Transcript of Most Replayed Moment: This Is The Best Exercise Protocol For Women! New

I hear a lot about VO2 maxes, so I thought, thought we should all be driving our cardiovascular performance up to get a high VO2 max.

Well, that's where the intensity is. Yeah. I think it's, that's only one thing.

I mean, and correct me if I'm wrong, but my understanding after reading and watching everything is it doesn't take that much to build VO2 max.

No, it doesn't. It's that high intensity that's a little bit uncomfortable where you're pushing at that max for, uh, you know, about 4 minutes. To build that VO2 in the sports science world, it's always been the 4x4, the Norwegian 4x4. 4 minutes on, 4 minutes off, 4 minutes on, 4 minutes off.

But that's not 3 days a week.

No, not at all.

Norwegian protocol is once a week.

Once a week at the most, right.

And the other sprints, just to give you, I tend to give my examples 'cause it makes it more real. But when I'm doing sprint intervals, I do it the 30, seconds on and then complete recovery, meaning I'm, for 30 seconds, I'm taking my heart rate as high as I can get it, and then I'll completely recover, which takes me 2 to 3 minutes. I just happen to do it on a treadmill, but the reality is you can do it on anything. It's a heart rate function, not an apparatus function. So for me, on a treadmill, After I'm done warming up, you can't do it cold or you'll hurt something.

Exactly.

After I'm done warming up, 'cause I'm a really short person, I punch the treadmill up to 11 and I am just working so hard I don't fly off the back. But that gets my heart rate up really high, about 186. Everybody's top heart rate is different. Mm-hmm. And then I completely recover and I do that 4 times.

And that's all you do.

It doesn't take that long, and you feel so good when you're done.

Yeah.

So I can't run at the moment. This morning I did explosive kettlebell swings.

Why can't you run at the moment?

Uh, I've torn hamstring and meniscus, so I can't run at the moment.

Running is in. Run clubs have come in strong. It's back in.

Yeah.

Are you at all concerned with the fact that people are running all the time and doing resistance training less because running is cool, like cool now. It's how people date. It's, yeah, it's— they're not going to nightclubs.

It's a sacrifice of other things. It's like we said about Pilates, you know, if all you do is running, then that is definitely not the best way to be. It's not the healthiest for your whole body. It's not that you're unhealthy, but we're really talking about how are we optimizing your body, your hormonal health for a variety of different goals. But also, if we look very micro running. 58% of runners have a luteal phase defect. That means that the second half of their menstrual cycle is not going to be able to last as long as we want it to, likely due to what Stacy was talking about earlier, this relative energy deficiency coming back to the brain. The brain signals is not as strong to keep that corpus luteum, what happens after the follicle, alive. And a lot of women say, I still have my period, so I'm okay. But if we're using our cycle as a vital sign, we can actually say the ratio of energy balance is not great. And it's often because we're doing it at sacrifice of other things. So if you're doing the strength training 3 times a week and you're running however you're spacing out your other days, that's such a healthy balance.

It's hard that you're gonna be in a bad position with that.

And you'll actually improve your running more so than if you were to run every day or every other day.

Mm-hmm.

'Cause if you're getting strong through full range of motion, then that feeds forward to better running economy. Then you can vary your pace without getting injured. But for people who are running every day and they're shuffling and they're getting stronger in their strong muscles and weaker in their weak muscles, then it perpetuates this.

And they're in my clinic.

Yeah, people are very keen on doing marathons and half marathons at the moment, and got a couple of friends that are doing a lot of marathons at the moment, and they're very, very, very skinny.

Oh, welcome to my world of Texas.

Yeah, is that healthy? I'm not even sure if that's, that's the right question one can judge from just looking, but being extremely skinny in that regard, being that sort of marathon runner physique.

There are some that are naturally predisposed to that, right? So naturally predisposed to having really good running economy, running biomechanics, having a leaner body. And this is what we were talking about the Olympics earlier, where you can see the ideal body type for that particular sport. And then there are those like me who build muscle naturally, it's pretty easy. So I'd never be a skinny little runner, and my running economy is a little bit off because of where I build muscle versus not. So not everyone is meant to be a long-distance runner, and there are some that are meant to be long-distance runners. So if we're talking about your friends who are like super skinny, are they economically viable for being a long-distance runner? Possibly. But we also have to look, are they male or female? What is their injury rate? What is their fueling? And then for me, I'd want to see the DEXAs of the women that are just training long distance and super skinny, because most of the time we see a higher visceral fat in and around the organs as we're talking about, even though on the outside, like super lean, but they have a really high percentage of visceral fat because of the inflammation, the low energy intake, and most likely estradiol suppression.

And that's the skinny fat thing you talked earlier. Yeah. Is there an evolutionary lens on this? I always think about this when we're having these conversations, like, what used to happen thousands of years ago.

We talk about the evolutionary biological theories, and there are a lot of sociologists that will counter what I'm getting ready to say, so I'll apologize in advance. We look at original hunter-gatherer type communities. The male body was designed to go out to find the calories. The woman body was designed to stay and take care of the offspring and make sure that home was set. If it was low calorie, menstrual cycle would stop because you didn't want to reproduce in a time of low calories. Body fat would come on because there weren't a lot of calories.

And so the equivocal in the time now is that I'm not eating enough or I'm burning more than I'm consuming?

Exactly.

So I'm in a calorie deficit in some way?

Exactly.

Okay.

In an energy deficit. So with the male body, and we see this, their brain and hypothalamus is not as sensitive to those nutrient deficits as much as a woman's body because we have menstrual cycle and menstrual cycle function. A man will lean up and get more cognitively focused in times of low calorie intake. So this is what we see with fasting data and we see with restrictive diets. And that was— we need to bring it back to that biological lens. Low calorie, I have to go find the calories, I have to be fit to go find the calories. Low calories, I need to not have to eat as much, so I need to store fat, and I can't have a baby because we don't have enough calories.

And then stress.

When we add modern stress onto that, that's a comprehensive addition of cortisol and addition of inflammation, and that also perpetuates body fat.

I mean, like stress 10,000 years ago would've been like a lion.

Oh yeah, it's a lion. But it's episodic.

Yeah.

Right? We had stress, and this is a natural stress response. We have to have them to survive.

Right. But these were episodic stresses.

Well, and your hormones would change for a very specific purpose that you would then go do. Your body would free up glucose from your liver. You're getting it ready in your bloodstream So you can go run from the lion. Yeah. And then things would shift back to normal. And what's happening with chronic stress is you're getting all the hormone shifts 'cause your body's really getting ready for the lion, except it's just that bad meeting you had.

Yeah.

And then you're just sitting there longer and you're not using that glucose up.

Exactly, exactly.

Are women increasingly overtraining?

I think the problem in this country is not, maybe in the women who are, really intentional. Maybe there are some that are overexercising, but if we look at a population, nobody is exercising enough.

Exactly.

I mean, I would take— people ask me all the time, tell me the first thing people need to do. I'm like, I'll take anything. I mean, I'll take getting off the couch with any method, whatever makes you happy.

I'll say, get off the couch and do 10 air squats. Thank you. That's enough. Yeah, that's enough resistance training.

So in the crowd that's like, I'm gonna invest in my health every day, that is not the majority of people.

Yeah, that's my bubble. Yeah. But who—

and they—

the people who listen to your show though, want to— might be a different demographic, we have to acknowledge, right? Than population of America. I mean, like a lot of people who listen to your show, Steven, are interested in health and their body and achieving certain goals. And so certainly, you know, I have practiced fertility in North Carolina and in Austin, and I see a completely different patient population, you know, in Austin, Texas, which is a very fit area.

People—

women are constantly overtraining. But to Stacy's point earlier about this, maybe evolutionary, what happens— women go into this hypothalamic dysfunction even before it's what we call like amenorrhea. Hypothalamic amenorrhea is essentially where the brain, where the hypothalamus is, shuts off, says can't reproduce right now, XYZ reason, no FSH and LH are coming out. You're not ovulating, you're not making estrogen, you're not going to get pregnant.

So you're more likely to survive.

Yeah, so it's a survival mechanism.

Pregnancy is dangerous as in hunter-gatherer society.

But there's state— modern medicine acts like you're perfect or it's turned off. And the reality is there's all these shades of gray in between where these different chronic stressors and your insulin resistance and your inflammation and you're over-exercising and you're under-fueling come in and make it so the hypothalamus is not responding correctly. And that's what we're trying to get people to intervene there before it gets too bad. And I see a large number of women who do fall into that zone where they are trying their hardest to be healthy, but what they are choosing to do is actually having a negative impact on their hormonal health and how their brain is interpreting their hormones.

And you—

it's very rare to see that in a man. Meaning the number one reason why I will see low testosterone is purely because many men are taking testosterone or because of other exogenous factors like marijuana use. It is very rarely my brain is not sending out the signals to cause my testicles to make testosterone.

I like to frame it where women are under-recovering, not overtraining. So if we're under-recovery, then it makes it more acceptable to fuel. And I always wanna bring it back to, it doesn't matter, like, because I come from high performance, I'm gonna use those words where it's like, not recovering enough. We wanna focus on recovery on these days. We wanna make sure that you're eating and fueling around. So it's never overtraining, it's always underrecovery.

But the balance is wrong. They're not recovering enough.

So what do you say to all the voices on social media that are just yelling at mostly women and telling them it's just a matter of willpower and you don't have the body composition you deserve?

Well, you swipe left and don't talk to those people.

Yeah.

But, That's me, right? But I mean, I'm talking to the woman in Ohio who's feeling defeated and stumbles across someone screaming at her on the internet that her body composition that she's not happy with is her fault.

I hate that because it's a construct of society, right? Especially Western society. This is where we have to educate. It's not your fault. These are the things that have come into play and lined up to create this situation. But now we have tools to offer you to take one step out of that situation, and let's see how many more steps we can get you away from the situation to improve your health.

Yeah.

And are the rules of exercise slightly different once you've entered perimenopause?

So this is where we really need to look at how we can use exercise and some environmental stress to create a really strong adaptive stress and really strong recovery stress.

Stacy, can you explain adaptive stress? Because I'm thinking of the 10,000 people who follow me who will be like, who have no idea what adaptive stress is.

So if I go and I do some resistance training, some heavy lifting, I wanna create a stress on my body that's gonna then have a signaling cascade to repair the muscle in a stronger way than when I first went in.

Because lifting the muscle damages the muscle?

Yes, and it creates a series of feedback mechanisms that make it repair stronger than when you first went in. So that's an adaptive stress. And we're looking at what levels of stress we can put, so it's a training stress, or what levels of stress we can use through exercise to really, really create an environment that improves our health. Okay. So if we talk about sprint interval training, the 30 seconds on and the 2 to 3 minute recovery, the reason why we want that super high-end stress of our heart rate is it then creates an eventual epigenetic change. So it's that environment that's going to create a change within the muscle that's going to allow that GLUT4 protein that I mentioned earlier to open up and have glucose come in, reducing insulin resistance. Also, with that really high, high heart rate, we're having a lot of stress on the muscle that's going to release some myokines, which are little hormone signals that then will go to the liver and say, Wait a second, we don't need to store visceral fat. We need to create non-esterified fatty acids, which can then go into our skeletal muscle to be used in the mitochondria as fuel.

So we want to have the stress that's strong enough to create these cascades of feedback mechanisms to improve our overall health. If we stay in that moderate intensity zone, we aren't creating a strong enough stress to create that signaling.

What are we doing?

We are exacerbating inflammation or exacerbating cortisol. Now cortisol isn't the demon, but when we have an elevation of it, and especially in perimenopause when we're sympathetically driven and we already have a higher level of baseline cortisol, if we are continuously in this moderate intensity zone, we never get a signal to allow that to drop. So if we're looking at polarizing, which is top, top end and low recovery, and then with the top end, we get the signal cascade of improving body comp, improving insulin sensitivity, as well as getting growth hormone and testosterone responses, which then feed back to drop cortisol.

So am I right in thinking the solution if I'm perimenopausal is to do high-intensity interval training for short periods of time?

So we look at the quality of the training, not the volume of the training. So if we're in our reproductive years, then Yes, you can do the moderate intensity stuff because you have estrogen and some of our other hormone feedback signals that are going to drop cortisol. It's gonna allow your body to recover and repair.

And when you, what makes quality training? What is quality training?

So this is your Polar. So you have a very specific session that you're going to do. So for Wanda, it's your 30 seconds on as hard as possible, 2 to 3 minutes recovery. Do that 4 times, that's your session.

Okay, I'm gonna try and summarize this. See if— this is a test, see if I understood all of this stuff. So if I do a lot of volume but I play in that sort of medium intensity range, I'm basically just like stressing out my body in all the worst ways.

Exactly.

Like the inflammation, it's just not good for my body necessarily. If I don't do vigorous enough exercise, then that's also bad because nothing's gonna break and therefore build. It's nothing's gonna adapt, nothing's gonna grow. If I do it for long periods of time, really anything for long periods of time, that's also stress. But the key thing to do is to do shorter, higher intensity exercise that'll cause my body to adapt, but won't put it into that inflamed stressful state.

And you also have to pepper in some lower intensity work. So this is your—

Flexibility.

So that you have recovery, you're getting blood flow circulating, you're tapping into some mitochondrial work so that you are still getting benefit of exercise, but it's not in that modern intensity. So that's what we mean by polarizing. So if we were to talk in like the zones talk that everyone talks is out there, right?

We're looking at—

What is zones?

So if we're talking about heart rate and the way that your body works, we have zone 1, which is just sitting around, You know, like you're— Yeah, we're in zone 1. Zone 2 is the BroScience kind of thing where you're like, let's, let's work in this zone 2 area where we're working.

I was in zone 2 when you were talking about menstrual cycle.

Yeah, there you go. That's it.

A little elevated.

Your heart rate's elevated, still a little bit to have a conversation. For women, it's good for recovery stress release. For men, it's good to improve metabolic flexibility. We're looking at zone 3, 4, that's the area you wanna stay out of unless you're specifically training for something that requires you to be there. So that would be your half marathons, your endurance races, that kind of stuff.

Everyone wants to stay out of zone 3, 4.

During training.

Oh, okay.

Yeah.

During training. Fine. 'Cause that's the medium range, right?

Yeah. That's medium range.

So you wanna jump into zone 5, hang around for it.

5, 6. Yeah.

Okay, a couple of minutes and then get outta there.

Yeah.

But in a week, this is what—

Yeah, it's crazy.

Let's be clear. So 2 to 4 days a week, you should be lifting progressively to lift heavy, meaning heavier weights, fewer reps, right? One compound lift a day plus the augmentive lifts that go behind it, right? So you're warming up first, then you're gonna do one lift, and then you're gonna do your jumping or your balance work. The other days of the week, you will do preferably low intensity doing anything, walking briskly down the New York street could count as that. It's continuous motion. And then a couple days a week, add in your sprint intervals, your really high zone 5, 6 high intensity. And then when you've got that, you can add in your 4x4 VO2 max on one of the other days, because it sounds like a lot, but when I work with non-pro athletes, I layer on behaviors.

Absolutely.

Because if I say all of this at once, nobody's gonna do anything.

Mm-hmm. I always describe it as we have these pillars, right? First, we have to nail sleep. Doesn't matter who you are, you have to. Same. 'Cause you cannot—

Sleep is non-negotiable.

Yeah, you cannot invoke any kind of metabolic or body composition composition change without adequate sleep. Also improves stress resilience. Then we look at nutrition and physical activity. The behaviors that go with both of those are somewhat independent. You have some people that are more motivated to do physical activity and some people who are more motivated to change nutritional habits. Most of the time they're two different personalities. So we have to look at what comes next. And then we also have, which isn't lesser importance but often neglected, is the mindfulness and community. So this is being out in nature. It's connecting with friends, might be going to group exercise class. It might be just having coffee. But that is really, really important for parasympathetic and whole, like, whole being.

Stress response.

Exactly.

So there's a new book out coming out called Joyce Bann. I don't know if you've spoken with her. So she's a gerontologist and works with the very elderly. And she has a very specific, you know, what determines is who's gonna kill it in that last decade of life. And that community part, using your brain, you know, having interactions with human beings, seems to be the key. And if you don't keep that going through this 40s, 50s, 60s, when you get to 70 and 80, you're not going to have a great end of your life.

And what about the last phase then? So someone's post-menopausal, does their exercise recommendations changed at all?

We like to start the habits early and continue them through. If you haven't started, it's not too late. As we're seeing, like, with Lifemore and some other of the older age research that's coming out, it's never too late to start. We just have to be very careful of how you start, to have support and phase you into these different exercise modalities.

Is it the same exercises though? Meaning, you know, the 3 days a week, the mobility, the strength?

I am firmly postmenopausal. And I am doing all these things.

But it's different, different people always ask me, what does heavy lifting mean?

Right, it's relative.

It's relative. My heavy is not gonna be Stacy's heavy, or I should say it the other way, Stacy's very heavy is not gonna be my heavy.

In "Lift More," they just, the authors describe the one rep max. And so one rep max is like safely, what is the heaviest you can do one rep? You know, so for a bicep curl, what is the heaviest weight I can do one to fail, you know, I'm gonna fail after this one. And for me, that was about 20 pounds.

With good form.

Exactly, safely with good form. And so I could nail 20. And so then they took them down to about 70, 80% of that, which for me was about 15, 16 pounds. So that you can usually do about 5 reps before you hit failure. And that is what they consider lifting heavy. And that seemed to really resonate with my followers to understand what that meant.

And there's so many women that underestimate their strength. Mm-hmm. See them and they gravitate towards the 10-pound dumbbells. It's like, put that away, go to the next one, do a couple of lifts with that. And then ideally I want you to put that away and pick up the next one, 'cause that's gonna challenge you. Because women have been so conditioned to do 10 to 15 reps to get quote toned and not really put in the work they need to, to build muscle and to get the benefit outta strength training. And I, I'm always telling women, you're underestimating yourself in so many facets. Don't cheat yourself with the strength training as well.

Because people have to remember what we're training for now. It's different than, I had a woman recently say, I was taught to do biceps curls, 5 pounds, 30 times. Well, after 30 times, not only are you bored, but you'll probably be at failure 30 times. That will build endurance. I am training to be as strong as possible, and when I'm— when I have strength down, then I start playing with tempo so that I could build, replace some of the explosive muscle fibers that I'm going to lose over time.

To your point, Rhonda, I am just been writing my book in Cape Town, as I told you before we started recording, and one of the studies that I read about while I was writing the book was a study done by some— a guy called Hal Hirschfield and his colleagues, where they asked— they put people in these MRI scanners and they asked them to think about a famous celebrity, and then they asked them to think about themselves today, and then they asked them to think about themselves in 10 years' time. And in 10 years' time, the same brain regions lit up as if they were thinking about the celebrity, which kind of led them to conclude that in our brain we almost see our future selves as a bit of a stranger.

Yes, that's right.

And so when we think about long-term planning, this is in part why a lot of this advice is often most effective when it's put in the context of like short-term performance or cognitive benefits. Because we really do struggle to like care about ourselves at 90. And I think we all kind of think we can just figure it out later.

I think what's different for women, especially in menopause, is because we're also taking care of our parents in so many ways. You know, we're in this like raising kids, going through our our own hormonal upheaval, and then watching our mothers, our grandmothers, our aunts age. And we— the way society is set up, women become the caretakers of their parents, generally the oldest daughter. And I have to give full credit to my sister who lives in the same town as my mom and is a nurse. So she really is bearing the brunt of taking care of Mama because I'm living this life. So thank you, Leah, if you're watching. It is such a tremendous stress, you know. And so our motivation, my sister and I, is like, we don't wanna do this to our daughters.

Yeah, exactly. The other thing I wanna bring in is the brain health component, right? We talk about Alzheimer's and dementia, and one of the reasons I really preface doing high-intensity work is the lactate production. 'Cause we're finding more and more research coming out, um, showing that part of the development of dementia and Alzheimer's and the plaque is a misstep in brain metabolism. So when we're looking at brain metabolism and the brain uses a lot of glucose, it also uses lactate. Now for women, we have less of the glycolytic or lactate-producing fibers, and we tend to lose those with age. Men are born with more, tend to hold on to them more, so it's not necessarily as big an issue for lactate production. Men need to spend more time in the low intensity being able to produce more of our fat-burning capacity. But for women doing that high-intensity work and being able to produce lactate to then allow the heart and the brain to use that preferential fuel feeds forward to reducing the misstep in this brain metabolism component that occurs. And it's such a sex difference when we're seeing a change in glucose metabolism in and around perimenopause into menopause.

So it's that lactate production that I, is kind of the offshoot of the high-intensity work that's super important for brain health as well as—

When you look at glucose metabolism in the brain, I'm talking specifically coming out of Arizona and, and from Lisa Mosconi's work, and they looked at glucose utilization in the brain, especially the forebrain, through the transition. It's wildly different based on what phase of perimenopause, menopause, and postmenopause. That they're in, and it's absolutely astounding. And they're seeing patterns that can give clues that may be the women who are headed towards the dementia route versus those who aren't.

And women are significantly more likely than men to develop dementia and Alzheimer's.

Yeah.

Largely because they have certain unique biological risk factors and also 'cause they live longer.

And the sociocultural component. I keep bringing it up 'cause I work—

Yeah, stress.

Yeah, but also if we're looking at women who are 80, 90 years old, now, their upbringing to this point is completely different than ours, meaning that the job availability and the brain stimulation they had when they were in their 40s, 30s, 40s, 50s, completely different than what we have now.

Better or worse?

Worse.

So they didn't have necessarily opportunity to be scientists, lawyers, medical doctors, so they didn't have as much stimulation of brain and, and implications on that neuroplasticity. So we're seeing a higher episodic issue of dementia and Alzheimer's in older women now because they didn't have the same lay-down effect that we have now as 50-year-olds, 40, 50-year-olds, and this— and the stimulus we have for neuroplasticity.

Oh, so, okay, like you're laying down brain pathways and neural fibers.

So neuroplasticity, think about it like the bone, but you're creating pathways in your brain to make you healthier by more resilient, more resilient to dementia.

But they're also going to have a stronger brain younger.

Are they not going to have more stress if they're working?

Maybe.

Maybe.

Fascinating study, and this one shot me out of a cannon emotionally, was if you choose to become a caretaker of a parent with dementia, you have a 60% increased risk. Now there's a genetic component, but when they took the genetics out of it and they feel like it's the stress of caregiving for that parent, you are signing your own death warrant 'cause now you are increasing your risk of death.

'Cause yeah, 'cause I'm right in thinking that women are still both caregiver and now in the corporate world.

Yes. Yep. Yes, that's right.

So it's both.

Yeah.

Stress from both ends. Lactate production for the win.

Let's get that glucose.

But you have to have an active plan to combat this, right? We're not gonna live in a world that is stress-free. If you're a woman in the world, you are likely to have a caretaking role in some fashion, even if you are chasing other dreams when it comes to professionally. Building good brain pathways is wonderful as far as a way to help start from a higher standpoint before you have brain loss. However, we've, just like we've said on these other tangents, the brain is that too. We need to think about active ways we're gonna combat what is happening in today's world naturally. And some of the factors are modern society that put us into this pro-inflammatory state. But we need to think about making lactate, what, you know, what's important for us. And it really is a plan. This whole, I'm gonna figure it out when I'm 90 and the problem's in front of me, is too late for these medical problems.

So, and back to your point about neuroplasticity, we're not reading as much, we're on our phones.

And so, Not in my house.

Yeah. And so, as a culture, there's this worry that all this time on the phone and these dopamine hits, but not creating stories in your head and reading for pleasure at night. You know, a lot of women are on their phones now before bed rather than developing that neuroplasticity that we get from storytelling.

What you just listened to was a most replayed moment from a previous episode. If you wanna listen to that full episode, I've linked it down below. Check the description. Thank you.