Dr. Jordan Feigenbaum and Dr. Austin Baraki discuss the challenges and benefits of unilateral exercises like Bulgarian split squats, refute Dr. Gabriel Lyon's claim that obesity is due to insufficient muscle mass, and more!

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The podcast discusses what happens when people stop exercising, how much exercise is necessary, and how to program exercise with limited time.

Recommendations for training on limited time:

•  Resistance training: 3-5 sets per muscle group per week of compound exercises at >65% 1RM for strength. Add isolation exercises if desired. 
•  Conditioning: 150 mins/week moderate or 75 mins/week vigorous intensity. Split up however you want. Be careful about doing too much sprint/max intensity work. Gradually build up if desired.
• Strategies for efficient programming include:
•  Modifying warm-ups to be more time-efficient (short rest, less reps, bigger jumps)
• Using supersets of antagonist muscle groups or unrelated movements
•  Employing "every two- or three- minute on the minute" protocols. e.g. E2MOM or E3MOM: 5 @ 8, then 65% x 5 e2mom x 3 sets or > RPE 8
•  Use time caps on sessions, e.g. 20-minutes for movement 1 or work up to 1-rep @ RPE 8 in 8 minutes, then 12 minutes perform maximum sets of 3 to 5 reps with 70% e1RM
• Flexibility in scheduling is key - focus on getting the total amount of work done over a 1-2 month period rather than worrying about perfect weekly routines

Time Crunch Template (Update coming soon!)

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References:

Detraining Podcast

• Wolin 2008
• Sturm 2019
• Garcia-Hermoso 2022
• Benito 2020
• Radaelli 2015
• Grgic 2018
• Nolan 2018
• Chen 2022
• Gavanda 2020
• Hortobagyi 1993
• Halonen 2024
• Mujika 2001
•  Smith 2003
• Encarnacao 2022
• Staron 1991
•  Ivey 2000
• Grgic 2022
• Piercy 2018
• Hamer 2017
• Khurshid 2023
• Schoenfeld 2017
• Krieger 2009
•  Perkin 2019
• Fyfe 2022
• Androulakis-Korakis 2021
• Borde 2015
• Lesinski 2016
• Yang 2018

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In this episode, Drs. Feigenbaum and Baraki discuss a complex case of a 60-year-old female with a history of type 2 diabetes, hypertension, high cholesterol, and pulmonary sarcoidosis presenting with exertional shortness of breath. Initial tests showed a heart rate of 50 bpm, prolonged PR interval, and patchy fibrosis in the heart. What's the diagnosis?

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Case:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7383351/ 

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Dr. Jordan Feigenbaum and Dr. Baraki discuss osteoarthritis (OA), emphasizing its complexity and the importance of a holistic approach. OA affects joints, causing pain, stiffness, and reduced function, with knees being the most commonly affected. Risk factors include age, prior injury, obesity, and inflammation. Diagnosis often relies on clinical history rather than imaging. Treatments include exercise, weight management, and non-pharmacological interventions like knee sleeves. Pharmacological options include topical NSAIDs, oral NSAIDs, and GLP-1 receptor agonists, with a cautious approach to opioids and steroid injections. Surgery may be considered for severe cases, but lifestyle changes and appropriate exercise are crucial for long-term management.

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Resources:

• https://www.barbellmedicine.com/blog/the-barbell-medicine-guide-to-osteoarthritis/
• https://www.barbellmedicine.com/blog/what-do-knee-sleeves-do/
• https://pain-calculator.com/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC2730438/
• https://pubmed.ncbi.nlm.nih.gov/27103611/
• https://pain-calculator.com/treatment/osteoarthritis-pain/viscosupplementation-publicly-funded-trials/
• https://www.nephjc.com/news/nsaids-vs-opioids
• https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard

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In the November 2024 research review, Drs. Jordan Feigenbaum and Austin Baraki discuss the effects of de-training periods in resistance training and the potential benefits of carbon monoxide supplementation for enhancing altitude training. New research investigated 20 weeks of continuous training vs. two 10-week periods of training separated by a 10-week off period. The results are....not what you might expect! The second study explored the use of carbon monoxide to stimulate red blood cell production and what effects it had regarding VO2 max and power output in elite cyclists. Ethical and monitoring concerns are also discussed.

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Case:

• https://pubmed.ncbi.nlm.nih.gov/36205802/

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In the Barbell Medicine Podcast, Drs. Feigenbaum and Baraki discuss a case of a 21-year-old female presenting with severe throat pain after a gym session involving heavy squats and deadlifts. The patient's symptoms worsened over six hours, and she had no fever or cough. Her physical exam and initial lab results were normal, except for a slightly elevated white count.

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Case:

• https://pubmed.ncbi.nlm.nih.gov/36205802/

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Dr. Jordan Feigenbaum and Dr. Austin Baraki discuss the fundamentals of exercise programming. They outline four major evidence-based goals for programming regarding health: strength, power, hypertrophy, and cardiorespiratory fitness. They introduce the WATER model for programming variables: weight (intensity), amount (volume), type (exercise selection), effort, and regulation (how-to regulate these variables). They stress the importance of matching training stimuli to individual needs and preferences, and the benefits of varying training intensities and modalities for comprehensive fitness development.

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Hypertension Podcasts and Articles:

• https://www.youtube.com/watch?v=9IEFJ_90vGE
• https://www.youtube.com/watch?v=JCPAffRLtNo
• https://www.youtube.com/watch?v=kI6QwgKLP0M

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Drs. Feigenbaum and Baraki discuss high intensity interval training.

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Hypertension Podcasts and Articles:

• Article
• Episode 177
• Episode 178

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Drs. Feigenbaum and Baraki discuss high intensity interval training.

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References:

1. Sabag A, Little JP, Johnson NA. Low-volume high-intensity interval training for cardiometabolic health. J Physiol. 2022;600(5):1013-1026. doi:10.1113/JP281210
2. Creemers, Noortje & Foster, Carl & Porcari, John & Cress, M.L. & de Koning, Jos. (2017). The physiological mechanism behind the talk test. Kinesiology. 49. 3-8. 10.26582/k.49.1.15. 
3. MacIntosh BR, Murias JM, Keir DA, Weir JM. What Is Moderate to Vigorous Exercise Intensity?. Front Physiol. 2021;12:682233. Published 2021 Sep 22. doi:10.3389/fphys.2021.682233
4. Seiler, Stephen & Tønnessen, Espen. (2009). Intervals, Thresholds, and Long Slow Distance: the Role of Intensity and Duration in Endurance Training. SPORTSCIENCE · sportsci.org. 13. 32-53.
5. Jamnick NA, Pettitt RW, Granata C, Pyne DB, Bishop DJ. An Examination and Critique of Current Methods to Determine Exercise Intensity. Sports Med. 2020;50(10):1729-1756. doi:10.1007/s40279-020-01322-8
6. Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(16):1227-1234. doi:10.1136/bjsports-2013-092576
7. Coates AM, Joyner MJ, Little JP, Jones AM, Gibala MJ. A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med. 2023;53(Suppl 1):85-96. doi:10.1007/s40279-023-01938-6
8. Laukkanen JA, Isiozor NM, Kunutsor SK. Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants. Mayo Clin Proc. 2022;97(6):1054-1073. doi:10.1016/j.mayocp.2022.02.029
9. MacInnis MJ, Zacharewicz E, Martin BJ, et al. Superior mitochondrial adaptations in human skeletal muscle after interval compared to continuous single-leg cycling matched for total work. J Physiol. 2017;595(9):2955-2968. doi:10.1113/JP272570
10. Mølmen, K.S., Almquist, N.W. & Skattebo, Ø. Effects of Exercise Training on Mitochondrial and Capillary Growth in Human Skeletal Muscle: A Systematic Review and Meta-Regression. Sports Med (2024). https://doi.org/10.1007/s40279-024-02120-2
11. Arboleda-Serna VH, Feito Y, Patiño-Villada FA, Vargas-Romero AV, Arango-Vélez EF. Effects of high-intensity interval training compared to moderate-intensity continuous training on maximal oxygen consumption and blood pressure in healthy men: A randomized controlled trial. Biomedica. 2019;39(3):524-536. Published 2019 Sep 1. doi:10.7705/biomedica.4451
12. Helgerud J, Høydal K, Wang E, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665-671. doi:10.1249/mss.0b013e3180304570
13. Su L, Fu J, Sun S, et al. Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: A meta-analysis. PLoS One. 2019;14(1):e0210644. Published 2019 Jan 28. doi:10.1371/journal.pone.0210644
14. Wen D, Utesch T, Wu J, et al. Effects of different protocols of high intensity interval training for VO2max improvements in adults: A meta-analysis of randomised controlled trials. J Sci Med Sport. 2019;22(8):941-947. doi:10.1016/j.jsams.2019.01.013
15. de Mello MB, Righi NC, Schuch FB, Signori LU, da Silva AMV. Effect of high-intensity interval training protocols on VO2max and HbA1c level in people with type 2 diabetes: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2022;65(5):101586. doi:10.1016/j.rehab.2021.101586
16. Steele J, Plotkin D, Van Every D, et al. Slow and Steady, or Hard and Fast? A Systematic Review and Meta-Analysis of Studies Comparing Body Composition Changes between Interval Training and Moderate Intensity Continuous Training. Sports (Basel). 2021;9(11):155. Published 2021 Nov 18. doi:10.3390/sports9110155
17. Hostrup M, Bangsbo J. Limitations in intense exercise performance of athletes - effect of speed endurance training on ion handling and fatigue development. J Physiol. 2017;595(9):2897-2913. doi:10.1113/JP273218
18. Gibala MJ, MacInnis MJ. Physiological basis of brief, intense interval training to enhance maximal oxygen uptake: a mini-review. Am J Physiol Cell Physiol. 2022;323(5):C1410-C1416. doi:10.1152/ajpcell.00143.2022
19. Metcalfe RS, Babraj JA, Fawkner SG, Vollaard NB. Towards the minimal amount of exercise for improving metabolic health: beneficial effects of reduced-exertion high-intensity interval training. Eur J Appl Physiol. 2012;112(7):2767-2775. doi:10.1007/s00421-011-2254-z
20. Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012;590(5):1077-1084. doi:10.1113/jphysiol.2011.224725
21. Casado A, Foster C, Bakken M, Tjelta LI. Does Lactate-Guided Threshold Interval Training within a High-Volume Low-Intensity Approach Represent the "Next Step" in the Evolution of Distance Running Training?. Int J Environ Res Public Health. 2023;20(5):3782. Published 2023 Feb 21. doi:10.3390/ijerph20053782
22. Burnley M, Bearden SE, Jones AM. Polarized Training Is Not Optimal for Endurance Athletes. Med Sci Sports Exerc. 2022;54(6):1032-1034. doi:10.1249/MSS.0000000000002869
23. Casado A, González-Mohíno F, González-Ravé JM, Foster C. Training Periodization, Methods, Intensity Distribution, and Volume in Highly Trained and Elite Distance Runners: A Systematic Review. Int J Sports Physiol Perform. 2022;17(6):820-833. doi:10.1123/ijspp.2021-0435
24. Foster C, Casado A, Esteve-Lanao J, Haugen T, Seiler S. Polarized Training Is Optimal for Endurance Athletes. Med Sci Sports Exerc. 2022;54(6):1028-1031. doi:10.1249/MSS.0000000000002871
25. Rønnestad BR, Bakken TA, Thyli V, Hansen J, Ellefsen S, Hammarstrøm D. Increasing Oxygen Uptake in Cross-Country Skiers by Speed Variation in Work Intervals. Int J Sports Physiol Perform. 2022;17(3):384-390. doi:10.1123/ijspp.2021-0226

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Drs. Feigenbaum and Baraki discuss a mysterious case of arm pain after curling that gets MUCH worse.

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BRI Calculator

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References:

Koenig SJ, Toth AP, Martinez S, Fletcher JW, Goldner RD. Traumatic pseudoaneurysm of the brachial artery caused by an osteochondroma, mimicking biceps rupture in a weightlifter: a case report. Am J Sports Med. 2004;32(4):1049-1053. doi:10.1177/0363546503258768

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