How do you view the heavy use of alcohol alongside the use of GLP-1 medication, and how can I be more empathetic to folks who continue to binge drink 1-2 times per week while one these medications, since GLP-1s help get an individual healthier and excessive drinking is the opposite of healthy?
For context, there has been an explosion of GLP-1 usage in my friend group (mainly due to one of the friends being an NP in a weight loss clinic giving prescriptions to others). Overall, I am pro-GLP-1 and the benefits. However, one thing that I get hung up on is the use of these medications while the users continue heavy alcohol use. I understand the obesity as a disease model of thinking and empathize at how tough it is to create healthy food environments (even for upper middle class families that can easily afford it), but I really struggle with the dissonance of seeing someone use GLP-1s to reduce body weight while simultaneously drinking 3-4 times per week, much of which would be considered binge drinking. Is it potentially a case of them also having alcoholism, even though obesity and alcoholism may be connected?
Building tolerance to high heart rate conditioning work
Austin recently shared some half marathon stats on Instagram that got me thinking about heart rate and adaptation. His average heart rate was 178 bpm, which really stood out to me. While I’ve been doing conditioning work consistently for over a year, I can’t imagine sustaining a heart rate that high for such a long time. Obviously, Austin does a ton of conditioning, so my question is: Did he build up this tolerance intentionally and gradually by exposing himself to longer and longer intervals or training sessions at high heart rates? Personally, I can’t see myself running at 178 bpm for more than a few minutes, but I also haven’t specifically trained for that kind of endurance.
Bouldering for health
How would you rate the sport of bouldering or rock climbing to meet physical activity guidelines? It is a trendy sport among my peers, many of whom do not engage in dedicated gym or cardio training outside of their sport, and I am wondering how does compares to strengh training - cardio training split for long term health.
Fiber intake
Is there a liner relation between fiber intake and health outcome . Does psyllium husk count towards this fiber . I know u have mentioned somewhere supplemental fiber have minimum effect on health compared to Whole Foods. Thanks for all the great information shared on this platform Thanks Easwara
Finding An In-Person Coach for Elderly Parents
Hey hey. In the spirit of the gifting season - wondering how you would approach finding a good/qualified in-person coach as a ‘get started’ gift to encourage aging parents (mine are 65 & 77) to begin a resistance training/basic exercise program? I know you'll say "use us - we have the best coaches!" and I don't doubt that, but I'm pretty confident my parents (and perhaps others') need someone to actually push them, hold them accountable, and walk them through things in-person. I know you've both said in the past that certifications don't matter and it's more about length of training experience, etc - but I feel like that makes me...even less able to sort through the noise of potential options. I feel like the risk of sending them to someone bad/unqualified (who might injure them and make them never want to try again) could outweigh the potential benefits. Or is that the wrong attitude? Send help. Thanks!
Pain/Rehab - Minimum Physical Activity Guidelines
First off, thank you guys so much for helping me navigate the uncertainty of clinical practice as a new grad PT. My question concerns helping patients meet the minimum physical activity guidelines. I work in a clinic that primarily sees veterans so 90% of my caseload is chronic pain in some fashion. The overwhelming majority of them do not do any formal exercise. I see it as a goal to find ways to get them to meet physical activity guidelines even if we cannot get immediate reductions in pain. I am constantly trying to improve my motivational interviewing skills and anchoring our plan to something meaningful to the patient but it feels like I am fighting a losing battle trying to get these people to meet minimum physical activity guidelines versus all of the passive options that our clinic also offers (chiro, acupuncture, massage, shockwave). Often, I will see patients stop rehab if their pain does not quickly improve but continue with another specialty, as getting your back cracked and doing an RPE 1 exercise is more alluring. Do you guys have any tips for navigating these scenarios?
Trap Bar Deadlift vs Conventional
Alright, Docs, what's the consensus on trap bar deadlifts vs conventional? I'm not looking to compete in a powerlifting competition and find the trap bar a lot easier on my lower back. Am I missing out on some critical gains? Also, does high handle vs using the low make a huge difference?
Rampant Consumerism
Happy holidays, guys! By the time this airs there will still be a few days left to do some holiday shopping, so what are a couple things you'd recommend for us to get for the fitness enthusiasts in our lives? Could be training gear, tools, books, subscription services, or even stuff completely unrelated to training.
How would you proceed if you worked in a team where many colleagues were working with very outdated approaches?
(This is long and includes multiple questions, excuse me. The tldr is basically the title question.) I work in an outpatient rehab clinic that specializes in surgical and orthopedic cases. Most of the patients come to us with chronic pain or postoperatively after disc surgery or joint replacement, but we also see many patients after sports injuries, etc. I like the patient clientele, the work is fun (even if it is sometimes extremely exhausting), and I also like the team. We have about 12 physical therapists (including myself), but unfortunately, there is only one other colleague in the team who has been reading research or even guidelines in recent years. Most of them are long-established and have been treating patients for years in the way they were originally taught (which, unfortunately, is not really good in this country). This is particularly frustrating when I am sick, because I build up a certain relationship of trust with patients and provide them with information based on my understanding of the evidence. This is often undone later by colleagues, and patients then don't really know what is right and what is wrong. One example is that patients with non-specific back pain should avoid lifting. It is time-consuming and, in a way, uncollegial for me to constantly have to revise what my colleagues have said to patients. In general, my colleagues are at least somewhat open to new approaches, but I find it difficult to communicate this with them because all of them have way more experience than I have. I don’t want to be a bad colleague but honestly I think this approach of low value care already had life changing consequences for some patients. It’s really frustrating long term, especially because I like my colleagues personally. Also I don’t really know where I would start with maybe changing this. My question is: How would you maybe communicate this in a team? Would you even try to change the opinions of multiple people in a team? I already work on a “lecture” type project on why we do research in the first place, how to research and interpret literature because I sometimes teach trainees. Is this something you would also try to present to your colleagues?
Prioritizing pace vs heart rate during cardio intervals
When doing cardio intervals (e.g., 3-minute intervals @RPE8+), should I focus on maintaining a consistent pace—even if my heart rate gradually climbs—or is it better to start fast and then adjust my speed to keep my heart rate steady, even if that means slowing down over time?
How often should an individual be experiencing pain or discomfort related to training?
Question: How often should an individual be experiencing pain or discomfort related to training (If you can even attribute it to the training)? I sometimes experience pain or discomfort in the same areas when I am pushing my training sessions over a training block. However, I am curious as to whether or not there are some sort of established normal ranges of injury rates for people with a history of injury or pain, and if so, do they vary based on the different areas of the body (e.g lower back and knee)?
Follow up on cardio with limited time
Last month, I asked a question about progressing cardio with limited time and you guys gave me a lot of good information. Thank you so much! I do have some follow up, because I think I left out some key info. For reference: AMA #13, timestamp 1:02:00. To summarize last month (with some corrections to the details): -my prompt: 40yo, male, new to cardio training. I currently have a self-imposed, but nevertheless “locked in” constraint for cardio training availability; 2 sessions/wk for 25-30 min. I have been jogging at a steady pace for the entire duration of each session. 3 to 4 months of doing this, and my pace has improved, but recently plateaued at around 12 min pace. How do I progress within these time constraints? You responded with data justification for higher intensity to further progress within the time constraint. You then gave some example recommendations that I interpreted, and am trying to apply like this: Session 1) HIIT Run/walk intervals. Running interval at a faster pace (e.g.: 9min/mile) then brisk walk for 1-2 minutes. Progress running interval from 3min to 5min. Session 2) Surges/sprints: -Jog 10 minutes targeting 85% max HR - which I believe you mean should be faster than my 12 min pace -EMOM: surges, then back to pre-surge pace for the rest of the minute. Surge double progression: 5-10sec duration, and/or 5-10 rounds -Jog 10 minutes (target 85% max HR) You then mention that eventually, this will also plateau. And the biggest lever is more time. Understood. Session 1) I have no follow up questions, this has been fun. Session 2) To be fair, I haven’t tried this yet. But this gave me pause because the second jogging block at 85% max HR is actually lower intensity than my current steady pace run. Info I left out: I consider my “steady pace session” hard. I’m typically at 160bpm by min 10, 170bpm by min 20, and then I’m just trying to not walk but also not redline for the remainder. But usually hitting the 175-178 for the last 5 minutes. That is, my “steady run” feels high intensity. (Maybe helpful, max HR ~185.) I worry that you may want to turn down the intensity a bit. However, I enjoy these steady pace sessions. They’re challenging but dont interfere with my daily life. Also, I don’t want to give up the musculoskeletal-adaptation grounds I have gained, as it took quite a lot of effort. With that additional information, would you tweak your recommendations?
What doesn't translate to the real world?
Epidemiological studies have well-known limitations that you have discussed in the past. While RCTs are the gold standard for causality, most studies outside of drug trials (things like exercise science and nutrition RCTs) are right around the duration of a typical college semester, 12 to 16 weeks. What is something that either has shown up as effective in such studies that you suspect wouldn't actually work as well for years in the real world or something that has yet to have a positive result over 12 to 16 weeks that you suspect actually does work over a longer timeframe outside the lab setting?
Pre-Exhaust Training
Docs, what is your take on pre-exhaustion exercises before hitting compound movements? Specifically doing something like leg extensions before squats. I have found that this technique seems to help with mind muscle connection, but also limits the amount of weight I can use on the main lifts.
How do I set up a peaking phase for a powerlifting competition?
About once a year, I find myself wondering how to change volume and intensity in the month or so leading up to a powerlifting meet. Does it have to be more complicated than gradually dropping the volume and adding low rep high intensity exposure, and how individualized does it have to be? What should happen to the volumen and intensity of the accessory movements during that time?
Recent RCT on vitamin D supplementation for respiratory illness: Thoughts?
Whenever Vitamin D was discussed on the podcast, my takeaway was that it's useless for most people. A recent RCT [1] apparently found significant reductions in the incidence of respiratory infections for the cohort supplementing vitamin D. Does this update your opinion on this supplement at all? Why or why not? 1: https://ijmpr.in/article/the-role-of-vitamin-d-supplementation-in-the-prevention-of-acute-respiratory-infections-a-double-blind-randomized-controlled-trial-1327/
prior dietary patterns effect on your choices today
I find that the way i eat prior to how I'm eating today effects my cravings/appetite. If I eat pizza and McDonalds every day for the last 7 days then shift to eating a different pattern thats more homecooked meals today, then there is acutely a higher tension on adhering for today, however the important thing I want to note is that the difficulty feels transient, as in if I then keep eating that way for lets say a week, that new prior timeline of eating makes eating that way easier, and reflecting on that makes this whole process much more reassuring and makes me more adherent, my question is, is this normal? Im not saying its easy... but it is kinda reassuring to know that you wont feel the inclination to eat a meatlovers pizza at rpe 10 forever, it does seem like that dies down if you give it some time (and not understanding that it gets better I have to assume dings a persons confidence in the process or there self efficacy cause the first day your shifting the pattern does not feel super great)
Is there such a thing as "too low" LDL/ApoB?
Hi docs. I have two doctors in my life (my PCP and my cardiologist) who cannot seem to agree on whether there is such a thing as an LDL/ApoB that is too low in the context of primary prevention. I've reviewed what I could of the literature and honestly it seems as much a question of epistemology and risk management as science or medicine. One doctor argues that the evidence from clinical trials and from people born with certain genetic mutations shows that levels at or lower than that of a neonate are, at the least, not harmful. The other argues that we don't have multidecade evidence of what happens when we reach those levels in humans through pharmacologic intervention rather than genetic mutations. Without making this about my specific case, how do you think about an issue like this?