First impressions are important, and a limp handshake is not a good calling card (1). It’s not particularly good news for you either, if you have one, because it is strongly associated with early death.
Research in this area initially focused on poor handgrip as a prognostic for cardiovascular disease (CVD), but it soon broadened out. Handgrip strength, commonly used as a measure of general muscular strength, has been shown in a series of prospective studies to be inversely associated with CVD, Type 2 diabetes, cause-specific mortality and all-cause mortality outcomes (2-12), plus the closely related conditions of sarcopenia (13) and osteoporosis (14).
Low handgrip strength will make you more likely to be hospitalized earlier in life, and once you have been admitted it is a good predictor of increased complications and hospital costs (15). It is also prognostic for more complications after surgery (16), and for increased mortality after age-related trauma such as hip fracture (17).
In short, the weaker your grip on the handrails of life, the faster you slip into the grave.
The links are fairly obvious. Physical activity improves health and life expectancy (18-27) via multiple mechanisms including enhanced cardiorespiratory, muscular and therefore metabolic fitness (19-27). Handgrip strength is merely the most accessible (and so most validated) measure of muscular fitness. It is significantly protective; in hypertensive subjects, a good handgrip neutralizes the increased risk of cardiovascular death (28).
I usually insert a few sentences early in each post moaning about how things are getting worse.
In keeping with this morbid tradition there is research showing that among Millenial men, handgrip strength has fallen by as much as 15% below the standards set by their rather more robust fathers (29). No longer hewers of wood and drawers of water, modern man is more likely to be a tapper on keyboards and a swiper on Tinder, and not only his grip strength but his entire physicality has degraded. Among Millenials, the ageing process is so accelerated that their major decline in health starts at an average age of 27, a full 5 years earlier than in Gen X’ers (30).
This physical deterioration is also seen in the increasing numbers of middle-aged and elderly with sarcopenia, sarcopenic obesity and osteoporosis (ie 31, 32). Importantly, these are slowly developing disorders. The pre-clinical phases of these conditions start much earlier in life (33, 34), and all the trends are negative.
Even paediatric sarcopenia is likely becoming more widespread, due to the progressive reduction of structured physical activity in schools. This is reflected in a generational and continuing loss of physical fitness in children and adolescents (35, 36). This potentially very serious problem urgently requires further study and remedial action (37).
There is better data for older age groups. The USA army, for example, is failing to get enough recruits into boots due to the shrinking pool of physically able American youth (38, 39). It is also losing 650,000 days of work / year among active-duty troops due to obesity-related health issues (39). Over 68% of active personnel are overweight or obese (39, 40), as are 80% of veterans (41).
If future warfare is going to be waged by mechanical rather than human drones, shrinking muscles and expanding waistlines may not matter militarily. However, they will beat health and life expectancy even further down than the 2 years loss we have seen caused by the criminally inept governmental handling of Covid (42), where lockdowns have reduced fitness even further (43-45).
So, what can the owner of the limp noodle or wet fish handshake do about it?
Firstly, go back in time and tell your mother that she needs to get into shape before thinking of getting pregnant. Maternal dysnutrition, inactivity and overweight create epigenetic changes that make babies prone to becoming overweight and developing metabolic, cardiovascular and other diseases in later life (46, 47).
This is partly because those babies will be born with reduced numbers of muscle fibers (48, 49), and as children and adults they will have reduced muscle mass and function (48-50). The crucial endocrine and metabolic functions of active and well-developed skeletal muscle will be impaired, and manifest as reduced handgrip strength and reduced health expectancy (51, 52).
For those who paradoxically still do not yet will have had no access to a time machine, nutrition and exercise is even more important. If you already have one or two epigenetic strikes against you, and live in a junk food-infested, sedentary and obesogenic environment, you won’t do well at all (46-52).
You don’t have to be fatalistic, however, because your future was not necessarily written in utero.
Bio-archeologists used to think that early life adversity as measured by ie linear dental enamel hypoplasias (tiny grooves around the tooth) was a near absolute determinant of life expectancy (ie 53), but research in modern and more fluid populations suggests that a poor start can be largely or completely nullified by a healthier later life (54).
Instead of waiting for a transplant, opt for a change of heart.
Move your diet in a low-carb direction, eschew ultra-processed foods and take short walking breaks during the work day (55). These three easy steps will provide significant protection against the problems caused by your parents and our pathogenic post-modern lifestyle. If you add a comprehensive pharmaconutritional program you will create your own Blue Zone, and jump onto an even longer health/time line.
For those interested in building muscle we can return once again (56) to intermittent fasting, or time-restricted eating.
We evolved in a world of food insecurity, as did all animals, and intermittent fasting, our default mode, creates a healthier metabolic profile. Short-term fasting raises testosterone (57) and growth hormone levels (58) in normal weight men, and has been linked to improvements in body composition (59). It has even been shown to improve cognitive function (60), at least in mice.
There is evidence that taking aerobic exercise during the fasting period is helpful, and that muscle building can be further accelerated using blood flow restriction training (61, 62), so here are another couple of easy steps you can take to grow new mitochondria and muscle (63), and unchain your inner Hercules.
We should also consider the positive side of oxidative stress.
Mitohormesis (mitochondrial hormesis) describes the induction of a favorable biological response via relatively low levels of oxidative stress applied in the mitochondria. This may improve mitochondrial function and/or numbers (mitochondrial biogenesis), depending on the nutritional and energetic context, and plays a central role in blood flow restriction training (64).
As oxidative stress is involved in mitohormesis, researchers are exploring the benefits of ionizing radiation (65-68). The positive clinical effects of low-dose X-rays are being proposed as a way to enhance patient mobility (65), and have been recorded in pain management (66) and in the treatment of Alzheimer’s (67, 68). Theoretically, they should also make you fitter.
Transoceanic flights are a more expensive but also more interesting way of being irradiated (69). Alternatively, Big Pharma is working on drug shortcuts to achieve mitohormesis and mitochondrial biogenesis (ie 70), but as with all drugs you can expect a plethora of exciting adverse effects.
Setting aside the dubious pleasures of X-rays, air rage and designer pharmaceuticals, I prefer to use food-based pharmaconutrition and recommend you to the mitohormetic effects of the epicatechin gallates from green tea (71). Excellent alternatives include the metformin-like (72, 73) alkaloid berberine from barberries (74), or the saponins from Gynostemma spp (745. They are available here (76) and here (77).
This is not just a vanity project. Sarcopenia and osteoporosis are waiting for you further down the road, and will eventually steal your health and independence if some other crisis doesn’t intervene. Preventative action now will push those problems many years into the future. And because brains and brawn work very much together, it will keep your mind sharper as well (78- 80).
If all you want to do is make a better first impression, a handgrip strengthener (81) might help.
Next week: Sunshine, shadows and sleep.
- Chaplin WF, Phillips JB, Brown JD, Clanton NR, Stein JL. Handshaking, gender, personality, and first impressions. J Pers Soc Psychol. 2000 Jul;79(1):110-7.
- Rolland Y, Lauwers-Cances V, Cesari M, Vellas B, Pahor M, Grandjean H. Physical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol. 2006;21(2):113–122.
- Sasaki H, Kasagi F, Yamada M, Fujita S. Grip strength predicts cause-specific mortality in middle-aged and elderly persons. Am J Med. 2007;120(4):337–342.
- Ruiz JR, Sui X, Lobelo F, Morrow JR Jr, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337(2):a439
- Celis-Morales CA, Lyall DM, Anderson J, Iliodromiti S, Fan Y, Ntuk UE, Mackay DF, Pell JP, Sattar N, Gill JM. The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants.Eur Heart J. 2017;38(2):116–122.
- Cooper R, Kuh D, Hardy R, Mortality Review Group. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:c4467.
- Zaccardi F, Franks PW, Dudbridge F, Davies MJ, Yates T. Mortality risk comparing walking pace to handgrip strength and a healthy lifestyle: a UK Biobank study. Eur J Prev Cardiol. [cited 2019 Nov 12]. DOI:10.1177/2047487319885041
- Leong DP, Teo KK, Rangarajan S and 22 others. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.Lancet. 2015;386(9990):266–273
- Bohannon RW. Grip strength: an indispensable biomarker for older adults.Clin Interv Aging. 2019;14:1681–1691.
- Karlsen T, Nauman J, Dalen H, Langhammar A, Wisloff U. The combined association of skeletal muscle strength and physical activity on mortality in older women: the HUNT2 study.Mayo Clin Proc. 2017;92(5):710–718.
- Farmer RE, Mathur R, Schmidt AF, Bhaskaran K, Fatemifar G, Eastwood SV, Finan C, Denaxas S, Smeeth L, Chaturvedi N. Associations between measures of sarcopenic obesity and risk of cardiovascular disease and mortality: a cohort study and Mendelian randomization analysis using the UK Biobank. J Am Heart Assoc. 2019;8(13):e011638.
- Laukkanen JA, Voutilainen A, Kurl S, Araujo CGS, Jae SY, Kunutsor SK. Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events. Ann Med. 2020 May-Jun;52(3-4):109-119.
- Moreira VG, Perez M, Lourenço RA. Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies. Clinics (Sao Paulo). 2019 Apr 8;74:e477.
- Lin YH, Chen HC, Hsu NW, Chou P, Teng MMH. Hand grip strength in predicting the risk of osteoporosis in Asian adults. J Bone Miner Metab. 2021 Mar;39(2):289-294.
- Guerra RS, Amaral TF, Sousa AS, Pichel F, Restivo MT, Ferreira S, Fonseca I. Handgrip strength measurement as a predictor of hospitalization costs. Eur J Clin Nutr. 2015 Feb;69(2):187-92.
- Mahalakshmi VN, Ananthakrishnan N, Kate V, Sahai A, Trakroo M. Handgrip strength and endurance as a predictor of postoperative morbidity in surgical patients: can it serve as a simple bedside test? Int Surg. 2004 Apr-Jun;89(2):115-21.
- Gutiérrez-Hermosillo H, de León-González ED, Medina-Chávez JH, Torres-Naranjo F, Martínez-Cordero C, Ferrari S. Hand grip strength and early mortality after hip fracture. Arch Osteoporos. 2020 Nov 21;15(1):185.
- Lear SA, Hu W, Rangarajan S and 25 others. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390(10113):2643–2654.
- Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.JAMA. 2009;301(19):2024–2035.
- Artero EG, Lee DC, Lavie CJ, Espana-Rivero V, Sui X, Church TS, Blair SN. Effects of muscular strength on cardiovascular risk factors and prognosis.J Cardiopulm Rehabil Prev. 2012;32(6):351–358.
- Hagnas MJ, Kurl S, Rauramaa R, Lakka TA, Makikallio TH, Savonen K, Laukkanen JA. The value of cardiorespiratory fitness and exercise-induced ST segment depression in predicting death from coronary heart disease.Int J Cardiol. 2015;196:31–33.
- Laukkanen JA, Makikallio TH, Rauramaa R, Kiviniemi V, Ronkainen K, Kurl S. Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study. J Am Coll Cardiol. 2010;56(18):1476–1483.
- Wolfe RR. The underappreciated role of muscle in health and disease.Am J Clin Nutr. 2006;84(3):475–482.
- Saeidifard F, Medina-Inojosa JR, West CP, Olson TP, Somers VK, Bonikowske AR, Prokop LJ, Vinciguerra M, Lopez-Jimenez F. The association of resistance training with mortality: A systematic review and meta-analysis. Eur J Prev Cardiol. 2019 Oct;26(15):1647-1665.
- Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022 Feb 28:bjsports-2021-105061.
- Nascimento W, Ferrari G, Martins CB, Rey-Lopez JP, Izquierdo M, Lee DH, Giovannucci EL, Rezende LFM. Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies. Int J Behav Nutr Phys Act. 2021 May 29;18(1):69.
- Stump CS, Henriksen EJ, Wei Y, Sowers JR. The metabolic syndrome: role of skeletal muscle metabolism.Ann Med. 2006;38(6):389–402.
- Liu W, Leong DP, Hu B, AhTse L, Rangarajan S, Wang Y, Wang C, Lu F, Li Y, Yusuf S, Liu L, Li W. The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension: Findings from the Prospective Urban Rural Epidemiology China Study. J Sport Health Sci. 2021 Dec;10(6):629-636.
- Fain E, Weatherford C. Comparative study of millennials’ (age 20-34 years) grip and lateral pinch with the norms. J Hand Ther. 2016 Oct-Dec;29(4):483-488.
- Ryu M, Jo J, Lee Y, Chung YS, Kim KM, Baek WC. Association of physical activity with sarcopenia and sarcopenic obesity in community-dwelling older adults: the Fourth Korea National Health and Nutrition Examination Survey. Age Ageing. 2013 Nov;42(6):734-40.
- Li JB, Wu Y, Gu D, Li H, Zhang X. Prevalence and temporal trends of presarcopenia metrics and related body composition measurements from the 1999 to 2006 NHANES. BMJ Open. 2020 Aug 5;10(8):e034495.
- Silva TLD, Mulder AP. Sarcopenia and poor muscle quality associated with severe obesity in young adults and middle-aged adults. Clin Nutr ESPEN. 2021 Oct;45:299-305.
- Bass MA, Sharma A, Nahar VK, Chelf S, Zeller B, Pham L, Allison Ford M. Bass MA, Sharma A, Nahar VK, Chelf S, Zeller B, Pham L, Allison Ford M. Bone Mineral Density Among Men and Women Aged 35 to 50 Years. J Am Osteopath Assoc. 2019 Jun 1;119(6):357-363.
- Tomkinson GR, Lang JJ, Tremblay MS. Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014. Br J Sports Med. 2019 Apr;53(8):478-486.
- Rajbhandari-Thapa J, Metzger I, Ingels J, Thapa K, Chiang K. School climate-related determinants of physical activity among high school girls and boys. J Adolesc. 2022 Jun;94(4):642-655.
- Ooi PH, Thompson-Hodgetts S, Pritchard-Wiart L, Gilmour SM, Mager DR. Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children? JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):407-418.
- Schvey NA, Barmine M, Bates D, Oldham K, Bakalar JL, Spieker E, Maurer D, Stice E, Stephens M, Tanofsky-Kraff M, Sbrocco T. (2017). Weight stigma among active-duty U.S. military personnel with overweight and obesity.Stigma and Health, 2(4), 281–291.
- Reyes-Guzman CM, Bray RM, Forman-Hoffman VL, Williams J. Overweight and obesity trends among active-duty military personnel: a 13-year perspective. Am J Prev Med. 2015 Feb;48(2):145-153.
- Nguyen XT, Quaden RM, Song RJ, Ho YL, Honerlaw J, Whitbourne S, DuVall SL, Deen J, Pyarajan S, Moser J, Huang GD, Muralidhar S, Concato J, Tsao PS, O’Donnell CJ, Wilson PWF, Djousse L, Gagnon DR, Gaziano JM, Cho K. Baseline Characterization and Annual Trends of Body Mass Index for a Mega-Biobank Cohort of US Veterans 2011-2017. J Health Res Rev Dev Ctries. 2018;5(2):98-107.
- Islam N, Jdanov DA, Shkolnikov VM, Khunti K, Kawachi I, White M, Lewington S, Lacey B. Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries. 2021 Nov 3;375:e066768.
- Valabhji J, Barron E, Gorton T, Bakhai C, Kar P, Young B, Khunti K, Holman N, Sattar N, Wareham NJ. Associations between reductions in routine care delivery and non-COVID-19-related mortality in people with diabetes in England during the COVID-19 pandemic: a population-based parallel cohort study. Lancet Diabetes Endocrinol. 2022 May 27:S2213-8587(22)00131-0.
- Deoni SC, Beauchemin J, Volpe A, Dâ Sa V; RESONANCE Consortium. Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health. medRxiv [Preprint]. 2021 Aug 11:2021.08.10.
- Cheng HP, Wong JSL, Selveindran NM, Hong JYH. Impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 and type 2 diabetes mellitus. 2021 Sep;73(3):499-506.
- Parlee SD, MacDougald OA. Maternal nutrition and risk of obesity in offspring: the Trojan horse of developmental plasticity. Biochim Biophys Acta. 2014 Mar;1842(3):495-506.
- Pullar J, Wickramasinghe K, Demaio AR, Roberts N, Perez-Blanco KM, Noonan K, Townsend N. The impact of maternal nutrition on offspring’s risk of non-communicable diseases in adulthood: a systematic review. J Glob Health. 2019 Dec;9(2):020405.
- Bayol SA, Bruce CR, Wadley GD (2014). Growing healthy muscles to optimise metabolic health into adult life. J Dev Orig Health Dis 5, 420–434.
- Brameld JM. The influence of undernutrition on skeletal muscle development. Br J Nutr 2004; 91: 327–8.
- Mikovic J, Lamon S. The effect of maternal metabolic status on offspring health: a role for skeletal muscle? J Physiol. 2018 Nov;596(21):5079-5080.
- Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body composition, and mortality. Int J Epidemiol 2007; 36: 228–35.
- Jaramillo PL, Gomez SG, Vanstrahlen Gonzales L, Zarate-Bernal D, Distefano K, Cohen D. The Interaction between Epigenetics, Muscle and CardioVascular Diseases. J Clin Epigenet. 2016, 1:1. & 2015, 1:7
- Boldsen JL. Early childhood stress and adult age mortality–a study of dental enamel hypoplasia in the medieval Danish village of Tirup. Am J Phys Anthropol. 2007 Jan;132(1):59-66.
- Amoroso A, Garcia SJ, Cardoso HF. Age at death and linear enamel hypoplasias: testing the effects of childhood stress and adult socioeconomic circumstances in premature mortality. Am J Hum Biol. 2014 Jul-Aug;26(4):461-8.
- Yates T, Edwardseon CL, Celis-Morales C and 14 others. Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study.(2020). J Gerontol. 75(1), 139-146
- Röjdmark S, Asplund A, Rössner S. Pituitary-testicular axis in obese men during short-term fasting. Acta Endocrinol (Copenh). 1989 Nov;121(5):727-32.
- Ho KY, Veldhuis JD, Johnson ML, Furlanetto R, Evans WS, Alberti KG, Thorner MO. (1988). Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man.The J Clin Invest 81(4), 968–975.
- Catenacci VA, Pan Z, Ostendorf D, Brannon S, Gozansky WS, Mattson MP, Martin B, MacLean PS, Melanson EL, Troy Donahoo W. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring). 2016 Sep;24(9):1874-83.
- Li L, Wang Z, Zuo Z. Chronic intermittent fasting improves cognitive functions and brain structures in mice. PLoS One. 2013;8(6):e66069.s
- Vechin FC, Libardi CA, Conceicao MS, Damas FR, Lixandrao ME, Berton RP, Tricoli VA, Roschel HA, Cavaglieri CR, Chacon-Mikahil MP, Ugrinowitsch C. (2015) Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly.The Journal of Strength & Conditioning Research 29, 1071-1076.
- Centner C, Zdzieblik D, Roberts L, Gollhofer A, König D. Effects of Blood Flow Restriction Training with Protein Supplementation on Muscle Mass And Strength in Older Men. J Sports Sci Med. 2019 Aug 1;18(3):471-478.
- Musci RV, Hamilton KL, Linden MA. Exercise-Induced Mitohormesis for the Maintenance of Skeletal Muscle and Healthspan Extension. Sports (Basel). 2019 Jul 11;7(7):170.
- Groennebaek T, Sieljacks P, Nielsen R, Pryds K, Jespersen NR, Wang J, Carlsen CR, Schmidt MR, de Paoli FV, Miller BF, Vissing K, Bøtker HE. Effect of Blood Flow Restricted Resistance Exercise and Remote Ischemic Conditioning on Functional Capacity and Myocellular Adaptations in Patients With Heart Failure. Circ Heart Fail. 2019 Dec;12(12):e006427.
- Vaiserman A, Cuttler JM, Socol Y. Low-dose ionizing radiation as a hormetin: experimental observations and therapeutic perspective for age-related disorders. 2021 Apr;22(2):145-164.
- Donaubauer AJ, Becker I, Weissmann T, Fröhlich BM, Muñoz LE, Gryc T, Denzler M, Ott OJ, Fietkau R, Gaipl US, Frey B. Low Dose Radiation Therapy Induces Long-Lasting Reduction of Pain and Immune Modulations in the Peripheral Blood – Interim Analysis of the IMMO-LDRT01 Trial. Front Immunol. 2021 Oct 12;12:740742.
- Chung M, Rhee HY, Chung WK. Clinical Approach of Low-Dose Whole-Brain Ionizing Radiation Treatment in Alzheimer’s Disease Dementia Patients. J Alzheimers Dis. 2021;80(3):941-947.
- Cuttler JM, Abdellah E, Goldberg Y, Al-Shamaa S, Symons SP, Black SE, Freedman M. Low Doses of Ionizing Radiation as a Treatment for Alzheimer’s Disease: A Pilot Study. J Alzheimers Dis. 2021;80(3):1119-1128.
- Mohler SR. Galactic radiation exposure during commercial flights: is there a risk? 2003 Apr 29;168(9):1157-8.
- Valero T. Mitochondrial biogenesis: pharmacological approaches. Curr Pharm Des. 2014;20(35):5507-9.
- Xiong LG, Chen YJ, Tong JW, Gong YS, Huang JA, Liu ZH. Epigallocatechin-3-gallate promotes healthy lifespan through mitohormesis during early-to-mid adulthood in Caenorhabditis elegans. Redox Biol. 2018 Apr;14:305-315.
- De Haes W, Frooninckx L, Van Assche R, Smolders A, Depuydt G, Billen J, Braeckman BP, Schoofs L, Temmerman L. Metformin promotes lifespan through mitohormesis via the peroxiredoxin PRDX-2. Proc Natl Acad Sci U S A. 2014 Jun 17;111(24):E2501-9.
- Herzig S, Shaw RJ. AMPK: guardian of metabolism and mitochondrial homeostasis. Nat Rev Mol Cell Biol. 2018 Feb;19(2):121-135.
- Zhu X, Bian H, Wang L, Sun X, Xu X, Yan H, Xia M, Chang X, Lu Y, Li Y, Xia P, Li X, Gao X. Berberine attenuates nonalcoholic hepatic steatosis through the AMPK-SREBP-1c-SCD1 pathway. Free Radic Biol Med. 2019 Sep;141:192-204.
- Ha TKQ, Pham HTT, Cho HM, Tran VO, Yang JL, Jung DW, Williams DR, Oh WK. 12,23-Dione dammarane triterpenes from Gynostemma longipes and their muscle cell proliferation activities via activation of the AMPK pathway. Sci Rep. 2019 Feb 4;9(1):1186.
- Tsui CK, Dishart JG, Dillin A. Brains and brawn: Stress-induced myokine abates nervous system aging. Cell Metab. 2021 Jun 1;33(6):1067-1069.
- Rai M, Coleman Z, Curley M, Nityanandam A, Platt A, Robles-Murguia M, Jiao J, Finkelstein D, Wang YD, Xu B, Fan Y, Demontis F. Proteasome stress in skeletal muscle mounts a long-range protective response that delays retinal and brain aging. Cell Metab. 2021 Jun 1;33(6):1137-1154.e9.
- Gomez-Pinilla F, Hillman C. The influence of exercise on cognitive abilities. Compr Physiol. 2013 Jan;3(1):403-28.