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"Forever Strong" - A Book Review

Dr. Gabrielle Lyons is a board-certified family physician who earned her undergraduate degree in nutritional sciences from the University of Illinois. She completed a research and clinical fellowship in geriatrics and nutritional sciences from Washington University in St. Louis. Her first book, "Forever Strong", was published in 2023. It is a significant departure from the typical health advice and information that you will hear from the mainstream medical establishment. The main thrust of her approach is something that she calls Muscle-Centric Medicine, which stresses treating the skeletal muscle as an organ. She believes that, "Your ability to survive and thrive - no matter your age - is directly related to muscle tissue health."

In the very first chapter, Dr. Lyons sets the table for the rest of the book by discussing the need to shift from a fat-focused paradigm to one centered around building muscle. She notes all of the conditions that poor muscle health can influence, from cancer to sarcopenia and even Alzheimer's. The author highlights the importance of skeletal muscle and its role in your immune system, saying, "Training also boosts your immune function via peptides - small molecules composed of amino acids - released during muscle contraction. Key peptides can send signals in the body that help fight off germs and reduce inflammation." Later in the same chapter, she discusses myokines, which are hormone-like proteins released by the skeletal muscles that circulate in the bloodstream and help regulate other body functions, particularly glucose metabolism. One myokine in particular, BDNF (brain-derived neurotrophic factor), boosts the formation of new brain neurons, which can facilitate learning and memory.

When discussing disease, Dr. Lyon correctly points out the limitations of traditional Western medicine, saying that it, "...Skews its emphasis toward what's making us sick while overlooking prevention. This tendency leads many doctors to focus on fat and glucose while disregarding the skeletal muscle that could correct the imbalance." The author is right; when is the last time your family physician ever talked about lifestyle changes, weight training, or nutrition? I would add the over-reliance on pharmacology to the doctor's assessment. She goes on in chapter four to discuss nutritional science and is quite critical of the government's recommended guidelines. Dr. Lyons says, "To repeat, it's critical to recognize that the goal of government-funded nutritional guidelines was never (her emphasis) to help individuals achieve exceptional health. Instead, setting forth minimum (her emphasis) intake values was intended to prevent deficiencies." Ignore the RDA; it won't help you to live your best life and be disease-free. The author believes that most people do not consume enough protein, which makes it hard for them to maximize muscle growth even if they regularly strength train. Eating one gram of protein per pound of body weight is the starting point that she recommends.

There is a lot of good information in this book, and it speaks to the overall attitude that each one of us controls our own destiny. Dr. Lyons details five fundamental attributes that all of us have inside of us, which are courage, perseverance, self-discipline, adaptability, and resilience. We will all face adversity at some point in life, and developing these qualities will help us to succeed when the going gets tough. Building muscle is your best ally in the larger plan of fighting off chronic disease, and the author does a commendable job in emphasizing the importance of weight training. The good doctor lists all of the essential amino acids, the ones that our bodies cannot make and must be obtained through our diet. I won't go through all of them, but she mentions that leucine is the most important amino acid for muscle health. There is a terrific understanding of nutrition (as one would expect from someone who earned a degree in nutritional sciences, but not generally common in the medical field), and I was pleased to see that she dismissed the myth of the connection between dietary fat and body fat. Again, her anti-establishment approach was wonderful to see.

Unfortunately, I was disappointed by the exercise advice given in this book. Much of what is prescribed here constitutes overtraining in my opinion, and there are references to steady-state activities that are high-force in nature and can lead to overuse injuries. The author has a poor understanding of several concepts that are quite relevant to proper exercise, namely the dose-response relationship of exercise, which explains that just like in pharmacology, you want the minimum dose necessary to stimulate optimum benefit. She seems to be unaware that you cannot segregate the aerobic metabolic pathway from the anaerobic pathway, and that while you may use more of one pathway than another in a given activity, both are always in play. Dr. Lyons recommends exercises that involve the use of dumbbells as well as unilateral and alternating movements, which leads me to believe she doesn't appreciate the dangers they pose to the pelvis and spine. There is no mention of speed of movement, so I can only infer that she doesn't fully acknowledge the dangers of excessive force on joints and connective tissue. Finally, when Dr. Lyons talks about "cardio training" she makes reference to VO2 Max, which most regular readers of this blog know doesn't actually measure anything, and has been called "the Monopoly money of exercise" by Dr. Doug McGuff. The scientific stuff in this book is great; the exercise advice, not so much.

In spite of my criticisms, I enjoyed this book. As I mentioned before, very few medical doctors really go to these lengths to espouse the importance of skeletal muscle and the benefits of regular strength training. In my own experience, I can now include Dr. Lyons with Dr. McGuff, Dr, Carol Currier, and Dr. Michael Hasz as physicians who "really get it ". There is a positive message in the book and an underlying theme of self-empowerment that can serve as a convincing inspiration to spring into action. I encourage you to read the book and decide for yourself.

Posted February 22, 2024 by Matthew Romans

It is About Making You Better

Self-improvement is a continuous process. Mastery takes a lifetime. Those are just a couple of the maxims that I often come across when I read self-help, philosophy, and leadership books. It is a noble endeavor to want to improve yourself and not be content with who you are at this very moment. Constructive criticism can be difficult for some people to accept, because sometimes the truth hurts. It is not what we want to hear, but it is what we need to hear if we want to build on who we are because no matter how self-aware we think we are, we all have blind spots. If you are not progressing as a Total Results client as you hoped you would, we should examine why that is the case. Accountability is important but it is not about taking you to task. Everything that we do at our facility is about making you better.

The nature of exercise instruction is to be critical, to point out and correct mistakes so that we can maximize your performance. As an instructor, it is important to me to balance being critical with providing positive reinforcement and encouragement. I am up front and honest with potential clients when discussing expectations during an initial consultation. I explain the importance of proper form, exercise intensity, and mastery of speed of movement and turnarounds, but I also am very careful to mention that this program is not a cure-all, and that their degree of success is largely predicated on what they do when they are not here. Naturally we don't want to scare anyone off, but I don't want there to be any illusions about what our philosophy entails. Sometimes people decide that this isn't the program for them, and that's okay. I would rather learn that right off the bat rather than a couple months down the road.

Correcting form discrepancies is the most important aspect of being an exercise instructor. Proper form is not just something that we give lip service to; it is the very essence of our exercise philosophy. These discrepancies are not conscious decisions by the client to do the wrong thing, but rather instinctive acts to try to make things just a little bit easier. These form discrepancies must be corrected immediately and repeatedly until they no longer occur, but please remember that these criticisms should never be taken personally. Many other instructors in our industry are not as strict about form as I am, but it is not because I enjoy being critical. It takes courage to want to teach and correct behavior, especially when you know it might not be well-received. I have a responsibility to uphold the high standards that we have had at Total Results for over 20 years, and I would do the client and myself a disservice if I let certain things slide. If I let one thing go, it can very easily become a slippery slope, and it is important to be consistent across the board. Praise and positive reinforcement are also important, because that helps to solidify proper behavior and execution. Consistent and honest feedback is the key to improvement in any aspect of life, especially in exercise.

Discomfort is a natural part of high-intensity exercise. In order to stimulate true positive change in the human body, you must do something intense and significant to induce the body to adapt, and that feeling is not pleasant. I would not sell anyone a bill of goods that our workouts are fun, but they are critical for building and maintaining skeletal muscle mass. I am certainly not a masochist, and I don't enjoy seeing people in pain, but the dull ache and intense fatigue that you experience during a workout is brief and is not indicative of injury. As my friend Al Coleman used to say, "Don't run from the discomfort, chase after it." Also unpleasant to some is the cold temperature and fans that we have in our exercise studio. This is necessary in order to keep you from overheating during your workout. High-intensity exercise causes your muscles to produce a tremendous amount of heat, and if the workout space isn't properly chilled or ventilated you can overheat sufficiently to short-circuit your performance. No, it isn't particularly enjoyable to be in a cold environment with fans blowing on you, but this is what is necessary to optimize your workout experience. You will warm up within the first two exercises. I also must maintain a clinical demeanor during your session. Sometimes this throws people off initially, but I can assure you that I am not trying to seem distant or unfriendly. Exercise is a serious endeavor that requires focus, and chatting mindlessly during your workout can increase your risk for injury as well as diminish your performance. I enjoy talking with clients before and after sessions, but proper perspective must be maintained. Our studio environment and my instructional style are all carefully cultivated to give you the best opportunity for success.

All we want is for you to prosper. No one ever said our workouts are easy, but the reward comes when you start to see and experience the fruits of your labor. Understanding why we do certain things will help you to focus on what is important and keep things in proper perspective. Not every workout will be record-setting, of course. You will have some days where you feel great and others that are a struggle. Be emotionally mature and take responsibility for your success as well as your failures. We are your health partners, and everything that we do is geared toward making you better.

Posted February 08, 2024 by Matthew Romans

Three Pillars of Health: Weight Training, Intermittent Fasting, and Nutrition

Total Results is not simply an instructional exercise facility. Yes, exercise is critically important, and in order to achieve a top notch workout experience you need a clinically-controlled environment with proper temperature controls, specially engineered equipment, and a knowledgeable instructor to regulate safety and push you to the requisite level of effort. I see myself as a teacher, and that goes well beyond what happens during the 20 minutes of your workout. In my estimation, there are three pillars of health that will optimize your results. Those pillars are intermittent fasting, proper nutrition, and high-intensity weight training. I discuss these three concepts with clients on a regular basis.

Intermittent fasting involves waiting at least 12 hours between your last meal of one day and your first meal of the next day. That description is a bit simplistic, but it's not really that complicated to understand once you dive in a little deeper. Most recommendations call for fasting between 14 and 18 hours per day, but other sources have suggested fasting for 24 hours a couple of times per week. A 16 hour fast and 8 hour feeding window (time between your first and last meal of the day) is what I generally stick to, and it's not as difficult to follow as you might think. The benefits of fasting include hormone regulation, blood sugar control (avoiding spikes and crashes), lowering blood pressure, fat loss, reducing systemic inflammation, maintaining insulin sensitivity, and enhancing your body's ability to use body fat as a primary fuel source. There are a lot of different ways you can practice intermittent fasting; through experimentation you can find the strategy that best fits your lifestyle. It's a bit of a challenge at first, but after a few days or a week you find it's not that difficult, especially since you should be asleep through a large portion of the fasting period. If you eat a proper diet, fasting comes much easier, which smoothly brings me to the next pillar of health.

Nutrition is the means of giving your body the raw materials it needs to not only achieve and maintain homeostasis, but also make physical improvements. If you don't put the right fuel into your car, it won't go anywhere. You need all three macronutrients: protein, carbohydrates, and fat, although carbohydrates are the least important to consume. This is because the body can create glucose out of other substances through a process called gluconeogenesis. There are essential fatty acids, and essential amino acids, but no such thing as an essential carbohydrate. This is why ketogenic diets are quite successful. I'm not suggesting that you need to get on a ketogenic diet (although I wouldn't discourage you if you did), but I do recommend a single-ingredient, whole foods approach. Limit sugars and processed foods, and if you see ingredients on food packaging that you cannot pronounce, you don't need them. Try to get your carbohydrates largely through fruits and vegetables, but minimize the fruits with high glycemic indexes (like bananas). You need protein that comes from quality sources: chicken, fish, beef, eggs. Eat plenty of good saturated fat; this will come from the aforementioned protein sources, but also through butter, nuts, and some other dairy like full-fat yogurt. If there were a fourth pillar of health I would include supplementation with vitamins and minerals, but it makes sense to include that here. At minimum, take a vitamin D supplement, but also consider fish oil, magnesium, vitamin C, and zinc. These will help fill in any nutritional gaps you may have, and also enhance your immune system.

Weight training is the X factor. Total Results exercise is essential for building and maintaining lean muscle, improving bone mineral density, strengthening connective tissue, improving metabolic and cardiovascular conditioning, increasing your resistance to injury, and helping you to maintain your functional independence. That is a lot to accomplish in one or two 20-minute sessions per week! Our exercise protocol can also help with things you probably haven't even considered, like contributing to better sleep, stress management, and improved focus. Your skeletal muscle is the only type of muscle tissue over which you have volitional control, and it is the single most important contributing factor to your overall body shape and appearance. No other form of physical activity can do more for your body or your mind than strength training, and the Total Results exercise protocol is the safest of them all. Five to seven exercises encompassing the entire body, performed once or twice per week in proper form and with great effort, is all that you need. It's certainly not easy, but it is simple.

All three pillars of health must be practiced in order to optimize results. As I have said before, exercise is not a panacea. It is an extremely important component, but only one cog in the wheel. If you weight train without intermittent fasting or proper nutrition, you will get stronger but may carry excess body fat, have blood sugar fluctuations, unregulated hormone levels, and be deficient in several key vitamins and nutrients. Although intermittent fasting can make up for some holes in your diet, without weight training you won't speed up your metabolism, combat sarcopenia, or reverse osteoporosis. On top of that, consuming a traditional western diet with lots of sugars and processed foods will make it virtually impossible to get into ketosis or fast comfortably. Proper nutrition will not yield maximum results without the other two pillars.

You must incorporate all three health pillars in order to optimize not only your physical improvements, but your overall health. Combining all three is not as difficult as it seems, but it does require a true desire to change and a willingness to be honest with yourself in order to make lifestyle changes. If you create good habits that are simple, they will be easier to follow. Making an appointment at Total Results will not only instill a sense of accountability, it will help you get into a sustainable routine. Schedule a consultation and start practicing the three pillars of health today!

Posted January 26, 2024 by Matthew Romans

Progress - Don't Get Mired in Minutiae

Some of our clients are very attentive to detail and numbers-oriented when it comes to tracking their workout progress. They are very interested to know how much weight they use on a given exercise, what their time under load was, and how it compares to previous workouts. Other clients care very little about those things. These trainees often just want to come in, perform their workout, schedule their next session, and go home. There is certainly nothing wrong with either mindset, and part of what makes my work so stimulating is that each client brings something different to the table. I do believe it is important to periodically talk with clients about their progress and offer different strategies to help them achieve optimum results, and for those clients that are interested I send them a link to their workout spreadsheet so that they can keep up to date on their progress. Knowledge of results is definitely important, but I think you can drive yourself crazy if you focus too much on minutiae.

I certainly respect detail-oriented people, for I am one of them. However, over the years I have learned that although small things matter, it is important (and probably healthier) to see the big picture. This is certainly true when it comes to common goals that people often come to Total Results to achieve: strength gains and fat loss. An appropriate pace for losing fat is one to two pounds per week; this way we ensure that we hold onto muscle and all the other important tissues while just losing fat. Nonetheless, we must realize that fat loss is not going to be completely linear; it will likely look like a line graph that rises and falls at times. This is because we are human beings who are not perfect, and it is unrealistic to think that life won't occasionally get in the way of maintaining the right habits. A healthier approach is to take a long view and look at the trend rather than obsess daily. This is why I don't recommend weighing yourself every day or after every meal - your fat loss goal can very easily turn into an unhealthy obsession! Look at where you are on a given day and compare it to where you were when your journey began. Chances are great that you have made significant progress worth celebrating.

The same view holds true for increasing your strength. When novice clients start at Total Results, they usually increase their poundages quickly over the first few weeks. This is due to a couple of factors. One is the learning effect; clients are learning new movement patterns and acquiring skill, and your central nervous system adapts to the new demands. The second reason is that beginning poundages are typically conservative, in order to optimize proper form, speed of movement, and turnaround technique. Once you reach muscular failure consistently on all the exercises, the law of diminishing returns enters the equation. You will not continue to add weight or increase time under load (TUL) on every exercise for every workout; it doesn't work that way. Yes, we will continue to increase the load by a couple of pounds or improve TUL every few sessions or so, but do not get discouraged when it doesn't happen every time. That is in no way a reflection of your workout performance. I also recommend not putting an emphasis on achieving an arbitrary TUL; some people seem to think that two minutes is a magical number. It isn't. The real objective of exercise is thorough inroad, and if that happens in 1:40 rather than two minutes, so be it. If you do the right things between workouts (proper sleep, nutrition, hydration, supplementation, managing stress) and give your best effort during each session, you will succeed.

While looking at your workout spreadsheet and weighing in are very specific measurements of progress, there are also general ways to get a feel for how you are doing. Taking both the general and specific viewpoints together paints a clear picture of your progress. How do you feel? On the whole, are your energy levels higher and more stabilized than before you started working out? Minimizing processed foods, sugars, and eating a whole-food, nutrient-rich diet will level out your blood sugar and regulate hormone secretion, making it much easier to avoid spikes and crashes. How do your clothes fit you now compared to when you started? If they are looser, that indicates that you have lost inches (and body fat) while gaining muscle. On the whole, are you less susceptible to minor colds and other infections? Do you have fewer aches and pains, are you more participatory in life, and are you still functionally independent? Increasing your strength makes you more injury-resistant, less reliant on mobility devices, and more energetic, which will enable you to perform tasks with less effort. These are qualitative measures of progress. Small victories add up to big results over time.

Bill Walsh, the Hall of Fame football coach and three-time Super Bowl winner, often said that the score takes care of itself. This meant that if his teams executed correctly and did the things they needed to do instead of worrying about the other team, the outcome would be in the San Francisco 49ers' favor. Another of Walsh's maxims was, "Concentrate on what will produce results, the process rather than the prize." To that end, I would add that you are better off obsessing about proper form rather than the result of each exercise. Great form leads to an exceptional stimulus, which is what the body needs to make physical improvements. Remember that learning is a continuous process, and mastery takes a lifetime. Treat each workout as an opportunity to achieve something meaningful, and you will be amazed at what you can accomplish.

Posted January 11, 2024 by Matthew Romans

Treat Ailments With Aggressive Therapy

If you are a regular reader of this blog or a Total Results client, you probably know that I am not a big fan of traditional physical therapy. I believe that conventional orthodoxy is centered around outdated modalities that do little more than check off a box and satisfy an insurance company, but in reality offer little to no benefit. Here is the familiar scenario: you experience some lower back pain that doesn't seem to go away in a few days or a couple of weeks. You decide to schedule an appointment with your regular doctor, who then refers you to an orthopedist. Naturally, appointments with a specialist are harder to come by, so you have to wait a couple of weeks. In the meantime, your back pain is no better. After being examined by the orthopedist, you are prescribed six weeks of physical therapy. The therapist has you undergo electrical stimulation (in the misguided attempt to trigger muscular growth), ice the area, as well as perform a series of random exercises with no consideration for safety and very little supervision or instruction (in fact, you probably could have done them just as effectively in your living room). After six weeks of this, there is little to no improvement; sounds like a big waste of time, doesn't it?

If this story has happened to you, you are not alone. I have instructed exercise for nearly 25 years, and in the course of working with clients and injuries, the above scenario is what my clients have experienced approximately 90 percent of the time. Not only is traditional physical therapy largely a waste of effort and resources, there is a solid chance that these misguided practices could make you worse off than before you started! I saw this first hand when I worked at Fairfax Racquet Club; our studio was across the hall from a physical therapy clinic. I would see therapists juggling multiple patients at a time and offering little to nothing in the way of instruction or guidance. It was no surprise that the patients didn't get much better, at least until they started strength training with me once or twice per week. That is because high-intensity, slow speed weight training is the embodiment of what physical therapy should be. The trigger that reduces pain and restores function is working to build strength in the injured or affected area. If you do not work aggressively (but safely) to treat the ailment, it will not improve in a timely fashion.

As a former competitive athlete approaching 50 (still hard for me to believe) and with a lot of miles on my odometer, I occasionally experience some discomfort in my knees, hips, and lower back. I recently had a bout with some significant right lower back pain from an unknown source. I have a very active job that involves a lot of crouching, bending, and standing, and this proved to be difficult in some planes of motion. Over the years I have learned that the natural tendency for most of us in this situation is to do nothing, to just simply let the area rest. That may be good for a day or two, but you need to keep moving. If you don't, it gets easier to become averse to the discomfort, but a certain amount of discomfort is a part of living a useful life. You can choose to fight through it or accept it; I chose the former. Rather than skip my weekly workout, I resolved to do my very best even though I was not 100 percent. I performed the Lumbar Extension exercise, and even though I didn't set any records my back felt better afterward. The next day as an experiment, I decided to perform a very low intensity set of the Linear Spine Flexion exercise. This exercise is not part of my normal routine, largely because it is challenging to use without assistance in setting the timing crank. The Linear Spine Flexion helped me to work out the kinks, and it felt like getting an adjustment. I performed this exercise one more time on the following day, and after that my back pain was gone. This recipe should be used in the future.

Weight training is therapy. You can just as easily substitute knee, shoulder, elbow, hip, or ankle pain for back pain, and our approach in treating it will be the same. Simply avoiding that injured area makes sense on an emotional or psychological level but if you do nothing the muscles surrounding that joint will eventually atrophy, thus compounding the problem. I can treat shoulder pain by modifying movement arm positioning or substituting upper body exercises, and also incorporate a hanging exercise to relieve impingement in the shoulder joint. Hip pain can be addressed by performing variations of the Leg Press exercise. Knee pain can be improved by strengthening the quadriceps and hamstrings; the Calf Raise exercise helps to rehabilitate ankle injuries. I have accumulated a lot of tools to treat different ailments, it's just a matter of finding the right combination. No, exercise is not a cure-all, but it is our best weapon to improve health and improve orthopedic ailments.

Don't let pain make you fearful and keep you on the sidelines. Working through the discomfort will give you a feeling of active participation, or being in charge rather than passive. Exercise is both a remedy and a preventative measure; building and maintaining strength lessens your risk for injury and also minimizes any injuries or ailments that you do incur. Therapy should be about restoring strength, function, and range of motion while working to reduce pain. Traditional therapy leaves a lot to be desired. Take charge today with Total Results!

Posted December 28, 2023 by Matthew Romans