Total Results Blog

Dr. Marcia Angell is a physician trained in internal medicine and pathology. She is the former editor-in-chief of The New England Journal of Medicine, and was named by Time magazine as one of the twenty-five most influential people in America. In addition to writing "Science on Trial" in 1996, she published "The Truth About Drug Companies" in 2004.

This book takes a good look at the pharmaceutical industry from the perspective of someone who not only worked at a prestigious medical journal that published drug studies, but who also prescribed medications and treated patients. Much of the information that is discussed in this book is stuff that you won't find mentioned by the establishment media or in the ubiquitous commercials on TV. Yes this book is twenty years old, but the drug companies operate the same way now that they did back then (if anything, they are less scrupulous now). Chapter 4 poses the question, "Just how innovative is this industry?" The drug companies often complain about the hurdles they must clear in order to receive Food and Drug Administration (FDA) approval for innovative drugs that save lives, but on closer inspection these companies are not as inventive as they would have us believe. According to Dr. Angell, "At least a third of big pharma's drugs are now licensed or otherwise acquired from outside sources - including smaller companies all over the world." That doesn't sound all that innovative. On this topic, she goes on to say that, "Researchers supported by the National Institutes of Health (NIH) usually do the initial work of drug discovery. Then the drug companies keep stringing out and exploiting those discoveries."

Chapter 5 sheds some light on what are called "me-too" drugs. These are drugs that are classified by the FDA as being no better than existing drugs that are already on the market to treat the same conditions. "Me-too" drugs are often introduced just as an existing drug is scheduled to go off patent, and she gives the example of Nexium (a popular heartburn drug) and its predecessor Prilosec. This was in spite of the fact that Nexium was only a marginal improvement over Prilosec in just two of the four clinical trials that were conducted. "Me-too" drugs usually target very common and long-term conditions, such as high blood pressure, depression, and arthritis. There is more money to be made by treating the condition than by curing it with lifestyle modifications. According to the author, "Once upon a time, drug companies promoted drugs to treat diseases. Now it is often the opposite. They promote diseases to fit their drugs. Nearly everyone experiences heartburn from time to time. The remedy used to be a glass of milk or an over-the-counter antacid to relieve the symptoms. But now heartburn is called 'acid reflux disease' or 'gastroesophageal reflux disease disease (GERD)' and marketed, along with the drugs to treat it, as a harbinger of serious esophageal disease - which it usually is not."

Stretching out the length of patents is another tactic that the drug companies use to extend exclusivity and enhance their profits. Patents are usually granted for twenty years, but it can take several years for a drug to go through clinical trials and gain FDA approval. This impacts the profitability of a drug, so the drug companies will go to great lengths to extend their patents. The Hatch-Waxman Act extended drug patents for up to five years if FDA approval was delayed due to clinical testing. Additionally, the Food and Drug Modernization Act of 1997 provided an additional six months of patent protection if companies test their drugs on children. Brand-name companies may also collude with generic companies to keep prices high or delay their entry into the market. And, as I mentioned earlier, drug companies will launch virtually identical drugs with new names just as the patents are set to expire. This was the case with well known drugs such as Prilosec, Claritin, and Prozac. The fact that our federal government has created these giant loopholes for drug companies to exploit should illustrate to you that meaningful positive change to the system isn't likely to come anytime soon.

While I was disappointed that there is not more of an emphasis in this book about the importance of lifestyle modification as an alternative to taking potentially harmful medications, there is very useful advice in the afterword section. Dr. Angell provides several questions to ask your doctor if he or she wants to prescribe you a drug.

1. What is the evidence that this drug is better than an alternative drug or some other approach to treatment?

2. Has the evidence ever been published in a peer-reviewed medical journal?

3. Or are you relying on information from drug company representatives?

4. Do you have any financial ties with the company that makes this drug?

Polypharmacy is a real concern in a medical industry that simply prescribes a drug for every little malady. The author mentions the tale of a 50 year old woman who was on eighteen different medications for a variety of ailments, and as a result could barely get around, was constantly dizzy, and could hardly stand up. This is a problem! According to the author, "What she probably needed was less medication and more medical attention. Experienced specialists are familiar with this phenomenon of overmedication and often start their evaluation of a patient who is not doing well on multiple drugs by eliminating most of the medications. Frequently, the patient improves."

You are being lied to by the drug companies. They are not honest and they do not care about you. They aren't even innovative! As Dr. Angell explains, "Over the four years beginning in 2000, there were just 32 innovative drugs out of a total of 314 approved drugs." This is not the first book about the pharmaceutical industry that I have reviewed for this blog; in fact, I have reviewed several. Every book highlights something new for me, and I appreciate the perspective of someone who has both treated patients and reviewed clinical trial data for a prestigious medical journal. This book is worth reading, and I encourage you to draw your own conclusions.

I am often hesitant to tell people that I meet exactly what it is that I do for a living. That is not because I am embarrassed about my work; in fact, it is quite the opposite. I am proud of everything that we have accomplished at Total Results over the past 23 years and I believe wholeheartedly in our philosophy and everything that we stand for. The reason I say this is because discussing exercise with most people can be a tricky proposition. For one thing, many people hold their exercise ideals as tightly as they do with their views on religion and politics. Most individuals have been grossly misinformed by what they see in gyms and in the media, and as a result they have virtually no idea how proper weight training works in terms of how physical improvements are made. Talking to people about this subject and helping them to understand can be like running into a brick wall. Some people are willing to learn, and those individuals often eventually become Total Results clients. Others hold onto their preconceived notions about exercise and cannot make the intellectual leap to the next level.

"More exercise must be better." This mantra is usually touted by people who don't like to work intensely. They would much rather perform more exercises and spend more time in the gym (much of it spent socializing) then work with the requisite effort and focus that will bring optimal results. One of our clients, who has been working with us for several years, recently had a conversation with a friend of his who is a bodybuilder. Our client, who is tall and very lean, was told by his friend that if he wanted to add more muscle he just needed to "add more weight" to what he was lifting. Yes, there are people out there that still think this way. They believe that if some is good, more is better. You can see how this could develop into a slippery slope very quickly. At what point is it enough? One's safety can very easily become compromised with too heavy of a mechanical load, and overuse injury and overtraining can quickly happen with too high a volume of training as well as training too often.

"You have to train fast to be fast." This is still the foundation of the Olympic lifting crowd, and unfortunately it is still pervasive in organized team sports at the high school, college, and professional levels. These individuals mistakenly believe that in order to train the fast-twitch muscle fibers (which have the greatest capacity for power, explosiveness, and growth), you must lift weights fast. This is pure nonsense, and it is a display of ignorance because they likely have never heard of the size principle of recruitment. This means that when a mechanical load is placed on the body, muscle fibers are recruited in sequential order based on size. Slow-twitch fibers are recruited first, followed by intermediate-twitch fibers, and then fast-twitch fibers. You cannot go out of order! Fast twitch fibers are only recruited if the intensity of effort exhausts the slow-twitch and intermediate-twitch fibers first. Lifting weights in an explosive fashion only increases the risk of injury.

"Split routines are the way to go." Don't go by what you read in fitness magazines or bodybuilding forums. Most people that spend time in these forums (even in high-intensity forums) have entirely too much time on their hands, and their views are severely misguided. Split routines, in which you divide your workouts up each week based on training certain body parts, are a surefire way to grind your progress to a halt by overtraining. Your body is more than just a collection of parts. It functions as a unit, and should be trained as such; that is why we perform whole-body workouts at Total Results. If you train with the proper amount of focus and effort, one or two workouts per week consisting of five to seven exercises will stimulate optimal gains while not tapping out your body's fragile recovery ability.

"20 minutes can't possibly be enough." You are paying for results, not simply just trying to rack up as much time in the gym as possible. The human body is resistant to change; it wants to maintain the status quo as much as it can. You must give the body a very good reason to adapt, and that is where intensity of effort becomes critical. The body perceives a high-intensity weight training workout (particularly when you use a slow speed of movement and go to muscular failure) as an existential threat, so it must mobilize its resources to make physical improvements to guard against this "threat." If you are working with the proper amount of effort, a 20 minute workout is not simply something we can get away with, it becomes a necessity to keep the workout brief. Your genetics play a significant role in determining what type of visual physical improvements you make from Total Results workouts, but regardless of your genetics you can become stronger, better conditioned, more resistant to injury, and more fit if you put forth the effort on a consistent basis.

Exercise must be purposeful, not haphazard or instinctive. It's not about trends or fads, or what happens to be currently popular. Most people are not particularly sophisticated when it comes to understanding exercise. The media must carry much of the blame for this, but the individual should also bear responsibility. The correct information is out there, it just takes effort to uncover it. The Total Results exercise philosophy is built on tried and true principles that go back over a half century. Time is the most precious commodity that we have; don't waste it by pursuing ineffective mediums. Choose Total Results.

While I am not a fan of the Las Vegas (formerly Oakland) Raiders, I have always admired the slogan that former owner Al Davis used to capture the franchise's philosophy - "Commitment to Excellence." A sign was prominently displayed inside their old stadium and is featured at their training facility, and this statement reflects the team's dedication to maintaining a high standard both on and off the field. This is one reason that the Raiders were one of the winningest teams of the 1960s, 1970s, and 1980s, and they earned three Super Bowl trophies.

A commitment to excellence has nothing to do with natural talent and ability, but rather a willingness to do the things that are required in order to achieve success. Jerry Rice is the greatest receiver to ever play in the NFL, but he was neither the fastest nor the most supremely gifted player that we have ever seen. However, nobody worked harder. A quote attributed to Rice is written on the wall at Dominion High School (where I coach football) that says, "Today I will do what others won't, so that tomorrow I can do what others can't." Sure, one must have significant genetic gifts in order to play in the NFL, but this philosophy is not limited to athletic endeavors. It is about developing the mindset that anything worth doing is worth doing right, going for what you want in life, but also making some sacrifices and sticking to a plan every day.

Total Results has had a commitment to excellence for over 20 years. Day in and day out we seek to provide the best exercise experience possible for our clients by utilizing a philosophy with a proven track record. We strive to keep learning and improving, never being satisfied with where we are or what we know. One great thing is that we tend to attract clients who have the same mindset. One of our longest tenured clients is a successful attorney who is in his early 60s and travels quite frequently for work. Because of his hectic travel schedule, he makes sure to book his appointments a couple weeks in advance and very rarely misses a workout, even if he has just returned from overseas. He recently went on a fishing trip with some friends, and at the end of the trip they took a group picture to commemorate the experience. They are all roughly the same age, but our client looks considerably younger and fitter than his peers, due in no small part to the consistent work that he has put in over the last two decades.

We have a husband and wife in their early 60s that have been Total Results clients for a little over three years, and both have exercised twice per week consistently in that time. They were recently on vacation and decided to water ski, which neither had done very recently. Accompanying them on the trip was their nephew, who I believe is in his late 20s. Our clients had no trouble at all, while their nephew did not fare nearly as well. When asked how it was that they were able to ski so well, our clients told their nephew about the work they had put in at Total Results. Our oldest client is 93 years old and has been exercising at Total Results since 2003, yet she was introduced to high-intensity weight training by her son in the 1980s. While she uses a cane to walk much of the time, she does not use one during her workout, and she rarely misses a session. That is a commitment to excellence. I can think of countless other examples of our clients being able to do more in life while exerting less effort. This is a product of consistent hard work and having a mindset of, "I can."

Total Results is an investment in yourself. Sure, you are making a financial commitment, but you are also making a decision to focus on what is important so that you can reap the benefits of the work you are putting in. We at Total Results have a commitment to excellence and a standard that we set for ourselves that must be met or exceeded every time. We have a relentless enthusiasm, which we believe is contagious, and it is that drive that keeps us going every day. How committed are you? How badly do you want to succeed? It is all within your control. Together, we can't lose!

One should always take their mental health seriously. We live in a complicated age in which we are more accessible than ever, and we find ourselves subjected to distractions in the form of 24 hour news, the Internet, social media, video streaming services, and communication platforms. The near-constant exposure to technology can hijack our sleep schedule and darken our mood. Let's face it, who wouldn't be in a bad disposition much of the time if they constantly followed the 2024 presidential election? Mental health awareness has garnered an increasing amount of attention over the last few years, and rightfully so. One positive outcome of our current environment is that someone who is dealing with mental health difficulties is not branded with the same stigma that they once were. We all face challenges every day, and there is a good chance that someone you know is dealing with adverse circumstances, whether they show it or not. While actions matter more than words, people deserve compassion and understanding rather than a rush to judgment.

The mental component of exercise can never be underestimated. Remember that your brain controls your body, and that skeletal muscle is the only type of muscle tissue in the human body over which you have volitional control. Smooth muscle helps with digestion, nutrient collection, and removal of toxins, while cardiac muscle controls the beating of your heart. All of these are important actions but they are involuntary. Contraction of skeletal muscle occurs as a result of conscious effort that originates in the brain; it does not happen on its own. In order to get the most out of proper exercise, we need to focus as much of our brain's capacity on the task at hand. Don't get stuck in your own head!

What do I mean by that statement? Getting stuck in your own head can take on several different forms. One scenario often happens when clients return after a couple weeks off, either because of a vacation or some other absence. They will often struggle in their first workout back, in part because I think they lose sight of the amount of effort that is required during a Total Results workout. I saw a phrase that I really liked in an article I read this morning that said, "Prepare for a high level of discomfort." The article had nothing whatsoever to do with exercise, but I thought it was appropriate for what a Total Results workout entails. Clients sometimes forget the manner in which our machines are designed, where the resistance is typically heaviest in the beginning of the movement and becomes easier once the cam falls off. I see this often on the Chest Press exercise; it's not that they are unable to move the weight, it's just that they are seemingly unprepared for the amount of effort that is necessary to overcome inertia at the start. This is a mental hang-up, not a physical problem. While you may lose some cardiovascular and metabolic conditioning if you take a few weeks off, you are very unlikely to lose muscle or strength during that time. The same scenario can present itself on the Leg Press. At the start of the exercise there can be a slight delay between the brain sending the message to your muscles to contract and when movement actually occurs. It is only fractions of a second, but in your perception it seems like you are suspended in time. Exercise some patience. If you contract your muscles, the weight will eventually move.

Fear and negative thoughts are also examples of getting stuck in your own head. Fear of what, exactly? It could be fear of exertional discomfort, fear of not performing well, or fear of being injured. Don't give in to fear; no matter how uncomfortable a Total Results workout is (and it is uncomfortable - making lasting physical improvements is not easy), it only lasts for twenty minutes. I believe that many people don't start with Total Results out of fear, or because they feel that they "need to get in shape first." They are missing the point. Putting the work in at Total Results is what will make the difference, not trying some less effective method first. Do not be fearful of injury; that is the main reason we go to great lengths to teach our protocol in the first few sessions and make sure all of your exercise settings are correct. It is why we painstakingly explain the preliminary considerations during an initial consultation. Yes, it may feel like we are throwing a lot of information at you at first, but it is necessary in order to optimize your safety. Our exercise protocol is safer than stepping off a curb, as long as you follow our instructions. Get out of your own head! You are capable of far more than you give yourself credit for.

In the last year or so I have started giving clients access to their workout spreadsheets so that they can track their progress over time. This is important because I believe that knowledge of results is a vital factor for keeping clients motivated, but also in terms of celebrating their successes. Sometimes, however, this can backfire because some clients will obsessively pore over each workout and fret if they don't add weight or increase their time under load (TUL) every time. Sure, you will likely experience rapid progress in the first several weeks, but part of that is because we estimate your beginning poundages conservatively at first in order to teach proper form. After four to six weeks any increases in weight and TUL are more the result of physical adaptations than they are the learning effect. Progress should be steady but change does not happen overnight, and it is also important to note that as a client becomes more experienced they will come across the law of diminishing returns. This means that it is unrealistic to expect that you will progress at that same rate indefinitely. Yes, we will still continue to be progressive in our approach, but the weight increments will be added less frequently and in smaller amounts. Consequently, if clients do not believe they are progressing fast enough they will often make the mistake of adding in more activity to their lifestyle, applying the fallacy of, "if some is good, more is better." Don't fall into this trap, and don't succumb to paralysis by analysis. We want you to think critically when it comes to exercise, but don't overthink it. Total Results clients should have as many tangible markers of their progress as possible, but please don't obsess over your chart.

Author Ryan Holiday says in his book "Courage is Calling" that, "All growth is a leap in the dark. If you're afraid of that, you'll never do anything worthwhile. If you take counsel of your fears, you'll never take that step, make that leap." He goes on to say, "Training is not just something that soldiers and athletes do. It is the key to overcoming fear in all situations. What we do not expect, what we have not practiced, has an advantage over us. What we have prepared for, what we have anticipated, we will be able to answer." Exercise should be hard, but once you tell yourself you can't do something it won't happen. Believe in yourself! Total Results is non-judgmental. We simply want to help you to become the best version of your current self. Put negative thoughts out of your mind, be a learner, and keep an open mind. You can do it!

John J. Ratey, MD, is an associate clinical professor of psychiatry at Harvard Medical School, and has co-written several books over his long career in medicine. Eric Hagerman is a former editor at Popular Science and Outside magazines, and his articles have also appeared in The Best American Sports Writing 2004, Men's Journal, and PLAY. In 2008, Ratey and Hagerman teamed up to release "Spark", which discusses the relationship between physical activity, exercise, and the brain. I took an interest in this book after having a conversation with the Head Freshman Football Coach at Dominion High School, Carlos Hercules. He and I attended a sports expo for rising 9th graders at the school that took place before the high school day typically starts. I had noticed that there was activity going on in the main gym, which I then learned was called Zero Block. I had heard of Zero Block before (it is called Zero Block because it takes place before the traditional First Block period), but I assumed it was some sort of punishment. In fact, kids voluntarily sign up for Zero Block because evidence shows that performing physical activity early in the morning helps people of all ages to be more alert, focused, and have more energy for the first several hours of the day.

The first chapter (after the introduction) details the radical and experimental program that took place at Naperville Central High School, which is located just west of Chicago. Here is where the concept of Zero Hour P.E. was first implemented, and it was spearheaded by physical education teachers Neil Duncan, Phil Lawler, and former high school football coach Paul Zientarski. In Zero Hour P.E. the students did not participate in just the traditional team sports and games that you would expect to see in your standard gym class, but they had a menu of options that included kayaking, dance, rock climbing, as well as running the mile. Students were graded on effort rather than performance, which encouraged them to stick with it and not give up, and they had targets to shoot for in terms of heart rate, blood pressure, and body fat, which motivated them to take ownership of their fitness. Even better was the fact that Zero Hour P.E. had a positive impact on standardized test scores and graduation rate. According to the authors, the two high schools in the Naperville district "...boast a 97 percent graduation rate." At Naperville Central High in particular the "...composite ACT score for the graduating class of 2005 was 24.8, well above the state average of 20.1." Pretty impressive.

The second chapter discusses learning, and right off the bat Ratey and Hagerman tell us that, "In addition to priming our state of mind, exercise influences learning directly, at the cellular level, improving the brain's potential to log in and process new information." Exercise can strengthen the affinity between the brain's neurons, thus making the connection easier and the new information that is processed is more likely to stick in your memory. VEGF (vascular endothelial growth factor) is a hormone produced during exercise that can push through the blood-brain barrier and help stimulate the machinery of learning. The authors note that, "When our body's cells run short of oxygen, as they can when our muscles contract during exercise, VEGF gets to work building more capillaries in the body and the brain." Just learning how to properly perform Total Results exercise challenges your brain, and perfecting your form shows that you have strengthened the circuits linking different parts of your brain such as the cerebellum, prefrontal cortex, and basal ganglia.

Most of us are aware that exercise helps improve depression, but many of us probably don't know that it can be just as effective as taking antidepressant medication. Researchers at Duke University undertook a study in 1999 in which 156 people participated. They were split up into three groups: one took Zoloft, one group exercised, and the third group did a combination of the two. The exercise group, it should be noted, walked or jogged for 30 minutes, three times a week, at 70 to 85 percent of their aerobic capacity (although how they measured that was not discussed in the chapter). At the end of the study, all three groups showed a significant drop in their depression, which led the chief researcher to conclude that exercise is as effective at improving depression as medication. While those results are certainly encouraging (I know that I would rather walk than take medication with nasty side effects), I have worked in the field of exercise for long enough to have some skepticism with how exercise related studies are often conducted. Certainly this would merit further examination.

I have a few concerns about this book, even though I did enjoy reading it. One question I have is, why is there so much reverence for Kenneth Cooper? Sure, he's a notable figure in the world of running, but in my opinion he did far more to wreck people's knees than improve their hearts with his "Aerobics revolution" that began in the late 1960s. According to Ken Hutchins, Cooper was far more of an evangelist than a scientist, and we have come to learn of the extreme muscle-wasting that comes from developing a running habit, not to mention the overuse injuries. Second, there is no real definition of exercise in this book. It seems to me that any type of movement or activity would qualify in the authors' eyes. One must also understand that a truly clinical definition of exercise has only been developed by the aforementioned Hutchins. He defines exercise as, "A process by which the body performs work of a demanding nature, in accordance with muscle and joint function, in a clinically controlled environment, within the constraints of safety, meaningfully loading the muscular structures to inroad their strength levels to stimulate a growth mechanism in minimum time." Sure, I believe that movement is good for you, and that as human beings we were not designed to sit still, but some activities are higher risk than others. Extreme activities may alleviate depression and improve mood, but what if you get injured in the process? That could also cause depression, and that other side of the coin seems to be ignored. Improved body image, confidence, and mood elevation can result from one or two Total Results workouts each week. I have not conducted any studies on the matter, but I have enough anecdotal evidence over the past 25 years to realize that I am onto something.

Although "Spark" is slow-moving at times, I thought it was beneficial to read in order to comprehend a different point of view. Dr. Ratey and Mr. Hagerman write well together and give a lot of good information. I encourage you to give the book a read and draw your own conclusions.