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Doctor Doug McGuff Talks Fitness and High Intensity Training For The Over-40s

Is it ever too late to get fit? If you start training following a resistance training protocol later in life, will you still get the myriad health benefits of HIT? Doctor Doug McGuff explains the differences between training in your 20s and 40s and the best approach to fitness in middle age.

Doug McGuff MD, is a family man who successfully combines a highly intense career as an emergency physician, with a passion for high intensity exercise. A long-time strength training enthusiast and advocate, he has written four books on exercise including co-authoring the best-selling Body by Science. A fifth book, The Primal Prescription details how to navigate the modern healthcare system and when possible, how to avoid it altogether. For over 20 years Dr. McGuff has also operated Ultimate Exercise a personal training facility in Seneca, helping to keep South Carolinians and enthusiasts from all over the globe in peak physical condition.

Now in his mid-fifties, with a biological age much younger and stronger than his chronological age, Dr. McGuff was the person I thought of first when the topic of HIT for those in their forties and beyond, came to mind. What follows is the result of a candid conversation I recently shared with Doug on this valuable topic.

Do you think its too late to get fit? Do you think an exercise routine will eat away too much of your already limited time? Let’s catch up with Dr. McGuff’s thoughts on fitness in middle age, you may really enjoy what you are about to see and hear.


The Difference between Training in your 20s and 40s

Most of us in our 40’s (and beyond) have bought into the perception that we are less fit, less able to perform well at exercise and in general unable to do what we used to do physically because of our age. We buy the notion that the aging process has got us and the inevitable decline has begun. As a trainer I can’t tell you how many times I have had new clients state that they are “falling apart” and “I suppose it’s all part of getting old.”

Dr. McGuff does an interesting flip on this perspective, he believes that it is not the physiological process of aging that makes us feel less energetic and less capable in our 40’s than we were in our 20’s, rather it is the stressors and responsibilities that we have accumulated as fully-fledged adults.

Think back to the young, single and possibly carefree individual you were at college or in your early twenties and compare that experience with the 40-something you: the you with a career, a dependent family and probably a mortgage too. The deluge of responsibilities and lifestyle stressors that a typical 40-year old faces, usually means the amount of exercise that they can tolerate and benefit from is going to be significantly different. Or, you probably can’t get away with what you got away with in your 20s, in your 40s.

Doug says “to be superhuman you have to realize you are only human”, in other words you need to understand and accept the constraints you are working within now. A 20-something athlete has all the time in the world to focus on their training, recovery, nutrition and sleep. The 40-year old father or mother of two pursuing a challenging career has none of those luxuries. To benefit from exercise now you will need to be disciplined enough to workout and own the intellectual understanding and restraint to not attempt to train like a 20-year old.

This all means you will need to be smarter in how you apply exercise for best results. With wisdom comes age.


The Risk of Injury During Exercise

Dr. McGuff points out that one aspect that does significantly change physiologically as we age is our injury risk.

Primarily this is due to a gradual deterioration of the quality of our connective tissues including elastin and collagen, which happens from around the age of 35 onward. Exposure to high forces now presents a greater risk in our 40s: there is a reduction in safety margin. Tendons and ligaments are less elastic. Not only is there a greater injury risk in middle-age, we are also likely to require longer to recover from any injury sustained too.

What does Doug suggest we can do to protect ourselves?

  • When resistance training adopt a sensible approach, with HIT the risk of injury is much smaller compared to other forms of exercise. A safe approach to exercise technique, form and biomechanics (ala Bill DeSimone) is now a requirement, rather than an intellectual preference.
  • When exercising perform exercises slowly and smoothly- cadence and control is key.
  • Eat a diet rich in animal protein including collagen- consider well-marbled meats and bone broths.
  • Also consume foods rich in vitamin K- green leafy vegetables, cruciferous vegetables and fish, liver, meat and eggs.


The Benefits of HIT for the Over-40s

Dr. McGuff emphasizes that the results of applying an appropriate stimulus (HIT) combined with adequate recovery and a reasonable whole food diet will “blow most people’s minds”. If you weren’t particularly athletic earlier in life you will find yourself in better shape and stronger in your 40’s than you were in your 20s.

On the other hand, the individual who was athletic throughout their twenties but then let the exercise habit drift through their 30s will find that it is much easier to regain their shape, athleticism and fitness.

Doug notes the most apparent changes from applying HIT

  • A doubling of strength in 12-20 weeks is common
  • Some individuals will end up stronger than they have ever been in their life
  • Positive body composition changes (increase in lean mass, decrease in fat)

The results are almost too good for people to believe from just 15 minutes of resistance training 1-2x per week. Return on time investment may be such that some individuals fall into the trap of thinking that if some is this good, then more is going to be even better- and this is very rarely the case for a 40-something. The results are this good because HIT is aligned with the demands of your reality in a way that protocols requiring more of your time and finite energy are not.


Beyond the most apparent improvements above, there is a valuable systemic impact related to muscle strengthening according to Doug. Movement, he offers, is our most preserved biological function, and skeletal muscles being the organs that produce movement are therefore supported by all the other organs. When you engage in HIT or strengthening exercise muscle calls on all those organs- ultimately demanding that they improve to better support further muscle function. Bone and connective tissue strengthen, skin becomes more youthful, in short: all aspects of health and appearance improve.

Modern life without intense exercise makes a person feel like they are falling apart. HIT turns the modern experience on its head.


The Best Routine to Start Out, Frequency of Training and Recovery

The Big Five plus One:

  • Upper Push Horizontal Plane, e.g. Chest Press
  • Upper Pull Horizontal Plane, e.g. Row
  • Upper Push Vertical Plane, e.g. Shoulder press
  • Upper Pull Vertical Plane, e.g. Pulldown
  • Lower body pressing movement, e.g. Leg Press


  • A hinging movement around the hips, such as one of the following: lumbar extension, roman chair extension, superman on floor, deadlift.

Doug notes that his suggested routine above is so effective because you will be able to challenge and fatigue the main muscle groups of your body in a short amount of time.

Then, as he adds, it can be as simple as a case of “Wash, rinse, repeat.” I asked him how often this should be done when you start out. His advice is for the first couple of weeks is to ideally train Monday, Wednesday and Friday. This initial frequency will aclimatise you to the exercises and the routine helping you develop the skills of exercising well, more quickly at the outset.

Then Doug suggests reducing to two workouts per week, for example you could train Monday and Thursday. Your skills at performing the exercises and working to momentary muscular failure (MMF) will be improving by now and you will be able to fatigue your muscles more effectively, hence the need for a longer recovery time between workouts.

After this point your workout frequency can become individually regulated, Doug suggests adding an extra days rest between workouts if you feel that your progress is bogging down, or if you feel fatigued. Your life stressors and demands will have an impact on the best frequency sustainable for you at any given time in your life. Aspects such as nutrition quality, work stress, relationship stress, sleep quality/quantity and so on all play a part in your ability to recover from exercise. As Dr. McGuff points out, recovery is a process that occurs cumulatively too, not just between individual workouts.

The simplest option is of course a once a week schedule which Doug suggests that nearly everyone can benefit from.


The Impact of HIT on Myokine Release and the Immune System

Dr. McGuff points out that the exercise stimuli of a Big Five style HIT workout is, in and of itself, a negative threatful event. It can be viewed as a hormetic stressor- when the dose and frequency is right a favourable biological response occurs.

The fact that intense exercise is a stress to the physiology can be seen in the dip in immune function that occurs for a period of about 1.5-2 hours after a workout. However, there is then a bounce-back from this and over the longer term immune function is enhanced, Doug notes, “the acute threat to the immune system creates a positive adaptive response.”

He then details a couple of specific immune-related responses:

Intense exercise causes a massive spike in the cytokine/myokine interleukin 6 (IL-6) which acts as a pro-inflammatory- one would think a bad thing. However, this spike caused by intense exercise has a knock-on effect of downregulating IL-6 receptors so that at baseline (between workouts) circulating IL-6 is less biologically active- a good thing.

Myokines are proteins that play an important role in signaling changes to occur; within the cell (autocrine), in nearby cells (paracrine), and even systemically (endocrine). The changes that are stimulated are widespread, including benefits such as positive metabolic adaptations, tissue repair and immune function enhancement.

Myokine proteins are secreted by muscle cells during muscular contractions, Dr. McGuff suggests that the net effect of myokine release in response to HIT is protective against inflammatory conditions and even cancers.

Some individuals may be faced with health challenges in middle-age that compromise their immune function, I wanted to know what role Doug thought HIT could play for these individuals and whether the protocol needs to be adapted in these circumstances.

He elaborates that many individuals with cancer and who are undergoing chemotherapy attend his facility Ultimate Exercise in Seneca SC, with the encouragement of their oncologists. The only adaptation made to the HIT protocol is an autoregulatory/ self-adaptive one. This means that the individual’s fatigue level on the day of their workout dictates their intensity level- or how close to MMF they go with each exercise. Bags of energy and they will exercise like any other client, somewhat fatigued and the set will simply last as long as they feel capable of putting in a good effort.

This autoregulation also means that the further the client gets into their chemo-regime the more the absolute intensity will typically reduce, until a point, usually in the last couple of weeks, when they will dropout of their weekly workout altogether, to then reappear a few weeks after the round of chemotherapy has concluded.

Dr. McGuff points out that HIT workouts stimulate the secretion of myokines that work synergistically with chemotherapy, citing an example of interleukin-8 which has been shown to be inhibitory to the growth of breast cancer tumors.


Training to MMF Safely (if you don’t have a HIT facility or trainer close to hand)

One concern that many people discovering HIT have is how they are going to apply it themselves, if they aren’t lucky enough to currently have access to a recommended local HIT trainer or gym well-versed in a safe, high-intensity approach to resistance training. I put the question to Dr. McGuff as to how individuals can best apply HIT, in these cicumstances.

Despite HIT often being allied with advanced, sometimes esoteric and even rare exercise equipment, and whilst enjoying the benefits of such equipment at Ultimate Exercise (UE), Doug is a pragmatist. He notes that with regular commercial selectorized exercise machines, as seen at your local gym, the greatest risk- that of losing control of a weight and dropping it on yourself is eliminated. This, he says, makes it relatively easy for a new exerciser to begin attempting to exercise intensely toward the point of momentary muscular failure (MMF). Recognizing the skill acquisition required to be able to get to MMF, Doug points out that you actually don’t even need to go all the way to MMF, especially to start out with.

His guiding principle is that you produce a high degree of effort in an exercise, resulting in exertional discomfort (not pain) that falls somewhere in the ballpark of MMF. In other words, you give it your best effort so that your muscles experience a meaningful and out of the ordinary stimulus. By doing this you will be exposing your muscular system to a degree of challenge that is currently alien to it- and that will provide the impetus for the muscles to change, for the metabolism to be activated, for myokines to be released and so on down the line goodness.

Dr. McGuff emphasizes the fact that muscles do not require a “perfect” stimulus to positively adapt- “go as far as you can, go controlled and smooth.” The last part of his comment alludes to one of High Intensity Training’s other key differentiators- a primary focus on safety in eliciting the stimulus. Walk into any commercial gym and you will see people flinging weights around with near reckless abandon, an approach that is at best questionable for joint-health and certainly detrimental to training longevity. The “move the weight up-and-down as fast as possible and stick more weight on next time” mindset is the ultimate undoing of many an initially motivated 40-something. It is a path that leads most to conclude that strength training is a young man’s game, their mid-life experiment leaving them with little more than a badge-of-pride gym injury and the thought that gardening may be a more appropriate form of exercise.

HIT is different the emphasis, as Doug points out, is on quality muscular contractions and producing fatigue calmly and safely- HIT presents the intrinsic flip side to the extrinsic pile-the-weight-on norm. Dr. McGuff, wants readers to simply pick a weight that will challenge the musculature within a broad spectrum 1-3 minutes of continuous contractions (back-to-back slow-paced reps). The idea is to engage in a technique and form that exploits every last drop of value out of a given weight. Adding weight then becomes the last resort in enhancing the stimulus, rather than the first. This is an approach that Doug points out is sustainable for individuals right up into their 80’s and 90’s. Indeed, 80 year old Clarence Bass, a long-time, once a week strength training advocate, is a walking billboard for the benefits of this sane approach to resistance training.


Training Clients with Parkinson’s, Motor Neurone Disease and Multiple Sclerosis

Inspired by a recent question from a gym owner, and my own long-term work with an individual with Parkinson’s disease, I decided to check in on Doug’s thoughts on the value of HIT for individuals challenged by similar conditions. In these circumstances, he suggests that HIT can help to prolong the active life of those with diseases such as motor neuron disease and multiple sclerosis.

He has himself witnessed the astounding progress of a UE client with Parkinson’s, a lady who struggled to physically cross the 1-inch doorway threshold during her first visits to the gym, due to her tremors. This same individual is now taking hiking expeditions and delights in regaling Doug with news like the fact she has been able to put her own carry-on luggage in the overhead locker for the first time in ten years. A case of the gym stimulating experiences of great benefit: real-world improvements: making life that bit better, that bit less challenging. Dr. McGuff puts these benefits down to the fact that the act of aggressively recruiting muscle tissue through HIT activates motor units, and as he says “neurons that fire together work together”.

HIT also stimulates the release of BDNF (short for brain-derived neurotrophic factor) a protein that promotes the survival of nerve cells and helps to preserve neuron connections. This, combined with the fact that each available motor unit is stronger from strength training now means that whatever the individual is able to fire, despite their condition, is improved. If day-to-day life and independence gets easier as a result of one or two workouts per week, HIT will have more than proven its value.


The Key Takeaway Message

You may well be lucky and not have to endure one of the aforementioned conditions, but as a 40-something living in today’s convenience-centric world your physiology will begin it’s inevitable yet unnecessary decline, without regular and consistently intense exercise interventions. The great news is that 1-2, 20 minute workouts per week, as recommended by Dr. McGuff will rapidly kick your musculoskeletal, respiratory, circulatory, digestive, endocrine, immune, and nervous systems back in to gear.

And you may even leave your 20 year-old self, standing in the dust too.


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