A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation

ARTICLE| VOLUME 25, ISSUE 9, 104869, SEPTEMBER 16, 2022 PDF [3 MB] Figures Save Share Reprints Request A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation Marc T. Hamilton 3 Deborah G. Hamilton Theodore W. Zderic Show footnotes Open AccessPublished:August 04, 2022DOI:https://doi.org/10.1016/j.isci.2022.104869 PlumX Metrics Previous Article Inferring potential landscapes from noisy trajectories of … Next Article Transcriptome-wide association study of HIV-1 acquisition … Highlights Summary Graphical abstract Subject area Introduction Results Discussion STAR★Methods Data and code availability Acknowledgments Supplemental information References Article Info Figures Tables Related Articles Highlights • We developed a method to capitalize upon the unique phenotype of the soleus • “A high quality versus large quantity perspective” for muscle activation • Singular movement targeting the 1 kg soleus easily sustains oxidative metabolism • This method provides a distinct muscular activity stimulus for metabolic control Summary Slow oxidative muscle, most notably the soleus, is inherently well equipped with the molecular machinery for regulating blood-borne substrates. However, the entire human musculature accounts for only ∼15% of the body’s oxidative metabolism of glucose at the resting energy expenditure, despite being the body’s largest lean tissue mass. We found the human soleus muscle could raise local oxidative metabolism to high levels for hours without fatigue, during a type of soleus-dominant activity while sitting, even in unfit volunteers. Muscle biopsies revealed there was minimal glycogen use. Magnifying the otherwise negligible local energy expenditure with isolated contractions improved systemic VLDL-triglyceride and glucose homeostasis by a large magnitude, e.g., 52% less postprandial glucose excursion (∼50 mg/dL less between ∼1 and 2 h) with 60% less hyperinsulinemia. Targeting a small oxidative muscle mass (∼1% body mass) with local contractile activity is a potent method for improving systemic metabolic regulation while prolonging the benefits of oxidative metabolism. Graphical abstract Figure thumbnail fx1 Hamilton, MT. et al. (2022) iScience. ' A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation

View Large ImageFigure ViewerDownload Hi-res imageDownload (PPT) Subject area Health sciences Physiology Human metabolism Introduction By ∼2010 over half of American adults and 80% of those >65 years old had either prediabetes or diabetes (Menke et al., 2015; Xia et al., 2022). There is also currently a high prevalence of prolonged sitting between 9 and 11 h/day (Craft et al., 2012; Healy et al., 2015; Matthews et al., 2018; van der Berg et al., 2016) at a low metabolic rate during seated behaviors (Newton et al., 2013), especially in people who are at high risk for age-associated metabolic diseases such as metabolic syndrome and type 2 diabetes (van der Berg et al., 2016). Even in nondiabetics, postprandial glucose concentration in the 60–120 min range of an oral glucose tolerance test (OGTT) has often been described as one of the strongest independent metabolic risk factors for chronic disease because of linkages to Alzheimer disease (Kakehi et al., 2018; Ohara et al., 2011), neuropathies (Buysschaert et al., 2015; Papanas et al., 2011), dyslipidemia (DeFronzo and Abdul-Ghani, 2011; Festa et al., 2004), and cardiovascular conditions (DeFronzo and Abdul-Ghani, 2011; Succurro et al., 2009). Of concern, glucose tolerance is relatively difficult to improve by a meaningful amount during most therapies, including after substantial amounts of weight loss or exercise (Jansen et al., 2022; King et al., 1995; Knudsen et al., 2014; Magkos et al., 2016; Rose et al., 2001; Ross et al., 2000, Ross et al., 2015; Slentz et al., 2016). There is no doubt that inactive muscle fibers require little energy (Dela et al., 2019; Kelley et al., 1994; Rolfe and Brown, 1997) and that the whole-body oxidative metabolism is low throughout many hours of the day when sitting with inactive muscles (Newton et al., 2013); this may be one of the most fundamental yet overlooked issues guiding the way toward discovering metabolic solutions to assist in preventing some age-associated chronic diseases. During periods of inactivity, skeletal muscle accounts for only ∼15% of the whole-body postprandial glucose oxidation in nondiabetic controls of similar age and BMI as in the present studies (Kelley et al., 1994), despite being the body’s largest lean tissue mass (∼21–31 kg in women and men) (Heymsfield et al., 2022). Consistent with this, multiple studies using the arteriovenous balance method of the lower limb have calculated that the oxygen consumption (VO2) of inactive muscle is ∼1–2 mL/min/kg Dela et al., 2019; Kelley et al., 1994; (Rolfe and Brown, 1997). Therefore, during acute inactivity, the muscle-mass-specific VO2 (in units of mL/min/kg muscle) is even less than the modest value of ∼3.0–3.5 mL/min/kg body weight for the basal metabolic rate lying down or during prolonged sitting throughout the day in a whole room calorimeter (Newton et al., 2013). Thus, contrary to a common notion, even though skeletal muscle is the body’s largest lean tissue mass, it is unlikely the dominant contributor to the oxidative metabolism of either glucose or lipids when sitting at resting energy expenditure. The prevailing perspective (mostly from epidemiology) has been that there is a whole-body metabolic rate threshold that must be exceeded to induce a robust gain in metabolic health responses. Furthermore, the specific muscles recruited and types of contractile activity have largely been disregarded in human research. Taking a step back, we took a more physiological perspective in the current experiments. Herein, we tested the direct and immediate effects of sustaining a high duration of elevated oxidative muscle metabolism when sitting. We used 2 guiding principles in our approach. First and foremost, as described earlier, the energy demand is minimal in resting muscle fibers. Therefore, mitochondrial oxidative phosphorylation is capped at a relatively low ceiling during inactivity (Dela et al., 2019; Kelley et al., 1994; Rolfe and Brown, 1997). Related to this, the elevated energy demands and fuel requirements for carbohydrate oxidation quickly come to an end when an exercise bout ends (Horton et al., 1998; Wasserman et al., 1991). For these reasons, there is a need for understanding the biochemical effects of sustaining an elevated rate of oxidative metabolism by skeletal muscle, but with a subtle rate of whole-body energy expenditure. Second, slow oxidative muscle has multiple intrinsic molecular and phenotypic features favoring specialization in prolonged contractile activity, in part because of the capacity for using more blood-borne fuels and hypothetically less glycogen in some physiological conditions; this is supported by animal (Bey and Hamilton, 2003; Cartee et al., 2016; Deshmukh et al., 2021; Halseth et al., 1998; James et al., 1985; Mackie et al., 1980; McDonough et al., 2005; Terry et al., 2018) and human (Deshmukh et al., 2021; Gollnick et al., 1974a, Gollnick et al., 1974b; Jensen et al., 2012; Johnson et al., 1973; Murgia et al., 2021) studies that have long described the heterogeneous qualities between different fiber types within a muscle and between different muscles. The soleus has a greater predominance of slow-oxidative fibers (∼88% of the soleus mass is type I slow-twitch fibers) than 36 other human muscles that have also been fiber typed (Johnson et al., 1973). The soleus is a slow-twitch postural muscle that has motor neurons and other features favoring a lower threshold of effort needed to recruit it for more time and intensity than other limb muscles (Hodgson et al., 2005; Monster et al., 1978). Compared with other leg muscles, highly controlled studies in rodents have found the soleus has a phenotype favoring more uptake of both plasma TG (Bey and Hamilton, 2003; Mackie et al., 1980) and blood glucose (Halseth et al., 1998; James et al., 1985). It has distinctive vascular features enhancing delivery of blood-borne fuels and oxygen (McDonough et al., 2005), relatively high levels of hexokinase II and GLUT4 (Jensen et al., 2012), and a relatively low concentration of glycolytic enzymes and glycogen phosphorylase (Gollnick et al., 1974a, Gollnick et al., 1974b). However, walking can cause rapid rates of glycogen depletion in the soleus as in other muscles (Jensen et al., 2012). Therefore, it is far from certain whether there is an effective physiological approach to capitalize on the phenotype of this slow oxidative muscle to improve systemic lipid and glucose metabolism. The scientific challenges and potential impact of developing a method for raising oxidative metabolism locally by a small tissue is perhaps best understood in light of the already much more established scientific interest (Chen et al., 2020) in activating another small tissue with an oxidative phenotype, brown adipose tissue (BAT). The soleus (Bey and Hamilton, 2003; Halseth et al., 1998; James et al., 1985; Jensen et al., 2012; Mackie et al., 1980; Petersen et al., 2003; Song et al., 1999) and BAT (Chondronikola et al., 2014; McNeill et al., 2020) are both tissues making up too small a percentage of total body mass to alter energy expenditure unless methods are developed to cause an intense local metabolic activation. Yet under some conditions, both might possibly be equipped with a phenotype favoring exceptional metabolic rates over prolonged periods of time. The specific questions we posed are analogous to the hurdles already faced in BAT research; how can people consistently activate tissue specific oxidative metabolism at a meaningful rate to increase whole-body oxygen consumption and then sustain it for hours at a time? Even if methods were developed to make that possible, would raising the local metabolic rate by a small mass of tissue be sufficient to impact systemic metabolic parameters as complex as very-low-density lipoprotein (VLDL)-TG concentration and postprandial glucose tolerance? This work was part of an effort to develop a method of muscular contractile activity specifically geared for sustaining the possible distinct benefits of oxidative metabolism for prolonged periods, instead of sitting with inactive muscle at a low metabolic rate. The present experiments were designed to test the potential physiological influence of the human soleus muscle during hours of prolonged contractile activity. Results Overview of participants and experimental approach to raise muscle metabolism As outlined below and described in more detail in the STAR Methods and supplemental information, participants included an equal number of male and female volunteers with a wide range of BMI, age, sedentary time, and habitual daily steps (Table S1). With regard to free-living sedentary time and activity profiling (Table S1), the volunteers were representative of the populations we and others studied with objective wearable tracking devices (Barreira et al., 2016; Matthews et al., 2018; van der Berg et al., 2016). Free-living activity assessment showed an average of 10.7 ± 2.1 h/day sitting time (mean ± SD) with a range of 6–14 h/day. These studies focused on understanding the responses from local contractile activity of slow oxidative muscle when the total energy expenditure was relatively close to resting metabolic rate (∼0.5–1.5 kcals/min above rest, or ∼1.3–2.0 metabolic equivalents [METs, 1 MET = 3.5 mL oxygen/kg/min]; Figure S1 and Tables 1 and 2). This was accomplished by developing and testing a special type of isolated plantarflexion activity targeting the soleus when sitting (Figure S2), to increase the oxygen consumption from local contractile activity as described in the STAR Methods and supplemental information (Figures S3 and S4). For clarity and brevity, we use the term SPU, or “soleus push up,” for this specific type of plantarflexion because the relatively high soleus electromyography (EMG) on-time (i.e., soleus activation) coincided with upward angular motion of the ankle (Figures S2, S4, and S5). Table 1Metabolic rate and glycogen use during local contractile activity with SPU contractions Experiment I Sedentary control SPU contractions p-value Energy expenditure during SPU contractions METs 0.92 ± 0.04 2.03 ± 0.08 8 × 10−8 AEE (Δ kcal/min during contractions) — 1.51 ± 0.15 4 × 10−6 % increase whole-body energy expenditure during muscle contractions — 124 ± 9 3 × 10−7 Muscle glycogen concentration (mmol/kg) Vastus lateralis at the final biopsy 96 ± 6 92 ± 6 0.601 Soleus at the first biopsy (130 min contractions) 91 ± 5 76 ± 5 0.183 Soleus at the final biopsy (270 min contractions) 90 ± 5 68 ± 5 0.007 % of AEE contributed by soleus glycogen — 4.1 ± 1.0 0.003 Mean ± SEM. Glycogen contribution to activity energy expenditure (AEE) was based on 3.75 kcal per gram of monomeric glucose units derived from glycogen if completely oxidized. The soleus mass averaged 1.07 ± 0.25 kg (combined mass in both legs) in these 10 participants. The calculation of the % of the total AEE contributed by soleus glycogen during 270 min of contractions was calculated as described in the STAR Methods. The full aerobic combustion of 22 mmol/kg (90–68 mmol/kg) of glycogen would provide about 16 kcal for the combined 1.07 kg soleus muscles. To determine if the energetics of SPU contractions were different than when sitting inactive (control), the results were analyzed with paired t tests. To determine the effect of SPU contractions on soleus glycogen, a mixed effects model with Tukey’s multiple comparison tests was used, because comparisons of control versus contractions were performed at two time points (130 and 270 min). See also Experiment I results in Figures S1 and S8 and Table S2. Open table in a new tab Table 2Metabolic rate and carbohydrate oxidation during the 3-h oral glucose tolerance test Experiment II Sedentary control SPU1 SPU2 p-value SED vs SPU1 SED vs SPU2 SPU1 vs SPU2 METs 0.86 ± 0.05 1.31 ± 0.07 1.69 ± 0.12 5 × 10−8 3 × 10−6 9 × 10−6 AEE (Δ kcal/min) --- 0.60 ± 0.05 1.12 ± 0.11 2 × 10−8 3 × 10−6 4 × 10−6 Energy exp. (kcal/3 h) 207 ± 11 315 ± 16 402 ± 24 2 × 10−8 4 × 10−6 8 × 10−6 Total AEE (Δ kcal/3 h) --- 108 ± 9 (+36 kcal/h) 201 ± 19 (+67 kcal/h) 2 × 10−8 3 × 10−6 4 × 10−6 RER (VCO2/VO2) 0.84 ± 0.02 0.88 ± 0.01 0.90 ± 0.02 0.019 0.003 0.112 Total carbohydrate oxidation (mg/min) 135 ± 18 276 ± 14 392 ± 25 1 × 10−6 4 × 10−6 0.0002 Δ mg/min above control --- 141 ± 16 253 ± 26 1 × 10−6 5 × 10−6 0.0002 Total in 3 h (g) 24.2 ± 3.2 49.7 ± 2.5 70.6 ± 4.6 1 × 10−6 4 × 10−6 0.0002 Δ above control (g) --- 25.5 ± 2.9 (2.1 fold) 45.5 ± 4.6 (2.9 fold) 1 × 10−6 5 × 10−6 0.0002 Soleus carbohydrate oxidation (Δ mg/min) --- 113 ± 13 202 ± 21 1 × 10−6 5 × 10−6 0.0002 Mean ± SEM. Metabolic rate and carbohydrate oxidation during the postprandial period following the ingestion of 75 g glucose. Each individual performed a sedentary control and one or both of the levels of local contractile activity. The delta (Δ) is the difference between sedentary control and activity. Differences between conditions were determined by a mixed effects model followed by Tukey’s multiple comparison tests. N = 15 for SPU1 effects and N = 10 for SPU2. See also Experiment II results in Figure S1 and Table S2. Open table in a new tab Figure S6 provides a schematic overview to summarize the tests performed in two related experiments, each examining effects caused by raising the local energy expenditure with this type of soleus dominant plantarflexion. In the first experiment, we obtained 60 muscle biopsies from the soleus and vastus lateralis (VL) for measuring glycogen, which led us to determine in the second experiment the effects of sustaining this type of muscle metabolism in a 13-point OGTT after ingesting a 75-gram glucose load in a diverse group of 15 men and women. SPU contractions induce minimal soleus glycogen depletion Volunteers all responded well to the prolonged contractile activity and did not experience fatigue or other adverse responses to the prolonged contractile activity, such as cramps, joint pain, or muscle soreness. It is important to note that volunteers in Experiment I (Table S1) were typically sedentary (verified with an objective tracking device), and none of them had a high aerobic cardiorespiratory fitness (determined by treadmill VO2max or the maximal oxygen consumption test). In Experiment I, the SPU contractions increased the rate of total body energy expenditure from an average of 0.93 ± 0.04 METs to 2.03 ± 0.08 METs during the acute activity (Table 1). A more detailed analysis of the muscle mass and analysis of the rate of oxygen consumption (VO2) by the working muscle mass is provided in another section below. Glycogen was measured in the VL on each test day as a control for an inactive muscle during this local activity (Table 1). Moreover, when sitting inactive, the average soleus muscle glycogen was steady between the first and final biopsy (91 versus 90 mmol/kg). Together these findings show there was not significant uncontrolled day-to-day variation, and as expected, glycogen was stable in an inactive muscle during SPU contractions. The soleus glycogen concentration was reduced an average of 22 mmol/kg (90 to 68 mmol/kg) because of the 270 min of SPU contractions, which corresponded to a net rate of glycogen use of 0.080 ± 0.017 mmol/kg/min. The more certain rate between the two biopsies on the active day was similarly low at 0.053 ± 0.032 mmol/kg/min, but it was not significantly different from 0 (p = 0.130). Glycogen had not reached statistical significance after 130 min of contractions (p = 0.183). The concentration difference was significant at 270 min (Table 1). However, the net soleus glycogen reduction was equivalent to 4% of the 403 kcals total AEE (Table 1 and Figure 1). Consistent with that, theoretical calculations show that the high local energy demand could not have been sustainable for long as a result of the potential energy from soleus glycogen. Even in the extreme theoretical scenario of 100% glycogen depletion, aerobic combustion of all soleus glycogen can provide no more than 65 kcals (90 mmol/kg x 1.07 kg soleus x 0.675 kcal/mmol = 65 kcals) of the actual total 403 kcals or ∼5 kcals if the glycogen was broken down for nonoxidative glycolytic ATP production. The lack of a sensation of local fatigue or rising effort over time is consistent with minimal glycogen depletion. Figure thumbnail gr1 Figure 1Minimal contribution from soleus glycogen to the total energy for contractions (the activity energy expenditure) during prolonged local activity of the soleus with SPU contractions Show full caption View Large ImageFigure ViewerDownload Hi-res imageDownload (PPT) SPU contractions reduce VLDL-TG while raising fat and carbohydrate oxidation We measured the increase in total body fat and carbohydrate oxidation during the SPU contractions and compared this to when sitting inactive on the sedentary control test day. Furthermore, we determined if this method of local contractile activity would decrease VLDL-TG (and the total number of VLDL particles in plasma). There is strong prior evidence that acute activity/inactivity is a direct determinant of plasma-lipoprotein-derived TG uptake because of local mechanisms in the microcirculation of muscle, as shown with radioactive tracer studies in rats (Bey and Hamilton, 2003; Hamilton et al., 1998; Mackie et al., 1980). Fat and carbohydrate oxidation were increased in each individual during the SPU contractions (Figure S7); this was when the average respiratory exchange ratio (RER) was 0.78 ± 0.01 during the inactive test day and 0.80 ± 0.01 during SPU contractions (not statistically different). SPU contractions caused a significant VLDL-TG decrease (Figure S8). The triglyceride content (Figure S8) and number of VLDL particles (Figure S8 inset) within all 3 sizes of VLDL in the circulation were responsive. Most of the TG was contained in the large particles (Figure S8), even though most of the particles were small (Figure S8 inset). SPU contractions are a method to induce and maintain a relatively high local rate of oxygen consumption (VO2/min/kg muscle) during prolonged contractile activity A fundamental principle in exercise physiology is that a small muscle mass working in isolation can achieve a higher local oxygen consumption (VO2/min per kg) than when recruiting a large muscle mass (Cardinale et al., 2019). For example, the VO2 in the whole lower limb musculature in young ultra-endurance athletes reached almost 200 mL/min/kg during exhaustive cycling in a VO2max test and a significantly greater maximal local rate of ∼350 mL/min/kg by the quadriceps during intense isolated leg extensions (Cardinale et al., 2019). Thus, to better describe the effects of elevated oxidative metabolism on soleus glycogen, measurements of muscle mass were also obtained in Experiment I. These 10 individuals were also studied during treadmill exercise because that is a large muscle mass modality requiring compound movements across all of the joints and muscle groups in the lower limbs. The muscle mass of the entire lower limb (14.8 ± 1.1 kg) was estimated from the appendicular lean mass (minus bone) from dual-energy X-ray absorptiometry (DEXA) for when comparing energetic calculations described later. The mass of the soleus and other triceps surae (TS) muscles was directly measured from magnetic resonance imaging (MRI). The soleus was significantly larger than the two gastrocnemius muscles; soleus 1.07 ± 0.08, lateral gastrocnemius (LG) 0.169 ± 0.02, medial gastrocnemius (MG) 0.350 ± 0.02 kg. The soleus was 1.34% of body weight and 67% of the triceps surae, which was similar to previous MRI results of apparently healthy men and women (Kolk et al., 2015). The soleus dominated the recruited mass of the TS muscle group even more when calculated as the product of the anatomical mass and the percentage recruitment (percent EMGmax); the soleus accounted for ∼80% of the recruited mass with SPU contractions (Figure 2B ). The estimated 20% contribution by the gastrocnemius is potentially an overestimate because, unlike the soleus, the gastrocnemius is a 2-joint muscle crossing the knee and ankle joints. The energetic contribution from the gastrocnemius is markedly suppressed by bending the knee and thereby demanding a significantly greater energy contribution from the soleus (Niess et al., 2018; Price et al., 2003). The gastrocnemius remains in a flaccid position while the soleus is contracting intensely if the knee is bent during ankle plantarflexion (Kawakami et al., 1998). The soleus also has a highly pennated architecture favoring greater amounts of muscular work during plantarflexion than predicted by mass alone, giving it a physiological cross-sectional area that is exceptionally high (3–8 times more than most of the 20 other limb muscles studied) (Ward et al., 2009). Because of these reasons, the exact contribution by the soleus can be underestimated by estimates from only the anatomical mass. There are other smaller muscles in the lower leg that might offset the gastrocnemius estimates. Therefore, ∼80% of the increased energy demand above rest is the best estimate we have for calculating the local soleus oxidative metabolism of substrates during SPU contractions. Figure thumbnail gr2 Figure 2Whole-body and local oxidative metabolism during SPU contractions when sitting and during treadmill exercise Show full caption View Large ImageFigure ViewerDownload Hi-res imageDownload (PPT) The estimated soleus VO2 during the prolonged SPU contractions averaged 237 ± 21 mL/min/kg (80% of the delta VO2 divided by the soleus anatomical mass; Figure 2C). Furthermore, because the soleus accounts for most of the TS anatomical mass in these individuals (1.07 of the 1.59 kg), the soleus VO2 would only be slightly reduced to 197 ± 17 mL/min/kg if the oxygen consumption were distributed evenly across the entire TS muscle group. The rate of total body energy expenditure during moderate walking and SPU contractions was obviously much less than running (Figure 2C inset). However, the local soleus VO2/kg during SPUs was greater than the average muscle VO2/kg of the lower limb muscle mass during treadmill exercise (Figure 2C). The estimated VO2 of the lower limb musculature was 108 ± 10 mL/min/kg muscle during the last stage before exhaustion, assuming 75% of the increase in total body oxygen consumption is in the lower limbs at the end of the VO2max test (Cardinale et al., 2019). This same approach calculated that moderate-intensity walking at 3 METs consumed an estimated 30 ± 1 mL/min/kg for the lower limb musculature. From this, VO2/kg in the lower limb during walking is roughly ∼13% of the soleus VO2/kg during the 4.5 h of SPU contractions. In summary, the rate of total body energy expenditure from aerobic metabolism (kcals/min calculated from total body VO2) was by design lower when working the small muscle mass than using a large muscle mass while briefly running at VO2max (Figure 2C inset). Most importantly, though, these findings demonstrate the human soleus of untrained adults is capable of sustaining a high local rate of oxygen consumption in parallel with a low amount of glycogen depletion during prolonged contractile activity. SPU contractions improve postprandial glucose tolerance Table 2 describes the postprandial metabolic rate after ingesting a 75-gram glucose load when sedentary or at two levels of SPU contractions. Before beginning contractions, the fasted glucose values were not different (Table 3). Then, beginning early in the postprandial period and lasting until the final time point of the 180-min test, both levels of contractions resulted in sustained reductions in glucose concentration (Table 3 and Figures S10A and S10B). These effects were evident in both SPU test days. In SPU2, the average glucose concentration was reduced significantly by 19 mg/dL already at 30 min (Table 3) and trending to decrease 10 mg/dL in SPU1. The largest treatment effect over a 60-min period (averaging 5 consecutive measurements of each individual) was 50 ± 6 mg/dL in SPU2. Statistically significant differences lasted until at least 180 min. The separation in glucose concentration between the sedentary control and activity trials expanded up until ∼75–135 min (Table 3); this coincides with about the time frame most commonly studied when relating glucose to clinically meaningful pathologies (Buysschaert et al., 2015; DeFronzo and Abdul-Ghani, 2011; Festa et al., 2004; Kakehi et al., 2018; Ohara et al., 2011; Papanas et al., 2011; Succurro et al., 2009). Table 3Effect of sustaining local muscle metabolism on glucose concentration at each time point Time SPU1 effect at each time point SPU2 effect at each time point minutes N = 15 Control SPU1 Δ mg/dL N = 10 Control SPU2 Δ mg/dL 0 99 ± 2 101 ± 2 NS, p = 0.524 99 ± 3 102 ± 4 NS, p = 0.416 15 132 ± 5 123 ± 4 NS, p = 0.061 132 ± 7 124 ± 5 NS, p = 0.427 30 167 ± 6 157 ± 5 NS, p = 0.092 166 ± 7 147 ± 7 −19 ± 6∗ 45 190 ± 7 167 ± 7 −22 ± 5∗∗ 193 ± 6 165 ± 7 −28 ± 8∗ 60 201 ± 8 169 ± 8 −33 ± 7∗∗∗ 206 ± 6 163 ± 7 −43 ± 7∗∗∗ 75 198 ± 8 164 ± 8 −34 ± 8∗∗ 207 ± 4 159 ± 7 −47 ± 6∗∗∗∗ 90 192 ± 9 157 ± 7 −34 ± 7∗∗∗ 198 ± 4 151 ± 7 −48 ± 8∗∗∗ 105 186 ± 10 155 ± 6 −31 ± 6∗∗∗ 191 ± 4 142 ± 6 −49 ± 7∗∗∗∗†† 120 175 ± 9 146 ± 6 −29 ± 6∗∗∗ 182 ± 5 136 ± 5 −46 ± 7∗∗∗†† 135 165 ± 10 134 ± 8 −31 ± 6∗∗∗ 176 ± 6 128 ± 5 −48 ± 6∗∗∗∗†† 150 146 ± 11 121 ± 8 −25 ± 9∗ 154 ± 11 116 ± 7 −38 ± 8∗∗ 165 129 ± 11 106 ± 7 −24 ± 10 137 ± 13 103 ± 9 −34 ± 9∗∗ 180 117 ± 10 97 ± 7 −20 ± 7∗ 121 ± 13 92 ± 9 −29 ± 8∗∗ Mean ± SEM. Effects of SPU contractions were determined by a mixed effects model followed by Tukey’s multiple comparison tests. ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001, ∗∗∗∗p < 0.0001 versus sedentary control; †p < 0.05, ††p < 0.01 for SPU2 versus SPU1. N = 15 for SPU1 effects and N = 10 for SPU2. The zero time point was always taken when in the overnight fasted state and sitting inactive before the 3-h 75-g OGTT. See also Figures S10A and S10B for the graphical depiction of the time course for glucose concentrations for these results in Experiment II. Open table in a new tab Significant improvements in the total 3-h glucose incremental area under the curve (iAUC) (Figure 3A ) were found in both men and women, and in younger and older adults, and after segregating the subjects by other common ways of categorizing participants such as by BMI categories and if they were more or less habitually active than the average person (Table 4). Some participants in Experiment II had never exercised regularly in their past. Some others had been competitive athletes. However, all had noticeably more hyperglycemia during the acute sitting at a low metabolic rate and improved glucose tolerance by SPU contractions (Figure 3A and Table 4); this demonstrates there is an apparent biochemical robustness in realizing the immediate benefits of this type of muscle metabolism. Although we did not observe a trend between sexes or other groups (Table 4), one should be cautious when interpreting the relative effectiveness in subcategories until follow-up studies with larger sample sizes are performed. Figure thumbnail gr3 Figure 3Sustaining elevated muscle metabolism with soleus contractions is sufficient to cause improved glucose tolerance and reduced postprandial hyperinsulinemia, with up to a 52%–60% reduction in the blood glucose and insulin iAUC Show full caption View Large ImageFigure ViewerDownload Hi-res imageDownload (PPT) Table 4Three-hour postprandial glucose tolerance (iAUC) after subdividing participants Characteristics Mean Range N % iAUC SPU1 Effect p-value Interaction p-value Females 8 −39.8 ± 3.9 0.00002 0.804 Males 7 −38.5 ± 3.4 0.00003 Youngest (years) 38 22–51 7 −39.2 ± 3.2 0.00002 0.986 Oldest (years) 68 56–82 8 −39.2 ± 4.0 0.00002 Lower BMI 23.3 19.7–27.8 8 −37.9 ± 3.4 0.00001 0.602 Obese BMI 34.3 29.2–42.9 7 −40.7 ± 4.0 0.00005 Lowest habitual sitting time (h/d) 9.0 6.7–10.6 7 −39.4 ± 4.5 0.0001 0.939 Highest habitual sitting time (h/d) 12.0 10.9–13.9 8 −39.0 ± 3.0 0.000004 Lowest habitual steps (step/day) 4,365 2,061–5,544 8 −37.5 ± 3.3 0.000009 0.484 Highest habitual steps (step/day) 7,922 5,828–10,843 7 −41.2 ± 4.0 0.00005 Normal fasting glucose (mg/dL) 94 91–99 8 −37.9 ± 3.8 0.00002 0.595 Impaired fasting glucose (mg/dL) 108 102–115 7 −40.7 ± 3.5 0.00002 The 15 participants were divided according to the above characteristics to compare the % change in the glucose iAUC caused by SPU1 compared with when sitting inactive in Experiment II. Two-tailed paired t tests were used to determine if the % change in glucose iAUC caused by SPU1 (versus sedentary control) was significant in each subdivision (bolded column). The participant characteristic by activity level interaction was determined with a mixed effects model to determine if there was a difference in the iAUC response to SPU1 within each subdivision pair (far right column). From this analysis, we conclude that there was no evidence to suggest men were different than women for the glucose response to SPU1 nor were there any significant characteristic by activity level interactions for the other 5 characteristics. Mean ± SEM. See also Experiment II demographics in Table S1. Open table in a new tab SPU contractions reduce postprandial hyperinsulinemia and insulin secretion For the insulin as well as the glucose iAUC (Figures 3C and 3D), the Cohen’s d effect size (ES) was in the statistical category of “huge” (Sawilowsky, 2009) for both levels of muscle metabolism (SPU1 mean −41% and 3.8 ES; SPU2 mean −60% and 4.9 ES). By the 3rd hour, the average insulin concentration differences between the active and inactive state (Figures S10C and S10D) had expanded further to −50% (SPU1) and −71% (SPU2). These results indicate a progressively greater percentage effect of contractions over time on insulin, especially when examining the SPU2 effect. The trend over time indicates the insulin reduction (compared to sedentary control) would last longer than 3 h had the test been extended (Figures S10C and S10D). Therapies impacting postprandial metabolism are difficult to compare without evaluating both hyperglycemia in tandem with hyperinsulinemia because exposure to both impacts glucose uptake by body tissues additively or synergistically. Thus, in a simple index we computed the average of both glucose and insulin iAUC relative to the SED control. There was a large magnitude of effect in both SPU levels studied (Figure 3E). From these findings below, the reduction in insulin concentration was likely in part due to reduction in pancreatic insulin secretion. Overall, the C-peptide response was strongly correlated with the glucose effects (r = 0.81, p = 0.00003), as were the insulin effects (r = 0.65, p = 0.002). The C-peptide iAUC was reduced 30 ± 3% (p = 0.00002) by SPU1 and 44 ± 6% (p = 0.0003) by SPU2. Thus, there are other systemic responses of this type of sustained muscle metabolism beyond improved glucose concentration per se. SPU contractions increase carbohydrate oxidation during the OGTT We calculated the rate of carbohydrate oxidation during the OGTT in each individual (Figure 4A ) from VO2 and RER as summarized in Table 2. The individual results illustrate carbohydrate oxidation when inactive in the postprandial period and the consistently greater rate during SPU contractions in everyone (Figure 4A). Figure thumbnail gr4 Figure 4Recruitment during locally intense activation of a small mass dominated by the soleus consistently has the capability to raise whole-body carbohydrate oxidation above the rest of the body Show full caption View Large ImageFigure ViewerDownload Hi-res imageDownload (PPT) From the averages, the cumulative whole-body carbohydrate oxidation was about 24, 50, and 71 grams within the 3 h after ingesting the 75 g glucose load for the sedentary control, SPU1, and SPU2, respectively (Table 2 and Figure 4B). This local SPU contractile activity was sufficient to more than double carbohydrate oxidation and raise this source of fuel utilization higher than in the rest of all the tissues in the body combined (Figure 4B). Kelley’s study (Kelley et al., 1994) of nondiabetic subjects at a similar age and BMI as in the present study directly measured skeletal muscle carbohydrate oxidation in the whole leg at rest, and the rate by muscle was estimated at ∼0.7 mg/min/kg muscle (Kelley et al., 1994). This rate would be undetectable in a small muscle mass of 1 or even 2 kg, which would obviously be too small to cause a measurable influence on the total carbohydrate oxidation when inactive (see the Figure 4B model). This small muscle mass actively increased the rate 141 mg/min by SPU1; this corresponds to a rate of 113 mg/min by the 1.07 kg soleus, assuming 80% of the increase in carbohydrate oxidation was by the local muscle contraction. Therefore, any potential effect of the soleus muscle phenotype on postprandial carbohydrate oxidation would likely be undetectable at rest and would be magnified substantially by raising the local energy demand and VO2; this is illustrated in a simple model (Figure 4B) of 3 body compartments (a small recruited muscle mass, a much larger whole-body muscle mass, and the rest of the body). Taken together, these findings clearly demonstrate that the SPU contractions were magnifying the normally low rate of carbohydrate oxidation by a small mass of muscle, to the point that it becomes the most dominant tissue for carbohydrate oxidation in the entire body for the 3 h after ingesting glucose (Figure 4B). The sustained oxidative muscle metabolism concept: An integrative physiology model for understanding the impact of contractions on carbohydrate oxidation and glucose tolerance To reiterate, glucose regulation was improved by sustaining the local rate of oxidative metabolism during a relatively small increase in total body energy expenditure (Figure S1). Restraining the rate of total body energy expenditure was a way of minimizing systemic homeostatic disturbances such as an increase in catecholamines, which not only increases heart rate but also may be required for high rates of glycogenolysis during isolated soleus contractions (Richter et al., 1982). The small heart rate and blood pressure responses were a clear indication of a negligible systemic neurohumoral stress response to this type of contractile activity. The respective heart rate in SED, SPU1, and SPU2 was 73 ± 6, 79 ± 8, and 89 ± 7 beats/min; systolic blood pressure was 116 ± 6, 123 ± 4, and 124 ± 6 mmHg; and diastolic blood pressure was 77 ± 4, 78 ± 4, and 77 ± 3 mmHg. To put this in perspective, the total body energy demand of 1.3 METs (Table 2) ensured that the total body rate of energy expenditure was definitely less than the historical 3 MET minimal threshold often historically believed to be required for prevention of prediabetes and diabetes (Colberg et al., 2016). In fact, it is even below the threshold that behaviorists have used to define nonsedentary time (>1.5 METs). But are these low rates of total body energy expenditure and thereby low rates of carbohydrate oxidation theoretically sufficient to explain the large systemic glucose concentration differences? To address this, we analyzed the glucose lowering using the simplest possible mathematical model. The delta blood glucose was 33 mg/dL lower between SPU1 and control at 60 min (Table 3). Thereafter, this concentration difference between the active and inactive state remained in steady state (Table 3). Therefore, the grams of glucose accumulated in the blood and the rest of the extracellular distribution volume (Vd) can be calculated from a mass balanced equation. The Vd pool size is approximately equal to blood volume and interstitial fluid, or 230 mL/kg body weight (Livesey et al., 1998), which is ∼186 dL. The Vd accumulated 33 mg/dL less glucose during SPU1 in the first hour. On average, the Vd accumulated glucose at a 102 mg/min slower rate because of SPU1 contractions (33 mg/dL x 186 dL in 60 min). Therefore, the observed differences in glucose concentration required a physiological process to slow the rate of glucose accumulation by at least 102 mg/min. The observed increase in whole-body carbohydrate oxidation caused by SPU1 contractions above sedentary control averaged 141 mg/min (Table 2). The observed decrease in the insulin concentration during contractions (Figure 3) would obviously tend to attenuate the blood glucose reductions because of less insulin-dependent glucose uptake in various body tissues. Finally, the contractile-activity-dependent increase in glucose oxidation by the soleus muscle was calculated for SPU1 at 113 mg/min (Table 2). In conditions when intramuscular glycogen is not the predominant fuel for contractile activity, there is less competition with alternative substrates, including blood glucose. Therefore, from the findings we propose a model in which glucose tolerance can be rapidly improved by a large magnitude while sustaining a subtle, yet proportionate increase in carbohydrate oxidation, but this is under specific conditions when the recruited muscle fibers do not rely mostly on intramuscular glycogen to fuel contractions. Discussion These results indicate that the human soleus muscle is capable of raising, and sustaining for hours, the local rate of oxidative metabolism to high levels. From a physiological perspective, this kind of contractile activity was effective at improving systemic metabolic regulation quickly and by a biochemically meaningful amount to improve glucose regulation (Figure 3), even at the lowest SPU intensity studied (SPU1; Tables 2, 3, and 4 and Figure 3). Furthermore, the high level of endurance of the soleus during SPU contractions provides a tool for reversing the otherwise slow rate of muscle metabolism during long periods of inactivity (Dela et al., 2019; Kelley et al., 1994; Rolfe and Brown, 1997). We are unaware of any existing or promising pharmaceuticals that come close to raising and sustaining whole-body oxidative metabolism at the magnitude in the current study (Tables 1 and 2), including drugs that may activate BAT (Loh et al., 2019). A beta-3 agonist given at double the Food and Drug Administration (FDA)-approved dose increased energy expenditure in 3 h, but by only an average of ∼8.5 kcal/h (Loh et al., 2019). By comparison, SPU contractions were capable of raising the energy demand 10-fold greater (91 kcal/h above control during the 270 min of activity in our first experiment; Table 1), without any evidence of progressive fatigue or other physiological limitations in the unfit individuals studied (Table 1). We learned that through this method of contractile activity specifically geared for sustaining oxidative metabolism, only an extra 100–200 mg/min of local carbohydrate oxidation (Table 2) by a small muscle mass was potent enough to improve glucose regulation by a large amount after ingesting a large glucose load (Table 3). As described more later, carbohydrate oxidation increases profoundly during the acute minutes of relatively heavy whole-body exercise. However, there is not compelling evidence to believe that either in humans or animal models, carbohydrate oxidation remains elevated by even a small amount in the hours after ending an acute exercise bout (Horton et al., 1998; Wasserman et al., 1991). There was not an increase in carbohydrate oxidation after large muscle mass exercise within subgroups of people who had a significant excess post-exercise oxygen consumption (EPOC) (Horton et al., 1998). This finding of no increase in post-exercise carbohydrate oxidation above sedentary control levels was also demonstrated when experimentally changing the insulin concentration over a wide range (Wasserman et al., 1991). There is a competition at the cellular level between various substrates to supply the necessary energy for contractions. During exercise, muscle glycogen is generally the primary carbohydrate to fuel contractions and often accounts for about 72%–95% of the carbohydrate oxidation when it is available in normal concentrations (Bergman et al., 1999; Helge et al., 2007; Horowitz et al., 1999); this is observed even with lower intensity exercises such as cycle ergometry at 20%–30% of VO2 max (Gollnick et al., 1974a, Gollnick et al., 1974b) or quadricep extensions at 25% of the local VO2 peak (Helge et al., 2007). During isolated knee extensions at a local VO2 of 190 mL/min/kg muscle (when roughly comparable to SPU contractions in Figure 2C), the VL muscle depleted twice as much glycogen in 35 min (Helge et al., 2007) as the soleus did during 270 min of SPU contractions (Table 1); this is consistent with the possibility that with SPU contractions, the soleus may in some conditions deplete glycogen at a rate 10–15 times slower than the VL muscle of the thigh during knee extensions (Helge et al., 2007) or cycling (Bergman et al., 1999; Gollnick et al., 1974a, Gollnick et al., 1974b). A thorough review by Sylow and Richter concluded that blood glucose accounts for only ∼10%–18% of the energy during the time frame of a typical exercise session (Sylow et al., 2017). By comparison, these types of large muscle mass exercises (Bergman et al., 1999) potentially increase the total carbohydrate oxidation more than 10-fold greater than SPU contractions (Table 2). With cycle ergometry at ∼5 METs for 1 h, the rate of total carbohydrate oxidation was ∼1600 mg/min (Bergman et al., 1999), which was many times greater than SPU contractions could induce; this is also consistent with the carbohydrate oxidation in another study during 60 min of moderate intensity cycling combined with glucose ingestion (Horowitz et al., 1999). However, once glycogen is accounted for, the remaining carbohydrate oxidation due to blood glucose by the entirety of both legs during cycling was ∼180 mg/min (Bergman et al., 1999), which was relatively similar to the estimated rate of carbohydrate oxidation by the working soleus muscle during SPU contractions (Table 2). Prior work has suggested that when recruiting a smaller instead of a larger mass of muscle, there may be a shift in the relative reliance on fuels from glycogen to utilization of more lipids (Helge et al., 2007) and/or more blood glucose (Richter et al., 1988) to fuel contractions. A plausible hypothesis is the intrinsic metabolic phenotype of the soleus (Bey and Hamilton, 2003; Gollnick et al., 1974a, Gollnick et al., 1974b; Halseth et al., 1998; Hodgson et al., 2005; James et al., 1985; Jensen et al., 2012; Mackie et al., 1980; McDonough et al., 2005; Monster et al., 1978) requires less glycogen to fuel contractions, especially when there is not epinephrine stimulation (Richter et al., 1982). As described below, in addition to local muscle glycogen use, there are also systemic processes that tend to offset the ability of contractions to attenuate postprandial hyperglycemia during and after large muscle mass exercise (Devlin et al., 1989; Hamilton et al., 1996; Knudsen et al., 2014; Maehlum et al., 1978; Steenberg et al., 2020). Results from many studies support the concept that it is often difficult to improve postprandial glucose tolerance. Studies have identified specific mechanistic explanations for why oral glucose tolerance is generally not improved (Devlin et al., 1989; Hamilton et al., 1996; Knudsen et al., 2014; Maehlum et al., 1978; Rose et al., 2001) or even made worse (Flockhart et al., 2021; Knudsen et al., 2014; Rose et al., 2001) in the hours following traditional types of exercise that would rely predominantly on muscle glycogen as the source of carbohydrate. Those observations include people with normal glucose tolerance (Flockhart et al., 2021; Knudsen et al., 2014; Rose et al., 2001) to people with diabetes (Knudsen et al., 2014). The mechanistic explanations to date include compelling evidence of increased insulin resistance within the unrecruited muscle fibers after exercise sessions (Devlin et al., 1989; Steenberg et al., 2020), elevated rates of glucose appearance into the bloodstream (Hamilton et al., 1996; Knudsen et al., 2014; Maehlum et al., 1978), and also possible impairment of intrinsic mitochondrial function from intense exercise training (Flockhart et al., 2021). In studying the chronic effects of exercise training, a landmark study reported that there was a modest 13 mg/dL decrease in the 2-h glucose without a significant improvement in the entire AUC; this only occurred when doubling the recommended weekly volume of exercise training combined with a vigorous intensity (7 METs) and nutritional conditions, allowing for a 4.6 cm reduction in waist circumference (Ross et al., 2015). Other carefully controlled studies showed unequivocally no reduction in the 2 h glucose (or AUC) with progressive weight loss of 5%, 11%, or even 16% (Magkos et al., 2016); this was confirmed in another large experimental weight loss study after inducing 15% weight loss (Jansen et al., 2022). Nevertheless, given that carbohydrate oxidation is not elevated after an acute exercise session ends, the post-exercise glucose utilization by muscle is apparently restricted to the nonoxidative pathways. Therefore, as described next, there has been the need to better understand the immediate and direct effects of contractile activity. The present study tested the effects of sustaining continuous contractile activity, at two levels of energy demand, throughout the entire 3-h postprandial period. The contractions were already attenuating glucose concentration quickly within the first 30 min when glucose was still rising (Table 3). Thereafter, the glucose improvements continued to increase and remained significantly lower than the sedentary control level throughout the entire 3-h postprandial time course. Earlier studies also found that activity involving a large muscle mass (cycle ergometry at 59%–67% HRmax) completed after 45 min of the postprandial period transiently blunted the rise in blood glucose and insulin during the contractions (Aadland and Hostmark, 2008). However, this effect was short-lived and evident only between 30 and 45 min of the postprandial period, followed by significantly greater hyperglycemia than the inactive sitting trial after exercise stopped. Similarly, Kanaley’s group (Holmstrup et al., 2014) found that subjects with low glucose tolerance were able to decrease the hyperglycemia during 60 min of exercise (60%–65% VO2max). After stopping the exercise, the blood glucose increased above the level when they never exercised, and thus the total postprandial iAUC was not improved (Holmstrup et al., 2014). Although an intermittent exercise pattern slightly improved the glucose iAUC compared with the 60 min bolus of exercise, spreading out the contractile activity with brief breaks did not reduce the glucose iAUC compared with sitting inactive in their volunteers who had low glucose tolerance as the present participants (Holmstrup et al., 2014). That said, it is important to understand that as previously emphasized, there are distinct molecular and physiological processes impacting metabolic regulation with specific inactivity/activity approaches (Bey and Hamilton, 2003; Hamilton et al., 1998, Hamilton et al., 2004, Hamilton et al., 2007, Hamilton et al., 2014; Zderic and Hamilton, 2012). Here we have focused on a method of raising slow oxidative muscle metabolism to complement (not replace) existing approaches. Prolonged sitting has become ubiquitous across the lifespan (Craft et al., 2012; Healy et al., 2015; Matthews et al., 2018; van der Berg et al., 2016) and is not significantly less in regular exercisers (Craft et al., 2012). But it is important to remember that regardless of whether ∼45 min of activity is administered as many separate brief breaks or as a single daily bolus, it mathematically increases the energy demand for muscular work for only ∼5% of the waking day. Thus, currently recommended activity approaches are a not a direct solution for a high amount of time when skeletal muscle has a low muscle metabolism. A large number of studies have focused on “brief breaks” from sitting inactive, e.g., 2–5 min activity breaks each half hour or 6 min once each hour (Henson et al., 2020; Larsen et al., 2015; Loh et al., 2020; Thorsen et al., 2019). What may be missed is that brief breaks are, by definition, brief amounts of contractile activity and thus only brief periods to potentially benefit from oxidative metabolism. A systematic review has reported that lifestyle interventions replacing sitting time with standing and/or brief walking breaks have decreased sitting time on average only 30.4 min/day (Peachey et al., 2020). That said, a promising early study reported that taking 3 brief interruptions each hour to walk at 2 mph (∼3 METs) may reduce the blood glucose by approximately 5, 15, and 6 mg/dL at 1, 2, and 3 h respectively, with the average insulin concentration (based on AUC) reduced by about 12% (Larsen et al., 2015). In a thorough recent study, no differences were observed for plasma glucose or insulin with any of the 3 patterns of walking breaks to interrupt inactive sitting in men with abdominal obesity (Thorsen et al., 2019). Henson et al., 2020 summarized results when combining 4 large postprandial lab studies and concluded that the glucose and insulin were not decreased by standing versus sitting in the postprandial period. Also, the brief walking breaks generally reduced glucose <10 mg/dL and thus were physiologically small and/or nonsignificant in some large categories of people (e.g., no statistical influence in males) (Henson et al., 2020). Physiological studies relevant to this found that muscle glucose uptake appears to have a relatively slow time course at the onset of some types of contractile activity (Bergman et al., 1999; Horowitz et al., 1999; Mossberg et al., 1993). In studying the time course in the human lower limb musculature during cycling, there was no increase in glucose uptake in the leg after either 5 or 15 min of continuous contractions, and significant responses were not evident until after 30 min (Bergman et al., 1999). Taken together, there is a biochemical basis for the need to develop methods to understand and benefit biochemically from prolonged contractile activity. The literature is understandably filled with language about designing programs to “engage as much skeletal muscle mass as possible” and the necessity of “a sufficient amount of muscle mass” (Ivy et al., 1999; Laughlin, 2016). The findings presented here do not in any way interfere with traditional exercise programs for their own distinct benefits. There are hundreds of skeletal muscles and many microvascular and metabolic exercise training adaptations that are restricted to the recruited muscles (Laughlin, 2016). Thus, it is understandable that the paradigm for glucose management and other cardiometabolic outcomes has focused less on the quality of contractile activity than on the quantity of recruited muscle and raising the total metabolic rate to higher levels for short exercise bouts (e.g., 150 min/week). The Diabetes Prevention Program (DPP) and other recommendations either implied or explicitly stated that health-enhancing metabolic effects may require an energy expenditure in the >3 MET range (Knowler et al., 2002). The current findings obviously are inconsistent with the notion that all contractile activity near ∼1.3 or ∼1.7 METs is a “stepping stone” to the goal of exercising at >3 METs (Dunstan et al., 2021). All of this points to the “specificity principle” that is a key axiom in exercise physiology (Hamilton et al., 2007, Hamilton et al., 2014). Applied here, it means that the phenotype of the muscles recruited, and the duration of the elevated metabolic rate, will determine the distinct biochemical processes that regulate the effectiveness of physical activity. There have more recently been national guidelines proposing that people sit less and/or move more in addition to traditional methods of exercise (Dunstan et al., 2021). Unfortunately, this advice is still lacking in specifics about how to reduce sedentary time enough for the most meaningful health gains. The rapid and large decreases in skeletal muscle TG uptake observed in rodent inactivity physiology studies (Bey and Hamilton, 2003; Hamilton et al., 2007) have been heavily cited by epidemiologists and clinical trials specialists to provide biological plausibility to understand the observational associations of diseases related to sedentary time. What has been overlooked is the same publications cited to provide the biological plausibility for why muscular inactivity is unhealthy also alluded to a potential solution; those studies were primarily based upon the large local molecular and biochemical responses in the soleus muscle (in rodents) that are dependent on prolonged contractile activity (Bey and Hamilton, 2003; Bey et al., 2003). The present findings provide evidence that the human soleus muscle has the potential to contribute to systemic metabolic regulation. Finally, it might prove to be that the most interesting hypothesis raised by these results is that the human soleus, although only ∼1% of body weight, can sustain a sufficient metabolic rate for an impressive duration and improve glucose and lipid metabolism. Others have demonstrated significant beneficial correlations between the slow-red oxidative fiber type and chronic disease states (Gaster et al., 2001; Hickey et al., 1995). There has been interest in applying molecular biology techniques to therapeutically enhance the quality of skeletal muscle by increasing the amount of slow oxidative muscle fibers (Gan et al., 2013). It is important to note that the results were obtained from adults across the lifespan (22–82 years of age) and with a wide BMI range and habitual physical activity levels (Table 4). Findings reveal that the human soleus of these ordinary people was already physiologically capable of producing these responses. Looking back, studies in the 1870–1880s by Ranvier described the soleus remarkably well as a red muscle with curvy capillaries that is relatively slowly contracting and fatigue resistant, even when the muscle was obtained from highly sedentary animals such as the domesticated rabbits and cats (Ranvier, 1873, Ranvier, 1880). The SPU method is specifically geared for sustaining positive effects of prolonging an elevated muscle metabolism for hours (not minutes), but with a very subtle increase in whole-body energy expenditure while sitting (Figure S1). This low effort method by a muscle that is naturally geared toward prolonged contractile activity may avoid the potentially serious deleterious cardiac effects of prolonged endurance training in some people or the impairment of mitochondrial function after training with excessive exercise intensity (Eijsvogels et al., 2016; Flockhart et al., 2021). Many other questions will need to be addressed in order to understand the full translational potential. One understandable viewpoint is that prolonged periods of elevated muscle metabolism is an unrealistic expectation. Another perspective is that it is an opportunity for gaining the distinct health effects of elevating muscle metabolism by a biochemically meaningful amount. Limitations of the study (1) This study was not a clinical trial. This was an experimental physiological study, conducted in highly controlled laboratory conditions. This study also did not test effectiveness of a free-living lifestyle intervention. The underlying distinct cellular stimuli and systemic metabolic responses during this approach for local muscular exercise have potential to complement other unique types of activity that typically involve a large muscle mass, different kinds of muscle contractions, and a lower duration of activity. The development of the SPU contraction method provides a unique physiological method that has never been tested before to raise and sustain muscle metabolism (for hours, not minutes). The present study does raise more than one translational hypothesis for the field to test. First, this method provides muscle physiologists with an opportunity to determine the effects of prolonged and locally intense contractile activity on muscle plasticity and response to high duration stimuli. Second, interdisciplinary clinical trials specialists in related fields who study diabetes, resting energy expenditure, skeletal muscle, exercise, and sedentary behavior may find the present results impactful for informing their new research ideas. One should be cautious when interpreting the relative effectiveness in subcategories until follow-up studies with a large sample size are performed. The practicality will also depend on implementation in large parts of the population. The practicality will depend in part on evidence that people are capable of successfully performing SPU contractions outside of a laboratory without EMG feedback. There is a need to test when this could be integrated within the lifestyle without disrupting various seated behaviors. (2) These studies only identified some of the immediate responses to SPU contractions. There is a need to describe the additional longer-term cumulative effects of an intervention in people living with a higher rate of muscle metabolism. (3) Muscle glycogen utilization was not measured in Experiment II (during the glucose tolerance test). Therefore, we did not test for the interaction of hyperglycemia and SPU contractions on glycogen use by the soleus. However, it has already been established multiple times that feeding a moderate-to-large glucose load does not increase the reliance on muscle glycogen to fuel contractions, and more expectedly sometimes there is a tendency for glucose ingestion to modestly attenuate contraction-induced muscle glycogen reductions (Akerstrom et al., 2006). Also see Criteria for selection of the metabolic intensity in Experiment II in the STAR Methods. (4) Interrogating glucose kinetics with tracers and catheterization of an artery and vein in the legs for A-V balance measurements would be insightful to further test the model proposed herein. A catheterization study would also be informative to measure the peak VO2 during SPU contractions. The VO2 measurements we did obtain were always at a submaximal intensity that could be sustained with a low effort in order to avoid biasing the results when using stabilizer muscles while straining during an intense performance test. (5) We cannot discern from the current findings how SPU contractions are impacting either the endogenous or exogenous (ingested) glucose disposal, the effect of SPU contractions on the rate of appearance of blood glucose relative to the rate of glucose disappearance, and how the parallel decrease in plasma insulin is attenuating glucose uptake by insulin-dependent tissues (e.g., resting skeletal muscle in the arms while the leg muscles are doing SPU contractions). (6) One may find it tempting to generalize the effects we found to other modes and doses of activity. However, these results were limited to when performing a specialized type of contractile activity. Other types of “low effort” activity do not necessarily activate the soleus muscle metabolism enough to cause the same magnitude as demonstrated in the present experiments (Gao et al., 2017; Pettit-Mee et al., 2021; Thorp et al., 2014). Other types of activity may also rely more heavily on muscle glycogen and/or may stimulate systemic processes that tend to be counteractive to glucose lowering (Helge et al., 2007; Richter et al., 1988). One well-designed study reported that although standing continuously over a 2-h OGTT can raise EMG in the large muscles of the lower body, it did not reduce glucose at all compared with sitting inactive (Gao et al., 2017). STAR★Methods Key resources table REAGENT or RESOURCE SOURCE IDENTIFIER Biological samples Human blood samples This study N/A Human skeletal muscle biopsies This study N/A Critical commercial assays Insulin ELISA Mercodia 10-1113-01 C-peptide ELISA Millipore Sigma EZHCP-20K Infinity Glucose Hexokinase Reagent Thermo Scientific TR15421 EDTA BD Vacutainer BD 368857 Software and algorithms EMG Works Delsys Version 4.5 Prism statistics GraphPad Version 8.4.3 Excel Microsoft For Microsoft 365 Other True One 2400 Parvo Medics N/A Biopsy needles with suction (5 mm) Micrins INS122-5 Treadmill Sole F85 Trigno EMG system Delsys N/A Electrogoniometer with two ends connected by composite wire with a series of strain gauges Biometrics SG110 activPAL PAL Technologies Model 3 Blood pressure monitor Omron and Tango HEM-FL31 and M2 3.0T MRI Scanner GE Medical Systems N/A iDXA GE Healthcare Lunar N/A Open table in a new tab Resource availability Lead contact Further information and requests for resources should be directed to the lead contact, Dr. Marc Hamilton (mhamilton7@uh.edu). Materials availability This study did not generate new unique reagents. Experimental model and subject details Human subjects Informed consent was obtained before participation. Research conformed to the standards set by the Declaration of Helsinki and was approved by the appropriate Institutional Review Boards at the Pennington Biomedical Research Center and the University of Houston. There were in total 25 human volunteers in 2 sequential experiments, each using a randomized cross-over design so that individual participants could serve as their own internal control (Figure S6). Recruitment was aimed at providing an equal distribution of sexes, with a moderately wide range in age, BMI, sedentary time, and free-living activity level. The ranges and means for each descriptive characteristic are provided in Table S1. Details about inclusion/exclusion are included in the Method Details below for each of these experiments. Method details Soleus SPU contractions Both experiments utilized the same type of isolated plantarflexion that was done when sitting comfortably in normal chairs. This specific type of plantarflexion depended predominantly on the soleus muscle with some assistance from the gastrocnemius muscles (Figures S3 and S4). Secondly, unlike isometric plantarflexion contractions more commonly studied, this was an isotonic soleus activation that coincided with the angular motion of the ankle only when the ankle was moving upwards (Figure S4). Thus, to not overgeneralize from this to other types of plantarflexion and for brevity, the movement is described as an SPU, or “soleus push up”. See also the introduction of the Results for a summary of the supplemental figures for and Table 1 describing the participants. One primary intent was to limit the rise in total body energy expenditure to be well below the lower threshold of 3 METs defining “moderate intensity activity”. To that end, Experiment I tested the SPU contractions corresponding to ∼2 METs. Experiment II tested SPU contractions at ∼1.3 and ∼1.7 METs. The direct comparison of the whole-body energy expenditure of SPU contractions with treadmill exercise is described in Figure S1. Additional rationale and methods for testing this metabolic rate are described in more detail below. This singular movement by a small mass of muscle was isolated from other muscle groups typically used for large weight bearing compound movements like walking. The effects of this muscular activity were tested only while sitting comfortably. The feet were positioned on the floor and under the knees so that the knees were bent (Figure S2). The starting angle of the ankle was ∼70–90 degrees (90 degrees defined as when the tibia and sole of the foot are at a right angle). This type of plantarflexion movement was performed without adding external resistance beyond the weight of the leg (Figure S2). That avoided the necessity of using a resistance device while also minimizing potential muscle fatigue and tension-induced strain on soft tissues. Furthermore, the soleus contribution was accentuated during the seated plantarflexion because the knee was always bent, such that the metatarsophalangeal joint (MTP joint) in the foot was below the knee. The MTP joint was bending in concert with the plantarflexion of the ankle joint. When the knee is bent, the soleus contributes more to the work of plantarflexion as the gastrocnemius recruitment and energy demand is reduced compared to when the limb is straight (Cresswell et al., 1995; Kawakami et al., 1998; Niess et al., 2018; Price et al., 2003). Measurement of the soleus EMG provided instantaneous feedback to guide the intensity of soleus contractions and help teach how to effectively raise the local metabolic rate with this type of contractile activity (Figure S3). We had no difficulty teaching volunteers in either Experiment I or II how to do the local contractile activity in generally 1–2 sessions, especially with the assistance of the soleus EMG. Subjects were all consistently able to learn how to sustain a soleus EMG that is markedly greater than possible when doing treadmill walking. We found it was productive to instruct participants to focus mostly on raising the range of motion (ROM) (Figure S5) of the ankle plantarflexion in order to raise the soleus EMG intensity and VO2 (Figure S3B). Raising the rate was a less effective strategy (Figure S5). Notice in the examples of a male and female in Figure S5, when the ROM was doubled from a low level of 15 degrees to a moderate level of 30 degrees, the soleus EMG predictably doubled in these 2 volunteers. However, notice also that when the rate was doubled (from 50 to 100 contractions/min), the soleus EMG increased less than predicted. Furthermore, we found from experience that it could be counterproductive for volunteers to focus too much on using the rate as their guide for soleus activation, because raising the rate often caused an involuntary reduction in the ROM and VO2 response. In summary, we found it effective to provide EMG feedback while instructing participants to select a moderate ROM in order to comfortably maintain their desired level. A developmental study that proved to be instructive in perfecting the methods revealed a close relationship between soleus EMG and the contractile activity VO2 (Figure S3B). In 10 volunteers, the soleus EMG was incrementally increased in 6–10 min stages while measuring the steady-state VO2 responses within the last 3 min of each stage. The participants were instructed to begin at what was perceived as a very low ROM. The steady-state VO2 responses were measured when they raised the soleus EMG to progressively higher levels. A total of 42 measurements were obtained and the linear relationship between soleus EMG and the contractile activity VO2 response above sitting inactive is illustrated (Figure S3B). In summary, both experiments involved testing a subtle elevation in whole body metabolic rate above resting by contractile activity while sitting, and EMG feedback with direct measurements of oxygen consumption assisted in guiding the activity. Experiment I Participants Volunteers (Table S1) were recruited from a combination of newspaper and other types of advertising to interest the kind of participants who often avoid participation in a physical activity study. It was explained that this work may add knowledge about raising metabolic rate throughout much of the day, distinct from traditional exercises. Exclusion criteria included orthopedic or cardiovascular limitations prohibiting a safe treadmill VO2 max test, conditions contraindicating biopsies, and an inability to have an MRI. Protocol and procedures A total of 60 muscle biopsies were obtained for understanding the soleus glycogen responses of relatively intense local contractile activity from 10 somewhat unfit/untrained individuals (5 men and 5 women). Each subject served as their own control, for both an active and an inactive test day (always while sitting). Except for the activity, the sedentary control test was identical to the active test in all respects including the diet and activity before the testing. In addition to biopsies on each day, a blood sample was also obtained prior to the final biopsy for testing the effect of this small muscle mass activity on VLDL-TG concentration. The purpose of this first experiment was to study substrate metabolism over a prolonged duration of SPU contractions instead of inactive sitting. The habitual free-living sedentary time was measured in the current participants as described in detail below (see ActivPAL device). Most people in modern times have at least 7–8 h per day of sedentary time as determined with objective activity monitors in the USA and other developed nations (Craft et al., 2012; Healy et al., 2015; Matthews et al., 2018; van der Berg et al., 2016). One day participants sat inactive for 7–8 h. During the active SPU trial, subjects never sat inactive for more than 4 min at a time while accumulating 270 min of SPU contractions (Figure S6). Although these individuals were sedentary, they were instructed not to do any intentional moderate to vigorous exercise for at least 3 days prior to testing in order to avoid potentially glycogen lowering exercise. In order to help reduce possible variability in glycogen concentration leading into each test day, participants walked 30 min on a treadmill at a comfortable 2 mph pace the evening prior to the testing days (under supervision) and then fed the standardized dinner meal (also under supervision). Standardized meals were provided for all 3 meals the day prior to testing in addition to the small breakfast on the test day. The study was timed so that a blood sample for measuring VLDL-TG and then the final biopsy were obtained about 7–8 h after a small, controlled breakfast (7 kcal/kg, 33% carbohydrate, 14% protein, and 53% fat) which was provided 12–14 h after an overnight fast. Because these were among the first participants studied with this type of prolonged contractile activity and they were generally not accustomed to exercise, we asked them repeatedly to tell us if there was any type of discomfort from the contractions, including cramps, a progressive sense of muscle fatigue, joint pain, etc. and none of those type of adverse events was ever encountered. After enrolling participants, we incorporated time for preliminary testing for them to become familiar with the testing procedures, including how to correctly and reproducibly do the SPU motion with real time EMG feedback. (Figure S3A). In the preliminary testing, the participants walked for several minutes on the treadmill and then practiced until they could confidently sustain an EMG level that was always greater than the soleus EMG when walking (typically about twice the soleus EMG of walking and sometimes more). Experience showed that by raising the ROM, the soleus EMG could be maintained at a markedly greater level than when instead focusing on increasing the rate of contractions (Figure S5). In the preliminary testing and on the actual test days, oxygen consumption (VO2) and carbon dioxide (VCO2) production were measured at least every 30 min during the SPU contractions. VO2 was always obtained in steady state conditions. Subjects were not allowed to fidget when measuring VO2, under direct observation by at least 2 study staff at all times, in order to ensure an accurate evaluation of AEE. We allowed ample time for using the restroom and other breaks from the activity to remain comfortable. Using the real-time EMG feedback, they maintained the soleus EMG at an individual level determined in the preliminary test day to be above walking, required an energy demand ∼2 METs, and did not cause fatigue. The contractions with VO2 measurements were done in blocks of time up to ∼7 min long (longer if there was instability in VO2 because of a cough or movement), followed by shorter rest intervals to help maintain a resting position and possibly adjust the angle and setback of the chair or height. Muscle biopsies In all, a total of 40 soleus and 20 VL biopsies (150–200 mg) were obtained in 10 participants (2 soleus and 1 VL biopsies on each of the 2 days). Biopsies were taken at the midway and endpoint at the same time on the 2 test days for each individual. The 2 soleus biopsies each day were from different legs to completely avoid chances of inflammation or other effects of the first biopsy impacting results of the second biopsy. We used ultrasound to ensure optimal placement of the biopsy needle in the belly of the soleus muscle at the greatest muscle girth, using a Bergstrom needle with suction. Biopsies were obtained after 130 and 270 min of the contractile activity (Table 1 and Figure S6 top panel). The VL of the thigh was also biopsied as an inactive control at only the final time point (after the soleus). The VL biopsy served as an internal control for the glycogen concentration in a muscle that was not recruited to contract. VO2 and VCO2 gas exchange with indirect calorimetry VO2 and VCO2 production were determined using a TrueOne 2400 metabolic system from Parvo Medics. The gas analyzers and pneumotach were calibrated according to standard manufacturer procedures using certified calibration gases. Sufficient time to flush out the gas lines and average steady state measurements was always confirmed. The measurement period was extended when it was deemed helpful (such as if there was a fluctuation in VO2 caused by a cough or when taking additional time to confirm the precision of the result). We were careful to ensure participants were positioned when sitting completely relaxed to avoid extraneous movement beyond the intended SPU plantarflexion movement. This included positioning the chair back rest and height for each individual to optimize a restful position. Glycogen assay Muscle glycogen was determined from the measurement of glucose after acid hydrolysis with HCl using a standard enzymatic technique. Immediately upon taking the biopsy, any connective tissue or blood was removed and then frozen in liquid nitrogen. Muscle samples were then homogenized and boiled (100°C) in 1 M HCl for 2 h. After neutralization with NaOH, the resultant glucose concentration was determined by incubating for 45 min at room temperature with an Infinity Hexokinase reagent (Thermo-Scientific) that contained hexokinase and G-6-P dehydrogenase. Then the resultant molar concentrations of total glucosyl units were expressed relative to the starting mass of the boiled muscle sample (i.e, mmol glucosyl units/kg muscle). Magnetic resonance imaging (MRI) of the soleus anatomical mass The soleus anatomical mass was determined in these 10 individuals from MRI images of the TS muscle group in order to calculate the soleus contribution to the recruited muscle mass during plantarflexion. A 3.0T MRI scanner (Excite HD system, GE Medical Systems) obtained images every 1.0 cm of the entire soleus, medial and lateral gastrocnemius (MG and LG) muscles for determining the muscle volume and then calculating the muscle mass assuming a density of 1.04 g/mL (Kim et al., 2002). The relative recruitment of the soleus muscle and the other 2 TS muscles (MG and LG) was calculated as the product of the anatomical mass and the percentage of the maximal EMG. Maximal EMG was obtained from the highest EMG in at least 2 sets of standing heel lifts when standing on a single leg. When doing this, they stood on 1 leg and did maximal plantarflexion as rapidly and high as possible. The highest 1.5 s RMS signal from a moving average assessed every 0.01 s was taken as the maximum EMG signal. Dual-energy X-Ray absorptiometry (DEXA) and VO2max On a separate day from the two primary test days, DEXA (Lunar iDXA GE Healthcare Lunar) was used to calculate body fat as well as muscle mass of the entire lower limb. Additionally, an assessment of maximal oxygen consumption (VO2max) was performed, using an incremental treadmill test to exhaustion. They began by walking on a level grade for a 5-min warm up, and we progressively increased the speed and grade. We confirmed VO2max by heart rate and RER responses. The heart rate at maximum averaged 180 beats per minute and the age predicted heart rate was 182 beats per minute. The RER at the end of the test averaged 1.29, with a range of 1.16–1.51. After the 5-min warm up, the average time to exhaustion was 7.9 min (range of 5–12 min). VLDL-TG concentration A blood sample to measure plasma VLDL-TG concentration was obtained from an antecubital vein without a tourniquet before the final biopsy. EDTA treated blood was placed on ice, centrifuged under refrigeration for 15 min at 1000 × g, and stored at −80°C. The plasma VLDL-TG was measured by nuclear magnetic resonance spectroscopy as described previously by our laboratory (Harrison et al., 2012). Electromyography (EMG) The raw EMG was collected at 2000 Hz and bandpass filtered (20–450 Hz) with the Trigno EMG system (Delsys). EMGworks software version 4.5 (Delsys) was used to analyze the EMG and goniometry signals. The EMG signal was rectified by taking the root mean square (RMS) after subtraction of the mean microvolts. In preliminary measurements evaluating ROM (Figures S4 and S5), an ankle strain gauge goniometer (Biometrics) sampling at 148 Hz was used. One end of the 75–110 mm goniometer was attached superior to the lateral malleolus and the other block attached to the lateral aspect of the foot. ActivPAL device for demographic purposes during free-living behavioral monitoring For demographic purposes of free-living behavior, the ActivPAL device (PAL Technologies) was worn by all participants in both Experiments I and II. Participants were instructed to wear the device taped to the anterior aspect of the mid-thigh whenever awake (but not in water) for at least 4 days (averaging 10 days) during typical free-living conditions to capture sitting, standing, and stepping time; wear time was 16.3 ± 0.7 h/day over 10.3 ± 5.0 days (mean ± SD). Experiment II The second experiment determined the ability of 2 levels of this type of local contractile activity to impact postprandial glucose during a 13-point OGTT (N = 15). Participants Participants volunteered in part through community outreach at churches and senior centers. For practical and ethical reasons, a VO2max test was not included in this group because there was no exclusion criterion for orthopedic and cardiovascular conditions. However, people were excluded if they reported any recent or planned changes in diet, physical activity, medications, and other potentially confounding lifestyle factors that could be a risk for adherence. They were also excluded if they had a fasting glucose >125 mg/dL or HbA1c >6.4% (the thresholds for Type 2 diabetes), had physician diagnosed diabetes, or took glucoregulatory medications other than metformin. Three participants had been taking metformin for over 1 year. The free-living sedentary and activity time are in Table S1 and had a relatively wide range. By design, this experiment was inclusive of a relatively diverse group of people, including 7 men and 8 women (Table S1). We sought out participants who were at some risk for type 2 diabetes (T2D) based on either the participant (with regards to their own phenotype) or a family member with T2D. These individuals had a HbA1c range of 4.9–6.1 and fasting glucose between 91-115. Inclusion criteria included the goal of an equal number of both sexes/gender and adults age across the lifespan (range of 22 – 82 years). There was a fairly well-balanced proportion of minorities (7 non-Hispanic white, 5 African American, 2 Hispanic, 1 Middle Eastern). Protocol and procedures Generally, within one visit we were able to teach each one the proper biomechanical movement for an SPU contraction. All participants were able to learn how to successfully perform SPU contractions. Fifteen participants performed an OGTT while sedentary for 3 h and during at least one activity condition for 3 h. The 75 g OGTTs were performed following a 12–14 h overnight fast. This test was used because it is the standard for assessing the integrative physiology of glucose regulation and for comparing between studies (Knudsen et al., 2014; Magkos et al., 2016). The participants either sat inactive (control) or performed seated SPU contractions throughout the entire 3-h OGTT period using a repeated measures design in which each subject served as their own control. When recruited, participants were given the option of choosing to participate in two slightly different levels of this activity (SPU1 and SPU2 in random order). Steady-state VO2 and RER measurements were recorded at least once during each of the 3 h (on average 5 times). The average energy expenditure each hour is provided in Table S2. In addition to a thorough explanation of study requirements and demonstration of procedures, time was allotted for ensuring each individual was comfortable with how to weigh and pre-package their food to maintain a consistent diet the day before each test day. Participants were provided with food scales. If the participants felt that replicating their diet would be difficult, we purchased and provided them with food. With this approach, these participants were able to maintain their habitual dietary preferences/requirements. Criteria for selection of the metabolic intensity in experiment II Because this second experiment followed the results of the first experiment, the criteria for the setting the AEE (MET intensity) was as follows. The methodological aim was for these participants to perform SPU contractions at an AEE intensity less than that used in the prior Experiment I (see Figure S1 and compare Tables 1 and 2). The first rationale for a lower AEE range was to increase the probability that there would be the same or less demand for soleus muscle glycogen used to fuel contractions than in the first study. This avoided the unnecessary subject burden of the added biopsies. Secondly, we aimed to limit the VO2 to assess glucose tolerance when raising total carbohydrate oxidation by an expected amount of about 100-250 mg/min above the normal sedentary level, with the aim of testing if that range was sufficient to reduce the blood glucose response. The reason for focusing on this rate of carbohydrate oxidation is described in more detail in the Results and Discussion. Primary outcome in experiment II (postprandial hyperglycemia) This experiment tested the primary hypothesis that sustaining a low AEE (about 0.6 kcals/min and close to one-half of Experiment I) by SPU contractions would be sufficient to improve postprandial glucose concentration compared to sitting with inactive muscle at the normal resting metabolic rate. From the 180 min after ingesting 75 g glucose, the postprandial glucose responses were assessed by calculating the incremental area under the curve (iAUC) using the trapezoid rule. Furthermore, it was important that the absolute glucose concentration (mg/dL) and the delta glucose concentration were reported at each time point. Given the importance in reporting these results relative to sex and age (and other characteristics of interest to different fields of researchers), the average glucose iAUC responses were calculated in categorically different groups. Method of measuring blood glucose and insulin Blood during each OGTT was sampled at 13 timepoints in 3 h (in triplicate 10 min before the glucose ingestion and every 15 min until 180 min after the glucose ingestion) from a warmed hand. It was tested using a Contour Next EZ (Bayer) blood glucose meter. This involved a well-validated approach of skin punctures for obtaining arterialized glucose excursions during an OGTT (Brouns et al., 2005; Förster et al., 1972; Whichelow et al., 1967). Direct comparisons with arterial catheterization have shown that capillary blood from skin punctures on average agrees closely (within 2–3 mg/dL) during OGTTs with catheterizing an artery (Förster et al., 1972; Whichelow et al., 1967), thus accurately reflecting the delivery of glucose to tissues from the systemic circulation. A validation study in our lab was performed. From this, results established that there was linearity in the observed and predicted glucose concentration in the range of 81–335 mg/dL with the Contour Next EZ (Bayer) blood glucose meter. In our lab’s validation study, the average measured values of whole blood samples, were 3 ± 1% higher than predicted, while the coefficient of variation was 1.3% between replicates (Figure S6). Plasma insulin (Mercodia) and C-peptide (Millipore Sigma) concentrations were measured with commercially available ELISAs. EDTA treated venous blood was obtained every 30 min from an indwelling catheter in an antecubital vein and processed to measure plasma C-peptide in addition to insulin and additional assays (beyond the scope of this paper). The 6 mL blood samples were centrifuged at 1000 × g for 15 min in a refrigerated centrifuge and the resultant plasma stored at −80C. For reasons beyond our control, there was not venous plasma available for insulin assays in 3 of 15 subjects for SPU1 and 2 of 10 for SPU2 comparisons. Blood pressure and heart rate assessment Although not a major outcome, we checked heart rate and blood pressure (BP) in Experiment II during the activity and when sitting inactive with an automated cuff and blood pressure monitor (Omron model HEM-FL31, Tango model M2). In one particularly obese individual, we used a manual sphygmomanometer and stethoscope in order to obtain readings. The results were averaged for 8 participants in which we have complete data from all 3 test days. Quantification and statistical analysis Calculations During physical activity, the total energy expenditure (TEE) is the sum of the activity energy expenditure (AEE) and the resting energy expenditure (REE). AEE is therefore calculated by subtracting the REE when sitting inactive from the TEE: AEE=TEE−REE The caloric contribution of soleus muscle glycogen (in kcal units) to fuel the total AEE was calculated from the combustion of muscle glycogen as follows: Energyfromsoleusglycogenduringcontractions=(ΔGlycogen)(Soleusmass)(GE) where Δ glycogen is the difference between the inactive and active soleus glycogen concentrations (mmol/kg) and the glycogen energy (GE) is 0.675 kcal/mmol which is the amount of energy (kcals) derived from 1 mmol of glycogen when the glucosyl units from glycogen are completely metabolized by oxidative phosphorylation. The soleus muscle mass (kg) was determined in each individual from MRI. This is based on the understanding that each mmol of glucosyl units in glycogen provides 0.675 kcal energy (i.e., 0.675 kcal = 3.75 kcal/g x 180 g/1000 mmol). The increase in oxygen consumption of the entire lower limb musculature during treadmill exercise was calculated as follows. In each of these individuals, the entire lower limb lean mass was measured with DEXA. Running at VO2max was used as a mode of activity to exercise the muscles of the lower limb intensely. The VO2 per kg of the lower limb musculature during treadmill exercise was estimated with the understanding that skeletal muscle accounts for ∼90% of the leg lean mass (Cardinale et al., 2019), and that 75% of the oxygen consumption during “whole-body” exercise involving weight-bearing activity is from the large muscle mass in the lower limbs (Cardinale et al., 2019). From this, the oxygen consumption of lower limb musculature during treadmill exercise was calculated as follows: lowerlimbmuscleVO2duringtreadmillexercise=0.75⋅ΔVO2lowerlimbmusclemass where the lower limb muscle mass = 0.9 × lower limb lean mass, and ΔVO2 is the increase in the measured whole-body VO2 during exercise above resting. Each statistical test used is reported in the table and figure legends. Paired Student’s t-tests were performed when there was a single repeated measures factor with only 2 levels (e.g., inactive and active). When there were 2 factors (e.g., activity/inactivity and time) or more than 2 levels (e.g., inactive, SPU1, SPU2), results were analyzed with a mixed effects model for repeated measures with Tukey’s multiple comparison tests. Each p-value was adjusted to account for multiple comparisons with a family-wise significance set at a level of 0.05 for each mixed effects model. Effect size (ES) was calculated with Cohen’s d test. ES descriptors were as follows: d (0.01 < 0.2) = very small, d (0.2 < 0.5) = small, d (0.5 < 0.7) = medium, d (0.8 < 1.2) = large, d (1.2 < 2.0) = very large, d (≥2.0) = huge (Sawilowsky, 2009). Normality of the data was tested using the Shapiro-Wilk test. Non-normally distributed variables were log transformed before further analysis. Linear regression was used to examine the relationship between specific variables. Statistical tests were two-sided and significance was set at p < 0.05. GraphPad Prism software version 8.4.3 was used. Results are expressed as mean ± SE unless stated otherwise. Data and code availability Any reasonable request for data reported in this paper will be shared by the lead contact upon request. This paper does not report original code. Any reasonable request for additional information required to reanalyze the data reported in this paper is available from the lead contact upon request. Acknowledgments We appreciate the financial support of the American Diabetes Association (1-15-TS-14). Author contributions M.T.H., D.G.H., and T.W.Z. designed research; M.T.H., D.G.H., and T.W.Z. performed the research; M.T.H., D.G.H., and T.W.Z. analyzed data; and M.T.H., D.G.H., and T.W.Z. wrote the paper. All authors approved the final version of the manuscript. Declaration of interests We, the authors and our immediate family members, have no related patents to declare. The authors have been developing technologies to help instruct people how to do the SPU movement optimally. The University of Houston has the intent to patent potential intellectual property. Inclusion and diversity We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the study questionnaires were prepared in an inclusive way. 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Trends in prevalence and awareness of prediabetes among adults in the U.S., 2005–2020. Diabetes Care. 2022; 45: e21-e23 View in Article Scopus (5) The soleus push up, physical activity and metabolic health Physical Activity Oct 26 Written By Ciaran Regan Health Disclaimer: These articles are for educative and entertainment purposes only. They are not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a current injury or are in pain, please seek the advice of your regular health care provider. You are responsible for your own safety and health at all times. Especially, given physical activity is not without risk and can cause harm. By engaging with any content on this website you acknowledge and agree that Eccentric Physio is not liable for any direct, indirect, special, consequential, exemplary, or other damages arising therefrom. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this web site. Introduction Recently a study was published examining the metabolic effects of a novel prescription of a well known exercise, the soleus raise (1). The focus of the study, was to examine the potential effects of what was coined the ‘soleus push up’ (SPU), during and afterwards, on markers of metabolic health e.g. resting blood glucose and lipid levels. Positively, they found that the SPU was very useful in improving these markers at the measured timepoints. However, on reading the study, I feel it is important to make a couple points before considering if it is useful for you. The exercise To utilise the benefits of the SPU, one must do the exercise at a very light intensity for a total of 270 minutes over a 7-8 hour sedentary period; specifically, sets of 7 minutes with rest periods of 5- 6 minutes. Alternatively, one could do the exercise for 180 minutes without rest. This was beneficial across a wide population of metabolic health, ages, activity levels, genders, body mass index and daily step count. As far as how do you do the movement? The key variable was height, not how fast you do it. The beneficial effects were seen from lifting the heel a moderate height off the ground. Thoughts and critique My critique is that while this exercise may be a fantastic entry point for an individual who is sedentary, the activity itself requires active engagement. This will take ones’ attention away from the sedentary behaviour. For example, if you were playing video games, can you also coordinate lifting your heel for 3 hours. Instead, why not look to sustainably change habits around PA, by getting 30 minutes cardiovascular activity in over a day AND play your video games! While I appreciate this wasn’t the goal of the researchers, my concern is the SPU may be interpreted as a solution to sedentarism. Physical activity (PA) is a key cog in the framework of a both a longer life with greater health and a more physically capable life (2–6). To be straightforward, retaining moderate to high levels of PA, as you age, will literally slow down the aging process and reduce the risk of premature death (2). There has been discussion around accessibility to services which help one engage with PA (7). Important points have been made around reduced access to ‘prescription’, secondary to cost of access to ‘exclusive clubs’ such as membership gyms, private pay exercise groups or subsidy, via medical insurance. As Davenport et al., (7) goes on to suggest that PA is a public good and that sustainable engagement with PA may need to come from changes in social norms, and expectations, along with cultural and policy change around the environments we inhabit. Conclusion I am in agreeance with the idea that exercise, or PA, is a public good. It should be accessible and straightforward in its implementation. My article on PA summarises in clear and actionable steps how to begin engaging with PA. There are clear examples for cardiovascular options, along with instructional videos for bodyweight strengthening exercises. The article can be found here: https://themusculoskeletalclinic.co.nz/articles/exercise-and-physical-activity-how-to-know-when-youre-doing-enough [C] Soleus push up study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9404652/ References: 1. Hamilton MT, Hamilton DG, Zderic TW. A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation. iScience. 2022 Aug 5;25(9):104869. 2. Booth FW, Zwetsloot KA. Basic concepts about genes, inactivity and aging. Scand J Med Sci Sports. 2010 Feb;20(1):1–4. 3. Jayedi A, Gohari A, Shab-Bidar S. Daily Step Count and All-Cause Mortality: A Dose-Response Meta-analysis of Prospective Cohort Studies. Sports Med. 2022 Jan;52(1):89–99. 4. Lopez JPR, Gebel K, Chia D, Stamatakis E. Associations of vigorous physical activity with all-cause, cardiovascular and cancer mortality among 64 913 adults. BMJ Open Sport & Exercise Medicine. 2019 Aug 1;5(1):e000596. 5. 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 [Internet]. 2022 Jan 19 [cited 2022 Mar 30]; Available from: https://bjsm.bmj.com/content/early/2022/01/19/bjsports-2021-105061 6. Wang Y, Nie J, Ferrari G, Rey-Lopez JP, Rezende LFM. Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults. JAMA Internal Medicine. 2021 Feb 1;181(2):203–11. 7. Davenport TE, Griech SF, Deamer KE, Gale LR. Beyond “Exercise as Medicine” in Physical Therapy: Toward the Promotion of Exercise as a Public Good. Physical Therapy. 2022 Sep 1;102(9):pzac087. Copyright Disclaimer - This article is protected by the Copyright Act 1994. The author controls the copyright of this article. Recognition of the author’s right to be identified as the author will be acknowledged and when relevant the author will be acknowledged as the author. You will obtain the author’s permission before publishing any material from this article. For further information you can reference the Act here: https://www.legislation.govt.nz/act/public/1994/0143/latest/whole.html #themskphysio #soleuspushup #soleuspushupexercise #metabolichealth #physicalactivityguidelines #soleuspushup#soleuspushupexercisethe msk physiosoleus push upsoleus push up exercisehow to do the soleus push upsoleus pushup metabolic health#themskphysio PubMed Crossref Google Scholar Zderic T.W. Hamilton M.T. Identification of hemostatic genes expressed in human and rat leg muscles and a novel gene (LPP1/PAP2A) suppressed during prolonged physical inactivity (sitting). Lipids Health Dis. 2012; 11: 137 View in Article Scopus (18) PubMed Crossref Google Scholar Article Info Publication History Published: September 16, 2022 Accepted: July 28, 2022 Received in revised form: June 29, 2022 Received: March 10, 2022 Identification DOI: https://doi.org/10.1016/j.isci.2022.104869 Copyright © 2022 The Author(s). User License Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse Information Icon ScienceDirect Access this article on ScienceDirect Figures Figure thumbnail fx1 Graphical AbstractHamilton, MT. et al. (2022) iScience. A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation Hack to Lower BLOOD SUGAR [Even while Sitting] 2023 - Soleus Pushup KenDBerryMD 2.34M subscribers 185K views 2 months ago New research reveals a hack to lower your blood sugar even while sitting at your desk. Anyone can do this simple movement and watch their blood sugar go down. Use this simple hack to lower blood sugar while sitting at work or anywhere that you can't exercise. … Shop the KenDBerryMD store #yes2meat wear Premium Tee $21.99 Show the world you believe in the Nutrition and Health provided by eating meat! Custom designed graphic is printed in vivid color and high resolution using state of the art color transfer technology. Shirts are made from super soft 100% combed ringspun cotton. Printed in the USA. SHOP Spring 854 Comments rongmaw lin Add a comment... Marilyn Y Marilyn Y 2 weeks ago This definitely works for me. I'm 76, pre-diabetic I'm active but still sit a lot. Set my phone for 5 minute timer and try to do the solex pumps every hour. This morning I did two sets of 5 minute solex pumps then did my glucose. It was 105. I'm very happy with the results and going to keep doing it. It's easy with amazing results. 12 Reply 1 reply Alice E Alice E 2 months ago I used to do something like this years ago when I worked standing up in a station filling orders. I would go up and down or just stay lifted for minutes at a time. My calves got some serious muscle out of that. I’m gonna start doing this again. Doing this while I am writing this comment. ❤ Thank you! 161 KenDBerryMD Reply 6 replies Michael Duerr Michael Duerr 2 months ago I just wanted to compliment you. You have helped out so many and you look like you are reverse aging. I was 230 pounds a couple years ago. Eliminating carbs has changed my life at 47! 184 KenDBerryMD Reply 9 replies Victoria D Victoria D 2 months ago I’m wearing a CGM. Have not eaten today but my glucose is high! Just did this for a couple of minutes and got an 8 point drop! Thank you! 112 Reply 9 replies samich samich 2 months ago As an ex ballet dancer this feels amazing! I'm doing right now and it's stretching my sore stiff ankles as well as the backs of my legs and even the tops of my thighs. Thank you 😊 88 KenDBerryMD Reply 6 replies Luigi Lamorte Luigi Lamorte 2 months ago Update: Tested BS at 6:45 PM after 25 minutes of the Soleus exercise. It was 5.1. This is an amazing reading because I had eaten a steak and some cheese 1 hour 45 minutes earlier. Normally after such a meal, the reading would be significantly higher. Thank you Dr. Berry. Please respond to my comments. A few years ago my blood sugar had spiked quite high. I took the bull by the horns and went mostly Keto. Currently, I’m mostly carnivore. I owe most of this progress to Dr. Berry and others on YouTube. 42 Reply 6 replies Lily Mae Lily Mae 1 month ago I’ve done this exercise since you first posted this and it works amazingly! My blood sugar has been in the 90s consistently since I started. I’m blown away. Thanksgiving I reluctantly ate high carb and high sugar. I did this exercise off and on all evening and my blood sugar was 94 the next morning.❤❤❤ 12 Reply Terror1Void Terror1Void 2 months ago The soleus is overlooked. It's an incredible muscle. It can absorb up to 4.5 times your body weight in ground force while you're running. It's a strong muscle, don't neglect it. 31 Reply 1 reply Kelly Beard Kelly Beard 2 months ago I'll be darned: I sometimes wake up with a high fasting glucose (> 100). He is how my day has gone so far: 7:58AM - 103 mg/dL (pre-breakfast measurement) 10:27AM - 106 mg/dL (post-breakfast) 20 min of this soleus push-up thing, timed by Siri 🙂 11:13AM - 89 mg/dL For sure I will be repeating this experiment. 41 Reply K Moore1 K Moore1 2 months ago This is not only a wonderful tip for lowering blood sugar, it's also the very best recommendation I've ever seen for not wearing pants while you're working from home! But seriously, I'm going to use this exercise while one of my daughters is visiting us for Thanksgiving; she wants to impress us with her cooking skills. Also, just an update of my 3 months on carnivore: I've dropped 39.5 lbs. and I was able to climb a 7 foot stepladder, backwards, through a narrow gap between the steel rafters of a storage building I have been working on, so that I could attach the next-to-last roof panel with bolts and screws! I'm the youngest 61-YO my hubby ever met! He told me so, LOL 37 Reply 1 reply Luigi Lamorte Luigi Lamorte 2 months ago (edited) Tried the exercise for about 15-20 minutes. BS went from 6.3 down to 5.3. Thank you Dr. Berry. This exercise will become a daily event for me. 28 Reply 3 replies LA moon LA moon 2 months ago I have been looking for exercises to do while sitting. I'm not able to do much and every little bit helps. Thank you. 75 KenDBerryMD Reply Joanna Rippon Joanna Rippon 2 months ago I do these daily! I suffer from stiff great toe joints (very painful w/limited range) and do these exercises to loosen up the joints. Glad to know I’m helping my blood sugar at the same time. I had no idea! I’ll be doing more of these now! Thank you Dr B for all you do! 8 Reply 1 reply Jennifer Tomlinson Jennifer Tomlinson 1 month ago Type One diabetic here, and eating rice and chicken. Blood sugar started spiking, so I tried it. It worked great! Watched my CGM numbers go down and become more stabilized. After 15 years of type one diabetes all I can say is THANK YOU for this tip! Lifechanging. :) 8 Reply highflyer131 highflyer131 2 months ago This is why we love your channel. A Dr. that tells the truth instead of trying to push a prescription or sell some crap that doesn't work. Thank you sir, keep up the great work. 31 Reply Chrystal Thornton Chrystal Thornton 2 months ago As a carnivore newbie, I really appreciate all the detailed and organized presentations you give to answer all my questions. No wonder you have so many subscribers, you are the best for all things carnivore. 27 KenDBerryMD Reply 1 reply Luigi Lamorte Luigi Lamorte 2 months ago (edited) Did the exercise again. 3:00PM BS was 5.2. After 25 minutes of exercise, BS was 4.9. Only ate at 6:30 AM. I am very happy with the results. 13 Reply Sarah Gonzalez Sarah Gonzalez 2 months ago thanks for this hack! I have to go light duty at my job this week for 3 weeks as I just had part of my clavicle bone removed. have been keto for about nearly 8 weeks and down almost 36 lbs! thanks for your videos you and your wife are very inspirational to help keep people fit and living a healthy lifestyle! 37 KenDBerryMD Reply Modr Ribaz Modr Ribaz 2 months ago This has always been my go to move to reduce my stress in uni. 38 KenDBerryMD Reply 1 reply plumeria8357 plumeria8357 2 months ago Wow! It even helped me, as a senior, to feel more energetic to get up and take on the day! Thank you so much! 16 Reply Mary R Mary R 2 months ago Another advantage of this exercise: it brings blood flow back into my varicose veins! 49 KenDBerryMD Reply It’s just me It’s just me 1 month ago Omg!!! My sugar was 318 when started watching this video. When I did this exercise I promise you my glucose is now 297 on my CGM. This exercise really work for real. I know my glucose is high but I've subscribed to this channel because I want to start the Carnivore diet. Thank you so much. 6 Reply 1 reply Jesse Stewart Jesse Stewart 1 month ago Thankyou Doc. Reply mdepfl mdepfl 2 months ago Alright, this is INSANE! I watched this vid on a cruise and did this while, ahem, indulging. Just tried it again at home with CGM on. Stable at 99 all morning, started flexing to the music and within 5 minutes it went to 93! Keep the info coming Doctor, WHAT A TEACHER!!! 9 Reply Nancy K Nancy K 2 months ago I was doing standing calf raises almost daily last summer and my blood sugars were beautiful. I don’t do them anymore and sugars are not that great anymore. I’m going to back to doing these both sitting and standing and see if it helps. I wear a CGM so it won’t be any trouble to check often. Thanks for the tip! 12 Reply 9 replies Tony Watches Closely Tony Watches Closely 2 months ago After dealing with myelitis (derived from westnile) doing this with my left leg is dang near impossible but my right leg still functions so I'm hoping this will help. Your videos have been very helpful and I would get on your Patreon but since Patreon deducts automatically on the 1st and of course I don't get paid until the 3rd if I don't have the funds to cover it I'd get an ISF and that would really crush me. I'm trying to figure out a way around that though. Thanks Dr. Berry!! 15 Reply Asar Cadyn Asar Cadyn 2 months ago Fasting BG down from 5.8 to 4.8 (105-88) after doing this for 20 minutes while I read the news and watched a few short videos. Of course, my coffee with heavy cream might have helped and maybe the meter might not be accurate each time, but still a good result at even half the reduction. Thanks for sharing this. 👍 4 Reply Coach Stephen BSc Hons Coach Stephen BSc Hons 2 months ago (edited) Exercise pushes up blood glucose (in a good way, it's a normal expected response) and also improves insulin sensitivity so be careful to follow exactly what's said here otherwise it won't work. Do it seated as Ken is saying. Seated is important. I just tested this doing it standing and to fatigue. My blood glucose went from 5.1 to 5.5 and I only did calf raises for 90 seconds. I will obviously test the seated position later when I'm back to my normal blood glucose 12 Reply 5 replies SayWeCanFly SayWeCanFly 2 months ago 7 weeks into carnivore , 20 pounds down. Thank you for all your wisdom & insight. 8 Reply Double_Aut Double_Aut 2 months ago This exercise will be great for the holidays coming up when you don't want to disappoint anybody for not eating their high carb dish or dessert. Thank you Dr. Berry. 2 Reply 2 replies Debra Lash Debra Lash 2 months ago This would probably be good for people who drive for a living. Thanks Dr Berry! 51 KenDBerryMD Reply Bobby Morrow Bobby Morrow 12 days ago Thanks for the video! Quick question (as a Personal Trainer)...if you have some sort of 'weight' or 'band' on the knees, would the increased resistance increase the benefit/or lower reps needed? Thanks Reply Deepseaotter Deepseaotter 2 months ago Love your videos! This is cool! Because of you and Neisha, I’ve been doing keto for a couple of months, and have lost 35 pounds so far. Just started ketovore today, looking forward to even more great results soon! Really like your t-shirt, do you sell them? 😊❤😊🎉 13 Reply 2 replies Jules Wallace Jules Wallace 2 months ago I love this. I have stalled out on my fat loss and this will help get me back on track for sure. 3 KenDBerryMD Reply JG HK JG HK 2 months ago As a type 1 diabetic using a continuous glucose meter I’ve noticed vacuuming my stairs using an attachment and kneeling on each step all the way up burns blood sugar like crazy! 18 Reply JEN JEN 2 months ago Dr. Berry you are priceless! Love you and your channel!! Thank you for all you do to get the message out about the necessity of the PHD!🤗 I have also heard that the Soleus is sometimes referred to as the "second heart". Its strong contractions return blood from the leg back to the heart. 4 Reply Ryan Barber Ryan Barber 2 weeks ago Thank you for making a useful presentation with good information and without dramatic music and other useless distractions. Reply Hemingway’s Tractor Hemingway’s Tractor 2 months ago Just got home from quadruple bypass surgery and very limited on what I can do. Hopefully these will work the muscles enough to both help with the blood sugar and help alleviate all of the swelling in my legs. Thought I was doing so great with a 53 hour before/after surgery time until I learned they were pumping me full of insulin after the procedure. 42 KenDBerryMD Reply 14 replies KAT KAT 2 months ago I’ve never had a problem telling people, “I can’t eat that” 😂 Since one bite of regular apple pie can shoot my sugar up to 200 mg/dl Thanks for the tip! I’m going to try it right now! 32 KenDBerryMD Reply 1 reply Trisha Harris Trisha Harris 2 months ago Thank you Dr. I have been type 1 d for 7 years and always asked what I could do to lower my blood sugar besides just pumping insulin like crazy. I was always told, there’s nothing else. But of course I’m smarter than that and know they only tell me what has a price tag attached. I never stopped researching and I’m so glad I came across your video! You have made all the difference. High insulin is just as bad as high sugar!! 5 Reply Health 4 Life Strategies Health 4 Life Strategies 2 months ago Love, love, love you Dr. Berry...you are so down to earth and easy to listen to. This is exactly what I was looking for....stuck at a desk....doing Keto and not seeing my G numbers budge, granted they are not bad, 97-110, but I want to see them lower to get into a better BG/K ratio! Thank you so much for bringing this hack to light!!❤‍🔥 2 Reply David Davirgi David Davirgi 10 days ago This is so much fun and so easy to do and what a Godsend! Reply karen overholt karen overholt 2 months ago Thank you for this info! As a person with one leg and in a wheelchair this is very helpful to know as are so many of your videos. 4 Reply Jenny Meade Jenny Meade 1 month ago (edited) Thank you for this. I trained myself to do it every day just so I always remember how to do it. This is a valuable tool. Just like my diet, and everything else. I repetively do this daily! REPITITON REPITITON REPITITON REPITITION!!!!!!!!!! Reply Rose Highland Rose Highland 2 months ago Thank you so much, this is the best hack yet I've found to lower blood sugar. Coincidentally, I often use this exact movement to stretch my legs, and now I know why! You never fail to impress, doc, keep 'em comin'! 3 Reply leave the carbs take the fatty meat leave the carbs take the fatty meat 2 months ago Thanks so much for this! Seems easy and love that it’s free. 😊 1 Reply Karen Public Karen Public 2 months ago Oh my gosh. I’ve been doing that exercise post hallux vagus surgery. No dam wonder my A1c = 5.5 Thanks Dr Berry 15 Reply Marilu Cervantes Marilu Cervantes 2 months ago Every thing Dr. Berry says I have tested and it works, now I will test this exercise, Thanks Dr. Berry you rock 18 KenDBerryMD Reply 1 reply Maxine Adderley Maxine Adderley 2 months ago Hmm, I am diabetic, with neuropathy, one foot is frozen and the other is partially amputated, however, I do get on my body rider and tighten the tension which I have found to be helpful in that area as well as strengthening my legs and give me a more steady gait. Every bit counts, just make it happen for yourself 17 Reply 1 reply Paul Leavitt Paul Leavitt 2 months ago Hi Dr. Berry! I’m down over 40lbs since starting Keto back in January 2022. I only wish I had done this sooner. My A1c has been 5.5 -5.6 since March of 2022. Also my doctor really wants me to use Metamucil. One serving has like 10g of carbs in it. That’s like my daily total intake of carbs. Was curious of your opinion on Metamucil. 1 Reply 1 reply Pigeoneer Toy Pigeoneer Toy 2 months ago (edited) I love you so much, Dr. Berry, they way you tell things simply as they are. Many believe making things complicated will get them greater respect and prestige, but it's quite the opposite. I admire you more because of your no nonsense approach. That's why I keep recommending your channel 💖 1 Reply Ben Semisch Ben Semisch 2 months ago This is super interesting, what other muscles don't use stored glycogen? It'd be amazing to see a routine built around that idea and would probably end up changing the lives of a whole lot of folks. 12 Reply 5 replies abaneyone abaneyone 2 months ago You really do wanna help us Doc. Thank you! ❤️❤️❤️ 14 Reply Sherlene Mats Sherlene Mats 2 months ago I've done this for years standing. However, I have to say, I actually feel that inner muscle working when in the proper sitting position. At this very moment, I am conducting a little experiment. I ate a small bowl of raspberries now I am doing this maneuver. I'll check my CGM in about 30-40 minutes. 1 Reply Lacey Shrinks Lacey Shrinks 2 months ago Dr. Ken Berry spitting the facts we ALL need to hear and use to our advantage. Thank you so much! 5 KenDBerryMD Reply 1 reply Terryn Berry Terryn Berry 2 months ago I will definitely use this. I'm disabled and can't walk much, but this I can do. Thank you so much! Also, I'm glad you survived your encounter with the chainsaw. Farming can be "danger close" without a doubt! I was a farmer, too, so I'm very familiar with abrasions. 😁 1 Reply The Jones’ The Jones’ 2 months ago I just tried it and just doing it for 1.5 minutes took my blood down almost a whole point. This is amazing. Wish I could do it every meal to help me stay off the insulin this pregnancy but I suppose it would make my calves ginormous doing it that much. 1 Reply 2 replies Susan Leport Susan Leport 2 months ago I can see this being helpful for some of my clients who have balance issues and due to fear of falling, do not get enough exercise. Generally, these people also have blood sugar issues. Thank you! Reply 1 reply tyjomeb123 tyjomeb123 2 months ago Thank you Dr. Berry. Wonderful information. My legs feel energized after doing this exercise and it's one I can do being 3 weeks post op L hip replacement. 1 Reply 1 reply Kass Ermias Kass Ermias 2 months ago (edited) Our world needs a doctor like you who has human heart ❤️❤️❤️❤️ 13 KenDBerryMD Reply Winnie Winnie 10 days ago Ive been doing something for years. I call it muscle isolation and it works for a type 1. I just lift my toes towards my shin for a matter of minutes. Done Reply Peter Lutz Peter Lutz 2 months ago Question: How long or how many reps do you do of this exercise to be effective in lowering blood sugar? 2 Reply Europa 17 Europa 17 2 months ago I had never heard of this. Thanks for such a great tip! It really is easy to do. 1 Reply Micah Gourley Micah Gourley 2 months ago I LITERALLY wondered when/if you might do a video on this after I read this a few weeks ago. It makes me wonder if that's why I seemed to have good success doing HIIT on a stationary bike (often positioning the seat to where I had to pedal similarly, arching my feet)... Perhaps my targeting of those muscles helped to streamline (in a sense) more fat-burning, in combo with the benefits of HIIT? I've always noticed that HIIT on the treadmill, even with it on a near-full incline, never gave me the same overall sensation of 'burn' or endorphins afterward (a connection?). A lot of layperson conjecture here lol... Reply O Koloa O Koloa 2 months ago Dr. Berry, thank you so much for your advise. I tried this exercise while watching your video. My legs feel so relaxed after the exercise. My question, will this exercise help people with PAD? Very interested in your reply. Thank you again, Judie 4 Reply Lewelyn Trenhaile Lewelyn Trenhaile 2 months ago This is gonna be my go to exercise while sitting on plane. Can’t hardly move around in them seats. I do yearly 13 hour exhausting rides. 6 Reply 1 reply Lily Mae Lily Mae 2 months ago Thank you so much! I needed this last night when I went to my son’s birthday party and felt compelled to eat a piece of birthday cake after splurging on pizza. 😊 Now I know what to do. My husband and I frequently fall off the wagon when we visit our son’s house. We are very good maintaining otherwise. ❤🎉 Reply Andrew LeGrand Andrew LeGrand 2 months ago I’m an OTR trucker. I will put this exercise to task, thank you for your channel. 2 Reply j b j b 2 months ago (edited) Just as soon as you showed the drawing of the legs, I knew what to do, so was doing the exercise as I watched your video, Dr. Berry 😄. I dislike sitting at tables for very long, not liking to watch others eat, and I get restless, so I tend to 'fidget' my legs a lot; nobody can see it, so they don't know that I'm relieving the stress of having to sit there, and now I realize that I'm burning off glucose/sugar at the same time. Good to know that, because sometimes my food within a meal gets a bit "off track," so to speak. Not the entire meal, just maybe one thing now and then isn't perfect keto.... 3 Reply Freedom Forever Freedom Forever 2 months ago An excellent technique for lowering blood sugar without a lot of strain. Thanks. 6 Reply Mauro Sciaccaluga Mauro Sciaccaluga 2 months ago Don’t skip leg day! Since I started increasing resistance training in my legs my blood sugar went down 4 Reply 1 reply Kelly Grant Kelly Grant 2 months ago Wow! I can’t believe this works. Right before I watched this video my fasting BG was 140. After one minute went down to 128. Did another 30 seconds and down to 120. Amazing!!!! Reply Lady Farrier Lady Farrier 2 months ago Great for people that are driving all the time.... like me! Thank you Dr. Berry!!! 5 Reply Marilyn Y Marilyn Y 3 weeks ago I'm pre-diabetic, struggling to get BG below 100 last couple of months. It's been as high as 124. This morning at 7:00 a.m. it was 115. I know it's not bad but still.. I haven't had breakfast yet went out and did about 20 minutes of yard work then came in the house and sat down, saw your YouTube article. Did the solex push-ups for about a minute then rest and repeated while I'm looking at other YouTube videos. Half hour later got breakfast but did glucose test. It was 104. Going to try this off and on about 5 minutes every hour then tomorrow do my fasting stick to see the results. Very encouraged with what I just experienced 1 Reply 1 reply Lori DeMann Lori DeMann 2 months ago I learned this in physical therapy, didn’t know it lowered blood sugar too! Thanks for sharing! 2 Reply Amy Landis Amy Landis 2 months ago Can’t thank you enough. All your info and knowledge have improved my life significantly. ❤❤❤ Reply Charles Pierce Charles Pierce 2 months ago Thank you Doc, i am going to woods and doing the same. Loading up for a cold winter. Firewoods my secondary heat source. Ya looking well and healthy Sir. So glad your helping people too, makes us feel as humans instead of as mass numbers chasing that $$$$ cow. Love to you and family always.!! Reply MrSouthsideMuscle MrSouthsideMuscle 1 month ago Thanks doc Reply ArtThatTransformsUs ArtThatTransformsUs 2 months ago Hi Dr. Barry, I tried this out and my glucose actually went up! I did 60 of the push-ups and my glucose went from 107 to 116. I only waited a few minutes after completing my push-ups to measure. Should I have waited longer? Reply 1 reply Karmella Karmella 2 months ago for some reasone when im doing this exercise Im holding my back straight, very good! Reply Sofia Fatima Sofia Fatima 2 months ago Wow, it really does! Mine dropped from 10 to 8.7 3 Reply Rie Kodi Rie Kodi 2 months ago Thanks so much for this great tip. I have lost over 20 lbs since doing intermittent fasting in conjunction with keto in just three months. I may have done it in weeks time but do not prick my fingers to check my blood sugar. I just couldn’t bring myself to do that despite having diabetes. I just wait to get results from my 3-month blood work instead. Thanks to your videos. I’m off medications now. No more Metformin and Farziga. God bless. I’ve been sharing your videos with friends and family. Thanks so much for all you do to educate people on reversing Diabetes and saving lives. 1 Reply Hanif Al-Faruqi Hanif Al-Faruqi 2 months ago Your videos continue to be priceless…absolutely brilliant information all the time 💥💥 1 Reply M. P. M. P. 2 months ago I've noticed that as long as I massage my lower legs, starting with those muscles and tendons alongside the ankles that for me are always painful when I touch them, and following that everything bellow the knee, I don't get restless leg syndrome anymore; and I also have less pain everywhere else, as if the pain really originates there and spreads around! I'm not surprised to hear that it has something to do with insulin resistance. Reply Allen Gaible Allen Gaible 2 months ago Gonna be doing this every time I'm sitting down for a long time. Easy to execute. Once again movement is good for the human body. 1 Reply Lourdes Rodrígues Vas Lourdes Rodrígues Vas 2 months ago Thank you so much, Doctor! I have multiple health problems. The latest is AS or rather the Doctors can’t distinguish if I have AS or osteoporosis. At 70, I am not going to stop. I am going to gather as much information to keep myself active as ever. Of course I do have certain limitations but I do my level best. If possible, Doctor help me out with AS and osteoporosis and let me know the difference and how to exercise and come out of it. Thanks a million, Doctor! Reply James Platt James Platt 2 months ago I just did this for 15 minutes straight (have no idea how many reps), and my numbers went from 329 to 354. I figured this was too good to be true, but had to try it. I am at a desk off and on all day, mostly on, and will do it throughout the day- probably for several days- and report back later. So far though, not impressed. (And btw, I am not eating or drinking anything and have not had any food today yet.) Reply 2 replies Creative Dee Creative Dee 2 months ago Thank you Dr Berry. It actually feels good too. 3 Reply christian mueller christian mueller 3 weeks ago T1 here. Two hrs. after eating (Keto) : 108 mg/dl BG. Then, after one hour "push ups" : 96 mg/dl BG. Seems to work. Have to try it a few more times . Nice cut, Doc ! Reply Manager of 3Monsters Manager of 3Monsters 2 months ago I love this! Thank you!!🤗 5 Reply Christian Hirose Romeo Graham 廣瀬 グラハム クリスティン 路美男 Christian Hirose Romeo Graham 廣瀬 グラハム クリスティン 路美男 2 months ago This is why you're one of my favorite, if not, my most favorite online doctor. 8 Reply karron lane karron lane 2 months ago so interesting. i've been doing this w/o knowing the benefit. thanks so much. always a pleasure to tune in. 3 Reply Donn Donn 2 months ago Thank you, Dr Berry.❤️ I’m sure I can use this. :) 1 Reply SW Lehmann SW Lehmann 2 months ago Thank you so very much for showing me this!!! I will be sharing this with my family and friends!!! Thank you again!!! 2 Reply Mattly One Mattly One 2 months ago You are awesome. Thank you for ever thing you do. Great tip 10 Reply texan4now texan4now 1 month ago Thanks! I had read the story about Marc Hamilton's "discovery" and recently ran onto info that using a rocking chair burns calories and helps us in other ways. It got me to wondering if rocking is a form of soleus pushup. I really appreciate your info on doing the exercise very much appreciate. 1 Reply Jack Maddesty Jack Maddesty 2 months ago (edited) Starting my day out listening to the best folks on youtube while lifting heavy shit❤ Carnivore now for 5 weeks and I´m unrecognisable(did I spell that right?)… My body´s transforming into something I´ve seen in the mirror some 25 years ago, only much healthier😂❤ My IBS has hugely improved and I´m gonna keep going:) Intermittent fasting, pure carnivore and some physical training but not that much training actually. Big thanks to you, your wife and what I will call the Keto/carnivore gang here on youtube❤ PS: I will also give you huge credit for dressing the proper way for home office, as I think many practitioners cheat on this important subject wearing pants beneath their home office desk. Great job!👌💕 1 Reply Doggoneme Doggoneme 2 months ago Physical therapist had me do these after knee replacement surgery. Both sitting and standing. 2 Reply Pat Marvenko Smith Pat Marvenko Smith 2 months ago I will be doing this at my desk! Thanks! 10 Reply Michele Heath Michele Heath 2 months ago Holy crap this works. I know this is not a big deal but glucose at beginning was 145 and after 5 minutes it was 125. 😮 this is exciting! This is first thing in the morning and my glucose is always so high in the morning (but better than in the 200s like it used to be!) anyway, very interested to see what happens while I work! Thank you for this!! 3 Reply Pumpkin Pumpkin 2 months ago Oh wow. I did a few of these and I feel a little better. Thanks. I've been so off the wagon for a while now. Food addiction is tough to grapple with. 1 Reply Tylersan Tylersan 2 months ago Thanks so much for sharing this. Your videos are a life changer for me. 1 Reply Good, Slow, PROGRESS Good, Slow, PROGRESS 2 months ago I needed this today...sitting 9 hrs a day 6 Reply Fifi Suki Fifi Suki 2 months ago Thank You Dr Ken - This is really helpful to many who 'sit a lot' with Diabetes... 1 Reply leo andolino leo andolino 2 months ago Brilliant... so handy...thanks for your work... you help so many people who desperately need it. And in an interesting and entertaining way. You have the manner of a wise old country doctor in a young man's body. God Bless! Reply Lafreda Sias Lafreda Sias 2 months ago Great info - I am now maintaining my type II with diet. This is a great addition to my diet regimen. Reply Steven Domagala Steven Domagala 2 months ago Thanks for the tip. Wondering if there are other skeletal muscles that primarily burn sugar like the soleus? 8 Reply 1 reply James Moore James Moore 2 months ago Interesting - Years ago when I was working out at a gym they had a machine I used for seated heel raises with weights. Back then my blind sugar level was always low. When I ripped my quad badly and stopped working out for a while it went way up -- could this be a reason why it did that? 6 Reply 1 reply Michelle Tan Michelle Tan 2 months ago My system has been sugar free and low carb, but when I decided to binge on sourdough bread and butter, I experienced the most excruciating pain for over half the night. My toes were going in directions they don’t naturally go, my arches are cramping, and my calves lock so strongly. I have experimented and found this to occur if I eat anything with sugar too. Otherwise I never get cramps. If I continue to eat the sweet or high carb the next day it is not as bad, but then my sweet tooth craving will activate so I leave it out (mainly because of the level of pain). Is this normal? Will this exercise be enough to help me? 1 Reply 1 reply Linda Barnes Linda Barnes 2 months ago Kudos to you Dr Berry. I plan on doing this. Thank you so much Reply Michael Nicholson Michael Nicholson 2 months ago Hi Dr. Berry! Thank you all you do! Are you using your toes and balls of your feet to push up? Or using your legs to lift your heels off the ground? 8 Reply 3 replies Mario Palma Mario Palma 1 month ago Thanks so much, great content :) Reply debmarie55 debmarie55 2 months ago Fantastic info! Thank you! 2 Reply robert moore robert moore 2 months ago (edited) Just tried over 30 minutes while sitting, took BG 101 to 89. Quick decrease on a stubborn 101 using a CGM. T2D, living keto. A1c down from 9.4 to 5.7 in 3 months 18 Reply 5 replies Austen Eddy Austen Eddy 2 months ago Thank you for this - appreciate it! Going to incorporate because I WFHome and sit so much! PS - Those bookshelves poke my OCD...I want to style them/organize them every time I watch! You've got some great real estate for some more materials back there! 2 Reply BROKEWOOD 60 BROKEWOOD 60 2 months ago Thank you sir!! For all of your info! You are a real Doctor!! I have learned so much from your channel! Wish the country had more like you!! Keep up the truth that you share. Thanks ! 1 Reply J Ormond J Ormond 2 months ago Another great clip. Thank you. Will start doing this at my desk. Reply 1 reply Barb Lacy Barb Lacy 2 months ago So timely with Thanksgiving dinner coming!! I did not know what to or how much information to share with in laws who were kind enough to invite me! She is a baker extraordinaire and great chef. I will portion control, go heavy on the meat and butter and be polite, dessert I can ‘pack for home, I am so stuffed from this marvelous feast’ and do my soleus workout during dinner. I am bringing deviled eggs! 2 Reply Misty Dorsey Misty Dorsey 2 months ago Just tested this and doing it for about 20 reps 2x my BS dropped from 96 to 78 not long after eating. Reply Al Was Al Was 3 weeks ago I have been so sick since my 30's when I was a runner, a mom, wife and 7 days a week worker always on my feet. I can't relate to sitting until now that I am in my early 60's. We are retired and I sit way too much and have slowly been cutting out sugar and carbs. I have lost weight, but still have fibromyalgia and my thighs are just so severe muscle cramping I can't even sleep. I do go to PT and do the exercise at home too. I am 5' and weight 104 lbs. Loosing muscle or more fat is not an option for me. It has taken me, who is a very fussy eater and since I am a long-time carb eater, about 4-5 years to change my eating habits to mostly meat. It is a slow process, because it needs to be my way of life. That can be very challenging. It maybe some folks can do it at a month time or three-month time, but it has been longer for me. Especially when I'm cooking for my husband as well. He does love meat way more than me, but I have been cooking as he likes and just saying no to the side dishes of basmati, or potato or bread. And I am finding I do not crave much of the carbs like pasta, pizza, cheese, and other meals like that compared to eating eggs, more animal cuts of meat instead of a salad with Italian dressing, mmmm so good, but I have not had one in a long time, and actually even having breakfast food for dinner and things like that is challenging as is the shopping. Going past the fruit and veggies and mostly to the meat dept. is hard to do. Even as an amateur athlete who has done tons of research on this you might think it would be an easy fix, but it hasn't been that way for me. Not to mention the medications for pain relief I have been on for surgeries I have had and now are getting off those. It's a double whammy and can be very difficult many nights. Good luck to anyone who is changing doing this way of living compared to the food they have been suggesting we eat as their pyramid suggests. it's time for a new pyramid lol. It does get easier over time that's for sure. And I do pick and choose the amt. of any dairy or carb I have in a day. I guess you might say i am keto more than carnivore. But every step toward this goal has been worth it. Reply gloriaiarango gloriaiarango 2 months ago (edited) Dr. Berry I have been following you for years and thanks to you I'm carnivore now. I've been overweight since I was a teenager I have been in a low card diet since 20 years ago thanks to the book "Te carbohydrate addict's diet" and on a keto diet for 8 years now and last 3 months as carnivore. I never have been in ketosis while keto, the strips I used never showed the red-wine color just a very little pink on them. I was so frustrated and during covid after an induced comma of 2 weeks I was diagnosed diabetic. Never I imagined I had diabetes since I was eating very very few carbs. At the time my morning sugar was 126 but now my morning sugar is 145 most days. How is that possible if I'm not eating carbs?? Now while in carnivore I look slender people tell I'm losing weight and I look better (I'm 62 y.o.) however my blood sugar is rising and my weight is going up up. Besides that if my sugar spikes after eating a few grms of carbs the spike last for more than 8 hours some times for days. What's happening? Please, please I need help Reply 1 reply PMA PMA 2 months ago Super great tip Doctor. Love all your videos. 1 Reply Shidling Shidling 2 months ago Thank you for another great video, Dr B!! 4 Reply William Berliant William Berliant 2 months ago This is very interesting. I don't know if this muscle is related to the muscles you use to ride a bike, but after I ride my bicycle, my blood sugar goes down. Other exercises make it go up slightly. Swimming makes it go up a lot. I don't know why. 1 Reply R S R S 2 months ago This can be really helpful. Many many thanks! 1 KenDBerryMD Reply S JF S JF 2 months ago Thank you so much DR Ken. i am still in a wheelchair i am working on walking again with the keto/conivor life style this will help me out a lot!! Reply Deanna Miley Deanna Miley 2 months ago Thank you. I have learned more about blood sugar and how to control lower it than from my own Dr. Thank you for all the fantastic information!! Reply Camille Riggan Camille Riggan 2 months ago Thank you Dr!!!!!!!!! What a great exercise to know!!!!!! 2 Reply 1 reply Sreenivasa Murthy Sreenivasa Murthy 10 days ago It would be interesting to know why Soleus muscle is not able to burn glycogen and has to draw from blood sugar. What makes it special in this regard? Please share if research finding elaborated on this. Also, are there any other muscle(s) in humans that behave similarly? Thanks indeed for this really nice, almost undetectable exercise (trick) that comes handy when there is no escape from that encounter with mouth-watering high carbohydrate, calorie loaded dish(es). Reply Robert Kölich Robert Kölich 2 months ago I'd love to see a video regarding being underweight and starting the carnivore diet. Do I need to worry about sth, or is there anything I have to do differently than sb who's overweight/normal weight? i would appreciate a video, or even just an answer to my comment :) Reply Lynda Salgodo Lynda Salgodo 2 months ago I need knee replacements. This is perfect. THANK YOU! 2 Reply Rosemeri Barabe Rosemeri Barabe 2 months ago Would you please explain what "bathroom stall squats" are. I have never heard of that before. How do you do them? Do you have a video showing us how they are done? I would really like to know about this. Thank you for this great video. I will definitely do this while sitting at my computer. 1 Reply Hamza Qureshi Hamza Qureshi 2 months ago (edited) Had Dr Hamilton (the researcher) as my human perfomance physiology professor - he used to lecture so much about the soleus - amazing discovery! 3 KenDBerryMD Reply Danette Mannion Danette Mannion 2 months ago Hubby just told me watching this video that he does this all day in the recording studio! Interesting stuff Reply KellyVisionPictures KellyVisionPictures 2 months ago As a drummer ... I mostly play the bass drum and the hi-hat using the ball of my foot. It seems to me ... that motion is the same thing DR @KenDBerryMD is describing here. It's more fun to do it by playing the drums so ... I guess I need to practice more! :) Reply EZW EZW 2 months ago This is awesome doctor! Thank you! Reply Davil Davil 2 months ago I'll take that piece of pie! Then to the workout! With the one-arm alternating pushups too! Reply TheChicago35 TheChicago35 2 months ago You are a wealth of knowledge. Thank you😊 1 Reply Stewart & Di. Qld. Stewart & Di. Qld. 2 months ago (edited) Hi Ken this is Di commenting from Queensland Australia - a new subscriber. Firstly LOVE your accent. Re the exercise mentioned in this video I am going to try this by doing it as I have a desk job, I am 62 and have put on weight in the belly area... I gave up bread, rice , pasta and potatoes whilst I get this belly gone and understand that may be a long time. I introduced restricted eating and managed to get to one meal a day Monday thru Friday and then weekend 2 meals... lunch and dinner. Cut out processed foods and I am increasing my walking. My last blood work was said to be Normal but a lowering of HDL which surprised me as I eat avocados and oily fish ie salmon , sardines and tuna. No oils whatsoever for years. Eat the OLIVE not the olive oil ! Hopefully things will continue to improve BUT I cannot cut anymore meals out to improve things can I LOL Intense exercise seems to be the only thing missing to improve my HDL - I really want to boost it up and boost quickly - but I must admit to being concerned about injury from intense heart exercise as I have never pushed my heart and body that far for years ???? Thoughts anyone... belly rolls to get rid of here and HDL needs increasing as dropping away??? 1 Reply 2 replies Tanja Van Broeckhoven Tanja Van Broeckhoven 2 months ago (edited) I started this diet today and have some questions: I will make my own electrolytes with losalt and seasalt. Do I need to disolve it in water (and if so what would be the ratio of the water, losalt and seasalt?) or can I just put the salt on my food? Also, I would like to eat sardines, but all the canned versions are in olive oil, is that bad for the carnivore diet, is it better to eat them with olive oil, or not at all? Is it normal that I have to burp alot and hard after my first carnivore meal (bacon and eggs)? How do I make bonebroth, what kind of bones do I use and can it be bones with the meat still on, do I add vegtables to it or spices and herbs for flavor? What is the best way to prepare bone marrow? Do I have to eat lots of beef? I never liked the texture of beef. And I gag when I have to eat the fat on meat except for bacon. I understand that it is important to eat the fat of meat, but can I just eat bacon, eggyolks and chickenskin instead of the beeffat? Sorry for the many questions but I dont want to make big mistakes. And what are good recipes to eat liver for someone that really doesnt like liver, I hate the taste and the smell :o) Reply Rhonda E Rhonda E 2 months ago Thanks for sharing this, Dr. Berry. 😊 1 Reply OWG Garage OWG Garage 2 months ago Exercise starts at 5:15. 1 Reply Cher A Cher A 2 months ago I busted out laughing when dr. Berry said " Your boss won't notice you're multitasking under the desk" 🤣🤣🤣 Reply Beth Ann Crowe Beth Ann Crowe 2 months ago Thanks for all of your help‼️ 1 Reply Lisa Hause Lisa Hause 2 months ago Thank you, just had two kiwi’s 😂 I’m at my desk…trying it now…yep, definitely doable! 1 Reply Djinn-1 Djinn-1 2 months ago Great tip! Especially with the holidays coming :D 2 Reply Estervettie Hunter Estervettie Hunter 3 weeks ago (edited) Dr. Berry, I ate a sandwich with potato bread & fries. I paid for it with blood sugar readings of 213. I did this hack using the Soleus push-ups in increments of 30-50. My blood sugar dropped to about 115. So happy for this hack. I hope to resist the sandwich & fries next time. Thanks so much! Reply Diane Garrett Diane Garrett 2 months ago Thank you for the tip ❤ Reply krakoosh1 krakoosh1 1 month ago (edited) It would seem this could help people with restless leg syndrome. What I used to do when I had it was just go for a run. (Running on the balls of your feet, not heal to toe running) Reply Cary VerHalen Cary VerHalen 2 months ago Great content ♥️ Ty Dr. Reply Colpaert Laura Colpaert Laura 2 months ago That going be my new exercise thank you Dr. Berry Reply S.Z.Panzica S.Z.Panzica 2 months ago This is so cool. Thank you! 1 Reply LindyTN LindyTN 2 months ago This would be great for blood circulation too.👍 1 Reply Sheryl777 Sheryl777 2 months ago Thank you, this was a good tip! Reply James Kantor James Kantor 2 months ago (edited) Thank you, I am looking forward to trying this while sitting , after eating a healthy meal, when I do not have enough energy to go for a walk. 1 Reply 1 reply Michael Michael 10 days ago Just do this for 5 hours a day, and it's a quick fix. 1 Reply JP JP 2 months ago I did this back when I played basketball. After week 3 I kept hitting my head on the ceiling though. My doctor prescribed Ankle Weights and a helmet. 1 Reply kristin bailey kristin bailey 2 months ago I’ve got to get my blood sugar and blood pressure down. I’ve brought it down pretty good but not enough. I refuse to take prescriptions even though I really should be on at least the blood pressure one. It’s way too high. I’m going to work harder and do what I need to do! Reply - Gina - Gina 2 months ago Thank you so much Dr. Berry!!! God Bless you! Reply Seth Phillips Seth Phillips 2 months ago Great hack! As I lower the leg, can it help to raise the front of the feet simultaneously too? 2 Reply 1 reply anthony munafo anthony munafo 2 months ago Dr. Ken your videos are excellent! 1 Reply Jimmy Malone Jimmy Malone 2 months ago Thank you Dr. Berry for sharing with us. Reply 1 reply joanne kerr joanne kerr 2 months ago Ahahaha - I got a cramp in my right foot doing these exercises while I was watching you :) 1 Reply Alru Alru 2 months ago This will be great, especially with holidays coming up! Reply linda linda 2 months ago Hi, I am interested in a annual plan. I an in PST and work Mon-Wed 6 am-4:30pm. I would miss the live meetings. Are you ever going to change the dates or times? If so I would love to become a part of the community. Thank you for all you and Neisha do. Reply 2 replies A.F.S. A.F.S. 2 weeks ago There is actually a soleus machine at pretty much every gym. Its called the seated calf machine. Works ONLY the soleus!💪 Reply Booksmart The Alicorn Booksmart The Alicorn 2 months ago Thanks for the Soleus leg push up trick, Dr.Ken D.Berry! :D I love it! :D <3 Reply J Hull J Hull 2 months ago I'm a carnivore focused otr trucker... plenty of time on the road to make use of this exercise! 😃🚛 1 Reply Lisa c Lisa c 2 months ago Dr. Berry, can you do a video on nutrition and exercise for the pelvic floor. 2 Reply Diane Murray Diane Murray 2 months ago Hello Dr Berry, I am a big fan of yours since you started. I just watched your video about lowering you blood sugar by exercising your leg muscle. I have had cramps in my legs and toes for a long time but since I have been on the carnivore diet I haven't had any. Could this also have something to do with let cramps. My husband also gets cramps all the time I would love it if he would try the carnivore diet and see if this works. I think this is another positive thing about the Carnivore Diet. It's funny but I have always thought that I get my leg cramps when my blood sugar is high. 1 Reply Marilyn Y Marilyn Y 2 weeks ago Is there any other muscle that can be worked also to bring down glucose level? Reply Amy Atkinson Amy Atkinson 2 months ago Wonderful..thank you! Reply Joann McMullin Joann McMullin 2 months ago Got it! Thank u ! ❤️❤️ Reply Sylvia Seese Sylvia Seese 2 months ago This is good to know. Going to try it!! Thanks Doc. Your the best!! Reply Trucking with Diabetes Trucking with Diabetes 2 months ago Sounds great 👍🏻 Reply Duane Wolcott Duane Wolcott 2 months ago This looks like an ideal exercise to amplify by using elastic bands. Reply YuYo YuYo 2 months ago (edited) Hi @DrKenDBerryMD do you have any advices to cure interstitial cystitis?? I went carnivore 3 weeks ago and I started feeling better. Thank you so much for your videos. God bless you! 👉🏻❤ Reply 1 reply Philip Philip 2 months ago That is a very good tip Dr Ken 👍 1 Reply Aaron Smith Aaron Smith 2 months ago Is it possible to do this exercise with cerebral palsy do you think? I'm guessing the range of motion is important in this exercise. I was able to do maybe a 10% range from what was shown on the video. Reply Flying Circus Flying Circus 2 months ago Can you adapt this for air travel, and does it also help with blood circulation and prevention of deep vein thrombosis? 1 Reply El Miguel El Miguel 2 months ago Very interesting, thank you Dr Ken. Reply Denise Acorn Denise Acorn 2 months ago Thank you so much Dr. Berry!!! Reply Sheila Smith Sheila Smith 2 weeks ago Oh my gosh! This is where I have been having cramps at during the night! Reply Joe Garma Joe Garma 2 months ago Might seem like a nit-pick, but according to the study referenced in the video, form is very important in order to maximize activation of the soleus. In the Supplement Information document appended to the study, a diagram (Figure S2) shows that when performing the soleus push-up the knees are not at 90 degrees; rather, the knees are forward directly over the metatarsophalangeal joint in the foot (pretty much at the ball of the foot). I would link to it, but YouTube doesn't seem to allow that, last time I tried. 1 Reply Donna Aguilar Donna Aguilar 2 months ago I'm going to try this. I've been stuck sitting since I hurt my right foot 3 weeks ago. I'll start with uninjured foot....lol. thank you Dr Berry Reply Veronica Solomon Veronica Solomon 2 months ago Thank you, Dr Berry 🙋🏾‍♀️ Reply Lubna Malik Lubna Malik 2 months ago Thankyou Doctor I needed this. Reply Marlo Marlo 2 months ago (edited) I've been stuck at my desk working 10 hour days and had to stop exercising because don't have time. I went keto almost two months now and glucose came down 200 and I'm going start doing this too. I'm so curious if my blood glucose will lowers more. I need to drop it 80 more point to be normal. I'm trying anything to stay off meds. Super cool thanks. Hopefully I find time get some exercise in too. 1 Reply 1 reply Michael Hill Michael Hill 2 months ago Excellent trick, thanks a lot. Reply Gabi Gabi 2 months ago Thank you sooo much! Question: Do we use the soleus muscle when rowing? Reply Eddie Agnich Eddie Agnich 2 months ago Thank you great information! Reply William Gard William Gard 2 months ago I was wondering about some specific details about I’d you can tell if you’re using the correct muscle by how it feels, and whether it helps to put the weight on a certain spot, such as the outer ball of your foot. Reply Marjorie Curtiss Marjorie Curtiss 2 months ago Thank you Dr. Ken!😊 1 Reply Gayle M. Gayle M. 2 months ago Well, that's very interesting. Thank you. I will try this. 😊 1 Reply DSGN PORTAL DSGN PORTAL 2 months ago Great! So for how long can you do this to get results sitting down? Reply 1 reply John H John H 2 weeks ago Doing the same exercise for 270 minutes. You considering that as quickly Dr Berry Sir? Reply No Reply No Reply 2 months ago Dr. Berry great video!! Very interesting How many points can this exercise lower my blood sugar? 1 Reply Karen Toynton Karen Toynton 2 months ago Thank you for sharing. Your information was very helpful. I will give it a try. Reply Ana Lozada Ana Lozada 2 months ago (edited) I’ve been doing this exercise my whole life since I’m a dancer, and not knowing of the health benefits. 😬😂 This is a very common warm up exercise in Ballet before we go full force in the class. ☺️🩰 Reply George Daws George Daws 2 months ago Thanks for this, I will for SURE give it a try virtualhug Reply Luke Claydon Luke Claydon 2 months ago Don’t eat something you don’t want no matter who tells you, don’t fear judgement be your authentic self 1 Reply Venkata Ponnaganti Venkata Ponnaganti 2 months ago Wow. Thank you Dr. Ken Berry. It is quite possible to do it. 1 Reply Devanushi Chaliha Devanushi Chaliha 2 months ago This is very helpful. Reply Li Qin Li Qin 2 months ago Probably the best general practitioner in the world! 1 Reply MAMUNDUR VELMURUGAN KARUNAKARAN MAMUNDUR VELMURUGAN KARUNAKARAN 2 months ago Thank you Doctor for sharing to reduce the glucose levels. 1 Reply John Berger John Berger 2 months ago Bathroom Stall Squats? What's that? Could you do a video and explain, plus show us how to do it? Thanks for this great video. Reply S C S C 2 months ago Im doing keto and it does fix my prediabetes and GERD. I lost weight too and feel better, but cholesterol went up thru the roof. Watched your video about cholesterol and its explain most of it, but can you make a video about lipoprotein (a) ? 1 Reply 1 reply F Pinto F Pinto 2 months ago Really Grateful for this advice. Reply Jim Lynch Jim Lynch 2 months ago Can this soleus exercise be done while sitting with your legs elevated or must it only be done as shown? 1 Reply Hawten Slaton Hawten Slaton 2 months ago Thanks Doc, that is a great hack! Reply moon510 moon510 1 month ago Will have to try this Soleus lift until my next blood test. Reply Susanne Schauf Susanne Schauf 2 months ago Thank you Dr. Berry! 1 Reply Julie Weatherhead Julie Weatherhead 2 months ago Thanks for the info Doc!! Reply DZ Z DZ Z 2 months ago Thanks for this video. I saw the article on this research, and I sort of bought into the implied "you need special" instructions to get the "benefits". I can't wait to see how this works for me! Do you know of a way to get a CGM without insurance that isn't outrageously expensive? 2 Reply Jay nayk Jay nayk 1 month ago Does this exercise help lowering LDL also Reply Charlie Bumstead Charlie Bumstead 2 months ago Dr. Berry, I have a question totally off this subject. I'm concerned with the fast inflation of food that, at some point, I'll have to go off carnivore to something like beans and rice. Any help you could give would be great. I'm sure others are wondering that as well. Reply flyrocket19 flyrocket19 2 months ago Will this help with leg cramps? Been carnivore over a year but after 6 months I started getting leg cramps while sleeping night after night and it's unlike anything I've had before I'm talking 11/10 levels of pain. It's better now but still get the frequently. Would love to hear feedback from anyone. 2 Reply Brad C Brad C 2 months ago Appreciate your honesty... Reply Sofya Lizzy Sofya Lizzy 2 months ago Thank you Dr. Berry!! 1 Reply Heavymetalcat Heavymetalcat 2 months ago Thanks dr. Berry!! I'll try doing this I hope they help me, I'm a type 1 diabetic. 1 Reply mj dela mj dela 2 months ago Dr. Berry, a lot of long term Keto influencers are now saying that Keto can't be done long term and are going low carb or as you suggest carnivore. Do we have more data? Can you make a video about this? Thank you! Reply LeahStormGaming LeahStormGaming 2 months ago As a gamer, I sit too long and snack too much. Thanks for this info!!! I can't wait to start doing this. 2 Reply Buck Dezno Buck Dezno 2 months ago TY. Another great tip! Reply Tano Welch Tano Welch 2 months ago Doc Berry I am a little confused by your explanation of how the soleus works in regard to glucose. Are you saying that unlike other muscles the soleus cannot store glucose this when this muscle is activated it must draw directly from the blood surgar in order to make ATP via the Kreb Cycle? Reply Terry C Terry C 2 months ago This is too simple for excuses. Thanks! Reply The Land Savior The Land Savior 2 months ago Never heard of it before, would like to give it a try. How about leg fatigue? Anyone have comment on this issue? Reply 1 reply Meya Tetana Meya Tetana 2 months ago I don't believe in short cuts. I started taking little stretch breaks where I get up and walk around office every 10 or so minutes and that has kept me from getting restless while working Reply Jin Kaur Jin Kaur 2 weeks ago Thank you hope it helps Reply Bass Player Bass Player 1 month ago Doing heavy bench presses knocks my BS way down fast Reply Patricia Varga Patricia Varga 2 months ago ❤❤❤. Thank you! Reply Melvina Jessop Melvina Jessop 2 months ago (edited) Dr ken do you read all those books behind you or is it just for looks? I am type two diabetic I really learn a lot from your videos keep it up❤ Reply 1 reply Corliss Adams Corliss Adams 2 months ago Thank you Dr. Berry!!! 2 Reply Diane Taylor Diane Taylor 2 months ago Great hack! Thank you. Reply codniggh codniggh 2 months ago I have very strong those muscles because I use barefoot shoes, normally with conventional running shoes or any shoe, that and many other muscles in the foot ankle calf and all of that to the butt becomes unused and all the weight goes to the column, but when you walk or run this way, all those muscles get activated, so you can walk or run using that muscles mainly and you use more blood sugar. Reply Aspinall Sandy Aspinall Sandy 2 months ago Will try this very useful information, Thank you ,love watching your videos Reply rober may rober may 2 months ago Hi Dr Berry, I follow all your videos and am now reading your book, I am getting much fitter but my blood presure is a bit high, will taking ground flax seed help lower it? Rob. Reply 1 reply DF USA DF USA 2 months ago This is sooo cool … thanks doc Reply Nitro 200 Flyer Nitro 200 Flyer 10 days ago Will it work just as well if you do this standing ? Reply Ketones Not Glucose Ketones Not Glucose 2 months ago What if you are in ketosis all day long? Does it increase ampk? While the mitochondria uses ketones? Reply Carol Cole Carol Cole 2 months ago I am all ears for this ! Reply Ray Matthew Ray Matthew 2 months ago Dr. Berry, what about sewing machine legs? I used to do that a lot in high school involuntarily where my knees would bounce rapidly from my feet lifting my heels off the floor rapidly. Reply Lisa Harper Lisa Harper 2 months ago I do these standing up every morning. 1 Reply 2 replies Gabriel Bryant Gabriel Bryant 2 months ago Thank you for the information Reply R asraster R asraster 2 months ago The paper and the author's video actually both have the heel moved back a bit from under the knee. The metatarsalphalangeal joint (MTP) is directly below the knee Reply Christine Helmus Christine Helmus 2 months ago Doing this causes my calves to cramp within seconds. Am I doing it wrong? Reply Benito Montemayor Benito Montemayor 2 months ago (edited) My mom drinks coffee with lots & lots of sugar w/ milk. She has been a devout Jehovah’s Witness for around 55 years and is 91 years of age. She has been suffering from that calf muscle for years, but she will not lay off of sugar. 1 Reply mb7 b mb7 b 2 months ago Thanks for the video Kind Sir. What would be the effect if you push down on the kneecaps while doing this? Reply Coastal 805 Coastal 805 2 months ago Thank you, Dr. Berry! 😃 Reply C L C L 3 weeks ago my blood sugar jumped 18 mg/L after doing this for 8 minutes. anyone know how that could be? i ate 1.5 hours before Reply Aussie Sam Aussie Sam 2 months ago Dear Dr Berry. I tried this at my work desk but my colleagues called security when they saw me sitting at my desk with no pants on. What should I do? 5 KenDBerryMD Reply 2 replies Marwin Braun Marwin Braun 2 months ago Thanks for the Sixpack Doc! 2 Reply Chris Mety Chris Mety 2 months ago how does carnivore diet affect thyroid? By the way, Thank you for posting videos. I have learned so much from watching 1 Reply Rasfer Rastfarian Rasfer Rastfarian 2 months ago Awesome Hack! Thanks dr Berry! Reply DUDUK TV DUDUK TV 2 months ago Dr Ken! Could you do a video on Keto Rash and how to avoid it? 1 Reply Jack Wells Jack Wells 2 months ago Hi Doc, 9 mths 78lbs Thanks 3 Reply Silva Maney Silva Maney 2 months ago Thank you Dr Berry,God bless you. KenDBerryMD Reply Tim Dailey Tim Dailey 2 months ago Are these more effective when shoeless and can you add weight to your lap to increase the burn? Reply Ramaprasad Chintapalli Ramaprasad Chintapalli 2 months ago Thanks you so much 🙏🙏 1 Reply Sivan Aviv Sivan Aviv 2 months ago Hi, would you be interested in making a video about reversing hair loss in women with the carnivore diet? I think this could interest many people Reply Debra 007 Debra 007 2 months ago (edited) How interesting. 😏 I have little grannies at my work. It is very hard to say no. I do this exercise on the airplane. Reply Jian Lakerson Jian Lakerson 2 months ago (edited) If my feet are up on the toes my knees bounce. I've heard that this condition is some kind of "disorder," but indeed it has been there since early childhood. A friend used to remark that this is why (not entirely) I didn't gain weight. Truth is, I had hyperthyroidism and was 130 lbs at 6 feet in height until I was nearly 30 years old. But then the HGH began to wear off. I'm wondering now if this motion is connected with this exercise even though it is twice as fast? I burned a lot of blood sugar. Reply John B John B 2 months ago It's just a seated heel raise. I do them at the gym twice a week, with resistance. KenDBerryMD Reply 1 reply Rhonda E Rhonda E 2 months ago This is excellent information. I will be doing this. Reply KC KC 1 month ago Thank you so much. I will try it. Everything is a medical solution with most MDs. Reply Thabi Letsunyane Thabi Letsunyane 2 days ago does it help build the muscle tho? Reply Chris Minifie Chris Minifie 2 months ago Perhaps this would be good on a long flight; also reduce risk of deep vein thrombosis 2 Reply 1 reply Ralph Cantrell Ralph Cantrell 2 months ago As a life-long sufferer of chronic, near-constant nightly leg cramps that are centered in the area of the soleus/gastrocnemius and can reach 8 or 9 on my personal, 0 - 10 pain scale, I would be very hesitant to make use of this particular hack. The frequency/severity of these cramps is greatly intensified by any "exercise" that affects those particular muscles, and I just wouldn't risk that for the world. Reply 3 replies Daniel Ploy Daniel Ploy 2 months ago Soleus push-ups along with Kegels. What more is healthier? Good work MR Ken. 1 Reply QB QB 2 months ago Doctor Ken, Please do a show on a hepatic porphyria diet that will lose weight safely for people with hepatic porphyria. Link any diet or food list references you find and daily vitamin protocols for hepatic porphyria because this is VERY under addressed to the point of nothing offered I could find. Food carbs is the only treatment for hepatic porphyria yet there are no diet books or vitamin lists or holistic food lists for hepatic porphyria’s like HCP and AIP. Please address this or write some books on it to fill that gap! 1 Reply Cesar Javier Barbosa 2 Acid Green Cesar Javier Barbosa 2 Acid Green 2 months ago Even at my high carb diet, I'm mostly standing all day, so I can get away from the high carb to a certain extent. I don't consume seed oils. Reply 1 reply Cherrie McBratney Cherrie McBratney 2 months ago Would this help with circulation and fluid retention also? 3 Reply 1 reply eddie munster eddie munster 2 weeks ago Is the Soleus the only muscle in the body that has this inability to burn glycogen? Reply Janice Stallings Janice Stallings 2 months ago Would that help circulation also? Reply Shelly Aubey Shelly Aubey 2 months ago (edited) Carnivore for approximately two weeks. FBS this morning=204. After four sets of ten of this exercise=226. *sigh*🤔 Reply Ellen L Buikema Ellen L Buikema 2 months ago Thank you!! Reply M. Obscura M. Obscura 2 months ago Fantastic 😂 thanks for sharing this great undercover hack! Reply Gilmour11 Gilmour11 2 months ago (edited) I started meat only 18 days ago and I’ve been getting super flushed and red throughout the day and it gets worse after I eat. What is causing this? My and my sister’s skin is extremely dry and now I even have noticeable bags under my eyes for the first time in my life. I can’t figure out what could be happening. We both look like we have age 7 years in the last 18 days and I am not exaggerating whatsoever. Im eating lots of fat as well so it’s not a lack of fat. I’m really hoping that our appearance takes a turn for the better soon. I look horrible. Reply Prosper swatty Prosper swatty 1 month ago I did it for the first time and my blood sugar droped by 8 points. When I do it now it spikes by 6 points, why ? Very intersting Reply Gwen Gwen 2 months ago Funny that I do this all the time at my desk when I’m in boring Teams meetings! Watch out for wildcats! Reply Sharon Backos Sharon Backos 2 months ago Thank you! Reply Anomar Namloh Anomar Namloh 2 months ago I taught Chair Aerobics and these "Push-Up" were a staple of and a go to in my classes. Reply Marilyn Y Marilyn Y 2 weeks ago Hope everybody understands you do the solex pump sitting down and just flexing up on your toes. This is not a standing calf raise although I do it just to keep the muscles in my legs in shape Reply Rich E Rich Rich E Rich 2 months ago I tried doing this and got severe calf cramps, ah of joys of getting old! Reply Hanna Crow Hanna Crow 2 months ago What would be the optimal blood sugar and ketone level upon waking? Reply Chdara Chdara 2 months ago Thank you Dr Berry🇨🇦🇯🇲 I tell the world about Reply Scott Morgan Scott Morgan 2 months ago If the Soleus can't burn glycogen, what happens to it after this exercise? What if you end up using this exercise a couple times a week and that soleus can't burn the glycogen? Reply 3 replies CarolJean Fourie CarolJean Fourie 2 months ago Ok, wait ... now I'm also VERY interested in knowing how you do the 'squats'?? 1 Reply 1 reply Superfly.w Superfly.w Superfly.w Superfly.w 2 months ago Hi Doc. New sub right now I have latent TB on treatment for about three months now I also have anxiety disorder and palpitations. Will going on carnivore diet make my palpitations worse? Reply mandms bolonga mandms bolonga 2 months ago When I was pregnant with my first child, it was recommended that I sit in rocker and rock for about 10-15 min 2x day. The motion I would use is this motion, who knew? Reply SolidAirRecords SolidAirRecords 2 months ago fantastic, I emailed to several deskbound friends! 1 Reply Scott Ashmead Scott Ashmead 2 months ago Parents would always say stop bouncing your leg (nervous habbit) so I wonder if this was just a natural reaction for my body to burn the glucose when I was studying/working.... Don't have access to a CGM to test the theory right now to see if you get similar effects from just the leg bounce... Reply Rob John Rob John 2 months ago (edited) How low of a glucose is safe? My labs last week put me at 56. They were concerned and immediately called me about. I guess the better question is when should I get concerned? Reply Half Warrior Artist 67 Half Warrior Artist 67 2 months ago Will this help if only one leg can move? My left leg is ’disconnected’ from my brain (hemiplegic),and I can’t move my left leg at all. Right leg still works. Thank you Dr. 1 Reply 3 replies CA B CA B 2 months ago When I ate many carbs in the past I would do "foot push ups" against the footboard of the bed. Did not connect the two bc I ate mostly carbs then. I have not done that in years now. TY Reply Henry Carlson Henry Carlson 2 months ago So Wise, Thank You. 1 Reply Pumpkin Pumpkin 2 months ago Perfect time right before the holidays Reply Bryson Romain Bryson Romain 2 months ago Dr. Berry, you’re awesome Reply Barbara Pinto Barbara Pinto 2 weeks ago Thank you so much God bless Reply Steve Berthiaume Steve Berthiaume 2 months ago The "c" in "gastrocnemius" is silent; the word is split between the greek roots "gastro" and "cnemius" which has a silent "c" 1 Reply I am human I am human 2 months ago Summary:don't ignore calf training 1 Reply Dr. Robert Johnson Dr. Robert Johnson 2 months ago But just like when my Dr said, salt raises blood pressure. Stop salting your food. The first thing I ask is the..”yes, but by how much?” So if that can lower my blood sugar, is it in a meaningful amount? For instance, salt raises your blood pressure about 1% per 1,000 mg of salt. So after 100 reps of “push ups” how much sugar is removed? These are important things to know. And to see anything really measurable it needs to by outside the 20% margin of error by those devices checking blood sugar. 1 Reply 1 reply Cesar Javier Barbosa 2 Acid Green Cesar Javier Barbosa 2 Acid Green 2 months ago Fat and protein first, then I go after carbs. It slows down my spike. Reply Sharon C Sharon C 2 months ago Love ya! Thank you!!! Reply khamen723 khamen723 2 months ago Does this muscle also trigger when walking? I walk several miles a day Reply Rhonda E Rhonda E 2 months ago True. This is no excuse for eating carbs. Lol 😊 2 Reply DS DS 2 months ago Anyone that is T1D knows what the trampoline effect is. This is the explanation of it. Very cool. 2 Reply greg hoffman greg hoffman 2 months ago I am going to start a carnivore diet in about a week. I ordered three books, 2 cookbooks and one explaining the ins and outs of what you need do. I would like to know what if any veggies can be used. Mainly cabbage, cucumbers, peppers, and onions. 1 Reply 2 replies Jari Kinnunen Jari Kinnunen 2 months ago I am doing upper body swing in many direction while watch videos. It`s good for bad back. 1 Reply Renee Paz Renee Paz 2 months ago Doc, just a quick question: is having loose stool a side effect of doing carnivore diet? Reply 1 reply The Source The Source 2 months ago i have a trampoline that i bounce on that works my calves. does that work the soleus muscles effectively? Reply Anders Welander Anders Welander 2 months ago Very cool. I have some Dexcom cgms that I'll wear at some point and then I'll be able to test this. Reply Victor Connor Victor Connor 2 months ago Ken, do people on the carnivore diet need vitamin C at all? And if so, where would we get it in our food? 1 Reply Arkvizal Arkvizal 2 months ago (edited) 6:05 - 6:16 made me laugh so hard XD Reply Kevan Hess Kevan Hess 2 months ago Mmm saw this yesterday on Instagram.Also suggested by the glucose godes.i amWilling to try it especially at restaurants. Reply Vernon Kuhns Vernon Kuhns 2 months ago How about putting something heavy on the thighs while doing this exercise??? Reply Ron Silva Ron Silva 2 months ago Thank you so much keep doing what your doing . And keep working with the chain saw in the woods it’s soothing and so is a good axs and splitting wood it’s good and relaxing and learn to sharpen your chain with a file get good at it ☝️☝️👍👍👍 Reply Bob M Bob M 2 weeks ago I'm pre-diabetic and would rather lose weight than go on meds. I got a call from my Doctor 's Secretary that they want to do a blood test and have booked me in for 9th January, just after the holidays! Panic! How long does the blood sugar stay down after doing this exercise, I really don't want to be on more meds, as I'm taking blood pressure tabs as it is. Any advice please? Thanks. Reply Greg Vaughn Greg Vaughn 2 months ago I subconsciously bounce my knee like that since I was a kid 2 Reply 1 reply Miranda Killjoy Miranda Killjoy 2 months ago What about kidney health being a diabetic with CKD STAGE3 , a lower sugar number is good but I also need to lower my insulin levels So I’m asking should I do this exercise with CKD? Reply Aunt Dee Aunt Dee 2 months ago You are the best!!! 7 Reply Liz Jhones Liz Jhones 2 months ago Hi Dr Berry, I have been trying to gain weight for a couple of years now with very little success, I'm not on any medication atm. came across one of your videos from about 4years ago. You've talked about medicines & antihistamines which can make you gain weight? I'm hoping to try the once which can help improve appetite, Please if you have any recommendations will be greatly appreciated 🙏 1 Reply Rob Lents Rob Lents 2 months ago I had quad bypass 6 months ago. I was and am in excellent physical shape. I am 54 and have eaten "healthy" for a long time prior to the surgery. Is it safe to go carnivore? Reply 1 reply Bev G Bev G 2 months ago Ty so much Doc! Reply Rose Jackson Rose Jackson 2 months ago Thank you for this information Dr. Ken and I did think a kitty cat attacked you, lol. Reply Bruce Prigge Bruce Prigge 2 months ago Thanks! :) Reply Grzegorz Durda Grzegorz Durda 2 months ago Seated calf raises people. Bodybuilding's classic exercise. Reply Chrissy Ellem Chrissy Ellem 2 months ago As a kid the thing I did under the table was feed my dog all the food I refused to eat lol Reply AL from L.A. AL from L.A. 2 months ago Thank youse Sir 🙂 Reply Elfena Elfena 2 months ago I purchased your book Common Sense Labs. I recently had my labs done. My LDL 237 my Trig 81 my HDL 87. Military doctor want to prescribe statin because LDL. She’s giving me 3 months to lower it. I’ve been doing ketovoir or Low carb at least 3 yrs. Labs also shows abdominal aorta calcification. Did the high LDL cause this? I hope that when I see my doctor I’ll be prepared and have your Common Sense Labs with me. Reply 1 reply Karen Black Karen Black 2 months ago I just got back from Applebees and splurged with 4 mini cinnamon rolls. I'm going to try this. Reply Ann Parker Ann Parker 2 months ago I saw the research and was so disappointed that it seemed to only work with the things you mentioned, electrodes and scientists and a doctorate. Thank you more than you know. Reply coffeemachtspass coffeemachtspass 2 months ago Those of us who suspected it are vindicated. Dr. Berry DOES make his videos without pants on. 1 Reply NO THANKS NO THANKS 2 months ago (edited) I have been doing Keto for about about 1 year. Can keto cause xanthelasma? I have a small area under my left eye I'm Concerned with. I am 6ft 2 inches tall Ihave lost 24lbs 194-170. I feel great. I didn't have any underline health concerns beforehand/starting keto just trying to stay healthy and lean. I still need to go in for my yearly Physical. I haven't had any blood work since I started keto. I have gone off keto for short times, but mostly on keto. Keeping track with keto moto blood checker. Averaging .7 keto leve most of the year. Thanks Jason Reply Victoria L G Victoria L G 2 months ago Dr Berry, please find 5 more muscles that do this. I'm on board! 2 Reply Joanne Morrison Joanne Morrison 2 months ago Does this also mean, it can affect one’s blood pressure also? 1 Reply Kim sellars Kim sellars 2 months ago My glucose has been as low as 54 but usually in the 84 range but my keytones are .3. I have only had 5 carbs in the last 24 hours. I don’t understand what’s going on. Reply missing1person missing1person 2 months ago I want to see this with a continuous blood glucose monitor Reply Kris Justin Kris Justin 2 months ago Whenever someone asks me about how to lose weight, I just refer them to Dr. Berry. Simple! Reply DivineAmairani DivineAmairani 2 months ago This doesn't work if one has low insulin production. Not enough insulin to deliver glucose to cells, no matter how long or hard one exercises, it won't speed up glucose leaving the bloodstream 1 Reply Eileen Vaughan Eileen Vaughan 2 months ago Great 👍 Reply Hannah Zander Hannah Zander 2 weeks ago This is a natural movement for us fidgety types. Reply Smoked Brisket Smoked Brisket 2 months ago (edited) Doing ketogenic diet for a while now. Fasting glucose is mid- to upper-70s, down from 263 to 226, triglycerides down to 74, HDL up to 54, but my keto sticks only ever show trace ketones. Why am I not throwing off ketones in my urine? Has my body just gotten accustomed to using fat for energy? Or is there something else going on? Also doing IF, generally 20 hours once or twice a week, then a full 24 hour fast from Thursday night to Friday night. Reply Caramia Caramia 2 months ago I can't imagine stuck behind a desk all day . 1 Reply Geanora Westlake Geanora Westlake 2 months ago love the idea of the CGM. How do I get one? Reply RJ Lee RJ Lee 2 months ago Do vitamins need to be taken with food? Reply Brian Brian 2 months ago Exercising while I watch the Phillies win the would series!!! 3 Reply 3 replies Pat Walkins Pat Walkins 2 months ago That is why doing sprints after eating lowers the BG quickly Reply Janet Newbill Janet Newbill 2 months ago Thanks dr Berry your so funny !! Reply Roger Carroll Roger Carroll 2 months ago It might work if you do this four and a half hours at a stretch. This is not a sufficiently proven item yet. Reply Adam WithanA Adam WithanA 2 months ago Just found out it works on the 🚽 too 🥰 1 Reply Papinoo 11 Papinoo 11 2 months ago (edited) The original report says that to get 50% reduction in glucose you need to do the exercise for 270 minutes! What am I missing here? Reply 4 replies moon510 moon510 1 month ago As I watched the video I was wondering about dancers, especially ballerinas: do most or all of them have no blood sugar or diabetic problems? Reply googoo554 googoo554 11 days ago Thank you so much Reply Seriously Carnivore Seriously Carnivore 2 months ago once I get my cgm I will test this out 1 Reply CZRider CZRider 2 months ago Does loading some weight, like across my thighs improve the response?? 2 Reply 1 reply 47retta 47retta 2 months ago How long or how many bathroom squats do you have to do to get results? Reply Brian Kimmins Brian Kimmins 2 months ago Doc Berry THANKYOU VERY MUCH, I'm getting back into living a longer life. Bee Kay PNG Reply SweetSmilinSteph SweetSmilinSteph 2 months ago So cool! Reply Lucy Erda Lucy Erda 2 months ago I wonder if walking also works the soleus? :D 1 Reply Stef Diaz Diaz Stef Diaz Diaz 2 months ago Bend knee seated calf raises, a very popular bodybuilding excersise. Reply mazuazul mazuazul 2 months ago Would be nice a video about carnivore and sulfide SIBO, I have a lot of doubts and I do not know how to do it when the first thing a doctor say is that I need to stop eating meat with this kind of SIBO. Reply 1 reply John Karavitis John Karavitis 2 months ago I find this hard to believe. Link to research that the soleus can't store/use glycogen. Also, what are the implications for runners re training and running marathons? Reply MC1R Positive Susie Q MC1R Positive Susie Q 2 months ago @Dr.Berry How well can this work first think in the morning if you suffer from the Dawn phenomenon!?!?!????? Plz respond🤞 3 Reply Jerry Lee Colbert Jerry Lee Colbert 2 months ago So I heard another doctor say that we can eat fruit on the Carnivore Diet, is that true and if so does it provide any benefit that we are not getting from strictly eating meat? Reply TREND TREND 2 months ago (edited) During riding bicycle I notice something very strange! When I push pedals with tips of my soles it more efficiently lowering my blood sugar then pushing with heels! Nobody would believed me! Probably it is from reason you just explained! I was puzzled by it, but finally I know cause! 2 Reply 5 replies Tricia Skiles Tricia Skiles 2 months ago Love the new glasses! Reply BeingInTheMessiah BeingInTheMessiah 2 months ago Not related to the video but its most current so I thought I'd share. 11,000 year old stone fish trap discovered off Alaskan coast, oldest in the world. People understood and cared about Salmon migration patterns and sought them out. Reply Ali Jazani Ali Jazani 2 months ago damn , i came here hoping to hear you say that we can lower our blood sugar while sitting and eating meat and not eating veggies or carbs 😁 1 KenDBerryMD Reply Justin Isenberg Justin Isenberg 2 months ago Just came across this channel and I was wondering if it would be ok to go carnivore with gallstones. Reply 2 replies Gail’s Food, Music and Stuff! Gail’s Food, Music and Stuff! 2 months ago lol, i was just going to ask if you had a cat, but you explained the scratches. lol. ok, so im doing that exercise right now, thx for the tip. Reply Mr Push Mr Push 2 months ago Let's get imperical here, how MUCH say per set of 100 reps does this lower blood sugar? Without an idea, who knows what this might or might not do? Do people need to do 300 or 3000 to see any notable reduction? 2 Reply 5 replies Kevin Gallen Kevin Gallen 2 months ago The British police used to use a similar technique when they used to walk the beat. Reply Charles Tait Charles Tait 2 months ago When you first said “under the table” I got a bit nervous! 3 Reply 1 reply Brownmahfun Brownmahfun 2 months ago Love, love, love the specks. 1 Reply Russell Robinson Russell Robinson 2 months ago Probably works on restless leg syndrome too!? Reply The Slider The Slider 2 months ago No one is "forced" to eat high carb food! 1 Reply 2 replies Tom Noyb Tom Noyb 2 months ago Isn't Glycogen the short-term energy stored in the muscle, used only when energy demand exceeds external supplies? In other words, when engaged in strenuous activity muscles use food first, fat second and Glycogen last? Glycogen is the energy of last resort? Because when muscles (including heart) run out of Glycogen, they fail. You "hit the wall." And when your heart "hits the wall," you die. Under-table lifts aren't going to run heart out of Glycogen obviously; especially at the dinner table - that's not the point. Point is that this doc doesn't seem to have a clue how Glycogen functions? Bringing his whole theory into question? Reply beastshawnee beastshawnee 2 months ago idk if ai imagine it but when my Blood sugar feels too high and I am just home on the couch-I take a couple pinches ofsea salt in my cheek…it seems to help stabilize it a bit? anyone else notice this? Reply Sarah-is-Lovely Sarah-is-Lovely 2 months ago Oh that shirt is perfect! Reply S Lewis S Lewis 2 months ago And I thought it was just a nervous habit! Reply Joann Santos Joann Santos 2 months ago (edited) Can we normalize shorter intros with less preamble?? 1 Reply HannibalTheHuntur HannibalTheHuntur 2 months ago This channel, as well as others that like to promote these diets that I myself have benefited from, have failed to address the issue of prurigo pigmentosa time and time again, the skin condition associated with the keto and carnivore diet as well as the fasting state. Reply 2 replies Joe Camel Joe Camel 1 month ago Most kids know this instinctively 😉. Reply Brenda Hunter Brenda Hunter 2 months ago (edited) Those of us who have blood sugar issues need to stand firm against social pressures of eating carbs. Just say no! Why should we be bullied into eating something that we know is harmful? I never see anyone pushing meat on someone who declares to be vegan. What about alcoholics? Do they feel they must drink so as not to hurt someone else's feelings? My sis in law has this superstition that if everyone doesn't have a piece of birthday or wedding cake, it's bad luck for whomever the cake is for. I tell her it's bad luck for me as a carboholic if I do eat it. I will certainly employ this exercise as my BS is always too high just from breathing. I'm just saying we have to be responsible for what we feed our bodies and granny will have to get over it. We should be insulted that she would insist we eat something that is poisonous. Pass the 🥓 bacon, please! Reply TASTING THE HEAT TASTING THE HEAT 2 months ago Thank you. 1 Reply Tom Condon Tom Condon 2 months ago Off topic, I've been looking for the forum to address you, and CarnivoreMD. Joe Mercola just published a piece on avoiding kidney damage. He said too much meat causes acidity, and a.) Needs to be avoided, and, b.) Should be mitigated with fruits and VEGETABLES. Link on request. Reply G S G S 2 months ago The Bible is the most historic book on the planet and it consistently refers to grains (bread) as part of their diet. When you say our ancestors didn’t eat plants are you including the civilization of Jesus’s time on the earth? Reply JFJ JFJ 2 months ago Thank you Dr. Berry Reply Mr. Skipper Mr. Skipper 2 months ago Thanks Doc. Reply Adrienne Murphy Adrienne Murphy 2 months ago Thanks!! Reply Sandy Morrison Sandy Morrison 2 months ago Thanks - I do these, but I didn't know why... Reply Daniel Delgado Daniel Delgado 2 months ago $4.99 Thanks! KenDBerryMD Reply Robert Brown Robert Brown 2 months ago Question: I'm stage 4 ckd, will a keto or carnivore diet help me ? Doctors say my kidney failure is from vasculitis. 1 Reply PugetSoundComedy PugetSoundComedy 2 months ago Thanks @KenDBerryMD You're Awesome! Reply Max Larson Max Larson 2 months ago (edited) How come your legs have cuts Dr. Berry? Hopefully everything is good. UPDATE: Should have watched the very end of video. lol Reply Monte Lang Monte Lang 2 months ago I have a CGM. My sugar was 79. Then I did this soleus push up for a few minutes and my sugar went up to 84! Hmm... Reply Varinia Garcia Varinia Garcia 2 months ago $1.00 Thanks! KenDBerryMD Reply RothGamez RothGamez 2 months ago If I'm doing it standing, is it the same as calf raises? 1 Reply iamafractal iamafractal 2 months ago Does an hour a day of walking activate this muscle? 1 Reply jimmy HVY jimmy HVY 10 days ago is there more muscles like the Soleus ? Reply Key West Fan Key West Fan 2 months ago Just went to Greece to visit family. All of the family members were constantly trying to shove food down my throat. Bread, spanakopita, desserts, pastichio, mousaka etc. Made it clear that I don’t eat that stuff but it’s like it went in one ear and out the other. Still insisted on making this stuff daily for me. So frustrating. It’s like you inferred. Almost feel like it’s my fault and being disrespectful by not eating this stuff. Reply Natural Wonders Natural Wonders 2 months ago Thanks always 🙂🌴🙂🌴🙂🌴🙂🌴 Reply Elisabeth Stauble Elisabeth Stauble 2 months ago $10.00 Thanks! Reply KenDBerryMD · 1 reply DIGTHE VOICE DIGTHE VOICE 2 months ago Will it lower blood sugar from gluconeogenesis since it's demand driven? 1 Reply Black Jew Black Jew 2 months ago So I have been doing this for year, to not kill my boss, now I know why it works. Reply Harold Marsh Harold Marsh 2 months ago I was doing that as a OTR truck driver for blood flow,,, Little did I know. Reply Jane Osborne Jane Osborne 2 months ago You'll "get in touch with your inner soleus."🤣🤣🤣 Reply Gaby Raul Gaby Raul 2 months ago Hello, I have rosacea, is the carnivorous diet a good option for me? On the carnivorous diet can I take creatine? Reply Malak Alhamwe Malak Alhamwe 1 month ago Thank u very much Reply Sashmiel Sashmiel 2 months ago Its funny that I used to do that on my own as a nervous tic, I thoguth. Wuld explain that once I trained myself not to do it ... Reply colm rooney colm rooney 11 days ago haha now thats what I call a "hack". I only ate some grapes at night... are there any other muscles that do this as well? Why is it this muscle in particular? Reply Nilima Mittal Nilima Mittal 2 months ago Is this the same muscle that gets used when you bounce your knee and fidget? Reply Mega Mega 2 months ago I'm non diabetic hypoglycemic and my calves and forearms become sore when my blood is low Reply Wahid Rashidzada Wahid Rashidzada 2 months ago If someone has hypoglycemia then they have to make sure they don't do this exercise. 1 Reply typhon800 typhon800 2 weeks ago I fired a guy for chronically “multitasking “ under his desk. Seriously 😂 Reply pct2r pct2r 2 months ago Thanks Dr Berry Reply Ankica Lukic Ankica Lukic 2 months ago Thank you dr K Bery Reply Paige Morgan Paige Morgan 2 months ago Thanks Dr. B. Reply Yvonne Yvonne 2 months ago I already feel low sugar😆 Reply Teresa Teresa 2 months ago I've noticed after I've eaten too many carbs that my heart races and I feel weird. Is that my blood sugar being too high? I do not like that feeling. Reply 1 reply cj432T cj432T 2 months ago (edited) Question I'm sure you're tired of but - Is red meat bad for the prostate or not? Too much confusing info online imo? Thank you Dr. K.B. Reply 1 reply Herbert von Sauerkraut unterhose Herbert von Sauerkraut unterhose 2 months ago (edited) Cramp city... I've seen this exercise before. 👍 Reply Robert Newsome Robert Newsome 2 months ago I wonder if this hack will serve to accelerate reduction of the A1c. Reply timshel Leo timshel Leo 2 months ago I tried your hack...To my bewilderment my blood glucose went from 108 to 123 !!!. Back to the drawing board .sigh. Reply 1 reply ANGELA MCFADDEN ANGELA MCFADDEN 2 months ago Starting to decrease carbs eating more meat ... Want to get some blood work done ... What do I ask for ... Thank you Reply Joseph A Nagy Jr Joseph A Nagy Jr 2 months ago That looks like leg fidgetting. I've been doing this for decades just as something to fidget. Reply Jennifer Mathews Jennifer Mathews 2 months ago Will it help a Type one diabetic that does not make insulin or glycogen? Reply KenDBerryMD · 1 reply hamstersniffer hamstersniffer 2 months ago 4:00 me now putting down the fudge brownie 1 Reply Cindy Wilkins Cindy Wilkins 2 months ago Where can I get a CMG? Does it take a docs prescription? 1 Reply Ev Ev 2 months ago Quick question, do you need to be barefoot? Reply Yves Baggi Yves Baggi 2 months ago (edited) But where does that blood sugar go? Doesn't it get stored as fat? Reply benjamin aguilar benjamin aguilar 2 months ago It is also known that that muscle is made mostly of zinc Reply Min. Bread of Life-Pan de Vida Min. Bread of Life-Pan de Vida 2 months ago Where I can see the links the doctor mentioned? Reply Scott 0str Scott 0str 2 months ago Can you please test this with a continuous glucose monitor and report the results? Reply 7 replies Terry Jones Terry Jones 2 months ago what's the chances of getting leg cramps with this? 1 Reply P. Shawn Faherty P. Shawn Faherty 2 months ago Wow. Great hack. Love the comment about G’ma’s apple pie 🥧 ala mode! Reply Vani Hansen Vani Hansen 2 months ago Ha I'm diabetic but I'm going to try this 2 KenDBerryMD Reply 1 reply Cheryl I Cheryl I 2 months ago I often wish you could just get to the point Thank you kindly though Dr Berry 1 Reply E V E V 2 months ago I am a Patreon but I was somehow removed from the mailing list. I have sent several emails to asked to be put back on it but I have heard no response from anybody. My Patreon membership is set to renew in December and I can’t even talk to somebody. I’m also looking for the list that you put together of doctors in your area that do keto or carnivore. Thanks for any help from anybody with this situation!! Reply TBD TBD 2 months ago Me call this calf-raises at the gym. 1 Reply Jack Jack 2 months ago I'm going to have to eat Christmas dinner or I'll never here the end of it 😪 Reply LYCIA MCDONALD LYCIA MCDONALD 2 months ago Thank you Reply Tam S. Tam S. 2 months ago Thank you Figure thumbnail gr1 Figure 1Minimal contribution from soleus glycogen to the total energy for contractions (the activity energy expenditure) during prolonged local activity of the soleus with SPU contractions Figure thumbnail gr2 Figure 2Whole-body and local oxidative metabolism during SPU contractions when sitting and during treadmill exercise Figure thumbnail gr3 Figure 3Sustaining elevated muscle metabolism with soleus contractions is sufficient to cause improved glucose tolerance and reduced postprandial hyperinsulinemia, with up to a 52%–60% reduction in the blood glucose and insulin iAUC Figure thumbnail gr4 Figure 4Recruitment during locally intense