210. How to Build a Training Week You'll Actually Repeat (Training Series, Part 1)

0:00 Welcome to Medicine Redefined. I'm Dr. Ultima Sharajah. And I'm Dr. Darsha. Let's put the hell back in healthcare. Most people who train consistently can tell you what they did in the gym today, but far fewer can tell you what their week is designed to build. And that gap matters. It's easy to gravitate toward the training we enjoy, whether that is lifting, running, or a class that we never want to miss, and to assume that it's covering all of your bases. But often it doesn't. Meanwhile, much of the conversation about fitness focuses on details such as how close to failure to train or which program you must follow for optimal gains before the basic structure of the week's in place.

0:47 This episode begins a five-part series on how to program your training with one goal, a practical framework for deciding what belongs in your week. So over the next five weeks, Darsh and I will cover the training week as a whole, then strength, cardio, speed and power, and lastly, mobility and stability. In this first episode, we outlined four training qualities, three questions to ask before writing a program, and a sample week for people who already train, along with how to adjust it when life gets in the way. Darsh discusses his preparation for High Rocks, and I share how I've adopted my own training around surgeries and joint limitations.

1:27 Welcome. If you're a high performer who wants a clear plan for longevity, performance, and staying active with fewer setbacks, and you want to work with me directly, you can book at refininghelprx.com. All right, let's jump in. Darshan Shah, what is up? Not much, man. How you doing? I'm excited. I'm excited. I'm actually... A lot of our conversations recently have been about the concern for AI. And I'm actually tempted not to talk about this because I just read Cal Newport's newsletter about how another anthropic engineer resigned and how they're going to kill millions. I didn't read the newsletter, but I did see the headline come out at least. Got it. Well, as tempted as we are, we're not going to talk about that.

2:08 We have an agenda, we're going to stick to it. And it's a tall task asked to us by a listener and a colleague, and I respect him a lot. And I thought that this would be a good way for us to touch on this systematically. And so a listener has asked us to cover our approach to training and inquired more about what they meant by that. They wanted us to cover endurance, mobility, aerobic capacity, speed, and running in general. And That sounds like a lot, of course, and I was overwhelmed. But really, as I thought about it, I realized it's really one question. It says, what belongs in my week, maybe a comprehensive week? And how do I make all these things fit? Right? Where this... Most of us are maximizers and shifting to be satisfizers.

2:52 And I think that the timing is actually quite good for this question because this spring, the American College of Sports Medicine published its first major update to the resistance training guidelines since 2009. So it's 17 years in the making. And it's one of the clearest messages. That's going to bother some people, especially those who are influencers of social media, and this is where they make their money. So today, maybe we'll start off with talking about what that paper says and what are the four qualities and questions to ask before you write your week. And we get to even touch on what your current program looks like, what my current program looks like, how do we build it, how do we think about changing it? What are some of the guardrails we built on when the program breaks, not if, when it breaks?

3:35 And so this is going to be episode one of five, we thought. And we'll build on some of those core components of a comprehensive training program. And what do you think about that? Sounds great, man. I think this is going to be super, super valuable, not only for listeners, but also for myself. I mean, I'm also a trainee junkie, but I don't have the qualifications you do when it comes to kind of how you learned about this throughout your career. So I learned from you and I'm sure the guests are as well. I appreciate the guests or the listeners. Yeah, maybe guests. But I think that what we could also do is we could maybe shout out some fitness professionals that have either been guests on here or the ones that we like to extract some of this knowledge from. Because again, yes, I have a background in this and I do enjoy doing this a lot.

4:20 I use exercise as medicine all the time. But there are people who have, again, domain level expertise much deeper than I do refer to from time to time. First, let's talk about this ACSM paper. For those who don't know, the American College of Sports Medicine is probably the most important parent academy when it comes to bridging the gap between rehab and performance, something both you and I are passionate about, right? And it does put out positional guidelines for both medical literature as well as true training But if you are more in the performance-based aspect, you might look at the NSCA or something with respect to that. But I think ACSM does a pretty good job. And so it publishes Position to Stand. This is the first major update, as I mentioned, in the last 17 years. And it's not just a panel of experts giving opinions.

5:00 This is an umbrella review. So what that means, it's a systematic review of other systematic reviews, right? And so it's 137 of them, mostly built on randomized controlled trials in healthy adults. And the big finding was that... It's not that details don't matter. It's that we tend to persevere the details too much, right? And so the big finding is that the resistance training itself reliably improves strength, muscle, power, gait speed, balance, and how fast you can get out of a chair compared to not doing it. Shocker. Any exercise is better than no exercise, right? But everything else is actually second order. And that's, I think, the main headline for most people.

5:41 That being said, I think people who are probably listening to this and this colleague of ours who had the question, they want more than that. So let's get into the second order stuff. So this is where people have been arguing for 20 plus years. They still do this more than ever. And so for most people, training every set to failure they looked at, choosing machines over free weights or running on complex periodization schemes doesn't consistently produce better outcomes. Yeah. which I know is going to be sour for some people to taste because that's exactly where the sexy stuff on social media tends to sell. So let me take those one at a time. So training to failure is the first one. As the paper says momentary muscular fatigue, that's how they describe it.

6:24 It's no consistent added benefit for strength or size compared with stopping a couple of reps short. So that's the big one, right? There's a whole culture built around grinding out every last rep. A couple of people that I do follow, that I do respect, they're talking about high intensity programs. And whether it's low volume or high volume, taking reps or sets to failure is going to allow us to maybe make more efficient gains, right? Efficiency is something that we really find interesting. And so the next one is machine versus free weights. I don't find this to be as much of an argument, but I think in the era of functional training back in the day, I guess even High Rocks, is it the one that you brought to my attention, right?

7:08 This might be another thing that people are getting into debates, but neither one, according to this paper, was constantly better for strength. or for muscle size. And they said the evidence wasn't good enough to call it between the two. So what does that say? To me, it says pick whichever lets you train safely, add weight and progressively over time and continue showing up. I think that's going to be ultimately the thing that I'm going to reinforce that I continue reinforcing is when you have such variability in the literature, We want to pick the implement or the tool that's going to allow us to reliably show up over time. Consistency is going to beat anything over just decades of training time. And then periodization, right? This is something that I really value.

7:49 I know you do as well. We've talked about this here and there offline and online. But what this is, for those who don't know, it's a fancy word for planning your training in phases, right? Both micro phases and macro phases. What turns out, again, it didn't really improve muscle size. And for strength and power, the evidence wasn't sufficient enough to decide either way. So it's really equivocal. And so the honest line is it's not required for most people. I'm not saying that it doesn't work. It's just that it's not required, right? And so those are some of the differences. Any questions on that before I continue to do it? Do you want to talk a little bit about RPE? Because I think that's something that I'm seeing more and more a lot of fitness influencers talk about, but I'm not sure if the listeners may understand what that is.

8:30 Because when you say two reps before failing, I think a lot of people think they're actually at failure, but they're not really hitting that RPE of 10, maybe. Well, what you describe right now is RIR, reps and reserved. So let me see if you take a crack at it, and then let's see if I can add any value to that. I guess, what do you use? And then how would you describe it to somebody who didn't really understand? Sure. So I typically use RPE, rate of perceived exertion, right? So if I'm trying to hit, let's say... close to failure, but I want to go one to two reps right before failure. Then I'm hitting an RPE of eight to nine, which would also be a reps in reserve of one to two because I could have two left. I think what I see for most training plans, I think if people were to like follow Jeff Nippard or download some of these PDFs online or whoever they might buy from, I think they are typically going to see RPE.

9:18 which is your rate of perceived exertion, which is, again, that or IR are kind of inverses of each other. But anything I missed there, feel free. No, I think you nailed it. What I have found, and I think some of the coaches that I tend to... the work that I follow, will say that from a coaching perspective, RIR is a little bit better because the studies will also show it depends on where you are in your training journey. If you are a beginner or intermediate lifter, you constantly underestimate what your rate of perceived exertion and what that quote unquote failure actually is. So what they'll do is in these studies, they'll take beginners or an immediate lifter, then they'll say, I want you to go two reps shy of failure.

9:59 And then they'll get them to that point and they'll say, okay, now you got to push. And turns out that these people tend to have another five or six left actually in the tank. until true failure. So you really have to have a long enough training age to recognize what true failure truly is. So then RIR tends to be something that's a little bit more, is something that people can wrap their mind around a little bit better. Say, hey, could you have done two more reps? Could you have done three more reps? And it's like, no, I really felt like that. Again, that also isn't as accurate for beginners and intermediate lifters, but probably advanced lifters are much better. better when it comes to a true RPE and RIR. So I think that from a coaching perspective, people can wrap around their mind what RIR is. If you really look at it as inverse, then maybe you're really using both.

10:42 But yeah, I think you nailed it in terms of the explanation. So RPE, you're saying you're at 80% or eight or nine out of 10. I think people should understand that there are multiple ways that people use RPEs. What you're using on a scale of one or 10, RPE from The medical context, if you've done a Bruce protocol where you're actually doing either a VO2 max test or you're doing a stress test, it's going from 6 to 20. I don't know why it starts at 6, to be honest with you. Is it like some data logarithmic stuff? Like some weird thing. I think it's called the Borg scale. You could quickly... do a Google or chat GPT for us right here, perplexity maybe. But yeah, it starts at six to 20 and 20 is like the absolute mass exertion. You cannot sustain that for prolonged periods of time.

11:23 And so that's, they just point to it and you just, you point on the actual scale. Coming back to this ACM paper, right? So it sounds like a lot of what they said, it's nothing matters, nothing matters, just grind at the basics, do it over time. But I don't think that's really the message that I took away from it. I think the message that I take away from it, and I should say that, These studies really looked at those beginners and intermediate people. That's not you. That's not me. Probably isn't going to be a lot of people listening to this. And so I think ultimately what matters is really depends on the goal. And that's really where I like to start when somebody is talking about, hey, can you help me set up a training program or when I'm looking to set up a training program and I'm periodizing.

12:04 So if the goal is strength, then what they do talk about is that heavier loads, at least 80% of your run max, so this would be RP of eight, exactly how you said. at least two sessions a week through full range of motion, two to three sets, and putting the more important lifts that are going to be more neurologically taxing earlier in the session is the way to go. If the goal is muscle size, your total weekly volume matters, roughly 10 or more sets per muscle group per week. This is not a new concept. People like Mike Isertal and who else? I think Dan Goh. And a lot of these other performance coaches online have talked about this as 10 to 20 sets is where you want to be. Turns out that even less than that can matter depending on your intensity, but I digress.

12:50 The other interesting thing is the frequency on its own didn't act much more once volume was matched. So two to four days, really two days minimum is really what's okay as long as the total weekly volume is minimum 10 sets. Now, if your goal is power, which we're going to spend a whole episode on, that's going to be episode four, moderate lows, 30 to 70% of your one RM, one rep max, moved with intent, fast intent at low to moderate volume. And one thing, again, like I already talked about, right? This is not people new to lifting. And so if you've never really touched a barbell or you're just getting into it, the message is just start and don't overthink it. Right. What can you do consistently show up and just move some weight and you're going to be OK?

13:35 So that's the frame for this whole series is we want to focus on the basics. Simple things do matter as you get more advanced and you build more training age. Then you can start looking on or focusing on the specifics over time. Perfect. I got nothing to add to that. You got nothing? Nothing. I'm killing it. You got it. No, I love it. And I guess my question here for you would be is, what are your thoughts about the periodization piece? I know you and I have talked offline about it, but do you want maybe either share what your current thoughts on this is? Is that something you're looking at? I know you've been playing a lot of tennis. So is this a time for you to talk a little bit about what your training looks like?

14:16 Yeah, I think, so let me start with the periodization. I think I was doing a lot more of it prior, I would say in the past five to 10 years, definitely when I really started getting more into lifting, probably around 18 in college. Prior to that, where sports kept staying athletic and then really started hitting the weight room and then learning all the principles that we're talking about. At that point, periodization, I was really just learning from bodybuilding.com, Jim Stefani, just going through different training programs and realizing that, oh, these guys in a 12-week program are breaking it up into three, four-week phases, right? So one phase might be getting the muscles adjusted per se, right? And you're doing higher reps, let's say. Then the next week, you might do more like German volume training and you're doing a lot more sets with lower weight.

14:58 And then for that last phase, you might be doing drop sets and you're changing up the program. And I know back in the day, they used to say like P90X, you want to create quote unquote muscle confusion, which I think has now been debunked. But what periodization at least allows in the micro phases and macro phases is that it does give your muscle different mechanical tension, I guess, throughout. that 12 week. So within like those 12 weeks, I would even have different training. And then after those 12 weeks, let's say I was trying to put on a lot of muscle. Well, in the next 12 weeks, let's say I want to do more like kind of fat loss. So maybe the training stays the same, but I'm adding more cardio and I want to add and build my aerobic base. So I do that for another 12 weeks. And then I'm just based on what my goals were and how I wanted to look aesthetically or if I were trading for anything at that time, I really wasn't.

15:44 It's not until now that I'm doing High Rocks that I really have revamped the way I've been trading. So now since High Rocks is in about a month or six weeks, My training has really been all over the place because it's tough. I mean, now that we're in our 30s, I'm also thinking about, do I really want to train for something specific or do I want to train mainly for longevity and then add a little bit of sprinkling to that specific thing, which is now high rocks. So like you said, played a lot more tennis. High Rock specifically, I'm doing about two to three straight training sessions a week. I'll usually split that as a lower body, upper body, and then like a kettlebell workout. I'll play tennis once a week, maybe twice a week. And then I'll do a zone two run with recovery.

16:26 And then another day is like a High Rock simulation, which is more threshold training. So I'll pretty much do that until High Rocks. And then... Depending on how I feel, I might continue something similar to that. I'm expected to probably lose some muscle mass coming up to high rocks because the cardio is very important and that's something I need to build more on. So once high rocks is over, I'll probably cut back a little on the cardio, still continue with maybe some threshold training because, I mean, I just enjoy sprinting. I enjoy that kettlebell workout while getting that sweat heartbreak going up. But incorporate a little bit on maybe another day of strength training in the week. And that's more your zone five that you're describing right there. Correct. Yeah. Zone four, five for that threshold. Yeah.

17:06 No, I love that. Okay. I'm going to do mine, but I'm going to do it towards the very end. But that's actually really good. It's actually because you're touching on pretty much all of the important qualities that we want to see. So before I get into the four qualities and tee this up for people in terms of how we're going to break this down over the next couple of episodes, five episodes, including this one. I do want to caveat this because I think that I've emphasized that simplification is everything. I don't want to oversell simplify because I think sometimes people will say, listen, simplify means that I can just coast. And that's not what I'm saying, right? I'm saying you don't need to train to failure. You don't need to periodize, but that's not permission to coast. What it is that simplification is...

17:49 It's you have to stop treating complexity as the entry fee to not doing something. And that's the whole point. So if you've never done something, just go ahead and get in it and you're going to see benefits like the most gains, newbie gains, as they say, that's going to be amazing. You're going to feel great. And then as you get more advanced into your training, things get a little bit harder and you do have to complexity. That's where the quote unquote muscle confusion comes on. Right. But. Complexity isn't all of the program at that point. Complexity, you've earned it at that point. And that's one thing I want to say. The other one quick note on the evidence that we've talked about from this ACSM paper, because we're going to come back to this across the series when we talk about the different domains, is when the outcome is strength, muscle, or physical function, we often have randomized training trials that we can look at.

18:39 So you can put people in a room for 12 weeks, depending on the training level, whatever it might be, and you can measure it. You can put size, all that kind of stuff. When the outcome is mortality and morbidity, much of that evidence is coming from long term observational cohorts. In fact, that BJSM paper that we talked about, which turned out that tennis actually was probably the best thing for longevity, right? That was an observational cohort because you can't randomize people to 30 years of exercise, right? So both of these types of studies are useful. They're just answering different questions. And they're also carrying different kinds of uncertainty. We're going to plant this in your mind right now and we'll come back to it. So how long you live and what your body can do are different questions and different outcomes. I'm really passionate about that.

19:20 I've talked about the concept of having capacity. That's really what physiatry is. If you focus on function, we love that. And finding out about one doesn't automatically tell you about the other, but it is a strong enough signal. Anything to add to that as a fellow physiatrist here? No, man. I think he nailed it again. You're on fire. Awesome. Awesome. This is why you're here as my cheerleader. That's right. Um, So four qualities, right? So aerobic fitness, you've touched on that. Cardio, you refer to as that aerobic capacity. So what this buys you is the sustained effort, which you need for high rocks, right? And tolerating harder effort in real day to day, cause I want to give really tangible examples of what that might look like for people. This is the ability to walk up hills. If you want to go to Switzerland and you want to have a great time, the Alps, that's what that's going to look like.

20:02 This is the ability to take stairs in case the elevator is not working. This is being able to play longer with your kids. Strength, right? This is your ability to produce force and keeping muscle over time. What does that look like in real day to day? Carrying luggage when you're traveling, picking up your kids, carrying groceries inside, getting up from a low chair or even the toilet. power. So this is your ability to produce force quickly. What does that look like in real life? This is you might trip over something and you quickly catch yourself. So getting that foot underneath you, sometimes taking two stairs at a time. Maybe you're walking up to the elevator and it's about to close and you're going to run and try to catch it. or quickly sprinting through the terminal because you are missing flight, something that I'm doing pretty much all the time.

20:47 And then last but not least is mobility and stability. I don't want to say most important, but oftentimes people will say this is going to be the basis of everything. So this is range that you can reach and control that range at end ranges, right? So it's something that MagShake way back in the archives talked about this. In real life, this is being able to reach overhead, go for that shower head, reach for the cupboard, and go for that shower head. Stepping downstairs when you're descending, maybe walking down the porch, turning without wobbling and losing your balance and falling. And like all of this matters individually, but it's also important to know that one activity can train several of these. insert your kettlebell workout that you were talking about, right?

21:29 For instance, running trains aerobic fitness. It's training some power, but it's almost training no upper body strength. So if that one activity becomes your whole week, you've got a hole in your training. And that's not necessarily a moral failing, but it is important to audit your program to recognize where the gaps are and how do we fill that gap in. Any thoughts on that? Yeah, no, I think what's super important is what you nailed, how I think a lot of people gravitate towards what they love, which is awesome, right? Because that's like the head start, but the gaps is what's important. So like you said, those marathon runners, that's really big now, the run clubs. So a lot of people think, oh, because I'm getting my endurance and yeah, I'm building leg strength, I'm good for the week. But you're right. I mean, there's so many other things that I think people need to focus on too, that can only help them overall with their quality of life.

22:15 Yeah, no, I love it. And it's important to also acknowledge that sometimes that trade-off is worth making, right? If you are training for a marathon, then that makes sense. It's that short-term goal. Like you just said, you said, hey, listen, right now I'm going to lose some muscle, man. You acknowledged it up front and that's okay because right now the goal is because this is the limiting factor cardio is going to be. And so that's okay too. I think a lot of time, to your point, I mean, people do run clubs for a variety of reasons. I don't know because you're never going to catch me with one. But... I imagine my understanding is that there's a collaboration, there's camaraderie, there's social connection, all that kind of stuff. But if that's your only exercise and you're like, oh, I want to be healthy long term. Well, let's define what that truly means. And healthy long term, when you look at these morbidity mortality studies, when I talked about capacity and also just lifespan, well, that that looks like a lot of things, because if you're you're.

23:05 cardiopulmonary system is rock solid, but you fall and break a hit. That's going to deteriorate pretty fast. So we'll come back to that. Sorry, go ahead. No, I was gonna say, let me ask you this. This isn't biased towards one gender or anything, right? No, I mean, to my knowledge, no. I think we can probably talk about anecdotally where our experiences, but this study, to my knowledge, no, I looked at it, or at least the umbrella of systematic reviews, they give general guidelines towards everything. We will probably, again, anecdotally, we'll talk about how certain genders probably will tend to gravitate towards those. I'm curious to get your experience too, because you do live in Tampa, where the weather is better, so people are out a little bit more in run clubs.

23:45 Have you ever been part of a run club, by the way? No. When I first came, yeah, but for the exact reason that you said, like the social blast bag made some friends during it. So that was really just, and I had so much free time. So I was doing two a days. I've been doing the wrong club and then I lived. Getting to the outstanding questions. So before I, like I said, before I write a week for anyone, including myself, there are three main questions that I like to ask. And question number one is, what do I want to improve? And I mean specifically, right? Let's define the objective, define the outcomes. Is it, are we getting in shape is not an answer. Is it hiking without stopping? Cause you have a trip planned. Is it getting back to playing soccer? Is it being able to do a high rocks competition? Is it not losing strength through your fifties as you are going through perimenopause and menopause?

24:30 So a priority isn't there. So we're excluding everything else. It just gives us clarity, right? It gives us clarity on how we're going to decide where to use our finite amount of energy and what we're going to focus on. So there's not a conflict and there is going to be an inevitable conflict. Number two, what can I actually repeat? like days, minutes, equipment, whether or not you like it, whether you like it to come back to your question. And this is important because you have to build a fallback plan, right? So they're the ideal version of the plan. And then there's the, what happens when my kid gets sick? What happens when a project deadline and I miss, right? Or what happens when I travel? You have to have that version as well.

25:11 So the fallback week at the same time as a real week, Hopefully you're going to have the fallback week that you have to take out of your back pocket infrequently, but it has to be there. And the number three is, how am I going to know if it's working? Right. So is it going to be more reps at the same load? Is it a failure run feeling is becoming easier at the same pace? Right. Whether you're running on the treadmill or outside, are you tolerating the thing you actually came for? And I mean, I'll say this plainly. Soreness is not a reliable measure of progress. It is a measure of novelty, though, to come back to. And I think historically, we used to think that because you're sore that you're progressing. And that's not necessarily the case. And we've known this for a very long time.

25:52 And they talked about it here as well. I think this is where the tech gets exciting because I think the tech does a great job in terms of seeing your progress, right? So like, for example, the Apple Watch can monitor your VO2 max, right? And it's a proxy. From my understanding, it's not the best for beginners or if you're very much on the low end of, I should say beginners. If you're somebody who's very low on VO2 max or if you're somebody very high, it could overestimate and underestimate. But if you're somebody who's like, it has decent fitness, it does actually a pretty good job with their algorithm as far as making sure your aerobic capacity could go up or something. So... The tech, I think, is great. You look at resting heart rate, we can look at HRV, but like you said, just the subjective things about pace. And so if you've been running for me, for example, 7.5, I was like exhausted running for three minutes on that maybe a month ago.

26:34 And now I'm like, oh, I've got to create this up to eight and I can nasal three. There's definitely, I think, excited to talk about those types of things and how people can get creative by actually understanding what's working, right? It doesn't always just have to be the scale, which is what we're accustomed to looking at. Right. Now, a... I suspect some people are probably wondering, well, what if I want all of those qualities, right? I want to be stronger. I want to be better at cardio. I want to be leaner. Do you have to pick? And the answer is, like I said, you can improve several things at once, especially if you have not been training them deliberately for a long time. You're going to see gains everywhere. Or if you have no training experience. But what is finite is your, it's not your ability to adapt, it's your ability to recover and pay attention, right?

27:16 Four hours a week trains a lot if you're training comprehensively. Four hours a week trying to maximize five different things trains none of them well, right? So you have to pick which master you're trying to serve here. And on the note of being leaner and the scale that you brought, I think that's mostly decided outside of the training session. And sort of like training is not a great way to get on a fat loss program, but- we're not going to touch on that part of it. So let's maybe this one, here's what I'll say is with respect to session length, I think they had talked about, it can be at anywhere as little as 20 to 30 minutes. I'm going to say for the intermediate trainer, if you're including your warmup, which I think is absolutely critical and non-negotiable, probably 45 to 60 minutes is a realistic default for most healthy adults.

28:00 If you absolutely are short for time on that fallback week, 30 minutes can keep you in the game. But 45 to 60 is probably where you want to be when you properly warm up and you want a good quality session. And that's a key phrase there, good quality session. In fact, I remember... listening to Andy Galpin, I think he was either he's talking to Dan Garner or he was on Stephen Barless, where he talked about the interval for rest between his training sessions is how long as little or as much as you need to get a quality set for the next set set to set that he's not even monitoring it. And I thought that was actually really cool, right? Because historically, I would say anywhere from 16 to 90 seconds. And depending on what you're going for, if you're going for training density, that really can matter.

28:41 But if you're only going for quality, that's your metric I personally will sometimes go 60 to 90 seconds, but I love being in the gym. And depending on the phase of life and what's required of me outside of the gym, maybe I can't do that. I also have some constraints in terms of physical limitations that I'm dealing with. So I do have a longer warm, but we can touch on that if you think that's important. So here's what a week will look like. Oh, sorry. Did you want to add anything there? No, no, go ahead. Yeah. I think this is what kind of a sample week that I want to put out for people, what that might look like if who is already training three or four days has a gym, has a decent base and wants to know what their week is built like. So Monday, they might do a full body strength training session with a 10 to 15 minute warm And then that could be 45 to 50 minutes of lifting.

29:28 Tuesday, it could be an easy aerobic workout, right? This would be a conversational 45 minutes. This is what we would call it quote unquote zone two or steady state cardio. Pick your tool of choice. It could be outside walking with a rucksack. It could be on an elliptical bike, whatever you feel. Wednesday, it could be your second strength full body session, similar structure to the first one. Ideally, you're rotating in a couple of exercises. So you are hitting those muscles that we talked about. You can get the 10 sets a week. Thursday could be your second aerobic session, 45 to 60 minutes again, with one harder block inside of it, right? So this could be towards the very end. It could be somewhere in the middle. So you're adequately warmed up. And this could be that zone five session that you dedicate to, but people can actually build it in.

30:10 This is actually what I do is I will combine my session, but it could be 15 to 20 minutes in there at an effort that you could not talk through, right? So it's really hard and it's not going to be sustainable for a long time. Friday might be something that you could just take off. You could do an easy 30 to 45 minute movement session. When we talk more about the mobility, stability, we can, if you want it and you had an appetite for more training, you could build that in. And then Saturday could be a much longer, easy aerobic. This could be a hike with the family. This could be just a long walk and Sunday could be off, right? There are some people who like to move every single day and this could be a quote unquote recovery workout. Again, it really just depends on how much time you have to give.

30:51 I recently talked about a time Rx protocol, which is the time that you have, the intensity, the modality, and the episodes that you're going to do over time. So again, everybody's a little bit different, but that's about four and a half to five hours a week, two strength days, three aerobic days. And it hits the minimum effective dose, right? The CDC guidelines talk about 75 minutes of moderate to vigorous or 150 minutes of moderate aerobic activity, which it's kind of the floor. Now, it's not to say that you don't get any benefits if you get less than that. Remember, anything is better than nothing. But those are kind of the requirements.

31:31 I will come back to that because an interesting study recently that I talked about benefits all the way up to 600 minutes. So I think that'll be in the aerobic exercise because people think that there's this J curve, which is there, not there. Just a little teaser. Any questions on that or anything that you would change about that? I think the plan's pet's prey because you're hitting on everything. But what about the person who is just doing classes, right? So this is become very popular because now class passes out. But there's also so much marketing behind Pilates, F45, berries, orange sherry, lifetime as its classes. But, you know, it's just an easy way for one people to meet each other, similar to a run club, but also feel like, oh, I'm getting my heart rate up and I'm doing some sort of potentially strength training, of course, unless it's yoga or Pilates.

32:13 How should people think about that? Again, it depends on what the objective is. If the objective is to have a comprehensive program because you're interested in playing the long game, then that's insufficient. It also matters on what type of class we're talking. If it's just a run club, we've already touched that. If it's just Pilates, I am told, I've never done one and I do want to do one, that it requires an intense amount of stability And I think you've seen people will post these Instagram reels of like bodybuilders, like these individuals trying to do Pilates and struggling. And it's just there's something called the set principle, right? Specific adaptation to imposed demands. And they don't have any imposed demands. So, of course, they're going to struggle. That's not.

32:54 It's not a cool thing, but people tend to use that. So it doesn't impress me whatsoever. But you are trading off. If you're a one trick pony, you just understand that you are, again, like I said, you're leaving a lot on the table. But if you want to be the best Pilates person in the world and your Pilates instruction, this is your job, then maybe that's the one. Just identify what your goal is. My job is not to judge what somebody wants to do. We just, they come and they tell me, I want to be really healthy in my 60s and 70s. And all I do is Pilates. And I'm going to say, well, that's not the best way to get there. Does that answer your question? Yeah, no, I think so. I think it just reinforces that people need to hear this because I think the culture is so big now for these classes and they suck you in because, yeah, you do feel like you're getting a great workout and you have the community and you're just like, oh, I want to go back.

33:37 But yeah, I think it is important when people realize, wait, when I look 30 years from now, what are the things that are going to matter? And like you said, preventing falls, being able to travel, it's definitely going to have to expand their knowledge of their own body in terms of how it works in space. Yeah, I guess if I could just use a simple food analogy, what I would say is like we apple, apples are phenomenal. You're going to find very few people who are not going to benefit from eating apples. But all you eat is apples. You're leaving on the table, right? Yeah. And that's your only form of fiber. You're leaving a lot on the table to shout out to, but I'll talk about the different types of fiber. Yeah. Again, that's not me.

34:18 It's better than eating no fruit, but yeah. And so that's what I'll come back to. Yeah, I think the one thing I'll say with my training now, I did mention I have some constraints. I had shoulder surgery about coming up on nine months. And so I'm definitely progressing, but there are some constraints. I've dealt with some musculoskeletal injuries. I'm two weeks out, two years out, excuse me, two and a half years out from hip surgery and had a hip scope. Now, unfortunately, I have hip arthritis. And so I do have to modify. And so... how much volume some of these aches and pains can tolerate really matters for me. So I like to train. Typically, I like to have a bias towards strength training, strength and power speed training.

34:58 And so I like to do two upper body sessions, two lower body sessions. Life is a little bit stressful outside of training right now with respect to my sleep has been compromised, work's been a little bit harder. So right now what I'm doing is three full body training sessions. which I mentioned could last anywhere from 60 to 90 seconds. And yes, I do calculate. Here's what's really cool about some of these LLMs is now you can put your program in and say, hey, you could actually take the transcript from this and say, hey, Kate, can you actually calculate per muscle group? Am I hitting that 10 to 20? Right. A minimum 10 per muscle group. And it'll do that. It is important to recognize that there are a bunch of exercises when you're doing compound lifts. If you're doing bench press or a pushup, you are getting deltoid work, particularly anterior deltoid.

35:43 You're getting chest work, even though it's a chest exercise, but you're also getting tricep work. So that counts. Yeah. It's not dedicated 10 sets of chest. Dedicated 10 sets. Depending on what your goal is, if you're a bodybuilder, you're going to have to do some version of that. But if we're going for general health, then that's not necessarily the case. My fourth day is going to be that aerobic and zone 5 session all combined, which is going to be about 45 minutes. I like to do that on an aerodyne bike. That's my preferred wear. to get zone five or an assault bike, some people will call it. Yeah, it really depends. Again, some of my training is also initially after my surgery was a lot of training, the contralateral extremity and lower bodies because I was just rehabbing it. And now the shoulder can only tolerate a certain amount of volume because it's a post tenodesis.

36:25 And so you also have to recognize that what's your tissue tolerance and what is what we talked about this concept of allostatic load. So when people think about manipulating load as a variable, they're thinking about, right, sets, reps, intensity, RPE and RIR we talked about. Well, how you're sleeping, your sleep quantity, nutrition, if you're adequately, if you have adequate calorie intake, if you're adequately hydrated, what your perceived stress is, distress in life, right? Like you have been building in Tampa and you're picking up. multiple locations. And at some point, I don't know if you have a PA or at this point, but I know you were looking to add help. Well, that was a lot on your plate.

37:07 Well, that is going to play into how much load you can take into the gym. So this concept of allostatic load is really important, which we'll come back to maybe towards the very end that I'll talk about. I think that is all the thoughts that I have. Hopefully that's helpful for people. Anything you want to add to that? No, I think as we go down the rabbit hole in each of these domains, I think, yeah, we're going to be able to kind of explain a little bit further and hopefully gives people clarity. And just I invite people to ask us questions, too. I know whether it's on social or you want to email us at medicineredefined at Gmail or whatever it is now that we use for email. Yeah, I think connect at medicineredefined. There we go. Connect at medicineredefined. There it is. Yes. It's all right.

37:47 He's new here, folks. All right. So here's, I have something actionable for the listener. I'm going to ask everybody, hopefully, if you're listening this week, I want you guys to draft two weeks on one page, right? So the week you want. the ideal week, right? With the whatever allocated time that you give into your strength training sessions and your zone two, zone five sessions and the week you fall back to, right? So something that's going to cause, allow you to have minimum effective dose where you're not skipping because that's the problem. People think that if you can't do your program, then they're going to do no program and progress over perfection is the name of the game. So remember, we talked about this. We don't want... perfect be the menu of good.

38:27 So good is good enough. And that's better. And this ACSM paper showed that. And that if there's anything that I want you to walk away from, that might be the most important thing. We'll see. Maybe if you have some time or there's a demand, we'll put a one page planner for people in the show notes for qualities. But I want you guys to come back. Either our next part of the series is going to be us talking about strength, followed by power. Nope, excuse me, followed by aerobic capacity, then power and the mobility and stability. Hopefully you guys will tune in and hopefully this is actionable. Love it. Till next time, buddy. Thanks for listening to another episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this.

39:09 You can follow us on Instagram, Twitter, and TikTok at medredefined. We also want to thank our team for the production of this podcast, specifically Ethan Ju on video, Harita Yehpuri on social media, Zanab Lugmani on research, and Saira Khan for newsletter. Oh, and if you want to get similar bite-sized information delivered to your inbox every Sunday, please be sure to sign up for our newsletter. Also, if you enjoy this show, please be sure to subscribe, review, and share with anyone who you think will gain value from this as well. Now, time for the ever-so-important disclaimers. This podcast is intended for general public use and is for educational purposes only. It does not constitute the practice of medicine, nor should be construed as medical advice.

39:49 No physician-patient relationship is formed, and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues.