Hey everyone, welcome to the Drive
Podcast. I'm your host, Peter Aia.
[music]
Welcome to another Ask Me Anything
episode with Dr. Peter Ailla, Stanford,
educated physician.
How you doing?
>> Thank you for that incredible
introduction. I'm doing well and I I
appreciate you having me back. I just
wanted to make sure you knew it was your
show, so I thought more of an
introduction would make it feel more
like home.
Um, [sighs] before we start today's
topic, how's your day going? You learn
anything new today? Have you uh been
educated in any way?
>> Well, you're always learning, Nick.
That's the thing. Uh, at least I think
we should all try to be learning at all
times. And uh today I had a a
particularly fun day. I I went to my
son's school uh to uh to take him lunch.
This is something that I I like to do
once in a while is take lunch and eat
with my kids. And um he wasn't really in
the mood to have lunch with me today,
which uh happens from time to time with
seven-year-olds. So, I ended up just in
the cafeteria sitting at a table all by
myself eating lunch. Um, which in and of
itself was pretty funny cuz I really got
a kick out of watching all the kids, you
know, do doing their thing. But
eventually a bunch of kids in his class,
I think, felt bad for me and they came
up and just sat around me and they
started asking me a bunch of questions.
Um,
which of course turned into me asking
them more questions like what are they
doing in PE? What are they learning in
science? That kind of stuff. But the kid
sitting right across from me noticed I
was drinking a diet soda. And
truthfully, I don't really drink that
many. I'm mostly a Toppo Chico, you
know, Waterlue guy. But this was the
first thing I grabbed. And he said, "Uh,
huh, I noticed you're drinking whatever
it was I was drinking, a fresca,
actually. Um, you know that that has a
sweetener in it that is 500 times
sweeter than sugar?" And I said, "Oh,
yeah. I I think that's how they get away
with making it have no calories. He
goes, "You know that causes cancer,
right?"
I just decided at that moment probably
not a good time to argue the the
abundance of the human literature and
the animal literature and all that. So,
I I let that one go. But but I
appreciated the conviction and his
concern for my health. He also pointed
out afterwards that it wasn't going to
kill you quickly because you were only
ingesting so little of it, which I
thought was a very astute comment for a
seven-year-old. Uh, but anyway, needless
to say, I had a lot of fun doing second
grade lunch today and um I would be
interested in going back.
I I do love it, especially because
you've openly talked about how when you
go to like parties and events where
there are adults there, you usually
don't explain what you do cuz you don't
want to have those conversations. And I
love the fact you went to the local
elementary school and they roped you
into that. And I think, you know, we
were talking briefly before this and I
think Jessica and our team had a good
idea and you know, people in the
audience can let us know if they think
this is good, which is maybe we do get a
panel of these sevenyear-olds together
and do a round table on what elementary
kids think about health, nutrition,
exercise, protein, microlastics, seed
oils, you name it. It sounds like your
local elementary school has a lot of
insights on these topics.
>> Honestly, if our audience wants to hear
the seven-year-old round table, I am
totally game to get seven uh to get, you
know, a group of three or four or
sevenyear-olds around the table and
really go deep on the health issues that
mean most to them. I I it's probably
it's probably quite insightful.
>> Yeah, it is. Yeah. Well, let us know if
we should do it and we will make it
happen. But for today's AMA, we are not
talking about that. We're actually going
to talk about one topic and that is all
things related to muscle mass and muscle
strength. So, it's something that we've
talked about on a lot of different
podcasts. You openly talk about the
importance of it and we've gathered a
lot of questions that have come in and
these questions are going to deal with
why is muscle mass and strength
important? the difference between muscle
mass and strength. Which one matters
more? How can you start to increase your
muscle mass and strength? Whether you're
old, young, male, female, the role of
nutrition and protein, one of your
favorite topics in this. And then we'll
end with some different programming
options for different types of people if
they want to start applying this to
their life or if they want to start
going further than their current
exercise programming. So with all that
said, some people may say, you know, you
have a lot of information on this
already in episodes with Lane Norton,
Andy Galpin, Mike Israel, and many more.
So what would you say to someone who
asks like why are we now dedicating an
AMA to this? I think it's a it's a fair
question and one that we internally kind
of kicked around and and I think two
things put us in in the situation we're
in. So, one is we we continue to get
asked more questions about this than
almost anything. I would say it's among
the three most asked about topics. Um,
but I think the second thing is because
we have so much content out there, if
you want to kind of get the TLDDR on
this, you're going to be spending hours
and hours and hours, you know, sort of
20 hours worth of digging. And so what
we thought we could do was organize the
content in a way that would make it much
easier for a person in what will
undoubtedly be a much smaller aloquat of
time um to get everything that they need
to get out of this at the sort of zeroth
order and maybe first order level um and
then really kind of through the show
notes and um supplemental material go as
deep as they want uh if if they need
more content. But I but I I think we're
going to we're going to deliver on this
one. We've we've put a lot of work into
it.
Well, you should because it sounds like
if you don't, next time you go to school
pickup or drop off, you're going to hear
an earful from some kids. So,
>> I'm half expecting the next time I go in
for someone to be like, "Dude, like why
are you so weak looking?" Like, I mean,
like, why do you have such chicken arms?
Like, do you not work out?
>> Yeah. I mean,
I'm not saying it's a good idea. I'm
just not saying it's a bad idea if you
roll up to the next one shirtless, maybe
after a little dehydration, a little
pump prior to just to let those kids
know who's in charge
on that. Um, let's start with some
definitions. Muscle mass, muscle
strength. Two things that are kind of
used intertwined, but also a little
different. We'll get into them here
where I think it'd be helpful to start.
What is the definition of each of those
and how we're going to talk about it? So
I mean I think most people understand
that they are different. I think the
confusion comes from the fact that we
will interchangeably talk about metrics
of both of them and we we're going to
clarify this but of course muscle mass
is simply the total amount of skeletal
muscle in the body. There are three
types of muscle in the body. Um we have
cardiac muscle which looks and behaves a
lot like skeletal muscle but has
properties that allow it to basically
run nonstop for the duration of your
life. We have smooth muscle that is
actually quite distinct from skeletal
muscle. Uh but the bulk of muscle in the
human body is indeed skeletal. Um it has
contractile properties that allow it to
generate force. It has certain metabolic
requirements. Um but nevertheless, this
is this is what we're referring to.
Again, I think of this as having um a
structural function and a metabolic
function. We're going to talk about both
of these. Um, of course, the related
metric is strength. Um, and that's the
ability to exert force to overcome
resistance. Uh, so again, I think that's
very intuitively obvious to everybody.
Um, but but nevertheless, we could we
could talk about those things. Um, two
additional concepts just to introduce is
the um the the idea of hypertrophy. Um,
so in addition to how strong a muscle
is, how much force it can overcome, we
can talk about the size of the muscle.
Um, and then we can talk about power.
Um, which is something that probably
doesn't get talked about enough,
although we certainly talk about it
quite a bit on the podcast. And power
should not be confused with strength,
although there's a strong relationship
between them. Power incorporates
velocity. So um uh and there's an
inverted U shape between that describes
the relationship where the as resistance
goes up um one is able to move with high
enough speed that they can continue to
increase power but as the resistance
gets beyond a certain point speed will
come down and actually power is coming
down even while strength is going up.
So, um, that that kind of rounds out
some of the semantics.
>> And just hitting this right off the bat,
why is muscle mass and muscle strength
important for someone to consider in the
concept of lifespan? Aka, why should
everyone who's listening to this care
about this topic?
>> I think what I want people to kind of
fixate on now is while we will go back
and forth between them, that is simply
um an outcome of the data. So we we we
have to lean on sort of what data are
out there and sometimes the data are
looking at uh muscle mass. Um sometimes
they are looking at strength, sometimes
they're looking at both. What we really
care about is strength. And therefore
when we look at measurements of lean
muscle, which is very easy to measure,
it's actually, you know, that that's a
big part of why we measure it. It's
objective. It's easy to measure. Um, and
it can be compared across studies much
more easily than strength can, for
example. Um, although when you
standardize metrics of strength,
obviously it can be pretty easy as well.
But it's it's the strength that we care
about and it's strength that is probably
much more highly associated with uh not
just correlated with but causally
associated with mortality,
cardiovascular disease, neurologic
disease than muscle mass itself. So what
I would say is we talk about muscle mass
a lot. We care about muscle mass a lot.
It plays an important role in the
metabolic function of muscle. But maybe
above all else, just think of it as a
great proxy for strength, not a onetoone
proxy. I know everybody listening to
this has met a really wiry person who is
insanely strong. And there are actually
some people who have quite a bit of
muscle mass and yet they're not actually
that strong. Um, but if you exclude kind
of the extremes in the bookends, there
seems to be a reasonable mapping between
muscle mass and strength. And Peter, is
there anything we know about how much of
a difference muscle mass strength can
make as it relates to lifespan?
>> Yes, I I think this is a great way to
think about all of the things that are
associated with mortality. So, um I
sometimes will ask this question of
people, you know, as just a way to to
demonstrate and not to be cheeky, but
just to kind of demonstrate the obvious,
as a way to, you know, you know, reframe
the discussion. So if I say to a group
of people what factor is most associated
with mortality let me know what you
think and people will say you know
smoking high blood pressure you know all
sorts of things the answer is age right
so nothing associates more with
mortality than age which by the way as a
total aside is why I still find aging
clocks to be unhelpful because biologic
age chronologic age. Trying to suggest
that those are different requires
demonstrating that biologic age as
demonstrated through um an aging clock
is a superior predictor of mortality
than chronologic age. Um and nothing has
come close to even being within the zip
code of the zip code of the zip code of
the thing that I'm talking about. So
when you look at GMert's law for
mortality, you see an exponential
increase in mortality with age. Um
[clears throat] I'm going to pull up a
figure here in a second in which I tried
to depict
law by decade. Um in other words, what
was the relative risk of mortality with
each passing decade? And it dwarfed all
the other stuff on here. So it didn't
make sense to put on. I'm only throwing
all that out there, Nick, as an aside to
say um I am excluding the elephant in
the room with this uh with this figure
that we put together um by excluding
age. But if you [clears throat] take
that off the table, what I'm showing you
here is a collection of hazard ratios
for all cause mortality. Again, not from
head-to-head studies. These are from uh
at least four if not five different
studies, all of which will be referenced
in the show notes. But what we're
showing you is what is the um increase
in all cause mortality for individuals
across these uh various uh data points.
So if you consider the figure here um
some of these will be completely
familiar to people who have heard me
talk about this in the past. So if you
look at the things on the left of this
graph, we're looking at uh markers of
cardiorespiratory fitness. The easiest
way to measure that by far, of course,
is V2 max, which is why we talk about it
so much. So if you're comparing what's
called above average to elite, that's
basically someone who's in the um third
quartile, so 50th to 75th percentile, uh
to someone who is um you know in the top
2%, we're talking about a two-fold
difference. Uh by the way, the little
bars on this thing, those are error
bars. So 95% confidence intervals. Um,
if you're looking at someone with low V2
max, uh, so, you know, this would be
somebody in the bottom 25 percentile to
someone in the top 2 percentile, you're
talking about a fivefold difference in
mortality, meaning there's a five times
greater difference of dying in the
subsequent year from any and all causes.
Um, I'm going to skip some of the other
V2 max ones, but let's say you look at,
you know, grip strength, right? So you
look at every reduction of grip strength
by 10 kilos is about a 30% increase in
all cause mortality. Um when you look at
different metrics of muscle mass um if
you compare bottom to say middle
quartile of muscle mass you're talking
about 2.3 hazard ratio which means 130%
increase in all cause more mortality. Uh
and again at the right side of this
figure, I'm just showing you things that
people would commonly and appreciate uh
are driving mortality, such as type 2
diabetes, which is about a 40% increase
in all-c causeed mortality. Uncontrolled
hypertension, high blood pressure, about
a 60% increase in all-c cause mortality,
and of course smoking, which from a
modifiable lifestyle behavior would be
right near the top of the list um at
about a 2.8 hazard ratio, at least in
one study. I've seen other studies that
has it as low as 1.4. for obviously the
duration of tobacco use comes into that
but there's no mistaking the role on
that. So what do we take away from all
of this? We take away from this that
muscle mass, strength, cardiorespiratory
fitness play an enormous role in
predicting how long you're going to
live. Um and again while age is the the
the king of kings when it comes to
predicting how much longer you're going
to live, these things play a huge role
as well. And we talked about grip
strength before, but I think it'd be
worth just quickly double clicking on
grip strength. And can you talk about
how that is related to mortality?
>> Yeah, I mean grip strength is a very
easy thing to test. So when I moment
ago, I said, hey, look, um, muscle mass
is often used as a proxy for strength.
Why? Well, it's because DEXA is a
ubiquitous test. It's very easy for
researchers to use DEXA. It can be
standardized from one place to another,
so it's easy to use. So then when you
start to think about strength metrics,
well, one of the easiest things that we
can do is test grip strength. It's also
not just easy to reproduce, u but I
would argue it's a great representation
of upper body strength. So people who
have a very strong grip tend to have a
very strong upper body. Um you can't do
many things that require a lot of upper
body strength if your grip is very weak.
Um so nevertheless if we look at uh grip
strength what do we know about it? So
there was um a study called the pure
study that measured grip strength in you
know somewhere in the ballpark of
140,000 people across 17 countries. Um
and they found that lower grip strength
compared to higher grip strength uh was
a significant predictor of all cause
mortality. So every 5 kilogram reduction
in grip strength was associated with a
16%
increase in mortality. Meaning every 5
kilos or 10 lbs of reduced grip strength
compared to someone who had more grip
strength to that amount there was a 16%
chance of dying in the subsequent year
from any and all cause. Um another very
interesting study um looked at uh people
in their eighth decade of life. So these
were people um aged 70 to 79 at baseline
and it followed them for 7 years. And so
these people were divided into
quartortiles based on muscle mass and
strength. So separate separate analysis.
So, DEXA was used to quantify muscle
mass and um I believe they use uh uh leg
extension for quad strength. They might
have used grip strength as well um for
upper body strength. Okay. So, basically
you have um quartortiles of strength,
quartortiles of muscle mass in people
who are in their eighth decade of life
and they are prospectively followed. Um,
and what we're looking for basically is
what's called the Kaplan Meyer survival
curve. So, if you pull up these curves
here, Nick, you can see that there's uh
obviously because it's a Kaplan Meyer
curve, it's cumulative. You can see a
monotonic increase in mortality for all
groups, but what you notice is the
strongest groups and the groups with the
most muscle mass always have the highest
survival. Uh again, the uh mortality
rates are pretty high in this figure,
right? This is a seven-year follow-up in
people that are starting late in life.
So, you you you wouldn't expect to see
this steep a mortality um drop in uh you
know, if they were doing this in people
aged 50 to 59, two decades younger. But
the reason I suspect that they chose to
do this is because they wanted to
actually see some separation. So uh
again another very clear indication of
at least a very strong association
between muscle mass and muscle strength
in terms of all cause mortality.
>> And [clears throat]
what do we know about muscle strength
and muscle mass being causally related
to mortality? Because I think sometimes
you're going to hear people say, well,
is it just that people who are stronger
tend to be healthier in other ways too
and then live longer as a result? So,
how do you think about that? Yeah, I
think this is a very important question
because I absolutely believe that there
is birectionality in this association.
So the healthier you are, the more
easily you can do the things that make
you stronger and make you have more
muscle and that should be playing a role
in how long you live in addition to the
fact that doing those things allows you
to live longer. So how so so that's my
thesis, right? So how how would you get
at that? Well, you you know it's very
difficult to do a randomized experiment.
Um but if we look at uh Mandelian
randomization um which again we've
talked about many times in the past but
this is basically looking at um
genetic scattering of traits that we
care about um and asking the question
how does that impact the parameter of
interest. So if we look at mandelian
randomization studies um that look at
the relationship between muscle mass and
mortality they do in find at they do
find at least partial causality
um rather than strength just being a
proxy for general health. So one study
that looked at I mean
300 350,000
Finnish uh bioank participants used a
polygenic score as a proxy for grip
strength. So in other words, um a whole
series of genes uh were associated with
grip strength. Again, this is not hard
to imagine, right? Everybody knows that
person who's just stronger than
everybody else, right? Um and um when
they looked at the that polygenic uh
marker for grip strength and uh assessed
the relationship to chronic disease and
mortality, they found that each standard
deviation increase in grip strength from
the polygenic score was linked to a
reduction of risk for vascular dementia
by 7%, obesity by 6%, uh 5% for type 2
diabetes at 4% per mace, and 3% for all
cause mortality. Um so again that's one
way to look at this. Um but again it
suggests to me birectionality here in
that yes I think that the magnitude of
the benefit that we see in the pure
observational cohorts uh clearly
reflects the health of the user as well
that enables them to train. And Peter,
in the past when we talked about V2 max,
you've often spoke about how it is such
a good metric because it's an integrator
of the work done, right? Meaning you
can't just cram for a V2 max test the
week before and greatly increase your V2
max. Is that also kind of similar to
muscle strength, muscle mass? I think
that's exactly why V2 max, muscle mass,
and strength show up as such strong
predictors is that they they integrate
and aggregate years of work that go into
producing high results. You know, we say
this all the time to our patients um
when they show up and test very poorly,
right? So, when someone shows up and
they're in the bottom, you know, 5% for
muscle mass and their strength is poor
and their fitness is poor, um, we we we
explained to them that this is not
something that's going to turn around
this year. Um, this is not like fixing
your APOB, even fixing your insulin
resistance and things like that, which
take a lot of work. This is the longest
part of your health journey if you're
starting with a very low base. Um, and I
think just, you know, understanding that
and saying, "Look, this it's going to be
probably three years before we get your
V2 max from 30 to 50." Um, but but it
can be done, uh, provided you're you're
able to and willing to to train.
>> So far, we've kind of talked about the
benefits of lifespan as it relates to
these metrics. What do we know about the
benefits of health span? So, not only
living longer, but also living better.
>> Yeah, you've obviously heard me say
this. Um, I think that exercise should
still be viewed as the the, you know,
the most, if not one of the most
important things that we can do to
modify our behavior, even if it played
no role in lifespan. So, even if you
told me that all the exercise that that
I do um was going to shorten my life by
a year um related to being sedentary, uh
what would I do? And the answer is I
would still do it because of the effects
on health span. Now, of course, that's
not that's a false choice. Um, it's also
increasing lifespan, but but my point
being is just the health span benefits
alone are are important. Um, so, you
know, I think there's lots of ways to
talk about health span, but maybe we
just sort of put it all together and
talk about all the benefits of of muscle
health. So, there are lots of ways I
think that muscle impacts health span
and lifespan. Maybe we just take a
minute and look at each. So, let's start
with metabolic health. So, we've
discussed this on many previous
podcasts, but and I alluded to it
earlier in our discussion, but um muscle
is the predominant sync for insulin
mediated um and even non-inssulin
mediated glucose uptake. So, the more
skeletal muscle you have, the more
easily you can buffer blood sugar. And I
would hope that I don't need to spend
much more time explaining why
maintaining low blood sugar is an
imperative part of reducing not just the
risk of type 2 diabetes but more
importantly I would say heart disease uh
di um uh dementia and cancer. So
anything that you have that aids in the
shunting of glucose easily into muscle
is going to uh improve that. And
therefore we want muscle that has
sufficient size. Say someone that can
hold 3 to 500 g of glucose in storage.
Um and also we want insulin sensitive
muscles that allow the muscle to take
that up with the least amount of insulin
possible.
Um we talk about inflammation. So muscle
is uh an endocrine organ. This is not
necessarily intuitive to people. We
don't really think of it this way. Um
but it is indeed an endocrine organ
which means it secretes signaling
molecules called myioines such as
interlucan 6 which has an
anti-inflammatory role. Um most
[clears throat] of the interlucans we
think of are actually pro-inflammatory
but that's not the case with all of
them. uh and so indeed irrin IL6 can
actually reduce inflammation and improve
metabolism. By the way, it's worth
noting, Nick, um many people have looked
at these uh interlucans and uh miaakines
as ways to biologically
mirror the effects of of of exercise
without actually exercising. Uh so for
what it's worth uh I don't know 14 years
ago or so I remember irisin was all the
rage when it was discovered as a
miaakine and of course people
immediately said listen we just need to
figure out a way to inject people with
iris and we will uh we will produce the
effects of exercise without doing it and
of course these things have never panned
out now I'm not going to give up on this
approach I uh I know one of our previous
podcast guests uh Mike Israel really was
convinced that within in a decade, no
one will need to exercise. We'll just
inject people with miaakines. Um, I'm
not nearly as bullish as he is on that,
nor do I think I would even find that
interesting. I actually enjoy the act of
exercise. Um, but at least his view was,
look, we we will be able to produce all
of the metabolic benefits of of exercise
by doing this. The fact that we haven't,
by the way, suggests to me the vastness
of what exercise does, right? um you
know, it's not going to come down to two
or three miaakines. It's going to be an
entire cascade of things that probably
affects why this is happening. Um again,
in the show notes, we're just going to
link to all of the places where these
things have been discussed in great
detail. Um the other thing to consider
which again I think is something we
fortunately don't have to think of um
under normal circumstances but it really
does matter when a person gets sick is
that muscle is indeed the reservoir for
protein. Um so we don't store protein
the way we store glucose and the way we
store fat. Right? So I think everybody's
familiar with the idea that we store
infinite amounts of fat. Right? as as
much as our fat cells will get fat, we
can store fat and that can provide us
with months and months of energy. Uh we
don't store that much carbohydrate, so
we're kind of we're kind of stuck there
with our glycogen supplies. Of course,
anything excess will store as fat. Um
and we don't store protein in the
traditional sense outside of the muscle
itself. And so what that means is the
more muscle you have, the less muscle uh
you will end up losing in a period of
illness or stress like surgery,
infection, hospitalization, burns,
things of that nature. Um so again, I
think this is a big part of why people
with more muscle mass consistently have
lower mortality, right? They're more
likely to survive hospitalizations,
infections, car accidents, you name it.
Put stress on the body, more muscle is
better. Um, then we kind of just get
into the obvious stuff, which I don't
think I need to spend much time on,
which is movement and and and activity
in life. Um, you know, the the the more
you move, the more you're alive, the
less you move, the less you're alive. I
I don't think too many people are going
to disagree with that. And um I don't
think we need to spend much more time
talking about the centinary decathlon as
the mental model I think about for how
to prepare for the marginal decade. But
there's really no scenario under which
you're going to have an optimal marginal
decade um if you are not physically able
to move and do as much of what your
heart desires. Um we talk a lot about
falls. Um I actually just sent the team
an email earlier today about um uh a
study that I was looking at that very
nicely summarized just the significance
of the fall literature. again um 300,000
hospitalizations a year in the United
States alone. Apologies for those not in
the US listening. I don't have the
stats, but you can extend them by proxy.
Um 10 to 30% one-year mortality for
those above 60. And very few of these
individuals if they suffer a femur
fracture are going to return to their
state of previous health and mobility.
So again, I I think all of these things
taken together um should really remind
people of why this matters. If if you
just want to look at how mortality uh is
driven in falls, uh I'm going to rattle
off by decade what the death rate per
100,000 is um from a fall. So if you're
25 to 35, it's 1.1 deaths per 100,000.
If you're 35 to 45, it's 1.7 deaths per
100,000. 45 to 55, 3.2 deaths. 55 to 65,
5.7 deaths. 65 to 75, 13.2 deaths. 75 to
85, 50 deaths. And by the time you reach
85 and up, it's nearly 200 deaths. So,
um, anybody plotting that will realize
it is the true definition of an
exponential growth curve. Double
clicking on that, before we move to kind
of how does someone start to increase
our muscle mass and strength, can we
just talk a little bit more about what
we know about how we gain and lose
muscle as we age and why muscle is so
important when we're older and why that
means that you can't wait until you're
at a certain age to start caring about
it. So muscle strength peaks in the 30s
typically, maybe even the early 40s.
Again, notice I'm not talking about
power. Power peaks sooner than that. Um,
so that incorporation of speed. Um, but
strength is going to peak in the uh
fourth or early part of the fifth
decade, but it will decline um with age
at a rate of about 1 to 2% per year.
um this rate continues largely
uninterrupted unless there is a
significant change to health status. Um
and uh but once you hit about the age of
70 this acceleration continues. Um and
one of our previous guests, Luke Vanlon,
really made a point that I thought was
so interesting, which is when you look
at these curves that represent a decline
in muscle mass, a decline in strength,
and a a decline in activity level, they
look physiologic.
Um, which means they look beautiful and
smooth. But he said that's just because
you're looking at population-based
averages. When you look at this at the
individual level, uh, for most people
it's relatively slow decline punctuated
by rapid uh, periods of decline with
inactivity. So the key here is avoiding
inactivity, avoiding time without
training. Um, one of the greatest things
that leads to that inactivity is injury.
So that's why um as far as I'm concerned
once you reach my age uh in your 50s,
rule number one of training is don't get
injured, right? Do not miss workouts
because you are injured. Um and and and
I think that just only increases as you
age. And that and that's why I do worry
when I see, you know, someone who's in
their 60s and 70s having a significant
injury which is going to take them out
of training for months at a time. Um, so
again, we'll we'll kind of link to much
of the details around here. I don't
really want to just rattle off all the
numbers. It gets a little overwhelming.
Um, but but we'll we'll kind of go to
some of the more granular data of of of
what this looks like. I think you know
we can summarize it by pulling up kind
of a schematic right so there's a
schematic here that talks about how look
age on the x- axis
um relative function muscle mass put
every whatever proxy you want on the y-
axis um it's going to peak at about the
age of 30 and you you'll see in this
figure basically three levels of decline
and the levels of decline um are going
to be dependent on the level of
activity. So a very active individual
lower level of decline still declining.
A population average quicker level of
decline and a sedentary individual much
quicker level of decline. And where does
it become relevant? It probably becomes
relevant in the 70s. Uh in the eighth
decade of life um is where you really
start to see the difference. And the
problem is you don't want to be on that
red curve in this figure that I'm
showing. Um
and and and figure it out when all of a
sudden everything is taken away from
you. Right. If you're on the red curve
today, you know, get to that blue get to
that green curve uh by increasing
activity.
>> Yeah. And on that graph, I think it's
interesting because there's almost two
components too, which is if you've
already passed your peak, you really
want to make sure you decline at the
slowest rate possible. But if you're of
the age and listening or watching this
and you haven't passed your peak yet,
you really want to make sure your peak
is as high as you can go because that's
the other aspect that affects your
decline. Correct.
>> Yeah, that's a great point. It's very
true with something like V2 max, very
true with something like bone density.
Um, I'm very grateful for those
formative years of my life, age probably
13 to 18, 19, when I was training
absurdly hard. On the one hand, the
drawback of that, Nick, is I have awful
scars to show for some of the stupid
injuries, uh, especially to my back. On
the positive side, I like knowing that
my V2 max was, you know, in the 70s or
maybe even at the I think at one point
even the, you know, low 80s at that
point. And so even though I'm much lower
now, um, I'm still relatively high
because I started from such a high base.
Um, and so, yeah, you're right. I don't
think our audience particularly skews on
the on the younger side of 30, but for
those listening or for those who have
kids, you want to really encourage your
your kids or yourself to reach your
maximum genetic potential because it's
going to get that glider a lot higher
and give you uh even more room to stay
on that green curve as you age. And of
course, you know, if you can do it
without injuring yourself like like I
did as an idiot, then you've really won
the game because it it wasn't necessary
for me to do the stuff I did to injure
myself. It was just due to sheer
ignorance.
>> That's another topic we could talk about
with the seven-year-olds at the round
table. So, we can park park stupid ideas
that you do when you're young. Um, but
moving on to kind of now the crux of
this and what most people care about is
getting into the nitty-gritty around how
to increase muscle mass and strength. So
I think starting with just a general
question of what do you think is the
most effective approach when you look at
resistance training for someone to put
on muscle size, strength, mass? So I
think one has to align around what it is
that they're trying to optimize. So
optimizing for strength and optimizing
for hypertrophy will require different
types of training. So to take two
extremes of this, if you're talking to
Lane Norton and he's preparing for a
powerlifting competition, which even
though the the word power is associated
with it, is the purest demonstration of
strength. His training looks nothing
nothing like Mike Israel's training as a
bodybuilder where he is training
maximally for hypertrophy. Now, I say
nothing like they're both in the gym.
They are both doing, you know, lifting a
lot of weight. Um, but a closer
examination will reveal pretty quickly
that they're doing very different
things. Now, most of us are not doing
either of these things. Most of us are
not um are going to be kind of in the
middle, right? We're training for
strength, but not maximum strength. Um,
I have not deliberately done a one rep
max in 15 years, and I'm very confident
saying I will never deliberately do
another one rep max in my life. Meaning,
I'm never going to be training for
maximum strength. Um, at the other
[clears throat] end of that spectrum,
strength is still very important to me.
And that means I do need to be in a
slightly lower rep range uh than just,
you know, at the other end of the
spectrum where I'd be training pure
muscular endurance. And I'm still doing
things that are strength-based
principles uh that that I wouldn't
necessarily be doing if I were purely
optimized around hypertrophy. Okay,
we're going to talk about this in much
more detail, but I just throw that out
there a couple of extremes. So the
principle underlying resistance training
regardless of whether we're talking
about hypertrophy uh or strength is one
of progressive overload. And the idea
here is that you constantly challenge
the muscle with increasing demands to
force adaptation. Now how this works has
been discussed and I I want to say I
think probably the podcast with Andy
Galpin might be the one where we went
into most detail here. Um, so obviously
we're gonna we're going to link to all
of that, but the the reason all of this
happens is is basically a function of
muscle fiber recruitment. So people
might remember from those episodes that
we have type one and type two fibers.
Uh, the fiber type refers to um many
differences in these muscles. It it
refers to uh the force with which they
can contract. It refers to their
metabolism uh whether they uh are more
glycolytic or oxidative. uh but
basically we want to increase load and
volume uh over time to recruit higher
threshold motor units. Um so another
important principle here is muscle
protein synthesis. So we we we have to
be able to provide the substrate for
these uh muscle fibers to repair and
grow. Um and then of course you have to
have neurologic adaptation. So, um this
is something that has taken me a while
to sort of explain to my daughter who
really really has taken a huge enjoyment
for uh uh you know going into the gym
and you know she's at that age where
she's you know she's running track and
wants to work out all the time and I
kind of have to explain to her that she
needs to recover a little bit. Um her
neurologic system is actually fatiguing
when she keeps trying to do all these
things at all the times. But we have to
basically be able to train the motor
units to to fire correctly, to sync
correctly, how to control them. Um, and
again, all of these things factor in.
So, so broadly speaking, I just want
people to understand you have this
overall idea of uh progressive overload
and you have to be able to tap into
different motor units. um you have to be
able to provide um amino acids for
muscle protein synthesis and you need
time for neurologic adaptation.
>> And let's talk a little bit more about
how would someone implement progressive
overload. I think it's kind of a term
that people may have heard, but I think
walking people through how they would
actually go about that in the gym would
be helpful.
>> Yeah, there are there are many ways to
do this. Um so one of them is maybe the
most obvious way that people would
naturally think of which is you can
increase the load or the weight. Um but
you can also do it by increasing the
reps um that you do in a given set or
the number of sets or the time under
tension which is one of my personal
favorites or decrease the time between
sets. Um, so again, let's talk about
each and within each, I would encourage
everyone to think about which ones um
might be safer, uh, which ones might
make more sense if you're lifting alone
versus lifting with others, which one
might make sense under certain types of
exercises versus others. I'm going to
use myself as an example here, uh, but I
would like people to sort of think about
this for themselves. Okay, so increasing
weights directly. It's obvious. I don't
need to say it anymore about this. Um
[clears throat]
but I will call out places where this
might not make sense. Right? So um for
me I uh I just know that there are
certain parts of my body that I don't
want to add more and more weight to. So
I'm not going to add weight. Where
where's an area where I feel very
comfortable just adding weight because
the risk of increased loading doesn't
seem to matter. Doing a bicep curl.
Right. great way for me to to increase
um uh o to increase overload. Uh would I
do this on
um you know something that has some
degree of axially loading? Not anymore.
Uh I would in the past I won't today.
Okay. Increasing reps. This is great. Uh
but again we want to go back to the
principle here. If you are exceeding
reps, it might imply that you weren't
doing enough in the first place at a
given weight. So remember, we're always
kind of trying to target um one to two
riir. So I guess we could say here if
you're in the two rep in reserve and um
you want to move to 0 to one without
increasing the weight, that would be a
manner of progressive overload. But the
truth of the matter is here, once you
start exceeding 12 to 15 reps, you are
shifting more stimulus towards muscular
endurance. That's not a bad thing at
all. You just have to be aware of what
your goals are. Um, extra sets and
volume to me is a great way to increase
overload um without necessarily
increasing weight. Again, another part
of that is decreasing time between sets
or super setting. I also enjoy that a
lot. Again, as I said a second ago, one
of my favorite ways to um increase uh
the uh the overload or to progressively
overload is time under tension. So my
shoulders don't love bench press
anymore. Um so one of the things I
really enjoy doing is very slow sets
because I can use much less weight and I
have a little bit of arthritis in my AC
joint on the right side. All the muscles
are fine, but I just don't want to
aggravate that AC joint. So, a I'm using
dumbbells because I can put them in a
position that's a little easier on the
shoulder, but I can also I don't have to
use super heavy dumbbells. I mean, if I
told people how much I bench press,
they'd be like, "That guy's a chicken
chest." Um, but I'm, you know, if I'm
bringing it down slowly, if I'm doing
pauses at the bottom, if I'm increasing
time under tension, I'm still getting
um, uh, the stimulus for for for growth
and strength uh, without having to rely
on enormous amounts of weight. So again,
I think it's just helpful for people to
think about these things in the context
of themselves and within the exercises
they do because you might adapt a
different one of these uh for a
different type of exercise. Would have
been really great if you would have told
that seven-year-old today when you were
being lectured about your diet soda how
much you bench press because I would
love to hear what his reaction to how
strong you were as well because maybe he
had some tips for you. Yeah, there's no
way I would have fessed up to that kid
how bad my bench press is because like I
he wouldn't have let me out of the
cafeteria. He would have called the
other kids over to just mock me.
[laughter]
I love it. Um and it so for people
thinking about this and how to apply it,
how often do you recommend patients like
work on increasing those different
levers
in their like daytoday, week to week,
month-to-month training? I mean, the
truth of the matter is you always need
to be kind of trying to push this. Um,
of course, uh, as we age, it's going to
get harder and harder. And of course, at
some point, we are going to be taking
steps backwards, but the goal is you
just don't want to get to the point
where you're you're not pushing the
envelope of what you're capable of. Now
again, someone who's just starting out,
you know, they it's it's their first few
months of ever doing resistance
training, they're they're going to be
able to increase uh
you know what I'm calling total load,
which is a function of load, reps, uh
rest, volume, like just you know the
overall metric that encapsulates
everything by 5 to 10% per week. whereas
an advanced uh lifter might be at 1% uh
increased load per week. Uh so so again
it's just it's just really a function of
um you know what your experience is but
but again it's uh you know think of it
through the lens of always try to push
forward and then of course just to be
clear we talk about having a de lo week.
We talk about, you know, periods of
backing off, but I'm I'm talking about
not including those periods.
>> And can we doubleclick on kind of the
phases of a movement? So, concentric,
eccentric movements and how one just
kind of define them again for people and
then also how people can utilize those
both different movements as they think
about getting stronger.
>> Yes. So a concentric contraction occurs
when a muscle is getting shorter while
producing force. This is what most
people think of when they think about
lifting a weight. So again, we talk a
bicep is the easiest way to think about
this, but of course it's true for any
muscle. So, if my arm is straight and
I'm curling uh a dumbbell up using my
bicep, the concentric phase of that is
while the bicep is getting shorter um
and I'm I'm lifting it up. So, training
the concentric phase is where we build
power and force output. Um, so the
faster you do the concentric phase, the
more power you generate. Is there a time
and a place for that? Absolutely. One of
my favorite exercises is on the Kaiser
leg press machine, which is a pneumatic
machine doing explosive single leg uh
leg presses. Obviously, something you do
after a big warm-up. Uh you don't want
to put an old guy like me on a into an
explosive movement, but you know, I'm
usually doing this twothirds of the way
through my warm-up uh through my
exercise. Um which means I'm leaving a
little bit on the table because I'm
coming into it a little bit of pre-
fatigue, but I that's a trade-off I'm
willing to make at my age to reduce the
risk of injury. And I'm going to not a
maximum weight because remember maximum
weight is not going to drive maximum
power. I'm optimizing for power. So, I'm
taking kind of a a weight that's maybe
twothirds towards my, you know, what I
would really do for a high strength set,
and I'm doing the most explosive
movements I can do with each leg. And
again, the reason I like this Kaiser
machine, I have no affiliation with
these guys, is it's measuring speed and
force and power. And so, I'm just doing
a power max optimize. By the way, once I
fall below 92% of peak power, the set is
over. So, I'm really optimizing around
peak power there. So, again, that's all
focus on concentric movement. Now,
conversely, eentric contraction is what
happens when a muscle is lengthening
under tension. Now, sometimes when we
lift, we are ignoring that eccentric
phase. When I'm doing that explosive
movement, the my leg is blasting out
under maximum power of the concentric
phase. When I'm bringing that leg back,
I'm not making any effort to do so
slowly. I'm not trying to put any stress
in the eccentric phase. The slower
you're bringing that weight back, the
more eccentric tension you are under. So
again, going back to the bicep curl, I
curl this thing up. The slower I let
that thing come down, the more eccentric
tension I have. And by the way, that's
what places the mechanical stress on the
muscle fibers, which creates more micro
tears and damage within the fiber. And
that's what's actually driving
hypertrophy. So, whenever you're
watching bodybuilders train, because
again, bodybuilders primarily concerned
with hypertrophy, you'll be amazed at
the eentric control that they
demonstrate. Now, this is very important
for minimizing injury. you have to, you
know, one of the things that I I think
maybe sometimes people do wrong is
they're not paying enough attention to
their eccentric phase and they're uh,
you know, they're they're you know, for
example, like if if you're doing uh a
leg curl, so you're sitting on a machine
and you're curling back under the
concentric phase, you're shortening the
hamstring and you just let that thing go
back. Um, you know, it's very easy to
injure these muscles. So, I think we
should almost always be be in control
under the eccentric phase. The question
is how much emphasis do you want to put
on each? So to give you just one more
final extreme example when I was cycling
a lot um so this is more than 10 years
ago. Um anybody who knows anything about
cycling knows two things are true. You
want very strong legs and you want to be
as light as possible. So what role would
weights play in a cyclist's training?
Well, one of my favorite exercises to do
was very heavy, and by very heavy I mean
typically five reps, very heavy hexar
deadlifts with drop sets. Uh, by drop
sets, I mean literally not dropping I
mean not dropping weights. I mean
dropping the weight itself at the top.
So in other words, heavy pickup with
good explosion on the concentric phase.
And you have to do this with a trap bar,
not a straight bar, because then you at
from a standing position drop the bar.
So the whole hexar just drops and then
you drop yourself down and with no
tension and you pick it up and you do it
again. So why would I do that? Well, I
wanted maximum strength and power with
zero size, right? Because size is
weight. Cyclist doesn't want any weight.
He just wants to have the strength. Um,
so that was a very powerful exercise.
And by the way, I could do that three
times a week, sometimes four times a
week because without the eccentric phase
and without the tearing under tension of
those muscle fibers, the recovery is
very quick. Um, there's a lot of other
things I did around those workouts. I
was doing a lot of plyometrics, um,
what's called a a post activation
potentiation type workout. So, there's
lots of really cool things you can do,
but maybe that's more than you wanted,
Nick. just think that that understanding
concentric eccentric is is is is a very
important uh tool for training.
>> And Peter, you mentioned this when we
were talking about the Andy Galpin
episode where you talked about muscle
fibers. Can you kind of give a brief
summary of muscle fiber types and how
they change with age again?
>> Yeah. So whether you're talking
strength, power, hypertrophy, they all
have an association with a type of
muscle fiber. So strength and power are
associated with the type two fibers. the
fast twitch fibers um and the the
endurance type stuff um is is the type
one fiber association. So slow twitch
fibers. Um so again type one fibers less
contractile force twi you know contract
slower less power uh metabolically
more fat dependent right they are more
metabolically flexible type two they're
they're they're um uh they're the red
fibers by the way right so they're
they're red because they're lots of uh
lots of mitochondria lots of capillaries
type two fibers Um, these ones have more
contractile force um, metabolically
glycolytic.
And one of the I think one of the most
interesting things that that Andy talked
about in in in the podcast that always
stuck with me and has stuck with me
since is that um one of the most and I
don't remember if he even described as
the sinquanon of aging but certainly one
of the hallmarks of aging is the atrophy
of the type 2A muscle fiber. So the
fibers that are most responsible for
power um explosiveness are the ones that
start to atrophy when we are already
quite young in our 30s and 40s. Um so
you know power is the first thing we're
going to lose. Then we lose strength.
Then we lose size. That's kind of the
the order in which things go. And
therefore, we think it's very important
for people of any age to always
incorporate power training in what they
do. There's a use it or lose it aspect
to this. Um, and you know, we just think
that it's it's imperative that we keep
it.
>> That makes sense. And so, if someone's
thinking, okay, how do I improve my
power in the gym? What advice would you
have for them?
>> It's a lot like what I've talked about.
You want to be able to move quickly
through concentric phases. um and and
that turns out to be superior to
traditional resistance training. So
there have been a number of studies that
have looked at this. We found one review
of 13 studies that found power training
superior to traditional strength
training for power. Um, in other words,
when you took people and you had them
lift a certain amount of weight versus
lift the same amount of weight, but
doing it quickly, not surprisingly, the
improvements in power came in the
individuals uh that were lifting
quickly. And I'm I just for the sake of
time, I I've taken a little longer than
I intended to to to this part. I'm not
going to go through all of the studies.
They're in the show notes. Um, but
they're they're actually quite
remarkable the differences in power
based on the training. again, you will
become better at whatever it is you
train for.
>> And you kind of hinted at this earlier,
but I think it's worth kind of
explaining quickly in a question cuz
it's one we get asked a lot, which is
what quote unquote intensity should I be
training at. Right? So, it's something
that I think people hear a lot. And so,
how do you think about the word
intensity when it comes to someone's
training?
>> Well, first of all, it is a very
important variable in this entire
equation. I think there are different
ways that you can think about it. So you
can think about muscular failure which
is the point at which you can no longer
perform another rep. Um do you need to
do that very often? No you don't. Um in
fact there are risks associated with
doing that. I find myself there
once or twice uh during an entire
workout. Um and I'm not usually
designing myself to go there but but
it's it's going to happen obviously.
Then you have technical failure. Now,
this is a place where I do get to quite
a bit in a workout. This is when um I
can't do another rep without
compromising my form or cheating. And
again, I think this is maybe easier for
people who have been lifting weights a
longer time, you have a little bit more
of a sense of what cheating looks like.
And that can be something as little as
just rocking a little bit on a curl or
not doing a full enough rep or bouncing
on the bottom or something of that
nature. So again, if you're if you're
and and and by the way, I'm not here to
say that techn that you should always
stick to perfect form. I've heard people
far more intelligent and informed about
bodybuilding than I will ever be talk
about all sorts of reasons why sometimes
progressing through technical failure
and going into cheat reps is a great
thing to do. Um and again, I would just
kind of defer to to to the experts on
that. The way I think about this though
and I think the most helpful way is to
go through the rep and reserve analogy
or not analogy but framework really
right which is
and again I think this is where most
people ought to live is in the one to
two riir rep in reserve uh area. It's a
very safe place to be. You're not going
to get into trouble and by the way
you're virtually getting the same
benefits as going to failure on every
set which truthfully is almost
impossible anyway. So, that means I'm
stopping at a point when I could only do
one or two more reps. Now,
you're never going to know what that
feels like if you don't fail a couple of
times. So, you you sort of just you got
to accept the fact I'm going to have to
fail. Um maybe don't pick a bench press
when nobody's around as the time to
figure out what that feels like. But you
can definitely figure that out when
you've got a spotter and you can
definitely figure that out on an
exercise where the consequence of
failure is very low. And uh again,
everybody can figure this out. And once
you know it, I would just encourage
people to be in the 1 to2 ri um range
for virtually everything they're doing
unless again they have very specific
goals around power or around uh extremes
of strength. Peter, another question we
get asked is, "When I'm in the gym,
should I be focusing on specific muscle
groups? Should I prioritize full body
movements?" Kind of. How do you think
about that for yourself and your
patients?
>> Compound exercises, which I think people
are familiar with that, but they're
they're they're exercises that would
engage multiple muscle groups and
joints. It's really the joints that
they're talking about, compound joint,
uh, simultaneously. So, a squat, a
deadlift, presses, rows, these these
provide the foundation for overall
strength and muscle mass. And so, again,
when we talk about powerlifting, which
again is such an awful name, it should
be called strength lifting. Um, it only
has three exercises. A squat, a
deadlift, a bench press. So, those are,
you know, three of the most important
exercises there are. Clearly, the
foundation for what they do. Similarly,
when you look at bodybuilders at the
opposite end of the spectrum trying to
generate as much muscle mass as
possible, pretty rare that they're not
doing some variations of those. Now, a
lot of times injuries will, you know,
allow them to do other things. They
might not do a perfect squat. They might
end up doing variations of squats, but
they're they're basically all working in
the same thing. Um, isolation exercises
are also totally helpful, valuable. uh
we should be doing those as well. It's
really kind of a question of time and
[snorts] goals. Um so if if I don't have
much time in the gym, I'm only doing
compound exercises. Um right, if I h and
I I'm trying to make the time to do uh
accessory movements as well, but I
typically start with my compound
movements and then move to my accessory
movements later. Um, other things to
think about is that compound movements
uh are are actually
they're they're challenging, right? I
mean, there's a skill to doing a
compound movement. Uh, anybody listening
who's um, you know, gone down the rabbit
hole of powerlifting and learning how to
do a deadlift correctly and learning how
to do a squat correctly understands that
you can have all the strength in the
world, but if you don't have the control
um, and and if you don't have the
coordination to do these exercises,
you're you're not going to be able to
translate your strength accordingly and
you're probably going to get injured.
Um, and so in many ways that becomes uh
part of the part of the uh enjoyment of
doing those exercises is it's a
technique more than it is just kind of a
mindless activity. Is resistance
training the only way to build muscle. A
lot of times we'll get questions on how
effective are body weight exercises like
I like calisthenics, I like yoga. Is
that sufficient as we think about muscle
strength, muscle mass? Well, resistance
training with weights is hands down the
most effective way to build muscle. Um,
it's not the only way. Uh, one could
clearly with the right types of body
weight exercises, um, build muscle. Um,
that's going to be especially true for,
you know, beginners. Um, but I think we,
you know, we need to sort of acknowledge
that it's going to be very difficult
with many of the body weight exercises
to get to that one ri phase. Now, of
course, um, pull-ups and push-ups can
get you there. The advantage of a
pull-up is most of us are going to get
there in a rep range that is more
congruent with hypertrophy and strength.
I don't I'm sure there's data out there
that say the average male and the
average female can do x number of
pull-ups. It's a low number. Conversely,
push-ups for most people, I think
certainly once they become fit, most
people would be doing enough push-ups
that going to failure, they're really
going to be out there in um in in muscle
um endurance land and therefore they're
really not going to be able to put on
much size. So, if size and um and
strength are priorities, body weight
exercises are not going to be your most
effective way to go. Doesn't mean you're
not going to get some benefit. You will,
uh but you're probably going to get more
muscle endurance.
>> And how do women need to think about
this compared to men? So, one question
we often get is, as a female, should I
be thinking about resistance training
any differently as you continually talk
about it? You know, I think it's safe to
say this is an area I'm looking forward
to exploring a little bit more on the
podcast. Um, at the surface level, the
advice is generally the same. Um, so, so
there's not like some wildly different
magic principle that says, "Oh, women
need to only go to three reps in reserve
or need a totally different amount of
volume." for the most part it's
generally the same in terms of these
principles and protein requirements. Um
but obviously the strength to weight
ratios are going to be a little bit
different. Women tend to have more joint
laxity um and they may be more
susceptible to injury. So they might
need to be even more mindful um of tempo
work, maybe more focus on the eccentric
phase. Um but again, we're still
thinking about um the same the same rep
ranges. Um the hormones create a totally
different issue, right? So reduction of
estrogen and testosterone during
menopause if they're not on HRT, um will
lead to elevated rates of of sarcopenia.
So we're not, you know, we're talking
about women who are not professional
athletes, but ordinary women. Um, and so
if anything to me that just says women
need to be at least as mindful, if not
more mindful of this. Um,
again, I go back to the podcast with
Belinda Beck, which is, you know, one of
the one of the most enjoyable
discussions I' I've ever had just about
the the sheer bliss of of watching these
women in their 60s doing a, you know, a
clinical trial where they're basically
instructed to just walk around and lift
heavy weights and see how that improved
their strength, how that improved their
bone density, how it just improved their
quality of life overall. So, um, yeah,
women women need to be lifting weights
as much as men is the is the big
take-home. And while there may be third
and fourth order differences, I wouldn't
let any of those discourage anybody from
from jumping on it. Now, what are some
metrics that people can do in the gym to
track their progress on strength slash
goals they should have? You've often
talked about a few in the past um in
different spots, but do you just want to
talk maybe about a handful of if
someone's in the gym wants to test where
they're at, what are they what are a few
things they could do to see?
>> Yeah, I mean before doing that, I think
it we should acknowledge that tracking
one RMS as a metric, one rep max as a
metric of of what one can do is is a
totally reasonable way to do it. And
it's a way that I used to do it for many
years, right? I used to be very tuned in
to my one rep max of a squat, a
deadlift, a bench. Um, and by the way, I
didn't always do the one rep max. So,
there's there are very predictable
formulas that say if you can do if this
is your five rep failure, your four rep
failure, your three rep failure, your
two rep failure, you can, and we'll link
to the table that shows what the formula
is. It's pretty straightforward. So
truthfully, I would do a lot of twos and
threes, like, you know, max two, max
three, and impute my one rep. Okay, I
don't do any of that stuff anymore. Um,
and today what I tend to focus on are
other metrics that I care about. Some
are power related, some are strength
related. So I still keep track of like
my long jump, right? So just a standing
broad jump. Um, again, why do I love
that? I think Andy Galpin also talked
about this amazing exercise once you're
warmed up. Don't do that one cold. That
is testing in one movement your maximum
power and your eccentric strength. So, I
don't know if you've done many standing
jumps anymore, Nick, but the takeoff is
a maximum concentric power movement. But
to stick that landing, you have to have
the brakes. That's a maximum eccentric
movement. And so, you know, one of the
metrics that I just maintain in my life
as I think about aging is I want to go
as long as I can in life being able to
do a broad jump that is taller than my
height. So, you know, on my floor I have
uh slightly longer than my height. I
have six feet marked out on the floor.
And every day I'm like, "Hey, I don't do
it every day, but like every day I want
to be able to make sure I can
comfortably do that." And at some point
it's not going to be easy, right? And
maybe at some point I won't be able to
do it. Um, pull-ups, I think, are a
great test for people. Um, especially if
done under control, uh, with complete
range of motion. Uh, maybe doing an
exaggerated eccentric. So, we would say
for males, five or more with for
females, three or more complete pull-ups
with a 3-se secondond eccentric. People
have heard me talk about a dead hang. We
we say a target for a male would be 2
minutes, for a female, a minute and a
half. a wall sit with thighs parallel to
the floor. Two minutes for both men and
women. Um, a farmer's carry, we would
say, um, you know, can you carry a 100%
of your body weight? So, 50% in each
hand for a minute. As a male, 75% of
your body weight, half of that in each
hand if you're a female. Um, a box step
up with 25% of your body weight in each
hand, five reps per side. That's that's
a big big ham glute test. Um, and then a
wall push-up. So, we do a wall push-up
just so that your feet um don't you
don't rock back and forth. It basically
prevents cheating. So, we'd say, you
know, could a guy do 20, you know,
really well uh controlled push-ups?
Could a could a woman do 10? Those would
be amazing uh markers of strength. And
and I think that, you know, what's more
important to me is is not whether you
hit these targets, it's whether you're
making progress. We've talked about this
before, so I think we can kind of go
through it quick, but just if people are
doing dexes to measure their muscle
mass, do you just want to remind people
what metrics they're looking at on a
DEXA and what percentile you like to see
them at?
>> Yeah. And some DEXAs just give you this
information. Most don't. You usually
have to calculate it on your own. So, we
look at appendicular lean mass index and
fat-free mass index. So, assuming you
have a um a DEXA scan that's not showing
this to you, you you want to go to the
section where it says, you know, it
shows you lean mass uh by extremity. So,
you would literally, you know, add up
how much lean mass in left arm, right
arm, left leg, right leg. Uh put that in
kilos. So, if it's done in pounds, you
got to convert it to kilos. Um and then
divide it by your height, which has to
be in meters squared. And um and then
that number you put on a nomogram which
we'll include in the show notes and then
you'll see your percentile. You do the
exact same exercise with fat free mass
although there it's easier because
you're just looking at total mass
subtracting out fat mass and dividing
that by the height in meters squared. Uh
and again you'll you'll see these things
are you know often um I would say
concordant but they can be discordant.
Um, and you know, we we like to see
people above or at the 75th percentile
for each of those metrics. Uh, but
again, um, you know, not everybody's
going to get there, right? There are
some people whose genetics, like my wife
will never ever ever get above the 75th
percentile. She's just not built that
way. She has a tiny build and um, that's
it's fine. We just, you know, we focus
on her strength goals, not her size
goals. um she's she's, you know, she's
not gonna put that weight on. Um so so
again, we're not going to spend much
more time on it because I don't think
it's nearly as important as as the
strength side of things.
>> That uh 7-year-old earlier today, what
percent you think he was in ALMI, FFMI,
was he above 75? Was he a strong kid?
>> Um you know, it's funny. I've never seen
the kidnomograms. They're going to be
different cuz they're so short, but I'm
pretty confident he's going to be 97th
percentile by the time he's in high
school.
>> Okay. So, he's he's strong. He's got
potential.
>> So, you got
>> As long as he stays away from diet soda.
Yeah. I mean,
>> well, how do you think he got so strong
to date?
>> He's not sitting there sipping diet
cokes like a chump, you know. Um, okay.
Moving on from how-to questions to now
how often questions. So, how can someone
balance rest and recovery with intensity
of workouts? A common question we get
asked is, you know, how frequently
should someone work out? And obviously
that's going to matter on how much time
they have, but also how do you think of
that with balancing that rest recovery
with also needing to kind of push to
failure often like we've talked about
before your training age, experience,
age, genetics, other stressors,
nutrition, sleep play such a role in
this. Um, and and because it's all so
obvious which direction these things go
into, again, I'm not going to go down
the rabbit hole of each of these. It
should be apparent that if you're young,
if you're focusing on nothing but
training, if you don't have any other
responsibilities or stressors in your
life, if you're sleeping eight or nine
hours a night, eating non-stop, like
there's a scenario where you can just
train all day every day, and then
there's a scenario where you're like the
rest of us and you got to pick and
choose. Um, and uh, I've I've
experienced all sides of this. And um,
I'll I'll probably just come at this
through the lens of what I do and what I
recommend my patients do because my
patients like me have time is their is
their bottleneck. Um, and and I think
that's probably true for most people
listening is we don't have infinite
amounts of time. So, how do we make the
best use of the time we have?
Um,
I think it is abundantly clear that if
you train with the with the right
exercise selection,
um, with the correct intensity,
uh, the right volume,
you might only need to train each body
part once a week. In fact, some of the
most serious bodybuilders of all time
have got away with training each body
part once a week. And if they can do it,
certainly the rest of us schleps can do
it. Um, now of course you can do
um body, you know, you can do full body
workouts two to three times per week and
rotate the types of exercises that go
into it. I find that approach to be
better for people who are early to
strength training. Um, whereas I find
the more experienced you get, the more
you want to kind of go deeper on a set
of muscle groups for um uh for for a for
a given day. So, I I've played with all
of these. I really like what I've been
doing for the past year or so, which is
three resistance workouts a week. Once a
body part is done once a week and that's
it. Um, it's done very hard and it's it
takes me a couple of days for that body
part to recover. So, for example, when I
do legs on Monday, which I do, my
Tuesday zone 2 ride is
like that. That would be the most I
could muster up. Um, I would not even
attempt to do a V2 max workout the next
day. Um, and sometimes I'm sore for from
the lift for a day or two. Um, not
uncommon. Um, of course, we also talk
about de loing. I I referred to this
earlier. Um Mike Estretell on a previous
podcast recommended one week every eight
to be either a significant D lo or even
potentially a full off week. Um and then
um a two week, you know, don't even go
to the gym. Maybe just, you know, do
some other exercises once a year. And
again, I think that's part physical. I
also think it's part mental. Um, now
again, part of that is when you're
training at the level that somebody Mike
is at, uh, it's it's probably an
important thing to consider. At my level
and for my patients, I typically am not
recommending it because none of us are
training quite hard enough where we
really need that full D load. life tends
to offer us dloads through vacations uh
or and things of that nature anyway
where you you you might just use your
trip away where you can only use the
hotel gym as your as your time to to
kind of uh uh de lo.
>> Is there a way for someone to tell maybe
if they are overtraining or another way
to think about it is someone who's newer
to training and they're starting to
train. Is there a way or something that
they can pay attention to to say, "Okay,
maybe it is worth dialing it back for a
few days to rest."
>> I know this is going to sound very
unscientific, but I I have not found
anything to be a better predictor of
this than willingness to train. Um, now
I do look at other factors. So,
especially on the cardio front, I'm very
attuned to my resting heart rate and my
heart rate variability and my sleep
quality. Um,
those things tend to be far less
predictive of my performance in the
weight room. Um, but
I think it's important that people learn
to differentiate the reluctance to train
because I'm really busy and I don't want
to get up from my desk or, you know,
leave what I'm doing now to go in the
gym versus, okay, now that I've gotten
to the gym and I'm warmed up, I still
don't want to train. Those are two
different things. I often experience the
former. I'm too busy. I'm in a good
groove. I don't really want to go and do
this thing versus, okay, no, no, I'm
here in the gym. I've got through my
warm-up sets. I actually feel like
crushing it. When the when I'm in that
second set and I still don't want to be
in there, that's usually a sign I
shouldn't be in there. Um, or if I if
I'm going to be in there, I should
totally mix it up and do something that
is totally unrelated. Just work on a
whole bunch of movement things. Uh, and
just sort of get out of it and come back
for another for another day. Um so that
that's that to me is I I think very
important. I will add a caveat to that
which is um
you h that that technique tends to be
more applicable the more experienced you
are. So you know if I took a person
who's never exercised and said hey just
use your interest in exercising as a
metric they might never exercise. So uh
uh unfortunately you you have to sort of
um develop enough experience to be able
to use that.
>> One question we get commonly asked which
I think is just due to the rise of
wearables that people have is where does
HRV fit into understanding where
someone's at in if they should be
training intensity day off etc.
>> Yeah, we've certainly talked a lot about
about heart rate variability. Um,
and I do think that um, the absolute
number comparing yours to your friends
is is not relevant, but comparing yours
to yourself, provided you have a an
accurate way to measure it. Again, I've
talked a lot about how I like using a
device called Morpheus.
Um, again, no affiliation with Morpheus,
but I like it because um, you use either
a chest strap or an armband where the
optical sensor is is in the ancubital
fossa. So you're actually getting a very
accurate measurement. Uh things on the
wrist and hand are not are not nearly as
accurate. So for for that setting, you
know, seeing your HRV consistently low,
especially if accompanied by high
resting heart rate, that usually tells
you you're fatigued. Um low
parasympathetic flow, high sympathetic
flow. Um again, it doesn't mean you're
going to have a bad workout. By the way,
I've I've actually paradoxically had
some insanely good workouts. um waking
up on the heels of high sympathetic
drive. Why? Because that at least
transiently gives me a big boost, but
chronically that's problematic. And so
chronically one has to be mindful of how
you meter that experience and finding.
And let's say outside of kind of what we
talked about HRV and willingness to
train, are there any other, let's call
them warning signs that if someone's in
the gym, they're very willing to train,
excited about it, but if they're seeing
certain things, feeling certain things,
they should kind of think to themselves,
okay, maybe today is not a day to push.
I would say persistent muscle soreness.
Um, like you're not getting that, you're
not recovering, right? So, so you're
getting the good quote unquote burn that
normally accompanies maybe a workout a
day or two after, but it's never going
away. It it might be that you really
need to take a rest uh at least from
those body parts. Um, another one that
I'm pretty mindful of is just decreased
performance. Um, and because I log a lot
of my data, especially on the bike, I'm
very cognizant to the meta cycles I go
through in the year. And uh I sort of
have a sense of like for example because
I live in Austin, this is not going to
be surprising to anybody who's been here
in the summer, my performance on the
bike actually goes down in the summer.
Um probably by 57%. And this is, you
know, I've been here 5 years now, so
it's it's a pretty reproducible finding.
And I I believe it is solely just due to
the heat, right? Even though I'm still
going to go out early in the morning to
do a ride, like it doesn't matter. It's
like the difference between riding at 85
degrees and riding in the winter if it's
55 degrees is huge in terms of V2 max
performance. Um so you know but knowing
absent or in addition to those changes
are there other decreases um in
performance and again here we're talking
about being in the gym. I think that's
important. Um I think you also have to
be very mindful of pain that that is
indicative of potential injury. So, you
know, joints that are hurting, uh things
that are hurting that hurt more with
use. Uh those would be those would be uh
things I' I'd care a lot about. Um
again, I I I there are probably other
things. The problem is other changes
like mood um and irritability, which
which can certainly indicate
overtraining. Um they they are so
non-specific that it's very difficult. I
think you have to just
kind of try to gushalt um through
thinking about these things.
>> A question that we get asked a lot about
especially when it relates to newer
people to exercise, right? So if
someone's listening and they're like,
"Look, I haven't been resistance
training. I want to start. I'm really
worried about getting injured." Right?
Because you often talk a lot about the
benefits of HellSpan not being injured
and the ramifications that can have. you
have a patient come to you and say,
"Hey, I'm willing to do this. What are
some ways that I can start this in hopes
of not getting injured and doing this
for a long time?" What advice are you
giving them?
>> It's in line with what we're saying
here, right? Which is I think everybody,
but but certainly a beginner or somebody
coming back to it after a significant
period of time off. So, someone who
might have been the high school football
star who lived in the weight room, but
now they're 40 and they're kind of
coming back to it. Act as though you've
never done this before. Focus on injury
prevention. Uh work on gradual
progression. Learn foundational
movements. Learn correct form. Um
joint injuries often result from high
load fatigue. Both of these. Um so you
you you you want to have controlled
movements both on the eccentric and
concentric side. So even if you're not
exaggerating concentric, if you're just
doing, you know, one to one tempo or one
to two tempo, still controlling it. Um I
think that assisted movements are really
really helpful. Um so even, you know, on
pull-ups and things of that nature.
There's enormous value in doing pull-ups
with bands. um so that you can get into
a complete rep range. Use proper
scapular control um and not injure your
shoulder or your elbow because you have
to cheat because it's just such a heavy
movement. Um again, doing lots of things
with body weight until you figure out
the the the right position to be in. Um,
again, I've talked about some of these
before, but relying more on eccentric
load to keep the weight down. Um, and I
think another very important principle
for everybody, certainly something I
spend a lot of time adhering to, is is
is using um unilateral things. So, uh,
so much of what I do for my legs, I'm
just trying to think, one,
I would say 50% of everything I'm doing
on a leg day is single leg. uh which
means I'm doing my left and right leg
are doing separate things which is
allowing me to actually use a fraction
of the weight. [snorts] Um but I'm still
you know obviously getting the the same
amount of work. Um it also develops I
think a better coordination for many
things. So so I think those are kind of
some of the principles that are that are
helpful here.
>> Moving on to now things outside of the
gym specifically nutrition. So obviously
you've talked in the past nutrition is
an important factor as it relates to
muscle growth. So how do you think about
protein which is something you've talked
about before for variety of reasons as
it relates to growing muscle and how
much protein should people get?
>> Again the recommended dietary allowance
the RDA is 0.8 8 g per kilogram per day.
Um, that's sort of the lower threshold
to prevent malnutrition.
Um, it's it's it's generally very
inadequate for trying to build muscle or
even [clears throat] preserve muscle
once you age. So, if if you're if you're
trying to do what we're talking about
here, you're going to want to be in the
1.6 to 2.4 4 gram per kilogram per day.
Um kind of call that 08 to one gram per
pound of body weight. Um people who are
less active and older might even need to
be higher due to anabolic resistance. So
easy rule of thumb, roughly a gram per
pound of body weight. Um if you're older
than 60, you might even need a little
bit more than that. Um, again, if you're
a little bit less than that, it's not
the end of the world. I ju when I see
but if but what you don't want to see is
somebody at 0.4 g per pound or.5 g per
pound of body weight. I think that's
almost certainly uh insufficient to to
meet the demands of aging.
>> Another question we get often asked
types of protein. Are there types of
protein that matter more than others?
>> Yeah. So there are, you know, proteins
are made up of 20 amino acids. nine of
them are essential so the body can't
synthesize them. So those are the
highest priority is getting essential
amino acids. Um leucine being one of
them also turns out to be a very
important amino acid at triggering
muscle protein synthesis um or MPS as we
call it. Um and so we're really looking
at the completeness of a protein source.
So how many of the essential amino acids
does it have? What's the digestibility?
Um and when it comes to those metrics um
animal proteins
generally if not completely outdo animal
proteins uh for completeness and
digestibility. So really the big three
that we think of are dairy, eggs and
beef. Um, so if you have a diet that's,
you know, that's giving you sufficient
servings of dairy and beef and eggs, you
can be 100% sure you are getting
sufficient amounts of protein just by
hitting your volume numbers. Now, I
realize that many people listening to us
either don't fancy those foods or for
other reasons might choose to abstain
from them altogether. The good news is
it's okay. You don't have to consume
animal products to meet your goals. Um,
you can indeed achieve these goals with
plant-based proteins. It will just
require two things. It will require
probably eating more protein and
probably cooking the protein whenever
you can to increase the digestibility
and absorption of it. Um, we often
recommend with patients who heavily
favor plant-based proteins to, um, and
by the way, plant, you know, there, as
you can appreciate, there's variability
in here, right? So, there's people who
don't want beef protein, but they're
still happy to consume eggs or dairy
protein and and vice versa. So there
there's lots of ways around this, but if
we're talking about somebody who's who's
really only going to be interested in
plant proteins, um we tend to get them
to try to really focus on hitting the
right amounts of of some of the
essentials. And and and I'm not going to
lie, it's not easy. It's not the optimal
way to do it. Um but but if if you're
willing to make the choice, then I I
think, you know, you have to put a
little bit of effort into that.
>> What about protein timing? How do you
think about the timing of protein
throughout a day as someone is thinking
about optimizing their protein intake?
>> You know, I think the data on this are
still evolving and I think the way I
would have answered this question two
years ago is probably different than the
way I would answer it today. And I
honestly think it depends a lot on the
protein source. So a lot of times
studies that are looking at this are,
you know, they're using radiolabeled um
isotopes of amino acids in liquid form
and they're measuring muscle protein
synthesis and those studies tend to find
that you want multiple small protein
meals. Um, you certainly want to get
your first do bololis of protein right
after working out and then you, you
know, you but you can only incorporate,
you know, 30 or 40 of those grams and so
you need to be continually reactivating
over time. Again, that might be true for
this the the situation in which that's
done. We've also seen that casein versus
whey, which is also a dairy protein, uh,
produces a much longer a much longer and
slower delivery of the amino acids. Um,
and and so I tend to think a lot less
about this than I used to. I used to
really uh worry about exactly when I was
um when I was consuming protein. Now
that I don't consume like whey protein
shakes that much, if if at all, and I
tend to eat more of my protein,
I'm like, you know, I'm just trying to
get 50 40 to 50 grams of protein
uh you know, four times a day um through
a meal or snack and I'm not thinking
that much more about it. Um, what I try
to do is avoid lower sources, uh, like
lower doses. So, I'm not just going to
be out there eating 10 grams of protein
in a sitting, um, and nothing else. Now,
again, we've covered this so much in one
of our previous newsletters that I think
again, just as everything that we're
talking about here, the show notes will
have a lot more detail on this.
One question we get asked a lot about I
think as you kind of mentioned like this
field is evolving but I think one thing
that sticks with people is the
importance of postworkout protein.
How necessary is that?
>> Again I think it's less important than
we used to think. Um I'm I am going to
consume protein pretty much right after
a workout but that's also because I'm
not consuming protein typically before
the workout cuz I'm working out in the
morning. But that window, that anabolic
window is pretty broad. I mean, four to
six hours. So, I don't think it's
something one needs to lose sleep over.
Uh, your hunger will probably dictate it
anyway because you're going to be hungry
within an hour or two after a workout,
although probably not right after. Um,
so I don't think you need to stop the
press. I don't think you need to, you
know, stop for breakfast right after the
workout and miss, you know, and be late
for work or whatever. I think you can
you can certainly wait an hour or two.
Um and and I I think uh again that
especially with um with what we
understand today based on that anabolic
window.
>> Another piece of this that we get asked
a lot about is let's say someone is
timerestricted eating or fasting quote
unquote throughout a given day, right?
So they're only consuming food for a few
hours throughout the day. And then we
also have people who are fasting for
multiple days. So how does fasting
caloric restriction whether within a day
or multiple days impact muscle mass? And
how should people who are using those
tools think about that so they don't
potentially lose too much muscle. Some
of these things are going to be less
relevant if you're using high amounts of
anabolic steroids where you can kind of
fight the inertia of this more. But if
we limit this to people who are either
not taking anabolic steroids or who if
they are, you know, they're doing it
under um physiologic replacement levels,
um it's very difficult to maintain
muscle mass as you are losing weight. So
if you create enough of a caloric
deficit, regardless of how you do it,
fasting, intermittent fasting, you know,
timerestricted feeding, whatever you
want to call it, anything that creates a
caloric deficit sufficient enough to
induce weight, weight loss is going to
put muscle mass at risk. Now, what can
you do to minimize that? You can meet
your protein needs of approximately one
gram per pound of body weight and
maintain high levels of resistance
training. Um
now again
when I was doing a lot of fasting um
obviously I was creating an enormous
caloric deficit that's you know I was
not eating a thing. Um so I was not
getting any protein. I did resistance
train but again all the resistance
training in the world wouldn't have
mattered. By the way had I [snorts]
still consumed
200 g of protein for a whopping total of
800 calories per day. I'm not convinced
I would have been able to have fought
off much of the muscle mass loss because
that is still such a low calorie amount
that I was going to, you know, I'm in
such a caloric deficit that I was going
to lose weight. Most of that protein
would have been converted into glucose.
I suspect I don't think I would have had
enough anabolic stimulus to to maintain
muscle mass. So, um, you know, I would
say that when you look at bodybuilders
who again are the masters of this,
they're not going through enormously
rapid periods of weight loss. And that's
generally what's allowing them to
preserve lean mass in addition to, of
course, the use in is is often the case
in in untested bodybuilding, the use of
of anabolic steroids. Even if you look
at people who are in tested categories
of bodybuilding where they're they're
they're drug-free, um I still think
their fidious attention to diet and how
they're doing it is um uh is is what
allows them to do this. Now again, there
are data that suggests that protein uh
intake by itself can be uh proactive and
we know this, right? So again, I think
it was I think it was Luke Vanlon who
had this great analogy of the bricks are
the brick layers, right? So protein by
itself is able to induce muscle protein
synthesis again in the context of modest
calories. Um, so there there are some
studies we'll link to that will show
that even with significant caloric
restriction, not as extreme as I just
described, but say a 30 to 40% caloric
restriction, sufficient enough protein
and resistance training um is able to um
maintain some amount of muscle mass and
maintain some levels of muscle protein
synthesis. So again, it can be done.
It's a it's a needle that is not trivial
to thread and for most people losing
weight especially if you're losing a lot
and or losing it quickly uh you're going
to probably give up some lean mass.
>> And Peter then beyond protein any other
aspects of nutrition that someone should
be aware of as they're using to think
about supporting muscle gain?
>> Yeah. Um obviously hydration matters.
sounds silly but g given that muscles
themselves are made up of 70% water
which explains why creatine uh uh plays
plays a role here um you know so so so
I'd say you know hydration creatine use
um and recovery um so so fail failure to
recover uh is going to make it very
difficult to grow and um that's you know
one of the things that people who are
overtraining are sort of missing on. Um,
so dehydration of course reduces the
function of of muscle. Um, creatine,
again, we've talked about it a bunch,
but it's just worth, you know,
remembering what it is. Creatine is a
phosphate donor. Um, so it's kind of the
fastest way to to generate ATP.
um multiple clinical trials,
metaanalyses non-stop demonstrate that
creatine is favorable in terms of
strength, power, and muscle mass. U so I
always tell people it's really one of
the few supplements that I almost
universally recommend. There aren't many
things that I just think universally
make sense to people who are exercising
or anybody for that matter. Um, and and
creatine's probably the closest we have
to that to that list for me.
>> Beyond nutrition, any other quote
unquote lifestyle factors that people
should be aware of that can affect their
ability to gain muscle, focus on muscle
mass, resistance training.
>> Yeah. So again, besides things you can't
change like genes, we've talked about
the training itself, we've talked about
the nutrition itself, um recovery,
hormones, sleep, stress, huge huge role
here. Um and and again, so let's take
the most obvious of these, which is
hormones, right? The more testosterone
you have, the easier it is to put on
muscle mass. Full stop. This is true if
you're a man. This is true if you're a
woman. This is true if you're in
menopause. is true. If you're not in
menopause, um more testosterone, all
things equal, more muscle. Um especially
when uh when when compounded with a
training effect. Um but what's a lot
more difficult to appreciate is more
cortisol, less muscle, right? So uh uh
chronically elevated levels of cortisol
are actually catabolic to muscle. uh we
see the most extreme example of this
when we look at a patient with Cushings
disease or Cushing syndrome where they
actually experience muscle wasting due
to the hypercortiselmia. But for many of
us listening who don't have Cushings
disease but who still probably walk
around with too much cortisol, uh it's
definitely hurting us. And
unfortunately, you don't have a pill you
can take that makes your cortisol levels
go down. You've got to do all of these
challenging things that we all are
working very hard to do to reduce our
level of perceived stress. um if you're
not sleeping enough, you're not
recovering enough, right? This is when
the body is mostly going through its
rebuilding and and and and resilience
phase. Um and you know, we joke about it
like we you know, you see bodybuilders,
they're like sleeping 9 10 hours a day.
Um right, and and they're they just
they're they're putting their bodies
under so much stress that they need that
maximum time to recover. Um so so again,
I think the the harder you're training,
the more you need to sleep, for sure.
Um, consistency of course plays such a
big role in this. Um, again, so many
things in health come down to
compounding and you are not going to
make great gains if you are inconsistent
in in what you're trying to do in the
gym. So, if you you could have the best
month of your life, but if the next
month you're inconsistent um, and you
repeat that cycle over and over again,
it's it's not going to really matter.
So, Peter, I think what would be helpful
as we kind of think about wrapping this
AMA is kind of picking a few different
types of people. Let's say someone who's
newer to exercise and newer to
resistance training and is younger. What
does some programming look like for them
and how could they take that information
to a gym and start to execute against
it? We can look at someone who is newer
to exercise but older and look at how
that maybe differs than the younger
person. And then I think we can look at
someone who's very like seasoned at
resistance training and has been doing
it. Is there anything they should do to
modify their workouts to really have
maximal achievement here based on what
we talked about? So I [clears throat]
think let's start with someone who
hasn't been resistance training is quote
unquote younger. you know, patient comes
to you and says, "Hey, I'm willing to do
this. What do you want my programming to
be? What should it look like when I get
to the gym?"
>> So, first off, many ways to do this and
and you know, there are going to be
trainers listening to this who say, "I
wouldn't do this. I would do that."
Look, I I think there's lots of ways to
do it. This is one way to do it. And by
the way, this is a really really fun
demographic of people to work with. Why?
because if they adhere to this type of
of of routine, they are going to see
pretty remarkable gains. So, one way to
skin this cat is to actually do the
exact opposite of say what I'm doing
where you do a 3-day full body program.
Um, that on each day you will do each
body part to some effect. Now again, I
don't recommend this for someone who's
more advanced and wants to use more
intensity and things of that nature. Um
but uh but but for this person, it can
be great. So I would say look, do a
Monday, Wednesday, Friday or a Tuesday,
Thursday, Saturday split. Um we're going
to do time in gym 1 hour each workout.
So again, this is this is exactly what
we're going to do with a patient in this
situation who we're just introducing to
the gym. Once they've get let's so let's
just say Nick, we've got a person who's
been long on cardio. Um
so more typically this by the way might
be a female. Not to stereotype, but
that's more often the way it shows up.
They're super long on cardio, in great
shape. Um very low muscle mass though.
They've never lifted weights before. I'm
and but but then I'm gonna say to them,
hey, you know, how much are you willing
to exercise a week? They say they're
willing to give me six hours a week of
training. We're gonna put their we're
going to take them to very high levels
on their cardio front in 3 hours a week,
but I'm going to have them spend these
three 1-hour sessions in the gym. So, um
1 hour in the gym. We would target a
minimum of 10 and maybe as many as 20
sets per body part per week. So again,
they're going to spread that out over
the three uh workouts. They might do 3
to four sets per exercise, anywhere from
six to 15 reps per exercise, anywhere
from 90 to 120 seconds per exercise. I'm
often going to have them super setting
on this because we have the luxury of
them doing whole body. So, they're not
they're they're getting rest from a
given exercise, but while they're doing
something for their back, um I might
have them rest quote unquote by doing
something for their chest. So, you're
using opposing muscles. Um start them
out at a very low intensity of 3 to four
RIR, working them up to 1 to two ri. Um
and again, this is a person who's not
going to stop moving. um they're going
to, you know, we're we're either going
to pair opposing muscles like chest and
back um or completely different. I mean,
as recently as two years ago, I was
doing a whole body workout every uh
maybe three days a week where I was
alternating like like lower body, upper
body, lower body, upper body, supersets
all the way through. So, again, lots of
ways to do this, but that that would be
one way to do it. you kind of hinted
there, but just I think superset
sometimes is a new term for people. So,
do you just want to give like a really
quick clean definition in case people
didn't pick it up from what you just
said?
>> Uh, yeah. So, it's it's basically you
are, let's say you're doing um a bicep
and a tricep superset. Instead of just
doing bicep curl, rest, bicep curl,
rest, bicep curl, rest, you would do a a
bicep curl and then a tricep extension
or something like that, and then a bicep
curl and then tricep extension. So,
you're resting your you're resting one
muscle while you're working an opposing
muscle or a completely different part of
the body. So, again, it's much more
timeefficient.
To be clear, you wouldn't typically uh
you could there's a totally different
reason for doing this, but for this
person, I would not superset chest and
tricep or back and bicep because those
are not really opposing muscles and
you're now getting into fatiguing
supporting muscles. So again, there
there's a time and a place for that. If
you're trying to make improvements, so
for example, if you're trying to improve
your pull-ups, you will superset them
with bicep curls, right? because you're
pre- fatiguing the bicep. Um, and so
you're you're you're drawing out you're
you're trying to get those uh you're
trying to double up on failure and break
through plateaus and things of that
nature. Not not what we're doing with
this person.
>> Perfect. So now let's take same person,
new to training, haven't been resistance
training, but they're older in age. How
does kind of the programming you gave
the younger person differ here? Again,
the principles are the same because
they're new to this, but we want to
probably start with lower volume, lower
intensity,
um, and maybe increase a little more
gradually. Big big form here. Uh, big
focus is is on form, of course. Um,
and, um, probably slower tempos. Um, so
again, um, looks very similar to the
other person, but the intensity is going
to be considerably lower. That other
person, by the way, is going to really
feel smoked in the hour because they're
not going to stop moving. Uh, this
person, depending on their age, I might
even not do the super sets. By the way,
um, and and therefore they have fewer
exercises that they're going to get done
if they're allocating the same amount of
time.
>> For these newer people, some one of the
questions we can get asked is, if I'm
going to the gym, I have two options,
right? I have free weights, which could
be dumbbells, kettle bells, etc., and I
have machines. So, based on the comment
you just made about form, if someone's
newer to the gym and has that
optionality, do you traditionally like
to encourage them to start with machines
because there's less risk in the form
variation than free weights?
>> I think it depends on their setup. So,
sometimes they'll have a trainer and if
the trainer is really good, I I think
it's fine to do anything. Look, I mean,
again, go back to the Belinda Beck
discussion of the LiftMore study. I
mean, these they did the exact they were
deadlifting. Like 65year-old women who'd
never touched a weight in their life,
we're deadlifting. This is one of the
most complicated movements you could
ever try to teach somebody. What does it
tell me? It tells me if you if you know
how to teach somebody how to do an
exercise, they can do it, right? So, I
don't think it has to be that, oh, if
you're a novice, you have to do
machines. I think machines are great,
right? Um, and it is it's a great way to
start and and sometimes it's a less
intimidating way to start. Um, and
especially for a person who doesn't have
a trainer and is kind of going to go and
figure this out at their at their gym,
which by the way might seem really
intimidating if they have to go to the
section of the gym where there's just
benches and sweaty dudes and dumbbells.
Uh, but maybe it's less intimidating,
you know, to be where the machines are.
So, um, I don't want to make too much
hay out of it. I just, you know, I just
kind of want that person in the gym and
and moving stuff around and um and and
and developing a little bit of
confidence without hurting themselves.
And machines are a great way to
accomplish that. So, let's now take a
person who's been resistance training.
Anything specifically you recommend to
them for their programming? Should they
modify in any ways? What type of advice
are you giving a patient who's
resistance training some in the gym but
comes to you and says hey I want to
maximize this for lifespan health span
benefits what would you say
>> honestly at this level Nick it's totally
different right I mean if you take the
seasoned person who's saying
I love doing this but now I want to this
is kind of like me talking to me right
like now what am I thinking about and
and I have many patients who are in this
boat as well they They love lifting
weights. They've been doing it for a
long time, but they're they want they
need a direction to go in. And I think
this is where the centinarian decathlon
becomes very very helpful, right? Which
is okay. You have to define your sport.
What is it you want to be able to do in
the last decade of your life? You know,
I want to be able to swim a mile. I want
to be able to ride a bike. I want to be
able to hike. I want to be able to uh
play soccer with a kid.
um the I need to be training in ways
that allow my muscles to be able to do
that. So, a lot of it actually comes
down to
taking things away that were increasing
risk. I haven't deadlifted in over a
year. Now, truthfully, most of the times
I deadlifted, I felt pretty good, but
once a month, I didn't. I was just too
fatigued. I I just was too distracted. I
just did something where my back would
get a little irritated. Was never a big
problem. It's not like it ever resulted
in sciatica or any of these cataclysmic
outcomes. But it just occurred to me. I
was like, "Well, I don't need to take
this risk anymore." Okay. Now, again,
there's going to be somebody listening
to me that says, "This guy's horrible.
How could he stop deadlifting? What an
idiot." Okay, fill your boots. You want
to deadlift all day, knock yourself out,
and I hope you do it safely for the rest
of your life. I can just tell you that
for me the riskreward trade-off wasn't
there when there are so many other
exercises that I can do. I can do
headfield lunges and squats. I can do
belt squats. I I can do so many things
that are producing virtually no axial
load on my spine and I never ever have
even the slightest irritation. So I'm,
you know, that's an adjustment that I've
made. Is that making me bigger or
stronger? No, it's not. It's d-risking.
So d-risking is becoming a component of
taking myself towards my goals. Um it's
also focusing on things where I see
deficits, right? It's also focusing on
areas where I say, "Hey man, like
[snorts] you know, um well, I'll give
you an example. Like I am constantly
worried, as I think every middle-aged
person is, about tearing their Achilles.
We we all have a friend who's done it.
I'm sure somebody listening to us has
done it. Um,
I'm very paranoid about this, right?
It's such a devastating injury. It sets
you back so far and it always seems to
happen when a person's muscles exceed
the capacity of their connective tissue.
So, you're you it's often someone who's
pretty athletic or who was formerly very
athletic who tries to go back to do
something and they engage in an
explosive movement, but then they tear
the connective tissue. So I it sounds
silly. Spend a lot of time bouncing.
Spend a lot of time doing exercises like
calf raises that are, you know,
seemingly quite boring, but that just
work on strengthening that uh that
connective tissue between the muscle and
the bone. Um so I can't give a generic
answer here other than to say this is
finishing school. This is where I mean
look this is why we created 10 squared
right is uh and I I haven't talked too
much I guess about 10 squared but but
this is why we created an entire um
company around taking people regardless
of their level of athleticism or
experiencing experience and training
them for the marginal decade because the
level of of of um um I think of of
precision that you need to train for
this uh is as is as important and as
nuanced as if you were training for a
very specific sport at a young age like
a decathlon or um you know a triathlon
or something like that.
>> Awesome.
I think that covers everything we wanted
to cover in this AMA. So that said,
anything you want to add? Anything
randomly in your head? Any advice on
life that you have for anyone out there
still listening?
still listening. God, that sounds
depressing. I don't think so. I think
I've spilled all my advice for for a
month.
>> There we There we go. Well, good thing
we'll see you next month then and we'll
get more of that life spilling advice.
[clears throat] I think that's all we
got. Peter, thank you very much for
showing up again.
>> Thank you.
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