Welcome to the Barbell Medicine Quick-Start Guide. Whether you’re here for the first time or a long time reader, thanks for joining us. We’re hopeful that this resource will be useful for you and we’re pumped that you’re here and ready to make some changes to your training and nutrition!
First, what is Barbell Medicine?
Barbell Medicine is comprised of:
- Jordan Feigenbaum, MD, MS
- Austin Baraki,MD
- Leah Lutz
- Alan Thrall
- Vanessa Burman, RD
- Jessica Griffith RN
- Tom Campitelli
- Michael Ray, DC
- Derek Miles, DPT
- Charlie Dickson, DPTc
- Alex Kovaleski, PTA
- Hassan Mansour
- Mark Stanwyck
The company was formed officially in 2012 with the goal to combine modern medicine with strength and conditioning, though many of us have been coaching and involved in our respective professions for much longer than that. The main idea is to get more people training, modifying their nutrition, and engaging in other healthy lifestyle habits correctly in order to prevent, treat, or decrease the burden disease.
We’re focused on putting out high-quality information that is trustworthy, useful, and actionable so that we can help others. While the Internet is certainly full of information on diet, training, and lifestyle modification, the accuracy of such information is often lacking and subsequently, we need to separate the wheat from the chaff. This page serves as our main resource for how to get started, frequently asked questions, and resources for you to leverage on your wellness journey.
If you’re new to the fitness world and/or have never trained with barbells before, but are looking to get started today, navigate to our Beginner Prescription by clicking on the hyperlink. For other topics, use the Directory below to navigate the page. If at any time you want to return to the top of the page, click the box in the lower right hand corner and you’ll be directed back up here.
“Where do I start with exercise to improve my health?”
This is the question you’re likely to ask or respond to from someone who is not currently exercising and we’d like to equip you with some information.
First off, what is health? Our current accepted definition of health is: “the ability to adapt and self-manage in the face of social, physical, and emotional challenges” (Huber 2011). This definition emphasizes the importance of self-efficacy, defined as an individual’s belief in their own “capabilities to execute a course of action” or to achieve a goal (McAuley 2011). Promoting health in a way that comports with this definition requires attention to various biological, psychological / emotional, and social / environmental factors that can influence our health and well-being (Engel 1977). One of the most potent interventions available that can improve health through all three of these mechanisms is physical activity.
The 2018 Physical Activity Guidelines for Americans recommend 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.
 *Aerobic physical activities of different intensities can be combined in order to meet activity targets.
⤈ Intensity levels are 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. Moderate-intensity activities are defined as 3-5.9 METs, e.g. walking at 3 miles per hour (3.3 METs) , heavy gardening (4 METs) , or cycling at 10 miles per hour (4 METs) Vigorous-intensity activity is defined as 6 METs or greater, e.g. strenuous hiking (6 METs), running at 6 miles per hour (10 METs), or aerobic calisthenics (6-10 METs).
Despite the strong recommendation that all adults engage in resistance training, there appears to be a significant bias against regular participation in resistance training. The 2017 National Health Interview Survey data show that while 53.1% of adults age 18 and over met aerobic physical activity guidelines, only 23.5% guidelines for both aerobic and muscle-strengthening activities (CDC 2017 [pdf])
Resistance training encompasses lifting weights of all types- even body weight exercises like squats, push-ups, pull-ups, etc. and there are many benefits with this type of exercise. However, there is significant overlap with other types of exercise, e.g. cardio, pilates, yoga, and we should be clear about the benefits that resistance training over these other forms.
Here are some of the things resistance training does better than any other form of exercise:
- Improves strength
- Builds lean body mass
- Increases bone density
Strength is the display of the force production by muscles in a specific context, e.g. when you’re lifting a weight from the floor like in a deadlift for a set amount of repetitions or lifting groceries- you do so by creating muscular force against the external resistance- in this case the barbell or the grocery bag.
When we train with weights in a progressively overloaded manner by gradually adding repetitions, load, or otherwise increasing the amount of stress applied to the body, we adapt by improving our muscles’ ability to produce force in the specific exercises we are doing. This increased force production can be applied or transferred to other tasks.
For example say we have a 65 year old female who has trouble putting the dishes in the cupboard overhead and we teach her how to press overhead with a barbell and progressively improve her strength through training, she will be able to perform this task much easier. This process can be translated in many scenarios.
With respect to increase lean body mass- specifically skeletal muscle and bone mass- resistance training has no equal. When the muscle’s ability to repeatedly produce force is challenged via exercise, it responds through a series of both neurological and structural adaptations that male it better at producing force.
Balance for example, involves neurological and muscular processes that allow a person to be aware of their body’s positioning relative to their surrounding environment (neurological) and respond to any change in this relationship via muscular force to prevent a fall or loss of balance. When we train with weights that require balance be maintained, e.g. free weights, we can improve this ability. Other neurological adaptations that occur include increased voluntary contraction strength (how much force your body can willingly create), decreased antagonistic muscle co-contraction (how much force opposing muscles/muscle groups create during a movement), improved motor patterning, and more.
On the other hand, muscles respond to resistance training by increasing their size or cross sectional area (CSA) by a process called muscular hypertrophy. Increases in muscle fiber size produces an increase in the size of the muscle as a whole, which ultimately increases the amount of force a muscle or muscle group can produce.
Additionally, there are many other benefits to resistance training on cognitive, cardiorespiratory, metabolic, psychological, and performance that make it indispensable as far as one’s overall exercise plan. As mentioned above, the 2018 Physical Activity Guidelines for Americans recommend at least twice weekly resistance training for all adults and we agree with this. We would prefer three weekly resistance training sessions if we had our druthers, but two times per week can be a good starting point as well.
Day 1 QuickStart
The QuickStart guide is for folks who have never formally trained with a barbell before, e.g. they’ve never been on a strength training program with an explicitly planned progression at regular intervals. For most, if you’re not sure that you’ve formally trained with a barbell before, you probably are exactly who we’re talking to. Additionally, if you “used to workout a long time ago”, but there’s been many months or years since that time, you’re also who we’re talking to. On the other hand, if you’re a person who has engaged in regular barbell training for a significant period of time then you might not be in our QuickStart demographic. If that’s the case, click here and read a little more to see where you stand. Everyone else, head on over to The Beginner Prescription, download the PDF (or browse the web-based article), and get started. Some additional instructions are included below.
First, what do you need gym-wise to start training with barbells today? All you really need is a membership to a gym where there are barbells, squat racks, weights that slide on the barbell, and a bench for bench pressing. Alternatively, If you want to start resistance training using exclusively machines, dumbbells, or other non-barbell implements, we’d recommend picking up our Beginner Template, which allows users to select their own exercises.
That said, the free version of The Beginner Template (called The Beginner Prescription) we have provided “pre-programmed” defaults that assume the individual is primarily interested in training with barbells. However, for those with equipment limitations or other preferences, these movements can be swapped out for their “analogs” using machines or other forms of progressive resistance.
Not sure what a barbell, squat rack, weights, or a bench look like? Click the hyperlinks here ( barbell, rack, or weights) for some examples. If a gym doesn’t have these items we’d advise forgoing the cash outlay to join a gym that doesn’t have these staples. Most commercial gyms- even the $20.00/month ones- have these equipment. Not all equipment looks the same, particularly in commercial gyms, so we should allow for some variation.
Second, should you be screened by a medical professional prior to initiating training? As a medical professional, I am obliged to say that this article is meant for general informational purposes and should not be taken as medical advice. However, The American College of Sports Medicine (ACSM)- one of the large associations who provides clinical guidelines on these sorts of topics, tells us the folks who need to be screened are those who either exercise currently, but who have symptomatic cardiac, metabolic, or renal disease OR those who do not exercise currently and also have cardiac, metabolic, or renal disease regardless of if it’s symptomatic or not. See here for their published guidelines. Additionally, the ACSM actually recommends that all adults engage in resistance training at least twice per week.
Tl;dr: If you are over the age of 18 without known cardiac, metabolic, or renal disease- you are likely okay to begin exercise without clearance from your doctor. If you do not know if you have cardiac, metabolic, or renal disease OR upon starting exercise you have symptoms like chest pain, dizziness, blurred vision, profound shortness of breath, or other issues- you should stop exercising and see your doctor.
Now that you’ve made it this far, we’re going to start training TODAY. Scroll down to Week 1 on The Beginner Prescription to see what your three training days are going to look like.
We’re going to be using the squat, press, bench press, and deadlift as our staple exercises on The Beginner Prescription. The beauty of this beginner program is that it: increases technical proficiency with the selected exercises, improves proficiency with the use of Ratings of Perceived Exertion [RPE] across a variety of repetition ranges, and increases work & recovery capacity to improve tolerance for training. It is designed specifically for people who have not been regularly engaging in strength training, e.g. Beginners. It is NOT a powerlifting program.
A brief aside, Powerlifting is a barbell sport where a competitor receives three attempts at maximal weight on three lifts: the squat, bench press, and deadlift to produce his/her best total. There are weight classes and the person with the highest total is the winner of that weight class. While Novice Linear Progression does use powerlifting movements, it is designed to increase strength in a more general manner rather than always maximizing the weight on the bar. For this reason, the techniques we (Barbell Medicine) advocate for in a novice population may differ than what is seen on the platform from an elite level powerlifter. The latter may use a much wider stance in the squat or deadlift to decrease range of motion, for instance, but we don’t necessarily want that. It should also be said that competitive powerlifters are not novices, by definition, as there is enough participation within the sport that only people with a significant history of formal barbell training (e.g. not novices) are actually competitive.
- Gear: Stretchy gym shorts or pants*, weightlifting shoes**, socks, cotton t-shirt.
- *Gym shorts that go below the knee or pants that are not stretchy can interfere with squatting mechanics due to the material of the short becoming taught somewhere around parallel (but not always below). Stretchy fabric eliminates this risk.
- **Weightlifting shoes are great to have and we’d recommend buying them. See my review below and this article on their utility. However, if you don’t have weightlifting shoes right away that’s fine- just go to the gym and train in what you have. A flat, minimally cushioned shoe would work better than a running shoe, but really it’s fine. Don’t train barefoot, as there is no improvement in muscular force being produced in the foot (or elsewhere), your arches collapse, your feet are subject to injury, and there are other people at the gym who may not care to deal with your bare feet.
- Go: Go to gym. Pay membership if you have to. Do not use one of their trainers. Repeat. Do NOT use one of their trainers. I have been to hundreds of gyms all over the world and there is currently only a handful of trainers who work at commercial gyms who are worth their fee. If you’re not in St. Louis, Missouri seeing Cody Miller SSC then our advice stands. Seek out squat rack. It is just fine from a gym etiquette perspective to ask someone who is using the rack (if there isn’t a free one) how many more sets they have. You may even be able to “work-in” with them.
- Set: Set the bar across the “pins” (the things that hold the bar in the rack) such that the barbell is mid-sternum. If it is too high, you’ll have to tip toe the bar out of the rack. This is bad. If it is too low, you’ll have to finagle yourself under the bar in an uncomfortable manner, which is also bad. If you’re working out with a friend who is shorter than you- they get to choose where the bar is in the rack.
- Warm Up: We’re going to do sets of 5 repetitions with the empty barbell with the technique shown below. We’ve included some trouble shooting points as needed:
- It is okay if you’re above parallel the first few sets. This will likely improve as you warm up. You do not need to foam roll, stretch, or do other non-squat things to warm up for the squat. The best way to warm up for the squat is to…squat. It increases temperature of the muscles making them work better and helps you practice your form for the work you’re about to do. Do 3-5 sets of 4 with the empty bar.
- If you’re having problems with your grip, try this squat-specific stretch. If that doesn’t work, you can high bar squat for the time being and things will be just fine.
- If you cannot get below parallel by the 3rd to 5th set of 4 repetitions with the empty barbell, you may have to modify the squat. If there is a lighter bar available, e.g. a 15-25lb “training bar”- try that. If you don’t have one of those, but do have access to a leg press (or want to use a leg press anyway) use that instead. Use the same stance described in the squat video above and lowering the sled by bending (flexing) your knees and hips until your hip joint is below the imaginary vertical line running from the top of your knee down to the floor.
- Squat: After the empty bar warm ups described above, add a little weight to the bar (10-20lbs) and do a set of 4 repetitions. Rest 2-3 minutes then add a little more weight to the bar. Repeat this process until one of the following happens- the bar speed slows down slightly , your technique breaks down slightly, or you’ve rated the weight “RPE 6”, e.g. you feel like you could’ve only down four more repetitions.
- If the bar speed slows down during your set of 4 reps noticeably (compared to the empty bar sets or your early warm ups), we’ll call that your first “work set”, or RPE 6.
- Rest 3-4 minutes and add ~5% more weight (e.g. if you squatted 50kg x 4 repetitions, add 2.5kg) and perform another set of 4 repetitions. Rate the RPE here.
- If it feels like RPE 7 (e.g. you think you could perform only 3 more repetitions), add ~5% more weight (e.g. if you squatted 50kg x 4 repetitions, add 2.5kg) and perform another set of 4 repetitions after resting 3-4 minutes. Rate the RPE here again.
- If it feels like RPE 8, congratulations, you’ve just finished the first exercise of the day. Annotate the weight used (including the barbell, which usually weighs 20kg or 45lbs) in your an app on your smartphone that lets you write stuff down and save it or write it down in a journal. Out of convention, if you squatted 50kg for 4 reps @ RPE 6, 52.5kg for 4 reps @ RPE 7, and 55kg for 4 reps @ RPE 8, you’d write that as follows:
- 50 x 4 x 1 @ RPE 6
- 52.5 x 4 x 1 @ RPE 7
- 55 x 4 x 1 @ RPE 8
Repeat the above process for the rest of the exercises from The Beginner Prescription using the designated repetitions, sets, and RPE ratings. Below are some additional instructional exercise videos from Dr. Feigenbaum and Barbell Medicine coach, Alan Thrall:
Of note, the standard diameter of a weight plate is 450mm or 17.72″. This places it 225mm or 8.86″ off the ground with a standard weight plate. In commercial gyms, it is common for only the 45lb or 20kg plates to be this size whereas the other plates are smaller. If you did not squat > 135lbs or 60kg for your work sets, then it is likely you’ll need to start with a lighter weight than 135lbs on the deadlift to warm up. In this scenario, we will need to space the bar correctly off the floor using mats, plates, or other gym materials such that the center of the barbell is 225mm/8.86″ off the ground (or close to it). In other words, don’t use very small plates and deadlift from the ground. It will be very difficult if not impossible to do this correctly.
- Are there any additional resources you recommend to help understand this better?
- Do I need to do cardio or other activity?
- Yes! The current guidelines make recommendations about minimum aerobic activity, e.g. 150-300 minutes per week of moderate intensity aerobic activity or 75-150 minutes of vigorous intensity aerobic activity.
- Additionally, those who have cardiometabolic disease, e.g. heart disease, high cholesterol, high blood pressure, diabetes, a waist circumference >40″ (male) or 34,5″ (female), or other obesity-related disease processes will likely benefit from more physical activity rather than less, as there is a dose-response relationship between exercise volume (how much you’re exercising) and health outcomes (e.g. blood pressure-lowering effect). In other words, the more active individuals are, the better exercise works at making individuals healthier.
- That said, getting started is a great start towards improving your health and we’ll help you work up to your target physical activity over time. In The Beginner Prescription, we recommend starting with one 25-minute session per week of steady state cardio with a pace that is only somewhat challenging, i.e. you can talk, but not sing. We also recommend aiming for 5000 steps per day as a baseline unless you’re already walking more than that, in which case we’d happily add an additional 500 steps to your daily average.
- We discuss this more extensively on our podcast here.
- I’m old. Should I do this program?
- Yes! The Beginner Prescription is appropriate for all adults, including elderly individuals.
- What should I eat?
- How should I measure my waist?
- What kind of grip should I take on the deadlift?
- What should I do if I have pain in ____?
- More coming soon!
- Coming soon!
- BMI Calculator
- Is BMI Important?
- Yes, though it should be accompanied by a waist circumference to further clarify the risk for of obesity-related disease processes. See the video for more information.
Supplied by BMI Calculator USA
- Is there anyone who shouldn’t start training right away?
Have you ever done a review on weightlifting shoes?
- Sure have!
- Nike Romaleos III: These shoes are, for me, probably the best compromise of all the features I look for in a shoe that I’ve highlighted below. They have a millimeter over the standard 3/4″ effective heel height, a metatarsal strap that is the appropriate length and correct location to be functional, a deep heel cup, and a toe box that doesn’t feel like a piece of concrete. I think that if you liked the Adipowers, you’ll love the Romaleos III’s as the heel cup, upper, and tongue are slight upgrades. If you have a wide foot, e.g. greater than a D width, the toe box may be a bit narrow, but for everyone else these would be my recommendation unless you like a taller heel (Leistung 2) or a stiffer shoe carcass (Reebok Legacy). The price point at 200.00 is in line with other top-end shoes and they are widely available. I also like that they ship with high quality laces and competition insoles so you can see which fit and feel is best suited for you.
- Adidas Power Perfect 2: This may be my favorite shoe of all time and if Adidas had updated the colorway it probably would’ve won top honors. Again, for wide feet this probably isn’t the shoe to get because of the narrow toe box, but for everyone else the sizing is dead on. The shoe is made of high quality leather, the heel cup is deep and there is no heel slip, and the metatarsal strap- while a bit long if you like the crank the shoes down- is in the perfect spot. The crepe sole also allows for easy modification and shimming if you need to do so for a leg length discrepancy. Best thing about these shoes, however, is the price point at about 120.00. There’s not a better shoe on the market for this price in my opinion. C’mon Adidas, update the colorway!
- Tie (Adidas Leistung 2) and the Reebok Legacy. A tie? What?!? I know, how could this happen and especially with two very different shoes? Well, I really liked the Leistung 2’s for it’s innovation and fit, but the heel height of about an inch was a deal breaker for me. Conversely, the Reebok Legacy had the right heel height, great fit, breatheable heel cup, and the metatarsal straps were well position and innovative too with no velcro where the laces would lie, but the shoe is very stiff and heavy. It is similar to the Nike Romaleos I and II’s, but with a modern toe box that isn’t quite as “numb”. I honestly think the BOA system for the metatarsal strap on the Adidas shoe is the best innovation I’ve seen on a lifter in quite some time and, additionally, the material that the shoe carcass is made out of is top notch. I just wish it didn’t have a 1″ heel. The Reeboks ended up being a bit too stiff for my liking, but that is my preference and if you loved the Romaleos I and II’s, you’ll love the Legacys more because the metatarsal straps and toe box are improvements in my opinion. The Reebok probably gets the nod for wider foot lifters too.
- Adidas Adipowers: I have actually had 3 colorways of these shoes- the original (and controversial) London edition shoes in 2012, the black and red shoes in early 2013, and the all-white storm trooper colored lifters in mid 2013. These shoes are great for the folks with a wider foot. The heel and heel cup is solid, the shoes are light, and the toe box is flexibleallowing the lifter to feel significantly more than the Nike Romaleos I and II’s. Ultimately, I didn’t like the metatarsal strap’s positioning and length (and velcro) as much on these shoes compared to the Reebok, Romaleos III, or Leistung II, but since these are the older editions they are available for a pretty steep discount at multiple locations. I would recommend them for folks on the fence about getting a pair of quality shoes who don’t want to spend the 200 dollars for the latest and greatest.
- Nike Romaleos I and II: Back prior to the 2008 Beijing Olympics, Nike released their first iteration of the Romaleos. At the time, their biggest competition were the Adidas Adistars and the shoes couldn’t have been more different. The main defining features of these Nikes were that they were very stiff, the metatarsal straps were a little too long, and they were hot. Not alot changed between the first and second edition besides them losing a little bit of weight and getting some different color ways. They are a great shoe nonetheless and given that they are discounted because they are the “old” models now, I think these are a great entry level shoe for folks who’d rather wear a swoosh than 3 stripes.
- Rogue by Do Win: These were my first pair of shoes back in 2008 and they were definitely old school being made from suede. They were very wide, heavy, and low on the technology front- but this just goes to show you how far shoes have come for lifting since CrossFit and the subsequent barbell training explosion. I don’t think these guys are even being made anymore, but I don’t like shoes like this as a rule because they smell, they stretch, and there are better options at the same price point.
- No Bull Lifter: The most expensive shoe on our list at 300 dollars retail is the No Bull lifter. Vaunted as being made via a meticulous, craftsman-like process, these shoes are actually made in China- likely with a master craftsman nonetheless. Unfortunately, the shoes have some shortcomings that I think can be fixed going forward with some design modifications. To begin, the heel cup is nearly non existent and the heels do move around quite a bit. The laces are more suited for dress shoes than athletic endeavours and will not get the shoe tight enough so that the foot doesn’t slide around in it. The metatarsal strap is about 1/2″ too far back from where it needs to be to support the lifter’s arch and, additionally, the material of the shoe carcass is quite flexible so that the shoe tends to be quite flexible. The stacked leather heel and crepe sole is a nice feature, paying homage to the old Safe squat shoes, but the boot of the shoe itself is not suited for lifting just yet. I think they can improve on the product, however, and am interested to see what they come up with for round 2
- Who should I follow on social media for more quality content?