37 Modulating Extremes While Exercising

InForm Fitness Podcast


The Power of Ten workout, as discussed here at The Inform Fitness Podcast, is a high-intensity, slow-motion strength training protocol closely modulated with your very own one-on-one, personal trainer. 
Here in Episode 37, we discuss the potential dangers of not closely modulating a high-intensity exercise program such as CrossFit, excessive spin classes, or marathon training.  Working out under very extreme conditions could result in a rare but serious health condition called rhabdomyolysis (rhabdo).  
Rhabdo occurs when muscle tissue breakdown results in the release of a protein (myoglobin) into the blood that can result in kidney failure.  In this episode, we explain the symptoms rhabdo, the short & long-term effects, and how can you avoid it?
Good Morning America recently reported on the dangers of rhabdo: https://www.youtube.com/watch?v=KqMXSN-1HA4  
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Adam:             Our motto has been for a long time, the exercise you need to live a life you want, and part of knowing what exercise you need is basically if you want to get down to it, we’re modulating your intensity. How intense is enough to get the responses that we need. Exercise is not about building and seeing how much you can endure; and the more you can endure doesn’t necessarily mean you’re getting healthier and healthier the more you can endure. It ends up getting into a law of diminishing returns. You don’t get out ten times more results in fitness, or health, by doing ten times more work.

Tim:                 InForm Nation, welcome to episode 37 of the InForm Fitness podcast. Twenty minutes with New York Times bestselling author, Adam Zickerman and friends.          Now, we say twenty minutes, but as this show continues to evolve, so do the topics and twenty minutes sometimes doesn’t seem like enough. So we may have to change the name here pretty soon.

Adam:             I remember when we were thinking about the concept and going back and forth about how we were going to do it, and I was like, “if we can’t explain something in twenty minutes, then we don’t know our subject well enough.” Well, I guess we don’t know our subjects well enough. There’s a lot to talk about. We try our best.

Tim:                 Well just the opposite, I think because it is—

Mike:               Well, the workout, the workout on its own is a twenty minute workout. In fact, it’s quite a bit less than that when you add up the actual time you’re under load on all             the machines when you’re in the workout, but yeah, sometimes these topics that need to be discussed or questions with clients, they just run on a little bit. Usually stuff is complicated, often times the answer is, there is no answer. We have to sort of look over time and see—try to locate patterns and hypothesize and go from there.

Tim:                 And that ties into the podcast too, because we initially tried to keep the podcast the approximate length of a traditional workout at InForm Fitness, but these topics, actually I think just the opposite of what you said, Adam, earlier that they’re complex that twenty minutes doesn’t even seem like enough and that’s proven itself.

Adam:             Well, what I want to start doing forward actually with some of these podcasts, these episodes. What I’ve been noticing when we’ve been doing it and looking back on all of this that we have taken on broad subjects. We’ve had some very broad—but within these topics, there are subjects within themselves. So that’s what we’re going to start doing; we’re going to start narrowing down a little bit some of these issues that we’ve been talking about. For example, last week when we were talking about it and two weeks ago when we were talking with Doug Brignole and we did those two episodes with Doug. Rhabdo came up, or Rhabdomyolysis came up [Inaudible: 03:00] and that’s a condition where your muscles literally bust apart and their inwards kind of spread out, and it causes all kinds of problems which we’re going to go into. That in and of itself is a subject is what we’re going to talk about a little bit today, and Rhabdo is a good example of a subject that comes up in broader talks. So for example, we were talking about intensity when Rhabdo came up, and how intense is intense and how intense should      something be? How often, and that’s kind of what I want to get a little bit deeper into. This idea of intensity, this idea of going to extremes, and Rhabdo is just a symptom of that. Oh, by the way, Rhabdo is short for Rhabdomyolysis, lysis meaning to explode. What happens with Rhabdo, which is short for Rhabdomyolysis is through—usually it’s a condition that happens though trauma. They call it a crush trauma, where you’re in a car accident or you fall two     stories out of a window or something like that. That’s probably the most common cause of Rhabdo, and of course during this type of trauma, your muscle cells break open. The myoglobin in particular comes out; all the fluids come out, and your kidneys have to deal with that and flush it out, and that can be an overload and you get into all kinds of kidney problems, and you might have to go onto dialysis if it’s bad enough. It’s something that’s really never been talked about unless you’re basically an E.R. physician. Rarely it was something that was talked about in exercise, but it’s been coming up a lot. It’s been around in exercise, I mean endurance, ultra endurance athletes were experiencing Rhabdo. Marathon runners, the Tour de France. There’s probably been, each year, in the endurance, athletic, 25-50 cases a year would occur, and now, we’re reading about it in the New York Times. So not only did we talk about it last week with Brignole—and it comes up when you talk about intensity, but now it’s coming up in pop culture, like the New York Times talking about—in its fitness section, in its science section, talking about Rhabdo. I’m like, wow, and why is that, why is it all of a sudden being picked up, and it’s because it’s become prevalent in the exercise world. More so than even in the medical world where there’s trauma.

Mike:               And cited more specifically in spin classes, high intensity spin classes, with newcomers.

Adam:             So, it brings up this whole idea of extremes. Of how intense is enough, and a lot of my clients brought me the article or mentioned the article and said, “hey Adam, you do a really intense workout. Is this too intense for me?”

Tim:                 You know, when I first started my workout at about—now close to a year and a half, two years [ago] or so, I have some people in the medical community in my family and they were, initially, warning me about this. They said, too intense could really—your muscles could explode and you could have kidney issues and they didn’t use the medical term Rhabdo but they warned me about that, but after a year and a half—I know we don’t get too intense at InForm Fitness for that to    happen because you trainers catch us, right when he hit that failure.

Adam:             Our motto has been for a long time, the exercise you need to live a life you want, and part of knowing what exercise you need is basically if you want to get down to it, we’re modulating your intensity. How intense is enough to get the responses that we need. Exercise is not about building and seeing how much you can endure; and the more you can endure doesn’t necessarily mean you’re getting healthier and healthier the more you can endure. It ends up getting into a law of diminishing returns. You don’t get out ten times more results in fitness, or health, by doing ten times more work. If it wasn’t for exercise and the people that work out hours a day, if they weren’t doing it on a bicycle and they were working that hard on a daily basis, if it wasn’t on a bicycle, it’d be called manual labor. Nobody has ever said that manual labor is good for you.

Mike:               I think it’s an interesting question, like when you just mentioned how much can you endure. There’s a lot of people who, when they exercise, and frankly I was attracted to workouts that would push me beyond the edge. I loved workouts, I loved taking bike rides where the wheels were higher and being with a trainer who would just push me so far beyond my limits that I’d fall down on the ground and I couldn’t do anything after that. I loved to brag to people about it, like, “oh my god. You’ve got to do this, it’s unbelievable.” There’s a certain type of person that is attracted to workouts like that, which is something that we have to be very, very careful for. We have a lot of Type A clients that come here and getting them to understand going to intensity in a safe way, but also understanding a certain level of restraint is as equally important in how you set up your dose of exercise. The same way you set up your dose of food and your dosage of sleep, there’s a certain amount that’s different for everybody, and as Adam said, our job is to modulate this and to customize it based on the person who is in front of us. Our workout is generally the same idea. Like the Power of 10 is slow weight training, on machines mostly, but not necessarily, and we start slow and way below what we think they can actually tolerate, and then graduate to a higher intensity that we think they can manage safely etc etc.

Tim:                 You’re one on one too with your clients, unlike some of the other workout facilities, such as, we’ll just say Crossfit. Because if you were to just Google Rhabdo, it’s tied in with Crossfit, and a lot of the interviews that I’ve seen on YouTube of those who have experienced Rhabdo, they’re in a Crossfit class where they’re not necessarily one on one, but they feel that peer pressure with all of those in the class to take themselves beyond that limit and that’s a very significant distinction between what you do at InForm Fitness and in the Crossfit community.

Adam:             These coaches in these boot camp type facilities are just pushing people too hard too often, and too long. It’s a combination of not only the intensity itself, but how long are you being exposed to that intensity in a given workout? Is it a twenty minute workout, fifteen minute workout? Is it an hour workout? These spin classes can sometimes be on and off, in varying intensities, for 45 minutes to an hour. For somebody that hasn’t built up to that, that can be too much too soon, but maybe twenty minutes is fine. So not only are you varying and building up to intensity, but how long it lasts and how often are you doing it. Are you doing it every day? Again, we have this mentality that more is better. So this Crossfit stuff and these bootcamps, they’re kind of telling you to come every day, and you’re doing it for an hour every single day, and a lot of these people—like Mike was talking about, there’s this group culture. There’s this camaraderie that goes on, and they see some of the veterans doing it, some of the people that have gravitated to it, that are made for that kind of activity, and then everyone else. The masters are looking at the few people that really excel at it, and they try to do it, as     weekend warriors, as baby boomers, as normal, sedentary people, and they’re pushing themselves to the max right off the bat, and that’s a badge of honor. I don’t know if they still do, but Crossfitters have kind of used getting to Rhabdo as a badge of honor. It’s crazy.

Mike:               I think like looking at the instructor and the guys and girls who really excel at it, and using them as a model for what you can do also is sometimes it leads you down a bad road. I think a lot of people do that in every sport too or every exercise. A lot of people go to a Bikram yoga class for example, and say, “oh my god, those teachers are unbelievable. Look at those hot bodies in Bikram yoga,” but usually those are the type of people who have been doing it for a long time and they’ve been—they’re probably former dancers and they’ve had a body that           was like that before they even did the Bikram yoga, and therefore it’s easy for them to show excellence in the practice as well, for that they’re trying to do.

Adam:             It’s a common thing. You see somebody who excels at a particular thing tied to their game and you think, if you do what they do you’ll be there too, and it’s just not the case. The causation is the opposite. I think we’ve talked about this in prior episodes. I mean we look at a dancer and how great they are at pilates, and we think that pilates made them look that way, or dance made them look that way, but actually it’s the opposite. They dance because they look that way. They just have the genetics for it. We had a very interesting conversation last week with Doug about intensity, and you have to find your intensity. So I just want to kind of recap, and what do you do with this information we’re talking about? This idea of modulating intensity and I know we talked about it in the last episode with Doug, and I agreed with him 100% on this. By the way, I’m going to be making commentaries on the last episode with Doug, because a lot of people said to me, “oh, that was really interesting, but it sounds like he said some things counter to what you’ve been saying,” and I don’t want these episodes to be so sterile and to be all my opinion. Like Fox News, and you bring everybody on who’s going to agree with your viewpoint or CNN for that matter. I want to bring in all viewpoints, but I do want to comment about some of the things that were talked about on that and clarify a few things, and bring up some points. One of the points that we talked about that I do agree with is this idea of—the proper way to          workout and what intensity is best for you is something that you find. It finds you, it’s not like you have to find the perfect intensity. The right intensity will actually find you if you’re strategic about approaching it, and this is the takeaway. First of all, if you workout with us, this is what we do when we take on a new client, and it’s what you should do for yourself. The first thing you do is learn the technique. Learn what the technique is going to be to reach this level of intensity. We          recommend slower reps, nice and controlled. Don’t lock out your joints, all the biomechanical stuff that we like to incorporate, and do it slowly and work it out. And learn how to do it and if you’re not experienced with really high intense exercise and taking the muscles to its limits, don’t. Just flirt with it for a while and then take it to the next level, and you’re timing yourself. So what you can do is you can very easily say, I lasted 20 seconds last time, or a minute and 20 seconds last time. I’m going to use the same weight, but now I’m going to last a minute and 25 seconds. Just add five more seconds, you can be very conservative with this, and just get good at the technique and keep pushing yourself until eventually you can really wipe out that muscle pretty much until you can’t lift it anymore. Still breathing properly, not putting yourself in harm’s way, still going slowly, and after five or six exercises like that, if you’re feeling pretty spent, you did your job for the most part. Then you take it from there, and you keep varying intensity and             you’re monitoring intensity by timing how long it takes you to get to a certain level of fatigue.

Tim:                 But a key component here too, Adam, is rest though, unlike some of the others.

Adam:             So that’s the point with the technique and the other part about approaching this whole thing and making sure you don’t even get close to reaching something as severe and as serious as Rhabdo, is it’s going to be very hard if you modulate your intensity and you learn how to workout intensely and you only do it for twenty minutes at a time. And you only do it once or twice or three times a week even. It’s going to be very hard to get to that level because that’s not what causes Rhabdo usually. The cases of Rhabdo—first of all, I’ve been doing this for twenty years, and even at the beginning when I was overzealous and I pushed people probably a little bit too hard at the beginning, and didn’t understand this as well as I do now, I still didn’t have anybody that reached Rhabdo and it’s been twenty years now. I don’t think we’ve even come close to having somebody each Rhabdo. A couple of vomiting sessions here and there, but that’s about as far as it’s gotten. That’s the           trick, and the reason we haven’t. Not only is it learning to        work up to a certain level of intensity, but it’s modulating that intensity in terms of frequency and duration. Those are the three things you have to monitor and balance and if it’s not too long, and you’re not doing it too often, and you build up to a level of intensity, for you to reach Rhabdo or anything close to it, you have to be that freak that has a genetic propensity for it. Which is also another thing about this is, not everybody who joins Crossfit or spin classes and starts hitting it hard right from the beginning is going to—most people are still not going to reach Rhabdo. Even if they don’t do what I suggest. There is a certain level of—some people have a propensity to reach Rhabdo. They’re just—genetically speaking, they’re probably a little bit on the other side of the genetic coin when it comes to that.

Mike:               I think this is a very—it’s newsworthy and it needs to be mentioned by the Times, and the fitness community does need to know about it, but even in Crossfit circles and spin classes, it’s a very outlying condition that I don’t think most people will ever, ever, ever have to be concerned about, but Adam’s big point, and it’s whether you’re doing slow weight training or any exercise for that matter. I think the most important thing is to at first learn the technique, get an expert who can teach you the technique. A big part of technique, and this is going off in another direction but I’m just going to mention it, is just knowing how to breathe. A lot of problems that sometimes people have in exercise is just because they’re not breathing correctly, or they can’t perform because they’re not breathing the way that the activity demands. Our technique in itself also, you could be doing things slowly, but if you’re not breathing correctly, you could run into problems in that as well. Another thing that has to be carefully considered when you’re doing    intense exercise.

Tim:                 Now, for those that are doing this on their own, this type of workout or any type of workout, can you give me some of the symptoms of Rhabdo that might be      going too far?

Adam:             First of all, there’s a very quick blood test that you can test for, plus your urine turns all dark brown, reddish brown. That’s from all the myoglobin that’s being filtered out. Very fatigued, hard to move the limbs, muscle soreness, nausea, dizziness. That’s not getting better, it’s different than feeling a little lightheaded after a hard workout. It’s accompanied by a lot of stiffness and pain in the affected areas. Swelling and real fatigue, like hard to move the joints. It’s pretty obvious     when somebody is in that state, and if you were to be brought to an emergency            room, the first thing they’d do is hydrate you. One thing that happens besides your kidneys being overloaded with trying to clean out all the myoglobin is because your cells explode and the water pressure within the cell drops, all the fluids from outside the cell rush in. It’s like getting a hole in your boat and what happens? The lake starts coming in. When that happens, you become severely—your blood volume drops, and therefore you go into shock. So this can be a very serious situation, and the fact that it’s happening more often in the exercise industry is        concerning, is reason for concern so that’s why we’re talking about it, because again, it’s happening more in the exercise world and that’s ridiculous. It shouldn’t be. So anyway—

Tim:                 Is this more prevalent in the exercise community than say, a sports injury?

Adam:             It’s not so much a sports industry as just over exertion of your muscles basically, so they give out.

Mike:               I think it’s more associated with training than—

Adam:             It’s associated with a lot of training, and again, endurance, athletics, and sports, they always have a percentage of that happening. Training camp, football, training camp, basketball camp, so they’re just pushing you, pushing you, Bobby Knight style and that’s where it’s been known to happen but that’s extreme, high, elite level athletics and they take it too far and again, there can be a genetic propensity. Think Len Bias for example, from the Celtics and how he just dropped on the court. There’s probably some kind of congenital thing that happens as well, but the fact that’s happening to everyday people now more often, that’s concerning because we’re about preaching exercise for health, not exercise to become a world class athlete and we don’t want people to confuse a lot of these activities with having better results or burning a lot of fat, and this extreme mentality, that we honor people who can—we look at Navy Seals and we admire them, but it doesn’t mean that training like a Navy Seal is good for your health. It’s a big difference, and because we admire a Navy Seal for example, we want to emulate that, including the way they train, and it makes us tough, it makes us strong. It feeds our egos, but it’s very unhealthy behavior ultimately, and you’ve got to remember why we exercise. We exercise to maintain our strength as we get older, not screw up our joints in the process, and not really undermine our health in the process, and getting Rhabdo is undermining your health for sure. We’re not talking about, again, if you’re lucky, you overcome it if it’s not a severe case, you overcome it. You go to the hospital, they give you—they hydrate you because like I said, your fluids drop dramatically and your kidneys are overloaded, so they flush you out basically, and they give you a lot of fluids. If that’s not enough, they’ll put you on dialysis, and if it’s really severe, you might have long lasting muscle damage and long lasting kidney damage and the worst of it. So it’s not worth it, and you don’t ever have to work out that hard and get that close to reaching a condition like that to get healthy, to get fit. I think a lot of people that gravitate to these type of activities, I think, and this is definitely room for discussion and we can bring some people on in the future about this. I think replacing it with something else, some other void in their life, and it’s really not about health. I think intuitively a lot of people realize, this can’t be good for me doing it this much, and I think they’re filling a void. For example, a lot of anorexics or former anorexics or people that have eating disorders that try to overcome it, they end up going into programs where they’re over exercising now. You have a lot of people that—bariatric patients, people that have lost dramatic amounts of weight, that used to eat tremendous amounts of food, that now they can’t. They just can’t because of the surgery they had doesn’t even allow them to eat like that anymore, so now they have to find some other outlet for whatever caused them to be overeating like that in the first place and they end up now joining Crossfit and they end up putting themselves in another kind of addictive state or place. I’m very sensitive to that   because I’ve seen it over the years, happen over and over again. People that—recovering drug addicts or recovering alcoholics. They end up overcompensating with something else.

Tim:                 So what would seem like a healthy option, a healthy choice, can be taken to the extreme, to their disadvantage, clearly.

Mike:               I think it’s associated with certain psychologies and certain personalities. I think sometimes people feel that this fulfills that for them as well. Sometimes they’re not looking at it—maybe when they first come in here, or there’s an element of the intensity that’s involved that people may actually may use for that.

Adam:             Absolutely, and we have to pull the reins back on our clients who ask to come do this three times a week, or they say to us, “I have to do something else.” Or they        end up joining other programs.

Mike:               We hear that all the—I had a client just this week, she literally wants to come four times. I’m like, “do you have any idea what you’re talking about?” The thing is, it is actually associated with I think a compensation for something else in her life. Regardless, we went into talking about Rhabdo today, and I think the apparent topic I think is about going to extremes. Modulating where extreme is appropriate and where it’s not appropriate.

Adam:             Actually, kind of, extreme is rarely appropriate. There’s no reason to go through extreme ranges of motion, there’s no reason to restrict your calories in an extreme way. There’s no reason to work out at extreme levels of intensity. I don’t know, give me an example where extreme, unless it’s life saving, where you need to do anything extreme.

Mike:               I think that’s true. What I’m talking about is perception of things, because I know that people that what we do is extreme, and I know, for example, we talked about this yesterday morning. There are people who think that—Adam has had tremendous success in doing a ketogenic diet conjoined with some intermittent fasting, and to a lot of people, that’s extreme. So that’s my point that this is—

Adam:             So who am I to talk about, be careful of being extreme when you just did a ketogenic diet, Adam, right.

Tim: We’ve talked a lot about intensity on this podcast over the last year and a half or so, and people’s perception might be that we do take it to the extreme, so this episode can dispel that myth.

Mike:               Well, people’s perception is often times is their reality, and even saying, for example, forget even danger. Just say, I did this workout, it was once a week for twenty minutes or whatever. That is an extreme statement that most people, based on what their beliefs are about exercise, that’s extremely ridiculous.

Tim:                 On the other side of that though, when you explain to them, those that are saying that’s ridiculous and there’s no way you can see results, but when you tell them, the reason that I’m seeing results is because I’m being pushed to muscle failure and then hold for ten seconds, and that’s where they go, “oh, that doesn’t seem safe.” Like you said Adam, you’ve been doing this for twenty plus years and have never seen a Rhabdo case once.

Mike:               The great many—we’ve had tons of wonderful publicity over the years, but I’ve got to say—we’ve done marketing, websites, so many different things and we have our podcast here and we have lots of fun guests, but I’ve got to tell you. What really brings people in here are existing clients and their results. They refer somebody—they come in like, “listen. I thought it sounded ridiculous but so and so is stronger and they lost all this weight, they only workout once a week, and I thought this is crazy, so now I’m here.” That’s literally what—everybody’s BS detector goes off usually when they hear that oh, this is a twenty minute workout, but it’s—that’s what I’m—

Adam:             If there was a children book that represent who we are as a philosophy, it would be Goldilocks and The Three Bears. No, not the wolf and the three pigs, no, not that one. Not Hanzel and Gretel.

Mike:               You haven’t read, Curious George Goes to Crossfit and Gets Rhabdo? That’s a good one actually. Boy did he learn his lesson in that one, he was so curious.

Adam:             So that’s not the children story that would represent who we are.

Tim:                 But the one that would would be Goldilocks, right? So explain Goldilocks.

Mike:               You lost me at Goldilocks by the way.

Tim:                 So she’s eaten the porridge, where do we sit.

Adam:             Too hot, too cold, just right. We’re trying to find what’s just right; hard enough but not too hard, that whole deal. That’s always very sexy to everybody, but it’s a golden rule that we learn at a very young age and we have to constantly remind ourselves of that golden rule, I think.

Mike:               Yeah. You know what I was thinking before, going back to the parent topic of extremes and everything. I wanted to consider something—from our experience, we’ve never—Adam and I have done this a long time and we’ve never experienced a Rhabdo case or anything even close to a Rhabdo case frankly, but the idea of going to extremes is something that is relevant to, I think, everybody. And whether you’re working out with a trainer or on your own or in a team setting or whatever, in a group setting, figuring this out is a lot easier said than done, and when you’re exercising in a worthwhile fashion, you want to think about—imagine what your limit actually is and finding that is sometimes difficult, and then what you want to do is just go outside of that range just a little bit and then come back into that range. You want to be slightly outside of your comfort zone and back in, and that’s the trick in how to restrain that.

Adam:             There’s no rush, but at some time, you do have to learn to push yourself and keep going.

Mike:               Yes, and that’s the trick. The thing I was thinking about while you were talking before is that there are people that have cardiovascular endurance levels and muscular strength levels, but sometimes they don’t have the orthopedic strength, or the joint strength, or the mobility in order to do certain things, and I think that is something where you really have to take what we’re saying into consideration, because people can run—they have the endurance to run ten miles at a seven minute mile pace, and they can. Their heart can support that, but their knees can’t support that, and there are people that they don’t listen to their knees when they’re trying to actually figure this whole thing out. Those are the types of things that we need to consider in our workouts right now, is where our limitations, because we may have strengths in one avenue, like cardio, but no strong in something else. And finding that balance, Goldilocks style is literally—that’s the challenge for all          of us. As trainers and as clients and everyone.

Tim:                 Alright, thanks guys. Great discussion today. That was part one of a two part episode regarding modulating intensity. Since we spent the entire show today discussing the need for modulating intensity in your exercise program, next week, we’ll shift our focus to our diet. Now, if you’re a subscriber or a regular listener of the podcast, you know that earlier this year, Adam adopted a ketogenic diet. Some would say that that would be an extreme decision, or is it? How safe is it to make extreme changes in your diet? We’ll discuss all of that and more, next week. Hey, if you’ve not yet stepped inside an InForm Fitness location and you’re lucky       enough to be near one of our seven locations across the U.S., what are you waiting for? Become an official member of InForm Nation and give the Power of 10 workout a try for yourself. Seriously, just twenty to thirty minutes of safe, modulated intensity with your one on one trainer and you are done for the entire week. Burn off the fat, build up the muscle, and join the movement. Visit informfitness.com for all of the locations across the country, all of our podcast episodes are there, and a ton of videos. And finally, check out the show notes for today’s episode for a link to Amazon, to pick up Adam’s book, The Power of 10:The Once a Week, Slow Movement, Fitness Revolution. You can pick it up in the Kindle version for like less than ten bucks. I’m sure you noticed that we missed our buddy Sheila Melody today. She’ll be back with us in just a couple of weeks.        So for the rest of the team, Mike Rogers and Adam Zickerman, I’m Tim Edwards       with the InBound Podcasting Network.