Transcription
I think Now's the Time to kind of look at that a little bit, which is you have a patient who's older, they come to you, and they have not been strength training. And you know, maybe they even do a DEXA and they see their metrics are really low as it relates to muscle mass. How do you start to incorporate that strength and resistance training to that individual?
Well, I mean, I think there's a real parallel here with what we talked about on the endurance side. So I always start from the same vantage point, which is if you're new to strength training, I want to make sure that in two to three months, you're looking back at the last two to three months thinking, A, I enjoyed that, wasn't as bad as I thought it was. Because remember, if someone hasn't lifted weights before, there's a reason, right? Like there's something about it that they are either intimidated by, afraid of, or didn't think it was valuable enough. I mean, there's a reason for it. So A, I want to undo that reason. Um, secondly, I want them to feel something is different. I want them to feel like, well, you know, I remember when I started this, I could only do this many push-ups, and now I can do that many push-ups. Or when I was doing leg extensions or leg presses, I had the pin on this weight, and now it's like 50% higher. And um, so, so, so that's, that's the first principle.
Second principle is again, similarly, we are going to start with volume more than we are going to start with load. Muscle, muscle, muscular resistance matters more to me than strength at this point. So I'm not going to lead in with, let's go after those type two fibers. It's going to be, let's work on the type one fibers. And I don't care if you need to do 15 to 20 reps on every exercise, so be it. Um, I'm not even really at this point going to be concerned with all the nuances of RPE, right? You know, and we've talked about this on many podcasts, including not just the podcast with Andy, but with Lane Norton. Um, the data are that, you know, it, the number of reps you do for hypertrophy and strength don't, especially for hypertrophy, don't really matter, provided you get to within one or two reps of failure. Well, we're not even really going to push that out of the gate. Um, we might prescribe, hey, pick a weight that you fail at about 12 to 15 reps. Um, but again, less concerned as to whether that's an RP2 or an RP4.
Um, the other thing to keep in mind is, in parallel to this, you've got to be working on some of the stability stuff, which is not necessarily weight-based. So this is where you're working on, um, intra-abdominal pressure exercises, really making sure that they can kind of pressurize the cylinder as we stay, um, breathing exercises. So a lot of the stuff we borrow from DNS and PRI, where we want to make sure that they can move their ribs correctly. Um, and obviously, you want to make sure that they have the ability to even recruit muscles correctly. And a lot of those things are kind of hard. But you know, I, I'll never forget an example Beth Lewis had me do, um, you know, one of the early times when I met her, which was, you know, laying on a floor, right? So picture me laying on my back, um, my knees are up, U, like my knees are up, but my feet are flat on the ground, right? So I'm in a very relaxed position. And it was an exercise around being able to sequentially recruit hamstrings one leg at a time and put the foot down into the ground and pull it back, if that makes sense. Um, so again, that's a pure hamstring isolation exercise. And yet, despite having very strong hamstrings, I really struggled to do that exercise while keeping my pelvic floor stable. Um, so again, those are the types of things where you're not going to get injured, but you're going to have to learn to start recruiting and controlling a muscle. And again, once you do that, you're much safer lifting.
And how do you think about resistance training for people kind of who are in the even older category, which is let's say 65 plus? I know at the outset, you kind of mention that at a certain point, the muscle mass you're losing and the things you have to be aware of is even higher. So how do you talk to a patient about this who is even in that older category?
I think you just have to do everything a lot slower. So for example, somebody at this age, um, you know, you'll do TRX, but you want to be much more stable in the positions you're doing. I would, would almost without exception, only have somebody at this age, if they've never lifted before, um, only using machines to start. I wouldn't really want them mucking around too much with dumbbells outside of maybe doing carries. Um, but I, I don't, I wouldn't want them picking even picking up dumbbells to do lunges or things like that. I would sort of save that for phase two of what they're doing. Um, and truthfully, you know, even though DNS, Dynamic Neuromuscular Stabilization, which people know I'm a big fan of, um, when people think about it, you sort of think of these baby positions. Well, the reality of it is, those positions are very important, uh, for people of any age. And so, um, teaching an older person, uh, especially a person who's new to physical activity, some of those positions is very valuable because A, it's doing all the stuff I talked about a second ago, but they're also getting comfortable with being on the floor and moving on the floor again. This is a, something that, you know, you and I will take for granted, Nick, for some time. Um, but, but people, you know, 20 years older, 30 years older than us, um, can't take for granted that being on the floor, moving on the floor, and getting up on the floor unassisted, um, is, is something that that they should be able to do easily.
And you kind of hinted at it there. So let's say someone is kind of in this older bracket, even 50 plus, and they're like, okay, I'm going to start resistance training. They obviously don't have a home gym, right? Most of people in that category aren't going to have that. And so if they do walk into kind of their local gym, fitness center, you would encourage them to start on the machines at first and lower weights, just to slowly work that up before grabbing free weights, grabbing dumbbells, anything like that?
I mean, again, I, at this level, it's difficult for me to provide, you know, very, very, um, thorough analysis because everybody is different. And and clearly, what, what you might say makes sense if this person also happens to have a trainer who's really good with them. Yeah, you're going to say, look, you're going to push things a little bit quicker. But if we're really starting at, hey, this is a person who's, you know, going to be doing a lot of this stuff alone in a gym where there's a ton of intimidating stuff going around, I would say, yeah, like let's stick with the machines. Um, and I wouldn't be trying to do, you know, dumbbell presses or, you know, Kettle, you know, kettlebell exercise or anything like that. No, I, I think you, you really want to build your strength and stability, um, with body weight and with machines before you progress. Again, if you have the luxury of having a trainer and that trainer is very good, I think they'll be able to progress you more quickly to those other things.
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