Category Archives: Topic of the Week

Degeneration? More Like Normal Aging

It is absolutely imperative that we fitness industry folks understand that degeneration is a normal aspect of aging. If we told everyone with degeneration not to exercise, everyone would suddenly be sedentary, and a host of greater problems would rapidly arise.


If you don’t have some signs of degeneration, then you’d be “abnormal.” I’m fairly certain that if all of the people reading this post were to obtain full body MRI’s, evidence of degeneration would show up in multiple regions of the body in 100% of individuals. Want some evidence?

First, let’s talk about spinal intervertebral discs. Around 20% of teens have mild disc degeneration, and 60% of discs of 70-year olds are severely degenerated (Urban and Roberts 2003). If you’re looking at the L5-S1 disc of 70-year olds, over 90% of them will be degenerated (Hagiwara et al. 2014).

Looking at people with zero back pain, 64% have abnormal discs (52% had bulges, 27% protrusions, and 1% extrusions), with 38% of the individuals having abnormalities in multiple discs (Jensen et al. 1994). According to a systematic literature review by Brinjinkji et al. 2015, “The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.”

When looking at arthritis, around 7% of 18-44 year olds have it, and in persons 65 or older, this percentage rises to 50% (2010-2012 NHIS).

If we hone in on the knee joints, 20% of persons under 65 have knee osteoarthrits, whereas 50% of persons over 65 have it (Bhatia et al. 2013). Even 50-90% of athletes with no pain have serious knee abnormalities under MRI (Brunner et al. 1989, Mayor & Helms 2002, Kaplan et al. 2005, Walczak et al. 2008). Regarding meniscal tears, here’s what Dr. Felson had to say: “The rule is, as you get older, you will get a meniscal tear. It’s a function of aging and disease. If you are a 60-year-old guy, the chance that you have a meniscal tear is 40 percent.”

At the hip, 100% of persons older than 60 have acetabular rim degeneration (Leunig et al. 2003), and 63% of gymnasts have signs of ischiofemoral impingment (Papavasiliou et al. 2014).

If we examine the shoulder joints, we’ll see that 31% of persons older than 60 have shoulder osteoarthritis (Chillemi & Franceschini 2013). In 40-70 year old males, 96% have abnormal ultrasound scans – ranging from subacrominal-subdeltoid bursa thickening (78%), acromioclavicular joint osteoarthritis (65%), suprispinatus tendinosis (39%), subscapularis tendinosis (25%), partial-thickness tear of the bursal side of the supraspinatus tendon (22%), posterior glenoid labral abnormality (14%), amongst other abnormalities (Girish et al. 2011). Dr. Andrews found that in healthy professional baseball pitchers, 90% had abnormal shoulder cartilage and 87% had abnormal rotator cuff tendons. For this reason, he stated, “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI.”

As you can see, degeneration is not abnormal – it’s a normal process of aging and it shouldn’t be thought of as a reason to stop moving and exercising. Every single one of us have degeneration, yet we still find ways to exercise. Strength & conditioning and sports medicine professionals must embrace this phenomenon and provide recommendations as to how individuals with varying signs of aged joints can continue being active, employ resistance training, and participate in sports in the most optimal manner possible. This requires consideration of total health & wellness, since sedentarism can lead to weight gain and obesity, metabolic syndrome, frailty and sarcopenia,  and depression (for a comprehensive list of reasons why exercise is beneficial, click HERE).

Focusing on people’s degeneration can provide a nocebo effect which is counterproductive and can lead to pain or increased pain. Instead, we should focus on what people can do (not what they can’t), and augment the way we talk about “degeneration” by assuring people that it’s normal and part of getting older. Activities and exercises can be modified so that individuals can well-tolerate them. Knowledge of proper progressions and regressions (I refer to this as, “Movement Pattern Continuums“) in resistance training goes a long way in keeping people strong and healthy.

Props to The Sports Physio Adam Meakins for providing me with the idea for this blogpost.


Squats and Deadlifts Won’t Make Your Waist Blocky

Preface: Because this topic is highly controversial in various fitness circles, I decided to back up my writing with anecdotal evidence in the form of photographs. I’m not just some geeky arm chair expert, I’m an actual personal trainer (Instagram page HERE) with 18 years of professional experience. Therefore, throughout this article, you will see pictures of clients I’ve actually trained in person, each of whom performed squat and deadlift variations throughout the course of their preparation. 

For the past couple of decades, bodybuilders have been cautioning fellow bodybuilders, advising them to avoid squatting and deadlifting on the premise that they add mass to the midsection and create a blocky appearance. This advice is especially doled out to female competitors, since it is of even greater importance for them to maintain their curvy, feminine appearance.

But is there any truth to this claim? Let’s delve deeper into this matter to see if it holds up under scrutiny. The first problem with the claim that squats and deadlifts make your waist blocky is the subjective nature of what entails “blocky.” From the side view, larger erector spinae and rectus abdominis muscles could cause an individual to appear blockier, but it is unlikely that this is what people making the claim are referring to. It is more likely that these people are referring to the front view, which would be most impacted by the size of an individual’s internal and external oblique muscles.

Squats and deadlifts didn't give Katie Coles a blocky midsection

Squats and deadlifts didn’t give Katie Coles a blocky midsection

The second problem with the claim is the complete lack of longitudinal training studies investigating the effects of squats and deadlifts on abdominal wall hypertrophy or comparing the core muscle growth associated with squats and deadlifts to that achieved via single joint exercises such as supermans, crunches, and side crunches. Since there are no training studies to go by, all we can do is speculate based on acute mechanistic studies.

This leads us right into the third problem with the claim – squat and deadlift naysayers never seem to pinpoint a mechanism as to how squats and deadlifts lead to excessive growth in the midsection. Since they haven’t narrowed down a mechanism, one can only guess as to how they believe this happens. I imagine that they believe that squats and deadlifts create excessive core muscle hypertrophy due to very high activation in the abdominal and oblique musculature.

Squats and deadlifts didn’t give Erin McComb a blocky midsection

It is indeed true that squats and deadlifts highly activate the erector spinae muscles. Interestingly, squats activate the lumbar erectors to a greater degree than deadlifts, whereas deadlifts activate the thoracic erectors to a greater degree than squats.[i] However, several studies to date show that abdominal and oblique activity during the squat and deadlift are not substantially high, and that basic ab/core isolation exercises outperform squats and deadlifts in abdominal and oblique activity.2-5

Through EMG experimentation in my own lab, I’ve found that many common exercises match or exceed squats and deadlifts in rectus abdominis and oblique activation, including chin ups, military press, hip thrusts, reverse hypers, push ups, pullovers, tricep extensions, and curls. In addition, I’ve found that most targeted abdominal/core exercises exceed (sometimes far exceed) squats and deadlifts in abdominal and oblique activation, including RKC planks, side planks, bodysaws, hollow body holds, ab wheel rollouts, weighted crunches, straight leg sit ups, hanging leg raises, dragon flags, lying leg raises, suitcase carries, side bends, cable chops, and landmines.

Squats and deadlifts didn't give Sammie Cohn a blocky midsection

Squats and deadlifts didn’t give Sammie Cohn a blocky midsection

I propose a multifaceted alternative reason for why bodybuilders believe that squats and deadlifts create a blocky appearance. First, due to increased knowledge pertaining to training, nutrition, and supplementation, bodybuilders have gotten exceedingly larger over the past couple of decades. Bigger bodies require larger organs in order to carry out their necessary processes. Therefore, bodybuilders’ entire midsections are growing larger, but this doesn’t apply to women that strength train, since women generally avoid intentionally growing their bodies 25-50% larger.

Second, many bodybuilders regularly take a variety of performance enhancing substances including human growth hormone, which is believed to lead to increased organ growth and a distended appearance in the belly region in bodybuilding communities. Obviously, this factor also doesn’t warrant consideration from women because they generally avoid taking human growth hormone in concordance with other anabolic drugs. Heavily drugged bodybuilders experience a wide range of side effects that natural lifters don’t need to concern themselves with, including acne, expedited hair-loss, and distended bellies.

It can't be the drugs, right? It's gotta be the squats and deads!

It’s gotta be the squats and deads…it can’t be the drugs, right?

And third, bracing the core during squats and deadlifts requires considerable intraabdominal pressure (IAP) to properly stabilize the spine. Though the diaphragm muscle is largely responsible for this increase in IAP, humans are by nature quite poor at relating sensation to proper physiological actions. Therefore, bodybuilders confuse high diaphragm activity and subsequent outward pressure in the midsection with high levels of abdominal and oblique activity.

Old school bodybuilders believed that “drawing in” the abdominal wall through vacuum poses helped keep the midsection tight through transversus abdominus (TVA) strengthening. One could plausibly make the argument that frequent bracing of the core leads to growth in the midsection due to pushing outward on the abdominal wall via IAP production. Even though abdominal and oblique activation is low during squats and deadlifts, the midsection could grow due to increased connective tissue extensibility due to persistent stretching. However, bracing the core doesn’t involve maximal expansion and stretching of the abdominal wall, so this is doubtful.

Squats and deadlifts didn't give Chelsey Mcallister a blocky midsection

Squats and deadlifts didn’t give Chelsey Mcallister a blocky midsection

Having trained numerous bikini competitors, I can tell you that midsection appearance is largely related to genetics. Although my clients train in the same fashion and perform the same exercises, some of them step on stage with narrow, tapered waists while others aren’t quite as lucky. However, not a single bikini competitor ever showed up on stage appearing blocky, despite including squat and deadlift variations in their prep. If a woman is concerned with obtaining a blocky appearance, I would recommend ditching targeted abdominal and oblique exercises rather than avoiding squats and deadlifts.


Squats and deadlifts highly activate the erector spinae to prevent flexion of the spinal column. The abdominals and obliques cocontract along with the erectors in order to enhance core stability, but the levels of activation reached in these muscles is on par with many common strength training exercises. Furthermore, most popular isolated core exercises, both static and dynamic, activate the abdominals and obliques to a much greater degree than squats and deadlifts. Therefore, on the basis of abdominal and oblique activation, if lifters should avoid squats and deadlifts to prevent becoming blocky, then they should also avoid most other popular exercises, which is ludicrous.

Women do not need to fear that squats and deadlifts will cause them to develop a blocky midsection. This phobia has been generated by well-intentioned but misguided bodybuilders who use squats and deadlifts as a scapegoat to explain the excessive midsection growth that they experienced when they packed on dozens of pounds of muscle mass in concert with human growth hormone, insulin, and anabolic steroids. What these bodybuilders experience doesn’t apply to the masses. This conclusion is anecdotally supported by the fact that most top-level bikini competitors regularly include squat and deadlift variations in their training.


  1. Hamlyn et al. 2007 | Trunk muscle activation during dynamic weight-training exercises and isometric instability activities
  2. Bressel et al. 2009 | Effect of instruction, surface stability, and load intensity on trunk muscle activity
  3. Aspe & Swinton 2014 | Electromyographic and kinetic comparison of the back squat and overhead squat
  4. Willardson et al. 2009 | Effect of surface stability on core muscle activity for dynamic resistance exercises
  5. Escamilla et al. 2002 | An electromyographic analysis of sumo and conventional style deadlifts


Current Position Statement on Anterior Pelvic Tilt

There are many misconceptions in the strength training and physical therapy communities regarding anterior pelvic tilt (APT). In this article, I will post my current thoughts and beliefs pertaining to APT, specifically concerning the questions listed below. Where possible, I will support my statements with scientific references from the literature.

  1. What is APT?
  2. Is APT advantageous from an evolutionary perspective?
  3. Can we fully trust all research measuring APT?
  4. Is APT abnormal?
  5. Does APT lead to low back pain in typical everyday living?
  6. Can APT lead to back injury in heavy resistance training?
  7. Do the spine and pelvis actually stay in neutral during heavy or explosive movement?
  8. Why do ground sport athletes tend to develop APT?
  9. Why do lifters tend to APT during various resistance training exercises?
  10. What strategies can be employed to shift APT towards a more neutral alignment?

What is APT?

Possessing anterior pelvic tilt simply means that your pelvis is tilted forward to a greater degree than what is deemed normal. As you’ll see later in the article, there are issues with classifying anterior pelvic tilt. In the video below, Sam Visnic does a great job demonstrating what anterior pelvic tilt is, however, since he created this video in 2011, some of his opinions might have changed since then. I have different data with regards to correlations to back pain and normal degrees of anterior pelvic tilt, which will be explained below in the article. However, the video does a good job of representing the current prevailing thought process that most manual therapist and sports medicine professionals (including licensed massage therapists, physical therapists, osteopathic doctors, occupational therapists, athletic trainers) share in regards to APT, so it’s definitely worth watching.

In case you didn’t watch the video, I got you covered. Tilting the pelvis forwards as in the action depicted in the first image below is referred to as anterior pelvic tilting, or anteriorly tilting the pelvis, whereas tilting the pelvis rearward as in the action depicted in the second image below is referred to as posterior pelvic tilting, or posteriorly tilting the pelvis.

Left: Anterior Pelvic Tilt, Right: Posterior Pelvic Tilt

Left: Anterior Pelvic Tilt, Right: Posterior Pelvic Tilt (from Neuman 2010)

Stand up and take a moment to move your pelvis into these positions. Notice the different musculature responsible for producing these motions. If you do them correctly, you’ll feel the lumbar erectors and hip flexors tilting the pelvis anteriorly, and you’ll feel the glutes and low abs tilting the pelvis posteriorly.

Interestingly, if you were somehow able to reside inside the acetabulum of the hips, you wouldn’t be able to discern between anterior pelvic tilt and hip flexion, or between posterior pelvic tilt and hip extension. To quote Neuman 2010:

Theoretically, a sufficiently strong and isolated bilateral contraction of any hip flexor muscle will either rotate the femur toward the pelvis, the pelvis (and possibly the trunk) towards the femur, or both actions simultaneously. These kinematics occur within the sagittal plane about a medial-lateral axis of rotation through the femoral heads. Note that the arrowhead representing the line of force of the rectus femoris in FIGURE 1, for example, is directed upward, toward the pelvis. This convention is used throughout this paper and assumes that at the instant of muscle contraction, the pelvis is more physically stabilized than the femur. If the pelvis is inadequately stabilized by other muscles, a sufficiently strong force from the rectus femoris (or any other hip flexor muscle) could rotate or tilt the pelvis anteriorly. In this case, the arrowhead of the rectus femoris would logically be pointed downward toward the relatively fixed femur. The discussion above helps to explain why a person with weakened abdominal muscles may demonstrate, while actively contracting the hip flexors muscles, an undesired and excessive anterior tilting of the pelvis. Normally, moderate to high hip flexion effort is associated with relatively strong activation of the abdominal muscles. This intermuscular cooperation is very apparent while lying supine and performing a straight leg raise movement. The abdominal muscles must generate a potent posterior pelvic tilt of sufficient force to neutralize the strong anterior pelvic tilt potential of the hip flexor muscles. This synergistic activation of the abdominal muscles is demonstrated by the rectus abdominis (FIGURE 2A). The extent to which the abdominal muscles actually neutralize and prevent an anterior pelvic tilt is dependent on the demands of the activity—for example, of lifting 1 or both limbs—and the relative strength of the contributing muscle groups. Rapid flexion of the hip is generally associated with abdominal muscle activation that slightly precedes the activation of the hip flexor muscles. This anticipatory activation has been shown to be most dramatic and consistent in the transverse abdominis, at least in healthy subjects without low back pain. The consistently early activation of the transverse abdominis may reflect a feedforward mechanism intended to stabilize the lumbopelvic region by increasing intra-abdominal pressure and increasing the tension in the thoracolumbar fascia.

Without sufficient stabilization of the pelvis by the abdominal muscles, a strong contraction of the hip flexor muscles may inadvertently tilt the pelvis anteriorly (FIGURE 2B). An excessive anterior tilt of the pelvis typically accentuates the lumbar lordosis. This posture may contribute to low back pain in some individuals.

Although FIGURE 2B highlights the unopposed contraction of 3 of the more recognizable hip flexor muscles, the same principle can be applied to all hip flexor muscles. Any muscle that is capable of flexing the hip from a femoral-on-pelvic perspective has a potential to flex the hip from a pelvic-on-femoral rotation. For this reason, tightness of secondary hip flexors, such as adductor brevis, gracilis, and anterior fibers of the gluteus minimus, would, in theory, contribute to an excessive anterior pelvic tilt and exaggerated lumbar lordosis.

And here’s another quote from Neuman 2010:

With the trunk held relatively stationary, contraction of the hip extensors and abdominal muscles (with the exception of the transverse abdominis) functions as a force-couple to posteriorly tilt the pelvis (FIGURE 4). A posterior tilting motion of the pelvis is actually a short-arc, bilateral (pelvic-on-femoral) hip extension movement. Both right and left acetabula rotate in the sagittal plane, relative to the fixed femoral heads, about a medial-lateral axis of rotation. Assuming the trunk remains upright during this action, the lumbar spine must flex slightly, reducing its natural lordotic posture. While standing, the performance of a full posterior pelvic tilt, theoretically, increases the tension in the hip’s capsular ligaments and hip flexor muscles. These tissues, if tight, can potentially limit the end range of an active posterior pelvic tilt. Contraction of the abdominal muscles (acting as short-arc hip extensors, as depicted in FIGURE 4) can, theoretically, assist other hip extensor muscles in elongating (stretching) a tight hip capsule or hip flexor muscle. For example, strongly coactivating the abdominal and gluteal muscles, while simultaneously performing a traditional passive-stretching maneuver of the hip flexor muscles, may provide an additional stretch to these muscles. One underlying advantage of this therapeutic approach is that it may actively engage and potentially educate the patient about controlling the biomechanics of this region of the body.

Is APT advantageous from an evolutionary perspective?

No, it’s not. In fact, the opposite is true – posterior pelvic tilt (PPT) is advantageous. As we’ve evolved as humans, our lumbar spines have become more lordotic but our pelvises have become more posteriorly tilted to better conserve energy while standing, walking, and running by allowing us to utilize passive elastic energy storage from stretched soft tissue at the front of the hips. To quote Hogervorst et al. 2009:

When a chimpanzee walks upright, the pelvis is more vertical, but the hip maintains about the same position in the pelvis, i.e., is not extended. This is not caused by a lack of possible extension of the hip joint, but by a stiff lumbar spine that lacks lordosis (extension or retroflexion). The chimpanzee walks with flexion of both hips and knees to compensate the forward bent position of the spine that keeps the centre of mass of the upper body forward (ventral) to the sacrum. This “bent-hip, bent-knee gait” brings this centre of mass closer to the point of ground contact of the feet, but at the price of considerable work for hip, knee and back muscles.

When a human walks upright, hips and knees can be in much more extended positions because lumbar lordosis aligns the centre of mass of the upper body with the sacrum and the point of ground contact. Lordosis was made possible when considerable reduction in height of the ilium “freed-up” the lumbar spine, which itself lengthened when the number of lumbar vertebrae increased to five or six. A larger distance developed between lower ribs and iliac crest, creating a waist in the human trunk (as opposed to the barrel shaped ape trunk). The sacrum broadened markedly and tilted forward (horizontally). Changes in the shape and position of the facet joints further increased lumbar spine mobility. Lumbar lordosis thus benefits energy-efficient upright walking. In humans, standing erect requires only 7% more energy than lying down. Dogs use considerably more energy standing than lying, presumably because they have their hind legs flexed.

The downside of this “mobilization” of the lumbar spine may be a relatively insufficient erector spinae muscle. The potential for hypertrophy is likely hampered by the dorsal position of the transverse processes that developed with the “shortback”. Scoliosis and spondylolisthesis are virtually absent in the great apes. Perhaps these spinal malformations in humans are associated with the length and mobility of the lumbar spine and a relative erector spinae muscle insufficiency.

According to Neuman 2010:

Achieving near full extension of the hips has important functional advantages, such as increasing the metabolic efficiency of relaxed stance and walking. Full or nearly full hip extension allows a person’s line of gravity to pass just posterior to the medial-lateral axis of rotation through the femoral heads. Gravity, in this case, can assist with maintaining the extended hip while standing, with little activation from the hip extensor muscles. Because the hip’s capsular ligaments naturally become “wound up” and relatively taut in full extension, an additional element of passive extension torque, albeit relatively small, may further assist with the ease of standing. This biomechanical situation may be beneficial by temporarily reducing the metabolic demands on the muscles but also by reducing the joint reaction forces across the hips due to muscle activation, at least for short periods.

Can We Fully Trust All Research Measuring APT?

No, we cannot. Research data pertaining to anterior pelvic tilt should be interpreted with caution. Due to normal variations in pelvic shape within the human population, it is quite difficult to accurately determine pelvic posture, so all studies examining APT should be interpreted with caution (Preece et al. 2008).

Is APT Abnormal?

No, it’s not. According to a published study by Herrington 2011, 85% of males and 75% of females presented with an anterior pelvic tilt, 6% of males and 7% of females with a posterior pelvic tilt, and 9% of males and 18% of females presented as neutral. Anterior pelvic tilt is also the most common postural adaptation in athletes according to Kritz and Cronin 2008, and it seems to naturally occur with athletes that do a lot of sprinting. Therefore, it’s actually normal for healthy individuals to possess APT, and the average angle of anterior pelvic tilt ranges from 6-18° depending on the study and methods used to determine the angle, with around 12° appearing as the norm (ex: Youdas et al. 1996, Youdas et al. 2000, Christie et al. 1995, Day et al. 1984).

Sprinters tend to have APT

Sprinters tend to have APT

It is therefore normal to have some anterior pelvic tilt, and you shouldn’t be overly concerned about trying to neutralize your pelvic posture, assuming it’s not severe. To put it another way, if you don’t have some APT, you’re not normal.

Does APT Lead to Back Low Back Pain in Typical Everyday Living?

No, it does not. Studies examining the relationship between APT/lumbar hyperlordosis and back pain have consistently shown no or weak links – here are ten of them but I’m sure there are more (Murrie et al. 2003, Schroeder et al. 2013Nakipoğlu et al. 2008, Ashraf et al. 2014Nourbakhsh & Arab 2002, Youdas et al. 2000Tüzün et al. 1999, Mitchell et al. 2008, Christensen & Hartvigsen 2008, Laird et al. 2014). Again, do not be paranoid if you have some APT; it’s normal and it doesn’t increase the risk of developing low back pain compared to those with more neutral pelvic alignments, assuming heavy and explosive loads aren’t placed upon the structures on a regular basis.

There’s a lot more to low back pain (and pain in general) than meets the eye. Posture, structure, and biomechanics only provide part of the picture. For those interested in learning more about pain, please do the following:

  1. Learn about the biopsychosocial model of pain (as opposed to the postural/structural/biomechanical model)
  2. Follow Jason Silvernail and listen/read his interviews HERE and HERE
  3. Look into the work of Lorimer Moseley and other pain experts
  4. Also follow Greg Lehman (website, Twitter), Todd Hargrove (website, Twitter), Paul Ingraham (website, Twitter), and Adam Meakins (website, Twitter)

Can APT Lead to Back Injury in Heavy Resistance Training?

Yes, it can. However, please understand the difference between exhibiting APT as a posture and anteriorly tilting the pelvis as a movement strategy during heavy resistance training. As eluded to earlier in the article, you should definitely not be worried if you have a little bit of APT posture. There are a hundred thousand athletes practicing or performing right now with APT, and they get by just fine. Believing that APT is dangerous can deliver a Nocebo effect which isn’t good. Slight pelvic tilt is fine, but going too far into APT will usually result in excessive lumbar hyperextension, and going too far into PPT will usually result in excessive lumbar flexion (Levine & Whittle 1996, Day et al. 1984). Hence the term, “lumbopelvic rhythm” – lumbar extension and APT are associated with one another, as are lumbar flexion and PPT. When moving near the end ranges of their postural capabilities, these extreme postures combined with heavy loading can easily lead to injury over time.

Spinal hyperextension under high load can lead to higher incidents of spondylolysis and other injuries to the posterior elements of the spine (Roussoully & Pinheiro-Franco 2011, Alexander 1985). When you lift heavy weights, you usually want to keep your spine and pelvis as neutral as possible. However, there is some wiggle room in that it is possible to slightly tilt the pelvis anteriorly or posteriorly without dramatically affecting lumbar posture (it is my unsubstantiated belief that the sacrum must move with the pelvis which would mostly alter L5-S1 and L4-L5 posture, but L3-L4, L2-L3, and L1-L2 posture could remain relatively unchanged, but this would require study to substantiate the claim), which leads in perfectly to the next section.

Do the Spine and Pelvis Actually Stay in Neutral During Heavy or Explosive Movement?

Your spine and pelvis never really stay in neutral when performing dynamic movement; that’s a misconception. For example, the spine has been shown in the research to move considerably during exercises and activities that are thought to involve a relatively stable lumbopelvic region, including squats, deadlifts, kettlebell swings and snatches, rowing exercises, overhead pressing, good mornings, strongman exercises, sprinting, and jumping:

As you can see, the spine and pelvis do indeed move during heavy and explosive movement, indicating that the spine and pelvis are used dynamically to generate torque. In fact, during the deadlift, the spine can be used just like a crowbar by relaxing the lumbar erectors and using the hip extensors to “wind up” the spine against the barbell load until sufficient muscle torque is produced to raise the barbell off the ground, thereby relying on the passive structures such as the iliolumbar ligaments for torque generation. To quote Snijders et al. 2004:

For explanation of the loading mode in slouching we compared the spine with a crowbar, using the iliolumbar ligaments as fulcrum and pivot. This comparison illustrates the kinematics as well as the expected force magnification. Characteristic for the crowbar model is forward flexion of the spine combined with backward tilt of the sacrum relative to the pelvis. This loading mode is maximal when back muscle protection against flexion is absent, e.g. in relaxed slouched sitting. In this respect model calculations resulted in iliolumbar ligament stress near failure load.

Regular use of this lifting strategy would therefore be highly recommended if it weren’t markedly more dangerous, as the spine is not well-suited to handle full flexion of the spine. The spine is indeed designed to move during high load and high power sporting actions, but the motion should be limited to mid-ranges. Moving to end ranges of flexion, extension, lateral flexion, and/or rotation is exponentially dangerous and risky. Therefore, it’s wiser to rely more on the active structures (contracting muscles) than the passive structures (stretched erector spinae, stretched spinal ligaments, etc.) for torque generation under heavy loading. What then is the appropriate spinal and pelvic posture for every situation?

The answer to this question depends on who you ask. Stu McGill, the world’s leading expert in spinal biomechanics in relation to strength training, would tell you that the neutral position is always best for spine safety…both neutral spine and neutral pelvis. However, two legendary sports scientists by the names of Yuri Verkoshansky and Mel Siff (also the authors of Supertraining), felt otherwise. According to them:

The pelvis plays a vital role in the ability of the athlete to produce strength efficiently and safely, because it is the major link between the spinal column and the lower extremities… a neutral pelvic tilt offers the least stressful position for sitting, standing and walking. It is only when a load (or bodymass) is lifted or resisted that other types of pelvic tilt become necessary. Even then, only sufficient tilt is used to prevent excessive spinal flexion or extension… The posterior pelvic tilt is the appropriate pelvic rotation for sit-ups or lifting objects above waist level. Conversely… theanterior pelvic tilt is the correct pelvic rotation for squatting [and] lifting heavy loads off the floor. – Supertraining 2009

I’ve asked Stu McGill for his take on this matter and he defends his stance, saying that neutral spine and neutral pelvis is always best. He and Mel Siff were close friends before Mel passed away, and he believes that Mel would defer to his judgement on this topic since Mel (and Yuri) weren’t spinal biomechanists and didn’t study the topic for a living. My thoughts on this matter waiver, and lately I’m more inclined to agree with Stu. However, based on my experience, individuals with flexion intolerant spines seem to benefit from slight APT at the bottom of squats and deadlifts, and individuals with extension intolerant spines seem to benefit from slight PPT at the top of hip thrusts, back extensions, and deadlifts, indicating that ideal posture depends on the individual.

If you agree with Mel and Yuri and you believe that some slight pelvic tilt can help buttress the spine by creating torque in the necessary direction in order to help stabilize the spine and better prevent buckling, just make sure that the pelvic tilt kept in mid-ranges so it doesn’t dramatically impact spinal posture. In conclusion, either keep the spine and pelvis in neutral to the best of your abilities at all times during exercises that require core stability, or allow for some slight APT with the hips flexed and some slight PPT with the hips extended. Obviously, individual differences in anatomy and injury history must be taken into account when making this decision. Later in this article there will be an embedded video which will shed more light on this topic.

Why do Ground Sport Athletes Tend to Develop APT?

Ground sport athletes generally do a lot of running and sprinting. Kritz & Cronin 2008 state:

The advantages of anterior pelvic tilt and resulting lordotic posture are believed to be an increased hip extension, which allows the running and jumping athlete to apply force over a longer time resulting in a greater impulse.

Although the theory provided by Kritz & Cronin is very plausible, it is important to know that elite sprinters do not use greater hip extension ROM compared to novice sprinters, however, there are still a couple of very good reasons why APT could be markedly beneficial for sprinting speed.

The first reason is that the hip is stronger at hip extension when it’s flexed forward. Worrell et al. 2001 showcased the torque-angle curve for maximal isometric hip extension. Essentially, hip extension is strongest when the hips are fully flexed and weakest when the hips are fully extended.

This relationship has been shown to exist in probably 8 different studies that I’m aware of, and I verified this relationship on myself when I was in New Zealand experimenting on the Human Norm isokinetic dynamometer at AUT University. I assumed that since I could hip thrust 600+ lbs but only squat around 400 lbs at the time that I would possess an altered hip extension torque angle curve – one that was more flat or more even throughout the hip range of motion. But this wasn’t the case. I, along with subjects in all the other studies, possessed approximately 2.5 times more hip extension strength at 90 degrees of hip flexion compared to at 0 degrees of hip flexion (neutral position). Since APT is synonymous with hip flexion, this means that the hip range of motion associated with ground contact during sprinting will be stronger in someone with APT compared to someone with a more neutral pelvic posture.

The second reason is that at mid-stance during ground contact in gait, the hip ligaments that resist hip extension pull taut and reduce hip extension power (Simonsen et al. 2012). In fact, they reverse hip extension torque production to hip flexion production, which doesn’t make a lot of sense being that hip extension torque generates horizontal propulsive force into the ground (Huang et al. 2013) and is critical for faster running speeds (Schache et al. 2011). Horizontal force production is critical for faster running speeds as well (Brughelli et al. 2011, Morin et al. 2011, Morin et al. 2012, Morin et al. 2015). An athlete with more APT, or one that anteriorly tilts his or her pelvis to a greater degree when on the ground, will not run out of hip extension range of motion as quickly as an individual with a more neutral pelvic posture when the foot is in contact with the ground during sprinting, which will prolong the production of hip extension torque and subsequent horizontal propulsive force generation.

These theories need to be substantiated in future studies in order to be considered valid.

In Olympic weightlifting, at the bottom of a snatch lift, APT appears to be a highly important variable for successful lifts (Ho et al. 2007). This is probably due to the tendency to place the lifter in a better position to maximize power output during the 2nd pull phase of the lift. Heel elevation increases APT (Franklin et al. 1995), so it’s a wise strategy to wear heeled shoes when performing Olympic lifts.

Why do Lifters Tend to APT During Various Resistance Training Exercises? 

Any good strength coach witnesses dozens of incidents of APT during resistance training on a daily basis. You’ll commonly witness lifters anteriorly tilting their pelvises during glute ham raises, Nordic ham curls, lying leg curls, planks, ab wheel rollouts, push-ups, hip thrusts, glute bridges, back extensions, squats, deadlifts, good mornings, and bent over rows. The reasons why individuals resort to excessive anterior pelvic tilt during heavy resistance training is multifactorial and dependent on the movement in question and will differ depending on whether the APT occurs during a squat, a hip thrust, or an ab wheel rollout. Interrelationships between relying on the spine and pelvis for stability, relying too much on the hamstrings for hip extension, possessing poor gluteus maximus and/or abdominal strength, possessing excessively tight hip flexors and/or lumbar erector spinae, possessing unique individual hip anatomy, and/or possessing faulty motor engrams must be examined.

In case a list helps you, the reasons why athletes resort to APT are due to a combination of:

  1. Lack of knowledge of sound exercise form
  2. Poor motor control in the lumbopelvic region
  3. Insufficient abdominal/oblique strength and stability
  4. Insufficient gluteal strength and stability
  5. Insufficient hip extension mobility/tight hip flexors

Here I will provide my opinions and elaborate upon the general reasons why APT occurs during various types of movements.

Knee Flexion Exercises: glute ham raise, Nordic ham curls, lying leg curls

During knee flexion exercises, it is very common for lifters to resort to APT. Let’s assume that the lifter indeed understands proper form and isn’t anteriorly tilting the pelvis just because he or she doesn’t know any better. With this assumption met, lifters APT during knee flexion exercises to provide a muscular advantage. Since the hamstrings shorten during knee flexion, their force production potential is diminished. Knee flexion, hip extension, and posterior pelvic tilt shorten the hamstrings, while knee extension, hip flexion, and anterior pelvic tilt lengthen the hamstrings. By anteriorly tilting the pelvis during knee flexion, the length change is mitigated (the hamstrings don’t shorten as much), thereby allowing for better force production. For these exercises, it is natural for a lifter to resort to APT because it improves exercise performance. However, just because a particular technique allows for better performance, it doesn’t necessarily mean that the technique should be used, since it could lead to suboptimal results in strength and mechanics on the field. Therefore, it is recommended that the lifter focuses on motor control drills for the lumbopelvic region and learns how to keep the pelvis relatively stable during these exercises. Exercise difficulty can be regressed, and eventually the hamstrings will become stronger at shorter muscle lengths, thereby solving the problem.

Anti-Extension Core Stability Exercises: planks, ab wheel rollouts, push-ups

During anti-extension core stability exercises, it is also quite common for lifters to resort to APT. Let’s assume that the lifter indeed understands proper form and isn’t anteriorly tilting the pelvis just because he or she doesn’t know any better. With this assumption met, lifters APT during anti-extension core stability exercises for different reasons compared to knee flexion exercises. In the case of these exercises, the abdominals and obliques simply cannot maintain lumbopelvic stability during the exercise, and therefore they “fail” by entering into an eccentric contraction. Eventually, stability will be reached due to 1) bony approximation of the lumbar spine, which happens when the vertebrae get closer together – this provides passive stability, and 2) stretching of the anterior core muscles, which also provides passive stability. For these exercises, it is natural for a lifter to resort to APT because it improves exercise performance. However, just because a particular technique allows for better performance, it doesn’t necessarily mean that the technique should be used, since it could lead to suboptimal results in strength and mechanics on the field. Therefore, it is recommended that the lifter focuses on motor control drills for the lumbopelvic region and learns how to keep the pelvis relatively stable during these exercises. Exercise difficulty can be regressed, and eventually the abdominals and obliques will become stronger and better able to stabilize the neutral lumbopelvic position, thereby solving the problem.

Anteroposterior Hip Extension Exercises: hip thrusts, glute bridges, back extensions

During anteroposterior hip extension exercises, it is also very common for lifters to resort to APT. Let’s assume that the lifter indeed understands proper form and isn’t anteriorly tilting the pelvis just because he or she doesn’t know any better. With this assumption met, lifters APT during anteroposterior hip extension exercises due to 1) weak glutes, especially at shorter muscle lengths (at end range hip extension), 2) substituting lumbar extension and anterior pelvic tilt for hip extension, which provides an illusion that full hip extension or hip hyperextension is reached, and 3) producing a muscular advantage for the hamstrings musculature – by anteriorly tilting the pelvis during hip extension, the length change is mitigated (the hamstrings don’t shorten as much), thereby allowing for better force production. For these exercises, it is natural for a lifter to resort to APT because it improves exercise performance. However, just because a particular technique allows for better performance, it doesn’t necessarily mean that the technique should be used, since it could lead to suboptimal results in strength and mechanics on the field. Therefore, it is recommended that the lifter focuses on motor control drills for the lumbopelvic region and learns how to keep the pelvis relatively stable during these exercises. Hip flexor stretches for the psoas and rectus femoris can be employed if they are limiting hip extension mobility. The arc of motion during these exercises should stop once the hips run out of extension and reach the limits of its mobility. Exercise difficulty can be regressed, and eventually the gluteus maximus will become stronger at shorter muscle lengths, thereby solving the problem.

Axial Hip Extension Exercises: squats, deadlifts, good mornings

During axial hip extension exercises, it is also very common for lifters to resort to APT. Let’s assume that the lifter indeed understands proper form and isn’t anteriorly tilting the pelvis just because he or she doesn’t know any better. This is important to consider because many individuals have been taught to APT considerably during these movements, since this has been the prevailing cue over the past decade – think “chest up,” which emphasizes thoracic extension but will often bring the lumbar spine and pelvis into extension along with it. I still use this cue all the time with my clients, but “ribs down” has become popular too in the past couple of years, which emphasizes stabilization of the lumbar spine and is to be used with individuals that are prone to excessive spinal hyperextension during axial lifts. At any rate, assuming that individuals are aware of proper technique, lifters APT during axial hip extension exercises due to 1) producing a muscular advantage for the hamstrings musculature – by anteriorly tilting the pelvis during hip extension, the length change is mitigated (the hamstrings don’t shorten as much), thereby allowing for better force production, 2) substituting lumbar extension and anterior pelvic tilt for hip extension, which provides an illusion that full hip extension is reached, and 3) weak glutes (mostly in the case of the deadlift), especially at shorter muscle lengths (at end range hip extension), and 4) better passive force production at the bottom of the lifts – APT will lead to a greater stretch in the glutes, hams, and adductors, which increases muscle force production via elastic recoil. For these exercises, it is natural for a lifter to resort to APT because it improves exercise performance. However, just because a particular technique allows for better performance, it doesn’t necessarily mean that the technique should be used, since it could lead to suboptimal results in strength and mechanics on the field. Therefore, it is recommended that the lifter focuses on motor control drills for the lumbopelvic region and learns how to keep the pelvis relatively stable during these exercises. Exercise difficulty can be regressed, and eventually the responsible muscles for carrying out these exercises will become stronger at the appropriate muscle lengths, thereby solving the problem.

What Strategies can be Employed to Shift APT Towards a More Neutral Alignment? 

The vast majority of people don’t need to stress about their pelvic posture; they’re within the normal range and they aren’t in danger of experiencing injury. However, certain individuals will benefit from actively attempting to shift their postures towards a more neutral alignment, or at least from improving their motor control and stabilization strategies during exercise. Most manual therapists will recommend manual therapy such as massage or self-myofasical release (SMR) along with static stretching in order to improve APT postures. These methods can certainly help, but they pale in comparison to proper strength training in terms of efficacy in altering posture. So definitely do your stretches, but make sure you strengthen the proper muscles, especially at their respective suggested muscle lengths. It is recommended that the following strategies be employed for improving APT:

  1. SMR for the rectus femoris, adductors, and erector spinae
  2. Static stretching for the psoas, rectus femoris, adductors, and lumbar erector spinae
  3. Strengthening the abdominals and obliques, especially via posterior pelvic tilt
  4. Strengthening the glutes, especially via posterior pelvic tilt and at end-range hip extension
  5. Being mindful of using APT postures throughout the day and also during resistance training

Case studies by Yoo 2014 and Yoo 2013 have shown that strengthening opposing lumbar and pelvic force couples will lead to marked changes in lumbopelvic posture. Strengthening the abdominals and glutes will cause APT to move to a more neutral position, and strengthening lumbar erectors and hip flexors will cause posterior pelvic tilt (PPT) to move to a more neutral position. It’s important to note that studies such as Walker et al. 1987 have shown that those with APT are not weaker in the abs and studies such as Heino et al. 1990 have shown that those with APT do not have less hip extension ROM, but to alter pelvic posture, you’re probably going to need to get even stronger at shorter muscle lengths and longer hip flexors and erectors, in addition to modifying daily postural habits. Stretching is also important. Below is a video that shows various ways of improving hip extension mobility through hip flexor stretching, with special techniques such as tilting the pelvis posteriorly to increase the effectiveness of the hip flexor stretch.

It is vital to possess powerful hip muscles to dynamically propel the body as well as strong lumbopelvic muscles to stabilize the core. But strong muscles isn’t enough. You also need plenty of technical practice to ingrain proper movement patterns. Here’s a good video to watch pertaining to the lumbopelvic hip complex during squats, deadlifts, hip thrusts, and back extensions.

As I stated above, even though possessing anterior pelvic tilt is normal and you shouldn’t be overly concerned about it, some individuals with excessive and painful APT should strive to better neutralize their pelvic postures. Moreover, individuals that utilize excessive anterior pelvic tilting strategies while resistance training will want to learn how to better control the pelvis. In my opinion, the best way to combat APT is by focusing on increasing posterior pelvic tilt strength via the following abdominal and glute exercises: American hip thrusts, back extensions with a rounded upper back, glute bridges with a flattened lumbar spine, RKC planks, and hollow body holds. The videos below will be useful:


APT does not provide a muscular advantage during walking, but it does during sprinting and Olympic lifting. More individuals have APT than PPT or neutral pelvises, indicating that it’s normal to exhibit some APT. APT does not lead to low back pain in everyday living but it can lead to low back injury during sports or resistance training if excessive and not kept in check. The spine and pelvis move during heavy and explosive movement, indicating that they are used dynamically to generate torque, however, their motions should be kept in midranges; end ranges of spinal and pelvic motion are risky and dangerous under high loads. The reasons why athletes and lifters rely on APT during sports and exercise depends on the motion and exercise in question and is multifactorial. Resistance training, motor control training, static and dynamic stretching, and manual therapy should all be used to augment pelvic posture or pelvic mechanics during exercise if it is deemed safer or more advantageous.

As I learn more over time, I will update this page and keep it current.

Recommended Reading

Don’t Be Donald Duck

Why do I Anterior Pelvic Tilt?

Courageous Conversations With Coaches: Anterior Pelvic Tilt With Elsbeth Vaino

A Better Way to Teach Barbell Glute Bridges and Back Extensions

Weightroom Solutions: The Hyperextension-Prone Lifter

Anterior Pelvic Tilt and Lumbosacral Pain as it Relates to the Hip Thrust and Glute Bridge


Cardio & Appetite: Does Cardio Make You Fat?

Cardio & Appetite: Does Cardio Make You Fat?
By Fredrik Tonstad Vårvik

Does endurance-training (cardio) increase or decrease your appetite? What about resistance training?

Some might say that exercise increases appetite, while others say the opposite. The plain truth is that since exercise burns calories, you should think appetite increases to make up for those burned calories. For those who want to lose weight, that might come as a shock. What sounds logical is not always true. The media have done a great job of convincing the public that exercise increases your appetite and that you end up eating more and getting fat.

I have read and looked into the latest reviews and meta-analysis, which should sum up nicely what we know to date. The research that has been done is mostly short-term. The authors of the studies admit some limitations of the studies – mainly sub-optimal study design and small sample sizes.


Short term

A meta-analysis by Schubert et al, 2013, looked at acute energy intake up to a maximum of 24 hours post-exercise (1). Twenty-nine studies, consisting of 51 trials were included. Exercise duration ranged from 30 – 120 min at intensities of 36-81% VO2max. Test meals were offered 0-2 hours post-exercise. If subsequent meals were presented, they were 4-5 hours apart, from 1-4 meals. The overall results suggest that exercise is effective in producing a short-term energy deficit. Meaning that the subjects did not compensate for the energy they expended during exercise, in the 2-14 hours after exercise. Forty-five studies reported relative energy intake after exercise. They showed that participants compensated for the energy used in exercise by around 14%. All trials reported absolute energy intake. Despite large energy expenditures, the absolute energy intake was only slight higher in the exercise group compared to the no-exercise group, with a mean increase of about 50kcal.

These results are in line with a review of Deighton et al 2014 (2). Namely, that an acute bout of exercise does not stimulate any compensatory increases in appetite and energy intake on the day of exercise.

Short and long term

A review by Donnelly et al 2014, included 103 studies in their review (3). The study design included cross-sectional- , acute/short-term- , non-randomized- and randomized-studies. Exercise duration ranged from a single 30-min exercise bout to daily exercise over 14 days. Energy intake was measured from once post-exercise up to 72 weeks. Overall, the energy intake was reduced in participants doing exercise compared with participants not doing exercise. As noted by the authors: “our results from both acute and short-term trials suggest that any observed increase in post-exercise energy intake only partially compensates for the energy expended during exercise. Thus, in the short-term, exercise results in a negative energy balance.”

As for long term, only 2 out of the 36 non-randomized and randomized trials, in duration from 3 to 72 weeks, reported an increase in absolute energy intake in response to exercise. Moreover, 30 of the studies reported no change in calorie intake, while five of the randomized studied reported significant decreases of 200-500 calories per day in response to training.

Blundell et al, 2015, agrees that exercise has little effect on energy intake within a single day (4). However, in the long-term, there seems to be a raise in compensatory energy intake, ranging from 0 % to 60 % compensation in energy intake for the exercise expenditure.

Low, medium & high fitness level

The meta-analysis by Schubert et al, 2013, indicated that individuals of low and moderate fitness reduce energy intake more than those with high fitness level (1). They reference previous work that agrees that individual who are more physically active more accurately regulate their energy expenditure. The researchers write that active individuals compensate for about 23% of energy expended while inactive individuals actually had a negative compensation of -35,5%. In Donnelly et al’s review, they found no difference in fitness level and energy intake (3).

Resistance training:

Five interventions in Schubert et al’s meta-analysis utilized resistance training (1). The sessions were between 35-90min with 10-12 repetition maximum and 2-4 sets. Acute energy intake up to 14 hours were reduced compared to energy expenditure; however, it was not as reduced as the groups with endurance training. Worth noting is that energy expenditure of resistance training is difficult to quantify precisely. So don’t stop doing resistance training, there are a lot of other positive advantages, like improved body composition. In addition, the review by Donnelly et al found no difference between energy intake post-exercise in endurance exercise and resistance training (3).

Intensity & duration

An effect of exercise intensity was not found in Schubert et at’s meta-analysis (1). However, the researchers mention in the text that others have found that intensities above 70% VO2max appears to reduce appetite but with minor changes in absolute energy intake. In contrast to this finding, Donnelly’s review found no significant difference in exercise intensity and duration on energy intake (3). Deighton et al also concludes that high-intensity does not reduce appetite more than low-intensity (2). However, if you look more into the studies analyzed in Donnelly’s review you will see that high-intensity might have some advantages concerning reducing energy intake.

Compensators & responders

The mean (average) in Schubert et al’s meta-analysis showed a short-term reduction in energy intake (1). However, some actually increased their absolute energy intake post-exercise. Some of the trials in Donnelly et al’s review also increased their energy intake, meaning that some compensate more after the energy deficit the exercise gives (3). Compensators have showed an increase in hedonic response to food, which means they are more sensitive and “weak” to food that give more pleasure eating.

How does exercise influence appetite?

As stated in the start of this article – since you burn calories through exercise you should expect to increase appetite and make up for it with eating more. As the research says, in most people it does not.

The reason might be because exercise suppresses ghrelin levels (a hormone that stimulates energy intake), while increasing hormones that increase satiety, such as peptide YY (PYY) and glucagon-like-peptide 1 (GLP-1) (1). This is in line with data from Blundell et al, 2015, which means that increased physical activity improves satiety signaling and appetite control. And that this system gets deregulated in sedentary people, thereby permitting overconsumption, as shown in the illustration (4).


Exercise does also make adjustments other than with gastrointestinal hormone response and gastric emptying: blood flow, muscle cellular metabolism, adipose tissue biochemistry as well as brain activity gets adjusted by exercise.

Why do individuals lose less weight than would be expected during long-term exercise interventions?

Several theories exist regarding why individuals do not lose as much weight as expected during an exercise program (1).

  • Some might change their dietary intake in response to exercise, especially the compensators
  • Some prefer sweet and high-fat food post-exercise
  • Energy intake may not increase per se, but rather a compensation of physical activity outside the exercise program decreases
  • The research mentioned in this article, stated that there is a highly individual difference between how much you compensate with energy intake, if you compensate much you will see little difference in weight

The bottom line is, on average, exercise will not make you eat more. Moreover, exercise is a tool you can use for losing weight. Energy expenditure of exercise is the strongest predictor of fat loss during an exercise program, according to Deighton et al (2).

Author bio

Fredrik Tonstad Vårvik is a personal trainer & nutritionist. He writes articles and work with online coaching at fredfitology. Follow him and his colleagues at facebook & twitter. Check out FredFitology for more info.



  1. Schubert MM, Desbrow B, Sabapathy S, Leveritt M. Acute exercise and subsequent energy intake. A meta-analysis. Appetite. 2013 Apr;63:92–104. LINK
  2. Deighton K, Stensel DJ. Creating an acute energy deficit without stimulating compensatory increases in appetite: is there an optimal exercise protocol? Proc Nutr Soc. 2014;73(02):352–8. LINK
  3. Donnelly JE, Herrmann SD, Lambourne K, Szabo AN, Honas JJ, Washburn RA. Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults? A systematic review. PloS One. 2014;9(1):e83498. LINK
  4. Blundell JE, Gibbons C, Caudwell P, Finlayson G, Hopkins M. Appetite control and energy balance: impact of exercise. Obes Rev Off J Int Assoc Study Obes. 2015 Feb;16 Suppl 1:67–76. LINK