Regular readers of this blog will know that I am VERY discriminating with where I get my fitness information from to the point where I’ve been called contrarian by many others for questioning popular theories and methods.

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Frankly, I don’t do this as a publicity stunt and I like to think I take a balanced approach to studying and presenting every topic.  As such, I’d like to think that people would trust my opinion on things I review here and know that I’ll never recommend anything just to make a quick buck.

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For this reason I hope you’ll take my recommendation of Mike Robertson’s new Bulletproof Knees and Back Seminar product very seriously.  Honestly, I have yet to review the product (it is on its way), but I can say without a doubt that I am positive it is going to be outstanding.  I think I currently own every product Mike has ever produced and his work has never been a disappointment. 

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More to the point, Mike is a stand up guy who is constantly in the trenches training clients and refining his methods in one of America’s top facilities.  And despite this, he never hesitates to take a second to answer emails and help out those who need it.

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In fact, when Mike asked me if I’d put together a bonus for his product I jumped at the chance to help him out.  I’m not making a cent for promoting this product and I didn’t bat an eye at the thought of putting together a bonus for his product (completely for free) because I know that it is going to be solid and something I can be proud to support.

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If you are a fitness professional and are dealing with clients who have knee or back pain (that is pretty much all of us) I have no hesitation in recommending you check out The Bulletproof Knees and Back Seminar.

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It is on sale until Friday and after that the price will jump by 50 bucks so if you’re keen to be the “go to” trainer for dealing with knee and back pain then I’d highly suggest you take advantage of this sale today

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The Bulletproof Knees and Back Seminar <— Get it Now!

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As my frequent readers know, I’ve written several posts in the past where I’ve investigated some of the research done on the Functional Movement Screen.  You can check out the four articles below to get up to speed.

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Interrater Reliability of the Functional Movement Screen

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Core strength: A New Model for Injury Prediction and Prevention

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Research Review: Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen?

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Research Review: Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen?

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In the near future I will provide my review of Gray’s book Movement and my final review on the FMS as a whole (I’ve honestly been meaning to get to this for some time).  However, today I wanted to share with you an interview I did recently with Dr. Robert Butler who is currently one of the principal investigators of the FMS.  My goal here is to provide some balance to the discussion and to share the current state of FMS research.

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Without further ado, let’s get at it!

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Mark:  Thanks for taking the time to do this interview today.  Could you please tell my readers a little bit about yourself and your background?

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Rob – Mark, it is a pleasure and honor to be able to participate in this interview. As far as my background, I am currently an Assistant Professor in the Doctor of Physical Therapy Division at Duke University as well as a Clinical Researcher for Duke Health Systems Sports Medicine Division.

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I completed my undergraduate degree at Marietta College with a degree in Biology. I then followed up with MS in Movement Science with a concentration in Biomechanics from Springfield College and received my PhD in Biomechanics and Movement Science from the University of Delaware. After completing my PhD, I completed a post-doc at UNC-Chapel Hill before completing my DPT at the University of Evansville.

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It was at the University of Evansville where I began working with the Functional Movement Screen through collaborative work with Kyle Kiesel. My research has focused on the role of functional movement outcomes in identifying and addressing movement dysfunction with regards to reducing injury risk, improving therapeutic outcomes, and reducing the rate of joint degeneration.

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I currently have 14 publications in peer-reviewed manuscripts and have had over 50 abstracts accepted for presentation at national and international meetings.

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Mark:  That’s excellent Rob!  You’ve recently been involved with some of the research on the Functional Movement Screen.  Can you talk a little bit about how this opportunity came about and your affiliation with the system?

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Rob – I was a student and a fellow faculty member with Kyle Kiesel at the University of Evansville and I originally rebuffed the idea of the screen as I went to tinker in the high tech motion analysis lab I directed. However, as I learned more about the system I began to appreciate the use of the screen in clearing the fundamental motor programs that we often attempt to retrain at a higher level in athletes who are having pain and seek out biomechanical based movement retraining. It quickly became the screen that all of the runners at our clinic would have to pass prior to higher level gait retraining, it was our blood pressure test for movement.

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We found that as the fundamental pattern issues resolved there tended to be less of a need for higher level retraining. This continues to be the notion with which I encourage the use of the screen. I never have had a formal affiliation with Functional Movement Systems until recently when I began to instruct some of their courses. In addition, Functional Movement Systems has never financially supported any of the research projects that we have published.

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Mark: Looking at all of the research that has been done to date on the Functional Movement Screen, what things do you think we can currently say we know about the system?

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Rob – I think we can say the screen is reliable between raters trained in the system. We found very high reliability in a recently developed 100 pt screen we use in a research setting which simply forces the rater to score each individual component of the test. I think this step-by-step grocery list approach addresses some of the questions you raised in regards to the reliability study.

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I think we can say that performance on the screen can identify individuals at a higher risk for sustaining an injury in the NFL, military and firefighters. We have two larger scale studies, one in the NFL (N =232) and one in firefighters (N=109), that are currently in review that address these gaps in the currently available literature. The study in the NFL will also be the first study to formally support the role of an asymmetry on the FMS and elevated injury risk in the scientific literature.

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I think we also can say that performance on the FMS is modifiable when using a movement based intervention program.

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I do want to touch a bit on the generic “elevated risk for injury” comment that tends to draw so much ire. Sometimes this comment is taken out of context and I hope this commentary will clarify. The elevated risk of injury in subjects =< 14 on the composite score is 2.2x based on our current study in review. It is not an end all be all number but it was statistically derived and not randomly fabricated by the research group.

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The factor that tends to be the strongest consistent predictor of injury is a previous injury; however, this factor is not modifiable. Teasing out this factor is often difficult from a research design standpoint; however, we recently were able to accomplish this in a prospective epidemiology study in collegiate athletes. The results of the study observed that poor movement was a much stronger predictor of non-contact lower extremity injuries in comparison with previous injury alone. We are working on the publication of these findings.

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That being said, no one that I work with is suggesting we have solved all of the non-contact lower extremity injury worries with this model, rather we have simply outlined some patterns that should probably be cleared to minimize injury risk. Our clients do not sit on the couch and as a result they have a risk of injury. The FMS gives us a consistent feedback loop to clear through and maintain motor programs in order to minimize our client’s injury risk when exercising.

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 Mark: What things do you think that we don’t yet know, but might in the future?  Can you tell us what research is on the horizon for the FMS or is awaiting publication?

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Rob – The one thing that continues to arise in the literature is that a prior injury is one of the strongest predictors of subsequent injuries. This suggests that something inherently changes in the motor program following an injury and at this point in time we have yet to establish rehabilitation protocols that normalize the effect of the injury that is being rehabilitated. We think that the FMS may be an integral component of normalizing movement patterns during rehabilitation from an injury. The addition of this model may allow for the factor of prior injury to be removed from the injury equation.  This large scale study can only occur following a series of other studies;  however, it continues to take up valuable space on the office white board.

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We also are not sure how changing the FMS scores effect injury risk and this is another component that we are currently researching. This is often one of the fundamental and appropriate critiques of the system, however to the best of our knowledge there are not many other systems that have shown this either, particularly in an efficient and individualized manner. The goal of the FMS model is to provide an efficient screening process that provides a systematic intervention scheme based on the results of the testing. The goal of the screen is to identify the weakest link in the chain which is a different paradigm in retraining compared to the majority of the group programs that are currently promoted.

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In addition, the goal is to utilize the system in 100s of people a day not 100s of people a year. To borrow from the cardiovascular literature again, it took researchers approximately 30 years from the time hypertension was established as being a risk factor for cardiovascular disease to the research showing that reducing hypertension actually reduced the risk for a cardiovascular event. However, physicians did not wait 30 years to develop models to monitor and reduce hypertension. They proactively addressed the modifiable risk factors to optimize the health of their patients. I feel as if this is a nice and appropriate corollary to the Functional Movement Screen and corrective exercise strategy except that the FMS assessment and treatment is cheaper, easier, and more accessible with less potential side effects.

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Another area that continues to be examined is the composite score cutpoints of the screen in different populations. I think the =< 14 serves as a good starting point but not an end all be all and I think this view point is shared by the majority of the Functional Movement Systems group. The evidence currently supports the specific =< 14 cut off in the certain populations it has been established in, however, we expect that the relevant cutpoints for elevated injury risk may differ across populations.  We are looking to establish relevant injury prediction cut points across recreational, amateur and professional athletes of different age groups and across sports. Other research will also expand to look at the loading of certain variables on the injury algorithm.

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It may be that in certain populations performance on certain components of the FMS may have stronger relevance to injury prediction than other components of the test.  That does not disregard the seven FMS tests and the FMS model rather it would serve to establish a set of specific thresholds for performance on the FMS in a given population along in the presence of general movement competency.

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Finally, we are looking at linking the FMS with other tests that have been related to an elevated risk of injury to provide a more robust model for injury risk identification. It is likely that multiple tests that have independent movement constructs from the FMS will provide a more complete assessment to provide the optimal feedback to individuals who work in the realm of injury prevention.

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Mark: Now I know you were a little miffed about some of the comments about on my most recent review of the FMS research.  Please feel free to take a second to address some of these comments.

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Rob – I cannot recall my initial thoughts on this, however, I think the overlying concept that people have a difficult time with until they use the screen is that the FMS is a filter to catch large scale movement dysfunction not 2 degree differences in movement patterns.  The goal is to establish basic movement competency, to get your movement BP to 120/80. Why is it okay for a 14 year old to lose the ability to deep squat when in a 2 year old it would be a medical emergency?

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Part of it boils down to a lack of standards for basic movement competency. There are a number of research studies that have associated mal-alignment and poor movement with injury and pathology using much more precise and sophisticated equipment. This is one of the reasons why I feel the screen is often dismissed at first site…. It has to be more expensive to be meaningful… the course has to cost more to be worthy of my time …. my patients/clients could pass that test easy. These are often the comments reflected back to the screen.  My response to these lines of comments is fairly standard… “Perfect, then if you are interested just start collecting the FMS data and just see what happens.”

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The screening process is outlined in the reliability study (Minick et al., 2010, J Strength Cond Res) and Gray discusses how to build your own kit in “Athletic Body and Balance” for less than $20. All the information is out there for someone who wants to learn and incorporate the screen. The uber-transparency of the model is one of the reasons I am drawn to it. In a world of rehabilitation where there are often closed door assessments and jargon laden evaluations it is nice to have a model for all to understand and talk about at a common level of understanding across disciplines.

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If all the screen is used for is a standardized way to assess basic patterns of movement that were imperative in the neurodevelopmental process then I think the screen has accomplished a great deal. The importance of these fundamental patterns become more clear everyday as my two girls learn to defy gravity from the ground up and balance their own dual pendulum setups as they explore their everyday lives.

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Mark:  And finally, where do you think the FMS is most useful for the average trainer who is about to start training a new person?

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Rob – I think the screen gives everyone (you, the client, the client’s family, the client’s MD, a client’s MD in another country) an idea of where the client’s program is headed and why it is headed in that way with regards to the client’s plan of care.  I love the fact that health care providers do not have to speak the same language to talk movement.

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The screen also gives the patient some specific goals that they can often self-assess.  My patients often want to know we they aren’t running, jumping, doing kettlebells for Turkish getups, etc. during therapy.  I often will have a rationale in my mind as to why we are not doing these activities and when I explain the rationale for this it often falls on deaf ears. However, the second I give them the criteria of a wall squat with hands overhead and hips below parallel prior to starting plyometrics it tends to stick with the individual to a greater degree and the patient tends to become more engaged in the pursuit of the goal.

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I love empowering my patients to move better and to screen themselves in whether or not they are making gains.

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Mark:  Awesome!  Thanks for the interview Rob.

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Rob – Mark, thanks for your time and patience as I put this together. I hope this interview can provide some open dialogue with regards to the screen and what it can and cannot do. I look forward to speaking with you more in the future as we all aim to provide the best care and information to the clients and patients we serve.

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Like this interview?  Please share!

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What do you think?

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Let me begin this post by saying that the last few weeks have been absolutely CRAZY for me.  I finished up my bonus for Mike Robertson’s new product and completed my soon to be released product How to Read Fitness Research all while my whole family was sick with a cold.

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To make matters worse, while my nose was already stuffed up, my 15 month old daughter decided to jump backwards while playing on the bed and give me a flying reverse headbutt to the nose.  Frankly, her technique was only about a 5, but the damage inflicted was a solid 10 out of 10.  Within seconds my nose started gushing blood like a firehose and left our bedroom looking a little bit like a Friday the 13th movie.

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Needless to say, I’m fully recovered now and the work got done, and I’m back to work on getting the sales page and related issues hammered out for my product that will hopefully drop before the end of the month.

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In any case, let’s get down to today’s topic: “Metabolic Conditioning”

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In my previous post I mentioned that I was pretty much not buying into the latest craze of “metabolic conditioning” for weight loss.  Today I want to talk a little bit about why that is.

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Before I start I want to reiterate what I said in another post about weight loss versus fat loss.  In short, I stated that you don’t necessarily need to lose weight to improve body composition.  Anyone reading this blog probably knows that you can simultaneously lose fat and gain muscle. 

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However, the more trained you are the more difficult it is going to be to do this to a large degree.  After 2-3 years of training you simply aren’t going to be losing 15 pounds of fat and gaining the same amount of muscle (without drugs).  So if you’ve been training for a while and you want to be leaner you’re going to need to lose weight.

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With that said, I think it is safe to say that if you’re not restricting calories and you start exercising you can expect to lose some weight.  However, in studies lasting as long as one year, the weight loss from exercise alone is pretty modest.  Looking at the graph below, you’d might expect to lose only 7kg (15.4lbs) in 12 months.

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Wing. Med Sci Sports Exerc 1999;31(suppl):S547.

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And further research demonstrates that it takes a decent amount of activity (more than 200 minues per week) to get results that exceed these.  Looking at the graph below we can see that it will take approximately four 50 minute workouts per week to achieve a weight loss that averages about 2.5 pounds per month.

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Jakicic et al. JAMA 1999;282:1554.

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Of course, since it takes one heck of a lot of exercise to create the same calorie deficit that could be achieved with food, diet alone is typically more effective than exercise alone for weight loss.  In fact, losing 15kg (33lbs) in four to six months certainly isn’t beyond the realm of expectation for someone who is sticking to their plan. 

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However, when we look at the research, it appears that adding exercise to an already effective diet produces very little (if any) additional weight loss.

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Wing RR. Med Sci Sports Exerc. 1999;31(suppl):S547-S552

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So if you’re already restricting your caloric intake, adding any kind of exercise is going to do little to accelerate your rate of weight loss.  Instead, you’d do well to focus on using exercise for other important things like maintaining muscle mass.

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Int J Obes Relat Metab Disord, Ballor and Poehlman;18:35. Copyright 1994 Macmillan Publishers Ltd.

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So when it comes down to it, if you’re trying to lose weight (or fat) diet is going to be the key to your success.  Adding in ANY type of exercise is not going to have a huge impact on weight loss.

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As a result, I think it is safe to say that despite the arguments about post exercise calorie burning from metabolic conditioning workouts (which is actually a LOT smaller than most people think anyway), using ”metabolic workouts” to accelerate weight loss is pretty useless.

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I will say, however, that I do use exercise pairings, supersets, and circuits to fit in more training volume for hypertrophy or to elicit a cardiovascular training response (you know…for that silly thing called health), but I am under no illusions about its effects on body compostion or fat loss.

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The Big Picture

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Focus on diet for fat loss.  Use your training to retain muscle and improve performance.

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If you’d like to review studies like this for yourself, check out my product How to Read Fitness Research.

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Just the other day I received this email from a reader of this blog and thought I’d post it (with his permission) so we could all benefit from the answer.

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Question:

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“I just read your article Weight Loss, Fat Loss, and Calories and am having an issue that is driving me nuts.  I have been eating around 2000-2200 calories per day and have been averaging about 5000-6000 calories in the negative each week yet have not lost a dang pound.

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Here are my calories from last week:

1,462
2,137
2,313
2,017
2,152
2,900
3,586

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I am also cycling carbs and calories. Coming from a bodybuilding background and having studied nutrition this has me stumped.  I am 49 years old, 5’10″, 186 pounds, and about 20% BF. I workout 4 days a week and burn an average of 600 cals from my workouts.

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For the last 4 months I have been in a deficit yet have gained 6 lbs.  For the last two of those months I have been doing Martin Berkhan’s intermittent fasting, which I like, and nothing.  On paper just these past 3 weeks I should lost 4 lbs but lost zippo and my pants that used to be very loose are getting tighter.
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Any thoughts?”
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Answer:

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As my friend John Berardi used to say: “However Beautiful the Strategy, You Should Occasionally Look at the Results.”
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Your attention to detail in creating your plan is excellent, but I think you’re failing to look at the results and adjust accordingly. If you’re not losing weight then you are not in a deficit regardless of what the calculations say. There is no magic. If you want to lose weight you need to reduce your calories. There is no way around this.

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Personally, I never use calculations as I find them misleading and I think some people get really hung up on what they “should be” losing. I estimate a starting point based on my experience and adjust calorie intake solely on the outcomes on a biweekly basis. If weight is not moving then the calories HAVE to go down.  Regardless of whether you eat twice per day or six times per day, this fact remains true.

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I also don’t adjust calories for workouts as research has shown that despite increased calorie burning from exercise (acute), it makes little additional difference in terms of weight loss in the long term when combined with a solid diet.  I don’t know why this is, but it appears to be the case.

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I think your initial daily calorie values have served their purpose and you need to adjust your intake from here forward based on your results and not what “should” be happening.

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If I were you I would drop the calorie and carb cycling as I don’t feel these details are necessary at 20% body fat.  Refeeds can become increasingly necessary as you get leaner, but for now I think you need to just worry about creating a deficit and getting the scale moving.  I would set a standard daily calorie intake and maintain that for two weeks.

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If this fails to produce weight loss I would then reduce by 300-500 calories per day for two more weeks and repeat as necessary until you start to see results.  THIS will be your calorie target and it is not necessarily going to remain fixed forever so you will need to continually adjust up or down depending out your results.

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In terms of workouts, I would focus primarily on muscle retention (I don’t buy into this whole “metabolic workout” craze) and limit workouts to 2-3 per week.  But ultimately, I think that when you get your calories at the appropriate level the results will come steadily and you’ll find that fat loss doesn’t need to be nearly as complex as most people make it.

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