strength

The Stress Cup and Allostatic Load

August 4, 2016 By Dr. Chris Hardy 5 Comments

The Stress Cup Metaphor

This is the second in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series.

The Stress Cup is a visual representation of allostatic load, the total amount of stress. In the example above, the cup is pretty full—can you relate to it? We have a little space left at the top, and if you can stay within your stress cup without overflowing it, you can achieve a positive adaptation to your training.

Let’s assume my trainer says he has a great workout for me today: limit squats for four or five sets then full sprints afterwards. That might sound awesome, but the stress from the workout he planned for me might overflow my already full stress cup. Can my body successfully adapt to a training challenge that also over-filled my stress cup? No, I will experience allostatic overload. And, this failure to adapt will cause a huge stress response as the body and brain attempt to adapt. If this happens over and over, it will cause serious, deleterious health consequences far beyond an overtraining situation.

Allostatic Load and Daily Training

Undertraining is not enough stimulus for adaptation. The green area on the chart below indicates acute overload—a good workout session with good adaptation. Not much recovery will be needed. But, many times we will overreach with a session that pushes past our limits. While we can still experience good performance enhancement and positive adaptation, we must be cognizant of our recovery, which will take longer. Last, there’s overtraining, and since we can’t adapt to it we will have decreased performance and sometimes a very lengthy recovery period.

Training Stimulus Continuum

Too much overreaching without adequate recovery becomes overtraining syndrome, a medical condition. Overtraining syndrome is a prolonged imbalance of training load and recovery. For example, we might have a great session then rest for a day, then we hit it again and realize we need to rest more—but instead we do max deadlifts with no recovery. Basically, this will cause the stress cup to continually overflow since we have not allowed for recovery and have accumulated training load over time.

Overtraining syndrome is a big deal. If you truly have it, it can take months for a full recovery. While it happens more in elite athletes, it can happen with your clients, because they have other sources of stress beyond their training. Think about allostatic load and overtraining as the same thing. Your client might constantly have a high cortisol level because their stress response is over reactive. High cortisol for a long period of time is bad for body composition and general health.

A good coach should be able to spot the following problems early: fatigue, decreased performance, increased resting hart rate, insomnia, irritability. The stressed out brain starts overreacting. For example, if someone makes you mad at work instead of a calm conversation you snap at them—that’s the overstressed brain being more animal-like and it happens with overtraining too.

Remember, the brain is trying to protect you. So, if you feel like you shouldn’t be training, then listen and learn to spot this with your clients. Overtraining begins at this stage with a very animal-like dominant sympathetic system. Over time, if you don’t listen, your body can even become resistant to the fight or flight response. Parasympathetic overtraining means that you’ve dug such a deep hole for yourself that you can’t even raise your heart rate. I’ve heard of cases when people have needed one to two years to fully recover—and that’s not an exaggeration. It’s more than just your athletic performance, long-term failure to successfully adapt is the same as the long-term allostatic overload seen in all these conditions. In medicine, this is a new concept and new way of looking at chronic diseases.

Now, the mechanism—and this is in Strong Medicine as well—is that if your stress cup is overflowing for long periods of time, you are also generating inflammation or oxidative stress. Oxidative stress is an excess of free radicals or reactive oxygen species—and they drive chronic diseases. But if you’ve maintained your stress cup, even though you still get inflammation and oxidative stress from exercise, it will be short term and you will adapt to it. You need inflammation and oxidative stress to heal injuries, and for your immune system to respond to infections. Correctly dosed exercise can really be the fountain of youth.

Overtraining is catabolic. If your clients want to lose body fat and gain muscle, overtraining does the opposite. Excess cortisol wastes muscle and puts body fat in unfavorable places. The term “skinny fat” describes someone with low muscle mass, and low weight, but they look soft around the middle. Your clients don’t want that and you’ll need to educate a client who wants to try losing weight by eating an under 500 calorie a day diet while getting mashed under a high intensity exercise program. While they will lose weight with that plan, much of that weight will be muscle mass.

It’s important to keep in mind that we are all individuals with different issues filling the stress cup. Who are you training? It might sound intrusive, and your clients might wonder why you want to know about your stress, but it is important. You must know who are you training and what’s filling their stress cup. There are variations in what’s filling it, and there are many different sized stress cups.

This chart is inspired by Starbucks. You can categorize your clients into a stress cup size. If they’re on the small side of the chart, they’re vulnerable, and you won’t be able to do a whole lot with them right now. Then on the other side, there’s a 20 year old who can go drinking all night ,and train hard the next day with no problems because their stress cup is huge. …But it will shrink if they keep doing that!

For example, let’s compare the 20 year old and a 40 year old stressed out executive. If I am a trainer who wants to do a cookie cutter (one size fits all) bootcamp workout, the 20 year old will have no problem with room to spare. But it will be too much for the 40 year old. Is your client vulnerable or resilient? It’s really important to figure out who you are training. Even if you have a smaller stress cup or are older, it doesn’t mean you can’t still perform at high levels. There are the Mike Gillettes, and Marty Gallaghers out there and many others in the room who perform at high levels—but they often need more recovery than when they were 20. But there’s some good news, through exercise you can slow that progression down significantly. Greater resilience is the picture of healthy aging. We can also reverse the process. Over time with smart training at the correct dosing, we can slowly build the size of the stress cup to an extent.

But the largest cup on the chart is not the norm. The small crumpled stress cup on the other side of the chart is the sad truth I face very often in public health. Many people of the general public are dying in their 60s and even earlier. These are the people we need to help. Sure it’s great to train an athlete who wants to enhance their performance, but you can really make a drastic impact on public health by training everyday people. Unfortunately, the medical profession is not doing it—they’re managing diseases, not preventing or reversing them.

Estimating the size of someone’s stress cup is not an exact science. If someone has high stress, a chronic disease, poor sleep, and very little exercise, we can assume he has a small stress cup (or “Tall” on the Starbucks chart). Another example might be a 45 year old female and the only reason she’s a medium (“Venti” on our chart) is that she’s 45. But otherwise she has minimal work stress, good sleep, no diseases, mediates regularly, and has a high fitness level. We intuitively know that we can’t train both of these clients the same way.

Hormesis

Before we discuss exercise and recovery doses, we take a little step back and talk about the concept of hormesis. I learned about hormesis from my toxicology training—a small dose of something might be beneficial, but the same thing at a higher dose could be harmful or cause death. Radiation is a perfect example. Lose dose radiation accelerates DNA repair—it helps our cells regenerate and repair themselves. But, high doses of radiation can kill us.

The famous quote is from Paracelsus in the 16th century. The chart below simply shows that when we go from left to right, the challenge increases. For our example, exercise, it isn’t really classic hormesis because doses that are too low are also bad. But there’s also a nice middle dose that’s “just right”, but as we continue to the right, the dose increases and begins to cause problems. In the example of exercise, point A represents a sedentary person who has very little physical activity. As we go right there’s an optimum dose that’s giving good effects, but if we keep going, overtraining occurs and can cause problems. The example can be made with food—under nutrition at point A, perfect the right amount of calories and the right kind of food at point B, and point C is over nutrition which we see all the time.

Hormetic Window Chart

The hormetic dose is the ideal dose leading to beneficial change/positive adaptation. Much like pharmaceuticals, prescribing the correct exercise dose is crucial. Consistent under dosing leads to no progress—you need enough exercise to promote positive adaptations. And overdosing leads to overtraining. Exercise is more powerful than any pharmaceutical across the board. Pharmaceuticals just manage diseases, while you can reverse chronic disease and improve health with exercise. As a trainer, you should place as much importance on prescribing exercise, and think about it as seriously as a physician does with pharmaceuticals.

***

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Strength After Sixty – Resilience Against Frailty: Part II

May 21, 2015 By Dan Cenidoza 15 Comments

If we look at the physical aspects of frailty as discussed in Part 1 of this article, it is evident that the strength, mobility and stability of the musculoskeletal system declines as we age. Exercise is the only remedy for this. There is no pill you can take to move better or become stronger. With the proper training, movement and physical strength can be restored, and maintained, at any age. If you are young, consider strength training as part of your retirement planning. If you are old, better get started now.

This article will discuss some of the basic activities of daily living (ADLs) and exercises that best support them. The exercises can be scaled to be appropriate for anyone, regardless of their current physical condition.

Rising from a seated position to standing (and vice-versa) and walking are foundational ADLs. We will assume that our hypothetical trainee can stand and walk, but not much more (injured or wheelchair bound individuals will be discussed in another article). From a strength coach’s perspective, we want to strengthen and improve the ADLs of the sitting to standing transition as well as walking. Squats are the most high-yield exercise to achieve this goal. “Bad knees” and “bad backs” are the most common reasons trainees give to avoid squatting. Properly instructed squats with thoughtful progressions can often surmount these obstacles and get an aging trainee squatting safely and pain free.

Many older trainees may have been told by their physicians (who most often have no strength training background) that they should never squat. It is probably a safe bet that their doctor has not told them that they should never get out of a chair or rise from the toilet seat. Squatting is a fundamental movement for these crucial daily activities. The best starting exercise to train standing from a seated position in senior fitness circles is called “chair stands” (“box squats” in powerlifting).

Box squats allow for this important movement to be performed at varying ranges of motion. Typically, the greater the depth of a squat, the more strength, mobility and stability are tested. A lack of any one of those things could compromise how deep a person could and should squat. For the lowest functioning individuals, we will use double stacked chairs and do bodyweight squats; for the high functioning individuals, we will do full squats with added weight.

Case Studies:

Mrs. Ethel was a 92 year old woman with severe kyphosis (aka hunch back). She walked using a walker with her head looking straight down. Her posture was so bad that when you passed her in the hallway she had to turn to the side to look up at you. Mrs. Ethel could barely stand even from a double-stacked chair, so that’s where we started. She was challenged to not use her arms to assist, to stand a little taller at the top of each rep and descend under control (no “plopping”). A sticky note was placed on the wall in front of her to look up at, and it was gradually raised higher over the course of her program. She would probably never stand completely upright again but we countered the effect gravity was having on her with simple cues like “stand tall” and “look up”. As her leg strength increased we moved to a single chair (lower starting position); first allowing use of the arms for assistance and then without. With 20 repetitions being her “max” she never needed an additional load.

Compare this to Mr. Frank, a 85 year old man who exercised regularly since he left the military 50 years ago. He could squat to below parallel and his range of motion was limited only by arthritic knees and his preference for biceps curls instead. He could also maintain proper form under a load. Although shoulder mobility might prevent him from holding a barbell behind his back as in a true powerlifting squat, dumbbells and kettlebells could be held as a front or goblet squat. Mr. Frank has more options available to him for progression as he could safely increase weight, repetitions and on good days even try to go lower (albeit with less weight).

By squatting deep and with a load, we can improve the strength, mobility and stability qualities required to stand up and walk. Appropriate squat depth and load will vary significantly with each individual. It is helpful to remember the concepts of hormesis and allostasis covered in the beginning of Strong Medicine when deciding on the proper “dose” for squatting. With these concepts in mind, proper dosing can be successfully prescribed by the fitness professional well-versed in squatting mechanics (see Marty Gallagher’s previous article on the squat for a master class). The squat is a basic human movement that you will need to do for the rest of your life if you plan to be independent into old age. Performing this exercise regularly will not only maintain strength, but also develop both the mobility and stability that is crucial for preventing frailty.

The other exercise that translates extremely well to ADLs for the senior is the deadlift. This deadlift is one of THE best cures for osteoporosis. The deadlift and the partial deadlift allow for heavier loads to be used to maximize bone density and prevent muscle wasting. Deadlifting is a pure strength movement that can be scaled to the senior population. This lift is based on the hip hinge movement and contrary to idea that deadlifts are “bad for the back”, a proper deadlift can rehabilitate a weak back. Neurosurgeon Patrick Roth, M.D. prescribes a kettlebell deadlift as part of his spine rehabilitation program in his excellent book The End of Back Pain.

There is a deadlift variation that is appropriate for anyone. For some a load is not appropriate at first, but everyone should be taught the hip-hinging movement central to the deadlift. Arguably, the hip hinge should even be taught before the squat, especially considering that squatting “starts” at the hips.

Another benefit to the deadlift is that it has a shorter range of motion, making it safer for more people. It is also a less technical movement, making it easier to learn. A good coach can teach the hip hinge and tell when individuals are ready to progress. Again, progressions can be made in the form of additional load or greater ROM. As a rule, I use where the wrist falls on the body during the exercise to determine where people can safely pull from. If technique can be maintained to a point where the crease of the wrist passes the knee for instance, then the trainee can pull from there. Setting up at this height will allow for a 2-3 inch “buffer” so the lifter is not pulling from his/her end-ROM.

Paula Hip Hinge — *Paula is able to maintain a neutral spine to a point where her wrists touch her knees in a hip hinge movement, thus making a knee-height partial deadlift a safe range of motion for her.*

A brief note on set up.

Any powerlifter reading this will know how to set up a power cage for rack pulls. To pretty much everyone else reading this those last few words are foreign, especially to your average 60+ year old exerciser. This is unknown territory that can be downright frightening to some people. Fortunately there are machines that allow set up for partial deadlifts with adjustments as simple as pressing a button. Many senior centers are equipped with pneumatic or computerized machines to allow user friendly solutions to older adults. Unfortunately you will see few “racks” in these centers. We can speculate on why that is the case (i.e. liability, funding, misuse, lack of qualified personnel, etc) or we can make a call to action for fitness centers to offer deadlifting options. The importance of real weight bearing exercise to combat sarcopenia, osteoporosis and frailty syndrome cannot be overstated. Partial range of motion deadlifts must be made available to the population who are at most at risk if we are to reinforce our position against frailty. If this means expensive equipment or powerlifting coaches posted by the powercages in every senior center, so be it. The cost of equipment is minimal and justified by the potential for improving the quality of life and avoiding catastrophic injuries such as hip fractures from falls.

Paula Power Rack Lift — Paula has moved out of osteopenia and into normal range bone density at 57 years of age. Here she is working on her retirement plan making strength deposits with 225lbs, pulling from the rack for a safe range of motion to maintain pristine technique for her current mobility.

Aging is a process that we all face. Strength training is a necessary component to aging successfully, but we need effective methods. So much of senior fitness boils down to the end goals of standing tall, and standing strong. We need the right balance between mobility and stability, and for most of us, strengthening the posterior and stretching the anterior. When properly programmed, the squat and the deadlift address the core activities of daily living for the senior. These two exercises alone give people a simple approach to not just exercising, but improving the quality of their lives. Humans are meant to lift weight and load their bodies. If we can get more intersection and synergy between the powerlifting community and the retirement community, geriatric health and senior fitness will flourish.

****

Dan Cenidoza, BS, CSCS is a personal trainer, professional strongman and owner of Art & Strength in Baltimore, Maryland. He has a degree in exercise science and specializes in kettlebells and strength & conditioning. His mission is to instruct and inspire people to live stronger, healthier lives. artandstrength.com facebook.com/artandstrength

How to Squat: Re-learning the Ultra-Basics You Never Learned to Begin with…

May 7, 2015 By Marty Gallagher 20 Comments

Goblet Squat

As my old powerlifting coach used to say about squatting, “If it’s excruciating, you’re likely doing it right.” He was addressing the idea that there is a fair amount of discomfort involved with proper squatting. Note I didn’t say “pain.” The word pain is so loosely used in fitness and it has lost its meaning. When the meatheads say, “No pain, no gain!” What they really mean to say is “there should be a certain amount of physiological discomfort accompanying most any effective progressive resistance exercise. When we exert maximally, as we should, there is discomfort, and it can be intensely “uncomfortable.” But our factual explanation doesn’t sound near as taunt or sexy as No Pain! No Gain!

Pain is accidentally slamming your hand in a car door or cutting yourself while dicing onions: grinding out the 5^th rep of a result-producing hypertrophy-inducing set of goblet squats is extreme discomfort – not pain. We learn how to exert maximally without need to self-inflict a hernia or a stroke from strain. We need learn how to exert maximally, yet exert safely. There are three rules to remember when it comes to exerting with maximum effort in any hardcore progressive resistance training exercise….

Push or pull evenly and always stay within the precise technical boundaries: most weight training injuries occur when the lifter strays outside the proscribed techniques for the specific exercise. We have archetypical techniques for all the major and minor exercises. Adhere as closely as possible to these technical ideals. The lifts are archetypical because the leverage is optimal and the push/pull position stable.
Never twist, heave, contort or jerk on a weight: real iron pros use a smooth application of power to attain 100% (or more) of capacity. Push or pull maximally while braced internally; tight and muscled, exert with great deliberation and evenness. Those that break form, usually to slip or slide through a sticking point, get injured. Nothing gets you hurt quicker that jerking or contorting or trying to be cute with maximum poundage.
Learn how to miss a rep safely: those that lift long enough and lift heavy enough will sooner or later miss a repetition. No big deal on a standing curl using a 60-pound barbell; it can be a very big deal if you miss the 5^th rep in the back squat ¾ of the way up with 315 draped across your neck. There are real safety issues: hardcore resistance training can be injurious.

Stance: the first step in learning how to squat is “playing with” the squat stance width. The goal is to find a width that allows the squatter (you) to descend and ascend while adhering to our technical ideal: we seek to squat with vertical shins and a vertical torso, ideally only the femurs move as we rise and fall; moving with great deliberation and precision over an exaggerated range-of-motion. Every one has an ideal stance width that allows us to attain and maintain this signature squat stance width technique.

More than likely, when you find the correct stance width, one that allows you to sit upright in a bottommost squat position, when you go to arise, you will be weak as a kitten, likely unable to arise from the ultra-deep relaxed squat position without breaking form or without some sort of assistance. We do nothing in the course of living our normal lives that gives us power and strength in this extremely disadvantaged position.

However, by identifying the archetype, by finding that stance width particular to you and your particular bodily proportion, you are now ready for the next step: strengthening our legs by concentrating all our effort at getting stronger in this one very specific exercise, done a very specific way. Maximal squat difficulty results in maximum squat benefit: that which does not kill me makes me stronger – and gives me powerhouse, tree-trunk legs. So we squat using this weak-as-a-kitten stance and we hammer away and improve, one excruciating squat session at a time.

Self-administered forced reps: our squat motto is, “better to fail with integrity than succeed by breaking form.” Other squat school teach ways in which to slip and slide past squat sticking points: the easiest way in which to make squats easier is to make them “shallow,” barely dip down, barely bend the knees on each rep. This strategy could be summed up as, how do we “make heavy weights light,” whereas our philosophy is to use strictness, extreme ROM and other “intensity enhancers” in order to make “light weights heavy.” We say, don’t avoid sticking points, seek them out; slogging through sticking points is where the gains lie.

The dilemma for the athlete new to this weak-as-a-kitten stance width is how do I train? What do I do and how do I do it?

Initially, very few people are able to perform more than one or two super-strict ultra-deep bodyweight squats using the wider stance. The solution is not to shorten or “fudge” on the squat depth; rather than compromise on the technique, the solution is to squat perfectly but with assistance. How do we do that? We start with bodyweight squats and in order to attain perfection on every rep, give yourself as much “arm assistance” as is needed to enable you to perform a perfect squat rep on every single rep.

You might need to give yourself a little help, you might need to give yourself a lot of help, on some reps you might not need to give yourself any help – whatever is needed, to whatever degree, should be used to ensure that technical perfection is adhered to on each and every squat rep. We swear allegiance to the technique: poundage and muscle invariably comes in time.

The self-administered forced rep: Stand in front of a vertical pole or in a door frame. Place the hands at waist height on the pole and squat down. At the bottommost point, sit erect and come erect; pull upwards with the hands with as much force as is needed to assist your thighs. Complete the assigned reps for the set. All the reps might need varying degrees of assist, but all the reps were technically perfect.

Self-Assisted Squat

Perfect sets of five: the iron elite, top strength athletes, loves the five-rep set. A balls-to-the-ball set of fives strikes the perfect balance. At one extreme is the sarcoplasmic inflation associated with high, 10 to 15 rep sets. At the other rep extreme are the pure strength attributes associated by performing heavy triples, doubles and singles.

The kettlebell or dumbbell goblet squat: we seek to find the optimal stance that allows us to adhere to our bodyweight squat technical archetype. Over time we worked up to 3 sets of 10 perfect ultra-deep bodyweight squats. Time now to up the ante: a person could choose to continue down the rep road, perhaps work 3×10 in the bodyweight squat up to 3×15 and eventually 2×20. However, past 10 reps and we veer out of the realm of absolute strength and into the realm of strength-endurance; suffice to say, higher reps invoke a different physiological effect. Here’s how we break into “real” goblet squatting using poundage…

Session	Payload	Sets and Reps
1.	10-pound dumbbell	3 sets of 3 reps
2.	“ “	3 sets of 5 reps
3.	“ “	3 sets of 8 reps
4.	“ “	2 sets of 10 reps
5.	15-pound dumbbell	3 sets of 3 reps…repeat the process

This is a basic periodization (preplanning) approach to squatting.

Goblet Squat Hell: making light weights heavy- a properly performed set of ultra-deep goblet squats will tax even the seasoned competitive back squatter. Goblet squat technique has to be exacting if results are to be optimal…

Tuck the dumbbell or kettlebell tight under the chin and tight to the torso
Inhale as you descend, initiated with a hip hinge and knee bend
Do just free-fall, pull yourself downward, contract hams and glutes
As you lower down and hit parallel, exhale, relax and sink further
Maintain an upright (though relaxed) torso; don’t’ collapse forward
Relax the leg muscles and allow the weight to push you downward
Knees are pinned out, shins are vertical, torso erect, position is perfect
Pause briefly
Time to rise up out of the bottom
Start the rep maximally relaxed and “pre-stretched”
In the bottommost position, inhale, push down with feet, knees pushed out
Transition from relaxation to generating maximal tension before movement out of the bottom
Optimally, while arising, nothing changes except the upper thighs, opening the angle relative to the upright torso (ie the butt does not rise before the torso starts to move)
The squat rep ends in a “hard” lockout at the top

The lifter then inhales and commences the next rep…

The editor demonstrates the ultra-deep goblet squat sequence: Photo #3 shows the bottom position with tension maintained. Photo #4 shows the new bottom position after exhalation/relaxation. Notice how the gluteals drop further in relation to the rock in this photo. The few more inches of depth results in significantly more physical demand to rise “out of the hole” during the ascent. This translates into a bigger neuromuscular load and resulting adaptive response.

King Squat: The ultra-deep goblet squat, done deep and upright, will tax the mightiest of squatters: a good rule of thumb, a strong squatter, say a man capable of 315 for five reps, ultra-deep back squat without gear will be mightily taxed by a single 75-pound dumbbell in the 5-rep goblet squat. Let us ponder this for a moment and soak up the implications.

Riddle me this: a strong man is taxed maximally by goblet squatting a 75-pound dumbbell for five excruciating reps. That same man is taxed maximally front squatting 185-pounds for 5 rep and has to exert, all out, in order to make 255 for 5 reps in the hi-bar back squat. So here is the question – why bother to front squat or back squat? If all three squat variation are equally difficult, and, more importantly, that the results obtained from each is identical, then somebody please remind me why I am messing around with a 250-pound barbell on by shoulders?

If results from the three technically identical, equally taxing squat styles are identical, then henceforth why not just stick to ultra-deep goblet squatting with a lone, modest-sized dumbbell tucked up under my chin?

Current Best	High-Bar Back Squat	Front Squat	Goblet Squat
	155 x 5 reps	95 x 5 reps	40 x 5 reps
	205 x 5	115 x 5	50 x 5
	275 x 5	205 x 5	75 x 5
	315 x 5	255 x 5	85 x 5
	365 x 5	275 x 5	100 x 5
	405 x 5	315 x 5	120 x 5

These are realistic “spreads” between the three types of squatting; a balanced lifter executing their squats as technically intended will exhibit the balance shown above.

What if? So here is the tantalizing question: what if the man capable of (initially) performing 50 x 5 in the ultra-deep goblet squat, and ergo, is also capable of a 115×5 paused front squat and a 205×5 capacity in the back squat. What if, over time, that same athlete worked their goblet squat from 50 x 5 up to 100 x 5? Let us further assume the lifter works the goblet squat exclusively. Now here is the question: that lifter originally had lifts of 50 x 5 in the ultra-deep goblet squat and that level of strength normally indicates 205 x 5 in the back squat and 115 x 5 in the front squat. If he successfully works up to 5 perfect goblet squats with a 100, does that mean that he also is capable of 365 x 5 in the back squat and 275 x 5 in the front squat, all as a result of radically increasing his goblet squat capability?

Would that not be profound? We would be able to use smaller, much more manageable payloads in ways so clever and so excruciating as to be maximally effective. Why go to the trouble of handling a barbell quadruple in weight? If results are equal, I myself would prefer to wrestle with a kettlebell or dumbbell held in front of me, not on me or above me. If we need to bail mid-rep (it happens occasionally when you push with all your might) you simply drop the dumbbell or kettlebell on the ground in front of you.

If you do them right, on the final reps of a top squat set, it feels as if the blood in your veins is chemically transforming into gasoline and a spark ignites the gasoline; your veins have fire coursing through them, searing lactic acid sets the squatters thighs on fire. No pain, no gain! (That rolls off the tongue so much better than, “No discomfort, no hypertrophic-adaptive response!”)

Editor’s note:

Many of you may think the exhalation and relaxation at the bottom of an ultra deep goblet squat is technique sacrilege. Keep in mind that we are using very light poundage and any posterior pelvic tilt with exhalation at the bottom will not put you at risk of spinal injury, especially if you keep your torso vertical. The idea is to place you at a very mechanically disadvantaged position from which to start the squat ascent, at a depth most of you have not achieved at the bottom of a squat. A controlled ascent using pristine technique from this deepest of bottom positions is what makes “light weights heavy” and gives a potent neurological stimulus for growth with minimal risk of injury. Check your egos at the door and try the ultra deep squat cycle that Marty has prescribed starting with bodyweight only and progressing to the goblet squat. Going back to your traditional squat depth and technique after this program will seem like commutation of a life prison sentence. You will emerge stronger and more resilient.

***

Marty Gallagher is the author of Strong Medicine, The Purposeful Primitive and Coan: The Man, The Myth, The Method. Gallagher coached the United States team that won the IPF powerlifting world team title in 1991. He is a 6-time national masters champion and national record holder. He was the IFF world master powerlifting champion in 1992. He currently works with elite athletes, spec ops military and governmental agencies.

Strength After Sixty – Resilience Against Frailty: Part I

April 30, 2015 By Dan Cenidoza 16 Comments

Strength After Sixty

The topics of osteoporosis, sarcopenia, and the frailty syndrome are extremely important for anyone over the age of 60 or anyone planning to be in the future. This article will look at the need for preventative measures, the means to healthy aging of the musculoskeletal system, and the steps you can take to ensure that you will live out your years on this earth strong and physically capable.

Osteoporosis is a well-known condition involving decreased bone density with aging that most people are familiar. Sarcopenia is a disease of muscle loss and weakness that is the lesser known evil-twin of osteoporosis but just as important to understand. These two conditions comprise the public health problem known as frailty syndrome, which has unfortunately become increasingly common in aging adults.

Frailty syndrome is technically defined as “a decline in the functional reserves with several alterations in diverse physiologic systems, including lower energy metabolism, decreased skeletal muscle mass and quality, and altered hormonal and inflammatory functions.”

For a more user-friendly definition picture in your mind a stereotypical “old person.” You think of little gray haired men and women who are hunchbacked and have trouble walking. They are too weak to even stand, and look as if they would shatter with a minor fall. That image is what many of us now associate with the word “old.” No one wants to become the embodiment of this image as we age. We cannot slow the passing of the years, our chronological age, but we do not have to succumb to frailty. Strength training is not just for the young. You can become stronger and more resilient in your 60’s, 70’s, 80’s and even 90+. Strength training is arguably more important for the aging person and absolutely essential for healthy aging.

Frailty is what makes falls the leading cause of both fatal and nonfatal injuries among older adults.^{^[1]} Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.^{^[2]}

The financial cost of frailty is huge. In a 2002 study, the cost of an individual fall averaged between $14,306 and $21,270.^{^[3]} The cost increases rapidly with age and could easily exceed most peoples retirement savings. In 2013, the total direct medical costs of fall injuries for people 65 and older, adjusted for inflation, was $34 billion, and is expected to reach $54.9 billion by 2020.^{^[4]} ^{^[5]}

Fortunately there are steps we can take to avoid the bleak and costly condition of frailty as we age. Physical exercise is well recognized by both the layperson and the medical community as an essential part of a healthy lifestyle. Doctors will tell you the importance for “weight bearing” exercise when it comes to osteoporosis and sarcopenia. Unfortunately, there are only a very small percentage of physicians who actually know how to properly prescribe and program weight bearing, bone strengthening exercises.

Physicians are trained to diagnose and treat disease, but most do not have the expertise to write exercise prescriptions or coach weight training techniques. It is ironic that exercise, one of the most powerful disease-preventing modalities, is not taught in medical education.

In my opinion as a strength coach and fitness professional, that lack of basic education is why there seems to be lack of information coming from the medical community about effective weight-bearing exercise. If you look at the Surgeon General’s Report on Bone Health and Osteoporosis, strength training is underemphasized and casually mentioned along other activities such as walking, dancing and gardening. No one ever seems to mention that those who have the strongest muscles (such as weight lifters and powerlifters) also have the most dense bones, and never succumb to osteoporosis or sarcopenia.

It’s understandable why a physician who is not also a trained strength & conditioning specialist would not elaborate on such a topic, but most will confirm that loading the axial skeleton is what increases osteoblast activity, resulting in bone production. Because of the body’s hardwired adaptive response to loading, the heavier the load is, the stronger the bone. However no doctor in their right mind would tell their patient to go lift the heaviest weight they possibly can, especially if that person was already showing the signs of frailty syndrome.

I have the unique position of being strongman and a strength coach who has worked with the senior population for the last 10 years. As a young trainer, I begun my career at a retirement community, and in the same calendar year won the Maryland Strongest Man contest. I also did a stint working as a strength assistant for the Baltimore Ravens. I have since gone on to open my own gym and work with people of all ages and backgrounds. Senior fitness was my first paid position as a strength professional, and I still teach a weekly class at the same retirement community at which I started my career.

My work with seniors has highlighted the importance of the role strength training plays in health and longevity and countering the negative effects of frailty syndrome. I have seen people of 70, 80 and 90 years of age who, because of regular strength training, do not fit the characteristics we associate with “old.” I have documentation of post-menopausal women (those most at risk for osteoporosis) I have coached achieving increased bone mineral density measured by DEXA scans.

One of Dan’s clients, Tom (age 70) on left, and Strong Medicine co-author Marty Gallagher (age 65) on the right. Both are embodiments of strength after sixty.

I know how to program advanced powerlifting techniques and scale them to the senior population, and as much as I’d like to say “follow this exercise program to stronger bones” there are many things to consider in exercise prescription. There are obvious things such as which exercises for how many sets and reps, but there are more complex things like needs analysis, individual body mechanics, safety and technique. Just as a doctor would not write a drug prescription to a patient he has never met, I cannot write a cookie-cutter program to cover everyone reading this blog post. That being said, in part 2 of this article, I will cover some general techniques and principles for strength training an aging population. With the proper application of resistance training our potential for strength is limited only by the number of years we have left to train. Exercise is an individual responsibility and those who strive for strength will achieve it at any age. Survival truly is, of the strongest.

Editor’s comment:

The importance of this topic cannot be overstated. Dan has done an excellent job describing the problem we are facing with frailty in our ever-growing aging population. There is an unmet need for real strength training programs for our seniors that are both effective for reversing/preventing frailty and safe. If you are a trainer looking to make a huge impact on public health, start acquiring a skill set to work with this population. Dan has considerable experience and expertise in this area and is going to lay out some general training principles in Part II of this post so stay tuned…

****

References:

^{^[1]}Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013

^{^[2]}Rubenstein LZ. Preventing falls in the nursing home. Journal of the American Medical Association 1997;278(7):595–6.

^{^[3]}Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Physical Therapy 2009.89(4):1-9.

^{^[4]}Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006a;12:290–5.

^{^[5]}Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.trial. The Gerontologist 1994;34(1):16–23.