ATHE_Transcript_Ep 647_Why Your Breathing Pattern Might Be the Ultimate Health Clue with Dr. Andy Galpin

[00:00:00] JJ Virgin: I'm JJ Virgin, Ph.D. dropout. Sorry, Mom. Turned four-time New York Times best-selling author. Yes, I'm a certified nutrition specialist, fitness hall-of-Famer, and I speak at health conferences and trainings around the globe, while I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information that I uncover with as many people as I can.

[00:00:26] And that's why I created the Well Beyond 40 podcast to synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode, we'll talk about what's working in the world of wellness, from personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness.

[00:00:45] Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100.

[00:00:59] Last year, I listened to this amazing, was a four-part, I think it was a six-part series on Huberman Lab. With Dr. Andy Galpin, it was literally, I think, 20 hours of exercise science, and I didn't listen to it once, by the way. I listened to it three times, and then I went down the rabbit hole of Dr. Andy Galpin, where I started listening to his five, his twenty-five-, and fifty-five-minute exercise physiology snippets on YouTube and searching for any interview that I could find.

[00:01:33] So I'm here at the metabolic health summit, and I discovered that he was speaking. Not only he was speaking, he was speaking right after me, and I'm like, perfect. I am finally going to get that interview with him that I've been dying to have. And I'll, I'll give you a little heads up. This interview, I could have done another four hours too.

[00:01:51] And one of the things I knew after the end of it was that I would definitely need to have another one. So what I really wanted to get from Dr. Andy Galpin was how do you identify where you are. What the key things you should be looking at in your exercise program, specifically for those of us 40 plus,

[00:02:10] focused on, you know, is there any difference between men and women? What should we be looking at as we age? What should we be looking at in terms of the metrics we should be checking in on? We're going to talk about the importance of VO2 max and how this is such a very, very important test. And I will tell you, I did a predicted one.

[00:02:29] I've been kind of putting off doing the real one because they hurt, but I'm going to do it, and I will share my results. I will also do it on video, and I'll get my husband to do it with me because he always says game. You're going to learn about what else you need to look at, things like grip strength and balance, and then what you need to do about them.

[00:02:46] And then we're also going to talk about something that he mentioned yesterday while we were in his talk that blew my mind. So, it's the more important marker than HRV that will really tell you how well you're recovering. Plus, we'll talk a little bit about his affordable sleep lab. You can now do a do-it-yourself sleep lab at your home.

[00:03:05] That's FDA-approved. So, I mean, there's so much good, juicy stuff in this interview. So, you are going to want to listen to this one, I think, a couple of times, and I also want you to, you'll want to check out the show notes, jjvirgin.com/andy. We're going to share the information on his sleep lab.

[00:03:22] He now has a direct-to-consumer lab testing company, really the difference of looking at labs for performance rather than for disease. And I know we're all looking at how do we get better with age. This will help. Also, we will link to his new podcast coming out soon called Perform. So lots of great stuff here.

[00:03:40] And let me tell you a little bit about Dr. Andy Galpin before he comes in. He doesn't look like this, but he's a full-tenured professor at California State University. I say that because he like, literally looks like he's 25. He is the co-director of the Center for Sports Performance and the founder-director of the Biochemistry and Molecular Exercise Physiology Lab.

[00:04:00] He's a human performance scientist with a Ph.D. in human bioenergetics and over 100 peer-reviewed publications and presentations. He's worked with elite athletes, all-star, all-pro, MVP, Cy Young, Olympus, gold medalists, majors winners, world titleists, across all sorts of disciplines from the UFC, Major League Baseball, NBA, PGA, NFL, Boxing Olympics, Special Forces.

[00:04:24] But he also now works with executives, so he's used, he's gone the whole gamut. He's also the co-founder of Absolute Rest, that sleep-testing company that I was talking about. Biomolecular Athlete and Rapid Health and Performance. I am so excited to share this interview with you. I will be right back with Dr. Andy Galpin. Stay with me.

[00:04:50] So, Dr. Andy Galpin, I am like beyond excited to have you here. I'd love to dive in, and it kind of goes along with Stacy Sims' whole thing of women are not small men and looking at exercise prescription because this is obviously a podcast more for women. What is different here with women versus men in terms of exercise?

[00:05:11] Dr. Andy Galpin: Well, they're not small men, that's a very good point, um, but they're also not a different species, either. And so, if you were to paint a Venn diagram, where is that overlap? All right, in other words, how much is male-specific considerations? How much is female-specific considerations? And how much is it doesn't matter?

[00:05:28] I think that overlap is perhaps more than some people will realize. And I can say I have coached plenty of female athletes. We have plenty of females in our executive programs. The cores are the same. The overarching principles, there's a thing that we'll say all the time, which is the methods are many, but the concepts are few.

[00:05:48] I don't strongly believe the concepts of training a male versus female are any different whatsoever. There may be some different methodologies, but really, those differences are a function of that individual human more than anything else. And so if you're to ask me, do you train all your men the same?

[00:06:04] That goes down to the individual person. So if that person needs it, great. If not, we don't go out of our way to do that unless there's a specific reason to do it, which I'm not against. But there's more goals, and it's more that person, just like I'd say, do you modify your training for somebody who's taller?

[00:06:17] Well, if we need to, then yes, but if we don't, like, it's not a rule. You don't do that exercise, you do this exercise. Absolutely not. Does that person need it? Yes. No. And that's how we go about it.

[00:06:27] JJ Virgin: Yeah. And I loved the way you walked through yesterday in that lecture about the different ways that you did considerations and priority at that. That was fantastic.

[00:06:34] Dr. Andy Galpin: Yeah, we have a pretty comprehensive system, like we were interested in getting traditionally going back. I have always worked with professional athletes, amateur athletes. And what that means is we have a very specific goal on a very specific day. And so that puts pressure on you to say you can't miss.

[00:06:50] You can't be wrong, because we have Olympics on a certain day, we have world championships, we have the Super Bowl, like these are days, and we don't get to move them. Having taken that model then and applying it to other people, the same thing is here. Now, the dates aren't as firm and as tight, but the people we have traditionally worked with they don't have time either,

[00:07:07] Right? And so, they don't have a day they have to compete, but we, we can't afford six months of missing because it's like, hey, I feel terrible. Our approach to that is, then, let's be as comprehensive as possible with our analysis so we can figure out what the highest likelihood of certainty this path we're going to put you on is the most likely to succeed, and I'm using a couple of terms there very intentionally.

[00:07:27] There is no guarantees. I've done this for a very long time, and we've had a lot of things on the line, and we've had a lot of success, but physiology is still mysterious. Most likely you're probably going to have the best success if we start here and that's as much as we can ever guarantee.

[00:07:40] JJ Virgin: It almost feels like nowadays, like back when I was in school, there was a hypertrophy range, there was a strength range, you did those ranges, you didn't go outside of that range if you went out to that, it was endurance, and now it's so broad, it's almost more confusing, but I think the point is, like, it all can work.

[00:07:57] Dr. Andy Galpin: Yeah, and so it really comes down to defining work. Like when you say work, what does that mean for you? When I talk about the word performance, like what does performance mean to you? So, performance isn't one rep max. It isn't energy throughout the day. It isn't focus. It isn't muscle size. What do you mean?

[00:08:14] How do you want your body to perform? We tend to bundle it into three categories, and that's for the most part. All people really care about in terms of their physical body, which is you want to look a certain way. How do you want to perform? You just talked about that. You define perform. What's that mean to you in your context?

[00:08:29] And how do you want to feel? All we're doing is trying to identify, you tell me what you want to look like. You tell me what you want to perform like, and you tell me how you want to feel. We're going to go find the tools that we think is best for that physical performance metric, or for that feeling you need, or for that body composition thing, now we're going to say, based on all the individual data we have on you and all of this combination of goals, And if you start running a little bit of calculus, so you realize, well, that's a lot of different possible solutions.

[00:08:57] So now we have sleep solutions. We have training solutions. We have nutrition solutions. We have supplementation and breath work, and all these different things we can pull out. And we're not just going to give them to everybody because it's completely unusable.

[00:09:08] JJ Virgin: It's interesting because I've been working on a program on just a very basic, you've been walking, maybe you've been doing a little yoga.

[00:09:15] Let's get started. But what about this? And so in looking at this, and, I know you've got now a blood test company, but if someone was starting and they just wanted to be able to listen to this podcast, go through kind of a decision matrix and go and get started on something, what would be some of the key things you would have them kind of think about in terms of where they're starting that they could go, this would be a good starting point?

[00:09:41] Dr. Andy Galpin: Yeah. So that, we do this in every single person we work with, and that is, we go through this entirely. Comprehensive analysis, because when we finish that analysis, what we do is then we identify what we call performance anchors. So, these are things that are anchoring and holding you back. These are things that are constraining your life or your physiology or whatever it is that you're trying to solve.

[00:10:00] All we're going to do is find those things. And then we're going to pick those off in the order of severity. What is the biggest hole in your game? What is your biggest performance anchor? And just start there. Maybe that is nutrition. Maybe that is physical activity. Maybe that is mental health. Maybe that is sleeping.

[00:10:17] If all you have is one starting place, let's start with the thing that's going to give you the easiest win. Now, the last little context of that is, if there's an area that you feel like is your biggest problem, but you've had a lot of issues with it, start somewhere that's going to be an easy win. Where are you going to see progress in?

[00:10:33] Maybe that is we're going to go from one walk to three walks a day. Like let's get momentum, let's get an easy win. Don't pick something that you're already doing great at. So, find one where you're like, I don't really want to do this. It's going to be hard, but I don't have this entirely horrible stigma, this track record, this pattern of failure on, and now we're just going to have like all kinds of problems.

[00:10:53] Especially if you don't have support. You have a coach or somebody that can support you, then start with that hard one, because that's going to make the biggest dominoes fall. But if you can't do that, then I would say, pick the next one down that, that is something like, I really honestly haven't tried to strengthen much.

[00:11:07] I really honestly haven't tried to work on my sleep. Okay. And then maybe start there.

[00:11:11] JJ Virgin: I love that because that is actually how I set up every single one of my programs is what's the first win? Yeah. The one thing. Nothing else. Yeah. Like what I find with, if I just have people increase their protein, it's like the birds come out and sing.

[00:11:27] Yeah. So, I love the things that the little hinge that swings the big doors. I'd love you to talk about what happens 30 plus, 40 plus, 50 plus. As we start to age. Yeah. And what's happening to our muscle and specifically, because I know you talk a lot about fiber types and what's happening to our muscle.

[00:11:45] Dr. Andy Galpin: So, when you look at these hallmarks of aging, and here, we need to separate chronological age from however else you want to define this health span, performance span.

[00:11:56] JJ Virgin: Yeah.

[00:11:57] Dr. Andy Galpin: This is to say, okay, it's not about living to X number. It's about, can you continue to live in the lifestyle you want to live for the longest time possible?

[00:12:03] Yeah. Let's assume you want to have the functionality as long as possible. When you feel good and you have energy and you're not alive, but sitting in a bed all day kind of thing, if that context is true, then we start just going backwards and thinking, what physical attributes do we need to have that allow us to function?

[00:12:19] And we start looking at stuff. It's actually going to sound like an athlete-testing paradigm. If I were to test an athlete and say, how do I get you? I want to identify the best player on my team or the person who's got the most success or whatever, and you would do something like what's our maximal aerobic capacity, what's my leg speed, how much muscle mass do I have, how fast are my reaction times, you think okay that's all sports stuff.

[00:12:42] That's the exact same thing. You need to know your VO2 max. It is one of the strongest predictors of how long you're going to live. This is your maximal aerobic capacity.

[00:12:50] JJ Virgin: Okay, so define VO2 max for the listeners.

[00:12:52] Dr. Andy Galpin: It's your maximal ability to bring in and utilize oxygen. So, this is typically done, if you think about this from a medical testing perspective, on a treadmill or a bike.

[00:13:01] You have a little mask on, and we see what is the maximum amount of oxygen you can bring in and utilize. You're going to go to a maximum heart rate. Imagine being on a bike, and the bike just gets harder and harder and harder for 10 minutes until you just can't pedal anymore. So, it's not a particularly fun test if you want to define it that way, but it is incredibly valuable test.

[00:13:19] In fact, if you stack this directly against, pick your metric. Hypertension, grip strength.

[00:13:24] JJ Virgin: What is so crazy to me, and I was thinking about this the other day, they always talk about how doctors get one hour of nutrition training. I go, but they get zero hours of exercise and exercise is this huge category of everything.

[00:13:37] Yes. Like the kitchen soup of movement. It's crazy enough that we're not doing body composition. Yeah. But it's a whole another step to, we're not even doing some kind of a predicted VO2.

[00:13:46] Dr. Andy Galpin: Yeah. Even if you don't throw a body composition in there, it won't be as important as you go to max.

[00:13:49] JJ Virgin: So, for VO2 max, how valuable are the, like, go out and do the Rockport mile, like the predicted ones?

[00:13:58] Dr. Andy Galpin: You're talking about something between 100 and 200 dollars typically so that they're becoming more accessible. You can do a sub-maximum test. You can also do an estimate test. A Cooper's 12-minute test is one of the most standard ones. So, you run for 12 minutes to see how far you can get. You take that distance, you plug it into a calculator, and we'll estimate it.

[00:14:15] So if you want to do the sub maximum test, there are literally two-minute step tests where you step up and down on a very small box for two minutes. You measure your heart rate, and you can predict it from there. And those are reasonable for, for the average person, they're going to be pretty good at predicting it because what you're looking for VO2 max for this person is not splitting the hairs if you're the 90th percentile or 95th percentile or 80th percentile.

[00:14:38] What you're looking for is, are you in the bottom 20th? There are very strong data that suggests if you take everybody in the world and you just say, okay, whatever your, all of your VO2 maxes are, let's split you up. The top 20th percentile, the next 20th percentile, being in the bottom 20th percentile is one of the worst things you can possibly do for your health.

[00:14:55] In fact, if you look at how much going from the second quintile there to the third, that reduces risk 10, 20%, right? Like it's an instant report. But going from the worst. To the second worst category is like a doubling or tripling of your hazard ratio or survivor risk, depending on which paper you want to pull from here.

[00:15:13] And so the one thing I'll say here is like, if you really care about your health, just do not be in that last quartile or quintile. Don't be 10, don't be 20. I don't need you to be 60, 70, 80, really, if you don't want to, but if you, just. Do not be in that bottom 20 to 25 percentile. Roughly for females, you're looking at something like 15 milliliters per kilogram per minute is what we call the line of independence.

[00:15:36] So 15, 16, depending on the study, right? What that functionally means is, if you are below that, it becomes extremely hard to live by yourself. Okay, most people who are 40, 50, 60 years old are not that low. Those women are probably going to be 25. Wow, 28, maybe, something like that. Here's the problem. We know that declines with age.

[00:15:57] Even if you stay fit, it doesn't decline as much if you stay fit. You have control over it, but it will decline. And we know that it'll decline something like 1 percent per year at this middle age range, right? It accelerates right around 40 to 50 years old and has a sharp acceleration in the drop.

[00:16:13] JJ Virgin: So, with age, you don't necessarily have to see a decline unless you start out highly conditioned. Yeah. Then you're going to see a decline.

[00:16:21] Dr. Andy Galpin: Everyone's going to decline some, right? We have done a study in 80- and 90-year-old Olympic and world champions in cross-country skiing. So these people won world championships in the 1940s and 50s, didn't stop racing. They have 50 plus years of consecutive skiing racing, okay?

[00:16:37] But they were presumably most cross-country skiers going to be in the 80s, 75, 80. When by the time we got them, they were still almost 40 in their VO2 max. We compared them to the same age individuals who were not skiers, and that group average was like 21, 22. So that line of independence for men is like 18.

[00:16:55] So those folks that we tested lived by themselves. They are a few points above that line of independence. Activities of daily living, like sitting here right now, we're probably at 5, 8, something like that. If we were to walk up the stairs like you're at 11, 12, 13, something depending on where you're at. So, you fall below that number, the reason you can't live independently, your fitness, and getting up off the toilet is now 75 percent of your heart rate.

[00:17:18] You're at this huge percentage of your heart rate without doing anything. If you are at 21, and you're 40 years old, even if you train as hard as possible, you're going to cross that line pretty soon if you don't do something. And so, if you can train to take that from 20 to 30, now all of a sudden, a 1 percent decline means you're not going to cross that 17 or 16 mark until you're in your 90s.

[00:17:39] So that little bit of bump is everything. If you take somebody like that and you improve their VO2 max by six. So go from 20 to 26. You're probably cutting the risk of death in half over the next 15 years. It's that powerful. This is one of the main drivers in people having this drop in quality of life is you just can't be unfit.

[00:17:58] There's nobody who gets through this unfit.

[00:18:00] JJ Virgin: So, these things that change as we age, that people can then see so they can then prioritize starting with VO2 max, what are some of the other changes that happens in the way we can see them?

[00:18:12] Dr. Andy Galpin: So that's one of the biggest ones. If VO2 max is not the largest predictor of longevity, then it's generally leg strength. And so, depending on the study, sometimes leg strength is a better predictor than actual VO2 maxes. Sometimes it's equal. It's insanely important to not have weak legs as you age. Couple of reasons why from two perspectives, one is fall prevention. If you look at the, the research on what happens if you fall and break your hip over 60 years old.

[00:18:38] it's almost a death sentence. Now, there are many things that go into why people fall. There's sometimes just accidents. But a large part of it is you either have done one of a handful of things, and you've lost balance. Whether you just lost your balance, or your dog walked out in front of you really quickly and cut your foot or your slipper fell or like something like that happens, right?

[00:18:54] Now balance is then the first thing to train, right? So, make sure you don't lose your balance and reduce your risk by doing that. Second, thing is if you've lost your balance, you have to be able to brace yourself from that fall. That requires leg speed. I have to have the physical speed. Now, this goes back to what I said.

[00:19:09] This is a sport. I'm testing. I need to know your foot speed. I need to know if you trip and fall, you have the ability to get your foot out in front of you to prevent yourself from that fall. Now, once you've done that, we have to have what's called the eccentric strength. So, this is the bracing strength.

[00:19:22] So, your foot lands out in front of you. You have to have the strength to stop your body from then collapsing and falling all the way to the ground. That's leg strength. So, I have to have those things. I have to have not lost my balance. I If I did lose my balance, I have to have then the speed to put myself in the right position.

[00:19:37] And then once I got my foot in the right position, I have to have the strength to actually stop the fall from happening. That is balance, that is speed, that is strength. It's the same thing for an athlete. We have this saying, if you have a body, you're an athlete, and this is exactly what we mean by it, right?

[00:19:53] You can't afford to not be athletic in this sense. My point is you need to have high control of your body, or you're just increasing your risk of bad things happening. Now, that happens specifically because of two main reasons number one, neurological loss. Number two, A loss of functional ability in your muscle, uh, the amount of fast-twitch fibers you have is lost as you age, that is also preventable, physical strength, muscle quality, all of these things, uh, deteriorate with age.

[00:20:20] If you don't do anything about it.

[00:20:22] JJ Virgin: So, what are some of the ways that someone might be able to tell them some simple at home tests, like maybe a grip strength test, or a vertical jump test, or a stand-sit-stand test. What are some of the things you recommend?

[00:20:33] Dr. Andy Galpin: All those, all those things are great. The, the lowest barrier to entry would be your grip strength test.

[00:20:38] Um, a little dynamometer is what it's called. So, you can squeeze it, and it'll tell you. That is a really important test. A lot of people have misconstrued why grip strength is important, but it is a very good overall proxy of a number of things. Your overall strength, of course, is a strong proxy of frailty, fall prevention, bone mineral density, malnutrition.

[00:20:58] All of these things have been associated and shown to be correlated at the population level with poor grip strength. In addition, a recent paper came out showing asymmetry. So, if your right hand is stronger than your left hand by more than 10%, that is also now associated with advanced aging. This is what specifically in this paper looked at.

[00:21:17] It is potentially a sign of nerve denervation happening in that weak side. So, you want to pay attention to that very strongly. There's a company actually called Axioforce, and so they make what's called a force plate, but they make it in the sole of your shoe. So, you put this thing in, and it's just like a shoe, like your sole, and it goes in there.

[00:21:35] And this can measure the exact amount of force you're putting on your body as you're walking, as you're doing everything else. Now, why that matters is they can actually detect changes in what's called your gait pattern. So, how you're walking up, everyone can think about this. When you're 30 years old, you have this normal walking pattern.

[00:21:50] But as you age, you start to shuffle, right? This is one of the hallmarks of aging. So that's your gait pattern, right? How you're normal walking. You can see changes in that gait pattern happen way before you start seeing symptoms of neurological decline or cognitive decline. And so, this is early Parkinson's, dementia, and things like that, right?

[00:22:07] JJ Virgin: Would you have to have someone's normal gait first and monitor it over time?

[00:22:10] Dr. Andy Galpin: Both would work because there's also just signature patterns of gait dysfunction. So, it's your first time doing it, you can throw it on. To go back to the grip strain thing really quickly, we actually had Dr. Tommy Wood in his lab, uh, we published a paper recently with a couple of things to be shown there, but one of them is the fact that you can actually predict cognitive function and cognitive decline with a basic grip strength test.

[00:22:31] So it is very important, your risk of dementia and Alzheimer's is also can be predicted with this model. That's data is really, there's nothing you can do about early onset, unless you're genetic, these are people who get Alzheimer's when they're in their 30s. But late onset is what we call this is highly preventable.

[00:22:46] Certainly, late-onset dementia is extremely preventable with a number of different activities. There's like seven independent factors that go into it. But your strength is the canary in the coal mine. But in order for you to be strong, this requires a couple of things. One of it is your muscle fibers themselves have to contract force.

[00:23:02] That's great. But something has to tell it to contract, and that's your neurological system. So, if you become weak, then it's a strong likelihood that your nervous system is now starting to break down. Your brain works on the same thing. So, we're literally testing in a very small way brain function by testing your strength.

[00:23:19] And this is why you look at the research. On both ends of the spectrum, what happens to brain aging when people strength train? It's astronomical positive associations, right? So, we know strength training is incredibly important for brain health over time. Like literally physically brain aging, whether you look at association studies, look at the people who've aged well and those who haven't, and look, those people have exercised, or direct interventions.

[00:23:44] You're gonna have a really hard time seeing people stay really healthy without some way of maintaining strength.

[00:23:51] JJ Virgin: So, we need VO2 max. Yep. We need strength. Yep. We need balance. Yep. If someone's listening and they don't have access to go see, uh, exercise physiologist, get tested, get a program. Yeah. They can listen.

[00:24:07] They can do even a predicted VO2 max. So ideally, they can do the other one. They can do, uh, some kind of body comp. They can do grip strength. They can do stand to sit, and they need to get started.

[00:24:17] Dr. Andy Galpin: Yep. I think it's easy to think about if you want to age well, it's more important to be strong than just to have muscle.

[00:24:24] This is one of the key things we have to emphasize successful aging. And so, if you are concerned about, I don't want to gallus muscle, fine. Don't be in the muscle. But you're not going to live well weak. You have to get strong. That's nonnegotiable.

[00:24:37] JJ Virgin: People don't understand that there's muscle hypertrophy, there's muscle strength, there's muscle power. They're not the same. There's overlap. But you know, what you do to train strength is not the same as what you do to train size.

[00:24:49] Dr. Andy Galpin: There's an overlap there, but it is not the same thing at all. So, it is very simple to train for power, to train for muscle strength, to train for muscular endurance, to train for joint health, or flexibility, effort, balance. All those things can be accomplished without doing anything to add muscle mass. And it's actually fairly simple with a small amount of actual science knowledge. People should be able to deliver that program, no problem. Physiology is somewhat different between men and women.

[00:25:17] Women have an equal amount ability to gain muscle mass as men. Women gain muscle mass at the same exact rate as men. They're just smaller people. So, the absolute gain is much larger. So, if you want to gain muscle at any age, you can do that, by the way, in men and women. And there are number of studies, we've done plenty of them ourselves, and other people have.

[00:25:35] You can absolutely gain strength and muscle well into your 80s.

[00:25:38] JJ Virgin: But so, if you are, I'm trying to pin you on this, I think you probably don't want to do this, but the person coming in who is like post-menopausal, maybe a little osteopenic, they haven't ever really weight trained, they've done yoga, maybe some group acts, they walk and they're probably in the 60s.

[00:25:57] Yeah, super easy. They'd like to get. And toned arms like to look a little better, too. They want to feel great. They want it all. And they've got 30 to 60 minutes a day.

[00:26:06] Dr. Andy Galpin: You have to have the framework here, right? I'm just asking you to make sure we're checking all those boxes at least once. How you go about doing that?

[00:26:14] Hey, now we have tons of options. And so, my real answer to that is when we're going over your program, that's what I'm looking for. I don't care about is yoga good or Pilates. Cause that doesn't matter. My question, what is it doing? If it's doing one of those three things, and cool, check that box off. We're good there.

[00:26:27] If it's not, then we find something else to fill that slot, right? So, let's take a yoga, let's take a Pilates. Uh, are you gonna be working on strength and stability in different areas? Now again, if this is your first entry into exercise, everything counts in this. It all counts, yeah, exactly. I would then go back to, what's that walk look like?

[00:26:44] Is that a 10-minute walk? Alright, that's probably not gonna improve your VO2 max. Not enough of a dose, not enough of a time, not enough intensity. Can we stretch that thing out? Can we get it to 40 minutes? Can we get it to 3 times a day? Okay, great. If you don't wanna do 40 minutes, then give me 3 of those walks a day.

[00:26:57] Which is cool. We're going to get some movement in, at least. All right, great. If not, can we start extending it out there? Can we do anything one time during the week where we get your heart rate up to max? What's max? I don't even care. What feels like max for you, that's good or not.

[00:27:09] JJ Virgin: Which is probably not quite max.

[00:27:10] Dr. Andy Galpin: It's just more than you're doing. And if that is in your yoga class, great. If that's in your group activity class, phenomenal. If you want to get on a bike, sure. You want, I don't even care. I'm asked, and don't worry about this is methods or many concepts are for you. I'm going after concepts. You tell me the method that's acceptable for you.

[00:27:28] Then, coming back, how are we going to develop muscle size? And how are we going to develop muscle strength and joint integrity? While you're in that same place, can you find a couple of machines? Do two sets of ten. What weight? I don't even care. Figure it out. Do a weight they like. You're trying, but you're not waking up so sore for two or three or four days.

[00:27:46] I want you on a scale of soreness, the next day, 2 out of ten. I don't want you to wake up being like, man, I don't feel anything. You probably didn't do enough to stimulate growth or strength. I want you going, yeah, that it is a little tight, but I don't want you going like, ah, I think something's torn. I can't work out for a week now because this is so sore.

[00:28:04] This is a pretty solid thing. The only other component we really haven't addressed here yet is now this kind of balance thing. So, ideally, we would like to do some of these exercises, where if we cannot be on the machine, that's great. Are we supporting our own body? Can we do it with on one leg at a time?

[00:28:20] Can we do something else where we're stepping up and stepping down on something? Somewhere there, that's a little bit more where one side of your body has to work while the other ones are not there. Something like that. It can be condensed into a three or four day a week program, where you're like walking most days, but really, you're doing your gym stuff two, three times a week.

[00:28:38] That that's going to be pretty good for a lot of people.

[00:28:45] JJ Virgin: I've been, uh, teaching people if you can't do anything else, just get a little TRX because you can actually do a lot of balance. Yeah. One leg. It's what a one-legged lunge, you know.

[00:28:55] Dr. Andy Galpin: It's like literally just standing on one leg. Do nothing else, just stand on one leg for a timer, hold it for 20 seconds, do the other leg, do a couple of sets of that, like, that, that's actually gonna be enough, for some people,

[00:29:06] JJ Virgin: to start…

[00:29:07] Dr. Andy Galpin: Totally?

[00:29:07] JJ Virgin: And then, you know, one of the things I think is important is walking's not exercise once you get conditioned. I think of exercise, I think of that as activity, and we need to do a lot of it.

[00:29:18] Dr. Andy Galpin: You should differentiate physical activity from exercise.

[00:29:20] JJ Virgin: And how would you do that?

[00:29:21] Dr. Andy Galpin: In the general way that I will structure this, exercise is specific intent. Physical activity is not, right? So, if you're gardening, you're not specifically intending to, like, have a certain amount of progress, you're playing with your grandkids, that's physical activity, that's great, super important, you're surfing, great, that's all awesome, you're kiteboarding, or stand-up paddle boarding.

[00:29:39] Exercise typically, again, this is an overlap here, is structured and specific. Alright, so we're going to go to this class this many days a week, we're doing an hour, we're doing 30 minutes, so we have a little bit more plan there. There is a need for variation in movement, but specificity is more important for these individuals, right, so be specific and intentional, so we know what we're doing.

[00:29:59] And we could have some idea of overload and what we're doing. Variation is great for physical activity. So, to go for a hike, garden, walk, they have a lot of variation there. But when it comes to your exercise, you want to be a little more intentional. So, we make things happen. One of the biggest reasons why people have the complaint of, oh, I did all this stuff. I worked out really hard for two months. I never saw any progress. It's often because you just did too many different things. And its sort of like, you washed one dish, you clean one sock, you put one thing, and then the house and still a mess. Yeah. Do all the dishes. Great. There's still all the mess over there, but you'll see progress.

[00:30:33] And you did get progress, but it's so small in so many areas. You don't feel or perceive anything because you functionally feel any different. You don't look any different and you're not performing any different. So, you feel like you didn't make progress. So, in that case, like be a little more focused. So, you can at least be like, wow, whatever's going on, but like, man, my legs are definitely stronger.

[00:30:51] That's great. Or I've definitely lost some weight, or whatever the case may be.

[00:30:55] JJ Virgin: I love so much if we focus on my legs are stronger. Yeah. You know, and that's why I like doing a grip strength test, or even doing predicted VO2 max or looking at how many more stairs you can do on the step mill, something. So, we're getting, for women especially, the focus, well, if we're going to use the scale, you have to do body comp.

[00:31:12] Dr. Andy Galpin: I mentioned one of the reasons why leg strength is important, but the other one is this. A lot of people underappreciate the overall role of leg strength in cardiovascular fitness. So, think about it this way. If you are at the airport and you have to go up the stairs and all of a sudden you get up the stairs, and you're just out of breath and you're like, oh my gosh, and now you're carrying your luggage and you're like, man, I can't. So, because of that, you don't want to travel as much anymore. You start thinking about these activities, and you're just like, oh, I don't want to do that.

[00:31:36] Maybe you are directly or indirectly associating it with the suffering. But either way, that part of, like, man, I actually don't even feel confident I can do that anymore. So now we start losing social connection. We start losing these other parts. We start losing our vision, seeing things in different plans, and we end up just isolating at home.

[00:31:51] It's just horrific for overall health, right? One of our major markers of loss of brain health is isolation, right? You don't want to do that. So why did that happen? Is it because you're out of cardiovascular shape? Maybe. but if your legs are weak, and every time you take a step up the stairs, it's like doing a one rep max leg press.

[00:32:09] I don't care how cardiovascularly fit you are, that's gonna make you go… [panting] If I now take that step up the stairs and now that represents 2 percent of my leg strength, all of a sudden you'll get to the top of the stairs, and you won't have changed your heart rate at all, because it wasn't a very high percentage of your effort.

[00:32:24] So having strong legs is critically important because it's your interface with the world. You connect to the physical world via your feet. 3How your ability to put force into the ground and move it will determine exactly how confident you feel in moving throughout this world. When you lose locomotion, everything goes down.

[00:32:41] JJ Virgin: I want to talk about one more thing that respiratory rate is a better measure than HRV. Of course, then I immediately went and looked at my respiration. I'm like, Oh, mine's 16. I think you said this, the norms were 12 to 20. You don't want to be over 14. Now what? Although it's fine. Now I got something to work on.

[00:32:56] I have no idea how to work on it. So, talk a little bit about that. Cause you were talking about that in terms of, I think, recovery.

[00:33:02] Dr. Andy Galpin: HRV, this is the variability of your heart rate. What this effectively means is, let's say your heart rate is 60. So that means you're beating 60 beats in one minute. Okay, great.

[00:33:11] It doesn't actually work like a metronome. At the end of 60 seconds, it will accomplish 60 beats. Now that's small, you won't even perceive it, right? So instead of being every second on the second, it's 1.1 seconds, it's. 95, it's something like that. But that variability in your heart rate is a strong signal of what's going on with your autonomic nervous system.

[00:33:29] That is your balance between being in what's called fight or flight or freeze. And rest and digest. Okay. Now, both are good at the right time. Yeah. When we're doing this right now, I hope we're a little bit into the sympathetic drive, right? A little more focused, a little more alert, a little more tentative.

[00:33:43] My vision is narrowed on you. I don't need to see what's going on in the rest of the world, I don't need any big digesting food, I don't need to be lethargic. It's also anxiety. It's worry. These are the similar traits, right? I need to be a little worried right now. What's going on? What are they thinking?

[00:33:56] What are you thinking? Like, I need to be a little anxious. This is what you want, right? Rest and digest is the same thing. I want to be lethargic and depressed before I go to sleep. I don't want to have a ton of energy. We're like great, right? So, you want to balance. It's not a switch. It's a spectrum. So do, little things put you up and down the spectrum, and there are certain times a day you want to be a little bit bold.

[00:34:14] Great. So, something like an HRV score will tell you where out on that spectrum are you, right? So, a high variability, and this is really counterintuitive, but a high variability, so way off beat suggests a lot of parasympathetic drive. Think about this, right now, our HRVs are low. So, you and I are heart rates I guarantee you're like pretty every second on second.

[00:34:34] And why is that? I wouldn't want sporadic, right? Ah, got it. Focused. Bingo. Focused. I have a known drive of metabolic demand. I have a known energy output. Make sure I don't want to miss some time of my heart pumping. You're stressed. You're driving. You're in traffic You're an important meeting.

[00:34:49] You're training. You're exercising. I want my heart on time. So, if you take a look at your HRV, generally what happens is, you can look at this in two ways. Your absolute score, so a very low HRV, suggests you're very sympathetically driven. A high HRV suggests very parasympathetically driven. Typically, it's better to be high, right?

[00:35:10] Now, that can be a problem in some circumstances, we'll see this 10 percent of the time, where people are lethargic and depressed, can't get to the gym, can't get motivated. And their HRV is actually too high. But that is rare. Most of the time, we're dealing with people whose sympathetic drive is too high and their HRV is very low.

[00:35:27] These are hard chargers. It's this typical type A. Yeah, of course. Why do you feel terrible all day? When we look at your HRV, you're like, oh, okay. Because you're walking around, even if you have no motivation to do anything, I'm not focused, I feel terrible all day. I feel like death in the morning. I wake up, I sleep eight and a half hours.

[00:35:42] I feel like death constantly. HRVs can be in the tank. You can think about this as like, you're pumping adrenaline nonstop. Your energy exertion is so high. How are you not going to be tired all the time? Right. So, I realized you said both cases can be fatigue because fatigue is not like a super simple thing.

[00:35:57] HRV is great. So, it's absolute score can tell you information there. The deviation you have over the days will also tell you that. And so, let's just say, just to give a number, it doesn't make sense. We'll just say your HRV is 50. And now I can say, okay, 50 is okay. But if you came in and the HRV on a typical, there's a lot of ways to measure it.

[00:36:14] So, like, don't hold these scores, but there are data on if you get below 30, this is associated with cardiovascular disease, lots of potential issues there. You're in the teens, like this is generally a very bad time. You're in the hundreds, you're probably okay. All right, great. Let's just say you're 50, where it's like, it's not incredibly low or incredibly high, but then all of a sudden, you're looking at it, and your weekly average is now 45.

[00:36:35] And now your weekly average is 40. And now your weekly average is 35. And notice I'm saying like weekly average. Don't trip on what happens like day to day. It's tons of things happen. There's what we call a standard deviation. There's a no standard deviation that just happens. That isn't the only one.

[00:36:48] What you want to pay attention to is what's happened to your weight over time, right? Like, HRV is the same. So, it's a very good indicator of are you cooking yourself? Do you need to slow down? Respiratory rate, to me, is more important because it'll tell you an action step. So, probably a very good idea for one of the steps we're going to look at for somebody that has a really low HRV is, do you have a sleep disorder?

[00:37:08] Is that going on? Respiratory rate will tell you that because if you are breathing excessively overnight, again, it could be you have a blockage, and this will often happen for people that have a reasonable respiratory rate during the day, but then it gets really high at night. That's just positioning, right?

[00:37:22] So you're standing up here, your tongue is not in the back of your throat, and then when you go to lay down, something's falling, causing sleep apnea, you're in the wrong position, like all these things can be fixed and should be addressed, right? All kinds of problems associated with that. But respiratory rate is something like a resting heart rate, is going to change as you get more fit.

[00:37:38] So your resting heart rate will get lower as you become more fit, and as you become unfit, it goes up. But that takes kind of weeks and months to change. HRV is more sensitive than heart rate, but that still does take, again, you need to kind of look at least a five-day average on minimum before.

[00:37:53] JJ Virgin: And it's sensitive to a lot of stuff.

[00:37:55] Dr. Andy Galpin: Respiratory rate will change in a day. You can see, I promise you last night, I could look, my respiratory rate was much higher last night than it was on average because I'm traveling, I'm three time zones off. So, respiratory rate is really, really important. It's also the primary intervention place. So, if your HRV is cuckoo.

[00:38:13] Then I have to kind of figure out, it could also just be normal, your physiology. It could be like you're training too hard; you're training not enough at all, I'll back up. Rest HRV is a colloquial measure of global stress, and the way that we say this in physiology is stress. So, your body will handle physical stress, nutritional stress, psychological stress.

[00:38:34] All this goes into a giant stress bucket. So when I see your HRV's tank, respiratory rate, though, is the thing where we can go. This is causing an acute change in your physiology because you're overbreathing. This lowers what's called hypocapnia. If done chronically and high enough, this can be what we would medically call this chronic hyperventilation.

[00:38:53] This causes respiratory alkalosis, which then causes metabolic acidosis. And so now the entire system is thrown off. The kidneys start changing what they're doing. Hydration becomes an issue. Reabsorption of electrolytes becomes an issue. And everything just gets thrown off. And in this case, being driven by the fact that you're overbreathing.

[00:39:10] Last couple things and I'll tell you how to fix it here in a second. First thing you're checking is sleep apnea sub-disorder. The second thing then is you're coming back, and you're just checking overall arousal state. Like, what did you do before bed? Did you make all the obvious, nonsensical things that everyone tells us not to do?

[00:39:25] Oftentimes, though, if it's none of those things, and it's not basic fitness, then it could be a learned pattern. And so here's what I mean. When, let's just say we have some sort of, it could be positive or negative, because I don't always frame this as negative. But let's say there was some sort of trauma, okay?

[00:39:40] You had a, like an injury, or you had a bad interaction with somebody, or you just had a really hard time at work. You put building a business, or you went through medical school, or you had kids, or it also could be positive. Just had all this great stuff happen. Again, like it's not just negative, but something happened that pushed you into sympathetic drive. Okay, so this is why I laid all that foundation. When you are in a sympathetic drive, your respiratory rate goes up. I guarantee you our respiratory rate right now is higher than normal just because we're excited and engaged, right? That's just normal, what it should be doing.

[00:40:09] When we're done, it's going to go back down and lower, lower than normal, right? That's the whole point. So you had a great positive thing happen. It doesn't really matter. If that thing was either traumatic enough, good or bad, or long-lasting enough, then that can now become a learned pattern because it is a cycle, right?

[00:40:24] So what happens is, if you were to hyperventilate right now, you would feel physical sensations. A lot of those physical sensations, people don't know how to interpret, especially because they don't know they're overbreathing. And in the talk yesterday, I made people do that. If you were sitting there and those exact same feelings hit you, and you weren't overbreathing, you'd be like, am I sick right now?

[00:40:41] What is happening? Like I'm all these things, I'm getting chest pains, something's wrong with you because you are overbreathing, but you just don't know it. In that talk, I exaggerated it, and I made you know you were doing it. When you don't know you're doing it, it's the same exact physiological response. So people freak out.

[00:40:56] So this drives pattern. This drives anxiety, which then drives lower hyperventilation, right? Because then they're right back into it. They're like, Oh my God, something's wrong with me. But what you're feeling is a response of your feeling, and now you're back in that loop, and now you're directly causing it again.

[00:41:12] Once that trauma or stress is gone, kids have grown up a little bit, company's actually working, I've moved out of that relationship or whatever, right? If that pattern was around long enough, you will just continue the same normal physiological breathing pattern, even when the stress was gone.

[00:41:26] JJ Virgin: And so the obvious question is…

[00:41:28] Dr. Andy Galpin: How do you fix it?

[00:41:28] JJ Virgin: Yes.

[00:41:29] Dr. Andy Galpin: Great. Number one, don't have kids.

[00:41:31] You know that people don't realize this, but having children is one of, if not the most common cause of sleep disorders. It will carry you the rest of your life unless you go fix it. We see this a ton in people. One of the first things we asked is do you have kids?

[00:41:44] When did your bad sleep start? With kids, great. If your kid struggles to sleep for months, that becomes a new norm. Or years. Then why do you think that pattern is going to break? It's not a sleep dead issue, it's a sleep pattern issue. We've had people, and we've solved over 80 percent of their sleep disturbances by just changing the position as they sleep in bed.

[00:42:03] And that happens at night one. So we can actually identify, hey, your problem is when you sleep on your right side, or your problem is on your left side or your back or whatever. And I just, we can easily train you to not sleep on that side for very cheap, and almost all, again, 80 plus percent of their sleep awakening events are gone in night one, and they never come back.

[00:42:17] We get this routinely. People are like, I slept all through the night for the first time in decades. One of the other biggest drivers of sleep disorders is the spouse. I can't even tell you how many times people have blot and done absolute rest. And then they're like, oh, actually, if you check out, you're pretty good.

[00:42:31] And then what we realize is it's their spouse that has a sleep disorder. And because their spouse is doing so much that they're keeping them up at night and they don't, they never realized it. Things like snoring. Snoring is just thought of as innocuous. It's not. We will see that a bunch where we're like, yeah, okay.

[00:42:45] So we actually ended up starting, like, we have a little thing where we do like a couple's package because we got it so much-

[00:42:50] JJ Virgin: Makes, I mean, you have to have a couple's package. And I would assume that if we're used to sleeping with dogs, we sleep with dogs because that's the norm state.

[00:42:56] You know, my three pillars of powerful aging are eat protein first, obviously nutrition in general, but start there. So you make sure you get it lift heavy things, the exercise size, and sleep through the night recovery side. I know if we nailed even those three things. Like we changed the world.

[00:43:12] Dr. Andy Galpin: It's funny. Uh, people just assume that sleeping the night is not something that happens. I know.

[00:43:18] JJ Virgin: They think you need less sleep as you age. Like you need less food as you age. No, no, no.

[00:43:23] Dr. Andy Galpin: It shouldn't be normal. You shouldn't have to wake up multiple times a night like it should be normal. We've done this a ton.

[00:43:28] JJ Virgin: This is cool. This is a really cool resource. I know you also have a lab testing company, direct to consumer, which it's, I'd love to have you back just to talk through that because that's a huge one and your podcast, which right now. Only has the trailer.

[00:43:42] I really love your 55-minute physiology. So those are fantastic.

[00:43:48] Dr. Andy Galpin: Yeah, the podcast will be released a little bit later this spring, early summer. It's called Perform with Dr. Andy Galpin. It's not a weekly show. It is just 10 episodes per season. The basic idea of the show is, I'm not an MD. I don't do medicine. I don't do disease, really. What we all do are going from good to great. So how do you go from I'm pretty good with my physical abilities. I want to go to great. How do I go from good in my sleep, and I need to go to great. And that's really what the entire show is about. So it is about high performance.

[00:44:19] JJ Virgin: Love it. Love all that you're doing. Thank you for doing it.

[00:44:21] Dr. Andy Galpin: Let me answer your respiratory question. If we figure that stuff out, and it's not sleep disorder and all those other things, then we're looking at arousal. And typically, very commonly, what happens is if this was a learned pattern, or it could still be a current behavior.

[00:44:34] What that current behavior looks like is, and so the gentleman that asked this question in the talk yesterday, he came up and he said, Hey, my respiratory rate's like 17. And I'm like, that's too high. And we were at the end of time, and I said, can I answer this in under one minute? And they all laughed, and I'm like, I don't know.

[00:44:47] I don't even know anything more about you. Can I tell you who you are? And I can do that right now in the same time. And he was like, what? And I'm like, yeah, I've just seen this so many times. I'm like, great. Do you track, uh, your sleep and respiration rate? It's like, yep. I'm like, great. Stop tracking it, number one, right?

[00:45:01] Because there's things called orthosomnia, which is a sleep disorder that is caused by sleep tracking, right? They're the same things have their clinical trials on this with fitness trackers. Step activity. These things can be incredibly helpful. Super awesome for accountability and awareness. They can also be a death sentence for some people.

[00:45:18] I don't mean literally, but like, they are demotivating. They are just rewarding you, reminding you how terrible you are and how un-close to your goals you are. Like these can be really powerful. So really be careful with any tool. If it's working with a person, awesome. If you don't know, try it. Great. But if you start seeing people, it's getting worse, like stop.

[00:45:36] So I'm like, let me track all your stuff. Like, yeah, of course. I said, great. You work out most days. He's like, absolutely. And I'm like, and you listen to podcasts during your workouts? And he's like, yep. And I'm like, ahuh? And then you have probably a company and he's like, yep. I'm like, ahuh? Great. And you have how many kids?

[00:45:48] He said two. I'm like, great. And he was like, Oh, I'm like, when do you ever reduce arousal? I don't. You listen to the podcast the night before bed? Yeah. I told him when you train, when you have other time, I'm totally fine with listening to podcasts while you work out. This is not a big deal. In his case, it was not a good idea, though.

[00:46:06] Because I just think you don't have any time in your day where you don't have input coming in. You have to have some time where there is just calm. You're not doing anything. Yeah, I meditate. Well, that's great. That's awesome. But you still have input coming in the other 23 and a half hours of the day.

[00:46:20] It's not enough. You have to be able to process. So take the earbuds out for a few minutes. 10-minute walks, whatever we have to do. And number two, you have to retrain your breath rate. So now we're going to do workouts where we are controlling your breath rate. This is all amazing work. You need to have time in your day where you're retraining that rate.

[00:46:38] Where we say, I don't care what you do for workouts. But we're going to slow intake, slow exhale while we're working out because we need to retrain. Now, typically, people like this, for the record, I'll throw another one on the guy. I'm like, let me guess, you feel better when you're working out. He's like, yeah, of course, because you're overbreathing at rest.

[00:46:57] So you kind of catch up with yourself. Bingo. Your metabolic supply meets your demand and you feel normal. It's exactly the test. And I'm like, his case, not yours, his. We need to have time where we bring your respiratory rate down when you're not working out. So you learn, oh, this is how much I should be breathing. And that's when you'll feel normal when you're not working out.

[00:47:17] JJ Virgin: And I might be obsessively always filling my time with every single thing. The brief meditation and the brief 15 minutes.

[00:47:24] Dr. Andy Galpin: Is that enough?

[00:47:25] JJ Virgin: A little unplugging could be better. Well, we have a lot to put in the show notes because you've got a lot of stuff going on, and I super appreciate it. YouTube channel, upcoming podcast, sleep company, lab company. I will put it all, not the book. Yeah. I'll put it all at jjvirgin.com/andy. Great. Make it simple. And thank you. And I would love to have you come back and talk about the whole lab company from that blood company.

[00:47:49] Dr. Andy Galpin: And it makes it easy for people to get blood work done from the perspective of performance. So it's not disease stuff. It is, what should you look like if you are, you can call it optimal, you can call it whatever you want, but it is, if you want your blood analyzed from the perspective of not just disease management, but really trying to, to optimize health. That's something.

[00:48:11] JJ Virgin: I'm glad you said that because it's very different. Cool. Thank you. Thank you. Appreciate you.

[00:48:18] Be sure to join me next time for more tools, tips, and techniques. You can incorporate into everyday life to ensure you look and feel great. And more importantly, that you're built to last and check me out on Instagram, Facebook, YouTube, and my website, jjvirgin.com.

[00:48:34] and make sure to follow my podcast so you don't miss a single episode at subscribetojj.com. See you next time.

[00:48:48] Hey, JJ here. And just a reminder that the Well Beyond 40 podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment.

[00:49:08] If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health related advice from your healthcare professional because of something you may have heard on this show or read in our show notes.

[00:49:28] The use of any information provided on this show is solely at your own risk.
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