Hey Docs, hope all is well with you and the crew. I could use some help with a training issue that’s complicated by a medical condition I have, which is hypertrophic cardiomyopathy. It was diagnosed when I was a young man, and I’m now 69, so I’ve lived with it all my adult life. I’m under the care of excellent cardiologists and have been for decades. They know about my weightlifting and are ok with it. I’m well protected (meds, ICD/pacemaker, etc.) and my condition is well managed. I have struggled for a long time with rep ranges higher than 5, specifically with squatting. The issue is that I hit my cardiovascular limits before I can really fatigue the muscles. I did PowerBuilder I last year, and it was miserable. The AMRAP and myo-rep sets were brutal for me, and to top it off, I got weaker or stagnated on all my primary lifts. I know I need to accumulate volume, particularly given my age and anabolic resistance. But what is the best way for someone like me to accumulate volume while working around my limitations? More sets with lower reps? Can that provide nearly the same stimulus as fewer higher rep sets? And if I go the route of more lower rep sets, do I need to load those sets heavier than higher rep sets, even if the total workout volume is the same? I know this is a lot to throw into a post, so I really appreciate any advice you feel ok with offering. Thanks for everything you guys do.
Adapter,
Thanks for the message and glad to hear you’ve had excellent care with respect to your condition. A few general thoughts here that should not be taken as medical advice:
- It is possible that some of the medications you’re on may limit your cardiorespiratory fitness development and performance. That said, it is also possible that your cardiorespiratory fitness may benefit from some further development. This is quite common. I suspect both things are true and while I would not change anything related to the medical management, I would aim to improve cardiorespiratory fitness- though not via resistance training in isolation. Rather, I would rely on the conditioning work in whatever program you’re doing to do this along with some resistance training efforts that challenge your conditioning, e.g. sets of 8-12+ with loads you can handle on exercises you may feel more comfortable pushing, e.g. leg press, hammer strength chest press, DB work, etc.
- I don’t know that you need more volume than what’s in PB I, but I do think that reducing training volume is generally not a great way to improve fitness.
- If you’re wanting to replace higher rep sets with something you can tolerate, my preference would be to reduce the RPE by 1-2 points and reduce the load rather than change the rep scheme. For AMRAP work, this would turn take RPE 10 into RPE 8.
- If you’re wanting to replace the rep scheme, I don’t have a great substitution that equates 10 @ 8 to a set of 5 and yields the same training stress. In a pinch, I would do the same amount of sets programmed for less reps, but then also lower the RPE target by 1-2 since the load itself has an impact on training stress. Practically speaking, you could do the following if you want to change things:
- For higher rep sets, change 10 @ 8 x 3 sets would change to 5 @ 6 x 3 sets
- For myoreps, change 12-15 @ 10, 3-5 to 3 sets of 10-12 reps @ RPE 7
- For AMRAPs, change 75% e1RM AMRAP to 75% e1RM to 3 RIR/RPE 7 Hopefully this helps!
-Jordan
Doc, thanks so much for this. I do work on GPP in my programming, but I’m sure you’re right about my meds and need for cardio development. The thing that struck me in your advice was the idea of modifying the RPE. I feel a little silly for not thinking of this myself, especially given the content you’ve published about lower fatigue programming. But being on the threshold of geezerdom, I have to admit I still harbor that old bias of “harder is better”. So some of my sufferfest is self-inflicted. I’m going to go with your advice, and I think I’m going to check out the Lower Fatigue program you offer. I’ve been working the Powerbuilding path, but at this point I’m more interested in strength than hypertrophy, and maybe the Lower Fatigue route would work better for me. I’ll touch base back in a couple months or so and let you know how it goes.
Thank you again, and the whole crew, for everything you do.
Thanks for the kind words. I’ll be interested to see how you do, so please keep me updated.
Related to the discussion of intensity, I think the big take-away is that VERY HARD efforts may work slightly better than LESS HARD efforts, though this doesn’t seem to be supported by data when people do the same amount of training AND it is unlikely someone could do much of them because they’re so hard.
Hi Doc, hope all is well. Last we spoke, you asked me to update you on how things went with the implementation of your suggestions on how I could train better with my cardiomyopathy. Well, things went pretty well as far as I’m concerned. I competed in my 2nd ever powerlifting meet on May 20. I am now the Georgia Raw Masters 4a 67.5kg record holder in the Bench, Deadlift and Total! I missed the Squat record, but only by 2.5 kilos, so I’ll get that one next time. I know a lot of guys on the Forum would laugh at my numbers, but I’m thrilled, and I can’t thank you enough. I bought the Low Fatigue template and just started the Low ISF 3 Day version this past week, and so far I’m loving it. I feel like I got a couple of extra days in the week back, and I look forward to training! I can’t weigh in on performance yet with the Low Fatigue program, but conceptually it seems in line with your earlier advice, so I’m optimistic. Once again, THANK YOU! You and your crew are the best!
I do actually have one question about the Low Fatigue approach I’d like to shoehorn into this post. I’m not super confident in my ability to accurately estimate RPE when I do sets where the program calls for RPE less than 8. Does it make sense to occasionally run a set at RPE 6 or 7 out to RPE 9 just to make sure I’m reasonably accurate in my RPE estimation? Thanks again,