#196 - AMA #32: Exercise, squats, deadlifts, BFR, and TRT
Peter Attia, joined by Nick Stenson, details his weekly exercise routine, including cardio and lifting splits, and how he incorporates blood flow restriction (BFR) using specialized cuffs. He also touches on specific lifts and introduces a discussion on testosterone replacement therapy for men and women.
Deep Dive Analysis
9 Topic Outline
Introduction to AMA #32 and New Co-host Nick Stenson
Peter's Current Weekly Exercise Routine Structure
Flexibility and Timing of Workouts
Incorporating Blood Flow Restriction (BFR) into Workouts
Comparing BFR Cuffs: Ghetto Style vs. Smart Cuffs
Understanding Occlusive Pressure in BFR
Subjective Experience of Effective BFR
Optimal Timing for BFR within a Workout
Dead Hangs and Finger Pull-ups Training
4 Key Concepts
Blood Flow Restriction (BFR)
A training method where blood flow to a limb is partially restricted during exercise, typically using cuffs, to achieve muscle growth and strength benefits with lighter loads. It creates a hypoxic environment and metabolic stress, mimicking the effects of heavier lifting.
Occlusive Pressure
The amount of pressure required to completely stop arterial blood flow to a limb. In BFR, exercise is performed at a percentage of this pressure, usually around 30% of arterial occlusive pressure, to restrict venous return while allowing some arterial inflow.
Doppler Device
A medical device that uses sound signals to detect and measure blood flow in arteries, often used when a pulse cannot be felt manually. It can be used to determine the exact arterial occlusive pressure, which is crucial for precise BFR application.
Lactic Acidosis (in BFR context)
The sensation of burning and fatigue throughout the entire muscle group during BFR, indicating effective metabolic stress and the accumulation of metabolites. This sensation is a sign that the BFR is working correctly, as opposed to just localized pain from cuff constriction.
7 Questions Answered
His macro structure includes cardio on Tuesday, Thursday, Saturday, Sunday (Zone 2, with Saturday potentially adding Zone 5 or a longer anaerobic ride), and lifting on Monday, Wednesday, Friday, Sunday with an upper body/lower body split.
He prioritizes getting all four lifts in each week, even if it means moving days around or doubling up on a different day, but he will never compromise a lift.
On weekdays, his lifts are done first thing in the morning, around 7:15-7:30 AM, after his morning routine with the kids. Weekends offer more flexibility for timing.
He uses BFR every day he lifts, typically at the end of the workout, performing one to two exercises per muscle group using specialized cuffs.
Cheap bands are less accurate for pressure and can cause localized pain, while advanced cuffs measure occlusive pressure, apply consistent pressure, and are designed for specific limbs, leading to a more effective and less painful experience.
Peter Attia prefers to do BFR at the end of his workouts as a finisher, believing it's better to be fresh for the heaviest, most neurologically demanding exercises.
He has achieved a dead hang of over three minutes, typically performed at the end of a workout.
17 Actionable Insights
1. Structured Weekly Exercise Plan
Implement a consistent weekly exercise routine with cardio on Tuesday, Thursday, Saturday, Sunday (Zone 2 for 45 mins, with Saturday optionally including a 30-min Zone 5 workout or longer anaerobic ride), and lifting on Monday, Wednesday, Friday, Sunday (using an upper body/lower body split, e.g., lower body Monday/Friday, upper body Wednesday/Sunday).
2. Prioritize Cardio Before Lifting
Always perform cardio before lifting, as doing the reverse has been demonstrated to erode strength training gains.
3. Never Compromise Scheduled Lifts
Prioritize completing all four scheduled lifting sessions each week, even if it means moving days around or doubling up on a different day, to ensure consistency in strength training.
4. Invest in Quality BFR Cuffs
For effective blood flow restriction (BFR) training, invest in high-quality cuffs (e.g., ‘smart cuff’) that measure occlusive pressure, as they provide a significant improvement over basic bands and are considered worth the cost.
5. Daily BFR at Workout End
Incorporate blood flow restriction (BFR) training at the end of every lifting workout, typically for one to two exercises per muscle group, such as a leg press set after a leg session or bicep/tricep sets after an upper body session.
6. Standard BFR Rep Protocol
When performing BFR, follow the standard protocol: 30 reps, rest 30 seconds, 15 reps, rest 30 seconds, 15 reps, rest 30 seconds, 15 reps.
7. Calculate BFR Training Weight
To determine the appropriate weight for BFR, use 30-40% of your one-rep max (1RM); calculate this by taking your best 10-rep weight, dividing it by 0.75 (to estimate 1RM), and then multiplying the result by 0.3 to 0.4.
8. Optimal BFR Occlusive Pressure
When using BFR cuffs with an inflation device, ensure they measure occlusive pressure and aim to operate at approximately 30% of the arterial occlusive pressure for effective training.
9. Identify Proper BFR Sensation
When BFR is applied correctly, the sensation should be one of lactic acidosis throughout the entire limb, as opposed to localized pain from the band’s constriction, indicating a true occlusive effect.
10. Consistent Weekday Morning Lifts
On weekdays, schedule lifting sessions consistently around 7:15-7:30 AM, after morning routines and once children are out the door, to maintain adherence.
11. Build Dead Hang Strength Progressively
For dead hangs, aim for 2-2:30 minutes most days without going to failure, as this approach helps build strength progressively rather than always pushing to max effort.
12. Integrate Finger Pull-ups
Incorporate finger pull-ups into your routine, starting with four fingers and progressing to three fingers (e.g., three sets of four four-finger pull-ups, followed by four sets of two three-finger pull-ups), to significantly enhance grip strength.
13. BFR as Workout Finisher
Use blood flow restriction (BFR) as a finisher or near the end of a workout, rather than before heavy, neurologically demanding exercises, to ensure you are fresh for primary lifts.
14. End Workouts with Dead Hangs
Consider incorporating dead hangs as the very last exercise in a workout to build grip strength and finish the session.
15. Consult Healthcare Professionals
Always seek the assistance of healthcare professionals for medical advice, diagnosis, or treatment, as the podcast content is for general informational purposes only and not a substitute for professional medical guidance.
16. Avoid DIY Doppler for BFR
Do not attempt to use a Doppler device to measure occlusive pressure for BFR with basic bands, as it is cumbersome and impractical; instead, invest in cuffs that can accurately measure and adjust pressure.
17. Watch Podcast Videos for Visual Aids
Watch the full video version of the podcast (if available to subscribers) or the sneak peek on YouTube, especially when figures are discussed, to enhance understanding.
3 Key Quotes
I will pretty much will never compromise a lift. I will always get those four lifts in during the week, no matter what.
Peter Attia
I just think when I'm doing my heaviest, most neurologically demanding component of exercise, I want to be a little fresher and I don't want to be as taxed.
Peter Attia
The jump from four finger pull-ups to three finger pull-ups is so much harder than I would have ever guessed.
Peter Attia
1 Protocols
Standard Blood Flow Restriction (BFR) Procedure
Peter Attia- Perform 30 repetitions.
- Rest 30 seconds.
- Perform 15 repetitions.
- Rest 30 seconds.
- Perform 15 repetitions.
- Rest 30 seconds.
- Perform 15 repetitions.