Menopause, Muscle & Myths: What the Science Really Says with Dr. Tony Boutagy

So at any age, you can take up lifting weights. You can say, well, I'm 80 and it's too late. It is not too late at all. Because in eight weeks, you can improve lower body strength 300%.

Mm-hmm.

Tony, welcome to the podcast.

I'm thrilled to be here. Thanks for having me.

Tony, let's start with your background. Can you tell us a little bit more about your educational and of course your sporting background for us?

The sporting one is very easy to cover in a sentence. I'm a failed triathlete. In the nineties, one of my childhood friends, Greg Bennett, was making waves in the world of triathlon. And I thought, well, if he can do it, I can do it. And I trained and trained. And when I finished the bike leg and started the running, people were already finishing the run. So I worked out pretty quickly. I was not going to make it. And I studied sports science instead.

Amazing. You're the perfect guest for us, Tony, because we have lots of triathletes that follow us here and that are listening in. we also, ⁓ the target audience, the viewers are everyday athletes. So that's who we're speaking to on this podcast. So it sounds like you've got loads to offer us.

amazing.

So sounds like you've worked with a wide range of clients and including many women navigating perimenopause and menopause. What got you into that target group?

It was only because I work with the general public who was going through that transition. And it is important for coaches to really understand the context and the physiology of whoever you're training. And when I first started, when I was a teenager, virtually every one of my clients was in their twenties or thirties, but then they got to their late thirties and forties and fifties.

And I had to learn more about the menopause transition, but I also had to learn more about training elderly individuals because some people I started with when they were 60 and then they ended up being 80. It's just pure transition, life transition where coaches just have to learn what's not in their wheelhouse. Cause I was a 20 year old guy. I had to learn what females were going through. So you read research and position stands or speak to other coaches. And it's purely because I've had clients for

over 20 years, you've just gone through it, that you just have to go through it with them, find out quickly what works and what doesn't, and then change that based on the physiology of what you're learning in science.

Was it difficult for you as a male coach? I don't understand all the nuances that women go through.

Look,

absolutely. And it comes with a great sense of humility. And it's not lost on me when I either speak to women about what they're going through or provide solutions. I know that I'm a guy and I don't have these issues. But having been married and having kids and having parents, you hope that you become a better listener and can ask better questions and try and problem solve.

where we don't have maybe a really clear answer in research. And that is, if there could not be a clearer position, that is through the menopause transition where we just don't have all the good answers. But there's so many clues if you listen and ask the right questions. And the process keeps being refined and improved, but we do have very good answers. We just hope that we have better answers next year and the year after.

Yeah, yeah, absolutely. I think, like, I love your podcast, And I think one of the...

latest ones You were talking about some of the myths that circulates in social media and how you as a male coach don't necessarily understand what's going on. And I think you guys had a, you remember who you were talking to?

Yeah, there's a number of interviewees who we have covered the myths and I try and actually cover the myths in each podcast because it's good to get a different perspective of people doing research in various fields, whether it was Paul in Zone 2 or whether it was a menstrual cycle with Lauren Colenso's sample. But every interviewer I ask, are there sex differences in what you're studying? Is there...

Difference in menopause transition pre-peri-post. What do you see? And I just interviewed a vitamin D expert yesterday, a guy with more than 600 publications in the field. And one of the final questions was, do you see sex differences in vitamin D metabolism? And it was just a simple no. And I waited for something. Okay, next question. And sometimes there is, but the girl I interviewed last week, Jenna Gillen, on interval training, I...

you

we were talking about sex differences and she says, I think we really need to talk about sex similarities because although there are physiological differences, get, we go down those rabbit holes of how different we are and therefore we need very different approaches. That's led to a rhetoric and narrative which makes women very angry. And that is all the studies are in men. We don't know anything. We are understudied, ignored, and therefore we have to do programs that are male dominated.

Yes.

that are for men and we're not men. And that is utterly offensive to researchers who either do women specific research or they study both together and look at these either differences or as Jenna said, the similarities in the training response. And that mirrors my experience, but also mirrors the experience of many other fabulous coaches that I know. When I asked them, do you have male and female?

Mm-hmm.

specific programs and the answer is no they all train together. Okay so somebody's hasn't got that memo.

Yeah, totally. We hear women are not small men and all kinds of these marketing messages. And I think I often ponder when I'm running and walking and I'm like, why are we focusing on the differences so much? I know why it's marketing and it's selling products and stuff like that.

Let's really back unless Paul has something, any thoughts that you want to share here?

Well, no, I mean, I literally just finished training my daughter who's a swimmer and she's 15 and she's getting so strong. we're really seeing the transfer effects through that. But I was just kind of like, was just nodding my head because honestly, I wouldn't have trained her today any different than I would if I had a 15 year old young boy and she was, was killing it. Yeah.

it's a needs analysis, isn't it? So where are your deficiencies? And they're not specific. Now

Exactly.

there's

in the world that I work in, which is aesthetics, there are preferences, no question, you could look at a program and say, I bet that's for a female, why would you guess that? Well, I've got four exercises for the glutes. And I don't have any more for the calf or any more for the forearms, right? You could guess that based on preference. But I didn't

Yeah.

that area or that rep range or the set number or the frequency or any other variable because of sex. I picked it based on preference. And when it's in strength and conditioning, we test to find out what they're not good at and fix it with intelligent programming. But we don't do it based on, you're a female, so you need more hit and sit and less zone two because you have more oxidative capacity. Well, when you go and look at those claims,

which are now being tempered as, you just need less of it. We're never saying don't do it. But it's the reason. And the reason is because you've got more slow-twitch fiber, you've got greater oxidative capacity, better lactate transporters. So you don't need that kind of work. And then you look at the reference and it's in mice. And the people are saying, women are not small men. And then you're using a mouse study. So what you're really saying is that women are closer to being a mouse than being a male. And this is surprising to me.

Mm-hmm.

But Jenna Gillan's work has looked at oxidative capacity and found basically the same thing when they've used better measurements of looking at it.

I'll tie this back into why I asked you if you found it to be a difficult position to be a male coach to lot of perimenopausal women. it kind of comes back down to, I think it's wonderful, first of all, that you're doing this work with women as a male because you have a little bit less biased opinion and experience.

So when somebody is telling you like, what do you know, you're a guy, right? I'm just like, no, we tend to have our own bias. And when we read all this, you know, social media messages and some of these very well-known people, they say their message with such a convention that it's...

It's easy to believe it because we are going through this transition and we don't really know what is working. So like I personally would trust a male coach with a little bit less bias in one way or do another. I'm thankful for, you know, Paul coaching me through my transition.

And it comes to experience, doesn't it? So would you prefer a coach or a doctor or a physician, whatever that is, who is the most experienced irrespective of gender? So my general practitioner, my physician is a female who talks to me about men's issues. Why do I have her? Because she's been doing it for 40 years. sex was never a decision in making. And for me as a coach, I've done over 90,000 training sessions.

Mm-hmm.

Yeah.

So I've got experience across the lifespan from people who are younger than 10, who I've coached, to individuals in their 90s, from people across four Olympic games, from five Paralympic games, 20 world championships. There's experience that then filters down to what we're saying. And if the pushback is, you're a male, that's okay. You don't have to listen to me. You can listen to somebody with no experience who doesn't coach anyone.

but just makes statements that, well, you're not a man, so therefore you should do this. You're welcome to do that.

Mm-hmm.

Mm-hmm.

All right. Let's let's drive dive right into some of the myths that you have debunked with the experts in their fields with the podcast Stronger with Time. Can you mention a couple of these myths that are most harmful or misleading for especially perimenopausal and menopausal women?

The biggest issue that I see is that we've got a lot of training tools depending on who you are, what you want, how you recuperate, what you enjoy. And these, this is a smorgasbord of different options. And the issue that I see as a coach is somebody who's not a coach coming in and saying, females need to do this, this, and this, and not that. And then I think, well, that's maybe

Okay, but it might not be okay. In other words, you could do that, but you don't have to do that. And the coach in me says, well, if you are going to do maximum strength training for your bone or for your muscle fibers, you should be prepared for that. And you need to work your way towards that. And we use maximal strength training, but not always, because it's very, it has a little wear and tear on your joints and your muscles. So we

oscillate, we go into it, we come out of it, we periodize it, in other words. And I think that's a myth, but it's also based on really shaky science. The science says women lose estrogen, women have less fast twitch fibers, which means they should do high intensity five reps of five maximal strength training, because that's the best way to build muscle if you're a post menopausal woman. And that is a real misunderstanding.

Mm-hmm.

of how muscle fibers work. Firstly, and secondly, it's been shown over and over that the lack of estrogen doesn't affect your propensity to get stronger or grow muscle, which is amazing news. We've also got data to show that you can grow muscle across a spectrum of rep ranges. Now, I like that as a coach because I can give a female 12 to 15 reps if that's what they like doing. And I can also give them four to six reps

if that's what they like doing, but in reality, I just weave those in and out across a training year. So I really don't like narrow prescriptions. So that would certainly be the big one that so many options have taken off the table for females who are just wondering, well, what do I do? I've told I have to lift heavy. Well, you can, but you don't have to. And you need to earn the right to do that.

Mm-hmm. Mm-hmm.

That's right. Like personally for me, like I like the heavy range because I know it's done quicker. Like I can't bring myself doing 20, 30 reps and it's like, no, let's go. But some people might like enjoy that better than lifting heavy.

Right. Right, right.

Yeah, and we rarely do

that. We might do that with blood flow restriction for different reasons. If there's orthopedic issues and we just can't load the joints. How many females I work with over 55 who've got osteoarthritis in the knee or who've worn away cartilage or had knee replacements. Well, we use blood flow restriction and we might therefore use one or two sets of 30 reps to get a comparable result compared to lifting heavier, but that's context specific.

Mm-hmm.

But where you are using 15, 20, 25, 30, there tend to be more finishes. They're just, let's do something a bit different. It's one set on the leg press, let's go until you can't do anymore. But we're not doing three or four sets of 30 reps of five different exercises. You have to be masochistic to do that. But of course we typically work in the eight to 12 rep range and we drift down towards four to six sometimes and we drift up towards 15. But it's also

Mm-hmm.

safety requirements as well. So if we determine deficits in scab stabilizers, rotator cuff, Achilles tendon, foot muscle, we then spend more of those strength endurance ranges there because they respond better. We've got decades of training wisdom on what areas or what they're trying to do, stabilize versus create powerful movements. We learn from that, even though we might not have a lot of good science on it, but

Mm-hmm.

People have done this for decades and it works predictably. So we kind of pick the rep range based on what we're really going after.

Yeah. And like with any training, like you want to have a little bit of a variation in what you do. So, uh, and not always do the same strength training, right?

the clients will tell us that anyway. If you come with two of the same programs in the same rep range, they'll raise their eyebrows and go, didn't we do eight reps last time? Right. So variation is important. There's a big difference between what the science tells us over six or eight weeks versus what coaches know we need. And it might not be, it might not make the biggest world

Mm-hmm.

Mm-hmm. Mm-hmm.

something really special in you. And because they believe that, they really buy into it as opposed to always staying at five sets of five.

Yeah. And you mentioned clients buying in, think that's half the cake, isn't it?

Right, yeah, it's a big part of the cake.

Mm-hmm.

Yeah, I'm just agreeing with everything you guys are saying. I think there's a little bit too much, I don't know if it's simplification or over, or complication in the whole thing with these messages that sort of led this off to create these myths. But again, back in this gym right here, I had a 15 year old, up and coming high performance athlete as my daughter was a swimmer. And then I had my

⁓

peri-menopausal wife, 50 plus, in the same gym. Kaia, the young one, started out as a young one with lots of reps, dialed in the motor patterns, and now she's kind of progressing to heavier weights. And then my wife hasn't had a history of strength training, so she's just sort of putting in those motor patterns to learn these movements for the first time.

You can never just say, there's just this one way to do things. There's one way to skin a cat. There's so many different ways to skin a cat and the context has to be first and foremost. What's the goal?

Yeah, yeah, yeah.

Mm-hmm.

And

this is the heart and mind of a coach is to ask those questions. I often ponder where does misinformation come from? And it almost looks like you form a statement like women aren't small men, i.e. there's sex differences that have to be appreciated. And physiologically, that's not new. That's been studied for decades. That's how we know because males and females have been compared together, hydration.

fuel metabolism, fiber type on and on and on and on this textbook, I've got dozens of textbooks right behind me on this very topic. And then it's like, because of those sex differences, let's now write a specific program. But if you consulted the coach, then the coach could save you the trouble and say, that doesn't mean anything in the real world. They are of interest to the physiologist. But they are of no practical relevance to the coach. And that's all we care about.

And it's almost like some folk go to chat GPT and say, find me sex differences. And then the papers come up and then the exercise prescription comes. That's what it looks like. But if you had spoken to coaches, you would realize that they don't make any difference. But what's more egregious is that the studies that compare males and females are ignored when they shown that there's a similarity and

they have to resort to rodent literature to find this. So let's take faster training as an example. Now our knowledge base is incomplete, although we've got an enormous amount of evidence in the metabolic syndrome population group. Looking at training, especially aerobically before exercise, before a meal versus afterwards. There's quite a few papers there, but there's a handful of normal general public population groups there as well.

It generally shows for the general public that there's very little difference, whether you train fasted or fed. And in the metabolic glucose control cohort, there is a slight improvement across 24 hour glucose control. And those mechanisms aren't fully understood, but males and females respond similarly, and there seems to be a benefit. But yet there's a lot of vocal opinion that says the worst thing

A female should do is train in the fasted state. And the reference is to neuropeptides, especially kisspeptin, in a rodent model. And then when asked for more data, well, here's a narrative review of rodent studies. And they ignore all the human studies. And again, just as bad, they say there's no studies in humans. So you're using mouse studies and ignoring all the human studies. Now the general public don't know this, that it's been a real bait and switch.

Mm-hmm.

Mm-hmm.

But that

is the responsibility now of scientists who know the data to say, hang on, that's not true. We do have studies. It's not perfect database. We always want more, but that shouldn't stop us from talking about what we have, designing better studies, and then giving options to females, which is very simple. If you like to train before breakfast, go ahead. It's not the worst thing for you. But if you don't feel great, don't. You've got options. There should be no barriers to exercise.

Yeah. Yeah.

Yeah. The message has been very, very frightening and yeah, frightening. even for me, a couple of years ago, I went and asked Paul like, hey, this is the message out there and I should be worried about low energy availability and reds if I go fast doing fasted and all my female hormones will tank.

Brightening.

low bone mineral density.

Yeah.

low bone mineral density you are worried about getting and.

Yeah, yeah, it's very-

Well, it's pretty simple, isn't

it? You just eat when you get back from the training session, right? So the 300 or 600 calories you expend in the fasted state, which is primarily coming from your body fat tissue, are we honestly arguing that is going to dysregulate your appetite for the rest of the day, lose your bone mass and your muscle mass? Muscle mass is not lost in two hours. This is lost over many days. Bone is lost over many days. So this concept that

Exactly. Yeah.

the

that one or two hours, but these people are saying that you shouldn't even go for a walk. It's frightening because they get on really big platforms. Everyone accepts that it has to be the truth. And no one's fact checking this. Let's fact check it. Well, what's your database? Are we really thinking that a neuropeptide study in a rodent is sufficient evidence to warn a female off or site red studies, relative energy deficiency in sport?

Mm-hmm.

as an argument to stop females from training. But what about men? The whole idea of reds is that the low energy conditions that was exclusively thought to be females in the 90s with Anne Lauks's work, they realized that that female athlete tried also existed in males with low testosterone, not just loss of the menstrual cycle. So a whole new term was brought about to be inclusive. So it's just not a female issue. It's a male and female issue. And I have had

Mm-hmm.

I've done a blood draw on a male cyclist who basically did a essentially a 24 hour ride. And we measured his I mentioned this to point we measured his testosterone and he was zero, he had unmeasurable testosterone. So these things in low energy can absolutely occur. Why does it have to be specific to females and you could say, well, they are more tendency to have under eating and so forth. Fine, let's address that issue. But if you eat straight after that faster training, what

Mm-hmm.

possible issue can you say other than it's going to dysregulate your appetite for the rest of the day? Well, that's a testable hypothesis. Does it or does it not? And if it does for you, then let's address that. But to make a blanket statement, well, that's irresponsible.

Mm-hmm.

Yeah. And this is exactly why I just love you, Tony. Like you don't forget the common sense in all of this. I mean, like to me, stating that you're going to lose your menstrual cycle, bone mineral density, and all these horrible things will happen to you if you go to a fasted run for an hour, maybe once a week. And immediately, like

It doesn't make sense. Women have not been hungry ever in our evolutionary times. We can survive for a while without food, right?

It's basically saying females are weak and you always need to exercise with fuel on board and that fuel has to be something you ate just 15 minutes before. That advice is dreadful advice.

Yeah.

Mm-hmm.

Yeah, it

makes us like, women are weak and we're not, you know, that's, yeah, completely opposite. All right. So we talked about fasted training as one of the myths that are harmful and misleading and then the strength training that we need to lift heavy.

No, no they're not. Yeah.

What is your advice for everyday athletes trying to cut through the noise?

Exercise is not complex. It's very straightforward and very simple, which means if you are hearing a very specific protocol that is sex specific, I would question that. Look at how athletes have trained over many years. And if you hear advice that everything you've ever heard is wrong, then chances are that viewpoint is wrong. They're trying to sell you something. They're trying to get clicks. They're trying to get followers.

because the advice of exercise being spread across a number of different intensities and modes and different types, it's not particularly sexy. Once we wrap up today and we walk away with actual advice, you should all be thinking, actually that does make a lot of sense. There's nothing too sexy there. That doesn't sell a book. All the good books written by experts on training and nutrition, they're not bestsellers. The bestsellers are, need this protocol in this exact way.

Mm-hmm.

Mm-hmm.

Yeah.

Since you're an expert, you work with athletes in different ranges, but you also work with aesthetic athletes, Like bodybuilders. And I would love to pick your brain about body compasses and changes in perimenopause specifically.

Mm-hmm.

you

the

Mm-hmm.

and not have testosterone that's unmeasurable. There's ways of doing this and cycling the calories and, but also the adoption of resistance training, which was really anathema and steered away from for so many years for endurance athletes for fear of getting bulky and losing their mitochondrial content and going backwards. And no endurance athlete wants extra bulk. Again, it comes with this misunderstanding that all weight training is not created equal.

Yeah.

to put on muscle is a very different program to getting stronger or more powerful. And this message now is really getting out there mainstream, which is great news. The advice is to always look at what you've been doing historically and where the holes in the armor are. What have you been ignoring? We could do that both from your aerobic training. You'll have ways of training that do one aspect or one system, and you ignore others.

So you could get the best improvement by focusing on what you're not doing. We would use that same approach when it comes to resistance training. Are you actually ever doing resistance training? And if that's the case and you've been ignoring it, then we can prescribe you a really low time commitment just to bring that level up and you'll have a marked improvement in recovery, soreness, strength and balance. It's really rather simple, but it's looking at what you haven't been doing.

and then implementing that in a really strategic way.

This might be a little bit silly question, what would be, let's say we have an endurance athlete, a triathlete who works out maybe 10 to 12 hours a week. What would you say is the minimum amount in hours of strength training that they should be doing in perimenopause?

you could get away with under an hour. If you haven't been doing much, at least for the first six months, you could do one set per exercise. Now that's one work set you might need and even I would need with 35 years of weight training experience, I will need one or two warm upsets to know what my work weight will be unless I'm doing it week after week and I know exactly what that is. But if I'm training at a new gym,

Thank

And it's different equipment. will need a few sets of, yeah, that's the way that I'm going to use. But one work set is really all you need. And I think the major error that endurance athletes makes is that they follow more of a bodybuilding approach, multiple sets, work to failure, multiple exercises per muscle group. And that is not how we write programs for endurance athletes, because what we want is to improve a metric of muscle. We want it to get stronger.

Mm-hmm.

Mm-hmm.

But we don't want to interfere with the contraction property of your endurance session. So we'll either strategically place them on days where you've got a rest day the next day, or you're going to be doing something easy that maybe that afternoon or the next morning. So there's no interference with that I've got heavy legs or heavy shoulders. Of course, in time, you just adapt and you can do whatever you want in the weight room and it never affects it. But that takes a long time to build up that kind of work.

capacity so that they don't interfere. But it's about knowing where to place them in the week in relation to your quality sessions. That's where the idea of a hard, easy alternation works really nicely. But it's also one exercise per muscle group, one set. And therefore, I would rather spread that across the week. So rather than hours per week, it's how much would you put into a session? And that could be 30 minutes, 30 minutes, 30 minutes or 20, 20, 20. You don't need to do a lot.

Mm-hmm.

And what I'm often doing in the first six months is finding out what the opposite of the sport does. So for swimming, that's a lot of internal rotation. So we do a lot of external rotation and scat retraction work because swimming is protraction and internal rotation. Running is very Achilles tendon loading. So we do a lot of dorsiflexion. Cycling is a lot of hip flexion, knee extension. So we're looking at always doing the opposite.

Mm-hmm.

in that first six months, because you can improve muscle strength by 300 % in weeks. There's no way you can do that in any other mode other than with strategic opposing resistance training. So the brain doesn't detect such strength and balances. And then once we've done that, then you can keep testing and finding out what you're not good at. And you can either use strength training to enhance contractile properties, or you can keep doing it to balance. It just depends.

How long have you been doing your sport without doing weight training? Because weight training is the only way that you can counteract what you're doing in the sport.

So fascinating. I want to get a clarification on something and I think it was Dr. Philip Stewart that spoke about this with you and your podcast was muscle strength, like a strength increase and muscle size, right? So max strength versus strength improvements in general. Can we talk about that?

Strength simply is defined as the muscle or group of muscles ability to produce force. That could be at 30 reps, 20 reps, 10 reps, one rep. They all have different names, maximal strength, relative strength based on body mass, strength endurance if you're doing it for a long period of time. And then you can get into the nitty gritty of contraction speed, whether they're isometric and so forth. So strength is a really big umbrella term.

Unfortunately, what we see in social media is the word strength being conflated with maximal strength, which is the muscles maximum ability to produce maximum force, i.e. your one rep max. For almost everyone outside of sports, weightlifting, powerlifting, you don't ever need to know that or do that. You could do five reps and that's still lifting heavy. It's close to your maximum.

If you did 10 reps, it's further away from your maximum. So you'll get better at 10 reps, but not necessarily one rep. I don't know any peri-postmenopausal female that needs to be maximally strong. They just need to be strong. And when you're 80 or 90 or 100, you just need to be strong, not maximally strong. So again, it's confusing these terms deliberately, because people are saying they know the difference.

Mm-hmm. Mm-hmm.

I'm

sure they know the difference. it's they're using these terms really loosely to frighten women that everything you've been doing is wrong. If you've been doing 12 reps, that's terrible for women. You need to do five reps. So why? If you get stronger at 12 reps, you're stronger. The reason why we get stronger at four or five reps is because our brain learns the pattern that we're doing. It's modal learning neurological. When you do 10, 12 reps,

Mm-hmm.

There are different patterns of neuromuscular recruitment going on, but there's more of a stimulus towards muscle mass. And you will hear that five reps is the best for postmenopausal women for muscle mass. That's just simply not true. We've just got so much data to show that reps in the moderate rep range, eight, 10, 12, 15, produce a bigger effect size for muscle volume, muscle mass. So I don't know, sometimes facts are just mixed.

That's just wrong, right? That's just dead set wrong.

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So rep range is a little bit lower. There becomes a signal for neuromuscular adaptations as well. then, yes.

The brain learns what you're doing a squat pattern,

a deadlift pattern, a military press, a chin up. What you need to do the five reps, the brain learns what to turn on, what to turn off, what to stabilize, very specifically to that intensity domain, which is different to doing it for 10 reps or 15 reps. The question that we always ask is what are you trying to get from your exercise program? And if it is to get maximally stronger,

Mm-hmm.

Mm-hmm.

then you need to spend some time closer to your maximum. The question for the coaches is that effective to do that long term or would it be better to alternate periods of closer to maximum with more moderate rep ranges to affect the nervous system differently, to use different patterns of muscular recruitment, to provide a varying stimulus to both muscle and bone? And the coach says, course.

We use an alternating undulating form of periodization. Few programs in the moderate rep range, few programs in the heavy rep range. And of course, you can play around with that in any number that you want. If there's one thing we know from periodization literature, it's that it's variety that's causing the positive response, not a specific protocol.

So for somebody who is, technique is great, has a long, long history of strength training. What would you recommend as she is getting into perimenopause and notices that she's just getting a little bit slower? So would you undulate between the low reps a little bit more towards the max strength?

Yeah.

And then after what six weeks or a month, go back to 10, 12 rep range and ondulate in between those.

There's probably a few considerations. If you're detecting that you're getting a little bit slower, we need to try and work out why that is the case. Are you not recovering well between training sessions? And if that's the case, we need to address your weekly intensity volume distribution to make sure you're recovering well between your key sessions. Secondly, are you taking sets too close to muscular failure, which is not giving you any extra benefit for any

Mm-hmm.

metric of muscle we're interested in, but simply delays recovery. And that's really clear when they look at jumping ability two hours later, next day, day after that. When you go to failure, you have worst neuromuscular performance for days later. So we don't need to take it to failure. Are you performing too much volume per muscle group? I'm a big fan of distributing that volume across the week. So rather than doing deadlift, hip thrust, good mornings Romanians on Monday, I would do

Mm-hmm.

Deadlift and hip thrusts, Monday. Wednesday, I'll do Romanians and back extensions. And Friday, I would do reverse hypers and lunges. Because it's your first set that's the most stimulating. When you do a second set, it's not as stimulating. It's not when you do three or four sets that you get three or four times the benefit. You're getting a little bit more benefit. And the meta-analyses generally show that one set versus three set is not three times the benefit. It's 1.6 to 1.8 times the benefit.

Mm-hmm.

So it doesn't make sense that you're doing all of this work and getting less and less benefit when you could come back when you're fully recovered and get that 100 % benefit again. So you just distribute it across the week. So for an endurance athlete, it's an absolute no brainer that you would spend 20 to 30 minutes three times a week doing less volume because then you're recovered, but you get more benefit for everything you're interested in terms of strength and muscle.

Yes!

Hmm.

Yeah.

Mm-hmm.

Mm-hmm.

So that's how I would do it. Really different to a physique athlete who's not doing any aerobic training, who doesn't need to train that muscle again for another four or five days. You can go to town. You can do a leg day. We don't do that with anyone interested with a performance metric. Very different programming styles.

Mm-hmm. Mm-hmm.

obviously we've started out to say strength training is important for every human being, every individual. But when we do look at one kind of issue with females, there is this little bit of a race to almost add strength training onto your body.

because there are, and I don't think the science has changed on these, there is this with menopause, there are these marked changes in the hormonal profile that does happen at this point with a speeding of, I guess, that loss of bone mineral density. And I reflect on my mom right now who's, bless her, she's doing a strength training workout now with a strength trainer.

in their gym at their facility and she's 81. ⁓ you know, and she knows intuitively that she needs that and because balance, she's noticed, know, balance, vision, all these sorts of things. So what is the science sort of saying on that and are there some special considerations and maybe some more urgency for females, Tony?

Amazing.

the bone is a real issue. And that is because estrogen has such strong affinity to bone remodeling that in all of the longitudinal data, you see bone go off a cliff at the perimenopause menopause transition. The data doesn't seem to show the same thing for skeletal muscle, believe it or not. So there is a decline, but that decline seems to be more age matched because when you look at the age differences,

in muscle volume between males and females, they seem to decline at a really similar rate, the 40 to 45, 45 to 50, 50 onwards, but not bone, bone goes off a cliff. Where there seems to be some error of debate is neuromuscular function of muscle around menopause, because not all studies agree. So there's an area of conflict, how do you measure it? What kind of activity were they coming from and so forth? Because the more you

you build it and then stop for studies, then you see D training. So this is an area that's difficult to give really precise findings. But if we were to look at the totality of literature, bone is lost considerably through the transition. Muscle mass, not so much, but muscular metrics of performance like power seem to drop a little bit faster than muscle mass.

So therefore the antidote is resistance training because resistance training affects bone significantly. And in all the meta-analyses that looked at all the different modes of exercise we can do, resistance training, whether you're looking at lumbar spine, total hip, neck of femur is ticking the box for all of those sites because it can be site specific. It also can address the age-related loss in muscle mass.

and the neuromuscular functions. So it seems to be the modality of exercise that should be prioritized. Fast forward 20 years to when you're in your 70s and 80s, strength is one of your biggest predictors of your ability to do a maximal test for VO2 max. So if you look at the data in the 80s and 90 year olds, which is so robustly associated with longevity, by simply doing leg resistance training, you improve your VO2 max by 6 to 10 points.

It's just because you've got more strength to do the test. So I think that really does point in one direction that for the menopausal transition, and we love exercise full stop, but what's the hierarchy? The hierarchy should be resistance training and then followed by aerobic training to make sure you're giving your adaptational energy to lifting weights first and foremost.

of

Awesome. Well said. That's great. So yeah, it should be prioritized. Yeah, it's important. There's almost a, there's this, and there's this little bit of a race too, isn't there? It's like, you don't want to start real low, right? When you get to 50. Like, you know, if that's situation, fair enough. And there's things you can do about it. But there's also this opportunity window too, right? When you're young, like my daughter, 15,

through to Marjaana's age, towards menopause, right? Like it's, yeah, so you've got this real good opportunity to load that bone on and it's gonna be slower to come off.

Yeah, right.

not being understood by people who are influences. It's kind of like they can't look at the history of science and therefore have spent their time being myopically focused on what are the differences. Let's exploit that and frighten women into doing this only form of training. And because many of these people hold themselves up as the Messiah for all females health.

Thank

the public just think that they are the authority on the topic when that is absolutely the furthest from the truth.

And what I've understood from the research is that it's never too late. You can put on muscle mass, you can get stronger even after menopause. there's hope, ladies.

Even when you're 81,

my mom is just loving her program and she's feeling so much more confident about moving around the place. She's feeling like she's got better balance, so amazing.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.

That's amazing. Yep.

Let's

Yeah.

dive into that one. So the gold standard that we use is a meta-analysis. The meta-analysis looks at all the studies and pulls all the subject data together to give us the best likelihood that the evidence that we have is right. We've got meta-analysis comparing males and females on strength training in the 40s, 50s, 60s, and 70s. These studies show that males and females respond the same way in muscle mass.

females slightly more because they're coming from a lower level. In the 40s, 50s, 60s, 70s. We've got individual studies by people like Maria Fiatarone Singh that has people in their 80s, 90s and hundreds lifting weights and they increase muscle mass and they increase strength. The oldest subject she had was 106. She started in the study at 96 and passed on at 106. She increased muscle mass and strength.

balance improved, stair climbing improved, confidence improved, muscle mass strength, it all improved. So at any age, you can take up lifting weights. You can say, well, I'm 80 and it's too late. It is not too late at all. Because in eight weeks, you can improve lower body strength 300%.

Mm-hmm.

And think about the benefits, like the downstream benefits of health when you increase your muscle mass, right? It's incredible.

So good.

You mentioned something about neuromuscular functioning, ⁓ declining around the, you know, transition to menopause. I really like, neuromuscular function is really difficult to understand for everyday athlete. I have an example. I live outside Houston and it's pancake flat. This summer I went to Canada where

Lots of uphill, downhill, uphill. So I got that neuromuscular stimulus that I don't get in my everyday life. And you know, you're sore, you're fatigued longer. And it got me thinking, and I've been listening to your podcast and I can't remember the researcher's name. You guys, you guys had a wonderful episode about neuromuscular.

That would be Severine Lamon.

Yes, yes.

And I can't, like I'm trying to wrap my head around this whole neuromuscular function decline, because I think that is my problem, not having the uphills here. So I can't get that stimuli. So I think my getting slower is neuromuscular decline.

Mm-hmm. Mm-hmm. Mm.

Yeah,

Yeah, so this is what makes I mentioned before, it's really difficult to try and tease out what's going on. But her work, which is longitudinal, has shown that muscular power is declining quite sharply through the menopause transition.

Interesting.

Mm-hmm.

The real error of interest to us is yes, that is happening. We don't quite know, and I've spoken to Severine they don't know why it's happening. These are association studies. They just show that it's happening. But by adding the correct exercise stimulus to address muscular power completely stops this issue from ever happening. And in every female that I have trained through the transition,

Mm-hmm.

or taking them on after they've passed menopause, we improve all metrics of muscle, whether it's muscle mass on a DXA scan. I've had just in the last six months, a 70 year old increased muscle mass by 1.5 kilos and a 66 year old since the end of the lockdown, so three years ago, go up three kilograms in muscle mass. So you can improve muscle mass at any age, but strength goes up and power goes up. It's all...

well and good to say this is what will happen if you don't do anything. But exercise is the solution because it completely attenuates and blunts that age-related or menopausal-related change in the metrics. I think the metrics are good to say this is what will happen if you don't do anything, but exercise is the solution.

Mm-hmm.

Mm-hmm.

And what are your thoughts on, is it more of a lifestyle change or is it physiological change? Like if you could put any numbers. ⁓

I think it's case by case. Yeah, it's case by case. So

there will be, so I'll talk from my experience, there's been a number of the females with whom I work that sail through menopause, minor inconvenience, minor hot flushes, but not a heck of a lot. There's others where it's a nightmare for them. And I've stood with them and this T-shirt just becomes drenched.

Just standing as we're talking about to start training. This tells me as a coach that I need to ask good questions and then intelligently write the program for that individual. This explains a large part of why we see strong associations in neuromuscular function with females through the transition. It's because tendon properties change.

Mm-hmm.

there's more likely to be tendinopathy. And because of sleep impairment and just feeling dreadful, they stop their top end training, power training stops, interval training stops. And therefore we see these declines rather than the drop in estrogen. Because when you speak to estrogen experts, say that we can't work out how that's working. So yes, we acknowledge the strong association, but we can't work out the mechanism.

Mm-hmm.

Mm-hmm.

because

estrogen doesn't seem to be doing that in skeletal muscle. So there must be something else. And that's my observation, which of course, tomorrow a study could come out showing exactly what it is. But where we are currently, I'm more likely to think it's the symptoms, vasomotor symptoms, tendon property changes, just feeling dreadful, stopping your high-end training. And therefore we see those strong associations. So we have to address those.

Mm-hmm. Mm-hmm.

on a case-by-case basis.

Mm-hmm.

Yeah, I'm actually just, looking on

Yeah, I can, I, yeah.

Marjaana's short interval of VO2Max session, 30 30s basically. She just did one set pretty solid still MJ, like you touched on five 30 Watts, which is solid, right?

MJ, I'm reading in your comments. And that was a tough one for you to go to. Almost a kind of Tony's point, right? You weren't feeling super great on that day, but you did one set, just touched on those.

And I almost kind of wonder with some of this too, I was reflecting, I think it's almost a symptom of if you don't use it, you kind of lose it, right? So yeah.

Mm-hmm.

Yeah, I

that I could get through that workout now. But I could do one of them. I could do 10 minutes of that, but I couldn't do that three times. What is more important? Do I dial it back and try and aim for the three of them, or do I just do one lot of 11 minutes and call it a day, but do that at peak power?

Yeah, that's a great question. I think it totally just depends on your goals, right? Like if you were working towards training for something that required that VO2 demand, then you probably want to work towards lengthening it out and get a little bit more time at VO2 max progressively. But if you're in MJ's sort of situation in this exact workout that we're just talking about, she wasn't feeling so hot.

And she just, but she knew, think intuitively that she wanted to touch on those and she just did one set and she hit, you know, really impressive power for just that one set, you know, hit the target, walked away. like, I'm done, I'm done kind of here. So.

Yeah. Yeah. Yeah. Yeah. And how long was

Mm-hmm.

that set?

Just look at it here.

five

minutes. I think it was five times 30 30s.

Yeah, it was five

times, but you only did like, you did four, you did a set of four, you did a set of five, and you did a set of five. Basically, she did like three by fives. So just nothing extensive like the Ronstadt one that you kind of said, like just a sort of a shortened version. She was done in 45 minutes and yeah, it great.

Mm-hmm.

Yeah.

Yeah. And that's generally the advice I give to my females who turn up not quite feeling and didn't sleep quite well, don't know what they're expecting is warm up into zone two, hold zone two. And once you get to that 30 minute mark, assess, how do you feel? And if it's, feel dreadful and my legs are heavy and I want to go to bed, we can the session. And if they feel okay, then we squeeze out 10 minutes of 30, 30s.

and see what we can squeeze out of the muscle for that day. And that's again, a case by case, but that's the general framework that I would use.

Mm-hmm.

Yeah, that's my motto. I've been telling myself like lose it. No, use it or lose it all summer long. So I've been doing sprints with my 14 year old son who is just a beast and working out with him because I'm thinking like this neuromuscular function and stimuli that I think my body really needs. I'm an endurance athlete.

That is not the first thing that I would go after. But now that I just feel better and I feel stronger and more efficient and like an athlete again when I hit that neuromuscular load.

Yeah. And I love one

Yeah. Let's not forget that we

of the things.

die with our... Yeah, go ahead, Paul.

I just, I mean, I wanted to reflect back on one of your comments that you said and just put a, you know, put a stamp on it. And it's like, just like what, you know, if, if you're not actually training for something, it's like, what does my system need? And we've got so many tools in the toolbox that we can kind of use. Right. But it's like, if you haven't, know, you want to get some zone two in your, in your week, you want to get some, some high intensity interval training in your week. You want to get some neuromuscular stimulus in your week. You want to get some strength training in your week.

Mm-hmm.

Are you missing any this? We know they're all important. And yeah, it's like what are you short of and what fits in with your context and your time? And this is the art and the science that we're kind of all trying to blend, I think, as everyday athletes.

Mm-hmm.

Yeah.

Yeah. And there's a number of models that we can use to help that. But to go back to your point MJ is that we die with our slow twitch fibers and we can do endurance work until the day we're no longer here. But it's the fast fibers that decay with time that's responsible for the neuromuscular functioning. It is critical that we have exercise stimulus that stimulates those fibers to either maintain or develop.

Mm-hmm.

Mm-hmm.

And what Maria Fiataron's work shown is hyperplasia. We can grow new fibers. So she's done work in the 80s where you grow new fibers, which is just really quite dramatic and quite contrary to the current viewpoint about how we grow muscle. And this means that we need exercise options that are stimulating different pathways. So to Paul's point of doing lower intensity metabolic zone two work,

Mm-hmm.

and we need exercise stimulus to promote muscle mass, and we need exercise stimulus to promote neuromuscular function. The question, the age-old question is, do we do it all in the same week or do we do it more sequentially? And the answer is we don't know, but what is apparent and very clear is that we do need that over at least a few months stimulus. So whether you do them more sequentially,

do muscle mass, which helps you do strength work for neuromuscular function, which helps you do power work. And we do them program by program by program. Or do we use an undulating approach where Monday you might focus on strength and power and the other days of the week we focus on muscle mass. I use all the options and I find out what a client really enjoys, which means they've bought into it. And then I give them more. So I'm always paying attention to, I like that session. Great. Make a note. I'll do more of that style of training.

But the takeaway point is across the months, you're ticking the box for heavy and fast or heavy and fast because fast is often less load but moved quickly. And we've got more volume for muscle mass. And yes, we do different types of interval work and low intensity work in between.

Tony, Tony, gotta double click on the hyperplasia because I thought I missed an innings there because I wasn't aware. I thought it was all about hypertrophy and hyperplasia was debatable and there's a whole camp that say, that doesn't happen except in mice or something like that.

I picture it, yeah.

Yeah,

yeah. So if you look at Brendan Roberts' work and Brad Shellenfeld's work, and the body of literature is assessed up to typically in males, but typically up to 40 years of age. If hyperplasia is occurring, it's not occurring very much. So we don't kind of really consider it a big deal. Where we do think, yeah.

All

Right. And for the

listener, hyperplasia, we're making more muscle fibers, right? And with hypertrophy, you're taking an existing muscle fiber and you're adding cross-bridges to it. So you're actually making that single muscle fiber a lot bigger. Please continue, Tony.

That's

Correct,

correct. And to their point, if it is happening, it's not a big deal. So let's not do a specific protocol for it or really worry about it. Then when you look at the elderly literature, we see a different picture. And that is you see new muscle fibers forming and that's clear and unequivocal.

Really?

So Tony, what are your take home messages for the everyday athlete?

Create a hierarchy of what you want to get for your health and fitness. And it may well be a performance goal, but you also have the idea of aging well in the best possible condition. And for many of us, if it's not a performance, it's I just want to feel good and I want to age well. And if that's the case, we've got a number of different exercise buckets that we need to devote some time to. Now, not all of those buckets require the same volume and time commitment.

the development of strength and power, or even VO2 max doesn't require enormous amounts of time. Whereas developing muscle mass or endurance, endurance requires a lot of time. This is where we look at the week, work out what is the most important that gets our brain freshest after a recovery day, maybe on a Monday, it could be on a weekend when you don't have any other commitments, so you can train and then rest, do it with other people so you can push each other on

Everyone must make that call for themselves. But what is really clear is that we need exercise to stimulate strength and power, which also stimulates bone, muscle mass with a little bit more volume, which also stimulates bone. And then we've got the different modes of aerobic training, which either might be performance driven, or it might be just general. we kind of do some biking and some running and some swimming and so we mix it up. So we get different neuromuscular patterns as we age.

And then we progressively overload it, trying different models of progression. So some heavy weeks, some light weeks, put them in the same week, but variety I think is really important. And target all the exercises where we know we're gonna lose bone. And that's lumbar spine, that's hip, that's femur. So include exercises for lumbar hip thigh, which could be squats or deadlifts, leg press back extension.

You can make those exercise specific calls based on your anatomy and whether you've got injuries and what equipment you've got available. But you should look at your program and think, yeah, I feel that in the hip region or the lumbar spine region and so forth. And we try and encourage a daily approach to exercise because exercise does wear off in terms of its health benefits, whether it's improving glucose control, improving muscle stimulus ⁓ for growth or neuromuscular function.

it wears off. And so rather than having a heroic session one day and then several days needing to recover, we tend to dose that a little better. So you're doing something each day and you then get the health benefits and then you get the long lasting muscular benefits as well.

I think your philosophy matches well with ours instead of big heroic workouts. Just split it up into three 20-minute strength workouts per week instead. Yeah.

Right. Right.

I think most coaches agree on what works.

Sure, there's preferences and subtle differences, but if you get a hundred coaches who've been all coaching for 30 years, we're all going to see the world pretty similarly. Cause if it doesn't work, we don't use it. Where there's controversy is where people who don't coach pretend that they do and say, this is the best thing that you can do.

Beautiful.

That's very

well said. Yep, I could not agree more, Tony.

Thank you so much for sharing your wisdom and joining us today. I'm sure we could have talked a lot longer, but maybe next time.

You know, mindful of your time, Incredible. Yeah, you're just ⁓ such a wealth of ⁓ important information for all of us, the everyday athlete, the scientists, the strength and conditioners. Just, yeah, really, really appreciate you, Tony, and thanks so much for coming on and sharing your wisdom. Would love to have you back at a later date to keep things going. That's great.

My absolute pleasure anytime. Yeah, thank you.

Yeah, anytime. Thanks for having me.