Total Results Blog

Casey Means, MD, earned both her undergraduate and medical degrees from Stanford University. She completed her residency as a head and neck surgeon at Oregon Health and Science University before leaving traditional medicine to focus on the root causes of why Americans increasingly suffer from chronic diseases. "Good Energy" was written with Dr. Means's brother Calley Means, and it was published in 2024.

During her surgical residency, Dr. Means treated patients with numerous chronic conditions, such as migraines, sinusitis, tonsillitis, and various other ailments. Typically she would prescribe various medications to treat the problem, and if those did not work she would perform surgery. Eventually she realized that she was treating the symptoms rather than fixing the underlying root cause. This prompted her to leave her position as a chief resident at OHSU and open her own practice. Establishment medicine tends to treat every condition separately, without realizing that all the processes in the body are interrelated. As the author states, "...inflammation-which leads to disease, pain, and suffering-takes root because core dysfunctions occur inside our cells, impacting how they function, signal, and replicate themselves." She also correctly points out that, "...every institution that impacts health-from medical schools to insurance companies to hospitals to pharma companies-makes money on 'managing' disease, not curing patients."

Dr. Means makes the distinction between "bad energy" and "good energy." "Bad energy" is when normal metabolic function has tipped into dysfunction, and is largely the result of three things: mitochondrial dysfunction (in which the powerhouse of the cell is overburdened and cannot produce enough ATP), chronic inflammation (mitochondrial dysfunction is perceived as a threat and the body formulates a fighting response), and oxidative stress (free radicals cause damage to the cells and lead to dysfunction). Mitochondrial dysfunction can be caused by many things, namely chronic overnutrition, a sedentary lifestyle, chronic stress, sleep deprivation, medications and drugs, and nutrient deficiencies. When mitochondria do not function properly, they cannot convert food energy into cellular energy, which can lead to chronic disease. On the other hand, "good energy" can be measured by looking at five markers that are typically tested during an annual check-up. The author says that you should strive for a triglyceride level of less than 80 mg/dL, HDL cholesterol of 50-90 mg/DL, a fasting glucose level of 70-85 mg/dL, blood pressure of 120/80, a waist circumference (depending on your ethnicity) of less than 37 inches for men and 31.5 inches for women, and a triglyceride-to-HDL ratio of 1. This would indicate that your cells are functioning optimally and you have achieved true metabolic health.

The book is divided into three sections. Part 1 is "The Truth About Energy", Part 2 is "Creating Good Energy", and Part 3 is "The Good Energy Plan." I particularly liked chapter five, which covers some principles of proper nutrition. The author does a nice job of explaining the inherent dangers of the contemporary Western diet that is filled with processed foods, and she discusses omega-3 and omega-6 fats and their respective roles in biological function. Dr. Means says that we should look at eating as a means of matching our cells' needs with our oral inputs, and that food is how we communicate with our cells. The most important advice that the author gives is to focus on eating unprocessed food and not worry about diet philosophy. Many different diets will work, provided you eat plenty of protein, vegetables and fruits, and essential fats, while avoiding sugars and processed foods. If you are satisfying your vitamin, mineral, and trace element requirements, it doesn't really matter what template you follow.

I enjoyed reading this book. Dr. Means includes helpful grids for each micronutrient and food sources where they can be found. There is also an exhaustive list of foods to avoid. The author provides other helpful lifestyle strategies, such as how to incorporate movement into your daily routine, managing stress, optimizing sleep by minimizing exposure to artificial light, and explaining the benefits of exposure to hot and cold temperatures. In the back of the book there are recipes that you can follow for breakfast, lunch, dinner, and snacks that are healthy alternatives to fast food and the prepackaged stuff so commonly found in grocery stores. My only point of contention with the good doctor is over her strength training recommendations. I believe that a frequency of three times per week is too much, and that the Total Results methodology is superior. However, I do agree with the author that strength training should be considered an essential component of everyone's life.

How can this book help you? It will educate you about the real reasons why the number of people suffering from chronic (and preventable) diseases has skyrocketed over the last forty years, and it should crystallize for you how the medical establishment, pharmaceutical companies, and big agriculture profit by keeping you sick. If someone as accomplished and respected as Dr. Means walked away from a lucrative specialty practice, that should tell you something. I encourage all of you to read this book and utilize the strategies put forth to optimize your health and independence. You can and should feel amazing, no matter your age.

There are many different ways to measure and track exercise performance. We create a spreadsheet (either in Microsoft Excel or Google Sheets) for each client and record the order and selection of exercises, their machine settings, weight (resistance), time under load, and make note of any recurring form discrepancies that are committed for each workout. Our exercise philosophy is the same for every client, but every individual is different; this is why we tailor each exercise routine to meet the needs of each person that is under our tutelage. Naturally, every client wants to perform at his or her best in every workout that they undertake, but different factors can make that an impossibility. There are physiological and mental considerations that have a positive or negative effect on one's exercise performance. How you approach this on an ongoing basis will have a great impact on your level of sustained success.

Some of these factors have been discussed in previous articles, but I thought this was important enough to merit a separate article on the topic. We all have individual differences, which I believe should be celebrated. Metabolically, everyone uses energy at different rates, which means that from one person to the next recovery and exercise frequency can vary. This is why some Total Results clients exercise once per week, while others come twice per week. Some train more intensely than others, which also necessitates a reduced volume and frequency of exercise. Some clients, if they have genetic advantages, can get away with things that others cannot. Since I have a genetic propensity for leanness, I could probably still make decent progress while making poor dietary choices, but I choose not to do that. It would likely catch up to me sooner or later in any event. Just because you can get away with doing certain things that are detrimental to your progress doesn't mean that you should.

Here are five factors that can significantly impact your performance.

Mental state. Attitude is everything! I often refer to the old Henry Ford quote: "Whether you think you can or think you can't, you're right." A positive attitude is absolutely necessary when you are dealing with the adverse circumstances and discomfort that a Total Results workout entails. If you are distracted (and let's face it, that is a battle that most of us have to fight every day), you will struggle. Shut everything else out of your life for 20 minutes and focus on completing something that is truly tangible and meaningful. Show no fear! Accept the fact that what you are about to do will be difficult and uncomfortable, but the realize that the reward comes on the other side in the form of accomplishment, empowerment, and independence from the sick care system.

Proper sleep. Matthew Walker's book "Why We Sleep: Unlocking the Power of Sleep and Dreams" is one of the most useful books that I have read in the last decade, and I have recommended it to scores of clients. Walker recommends getting between seven to nine hours of sleep per night, and says that anyone sleeping for less than seven hours per night on a consistent basis is functioning at a much more diminished capacity than they realize. Eventually, it catches up to you and can lead to a whole host of health problems. Sleep is important for so many reasons, but especially for recharging your mental batteries and helping to facilitate tissue repair after a workout. Sleep soundly and sufficiently for a few nights in a row prior to a workout, and you will notice a tremendous difference in your performance.

Nutrition. You wouldn't put low-octane gas into a sports car, so why eat junk food before a workout? Do not pay attention to government guidelines, their food pyramid, or most of the commercials that you see on TV. Just like a car needs fuel before a road trip, your body needs to be properly fueled in order to do the things you want it to do. Consume single-ingredient whole foods, select high quality sources of protein (1 to 1.5 grams per kilogram of body weight), and find good sources of saturated fat. Fruits and vegetables should be your primary source of carbohydrates. Avoid processed junk and minimize sugars. Simply put, you should consume the foods that will provide the vitamins, minerals, and other raw materials that you need for optimal energy and recovery.

Protein intake. Most people do not eat enough of it! I touched on this in the previous section, but you should strive to take in 1 to 1.5 grams of protein per kilogram of body weight. Simply divide your body weight by 2.2 and you will have your ideal number. In order to build muscle (which should be a goal for everyone), you need protein to repair the tissue that has been broken down in the course of a workout. Good sources of protein include beef, chicken, pork, fish, and eggs, and some protein should be consumed with every meal. If you are a vegan this will be a challenge, but there are alternative sources of protein that you can consume such as flaxseed, lentils, and tofu. I should point out that plant-based sources are incomplete proteins, meaning that they do not contain all of the essential amino acids, so variety will be key.

Activity level. Movement is important for our health, but it is very easy to overdo it. I believe that sitting for long stretches of time is unhealthy for your mind and body, but it also bears noting that our recovery systems can be somewhat fragile. Less is often more, and if you are running or biking three or more times per week your Total Results workouts can suffer. Low-level movement, such as walking, traditional yoga, or golf probably won't negatively impact you too much, but do exercise good judgement when deciding other activities to pursue.

The good news is that all of this is within your control. You have the power to do what it takes to ensure lasting success and robust health. Please let us know how we can help you on your journey!

A few weeks ago, long-time Total Results client and friend Dr. Matt DiLorenzo shared with me a YouTube video of a man performing a bent-legged barbell deadlift in a gym. There were a few flaws in his form in terms of his hip positioning, which led to him being slightly off-balance, and a couple of subtle cues and corrections by a lifting coach helped the man to improve his execution of the exercise. This led me to think about deadlift exercises in general, something that I have not considered and have not performed in many years.

The bent-legged (or traditional) deadlift, in simplistic terms, involves squatting over a barbell that is on the floor and raising it until your knees and torso are straight. The deadlift involves all of the lower body musculature, as well as the latissimus dorsi (large back muscles), spinal erectors, abdominals, and forearms. It is a very large exercise, and can be a productive option for those of you that only have access to free weights. In my opinion, using a hexagonal or trap bar is superior to using a straight barbell because it is easier to keep your back straight and you won't have to worry about scraping the bar against your shins. Unfortunately, the effectiveness of the exercise will likely be limited by your grip strength and your lower back muscles, as both are likely to give out before the targeted muscles are thoroughly inroaded.

Another deadlift option is the stiff-legged deadlift, which mostly targets the hamstring muscles for the lower body. In many instances this exercise is performed with a straight barbell and a box or platform is used so that the attached weights do not hit the floor and impede your range of motion. The knees are to be kept with a slight bend so that they do not pop backward, and your lower back should be straight. You will lower the bar until you feel a slightly uncomfortable stretch in your hamstrings, and then raise the bar until your body is back in a vertical position. Just like with the traditional deadlift, however, you will probably find that your hands and lower back will fatigue more quickly than the intended musculature.

Fortunately, Total Results has machines that will target and develop those muscle groups in a safer and more effective way than performing either of the deadlift options. The Leg Press, Lumbar Extension, Pulldown, and Compound Row exercises will do a far better job of inroading the lower body, spinal erectors, and latissimus muscles, and the movement arm is much easier to control than a barbell. These machines also naturally lend themselves to using a slow speed of movement because that is how they were engineered. The Seated Leg Curl is a better choice than the stiff-legged deadlift, because the nature of the machine's design eliminates lower back fatigue as a limiting factor. Additionally, all of our machines are manufactured with a cam that varies the resistance throughout the range of motion based on leverage and your muscles' natural strength curve. You are stronger in some positions and weaker in others, so the cam allows strength to match resistance. A barbell will always provide the same resistance no matter where you are in the range of motion, and our machines made by MedX and Super Slow Systems will give you a more complete workout.

Another consequence of watching that deadlift video is that it caused me to ponder some typical gym behavior. I have not worked out in a commercial gym in over twenty years, but some of the behavior that I witnessed is indelibly seared in my memory. I suspect much of it still goes on at gyms all over the country. Many gym enthusiasts who weight train will do something different every time they workout. No doubt they are buying into fitness lore and myths that have been perpetuated for decades. When I first got into the exercise business it was the stuff that you found in the muscle magazines; now it's typically stuff that is put out on social media. The more things change, the more they stay the same. You often hear about the need for variety in exercise routines, as a way to "shock" the body into growth. In reality, exercise variety is quite overrated and not really necessary in order to produce tangible physical benefits. Ken Hutchins, the originator of the Total Results exercise protocol, even devoted an entire chapter about this in his book "Super Slow: The Ultimate Exercise Protocol", titled "The Need for Non-Variation in Exercise." Hutchins believes that too much variation is an obstacle to becoming more neurologically efficient, which means that you will not perform each exercise as effectively as you should and will diminish both the exercise stimulus and your progress. I believe that a little variety is useful; at Total Results we make sure to incorporate vertical and horizontal pushing and pulling exercises for both the upper and lower body in order to develop symmetrically and minimize any muscular imbalances. In fact, most of our twice per week clients will perform an A and a B routine each week, although this isn't done explicitly for the sake of variety. These clients are still at the point where they benefit more from coming twice per week instead of once, but performing the Leg Press and some other exercises every time can overtax their recovery ability. Performing an A routine (which typically contains the Leg Press and Lumbar Extension exercises) and a slightly less demanding B routine allows us to incorporate some smaller but very important exercises like the Calf Raise and Cervical Extension, while facilitating steady progress. Physiologically, you do not need variety; it is actually possible to do the same routine each time and still make improvements. Too much variety can also lead to haphazard record keeping and inadequate exercise intensity.

Now for a few random musings! I spent some time with former Total Results owner Tim Rankin a few weeks ago at former client Paul Logan's house. Many of you know that Tim and his wife Pam moved to Florida nearly four years ago, and they are doing great. We talked a little about exercise, and he shared a few stories about the headaches of working out at Planet Fitness (he definitely got spoiled by owning a private exercise facility for twenty years). One thing that he has grown to appreciate and misses the most about Total Results is all the movement that he performed every day when he was an instructor. We are up on our feet quite a bit throughout the day as we instruct clients, and there is a lot of bending, turning, and twisting in multiple planes of motion when we set up machines before workouts. Yes, we do sit at our desks but it is usually for very short stretches. Tim has successfully found other ways to incorporate low-level movement into his daily routine, but I think it underscores how important it is for us to get up and move during the day, especially if your work involves being at a desk and in front of a computer for long periods of time. The human body was designed to move, and if you are fortunate enough to be in good health it seems like a crime to not take advantage of it. Don't sit still. Time waits for no one!

You have the power to take control of your life and your health. Do not allow someone or something to stand in the way of having the body and the life that you have always wanted. Total Results can provide safer and more effective alternatives to the exercises available at the gym. We can craft a customized exercise routine that will stimulate lasting physical change without overtraining or causing injury, and we can provide the highest quality instruction and guidance about what to do when you are not in our studio. Become the best version of yourself with Total Results!

We are often enamored with things that are flashy and catch our attention, while at the same time we fail to realize how much effort goes into making something that is very difficult look easy. No matter how naturally gifted a person is in a certain endeavor, everyone starts with the basics. Michael Jordan, in my opinion, is the greatest basketball player that ever lived, and while he had a well-earned reputation for being a clutch scorer, he was also a tremendous defensive player. He learned from his college coach, Dean Smith, that you play defense with your feet rather than your hands, you must be able to see both your man and the ball, and you must stay between your man and the basket. In short, he learned the fundamentals of being an all-around player. In the Super Bowl last weekend, the Philadelphia Eagles reminded everyone (especially the Kansas City Chiefs) that while spread offenses and throwing the ball all over the field attract high ratings, football still comes down to the fundamentals of blocking, tackling, and forcing/avoiding turnovers. In short, success in any field, whether it is in sports, academics, or business, depends on mastering the fundamentals.

People who desire to achieve great things never get bored with the fundamentals. If you do not master the fundamentals, you cannot take the next step in your development. John Wooden won ten NCAA men's basketball titles, yet every season during the first practice he meticulously went over with his players how to properly put on their socks and shoes so that they could avoid blisters. That seems extreme, but it reinforced Coach Wooden's commitment to teaching the fundamentals that contributed to their success. Mastering the fundamentals is a critical element to the teaching that goes on at Total Results. Very few "trainers" or exercise enthusiasts understand the concepts that make up proper exercise, nor do they realize that these teaching points must be emphasized over and over again.

What are these exercise fundamentals that must be mastered in order to optimize success? The first fundamental is proper breathing. That seems a little silly at first glance, since everyone knows how to breathe, but there is a certain way that we want you to breathe during your workout. You should breathe exclusively through your mouth, in a shallow and repetitive fashion, with a relaxed jaw and no lip pursing. We want you to breathe freely, but also avoid overbreathing too early in the exercise so that you don't prematurely fatigue. This will help you to get oxygen to the working muscles, blow off carbon dioxide, and also prevent the pH levels in the muscles from becoming too acidic (this can also cause premature fatigue). This requires much prompting and cueing on the part of the instructor to establish good habits in the first few sessions, and while most clients get the hang of it fairly quickly, everyone needs a reminder now and again.

Another fundamental element to proper Total Results exercise is having the right mindset. Why exactly are we doing this? It is important to understand the main objective of exercise: thorough inroad. Some clients struggle with this either initially or once they start to encounter meaningful resistance. Most people assume their purpose is to perform as many repetitions as they can with as much weight as possible, but that is incorrect. What we really want to do is fatigue the muscles safely and deeply enough to elicit an adaptive response. If you are too focused on squeezing out more repetitions, you are far more likely to take liberties with your form and enter unsafe territory. This defeats the true exercise objective. Keep your mind in the right space and realize that when you are struggling and the movement arm is difficult to move, this is the most effective part of the entire exercise.

Our ideal speed of movement is ten seconds raising the weight and ten seconds lowering the weight. Bear in mind that while this is what we strive for, no client is perfect in terms of speed. Anything between eight and twelve seconds in each direction will meet our standard, so you have some leeway. We want to minimize potentially dangerous forces and maximize muscular loading, so ten seconds is the sweet spot. Pace goes along with speed. An evenly paced movement is preferable to one that is inconsistent, so I instruct clients to shoot for a rate of acceleration of about one inch per second. Even though each exercise has a slightly different stroke (distance between start point and end point in the range of motion), that seems to do the trick. Clients can help themselves by counting in their head or using the clocks that are situated on or near most of our machines in order to develop pace.

Our turnaround technique involves smoothly and carefully changing directions at the end of each positive and negative excursion. When Ken Hutchins first developed our protocol, he was unsure if this speed of movement could even be applied to compound exercises (movements that involve multiple joints and muscle groups). That dilemma was solved when he developed the turnaround technique. When changing directions at the lower turnaround, you want to let off the force just enough to bottom out the weight stack without unloading the musculature, and then push or pull just hard enough to begin the next repetition. This ensures a smooth and continuous movement. Naturally this becomes more challenging and fatigue increases, but attention to this small detail makes a huge difference.

These fundamental elements of exercise are introduced during both the preliminary considerations and sample workout portions of the initial consultation, and are reinforced during almost every workout going forward. If I see that a client is struggling with form, I will not hesitate to lower the weights to help them reacquaint themselves with proper fundamentals. Some of our most successful long-term clients are the ones that strive for mastery and realize that it is a life-long pursuit. Even when you master the fundamentals, you will always return to them, as they are the bedrock on which to build success.

If you're going to do something, you might as well strive to be the very best you can be. I read a great quote in Brian Johnson's book "Arete" that said, "Average performers practice something until they get it right. Elite performers? They practice until they can't get it wrong." Master the fundamentals and reap the full benefits of your exercise experience. Make it a game!

An initial consultation with a prospective Total Results client is very comprehensive and information-dense. The most important aspects of that hour-long meeting are to connect with and better understand the prospective client's needs, but also to learn about their medical history and to explain areas of preliminary consideration (which covers safety and expectations). Those are non-negotiable and must be discussed before we even go into the workout room. I also will give a general overview of our exercise philosophy and briefly touch on the fact that our workouts are brief, infrequent, and intense. Most people initially have a difficult time wrapping their minds around the fact that our sessions typically entail six or seven exercises and last about twenty minutes. Even in 2025 this concept runs counter to what most people in the exercise field are doing - traditional weight training workouts take longer to complete and are performed more frequently. Why do we use only one set of each exercise, and is it wrong to perform multiple sets?

Essentially, there are two philosophies in weight training: the volume approach and the inroad theory of exercise. The volume approach has its origins in the bodybuilding world, where trainees lift weights anywhere from three to six times per week and split up their routines by body parts (back and biceps on one day, legs on another day, chest and triceps on a third, etc.). Typically, multiple sets of each exercise are performed, sometimes going to the point of muscular failure, but other times completing an arbitrary number of repetitions per set. Workouts can last beyond 90 minutes, but the thinking is that a high volume of exercise will stimulate muscular growth. This excessively high volume approach has only gained popularity within the last half century; old-time bodybuilders of yesteryear used much lower volume than the enthusiasts of today. To be fair, a couple of well-known bodybuilders actually bucked the trend of the industry and trained with much lower volume and frequency. Dorian Yates won six consecutive Mr. Olympia competitions in the 1990s by using a more high-intensity approach. Mike Mentzer developed a low-volume and high intensity approach that he called Heavy Duty, and he was very successful in the 1970s (most observers believed he should have beaten Arnold Schwarzenegger in the 1980 Mr. Olympia contest).

The problems with the volume approach to weight training are multifold. Most of these workouts are performed without a regard for speed of movement, and faster speeds lead to greater force, which is the root cause of any acute injury. Consequently, a greater volume of exercise will overtax the already finite recovery ability that most people have, thus increasing the risk of overtraining, stagnation (or reversal) of progress, illness, and overuse injury. Professional bodybuilders and competitive athletes that look muscular and fit when training in this fashion usually do so as a result of having favorable genetics and/or taking performance-enhancing drugs. Finally, this approach requires more time spent in the gym in one week than most people can spare. Ask yourself: is it realistic to spend 90 minutes in the gym 3-5 times per week and still have a meaningful life?

The inroad theory of exercise (which is what the Total Results exercise protocol is built upon) has its roots in the classic sciences of biology, chemistry, physics, muscle physiology, and concepts of motor learning. It starts with the understanding that the body wants to do whatever it can to maintain the status quo, so if you want to create significant and lasting physical change you must give the body a very good reason to adapt. This is the very point of training in a high-intensity fashion; by utilizing a slow speed of movement we eliminate momentum and force the muscles to contract with a greater amount of effort. Intensity can be defined as inroad (depth of the fatigue of a fresh muscle's strength) divided by time. We take each exercise to the point of and beyond muscular failure, which ensures that we have done everything in our power to deeply fatigue the group of muscles involved in a given exercise. This is the stimulus that we seek, and it is what the body interprets as an existential threat to mobilize its resources to make physical improvements.

Why do we only use one set per exercise? Dr. Doug McGuff, an emergency room physician, owner of Ultimate Exercise exercise studio, and author of "Body by Science" and Ultimate Exercise Volume 1" discusses how exercise has a narrow therapeutic window. This is really the same principle as is used (or should be used) in prescribing medication. Not enough of the drug will not produce any positive effect, while too much of a drug will cause a toxic reaction. Most people require a lot less exercise than they realize, and often sacrifice meaningful effort for a high-volume approach. We should strive for the minimum dose of exercise necessary to elicit the adaptive response, which lends credence to the idea of performing shorter and more intense workouts less frequently. Further, performing multiple sets of an exercise is redundant, especially if you train to failure. Going to failure is the stimulus that was needed, but completing two more sets does not go beyond the initial stimulus; it simply reintroduces the same stimulus (and likely less effectively) multiple times. Lastly, we want to keep cortisol levels from becoming elevated. Cortisol is a stress hormone, and elevated levels can result in anxiety or depression, high blood pressure, weight gain, and poor sleep. The high-volume approach can lead to these negative changes. On a lighter note, Arthur Jones (founder of Nautilus and the father of high-intensity training) told a story in his autobiography about Arnold Schwarzenegger visiting the Nautilus headquarters sometime during the 1970s when he was at the peak of his bodybuilding career. It was not uncommon for several of the top competitors of the era to workout at Nautilus from time to time, but Jones recounted that Schwarzenegger left the compound very abruptly because the workouts were too demanding for him. I guess he preferred his old high-volume approach.

Multiple research studies support the idea that single sets of exercise are preferable to multiple sets. A study performed in 2024 by Brad Schoenfeld concludes that one set of exercise taken to failure can produce better muscular growth compared to two submaximal-effort sets. Two 30-minute sessions was all that it took. The link to the study can be found here: https://sportrxiv.org/index.php/server/preprint/view/484/1032. Wayne Westcott and Richard Wientt conducted two studies in 2001 that examined the difference between training with a faster speed of movement versus a slower speed. In both cases, the slower-speed group produced better results. This study can be found here: https://www.researchgate.net/publication/11894824_Effects_of_regular_and_slow_speed_resistance_training_on_muscle_strength.

Most people in the gym simply do not work that hard, because it is much easier to perform multiple sets of an exercise than one, intense, and properly executed set. It requires more effort, focus, and discipline to give your all for twenty minutes, and then get out of the way and allow the body to do what it needs to do. Time is a factor as well, and while intense workouts are psychologically and physically challenging, they are also shorter and more sustainable over the long term. After all, isn't uninterrupted meaningful progress what you really want? Let Total Results show you the way.