The Peter Attia Drive - #196 - AMA #32： Exercise, squats, deadlifts, BFR, and TRT

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.140 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.160 Hey everyone, welcome to ask me anything episode number 32. I am joined today for the very first

00:00:45.800 time on this podcast by Nick Stenson, who you'll get to know during this episode, but basically

00:00:50.380 Nick has been working with me, well, off and on for 10 years, but he's been working with me

00:00:54.240 specifically around the podcast since we decided to do this, which is God, we're coming up on four

00:00:59.140 years ago. It was in the spring of 2018, I think when we made that decision and Nick is going to

00:01:03.140 be taken over for Bob on the AMA. It's a totally different vibe, but we had a field day. I felt

00:01:08.480 this was probably a little bit more conversational and the hope is that because Nick is quote unquote

00:01:12.480 a lay person and doesn't have the technical background that Bob does, that maybe he'll be

00:01:16.800 interrupting me more and asking more questions and maybe that will provide a more valuable experience.

00:01:21.120 So in today's episode, we talk about a bunch of things. We started off by doing some follow-up

00:01:25.760 questions on blood flow restriction, which we had some great questions following the

00:01:28.680 podcast with Jeremy Lineke. I think we go from that then into talking about some of my favorite

00:01:33.920 lifts. So squats, deadlifts and hip thrusters though, not through the lens of blood flow restriction,

00:01:38.780 but just more broadly talking about the importance of those lifts, how they fit into the overall

00:01:43.880 ballpark of a centenarian Olympic training program. And after a pretty deep dive on all things

00:01:50.220 related to lifting, we get into testosterone replacement therapy, both for men and women.

00:01:55.020 So we double click on some of the things we discussed in the previous AMA on testosterone

00:02:00.400 replacement therapy, specifically around the risks of cardiovascular disease. But also we do a little

00:02:04.160 bit more of a clinical discussion around how we actually replace testosterone, what our targets

00:02:08.220 of therapy are, what are some of the do's and don'ts. And then we actually get into some

00:02:11.900 questions about females and testosterone replacement therapy. This is an area for which we have far less 1.00

00:02:16.320 data. So there's a little bit more speculation, but we also talk about that. If you are a subscriber

00:02:21.040 and you want to watch the full video of this podcast, which again, I generally recommend you do

00:02:24.640 because we go through a number of figures here. You can find it on the show notes page. And if you're

00:02:29.140 not a subscriber, well, I hope you become one, but you can certainly watch the sneak peek of this video

00:02:33.660 on our YouTube channel. So without further delay, I hope you enjoy AMA number 32.

00:02:38.440 All right, well, here we go. Another AMA. Of course, I'm joined with a new co-host for this episode,

00:02:50.120 Nick Stenson. And Nick, we'll save the intros till the end, but you ready to jump into this?

00:02:55.800 Yeah, let's do it. We compiled some good questions here. I think it should be a fun one.

00:02:59.480 Yeah, you showed me the list that you were working on and it's got me a little overwhelmed. If we can get

00:03:04.220 through it, I'll be super impressed, but you've, you've got a good, great question. So just tell

00:03:08.620 me where you want to start. So we got a lot of good questions following the Jeremy Lineke and some

00:03:14.740 of the exercise podcasts. So I thought we'd kind of start there and there's some blood flow restriction

00:03:20.220 questions, but I thought it might be helpful for people before we get into some of those specifics.

00:03:24.880 Just what is your current exercise routine look like each week? I know it's always changing,

00:03:30.720 but if you can give people a rough overview, I think that will be helpful as we get into some

00:03:35.240 of these other questions. Yeah. I mean, the actual macro structure of what I do has not changed much

00:03:41.560 in the last year. The micro structure has changed a lot, meaning the exercises have changed a lot,

00:03:46.460 but the macro structure is that on, let's see, Tuesday, Thursday, Saturday, Sunday are cardio days.

00:03:54.060 So Tuesday, Thursday, Sunday are zone two. Saturday is either a zone two followed by a zone five as

00:04:05.460 kind of a separate workout. So each of those are 45 minutes zone twos, and then kind of like a 30

00:04:09.720 minute zone five as a separate workout that's done almost immediately after. So basically getting out

00:04:14.480 of bike clothes and putting on stair climbing clothes. Alternatively, I might just do a longer

00:04:19.880 bike ride on Saturday and make it more of an anaerobic workout. Uh, then from a lifting standpoint,

00:04:28.020 it's Monday, Wednesday, Friday, Sunday is lifting. And about, I don't know, nine months ago, I switched

00:04:36.200 to an upper body, lower body split. I used to lift three days a week and do upper body, lower body every

00:04:43.100 day. So each day I was doing kind of pushing, pulling and hip hinging. And now the lower body component,

00:04:49.540 I think is Monday, Friday, the upper body is Wednesday, Sunday. And I always lift after doing

00:04:56.700 cardio because I think the reverse has been demonstrated to erode strength training gains.

00:05:02.120 Peter, what happens if you miss a day? Cause I noticed you didn't say day one, day two, day three,

00:05:06.860 you were very distinct on the days of the week. I know you typically don't miss a day, but if you

00:05:11.260 miss Wednesday, do you just scrap those exercises and then just continue with your program? Or are you

00:05:16.860 trying to make up in the interim? No, like yesterday, Sunday would have been a ride followed

00:05:23.500 by lift day, but I was on the track the whole day and I knew, you know, I knew that in advance.

00:05:27.780 So I just ended up doing that lift on Saturday, but obviously was shortchanged on the zone two for

00:05:33.600 yesterday. So I will pretty much will never compromise a lift. I will always get those four

00:05:39.620 lifts in during the week, no matter what. And sometimes it just means moving the days around or

00:05:45.300 doubling up on a different day. And what about timing? Do you have a preference morning,

00:05:50.140 afternoon, evening? Is that flexible as well within kind of your schedule?

00:05:54.100 A little more flexible on weekends, but Monday through Friday and pretty much no flexibility.

00:05:58.340 Those lifts have to be done first thing in the morning and not first thing in the morning. So 0.90

00:06:01.200 morning routine is kind of more about the kids and stuff like that. But once they're out the door to

00:06:06.600 school, it's around seven 15, seven 30. That's when I'll typically lift.

00:06:10.720 Got it. I know from the Jeremy Lineke podcast, you were talking about how you were starting to

00:06:16.900 incorporate blood flow restriction. So I think one of the main questions we saw from subscribers

00:06:21.900 after that was, how are you utilizing that into your exercise program? Is that something you do

00:06:26.960 every day? Is it days like you mentioned where you were just not really feeling it and it was injury

00:06:32.260 prevention, or if you had an injury, you were trying to recover. How do you utilize that throughout the

00:06:37.380 week? So I have really enjoyed blood flow restriction, especially since I got new cuffs.

00:06:43.980 So when I started, I was doing it purely ghetto style and I still, I enjoyed it, but I wasn't even

00:06:50.600 coming close to tapping into sort of what the potential of that was for the last, oh God,

00:06:56.500 probably three months. I've been using the brand is actually called smart cuff and it's a night and

00:07:02.940 day difference. So they're kind of absurdly expensive. I don't remember how much they cost. I want to say

00:07:06.980 like $600 for the four cuffs, two upper body, two lower body, plus the device, which is what really

00:07:13.140 makes it so essential. Meaning the device that is measuring occlusive pressure and pumping each time,

00:07:17.740 but it makes such a difference that in my mind, it's just totally worth it. I do plan to try a couple

00:07:24.060 of other devices out. There's even more extreme versions of this that apparently have better features

00:07:29.460 like the katsu one, but my guess is there will be no bigger jump than the one I took from going from 1.00

00:07:35.460 basically $20 junkie bands to, to these ones. And so I do BFR every day that I lift and I just do at

00:07:43.820 the end of the workout, I'll typically do one to two exercises depending on the muscle. So today,

00:07:48.620 for example, at the end of a leg session, I did a BFR leg press set at the end of an upper body session.

00:07:56.320 I'll probably do a bicep set and a tricep set. And I'm always doing it in the way that we discussed

00:08:00.720 on that podcast, but just for folks to remember, it's 30 reps, rest 30 seconds, 15 reps, rest 30

00:08:09.320 seconds, 15 reps, rest 30 seconds, 15 reps. That is the standard prescribed procedure for BFR.

00:08:16.520 You're doing this at a weight that is 30 to 40% of your one rep max. So the easiest way to calculate

00:08:24.920 that is to take the weight that you can barely get 10 reps with. So what is your best 10 rep weight?

00:08:32.780 Divide that by 0.75. So your best 10 rep weight is about 75% of your one rep max. And then you

00:08:41.600 multiply the resulting figure by somewhere between 0.3 and 0.4, depending on how strong you are. So

00:08:47.560 use an example, if your best 10 rep of curls is 40 pounds, you would divide 40 by 0.75, which what is

00:08:57.000 that? That takes you up to 57 or something, I'm guessing. And then you would multiply that by

00:09:02.880 somewhere between 0.3 to 0.4. I typically tend to go closer to 0.4. That becomes the weight that you'll

00:09:08.320 use for the BFR. With these smart cuffs, you have a whole additional variable, which is it comes at

00:09:14.300 three different pressures. So it calculates the pressure. And again, just for the refresher for

00:09:20.060 folks, the purpose of blood flow restriction is to operate at about 30% of the occlusive pressure,

00:09:26.760 the arterial occlusive pressure, which when you're using kind of crap, you know, just bands,

00:09:32.640 you don't really have a sense of what your occlusive pressure is unless you're applying a Doppler signal to

00:09:39.020 your distal extremities, which is very cumbersome. Instead, when you use these cuffs that come with an

00:09:44.040 inflation device, they're actually measuring the occlusive pressure. So the first time you do it,

00:09:48.280 it takes a little longer. And then it says, okay, now I know what it is for your arms and your legs.

00:09:54.720 Do you want to go at the highest level of intensity, medium level intensity, or a lower level of

00:10:00.560 intensity, which basically just adjusts the pressure. And you mentioned a Doppler signal for

00:10:05.540 your other bands. Can you just remind people what that is in case they're using this with cuffs that

00:10:10.440 don't have kind of what yours have? Yeah. The Doppler device, you'd have to buy one. And that's

00:10:14.860 the reason I think like, if you're going to go to the trouble to buy a Doppler device, you might as

00:10:18.740 well buy a smart cuff or something similar, but it's basically a medical device that we used to use in

00:10:23.500 the hospital all the time when you can't feel a pulse. Like if you put your hand on your radial

00:10:29.000 artery here, you can feel the pulse, hopefully if you're healthy. But in people who have peripheral

00:10:34.140 vascular disease, you can't because their pulse is too weak. So the Doppler is basically,

00:10:38.720 it looks like a little pen. You put it there with a little bit of jelly. So it has better sound

00:10:43.720 conduction and it's basically sending a sound signal to the artery and it's recording that sound. So

00:10:49.920 when there's complete occlusion, you'll hear nothing. And if there's only partial occlusion,

00:10:55.000 you'll hear like a woo, woo, woo. And it's sort of picking up that, that sound. So what you would

00:11:00.740 basically do is use this device to figure out how tight to go. But of course, then you're like trying to

00:11:07.100 figure out like how tight to make the band to get to that occlusive pressure. And then how do you even

00:11:13.540 know how to back off it? So you'd have to use a cuff that at least allows you to know how many

00:11:17.240 millimeters of mercury you're putting in to figure out what complete occlusion is and then backing it

00:11:22.460 down. In my opinion, it's just not worth doing that. No, that makes sense. One of the things I was

00:11:27.320 surprised by, cause I was in your gym the other day and was just the difference between the two cuffs.

00:11:32.160 And I think because of that, I asked you to pull them out just so you can show people,

00:11:35.460 do you have them quick? Yeah. Yeah. So these are kind of what my cheap $20 cuffs were that I used

00:11:42.220 for many months. You have two of these and you would kind of wrap them around your arm and your

00:11:47.380 leg. And you sort of look like a bit of a heroin addict cause you're sort of like trying to squeeze

00:11:52.340 this thing. Again, I would just York on them really hard until I would, my guide was once it hits seven

00:11:59.600 out of 10 pain, that was probably the right spot. But I find that's very inaccurate. The current cuffs,

00:12:06.580 this is the arm cuff. So it's obviously a much more rigorous cuff and you apply this, slap it on.

00:12:14.980 Then a little device hooks onto here that hooks up to a little pump. That's where I program this thing

00:12:20.540 and that will achieve the occlusive pressure. The other thing I really appreciate now is like,

00:12:26.620 look at how thick this thing is just for the arm, right? Look at the leg one, like totally

00:12:33.040 different, right? Yeah. Cause I could never get, I was never really doing BFR for my legs when I had

00:12:39.480 that little blue thing. Whereas with this thing, wow, you get it, you get, you really are getting

00:12:45.000 the true occlusive effect. And what are you using to measure the difference there? Or how do you know,

00:12:51.200 like it's working? How can you tell us it just feel? Subjectively. Yeah. It's not hurting where

00:12:56.700 the band is compressing me. I'm feeling that sensation of basically lactic acidosis throughout

00:13:01.780 the entire leg, as opposed to just the pain of being constricted where the band is when it's a

00:13:07.280 thin band. It's interesting to note the pressure of occlusion is much higher than systolic pressure

00:13:14.580 because it's a function of how wide the band is. So I noticed today when I did my legs,

00:13:20.580 the occlusive pressure was 158 millimeters of mercury. Well, that's way above my systolic

00:13:27.680 pressure. My systolic blood pressure is very low. I tend to run super low in blood pressure as

00:13:31.740 evidenced by the fact that I face planted in Brazil last month. And my upper body occlusive

00:13:37.720 pressure with those cuffs is about 58 millimeters of mercury. So you have one that's like, or sorry,

00:13:43.120 94 millimeters of mercury tends to be a approximate occlusive on upper body, 154 or something, 158 on

00:13:51.020 the lower body. But again, it's also a function of the width of the cuff. So that's why I realized

00:13:56.500 just knowing your blood pressure isn't enough to do this. Yeah. And you mentioned you always do it at

00:14:02.940 the end of the workout. I assume that's purposeful. Have you ever played around with like prior to your

00:14:08.220 actual workout and maybe others could speak to it for me personally? I just think when I'm

00:14:13.060 doing my heaviest, most neurologically demanding component of exercise, I want to be a little

00:14:19.800 fresher and I don't want to be as taxed. Whereas I kind of like using this as sort of a finisher

00:14:24.820 or near the end. Sometimes I'll do, I'll still do something after this, but you know, like I'll do a

00:14:30.380 dead hang is usually the very, very last thing I'll do. So I'll kind of mix it up a bit.

00:14:35.520 You'll never do a dead hang with a BFR cuff on. I tried. It didn't, it didn't matter. It didn't,

00:14:40.300 it didn't impair the ability to do it at all. Cause the dead hang is really about grip and that didn't

00:14:44.540 seem to be impaired by the upper body BFR, but I have tried it once. What's your record for dead

00:14:49.000 hang these days? Like a little over three, three 10. Jeez. But that's at the end of a workout. And I

00:14:56.640 think, you know, if you do these fresh, I think you can go a little more. Yeah. Do you have a goal

00:15:00.840 set in mind that you want to hit? I was super happy to get over three. I mean, most days when

00:15:06.420 I do it, I just want to go to two, two 30 and not go to failure and just kind of build strength

00:15:12.960 without failing every time. Lately, I've been doing a lot of finger pull-ups. I think I showed

00:15:18.300 you that device. Yeah. Yeah. That thing is painful, super painful. Gives you a new respect for those

00:15:24.120 climbers. Oh, that was the first thing I thought of. Cause walk people through, you're not doing all

00:15:28.500 four fingers, right? You only are doing three and you're just straight in the pull-up position.

00:15:33.540 I do both. So I'll usually start with four fingers, but that's very easy, relatively speaking. But the

00:15:38.500 jump from four finger pull-ups to three finger pull-ups is so much harder than I would have ever

00:15:45.340 guessed. Oh, I can't imagine. And are you looking to do two finger and one finger? Is that the goal?

00:15:50.820 It's just to just lift yourself up. If I can do four sets of two, three finger pull-ups

00:15:57.420 at the end of doing, you know, maybe three sets of four, four finger pull-ups, that's pretty good.

00:16:04.920 For sure. One other question we had on the BFR was, do you ever do it in zone two training?

00:16:11.000 Like, have you ever played around with that? Thank you for listening to today's sneak peek

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The Peter Attia Drive - February 21, 2022

#196 - AMA #32： Exercise, squats, deadlifts, BFR, and TRT

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