Q&A: Cholesterol Lowering, Volume vs. Intensity For Hypertrophy Volume, Zone 2 Efficiency, and More

0:28Welcome back to the Barbell Medicine Podcast. All right, that's it for the pitch. On to the show.

0:38Party Pats, what's your question, caller? What is your favorite cholesterol-reducing medication for the Gen Pop? Should I try to get the crazy monoclonal antibody that blocks the LDL receptor reuptake protein? No, so you're talking about a PCSK9 inhibitor, although the study just came out, I believe it was last week, where it showed that a PCSK9 inhibitor was good for primary prevention in heart disease. It basically means if you've never had a heart attack, it actually prevents people from having a heart attack or those major adverse cardiac events due to how powerful it is and the large magnitude of cholesterol lowering from that.

1:19That said, most people would do fine with a statin. It's very cheap, easy to get. Now, if the question is, do you need it, depends on your risk. And so, yeah, there's a lot to that. We've published a lot on cholesterol lowering. And so just briefly, when you think about cholesterol and its risk towards heart disease, in this case, the risk is proportional to the exposure. Basically, that means the higher your atherogenic load and the longer you've been exposed to it, the more risk you're going to get from cholesterol. And actually, in this case, the lipoproteins that carry the cholesterol around the body.

2:02And specifically, we're talking about things like LDL, triglycerides, and anything that has an apolipoprotein B on it. That's your atherogenic load. And so the higher, the more particles that you have, so the higher the count. And the longer you're exposed to that without any sort of mitigation, the worse it is. And it seems like the lower it goes, the better. And we're talking about lowering levels down to neonate levels. So I don't know what your levels are, and this is not medical advice. This is edutainment, but lower is better. And people will invariably say, no, look at this study. It's an observational study.

2:37It shows that people with lower cholesterol levels tend to, there's more mortality there. They die sooner. And that is because there are medical conditions that actually, by virtue of that medical condition, cause low cholesterol. Like cancers, for example, will tend to cause a lowering of cholesterol levels. But when we see people who have genetic mutations that actually keeps their cholesterol levels low for their lifetime, they have the lowest risk of heart disease, period. So lower is better. Whether or not you need a medication, that's something you should take up with your physician. I don't think starting with the PCSK9 inhibitor is what I would do.

3:17I'd probably favor a statin plus or minus azetamide if someone needs it or something like that. But yeah, some people would benefit from a PCSK9 inhibitor as well. David Rodriguez, 168. Hey, Doc, why are a lot of fitness influencers like... I think that was an autocorrect. Advocating for very low volume training to failure. is this trend because high intensity is greater than hypertrophy? I think what this question is getting at is, is higher intensity more productive than higher volume training for hypertrophy? And I would just say simply, no, that's not really the case. Both factors are related.

4:01And so I think about this as almost like a functional threshold. For hypertrophy training, for example, there is no like minimum intensity meaning that you could theoretically train with like as low as 30 percent of your one rep max or as heavy as you know 90 percent 85 percent of your one rep max um so really anything between like three and twenty three and twenty five three and thirty reps if you're doing you know blood flow restriction stuff uh at the at that high end the point is you have to get somewhere in your failure right and we're talking at least you know four or five reps left before you would you would get to task failure and so at that point if once you're at that threshold then the relationship that you see between training and hypertrophy is a dose dependent relationship between volume the higher the volume is generally the more hypertrophy people get provided that they can tolerate it and usually there's like an on-ramp where people are sort of getting used to it or accommodating towards the training load and then and they start growing.

5:02Or at least we can actually pick up the muscle growth a few weeks in. So like week three, week four, that's when you can kind of detect it. Some of that's due to the testing issue, like how do you actually just measure very small, minute amounts of hypertrophy. But, yeah, that's kind of what happens. Now, once you get north of, you know, it's definitively high volume. And admittedly, there's no consensus on what is low volume, what is moderate volume, what is high volume. We're all just kind of making it up. But when you think about doing more than, let's say, 15 sets per week, 20 sets per week certainly would qualify.

5:38At that point, the volume lever has been kind of pulled, right? It's been pulled. And for hypertrophy at that point, then intensity is the other lever that you'd want to pull. And so taking more of those sets closer to failure would probably get you more hypertrophy than adding more volume. So that's the thing there. But advising people to do low volume intensity or low volume training to failure to be being superior to higher volume training at that functional threshold, that is not consistent with the research. So it's an option, just not like an optimal one. And, you know, generally speaking, when I'm thinking about programming, I want people to do as much training as possible.

6:24Right. And the two biggest bottlenecks are time. And then their physiological tolerance. So logistical tolerance, time mostly, and then physiological tolerance. How much can they recover from? More training, generally speaking, more training load specifically generates more fitness adaptations, more health adaptations, and so on and so forth. So doing less than that can work, but you're leaving gains on the table. Chris Ansari, what is the ideal way to regulate volume? adjust based on if I'm seeing progressive overload or not? Yeah, there's a lot to unpack here. So regulating volume insinuates that there's some sort of dynamic adjustment that needs to be made throughout a microcycle, so like one week of training, or a mesocycle, so like a training block.

7:18And I don't know that that has to happen. There are ways to do that. so for example i could prescribe a workup to a set of five reps on the squat at rp7 and then do three more back off sets but terminate the set once you hit rp6 and so on a good day you're going to do more reps more volume than on a day where your performance is down that's one way to regulate volume i like doing that if somebody's training resources and recovery resources are more dynamic That said, the total volume doesn't actually change that much. And a person who's going to like a powerlifting meet, for example, and who presumably has a lot of resources to train, sometimes I worry that we're not getting enough training volume in.

8:05And so in that case, I would do an alternative prescription, five reps at RP7, then do 20 total more reps. No set is higher than RP7. Adjust the reps per set to meet that RPE cap. so that's how i would do it like within a micro cycle or a mesocycle over the course of like a training year or training career volume is one of the biggest levers that we can pull to sort of manage training load because over time you're going to need more training load to match your new level of fitness provided it's going up but if your fitness level is going down then you'll need less training load sometimes that happens various things that come up in life and so how do you know when you need to increase training load.

8:47And I think the main things that you need to focus on is one, am I still making progress or not? If you are making progress, it's really challenging for me to want to recommend a change, period, any change. So carry on. We're assuming that that improvement in progress is real and not an artifact. And so what I mean by that is, you know, day to day, your performance, my performance, everybody on this, you know, Instagram live, their performance oscillates, It ebbs and flows. It goes up and down within some non-zero percentage range. There's a ceiling and a floor, right? And I think based on the data right now that we have, it's probably somewhere between plus 5 % and minus 5%.

9:29That's your kind of normal range. And so I would expect people over a three-week, four-week, more weeks period, if the program's working for them, their strengths should trend up above that sort of ceiling. So if anything greater than a 5 % gain in strength, I tend to think is real, just like anything more than a 5 % loss in strength that persists more than one session, I believe that is likely to be real. So we can call that our minimal clinically important difference in strength because anything less than that I think is mostly artifact, right? So if someone is seeing progress, I'm probably not changing the training.

10:06If over four weeks, five weeks, six weeks, they're not really seeing progress, then I start wondering, okay, are they overdone? Are they overcooked, right? Are we cooked chat? Or are they not generating enough training stress from their current training load? And so you think about how are they sleeping? How's their motivation? Any injuries? Things of that nature. Do they feel fatigued? Do they sore all the time? and so you kind of got to weave your way through this little bit of the art of programming and it's an educated guess based on that sort of information um and so if you think the person is doing well with the training they're ready most of their sessions you know session rp four five something low they're not really sore they're sleeping well they're highly motivated to train no real injuries to speak of their environment is resource rich they're ready to go they probably could use more training load and volume is one way to increase that if on the other hand they're super sore very fatigued tired not motivated burnout whatever it's like maybe the training load is actually too high we got to dial it down um so that and that is how i would you know you can use volume to adjust that that's one parameter of many right including intensity proximity to failure exercise selection there's a lot of different changes here and so in the new low fatigue template, the second generation, I got a few pages on kind of how I think about this.

11:30That was maybe what a few minutes. But yeah, there's more in that ebook that accompanies those programs. And you can see how that actually shakes out in a real program. So I would reference that. If you have more questions on this, this podcast is brought to you by Biggs. At Barbell Medicine, we spend a lot of time talking about what it takes to build a body that can handle high-level performance, but the recovery in the health side is just as critical. Over the last six years, an incredible team of healthcare professionals did something that most people thought was impossible. They helped rebuild the body of legendary Olympian Lindsey Vonn after a series of devastating injuries.

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15:16Yeah, this is a great question. We have a podcast that I did on Pilates, reviewing the evidence on it and its history and whatever. It is not good for virtually anything that people do exercise for. And what I mean by that, if you think about resistance training, what is the purpose of resistance training? Well, we want improved muscle quality, muscle function, increases the muscle mass, so strength, hypertrophy, power, bone mineral density, right? So all of these sort of we're applying resistance training to the human body to get all of these outcomes. Pilates is not good for that. It's not good for strength, not good for hypertrophy, not good for bone mineral density because it doesn't load the skeleton enough.

16:01It's not good for that. It's not good for generating cardiorespiratory fitness either. And so I view it as an accoutrement. If somebody is meeting or exceeding, ideally exceeding the current physical activity guidelines, and they want to do Pilates on top of that, that's fine. It's mostly like something that they enjoy doing. It's kind of like any other recreational activity. That's how I view Pilates. It's not a training modality. It's like recreation, which is fine. If somebody is asking me, look, if I did Pilates instead of doing more training, which is likely to get me better results, and by results they mean muscle mass, muscle strength, bone mineral density, muscle power, balance, coordination, whatever, related to producing force in a coordinated manner, well, it's not very good.

16:48It's not. It doesn't mean Pilates is bad. It's just it's good at getting better at Pilates. That's it. And it's great physical activity. Um, just like anything else. So yeah, I view it as an accoutrement. Um, but I don't, uh, I don't recommend it to replace, um, real exercise. And that's maybe the most shade I'll throw at Pilates. I don't, I think it's fine. I've done Pilates before. Yes, it can be hard. There are a lot of hard things that people can do that don't really contribute to fitness. Um, Pilates is, is one of them at this time. Um, but yeah, certainly better than no activity, just not enough to qualify as strength training, not enough to improve muscle mass, not enough to improve cardio respiratory fitness.

17:33Yeah, just recreation. Daniel Sarp, is zone two cardio really that amazing for cardio respiratory fitness and health? Simple answer, no. Longer answer, it could be. The thing is this, if someone is advertising zone two is like this panacea that you should only do your cardio zone two because it has the most robust effect on health we would need some better evidence to show that to be the case and in fact a recent data a recent study came out showing that higher intensity than zone two would be is more efficient at improving health than moderate intensity so they found the vigorous physical activity you know depending on the health condition or medical condition that you're assessing risk on, vigorous intensity physical activity was, you know, four times, five times, nine times as effective as moderate intensity physical activity, which zone two would fall into.

18:35It doesn't mean that zone two is bad. Zone two can be very good. And so it can be useful when people are doing high volumes of conditioning. And what I mean by that is like, they're doing way more than the current physical activity guidelines, which is at least 150 minutes per week of moderate to vigorous physical activity. And so if somebody is not doing, you know, a couple, you know, three hours, four hours, five hours of cardio per week, endurance training per week, then I don't think it matters if they're doing a bunch of zone two stuff. I think it can be useful to work up the training load, the training volume, because it's not very fatiguing.

19:10So you can do more of it, but I still would expose people generally to some higher intensity work. You know, 80-20 is the traditional rule. 80 % should be low and slow, moderate intensity. 20 % would be a higher intensity, but that's only for people that are doing a lot of cardio work. If someone's only doing 60 minutes, 90 minutes, two hours, 120 minutes per week, I don't think it matters. This doesn't mean I would do only sprints, but I think more vigorous activity. So it's zone three, zone four. Yeah, it's all fine. But if we're directly comparing three hours per week of zone two versus three hours of zone three, I don't think there's a difference in outcomes.

19:46Three hours of zone two versus three hours of zone four, I don't think there's a difference. That's probably too much of the higher intensity work for some folks just to tolerate.

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20:28Thanks for listening. We'll catch you next time.

20:35Woo!