We received a great e-mail message from high-intensity trainer Gus Diamantopoulos (who also provided the charts for our color insert section of Body By Science) that we would like to share with you. Gus owns “The Strength Room” (located on 21 Camden Street, Unit 100, in Toronto, Ontario). Here’s what he had to say:

Much of what we do as high-intensity instructors is impelled by the desired aesthetic improvements in people’s physiques. In fact, if we’re going to be straight up about all of this, I can’t imagine that there are many of us who begin training for any OTHER reason than to satisfy that desire to look like our favorite childhood superhero. But as we get older (and maybe wiser), we can’t help but realize that the true value of high-intensity exercise is in the way that it positively affects our health and improves our basic physiologic functions.

Lip service is often paid to the idea of health improvements through exercise but actual, measurable repeatable results are the true test. Rehabilitation, functional restoration, and addressing the biomarkers of aging is where high-intensity exercise truly shines. And friends, there is nothing (nothing!) that compares to the realization that we have at our disposal the means to literally do what humans have fabled and dreamed of since antiquity: to slow the hands of time for longer, better life. In his article “Fountain of Youth” Dr. McGuff has aptly indicated that we finally have the true ‘elixir’ of youth, health, and vitality, even as we age!

In keeping with this idea of high-intensity exercise as “medicine,” I wanted to share with you exactly the kind of effect proper exercise can have on Sarcopenia and its more malevolent cousin, Osteopenia. With permission from my dear long-time client Marc, the following letter to me from earlier this year crystallizes my point that we can stop and even reverse the ravages of age and time:

Hi, Gus,

As you may remember, I was diagnosed as an osteoporotic around the time I began training with you in 2002. The T-score on my first bone scan that year was -3.5, a very bad number for someone my age. A bone scan in 2003, with a T-score of -3.2, showed a significant improvement. A scan in 2004 came up with the same numbers.

Between the first and third scans, I was using a drug called Fosamax, along with diet changes, calcium and vitamin D supplements, and strength training to manage my condition. After that third scan, partly because of the poor numbers, I discontinued taking Fosamax, out of concerns for negative side-effects associated with use over time.

 Since that time, I’ve continued using diet andstrength training, with the occasional use of supplements, as my only tools to deal with this condition. I had resigned myself to remaining osteoporotic, intent on mitigating its effects as best I could through strength training and diet.

Every year since, when I met with my GP, he’d bring up the subject, imploring me to at least have bone scans. I refused, until this year, and today I had my first scan in five years. The results are as follows:

A T-score of -2.3, which means that I am no longer considered to be osteoporotic!

Now, I want to qualify what I’ve stated earlier. While I say I looked to diet as part of my approach to bone health, I still probably drink too much coffee, consume too much protein and not enough green plant food. As well, often neglect to take my supplements. The only thing I’ve done consistently over all this time is the strength training I’ve done with you. So, to give credit where credit is due, I salute you, Gus.

Many thanks, Marc

 And that, friends, is really what proper exercise is all about!

– John Little

After a few technical glitches, we were finally able to present exercise physiologist Ryan Hall’s excellent graph on the effects of training twice per week versus training once per week. Ryan is one of the top personal

It can take beyond 10 days for muscle to recover and grow from a high intensity workout. Training again before this time can for many people (by no means all people) actually serve to prevent or delay the growth one has stimulated from being produced.

trainers in North America (if not the world), and certainly one of the few who understands the mechanics of exercise down to a cellular level. You can read about his background and his groundbreaking research by clicking on the “Recommended Trainers” icon and scrolling down to his section.

In a related vein, I recall corresponding with Ryan shortly after “The Nautilus North Study” was published (for those who don’t know, we performed a study utilizing a Bod Pod body composition testing machine in order to test when, and to what degree, muscle mass increased after a high-intensity workout and found that for the vast majority it was 7 days, with some outliers — such as myself — requiring some 10 to 11 days to elapse before the benefit from the previous workout was produced).

Ryan informed me of a study that he had included in a lecture that he had conducted some several years previously in which a muscle was deliberately damaged to some degree, either through the injection of a myotoxin or by mechanical muscular work (such as takes place during an intense set of exercise). He shared with me that after such an “event” takes place, the protein content of a muscle is actually reduced (this is determined by the wet weight of the muscle in animal studies). Ryan believed this to be  due to an inflammatory action, such as the consumption and clearing away of damaged or necrotic tissue, and that in the myotoxin injected limb, the muscle mass was reduced to roughly 66% of its baseline weight by day 4. By day 14 (or two weeks later), the muscle had recovered and its weight was back to what it was prior to the administration of the injection. However, it was day 24 before it over (or super) compensated, increasing its pre-injection weight by roughly 10%.  The interesting thing was that, according to Ryan, the physiological response (and processes involved in the production of this response) was the same for the mechanical damage muscle, except the recovery period was somewhat quicker. “Recovery, as defined by the percentage of damaged fibers in a biopsy, was complete within 10 days in the mechanical damage model as compared to 24 days in the myotoxin injected model,” Ryan recalled.  

In other words, recovery from an intense workout was 10 days, and presumably the “growth” stage would follow this period, making the time off between workouts falling somewhere after 10 days had elapsed. This is what I found in the Nautilus North Study as well, again, with the average recovery and overcompensation period (for most subjects) coming at day 7. It is information such as this, and continued research as conducted by trainers/physiologists such as Ryan Hall, that will broaden our understanding of the importance of recovery and the true nature of exercise.

Both Doug and I encourage you to read Ryan’s very informative piece in the “Recommended Trainers” section, and, if you’re fortunate enough to live near his facility, to actually drop by and purchase a workout with him. Ryan’s facility is called “ONE TO ONE Personal Training and Clinical Exercise,” and is located at  735 Octavia St. New Orleans, LA.

– John Little

Two of the forum contributors have uncovered an error in Body by Science.  At the bottom blog post (under Welcome) Marc Pharmacist and Ryan Hall discuss a statement that is in paragraph 1 of page 46.   During a discussion of fiber type characteristics I made a statement that the twitch velocity of fast twitch fibers is actually slower than the twitch velocity of slow twitch fibers.  This statement is WRONG.   Fast twitch fibers actually have a faster twitch velocity than slow twitch fibers, and they usually are innervated by motor nerves that have a higher conduction velocity.  As one reads this section, please make this correction and the remainder of the surrounding text should still make sense.

Despite two rounds of editing before submission I failed to correct this error, most likely because I had it in my head that it was true.  Thanks to Ryan and Marc for pointing this out. 

Aslo, figure 3.3 on page 63 does not have all the detail that it should.  Ryan submitted a correction under the instructors section, but the graphic does not show up.  As soon as we can figure out how to get the graphic to appear on this website, I will post that correction at the top of the blog.  Once all the proper lines are inserted, the graphic is very instructional and shows quite well why we advocate once-a-week training for most subjects.

Once again, thanks to Marc and Ryan, and my apologies for the error.

Doug McGuff, MD

This morning I have scheduled a booksigning at The Barnes & Noble store in Greenville, South Carolina.  The event is scheduled for March 28, 2009 from 2:00-4:00 pm.  The appearance will include a brief lecture followed by a question/answer period and the book signing.  The store is located on Haywood Road across from the Haywood Mall.  I will post reminders as the event gets closer.

I will be giving my first lecture and booksigning this Saturday January 24th at 1:00 pm at the Booksmith in Seneca, SC.   The Booksmith (www.thebooksmith.com)  is located in the Dogwood plaza shopping center.  Anyone in the region, please drop by and say hello.  For those not in the area, I am having the introductory lecture videotaped for posting on bodybyscienc.net.

Also, check out the recent news article posted to the right under “links”.

Doug McGuff, MD

Within weeks of the release of Body By Science we have been inundated with requests from facility owners who wanted to purchase bulk orders of the book. Thanks so much for your overwhelming support of the book and its message of efficient, evidence-based exercise.

For those interested in purchasing bulk orders, our publisher (McGraw-Hill) has advised that all interested parties contact Miss Yin Yin Chan at: Yin_Chan@mcgraw-hill.com.

This workout occurred after 6 days rest.  I have finally pulled back to Sunday for my weekly workout, as UE is filling up quick and it is hard to get into my own place…a good problem to have.

Normally, I do a 3 way rotating split.  However, after a few rounds I will do a two-way split by simply adding leg press to the upper body portions of my three way split.  If I am getting enough rest (not working in the ER too much), I really enjoy the metabolic effect of including the leg press.  Here is what I did.

Med X Leg Press:  upright seat, 3 holes pinned out:  604/2:00, Overhead Press:  seat posn 6, 3 holes pinned out- 340/1:40 rest 10 secs, 1 RP,  Nautilus Plate load bicep with SuperSlow retrofit 60/1:30 plus 1RP, Tricep pushdown on SS pulldown stage reps 70/mid point to contracted to fail, 40/stretch to midpoint to fail,  formulator wrist flex 20/1:30, wrist ext 10/1:20

Elapsed Time=10:50.   Approx total TUL=9:35.  Average rest between exercises=12 seconds.

Today, I feel pleasantly sore.  Not overly tired or hammered. 

Thanks to all WOW posters.  Everyone has a slightly different approach, but it is very illustrative for visitors to this sight to say the numerous ways that great results can be produced with intense, brief, time-efficient workouts.  Lets start posting some video WOW’s soon

Doug McGuff

The other day John Little forwarded me a study from Stanford that concluded that running promoted longevity and preserved functional ability in older age.  He asked me to comment on the study which you can view below:

By ERIN DIGITALE

STANFORD, Calif. — Regular running slows the effects of aging, according to a new study from the Stanford University School of Medicinethat has tracked 500 older runners for more than 20 years. Elderly runners have fewer disabilities, a longer span of active life and are half as likely as aging nonrunners to die early deaths, the research found.

“The study has a very pro-exercise message,” said James Fries, MD, an emeritus professor of medicine at the medical school and the study’s senior author. “If you had to pick one thing to make people healthier as they age, it would be aerobic exercise.” The new findings appear in the Aug. 11 issue of the Archives of Internal Medicine.

When Fries and his team began this research in 1984, many scientists thought vigorous exercise would do older folks more harm than good. Some feared the long-term effect of the then-new jogging craze would be floods of orthopedic injuries, with older runners permanently hobbled by their exercise habit. Fries had a different hypothesis: he thought regular exercise would extend high-quality, disability-free life. Keeping the body moving, he speculated, wouldn’t necessarily extend longevity, but it would compress the period at the end of life when people couldn’t carry out daily tasks on their own.  That idea came to be known as “the compression of morbidity theory.”

Fries’ team began tracking 538 runners over age 50, comparing them to a similar group of nonrunners. The subjects, now in their 70s and 80s, have answered yearly questionnaires about their ability to perform everyday activities such as walking, dressing and grooming, getting out of a chair and gripping objects. The researchers have used national death records to learn which participants died, and why. Nineteen years into the study, 34 percent of the nonrunners had died, compared to only 15 percent of the runners.

At the beginning of the study, the runners ran an average of about four hours a week. After 21 years, their running time declined to an average of 76 minutes per week, but they were still seeing health benefits from running.

On average both groups in the study became more disabled after 21 years of aging, but for runners the onset of disability started later.

“Runners’ initial disability was 16 years later than nonrunners,’” Fries said. “By and large, the runners have stayed healthy.”

Not only did running delay disability, but the gap between runners’ and nonrunners’ abilities got bigger with time. 

“We did not expect this,” Fries said, noting that the increasing gap between the groups has been apparent for several years now. “The health benefits of exercise are greater than we thought.”

Fries was surprised the gap between runners and nonrunners continues to widen even as his subjects entered their ninth decade of life. The effect was probably due to runners’ greater lean body mass and healthier habits in general, he said. “We don’t think this effect can go on forever,” Fries added. “We know that deaths come one to a customer. Eventually we will have a 100 percent mortality rate in both groups.”

But so far, the effect of running on delaying death has also been more dramatic than the scientists expected. Not surprisingly, running has slowed cardiovascular deaths. However, it has also been associated with fewer early deaths from cancer, neurological disease, infections and other causes.

And the dire injury predictions other scientists made for runners have fallen completely flat. Fries and his colleagues published a companion paper in the August issue of the American Journal of Preventive Medicineshowing running was not associated with greater rates of osteoarthritis in their elderly runners. Runners also do not require more total knee replacements than nonrunners, Fries said. 

“Running straight ahead without pain is not harmful,” he said, adding that running seems safer for the joints than high-impact sports such as football, or unnatural motions like standing en pointe in ballet.

“When we first began, there was skepticism about our ideas,” Fries said.  “Now, many other findings go in the same direction.”

Fries, 69, takes his own advice on aging: he’s an accomplished runner, mountaineer and outdoor adventurer.

Hanging on his office wall is a photo he jokingly describes as “me, running around the world in two minutes.” In the dazzling image of blue sky and white ice, Fries makes a tiny lap around the North Pole.

Fries collaborated with Stanford colleagues Eliza Chakravarty, MD, MS, an assistant professor of medicine; Helen Hubert, PhD, a researcher now retired from Stanford, and Vijaya Lingala, PhD, a research software developer.

The research was supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and by the National Institute on Aging.

# # #

John asked me to comment on the researchers’ conclusions, but I find commenting on the methods more illustrative of what is wrong with this study.  This study incorporates a very common thinking error that leads many of us to improper conclusions.  It involves embracing a type of bias called survivorship bias.   The methodological flaw in this study is there is no randomization.  The subjects in the experimental group were long-standing runners who were active runners at age 50.  The study ignores the “graveyard” of people who used to run but quit before they turned 50 because of injury or illness that could have been related to the “treatment” being studied.   The study also fails to recognize that the strong survivors are still actually weakened by the activity logging less running time and being more debilitated (though less debilitated than those that self-selected themselves to “the graveyard”).   Author Nassim  Taleb discusses this concept in his book The Black Swan under the heading A Health Club for Rats.  Since Taleb covers the topic so much more elegantly than I could ever hope to, I will quote excerpts below.

…”I came across an article discussing the mounting threat of the Russian Mafia in the United states…The article explained their toughness and brutality as a result of their being hardened by their Gulag experiences.  The Gulag was a network of labor camps in Siberia where criminals and dissidents were routinely deported…Many deportees did not survive these labor camps.

Hardened by the Gulag?The sentence jumped out at me as both profoundly flawed (and a reasonable inference).  It took me a while to figure out the nonsense in it since it was protected by cosmetic wrapping; the following thought experiment will give the intuition.  Assume you’re able to find a large, assorted population of rats: fat, thin, sickly, strong, well-proportioned, etcetera…With these rats you build a heterogeneous cohort…You bring them to my laboratory…and we put the entire collection in a large vat.  We subject the rats to increasingly higher levels of radiation.  At every level of radiation, those that are naturally stronger (and this is the key) will survive; the dead will drop out of your sample.  We will progressively have a stronger and stronger collection of rats.  Note the following central fact: every single rat, including the strong ones will be weaker after the radiation than before.

An observer endowed with analytical abilities, who probably got excellent grades in college, would be led to believe that treatment in my laboratory is an excellent health-club experiment, and one that could be generalized to all mammals (think of the potential commercial success).  His logic would run as follows:  Hey, these rats are stronger than the rest of the rat population.  What do they seem to have in common?  They all came from that Black Swan guy Taleb’s workshop.  Not many people will have the temptation to go look at the dead rats.

Next we pull the following trick on The New York Times:  we let these surviving rats loose in New York City and inform the chief rodent correspondent of the newsworthy disruption in the pecking order in the New York rat population.  He will write a lengthy (and analytical) article on the social dynamics of New York rats that includes the following passage:  “Those rats are now bullies in the rat population.  They literally run the show. Strengthenedby their experience in the laboratory of the reclusive (but friendly) statistician/philosopher/trader Dr. Taleb they…”

Dr. Taleb’s analysis of this article perfectly parallels the flaws in this study.  The study selected long-standing runners who were fairly advanced in age and only then began any longitudinal followup.  In essence only the stronger rats who had already survived significant radiation doses were followed.    The author himself is a dedicated runner and endurance athlete, which could even compound the selection bias and the author’s own blindness to it.  Even more importantly, this sort of bias is most profound when the supposed beneficial intervention is most harmful.  This has been born out in many recent drug cases where medicines that were supposed to improved long-term functioning in survivors and then later investigations of the raw data found that the drug was simply killing the patients with more severe disease, making their survivors appear healthier.  I won’t mention what drugs this has happened with, because you saw what happened to Dr. Richard Kimball (played by Harrison Ford) in the movie The Fugitive.  

Once again, Nassim Taleb drives this point home much more clearly than I in the quote below:

“There is a vicious attribute to the bias: it can hide best when its impact is largest.  Owing to the invisibility of the dead rats, the more lethal the risks, the less visible they will be, since the severely victimized are likely to be eliminated from the evidence.  The more injurious the treatment, the larger the difference between the surviving rats and the rest, and the more fooled you will be about the strengthening effect.

The cognitive errors in this study are so bad that (in my opinion) it should not have passed peer review and been published.  It is always fun to look at a studies funding source.  In this case The National Institute of Arthritis and Musculoskeletal and Skin Diseases.  This institute exists becauseof the existence of arthritis and musculoskeletal disorders.  In BBS we cite studies that show running increases the risk of arthritis, musculoskeletal disorders and skin cancer.  While not a conscious deception I’m sure, this does seem kind of like the dentist that gives out lolly pops to kids after their appointments.  In conclusion, I told John that this study may well prove exactly the opposite of what it suggests.  To any readers of BBS, I would suggest reading Dr. Taleb’s Fooled by Randomness, and The Black Swan.   Both books highlight cognitive errors that are common in research and that can lead your training astray.

Doug McGuff, MD

On my last post I intended to post my workout of the week (WOW).  I did this yesterday which was 6 days from my last workout.  I am gradually trying to pull back to doing my workouts on Sunday as Ultimate Exercise has been very booked up.

I sort of threw this workout together, as I had to squeeze it in between two client appointments.  It is slightly more volume than usual.  I was feeling frisky and wanted to throw in the leg press for a good metabolic effect.

The workout was as follows: (wt/TUL)

Med-X leg press:  pinned out 3 holes 760/1:45.  Nautilus Pullover with SuperSlow retrofits: 200/1:37.  Med-X compound Row with SuperSlow retrofits: 320/1:40.  SuperSlow Systems pulldown (NO CAM): 140/??. Med-X Chest press: 380/1:15—partials at 180/??.  Total elapsed time= 10:02.

Today, I feel pleasantly sore in the muscle groups worked.  I feel good and energentic.  Despite the slightly higher volume, and 6 days recovery instead of 7, I don’t have that “run over by a truck” feeling that can come with adding volume.  This is probably accounted for by being off from the ER for several days.  Of all the things in my life, a tough ER shift has the biggest adverse effect on my recovery.

Please post your own WOW’s if you are so inclined.  In the future it would be fun to video post various WOW’s.

Doug McGuff, MD

This represents my first ever attempt at blogging. I have been wanting to get some content up on bodybyscience.net, but have been so busy with the book’s release that I have run out of day before I can put anything up.

I would like to thank all the well-wishers who have called, posted on the message boards and left comments on Amazon etc. Your encouragement means a lot to me (and to John as well).

Yesterday I was occupied with speaking with friends and facility owners around the country trying to arrange lectures and booksignings. I also spent time signing books for all of my wonderful clients at Ultimate Exercise.

Appearances scheduled to date include: January 24, 2009, 1pm at the Booksmith in Seneca, SC 283 Market Street, 29678. Phone: (864)885-0872. web: www.thebooksmith.com.

January 31, 2009, 1pm at the Open Book in Greenville, SC at 110 South Pleasantburg Dr. 29607. Phone: (864)235-9651. web: www.theopenbookonline.com.

February 10, 2009, 7pm at the Inside Outside Spa. 4499 Medical Drive #225 San Antonio, TX 78229. Phone: (21)616-0586. Medical Director: Charles Christian, Jr. M.D. Web: www.insideoutsidespa.com.

February 11, 2009, tentatively 7pm at Efficient Exercise Jollyville, 11602 Jollyville Rd. Austin, TX 78759. Phone: (512)795-0101. Web: www.efficientexercise.com.

In the days to come I look forward to addressing some of your comments and delving further into training issues. John Little has forwarded a study on the benefits of running that he wants me to comment on and that will be upcoming.

If there are any facility owners who would like to try to arrange appearances/lectures or booksignings please leave an email under comments and I will forward them to our publicist. Given the business of my schedule ER, UE, family, and BBS- I can’t do them all, but I will do what I can.

Once again, thanks for checking in on bodybyscience.net. Keep checking back for additional comment.

Doug McGuff, MD