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Strong Medicine

Exploring the Science, Art and Practice of Sustainable Health and Strength

Stress Cup

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.

Stress Cup Size Chart

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.

Hormesis Quote

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.

Filed Under: Strength Tagged With: allostatic load, Chris Hardy, fitness, hormesis, strength, Stress Cup, Strong Medicine, training

The Mechanics of Stress Response

July 21, 2016 By Dr. Chris Hardy 3 Comments

Chris Hardy Navy Diving School

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

I was 23 years old and had graduated from one of the toughest schools in the military. It was designed to mentally and physically beat you down. After 5-6 months, I came out thinking I was super human—of course at 23 we think that anyway. We were crushed with physical training twice a day with academics in between. But, when I graduated, I really didn’t know anything about training others. I thought training and getting better was all about getting beat down as hard as possible. But, I didn’t know that I would soon be facing a different challenge.

When I arrived at my new unit as the new guy, and they put me in charge of their training. They were all seasoned deep sea divers—a very physically demanding job, probably one of the hardest on the planet. Training military divers is like training athletes. They’re a very resilient, self-selected group. My dive school class started with 35, and 13 graduated. So the people who graduate are pretty hard to break. They put me in charge of their training, and over the next two years I developed my own routine of mashing them as hard as I could, because that’s what they wanted.

Overweight General Population ClientDuring that same time, I got interested in medicine. I didn’t always want to be a doctor, but at 25, I decided I needed a change of pace. I went to college and thought that since I was already a trainer, I would train people while I went to college.

I was used to dealing with military deep sea divers, and all I was working with people who have diseases and were out of shape. I didn’t know how to deal with any of these conditions and it blew my mind. I decided to learn more and started getting certifications. Over the next 20 years, I tried to hone my training craft and I even became a doctor along the way!

I wanted to know how to get results for these people without breaking them in the process. I couldn’t train them like Navy divers, because they wouldn’t come back and I would certainly break them. In 22 years as a trainer, and 12 years as a physician I don’t have all the answers, but I have developed a framework.

Your clients want results from you, but what’s your responsibility to them? Safety, or as in medical terminology, “do no harm”. We want them to achieve their goals, but we want them to do it safely. Sometimes you have to save your clients from themselves, because they think they know what they want but you really need to educate them. We also have a popular culture that creates more challenges for us in the perception of what exercise and weight loss should be like.

Quote Primum Non NocereTV shows like The Biggest Loser and other transformation programs are what our clients are seeing. They’re getting the message that every workout needs to be a beat-down, and if you’ve watched that show or others like it, there’s a calorically restricted diet. And that’s what our clients think will get them results. How many of you have new clients come to you expecting that kind of workout—and who aren’t happy when they don’t get it? Or maybe you aren’t getting clients because they are too scared to even come to your gym.

We have a huge opportunity. As a good coach, we need to educate our clients on why the beat down workouts are not a good approach.

What is Coaching?

Coaching is an art with a scientific foundation. If you’re a professional, you have the art down, so now we will look at our foundation to answer some key questions:

  • How can I optimally dose the training on any given day for my client?
  • How can I prevent overdosing but still training the client hard enough so that they achieve their goals?

We aren’t letting our clients off the hook, this is the holy grail of training.

When I look at any problem, I want to go back to underlying foundations—that’s how I wrote Strong Medicine, and it’s how I approach medicine. I look at the foundations of the problem in the first place—it’s what I call first principles. Next, we can build a conceptual framework to answer the questions from the bottom up.

Before we could build a space shuttle, we first had to figure out how to make fire. In building up our conceptual framework, let’s begin by defining exercise. Exercise is a form of stress. What is stress? , Hans Selye defined stress as an engineering term as the amount of force per unit area. Now we say, “I’m under a lot of stress” or, “I am stressed out”.

Stress Examples

Anything that triggers the stress response is a stressor—including exercise. Getting attacked by a bear, traffic, or doing dumbbell presses are all sources of stress. External stress examples include food, water, activity, your work environment, traffic. Internal stress can come from diseases—it all activates in the brain.

Is Stress Good or Bad?

Both, it depends. Short term stress is necessary for survival and if you want to make any gains in the gym. Marty Gallagher will tell you that, you can’t have sub-optimal stress if you want to make gains in the gym. But the chronic stress in an over-trained endurance runner or someone who is just completely burned out at their job is not good.

These chronic stresses actually lead to physical changes in the brain and nervous system, and over-activates our stress response. You could argue that the modern environment has toxic levels of stress and that our physiology is at odds with our modern environment. We are probably not wired to handle what we’re dealing with on a daily basis. We can easily recover from short term acute stress, and most of the time we’re not under it. But, many people are now under constant chronic stress, including your clients. And, you can’t train your clients as if they live in a vacuum.

BrainThe brain is command central for the stress response. It receives, evaluates, and responds to stress in our environment from all sources. It is very important to understand that stress is everything the brain perceives as stress—whether or not the issue is a threat to life or limb. If your brain perceives something as stress, then you will trigger the stress response.

It is especially true in modern society. If your boss is a real jerk and you’re under stress at work, that same fight or flight response will be active as if you were running from a bear—maybe not to the same degree, but it will still be active.

We have fast and slow pathways. Simply put, the hypothalamus is a very small part of the brain but it’s actually central to the stress response. When the brain perceives something threatening—if someone scares you—then you get that fluttering heart, “all-jacked-up” feeling. That’s the fast pathway, and it’s direct to the adrenal glands. It dumps adrenaline, epinephrine, and norepinephrine. Afterwards, about twenty minutes later, the slow pathway through the pituitary gland and down to the adrenals is active. It’s a hormonal system that secretes cortisol which helps you recover from the stress. For the purposes of this post, that’s all you need to know about neuro-anatomy.

Those of you who have also trained in Chinese Medicine or follow Taoist philosophy know that the Yin/Yang concept works very well to describe the autonomic nervous system. (Autonomic just means that I don’t have to think about it for it to happen—I don’t have to think to raise my heart rate or to breathe at night.) The autonomic nervous system has two branches, sympathetic (fight or flight), and parasympathetic (rest and recovery). The “fight or flight” system is actually the most inflammatory response in the body. The parasympathetic system is the opposite. Typically, the parasympathetic system should be dominant most of the time, and the sympathetic should only be active when we need to use it for a “flight or fight” response or during exercise. The sympathetic system is used in response to stress—but it should be used minimally.

Autonomic Nervous System Diagram

The parasympathetic system is dominant for the recovery to all of the exercise you’re doing (and that your clients are doing). It’s also when that anabolic response to exercise occurs. But, if the sympathetic system is on all the time—as it is for many of our clients and ourselves—in the long term it will lead to muscle-wasting and chronic diseases.

How the Brain Controls Stress Response

Three main parts of the brain control the stress response to perceived threats. The prefrontal cortex (we also use it to maintain attention) right behind the forehead determines if something is truly a threat using higher reasoning. Our memory center, the hippocampus also helps us determine if something is threatening or not. The prefrontal cortex and hippocampus can override the threat response together if they have determined something has been seen or experienced before and is probably not threatening. The amygdala is the brain structure which drives the threat response, it responds to learned fear and the emotional reaction of stress. If I got an electric shock every time someone rang a bell or hit a gong, then pretty soon every time I would hear a sound like that, I would have a severe stress response. That’s what the amygdala does.

Normally, the hippocampus and prefrontal cortex inhibit the stress response, and the amygdala will activate it. It’s a three prong connection, and the brain will perform normally if the parasympathetic system is dominant most of the time. For example, if you see long cylindrical object across your path while walking in the woods, the prefrontal cortex will pay attention to it, the hippocampus will respond that it recognizes that it’s probably a stick, and will generally keep the brain from triggering the stress response.

Brain Diagram Stress StructuresBut over time, a brain will change in response to chronic stress. The word neuroplasticity means that the brain can functionally and structurally change. We used to think that psychological stress was “all in your head”, but in fact the brain can change its structure and how it functions—and you can actually be lose neurons. A person who is stressed out or depressed over a long term will have a physically different brain—the hippocampus will shrink under chronic stress.

Epigenetics is how the genes in our DNA are expressed. In Strong Medicine, I used this example: genes are a recipe that says I need four eggs to make a cake. So, if I do a mutation and use five eggs, then that’s a mutation to the genes. Epigenetics doesn’t change the genes, it just tells me how many “cakes” (if any) will be made from the recipe. When someone is under constant stress, everything is involved including hormone pathways. Everything involved with the stress response will be amped up and producing more products for the stress response.

So, someone under chronic stress will respond differently to exercise. If their stress response is overactive, it won’t take much to activate it, and they will have a harder time recovering from exercise because the sympathetic nervous system will be more dominant. If they are already in such a fight or flight state, it will take longer for the parasympathetic nervous system to allow for recovery. Normally the brain would use these mechanisms for survival, not a chronic perceived stress.

Stress Examples 2

Going back to our example with the stick across a path in the woods, if the brain is under chronic stress it will become more animal-like. The structure has changed and when someone with a chronically stressed brain sees something lying across the path, and the hippocampus memory has shrunk, you might jump straight to the conclusion that the object is a snake and trigger the stress response. The chronically stressed brain responds and reacts as opposed to focusing, maintaining attention, and drawing on previous memories.

How does all of this relate to fitness and training? As trainers—and I’ve done this myself—we often focus only on physical stresses. But, we aren’t training in a vacuum, so we must consider our environments. Our clients are faced with many sources of stress outside exercise stress, and we want to train them effectively. Allostasis is a broad concept that basically means “achieving stability through change”. While homeostasis means that a specific equilibrium is maintained, allostasis changes the point we come back to maintain that equilibrium. The stress response is part of this process. If you are trying to achieve stability with the environment, then we are also trying to achieve stability with anything perceived as threatening, challenging, or dangerous, right?

Allostasis is the mechanism responsible for adaptation to any challenge, exercise, or social, psychological activity. We need some psychological stress to become resilient, but too much of it and we can become depressed and anxious. Nutrition is similar, we need to be adequately nourished but not overly so, since the body will adapt to over-nutrition, and we see that all the time. The same is also true for sleep—too little sleep and the body adapts with a stress response, and new science is showing that too much sleep is also bad.

As far as the brain is concerned, recovering from a training challenge with endorphins, and growth hormone building bigger muscles and more mitochondria is allostasis—the brain will think that you need to get stronger to survive that type of challenge/stress again. Allostasis brings you to a new set point as opposed to homeostasis taking you back to the same equilibrium. This is a relatively new concept. Total stress is also called the allostatic load—allostasis is the change, and allostatic load is everything that the brain perceives from the environment as stress.

 

***

The next post in this series will outline a visual representation of the Stress Cup and how to use it to optimize your training and client training programs.

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.

 

 

 

Filed Under: Mental Health, Motivation Tagged With: allostatic load, autonomic nervous system, brain, Dr. Chris Hardy, mechanics of stress response, stress, stress adaptation, Stress Cup, Stress response, Strong Medicine, training

The Stress Cup and Training

September 10, 2015 By Paul Britt 9 Comments

Paul Britt, RKC Team Leader with Dynamometer

How full is your stress cup? For those that have not read the incredible book, Strong Medicine, the stress cup is a great way to view your overall stress levels. The cup can only hold so much before it overfills and starts to spill. If your cup is running over then you are not able to train effectively and other areas of your life will suffer also.

As Dr. Hardy writes, there are a lot of ways to check on your stress and oxidative inflammation levels. You need to know what your cholesterol is, the levels of associated lipid profiles, and markers of inflammation. If you do not know your levels, you do not know where to go and what your end goal should be. But, you cannot check these numbers on a daily basis. I personally chose to have lab work done about every 4 months or so. That time frame corresponds with the 120 day life cycle of the typical red blood cell. I have found that any changes I have made will be detected and quantifiable in that time frame.

But, you also need to use something that will allow a daily check of your stress cup. A little background before I go any further. My stress cup is pretty full most days. I have three kids, run my gym and training business and I am a full time student in Parker University’s Doctor of Chiropractic program. I leave my house at 5:15am and often return home at 7pm. My days are long, and at 47, tend to be pretty stressful. My school goal is to maintain a 3.2GPA and my current training goal has me training for the Beast Tamer, 48kg kettlebell pistol, press and pullup. I had to find something that would allow me to check my stress level on a daily basis to maximize my training and not add any extra stress or lengthy procedures.

Dr. Hardy spoke about Heart Rate Variability at the Dragon Door Health and Strength Conference as an indicator of the health of our autonomic nervous system. To live the Strong Medicine way we want the parasympathetic nervous system (PNS) to be the main operating system in our daily life. It is the “rest and digest” system. However, in today’s society, the sympathetic nervous system (SNS) is often running at a low volume in the background. The everyday stresses that we allow to affect us keep the SNS pump primed and stress hormones continually trickling into the body. The SNS keeps the stress cup filling all day long and that affects training.

I looked into Heart Rate Variability (HRV) as a method to measure my stress levels for training. A quick, easy explanation of Heart Rate Variability looks at the spacing between heart beats. The more regular the space is between beats, the more the sympathetic nervous system is piloting the ship. You want there to be some variability between beats as that means the parasympathetic nervous system is in charge of everything. The drawback for me was the need to wear a chest strap to measure pulse rate during sleep as HRV is measured upon waking and prior to getting out of bed. It added a little to my stress cup as I did not sleep well with the monitor strap around my chest at night. Sleep is one of my cup fillers that I am working on as it is, but that is for another article.

Dr. Hardy mentioned grip strength as a possible tool to measure the stress cup on a daily basis. There are studies that have shown that a decrease in grip strength is correlated with strokes, heart attacks and overall longevity—it made sense that it would also be an indicator of Central Nervous System health. I also liked the fact that it was a quick and easy check that I could do daily before I trained.

I did some research on the subject and found some others had used grip strength for the same purpose with pretty good results. What I did not find was a consensus on numbers. Everything I read indicated that you need your baseline number, but everything else was across the board in regards to what constituted having a full stress cup. Dynamometers are pretty cheap online, so I bought one and began to play with it.

My initial baseline was an average of three different readings after two days of rest. I measured, waited five minutes, measured and repeated one more time to develop my numbers. The first training session using the dynamometer was the next day. My grip strength was dead-on my baseline and it was a great session, my press and pistol were really strong that day. I monitored my grip strength on a daily basis while using a program based on Easy Strength to train. My testing procedure is the same every time, I perform it in the same position and close to the same time that I initially tested. I try to keep the outside variables at a minimum. I feel that this is the best way to get an accurate reading.

I found on days that grip strength was at baseline or higher, I had incredible training sessions. In fact on days that it was higher, I was using a 44kg kettlebell for my lifts. But what about those days below the baseline? I tried to push through a few of those days to see what the result would be. The days that I tried to push hard, even though my grip strength was not at baseline, were rough. I did not make my numbers and I would lose a few days of training.

I looked at my daily numbers and came up with a guide that works pretty well.

  • Baseline: Green light to train heavy
  • 3-5% decrease: Yellow light, medium day
  • 6-8% decrease: Light or recovery day
  • 10% or more decrease: Take a break and rest

Remember, this is a quick test to determine how full your stress cup is—it is just a piece of the puzzle. You need to know your numbers on blood work, body composition, and determine as many other numbers as possible (such as amount of sleep) to help you maximize your health and avoid overfilling your stress cup.

***

RKC Team Leader Paul Britt has been an RKC kettlebell instructor since 2006. He is currently earning his Doctor of Chiropractic, while still training clients at Britt’s Training Systems, his award-winning Hardstyle Kettlebell Training Facility in Rockwall, Texas. Paul is a Certified Kettlebell Functional Movement Specialist (CK-FMS) and PCC Instructor and has worked with  the top Chiropractors in North Texas. Please visit his website brittstrainingsystems.com or Britt’s Training Systems on Facebook for more information.

Filed Under: Maximizing the Health-Span, Strength Tagged With: Dynamometer, grip strength, kettlebell training, Paul Britt, strength training, Stress Cup, stress management

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