Direct Line (Free): GLP-1 Muscle Loss and Creatine, Bulking vs Cutting, One-Hour Training, & Detraining

0:00 [SPEAKER_00]: This is the Barbell Medicine Directline, our monthly ask us anything, not normally the whole episode is behind a paywall for our Barbell Medicine Plus subscribers. [SPEAKER_00]: But this month we pulled four questions out of it to give you a free run at it. [SPEAKER_00]: Yeah, we're talking about GLP1 drugs again and what effects they have on muscle mass, but this time we got a different bend on it.

0:18 [SPEAKER_00]: whether creatine helps or not. [SPEAKER_00]: Then we talk about whether bulking and cutting does anything compared to main gaining, how to train on one hour a week, and how fast you actually lose your gains when you stop training. [SPEAKER_00]: The full two hours in every back episode live on Barrel Medicine Plus, which is now bundled with Barrel Medicine Premium.

0:36 [SPEAKER_00]: More on that at the end, let's get into the episode. [SPEAKER_00]: All right, next question is about creatine on GLP1s. [SPEAKER_00]: So the question is resistance training on GLP1s, creatine, yay, or nay has it been studied. [SPEAKER_00]: So I think why this all matters, it goes back to this muscle mass loss concern, and perhaps even more specifically a decrease in muscle function as a result of that muscle loss from GLP1s.

1:02 [SPEAKER_00]: We have talked about this ad length before, but just to recapitulate, [SPEAKER_00]: We need to reframe how we're measuring muscle loss because, again, people put dexa this x-ray technology on a pedestal like, well, it's super accurate. [SPEAKER_00]: There are no errors here, but that is definitively not the case.

1:22 [SPEAKER_00]: Dexa splits up the human body compartments into bone. [SPEAKER_00]: fat and everything else. [SPEAKER_00]: And that everything else, the sort of third bin, gets called lean mass, but it's also water, glycogen, organ tissue, and specifically intramuscular and intra-liver fat. [SPEAKER_00]: So when weight loss occurs, all of that goes down.

1:45 [SPEAKER_00]: glycogen goes down, liver fat goes down, specifically with GLP ones, inflammation tends to go down intramuscular fat goes down, but all of that is red as lean mass loss by dexic because it cannot differentiate between those compartments. [SPEAKER_00]: Sure, it does pick up actual loss of adipose tissue that stored in body fat, but the fat that stored in your liver and the liver mass itself and the fat that stored in your muscle also goes down and dexterous reads that as lean mass.

2:12 [SPEAKER_00]: So, if you were to think about a sort of prediction, how much lean mass would you predict to actually be lost from GLP ones? [SPEAKER_00]: It would be the same as a diet-only intervention, which would be about one-quarter of all the way being lost would be muscle mass. [SPEAKER_00]: That is the prevailing sort of line in the sand that's been drawn for years and years and years.

2:36 [SPEAKER_00]: And so things you can do to modify that include resistance training, [SPEAKER_00]: Dieter, a changing the dietary intervention, adjusting the rate of loss and a better instrumentation to capture what's actually being lost. [SPEAKER_00]: All right. [SPEAKER_00]: So we're going to go through that with respect to training the studies to date on GLP ones and resistance training are relatively small.

3:06 [SPEAKER_00]: showed that with resistance training, you lose about half as much lean body mass, also those people got stronger. [SPEAKER_00]: There's the T-Rex study, which we have some preliminary results from great name by the way, but the resistance training arm roughly halved the amount of lean mass that's being lost versus the GLP1 alone.

3:25 [SPEAKER_00]: And this is the same relationship that you see with diet interventions versus diet plus exercise. [SPEAKER_00]: So if the sort of prediction was that, you're gonna lose about 25 per every, for all the way that you lose about 25 per cent of it is lean mass, right? [SPEAKER_00]: Accepting that it's not just contractile muscle tissue, [SPEAKER_00]: with resistance training.

3:45 [SPEAKER_00]: We think you're going to cut that in half. [SPEAKER_00]: That is our prediction. [SPEAKER_00]: It's not been studied adequately with GLP ones, but there's this that is the state of the evidence. [SPEAKER_00]: My hot take, get your take on this Dr. Barackie. [SPEAKER_00]: I actually predict that GLP ones [SPEAKER_00]: whether they're combined with resistance training or not, may actually have a more favorable muscle preservation effect, meaning that people don't lose as much, quote, actual muscle tissue when they just do the GLP1 alone, or when they do GLP1 plus resistance training, compared to diet alone versus diet and exercise alone.

4:22 [SPEAKER_00]: Why would I say that? [SPEAKER_00]: I think these GLP ones are just much better at reducing what we would call ectopic fat storage. [SPEAKER_00]: Ectopic just means look, your fats in a place that shouldn't be in the liver, in the muscle mass, and then visceral adipostation that fat around your the organs, your internal organs.

4:39 [SPEAKER_00]: It just seems to be better than diet alone. [SPEAKER_00]: So I actually think like maybe it's even, it would be even more favorable. [SPEAKER_00]: I don't know how does that strike you. [SPEAKER_01]: It is indeed a hot take, and I'm going to be reluctant to sign on to hot takes that involve what I'll call like a positive claim.

4:54 [SPEAKER_01]: And I will stick with the null hypothesis for now until I have a reason to move my opinion elsewhere. [SPEAKER_00]: Yeah, I mean, there's some evidence here that, um, particularly like to zip a tide, which is the dual agonist GIP and GLP1. [SPEAKER_00]: Yep. [SPEAKER_00]: and then specifically the newer agents that are triple agonist or more that involve a glucogon receptor agonist like retatratide, a servo-detide, there's a few other ones.

5:20 [SPEAKER_00]: The glucogon receptor agonist seem to like really get rid of liver fat and the liver mask goes down, meaning that a bigger proportion of the lean mass loss is from the liver. [SPEAKER_00]: So again, if you compared some body who lost 20 pounds with diet alone, [SPEAKER_00]: versus they lost 20 pounds with one of these either turns epitide or tattretide.

5:39 [SPEAKER_00]: If when it's approved, servoed a tide or whatever, I actually think that they've lost more non-contractile tissue because it's so damn good at getting rid of liver fat, this real adipose tissue and intramuscular fat. [SPEAKER_00]: That's my hot take. [SPEAKER_01]: And there's something that Lily has an opportunity here because they certainly have the cash at this point with how successful they've been to date to not use Dexis scans for their studies.

6:01 [SPEAKER_01]: And instead just do MRIs and people. [SPEAKER_01]: And then that would answer the question. [SPEAKER_01]: And if they were able to show something like that, then boom, like that's the biggest. [SPEAKER_01]: You know, flex that they would have. [SPEAKER_01]: It's not only do you have the most effective drug, but by MRI proven, like the least muscle mass loss or something like that.

6:14 [SPEAKER_01]: And then they're going to start combining, you know, with some of the, the myestatin inhibitors potentially and show some effects from there. [SPEAKER_01]: There's going to be even more efficacy. [SPEAKER_01]: I think once we start combining with like, Eloralintide. [SPEAKER_01]: So that's one that I'm like very optimistic about as a, it's an amuline receptor agonist that when combined with terzepotide, actually, so like you have patients who are plateaued on 15 milligrams of terzepotide and then you add the allural entide, which is an amuline agonist and they start losing weight more beyond that without substantial side effects.

6:47 [SPEAKER_01]: And so, [SPEAKER_01]: There's again, the future is bright for this field, and then if they could just put these concerns to bed about like loss of muscle mass and things like that, particularly like unique loss of contractile tissue, muscle mass strength, like things like that, by using better measurement tools than Dexa, then they would definitely have the strongest case in this space.

7:07 [SPEAKER_00]: Yeah, I feel very confident, supremely confident, in fact, that adding resistance training to a GLP1 for an individual is going to be beneficial for preserving muscle mass. [SPEAKER_00]: You're probably going to cut at least half of the actual contractile muscle tissue loss. [SPEAKER_00]: That's our prediction.

7:23 [SPEAKER_00]: I feel less confident, but optimistic that the actual amount of loss from GLP1s is [SPEAKER_00]: perhaps a little bit better than diet alone. [SPEAKER_00]: And on the same vein, I don't think that the muscle losses are excessive, at least by available data. [SPEAKER_00]: If there was all this sarcopenia signal, for example, I would feel differently, but to date, yeah, that's not the case.

7:51 [SPEAKER_00]: So ultimately, resistance training has been understudied in this population, but I think we have no reason to expect that it would be like bad. [SPEAKER_00]: But I don't think that's what she's asking. [SPEAKER_00]: More just like, look, what is the actual evidence on this? [SPEAKER_00]: It's a little skinny at this point.

8:05 [SPEAKER_00]: The second part of this question was what about creatine? [SPEAKER_00]: This has not been studied in GOP once period. [SPEAKER_00]: So to the extent that somebody says, look, this is evidence-based for reducing the muscle loss from GOP ones. [SPEAKER_00]: Well, one, the muscle loss really wasn't that crazy to begin with thing one.

8:17 [SPEAKER_00]: Think to it's never been studied in GOP ones. [SPEAKER_00]: And then the third thing is when it's been studied outside of GOP ones, it has a very modest effect and even more modest to arguably small, perhaps negligible, [SPEAKER_00]: The effects on muscle mass and strength to some degree are mostly related to, again, training load.

8:38 [SPEAKER_00]: We go back to sort of maximizing training load, and so in generally speaking, people on creatine can do a few more reps, lift a little more weight, training load goes up a little bit. [SPEAKER_00]: Strength performance does have some sort of direct effect from creatine based on energy because of the actual in many individuals.

8:53 [SPEAKER_00]: Now they have more intracelular energy to commit to heavy efforts, but for hypertrophy really it's mostly through training load and it's a pretty small effect. [SPEAKER_00]: Still nothing in GLP ones. [SPEAKER_00]: but if somebody on a GLP one was interested in using creatine, fine. [SPEAKER_01]: Yeah, I actually did a little searching and I found that there is a kind of pre-registered pilot trial on a clinical trials.gov.

9:15 [SPEAKER_01]: This is from the University of Saskatchewan. [SPEAKER_01]: I don't know. [SPEAKER_01]: I'm interested to see. [SPEAKER_01]: Yep, shout out. [SPEAKER_01]: I have some background family background up in that part of the world. [SPEAKER_01]: And so it looks like they are doing a randomized trial of 40 people starting jumping one agonist to receive either 10 grams per day of creatine solid dose or placebo during a resistance training program which will be three days per week for 12 weeks.

9:38 [SPEAKER_01]: And so they said it is hypothesized. [SPEAKER_01]: That participants on creatine will have superior maintenance of lean tissue masks. [SPEAKER_01]: We'll see again how they choose to measure that and function performance compared to participants taking placebo. [SPEAKER_01]: Now, this is going to be a tough one, I think, because again, to your point, the effect of creatine in general tends to be relatively modest and you have two groups that are both training.

9:58 [SPEAKER_01]: And so it's like you need an effect that outweighs the bet the effect of training itself to a big enough degree that you're going to be able to detect that difference in a sample of 40 people over 12 weeks. [SPEAKER_01]: I question the power of this trial, it's going to depend on how they're training these people and then also how they're measuring the outcomes, but it looks like the study start date was May 25th of 2026, so like three weeks ago, and it's completion.

10:22 [SPEAKER_01]: I don't know why it says primary completion estimated is going to be in December of 2027, so that's the, you know, that's the pace that research goes at. [SPEAKER_01]: So we'll see. [SPEAKER_01]: I'm looking forward to the results of that one. [SPEAKER_00]: Yeah, watch this space. [SPEAKER_00]: Yeah.

10:34 [SPEAKER_00]: All right. [SPEAKER_00]: So that's the story on a GLP one, the resistance training evidence today, creatine. [SPEAKER_00]: All right. [SPEAKER_00]: Next question. [SPEAKER_00]: We're going to talk about one of the most. [SPEAKER_00]: Longest lasting arguments in the finished space. [SPEAKER_00]: Vulcan and cutting should you do that or should you just maintain weight your main gaining right so the question is does Vulcan and cutting actually do anything meaningful If a guy goes from a hundred eighty to two hundred pounds back to a hundred eighty pounds while training isn't he just back to one eighty without without without any Body composition change explain from the training itself feels like the industry oversells it

11:12 [SPEAKER_00]: I mean, look, I'm going to climb no agree. [SPEAKER_00]: I'm not going to protect the fitness industry. [SPEAKER_00]: Most of what's being said in the spaces is BS. [SPEAKER_00]: So, probably this included, but I think the main proposition here is as follows. [SPEAKER_00]: You have to gain weight or bulk in order to increase muscle mass and you're going to accept some degree of fat gain.

11:30 [SPEAKER_00]: That is true. [SPEAKER_00]: The proportion determinants, so how much fat to muscle mass are training? [SPEAKER_00]: right? [SPEAKER_00]: Genetics, drugs, and the rate of gain. [SPEAKER_00]: The more training that you're doing, the more favorable your genetics, the more drugs that you use, and the more modest the rate of gain, the better proportion you're going to have, meaning more muscle mass versus fat mass, and then the opposite is also true.

11:57 [SPEAKER_00]: Then, after doing the bulk and gaining the weight, in order to be leaner, you need to lose the body fat, and you're also going to accept some degree of muscle loss, muscle loss, which is also true. [SPEAKER_00]: And the thing that determines the proportions here, again, relative fat, relative to muscle mass are the same things, training, genetics, drugs, and rate of loss.

12:16 [SPEAKER_00]: With more training, more favorable genetics, more drugs, and a more modest rate of loss, we would predict more fat to be lost relative to muscle mass, and with less training, less favorable genetics, less drugs, and a faster rate of loss the opposite, more muscle loss relative to fat mass.

12:33 [SPEAKER_00]: Now, I take that proposition and I compare it to the alternative. [SPEAKER_00]: I'm just going to go maintenance. [SPEAKER_00]: You would predict a slower amount of muscle gain, [SPEAKER_00]: particularly when you go slowly because muscle gain itself is relatively slow and there are problems with measuring this accurately.

12:52 [SPEAKER_00]: So like you may not know that you're not actually gaining a muscle if you're just using Dexa, for example, the error bars are there. [SPEAKER_00]: It's pretty noisy, which is also totally fine because like... [SPEAKER_00]: how fast you need to go really, right? [SPEAKER_00]: Is there like a, or is it a race, you know?

13:07 [SPEAKER_00]: The other alternative would be like to try to train in a deficit where you can gain some muscle mass, but we've predicted to be even slower. [SPEAKER_00]: Some of this actually coming from like redistribution of muscles that you are necessarily using in training to muscles that you are.

13:19 [SPEAKER_00]: We saw that in a recent study. [SPEAKER_00]: So for me, the decision here should you do bulking, verse, main gaining, verse, and get trying to gain muscle mass and a deficit, it all comes down to first health to constraints and then three what are your preferences. [SPEAKER_00]: Health wise, if someone's got a BMI that is very consistent with carrying excess body fat, right, which would generally be above 30, certainly above 35.

13:45 [SPEAKER_00]: Alternatively, if their waste circumference was passed, this sort of known cut points generally from men, it's at its most extreme end, 40 inches, less extreme, 37 inches for women, 31 in 29. [SPEAKER_00]: Or if their waste to hip ratio is significantly above the target, which is 0.5, and or if they have an atoposity-based chronic disease, high blood pressure, dyslipidemia, insulin resistance, whatever, all of the is a signal like you'd probably benefit from weight loss.

14:13 [SPEAKER_00]: That's case scenario. [SPEAKER_00]: If you're not in a good place to do that, then maintaining your weight while trying to improve body composition, via exercise and lifestyle change would be great. [SPEAKER_00]: Is this how you think about weight gain, weight management with respect to health?

14:26 [SPEAKER_00]: Like, I imagine most of your patients aren't coming in like, doc, I really just want to gain 20 pounds of muscle. [SPEAKER_00]: Like, I feel like I need to do that, but theoretically, if you had that and you were trying to say, is this a good idea about idea? [SPEAKER_00]: Does that framework from a health perspective makes sense to you?

14:41 [SPEAKER_01]: Yeah, I'd fully agree with that line of reasoning. [SPEAKER_01]: The vast majority, obviously, with the type of work that I'm doing more of these days and in weight management involved conversations around weight loss and those types of goals, the types of health consequences we're trying to mitigate, making sure it's being done that like a relatively safe rate that people aren't losing weight, that an unsafe rate, things like that.

14:59 [SPEAKER_01]: But sometimes I've also seen patients who maybe have taken things a bit too far and we need to slow things down, sometimes even deliberately gain some weight. [SPEAKER_01]: If anything, besides all the question of like what works best in the situation, for folks who have had dealt with overweight no-be city in the past, having that conversation of like we've actually gone too far and we need to actually do a little bit of gain some weight.

15:19 [SPEAKER_01]: It can be super challenging because they're like I've lived with obesity my whole life and it's really tough for me to like get wrap my mind around the idea that I actually need to deliberately gain some weight. [SPEAKER_01]: So [SPEAKER_01]: But those have been some of the more interesting and challenging conversations that I've had recently, not being in the space where I'm like coaching bodybuilders, actually either these days or arguably ever.

15:38 [SPEAKER_01]: It means that I've fortunately been spared much of these conversations, but I wouldn't want to deliberately incur a lot of health consequences by way of weight gain. [SPEAKER_01]: And to say, oh, well, we were trying to gain some muscle mass. [SPEAKER_01]: We're going to give you hypertension and insulin resistance, but don't worry.

15:54 [SPEAKER_01]: It will just like, you know, it'll be easy to lose the [SPEAKER_01]: So that is not the approach that either of us would recommend for folks. [SPEAKER_00]: Yeah. [SPEAKER_00]: Yes. [SPEAKER_00]: I do think health, again, primarily should be the major lover here or major like determinant of which direction that you go mainly again to solve for training load because if you are.

16:14 [SPEAKER_00]: your health is declining. [SPEAKER_00]: That is going to compromise training low-long term. [SPEAKER_00]: The second is constraints. [SPEAKER_00]: So if you think about a person who's like, look, my health is otherwise fine, but I agree with you. [SPEAKER_00]: I'm going to monitor health.

16:24 [SPEAKER_00]: So what's down this algorithm? [SPEAKER_00]: What's the next branch point? [SPEAKER_00]: Well, is there a reason why you would specifically want to choose a faster [SPEAKER_00]: either rate of gain or rate of loss and depending on which direction you to go, it may be with your competitive season.

16:41 [SPEAKER_00]: You're like, look, I can train hard during the off season. [SPEAKER_00]: I got a lot of extra training resources because I don't have my competitive sport. [SPEAKER_00]: Just have some practice, some maintenance sort of upkeep of skill set and so on and so forth. [SPEAKER_00]: Perhaps that is your branching point there, right?

16:56 [SPEAKER_00]: The other thing I would consider here, maybe the next branch point is just preferences, right? [SPEAKER_00]: A person with the history of obesity, [SPEAKER_00]: We're about recommending a faster rate of gain. [SPEAKER_00]: Generally speaking, you would predict that person is likely to gain more fat mass in general, compared to a person who's never had that issue, whether that's a result of being obesity sensitive or obesity resistant, probably playing a part there in addition to other factors.

17:23 [SPEAKER_00]: But the idea that it's easy to lose fat and to keep fat off, unfortunately, is not supported by evidence. [SPEAKER_00]: If that were the case, [SPEAKER_00]: then lifestyle interventions, intensive lifestyle interventions with nutritional counseling, exercise counseling, monitoring long-term would be far more successful and unfortunately that is not the case.

17:43 [SPEAKER_00]: So I think it is fine to accept fat gain when you are gaining muscle mass. [SPEAKER_00]: But I think doing it rapidly and maybe even haphazardly with the [SPEAKER_00]: inconsistent with the current evidence and I think ultimately would set people up for failure. [SPEAKER_00]: So practically speaking, I think it in a most favorable situation you'd have somebody do a small increase over maintenance.

18:08 [SPEAKER_00]: A small surplus, like 100 to 300 calories. [SPEAKER_00]: And you would confirm that a person in a small surplus by their scale weight gradually moving up. [SPEAKER_00]: Pretty modest amount, a few pounds a month, perhaps. [SPEAKER_00]: Unfortunately, we can't use Dexa, which would be arguably the most accessible and highest fidelity sort of test of body composition and changes in body compartments that people have access to because nobody's going to name a IRCT for this.

18:34 [SPEAKER_00]: It's just too noisy. [SPEAKER_00]: It's the problem. [SPEAKER_00]: Um, I would have people while they're doing this still assume a health promoting dietary pattern, meaning they're getting enough protein, which we think is somewhere between like 1.4 to 1.6 grams of protein per kilogram body weight per day.

18:52 [SPEAKER_00]: a little bit higher for some folks, but again, it's mostly on the margins. [SPEAKER_00]: They're still consuming a lot of fiber per day, 30 to 40 grams per day, sort of minimum, and they're still kind of watching their saturated fat intake, particularly from red meat, and butter, things like that, keeping those to 10% or less of the dietary pattern.

19:11 [SPEAKER_00]: We need to solve for adherence here, because if the goal and exercise prescription is to maximize training load, the goal and dietary prescription is adherence. [SPEAKER_00]: And this isn't like one day a week, right? [SPEAKER_00]: Just like one training session is not gonna determine your outcomes, one day of eating well, is not gonna determine your outcome, and just one week is not that either, it's months and months stacked on top of each other.

19:33 [SPEAKER_00]: And so I actually think, or maybe speculating here, of course, that, [SPEAKER_00]: poor adherence over multiple weeks and maybe like obesity resistant sort of genotypes has what's led to like the existence of the dirty bulk advice like now you look you got at pizza, put olive oil on top of it and then wash it down with the you know sheet cake or something like that.

19:54 [SPEAKER_00]: And it's like all you're doing is solving for the other days of the week under eating, perhaps with a genetic set up that ultimately is resisting weight gain. [SPEAKER_00]: Those people may need more aggressive sort of, you know, a calorie surplus is more more modern, but I still don't think a dirty bulk is really the answer there for most folks.

20:14 [SPEAKER_00]: Last part of the practical stuff it has to do with a planned timeline. [SPEAKER_00]: A lot of people, particularly in this guy's example, 180 to 200 back to 180, it's like how long do that take because legitimately gaining 20 pounds, that's like a year endeavor, right? [SPEAKER_00]: And I would expect [SPEAKER_00]: that a strong a significant proportion of that would be muscle mass actual contractile muscle tissue.

20:36 [SPEAKER_00]: If you did that at three months, I suspect less, right? [SPEAKER_00]: And so yeah, that yo-yo thing, you see that all the time show it practically. [SPEAKER_00]: I'd also have like a waste cap, something like that, or like, oh, your blood pressure is going up, your sleep apnea is getting worse, something like that.

20:51 [SPEAKER_00]: If that's going up, it's probably not worth the risk, but also ensure that people are training, which I think [SPEAKER_00]: And then you would individually individualize your approach based on their response, whether or not you want a slower or faster rate, how long you're going to do this for and the actual training that you do it's all based on preferences and your response anything you want to add to this sort of bulk cut analysis.

21:15 [SPEAKER_01]: Not a ton. [SPEAKER_01]: I'm generally not a fan of dedicated periods like this myself. [SPEAKER_01]: I prefer just more incremental sort of things. [SPEAKER_01]: Kind of like how I design like training programs, since we're more incrementalist in nature, rather than like very discrete, very divergence, sort of blocks from one phase to the next.

21:28 [SPEAKER_01]: The exception would be somebody who is a multi-sport athlete. [SPEAKER_01]: So, you know, I've worked with folks who like during part of the year, they like to train up and compete, maybe do a powerlifting meet, and then the other into the year, they like to train more in the endurance realm and run a, you know, a 10k or a half or a full [SPEAKER_01]: That's some clients who like to do that over the years, and so that sort of alternating ends up being less of like a deliberate bulk and cut, but more of like you're just kind of like eating based on the demands of your sport and then the training almost takes care of the rest, so they naturally will tend to lose weight when they shift their dietary pattern and they're like running, you know, 50, 60 plus, you know, 100 mile weeks or something like that, and then when they cut all that back doing just like a minimum and then their focus more on powerlifting and eating to fuel that than the weight gain and muscle muscle tend to come back a little bit.

22:10 [SPEAKER_01]: So it's almost more like accidental, rather than very deliberate. [SPEAKER_01]: But short of that, again, not being a body building coach, I don't tend to, you know, subscribe to that idea or put it into practice very much myself. [SPEAKER_00]: Yeah. [SPEAKER_00]: Yeah. [SPEAKER_00]: I just think generally speaking, trying to increase muscle mass if that is your primary goal, straight up maintenance, meaning that your body weight doesn't go up at all.

22:28 [SPEAKER_00]: I'm likely to get you there. [SPEAKER_00]: Yeah. [SPEAKER_00]: Yeah. [SPEAKER_00]: Yeah. [SPEAKER_00]: Difficult. [SPEAKER_00]: All right. [SPEAKER_00]: This next question is about training when you're extremely short on time. [SPEAKER_00]: So the question is, if someone is extremely short on time, training just once a week for less than an hour and their goal is health and overall well-being, [SPEAKER_00]: or doing a larger variety of technically easier movements to give the body more movement diversity.

22:56 [SPEAKER_00]: So just to make sure I understand the question, if it's two to three heavy compound lifts, so multi-joint exercises like the squat, bench press, deadlift, [SPEAKER_00]: Right. [SPEAKER_00]: And what's the comparator? [SPEAKER_00]: Because it says technically easier. [SPEAKER_00]: And I don't know that those exercises are super technically demanding.

23:15 [SPEAKER_00]: I mean, you could make the argument that a machine based type training plan would be less skill dependent rights, not freestanding a real balance component there. [SPEAKER_00]: but I don't know that that necessitates a greater or smaller amount of exercise variation, right? [SPEAKER_00]: And you know, it's certainly not gonna be like dumbbells, right?

23:39 [SPEAKER_00]: Cause I think like a dumbbell split squat or Bulgarian split squat with dumbbells may actually be like more technically demanding. [SPEAKER_00]: I also think it's important to point out that, [SPEAKER_00]: Because the exercise variety is not likely to be different. [SPEAKER_00]: It's just a variable that you can go up or down.

23:55 [SPEAKER_00]: I don't think that that's really part of an important part of the calculus here that decision making when it comes to exercise prescription. [SPEAKER_00]: Generally speaking, when I think about exercise selection, [SPEAKER_00]: I'm thinking it's mostly personal preference, right? [SPEAKER_00]: Like, what does the person want to do and what they have access to?

24:12 [SPEAKER_00]: And then the trainability, which is it's a made-up word that I use to refer to, can the person do the exercise with minimal discomfort and pain? [SPEAKER_00]: Is there technique acceptable? [SPEAKER_00]: So it's repeatable, it's fairly efficient. [SPEAKER_00]: It meets the points of performance.

24:27 [SPEAKER_00]: Can they load it, you know, throughout a relatively wide range of different intensities? [SPEAKER_00]: And then, you know, [SPEAKER_00]: is it something that they can do a lot of without getting a two fatigue? [SPEAKER_00]: So, for example, somebody may want to train the overhead squad, but their technique isn't there yet.

24:44 [SPEAKER_00]: They have some pain when doing it. [SPEAKER_00]: They don't really have access to a lot of different entesies they can use because of these things. [SPEAKER_00]: For example, and then it causes a lot of fatigue because they're not really able to do the exercise that well. [SPEAKER_00]: doesn't mean they should never do the overhead squat or train that movement pattern, but does it deserve a full slot in their exercise program, especially when the time is limited like a regular back squat or a leg press even, right?

25:12 [SPEAKER_00]: Like in that case, if someone can't really train the overhead squat, they're mostly just doing, you know. [SPEAKER_00]: practice, practicing the movement, compared to the leg press, where they can load it, you know, relatively heavy, a lot of different rep ranges, no pain. [SPEAKER_00]: They can do a lot of that, that'll get in generating too much fatigue.

25:28 [SPEAKER_00]: When you think about, you know, health sort of benefits from resistance training, that's clearly going to be the winner. [SPEAKER_00]: There. [SPEAKER_00]: So to start this out, I don't know what the comparator would be between like two to three heavy compounds that are presumably barbell based versus other multi joint exercises that are not barbell based.

25:45 [SPEAKER_00]: Right. [SPEAKER_00]: If that gave that's the comparator, I'm going to talk about health. [SPEAKER_00]: They're the same, right? [SPEAKER_00]: And if we're talking about performance, like strength, well, then it matters how we're measuring strength, right? [SPEAKER_00]: So for example, you can have somebody do like Smith machine squads or a leg press and compare it to that person's evil twin just doing only parbole backsquads, right?

26:05 [SPEAKER_00]: And then you test their leg extension strength in three months. [SPEAKER_00]: I would not predict there to be any differences, provided they did similar amounts of training load, which is the real goal here, right? [SPEAKER_00]: When you're making a plan for somebody making a program for them or yourself is to maximize training load where training load is not only the amount of exercise that you're doing, but also the nature of it right.

26:29 [SPEAKER_00]: So you think about like five sets of five on squat versus five sets of five on leg extensions. [SPEAKER_00]: The volume is the same, but the nature of the exercise are different. [SPEAKER_00]: So you're going to get differential effects, including the fatigue costs of each one. [SPEAKER_00]: Why would we want to maximize training load?

26:45 [SPEAKER_00]: You might ask, well, we think there's a dose response relationship between training load and both health and fitness outcomes or performance outcomes. [SPEAKER_00]: And really, you could just say training adaptations, right? [SPEAKER_00]: Just lump all of that together. [SPEAKER_00]: The more training that somebody can do specifically training loads is not just volume.

27:03 [SPEAKER_00]: the better sort of or the more adaptations that they're likely to get. [SPEAKER_00]: There are two big bottlenecks here. [SPEAKER_00]: One is time. [SPEAKER_00]: In this case, once a week, for less than an hour, and the second bottleneck here, or in generally speaking, is the physiological tolerance.

27:19 [SPEAKER_00]: So not just can a person perform, the exercises listed on paper, but can they recover from it, right? [SPEAKER_00]: And so, [SPEAKER_00]: As you go along your training career, things are going to change. [SPEAKER_00]: You're going to have different logistical sort of constraints, time and training resources.

27:34 [SPEAKER_00]: So that'll be a constraint on training load and your physiological tolerance, your recovery capacity will also change. [SPEAKER_00]: Sometimes better, as fitness goes up, sometimes less, as fitness goes down, these things are all dynamic. [SPEAKER_00]: So the other thing I want to say about training load is that, you know, [SPEAKER_00]: I'm less concerned about the training load in one specific session, as I am concerned with training load over a longer time scale.

28:00 [SPEAKER_00]: So it's not just one workout, not just a week of workouts and not just like a month of workouts, but like six months of workouts. [SPEAKER_00]: I want to know how much training load did the person do. [SPEAKER_00]: and I want to maximize that. [SPEAKER_00]: So as a practical example, let's say you had somebody had a four day a week program and one week they did three days a week and the other week the next week they did five sessions in a week, right?

28:20 [SPEAKER_00]: So the training load is just this exact same as it would otherwise if they did four days, so on week one and four days only two. [SPEAKER_00]: To me, that all washes out, you know, over a long enough time period. [SPEAKER_00]: In this particular case, we only have one day a week, so you know, we really have to get as much out of that as we can.

28:38 [SPEAKER_00]: So within that, and I think maybe more pertinent to this question, exercise selection is another way to sort of distribute and manipulate training load, mainly based around fatigue costs, and we think that fatigue costs are related to how much muscle mass is being used, like more muscle mass, a little more fatigue.

28:58 [SPEAKER_00]: how much range of motion is the individual moving through where a much larger range of motion is likely to cost more fatigue than a much smaller range of motion where things that are relatively closely related like a squat to one inch below parallel to a squat to three inches below parallel.

29:14 [SPEAKER_00]: That probably washes out, probably not big enough. [SPEAKER_00]: The absolute loading contributes so heavier things tend to be a little bit more. [SPEAKER_00]: fatiguing, then lighter things. [SPEAKER_00]: Again, the gap has to be big enough to matter people always say things like all the deadlift is more fatiguing than squat, one is actually tested.

29:32 [SPEAKER_00]: Not so much the real big thing there and this is kind of an aside is that most people have done way more squat training than they have deadlift training so they're more tolerant of the squat. [SPEAKER_00]: That's another aside. [SPEAKER_00]: We think skill requirements likely affect fatigue where something like doing a power clean or a snatch or something would be [SPEAKER_00]: You know, like a leg press, it's due to the skill difference is, again, the gap has to be big enough to matter.

29:56 [SPEAKER_00]: And then things that are a little bit more concrete that don't, the gaps don't have to be so big to matter. [SPEAKER_00]: We have to do with volume, right? [SPEAKER_00]: More reps, more sets, this is fatigue, and proximity to failure. [SPEAKER_00]: Closer to failure are all the way to failure, even that momentary failure would generally increase fatigue.

30:13 [SPEAKER_00]: So you can select exercises that use more or less muscle mass, more or less range of motion, have substantial differences in absolute loadings, skill requirements, things that kind of allow you to do more volume or less volume. [SPEAKER_00]: And, you know, the proximity failure, things just an exercise prescription sort of variable that we use.

30:36 [SPEAKER_00]: So at this amount of training, though, one session a week, I don't think this is that important. [SPEAKER_00]: It's more like, what are the exercises the person wants to do, what they have access to, what will they do, and then just, you know, try to do as much as possible. [SPEAKER_00]: This is the same analogy, and we'll come back to this another question between conditioning intensities, like the intensity of somebody's cardio, right, where you have people saying, you look, you got to do all the zone one zone two easy stuff, and while that can be useful, [SPEAKER_00]: as a sort of heuristic or a general rule of thumb, if somebody doesn't have a lot of time to do conditioning, then that is the wrong sort of prescription.

31:14 [SPEAKER_00]: So for example, if the current guidelines say, look, you do somewhere between 150 to 300 minutes of moderate to vigorous on activity, that would be like steady state type stuff. [SPEAKER_00]: But the person only has an hour per week. [SPEAKER_00]: Well, they would be better served by doing higher intensity, conditioning and work, whether it's discontinuous, so high intensity, high intensity, interval training, or more continuous stuff, but still at a higher intensity, that would be better because of the limited time than doing lower intensity stuff off of the same amount of time, right?

31:44 [SPEAKER_00]: It only matters when you get to higher volumes, and we'll come back to that. [SPEAKER_00]: So, it should be clear by now that the real issue here is that one time a week with one hour of training, the training load is going to be very, very limited. [SPEAKER_00]: Um, that said, you can still get a lot out of a little, um, you know, like muscle strength and in activity, uh, correlates with roughly a 10 to 17% lower all cause mortality in, um, in data sets, pretty large data sets, where most of that benefit come from doing like nothing to moving to just doing 30 to 60 minutes a week, you can get like, you know, a lot out of a little.

32:19 [SPEAKER_00]: Are you going to maximize so I just performance or health benefits in response to resistance [SPEAKER_00]: Because they're not going to build enough muscle and a strength bone mineral density, you know, other sort of effects we see, particularly with respect to metabolic health. [SPEAKER_00]: Most people will need more training than that.

32:37 [SPEAKER_00]: The other big concern here is that I'm assuming and, you know, risks there that within this one hour per week workout, they also have to get all their condition in and two. [SPEAKER_00]: And similarly, there's a dose response relationship between. [SPEAKER_00]: Cardi-Restory Fitness training load.

32:54 [SPEAKER_00]: and Carter's free fitness improvements. [SPEAKER_00]: So like each one metabolic equivalent increase or a metabolic equivalent is basically a measurement of how much energy is being used during the activity. [SPEAKER_00]: Each one met in increase. [SPEAKER_00]: This is also used to measure somebody's cardiovascular fitness, their capacity.

33:14 [SPEAKER_00]: So because it correlates to energy, [SPEAKER_00]: We're sitting at rest is like a one med activity and like an eight med activity would be running at a pretty good clip you're using eight times as much energy. [SPEAKER_00]: So if you can increase somebody's cardiovascular fitness by one met then that a correlates to a 13% lower mortality for each met there.

33:37 [SPEAKER_00]: If you can't do any conditioning, you're going to be challenging to increase your cardiovascular pre-fitness lifting, doesn't really do that unless somebody has really, really low cardiovascular pre-fitness levels to start, and then you get a little bump, but then it plateau is very quickly.

33:49 [SPEAKER_00]: So we would have to do all of this. [SPEAKER_00]: some lifting and some conditioning in that hour, and then basically try to do as much as we can within that hour. [SPEAKER_00]: So what would you do? [SPEAKER_00]: We're gonna try to do as much resistance training volume as we can while preserving some time to do some conditioning.

34:07 [SPEAKER_00]: The way I would do this would look a lot like our time crunch template, our two day per week time crunch template, and I would just split that over two weeks. [SPEAKER_00]: And I think super sets would be very useful here because we can get more training load in here. [SPEAKER_00]: by doing so.

34:20 [SPEAKER_00]: Specifically, if we do what are called alternate peripheral supersets, where you do something like an overhead press, superset it with the lake press, right? [SPEAKER_00]: Because they just don't have a lot of crossover muscles. [SPEAKER_00]: And so we can preserve training load. [SPEAKER_00]: Right.

34:35 [SPEAKER_00]: So not only how many reps and sets of persons doing, but how much weight they're lifting, the intensity, also contributes here. [SPEAKER_00]: Compared that to doing like bench press and flies, agonist agonist superset well, the train load suffers. [SPEAKER_00]: So I would think that and so I would basically do our two day per week, time crunch template and split it up.

34:53 [SPEAKER_00]: every two weeks so you're kind of doing work out A on week one, work out B on week two, work out A on week three, work out B on week four. [SPEAKER_00]: So you basically just have different exercises for all of the major movement patterns. [SPEAKER_00]: The squat press the pole and a hinge so it could be like a back squat and a leg press the squat pattern.

35:15 [SPEAKER_00]: It could be for the press. [SPEAKER_00]: It could be a bench press and an overhead press could be machine press and a dumbbell or a red press whatever For the for the pole it could be a chess supported row and a pull up chess supported row lat pulled out something like that and then hinge could be like a deadlift and hit the rest I'm just making it up and so yeah work out a you have you pick four of those right one squad one press one row one hinge [SPEAKER_00]: Set them up alternate peripheral and the next week do the other ones also set up with that alternate peripheral through to superset and I would do some conditioning afterwards and because of the time crunch that's probably going to be higher intensity stuff high intensity intervals probably bordering on sprint intensity intervals for this for this individual.

36:00 [SPEAKER_00]: So if the goal is overall health and you only got one hour per week, the best use is sort of this hybrid approach. [SPEAKER_00]: Yeah, I think most of the exercises should be multi-joint exercises. [SPEAKER_00]: They can become compound movements. [SPEAKER_00]: They should be compound movements, but they don't have to be barbell based.

36:16 [SPEAKER_00]: They could be machine based. [SPEAKER_00]: They could be some blend of the two either way. [SPEAKER_00]: And you should do some condition at the end. [SPEAKER_00]: All right. [SPEAKER_00]: Next question. [SPEAKER_00]: In the progressive loading episode, you explain that the nervous system muscle tendons and bone adapt to strength training on different timelines, do they atrophy the same way.

36:35 [SPEAKER_00]: So, if you have a long layoff, do you lose muscle faster than bone density, does muscle atrophy outpaced the weakening of tendons? [SPEAKER_00]: Yeah. [SPEAKER_00]: So this all depends on why the person is experiencing detraining because that answer drives most of this and more than the specific tissue.

36:54 [SPEAKER_00]: So for example, you can detrain because you have had an injury right that it plus or minus being immobilized. [SPEAKER_00]: You could be immobilized for some [SPEAKER_00]: if about how to injury, I mean, in a cast, you could be sick, for example, with the body-wide infection, or some sort of severe disease, or you could just be outside of the gym, normally walking around, living your normal life, just not exercising.

37:23 [SPEAKER_00]: So all these things are different. [SPEAKER_00]: And I think most of the scary data with respect to like detraining and muscle loss, strength loss, bone loss, tendering modeling, a little less so that the data's not so great there. [SPEAKER_00]: comes from what I would call severe detraining environments, either the person's bed bound, they're mobilized, either a research study or due to injury or they have some sort of medical condition that keeps them bed bound on top of that they have an illness that is actively like kind of detraining them.

37:57 [SPEAKER_00]: So let's start with the mobilization. [SPEAKER_00]: This is a pretty fast and dramatic case especially around the muscle mass. [SPEAKER_00]: If you put a healthy young person's leg in a full cast, [SPEAKER_00]: their quadriceps cross sectional area, the size can drop by three and a half percent in five days and roughly eight percent by two weeks or 14 days.

38:18 [SPEAKER_00]: You put somebody's dominant arm and sling and their grip strength can go down by 20 percent in just a few days. [SPEAKER_00]: Pretty dramatic, pretty scary sound and stuff. [SPEAKER_00]: But we think the mechanism here is because the limb is unable to move right, it's being immobilized, that it compromises the excitation contraction coupling between basically your central nervous system, and later in your peripheral nervous system, how that tells the muscle to contract in a coordinated manner.

38:48 [SPEAKER_00]: And so that's why you see these relatively like dramatic decreases in strength. [SPEAKER_00]: This is different than just not going to gym or for a little while because you're busy right so it's a different scenario and further to this point or the last thing I'll say on this point. [SPEAKER_00]: there's a cross-training phenomenon that if you take somebody who has an immobilized limb and they work out the rest of their body, particularly opposite side of their body, does seem to preserve some of the muscular adaptations strength and strength and size to some effect.

39:17 [SPEAKER_00]: That seems to wane longer term, right? [SPEAKER_00]: You know, we're not talking about immobilizing somebody for six months and you can prevent any loss, but certainly for a few weeks, you can see less less of that loss. [SPEAKER_00]: That's case number one. [SPEAKER_00]: Case number two would be someone's on bed rest with an illness.

39:34 [SPEAKER_00]: Can't be even more dramatic than just the immobilization because not only is the person in functionally immobilized, they're in bed, but they also have the potential to have an illness that is actively sort of, you know, reducing their adaptation, actively decaying their adaptations. [SPEAKER_00]: So, um, [SPEAKER_00]: You think about a cannabolic illness like sepsis, right?

39:56 [SPEAKER_00]: Some body-wide infection that's gotten into the blood, that actively increases muscle protein breakdown. [SPEAKER_00]: You can see a drop in muscle size, muscle cross-sectional area, 26% in one week, which is significant. [SPEAKER_00]: So you have the unloading that's already happening because you're in bed-bound, right?

40:11 [SPEAKER_00]: So you are functionally mobilized, but on top of that, you have the condition that's adding on top of that's additive. [SPEAKER_00]: uh, injuries a little bit different. [SPEAKER_00]: Um, it's not people aren't always immobilized and you're generally not completely immobilized, but we see that strength falls pretty dramatically early on, but it doesn't keep getting worse.

40:33 [SPEAKER_00]: Um, so basically you see like a drop in the first few days, it kind of stabilizes and then as the person recovers heals gets better. [SPEAKER_00]: Um, tends to recover relatively quickly. [SPEAKER_00]: it just tends to be proportional to how long the person is unloaded for, right? [SPEAKER_00]: We're not exercising and so some of the stuff we talked about the previous sections apply here.

40:53 [SPEAKER_00]: But I think if we're just talking about an otherwise healthy person who's still active, maybe you're not exercising, but just going about their normal life. [SPEAKER_00]: The detraining stuff is pretty unimpressive. [SPEAKER_00]: I mean, top end strength seems to be preserved for at least a couple of weeks.

41:11 [SPEAKER_00]: They've got this in power lifters and division one strength power athletes and football players off the top of my head. [SPEAKER_00]: No real meaningful loss of strength or size after a few weeks. [SPEAKER_00]: Those were like highly trained individuals. [SPEAKER_00]: Over two to three months, strength loss does occur.

41:28 [SPEAKER_00]: Usually capped around 10% or so, although this does vary between individuals, and even if it's been years, people are still stronger than their baseline. [SPEAKER_00]: Generally speaking, again, unless we're talking about a mobilization, some sort of illness that is keeping somebody outside of the gym or otherwise from exercising.

41:44 [SPEAKER_00]: Yeah, so it just depends. [SPEAKER_00]: Why, right? [SPEAKER_00]: As a general here at Ristic though, strength is lost before size. [SPEAKER_00]: We see this in Sarkopinia too, right? [SPEAKER_00]: The rate of strength loss is about triple or three times as much as that of muscle size loss.

42:02 [SPEAKER_00]: But we see this in detraining data too. [SPEAKER_00]: Again, with people who are otherwise healthy or otherwise, you know, doing their normal activities of daily life, they're just not exercising anymore. [SPEAKER_00]: We see that. [SPEAKER_00]: We see relatively little data here on tendon adaptation, or we'll call it de adaptation or decay.

42:21 [SPEAKER_00]: There's not a lot of evidence here. [SPEAKER_00]: Well, you would predict that things to go something like this. [SPEAKER_00]: strength goes first size next tendons later and then bones way way later than that. [SPEAKER_00]: You're not going to see a big drop off there unless something else is going on.

42:39 [SPEAKER_00]: Within strength there is a little nuance here. [SPEAKER_00]: You know, we think about the different types of strength, strength, stamina, right, how long can you do a submaximal? [SPEAKER_00]: effort repeatedly before getting to failure. [SPEAKER_00]: We think about maximal, low velocity strength, like a one-ret max squat, and then we think about maximal, high velocity strength, so power.

42:59 [SPEAKER_00]: Seems like strength stamina falls first. [SPEAKER_00]: Some of those energy-related adaptations, you know, mitochondrial density, capitalization, energy buffering systems, that seems to decay a little bit sooner, so the strength stamina seems to go down first, then maximal, low velocity strength, so one RM stuff, [SPEAKER_00]: and then later still would be the maximum high velocity strength the power loss, which is why it is assumed, at least by some, that the loss of power, that's why it tends to be more predictive of sort of poor health trajectories because your further along down the pipe there.

43:35 [SPEAKER_00]: Now, after some detrain has occurred for whatever reason, I'm gonna give you [SPEAKER_00]: myself included have experienced a relatively quick sort of return muscle memory effect. [SPEAKER_00]: The question is, why does that happen? [SPEAKER_00]: And is it even like something real or we just all making it up?

43:54 [SPEAKER_00]: Well, it has been documented, but as far as why it happens, there are a number of theories here, none of them are perfect. [SPEAKER_00]: So I'll just, you know, instead of bearing the lead or whatever, I'll just say, look, I think it's some combination of all of these things. [SPEAKER_00]: But the first theory, [SPEAKER_00]: Let's call it mechanistic data for support.

44:12 [SPEAKER_00]: It's called the Myonuclear Domain Theory. [SPEAKER_00]: Now, Myonuclear Eye is basically the cell, muscle cells, depo, or area that it stores, the muscles DNA, muscle cells DNA. [SPEAKER_00]: It governs, or is responsible for the upkeep remodeling, repair, et cetera, of an area of muscular protein, and so we call this the myonuclear domain.

44:38 [SPEAKER_00]: It's domain is the protein it has control over. [SPEAKER_00]: Now, when a person detains, the myonuclear activity goes down, [SPEAKER_00]: right and so as a result the protein and it's domain the muscle protein is domain also goes down but the mild nuclei is most now intents and purposes retained not all of them so let me go away but many of them remain it's just the area gets smaller because the body's not asking it to do anything [SPEAKER_00]: And then when you start retraining the myonuclei are sent a signal to hey wake up man we got stuff to do and then the muscle grows and strength is recovered as well.

45:16 [SPEAKER_00]: So that's size and strength. [SPEAKER_00]: That's one theory here there's some data support this other data is not quite as clean it's at least one of the major theories as far as why muscle memory. [SPEAKER_00]: occurs. [SPEAKER_00]: The next one has to do with these sort of lasting neural adaptation.

45:37 [SPEAKER_00]: So coordination, movement efficiency, etc., that allow the sort of rapid restoration in strength, specifically, less to do with muscle size. [SPEAKER_00]: Um, and so again, there's less data on this, but that's a thought that look if you've done an exercise before you've accumulated some sort of neural adaptations coordination related adaptations for how to do the exercise efficiently, that those are kind of stored somewhere kind of like a software system and you get to kind of pull it from your memory bank when you are re exposed to the activity.

46:07 [SPEAKER_00]: Now, another theory actually has to do with sort of an epigenetic theory, which basically describes how the environment and your behaviors, et cetera, produce these sort of long-lasting changes at the level of the DNA, and subsequently how that DNA is expressed, and basically tells your cells and body in various tissues like what to do.

46:28 [SPEAKER_00]: So the idea is if you previously had trained a lot, you've basically changed your DNA to some level, and so [SPEAKER_00]: Yeah, when you remove that sort of training signal, the DNA is like one of my supposed to do now. [SPEAKER_00]: But then when it returns, it's like, oh, yeah, I remember what to do.

46:43 [SPEAKER_00]: And so that's one of the sort of methods by which muscle memory occurs. [SPEAKER_00]: Now, the interesting thing here is there's a thought there's also some negative potential changes that can happen at the level of the DNA due to various disease processes. [SPEAKER_00]: It's been most well studied in cancer.

46:56 [SPEAKER_00]: And I say, well studied, that's doing a lot of heavy lifting there, pun intended. [SPEAKER_00]: but the thought would be that sort of these negative histories that could potentially affect the DNA may also like attenuate, reduce, or otherwise compromise future adaptations. [SPEAKER_00]: I don't know, man.

47:15 [SPEAKER_00]: There's a lot to this. [SPEAKER_00]: It's just not cleanly explained by one of these theories, so I suspect that all of them to some degree are involved and you can watch this space. [SPEAKER_00]: But overall, the rate of decay really depends on the cause. [SPEAKER_00]: If it is an mobilization, that's like pretty severe.

47:33 [SPEAKER_00]: We'll give that a pretty strong signal for detraining, produces reductions in muscle size, strength, strength, going first, then size, then tendons, then bone. [SPEAKER_00]: If you paired on top of that unloading, due to the mobilization, [SPEAKER_00]: with some sort of systemic illness that on top of that causes additional detraining.

47:57 [SPEAKER_00]: Well, it's the same sort of ordering, but just more dramatic because you got two things, right, a little double hit type thing going on there. [SPEAKER_00]: On the other hand, if it's more just like haven't been the gym for a while, it's going to take longer for any of those adaptations to occur, but still generally speaking, [SPEAKER_00]: strength, size, tendons.

48:16 [SPEAKER_00]: And then bone. [SPEAKER_00]: Now with strength, you can't really decouple the decrease in muscle size and like the neural sort of stuff. [SPEAKER_00]: So that's just wrapped up. [SPEAKER_00]: Hopefully that answers your question. [SPEAKER_00]: All right, that's four of the questions. [SPEAKER_00]: Now, in the full episode, we also break down what the enhanced games actually proved about PEDs, the biggest resistance training paper in 17 years.

48:37 [SPEAKER_00]: What moves S-H-B-G that's steroid hormone binding globulin when you're on testosterone replacement therapy and what we learn in the hard way running our own supplement line plus a bunch more questions. [SPEAKER_00]: Speaking of things we sell, the full episode, the archive of past episodes, and a new direct line every month come with Barrel Medicine Plus, and you get discounts on coaching and templates plus or other products while you're there.

48:58 [SPEAKER_00]: As of this week, Barrel Medicine Plus is bundled with Barrel Medicine Premium. [SPEAKER_00]: which adds unlimited access to every training program we've published past, present, and future. [SPEAKER_00]: Strength, hypertrophy, conditioning, rehab, switch whenever your goal's change. [SPEAKER_00]: It's 1995 a month, and yeah, we named one thing plus and the other thing premium.

49:15 [SPEAKER_00]: We're much better at programming than naming. [SPEAKER_00]: Now, these questions were useful. [SPEAKER_00]: Head over and check them out at barbolmedicine.com.