Is It Safe to Train When the Air Is Full of Wildfire Smoke?

0:00 [SPEAKER_01]: Welcome back to the Barbell Medicine podcast. [SPEAKER_01]: I'm Dr. Jordan Vigambam and what you're about to hear is a free preview of the direct line I'm monthly ask us anything for our barbell medicine plus subscribers We had about a dozen questions this month, and we're gonna talk about two here the first one is on training in wildfire smoke And depending on where you live that could be a few weeks out of the year where you're exposed to wildfire smoke and the question is Whether the air quality gets bad enough that the workout causes more harm than good [SPEAKER_01]: There's some new data on that, so we're going to talk about it.

0:32 [SPEAKER_01]: And the second question is about the effective reps model, and the idea that only hard sets count towards your gains. [SPEAKER_01]: But that doesn't really square with the fractional sets idea. [SPEAKER_01]: So go something like this. [SPEAKER_01]: If a set only counts when you're within five repetitions of failure, then the triceps contribution in a heavy-venturous shouldn't count, but if you're going to count that as a fractional set for the triceps, then a warm-up set should count for the chest.

0:57 [SPEAKER_01]: both of those things can't be true. [SPEAKER_01]: So we're going to argue about it. [SPEAKER_01]: And with me, as always, is the second most handsome doctor in North America. [SPEAKER_01]: Dr. Austin Baraki, what's going on, man? [SPEAKER_00]: Again, you're really setting out some ambitious goals for the collective us today to tackle all of these things.

1:13 [SPEAKER_01]: Well, you know, I think when I was writing I try to write a little something funny, you know, to introduce you because it brings me great pleasure and I only have so many creative outlets. [SPEAKER_01]: In my, in my, in my head, the way that you answer all of this, you know, how should I align the air quality app?

1:29 [SPEAKER_01]: What do I think about a steroid taper? [SPEAKER_01]: What do I think about the effective reps? [SPEAKER_00]: I don't care. [SPEAKER_01]: I'm kidding. [SPEAKER_01]: You probably care about the steroid taper more than any of that, but yeah fair enough. [SPEAKER_01]: All right, well, let's get into it.

1:44 [SPEAKER_01]: Okay, the question is, we're entering into the part of the year, where some parts of the country are impacted by wildfire smoke and sometimes for weeks at a time. [SPEAKER_01]: I understand that exercise reduces health risks and PM 2.5, that's particular matter 2.5. [SPEAKER_01]: Talk about that.

1:59 [SPEAKER_01]: Raise health risks. [SPEAKER_01]: Is there some crossover point above which a workout does net harm, [SPEAKER_01]: from a performance and health point of view, and my right in saying that the crossover point for lifting and aerobic exercise are different since I usually lift indoors and don't breathe this heavily.

2:13 [SPEAKER_01]: I'm aware of the teneo paper, but I'm not used to interpreting that sort of literature. [SPEAKER_01]: I think that makes three of us on this. [SPEAKER_01]: Now, we do have some expertise in [SPEAKER_01]: interpreting research and applying it clinically. [SPEAKER_01]: So, you know, we have a good, I call it a pinball machine, sort of like orientation.

2:31 [SPEAKER_01]: You try to find different those little, I don't know what they're called in the pinball machine, on the way down where the ball hits and you're like, oh, that trips me up. [SPEAKER_01]: I need to figure out if that's legit or not, but we'll see if we can get you an answer here. [SPEAKER_01]: So, we're started with a PM 2.5.

2:44 [SPEAKER_01]: This is any particular particle in the air smaller than two and a half microns across. [SPEAKER_01]: That small enough slip [SPEAKER_01]: So it goes deep into the small airways and into your blood. [SPEAKER_01]: That's what we think. [SPEAKER_01]: It's measured by weight, micrograms, per cubic meter of air.

2:59 [SPEAKER_01]: So on a clean day, numbers usually in the single digits around five, but wildfire smoke can push it up to 100, sometimes past 150. [SPEAKER_01]: Now, that is different from what's on the weather app, the AQI or air quality index. [SPEAKER_01]: It takes the concentration and puts it into a 0 to 500 scale.

3:18 [SPEAKER_01]: So every different pollutant reads out on one scale, less than 50 is green, good air. [SPEAKER_01]: 50 to 100 is yellow, moderate, and above that, it gets [SPEAKER_01]: It's worse. [SPEAKER_01]: Now, these are all 24-hour averages. [SPEAKER_01]: The green, yellow, orange. [SPEAKER_01]: So now cast is usually what's used on the on the phone.

3:37 [SPEAKER_01]: That's weighted towards the last few hours. [SPEAKER_01]: So if like smoke is rolling in, for example, the app can read meaningfully lower than what you're seeing, basically, because again, it's an average. [SPEAKER_01]: The Teneo paper he talks about, this is from 2016, this has been out obviously for 10 years now.

3:54 [SPEAKER_01]: Now this is a modeling paper. [SPEAKER_01]: So it's a simulation of years of city commuting, not like a heavy smoke day from wildfire, again mostly city pollutants. [SPEAKER_01]: It's own out, authors say that short spikes weren't even modeled here, but so this is more like a framework type paper.

4:09 [SPEAKER_01]: They took a curve for how much exercise helps you and a curve for how much particulate matter hurts you. [SPEAKER_01]: They plugged in some assumed breathing rates for each sort of situation and calculated exposure. [SPEAKER_01]: They predicted that 90 minutes a day of cycling at 100 micrograms per cubic meter.

4:24 [SPEAKER_01]: is the tipping point. [SPEAKER_01]: Now it's worth knowing that the paper states the number three different ways. [SPEAKER_01]: The abstract says an hour and a half, the discussion says an hour and 15, and the other's own follow-up review paper says just more than an hour. [SPEAKER_01]: So 90 minutes is the highest one that they list, but it's hard to feel confident at whether it's an hour and a half or so an hour 15 or just above an hour.

4:44 [SPEAKER_01]: So effectively, it had to be really like a wildfire kind of exposure for 90 minutes, and it's a modeling paper. [SPEAKER_01]: But again, it's from City, particular matter, which is maybe different. [SPEAKER_01]: We'll get to that. [SPEAKER_01]: Austin, before we get to those numbers, what sort of health concerns do you have generally speaking when somebody's breathing in air like this?

5:04 [SPEAKER_00]: Yeah, so some of the specifics are definitely outside of my realm of expertise, but breathing in particular matter in general starts to raise concerns in a few different realms. [SPEAKER_00]: There is some variation depending on the type of particular matter that is being inhaled, so you know, in wildfires, I suspect that it is going to be.

5:24 [SPEAKER_00]: a bit more of this kind of fine particular matter that is from like we'll call it organic materials like trees and forests and things like that. [SPEAKER_00]: That is to be contrasted with inhalation of non-organic types of like [SPEAKER_00]: compounds from mineral dust and things like that.

5:43 [SPEAKER_00]: So you might remember from going through med school and get test questions about sand blasters and like the types of lung issues that they get. [SPEAKER_00]: Those are called pneumoconiosis, these kind of fiber-fibrosing lung diseases that come from. [SPEAKER_00]: inhaling different types of particles.

5:58 [SPEAKER_00]: Those sorts of inorganic kind of mineral dust and things like that. [SPEAKER_00]: So here it's a little bit more what I suspect is like organic material, things like that. [SPEAKER_00]: And so the health concerns that I'm concerned with can be broken down into those affecting people with pre-existing lung disease and or cardiovascular disease.

6:13 [SPEAKER_00]: So people who already have baseline COPD or emphysema, chronic bronchitis, asthma, other sorts of lung diseases. [SPEAKER_00]: Because those are the types of people that I see much more frequently when these types of things happen because I end up admitting them to the hospital more often for exacerbations of their COPD and asthma and things like that.

6:31 [SPEAKER_00]: Separate from that is what is the impact on them. [SPEAKER_00]: That's like a short term impact on a vulnerable population. [SPEAKER_00]: the others would be long-term impacts on people who have healthy lungs at baseline. [SPEAKER_00]: That is not probably as well characterized. [SPEAKER_00]: I suspect that there is an increased risk of developing some of these chronic lung diseases.

6:51 [SPEAKER_00]: There is certainly we know from inhaling things like even from cigarette smoke and increased risk of crossing the genesis and things like that. [SPEAKER_00]: I suspect that it would take quite a lot of chronic exposure to wildfires to deliver a similar [SPEAKER_00]: And then there's almost certainly going to be some some cardiovascular risks as well.

7:12 [SPEAKER_00]: So those are kind of like the big picture breakdowns that I have is like, what is the nature of the material that is being inhaled, how vulnerable is the person from a pulmonary and a cardiac standpoint? [SPEAKER_00]: And then what's the cumulative exposure that we're talking about here?

7:25 [SPEAKER_01]: Would it be fair to say that most of these like particulate matter inhalation type issues you're worried about are due to some sort of reactivity at the level of the lungs, whether it's like very acute causing like bronchospasm or like just general injury and inflammation and subsequent decreased function?

7:46 [SPEAKER_01]: Is that really the nature of this at this core? [SPEAKER_00]: Yeah, I mean, the lungs are essentially exposed to the environment in the same way that our skin and our GI tract are organs that are essentially wide open to the external environment, our lungs are as well. [SPEAKER_00]: So it's no coincidence that they are a frequent site of pathology, of infection, of inflammation.

8:04 [SPEAKER_00]: There's tons of immunity happening in the lungs. [SPEAKER_00]: So you're right. [SPEAKER_00]: something can very abruptly cause like a reactive, you know, bronchospastic sort of process, but you can also have things like hypersensitivity, pneumonitis, basically a massive allergic reaction in the lungs.

8:18 [SPEAKER_00]: We saw this type of thing happen. [SPEAKER_00]: For example, when like vaping started to get really popular, there was that like, you know, e-sigarette associated, you know, or vaping, induced lung injury and things like that. [SPEAKER_00]: So inhaling, you know, what we'll call foreign substances into the lungs, can trigger a variety of responses.

8:35 [SPEAKER_00]: and the nature of that response will again depend on the host, the person, and their kind of genetic predisposition, their allergic rate, topic predisposition, as well as what is the nature of the material that's being inhaled and what is the dose that they're being exposed to. [SPEAKER_00]: I think that those are all the different things that might influence what sort of reactive kind of process happens, how abrupt it is versus how chronic it is, the likelihood of developing cancer over a very long period of time and things like that with persistent exposure.

9:01 [SPEAKER_00]: Yeah, well said. [SPEAKER_01]: Okay. [SPEAKER_01]: Well, the best evidence we have here is that this will call it dirty air blunts the benefits of exercise, but we can't really see a point where our tipping point where it erases it. [SPEAKER_01]: And the AQI or quality index of 80 is where the benefit roughly halves.

9:19 [SPEAKER_01]: We just don't have any evidence that exercise ever becomes harmful in a particular environment. [SPEAKER_01]: So this is a study in BMC medicine from last year. [SPEAKER_01]: They took seven separate groups of people [SPEAKER_01]: about a million and a half adults with a median 12 years of follow-up.

9:35 [SPEAKER_01]: Below 25 micrograms a year, which is an AQI of about 80, so basically Los Angeles, hitting the exercise guidelines cut all cause mortality by about 30%. [SPEAKER_01]: Above that, in a city worse than LA on average, meeting the same guidelines still helped, but the benefit was roughly cut in half, down to around 12 to 15% in reduction of all cause mortality.

9:54 [SPEAKER_01]: Now the data we have here runs up to dose of 50 micrograms which would be an AQI of 137 and it's still protective there, wildfires kind of around 100, but obviously depends on the nature and size and you know your proximity to the fire, all these things can change. [SPEAKER_01]: still. [SPEAKER_01]: In all seven groups that were followed, exercise still tracked with living longer, so some benefit, a few caveats.

10:18 [SPEAKER_01]: This data set relies heavily on this sort of Taiwanese cohort or two big studies there. [SPEAKER_01]: The other studies didn't really show a separation here, including Hong Kong, which has like worse air quality, but still there's no real drop off there. [SPEAKER_01]: Either just really couldn't parse what was going on here.

10:34 [SPEAKER_01]: There's another study that modeled six cities, Helsinki, London, Sao Paulo, Warsaw, Beijing, and New Delhi, and that's what happens at active commuters switch to transit or work from home on high pollution days. [SPEAKER_01]: The idea is, oh, reduced exposure. [SPEAKER_01]: This should probably show a benefit.

10:48 [SPEAKER_01]: So they tested it. [SPEAKER_01]: Restricting these folks didn't lower mortality in a single one of those groups. [SPEAKER_01]: In Beijing and Delhi, mortality actually went up from the reduced activity, at least that's what the models was sending to show. [SPEAKER_01]: And again, this is a model, it's mostly about commuting, not training, we're doing intervals or anything like that, but it is, you know, one of the only studies here that actually asks whether a page is at a higher risk to do the exercise or it's not.

11:11 [SPEAKER_01]: Now, he's also right on the lifting here, the breathing rate, which we sometimes call minute ventilation, the total volume of air that you move in and out in a minute, [SPEAKER_01]: generally is lower with lifting. [SPEAKER_01]: So at rest you exchange about 10 liters per minute walking's 23 cycling's 43 researchers when they have people do lifting it's closer to walking than cycling.

11:35 [SPEAKER_01]: It was pretty interesting study what they did is they had people, both healthy individuals and folks with COPD, they had them do sets of 10 with 40% of their max, like extension as I recall, and then getting 80% of their max, and the breathing did not increase. [SPEAKER_01]: The effort increased, right?

11:52 [SPEAKER_01]: But their breathing rate and everything else did it. [SPEAKER_01]: So, and I thought it was interesting that they also included COPD's pre-elegant study there because you're like, well look, there's a vulnerable population. [SPEAKER_01]: It's going to be somebody with lung disease. [SPEAKER_01]: I think again, a caveat here is that, well, they didn't look at circuit training.

12:08 [SPEAKER_01]: And they didn't look at high rep sets, and when you do look at that, that does start to look more like conditioning, higher, higher, they're sort of a minute ventilation, which is what you would expect. [SPEAKER_01]: And again, this is like a single snapshot in time. [SPEAKER_01]: Nobody's like, okay, well, look, they did this during wildfires and like, what happened?

12:23 [SPEAKER_01]: So we don't have really have clinical outcomes there. [SPEAKER_01]: I suspect that, you know, most people would into it that indoors is better. [SPEAKER_01]: And we would agree with that. [SPEAKER_01]: You have some barriers in place. [SPEAKER_01]: But during the count, some California wildfires researchers looked at over a thousand buildings during this time.

12:40 [SPEAKER_01]: And even with people, you know, being indoors and they're still trained indoor, particularly that matter is still nearly tripled. [SPEAKER_01]: Basically because the outdoor air got so much worse that it still still came in so we're I kind of end up here is that I would favor exercise like the majority of the time It have to be pretty bad outside such that you may be considering like should we get out of here because like things are really good Yeah, yeah, yeah, I suspect the benefit to health would shrink [SPEAKER_01]: Right, mainly because you're going to get some exposure, but man, that tipping point still pretty high.

13:13 [SPEAKER_01]: For performance, it's actually much easier. [SPEAKER_01]: I don't think that there's like not doing it. [SPEAKER_01]: Is every going to really help performance, unless you were doing too much before? [SPEAKER_01]: That said, you could also delay it and still be fine, and it's not a huge deal.

13:24 [SPEAKER_01]: What also favor indoor? [SPEAKER_01]: Conditioning you whenever possible. [SPEAKER_01]: Um, and again, most of the stuff is from city, uh, related stuff, uh, pollution and wildfire maybe, maybe different. [SPEAKER_01]: Uh, and there's some evidence there, there's a scripts study, uh, where they looked at 100, uh, sorry, 1.6 million respiratory, uh, based admissions to the hospital.

13:44 [SPEAKER_01]: And effectively, in the city, that particular raised admissions by under one and a half percent per 10 microgram exposure, but wildfire was much more than that potentially. [SPEAKER_01]: Anywhere from 1.3% up to 10%. [SPEAKER_01]: So, a pretty big range there, and you know, depending on how you interpret that, you could say, oh, wildfire is much worse.

14:02 [SPEAKER_01]: But again, I think it depends on... [SPEAKER_00]: What the size of the fire is, how close you are to it, what's the nature of the, I mean, there's other stuff that we can't even comprehend or think about, you know, what direction is the wind blowing and how much of it and totally all sorts of things.

14:16 [SPEAKER_00]: Yeah. [SPEAKER_01]: Yeah. [SPEAKER_01]: So, and unfortunately, no real updates on the masks here with respect to wildfire smoke, because somebody asked that and that forum reply about six years ago. [SPEAKER_01]: So, [SPEAKER_01]: Austin, let's say you got a healthy patient in the situation.

14:30 [SPEAKER_01]: How are you approaching that conversation if they're just asking you? [SPEAKER_01]: And does that change if they have something like asthma and the sky is orange? [SPEAKER_00]: Yeah, well, the color of the sky I wouldn't say is the predominant feature that would drive my decision-making here, but rather the person's underlying vulnerability and what they're proposing to do.

14:50 [SPEAKER_00]: I think that if you're in a situation where there is a significant increase in airborne particular matter to which you are very vulnerable, susceptible, maybe you or somebody who has a history of [SPEAKER_00]: When this has happened in prior years, I have ended up in the hospital with an exacerbation or I have needed to go on prednisone or use my inhaler way more than I typically do just to maintain control or to be able to breathe.

15:11 [SPEAKER_00]: It's like, yeah, those are all things that obviously should modify what you're doing now. [SPEAKER_00]: And to your point, I would not avoid exercise, but I would strongly favor indoor exercise. [SPEAKER_00]: And as you mentioned, you know, even being indoors is not full proof. [SPEAKER_00]: But that also means that there's like literally no escape in that situation, unless you actually escape the area.

15:27 [SPEAKER_00]: So your options are like be inside and don't exercise or be inside and exercise. [SPEAKER_00]: In which case, the being inside and exercise is in my mind more likely to benefit you. [SPEAKER_00]: then staying inside to avoid the particular matter and then not exercising out of fear of some detrimental effect, which is, again, most likely outweighed by the benefits in that situation.

15:47 [SPEAKER_00]: So that would be where I would lean for a vulnerable person. [SPEAKER_00]: Did you have it? [SPEAKER_00]: Did you have a take there? [SPEAKER_01]: Yeah, so my take is it's like if this is going to be temporary, I think my concern over this almost drops to zero and both ways. [SPEAKER_01]: So like one, if it's just a week, for example, and you're talking about, you know, three outdoor sessions that are, again, you're not doing three or four hours at a time.

16:07 [SPEAKER_01]: I'm like, I'm pretty unconcerned, right? [SPEAKER_01]: But also if it's a week, I'm also unconcerned if you take the week off. [SPEAKER_01]: right because it's like you're training load and where the accounting for that sort of kicks in like oh we have fully realized all of the potential adaptations from the amount of training that you done is not over a day, it's not over a week, not over two weeks, it's many, many months stacked on top of each other right and so I'm like look if you take the week off because there's some concern here.

16:34 [SPEAKER_01]: I have minimal concerns about this sort of acute decline in health in response to that or acute decline in performance in response to that. [SPEAKER_01]: I think what the studies that we've been able to find here are more like, yep, chronically though, if people stop exercising because it's so frequent or so pervasive in that environment, that's what you would see a real sort of decline in sort of health and we would into it probably performance from there.

17:00 [SPEAKER_00]: Well, given that we like to try to turn things into contrived disagreement, I'll push back on your push back here. [SPEAKER_00]: And I think it's more so an artifact of the types of folks that we work with the most often. [SPEAKER_00]: So, you know, on your side, doing more in the coaching space with athletes who are more likely to be, you know, motivated and engaged in the process, such that if they did happen to take a few days or to take a week off, [SPEAKER_00]: It is almost a baked-in assumption because they have the same neurological affliction that affects you and I where we like can't stop training, that we are guaranteed to come back the following week and get back on the horse, whereas my experience much more than coaching these days working with patients and many patients who have, for example, struggled with various aspects of their health or their weight for long periods of time.

17:44 [SPEAKER_00]: for whom, you know, taking a week off of exercise for this reason, whether for the wildfire reason or for some other reason could evolve into two weeks off, four weeks off, six months later. [SPEAKER_00]: They're like, well, I took this one week off because of the wildfire and then I kind of lost momentum and I, you know, here we are, six months or a year later and I haven't been able to get back.

18:01 [SPEAKER_00]: to it. [SPEAKER_00]: And so that's kind of my would be more my concern. [SPEAKER_00]: And of course this just means like yeah, this stuff should be individualized to the person situation. [SPEAKER_00]: But that's kind of the perspective that I take and why my initial response was not just you know, take the week off.

18:15 [SPEAKER_00]: It's instead let's try to find a way to keep you active during the time in a way that's tolerable and doesn't flare up here. [SPEAKER_00]: You know, if you have any breathing symptoms or intolerance or sensitivity or something like that. [SPEAKER_01]: Yeah, yeah, if it affects it here and some definitely with you.

18:27 [SPEAKER_00]: Yeah. [SPEAKER_00]: Sure. [SPEAKER_01]: Yeah. [SPEAKER_01]: All right. [SPEAKER_01]: Your favorite question. [SPEAKER_01]: I think of this whole this whole podcast. [SPEAKER_01]: We're talking about hard sets. [SPEAKER_01]: Again, so how do you understand the relationship between reps and reserve, RIR, hard sets and fractional sets?

18:43 [SPEAKER_01]: This is the straw man of the statement, the person writes. [SPEAKER_01]: The general rhetoric is that if you aren't lifting to five repetitions in reserve or less, you aren't building much muscle. [SPEAKER_01]: That seems fair, but if that is the case, how does that reconcile with fractional sets from compound exercises?

18:59 [SPEAKER_01]: For example, a set of heavy bench are the triceps really hitting that under five reps in reserve point. [SPEAKER_01]: If not, why count to set it all for the triceps? [SPEAKER_01]: And if it is counted as fractional for the triceps, shouldn't warm-up sets that are over five repetitions in reserve, counts as fractional sets for the chest.

19:16 [SPEAKER_01]: So yeah, just some definitions here. [SPEAKER_01]: Reps and RIRs, Reps and Reserves, how many more you could have done, right? [SPEAKER_01]: Where an RIR of zero is a maximal set, all the way to failure. [SPEAKER_01]: And an RIR of five means you have five reps left in the tank. [SPEAKER_01]: A hard set is one taking close enough to failure that people are willing to count with this sort of arbitrary line in the sand, drawn at five.

19:35 [SPEAKER_01]: And a fractional set is when a muscle works as sort of a secondary mover or a helper, rather than the primary muscle of the main sort of muscle. [SPEAKER_01]: And you kind of have for some other fraction. [SPEAKER_01]: like chin-ups, for example, counting is like a half set for biceps, and so both of these arguments can't be true, meaning that the triceps, for example, shouldn't count during during bench press, but the chest should count during warm upsets.

20:05 [SPEAKER_01]: They can't both can't be right if the first premise about repetitions and reserve being less than five, and that's the only stuff that really counts is true. [SPEAKER_01]: I think the resolution of this is, we don't think that's true. [SPEAKER_01]: And there's some evidence here kind of to inform that.

20:19 [SPEAKER_01]: So the paper on this is a meta regression from 2024, the data driven strength guys and Zordos, I think are on this paper. [SPEAKER_01]: This is a type of study that pulls a lot of other studies and asks what kind of relationship is present between the variables, not just whether a relationship exists.

20:36 [SPEAKER_01]: So this had 140 results from 26 different studies on growth, [SPEAKER_01]: The best fit for growth, it looks kind of like a straight line. [SPEAKER_01]: Basically, continuous from failure all the way out past 20 reps in reserve. [SPEAKER_01]: So the benefit of going from like five reps in reserve to failure is about a tenth of a standardized unit, which is the scale that these researchers use when different studies measured muscle in different ways.

21:01 [SPEAKER_01]: Comparing, going all the way to failure, verse non failure, head to head, it's about a tenth to two tenths, [SPEAKER_01]: In a more direct study, this is analysis of 67 studies and about 2,000 people. [SPEAKER_01]: The authors tagged each set as direct or indirect for the muscle being measured for growth.

21:25 [SPEAKER_01]: Then they fit the model with three different ways. [SPEAKER_01]: Counting an indirect set is one. [SPEAKER_01]: an indirect set is half and an indirect set is zero and asked which data fit the best to the relationship to growth and they found that half fit the best. [SPEAKER_01]: It basically suggests that triceps receive some sort of stimulus.

21:44 [SPEAKER_01]: It's not like half the stimulus, but it's some non-zero amount of stimulus. [SPEAKER_01]: My position on this overall, which I think I stated a few times, any hard line sort of interpretation of effective Rebs model is wrong, meaning like you got to take every set to five repetitions reserve or closer otherwise it doesn't count.

22:04 [SPEAKER_01]: That's a hard line version. [SPEAKER_01]: the way I and I see this is more of a gradient, particularly for hypertrophy, meaning the closer you get to failure, I think you get a little bit more, but I don't know if it's proportionally more, and I don't actually don't think so. [SPEAKER_01]: There's a caveat that I'm going to come back to here in about 122 seconds.

22:21 [SPEAKER_01]: For strength, I am actually more confident that the opposite sort of relationship exists to a point provided the weights heavy enough to drive all of the strength adaptations neurological based and structural based, which we think is somewhere around in the 60 to 70 percent of a one-rate max range provided that heavy.

22:41 [SPEAKER_01]: I think staying further away from failure is generally better because you get better force production, more higher quality force production, less velocity loss. [SPEAKER_01]: And so most of your sets should actually probably be five reps and reserve, four reps and reserve, three reps and reserve outside of like straight up practice, what you're doing like a heavier single, which becomes more of a, you want to be a little bit more challenging, but still not failure.

23:02 [SPEAKER_01]: So Austin, here's the wood you rather before we get into some of the, some of the nuance here. [SPEAKER_01]: Would you rather have a client? [SPEAKER_01]: Would they take all of their sets to five reps and reserve? [SPEAKER_01]: Or all of their sets to zero, reps and reserve all the way to failure, which won't you rather have?

23:17 [SPEAKER_00]: Uh, I think that there is a baked in implication here, or I hope that there would be because of the amount of training volume would vary substantially between these two scenarios, right? [SPEAKER_00]: So if you said, I'm going to have my training take all of their sets to five reps in reserve that opens the door for them to do many more sets versus if they.

23:34 [SPEAKER_00]: did quote all their sets to zero reps and reserve that should if they're actually taking it that far substantially limit. [SPEAKER_00]: The amount of volume in terms of sets that they should be able to accomplish at least if the programming is not really really stupid and having them do numerous sets all the way to failure on multiple different exercises.

23:52 [SPEAKER_00]: So my. [SPEAKER_00]: big picture over arching bias in the situation independent of any degree of individualization for the person their preferences their situation would be for the former would be for taking everything to five reps and reserve and then doing a bit more across a variety of things.

24:06 [SPEAKER_00]: As my that's my bias, my preferred strategy. [SPEAKER_00]: I know that there's certainly those. [SPEAKER_00]: in the high intensity training space that would just say, well, instead, you should just do one set, take it to failure and move on, and maybe there are some people for whom that either works well, fits their psychology, maybe that's enough for them to respond to for a period of time.

24:23 [SPEAKER_00]: I don't think there's really anybody for whom that is going to be enough for like indefinite or long, very long term improvement, and so there are going to be edge cases, but that's at least my, my preference, my bias here. [SPEAKER_01]: Yeah, I think if you saw a bigger difference between, like, okay, if you stayed, you would all let a failure of staying shy of failure.

24:40 [SPEAKER_01]: If you saw a bigger difference in outcomes, you could be more compelled to say, okay, well, we're going to flip this. [SPEAKER_01]: If you don't have a lot of time, we're going to take it all the way to failure, you're just going to do fewer sets. [SPEAKER_01]: Now, that may be the practical strategy, just because the constraint is time, but if time is not the limiting factor here, [SPEAKER_01]: suggesting that taking okay two or three sets all the way to failure is better than doing six sets to, you know, three reps, four reps, five reps, shy of failure.

25:03 [SPEAKER_01]: I think that's where the thing gets sticky and I think that's where we end up kind of favoring the higher volume condition for not just growth, but like just other health benefits. [SPEAKER_01]: Because now your total training load has gone up and again, go back to this throughput or flux idea sort of sort of thing, which we'll talk about at another time.

25:22 [SPEAKER_01]: But I think the practical problem with the five RIR are going even lighter than that is sort of an anchoring issue. [SPEAKER_01]: Wherein, it becomes just increasingly harder to predict, well look at my actually at five reps in reserve. [SPEAKER_01]: And so there's some evidence here for sure.

25:39 [SPEAKER_01]: The closer that people go to failure, the more accurate their prediction tends to be. [SPEAKER_01]: And I think how this plays out in practice is that if you don't have a recent anchoring to draw from, you just get worse at it, the further you're removed from it. [SPEAKER_01]: So, for example, in our programs, in a lot of ways that I program people, the very first week is sort of an on-ramp, and they'll do a sending set, so like squat for it 7, 4, 8, 4, 9, or 4, 6, 4, 7, 4, 8, whatever you want.

26:07 [SPEAKER_01]: And the idea is that you sort of triangulate your strength potentially. [SPEAKER_01]: Like, okay, here's what I'm at right now. [SPEAKER_01]: I got three shots at it. [SPEAKER_01]: I'm orienting myself into a particular ballpark for strength. [SPEAKER_01]: One way is to just keep, you know, then you sort of change the program in and basically, here's your program that we're going to see if it works for you.

26:23 [SPEAKER_01]: So at a person just goes on and does that until it stops working. [SPEAKER_01]: That's one way to do it. [SPEAKER_01]: The way I have been sort of migrating towards is like every fifth to seventh week. [SPEAKER_01]: I'll put a re anchoring week. [SPEAKER_01]: We'll, again, do the ascending sets.

26:37 [SPEAKER_01]: Sometimes, particularly on machine-based exercises, dumbbell-based exercises, low-stakes exercises, overall, I'll have people go either close to failure, or all the way to failure, to sort of reorient themselves. [SPEAKER_01]: Like, hey, did your strength change? [SPEAKER_01]: Have we had some sort of drift here?

26:52 [SPEAKER_01]: Either RP going up? [SPEAKER_01]: When it shouldn't have or an RP going down, when that really wasn't our target, that's just a strategy And admittedly sort of a hedge to sort of avoid that problem. [SPEAKER_01]: I don't have like a ton of hard data showing you look. [SPEAKER_01]: This is demonstrably better From muscle growth and strength.

27:07 [SPEAKER_01]: That is one way I kind of approach that that issue But where I overall kind of come at this is that I do think that warm-ups and easy sets do deliver some non-zero amount of training stimulus for both strength and muscular growth. [SPEAKER_01]: I think for hypertrophy [SPEAKER_01]: The closer you get to failure, there's a gradient sort of where you get more and more growth.

27:30 [SPEAKER_01]: It's not linear, right? [SPEAKER_01]: And so I think there's a sort of tipping point where you get to like RP-8-7-8, you know, on some of these sets and you go above that, yeah, you might get a little more growth, right? [SPEAKER_01]: But you get a lot more fatiguen so you can't do as much.

27:45 [SPEAKER_01]: And so there's some sort of a tipping point there. [SPEAKER_01]: Which ultimately has to be balanced against will how much training can the person do because you know on to some extent You can rob Peter to pay Paul and that'll work for a little bit, but then it You know eventually you're like, well, how do we do more training load?

27:58 [SPEAKER_01]: And if you're still constrained That can be problematic for strength on the other hand I do not have as much sort of a squish a more like look. [SPEAKER_01]: It's got to be heavy enough to really work well for strength Well is doing a lot of heavy lifting there pun intended because I do think lifting almost anything has the potential to make you stronger to some degree [SPEAKER_01]: We think the sort of inflection point is somewhere between 60% to 70% of your one right max.

28:21 [SPEAKER_01]: And then after that, it's literally how much of that work can you do. [SPEAKER_01]: And I think staying further away from failure ends up being a little better. [SPEAKER_01]: So if all of that was word salad to you and you're like, dude, give me a line, what to what? [SPEAKER_01]: Oh my god, I look high-perrophy somewhere in that sort of seven to nine range is where I would land particularly for machines, dumbbells, other things.

28:39 [SPEAKER_01]: And now that you mean RPE, not rep range and just people don't take that the wrong way. [SPEAKER_01]: Yeah, correct, correct. [SPEAKER_01]: Yeah, wide range of viable intensities. [SPEAKER_01]: So it can be a wide range of reps, but yeah, RPE should be somewhere 7-9 for a straight-up high-perch if you work, particularly that low-stakes, machines, isolation stuff.

28:57 [SPEAKER_01]: And then for strength work, I'm thinking like RPE 4-6, you know, for the majority of R-4-7, if you like, you know, whatever, but if generally you're staying further away from failures such that you're not losing as much bar speed at the end, which tells me that the force production is higher quality.

29:12 [SPEAKER_01]: middle to middle grade, because you can see it move faster. [SPEAKER_01]: Austin, do you have any differences of opinion there? [SPEAKER_01]: Any steel man on my argument, you want to push back, you want to argue on the internet? [SPEAKER_00]: No, well, no, and definitely not about this topic.

29:23 [SPEAKER_00]: I think your assessment upfront that I don't care that much about this is accurate, but I don't want to say that in a way that comes off as dismissive, but instead why I don't tend to care that much about this argument. [SPEAKER_00]: For example, the idea of it should be, you know, three reps and reserve or four or five or six reps and reserve or should I do, you know, three sets or four sets or five sets of four reps or five reps or six reps or things like that.

29:49 [SPEAKER_00]: And the main reason is that I feel that the differences in inter individual response to training dwarf. [SPEAKER_00]: the differences in impact of anyone or combination of these decisions, such that the more practical strategy is just pick something, do it consistently for a while, see what happens and iterate on that.

30:13 [SPEAKER_00]: If you are agonizing over, should my stats be to three reps in reserve or four or five? [SPEAKER_00]: that may not be relevant for you, or it may be depending on how responsive are you to the training set up in general. [SPEAKER_00]: And if you are somebody, because I just did a consult for example yesterday with a guy who he has identified in himself, that he does much better in terms of training tolerance in adaptation in everything to just generally hire a higher rep work and doesn't do as well with much higher load lower rep work from like a pain, injury, various sorts of things.

30:50 [SPEAKER_00]: And he has struggled repeatedly over time, and it's like, well, why are you kind of beating your head against the wall trying to do this thing that you don't respond that well to when we have you have identified already something that you do respond well to and your goals do not require you to do low rep high, you know, load work like for competitive powerlifting you don't have to do that.

31:08 [SPEAKER_00]: And so you're getting frustrated for reasons that are kind of unnecessary here whereas somebody else might have completely the opposite. [SPEAKER_00]: sort of phenotype. [SPEAKER_00]: They might demonstrate or illustrate or experience that, hey, I do way better with doing a couple heavy sets of three, and I don't do nearly as well with higher reps. And if there's no reason otherwise why they ought to do something different, then that's totally fine.

31:29 [SPEAKER_00]: So my take is that individual variation tends to outweigh a lot of these things. [SPEAKER_00]: And that, I think, partially, my gut is that that partially explains why, for example, [SPEAKER_00]: those guys doing that research, you know, for, for, you know, slogging through that statistical work and things like that.

31:48 [SPEAKER_00]: But I also think that the trends that we observe are relatively modest overall. [SPEAKER_00]: It's not like this massive sort of effect difference in a lot of these situations. [SPEAKER_00]: And I think a big part of that is that it gets kind of washed out by individual variation. [SPEAKER_00]: I might be wrong.

32:03 [SPEAKER_00]: Maybe they would have a different take and push back against that. [SPEAKER_00]: That's totally fine. [SPEAKER_00]: But that's kind of the way I approach it in practice is not being so concrete with these very specific targets. [SPEAKER_00]: But rather saying like here, here's what the general like literature and our experience illustrates as like reasonable trends on which to base our initial intervention.

32:20 [SPEAKER_00]: And then we just kind of like tinker with it based on your response. [SPEAKER_00]: And then the last [SPEAKER_00]: Let's say you're agonizing over. [SPEAKER_00]: Should I do something to like three reps in reserve or four reps in reserve or five reps in reserve yet over the course of a year you miss a total of [SPEAKER_00]: 10 training sessions for whatever reason.

32:38 [SPEAKER_00]: I think you missing 10 training sessions probably outweighs, you agonizing over those types of things. [SPEAKER_00]: Or you skip a total of like 30 sets across the whole training gear. [SPEAKER_00]: I suspect that that also outweighs, the difference of whether I did one extra rep on these sets and took it an extra rep close to failure or not.

32:57 [SPEAKER_00]: And so I think, again, that's where I'm like putting my emphasis on the variables that matter much more. [SPEAKER_00]: The even if it is maybe not optimal from like a strength stimulus on a per set basis if you just like do all the sets over the course of the year You're probably gonna end up ahead Versus doing the perfect proximity to failure, but then just like skipping some sessions going on vacation taking time off Which I'm not saying is the bad thing.

33:17 [SPEAKER_00]: That's just like life people are gonna do that But then it's like why are you agonizing over these tiny details which now like that's my case for why I don't care I think the agonizing maybe the more important exactly [SPEAKER_01]: I think, you know, I've been wrecking my brain for over a decade, trying to find a way that I feel like adequately measures training load, which is not just the amount of training that you're doing, but the nature of it.

33:43 [SPEAKER_01]: Right. [SPEAKER_01]: So all of the other variables kind of combine together. [SPEAKER_01]: It can't be tonnage, just wait times reps. [SPEAKER_01]: It can't be the number of hard sets, the number of fractional sets. [SPEAKER_01]: Not to say that's bad, it's very practical. [SPEAKER_01]: You can use it, but I'm getting it.

33:54 [SPEAKER_01]: As the number doesn't tell you what you want. [SPEAKER_01]: What you're trying to figure out is a sort of dose response relationship, kind of, or a mathematical formula you can use to lay out and then project your training, right? [SPEAKER_01]: And so a training stress score, where you would take the, you'd have a modifier for the exercises a compound as an isolation.

34:13 [SPEAKER_01]: Is it freeway to zip machine? [SPEAKER_01]: and then the average intensity and the RPE and how much volume you did and you would, you know, it's not just you'd have to come up with some sort of algorithm or equation that plugs all these variables in and gets you a number and even then you take that number and you have to apply it to a large population and come up with outcomes that are tracked together and then it gets so noisy and I just [SPEAKER_00]: I think the main challenge that you're talking around but not explicitly articulating is that in the context of this our world strength training resistance training, we do not have a perfect measure of internal load.

34:49 [SPEAKER_00]: If you contrast it with the endurance training world where, for example, they can base a lot of things on having good heart rate data and then maybe accounting for [SPEAKER_00]: You know, duration and peak heart rate and average heart rate reserve and predicted heart rates and then ambient conditions heat and humidity and how that might impact things and all sorts of things you can get a lot more granular and get a better sense of just like looking at the data and being like oh damn that looks like a very very difficult session.

35:13 [SPEAKER_00]: You know, in string training, our best met, you know, quote unquote metric if you want to even call it that of internal load is like, yeah, the person's kind of subjective rating of it, which is fine. [SPEAKER_00]: For our purposes as it has been for a very long time, but it is not nearly as like granular and lets you make a lot of prospective decisions in an participatory manner and things like that.

35:32 [SPEAKER_01]: I just want numbers. [SPEAKER_01]: I won't get them. [SPEAKER_01]: Okay, that's it for this free preview of our direct line from August, 2026. [SPEAKER_01]: The rest of it is on Barbell Medicine Plus and there are 10 more questions there as well. [SPEAKER_01]: Including, do you need a $5,000 machine to fix your back and how to find a physical therapist who won't just put a hot pack on you and call it a day?

35:54 [SPEAKER_01]: And what the internet has done to dopamine? [SPEAKER_01]: Barrel Medicine Plus subscribers also get the articles that I've been writing in our community section, none of these has been published yet. [SPEAKER_01]: First one is commentary on the military's new testosterone clinical practice guideline, a longer or deeper look at how many calories it actually takes to build muscle, some practical recommendations, and whether different diets produce different health outcomes when the weight loss was equated.

36:18 [SPEAKER_01]: This study was keyed over the world, and some of the keyto influencers are misquoting it. [SPEAKER_01]: Go figure. [SPEAKER_01]: And then finally, another article on statins in older adults finally, which is the discussion of the Star Retrial. [SPEAKER_01]: All that and more, if you subscribe to Barbell Medicine Plus, it's 9.95 a month, you get the direct line in full every month, you get to ask your own questions, you also get ad-free listening to all of our episodes, early access to all of our episodes, bonus podcasts, bonus videos, bonus articles, plus you get 10% off all of our programs, and our programming library prescription, plus discounts on consultations, seminars, learning,

36:53 [SPEAKER_01]: and everything else. [SPEAKER_01]: You can try it for just $1 a month. [SPEAKER_01]: The link is in the description below. [SPEAKER_01]: Hope to see you there. [SPEAKER_01]: For everyone here at Papal Medicine, I'm Dr. Jordan Faganbaum, that's Dr. Austin Maraki. [SPEAKER_01]: We'll see you next week and every week right here on the