Dr. Patrick: With designing this program, differences between men and women, should women then really be focusing more on the multi-joint exercises, specifically also because of the effects on the bone mineral density? Or, I guess, all of us should be focusing more on that?

Dr. Schoenfeld: Yeah, women really should not train much, if at all, different from men. The one area that there seems to be some evidence is that women are able to recover a little more quickly, both inter-set...so, they can actually rest somewhat shorter, and gain back most of the volume load, like I said. It's not clear whether this has something to do endogenously, internally, or whether it's the fact of just, in general, using lighter loads than men so it's easier to, you know, come back if you're using 200 pounds versus 100. We don't know. And even their recovery between sessions may be a little better, their ability to recover. There's some evidence of that. But as far as the overall program, I don't program women much, if at all, differently than men.

Dr. Patrick: For recovery, you hear a lot about the importance of recovery, the importance...what does that mean? What does that mean?

Dr. Schoenfeld: Well, it means that you need to take sufficient time so that you're able to come back strong for your...and it means a lot of different things, depending on the context. But I think, in the context of our talk, that you're able to come back with sufficient energy and joint-related reserves where you're able to train effectively in your next session, that your training is not compromised the next time you're going to lift.

To some extent, it also has to do with the muscle protein synthetic response, which is roughly the time course...it's about 48 hours, it can be truncated a little as you get actually more advanced, you seem to get a higher spike. So, it happens quicker and actually trails off a little more quickly in some of the research, which is I think getting a little too much into the weeds. But theoretically, you probably wouldn't need to train a muscle or it would be beneficial to give it 48-hours rest so that you can maximize that and work on other things or even just recover. Or it certainly doesn't seem to be beneficial to train it on a daily basis, the same muscle, and having that recovery allows you to do other things that would potentially develop your body and/or your health to a greater extent.

Dr. Patrick: Does it blunt hypertrophy if you're training the same muscle...

Dr. Schoenfeld: No, so, there's actually some interesting...it's kind of equivocal. You could tell I've done a lot of work on all of these variables. So, we carried out a study, these were young men. We don't have any evidence in older people, and I can make a case where it might because recovery seems to be blunted in older, but I'll get to that in a minute, but in young men we had them doing either the same exact routine done over three days with more...so, when they did it over three days, they performed more sets per session. So, like, each session was twice as long, or else doing shorter sessions spread out over six days, the same exact routine. And no difference for most of the muscles, but we looked at the biceps and the biceps growth was much greater in the group that did three days versus six days. Is that an anomaly? Again, we don't know, you'd need to replicate the study.

Now, as I just mentioned, older individuals' recovery does start to become a factor. And this is just, look, ageing. Certainly, you can stave off aging but you can't prevent it and the consequences of it. So, to a large extent, we can live extremely healthy and vibrant into our older years, provided we take care of our bodies and do things. But father time, mother time, we'll catch up to some extent, and we do have to take this into account their programming. So, like I said, no differences between men and women per se but there are differences between younger and older individuals. And one of them, when I have consulted with older individuals, is to factor in not have as much volume, so, the ability to tolerate volume seems to go down, to some extent. And by the way, interestingly, it seems their maintenance needs to be somewhat higher for volume, so, they can't use high volumes but also they need to have kind of a higher minimum volume to maintain their mass. There's limited evidence of that but there was one study in particular that seemed to indicate that. And also having more cognizance of inter-session recovery and sometimes having fewer sessions per week.

Dr. Patrick: How much recovery would the older people...

Dr. Schoenfeld: So, again, this really depends on the individual because those older individuals, like I mentioned, can wipe the floor with 30-year-olds, and there's other ones. So, these are things that it really will depend upon...so, it depends how long have you been training? Were you just new, when you were 60-years-old, to training or have you been doing it since you were 20? You know, do you have joint-related issues? What's your nutritional status? What's your sleep and stress status? Are there any other medical issues? So, a lot to unpack.

And on a general level, I think kind of three days a week is a default that would be a good...I mentioned that two days a week people can still make robust gains but I think three days a week would get you a little better gains. And if possible, even, on a minimalist basis, if you can do three half-hour sessions per week, I think that's a good kind of minimalist guideline for everyone, including older people. And then, you know, some older individuals can do what's called a split-body routine where they can do, let's say, Monday-Tuesday, Thursday-Friday, and upper/lower type routine and recover well. Whereas others need that, you know, "Shouldn't do more than three days a week."

Dr. Patrick: All right. Is there anything that can speed up recovery? So, recovery being passive recovery, active recovery, like, things that can help speed it up nutrition-wise or other things as well.

Dr. Schoenfeld: Yeah. First of all, being recreationally-active, so, blood flow does help with recovery. One of the worst things you could do is just be a couch potato. So, let's say you do a resistance-training workout and the rest of the week you're just sitting on the couch, you know, munching on bonbons and watching your favorite TV shows. The circulation itself is going to optimize the delivery of nutrients and expedite delivery and recovery in that respect.

Other things have somewhat less evidence behind them. So, massage has been shown to potentially help recovery. What's the problem with that? Well, it's hard to sham massages. So, when your massage feels really good and, "Hey, I feel better." Is that because of the massage or because of the psychological effect that you get? "I feel better now, I feel vibrant." Foam rolling, you know, these are all things that it's hard to sham them properly and get a sense, "Was it really the treatment or was it the placebo effect?" Because you always want a placebo, if you're comparing it against nothing, then, "Hey, it felt good, so, I feel I have better recovery."

You know, taking in proper protein itself, that to me isn't a recovery strategy, that just should be part of your lifestyle, if you want to maximize your results. But if you're not taking in enough protein, protein are the building blocks of your muscle and of any tissues, so, you're not going to get proper, quote unquote, recovery if you're not optimizing your protein nutritional intake.

And then there's other, I mean, essential fatty acids, particularly n-3s, your Omega-3 fatty acids seem to have certain beneficial effects on muscle development, particularly it seems for the older people. But we don't have great evidence longitudinal, we have some good acute studies that seem to show that... Anyway, so, these are all, I think, strategies... Again, cost-benefit. Well, massage, if you're paying for it, doesn't cost that but, if you have, let's say, a significant other that can massage you, also foam rolling, you know.

There is some evidence that cold-water immersion, we can kind of get into this, might expedite, quote unquote, "recovery" so that you're not going to be as sore. So, if the recovery has to do with getting back to trainability levels so that you're reducing soreness...and heat, by the way, is another thing, which generally does not seem to have negative effects at least. So, again, those are potential strategies.

Now, if you want to get into...it's kind of interesting with cold-water immersion, cryotherapy, particularly it's been shown with the cold-water immersion, there is emerging evidence that it actually has negative effects, particularly on hypertrophy but on strength measures as well. Somewhat limited evidence, but it's been shown there's triangulation of evidence, meaning that we have acute data that shows it blunts intracellular anabolic signaling, that it blunts muscle protein synthesis, satellite cell. When you talk about anabolic signaling, the pro-inflammatory response, which, on one end, is why, quote unquote, it helps with recovery but the acute pro-inflammatory response actually has been shown to have a positive effect on muscle development. So, chronic inflammation bad, acute inflammation good. At least that's the extent of what we see from the literature. And there's been longitudinal evidence showing that it blunts hypertrophy over longer-term studies.

Now, that is when these studies have been done doing this every day, or very frequently, post-training. I would say that, if you're only going to do it one time, let's say you're feeling really sore, nothing wrong with getting in a cold tub. It doesn't mean all your gains are going to go if you occasionally do a cold-water immersion but I do think that using it frequently, probably, if your goal is optimizing muscle growth, not a good thing.

Timing might be a concern. So, if you want to do that, probably spacing it out at long periods after. But then you might not get the benefit you want. Like, if you're sore, you're going to want to be doing it when you're sore. So, if you're sore the following day, yeah, I think that might be beneficial where you've kind of gotten out of your window, or at least gotten the majority of your protein synthetic responses in. But again, the primary reasons that cold-water immersion seems to have negative effects, number one, blunting of the pro-inflammatory response, number two, blunting of the circulatory response, that cold water restricts the circulation and, thus, you're not getting nutrient delivery to the muscles. It's speculative but that's the work in theory.

Dr. Patrick: Right, so, that would make sense to not do cold-water immersion right after your training?

Dr. Schoenfeld: Yeah.

Dr. Patrick: Like, I like to do cold-water immersion for brain benefits like in, you know, feeling you get norepinephrine release and it affects my anxiety and my mood and focus and attention. But I don't ever do it after strength training, so, it's usually on a day that I'm not strength training.