Wendy:  3 x 3 workout.  Chin-up, Push-up, Leg Press.  On the final two rounds, she did Goblet squats instead of Leg Press.  The first round of leg press made the goblet squats plenty hard.

Doug: MedX Overhead Press, Infimetric Rear Delt, EZ Barbell Curl, Triceps pushdown on SS Systems Pulldown, EZ reverse Curl, Formulator, Leg Press.










I searched Pubmed and the internet for an interesting topic.  I came up with nothing worth sharing this time.  The only thing that I can share this week is that even after doing this repeatedly since I was about 14 years old…I still love it.  Even after writing something down here for going on 6 years…I still love it.  Even when I am sick of balancing the books, keeping up with taxes, dealing with the crab-bucket of the HIT world, and fitting in workouts around a psycho schedule…I still love it.  When I was 14 and thought of how I might be when I was 52, this is pretty much what I was shooting for, and that is why…I still love it.

Post your WOW’s…and why you still love it.

I have not done a workout in 2 weeks.   In order to “make room” in my schedule to speak at the 21 Convention I had to stack up shifts before and after the trip.  As usual Anthony did a very professional job and treated everyone in attendance like royalty.  I got to see Anthony, Skyler Tanner, Bill DeSimone, Eric Daniels,  and James Steele.  I arrived late Friday and had to leave early Sunday, so I missed seeing Drew Baye and Ellington Darden.

Since I do not (yet) have a workout to post, I wanted to put something up to reboot the discussion.  Of all the clients we train at UE, probably the most marked improvements have been seen in clients with neurodegenerative diseases, especially Parkinson’s disease.  My own father died of the complications of Parkinson’s disease in 2004.  He was diagnosed when he was my age and remained fairly robust into his 70′s and only showed rapid decline in his 80′s.  Nonetheless, it did have marked effects on his physical abilities as time went by.  I wish I had known earlier what a difference strength training would have made for him.  I was deeply involved in HIT ever since the early days of his diagnosis, but never once considered that it was something I should get him to try.  Perhaps he gave me the “vibe” that he was not interested, but it was much more likely that I was simply a self-absorbed teenager (and later, a self-absorbed adult).  All I can say is that now having seen what strength training does for people with Parkinson’s, I can say that not bringing it to my “Pop” stands as one of my biggest regrets.  I was deluded to think that some people may have lost to much ground to strength train, when in fact those that have lost the most ground are the ones who stand to gain the most.

As a demonstration of this fact, I offer the following study on high intensity exercise in Parkinson’s patients.  In particular, pay attention to the incredible percentage increases in performance across multiple domains.  How many studies ever demonstrate this kind of improvement?

J Appl Physiol (1985). 2014 Mar 1;116(5):582-92. doi: 10.1152/japplphysiol.01277.2013. Epub 2014 Jan 9.
Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson’s disease.
Kelly NA1, Ford MP, Standaert DG, Watts RL, Bickel CS, Moellering DR, Tuggle SC, Williams JY, Lieb L, Windham ST, Bamman MM.
Author information

We conducted, in persons with Parkinson’s disease (PD), a thorough assessment of neuromotor function and performance in conjunction with phenotypic analyses of skeletal muscle tissue, and further tested the adaptability of PD muscle to high-intensity exercise training. Fifteen participants with PD (Hoehn and Yahr stage 2-3) completed 16 wk of high-intensity exercise training designed to simultaneously challenge strength, power, endurance, balance, and mobility function. Skeletal muscle adaptations (P < 0.05) to exercise training in PD included myofiber hypertrophy (type I: +14%, type II: +36%), shift to less fatigable myofiber type profile, and increased mitochondrial complex activity in both subsarcolemmal and intermyofibrillar fractions (I: +45-56%, IV: +39-54%). These adaptations were accompanied by a host of functional and clinical improvements (P < 0.05): total body strength (+30-56%); leg power (+42%); single leg balance (+34%); sit-to-stand motor unit activation requirement (-30%); 6-min walk (+43 m), Parkinson’s Disease Quality of Life Scale (PDQ-39, -7.8pts); Unified Parkinson’s Disease Rating Scale (UPDRS) total (-5.7 pts) and motor (-2.7 pts); and fatigue severity (-17%). Additionally, PD subjects in the pretraining state were compared with a group of matched, non-PD controls (CON; did not exercise). A combined assessment of muscle tissue phenotype and neuromuscular function revealed a higher distribution and larger cross-sectional area of type I myofibers and greater type II myofiber size heterogeneity in PD vs. CON (P < 0.05). In conclusion, persons with moderately advanced PD adapt to high-intensity exercise training with favorable changes in skeletal muscle at the cellular and subcellular levels that are associated with improvements in motor function, physical capacity, and fatigue perception

Post Your WOW’s and your thoughts.


The family and I went down to UE on Sunday for our workouts.  They were as follows:

Doug:  Chin-up, MedX Chest Press, Nautilus Pullover with SS retrofits, MedX Leg Press

Wendy:  Chin-up, Bench dips, EZ bar biceps curl, Infimetric lateral raise, Barbell Squat

Things have been very busy lately, so I will simply provide some updates.  My podcast with Dave Asprey comes out October 21st at www.bulletproofexec.com.  I also gave a long podcast/interview with Ben Greenfield that will be part of his Rev Yourself event November 17-21, 2014 (www.entheos.com/REV-Yourself/Doug-Mcguff).  Finally, I will be speaking at the 21 Convention in Tampa on Saturday October 25th (www.the21convention.com).  My lecture this year will not focus on physical training, diet or medical economics.  This year my lecture will focus on cognitive techniques for functioning and thriving in high stress environments.  It is a bit of a stretch, and I hope the attendees like it, but I felt that 25 years in high acuity ER’s have given me some unique insights, many of which have been passed on to me by the best in my field.

Post your WOW’s and your thoughts.

I went down to UE after closing to do payroll.  I was unable to workout on the weekend due to work at the ER and Monday was too booked up to get in during the day.  It is very rare for me to work out in the evening, so this was a unique experience.  This was a solo mission, so no instagram photos of this workout.

Nautilus Pullover with SS retrofits, MedX Chest Press, MedX Compound Row with SS cam, SS Systems Neck Flex/Ext, MedX Leg Press

Being the end of the month, I had a lot of errands to run throughout the day.  While sitting at an intersection, I noticed the traffic cameras sitting above the traffic light.  Later at the gas station I noticed the fish-eye lens on the gas pump and then the multiple domes in the ceiling of the store covering the cameras that watched me from every angle.  Next, a trip to the bank to make a deposit revealed a surveillance camera pointing directly at me.  Even when I dropped by a Starbuck’s for an Americano I was under the watchful eyes of several ceiling cameras.  I am fairly certain that my entire day could be reconstructed with the use of surveillance footage.

As I was setting up for my workout, I realized this was the only place I had been all day where I was not being spied upon.  I am proud of many things in my business.  We have helped enumerable clients to live stronger, healthier a longer lives.  What I never thought about until now was that Ultimate Exercise is a refuge where our clients can come and know that they are not being watched on hidden camera.  Further, my employees are not recorded or monitored and they are not subjected to drug screens or background checks.  I generally believe that if respect people’s privacy, they will reward you by being worthy of your trust.  Building an entire society around a lowest common denominator makes the bad worse, and the good resentful.  I am happy that my business is one of the last places where Big Brother is not watching.

Post your WOW’s and your thoughts.

Doug: Overhead Press, Thick Bar Biceps, Nautilus Plate Load Triceps with SS retrofits, EZ reverse Curl, Thick Bar Wrist Flex/Ext, Calf Raise on MedX Leg Press, MedX Leg Press.

Wendy: Chin-ups, MedX Overhead Press, MedX Compound Row with SS retrofits, Pushups, MedX Leg Press

I was reluctant to post a new WOW because the quality of the comments on the last thread have been so good that I did not want to interrupt.  I am hoping that you guys will simply pick up where you left off.  I am very fascinated with everyone’s thoughts on load, progression and what it all means (or doesn’t).  Joe A (welcome back!) made some fascinating comments about the 80% of physique enhancement that is not related to the actual workout protocol.  Perhaps we can expand the discussion into this area.  I think we are all doing the best we can with what we have in the training realm, and even if we could do better, there is probably a diminishing marginal utility with respect to results.  So lets talk about that other 80% a little more. Post your WOW’s and your thoughts.



I am way behind on posting.  I just took my American Board of Emergency Medicine recertification test this week.  In my specialty, once you are board-certified you are not done.  There are ongoing requirements and yearly tests based on the current literature.  Then every 10 years you must take a board recertification exam.  If you don’t pass, then you lose your board-certified status.  This is my second go-round for recertification, and it seemed much tougher and less relevant than the last time I took it.  I am glad to have it over.  My mind feels like I am in suspended animation after such a massive knowledge dump (not to mention the massive amount of memorized material that was not tested).  Now all I have to do is wait 90 days for scores.

This week I also did a podcast interview with Dave Asprey of The Bulletproof Executive (www.bulletproofexec.com).  The interview was focused on myokines, but we went off on all sorts of tangents.  One of our big topics was the use of stress inoculation training for high stress occupations such as special forces, emergency medicine etc. Watch for the podcast to be out soon.

One thing that I have always believed about high intensity strength training is that there is intrinsic value in it just because it is hard.  There is something about doing hard things that I think makes us better humans…..humans that are able to rise to challenges and to survive threats to life or limb.  This is why, at my core, I feel some affiliation with Crossfit.  They embody the value of doing hard things.  What I like about our approach is that we can invoke a similar or greater degree of hard, without the escalating risk of injury.  In any case, I recently found a lecture that articulates the value of doing hard things better than I ever could, so I offer it up here: http://vimeo.com/50273432

Finally, here are my two most recent WOW’s as well as Wendy’s.  Wendy has been doing freehand and free weight routines recently.  We have been recording them and posting short clips on Instagram.  The female contingent has gone wild over it, so there seems to be a interest amongst women of how to apply BBS principles with little or no equipment.

Doug’s WOW’s:  Lumbar Extension, MedX Chest Press, Pullover, MedX Chest Press (vertical grip), Neck Flexion, MedX Row with SS retrofit, Neck Extension, Leg Press.

MedX Overhead Press, Nautilus Plate Load Biceps, Nautilus Plate Load Triceps, EZ reverse Curl, Formulator Flex/Ext, Reclined Seat MedX Leg Press

Wendy WOW:  Negative Only Chin, MedX Chest Press, EZ bar curl, Infimetric Triceps, Barbell Squat-then free squat, Manual Neck Extension/Flexion

Post your WOW’s and let me know your thoughts on the hidden value of hard.

It has been a couple of weeks since I’ve last posted.  Our most recent WOW was performed on 8/24/14.  I was due for shoulders/arms/leg press.  After the Mercola interview, I received lots of requests for how to begin training when you have little or no equipment.  For this reason, Wendy elected to do a minimal equipment workout.  We recorded snippets of video and posted them on instagram at ultimate_exercise_.  Hopefully this will encourage newcomers to just get started and build from there.

My WOW: Thick Bar Overhead Press, Rear Delt Fly, SuperSlow Systems Biceps, Triceps Presses on the SS Systems Pulldown, EZ bar reverse curl, Formulator Flex/Ext, MedX Leg Press in reclined (squat) position

Wendy’s WOW:  Chin Up (regular cadence), Pushups (regular cadence), Lumbar Extension on SS Systems Pulldown, Thick Bar Overhead Press (slow cadence), Goblet Squat holding barbell plate (slow cadence)

Recently Chuck Spencer over at www.go2strength.wordpress.com made a post that resonates with a major component of BBS:  the contribution of skeletal muscle to cardiac function.  Chuck eloquently made a connection that cardiology researchers still have not fully realized: that the loss of skeletal muscle is a major contributing factor in the development of congestive heart failure.  Traditionally, congestive heart failure is thought to occur almost exclusively due to cardiac muscle damage that occurs from coronary artery blockages and resultant death of cardiac muscle.  Congestive heart failure (CHF) is also attributed to damage that occurs when the heart has to pump against elevated systemic blood pressure (left-sided heart failure) or elevated pulmonary artery pressure (right-sided heart failure).

The medical literature has tons of articles discussing the existence of sarcopenia (muscle wasting) in congestive heart failure.  Traditionally, CHF is thought to decrease exercise tolerance, which results in decreased exercise and thus sarcopenia.  There are even articles that show that resistance exercise increases muscle mass and exercise tolerance in those with CHF.  What the medical literature fails to do is to consider is how sarcopenia may be an independent contributing factor in CHF….that pre-existing sarcopenia may induce or make one much more vulnerable to CHF.

Skeletal muscle is “the forgotten pump” in cardiac output.  The reason that skeletal muscle is so integral to cardiac function is because of Frank Starling’s Law of the Heart (http://en.wikipedia.org/wiki/Frank–Starling_law_of_the_heart).  Starling’s Law states that cardiac output is directly proportional to the volume of blood that is returned to the heart.  If a larger volume of blood is returned to the right side of the heart, the ventricle is stretched and the cardiac myocytes are in turn stretched, which causes them to contract more forcefully.  Well, guess what the major determinant of venous return to the right heart is?  You got it…skeletal muscle mass and how hard it is working at any given time.  Through this mechanism, cardiac output can auto-regulate on an almost purely mechanical basis.  So when a large mass of skeletal muscle is working really hard, a large volume of venous blood is massaged and milked back toward the heart, which in turn automatically provides an increased cardiac output to fuel the very muscles that are providing the needed venous return.

Here is another cool thing about skeletal muscle’s contribution to Frank Starling’s Law:  coronary artery blood flow is directly proportionate to the volume of venous return on the right side of the heart.  When a given volume of blood arrives in the right heart, Frank Starling’s Law dictates that this is the volume of blood that will be delivered to the left ventricle, which in turn determines the volume of blood that will be ejected out of the aortic valve into the aorta during systole.  During diastole (the relaxation phase) a portion of the blood ejected into the aorta will backwash into the now closed aortic valve.  At the base of the aorta are three valve leaflets that are now closed and look like a Mercedes emblem.  Two of these leaflets have “ostia” or openings that lead into the left and right main coronary arteries (http://www.vhlab.umn.edu/atlas/aorta/coronary-artery-ostia/index.shtml). Thus we can now see that volume returned to the right heart determines blood ejected from the left heart and thus the amount of blood that will flow through the coronary arteries.  This is the basis for a type of treatment for coronary artery disease and congestive heart failure called “extracorporeal counterpulsation” (http://en.wikipedia.org/wiki/Enhanced_external_counterpulsation).  This system uses air bladders on the legs that contract in synchrony with diastole to enhance venous return and thus improve coronary artery blood flow, collateralizing of coronary arteries and improvement of cardiac function in those with CHF.  Well, guess what does the same thing by the same mechanism?  You got it…resistance exercise.

Am I saying that resistance exercise will prevent coronary artery blockages.  No!  Even someone that follows a very clean diet (insert your favorite) and performs resistance exercise (or cardio or whatever) can still develop coronary blockages for reasons that are still not well understood.  (As an aside, I am becoming more convinced that other elements are at play, such as an infectious process or perhaps alterations in the gut microbiome.) However, if you have blockages, it would be great for there to be lots of large calibre collaterals and a myocardium with lots of physiologic headroom.  So next time someone asks you what you do for “cardio”, tell them that you do high intensity resistance exercise.

Post your WOW’s and your thoughts.


Wendy and I both did our workouts this week.  It has been fourteen days since I posted, so I will list last week’s WOW first.  This was the two-way split that emphasized chest and back:  Lumbar Extension on SS Systems Pulldown, MedX Chest Press, Nautilus Pullover, MedX Chest Press (narrow/vertical grip), SS Systems Neck Flexion, MedX Compound Row, SS Systems Neck Extension, MedX Leg Press.  Videos and photos are available on Instagram at ultimate_exercise_.

Wendy mixed things up a little this week.  Her workout was: MedX Chest Press, Bent Fly as pre-exhaust for, MedX Compound Row, MedX Overhead Press, TSC Adduction/Abduction as immediate pre-exhaust for, MedX Leg Press.  Photos and videos will be posted throughout the next few days at Instagram.

My workout this week:  TSC simple row as pre-exhaust for, MedX Compound Row, MedX Overhead Press, Nautilus Plate-load Biceps, Nautilus Plate-load Triceps, Formulator Flexion, Formulator Reverse Curl, MedX Leg Press. Once again, watch for photos and video at our Instagram site.

This week I am linking a full-text article that I found through Mark Sisson’s “Weekend Link-Love” (www.marksdailyapple.com).  It seems that researchers are jumping on the muscle=longevity bandwagon in a BIG way.  This article is just the latest explaining why muscle is such a good thing to have in abundance.  Apparently there is a “longevity protein” called Klotho that is strongly correlated with both lifespan and skeletal muscle mass.  In this article they show evidence that Klotho is not just correlated with skeletal muscle, but is actually produced by skeletal muscle activity, and that the degree of Klotho upregulation may be proportionate to one’s level of strength and fitness.  Here is the link to the full-text article: http://journal.frontiersin.org/Journal/10.3389/fphys.2014.00189/full.

Finally, my interview with Dr. Mercola went up today.  Immediately, Body by Science dropped to #716 on Amazon, an indication of just how big of an audience he has.  Much of the interview was spent discussing my recent infatuation with all things myokine-related.  I am really pleased with how it came out (except for how my face looks on Skype video).  Check it out here: http://articles.mercola.com/sites/articles/archive/2014/08/10/high-intensity-strength-training.aspx.

Post your WOW’s and your thoughts

Wendy and I both did our workouts today.  Check out our Instagram page :_ultimate_exercise to see some photos and videos.

My WOW: MedX Overhead Press, Bent Fly (jrep halves), Lateral Raise (jrep halves), Thick Bar Curl, Triceps Press, Thick Bar Reverse Curl, Formulator Flex/Ext, Trap Bar Squat

Wendy’s WOW:  Pushups, SuperSlow Systems Pulldown, MedX Overhead Press, Barbell Squat, Manual Neck Extension, TSC Neck Flexion.

I am finally coming out of an extended period of ER work (lots of partners on summer vacation) as well as tons of activity with interviews and phone consults, so I added a few movements and did a Trap Bar squat to finish off.  I feel great tonight, but will report back in the next couple of days.

Speaking of interviews, I have recently finished podcasts with Dr. Joseph Mercola (www.mercola.com), and Ben Greenfield (www.bengreenfieldfitness.com) which should both be up in the near future.  I will try to give a heads up when they go online.  This Thursday I will be doing a live interview (also recorded) with Diana Hsieh, Ph.D (www.PhilosphyinAction.com).  We will be discussing the effects of government controls in medicine in general and emergency medicine in particular.  I am certain some exercise discussion will also take place, but for anyone interested in what the current healthcare landscape looks like from the inside out, check us out at 9pm EST live, or check out the recorded podcast at your convenience.  Finally, I will do an interview with Dave Asprey at the Bulletproof Executive (www.bulletproofexec.com) on September 11th, so keep an eye out for that podcast later in the Fall.

After our workout (and some back to school shopping) we came home and cooked some burgers on the grill.  Afterwards, Wendy and I were talking about what an incredible benefit lifting weights confers.  We marveled at some of the UE clients that were walker-dependent that are now completely independent and with amazing posture.  We have a client that worked out at UE for some time and used it as Prehab and Posthab for bilateral knee replacement and had the fastest recovery her Orthopedist has ever seen.  I marvel daily how Wendy looks better at 50 than she has at any other point in her life.

As we talked further, we discussed the broader public health implications of lifting weights and how one does not need a state of the art training facility with professional instruction to reap the benefits.  I am sure we all remember the early days when we first picked up a barbell and how quickly it changed our lives.  That is the beauty of resistance exercise…skeletal muscle is so adaptable that weight training does not even have to be done that well in order for someone to reap incredible benefits.  I cringe to think of my early form and programming in my parents’ garage with that bronze-colored Sears weight set, but I have never seen such dramatic results in such a short span of time.  The enthusiasm for those early results and the attempt to reproduce them after the early gains slowed, is what drove my study and interest up until this day.  This is why I love reading your comments so much.  There are so many variations in applying effective, safe and time-efficient exercise that newcomers can see there are many ways to garner the stimulus.  We acknowledge that skeletal muscle will produce amazing adaptations regardless of what you have available to you, yet we encourage those who blaze the trail of engineering ideal equipment and refinement in protocols.  So to anyone reading this blog who is considering getting started, all I want to say is….Just. Lift. Weights.  Go to a sporting goods store and buy a 110lb set, or just do freehand exercise.  Use the pamphlet that comes with the set.  Buy any book that appeals to you, I don’t care if it is BBS or if it is “Starting Strength”.  I would highly recommend Drew Baye’s books at (www.baye.com).  Whatever you do, just get started


Special thanks to John Little and our webmaster for fixing the “depreacate” message and updating the WordPress program.  My inability to post has actually been a blessing in disguise as I could blame it all on the malfunction rather than the fact that I have actually been too busy and preoccupied to post.   My hectic schedule has also required me to revert back to a 3 way split where each section gets trained once every 21 days.  Due to scheduling, this workout was preceded by 10 days of recovery.  Wendy was due for her workout and had 17 days since her last workout.  This was purely related to scheduling issues and not due to debates on frequency on the previous post.

My WOW (chest/back):  Chins, MedX Chest Press, Nautilus Pullover with SS retrofits, MedX Compound Row with SS cam.

Wendy’s WOW:  MedX Chest Press, SS Systems Pulldown, MedX Overhead Press, EZ bar Biceps Curl, Pushup, Leg Press, Manual Neck Flex/Ext

With all the changes going on in the medical side of my life, studying for my Emergency Medicine Board recertification (has to be done every 10 years), preparing for podcasts, and doing consults, I have not had time to research a topic for this week’s WOW, but you all seem to have no problems keeping yourselves entertained.  I recently did an hour and a half podcast with Dr. Mercola (www.mercola.com) which should be coming out soon.  On July 22 I will be be doing a podcast with Ben Greenfield (bengreenfieldfitness.com) and I will do a live broadcast with Diana Hseih on July 31st at 9pm EST (philosophyinaction.com) and it will also be recorded.

I have enjoyed the discussions and tone of the blog (for the most part) and always learn a lot from your discussions.  I have referred some of my phone consult clients and Dr. Mercola’s listeners to specific comments and some of your recorded workouts, so….

Post your WOW’s and your thoughts

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