#414 ‒ Resistance training as we age: optimizing exercise selection and training intensity for muscle growth, function, and injury risk management | Jeff Cavaliere, M.S.P.T., C.S.C.S.

View the Show Notes Page for This Episode https://peterattiamd.com/jeffcavaliere/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=261102-pod-jeffcavaliere&utm_content=261102-pod-jeffcavaliere-podfeed Become a Member to Receive Exclusive Content https://peterattiamd.com/subscribe/?utm_source=podcast-feed&jeffcavaliere%20=referral&utm_campaign=261102-pod-jeffcavaliere&utm_content=261102-pod-jeffcavaliere-podfeed Sign Up to Receive Peter's Weekly Newsletter https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=261102-pod-jeffcavaliere&utm_content=261102-pod-jeffcavaliere-podfeed In this episode, Peter welcomes back Jeff Cavaliere, a physical therapist, strength coach, and founder of ATHLEAN-X who has spent decades bridging the gap between rehabilitation, athletic performance, and strength training. Jeff begins by sharing how his experience working with professional athletes and managing his own injuries has shaped his approach to building strength and muscle while minimizing injury risk. He discusses how training should evolve as we age, particularly for those in their 40s, 50s, and beyond who want to continue making progress without compromising long-term joint health. Jeff explains why excessive training volume can be counterproductive and how to balance reps in reserve with training to failure to maximize results while managing fatigue and injury risk. He also explores the differences between training for aesthetics and functional performance, explaining why these goals are not necessarily at odds. The conversation then shifts to a muscle-by-muscle breakdown of effective exercises for building strength and hypertrophy. Jeff highlights common training mistakes, offers modifications for those dealing with pain or injury, and explains why often-neglected muscles deserve more attention. Finally, he walks through his "exercise graveyard," identifying popular exercises that may carry unnecessary injury risk and offering alternatives that deliver similar benefits with less risk. Throughout the episode, Jeff provides actionable guidance for making training more effective, sustainable, and adaptable as we age. We discuss: Jeff's passion as an educator and the path that led him to build his YouTube channel [2:30]; Jeff's injury history and how he overcomes injury in training [11:00]; Qualities of great athletes and the tragedy of injury [20:15]; Tom Brady—an example of the value of pliability and consistency [24:30]; The athlete's mindset, how training changes in midlife, and the importance of a warm-up [28:15]; Reducing risk of injury in middle age and beyond: reps in reserve, training to failure, and junk volume [35:15]; How training intensity changes in midlife [44:30]; Hypertrophy: misconceptions and common mistakes when training shoulders [48:15]; Deltoid muscles of the shoulder: exercises beyond the overhead press [59:45]; Triceps: compound movements and exercises that target the long head [1:11:15]; Upper arm: best approaches for building hypertrophy and strength [1:21:00]; Biceps: nuance around training [1:24:30]; Forearm exercises that target the flexors and brachioradialis [1:31:45]; Pecs and chest: pressing and crossover movements [1:34:15]; Great abs: nutrition, rotation exercises, interval training, and more [1:45:30]; Back: exercises to create that V-shape [1:52:30]; Legs: training the quads, glutes, and more [2:02:00]; Calves: training the gastrocnemius and soleus [2:13:00]; Jeff's "exercise graveyard" and recommendations for modifications that achieve results with less risk of injury [2:21:00]; and More. Connect With Peter on Twitter https://twitter.com/PeterAttiaMD, Instagram https://www.instagram.com/peterattiamd/, Facebook https://www.facebook.com/peterattiamd/ and YouTube https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:11Dr. Peter Attia?

  Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive, member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription.

• 0:54Dr. Peter Attia?

  If you want to learn more about the benefits of our premium membership, head over to peterattia MD.com/subscribe.

• 1:04Dr. Peter Attia?

  My guest this week is Jeff Cavalier. Jeff is a physical therapist, strength coach, and founder of AthleanX, one of the most trusted and influential fitness education platforms in the world. Prior to that, Jeff served as the head physical therapist for the New York Mets, and he has spent decades bridging the gap between rehabilitation, performance, and strength training. This is Jeff's second appearance on the Drive after joining us last year for our Strength Roundtable. In this episode, we talk about how to train for strength and hypertrophy while minimizing injury risk, especially as you move from your 40s into your 50s and beyond, why junk volume is one of the biggest mistakes lifters make, and how to think about productive reps instead, reps in reserve, how to use them correctly,

• 1:46Dr. Peter Attia?

  when to train to failure and when not to, Jeff's own injury history, including shoulder and foot issues, and how they shaped his philosophy on training around pain, the differences between training for aesthetics and functional training, and why they're not actually at odds, Jeff's list of common graveyard exercises that increase injury risk without delivering enough gains to potentially justify them, why calves, glutes, and smaller stabilizing muscles deserve far more attention than they get, how to adjust training variables like volume, intensity, and frequency as you age without giving up performance, and finally, a body part by body part breakdown of some of the best bang-for-your-buck exercises. So, without further delay, please enjoy my conversation with Jeff Cavalier.

• 2:36Dr. Peter Attia?

  Jeff, man, thank you again for coming back to Austin. So, good to see you again.

• 2:39Speaker 01

  Super happy to be back here.

• 2:41Dr. Peter Attia?

  You've been here in the heat, you've been here in the cool, it's all great.

• 2:44Speaker 01

  This is a beautiful place. We were talking to the driver on the way over, and I said, "Where's the one place in Texas that I should, if you were to choose one place?" He says, "Honestly, Austin, because it offers the most diverse opportunities, and not just the nightlife, but it has the scenery, the culture, so I love it."

• 3:00Dr. Peter Attia?

  Awesome. We'll try to get you to move here.

• 3:02Speaker 01

  Yeah.

• 3:03Dr. Peter Attia?

  Well, there's a lot I want to chat about with you today, and I also realize that for some people listening or watching right now, they might not know a lot about you. So, maybe just briefly tell us a little bit about your journey to here. We didn't talk about it really on the Roundtable, so maybe just explain a little bit about how you found your way to doing what you're doing right now.

• 3:23Speaker 01

  Growing up, I always wanted to get ultimately involved in some career where I could help people or educate, because I always loved doing that. My father was a doctor. I had aspirations at one point as the third kid of three to maybe become a doctor, because no one else had. But for me, I always had this other love of sports, though, too. So, if I could figure out a way that I could get into working with athletes at the same time that I could help people, not just athletes, because it's a smaller population, then I would find I would feel would be my perfect fit. Well, I started being able to work strictly with athletes as I got a job with the New York Mets. I'm a physical therapist. I was their head physical therapist for three seasons, and then left to pursue whatever this was

• 4:07Speaker 01

  ultimately going to become. But I started pretty early making videos for YouTube, educational videos for YouTube, focused on trying to take the lessons that I learned from training with top-level athletes and apply them to people who are never going to get paid to do this, were never going to get a pro contract, but just wanted to be able to benefit from what they need to focus on to perform at such a high level. Because I think we all have a lot more we can do if we focus on the right things. And I started off with a couple of videos, and the next thing you knew, a couple more subscribers, and I saw that there was an opportunity to continue to pursue that path, and I did. And ultimately, here we are now, almost 15 million subscribers, doing what I've done since day one, which is just trying to use the platform to educate and empower people with the techniques and

• 4:52Speaker 01

  strategies from both the realms of rehab as a physical therapist and strength and conditioning, as my other role was with the Mets, because to me, they're all one continuum. If you're hurt, you're just less functional at the moment, but as you become able to get higher and higher levels of function, you could get to extreme levels of function and capabilities, and that's athleticism.

• 5:10Dr. Peter Attia?

  What year did you start the channel in earnest?

• 5:13Speaker 01

  2009 is when I actually started to make content for it. My years with the Mets were 2006, 2007, and 2008.

• 5:18Dr. Peter Attia?

  When you think about the evolution of the channel, there's so much content on there, how do you think about that from the standpoint of injury prevention to a lot of the stuff that I actually probably discovered maybe on Instagram a few years ago, maybe a little longer than that. I've been following you for quite a while. But a lot of it is on, honestly, like, why is it that when you're doing a lat pull-down, you're not getting the right engagement? This is geared towards function and hypertrophy, as you said, like, this is not about an injury, this is about making progress. Has that been an evolution for you, or have you always provided information on that continuum?

• 5:50Speaker 01

  I've always provided people information on that continuum, because I feel that's the part where my skill as a physical therapist comes in. Because if you're in a rehab setting and somebody comes to you with whatever ailment they have at the moment, and they need help, you will never be able to follow the playbook as instructed, or as written, or as the protocol comes that says, "This is what you're doing one week later, two weeks later, three weeks post-op, whatever." Something always comes up where that individual has something that doesn't feel right, or they don't have the range of motion that's expected, or something is preventing the playbook from being able to be executed. That's where you need to be flexible enough to be able to say, "Well, okay, try this instead." It could just be

• 6:33Speaker 01

  simply moving your leg further out into abduction to then go do a leg lift. All of a sudden, pain-free motion, again, they're able to do the activity. So, if you don't have that ability to have a lot of flexibility in your approach, then I don't think you can effectively perform a rehab on somebody. It's no different in weight training and strength training. Not every exercise will feel great for every person, or feel as effective as it should. There's tips that you can give them to increase the stimulus that you're feeling, and that might work for almost everybody, but there's still going to be people who don't have that effect with the exercise they're doing. So, you need to find exercise number two or three. And the beautiful thing about strength and conditioning is, there's

• 7:15Speaker 01

  never just one option. There's usually like hundreds of options to go to. So, if you're diverse in your playbook, you're going to be able to do that. So, I think over the years, my ability to navigate even similar issues, I've done 1,700 videos at this point. I mean, we've covered a lot of the same issues twice, but coming at it from a different angle and making it click for somebody for the first time, because we're explaining it slightly differently, is probably where the power is.

• 7:38Dr. Peter Attia?

  You've probably observed the same thing that many people have observed, which is some combination of the human attention span appears to be getting shorter and shorter, and platforms seem to recognize that and prioritize shorter and shorter content. Now, I think I'm a bit of an unusual person in that I don't like short-form content. I really like long-form content. I like watching a 20-minute video where I will learn something in depth that's at the master's level, as opposed to a one-minute video that just shows me something at a superficial level that, obviously, even if it's correct, it's incomplete. How has your ability to provide content evolved in that environment, and are you still making

• 8:23Dr. Peter Attia?

  a lot of long-form content? And how have you basically struggled with trying to educate people as much as you can, but understanding that your opportunity to do so, like every one of us who's trying to educate people, it's narrowing?

• 8:38Speaker 01

  It's been a huge challenge for me personally, and I think even for obtaining the information that I do like to obtain, because like you, I like to find that long form content. I like to dive deep. I have no problem taking a three hour podcast, or even just a 40 minute video and chunking it down into sessions so that I can watch 10 minutes now and then watch 10 minutes again later. I have no problem with that. What I don't like is the watering down or the thinning out of the content, specifically because it needs to fit this format, this short form format. What you're forced to do as an educator is to pick and choose the things that you think are going to be the most impactful, but you're not really even given the opportunity to explain why.

• 9:20Speaker 01

  I'll give you a great soundbite, but is the soundbite really valuable if you don't also understand why? Because unless you remember or memorize that soundbite and can implement whatever the soundbite is telling you to do, if you forget the why, then you may never be able to actually understand why you're doing what you were told. That is why I've always done long form content, because I want to have the opportunity to explain the, we have a joke internally at my company where they say, sets and reps, please, because that's what people literally will say in comments. They'll bypass the entire explanation of why, which again, I feel is not just, I'm not trying to make a long video. I'm trying to give you the information that you need to be able to implement this, not just on whatever I'm teaching you in that video, but other things too.

• 10:03Speaker 01

  Sets and reps, please is basically the punchline to like, I don't want to hear any of that. I just want to know, tell me the what. I struggle, I still struggle, but I will always continue to make long form content. Now, we've had to make short form content. I've had to take clips from these longer videos and convert them into things that we can present in short form format. I have had to make them more intentionally engaging in the first three seconds, because I know that is the attention span of the person who's about ready to flip that thumb one more time and skip right past me, to have something that's going to catch their eye, just so that I can have the opportunity to teach them whatever I think is going to be valuable. I think that's a game that kind of sucks, to be honest with you, but it's sort of part of what social media is evolving into.

• 10:47Dr. Peter Attia?

  Well, the good news is, I don't know how many minutes we're into this discussion, probably 10 or so. I can assure you that any of the people that need to get hooked in the first three seconds are not only gone from this, they're like, they're 10 steps removed. Anybody who's still sticking around is in this for the long haul, so we should not be apologetic for the fact that we're going to talk about many topics in depth. Let's start with, well, one other kind of personal question that I think helps set the stage, Jeff, is help people understand your own personal injury history. You don't get to be in your 50s like we are without a lot of stripes on your back. And I think that can also explain sort of where you're coming from. So I know of at least two injuries you've had. You probably had more like, what are some of the major sports injuries, training injuries

• 11:31Dr. Peter Attia?

  that you've experienced?

• 11:33Speaker 01

  The most significant injuries that I deal with on a daily basis are probably a result of poor training advice, overzealous attempts to become something that I wasn't, you know, in my teens and early twenties in terms of being a lifter or a bodybuilder. Most of all, not correcting some of the issues that I knew were there, but I felt were like old man issues when I was 20. So for instance, I have incredibly flat feet. If I took my shoes off now and stood, you think I have flippers on my feet? That is how bad they are. There's no arch in my feet. Knowing now what the implications of that could be with every single step you take having to be, the consequences of those absorbed somewhere else up the kinetic chain, my knees, my hips, my back. I would have done something back then to become a lot more diligent with finding the

• 12:17Speaker 01

  right orthotic, with actually staying true to wearing the damn thing, not taking it out because it was uncomfortable in one shoe or it wasn't really, couldn't wear my favorite shoes because of it. So that had a lot of repercussions on my knees that I feel every day, every day. Now, there's things that I've been able to do and work around, which we can talk about, because I believe you should be training, no matter what your pains are, there's ways to train around them. But I have been able to navigate that. Now, the other one that I significantly deal with is in my right shoulder, torn labrum, 50% tear of my supraspinatus rotator cuff, degeneration in that shoulder as a result of the torn labrum. Your labrum is basically there to provide a nice level of support inside the joint.

• 13:01Speaker 01

  When you tear that and that bone is able to kind of move around a lot more freely than it should without the stability, you can get a lot more accelerated arthritis and degeneration in that shoulder. I was told that I had the shoulder of an 80 year old person. So I'm only 50, that's a little disconcerting, but right now that doesn't actually hurt. So I'm able to do almost anything in the gym that's not unwise, because I've learned how to sort of train around those things, but it's always going to be persistent there.

• 13:27Dr. Peter Attia?

  To be clear, you have a 50% labral tear and independent of that tore the rotator cuff.

• 13:34Speaker 01

  Yes.

• 13:34Dr. Peter Attia?

  And you have at least a 50% tear in, did you say infraspinatus or supraspinatus?

• 13:38Speaker 01

  Supraspinatus.

• 13:39Dr. Peter Attia?

  And the other three muscles are?

• 13:41Speaker 01

  They're pretty intact, yeah.

• 13:42Dr. Peter Attia?

  And how many years ago was that?

• 13:43Speaker 01

  So that was actually the funny part about that injury, because that, I've told this story before, that was on a dare, on a bet.

• 13:49Dr. Peter Attia?

  Oh, I know this story.

• 13:50Speaker 01

  Yeah, so I was coaching with the New York Mets and it was my second year with them. And so I was very comfortable around the guys at that point. Definitely would be known to ride each other's weak points and where their insecurities would be. And I think they all knew I wanted to be an athlete one day. I wish I was a baseball player on the other side in uniform, but I picked up a ball one day and I was standing next to one of our all-star outfielders. And I said to him, just casually, because we used to do our conditioning on the out and right field. I said, you know what's crazy? It doesn't look that far from here to third base. It just doesn't. And he's like, really? And he hands me the ball. He goes, why don't you try throwing it there? I said, it's not that far.

• 14:29Dr. Peter Attia?

  How close are you to the wall?

• 14:30Speaker 01

  We're on the warning track, so just in front of the warning track.

• 14:33Dr. Peter Attia?

  To me, it looks far as hell, by the way.

• 14:35Speaker 01

  To me, it didn't look so bad. And maybe again.

• 14:37Dr. Peter Attia?

  No, but I think when you're on the field, it's different.

• 14:39Speaker 01

  It is different. It's definitely different. Things look a little closer. So he handed me the ball. I said, what do I get if I do it? He says, a thousand bucks. And so I said, all right, give it to me. And I basically crow hopped about three steps or so. I backed up a little bit, threw it. As soon as I let it go, I don't even remember seeing the ball land. I think it was somewhere around second base that it landed and bounced and rolled pathetically towards third base. I felt like a zipper like pain in my shoulder and I knew that I had just screwed up. It was pretty debilitating for the next couple of weeks in terms of that really acute injury, but then I was able to, of course, I still had to go to work every day and, but there's a lot of laughing that went on at my expense. My ego was hurt way more than my shoulder at the time, but I've since lived with that because that was never repaired.

• 15:23Speaker 01

  And I went through some periods where I could not train with a variety of exercises without pain. Impossible, impossible. And I tried all different ways. I did everything I just mentioned to you before, the slight angling of the arm and the changing of the, nothing would work, except for completely getting away from some of those irritating exercises and then getting into some other movement patterns. And I was able to get back to the point where now I can bench press. I don't barbell bench press, but I dumbbell bench press. I'm able to, I'd say pretty much do a full training routine without limitation from the shoulder. I do know that if I were to go do something like, let's say a dip too low, and I do this sometimes trying to demonstrate the wrong way to do things and I'll show, okay, don't do this, I'll feel it for days after.

• 16:07Speaker 01

  So unless I'm intentionally trying to show a mistake, if I were to do something dumb, like if I were to try to attempt the muscle up again, which I've done, that could go from feeling so good right now to back to feeling awful. And it could be for a long period of time. So I'm very careful in terms of the things that I do engage in and don't do.

• 16:26Dr. Peter Attia?

  When you had that failed throw to third base, did you sublux as well? Or was the torn labrum a totally separate injury that resulted from presumably subluxations elsewhere in your life?

• 16:36Speaker 01

  No, no, I had never had any other shoulder issues my whole life.

• 16:39Dr. Peter Attia?

  So that labrum, you think came from that as well?

• 16:41Speaker 01

  Oh, yeah, yeah, yeah. Because when you try to throw it that hard, that quick velocity, you can get a slap tear from that one extreme effort that was overreaching by everything I had, basically adrenaline driving me to not look stupid. I did have a nice punchline to that story. I don't know if I shared this one last time, but I was subsequently challenged, just goes to show you how dumb I can be with that mentality of an athlete. The following year at home plate, we're looking at first base. Now that looks very close. I don't care, even if you're sitting in the stands, it doesn't look that far, but that's 30 yards. And so I said, isn't it crazy how like quarterbacks who throw the ball 60 yards in the air is like, that's a huge feat, or they talk about how incredible it is. I said, that's 30, that's half the distance right there.

• 17:25Speaker 01

  You could throw this on a regular pass. Knowing what I did the previous year, another player stepped up and challenged me to see if I could throw a football 60 yards.

• 17:34Dr. Peter Attia?

  60 yards?

• 17:34Speaker 01

  60 yards.

• 17:35Dr. Peter Attia?

  Well, how did you go from 30 to 60?

• 17:37Speaker 01

  Because I said it was only half the distance to this accomplishment of 60 yards. Like I could do that with my eyes closed right now. You can see how I tend to put myself in horrible situations quickly. But I was then challenged to do that. And we got out of spring training, went to Miami where we opened up our season. And of course, there's a football field there. So we're played on a converted football field back before they moved into the new stadium. And they walked off 60 yards for me. This time it wasn't just one player, the whole team gathered around. Everybody's there and I had, they had someone pace out 60 yards and I had the football. I crow hopped a few times, I threw it, I threw it 60 yards.

• 18:16Dr. Peter Attia?

  Some redemption.

• 18:17Speaker 01

  Some redemption. When I got to the.

• 18:18Dr. Peter Attia?

  But sorry, this is only one year after you've torn the rotator cuff and the labrum.

• 18:21Speaker 01

  And this is what's so great about this story. It's not that I threw it 60 yards, which by the way, I was handed a thousand dollars in cash shortly thereafter. So they did hold up to their end of the bargain. What's interesting about that is the only difference was the plane that you're throwing in. When you're a baseball player and you're throwing and you're out here, there's so much stress on the shoulder and the rotator cuff from here. When you're in this position here, like a football player, there's so much less stress. You're putting your body into what we call the scapular plane. You've got a lot of triceps that are helping this movement. It feels completely differently. I don't have the pain and stress in my shoulder when I throw from there. How is it that one person not only destroys their shoulder doing the

• 19:04Speaker 01

  other thing, but does something that somebody from the outside would be looking at as the same thing? Oh, he's throwing again? But it's not. It's a completely different throw.

• 19:13Dr. Peter Attia?

  Pardon my ignorance, Jeff, but I understand why a pitcher would be out here because they often want to put spin on the ball. But if you're the outfielder and you don't need to put spin on the ball and you're just going for distance, why wouldn't you mimic the quarterback's mechanics?

• 19:28Speaker 01

  Probably a good question, but I think that you're able to get more torque from out here. Obviously, that's because you have that longer distance in the arm. So you're able to throw that ball further and faster. With a football, usually your targets aren't as far down the field. And when they are, your desire is going to be to arc them and lead them. It's more timing than anything. I think when you're trying to throw for maximum velocity, you're going to want to rely on that longer arc of movement. And when you're an outfielder, ball's going to get there fast. You've got to throw the guy out at second base, third base, like I tried, or home. So to get maximum velocity, you're going to probably want to be out there mechanically. And a football player, they can do it with a strong arm and distances of 20 or 30 yards, 15 yards, 10 yards. But when you're throwing

• 20:13Speaker 01

  long and deep, you usually got so much arc that you don't have to have as much of that speed, but just the arm strength to get it out there.

• 20:20Dr. Peter Attia?

  When you look at some of the greats, let's take Bo Jackson as an example. And obviously for you and I, I mean, that's, we can remember every single play he ever had. I realize that some people may be too young to remember what it was like to watch Bo Jackson. But one never got the impression that Bo was, got that way through training. He literally just seemed like he, I don't know, was somehow born knowing how to do what he did. Is that because his natural innate talent was around the mechanics of throwing? Or do you think that there are innate differences in the structure of the rotator cuff that would enable him to get away with a higher torqued position?

• 21:00Speaker 01

  I think that the idea that athletes are born is not entirely accurate. And I also think that athletes are made is not entirely accurate. I don't think that people who are unathletic can achieve the highest levels of athleticism simply by spending the 20,000 hours, right? And vice versa. So when you look at a guy like Bo Jackson, like these outliers as just tremendous athletes, they're always going to have characteristics that make them the outlier. They're going to have higher percentage of type 2 fibers. They're going to have, because we have a lot of muscles where we have distribution of type 1 and type 2, slow twitch, fast twitch. They're going to be a lot more twitchy is what we say. They're going to have stronger mind muscle connection. So when they go to

• 21:44Speaker 01

  do something, the reason why it looks so easy when they pick something up for the first time is that the coordination requirements that are tough for a lot of us, even just getting on a bike and trying to coordinate that, they pick these things up so easily. Most of all, because I think they have great neuromuscular efficiency. They can do what they're telling their muscles to do. And I believe they have amazing proprioception, which is another perception of your body's position in space, or really what your joint's positioning is in space, that a lot of us have to learn and practice and get good at. They have inherently great proprioceptive intelligence. I think when you can put all those things together, and then you have someone who's actually very fast, because speed isn't something everybody has either, when they're fast, when they're explosive,

• 22:26Speaker 01

  twitchy, as I said, strong, now you're able to do things. And again, when you can pick these skills up so quickly, you're able to do things that look almost effortless that others would require a lot of effort to even make it look like they're doing it right, let alone doing it at the level that they're doing it. So I mean, Bo Jackson, he was a once in a lifetime athlete. It's just amazing how short his career was because of injury. And that's another thing, no matter who you are, you might recover faster because of some of the things we talked about. But injury is injury. Injury can happen to anybody at any time, especially in a contact sport like that.

• 23:05Dr. Peter Attia?

  But his was such a freak injury, too.

• 23:07Speaker 01

  Awful.

• 23:08Dr. Peter Attia?

  And again, you don't see that injury a lot. Like if you said, oh, it was an ACL or something like that, you'd say, yeah, yeah. But to have the avascular necrosis of a hip that comes out of, I mean, it's just, it's crazy.

• 23:20Speaker 01

  Even not knowing, because I remember actually when that happened, and it went down, he got injured. And what it could have been at that time could have been a bunch of different things. But when it was determined, okay, it's a hip fracture, then to heal that way, heal improperly, and then he develops avascular necrosis, that's just sort of tragic, especially as a sports fan to see like that have to happen to him. Because it could have healed normally, but it didn't. That's somewhat tragic. One of my best friends from the Mets, David Wright, amazingly talented, all-star, perennial all-star, he was fielding a ground ball at third base, coming in, and Carlos Lee, big, they call him the Caballo or something like, big guy, came down the line and collided with him. He broke his back, a transverse

• 24:04Speaker 01

  fracture of his lumbar spine. It healed improperly, basically healed with a lot of bony spur formation. Now he gets a lot of compression on the nerves there. It feels like a hamstring injury the following year because he's getting burning down the leg, but it's not the hamstring that's causing the problem. And ultimately, that led to his retirement, or to him not being able to play the game that he was. He was a surefire Hall of Famer, surefire Hall of Famer, from a freak accident that just continued to cascade in terms of its healing going wrong, basically took him out of the game early. So some of the greatest athletes we've ever seen can still be brought down by injuries. And it's tragic when it happens because it has so much.

• 24:42Dr. Peter Attia?

  So when you see athletes that combine the best of both worlds, which is to say they have the skill to be all-stars, but then they also end up having the career longevity to realize that dream, I can't think of a greater example than Tom Brady. It always annoys the hell out of me when people talk about his lack of athleticism. It's the dumbest thing I've ever heard, right? Like, the guy's a better athlete than anyone you've ever seen. Let's forget that. But again, what also allows Tom to go down in history as the greatest football player in the history of the sport is that he played so long, and that he did so relatively injury free. I mean, he had an ACL injury that didn't derail him at all, missed a year. And when you think about something like that, Tom is one of the most deliberate people in the world when it comes to how he thinks about conditioning

• 25:24Dr. Peter Attia?

  his body. And one of the things he talks about a lot is pliability. And he talks about how, at least at his position, it's less important how strong he is, it's more important how pliable he is. How trainable do you think that is across the board?

• 25:36Speaker 01

  I think it's trainable. I think it's basically sometimes avoiding some of the things that take away pliability. So if you're focused on just strength and just building as big muscles as you possibly can, then you're going to be trading off some of the elasticity of that muscle. So being able to build to a certain point, or try to create as much growth as possible, to a point where you're still able to functionally use that muscle and to have the elasticity in that. So that means you still have to work on your flexibility. You still have to work on your mobility. I hate the term muscle bound because it just sounds like such a cliche from the old days. But that is really essentially what's happening. When you become muscle bound, you're not also working in the elements

• 26:18Speaker 01

  of flexibility and mobility. And I think Tom Brady has always done that. He's never been worried about being Mr. Olympia. Wasn't his physique that was leading his success on the field.

• 26:28Dr. Peter Attia?

  It hasn't been for any quarterback, and yet it still strikes me that there's something Tom is doing different than all the other quarterbacks, or most of them.

• 26:37Speaker 01

  I mean, to me, when I think of Tom Brady, and I've actually heard this from some players, he is the epitome, this is a great, because it segues into anything we're talking about later on in fitness, consistency. He is the epitome of consistency. Consistency is the key that unlocks every single door when it comes to physical performance or just overall health and longevity. If you can stay consistent with what you do, then you're going to have a lot more resilience to injury. You're going to have that ability to focus on the things you know you need to focus on. And even if you don't like them, I don't like stretching, I hate stretching, but being able to show up and continue to do that, that's the consistency part of it. He, I'm sure, has so many things that he

• 27:18Speaker 01

  did in his preparation that weren't his favorite things, but it was never a negotiable of him not doing them. So to me, I think his superstardom and his legendary status comes from his consistency in doing even the things that he didn't really want to do. I think what happens to a lot of people, and even a lot of athletes, is that they tend to narrow down to the areas that they like the best, or they perform at well. You're never going to be as good as you can be if you always focus on the things you do well. You have to focus on the things you don't do well at to sort of round out and fill in those gaps so that you're able to create an end product that is more fortified than not.

• 27:59Dr. Peter Attia?

  And that's really a lesson that goes far beyond trying to be the best player in the history of the NFL. That's true for all of us. And you've heard me talk about this a lot is I do want everybody to think of themselves as an athlete. And then the sport, it's not football and it's not tennis or necessarily anything like that. It's just life. Life is a sport. Luckily, it's not as demanding a sport as being on a football field, but it's still a sport. It's a sport where you get to define the rules. You get to define the objective of the game. But if you treat it like that, and then you start to adopt an athlete's mindset, the athlete's mindset says, there's a distinction between training and exercise. Training has specificity. Training has sometimes doing things I don't want to do. It means creating a well-balanced and structured program. And I want to talk about all these things with you today.

• 28:44Dr. Peter Attia?

  So let's start with the idea of transitions and stages in life. So I'm sure you feel the same way I do, but we're half the men we used to be already, and we're not even there.

• 28:57Speaker 01

  Being reminded every day.

• 28:58Dr. Peter Attia?

  Yeah. Sometimes people, I've said this to people and they're like, I don't know what you're talking about. I feel amazing and I'm your age. And I'm like, that's great. I'm very happy for you that you do. But it's also, you didn't do half of what I did when I was younger. You were sort of a fat, out of shape bump on a log until two years ago. And so that's why at 55, you feel better than you did at 53. And that's great. Nothing makes me happier than seeing somebody who's never done anything their whole life, and they're now finding their own. That's great. But there's another subset of people like you and I, who have been insanely active our whole lives, and we're still doing fine. But if we're being brutally honest, we're a fraction of what we used to be. We don't have the recovery. We don't have the speed. We don't have any of those things. Knowing

• 29:39Dr. Peter Attia?

  and understanding the inevitability of some decline, how should people who have been active their whole life, who were showing up in their 40s and their 50s and their 60s with the, I don't want to say inevitable, but the very probable wear and tear that came from doing dumb things when you were young, and experiencing a decline because you're starting from a higher place? How do you think about coaching these people such that they get to 90, and they can still do everything they want to do? And by the way, do it at the level of what we would think of as a fit 65-year-old?

• 30:17Speaker 01

  That's a good question. First of all, I think you have to do what we've done, which is come to the realization that it isn't exactly like it was when we were younger. Because some people will fight that. They'll fight the fact that things have changed. They'll fight the fact that it might require a longer warm-up than you used to do, or I used to be able to do this. Like, for instance, I'll say, I used to be able to do just one quick warm-up set before getting into my working sets. Why can't I do it now? Like, I think we fight that for a while. I did fight it for a while. Probably in the last three to four years was my transition period to start realizing and see some of these changes.

• 30:51Dr. Peter Attia?

  And what was the signal for you that you needed to do that?

• 30:53Speaker 01

  More achiness in the morning when I would wake up from training. I'm okay. I'm accustomed to feeling sore when I wake up the next day. I think that makes me feel alive. The soreness I'm talking about is not joint soreness. I'm talking about muscle soreness. I know I worked a muscle two days ago, or a day ago. But when it starts to get to be more joint feel and joint-related, I know that I'm maybe not allowing myself to recover enough, or I'm doing too much at too quick of a pace, or I'm not preparing myself to do whatever I am doing. And therefore, I think that's the part of the warm-up that I wasn't really doing enough of. And you just have to be honest with yourself and say, hey, what am I not doing that I could try that is going to potentially change whatever it is I'm

• 31:36Speaker 01

  feeling? I think you're going to feel something, though, and that is going to be your sign as to where you should start. And that, for me, is usually in the form of either that joint soreness, like I said, or too much fatigue, waking up fatigued, maybe even irritability at things that wouldn't have made you irritated before. These are signs that you might want to start looking into your recovery. From the recovery standpoint, the two factors of that are, what is the actual work you're doing? And then what are you doing to prepare to do that work?

• 32:06Dr. Peter Attia?

  Sorry, in that second category, Jeff, just to make sure you understand that. The first category is, what are the activities I'm doing to recover? And then the second is, how am I eating, sleeping, all the other things that go into?

• 32:16Speaker 01

  Or what is the actual workout that you're doing? What does the training look like that you're doing? So the training itself could be problematic, because it could be too much volume. Or what am I doing to prepare myself? And that does occur, not just in terms of the warm-up or right before the workout, but you're eating, you're nutrition, you're sleeping, the other elements that will go into recovery. I'm sure we're going to find, all of us will find, one or two or five areas that we're probably not doing the things that we could or should, that might make us feel better. And I say might, because I don't believe that there's one recommendation for people when it comes to preparing to do something, or recovering from what they're doing that's going to work for everybody. I think we have to conduct our own experiment on ourselves and see what

• 32:59Speaker 01

  the end result is. How do you feel after doing whatever it is that you're doing? So try something different. For me, I actually tried to utilize bands before training. I could take my bands out and work on warming up my rotator cuff, or doing some of the movement patterns I'm going to be doing that day, but just doing with bands. And then I always say that the beauty about bands is that they're perfect for warming up, because they stretch as you're able to do more. So they have that built-in capacity to handle more as you can give more. So if you're just doing the first few repetitions with bands, and you're just kind of feeling creaky, or you're not really warmed up yet, as you're able to do more, they can handle more. They can absorb more of what you can handle. I

• 33:40Speaker 01

  like the fact that bands can be used to warm up. And it's something that I started doing just individually. I'm not saying that everyone should run out and try bands, but it is a good recommendation. And when you do that, you warm up your joints, the muscles actually get more prepared to do what they're going to do. Now, even if I handle the same loads that I did in a workout without that warm-up, my joints are more ready to handle it. Proprietary, my joints can feel what I'm about to do, because I just did something similar to that and that motion. And then I actually can get into using the weights, which provide a different source of tension. The weights are going to be differently felt than the bands will. I'm more prepared to handle that. The joints are more prepared. And as I said before, that muscle up, all it takes is one bad repetition to make this shoulder go from

• 34:23Speaker 01

  100 back to zero again. So you can imagine the accumulation of however many repetitions you're going to do in a workout, ill-prepared or not prepared well enough, can pile up and start to have some negative consequences. So I think that's what people have to do. They need to come to grips with the fact that not everything is going to remain the same. I've mentioned before that I've always had great eyesight, after I had them fixed with LASIK, but I've had great near vision. Last two or three years, I struggle. Every time I pick up something to read, a pill bottle or anything, it's very difficult to read. And it frustrates the hell out of me, because I didn't do anything to merit that type of decline. Nothing. I'm very consistent with what I do in all aspects of my life.

• 35:05Speaker 01

  So that is simply just an age-related decline that has nothing to do with anything that I'm doing to cause that acceleration of that. I take care of my eyes, have regular eye visits. It's something else that's causing that. I have to understand that that is going to come from age. What are you going to do about it?

• 35:21Dr. Peter Attia?

  Yeah, no, it certainly will. When you think about this transition from your 40s to your 50s to your 60s, and I focus on that, not because there aren't people listening to us who are 20 or 30, but I do think that there's a huge cycle between that 40, 50, 60. So I want to kind of focus there for a moment. What do you think is the most prudent strategy for reducing risk? And I'm just going to limit this to resistance training for the moment. Is it reducing overall volume? So if I said to you, Jeff, when I was in my 30s and early 40s, I would be doing 25 sets per body part in the gym. Should I be taking that down to 10 to 15 sets? Is it reducing absolute weight, and therefore increasing

• 36:06Dr. Peter Attia?

  reps a little bit? So, hey, I've always trained at one to two rep in reserve, and I'm going to continue to train at two rep in reserve, but that weight is actually coming down. What it's taking me to get to one to two RIR is a lower and lower weight as I age. Is it frequency of training? The number of times, how many days that go in between training muscle groups? How do you think about all the potential levers a person can pull to still maximize their performance while minimizing the risk of injury?

• 36:33Speaker 01

  That is the essence of what we try to do. That is what we have to master. So there's a couple of parts to this. So first thing, I'll give you the short answer. Of those three options. I want volume to come down. I want productive repetitions to go up. I want repetitions to actually mean something. And when I do that, that means the intensity is going to go up. So you'll have to train harder, but I will save a lot of the junk volume that I believe just winds up wearing and tearing and creating an accumulation of wear and tear. That's not only not necessary, but again, it's ultimately unproductive. So we have to look at it though, starting from this concept of reps and reserve and whether or not you actually prescribe to the exact reps and reserve specifications

• 37:18Speaker 01

  of, hey, one RIR, two RIR. Some people don't train that way, but they think-

• 37:22Dr. Peter Attia?

  Can you explain?

• 37:23Speaker 01

  Yeah.

• 37:24Dr. Peter Attia?

  I rattled it off quickly, but I want to make sure everybody knows what I mean.

• 37:26Speaker 01

  Sure. So reps and reserve is essentially a measure of how hard, let's say you've taken a set. So a zero reps and reserve is you've taken that set to full mechanical failure where you cannot lift that weight anymore in good form. One RIR would basically mean that if you were to do a grinder, if you were willing to grind out one more repetition, you probably have one more repetition in you. Two to three RIR is essentially where you've got another one or two left in the tank, but it's still difficult, but you're stopping at that point. Nobody that was watching you from the outside would visibly really be able to tell that you've reached your maximum. Four RIR or more to me already starts to become junk volume and it's exasperated by-

• 38:07Dr. Peter Attia?

  Outside of a warm-up set.

• 38:08Speaker 01

  Yeah, outside of a warm-up. It's just exasperated by the fact that we as a whole, and I'm talking about even some trainers themselves, we don't fully appreciate or have the internal scaling tuned in to measure what real effort is. And that's for a variety of reasons. I would guess that we undershoot what we're capable of doing by one to two to three repetitions often. So when you don't have this measurement of zero, what zero means, then everything else is very difficult to gauge, especially if you don't have a lot of training experience to be able to feel the nuanced difference between a one or a two,

• 38:49Speaker 01

  or a two and a three. So to me, what I want people to do is to start at almost every opportunity, training as close to mechanical failure as possible. Now, there's a few things that get in the way here. There's psychological failure. Psychological failure is not necessarily, I can't mechanically lift or make my muscles contract to lift this weight again. It's, I don't really feel like doing another repetition because the discomfort that's caused by this repetition is something I'm not really willing to put up with. There's a big difference between that and what your muscle can actually do. So when we push ourselves past psychological failure, then we

• 39:28Speaker 01

  get into what we call form failure. And form failure is where the speed of the repetition might go down. I'm okay with that. Actually, I advocate for slower repetitions anyway, but the speed might go down a little bit. The form might get a little loose in terms of like a little bit of cheating, but that's okay too, because as long as you're properly stabilizing your body when you're doing it, you don't look like you're performing a different exercise. That's still okay, acceptable. What's not okay is joint pain. If you feel joint pain at any step of the way, you should stop because you're probably not even training the muscle at that point anymore. You're obviously putting the joints in the middle. And then allowing yourself to just push to that point where the exercise can't physically be completed, where that

• 40:10Speaker 01

  exercise you're doing in a bench press, you can't move the weights anymore. That's where you stop. And that's where I believe people need to get themselves to do more often. And most of us either have that calibration that's not calibrated correctly, so we're not gauging that effort correctly. Even if it looks like we're doing the right things and we're accumulating the right volumes, like you said, paper, the signal's not there. The intensity is not there. You need to get to a point where you can objectively say, well, the signal's here because I can't move this weight anymore. And the more you do that, you can take away a lot of those sets. And so even though you might be counterproductive to think, well, by training harder, I'm going to apply more stress to my body and make it harder for me to recover. No, you're actually,

• 40:53Speaker 01

  because you're applying less of that junk volume, and certainly in terms of joints, less of that wear and tear. Because even just raising my arm up here every single time is another, as I say, rotation on the tire. At some point, the tires on that car have to get changed. You're going to run out of rotations on the tire. Why waste them? And a repetition that is completely nonproductive, for you mentioned, building muscle, because that is what we're trying to do in this case. We're training for hypertrophy. So if you're not pushing yourself to a point where you can stimulate those high threshold fibers, the ones that can grow, then what are we doing? We're not accumulating anything that's going to build strength or hypertrophy. So therefore,

• 41:33Speaker 01

  we're not building that resilience that we're trying to build. So objectively getting you to do more of your sets too. Good form failure, not talking about ugly repetitions and losing stability of your body while you're doing it. I'm talking about good form failure. Then you can bring down those repetitions and those sets quite a bit, get rid of a lot of that volume, and through the increased intensity, have a way better outcome.

• 41:56Dr. Peter Attia?

  So for certain exercises, it's safe and relatively straightforward to determine a zero RIR. To your point, and I agree with you completely, this is exactly the thing we explain to our patients is, especially people who are new to resistance training and we're trying to build these habits, you can't know what one or two RIR is until you know what zero is. You have to fail.

• 42:18Speaker 01

  Yeah.

• 42:19Dr. Peter Attia?

  And so I want you to start to learn what failure looks like. It's safe and straightforward to learn what failure is if you're doing an overhead tricep extension, because the cost of failure is really low, especially if you're doing it on a cable pulley or something like that. But how do we map that out to somebody who's doing front squats or back squats?

• 42:37Speaker 01

  When we're talking about the big compound lifts, especially if you're trying to train for strength, where your rep ranges are going to be lower, I don't believe training all the way till failure is the way to go. I think saving one repetition there, maximum two repetitions-

• 42:48Dr. Peter Attia?

  Well, I'm just saying to learn, when you want to teach them what one or two RIR is, how does someone figure that out in a squat?

• 42:54Speaker 01

  Obviously with the right setup, you can put somebody in a rack and have the safety pins there. And then you can even have them squat to a box. So they have a little bit of the assuredness of knowing that they're not going to bottom out.

• 43:04Dr. Peter Attia?

  Yeah, fair.

• 43:04Speaker 01

  They can get to a box. So I think there's things we could do to manipulate that. Deadlift, one of the things we do oftentimes is elevate the bar either through a trap bar, so the handles are elevated, or-

• 43:14Dr. Peter Attia?

  Put the plates on-

• 43:15Speaker 01

  Just to be able to give them a little bit more security in knowing that when I do fail here, it will feel like I'm in a safe, secure position. You could always strip away the pads at that point, or you can take away the box. But again, in those big compound lifts, it's not really even necessary to do that, to go all the way to failure, to see those benefits. You can take that one rep shot. Because again, remember, I said that the zero RIR is really truly that maximum last rep that is going to look like a grinder to people. Doing these things on those front squat or other lifts can become a recipe for disaster, especially for people that-

• 43:51Dr. Peter Attia?

  That's a sport. It's called powerlifting.

• 43:53Speaker 01

  Right, exactly. Right. It's not necessary when we're talking about those exercises, but something like a lat pulldown, like you said, or a barbell curl. Like I say, a barbell curl, there's nothing safer in the world. When you're going to fail, you could simply just release it from your body. I'm going to say, I'm not advocating to throw the weights around the gym, but it's in front of you and it's going to safely go down to the ground, to the floor, to the bench, whatever's in front of you. You don't have to worry about that. It's not like you're getting crushed under the weight in a bench press. I gauge a lot of the train to failure or absolute failure recommendations based upon the environment of the exercise you're performing and how safe it is to actually do that. Because there's no benefit that you're going to gain that's going to outweigh the risk that could come

• 44:34Speaker 01

  from a poorly performed repetition with a weight that's already in a fatigue state, where you're handling a weight in a fatigue state already.

• 44:41Dr. Peter Attia?

  I know from all of my time training, that there are just certain days when I'm not able to push as hard as other days. And this is not just true in the weight room. It's true on the bike. It's true in the pool. So it's true with cardio. It's true with resistance. And I've long wondered why. What is it that allows me on some days to push so much harder? And why are there some days where there's almost like a built-in governor? And it just says, I'm not going to let you go past this threshold of pain today. I'll be honest with you, that is something that I've probably noticed a little more of lately than I noticed

• 45:23Dr. Peter Attia?

  in my 30s and my early 40s. Even up into my early 40s, I had almost a supernatural ability to do what I called burn the matches every single day. And I would do this very strange thing, even on a recovery day. If I was out for a recovery ride, I would still always do a four or five minute all-out hill climb. Even an easy swim, I would still do an all-out set for 400 yards or 300 yards or something. Today, there are many days when I could never do that. So do you think that's a consequence of aging? Do you think that's a consequence of stress in life or other things that the body can only manage so many things? And if you have too much stress in your life about work and kids and things like that, you just

• 46:06Dr. Peter Attia?

  can't bring all of your energy to a workout? I mean, what do you think is driving that? I'll add one final question, which is really the question at hand, which is, how can an individual understand, are they at psychological limit or mechanical limit?

• 46:19Speaker 01

  Those are definitely the two biggest contributors of the psychological and mechanical factors. However, psychological could be driven by your recovery. So whether you're getting a good enough sleep that night, whether you are undergoing stress outside the gym in your life, these factors chip away. They chip away at your ability to tap into that next level, I think. They don't chip away at your ability to show up. That's just part of your habit at that point. They chip away at your ability to tap into that next level of intensity to train and do what you're saying, burn the matches, because that does take a reserve. You're tapping into reserves there. And if the reserves are already tapped out because of these other stresses or- Your, again, lack of sleep and other factors that lead to poor nutrition that lead to

• 47:03Speaker 01

  the feeling that you're having, then that's going to prevent you from tapping in. I think what contributes more to that, though, it sucks because it's sort of the inevitable part of what we're dealing with, but it is the aging contribution. We know that as we age, obviously, we're losing type 2 muscle fibers, we're getting weaker, we're losing the muscle mass itself. So, things that used to be achievable with less effort because of higher levels of strength and the higher distribution and proportion of type 2 fibers, that's starting to physically go away. So, things that you used to be able to do are going to become more challenging. Now, we try to like push through that and say, "Okay, I gotta push harder." But then we have the hormonal contributions to that, too, that

• 47:46Speaker 01

  make pushing harder and doing harder things more easy. That is starting to get challenged, too, as we get older. So, we start to get a decrease in the hormones, the male hormones that are driving, and women see the same effects here, too. They're getting a decrease in their hormones that provide that level of effort, and also the hormones that help to regulate stress and help to regulate sleep and help us to have undisturbed sleep. These are all starting to get disturbed as we get older, and I think that whole picture makes it more difficult to do the things that we used to do.

• 48:20Dr. Peter Attia?

  Let's stay on this sort of physique hypertrophy side of things for a while, and let's take kind of a nuanced look at muscle and muscle groups specifically, head to toe. And I want to talk about the most common misconceptions, the biggest mistakes people are making, and maybe what the greatest unlocks are for folks who have been frustrated in lack of gains in these areas. And whenever possible, or whenever you feel that it adds value, feel free to distinguish between male and female. But I also kind of assume at the end of the day, male and female training has to be pretty similar, right? I mean, the same principles of progressive overload apply. So, I don't know if that even makes sense as a valid question. I also realize that, of course, men and women sometimes have different

• 49:04Dr. Peter Attia?

  goals with respect to what they want physique-wise. But anyway, feel free to handle that part as in any way you choose. So, where would you say we're starting at the top? Shoulders, traps?

• 49:13Speaker 01

  Shoulders.

• 49:14Dr. Peter Attia?

  Okay. So, you've got somebody like me with salmon shoulders. They don't really bulge out at all. By the way, I'm taking notes for myself. What are the biggest mistakes people make? And when people want to beef up their shoulders, what should they be doing? What are they doing wrong?

• 49:27Speaker 01

  The shoulders are a three-headed muscle, posterior deltoid, middle deltoid, and front deltoid. So, people do take an approach where they try to choose exercises that will focus more on one head versus the other. There's a lot of people who say that the front delt doesn't need to be trained because it gets a lot of work in pressing and overhead pressing. It depends on how detailed you want to get or how specified you want to get in terms of building up shoulder development, but it's a head of the deltoid, it's a muscle, and it needs to be trained. I think if you were to try to develop optimal size of your shoulders, you're going to want to choose exercises that do focus on each one of the heads of the delt individually, and that with the most attentions. You're not going to isolate one versus the other, but with the most attention. And then you're going

• 50:10Speaker 01

  to want to make sure you're still doing your compound lift, which is always part of every muscle we're going to talk about. Like, what's the compound lift you could do where you have other muscles assisting that work? So, you can push that muscle to and through its failure point, like we talked about. For me, it starts with a vertical pressing movement of some sort, to be able to do some vertical pressing, which is really a point of contention for some people because that's going to be orthopedically one of the things that hurts the most. But there's always some modification to that that I believe you should be able to do.

• 50:45Dr. Peter Attia?

  And sorry, let's just say, why is the vertical press so important to you? Is it because it's getting all three heads simultaneously?

• 50:51Speaker 01

  It gets all three heads simultaneously. It's a functional requirement of life to be able to lift our arms up overhead. I'm not saying that we have to lift our arms up overhead with weight in our hands, 40, 50, 80 pounds, whatever we're doing.

• 51:02Dr. Peter Attia?

  If you want to put a suitcase into an overhead bin.

• 51:04Speaker 01

  I just witnessed it as we were flying here, someone trying to lift their suitcase. I was wondering if I had to step in and jump in and help because it looked like a struggle to get it up into that overhead bin. You need to be able to handle weight overhead. And so, I also think that it also uses full range of motion to do that. We never want to forego full range of motion. Full range of motion is the nutrient to the joint. If we only stuck with movements that worked the front, middle, and rear delts, we could theoretically stay below shoulder level our entire training session. I want to see you get your arm up overhead so we're getting that shoulder through its full range of motion, joint itself through its full range of motion. It's not always about just the muscle itself, it's about the joint that you're trying to train around to get the full function that we're looking for.

• 51:49Dr. Peter Attia?

  Now, someone like you, Jeff, with some arthritis already in your right shoulder, let's just assume you had a little bit of AC arthritis as well. So, now-

• 51:57Speaker 01

  I do have some of that, too.

• 51:58Dr. Peter Attia?

  So, there you go. So, what are the modifications you make? How do you safely accommodate that motion? Because obviously, gosh, I mean, back when I was a kid in high school, we were doing it behind the head. I don't think people are doing that anymore, are they? Most people are doing an overhead press in front, I assume?

• 52:13Speaker 01

  Not if they've been watching me. I hope not, no. But this is the thing that people get a little bit disturbed by if I say this, or if I throw an exercise, I say into my iron graveyard. It's not because I want to have an issue with the exercise, it's that I know I can give you an exercise that will give you the same benefits-

• 52:28Dr. Peter Attia?

  At less risk.

• 52:28Speaker 01

  Without the risk. What's the point?

• 52:30Dr. Peter Attia?

  Right. We should just make that disclaimer now because I can already see the hate comments coming in. Because there is always going to be at least 100 people on planet Earth that love every single exercise and have a great argument for why you should be doing back squats on a piano, standing on one leg with an elephant strapped to your testicles. And anybody who says that's a dumb idea is a total poser.

• 52:54Speaker 01

  Yeah, totally.

• 52:55Dr. Peter Attia?

  And it's like, no, you're right. If you can do that without getting injured, you should absolutely do it.

• 52:59Speaker 01

  Well, that's my answer to that. It's like, if that's what you do, and again, go back to what we mentioned before, if you can feel a greater stimulus that way, "No, but it's the best way I feel my middle delts work," then do it. I'm not saying don't do it, but I have to make recommendations for people that I think are largely appropriate for the majority of people. And I don't think that that exercise is going to give people this superior benefit that it can't get from just simply getting your elbows out in front of your body and doing the press from in front of you. For me, specifically, I can do things like a landmine press where I can get my elbows out even a little bit further in front of my body.

• 53:33Dr. Peter Attia?

  So, tell folks how you do a landmine press.

• 53:35Speaker 01

  So, a landmine press is essentially you take a barbell, put it into a corner of a room. If you're training at home, put a towel there so you're not ruining the corner of your room. But you basically put the empty bar in the corner, you load up your weight on the front side of the barbell, you put two hands on that end of the barbell, and you're pressing up and away from your body like that. All you're doing there is taking away some of the verticality of the exercise. Again, going straight up is going to require the most range of motion at the shoulder, and people that have orthopedic issues might find that all of that range of motion is tough to tolerate right now. So, when you put it out in front of your body, you're cutting down that angle by about 45 degrees.

• 54:10Dr. Peter Attia?

  Can you want people doing this symmetrically? Meaning, not off to one side, straight up and down the middle?

• 54:15Speaker 01

  I love asymmetric loading. I love that, too. Oh, yeah.

• 54:17Dr. Peter Attia?

  So, you'll do one arm?

• 54:18Speaker 01

  Could do that, too. Yeah, absolutely. I could do them up and over. I love to do things that are a little bit more challenging in multiple planes when we can. But if we're starting out, we're trying to get somebody to actually just feel this motion, definitely I would have them start right center chest and push up and out. But you're basically cutting down some of that overhead requirement, some of the range of motion requirement, which is going to make the exercise feel a little bit more tolerable. You're also, as I mentioned earlier, you're getting a little bit more tricep involvement the closer those elbows get in because you're getting more flexion at the elbow, so they have to extend. So, you're getting some assistance from triceps on your way to being able to do your shoulders, which is, I think, a good point to point out here. Any injury you're dealing with is not a mandate to completely rest. It's not. It's a mandate to choose safer, more appropriately

• 55:03Speaker 01

  loaded and progressed exercises. That's the requirement here, not to completely rest because resting in and of itself actually contributes to more of the dysfunction. Time is one part of recovery, but the loading of the tissues themselves is another promoter of recovery. So, when you remove that load entirely, things start to go wrong at an accelerated pace. So, what you want to be able to do is find the exercise modification that you can do, and then you progress. You add more weight to that, or you start to step closer to this landmine so that your positioning is now a little bit more vertical, and then to the point where you can actually press overhead vertically. And it's not going to always be limited potentially if you follow the right progression. There's an analogy

• 55:47Speaker 01

  I use. If you thought of an injury to a certain joint or painful exercise like this overhead press, it shouldn't be looked at as a city shutdown. It's just a single road closure for now. That's it. We can take that overhead press that I can't do, let's say, just the dumbbells overhead, and then we reroute it, and we do this landmine press instead. Okay, great. We didn't shut the whole city down to do this. Now, let's just say, though, that all of those are harmful at the moment. They're all hurt. And I use pain as the guidance, pain of joint pain as the guidance. Then we take the backroads and we do something completely different, like a row. Cause if I row, I'm not training my overhead pressing at this point, but I'm putting the shoulder through range of motion. I'm going into extension of the shoulder. I'm bathing that synovial fluid into that joint.

• 56:31Speaker 01

  I'm helping to promote recovery. These little steps along the way, though they might look remedial, are part of the overall progression back to function. So when we talk about, again, this landmine press, don't think that you're married to this exercise for the rest of your life. Understand it's a step in the way to being able to overhead press. I think that's what people do a lot of times is they just, they feel like they're not able to do the thing. So therefore don't do any of it or choose something completely different. That's not going to provide the same stimulus that we're looking for. And we talked about that with squats a little bit the last time we were here. Just doesn't feel right for you, but there's other things you could do to maybe progress yourself to the point where squats would feel right again.

• 57:10Speaker 01

  But for overhead pressing, I need that and I need to have that as my compound movement, whatever form it might take, whatever step in the progression it might take.

• 57:17Dr. Peter Attia?

  In the hierarchy of barbell straight in front of you to dumbbells is the idea that with dumbbells, look, I'm going to allow you to take a little less pressure off the AC joint by bringing them like the more midline you're going, you're approximating the landmine. So for you personally, with your shoulder history, are you using a barbell or are you using dumbbells?

• 57:39Speaker 01

  I'll use barbells infrequently, maybe 20% of the time. And again, sometimes because I want to retest my abilities to see how close I've come to being able to use them paint free again. And I can, I can use them paint free now. One of my best modifications when you're doing a barbell press, if you have shoulder issues is to narrow up the grip. Because the narrower the grip is, you can see the elbows follow. So as I start to narrow my grip, my elbows will follow, the elbows start to bring obviously a change in shoulder alignment with it. So now I'm back into sort of that scapular plane and I'm able to press from there. So that's one modification I'll make if I use the barbell. I will almost always opt for dumbbells. One of my favorite things to do with dumbbells is to simply do one at a time. So you mentioned the asymmetrical, I love being able to do one dumbbell at a time.

• 58:24Speaker 01

  I can handle more weight that way. So that's back to that idea of increasing the stimulus, increasing the intensity. I can increase the intensity, improve the mechanics of the exercise on the joint. Cause I can take that one dumbbell, push it up and overhead and then stack the joints. I talk a lot about joint stacking wrist over elbow, over shoulder and have that good stability from underneath. When I'm pressing from out here, we don't get that same level of stacking. So if you have any instability type injuries, like a labrum tear, you're not going to feel as comfortable out there unsupported as you are with everything stacked on top of each other. So I like to do that variation of the exercise. It also feels, some exercises are just more fun. It feels fun to be able to.

• 59:05Dr. Peter Attia?

  Do you do that seated or standing?

• 59:06Speaker 01

  Standing. I like to do as many things as I can standing because even for a shoulder exercise, again, if I'm advocating, not trying to always go so light and again, increasing some of the weight you're using here, then I like the fact that I could have my legs to rely on. If I need a little bit of that extra cheat to push myself through to those higher intensity repetitions. I'm not saying that you always have to do them with cheat or with a push press, but they're there if you need them. Otherwise you could simply do them as a strict rep, but still standing is just a more athletic position for people to be in. I think that has the best carryover.

• 59:40Dr. Peter Attia?

  What I'm hearing you say is if you only have time for one deltoid exercise, it should be the overhead press. Because it's the compound movement that hits all three heads.

• 59:50Speaker 01

  Yeah.

• 59:51Dr. Peter Attia?

  Okay.

• 59:51Speaker 01

  I believe so.

• 59:52Dr. Peter Attia?

  So now if you could add a second or a third movement, presumably you're not going to want to bang on the anterior portion again, because you're getting enough of that through presses. Are you going to want to do something for the lateral head or the posterior head?

• 1:00:05Speaker 01

  Yeah. So either of those other two options, again, I agree with your questionnaire entirely. That would be the third choice, the front delt would be the third choice of the three. But I think if back to what I said originally, if you were trying to maximize hypertrophy of the shoulder, you can still do front delt exercises again, there's a lot of fear around.

• 1:00:20Dr. Peter Attia?

  Can I ask a silly question? You know, when you see somebody who's, and this again is both male and female, both tend to prioritize having a nice separation. Is that visually created by the lateral delt or the anterior delt?

• 1:00:33Speaker 01

  So that's where I think the front delt is a little underappreciated. Cause I think it does create, if you're talking about the visual aesthetic of it, that separation between the chest and the deltoid. Cause you're getting that line that comes in on the anterior part of the shoulder. But when you're looking at that roundedness of the shoulder, that is almost entirely coming from the middle delt. You're not even really seeing the rear delt there. The visual benefits of the rear delt is when someone turns to the side. And then you see whether they have a rounded shoulder there or whether they have like an emptiness to their shirts in the backside of their shoulder there. But the rear delt is one of the most functionally important for maintaining proper balance of the joint itself. So I think as a physical therapist, my next answer should be the rear delt.

• 1:01:16Dr. Peter Attia?

  Rear delt.

• 1:01:16Speaker 01

  Cause I know the exercises that go to training that are going to have a lot of other benefits to you posturally. And again, maintaining joint health for the long run. But if you're talking about strictly aesthetics and what you wanted to do to have a better appearance when looked at from the front, then it's going to be the middle delt.

• 1:01:31Dr. Peter Attia?

  So what's a middle delt exercise?

• 1:01:33Speaker 01

  So any lateral raise is good. I do like the cable lateral raise a lot because it's got tension throughout the exercise for a longer portion of the range of motion. If we do a lateral raise with our arms at our side, the exercise has basically zero tension at the bottom. And it starts to rise up as I raise the dumbbell up. But with the lateral raise of the cable, first of all, I have a stretched tension on the delt itself in that starting position. And as soon as I start to pull, I'm already getting higher levels of tension in the middle delt. And they are maintained as long as you sort of manipulate your body or your arm position in space as you go. We're always trying to get when we use cables, this perpendicularity between the cable and that moving structure.

• 1:02:18Speaker 01

  So if I have my arm here, it's my forearm, that's really the moving structure that I'm focused on. How long can I maintain this relationship of the cable in my forearm and this perpendicular alignment? If I can do that and pull up, again, I sort of manipulate my arm in space to feel where that is. Then I'm going to feel that middle delt working at a high level throughout almost the entire range of motion.

• 1:02:39Dr. Peter Attia?

  For people who are just listening to us and not watching us, you're doing kind of a cable, raise is almost the wrong word. You're basically doing a cable movement across your body.

• 1:02:48Speaker 01

  Across like a rowing.

• 1:02:49Dr. Peter Attia?

  Yeah. Because you don't need gravity when you have the cable.

• 1:02:50Speaker 01

  Right.

• 1:02:51Dr. Peter Attia?

  You're doing an across the body kind of row. And by the way, what we'll do in the show notes for this podcast is we'll link to videos you've made on each of these. Cause that'll actually make it really productive for people to go and see like, okay, that's exactly what he means. Okay. And by the way, I have no affiliation with the company, but I have become completely enamored with and obsessed with Voltra. Have you been using this thing?

• 1:03:12Speaker 01

  No.

• 1:03:13Dr. Peter Attia?

  Do you know what I'm talking about? It's kind of electromagnetic. I really, really like it.

• 1:03:16Speaker 01

  Oh yeah? What have you been using it for?

• 1:03:18Dr. Peter Attia?

  One of my patients gave it to me. I love that. I actually bought a second one. So now you can pair them and I use it for a lot of things right now.

• 1:03:25Speaker 01

  Like where you can manipulate the separate tensions, eccentric tension?

• 1:03:28Dr. Peter Attia?

  Yep. That's the first thing that I fell in love with was the manipulation of concentric and eccentric tension. It's frankly, I mean, just a space saving device. Like I've got one of those big free motion things, I'm selling it. I've got all these other things I'm just getting rid of because it just replaces them. Frankly, if I didn't already have a lat pulldown machine, I'd get rid of that thing too. Because you can do pulldowns on this thing. You can do belt squats with this thing. I mean, all you need is a really good rack and this device, because it clips into.

• 1:03:54Speaker 01

  Yeah. We had one in the gym for a while as by a company, Kineo, who had lent the piece to me. I, we were able to do some really cool things with it, but it was hard for me to show them to people on YouTube. Cause nobody had the machine and nobody could do it. But as far as like geeking out on the stuff myself, I love that. I mean, I love the ability to increase the eccentric load even more than we can concentrically. Because our bodies are able, obviously to handle a lot more eccentrically than we can concentrically. So if you can take a load that you can handle concentrically, but then double that load eccentrically, you're getting challenged in a big way.

• 1:04:29Dr. Peter Attia?

  And I've been so interested in which exercises I have more eccentric strength than others. You know, and it might just be a function of the absolute weight, but it's been amazing to me on some areas where having a big eccentric load is manageable. And in others where the eccentric addition above concentric can't be that much. It can only be like 10 or 15%. So I think I'm scratching the surface of how to use this thing, but I am enjoying the hell out of it.

• 1:04:54Speaker 01

  There's a million things you can do with those. They even have the different modes of the elastic. You can make it feel like a band.

• 1:05:00Dr. Peter Attia?

  Or like a chain.

• 1:05:01Speaker 01

  Right, right, right. Like a chain where it increases. Yeah. So I mean, it's really cool stuff. It's definitely for the nerdier types like ourselves who like to do this. But as long as we know how to use it and apply it with the people who see us, then they can benefit too.

• 1:05:13Dr. Peter Attia?

  Okay. So that's your go-to middle delt. Obviously the rear delt is something you already alluded to where you could be doing a row. You could be doing face down on a bench, doing a lateral raise or something like that. What would be your kind of number one go-to rear delt?

• 1:05:27Speaker 01

  I believe that though a smaller muscle group and though one that doesn't often get trained directly, it definitely gets skipped the most out of the three of the delts by most people.

• 1:05:37Dr. Peter Attia?

  So number one skipping is leg day, number two skipping is rear delt day.

• 1:05:41Speaker 01

  Rear delt day, yeah. It doesn't get the love it should, but again, as a physical therapist, I know its importance in more than just looking a certain way. I, at the same time, believe that it doesn't get loaded anywhere near what is capable of being loaded, or it doesn't get subjected to the stresses that most, when they do, actually don't skip the day, they actually do the exercises, they're not loading it enough. So for me, the most effective way to hit the rear delt and hit it with a lot of weight is a seated cable row. And we do the seated cable row with wide elbows. So you have your elbows lifted up away from your sides and your goal is to drive the elbows back behind your body. And all you have to do is just simply, you could even do it sitting in your chair. If you drive your elbows back

• 1:06:23Speaker 01

  behind your body in a row, you'll feel that rear delt really, really contract strongly. Well, with a row like that, we can utilize good weights and we're getting good assistance from the other upper back muscles and from the lats to do the exercise. But the rear delts will feel the brunt of that load if especially you're focused on, and this is where I think sometimes it's never just the movement, it's not just A to Z, it's A through Z when you do a movement. I don't ever want people to just look at an exercise and say, oh, I see he's going from here to here on this row, just moving those elbows back. How are you moving it back? If you focus on driving it with your rear delts and contracting your delts as you pull, you'll feel less on the lats, you'll feel less of the contribution

• 1:07:07Speaker 01

  from the other areas that are contributing but not dominating. It's easy to let the muscles that are usually dominating that movement, like the lats, come in and dominate. But if I focus on that rear delt doing the move, which relies on the knowledge of knowing the rear delts are going to pull the elbows back behind the body, that's part of this whole why these shorts versus long videos, we have problems because I want you to not just see the exercise, but understand why this works. When you understand it's the moving of the elbows back into extension behind the body that drives the rear delts, then you know why that exercise could work and you could actively work to make that movement recruit more of the rear delts when you do it. And your load is going to be significantly more than you'd ever use if you were doing a I, Y, or a T, which a lot of people will

• 1:07:52Speaker 01

  do if they say, I'm going to do some rear delt work. Nothing against those exercises, they're fine, but those are light work for a muscle group that can definitely handle more.

• 1:07:59Dr. Peter Attia?

  Again, for people who aren't able to watch us, one of the things that you did that I think stands out is the elevation with which you're doing it. So the higher those arms, so you're almost pulling to your face.

• 1:08:10Speaker 01

  Upper chest, the elbows are going to drift away from your sides around 45 degrees or maybe enough to 60 degrees or so. They're going to drift out away from your sides.

• 1:08:19Dr. Peter Attia?

  Yeah. So if you're just doing a normal narrow grip cable row, you're not getting, you're not getting enough rear delt.

• 1:08:25Speaker 01

  And that's how, again, this is why I love exercise so much because that is how you shift the focus. It's still the same exercise. It's still a row, it's still a seated row. But if my elbows are driven tight to my sides and I ducked it tightly against my sides, I'm going to get more lats. If I allow my elbows to drift, I shift it away from the lats into the upper back and rear delt. So movement is not enough to describe what you're doing. It's the muscles that contribute and how you do the exercise that determines the effect you get.

• 1:08:51Dr. Peter Attia?

  Should we say anything then about the anterior delt as a dedicated activity? Or have we kind of hit it?

• 1:08:56Speaker 01

  It's simple enough. As I said, if aesthetics were your goal and you wanted to build the ideal shoulders that way, I would still do a front delt exercise. Something as simple as a front dumbbell raise could do the job, or a cable stretch raise because I can hold on to the cable, step away from the machine a little bit. My arm is now behind my body to start. So I'm getting a good stretch on the front delt to start and then I can rise from there. So you could also do this in an incline position, sitting on an incline bench, maybe 60 degrees or 70 degree incline. You sit there, your arms will be behind your body just because of the positioning of the incline bench to start. So you have a little bit of a stretch on the front delt before you go into your front raise.

• 1:09:36Dr. Peter Attia?

  Any injury considerations with that? Are there any people whose shoulders are going to hurt with that pre-stretch?

• 1:09:41Speaker 01

  No, I don't think so. No. I think that's a pretty safe position to be in. I mean, just getting back behind, I think a lot of us don't do enough of that, actually. We don't get behind our body enough. That's a good, safe position of the shoulder because you're not in an elevated position. More problems with the shoulder come when it's elevated than when it's down at your side. Any of the impingement type issues or things that you feel that are uncomfortable come more when you get past this area they call it of a painful arc, which is beyond 60 degrees of elevation and abduction into like the 120 degrees or past shoulder level. And then of course, when you get towards terminal range of motion, that stuff can become more problematic. But positions of the shoulder down with your arm at your side don't tend to be aggravating.

• 1:10:22Dr. Peter Attia?

  And when you're starting from that pre-stress position and lifting, let's say you're at that 60 degree incline, how high do you need to lift? Just arm parallel to the ground?

• 1:10:29Speaker 01

  Parallel to the ground, yeah.

• 1:10:30Dr. Peter Attia?

  All right. So that's pretty good on delt. Everything you just described, how many sets are you thinking, how many working sets, meaning one to two RIR working sets for total?

• 1:10:40Speaker 01

  Right. That's key because without the intensity indicator there, it's going to vary completely. So I, given that I'm a big believer in the intensity being near failure, at failure, you're looking at eight to 10 sets in a week is needed. Some people separate those depending upon what split they're following. But I mean, if you're doing just, let's say a traditional bro split, we call it, where you're just doing one muscle group at a time, I mean, you've hit eight high intensity sets across the exercises.

• 1:11:08Dr. Peter Attia?

  So you could mix them up. You don't have to do them all each week.

• 1:11:10Speaker 01

  No, no, you could vary. I mean, I like to always include the compound. I might shift the focus between the rear delt and middle delt specifically if I was limited to time or volume.

• 1:11:20Dr. Peter Attia?

  Okay. Where do you want to go next? You want to talk about go down the arm or just talk chest and back?

• 1:11:25Speaker 01

  Well, let's go down the arms.

• 1:11:27Dr. Peter Attia?

  Okay. Let's hit the triceps.

• 1:11:28Speaker 01

  Okay.

• 1:11:29Dr. Peter Attia?

  So there's again, three heads of these bad boys.

• 1:11:31Speaker 01

  Three heads here again. So you don't have to be as specific here because really there's one differentiator between the long head, the tricep and the other two heads, the lateral medial head. All three of them extend the elbow. So they straighten the elbow out. The long head, because it has an attachment that crosses the shoulder joint onto the scapula, is affected by positioning of the arm itself, the shoulder itself. So when you put your arm up overhead, you're putting that long head in a more stretched position to start the exercise. When you put that arm back behind your body and extend your elbow, you're having an effect on the groove contraction of that long head because you're getting a more complete contraction if your arm is back behind your body. So

• 1:12:12Speaker 01

  what I always recommend is though there's three heads, I really like to see you do a good compound exercise that just focuses on extending the elbow. Do an exercise that places tension or a higher amount of tension on the long head in that stretched position and do an exercise that places more tension on that long head or takes advantage of the fact that the long head could be in a position of greater contraction with the arm back behind the body. So those are my three real staples or requirements. The compound exercise is not as big or as important to me in terms of, let's do something like a bench press where I'm getting assistance for like a close grip bench press, where I'm getting assistance

• 1:12:53Speaker 01

  from the chest and shoulders too. I think you still do a heavy lying tricep extension as your compound exercise. And you're also checking off that box of the stretching of the triceps long head at the same time. That's my favorite exercise for a number of reasons.

• 1:13:09Dr. Peter Attia?

  So laying on the bench, you've got a bar, you could use an easy grip bar.

• 1:13:13Speaker 01

  Or a regular straight bar, but that could be harder on people's wrists.

• 1:13:16Dr. Peter Attia?

  Okay. But you would prefer a bar to dumbbells?

• 1:13:18Speaker 01

  Dumbbells are okay. I don't mind dumbbells at all. I use dumbbells a lot myself, but people sometimes can feel it to be a little awkward because they can't ever time the dumbbells right in terms of extension.

• 1:13:29Dr. Peter Attia?

  So again, the technical term for what you just described, right, would be humeral extension or extension of the?

• 1:13:34Speaker 01

  Of the elbow, yeah.

• 1:13:34Dr. Peter Attia?

  Yeah. And so how much do you need to get enough long head pre-stretch? Are you doing that with, so again, for people listening, I'm trying not to use my hands that much. If I'm laying on the ground and I bring my arms up to, my humerus up to perpendicular to the ground, is that enough stretch?

• 1:13:54Speaker 01

  No.

• 1:13:54Dr. Peter Attia?

  Or does it need to be really opening the axilla up?

• 1:13:58Speaker 01

  Yeah. You have to open up those armpits for sure. You got to get your body to a position where I'd say, so if you're laying on your back and your arm was directly pointed to the ceiling, you would be at a 90 degree, right? So I'd say you're going to want to be at least 120 degrees or so more. You go a little 30 degrees back behind your head. A nice ballpark area for that is that your arm is sort of approximating towards your ear. So your bicep is sort of getting close to your ear.

• 1:14:22Dr. Peter Attia?

  So this is the workhorse of the tricep.

• 1:14:24Speaker 01

  I believe this is the best exercise you can do. It could be loaded up really well. Again, I like the compound nature here comes from the fact that the lats can assist you in coming back to the top. So if you have a little bit of fatigue, you always have that lat that can actually pull and kick in and help to pull that arm back up towards the top of the extension. Matter of fact, there's a great exercise that utilizes that on purpose. It's called a PJR pullover, where you're just taking a dumbbell, in this case, two hands on the dumbbell, allowing it to go back into what would traditionally look like an old Arnold pullover, but you'll let the elbows bend. So they bend to the bottom. Now you've got that good stretch on the long head, the triceps. You extend first to get the momentum going, use the triceps to extend the elbows, and then you continue it by using your lats to drive the dumbbell up to the top.

• 1:15:08Dr. Peter Attia?

  If you compare this exercise to an overhead tricep extension, where you can easily be starting in the same position, but when we're doing the overhead tricep extension, our humerus stays generally fixed.

• 1:15:21Speaker 01

  Are you saying with a dumbbell?

• 1:15:22Dr. Peter Attia?

  No, with a cable. I'm sorry, with a cable. Yeah. How do you compare those two? Do you prefer the lying one or would you do them both and just say, I'm going to use much more weight in the lying down one because I'm getting lat to help me lift it back to a perpendicular 90 degree position?

• 1:15:37Speaker 01

  I don't like that exercise performed that way very much because I think that, again, we talked about that perpendicularity of the cable and the moving segment that is lost pretty quickly in that exercise to become pretty parallel pretty quickly. So you lose a lot of the tension. What I advise when people do that push away type exercise is to get the arms up overhead in a higher position. So if you're using a rope, when you pull down, you can see that that's pretty perpendicular there. And as you come to the top, the rope is still sort of perpendicular to the forearm to a greater degree. You'll feel it much more in the tricep throughout the entire exercise as long as you are doing it from a higher arm position throughout. When you start to lean forward and do that, again, you can see like as I'm leaning forward, the cable is going to be right about here, almost in line with my forearm, and you're going to lose some of that tension. The dumbbell

• 1:16:22Speaker 01

  variation, which is I thought you were asking about, the dumbbell overhead variation where you have two hands on one dumbbell and extend overhead, that one gets more elbow flexion, but doesn't get as much of that shoulder flexion up behind the body relatively. So you could feel it less in the triceps for that reason, but it does create some internal rotation of the shoulder to grab the dumbbell in that position. That could be very uncomfortable for some people. The more you can get your elbows out in front of your body, externally rotating your shoulders and getting your hands to almost squeeze the dumbbell and your elbows almost to pinch together, that will alleviate some of that shoulder discomfort. But you can manage that by simply taking an inclined bench and performing it on an inclined bench because now your arms don't have to be back like they would in a vertical

• 1:17:06Speaker 01

  position here, all the way to here. I could be in an inclined bench and get that level of extension of the elbow, but not have to have this arm as high on my body as I have to. And then so it feels more comfortable to people. And when you're in this vertical position, again, you're bearing the weight of gravity completely, and you're going to have the most range of motion at the shoulder to do that than you would, you know, we talked about 120 degrees on the lying version. So there's less of that overhead range of motion that's required in the lying version of that.

• 1:17:34Dr. Peter Attia?

  Okay. So clearly you've established what the workhorse is on that one, lying tricep extension with a bar ideally. What would be the, for lack of a better word, the accessory or additional tricep activities you would add to that?

• 1:17:46Speaker 01

  Then if we wanted just the one that hits the medial lateral head, the function of just extending the elbow, I still love a classic tricep push down. I don't care if you do ropes, if you do a straight bar, whatever seems to be most comfortable.

• 1:17:57Dr. Peter Attia?

  What are the pros and cons of each?

• 1:17:58Speaker 01

  I think it depends on people's health of their wrists. Some people might find the rope gives the wrist a little bit of a break, whereas if you have the bar, you have two hands on a fixed bar. Because of that, if you have some immobility issues in your wrists, then what happens is the shoulders actually do get affected by that. The position of the shoulders, the position of the elbows gets affected because if I can't grab onto a straight bar because I lack the ability to get a fully flattened wrist, then what happens is your elbows will flare, your shoulders will internally rotate. So now all of a sudden, you're doing your push downs for what I call this jackhammer position, which is like this because I can't get there. So I have to do this. When I do that, now all of a sudden I'm pushing down. If I have a straight bar, a lot with my chest,

• 1:18:41Speaker 01

  I basically turn this into a straight bar dip. And so I'm taking a lot of the focus away from the triceps.

• 1:18:46Dr. Peter Attia?

  So is there a difference between, let's just say you're doing it with a single arm to make life easy. So you're doing a press down where your palm is facing laterally. I'm trying to be descriptive for folks not watching, but you're sort of coming down this way versus turning the palm to the floor this way. If assuming your wrist can accommodate both, does it have any bearing on the tricep, provided the upper arm's in the same spot?

• 1:19:11Speaker 01

  If the upper arm's in the same spot, no. And that's where there's some controversy around because people, I've actually talked about the underhand tricep push down that people can do. And there are benefits to the underhand tricep push down. If you are not, you have to be conscious about what's happening to the rest of your anatomy. We're not just a disconnected arm. We have multiple joints here. So what I'm saying is that when people do this underhand grip, what happens is the elbows will tend to become more approximated to the body. And then what that will do is it will actually give you a chance to stay in this closer position and get into a deeper position back behind your body to get that long head into a more contracted state. Whereas if I'm here and my elbows are out in front of me, I can't, I almost get blocked by the bar. I can't

• 1:19:54Speaker 01

  really get back to that position. So it's a subtle difference. But again, when we talk about training like an athlete, again, I always say that the reason why we say that is because athletes would care about the subtle differences because it matters. And when you're looking for every edge, when you're looking for every possible nuance that might contribute to a better exercise, you need to consider these things. So the arm position gets affected by that wrist position. And so if you are able to get into that position more effectively because of the change in wrist position, then you might want to consider that too. The trade off there is it's a weaker wrist position. So you can't handle as much weight as you could when your palms are on top of that bar. So trade off. But again, tension is the language that muscles speak, not necessarily the

• 1:20:39Dr. Peter Attia?

  Exactly. And even though you have less weight, if you're able to get the elbow behind you and get that huge amount of stretch into it.

• 1:20:46Speaker 01

  You're going to get a little bit more stimulation on the long head added to the other two that you're getting just from the extension itself at the elbow. That is, again, this dance that we play between, well, a little less tension, but more effective contraction. So I feel what is the end result? It's all going to factor into that tension, that language the muscles are speaking to determine how much of an effect you're feeling.

• 1:21:05Dr. Peter Attia?

  Okay. What other exercise would you consider a very important one for someone who is struggling to add mass or strength to the upper arm?

• 1:21:12Speaker 01

  This is another controversial one, but it's true. You need to do an exercise that would get that long head in its fully shortened position. So something that contracts that elbow with your arm behind your body. So we're talking about some form of a tricep kickback. You could do it with a cable. You could do it with dumbbells. You could do it on an inclined bench, face down. But the long head of the triceps will be in its fully contracted state when you are able to get full elbow extension and shoulder extension at the same time. And that is one of the only exercises that allows you to do that. Other than some of these push down variations I've talked about, where you can get a straightened elbow and get your elbow position back behind you a little bit. You could do that on a push down if you had a long rope, right? A long rope that you could position your

• 1:21:57Speaker 01

  arms behind your body. And we call it a drag push down where you're actually dragging your hands down your body. So when you finish, your hands will be on the side of your legs, your elbows will be back behind your body. You'll have the same type of effect there, but not everybody has a rope long enough to pull that off. A regular gym rope won't cut it. If you attach two ropes, you could possibly do that.

• 1:22:16Dr. Peter Attia?

  Before we move on to bicep, maybe we can talk about this after or before, but benefits and cons to super setting tricep with bicep with deltoid. How do you think about the entire complex? Because it's not uncommon for somebody to say, I'm going to do arms on a day. And that might just be dealt bicep, tricep, if they're going to do chest and back on another day. So how do you think about the trade offs of that?

• 1:22:38Speaker 01

  All that does is really affect your overall volumes for the week and how you're distributing your volumes for the week. It wouldn't impact my exercise selection, I don't think, triceps. If I was still training, if I was training biceps on the same day, unless I had some kind of a orthopedic issue where the accumulation of multiple positions from these different exercises is causing me to feel more joint soreness. Again, if we're choosing the right exercises, it shouldn't be doing that anyway. So if that's not the case, I don't have any objection to people doing biceps and triceps together. They tend to look at them as two smaller muscle groups that, because they're antagonistic to each other, feels good to train them on a day. While you're fatiguing one, you're not necessarily fatiguing the other. So I feel fresh on both sides of that. People that do triceps at the end of shoulders

• 1:23:21Speaker 01

  or chest, it's another good thing to do when you're talking about maximizing recovery because all of those pushing muscles that have a similar function are going in the same day. So when I come back the next day, if I'm doing pulling biceps and upper back and back, then I'm getting a complete reprieve of those muscles. And if I go do legs the next day, I'm getting a reprieve of two days of rest before I come back to them again. So that's really the consideration is how it impacts recovery. But from an individual exercise selection, my choices wouldn't change on the triceps if I trained them with biceps. If I did train them with something that was doing a similar function like chest and tricep and shoulders, then I might decide on how I want to change exercises up. Like there, the bench press, we know is going to act as a secondary compound to the triceps, or it's going to help the triceps.

• 1:24:06Dr. Peter Attia?

  So let's say you did that split. You said, I'm going to do chest, shoulder, tricep is one day, back, bicep is another day. You would still start presumably with your chest exercises because it's the biggest compound movement and you would move probably from chest to shoulder toward tricep.

• 1:24:21Speaker 01

  Unless, again, it depends on how aesthetically driven somebody is and what they're trying to accomplish here. If they had weaker triceps or weaker development of their triceps, you might want to prioritize your triceps first and go do your triceps training first when you're most fresh and then come back and do the others if they weren't of as high a priority.

• 1:24:37Dr. Peter Attia?

  So for those of us with puny biceps, what are we doing wrong? What are the most common mistakes people make and how do they fix it?

• 1:24:44Speaker 01

  When it comes to biceps, I believe the number one stimulus for bicep growth is the eccentric overload of the biceps. The fact that, especially when we're talking about most of these pulling muscles, the eccentric is going to be the part where you're lowering the weight under a slower tempo, trying to accentuate the stretching tension that we get, in addition to the fact that the weight itself is applying tension. So we're getting tension two separate ways. We could do that with a heavier barbell curl. We could do a cheek curl where you're actually, yeah, you do some repetitions that are as strict as you can, but you get a little bit loose on the form to get the weight up. And then you have to really fight the weight on the way down. You will always be stronger on that way down than you are on the way up. So if you never really do that and tap into

• 1:25:28Speaker 01

  some of the cheating of the concentric to get up, then you're never really going to apply the same level of eccentric overload that you can. So I like doing the barbell curl with a cheat. Chin ups are one of my favorite ways to eccentrically challenge the biceps. So if I get up there and lower myself down, I could change the exercise to be a little bit more focused on the biceps by just opening the angle a little bit of the chin up. A lot of times people will do a chin up and they'll pull until their biceps are touching their forearms. And that's going to get a lot of lat engagement. But if I can just open the angle and get my body a little further away from the bar, now I've shifted some of that focus to the biceps. And I want to again handle those eccentric repetitions as slowly, as painfully,

• 1:26:13Speaker 01

  in a good way as possible. I was always a fan of doing chin ups and trying to challenge myself to hold on to the bar for as long as I can. I used to win the flexed arm hang every year at field day because I used to basically work at it in the off season of field day. I was like determined to win that every year. I enjoy trying to hang and hold myself in a flexed

• 1:26:35Dr. Peter Attia?

  What did it take to get the top mark? I remember this.

• 1:26:37Speaker 01

  I bet you I was around 45 seconds to a minute I was able to do it for. Like I think that was like the winning requirement was, which is still tough now. I usually do them only in a fatigue state though. So at the end of a workout is a great way for me to finish.

• 1:26:50Dr. Peter Attia?

  And remind me, it's taking me back to third grade. You had to keep your chin above the bar?

• 1:26:53Speaker 01

  Chin above the bar, yeah. Get up there, chin above the bar and just hold for as long as possible. Now I extend it past that though. So now what I'll do is it's not just chin below the bar. I keep going until my feet hit the floor. So as long as I can go for a set is what I'll do. But again, I like to do that as a finisher at the end of what I'm doing, not as the primary source. Any type of eccentric overload is great. And again, when it comes to biceps, where is the risk? If I'm on a chin up bar, I simply let myself go and my feet hit the floor. If I have a barbell and it's going down, it's going to accelerate faster. I put it on the bench or wherever I have to put it back in the rack. It's not like the stress that we have when we are doing a bench press of some sort where the weight's coming down on top of us, or a squat when the

• 1:27:36Speaker 01

  weight's coming down on top of us. We have such a safety net when we do these exercises that not utilizing them is a big opportunity missed.

• 1:27:44Dr. Peter Attia?

  Now, what about hitting different parts of the bicep? How about, for example, like a preacher curl versus an inclined bench with arm behind you curl? Like what are the trade offs or advantages?

• 1:27:55Speaker 01

  So short head, long head is the differentiator here. The two heads of the bicep are the short head, long head. The long head gets its name because its attachment is higher in the shoulder. It's actually attaching inside the shoulder joint to that labrum. And then the short head has an attachment that's lower. The long head is going to be better hit because again, it's crossing that shoulder joint with things that place it on stretch by getting it back behind the body, which is the inclined dumbbell curl that you mentioned. The inclined position when my arms are hanging is going to put them back behind the body a little bit. And it gives you that slight pre-stretch on the exercise. That slight pre-stretch is supposed to allow for a better recruitment of the muscle fibers to the exercise. But it also, I believe this main driver

• 1:28:38Speaker 01

  is it just gives that second level of tension, that second source of tension beyond just the dumbbells itself. You're getting a stretching tension on top of the dumbbells themselves. So an inclined dumbbell press is good. That could become a little bit irritating to people that have shoulder issues though, if they go too low on that.

• 1:28:55Dr. Peter Attia?

  You would incline at what? 60? 45?

• 1:28:59Speaker 01

  45 might be a little on the edge there. I say 60 degrees is more comfortable for me. The short head is really, again, just flexing the elbow, getting your arms out in front of your body.

• 1:29:10Dr. Peter Attia?

  So that's the preacher curl?

• 1:29:11Speaker 01

  Curl, cable curls, just a standard cable curl. The traditional barbell curl would hit more of the short head. And then there's also this concept of what you see is what you train. So when you're looking in the mirror, if your arms are rotated outwards and you can see the inner portion of your bicep more, that's your short head. This portion that you see on the inside is the short head. That would be working more of the short head. So I have an exercise variation we call the no money curls. I have no money. My hands are out here at the side. I got nothing. External rotation of the arms there, curling from that position there is going to work more of that short head. When I have my arms internally rotated more and curling from that position like I would from a drag curl, anything like a go around a drag curl, then I'm seeing

• 1:29:55Speaker 01

  more of that outer portion of the bicep visibly in the mirror, then I'm going to be working more of that long head also. So that's another indicator of how you can differentiate between the exercises.

• 1:30:06Dr. Peter Attia?

  Now, for someone who's not a bodybuilder or really in the minutia of trying to differentiate, is bicep one of those things where as long as you are adhering to really good principles of eccentric loading, getting something on long head and short head, exact arm position might not matter, it's get the volume right, get the stimulus right and go?

• 1:30:26Speaker 01

  Yeah. I think for most of these muscle groups, if people did even just these basics and they're just trying to make sure that they're checking off the boxes of actually doing some exercises for biceps, shoulders, chest, all these muscles we're going to talk about, they're going to see amazing results from them. Arnold was famous for having his golden six, just having six exercises that you can do that are going to essentially provide the biggest bang for their buck. You worry about progressively overloading on them and getting stronger. They're going to create a good physique at the end of the day. But the nuances, I think, help a lot when it comes to training around and navigating around injuries or limitations because again, back to what we said in the beginning, if you have the understanding of where you can go, when you do

• 1:31:09Speaker 01

  hit one of these roadblocks or closures, then you have the rerouting possibilities. And if you don't understand what's part of making up that movement, you don't have the ability to do that so freely.

• 1:31:20Dr. Peter Attia?

  And would you put bicep and tricep in the same category as delt where you're talking about eight to 10 working sets per week to make gains? Or do you need a little more?

• 1:31:27Speaker 01

  I don't think you need a little more. I think if anything, you could get away with less. I mean, as long as they're high effort taken to failure sets. I mean, they're a smaller muscle group. They don't need as much. And they're definitely going to get additional benefits from the other compound movements that you do. When you're training chest, you're going to be training your triceps. When you're training your back, you're going to be training your biceps. So you're going to get some additional volume in any way in their accessory role.

• 1:31:51Dr. Peter Attia?

  Okay. What are your favorite forearm exercises that aren't obviously getting all the work already with bicep and stuff like that?

• 1:31:57Speaker 01

  Forearms, I think it's rather boring when it comes to forearms because if you look at the wrist function side of forearms, meaning the extending and flexing of the wrist, you can get a lot done with two basic exercises, just simple barbell wrist curls or barbell wrist extensions or dumbbell wrist extensions, dumbbell curls or cable. You can do the same thing, whichever position or whichever device you want to use, you can do that. When you extend the benefits beyond that to the forearm itself, we can move our forearm in space and still work forearm muscles. So the brachialis is a muscle, the brachioradialis is a muscle that crosses from the upper arm down to the forearm itself that we can get with reverse curls and exercises that we can load more heavily. But it is a big muscle that sticks out and provides a lot of

• 1:32:42Speaker 01

  forearm development. So just limiting it to wrist curls and wrist action is not enough to train your forearm. You can get even more into the minutia when you start to do radial deviation and ulnar deviation and pronation and supination. And those are all amazing movements. I like to just resist them all with bands. I've actually done a video where I show you how to do all those movements with just bands. And again, it's something that can match your ability level based on just how much resistance or how far away you step from the anchoring point. I do like one other functional type exercise, which we used to do in baseball a lot. It's just a roll of some sort. So an over under roll, you could take just a barbell itself and roll forward until

• 1:33:23Speaker 01

  you fatigue and then you roll backwards fatigue. All it's doing is basically the rolling forward is essentially creating wrist flexion and getting the flexors and the rolling backwards of the bar is getting wrist extension, training the extensors on the back of the forearm.

• 1:33:36Dr. Peter Attia?

  And you're doing that on the ground?

• 1:33:38Speaker 01

  Just standing in space with a barbell in my hand, just rolling over that barbell until you can't do it anymore. We've shown before more elaborate version, which is really pretty cool, but you take a band and you wrap it around the edge of a barbell that's in a rack. You take that band and then anchor it to a kettlebell or a dumbbell. You just tie it around the kettlebell or dumbbell. You have that. And now what you do is you roll over the top of that end of the barbell until you lift that kettlebell weight all the way to the top. And then more importantly, you unroll it just as slowly and under control because what it wants to do is just go right back down to the ground. So you have to unroll it very slowly and go back down to the ground. So it's another way to like almost gamify forearm training because again, forearm training can be pretty boring and straightforward, but effective.

• 1:34:22Dr. Peter Attia?

  Okay, let's go to everybody's favorite. Let's talk PEX.

• 1:34:25Speaker 01

  PEX, International Chest Day every day.

• 1:34:28Dr. Peter Attia?

  I was talking to a buddy of mine yesterday and I hadn't talked to him in a while and he's a really serious guy when it comes to his training. And I was like, all right, what's new in your workouts, man? And he goes, chest day every day.

• 1:34:39Speaker 01

  Yeah, yeah.

• 1:34:40Dr. Peter Attia?

  Which of course, he's being facetious, but the fact that that was his joke.

• 1:34:42Speaker 01

  I mean, it's the centerpiece on the torso. So I think when people, that and abs, so when people see themselves in the mirror every day, that is the thing that catches their eye first. So I think that's why it gets so much attention. When it comes to the chest, there's two major requirements here. You want to get some type of pressing movement and you want to get some type of movement that add ducks or brings the arm across the chest. So when it comes to the pressing movements, you have options of obviously barbells, dumbbells, machines. They're all gonna do pretty much the same thing in terms of the movement itself, but how it feels can be drastically different. And this is where, when you have shoulder issues, and I can speak from experience here, some of them are gonna feel a lot more uncomfortable than others.

• 1:35:27Speaker 01

  When I was going through that period of inflammation in that joint, which was long after, by the way, long after the injury itself, I had kinda re-aggravated that injury in demonstrating some of these bad exercises to do early on on my channel. I couldn't do any pressing. I could not do any pressing at all. There wasn't a pressing variation that I could find that was comfortable for me. So I did all of my work through the adduction crossover type exercise, taking a cable, grabbing onto the handle, and then crossing my arm over my body. I think the ability to pull the cable in with your bicep to kinda get it going, or know you have that option, takes away some of the instability that might come from having your arm way out in front of you and that long moment arm that could be placed on the chest.

• 1:36:08Speaker 01

  So I found that to be a good rerouting option for me. I was able to, after doing those exercises, get back to the point where I could press. But when it comes to the press itself, incline, flat, decline, if I had to choose one, I'd say incline, because most people have weaker development of their upper chest relative to their lower chest or middle chest. So an incline bench press will cover the weakest point of development and still do a really good job of hitting the rest of your chest. But I think dumbbells give people with any issues the most opportunity to train pain-free. And if you still have pain when you train with dumbbells, slow it down. The slowing of the dumbbell, especially during the eccentric portion of it,

• 1:36:51Speaker 01

  is gonna give your joint the opportunity to feel safe and overcome any instability that might be causing some of your pain. I believe that a lot of times, even though there's structural problems in the shoulder, when you combine structural issues with instability, they feel really vulnerable. Those structures feel very vulnerable. So when you can provide stability, mostly just by slowing the pace down, then that structure itself could feel a lot more supported and safe, and it doesn't cause the pain and discomfort that it would. And you're able to get into those fine-tuned positions we talked about before, where you know it feels good there.

• 1:37:30Dr. Peter Attia?

  Yeah, you can sort of bring the elbows down a little bit. And so you're at an angle that maybe doesn't allow for the maximum. I mean, you're using more tricep potentially, but you're also taking more stress off the AC joint.

• 1:37:41Speaker 01

  It feels like something that is overall.

• 1:37:43Dr. Peter Attia?

  But it's interesting that you would preferentially say, "Look, if you've only got time for one pressing movement, make it the incline over the flat, and then let's get you over doing flies or cables or something as well." That's probably a common mistake people make is maybe spending a disproportionate or too much time pressing and not enough time using the adduction.

• 1:38:02Speaker 01

  Definitely, and I think that you should not over-exaggerate the angle of your press, though, when you're doing the incline bench. I like to keep it around 30 degrees or so. The higher you start to go, the more you start to shift that focus into the shoulders and that front delt again. So I think 45 degrees would be the maximum for me, but 30 degrees is where I like to train from on that incline.

• 1:38:20Dr. Peter Attia?

  And then let's talk a little bit about different ways that one can do adduction. You obviously referred to cables. Of course, all of us grew up watching Arnie do flies. Looks like there's a lot of risk on the shoulder with just a heavy fly on a bench.

• 1:38:32Speaker 01

  I've thrown that one in my iron graveyard too. And again, only because.

• 1:38:36Dr. Peter Attia?

  I cannot wait to see the comments of people who are just so angry that you've said that.

• 1:38:40Speaker 01

  I'm so, look, they say it's fear mongering. I'm not fear mongering. I'm saying, "I hate the exercise." I'm recommending people do the alternative, because the alternative can give you many of the same benefits without the risk. The anterior shoulder capsule is quite vulnerable in that position, period. You have a weight in your hands, and no longer could just use lighter weights. What if I wanna use weights that are somewhat heavier, because I wanna challenge myself more eccentrically? Well, I could take the exercise down to the floor. I'm still doing the fly. You like the fly, I'll do the fly. I'll do it down on the floor. Now I have.

• 1:39:13Dr. Peter Attia?

  But can you get as much stretch when you're on the floor?

• 1:39:15Speaker 01

  You can't get as much, but again, we're doing these little trade-offs back and forth. If I wanted to get a little bit more stretch, I could stand up and go do a cable crossover. And because I can position myself differently in a cable crossover, and I could get my arms in a slot that are more comfortable for me, and because I can control some of that vulnerability to stretch, because I can utilize the biceps to offload that in any way by engaging them or not in that back position, then I have a safer exercise option that still, most importantly, gives me the adduction and also gives me better resistance through more range of motion of adduction. If I take a dumbbell fly and I pull it to the top, once I get to the top, I don't have much resistance to that adduction anymore. If I have my cables and I pull them, I could go to midline and still go past midline

• 1:39:59Speaker 01

  and still get more of that effect.

• 1:40:01Dr. Peter Attia?

  Do you remember the old Nautilus machine? You'll never see these things anymore, but I feel like they were some of the best machines ever engineered. But this machine that was just a fly machine, it had round bolsters that, I'm sure other companies make it besides Nautilus, but it allowed you to do a fly with your arms at 90 degrees.

• 1:40:20Speaker 01

  Yeah, yeah.

• 1:40:20Dr. Peter Attia?

  And so you could actually load this thing up to the ends of the earth, and your shoulders didn't hurt. Whereas today, you go into most gyms, the fly machine is a handle. You just can't go that heavy. Why the difference?

• 1:40:32Speaker 01

  Because I think people didn't take to that machine as much, because they didn't feel that big stretch as much. And what happens a lot of times is when you extend your arm out, the elbow out, you start to involve other muscles that get subjected to stretch that get perceived to be stretch itself, like on the peck itself. The only thing that's gonna dictate that stretch on the peck is the position of the humerus relative to the body. So if I get to here, whether I'm here, whether I'm here, is not really affecting the stretch of the chest.

• 1:41:02Dr. Peter Attia?

  But you feel the bicep stretch when you're out here.

• 1:41:04Speaker 01

  You feel other muscles start to get involved, the coracoplegalis. You start to feel other things get involved that give the perception of more stretch. And when that happens, people feel like, "Oh, I like this exercise more, because I can feel this stretching me more." Again, it's the unsupported nature of that that I don't like as much. When we're doing that cable crossover, it may seem unsupported, but it is supported, because the stacks are gonna engage at some point, depending upon how far away I get. So I know I've got that bottomed-out position, depending upon how far away from the machine I get or how much I pull.

• 1:41:36Dr. Peter Attia?

  Do you like to cable fly with single arm or double?

• 1:41:39Speaker 01

  I like them both. I like them both. When I'm really trying to focus on one side is when I'm trying to get like a really good contraction on that side. If I'm just trying to move heavier weight, then I wanna grab them both together and make sure I do that. What I always advise people against when doing that exercise is like leaning too much in that, because they'll lean in as they do it. And basically, that promotes the rounding of the shoulder. They'll get too much dominance of the shoulder to do it. I always say, as you're pressing, you wanna lean back, almost wanna stand upright, so your chest is out in front of the movement and doing the majority of the work, and not your shoulders tending to round out and dominate the movement. I don't care what direction you go there. You can go straight across midline. You could go high to low. When you go from this position, from a higher grip position,

• 1:42:22Speaker 01

  down towards a lower grip position, you're gonna work more of your lower chest, because basically stimulating more of a dip. And then if you go from a lower hand position to start and a higher hand position at the finish, then you're stimulating more of that orientation of the upper peck fibers. You're mirroring their direction more, so you hit those more effectively. That's, again, that's more of a weak point.

• 1:42:41Dr. Peter Attia?

  And would you say like 50/50? If you're gonna do 10 to 12 working sets of peck, would you say half of that should be pressing, half of that should be fly?

• 1:42:51Speaker 01

  I think that's fair, yeah.

• 1:42:52Dr. Peter Attia?

  You mentioned dips. Where do they belong in our toolkit for triceps and lower peck?

• 1:42:57Speaker 01

  I like dips. I know that people find them to be, they believe them to be somewhat of a risky exercise, but I think if they're done responsibly through reasonable ranges of motion, not extreme ranges of motion, I've seen recommendations of people saying to get really, really low. And things change when you're fatigued. So when you start to get more and more fatigued in a set, even something that started out that seemed to be a good, safe exercise can become unsafe because of the fatigue. The dip is one of those exercises that can become more and more unsafe because of fatigue, because all of your body weight is being basically sunken downward as you're trying to hold and push yourself back up. But as it sinks down, it's putting more and more internal rotation onto your shoulder.

• 1:43:38Speaker 01

  But if you're aware of that as a negative feedback point, like that is something you're trying to avoid, then you stop yourself in that range of motion higher than the point that becomes vulnerable. And if you start to perceive that your fatigue is overcoming your ability to control yourself in that range of motion, then you stop the set. So I think there's ways that you can do that exercise. You could also put a band there and do an assisted dip, so you're just basically hanging it over the handles and you're putting your knees on top. There's a lot of things you can do, but I don't like to avoid the exercise entirely, because I think it's one of the best ways to stimulate, especially the lower chest, with that good stretch from the bottom position.

• 1:44:16Dr. Peter Attia?

  So you're basically using depth and range of motion to manage? Because again, you're the perfect candidate of somebody who shouldn't like that exercise with your torn labrum.

• 1:44:23Speaker 01

  Yeah, always. I use depth and control of that depth. When I do try to get a little bit more into a stretched position, I feel like, "How stable can I keep my body position?" One of my big keys, I say, is to be able to drive your shoulders down. You want your shoulders away from your ears. If you start to feel that your shoulders are riding up towards your ears, or you feel like you're shrugging, you don't have control anymore. You should at any point in time be able to keep your shoulders depressed and have that distance between your shoulders and ears as a check, a form check, regards to your stability of, in control of your shoulders in those bottom positions. Then when I get to the top too, same thing, because when you get to the top, your whole body weight's gonna wanna sink you down into that shrugged position. You wanna actually actively drive your elbows down, unshrug the shoulders.

• 1:45:07Speaker 01

  But the dip would fall into the pressing category, as would a push-up. Any of these where you're just pushing your arms out, down, overhead, in terms of a chest activation, it's usually the push-up, the dip, and the bench press as your main pushing options. The only, the adduction exercises are gonna be the ones that cross that arm across midline.

• 1:45:25Dr. Peter Attia?

  You wanna do back next or abs? I mean, stay on the front of the body or?

• 1:45:28Speaker 01

  Stay with the abs.

• 1:45:29Dr. Peter Attia?

  All right, let's talk abs. They say that most of the ab work is done in the kitchen.

• 1:45:34Speaker 01

  That is so true. Strengthening the abs and getting aesthetically pleasing abs is really two different things too. I think that when we look at the contributions of nutrition and whatever ab exercises you're doing, this is nutrition 99 times out of 100 is what is responsible for what you're seeing. Nutrition is going to control your body fat levels, period. What you see when you get rid of that body fat is determined by your dedication to ab training. I do not believe that doing the compounds is enough for your abs. I never believed that. I think that there are so many other things that your abs are responsible for in terms of motions and movement patterns. You're not doing that all from a series of compound exercises.

• 1:46:17Speaker 01

  As a matter of fact, in the compounds, their role is mostly just to stabilize. They're not creating rotation. They're not preventing rotation. Sometimes they're preventing rotation, but they're certainly not creating rotation and not creating rotation under load. So how do we do that? The exercises that you pick, once you get your body fat levels low enough, should hit these major functions. My major functions when it comes to abs are their ability to create top-down movement, which means pulling my rib cage towards my pelvis. Cause the flexion of the spine is really the main responsibility of the movement of the abs. Their stabilization requirements are huge, but there's no movement going on there. So the flexion of the spine is coming from top-down movements,

• 1:46:58Speaker 01

  bottom-up movements where the pelvis is moving towards the rib cage itself, any type of reverse crunch. The same two things, but done with rotation. So it's now not just top-down, but it's top-down and rotating. So we call it top-down rotation. Bottom-up with rotation. So anything where you're bottom, you're pulling that pelvis up, but rotating at the same time or twisting. Then we have the obliques themselves that are going to be feeding right into working in conjunction with the abs. And then sort of mid-range movements where both rib cage and the pelvis move towards each other at the same time. So those are like V-ups and exercises that do that. How you do these, anything done on the floor is generally going to be easier, generally going to be easier than if you were to perform them hanging from a bar.

• 1:47:42Speaker 01

  Because we have more of our body weight being subjected to gravity that we have to lift. Anything like a leg raise done from the floor is a hell of a lot easier than a leg raise done from a bar.

• 1:47:52Dr. Peter Attia?

  How do you do top-down on a bar?

• 1:47:55Speaker 01

  If you're going to do it with weight, you're going to do a cable, like a crunch pull down.

• 1:47:58Dr. Peter Attia?

  Got it. Okay.

• 1:47:58Speaker 01

  Yeah.

• 1:47:59Dr. Peter Attia?

  And how does one think about their portfolio when they think about all those things? So obviously the easiest top-down is a crunch. And then crunch with rotation is top-down with rotation, leg up from the floor with rotation, hanging leg raise with rotation. You're basically picking from those. How are you defining sets and reps for this funky muscle group?

• 1:48:20Speaker 01

  So I believe it's hard to define sets and reps for people when it comes to ab work. Because a couple of things, number one, we all can do different amounts. More so, we do a better job of creating good quality contractions when we're not just focused on a number. If I really just wanted to get a good ab workout, I'd really just focus on getting slower, meaningful, concentrated contractions on the abs because it's too easy to involve the hip flexors. It's too easy to involve momentum. And we get so lost in the ability to say, yep, 30, 35, 40 of what, 40 of what? Of waist. Like there was nothing that actually was very productive there. So I'd rather see you either just do it until you can't do them anymore.

• 1:49:04Speaker 01

  So just train the exercise to failure, whatever that is. And know that you've done them slowly and considerably. So you're doing the right thing for you're trying to develop. Or I'd like to see you just do them for a series of specific amount of time, but focus on rotating through them as fast as possible. So I might not get complete fatigue from the one 30-second bout that I'm doing, but knowing that I'm going to go into the, immediately to the next one mechanically offset. So it's a little bit, so I can still do it even if I'm fatigued from the other one, right? There's always a mechanical drop-down effect that's happening. So I can still keep doing exercise. But knowing that the end result of this will be at the end of these six minutes, seven minutes, whatever, I'm going to be toast.

• 1:49:45Speaker 01

  I can do that if I shift the focus a little bit around the abs from the top-down movement to the bottom-up to moving those focuses around is going to allow me to keep going for 30-second intervals with very little rest periods in between. That at the end of it all will have a cumulative effect. So those are the two ways that I usually like to do it. We've got plenty of workouts where I've posted where I do it in follow along fashion, where I just program it and tell you what to do. But there's a lot of variety within those because it's the movement pattern that's most important. The exercise itself isn't that as important. It's the ones that you tend to feel the most and feel the best contraction on are the ones I try to push people towards.

• 1:50:26Dr. Peter Attia?

  What would be your favorite pure rotation exercise? If you're going to pick one pure rotation exercise, would it be one knee up, one knee down with a cross-body cable?

• 1:50:36Speaker 01

  So I like any type of, we call them sledgehammers where you just basically take two hands on a cable and you're trying to rotate. What I also like from those is when you get out to that position, having to hold them and then step out even further. Cause especially if you're doing with bands.

• 1:50:51Dr. Peter Attia?

  You would prefer, you want to see that standing? You want to see that in a split stance?

• 1:50:55Speaker 01

  Standing. Yeah, standing. Well, I mean, this is standing. This is a squared up stance, standing. If we wanted to get really powerful with, I could split your stance a little bit more because now I'm focused on driving as much power from the ground up. And I could do that too. And those are explosively performed, but still under control. Everything that I say is explosive is still under control. Because it's not enough to just get yourself out into that position, but to control it on the way back, always. So I like to do any of those variations. Again, we could do them even isometrically where if I have the, let's say again, band in my hand and it's out in front of my body, I can jump out even further laterally, which is going to increase the tension on the band and want to whip myself back and to rotate towards the anchor point.

• 1:51:39Speaker 01

  Don't let it. You keep your body face straight ahead. You're undergoing like these spontaneously increased rotational demands or these isometric rotational demands. And that's a great way to, that's a really good athletic way to train because A, you're on your feet. But because we do get subjected to so many spontaneous forces that try to change body.

• 1:51:59Dr. Peter Attia?

  Yeah.

• 1:51:59Speaker 01

  Try to change body position and we don't allow it. Some people that have a hard time being able to do this, well, you might've seen it before. They'll take a physio ball and they'll hug the physio ball with a cable. So they're doing the rotation with it.

• 1:52:11Dr. Peter Attia?

  Yes, yes, yes.

• 1:52:12Speaker 01

  It's a great way to go for beginners too, because they feel like, okay, I'm hugging and I'm moving as a unit. I'm not just like moving my hands in space because a lot of the tendency, if you're just doing these band exercises for beginners, is to try to move with their hands only. I want you to think of your hands being united with your belly button and core, and you're moving it as a unit. Cause that's how you're actually going to train the core itself. So if you find that your arms are independently moving, lock them up with that physio ball and that sort of helps to do that.

• 1:52:38Dr. Peter Attia?

  Let's talk about Dorian Yates in the back. Again, notwithstanding the fact that like a bodybuilder will break this down into every possible angle of the back. But if we're just talking about this through the lens of normal people who are going to throw eight to 12 sets per week at the entirety of their back, inclusive of traps, rhomboids, lats, the whole thing, even the lower muscles, the erector spinae muscles, how would you create a protocol? And again, always for the person who is saying, look, I want more of a V shape. I want to taper down here a little bit. I have to get my lats bigger. What are the mistakes and how do we need to train?

• 1:53:09Speaker 01

  The back is obviously made up of a lot of muscles and it's a big area. The most effective way I think to look at it programmatically is to think, vertical pulling, horizontal pulling, low back specific, upper back focus, right? Upper back scapular type retraction work. So the upper back work pulling versus the vertical or horizontal pulling is mostly dictated again by the positioning of those elbows. We referenced earlier, like the more those elbows drift during like say a seated row and they drift higher, the more you're going to get into that extension of the arm as the main focus. So you're going to get more of this mid-back rhomboids, upper traps, mid-traps. That's going to be tapped into the most when you allow the elbows to drift.

• 1:53:55Speaker 01

  If you do a row, which should be a basic compound exercise to perform, then you're going to get more of the lats if you're doing that with a tighter arm position. The issue with the row could be that someone with a low back issues or weakness might find that any freestanding row position could be challenging where they start to fatigue more in the low back prior to their lats. In that case, the chest-supported row done face down on an incline bench gives you the option to continue to overload your lats as you start to build up your low back strength. I don't ever recommend you do chest-supported rowing and that's where you stay. I think everyone should be able to row under load from a standing position. And so you just have to work your way up to the point where you can do that. That's where the low back strengthening comes in.

• 1:54:40Speaker 01

  Okay. So you're working your way up from your chest-supported row to your standing barbell row variation. But at the same time, you're working on your low back. You gotta strengthen your low back. And there's a lot of ways to do that. I like classic hyperextensions over a physio ball. I like reverse hyperextensions. Those are my favorite ways to do that. I like Superman-type exercises where you're laying flat on the ground and you're raising your thighs off the ground at the same time that you're raising your arms up. Cause then we could stimulate some of that upper back muscles too. Those are the things that look a little rehab-ish, but at the same time, they're only looking rehab-ish because they're exercises that you never do. And they're exercises that target smaller areas relative to their larger neighbors.

• 1:55:22Dr. Peter Attia?

  Let's go through the Superman as an example. So if you're doing that, what constitutes a working set?

• 1:55:28Speaker 01

  Failure.

• 1:55:29Dr. Peter Attia?

  How many reps? How long a hold? How do you think about it?

• 1:55:32Speaker 01

  Anything where especially these corrective type exercises, because I say corrective, like you're correcting a weak low back in this case. So these corrective exercises, they should always be done with a mentality of really good, high quality repetitions. So I hate when we say, do a set of 15 of these. I'd rather you think of that as doing 15 sets of one, right? I want you to feel every single one of those purposely in the low back. And also in a Superman, you're trying to teach the low back to be supported by the glutes. One of the biggest reasons why we get low back issues is because the glutes are not doing their job to basically support the pelvis from below. And so it's causing the low back to have to take on more of the brunt of that.

• 1:56:17Speaker 01

  So the low back gets overworked. If you can do the exercise where you squeeze, in this case, the squeeze your glutes together first, get that stability, then lift off the ground and get into this extension, then you're going to feel it differently, but you're going to feel it properly. So doing enough of those in this 15 sets of one mentality will start to get that neuromuscular re-education that's lost. It's not so much about being able to overcome huge loads there. It's about being able to train the muscle neuromuscularly to start to respond more effectively. So I think when you start to do some of those exercises and work them in, and I work them into regular back day, that's the end, but it's just no less important than the heavier vertical pull or push exercises.

• 1:57:01Dr. Peter Attia?

  I see. So we're going to hit lower back primarily through the horizontal and vertical stuff. So for example, a seated unsupported cable row, when you're going heavy, your lower back has to do a lot of work if you're doing a standing row.

• 1:57:13Speaker 01

  More so in the standing row, yeah.

• 1:57:14Dr. Peter Attia?

  Yeah. So that's where you're getting lower back, but then you'll finish it with the Superman's.

• 1:57:18Speaker 01

  With direct work, yeah.

• 1:57:19Dr. Peter Attia?

  Yeah, got it.

• 1:57:20Speaker 01

  Yeah. And try not to be bored with them, thinking that they're something remedial. They're, they're just as important as the other exercises because they help to connect those weak links that are probably taking away some of the capacity you have on the bigger exercises, because they are the weak link.

• 1:57:35Dr. Peter Attia?

  Going back to the kind of workhorses of this are the vertical and horizontal pulling. But the key is if you're doing this for the purpose of your lats, keep the elbows in.

• 1:57:45Speaker 01

  Elbows are going to be tighter, yeah.

• 1:57:47Dr. Peter Attia?

  So you do not need wide grip activity here. You don't need a wide grip lat pull down. Like if you used to think, well, I want a V shape, I should be grabbing the thing out as far as possible, but really you don't need to.

• 1:57:58Speaker 01

  No, the wider the grip, actually you start to shift the focus to the muscle called the teres major, which is, they call it the lat helper. So it does functionally very much the same, but the angle of the hands being that far out actually shifts more of the load away from the lats to the teres major. Again, aesthetically, something that a bodybuilder would want, it's going to actually support the overall appearance of what you're seeing back there. But functionally for 99% of us, you don't need to go that wide to do that. And you're probably just inviting some awkwardness to the shoulder joint that you might feel the repercussions of down the road.

• 1:58:31Dr. Peter Attia?

  And then upper back and scaps specifically, what are sort of your favorite activities?

• 1:58:37Speaker 01

  My favorite is the face pull. I talk about the face pull all the time. I like the face pull because it isn't necessarily just corrective in nature. It could actually be loaded up enough to cause hypertrophy of the rear delt, the mid traps, the rhomboids, the rear delts. Like it's got a lot of benefits.

• 1:58:53Dr. Peter Attia?

  Tell people how you like to do it. You're doing it with a rope, you're standing.

• 1:58:55Speaker 01

  Yeah.

• 1:58:55Dr. Peter Attia?

  A cable machine.

• 1:58:56Speaker 01

  So it's definitely become a lot more popular since I've talked about it for many years, which I love seeing. I see people literally do it in the gym now. But there's two ways to do it. The first thing is you really should attach two gym ropes to the device to be able to do this properly. When you do one, like the regular gym rope that we see in all the gyms, it's not long enough to get the elbows open enough to a 90 degree angle. What's going to happen is your elbows are going to be bent in this position. The bending of the elbows, once you add weight, starts to drive what? Starts to drive your hands forward and your shoulder into internal rotation. So if I can get my hands wider, it's still going to promote internal rotation, but I wind up being able to get into a stronger position here and work external rotation.

• 1:59:39Speaker 01

  Like I have a target to go towards external rotation. I can't here, with the short rope, I can't. So by attaching the two ropes, now I have enough length in each hand. And then what I try to do is again, get a good stable base. I don't usually perform these out of a split stance. I usually do them out of a squared up feet, even with each other's stance. And the reason why I do that is I think it's a good way to limit the amount of load that you're using there. So while I think you can go a little heavier here, I don't think you should be loading these up so heavy that you're relying on a split stance to get so much stability that you can pull that weight back. So it gives you a nice top end when you can't balance yourself anymore and you're being pulled forward on the exercise because you're.

• 2:00:22Dr. Peter Attia?

  Probably doing too much.

• 2:00:23Speaker 01

  Doing too much. Now we use the pulling of the hands as the guidelines. I don't want to just pull the elbows back because I might let the hands lag behind. To get external rotation at the shoulder, I need to drive with the back of my hands. So if I can think about opening my elbows up or opening my chest up, squeezing those scapular muscles together, and then pulling my hands back, that's how you want to perform the face pull. At the end of it, you want to have, almost looks like you're doing a double bicep flex for someone who's looking at you from the front or the back. You have those 90 degree angles and you're pulling straight back. At that point, there's one other little tweak that I think is amazing if people can handle it, is you then from this position, not only you increasing your tension and time under tension at that spot, but you raise your arms up overhead.

• 2:01:05Speaker 01

  So what you're doing there is in this peak contracted position, now you're raising your arms up and that starts to get into the lower traps. So lower traps have a lot of control and function when you raise up overhead and the shoulder blades are rotating. They provide good stability there. So you're adding one other element to the exercise at a very little extra cost. And it just simply requires a raising and then a lowering of the hands back again to where they started. And then you let the weights go back to the beginning position. So you're just basically adding one additional raise at the end position and then let the arm go back. So it's basically a face pull and press.

• 2:01:41Dr. Peter Attia?

  And again, it's really, you're really overlapping rear delt here as well, correct? I mean, you're hitting that rear delt again. Is that an argument for doing delts on the same day you do back?

• 2:01:50Speaker 01

  I do that a lot. I look at upper back and delts as having a lot of shared functions. So I think that you can pair them up if you're trying to do the agonist muscles working together.

• 2:02:01Dr. Peter Attia?

  All right. Let's talk about legs in any way you see fit. Do you want to talk about quads, hamstrings? Are you going to talk about everything from the knee to the hips as one? And let's just go through it.

• 2:02:11Speaker 01

  No, I think you split them up. I think of them sort of as anterior, posterior. But even within that, I think there's exercises that stress the hamstrings from a lengthened position and those that stress them from a knee flex position. And anteriorly, I mean, I think when we're talking about the quads, we have a lot of different options from squatting that will do a great job. The squatting will hit the posterior chain too. So let's start with anterior. If you were to do the anterior and you wanted a more quad focused option, then there's a couple of things that you could do. Number one, you can carry the weight more anteriorly. So that's why we have the front squat.

• 2:02:47Dr. Peter Attia?

  Cyclist squats, all these.

• 2:02:48Speaker 01

  That gives us a chance to direct some of the load a little bit more effectively towards the quads. I love the front squat. You have to be okay with the fact that you're not going to be able to handle as much weight there. But again, that's almost irrelevant when we're talking about at the end of the day, it's the tension the muscle feels. It's not the actual weight that's on the side of the barbell or dumbbells. So that gives you that chance. A goblet squat would be another option for that. The transition between the two is a belt squat because that weight gets directed more directly downward. I love the belt squat because it doesn't require the loading on the back for people that don't have the strength to support that. And I have an exercise that I like to do, which is a squat variation called the Spanish squat. And you basically take a band and you put it around the back of your knees.

• 2:03:34Speaker 01

  Take your pair of, usually done with dumbbells. You back away from the band. So it's already, if you were to let the band pull you, it's already pulling your knees into flexion. It's trying to drive you into flexion. The only way to get that band to get into the proper position is to drive your knees back against the resistance of that band. So you're getting really resisted terminal knee extension. Now you have your dumbbells at your sides, you reach down to the ground, you pick them up. Now you squat down, as you squat down, obviously your knees are flexing. You get down to the bottom of the squat and you can go pretty, as heavy as you can hold the dumbbells here. So you can go 60s, 80s, hundreds, whatever you can hold. As you come back up to the top, you get toward that last 20 degrees or so, you have to drive your knees up against the resistance of that band to get that fully extended knee. It's basically taking the elements of a leg extension, but because you're doing it in

• 2:04:19Speaker 01

  a closed chain way with your feet in contact with the ground, it's brutal, but it's a great combination of an exercise. It takes a regular squat and it adds an element of resisted knee extension at the end. That's just amazing. I like doing that. If people are limited by their grip strength, they're not able to load heavy enough because they can't hold that weight, then that may not be a great option for them. But a lot of times they're overcoming that because of the added resistance of the band. That makes it so difficult. I also have taken two Bulgarian split squats as a favorite of mine because I know that I can effectively hit the quads more one leg at a time, which is another benefit.

• 2:04:58Dr. Peter Attia?

  So when you're doing a Bulgarian or rear foot elevated, you're fatiguing in the front of your leg more than the back of your leg?

• 2:05:05Speaker 01

  If you maintain your upright posture. So the big cue there is to maintain as tall of a chest position as you can. A lot of times what we'll do is we'll go down into the exercise and angle forward. As we angle forward, that is going to quickly and significantly shift the load to your posterior chain, to the glutes. And of course the quads too, but more so to the glutes as you start to lean forward more. If you maintain an exaggerated and not in a harmful way, but an exaggerated way, your upright posture, just don't allow yourself to sink forward, then you're going to hit the quads very strongly in that. Same thing with a reverse lunge. Absolutely one of my favorite exercises for posterior anterior, depending upon how much angle of my torso I allow.

• 2:05:47Dr. Peter Attia?

  Okay.

• 2:05:48Speaker 01

  It's funny because we're kind of talking legs in general anyway.

• 2:05:50Dr. Peter Attia?

  Yeah, it's impossible for me to think about legs as anterior posterior. I just think of legs as legs and the balance shifts a little bit between, am I lifting my heels? Am I not lifting my heels?

• 2:06:01Speaker 01

  Yeah, you don't hear me talk much about if my exercise favorites were the leg extension, you might hear me speak a little bit more like that, but anteriorly, I know I can shift the focus by positioning the body differently in space, but I don't have a lot of go to specific, hey, quads. I'm really focused on the quads here because I don't do a lot of leg extensions. They're not a great exercise personally for me for my knees, given my history of knee issues and for a lot of people, they don't feel so great. If you can do the exercise and there are no issues with pain, it's the equivalent of a concentration curl for the biceps.

• 2:06:36Dr. Peter Attia?

  If somebody is saying, you know, my legs are just so skinny. I really just want to put some muscle mass on my legs. What are you saying? Is this where, hey, we got to go up to 16 sets working in a day? I want you to focus just on the compound lifts or like what guiding principles? Do you give that person who's trying to put some muscle on their legs?

• 2:06:54Speaker 01

  Definitely have to go heavy enough. I think that a lot of times people don't go heavy enough with their leg training. And I think that legs respond a little bit more to slightly higher volumes. So I think rather than potentially doing more and more in one day, which you really start to, you know, how fast you can tap out when it comes to leg training. It'd be better to probably just schedule a second session in the week, volume wise, increase in the number of sessions that you're training legs. So that's where these options of being able to shift the focus a little bit around anterior, posterior gives you some flexibility and not doing the same exact workout twice, but it gives you a chance to train your legs and stimulate them twice. So you have more opportunity, but being able to build bigger legs.

• 2:07:38Speaker 01

  I mean, some of us are just never going to be able to build them as big as others because it tends to be one of those areas like the calves that are just genetically, I call them calves or cab nuts and I'm a cab nut for sure. The leg growth and size and strength and power even from the athletes, like it's quite oftentimes something you're born with, but not that you can't improve it all. But that's something that's heavily influenced by genetics.

• 2:08:03Dr. Peter Attia?

  So what we want to have is a good rotation of movements and basically say, look, if I'm going to just try to do it all in one day, I'm going to get 12 to 14, 16 sets, working for legs on a given day. I'm going to pick and choose from these exercises and I'm not necessarily doing the same workout every time.

• 2:08:21Speaker 01

  Yeah, definitely not. You don't have to do the same workout every time. Even just between, if I had to choose between reverse barbell or dumbbell lunges and Bulgarian split squats, both similar in that.

• 2:08:32Dr. Peter Attia?

  You wouldn't do those two in the same day necessarily.

• 2:08:34Speaker 01

  I don't need to, because the positioning of the legs is similar enough. I don't necessarily need to do that. One is more dynamic than the other. So I factor that in when I think about programming, like the lunges is going to be more dynamic. Whereas you're more fixed in the Bulgarian split squat. But I'd want to have something that I wasn't potentially being limited by balance or coordination. That every time I train my legs, it was some sort of a squared up, balanced out squat, two footed squat.

• 2:09:02Dr. Peter Attia?

  I mean, the problem I have with training legs, which I enjoy, I really, for whatever reason, I've always enjoyed it since I was very young. There's just too much to do because in addition to all of the exercises you just went through, which are important for strength hypertrophy, there are all these sort of unsexy things that we have to do as well. We've got to get all that glute med training in. We've got to make sure you get the adductors working and they're not really adding size, but they are adding time to the workout. So how do you think about making sure people are doing a lot of the lateral movement with the legs? Like really dumb looking things, curtsy squats and things like you just got to kind of do those things.

• 2:09:42Speaker 01

  The same way that we talked about the low back being the stuff that it can be relegated towards the end of the workout, requiring less of your energy, but it's still part of the workout. And it's no less important. As a matter of fact, it's just as important. For me, that is the glute med training. It is the fact that we don't get a lot of frontal plane stimulus from the bigger, more popular exercises, all the ones we just mentioned, lunging, split squatting and squatting are all sagittal plane exercises. So unless we are lunging laterally or if we're.

• 2:10:13Dr. Peter Attia?

  Like a caustic.

• 2:10:14Speaker 01

  Caustic we could do.

• 2:10:15Dr. Peter Attia?

  But that's not going to give you much hypertrophy, right?

• 2:10:17Speaker 01

  Depends. I mean, depends on how, on a caustic, I mean, if you're getting deep into that squat and you're, and you're, yeah, I mean, again, it's that same tension equation. Like as long as the tension is high enough and you're overcoming it and fatiguing because of it and reaching failure because of it, then you're going to gain benefits in hypertrophy. But the ones that I think about for glute medius, like I have a series of exercises where we do hip bumps against the wall. All you're doing is letting yourself drop down to, this one's a little bit hard to describe, but you're essentially standing close to a wall. You're standing on your outside leg, so not the inside leg. The inside leg is just lifted off the floor. You're letting your hips get lazy. I say you're letting your hips drop out to the side, straight in the frontal plane, just letting it kind of bump out away from the wall.

• 2:10:59Dr. Peter Attia?

  Okay.

• 2:11:00Speaker 01

  And then from there, all you're going to do is just drive yourself back to where you're, because at that point, your pelvis is going to be tilted towards the wall. You're going to drive yourself to a level pelvis. That's coming strictly from the glute medius and abducting the hip in to get into that position.

• 2:11:15Dr. Peter Attia?

  And sorry, what do you call that exercise?

• 2:11:16Speaker 01

  I call it just a hip drop or a hip bump. You'll feel that very quickly and you'll realize how weak you are in that plane, even if you are a heavy squatter, because if you're not.

• 2:11:26Dr. Peter Attia?

  Totally different.

• 2:11:27Speaker 01

  If you're not doing it, you're not doing it. Those muscles aren't really as active, nearly as active in that position as they are when you're doing a regular squat. These are humbling exercises, but they're no less important to do. You need to get over the fact that, okay, I'm pretty weak here. We had some of the best athletes in the world that would have do these exercises or even we would test people by having them get on their stomach and essentially bend their knees and then I would rotate their leg in or out, right? So they're from that, I'm using their leg as a fulcrum and I'm basically rotating it out. The degree to which I can control that leg in space and I tell them, don't let me move it is crazy.

• 2:12:05Dr. Peter Attia?

  They just don't have the external.

• 2:12:06Speaker 01

  Rotation strength. No, none. I mean, and we're talking about.

• 2:12:09Dr. Peter Attia?

  Best athletes in the world.

• 2:12:11Speaker 01

  Seriously powerful people because they don't train that enough. You could actually train that motion specifically by literally getting a band anchored to something stable and then putting yourself in that position on your stomach and rotating against that resistance. You can work it. Is it goofy looking? Yeah. I mean, if you're doing that in a gym, it would be goofy looking. Would you feel self-conscious because it's hard to do? And you can't even imagine why you can't make your leg move like that? Sure, but it doesn't negate how important it still is. And when we're talking about people with low back issues or hip pain, these become a factor because it matters. It matters getting those weak muscles to become more in balance with the other dominant muscles is going to provide more stability for that joint and then take some of the load

• 2:12:55Speaker 01

  and stress off the muscles that are trying to do too much, like the low back.

• 2:12:58Dr. Peter Attia?

  Okay. Now again, I'm keeping this deliberately away from the recovery side because there's so much more we could talk about on how to stabilize a knee and things like that. But I'm trying to keep this to the aesthetic. Let's finish it up with calves, two big muscles. What are the principles around training calves? Again, we're talking about those of us who are, don't have these genetically perfect calves you see on the odd specimen.

• 2:13:23Speaker 01

  So you mentioned two muscles. So there's the gastrocnemius and the soleus. Gastroc is one that crosses the knee. That's again, there's these muscles, right? We talked about before the triceps, some of these that cross those joints. It crosses the knee and the soleus does not. So how you train them is determined by the position of the body when you do it. So to hit the gastroc most effectively, you're doing them from these straight knee positioned exercises, like a standing calf raise or toes in, toes out, whatever that variation might be. To do the soleus, you wouldn't necessarily need to have that knee straight. You could have a knee bent. So any of those seated calf raises are going to do that. The biggest thing that I think I've advocated for when it comes to calf training

• 2:14:04Speaker 01

  is the removal of the ballistic element of the exercise because the calves, the Achilles is so accustomed to handling the ballistic transition from foot on the ground, midfoot, absorbing those forces and then locking up and propelling you into the next step. So good at handling those quick transitions.

• 2:14:27Dr. Peter Attia?

  By the way, I just want to pause on that for a second, Jeff, sorry to interrupt. I just don't think from an anatomic perspective, we appreciate how remarkable that part of our body is.

• 2:14:37Speaker 01

  Oh gosh.

• 2:14:38Dr. Peter Attia?

  The ability of the foot Achilles calf complex to navigate us through the world. It is in many ways sort of heartbreaking when you come across somebody who's never taken advantage of it. They've never run, they've never jumped and they're now in mid, late life and they're shuffling around and that Achilles has atrophied away. Those muscles are not reactive anymore. The tendon doesn't have the supple nature to do all those things. And yet you realize we were all born with the capacity to do something as dramatic as a broad jump or sprint, jump off a box. The forces that are required.

• 2:15:18Speaker 01

  To me, it's the timing too. The timing is so precise. You're basically asking your foot from the moment it hits the ground, the midfoot, which is just a series of bones in there, right? That are all sort of aligned to become adaptable to the surface. So they loosen, they literally loosen, they loosen through that active pronation of the ankle complex and the foot complex. So as it starts to hit the ground, you're getting this loosening of those bones so that you can adapt to the surface. They call it a mobile adapter function of the foot. So you can adapt because maybe the ground's rocky or a hill that you're running. You can't just be rigid. So it gets into that position. And then it has to be able to, within a moment's notice, if you're running especially, be able to, as it's being brought back behind you again into extension,

• 2:16:03Speaker 01

  quickly shift from being mobile and loose from, to be able to absorb the forces there and not just jolt your entire knee and hip joint. To then becoming rigid and locked up to become basically a propulsion maneuver, like a lever that's going to then drive you into the next step. So it happens in microseconds to be able to go from this to this to this to this completely opposite functions. And if it doesn't handle it well and it stays a mobile adapter for too long, when you go to propel yourself, you don't have that rigidness to basically lever your body off the ground. Now you're going to rely too much on the structures in there to try to do that. That's where you start to get plantar fasciitis, you start to get Achilles tendonitis. All these things start to go wrong.

• 2:16:45Speaker 01

  Same thing, if you don't have a good enough adapter to the surface, then every step you take becomes too jolting to all those joints up that kinetic chain. They're going to have to absorb the force that the foot couldn't. It is definitely remarkable.

• 2:17:00Dr. Peter Attia?

  And so with all of that said, we could do an entire podcast on just how you do that. Fortunately, we've done a bunch of content on that. But now coming back to this main principle, you're saying, look, if you want those muscles, the soleus and the gastro to get bigger, you can't let the body cheat its way out of doing what it's so good at, which is what it was designed to do.

• 2:17:20Speaker 01

  That's what it's designed for. So I think there's a hack to calf training is to try to turn off that responsibility of the Achilles tendon so that it's not trying to jump in and ballistically do what it does, but it forces the muscles to almost inefficiently temporarily, because that's what we're trying to do, is inefficiently stress them so they can grow, is it makes them do more of the work. So you go into a bottomed out position, you stay there for four seconds and then you start to come out of that position. You do it slow and controlled. You don't try to explode out of position because you can quickly turn back to that tendon elasticity to do the job. I'm talking about making the muscles inefficiently have to slowly contract and drive your body out of that position. And doing it one leg at a time tends to allow for the overload that people don't get when

• 2:18:05Speaker 01

  they're just doing these two-legged exercises. So if you don't have external load from a machine or a calf raise or something like that, you can do it more effectively one leg at a time. But the biggest key is to lower yourself slowly, stay down in that position for four seconds and then kind of drive yourself up out of that over a slower graded pace than just explosively getting out of that position. And that's the same thing, whether you're doing the seated calf raise, focus more on soleus, or whether you're doing the standing calf raise.

• 2:18:32Dr. Peter Attia?

  There's so much literature on this and I've seen it and it's very interesting that shows that if you're just training for hypertrophy and strength and not sort of injury recovery, I've seen different things that say range of motion doesn't matter as much as people think it does, or it's the bottom half versus the top half of the range of motion. Any thoughts on that?

• 2:18:48Speaker 01

  For hypertrophy?

• 2:18:49Dr. Peter Attia?

  Yeah.

• 2:18:50Speaker 01

  I think that all of that content got like a little wayward in the last year or so, to the point where I was seeing recommendations of avoiding the concentric on exercises, like working on the stretch position, that sort of terminal position of the exercise and the contracted position didn't matter as much. First of all, it didn't sound right to me back then and I think research is starting to already prove that not to be the case. None of that makes sense to me as a physical therapist.

• 2:19:14Dr. Peter Attia?

  From a function perspective.

• 2:19:15Speaker 01

  A hundred percent. And ultimately even hypertrophy is going to still require normal functioning to maximize that muscle. So I think that you want to apply, like I think where that all came from is that stretching a muscle is another form of stimulus. It's another form of tension. The weight itself provides that tension. When you stretch the muscle, you're adding a second form of tension. To believe that stretching positions of exercises cause better results is not a surprise because it's providing more accumulated tension. But to think that that would mean, okay, let's just hang out in this position and let's not focus on this other range of motion requirement, certainly not for strength, but even for hypertrophy, I don't think it really adds up or makes too much sense.

• 2:19:59Dr. Peter Attia?

  What about a volume perspective on the calves? They're kind of an unusual muscle in that they're being used a lot throughout the day, every day. Is there an argument that you can't just train them once a week if you want to make gains?

• 2:20:11Speaker 01

  I actually think that's true. I think that they're similar almost to the abs in a way and that the abs are also highly responsible for postural stability and they're working very often, not under high loads, but they're working very often. So I think that when it comes to the calves, they're used to handling very high loads. They're carrying your own body weight around one leg at a time for many, many steps in a day. Subjecting them to more of this focused inefficient hypertrophy work more than once a week is certainly worthwhile, probably two to three times a week, maybe even four times a week. It's like, again, like abs, you don't have to do it for a long period of time. Couple sets, just do it focused and get it done. I don't think for ab training, I don't spend more than, I hate to say it, like six-minute abs, five to 10 minutes, you're done.

• 2:20:56Speaker 01

  You don't need to do a whole hell of a lot, but you need to do it consistently.

• 2:20:59Dr. Peter Attia?

  Do it every time.

• 2:21:00Speaker 01

  Yeah.

• 2:21:01Dr. Peter Attia?

  Okay. Not to create rage bait, but can you give me some of the other graveyard exercises? We've talked about a couple. You've actually got a great video on this, which we'll link to, but just to give people a precursor for what goes on the, and again, we'll frame it as not that these are absolutes, just for the people who can't work in gray. These are things that for most people, you're not getting enough juice out of the squeeze.

• 2:21:23Speaker 01

  No.

• 2:21:24Dr. Peter Attia?

  Your risk of injury is going up disproportionate to the gains and you might be able to get somewhere between 90 and a hundred percent of these gains, doing something at far lower risk. That's what we're talking about.

• 2:21:34Speaker 01

  That's the whole premise. And I believe that you're always going to find the person who says, I've done these my whole life and I've never had nothing to eat.

• 2:21:41Dr. Peter Attia?

  And my grandmother smoked her entire life and didn't die of lung cancer. That doesn't mean that everybody should smoke. That's the way to think about it.

• 2:21:48Speaker 01

  My, my answer sometimes, if I want to get them a little irritated, I said, yeah, I've been doing it my whole life. Well, it hasn't done it yet. Who knows? Because I'm pointing to the parts of the exercise that are just not biomechanically ideal and therefore, just like the exercise I described before, where especially you start to add fatigue into the equation, they increase the risk that you're going to break form enough to potentially cause issues. In that regard, I hate the upright row. I have no problem expressing my hatred for that exercise. It is the dumbest single exercise that was ever created, simply because I can fix it by just changing one position of the elbow and the wrist. That's it. And you can still have your upright row, but just let's call it something different.

• 2:22:32Speaker 01

  Let's call it a high pull. Because the upright row is essentially relying on the fact that you're going to pull this barbell or dumbbells as high as you can towards your chin, lead with your elbows, get as high as you can, which I can't even do because of these shoulders of mine, but get as high as you can with your elbows, to the point where they, some people, you've probably seen them, they look like their elbows are almost vertical. Right, exactly. You do a much better job than me of doing the wrong thing. But I, I basically think not only are you getting into this extreme position, but you're loading it. What am I loading? I'm loading internal rotation. I'm driving this arm, this shoulder into internal rotation under load and elevation. What all I have to do is just lead with the wrists rather and keep the elbows down and

• 2:23:15Speaker 01

  I'm still pulling high and I'm still getting up into this position. I'm still getting abduction of the shoulder, which is why you feel in the shoulders. I'm still getting trap work, which is what you're going to feel when you do the upright row also. And all I've done was just change one position that doesn't sacrifice any of the benefit of the exercise, sacrifices none of the benefits. So if you ever wanted to heat me up and talk about one exercise that belongs in the graveyard, that's the one that will always be in the graveyard for me. And there really is not a defense of it. If you've done it and you like it and you haven't gotten injured with it, then keep doing it. But why would you not at least consider an alternative that sacrifices, you said maybe 90% of the value? This still has a hundred percent of the value without the wrist. So why wouldn't you try that? So that's one. These behind the neck positions that we talked about, the press, overhead press, lat pull

• 2:24:00Speaker 01

  down, but there's leeway there. Some people feel it more, I think, when they do it behind the neck for whatever reason.

• 2:24:06Dr. Peter Attia?

  Depends what it means though. You know what I mean? Like as you said earlier, you might feel it in terms of a stretch more when you're doing a deep fly off the bench.

• 2:24:15Speaker 01

  Yeah, right, right.

• 2:24:16Dr. Peter Attia?

  But be careful what you're feeling. Like yes, of course you feel it more. You're going to feel more of a stretch in the lower bicep, but that's not why we're doing the exercise. I always wonder when people say, I feel it more, if they feel it more where they should feel it more.

• 2:24:27Speaker 01

  Another guy you mentioned, Dorian Yates, I used to watch Lee Haney a lot. Remember Lee Haney? So Lee Haney had a shrug that he did behind his back.

• 2:24:34Dr. Peter Attia?

  Oh, I remember this.

• 2:24:35Speaker 01

  And he called it Haney shrugs. And he says, and they asked him, why do you do it behind your back? He said, where are the muscles? They're back there, aren't they? So it's like, okay.

• 2:24:42Dr. Peter Attia?

  But when you're an eight-time Mr. Olympia, whatever he is, I think you can get away with saying anything.

• 2:24:47Speaker 01

  Right. And you know, along the same lines of the barbell positioning for front squat versus squat, I understand what he's talking about, but I do think that there's this feel element that comes into play there. So if you do the behind the neck pull down, you can soften that up a little bit by just allowing the elbows to not flare back when you're doing it, but let them drift a little bit more towards the front. I could still pull behind my head, but have my elbows drifted more towards that scapular plane. So there's some modifications I can make that would make that exercise better. It's not necessarily a horrible graveyard exercise with this modification, but again, for many or for most, why not pull to the front? I think you're going to get a better pull when you pull to the front anyway. You're going to get a better engagement of the muscles you're trying to build. Same thing with the overhead press.

• 2:25:31Speaker 01

  You could press more safely there. You can actually get the elbows out in front of you even when doing that, which would allow you to do that. But personally, I feel like the press from the front just feels better for me and for most. What else? I think I have this dumbbell side bends in my graveyard. I mean, that's just a pointless exercise. It's just basically riding the seesaw by yourself, up and down, no additional benefit. You're going to more effectively train the obliques with rotational work every day than you are with just straight side bending. They have a function of side bending, but they're going to be way more effectively targeted and trained with rotational work than they are with that. That one's in my graveyard. There's not many more. The fly we talked about was in the graveyard. There's not many more, honestly. I might get the criticism from now and again of creating this graveyard for certain exercises,

• 2:26:16Speaker 01

  but I think more than anything else, I'm adaptable to most things because I think that, as we talked about earlier, like my biggest asset is my ability to take an exercise and figure out ways to adapt it to become something someone can do, even in the face of discomfort at that moment. Cause I know how important it is to continue to stress tissues and not immobilize them or not completely get away from them. The fastest way to slow recovery from an injury is to not do something for it. You want to be able to still stress those tissues. Time is not the only thing that heals injuries. Time and the stress, the particular stresses of those tissue structures is what's really important.

• 2:27:01Speaker 01

  Mechanical stress is super important to that recovery process.

• 2:27:04Dr. Peter Attia?

  Well, Jeff, this was a super interesting conversation. It's actually given me a lot of ideas for things I want to tweak and modify in my training. I suspect it will be for others. Like I said, we're going to put together in the show notes, videos from your archives that will actually demonstrate all these exercises. So my hope is that people can go right to that and become their own trainers, basically, right? It's like, how do I formulate my own workouts here? So anyway, as always, so much fun sitting down with you, Jeff. Really appreciate it.

• 2:27:31Speaker 01

  Appreciate you having me on.

• 2:27:33Dr. Peter Attia?

  Thank you for listening to this week's episode of The Drive. Head over to peterattiamd.com/shownotes if you want to dig deeper into this episode. You can also find me on YouTube, Instagram and Twitter, all with the handle peteratiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical

• 2:28:18Dr. Peter Attia?

  advice, diagnosis or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com/about, where I keep an up-to-date and active list of all disclosures.