Here is a question I am frequently asked: “Why did you build a gym in your medical weight loss clinic?” The Only Weight Loss Clinic in Phoenix with a Gym I must admit, Start Clinic Gym is really my pride and joy. Every specialized piece of equipment we have in our Phoenix gym I also have in my home gym. I have worked and re-worked all the individual training protocols that I am teaching our trainers and our patients and clients. I say patients and clients because the application of what I have learned will vary depending on age, sex, fitness level, and individual goals, whether you are a weight loss patient, competitive athlete, housewife or executive in the pursuit of optimal fitness, health or sports performance. Sport training clients cover an amazing spectrum from high school athletes looking to increase speed and strength in preparation for college scout day to middle age weekend warriors looking to enhance tennis or golf or body image to elderly retirees who simply want to increase stamina and hold on to some vestige of youth. Patients typically are either those in our medical weight management programs who want to start exercising as a means of enhancing the fat loss they are getting with medications, patients who have reached their goal weight and understand that the most effective way to maintain goal weight is through daily exercise, or they are patients who do not meet our strict criteria for appetite suppressants and need to participate in interval training in order to jump-start metabolism to burn off extra body fat.
Exercise Tailored to Your Needs
The beauty of our design and equipment selection is this: every piece of exercise equipment, whether it be for cardiovascular exercise or for progressive resistance exercise, for strength, power, endurance, flexibility or sport specific movements, is designed to accommodate every individual from a deconditioned state to highly competitive by simply varying the duration, frequency, and intensity of the exercise prescription. We also do not expect you to perform at a level for which you are not prepared. Every patient or client receives a pre-participation fitness assessment that may also include body composition, EKG, labs, and physical measurements. In a word, our approach is Medical! We don’t throw you in with a “trainer” with a high school diploma and we don’t program you for failure so frequently experienced with Cross-Fit or similar gym training classes where the level of musculoskeletal or cardiovascular fitness may be inappropriate or inadequate for the prescribed tasks.
The best way to illustrate this is to describe specific equipment and the science and/or practical applications behind our approach to training. Most of our equipment is very high tech (also expensive) and not available in many if any gyms in the Valley with the exception of high-level training facilities for professional and competitive amateur athletes. Some of our equipment is at the opposite end of that spectrum on purpose—we want our patients who are typically not athletes to feel comfortable, especially if they are new to working out, and we want to give them a foundation that allows them to transition to an eventual home maintenance exercise program that is doable with minimum supervision and with affordable equipment
Interval Training Burns More Fat
We are advocates of interval training in our Phoenix gym. High intensity shorter duration exercise is more effective than traditional steady state cardiovascular exercise for both athletes and weight loss patients. HIIT (high-intensity interval exercise) has been shown to more effectively increase aerobic and anaerobic capacity in competitive athletes. HIIT has also been shown to more effectively burn body fat than cardio. So we firmly believe HIIT provides our patients and clients the best of both worlds. Our challenge is to then find the best forms of exercise to cater to their specific goals.
We do have Keiser bikes, Keiser Total Body Trainers, and Precor Commercial Model treadmills fulfilling the need for traditional cardiovascular exercise but we use them more for interval training and for warming up prior to our strength training classes.
Interval training has been shown by recent science to be a more effective means of burning fat than steady state cardio. In fact, a study in Japan revealed that high-level athletes on a bike at over 90% of maximum oxygen consumption capacity for four minutes three times weekly showed greater increases in both aerobic and anaerobic fitness than similarly skilled runners at a steady state on a treadmill for an hour five days per week. Of course, we don’t expect a patient who is obese to achieve that level of intensity. But with the use of a heart rate monitor we can determine a reasonable intensity and duration that allows them to get their heart rate above 80% of maximum for a short duration of anywhere from 20-90 seconds followed by a variable rest period determined by monitoring their heart rate until it reaches below 50-60% of maximum predicted. Deconditioned individuals take longer to recover and may actually take longer to elevate their heart rate if they are not accustomed to regular exercise. Safe zones are established under supervision, unlike a gym where heart rates may not even be monitored and where the patient is not evaluated to determine an appropriate exercise level.
One of the less obvious side benefits of short duration intervals is reduced stress on the musculoskeletal system. Pounding the pavement has fallen out of favor for several reasons of which wear and tear on joints may be the most obvious barrier to long slow distance. A less recognized negative effect of long slow distance is increased exposure to oxygen free radicals, a normal byproduct of endurance exercise. In the late 90’s I was the featured speaker at a nutrition company national meeting along with Ken Cooper MD, considered the father of modern aerobics. Dr. Cooper was promoting a new book first published in February of 1997 entitled Antioxidant Revolution. This book was written in response to his alarming discovery of increased rates of cancer in his marathon patients, presumably in response to increased free radical exposure caused by frequent endurance exercise. As a result of my discussion with Dr. Cooper I have religiously taken antioxidants daily since then, the most important in my opinion ironically being the topic of my presentation that day on the benefits of nature’s most powerful antioxidant, oligomeric proanthocyanidins, unique plant-sourced phytochemicals found in grape seed extract and pine bark extract (based on the research of a brilliant French biochemist, Jacques Masquelier PhD starting in the 1950’s).
Tabata Training Prescription for All Levels
Of all the common high intensity interval prescriptions the most popular appears to be “Tabata Training” that has morphed into 3-5 weekly sessions of 20 minutes of highly intense interval training: 20 seconds of exercise is followed by a brief 10 second rest and repeated for four minutes. After one minute of rest four minutes of 20 seconds of exercise/10 seconds of rest intervals are repeated and followed again by one minute of rest. Four sessions of exercise intervals of four minutes each are separated by one minute of rest for a total session of 20 minutes. Believe me, your heart is pumping and you have worked up a really great sweat by the time you are done. This form of HIIT appears to more effectively give you an “after burn”, meaning your metabolism remains elevated for up to 48 hours after a session of HIIT. By alternating intense exercise with intervals of moderate to low intensity exercise, metabolism gets a boost while also effectively building lean muscle tissue.
Our favorite Tabata protocol is to create eight different stations with Kettlebells. Eight stations simplify the math and cover both upper and lower body exercises. Twenty seconds of exercise and ten seconds of rest equal 30 seconds multiplied by eight different stations for a total circuit lasting four minutes. We love Kettlebells for several reasons, not the least of which is Kettlebells are an affordable investment for our patients. For less than $200 an individual can purchase several Kettlebells, a few stretch bands, and a core exercise ball and do all kinds of great home workouts.
Anyone Can Benefit from Interval Training Regardless of Fitness Level
We anticipate at least 4 primary focus groups for individualized and group training:
- Obese patients (BMI >30) desiring a low level exercise program to complement medical management with eventual transition to an independent home program
- Overweight but not obese patients (BMI <27) who do not meet criteria for anorectic medications but desire to achieve weight loss goals with lifestyle changes including dietary advice and supervised exercise
- Normal weight individuals desiring a higher level of physical fitness for improved general health and appearance
- Higher intensity sport training for amateur and/or professional athletes who prefer to work out under medical supervision on superior equipment
Specialized Equipment Designed to Maximize Performance with Minimal Risk of Injury[/title][fusion_text]Our equipment was chosen with specific purposes in mind in order to achieve goals expressed by the different categories of patients or clients as noted above. Permit me to give you a description of the applications for each special piece of equipment.
In addition to Olympic weights, dumbbells, and kettlebells, we offer Keiser Functional Trainers, Keiser Power Rack, Power Plates, and Vertimax. Our Keiser equipment utilizes pneumatic resistance (air compressors) to accommodate total body strengthening and endurance training at any speed, any angle, any resistance.
Air resistance permits total body strengthening and endurance exercise with reduced risk of musculoskeletal injury and reduced exercise-induced muscle soreness for the beginner or the deconditioned more athletic individual. Air resistance also allows high-speed training that may be more sport specific than what can be achieved with more traditional plate-loaded resistance machines. More importantly, regardless of upper or lower body specific exercise, the use of cables and adjustable levers requires core stabilization regardless of specific exercise, hence facilitating a popular form of sport training called “functional exercise”.
Keiser Functional Trainer
The Keiser Functional Trainer is a tower device with two adjustable arms bearing cables. Multiple different attachments provide an infinite variety of exercises for upper and lower extremities, chest and back, hips, trunk stability and core strength. Air resistance allows training at high speed without the disruptive effects of a weight stack that will bounce up as you overcome inertia and then jerk the cable on the way back down. Air resistance is more functional for speed training and also generates less muscle soreness after exercise. This device has something for everyone from high-level athlete to obesity patient. As mentioned previously, it is called a “functional” trainer because the options for mimicking sport specific movements or activities of daily living are virtually limitless. And regardless of the specific strengthening exercise, all muscles of the core are used to stabilize your body so you get the added benefit of total body conditioning not always possible with barbells and dumbbells, particularly with any exercise with a rotational component. The Keiser FT is one of my favorite machines for golf! I can do squat jumps, tricep pressdowns, trunk rotations, wood chops, and karate moves all in succession with only a brief stop to adjust the arms and change the resistance.
A great example of how functional training helps to minimize musculoskeletal injury is low back pain, one of the most common aches and pain complaints in primary care. Most gyms today do not do an effective job of safely strengthening important hip and lower back stabilizers—in fact, a typical reaction to your complaint of low back pain is for the trainer to show you crunches and situps, exercises proven in clinical research to actually make lumbar disc problems worse. Gyms may completely ignore the recent spine research revealing the importance of the gluteal muscles as the foundation of a healthy lumbar spine. Many of our overweight patients have chronic low back pain as a result of the abnormal mechanical forces on the lower spine and when they go to a gym the first thing their ignorant trainer does is give them the wrong exercises to “cure” their back pain. Our spine protocols work wonders because the focus is on the correct exercises and we have the right equipment to isolate weak muscles of the core, trunk and hips as we simultaneously work on core stabilization and proper body mechanics. When you learn how to properly stabilize and protect your back in our Phoenix gym, it carries over to daily activity.
I cannot resist the temptation to tell you more about Kettlebells! We have seen the rise in popularity of Kettlebells in the past ten years for a very good reason. Once considered kind of gimmicky, athletes and trainers are finally realizing how effective Kettlebells are as a superior training tool for strength training, cardiovascular conditioning, high intensity interval training, core stabilization, all around musculoskeletal coordination, mobility, and balance training. Kettlebells are so appealing to me because they emphasize many of the same concepts I describe as advantages of the Keiser Functional Trainers, powerlifting, dumbbells and Olympic weights, and bodyweight exercises. You are required to use your body more as a functional unit than with traditional weight training where the tendency is to isolate a given muscle and work that muscle to failure. Doing biceps curls may help the ego but doesn’t do much for my golf game. Because Kettlebell movements incorporate the body as a more functional unit, you are more likely to burn more body fat using Kettlebells as the primary exercise modality for your interval training. You are mostly standing and working multiple joints in multiple different directions. In other works, Kettlebells allow an efficient means of developing strength, power, speed, coordination, cardiovascular conditioning, flexibility and balance, and more efficient fat burning than almost any other form of exercise other than sprints—how many of our weight loss patients are going to run sprints in the parking lot?
It is difficult to describe Kettlebell exercises—you really need to demonstrate each movement and provide hands on instruction. The latter is critical when you look at online photographs and some of the so-called education videos on YouTube. It is readily apparent many users were either poorly or incorrectly taught or have an inadequate understanding of body biomechanics. We provide intensive training sessions just to learn the how of each exercise before we throw you into a class or send you home with an exercise prescription. But in brief, there are certain favorite Kettlebell exercises that tend to give you the biggest benefit for time spent:
KB swings, KB Goblet squats, KB military press, KB cleans, KB dead-lifts, KB snatches, KB lunges with press, and bent over rows. Those are just a few of literally dozens of exercises we teach our clients. I tend to be old fashioned based on my prior personal or professional experiences. When I was a volunteer physician at the US Olympic Training Center is Colorado Springs I was unofficially assigned to Judo, Wrestling, and Powerlifting. I was in my early forties and not only learned some really cool Judo moves, I got a first hand education from world champion Olympic lifters and have done squats, cleans, clean and jerk, dead-lifts and bench presses every since. My favorite home garage routine is to do five sets of five reps of five different Olympic lifts in succession, all within 30 minutes prior to dinner. I have no trouble sleeping that night! To those who know me it should be no surprise that we have a power rack in our clinic. But it is no ordinary half rack. Keiser provided us with a rack that combines air resistance so we can load a 7-pound bar with any amount of weight in less than one-pound increments. That allows us to train older or deconditioned patients who would eventually like to train with an Olympic bar that they initially cannot even lift safely (45 lbs). With high performance athletes the combination of Olympic plates and air resistance increases power more rapidly—for example, during a squat the weakest part of the movement is at the bottom of the squat and as you stand up you are stronger but the amount of weight on the bar is limited by the amount of weight you can bring up from the thighs parallel to the floor position (or all the way down for an Olympic squat). By adding cables that provide air resistance the amount of resistance will increase as you reach the top of your squat or a bench press for that matter. Or perhaps you are unable to do pull-ups or dips with body weight and we can provide air assist to maximize your training effort. This is just another example how our more advanced equipment contributes to greater progress in the gym and enhanced performance.
Another means of facilitating a specific exercise is to train on our professional level vibration plates from Power Plate. Vibration training has been shown to facilitate recruitment of fast twitch muscle fibers. This may produce a greater strength response to training but I found a more practical application—if I do a complete workout of multiple progressive sets of Kettlebell Goblet squats on the power plate I experience little or no exercise-induced muscle soreness of hips and thighs the next day. If I do the same workout off the plates I know the next day when I have overdone it. I can only hypothesize regarding the science—since fast twitch fibers are theoretically stronger, recruitment of more fast twitch may reduce the load on slow twitch muscle fibers and less soreness the next day may possibly be a relative sparing of those fibers, who knows? The important point for me has been it works!
We have vibration plates in our gym for several additional clinical reasons. After 23 years on insulin I was developing a little bit of peripheral neuropathy in my feet affecting my balance on the golf course. My instructor asked me one day if I was aware of any balance problems—sensory neuropathy affects messages to and from joint position sensors (proprioception). I discovered that by doing balance exercises on the Power Plate my balance improved—you know by now I will do anything for better golf! And without going into details, when a family member had a stroke with reduced sensation, balance and strength on one side of the body, daily workouts on the vibration plate were a literal godsend in improving motor control and balance as well as renewed confidence upon losing the fear of falling. In other words, Power Plates fit our gym paradigm, providing training opportunities for our patients with variable levels of functional ability and need. It is a marvelous effect of science to see people improve and reach goals they either did not think were possible due to underlying physical limitations or to be amazed at how much more rapidly goals can be achieved with the right equipment and the proper instruction.
The final piece of equipment for review is our Vertimax. This is a unique platform device with cables that attach to the trunk and limbs. It was originally conceived to train for explosive power in all major muscles groups of the trunk, hips and legs for vertical jump sports and sports requiring aggressive acceleration/deceleration movements forward and back as well as side to side. It is a great tool for young athletes in track, football, basketball, tennis, and volleyball. As time has gone by other applications include training the rotational demands in sports such as baseball and golf. Here are just a few sport specific examples:
Baseball: improve leg, arm and hip rotation speed and power to increase hitting distance and throwing speed, dramatically improve 60 yard sprint times for base stealing and defensive plays. Basketball: the leading vertical jump program that also adds speed and quickness. Football players improve 40 yard sprint times and increase vertical leg and arm lift. Soccer: more explosive kicking power, quickness, and stamina. Tennis: first step quickness, hitting power, lateral speed. Track and field: sprint speed, lower body explosive power. Golf: rotational speed and power.
We use Vertimax mostly for our high school athletes—Start Clinic is committed to youth that extends beyond sports to health. We want to be leaders in the fight against child obesity. We are also committed to healthy sports participation as a component of the maturation process of ‘growing up’ into responsible adults. As part of that commitment, we invested in Vertimax in addition to our other superior gym equipment. Although I focused here on youth, the Vertimax is applicable to any adult desiring to develop the broadest range of athletic abilities for virtually any sport requiring speed, agility and power. Vertimax is utilized by most pro sports teams (NFL, NBA, MLB and NHL) and is now available for you at Start Clinic. Call 602- 795-3649 to schedule your initial consult today.
To wrap it up, Start Clinic has a gym to help you maximize human performance regardless of your physical condition or specific goals. We are here to help you feel better and look better. Believe me, exercise truly is medicine!