Psychiatry & Psychotherapy Podcast - The Best Exercise Program For Depression

Episode Date: September 30, 2020

In this episode, we review studies on strength training, exercise, and depression from the last 2 years. It is well known that any form of exercise is beneficial for people with depressive symptoms, with strength training being most effective. Strength training can be both a treatment for patients with depression and a protective mechanism against the onset of depression. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com. Sign up, sign in, take the test, and the certification is emailed to you in seconds. All right, welcome to the psychiatry and psychotherapy podcast. I am joined today by none other than Matt Reynolds.

He is an elite level strength training coach. He was a strong man, professional status. He founded one of the most successful online strength training programs, Barba Logic. He is the host of Barba Logic podcast, which has about 150,000 listeners per month. And he is my strength coach, actually, and has been my strength coach for a while. and what that means is that whenever I do my squats, deadlifts, rowing, any of that stuff, I video the last set, I put it up, and he comments on it. And I've done some leadership development coaching for him.

So we've become friends. And I'm also joined today with Kyle Logan. He's a fourth-year medical student who has been working on a project looking at the effects of strength. So guys, welcome to the podcast. Thanks for having me, man. I'm excited. You've been on my podcast three or four times now. I know.

And now I like, the reason why I wanted to bring you on, Matt, is because I have had a lot of success with a couple of my clients who have actually followed through with getting a strength coach. And I'm looking at the data from the last two years of these studies that have come out. So we specifically said, let's only look at the studies that have come out in the last couple years. and let's look at the big meta-analysis and let's try to figure out like what is the best exercise for people with depression for people with psychiatric issues. And it was strength training and high-insensity interval training. Yeah. And so I thought, hey, let's go through a little bit of that data, not in a way that's going to bog people down, but just to kind of convince them. And then let's get Matt Reynolds on and talk about like the process of getting strong because there's there's a science here.

and it's like I've become aware of it in the last couple years, working with you, listening to your podcast, but I don't think a lot of people really understand this. And so I really wanted to talk about how to go from zero, like you're doing literally nothing. Like I have this one patient that I recently got going, she stays in bed most of the day. And so how to go from there to like in maybe the 95th percentile

of your age group for strength. which I think it may be a couple year journey, but I think it's a worthwhile journey. Sure. And I think it's going to help people with their depression, with their mood issues. So, you know, we're speaking in this podcast to therapists.

We're speaking to psychiatrists, people who are medical students, people coming up in training. And, you know, I imagine patients are going to jump on and want to know, oh, you know, what's the best program for me as well? Yeah, all good. I think it's interesting because we can bring kind of both sides of the spectrum there,

that certainly we like the data and we like the science at barbell logic. But the real advantage, I think, that we bring to the table is that I don't believe there's anybody ever who has strength coached more people than us in history. We've coached thousands and thousands and thousands of people specifically for strength and this high intensity interval style conditioning that you're talking about. And so while the data absolutely matters, hopefully what I can, and bring to the table today is the experience as well. Say, look, no one has tested more people in this exact realm than the coaches at Barbell

Logic. Yeah. And, you know, it's, I feel it's a huge privilege to also be coached by you because I know you've been doing this for like literally your whole adult life and you're at the top of the game. You were, you were one of the top power lifters, you know, strongmen. and you're still incredibly strong. So you've lived the life, right?

So you're not just like a physical therapist who's going to try to help people get strong who have never really done it themselves. And yet you have this incredible now amount of experience in trying to help people get past roadblocks. You've helped me get past a bunch of roadblocks for myself. So just to give people an idea before I started working with Matt in, I think it was January.

So it's been about nine months now. Before that, I had been basically trying to do this all myself. I had been to a couple conferences, strength training conferences. I had some friends who were into it, so we would kind of coach each other. But I had never gotten past certain roadblocks. I had gotten stuck in my lifting kind of around the same numbers. And it's been really interesting and surprising, actually, to see how you kind of like sequentially have helped me push past certain strength,

kind of like mental blocks and roadblocks. Sure. Because there's a psychological piece and there's a physical piece going on. Yeah, absolutely. What I hope we can delve into just a little bit in the show today is it's really not that complicated. And I think maybe that's really one of the biggest pieces, right? People are, people have some fear about doing it in the first place.

They don't know where to start. You know, the fitness world, especially the one that we see on Instagram is rife with misinformation and people who are focused entirely on aesthetics or taking pictures themselves in the mirror and scantily clad clothing. And there is a select few people out there who are strength training really for health and for quality of life improvement. And when that is the focus, it actually isn't that complicated. So I hope we can dive into that a little bit. You know, you talk about some of the changes we've made. They're just very simple, minimum effective dose changes, much like what you would do with your patients with prescription

medication you would give them. You don't change a million things at once. You just, you know, you change a tiny thing. And we do the same thing in strength training. So hopefully we can find that common ground there. Yeah. So Kyle, I want you to kind of answer this question here. So from the data, I think what we found is that the most recent articles show that increased and strength have the biggest impact on depression. So we're going to talk about that. So tell me about the studies for that cow real quick. So as Dr. Peter was saying, this is research over the last two years. And we have a couple articles right here. There's a large meta-analysis, 33 randomized control trials, kind of the top level of research. 1,877 patients. They were found to

to have resistance training to have a mean effect size of 0.66 on reducing depressive symptoms. And another interesting thing in the study was the number needed to treat was four to have one patient interremission. And just to give, so an effect size of 0.66, Matt, what that means is like, imagine like a bell curve of depression. Sure. And you're going to move people. Point 66 standard deviations from where they started.

Right. That's 33 randomized controlled trials, 1,877 patients. So that's a lot of people that they looked at. And that affects size change. That is pretty similar to what we would see with medication or psychotherapy. So I literally tell people, look, strength training is going to be as good as one antidepressant. That's right. And it's going to be part of the overall picture, because people,

don't just need to move .66 standard deviations. Usually they need to move around two or three to get back to normal. So it's like part of the package of what I give people. Okay. Tell me about this other meta-analysis. So another meta-analysis involving 27 randomized controlled trials with 1,452 clinically depressed adults revealed an effect size of 0.96 for strength training and an effect size of 0.52 for endurance training on decreasing.

depressive symptoms. And when you only counted endurance training lasting longer than 10 minutes, the effect size increased to 0.62. Yeah. So what this basically showed was that there is a stronger effect size, meaning more standard deviations of movement away from depression in the people who did just strength training. Compared to, compared to just cardio, running. So compared to just going out there, going for a jog,

this is much more effective. What most people do when they start, because that's all they know how to do, right, is to just jog around the neighborhood, which is not a bad move. If that's all you know, it's still a starting point. I would never put down a person

who's trying to do something. But the studies have clearly shown that if instead you had to choose between one, if you had to choose between two, you had to choose one, strength training is going to give you the best bang for your book. Yeah. Okay, go over this next one, randomized control trial of youth. So now we're talking about 15 to 25 year olds and specifically I think this one's important because right now

in the midst of the pandemic, there is an epidemic within the youth of suicidal thoughts. I think something like 20% of people in this age group have had at least one suicidal thought in the last month, 20%. So this trial on 68 youths, age 15 to 25, meeting MDD criteria, were assigned to either resistance training or high-intensity interval training for 12 weeks. After this 12 weeks, no significant association was found between strength and aerobic exercise attendance, but there was a dose-dependent change relationship between increases in the YMCA bench press test and decreases. in depression severity with an effect size of 0.51. So basically half a standard deviation,

better decrease in depression if they got a much better bench press. Yeah. If they got markedly stronger, there's clear correlation with a decline in depression, right? That was, that's, and that's really cool because it's like, okay, then the question is, how do we get them the strongest, the fastest? Yeah. that and that becomes like what we're really aiming at.

Okay, we want a program that can get people stronger, that can get whatever they're lifting, squatting, benching, deadlifting. We want to get that strength up the fastest we possibly can because that's going to make the biggest impact. Absolutely. Do you want me to tell them how to do that or do you want to hold off? Hold on for a second. We're going to get there.

That's like... I'm like sitting on the chair and I've got my hands underneath the seat and I'm like, shaken because I'm like I can't wait to tell. Let me, I want to tell people, man. Let me, let me tell me take the bridle off. Let me tell them. Let me tell them how to do it. But no, I'll wait. Okay. We'll keep teasing. We're going to build it. We're going to tease for a while. Well, you know, doctors are only convinced if you show them some data. Yeah. Give me the data first. Okay. Now let's move it to practical. Okay. Got it. So talk about this study, this cohort study of around 6,000 Chinese participants and what they found

with hand grip strength. So in this cohort study of 6,392 adult Chinese participants, they found that incidence of depressive symptoms was higher in populations with lower hand grip strength. And the incidence of depression was 11.9, 15.5, and 22.1 for the strong, moderate and weak hand group, weak hand grip strength group respectively. So there were almost twice as many depressed patients in the weak hand grip strength group compared to the strong group. Yeah. And so what this really points at is there's something about being strong that decreases the incidence of future depression. So I tell my patients, look, get strong and you'll be less likely to have this level of misery again in your life.

And the authors also did a meta-analysis with this study and five other studies across different countries. I think one was in the UK, one was in Germany. And so the total number of patients was 26,473. And they also found a significantly decreased risk of depressant symptoms among participants with strong hand grip strength, having a relative risk of 0.74. 0.74, that's significant. So just even the hand grip strength, Matt,

I don't know if you've heard of this type of study, made an impact. Well, and this isn't a study, right, that you put someone on an exercise program. This is looking at people who are already strong, moderate, or weak. So when you look at somebody who is strong, when I think of, we're talking about over 26,000 participants and a very detailed study of over 6,000,

Chinese adult participants, right? When someone has strong hands, what do you think about? I actually don't think about weightlifting necessarily. Practically, what do you think about? What do I think about? I think this person has, you know, their body is working.

That's right. They've done hard things. They've done hard things, right? They've worked hard. Really, that's what that means. Strong hands, right? How many farmers, how many mechanics, how many people who have worked hard but have never lifted weights,

but they've still developed as a byproduct of their occupation, a base level of strength that they probably didn't even know correlated with depression. And then later you look back and say, you know what? What we're seeing is someone who works hard, hard physical labor, works hard with their hands, works hard with their body. There is clearly a correlation here. Yeah.

Okay. the next big thing that we, the next big point we wanted to look at is, is high intensity interval training better than moderate continuous training? So is it better to do more bursts of sprints compared to like just, I'm going to jump on the treadmill for 20 minutes and go at a steady state? And so there's a bunch of studies that looked at this. Kyle, take it off with the first one. So the first one we're going to talk about is a randomized controlled trial of 59 in-patients. So they're in an inpatient facility with major depressive disorder. They found sprint

interval training comparable to continuous aerobic training on reducing depressive symptoms with a large effect size of 1.1. The study also found improvements in VO2 max were predictive of improvements in depressive symptoms. And when you compare the two, the net training load of sprint interval training was 12.5 minutes compared to 20 minutes of continuous aerobic training. Yeah, so they found gains, you know, like how much the total gains was significantly associated with the decrease in the depressive symptoms. Yeah. Okay. 1.1. 1.1. 1.1. That's huge. That's pretty good. And remember, for how long of training? 12 and a half minutes.

12 and a half minutes. So when you start talking about, when you start talking about bang for your buck, an effect size of 1.1 for 12. and a half minutes. Like, somebody's going to have to convince me why we shouldn't be doing that. Everyone has time to do that. So that's a fantastic study. Yeah. Yeah. Okay.

Tell me about this systemic review and the meta-analysis of high-intensity interval training for severe mental illness. So this looked at nine articles on high-intensity interval training for people with severe mental illness. And of these seven studies examined high-intensity interval training on mood or on a major depressive disorder, and they found a significant improvement in the mood of 0.641 following high-intensity interval training, and also of the studies examined four of these randomized controlled trials compared high-intensity interval training to moderate continuous training

as the control condition, and they found moderate improvement in favor of high-intensity interval training compared to the moderate continuous training for increased mood. So it favored high intensity interval training is what you're saying. Yes. Okay. So the next study we're going to look at is a randomized controlled trial of 34 in patients with major depressive disorder comparing high intensity interval training to moderate continuous training on depression severity and arterial stiffness and showed high intensity interval training had an effect size of 1.48

and was more effective at reducing depression severity than moderate continuous training of 1.4. But they also found that the moderate continuous training was more effective in additionally lowering peripheral artery stiffness. I think this is like diastolic blood pressure. The study only lasted four weeks with 12 training sessions. 12 training sessions, and look at that, a huge improvement. Okay, so tell me about this, Kyle, tell me about the systemic review and meta-analysis of high-intensity. interval training. So this review looked at 12 interventional studies and they found high intensity interval training reduced depression severity using the pre and post measures with a effect size of 1.36.

Yeah. So to conclude, it looks like from all these studies looking at high intensity interval training compared to continuous moderate training, both have value, but the high intensity interval training, I think is a little bit better. Would you say that that? that would make sense? I would say it's better. Like the net training time is less. So I think it's, I think it compared to a moderate continuous training, high intensity interval training is the way forward.

Okay. And the next thing I wanted to look at is what about high intensity interval training and strength training? So when you combine those things, what we found was that a lot of the studies pointed at both of them working together synergistically. So briefly tell me kind of some highlights of these three studies you looked at here. So in one, it's a large population study of over 17,000 adults, and it found the combination of aerobic and muscle strengthening exercise was associated with the lowest likelihood of reporting depressive symptoms, followed by aerobic only and muscle strengthening only.

Okay. And then this other meta-analysis showed that combined aerobic and strength training, they looked at 17 studies. They showed that it increased peripheral brain-derived neurotrophic factor. Have you ever heard of that one, Matt? Brain-drive neurotrophic factor? I mean, I think I could... That sounds like a supplement that... It sounds like a supplement, though.

No, you can't get that one unless you work hard. So basically, they found that low-to-moderate aerobic exercise did not increase something called BDNF. but the combined aerobic and strength training did increase it. And we're going to talk about that in a second and what that is. But basically it's like miracle growth for the brain. So there's these studies of cognitive decline in elderly people, and they found that strength training decreases or halts the cognitive decline,

like the amount, the percentage of the brain that sort of goes away every year, you know, that like naturally goes away. And so I think it probably has to do with this brain-derived neurotrophic factor. That's probably one of the reasons why there's this sort of halting of brain loss. Okay. Super interesting. So one final study here showed that was a cross-sectional study of over 5,000 Australian women and found that a combination of resistance training and aerobic exercise yielded lower probabilities for depression

compared to aerobic alone. And the relative risk ratio was 0.6. one. So the reason why I think this is so important because so many psychiatrists, so many mental health professionals, we stop at like, okay, great, the person's doing some jogging. But what I think the data says is strength training is so, so important. I just want to like, I want to get to kind of the heart of, there's a lot more in this document. And so if you guys want to look at the data, we've cited everything. This will be on the website. We go into, to brain-derived neurotrophofer factor,

how it's miracle grow for the brain, how it's gonna be good for, how it's gonna be good for you. We go into, you know, all of the different other good things that strength training does. For example, it's good for bone health, it's good for sexual health.

Even in people, interesting, we found one study mat where people had, they had prostate cancer. And so they needed to be on, like an androgen blocker. and that's like death to testosterone for men. Right. It's the opposite. It's really bad.

That's right. The opposite of testosterone. Yeah. And they found that strength training actually got their sexual function up. So it's probably more than just pure testosterone that it's increasing. It's probably increasing a lot of other good things for your sexual health. It's good for cardiovascular health, weight loss. They found that aerobic training alone.

was not as good as aerobic training and resistance training for fat loss. Yep. And diabetes prevention, there was a big study that looked at how there was a 60% reduction in diabetes type 2, which is, you know, practically an epidemic of older people in America. Absolutely. And specifically in our patient population, if patients have like schizophrenia and they're on an antipsychotic, it increases the risk of diabetes. And so I try to get them on strength training regimens.

so that they have a decreased risk of developing it. Okay, tell me about the rate of injury and weight training because someone's going to say weight, but like it's really dangerous, it causes a lot of injuries. So what did you find? So when I was looking this up, I actually thought it was going to be higher

and more comparable to a contact sport, but it was completely the opposite. So a systematic review in 2017 looked at the risk of injury and weightlifting, and they found it to be a, three injuries per 1,000 hours of training. And when you look at powerlifting, it was also around three injuries per 1,000 hours of training, which is comparable to other non-contact sports.

And when we look at contact sports like American-style football, it's 9.6 injuries to 1,000 hours of training. And when you look at competitive soccer, it's 53 injuries for every 1,000 hours of training. Okay, so basically 25X, soccer is 25X more dangerous than weight training. It's crazy. And also, just like, here's a really important note. That study, which we quote quite often at Barbell Logic in our marketing data and whatnot, especially when we're working with insurance companies and whatnot, right, is that remember that when we're talking about weight lifting as a sport, power lifting as a sport,

And that is not even the same thing as what we're trying to do here, which is to get people generally strong, right? So it would be the same thing as, think about soccer. You can go out for exercise and kick the soccer ball around in your backyard with no one else for fun to get your heart rate up. What would the injury rate be for that? Probably very low. The injury rate that is quoted there for soccer is when you're actually playing competitive soccer, the very nature of competition, will make the thing because we're wired to be competitive, right? We're going to try a little harder. There are other people involved that you could get hurt or you will get hurt more often.

Weightlifting is no different. When someone is literally trying to squat the most weight they possibly can for a single rep in front of a large audience and judges, obviously the injury rate was going to go up there. But that's not what we're even asking people to do. We're just saying, hey, we want to figure out how to strength train to get. generally strong, which is actually going to reduce that. So an injury rate that is already low among the competitive weightlifters is going to be even lower for the average person who's doing this for general strength training. That's a really good point. That's a really good point.

And I think the other thing is with looking at that last set when someone's squatting and deadlifting, a lot of the times you're looking at, you know, is the technique, starting to fade. That's right. And so I think the injuries happen when you get to a place where your technique is not good and you're lifting heavy. But what would happen is as my technique starts to, you know, starts to sort of get worse, Matt would decrease my weight 20% and then, or I don't know, 20% is probably not exact.

Yeah, that's not right. Maybe 10%. 10%. And then what he would do is he would focus on my technique. and then we'd slowly pick up the weight again. That's right. You know? And so, okay, we have gotten through the studies,

and now I would like to kind of get into some of the practical aspects of like, okay, how do we start? So this is what you've been waiting for, Matt. All right. Taking the bridle off. So, okay, let's say someone, let's start with this basic idea of you, create a stress that's big enough to cause an adaptation. Yep.

It's the stress recovery adaptation syndrome, right? There's a stress that you have to expose your body to, that it's not used to. And as long as it's not so great, as long as it's not so much that it kills you, which it shouldn't be, then your body will adapt to that stress. It's that simple. Yeah. And I think a lot of people, if they did actually, back in the day, and that now they've been out of exercise for a long time, they want to go hard.

Yep. And so they end up, like, going out on the weekend, slaying themselves, and then they're out for like six days. Yeah, because they're so sore. They can't sit on the toilet. Yep. That's a real bad place to be. So I had this one guy, for example, very, very depressed, was in the military, used to squat very heavy. And so I said, I literally want you to start with like a third of what you used to do. Do three sets of five. And then I'm only letting you go up five pounds each time you do it. And you can work out every other day.

And so he started slow, you know, and he's like, I really want to throw on an extra 25 pounds the second time I do it. And I'm like, no, you have to start slow. You have to just incrementally go up. And by the way, he could have done that weight. He could have thrown 25 more pounds on. but the risk was not worth the reward. Doing 25 pounds less is still more stress than what he's used to, and so it will still cause the desired adaptation.

Listen, it's the same, I'm telling you, it's the same thing as medication. And when we start to look at exercise and strain training as medicine, then the goal is the minimum effective dose. Why would you take the maximum dose? At some point you get to a minimum toxic dose. Why would we even play there? Let's do the minimum effective dose for the desired adaptation, adapt, and then go up just a little bit, add a little more stress each time. That makes far more sense, and it's far safer.

Right. So just to give you an idea when recently I started some of that high-intensity interval training with Matt, and he had me on the rowing machine. And I used to row in college. and when I used to row in college, we would do three 20 minute pieces as like a normal workout. And Matt had me do three or four, he started me off with three sprints, about 12 seconds each. Yeah, 100 meters. 100 meters on the road for three rounds with, what I give you, 60 seconds or 90 seconds rest between them?

60 seconds rest. Okay. So that means the whole workout was four minutes. Yep. For that part of it, I was also squatting and deadlifting. That's right, for the high-intensity interval training. And then, you know, four days later, we did four 12-second pieces, you know, and then he had me do three, 24-second pieces, and then he had me do four 20-second pieces, and then he had me do one, you know, one-minute piece,

and then he had me go back and start doing, you know, six, 12 second pieces and then, you know, and then go up to five, 20 second pieces. Now, the reason why I'm giving this example is because most people are starting thinking, I have to go do something that's so psychologically hard and it's just not necessary. That's right. You think about the person, you know, you're talking about one of your patients who basically lays in bed all day. What, what what what what what step one for that person uh probably walk into the mailbox and walk them back in or or right i mean it's just like right you start conservative and then the next day you walk down to your neighbor's mailbox and back and then you know and you add a little bit every time that that

that concept is called progression and we utilize progression in in strength training and in in energy systems training, which is what hit is doing, what high intensity, we're training the energy systems of the body. And so we start very conservatively and we add a little bit at a time. And where that conservative piece is for the 75 year old is going to be different than where it is for the 18 year old kid who is still in the middle of playing high school athletics. Like their start point will be different, but it will all be conservative at the beginning and slowly add a little bit each session over time. Yeah, that's key.

I've had a number of people who I will see, and they'll come in with their loved one, and they're on a wheelchair. They might have been in the hospital for six months. They had severe sarcopenia, and they can barely get out of the wheelchair, you know, so they're basically pushed around. And what I would do with them is I would grab them underneath the, the armpits, and I would have them squat out of their wheelchair to see how strong they are and how much I would need to help. And, you know, this one person in particular could do about half of it,

right? Yep. So the reason why they couldn't stand up on their own is because their arms aren't strong enough, their legs aren't strong enough to get out of the chair. What then I did was I taught their loved one to basically help them squat. And I said, you're going to do two of these, you're going to wait five minutes, you're going to do two of them, you're going to wait five minutes, you're going to do two of them. That's right. And you're going to do that every other day. And I've had a number of these people after about three months,

they can now squat out of the chair five times without any help. That's right. And when you can squat five times out of a chair without any help, you can now walk. That's right. That's right. And so literally, like, we've had people come in. It's this day-tribun program that I run.

They do a lot of therapy, but I get them to squat as well. And by the end of the program, they're walking out. And they are just ecstatic. They're so happy because their life just changed. Sure. Yep. So when we think about, let me ask you a question. So with this episode being focused primarily on the effects of strength training

and energy systems training or conditioning on depression, with the aggregate data of most of your clients, would you say that most of your clients who struggle with depression, though, would be a little more in middle of the bell curve for, physical ability. Could most of them stand up out of a chair on their own on day one? I would assume the answer is yes, but I want to make sure. Yeah. Okay. I'm, I think I'm starting this from the very bottom because I think I think that's like once you understand that, you know, a 70-year-old woman who's been chairbound can do something that would potentially get her to a place where she could walk.

That's right. And by the way, we have these stories all. over the place with coaching. So I have a lady that I've one of my favorite clients. She is now 84 years old. When she came to me, she was 79. She had been a widow for about eight years at the time. Her kids all lived in the Pacific Northwest and away from here. And she had a big two-story house. And she hadn't even been up the stairs in the two-story house in a couple of years. She had double hip replacements, a knee replacement, two inches cut off of one of her Achilles tendons. the vast majority of her back had been fused together. I mean, she was just, you know, she was like the bionic woman, the $6 million woman.

Now, this all happened before I met her, right? 79. What did I teach her how to do? I taught her how to stand up out of her kitchen chair on her own on day one. And we added a little bit every single day from there. And now she's 84 and she deadlifted. She picks a barbell up off the floor with 150, pounds for sets of five. And she has never had an injury in the five years that I've trained her.

She was struggling to get on and off the toilet. She was struggling to get in and out of the car. Her brain was super sharp. She told great story. She had an incredible memory. But her physical body was failing her. And now she squats. She presses. She deadlifts. Now she doesn't squat with a barbell on her back. She's, you know, she's 84 years old and she's kifotic. But she does do goblet squats. She sits on a box and she holds a medicine ball. But she can pick up a barbell with weights on it off the floor. She can do that, no problem, right? So she's done those things very slowly over the course of a four or five year period.

And it has completely changed the quality of her life. She bought a little sports car. She's completely independent. I mean, look, for her, when you struggle to get off the toilet, the next stop is the nursing home. That's it. And now she has no problem. obviously, walking up the stairs, going to the second story of the house, getting in the little sporty coop she bought, deadlifting, getting around, you know, walking around, you know, the grocery

store. I mean, it's just no problem at all. So she is now strong enough to do anything that life would throw at her. And it's the late in her 80s with all those surgeries. And now she also has reserves. That's right. She has reserves. Like if something hit her, if for some reason she ends up sick or something, she has some reserves. And, you know, people who have sarcopenia do not have reserves. That's exactly right. So it's, it's, it's kind of like your 401k, you know. It's exactly like you're 401k. It's like you're putting money in the bank, uh, slowly over years, and then at some point you need to cash out. And the other thing about strength is like, once you're strong, you can get back to being strong a whole lot faster. That's right. Well,

Strength is the take takes the longest of all the physical abilities. It takes the longest to build. But it also takes, it's, it's the slowest to lose, right? Whereas cardio, like V-O-2 max, you can actually, you can actually get a very healthy, very competitive V-O-2 max in a short period of time. But if you go on vacation to Mexico for two weeks and drink margaritas in the swimming pool, your VO2 max is not very, it's going to take a little bit to get it back up to par. Right. So strength is quickly, or it takes a long time to gain and a long time to lose,

whereas those energy systems training is, they're quickly gaining quickly lost. And you talk about that time period where she's built up that 401K, that physical 401K, she has had to unfortunately deal with that here in 2020 with COVID. She's 84 years old. She can't go out and train around people. people at 84 years old. So, but she had built up this great base of strength that now she's prepared herself so that any time where she now has to make withdraws out of that 401k, there's enough of a balance there that it doesn't throw her into illness. She's fine. She's fine.

Right? And we're very close probably to bring her, bringing her back in and having her train with the barbells again. But because of her demographic, she can't go out and be, I mean, she's just sort of homebound right now. And we've, she's doing stuff at home. And we've, she's doing stuff at home the best she can and you know she's walking the stairs as often as she can she's doing those things but you're exactly right is exactly like a 401k you make deposits when you can so when the day comes when you have to make the withdraws you had already paid your dues and it doesn't throw you in so she doesn't her osteopor like her bone density numbers are incredible right she doesn't have sarcopenia at 84 she's built muscle from 79 to 84 as a female which on no hormones which most doctors

would say is essentially impossible. It's not. We've watched it happen over and over and over again. Yeah, there's a myth out there that, like, you can't get stronger once you pass a certain age, and it's just not true. It's just absolutely not true. My critique of physical therapy,

because often physicians will be like, oh, I'll just send them into physical therapy, is they do bans. They do, like, I had this one patient, broke my heart. They were having them squat twice a day, like sets of time. 10, and I was like, that's just too much.

So one of the things that I've learned from you is like, when you first start out, if you're older, twice a week is probably where you want to be. And if you get, if you're younger, maybe three times a week. But that's about as much as you can put on your body. That's right. Would it be okay with you for a second? Let's talk through like what that, what those kind of big picture items are for how to get started for the average person?

Yeah, so here's the way I look at it from a logical kind of the way my brain works. So the first thing we have to think about is if someone goes to the gym, especially like a big box type gym, there's an infinite number of exercises that they can do, right? There are hundreds of machines, and if they don't know where to start, what would you possibly, like, where do you go, you know? And so we have an exercise selection criteria that we use. And we think, and it's because we want to think, about, you know, what's going to get us the biggest bang for our buck.

But so you take these infinite number of exercises and you can apply some criteria to it, right? And that criteria that we use for exercise selection is we try to find exercises or choose exercises that use the most muscle mass. And an easier way to say that is we want to find exercises that make the most joints move, bend and straighten, right? because that's what muscles do. And so you start thinking about, well, I could do a one arm dumbbell curl where only my elbow bends. And that's not working very much.

So I've got to do a whole bunch of exercises to work my whole body. If I'm doing things that are single joint exercises, the body is made to work in a, in a, it's a system. It's systemic, right? It's an organism. It's not meant to take, take the bicep out and just do the thing. We're made to work together. And so we try to pick exercises that use the most muscle mass. We try to pick exercises that we can train over the greatest effective range of motion.

We want to move through that full range of motion. It's healthy. It's good for mobility. It's good for agility. It's good for flexibility. People that do strength training correctly, the vast majority of them will never have to do things like yoga. And I'm not saying yoga's bad. Yoga's great.

But your mobility is enough because you are doing. full range of motion squats, you're doing full range of motion presses, you're working those joints through the full, through the full safe range of motion, right? And lastly, and this is the one that's sort of like, duh, is if strength training is the goal, that we want to choose exercises that will allow us over time to titrate up a little bit at a time and use the most weight, because strength training, and maybe it's clear or important to say this, straight training is literally defined as being able to produce force. And the person who can produce the most force is the strongest.

So what we're trying to do in strength training is learn how to produce more force. Now, if you're that person that now walks into that big box gym with the hundreds of exercise machines and hundreds of cardio machines you don't know where to start, and you apply those basic criteria, and we've done this for decades now. We literally get down to four or five exercises. We get the squat, which is literally like sitting down and standing back up. It's a sit to stand. We get the deadlift, which is picking stuff up off the floor.

We get an overhead press, which is exactly what it sounds like. You press things overhead, and we get the bench press, which everybody knows. It's the one you lay down on the bench press, right? You lay down the bench and you press, you press vertically while laying horizontally. And that literally works the entire body. Really the only thing that potentially is left out is some of the muscles of the upper back. And to train those, we do chin-ups or if someone is unable to do chin-ups, then we can do that machine at the gym that they call the lap pull-down machine.

And literally those five exercises will train every single muscle. in your body. And even for those competitive power lifters, competitive weightlifters, who are at the absolute top of their game, 95% of everything they do in their entire career will be those five exercises. Yes, they'll do a few extra things because they're competitive here and there. But for the average person who's just trying to get generally strong, that's literally all they need. And so it's very, very simple. Yeah. Yep. So I see. I, started, once I figured this out, it was, I think about three years ago, I started squatting. You know, so for me, it was about the barbow, which is 45 pounds and a 45 pounds on each side.

So it's 135. Yep. Three sets of five. And by the way, for Pete, I think most people listen to you, no, I mean, you've got a big frame on you. You're like eight foot two and like, four hundred thirty pounds. You're built like the world, like a world strongest man. Like you're, yeah, you, if you had decided. not to be a psychiatrist, you could have been the world's strongest man based on your frame.

I don't know about that. Well, I'm exaggerating, but you're a big guy. I'm a big guy. I'm a big guy. To start with is very, that's far on the right side of the bell curve. I just, I think that's important for people to understand. We made this point earlier. It is perfectly okay to not even be strong enough to start with the empty barbell and to work up to an empty barbell.

Right. You're, you're a big guy. What are you six? What? Well, so I'm six five. When I started, I was about 260. And, you know, I was a competitive rower in college. So I rode at, you know, one of the top three programs in the nation for four years,

which is, you know, a lot of legs. It's not just arms in case you've never seen rowing. And, you know, a lot of my, a lot of the people who rode with me had already been in the Olympics or were eventually in the Olympics. So this was like an elite level group. If I wouldn't have gone to medical school, I could have, you know, gone out to the national team and if I would have slaved away for four years I would have been in the Olympics, right? So that was kind of the level of the training that I was doing. Well, and we still started

you with those same four exercises at a pretty conservative weight that would be, that was conservative for you. And we slowly added a little bit over time and got you stronger and stronger and stronger for you. And again, it's not about you versus somebody else. You're not a competitive lifter. You're doing this for the quality of life and health benefits. That's why you do this. Yep. So one of the other things I think is really important to think about for the practitioners that listen to this podcast is to, again, I think it requires a paradigm shift to think about strength training and conditioning as medicine, right? And so when we think about the medicine criteria that you would use, and let me be very clear, I am a strength coach, I am not a doctor.

So if I say something here that you please jump in, but from what I understand and also from what I am, we have a lot of doctors that work for us as strength coaches at barbell logic online coaching. And one of my favorites, his name is Dr. Jonathan Sullivan. We'll plug for our podcast. We're about to come out with a series on barbells and health, strength and health. And he wrote a book called the Barbell Prescription. He was an emergency room surgeon, emergency surgeon for like 30 years. And he's a fantastic strength coach.

And he started to see this problem for years and years. There's everyone that came in to the vast majority that came into the emergency room was what he called the sick aging phenotype. It was that, you know, they'd come in for this thing, but they were they were all overweight. They had blood sugar problems. They were hypertensive. Their cholesterol was high, right? What we now call metabolic syndrome, which wasn't the case back then. 90% of the people that came in would have that thing.

And he was trying to figure out what was going on. And so over time, he developed this, this medicine. criteria for specifically for exercise. And it's the same criteria that you would use for pharmaceuticals. And it's this, any medicine that we prescribe should be safe, as safe as it can be. And we've already discussed based on the data that weightlifting, strength training is incredibly safe. You don't want to hurt people that would defeat the purpose. So it must be safe. It needs to have a wide therapeutic window, right? The range between the minimum effective dose and the minimum toxic dose needs to be really wide.

Drugs that you increase by a little bit and potentially kill people, that's a very dangerous drug to take, right? It's not very safe. And strength training allows us to titrate up from literally nothing, from literally a PVC pipe, to a child's aluminum barbell, to a slightly heavier barbell to as much weight as you could possibly eventually, you know, the world champion weightlifters, the kind of things, they have 1,000 pounds, 800 pounds, which is not what we're telling your listeners. to lift, right? But it has a very wide range of a therapeutic window. It's, it's comprehensive,

right? I want, I want something that has a comprehensive effect. I want a wide range of effects. If all strength training does is make me strong and it doesn't change, it doesn't have this effect on depression, it doesn't have this effect on sarcopenia, it doesn't have this effect on bone density. What's amazing about strength training is it's effects, are so incredibly wide range. It makes it a wonderful medicine, right? And the last two are, is that it is specific and effective. And really there, we know that what's really interesting

about all those studies that we read at the beginning is they would use these terms, resistance training. And often when you look at the resistance training they do, it's not even very good. But any resistance training seems to work significantly better than no resistance training. And what I think we do well, and the reason I hope that you've had me on the show is because we think we have found over decades

the most effective way to do this and the most specific way to do this. And lastly, the simplest. That should be simple and efficient. And so people are busy. You can't, your patients cannot train three hours a day, six days a week. They're not professional athletes. And what we found is when you read through these studies, literally things like 30 minutes, three times a week, gets this incredible bang for your buck. And that's why strength training is so amazing, because it fulfills all of that medicine criteria that the practitioners are already using for pharmaceuticals, only we don't have to take anything exogenously. We can actually do this on our own and have an incredible impact. And that's pretty amazing. Yep. And so just to give people an idea what we're talking

about if you add five pounds to the bar three times a week, you know, you're going up 60 pounds a month. That's right. And so for the first four months, I was able to continue that until I got around a 300 squat, 300 deadlift. And I kind of continued in that area for about two years until you became my trainer. And through your coaching and programming, you know, my squat. You know, my squat. went up to about 380. Now we've dialed me down quite a bit because I wasn't going deep enough. So there's like this kind of balance of technique and strength.

And I think for me, because I'm not a competitive strength trainer, I'm doing this for longevity and for total brain function, for optimizing, you know, all the good hormones that I want optimized without adding any hormones to myself. That's right.

We're a little bit more on the, you know. Conservative side. Conservative side. You're not chasing numbers. You don't have to chase numbers. Yeah. I do actually want to start rowing again and maybe competing.

I want to talk about that eventually. But the idea is that, you know, I mean, I'm an, I was already an athlete, right? So I trained a guy out of my garage who had never been an athlete, never done any sports. And he got up squatting around like, you know, 155. he was deadlifting around to 25 and he has like a body type of someone who if you looked at him when he first started you would be like this guy has never done anything physical in his life

you know and so it's what's amazing to me is how fast people can get strong with the proper coaching and with the proper model and if you're listening to this and you're like that's like that's like a lot of ways wait, I don't know if I'd ever want to do that. That's fine.

I mean, my wife started doing this. She's being coached. And she, you know, she was squatting a bar, you know, 45 pounds. She was a, she played tennis in college. And now she's doing, you know, maybe like 105 pounds, 120. And she's got good technique, which honestly, it's taken her four or five months to get the good technique. Sure. To get to get into a place.

where it looks good. But what the benefit of that is is that, you know, her bones are going to be stronger. She's going to be more resistant to different medical issues. So, yeah, I just want to throw that out there. Well, and even somebody like, like you or like your wife or, you know, most of our clients who don't necessarily come in depressed, will train and will, after three months, notice a marked improvement in social, emotional, mental well-being. This is just, and this is not a meta-analysis. This is Matt Reynolds, who has trained thousands of people. They didn't necessarily notice that there was an issue in the first place. They just go, wow, I feel more confident. I feel better. I feel like my quality of life is better. I carry myself a little bit different. We're not

talking about, just be clear, we're not talking about arrogant, sorry, bodybuilders. We're not talking about people who lift just to look good. We're talking about who who train to be healthy. And then they look back and they go, wow, what I have found, what we've coined the term in our, in our business and our podcast of voluntary hardship. When people walk through this fire of voluntary hardship, they notice that they are refined by it. You don't have to lift weights. Wait, that's not the same thing as going to war. It's not the same thing as being pushed into involuntary. Involuntary hardship is different and it refines some people and it crushes other people, right? But voluntary hardship, when I choose to do hard things on my own, on my own, I take personal

responsibility to do it. Even for people who don't have depression and aren't wired for those things, or even like for me, because I can speak about myself, like I'm wired for some anxiety, training is an incredible medicine for me for that. I train and I am. less anxious. I train and I feel better. I train and I carry myself better. I train and I'm more confident. I'm trained and I feel better about talking on a podcast. These are the benefits that I never thought about when I started. I just did it because I wanted to get big and strong because I was a college kid and wanted to get big and strong. Now I do it for health. And it's been incredible. The confidence, it's interesting how launching my own podcast coincided with having about

two months of strength training. Yes. Because I had been sitting on the gear for about two years and had different ideas and what I would do. And, you know, I do think it improves your confidence because, you know, it does affect things like testosterone. And it does affect, you know, your stress, how you handle stress. One of the biggest psychological things that I'm thinking that strength training can do for someone

is it creates not only a physical stress, but a psychological stress. So the stress system in our body, physical stress and psychological stress are, you know, the same hormones, cortisol, noraphyran, you know, like epinephrine, like all of this is released every time you have a stress. And so what's happened in our culture is a lot of people can go months and months without having a stress. And so then the stresses that are small start to become big stresses. And so what I see with a sequential program, with the voluntary hardship that you have to go under to do it right, because honestly it is hard sometimes. Like sometimes I don't want to squat, especially when it's like

getting pretty heavy. What it does is it creates a stress and that stress allows my body to learn how to deal with stress better. That's right. What we found is that when you spend time doing these hard things, that nobody else makes you do, that you choose to do, strength training is a wonderful, and we haven't really even talked about the high-intensity interval training, which is also really, really hard and not very fun,

and your heart gets racing like crazy. It's called high-intensity because your heart rate gets up 90% of its maximum capacity. It's pretty intense as well. when you do those things, it's interesting. It's not that it makes these things not painful, but when you get laid off from your job, when you deal with a year like 2020, where we've had COVID and all sorts of upheaval in the United States

and people are struggling financially and the economy is crashing, you know, when someone gets sick, when you lose your parent, you're a little better prepared to handle those big, involuntary stresses when you have forced yourself to go through the voluntary stressors. That's what we found. And by the way, there isn't a study on that. There is no metadata on that. Yet we know out of the years, the decades that we've done this, that it is the case. And we know it personally. You know it because you've done it. I know it because I've done it. I have coached

thousands of people. I've watched them report that in the testimonials of people. They see that. that as a massive positive impact of strain training. Yeah. Well, I mean, I think that the data showing that it decreases the future incidence of depression is showing that. That's probably a point. Yeah. Because when you have a multitude of stresses, that usually can trigger someone into a depression

if they're wired that way. And, you know, for myself, I get first migraines. That's probably the first thing that hits me when the COVID hit and I was doing 100 percent video calls. After about a month, I started to get headaches pretty frequently. And that's about the time where I reached out and was like, hey, I want you to be my coach. And now I have maybe one every like three weeks. So it's pretty infrequent compared to where it was, you know.

And, you know, I have a lot of stressors in my life that kind of fluctuate in and out. But I do think that there's something about sort of progressing. getting stronger, that influences the overall way that we metabolize stress. And so with every patient that I have, every patient's going to have stress. So I want all of my patients squatting. It's kind of, it was a joke for a while because I was literally like getting every patient to squat and I was showing them how to squat, you know, in the office. And some of the residents who don't understand this philosophy.

was like, what is he doing? They just didn't understand how important it was. And, you know, I would try to convince them and talk to them about it. And so I'm glad we can do a long form so that I can say, hey, listen to this podcast because this will explain my thought process. You know, I'll put you on the spot here for a second. For me, strength training is hard, right? Let's be clear.

This is a hard thing. It doesn't have to start that way. It starts conservative, but over time it's going to get hard. That's why we call it voluntary hardship. It will get hard. It has to be hard to make you better to actually get that adaptation. And hard for some people, sometimes some people just aren't cut out. They just won't do hard.

Okay. But for me, my experience is that for far greater than 99% of my clients who have bought into strength training for at least six weeks, none of them would ever come back and say, that was a bad move for me. I wish I had not done that. It just seems like everyone that does it for, if you'll give it four to six weeks, it'll change your life. That's all there is to it. Is your experience similar? Yeah, I think, I mean, I obviously have kept with it. A couple years ago, I bought all the gear to be able to do it out of my garage. And it's helpful too when you have small kids. because I don't have to go to the gym. That's right. I don't have to deal with all of the gym politics

or people looking at me funny or, you know, waiting for someone to get done with the squat rack. So I've always done it out of my house. And it allows me to, you know, do it while my kids are sleeping. So there's a positive there. And I think that although it's hard sometimes, it's like I'm progressing. I'm still making gains and it's been three years.

Like now we're doing more, rowing and high intensity interval training with the rowing. And there's something exciting about getting back on that. It's not fun all the time. Honestly, it's like, it's really hard. And it's psychologically hard to get on the rowing device by myself in the garage late at night. If you have rowed, you might know what I'm talking about.

Like, it would be easier if I was in a group doing this, doing this. But unfortunately, there are not like, you know, I have friends who come over and live with me. That's been really helpful. Rowing groups. Yeah, we're thinking about where we could possibly do that. What about for your clients? So as you've now prescribed this exercise medicine for probably, certainly scores of not hundreds of clients. Of the ones, I know there are people that always, because I see it, we see it on our own practice all the time.

There are people who do it for a week, 10 days, and they're just like, I just can't do this. This is too hard. And I understand. But for the people who have done it for your clients, just aggregate, who have done it for four to six weeks plus, how many of them or what percentage have come back and say, I really wish you had never had me do this. I feel like this has made my life worse as opposed to better. Yeah. I mean, 100% have said, thank you. Right? They get it. They don't, like honestly, the hardest part is to get them started to get them to get them going. And so lately, if I can connect them with a coach, it's interesting because I'm in this world, I know coaches in different states and different cities. And so in the midst of COVID, I've had a number of patients who are not in my area. I do, you know, I do some long-distance stuff. And I have connected.

them with someone who came to their house. You know? Right. Like I have this like 80 year old lady who now a coach comes to her house and works her out. And, you know, this is someone who I trust, who I've worked, who I met at a conference. And, you know, it's, it's been helpful. And it's literally going to be, it's going to be as big of a piece in my mind as the therapy that I provide once a week.

Absolutely. Sure. The therapy is going to help them. you know, counter-negative narratives that they have, deal with psychological stress. Like, I 100% believe that's important. And the medication. This person's also on medication. I mean, some people are just wired three to four standard deviations in one direction, right?

Towards neuroticism. Like, they've always had anxiety. And so medications might be important, right, for this type of person. So, but the combination of all of it together really does give. the value to a place where that person's life is very changed. Yeah, that's great. And so, yeah, I would say 100% who start do not regret. It's interesting.

As you were talking through that, I was thinking through this sort of three-pronged head of strength training, therapy, and medication. And not all people need all three. But both therapy and strength training for you and for a good person, professional, as I would hope most people who are listening to this podcast are. It's sort of low risk, high reward, right? Like therapy, you are a professional at therapy. You can probably have a fairly low risk with therapy. Like you've learned that same process that I apply to strength training of starting, you know, probably not too intense and slowly working in. I don't know. This is not my

skill set. Yeah, obviously. But the point here is that those two. Those two are low risk, high reward. The medication piece is often high reward as well, but it's also much higher risk because you're not exactly, especially when you're dealing with hormones, you're not entirely sure, right? It takes, sometimes there's, it takes a while to figure out what the right combination of medicine is for your patients so that they get the reward that you're looking for, the effect that you're looking for. But the therapy and the strength training, we, strain training is the simplest, I think, with the lowest risk and a very high reward. I won't say the highest reward, but everybody benefits, right? And the vast majority of people are going to

benefit from the therapy. And then the medication is the one that's a little bit more difficult. And it certainly has a great ROI as well once you get it honed in, but it's tough probably at times, I would imagine, to get it honed in. Yeah, medication, you know, has side effects. And so a lot of people come to me already on medication. The people who come to me on medication may be on, you know, sometimes even five or six medications. And they don't want to be on five or six medications and they're still miserable. And they have sexual side effects of the SSRIs and the SNRIs and, you know, other things. And so, you know, once they're out of depression, it's like, okay, how can I get them to a place where now they don't need to be on as many medications? And one of the

things I constantly say to them is getting a good strength training program will change the amount of medication that you need to be on. And so if I can get someone in strength training and in therapy, they may not even need medications depending on the severity or what's going on, you know. And so ideally, in my mind, I would much rather use less medications just because I know, you know, for every person I put on, for every 10 people I put on an SSRI, probably about seven of them are going to have some sexual side effects. And, you know, sexual side effects are really do lower the quality of life for a lot of people, you know, if they're not able to have an orgasm, have an ejaculation, have a full arousal, full desire, sexual desire, you know, and that impacts their family unit as well. So,

that's right. Yeah, I think, I think that eventually I almost want a gym attached to my practice. Yeah. I had someone from Australia reach out. She's probably listening to this. She was like, hey, do you have any best practices

on how to have a gym attached to your practice? At this point, I don't. Other than the model that you want is probably something close to what you're talking about, you know, and learning a lot from that book you recommended and your buddy who wrote that book.

Barbell prescription is great. I recommend that book. That's the one book I will recommend. end. Yep. You go on Amazon. And again, and just be clear, I don't make a dollar off that book. So Barbell Prescription is a wonderful book.

I'm also not here to promote my business. I will say this. We went into the big picture pieces of what lifts to do and some of the big picture basics of the program. But for us at Barbell Logic, our content is always and will always be free. And so for people who are wondering, well, he talked about doing things like squats and deadlifts and presses and bench presses. And I kind of know what that stuff is, but I don't really know, and I don't exactly know how to do it right. And when they talk about the program, like,

okay, it's only three days a week. All of that stuff, we have online, we have a great YouTube channel at Barbell Logic where highly professionally produced videos are very short that are like three minutes, four minutes long that teach you how to do the lifts that show you how to do the program. It costs nothing, right? It costs nothing. You can go and we always want that to be free because we want to expose people to that information so that we can change as many lives as possible. Yeah, and to be clear, I don't have any financial relationship with Barba Logic. I'm not making any gains by pushing you that direction.

That's where I get my coaching done. You were a full paying client. Your family pays for coaching at Barba Logic. Right, right. Yeah. But I think what I'm interested in is helping the most people possible. At the end of the day, if you're a therapist, if you're a psychiatrist listening to this, you know, consider getting, consider you're starting your own program first, right?

That's right. See what the benefits are. See what the process is like because it's going to make a difference. It's going to make an impact in how you feel, you know? And it's another tool in our tool belt. We need as many tools as we can to be able to help the most people possible. And at the end of the day, from the data that I presented, from those studies, you know, We'll link that in the blog.

We'll show you, maybe I'll link some of your YouTube videos on like squatting, deadlifting, just to give people an idea on what that looks like. But it does work. It's hard to get going. I've had a lot of patients who, when I talk to them about it, it takes a couple conversations. It might take like four or five sessions of me bringing it up for them to actually follow through. Sure. And I'm hoping that I can give them this resource as well as a way of saying, hey, check this out, listen to this.

understand why I think this is important, understand some of the basics of what you're doing, you're creating a small stress, you're taking a day off, you're creating another small stress, you're taking a day off. You know, and it could start, I started one patient like,

hey, I want you to walk out of your house five minutes in one direction, and then walk back. And then every day, I want you to add 10 seconds to that. Yep. It's the same kind of idea. That's a good starting place.

It's a progression. That's right. And over weeks, she'll get up to 30 minutes. And then, you know, once she's at 30 minutes, I'll add in a little high-intensity interval training. And then eventually I'll have her start, you know, doing some strength training as well to create that extra benefit, right? And I think it'll make a huge impact. I know it'll make a huge impact. Hey, is there anything you wanted to mention before we sort of wrap this thing up here?

pearls or big takeaways that you'd want people to have. Here's what I would say. And I don't want to put words in your mouth, but what I'm hearing you say is, is that for you and your practice, strength training is as important or is one of these major, major pieces of importance, along with therapy and medication. And for a lot of practitioners, they're not using it. And if we consider ourselves as practitioners, professionals and we take pride in what we do, that I think we have a responsibility to learn everything we can about the things that will improve the lives of our patients. This is huge. And so if I'm listening to your podcast and I have earned trust, or you have earned the trust of your listeners, as I'm sure you have for many, and you are talking about

this has changed my life and changed the lives of my patients, but I think we have a responsibility as practitioners to do everything we can to research that and learn about it for ourselves because it can impact the lives. Ultimately, what are we trying to do as practitioners, but improve the lives or patients? And I, listen, I'm not a doctor. I'm not a psychiatrist, but I am a practitioner. I can't do all three of the things that you can do.

I can only do one. I can do the strength training part. I can't do, I can't give therapy. I can't give medication, but I can give strength training. And I'm going to learn everything I can about it. And if there are pieces in my world that will teach me over time as technology progresses and knowledge progresses, that I can continue to learn

so that I can change the lives of my clients for the better, certainly the bell curve there. I think I have a responsibility to do that, and I think it's the same for people in your profession. You know, it's interesting. We spend, you know, what, by the time you graduate medical school, you've probably spent about 10,000 hours learning.

By the time you graduate residency, you've probably spent another 10,000 hours. and and yet, you know, this is something that probably for some people is completely new. You know, like maybe they thought, you know, walking or cardio, right, but strength training, really? Strength training? Increasing strength? It's something that's new. And so I would say, you know, how many hours have we spent learning about these other things? And what if you spent you know, 10 hours, just even 10 hours learning about the importance of strength training. Maybe even just one hour, just jump on my, jump on my blog, read the actual, like, what we've

written about this. It's going to be kind of a summary of what we've talked about here. We'll cite the studies. You can look at those studies. You can come to your own conclusions on what the best practices are. And, yeah, so we spend 20,000 hours learning about everything but strength training. That's right. So maybe spend 10 over the next month or so jumping on my podcast.

I'll try to link some of the key information on where to start. I have a couple other episodes on strength training. I have written a couple articles on this stuff already looking at the cognitive function, looking at depression. And you know, maybe get a book, you know, the book I recommend, this strength training book by this other doctor guy. So I'm excited for you guys to kind of consider this as an option. I think it's going to really change the way that you feel.

It's like, I'm going to do an episode actually, Reynolds, on how to retire well with financially, specifically. We've done one retirement psychologically. I'm going to talk about how I invest my money in a way that's very simple. It takes four hours a year of work, four hours a year, and it has a huge impact because of compounding interest. Sure. And there's so much financial information out there.

that's just complete fluff, you know, people wanting to make money on you. So I'm going to give you sort of what I found from about 20 books of reading and maybe, you know, all the work that I've done. And in the same way, I think strength training is like, do you want the best physical health when you're 70 years old? Like, have a strength training regimen, invest some money in yourself, just like you would, any other place to just be in a better place. And it's not that complicated. It's just like your financial piece, right? So people that try to get make money off of others in the financial realm, just like in the fitness realm, one of the things that becomes very attractive is if I can make it very complicated, they have to continue to pay me because they'll never figure it out. It's complicated. But the reality is, is that learning how to live financially free and build wealth is actually not complicated and learning how to live physically free. And learning how to live physically free.

and strong and improve your physical quality of life is also not complicated. Neither are easy. It's hard, but it's simple, right? It requires some effort, but it's not very complicated. And so I think that's why there's so many charlatans in both of those industries. Yep. Yep. Well, I mean, everyone wants to say that their way is the only way of doing it. Sure. And everyone wants to, you know, the financial world is a world, largely of salesmen. That's right. And so is the fitness world.

And so when I did my research, which eventually led me to you, like I didn't start with you. I was doing a lot of digging. I was reading everything. I was, you know, pursuing this for, for, you know, a while. It's, it's been a journey. So I'm trying to give the best information that I can find possible. Put it out there.

Hey, start where I, you know, where all my sort of research has led me. Kyle, I'm over here. I'm thinking, what is Kyle? Kyle thinking as we're going through this. You haven't spoken for a long time. Is any of this new for you? Or is this kind of like... Yeah, I mean, I was like thinking back on my own strength training, like early college. I was doing like deadlift squat bench. And I was doing like six by six, you know. And I was just so sore when I went home like the next day. Like you said, like just in pain, like sitting on the toilet. I'm like, how much time have I wasted? Yeah. I want to give the, the

you know, the slow progression. That's right. I'm excited to try that, you know, once the gyms open up after COVID. But you can come hang out in my gym. Sounds good. I'll get you started. Six by six is like the person that eats seven ibuprofen. Yeah.

That's what it is. That's a good way to explain it. But you don't have to have seven ibuprofen. One will work usually in the beginning. And then when it, you know, eventually you'll go to two. Like it's minimum effective dose. And it's, and sometimes six by six works. But the question is if two,

two by five or three by five also work, why would you do six by six? That sounds terrible. I don't want to do that. You don't want to do that. If one ibuprofen works, why would I eat seven? That's terrible I do. And it can be counterproductive to actually overstress your body. Absolutely. Right. So just having, you know, three sets of five, I think it's sufficient for most people to get to a really good spot where they're pretty strong. You know, it might get more nuanced eventually, but three sets of five. I think it's sufficient. five is like a pretty good way of doing it. Yeah, like we literally, we've said it, we've kind of danced around this, Peter,

but it's this. We do three sets of five repetitions on a lift. So we take the squat, we warm up properly with good technique. Let's say that day we're going to squat 65 pounds, which isn't very much. We're going to do 65 pounds for five reps. We're going to wait three, four minutes.

We're going to do 65 pounds for five reps. We're going to wait three or four minutes. We're going to do 65 pounds for five reps. Now we're done, A few days later, when we come back, guess what we're going to do? The same thing, instead of doing 65 pounds, we're going to do 70 pounds. It's literally that simple. It's literally that simple.

That's what you do on the lifts. Yep. One other thing I'll say is, like, after getting more exposure to depressed patients, you talk to them and, like, they're not really proud of much in their life. But, like, what Dr. Peter was saying, like, if you add 65 pounds to your squat, over a month, that's incredibly powerful. And I think that could have like a psychological effect too of like you're building yourself,

you just care about yourself so much. Yeah, it shows yourself value. It's the same thing of like starting to get someone who has not clean their house to slowly clean their house. It's like then when their house is clean, their bed is made, things are put in an orderly fashion, it's like they're proud of that. That's like I've created order to the chaos of my life.

Strength training creates order to the chaos of our body. That's exactly. It's like we're putting our body through a system that our body doesn't like when it's going through it, maybe for a couple minutes of the actual lifting time or a couple minutes of the actual high-intensity interval time, but then our body just responds with like producing all of the good things that we want our body to produce.

You know, so I had like a patient who was like, should I get on testosterone? And I was like, well, honestly, I think if you lifted weights and you stopped eating junk food and you started sleeping eight hours a night with that CPAP, I think your testosterone would be radically changed. And it was.

That's right. It was. He went from being in the 10th percentile of men to like the 50th percentile. That's right. Just by changing lifestyle stuff. So it's like, okay. That medication really just,

it's, you're medicating the symptom. The symptom is he has low testosterone. What's the problem? The problem is he's sedentary. He eats junk. He has sleep apnea. Right. He chokes all night long.

And as a result, his testosterone is low. What do we tend to do? Treat the testosterone. How about we make a lifestyle change? That will, and almost always, not always, but it's certainly, there is no downside for the lifestyle change. If he makes the lifestyle change and he sleeps better and he eats better and he exercises and his testosterone is still low, you might have then sent.

him to the doctor to go get that maybe maybe but most of the time you're probably finding that when you actually attack the root of the problem and the problem and not the symptom of the problem then you get a bigger bang for your buck yeah man i'm thinking a couple surprises i had of getting coached by you is how positive you are so what what reynolds does is he watches a video of me squatting and then he records a video on his computer of him commenting on my squatting So every morning I wake up to a little video of Reynolds commenting on my squat. And what surprises me is you're usually very positive when you do it. Like I didn't expect the positivity.

Wow. Thanks. And that's been a nice surprise. It's like, wow, hey, good morning. Good to see you. Okay, let's see this. All right. That one looked good. Okay, that one, that squat was a little bit too high.

Oh, you're doing it again. Your squats a little bit too high. Okay, we got to figure that out. You just kind of, you naturally, I think, learn the compliment sandwich. I don't think about it. I mean, I never think about things like that anymore. I've just done it for so many thousands of hours. So you talk to somebody.

The key is you're trying to encourage them to keep going. I know it's hard. I've done it. I do it. It's hard. Right? So people like, and even now, I have been lifting competitively for 24 years. And I still have to work every single day when I squat on my squat form or on my deadlift form.

It's not just automatic. it takes work, right? And so I know what it's like to work on those things. So yeah, it's important to be, it's important to be encouraging. Now, I do have some clients that sometimes need a talking to, right? They need a little bit of butt chewing. Like they start to do one and they just kind of give up. And you have to have a good, as coaches, we are certainly not psychiatrists, but there's a little bit of that. You've got to read their personality enough to go, I need to figure out if this person needs encouragement, to do better on the next session, or a little bit of come to Jesus meeting to do better. Like, hey, that really wasn't heavy.

You just stop trying, right? Sometimes I have to say that to people. But you're somebody that I think you're very self-motivated. And so encouraging you and walking you through the technique changes, that's key. And we've said all along for us, the biggest thing that makes, the things that make the biggest impact in strength training are consistency and form. And so if you do this and you don't miss three days a week and you make sure that your form is correct. you, you have a coach, then you're 90% of the way there. The program matters far less than just

consistency and technique. That's key. Yeah. Okay. Well, I, gosh, I think we could go on. We'll have to do a part two or something. Love it. And if people have questions, if people want to know, you know, stuff that maybe we didn't cover, shoot me a DM and we'll make a list of that for part two. But hey, man, it's been good to see you. Thank you for having me on the show. It's been a blast. Yeah. We'll talk soon. We're going to come out and on our podcast with the best of Dr. Peter series soon. Seriously. Because now we've been on the show and it. Yeah. It'll be great, right?

And we'll put it, it'll be kind of like a rewind series. And then you can send some of your audience and be like, if you want to hear me dive deeper into this strength training, you can listen to the best of Dr. Peter series on the Barbell Logic podcast. I'm serious. Nice. Yeah. We were talking about it at the other day. Once we, once we record that. I'll email out my email list and share that with them. Awesome. Thanks for having me on the show, sir. I appreciate it. All right.

So, yeah, if you want to check out the blog that will go with this, it will have all of the links to get to know Matt more and get to know the studies more. And we'll put some links to the YouTube videos. I would recommend watching on technique to get you started. All right. Have a good one.