The Food Medic - S6 E6: Barbell Medicine: resistance training for health + longevity with Dr Jordan Feigenbaum

Episode Date: August 11, 2021

Jordan Feigenbaum is a physician, strength coach, and powerlifter. He started Barbell Medicine in 2012 in an effort to bring the best of modern medicine to strength and conditioning and vice versa. Jordan is passionate about a variety of issues related to public health, education, and sport.This episode covers:- The story behind barbell medicine: bench to bedside- Health benefits of resistance training- Why recommendations to do resistance training are not more widespread in medical practice - How we can integrate resistance training into primary care- Advice for people new to weight training - Fears around causing or triggering pain when lifting heavy - Pain and injury management in weight lifting.- Jordan's big rocks when it comes to health and longevity.If you loved this episode make sure to give it a review, rating (hopefully 5 stars) and share it with your friends and family. instagram/twitter/facebook: @thefoodmedicwww.thefoodmedic.co.ukThis podcast episode is sponsored by WHOOP. Right now, you can get your first month free when you checkout through join.whoop.com/thefoodmedic Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and welcome back to another episode of the Food Medic Podcast. I'm your host as always, Dr. Hazel. So on today's episode, we're going to be talking about two of my favorite things, weightlifting and medicine. People often say that exercise is medicine, and actually this was the topic of my TEDx talk. But I do think there's this assumption that when we talk about it, we just mean aerobic exercise or cardio. And resistance training often falls by the wayside, but it's of equal importance. And today we're going to discuss just that. So for this conversation, I'm joined by the one and only Jordan Feigenbaum, a physician, strength coach and powerlifter. He started Barbell Medicine in 2012 in an effort to bring the best of modern medicine to strength and conditioning

and vice versa. In this episode, we chat about the health benefits of resistance training and why recommendations to do it are not more widespread in medical practice, advice for people new to weight training, fears around causing or triggering pain when lifting and Jordan's big rocks when it comes to health and longevity. I really enjoyed this conversation. It's super informative. Like I said in the episode we've been speaking on and off online for many years and share a lot of the same values, interests and passions. If you love this episode please do let me know. Make sure to leave a review, a rating and share a lot of the same values, interests, and passions. If you love this episode, please do let me know. Make sure to leave a review, a rating, and share it with your friends and family.

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tracks all four stages of sleep so you can get a breakdown of how much REM and slow wave sleep you got. It's allowed me to figure out ways which work for me to optimize my sleep. Whoop can help anyone perform better whether you're preparing for a 5k, training for an event or just looking to build healthier habits, Whoop can help you make smarter lifestyle decisions with data that is personalized to you. Right now you can get your first month free when you check out through join.whoop.com slash thefood medic. First and foremost, it's so nice to actually properly connect with you because we've bumped, I guess you could say bumped into each other online and we've got various like mutual friends and connections. So I really wanted to have a proper

conversation with you for a long time. And what better way to do it than on a podcast? Yeah, no, this is great. We've been Yeah, we're like, like ships in the night, just passing by each other on the internet. And then now we get to connect on a podcast. So hopefully people are listening. Hi. That was far more poetic than my intro. So I want to hear your story and obviously your backgrounds in medicine like mine. And you started Barbell Medicine, which is a fantastic resource and organization for people. But how did it all start? Start from the beginning. Sure. Yeah. So if you guys don't know me, my name is Jordan Feigenbaum. I live in

California and I started Barbell Medicine in 2012. That's when I was in medical school. So in the US you do your college degree and then afterwards you can go to medical school. I took like a five year break between my like undergraduate degree and medical school. And I owned and operated a gym in addition to doing some trainer education for personal trainers in the area. There was a large company that basically contracted my services to do that. So I was in the role of educating coaches and trainers and running a gym prior to medical school. So that was my background when I went into medical school. Got into medical school, started doing that just my preclinical years, which is all in the classroom. And in medical education, I do feel for them because there's so much information that they're trying to teach you. It seemed to me, though, that a lot

of the lifestyle aspects that we were almost being just paid lip service to. So it was like almost understood. Yes, yes, of course, exercise is beneficial and you should counsel your patients on exercise. And yes, of course, eating a health promoting diet is going to be useful and you should definitely address that in your visit. But as far as the nuts and bolts of how to do that and like points of performance or, you know, standard of care within those aspects of lifestyle medicine, those just weren't even being addressed. And that was reflected in the literature. You know, when I kind of did this quality improvement project during my second year

of medical school, I looked at how many primary care physicians even know what the current exercise guidelines were and then how many were recommending them. And so that's like 10% even know that they exist, like in what they are, and less than half of them who know what they are, are even addressing them in a primary care visit. So I was like, there's a need here for probably more education from the health professional side. But then coming from a gym owner, gym operator, coach standpoint, I also knew that there's a huge gaping hole for trainers who needed to learn about medicine in particular like you know their clients are going to have medical conditions if you're working with the general population or even athletes you

know that you're going to need to know about high blood pressure and diabetes and injuries and rehab and stuff and so i was like okay how do i blend these together because these are my two passions medicine and exercise and coaching so yeah i created this company on a whim. I was like, well, I'll just put out some information in the internet and you know, I'll feel good about it. I didn't plan on this being like a business or something that was going to expand the way it did. But yeah, within the first, I don't know, 18 months of like having the domain, there were a lot of inquiries for either consultation work with other providers. And I was still in medical school at this point. So I'm like, wait, you're an attendant, you're a full,

you know, fledged physician, you want me to tell you about this? That's crazy. And, and then also just from other, you know, strength coaches who were like, wow, we'd love to have you do a seminar, we'd like to, again, more consult work. So that's kind of where it started. That was 2012 into 2013. And then we've just expanded bringing other physicians and fitness professionals and other, you know, physical therapists on board and just trying to put out as much high quality content as we can to fill this gap. It's like bringing strength conditioning to modern medicine and vice versa. And how do we blend those two together? Ultimately, we'd love if more physicians were recommending specifically exercise to their patients and using behavioral change strategies to do that. So it's not just enough to know what the recommendations are and to just say, yeah, you should exercise more. It's like,

duh, no, but none of the patients and none of the public is like, yeah, exercise is actually bad for you. Like that's not a widely held belief, but as far as engaging in the behavioral change strategies and motivational interviewing techniques to achieve the behavioral change, you know, that's kind of where we're trying to bridge the gap. And we're coming up on our 10 year anniversary next year. So that's going to be fun. I didn't, again, if you would have asked me this 10 years ago, Hey, what's Barbell Medicine doing in 10 years? I'd be like, probably nothing. I don't know.

I mean, it's just, you never expect it. Right. So it's been kind of fun, but yeah, that's our journey. It's amazing. And very similar to mine, I guess mine has always been slightly more nutrition focused, but I was also in medical school in 2012, when I started the food medic for similar reasons in that in lectures, we were kind of always putting in, you know, lifestyle factors and just mentioning them, but there is no real direction when it came to

prescribing it. I'm using that in loose terms. And I guess everyone just thought it was very much you know common sense we all know how to eat good food and healthy food we all know that exercise is good for us but you mentioned something really important that it's not just kind of telling people what to do there's the whole behavioral factor around it so there's so many things to pick apart there and I guess one of the other things you mentioned is like not many physicians are aware of the guidelines surrounding physical activity and I think the same is true for a lot of people or they know part of it but they don't know all of it and so I'm pretty sure it's the same here in the UK as it is over in the States in terms of the amount of minutes that you should be doing. I mean, no one's counting how many minutes they're doing roughly, but ideally it's like 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity across the week, plus two days of kind of strength training, resistance training.

And that second part, in terms of doing strengthening exercises is often forgotten about, especially when it comes to older adults. And arguably, it's more important when we get older because of so many things like sarcopenia, muscle balance, all of those kinds of things. So let's have a discussion around the benefits that come from resistance training in relation to health. Sure. Yeah. So the exercise guidelines, you laid them out perfectly. Those are the minimums. So if people can meet those and then exceed them, that would be ideal. Right now, if you query people like, Hey, how many of you are meeting the aerobic guidelines? Roughly half of people, adults in the UK and also the United States, about half will respond,

oh yeah, I'm doing it. But when you actually strap like an accelerometer, like a fancy Fitbit or Apple Watch or something to these people and monitor their activity, it's less than 10% if you allow any duration of activity to count moderate or vigorous and that if you only allow at least five minute bouts to count which is kind of the current guidelines like look you have to be exercising for about five minutes continuously for it to count as exercise it can't just be like briskly walking to the fridge for 30 seconds then it's less than five percent and that's just aer Now, if you layer the resistance training component on top of that, it's less than 1%. So huge, huge need here to like get people up to speed. And then I would argue that more people are probably trying to or engaging in behaviors that are bringing them

towards the aerobic minimums than the resistance training. But I view them as equally important for at least long-term sort of health span is what I like to kind of refer to rather than lifespan, just health span, how long you're healthy, active, able to participate in a life that's high quality. So unique benefits to resistance training would basically revolve around the musculoskeletal system, or as the Aussies would say, musculoskeletal system. So stronger muscles, more lean body mass, which tends to allow folks greater functional capacity into later in life. Functional capacity, just referring to your ability to like do stuff, whether that's activities of daily life, like carrying groceries in, you know, or interacting with family members or, you know, whatever. So having stronger muscles, carrying more lean body mass, all good things. One of the emerging sort of benefits has been metabolic health. Effectively, we think of muscles as big like sugar sponge. So as we age, loss of muscle tends to reduce that sponge. So

we're not as able to use, we lose some ability to use sugar, use energy sources for fuel. And so that can contribute to increased diabetes risk as we age. There's also increase in bone mineral density, which we think particularly for women, we want to get them resistance training early in life to sort of build up this physical 401k that they can draw from as they age, because trying to reverse it later on in life seems to be a little bit more difficult, although it's never too late to start. And a lot of stuff with respect to fall risk and sort of independent living. And so it's unclear if there's one mechanism or multiple mechanisms, I'd probably lean towards the latter,

as far as preventing folks from falling and continuing to be able to live independently seem to have some pretty good correlation with strength metrics and lean body mass metrics. And sometimes in the research, they measure power. So how quickly you can produce force. But the whole point is that this works well with aerobic activity. So it's not one or the other. You should do both. I think resistance training kind of gets a bad rap because folks assume that the injury risk is like super high when in the reality, even at the competitive level for resistance training, so powerlifting, Olympic weightlifting, CrossFit, the actual injury rate is similar to recreational cycling.

And nobody's saying that, yeah, you know what, you might want to lay off the cycling or avoid the cycling because it's very dangerous. Now look, a motor vehicle accident, yes, that would be terrible, but relatively rare. But when you actually look at the injury rates per thousand hours of participation, we're very, very similar. And resistance training is much, much lower than other non-contact sports. So safety seems to be high. Efficacy seems to be relatively high. So on balance, the risk benefit ratio is firmly in the benefit category. So that generally leads to like, what kind of resistance training should I do? And it's really whatever you want to do. The main things are working the major muscle groups multiple times per week, getting somewhat

close to failure. So it should feel not good, actually, is what one of the studies that I like to reference. They used this feeling scale to sort of gauge how hard people should go, how many reps they should do. And it's like, yeah, you should keep doing repetitions until it feels not good, which is great. Look, we don't need to medicalize. Yeah. But you know, I think people particularly in the training space really want to, you know, we have to have this very specific program or whatever. And I think it can be useful for people that are geeked out on training. I mean, that's,

I fall into that category. But if you're trying to get your parents to exercise, grandparents to exercise or a friend, the reality is like, Hey, what do you want to do? What are you willing to do? And that has the lowest barrier to entry for you and mate work, the major muscle groups multiple times per week, get, make it feel kind of uncomfortable. And from a health perspective, like I'd sign off on that seven days of the week. If you're have more performance or anti-goules, sure that we can go down that rabbit hole, but main thing is getting people to start. And so, you know, I think physicians, I do empathize with them because they get unfairly criticized for not recommending resistance training enough. I don't know that simply educating them or providing more

resources on like here, what the recommendations are and here are examples of those recommendations, which is something we do. I mean, that's not the key to the lock. That's not what's going to put people or really improve this, I think. The reality is we're kind of boxed in by the healthcare system. We don't have enough time. So that's the biggest barrier that physicians, you know, cite for not recommending routine exercise, including resistance training. And then the fact that they don't do it themselves, they feel like they're not a subject matter expert, which is true. You're not going to your doctor for exercise advice, because that's not what

they're trained in. You want them to operate up to their level of training, which is, I would argue, more complex than exercise. So I think that there needs to be this referral system probably to the actual exercise experts and they need to work with the physicians. But obviously that's, a lot of changes would have to take place for that to happen. But I, again, I don't want to, you know,

throw the doctors under the bus and say, look, it's your fault. It's like, look, this is an imperfect system. And I think, yes, increasing your knowledge base about what the recommendations are, how to do that, how to engage in behavioral change counseling, that's all well and good. But ultimately, I think if we really want to move the needle, there's going to have to be a better referral system. And we're going to need to get more doctors to exercise too, because they're part of the population. You know, they're part of this population who's not doing this. And I feel like if you had more doctors that were exercising, they'd probably feel more comfortable recommending it and have more experience too. Yeah, no, I completely agree. I think you made a really good point.

It's maybe if you asked me eight years ago when I was kind of first entering this field, I had these grand ambitions and I was like, all of this needs to be included in the medical school curriculum. That's not possible. Like it's not possible. I don't think it's required. But I do agree with you. There needs to be some linking up, a better referral system.

Over here, there exists a referral system, but it's not really used. I mean, I've never used it. It's used by primary care physicians to refer to personal trainers that have basically an added qualification that allows them to deal with people who have chronic illnesses. But from speaking to practitioners, they're like, I don't really know how to access it. It's not really available in all places. So there's loads of different kind of barriers to actually accessing it. And then I think people just don't do it. But I also think there needs to be more recognition as part of the wider public health measures and campaigns that

this is an unmet need, essentially. Yeah, I mean, the PSA and public health promotion of resistance training and exercise, I feel like we could do a lot more on that front. It's not that the World Health Organization or various national organizations aren't doing anything. It's just like, where's the really sexy campaign? You know, where's Ronaldo, Cristiano Ronaldo and like The Rock and, you know, a handful of other very, very influential figures, you know, really getting behind this PSA because that would be something I think that would move the needle, at least public sort of interest

in this sort of stuff. But to your point, yeah, there's a referral system here in the United States as well. The American College of Sports Medicine is like this additional qualification. They have a health and fitness specialist and there's additional sort of certifications you can get that says like, oh, you're a cardiac rehab specialist. We don't need people with that level of qualification sort of just doing therapeutic exercise, if you will. We don't need physical therapists or physiotherapists doing therapeutic exercise. We don't need specialized sort of qualifications to render that service. What you really need, again, is just reduce the barriers to sort of access here. So if you had a

patient in your clinic and you were saying, hey, are you willing to start exercise? And they said, yeah, I just am unsure. I'm like unclear on like where to start and what to do. And, you know, a bunch of questions, ideally you'd say, well, cool. All right. So after we close out this visit, walk down the hall, you know, Jordan is in the clinic gym and he's going to take you through the through your first session and answer all those questions for you. And then, you know, it's just a value add right there because they don't have to go anywhere. They're right there. You know, there's a bunch of studies on some other public health issues like sexually transmitted infections, vaccinations, et cetera. It's like, if you can render the service right there without them having to leave or like make another appointment or go

through additional steps, the uptake rate is much, much higher. So ideally in a perfect world, you'd have the clinic and the gym connected together or, you know, for nutrition, there'd be right after this visit, there's this nutrition education class or cooking class or shopping for food, something right now that remains yet to be seen whether that would on a large scale move the needle. But I think if we're trying to do a better job of this, it's unlikely that the physicians are going to get all of a sudden way more time to counsel folks. I mean, really? And even if they were granted more time. Okay, so you've done the behavioral change counseling, the person is ready to make a change. They're interested in starting what do now? Well, they're still not going to have enough time to like write out this prescription and making and check for understanding and follow up. So again, the referral system would be super useful there. In addition to just more public health like campaigns. I mean, if you tell people what the guidelines are, they're like, there's a lot of numbers there. Also, like if you read the numbers that they, you know, they're

saying, oh, moderate aerobic activity, that's, you know, four to six METs and some of the way, what's a MET? And then you have to explain that. And you're like, look, those papers and scientific guidelines like need to exist. That's super useful for practitioners. But as far as like publicly and to their credit, the WHO and the ACSM have decent infographics. But the problem is that they're so generalized that I think it still leaves people like wanting in a way. It's kind of like the food guidelines. It's like, yeah, eat more vegetables and fruits. It's like, OK.

And then they'll say maybe at best, like, I think that what's the campaign in the UK? Is it get your five? It's a five a day. Yeah, five a day. Yeah. And they're like, maybe at best, like, I think that what's the campaign in the UK? Is it get your five? It's a five a day. Yeah, five a day. Yeah. And they're like, well, what's a serving? You know, so I think on some levels, it needs to be more specific and more accessible. And then after you have all of that, the public health stuff, then it's like, all right, well,

what about the underserved communities or people with reduced access to even places to exercise? They don't have a park nearby. They don't have access to a gym. There's, you know, it's like, well, sticky conversation. It's a sticky conversation, but it highlights all the variables. Like, I mean, we know when it comes to health behaviors that just educating people isn't going to change things most people know that they need to eat five a day or they need to move their body and you know it's good to get enough sleep and things like that but it's changing the behavior and socio-economic issues are are one thing environment pandemics like there's so many

different things in the way even language that we use I think when it comes to discussing resistance training weight training when I'm using that language especially with patients who are not the people who I'm chatting with online automatically assume that I mean heavy weights in a gym with barbells and things like that but when we're talking about muscle strengthening exercises, we can really trim that back and we can remove all of the big, scary weights and just talk about body weight using bands. There's so many different things. And I think that conversation is often forgotten about. Oh, yeah. So our business is called Barbell Medicine. You know, it's funny, I was in medical school when I came up with this name.

I was like, Barbell Medicine. I like barbells, like medicine, cool, smash it together. And then I came up with this little translational research, like slogan with you from bench to bedside, you know? Yeah, I love that. The woman I was dating at the time, she goes, that's a terrible name and a terrible slogan. It's never going to work.

And I was like, they immediately break this off. There's no way. It's so good. But I think you need to explain to like non-medic scientists why it's a good slogan. Sure. Yeah. So translational medicine, translational research is the idea that you take an idea for some sort of intervention, whether it's a medication or treatment or whatever from the laboratory bench. And then it gets translated through multiple series of studies to the clinical medicine, aka the bedside. And so the idea was we're going to be able to provide high quality resources and tools that span from preliminary research all the way through.

These are clinical guidelines or sort of better supported ideas. And so, yeah, anyway, she didn't like the idea. We didn't last very long, but now look who's laughing now. Yeah. But so, you know, people say, oh, your business is barbell medicines. You just must, you're a barbell guy, only heavy weights. And I'm like, well, me personally, like, yes, I've been a power lifter now for, I don't know, over 10 years. And so in powerlifting, you squat, you bench, you deadlift, that's the sport. But I don't advocate for that to people in general. My usually when I'm engaging in this conversation with somebody who's interested in starting

exercise, my very first question to them is, what kind of exercise would you like to do? And then trying to fill in the holes. So usually, you know, that response will tell me where somebody's sort of knowledge bases and their preferences. So they may just completely talk about cardio respiratory exercise or cardio. You know, I like to walk, I like to ride my bike, swim, whatever. And like, that's great. How about lifting weights or resistance training? Resistance training I'll usually actually define is just using any external weight. And they're like, oh, I don't do that. And then we sort of start right there addressing any sort of barriers.

But as far as when it comes time to actually recommend like what exercises to do, I really try to get a handle on what are their preferences? What do they feel comfortable with and what do they have access to? So someone's like, yeah, I actually have a member at this gym. I don't necessarily feel comfortable using barbells. Like if something machine-based would be preferable, because I feel like I could get that a little bit easier. I'm totally fine with that. And in fact, when we wrote our up-to-date article, up-to-date is like the doctor's Google. If you see a patient in the clinic and you're like, I have no idea, or I want to make sure that I'm up-to-date on these

guidelines, you go to up-to-date and you type in whatever the clinic and you're like, I have no idea, or I want to make sure that I'm up to date on these guidelines. You go to up to date and you type in whatever the condition is or the medication or whatever. And then this like very current evidence-based article pops up. So we wrote the article for strength training and primary care and like how to dole those guidelines out. And so we actually put a machine-based program in there and people, particularly those who are like in the healthcare field, but also follow us on social media and are aware that we're like power lifters and, you know, strength enthusiasts. They're like, wait, you guys put out

a machine-based program or like, yeah, totally from a health promotion standpoint, this matters very little. And so try to highlight what people prefer. You prefer machines, dumbbells, barbells. If you have no preferences, cool. What would you feel comfortable doing? And you're sort of making the person a manager of their own program, their trajectory here. They're taking ownership or building self-efficacy and starting there. And then, all right, do you have access to this stuff? Somebody is like, you know, honestly, I want to get into Olympic weightlifting, like oddly specific, but sure. Let's, let's do that. Do you have access to a barbell? No, I do not get into Olympic weightlifting, oddly specific, but sure, let's do that. Do you have access to a barbell?

No, I do not. Okay, well, so we're going to have to adjust what you want here. And I think I would rather people know less about the hard science behind all of these recommendations. Like, what does the data say about muscular hypertrophy and training to failure? What does the data say about intensity ranges for optimal strength improvements? I don't really care if you're a trainer and much less if you're a physician and you know that. I'd rather you be more well-trained in behavioral change and motivational interviewing sort of techniques

to sort of elicit people's narrative, get people talking about what they're wanting to do, willing to do, able to do, because that's how you get people to do the thing. You don't need to explain to them like, hey, did you know that the more that you train, the higher volume that you exercise, the more muscles you'll grow? Like that's not going to change anyone's behavior. That's just a fact. To the extent that people have questions or there's knowledge gaps that are preventing them from making a change, that's where you as a subject matter expert can come in and plug that gap. But if you don't know that, you can look it up.

The behavioral change stuff is, as you said earlier, much, much, much more important. Yeah, often the missing piece. And when we're talking about training the major muscle groups, like if we really break it down, what are some of the fundamental kind of like core exercises that you think should be included in most people's programs, if they're just looking to basically strength train for health improvements? Yeah, this is actually a very difficult question to answer. Because I don't know that there are any movements specifically that I hold, you know, and yes, you have to do this. Absolutely. Usually when I talk to other lifters or people

engaged in like in sport, or they like, like to train with barbells, I tell people like, you know, you should have some sort of squat type exercise. You should have some sort of pressing exercise with the upper body. So that's overhead or bench press or something like that. And then you should have some sort of rowing exercise. And in reality, that's going to get you pretty close. But to the general public, they're like, that doesn't really make sense. And so then I'm like, okay, you need an exercise for your legs where both your hips and knees are moving. You need an exercise where you're working your back muscles.

And then you need an exercise that's working the front of your chest where your elbows and your shoulders are both moving. And at that point, you've basically just said, look, here are like three sort of movement archetypes that we're trying to get you to do. I also find that giving people examples helps. So when we talk about the leg exercise where both your hips and knees are moving at the same time, like a squat, like a leg press, if they don't know what these are, I'll sometimes pull up a video. It needs to be a calculated conversation in a way and need to check for understanding our

regular basis. So that's why I like having like multiple either illustrations or examples or something like that. But when people, if people are listening to this and they're like, all right, what sort of movements do I need to pick? You need to have something that works the lower extremities, preferably a compound movement. And I say compound just moving more than one joint at a time, which is why I kind of stipulate hips and knees at the same time. So if it's a leg press, great squat, great split squat. So a lunge, whatever, once you've decided which type of exercise you're most willing to do, most excited to do most able to do, then figure out how you want to load it. Do you want it to be a machine? Do you want it to be a

barbell? Do you want it to be a dumbbell kettlebells? Do you want to bands? Do you want to just body weight? That's all well and good. Just provided someone has access to is willing to do it, able to do it. Same thing for the upper body pressing motion. Again, you want shoulders and the elbows to move. It could be vertical. So overhead could be horizontal where you're lying down. It could be somewhere in between like an incline.

Figure out, do you want it to be machine-based, barbell-based, dumbbell-based, kettlebell-based, body weight-based, whatever. My only stipulation is, again, there's this wide range of reps that will quote unquote work to sort of meet these sort of health promoting exercise minimums. And if you put a gun to my head and you say, what's that rep range? I think it's five to 30-ish reps, less than five. I think you're not necessarily doing enough exercise. And then over 30, we start getting much more into this sort of aerobic and less like a lean body mass promotion. Just the reps are too high. So yeah, that's your big rep range and it's got to feel uncomfortable in that range. So if you only want to do body weight stuff, someone's in the clinic, they're like, honestly,

I just want to do body weight stuff. That's something I feel comfortable with. I'm willing to do it. I have access to it. I can do it in my house. I'm like, excellent. The problem would be if this person, for whatever reason, was already at a high level of fitness and could do like 30 body weight squats in a row without it ever getting hard.

And you're like, that's great. But I don't know that at that point is really counting as resistance training. It just needs to be harder sooner. Same thing with like pushups, right? But yeah, you can go a long way with just body weight stuff. The real issue is most folks, particularly if they're sedentary, older and detrained, body weight stuff is way too hard for them. I mean, they can squat down and up off the couch, which is actually a test we use, one of the tests we use for like sarcopenia, the timed, sorry, sit to stand.

Yeah. Basically, you got to do five reps without using your hands in less than, I think it's 20 seconds or 30 seconds or something. So if you're listening to this and you're like, you know, my parents, whenever I see them get out of chair, they always use the armrests or they always put their hands on their legs to help them up. Ask them, hey, can you stand up without using the armrests or putting your hands on your legs and to see if they can do it. If they can't or they're really struggling to do it once, they probably fail that sit to stand test, which suggests they would benefit a lot from resistance

training, which is a nice little lever you can pull. It's not that you would say, Oh, look, see, you know, your muscle strength and muscle mass is a little low. You need to exercise. It's like, Hey, I'm concerned that maybe you're not getting around as well as you used to. Would you be willing to at least discuss, exercise is something you're willing to do. And if they say no, try again later. But yeah, hopefully those movement archetypes are kind of how I frame my thinking about this from an exercise minimum standpoint. And there's so many different ways to meet these guidelines. And I think ultimately personal preference should play the biggest role. Yeah, I think that's a great message but i also think the kind of three core areas that you put them into is also quite useful

for people because there's so much room within that to move about and variations of particular movements um but the one thing that i want to move on to next is pain which I think you guys, I'm like, do I want to get into this? But you and your team talk about it so often and also cover it so well. Maybe we can like take an example and pick that apart. Like when it comes to the deadlift, a lot of people avoid it out of fears that they'll have back pain or some people avoid it out of fears that they'll have back pain, or some people avoid it because they have back pain. And it's not just down to technique. There's also lots of other things that could be causing that pain. And so could you talk us through maybe your step by step approach when

it comes to someone experiencing pain in example, when they are lifting, like in a deadlift, which is lifting a weight from the floor? How would you tackle that and advice you'd give to someone? Yeah, so just from like a, again, 10,000 foot view, the way we try to shape our message is that exercise, including resistance training, including heavyweight training is relatively safe compared to many other activities. And no one gets out of life unscathed. So, you know, risk of pain is high. It's a hundred percent. If you live a long enough life, you're going to have pain. As far as how's that relates to activity. Most of the time when people have pain from physical activity exercise in particular, it's usually due to a loading issue. And I don't mean that just by heavyweights.

What I mean is like the total training stress. So that's weight lifted, the amount of times you lifted it and the amount of sets that you did that over and over and over again, on top of what exercise you've done recently, in addition to your environmental stress, psychological stress, et cetera. So in any case, the stress becomes too great for you to tolerate. And so fatigue is very, very high. And one of the body's protective mechanisms is pain. And basically it's saying, you're a little bit overdone right now.

It doesn't mean that something anatomically is wrong or needs to be fixed. Certainly there are cases of that. Very unlikely in physical activity and resistance training. So just as an aside, when we look at actually injuries in from resistance training, in general, they tend to be self limiting and resolve within 14 days, regardless of what people do, which suggests

that these are not catastrophic injuries, like, oh, I tore a muscle or I ripped the tendon off the bone. In general, these are very short-lived self-resolving sort of issues. People do get hurt and sometimes they experience pain after exercise, during exercise or whatever. And we just tend to frame that as this complex sort of experience that stems from what you're doing physically, your sort of mental state and what's going on around you. So a lot of different inputs here. Well, as far as what to do, if you have, are having pain or are fearful of having pain during a particular exercise,

like the deadlift probably gets the worst rap out of all of the exercises. One, the name is terrible dead lit. Like, come on. Like when they were naming this, I understand, you know, you want to be tough

guy or whatever it's the deadlift it could have been live lifts there could have been you know pickups whatever anyway we'll we'll change the name because yeah i mean i'm just saying yeah if you're trying to get your mom to lift a weight a barbell loaded with plates from the floor you'd say mom we're just going to do pickups today. It's probably more accessible than deadlifts, at least less intimidating. So the way that we try to conceptualize this is that people have a sensitization or are sensitive to a particular movement at a particular place in time. It's not going to be forever. It's going to get better, most likely. And that trajectory towards recovery is going to ebb and flow. There's going to be forever. It's going to get better, most likely. And it's, you know, that trajectory towards recovery is going to ebb and flow.

There's going to be good days, bad days. But again, most of the time, this is self-limiting. So how do we get over the sensitization? How do we desensitize somebody to a particular movement? The first thing is we don't want to rest. We don't want to be sedentary. Not only because there are, you know, benefits from continued physical activity with respect to the trajectory and the recovery rate tends to be faster, but also just the risk of being sedentary,

particularly for prolonged periods of time, but even in short periods of time, not great. So motion is lotion. We want people to move. And specifically, we want people to move in a similar manner to the offending sort of activity if it happened during an exercise. So if it's in dead lifts, we want people to start dead lifting. So let's say you completed a set and you're like, my back doesn't feel right, or I felt a pop or this, that, and the other. So none of those things are specific enough to be like, wow, that's very worrisome. So what we'd like to have you do if you're like, I'm going to call this workout, I'm just going to go home and lie on the couch.

Instead, what we'd rather have you do is, all right, let's take the weight off the bar. Let's start with the empty barbell. Can we just do deadlifts with the empty barbell? Move through that same range of motion using the same movement pattern. The idea is to show yourself, wow, I can do this. I'm not, you know, broken.

I can manage this. If that's not possible because the sensitization is too high. Okay. Can we do this at a partial range of motion? Can you do a deadlift just from right below the knees? Okay. That's still too much. How about just above the knees? Okay. No, that doesn't work. All right. Let's take the barbell down. Can we do a, just a hinge from the hips with body weight? And so you can regress as far as you need to, to find that entry point, to start sort of exposing somebody to a small challenges. The idea is to amass enough wins, conquering those challenges to reduce that sensitization to a point where it's no longer there. So that's kind of like an overview of what we're trying to

do. Now, everybody's different, you know, and can have a different experience here. But I think if your listenership, if they're like, yo, we don't, we don't deadlift because it's dangerous. The risk is too high. First and foremost, that's not true. And so the idea that you should avoid a particular exercise, to me, that just leaves you exposed to stuff you might, you know, need to have some proficiency in at some point. You know, if you leave the deadlift or picking stuff up or using your legs in a bent over position untrained, that seems like a gaping hole in your fitness. You know, you're gonna have to pick up groceries off the ground. You have to pick up a, you know, an infant off the ground you stuff like that so i think we shouldn't avoid that

exercise in particular the deadlift but it doesn't mean you have to deadlift with the barbell you could do it with dumbbells you could do it with the kettlebell you could do it from a range of motion where it's higher off the ground again finding something that you want to do that's first and foremost for just exercise promotion but if you have been hurt on the deadlift, I want you to start deadlifting today. Again, motion is lotion, we want to get people moving and really desensitize folks to the movement that may have caused some pain. I like that motion is lotion. Yeah, you can use it. I'm taking that one. So I mean, we've centered most of this conversation around longevity and health.

And that was the purpose. That was what I really wanted to focus on. But outside of that, when we kind of focus in on lifestyle in general, what are some of the big rocks from your point of view that we should all be prioritizing for health and longevity? Oh, man. Should we just answer, like, what is the meaning of life? You can answer that first. Yeah. Easy questions. So first and foremost, engaging in regular physical activity, meeting the guidelines should be a goal for everybody. So again, 150 minutes of moderate intensity activity or aerobic activity, or 75 minutes of vigorous intensity, aerobic activity plus resistance training, do that.

So that's one of the rocks. Being inactive is a major global issue with respect to health outcomes. Get moving. Second thing would be eating a health promoting diet. Similar to the sort of exercise guidelines, there are many different ways to eat a health promoting diet, but ideally it should result in a healthy body composition so that your BMI and your waist circumference are within range. So you're not carrying around too much excess adipose tissue, fat tissue, and it's something you can adhere to. Third rock or pillar would be sleep as far as

getting enough quantity and quality of sleep. So a lot of different strategies here, uh, avoid alcohol and caffeine prior to bedtime, certain dietary behaviors. Some people, for example, if they get heartburn, that might keep them up. There's a lot of different strategies there, but sleep another big rock, avoid smoking and other, um, substances, uh, that are associated with poor health. Again, I think if you asked people on the street, like, hey, is it healthy to smoke? Like nobody's saying yes, but there are still a large population of folks who smoke. And so that needs to be in the front of a clinician's mind and also the public.

Probably routine appropriate medical care. This is not like an annual screening or like see your doctor every year, but we have pretty good evidence for monitoring blood pressure, screening for depression, and then vaccinations. Those would be like the four big like sub points for the routine medical care. Different demographics are going to have different sort of how often you see your doctor and stuff. But seeing a doctor, that would be useful. You can go see Hazel. Yeah. And then I think, you know, this, this is a little woo. So maybe surprising to some folks who have been listening or following me for a while, developing this sort of meaningful connection with a peer group and have a supportive social network and plugging in

to your community, I think is super important just for like, why are we here? You know? Yeah. Okay. My health is now great, but like I have no social support system. I have no, you know, you need friends, you need family members or, you know, whatever to sort of have these deep, meaningful connections. I think we're social beings. And without that, it'd be really hard to have a healthy and high quality health span you know into into old age so i think those are my big rocks did i miss anything no i don't think so i think yeah the social side of things is really important and i i think more and more we're starting to realize how like social isolation is such a risk factor for many different types of poor outcomes

but like you said as well it's you know it's all well and good like trying to optimize your health but if that's all you're doing and everything else falls by the wayside then what are you optimizing your health for what is the meaning of life? Next question. Yeah, they see I told you we were coming back to that. No, I won't give you that question. But I guess what would be your kind of your biggest takeaway from from our conversation for people to go home with? Yeah, I think it's not surprising to hear that exercise is health promoting. I think the biggest takeaways are one, there are many different ways to fulfill and exceed the exercise guidelines based on your preferences, whether that just be health and longevity, or if you have some sort of performance goals, again, many different ways to tackle that. And

so there's no one best way to exercise. The recommendations are intentionally vague and broad so that people can kind of pick and choose what they want to do based on their preferences, which is likely to improve their adherence, build self-efficacy, all good things. So that'd be one big thing. And then the other big thing is that the behavioral change process is very complex and really at the center of addressing the sedentary pandemic. There are just way more people who are more sedentary now than ever. And the core of that is behavioral change. And so learning and having skills and tools and resources to help folks change their behavior, that's what makes you somebody an effective practitioner, whether that's in the medical

space, whether it's in the fitness space or whatever. You can have all the knowledge in the world, but if you don't have the skills to help somebody change their behavior, I don't know how effective you can be in this space. You might be able to be popular on Instagram. You can make infographics, but I don't know that you can actually help folks. Is that a dig at me? No, I love it. Oh, I was just going to say, hey, so for everybody, so I came across Hazel's account. So one, the food pictures, the aesthetic. Oh my gosh. I was across Hazel's account. So one, the food pictures, the aesthetic, oh my

gosh, I was like, this is excellent. So then that's how this happened. Thank you. And so if people want to learn more about Barbell Medicine and the work that you're doing, what various platforms are you present on? So the main Barbell medicine across all accounts so it's barbell underscore medicine on instagram barbell medicine on youtube twitter we're not on tiktok yet holding out i don't know if i can get into that oh my god please i would love that just want to dance on tiktok and then my personal account on instagram is jordan underscore barbell medicine and then our website is barbellmedicine.com we have our full catalog of articles and resources on there. And a podcast.

You just Google Barbell Medicine. And a podcast. Oh, yeah, shoot. You got a podcast. Yeah, it's unsurprisingly Barbell Medicine podcast. You can find that. And yeah, I think that's it. Amazing.

Okay, guys, that was jordan i hope you found that podcast interesting inspiring whether you are a physician or doctor healthcare professional of any sort or just someone who's interested in getting into weightlifting and wanted to know more about the benefits. I hope we've convinced you. If you want to learn more about Jordan, make sure to check out his Instagram page. He is a serious weightlifter, or should I say powerlifter? He really did not sell himself, but he lifts some serious weights. If you did love this episode, make sure to give it a review, a rating, hopefully five stars, and share it with your friends and family. That's's all for me and I'll see you again next time