I went down to UE after closing for the following workout:

SuperSlow Systems Overhead Press

Nautilus Plate Load Biceps with SS retrofits

Nautilus Plate Load Triceps with SS retrofits

EZ Bar Reverse Curl

SS Systems Leg Press

Recently, while listening to a continuing medical education podcast, I became aware of another way the high intensity exercise could prove enormously beneficial when you least expect it.  Suppose you go for a day at the beach.  You are unloading the jet ski off a trailer when you slip and scrape your shin on the tongue of the trailer.  You hop up and down, cussing, but eventually you walk it off and go on to have fun in the surf and sand.  A few days later you note that the area on your shin has become red, painful and has some red drainage.  You wait it out for a day, and it gets worse…bad enough for you to go to the local urgent care where you are prescribed some antibiotics.  You fill the prescription and take them dutifully, but the area only gets worse.  The redness has spread, and the entire front of your leg is exquisitely painful.  This time, your wife brings you to the local ER where you are given a dose of IV antibiotics and you are written for an additional oral antibiotic.  The ER bandages your IV site and asks you to come back the next day for a recheck and another dose of IV antibiotics.  That night the leg becomes so painful that even air passing over it is excruciating.  About 2am you have shaking chills and you spike a fever of 104.5.  Your wife wakes to soaked bed sheets and decides you are going back to the ER NOW, but when you try to stand up, you faint and collapse in a ball on the floor.  An ambulance is called and the paramedics find you with a blood pressure of 83/38 and a heart rate of 140.  Your cellulitis has turned into necrotizing fascitis and you are in septic shock.

The bacterial toxins circulating in your bloodstream and the cytokine storm that they induced have caused all variety of organ dysfunction.  Vascular tone is lost and your blood pressure plummets as your blood volume is now circulating in a much larger container.  When your lactic acid is measured, it is astoundingly high (a level of 4.5, where normal is less than 2.0).  In current sepsis management, lactic acid is the major biomarker for the severity of sepsis.  What had always been assumed was that as blood pressure dropped, and oxygen delivery to organs and tissues decreased, these organs and tissues reverted to anaerobic metabolism, the end product of which was lactic acid. It all made perfect sense.  Except, like many things that make perfect sense, that is not what turns out to be going on.  It turns out that in sepsis oxygen levels and delivery can be supra-normal and excess lactic acid is still generated.  It turns out that this overproduction of lactic acid is due to the body’s major surge in catecholamines as it struggles to survive.  See the article below for details on how this was figured out.


As epinephrine and norepinephrine pour out in response to the stress of infection an amplification cascade of glycogen mobilization is triggered, accelerating glycolysis.  In addition to generating ATP more rapidly through glycolysis, the end substrate of glycolysis, pyruvate is presented to the mitochondria at a rate that maximizes aerobic metabolism as well.  The catch is, as we discussed in BBS, pyruvate can be generated at a rate much faster than the mitochondria can handle.  As pyruvate stacks up, unable to enter the mitochondria, it is acted upon by lactate dehydrogenase and turned into lactic acid.  This is a necessary side effect of the need to crank up energy production in the body’s massive effort to fight off infection.  However, in the right conditions, and up to a certain point, the lactate can actually be used as fuel.  Circulating lactate can be carried back to the liver where it can undergo gluconeogenesis and serve as new substrate to keep the whole process going (A process known as the Cori Cycle).  For those of you who have read BBS, this should sound vaguely familiar.  It is the exact same process we described in the chapter on global metabolic conditioning, where catecholamines released during high intensity exercise pushed glycolysis to deliver pyruvate to the mitochondria faster than it could be utilized, simultaneously ramping aerobic metabolism to its maximal extent and driving elevated lactic acid levels, which in turn up-regulated the Cori Cycle and blood buffering systems to offset the ensuing acidosis.

Eventually, in sepsis, as in a high intensity workout, these systems eventually become overwhelmed.  In sepsis, it is septic shock.  In high intensity exercise, it is carpet time.  In sepsis when shock ensues the first step is to aggressively administer IV fluids to correct fluid losses from fever, vomiting, respiration as well as to fill the now dilated vascular tree.  When this fails, IV norepinephrine can be given.  This raises blood pressure by constricting the dilated vessels, but it also stimulates beta receptors and further drives glycolysis and pyruvate production-paradoxically raising already high lactic acid levels.  Much of the ability to survive sepsis, it seems, is the ability to “go there” in terms of accelerating glycolysis, as well as making productive use of the lactate that is generated.

This is where high intensity exercise comes in…and this is true for interval training, Crossfit and for HIT.  The degree to which we can improve our ability to absorb this “metabolic whallop” as Greg Glassman calls it, is the degree to which we might be better able to survive the sepsis process.  Now please don’t mistake me as saying that one should seek out “carpet time” as a goal, because I am not.  It is not necessary to provide a good stimulus and done regularly will lead to stagnation and overtraining.  But, I think it is important to realize that you can become capable of easily handling workloads and a pace of work that would previously would have made you quite ill.  What can make the average person vomit or pass out, can easily be handled by someone who has gone through an appropriate progression of metabolic conditioning.  This can be achieved without ever pushing beyond the brink, if you approach it intelligently.  If you do want to push up to, or even beyond, the brink it is easy to do.  If you pick the right movements and do them at an aggressive pace, you can make anyone vomit and require “carpet time”.  The relationship between glycolysis (the more ancient part of our metabolism), will always be able to outpace the mitochondria (a relative newcomer as a symbiotic proto-bacteria that ate the waste products of the cell).

Someone that has trained this metabolic systems to run at peak capacity, and has also up-regulated the pathways that make productive use of lactic acid, the way a drag car uses nitrous, is much more likely to survive a bout of sepsis.  Once again, HIT offers more than just aesthetics.

Post your WOW’s and your thoughts.


I did my most recent WOW on Halloween.  I did Back/Chest and Leg Press.  The workout was as follows:

Lumbar Extension on the new SuperSlow Systems Pulldown.  The fall-off cam seemed to intensify the contraction at full extension, and allowed a more gradual run-up to complete fatigue.

MedX Chest Press

Nautilus Pullover with SS retrofits

Medx Row with SS cam

SuperSlow Systems NeckFlex/Ext

SuperSlow Systems Leg Press

One of the most interesting presentations at the Dresden conference was given by James Fisher, MSc. of Southampton Solent University.  James has done a series of articles investigating the effects of advanced methods of HIT that have traditionally been done to elevate the intensity to higher levels in order to produce a deeper state of fatigue, and thus a more profound stimulus, with the intent of producing a more pronounced response.  James has developed study designs to investigate pre-exhaust training, breakdown training and rest-pause training.  He has also investigated varying rest intervals as it pertains to intensity of the stimulus and the consequent results.  In addition to training his own study subjects, James collaborated with Luke Carlson of Discover Strength in Minneapolis, MN in order to have a broader range of study subjects.  The upshot of these studies is that none of the advanced techniques produced results that were any better than a very simple program of single set to failure (SSTF) training.  Here is a link to the abstract of the Pre-Exhaust study and it in turn has a link to the full-text article:


I  believe the conclusions of these studies are likely correct.  My only reservation is that the scientific method itself may be setting the testing variable up to not show a difference.  As part of the study design, the element to be tested must be isolated in order to test the null hypothesis (that the element being tested does not make a difference).  In the scientific process, other elements that may be included in tandem with the tested variable may be excluded.  The exclusion of these tandem elements may be excluding something that is permissive for the tested variable to actually work.  Also, the contribution of the tested variable over a longer time span, and as a part of an ebb and flow process of autoregulation over time can never be known.  What can be gleaned from these studies, however, is just how well basic SSTF actually works, and how all of our fiddling around the margins may be producing results that, while significant to us “geeks”, may be too small to measure in a meaningful way.

Post your WOW’s and your thoughts.

I did the following WOW at UE this past Friday (Shoulders/Arms/Leg Press):

SuperSlow Systems Overhead Press

EZ Bar Biceps Curls

Triceps Rope press on SuperSlow Systems Pulldown

EZ bar Reverse Curl

SuperSlow Systems Leg Press

James Steele, PhD gave a great lecture on the false dichotomy that exists in exercise physiology because researchers tend to fixate on the exercise modality as it pertains to the aerobic/strength continuum rather than concerning themselves with the relative effort used with whatever modality one might choose.  The research camps have settled out largely based on modality such that running, cycling and swimming tend to dominate in aerobic literature while weight training modalities dominate in strength and hypertrophy literature.  James used literature from both camps to demonstrate that the real issue is effort and not the chosen modality.  He cited numerous studies where strength and hypertrophy adaptations could be obtained with modalities (such as cycling) that were normally considered aerobic modalities if a high intensity of effort was used.  He then discussed literature that demonstrated that significant aerobic adaptations could be had with high effort protocols that required very little in the way of time, and that these adaptations equalled or surpassed the aerobic adaptations of lower intensity approaches that involved much longer and more frequent training sessions.  In doing so, James hoped to bridge the gap between these modality-based factions and show that both strength and metabolic conditioning (including aerobic conditioning) could be obtained in a time-efficient manner.  The time-efficiency of this approach was shown to be beneficial from a public health standpoint, since the time commitment involved in exercise is the major factor in non-compliance with exercise programs.

James said it much more eloquently in Dresden, as well as in his paper which I offer below:


The only objection I note is the seeming equalization of exercise modalities.  While it is true that effort is the great equalizer amongst the modalities, the use of strength training modalities allows high effort with a low risk of injury.  By use of proper form, the forces involved actually become less as muscle is fatigued.  Aerobic modalities used in high effort fashion results in a requisite increase in force that does not abate as fatigue accumulates, making the risk of injury significantly greater.  The emphasis on effort and the recognition that aerobic conditioning can be obtained with high intensity, time efficient protocols is the most important aspect of this paper in my opinion.
Post your WOW’s and your thoughts.

I have returned from my trip to Europe.  It was an amazing experience, made more amazing by the fact that it came at a major inflection point in my life.  After 20 years as a partner in an independent emergency medicine group, the forces of social engineering finally caught up with us as our contracted hospital was taken over by a regional healthcare system.  This takeover was not a hostile event as much as it was a savior event created by the economic landscape of the Affordable Care Act.  One of the major features of this landscape is that physicians are being transitioned into becoming hospital employed.  This is also an absolute necessity, designed by the ACA, as the regulatory burden on physician practice is now so great that it cannot be met without the backing of a major institution.  So I worked my last shift as an independent practitioner who owned my practice and then I left for Dresden, Germany to participate in the International Congress on Muscular Training sponsored by Kieser Training.

I arrived in Dresden on September 24th.  Immediately, I ran into James Steele, James Fisher and Jurgen GieBing.  We all went out that afternoon and walked the city, taking in the amazing architecture.  We had dinner and totally geeked-out on HIT and exercise science.  The following day was the start of the conference.  It was held in the Deutsches Hygienemuseum Dresden-a national museum devoted to medicine and health.  The museum contained a section on exercise that featured a display of Zander machines sitting alongside some of the most recent machines from the Kieser line.  The venue itself was the most impressive I have ever seen amongst all the conferences (medical or exercise) I have attended.  The lecture hall was massive and the audiovisual support was amazing.  The attendance was massive.  I do not know the exact numbers, but I would put it between 500 and 1000 attendees.  About half of the lectures were given in German and the other half in English.  For those in the audience who did not speak both languages, ear phones were provided with live translation being carried out by very capable translators (it was like being at the United Nations!).

Werner Kieser gave the opening address, which was inspiring and well-received.  This man definitely continues to carry the torch for Arthur Jones and does it without compromise or apology.  I was one of the earlier lecturers, and it was nice to have the pressure off early.  I spoke in very general terms about how I came to appreciate that HIT seems to ignite an “active genotype” once a certain level of muscular/metabolic condition is achieved and how I came to realize this by my spectacular failure in convincing UE clients to “take it easy” between exercise sessions.  I was the only speaker who was not a university-based research scientist, so the rest of the conference involved presentations of research related to high intensity strength training.  In subsequent posts, I will go through the basics of each and every lecture.  I came away from this conference realizing that this kind of training is even better than I had realized.  In fact, I think it may be the most powerful public health initiative available at our disposal.

The morning of the second day, myself, the James x 2 and Jurgen all snuck over to the local Kieser gym and got a workout in.  The facility was beautiful and fully equipped, including new machines that borrowed from old Nautilus designs, but incorporated MedX technology.  These pieces included the multi-exercise, the neck and shoulder (shrug), forearm (flexion/extension/pronation-supination/grip), rotator cuff, ankle pronation/supination,  and ankle dorsiflexion.  There was also a new addition of a pelvic floor machine. I wish Kieser would come to America, but alas he states the legal environment and corporate taxation in the “Land of the Free” is just too unfriendly.

There is literally too much to talk about in one post, so I will break my experience out into a series of posts discussing the different elements of this amazing conference (as well as my experiences in Dresden and then Paris).

Yesterday, I did my first WOW since returning.  Due to scheduling, I had to go to Fike where I did shoulders/arms/legs.  It was a great workout, mostly due to the lack of ER stress for 2 weeks.  Today I am pleasantly sore but not with any sense of ROBAT.  I did the following: (barbell overhead press, bent DB flies, EZ biceps curl, Triceps pushdowns, DB shrugs, DB grip exercise done MAE style, DB hammer Curl, BB squats).

Now it is time for me to head off to my first shift as a Health System-employed emergency physician!  Also, check out Instagram (ultimate_exercise_) as I will be uploading images over the next few days.  I will make incremental posts on my days off, so stay tuned.  In the meantime…

Post your WOW’s and your thoughts.

I did the following WOW last Friday with the UE team (Ed, Sherry and Joe) delivering payback after I supervised their workouts.  It went like this:

Nautilus Pullover with SS Retrofits

SuperSlow Systems Pulldown (the one with the fall-off cam)

MedX Chest Press

MedX Compound Row with SS fall-off cam

SuperSlow Systems Neck Flex/Extension

SuperSlow Systems Leg Press

I have been doing a lot of ER work lately, so I really felt this workout…during and after.  I have enjoyed the comments from everyone on the last blog post.  However, I must admit that I cringe a little bit when the topic turns towards diet.  Everyone has a fairly impassioned opinion, and things can get snarky pretty quickly.  We all come to these opinions through a thinking pathway that is more error-prone…the pathway of induction.  This is as opposed to the pathway that is a little less error prone, which is deduction.  In deduction we take general observations to make specific conclusions.  Thus if something is true for a particular class of things, it tends to be true for all members of that class.  Deduction is therefore the basis of the scientific method where we go from a general theory to specific observations.  Induction is just the opposite.  Inductive reasoning takes specific observations and makes generalized conclusions from it.  Inductive reasoning has a place in the scientific method, but only for generating hypotheses or theories.  Inductive reasoning allows for a conclusion to be false.  For example “James is a grandfather.  James is bald.  Therefore, all grandfathers are bald.”  Where we get into senseless arguments over diet is where we think we have developed our beliefs deductively, when we have in fact generated the beliefs through a process of induction; we find something that works for us personally, and then we try to generalize our experience to be valid for everyone. There are definitely elements that a facts derived through deduction, such as a calorie deficit will result in fat loss.  However, there are many inductive pathways to this deductively derived fact.

Regardless of the ways in which we tend to get things wrong, there is one way that I think every person that entered into the discussion of diet got it right, and that is everyone used Metacognition.  Ayn Rand (love her or hate her) made a very astute observation that the human animal does not have an automatic consciousness.  Humans actually have to expend mental energy to become conscious and turn on the thinking mechanism.  Once thinking is set into motion, it can exist on two levels.  The lower level is simple cognition…you have turned on your consciousness and you commence thinking.  The higher level of cognition involves keeping active the mental energy you used to turn on your thinking to continue to monitor your thought processes.  You are literally thinking about your thinking.  It is this process that is called metacognition.  It is the type of thinking that Thomas referred to in the last comment thread when he admonished “mindfulness” in our eating habits.  More than anything it is this lack of mindfulness that is responsible for our current obesity epidemic.  There are lots of theories about industrial food substances, serving sizes, sugar, fat, viral infections and what not, but I think the real issue is that metacognition has fallen out of fashion over the past 40-50 years.  To put it bluntly, America has become lazy, stupid and fat…and it’s not OK.    From my childhood I distinctly remember people in line at a local cafeteria ordering a meat patty, some cottage cheese, a salad and some cubes of Jell-O for dessert, fully aware that what they really wanted was the all-you-can-eat special.  But they were continually in a metacognitive state where they weighed the hierarchy of their values and decided that nothing tasted as good as thin felt.  This type of mindfulness was so prevalent in the 60′s and 70′s that almost every restaurant had a “diet plate” on their menu, and typically every adult in the dining party would order it.

I have had the distinct pleasure of sitting down to a meal with many of the posters on this blog.  Guys like John Tatore, Skyler Tanner, and David Landau.  I distinctly remember sitting in a hotel restaurant and watching David Landau order from the bar.  He was preparing for a contest and was already very lean.  I was amazed when he was delivered a big, loaded hamburger with a large pile of french fries.  I watched him in disbelief as he consumed…..about 1/3rd of what was on his plate.  Certainly not my dietary approach, but an amazing display of metacognition and self-restraint.  Part of my metacognition is the realization that I have a very hard time resisting that kind of food reward, and instead I select a dietary pattern that does not tease my weaker tendencies.  John Tatore and I seem to be on similar pages, as our choices seemed almost identical the last time we saw each other in Cleveland.  Skyler is more of a foodie.  He is very scientific and precise about his choices, but I mean to tell ya’…if he’s gonna put it in his mouth, he makes sure that it is going to taste damn good.  For Skyler, food is art.

You see, the bottom line is this:  I really don’t give a shit what you eat or the type of dietary approach you select.  What I do think is important (and admirable) is that you all seem to do it with metacognition.  You are thinking about your thinking.  You are asking disconcerting questions.  Where you are weak, you take measures to decrease your cognitive load to make correct choices easier (such as patterned eating, low food reward and intermittent fasting).  You make every effort to expose your errors and your weaknesses so that you can correct and avoid them in the future.  It is this kind of mindfulness that makes me proud to have an affiliation with the posters on this blog.  It works for diet.  It works exercise.  It works for life.

Post your WOW’s and your thoughts.

Just checking in to let you all know I am around.  Posting frequency has dropped off due to lots of ER work during the busy summer months.  Despite the increased work frequency, my recovery has been somewhat above baseline.  I have therefore settled into a two-way split that I do about every 5-7 days.  In general, the split looks something like this.

Back/Chest/Legs:  Pulldown, Chest Press, Pullover, Row, Neck and Leg Press (or Calf Exercise if I need to protect recovery resources).

Shoulders/Arms/Legs:  Simple Row, Overhead Press (favoring my new SS Systems machine), Bicep movement, Tricep movement, Reverse Curl or Formulator, Leg Press

My last workout was Wednesday and was the workout listed above, including Leg Press.  I have really enjoyed the thoughtful and respectful discussions that have been going on recently.  Reading the input of everyone makes me realize what an incredible community this actually has become.  The participants all represent how variations of sensible training really does produce some incredible results…truly elite fitness, but without the torn rotator cuffs and blown out ACL’s so common in today’s culture.  While we sometimes go down a vortex of over-thinking, we all walk the walk where it counts.

Post Your WOW’s and your thoughts

I decided to interrupt the run-up to 1,000 comments by posting my most recent WOW.  Photos are posted on Instagram at ultimate_exercise_.  I am sticking with a two-way split which is similar to my 3 way split except hip and thigh is grouped with shoulders and arms and calves are grouped with chest and back.  I got a little bit of a mini-workout on Wednesday and Thursday when I prepped and cleaned the SuperSlow Systems equipment that I recently bought in preparation for transport to UE.  I was supposed to do it on Wednesday, but the Penske truck did not get delivered on time.  I had to work in the ER the next day, so Wendy took over transport duties with breakdown/lifting done by my son Eric and a couple of fantastic hired helpers.  New pieces include a SuperSlow Systems Leg Press,  SuperSlow Systems Pulldown (with cam!), MedX Row with SS fall-off cam (duplicate of my current row), SuperSlow Systems Ventral Torso, and SuperSlow Systems Overhead Press.  I also got a vintage Nautilus Leg Curl and Leg Extension in the deal.  The Nautilus Pieces will require refurbishing, but nothing too major.

WOW 6/20/15- SS Systems Pulldown (Jreps in 1/3rds), MedX Chest Press, Nautilus Pullover, MedX Row with SS cam, MedX Leg Press, Neck Flex/Ext on SS Systems Neck.

Tomorrow I will likely perform a pre-exhaust arm routine so I can play with the new equipment:  SS Systems Overhead Press, Nautilus Plate Load Biceps, SS Sytems Pulldown,  Nautilus Triceps Extension, Chest Press, MedX Row, SS Systems Leg Press.

I recently overheard a discussion on the worn-out topic of barbells vs machines as it relates to exercise being “functional”.  The conversation made me recall something Greg Anderson said to someone who innocently asked him the same question.  In classic Greg Anderson style he exclaimed “Give me a break!  A barbell is a f’ing machine!”.  Greg went on to explain how barbell movements could not be done without use of advanced metals, precision machining and perfect balance.  He made note of the perfect diameter for gripping and how it would be impossible to deadlift or row meaningful weight without precision knurling on the bar.  Too coarse of a knurling and you would rip off skin, too smooth and the bar would slide from your grip to potentially knock your kneecaps off.  He then went on to observe how cleans and snatches would snap your wrists if it were not for collars rotating on precision needle bearings.  Even my Sears cement barbell set had a rotating center sleeve to allow such movements (not to mention smoother barbell curls).  Finally, without precisely tempered metal, there would not be the perfect amount of flex and snap to make those “functional” push presses even possible.

I am not arguing against barbells or for machines in general.  Many machines are so poorly designed that a barbell is infinitely better.  However, just because a barbell is seemingly simpler than a machine does not make it more “functional”. In fact, an Eleiko barbell incorporates more advanced technology than most commercially available machines.  However, a well-designed machines that track muscle and joint function and utilize the concepts of biotensegrity in their design can produce improvements in strength and performance that qualify as exceedingly “functional” improvements.  Primitive does not equal functional.  If you have a long, overhanging acromion process then overhead snatches and overhead squats are the furthest thing from functional.  Injuries are not functional.  Stronger is functional.

As an example of barbell technology, see the videos below:



Post your WOW’s and your thoughts

It has been over a month since I posted.  Perhaps I should starting calling this a W.O.M.!  Things have been very stressful on the medical side of my life with all of the changes brought about by the “Affordable” Care Act.  I won’t bore you with the details, except to say that my workouts have been a sanctuary during an incredibly stressful chapter of my life.  Wendy and I both did our WOW’s today and enjoyed them a lot.  This was the first Legs/Abs day that I have had at UE in some time.  The timing just never seem to coincide for legs.  As such, I was going to Fike gym where I was doing calves, leg extension, leg curl, squats and the hammer clam-shell abdominal.  Today I did only the following:

Calf Press on MedX Leg Press-Jrep halves

MedX Abdominal

MedX Leg Press

I was simply astounded at what an amazing machine the MedX Leg Press is.  With that one single set I felt more of an effect than I do from the 3 separate movements done at Fike.  Tonight I cooked grass-fed burgers for dinner.  I had to walk up the steps of our deck to get to the house, and I nearly dropped the plate of burgers because walking up the steps was like re-living the leg press!!

Wendy’s WOW was as follows:


MedX Chest Press

Lumbar Extension on the SuperSlow Systems Pulldown

MedX Overhead Press


She also threw in shrugs and TSC neck

I was recently putting together a PowerPoint lecture to give to local groups/organizations about the benefits of strength exercise.  In doing so, I found some new articles on the effects of myokines on bone density.  It seems that there is hormonal/chemical cross-talk between muscle and bone that signals for increases in bone mineral density.  It use to be believed that increases in bone mineral density where due to adaptations to mechanical stress and strain that were applied to bone.  Hence the popular notion that there was value in “load-bearing exercise”, hence one had to incur impact forces in order to provide the stress necessary for bone thickening.  The obvious paradox with this was that those with osteoporosis had to risk fractures in order to protect themselves from fractures.  It is amazing to me that Ken Hutchins’ Osteoporosis Study challenged this notion over 30 years ago.  Now molecular science is proving him correct.  It seems there are a host of myokines that mediate cross-talk between muscle and bone in a paracrine and endocrine fashion that results in bone density improvements without consideration for mechanical stress/strain.  For instance, myostatin knock-out animals are seen to have bone density improvements that mirror muscle mass improvements with NO mechanical stress.  What we now know is that it is indeed possible to improve a person’s resistance to bone fractures without having to risk giving them a fracture in the process.  While the scientific and pharmaceutical world will try to develop this notion into a pharmaceutical (what I call pushing with a rope); we all know the real answer is to get these hormones honestly…through low force/high intensity exercise.

Here is a link to one of the articles discussing this concept: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380142/

Post your WOW’s and your thoughts.

I apologize for the drop-off in my posting frequency and thanks for keeping the discussions so lively and interesting.  I did the following WOW this past Thursday at Fike.  Wendy came over toward the tail end of my workout and I put her through a Big 5 routine.  Ed, Sherry and Joe have been jammin’ over at UE.  It is great to have so much business, but when my days off are during the week, it is near impossible to get in for a workout!  A great problem to have.

My workout was as follows:  Barbell Overhead Press, Dumbbell rear delt fly, Barbell Curl, Triceps cable pressdown, Reverse Curls, Dumbell Shrugs.  I used high rep pre-exhaust, followed by standard set to failure on overhead press and shrugs.  I did J-reps on the curl and triceps and rear delts.  Standard SS on reverse curls.

Wendy did the following on Life Fitness/Hammer Plate Loading machines-Under grip pulldown, Chest Press, Row, Overhead Press.  The Leg Press machine was out of service, so she did goblet squats with a kettlebell.

There has been a good deal of buzz over Brian Johnston’s High Density Training protocol which involves using a 30 rep set, then a 12 rep set and then an 8 rep set with escalating weights and brief rest between sets.  Brian feels that the variation that this offers, along with a large number of contractions per unit of time are what make this potentially effective.  It certainly provides an impressive pump and a short term enhancement of appearance and fullness (in my limited experience).  There have been other such protocols that offer similar benefits.  Art Devany always liked a high, medium, low rep scheme for his movements.  There has been a lot of research showing the benefits of vascular occlusion and SS/RenEx protocol with longer time under loads produce a similar experience.  Why these protocols might produce enhanced results is not really known.  Theories are that the occlusion that occurs from the early pump creates an acidotic environment that enhances more aggressive recruitment of the higher order motor units.  It might also be that multiple cycles through lower order motor units during the high rep set may accelerate the sequential recruitment that occurs during the more traditional portion of the bout.  Or, it might simply be that the increased inflammation produces as sustained pump and edema that produces a short term sensation of enhanced size and appearance.  I think the last possibility may have a lot to do with it.  My first cycle produced profound soreness and sustained pump.  The second and third bouts, less so.  There are those that would say this is an indication of how quickly the body adapts and why continued variation is needed.  There are others who argue that the effect is illusory and short-lived and that such protocols are a meaningless detour from what really works.  I must admit that I am not really sure.  I am 40% the former and 60% the latter in my opinion.  Honestly, I really don’t give a crap as long as the readers of this blog continue to train on a consistent and life-long basis, as the real benefits go beyond our eternally springing hopes.

With that in mind, I found it fortuitous that the following article appeared recently.  Just looking over the abstract, the methods were pretty lousy and the study was so short lived in duration that no real conclusions can be drawn, but it is interesting how concurrent experimentation goes on in all fields.

Eur J Appl Physiol. 2015 Mar 10. [Epub ahead of print]
A single set of exhaustive exercise before resistance training improves muscular performance in young men.
Aguiar AF1, Buzzachera CF, Pereira RM, Sanches VC, Januário RB, da Silva RA, Rabelo LM, de Oliveira Gil AW.
Author information

The purpose of this study was to examine the effects of an additional set of exhaustive exercise before traditional hypertrophic training on quadriceps muscle performance in young men.
Subjects performed maximal dynamic strength (1RM), local muscular endurance (LME), and magnetic resonance imaging (MRI) tests before and after an 8-week hypertrophic training program using a knee extensor machine. After baseline testing, the subjects were divided into 3 groups: untrained control, traditional training (TR), and prior exhaustive training (PE). Both the TR and PE groups trained using the same training protocol (2 days week-1; 3 sets of 8-12 repetitions at 75 % of 1RM); the only difference was that the PE group performed an additional set of exhaustive exercise at 20 % of 1RM before each training session.
After 8 weeks, the PE group experienced a greater (P < 0.05) increase in 1RM, cross-sectional area, and LME than the TR group. Additionally, no changes (P > 0.05) in daily dietary intake were observed between groups.
These results suggest that the inclusion of a single set of exhaustive exercise at 20 % of 1RM before traditional hypertrophic training can be a suitable strategy for inducing additional beneficial effects on quadriceps strength, hypertrophy, and endurance in young men.

Post your WOW’s and your thoughts.

I did the following WOW under the supervision of UE instructor Joe Byers.  He did the same workout under my supervision (except Joe did Leg Press instead of Neck as the last movement).

TSC Simple Row (as pre-exhaust for)

MedX Compound Row with SS cam

MedX Chest Press

Nautilus Pullover with SS Retrofits


SuperSlow Systems Neck Flex/Extension.

After the workout I was closing up shop and got a call from a prospective client.  The reason for the call was one of the most common issues that brings us new clients….the results of a recent DEXA scan.  People often become very alarmed when their DEXA results return with poor scores and their doctor recommends starting bisphosphonates (medications like Fosamax) to try and reverse their bone loss.  This usually triggers an internet search on treating and preventing osteoporosis, which invariably uncovers some article about SuperSlow and its genesis in the Osteoporosis Research Project at the University of Florida.  This in return creates some sort of link to Ultimate Exercise (or many other such facilities).


I have always been a pretty vocal opponent of DEXA scans because I feel that they alarm patients (a morbidity) and triggers the urge to do “something”.  That something is usually bisphosphonates, a class of drugs with some pretty gnarly side-effects. Further, the benefits of increasing bone mineral density have always been a little oversold by correlating an absolute increase in bone density with a relative percentage risk reduction of fractures.  Further, literature suggests that the real correlate for fracture risk is your starting level of bone mineral density, NOT the level you improve to.  To me this has always suggested that bone density was simply a surrogate marker for fracture risk.  I have always suspected the real marker for risk was muscle mass and the resultant strength level.

If we look at these images lifted from Skyler Tanner’s post on bending the aging curve, we must ask ourselves if the sedentary person’s real risk of a fall and subsequent fracture really dependent on the bone density of his femur?  Or…is the real problem the atrophy that has occurred in his thigh muscles and the fact that if he gets the least bit off of his center of gravity he is going down.  And when he (or she) does go down, there is not enough shock absorbing skeletal muscle to protect that frail femur from snapping in two.  If you stuck that frail bone in the middle of all the muscle in the pictures above or below, do you think it would stand a much better chance all the way around?

But the situation is actually much better than that.  Because, when you improve the muscle mass the bone mineral density tracks right along (as does all other organ mass).  It used to be thought that the bone mineral density was increasing because of the forces upon the bone…strain and stress that could also risk a fracture.  But I have seen too many clients improve bone mineral density without exposure to dangerous force to believe that.  As it turns out the increase in bone density, as well as other improvements in organ mass, are related to muscle to organ cross talk mediated by myokines.  There is even evidence that myokine exposure can improve bone density in the complete absence of stress/strain loading.  So when someone tells you that slow cadence, force-controlled exercise does not sufficiently stress the bone to improve bone density, you can smile and walk away.  As it turns out, training in this way gives you all of the upside and none of the down side of the traditional notion of “load-bearing exercise”.  What the new research on myokines is demonstrating is that proper strength exercise is the most profound public health initiative that we have available too us.  The economic implications of a vibrant and productive aging populace, as opposed to a debilitated and dependent one is almost too big to imagine.

This is especially true in light of the collapse of our medical and social entitlement systems.

To get further insight into the issue of muscle-bone cross-talk via myokines, check out the interview linked below:


Post your WOW’s and your thoughts


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