-: Let's look at the training adaptations that we get.
Now, in terms of respiratory muscle efficiency,
we have range of motion and strength.
In terms of the heart, we have stroke efficiency, volume,
like I said, that's range of motion and strength,
which would be like the power of the stroke.
Increased vascular pliability, density and penetration,
so when I say vascular pliability, essentially,
what you have to think of is that you're pushing blood
through all this tube system that is your vascular system,
and if the tubes are rigid,
when the heart pumps, there's a lot of resistance,
it's like the equivalent of if you were trying to blow
into a really long straw, you'd be like, hmm,
it would be very hard to blow
through the straw because the opening is so narrow,
you're getting a ton of resistance
because the air can't expand very fast.
Now, if you were to blow into a small opening that then
opened up wide, like you were to blow into a funnel,
you would be able to blow much easier, and this is where
vascular pliability comes in, 'cause essentially
what it does is the vascular tissue can stretch,
so as the heart pumps, there's a give, there's an expansion
to the vascular tissue there that decreases the resistance
that the heart has to overcome, and then that pressure,
almost kind of moves like a wave through the vascular
tissue, like it'll stretch, and then it'll kind of move,
kind of like, looking like when a snake swallow something
and there's that glob going through it,
but like much faster and more fluid, if you will.
The more pliable your vascular tissue, basically,
the easier the job is on your heart,
so that's why things like, you know,
omega-3s and stuff like that can be very valuable
from a cardiovascular health standpoint,
because they affect the playability of the vascular tissue
whereas inflammation and clot, or not clotting,
but like fibrinogen buildup, plaque buildup,
that stuff increases the rigidity of the vascular system
which forces blood pressure to go up,
and harden up and your heart to work harder,
so we want maintain vascular pliability and a lot of that
is gonna be from managing nutrition and stress, okay?
The density of the vascular tissue
and the penetration we already talked about,
but those are things that we can improve with training.
We can increase red blood cell count
through certain types of training,
so the more metabolic or aerobic type training you do,
you will increase your red blood cell count, and then
increase local buffering and systemic proton and CO2
clearance, which then obviously, decreases the burden
on the cardiovascular and cardio-respiratory system.
Nutritional supported adaptations.
We can also get increased red blood cell quality
or quantity, but quality is the thing
that we get from better nutrition.
So we can't train ourselves into higher quality
red blood cells, but we can nutritionally support
higher quality red blood cells,
because not all red blood cells are equal,
you'll have bigger ones, smaller ones,
some with like properly made hemoglobin,
some with the Hb that's missing things or whatnot,
and so, basically, you have a red blood cell,
that's not as efficient at storing oxygen and whatnot.
We can get increased local buffering and systemic proton
and CO2 clearance by providing ourselves all
of the substrates that we need to metabolize those.
We can get increased vascular pliability as well through
through proper nutrition like omega-3s.
Increased vascular density and depth, from a nutritional
perspective, that's mainly gonna come from drugs,
which really isn't the focus here,
but a lot of things like growth hormone and IGF
even androgens will promote vascular hypertrophy
if you will, as well, so you can get those adaptations
through pharmaceuticals as well.
So, now that you kind of understand how that works
and we know all this stuff going together,
what can we assess?
To start with the most obvious,
is that we can do blood work, right?
If we're measuring, you know, blood,
why not just actually do blood work?
And so, with blood work, the main things that
we're looking at is the RBC quantity and quality.
My suggestion with this is because when you're looking
at RBC quantity and quality, a lot of the basic blood work
is an oversimplification, doesn't give you the whole story,
and is likely not to give you so useful information.
For instance, one of the things that you're looking for is,
one of the things you're looking at in terms of red blood
cell quality is the size of the red blood cells, okay?
Red blood cells that are too big
get stuck and can't go deep into the capillaries,
so they create obstruction issues,
and what can actually happen, under high blood pressure
situations like when you're training
or high impact things like running,
is that you can actually shred those red blood cells,
'cause literally, they're trying to get down a tube
that's too narrow, you created enough pressure,
and you just literally shred the red blood cells,
so red blood cells that are too big can be a problem.
But red blood cells that are too small are also a problem,
because they essentially can go places
where they're not supposed to go,
and that can create issues as well,
also, they have a poor surface area.
So we want red blood cells that have the right size,
we wanna have a high average of our blood cells
or a high amount of them to be an average size
that is beneficial for to getting deep into the capillaries,
but also having enough surface area to be efficient.
Now, with a simple test, what they're gonna do
is they're just gonna look at the average,
and you could have several nutritional deficiencies
going on, whether that be an iron issue,
a B-vitamin issue or whatever it is,
a stress or an inflammatory thing going on,
and so what you could have is you could have
some big blood cells and some small blood cells,
but the average is gonna make it seem
like everything is fine, the average size is fine,
because you have basically problems in both directions.
That's where having a comprehensive report that actually
looks at what's the variation in those blood cells,
that's where asking the doctor to look into that,
you will get a better idea and they will also have
a better idea of how they could improve
this person's quality of their red blood cells.
Quantity is not that hard figure out, but quantity,
does quantity matter that much if quality is poor?
That's why I suggest that if you are looking, especially,
for somebody that's got a cardiac condition or they seem
to just have very poor cardio-respiratory performance is
if you're gonna get blood work done, definitely,
refer out to a doctor and request they do a comprehensive
panel looking at the variability in red blood cell,
size as well, as that can be a great indicator as well,
they can also look deeper into, instead of just
measuring just ferritin, you know, they can look at some
of the things there to know whether or not you are actually
getting quality hemoglobin within those red blood cells.
When in doubt, general nutrition support
is a safe start, multi minerals, omegas,
obviously, you should be putting people on enough protein,
I mean, that's the limiting factor there,
so if we're at least giving those co-factors,
that's a good thing.
What we don't know is if we're fighting a bunch
of inflammation or whatnot, that may be, you know,
making it harder to get quality red blood cells
despite giving those things, and again, that's for then,
getting them to the doc and looking at the CRP
and stuff like that, might be beneficial.
All right, blood pressure.
This is something that you don't need to go to the doc,
you can get your clients to have a blood pressure cuff
at home, you can have one in the office, et cetera.
Refer to the doc if it's out of range,
but what you wanna do, especially, with blood pressure,
is you wanna have, essentially,
whether you do it as prints, email, whatever,
you wanna have resources and strategies,
if I have a client and their blood pressure is high,
what are the options that we have from a lifestyle
perspective, from a training and a nutrition perspective,
that we can do with this, so that if they are out of range
and you send them to a doc, you can say,
"Hey, go to the doc, get your blood pressure
checked there as well.
And if it's high, or whatever,
they're gonna have their recommendations,
but what you should as a client is you should
be able to make an informed decision or at least
be able to have an informed discussion with your doc
on whether or not you want to give some
of these interventions a try before you go on drugs,
or whether or not your plan is like,
they're gonna put you on a drug that you're like,
okay, but I'm also going to do all these other things,
and my goal is to get off the drugs."
Because blood pressure drugs, while they may be necessary,
are definitely not ideal, neither are cholesterol drugs,
most pharmaceuticals are not ideal long-term.
For people with body composition goals, right?
If they're on like a beta antagonist,
that's going to affect your ability to mobilize fuel
and lose body fat, is not necessarily a good combination.
The other thing is blood pressure drugs
make it harder to assess exercise, to assess,
basically, everything to do with heart rate,
as soon as you start throwing these medications in there,
now, we really can't use a lot of the data.
When we're looking at
whether or not somebody should go on medication,
that's a conversation between them and the doc,
but you should probably have resources available
so that if a client does have high blood pressure,
they at least know what their options are,
you know, you can't tell them to go against their doc,
but what you can do is try and give them
as much of the full picture as possible
in terms of all their options, obviously,
if you have somebody that's not gonna commit
to the lifestyle and nutritional changes,
they're probably better off going on blood pressure drugs,
as sad as that is.
All right, next, we have heart rate,
and there's a bunch of these,
so I'm going to take a drink.
Ah.
Okay, so we're looking at heart rate.
We have different ways that we can look at heart rate,
we can look at morning heart rate, resting heart rate,
max heart rate, heart rate recovery,
heart rate to exertion ratio,
lot of different things that we can use.
Morning heart rate is a great way to be consistent
and kind of like get something that's like,
okay, is this going up or down?
But if people are using, you know, watches,
apps, finger thingies, whatever it may be,
they might have things where it's like, okay,
you can get a resting heart rate,
but you have to qualify what a resting heart rate is
so that you can compare it.
Like, does that mean like sitting
and nasal breathing for five minutes?
What qualifies resting when you measure that heart rate
and how long do you have to be in that state
before you can get a consistent measure?
So morning heart rates are always gonna be
the most consistent, the most accurate,
and it's gonna be the least affected by other variables,
because hopefully if you just woke up in the morning,
you're relatively in a consistent mental state
and physical state every morning.
It's not like one morning you just finishing,
you know, a very stressful meeting
and another morning that you're not,
you will get that issue with resting heart rate,
nutritional stuff is not gonna impact that, you know,
last consumption of caffeine, carbohydrates, you know,
how long it's been since your last meal, et cetera,
are not likely to be the factors
when we're measuring morning heart rate.
What will impact morning heart rate is sleep,
but likely, in those cases, morning heart rate and sleep
are gonna be telling you the same message,
so they're not conflicting.
If you are gonna do one of these morning heart rate,
I would say would be the first one that you would go with,
'cause you get, you know, usually the most usable
and the most consistent data.
Max heart rate can also be something good,
especially, if one of your goals is to improve aerobic
or cardiovascular cardio-respiratory performance.
So as somebody gradually pushes intensity, you should see
that they are able to achieve higher intensities
without the heart rate going up at all,
also you might want to know that they're actually
able to improve their max heart rate over time.
Heart rate recovery, I would argue, is one of the most
important ones in terms of us tracking recovery,
which makes sense, heart rate recovery is a better marker
for recovery, If we just go by the linguistics of it,
but essentially, that's a good measure
of the system as a whole, because you can,
like getting to a max heart rate just means
that at the cardiac level you've improved,
but if your heart rate recovery is improving,
that means the system is a whole must be getting better.
Now, it could be that just one aspect is getting better,
but at least it tells you that whatever the limiter is
is getting better because in this case,
if heart rate is coming back down that means that
we have sufficiently delivered the oxygen and gotten rid
of the metabolites at the areas that we needed,
and so the actual, like, the stimulus
for the higher heart rate is going away.
So the job is done, right?
We have completed the hobbit's journey,
if the heart rate recovery is going down,
so that's the best way of kind of assessing
that we have made it all the way back,
we've throwing the ring into the fire and now it's safe,
basically, heart rate recovery is the best measure for that,
And what you need to do with that is you need
some sort of consistency, but you're looking at,
in our sense, we would be looking at heart rate recovery
after similar exertion whether that be, you know,
squat for the same number of reps or a certain interval.
Obviously, if you're doing aerobic activity
that's gonna be the easiest place to track this,
you have somebody do X amount of RPMs
at extra resistance on a bike, or you know,
X speed at X incline on a treadmill, whatever you wanna do,
X watts, depending on the tool that you have,
but then what you want to do is figure out, okay,
how fast does the heart rate come down after that, right?
And what may happen over time is that for the same level
of activity the heart rate doesn't go up as much,
so then, you change the activity to a higher intensity
to get the heart rate back up to similar or higher,
and then, you start tracking the recovery from that point.
And then heart rate to exertion ratio, so this is,
essentially, looking at exactly what it sounds like,
it's that, okay, based off of where the heart rate is,
how fatiguing do they find that activity?
So basically, if somebody doesn't feel like they're working
that hard, but their heart rate is really high,
that likely means that their cardiovascular
cardio-respiratory system is pretty inefficient, right?
But if their heart rate is really low,
and they're working really hard, that could mean
their cardiovascular system is very efficient
or it could also mean that their local tissues
are very inefficient.
You need to take both sides into account
when you're using the heart rate to exertion,
'cause they could be locally de-conditioned
or they could be cardiovascular de-conditioned
and you you could get different stories there,
and they could suck at both,
which could give you a balanced ratio, right?
So you have to know both sides of that equation
if you're gonna use that assessment.
HRV.
So HRV got really popular, and then,
it kind of became less popular, and I think that's because
people thought HRV was just gonna be this magical tool
that just like answered all of the questions in training
on what to do, and that was not the case.
It's not that HRV is an impractical tool,
but it's not really a direct aerobic fitness marker,
more so it gives you an idea
of kind of how the general stress is impacting your ANS.
So the more stress you're under, essentially,
basically the more inhibition we get of the vagal tone
which is gonna give us less variability in the heart rate.
When we're looking at HRV, all it does is like,
if HRV is trending in the wrong direction,
is essentially just gonna say,
hey, you should look and see why,
but it doesn't tell you why.
And it doesn't even tell you if it's a significant amount,
per se, depending on the activities, 'cause when it comes
to resistance-based training, the accuracy of HRV trends,
in terms of training performance,
pretty much the research has kind of said,
yeah, it doesn't seem to correlate very well,
but mostly for aerobic activity.
Now, the thing is that they're looking just at performance
and we often know that recovery,
we lose the ability to recover
before we lose the ability to perform.
I wouldn't throw HRV out just because you're focused
more on resistance-based training,
I would use HRV kind of like, you know,
it's like an under script alarm that like,
hey, we're kind of getting to that point,
we might still have, you know, a few more good sessions
or whatever in it, but likely, we're not losing performance,
but we could be losing the efficiency
and the amount of adaptations that we're getting
because recovery is starting to go down.
So I'd use HRV as that alarm of,
hey, I should check and make sure everything
looks like it's gonna be recovering well,
or what I could possibly do to bring that up,
or if I need to make some acute changes
to the program, deload, et cetera,
kind of give you a little bit of an early warning
on that stuff with resistance training.
Obviously, the more you're focused on metabolic training
and the more aerobically demanding, the higher correlation
you're gonna get with HRV versus the further away,
like if you're doing a neuro program,
your HRV may correlate to performance really poorly,
but it might correlate much better
on the metabolic side of the continuum.
All right, the next one is respiratory muscles,
so how can we assess those?
We have range of motion testing, practical testing,
muscle testing, you can get a spirometer
or use a respiratory training device,
basically, those are things that you can blow in
like a spirometer, it's basically to measure how much air
you can exhale and like how fast, et cetera,
whereas respiratory training devices,
some of them can measure, but they also can give you
resistance to inhaling and exhaling.
So you can literally exercise, you know, breathing,
you can add resistance to the inhaling and exhaling
and then you can also use like, you know, a PO2, or a Moxy,
a Moxy is gonna measure the local oxygenation
whereas PO2 is gonna measure your blood oxygen.
When we're looking at, when I say blood I will say like,
it's measuring it at the vascular level rather than
the muscle level or the capillary level, I should say,
Moxy at the capillary level
and the PO2 measure at a venous level.
Now, if you're gonna use those devices,
remember, that like if you're just training
the respiratory pattern that you have,
but you have an issue with some of those muscles,
you might just be training the compensatory pattern
and getting better at the compensatory pattern.
So I would use a spirometer or a respiratory training device
in addition to also making sure I'm doing some trunk work.
Now let's just pause for a second
and go through respiratory muscles, what are the major ones.
The diaphragm, obviously, that's the big one,
hard to attach a dumbbell or a pulley
or leg curl to the diaphragm.
So that's the one where, if I was using like a respiratory
training device, that would be getting the most direct
training, 'cause I'm literally doing that,
but the diaphragm works in concert with the abdominals,
with basically, that everything from pecs, lats to traps,
all the things that attach to the rib cage, you know,
are gonna have somewhat of an impact,
but the big players are gonna be your abdominal muscles
and like the muscles on the back of your rib cage,
so your serratus posteriors, your erectors,
things like that, like all of your trunk extensors.
In order of importance, I would say, diaphragm,
then your abdominals, starting with TVA,
then probably the obliques, and lastly, the rectus.
And then, I would say then probably you're moving
into the posterior, 'cause basically, you get the most
motion out of the diaphragm, in terms of breathing,
and then the most restriction of that motion
would be the abdominals and obliques,
and then the thing that would affect the smaller,
more minute motions after that would then
be the muscles on the posterior rib cage.
This is where actually doing like actual trunk
extension and rotation and stuff may actually be valuable,
this is not so much from a physique standpoint,
maybe like doing these little exercises isn't gonna be
the thing that takes your deadlift to the next level,
it may, it may be very important for that,
but it may be really good to actually just go through
some of these positions and work range of motion
through the trunk to make sure that you're keeping
all of those respiratory muscles healthy
from a neurological perspective
so that they have good range of motion.
Obviously, you can load them directly,
but you probably don't need to do like a bunch
of little froufrou exercises, loading them all directly,
from the strengthening standpoint, you need to do
a light exposure from a range of motion standpoint,
and then, you know, they're gonna get loaded
in the other exercises where you're stabilizing
and breathing, et cetera.
Last one, I believe, on what you can assess here,
is airway restriction.
So that's, you know, congestion,
whether somebody is nasal breathing,
what their nasal breathing activity threshold is,
their nighttime PO2, can be a way of looking at,
doing a sleep study for sleep apnea,
lots of ways that we can look at airway restriction.
You know, some people may have a deviated septum
you don't know, but congestion, there's a lot of things
that may be can affect congestion, right?
It could be allergies, it could be food, even stress,
and just like things that are just gonna affect
the immune system general can affect digestion,
not digestion, congestion, right?
Nasal breathing activity threshold,
that's basically the level of activity you can do
and still be able to breathe through your nose,
and that's gonna be a combination
of how open your nasal passages are
and how well your respiratory muscles work,
so basically, the better your respiratory muscles,
the greater pressure change they can create
which means that you can suck more air
through a smaller hole and push more air out
through a smaller hole because you have that
greater change of volume in the lung cavity.
If those muscles are either short range of motion
or lacking in strength and you're also congested,
you're gonna wanna breathe through your mouth
because that's not only gonna make it easier
to get the air in and out,
it's gonna decrease the workload on those muscles, and so,
you're gonna start breathing out of your mouth earlier
if you have a poor nasal breathing activity threshold.
I mean, for some people that might be,
literally, at rest, they breathe through their mouth.
Me, if I'm congested, man, I go to mouth breathing
really, really fast, so the big thing for me
in terms of maintaining proper ANS function,
a lot of times, just managing congestion, so that I can be
nasal breathing at a higher activity threshold,
and that has more to do than me sitting here
and maybe like, hmm, meditating or whatever,
it's like, yeah, it doesn't matter,
because I can't breathe through my nose very well,
and so, that's the main driver.
Nighttime PO2 can give you an idea of,
basically, how well you're breathing at night,
and if you have issues with that then maybe,
then you need to look at managing congestion,
and possibly if you can't improve it,
then we need to go to a sleep study for sleep apnea.
One thing I wanna say here is, you know,
a lot of people may rush to get under the knife,
do not underestimate the impact of postural muscles,
congestion and body fat on things like sleep apnea.
A lot of times people are gonna go,
they're gonna get a CPAP or they're gonna get a surgery
or something like that, and it could be like, actually,
if you cleaned up your diet, dropped some weight,
you know, maybe we did a Neti pot thing for awhile,
I mean, there's actually research that has shown that like
people get improved nasal breathing and stuff
through consistent use of something like a Neti pot,
just make sure you use it properly,
don't give yourself amoebas in your brain that kill you,
that sort of thing, make sure you use distilled water
to be safe, boil it first, and clean that thing,
don't reuse the Neti pot night after night,
I mean, sticking it up your nose, recycling buggers,
that's not the way to go.
But those things, used consistently,
may help you from having to sleep like Darth Vader
or have your nose cut in half.
With anything, make sure you've exhausted all your options
before you start going under the knife.
All right.
(air swooshing)