213. Power Fades Faster Than Strength: How to Test It and Train It (Training Series, Part 4)

0:00 Welcome to Medicine Redefined. I'm Dr. Ultima Sharajah. And I'm Dr. Darsha. Let's put the health back in healthcare. 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 refininghealthrx.com. All right, let's jump in. Welcome back. Thank you. Thank you. How we doing? Good. I really like the glasses, man. You don't wear them often, do you? These are new. Oh, are these prescription glasses or are they? Yeah. Prescription, yeah. Warby Parker. Are you farsighted? Yeah, that's always confusing.

0:40 Farsighted means you can't see. I don't know. Yeah. Is reading hard for you? Do you need glasses for reading or do you need glasses to look far away? For clarity and reading, so I have something called carotoconus. I don't know. Have you ever gone through this? No. Wow. I want to skip. Let's skip. Let's go to this one. What is this? So I have a diagnosis called carotoconus. So my cornea. Is this the thing that you get after you get STDs? Is that the one? What? I need a damn it. It's a quaila. Yeah, I see. No, so my cornea... I think that's awesome. No, your parents listen to this, don't they? No, they don't. Oh, my dad does. That's fine. My cornea are both torrid.

1:21 So it's either genetic or it can be done through like eye rubbing. Usually presents like in your early 20s. Predominantly Hispanics for some reason. Although I'm not Hispanic. So my automatist found it. It was like, hey, we're doing a mapping or scan. And... Over time, my like lens or like I just got a lot of glare and I couldn't see like reading as well. So what happens is light refracts at different angles for me. So whenever you go to the optometrist, you know how you like close one eye and read like left to right every letter? Mm-hmm. So typically when somebody does that, they can just scan letter by letter by letter by letter. And it's the same focus. It's the same light entering the eye. For me, I have to like look.

2:02 And then if I look at a second letter, it might not be the same as the third or the fourth. And the fourth might be more clear, just the way the light hits at different angles. So I've got something done called cross-linking where... of one of these surgeons like took off a little epithelial layer of the eye and they put in riboflavin in there and then they cross look it with like vitamin, like with a UV. So it like completely just locked my eyes in. So I can either do like hard contact lenses if I wanted to, which I heard are not that comfortable. Or I just wear glasses like as I need to. So I do a lot of glasses when just reading or doing like work. I don't need them per se, but I will strain my eyes if I like I'm doing notes or something. Wow.

2:42 No, I didn't. I don't think this is the first time you're sharing that story on that. Yeah, that's amazing. Eyes are so cool, man. Let's talk about power and speed, baby. Yeah. So back in episode one, I had said that strength is, we'll start about with definitions. I think that's really important. So we've talked about strength is how much force you can produce and power is how quickly you can produce it, right? And so today we'll talk about why that difference matters more and more with every decade that we progress onto life and how to train about wrecking yourself. I think that is probably important. Hopefully this one is going to be more fun for you and I, because this is exactly what we'd like to do. And I'd be curious to see. We've been talking a lot about Hierox and we're really getting out of the wire, right? We're in the month of October and we can maybe pinpoint exactly which would be classified under a specific power and speed.

3:28 I'm curious if any part of Hierox. But quick vocabulary for folks, just to recap, strength is how much force you can produce. Power, as I said earlier, was force times velocity. So it's how much meaning force you can produce fast. Speed is on the real far end of that curve. So this is going to be very light load, very fast. It's things like sprinting. I know it's intuitive for more people. The last one might not be, although people use this inappropriately at the time. They'll say rate of force development is how fast force rises in that first fraction of a second. So it's the quality behind both speed and power. And I had shared these curves with you. So if you look at figure one here, and we'll try to link this for people here. So if you think of like force on the y-axis and speed on the x-axis, you have this descending curve all the way to the far left is high force, low speed.

4:15 That is going to be maximal force production, heavy lifts. So think about one repetition maximum. As you progress onto the continuum on the x-axis and you're getting more speed, you're putting more force into the ground. Somewhere between 30% to 70% of your 1RM is moderate lows. If you move them with intent, move them with a lot of velocity, that is the optimal range, quote unquote, the power zone. And the far end of the curve where you're basically down to the zero on the y-axis, you don't have a lot of force. Some people will debate this, but you have a lot of velocity. You're moving as fast as hell. And so sprinting track athlete, I think you were 100 to 200 runner, 200. 100, 300 meters, 4x1, 110 hurdles. You had indoor track too, huh? No, I didn't.

4:55 I wasn't allowed to do indoor track. Thanks, Dad. You had, wait, there was a 300 outdoor track event? Yeah, Pennsylvania. Yeah, I probably had 300 hurdles. Nice. Did you ever go to the Penn Relays? Eighth grade. Yeah. Nice. Eighth grade. Look at you. Yeah, sprinting lightest and fastest, right? That'll be on the far right. And so the reality is, as I mentioned, all sprinting is powerful. Right. Give a shout out to Usain Bolt and Johan Blake. Nobody's talking to me that these people are not powerful and producing a lot of fortune with every single time they touch. But most power training, the way that we're gonna talk about it in terms of how can you craft this and hone this in and try to hold onto it as much as possible really. It's, and how can we relate to everyday life? Standing up from a chair real fast.

5:36 I talked about taking the escalator, the stairs maybe two steps at a time or quickly sprinting to try to catch your flight or whatever you might. The sport of your preference are tennis. I guess looking at some of the stuff that I sent you ahead of time and maybe even think about these definitions, where do you think that your power shows up in your game specifically? I'll say tennis in general is a very power oriented sport. Like in order to be good and get to the next level, everything is about power. So everything is kinetic chain, right? So when you look at power, you get to start from your feet and then you're going to load up your hips and then it's going to go into your core and then it's going to transmit out of your arm and hand and then racket. So that's your serve.

6:17 That's your backhand. That's your forehand. That's even when you're, I wouldn't say sprinting, but even when you're shuffling. So you're not actually sprinting, but you do need a lot of that. Yeah. You do need a lot of quick power off your reflexes to go get a drop shot or to go backwards. So really, yeah, it's funny because a lot of people, when they assume power, they think muscular people like bodybuilders, that type of image comes to mind or that schema. In tennis, you're seeing a lot of more lankier athletes now, but they're all even more powerful than they were in the past. So that is essentially a lot of their training. Skinner is the big one right now, right? Center. Center, sorry. Yeah, well, and some of this has to do with the fact that the sport of powerlifting is actually not powerlifting, right?

6:59 Olympic lifting should be powerlifting and powerlifting should be strengthlifting or some version of that. So for those who don't know, powerlifting is the big three lifts. deadlift, squat, and bench press. And Olympic lifting is going to be more hand clean stuff that's actually more powerful. So I think, I don't know who did that 75 years ago. We got to go back and beat that person up a little bit. But yeah, that might be one of the reasons. What's interesting, what you just talked about, it's actually a couple of more things that we're not even going to touch on this, but critical component before even power is change of direction, right? So shuffling to the planting and then accelerating the other way, like that's a lot of power coming back from that hole. So change directions. Maybe as an athlete, that arguably might be the most important skill.

7:40 When we used to train at Bracey, like this would be the most important thing. I think that would be applicable. Think about change direction in any sport, whether it's soccer, football. maybe not track, but a lot of these sports, I think that's going to be the most valuable thing, community reactivity. So in traditionally power, this is not going to be an athlete-focused lecture. I think this could be general pop, maybe a little bit of athletic population applicable to that, as well as even the higher performer. What we do know and people recognize, right? So this term sarcopenia we talk a lot about is age-related muscle loss. Some people will also include strength into that, although the more appropriate term is dynapnea for that. Power doesn't really have a term. There's a proposed term called parapenia. It seems to be a little cool, but also a little lame at the same time.

8:20 Some people will say I think dynapnea is actually both strength and power decay over time. But what we know is in older adults, and this comes literally from actually older adults, literature looks at people like 65 and older. That's where a lot of these studies are done. They show all the way as early as 90s, that leg power seems to fade about twice as fat as strength. So you've probably seen curves on social media where say, oh, after the age of 30, after the age of 35, you're losing about 1% a year in strength and muscle. Power, it's going to be somewhere in three to 4%. So it's actually much more significant. And so that, and we'll talk a little bit about like what the implications of that are, both clinically and from a longevity perspective and why we need to hold on to that.

9:01 And this is a trainable quality that we need to all to prioritize. Like I said, it doesn't, because it doesn't necessarily wait for 60, right? There was another study that I came across in all the way back in 1997, Meder et al, that looked at power was started declining it by the age of 40. It's just a couple of years ahead of me. I belong after you, my friend. So the news is you're doing it. But the study that I think that is critical here to look at this paper that I came across from a group in Spain, I think Balazsar Fernandez, they retested people of 565 adults over the age of 65, eight years apart. And they looked at this sit-to-stand power test, which is a clinical thing. I think you and I had talked about this before. It's like, how fast can you sit-to-stand five times? And it's a really simple thing that people do.

9:43 And so this is figure three dark that I'm looking at. I found interesting here was that it wasn't the fact that people who were far less powerful or did not perform as well over time. It's not that they lost leg muscle. They held onto the muscle, but 95% of the less power per unit of leg muscle was because of poor muscle quality. So they had the same density, the same volume of muscle. It wasn't the morphology that changed over this eight-year period. It was whatever... I know what it was, but it's the muscle quality, right? Which is more of like a central nervous system neural input. We've talked about the nervous system precedes the muscular system, which is, again, going back to when we were talking about strength, is why do you train strength earlier on?

10:26 Your central nervous system is more fresh. Power is actually going to... Speed and power has to even precede that. It turns out the reserve of... how fatigued your state can be to train this quality, specifically speed and power, it's threshold is far lower than even strength. So anything onto that, any questions on that or anything do you think that needs to be elaborated or that confusing? No, I think he explained it well. And I think as we go on, it'll probably be more applicable to people as they think about how to train forward. I think people jump ahead in their heads. Yeah. So I guess maybe the one question is I'm talking about things that we had mentioned, right? Yes, life's a man matters, like how long you live, but it's also important by how well you move and what capacity and capability we have, right?

11:07 Because we want to be able to do things age gracefully. And so people might have heard about the Toledo study for healthy aging, right? There's a couple of these out there that people look at just longevity. So in this one, they looked at almost 2,000 people. Again, most of these studies, unfortunately, nobody looks at the middle-aged man. They're looking at the young athletic population or you're looking at the elder people. especially when you're looking at longevity based studies. So that's the unfortunate part of it. But I think the principles are applicable. And so this is figure four. And when this sit to stand power test, I think I will give people one way, as any Galpin says to investigate is this is one thing that they can do. What they found is that people who had lower citizen power scores had worse outcomes. Folks who had lower sit to stand power, their risk of dying was 57% higher in men and about double that, right?

11:56 So 204% in women. And also in women, it also correlated with higher rates of hospitalization. So I think that's concerning because it just... signifies how important it is and it's not talked about. In fact, when I think we had decided that we were going to do this series, I didn't think this was going to be as... for me to think about, wow, this is a real big deficit in my program. And I think when you're younger, You recognize the speed and power important, right? You're a sprint athlete, you're a track, you're just doing that by the nature of wanting to perform. But I think in the game of longevity, we don't talk about this enough, despite longevity being such a buzzword.

12:38 People are not talking enough, I think, or it's not getting enough love as how do we preserve and train and improve upon power and speed. But if you, because if you look at the implications of that degradation and power over lifetime versus strength over lifetime. Power is more important. Now, strength is built into that because they're forced production, but power is more important. Would you agree with that statement or this assessment that I have of social media and just? Yeah, I think so. The only person I ever really hear talking about is Clay Moss. So shout out to him because, I mean, he talks a lot about how. our parents will end up walking, right? When you think of a cardio sense and, oh, walking's good, it can help with balance, getting, of course, but it doesn't translate to power when you look at hip fractures and those falls and all the data that we talk about and that we see as rehab docs, right?

13:26 I mean, how many women come in because one osteopenia, osteoporosis, But yeah, I think he talks about a good amount where walking is good, but it's not solving for what a lot of people think is reduction in falls. That's where that power comes from, that deceleration that you mentioned earlier. So we'll get him on at some point and we'll contact Trump about that too. Yeah, I'm looking forward to that. I'm going to shout out to one of our physiatrists talking about that. We're going to come back to this for the next episode because people give a lot of attention or at least the folks I've heard Andy Galvin talk about this on YouTube. he who shall not be named episode talking about the importance of power in preventing falls. But there's actually more to it than go that, that as I think the center posted about this a couple of months ago. So we'll come back to that.

14:07 But I guess maybe let's now get into to make it more tangible for people and more actionable is how do we trade? So coming back to that ACSM paper that we've been referencing time and time again through this series for power point, they point to moderate lows. As I mentioned earlier, 30 to 70% of your max one RM, you have to move it fast. as fast as you can on the way up at low to moderate volume. So in this paper, they say, hey, you want to say about roughly shy of 24 reps across all of your sets? So you'll probably do anywhere from three to five. Maybe you could go up to eight. So if that three sets of eight or probably want to stay closer to that. The biggest... things you want to look at depending on what exercise you're doing. It's like another way to look at it. If you're doing Olympic lifts, you're maybe not doing a lot of reps of eight unless you're a true Olympic athlete or you're training for that.

14:49 Probably not my favorite thing to do when people are trying to develop power, especially not Joe Smo. We're going to go into doing snatches and power cleans and tank cleans and stuff. So if we're thinking about like box jumps and med ball throws and kettleball swings, we might consider doing reps of threes and fives and with amounts of rest in between. I'm talking three minutes, five minutes, really boring stuff. We can talk about how we actually fill that. strategy that we have is with filler chronicle exercises to train other qualities that we want to improve. But that's what you need, right? It's a nervous system thing. And it's really important, right? Because when you look at older adults and you pull all the trials, power training beats regular strength training for power itself. And with the smaller edge on the actual functional test that we measure.

15:33 So that sit to stand test that we had talked about. So this is the negative side, right? So the power training, you train that and people do better. So for instance, if we're training for box jump and we want to develop power, people do better for box jump. We're doing the ladder. People do better with ladder, whatever test you want. That doesn't always translate into functional test. That's probably more a, it speaks more onto the, uh, inability for these functional tests to actually represent what that means, I guess, functionally from a longevity perspective, from a health plan perspective, rather than the saying that there's no carryover from power to real life. Did I make sense there? When I said that, I think it's like, we don't have good functional tests to capture the importance of some of these things is what I'm trying to.

16:13 And I don't want people to take that, okay, oh, light and fast beats heavy. Because we did spend a whole episode talking about the importance of strength. Turns out that if you do like to move heavy loads, right? We talked about 80% or greater for strength. Well, you can get both actually. Because if you were doing heavy lifting and you, again, do it with intent and you try to move the weight as fast as possible, as explosively as possible, this is that concentric phase that we had talked about. So the eccentric, let's just say, oh, I'll use... a squat because of the better version as you're going down, that's the eccentric phase. Let's say you're controlling it in three to four seconds and you're explosive on the way up, even if your bar is moving slowly, outwardly looking at it, but you're trying to move with the antenna as fast as you possibly can.

16:54 You're building that rate of force development. Does that make sense? Cool. Is there any type of interference if you are trying to train like straight power or do you think they're both tend to concordant and you can both will That's a great question. They're complementary. I would say they're much more complementary as opposed to trying to train for endurance versus muscle hypertrophy, right? Like they're not. They're going to rub. In fact, one of the methods we'll get into is a construct training is you're actually pairing both of them together. You do a really heavy strength movement. You might do 90% of your one arm for squats, and then you wait three to four minutes, and then you might go do five box jumps. And you wait three to four minutes, and you might come back. It's this concept of post-activation potentiation.

17:35 Without getting too much in the weed, we'll talk about that, right? Yeah. Let me ask you one more thing. Do you think power needs periodization? Because again, a lot of like lifetime fitness and a lot of these gyms, now that they're trying to follow the science, they'll have a power phase, endurance phase. Do you need a power phase or can you just throw it in once a week on top of whatever else people are trying to globally train? Depends on what your objective is. If you're trying to jump higher, then yes. If you're training to increase your vertical jump or broad jump, if you're training for the NFL combine, yeah. Right. If you're just I think when you me and you, we want to be healthier, we want to train this quality. So everything we've talked about doesn't degrade over time. It will still. But we want to reduce that slope coming down and we want to help it help us be stronger so you can have the rate of force development.

18:20 I don't think that's necessary. I think, again, we're getting too much into the. But yeah, if I'm trying to increase my vertical jump by three inches, then I think that's not really good. So the other lever is like, when do you stop the set? That's really important to understand. So this is not going to be a surprise to you. It's like, we look at, yeah, when your central nervous system is fatigued, but how do we know that? I mean, one way is that people will look at it. And the Olympic athletes do this all the time. They'll have this bar speed device that they'll attach to it. I think Lane Norton actually does this as well as when he's like doing really heavy, he'll attach that. And it's seeing how fast are you moving the bar. So this group out of Brazil, I think Projel Blanco, is they looked at young men who are squatting and it each set once the bar speed had dropped by either 20% or 40%. So this is figure six stars that you're looking at.

19:02 So the group that did 20%, the 20% group, like when they stopped the set, they did 40% fewer reps overall, but they got similar strength gains and they improved their jump even more, right? So they did less volume of work, but they improved their jump by about 9.5% versus 3.5% in the group that waited until their speed dropped by 40%. Which is interesting because that group is doing more work. So here volume isn't the thing, right? Because we're looking at a completely different thing. This is answering the question that you had asked earlier. So I think that's like really important to understand. It's like, what's the game that we're playing? And that's what we're going to train toward. So yeah, if you're running a hundred meter dash and you're training for that, like you don't do a lot of volume. I think a couple of key principles that we are training this, and if you think it's worthwhile talking about specific exercises, maybe it is, let me know.

19:49 But I would say principles of what you're going to do, you got to put a very first in session. So this is going to be after that 10 or 20 minute warm up that we had talked about in the very first episode, as fresh as you can before strength training. unless you're skipping it. If you have an intentional reason, I'm going to make the case after this that we should not. Three to five reps fast, a few sets, enough rest until the next set is still fast. If you start noticing, it's going to be a little bit hard unless you have a lot of kinesthetic awareness like you had talked about, or if you have external coaching cue, like you're not moving it as fast as you are. If you're thinking like, If you're doing things like medicine ball throws, so imagine that you have a facility. So you probably a lifetime have this where you have a big turf field and you're doing medicine ball throws and you're getting the ball consistently 20 yards, 20 yards.

20:30 And all of a sudden it's going 18 yards and then 17 yards, 16 yards. Well, two, one, two things are true. One, you're done completely. Two, you're not giving yourself adequate rest time in between. You're trying to go through, which is generally what most people do with people like you who are CrossFit at high rocks. It's a go, go. It's more of a metabolic type of workout. It's not true power training. But I think that's one of the big shots at CrossFit early on. It's like you're not really developing true power. Again, this is for the regular Joe Schmo, who's training for Hierox in CrossFit. I'm not talking about the CrossFit. We're not talking about Tia Claire Toomey here. Racer, Matt Racer. Yeah, yeah. Those are different. Those are different mutants. The one thing I will say, I recently listened to an Andy Galpin episode, which is a really cool episode about training and preventing injury.

21:13 and asymmetries. We'll link that. I forget which episode it was, but it was really good. I would make the case now that at least we should make at least one of these lower body power training thing, at least single leg. So you're covered there with your sprinting, but other folks can, it can make like a single leg step up, explosive step up or single leg, which can train multiple athletes. I think for my, shout out to my elite or high performer, a couple of upgrades. So don't necessarily focus on the rep count, focus on the speed and intent. If you see that degrading over time, then you're going to cut out. Keep a heavy day and move it with fast intent. I think this is going to be your 85 to 95% and move it as fast as you possibly can. I think that probably challenges rate of force development a little bit.

21:56 better in my personal opinion. For me, it does. And think about those contrast sets. So coming back to the contrast set would be, like I said, the heavy set. You take four to five minutes, then you go do maybe really high explosive box jumps. So this might be a way to challenge it. So a famous coach, Joe DeFranco, is world-class at this, right? He's worked with He was Triple H's coach for like the entire thing. He's worked with WWE, a ton of NFL athletes. He's worked with that and he's world class at developing this. And this is one of his favorite methods to build explosive speed and power is to do contrast training. Yeah, I think that's, and we have this at figure as well, so people can look at figure seven for this one as well.

22:38 Anything on that before we should move to speed or anything you want to add to that? No, I'll say, I know you talked about an actual device. I've heard Jeff Nipper talk about iPhone apps now to actually track velocity. So I was just Googling it. I think there's one called metric peak strength. Those are mainly for Olympic lifting. And then, of course, if you're doing cycling and things, they're going to have your own things for that, for power. Watch and stuff, yeah. So this metric is an... And if you upload a video and it analyzes or what? The camera actually is... So you're going to have it facing towards you. The camera itself is going to be able to monitor your velocity. I'm assuming you have to, like, your first rep guide it to be like, this is my bottom, this is my top or whatever. Sure, calibrate it. Yeah, it should be able to...

23:19 Cool. Yeah, I wonder how accurate it is compared to an actual device. That would be interesting to look at. But I mean, look, they got tools out there and you use that. Depends on what you're interested in, how you want to play this game. I won't spend too much time doing speed, but I do think it's worthwhile. I think speed is like a really complex thing if you're truly trying to build speed. But I think for most people, like power and speed, we can put together in what we already discussed. But the word speed is entitled, so we have to do a little bit of it. I think the biggest thing with this is that if you're going to try to incorporate things like sprinting and all the stuff that's on the far end, that force velocity curve, then you got to be really careful how you get into it. In athletes, the biggest red flag for the next hamstring strain is a recent or a previous hamstring strain.

24:02 You were talking about how you had a little hamstring tweak in one of the previous episodes. But if you've had a previous hamstring strain, like this paper that I came out in 2020, it's a green paper in the show notes people look at. almost five times the risk of a hamstring injury if you've had a recent previous hamstring injury. And older age and any previous strain, that's more likely to happen. So you got to be careful, right? So basically the point is, if you haven't run fast in years, don't make the soccer field or the kids' field day your first sprint or softball your first sprint. I know people want to do that on the weekends. You've got to build up to it. So the lowest level here would be for sprinting in figure eight Darsha would be you start with strides at 70 to 80% effort. Then you might go to hill sprints or maybe incline treadmill sprints, some version of that.

24:45 Again, it shortens your stride with the hill sprints. It's a little bit more dominant as well. And then you might get into flat all out sprints. Probably most people should not be getting to flat all-out sprints, even at all-out sprints. And elite athletes will tell you, the ones who are training for the 100-meter dash, or they are probably most of the time pushing anywhere from 90% to 90%. They won't go 100% if ever in their training time. You did a lot of that. Do you agree with that? Yeah. We did a lot of striders, a lot of striders, a lot of 70%, 80% work, a lot of... skips, splits, A skips, B skips, B skips, a lot of that. And then just a lot of fourth production, right? Like getting off the block, getting off the block, getting off the block. It was just like 10 yards, 10 yards, 10 yards.

25:26 Well, tell me about your sprints now, cause you do a lot of that. So, I mean, it's on a treadmill. I mean, unless I'm actually out of a track, it's very difficult for me to get out there. No, I don't do a flight. I do just flat out. And I do a lot of, some of the kind of weird people will stare at me because I was a hurdler. So I'll actually, it's my hurdle form on the treadmill itself. So I'll like jump and bring my leg up if you're like, what the hell is it doing? So the problem is lifetime treadmills, they go up to 16 miles per hour. So for me, that's probably 75, 80%. So, I mean, that's what I'm spurting off right now. But that's where I'll do a minute at that speed and then just... Have you ever tried the curved treadmill? Yeah, I'm not the biggest fan. Why not? I don't find the same, like I'm not using the same muscles as I usually do when running.

26:10 And I find it to be more resistant. Like I'm not like bouncing. I mean, it is, right? Because the treadmill is actually moving. The belt is moving for you, right? And so that would be one, again, the reasons you're doing it are very different. But if you're training, like if you were training for track or training for performance, if you were a master's athlete, you might not want to do that. That might not be the bulk of that because the belt is actually doing the work for you. You're still moving at high speeds as opposed to moving the ground behind you. One thing that we would, when we would teach speed and acceleration, and the A-skips is the idea. The A-skip is you have this cycle that you come through. You actually pull the ground. You're pulling the ground behind you. You can't do that if the belt is doing. This might be a little too technical for most people, but I was just curious because I've had...

26:55 I like it. I don't use the Lux. I haven't done a sprinting a long time because of stupid orthopedic issues that I've had. Yeah. But some people love it. Absolutely love it. Yeah. I find to be a lot of hip flexion, a lot more dominant hip flexion versus the treadmill. I mean, bounce. I'm able to hop a little bit more and use my entire leg kind of. Yeah. There is a little bit more of a give on the regular treadmill. I think treadmills depend too. Do you do incline sprints on the treadmill or do you? I don't. I haven't at least, but yeah. Probably should without to get a little higher speed. But then like you're saying, like you're going to shorten your stride and everything too. Yeah, it depends on if that's important to you. Yeah, this is the gap in my program. My only fast work right now is airdyne sprints, as I talked about, 30 second all arounds. And that's really more conditioning because two to one work ratio is not, or excuse me, one or two work ratio.

27:39 The rest ratio, you're not doing peak output. And yeah, and for cyclists, like they can look at watts and try to keep a sustained watts. If you were doing it on airdyne bike or any type of cycling, and if that starts dropping from time to time, Again, it's just really depend on what works for you. But yeah, I think that here's, that's my floor right now. And the next phase, when I come back from vacation, I'm going to be adding probably in the form of some type of medicine ball throws. I do like medicine ball throws becomes a full body, both upper body power and lower body power. I think a lot of the data that we look at from a longevity perspective is looking and studying lower body power, but upper body power is important too. Being able to catch yourself when you fall is going from a pretty rapid descent in a push-up position. I think that if people wanted to test it, something that has been looked at the literature that you can do tonight is the timed five set to send.

28:25 So in the studies, they have people cross their arms. You know, this is a 65-year-old, so I don't want to offend anybody here. But yeah, you're pretty much a little above 90 degrees where your hips are going to be. And how fast can you go up and down? And then you can track that. And there are multiple studies that look that you write that time down, you train power, you come back, you can reassess it. It'll take a couple of seconds after eight weeks. Do you have any tests for power? Is this a conscious quality you've been training or you're just training for high rocks? A little bit of both. I would say it's probably a 20% connoisseur, 80%. I just like to train that way. Like, I'll just think about, oh, how do I bury it? Let me add some speed to my bench press or whatever I'm doing.

29:06 Pyrox, I think it's just, it requires it, right? When you're looking at Ski Erg, you're looking at a lot of power, that top, the row, a lot of power just to get those chains moving. Burpees, things like that too. I mean, it's just part of it. But doing this discussion, I'm kind of like, okay, let me actually program it a little bit more. Yes. In the short term, though, things are power, but how long are you doing skier for? Is it for time or is it what is it? It's for meters. You're doing a thousand meters. Yeah. How fast can you do a thousand meters? Probably, let's say I'd do it two for five, probably five minutes, 30 seconds or so. Yeah. Yeah. So at that point, it's more metabolic, right? Like you're already in a 75. Historically, when you were an athlete, how would you assess, would you have, okay, I've got to try to jump on a higher box?

29:49 Yeah. Yeah. Basketball, a lot of basketball, vertical jump training for me. So I was, it's crazy. I was like five, six, but I played center for my community team because I could touch it. I touched it. So I could rebound. So yeah, like a lot of... I was a young guy playing center. That was amazing. Yeah. Yeah, go off and get five, 11, six foot guys. That was wild. Yeah. Jeez. Right, that's where you're at. Yeah, that's right, for my eyes. What was I going to say? Yeah, that's cool. That's cool. All right. So I think that's pretty much closing that. Important thing to do is certainly got to add that. Again, I cannot emphasize the importance of being careful, making sure that we're not training in a nervous system fatigue state. And, yeah, I'm excited to hopefully get people's feedback on this.

30:30 But I think this is an important quality that needs to be entered more in the longevity conversation. I mean, a lot of things and maybe I don't know why. I think probably because people it's boring, right, to sit there three minutes between a set or four minutes between a set. Like, what do we want to do? It's not as a go-go. It's not efficient. So I think it's a little bit challenging, but it's like eating your vegetables. You got to do it every now and then. You need that fiber. I totally agree, man. And like, from my perspective as a rehab, do a lot of inpatient rehab. I don't know how much my therapists are actually consciously focusing on this with our patients. This is like the bulk of it. This is what they need is that power and teaching them how to prevent falls and walking and whatnot. Just having that power, like you said.

31:10 But it's tough when your length of stay is about 10 to 12 days now rather than two, three weeks. It's like, how do you focus on doing this? So I wonder in the outpatient setting. try to build awareness at least for people to then maybe ask their therapists about this. How do I train for this in the outpatient setting? What they can do at home? I think we should do this is if we're having a conversation with outpatient physical therapists who particularly work in geriatric population, ask them, hey, do you do this sit to stand test? It's so lame that the metrics the insurance companies have, right, are their assessment and stuff. And- Yeah, I can't say either my mom, who's been doing physical therapy for a knee or back issue, had that done part of assessment. My mother-in-law, that didn't happen.

31:52 I do wonder. I'm going to ask. I don't talk to a lot of people who work in geriatrics, but you do make a good point on the inpatient side. I think it's tough too, right? Because you can easily say a patient's on contact guard or minimal assist level, right? Just one person. One person with what? Just walking or just standing. That doesn't translate to... maybe their day-to-day activity, right? And a lot of times they're like, oh, great, you're at a minimal assist, you're at a contact guard. And they're like, yeah, but I'm not even close to- Tell people what that means. Yeah, a contact guard is basically, the therapist will basically have their hands hovered around the patient. They're not exactly assisting the patient, but just in case the patient were to fall, there's that safety. So the patient can walk with a little bit more confidence, minimal assistance, one person is helping the patient.

32:33 And when you're at that level, insurance- doesn't think inpatient rehab is necessary. So once you've reached that high level of function, they're gonna say, okay, you can go to a skilled nursing facility, you can go home, or sometimes they'll deny you. But to these patients, a lot of them will tell me, well, I'm not even close to being back 100%, right? And so how do you subjectively and objectively judge how these patients need to live their lives? I think that's what's tough and so frustrating about our health system is having these conversations, like, hey, we only have 12 days, I don't know what to tell you, but we're gonna have to figure this out after your discharge from us. People don't have the knowledge like we're talking about now. How do they even go about it? To make this make sense for me, When somebody is, quote unquote, too high level or too high functioning for the acute care inpatient rehab, they're ready to go to a skilled nursing facility, which some people also call subacute rehab, right?

33:21 They're interchangeable. Where in the time that I've spent in a subacute rehab, you're not doing much. Degrading day by day. So how does that make sense? Why do people get discharged to a subacute rehab? Because that's like... Again, I don't want to be disrespectful, but difficult to get worse in that block. That's what the data shows. It shows like 30% of people don't actually ever make it home once they go to a skilled facility. So it's twofold. One, the patients themselves have this idea that skilled rehab will be more rehab, which for sure, it's an hour a day, but they think they need more rehab. So we try to convince them that, hey, do outpatient therapy or do home health, which no offense, home health is also not much.

34:02 But we always, we're based... biometric that inpatient that we have to have a low enough subacute discharge rate less than 5%. The rest have to be at a community or ALF or whatever it might be. The second reason is just discharge disposition. They're not safe to go home, but their time has come up. So they have more medical needs. They need wound care, whatever it might be. You're going to get into a subacute rehab for that reason too. And then maybe long-term care after that. So yeah, it's just kind of how it's designed. Well, less than 5% is actually pretty good. I didn't know. Yeah, that's what we're judged on. Yeah. So that's a target. That's cool. Okay. Well, that's encouraged. For some reason in my mind, I thought it was a lot higher. It's getting higher from the acute hospitals to skilled. Because length of stay is everything now.

34:42 Skipping inpatient rehab. Denials have gone through the roof. I got to do a peer to peer today on a amputated patient, left BKA. And they got denied to come inpatient rehab. Below the knee, got denied to come inpatient rehab because they were at a minimal assist to contact guard and they could hop once he wasn't sick enough. I was just, I don't even know what to tell you. Did you win it? No. And it was Humana. So there's that. All right. Well, I wanted to end it on a high note, but on the somber note, we'll love you guys in the next one where we're going to talk about mobility, stability, and staying upright and staying capable. We'll finish strong with this one. Until next time, buddy. Thanks for listening to another episode of Medicine Redefined.

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