WHOOP Podcast - Dr. Kevin Sprouse, leading sports doctor, shares how WHOOP helps his athletes conquer the Tour de France

Episode Date: September 9, 2020

Dr. Kevin Sprouse is one of the leading sports medicine and exercise physiology experts in the country. He works with some of the best athletes on the planet, including baseball and football players, Olympians, and some of the top golfers on the PGA Tour. Kevin is also the medical director for EF Pro Cycling, one of the top 10 cycling teams in the world. WHOOP is the official wearable of EF and Dr. Sprouse shares how his team is using WHOOP data science to monitor rider well-being and to help optimize their performance during the Tour de France. Kevin discusses why he got into the field (2:29), why cycling and sports science go hand-in-hand (5:17), how recovery leads to success during the Tour De France (9:36), what his team does to improve recovery (15:25), learning how you best recover (17:38), antioxidants and free radicals (21:13), glucose monitoring (23:48), absurdly high strain data from the Tour de France (27:34), why 24/7 health monitoring is critical (31:12), understanding how alcohol affects your body (39:27), avoiding over-reliance on medication (42:57), and why the top cyclists in the world are, in his opinion, the fittest aerobic athletes on earth (45:42).Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

What's up, folks? Welcome to the WOOP podcast. I'm your host, Will Ahmed, the founder and CEO of WOOP, where we are on a mission to unlock human performance. What does WOOP do? We build wearable technology. We measure things like sleep and recovery and stress. We help you become a better version of yourself.

At least that's our mission. And you can find the technology at Woop.com. If you don't have a Woop membership, you can get 15% off your WOOP membership by using the code Will Ahmed, W-I-L-L-A-H-M-E-D. This week's guest is a brilliant leader in sports, medicine, and exercise physiology. Dr. Kevin Spouse, he works with some of the best athletes on the planet, including baseball and football players, Olympians, some of the top professional golfers on the PGA tour, and particularly relevant right now, Kevin is also the medical director for the EF

pro cycling team, which is one of the top 10 cycling teams in the world, and competing right now in the Tour to France. So he is actively using Woop right now on his athletes at the Tour to France. Woop is proud to be the official wearable of EF. That's a partnership we just announced in the past few days. And we're excited to be helping the EF team train and recover over during the tour to France. Kevin and I discuss why he got into this particular field of medicine, the critical role data plays in training elite cyclists, and really a lot of different sports. We go deep on a bunch of different sports. Why the pill for every ill mindset is misguided, his tips and tricks for optimizing performance, and how he uses whoop in his own life and why he

recommends it to his patients. I think Kevin has a really insightful point. point of view on WOOP and more broadly sports medicine. And without further ado, here is Kevin. Kevin, welcome to the WOOP podcast. Hey, Will, thanks. It's good to be here. So how would you describe what it is that you do? That's a good question. I'm jumping right into it. So I'm a sports medicine physician, but probably not what most people think of as a typical sports medicine doc. I trained in exercise physiology prior to med school. And when I started my practice, I was pretty adamant that I wanted to bring exercise physiology and nutrition performance into medicine. What I had seen is that, you know, it's not novel to say it now, but there was a lot

of focus on disease and how things go bad, but we didn't really focus on how to make someone who's healthy perform better. And not in a nefarious. way. Like there's been, that's well detailed in history, right, how doctors get into sports and pull all kinds of levers that they shouldn't be pulling. But rather to look at the literature, because really in sports medicine and in sports performance, it's the only body of literature we have that looks at patients who are well, who have no ongoing disease processes and says, what can we do to support their performance? So I wanted to bring that. And into sports medicine here in the U.S., which was kind of lacking at the time.

So that's what I do. And you get to work with fascinating, high-performing people. I mean, across Olympians, PGA tour players, NFL players, MLB, triathletes. I mean, we're going to talk hopefully a little bit about cycling. You know, was it obvious for you that you were going to go down this path? It was, but that's easy to say. there's a lot of doctors who get into sports medicine wanting to work with athletes, and it doesn't happen.

It was obvious to me that that's what I wanted to do. And fortunately, right out of fellowship training, which was my subspecialty training in sports medicine, I started working with the EF cycling team. It wasn't EF at the time, but it was the same program. So I've been doing that now for about 10 years. And then the rest of my practice kind of built on the back of that. And I started working with other endurance athletes. triathletes, runners, track and field.

The first pole vaulter that came into the office, I didn't quite know what to do with, just from a sporting standpoint. But the tenets of performance often carry over between sports. And so when that extended into baseball, football, and then golf, Scott Stallings, who's been on your podcast, was the first golfer I started working with about three years ago. And when he came in, we had a little bit of a conversation that, You know, I understand the physiology. I understand performance.

I'm not a golfer. So, you know, that part we may have to learn together. And now I've got eight PGA guys I work with. Tell me, so EF cycling, would you say that was sort of your biggest leap into sports medicine? And obviously there's so much that goes into a tour to France as an example. It definitely was the biggest leap. And cycling is interesting from a sports medicine and performance standpoint. point in that there are so many measured variables and metrics that we follow, you know, heart

rate, power output, all the time, distance, climbing metrics, that it's kind of a playground for somebody who's into the science and performance. And you'll see, even in the sports performance literature, what typically is used as the prototypical sport when testing something, you know, testing a theory or testing a supplement or a training regimen, whatever, is cycling because you can control for so many things around those variables. So for me to go straight into cycling, which was also just a passion of mine, was both fun but also, I think, a little bit fortuitous with respect to the rest of my career. Yeah, I mean, in some ways, to me,

cycling almost feels like the pinnacle of like a sports medicine control group because it seems so isolated around performance, right? Like, the person who is the most finely tuned is, you know, is the person who wins. And, like, you just can't say that about most sports, you know, because there's a huge talent component to other sports that's, you know, I mean, Tiger Woods won a U.S. Open on a, on like a broken leg, right? So that was hardly optimal. Now, if you think about cycling, let's start there.

What was something that you observed maybe in the first couple years that over time you were able to start influencing? I think, I mean, without a doubt, the answer to that question comes to mind quickly and it's sleep. When I got to my first race on the world tour, I'll never forget, I came with this big medical kit, I had all the bandages I could need, I had the medications I thought I would need. And very quickly, I realized the number one most common concern or complaint of these athletes was, I can't sleep. And to me, as kind of a recreational cyclist, a day on the bike would wear me out and I'd sleep great. So I got there and I was immediately scratching my head.

I was like, can these guys not sleep? This is crazy. This is not what I expected to be encountering. And then as I learned more, one, I mean, there's lots that goes into it, but there's the fact that race is in typically in the afternoon or early evening, they've maybe had a caffeine gel to finish it off, whether that's a climb or a sprint. They're all amped up. Dinner is late.

There was a transfer. There's travel. It really doesn't set itself up well to be a good sleep environment. You're in a hotel. Sometimes there's not air conditioning. It's the middle of summer. And so that we had to start kind of back engineering a little bit. And very early on, we recognized that, you know, sleep medication wasn't the way to go.

It has its place, but not as a common use. What would be an example of sleep medication that was used, but probably not a way to go? optimal for this group. Yeah, like, um, like an ambient. Okay, so something pretty, pretty intense, pretty heavy. Yeah, yeah, which you'll see across sports. I think there's been a big move away from, but just, uh, I mean, cycling was no different that there tended to be an overly pharmacologic response. There was nothing, there's nothing banned about it. There's nothing that is just straight up bad medicine. But to me, if our goal is performance, And we know that these type of pharmaceutical aids for sleep are not really fostering the best

restorative sleep, then that wasn't the way to go. Well, that's such a, just on that point, that's such a great point, because we've seen a lot of data on sleep alongside Ambien, I mean, because a lot of our WOOP members take Ambien or have experimented with it. And what we've seen is it makes your sleep latency, so how fast you fall asleep, much faster. So people will fall asleep much faster than they otherwise would. But the quality of that sleep, in particular, your REM and slow wave sleep is depressed. And especially for a tour to France, competitors, I mean, slow wave sleep when you're producing 95% of your human growth hormone,

that's got to be so important. So it makes all the sense in the world that you try to move away from that. Oh, it's massively important. The, I mean, the big determiner stage to stage on who does well across the entire tour is how well you can recover and go again the next day. So the deep sleep and like you said, the physical recovery restoration there hugely important. But the REM sleep too. You've got to be able to kind of approach the next day with focus and, you know, get to the important points in the race with your mental wits about you. And so if you're sacrificing both of those performance, especially in the long term, is going to really suffer. So you were saying, okay, it used to be, you know, there used to be more of the on the ambient side, and then you guys rethought it.

So what are some of the things that you've introduced that you feel like have been successful? It's a lot of the stuff that you've probably heard sleep experts talk about it, sleep hygiene. So it's recognizing that, you know, staying up and watching a movie on your iPad is going to detrimentally impact your sleep. But if you've been in the tour all day and you want to prop your feet up and just relax, that's what you tend to do. So there's education around that, teaching the guys that, hey, that's not ideal. Read a book if you can. And a lot, not if you can, they can all read. But if you can, if that kind of does the trick for you, right, go to a book.

But if not, maybe use blue light blocking sunglasses or glasses. And we implemented those with one of our partners five or six years ago, I think, for the guys to use in the evenings when they're, you know, watching a movie or even FaceTiming the family or something like that before bed, we look at the temperature in the rooms because, again, some places don't have air conditioning. We've played with devices like the chili pad and brought those in. I think we first did that maybe five years ago. We've got portable air conditioning units that we've taken to some races. And so we're always trying to figure out how to basically hack the basics when we're on the road. The same stuff that you would do at home

that we'd hear about for typical sleep hygiene. We just want to bring that on the road and put that into play in place of prescriptions, basically. Have you looked at sleep consistency too? So trying to get folks to go to bed and wake up at the same time, or is that harder with the schedule? It's harder, but that doesn't mean we shouldn't approach it. Right, right. Sometimes it's out of your control, in which case, we don't want the guys catastrophizing about it, right? Like, if you can't control it, don't sweat it, move on. But when you can, let's move toward that. So last year at the tour, we had one guy whose sleep was declining, his HRV was declining, kind of everything you would expect to see with declining sleep.

Like you just wasn't recovering. Yeah. And pointed it out, made some small changes, and just kind of set things back on track. And it wasn't rocket science. But when you can see the data and you can correct before it's problematic, then, I mean, that's kind of ideal in sports, right? You don't want to get to where there's a problem. You want to beat it before that.

Well, it's a very whooped mindset. You know, we always say you can only manage what you measure. And so if you think it's important to be able to improve your sleep, you need to measure it, right? And look at the different baselines and look how it's changing. And it sounds like you've really brought a lot of that to TF cycling. Now, and by the way, it's so interesting, listen to you talk about this with like the most finely tuned athletes in the world. Because it's the same stuff that we're telling, you know, executives. you know, everyday consumers in terms of how they can improve their lives.

You know, you're talking about colder bedrooms, darker bedrooms, sleep consistency, you know, darker room, get off your devices. If you're going to be on your devices, use blue light blocking glasses. You know, that's what I think is so fascinating about sports. I think it's so fascinating about the work that you do is that you're creating a bridge that is attainable and aspirational at the same time, right? The best athletes in the world are doing this to win the tour. to France. And guess what? You can do it at home. Yeah. And that, I mean, in a nutshell,

that's kind of what I love about sports medicine is that in my practice, it's a very small practice. But about two-thirds of my patients maybe are professional athletes. And the other third are executives, recreational, aspirational guys. But the tenants are the same. And what helps them do well, be at the boardroom or whatever they're doing, it's often the same things that set the athletes up to do well in their job. And so if we can kind of pull that all together, again, it goes back to the idea that really the only part of medicine that informs performance where we look at healthy individuals and try to make know what makes them perform best is sports medicine. So it's widely applicable. Yeah. And again, I think it's the sleep and recovery

aspects, the lifestyle aspects that we can learn from the best athletes in the world are actually highly attainable. I mean, you and I may not be able to dunk from the free throw line like Michael Jordan or LeBron, but speak for yourself, Will. Yeah, okay. But we know, but we can, we can adopt a lot of the same sleep methodology, recovery methodology that they do. Right. And I think that's, that's a powerful bridge between the best athletes in the world and everyday consumers. Yeah, and it's actually an area where you might perform better than they do. Yeah, right. When we start to look at numbers on some of the best performing athletes, sometimes just by necessity, those things suffer a bit.

And sometimes cyclical or whatever. Totally. Yeah, I mean, we can excel in our own spaces. Okay, so now we talked about sleep. What about on the recovery side? What are some things that the EF cycling team specifically is doing to help recover? It's pretty in depth because, again, that's a big determinant of how well we do in the race as a whole. So nutritionally, there's a big aspect that focuses on nutrition.

And that from the time they cross the finish line, it's getting carbohydrate into them to replenish glycogen. It's following that up with more carbohydrate plus protein, getting some real food in them. and then having a kind of a cadence to their eating the rest of the day, the rest of the afternoon. We travel with a chef who's got her own chef truck and makes just amazing food for the guys. And so that nutritional component really over the last 10 or 12 years has really been just taken in by the teams and totally managed,

whereas it used to be left to the hotels. You'd show up. The hotel had pasta and red sauce and overcooked chicken and that's what you performed on. And so we've really taken a much more scientific approach to that. There's massage. There's devices like the Norma Tech recovery boots. I mean, we kind of employ as many of those things as we can throw at it to improve recovery.

And where are you at on a lot of cold therapy? Do you guys like icing, cold showers? Yes. I think it's a great tool. What's difficult in Europe is it's very hard to find ice. There you go. oftentimes you'll go to a hotel and say, hey, we want to put together an ice bath for some of the guys. Can we get some ice?

And they'll bring you a cup like this from the bar begrudgingly, right? They're like, ah, I guess you can have this. So oftentimes we just can't make that happen. It can be cold showers. I mean, that's amazing. It's crazy. I mean, it's just a cultural difference. It's not that they don't have the capability.

They just don't put in these big ice machines because they're not drinking it. They don't use it. But every competitor is dealing with the same. cultural issues too so right it's a level playing field yeah playing field so so you like cold showers though i do well i mean i think there's utility for them i will say i think there's individual response to them as well to any of these modalities right so in general what we find in sports medicine literature when looking at things like this is there's not great evidence for any one recovery tool you can kind of find studies for or against and and when you weigh it all out it's kind of just

flat line but we know that for individuals when you implement certain things the response can be pretty substantial and so using something like who to measure for an individual you know if we implement this strategy cold showers ice baths whatever for a week what does that look like if we take that away and instead do massage for a week what does that look like you can start to to find what each person's ideal recovery regimen looks like. I love that because I talk all the time about how people can use whoop to sort of a, B, test what's good for them, right? Like you've got a control and then you introduce something new.

Does the new thing help? Yeah. I love that. What's an example of something that you've just seen a really wide split on in terms of this works amazingly well for one person and terrible? I remember the paleo diet had this, you know, huge, huge moment. This is maybe a few years ago. I mean, you keep me honest on this, but like maybe it's four or five years ago.

And we worked with some professional athletes whose data looked amazing. And then we worked with some high profile athletes, like even like a LeBron James. And their data was like totally out of whack. And I was just, I was so blown away by how wide the spectrum was. It wasn't like marginally better, marginally worse. It was like profoundly different results. What are some examples like that for you? Well, as soon as you said that, I was going to say diet, because diet is something that

people are very dogmatic about. They latch on to something and say, this is the only way to do it. But what we know is it may be a great way to do it for them, but not their peer. Somebody's doing the same thing. And being able to measure the response to something like diet over the course of, you know, a month, try an intervention, try a dietary technique, measure. for a month, you can know whether it's a good idea for you. It doesn't mean that it's trash for the other person that it worked for. It just means, you know, maybe it wasn't great for you. Diet's a big

interest of mine. It's kind of like religion and politics. You know, a lot of times in the sports world, you just want to avoid the topic because somebody is so dead set on their diet being the perfect for everyone, right? Yeah. And so I like to take a much more objective approach. And if an athlete comes to me and they want to perform as a vegan or a total carnivore, great, let's look at that. Let's see how that works for you. Let's check some blood work. Let's look at your performance.

Let's see how to set this up best. To me, there's no right way. There's just a lot of small boxes. You've got a tick along the way to get your diet right from an overarching standpoint. And then we look at things very situationally, you know, periodization of diet. Are you in a training phase or are you competing? Are you looking to adapt at the moment? Are you looking to recover?

Because those are very different scenarios. And we know that adaptation can be hindered by certain dietary inputs and supplements, you know, high levels of antioxidants and things like that. You may not get as fit as a result of the training you're doing because of what you're taking or eating. But if recovery, like at the Tour de France, day-to-day recovery is more the goal than, your diet and supplement regimen may look very different than when you're just trying to get fitter. I love that. So what would be some things that you would be more focused on from a diet or supplement standpoint to emphasize recovery? Some of the interesting things that we've seen in the literature are the addition of high levels of antioxidants while training. So what happens when you're

exercising, your body creates or produces free radicals, reactive oxygen species. And there's been this mentality for a long time that you've got to get rid of those those are bad you've got to buffer them take antioxidants get rid of them but what we've learned is that they're actually they serve a purpose they're a signaling molecule in the body and as those reactive oxygen species go up it's part of the trigger to your body to say hey this was more than we were up for we've got to adapt get stronger so that next time we see the same stress the body's in a better place so if you knock those down immediately you you blunt some of that signaling process and and decrease how you fit you may get from that one workout now it's not a light switch i mean you'll still benefit from the workout but

the idea is to be as efficient and effective as possible around that training session around everything you do yeah so it may be advice to not take a multivitamin during a big training block or it might be advice to just time that differently don't take it within five or six hours of training. Let's let's let's let that signaling process happen before you throw the antioxidants in. Got it, because they're going to reduce the levels that you just described. Right. Going to turn down that signal. It's fascinating. And from a pure, from a pure food intake, it sounds like your team is, you know, everyone's got their own preferences and things that work for them. For sure. And a lot of that's trial and error. Yeah. When you get to the

that level, you kind of know what suits you well. They know what they like to have on the bike. They know what they want to have for breakfast and dinner. But we also try to dig into that trial and error process and help them with it. So, you know, with some of the cyclists, a lot of my golfers will implement continuous glucose monitors and look at 24-7 glucose curves through a day and see, you know, in a given climb or on the 16th green, you know, if they report some mental fogginess and we say, hey, well, your glucose had plummeted. You were 65. When did you eat last? Oh, well, I kind of forgot. We can help tailor some programs to put them where they need to be to perform best. So interesting. What do you think of glucose

monitoring, broadly speaking? Do you think that's something that, you know, should everyone wear a 24-7 glucose monitor for a week at some point? For a week? Yes. Yes. I think so. I mean, I think it's probably one of the most underutilized tools that we have in medicine, because you get that instant feedback. So you take a patient who, whether it's from a performance standpoint or a health standpoint, they're suffering, say someone a health standpoint. They go to the doctor, they've got a slightly high glucose, slightly high A1C, which is another measure of glucose. And the doctor said, hey, you've got to eat better and exercise. Come back in six months and we'll recheck it. What does that mean. And when you come back in six months, you have a hard time knowing what you did that

affected things. But if you throw a sensor on and can eat a meal and then look at your number, go for an exercise session, look at your number, you have instant feedback. And so what I've seen with my patients from a health or performance standpoint is that instantaneous feedback is it provides kind of the lever they need to move them in the right direction. And a lot of them come back and they say, can I get another one of these? Because they last two weeks. They're like, can we keep doing this? Now, if an everyday consumer's listening to this, how would they find a glucose monitor?

How would they be able to do that? Right now, primarily it needs to be through your doctor. Okay. Their prescription based, you got to have prescription for it. They're not necessarily expensive. Some of them are, but some are like 60 bucks out of pocket. There are some companies that are out there at various stages of development where it's going to be, they'll be geared toward consumers.

And so I don't know where the different companies are in their stages, but I think some are already taking people where you can basically get online and a doctor within their company will prescribe one to you and it gets sent to you and you can use it along with their software and things like that. Now, is that something you did with Scott Stallings at one point? we've had Scott on a number of glucose meters. Because his transformation has been incredible. You know, this is a guy for people listening, professional golfer who had chronic fatigue

to now professional golfer who's maybe the fittest guy on tour. I mean, I would say hands down the fittest guy on tour. There's some guys now who are nipping at his heels, but he, yeah, he's super fit. Yeah, and he mentioned, normally I wouldn't talk about patients publicly, but he mentioned, he's like, go for it, you know, tell the story. So, you know, I started working with Scott three years ago when he was, I think he was about 240, 250 pounds, maybe when he came into my office. He's now 185, 190 solid muscle. Yeah.

Yeah. Yeah. And we've used things like glucose monitors along the way to help dial in his diet. We do lactate testing to look at both the fitness component, but also kind of get a look under the hood physiognit. to see is he is he physiologically efficient is he burning fat when he should be carbs or glycogen when he should be and so we've used a lot of those tools to tailor that process I want to be clear I don't take any any of the credit for Scott's transformation he did the hard work his trainer Adam Adam who I think you've met Adam Carley totally yeah great good is awesome

and really led the charge on that but hopefully I provided a little advice here and there that may have helped them out. Yeah, that's awesome. So let's talk about EF cycling. We're now underway at the Tour de France. What can you tell us about what you're seeing with WOOP and the data and how you're using it? Yeah, so this has been fascinating. I think people who are cycling fans will be interested to see the WOOP data as it comes out because, you know, as a recreational cyclist, you're wearing your Woop and you're on the bike and you kind of see the numbers and you're like, I think that was pretty good. We've had some guys in years past, Nielsen Palace has been wearing Woot for a while, Lawson-Cratic, obviously. And so we've had little views into the data here and there, but to have

the whole team on it has been fascinating. So what I've been interested to see is like the daily strain scores, which the average isn't 20.7, but the number I see most frequently is 20.7. And I know it goes to 21, right? Yeah, it's very hard to get to 21. In fact, we're not convinced it's actually possible without dying because you have to be at like 90 to 100% of your max for 24 hours. But 20.7 for people listening is insanely hard. I mean, I ran the Boston Marathon.

I got like a 19.9. So, you know, these guys are doing just an insane amount of strain every day. And that's day after day. So I'm looking at one guy here, 20.7, 20.7, 20.7, 20.4. And these are with recovery scores that are anywhere from 20s up to 80s. To your point, you know, some days you can recover well. Some days, it's a long transfer, late dinner, short sleep, and it is what it is. And one of the things I always try to impress upon my athletes is when they're looking at this data, a recovery score of 28 or 31,

one or some of these that we see, it doesn't mean you can't perform that day, right? Don't, don't catastrophize it, but we don't want to see that trend out for, you know, a week at a time. We've got to address it if it's happening day after day. But we'll see some low recovery scores and we'll see them pop up to like an 86 or a 67, 87. So they find that way to get that recharging in there and go again the next day. It's been fascinating to me to see this. And we've got it on our staff too, which I didn't know, I don't know if you're aware of, but being able to look for me, typically I'm at the tour. I can't go this year because of the travel ban, but being able to see our staff as well and our directors, our coaches, you know, making sure that they're recovering

day to day, that they're in a place where they can mentally approach the task at hand, which is logistical, it's competitive, all the things they have to manage. It's been really fascinating. Yeah, the remote monitoring aspect of whoop is something I've always been quite proud of because you know my experience as a college athlete was like okay well you're with us for three hours but like what are we doing the rest of the day or even you know off season like how are people training and and you know you said you have like an excel all of a sudden that's like everyone's writing in their workouts or whatever but that that's what I think's cool about whoop is that you can look at every single person in real time where are they at yeah

For sure. In cycling, we have a long history of monitoring athletes during their training, looking at all the metrics that we talked about earlier, power, heart rate, all those things in databases that are pretty powerful, but that's only three to six hours a day. And we don't know what they're doing the rest of the time. Totally. And I don't mean that like they're going out and drinking and party. And it's more like it's very hard for us to help them with poor recovery, fatigue, things like that, if we've only got a very myopic window into their day,

but we can open that up and see everything that's going on, it just serves, it helps us be much more helpful to get them to where they need to be. Yeah, and it's sometimes can be these sort of small things you wouldn't even think, but they end up playing this huge role in recovery or whatever. I'd say it's frequently that. I mean, it's, usually it's not the, the, the, the, groundbreaking. thing that you figure out on how to get somebody to recover. It's just noticing that, oh, wait, you're doing that every day? Let's take that out and see what happens. And then things turn right.

I remember we worked with a college tennis team that was over training because the guys were so competitive over ping pong of all things. And they would have these like two hour ping pong matches and like, why is everyone on the team getting like injured? And it was just like, it turned out just this weird small little hobby that no one thought of as strain. But it was, you know, it was running these guys down. So, okay, so let's say you wake up and you're looking at someone's data and maybe they're in the red, you know, they have a red recovery on whoop. What might you do differently than if they say we're in the green that day? Is there something specific for that morning you might think about it a little differently? It depends on whether it's a

competition scenario or a training scenario. If it's competition, maybe but Probably not. We probably just have to push through unless there's a scenario where in, say, the Tour de France, you've got two or three guys that you may be trying to get into the break, which is going to be, they're going to be off the front for three or four hours working super hard. And one of those guys who's kind of designated for that, if they wake up with a recovery of 18, you might say, hey, we're actually going to hold you back and let these two guys try to get in. But typically, I feel like... That's cool. So it's fact of, you know, thinking about how it could you know, affect a little bit of the strategy. We're not going to burn this guy out in the front.

If this person's already run down, we might put someone else there. Yeah. That's cool. Yeah, but resources being limited in terms of, you know, riders and competitive strategy and those things, more often than not, you just have to go for it in the competitive scenario. Yeah. But in training, That's a totally different thing. So in training, even building a training program around HRB, which has been pretty well studying, has been shown to allow someone to progress much more quickly and consistently without injuries, without setbacks. And so using that to say, okay, you've got a six-hour ride plan today as your training,

but you just woke up and your HRV is tanked, your recovery score is tanked, you only slept five and a half hours. Like, let's switch this. You're supposed to do the long ride today and have an easy day tomorrow. Let's flip those. Take your recovery now, do the long one tomorrow when you're presumably going to be recovered and less chance of injury, illness, better response to the training. That is really effective. Yeah, I mean, HRV for me personally, it was the most fascinating thing that I did, you know, I did research on when I was an undergrad at Harvard. I I mean, that's how I got into the space. I did a lot of physiology research.

And I, you know, I read something like 500 medical papers. And I don't know, maybe two-thirds of them were about HRV. And I was just like, this is the coolest thing. And truly, it was being used by the world's best cyclist, but it was also being used by, like, the CIA for lie detection. And it was being used by cardiologists to predict heart attacks. But you had to go get a 12 lead KG. Like you couldn't use to do a daily.

saying that because I remember I was like but wait you have to go like get hooked up to an electrocardiogram for this or wear this ridiculous chest strap all the time and so probably the single greatest accomplishment of whoop from a technology standpoint was that we were the first product to measure heart rate variability accurately from the rest yeah and a lot of it was from that research because it was just like there was so obvious to me that that was the future you mentioned some of the chest straps that came out there's still some devices or apps and things that use that. But the problem I always had with that was immediately you wake up and you put this thing on, even if your goal is to kind of lay there quietly in bed and you're

not going to start thinking about things. But no, the mind starts going, you know, you got to get up, go to the bathroom, it's not a clean measurement. And so being able to measure it at night when there's, I won't say no other inputs, but minimal inputs otherwise, it's just such a better of the data, even than, you know, the 12 leads that we had in the 50s and 60s. Yeah, and I'm glad you brought that up. Funny enough, for about a year and a half, I did that chest trap thing every single morning. Yeah, me too. And so I figured out, you know, okay, if you're lying down, you get a better reading. If you don't have to get out of bed, you get a better reading. If you can breathe a certain way, like you can game it. Yeah. Yeah, you could totally hack it.

And so when I met with sports teams, they're like, oh, don't worry, we've got this HRV thing figured out we've got you know chest traps they'll show up to practice we'll get it on them i was just like that's not an accurate reading because who knows do they just drink a couple coffee did they just talk to their agent did they just you know all these things are affecting that reading and so you're absolutely right about about the control uh what are some other aspects for whoop in in your practice or how do you think about using it with some other some other athletes i'm a big fan of the raw data in whoop and i don't mean to kind of step away from the recovery score and those things but I think to your point earlier, when you see a recovery score that's red,

immediately my eye goes to sleep time, deep sleep, REM sleep, HRV, resting heart rate. But looking at those things and saying, okay, we know something's off. Now let's dig into it a little bit. That I've found really useful. And to kind of go backwards from that, if we're working on someone's sleep and we're implementing like a new bedtime for them or a consistent bedtime or telling them, hey, put the iPad down and let's read a book. It gives us something, it's a measurement that helps us with many aspects of performance and

recovery. You know, I may not be looking, if we're working on sleep with someone, I may not spend that much time looking at their heart rate, but I may look at heart rate variability, timelessly, deep sleep, those things. So really pulling out the individual variables and kind of bucketing, based on what it is we're doing with that person. I find that really useful. Yeah, that's fascinating.

I mean, there's just a lot of different ways to use the data. Obviously, you have your own approach, which I think is really thoughtful. How about for you personally? What are some things that you're trying to improve in your own life? Yeah, it's a good question. Sleep has been a big one historically coming out of medicine. There was a long period of time where my normal bedtime was midnight and my wake-up time was for for years um so tough yeah and and you know i kind of typically i thought i did fine with that

and you just kind of push through like that's what you do so sleep has been something for me although i've gotten it to a much much better place so now within sleep i try to kind of play with the stages try different things whether it's environmentally but also with different supplements so looking at whether it's individual melatonin, 5-HTP, magnesium doses, some proprietary supplements that put a bunch of things together and see how it impacts me. You know, I definitely do a lot of trial on myself in that regard and then go to patients and say, hey, this worked for me. It may not work for you.

Like, you know, just laying this out there, but this is something to try. I found it really interesting to look at alcohol intake. So timing of alcohol, amount of alcohol, both kind of well documented and certainly show up over and over, but the type of alcohol. So I had this thing happen a couple years ago where I came home from the hospital and I poured a really nice bourbon, just two ounces, it was going to sip on it while my wife was making dinner, we were getting ready, whatever, drank it. Sleep was terrible. It's like, all right, well, it's hard to just pinpoint that. So the next night, I was like, I'm going to try this again. One drink, two ounces, same timing, terrible sleep.

One of my nurses had given me a really nice bottle of scotch. He was a big fan of scotch and gave it to me. So I was like, the next day I poured the same thing, two ounces of scotch, sip on it while my wife's making dinner, slept like a baby. And so I went back and forth between the two. And I did this trial not for weeks on it. I didn't just keep drinking, but I kind of pull this little trial out every now and then. And consistently it had that effect.

And I have no idea why I don't understand the reasons for that, but it's true. And so working with patients on what they drink is important, too, I think. It's highly personal. And we've seen this, like, first of all, some people just metabolize alcohol more effectively than others. And some people have a profound effect on their body. Golf is an interesting one for this because golfers have been known to have, you know, a drink or two, maybe before even a tournament round and like for some of our golfers that it doesn't actually affect their data all that much and then you look at a guy like like rory mackroy's told me he's pretty

much cut out alcohol because if he has a glass of wine like it throws off his data that profoundly and so you know it's interesting what we've seen generally speaking is that the obviously the longer before bed the better right sure uh less alcohol the better um wine's better than beer and clear alcohol is better than dark alcohol so you know wine and vodka maybe you're better than a rum that's sort of that's like generally directionally what we've seen and then of course there'll be people who are complete outliers to all of that yeah yeah and I think I think again going back to this idea that you find what's generally applicable and people can start there and test it on themselves you know I know for me more than one drink of anything

going to pretty much trash my sleep. The best case for me is something pretty light, a glass of wine, maybe a beer at dinner time or before, and then skipping it after. But I do much better with nothing. So normally five days a week, at least, I'm having nothing from an alcohol standpoint. But I've got, I can think of one PGA guy that I work with who consistently has better sleep if he has a drink, you know, after dinner before bed. And who knows, there's probably, there's probably physiological component to that, but there's probably a psychological component too of just kind of being part of that wind down routine. And if it's just one drink, you know, great. I've got no problem with that. Yeah. Now, you're quoted as saying that you push back against the pill

for every ill mentality. What does that mean to you? Well, I mean, I think in medicine and in our kind of health care system within this country and, I mean, even with the Western world, there's very much this idea of, oh, this is your diagnosis, well, here's what you should take for it. And there's a place for that. I've got no problem with the pharmaceutical industry and medications and those things, but we're far too dependent on it. And so what I like to do is say, okay, if this is your diagnosis, what's gotten you there and how can we kind of reverse engineer this and get you out of it? Medications may play a role in the short term. They may be avoided entirely.

They may be necessary, but let's not focus on that as the fix because, you know, if you're not sleeping well, it's not because your body has some inherent lack of ambient, right? It's something else you're doing is making you not sleep well, so let's address that. During COVID, I think this has really been laid bare in America. You know, we know that people who are infected with COVID do much better if they're just generally healthier and in a better place, right? Don't have underlying conditions. But for years now, it's kind of been like, well, you know, you've got high blood pressure.

That's okay. We'll get you on a medication. You've got, you're trending toward diabetes. Well, come back when you have it and we'll start you on a medication. We don't have a medication for COVID. We don't even have a medication that kind of limits your risk. And so we go back to this idea of limiting preexisting conditions, maximizing fitness and on the front end. And I think maybe this has been a good reminder to us that we can't just rely on

our prescription pad to do what's best for patients. I think you're right. And by the way, I go a step further with COVID where like I think there should have been a public health announcement that was like, hey, it's important to get a lot of sleep during this time. It's going to help your immune system. Or hey, it's important to, you know, get some sunlight. It's going to boost vitamin D. you know, I mean, just some simple things that maybe can, you know, if you have, if you have society at large, just shift in a slightly healthier lifestyle, you in turn actually may be able to improve outcomes meaningfully. Yeah. And a lot of times it's small contributions from multiple actions. And unfortunately, we're very much in a mindset that things are either

effective or they're ineffective, right? Like that, they did a study that didn't work, move on. But, And we've seen this in masks, right? Initially, it's like, well, is a mask effective at protecting you? Well, if your end point is someone with COVID coughing in your face and you have a mask on, maybe not. But if you look across the population, we know, yes, it's going to decrease incidence of infection. It's going to decrease severity of infection. And what's happening is not the mask is useful or not useful, but is decreasing exposure, decreasing viral load, playing an important role but it doesn't make sense to talk about it in a binary fashion and

I think we see that throughout medicine when you hear optimal performance who or what comes to mind right now optimal performance is the front end of the tour de france I mean those guys who when it hits a climb and the others start to peel off now they've done their job they're I don't mean to put them in a bad place but like the the domestiques the workers who get the climb the GC contenders for the overall prize to the base of that last climb, they're incredible athletes. But then eventually they peel off and the cream is just left there to rise, right? Like you've got the 8, 10, 12 guys who are truly probably the fittest people from an aerobic standpoint or the fittest athletes in the world at the moment. And you get to watch them take

off up the hill. And that, I think, is just, I love it. When you say the fittest aerobic athletes in the world, so just to pressure tests that, why would the fittest cyclists be aerobically better than the fittest swimmer, for example, or runner? Yeah, I mean, I think there's an argument to be made, but I think specifically at the Tour de France, you've got a 21-day race where these guys are performing at that highest level day after day after day. Now, there will be strain scores that are higher some days than other days. but they're up there every single day. Whereas a swimmer is going to have big training days. I don't mean to downplay any of that, but they'll have a meet

and then they'll have a significant amount of time off and then they'll have another meet. It's much more cyclical as opposed to sustain. You see that in triathletes? You know, Iron Man triathletes, amazing. They're right up there too. But they're not doing an Iron Man 21 days in a row. So I think there's an argument to be made that in cycling specifically the Tour de France

where you get the best of the best, you can really say that these guys, if they're not the fittest endurance athletes in the world, they are certainly among the top half a percent. Well, Kevin, this has been so fascinating, man. It's been great spending time with you. And I think everything that you're doing within sports is so compelling. We've got to get you back once the Tour de France is close to. winding up or once it's finished we can hear about some of the all the amazing strains and recoveries and sleeps let's do it we'll dissect all 21 days worth of uh worth of data yeah that would be

fun now uh work can folks find you if they if they're interested to learn more about your work so my practice is podium sports medicine and it's uh podiumsportsmed.com and then we've got a podcast as well called the podium that you can find me pretty much one of those two places awesome Well, we'll include that in the show notes, and Kevin, good luck with the rest of the Tour de France. Thanks, Will. I appreciate it. Good talking to you. Thank you to Kevin for coming on the WOOP podcast. Reminder, you can use the code Will Ahmed, W-I-L-L-A-H-M-E-D to get 15% off a W-WP membership. Follow us on social at W-W-O-O-W-A. We'd love to hear from you. Stay healthy and stay in the green. You're going to be able to be.