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In this episode of The Barbell Medicine Podcast, Drs. Baraki and Feigenbaum discuss a mystery case of 38-year-old woman who experiences chest pain during a Zumba workout.
Case: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-018-1696-x
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In this episode of The Barbell Medicine Podcast, Drs. Baraki and Feigenbaum discuss two recent research papers. The first one examines the optimal level of calorie restriction for improving cholesterol levels in the setting of exercise. The second study focuses on risk factors for running-related injuries.
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Papers:
https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2025.1510949/full
https://onlinelibrary.wiley.com/doi/10.1111/sms.70004
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In this "mystery case" episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through a real medical case of a 21-year-old male who presents to the emergency department with a 5-day history of fever, headaches, and a 1-day history of an itchy rash. The rash started on his face and spread to his chest, back, and thighs, sparing his palms and soles. He also reported nausea, vomiting, and diarrhea. He's been taking a weight loss supplement and his fever persists to greater than 104* F. What's the diagnosis?
References:
Case: https://pubmed.ncbi.nlm.nih.gov/25367505/ Dinitrophenol and obesity: an early twentieth-century regulatory dilemmaThe Return of Rainbow Diet Pills2,4-Dinitrophenol (DNP): A Weight Loss Agent with Significant Acute Toxicity and Risk of DeathUnited States v. BachynskyResources Page: https://www.barbellmedicine.com/resources/
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In the 10th episode of the "Great Debates in Fitness and Health" series, hosts Dr. Jordan Feigenbaum and Dr. Austin Baraki debate controversial fitness and health topics including dietary supplements, alcohol, sumo deadlifts, muscle mass gain, PEDs, and more.
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In this podcast, Drs. Baraki and Feigenbaum review a mystery case where the patient presented with 3 days of progressively worsening left hip pain. He had a similar episode about a year ago that required surgery. Dr. Baraki walks through a differential diagnosis, considering potential causes like infection, crystal-induced arthritis, bleeding disorders, and avascular necrosis. Further testing revealed a bloody joint effusion with high white blood cell count, and an MRI showed synovial proliferation with frond-like projections. What's the diagnosis?
Case: https://journals.lww.com/acsm-csmr/fulltext/2023/09000/pigmented_villonodular_synovitis_recurrence.3.aspx
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In this podcast, Drs. Baraki and Feigenbaum discuss training during weight loss. While increased exercise can support health, dietary restriction is the primary method for weight loss. They note that strength, muscle mass, and endurance can be maintained during modest calorie deficits, with studies showing significant gains even in large deficits in trained individuals. It was also noted that the size of the energy deficit matters, with small deficits having minimal effects and larger, sustained deficits being detrimental. Practical recommendations include meeting physical activity guidelines, maintaining protein intake of 1.6 g/kg/day, and a moderate calorie deficit of 250-500 calories per day.
Case: https://pmc.ncbi.nlm.nih.gov/articles/PMC4885268/
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In this podcast, Drs. Miles and Feigenbaum review a mystery case where thee patient presented with severe bilateral leg pain after attempting a 620 lb squat. We discuss anabolic steroid use, knee pathology, rehab strategies, and more.
Case: https://pmc.ncbi.nlm.nih.gov/articles/PMC4885268/
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In this podcast, Drs. Baraki and Feigenbaum review a misleading social media post from Comp Train regarding VO2 max, a new study on using heart rate variability (HRV) to guide resistance training programming in older women, and another study correlating American Heart Association's "Life's Essential 8" metrics with testosterone levels and risk of low muscle mass.
Papers:
https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2024.1472702/full
https://ajcn.nutrition.org/article/S0002-9165(24)01421-7/fulltext
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Alan Thrall joins Dr. Jordan Feigenbaum on this episode of the Barbell Medicine podcast. Alan, a gym owner and strongman competitor, shares his life update, including his children's activities and gym involvement. They delve into the benefits and risks of strongman training, favorite and least favorite gym equipment, incorporating strongman elements into commercial gym routines, and more.
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Dr. Jordan Feigenbaum and Dr. Austin Baraki discuss the challenges and benefits of unilateral exercises like Bulgarian split squats, refute Dr. Gabriel Lyon's claim that obesity is due to insufficient muscle mass, and more!
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The podcast discusses what happens when people stop exercising, how much exercise is necessary, and how to program exercise with limited time.
Recommendations for training on limited time:
Resistance training: 3-5 sets per muscle group per week of compound exercises at >65% 1RM for strength. Add isolation exercises if desired. Conditioning: 150 mins/week moderate or 75 mins/week vigorous intensity. Split up however you want. Be careful about doing too much sprint/max intensity work. Gradually build up if desired.Strategies for efficient programming include: Modifying warm-ups to be more time-efficient (short rest, less reps, bigger jumps)Using supersets of antagonist muscle groups or unrelated movements Employing "every two- or three- minute on the minute" protocols. e.g. E2MOM or E3MOM: 5 @ 8, then 65% x 5 e2mom x 3 sets or > RPE 8 Use time caps on sessions, e.g. 20-minutes for movement 1 or work up to 1-rep @ RPE 8 in 8 minutes, then 12 minutes perform maximum sets of 3 to 5 reps with 70% e1RMFlexibility in scheduling is key - focus on getting the total amount of work done over a 1-2 month period rather than worrying about perfect weekly routinesTime Crunch Template (Update coming soon!)
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References:
Detraining Podcast
Wolin 2008Sturm 2019Garcia-Hermoso 2022Benito 2020 Radaelli 2015 Grgic 2018Nolan 2018Chen 2022Gavanda 2020Hortobagyi 1993Halonen 2024Mujika 2001 Smith 2003Encarnacao 2022Staron 1991 Ivey 2000Grgic 2022Piercy 2018Hamer 2017 Khurshid 2023Schoenfeld 2017 Krieger 2009 Perkin 2019 Fyfe 2022Androulakis-Korakis 2021Borde 2015 Lesinski 2016Yang 2018For more of our stuff:
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In this episode, Drs. Feigenbaum and Baraki discuss a complex case of a 60-year-old female with a history of type 2 diabetes, hypertension, high cholesterol, and pulmonary sarcoidosis presenting with exertional shortness of breath. Initial tests showed a heart rate of 50 bpm, prolonged PR interval, and patchy fibrosis in the heart. What's the diagnosis?
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Case:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7383351/
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Dr. Jordan Feigenbaum and Dr. Baraki discuss osteoarthritis (OA), emphasizing its complexity and the importance of a holistic approach. OA affects joints, causing pain, stiffness, and reduced function, with knees being the most commonly affected. Risk factors include age, prior injury, obesity, and inflammation. Diagnosis often relies on clinical history rather than imaging. Treatments include exercise, weight management, and non-pharmacological interventions like knee sleeves. Pharmacological options include topical NSAIDs, oral NSAIDs, and GLP-1 receptor agonists, with a cautious approach to opioids and steroid injections. Surgery may be considered for severe cases, but lifestyle changes and appropriate exercise are crucial for long-term management.
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Resources:
https://www.barbellmedicine.com/blog/the-barbell-medicine-guide-to-osteoarthritis/https://www.barbellmedicine.com/blog/what-do-knee-sleeves-do/https://pain-calculator.com/https://pmc.ncbi.nlm.nih.gov/articles/PMC2730438/https://pubmed.ncbi.nlm.nih.gov/27103611/https://pain-calculator.com/treatment/osteoarthritis-pain/viscosupplementation-publicly-funded-trials/https://www.nephjc.com/news/nsaids-vs-opioidshttps://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standardFor more of our stuff:
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In the November 2024 research review, Drs. Jordan Feigenbaum and Austin Baraki discuss the effects of de-training periods in resistance training and the potential benefits of carbon monoxide supplementation for enhancing altitude training. New research investigated 20 weeks of continuous training vs. two 10-week periods of training separated by a 10-week off period. The results are....not what you might expect! The second study explored the use of carbon monoxide to stimulate red blood cell production and what effects it had regarding VO2 max and power output in elite cyclists. Ethical and monitoring concerns are also discussed.
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https://pubmed.ncbi.nlm.nih.gov/36205802/For more of our stuff:
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In the Barbell Medicine Podcast, Drs. Feigenbaum and Baraki discuss a case of a 21-year-old female presenting with severe throat pain after a gym session involving heavy squats and deadlifts. The patient's symptoms worsened over six hours, and she had no fever or cough. Her physical exam and initial lab results were normal, except for a slightly elevated white count.
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Dr. Jordan Feigenbaum and Dr. Austin Baraki discuss the fundamentals of exercise programming. They outline four major evidence-based goals for programming regarding health: strength, power, hypertrophy, and cardiorespiratory fitness. They introduce the WATER model for programming variables: weight (intensity), amount (volume), type (exercise selection), effort, and regulation (how-to regulate these variables). They stress the importance of matching training stimuli to individual needs and preferences, and the benefits of varying training intensities and modalities for comprehensive fitness development.
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Hypertension Podcasts and Articles:
https://www.youtube.com/watch?v=9IEFJ_90vGEhttps://www.youtube.com/watch?v=JCPAffRLtNohttps://www.youtube.com/watch?v=kI6QwgKLP0MFor more of our stuff:
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Drs. Feigenbaum and Baraki discuss high intensity interval training.
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Drs. Feigenbaum and Baraki discuss high intensity interval training.
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References:
Sabag A, Little JP, Johnson NA. Low-volume high-intensity interval training for cardiometabolic health. J Physiol. 2022;600(5):1013-1026. doi:10.1113/JP281210Creemers, Noortje & Foster, Carl & Porcari, John & Cress, M.L. & de Koning, Jos. (2017). The physiological mechanism behind the talk test. Kinesiology. 49. 3-8. 10.26582/k.49.1.15. MacIntosh BR, Murias JM, Keir DA, Weir JM. What Is Moderate to Vigorous Exercise Intensity?. Front Physiol. 2021;12:682233. Published 2021 Sep 22. doi:10.3389/fphys.2021.682233Seiler, Stephen & Tønnessen, Espen. (2009). Intervals, Thresholds, and Long Slow Distance: the Role of Intensity and Duration in Endurance Training. SPORTSCIENCE · sportsci.org. 13. 32-53.Jamnick NA, Pettitt RW, Granata C, Pyne DB, Bishop DJ. An Examination and Critique of Current Methods to Determine Exercise Intensity. Sports Med. 2020;50(10):1729-1756. doi:10.1007/s40279-020-01322-8Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(16):1227-1234. doi:10.1136/bjsports-2013-092576Coates AM, Joyner MJ, Little JP, Jones AM, Gibala MJ. A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med. 2023;53(Suppl 1):85-96. doi:10.1007/s40279-023-01938-6Laukkanen JA, Isiozor NM, Kunutsor SK. Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants. Mayo Clin Proc. 2022;97(6):1054-1073. doi:10.1016/j.mayocp.2022.02.029MacInnis MJ, Zacharewicz E, Martin BJ, et al. Superior mitochondrial adaptations in human skeletal muscle after interval compared to continuous single-leg cycling matched for total work. J Physiol. 2017;595(9):2955-2968. doi:10.1113/JP272570Mølmen, K.S., Almquist, N.W. & Skattebo, Ø. Effects of Exercise Training on Mitochondrial and Capillary Growth in Human Skeletal Muscle: A Systematic Review and Meta-Regression. Sports Med (2024). https://doi.org/10.1007/s40279-024-02120-2Arboleda-Serna VH, Feito Y, Patiño-Villada FA, Vargas-Romero AV, Arango-Vélez EF. Effects of high-intensity interval training compared to moderate-intensity continuous training on maximal oxygen consumption and blood pressure in healthy men: A randomized controlled trial. Biomedica. 2019;39(3):524-536. Published 2019 Sep 1. doi:10.7705/biomedica.4451Helgerud J, Høydal K, Wang E, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665-671. doi:10.1249/mss.0b013e3180304570Su L, Fu J, Sun S, et al. Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: A meta-analysis. PLoS One. 2019;14(1):e0210644. Published 2019 Jan 28. doi:10.1371/journal.pone.0210644Wen D, Utesch T, Wu J, et al. Effects of different protocols of high intensity interval training for VO2max improvements in adults: A meta-analysis of randomised controlled trials. J Sci Med Sport. 2019;22(8):941-947. doi:10.1016/j.jsams.2019.01.013de Mello MB, Righi NC, Schuch FB, Signori LU, da Silva AMV. Effect of high-intensity interval training protocols on VO2max and HbA1c level in people with type 2 diabetes: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2022;65(5):101586. doi:10.1016/j.rehab.2021.101586Steele J, Plotkin D, Van Every D, et al. Slow and Steady, or Hard and Fast? A Systematic Review and Meta-Analysis of Studies Comparing Body Composition Changes between Interval Training and Moderate Intensity Continuous Training. Sports (Basel). 2021;9(11):155. Published 2021 Nov 18. doi:10.3390/sports9110155Hostrup M, Bangsbo J. Limitations in intense exercise performance of athletes - effect of speed endurance training on ion handling and fatigue development. J Physiol. 2017;595(9):2897-2913. doi:10.1113/JP273218Gibala MJ, MacInnis MJ. Physiological basis of brief, intense interval training to enhance maximal oxygen uptake: a mini-review. Am J Physiol Cell Physiol. 2022;323(5):C1410-C1416. doi:10.1152/ajpcell.00143.2022Metcalfe RS, Babraj JA, Fawkner SG, Vollaard NB. Towards the minimal amount of exercise for improving metabolic health: beneficial effects of reduced-exertion high-intensity interval training. Eur J Appl Physiol. 2012;112(7):2767-2775. doi:10.1007/s00421-011-2254-zGibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012;590(5):1077-1084. doi:10.1113/jphysiol.2011.224725Casado A, Foster C, Bakken M, Tjelta LI. Does Lactate-Guided Threshold Interval Training within a High-Volume Low-Intensity Approach Represent the "Next Step" in the Evolution of Distance Running Training?. Int J Environ Res Public Health. 2023;20(5):3782. Published 2023 Feb 21. doi:10.3390/ijerph20053782Burnley M, Bearden SE, Jones AM. Polarized Training Is Not Optimal for Endurance Athletes. Med Sci Sports Exerc. 2022;54(6):1032-1034. doi:10.1249/MSS.0000000000002869Casado A, González-Mohíno F, González-Ravé JM, Foster C. Training Periodization, Methods, Intensity Distribution, and Volume in Highly Trained and Elite Distance Runners: A Systematic Review. Int J Sports Physiol Perform. 2022;17(6):820-833. doi:10.1123/ijspp.2021-0435Foster C, Casado A, Esteve-Lanao J, Haugen T, Seiler S. Polarized Training Is Optimal for Endurance Athletes. Med Sci Sports Exerc. 2022;54(6):1028-1031. doi:10.1249/MSS.0000000000002871Rønnestad BR, Bakken TA, Thyli V, Hansen J, Ellefsen S, Hammarstrøm D. Increasing Oxygen Uptake in Cross-Country Skiers by Speed Variation in Work Intervals. Int J Sports Physiol Perform. 2022;17(3):384-390. doi:10.1123/ijspp.2021-0226
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Drs. Feigenbaum and Baraki discuss a mysterious case of arm pain after curling that gets MUCH worse.
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Koenig SJ, Toth AP, Martinez S, Fletcher JW, Goldner RD. Traumatic pseudoaneurysm of the brachial artery caused by an osteochondroma, mimicking biceps rupture in a weightlifter: a case report. Am J Sports Med. 2004;32(4):1049-1053. doi:10.1177/0363546503258768
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Dr. Feigenbaum talks about the body roundness index and compares it to BMI.
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https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweightBoutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022 Aug;133:155217. doi: 10.1016/j.metabol.2022.155217. Epub 2022 May 15. PMID: 35584732; PMCID: PMC9107388.Ciemins EL, Joshi V, Cuddeback JK, Kushner RF, Horn DB, Garvey WT. Diagnosing Obesity as a First Step to Weight Loss: An Observational Study. Obesity (Silver Spring). 2020 Dec;28(12):2305-2309. doi: 10.1002/oby.22954. Epub 2020 Oct 7. PMID: 33029901; PMCID: PMC7756722.Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, Nadolsky K, Pessah-Pollack R, Plodkowski R; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocr Pract. 2016 Jul;22 Suppl 3:1-203. doi: 10.4158/EP161365.GL. Epub 2016 May 24. PMID: 27219496.Gruzdeva O, Borodkina D, Uchasova E, Dyleva Y, Barbarash O. Localization of fat depots and cardiovascular risk. Lipids Health Dis. 2018 Sep 15;17(1):218. doi: 10.1186/s12944-018-0856-8. PMID: 30219068; PMCID: PMC6138918.Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, Allison TG, Batsis JA, Sert-Kuniyoshi FH, Lopez-Jimenez F. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond). 2008 Jun;32(6):959-66. doi: 10.1038/ijo.2008.11. Epub 2008 Feb 19. PMID: 18283284; PMCID: PMC2877506.Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. BMC Cardiovasc Disord. 2019 Oct 28;19(1):238. doi: 10.1186/s12872-019-1223-z. PMID: 31660867; PMCID: PMC6819575.Abate N, Garg A, Peshock RM, Stray-Gundersen J, Grundy SM. Relationships of generalized and regional adiposity to insulin sensitivity in men. J Clin Invest. 1995 Jul;96(1):88-98. doi: 10.1172/JCI118083. PMID: 7615840; PMCID: PMC185176.Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res. 2017 Jul 1;113(9):1074-1086. doi: 10.1093/cvr/cvx106. PMID: 28549096Jensen MD. American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129(25 Suppl 2):S102-38. doi: 10.1161/01.cir.0000437739.71477.ee. Epub 2013 Nov 12. Erratum in: Circulation. 2014 Jun 24;129(25 Suppl 2):S139-40. PMID: 24222017; PMCID: PMC5819889.Sommer I, Teufer B, Szelag M, Nussbaumer-Streit B, Titscher V, Klerings I, Gartlehner G. The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis. Sci Rep. 2020 Jul 29;10(1):12699. doi: 10.1038/s41598-020-69498-7. PMID: 32728050.Zhu S, Heshka S, Wang Z, Shen W, Allison DB, Ross R, Heymsfield SB. Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites. Obes Res. 2004 Apr;12(4):633-45. PMID: 15090631.Thomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson CM, Ravussin E, Heymsfield SB. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring). 2013 Nov;21(11):2264-71. doi: 10.1002/oby.20408. Epub 2013 Jun 11. PMID: 23519954; PMCID: PMC3692604.Zhang X, Ma N, Lin Q, et al. Body Roundness Index and All-Cause Mortality Among US Adults. JAMA Netw Open. 2024;7(6):e2415051. doi:10.1001/jamanetworkopen.2024.15051 Zhang X, Ma N, Lin Q, et al. Body Roundness Index and All-Cause Mortality Among US Adults. JAMA Netw Open. 2024;7(6):e2415051.Rico-Martín S, Calderón-García JF, Sánchez-Rey P, Franco-Antonio C, Martínez Alvarez M, Sánchez Muñoz-Torrero JF. Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis. Obes Rev. 2020 Jul;21(7):e13023. doi: 10.1111/obr.13023. Epub 2020 Apr 8. PMID: 32267621.Zhou D, Liu X, Huang Y, Feng Y. A nonlinear association between body roundness index and all-cause mortality and cardiovascular mortality in general population. Public Health Nutr. 2022 Nov;25(11):3008-3015. doi: 10.1017/S1368980022001768. Epub 2022 Aug 19. PMID: 35983642; PMCID: PMC9991644.Cai X, Song S, Hu J, Zhu Q, Yang W, Hong J, Luo Q, Yao X, Li N. Body roundness index improves the predictive value of cardiovascular disease risk in hypertensive patients with obstructive sleep apnea: a cohort study. Clin Exp Hypertens. 2023 Dec 31;45(1):2259132. doi: 10.1080/10641963.2023.2259132. Epub 2023 Oct 8. PMID: 37805984.Wu L, Pu H, Zhang M, Hu H, Wan Q. Non-linear relationship between the body roundness index and incident type 2diabetes in Japan: a secondary retrospective analysis. J Transl Med. 2022 Mar 7;20(1):110. doi: 10.1186/s12967-022-03321-x. PMID: 35255926; PMCID: PMC8900386.Zhang Y, Gao W, Ren R, Liu Y, Li B, Wang A, Tang X, Yan L, Luo Z, Qin G, Chen L, Wan Q, Gao Z, Wang W, Ning G, Mu Y. Body roundness index is related to the low estimated glomerular filtration rate in Chinese population: A cross-sectional study. Front Endocrinol (Lausanne). 2023 Mar 28;14:1148662. doi: 10.3389/fendo.2023.1148662. PMID: 37056676; PMCID: PMC10086436.
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