEW REPS OF A SET.
ratings when reaching failure during
a set. Velocity, on the other hand, does
not decline linearly during a high-rep
thus, applying the degree of velocity loss
set to failure. Oftentimes, individuals
universally to predict the percentage of
can maintain the same velocity for a few
reps that have been completed is not a
reps during moderate- to high-repeti-
great metric. Besides, it’s more import-
tion sets; thus, velocity loss will be very
ant to predict RIR (how far someone is
minimal on the first few reps of a set.
from failure), rather than how many reps
Another issue is the use of velocity loss have been completed. To do this, it seems
rather than absolute velocities, which we more prudent for individuals to find out
have discussed previously. It’s difficult to how many RIR they have at specific ab-
give normative velocity loss percentages solute velocities. For example, a 1RM
because one person may have a starting squat is commonly reported around
velocity of 0.70 at 70% of 1RM, while 0.25 m/s in the literature (8, 9, 10),
another lifter has an average velocity of which would put someone at about an 8
0.60 m/s on their first rep. Therefore, at RPE (2 RIR) when they are at 0.35 m/s.
a velocity loss of 40%, the first individual Therefore, I would recommend finding
would be at a velocity of 0.48 m/s with what absolute velocities correspond to
the other individual at a velocity of 0.36 what RPE/RIR. This is actually easy to
m/s. This would theoretically leave the do in practice. Simply perform a set to
latter individual much closer to failure; failure at various intensities (70, 75, 80,

26
 APPLICATION AND TAKEAWAYS
1. Borg RPE and velocity loss are both decent predictors of the percentage of reps
completed at various points throughout a set with velocity loss being better than
Borg RPE when closer to failure.
2. This study has glaring issues that limit its application. However, from other data,
we know that RIR-based RPE is effective at accurately gauging proximity to failure
when close to failure during low- to moderate-rep sets.
3. This study does, however, highlight some of the inconsistencies with velocity loss.
When using velocity, it may be better to use absolute velocity values as opposed
to velocity loss and cross-reference those values with RPE/RIR. As discussed, this
can be accomplished by performing a set to failure and recording velocity on each
rep.

and 85% are probably the most relevant)
and track velocity throughout the set.
Afterward, you can match up each re-
corded average concentric velocity with
the RPE/RIR at that point in the set. Be
aware, however, that when you do this,
you will probably find very little change
in velocity over the first few reps at 70%
of 1RM, so at lower to moderate inten-
sities, I might only match up RPEs with
velocities once velocities start to consis-
tently decline on every single rep.
A final interesting note about this study
is that it reported the last rep on the 0.70
and 0.50 m/s sets to be 0.15 m/s, while
the last rep on the 1.0 m/s set was 0.20
m/s. Theoretically, these should all be
the same; however, it seems likely that
metabolic fatigue played a much greater
role in fatigue on the 1.0 m/s set, as ~41
reps were performed. Practically, this
probably translated to some shaking of
the arms and instability, which reduced
the ability to grind on the last few sets.
The 0.15 m/s last rep is also faster than
Helms et al (9), who reported a 10RPE
to be 0.10 ± 0.04 m/s on the bench press.
However, this difference in velocity at
failure between studies can be explained
by the current study using a Smith ma-
chine, a two-second pause on the chest,
and a cohort of fairly novice lifters ver-
sus free-weight bench press and well-
trained lifters in Helms’ study. Therefore,
if using absolute velocities to correspond
with RPE/RIR, not only should the ve-
locities be individualized, but the veloci-
ties should be exercise-specific.
Next Steps
The next steps are simple. We need a
study that assesses intraset velocity and
RIR-based RPE on the squat, bench
press, and deadlift and a statistical anal-
ysis that directly compares the accuracy

27
of RPE and velocity for predicting RIR.
These potential data can reveal if the
objectivity of velocity is indeed superi-
or to RPE for gauging RIR or if RPE
gets the job done by itself. No matter the
findings, certain personality types will
still make RPE a poor choice for some,
but the practicality in these data would
be wide-ranging.

28
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Conditioning Research. 2018 May 1;32(5):1352-9.
7. Zourdos MC, Goldsmith JA, Helms ER, Trepeck C, Halle JL, Mendez KM, Cooke DM,
Haischer MH, Sousa CA, Klemp A, Byrnes RK. Proximity to Failure and Total Repetitions
Performed in a Set Influences Accuracy of Intraset Repetitions in Reserve-Based Rating of
Perceived Exertion. Journal of strength and conditioning research. 2019 Feb.
8. Zourdos MC, Klemp A, Dolan C, Quiles JM, Schau KA, Jo E, Helms E, Esgro B, Duncan
S, Merino SG, Blanco R. Novel resistance training–specific rating of perceived exertion scale
measuring repetitions in reserve. The Journal of Strength & Conditioning Research. 2016
Jan 1;30(1):267-75.
9. Helms ER, Storey A, Cross MR, Brown SR, Lenetsky S, Ramsay H, Dillen C, Zourdos MC.
RPE and velocity relationships for the back squat, bench press, and deadlift in powerlifters.
The Journal of Strength & Conditioning Research. 2017 Feb 1;31(2):292-7.
10. Izquierdo M, González-Badillo JJ, Häkkinen K, Ibanez J, Kraemer WJ, Altadill A, Eslava J,
Gorostiaga E. Effect of loading on unintentional lifting velocity declines during single sets of
repetitions to failure during upper and lower extremity muscle actions. International journal
of sports medicine. 2006 Sep;27(09):718-24.

29
 Study Reviewed: Do Low-Calorie Sweetened Beverages Help to Control Food
Cravings? Two Experimental Studies. Maloney et al. (2019)

Diet Sodas and Adherence:

Helpful or Counterproductive?
BY E RI C HE LMS

Do “diet” sodas actually help you diet, or do they make it harder? Does
the calorie-free flavor curb your sweet tooth, or set you up for failure
by causing cravings? As you’ve probably learned by now from reading
MASS, the answer depends on the context – both the situation, and the
individual.

30
 KEY POINTS
1. This research examined ad libitum (as desired) food intake after exposure to
a food craving stimulus or control in two different experiments: 1) in diet soda
non-consumers versus frequent consumers, and 2) among frequent diet soda
consumers when diet soda was or wasn’t available during ad libitum eating.
2. In experiment 1, diet soda non-consumers ate more after exposure to a craving
stimulus than a control; however, frequent consumers did not. In contrast, in
experiment 2, frequent consumers ate more following a craving stimulus than a
control; however, they ate less when diet sodas were available versus when they
were not.
3. Frequent consumers of diet soda being “protected” against craving-induced
overeating was only observed in the first, but not second study. However, more-
or-less supporting the theme that diet sodas may aid weight loss efforts, less total
food was consumed when diet soda was available to the participants versus when
unavailable in the second study.

T
he present study (1) examined
an aspect of the hotly debated
topic of whether diet sodas are
helpful or harmful for weight loss. In the
lay public, the crux of the argument is
normally on faulty grounds, with most
anti-diet soda proponents claiming diet
sodas result in weight gain despite hav-
ing zero calories, due to “chemicals,” “in-
sulin,” “hormones,” “toxins,” or by harm-
ing “gut health.” To be charitable, there
is very preliminary data that at high (but
still within assumed-to-be-safe) dosage
ranges, a small minority of the available
artificial sweeteners could plausibly have
a minor negative impact on the gut mi-
crobiome; however, the only causal hu-
man data are from a controversial study
on the rarely used sweetener saccharin
(2). While there are sometimes positive
associations reported between BMI and
diet soda consumption, this is almost
certainly reverse causation; individuals
with a higher BMI are more likely to
be on a diet and subsequently consume
artificial sweeteners (3), as randomized
controlled trials broadly report replacing
regular soda (and sometimes even water)
with diet soda results in modest weight
loss (4). However, like I discussed last
month in my review of processed foods’
effect on ad libitum energy intake (5),
what is factually correct is not always the
same as what is useful. Indeed, we need
more data on how artificial sweeteners
impact craving-related ad libitum food
consumption in applied conditions rep-
resentative of the “real world.” This study
set out to do just that and examined how
consumers and non-consumers of diet

31
soda behave in ad libitum eating scenar-
ios after exposure to food cravings, and
how diet soda availability moderates this
behavior. In the following article, I’ll re-
view the findings of this study and ex-
plain their relevance.
Purpose and Research
Questions
Purpose
The broad purpose of this research,
conducted across two experiments, was
to determine the mechanisms (cog-
nitive/behavioral) by which diet soda
might affect eating behavior. Specifically,
by priming hedonic eating with a choc-
olate craving stimulus, this study aimed
to observe ad libitum caloric intake in
frequent diet soda consumers compared
to non-consumers (experiment one) and
in frequent consumers when diet soda
was and was not available (experiment
two).
Hypotheses
Experiment 1: Energy intake would
be greater after a hedonic craving stim-
ulus relative to the control stimulus in
non-consumers of diet soda, and fre-
quent diet soda consumers would be
protected from overeating during the
craving stimulus by seeking out diet soda
to drink instead.
Experiment 2: Frequent consumers
would be protected from overeating fol-
lowing a craving stimulus if diet soda
was available, and would overeat when
diet soda was not available.
Subjects and Methods
Experiment 1
120 male and female university staff
and students, age 31.44 ± 8.54 years,
participated in this study and were di-
vided into two 60-person groups based
on whether they were habitual consum-
ers of diet soda or non-consumers. At
baseline, all participants were given a
series of questionnaires related to eating
behavior, attitudes and beliefs about diet
soda, and enjoyment of diet soda. They
were also asked about their eating atti-
tudes toward chocolate. Table 1 shows
comparative characteristics of each
group, with an emphasis on their eating
attitudes. Following group assignment,
each group was exposed to a craving and
a control stimulus in a random order in
separate lab visits. In the craving stim-
ulus condition, they were given a choc-
olate bar which they had to hold, open,
and smell for a given amount of time. In
the control condition, they were instead
given a wooden block of the same shape
and size. Then, following the control or
craving stimulus, the participants were
provided both sweet and savory snack
foods, their regular soda of choice (or
full-sugar version of their preferred diet
32
soda in the diet soda consumer group), Table 1
water, and their diet soda of choice (or Characteristics
Frequent consumers of Non-consumers of diet

diet version of their preferred full-sug-

diet soda (n=60) soda (n=60)

ar soda in the diet soda non-consumer

Age (y) 30.45 (9.17) 32.43 (7.81)

BMI (kg/m2)
group), and were free to eat and drink
26.29 (4.26) 22.80 (3.48)*

TFEQ
whatever they wanted. The energy con-
Disinhibition 8.35 (2.62) 6.33 (2.77)*
sumed was measured and compared be-
DEBQ
tween groups and conditions. As a side
Restraint 3.24 (1.07) 2.63 (1.10)**
note, there was also a visual test where Emotional 2.96 (0.90) 3.01 (0.89)
images of regular and diet sodas and wa- External 3.25 (0.47) 3.30 (0.53)
ter were shown to the participants fol- Attitudes and beliefs

lowing the craving or control stimulus Appetite and weight

before the ad libitum eating occurred to

5.61 (6.07) 2.58 (1.16)*
management

see if the frequent consumers paid more Palatability and

enjoyment
5.10 (1.25) 3.31 (1.43)*

attention to images of diet sodas after ex- ACQ

periencing cravings. This served a useful Trait functional 34.66 (14.60) 35.53 (15.50)

purpose in that the researchers told the Trait guilt 44.56 (16.66) 31.91 (19.04)*

participants they were only investigating Trait craving 51.62 (18.27) 47.07 (22.46)

attentional focus after a craving stim- Values are means with standard deviations in parentheses

ulus, and not ad libitum energy intake.

They were told that the food was provi-
sioned simply as thanks for volunteering
and because they had to fast for at least
three hours prior to the study. The par-
ticipants were unaware their food intake
was monitored and measured and that
energy intake was the principal variable
assessed. However, while this served the
useful purpose of providing additional
control, the attentional data didn’t add
much to the principal findings, so I’ll
skip over them for the purpose of this
review.
Experiment 2
The second experiment was conduct-
ed in a similar manner, with the partic-
TFEQ = three factor eating behavior; DEBQ = Dutch eating behavior questionnaire;
ACQ = attitudes to chocolate questionnaire
* = p < .001, ** = p < 0.05 frequent consumers vs. non-consumers
ipants exposed to the same craving or
control stimulus, followed by provision
of food and the allowance of ad libi-
tum eating and drinking. In this case,
though, all 172 participants were fre-
quent diet soda consumers who were
equally divided into four groups: 1) the
control stimulus followed by food pro-
vision with diet soda available, 2) the
control stimulus followed by food pro-
vision without diet soda available, 3) the
craving stimulus followed by food pro-
vision with diet soda available, and 4)
the craving stimulus followed by food
provision without diet soda available.
The measured variables I’ll review were

33
 Table 2 Descriptive statistics for diet soda (available vs. unavailable) and craving (vs. control) groups

Craving diet soda Control diet soda Craving diet soda Control diet soda
Characteristics
available available unavailable unavailable

N 43 43 43 43

Age (y) 29.05 (12.94) 27.00 (9.48) 26.86 (11.95) 28.16 (12.66)

BMI (kg/m2) 26.94 (4.67) 25.90 (4.19) 27.36 (3.97) 27.54 (3.71)

DEBQ

Restraint 3.25 (0.78) 3.15 (0.87) 3.16 (0.84) 3.25 (0.75)

Emotional 2.91 (0.91) 2.79 (0.84) 3.05 (0.81) 2.75 (0.76)

External 2.92 (0.85) 2.93 (0.73) 2.86 (0.91) 2.83 (0.75)

Values are means with standard deviations in parentheses

DEBQ = Dutch eating behavior questionnaire;

the same, and the group breakdowns
are shown in Table 2.
Findings
The principal finding in experiment
one was that frequent consumers of diet
soda did not consume more energy fol-
lowing the craving condition compared
to the control condition, while the diet
soda non-consumers did consume more
energy following the craving stimulus
condition (Figure 1).
However, this finding was not repli-
cated in experiment two. Importantly,
in experiment one, there was a with-
in-group difference between conditions,
not a between-group difference (i.e. diet
soda non-consumers ate more food
during the craving condition than the
control condition, but the differenc-
es in how much they ate compared to
the diet soda drinkers in either condi-
tion were not statistically significant).
In experiment two, even when diet soda
was available, the participants (who were
all diet soda drinkers) consumed more
during the craving stimulus condition.
With that said, the total calories con-
sumed was lower when diet soda was
available compared to when it was not,
even if diet soda availability didn’t pre-
vent an increased consumption of ener-
gy following the craving stimulus (Fig-
ure 2).
Interpretation
There are a couple of ways to look at the
findings from a big picture perspective.
First, you could scratch your head at the
conflicting finding of diet soda drinkers
being protected against craving-induced
overeating in experiment one, but not in

34
 Figure 1 Mean energy intake following craving and control
conditions in frequent and non-consumers
900
Calories (kcal)
700
500
300
100
Frequent consumers
*p = 0.037
Error bars represent standard error of the mean
experiment two, and question the utility
of diet sodas for dieters. But, another per-
spective is that when diet soda was avail-
able in experiment two, during either
the control or craving condition, overall
food consumption was lower compared
to when diet soda was not available. That
isn’t the same as being protected from
craving-induced overeating as was sug-
gested in experiment one, but it at least
suggests a reduced magnitude of over-
eating occurs when diet soda is available.
If you’re application focused and sim-
ply want a black or white answer to the
* Control
Craving
Non-consumers
question I posed in the teaser of this
article (“Does the calorie-free flavor curb
your sweet tooth, or set you up for failure by
causing cravings?”), I’d say the evidence
leans toward diet sodas being helpful.
If you’re the curious type, you might
wonder why there was a disparity at all.
Even for those who just want the black
or white answer, it’s worth considering
the “why” of the findings. Reason being,
I think the utility of diet soda might dif-
fer based on the individual situation.
To help you understand why I be-
lieve that’s the case, we have to think
35
 Figure 2 Mean energy intake in the craving and control conditions and in the
diet soda available and unavailable groups
900 *
800
700
Calories (kcal)
600
500
400
300
200
100
0
Diet sodas available
*p < 0.05
Error bars represent standard error of the mean
deeper about who is really compared in
this study. Ask yourself, why do people
choose to drink diet soda? Notice fre-
quent consumers had significantly high-
er BMI, restraint and disinhibition (im-
pulsivity) toward eating, guilt associated
with eating chocolate, and higher be-
liefs that diet soda was effective in con-
trolling appetite and weight compared
to non-consumers (Table 1). Essentially,
this was also a comparison of a group
more focused on weight loss compared
to a group less focused on weight loss.
In experiment two, which consisted
solely of frequent diet soda consumers,
*
* Control
Craving
Diet sodas unavailable
they didn’t assess beliefs about the ef-
fectiveness of diet soda for weight and
appetite control. Since everyone was a
frequent consumer, questions were not
asked specifically about diet soda be-
liefs; however, not everyone consumes
diet soda for the same reason. Certainly,
if you recruit a large group of diet soda
consumers, you’ll get many who display
attitudes and traits associated with di-
eting, which will affect the group mean.
But, you’ll also capture a fair number of
people who are not dieting, but simply
looking for ways to prevent weight gain
by controlling “empty calorie” intake.
36
 APPLICATION AND TAKEAWAYS
It’s not totally clear whether or not diet sodas will protect you fully against hedonic
food cravings. However, at the very least, we can conclude that drinking diet soda
will at least mitigate the total amount of craving-induced eating that occurs after
exposure to an environmental food cue like an advertisement, the smell of cookies
when you walk by Subway, or your significant other whipping out a chocolate bar
while you’re on a diet.

You also might capture people who ar-
en’t dieting or trying to prevent weight
gain, but trying to limit sugar based
on their beliefs about sugar’s effect on
health. We know a fair bit about the at-
titudes of the 60 diet soda drinkers in
experiment one – indeed, at the group
level, they are much more characteristic
of “dieters” than non consumers – but
we don’t have the same knowledge about
the four groups of 43 diet soda drinkers
in experiment two. They didn’t differ in
any of the measured metrics (Table 2),
but it’s possible (especially when bro-
ken up into multiple smaller sample size
groups) that the groups’ reasons were
not homogeneous for consuming diet
soda and some groups had more or few-
er “dieters” than others.
Based on prior research (6), the au-
thors theorized that diet sodas can be
helpful, not just by satisfying cravings,
but rather because the act of seeing or
drinking a diet soda serves as a reminder
that you are indeed on a diet, and that
exposure reinforces your goals. In fact,
while not statistically significant, ener-
gy intake was actually lower (by about
~20% eyeballing the means displayed in
the bar graph of Figure 1) in the craving
condition than the control among diet
soda consumers in experiment one. If
you are dieting, and you’re put in a situa-
tion where you are exposed to images of
diet soda and given a bunch of non-di-
et friendly food alongside diet soda, you
may very well “batten down the hatches”
and stick to your diet with more vigor.
In fact, it’s quite possible that because the
two groups were specifically asked ques-
tions about their beliefs regarding diet
soda as a weight loss tool in experiment
one, while they were not in experiment
two, that the protective effect occurred,
as the questions acted as goal primers.
To tie it all together, while it’s specu-
lative on my part, it’s possible that diet
soda only acts to protect fully against
cravings when you are actively on a diet.
The diet soda is a reminder of your choice
to drink diet soda because you are on a
diet, reminding you of your goals, and
serving to bolster motivation. Also, as
an aside, among dieters who have a very
“set” consistent pattern of eating and
drinking behavior, diet soda can be used

37
as a direct swap for calorie-containing
beverages, which, when all else remains
the same, effectively reduces calories.
However, in non-dieting conditions, it
may have a more minor effect, not pro-
tecting against cravings completely, but
serving to curb cravings and blunt total
energy intake in an ad libitum setting
(e.g. you might eat fewer total calories at
a party if there is diet soda available and
you seek it out).

Next Steps
I would like to see similar research con-
ducted in heterogeneous groups of diet
soda consumers, differentiated by their
reasoning for drinking diet soda. We
could compare individuals who choose
to drink diet soda for weight loss or
weight loss maintenance reasons against
individuals who consume diet soda for
other reasons and see if there was a dif-
ference in ad libitum energy intake in
various conditions. That would really
tell us what the primary mechanism is
by which diet sodas might impact im-
proved adherence. If only the weight
loss or weight loss maintenance group is
positively impacted, we can safely con-
clude the effect of diet soda is due to
being reminded of your goal. However,
if an effect is observed in diet soda con-
sumers unconcerned with body weight,
we could conclude there might also be
an effect related to it satisfying cravings.

38
References
1. Maloney NG, Christiansen P, Harrold JA, Halford JC, Hardman CA. Do low-calorie sweetened
beverages help to control food cravings? Two experimental studies. Physiology & behavior. 2019 Sep
1;208:112500.
2. Ruiz-Ojeda FJ, Plaza-Díaz J, Sáez-Lara MJ, Gil A. Effects of sweeteners on the gut microbio-
ta: a review of experimental studies and clinical trials. Advances in Nutrition. 2019 Jan 1;10(sup-
pl_1):S31-48.
3. Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of
randomized controlled trials and prospective cohort studies. The American journal of clinical nutri-
tion. 2014 Jun 18;100(3):765-77.
4. Rogers PJ, Hogenkamp PS, De Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P,
Yeomans MR, Mela DJ. Does low-energy sweetener consumption affect energy intake and body
weight? A systematic review, including meta-analyses, of the evidence from human and animal stud-
ies. International Journal of Obesity. 2016 Mar;40(3):381.
5. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A,
Darcey V, Fletcher LA. Ultra-processed diets cause excess calorie intake and weight gain: an inpa-
tient randomized controlled trial of ad libitum food intake. Cell metabolism. 2019 May 16.
6. Papies EK, Hamstra P. Goal priming and eating behavior: Enhancing self-regulation by environ-
mental cues. Health Psychology. 2010 Jul;29(4):384.

39
 Study Reviewed: Upper and Lower Thresholds of Fat-Free Mass Index in a Large
Cohort of Female Collegiate Athletes. Harty et al (2019)

Using Fat-Free Mass Index to

Forecast Long-Term Gains for
Males and Females
BY E RI C T RE X LE R

At some point in their lifting career, just about every lifter wonders, “Exactly
how big can I get?” While fat-free mass index (FFMI) isn’t going to tell you
the exact limit to your potential, or perfectly weed out steroid-users from
drug-free lifters, it’s still a helpful metric for approximating muscularity and
understanding how big most people can get. Read this article to figure out
how big male and female lifters tend to get, and what this means for your
natural potential for muscle growth.

40
 KEY POINTS
1. Fat-free mass index (FFMI) has been used as a proxy for muscularity and has
previously been used to estimate upper limits for lean mass accretion in drug-
free lifters.
2. The current study (1) measured FFMI in a large sample of 372 female athletes.
The 97.5th percentile value was 23.9, but multiple athletes had values over 25,
and one athlete had a value over 27.
3. Current evidence suggests that it isn’t rare for males to have an FFMI as high as
28, or for females to have an FFMI as high as 24. Lifters can use FFMI to help plan
out their weight gain phases, but shouldn’t use it to arbitrarily limit themselves or
make baseless steroid accusations about others.

A
large percentage of lifters, at
some point in their career, have
an interest in getting really, really
huge. Inevitably, these lifters will reach a
point in their training career where they
begin to wonder exactly how big they
could get if they absolutely maximized
their natural potential. People have pro-
posed several ways to estimate a lifter’s
genetic limit for lean mass gains, using
tools such as a variety of online calcula-
tors, multiple joint and bone measure-
ments, the ratio of muscle to bone, and
fat-free mass index (FFMI). The beauty
of FFMI is that it is remarkably easy to
calculate, using very common measure-
ments that are hard to mess up.
In 1995, Kouri et al (2) published
a study assessing FFMI in resis-
tance-trained males, both with and
without a history of steroid use. The au-
thors noticed that their drug-free lift-
ers all had values below 25 kg/m2, while
many of the steroid users had values well
above 25. Based on this information, it
was implied that values above 25 might
be considered a “red flag” with regard to
steroid use. In the online fitness world,
the idea of a “natural limit” of 25 became
law, despite the very, very notable lim-
itations of the Kouri study (for example,
aiming to determine the upper limits of
human potential based on 74 commer-
cial gym-goers).
Unfortunately, the FFMI literature has
been male-dominated to date, and there
hasn’t been as much public discourse re-
garding a proposed upper limit for female
muscularity. The current study sought
to characterize FFMI values in a wide
range of sports, and to provide a prelim-
inary estimate of the FFMI upper lim-
it for female athletes. Results indicated
that FFMI differed between sports and
was positively associated with indices of
bone health. Most surprisingly, at least
three participants had values above 25,
with a maximal recorded value of 27.2!

41
This article will discuss what these num-
bers tell us about FFMI upper limits for
both males and females, and how to use
FFMI to guide your next bulking phase.
Purpose and Hypotheses
Purpose
The authors stated that they had three
central purposes; to report sport-spe-
cific norms for FFMI in female ath-
letes, to determine if these values dif-
fered between sports, and to estimate
an “upper limit” for FFMI in female
athletes.
Hypotheses
The authors hypothesized that FFMI
values would significantly differ be-
tween sports, with particularly low val-
ues expected in sports that they con-
sidered to be “weight-sensitive.” Such
sports included cross country, gymnas-
tics, dance, swimming and diving, syn-
chronized swimming, wrestling, and
weightlifting.
Subjects and Methods
Subjects
This study sampled 372 female colle-
giate athletes, representing a wide range
of sports. Table 1 shows the general de-
scriptive characteristics of the sample.
Table 1 Body composition variables of
subjects in the current study (1)
Mean ± SD
Height (cm) 167.55 ± 7.50
Weight (kg) 69.46 ± 13.04
BF % 24.18 ± 5.48
FM (kg) 17.50 ± 7.18
FFM (kg) (w/ BMC) 52.93 ± 7.38
BMC (g) 2543.79 ± 364.77
BMD (g/cm3) 1.204 ± 0.096
SD = standard deviation; cm = centimeters; kg = kilograms;
BF% = body fat percentage (using DEXA);
FM = fat mass (using DEXA);
FFM = fat-free mass (using DEXA);
BMC = bone mineral content; g = grams;
BMD = bone mineral density
Design
This study featured a very simple
design: recruit a big group of ath-
letes, measure body composition us-
ing dual-energy x-ray absorptiometry
(DEXA), then crunch some num-
bers. The researchers followed typical
pre-visit guidelines for DEXA mea-
surements, but weren’t able to stan-
dardize menstrual cycle phase or com-
petitive season (in-competition or
off-season). These aren’t particularly
critical details, and they are extremely
understandable, as studying collegiate
athletes is extremely difficult from a
logistical perspective.
42
 Table 2 Fat-free mass index values for each sport (1)

Sport N FFMI Range

Cross country 11 16.56 ± 1.14c,d 14.71 - 18.58

Gymnastics 35 18.62 ±1.12d 16.16 - 20.84

Dance 2 17.86 ± 1.17 17.03 - 18.68

Swim & dive 31 18.16 ± 1.67d 15.86 - 22.77

Synchronized swimming 29 17.27 ± 1.47c,d 15.07 - 20.68

Wrestling 19 19.15 ± 2.47a,b 15.04 - 24.45

Olympic weightlifting 15 19.69 ± 1.98a,b 17.19 - 23.84

22 18.98 ± 2.50a 15.27 - 24.38

Basketball 20 18.64 ± 1.87 15.96 - 22.37

Ice hockey 16 17.96 ± 1.04d 16.22 - 19.76

Lacrosse 40 18.58 ± 1.84d 15.94 - 26.35

Rugby 99 20.09 ± 2.23a,b 15.73 - 27.20

Volleyball 20 18.04 ± 1.13d 15.35 - 20.72

Water polo 13 18.35 ± 1.92 14.85 - 22.85

Total† 372 18.82 ± 2.08 14.71 - 27.20

All FFMIRaw data is presented as mean ± SD

a = significantly different from cross country (p < 0.05)
b = significantly different from synchronized swimming (p < 0.05)
c = significantly different from olympic weightlifting (p < 0.05)
d = significantly different from rugby (p < 0.05)
† = significant difference between sports (p < 0.001)

After the scans were done, FFMI was
calculated using the following equa-
tion:
Total lean mass (kg) + Total bone mineral content (kg)
(Height [m])2
For statistics, they were interested in
reporting “typical” FFMI ranges for
each sport, comparing between sports,
and assessing correlations between
FFMI and markers of bone health.
A Note On Height Adjustments
If you check out the original paper,
you’ll see that they applied a couple of
different height adjustments to their
FFMI values. One adjustment equa-
tion was derived from a previous study

43
 Figure 1 Fat-free mass index values for each sport

30

25
FFMI

20

15

10
Cross country

Gymnastics

Dance

Swimming & dive

Synchronized
swimming

Wrestling

weightlifting

Track

Basketball

Ice hockey

Lacrosse

Rugby

Volleyball

Water polo

Total combined
Olympic

Sport

FFMI values for each sport. The top and bottom of each box represent the maximum and minimum, while the middle bar represents
the mean value observed for that sport.

by Kouri et al (2), and the other was tweaking the exponent in the denom-
derived from a study my colleagues inator, with the “ideal” value probably
and I published in 2017 (3). The gen- falling somewhere around the 2.4-2.6
eral premise for height correction is range, but the most common approach
that FFMI, if not adjusted, tends to is to use regression-based mathemati-
be a bit biased, with higher values ob- cal adjustments.
served in taller individuals. Gains in In this study, the authors found vir-
body mass don’t perfectly scale with tually no relationship between height
height squared, and if we were to cube and FFMI. This is probably related to
height instead of squaring it in the the fact that not every athlete in the
FFMI equation, that would lead to an sample was necessarily trying to get as
over-correction. You could probably big as possible, as certain sports tend to
roughly account for this height bias by

44
 Table 3 FFMI
sports combined

All Sports Weight-sensitive sports Other sports

Percentile FFMI (kg/m2) FFMI (kg/m2) FFMI (kg/m2)

5 15.96 15.71 16.21

10 16.38 16.11 16.95

15 16.92 16.35 17.24

20 17.20 16.78 17.51

30 17.63 17.19 17.83

40 18.10 17.63 18.41

50 18.52 18.14 18.72

60 18.93 18.52 19.23

70 19.55 18.94 19.91

80 20.26 19.65 20.71

90 21.52 20.65 22.16

self-select and reinforce specific height
and body composition characteristics.
So, for this study, the authors (wisely)
ditched the height-adjusted values.
Findings
Table 2 shows the exact breakdown
of FFMI values by sport. That’s a large
amount of numbers, so the same data are
presented graphically in Figure 1, which
is a little easier on the eyes. Finally, Ta-
ble 3 presents some percentile ranges
for all sports combined, in addition to
separate values for weight-sensitive and
non-weight-sensitive sports. The au-
thors reported that the 97.5th percentile
value was 23.9, which was operationally
defined as the “upper threshold,” or the
upper limit that most female athletes can
realistically shoot for. The lowest ob-
served value was 14.7, and the highest

45
was 27.2. In addition, FFMI was posi-
tively correlated with both bone mineral
content (r = 0.53, p < 0.001) and bone
mineral density (r = 0.46, p < 0.001).
Interpretation
I want to focus the majority of this dis-
cussion on the concept of using FFMI
to establish upper limits for musculari-
ty, but first I want to address the other
results of this paper. The authors found,
unsurprisingly, that FFMI differed
among sports. This isn’t shocking, but it’s
still helpful to actually quantify patterns
that we know to be true. I used to do
a bunch of research on college athletes
that involved muscle ultrasound scans.
One day, a fellow researcher walked by
and whispered, jokingly, “Do you real-
ly need an ultrasound to know if you’re
looking at an athlete?” Point taken, but
there’s value in building a quantifiable
profile for athletes on a sport-by-sport
(or even position-by-position) basis,
as it allows us to understand the body
composition metrics that appear to be
associated with high-level performance
and injury reduction.
Along those lines, the authors found
that FFMI was correlated with bone
mineral density. This is pretty notable
for female athletes in weight-sensitive
sports, in which bone (and other) inju-
ries are quite prevalent. We’ve known
for a while that low energy availability
(as discussed in three previous MASS
THESE RESULTS SUGGEST
THAT IT’S NOT PARTICULARLY
ATYPICAL FOR FEMALES TO
ACHIEVE FFMI VALUES WELL INTO
THE MID-20S, AND IF IT ONLY
TOOK A FEW HUNDRED PEOPLE
TO OBSERVE A VALUE OVER
27, YOU CAN BE CERTAIN THAT
THERE ARE PLENTY OF DRUG-
FREE FEMALES OUT THERE
WITH VALUES COMFORTABLY
HIGHER THAN THAT.
articles by Mike, Eric Helms, and I)
can lead to both performance and injury
issues in athletes, and this seems to be
particularly prevalent in female athletes
(4).
We also know that disordered eating
is a common concern in female colle-
giate athletes, and researchers and prac-
titioners use extremely careful language
when discussing body composition with
this population. This study is admittedly
a bit dated, but researchers in the 1980s
surveyed 42 female collegiate gymnasts,
and found that 28 of them were told by
46

FFMI CAN BE USEFUL FOR
PLANNING PURPOSES.
HOWEVER, IT’S REALLY
IMPORTANT TO REMEMBER
WHAT FFMI IS NOT GOOD FOR:
IMPOSING LIMITS ON YOURSELF
AND MAKING BASELESS
STEROID ACCUSATIONS.
a coach that they were too heavy, and 21
of these 28 were using at least one un-
healthy weight-control behavior (5). So,
while these initial FFMI findings might
seem obvious, they give researchers and
coaches a body composition metric,
which likely relates to both performance
and injury risk, that isn’t fat-focused. As
a result, they can more readily discuss
objective, performance-oriented body
composition goals with their athletes
without dwelling on fat mass, which is
pretty useful.
The “maximum limit” for fat-free mass
index
As I mentioned in the introduction, a
large segment of the online fitness world
has long viewed 25 as the maximal up-
per limit for a natural, male lifter. So, if
you were above 25, you weren’t natural.
In 2017, I published a paper showing
that FFMI values exceeding 25 were
not only possible, but pretty common,
in high-level American football players.
In fact, 31.3% of the Division I players
exceeded 25, and we observed several
individuals above 28. Some people were
pretty bothered by the finding, and sug-
gested that the study was no more than
evidence of rampant steroid use. I dis-
agreed then, and I still do. But now, as
we’ll discuss, there’s even more evidence
to support my contention.
As a reminder, the conclusions of the
Kouri paper (2) rested on shaky ground
all along. They sampled only 74 males
from commercial gyms, and their inclu-
sion criteria only required that subjects
had been lifting for at least two years. If
you train at a standard commercial gym,
take a look around. Excluding the peo-
ple who have ever used steroids, select
74 guys. Do you think you’ve isolated
the upper and lower boundaries of hu-
man potential for any measurable char-
acteristic?
The other aspect of the Kouri paper in-
volved estimating FFMI of Mr. America
winners from 1939-1959. They selected
this time range because they felt it was
still plausible to believe that the compet-
itors had not yet started using anabolics.
I don’t feel comfortable using this data to
support or challenge any hypothesis, be-
cause body composition was essentially
determined by educated guesses. None-
47
theless, there were several Mr. America
winners that were comfortably above 25,
and those physiques were built using the
limited training- and nutrition-relat-
ed knowledge and resources that were
available over 60 years ago.
Overall, there’s just never been strong
evidence to suggest that a male can-
not exceed 25, but there was still some
pushback from reporting values above
25 in high-level male athletes. The pres-
ent study has reported values above 25
in females, so I would imagine there are
at least a few people losing their minds
over it.
Upper thresholds for fat-free mass index
in females
The current study recruited a sample
that was likely to contain some pretty
muscular females. They got a big group
of people (n = 372), and they were sure
to include sports that reward strength
and power, such as wrestling, Olympic
weightlifting, and rugby. In fact, they
found 99 female collegiate rugby play-
ers, which is a surprisingly huge number
based on the sample sizes for all other
sports. The biggest rugby player clocked
in with an FFMI of 27.2, but high values
weren’t restricted to the rugby players. A
lacrosse player had a value of 26.35, and
there were also individual values above
24 for the wrestling and track & field
teams. These values might seem high,
but my colleagues and I reported simi-
lar data from female collegiate athletes
in a recent study (6). Our study featured
a smaller sample size (266 versus 372),
and a different selection of sports, so
one wouldn’t expect our values to line
up perfectly. However, we also reported
a female with a value over 25, and sev-
eral individuals above 20. These results
suggest that it’s not particularly atypical
for females to achieve FFMI values well
into the mid-20s, and if it only took a
few hundred people to observe a value
over 27, you can be certain that there
are plenty of drug-free females out there
with values comfortably higher than
that.
Upper thresholds for fat-free mass index
in males
As I mentioned previously, our study
in football players found a large number
of males with an FFMI over 25 (3), and
the 97.5th percentile cut-off was 28.1.
The authors of the current study (1)
recently published a very similar study
in 209 male collegiate athletes (7), and
their results line up quite nicely with
our reported findings. Just by a visual
estimate from their figures, it looks like
they had three male athletes at or above
~29, and one of them was comfortably
above 30. For their entire sample, which
included several sports that place min-
imal value on attaining maximal levels
of lean mass (such as cross country, golf,
and swimming), the 97.5th percentile
was 28.3. Finally, a 2018 study (8) sam-
pled 95 large male athletes competing in
48
American football, powerlifting, Sumo,
or shot put, for the purpose of deter-
mining upper limits for muscularity. The
results indicated that the average FFMI
value was slightly over 25, there were
numerous athletes with FFMIs well
above 25, and a handful of athletes had
values above 30. So, based on the three
most recent studies in resistance-trained
males, it seems like you don’t have to look
extremely hard to find drug-free males
in the high 20s. Frankly, this shouldn’t
be shocking; a 1999 study on 36 Sumo
wrestlers included two subjects with
FFMIs above 36, and the authors found
that an FFMI of >30 tended to separate
the elite Sumo wrestlers from their sub-
elite counterparts (9).
Using fat-free mass index
Fat-free mass index can be really use-
ful, but there are a couple of things it
should not be used for. If you read our
study from back in 2017, you’ll see that
we aimed to report the 97.5th percentile
observed, rather than identify a univer-
sal “maximum limit.” The value was not
intended to be the maximum value pos-
sible, but rather an upper threshold that
most people could feasibly hope to aim
for, because most people are, by defini-
tion, not outliers. Along these lines, you
should not use FFMI to impose restric-
tive limits on your lifting goals, and you
definitely shouldn’t use FFMI to make
baseless steroid accusations about oth-
ers. We simply don’t have enough data
to know exactly how many people can
achieve the remarkable FFMIs that have
been reported in recent literature, but
you could theoretically be one of them,
and so could the random jacked person
that everyone accuses of being on ste-
roids.
What you can use FFMI for, is to help
plan out your weight gain phases. You
can estimate the FFMI of people who
are excelling in whatever you want to
excel in, whether that’s bodybuilding,
powerlifting, or some other athletic
endeavor. You can also determine your
“ideal” offseason body-fat percentage
(BF%) or the highest body-fat percent-
age you’d be comfortable with at the
peak of your weight gain phase. You can
then plug them into the equation below,
which gives you a weight to shoot for at
the given body-fat percentage that you
chose.
FFMI x Height(m)2
BF%
100
Based on the data currently available,
it seems that values substantially over 28
are probably a stretch for a lot of males,
and values above 24 are likely a stretch
for a lot of females. However, if you have
good genetics and tend to respond well
to training, you may be able to aim high-
er.
Limitations of FFMI studies
Whenever you read a paper that in-
tends to establish normative values or
49
 APPLICATION AND TAKEAWAYS
1. It doesn’t seem particularly unusual for males to achieve FFMI values as high as
28, and for females to achieve FFMI values as high as 24. For college athletes,
the highest observed values for males and females have been ~31 and ~27.
2. The body of FFMI literature is still small, so it would be premature to say we
have a firm understanding of the natural limits of muscularity. We really need
some huge studies that include genetically gifted, exceptionally well-trained
individuals to enhance our understanding.
3. You shouldn’t use FFMI to place restrictive, arbitrary limits on yourself or to
make baseless steroid accusations about others, but you can use it as a tool to
help plan your weight gain phases.

upper limits for FFMI, there are a few
key considerations to keep in mind. It’s
certainly important to consider whether
or not steroid users were effectively ex-
cluded from participation. Many studies
measure athletes that are subject to var-
ious drug-testing procedures, but it’s al-
ways important to realistically consider
how many drug users could have theo-
retically slipped through the cracks. The
second (and most important) question
is, “Did this sample include any freaks?”
And I can assure you, I mean “freak” in
the best possible way. If we want to make
inferences about upper limits for muscu-
larity, we have to make sure the sample
is large enough and contains people who
are genetically gifted enough and well-
trained enough to at least be close to
the top end of human potential. That’s
a lofty goal, so most samples fall short,
with some falling way shorter than oth-
ers. ever, it’s really important to remember
There are also plenty of inherent limita-
tions for the use of FFMI. As we’ve dis-
cussed, it’s slightly biased toward higher
values in taller people. It fails to directly
account for differences in the density of
fat-free mass, which varies on the basis of
age, sex, race, and several other factors. It
fails to directly account for the fact that,
at least to some degree, lean mass and
fat mass are gained and lost in unison;
this is why you can find plenty of Sumo
wrestlers with values well into the mid-
30s (9), but you’re unlikely to find much
of that among a sample of contest-ready
natural bodybuilders. Finally, as noted
previously, there are several methods for
trying to estimate an individual’s genet-
ic ceiling for muscle gain, and they each
have pros and cons. Fat-free mass index
is not a perfect proxy for muscularity, but
it seems to generally get the job done.
Despite some limitations, FFMI can
be useful for planning purposes. How-
what FFMI is not good for: imposing

50
limits on yourself and making baseless
steroid accusations.

Next Steps
Fat-free mass index is pretty straight-
forward, so complex study designs ar-
en’t really needed at this time. Instead,
we need more data using large data sets,
with samples that include people who
have been hitting the weights hard for a
long time, and (ideally) some genetically
gifted lifters. As more studies like this
come out, we should continue to devel-
op a better understanding of exactly how
big the typical male or female lifter can
realistically hope to get over the course
of their lifting career.

51
References
1. Harty PS, Zabriskie HA, Stecker RA, Currier BS, Moon JM, Jagim AR, et al. Upper and lower
thresholds of fat-free mass index in a large cohort of female collegiate athletes. J Sports Sci. 2019
Oct;37(20):2381–8.
2. Kouri EM, Pope HG, Katz DL, Oliva P. Fat-free mass index in users and nonusers of anabolic-an-
drogenic steroids. Clin J Sport Med Off J Can Acad Sport Med. 1995 Oct;5(4):223–8.
3. Trexler ET, Smith-Ryan AE, Blue MNM, Schumacher RM, Mayhew JL, Mann JB, et al. Fat-Free
Mass Index in NCAA Division I and II Collegiate American Football Players. J Strength Cond Res.
2017;31(10):2719–27.
4. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC
consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med.
2018 Jun 1;52(11):687–97.
5. Rosen LW, Hough DO. Pathogenic Weight-Control Behaviors of Female College Gymnasts. Phys
Sportsmed. 1988 Sep;16(9):140–4.
6. Blue MNM, Hirsch KR, Pihoker AA, Trexler ET, Smith-Ryan AE. Normative fat-free mass index
values for a diverse sample of collegiate female athletes. J Sports Sci. 2019 Aug;37(15):1741–5.
7. Currier BS, Harty PS, Zabriskie HA, Stecker RA, Moon JM, Jagim AR, et al. Fat-Free Mass Index
in a Diverse Sample of Male Collegiate Athletes. J Strength Cond Res. 2019 Jun;33(6):1474–9.
8. Abe T, Buckner SL, Dankel SJ, Jessee MB, Mattocks KT, Mouser JG, et al. Skeletal muscle mass in
human athletes: What is the upper limit? Am J Hum Biol Off J Hum Biol Counc. 2018;30(3):e23102.
9. Hattori K, Kondo M, Abe T, Tanaka S, Fukunaga T. Hierarchical differences in body composition of
professional Sumo wrestlers. Ann Hum Biol. 1999 Apr;26(2):179–84.

52
 Study Reviewed: Anthropometrical Determinants of Deadlift Variant
Performance. Cholewa et al. (2019)

Can We Predict if You’re Better off

Deadlifting Conventional vs. Sumo?
BY G RE G NUC KO LS

There are a lot of recommendations floating around concerning whether

you should deadlift sumo or conventional based on how you’re built. In
spite of the numerous recommendations, there was no actual research on
the topic. That changed with the study reviewed in this article.

53
 KEY POINTS
1. When subjects with prior training experience, but not deadlifting experience,
maxed on the sumo and conventional deadlifts, their 1RMs were virtually identical,
on average.
2. Their reps-to-failure performance with 60% of 1RM was virtually identical for
both deadlift styles as well.
3. While people with longer torsos relative to their total height were a bit better at
sumo deadlifts (and vice versa), the strength of that relationship was weak. No
other anthropometric variable was associated with performing particularly better
with one style of deadlift over the other.

F
or as long as I can remember, I’ve standing height (people with longer tor-
seen popular posts and articles sos were more likely to perform better
claiming that you should choose in the sumo deadlift). However, even
your deadlifting style based on various that was a very weak predictor. Thus, it
anthropometric factors like arm length, seems that simple anthropometric mea-
leg length, torso length, or just overall surements aren’t equipped to predict the
height. I wouldn’t be shocked if I wrote style of deadlift that lifters will initially
such an article at some point. Howev- be best suited to.
er, these recommendations have always
been based on a conspicuous lack of data
and are often contradictory. There’s a rea- Purpose and
son for that: Until now, no one had ever
studied the effects of anthropometrics on
Hypotheses
relative performance in the conventional
Purpose
and sumo deadlifts.
The purpose of the study was to see if
The presently reviewed study (1) mea-
any combination of body segment lengths
sured a slew of body segment lengths
could predict whether people would per-
and 1RM conventional and sumo dead-
form better in the sumo or conventional
lift strength in a sample of young sub-
deadlift.
jects who had prior training experience,
but no prior deadlifting experience. The
Hypotheses
only statistically significant predictor
of performing better in one style or the The authors hypothesized that sub-
other was the ratio of sitting height to jects with longer relative arm length and

54
shorter relative femur lengths would per-
form better in the conventional deadlift
than the sumo deadlift.
Subjects and Methods
Subjects
The subjects were 47 young lifters (28
males and 19 females) with some de-
gree of training experience, who did not
deadlift as part of their training routine.
This population was chosen because
the authors wanted subjects who could
quickly learn both the sumo and conven-
tional deadlifts, but whose performance
in both lifts would not be influenced by
prior experience with either lift. More
details can be seen in Table 1.
Experimental Design
Testing took place over four days. On
the first day, the researchers took an-
thropometric measurements and taught
the subjects how to correctly perform
unloaded conventional and sumo dead-
lifts. The anthropometric measurements
taken were as follows: standing height,
body mass, upper arm length, forearm
length, wrist girth, hand length, seated
height, torso height, upper leg length,
lower leg length, and ankle girth.
During the second day, the subjects
performed counter-movement jumps
for maximum height and maximum
crunches in one minute first (to see if
explosiveness or anterior core strength
Table 1 Participants characteristics
Sex (n)
Male (28); Female (19)
Height (m) 1.73 ± 0.09
Weight (kg) 77.6 ± 21.0
Age (years) 21.7 ± 3.0
Resistance training
experience (months)
11.0 ± 14.3
would be significant predictors), fol-
lowed by loaded sumo and conventional
deadlifts. After the subjects warmed up,
they performed their deadlifts for sets of
2 reps while the researchers added 5-10
kg per set. They reported their estimated
reps in reserve after each set, and the re-
searchers cut them off once they report-
ed four reps in reserve. This process was
repeated for both deadlifting styles and
was used to give the researchers an idea
of the sorts of 1RM numbers to expect
from the subjects.
During the third and fourth days
(which were both preceded by at least
48 hours without exercise), the subjects
worked up to a 1RM deadlift with ei-
ther the sumo or conventional deadlift
technique. The variant they performed
on the third day was determined by flip-
ping a coin. After the 1RM was achieved
(defined as a technical max; testing was
cut off when the lifters could no longer
maintain a neutral spine), the subjects
rested for 5 minutes and performed one
set to failure at 60% of their day 3 1RM
(they used the same load for days three
and four, even if the subjects recorded
55
 Table 2 Overview of study protocol
Day 1 Day 2
Anthropometrics Loaded deadlift training
Unloaded deadlift training
different 1RMs on both days). They did
all of the reps with a 1-2 second con-
centric and a 1-2 second eccentric tem-
po. The set was terminated when the
subjects could no longer maintain their
technique, or when they could no longer
maintain the required tempo. For both
the 1RMs and the sets to failure at 60%
1RM, straps were allowed so that the
subjects would not be limited by their
grip.
Findings
The subjects had similar sumo and con-
ventional deadlift 1RMs (116.4 ± 36.5
for sumo, and 115.6 ± 35.5 for conven-
tional). Reps to failure with 60% of the
day 3 1RM were also similar with both
variations (20.8 ± 6.4 reps for sumo, and
20.7 ± 8.9 for conventional).
There was a weak, albeit significant,
positive correlation between the subjects’
sitting height to standing height ratio
and sumo to conventional deadlift ratio
(r = 0.297; p = 0.043). In other words,
subjects who had longer torsos relative
Day 3 (at least 48 hours after Day 4 (at least 48 hours after
Day 2) Day 3)
Lift style randomly assigned Deadlift 1RM test
Deadlift repetitions to fatigue
Deadlift 1RM test
with 60% of Day 3’s 1RM
Deadlift repetitions to fatigue
with 60% 1RM
to their total height were more like-
ly to perform better in the sumo than
the conventional deadlift. Nothing else
was a significant predictor, and as you
can see in Figure 1, sitting to standing
height ratio wasn’t a very strong predic-
tor either.
Interpretation
As with any study, this present study
had both strengths and weaknesses. The
study population wasn’t perfect, but it
was probably the best population that
one could feasibly recruit. Since they
did have some prior training experience,
they were likely able to attain pretty de-
cent deadlifting technique with two fa-
miliarization sessions (since the deadlift
isn’t a horribly complex lift), but their
lack of prior deadlifting experience
would mean that they weren’t way bet-
ter at one technique or the other simply
due to the specificity of previous dead-
lift training. A perfect population for
this sort of study would be a cohort of
lifters who were highly trained in both
56
the sumo and the conventional dead-
lift, with similar amounts of experience
with both variations, but that would be
an incredibly hard population of people
to find and recruit for a study. However,
it’s possible (likely, even) that the con-
ventional:sumo deadlift strength ratio
that someone displays the first time they
try the lifts isn’t perfectly representative
of what their conventional:sumo dead-
lift strength ratio would be if they spent
a few years training both lifts. Thus, I
think this study was designed to answer
a question like, “the first time someone
tries deadlifting, which deadlift style
should they try first, based on their an-
thropometry?” rather than, “what dead-
lift style is going to be the strongest for
someone in the long run, based on their
anthropometry?”
However, even with that limitation,
this study is a valuable addition to the
literature. Since 2010, the recommen-
dation has been floating around in the
literature (2) that people with longer
arms should do conventional deadlifts,
and people with shorter arms should
do sumo deadlifts. I’ve seen quite a few
people cite that paper as scientific evi-
dence for the proposal that deadlift style
should be based on arm length, but it’s
important to note that the 2010 paper
was simply providing an overview of the
deadlift and giving recommendations
(some based on actual data, and some
based on the author’s logic or anecdotal
experience); the recommendation that
Table 3 Performance results
Sumo deadlift (kg) 116.4 ± 35.6
Conventional deadlift (kg) 115.6 ± 35.5
Sumo deadlift repetitions to
20.8 ± 6.4
fatigue
Conventional deadlift
repetitions to fatigue
20.7 ± 8.9
people choose their deadlift style based
on arm length wasn’t actually based on
any data, as far as I can tell. Thus, this is
the first and only study that has actual-
ly investigated whether anthropometrics
influence whether someone will be rela-
tively better at the conventional or sumo
deadlift.
In terms of the actual results, I feel
pretty confident saying that this study
found no meaningful predictors of rel-
ative performance between the deadlift-
ing styles. The sitting:standing height ra-
tio correlation was weak, and as you can
see from the actual figure, any prediction
one tried to derive would be incredibly
tenuous (and that was the strongest cor-
relation); it explained less than 9% of the
variance in the sumo:conventional 1RM
ratio.
Now, that doesn’t mean that nothing
predicts the style of deadlift one will be
best-suited to. If I had to hazard a guess,
I wouldn’t be surprised if greater hip ab-
duction range of motion was a positive
predictor of greater relative performance
57
 Table 4 Correlations (r) between anthropometric predictors and the
sumo to conventional deadlift ratio

Predictor Pearson correlation p-value

Arm to height ratio 0.037 0.807

Arm to sitting height ratio -0.088 0.556

Thigh to height ratio -0.093 0.533

Lower leg to thigh ratio -0.015 0.920

Lower leg to height ratio -0.182 0.220

Sitting height to height ratio 0.297 0.043

Abdominal crunches 0.156 0.296

Counter movement jump 0.025 0.871

in the sumo deadlift, for example. Fur-
thermore, body mass seem to be a pre-
dictor, at least among elite powerlifters,
with more lightweight lifters of both
sexes favoring sumo deadlifts. Howev-
er, I think your best bet for determining
the deadlift style you’re best-suited to is
simply training both sumo and conven-
tional deadlift, and seeing which one im-
proves in strength the fastest. Or, if you
don’t aim to compete in powerlifting,
you could instead choose your primary
deadlift style based on comfort once you
get plenty of reps under your belt with
both styles (your strongest technique
may or may not be your most comfort-
able technique). You can’t just take some
body segment measurements and come
away with a good prediction.
I’d like to make clear that while anthro-
pometrics don’t predict which style of
deadlift someone will be best-suited to,
anthropometrics should be at least some-
what predictive of deadlift performance
overall. Namely, long arms relative to to-
tal height should predispose someone to
being a good deadlifter, simply because
long arms decrease your range of motion

58
 Figure 1 Correlation between sitting to standing height ratio and sumo to conventional deadlift ratio

1.25
r = 0.297 p = 0.043
1.2
Ratio of sumo deadlift 1RM to

1.15
conventional deadlift 1RM

1.1

1.05

0.95

0.9

0.85

0.8
0.45 0.47 0.49 0.51 0.53 0.55 0.57

Ratio of sitting height to standing height

at the bottom of the lift, and most peo- pick as good of parents are generally
ple are weakest near the floor. However, pretty weak at both lifts, with anthro-
I would bet that even relative arm length pometrics playing a much smaller inde-
is a fairly weak predictor of overall dead- pendent role.
lift strength. Just as relatively long arms Finally, I’d just like to make it clear
should help the deadlift, they should that while average 1RMs were similar
hinder performance in the bench press. for both styles of deadlift, the spread of
However, among competitive powerlift- individual performances in favor of one
ers, there’s a moderately strong correla- style or the other was quite large. Most
tion (r ~ 0.70) between bench press and subjects performed pretty similarly in
deadlift performance – in other words, both deadlift styles (within about 5% or
even for lifts that are helped and hin- so), but one subject pulled almost 20%
dered by completely different anthro- more sumo than conventional, and sev-
pometric factors, people who are high- eral subjects pulled more than 10% more
ly trained and have a propensity to be conventional than sumo. MASS readers
strong are generally pretty good at both, should be savvy enough to know that
and people who are less trained or didn’t we can’t always (or can’t generally) map

59
 APPLICATION AND TAKEAWAYS
For the time being, I still don’t think there are any incredibly strong predictors of
which deadlift style you’re best suited to. Your best bet is to spend time training
both, and letting your performance and comfort tell you which style suits you best.

group averages onto individuals, but

since this study showed each individual
data point, it allows for a nice illustra-
tion of this crucial point.

Next Steps
The ideal study would be the one I pro-
posed at the start of the interpretation
section: Run the same study on a pop-
ulation of people who train both styles
of deadlift equally. In that study, more
measures could be added, such as hip
abduction range of motion. Single-joint
strength measures would also add to
the study, to see if relative joint-level
strength is predictive of performing bet-
ter with one deadlift style over the other
(i.e. if people with stronger quads rela-
tive to their hip extensors are relative-
ly better at sumo deadlifts, or if people
with stronger spinal erectors relative to
their hip extensors are relatively better at
conventional deadlifts).

60
References
1. Cholewa JM, Atalag O, Zinchenko A, Johnson K, Henselmans M. Anthropometrical Determinants
of Deadlift Variant Performance. J Sports Sci Med. 2019 Aug 1;18(3):448-453.
2. Hales M. Improving the Deadlift: Understanding Biomechanical Constraints and Physiological
Adaptations to Resistance Exercise. Strength Cond Jour. 2010 Aug;32(4):44-51.

61
 Study Reviewed: Cooling During Exercise Enhances
Performances, but the Cooled Areas Matter. A Systematic
Review with Meta-Analyses. Douzi et al. (2019)

Be Cool … Literally
BY MIC HAE L C . ZO URD O S

Sitting in a vest with crushed ice and drinking a below-0 degree Celsius
beverage has been investigated as a method to improve exercise
performance. Does it actually work? A new meta-analysis provides us
with answers.

62
 KEY POINTS
1. This meta-analysis examined if cooling the body during both aerobic and anaerobic
exercise can significantly increase performance.
2. The results showed a moderate effect for cooling to improve aerobic exercise
performance and a small effect for cooling to improve anaerobic performance;
however, none of the anaerobic studies were on resistance training.
3. Importantly, the results showed that for cooling to be effective for anaerobic
performance, the ambient temperature must already be hot. Further, while this
meta-analysis did not include resistance training studies, the resistance training
data that does exist is promising.

I
f you see someone wearing a cool-
ing vest or chugging ice-cold water
before or during training, they may
not be setting a new fashion trend or be
crazy thirsty. Rather, this person may be
purposefully cooling their body. Cool-
ing the body before exercise (pre-cool-
ing) or during exercise (per-cooling) has
been shown to improve performance,
especially when ambient temperatures
are high (2). However, data have shown
that endurance exercise performance has
been improved with body-cooling even
when ambient temperatures were fairly
normal (25ºC) (3). This article exam-
ines a meta-analysis (1) that evaluated
the effects of per-cooling on both aero-
bic and anaerobic exercise performance.
The results indicated that per-cooling
had a significant (p<0.001) and moder-
ate effect (effect size = 0.60) to improve
performance versus no cooling for aero-
bic performance across 36 studies. Only
9 studies were included for anaerobic
performance; however, the data did in-
dicate a small but significant benefit for
per-cooling (effect size = 0.27) versus
no cooling for anaerobic performance.
This meta-analysis also examined which
cooling techniques were most effective,
what areas of the body should be cooled,
sex differences, training status, and what
magnitude cooling should be used. This
article brings about a new topic for
MASS; thus, we will cover each of the
above points to provide a practical guide
for how to use per-cooling.
Purpose and Research
Questions
Purpose
The purpose of this meta-analysis was
to examine the effects of per-cooling on
both aerobic and anaerobic exercise per-
formance. The meta-analysis also eval-
uated different methods of cooling and
what areas of the body should be cooled.

63
 Table 1 Systematic review inclusion criteria

Study applied cooling during exercise and described the cooling technique and
1
application site of cooling

The cooling technique had to reduce body temperature (i.e. a cooling vest or cooling
2
drink) or cause a cooling sensation (i.e. water spray)

Study was a crossover design with one condition being per-cooling and the other being
4
no cooling

Meta-analysis inclusion criteria from Douzi et al. 2019 (1)

Hypotheses per-cooling studies.

No hypothesis was given, as is custom-
ary in a meta-analysis.
Subjects and Methods
Study Inclusion
As I’m sure everyone knows, a me-
ta-analysis does not have its own sub-
jects; rather, it analyzes data from all
of the independent studies that fit its
criteria to determine the overarching
findings on a topic. To be included in
this meta-analysis, the individual stud-
ies had to meet the criteria listed in Ta-
ble 1.
Studies that did not satisfy all crite-
ria in Table 1 were excluded. For exam-
ple, if a study was a crossover design,
but used pre-cooling, it was excluded
since the meta-analysis only looked at
In addition to just determining if
per-cooling was effective for both aero-
bic and anaerobic performance, the au-
thors of the meta-analysis also examined
the following related to per-cooling: 1)
sex differences, 2) influence of training
status, 3) aerobic versus anaerobic ex-
ercise, 4) type of cooling methods, 5)
most effective site of cooling, 6) com-
paring cooling in both hot (>28ºC) and
temperate (22-28ºC) ambient condi-
tions.
A total of 45 studies were included. 36
studies examined aerobic exercise, and
9 examined anaerobic exercise perfor-
mance. Studies were classified as aero-
bic if the duration of the performance
task was ≥ 76 seconds, and studies were
anaerobic if the performance task was
<76 seconds.

64
 Table 2
3
to be the best methods of per-cooling.
4 Decreasing skin temperature about 2ºC is preferable.
2
already high.
4 Decreasing skin temperature about 2.5ºC is preferable.
Findings
A summary of the main findings is in
Table 2.
Aerobic Exercise
Overall, per-cooling significantly im-
proved aerobic exercise performance
(effect size = 0.60) with no difference
between the sexes or for training sta-
tus for per-cooling benefits (p > 0.05).
Importantly, per-cooling was effective
when the ambient temperature was both
high (33.4 ± 3.4ºC, effect size = 0.57)
and temperate (23.4 ± 2.4ºC, effect size
= 0.86), although the finding for tem-
perate conditions is only based on three
studies. Cooling parts of the body (i.e.
head and neck) and fluid ingestion (i.e.
ice slurry) aided performance; however,
cooling the entire body, surprisingly, did
not significantly augment performance
versus no cooling. The average decreases
in skin temperature and core tempera-
ture were 2.1 ± 0.4ºC and 1.0 ± 0.7ºC,
respectively. The exercise duration of
65
the 36 aerobic studies ranged from 10
minutes to 90 minutes (average = 45.0 ±
25.3 min).
Anaerobic Exercise
Per-cooling had a small but significant
benefit for anaerobic performance (effect
size = 0.27) without any differences be-
tween the sexes or for people of different
training status. Dissimilar from aerobic
exercise, only whole-body cooling gar-
ments showed a significant performance
improvement, and cooling only helped
anaerobic performance in hot condi-
tions (>28ºC). The average decreases in
skin temperature and core temperature
were 2.6 ± 1.1ºC and 1.3 ± 1.0ºC, re-
spectively. The exercise duration of the 9
anaerobic studies ranged from 5 seconds
to 69 seconds (average = 21.3 ± 21.6 sec-
onds). Importantly, no anaerobic studies
included were on resistance training;
rather, these studies involved mostly
intermittent sprint exercise. However,
studies examining per-cooling’s effects
on resistance training do exist, and we
will elaborate on that data in this arti-
cle’s interpretation.
Aerobic vs. Anaerobic
As you might expect after reading the
above, the authors reported a statistically
greater benefit of per-cooling for aerobic
exercise compared to anaerobic exercise
(p<0.01).
Interpretation
I was excited when seeing this title
since this is a new topic for MASS. The
quick rehash of the findings is that cool-
ing the body during exercise is helpful
for both aerobic and anaerobic perfor-
mance. However, there is much more to
discuss, including: the method and area
of cooling, how long and how much to
cool the body, and – of course – what
mechanism is driving performance ben-
efits. Since this is a new topic for MASS,
we will keep the interpretation simple
and clarify each point raised above so
that you have an idea of how to actually
implement this. Further, we will discuss
the studies on lifting that exist but were
not included in this meta-analysis.
What Methods are Used to Cool?
We can divide cooling methods into
two main types. The first is external cool-
ing, which is typically accomplished by
wearing a cooling vest or garment, but
could also occur using air ventilation or
water spray. There’s also internal cooling,
which is ingesting a very cold beverage
(-1ºC to 4ºC), usually an ice slurry or
ice-cold water. When a beverage is used,
it is typically ingested ~6.5oz at a time
intermittently throughout long duration
exercise. Indeed, Riera et al (4) found an
ice slurry to improve performance versus
no cooling when ~6.5oz were ingested
every 5km during a 20km cycling time
trial. Although the ice slurry is used in-
termittently, the external cooling meth-
66
ods are usually applied for the totality of
aerobic exercise.
For anaerobic exercise, no study to date
has used cold beverage consumption.
For the external strategies, the cooling
vests are typically filled with crushed
ice, while cooling garments can be filled
with cold water and then sealed closed.
Oftentimes, research will use garments
that only cover one portion of the body.
For example, the current meta-analysis
found that cooled neck collars were ef-
fective at improving aerobic exercise per-
formance. For anaerobic performance,
although there was a significant benefit
for cooling, it is important to note that
only whole-body cooling garments im-
proved performance. The anaerobic re-
sults are only based on nine studies, so
it is possible that other methods or sites
of application are effective and we just
don’t know yet. In most studies, the ex-
ternal cooling garments have been used
both during recovery periods only (5) or
during the totality of exercise (6). Fur-
ther, this meta-analysis (1) reported an
average decrease in skin temperature of
2.6ºC and decrease in core temperature
of 1.3ºC across all anaerobic studies,
so as long as you follow the guidelines
above, then you can likely expect about
those changes in skin temperature.
Hot vs. Temperate Ambient Conditions
According to the meta-analysis, aero-
bic exercise performance was improved
in both hot and temperate conditions
with per-cooling. However, anaerobic
exercise performance only benefited
from per-cooling in hot temperatures
(>28ºC). I do think there is some ap-
plication to lifting since it’s not too un-
common to train in hot conditions. Any
other non-air conditioned garage gym
lifters in hot climates out there? Not
to mention, not all gyms have air con-
ditioning, and if you train at a CrossFit
gym, then you likely train in the heat too
and might consider per-cooling.
The Lifting Data
Even though no resistance training
studies were included in this meta-anal-
ysis, lifting studies do exist. In fact, a
recent systematic review from Latella
et al (7) included six per-cooling resis-
tance training studies and noted that
four of those studies showed enhanced
resistance training performance of some
kind when cooling the body between
sets. Specifically, Bacon et al (8) found
that rock climbers performed more reps
across multiple sets of pullups when ice
bags were put on the upper body between
sets; however, in this study, the rest pe-
riods were 17 minutes, which is incon-
sistent with real-world training. Galo-
za et al (9) observed men with at least
one year of training experience perform
~21% more reps over 4 sets of preach-
er curls at 70% of 1RM when ice bags
were put on the subjects’ biceps during
one-minute interset rest intervals. How-
ever, the Galoza study was not a cross-
67
over design, as two groups (cooling and
control) were used; this is why it couldn’t
be included in the present meta-analy-
sis. Interestingly, multiple studies (10,
11, 12, 13) have shown cooling only the
palms to improve resistance exercise
performance, which is inconsistent with
the meta-analysis conclusions that cool-
ing the whole body is the best way to go
to improve anaerobic performance. Spe-
cifically, Kwon et al 2010 (10) reported
that trained men performed more reps
over four sets of bench press at 85% of
1RM when cooling the palms between
sets versus no cooling in a crossover
design. Five years later, Kwon and col-
leagues completed a similar study in
women and found palm cooling to lead
to greater reps performed on the bench
press at 85% of 1RM when compared
to heating; however, no control con-
dition was used in the study on wom-
en (11). In the Kwan studies, the palm
was cooled during three-minute rest
intervals using a hand cooling device
that was set to 10ºC, and the ambient
conditions were temperate. Similar to
the Kwon studies, Caruso et al (12) also
found palm cooling (to 15ºC) to cause
greater maintenance of power output
over four sets of leg press compared to
no cooling in temperate conditions. The
data from Caruso represents the first
study to show that cooling of the upper
extremities can improve performance
on solely lower body exercise. The most
impressive results from per-cooling on
resistance training performance come
from Grahn et al (13), who also used
palm cooling. Grahn et al found acute
bench press reps to failure to be im-
proved with interset palm cooling versus
no cooling when core temperature was
elevated to 39ºC (13). Further, in tem-
perate conditions, Grahn et al conduct-
ed multiple longitudinal protocols and
found that bench press volume capabil-
ities were increased by 40% after three
weeks and pull-up volume was increased
by 144% over two weeks compared to
no cooling when palm cooling was ap-
plied during three-minute interset rest
intervals during twice a week training
in both protocols. The Grahn study also
conducted a longitudinal trial in which
10 men benched 2 times per week for
10 weeks with no cooling between sets
for the first 4 weeks and palm cooling
between sets for the final 6 weeks. Im-
portantly, loads in this 10-week protocol
were increased based on successful com-
pletion reps in the previous week. Grahn
reported no difference in the load used
between the first and last training ses-
sions of the 4 weeks with no cooling (97
± 25 kg), but significantly greater load
used in the last session of the 6 weeks of
cooling (110 ± 27 kg) and a 22% increase
in bench press 1RM after the 10 weeks.
Therefore, the authors attributed most
(if not all) of the increase in bench press
1RM to cooling. Obviously, you can get
stronger without palm cooling, so the
longitudinal results from Grahn seem
a bit of a stretch. When considering all
of the data specifically related to lifting,
68
the results do seem pretty promising.
To summarize, the data pretty consis-
tently show cooling to improve volume
capabilities, cooling has worked in both
hot and temperate conditions for lift-
ing, palm cooling is the most common
method, ice bags on the exercising mus-
cle have also been effective, and cooling
during the interset period seems to be
the way to go.
Mechanisms and Resistance Training
Possibilities
There are three suggested mecha-
nisms for body-cooling: 1) thermoreg-
ulatory, 2) central, and 3) psychophysi-
ological (2). Thermoregulatory changes
with body-cooling manifest as reduc-
tions in skin temperature, which have
been theorized to reduce cardiovascular
strain (14). Therefore, the reduction in
cardiovascular strain makes it logical
for much of the cooling data to be on
aerobic exercise.
I think the central mechanism is most
likely to explain the mostly positive re-
sults discussed in the section above for
lifting. During lifting, core temperature
can rise quickly, and when core tem-
perature is too high (>40ºC), areas of
the brain that drive motor activation
can be inhibited (15). Indeed, Nybo et
al (15) observed that during prolonged
isometric knee extensions (>30 sec-
onds), strength was greater with a core
temperature of 38ºC versus 40ºC, and
the authors attributed the difference to
increased central nervous system fatigue
and resultant drops in motor output in
the 40-degree condition. Interesting-
ly, Siegel et al (16) found pre-training
ice slurry ingestion to lead to improved
strength on a two-minute isometric bi-
ceps test versus no cooling. However,
the main research question in Siegel’s
study was to examine body-cooling on
running performance, thus a ~40-min-
ute run was done prior to the biceps
test. These studies, along with the
Grahn et al (13) study discussed above
suggest that when core temperature can
be lowered, resistance training perfor-
mance may increase, which is consis-
tent with the proposed central mecha-
nism of per-cooling.
A less-supported mechanism behind
body cooling is the potential psycho-
physiological component, which is
to say that body cooling could affect
the interaction between the mind and
body. While a specific psychophysi-
ological mechanism has not been di-
rectly shown, it is common for studies
that see performance improvements
to also have subjects report increased
thermal sensation and satisfaction and
decreased rating of perceived exertion
during and following cooling (2).
Lastly, I understand this sounds im-
practical, but I really don’t think it is.
You can purchase a cooling vest for as
little as $30 and outfit it with ice inside
or just bring some ice packs to the gym.
Most of us spend $30 per month on
69
 APPLICATION AND TAKEAWAYS
1. This meta-analysis shows that per-cooling can augment both aerobic and anaerobic
performance.
2. For anaerobic performance, the results of the meta-analysis show that the entire
body should be cooled; however, palm cooling is the most beneficial method of
application in the available resistance training studies.
3. Core temperature can rise pretty high during resistance training, which is likely
why the available per-cooling studies on resistance training show mostly positive
results. Practically, cooling is not too hard to do, so it might be worth a shot.

supplements, and this vest would be a

one-time purchase, and ice packs would Next Steps
be even cheaper. It’s hard to outright I would like to see if the enormous ben-
recommend, but I don’t think cooling efits for cooling seen in the Grahn study
is that hard to try, and if we are looking can be replicated. A pretty straightfor-
for any edge, then body-cooling could ward design with two groups training in
be worth a shot. Although, not related temperate conditions could help. One
to per-cooling specifically, cooling the group would use palm cooling between
body consistently post-exercise (twice sets during every session, and the other
a week for 12 weeks) with cold-water group would use no cooling. If this lon-
immersion has been shown to attenuate gitudinal study does show a benefit, then
anabolic signaling and potentially blunt a follow-up to that would be to compare
the satellite cell response to training different methods of cooling.
(17), which we have written about pre-
viously. While we don’t know for sure
if this happens with consistent pre- or
per-cooling, it is necessary to note that
this has occurred over the long-term
with post-exercise cooling. In short,
there is little to no risk with cooling the
body once or every so often, but if cool-
ing is used consistently, then you could
see diminished anabolic signaling.

70
References
1. Douzi W, Dugué B, Vinches L, Al Sayed C, Halle S, Bosquet L, Dupuy O. Cooling during exercise
enhances performances, but the cooled body areas matter: A systematic review with meta‐analyses.
Scandinavian journal of medicine & science in sports. 2019 Jul 24.
2. Stevens CJ, Taylor L, Dascombe BJ. Cooling during exercise: an overlooked strategy for enhancing
endurance performance in the heat. Sports Medicine. 2017 May 1;47(5):829-41.
3. Eijsvogels TM, Bongers CC, Veltmeijer MT, Moen MH, Hopman M. Cooling during exercise in
temperate conditions: impact on performance and thermoregulation. International journal of sports
medicine. 2014 Sep;35(10):840-6.
4. Riera F, Trong TT, Sinnapah S, Hue O. Physical and perceptual cooling with beverages to increase
cycle performance in a tropical climate. PLoS One. 2014 Aug 1;9(8):e103718.
5. Duffield R, Dawson B, Bishop D, Fitzsimons M, Lawrence S. Effect of wearing an ice cooling jacket
on repeat sprint performance in warm/humid conditions. British journal of sports medicine. 2003
Apr 1;37(2):164-9.
6. Tyler CJ, Sunderland C. Cooling the neck region during exercise in the heat. Journal of athletic
training. 2011 Jan;46(1):61-8.
7. Latella C, Grgic J, Van der Westhuizen D. Effect of Interset Strategies on Acute Resistance Training
Performance and Physiological Responses: A Systematic Review. The Journal of Strength & Condi-
tioning Research. 2019 Jul 1;33:S180-93.
8. Bacon NT, Wingo JE, Richardson MT, Ryan GA, Pangallo TC, Bishop PA. Effect of two recov-
ery methods on repeated closed-handed and open-handed weight-assisted pull-ups. The Journal of
Strength & Conditioning Research. 2012 May 1;26(5):1348-52.
9. Galoza P, Sampaio-Jorge F, Machado M, Fonseca R, Silva PA. Resistance exercise inter-set cooling
strategy: effect on performance and muscle damage. International journal of sports physiology and
performance. 2011 Dec 1;6(4):580-4.
10. Kwon YS, Robergs RA, Kravitz LR, Gurney BA, Mermier CM, Schneider SM. Palm cooling delays
fatigue during high-intensity bench press exercise. Medicine & Science in Sports & Exercise. 2010
Aug 1;42(8):1557-65.
11. Kwon YS, Robergs RA, Mermier CM, Schneider SM, Gurney AB. Palm cooling and heating delays
fatigue during resistance exercise in women. The Journal of Strength & Conditioning Research. 2015
Aug 1;29(8):2261-9.
12. Caruso JF, Barbosa A, Erickson L, Edwards R, Perry R, Learmonth L, Potter WT. Intermittent
palm cooling’s impact on resistive exercise performance. International journal of sports medicine.
2015 Oct;94(10):814-21.
13. Grahn DA, Cao VH, Nguyen CM, Liu MT, Heller HC. Work volume and strength training re-
sponses to resistive exercise improve with periodic heat extraction from the palm. The Journal of
Strength & Conditioning Research. 2012 Sep 1;26(9):2558-69.
14. Lee DT, Haymes EM. Exercise duration and thermoregulatory responses after whole body precool-
ing. Journal of applied physiology. 1995 Dec 1;79(6):1971-6.

71
15. Nybo L, Nielsen B. Hyperthermia and central fatigue during prolonged exercise in humans. Journal
of applied physiology. 2001 Sep 1;91(3):1055-60.
16. Siegel R, Maté J, Watson G, Nosaka K, Laursen PB. Pre-cooling with ice slurry ingestion leads to
similar run times to exhaustion in the heat as cold water immersion. Journal of sports sciences. 2012
Jan 1;30(2):155-65.
17. Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, Cameron‐Smith D,
Coombes JS, Peake JM. Post‐exercise cold water immersion attenuates acute anabolic signalling
and long‐term adaptations in muscle to strength training. The Journal of physiology. 2015 Sep
15;593(18):4285-301.

72
 Study Reviewed: No Longer Beeting Around the Bush: A Review of Potential Sex
Differences with Dietary Nitrate Supplementation. Wickham and Spriet. (2019)

Do the Performance Effects of

Beetroot Juice and Dietary Nitrate
Differ Between Males and Females?
BY E RI C T RE X LE R

Supplements that promote nitric oxide are in just about every pre-workout
supplement on the market. Nitrate, a primary component of beetroot juice,
is a notable nitric oxide promoter that is also found in a variety of fruits and
vegetables. Several studies have reported performance benefits of dietary
nitrate for males, but there’s a considerable lack of research in females. Read
this article to find out if nitrate actually improves performance, and if this effect
is similar for both males and females.

73
 KEY POINTS
1. The body of research on dietary nitrate and beetroot juice supplementation is
growing, but there’s a glaring lack of research on female participants.
2. The current review article (1) evaluated potential sex differences and found that
nitrate generally has less pronounced effects on blood pressure and exercise
economy in females than males.
3. Nitrate has been shown to enhance strength and power, and its direct effects
on muscle contractile function are the most plausible mechanisms for these
effects. At this time, there is insufficient evidence to conclude that males enjoy
larger strength or power improvements than females. However, it is a plausible
possibility, and we need substantially more research in this area.

N
itric oxide has an interesting
history. It was discovered in the
1700s, but its role in physiology
remained unknown for a couple hun-
dred years. Then, in the 1980s, a series
of experiments showed that nitric oxide
played a critically important role in car-
diovascular physiology by inducing re-
laxation of blood vessels (2). In the years
since, it was named “Molecule of the
Year” by the prestigious journal Science,
earned a Nobel Prize for the scientists
who discovered its role in the body, and
now we find some kind of nitric oxide
precursor in just about every pre-work-
out supplement on the market.
As the supplement research has
evolved over the last few decades, it has
become clear that dietary nitrate, often
consumed as beetroot juice, is one of
the more promising nitric oxide-pro-
moting ingredients out there. Unfor-
tunately, the overwhelming majority of
the nitrate/beetroot literature focuses
on endurance exercise rather than re-
sistance exercise, so its applications for
strength athletes are poorly understood.
The literature has another glaring flaw:
very, very few studies with female par-
ticipants. The current review paper (1)
evaluated the existing literature to ex-
plore sex-based differences related to
nitrate supplementation. The authors
suggest that, compared to men, women
have higher baseline plasma nitrite and
experience larger increases in plasma
nitrate, but experience smaller reduc-
tions in blood pressure and less consis-
tent improvements in exercise economy
following nitrate supplementation.
So, does this mean that males will en-
joy performance improvements from
nitrate supplementation, and females
will miss out? Read on to find out.

74

PEOPLE OFTEN THINK OF NITRIC
OXIDE PURELY AS A BLOOD FLOW
PROMOTER, AND THINK THAT
ENHANCING “THE PUMP” IS ITS
ONLY POTENTIAL CONTRIBUTION
TO EXERCISE APPLICATIONS. IN
REALITY, NITRIC OXIDE EXERTS
A WIDE RANGE OF EFFECTS
THROUGHOUT THE BODY.
Purpose and Hypotheses
This paper is a narrative review, in
which authors simply review the studies
that are currently available on the topic.
As a result, the paper is more descriptive
than hypothesis-driven, and hypotheses
aren’t always directly stated in this type
of work. The purpose was quite clear:
the authors set out to review the existing
literature documenting male and female
responses to beetroot juice and dietary
nitrate supplementation. The authors
also highlighted physiological differenc-
es between males and females that could
theoretically cause differential respons-
es to nitrate, which leads one to believe
that they likely suspected that males and
females may respond to supplementa-
tion somewhat differently. Finally, the
authors noted some areas requiring fur-
ther research in the future.
Subjects and Methods
As a narrative review, there aren’t re-
ally any methods to highlight or scruti-
nize. As opposed to a systematic review
or meta-analysis, authors for this type
of paper are free to highlight the litera-
ture that they deem most relevant to the
topic. From my perspective, they did an
excellent job covering the breadth of the
literature available and delivered the in-
formation in an unbiased manner, with
no evidence of cherry-picking.
As a review, they didn’t recruit any
subjects of their own, but they were in-
terested in assessing the overall repre-
sentation of males and females within
the entire body of research. They found
more than 100 studies using male-on-
ly samples, compared to only 7 studies
with only females.
Findings and
Interpretation
Before we get into sex-based differenc-
es, let’s establish a firm understanding of
how nitrate is supposed to work. Nitric
oxide is a gas and has an extremely short
half-life, so directly supplementing with
nitric oxide is off the table. Instead, we
75
 Figure 1 The effects of nitric oxide on exercise-related outcomes (3)

Dietary L-Citrulline
NO3-
L-Arginine
Bacterial
anaerobes

NO2-
Acidosis
NO
hypoxia

Exercise Mitochondrial Ca2+ Vasodilation Glucose Muscle

efficiency respiration handling uptake fatigue

Dietary nitrate (NO3-) is converted to nitrite (NO2-), which is then converted to nitric oxide (NO). Nitric oxide then exerts
a wide range of effects throughout the body, many of which have the potential to influence exercise performance.

tend to supplement with precursors to
nitric oxide; as a result, when nitric oxide
production is naturally increased during
exercise, we can be confident that pro-
duction won’t be impaired by a lack of
precursor availability. You can form ni-
tric oxide from arginine (and, indirectly,
from citrulline), but we’ll restrict our fo-
cus to the nitric oxide pathway that in-
volves nitrate.
When you consume nitrate, it is con-
verted to nitrite by bacteria present in
the oral cavity. That’s an important (but
sometimes overlooked) detail; this bac-
terial conversion is 100% necessary for
nitrate to work, so antibacterial mouth-
wash absolutely eliminates all potential
effects of dietary nitrate intake. Nitrite is
then converted to nitric oxide in a pro-
cess that is stimulated by conditions of
acute hypoxia and acidosis, as we often
observe during high-intensity exercise.
People often think of nitric oxide purely
as a blood flow promoter, and think that
enhancing “the pump” is its only poten-

76
 Table 1 Summary of key anthropometric, physiological, and metabolic differ-
ences between males and females (1)
Anthropometrics
[Hemoglobin] and red blood
cell mass
Fuel stores and utilization
tial contribution to exercise applications.
In reality, nitric oxide exerts a wide range
of effects throughout the body. Most
notably, there is some evidence to sug-
gest that nitric oxide reduces the energy
cost of exercise, enhances the contrac-
tile function of muscle, increases cellular
glucose uptake, and attenuates muscle
fatigue, in addition to increasing blood
flow. These effects are summarized in
Figure 1.
Males Females
Larger in stature (Wells 2007) Smaller in stature (Wells 2007)
Greater total mass Lower total mass (Wells 2007)
Greater relative lean mass Greater relative fat mass
(Wells 2007) (Wells 2007)
Greater proportion of lean
Greater proportion of lean
mass in the shoulders, chest,
mass in the thighs
lower gluteal region
(Abe et al. 2003)
(Abe et al. 2003)
Greater hemoglobin levels Lower hemoglobin levels
Greater red blood cell mass Lower red blood cell mass
Greater oxygen carrying Lower oxygen carrying
capacity (Murphy 2014) capacity (Murphy 2014)
Greater relative proportion of Greater relative proportion of
type II glycolytic skeletal type I oxidative skeletal
(Haizlip et al. 2015) (Haizlip et al. 2015)
Lower skeletal muscle Greater skeletal muscle
capillarization capillarization
Greater intramuscular
Greater glycolytic enzyme
triglyceride stores
activity (Green et al. 1984)
(Tarnopolsky et al. 2007)
Greater reliance on Greater capacity to mobilize
carbohydrate during intramuscular triglyceride
submaximal exercise stores (Tarnopolsky et al.
(Tarnopolsky 2000) 2007)
Greater reliance on fat during
submaximal exercise
(Tarnopolsky 2000)
Notable physiological differences between
males and females
Now, let’s briefly consider some rele-
vant characteristics that tend to differ
between males and females. As summa-
rized in Table 1, males tend to be taller
and heavier, with a relatively higher pro-
portion of lean mass to fat mass. Males
also tend to have more red blood cells
and hemoglobin, and lower capillary
density of skeletal muscle, in addition
to a greater proportion of type 2 mus-
77
cle fibers. As such, it’s relatively unsur- Figure 2 The most likely mechanisms by
prising that males tend to rely compara- which nitrate may increase strength and power (6)
tively more on carbohydrate metabolism
during exercise, whereas females tend
to utilize more fat during exercise. In
addition to these fairly well-known sex NO3-
differences, the authors of the current
review noted that females tend to have
higher baseline plasma nitrite levels, de-
spite having similar nitrate levels, which NO2-
may indicate that females convert nitrate
to nitrite more efficiently than males (1).
In summary, nitrate is thought to exert
effects related to some combination of NO
blood flow, oxygen delivery, mitochon-
drial function, and/or muscle function,
and there are notable sex-based differ-
ences that could potentially influence
each of these outcomes. Now, let’s take RyR sGC activity
nitrosylation
a look at what the researchers found as
they reviewed the evidence available. cGMP

Nitrate effects in males and females

PKG
This review paper concisely summa-
rized the current nitrate literature, with
a focus on three main outcomes: blood Ca2+ Ca2+
release sensitivity
pressure, exercise economy (that is, the
amount of energy expenditure required
for a given amount of exercise), and
performance. For relatively untrained
males, nitrate seems to induce a small
reduction in blood pressure. Some stud- Ftw df/dt Vmax Pmax
ies have also reported small blood pres-
sure reductions for relatively untrained Muscle contractile function
females, but the effect isn’t as large as in
untrained males. This difference may re- Dietary nitrate (NO3-) is converted to nitrite (NO2-), which is then converted to nitric oxide (NO).
Nitric oxide is thought to nitrosylated ryanodine receptors (RyR) and increase guanylyl cyclase (sGC)
activity, thereby increasing calcium (Ca2+) release and myofibrillar calcium sensitivity. This results
late to the fact that females have higher in enhanced twitch force (Ftw), rate of force development (dF/dt), estimated maximal shortening
velocity (Vmax), and maximal power (Pmax).

78
blood nitrite levels at baseline, or the fact
that females typically have lower blood
pressure than males. However, as sub-
jects become more and more aerobical-
ly fit, nitrate’s blood pressure-lowering
effect seems to diminish. In theory, you
could argue that this “lack of an effect” is
a good thing; if you have normal blood
pressure, you wouldn’t want your dietary
supplement to induce an acute episode
of hypotension.
In relatively untrained males, nitrate
supplementation has been shown to re-
duce the oxygen cost of submaximal ex-
ercise, thereby improving exercise econ-
omy by around 3-5%. As a result, there
are quite a few studies reporting small
performance improvements across a
wide range of performance tests in this
population. In fairly well-trained males,
the research generally indicates that
these improvements in exercise economy
and endurance performance diminish.
In the current review, only seven studies
evaluating performance in female-only
samples were identified, which high-
lights the glaring lack of female research
in this area. Effects on exercise econo-
my and performance were equivocal in
females, with the available studies re-
porting fairly mixed results. While this
sounds like the male literature is a lit-
tle bit more promising than the female
literature, it’s important to note a few
caveats. The body of female literature is
far too limited, with only seven studies,
to identify clear patterns or make defin-
itive conclusions. In addition, many of
the performance studies utilized pret-
ty well-trained samples and investigat-
ed acute (single-day) supplementation
protocols. This is notable, because the
male literature would indicate that more
robust effects are typically observed in
less-trained individuals, and when using
chronic (rather than acute) supplemen-
tation protocols.
While the possibility of performance
differences is not yet conclusively set-
tled, the research seems to indicate that
females have, at the very least, different
baseline nitrite levels and differential
blood pressure responses when com-
pared to males. These apparent discrep-
ancies are interesting and informative,
but the majority of MASS readers are
probably more interested in strength ef-
fects than blood pressure. So, let’s take a
closer look at strength and power-relat-
ed outcomes.
A focus on lifting performance
In terms of physiological effects, nitric
oxide is most widely known as a vaso-
dilator that promotes blood flow. As a
result, most lifters tend to think that ni-
tric oxide precursors, such as nitrate and
citrulline, inherently work via increased
blood flow. In reality, it’s highly unlikely
that the delivery (or clearance) of blood
is a critically limiting factor during resis-
tance exercise performance, and there’s
limited justification for the idea that de-
livering (or clearing) more blood would
79
 Figure 3 Potential sex differences associated with dietary nitrate supplementation (1)

• Oral microbiome (+)

• Oral hygiene practices (?)
• NO3 · dose (?)

• Mitochondrial function (?) • Baseline plasma [NO2-] (+)

• Ca2+ handling (?) • ∆ plasma [NO3-] (+)
• Cross-bridge cycling (?) • ∆ plasma [NO2-] (+)
• Plasma [cGMP] (?)

• Skeletal muscle as a
storage reservoir for
• Baseline blood pressure (*)
NO3- (?)
• Post-NO3- blood pressure (-)

• NO3- excretion (?)

NO3- = dietary nitrate; + = response more robust in females; - = response less robust in females; * = lower in females; ? = unknown

be inherently beneficial for acute per-
formance effects. As discussed in the
current review (1), the evidence is also
a little shaky when it comes to nitrate
significantly influencing mitochondri-
al efficiency. Larsen et al (4) did report
that nitrate supplementation enhanced
mitochondrial efficiency in a mixed
sample of males and females, but oth-
er studies have found no such effect (1,
5). At this time, it seems that strength
and power-related effects of nitrate are
most likely related to direct effects on
the contractile function of muscle.
When a muscle contraction occurs,
there are a couple of very critical steps in
the process: Calcium is released from the
sarcoplasmic reticulum, and that calci-
um binds to a myofibrillar protein called
troponin. Plenty of calcium release, plen-
ty of binding to troponin, plenty of force
production. As reviewed by Coggan and
Peterson (6), nitrate increases nitric ox-
ide production, and evidence suggest

80
that nitric oxide can increase ryano-
dine receptor nitrosylation and guany-
lyl cyclase activity (Figure 2). This not
only increases calcium release, but also
makes the myofibril more sensitive to
the force-promoting effects of calcium,
thereby enhancing force production and
shortening velocity.
Aside from the sciencey, mechanistic
minutiae, there’s some (admittedly lim-
ited) evidence that this carries over into
actual resistance exercise. Most notably,
Mosher et al (7) found that nitrate sup-
plementation enhanced repetitions to
fatigue on three consecutive bench press
sets taken to failure, using a load equiv-
alent to 60% of the subjects’ one-rep
maxes. Unfortunately, Mosher’s study
used male participants only, but it’s one
of the few nitrate studies looking at a
resistance exercise outcome with much
ecological validity at all. Coggan et al (8)
used a mixture of male and female sub-
jects, and found that nitrate supplemen-
tation enhanced leg extension power, but
only at pretty high contraction veloci-
ties (360 degrees per second). Similarly,
Hoon et al (9) found nitrate supplemen-
tation to attenuate muscular fatigue in a
leg extension test using a mixed sample
of male and female participants. Final-
ly, a recent study by Wickham et al (10)
studied a female-only sample, and while
they found no benefits for exercise econ-
omy or cycling performance, and many
of their muscle function outcomes were
unaffected by supplementation, they did
NITRATE SUPPLEMENTATION
DOES INDEED INFLUENCE THE
CONTRACTILE FUNCTION OF
MUSCLE IN FEMALES, AND
IMPROVEMENTS IN VARIOUS
STRENGTH AND POWER
OUTCOMES HAVE BEEN OBSERVED
IN MIXED SAMPLES CONTAINING
BOTH MALES AND FEMALES. IT
SEEMS PREMATURE TO CONCLUDE
THAT NITRATE AFFECTS FEMALE
MUSCLE FUNCTION TO A LESSER
DEGREE THAN MALE MUSCLE.
observe an increase in low-frequency
torque production.
There’s a pretty serious lack of research
pertaining to nitrate’s effects on resis-
tance exercise outcomes, but we can at
least make some observations based on
the evidence that’s currently available.
It definitely seems as if nitrate has the
capacity to influence muscle function,
and preliminary results suggest that its
effects are most notable during explo-
sive, high-velocity muscle actions (8),
and its effects are more pronounced in
the fatigued state (11). Finally, we have
81
 APPLICATION AND TAKEAWAYS
1. There’s a huge lack of research pertaining to nitrate supplementation in females,
and there are notable anthropometric, physiological, and metabolic differences
between sexes that could theoretically yield divergent responses to nitrate
supplementation.
2. Most of the research showing performance improvements with nitrate
supplementation has been done using untrained or recreationally active males
doing endurance exercise. When it comes to resistance exercise, it’s still unclear
if males experience a greater performance boost than females, or if performance
benefits will carry over to well-trained individuals of either sex.
3. There’s enough mechanistic and preliminary research to tentatively consider
nitrate to be a promising ergogenic aid, but that doesn’t mean you necessarily
need to supplement. Aiming to achieve daily nitrate intakes of 400-800mg, either
from food or supplementation, has potential benefits with minimal likelihood of
adverse effects.

observed that, at the very least, positive
effects on contractile function are ob-
served in samples that at least contain
some females. However, can the results
of Mosher et al (7) be reliably replicat-
ed? Are these effects larger in men than
women? Will women actually benefit
to a meaningful degree when utilizing a
test protocol that approximately resem-
bles “real-world” resistance exercise? If
we replicate these studies in well-trained
athletes instead of recreationally active
subjects, will we see similar results? For
now, these questions remain unanswered.
Practical considerations for beetroot/ni-
trate supplementation
We still have plenty to learn about ni-
trate supplementation and exactly how
much potential it has to enhance re-
sistance exercise performance. But, for
now, the preliminary results are promis-
ing. So, let’s discuss a few practical con-
siderations for those interested in nitrate
supplementation.
First, an effective nitrate dose tends to
be at least 400-800 mg (preferably to-
ward the higher end), which is equiv-
alent to 6.4-12.9 mmol. A fairly con-
sistent observation is that studies with
chronic (multiple-day) dosing protocols
observe more reliable effects than acute
(single-dose) studies. A very recent
study (12) helps explain why that might
be, as its findings suggest that humans
have the ability to store nitrate and ni-
trite within muscle, and that this stor-
age reservoir becomes depleted follow-
ing exercise. Notably, the sample in this
study included both males and females,

82
so this does not appear to be a male-spe-
cific finding. Finally, the nitrate supple-
ments that are currently on the market
aren’t great. A recent study (13) evalu-
ated 24 different beetroot juice products
on the market; nitrate content varied
pretty substantially between samples of
the same exact product, and there was
a 50-fold range in nitrate content be-
tween the products with the highest and
lowest dose. Fortunately, it’s totally real-
istic to obtain ergogenic doses of nitrate
from simple dietary modifications, and
at least one study has shown this to sig-
nificantly enhance multiple performance
outcomes (14). Foods with high nitrate
content include celery, beets, spinach,
rocket (arugula), and a variety of other
fruits and vegetables.
In conclusion, the current review article
certainly identified some discrepancies
between the male and female nitrate lit-
erature. Namely, women appear to have
higher plasma nitrite levels, lower resting
blood pressure, a smaller blood pressure
reduction from nitrate, and less consis-
tent improvements in exercise economy
and performance tests involving endur-
ance exercise modalities (such as run-
ning, swimming, and cycling). However,
when it comes to resistance training, the
most likely ergogenic mechanism relates
to direct effects on muscle function. At
this time, we have some evidence to sug-
gest that nitrate supplementation does
indeed influence the contractile function
of muscle in females, and improvements
in various strength and power outcomes
have been observed in mixed samples
containing both males and females. It
seems premature to conclude that ni-
trate affects female muscle function to
a lesser degree than male muscle, but
we need more research to reach a more
definitive conclusion. This isn’t the only
question that remains; as summarized
in Figure 3, we also need answers to a
variety of lingering questions pertaining
to how sex might affect nitrate dosing,
the conversion of nitrate to nitrite, mi-
tochondrial function, and intramuscular
storage of nitrate and nitrite.
Next Steps
This review made it abundantly clear
that there are several key questions that
need to be pursued. We need stud-
ies evaluating potential sex-based dif-
ferences pertaining to optimal nitrate
dosing strategies, intramuscular storage
and depletion of nitrate and nitrite, the
effects of nitrate on exercise economy
and mitochondrial efficiency, and intra-
muscular calcium kinetics and contrac-
tile properties following nitrate intake.
I’d love to see a female study similar to
Mosher et al (7) to evaluate the effects
of dietary nitrate in the context of a test
protocol that approximately reflects “re-
al-world” resistance training. It’d also be
great to see studies that directly com-
pare male and female responses, rather
than drawing conclusions by comparing
83
male-only and female-only studies with
key methodological differences. Finally,
we’ll need to determine if the effects of
dietary nitrate vary throughout the men-
strual cycle, and determine if habitually
increased nitrate intake actually enhanc-
es training adaptations over time.

84
References
1. Wickham KA, Spriet LL. No longer beeting around the bush: a review of potential sex differences
with dietary nitrate supplementation. Appl Physiol Nutr Metab. 2019 Sep;44(9):915–24.
2. Stuart-Smith K. Demystified … Nitric oxide. Mol Pathol. 2002 Dec;55(6):360–6.
3. Bailey SJ, Vanhatalo A, Winyard PG, Jones AM. The nitrate-nitrite-nitric oxide pathway: Its role in
human exercise physiology. Eur J Sport Sci. 2012 Jul 1;12(4):309–20.
4. Larsen FJ, Schiffer TA, Borniquel S, Sahlin K, Ekblom B, Lundberg JO, et al. Dietary inorganic
nitrate improves mitochondrial efficiency in humans. Cell Metab. 2011 Feb 2;13(2):149–59.
5. Whitfield J, Ludzki A, Heigenhauser GJF, Senden JMG, Verdijk LB, van Loon LJC, et al. Beetroot
juice supplementation reduces whole body oxygen consumption but does not improve indices of
mitochondrial efficiency in human skeletal muscle. J Physiol. 2016 Jan 15;594(2):421–35.
6. Coggan AR, Peterson LR. Dietary Nitrate Enhances the Contractile Properties of Human Skeletal
Muscle. Exerc Sport Sci Rev. 2018 Oct;46(4):254–61.
7. Mosher SL, Sparks SA, Williams EL, Bentley DJ, McNaughton LR. Ingestion of a Nitric Oxide
Enhancing Supplement Improves Resistance Exercise Performance. J Strength Cond Res. 2016
Dec;30(12):3520–4.
8. Coggan AR, Leibowitz JL, Kadkhodayan A, Thomas DT, Ramamurthy S, Spearie CA, et al. Effect
of acute dietary nitrate intake on maximal knee extensor speed and power in healthy men and wom-
en. Nitric Oxide. 2015 Aug 1;48:16–21.
9. Hoon MW, Fornusek C, Chapman PG, Johnson NA. The effect of nitrate supplementation on mus-
cle contraction in healthy adults. Eur J Sport Sci. 2015;15(8):712–9.
10. Wickham KA, McCarthy DG, Pereira JM, Cervone DT, Verdijk LB, van Loon LJC, et al. No effect
of beetroot juice supplementation on exercise economy and performance in recreationally active fe-
males despite increased torque production. Physiol Rep. 2019 Jan;7(2):e13982.
11. Tillin NA, Moudy S, Nourse KM, Tyler CJ. Nitrate Supplement Benefits Contractile Forces in Fa-
tigued but Not Unfatigued Muscle. Med Sci Sports Exerc. 2018 Oct;50(10):2122–31.
12. Wylie LJ, Park JW, Vanhatalo A, Kadach S, Black MI, Stoyanov Z, et al. Human skeletal muscle
nitrate store: influence of dietary nitrate supplementation and exercise. J Physiol. 2019 Jul 27; doi:
10.1113/JP278076.
13. Gallardo EJ, Coggan AR. What’s in Your Beet Juice? Nitrate and Nitrite Content of Beet Juice
Products Marketed to Athletes. Int J Sport Nutr Exerc Metab. 2019 01;29(4):345–349.
14. Porcelli S, Pugliese L, Rejc E, Pavei G, Bonato M, Montorsi M, et al. Effects of a Short-Term
High-Nitrate Diet on Exercise Performance. Nutrients. 2016 Aug 31;8(9).

85
Study Reviewed: The Placebo and Nocebo Effect on Sports Performance: A
Systematic Review. Hurst et al. (2019)

The Placebo Effect Impacts

Performance More Than You
Might Expect
BY G RE G NUC KO LS

The placebo effect is a well-known psychological phenomenon, but

we often forget about it in exercise research. We focus on how much
a supplement, device, or treatment improves performance relative to
a placebo, but a lot of the “real-world” improvements in performance
may actually be attributable to placebo effects.

86
 KEY POINTS
1. In a meta-analysis, placebo and nocebo effects both have small but meaningful
impacts on performance.
2. The placebo effect is larger if someone thinks they’re ingesting a banned substance,
such as anabolic steroids or erythropoietin (EPO).
3. Interestingly, for caffeine, up to two-thirds of the “real-world” increase in performance
with caffeine usage may be attributable to the placebo effect (though caffeine itself
absolutely still has a real physiological effect).

A
ny time a new supplement
study drops, savvy readers know
that one of the first things to
check is whether the study was place-
bo-controlled. Placebo controls are im-
portant, because part of the effect you
get from any treatment is the effect you
get from simply receiving a treatment,
even if that treatment doesn’t actually
do anything. If you can do 10 reps with
a given weight without taking a pill, 12
reps with a sugar pill, and 13 reps with
a caffeine pill, then simply taking a pill
gives you 2 reps, with caffeine only giv-
ing you 1 extra rep, not 3.
We mostly focus on how much a giv-
en supplement, device, or treatment
improves performance in excess of the
boost provided by a placebo. We gener-
ally pay less attention to the boost pro-
vided by the placebo itself. However, a
recent meta-analysis (1) fills that gap,
analyzing the research that has inves-
tigated the magnitude of the placebo
effect on exercise performance. Over-
all, it seems that placebo and nocebo
effects (the placebo effect’s evil twin
– worsening performance when given
a treatment you expect to harm perfor-
mance) have a small but notable effect
on physical performance. Furthermore,
when people think they’re consuming a
banned substance, or when they’re ma-
nipulated into believing the placebo has
already provided them a performance
boost, the placebo effect is even larger.
Purpose and Hypotheses
Since this was a meta-analysis, the
purpose was simply to statistically ana-
lyze all of the research investigating the
effects of placebos and nocebos on ex-
ercise performance. No hypotheses are
stated for meta-analyses.
Methods
The authors ran a search for studies
investigating the effects of placebos
and nocebos on physical performance.
To be included in the meta-analysis,

87
 Figure 1 Exclusion process of identified studies
Identification

Records identified through Records identified through

electronic databases other resources
n = 4026 n=8
Screening

Records screened Records excluded

n = 4034 n = 3992
Eligibility

Full text articles assessed Full text records excluded

for eligibility n = 10
n = 42 No control treatment (n=3)
Non-healthy participants
(n=2)
Inadequate placebo (n=2)
Non-sporting outcome
measure (n=2)
Included

Failure to deceive
Studies included in analysis
participants (n=1)
n = 32

a study needed to be published in an Once the studies were collected, the

English-language peer-reviewed jour-
nal, include healthy subjects, and re-
port at least one objective measure of
performance (i.e. not just pain, fatigue,
or perceived exertion). Furthermore,
to quantify the placebo effect, studies
needed to include a no-treatment con-
trol condition or measurement.
authors calculated effect sizes for each
study and “aggregated” them. The au-
thors don’t actually explain how they
performed the meta-analysis itself
(Fixed effects model? Random effects
model? Simply taking a weighted av-
erage of the effect sizes?), which is …
odd.

88
 Figure 2 Effect sizes for various placebo interventions

1.5

Large

1
Effect size (d)

Medium

0.5

Small

Trivial
0
Over placebos

Nutritional placebos

Amino acid placebo

Overall placebo effect

Overall nocebo effect

Caffeine placebo

Mechanical placebos

EPO placebo

+ placebo

TENS placebo

Steroid placebo
Preconditioning

Findings placebos or nocebos, while 12 investi-

gated mechanical placebos. Most of the
More than 4,000 studies were studies investigated the placebo effect,
screened, with 32 eventually meet- while only 5 examined the nocebo ef-
ing the inclusion criteria, represent- fect. Of the studies using placebos, 4
ing 1,513 total participants. Of those used overt placebos (i.e. they told the
32 studies, 20 investigated nutritional subjects when they were giving them a

89

ONE OF THE MOST LOGICAL
AND INTERESTING FINDINGS
OF THIS META-ANALYSIS
WAS THE MORE “SERIOUS”
PLACEBOS INDUCED LARGER
PLACEBO EFFECTS.
placebo), while 5 augmented the place-
bos with preconditioning via augment-
ed feedback (which I’ll explain in the
next section).
Overall, nutritional and mechanical
ergogenic aids significantly improved
performance. The effect sizes for both
were small (d = 0.35 for nutritional
placebos, and d = 0.47 for mechanical
placebos). Unsurprisingly, the placebo
effects generated by placebos claiming
to be banned substances were larger
(d = 1.44 for steroids, and d = 0.81 for
EPO). Interestingly, preconditioning
procedures also had a large effect on
performance (d = 0.82). Sham trans-
cutaneous electrical nerve stimulation
(TENS) was also reported to have a
large effect size (d = 0.86). Small ef-
fect sizes were noted for placebo amino
acids and caffeine (d = 0.36 and 0.40,
respectively). A completely fictitious
sport supplement was found to have a
small effect (d = 0.21). Cold water im-
mersion, sodium bicarbonate, ischemic
preconditioning, carbohydrate, beta al-
anine, kinesio tape, and magnetic wrist-
bands were all found to have trivial or
null effects. Overt placebos also had no
significant effect.
The nocebo effect was also small (d =
0.37). Since there were only five stud-
ies investigating the nocebo effect, the
researchers didn’t investigate whether
the type of nocebo used moderated the
outcomes.
Interpretation
The first thing I’d like to reiterate is
that the authors don’t make it clear
how they actually performed their me-
ta-analysis, so it’s hard to tell if they
mucked something up. I think they
just extracted the effect size from each
study and either averaged them or took
a weighted average. If that’s what they
did, their point estimates for each effect
size may be pretty alright (just skim-
ming the reported effect sizes, it doesn’t
seem like there’s an extreme amount of
variability within each sub-category),
but they may have either more or less
variance around the mean estimate than
they “should.” There are a few other sta-
tistical things I could complain about,
but I feel like I probably do too much
of that anyways, and the things I want
to complain about probably wouldn’t
meaningfully change my interpreta-
90
tion of this meta-analysis. However, we
probably need to be a little more cau-
tious with these findings than we would
otherwise need to be if their statistical
approach was more transparent.
One of the most logical and interest-
ing findings of this meta-analysis was
the more “serious” placebos induced
larger placebo effects. Since the place-
bo effect is a psychological phenome-
non based on expectancy (you think
what you’re taking will improve perfor-
mance, and that belief is what actually
improves performance), it makes since
that placebos that you think will have
a larger effect do actually have a larger
effect. I think just about anyone would
expect to improve their strength when
taking steroids, or improve their endur-
ance performance when taking EPO;
those substances are banned in most
competition because they do cause
large improvements in performance,
after all. And though just three of the
studies in this meta-analysis investigat-
ed banned substances (2 for steroids, 1
for EPO; 2, 3, 4, 5[NOTE]), all three
of those studies reported large effects,
and the mean effect for those studies
(d = 1.23) was more than three times
larger than the mean effect for all of the
studies in this meta-analysis (d = 0.37).
I’ve always wondered about the degree
to which the increase in strength people
report when they start taking steroids is
attributable to expectancy. People often
claim that they build a lot more muscle
THE PLACEBO EFFECT OF
CAFFEINE MAY BE JUST AS
LARGE AS THE “TRUE” EFFECT
OF CAFFEINE, IF NOT LARGER.
and experience a disproportionate in-
crease in strength. However, in place-
bo-controlled research (i.e. when peo-
ple who aren’t taking steroids are still
given injections to make them think
they’re taking steroids), it seems that
the boost steroids provide for strength
gains is disproportionately smaller than
the boost they provide for hypertro-
phy (6), with steroids helping subjects
build 3.3 times more muscle (4.23% vs.
13.92% increases in combined triceps
and quadriceps cross-sectional area),
while only helping them build 1.7 times
more strength (35 vs. 60 kg combined
increase in squat and bench press 1RM).
Since this meta-analysis found that the
placebo effect itself generates a large
improvement in performance when
people think they’re taking banned
substances, it does make me think the
reports of large, fast strength increases
in strength reported when people start
taking steroids may be based as much
on expectancy as the actual physiologi-
cal effects of the drugs.
91

AS A GENERAL RULE, IT PAYS
TO BE OPTIMISTIC; IF YOU
EXPECT TO PERFORM WELL
AND HAVE GOOD RESULTS
FROM YOUR TRAINING, YOU
PROBABLY WILL, AND IF YOU
EXPECT TO PERFORM POORLY
AND HAVE LACKLUSTER
RESULTS, THAT WILL
LIKELY BECOME A SELF-
FULFILLING PROPHECY.
Another interesting note is that the
placebo effect of caffeine may be just as
large as the “true” effect of caffeine, if not
larger. Meta-analyses find that caffeine
improves performance relative to place-
bo, with small effect sizes in the 0.2-0.4
range (7). This meta-analysis found that
the placebo effect for caffeine was asso-
ciated with an effect size of about 0.4.
Thus, in the “real world,” when people
take caffeine before a workout, the total
effect may actually be quite large (i.e. in
the d = 0.6-0.8 range), with about one-
half to two-thirds of the effect attribut-
able to expectancy, and about one-third
to one-half of the effect attributable to
the actual physiological effects of caf-
feine.
I was surprised that placebo TENS
treatment was so effective. TENS units
consist of electrodes that are placed on
the skin, with a current passed through
the electrodes that is sufficient to stim-
ulate the underlying nerves, but gener-
ally low enough that it does not cause
muscular contraction. Generally you can
feel a TENS unit working (it tingles at
low voltage and can be mildly uncom-
fortable at higher voltages), though you
can’t feel the current if the voltage is low
enough. For placebo TENS treatment,
you turn the unit on, and you may even
rig it up so that it will show that it’s
operating at a low voltage, but you don’t
run a current through it. While I sup-
pose the show of placing the electrodes
and turning the machine on may repre-
sent a “bigger” placebo treatment than
simply giving someone an unmarked
pill, I would have thought that people
would be highly skeptical that the ma-
chine was really doing anything if they
didn’t feel anything. However, it does
appear that sham TENS treatment
is quite an effective placebo. I doubt
MASS readers can really do much with
that information, but I thought it was
cool.
The finding that preconditioning
caused a large improvement in perfor-
mance is fascinating. For a positive pre-
conditioning study, you generally test
92
 APPLICATION AND TAKEAWAYS
The placebo effect has a small but notable effect on performance under most
circumstances. While it’s hard to placebo yourself, expectancy effects in general can
influence performance, so try to maintain positive self-talk about your training, and
try to avoid catastrophizing things that happen in your life, as doing so could harm
performance by triggering negative expectancy effects.

subjects at baseline, test them again preconditioning is combined with a

when giving them a placebo, while al-
tering the test to make the subjects feel
like they performed better, and then
test them another time with the placebo
but without the test alteration. For ex-
ample, you could test someone’s maxi-
mal bench press reps with 100kg on day
1. 48 hours later, you could give them
a placebo pill, tell them it’s caffeine,
and test their maximal bench press reps
with 90kg, while telling them it’s 100kg
(with altered plates so the bar still looks
like it’s loaded to 100kg). Their perfor-
mance should be better, which they’ll
attribute to the placebo pill. 48 hours
later, you give them the placebo pill
again, and test their maximal bench
press reps with 100kg. Since they al-
ready have the belief that the placebo
pill (which they think is caffeine) im-
proves their performance, they’ll prob-
ably perform much better on this test
with 100kg than they would have if you
hadn’t preconditioned them (i.e. session
1: 100kg with no placebo; session 2:
100kg with placebo). Preconditioning
essentially works to amplify expectancy,
and this meta-analysis found that when
placebo treatment, the total effect is (on
average) more than twice as large as the
effect of the placebo alone.
Predictably, overt placebos didn’t im-
pact performance. An overt placebo is
a placebo someone knows they’re get-
ting. If you give someone a pill and say,
“this is a placebo pill that does noth-
ing,” that’s an overt placebo (some-
times called an open label placebo). It
may sound ludicrous that the effects
of overt placebos even need to be re-
searched, but interestingly, overt place-
bos have been found to improve subjec-
tive outcomes (such as pain or nausea)
compared to a no-treatment control
(8), which I find fascinating. However,
when you’re objectively measuring ex-
ercise performance, people don’t get a
placebo effect when they know they’re
taking a placebo.
Finally, I want to draw attention to
the fact that the mean nocebo effect was
just as large as the mean placebo effect.
When people think something will im-
prove performance, it generally does,
and when people think something will

93
harm performance it generally does. In
a previous MASS article, I reviewed a
study showing that in some cases, be-
liefs about your genetics can affect your
physiology and perceptions more than
your actual genetics themselves do (10).
I’m not sure how relevant that finding
is in this particular meta-analysis (I
don’t think many people intentionally
take supplements or use interventions
that they think will hinder their perfor-
mance), but negative expectancy effects
are a pretty generalizable concept. It’s
something to keep in mind with your
self-talk and the interactions you have
with your clients. For example, if you
expect that your strength is going to
drop when you go into a calorie defi-
cit, it probably will. It may have done
so anyways, but the drop will likely be
larger if you expect it to take a hit. Or
if you expect a night of bad sleep to
hinder performance, your performance
will probably be lower (even though re-
search tends to find that one night of
bad sleep doesn’t have much of an im-
pact on acute performance; it tends to
negatively affect skill performance and
tactical decision-making, but not things
like force output or endurance [9]). As
a general rule, it pays to be optimistic;
if you expect to perform well and have
good results from your training, you
probably will, and if you expect to per-
form poorly and have lackluster results,
that will likely become a self-fulfilling
prophecy.
Next Steps
I’m still stuck on the idea of the pla-
cebo effect of steroids. A deception
study would be really cool, involving
four groups. All four groups are giv-
en pills. Group 1 is given oral steroids
and are told they’re being given oral
steroids. Group 2 is given oral steroids
and are told they’re being given an in-
ert control. Group 3 is given an inert
control and are told they’re being given
oral steroids. Group 4 is given an inert
control and are told they’re being given
an inert control. Since this meta-anal-
ysis found that overt placebos don’t
improve exercise performance, group
2 would show us the “true” physiolog-
ical effect of steroids, group 3 would
show us the placebo effect of thinking
you’re taking steroids, group 1 would
show us the “stacked” effect (placebo +
actual physiological effect), and group
4 would be the control group. I would
predict that groups 1 and 2 would easily
gain the most muscle, but I wouldn’t be
shocked if groups 2 and 3 gained simi-
lar amounts of strength.
94
References
1. Hurst P, Schipof-Godart L, Szabo A, Raglin J, Hettinga F, Roelands B, Lane A, Foad A, Coleman
D, Beedie C. The Placebo and Nocebo effect on sports performance: A systematic review. Eur J
Sport Sci. 2019 Aug 20:1-14.
2. Ariel G, Saville W. Effect of anabolic steroids on reflex components. J Appl Physiol. 1972
Jun;32(6):795-7.
3. Maganaris CN, Collins D, Sharp M. Expectancy Effects and Strength Training: Do Steroids Make
a Difference? The Sport Psychologist. 200;14(3):272-278.
4. Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, van ‘t Westende J, Post TE, Daniels JMA, Mo-
erland M, van Veldhoven PLJ, de Kam ML, Ram H, de Hon O, Posthuma JJ, Burggraaf J, Cohen
AF. Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, ran-
domised, placebo-controlled trial. Lancet Haematol. 2017 Aug;4(8):e374-e386.
5. I think the authors accidentally cited the wrong study for EPO. I think citation 4 above is the study
they meant to cite.
6. Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, Bunnell TJ, Tricker R, Shirazi
A, Casaburi R. The effects of supraphysiologic doses of testosterone on muscle size and strength in
normal men. N Engl J Med. 1996 Jul 4;335(1):1-7.
7. Grgic J, Grgic I, Pickering C, Schoenfeld BJ, Bishop DJ, Pedisic Z. Wake up and smell the coffee:
caffeine supplementation and exercise performance-an umbrella review of 21 published meta-anal-
yses. Br J Sports Med. 2019 Mar 29. pii: bjsports-2018-100278.
8. Charlesworth JEG, Petkovic G, Kelley JM, Hunter M, Onakpoya I, Roberts N, Miller FG, Howick
J. Effects of placebos without deception compared with no treatment: A systematic review and me-
ta-analysis. J Evid Based Med. 2017 May;10(2):97-107.
9. Kirschen GW, Jones JJ, Hale L. The Impact of Sleep Duration on Performance Among Competitive
Athletes: A Systematic Literature Review. Clin J Sport Med. 2018 Jun 14.
10. Turnwald BP, Goyer JP, Boles DZ, Silder A, Delp SL, Crum AJ. Learning one’s genetic risk changes
physiology independent of actual genetic risk. Nature Human Behavior. 2019; 3:48-56.

95
 VIDEO: Concurrent Training
for a Marathon
BY MIC HAE L C . ZO URD O S

You may know that running long distance isn’t the ideal form of cross-
training to maximize your strength. However, maybe you don’t care, and
you want to run a marathon anyway. I think this is cool, as once upon a
time I didn’t care and ran some, despite knowing the negative effects
on strength and size. Therefore, this video shows you how to accomplish
completing a marathon while affecting strength as little as possible.
Click to watch Michael's presentation.

96
Relevant MASS Videos
1. Concurrent Training Attenuates Anaerobic Adaptations Part 1. (Volume 1 Issue 3)
2. Concurrent Training Attenuates Anaerobic Adaptations Part 2. (Volume 1 Issue 4)

References
3. Wilson JM, Marin PJ, Rhea MR, Wilson SM, Loenneke JP, Anderson JC. Concurrent training: a
meta-analysis examining interference of aerobic and resistance exercises. The Journal of Strength &
Conditioning Research. 2012 Aug 1;26(8):2293-307.
4. Murach KA, Bagley JR. Skeletal muscle hypertrophy with concurrent exercise training: contrary
evidence for an interference effect. Sports medicine. 2016 Aug 1;46(8):1029-39.

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 VIDEO: Energy Intake to
Optimize Lean Mass, Part 1
BY E RI C HE LMS

“You must be in a surplus to build muscle”– An oft-repeated adage in the evidence-

based community, but perhaps an overly simplified statement. In part 1 of this
series, we draw on multiple reviews published in the last 20 years, and mechanistic
primary research to explore how energy intake influences hypertrophy, and when
and why a surplus might or might not be necessary to grow muscle.
Click to watch Eric's presentation.

98
References
1. Houston ME. Gaining weight: the scientific basis of increasing skeletal muscle mass. Canadian
journal of applied physiology. 1999 Aug 1;24(4):305-16.
2. Phillips SM. A brief review of critical processes in exercise-induced muscular hypertrophy. Sports
Medicine. 2014 May 1;44(1):71-7.
3. Rossow LM, Fukuda DH, Fahs CA, Loenneke JP, Stout JR. Natural bodybuilding competition
preparation and recovery: a 12-month case study. International journal of sports physiology and
performance. 2013 Sep;8(5):582.
4. Hulmi JJ, Isola V, Suonpää M, Järvinen NJ, Kokkonen M, Wennerström A, Nyman K, Perola M,
Ahtiainen JP, Häkkinen K. The Effects of Intensive Weight Reduction on Body Composition and
Serum Hormones in Female Fitness Competitors. Frontiers in physiology. 2017 Jan 10;7:689.
5. Hector AJ, McGlory C, Damas F, Mazara N, Baker SK, Phillips SM. Pronounced energy restriction
with elevated protein intake results in no change in proteolysis and reductions in skeletal muscle
protein synthesis that are mitigated by resistance exercise. FASEB journal: official publication of the
Federation of American Societies for Experimental Biology. 2018 Jan;32(1):265.
6. Pasiakos SM, Vislocky LM, Carbone JW, Altieri N, Konopelski K, Freake HC, Anderson JM, Fer-
rando AA, Wolfe RR, Rodriguez NR. Acute energy deprivation affects skeletal muscle protein syn-
thesis and associated intracellular signaling proteins in physically active adults. The Journal of nutri-
tion. 2010 Apr;140(4):745.
7. Carbone JW, Pasiakos SM, Vislocky LM, Anderson JM, Rodriguez NR. Effects of short-term en-
ergy deficit on muscle protein breakdown and intramuscular proteolysis in normal-weight young
adults. Applied Physiology, Nutrition, and Metabolism. 2014 Jun 19;39(8):960-8.
8. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun
C, Lundy B, Melin AK, Meyer NL, Sherman RT. IOC consensus statement on relative energy de-
ficiency in sport (RED-S): 2018 update. British journal of sports medicine. 2018 Jun;52(11):687.
9. Fagerberg P. Negative Consequences of Low Energy Availability in Natural Male Bodybuilding: A
Review. International journal of sport nutrition and exercise metabolism. 2018 Jul 1;28(4):385.

99
 Just Missed the Cut
Every month, we consider hundreds of new papers, and they can’t all be included in MASS.
Therefore, we’re happy to share a few pieces of research that just missed the cut. It’s
our hope that with the knowledge gained from reading MASS, along with our interpreting
research guide, you’ll be able to tackle these on your own.

1. Ortiz et al. A Systematic Review on the Effectiveness of Active Recovery Interventions on

Athletic Performance of Professional-, Collegiate-, and Competitive-Level Adult Athletes
2. Trezise and Blazevich. Anatomical and Neuromuscular Determinants of Strength Change
in Previously Untrained Men Following Heavy Strength Training
3. Dinyer et al. Applying the Critical Power Model to a Full Body Resistance Training
Movement
4. Schoenfeld et al. Calculating Set-Volume for the Limb Muscles with the Performance of
Multi-Joint Exercises: Implications for Resistance Training Prescription
5. Wilk et al. Changes of Power Output and Velocity During Successive Sets of the Bench
Press with Different Duration of Eccentric Movement
6. Leite et al. Does exercise-induced muscle damage impair subsequent motor skill
learning?
7. Dias et al. Effect of Acute and Chronic Xenon Inhalation on Erythropoietin, Hematological
Parameters, and Athletic Performance
8. Ghaedi et al. Effects of a Paleolithic Diet on Cardiovascular Disease Risk Factors: A
Systematic Review and Meta-Analysis of Randomized Controlled Trials
9. Marzliger et al. Effects of Lengthening Velocity During Eccentric Training on Vastus
Lateralis Muscle Hypertrophy
10. Jäger et al. Eight Weeks of a High Dose of Curcumin Supplementation May Attenuate
Performance Decrements Following Muscle-Damaging Exercise
11. Bloedon et al. Impact of anthocyanin-rich whole fruit consumption on exercise-induced
oxidative stress and inflammation: a systematic review and meta-analysis
12. Haischer et al. Impact of Cognitive Measures and Sleep on Acute Squat Strength
Performance and Perceptual Responses Among Well-Trained Men and Women
13. Vieira et al. Resistance Training with Repetition to Failure or Not on Muscle Strength and
Perceptual Responses
14. Coratella et al. Specific prime movers’ excitation during free-weight bench press
variations and chest press machine in competitive bodybuilders
15. Carzoli et al. The effects of eccentric phase duration on concentric outcomes in the back
squat and bench press in well-trained males
16. Kamali et al. Transcranial direct current stimulation to enhance athletic performance
outcome in experienced bodybuilders

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 Thanks for
reading MASS.
The next issue will be released to
subscribers on November 1.

Graphics by Kat Whitfield, and layout design by Lyndsey Nuckols.

101