Due to this relative deficiency-state in vegetarians and vegans, some aspects of creatine supplementation are seen as more akin to normalizing a deficiency, rather than providing the benefits of supplementation. In young vegetarians, but not omnivores, creatine supplementation can enhance cognition.[60][61] The increased gain in lean mass may be more significant in vegetarians, relative to omnivores.[59] Supplementation of creatine in vegetarians appears to normalize the gap in storage between vegetarians and omnivores.[62] This is possibly related to a correlation seen in survey research, where vegetarianism and veganism appear to be more commonly affected by some mental disorders like anxiety and depression.[63]
The largest determiner of your metabolic rate is actually your total body mass. “The more cells, even fat cells, in your body, the more furnaces you have burning at any given time,” Dr. Church says. Think of it this way: It takes more juice to charge your tablet than it does to charge your phone. People who are taller and have a larger bone structure, therefore, will have a higher BMR than people who are shorter and have a slimmer build. While you can control your body mass to some extent by gaining or losing weight, you can’t change your height or your bone structure. All in all, most of a person’s BMR is determined by genetic factors, Dr. Church says.
Some of the most common minor side effects include stomach discomfort, nausea, and increased bowel movements. Other potential side effects may include headaches, bloating, and increased thirst. There is always the chance that a supplement could cause an allergic reaction. This can result in rashes, swelling, or difficulty breathing, depending on the severity of the reaction. This is another reason why starting out with lower doses of new products is advisable.
As we all adjust to the time change, it’s worthwhile to consider how other aspects of our lives can sway our circadian rhythms. Circadian clocks govern the rhythms of sleep and activity in virtually all animals and are responsive to a variety of stimuli like light and stress. Research is starting to suggest that our eating patterns – specifically when we eat – can also have a pervasive impact.

Those micro-tears that are such a key factor for muscle-building need rest to rebuild themselves and grow stronger. When do they do that? When you’re asleep! “You have to rest and feed your muscles between workouts or you will tear them down and they will become weaker,” says Olson. “Over time, you run the risk of over-training, which can result in injury, and possibly even more sleep troubles.”
Another study found that one week of creatine supplementation at 25 g/day enhanced muscular performance during repeated sets of bench press and jump squat exercise. Creatine supplementation appeared to allow the subjects to complete their workouts at a higher intensity. The researchers concluded that, over time, working at higher intensities may provide a more intense training stimulus and improved muscular adaptations [10].
In particular situations, a coach may advise performing the valsalva maneuver during exercises which place a load on the spine. The vasalva maneuver consists of closing the windpipe and clenching the abdominal muscles as if exhaling, and is performed naturally and unconsciously by most people when applying great force. It serves to stiffen the abdomen and torso and assist the back muscles and spine in supporting the heavy weight. Although it briefly increases blood pressure, its is still recommended by weightlifting experts such as Rippetoe since the risk of a stroke by aneurysm is far lower than the risk of an orthopedic injury caused by inadequate rigidity of the torso.[10] Some medical experts warn that the mechanism of building "high levels of intra-abdominal pressure (IAP)...produced by breath holding using the Valsava maneuver", to "ensure spine stiffness and stability during these extraordinary demands", "should be considered only for extreme weight-lifting challenges — not for rehabilitation exercise".[11]

Creatine Ethyl Ester, or CEE for short, is a powdered form of creatine which has an ethyl group attached to the creatine. This is said to make the creatine more easily absorbed in the human body which would allow you to benefit the most. The studies have not been entirely conclusive as to whether CEE is better than creatine monohydrate. Since Creatine monohydrate is the single most researched form of creatine, it is
XPI's Decacor Creatine steals the #1 spot, with its 10 patented forms of rapid-release Creatine blend. This advanced, high-performance Creatine formula was developed to meet the needs of athletes looking to develop lean mass, strength, and intensify workouts. If it's extreme results you're looking for, Decacor is a cutting-edge, one-of-a-kind formula ready to deliver. Backed with a 100% Money Back Guarantee. Keep Reading »
When it comes to building muscle, your body only knows or cares about the tension, fatigue and damage an exercise is generating… not the type of equipment you were using when performing that exercise. It really couldn’t give the slightest crap about that. For this reason, ALL types of exercises and ALL types of equipment are capable of stimulating muscle growth.
When assessing the antioxidant effects of creatine, it does not appear to sequester superoxide and may not be a direct antioxidant.[241] Additionally, creatine failed to protect neurons from H2O2 incubation to induce cell death via pro-oxidative means.[241] These results are in contrast to previously recorded results suggesting creatine acts as a direct anti-oxidant.[242]
That being said, men aren’t the only ones who suffer from low testosterone levels. Women can also suffer from testosterone deficiency which can affect their overall well-being in addition to their sex drive. If you’re a woman or man concerned about your testosterone levels, in addition to using supplements like the ones below, you should contact your doctor who will be able to diagnose any deficiencies and recommend additional treatments.

Without a doubt, you can add muscle simply by eating right and lifting weights. But to truly maximize your growth potential, supplements are a requirement. Hence, we've compiled a rundown of the 11 best mass-gain supplements on which to spend your hard-earned cash. They're listed in order of priority, from the absolute most critical, can't-do-without supplements to the less crucial yet still highly effective ingredients for packing on size. The point is to help those on a tight budget decide which supplements to buy. If money is no object, then by all means knock yourself out and use them all as directed. Because after all, as far as we're concerned, you can never have too much muscle.
You can't scroll through Instagram without clocking a mammoth cheat day feast, but are real-life bodybuilders consuming such a crazy amount of calories every couple of weeks? Not quite. When he’s dieting for a competition, Terry incorporates ‘re-feed days’ into his schedule. This means he eats the exact same food, but essentially doubles the portion sizes.

Creatine is marketed as "nature's muscle builder" and "the most legitimate sports supplement around." Professional and amateur athletes alike are gobbling up this alleged ergogenic aid, hoping to increase their strength and performance. Creatine supplementation is claimed to increase muscle power by playing a role in the transfer of energy to help the muscle contract. Supplement labels state that "creatine is converted to phosphocreatine, which is important for short energy bursts such as sprinting and weight lifting" and that "depletion of phosphocreatine can result in muscle fatigue and fading muscle power." Claims are also made that supplementation increases muscle body mass.
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Though weight training can stimulate the cardiovascular system, many exercise physiologists, based on their observation of maximal oxygen uptake, argue that aerobics training is a better cardiovascular stimulus. Central catheter monitoring during resistance training reveals increased cardiac output, suggesting that strength training shows potential for cardiovascular exercise. However, a 2007 meta-analysis found that, though aerobic training is an effective therapy for heart failure patients, combined aerobic and strength training is ineffective; "the favorable antiremodeling role of aerobic exercise was not confirmed when this mode of exercise was combined with strength training".[36]
Ancient Greek sculptures also depict lifting feats. The weights were generally stones, but later gave way to dumbbells. The dumbbell was joined by the barbell in the later half of the 19th century. Early barbells had hollow globes that could be filled with sand or lead shot, but by the end of the century these were replaced by the plate-loading barbell commonly used today.[3]

This test measures a participant's ability to stand up from a seated position as many times as possible in a thirty-second period of time.[2] Testing the number of times a person can stand up in a thirty-second period helps assess strength, flexibility, pain, and endurance,[2] which can help determine how far along a person is in rehabilitation, or how much work is still to be done.


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How does creatine work? For those who remember their high school biology, creatine acts as an extra reservoir for phosphate groups. When your body starts running out of readily-available ATP (for example, when lifting weights), creatine can help donate some phosphate to ADP (to give your body more ATP). In terms of real-life application, creatine basically gives your cells a bit more extra energy.


For many people, appearance is the top priority when it comes to their posterior. But yoga practitioners also know that the glute muscles can do so much more than look great in jeans: They’re the primary players in many of the movements that make it possible to do yoga. The gluteus maximus, medius, and minimus—along with many other smaller, supporting muscles—act as a base of support for the pelvis and hips. What’s more, these hard-working muscles stabilize your femur (thighbone) in your hip socket, rotate your femur internally and externally, and draw your leg back. And yes, all of these actions also help us stand and walk, and even support us when we sit.
Research shows that strength training is especially effective at raising EPOC. That’s because, generally speaking, strength-training sessions cause more physiological stress to the body compared to cardiovascular exercise, even higher-intensity cardio intervals. However, it’s worth noting that overall exercise intensity is what makes the biggest impact on EPOC. So squats, deadlifts, and bench presses with heavy weights are going to be much more effective at raising EPOC compared to bicep curls and triceps extensions with light weights.
Moving through repetitions too quickly, going too fast; there is nothing gained by lifting weights fast. Some of the perks of lifting weight in a slow and controlled manner, include more total muscle tension and force produced, more muscle-fiber activation both slow and fast twitch fibers, and less tissue trauma. Remember, a joint is only as strong as the muscles that cross it; if you haven't lifted in a long time, or ever, be careful what you ask of your joints.
One of the biggest goals of bodybuilders is to increase their muscle size and strength. Bodybuilding supplements often contain many ingredients that help to encourage this. Branched-chain amino acids are a common ingredient that can significantly increase muscle growth. Other ingredients help to increase the levels of hormones, such as growth hormone and testosterone, that can also stimulate muscle growth.
If you have been diagnosed with a certain testosterone deficiency, ask your doctor and/or pharmacist to see if TestoFuel could be beneficial for you. Aside from balancing your testosterone, you may experience increased muscle strength while using this supplement during your intense exercise routine. Here are certain instances where TestoFuel could help correct your testosterone problems:

my name is Samtak and i recently started experimenting with some supplements after about 4-6 months of working out. as of right now i have a protein shake once a day with gainers in the protein powder and am trying to figure out how to use beta alanine and creatine in combination with BCAA. Can anyone help me figure out how to set out a good plan for better effects from these supplements? my current weight is 60 kg and i am 16
Branched-chain amino acids (leucine, isoleucine, valine) play important roles in muscle building. Some researchers have found that following exercise, the branched-chain amino acids, especially leucine, increase the rate of protein synthesis and decrease the rate of protein catabolism (Blomstrand, 2006). The billion dollar supplement industry has been quick to respond; leucine supplements are widely available in health food stores, with a cost upwards of $50 per container. However, because the research findings are inconsistent and little is known about the safety of these products, the American Dietetic Association (soon to be renamed the Academy of Nutrition and Dietetics) advises against individual amino acid supplementation and protein supplementation overall (Rodriquez, 2009). It may be that food sources of these proteins and amino acids provide the same effect for a small fraction of the cost.
Even human studies can be misinterpreted or manipulated. A few years ago a then-esoteric trace mineral called boron was found to increase testosterone, but only in older women, as it turned out. When boron was tested in young men engaged in weight training, it proved worthless for increasing testosterone. That doesn't mean boron is useless; it helps the body use the minerals calcium and magnesium, and it appears to increase mental alertness.
Sharma, R., Oni, O. A., Gupta, K., Chen, G., Sharma, M., Dawn, B., … & Barua, R. S. (2015, August 6). Normalization of testosterone level is associated with reduced incidence of myocardial infarction. European Heart Journal, 36(40), 2706-2715. Retrieved from https://academic.oup.com/eurheartj/article/36/40/2706/2293361/Normalization-of-testosterone-level-is-associated
This cellular influx may also decrease protein oxidation rates, which leads to increases in nitrogen balance and indirectly increases muscle mass.[379] This lowering of protein oxidation is from signaling changes caused vicariously through cell swelling[380][381] and appears to upregulate 216 genes[378] in a range of 1.3 to 5-fold increases, with the largest increase seen in the protein involved in satellite cell recruitment, sphingosine kinase-1. Most importantly for muscle hypertrophy, the protein content of PKBa/Akt1, p38 MAPK, and ERK6 increased 2.8+/-1.2 fold.[378] Sixty-nine genes are also downregulated after creatine supplementation, to less notable degrees.
"Start with two days for two to three weeks, then add a third day," says Davis*.*"Ideally, you should strength train three to five days per week, but work your way up—starting off at five days a week might shock your body." Here's a comprehensive three-day-per-week plan to get you started. Aim to complete 20-minute sessions, then gradually add on time in ten-minute increments until you're working for 45 to 60 minutes, suggests Davis.
If you're serious about putting on some muscle, then the most efficient way to do it is with three intense resistance training sessions and two lighter intensity workouts per week. “You need to have consistency in a workout program, hitting at least each muscle group two times a week to build muscle,” explains Lovitt. If you’re looking to switch up exercises, Olson suggests swaps such as sumo squats instead of traditional squats; step-ups on a bench instead of lunges; and then rotating back to the former. “These types of variation can be very effective in developing muscles, but the weights must still be fairly heavy that you’re using,” she says.
JAK2 (Janus-Activating Kinase 2) is a novel protein that has been shown to suppress the activity of the creatine transporter CrT in vitro. The effects of JAK2 on CrT are not well-understood in vivo, however. Given that growth hormone activates both c-src (increases CrT activity) and JAK2- which has been found to decrease CrT activity, it is plausible that JAK2 may function as a negative-feedback regulator of creatine uptake. Future research is needed to better understand the role of JAK2 on CrT activity in vivo.
A quantitative, comprehensive scientific summary and view of knowledge up to 2007 on the effects of creatine supplementation in athletes and active people was published in a 100 citation review position paper by the International Society of Sports Nutrition[5]. More recent literature has provided greater insight into the anabolic/performance enhancing mechanisms of creatine supplementation [15,25] suggesting that these effects may be due to satellite cell proliferation, myogenic transcription factors and insulin-like growth factor-1 signalling [16]. Saremi et al [26] reported a change in myogenic transcription factors when creatine supplementation and resistance training are combined in young healthy males. It was found that serum levels of myostatin, a muscle growth inhibitor, were decreased in the creatine group.
Polyethylene glycol is a non-toxic, water-soluble polymer that is capable of enhancing the absorption of creatine and various other substances [66]. Polyethylene glycol can be bound with CM to form polyethylene glycosylated creatine. One study [67] found that 5 g/d for 28 days of polyethylene glycosylated creatine was capable of increasing 1RM bench press in 22 untrained young men but not for lower body strength or muscular power. Body weight also did not significantly change in the creatine group which may be of particular interest to athletes in weight categories that require upper body strength. Herda et al [68] analyzed the effects of 5 g of CM and two smaller doses of polyethylene glycosylated creatine (containing 1.25 g and 2.5 g of creatine) administered over 30 days on muscular strength, endurance, and power output in fifty-eight healthy men. CM produced a significantly greater improvement in mean power and body weight meanwhile both CM and polyethylene glycosylated form showed a significantly (p < 0.05) greater improvement for strength when compared with control group. These strength increases were similar even though the dose of creatine in the polyethylene glycosylated creatine groups was up to 75% less than that of CM. These results seem to indicate that the addition of polyethylene glycol could increase the absorption efficiency of creatine but further research is needed before a definitive recommendation can be reached.
The gluteus medius muscle originates on the outer surface of the ilium between the iliac crest and the posterior gluteal line above, and the anterior gluteal line below; the gluteus medius also originates from the gluteal aponeurosis that covers its outer surface. The fibers of the muscle converge into a strong flattened tendon that inserts on the lateral surface of the greater trochanter. More specifically, the muscle's tendon inserts into an oblique ridge that runs downward and forward on the lateral surface of the greater trochanter.
Creatine citrate is creatine bound to citric acid, or citrate. Creatine citrate does not differ greatly from monohydrate in regard to absorption or kinetics.[83] Note that creatine citrate is more water-soluble than monohydrate,[84] but creatine absorption is generally not limited by solubility. The increased water solubility may play a factor in palatability.
After supplementation of creatine monohydrate (loading phase, followed by 19 weeks maintenance), creatine precursors are decreased by up to 50% (loading) or 30% (maintenance), which suggests a decrease in endogenous creatine synthesis during supplementation.[38] This appears to occur through creatine’s own positive feedback and suppression of the l-arginine:glycine amidinotransferase enzyme, the rate-limiting step in creatine synthesis, as levels of intermediates before this stage are typically elevated by up to 75%.[38]
I get lost every time I walk into my neighborhood GNC… the people who work there know their stuff, but nobody knows my body better than me and that’s where it all falls apart, but I’m working on that. I agree, I rather have grass-fed and more natural options as opposed to anything containing GMO in the products… The point is to become healthier, not go the other way…. But I also don’t want to get too much soy in my diet either… My wife is doesn’t want it for me and it’s given me headaches too, so I’m not really one for those. I guess small amounts of soy should be okay, right? Could someone be allergic to soy? There’s tons of other options though and I’m going to have to really look more into these here coz it has everything I’ve been looking for! Thanks for putting this together!
Expert tip: “Optimum form and range of motion for the squat is very dependent on your physicality, structure, joint integrity, limb length, strength, flexibility, and current condition,” Reames says. Your range of motion is 90° max at the knee. Some guys will be able to go lower than this, but not everyone will squat to parallel, he says. And that’s totally okay. “Stick to form and the appropriate resistance levels for you; the squat is still one of the best and simplest moves for overall strength, building lower-body muscle, core strength, and athletic performance. 
Testosterone is included in the World Health Organization's list of essential medicines, which are the most important medications needed in a basic health system.[111] It is available as a generic medication.[10] The price depends on the form of testosterone used.[112] It can be administered as a cream or transdermal patch that is applied to the skin, by injection into a muscle, as a tablet that is placed in the cheek, or by ingestion.[10]
How to Take It: If you decide you want to take BCAAs as one of your weight lifting supplements, you can easily get them and take them much like you would protein powders. One scoop provides 2.5g of leucine, 1.25g of isoleucine and 1.25g of valine. Take it before a workout, during or after. As with all supplementation, the aim is to reach your overall daily needs and goals.
Supporting the muscles of the back — In patients who complain of lower back pain, many experts recommend strengthening the glutes to improve posture and take pressure off of the lower body. Lower back pain is one of the most common complaints among middle-aged and older adults, often tied to lots of sitting, too little movement of the lower body and not enough stretching. (02)
Although research is underway, doctors do not know the long-term health effects of taking creatine supplements, especially in children who are still growing. Because of these unknown risks, children and adolescents younger than 18 years and pregnant or nursing women should never take creatine supplements. People with kidney problems also should never take creatine supplements.

Mitochondrial myopathies are a subgroup of mitochondrial cytopathies in which the skeletal muscle is negatively influenced. They are characterized by weaknesses in muscular function and energy metabolism.[547] These particular myopathies are thought to benefit from creatine supplementation, since creatine can help with some of the dysregulated energy production.[548]
You're aiming to kick start muscle hypertrophy, the cellular process that spurs growth. Researchers have found that the best way to initiate that process is by performing two or three sets of an exercise for six to 12 repetitions, with about 30 to 60 seconds' rest between sets. You're damaging the muscles with the work — then the protein you've been consuming will help build them back up even bigger.
The first thing you need is a weight training program that signals the muscle building process to begin. Research has shown that a well designed program will generate this “signal” via a combination of progressive tension overload (as in, getting stronger over time), metabolic stress (as in, fatiguing the muscle and getting “the pump”), and muscular damage (as in, actual damage to the muscle tissue itself).
Remember that each person is unique, and each body responds differently to treatment. TT may help erectile function, low sex drive, bone marrow density, anemia, lean body mass, and/or symptoms of depression. However, there is no strong evidence that TT will help memory recall, measures of diabetes, energy, tiredness, lipid profiles, or quality of life.
How: Place a resistance band around both legs, just above or below your knees. Stand with feet just wider than hip-width apart, toes turned out slightly, hands clasped in front of chest. Keeping weight in your heels, send your butt and hips back as if sitting in a chair and lower down as far as possible, pressing your legs outward against the band. Return to starting position and repeat.
Tongkat Ali, biologically called Eurycoma longifolia, is a herb found in Southeast Asia which is primarily used to boost male fertility. However, it is also known to boost testosterone levels significantly. Tongkat Ali has a low side-effect profile, been found to be generally safe and well-tolerated. A common side effect reported by users is trouble falling asleep which you can avoid by taking the supplement in the morning, preferably with breakfast.
Plyometrics exploit the stretch-shortening cycle of muscles to enhance the myotatic (stretch) reflex. This involves rapid alternation of lengthening and shortening of muscle fibers against resistance. The resistance involved is often a weighted object such as a medicine ball or sandbag, but can also be the body itself as in jumping exercises or the body with a weight vest that allows movement with resistance. Plyometrics is used to develop explosive speed, and focuses on maximal power instead of maximal strength by compressing the force of muscular contraction into as short a period as possible, and may be used to improve the effectiveness of a boxer's punch, or to increase the vertical jumping ability of a basketball player. Care must be taken when performing plyometric exercises because they inflict greater stress upon the involved joints and tendons than other forms of exercise.
Without a doubt, you can add muscle simply by eating right and lifting weights. But to truly maximize your growth potential, supplements are a requirement. Hence, we've compiled a rundown of the 11 best mass-gain supplements on which to spend your hard-earned cash. They're listed in order of priority, from the absolute most critical, can't-do-without supplements to the less crucial yet still highly effective ingredients for packing on size. The point is to help those on a tight budget decide which supplements to buy. If money is no object, then by all means knock yourself out and use them all as directed. Because after all, as far as we're concerned, you can never have too much muscle.

One thing to keep in mind with this set is that it contains animal products from gelatin and milk. If you are vegan, do not consume these capsules. In terms of weight gain, it is important to note that these capsules do not contain calories. You need extra calories to gain weight. Above all, since this bulking stack requires you to take several pills daily, make sure to talk to your doctor before starting this supplement regimen.
If you're 12 weeks out from a competition, you want to maintain as much muscle as possible while torching fat from every angle. This means low-intensity cardio – high intensity cardio speeds up your metabolism and burns fat very quickly, so you run the risk of burning muscle too, Terry says – either first thing in the morning on an empty stomach, or immediately after your weights session, once you’ve depleted those glycogen levels.
Creatine is marketed as "nature's muscle builder" and "the most legitimate sports supplement around." Professional and amateur athletes alike are gobbling up this alleged ergogenic aid, hoping to increase their strength and performance. Creatine supplementation is claimed to increase muscle power by playing a role in the transfer of energy to help the muscle contract. Supplement labels state that "creatine is converted to phosphocreatine, which is important for short energy bursts such as sprinting and weight lifting" and that "depletion of phosphocreatine can result in muscle fatigue and fading muscle power." Claims are also made that supplementation increases muscle body mass.
I can’t predict what sort of results you’ll see in that first year, but it can be pretty epic if you attack it right! Muscle growth might happen slower than you want, but I expect something different will happen along the way – you’ll fall in love with this idea of building STRENGTH! In fact, getting hooked on progress, and strength training is one of the best things you can do for yourself.
Ballistic training incorporates weight training in such a way that the acceleration phase of the movement is maximized and the deceleration phase minimized; thereby increasing the power of the movement overall. For example, throwing a weight or jumping whilst holding a weight. This can be contrasted with a standard weight lifting exercise where there is a distinct deceleration phase at the end of the repetition which stops the weight from moving.[40]

Yang, L., Calingasan, N. Y., Wille, E. J., Cormier, K., Smith, K., Ferrante, R. J., & Beal, M. F. (2009, June). Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson's and Huntington's diseases [Abstract]. Journal of Neurochemistry. 109(5):1427-39. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19476553
Preparation – If you have physique or aesthetic goals then you’re going to have monitor your nutrition. That being said, it will require a bit of work to prepare some healthy meals and ensuring you’re getting enough calories. Not only that, you must approach training in the same way. If you don’t have your gym bag essentials prepped, you’ll end up wasting time looking for your belt and wrist wraps which should already be packed.
Keep in mind that while creatine boosts your performance in the gym, helping you achieve better muscle building results, it is also associated with some side effects. One of the main concerns is that creatine may worsen or cause kidney problems. Creatine shouldn’t be taken in combination with diabetes medications, acetaminophen, diuretics or caffeine. As always, speak with your doctor before taking supplements to make sure that the product is safe for you (6). Generally, for most people, the supplement is considered to be among the safer weight lifting supplements.
If you want to take creatine as a supplement for bigger and stronger muscles, then the standard protocol is to have a “loading period” where you significantly increase your creatine intake for a few days or weeks. “This can prime your muscles to increase the amount of creatine that they ‘hold,’” explains Bates. “During the loading period, you generally take 5 g of creatine four times per day. After the loading period, you decrease the amount of creatine you take to a ‘maintenance’ level of 3 to 5 g per day.” (That’s also the recommendation from the International Society of Sports Nutrition.) (5)
Men who produce more testosterone are more likely to engage in extramarital sex.[55] Testosterone levels do not rely on physical presence of a partner; testosterone levels of men engaging in same-city and long-distance relationships are similar.[54] Physical presence may be required for women who are in relationships for the testosterone–partner interaction, where same-city partnered women have lower testosterone levels than long-distance partnered women.[59]
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