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Rapid increase in plasma growth hormone after low-intensity resistace exercise

with vascular occlusion

Article  in  Journal of Applied Physiology · February 2000

DOI: 10.1152/jappl.2000.88.1.61 · Source: PubMed

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Rapid increase in plasma growth hormone after
low-intensity resistance exercise with vascular occlusion
Yudai Takarada, Yutaka Nakamura, Seiji Aruga, Tetuya Onda, Seiji Miyazaki and
Naokata Ishii
Journal of Applied Physiology 88:61-65, 2000.

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http://jap.physiology.org/cgi/content/full/88/1/61#BIBL

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Effects of resistance exercise combined with moderate vascular occlusion on muscular
function in humans
Y. Takarada, H. Takazawa, Y. Sato, S. Takebayashi, Y. Tanaka and N. Ishii
J Appl Physiol, June 1, 2000; 88 (6): 2097-2106.
[Abstract] [Full Text]

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on the following topics:
Oncology .. Interleukin-6
Oncology .. Somatotropin
Oncology .. Growth Hormone
Physiology .. Exertion
Medicine .. Exercise
Medicine .. Fitness (Physical Activity)

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 J. Appl. Physiol.
88: 61–65, 2000.

Rapid increase in plasma growth hormone after

low-intensity resistance exercise with vascular occlusion
YUDAI TAKARADA,1 YUTAKA NAKAMURA,2 SEIJI ARUGA,2
TETUYA ONDA,2 SEIJI MIYAZAKI,2 AND NAOKATA ISHII3
1Yokohama Sports Medical Center, Yokohama 222-0036; 2Research Institute of Sports

Medical Science, Tokai University, Hiratsuka 259-1207; and 3Department of Life

Sciences, College of Arts and Sciences, University of Tokyo, Tokyo 153-8902, Japan

Takarada, Yudai, Yutaka Nakamura, Seiji Aruga, mechanical stress, neuromotor control, metabolic de-
Tetuya Onda, Seiji Miyazaki, and Naokata Ishii. Rapid mands, and endocrine activities. Among these factors,
increase in plasma growth hormone after low-intensity resis- secretions of some anabolic hormones have been clearly
tance exercise with vascular occlusion. J. Appl. Physiol. 88:
shown to depend on the prescription of exercise used
61–65, 2000.—Hormonal and inflammatory responses to
low-intensity resistance exercise with vascular occlusion were and are regarded as important in promoting muscular
studied. Subjects (n 5 6) performed bilateral leg extension hypertrophy. Kraemer et al. (11–13) have shown that

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exercise in the seated position, with the proximal end of their high-intensity exercises for large muscle groups (,80%
thigh compressed at 214 6 7.7 (SE) mmHg throughout the 1 RM, 10 repetitions 3 ,6 sets), done with an interset
session of exercise by means of a pressure tourniquet. Mean interval as short as 1 min, provoke more than a 100-fold
intensity and quantity of the exercise were 20% of 1 repetition increase in the plasma concentration of growth hor-
maximum and 14 repetitions 3 5 sets, respectively. In each mone (GH), whereas the same exercises with a much
set, the subjects repeated the movement until exhaustion.
Plasma concentrations of growth hormone (GH), norepineph-
longer interset interval (,3 min) do not. Plasma concen-
rine (NE), lacate (La), lipid peroxide (LP), interleukin-6 trations of insulin-like growth factor I (IGF-I) and
(IL-6), and activity of creatine phosphokinase (CPK) were testosterone have been shown to behave in a substan-
measured before and after the exercise was finished and the tially similar manner, even though the changes in
tourniquet was released. Concentrations of GH, NE, and La concentration are far less prominent in magnitude than
consistently showed marked, transient increases after the is the change in GH concentration (11).
exercise with occlusion, whereas they did not change a great One of the early processes to be involved in the
deal after the exercise without occlusion (control) done at the
stimulation of hypophyseal secretions of GH and go-
same intensity and quantity. Notably, concentration of GH
reached a level ,290 times as high as that of the resting level nadotropic hormones would be the intramuscular accu-
15 min after the exercise. IL-6 concentration showed a much mulation of metabolic subproducts such as lactate (La)
more gradual increase and was maintained at a slightly and proton (12, 23). The elevated concentration of
higher level than in the control even 24 h after exercise. metabolites and associated acidification within the
Concentrations of LP and CPK showed no significant change. muscles stimulate chemoreceptors (29), which may
The results suggest that extremely light resistance exercise then send afferent signals to the hypothalamic-pitu-
combined with occlusion greatly stimulates the secretion of
itary system through group III and IV nerve fibers (7).
GH through regional accumulation of metabolites without
considerable tissue damage. On the other hand, the high-intensity exercise and
associated recruitment of fast-glycolytic fibers would
lactate; norepinephrine; interleukin-6; muscle damage not be necessarily required for regional accumulation of
metabolites if muscles would be forced to contract in a
hypoxic condition and the metabolite clearance would
IT HAS BEEN GENERALLY KNOWN that heavy resistance be simultaneously suppressed. Such a condition is
exercise has a potent effect in promoting increases in expected to be satisfied when low-intensity exercise is
size and strength of skeletal muscle. This effect has combined with vascular occlusion.
been believed to be specific to the intensity of exercise, In the present study, we investigated the effects of an
in such a way that an intensity .65% of 1 repetition extremely low-intensity (20% 1 RM) exercise for knee
maximum (1 RM) is required for gaining a substantial extensors combined with vascular occlusion on plasma
effect (16). concentrations of GH and norepinephrine (NE) to see
The precise mechanisms underlying such an inten- whether they are elevated in phase with the increase in
sity specificity of resistance exercise remain unclear plasma La concentration. In addition, we also mea-
and may involve combinations of multiple factors, i.e., sured the plasma activity of creatine phosphokinase
(CPK) and concentrations of interleukin-6 (IL-6) and
lipid peroxide (LP) as indicators of regional tissue
The costs of publication of this article were defrayed in part by the
payment of page charges. The article must therefore be hereby
damage and inflammation, because hypoxia and subse-
marked ‘‘advertisement’’ in accordance with 18 U.S.C. Section 1734 quent reperfusion may produce reactive oxygen species
solely to indicate this fact. (ROS) and cause considerable tissue damage.
http://www.jap.org 8750-7587/00 $5.00 Copyright r 2000 the American Physiological Society 61
62 RESISTANCE EXERCISE AND GROWTH HORMONE

METHODS lactate dehydrogenase-coupled enzymatic system (1), radioim-

munoassay (2), high-performance liquid chromatography (34),
Subjects. Six young male athletes aged 20–22 yr volun- chemiluminescent enzyme immunoassay (26), and spectrofluo-
teered for the study. Their physical characteristics were rimetry for the reaction product of malondialdehyde and
height, 173.8 6 6.7 (SD) cm, and weight, 79.4 6 8.7 kg. They thiobarbituric acid (31), respectively. Plasma activity of CPK
were previously informed about the experimental procedure was measured with spectrophotometry for NADPH formed by
to be utilized as well as the purpose of the study, and their hexokinase and D-glucose-6-phosphate-dehydrogenase-
informed consent was obtained. The study was approved by coupled enzymic system.
the Ethical Committee for Human Experiments, University Electromyogram recording. Electromyogram (EMG) sig-
of Tokyo. nals were recorded from vastus lateralis muscle. Bipolar
Experimental design and exercise protocol. The subjects surface electrodes (5 mm in diameter) were placed over the
performed bilateral knee extension exercise in seated position bellies of muscles with a constant interelectrode distance of
with an isotonic leg extension machine. The range of joint 30 mm. The EMG signals were amplified and fed into
motion was from 0 to 90° (expressed as 0° at full extension). full-wave rectifier through both low (time constant, 0.03 s)-
Throughout the session of exercise lasting for ,10 min, both and high (1-kHz)-cut filters, analog-to-digital converted, and
sides of their thighs were pressure occluded at the proximal stored in a Macintosh 8100/100 computer. The rectified EMG
ends by means of specially designed tourniquets (width, 33 signals during force generation were integrated (iEMG) with
mm; length, 800 mm), and the pressure was released immedi- respect to time and used as an indicator of muscle-fiber
ately after the exercise session. The mean pressure given by recruitment during the exercise movement (3).
the tourniquet was 214 6 7.7 (SE) mmHg. The exercise
session consisted of five sets of exercise at a mean intensity of RESULTS
,20% of the weight that could just be lifted once throughout

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the complete range of movement (1 RM), with a short interset Plasma concentrations of La, GH, and NE. Figure 1
rest period (30 s). In each set of exercise, the subjects repeated shows plasma concentrations of La, GH, and NE mea-
the movements until exhaustion. The mean repetition per set sured before and after the exercises. All of the concentra-
was 14.4 6 1.6. The mean intensity and repetitions for each tions dramatically increased after the exercise with
set are shown in Table 1. Two sessions were made as pre- occlusion, whereas they did not change a great deal
experimental practice. For the control experiment, the same after the exercise without occlusion done at the same
subjects performed the exercise without occlusion at the same intensity and volume as that with occlusion. The concen-
intensity (,20% 1 RM) and quantity as those for the exercise
with occlusion. Here, each subject repeated the movement so
trations appeared to reach a peak immediately after
as to match completely the intensity and the number of exercise (0 min) for La and NE, and 15 min after
repetitions for each set with those in the exercise with exercise for GH, thereafter returning rapidly toward
occlusion. The sessions for experimental and control experi- their resting level in an exponential fashion. It should
ments were separated by 1 wk. The subjects were instructed be noted that the concentration of GH increased up to
to raise and lower the weight for ,1 s at an approximately 40 µg/1, a concentration ,290 times as high as that
constant velocity. All of the exercise sessions were preceded by before exercise. This magnitude of increase in GH
a 10-min warm-up on a bicycle ergometer at ,50% of the concentration was larger by a factor of ,1.7 than that
maximum heart rate and stretching of the major muscle reported by Kraemer et al. (13) for high-intensity
groups subjected to the exercise. resistance exercise with a short rest period (typical
Blood sampling. Venous blood samples (20 ml for each
point of measurement) were obtained from the subjects
bodybuilding routine), indicating that the exercise with
seated in a slightly reclined position through an indwelling occlusion can provoke strong endocrine responses even
cannula in a superficial arm vein. All of the blood sampling at an extremely low intensity. In addition, the time
was conducted at the same time of the day to reduce the course of changes in concentrations of NE and GH
effects of any diurnal variations on the hormonal concentra- appeared to be closely similar to that of La.
tions. A resting blood sample was obtained after a 20-min Plasma concentrations of IL-6 and LP and activity of
equilibration period. The exercise session started 5 min after CPK. Figure 2 shows plasma concentrations of IL-6 and
the resting blood sample was drawn. After the exercise LP and plasma activity of CPK measured before and
sessions, the occlusion was released and blood samples were after the exercises. The concentration of IL-6 gradually
obtained at 0 (immediately after exercise), 15, 45, and 90 min, increased up to ,1 pg/ml within 90 min after the
and at 24 h. All blood samples were processed and stored at
220°C until analysis. The subjects were refrained from
exercise with occlusion and was maintained at a slightly
ingesting alcohol and caffeine for 24 h and performing any higher level than in control (exercise without occlusion)
strenuous exercise for 48 h before the experimental exercise even 24 h after exercise. IL-6 has been shown to be one
session. of the early inflammatory cytokines, which are pro-
Biochemical analyses. Plasma concentrations of La, GH, duced in the early stages of exercise-induced muscular
NE, IL-6, and LP were measured with spectrophotometry for damage (19). Indeed, the plasma concentration of IL-6

Table 1. Intensity and repetitions for each set of exercise with occlusion
Set 1 Set 2 Set 3 Set 4 Set 5 Mean

Intensity, %1 RM 33.2 6 1.6 28.2 6 2.1 20.9 6 0.7 18.0 6 1.9 15.5 6 2.0 23.2 6 5.2
Repetitions 20.0 6 1.8 12.2 6 1.7 11.3 6 1.5 15.2 6 1.4 13.2 6 1.1 14.4 6 1.6
Values are means 6 SE; n 5 6 subjects. In control experiment, each subject performed exercise without occlusion at the same intensity and
repetitions for each set. 1 RM, 1 repetition maximum.
 RESISTANCE EXERCISE AND GROWTH HORMONE 63

has been shown to increase gradually after strenuous

eccentric exercises and exceed 4 pg/ml within 90 min
(9). The present exercise with occlusion gave rise to a
similar change in IL-6 concentration, although the
concentration measured 90 min after the exercise was
less than one-quarter of that reported for eccentric

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Fig. 2. Changes in plasma concentrations of interleukin-6 (IL-6; A)
and lipid peroxide (C) and activity of creatine phosphokinase (B) after
exercises with (r) and without occlusion (k). Values are means 6 SE
(n 5 6). Significant differences between 2 types of exercise: * P , 0.05;
** P , 0.01, Student’s paired t-test.

exercise. Because the mechanical stress was expected

to be so small in the present exercise, such an inflamma-
tory response was thought to be caused by productions
Fig. 1. Changes in plasma concentrations of lactate (A), norepineph- of ROS on reperfusion subsequent to an occluded,
rine (B), and growth hormone (C) after exercises with (r) and without
occlusion (k). Values are means 6 SE (n 5 6). Pre, before; Post, after.
hypoxic state. However, both the concentration of LP
Significant differences between 2 types of exercise: * P , 0.05; ** P , and the activity of CPK did not show a significant
0.01, Student’s paired t-test. difference from those after the exercise without occlu-
64 RESISTANCE EXERCISE AND GROWTH HORMONE

sion (Fig. 2, B and C). Therefore, even though the concentration suggests finer microdamage occurring
present exercise with occlusion may cause microdam- within vascular walls and/or muscle tissue.
age in vascular walls and/or muscular tissues, this The peak concentration of La after the exercise with
damage would be less serious than that caused by occlusion was twice as large as that after the exercise
strenuous resistance exercise. without occlusion. This elevation of La concentration
Electrical activity of muscle. EMG analyses were was presumably caused by both local hypoxia, which
made on vastus lateralis to obtain insight into the makes metabolism more anaerobic, and the suppres-
activation level of the muscle during the exercise with sion of La clearance within the muscle subjected to the
occlusion. Figure 3 compares the relative iEMG per one exercise. Because samples were taken from blood circu-
action of lifting movement (concentric action) during lating in the whole body, the local concentration of La
the exercise with occlusion and that during the exercise within the muscle should be much higher than mea-
without occlusion. The relative iEMG during the exer- sured. Such an acidic intramuscular environment has
cise with occlusion was ,1.8 times as large as that been shown to stimulate sympathetic nerve activity
during the exercise without occlusion (P , 0.01), even through chemoreceptive reflex mediated by intramuscu-
though both the force generated and the mechanical lar metaboreceptors and group III and IV afferent
work produced were to be the same between these two fibers (29). The same chemoreception pathway has
kinds of exercise. This elevated activation level of the recently been shown to play an important role in the
muscle at a low level of force generation may be related regulation of hypophyseal secretion of GH (7). Similar
to a hypoxic intramuscular environment, in which mechanisms may operate in the present exercise with
motor units of more glycolytic fibers are to be activated occlusion, because changes in NE and GH concentra-

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to keep the same level of force generation (18, 22). tions were apparently in phase with that of La concen-
Resulting production and accumulation of La may tration (Fig. 1).
further promote additional recruitments of motor units, Lines of evidence have been accumulated that GH
as has been reported in seriously fatigued muscles (17). and IGF-I play crucial roles in growth, development,
DISCUSSION and maintenance of skeletal muscle. In particular,
transgenic animals in which mRNAs of GH (20) and
The present study showed that resistance exercise IGF-I (15, 21) are overexpressed show highly developed
combined with vascular occlusion, even at an extremely muscularity and suppressed age-related decline in mus-
low intensity, causes enhanced muscular electrical cular size and function, respectively. Recent studies
activity and endocrine responses. Notably, the increase have shown that circulating GH stimulates synthesis
in plasma GH concentration was much greater in and secretion of IGF-I within the muscle, which then
magnitude than that reported to occur after the typical acts on the muscle itself to promote growth (6, 10, 28).
exercise (high intensity, short rest period) widely used Although whether administrations of exogenous GH
for gaining muscular size (13). Such an effect would not and IGF-I stimulate the muscular growth in adult
be associated with serious tissue damage, because both humans (4, 5, 24, 30, 32, 33) has been controversial,
plasma markers for muscular damage (CPK activity) combinations of GH application and exercise stimuli
and oxidative stress (LP concentration) did not increase have been shown to evoke interactive, positive effects in
considerably. However, slight elevation of plasma IL-6 potentiating muscular hypertrophy in both humans
and rats (8, 14, 27). Therefore, the present results
imply the intramuscular condition to be satisfied dur-
ing resistance exercise aiming the muscular hypertro-
phy: acute hypoxia and accumulation of metabolites.
In a practical view, long-term exercise training on the
basis of the present methodology would be potentially
useful for subjects to whom heavy resistance training
cannot be applied. Indeed, we observed in elderly
women that low-intensity exercise with vascular occlu-
sion for elbow flexors caused marked muscular hyper-
trophy and a concomitant increase in strength (unpub-
lished observations). In addition, periodical applications
of an occlusion-reperfusion stimulus effectively pre-
vented postoperational immobilization-induced atro-
phy of lower limb muscles after the reconstruction of
the anterior cruciate ligament (25). Although the possi-
bility of serious tissue damage was excluded, further
studies are required on fine microdamage in blood
Fig. 3. Comparison of integrated electromyographic (iEMG) activity vessels and subtle changes in blood flow, both of which
for 1 action of concentric movement in exercise with (right) and may stimulate thrombosis.
without occlusion (left). Values are means 6 SE expressed relative to
exercise without occlusion(n 5 6). † Significant differences between 2 Address for reprint requests and other correspondence: N. Ishii,
types of exercise, P , 0.01, Student’s paired t-test. Dept. of Life Sciences, Graduate School of Arts and Sciences, Univ. of
 RESISTANCE EXERCISE AND GROWTH HORMONE 65

Tokyo, Komaba Tokyo 153-0041, Japan (E-mail [email protected] 16. McDonagh, M. J. N., and C. T. M. Davies. Adaptive response
tokyo.ac.jp). of mammalian skeletal muscle to exercise with high loads. Eur. J.
Received 5 April 1999; accepted in final form 9 September 1999. Appl. Physiol. 52: 139–155, 1984.
17. Miller, K. J., S. J. Garland, T. Ivanova, and T. Ohtsuki.
Motor-unit behavior in humans during fatiguing arm move-
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