Getting “Stronger” With Aging – How Do We Score?

This is an expanded version of an answer I wanted to give over at Doug’s website to the question of how do you judge improvement in functional ability with aging. Specifically, Ed is almost 69 but feeling really solid about his strength. The exchange:

“Another Point: Folks, don’t fool yourself into thinking you’re “stronger” after 5 Years of aging – one might perform exercises better or score well on machines, but age Kicks Your A**”

Not sure I agree. I firmly believe that I’m as close to defying the aging process as could happen. Between 61 and 63 my measurable strength levels went up about 60-70% (despite “working out” with weights for 20 years prior…I had a good start). Going on 69 and they have not dropped one bit. So that said, in the last 5 years I’ve seen no decline in what I accomplished the first 2 years. Which says to me, I’m just as strong now as I was 5 years ago (not to mention I feel fantastic!)

The other trainer basically waves off Ed’s statement by saying he’s “keeping score on machines” and implies that a barbell bench press would be the “real” scorekeeper of his strength levels. Let’s talk about this.

What the heck is strength, actually?

Or specifically, what are the ways in which our body manifests strength? People with a little experience in this field understand that it’s not *just* muscle mass being added. There’s a whole host of compensatory mechanisms being used to make one “stronger” without a corresponding increase in size.

In Neuromechanics of Human Movement, Roger Enoka (the author) lists eight potential neurological areas for non-hypertrophy related strength gains:

  • Enhanced output from supraspinal centers (which they show from simply imagining muscle contractions)
  • Changes in descending drive that reduce the bilateral deficit (the inability to fully recruit all of the motor units during dual limb compound movements)
  • Increased motor unit synchronization
  • Greater muscle activation (EMG)
  • Heightened excitability and altered connections into motor neurons
  • Reduced coactivation of antagonist muscles
  • Greater activation of agonist and synergist muscles
  • Enhanced cross-education

Big list, but the important component is that basic coordination between the muscles is the single greatest contributor to non-hypertrophy related strength gains. Along with neurological adaptations, adaptations involving increased stiffness in the tissues that connect from bone to bone (tendons, extracellular matrix, etc.) can lead to increased force transmission from muscle to bone, which play a significant role in increased strength gains. The more “spring-like” the tissue can become, the more the force produced ends up moving through the barbell or apparatus attempting to be moved.

So in that sense, the trainer talking about keeping “score” with machines (or any exercise) is correct: they can lie to you. However, it’s important to note that these mechanisms cannot compensate forever. Imagine if they could: you’d be the 98lb weakling dead lifting 800lbs. Rather, these compensations occur in parallel with hypertrophy and within parameters. Eventually the compensatory ability reaches its ceiling for a given amount of muscle mass and you either add tissue or, if you’re near your genetic limit, don’t get any stronger or bigger. Such is life. But the take away is that if you’re getting stronger and your weight is stable, you’re probably not losing muscle. This measure is directionally accurate.

So how else can you keep score?

Body composition

Let me remind you that Ed is nearly 69. He’s on the downward slope of muscle mass and strength gains, where his peers are withering. Ed is making progress due to their rapid loss of tissue due to inactivity and sudden fat increase, a term called “sarcopenic obesity.” A great review of this can be found here.

From a visual perspective, this curve can be displayed. Here’s how it looks based on the literature:

Muscle curve ageThe original curve is from “Bending the Aging Curve” by Joseph Signorile. I added the “Paddon-Jones” curve, as one of Dr. Paddon-Jones former students was a muscle physiologist at Texas State University (where I received my masters). She explained that the original curve doesn’t account for the fact that people get injured, lose a lot of mass, and never recover to a “normal” projected loss. So the “gap” between a good functioning person training and their sedentary peers is even larger.

It looks great on a graph, but something more substantial is required. How about images?

psm.2011.09.1933_fig5 The 40 year old and 74 year old triathlete look nearly identical as far as muscle mass are concerned. Remember it is the total volume of tissue we’re looking at here; it’s difficult to sometimes see how a person actually is doing when they’re aging because of the breaking down of the collagen matrix in their skin making them look less “hard” than when they were younger. The muscle is there, but the skin lies a bit.

Ed notes substancial strength and tissue gains in his early 60’s. We see these improvements in sedentary 90+ year olds. It looks like this:

90 muscleBased on the above, it is reasonable to assume that one could “jump” a line if training is sufficient in intensity and progression. Perhaps this explains Ed’s jump in strength and maintenance thereof.

Another point: muscle is an endocrine organ. High quality work with muscle stimulates a more youthful expression in all of the organ systems in the body. It is literally the gatekeeper to youth.

Takeaways

  1. Strength is a directionally accurate indicator of lean tissue maintenance and/or gain during aging.
  2. Decay is inevitable but the rate of decay is largely within your control.
  3. The surest way to “keep score” of your physical function throughout aging is a yearly DXA scan to assess muscle and bone, a basic mobility screen, and strength as assessed by your training regimen. All of this with feeling really damn good covers both objective and subjective measures of physical function.

Whole 30 #2 Review

I was apparently ahead of the curve in proclaiming the paleo diet to not be magical in any way. Take that, johnny (and Jane?) come latelies! Here’s the thing: magic isn’t actually magic, but boy if it doesn’t resemble it. With that in mind, the value of such an eating strategy has never been lost on me, nor its utility. It’s really hard to screw up (unless you’re making “paleo donuts” or some sort of other stand in for your sugar addiction), gives you a ton of nutrients, jives with that whole “you’re a human animal” mismatch elimination thing, and satisfies my internal calculus.

Internal calculus? That is to say, in a cost/benefit analysis, the foods I don’t eat aren’t missed. Grains,legumes, and dairy do not offer anything my diet does not already have in abundance and only bring things that either subjectively make me feel rubbish or objectively are problematic in the body. Thus, they have no place in my regular diet. This simple calculus doesn’t work for everyone, some people need to bathe in the wonder that is a really great functioning, reduced-inflammation human body to “get” it. That’s where the Whole 30 comes into play.

I’m friends with Dallas and Melissa, so I guess that’s a disclaimer (though Dallas and I have stimulating conversation on all points in which we disagree, so no critical thought is lost in process). The utility for such a period of clean eating for us is a reset and a check: a post-birth reset after the whirlwind of generally good eating but not quite all the time because we had a newborn; and a check to see if our normal eating habits were or were not making us feel subtly not our best without our knowledge. So on we went.

There is a guide to how you’ll feel at what day throughout the process. It was a good sign that we never really hit those notes…I never wanted to stab anyone during a sugar comedown anymore than I usually do because there wasn’t a sugar comedown. Second, nepotistic articles in online magazines set up awesome straw men about such a diet, with lines going on about a paleo diet not having enough carbs for hard training athletes. Never mind that endurance athletes (who need way more carbs than your average meathead) wrote a book on the subject. Hell, further never mind that certain professional hard-training athletes (read: paid millions for their performance) find a great deal of success with such an eating plan. Digressing, in my experience is that I eat more carbs when I tighten up my diet because psst, unless you lived near the poles, you had fruits,berries, and tubers available to you! It’s food! An example of this was how many times Sarah said “How many bananas is that today?!” which means I was eating a lot!

So since Sarah and I have done this before, we had no problem with buying in and understanding the subtle cues to pay attention to throughout the 30 days. However, as we progressed Sarah would say things to me like “I’m not really feeling anything.” This was actually a good thing, as it meant that our normal habits were really pretty solid and that tightening up wasn’t really too much of a stretch. Contrast this with the first Whole30 where Sarah walks in around day 13 and tells me how damn good she’s feeling and how great her skin is looking etc. etc. Our normal was now really damn good, so we didn’t notice much improvement in that regard.

At the end of the 30 days, we went on our first post-birth date sans baby. We got some sushi, felt a bit drunk from the voluminous rice, a serotonin smoothie if you will, and then the next morning went back to our normal habits that had been adjusted by the past 30 days.

So other than subjective results, there were the body composition changes; I lost 1/3″ in my waist, a couple pounds, and a few mm’s on the caliper, though nothing major nor expected. I call in the clean diet fudge factor: doesn’t change how my clothes fit or how I feel, though the OCD’s out there would go crazy for it. Ebb and flow around a central point, like my weight which has been within 2.5lbs either direction of a “stable” weight for 4 years now. These measures are the same. Sarah lost 4lbs without trying and is now fitting into pre-baby clothing, which is a nice side effect of just eating damn good food.

In the time period since, ~3 weeks, we’ve come to an interesting conclusion: in our life, a diet that is basically Whole30 + wine & dark chocolate works great. We get all of that sweet mortality reduction from the booze and dark chocolate doesn’t make us feel…well, anything. It just feels like heaven as all dark chocolate should! Seriously though, it lets us have social latitude without feeling like we’ve been run over by a truck as a result. And what’s better than that?

They’re starting another Whole30 in January; if you’ve been jonesin’ to try, that’s as good a time as any. And no, I don’t get anything from the reference, unless you count having Dallas on my cell phone as compensation. College girls everywhere are jealous, I’m sure.

The Elderly Need More Exercise? Not Exactly.

An interesting discussion over at Doug McGuff’s message board regarding exercise and aging. This comment was of interest:

I suggest that the sedentary elderly require more exercise, not less. I am one such. A few minutes a week is not going to do it for sarcopenia or anything else. If I train once a week I cannot maintain my condition, strength,metabolic benefit, motivation or momentum. Nor can you if the rest of the time you are inactive.

Here was my response to this statement:

And I disagree; I think the elderly need more activity, not exercise. Further, the health education research is clear: in the elderly, physical activity and self-efficacy track side by side. The more confident a person is in their abilities, the more physically active they are; the more physically active they are, the more confident they are in their abilities.

If you make a person stronger in your studio, they’re more confident in their ability to do other activities. This is what Doug talks about when he says people want to move more after training for a number of months. Get strong and you’ll get more active relative to your starting lifestyle.

I’ll even make it a nice soundbite: have you ever heard the phrase “a stronger athlete is a better athlete?” The same is true of human beings throughout aging, that is a stronger human is a better (more active, more healthy, more resistant to cancer/metabolic disease/disability) human. (Emphasis mine…just now!)

There is a nugget of wisdom in there that I want people to pay attention to: “relative to your starting lifestyle.” If a person is doing zip and they start a once per week strength training routine that then leads them to take leisurely strolls because they enjoy it, they’re going to do a whole lot better for themselves compared to where they started as far as disease prevention and injury risk reduction. If you had a crazy triathelte at the same advanced age add the same dose of exercise, it wouldn’t make much of a difference. There’s a survivorship bias discussion that will be addressed another time, but here’s my advice: don’t take advice from an endurance athlete who has been training “all of their life” as the gospel…there’s more at play than just hard work!

I digress; elderly individuals should look at their training as an upside-down oil funnel: the widest, part is going to be activity that is very low in intensity but very high in frequency. It seems this is where one can start making a semantic argument that this too is “exercise.” However, it’s really just being a good human animal and setting a functional path: if you move a certain way today, you’ve got a good chance of moving that way tomorrow. The middle part of the funnel is going to be mobility work as maintaining joint free range of motion is paramount for maintaining activity levels. When looking at barriers to exercise, the less mobile people are, the larger their barriers to exercising become. For example, those with mobility limitations cite “poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise…”. Performing joint mobility work for 10-20 minutes a day, hell even starting at 5 minutes per day, when mobility is still pretty good will go a long way to maintaining mobility, which maintains activity levels and exercise efficacy. Finally, the tip of the funnel is exercise training, preferably of a high intensity nature. Muscle is the most plastic tissue in the body, the largest endocrine organ we have, and creating a sufficient degree of demand will improve all aspects of a person’s physiology. By its nature, it cannot be sustained for very long and requires a prolonged recovery period. That’s fine, as it means more time for the activities the person would rather be doing, which is going to set the table for continuing to do the activities until the day they die. All good stuff!

So no, the elderly do not need more exercise; they need just enough exercise to produce a body that feels good doing lots of physical activity that a person would rather be doing. Maybe this advice will produce a few more Stephen Jepsons in the world and how cool would that be?

Strength is a Skill

The subtitle of the post should be “…that doesn’t always lead to mass.”

I’m in the midst of writing a research review of publication and I came across a study on exercise volume and hypertrophy & strength changes. The study is titled “Strength and neuromuscular adaptation following one, four, and eight sets of high intensity resistance exercise in trained males” and is found in the Journal of Applied Physiology. Click above for a preview.

The study used 32 resistance trained males in a 10 week study of the squat at 1, 4, and 8 sets per workout performed twice a week. The authors concluded ” The results of this study support resistance exercise prescription in excess of 4-sets (i.e. 8-sets) for faster and greater strength gains as compared to 1-set training.” Yup, that’s true. No beef there. But let’s look at the numbers.

Strength Stats

So the numbers are cut and dry: the 8 set group saw an average increase in 37kg in their 1 rep max squat over the course of the 10 week study, compared to a 17kg increase from the 1 set group. Here’s the thing: when you compare the lean tissue changes, the result is much, much smaller. The 1 set group gained 2.03kg lbm over the 10 weeks, while the 8 set group gained 2.69kg lbm. So for the 8x increase in time spent training, and a 1 rep max 20kg higher over the same period, the trainees gained…0.66kg more? Really?

Strength is a skill and all of that time spent under the bar is practice. It just also happens to contribute to hypertrophy but not in a linear fashion. The fact is that if you want to get strong as fast as possible, more practice will get you with the movement pattern will allow a larger exertion to be controlled when performing that movement pattern.

The problem with these studies is that they cannot, due to funding, account for the long view of time. I’ve shown this crude sketch before but it’s relevant here.

Rate Of Gain vs. Injury Potential

While reaching one’s “absolute” potential is something very few are in danger of achieving, the fact is our progress slows down as we get closer to that absolute max. Understanding that each one of us has a limit, it must be asked that does doing more sets merely get us to that limit faster, only to coast longer? Given a time frame of say 5 years, would the 1 set group and the 8 set group be moving very nearly the same weight, all things being equal? I’d suggest that they’d be very close, with the reduced set group having spent less time in the gym and reduced occurrence of injury. There’s only so much recovery to go around and the tolerance for error becomes smaller under heavier loads.

So what’s your goal? If you want to powerlift, more time under the bar is better (though 8x the sets only got a bit more than 2x the strength gain…4 sets is a nice compromise in that regard). If your goal is lean tissue gain, strength improvements are important, though a side effect of quality contractions under sustained load with sufficient metabolic distress and enough rest and calories. Oh, and there’s that whole genetic thing to be discussed in another post! Finally, if your goal is robust health, improved function, and a better looking naked body, 1 set with a sound set of eating habits centered around real food is hard to beat. The time investment is paltry and the return is profound.

Body Criticism: It’s Turtles All The Way Down

Yesterday on Facebook, Krista Scott Dixon posted this:

Stump

She’s right: if you are otherwise free of pathology, there is nothing wrong with your body. This is a fitness industry-wide trap, to make you feel bad about your body as a means of motivation. Unfortunately it’s as big a trap as the one the Rebels encountered and far less entertaining.

It's a trap

The sort of self-talk that comes with this self-criticism is reactive in nature. Let me give you an example: if you decide, for some reason, that your deltoids are too small and “need” fixing before your physique is “perfect,” your goal is inherently about how imperfect you are and thus are in need of fixing. After you “fix” your deltoid size, you’ll find something else that is “wrong” and “needs fixing.” And you can do this forever, endlessly finding more and more that is wrong with you in the face of the recent “fix” you achieved, hence turtles all the way down. You may end up with a more beautiful body, but your journey there was on a wagon of self-loathing. In men, this is the root of the Adonis complex; in women, anorexia nervosa among others.

Your body is exactly the way it is; nothing to be fixed. One way to realize it is to actually do things with it that you’ve not done before. This is a proactive framework, where you add to the foundation that is you, not chip away at it. You lift more, learn to handstand, juggle, or some other skill. You take up a sport, take up yoga, take up tai chi, explore everything that you body can do. You come to realize that you’re a pretty rad machine; look at all you can do! If you were “broken” you’d never actually be able to do these sorts of things. Your body may change as a result, but that’s a side effect of learning all of the cool stuff you can do.

In Health Education, there’s a lot of discussion about intrapersonal theories. How do you teach a person a set of skills that allows them to rationalize better health decisions over their lifetime? Now omitting that there are a host of others factors that are likely more important (e.g. interpersonal factors, community factors, cultural factors for instance), these theories identify where people are in how they think and some of them point to how they think and aim to modify these behaviors. One in particular that is relevant to this discussion is the Theory of Planned Behavior (TPB). The theory states that a person’s attitude toward behavior, subjective norms, and perceived behavioral control, together shape an individual’s behavioral intentions and behaviors. Especially in fitness, it often goes like this: behavior (“working out = punishment for cake”), subjective norms (“everyone is so much fitter/prettier/skinnier/harder working than me”), perceived behavioral control (“But I can fix me! I can control everything and look like that!”), together shape a person’s behavioral intentions (“I’ll find every flaw, and until I do, post myspace angle photos hiding that which I perceive as such”). I’m sure I don’t have to elaborate, but a negative affect from the start will only lead to misery.

Here’s a suggestion: find something you want to do with your body (not to your body), really work at getting better at it, and stand back and be amazed at how far you were able to get when you didn’t worry about what was wrong with your body, but how many great things your body can do. It’s astonishing.

“Aging with Strength” is live!

This past spring, I was presented with the opportunity to speak at PaleoFX 2013 on strength training and aging. This was a fun challenge, as I was given a small block of time with which to fit a 40+ minute talk. This meant that I had to hit the big-picture points without leaving people in the dark and I think it came out well. I hope you enjoy it, especially the addition at the end with how little exercise it takes to cement these health outcomes.

So PaleoFX 2014 will be happening April 11th through the 14th here in beautiful Austin, Texas. Tickets for this event are now live, as is the preliminary list of speakers. I’ll be presenting a new talk on skill acquisition in high level athletics, so if you’re just plain tired of me talking about how awesome you can be when you’re old, you won’t want to miss this talk.

Get your tickets now!

Exercise Science is a Translational Science

My wife likes to take the piss out of me. While I’ve been working through my graduate degree, and people ask her what I’m studying, she likes to say, “Exercise science. I know, it sounds like a made up degree.”

She’s not wrong; “exercise science” does sound a bit nebulous to the point of gnostic wisdom. However it’s important to understand that most people think they have a clue about exercise and they simply do not. It’s a bit like Parkinson’s Law of Triviality: people have bodies, therefore they think they know how to exercise said body. Given the state of health in the United States, it should be clear that we have little in the way of cultural norms to maintain fitness, and even less cultural wisdom to get people on the right track.

Frankly, exercise is complicated stuff by the simple fact that you have to account for so many variables in so many subjects (body of knowledge subject, not human being subject). This is why exercise science is actually a translational science, a cross disciplinary, scientific research driven by the need for practical applications of science.  This type of science is often used in medicine and pharmaceuticals, because you need people to figure out how to take lab discoveries to trial as quickly as possible, and also to take these discoveries into best practice perhaps even faster. This came about because it takes an average of 24 years for a lab discovery to primary care setting, so long that “breakthroughs” that can save many lives leave so many dying before they can be applied.

The same seed is what has created a movement in health and human performance departments at universities to move away from terms like “exercise physiologist/biomechanist/kinisiologist” toward a unifying umbrella of “Exercise science.” This is because those are all part of what you study at the graduate level and then some. I made a picture with a mouse to illustrate the breadth of subject matter I learned in my studies (click for full size):

Exercise Science DIagram

Now if I walked into a lab that was devoted to any of those pursuits, I’d be dangerous. In the context of the human body and how it responds to an exercise stimulus, I’m better than any of those experts. I’m taking what they’re studying, mixing it with what others from totally different fields are studying, and attempting to mold a best practice that gets at the good stuff as efficiently as possible. I’ve been trained to be the ultimate generalist when it comes to understanding the human body and its response to exercise, which is exactly what an exercise science curriculum should do.

Yes, it sounds made up, but it’s really the shortest description of what it is we do!

Examine.Com Fire Sale – Last Chance For A Steep Discount On The “Supplement Goals Reference Guide”

My buddy Sol is celebrating a couple things this week:

  • He has established an amazing team over at Examine.com to help further improve his product and to give you more confidence in the information you’re getting that influences your supplement buying choices. These additions include:

-Dr. Spencer Nadolsky, a primary care physician
– Kamal Patel, MBA MPH PhD(c)
– Gregory Lopez, pharmD
– Bill Willis, PhD (biomedical)

  • He previously funded the website with Amazon affiliate links from the supplements being reviewed. This has been eliminated; the supplement guide is what they do and how they support themselves.

In celebration of this, he’s dropped the price of the Supplement Goals Reference Guide from $39 to $29. Here’s the thing: the sale ends tonight at midnight!

If you’ve been on the fence about picking up this incredible tool, now is the time. You’re not going to find a lower price, as it goes back up tonight.

Pick up your reference guide today!

More Lessons from Health Education: Leverage your Strengths

In Health Education, there is a set of principles and methods called Community Organizing. This is where a community is helped to identify problems within a community, mobilize resources, and implement strategies for reaching the collectively-set goals. Now, often this process is similar to how a consultant works in a business: they come in, determine what the “problems” are, and drop that on your desk for you to figure out. You can imagine how helpful that is.

However, there’s a flipside version where a person acts not as an outside “other” but rather engages the community, asking questions and seeing what they identify as the “problem.” Often, this is not what it seems to be, and an outsider would not peg the problem as such. Further, this person engaging the community is a facilitator, helping people to help themselves with resources identification, and community representation. But more than that, the facilitator aims not to problem solve but to leverage strength. Often, when a community can identify what they are good at and aim to get even better, things that were “problems” organically work themselves out.

There is a lesson here. So often in our drive for more “health and fitness and function” we look at all the things we aren’t doing or aren’t doing well. There is some good in this (see my last post about the low hanging fruit). However, if you only go around inside your head looking for all the things you’re not good at, you’re not going to think you’re good at anything. Instead, why not look for the things you do well and look to maximize that?

A personal example: I am an exceptionally elastic human being. That is I have always been very, very good at jumping, sprinting (once I get going), and the like. I had a 39″ vertical leap in high school in spite being rather weak. After realizing I was “weak” I spent 12 years trying to become brute-strong and, though I am stronger, I am also less explosive than I once was. In an effort to turn a weakness into a strength, I diluted the strength. I’ll paraphrase a Charlie Francis quote:

You don’t plow a field with a Ferrari

Learn from my mistake! If you’re good at something, push that “thing” as far as you can go. If you’re good at not eating after 6pm and are reasonably lean, don’t worry about some dietician who says you “need” to eat 6 meals a day. If you’re an explosive athlete, keep pushing that instead of what some bald, goatee’d powerlifter thinks of your deadlift strength. Find your strength and focus on that rather than anything you may be “weak” in!

Put In The Work

One of the things I stress with clients is that the low hanging fruit should be picked first. It’s fairly standards in this field for clients and trainers to “go for broke” and set up really complicated programming to reach their goal. To keep running with the metaphor, that’s like climbing to the top of the tree to pick fruit. Sure there might be better fruit up there but wasn’t the goal to eat?

Recently I’ve been dabbling in doing handstands. Sure I found all sorts of complicated programming and poorly written tutorials. After getting them I didn’t use them. When I finally came back to the goal I decided that I’d just practice every day. Even if that meant just one attempt upside-down, that was enough.

After a couple weeks of this I can kick up into a 5 second handstand. I can’t do this every time but I can certainly do it every day. And every day that I do it I get a little better at it. So there was no magic routine, just a bit of consistent “imperfection” toward the goal. Often, by the time a person needs a routine tune-up, they’ve surpassed their peers and need far less coaching all because they were consistent with something appropriate and intelligent but perhaps imperfect.

Consistent imperfection beats inconsistent perfection in this game.