Investigating The Interaction and Exclusive Effect Of 8 Week β-Hydroxy- β-Methyl Butyrate

(HMB) Supplementation And Complex Training On Lipid Profile, Body Composition,

Testosterone/Cortisol ratio and strength Of Elite Basketball Players Aged 19-26 Years Old

𝑇𝑜𝑓𝑖𝑔ℎ𝑖 𝐴𝑠𝑔ℎ𝑎𝑟 1 ., 𝑇𝑜𝑙𝑜𝑢𝑒𝑖 𝐴𝑧𝑎𝑟 𝐽𝑎𝑣𝑎𝑑 2 ., 𝐻𝑎𝑚𝑒𝑑𝐶ℎ𝑎𝑚𝑎𝑛 𝑁𝑎𝑑𝑒𝑟 3 .

1Associate Professor of exercise physiology, Urmia University, Uremia, Iran, 2 Assistant professor of exercise physiology, Urmia
University, Urmia, Iran, 3 State Universities of Urmia, MA degree in physiology of sport.

Abstract

BACKGROUND: Taking advantage of the effects of strength training in the basketball training
sessions, has significantly received more attention by coaches through recent decade, this issue
has led to use different ways of exercises to increase strength; One of these methods is known for
complex training (resistance and plyometric), that is performed during single training session and
will avoid athletes from training on multiple sessions and also provide a wide range of various
exercises through single session; on the other hand, ergogenic role of sport supplements are also
an integral part of competitive sports; Beta-hydroxy-beta-methyl-butyric acid (HMB), an
Intracellular metabolites derived from the branched chain amino acid Lucien, has attracted
particular attention During the last 35 years due to its anabolic, anti-catabolic and lipolytic
features in field of sport; However, as contradict results found in the case of long-term interaction
of these two factors as well as associated reports with the sport of basketball was scattered or
scarce; Therefore, the aim of this study was to investigate the effect of Interaction and Exclusive
Effect Of 8 Week β-Hydroxy- β-Methyl Butyrate (HMB) Supplementation And Complex Training
On Body Composition, muscle damage Indexes And Testosterone/Cortisol ratio Of Elite Basketball
Players Aged 19-26 Years Old.

METHODS: In this semi-experimental, randomized, double-blind, placebo-controlled study with

pre-test and post-test design, 40 male basketball players of Division 1 Basketball League aged 26-
19 years were selected and randomly divided into four groups of 10 people, including:
(1)Training-supplements(HMB), (2)Training-placebo group, (3)supplement(HMB) and (4) control
group. Complex training protocols was performed in 8 weeks through 3 times a week (on odd
days), on a regular basis by 60% to 80% of 1RM by all four groups, while at the same time four
group attended their regular basketball trainings on 3 days of week (on even days). Data’s were
expressed as mean (±SD) and analysis of variance (ANOVA), Bonferroni post hoc tests to evaluate
differences between the four groups (for difference between groups) and dependent sample T-
test for comparing the result of intra-group in different types in various times at the significant
level of p<0.05 was performed. All statistical assessments were assessed by SPSS software (21v).
RESULTS: The findings of this study showed that supplementation with HMB, complex training
and having both of these two factors through a chronic protocol, resulting in anabolic stimulus
testosterone
for a significant increased levels of testosterone and cortisol ratio, (p <0.05), lean body mass
(p <0.05) Based on BIA estimates and the percentage of upper and lower body strength (p <0.05),
so that the process of the increase in supplementary-Training group was observed more than
other groups, all these values was higher in the training group in comparison to supplement
group as well. In turn, cortisol serum levels and also lipid profile indexes were decreased in same
hierarchy of groups.
CONCLUSIONS: Beta-hydroxy-beta-methyl butyrate supplementation and complex training
separately contributed to preservation of muscle mass and strength increase and also lead to
deliver anabolic, anti-catabolic and lipolytic effects; moreover, the study indicates that the
interaction of the these two factors might lead to a synergistic effect on athletic performance.

KEYWORDS: Complex Training, HMB supplementation, Testosterone/Cortisol ratio, Basketball

players.

1. Introduction
In the recent decade, the utilization of strength training interventions integrated with
basketball training has been receiving notable attention among coaches. Incorporating
strength training activities may improve more variables than basketball training alone.
Because of the growing popularity of youth strength and conditioning programs, along
with the potential health benefits associated with this methods (Faigenbaum &
Westcott, 2009), it is important to find the most efficient method for enhancing fitness
performance in young athletes. One of these interventions is the combination of
strength and plyometric exercises in a single session named as complex training. More
specifically, complex training alternates biomechanically similar high load weight
training exercises with plyometric exercises, set for set, in the same workout. Hamza
(2014) adds that the concept of post activation potentiating considered modern
training concepts in the field of sports. where is intended to develop muscle strength
using a preliminary stage, a nervous activation and physiology of the muscles working,
by raising the largest amount of muscle fibers before starting to use strength training,
composite training one of the main forms of this phenomenon is the training (post
activation potentiating).An example of complex training would include performing a set
of squats followed by a set of jump squats. Anecdotal sources have described the
application of complex training (1, 2). The use of both plyometric and strength trainings
in the same workout is also an adequate strategy of training process organization,
which has highly positive effects on practice and training time management. Plyometric
and strength training are referred to as improving the most powerful motor
performance skills in young basketball players (3) and they are a significant component
of most conditioning program designs. A number of studies demonstrate the
effectiveness of plyometric compared to non-exercising control groups ( J.B. Blakey et
al., 1987, O.Diallo et al., 2001), other studies demonstrate an enhancement of motor
performance associated with plyometric training combined with Weight training or the
superiority of plyometric, compared to other methods of training K. Adams et al., 1991,
E.J. McLaughlin, 2001, J.F. Vossen et al., 2000. Andrejić (2012) found out that such
strategy demonstrated enhancement in motor performance among youth basketball
players. Similarly, Santos and Janeiro (2008) showed significant gains in the squat jump,
countermovement jump, Abalakov Test, and medicine ball throw using a similar
program. Faigenbaum et al. (2007) discovered significant improvements in strength
training with plyometric in long jump, medicine ball toss, and pro-agility shuttle than
strength training alone. Lastly, Fatouros et al. (2000) determined that combination of
strength training with plyometric participants produced greater vertical jump and leg
strength when compared with strength and plyometric training groups. Plyometric
drills are often combined with strength training, with the presumption that motor
performance may be enhanced to a significantly greater extent than each program
performed alone (Adams, O'Shea, O'Shea & Climstein, 1992; Faigenbaum et al., 2007;
Fatouros et al., 2000; Myer, Ford, Palumbo & Hewitt, 2005; Santos & Janeira, 2008).
There seems to be paucity in literature when using the previous intervention in
basketball PE. On the other hand, use of ergogenic nutritional supplements is
becoming inseparable from competitive sports. For just over a decade, β-hydroxy-β-
methyl butyrate (HMB) has been studied for its potential as an anabolic and anti-
catabolic dietary supplement assisting gains in strength, muscle size in humans when
used in conjunction with a training program. With some evidential support, HMB has
become one of the more popular nutritional supplements taken by strength and body
building athletes looking to improve strength and muscle size (12,16). Several
mechanisms of action of HMB have been proposed, largely on the basis of
extrapolation from early research on animals and deduction from indirect measures in
humans (17, 27). Supplementation with HMB may attenuate training-induced
proteolysis in the muscle via down-regulation of proteolytic pathways (15,17,27,30) and
may also stimulate protein synthesis similarly to leucine (30). Despite largely indirect
evidence to support a mechanism, several trials of the proposed ergogenic effects of
HMB on strength, body composition, and markers of muscle hypertrophy/atrophy have
been conducted in humans in conjunction with training program. Researchers have
found both gains (11,17,21,33) and no change in strength (13,14,19,28,35) with HMB
supplementation in both acute and chronic methods. These contradict results may be
related to study-specific characteristics, such as training experience of the subjects, the
HMB daily dose, the intervention duration, or the intensity, form, and volume of the
accompanying exercise intervention. Additionally, differential and inconsistent gains in
upper vs. lower-body lift performances have been reported, with the majority of
improvements being in lower-body strength (6,17,33,35). This apparent selectivity
indicates regional differences in the scope for adaptation that may have a physiological
basis or that may be linked to previous training frequency or the relative intensity of
training on various muscle groups.
Through access to what may distinguish this study from previous studies, is the
absence of any research on accompanying complex training with HMB
supplementation and also the link between the these two factor with a new cytokine
which is a recently discovered growth factor named interleukin-15 (IL-15), that
expressed in skeletal muscle (Grabstein et al.1994). In human skeletal muscle cell
cultures, IL-15 induces an accumulation of myosin heavy chain (MHC) protein in
differentiated myotubes, suggesting IL-15 as an anabolic factor in muscle growth
(Furmanczyk & Quinn,2003). IL-15 both stimulated protein synthesis and inhibited
protein degradation in cultured skeletal myotubes (Quinnet al.2002) suggesting that
skeletal muscle act as a cytokine-producing organ. It has been demonstrated that
skeletal muscles produce and express cytokines belonging to distinct different families.
However, whereas expression of several cytokines in skeletal muscle is very low and of
unknown physiological significance, it has recently been demonstrated that the
expression of some cytokines is markedly enhanced by muscle contractions. The
regulatory role of muscle contraction in regard to IL-15 is not clear. Previous human
studies have reported that skeletal muscle IL-15 mRNA levels were not changed
immediately after a 3 h run (Nieman et al. 2003) and that plasma IL-15 (measured up to
6 h into recovery) did not change in response to 2.5 h of treadmill running (Ostrowski
et al. 1998). Skeletal muscle IL-15 mRNA levels, measured immediately after a 2 h
weight training bout, did not differ from baseline (Niemanet al.2004), whereas plasma
IL-15 protein was increased immediately after acute resistance exercise in one study
(Riechman et al. 2004).
Bearing all these contradict results in mind, and the relatively low number of studies
investigating the effectiveness of HMB and complex training together over a longer
period on Hypertrophic/Atrophic trained athletes, the primary purpose of this
investigation was to test the hypothesis of the efficacy of an ergogenic nutritional
supplement and also the effect of a chronic heavy complex training bout on
hypertrophy indexes following expression of anabolic (IL-15, Testosterone)/catabolic
(TNFα ) indexes in serum levels of the subjects, In addition, we studied the interaction
effect of both these factors on IL-15 expression in serum of the subjects in four
different groups. The output of this review will then have practical implications for sport
coaches, nutritionists and/or physicians who want to know the current evidence about
the efficacy of these two factors in their specific sport discipline.

2. Materials and Methods

2.1. Subjects
Forty male basketball players from League One team of Iran Municipality club
volunteered to participate in this randomized, double-blind, controlled and parallel
design study. Following an orally and writing explanation of all procedures, risks and
benefits, each participant signed his informed consent prior to participation in the
study. Participants were not permitted to use any additional dietary supplementation
and did not consume any androgens or any other performance enhancing drugs.
Screening for performance enhancing drug use and additional supplementation was
accomplished via a health questionnaire completed during participant recruitment.
Subjects were from the same team and were randomly assigned to one of four groups.
They underwent a medical examination and a standard set of blood tests. Subject
characteristics are listed in Table 1 as mean±s.d.

Table 1. Baseline anthropometrics of study participants

𝑮𝒓𝒐𝒖𝒑 𝟏 𝑮𝒓𝒐𝒖𝒑 𝟐 𝑮𝒓𝒐𝒖𝒑 𝟑 𝑮𝒓𝒐𝒖𝒑 𝟒

Gender Male Male Male Male
𝑵𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒔𝒖𝒃𝒋𝒆𝒄𝒕𝒔 10 10 10 10
𝑨𝒈𝒆 (𝒚𝒆𝒂𝒓𝒔) 23.4 ± 4.5 23.7 ± 4.5 23.6 ± 4.5 23.3 ± 4.5
𝑯𝒆𝒊𝒈𝒉𝒕 (𝒄𝒎) 178.2 ± 8.9 178.2 ± 8.9 178.2 ± 8.9 178.2 ± 8.9
𝑩𝑴𝑰 (𝒌𝒈/𝒎−𝟐 ) 21.1±2.5 21.0±2.1 21.4±2.4 21.5±2.1

2.2. Study protocol

Athletes were members of the League One team of Iran Municipality club with a record
of at least 10 years of training experience, occupying high positions in national
competitions. Athletes were subjected to the randomization procedure and assigned
into 4 groups: HMB group, complex training group (CTG), HMB-complex training group
(HMB-CTG) and control group (CG). All players performed their same weekly basketball
day
trainings sessions for 3week on odd days during this 56-day study protocol. The
experiments were conducted using a preparation of HMB produced by Karen
mg
Laboratories by dosage of 38 kg (of total weight) per day in three doses as follows:
upon waking, immediately after training, and before sleep; lower doses were found
significantly less effective, and higher doses were not significantly more effective
(Gallagher et al.2000). The producer also prepared a placebo preparation containing
maltodextrin.
The consumed HMB dose was equivalent to the most commonly recommended intake
mg
of 38 kg (of total weight) HMB per day.
Subjects of CTG and HMB-CTG perform their complex training protocol on even days,
all sets of the weights exercise with a recovery of 60 seconds/set. This is followed by a
three minute rest before performing all sets of the matched plyometric exercise with a
recovery of 90 second/set. Load intensity was ranged between %60-%80, the complex
training program is described in Table 2, and on the other hand HMB group and HMB-
CTG consume their determined dosage of HMB supplementation daily on specific
times.
The schematic of study design is available in figure 1.

Week One Two Three Four

Intensity %60 - %65 1RM %65 - %70 1RM %70 - %75 1RM %75 - %80 1RM
 2.3 Testing Procedures

Subjects were assessed before and after an 8-week of protocol. All measurements were
taken during one day before and 48h after training at the same times of day. Tests
followed a general warm-up that consisted of running, calisthenics, and stretching.

Vertical Jump Test (VJ):

The subject stands side on to a wall and reaches up with the hand closest to the wall.
Keeping the feet flat on the ground, the point of the fingertips is marked or recorded.
This is called the standing reach height. The athlete then stands away from the wall,
and leaps vertically as high as possible using both arms and legs to assist in projecting
the body upwards. Attempt to touch the wall at the highest point of the jump. The
difference in distance between the standing reach height and the jump height is the
score. The best of three attempts is recorded.
 Seated Medicine Ball Throw (SMBT):

The subject sits with their back to a wall, on a mat facing the area to which the ball is to
be thrown, and with the feet extended and slightly apart. The ball is held with the
hands on the side and slightly behind the center. The ball is brought to the chest, and
then thrown vigorously out as far as possible. The back should remain in contact with
the wall at all times. Three attempts are allowed. The distance from the wall to where
the ball lands are recorded. The measurement is recorded to the nearest 10 cm. The
best result of three throws is used.

Statistical analysis
All statistical analyses were calculated by the SPSS statistical package (version 22.0.1).
The results are reported as means and standard deviations (SD). Differences between
two groups were reported as mean difference ±95% confidence intervals (meandiff ±
95% CI). Student’s t-test for independent samples was used to determine the
differences in fitness parameters between the two groups. The p<0.05 was considered
as statistically significant.

Blood measurements
Sample collection was performed in the morning (between 11:00 A.M and 12:00 P.M.),
after an overnight fasting and a minimum of 30 min rest before sampling, also they
were obtained prior to pre-test and during 48h after post-test session. These blood
samples were obtained from an antecubital arm vein using a 20-gauge disposable
needle equipped with a Vacutainer® tube holder. Each participant's blood samples
were obtained at the same time of day during each session following an overnight fast.
All blood samples were collected into Vacutainer® tubes, one containing no anti-
clotting agent and the second containing gel and clot activator. The blood samples in
the tubes were allowed to clot at room temperature for 30 min and subsequently
centrifuged at 3000 ×g for 15 min. The resulting plasma and serum was placed into
separate 1.8-mL micro centrifuge tubes and isolated and frozen at−80 °C for later
analysis.

Biochemical analysis
Serum concentrations of Testosterone were analyzed using a commercially available
Human Testosterone chemiluminescence Kit (Roche Diagnostics, Cat.No：CK-E91025),
per manufacturer's instructions, without modification. Listed sensitivities for
Testosterone were 0.007–0.056 ng·ml−1. The intra-assay coefficient of variation for
Testosterone assay was less than 5%. The serum concentration of Cortisol was
 determined using a commercially available electrochemiluminescence kit (Roche
Diagnostics, Cat.No：CK-E91025, EAST Biopharm Co). The sensitivity of this kit was 2.0
pg/mL, and the detection range was 15.6–500.0 pg/mL. Both the intra-and inter-assay
CVs were<15%. To eliminate inter assay variance, all samples for a particular assay were
thawed once and analyzed in the same assay run by a single technician.
Lipid profile indexes (LDL, HDL and Triglycerides) were analyzed using kits of Vital
Scientific® (Ellitech Group Spankeren, Netherlands) in the semi-automatic analyzer
model 300 MicroLab® Vital Scientific (Ellitech Group, Spankeren, Netherlands).

Results

Anthropometric characteristics of the participants are summarized in Table 1. No

baseline differences were found in any of the measurements among the groups. Table
3, 4 and 5 present the results of ANOVA for repeated measures models of the different
tests. It can be observed that baseline pre-test values of Biochemical markers, Lipid
Profile and Strength did differ significantly (p<0.05) after intervention, and also same
modifications were true comparing to the control group.

In relation to the biochemical data, the HMB group, complex training group and HMB-
CTG demonstrated a significant increase in Serum testosterone versus the PLB group
(Table 3), in turn; cortisol serum levels were decreased in same groups (Table 3); which
finally lead to a significant increase in testosterone to cortisol ratio (Table 3).

When compared with the body composition changes, (Lipid Profile and Fat) the HMB
group, complex training group and HMB-CTG showed a decrease in all four
components, unlike the PLB group (Table 4).

Concerning motor proficiency, there were obvious changes over the course of the
intervention program. The effect of HMB supplementation, complex training and their
combination compared with control group on power and strength measurements in
the study participants are shown in Table 5. Intervention groups resulted in a
significantly greater strength and power gain in vertical jump and Seated Medicine Ball
Throw.

An interesting finding was that the HMB-CTG, showed more significant value
differences in biochemical markers, lipid profile, strength and power related to other
groups, through comparing the inter-group difference values.
 Table 3. The effects of HMB Supplementation, complex training and their combination on
Biochemical markers (Mean values ± standard deviation) at pre and post-test times. (*p<0.05)

Control Group HMB Group CTG HMB-CTG

𝑷
Pre post Pre post Pre post Pre post
𝒏𝒈
Testosterone( ) 3.7 ± 0.74 3.79 ± 0.72 4.03 ± 0.75 4.8 ± 1 3.65 ± 0.62 4.56 ± 0.71 3.19 ± 0.64 5.22 ± 0.56 0.002*
𝒎𝒍
𝝁𝒈
𝐂𝐨𝐫𝐭𝐢𝐬𝐨𝐥( ) 9.98 ± 3.12 8.76 ± 1.79 7.93 ± 2.75 8.34 ± 2.8 8.12 ± 2.71 9.23 ± 2.77 8.18 ± 2.14 10.61 ± 1.45 0.142*
𝒅𝒍

𝐓𝐞𝐬𝐭𝐨𝐬𝐭𝐞𝐫𝐨𝐧𝐞
0.43 ± 0.05 0.38 ± 0.07 0.62 ± 0.21 0.56 ± 0.24 0.54 ± 0.21 0.5 ± 0.2 0.45 ± 0.05 0.4 ± 0.05 0.066*
𝐂𝐨𝐫𝐭𝐢𝐬𝐨𝐥

Table 4. The effects of HMB Supplementation, complex training and their combination on Lipid
Profile (Mean values ± standard deviation) at pre and post-test times. (*p<0.05)
Control Group HMB Group CTG HMB-CTG
𝑷
Pre post Pre post Pre post Pre post
𝒎𝒈
LDL( ) 87.6 ± 16.07 90.2 ± 14.66 83.2 ± 24.62 89.1 ± 21.73 84.3 ± 16.26 71.9 ±15.52 78.9 ± 25.25 59.1±12.9 0.00*
𝒅𝒍
𝒎𝒈
HDL( ) 51.3 ± 8.05 50 ± 8.04 45.7 ± 9.63 46.7 ± 9.29 54 ± 5.09 58 ± 4.1 47.8 ± 7.34 55.8 ± 4.91 0.007*
𝒅𝒍
𝒎𝒈
Triglyceride( ) 92.1 ± 17.06 106.5±21.15 95.4 ± 48.12 94 ±17.61 82.2 ± 22.17 72.7 ± 17.22 89.4 ± 24.95 67.8±19.94 0.007*
𝒅𝒍
Fat percent -
Caliper (%)
19.2±6.9 19.9±7.6 18.1±6.2 16.9±6.4 18.8 ± 5.9 16.6±6.4 18.5 ± 6.5 16.1±6.3 0.04*

Table 5. The effects of HMB Supplementation, complex training and their combination on
Strength (Mean values ± standard deviation) at pre and post-test times. (*p<0.05)

Control Group HMB Group CTG HMB-CTG

Pre post Pre post Pre post Pre post
𝑷
Vertical
Jump(m) 2.57±0.73 2.57±0.67 2.15 ± 0.72 2.81 ± 0.60 2.88±0.82 3.17±0.76 2.61±0.78 3.22±0.56 0.01*

Seated
Medicine
Ball
4.6 ± 0.74 4.71 ± 0.72 5.03 ± 0.75 5.8 ± 1 4.65 ± 0.62 5.56 ± 0.71 4.19 ± 0.64 6.22 ± 0.56 0.002*
Throw(m)

Discussion

This is the first study to evaluate the effects of complex training (resistance training +
plyometric training), HMB supplementation and their combination on anabolic and
catabolic state, body composition, power and strength of basketball players through a
chronic intervention.

The main findings from this study were the significant Increases in testosterone serum
levels, testosterone to cortisol ratio, the height of Vertical Jump and the distance of
Seated Medicine Ball Through; in turn, a significant decrease in cortisol serum levels and
lipid profile, which proved the Complex training and HMB supplementations efficacy.
Testosterone increase may indicate an exercise-associated anabolic adaptation.
Although the effects of different types of exercise on testosterone levels in men are very
well studied, few previous studies examined the effect of resistance and plyometric
exercise on testosterone level in elite basketball players.

Complex Training studies have produced increases in neural drive (IRFD) associated with
adaptations in contractile strength of skeletal muscle. (P. Agaard et al., 2002) Higher
EMG activity was discovered in the hamstring muscles during depth jumping indicates
that more fast-twitch fibers were being recruited, which in time could have provided
more propulsive power. This fact may have contributed to the increments observed in
the present study. It is postulated that the resistance exercise will have a performance
enhancing effect on the plyometric activity. (W.P. Ebben, P.B. Watts, 1998); Furthermore,
athletes that are found to be more explosive, which may be strongly related to their
nervous system capabilities, are often found to possess high levels of strength. (M.H.
Stone et al., 2004) Thus, maximum strength appears to be an important underlying
factor that influences of jumping. M.H. Stone et al. 2003, M.D. Peterson, et al., 2006,
though not directly measured in the current investigation previous literature indicates
additional considerations must be given to mechanisms involving a shorter amortization
phase, producing larger forces over the course of the jump, and simply being able to
better overcome the additional load. (M.H. Stone et al., 2003) M.D. Peterson, et al. (2006)
it is possible that maximum strength levels influence these mechanisms in a positive
manner.
Another possible mechanism of action of complex training efficiency is that the muscles
are involved in a very rapid switch from the eccentric phase to the concentric phase
(Stretch-shortening cycle). This SSC decreases the time of the amortization phase that in
turn allows for greater than normal power production. (A. Hamza, 2008). According to R.
Rahimi, Behpur, 2005 In the SSC the muscles undergo transition energy (from eccentric
to concentric muscle action), so that to train and enhance this transition phase requires
a complex training, such as the programs used in this study. The results of this study
showed that complex training has a more significant effect. These results are in
accordance with previous studies that have been shown as being equally effective (1, 2),
Resulting in increased anabolic factor, power output, and increased efficiency of the SSC
behavior that leads to Enhanced of leaping performance level. Research has found the
complex training can be beneficial to athletic performance A.K. Evans et al (2000). T.M.
Comyns. et al (2007) , While the opposite has also been reported. P. Jones, A. Lees,
(2003).

Nutritional supplements are commonly used by athletes to enhance athletic

performance. While it is believed that these substances increase the training-associated
anabolic adaptations and reduce their catabolic effects, increase muscle mass, decrease
fatigue, and improve aggression, very little scientific evidence supports this notion.

Accordingly, post-exercise increases in testosterone levels in elite athletes were usually

accompanied by a parallel decrease in cortisol serum levels, lipid profile indexes. Our
data are consistent with previous studies that demonstrated total body fat loss when
supplementing with HMB during RT for 12 to 24 weeks (Stout et al., 2013). The exact
mechanism is unknown; however, Bruckbauer et al. (2012) Q15 suggested that HMB
supplementation may improve metabolic capacity and fat utilization of myofibers, While
HMB may improve the capacity to utilize fat. Interestingly, in the present study, the
basketball practice did not lead to a significant increase in testosterone to cortisol ratio.
However, there was a significant correlation between the exercise-induced changes in
testosterone to cortisol ratio (r=0.53, p=0.01) in the elite basketball players.

Studies investigating the mechanisms by which β-Hydroxy-β-methylbutyric acid (HMB)

promotes increases anabolic factors, strength and power are relatively scarce and new.
Based on these studies, it is postulated that such supplementation would involve the
following mechanisms: (1) up-regulation of IGF-I gene expression in skeletal muscles, (2)
stimulation of protein synthesis by increasing the mTOR signaling pathway, and (3)
suppression of proteolysis by the inhibition of the ubiquitin–proteasome system.
Very few studies examined the effect of HMB supplementation and complex training
interactions. Although all 3 intervention groups showed improvements in the course of
8 weeks, the change in the HMB-CTG is more significant. Anabolic indexes improved
significantly with the training program, and subsequently; catabolic index showed a
reduction in serum levels of all 3 groups with notable changes occurring in the HMB-
CTG.

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