Long before the advent of barbells, dumbbells, and hi-tech fitness gadgets, there was the medicine ball.

This simple piece of exercise equipment has been around for over 2,000 years. Ancient Greek physicians used weighted animal bladders to rehabilitate injured warriors. Hippocrates — the father of medicine himself — was said to have his patients toss stuffed skins for therapeutic benefit. The term “medicine ball” dates back to the late 19th century, where it gained popularity in American physical culture circles and old-time gymnasiums. Teddy Roosevelt reportedly trained with one. So did turn-of-the-century prizefighters, soldiers, and circus strongmen.

Today, the medicine ball is often an underrated and underutilized implement. If you’re like a lot of gym-goers, you probably see the rack of medicine balls but aren’t entirely sure what to do with them — beyond maybe throwing them against the wall and slamming them on the floor.

But there’s much more you can do with medicine balls than that, and their variety of uses parallels their variety of benefits: medicine balls add resistance without the rigidity of weights and train not just strength, but speed, coordination, balance, and rotational power. They’re an ideal tool for developing explosive strength — a vital yet often overlooked dimension of fitness that not only supports overall health but helps stave off powerpenia, the age-related decline in muscular power that’s key to aging well.

Below, we’ll break down some of the best medicine ball exercises to build power, athleticism, and all-around old-school vigor.

Basic Guidelines

• Choose the right weight. For power and speed-based movements, lighter is better (6–10 lbs). For slams or strength exercises, you can go heavier (12–20+ lbs). The ball should challenge you without slowing you down.
• Choose the right kind of ball for the exercise. Use a softer ball for slams or partner work (a.k.a. wall balls or “D-balls”), and a hard rubber one for bounces and floor drills.
• Maintain form. The goal is explosive, controlled movement — not flailing or jerking.

1. Chest Pass

• Targets: Chest, triceps, shoulders
• How: Stand 3–5 feet from a wall or partner. Hold the ball at chest level and forcefully pass it straight out, like a basketball chest pass.
• Why: Builds upper-body power and coordination. Great warm-up for pressing days.

2. Rotational Throw

• Targets: Core, obliques, hips
• How: Stand sideways to a wall, holding the ball at your hip. Rotate through your torso and throw the ball into the wall as hard as possible. Catch on the rebound or retrieve and repeat.
• Why: Mimics the rotational power used in punching, swinging, or throwing. Builds athleticism.

3. Overhead Slam

• Targets: Lats, core, arms, legs
• How: Raise the ball overhead with arms extended, then slam it down into the ground with everything you’ve got. Squat to retrieve and repeat.
• Why: A total-body power movement that builds explosiveness. A great workout finisher — and stress reliever.

4. Front Squat

• Targets: Quads, glutes, core
• How: Hold the medicine ball at chest height. Squat down, keeping your chest upright and elbows tucked in. Drive back up through the heels.
• Why: Adds load to a bodyweight squat and forces you to brace the core.

5. Russian Twist

• Targets: Obliques, abs
• How: Sit on the floor with knees bent, feet hovering or planted. Hold the ball with both hands and rotate side to side, tapping it to the ground each time.
• Why: Builds rotational core strength and stability. Can be scaled up by adding speed or weight.

6. Wall Ball Shot

• Targets: Quads, glutes, shoulders, cardio
• How: Stand facing a wall with the ball held at chest level. Squat down, then explode up and throw the ball at a target on the wall 8–10 feet high. Catch and repeat.
• Why: Blends strength, power, and cardio. A brutal conditioning tool.

7. Medicine Ball Push-Up

• Targets: Chest, triceps, core
• How: Place one hand on the ball and the other on the ground. Perform a push-up. Switch hands each rep or after a set.
• Why: Increases instability and range of motion, hitting smaller stabilizer muscles.

8. Medicine Ball V-Up

• Targets: Abs, hip flexors
• How: Lie flat, holding the ball overhead. Simultaneously raise your legs and upper body, touching the ball to your feet at the top. Lower under control.
• Why: Demands coordination, flexibility, and core control.

9. Lunge With Twist

• Targets: Legs, core
• How: Holding the ball, step forward into a lunge. At the bottom, rotate your torso (and the ball) away from your front leg. Return to center and step back. Alternate legs.
• Why: Adds balance and core engagement to a classic leg movement.

10. Scoop Toss

• Targets: Glutes, hamstrings, back
• How: Face a wall or partner, hold the ball low, then explode upward and forward, tossing the ball with a scooping motion.
• Why: Mimics the hinge-and-extend pattern of jumping or Olympic lifting. Builds lower-body power.

Incorporating Medicine Ball Exercises Into Your Workout Routine

Medicine ball work makes a great supplement to calisthenics, sprinting, or kettlebell workouts. Or you can do them at the end of a weightlifting workout to build conditioning. If you’re going to use medicine ball work for that purpose, combine movements that supplement your strength workout. For example, if you hit your upper body that day with the weights, select medicine ball exercises that emphasize the upper body, like chest passes and overhead slams. On lower body days, do front squats and lunges with a twist.

You can even do a workout that consists entirely of medicine ball exercises. Here’s one short, intense circuit workout that hits every part of your body in just 20 minutes.

Medicine Ball Circuit Workout

Do 3–5 rounds of the following, resting 1 minute between rounds:

1. Overhead Slams – 10 reps
2. Front Squats – 10 reps
3. Rotational Throws — 10 reps (5 each side)
4. Russian Twists – 20 reps (10 per side)
5. Wall Ball Shots – 15 reps

For an added challenge, finish with a 2-minute max-rep slam test.

The medicine ball is an old-school fitness tool that still carries currency today. Once used by warriors, boxers, and strongmen, it remains a valuable, and honestly fun, training implement for developing explosive strength and vital conditioning.

Illustrations by Ted Slampyak

This article was originally published on The Art of Manliness.

In a story from ancient Greek philosophy, Hercules faces a choice between two paths: one promising pleasure and ease; the other, hardship and struggle — but also growth and greatness. According to today’s guest, this ancient parable is more relevant than ever.

Dr. Paul Taylor, a psychophysiologist and the author of the new book The Hardiness Effect, returns to the show to argue that comfort has become our default mode — and it’s making us mentally and physically sick. To reclaim health and meaning, we must actively choose the path of arete — a life of effort, engagement, and challenge.

Paul first outlines the four traits that define a psychologically hardy person and how we grow by embracing and even relishing discomfort. We then dive into the physiological side of hardiness. We discuss how intentionally seeking stressors can strengthen both body and mind and some of the practices and protocols that lead to optimal health. We end our conversation with what tackling heroic, Herculean labors looks like today.

Resources Related to the Podcast

• Paul’s previous appearance on the AoM podcast: Episode #941 — How to Avoid Death by Comfort
• AoM Podcast #1,087: Why You Need the Good Stress of Socializing
• AoM Podcast #793: The New Science of Metabolism and Weight Loss with Herman Pontzer
• The Choice of Hercules 
• AoM podcast on the benefits of sunlight
• “Don’t Die: Eat More Small Fish” by Michael Easter
• AoM Article: Nature’s Prescription — The 20-5-3 Rule for Spending Time Outdoors
• Norwegian 4X4 HIIT Protocol
• AoM article on Zone 2 Cardio
• Omega-3 testing

Connect With Paul Taylor

• Paul’s website

Listen to the Podcast! (And don’t forget to leave us a review!)

Listen to the episode on a separate page.

Download this episode.

Subscribe to the podcast in the media player of your choice.

Transcript

Brett McKay:

Brett McKay here and welcome to another edition of the Art of Manliness podcast. In a story from ancient Greek philosophy, Hercules faces a choice between two paths, one, promising pleasure and ease, the other hardship and struggle, but also growth and greatness. According to today’s guest, this ancient parable is more relevant than ever. Dr. Paul Taylor, a psychophysiologist and author of the new book, The Hardiness Effect, returns to the show to argue that comfort has become our default mode. It’s making us mentally and physically sick. To reclaim health and meaning, we must actively choose the path of arete a life of effort, engagement, and challenge. 

Paul first outlines the four traits that define a psychologically hearty person and how we grow by embracing and even relishing discomfort. We then dive into the physiological side of hardiness. We discuss how intentionally seeking stressors can strengthen both body and mind and some of the practices and protocols that lead to optimal health. We enter conversation with what tackling heroic Herculean Labors looks like today. After the show is over, check out our show notes at aom.is/hardiness. All right, Paul Taylor, welcome back to the show.

Paul Taylor:

Thanks for having me, Brett. It’s such an honor to be a returning guest on your bloody awesome show.

Brett McKay:

Well, we had you on a few years ago to talk about your book, Death by Comfort. You got a new book out called The Hardiness Effect, and I love that word, hardiness hardy. People need to use that more. And we’re going to talk about what that is exactly. But I want to talk about how you opened up this book and how it frames what you talk about in the book. You start off The Hardiness Effect with one of my favorite myths from antiquity. It’s the choice of Hercules. For those who aren’t familiar with that myth, can you walk us through it and then explain why did you use this myth as the framework for your book?

Paul Taylor:

Yeah, look, it’s one of my favorite stories as well, Brett, and the myth goes back to Socrates who told the story of a young Hercules and in the Greek version he’s Heracles, but we’ll just go with Hercules. So he was the son of the God, Zeus, and he found himself standing at a literal and a moral crossroads, and two goddesses appeared in front of him. One was Kakia who said her name was happiness, but it was actually vice and the other was Arete, which means virtue. Now, Kakia was beautiful and seductive, and she promised Hercules an easy life, one of luxury, one of comfort and pleasure. Without effort, everything he could possibly want would be handed to him. And then on the other hand, on the other road was Arete. She was pretty plain in appearance, but she had a bit of a natural beauty.

And she told him the truth that her path would be hard. It would demand discipline, courage, and effort, but it was the only one that led to true fulfillment. So Hercules, as we probably know, he chose the Arete path and that choice actually defined him. It leads to the famous 12 labors of Hercules. These were impossible challenges that he had to undertake, that forged his character and ultimately led to Zeus deifying and making him a God because he was impressed with this character. Now, this story, it’s not just mythological, it’s also psychological as well. And it actually inspired Zeno who I know you know Brett was the founder of Stoicism. And today, this represents the choice that we all have between a life of comfort and a life of challenge. And I used it to frame the hardiness effect because I believe that we’re living through our own version of that myth right now, only Kakia has had a makeover. She no longer tempts us with this debauchery, but seduces us with a life of comfort and convenience, the life of, we think about it’s climate controlled homes, processed foods that are engineered to hijack our dopamine systems. We have endless digital entertainment that gives us an illusion of connection, but ultimately delivers loneliness. And this modern life of ease, I think leads to a life of disease. Now it’s really comfort creep on a civilization scale. We’ve now medicalized normal emotional experiences. We’ve created effort for ease and created a society with a default discomfort. And the outcome really is fragility. It’s physical, it’s mental, it’s emotional fragility. And we see that in rates of obesity, chronic disease and mental illness reflecting it. So really the story of Hercules at the crossroads became my metaphor for modern human condition. And every day we choose, do we walk Kakia’s path of ease and decay or Arete’s path of discipline, growth and meaning. And really the hardiness effect is an instructional manual for choosing arete. In the modern world, it’s about building the psychological and physiological capacity to take the hard path because that is the one that leads to the good life.

Brett McKay:

At the beginning of the book, you talk about the consequences of our modern day Kakia path that a lot of westerners are living. And you get into the statistics, obesity, diabetes, mental illness has just been creeping up for the past several decades. And you argue that it’s because just our way of life where we can be sedentary and be isolated and not do hard things is what’s contributing to that?

Paul Taylor:

Absolutely, a hundred percent. If you take an animal out of its natural environment, that animal does not do well. And this is what’s happened to us is that we have slowly over time moved into an environment that is not natural for us. We are not meant to be creatures of comfort. It is actually through challenge, physical and mental challenge that we actually become really human. And when we don’t have those challenges, we actually decay. The body just reacts to the environment.

Brett McKay:

Yeah, I mean, we had Herman Posner on the podcast. He studies metabolism.

Paul Taylor:

Yes.

Brett McKay:

Yeah. One of the big takeaways I got from him is that the human body has to move. You have to move for overall health, and if you don’t, you just get fat. What’s interesting, other primates like gorillas and chimpanzees, they can sit around and eat leaves all day and they don’t get fat because they don’t have to move. But for some reason, humans, you have to move in order to stay metabolically healthy. And our environment, our lives no longer compel us to do that anymore.

Paul Taylor:

That’s right. And actually when you look, our biology is so wired from movement. Hernan is absolutely correct. And what we know is that when we don’t move, not only does it affect us physically, but it also affects us mentally and psychologically. Every time you exercise, I like to tell people there is a neuro symphony going on in your brain. There is this orchestra of neurotransmitters. Everybody knows about endorphins, but when you exercise, we also release dopamine. We release serotonin, release noradrenaline, release endocannabinoids, and cafallons in our brain. And these are all positive neurotransmitters that not only help your brain to function well, but are really important for good mental health. And so I always say to people, if you have a life where you’re not moving very much, and especially if you combine that with eating a crappy diet and not sleeping very well, good luck with your mental health because you are swimming upstream massively. We’re just starving our body of what it actually needs to perform normally, nevermind optimally.

Brett McKay:

So we all face this choice to choose Kakia, but the problem we have today is that it’s not so much a choice. Like Kakia is almost like the default and you have to kind of fight against it. And you have to choose arete intentionally. I mean, maybe you can argue 200 years ago you were kind of forced to choose arete because you had to farm and you had to work hard just to live your life. And kakia was sort of like a luxury. Today it’s the opposite. And you have to intentionally choose arete, and you propose that hardiness is the way to choose the path of arete. And what’s interesting, hardiness, it’s a fun word I think of the hardy boys, kind of these vital young men, you’re full of vigor, but there’s actually a psychological concept. How do researchers define hardiness?

Paul Taylor:

Yeah, look, it’s a bit of a close cousin to resilience and often they’re used interchangeably in the research, but they’re actually not the same. Resilience is more of an outcome. It’s about bouncing back, but it doesn’t tell you how to get there, hardiness actually does. So it was first identified by Dr. Suzanne Kobasa and Dr. Salvato Maddi in the 1970s and really explains why some people thrive under stress while other people crumble. So they did this landmark 12 year study at Illinois Bell and Telephone company, and they were going through a corporate crisis. And they found that over these 12 years, about two thirds of the employees fell apart under pressure, but a third of them didn’t just cope, they actually grew stronger. And they found that these group, they shared three core attitudes, a challenge orientation, a control orientation, and a commitment orientation. So let’s look at each one of those.

Challenge orientation and hardiness is about seeing both change and adversity as opportunities for growth rather than threats. Control is the belief that you control or heavily influence your environment or your destiny. And in psychology we call that an internal locus of control, and it’s also about focusing your energy on what you can control or influence rather than feeling like a victim. And then the last is commitment. This is about being fully engaged in life and living with purpose instead of withdrawing or wandering aimlessly. Now these guys started the research, but other researchers like Paul Bartone, he’s a US Army psychologist and he’s great and he’s a bit of a mentor of mine in this area. He really expanded the research and he found that hardiness actually predicted who passed and who feels basic military training, and then found that hardiness predicted who passed special forces selection course.

And it’s then it’s been shown that hardiness predicts career longevity and high pressure careers such as the military, police and first responders. And so if resilience is about bouncing back, hardiness is about bouncing forward. It’s the process that creates resilience. And the benefits are huge as well as predicting success in high pressure environments, high hardiness scores predict better cardiovascular health, stronger immune systems, lower rates of anxiety and depression. And even kids who are higher in hardiness are much more likely to go to university independent of their socioeconomic status, which is pretty critical. And then in my own PhD research, we ran a six week hardiness intervention and we saw measurable improvements, statistically significant in mental wellbeing, in stress tolerance and hardiness as well as measures of cognitive performance. So we showed that you can learn it, it’s not just a trait you were born with, it’s a set of learnable skills. And I’ve added a fourth C that of connection, which I’m sure we’ll unpack a little bit. But really for me, choosing hardiness, like you said, is today’s version of choosing the path of rite. It’s committing to growth through discomfort both psychological and physiological. And the payoff is a life that’s not just longer but also fuller and more engaged and more meaningful.

Brett McKay:

So what you’ve done in the book, you’ve broken down hardiness to two parts. There’s psychological and physiological hardiness, and it seems like those three C’s you laid out the challenge control commitment. And then the fourth one that you’ve added connection. We’ll talk about that here. That makes up psychological hardiness. Correct?

Paul Taylor:

Correct. That’s right, yes.

Brett McKay:

Well, let’s dig deeper into these different components, these four C’s of psychological hardiness you mentioned. The first one is challenge. This is about seeing adversity as a challenge instead of a stressor. How can seeing stress and adversity in your life as a challenge as opposed to something just to upset you, how does that change your psychology and even your physiology?

Paul Taylor:

Yeah, look, it has a massive effect. It changes how we think, how we act, and even how ourselves behave. So at its core challenge orientation, this is about how we appraise stress. It’s the view we take of it. So when something tough happens, whether it’s you’re in a big project given an argument or some sort of a setback, your brain decides almost instantly is this a threat or is this a challenge? And that split second perception actually dictates both your psychological leaning and your physiological response. So if you view it as a threat, you go into avoidance mode. So you’re motivated to leave, to procrastinate, to run away. It’s the flight part of fight or flight. Whereas if you see as a challenge, it’s what we call approach orientation. In psychology, you actually lean in and then physiologically it’s very, very different. When you see as a threat, your body constricts your blood vessels, cortisol rises, your cognitive flexibility drops, and the chemicals that the major stress hormone is cortisol, and I’ll come back to that in a second.

But when you see something as a challenge, your cardiovascular system actually responds like it does during exercise, your blood flows freely, oxygen delivery improves performance and cognition actually rise. And this is the fight part of the fight or flight. Now, the chemicals involved in your body with a challenge orientation, it is about the hormones, adrenaline and no noradrenaline, which in your side of the ditch, they call it epinephrine and norepinephrine. Now the half-life of those chemicals is about a minute, and that means with about four half-lifes, that chemical’s out of your body. So within five minutes, your body is back to homeostasis. So same me and you both have the same situation. You view it as a challenge, your body is back to homeostasis within five minutes. With me, because I’ve released cortisol, the half-life of cortisol is well over an R. So that means that ours later, even when that challenge or threat is gone, my body is still in a stress field. I still have cortisol going through my bloodstream, attacking my organs and my brain. Now this isn’t just theory. There’s research by numerous psychologists that show that our mindset towards stress literally changes our biology. And people with a challenge orientation, they recover faster from stress, they got lower inflammatory markers and they performed better under pressure. And I recently interviewed professor Jeremy Jameson. He ran a series of experiments with college students before an exam, I think, do you call it the GRE Brett?

Brett McKay:

Yeah. To get into grad school.

Paul Taylor:

Yeah, that’s it. The one to get into grad school. And he told half of them that anxiety was a normal thing and it actually prepared their body to action and could translate into better performance. And the other half the control group, he told no such thing. And then they all did a mock exam. And the people who he primed that anxiety, this challenge orientation, they did better in the mock exam, but they also then did better in the real thing as well. So your perception influences your performance as well. And the stoics understood this. 2000 years ago, Seneca said “A gem cannot be polished without friction, nor a man perfected without trials.” And the idea is that the friction is the forge. Hardiness is about leaning into that friction deliberately. That’s the key thing.

Brett McKay:

Yeah, I think that’s a powerful concept to understand if you see your stress in your life, not as a threat, but as a challenge, there’s so many benefits to that. Any tips that you found? Research backed tips on how you can strengthen your challenge muscle? I mean, I think one you talked about is this idea of acceptance and reprisal.

Paul Taylor:

Yeah, yeah, yeah. So this is really key. It goes back to even the historics who talked about life being hard, the Buddha, the first noble truth of Buddhism is life is suffering. Well, the word is actually dca, which means hard to do. So it’s first of all accepting that life is going to be hard. And then it’s about accepting that you are going to come through challenges in your life. And I tell this to my kids, I say to my kids, life is amazing, but it is also going to be hard at times. And it’s about how you react to that. So first of all, it’s just accepting that life is going to be hard, that occasionally you will get shit sandwiches from the universe and that acceptance puts you into a state where you can then reappraise. This. Reappraisal is training your brain to interpret stress as fuel rather than poison.

I call it stress alchemy. When you feel that surge, the heart rate rising, your tension, instead of saying to yourself, I’m anxious, say I’m energized. That’s the key thing. And this is the psychological framing, and it’s basically the Stoics talked about life being a contest. So it’s about getting yourself up for the contest of life and seeing these things as challenges to actually test and develop you. So that’s really key. And that reappraisal of viewing stuff as a challenge rather than a threat. You can do it not just in the moment when you’re dealing with stress, but also you can look back on it and actually taking time for your listeners to think of times in your life that were really hard or stressful. And then looking back now, how did that benefit you? What was the silver lining that came? So you can do this arete appraisal two ways. One is viewing things as challenges, but then secondly, looking back on the hard stuff and going, Hey, what did I learn from that? How did I actually grow from that? And that’s really key.

Brett McKay:

Alright, let’s talk about that second C, which is control. It’s about having an internal locus of control. What can the stoics and Admiral James Stockdale teach about developing an internal locus of control?

Paul Taylor:

I love that. So I have a copy of Epictetus’s Enchiridion, which roughly translates as a manual for life. And the very first line of this is of things, some are up to us and others are not. This is really about the stoic dichotomy of control and it’s one of the most powerful psychological tools ever developed. Marcus Aurelius, he put it beautifully, you have power over your mind, not outside events. Realize this and you will find strength. And this is really what’s at the heart of the control component. When you’re in control orientation, you don’t waste mental energy on things you can’t change, whether it’s the weather, other people’s opinions, the economy or those sorts of things. You focus on what you can do and what you can influence. And that actually reduces our stress. It takes us out of victim mode and gives us some agency, right?

So the stoic said that we must focus on that which we can control and refuse to invest our energy in that which we can’t control. And a lot of people get into trouble psychologically when they’re investing their energy in stuff they can’t control. They’re in their own heads wishing their past to be different, wishing other people to be different, wishing the universe to orientate around them. These are all things that we can’t control. Now, Stockdale, I love that you mentioned Stockdale. He’s a bit of a personal hero of mine and he is a modern day stoic and he really embodies this control orientation. Now Stockdale, he was shot down over North Vietnam and he spent seven and a half years in the infamous Hanoi Hilton prison camp. And four of those years he was in solitary confinement. He was tortured on 15 separate occasions. But what kept him going was stoicism is specifically Epictetus’s Enchiridion that he had brought that to war with him when he got shot down.

He talks about this in a number of his books as he ejected out of his aircraft and he was coming down to land, he could see the Vietcong coming in to capture him. And he said to himself, I’m now leaving my world, the world of technology and I’m entering into the world of Epictetus. And he knew that he couldn’t control his captors or his circumstances or the torture, but he could control how he responded to it. So Stockdale famously, he took control of his mind. He maintained leadership over the other prisoners because he was the senior officer in there and created meaning within chaos. And it was that focusing on what he can control that was really central to his success in there and him helping his other fellow prisoners to get through. Now, studies in both military and organizational settings show that people who have a strong internal locus of control, they experience less anxiety, they perform better under pressure and they recover faster from trauma. And so it’s proactive rather than reactive. And you can actually train yourself into this way as well. You can develop your control muscle if you like.

Brett McKay:

Yeah. How do you do that?

Paul Taylor:

Well, it’s basically changing your narrative. So say you got pissed off about something, a lot of people will go, they made me angry or this ruined my day, or I had no choice in this. All of those things are handing away control. It’s actually about self-awareness is really the first thing. And reframing that in your head from they made me angry too. I chose to feel angry. I decided to let that affect me. Now that can be a bit uncomfortable at first and a bit awkward, but it really is incredibly I empowering because what you’re actually training yourself to do is to realize that you have a choice about how you react to things. That’s really key. And I think that another second practice is the stoic idea of visualizing your day. Now this might seem a bit pessimistic, but it’s actually really helpful. It’s basically the stoic excuse to Marcus really famously would do this.

He would think about all the things that could possibly go wrong, the bad people he would meet and what he would actually do for that. So it’s about mental rehearsal so that when the bad stuff happens, you’re actually ready to do that. And then it’s about doing little small daily acts is about making your bed properly, finishing your workout even when you don’t want to. Choosing the healthy thing rather than the unhealthy thing and then reflecting on it and going, Hey, I made a conscious choice. There are around control. Every little action just builds that muscle bit by bit.

Brett McKay:

Alright, so the third C is commitment. What is it about commitment that makes us more hearty?

Paul Taylor:

Yeah, so it’s interesting, there’s a number of different elements to commitment, but they all interact with each other. So it’s really about being fully engaged in life. And I am increasingly concerned about modern society, and I know you are Brett as well. I listened to your podcast that there’s an increasing amount of people who are spending an increasing amount of their spare time within the confines of four walls with their heads buried in a bloody screen, either scrolling on social media or watching crappy tv. These people are what I call passive consumers of life. And it’s the polar opposite to high hardiness commitment, high hardy, committed people are fully engaged in life, whether it’s their work, their relationships, their health or their learning. They’re people. You know these people because they’re curious, they bring positive energy, they derive their meaning from participation, not from results.

And I really think that this commitment, it’s a bit of an antidote to apathy. So in our culture it’s really easy to live that passive life of scrolling, multitasking, of numbing yourself with drugs and alcohol. But when you’re committed, you’re really present. And the stoics really talked about this as well, and Seneca said, it’s not that we have a short time to live, but that we waste a lot of it. And this is about whether or not you are fully engaged. Now, linked to that in commitment to orientation is a sense of meaning and purpose. And in Viktor Frankl’s book, Man’s Search for Meaning, which I read as a 17-year-old that had a pretty profound effect on my life. And he showed that those who survived the concentration camps, they weren’t the strongest or the smartest, but they were the people who were committed to a purpose that was bigger than themselves. And the hardiness research actually echoes that. Salvador Maddie found that people who were high in commitment, they kept deeply engaged in their work and their relationships under stress. They handle stress far better than people with low commitment and they actually experience a lot less burnout.

Brett McKay:

So what are some things we can do to develop our commitment muscle?

Paul Taylor:

So one is about really clarifying your values. And I think part of the problem in modern society is the decline of religion. Now, I’m not religious at all, I’m more of a spiritual person, but I think what religion does was it gave people a sense of shared values and meaning. And when that’s missing, if you don’t deliberately find it, people can end up in an existential vacuum. So it’s really about getting clear on your values, the stuff that is meaningful to you, and then it’s about creating systems around because motivation that will get you started. So this gets into another part of commitment to orientation, which is about being committed to your health. It’s not just about having goals, but it’s about having processes that will actually help you to get to the person that you want to be and ideally linking them to your values.

And then I like to get people to do what I call a tombstone statement, which is what would you like to be written on your tombstone that would sum up your contribution to society or your little corner of the universe? It’s kind of a morbid thing, thinking of how would I be thought of when I’m dead? But that is the thing that uncovers that deeper sense of meaning and purpose. So getting clear on your values and on your purpose in life and then trying to live intentionally using those values as a compass. These are the things that really help to drive that commitment orientation.

Brett McKay:

Alright, so you added a fourth C to these three Cs of psychological hardiness. That’s connection. What is it about connecting with others that makes us more psychologically hearty?

Paul Taylor:

Well, look, Brett, the human brain is essentially a social organ. And we need that social connection. We know that when somebody is lonely, it is as bad for their health as smoking 20 cigarettes a day. It takes 10 to 12 years off your life and it’s hugely, hugely important. We talked about Stockdale in the Hanoi Hilton. The thing that got these guys through when they were put in solitary confinement was they created this thing called the tap code where they could tap out the letters of the alphabet on the walls and the pipes and they created all this shorthand and the tap code was the glue that held these guys together. When you connect with somebody else, you release oxytocin and vasopressin in your brains. Now they’re the hormones of love, trust, and social bonding, but they are also the most potent anti-stress chemicals that human beings produce.

And decades of research on military veterans as well as people who’ve been through trauma shows that those who are socially connected, who have people that they can lean into, they suffer much less PTSD and suicide than people who don’t have those social connections. And it’s because we are evolved to survive and thrive in tribes. And social support is one of the most powerful buffers against stress that we have. I mean Paul Barone showed this on PTSD and also there’s a researcher, she showed the people with strong social relationships, they’ve got a 50% lower risk of premature death than people who don’t have those relationships. So connection for me is hugely, hugely important. And that’s part of today’s massive problem of Kaia is that we are massively digitally connected, more connected than we’ve ever been, but we are really disconnected when it comes from to face to face perspective.

Brett McKay:

Yeah, we had Derek Thompson on the podcast a while back ago. He wrote an article for The Atlantic about how it’s basically there’s no loneliness epidemic because people aren’t really feeling lonely because we have all of this technology that can basically, we don’t feel like we’re lonely and so we don’t feel like we have the need to reach out to people, but we’re still seeing the ill effects of not actually connecting with other people.

Paul Taylor:

When you do face to face interactions, it is very, very different to online interactions. And he makes a good point that we don’t actually notice it because we still think that we are connected. But there is nothing that replaces that face-to-face interaction. And other research has shown that it is about catching up with people in person. It’s about having good friends that you will see at least once a month. That is one of the real key things here.

Brett McKay:

So it takes intention. You have to be intentional about this because everyone’s schedule’s crazy. You’re not just going to run into your friends like maybe you would’ve done a century ago. You have to plan for it, you have to choose it.

Paul Taylor:

You absolutely do. You’re a hundred percent right Brett. And it’s not about waiting for other people to organize something, it’s about being the connector in your little corner of the universe. Taking that on board I think is really key.

Brett McKay:

Alright, so that’s psychological hardiness. So there’s the four Cs challenge orientation, have an internal locus of control commitments to being engaged, have a higher purpose that you’re going for and then connecting with others that can give you psychological hardiness. Let’s talk about physiological hardiness. And we had you on last time talking about your book Death by Comfort. And one of the things we talked about in that podcast was how hormesis can be the antidote to the damage that all this comfort is causing to us physiologically. For those who aren’t familiar with hormesis, what is it?

Paul Taylor:

So hormesis is basically it’s summed up by the words of Frederick Nietzsche, that which does not kill us, and I’m sure all your listeners can finish the sentence makes us stronger. And this goes back, it actually goes back to biology like core biology. Edward Calabresi first noticed in his PhD research he was giving pesticides to plants to try to kill him and seeing what was the smallest dose that would actually kill them. And he found that at small doses, the plants actually flourished when they were given small doses of poison. And that led him to a whole heap of research and other researchers that they enjoined in. That shows that when we are exposed to small intermittent doses of stress, we actually get stronger, more robust at a cellular level. So when your body is presented with stressors, something called the cell danger response kicks off.

And that is the cells actually responding to stress by upregulating protective pathways. I describe them in the book, there’s things like NRF two and HIF one, but these drive our antioxidant defenses, they make our mitochondria stronger and they drive cellular cleanup processes like autophagy. And it’s basically your sales saying, Hey, we’re under a bit of pressure here. We need to get fitter, we need to train for this eventuality. And so for me, physiological hardiness and psychological hardiness or physiological hormesis and psychological hardiness, they’re like two sides to the same coin. The hardy mind reframes stress as a challenge and the body uses stress as medicine. So we actually, because of exposure to small amounts of stressors, and think of the obvious ones like exercise, cold exposure, heat exposure, all three of these activate these stress response pathways and not just in humans, in fruit flies, in worms, in cats, in dogs, in rodents, all primates all respond to those stressors and fasting as well with an upregulation of these stress response genes that in humans switch on at least 300 protective mechanisms.

So the goal here is not to avoid stress, but it’s to dose it deliberately. So there’s a hermetic curve. If you don’t do anything, it’s bad for you. You start to do some of these stressors, it’s good for you, a bit more is better, but there is an optimal point where it starts to become too much after that. And so this is about dosing it deliberately and intermittently. And the ancient stoics, they did it with cold baths and fasting, and this is about stress inoculation, it’s about nature’s physiological hardiness because of exposure to stress and appropriate recovery. That’s the key thing. And it actually keeps us biologically young and adaptable.

Brett McKay:

So in the book, in the section about physiological hardiness, physiological robustness, you provide different forms of hormetic stress, stress that can be medicine for individuals. One of the most potent ones is exercise. And in that section you recommend that people focus on two markers of fitness, VO2 max and strength. Why those two?

Paul Taylor:

Yeah, look, they are really critical. Just before I dive into that, two legendary exercise physiologists released a paper, I think it was 2013, exercise prevents and or treats 26 common chronic diseases. That is just crazy. You imagine if the pharmaceutical industry produced a pill that would simultaneously reduce your risk of 26 chronic chronic diseases and that the reason is that it releases all of these mykines, which are signaling molecules. But to answer your question now, so your VO2 max, that’s your maximum oxygen uptake, how much oxygen you can take in and use, and it’s the gold standard measure of cardio respiratory fitness. And lots of your listeners will have heard of it. And if they have an apple watcher or Garmin or whoop band or an oil ring, it’ll actually estimate their VO2 max and then you can look up tables online to see where you are.

What we now know is that your VO2 max is the single biggest predictor of how long you’re going to live way above everything else. So there was a massive 2018 study I talk about in my book from the Cleveland Clinic that followed over 120,000 people who’d all done stress testing on their heart and had their VO2 max measured and they followed these guys, they were in their fifties or their sixties at the start and they followed them for 15 years and a bunch died and a bunch obviously didn’t. And then they went back and looked at the data 15 years ago around their VO2 max and they found that VO2 max was associated with dramatically lower all cause mortality and there was no upper limit that meant that the fitter people got the longer they actually lived. And it was way more predictive of future death and having heart disease or diabetes or high blood pressure, any of those things.

So it is about training for your VO2 max. So how do you do it? Well, first of all is a bit of a base of zone two training, and your listeners may have heard of this. It’s 60 to 70% of your max heart rate. Basically you can talk but you can’t sing. Now that’s a base, but you can’t just do zone two and hope to improve your VO2 max. That will really help your mitochondria. The best way to build your VO2 max is the Norwegian four by four protocol. So this is basically you do four minutes of all art exercise, you can pick any piece of equipment, a rower, a step or a treadmill, whatever, or you can just be out running and you go as hard as you can for four minutes to the point that at the end of those four minutes, your heart rate should be 95% of your maximum. That is like I’m almost dying. And then you recover for three minutes. You just sort of turn your legs over for three minutes and you do that four times. That’s the four by four protocol. That is the single best way to re your VO2 max. And you only need to do that once a month. That’s key. And then I think, did you ask about the second one, which was about strength

Brett McKay:

Training? Yeah, strength, yeah, strength training.

Paul Taylor:

Yeah. Look, I know you’re a big fan of strength training and the second biggest predictive of how long you’re going to live is your muscle strength. And it appears in the research to be muscle strength, not your muscle mass. Stronger people live longer and they stay independent for longer. And it’s because our muscles aren’t just for movement. I mentioned it earlier, they are endocrine organs. Your muscle is an endocrine organ that secretes these molecules called myokines that reduce our inflammation, improve our brain health, and improve the health of all of our different organs. So really it is about using that muscle. And we know that becoming stronger is protective against sarcopenia. That’s that loss of muscle and bone as you age. And that if you become sarcopenic in old age, it actually dramatically increases your risk of pretty much every chronic disease. So I’m a big fan that everybody who’s listening to this podcast should be lifting heavy.

I don’t care what sex they are, what age they are. In fact, the older they are, the more important it is to lift heavy. And a good program if people don’t do it would be just full body strength training sessions. Ideally three of those a week focusing on compound movements, the big lifts that use multi joints, things like squats, deadlifts, presses, pull-ups. Plus also I think it’s really important to add in single leg work like Bulgarian split squats or lunges because that stability is really, really important, especially as we age and especially if you get over 50 as well as single leg work, do some balanced stuff as well because what we now know is if you’re in your sixties and you fall over and break a hip or a pelvis, you got a 50% chance of being dead within the next five years. So the takeaway here is simple. You need to train your body to be hard to kill. Cardio makes you harder to kill from the inside out and strength makes you harder to kill from the outside in and together is this physical foundation of hardiness. I think we need to do both.

Brett McKay:

Awesome. So yeah, strength train three times a week and then get in some zone two cardio and then a HIIT workout. 

Paul Taylor:

Get comfortable with being uncomfortable with the Norwegian four by four and you can just look it up. It’s not pleasant, but it’s useful.

Brett McKay:

I do it once a week. Yeah. So another hormetic stress you talk about is light. How is light a stressor?

Paul Taylor:

So light is both, as I said, it’s a hermetic stressor so you don’t get any of it and it’s really bad for you. You get some, it’s good, you get more, it’s better. But there is an optimal point and everybody knows with sunlight that you could get too much sun and that can cause skin cancer. But what most people don’t realize is that if you have low vitamin D or even suboptimal vitamin D, which according to different agencies, between 70 and 80% of us globally have suboptimal vitamin D, if you have suboptimal vitamin D, it increases your risk of pretty much every cancer other than skin cancer. Now, if I take a step back and talk about light in general, we now know that light is a signal to our body and it triggers adaptation. So morning sunlight sets your shahinian rhythm, it boosts your serotonin, it anchors your sleep wake cycle and without it your hormones drift, your sleep quality tanks and even your metabolism suffers.

So as I said, low vitamin D levels, they’re not just linked to increased risk of cancer, there is a significant increased risk of cardiovascular disease, a massive increased risk of depression. And actually they’re finding increasing vitamin D acts like an antidepressant. People with low vitamin D have immune dysfunction as well. So I’m all about outcomes. So it’s about getting your blood tested and you want your level to be, if you’re in the states, 40 to 60 nanograms per deciliter, that’s what you use. Over here we use nanomoles per liter. So it’s between a hundred and 150 MLEs per liter, or if you live in the states, 40 to 60 nanograms per deciliter. Now the other thing is you’ve got to look at your skin tone. If your skin is darker or you live further from the equator, you’re going to need to get more sun exposure than people with light skin or who live closer to the equator.

And then when we get to red and near infrared light, that’s when things get really spooky. I mean, Einstein talked about quantum physics as spooky action at a distance and we now know that light has quantum effects on our cells. It’s just ridiculous. But rather than do a deep dive into that, I want to talk about how we use this therapeutically. So red light and near infrared, their wavelengths are between 620 and about 1,050 or more. So red light, which is that sort of 620 to 700 ish, that has a massive effect on your skin. It’s great for healing, it’s great for inflammation, it’s great for eczema and even childhood acne and even in adults, it has really good effects on our skin. It’s good for wound healing, it’s good for burns. They now treating burns victims with red lights straight away and then near infrared lights, which has a slightly longer wave of length, kind of 820 to 1,015 nanometers that actually penetrates through your skin and actually interacts with your mitochondria and triggers the activation of an enzyme called cytochrome sea oxidase.

That’s really important for the electron transport chain, and I don’t want to get too geeky in the physiology, but basically near infrared light stimulates your mitochondria to produce more a TP, the cellular energy, and that’s the fuel for everything in your body. And we know that having good efficient mitochondria protects you against a whole he of physical diseases. So really this is about driving this cellular agents of energy, your mitochondria through that near infrared light. And then as I said, the red light’s good for your skin, but also sunlight is also therapy as well. And then the darkness is really, really important as well for those circadian rhythms. When you change your sleep wake cycle, basically you mess with your circadian rhythms and you mess with your biology. Most people don’t realize, Brett, that your hormones run off circadian rhythms and lots of your cells do too. So when you mess with your sleep cycles, you’re actually messing with your biology.

Brett McKay:

How do you get red light near infrared light?

Paul Taylor:

Yeah, so you can get panels and masks and things like that. So they’re all available commercially and there’s a range of expense based on the size of them and the par and all of that sort of stuff. I get mine direct from China from a factor, it’s called red L led and it’s a lot cheaper and they will make a lot of the ones that American brands put their brand on and doubled the price from it. But I have a red and near infrared light panel and I used it. I had open heart surgery at the start of this year. I found I was born with a dodgy aortic valve and I think that red light and near infrared massively helped my recovery.

Brett McKay:

So another stressor you recommend is nature. Typically we think of nature’s, oh, it’s relaxing to be out in nature. How is nature a stressor?

Paul Taylor:

Well, it’s this balance of stress and recovery that’s really key and nature definitely falls up more on the recovery side. Now there are obviously there’s a bunch of challenges out in nature, temperature, variation, terrain, microbes, all of these things that can stimulate adaptation and they strengthen our immune and our nervous system. So we actually know that when you spend time in nature, if you go walk through the forest, you actually pick up some of the microbiome from the forest, even walking beside the sea. You’ll pick up some of the microbiome in the sea and it actually is good for us. There’s stimulation of it, but then spending time in nature can be hugely relaxing as well and can give us profound recovery. The Japanese, they call it shin Yoku or forest bathing as some people may have found. And when I was researching the book, I couldn’t believe how many research studies, there were studies around forest bathing and study after studies showing that spanning even 20 minutes in nature, lowers your cortisol, lowers your blood pressure, lowers your heart rate, and actually improves immune cell activity.

And then we have the microbiome connection that I talked about. So when you or your kids, they play in the dirt or the garden or you walk barefoot, you’re actually exposed to the microbes in the soil and they interact with the microbes in your skin and even in your gut. And that helps us to regulate inflammation and immune function. So we know that kids who live on farms, adults who live on farms have got much more diverse microbiomes than people who live in cities. This is linked to something called the hygiene hypothesis, that basically our obsession with cleaning and disinfecting everything has actually weakened our immune systems and increased rates of autoimmune disorders and allergies. And an interesting little tidbit for your listeners, Brett, I live in Melbourne in Australia that has the highest rate of allergies anywhere in the world. And you know what they’ve linked it to.

Melbourne also has the highest rate of cesarean section birth anywhere in the world. And what we now know is that being born cesarean section completely changes the immune system, mostly through the gut microbiome. Having a natural birth actually triggers the activation of the immune system. So that time in nature is hugely important. And then there’s this whole idea of grounding or earthing, which I used to think was woo woo. But again, looking into the research, there’s actually a lot of physics behind it that basically when your feet or your body is in contact with the earth’s surfaces, the electrons on the earth, they have biological effects. Now the research is pretty early, but it’s very, very interesting. And there is evidence increasing, evidence of improved sleep, reduced inflammation from grounding our earthing and probably it’s due to changes in our autonomic nervous system and stress as well. So just getting out, spending some time walking, getting your feet, your bare feet on the surfaces of the earth, grass, sand, rock, whatever, actually reconnects us to the world and resets our electric charge. It’s pretty bonkers, but it is real.

Brett McKay:

And one prescription you give people to get more time outdoors is following the nature pyramid. We’ve written about this on the website, it’s really cool. So it’s the 20-5-3 rule. So you want to get 20 minutes in green space three times a week, five hours in a semi wild environment once a month and then three days completely off grid annually. So that’s like a camp out or something. And that’ll give you enough nature that you need for overall health and wellbeing.

Paul Taylor:

Yeah, I love that. I love the stuff that’s just simple that people can go, yeah, you know what, I can do that. And I tell you what, if you do that 20-5-3 prescription, you will notice a significant effect.

Brett McKay:

Going back to that balance between stress and recovery, you talk in the book about nutrition and you focus on a few things that are essential for health and strength. You talk about avoiding ultra processed foods, which is something we discussed the last time you’re on the show. You talk about protein, how essential protein is people should aim to get at least 0.7 grams per pound of body weight. It’s often better to get more, get a gram per pound of body weight. And then you talk about the importance of omega fatty acids. What are omega threes and why are they so important for hearty health?

Paul Taylor:

They’re essential and they are structural fats for your brain and they’re also very potent anti-inflammatories for your body. And I really encourage people to get their omega index tested. You can do this at omega quant QAN t.com. I’ve got no association with these guys whatsoever. They just do brilliant testing. So they’ll give you an omega index or an omega score. It’s the amount of omega threes and percentage of those fats in your rare blood cells. And what we now know is that if people with a score of 8%, they live about five years longer than those who score around 5%. Like you show me some one thing in nutrition that can extend lifespan by five years. I don’t think there’s anything other than omega fatty acids. And what we now know is that the Japanese, on average, their omega index is about 8%, Americans is about 5%, and the Japanese live five years longer than the Americans.

So we really need to increase our omega index and we can get there if you eat lots of fish. That’s why the Japanese have it, particularly fatty fish, salmon, sardines, anchovies. But a lot of people will have to be supplemented. If you’re not eating fish three or four times a week or more, you really got to supplement and about two grams of high quality fish oil or if you’re plant-based algal oil, the stuff algae, the stuff that the fish feed on, that is actually a really good way to reach your omega fatty acids as well. And I think as well as minimizing ultra processed foods, they are the two most powerful nutritional interventions you can do.

Brett McKay:

Yeah, something I’ve been doing lately for the past couple months is I’ve started eating anchovies and sardines. As a kid I was like, that’s gross. That’s what grandpas eat. But then Michael Easter, he had an article on a substack about you need to eat more small fish. I was like, okay. So I went to Whole Foods and bought some cans of sardines and anchovies and they’re not bad. They taste like tuna fish, anchovies a little salty, but I try to get two to three of those a week and it’s easy and it’s cheap. It’s not that expensive.

Paul Taylor:

Yeah, that’s right. And I’m a fan of eating anchovies, and I think it’s useful to explain to people why small fish, small fish don’t live as long the big fish, particularly big fish like tuna, you’ll find that they tend to have more heavy metals in them, more mercury, because they eat lots of small fish. So having the small fish like sardines and anchovies is a really good way to do it.

Brett McKay:

So you wrap up the book by revisiting the Myth of Hercules, and you frame your recommendations using Hercules’ mythical 12 labors, and they’re kind of a summary of the principles we discussed. So let’s end there. What are the Herculean labors a modern person should undertake to live a life of arete?

Paul Taylor:

Yeah, look, the first one I think is overarching and it’s actually forging the hardiness mindset. This is that actually choosing to see change and adversity as opportunity for growth just as Hercules did then it’s embrace life’s challenges. And I love this idea that stoics talked about life as a contest. The Olympic games are upon us, and I think we need to view life as a contest and actually get into the contest with passion and view all of these challenges as little tests of your character and wake up every day and go, you know what? I’m ready for the contest. I think that’s really key. Then it’s focus on the stuff that you can control. Don’t invest your energy in the stuff. You can’t get committed to life. Be fully engaged in life. I get people to look at their screen time and if you are spending three Rs or four hours of your life on screens extrapolated over your lifetime, that’s like 10 to 15 years of your life with your head buried in a screen.

So it’s, for me, it’s about choosing to engage fully in life. And then the other say about connection, having meaningful face-to-face interactions with friends. And then the rest of it is really about that physiological hardiness is actually engaging in these deliberate stressors of exercise, of heat, of cold exposure, of nourishing your body when you’re eating, of exposing yourself to beneficial light and then making sure that you recover. But the key for me, Brett, I think the last thing that I’d like to impart to your listeners is that recently scientists have roughly estimated our chances of ever having being born, and they reckon it’s about one in 400 trillion. And if you think about it, all of your ancestors way back to your homo Habilis, homoerectus ancestors, they all had to survive in order for you to be alive. Somebody probably survived the plague in England, one of your ancestors, somebody probably survived just World War I or World War II. But this is the thing is waking up every day and going, I have won the greatest lottery ever. I’ve had a one in 400 trillion chance of being alive. Let’s not waste it and let’s embrace the contest. I think that’s the key thing.

Brett McKay:

Well, Paul this has been a great conversation. Where can people go to learn more about the book and your work?

Paul Taylor:

So the best place to go would be my website, which is paultaylor.biz. You can get the book there. You can also get the book on Amazon and also my podcast, which is the Hardiness podcast. I think if you’re interested in this, there’s going to be a big deep dive on hardiness in that podcast.

Brett McKay:

Fantastic. Well, Paul Taylor, thanks for your time. It’s been a pleasure.

Paul Taylor:

Thank you for having me on again, Brett, and love your work. Absolutely love it.

Brett McKay:

Thank you so much. My guest was Dr. Paul Taylor. He’s the author of the book, The Hardiness Effect. It’s available on amazon.com and bookstores everywhere. You can find more information about his work at his website, paultaylor.biz. Also, check out our show notes at aom.is/hardiness where you’ll find links and resources to delve deeper into this topic. 

Well, that wraps up another edition of the AoM podcast. Make sure check out our website at artofmanliness.com. Find our podcast archives and check out our new newsletter. It’s called Dying Breed. You sign up at dyingbreed.net. It’s a great way to support the show directly. As always, thank you for the continued support. Until next time, it is Brett McKay reminding you to not only listen to the podcast, but to put what you’ve heard into action. 

This article was originally published on The Art of Manliness.

An important part of manhood has always been about having the competence to be effective in the world — having the breadth of skills, the savoir-faire, to handle any situation you find yourself in. With that in mind, each Sunday we’ll be republishing one of the illustrated guides from our archives, so you can hone your manly know-how week by week.

Your snoz is full of blood vessels, and nosebleeds happen when they incur some kind of damage. That damage can come from vigorous nose picking or blowing, outright injury (as in taking a punch to the face), or, very frequently, from exposure to dry air (whether via the outdoor climate or indoor heating). Nosebleeds are particularly common in children ages 2-10, but can occur at any age.

We don’t often see our blood outside of our bodies, so that when a nosebleed occurs, it can feel a little alarming. But unless nosebleeds are extraordinarily heavy, accompanied by other symptoms like high blood pressure and trouble breathing, last longer than a half hour, and/or happen more than twice a week, they’re almost certainly harmless. They’re just messy and annoying, so that you want to stop your own, or your kid’s, as soon as possible, by following the instructions above.

To prevent future nosebleeds, it helps to keep the nasal membranes moist by putting a humidifier in your home/office, using a saline spray 2X a day, and/or applying Vaseline inside the nostrils. More frequently occurring nosebleeds may need to be addressed through cauterization.

Illustration by Ted Slampyak

This article was originally published on The Art of Manliness.

If you’ve been following AoM for a while, you know that strength training is a central part of my daily life — the thing, other than my faith and family, that brings me the most joy and satisfaction.

Back in my 30s, I trained to hoist as much weight as possible. I did some amateur lifting competitions, so my goal was to maximize my one rep max on the main barbell lifts. My workout sessions would often last an hour and a half. I really enjoyed that season of my life, but the intensity of the training started to take its toll on me physically and psychologically as I entered my 40s.

I’ll be turning 43 here in a few months. I’m not the man I was a decade back. Life’s busier, and I have a body that’s not quite as forgiving as it once was. Long sessions leave me rundown instead of built-up. Training at this stage of life requires a different approach.

My longtime coach, Matt Reynolds, has helped transition my training for midlife. Since I know many of you reading AoM have grown up with me and are entering your 40s too, I thought it would be helpful to share what my training has looked like lately. Maybe it will give you some inspiration for your own programming.

The Program Framework

I do a strength-training workout 4X a week, using an upper/lower split, with each workout capped at 60 minutes. And I do a cardio workout 2X a week. Sundays I rest, except for taking low-key walks.

Here are the components of my routine:

Strength workouts:

1. Heavy main lift. Every session starts with a big compound movement: squat, deadlift, bench press, or shoulder press. I go heavy — something in the 3-5 rep range. I’ll occasionally do a heavy single. It scratches the itch to keep strength as a central part of training without beating me up with endless sets.
2. Backoff volume. After the heavy top set, I do 1-2 backoff sets at a lighter weight. This allows me to accumulate volume while staying within a recoverable zone.
3. Supplemental Lift. I’ll then do a supplemental lift. If it’s squat day, I’ll do a hamstring-focused supplemental lift like Romanian deadlifts or good mornings. If it’s bench day, I’ll do a shoulder-focused supplemental lift like dumbbell shoulder presses. Enough load to matter, not enough to wreck me.
4. Circuit. Each session finishes with a circuit — upper or lower, depending on the day. A mix of dips, chins, curls, rows, split squats, leg extensions, or whatever I have equipment for. The goal is simple: get the heart rate up, build some muscle, and walk out with a sweat.

Cardio

As I’ve gotten into midlife, I’ve put more emphasis on heart health. Three mainstays: Zone 2 cardio two times a week for long-term conditioning, rucks for a blend of endurance and load-bearing strength, and one weekly HIIT session to keep the higher gears sharp and to improve my V02 Max (I’ve got an article about VO2 in the works).

Adding Weight and Reps for Progressive Overload

On the heavy lifts, I add about five pounds a week. When I stall out, Matt will lower the weight, and then I start working my way back up.

For the supplemental lifts and circuit work, my goal is to be able to do three sets of 10-12 reps. Once I reach that goal, I’ll add weight to the lift and then do as many reps as possible until I get three sets of 10-12 reps again, and then I add weight again, and the cycle repeats.

Here’s what programming looks like specifically right now for me:

Monday (Lower Day)

Deadlift

• 1 set × 3 reps @ 500 lbs
• Backoff set: 1×5 @ 455 lbs

Box Squat

• 4×3 @ 365 lbs

Lower Circuit

On all circuits, I do the 3 exercises back-to-back, then take a 2.5-minute break, then perform the next circuit, repeating the circuit 3X

• Leg Press: 3×12 @ 285 lbs
• Leg Curl: 3 x AMRAP (as many reps as possible) @ 140 lbs
• Kettlebell swings: 3×20 @ 70 lbs

Tuesday (Upper Day)

Shoulder Press

• 1×3 @ 195 lbs
• Backoff sets: 2 x AMRAP @ 180 lbs

Machine Incline Bench Press

I use iso arms on my squat rack for this

• 3 x AMRAP @ 170 lbs

Pendlay Row

• 3 x AMRAP @ 260 lbs

Upper Circuit

• Cable Fly: 3×12 @ 250 lbs
• Overhead Cable Tricep Extension: 3 x AMRAP @ 150 lbs
• Dumbbell Curls: 3×12 @ 100 lbs

Wednesday

Zone 2 Cardio

• One hour walking on an incline treadmill

Thursday (Lower Day)

Hatfield Squat

• 1×6 @ 350 lbs
• Backoff sets: 2 x AMRAP @ 325 lbs

Good Morning

• 3×5 @ 95 lbs

Lower Circuit

• Leg Press: 3×12 @ 290 lbs
• Seated Leg Extension: 3 x AMRAP @ 160 lbs
• Hanging Knee Raise: 3×12 @ bodyweight (195 lbs)

Friday (Upper Day)

Bench Press

• 1×3 @ 270 lbs
• 2 x AMRAP @ 235 lbs

Dumbbell Press

• 3 x AMRAP @ 145 lbs

Upper Circuit

• Lat Pulldown: 3×12 @ 285 lbs
• Lateral Raise: 3×12 @ 35 lbs
• Incline Dumbbell Curl: 3 x AMRAP @ 70 lbs

Saturday

Cardio

• 30 minutes of Zone 2 cardio

HIIT Workout

• 4×4: 4 minutes hard, 3 minutes rest (repeated four times)

I sometimes substitute a one-hour ruck for this Zone 2 + HIIT routine. Just depends on what I’m feeling.

Daily Morning Routine

• 1-mile morning walk every day to take care of heart health

Lessons From Midlife Training

A few takeaways I’ve learned as I’ve adjusted my training for midlife:

• Strength still matters. I like keeping a heavy barbell movement at the center of each session.
• Adjust the main lifts as needed. Barbells can be hard on a middle-aged body. Feel free to adjust your technique for the barbell lifts as needed. For example, I no longer do traditional barbell squats and instead use a Hatfield squat due to issues with my shoulders and knee. If you can’t do a conventional barbell deadlift, swap it with a trap bar deadlift. Can’t barbell bench? Do dumbbell bench presses instead.
• Efficiency is king. I don’t need marathon sessions. Short and focused beats long and meandering.
• Make time for cardio. Adding consistent cardio has been a game-changer for my overall health and energy levels. It’s helped lower my resting heart rate, and it’s given me more work capacity. I don’t gas out anymore. Walk a lot for that cardio base and include one session of HIIT a week.
• Don’t be afraid to take time off. I’m still really religious about my training, but I’ve learned not to be afraid to take time off. If I’m feeling beat up or tired due to increased stress, I’ll swap out my usual training session for a walk or a ruck. If I’m on vacation, I don’t train; I just enjoy myself.

This isn’t the strongest I’ve ever been. But that’s alright with me. My thirties were about building a base of strength. My forties are about maintaining it while making sure I can still hike with my family, play pickup ultimate frisbee without wheezing, and avoid slipping into soft suburban dad syndrome. I train to stay healthy and because I enjoy it an awful damn much.

This article was originally published on The Art of Manliness.

Whether you’ve never stepped foot in a weight room or you’ve been lifting for years without seeing significant results, figuring out how to get big, strong, and jacked can feel overwhelming. There are endless programs, conflicting opinions, and a lot of noise about what actually works.

Today on the show, Paul Horn offers a grounded, field-tested take on what really helps average guys get stronger and more muscular — without burning out. Paul is a strength coach and the author of Radically Simple Strength and Radically Simple Muscle. We discuss why you need to get strong before you get shredded, how and why Paul modified the classic Starting Strength program, the strength benchmarks men should be able to hit, when to shift from powerlifting to bodybuilding-style training, why you should train your lower body like a powerlifter and your upper body like a bodybuilder, the physique signal that shows you’re in shape, the body fat percentage every man should get down to at least once in his life, and more.

Resources Related to the Podcast

• AoM Podcast #154: Strength Training for Everyone
• AoM Podcast #302: My Workout Routine & The Benefits of a Strength Coach
• AoM Podcast #826: From Novice to Advanced — The Weightlifter’s Journey
• AoM Article: The Re-Rise of the Machines
• AoM Article: Getting Ripped vs. Getting Strong
• Paul’s video on how to stretch your shoulders for the low-bar back squat
• Starting Strength by Mark Rippetoe
• AoM barbell training videos with Mark Rippetoe

Connect With Paul Horn

• Paul’s website

Listen to the Podcast! (And don’t forget to leave us a review!)

Listen to the episode on a separate page.

Download this episode.

Subscribe to the podcast in the media player of your choice.

Transcript

Brett McKay:

Brett McKay here and welcome to another edition of the Art of Manliness podcast. Whether you’ve never stepped foot in a weight room, or you’ve been lifting for years without seeing significant results, figuring out how to get big, strong and jacked can feel overwhelming. There are endless programs, conflicting opinions, and a lot of noise about what actually works today on the show. Paul Horn offers a grounded field tested take on what really helps average guys get stronger and more muscular without burning out. Paul’s a strength coach and the author of radically Simple strength and radically Simple Muscle. We discuss why you need to get strong before you get shredded, how and why. Paul modified the classic Starting strength program. The strength benchmarks men should be able to hit when to shift from power lifting to bodybuilding style training. Why you should train your lower body like a powerlifter and your upper body like a bodybuilder, the physique signal that shows you’re in shape. The body fat percentage every man should get down to at least once in his life and more after the show’s over. Check out our show notes at aom.is/SimpleMuscle.

All right, Paul Horn, welcome to the show.

Paul Horn:

Yeah, thank you. I’m glad to be here.

Brett McKay:

So you are a barbell coach. We’ve met at a Starting Strength conference a long, long time ago. You’ve actually helped me with some, when I was doing the low bar squat, I was having some issues with shoulder tightness getting under the bar, and you were very kind to give me a tutorial on a stretch on how to make that happen. 

Paul Horn:

For myself, that is my biggest contribution to the literature. I figured out a shoulder stretch and made a YouTube video, and to this day it’s my most popular YouTube video I’ve ever put up. 

Brett McKay:

It’s important information. Well, let’s talk about your background a bit. You’ve been training for decades and you’ve been a coach for a long time too. How did you get started with barbell training? What were you doing before that? When did you decide I got to pick up the iron?

Paul Horn:

Yeah, well, I was wasting a lot of time in the gym. Most young guys are when they start lifting. The short version is I was a vegan in college and I’m six one. I weighed about 160 pounds and I was a camp counselor and some of the other coaches were older and kind of bros and thought, we’re going to take you to the gym and try and bulk you up a little bit. And I went and absolutely loved it. Got hooked on the training, but my muscles were seizing up. I was cramping a lot and my buddy in his bro frat boy wisdom was like, Hey man, I think maybe you need some protein.

And so it went from being a vegan to eating tuna fish and then chicken and then full carnivore now. And so that was great. Towards the end of college I had bulked up quite a bit and just again, doing bro workouts and things that you find on the old bodybuilding.com and T Nation and all the websites that we used to go to. And then I got hurt and I ended up having my first shoulder surgery from bench pressing. So I was out for three months for the first time since I had started lifting. And I thought I should try and figure out why that happened and maybe if there’s a right way to bench press because when you’re a college guy and you’re just screwing around in the gym, you just look at what the other bigger guys are doing and copy them and they don’t know what they’re doing.

So in that hiatus, I stumbled across this book called Starting Strength. And since I couldn’t lift, I just read about lifting and it was, as you know, the best book on how to do the basic barbell lifts and why you should do them that I’ve ever read. And it blew me away. I was like, I’ve never heard it explained this clearly. So I went back to my college gym after I recovered from surgery and I started doing the Starting Strength program. And this was a time when the gym had one squat rack and no one was ever in it and no one had seen a pair of weightlifting shoes, belts were Velcro and nylon. And I just started doing this thing where you squat three times a week, which was crazy. We’d squatted maybe if we squatted, it was like once a week and you did seven other leg exercises.

And so I started doing this simple starting strength program and all of my gym buddies were like, dude, what the hell are you doing? You’re squatting three days a week. And I was like, I don’t know, this crazy guy in Texas told me that I should do this. And within about three months I was probably one of the strongest guys in the gym, which wasn’t saying much at the time. But then people started asking, okay, what is this program? What are you doing? Started asking me questions about lifting shoes and technique, and then I got really into it and my girlfriend at the time as a gift sent me to the Starting Strengths seminar in Wichita Falls just to, I just wanted to meet Rippetoe and he was like my hero. I had been reading all of his books. And so I went to that and back at that, in those days, they just kind of pulled you aside and said, we think that you should take the test for coaching.

We’ve been watching you and we think you might be a good coach and do you want to take this coaching certification test? Which was a very difficult test, but I thought, yeah, sure, what the hell? And ended up passing, I was one of two guys from that group that passed and came back to LA and thought, well, that was cool. And they emailed me and said, your name’s going on a coaching registry. I was like, okay, whatever. And I went back to my, at that time I was working a marketing job for a tech company and then within about a month I started getting emails. The book started gaining more popularity. People were buying it on Amazon, seeing how dense and technical it was, and then going to the coaching registry. And I was the only starting strength coach in Los Angeles. And so I just would get these emails all day like, Hey, I see you’re a coach.

Can you help me out? Can you help me out? And I’m like, I mean, I’m not really a coach, but I know a little more than you do. And so it just became so frequent that I asked my wife then at the time, if I could convert the garage into a personal training studio a little put two racks in there. And I just started training people before and after work and it just kept growing. And within about a year of that, I quit my job and opened up Horn Strength and Conditioning, which was the first starting Strength affiliate gym on the West coast. And it just blew up from there. I ran that gym for about eight years and then the pandemic happened, and the rest of the story is me moving to Idaho and all that stuff, but that’s my little bio.

Brett McKay:

So yeah, you’re starting Strength Coach, and while you’re coaching, of course you continued to train. You did some competitions, some amateur stuff, I believe.

Paul Horn:

Yeah, I was what we would call a recreational power lifter.

Brett McKay:

Recreational power lifter. So you’re doing the main lifts and then you talk about in your books we’re going to talk about today, it’s radically simple muscle and radically simple strength. You reached a point with your training journey as people say, where you started shifting goals for a long time, and I had the same sort of thing. It was just chasing numbers. How much more can I squat? How much more can I deadlift? And then you reached a point it’s like, man, this isn’t doing it for me anymore. And you kind of became a bodybuilder. Tell us about that.

Paul Horn:

I mean, that is, in my experience, the evolution of most lifters. Most guys get into it, they want to get laid and they want to look good with their shirt off and they just want muscles. And then a lot of it had to do with changing trends. CrossFit came out around this time at the same time starting Strength came out and there was this push away from machines and bro splits to like, Hey man, how much can you deadlift? And it became a thing. Strength training became real popular. And so a lot of us got into it and realized that, oh, this is now I have a real goal. It’s like a tangible concrete number, and it keeps going up. If I keep training and maybe you do a power lifting competition and you’re like, who cares about how big my arms are? How much can you squat?

But then there’s this point where when you start strength training as a novice, it’s fun. Every time you go to the gym, you put more weight on the bar and the stronger you get, the harder it becomes to put more weight on the bar. And so you reach this point where you’re like, you know what? I am not really enjoying this. What it would take for me to put two and a half more pounds on my press, it might not be worth it. And who cares? It’s two and a half pounds. It’s not a motivating training goal anymore. On top of that, again, as you may have experienced, most of us who were pursuing the strength thing got fat and we got hurt. 

So you get older and the weights are heavier, they’re beating the crap out of you, and it’s not fun. And you put on all this body weight, everyone’s telling you, you got to weigh 275, and you just don’t feel good. You don’t feel like you look good, you’re hurting and you’re like, what am I doing? And we all seem to have the same epiphany around that moment in your training journey, as you said, where you look at the machines and the Hammer strength bench presses and the lap pull downs and the cable and you’re like, those look pretty fun.

Maybe I should mix it up a little bit. And then you sort of move back into bodybuilding. And if you look at the history of the trend in fitness culture, that’s how it went. The nineties was all about the bodybuilding, and then the two thousands was CrossFit and strength training and starting strength. And then everybody started shifting back to a little bit more bodybuilding. And now if you go on fitness Twitter, it’s just threads of guys posting, no one’s doing a squat at all anymore. It’s all leg extensions and rows and isolation work. And so I like to, I think what I landed on with my books and what works for me now as an older lifter is a mix of hypertrophy, training, bodybuilding stuff, but you still, there’s a part of me deep, it’s an intrinsic thing of I still have to squat and deadlift. It’s not a real workout. You’re not on a real program unless at least once a week you’re getting under the bar and picking something heavy up off the ground. So I assume that your fitness journey was very similar to that.

Brett McKay:

Very similar. So back in the 2010s I got really into barbell training, Starting Strength, did recreational competitions like yourself and just chasing numbers. And it was great. It was fun. It gave me direction. I enjoyed it. But yeah, I reached this point. It was probably 2021, 2022 where I just started hurting. It was like tendon stuff. It was just like the tendons, it’s just really hard, the tendons. And then I was just looking haggard and I was fat. And my wife, I remember she looked at me, she’s like, what’s the point of this? You’re like, Sisyphus just pushing up that boulder. You just go down to the garage gym and just go up and down. That’s all you do.

Paul Horn:

You come in and you tell your wife like, honey, I pulled 505 today. And she’s like, okay, is that good? You’re fat.

Brett McKay:

Right? And I was just tired and beat up. And then also I just started not enjoying lifting. As you said, once you get really strong, there’s diminishing returns on your training. It just takes a lot more effort to just add five pounds to the bar.

Paul Horn:

Yeah, the commitment, it is just you have to say, is it worth it? Okay, my last squat PR was 465. I went on vacation, I got sick. I’m at 405 now. Do I want to do what it takes to get to 470? Is that going to be fun? And a lot of times it’s not. And that’s okay. We hammered people so hard back in the day on, the only thing that matters is the number on the bar. It doesn’t matter how fat you are, it doesn’t matter if you’re having fun. It just matters that you put five more pounds on that bar. And I can tell you what changed my mind was owning a gym and relying on paying clients to keep coming back and paying me. And you lose a lot of clients if you’re like, look, I don’t care about your goals because my goal for you is that you lift more weight. And they’re like, great, I’m going to go to someone else. So yeah, it’s a balance. And that’s okay.

Brett McKay:

Yeah. So what I hope we can do this conversation is talk about your philosophy towards strength training and then muscle building. It seems like you’ve landed in a nice happy medium. That’s kind where I’ve landed as well with my training. And I think this conversation will be useful for people who maybe have been lifting for a long time doing the barbell lifts, but I really hope we can get these guys who haven’t started strength training or weightlifting at all and get them into it. Because what you talk about in your books, it’s all about your goal with your clients is getting a little bit stronger, getting a little bit more jacked, more muscle, and then leaning out. And that is possible with barbells, along with some hypertrophy stuff, some bodybuilding stuff with a few dumbbells and a few machine exercise. And I’m going to talk about that. Let’s talk about for the rank beginner, when someone comes to you and they’re like, I want to get strong. I want to start strength training, I’ve never really done it before. I might’ve messed around with some program that I saw. People don’t read muscle magazines anymore on Instagram. What are the common misconceptions guys have about strength and muscle building when they first start working with you?

Paul Horn:

Yeah, well, there’s a couple. One is that, I mean, I tell them all the time, you are not going to look like you take steroids unless you take steroids. I mean, I don’t care how good you are at this. There is a difference between the guys. The Instagram influencers, like you said, are back in our day, it was the guys on the covers of the magazines and the bodybuilders drugs work. And there’s a reason that those guys are on the cover of that magazine. So one of the misconceptions is like, oh, I just have to lift some weights and I’m just going to be 250 pounds at 4% body fat. It’s like, it’s not going to happen. So there is that layer of misconception, but I think the big one, the practical one that most guys have to accept and they’re going to learn it one way or the other, is that you can’t get big and strong and lean at the same time.

You have to do them in order. And if you’re not big and strong yet, you got to get big and strong first. You have to build a foundation so that when you go into a fat loss phase, you actually have something to show off. And so many times I’ll get a young guy who’s a buck 50 and he’s talking to me about wanting to cut and wanting to see his abs. And I was like, and it’s just like, dude, you’re going to look like you’re sick if you cut anything off of your frame right now, you don’t have any muscle mass, so you have to spend a period of time, I use the word bulking cautiously because you can definitely get too fat and you don’t have to do that, but you do have to get bigger in order to get stronger. And that comes with a little bit of body fat hopefully.

And if you do it, you can skew it. So most of every new pound you put on is muscle. And so you still look bigger, you don’t look fat because you’re kind of filling out your frame. And then after you’ve spent a year, two years maybe working on your form, learning how to lift, adding muscle mass, all that stuff, then you’ve sort of earned the right to cut. You’ve earned the right to say, okay, I’ve hit some benchmarks with barbell training and I’ve put in my time and now I feel like I’m getting a little chubby and I want to spend six months trying to take as much fat off as I can while preserving the muscle mass. And that understanding the order and the importance of the order is like that’s the number one thing that most guys who haven’t done it think they can do it all at the same time and it never works. So they either figure that out or they never make any progress. They just kind of don’t look really jacked and they don’t look really lean and they’re not very strong.

Brett McKay:

And I imagine too, I had to learn this. That stuff takes time. You can’t expect this stuff to happen in less than a year, do the putting on mass and then cutting. I mean, you can make significant gains if you’re first starting out with your strength and your muscle mass, but really the secret sauce to getting stronger, getting more jacked, it takes time. You’re not going to see instant results after you after your first couple sessions.

Paul Horn:

No, it does take time. You’re literally building tissue. It’s a biological process that it does take time. The cool part is it’s persistent. And as you add on those layers, and then with intelligent bulking and cutting strategies, the first run in both the bulking phase and the cutting phase is the longest because you want to get as much out of your novice phase as you can in terms of strength and size. And so if you’re a true novice, that can take six months a year just to run out the novice phase, maybe early intermediate phase. And then the first time you cut, especially if you’re 25, 30% body fat. And if you’re going to try and cut down to where you can see your abs, which is around 10%, you got a lot of fat to lose. So that first block, their cycle of bulking and cutting is the longest one.

But then once you get through that, the cycles get shorter because you don’t put on as much fat, so you don’t have as much fat to take off. And the cycles get more fun because, or your training overall gets more fun because you see a light at the end of the tunnel for each phase and okay, a couple more weeks of this and then I can do something different. But yeah, it’s getting people through that first phase. And I’ll tell you, in my gym, it was the end of the novice phase, usually around the six month mark where they’ve been focusing on just driving up the numbers on squats and deadlifts and presses. And at that point it starts to get hard. They start laying awake at night thinking about their next workout. It’s a grind every session. It scares the hell out of you. And if they can make it through that and keep coming and not quit and get to the intermediate phase, they’re lifters for life. But I’ve lost a lot of clients where they’re just like, I don’t dunno, man, this isn’t fun anymore. And it’s grindy and then that’s it. They go sign up for jujitsu or something and we never see ’em again.

Brett McKay:

Yeah. Okay. So for someone who’s first starting out lifting, they want to get bigger, they want to get jacked, they want to get awesome, those death star deltoids.

Paul Horn:Is that a thing?

Brett McKay:

I think I’ve heard that somewhere. Death star deltoids. I think a lot of guys, that’s their goal. They’ll immediately go to sort of a bodybuilder hypertrophy program where they’re doing four day splits, six day splits where they’re working one body part a day. You take a different approach. It seems like your first priority, someone who’s first starting out is just to get generally strong in big first. So what is the best programming for that?

Paul Horn:

Yeah, I mean the idea here is we’re going to spend some time laying down a foundation. We’re going to build a foundation of just strength and size. You’re going to learn how to lift. You’re going to be doing these basic barbell lifts for your entire training career. They’re always a part of the program. You may add other stuff, but this is really what’s causing the most stress and doing the most work is squats, deadlifts, benches, presses, stuff like that. So we need to spend some time getting proficient at those lifts. You need to learn how to push yourself. You need to learn how to unrack a weight that scares you and try it anyway, and then learn that you can do things that scare you and all of that. So you need a lot of reps. You need a lot of practice time under the bar.

And so a basic linear progression where you’re just, you come in and you lift one day and then you try and beat it the next time. So it’s five pounds, it’s two and a half pounds, but the program is very boring and very repetitive. It’s just a couple lifts. And the only variable we’re manipulating is how much weight’s on the bar. So very, this is why software developers love programs like this. They get it. They can wrap their head around it. It’s like, oh, I came in. I could bench press 95 pounds. Now I can bench press 185. I guess it’s working

And we want to keep it simple. You don’t need all that stuff. You don’t need six different chest exercises and you don’t need to be in the gym six days a week. You just need a simple program where you’re getting better at the compound lifts and just driving the weight up. And so the Starting Strength Program is a fantastic beginner program, novice program. My version that I put in my book, A Radically Simple Strength, was just a modification of that program based on training real clients in the gym and needing to get them in out in an hour, keep them excited, keep them interested in training, not to beat up, not dreading their workouts. So I mean, do you want me to get into the details of my Novice program?

Brett McKay:

Yeah, let’s talk about the general programming. Let’s talk about Starting Strength first. It’s really easy to explain whenever someone comes to me like, Hey, Brett, I want to get strong and bigger and jacked. I’m like, you need to start with Starting Strength.

The reason I tell ’em that, because it’s literally, it’s the best weightlifting program for a beginner, and I’ll tell you why first, because it’s just so simple. There’s just four lifts you have to do. That’s it. It’s just deadlift, it’s squat, it’s bench press and shoulder press. You’re only going to train three times a week. Anyone can do that. And then the workouts are easy. It’s just like you’re going to squat at the beginning of your workout three times a week, and then one workout you’re going to do bench press and then the deadlift, and then the next workout you’re going to do press. And then the next work you do bench press and deadlift, and then it just kind of alternate. You alternate between the bench and the press and you’re getting a full body workout. You’re going to get really strong. And it’s just so simple. It’s fast, especially when you’re first starting out. You’re going to be in and out of the gym in 45 minutes even. I mean, I’ve got my kids doing Starting Strength. They’re like teenagers, for them the weight’s really light so they can get done in 30 minutes.

Paul Horn:

Oh yeah.

Brett McKay:

And for a person who’s first starting out, I think one thing that keeps people from being consistent is just workouts can be too complex. They’re doing too many lifts and it just takes forever because doing seven different exercises with three sets of 10 with Starting Strength, you’re doing three exercises in your workout and it’s three sets of five. So the simplicity of it, I think is one of its virtues. And then also with the linear progressions where you’re just adding weight to the bar, incredibly motivating. I remember when I first started my novice linear progression, I was excited every workout, I was like, man, I’m going to add more weight to the bar. This is exciting. So you get that dopamine rush and that dopamine rush gets you motivated, and it just helps build that consistency for training. I was not someone who trained consistently before I started starting Strength after that. I am a guy, I am a guy who trains. Even though my training has changed, I’m doing different stuff now. Starting Strength helped establish that foundation because motivating and it’s super simple, and I think that’s really important for a beginning lifter. 

Paul Horn:

As you said, this is something that takes time. And so you need quick wins. If you’re not going to be satisfied or excited about your training until you can deadlift 4 0 5, you’re going to be miserable. But it is a long journey. And so you need those little victories, those small victories of like, Hey, you know what? Today I might not be where I want to be. I might not be at my ultimate goal, but I’m better than I was last time and I can see it. And so you’re right, you get those little daily workout victories of lifting five more pounds than you did last time are enough to keep you going. And then by the time, for me, the big shift, what got me hooked was you do it long enough and then you look in the mirror or you look at your training log and you go, damn, I just went into the gym for an hour three times a week and I picked up some heavy stuff and my physical body has changed. I mean, it gives people agency. You realize, look, I might not be where I want to be in life, but I’m not useless. I have a say in how I present myself to the world, and it’s very motivating. And if you can get the guy to that point where you have this realization that I can actually change my own reality just with work, just with effort, it’s a part of you. You’re in the brotherhood of Iron for Life. It’s very powerful.

Brett McKay:

Okay, so starting Strength, it’s three sets of five. You’re doing three workouts with these four different lifts, you’ve modified it. What is your version of sort of a novice program?

Paul Horn:

So my take on the novice program, the main difference with how Starting Strength approaches it and how I approach it just again from it was a more practical strategy for running clients through a commercial gym. And that was starting. Strength is like the novice phase is your most productive phase. You eek out every little bit of progress that you can for as long as you possibly can. No matter how hard and grueling and grindy it is, if you can press two and a half more pounds, you do it. I look at my novice phase as the way that we’re going to get you to the intermediate phase because if we can get you to the intermediate phase of training, that’s when we get more variety. That’s when things get more fun. Everything becomes less grueling. You space out your workouts, you maybe have upper and lower workouts.

So my novice phase was like, let’s just learn how to lift. Let’s get a lot of reps in a lot of practice. Let’s build a reasonable foundation of size and strength, and then let’s move on. So I do ascending sets of five instead of three sets of five. So this is an old Bill Star thing. Rather than do all your warmups, take a five minute break and then do three sets of five at the same weight with a five minute break in between each one, we just do the bar and then we do a set of five at 60%, 70%, 80%, 90%, a hundred percent done. So your warmups kind of count as sets

And it’s real fast. And is it as productive for as long as the Starting Strength novice program? Probably not because at some point those ramping sets tax you a little too much, and so you’re kind of tired for your heavyset, but it’s good enough to keep the workout really short and make a lot of really good progress and build that foundation. And it’ll take you, you’ll be able to run that for about three to six months before it kind of stops working and you have to make some modifications. But every guy I’ve switched over to that program after running the Starting Strength Program was like, God, this is so much faster. It’s just like, I like going to the gym just, and again, if that keeps you training that little modification, then great, you’re going to end up in the same place eventually down the road. So that’s really the big one is we start out squatting, benching, and deadlifting, but we’re just doing ascending sets of five.

Brett McKay:

Gotcha. That makes sense. 

Paul Horn:

And then we move on in the second month of workouts, we start adding in some chin-ups and lap pull downs, so we’re not deadlifting every time. And then in the third phase of the novice program, which is like workout 25 till it stops working, I start adding in some curls and tricep extensions just because curls are awesome, guys want to curl. So by that point, I think you’ve earned the right to curl, to throw a couple sets of curls in at the end of the workout. And again, just to keep it, you give people a lot of what they need and a little of what they want and they’re happy. So that’s really the difference between my novice program and the starting strength. And again, Starting Strength is a fantastic program and it works really well. I’ve used it for decades.

Brett McKay:

And so again, the goal here is just getting bigger and stronger, putting on muscle mass, full body, the focus isn’t hypertrophy per se. There will be hypertrophy, your muscles will get bigger, but it’s not like that’s your main focus, just get bigger and stronger. 

Paul Horn:

Learning again, and learning the technique, like five sets of five ascending is that you get a lot of reps in there, you get a lot of practice, and we need that early on. And then again, it’s also learning how to grind, learning how to push yourself, and you have to learn how to do that. And so you need a lot of time under the bar and exposure to those sets that scare you towards the end of that novice phase.

Brett McKay:

For a guy that first year when they’re just starting out, they’re doing that novice phase, they’re learning the lifts, getting bigger and stronger. What are some good goals a guy could get to? What should they be going after? Are there any specific numbers you found?

Paul Horn:

Yeah, yeah. I mean the first tier of goals in my book are what we call plate goals, a 45 pound plate. So you want to be able to press 135, bench 225, squat 315, and deadlift 405. So it’s one plate, two plate, three plates, four plates, and that’s for one rep. So that’s the first benchmark that any guy can hit.

Brett McKay:

And if you do that, you’re going to be stronger than a lot of people.

Paul Horn:

Oh yeah. I mean the bar is so low, and especially now with the influencer trend away from heavy lifting and back to the machines and stuff, there was a period in probably 2010 where if you went to a gym, those numbers weren’t that impressive. And to competitive lifters, they’re not impressive. But to the average gen pop gym goer, especially these days when all the machines are coming back, if you could squat 405, you’re in the 1% of people at that gym and they’re very reasonable goals. They’re not hard to do.

Brett McKay:

And I think what it also, it makes you generally strong for life, generally strong and healthy for life. If you get those numbers, you’re not going to be beat up, you’re not going to hurt, but you’ll be able to help move your buddy on the weekend. And it’s not hard because you’re stronger.

Paul Horn:

Yeah, it’s a solid respectable foundation of strength and it’s attainable to anyone. And the thing is that, as you know, the numbers don’t matter. I don’t care if you can squat 315. I care that you’re doing a program and you’re trying to get a little better every time and you’re pushing yourself, but you do have to have a target. Guys need to have a goal because if you’re just training and you don’t have a, there’s no lighthouse you’re sailing towards, it’s hard to stay motivated. So that’s the starting point. And then once they hit those, we can either move on to what in the book, I call ’em hundo goals. So two hundred, three hundred, four hundred, five hundred. Lately what I’ve been doing is just saying, let’s take those plate goals, one plate, two plates, three plates, and let’s just, instead of your goal being to do ’em for one rep, let’s try and do ’em for five reps. So you’re going to end up you deadlift 405 for five. That’s your sort of phase two target. And then from there, there’s more goals, but most people never even get there. And that’s okay when as we talked about, start asking about more bodybuilding stuff, right?

Brett McKay:

We’re going to get to that in a second before we do. We’ll stick on this mass phase, getting generally strong, getting bigger when you’re first starting out, nutrition plays an important role. And the thing I noticed with a lot of guys that start training is they’re doing the program, but they’re not eating to fuel the gains. And what’s interesting, people have a lot of misconceptions about diet. I think people have more misconceptions about nutrition when it comes to training. Then the programming itself, because there’s just so much stuff out there. But really simply, what does a good diet plan look like when you’re in this beginning phase?

Paul Horn:

Well, the high level concepts is protein is the biggest thing. And you’re right, the hardest thing to do is not the lifting, it’s the eating because you have to eat three or four times a day every day, even if you don’t want to, especially if you’re a skinny guy, you got to eat more food than you want to. And when you get into a cutting phase, you got to eat less food than you want to. Diet is the hardest part of this whole thing. But the number one mistake guys make is they don’t eat enough protein. And it’s just if you’re not, I used to tell my guys all the time, if you’re not eating enough protein, then you are wasting your time in the gym because the protein literally builds your muscle tissue. So you’re doing all the hard work, you’re busting your ass in the gym, and then your body’s trying to rebuild, repair and add more contractile tissue, and you’re not supplying it with the bricks it needs to build.

So undereating protein and then undereating calories, if we’re talking about the novice sort of bulking phase for an underweight male lifter, they don’t eat enough food and specifically they don’t even eat enough protein. So carbs and fat, I try and keep this as simple as possible, just hit your protein goal. And at this point in my coaching career, I just tell everybody, your goal is 200 grams of protein a day more is better. If you’re 200 pound guy, fine, 220. If you’re 185 pound guy, 200’s, great. So for most guys, just hit 200 grams a day and then with those meals will come carbs and fat. And then just check your weight. If you get on the scale every morning after you go to the bathroom naked and look at the number, and if we’re in the novice phase or we’re in a bulking phase, that number needs to be going up every week.

So total it up over the course of the week. And if you’re a pound heavier than you were last week, you’re doing great. If you’re not and you go two weeks in a row, you need more food, it’s a math problem. You’re not eating enough calories. So the mistake that they make is usually it’s gaining too much weight too fast. So when you first start training, if you’ve never lifted, I always tell people in the first two, three weeks, don’t worry about the weight on the scale. Because a lot of times when a guy starts picking up a barbell, he’ll gain like 5, 10 pounds within a matter of weeks after the first month. That should start to slow down. And you want to hit an average of about a pound a week. If you’re a little fluffy coming into it, maybe you’re going to maintain depending on how much body fat you have, but if your body fat’s a little high, maybe shoot for half a pound a week while you’re trying to build this foundation of strength. But if guys, if you’re six weeks into the program and you’re gaining three pounds a week, you’re just getting fat, unnecessarily fat, and you’re going to end up getting to the end of your novice phase and thinking, well, this strength training just makes me fat. It’s like, you don’t have to do that. It’s a very, very modest amount of weight gain that you need to build that muscle tissue. Only so much muscle tissue you can build in a month, unless you’re taking drugs and it’s like two pounds of actual lean tissue. So that comes with other stuff. So at most, you’re looking at four pounds a month. Anything beyond that besides a rank, novice, underweight, 17-year-old. It’s like if you’re gaining more than four pounds a month, you’re getting fat.

Brett McKay:

Yeah, the trick is you want to gain weight, but keep fat gain to a minimum. You’re going to gain fat as you put on mass. There’s no escaping that. But the goal is make sure it leans more towards muscle tissue and less towards body fat. And I think, I know back in the day, starting strength, got a lot of flack for the goad gallon milk a day and all these guys just getting really fat and eating sheet cake.

Paul Horn:

Dude, we were so fat, we were so fat. 

Brett McKay:

You don’t need to do that. You don’t have to get fat to get big and strong. You can get slightly bigger week to week.

Paul Horn:

So my first, I looked around at, I remember being at the Starting Strength Coaches conference and looking around and we had some real strong guys there. I mean real good lifters. And Matt was one of ’em, Jordan was one of ’em. And I looked around and I thought, I’m trying to make a little niche for myself in this community, and I’m not going to be the strongest guy. In fact, someone had totaled up all the training logs on the starting strength forms and ranked all of us coaches. And I was like, my strength was dead center. I was totally like mediocre. And I thought, okay, I’m 252 pounds. I’m fat. I mean, I feel fat. I’m never going to be the strongest coach, so let me see if I can just lose, lemme see if I can get down to 10% body fat. I’ve never done it. Lemme see if I can see my abs. And so I did and it took, but I think I was the first coach in our community to do that. And I remember texting Grant Brogue, a fellow coach, and I had just hit 10% body fat, and I took a picture in the bathroom mirror and I sent it to him. I was like, I’m thinking about putting this on Instagram and it feels kind of lame. It’s a picture of me shirtless. And he just texted me back, he’s like, dude, post it. And I did. And within a matter of a year, all these other coaches and lifters started just shedding body fat. And that became starting strength. As we’ve said, it’s fantastic for lifting. It is a horrible book for nutrition unless your goal is to be a 275 pound fat lifter. 

Brett McKay:

Power lifter. Yeah,

Paul Horn:

Because a gallon of milk a day works. I’ve done it and it works, man. It’ll put weight on you real quick. But most guys, my average client is like, he doesn’t want to be a power lifter. He doesn’t want to be a bodybuilder. Just like I said, he wants to be a little bit bigger, a little bit stronger, not fat and not hurt. And so that first time through of learning how to manipulate my diet to actually get down to 10% body fat was sort of what I thought I could contribute aside from the more abbreviated novice program and stuff to fill the hole in sort of the starting strength community of like, Hey, if you guys want to really talk about strategies for getting lean, maybe I have something to offer. Done it. And then I did it a couple more times and I’ve gotten a lot better at it. 

Brett McKay:

Yeah. Yeah. So if you’re first starting out, put on some mass and if you’re underweight, make it your goal to put on one to two pounds a week maybe. And then if you’re already coming into it heavy, there’s a lot of guys who they’re starting out but they’re overweight, they’ve got a lot of fat tissue. You just reduce your calories, so you’re losing about a pound during that strength phase. If you’re bigger, you can get away with some recomposition, so you can put on some muscle mass while losing body fat at the same time. So yeah, you can get put on muscle mass while reducing body fat as well, but it’s going to be a gradual thing. You don’t want be no severe cuts where you’re reducing calories way low. You just want to lose a pound to a 0.5 pounds a week.

Paul Horn:

In my book, I sort of break the novice lifter into three categories. The underweight guy, the sort of fluffy untrained guy, and then the overweight guy. So if you’re coming in and you’re just a rail, you have a high metabolism, you’re a skinny dude for the novice phase, for the first couple months of the program, your goal should be to gain 20 pounds. And then if you’re kind of in the middle, maybe it’s gained 10 pounds, slow it down, go half a pound a week instead of a pound a week. And then if you’re coming in carrying a lot of body fat, what I say is just maintain, don’t try and gain weight. And because you will be able to recompose, so the only time you can add muscle and loose fat at the same time, there’s three scenarios. You are a brand new lifter, you’re already carrying a lot of body fat or you’re taking drugs.

So outside of those three states, you’re doing one or the other, you’re building muscle or you’re losing body fat. But so yes, for the guys who are coming in who have a high body fat percentage, just eat enough to kind of maintain, if the scale goes down a little bit, that’s okay. If it stays the same, that’s okay because if your weight stays the same but you put a hundred pounds on your deadlift, you obviously gained muscle and lost fat. And that happens all the time. Every time I have my guys do body scans at the beginning, like body composition scans at the beginning of their training when we start and maybe at the six month mark and so many guys are able to just recompose and it’s amazing and then it goes away.

Brett McKay:

Yeah, you got to do something different. Alright, so we’ve been talking about just getting for first guy, starting out, you’re going to do the basic barbell lifts, squat, bench, deadlifts, shoulder press. You’re going to work out three times a week. You’ve got your version of what a linear progression looks like, sending sets of five on the lifts, and the goal is to add weight each workout. Let’s say you’ve been doing this for a while, and then you have to kind of modify your programs. You can keep driving weight at the bar. Let’s say a client reaches the point is like, you know what, Paul, I’m happy with how strong I am. I’m generally strong. I can deadlift 4 0 5, I can squat three 15. I’m not going to do any recreational power lifting meets. I want to start getting jacked. I want to get those death star deltoids. What does your programming look like for these guys? Because it sounds like you’re going to keep doing these barbell lists, but you’re going to add in some other stuff. What does that look like?

Paul Horn:

Yeah, so like I said, the intermediate program is where things get more fun. There’s more variety and it’s less grueling. You have hard workouts, but you’re not squatting heavy, benching heavy and lifting heavy in the same workout. So my go-to intermediate program in the book, it’s called the Intermediate B program, and it’s four workouts and I have my guys run ’em over a three day week. We’re staying consistent with the three day training schedule that they’re used to, but we move from full body to upper lower splits. Now on Monday you’re going to bench press and then you’ll do a light overhead press, and then you’ll do some arm work, tricep extensions. On Wednesday you’re going to squat and deadlift. So I have you squatting heavy and deadlifting light, and then some chin-ups or something. And then the Friday you’ll flip Monday’s workout. So you’re going to press heavy and bench light and then do some curls and bro stuff just for fun.

And then the following Monday, so the fourth workout would be deadlifting heavy and squatting light. So it’s upper, lower, upper, and then the next week is lower, upper, lower. So you have one hard week where you have two lower body workouts, and then you have one easy week where you have two upper body workouts and one lower body workout. And so we’re spreading out the frequency. You’re not hammering yourself all the time. And the beauty of that is it’s flexible. So with upper lower splits, you can train two days in a row. You don’t need a day off in between upper and lower, which is nice. It’s a lot more flexible that way. And then the other thing I start incorporating, and this is where I sort of branch off from starting strength, but it’s something that I am very passionate about, is introducing rep ranges.

So before when you were a novice lifter, it was like, no, you get five reps. Your goal is five reps. If you don’t get five reps, you failed. Okay? And that’s okay. We all fail. You’re going to fail, but you have that target and you need to push yourself really hard. If you want to add more weight next time you got to get that fifth rep. When we get into the intermediate phase, I like to pump the brakes a little bit on the intensity of the live and die by the fifth rep mentality because guys are burnt out by that. And it’s like you don’t want to hate your workout. You work all day, your boss is yelling at you, your kids are running around screaming, you go to the gym and then you get four reps instead of five, and you’re like, can I do anything?

Right? It’s demoralizing. And so the rep range, what we’ll say is, for example, you’re going to squat. So you’re going to go in and you’re going to warm up, and then you’re going to do one set of squats and the rep range is three to five reps. So you have a minimum and a max, your goal is five. But hey, look, today, if you only have three or four, that’s okay. You’re in the range, you still had a good workout. The next time you just try again. What you’ll find is we all have bad days. Doesn’t mean your training isn’t working, doesn’t mean you did anything wrong. Maybe you didn’t get enough sleep, whatever. But you walk out of the gym going, look, at least I got three, so that’s okay. And the mental shift of taking that pressure off, it’s like one of the things I get emailed about most when guys switch from the Texas method where it’s like five sets of five rigid to this flexibility, it’s a mental, it takes a lot of pressure off and it keeps them really enjoying their training more and pushing.

If I tell you like, Hey man, let’s see what you got. Maybe you only have three today. That’s okay. A lot of times guys will, when they know that that pressure’s off, they’ll push themselves harder for five. It’s a surprising psychological thing. So we work up, you do one set of three to five, and then we do a back off set. So instead of doing sets across, we’re going to do one heavy set and then we’re going to take some weight off about 15%. And then you do another set for if it’s the squat, it might be five reps or five to eight reps or something like that. But if it’s the upper body stuff, maybe you push for as many reps as you can, but that other shift of you have one hard set, okay, you’re going to warm up and you have one hard thing to do today, especially on those lower body days where it’s like the deadlift.

Okay, look dude, you got one set of three to five today, and then after that we’re going to pull a little weight off and then you squat light, everything gets easier. And so just giving guys that everybody can do one hard thing. I don’t care how tired you are, I don’t care. Can you just get it together to do this one hard set? And then you move on. And those two things, the rep ranges and the one hard set, and then a back set is what I’ve found kept my clients and my current clients training with me. They’re not constantly failing.

Brett McKay:

So you’re going to shift to a four day split. That means you’re going to train upper body one day, lower body, upper body and lower body, something you’ve set in radically simple muscle. If your goal hypertrophy is like we’re not just working on getting generally big and strong, we’re actually going to do some bodybuilder stuff. You talk about your philosophy is train your lower body like a powerlifter and train your upper body like a bodybuilder. What does that look like?

Paul Horn:

So we’re talking about a trainee who’s gotten to the point, like we said, where they’ve established that foundation of strength, so they’re moving heavy weight. So these workouts can be stressful and a lot of them are like, okay, I did the boring workouts, I built this foundation. I’m strong and I want to mix it up. I’m feeling beat up. I’ve accumulated some injuries. And so the radically simple muscle program, which was just supposed to be A PDF, but ended up turning into my second book, I have guys shift to, especially if their goal is now like aesthetics. I’ve got this mass that I’ve built, but now I want to kind of shape it. So training your upper body like a bodybuilder and your lower body like a power lifter. There’s a number of reasons for that. One of them is exercise variety. So bodybuilding typically uses lots of different exercises, isolation movements, and that’s primarily because your upper body muscles can be segmented into basically pushers and pulls.

You’ve got your lats and your pecs and they do opposite things. So if you do a bunch of seated cable rows that doesn’t build your chest, you have to do some type of pressing variation, and those presses don’t really build your back and the upper body demands that there’s a reason for it. If we contrast that to the lower body, you can think of hamstrings and quads as pushers or pulls and pushers, but they’re both covered by the squat and the deadlift. Both of those functions happen in both of those lifts. So let’s just squat and deadlift. I don’t want to do seven leg exercises when squats and deadlifts work everything all at the same time versus, like I said, I can’t just have you curl because it’s not going to train your triceps. So that’s one part of it. The other part of it is aesthetics. When you size a guy up and we all do it, you see a guy and he’s like, that guy’s jacked. You’re looking at his upper body, right? You’re looking at those landmarks, those desirable aesthetic features, cap shoulders, a vein in the bicep, things like that. Okay, that shaping that is a bodybuilding. If you just focus on overhead presses, I promise you, you will not have shoulders. Would you say death star?

Brett McKay:

Death star deltoids.

Paul Horn:

Yeah. I mean, my shoulders never looked worse than when I was just pressing 200 pounds over my head. It just didn’t fill out the deltoids the way that something like very light lateral raises do. So there’s a bunch of different examples of that with the upper body. You need to do some curls. Chin ups are great, but curls, tricep stuff, it makes those muscles pop. And that’s what we want when we talk about an aesthetic physique versus the lower body. Unless you’re walking around with your pants off, your lower body just needs to be big, right? You need to have big legs and a big butt. And you could do that with just squats and deadlifts. So again, that will just squat and deadlift for the lower body and we’ll spend some time doing bodybuilding stuff for the upper body. And then finally it comes down to high reps versus low reps.

Bodybuilders use high reps. Traditionally power lifters use low reps. Your upper body joints are much smaller and much more sensitive. They don’t have as much structural integrity as the lower body. If you think about your hip joint, it’s like a sturdy ball and socket, your G glenohumeral joint in the shoulder. It’s like a shallow cup. And I’ve had three shoulder surgery, so I can tell you that is a very unstable joint, just banging out, grinding out heavy triples with bench presses and stuff like that, your wrists are going to hurt. Your upper body joints are not as tolerant of heavy weights as your lower body where you have more sturdy joints and a lot more muscle mass helping move the weight. So when you get into that phase of like, do I really care? Am I a powerlifter or do I just want to look good and feel good? Then maybe you spend some time bumping up the rep range in the upper body, taking the stress off a little bit with loads that are less likely to sort of fall out of the groove and end up tweaking something. And then the lower body, I dunno about you, I do not want to do high rep deadlifts.

Brett McKay:

No, that’s not fun. 

Paul Horn:

They’re miserable and you don’t have to, could just do a set of five, a set of three. So squatting sets of eight is just, I mean it’s brutal and I use it sometimes for cardio development, but ultimately I have a hard time counting past five for lower body stuff. So that’s the philosophy is we’ll do the bodybuilder stuff for the upper body. It works better for the requirements and the demands of that and the lower body, we just take care of by training like a powerlifter. And at that point in my training, one of the biggest shifts that I’ve made is squatting and deadlifting heavy every other week, which I thought would be counterproductive, but it’s actually been, I mean, my lips have never been better with only squatting heavier every 14 days, but you’ve got to get to the point where you can make that work and we can talk about that another time. Yeah,

Brett McKay:

I mean, it’s interesting. My programming has kind shifted to that train your lower body, like a powerlifter upper body, like a bodybuilder. So my current split that Matt Reynolds has me on, it’s Monday is a lower body day, and I start off with a heavy set of deadlifts, and then I do accessory work after that for the quads. So I’ve got a leg extension machine in my garage gym. So I do some leg, not high rep, it’s like 10 reps, but going on heavy, do some calf raises, and then my upper body day on Tuesday, I start off with heavy bench press, just typical bench press workout. And then after that I’m just doing bodybuilder stuff. So I’ll do some shoulder work. So I do shoulder dumbbell presses, maybe some lateral raises. So the assessor work is more shoulder heavy. And then I’ll throw in the curls, tricep extensions, lap pull down, and then Thursdays is my next lower body day. I’m squatting, I got my first lifts to the squat. Then after that I do assessor work for the hamstrings. So I’m doing a RDL, and then I’ll do some leg curls for the hamstrings. And then Friday it’s upper body start off with the press. So I’m doing barbell press and I’m not doing a lot of sets. I do one heavy set and then two back off sets that are as many reps as possible. And then my bodybuilder stuff, it’s more chest focused, so I’m doing an incline dumbbell bench press,

And then some cable flies or maybe some dumbbell flies, and then I’m doing a curl. 

Paul Horn:

Great exercise. 

Brett McKay:

Then a curl variation, and then another tricep exercise variation and then a row for the back, just get a different, and that’s it. And yeah, my lower body days are fast because really there’s not much there. The upper body days take a little bit longer because like you said, you can do a little bit more variety on the upper body.

Paul Horn:

I’ll have to send you my, so at the end of, I added a program after radically simple muscle came out because I did an experiment. I was at a point with my training that I was just, I mean, I’ve been doing this for a long time. As my buddy says, my training partner, he says, man, I hate training. I just hate not training more that feeling when you haven’t worked, but it’s like training just got after decades, just I just hate it. So I was like, how can I make this fun? Let me try something. And so I decided to see how little I could get away with. So I just picked a couple bang for your buck exercises. I think I did a bench press, a row, a squat, a deadlift, a pull up, overhead press, curl lateral. I just one exercise for each thing. And then I just started doing one set and I was like, I’m going to try and hit eight reps. If I hit eight, that’s it. I’m done for the day with that exercise.

Then my rule was if I don’t hit eight, two workouts in a row, then I’ll do a second set. I’ll do a back off set. I’ll go in thinking one set, and it worked for a couple weeks. It was like, I’m getting eight every time it’s going up. This is great. And then I’d stick for two weeks. And so I’d do a back off set, and then the week after that it would move and so cut the back off set. And so I’m just literally, the workouts are like 30 minutes. It’s one set, and man, I’m having a great time in the gym again. 

Again, it’s that mental thing of like, look, I’m only doing one set, so I got to make it work. But that type of program, and I always tell guys who email me about the book, the reason that it works is because I’ve put in the time to figure, to learn how to grind, to learn how to really push yourself, and it just takes time to understand what you’re capable of, that you have a lot more in you than you think. But if you’re a novice lifter, you don’t know how to push. So one set isn’t going to work because that one set isn’t going to be very stressful. But if you get to the point that you’re at where I’ve seen your deadlifts and stuff like that, and you’re like, look, Brett, you have one set, that’s it. That will be a very stressful set for your body. And it was totally an experiment. I put up a YouTube video about my new training experiment, and I’m never going back. It’s so fun. And the programming is so simple. Programming people make programming so complicated. It’s like, look, here’s the weight. Did you get all the reps you were supposed to? Great go up. Next time you didn’t. Okay, well, you need to add a little bit more stress. Then do a second set. Did it go up next time? Good. That’s it.

Brett McKay:

Yeah, no. Okay. So once you get to that point where you’re working, hypertrophy, workouts can become a lot of fun and it can also become really fast. Sounds like you’re kind of doing some Mike Metzner heavy duty type stuff there with the one rep or one set workouts with the exercises. I’m curious, guys, if their goals now physique at this point in their training when you’re lifting for strength, the goals are pretty easy. It’s like, well, if I just get more weight. If you’re working on physique, what are some good physique goals or benchmarks to hit for the average dude.

Paul Horn:

Yeah, so there’s two in my book, I talk about getting your bicep vein, getting arm vein lean.

Everybody always talks about abs, but you’re walking around with a shirt on most of the time, but you see a dude at the coffee shop and he’s got a big snake running down his bicep. You know that guy’s in good shape. It’s cool. So I much prefer that metric, and that’s just reaching a certain level of body fat. So numbers wise, I always tell guys that your first goal when you cut is 10%. You want to get down to 10% body fat. You should get down to 10% body fat once in your life to figure out how to do it right, because hard, I mean, for some guys, they walk around at 8% body fat, whatever. I hate you, not me, it’s not you. Most of us are very happy. Our bodies are very happy to not be 10% body fat. So you cut down to 10% and that’s usually where you can see your abs and your lean, but you’re going to look kind of skinny with your clothes on. You look pretty ripped at the beach, but once you get down there, now when you bulk back up, you’re going to skew more towards muscle gain than fat gain because the nutrient partitioning changes once you get that lean. So your body, it’s much easier to put on muscle and not as much fat once you strip it off. So the first goal is 10%, and then once you get sick of restricting of being miserable and dieting for that long, because getting to 15% is not hard, but as you start getting close to 10, your brain starts messing with you. So that last 3% is can be brutal. Of course, now we have these miracle GLP drugs that just make this whole process super easy. But yeah, my goal is you get down to 10% body fat, you can see the veins in your arms. That’s a good measure and pay attention to when that comes, mind pops up around 13%.

So that’s kind of my gauge. Do DEXA scans. So you want to get good at understanding your visual cues of your level of leanness, and then you’re tired of that. You want to go back, start moving weight again, setting prs, bulking back up. So we’re going to bulk back up until we hit 15%. That’s sort of my cap. Of course, I’m saying that to you right now at like 18% because I have not been taking my own advice, but traditionally you want to just cycle between 10 and 15%. That’s my approach to this. 15. You still look good. You still look athletic. You could still see maybe your top abs and it’s a healthy athletic physique. You’ll look good with a shirt on. You’ll look like a big dude. And then every so often you got a vacation coming up or a high school reunion or something. Maybe you use that as motivation to try and cut back down to 10 or 12% or something like that. And then you just keep cycling as you want to. But hitting that first 10 is hitting those first barbell goals, those tier one goals.

Brett McKay:

Yeah, that’s exactly what I’ve done. I did a pretty big cut in 2023.

Paul Horn:

How lean? Did you get to 10?

Brett McKay:

I don’t think I got to 10. I probably got down to 11.

Paul Horn:

Okay. It’s fun, right? Yeah,

Brett McKay:

No, it was awful. It was terrible. And then after that, I’ve just been bouncing back between, I’ve been hanging around like 15 to 12 is where I’ve been hanging out at.

Paul Horn:

That’s great. That’s great.

Brett McKay:

It seems to work for me. And the physique part, you got to to keep training hard because you want to maintain muscle mass, but a lot of it’s just nutrition. It’s just learning how to learn to reduce calories and be okay with being hungry and things like that. But again, it’s a skill that you develop and once you develop it, it’s pretty easy.

Paul Horn:

Yeah. You learn how to deal with the cravings, that you don’t eliminate foods, you replace them if you have a, I mean, have a habit of having a cocktail at the end of the night. It’s like you don’t just try and sit on the couch and stare at the wall, get a sparkling water and put lime juice in it and make it, there’s little psychological hacks for that last part, but man, yeah, it, it’s no fun. Your training, a big misconception guys have is, well, if I’m cutting then I’m going to get weaker. That is not true. I find that most guys can hang on to their strength in the gym. I mean, at least maintain. I’ve had plenty of guys set PRS during a cut, but it’s usually once it gets below 15%, 14, 13, then all of a sudden your strength just falls off a cliff and you feel like you’re a hundred years old and then you just got to ride it out and do the best you can to finish the cut and then get back to eating like a normal human.

Brett McKay:

Well, Paul, this has been a great conversation. Where can people go learn more about the books and your work?

Paul Horn:

Yeah, thanks so much for having me. This was fun. I’m glad we got to reconnect. Everything is on horn strength.com. That’s my website, and you can find links to books and all my stuff there. 

Brett McKay:

Fantastic. Well, Paul Horn, thanks for time’s. Been a pleasure.

Paul Horn:

Yeah, same. Thanks for doing what you do, man. I appreciate it.

Brett McKay:

My guest today is Paul Horn. He’s the author of the book’s, radically Simple Strength and Radically Simple Muscle, both available on amazon.com. Check out it website@hornstrength.com and also check out our show notes at aom.is/SimpleMuscle. Find links to resources we candel deeper into this topic. Well, that wraps up another edition of the AoM podcast. Make sure to check out our website at artofmanliness.com. Find our podcast archives. And while you’re there, sign up for a free newsletter. We have a daily option and a weekly option. They’re free. The best way to stay on top of what’s going on at AoM. Take one minute to give a review on Apple Podcast or Spotify. It helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member who you think was something out of it. As always, thanks for the continued support. Until next time this is Brett McKay. And remember, don’t just listen to the podcast, but put what you’ve heard into action. 

This article was originally published on The Art of Manliness.

An important part of manhood has always been about having the competence to be effective in the world — having the breadth of skills, the savoir-faire, to handle any situation you find yourself in. With that in mind, each Sunday we’ll be republishing one of the illustrated guides from our archives, so you can hone your manly know-how week by week.

If you’re physically active, you’ve likely rolled an ankle now and again. Ankle sprains come in two types: an eversion, in which the ankle rolls outwards, and an inversion (by far the most common type), where your ankle rolls inwards. Either kind of sprain results in the painful stretching or tearing of ligaments. When you sprain an ankle, you should immediately ice it, compress it, and elevate it to reduce swelling and inflammation.

But when can you start walking or even running again after you’ve sprained an ankle? The answer varies depending on who you ask. Many physical therapists and sports doctors recommend that you don’t resume physical activity until your ankle no longer hurts when you take a step. Depending on the severity of the sprain, that could take weeks.

Other physical therapists and sports doctors suggest that movement may in fact speed the healing process, and that walking and even running can resume less than 24 hours after a sprain so long as the ankle is given support through proper taping. Taping limits the range of motion of your ankle, which reduces the chances of it spraining again, which allows you to continue to engage in physical activity while it heals. Taping also compresses the injured area, which helps reduce swelling and inflammation.

Sprains are rated as mild, moderate, or severe. With a mild sprain, the ligament has just been stretched. Your ankle feels stable when you put weight on it and just feels a little sore and stiff. With a moderate sprain, the ligament has torn a bit. Your ankle doesn’t feel entirely stable when you put weight on it, you can’t move it very much, and it’s swollen. With a severe sprain, the ligament has been completely torn. You can’t put any weight on it, can’t move it, and it hurts a ton. Taping an ankle to resume physical activity immediately after a sprain should only be reserved for mild to moderate sprains. For severe sprains, you need to stay off your ankle for a few weeks so that the torn ligament can heal. 

This article was originally published on The Art of Manliness.

Modern medicine has given us incredible tools to peer inside the body and spot disease earlier than ever before. But with that power comes a problem: the more we look, the more we find — and not everything we find needs fixing.

My guest today, neurologist Dr. Suzanne O’Sullivan, argues that our culture of over-diagnosis is leaving many people more anxious, more medicalized, and sometimes less healthy. In her book The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker, she explains how screening tests, shifting definitions of “normal,” and the rise of mental health labels can turn ordinary struggles or idiosyncrasies into problems in need of treatment. We dig into everything from cancer and diabetes to Lyme disease and ADHD and discuss how diagnosis really works, why screening can sometimes harm as much as it helps, and how to know when a label is and isn’t useful.

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Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness podcast. Modern medicine has given us incredible tools to appear inside the body and spot disease earlier than ever before. But with that power comes a problem. The more we look, the more we find. And not everything we find needs fixing.

My guest today, neurologist, Dr. Suzanne O’Sullivan, argues that her culture of overdiagnosis is leaving many people more anxious, more medicalized, and sometimes less healthy. In her book, The Age of Diagnosis, How Obsession With Medical Labels is Making Us Sicker, she explains how screening tests are shifting definitions of normal and the rise of mental health labels can turn ordinary struggles and idiosyncrasies into problems in need of treatment.

We dig into everything from cancer and diabetes to Lyme disease and discuss how diagnosis really works, why screening can sometimes harm as much as it helps, and how to know when a label is and isn’t useful after the show’s over. Check out our show notes at AoM.is/diagnosis.

All right, Suzanne O’Sullivan, welcome to the show. 

Suzanne O’Sullivan: Thanks for having me. 

Brett McKay: So you are a neurologist and you’ve got a book out called The Age of Diagnosis, how Our obsession with medical labels is making us sicker and you’re making the case that in the past few decades we’ve developed this culture in the West where you have patients who are actively seeking.

Medical diagnoses for things they might not have thought about addressing a few decades ago. And this might actually be doing us more harm than good. And so in your book, you talk about over-diagnosis. What do you mean by over-diagnosis and why is it a problem? 

Suzanne O’Sullivan: Yeah, so I think the definition of over-diagnosis is crucial here because I think a lot of people, if they hear over-diagnosis, their mind immediately goes to this idea that, oh, there’s nothing wrong with that person.

They’ve been diagnosed and, and they’re complaining about nothing. But that’s really not what over-diagnosis is. Over-diagnosis could mean that someone is really suffering and they definitely have a problem. But that medicalizing, that problem is doing more harm than good. So if I give you a couple of examples, it can happen in different ways.

So one way that over diagnosis occurs is over detection. So now we’ve got all these amazing tests we can do. We have MRI scans, we have blood tests that weren’t available decades ago. The consequence of those tests is that we can pick up diseases and abnormalities at earlier and earlier stages. And when we do that, we usually treat everything that we find, but not everything that we find was inevitably going to cause a medical problem in the long run.

So not everything we find actually needs to be treated. So that’s kind of over-diagnosis by over detection, treating things that are there but did not necessarily need to be treated and wouldn’t have caused health problems if left alone. And the second way that we get over diagnosis is through over medicalization.

So that’s where you begin applying medical labels to things that may really just be ordinary types of suffering. So that may be giving mental health labels, for example. To people who are genuinely suffering. But it may be that that suffering is better addressed through examinations of life, such as, you know, changing your work circumstances or changing your relationship rather than referring to that suffering by a medical label.

So it’s really sort of, overdiagnosis doesn’t mean that a person doesn’t have a problem, but it’s asking the question whether referring to that problem as medical, is that really the right thing to do? And I also want to, I, my. Terrible talker, and you may often need to interrupt me, but at the, at the outset you said that we are seeking this out.

I have to say that that’s not my perception. I think it’s a kind of a collusion between scientists and doctors and the public. We’ve got tests and we want to do them, and we want to find diseases at earlier, earlier stages. We are calling people forward to be medicalized, but people are equally coming forward quite willingly and allowing that to happen to them.

Brett McKay: Yeah that was one of the big takeaways that I got from your book was that one of the reasons why this overdiagnosis is happening is that we just have these tests that are available to us that weren’t available decades ago. And I think what it’s done, and you talk about this in the book. Is that it’s really maybe distorted the lay person’s idea of how a diagnosis is supposed to work.

Because I think now with these tests, we think, well, you just take a test. You do the MRI, you do the blood test, maybe answer a few diagnostic questions, and then the doctor gives you this definitive diagnosis. But you argue with any medical diagnosis, there’s. An interpretive element to it. It’s not just this objective test.

Can you explain what people misunderstand about how diagnoses are actually made? 

Suzanne O’Sullivan: Yeah, so I mean, a diagnosis is much more of of a clinical process, so that means that you have a complaint, it’s a pain, or it’s a lump, or something along those lines. And through the doctor listening to the story of what happened to you and examining you, they form a theory about what the diagnosis might be and then the test.

And I think people often think the test is then done to make the diagnosis, but really the test is done in order to help with. The clinical diagnosis a doctor has already made. Now, the important distinction here is that tests are meaningless without that first part of the stage. And I think MRI scans are a great example of this.

So I have to always remind people that MRI scans only came into regular clinical use in the 1990s. So. We’ve really only been using them in clinics for actually a relatively short amount of time, and the early MRI scanners weren’t very strong. So the new scanners have only been around for 10 or 20 years.

Before we had an MRI scan, it wasn’t possible to look. Inside a healthy person safely. We didn’t know what the inside of a healthy body looked like. ’cause you wouldn’t do a CT scan, a CAT scan, which is the predecessor really well still in use. But you wouldn’t do a CAT scan on a healthy person because it comes with a big dose of radiation.

So you only did CAT scans if you really needed to. The consequence of that is we didn’t really know what the inside of the healthy body looked like until we began doing regular MRI scans, and we’d never seen the inside of the healthy body in high definition until we got the MRI scan. Another thing I remind people then is look at how different we are on the outside.

Most of us have two eyes, two ears. You know, we, we are basically the same, and yet we are completely different on the outside. We are also different on the inside. So we suddenly have this technology that allows us look at the inside of the healthy body as we never could before, and we’re suddenly finding all these differences that we quite frankly just didn’t realize were there because we’d never looked at the inside of a healthy body before.

So in the same way that some of us have big noses and some of us have small noses and some of us have birthmarks and you know, other kind of outward differences. We also have inner differences that really don’t matter in any way to our health. The minute you do a test, be it an MRI scan or a blood test or, or almost any test, you begin finding all these irregularities by the time you get into your fifties.

About 50% of people have an abnormality on their MRI scan. So what I’m trying to point out is that these tests will pick up loads of little things that doctors call incidental omas. So just incidental findings that don’t matter to a person’s health. So the thing you find on the scan is not making a diagnosis, it is being taken in the context of the story you told your doctor and what your doctor found when examining you.

And then the doctor dismisses or places emphasis on what they found in the test based on that story, the test. Produce red herrings all the time, and this is the case for almost every type of test. So doctors are constantly filtering through those red herrings based on the quality of the story that they got from you.

So it’s not really a case of that you go to your doctor and they ultimately do the test to make the diagnosis. They’ll make the diagnosis clinically, and then they’ll use the test to help them. So it’s a real art, but the story is still really central to diagnosis. 

Brett McKay: Have you noticed that younger doctors who have gone to medical school where these tests existed, they rely more on the tests than maybe an older doctor who didn’t have these tests when they were coming of age?

Suzanne O’Sullivan: Yeah, I absolutely have noticed that actually, and it is a concern. You know, I’m sort of, unfortunately, I hate to have to admit to it. I’m getting into the older doctor territory now. You know, I’m in my fifties and I qualified as a doctor in 1991, so I qualified just before we had a real kind of technological explosion.

And I think doctors of my era understand the clinical art and its importance a little bit more. Not in all younger doctors, but recently qualified doctors have all these incredibly high tech tests at their fingertips, and I’m not sure that they’ve learned the art of using them as well as they could always.

Of course, there’s many. Excellent doctors, but also there are doctors dependent on technology when I think really technology is a kind of an aid rather than something you should be dependent on. 

Brett McKay: Yeah, I noticed this. So I had a general practitioner for a long time. He was an older guy in his sixties, and at the physical we do blood work, the typical thing.

And sometimes he’d say, well, here’s this thing. It’s a little. Out of the normal range, but uh, it’s not a big deal. And he’d ask a few questions, are you experiencing any of the issues? I’d say no. And he’d say, okay, we’ll just keep an eye on it, but you’re fine. Well, he retired and then I got this new general practitioner when she was younger.

She was younger than I was. That’s a weird moment whenever your doctor’s younger than you. And I went in to meet her and she’s like, well, while you’re here, let’s just do some blood work. And I’m like, okay, whatever. Sure. And we did it, and there was some stuff that came back abnormal, not super out of the range.

And she said, okay, we gotta do more tests. I’m worried about this. And I’m like, wait a minute, I don’t. I don’t think there’s a problem. I’m not experiencing any things. She’s like, no, we have to do it. And for a while there I was kind of spooked. I thought, oh my gosh, maybe something’s really wrong with me. I don’t know.

But it was interesting. I saw that difference between a younger doctor. And the older doctor, maybe that’s just a situation where as she gets more experience, she won’t be so test happy. 

Suzanne O’Sullivan: Yeah, I think that probably is the case. You know, I think medicine is still really one of those careers where maturity makes a really big difference to how you practice.

You learn from, you know, what you see regularly and you will become a little bit less trigger happy with tests. But your story really, it illustrates the exact problem is if you do enough tests, you’ll find irregularities, especially as we get older. If I do blood tests in people in their sixties, I’ll rarely find that I get a hundred percent normal tests back.

There’ll be lots of little irregularities and that can really send a person down a rabbit hole, you know, ’cause you have a test to check the test and then that test shows something. And I’ve seen quite a lot of people going down that sort of medical rabbit hole that led nowhere. And a lot of us would shrug it off.

You know, most of us would just say, Hey, you know, it’s, you know, you’re a little bit worried, but it’s probably nothing. But it can take over some people’s lives. It can be very anxiety provoking. It can also have a lot of practical impacts on people in terms of insurance and things like that. So we, we do need to be, I think sometimes people don’t know what a good doctor looks like.

And I would say to people that good doctor isn’t the doctor who, when you go to them every time you tell them you have a pain or an ache somewhere, they do a test. That to me, isn’t the good doctor. The good doctor is the one who listens to you and understands when to do tests and when not to do tests.

If they do tests every time, then that’s a situation that concerns me. 

Brett McKay: One of the arguments you make in the book is that doctors should only give a diagnosis whenever it would be useful. What makes a diagnosis useful or not. 

Suzanne O’Sullivan: So again, you know, we’re doing all these tests and we’re constantly turning up irregularities, and it’s really part of the clinical acumen of a doctor to know how to communicate.

That to their patient and, and, um, what a patient can understand. So I, I think I use the example in the book. We can do a lot of genetic tests now and people with children who have learning problems can have quite extensive genetic tests done that sometimes show up. These things that we call variants of uncertain significance.

So again, we’re, we’re talking about a test here that’s only been around for 20 years and is turning up results that we don’t understand. And in the world of genetics, if you get a result you don’t understand, you call it a variant of uncertain significance. Now imagine you had a a two year-old child who’s struggling a little bit.

You get genetic tests and you’re hoping, those genetic tests will either tell you, you know, this is the problem, or there is no problem, and instead you get that middling answer, oh, your child has a variant of uncertain significance. Now nobody knows what that means. Could be absolutely nothing, could be something.

The question that I’m really asking is if that test result. Tells you nothing. Is it information that I need to pass on to you? I don’t think there’s a right answer to this question, by the way, because I think it depends on the doctor and the patient and their interaction. But if it’s possible that this test result that I got back that I don’t understand at all, and that might be meaningless and that I can’t really explain to you because it’s clinical significance is unknown.

If I pass that on to you and you spend the next 20 years. Terrified for your child’s health. Have I really done you a favor? Or if I withhold that information, am I being paternalistic and withholding information? You might want to know. So I think there’s a real delicate balance in medicine about what information you share and what you don’t share.

Because our job is not to find lots of irregularities that we don’t understand and then scare the living daylights out of our patients, which is becoming increasingly easy with all the tests we have available to us. 

Brett McKay: So in the book you talk about different areas where we’re seeing over-diagnosis happen.

Let’s talk about over-diagnosis in cancer. So I think all of us have probably seen reports that cancer rates are increasing, particularly among young people. Do we know if cancer rates are actually increasing or is that we’re just catching more cancer because we’re doing more screening? 

Suzanne O’Sullivan: Yeah, I think there’s pretty good evidence that cancer rates are increasing.

So if I make the distinction between symptomatic cancer, so symptomatic cancer is something you found a lump where there’s blood or there’s pain, you know, so you have a symptom that draws your attention to the cancer. And then the second type of cancer I’m gonna talk about is cancer found on screening.

And that’s where you are 100% healthy. You’ve been called forward for screening, and someone has. Found something that you didn’t know was there. So the first kind of cancer, symptomatic cancer that is increasing, you know, there is evidence that people under the age of 50, younger people than ever before are getting cancer.

So I do think there’s a real increase in cancer rates. Maybe it’s related to lifestyle, diet, obesity, et cetera. But we also have a problem of. Overdiagnosis in this group of screened cancer. So this is where people are being called forward and having mammography or blood tests to try and detect cancer that they haven’t detected because they’re perfectly well.

This type of cancer is subject to huge overdiagnosis, which I think it might be a little confusing to people, but we’re back into that sort of territory of. The inside of the healthy body is riddled with little irregularities. And until we got the technology to find them, we didn’t know that people lived out their lives with these super early looking cancer cells that never grow and never cause health problems.

So if you do autopsies and lots of people who died for other reasons, you find little. Abnormal cells that would be technically considered to be cancerous, but they never grew enough to cause health problems. The problem is when you do screening, you find these irregularities. They were always there. They were there in previous generations.

We didn’t know they were there in previous generations because we never looked at at them. We started screening and say the 1970s. Pre 1970s, we didn’t know that people lived out their lives with little abnormal cells that never go into anything dangerous. Post screening. We’re now finding these things, but we cannot tell the difference between an abnormal cell that will become malignant, life-threatening cancer, and an abnormal cell.

The won’t become malignant life-threatening cancer. And the consequence of that is we kind of have a tendency to treat all of them as equal when they’re not really equal. So a lot of people who are treated for cancer and screening probably would’ve been perfectly fine if we never treated them. I hasten to say, I don’t want to put people off from screening with this conversation.

You know, if they’re screening programs, it’s reasonable for people to present themselves for that, for that, but they need to know. About the uncertainties of the results so they can have a good conversation with their doctor about what they do if they got a positive result. So for example, if I have breast cancer screening and I was found to have an abnormal cell, I wouldn’t necessarily automatically say, well, I want, you know, all bells and whistles, cancers.

Tests and treatment, I might say, well, if it’s a very small localized abnormal cell and I know about these things, perhaps can we just do another scan in two months time and another scan two months time after that and see if it’s growing. So there are different ways of addressing these abnormalities when they’re found, and that’s what I want people to take away from this.

Brett McKay: Yeah. So a watch and wait. 

Suzanne O’Sullivan: Exactly. A watchful waiting. 

Brett McKay: What’s interesting though, with all this, and this is kind of counterintuitive ’cause I, I had a hard time wrapping my head around this, is that overall mortality rates for cancer are down. And so people would think, well that’s because, you know, we’re just catching this stuff earlier.

So the early screenings work, but that’s not entirely what’s going on. So what is going on? 

Suzanne O’Sullivan: Well, it’s a little bit a mixture of things and it is kind of a hard thing to wrap your head around. Certainly people are surviving from, say, symptomatic cancer, so cancers that unequivocally need to be treated.

People are surviving better because cancer treatments are better. You know, there used to be no treatment for melanoma. Now there is a treatment, so, you know, treatments for cancer are getting better. However, we also have these sort of really, um, kind of difficult to interpret cancer survival statistics from people who are getting.

Diagnosed with cancer from screening. So just imagine that you screen a thousand people for, for cancer, and let’s say a hundred of those were destined to get symptomatic cancer at some point in their lives, but you over diagnose 300 people and you treat all of those 300 people for cancer. Well, 200 of of those 300 were never going to get symptomatic cancer in the first place.

But if you now look at how successfully you treated those people, the results will look really optimistic. They were never gonna get cancer, therefore they didn’t get cancer and therefore they didn’t die of cancer, but they were never going to. Anyway, my hope I’m making sense here because it’s, yeah. It’s, you know, if you over-diagnose people with cancer and you treat too many people for cancer, you will make cancer survival statistics look a lot better than they actually are.

And that’s why a more useful way sometimes at looking at how successfully we’re treating cancers that are found on screening is to look at what we call all, all cause mortality. So you can look at one of two things. Did they die of cancer? One would hope if you’re overdiagnosed in cancer, that the answer to that question would be no.

So let’s look instead at this thing called all cause mortality. So deaths for any reason. And there was a really sobering study published, I think it was in the Journal of the American Medical Association in 2023 in which they looked at all cause mortality. People who’d been diagnosed with cancer and screening for a whole bunch of cancers like colon, prostate, breast, and they found that they had not prolonged any lives in most of the groups through cancer screening and the colon cancer group.

They had prolonged life by three months, but in the other groups like prostate and breast, people did not live any longer courtesy of their screening and cancer diagnosis. And the reason for that is if you’re over diagnosing, so you screen people. You save somebody’s life for sure. So you found somebody who had cancer that was gonna grow.

You found it, you treated it, you saved that life. But probably there are 10 or 20 other people who you treated who never needed to be treated, and now you have negatively impacted the health of those 20 people. So you’ve saved one person’s life, but you have. Affected the health negatively of 20 or 30 other people who might die of complications of treatment, for example.

So you’re saving some lives, but you are having a very negative impact on others. So it’s a kind of zero sum game, you know? Yes, some people are safe, but other people are given unnecessary treatment that is dangerous to them. 

Brett McKay: Yeah, cancer treatment is rough. 

Suzanne O’Sullivan: Yeah. You know, people always relate very strongly to the life that was saved in these questions because we all know people with cancer and we know people who’ve died of cancer, and it’s a very frightening thing.

I don’t think we think long or hard enough about the people who got the unnecessary treatment because. Radiotherapy, chemotherapy operations. These are really enormous things physically, but also the psychological impact of being told you have cancer is absolutely enormous. And then we’ve got the kind of financial impact in terms of insurance or jobs or applying for mortgages going forward.

So there’s, we’ve got a very kind of strong focus on saving that one life. And I think we have an unnecessarily kind of blase attitude to that overdiagnosed group. 

Brett McKay: One area in cancer where you see a lot of over-diagnosis due to screening. There’s a lot of debate around it. Is prostate cancer, why is prostate cancer so prone to over-diagnosis?

Suzanne O’Sullivan: Yeah. I mean, you know, so. Prostate cancer. It’s because the type of screening they do for prostate cancer at the moment. Now this will change and people are working on improving this, but at the moment the most common type of screening is just to measure a blood test for prostatic specific antigen. So this is sort of a, a blood test that if it is elevated, it doesn’t mean you definitely have prostate cancer, but it means that you could potentially have prostate cancer.

The problem with that test is it’s just completely unreliable. You know, I draw people’s attention to the fact that there is no national screening program for prostate cancer in the US or in the uk or in most countries in the world. And that’s because this particular test has such a reputation for over-diagnosis.

You know, studies are really different on these statistics. To give people a rough idea. If you screen a thousand men for prostate cancer using PSA, you will likely save one life, but you will probably find an elevated prostate in about 240 or 250 people. That’s a lot of men who are now kind of gonna go on a diag.

They won’t all be diagnosed with prostate cancer, but they will all be started on a kind of diagnostic odyssey of do they don’t? They have prostate cancer and tests and screening. A small number of them will have biopsies and. Small number of them will be told that they do have prostate cancer. But most of those never needed to know that because as men get older, a huge number of them develop cancerous cells in the prostate that never progress.

So there was an interesting study done in Detroit where the autopsies were done on people who had died in accidents and things unrelated in any way to the prostate. And they found that 45% of men in their fifties have abnormal cells in the prostate and 60% of men in in their. Might have that. Statistics might be slightly low actually, of men in their sixties have abnormal cells in the prostate.

So as men get older, they all get abnormal or a large number, get abnormal cells in the prostate. Once you start screening for that, using prostate specific antigen, you’ll over diagnose lots and lots of men. So the unreliability of the test is the reason we don’t do this now. I think the solution to this.

Is to screen the right people. So there are men who are at higher risk of prostate cancer than other people. People with family history of prostate cancer, for example. Um, black men are more likely to have prostate cancer, so you can still do screening. But screening is more meaningful if it’s done in people who are at high risk.

Whereas if it’s done in people with low risk, it can produce very unpredictable results. And also, if a person is really concerned about their health, they may still wish to discuss getting a PSA test with their doctor, but it’s important they know before they have that test done. How. Uncertain. The interpretation of the results will be know yourself in a sense.

You know, are you the kind of person who if they get that abnormal result back, will struggle to live with that knowledge? Or are you the sort of person who can enter a watchful waiting program and not worry too much? So it’s all about knowledge, so you know what to ask, and knowing whether you can handle the information that you get back.

Brett McKay: Yeah, I got an example of someone who had a deleterious outcome because of a PSA test. So he is in his fifties. Got the PSA, it was elevated and the doctor’s like, I’d like to do a biopsy. And for those who don’t know biopsies, they basically stick a needle through your rectum to your prostate and then extract some tissue.

And he’s like, I don’t want to, no, I don’t. I don’t think so. I don’t think I have prostate. I’m healthy. I don’t have a history of it. And the I said, no, you need to do it. And so he, he did it and he ended up getting sepsis from the biopsy. And he was in the hospital for a few weeks and he didn’t end up having prostate cancer.

There was nothing there. 

Suzanne O’Sullivan: Well that’s, that’s it. Precisely. I mean, you know, you will save the occasional life through this type of screening, but you will send a lot of people on this very, very unpleasant road of tests. So they’re working obviously very hard on, on proving this screening. And in the future I hope that things will be better, but at the moment, there is no national screening program for a reason, and that’s worth thinking about.

Brett McKay: We’re gonna take a quick break for your word from our sponsors and now back to the show. You mentioned colon cancer and there’s been more of a push in the past decade or so to get a colonoscopy, but I think the recommendation for the age to get your first one has been lowered. It used to be 50, now it’s 45, at least here in America. 

Suzanne O’Sullivan: Yeah. We don’t have colonoscopy as a standard screening tool in most countries. It’s usually testing for blood in your feces, and if there’s blood there, then that potentially is symptomatic cancer, but it could also be hemorrhoids. So that’s the usual type of screening that it wouldn’t be to go straight to colonoscopy because colonoscopies, you know that that’s an unpleasant test that comes with risks of things like perforation.

You don’t want to. Leap into that unless you have a family history. Again, we’re we’re, we’re always back to this sort of, these things need to be made. These decisions need to be made in the context of risk. It’s like, what’s your clinical story? What’s your story? What’s your background? If you’ve got a family history of colon cancer, then you’re in a high risk group, and then certainly colonoscopy is something you’d wanna consider.

But if you’re someone who’s very healthy with a very healthy diet, who is asymptomatic. Then that may be not something you want to consider. 

Brett McKay: Yeah, that’s something I’ve interesting. I’ve noticed America tends to be screening happy, like we love our tests and not so much in Europe. 

Suzanne O’Sullivan: Yeah. Well, do you know what we do fair bit of screening as well, but I, I think you’re, you’re right, we’re not quite as, I think it’s how to, a certain degree is how our health services differ.

You know, we, in the National Health Service in a way. I, I consider myself to be protected by the NHS from Overdiagnosis because, you know, there’s no, you can’t have a test on demand. We’re much less likely to have whole body MRI scans or to have MRI scans if you have no, or minimal symptoms and a. I’m quite happy with that term of events because the more tests you have, the more likely you are to find these incidental things.

And I think that once really sobering, um, study was in the New England Journal, I’ve forgotten the date of it now, but a very, very recent in the twenties roughly. And they looked at cancer diagnosis in high income countries like the US for example. Versus low income countries. And what they found was that, yeah, people live longer in high income countries.

Well that’s not surprising. You know, you, you don’t only have better healthcare, you also have better lifestyles, et cetera. But they found something else that is worrying. They found that much more people were being diagnosed with cancer in the high income countries than in the low income countries. But the cancer survival rates for those cancers were actually quite similar.

So. It seemed like a lot of people in high income countries, by virtue of having more tests and more high quality tests are being diagnosed with cancer potentially unnecessarily. No extra lives were saved by all the extra cancers being diagnosed. The paper estimated that, you know, for every cancer diagnosis, through all of this availability of technology, 10 probably weren’t necessary.

So, you know, I know that the NHS has a great deal of problems. It is. Needs to be a a lot better funded than it is, but there is something to be said for the lack of financial dealings between patient and doctor. You know, a patient comes to see me. The diagnosis is dependent on nothing but the story that they tell me.

I have no, they’re not my customer. I don’t need them to come back to me to be paid and so forth. And there’s something in this kind of financial transaction between patient and doctor that is, is potentially harmful. And I don’t think people always realize that. 

Brett McKay: Another area you talked about where there could be.

Overdiagnosis going on is diabetes. I mean that’s because the diagnostic boundaries have shifted in the past, I think, decade. What was that change and how has that led to overdiagnosis? 

Suzanne O’Sullivan: Yeah, so this is a trend in medicine in multiple different areas of medicine. So, you know, there’s lots of medical problems, which the diagnosis isn’t based on there being an abnormality.

It’s. Based on drawing a line between normal and abnormal, like what level of blood sugar are we willing to accept as normal? What level of blood pressure are we willing to accept as normal? And we’ve had this assumption in medicine that if we kind of keep moving, that if we can detect more and more people with borderline diabetes or borderline hypertension.

Or borderline obesity, borderline mental health problems, that we will help more people and therefore we keep adjusting the line between normal and abnormal to diagnose more and more people. So I think it was in about 2003, we had created this condition called pre-diabetes. So this isn’t diabetes. This is a kind of borderline state between being perfectly healthy and potentially going on to develop diabetes.

In 2003, they made this slight adjustment. To the measure that would allow a diagnosis of pre-diabetes and then a fasting blood glucose. You fast, you have your blood sugar taken. And on one day in 2003, if you had a measure of 6.1 millimoles per liter of fasting blood glucose, you were healthy. But then they adjusted that and said, no, 5.6 will be the new cutoff.

So it’s just a small change, you know, one day. 6.1 is normal. The next day, 5.6 is normal, but the result of that is that if the changes in the way that pre-diabetes was diagnosed was applied to everybody in the world, this small adjustment along with some other changes in how the diagnosis made would mean that half of Chinese adults would be pre-diabetic and a third of us adults would be pre-diabetic.

So. You are sitting at home minding your own business essentially, and you feel you’re perfectly healthy. And meanwhile, somewhere in the background, a committee is convening and deciding, you know what, what counts as normal glucose? And on a Monday they change it and suddenly you are. No longer healthy.

Now you are a patient, and this is done with very good intention. It’s because, well now we’ve recognized loads of more people with pre-diabetes, we can stop people getting diabetes. The problem is that it’s not working. The rates of diabetes are rising all the time. Even though for 20 years we’ve had escalating diagnoses of pre-diabetes, and this is really the absolute definition of overdiagnosis, is you identify more and more and more patients.

But you’re not actually making people healthier. And it may be that they’re not following the advice that they were given, for example, but what is clear is that this kind of growing, um, group of people with pre-diabetes is, is not benefiting them to know that. 

Brett McKay: Yeah. And it’s essentially about pre-diabetes.

It’s in this weird gray area ’cause it’s not officially a diagnosis, but then people treat it like a diagnosis. They think of themselves as a patient. Well, I have pre-diabetes and I have to do certain things to make sure I don’t get full-blown diabetes. 

Suzanne O’Sullivan: Yeah, that’s it. It’s not actually a disease, pre-diabetes.

It’s like a pre disease state, but it sounds very much like a diagnosis and in one sense it could be a great thing. So it depends really on your mindset and your lifestyle and how you respond to news. You know, if I was told that I had pre-diabetes, then perhaps I would respond by improving my diet and exercising a bit more and trying to lose some weight.

And, you know, it could have a really positive impact on me. It could be a really good. Thing for my long-term health, but somebody else might respond differently to that. If you take a healthy person and tell them, you know, now because of this blood test, I consider you a patient. That can have a very negative impact on other people.

It can affect, if you turn a person into a patient, they can start behaving like a patient. They begin noticing things about their body. You know, being told that you’re unhealthy turns your attention inwards to your body. And then you start noticing little things and worrying about symptoms you didn’t worry about before.

You know, in a sense, the creation of pre-diabetes, we created it to protect people’s long-term health, but we’ve underestimated the impact of the news that you have pre-diabetes on a person, how that might affect their kind of self-concept and how it might affect how they feel about their body and so forth.

Brett McKay: Yeah, it threw me for a loop for a while, so I remember I had some blood work done. My fasting glucose was high. It was like 102, and I was like, oh my gosh. I got pre-diabetes and I even went out and I bought a glucose monitor, started measuring my glucose every day, and I’m like, I don’t know what I’m supposed to do.

’cause I exercise, I eat right, I don’t drink. I’m doing everything. I’m not overweight. And I remember I finally talked to a doctor, I was like, what do I do? I have pre-diabetes. And they’re like, well, let’s check your insulin, your fasting insulin looks good. So you don’t look like you’re on the road to diabetes.

Maybe your glucose just runs a little high. In the morning and that’s your normal. 

Suzanne O’Sullivan: Yeah. Well that’s it. You know, again, I kind of remind people of how different we are on the outside and you know, these sort of differences exist on the inside too, and it doesn’t have to be an abnormality. And in a sense you made the important point there, which is you are otherwise a very healthy person.

You know, these things have to be taken in context. If I was told I had pre-diabetes and I was also a smoker. You know, my father had heart disease and my mother had a stroke and I’ve also got borderline high blood pressure. Well then these are issues that need to be addressed. But if you’re otherwise a very healthy person with a borderline blood test abnormality, then you don’t necessarily have to be so worried about it.

So we need to take these things in context and, and not be terrified of every abnormal result. 

Brett McKay: You mentioned high blood pressure, uh, has undergone. Uh, a change similar to diabetes and how we define it? 

Suzanne O’Sullivan: Yeah, I mean, you know, uh, so there’s this thing sort of borderline hypertension, which I guess is the same as pre-diabetes.

You know, you, your blood pressure’s kind of in that border area. You’re not really hypertensive, but you could spill over into that region. The level of blood pressure required to have borderline hypertension just keeps shifting and. In the US Now, borderline hypertension is a measure of 130 over 80. Now, when I was in medical school in the 1980s, 130 over 80, you’d be delighted with that blood pressure.

That’s perfectly normal blood pressure. Whereas now if if it’s a little bit higher than that, you potentially. Could be offered. Well, you’ll definitely be offered lifestyle changes, but you could also be offered drug treatment for that, something which would’ve been considered completely normal two or three decades ago.

In Europe, we use a slightly more generous cutoff, more around 140 over 80, or 140 over 90, because these are arbitrary cutoffs. No one knows where normal blood pressure begins and ends. So committees of experts get together and make arbitrary cutoffs. And when they do that, when the change was made to decide that blood pressure should now be normal, up to 130 over 80 and abnormal above that, that immediately made a third of American adults a borderline hypertensive, which is just astonishing statistics.

Can it really be true that a third of adults in the US are borderline hypertensive? The purpose is good. The purpose is prevent heart disease, prevent strokes. But how many people with borderline hypertension do you have to treat to prevent a stroke? Well, that could be, if I treat every single person I meet with borderline hypertension, I might prevent.

You know, one stroke per per a thousand people, but I might treat 150 people who never needed to be treated. So you always, with these adjustments, you’re always saving somebody, but you are equally, you can be guaranteed. You’re overtreating a great deal. Many people. More people. So you’re probably, you know, per life save you’re probably overtreating a hundred and 150 people.

But that’s, you know, that’s okay if it’s just a little kind of reminder to be healthy. You know, if you are the person who goes to your doctor and they say you’ve got borderline hypertension, and then you go home and your lifestyle is suddenly transformed by the news, well then that’s been great for you.

And I don’t object to that. But you could be the person whose life is taken over by concern about your blood pressure or who goes on tablets and gets side effects that makes you sick when you weren’t sick before, or whose health insurance goes so high that you can no longer afford it. So we have to think both sides of it.

Brett McKay: Another area you talk about where there’s a lot of over-diagnosis is Lyme disease. Why is Lyme disease so hard to diagnose and why is it vulnerable to over-diagnosis? 

Suzanne O’Sullivan: You know what, uh, the first thing I’d say is I don’t think Lyme disease is hard to diagnose. Lyme disease is very well defined clinical criteria and you know, no test is a hundred percent reliable, of course, but pretty reliable.

Two stage blood testing, there’s two stages of blood testing you have to make the diagnosis. So actually, I’d say diagnosing Lyme disease. Is relatively straightforward. The reason it’s so overdiagnosed is twofold. One, because Lyme disease causes a huge array of symptoms, many of which are symptoms that any one of us could, you know, have probably experienced at some point in our lives, like fatigue, joint aches, and pains.

Just these kind of non-specific symptoms that are part of loads and loads of different medical problems, including psychiatric problems, but also physical problems and also aging. So these are super common symptoms, so that makes Lyme disease very available to overdiagnosis. If you go to your doctor tired and they can’t think of any other explanation.

Well, Lyme disease is one that can be provided if you are desperate for an explanation. That’s one reason I think it’s overdiagnosed. It’s in a world where people are suffering and want answers, it’s an answer. The other reason it’s overdiagnosed is because the tests are misused. Really. You know, as I’ve said before, tests need to be taken in a context.

The tests for Lyme disease have lots of reasons. You can have a positive test but not have Lyme disease. So if you spent your whole life, you grew up. Living beside a forest in Connecticut where there’s loads of Lyme disease, chances are that in childhood you’re exposed to Lyme disease and developed immunity.

And later in life, if you have a blood test, you can test positive for Lyme but not have Lyme disease. Or maybe if you’re sick in some other way, you’ll get a false positive on the test. So the tests are easily misinterpreted and you’ve got a disease that has symptoms that overlap with so many other things.

And you’ve got a society that needs explanations when they’re not feeling well, and if explanations aren’t readily available, then Lyme disease. Will account for quite a wide range of symptoms. Then you also have an element of corruption added in here. You know, if you have a diagnosis that is available to give to people who are desperate for an explanation and you work in as a private doctor in, in this area, then over diagnosing is very, very simple because of the uncertainties in the blood tests.

Brett McKay: Yeah, I thought it was interesting you talk about, there’s a surprisingly large number of people who have been diagnosed with Lyme disease in Australia, but Lyme disease, the bacteria that causes Lyme disease doesn’t exist in Australia. 

Suzanne O’Sullivan: Yeah, I mean, this really speaks to the problem, so, you know, e exactly that.

I mean the, the type of the climate in Australia, the type of ticks that carry the bacteria that cause Lyme disease, they can’t survive in Australia because of the climate, and therefore nobody has ever found the bacteria in any ticks that. In Australia, and yet there’s something like a half a million people in Australia who believe they contracted Lyme disease in Australia, which is fundamentally impossible.

And yet people are getting these diagnosis. But you know, there’s similar. Very high misdiagnosis rates in the us. So a specialist Lyme disease clinic reviewed the diagnosis of a, a large thousands, I think it was 5,000 people who had a diagnosis of Lyme disease. Went to this specialist Lyme Disease Clinic, and they determined that 85% of the people who thought they had Lyme disease did not have Lyme disease.

So this is a diagnosis that is overused at an enormous rate. It’s estimated that about 60,000 people test positive in a, in a proper lab that is making the diagnosis correctly in the US 60,000 people per year. And yet something in the region of half a million people are being treated for Lyme disease.

So the number of people being overdiagnosis is very high. And I think that’s because it’s an available explanation for symptoms that people struggle to explain. And I think it’s also because there is a problem with people. Essentially giving out slightly over exuberant diagnosis for monetary reasons.

Brett McKay: What do you think is going on with these people who, you know, they get the diagnosis of Lyme disease, but maybe they don’t have it? Like they do the test and they don’t, there’s like, okay, you don’t, there’s no way you could have Lyme disease, but they’re obviously suffering. You know, they’ve got the fatigue, the joint pain, brain fog.

Similar thing happened with people after COVID and they’re like, I got, you know, this whole idea of long COVID, they’re obviously suffering. So what do you think’s going on? 

Suzanne O’Sullivan: Yeah, I think, I mean, that’s a super important point to emphasize, which you just did, which is to say that someone has been misdiagnosed doesn’t mean they’re not suffering.

But yes, so there’s, at any one point in time, there’s a lot of people who are suffering with non-specific symptoms like headaches, difficulty sleeping, joint pains, tiredness, and those people will be given a diagnosis that sort of makes sense at a. Particular point in time, and as you said, during a COVID pandemic, if you have that collection of symptoms, you’ll be, could be told you have COVID or long COVID.

You know, if you live beside a forest filled with Lyme disease or in a period when Lyme disease is common, you be given Lyme diseases that diagnose for the exact same symptoms. What is going on with these people? Well, there’s a variety. People are probably just hard to diagnose. They have something that we have not yet fully understood, like an autoimmune condition that we don’t yet fully understand.

But I would suspect that the largest proportion of these people probably have what I would refer to as psychosomatic symptoms. So I’m a neurologist. This would be something I would see very often. So a lot of people in response to stresses or anxiety or difficult lives or unhealthy lives, develop non-specific symptoms.

So we’ve all had this experience. You know, if you’re stressed, you get a headache, or if you are. Just very tired or not looking after yourself, you’re more likely to pick up colds and flus, or you get aches and pains. So our bodies are very vulnerable to developing physical symptoms in response to psychological stressors, and very common symptoms in that context are things like tiredness and aches and pains.

I actually see people with much more extreme versions of this with seizures, paralysis, blindness, and so forth. I think a great, many of these people have psychosomatic symptoms, but we live in a society that. Looks down on psychosomatic symptoms. So you know, if somebody is very sick, if they’re bed bound because they feel so bad, they literally can’t get outta bed.

And you learn that the problem has a more of a psychological cause than a physical cause that’s looked down on, you know, we don’t have a lot of respect for that. And that pushes people into the need to find an explanation that society is more understanding of. And usually that’s a physical disease. So I think there’s a lot of people who have an array of physical symptoms that probably arise out of psychological distress, but which are diagnosed as a disease because that’s the culture we live in.

You know, psychological suffering is not respected to the same degree as physical disease. 

Brett McKay: And you talk about once someone gets a di, like a medical, a biological. Diagnosis for what could be psychosomatic. It causes the nocebo effect where you start paying more attention to your body and thinking, oh, this is actually, this shows that I have this thing.

And it just sort of creates this vicious cycle downwards. 

Suzanne O’Sullivan: Yeah, I mean, this is the problem with all the medical labels we’ve been talking about. This is the problem for the people with hypertension, the people with pre-diabetes, the people with cancer, et cetera, is that once you’re given a medical diagnosis, it, it can have, you know, it’s, everyone’s familiar with the placebo effect, which is if you given a tablet and you believe it will work, it can alleviate your symptoms.

The exact same happens in the opposite direction, referred to as the no sibu effect. So this is where you know, if you believe something will make you sick, it can make you sick. I always say to people, listen, there is examples of this in everyday life everywhere. You know, if you were about to sit down to your dinner in a restaurant and you turned around and you saw the chef. 

Coughing into the food, which immediately changes your experience of your body following what you’ve just eaten. You know, um, if you eat something and then you suspect it was unhygienic after the fact, you can start feeling sick. This is the most normal thing in the world. So imagine now that somebody has told you that you have a disease and that it causes, you know, X number of symptoms.

You immediately kind of look at your body and beginning examining yourself for those symptoms. And I guarantee you, especially as you get older, your body is awash with things to be found. If you pay enough attention, you know that aching knee that you know, it only lasted a day. Normally you’d dismiss it, but you’ve just been told you have Lyme disease, so now you.

Place a lot of emphasis on that aching knee, whereas you might not have worried about it yesterday or you know, some little mole on your skin suddenly gets heightened in your perspective through anxious tension. This is the problem with medical labeling, is it reinforces not in everyone, but in a percentage of people, it can reinforce symptoms.

By turning anxious attention to your body and really worrying less about your health is sometimes the answer. 

Brett McKay: There’s been an increase in mental health diagnoses in the past few decades. Are there actually rising rates of mental health issues or are we diagnosing people that maybe don’t need a diagnosis?

Suzanne O’Sullivan: Yeah, so it’s such a super hard question answer in the sense that it’s so hard to untangle. In in one sense, there does seem to be evidence that suggests that particularly in the group of adolescents to young adults, say age 16 to 24, there does appear to be more mental health issues in this group, for example, more than any other, and that means they’re more likely to go to the doctor with symptoms and also that they have more mental health symptoms.

But does that mean that there is more mental health illness in this group because that can be explained in so many ways. It could be that we’ve got all these awareness campaigns going now, often targeted at young people and awareness campaigns in schools that bring people’s attention to mental health problems.

So are they going to their doctor because they’ve been. Given express instruction to examine themselves for problems, and they’re finding things we wouldn’t have found before because we didn’t think that way. Are they more symptomatic because of the anxious attention that they’re paying to their moods, or are they genuinely more symptomatic?

So I think it’s really hard to untangle. To what degree is the fact that young people have more mental health problems there because we have created that through awareness campaigns, through telling people to worry about small changes in mood, or is it a real increase in mental health problems. But I think whatever.

Conclusion you come to on that you have to say that there is an over-diagnosis of conditions like ADHD, and autism. Now, again, I emphasize that when I talk about over-diagnosis, I’m not saying this person isn’t suffering and you should ignore them and tell them to snap out of it. That’s not my attitude.

I’m saying that. Adolescents sometimes have struggles, and by over-diagnosis, I mean medicalizing those struggles by referring to them through labels of ADHD and autism might be harmful to them. The reason I say there’s over-diagnosis is very hard to spot over-diagnose an individual. So let’s say you’ve got a 16-year-old and they’ve been told they have a DHD, and they’re validated by the diagnosis and they feel better.

Is that over-diagnosis or isn’t it? You can’t really tell. You can tell by looking at the population. So we’ve been making mental health diagnosis at escalating rates since the 1990s. We’ve been telling young people they have ADHD and autism at escalating rates since the 1990s. Now, the purpose of seeking out those young people and giving them those labels is that the problem should be recognized.

They should get support, and then they should be happier, healthier. Better adjusted adults, but what do we see downstream? We’ve got way more teenagers getting diagnosis of ADHD and autism, but we also have way more young adults who now have mental health problems like depression and anxiety, and that’s the very definition of over-diagnosis.

It’s not to say that original group who were told they had autism and ADHD didn’t have a problem at all. But it seems to me that framing the problem through these lenses of autism and ADHD has not resulted in healthier and happier adults, and we really need to rethink what we’re doing. You know, my real fear is that you take an adolescent and you tell them that their communication problems are.

Abnormal and due to a brain chemistry abnormality or that their sort of attentional difficulties are not because they’re a teenager and teenagers have attentional difficulties, but because they have a dopamine and abnormality in their brain, then you potentially make that problem so concrete that a child can’t overcome it.

Adolescence is a time of change. You should have the opportunity to mature out of your difficulties or to work on things, and I’m afraid that because we tend to make a diagnosis and then accommodate them, we’re not giving children the chance to make the changes that we all made. 

Brett McKay: People get really touchy about this, particularly around ADHD and autism.

Uh, I know it can get very heated, the debates about it. Why do you think that is? 

Suzanne O’Sullivan: Yeah, I think it’s mostly because people kind of understand this conversation to mean that. Their difficulties are being dismissed as irrelevant or they don’t have struggles, and that’s certainly not how I feel about it. I think that adolescents in particular is a real time of difficulty, but also people who are getting diagnosis in older age, I believe the difficulties are real.

But I don’t think medicalizing the difficulties with these labels is the right thing to do. So I wouldn’t wish in any way for anyone to feel that. I’m saying we should go back to the old days where everyone was told to snap out of it or you know, I was in school in the eighties, you know, nobody in my class of 120 was recognized as having a special learning need.

There must have been someone, you know, so we had an underdiagnosis problem. I’m not suggesting we should go back there, but I’m suggesting that we should think about how we are helping struggling people and ask if it’s the right kind of help, you know, is it really optimal? I still think we should. If someone has a problem, then they need to be able to voice it and then their problem needs to be acknowledged, but is then attaching a medical label, the right way to go about things.

And I know that it can make people feel validated and I don’t want to take that away from people. But I think that a diagnosis needs to come with something more than validation. It needs really to lead to something more positive. Unfortunately, when you’re validated by a diagnosis, it can just make the symptoms worse because in order to.

Remain validated and remain part of this new tribe that you belong to. Courtesy of your diagnosis, you have to continue to not be well. Getting well means you lose your tribe and you potentially lose your diagnosis. So how do you get well in those circumstances, I think we’re better to frame our difficulties in terms of, you know, what in my life can be changed to make me feel better.

Rather than framing them through internal chemistry. 

Brett McKay: And in the case of ADHD, I mean, one of the things you do to treat it is, you know, prescribe Ritalin or Adderall, which, I mean, those are schedule one substances, like those can be highly addictive substances. And it’s like, well maybe you don’t need to get on that if you don’t need it.

Suzanne O’Sullivan: You know, it’s interesting how, how badly we learned from the past. You know, we had a whole benzodiazepine crisis in the eighties. You know, it seemed to be a drug that did amazing things for people, but then people got highly addicted to it. And then we had an opioid crisis, you know, for a while everyone thought opioids were the best thing ever, you know?

And look, look where that led us. We are not very good at learning from the difficulties of the past. You know, I’d be very loath to take a medication that is fundamentally a stimulant, which isn’t amphetamine-like drug unless I knew I had to take it. Now, that’s not to say that I don’t think there’s a role for medication.

There will always be people who have extreme disability. There always are hyperactive children who are so hyperactive. They really cannot. Engage in education and they may need something to help them through a difficult period. So I’m not a kind of, never say never, but this wide prescribing of stimulant drug seems really ill-advised to me.

Brett McKay: So what do you think the right balance is between diagnosing too much and not diagnosing enough? Like what do you want readers to take away from your book the next time they’re dealing with a health concern? 

Suzanne O’Sullivan: Yeah, so I think what’s really important is first of all, you know that you have choices very often, and I think that’s something people don’t really realize.

Uh, most medical. Situations are not urgent. So we have occasional emergencies, but most things you go to your doctor with, you can get a test result and you can think about it. So I think that we should be creating a system of more slow medicine where you get test results back and then you consider all the variables.

Are you a high risk? Person, what else in your life might put you at risk of this particular disease so that you can decide whether you need to react urgently or whether you may be someone who doesn’t have to worry and can go down a more watchful waiting pathway? I think it’s very useful for people to understand the uncertainties in test results ’cause it, it might feel like the best thing in a certain circumstance to have that blood test or to have the scan. You know, a lot of neurologists wouldn’t have a brain scan as it happens, and I think it’s useful for people to know that, that sometimes the scan that you have to relieve your anxiety can actually cause more anxiety.

I really want people to just do a balancing exercise when it comes to diagnosis. Ask themselves before they get that. Mental health diagnosis or ADHD or autism diagnosis. If I get this diagnosis, what will I get? What will it bring me that is positive? And if I get this diagnosis, what are the potential negative impacts of that diagnosis?

And you really need to be sure that what you get is substantially greater than what you lose through a diagnosis. 

Brett McKay: Well, Suzanne O’Sullivan, this has been a great conversation. Where can people go to learn more about the book and your work? 

Suzanne O’Sullivan: Well, I hope everybody will buy the book, which is called The Age of Diagnosis, How Our Obsession With Medicine is Making Us Sicker.

You know, I feel like sometimes when I talk about this subject, people might think I’m an outlier doctor that you know, who is this doctor coming along and saying all of these kind of slightly scary things. But actually everything I’m talking about is widely discussed within medicine. We’re just not having a good enough public conversation yet.

Brett McKay: Well, Suzanne O’Sullivan, thanks. Your time has been a pleasure. 

Suzanne O’Sullivan: Thank you for having me. 

Brett McKay: My guest there is Dr. Suzanne O’Sullivan. She’s the author of the book, the Age of Diagnosis. It’s available on amazon.com at bookstores everywhere. Check out our show notes at AoM.is/diagnosis where you can find links to resources and we delve deeper into this topic.

Well that wraps up another edition of the AoM podcast. Make sure to check out our website at artofmanliness.com to find the podcast archives. And while you’re there, sign up for a newsletter. We have a daily and weekly option. They’re both free. It’s the best way to stay on top of what’s going on at AoM. And if you haven’t done so, I’d appreciate it if you take one minute to review the show on your podcast app or Spotify, it helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member if you think you’ve gotten something out of it. As always, thanks for the continuous support. Until next time this is Brett McKay. Put what you’ve heard into action.

This article was originally published on The Art of Manliness.

I didn’t think about my blood pressure in my 20s and 30s. I only noted it when it got checked during urgent care visits. I always thought it was something I’d worry about when AARP sent me a welcome letter.

While I’m not quite ready for senior discounts, I’ve entered middle age and have become more interested in preventive health.

One health metric I’ve started to track regularly is my blood pressure, which I measure once a week.

Why?

Well, blood pressure is a key indicator of long-term health, and it’s worth monitoring when you’re younger and not just when you’re officially elderly.

High blood pressure, or hypertension, often has no symptoms. It’s a silent killer. Left unchecked, it damages your arteries and organs until it announces itself with a heart attack, stroke, or kidney disease.

Based on the stats, nearly half of you reading this article have high blood pressure.

That’s the bad news.

The good news is that there’s a lot you can do to keep your blood pressure healthy with straightforward lifestyle changes. If you need medical backup, modern treatments are effective and widely available.

In today’s article, I’ll cover blood pressure, its health importance, what raises it, and practical steps to keep it in check.

What Is Blood Pressure?

Think of blood pressure as the force your blood exerts against your artery walls every time your heart pumps. When your heart beats, it creates a surge of pressure called systolic pressure — the top number on a blood pressure reading. When your heart relaxes between beats, the pressure drops; that’s diastolic pressure, the bottom number.

So if you’re 120/80, the 120 is how hard the blood is pushing during a heartbeat, and the 80 is the pressure while your heart rests.

The American Heart Association defines a healthy adult blood pressure as below 120/80. Here’s the full list of blood pressure benchmarks and diagnoses:

• Normal: <120/80 
• Elevated: 120–129/ <80
• High blood pressure (Hypertension, Stage 1): 130–139/80–89
• High blood pressure (Hypertension, Stage 2): ≥140/≥90
• Hypertensive crisis (medical emergency): >180/ >120

If your systolic stays in the 120s, you’re not hypertensive but “elevated.” It’s like a diagnosis of prediabetes.

A systolic above 130 means a hypertension diagnosis.

The 120 vs. 140 Debate

For years, 140/90 was the hypertension diagnosis line. In 2017, the American Heart Association and American College of Cardiology lowered it to 130/80, labeling anything above 120/80 as “elevated.”

The change was controversial. Overnight, millions of people who’d been told their blood pressure was “fine” were suddenly borderline hypertensive. Critics said it over-medicalized healthy individuals in their 20s–40s, making more of them eligible for drugs.

Supporters countered that risk doesn’t suddenly appear at 140/90; it rises gradually. Lowering the threshold aimed to encourage earlier awareness and lifestyle changes, not just more prescriptions.

Different groups still disagree: European societies and the World Health Organization continue to use 140/90 as the benchmark for diagnosing high blood pressure.

Think of blood pressure as a continuum. Lower is better over time. If your blood pressure is slightly elevated, don’t panic, but don’t ignore it either. Take it as a nudge to tighten your habits.

Why Healthy Blood Pressure Matters

High blood pressure has earned the nickname “the silent killer” for a reason. You usually feel fine, until you don’t. Here’s what uncontrolled hypertension does behind the scenes:

• Heart disease and heart attacks. Chronically high blood pressure stiffens arteries and forces your heart to overwork. Heart disease is the number one killer of men in America, and high blood pressure is a main culprit.
• Stroke. Hypertension weakens brain blood vessels, leading to clots or ruptures — strokes that leave you debilitated or dead.
• Kidney damage. Your kidneys rely on tiny blood vessels to filter waste. High pressure scars them over time, leading to kidney disease or failure.
• Sexual health. High blood pressure is bad for your boners. Erectile dysfunction not only impacts your sex life but is also linked to hypertension and can serve as an early warning sign of cardiovascular trouble.

Common Causes of High Blood Pressure

Hypertension usually stems from a mix of genetics, aging, and lifestyle. Some factors can’t be controlled; others can be. Here are the main factors for men:

• Age. Arteries naturally stiffen with age, and plaque builds up. Expect blood pressure to rise in your 30s and 40s if you’re not proactive.
• Being male. Men get hit earlier than women. After menopause, women catch up, but until then, men lead in hypertension rates.
• Family history. If your parents had high blood pressure, you’re more likely to develop it too.
• Diet. Too much sodium (from processed and restaurant foods) and not enough potassium (from fruits and veggies) is a recipe for high blood pressure.
• Inactivity. Sedentary lifestyles weaken hearts and stiffen arteries.
• Excess weight. The heavier you are, especially around the middle, the harder your heart has to pump.
• Alcohol. Occasional drinks don’t have a big impact, but consistent heavy drinking raises blood pressure.
• Nicotine. Whether from cigarettes or Zyn, nicotine raises blood pressure by stimulating adrenaline release, which increases heart rate and constricts blood vessels.
• Stress. Chronic stress keeps your system revved up, nudging blood pressure higher.
• Poor sleep (and sleep apnea). Less than 7 hours a night — or untreated sleep apnea — can keep your pressure elevated.

Managing Blood Pressure: Lifestyle Strategies

The encouraging news about blood pressure is that lifestyle changes can have a huge effect on it, often enough to avoid or delay medication. Here are the big levers you can pull to keep your blood pressure in check:

1. Dial in your diet. Cut back on processed food and salt; eat more vegetables, fruits, lean proteins, and healthy fats.
2. Lift weights. While strength training spikes blood pressure during sets, it lowers it over time by improving heart function and blood vessel health.
3. Get in Zone 2 cardio. Aerobic exercise is a powerful lever for lowering blood pressure. Zone 2 cardio strengthens your heart, improves vascular flexibility, and trains your body to use oxygen more efficiently. Aim for 150 minutes a week through walking, cycling, rowing, or jogging.
4. Hit the HIIT. High-Intensity Interval Training (HIIT) can also help; short bursts of near-max effort followed by recovery periods give you big cardiovascular benefits in less time. I’m a fan of the assault bike for HIIT.
5. Lose weight if needed. Even just a reduction of 5–10% of your weight can improve blood pressure.
6. Limit alcohol. No more than two drinks a day. Less is better.
7. Quit smoking and Zyn-ing. Every cigarette and nicotine pouch tightens your arteries, spiking blood pressure. Quitting will relax them and reduce blood pressure.
8. Manage stress. Exercise, meditation, hobbies, prayer, time outdoors — whatever keeps you from running in the red zone all the time.
9. Get good sleep. Aim for 7–9 hours. If you snore, check for sleep apnea.
10. Deep breathing. Slow, controlled nose breathing activates the parasympathetic nervous system, lowering heart rate and blood pressure. Even 5–10 minutes a day of box or diaphragmatic breathing can help.
11. Catch some rays. Moderate sunlight exposure helps your body release nitric oxide stored in the skin, which relaxes blood vessels and lowers blood pressure. Research suggests people who spend more time outdoors have fewer heart problems than those who stay indoors. Aim for regular, sensible sun exposure.
12. Cut back on caffeine (if you’re sensitive). Coffee affects people differently. For some men, it barely moves the needle; for others, it can spike blood pressure for hours. If you notice big jumps after an energy drink or espresso, scale back.
13. Stay hydrated. Staying hydrated helps your kidneys balance sodium and maintain blood volume, supporting healthy blood pressure. Dehydration makes your heart work harder and can spike stress hormones.
14. Spend time in nature. Japanese research on shinrin-yoku (forest bathing) shows that being in green, natural environments lowers stress hormones and blood pressure. Follow the 20-5-3 nature prescription!
15. Check your numbers. Regularly track your blood pressure. Aim for once a week. See below on how to do it.

How to Take Your Blood Pressure at Home

To keep your blood pressure in check, monitor it regularly. At-home, automatic arm-cuff monitors are inexpensive and reliable.

I check my blood pressure once a week on Sundays.

Measuring at home can give you a more accurate reading than at the doctor’s office. A lot of people have “white coat syndrome,” where they get nervous at the doctor’s office and their blood pressure spikes, making it appear they have high blood pressure when they don’t.

Technique matters for blood pressure measurements. A sloppy reading can skew your numbers. Here are the best practices:

• Use an upper-arm cuff. Wrist and finger devices aren’t as accurate.
• Check at the same time. Mornings are best, before caffeine or workouts.
• Sit quietly beforehand. Rest for 5 minutes before taking a reading.
• Posture matters. Back supported, feet flat, arm resting at heart level. I keep my arm on the couch armrest to achieve the arm level height.
• Don’t talk during the measurement. Even chatting can bump your numbers.
• Take two or three readings. Do them a minute apart, then average them.
• Log your results. A written record (or the machine’s memory) shows trends better than one-off numbers.
• Avoid common mistakes. Don’t measure over clothing, after coffee, or right after exercise.

When Lifestyle Isn’t Enough to Lower Blood Pressure

Sometimes, despite doing everything right, your blood pressure stays high. Genetics and age can be stubborn. That’s when medication comes in.

There are several meds out there that lower blood pressure. The most common are thiazide diuretics and ACE inhibitors (like lisinopril).

If your blood pressure remains high despite lifestyle changes, talk to your doctor about medication.

Conclusion

Blood pressure is a scorecard of how hard your heart is working and how healthy your arteries are. Keep your numbers in check, and you’ll drastically reduce your risk of heart attacks, strokes, kidney disease, and even erectile dysfunction. Ignore it, and the silent killer may come calling.

So check your blood pressure. Make the changes you need to make: eat smarter, move more, stress less. If you need meds, take them.

Your heart and overall health will thank you for the effort.

This article was originally published on The Art of Manliness.

When you think of water workouts, your mind probably goes to lap swimming, water aerobics, or maybe some high-octane Navy SEAL pool drill. What probably doesn’t come to mind is treading water — something you learned in swim class as a survival skill and haven’t thought much about since.

But treading water isn’t just for passing a Red Cross test or keeping yourself afloat while waiting for a lifeguard. With a little intentionality, it can be turned into a surprisingly effective — and satisfyingly challenging — full-body workout.

Why Treading Water Is Good Exercise in General

Let’s first look at what makes treading water beneficial even before you try to level it up:

• Full-body engagement: An efficient tread uses your arms, legs, and core in coordination. The flutter kick, scissor kick, or eggbeater motion all activate your lower body, while your arms sweep and stabilize.
• Cardiovascular and muscular endurance: Staying afloat taxes both your aerobic capacity and your muscular endurance, especially the longer you do it.
• Low impact: It’s easy on your joints. If you’re dealing with nagging injuries or trying to stay active during recovery, it’s a solid option.
• Real-world utility: Treading water builds the kind of practical fitness that could one day keep you alive — or help you save someone else.
• Mental toughness: There’s a primal discomfort in the feeling of not being able to rest — of having no edge to lean on, no ground to stand. Learning to push through that discomfort builds your poise under pressure. 

How to Make Treading Water a Legit Workout

Most people tread water inefficiently and lazily — just enough to keep their nose above the surface. But that doesn’t activate the full potential of this exercise. Mixing in these elements will:

1. Add Time-Based Intervals

Instead of aimlessly bobbing around, structure your session like you would a gym workout:

• Warm up: 3 minutes easy treading
• Main set: 5 rounds of 1 minute hard treading, 30 seconds easy
• Cool down: 2 minutes easy

“Hard treading” means using faster, more forceful movements — like exaggerated eggbeater kicks and aggressive arm sweeps — to keep your upper chest and even your shoulders above the waterline.

2. Go Hands-Free

Cross your arms over your chest or raise them overhead while kicking. This forces your legs and core to work overtime and completely removes the assistance of your arms. Try to hold for 20–30 seconds, then recover with normal treading.

3. Hold a Weight

Grab a 5-10 lb object like a dumbbell or brick and hold it at your chest or overhead while treading. This instantly boosts the difficulty and mimics classic lifeguard or military pool drills.

Warning: If you’re not a strong swimmer, make sure a capable buddy or lifeguard is watching while you do this. It’s no joke.

4. Perform Water-Based “Strength” Moves

Mix in controlled movements to target different muscle groups:

• Water pushdowns: Push the water down as hard and fast as you can with straight arms.
• Flutter kick sprints: Keep your legs straight and kick rapidly without using your hands.
• Bicycle kicks: Mimic riding a bike while staying upright — harder than it sounds.

5. Set a Distance Marker

Pick a pool lane and tread from one side to the other without swimming — just vertical movement. This forces forward propulsion through awkward, inefficient movement, taxing your stabilizers and coordination.

Sample 20-Minute Treading Water Workout

Here’s a simple beginner-to-intermediate routine:

Final Tips

• Stay upright: The workout is in the vertical position. If you’re angled back like you’re floating in a La-Z-Boy, you’re doing it wrong.
• Don’t touch the bottom: Treading only works if you’re off the ground. Deep end only.
• Work up gradually: You’ll be shocked at how tiring this gets. Ease in and build your capacity over time.
• Use good form: Lazy flapping wastes energy. Focus on strong, intentional movements.

There’s something satisfyingly fundamental about treading water. You don’t need equipment, music, or a squat rack. It’s just you versus gravity. As opposed to other workouts, where the fitness being built seems several steps away from what might be called upon in the real world, you can viscerally feel it building your survival capacity. So tread away — you’re getting harder to kill!

This article was originally published on The Art of Manliness.

An important part of manhood has always been about having the competence to be effective in the world — having the breadth of skills, the savoir-faire, to handle any situation you find yourself in. With that in mind, each Sunday we’ll be republishing one of the illustrated guides from our archives, so you can hone your manly know-how week by week.

When you attempt to do the monkey bars, after taking an extended post-childhood hiatus from the practice, you’re apt to think one thing:

“$@%#! This feels awful!”

That terrible feeling is partly due to the fact that your arms have to support a lot more weight than they did when you were seven.

It’s also due to the fact that you probably don’t do much hanging as part of your fitness routine (even though you really should).

It’s worth getting over this shock to the system, though, and tackling the monkey bars more regularly. As an exercise that works your shoulders, back, arms, core, and grip strength, as well as your agility, there’s a reason the monkey bars are a standard fixture in both military and civilian obstacle courses. 

To make it across the monkey bars at all, you’re going to need a baseline of strength. General strength exercises like pull-ups will help get you there, but don’t ignore working on your grip strength; often the reason someone falls off the bars prematurely isn’t because their arms aren’t strong enough, but because their grip strength isn’t adequate. You can find a guide to strengthening your grip here.

Beyond general strength, traversing the monkey bars more comfortably and efficiently requires working on some foundational movements, as well as your technique.

On the former front, you’re going to want to start hanging on the regular, and Danny Clark, Master Instructor for MovNat, recommends these exercises in particular:

• Upward Reaching (focus on allowing the shoulders to flex fully instead of compensating with spinal extension)
• Side Hang (minimize “arching” the back and grip the bar with the pad of the hand; work up to at least 45 seconds)
• Scapular Pull (work up to 5 reps)

When it comes to technique, there are a few different ways to traverse the monkey bars. There’s the side swing, where your body is perpendicular to the bars and your palms are facing each other; this approach can sometimes feel more accessible and stable to beginners. The Front Power Traverse is a good method for when you’re looking for speed. If you’re first starting out, or find yourself in wet, slippery conditions, you may want to grip each bar with both hands before moving one hand to the next bar; while this method can feel more stable, it does make the traverse harder, as it stalls your momentum, slowing your progress and sapping more energy. As you get more comfortable on the rig, move to alternating your hands on the bars (i.e., you only have one hand gripping a bar at any given time).

For smoothness and efficiency, use the Forward Swing Traverse which, with tips and instructions from Danny, has been illustrated above. This traverse allows you to do the monkey bars with true primate-like flow.

The more you practice the monkey bars, the less terrible this effective bodyweight exercise will come to feel. So don’t leave the monkey bars behind in your childhood, and instead jump on them the next time you’re at the playground (there are a bunch of other exercises you can do while you’re there, too). 

Illustrated by Ted Slampyak

This article was originally published on The Art of Manliness.