February 2024

Dr. Gabrielle Lyons is a board-certified family physician who earned her undergraduate degree in nutritional sciences from the University of Illinois. She completed a research and clinical fellowship in geriatrics and nutritional sciences from Washington University in St. Louis. Her first book, "Forever Strong", was published in 2023. It is a significant departure from the typical health advice and information that you will hear from the mainstream medical establishment. The main thrust of her approach is something that she calls Muscle-Centric Medicine, which stresses treating the skeletal muscle as an organ. She believes that, "Your ability to survive and thrive - no matter your age - is directly related to muscle tissue health."

In the very first chapter, Dr. Lyons sets the table for the rest of the book by discussing the need to shift from a fat-focused paradigm to one centered around building muscle. She notes all of the conditions that poor muscle health can influence, from cancer to sarcopenia and even Alzheimer's. The author highlights the importance of skeletal muscle and its role in your immune system, saying, "Training also boosts your immune function via peptides - small molecules composed of amino acids - released during muscle contraction. Key peptides can send signals in the body that help fight off germs and reduce inflammation." Later in the same chapter, she discusses myokines, which are hormone-like proteins released by the skeletal muscles that circulate in the bloodstream and help regulate other body functions, particularly glucose metabolism. One myokine in particular, BDNF (brain-derived neurotrophic factor), boosts the formation of new brain neurons, which can facilitate learning and memory.

When discussing disease, Dr. Lyon correctly points out the limitations of traditional Western medicine, saying that it, "...Skews its emphasis toward what's making us sick while overlooking prevention. This tendency leads many doctors to focus on fat and glucose while disregarding the skeletal muscle that could correct the imbalance." The author is right; when is the last time your family physician ever talked about lifestyle changes, weight training, or nutrition? I would add the over-reliance on pharmacology to the doctor's assessment. She goes on in chapter four to discuss nutritional science and is quite critical of the government's recommended guidelines. Dr. Lyons says, "To repeat, it's critical to recognize that the goal of government-funded nutritional guidelines was never (her emphasis) to help individuals achieve exceptional health. Instead, setting forth minimum (her emphasis) intake values was intended to prevent deficiencies." Ignore the RDA; it won't help you to live your best life and be disease-free. The author believes that most people do not consume enough protein, which makes it hard for them to maximize muscle growth even if they regularly strength train. Eating one gram of protein per pound of body weight is the starting point that she recommends.

There is a lot of good information in this book, and it speaks to the overall attitude that each one of us controls our own destiny. Dr. Lyons details five fundamental attributes that all of us have inside of us, which are courage, perseverance, self-discipline, adaptability, and resilience. We will all face adversity at some point in life, and developing these qualities will help us to succeed when the going gets tough. Building muscle is your best ally in the larger plan of fighting off chronic disease, and the author does a commendable job in emphasizing the importance of weight training. The good doctor lists all of the essential amino acids, the ones that our bodies cannot make and must be obtained through our diet. I won't go through all of them, but she mentions that leucine is the most important amino acid for muscle health. There is a terrific understanding of nutrition (as one would expect from someone who earned a degree in nutritional sciences, but not generally common in the medical field), and I was pleased to see that she dismissed the myth of the connection between dietary fat and body fat. Again, her anti-establishment approach was wonderful to see.

Unfortunately, I was disappointed by the exercise advice given in this book. Much of what is prescribed here constitutes overtraining in my opinion, and there are references to steady-state activities that are high-force in nature and can lead to overuse injuries. The author has a poor understanding of several concepts that are quite relevant to proper exercise, namely the dose-response relationship of exercise, which explains that just like in pharmacology, you want the minimum dose necessary to stimulate optimum benefit. She seems to be unaware that you cannot segregate the aerobic metabolic pathway from the anaerobic pathway, and that while you may use more of one pathway than another in a given activity, both are always in play. Dr. Lyons recommends exercises that involve the use of dumbbells as well as unilateral and alternating movements, which leads me to believe she doesn't appreciate the dangers they pose to the pelvis and spine. There is no mention of speed of movement, so I can only infer that she doesn't fully acknowledge the dangers of excessive force on joints and connective tissue. Finally, when Dr. Lyons talks about "cardio training" she makes reference to VO2 Max, which most regular readers of this blog know doesn't actually measure anything, and has been called "the Monopoly money of exercise" by Dr. Doug McGuff. The scientific stuff in this book is great; the exercise advice, not so much.

In spite of my criticisms, I enjoyed this book. As I mentioned before, very few medical doctors really go to these lengths to espouse the importance of skeletal muscle and the benefits of regular strength training. In my own experience, I can now include Dr. Lyons with Dr. McGuff, Dr, Carol Currier, and Dr. Michael Hasz as physicians who "really get it ". There is a positive message in the book and an underlying theme of self-empowerment that can serve as a convincing inspiration to spring into action. I encourage you to read the book and decide for yourself.

Self-improvement is a continuous process. Mastery takes a lifetime. Those are just a couple of the maxims that I often come across when I read self-help, philosophy, and leadership books. It is a noble endeavor to want to improve yourself and not be content with who you are at this very moment. Constructive criticism can be difficult for some people to accept, because sometimes the truth hurts. It is not what we want to hear, but it is what we need to hear if we want to build on who we are because no matter how self-aware we think we are, we all have blind spots. If you are not progressing as a Total Results client as you hoped you would, we should examine why that is the case. Accountability is important but it is not about taking you to task. Everything that we do at our facility is about making you better.

The nature of exercise instruction is to be critical, to point out and correct mistakes so that we can maximize your performance. As an instructor, it is important to me to balance being critical with providing positive reinforcement and encouragement. I am up front and honest with potential clients when discussing expectations during an initial consultation. I explain the importance of proper form, exercise intensity, and mastery of speed of movement and turnarounds, but I also am very careful to mention that this program is not a cure-all, and that their degree of success is largely predicated on what they do when they are not here. Naturally we don't want to scare anyone off, but I don't want there to be any illusions about what our philosophy entails. Sometimes people decide that this isn't the program for them, and that's okay. I would rather learn that right off the bat rather than a couple months down the road.

Correcting form discrepancies is the most important aspect of being an exercise instructor. Proper form is not just something that we give lip service to; it is the very essence of our exercise philosophy. These discrepancies are not conscious decisions by the client to do the wrong thing, but rather instinctive acts to try to make things just a little bit easier. These form discrepancies must be corrected immediately and repeatedly until they no longer occur, but please remember that these criticisms should never be taken personally. Many other instructors in our industry are not as strict about form as I am, but it is not because I enjoy being critical. It takes courage to want to teach and correct behavior, especially when you know it might not be well-received. I have a responsibility to uphold the high standards that we have had at Total Results for over 20 years, and I would do the client and myself a disservice if I let certain things slide. If I let one thing go, it can very easily become a slippery slope, and it is important to be consistent across the board. Praise and positive reinforcement are also important, because that helps to solidify proper behavior and execution. Consistent and honest feedback is the key to improvement in any aspect of life, especially in exercise.

Discomfort is a natural part of high-intensity exercise. In order to stimulate true positive change in the human body, you must do something intense and significant to induce the body to adapt, and that feeling is not pleasant. I would not sell anyone a bill of goods that our workouts are fun, but they are critical for building and maintaining skeletal muscle mass. I am certainly not a masochist, and I don't enjoy seeing people in pain, but the dull ache and intense fatigue that you experience during a workout is brief and is not indicative of injury. As my friend Al Coleman used to say, "Don't run from the discomfort, chase after it." Also unpleasant to some is the cold temperature and fans that we have in our exercise studio. This is necessary in order to keep you from overheating during your workout. High-intensity exercise causes your muscles to produce a tremendous amount of heat, and if the workout space isn't properly chilled or ventilated you can overheat sufficiently to short-circuit your performance. No, it isn't particularly enjoyable to be in a cold environment with fans blowing on you, but this is what is necessary to optimize your workout experience. You will warm up within the first two exercises. I also must maintain a clinical demeanor during your session. Sometimes this throws people off initially, but I can assure you that I am not trying to seem distant or unfriendly. Exercise is a serious endeavor that requires focus, and chatting mindlessly during your workout can increase your risk for injury as well as diminish your performance. I enjoy talking with clients before and after sessions, but proper perspective must be maintained. Our studio environment and my instructional style are all carefully cultivated to give you the best opportunity for success.

All we want is for you to prosper. No one ever said our workouts are easy, but the reward comes when you start to see and experience the fruits of your labor. Understanding why we do certain things will help you to focus on what is important and keep things in proper perspective. Not every workout will be record-setting, of course. You will have some days where you feel great and others that are a struggle. Be emotionally mature and take responsibility for your success as well as your failures. We are your health partners, and everything that we do is geared toward making you better.