Getting and staying fit can be tough. And we have limited time and energy. So how should we allocate our precious resources of energy and time?
We can use the analogy of big rocks. Focusing on big rocks helps us get results, rather than get distracted and confused by minor or irrelevant things. It is a mantra I repeat to myself and clients to stay focused on what matters.
The Big Rocks Analogy
Imagine you have some small stones, big rocks, and a jar. If you first put the small stones in the jar, you’ll fill up the jar but not have room for the big rocks. However, if you start with the big rocks, you’ll fit all the big rocks in the jar AND have room for the small stones.
Similarly, in fitness there are big rocks and small stones. And there are some things that shouldn’t even go in the jar.
Example: Big Rocks for Weight Loss
Let’s take weight loss as an example.
One of the big rocks for weight loss is eating whole, minimally processed foods that keep you full. Another big rock is eating fewer processed foods and liquid calories (like soda, juice, and alcohol). Both of these big rocks reduce overall caloric intake which contributes to weight loss.*
On the other hand, a small stone for weight loss is eating an exact ratio of carbs, protein, and fat. This might be relevant once someone has lost a lot of weight and wants to get a 6-pack. However, for the majority of weight loss, focus on the big rocks first.
Lastly, there are things that don’t even belong in the jar. For weight loss this would be gimmicks like apple cider vinegar shots and green tea extracts. At best, they are a waste of time and money. At worst, they are a distraction from the big rocks that truly matter for weight loss.
Most Fitness Goals Have Big Rocks
The big rocks analogy holds for goals other than weight loss. For example, a big rock to get stronger is to lift increasingly heavier weights consistently over time. Choosing the best brand of lifting belt is a small stone.
Usually big rocks are not cool or sexy. The results take longer, but are real and sustainable.
Whatever your fitness goal, first ask what are the big rocks?
*There are other big rocks for weight loss, but for brevity, I’ve just listed two big rocks in this article.
We hear lots of narratives about stretching before lifting. Some lifters insist on stretching before training. Others claim that it hurts performance.
But what does the research say?
Behm et all did a systematic review of research on the effects stretching.1 They looked at the effect of stretching pre-exercise on strength. They examined other variables too, but we’ll focus on strength today.
What studies were included?
The review included 125 studies looking at:
Static stretching – holding a muscle at its lengthened position.
Dynamic stretching – moving joints through their full range of motion.
Proprioceptive Neuromuscular Facilitation (PNF) stretching – a technique of contracting and relaxing muscles to increase flexibility.
How did stretching pre-exercise affect strength?
Generally, static stretching and PNF stretching caused a decrease in strength afterwards. Dynamic stretching did not affect strength much afterwards.
Static Stretching
Static stretching was associated with a 4.8% decrease in strength.
But the story doesn’t end there. The researchers found a “dose-response relationship”. Meaning that as stretch duration increased, strength was further decreased. For stretches performed for < 60 seconds, strength decreased by 2.8%. However, when stretches were held for > 60 seconds, strength decreased by 5.1%.
Dynamic Stretching
Dynamic stretching had trivial effects on strength. Strength decreased by only 0.23%.
PNF Stretching
PNF stretching was similar to static stretching – it was associated with a 5.5% decrease in strength.
It makes sense that PNF stretching would follow the same trend as static stretching. Both involve relaxing and holding muscles at their end range.
What does this mean for lifting?
-If you want to maximize strength, do static stretching after training. -If you really want to do static stretching before training, keep it brief (30 seconds per stretch). Research suggests that a 30 second stretch increases flexibility as much as a 60 second stretch.2 -Dynamic stretching before training has trivial effects on strength.
I personally do not have clients stretch before lifting. In addition to this research, I’ve observed that static stretching is relaxing and calming. Before training, we want to get amped up and excited – the opposite of lying on the ground relaxing into stretches.
Static stretching can feel great. But to maximize lifting performance, save it for after training.
References
Behm, D. G., Blazevich, A. J., Kay, A. D., & McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 41(1), 1–11. https://doi.org/10.1139/apnm-2015-0235
Bandy, W. D., Irion, J. M., & Briggler, M. (1997). The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Physical therapy, 77(10), 1090–1096. https://doi.org/10.1093/ptj/77.10.1090
Throughout high school and college I was extremely skinny. My BMI was in the “Underweight” category and size “small” shirts fit loosely on me-despite being 6’2”.
My first real foray into resistance training was doing four barbell lifts; the bench press, the back squat, the deadlift, and the overhead press. I did 3 sets of 5 reps, adding increments of weight every session (and then weekly as strength gains plateaued). I followed this program for 3 months and saw increases in strength and bodyweight. I thought it was a massive success.
Here is the before and after:
Before
After
Weight: 165 lb
Weight: 187 lb
Pushups: 5 reps on 12” box
Pushups: 5 reps
Visible “4-pack” of abs
No visible abdominal definition
What led to such “massive success”?
To start, this was the first lifting program I ever did with any substantial load (weight). For years I had been a “rehablete”-performing lots of “mobility work” and “corrective exercises” in an attempt to alleviate chronic back, shoulder, and knee pain. Unfortunately, the net effect was still having pain and being out of shape.
Second, I had novice gains. For novices, nearly any training stimulus above their current fitness level will confer benefits. For example, it has been observed that even a walking program promotes strength and hypertrophy (muscle growth) in untrained people (Ozaki, 2019).
Third, I started to consciously eat more. I didn’t track anything. I simply ate slightly past fullness at each meal.
Lastly, I gained a considerable amount of body fat along with muscle. Looking at photos of myself at the time, I had a visible belly, but convinced myself that putting on so much fat was the necessary cost of gaining muscle.
Overall, there wasn’t anything special about sets of 5 reps nor the use of barbells.The “special thing” was that I resistance trained consistently with sufficient volume and intensity. I am confident I could have gotten similar results using machines instead of barbells. I probably would have had better hypertrophy results with higher weekly volumes (>10 sets per muscle group) as has been recommended based on research (Schoenfeld, 2018). For example, I did a weekly volume of 6 working sets for the chest in the form of the bench press. Clearly, this volume caused muscle growth, but there likely could have been more growth later into the program with a higher volume.
Recently, after slimming down to 175 lb, I did a hypertrophy program for 5 weeks. Here is the before and after:
Before
After
Weight: 175 lb
Weight: 179 lb
Pushups: 2 count pause pushup, with 20 lb of added weight, 5 reps
Pushups: 23 reps
Visible “4-pack” of abs
Visible “2-pack” of abs
Looking at my strength levels after slimming down to 175, I realized I had gained a considerable amount of fat in the first program. For example, following the first program I was doing 5 pushups at a bodyweight of 187 lb. However, later at 175 lb, I was able to perform 5 pushups with 20 lb of added weight-a net of 195 lb. I was stronger at a lighter weight and with better abdominal definition (a rough proxy for body fat).
What was different in this hypertrophy program?
First, I did higher rep work (up to 20 reps per set) and less low rep work (only as low as 8 reps per set).
Second, the volume increased weekly and was higher overall. For example, by the final week I was doing 15 working sets per week for the chest.
Third, I expanded beyond the compound barbell lifts to include isolation movements (like lateral raises and hip abduction). I also used machines (lat pull down, chest press, shoulder press)
Lastly, I calculated a daily target for carbohydrates, protein, and fat. Then I measured my food intake using hand portion estimates for whole foods and nutrition labels for processed foods.
A few reflections and lessons for the future:
Measuring bodyweight twice per week is crucial to track progress. Taking the average of two measurements helps focus on the weekly trend, rather than get too hung up on single measurements.
It took several weeks to become used to the higher protein intake. It still takes a conscious effort to hit my goal of about 175 grams per day.
Consuming tofu, eggs, and dairy (cottage cheese) makes a high protein intake more affordable.
Processed foods and liquid calories (i.e. juice, milk) can help to increase total calories since they are not satiating.
Barbells are not magical for strength or hypertrophy. I am not bashing barbells, but they have become a sacred cow for some lifters. I still think barbells are one of the best tools out there because of their versatility, ease of use, and relatively low cost.
Keeping some sort of food log is important to hit overall calorie and protein goals. Someday I may be able to eat for hypertrophy intuitively, but I’ll stick to logging my intake for now.
At the amateur level, your food measurement method does not have to be very accurate, but should be repeatable. I am sure my daily counting of “7 palms of protein” does not exactly correspond to 175 grams of protein. But it doesn’t have to. What matters is that I’m using the same measurement method and eating similar foods. It’s easy then to change food intake as my goals and weight change.
For me, gaining about 1 lb/week of body weight seems to offer an acceptable amount of fat gain. If I had finished this hypertrophy program with “no visible” abs and at a body weight of 187 lb like before I would not consider that level of fat gain worth the muscle built.
What’s next?
I’ll be going through a more strength focused program with lower rep work, which I haven’t done as much of this past year. I’ll continue measuring weight, start measuring waist circumference, and keep food intake at maintenance (but continue tracking).
Self-experimentation doesn’t mean just trying different inputs. You’ve got to measure your response and adjust accordingly.
People are often unsure of the difference between physical therapy and personal training. During a clinical rotation, I even had a patient refer to me and my clinical instructor as “the trainers”.
To confuse matters more, many physical therapists (including myself) are also personal trainers.
However, there are key differences in what each profession is trained and licensed to do.
Physical therapists are licensed and trained to diagnose and treat injuries and help those with disabilities or pain improve their level of function. Physical therapists use exercise, and sometimes other approaches, to improve function. Physical therapists are also trained to screen for more serious medical pathologies. They may make a referral to a specialist for further medical evaluation. For example, in rare cases shoulder pain could be related to a cardiac problem. A physical therapist might refer a patient to a physician because there could be a more serious cause of the pain that needs to be addressed.
There are several branches of physical therapy. Orthopedic physical therapists focus on musculoskeletal injuries. Some examples of patients would be:
-A teen who sprained their ankle and wants to play soccer again -A dad with chronic low back pain who has trouble playing with his kids -An elderly lady at risk of falling who wants to safely go to the grocery store
On the other hand, personal trainers are trained to help people reach fitness and athletic performance goals, such as building muscle, losing weight, and getting stronger. They often work with people who have an injury, disability, or pain. However, trainers are not licensed or trained to diagnose and treat injuries or pain (despite those online who claim that certain exercises or stretches cure pain). Some examples of clients would be:
-That teen soccer player who wants to get stronger and faster -That dad who wants to improve his endurance so he can play with his kids for longer -That elderly lady who wants to maintain her strength
Also, the titles used by each profession are slightly different:
-In the U.S., most physical therapists now have a “DPT” (Doctor of Physical Therapy) degree along with a “PT” (Physical Therapist) license. On a physical therapist’s business card you will likely see “PT, DPT”. -Personal trainer titles, on the other hand, vary widely since there are many certifying organizations. Some trainers use the title “CPT” (Certified Personal Trainer). And some coaches use the title “CSCS” (Certified Strength and Conditioning Specialist). -For more naming confusion, in many countries besides the U.S., “PT” actually refers to a personal trainer and physical therapists are called physiotherapists.
There is overlap in the types of exercises physical therapists and personal trainers use. And often a client may be seeing a personal trainer and physical therapist at the same time.
In short, physical therapists and trainers both use exercise but usually the goals differ and the scope of practice is different
Losing weight and keeping it off can be tough. Compound that with the challenges of dealing with an injury or pain. People often say things like “Since my knees started hurting, I packed on weight” and “After my back injury, I gained a bunch of weight” and so on.
Many people believe that weight gain is inevitable after injury or pain, since one “can’t” exercise anymore.
There are two issues with this sort of black and white thinking. First, there is probably a way to modify and continue exercise. Second, there are many other factors related to keeping weight off. This article will address the second part-the factors related to keeping weight off, also known as “weight loss maintenance”.
With over 40% of U.S. adults being overweight or obese, there has been ample research in this area (1). Varkevisser et al in 2018 performed a systematic review (a study of studies) of over 8,000 articles on weight loss maintenance (1). They examined all the factors that would predict weight loss maintenance (or lack thereof i.e. regaining weight).
They identified these following factors as most predictive of keeping weight off*:
-Monitoring weight
-Self-monitoring eating
-Increased physical activity
-Portion control
-Cutting “unhealthy” foods (sweets/junk food, fried food, fast food)
-Decreased energy intake**
-Increased consumption of fruits and vegetables
-Decreased consumption of sugar sweetened beverages, juice
-Decreased fat intake
Note that only 1 of these factors is related to physical activity. Now this doesn’t mean that exercise and physical activity don’t matter. It simply means that there are other factors we can influence as well.
Also, note that there is no reference to a single “best diet”, rather these are general strategies that work whether or not you follow a specific diet. Many patterns of eating can work to stay slim.
So how do these factors translate into practice? Here are some example tools and behaviors I use with clients:
Example Tools and Behaviors
Recording weight twice per week and taking the average as your weekly weight**
Getting 1 hour of physical activity per day (2). Logging activity could be as simple as writing in a journal or using an activity planner like this
Having “unhealthy foods” as a treat for special occasions. An example strategy is not keeping these foods regularly at home**
Consuming whole foods that are lower in fat. Examples could be choosing leaner proteins (chicken breast, 90/10 ground beef, fish, etc)**
Having alcohol and soda as a treat for special occasions. An example strategy is not keeping soda or alcohol on hand at home**
Purchasing fruits and vegetables that require minimal preparation. Some examples include apples, oranges, bananas, cucumbers, carrots etc**
This is a bird’s eye view strategy for staying slim after injury-each person will have unique considerations when applying.
Injury or pain does not condemn one to regain weight. In addition to continuing exercise (in a modified way), we have many other strategies to maintain that hard won weight loss.
*These were not the only relevant factors. There were other factors, but they had weaker evidence or had insufficient evidence. I’ve focused on the factors with the strongest levels of evidence here.
**Decreased energy intake is critical and is the net effect of most if not all of these nutritional factors. For example, decreasing consumption of sweetened beverages, decreased fat intake, and cutting unhealthy foods all have the net effect of decrease total energy intake.
References:
1. Varkevisser, R., van Stralen, M. M., Kroeze, W., Ket, J., & Steenhuis, I. (2019). Determinants of weight loss maintenance: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity, 20(2), 171–211. https://doi.org/10.1111/obr.12772
2. Brown Medical School/The Miriam Hospital Weight Control & Diabetes Research Center. (n.d.). The National Weight Control Registry. Retrieved January 04, 2021, from http://www.nwcr.ws/research/
Dr. Jahan: Engineer, Doctor of Physical Therapy 