Barbell Medicine - From Bench to Bedside

Barbell Medicine values the development of a well-rounded athlete and healthy individual, so while we have a clear focus on strength training, we aim to offer programming that provides a wide base of physical development. To that end, we aim to improve a number of physical characteristics including cardiorespiratory fitness, muscular endurance, muscular hypertrophy, and work capacity, e.g. the ability to tolerate a greater workload. For lifters, these types of fitness adaptations are relatively non-specific to sports performance and thus, fall under the umbrella of General Physical Preparedness (GPP).

In contrast to SPP, or special physical preparedness, is designed with the sole purpose of increasing the development of sport-specific abilities, GPP functions to lay the “groundwork” for future athletic development. These sessions give our lifters the opportunity to work in their weekly conditioning/aerobic training as well as some generalized accessory exercises. Typically, this accessory training is used to target muscle groups that would benefit from more volume outside of regular training or sport-specific practice. It’s common for our lifters to do two or more GPP sessions weekly, including anywhere from two to four conditioning bouts per week. If this sounds like a lot of activity, consider the physical activity guidelines for Americans — and remember these are minimum considerations and additional benefits occur with more physical activity. Piercy 2018

Additionally, since GPP training intentionally focuses on fitness adaptations that are not directly developed through routine training, we would aim to include a  higher variety of rep ranges and rep/set protocols than a lifter is used to. While competition and assistance exercise choices are restricted by definition, the options for GPP exercises are vast. For example, the conditioning component of GPP training can run the gamut from a steady-pace session on an assault/echo bike or rower to hard sprint intervals or aerobic tempo work. 

Whatever it looks like, GPP should take into consideration the “gaps” in physical development left unfilled by your sport training. In the likely event that your program is focused on improvements in the a barbell sport like PL, WL, or Strongman, dedicating some time to aerobic development and direct upper back, trunk, and arm work can help shore up those areas that are typically trained indirectly in routine training, e.g., in the competitive movements/events and their close variations.  Most of these movements and events stress large amounts of muscle, of course, but applying additional doses of targeted stress to reinforce other aspects of development (e.g. aerobic capacity) can make for a more well-rounded training routine. 

For this reason, our GPP days commonly target the trunk, upper back, and arms (biceps and triceps). They can also include rehab-focused training (i.e., Copenhagen planks or lateral lunges to apply stress to the adductors, or Nordic hamstring and leg curls with an eccentric focus for runners or those returning from a hamstring injury). We usually program GPP on its own, though it can be performed on the same day as a main training session or split up following several training sessions throughout the week. For example, if on your first GPP Day you have programmed cardio, upper back, and abs, and you decide to schedule cardio following Training Day 1, upper back following Training Day 2, and abs following Training Day 3 of the week, you can do this. (This is typically done to reserve another full rest day, though we recommend you are active every day, including rest days.)

In a strength-focused program, the main barbell lifts and their variants make up the bulk of your training week. That said, GPP is neither optional nor superfluous — though it is less specific and therefore often less-defined in our programming compared to main training sessions. That GPP prescriptions are more general is befitting of GPP work, that is, general training elements aimed at improving your overall fitness and body composition.

Conditioning: Low Intensity Steady State and High Intensity Interval Training.

Conditioning, often synonymous with cardio, can be broadly categorized based on its relative intensity, which can be approximated by heart rate, percent VO2max, RPE, pace, etc. Let’s consider a conditioning intensity spectrum with one end being low intensity steady state (LISS) and the other end being high intensity interval training (HIIT). Improvement in your cardiorespiratory fitness/aerobic endurance seems to improve multiple health conditions (see Where should my priorities be to improve my health)  and improve athletic performance through a greater work capacity, training tolerance and the aerobic performance itself. 

In general, the less muscular force required to sustain an effort, e.g. slower pace or less resistance, the more aerobic the activity is, which moves the conditioning towards the LISS end. Practically speaking, most conditioning efforts at or slightly less than either RPE 6-7 (breathing rate is increased, but can still speak in full sentences) or 70% of a person’s max heart rate* are aerobic. 

*The max heart rate formula 220-age= Max Heart Rate was created in the 70’s by Dr. William Haskell who reviewed 10 studies on individuals with and without heart disease to approximate this formula. It is widely regarded to not be very accurate for exercise applications.

Conversely, higher muscular force requirements favor more anaerobic activity like sprinting, hard cycling, using the prowler, kettlebell swings, and resistance training are representative of HIITHIIT is sometimes touted as a superior tool for weight loss,  this is still an active area of research. In general, it looks like both strategies result in similar levels of weight loss/weight control with neither being a clearly superior. Keating, 2017 As far as if HIIT or LISS is better for a particular application, that would depend on the following considerations:

  • What conditioning background does the person have?
  • Why do they need conditioning? 
  • What resources, e.g. time and equipment, do they have available to them?
  • What is the training goal?
  • What is their injury history? 
  • What are their conditioning preferences?

While we use both conditioning types in our coaching and templates (in alignment with the Physical Activity Guidelines) to improve cardiorespiratory work capacity, recovery rate, sporting requirements, metabolic parameters, and weight management, there are times where we favor HIIT over LISS and vice versa. 

For example, if a person has no prior conditioning history and is already lifting weights (very anaerobic) we tend to first include LISS for cardio, e.g. cycling, rowing, etc. for a certain duration of time. This aerobic capacity is an important physical characteristic to develop from both a health and performance standpoint that may not be achieved by resistance training alone. Furthermore, improvements in anaerobic function may actually worsen aerobic development without concomitant aerobic training, i.e. HIIT tends to be less effective from a conditioning standpoint without a base of aerobic development. Wilson, 2012

In persons already doing some LISS in their training; and/or who have a good aerobic base; and/or who are extremely limited on time; and/or who prefer HIIT to LISS so much they are unlikely to comply with LISS recommendations, we will recommend using HIIT. If the primary purpose in conditioning is general health improvement (not sport development), then the modality is fairly unimportant. Choose intensities and modalities that increase the individual’s buy-in and adherence to regular conditioning. 

 

Low Intensity Steady State (LISS)

We typically prescribed LISS in a fashion that allows a trainee to complete a significant portion of the recommended minutes of physical activity each week.  

The 2018 Physical Activity Guidelines for Amerincans include the following targets:

  • 150 to 300 minutes per week of moderate-intensity aerobic physical activity, OR;
  • 75 to 150 minutes per week of vigorous-intensity aerobic physical activity, AND;
  • Resistance training of moderate or greater intensity involving all major muscle groups on 2 or more days per week.
  • Note that the moderate and vigorous aerobic activity can be combined in various ways to meet these guidelines. 

Intensity levels, or the rate of energy expenditure required to perform any physical activity, can be described in the units Metabolic equivalent of Task, or MET. 1 MET is the rate of energy expenditure at rest, whereas a 4 MET activity expends 4 times the energy used by the body at rest. Met-minutes are measured by multiplying the duration (minutes) by the METs equivalent to determine the Met-minutes. The current physical guidelines recommend 500-1000 METS per week. Note that METs are expressed here for an average adult male. One limit of charting intensity is that this does not account for highly varied fitness levels or significant variations in body weight. When comparing an individual with COPD and a marathon runner, they will not have the same intensity levels during a brisk walk. The chart and references here aim to provide a reference for establishing your target intensity for various cardiovascular activities. Knowing the exact METS for an activity is not as important as understanding the targets and establishing greater precision in your aerobic output and measurements. 

Based on this, LISS is done at approximately 3-5.9 METs, and can be things like walking, cycling, rowing, swimming, or sled pulling. A session of brisk walking (5 METS) done for 30 min equals 150 MET-minutes.  Progress in LISS can be made by completing greater distances or using heavier resistance, or burning more calories, in a set time, using a similar cardiovascular RPE rating (see above).  It’s often more helpful to think about the intensity of your LISS in terms of RPE 6-7 or at an exertion level that allows you to speak in short sentences, but not sing.

Quite simply your LISS sessions should start with a reasonable duration and intensity for YOU, with progression in time and intensity.  This can be LISS starting at 20 min, at a pace that you can sustain but during which you can only speak in short sentences. Every 3-4 weeks you can add 5 minutes to this time, working up to 30 minutes LISS sessions, and then working to increase the intensity in your sessions. An interval-type approach can be also used if that is preferred, e.g. completing the programmed LISS in 5 to 10 minute chunks throughout the day.  The modality can be repeated or varied: brisk walking, jogging, rowing, cycling, cardio machines at the gym, sled pulling, and so on.  

High Intensity Interval Training

When selecting a modality for HIIT, we use the following criteria:

  • Low risk
  • Low skill requirement (unless sports specific-e.g. strongman and tire flipping)
  • Allow for 20-30s of high intensity cardiorespiratory work 
  • Low residual fatigue that negatively influences desired training outcomes

With these in mind we can assess if running, kettlebells, rowers, farmer’s carries, barbell complexes, and biking are all equally interchangeable. Let’s compare:

  • Running is certainly possible at high intensities (sprinting and uphill runs) and can be relatively low risk in adults with a history of running development and requires minimal equipment. However, the skill requirement for efficient, low risk sprinting is certainly higher than other modalities (at high intensity) like rowing and cycling and the residual fatigue on resistance training can be quite high in non-runners.
  • Kettlebells and farmer’s walks are similar in that they do require high amounts of force production and thus, are very anaerobic. They also can be sports specific for kettlebell athletes, CrossFit athletes, and for farmer’s walks- Strongman competitors. That said, they both require extra equipment, have the potential to produce large amounts of fatigue (grip fatigue) that may affect other training negatively. Finally, the cardiorespiratory requirements for both of these modalities are significantly lower than lower skilled activities like running, pulling a sled, or cycling.
  • Barbell complexes or intervals might seem appealing for HIIT/anaerobic work, however with these choices a lifter will often reach local muscular fatigue prior to achieving and sustaining for multiple intervals at a high cardiorespiratory output. 
  • Cycling and rowing are both relatively low skill, elicit a relatively large cardiorespiratory response with low residual muscle fatigue, and are very low risk. Rowing may produce a slightly higher fatigue given its grip and low back requirements, however.

As indicated in the comparisons above, we tend to prefer using cycling and rowing for general conditioning improvement, as these are generally low risk, low skill, allow for high stimulation of the cardiorespiratory system over muscular fatigue, and have low residual fatigue. Note that we avoid being completely black and white about these options however, as there are situations where other conditioning modalities are the most reasonable choice for a particular trainee, in a particular situation.  

We do expect some decrease in performance towards the end of  each interval and the last few intervals of a workout. Current research suggests that humans can really only sprint at 100% for about 7 seconds before some slowing occurs, even Usain Bolt, so don’t be too hard on yourself if you find yourself slowing down toward the end of a sprinting bout. Furthermore, we are using these HIIT recommendations in a general population (not sports specific) who are weight training, so the rest intervals aren’t being expanded to 5, 10, or 20 times the work interval in order to select for highly anaerobic development in a sprinter or similar.

We typically prescribe HIIT in rounds of work to rest intervals, with the number of intervals manipulated up or down for the desired training effect. A reasonable starting point for most is  5-7 intervals of 20-30 seconds of an all-out sprint, immediately followed by 1:30-1:40 seconds of complete rest. You can add an additional set every 3-4 weeks, if you would like, but we suggest that 15 rounds is likely a reasonable top end, with consistent focus on the improvement of your sprinting during the 20-30 second intervals. Adding rounds is just one way to progress, so be looking for progress in distance, recovery, split time, and speed.

Upper Back Work

There can be misplaced emphasis on certain upper-back movements in the exercise sphere — weighted pull-ups must be optimally trained, right? One rowing variation must be better than another. 

We’re not going to be too dogmatic on this, but there are some principles to understand when making your choices. When considering upper back hypertrophy, higher volume is important. It is unlikely you can do as much volume with a similar amount of intensity (for motor unit recruitment) without generating unwanted fatigue. This makes something like lat pulldowns a better choice for hypertrophy compared to pull ups/chins (especially weighted). 

For strength, if we agree that strength is force production measured in a specific manner then chin-ups/pull-ups improve strength for chin-ups and pull-ups, but probably not much barbell related outside of the novice (since everything works for them). In the context of a person wanting to get stronger as measured by barbell lifts, barbell rows would be a better choice, given it’s slightly closer specificity to the deadlift, though we’d recommend more deadlifting in most cases for more deadlift gains. 

You’re not training for a competition in DB rows. If you’re motivated by using the same movement and seeing the improvement in something like total reps completed (at the same weight over multiple sessions) or weight added with reps being maintained, or by the total pull ups completed in a set time, then by all means, keep that consistency and stay motivated.  If you enjoy that little bit of variation, freedom to decide in that session what you’ll do, or simply look forward to doing something new or varied, then switch it up-do chin ups and pull ups one week, and rows the next. Remember that we’re thinking about a life-time of training, not just one block here, so don’t get hung up on maximizing your pull up gains if that also bores you out of your mind, makes you want to skip it, or aggravates your elbow. A few weeks of change is going to be just fine. Think about how many pull ups you can accumulate over your life if you actually stick with training and don’t burn yourself out.

Exercise Selection

Some of our favorite upper back movements are:

  • Chins up (supinated grip)
  • Pull ups ( done in any and all grip variations)
  • Inverted rows 
  • Ring rows
  • Barbell rows
  • Dumbbell rows
  • Lever rows
  • Cable rows
  • Chest supported rows 
  • T-bar rows

Again, all of these options serve a purpose in your upper back hypertrophy and strength training, and some may play a small role in your barbell strength development. We caution over-emphasizing any one GPP movements direct training effect on the barbell lifts however. 

Sets/Reps

This can be prescribed in a set time with an AMRAP of sets/reps (like AMRAP in 7 min, completing sub-maximal sets with brief rests) or it can be a defined number of sets and reps (like 3-5 sets of 12-15 reps at RPE 7-8).  

The goal here is not to work on the heaviest weighted pull ups. This isn’t being programmed for pull up specificity, but for upper back development. Lighter weights, sub-maximal sets, and higher reps can be useful in this case. 

Torso/Trunk Work

Exercise Selection

Generally, we like isometric abdominal exercises, or those exercises in which the muscle contracts statically (this is because the muscles function this way to hold the trunk stiff during barbell exercises), but dynamic movements and working different planes of movement are beneficial as well. Most barbell athletes tend to miss out on frontal plane and rotational movements in sports practice, so the ab slot on GPP days can be a good time to work some in.Heavy squats, presses, and deadlifts are effective at strengthening the trunk musculature Comfort, 2011, but applying supplemental direct abdominal work is low-hanging fruit given the minimal time and recovery investments,, e.g. a prone bridge nets us similar activation of the abdominal musculature as a 6RM squat with substantially less fatigue. Tillaar, 2018 There is no need for a hardline stance on abdominal  training, as is common in different corners of the exercise world. Just go ahead and train your abs, directly and with consideration, like you do everything else.

Here are some of our go-to ab exercises:

  • Plank/prone bridge (standard or side variations on forearms or hands)
  • Ab wheel roll-out (starting on knees or standing)
  • Tuck hold
  • Hollow rocks 
  • V-sit or L-sit
  • V-ups (bodyweight or with barbell, or alternating side v-ups to include a rotational component)
  • Leg or knee raises
  • Sit-ups (or variation on glute ham raise machine)
  • Russian twists
  • Bus drivers
  • Windshield wipers (legs bent for beginners, or extended)

We recommend choosing 1-2 exercises per week and rotating the exercises every three to five weeks. Give yourself time to develop proficiency in an exercise before you move on. If your L-sits are lagging, work on nailing your tuck holds (on parallettes) first, then move on to L-sits; these sorts of exercise transitions can be an effective method of setting up some progression in your ab training. You don’t need to do ab wheel rollouts or planks year-round, nor do you need to periodize your weighted sit-up training.

Sets/Reps

We typically program AMRAPs or something like “10 minutes of trunk work” and let the lifter choose their own adventure. Having some freedom of choice has been shown to help adherence to training, which is a huge part of effective GPP long-term. 

For rep-based efforts, aim for RPE 6-7 or above for each set. 

For isometric efforts, the idea is to get within 30 seconds from failure for each set, resting about 20-30 seconds between sets in your AMRAP. You should aim to increase the time spent performing the exercise within the allotted time frame from week to week.

Exercise circuits of three exercises or more is not our preferred method, but it is a decent option nevertheless, if your focus is muscular endurance. In this case, pick several exercises to rotate through (say, 3-4 exercises in different planes), keep the reps high and the rest minimal. This is also a useful method for coaches to use in a team sport practice or class setting, where managing larger groups or keeping buy-in high is paramount.

Arms

In the context of GPP, we train the biceps and triceps for general strength and hypertrophy. The purpose of arm work during GPP sessions is to apply some additional volume and stress to the arms. Given that competition and supplemental exercises take higher priority, and that we are likely performing a high volume of bench presses, overhead presses, and rows in routine training, it doesn’t make sense for most trainees to use a ton of recovery resources by turning the arm work  of GPP into a bodybuilding-style arm session. 

Arm work usually consists of direct or isolation training for the biceps and triceps musculature. The biceps brachii, composed of a short head and long head, are a bi-articular muscle group, meaning they cross two joints, in this case, the elbow and the shoulder. The biceps act to flex the elbows, supinate the hand, and contribute, a little, to shoulder flexion. 

Although they are worked indirectly during various pulling movements (rows, chin ups, and pull ups, for example), applying additional direct training stress to these muscles is a good option for those wanting to strengthen them for performance, rehab, or aesthetic purposes.

The triceps brachii are composed of three parts: the long head, the lateral head, and the medial head. All three heads work to extend the elbow, but each has a different pattern of producing force at different degrees of shoulder elevation. We likely need a variety of exercises to target the triceps effectively, including some overhead work, as the medial head is preferentially activated at 90 degrees and above of shoulder flexion.

Exercise Selection

Exercise selection for GPP purposes can be informed by a few criteria. These are not rigid rules, but are nonetheless useful: the exercises (A) should directly target the muscle groups we intend to train, e.g., biceps and triceps brachii; (B) should have a relatively large range of motion including both a concentric and eccentric phase; and (C) should not be especially fatiguing when performed at higher volumes. 

Some of our standard choices that also tend to be fairly accessible options for most trainees:

Biceps

  • Standard barbell curls
  • Dumbbell curls of all varieties 
    • alternating DB curls
    • preacher curls
    • hammer curls, etc

Triceps

  • Cable press downs with various attachments (rope, straight bar, or V bar)
  • Lying triceps extensions with an EZ curl bar or a single dumbbell palmed in both hands
  • Overhead triceps extensions (with dumbbells, EZ curl bar, or a straight bar)
  • JM press, a hybrid of the skull crusher and close-grip bench press

Direct biceps and triceps training does not need to be more complicated than this, but variety can help break up the monotony and is warranted when a specific training stress needs to be applied (e.g., preacher curls at tempo for someone rehabbing biceps tendinopathy). Using various machines or cables for curls are also good options if you have access to this equipment. Using an axle or “fat bar” for curls, various grippers (e.g., Captains of Crush), wrist rollers, etc., can also be useful, especially for those interested in strongman competition, as various events in the sport can challenge the elbow flexors and grip. This isn’t the sort of highly specific grip work you’d do to hang on to a 1RM deadlift or to rock climb, but GPP is not designed to be specific in this way. Remember, we’re aiming to increase our breadth of movement here, not fall back on what we do in routine training.

Sets/Reps 

We usually prescribe either multiple sets (3–6 sets) of 10–20 reps @ RPE 7–9, or an AMRAP-style prescription. Higher-rep protocols at high RPEs are an effective and time-efficient way to work on arm hypertrophy. While multiple sets of 10–20 reps @ RPE 7+ would be highly fatiguing for most trainees in the context of larger/compound lifts, for isolation-type arm exercises this does not generate the same caliber of central or even peripheral fatigue. With an AMRAP protocol, we usually ask the trainee to limit all sets within the AMRAP to RPE 6–7 tops, so as to allow the accrual of multiple high-rep sets without acute muscular fatigue becoming the limiting factor for volume during the AMRAP. Arm work can usually be completed using “supersets”, where the exercises are performed back-to-back with little to no rest in between. This is an excellent time-saving strategy when you are in a pinch and needing to get GPP out of the way.

 Example Arm Work

Exercise Prescription: 10-min arm work AMRAP (superset 1 biceps and 1 triceps exercise, performing As Many Reps As Possible in 10 min). 

Here, the individual decides on dumbbell curls and a cable triceps press downs with a rope as the biceps and triceps exercises, respectively. The lifter sets a 10-minute timer and begins the AMRAP:

  • Alternating dumbbell curls: 20 lb DB x 15 reps (each arm) @ RPE 6
  • Triceps press downs w/ rope: 60 lbs x 20 reps @ RPE 6
    •  30 seconds rest 
  • Alternating dumbbell curls: 25 lb DB x 15 reps (each arm) @ RPE 7
  • Triceps press downs w/ rope: 80 lbs x 15 reps @ RPE 7
    • 30 seconds rest 

The lifter will stick with the heavier set of weights for the remainder of the AMRAP, although the number of reps may drop as the AMRAP proceeds. Repeat until the 10 minutes are up.

Relative to the rest of your programming, GPP is less specific and puts you in the driver’s seat when it comes to exercise selection. This is why it is important to understand what GPP is, why we program it, and how it functions in the context of your overall training. You can shape this general form of exercise to suit your needs and your preferences. For many lifters, keeping up with GPP is half the battle. Try your best to tailor the exercises and modalities to suit your goals and preferences and choose the work that you enjoy. Adherence here is the name of the game — so do your GPP, and make it something to look forward to!

About Leah Lutz

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About Hassan Mansour

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