What’s the worst that can happen if you train intensely? You might be uncomfortable for a brief period of time. There is always a risk of injury with everything.
But you are better for it. You are stronger, healthier, fitter, and more disciplined.
What’s the worst that can happen if you avoid discomfort and never train? Your body deteriorates. You put yourself at an even greater risk of injury due to being weak. The chances of developing metabolic disease increases and before you know it, your body will be fragile and riddled with health problems.
The misery of exercise now will pale in comparison to the misery of a sedentary life later. Instead of your body being a vessel of freedom, you will feel trapped in a body that can’t do what you want it to do.
The misery of exercise will harden your soul. It will make you stronger in every facet of life.
The misery of being sedentary will soften your willpower. It will make you weaker in every facet of life.
The worst that can happen with exercise is temporary discomfort. The worst that can happen with a sedentary life avoiding exercise is permanent discomfort.
Lately if you follow any “science backed” fitness coach or influencer they’re all saying that time under tension for muscle hypertrophy is outdated and you’re an idiot if you still believe in it.
But is it really fake? No. But, yeah it kind of is. It’s a bit complicated but since no one actually explains anything past their condescending POVs, I’ll do it here.
If you prefer to watch and listen to a video, here is everything in this article in this YouTube video:
Historically Inaccurate
For those unfamiliar, time under tension has long been proposed as the mechanism of muscle growth and hypertrophy. In a nutshell, when you are training for hypertrophy, keeping the muscles under tension for extended periods of time is the main mechanism of stimulating muscle growth.
The problem with time under tension is that time is the greatest factor being given attention in that equation, but no one has ever really found the critical threshold for how long a set should last for optimal hypertrophy. Even worse, it fails to specify how much tension. Is it time under a little tension? Moderate tension? High tension?
In fact, research keeps finding more and more evidence that keeps putting time under tension under more and more scrutiny.
They’ve found that people can achieve the same significant muscle growth with 5×5, which is nowhere near the traditional range for hypertrophy, just as someone doing like 3×8-12 or even 20 reps, which is more the traditional “bodybuilding” range.
Numerous studies show that you can achieve significant hypertrophy with very low rep sets like 3-5 reps and with very high rep sets like up to 50 reps. They even found that you can achieve about the same level of hypertrophy with 30% of your max as with about 80% of your max.
So what on earth is going on here?
Before we break down the research and what it means for time under tension, let’s at least gather up what we know about muscle growth.
The 3 Requirements For Hypertrophy
Muscle hypertrophy generally needs 3 things:
We know that it takes mechanical tension. The greater levels of mechanical tension in the muscle, the greater number of motor units and larger motor units are recruited, which is essential for muscle growth.
We know that it takes effort aka reaching some level of volitional fatigue. In crude terms we need to create some sort of environment of metabolic distress within the muscle to stimulate muscle protein synthesis and the other cascading anabolic events in the body. This also allows for greater recruitment of motor units as fatigue sets in, similar to principle 1. Just a side bar. The metabolic stress theory is also being scrutinized as well, as more evidence emerges to show that metabolic stress may not have as much impact on muscle growth as we once thought but that’s a topic for another day.
We also need some level of training volume. We can’t just do 1 set and call it good.
So now that we’ve established those three criteria, let’s at least summarize the findings from these studies. I’ll have links to the studies and reviews down the description below if you’re interested in reading them.
The Studies Summarized
Taken as a whole, here are what those studies have found.
You can achieve significant muscle hypertrophy with both low repetitions and high repetitions.
You can achieve significant muscle hypertrophy with a wide range of intensities from 30% of your 1RM to 80% or even higher.
Generally, taking the sets to or close to volitional fatigue aka failure seems to be a prerequisite for any of the rep ranges and intensity ranges to be effective. In fact, while achieving failure is not required or even recommended for strength gains, training at least into the ballpark of failure, around 4 reps in reserve or even less, seems to have a significant positive effect on hypertrophy gains. There are great bits of variability in this data as well as a lot studies having shown that training to failure is not a requirement for muscle growth, but the data does learn towards greater effort = greater gains.
You need to do more than a single set. Yes, that was a finding in one of the studies.
If you are using moderate loads, you don’t need to do as many sets, around 2-3 seemed to be sufficient. If you are using heavier loads, more sets were required to achieve similar levels of hypertrophy. In my little intuitive leap, this is likely due to ensuring that similar volumes and workloads are achieved. However, there was great variability in the data as some studies showed that there was no significant increase in hypertrophy with increasing the number of sets per week while others showed a strong dose response relationship to volume and muscle mass, meaning for every added set, there was an increase in hypertrophy. However, the data does lean towards the idea that there is a ceiling to the number of sets you should do on a practical basis.
Now, there is a lot more to be learned from these papers so I highly encourage you to go through and read them yourself.
A lot of that turns a lot of what we theorized about resistance training on its head, including the idea of specific rep ranges only suiting specific goals. You know, 1-5 reps is good for strength, 8-12 is optimal for hypertrophy, and any more than 12 is only for endurance. It’s what every fitness professional learns at some point and it turns out that it doesn’t even scratch the surface. It turns out the hypertrophy rep range might be all rep ranges
And it also seems to put time under tension under great scrutiny. Like I mentioned earlier, time under tension places an emphasis on the TIME aspect of lifting during a set but the plethora of evidence that we just went over shows that it’s way overvalued. In fact, a study by Brad Shoenfeld showed intentionally making the reps extremely slow, as in 10 seconds per rep, was not favorable for hypertrophy. If time under tension was really the primary factor in hypertrophy, very slow training should work, but it doesn’t.
But let’s not throw out the entire concept.
A New Perspective: Tension Vs Time
A better way to look at this isn’t time under tension.
We can reframe it as tension vs time and it’s an inverse relationship.
We also know that effort is a big factor in hypertrophy training, so we can insert it as
tension vs time = effort
That’s not a real equation I’m not great at math.
So as tension goes up, meaning increased intensity via heavier weights or purposefully creating more tension in the muscle, time as in reps to fatigue will naturally go down. As tension goes down, time or reps to fatigue will naturally go up.
By the way, even I’m not a huge fan of this equation that I just came up with because it still overemphasizes time.
Volitional fatigue is important. Absolutely none of this matters if you are taking it easy and stopping your sets far short of fatigue.
Actually, maybe I should write it like,
tension + effort to volitional fatigue = hypertrophy
The important thing here is effort and taking the sets closer to failure, but even then this isn’t a perfect relationship because as we approach the extremes of this relationship, we run into some issues.
For example, I’ve never really heard of anyone gaining a ton of muscle using sets of 1 or 2 reps with extremely heavy weights despite what we learned today, nor do I really hear of anyone gaining a ton of muscle using really light weights like 15% of your 1RM. And beyond that there’s the practical problems like burning out with a prolonged program of extremely heavy and high volume training, potential joint problems from excessively heavy training, and on the other end of the spectrum, your workouts will last forever if you’re only doing sets of 50 or more.
So in real life, it will probably always come back to moderate parameters.
So let’s take a moment to recap some of the lessons learned here and have some practical takeaways to apply to your own training.
Top Scientific and Practical Takeaways
You can achieve muscular hypertrophy with a wide range of intensities and rep ranges.
No matter which level of intensity or rep range you choose, effort and taking each set close to volitional fatigue or close to failure seems to be favorable.
Time under tension has historically overemphasized the importance of TIME.
Time or reps to fatigue has an inverse relationship to the amount of tension used, meaning high levels of tension will require less time to fatigue while lower levels of tension will require more time to fatigue. In any case, training close to failure, about 4 reps or less in reserve, is favorable for either situation.
You cannot escape the laws and requirements of muscle hypertrophy, which are mechanical tension, effort to fatigue, and volume.
As far as total volume goes, it seems like you can get away with doing about 3-4 sets of an exercise per workout and achieve good gains. But, there is data to show that doing more sets total per week has a benefit for hypertrophy.
So how do we transform this into something actionable for our own training?
First of all, it means that we can insert more variation into our training without fear of losing out on potential hypertrophy gains.
Second, you can start tailoring your rep ranges to each exercise depending on what typically feels good and makes logical sense for the kind of exercise you are doing.
So here is the way I organize my workouts and rep ranges. Side note, I usually do an upper body/ lower body split.
For your main, big compound lifts like the squat, bench, deadlift, and overhead press, focus on doing sets around the 3 to 6 or even maybe up to the 8 rep range. 4-6 sets will compliment these rep ranges well.
For your assistance lifts which may still be compound lifts but typically “smaller” exercises like lat pull downs, dips, rows, dumbbell variations, split squats, RDLs, etc, work around the 5-8 or 5-12 rep range. 3-4 sets for each of these exercises will likely work well.
For the smaller accessory exercises like bicep curls, tricep extensions, knee extensions, hamstring curls, lateral raises, etc, exercises that are typically a bit cumbersome to load incredibly heavily and maintain good technique, perform your sets at higher rep ranges like around 8-15 reps. 2-3 sets here will likely work really well. Now, that doesn’t seem like much but considering that these smaller accessory exercises are typically performed after the main lifts and assistance exercises towards the end of the workout, 2-3 sets should feel sufficient.
In all of these ranges, remember that you need to put in effort and take each set to relative fatigue.
And finally third, As far as rep tempo goes, we know that you don’t need to purposely make each rep take longer for better gains. However, a sensible way to standardize your reps and ensure you are creating adequate mechanical tension and taking advantage of what both eccentric and concentric contraction have to offer, a sensible approach is to control the eccentric portion of the lift through like a 1 or 2 count, and lift through the concentric portion as quickly and as powerfully as possible without breaking technique.
So I hope that you found this article helpful or at least thought provoking in some way. Time under tension has been a long standing concept but as new information comes out, the intelligent thing to do as movement professionals is to learn from it and apply it to our own practice or training.
Let me know what you think and if you have any questions, put them down below.
Getting better at anything usually requires you to do more of the thing. I wanted to test out this theory and see how many pounds I can add to my squat if I squatted every training session for 100 days.
To be clear, I’m not squatting everyday for 100 days. I’m squatting every time I train, which is typically 3 or 4 days per week depending on the program.
Getting strong typically requires 3 things:
Increasing absolute strength/skill via circa-max training (max effort training).
Improving speed-strength and power (dynamic effort training).
Appropriate training volume (hypertrophy training).
These elements are usually periodized and divided into distinct training phases (ie, having a volume phase, power phase, and strength phase), but I have never been a believer that different elements of fitness need to be separated. Each of these elements will be trained each week.
Because of the high frequency of training the squat, volume will typically be conservative, even during hypertrophy days to prevent premature burnout.
Will something like this actually work? We shall see, but as of yesterday, I started week 7 and 95% of my max moved like it was 80%. I’m only halfway through the program and haven’t even fully realized all of the gains.
On weeks that have 3 training days, I recommend training on Monday, Wednesday, Friday.
On weeks that have 4 training days, I recommend training Monday, Tuesday, Thursday, Friday OR Sunday, Monday, Wednesday, Friday.
Do NOT exceed the stated training intensities or volumes. Upper body work such as bench pressing and overhead pressing is addressed twice a week with limited volume designed to maintain upper body strength. Remember that when we add intensity and volume in one area of our training, we MUST decrease it from somewhere else.
Show me your habits, and I’ll show you your future.”
Or so the saying goes. It begs an urgent question:
Are your daily lifestyle habits giving you more life, leaving you stagnant, or are they slowly killing you?
You are the product of your daily habits. Your entire life is the result of the thousands of decisions you’ve made, but none more so than what you do everyday. These small changes to your lifestyle can help improve every aspect of your life.
1. Meditate
I’ve written quite a bit about the benefits of meditation, but here is the gist. Meditation will improve numerous aspects of your mental health including improving your dopamine balance, improving focus, decreasing anxiety, and improving impulse control.
Meditation is one of the only activities to “rewire” the brain that has a robust scientific basis. It has been shown to increase gray matter volume in the brain, helping with higher order decision making.
I use meditation in the mornings to get myself focused and help with getting my dopamine levels in order. Evidence suggests that meditating past 17 minutes will cause a gradual and positive increase in dopamine levels in the brain.
Here are some guidelines to get you started with meditation.
Find a quiet and comfortable place to lie down or sit. You can sit in a chair or on the floor.
Start with ten deep breaths, inhaling through your nose and exhaling through your mouth. Pay attention to each breath and follow each breath cycle from start to finish.
Let your breathing normalize and close your eyes.
Concentrate on your breathing. Each time your mind wanders off, gently bring it back to your breathing.
Start with about 5 minutes and gradually increase to 20-30 minutes.
The point is to exercise your brain’s ability to quiet down and focus on your breathing. In a world where we are constantly stimulated, it’s important to give our brains a chance to quiet down and rest.
2. Get the hell away from screens
Tech companies are experts at hijacking your attention away from what matters to you. If you are not careful, hours of your life will be stolen from you.
There is a simple reason for why we start to crave screens: our dopamine system. Dopamine is what motivates and pushes us towards certain goals and outcomes. In our evolutionary history, it’s what drove us to hunt and mate for the survival of our species. In modern times, it’s what motivates us towards advancing our careers and dreams.
The dark side of dopamine is that it will confuse things that give us pointless pleasure with things needed for survival. Hijacking the dopamine system is what leads to certain addictions and habits.
Scrolling through social media feeds is a low-effort, high pleasure activity that gives our brains an easy hit of dopamine. The problem is that there is no value to 95% of our daily screen time.
It’s already bad enough that precious time is lost through this screen time, but it’s effect on your brain is worse. It will make you less focused, more impulsive, anxious, and resistant to effort.
Don’t let the tech companies trick you. You don’t need your low-quality screen time to survive. Here are some tips to manage your screen addiction.
Delete all pointless apps on your phone.
Switch your phone screen to grayscale through the settings.
Read a real book.
Place your phone in a designated spot far away from where you normally hang out.
Explore what you are truly interested in. No one is passionate about scrolling through shitty content.
3. Find your purpose and pursue it everyday
Life is never made unbearable by circumstances, but only by lack of meaning and purpose.
Victor Frankl
A life without purpose is an empty life. Having purpose in your life is underrated and undervalued. There is almost nothing more important that feeling like your life has meaning and purpose.
In fact, it’s so important that people who feel like they have a purpose consistently live longer and lead healthier lives. One interesting study showed that simply giving an elder resident in a care home a plant to take care of improved quality of life.
Perhaps no one has demonstrated the importance of having purpose more than Victor Frankl, the father of logotherapy. Frankl lived through the horrors of the death camps during the holocaust and largely attributes his survival to his resolve of maintaining a purpose in life. He noted that those who still gave their lives meaning fared much better in the camps and in life. For more on Victor Frankl, give his book Man’s Search For Meaning a read. It should be required reading for everyone.
What is your purpose? What are you passionate about? This needs to be explored on a daily basis. Who do you value? What is the most important thing in your life? Once you have figured this out, you should pursue it everyday. Give everyday of your life some sort of purpose and meaning.
The meaning of life is to give it meaning.
Further Reading
Troels W Kjaer, Camilla Bertelsen, Paola Piccini, David Brooks, Jørgen Alving, Hans C Lou, Increased dopamine tone during meditation-induced change of consciousness, Cognitive Brain Research, Volume 13, Issue 2, 2002, Pages 255-259, ISSN 0926-6410, https://doi.org/10.1016/S0926-6410(01)00106-9.
Krishnakumar D, Hamblin MR, Lakshmanan S. Meditation and Yoga can Modulate Brain Mechanisms that affect Behavior and Anxiety-A Modern Scientific Perspective. Anc Sci. 2015;2(1):13-19. doi:10.14259/as.v2i1.171
Nakshine VS, Thute P, Khatib MN, Sarkar B. Increased Screen Time as a Cause of Declining Physical, Psychological Health, and Sleep Patterns: A Literary Review. Cureus. 2022;14(10):e30051. Published 2022 Oct 8. doi:10.7759/cureus.30051
I don’t know when it became the norm to do dozens of exercises each time you go to the gym. Back day has you doing 6 different variations of rows, leg day has you doing 8 kinds of lunges… What on earth is the point? Let’s take a moment to learn from minimalism. You don’t need to do that many different exercises.
You should only need 1-2 exercises per muscle group/plane of movement per workout.
“But that’s not enough! How am I going to get enough volume??”
It’s simple. You do more volume.
More sets, fewer exercises
Most people I know don’t necessarily want to do more. They don’t want thousands of exercises to sift through. They want to be shown a few things that will push them towards their goals.
Don’t get me wrong. Variation is good, but too much variation will derail progress and soften the focus of your training.
All of the evidence shows that total exercise volume is one of the most important factors for strength and muscle hypertrophy. This doesn’t mean you need to do dozens of different exercises and variations. Different studies will show that anything between 10 sets to 52 sets per muscle group per week will result in strength and hypertrophy gains. We will be aiming for the middle of that, around 10-20 sets per week per muscle group.
Taking the minimalist approach, you can just increase the number of sets per exercise. Focus on performing 1-2 big, compound movements per muscle group. For example, a great exercise for the upper back and lats is the seated cable row. Do 5-10 sets of 5-10 reps at a relatively heavy weight, control the tempo of each set, and see how pumped your back feels. You won’t be needing 5 more exercises for your lats and back.
Sample back/shoulders workout
Using this approach for a back and shoulders day, we can get a very well rounded workout.
Overhead Press: 6 sets x 5-8 reps
Seated Cable Row: 8 sets x 5-10 reps
Parallel Grip Pull Up: 6 sets x 5-10 reps
Dumbbell Lateral Raise: 5 sets 8-12 reps
My arms are shaking just typing out that workout. That gives you more than 10 sets per muscle group.
If you are the type to deadlift on back and shoulder day (even though it will fit better on a leg day or low back, glute, and hamstring day) here is how it can look like.
Deadlift: 5 sets x 5 reps
Dumbbell Overhead Press: 6 sets x 5-8 reps
Seated Cable Row: 8 sets x 5-10 reps
Parallel Grip Pull Up: 6 sets x 5-10 reps
If you do a chest/shoulders/arm day sometime later in the week, you can hit the shoulders a second time to supplement more volume with lateral raises.
Sample chest/arms/shoulders workout
Here is a sample chest/arms/shoulders workout.
Bench Press: 5-8 sets x 5-8 reps
Parallel Bar Dips: 5 sets x 5-10 reps
Lateral Raise: 5 sets x 8-12 reps
EZ Bar Curl: 5 sets x 8-12 reps
Note that I did a double whammy with the dips hitting the chest and triceps at the same time. If you are worried about the biceps not having enough weekly volume, keep in mind the biceps are heavily involved in rows and pull ups from the back workout.
Sample leg day workout
I usually split my leg days into 2 different workouts with one squat focused and one deadlift focused. Normally I perform about 5-6 exercises, but for the sake of taking the minimalist approach, we’re going to whittle that down.
Barbell Back Squat: 5 sets x 5-8 reps
Romanian Deadlift: 5 sets x 5-10 reps
Dumbbell Bulgarian Split Squat: 6 sets 5-10 reps
The deadlift focused workout performed later in the week will look like this:
Deadlift: 5 sets x 5 reps
Leg press: 6-8 sets x 5-10 reps
Good morning: 5 sets x 5-10 reps
The total sets for the quads is anywhere between 17-19 sets. The posterior chain will have about 15 focused sets but keep in mind the posterior chain is still working hard during normal squats.
Technical benefits of doing less
Most people shouldn’t be doing so many variations of exercises. Each exercise has its own technical challenges and it is impossible to get proficient at any exercise if you are doing too many.
When you cut down the total number of exercises that you are performing, you get a chance to hone in your technique on a few select exercises. When you are trying to learn a new skill, excessive variation will kill progress. Focusing on 1-2 variations at time will yield much greater gains in technical ability.
Do less to do more
One of the big lessons of minimalism is to have fewer things going on in your life so you don’t need to make so many decisions. By forcing yourself to pick just one or two exercises per muscle group, you spare yourself the headache of sifting through and choosing numerous exercises.
Plus, by doing fewer things, you can focus more of your time and energy on those few things. Instead of splitting your attention amongst 5 different exercises for your lats, you can focus on giving 100% of your effort on 1 or 2.
So as the cliche goes, less is more.
I just cringed at myself for saying that.
Further Reading
Schoenfeld BJ, Ogborn D, Krieger JW. Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. J Sports Sci. 2017;35(11):1073-1082. doi:10.1080/02640414.2016.1210197
ENES, ALYSSON1; DE SOUZA, EDUARDO O.2; SOUZA-JUNIOR, TÁCITO P.1. Effects of Different Weekly Set Progressions on Muscular Adaptations in Trained Males: Is There a Dose–Response Effect?. Medicine & Science in Sports & Exercise 56(3):p 553-563, March 2024. | DOI: 10.1249/MSS.0000000000003317
Baz-Valle E, Balsalobre-Fernández C, Alix-Fages C, Santos-Concejero J. A Systematic Review of The Effects of Different Resistance Training Volumes on Muscle Hypertrophy. J Hum Kinet. 2022;81:199-210. Published 2022 Feb 10. doi:10.2478/hukin-2022-0017
Being fit, strong, and healthy is hard work. You work hard at the gym, lift heavy, and run hard.
It would be such a shame to have the gains from all of that hard work robbed from you.
And you might be doing just that with these bad habits. Here are 3 things that could be killing your gains at the gym.
1. Not getting enough sleep
If there is anything that will almost immediately undo your hard work at the gym and completely sap your body of its performance, it’s sleep deprivation.
I’ve written at length about the benefits of a good night’s sleep and the detriments of sleep deprivation in previous posts, but it will always bear repeating. Literally every aspect of you health will get better or worse with sleep.
Sleep is the critical time that repairs, resets, and replenishes your entire body. Your brain literally cleans itself out during sleep. In fact, poor sleep quality has been linked to the incidence of Alzheimer’s disease and dementia later in life.
Your body secretes all of the necessary hormones to repair your muscles from your gym workouts. Sleep deprivation can give you the testosterone levels of someone ten years your senior. Not good!
If you have been neglecting your sleep and you generally feel tired, irritable, have difficulty concentrating, feel physical vulnerable or weak, fatigued, and unmotivated, it’s a critical time to focus on your sleeping habits. Here are some recommendations to get you started.
Go to bed and wake up at the same time everyday.
Get to bed by 10pm. The hours of sleep before midnight are more effective than the hours after.
Aim for 7-9 hours of sleep.
Make your room as quiet, dark, and cool as possible.
Shut off bright lights and screens at least 2 hours before bedtime.
Complete any intense exercise 3 hours before bedtime.
I once heard a trainer say that he doesn’t have any of his clients pay attention to nutrition. Unsurprisingly, he doesn’t train any high level athletes.
You cannot out-train a bad diet. Read that again.
Whether you are trying to lose weight or gain muscle, you cannot sustain an intense training program without paying some mind to your nutrition. If you are not supplying your body with the right caloric balance and nutrients for your goals, then you will never reach them.
Attaining a certain body composition, losing fat, or gaining muscle are all simple games in thermodynamics. If you are not paying attention to your caloric balance (caloric deficit for fat loss, caloric surplus for muscle gain), then you are relying on chance to take the reigns of your progress.
If you are not supplying your body with the right macronutrients, then you are putting your body under unnecessary stress to make certain metabolic processes happen. Protein synthesis cannot happen in the absence of adequate protein intake and certain amino acids.
If you are trying to get jacked and you aren’t giving your body the right supplies to make it happen, it won’t happen.
Here are two very simple guidelines to get you in the right direction.
Figure out how many calories you tend to eat during a typical day of eating. You don’t need to meticulously track every meal for the rest of your life. Use an app like My Fitness Pal to track your meals for about a week then make the big, obvious changes to your nutrition.
Prioritize your protein intake. Whether you are trying to lose fat or build muscle, optimizing your protein intake will only have positive effects. In order for muscle protein synthesis to occur, you need to consume about 30 grams of protein for the protein synthesis switch to turn on.
3. The weights you’re lifting aren’t heavy enough
The human body is an incredibly adaptable organism that will change in response to certain stresses. The problem is that those stressors need to cross a certain threshold of intensity in order to force that adaptation.
Strength training is an incredible form of exercise that will improve strength (duh), increase muscle mass, burn fat, improve bone density, and make the entire body more resilient, but most people don’t lift weights at the appropriate intensity.
It takes hard work to get strong. If you aren’t straining or feel like you did some heavy work, then you may need to push the intensity a little bit more. You should have to concentrate on maintaining tension throughout your body during each set. It should be challenging to maintain your technique.
Remember that the aim of strength training is to lift progressively heavier weights over time. Here are some guidelines to keep you on track:
Focus on gradual progress, even if it’s just 5 pounds heavier or lifting for one extra rep. Over time, those 5 pound increases will become 15, 20, even 50 pounds.
Maintain tension throughout the body. Grip the bar as hard as possible, brace the abs, squeeze the glutes, and control the range of motion throughout the entire movement. This is going to be more important as you lift heavier and heavier weights. You can’t lift 400 pounds of the squat while being loose and unstable.
Get mentally tough. Most people have never actually pushed themselves close to their limit.
Take that sh*t back
Looking back on my own journey of strength and fitness, I wish I can go back in time and slap my past self silly for these habits. I think of where I could potentially be if I didn’t make these stupid mistakes. How much stronger would I be? Would I have won that race against my friend to a 315 pound bench press? Would I be… jacked-er??
I get really mad about the gains I robbed of myself. So stop shooting yourself in the foot and quite these bad habits.
She struggled to stand up from her chair. Once on my exam table, it took all of her strength to roll from her side to her stomach. She needed help to return back to her side, then back to a sitting position. During our initial chat, she informed me that she fell a few nights ago next to her bed and couldn’t pull herself back up. She had to wait on the floor until morning when her son in law heard her calling for help.
Her diagnosis? Nothing in particular. I was initially called a few weeks prior to help with her low back pain, which we had resolved, and now I was asked to help with balance and strengthening.
An endless number of pathologies and problems can plague our elder years, but none more commonly degrades day to day living of the elderly as fragility and weakness.
Sarcopenia and Fall Risk
Sarcopenia is age-related loss of muscle mass (sarco: muscle, penia: little) that can start in our 40s. By the time we are 80, we can potentially have lost 50% of our muscle mass. It’s a much bigger problem than we think.
Age-related frailty cause elderly individuals to be less steady, unbalanced, and unconfident in their ability to go out and navigate the world. It can cause people to fall more often. Secondary issues to sarcopenia often can include osteoporosis, metabolic syndrome, sleep disruptions, and greater chances of all-cause mortality.
Add on a sedentary lifestyle that often leads to sarcopenia, and you may end up with sarcopenic obesity, characterized by high body fat percentages combined with low levels of muscle mass. The result is an individual who has an even harder time moving because of the extra weight on their frame.
All of this creates the perfect storm of difficulty standing up from a chair (or the floor, god forbid if they fall), difficulty navigating stairs, recovering from a stumble, and an increased risk of falling. Sarcopenia is a known major contributor to falling, and falling can cause serious medical complications.
So what do we do? If sarcopenia is the culprit and root cause of many of these problems, we must aim to slow or reverse this process.
The Squat/Sit to Stand
If there is one exercise I can prescribe for the above patient vignette, it is the squat or sit to stand. It is the exercise that addresses as many problems as possible with a single movement.
The gut reaction may be to overhaul this individual’s entire lifestyle, but we know that drastic changes are not sustainable unless they are on board. Most people will not be agreeable to a full lifestyle change.
Tests that involve the sit to stand have been shown to effectively measure global muscle strength of the legs, hips, and trunk. It is almost the perfect exercise.
The sit to stand is excellent because it is simple and easily scalable. If it gets too easy, you either hold a weight in your hands or progress to staggered stance, single leg, or free standing squat variations.
Sit to Stand Technique
To perform the sit to stand, sit in a chair where your knees are bent to at least 90 degrees. Scoot towards the front of the chair and bring your heels back behind the knees. Lean forward, and stand upwards by pushing your feet straight into the floor. Preferably, your hands should be held in front of you for balance or crossed in front of your chest.
Scoot forward, heels back, lean forward. Stand straight up.
The most common mistake with the sit to stand is sitting too far back and having the heels too far forward. This will cause you to swing your torso forward, using momentum to stand. The sit to stand should purely be a vertical movement, not a forward movement.
Sitting back too far in the chair will cause you to use momentum or fall back into the chair.
If the basic sit to stand is too difficult, sit on top of a pillow or use a taller chair to decrease the range of motion. Once you are able to perform at least 3 sets of 10 repetitions, decrease the height of the chair.
Progressing the Sit to Stand
There are numerous ways to progress the sit to stand. My preferred way is to have the individual hold a weight close to their chest like a goblet squat.
Holding a weight to your chest is an excellent way to progress the sit to stand.
Another way is to stagger the stance, effectively turning the exercise into a 1.5 legged sit to stand.
Put one foot forward, turning the sit to stand into a 1.5 legged exercise.
The natural progression from here is a single legged sit to stand.
Lift one foot off the floor and stand.
From here, you can progress to the free standing squat
The Squat Technique
Stand with a shoulder-width stance. Apply a slight external rotation force through the feet (as if you are trying to rotate your feet outwards but don’t let your feet actually move). This will engage the glute (buttock) musculature. Initiate the movement by pushing your hips slightly back, bend through the knees, and squat down over your feet. You will likely be leaning forward to some degree. If you have long legs, you will probably be leaning forward to a greater degree. This is fine.
Maintaining the external rotation force through your legs, push yourself back up into the starting position. Note that if you have uninjured knees, it is perfectly safe to allow your knees to travel past your toes.
The squat technique.
Battle Frailty
Ideally, the sit to stand or squat will be a part of a larger, more comprehensive strength program. However, we already know that large changes to a lifestyle unfamiliar with exercise are unsustainable.
Most of my patients don’t want dozens of exercises to choose from. They want to be shown a few things they can do to maintain their strength and balance. The sit to stand or squat is almost always one of them.
Following the inclusion of this exercise, every single one of my patients and clients score better in strength and functional testing. They also report being able to walk faster, having better balance, navigating stairs easier, and being more confident in their day to day movements.
It is no coincidence that people from certain areas of the world live longer. Individuals from Okinawa, Japan, historically have always sat on the floor. As a result, they need to perform a full range squat numerous times a day. These people regularly live past 90 and 100, all the while staying active and mobile.
Studies have shown that strength training alone decreases all-cause mortality. One specific study showed that grip strength is a reliable predictor of longevity. The problem of elderly frailty is huge, and strength training is the main weapon that we must utilize to combat it.
As the population grows older each year, this problem is only going to get worse. We can start by just doing one exercise.
Further Reading
Porto JM, Peres-Ueno MJ, de Matos Brunelli Braghin R, Scudilio GM, de Abreu DCC. Diagnostic accuracy of the five times stand-to-sit test for the screening of global muscle weakness in community-dwelling older women. Exp Gerontol. 2023;171:112027. doi:10.1016/j.exger.2022.112027 https://www.sciencedirect.com/science/article/pii/S0531556522003369
López-Bueno R, Andersen LL, Koyanagi A, et al. Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: A systematic review with dose-response meta-analysis. Ageing Res Rev. 2022;82:101778. doi:10.1016/j.arr.2022.101778 https://www.sciencedirect.com/science/article/pii/S1568163722002203?via%3Dihub
García-Hermoso A, Cavero-Redondo I, Ramírez-Vélez R, et al. Muscular Strength as a Predictor of All-Cause Mortality in an Apparently Healthy Population: A Systematic Review and Meta-Analysis of Data From Approximately 2 Million Men and Women. Arch Phys Med Rehabil. 2018;99(10):2100-2113.e5. doi:10.1016/j.apmr.2018.01.008 https://pubmed.ncbi.nlm.nih.gov/29425700/
My wife and I often let friends and budding gym goers lift with us. I don’t mind. I enjoy having a good community of lifters and I love teaching others about lifting. One friend got into lifting about a year ago and loves it. He is still a relative novice but you can’t beat his enthusiasm.
He tends to come over on leg days. He’s obsessed with the squat.
“I hit 295 on the squat a two days ago. I’m going to try and hit that again today,” he said.
Are you living, staying stagnant, or dying? Before you answer, take a hard look at your daily habits. If you want to see your future, you can disregard your beliefs, values, and pointless platitudes you recite to sound deep. If you want to see your future, look at your habits. Does your day to day give you more life, or does it suck away at your life? It’s true that how you do anything is how you do everything.
What if you changed a few things in your daily life that pushes you towards your goals a little bit each day? Simple things can make drastic improvements to your health and outlook on life. Here are 3 high-impact lifestyle habits that will give you new life.
1. Sweat, train hard, & lift weights
“No man has the right to be an amateur in the matter of physical training. It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable.”
Socrates
There is no argument about the evidence. Physical activity is essential for optimal health. Poor fitness and strength will plague your elder years if you don’t address them early. Exercise, particularly intense strength training, will improve the health of your musculoskeletal system, joints, and essentially every organ system.
But let’s set aside the “scientific” benefits for now. How will it affect your day to day life?
Regularly exercising at high intensities will give you more energy. It will make everything feel easier. It will teach you discipline.
Intense physical training will show you what your body is capable of. We often never learn what our body’s full potential is. How strong can you get? How fast can you really run? What are you actually capable of achieving if you learn to stick with an exercise program?
How long can you play with your kids? 5 minutes? 30? 60? What about for the next 10 years? How happy and full of life and energy can you really get?
These are things we often value but completely neglect when it comes to taking action. It’s hard to fully embrace living when it takes multiple attempts to stand up from a chair or having to sit out from running around with your kids, and it’s scary how quickly these situations creep up on us.
Get outside. Run hard. Jump. Lift heavy weights. Learn to live.
2. Eat good quality food
Recent inflation numbers aside, we are fortunate to live in a time when we have abundant and affordable access to good food. Even the run-of-the-mill, non-organic foods that Hacky-sack John scoffs at is miles better than what was regularly available a couple hundred years ago.
Unfortunately, with the boom in the food industry came a boom in highly processed foods.
These foods have much of their nutritional value stripped away in favor of texture and flavor.
I won’t lie. I love me good bowl of cereal, some chips, or chicken finger from time to time, but we need to exercise caution so these foods don’t make up the vast majority of our nutritional intake. It is easy to consume an excessive amount of calories and it’s hard to get the right combination of macro and micronutrients from these highly processed foods. What is more, we tend to lose a lot of food variety when eating a high volume of processed foods.
We tend to fare better when we eat a large variety of real, whole, and unprocessed foods. An easy way to add more variety is substituting certain portions of your current meals with items such as sweet potatoes, rice, salads (the possibilities with salads are endless), fruits, vegetables, good meats, and fish.
All of that being said, remember that the most important tenet of changing your body composition is still caloric balance.
3. Sleep well. Really well
Everything will get better or worse with sleep. When you sleep better, literally everything about your health improves.
Sleep impacts every system in the body. Disruptions to sleep can severely impact cognitive abilities, hormonal profile, emotional regulation, and physical performance. For gym rats, sleep deprivation will destroy your recovery and degrade your gym performance. Some studies cite a 20% reduction in cardiovascular capacity following a night of poor sleep.
If you neglect your sleep, no amount of bandaid interventions during the waking hours will reverse the damage done. There is no exercise program, nutrition plan, or supplement that will fix a lack of sleep.
Just go to bed on time. Here are some guidelines to get you started.
Go to bed before 11pm. The profile of sleep changes with different bed times, and tend to get worse with later bed times.
Make your bedroom as dark as possible. Cover bright LEDs with foil and tape. Use a sleep mask.
Make your bedroom as cool as your can tolerate.
Make your bedroom as quiet as possible. Use earplugs if needed. I recommend Mack’s Ultra Soft Earplugs.
Try and keep your bedroom for sleeping only. Keep work material and bright screens out if possible.
Go to bed and wake up at the same time everyday.
Try and get 7-9 hours of sleep every night.
You will be pleasantly surprised at how much better everything becomes when you regularly sleep well.
Give yourself new life
A better life is only a few habits away. Think about how different things can potentially be if you spend a little bit of time everyday to move towards your goals. Where can you be in a week? Month? Year?
If you want to see your future, just take a look at your daily habits and the group of friends you hang out with.
The Barbell Prescription: Strength Training for Life After 40 This book outlines a solution to a pervasive problem of aging: fragility brought on by the loss of strength and muscle mass. Lifting weights and strength training is for everyone. If you are a budding trainer or clinician, this should be required reading.
Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults. JAMA Psychiatry. 2017;74(10):1039-1045. doi:10.1001/jamapsychiatry.2017.2145 Correlation is not causation. However, we know that older adults who have a sense of purpose in their life tend to live longer and happier lives. This study explores whether having a sense of purpose in life is associated with improved physical function.
Effect of Weighted Exercises on Bone Mineral Density in Post Menopausal Women A Systematic Review Zehnacker, Carol Hamilton PT, DPT, MS1; Bemis-Dougherty, Anita PT, DPT, MAS2. Effect of Weighted Exercises on Bone Mineral Density in Post Menopausal Women A Systematic Review. Journal of Geriatric Physical Therapy 30(2):p 79-88, August 2007. More research is needed, but there is good hope for those who have osteoporosis or osteopenia. There is evidence to suggest that heavy weight training exercises can increase bone density in post menopausal women.
Being Mortal: Medicine and What Matters in the End What matters in the end? Medicine has performed miracles in improving and extending life, but even the experts often do not know how to talk about the end. Being Mortal explores the successes and failures of medicine in managing end of life matters. Perhaps the ultimate goal is not unnecessarily push away death, but to ensure that we live a good life until the very end.
