Hey everyone. Welcome to to post 39 of Strength & Conditioning For Therapists. Just a couple of weeks to go now before I announce the details of the Strength & Conditioning For Therapists Online Course! In the meantime, let’s get back to finishing off the topic of muscle hypertrophy, for now. So I think over the past couple of weeks we’ve arrived at a point where we know what hypertrophy is and have a decent idea of a prescription to generate optimal gains. There’s just one thing missing – FUEL. Do you ever consider the fuel that might be required to enable the tissue remodelling i.e protein for muscle gain?

Protein Consumption Stimulates Muscle Protein Synthesis (MPS)

…but the exercise bit is important!

Okay, as you’ve probably realised, the fuel we’re taking about here is protein. Protein is the basic fuel required to maximise the morphological changes in the muscle. It’s not quite that simple though, we need some other stimuli…

“An acute exercise stimulus, particularly resistance exercise, and protein ingestion both stimulate muscle protein synthesis (MPS) and are synergistic when protein consumption occurs before or after resistance exercise.”

Jäger et al (2017)

So we’ve developed a muscle hypertrophy programme for a patient; the resistance exercise will stimulate MPS – great. But is the person consuming sufficient protein to properly fuel the adaptation? This might be a particularly pertinent question in some patient populations, perhaps those patients and athletes worried about weight gain whilst injured…and may thus restrict their calorie intake.

The quote above means that combination of protein and resistance exercise results in greater stimulation of MPS than either in isolation. So, if you’re looking for optimal adaptation i.e. achieving the best input-output equation, then this is worth considering with your patients. The amount of protein ingested is particularly important on MPS post exercise.

Protein For Muscle Gain, How Much Is Enough?

The recommended daily allowance (RDA) of protein for US adults is 0.8 g protein/kg body weight/day (g/kg/d), which is similar to the recommendations of the World Health Organisation of 0.83 g/kg/d. Bear in mind, however, this reflects the minimum amount of dietary protein required, and should not be interpreted as the recommended daily intake (Carbone & Pasiakon, 2019), especially for people undertaking a resistance training programme, or any exercise for the matter. At this level, for a 70 kg person this equates to around 50g of protein per day.

Let’s look at building muscle mass; the protein for muscle gain requirements are quite different. A Position Stand from the International Society of Sports Nutrition (Jager et al. 2017) describes that for building and maintaining muscle mass, an overall daily protein intake in the range of 1.4–2.0 g/kg/d is required. This represents 98-140g for a 70 kg person. Whilst there is some research that suggests even up to 2.2g/kg/d is potentially even more beneficial in weight lifters and body builders and maybe more so in those that are dieting, I don’t think we’ll go far wrong in using this 1.4–2.0 g/kg/d range to apply to rehab, perhaps opting for the latter end of the continuum.

How Much Protein Per Serving?

Protein for muscle gain – does it matter how much you ingest in a serving? If, say you’re that 70kg person does it matter if you have have all 98-140g in one meal or drip feed it across the day? Well, yes.

It’s generally accepted that a 20-25g dose of high-quality protein is sufficient to stimulate MPS, less, well not so much and more…? Well maybe. Macnaughton et al. (2016) showed that 40g of whey protein stimulated a greater MPS response vs 20g following whole body resistance training – in young resistance-trained men. This is interesting, but again, from a general patient and rehab perspective, pragmatically a 20-25g dose should do it, with slightly more for older adults (that’s another post!).

Timing of Protein Intake; Does It Matter?

So, related to the above point, yes timing matters. So it’s not ideal to have all your allotted amount in one serving (your body can only process so much), but, you do need to make sure you have enough to stimulate MPS, and for maximum effect have some of your serving at some point after resistance exercise. Your body is particularly sensitised to protein for some time following resistance exercise – not just ‘that 30-minute window’.

So summarising the above:

  • 1.4 – 2.0 grams of protein per kg of body weight per day
  • minimum 20 grams per serving
  • consume several servings of protein across the day, e.g. separated by 3 – 5 hours
  • consume one serving post resistance training if able

What About Protein Shakes?

Protein shakes can be a quick and easy way of consuming one of your servings when you’re pressed for time. It’s not a coincidence that many gyms sell them! If you do, make sure it contains at least 20g of protein. Just a note here, shakes shouldn’t replace meals. it’s super important to eat a healthy and varied diet and it’s wise to get most of your protein from whole food, which contains the other nutrients required that the body needs.

What Is High Quality Protein?

So, this again is a post in itself, and I certainly don’t profess to be a prof in nutrition! For an open access discussion on this topic, see here. The basic answer is that for a protein source to be useful it needs to be digestible and useable by the body and have a sufficient amount and variety of amino acids (the building blocks of protein) that the body needs. Albumin (egg white) is one of the most complete proteins, skimmed milk is also good and has shown similar effects as whey on MPS when taken post resistance training. Incidentally, for a review of the benefits of milk on human performance, check out my friend Dr Lewis James’ brilliant review article (abstract here). Whey protein drinks show consistently positive effects on MPS post-exercise (when at the correct dose) and casein is probably more effective for protein synthesis for a prolonged duration. Then there’s obviously the 1000s of other vegetable and animal sources. Be sure to check out the open access review above to read about the quality of various other dietary protein sources.

Summary

So, where does that leave us? Well, first a conversation about diet and protein intake is wise with patients who are undertaking a resistance training programme. But remember, if they’re new to exercise, probably best not to overload them in the first session – first get them to establish the new (rehab/training) behaviour first, and then broach diet. If you turn up talking weight lifting and protein shakes, they could get completely the wrong idea!

Then, a few basic principles to help optimise the effects of the resistance exercise as mentioned above. Get somewhere close to this and you’re doing a good job!

  • 1.4 – 2.0 grams of protein per kg of body weight per day
  • minimum 20 grams per serving
  • consume several servings of protein across the day, e.g. separated by 3 – 5 hours
  • consume one serving post resistance training if able

ONLINE COURSE

2 WEEKS TO GO!! Details of the Feb-March enrolment for the Strength & Conditioning For Therapists Online course are coming soon…!  Make sure you’re signed-up to receive the information

If you’ve downloaded the free 14-page S&C Guide for therapists, then you’re on the mailing list and you’ll be first to hear about the Online S&C course. Make sure you check your junk mail for our e-mails!

If you haven’t downloaded this guide, what are you waiting for? Over 1800 people are using it right now. Just click the link above and you’re good to go!

References

  • Carbone & Pasiakon (2019). Nutrients; 11(5):1136-
  • Jäger et al. Journal of the International Society of Sports Nutrition (2017) 14:20
  • Macnaughton et al. (2016). Physiol Rep, 4 (15).