TMD’s Podcast | Golden Nuggets: Episode 3 – Dr. Cody Misuraca – Resistance Training for the Older Adult

by | Jan 19, 2021 | 0 comments

Dr. Joe chats with Dr. Cody Misuraca about resistance training for the older adult including health considerations, myths and ways to think about exercise that may help to decrease barriers and increase motivation!

Dr. Cody Misuraca is head coach at Waypoint Strength and Performance, an online remote coaching platform for barbell athletes and other fitness goers looking to improve performance. Follow him for physical therapy, fitness and pain content @codymisuraca.dpt and @coffee_bycody for all your coffee complexities and needs


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Dr. Joe Camoratto (00:00): 

So this is Dr. Camoratto with the golden nuggets podcast for the movement doctor. And I have here Dr. Cody Misuraca out of San Diego, California. He is a all around great physical therapist, Instagram influencer, and the head of Waypoint Strength, which is a pain and rehab and strength coaching really just coach, right. I mean, you you’ve probably do a better job of explaining it than I can. 

Dr. Cody Misuraca (00:32): 

Yeah. Thanks for having me on. Yeah, I’m Cody. I’m a physical therapist in San Diego. I kind of wear a lot of hats, so Waypoint Strength performances like the, the business that I run and you know, like active on Instagram and I have my website there that is primarily strength coaching services. I personally kind of shy away from doing rehab specifically cause I have a lot of clients that just want to get stronger getting into lifting weights or exercising maybe for the first time or just for the first time in a long time. I do work with people that are in pain, dealing with injuries. But like overall I’d say those services or strength and conditioning. My full-time job is working as a physical therapist in an outpatient orthopedic clinic for a hospital system in the Southern California area. 

Dr. Cody Misuraca (01:25): 

And over the last year with everything that’s been going on in the world pandemic wise I’ve been doing more time in the hospital of the acute setting. Something I kind of did on and off my whole career. I’ve been a physical therapist for about five years. And in the last year I’ve just been doing more of that in the hospital too. So I kinda, at this point I’m kind of working in all realms from, you know, acute care hospital. You know, people are really sick to outpatient ortho clinic and then people that are just looking to train. 

Dr. Joe Camoratto (02:00): 

Yeah, I think you’re a great resource for what we’re going to talk about today, which is a resistance training for the aging or older adult, because I mean like myself, I’ve worked in a whole host of settings from acute care. I’ve never worked in a SNF. I’m actually pretty proud of that. From acute care to like rural access a hospital to, you know, outpatient with the military and it kind of helps to see all of those different like sliding scale ranges of human adaptation and performance. And so I think that that will be good for what we’re going to talk about, which before we get into that, what are you drinking? Because I know that your coffee connoisseur even just opened your own coffee Instagram. If you want to plug that as well. 

Dr. Cody Misuraca (02:47): 

Yeah. Started a sort of the new Instagram coffee influencer page yesterday. That’s @coffee_bycody. But no, I’m a, I’m a big coffee nerd. So right now I’m drinking, it’s the bag I picked up yesterday from a roaster here in San Diego bird rock coffee roasters. If you’re looking for great coffee, check them out, they do an impeccable job. But this is a washed Ethiopian, uh the name of it is Shantaween. The bag lists strawberry is one of the tasting notes and that definitely definitely comes through aromatically and in the cup. So it’s good, good stuff. 

Dr. Joe Camoratto (03:26): 

I can definitely recommend the Cody coffee page because I personally have been using your 13 to one water to a bean weight ratio for probably over a year now. And, and you can imagine my dismay when I 

saw that, you were changing that ratio to something different recently, so I’ll have to explore my, my flavor a little bit, a little bit more. 

Dr. Cody Misuraca (03:50): 

There’s so many different ways to brew coffee. Yeah, it’s changed over the years for me too. I did 13 to one for a long time. Currently, if I’m doing pour over, it’s like a 15 to one. I’m putting out a post in a couple of days how to do a pour over where the V60 so keep an eye out for that. Watch out for that self hard hitting 

Dr. Joe Camoratto (04:11):
 Temperature. Gooseneck electric kettle, right? Yeah. 

Dr. Cody Misuraca (04:14):
 Yeah. I, I’ve got one of those fancy fancy ones where you just, you set it to the time you want it’s 

electric, so 

Dr. Joe Camoratto (04:19): 

Yeah, that’s crazy. Yeah. all right, cool. So resistance training for the older adults. I love this category because I feel like it’s so under dosed, if you would say, I mean, as physical therapist, the APTA has released guidelines to say, you know, make sure you’re not, under-dosing your geriatric clients. And I think that it’s really something that gets breezed over a good bit and kind of gets lost in the translation as far as tiptoeing around people who are trying to train or trying to exercise or get into it as, as they’re aging, because there’s so many misconceptions and myths out there. Some of which I hope to hit on including like you know, high intensity exercise is dangerous or bad for you, especially in the weight world. You know, there’s so many things as far as joint health blood pressure going up with heavy lifting. I know that I see that one a lot. And just kind of like this thought that we need this aging generation to just slow down and just settle into their deathbed. Yup. So as far as that topic goes, where do you start as far as education goes? So you have an older athlete who’s interested in getting into resistance training, but doesn’t know where to start. 

Dr. Cody Misuraca (05:44): 

Yeah. So I’d say if someone’s coming to me, who’s like interested in resistance training already. That’s, that’s like over half the battle right there, because like you were saying that the idea lifting weights and resistance training in the older adult is it’s kind of an issue in physical therapy and healthcare, you know one of the biggest barriers to getting into resistance training for older adults is a lot of the messaging out there about injury risk. And, you know, you’re going to get hurt. You’re going to, it’s going to load your back and your knees too much and stuff like that. So I’d say like the hardest part for me is convincing people that it’s a good, good idea in the first place, or maybe not hard, but like that’s, that’s where a lot of the work is. If someone’s coming to me and saying like, I want to do this, we’ve kind of taken care of a lot of the hard stuff already. 

Dr. Cody Misuraca (06:34): 

But I think generally speaking something that’s really important to keep in mind is at the end of the day, the benefits that come from high intensity exercise and resistance training are independent of the specific mode. So what that means is like how you go about doing it, which exercises you select is less important than the fact that you’re doing it at a high intensity, that you’re loading major muscle groups, 

that you’re doing a sufficient amount of intensity and volume. And so bearing that in mind I do not, or I try to avoid pushing people in the direction of specific exercises, right? Like, you know, you don’t have to, you don’t have to do barbell back squats three days a week to, you know, benefit from resistance training. Right. you know, you can do any number of things. And so I try to help people find like lower the barrier of entry and find like a good, good starting point that works for them. And so, you know, trying to identify things that are meaningful to them in terms of like, you know, tasks, they want to be better at or movements that they enjoy. And that’s where I start, you know, typically it doesn’t need to be specific exercises. You know, cause again, the, the benefit from this comes from the load, the intensity consistently performing it, the like exact specific type of exercises that you’re performing is far less important. 

Dr. Joe Camoratto (08:02): 

Yeah. It’s, it’s quite interesting shift from thinking that there’s like one way to do things, to realizing that load can be measured in a significant amount of ways. And if we’re trying to think of fitting every like round peg into a square hole, as far as trying to get a bar on everybody’s back, it can be quite difficult, especially considering that there’s this unfortunate theory that like the bar is evil and only for young people, I mean, even, even people like really close to me understand that the things that I do are like the devil’s work, you know, I, I was at my grandma’s house yesterday and I showed her a video of my dad that lifting 265 sumo, And she was like, are you trying to kill my son? And I was like, no, I’m trying to do the exact opposite. So it’s, it’s, it’s definitely interesting when you consider that resistance is resistance. 

Dr. Joe Camoratto (08:55): 

And if we’re thinking about that as just more than what like active range of motion is, and it can be whatever you really want it to be. And if we’re thinking about like behavioral change, which is really the name of the game with all of this stuff like you said, coming people coming to you, looking for resistance training is already like a great foot in the door, but being able to meet them where they’re at, which is kind of like, like 90% of the challenge, how do I fit what I want to do around what this person wants to do, knowing that it’s going to benefit them is like finding out what it is that they’re going to enjoy while we do the thing that we know is good for them. 

Dr. Cody Misuraca (09:35): 

Absolutely. Yeah. And I do think that like barbells have a lot of benefit primarily just because they’re very like space efficient. You know, if you’re looking to outfit a home gym, for instance you know, there are so many different kinds of implements you could have and could use, but if you want equipment that is fairly space efficient and you can dose the load fairly specifically, like in small increments, if needed kind of with like a never-ending cap on how much load you could use barbells are great for that. So I don’t think there’s anything specifically special or beneficial about a barbell versus any other implement. However, I think that for a home gym you know, having doing barbell training is probably super space efficient. That said, you know, I, it can be, you know, if you’re, if you’re facing some of those concerns or fears around barbell based training, you know, like your grandmother said, you know, are you trying to kill my son. 

Dr. Cody Misuraca (10:34): 

Starting people there, even though that may be like one of their better options, long-term starting people there may not be a good introduction. Right. but yeah, you’re, you’re trying to change behaviors. And so starting with things that they enjoy, things that they’re going to be able to perform easily, things 

that like mimic parts of their life, that they’re trying to be better at just to build a routine and consistency first. And once you’ve kind of taken that next step through the door, then you can start to implement some of those other movements or implements that, you know, maybe they have some, some fear, fear to, or a fear of or concerned about. 

Dr. Joe Camoratto (11:12): 

Yeah. And that’s one of the main barriers in in the aging population is pain, and then I think fear of injury, right, is that you, I know you sent me that paper of the motivators and barriers. I think pain like what were they again, the, the barriers, the number ones? 

Dr. Cody Misuraca (11:30): 

Um so up there was definitely concerned about just like musculoskeletal injury risk. So, you know, just this idea that lifting heavy weights is going to is going to hurt you. Right. and then another one that was up there was concerned about you know, like having a heart attack or stroke or something like that. I think those were the main ones you know, for, for specific populations. Older women specifically will often have concern about, you know, becoming too muscular, too bulky. And, you know, so there’s a lot of things tied into societal beliefs and expectations as well. But kind of across the board is probably the main, the main barriers are related to fear of injury, you know, fear of risk of harm to their health. And then just like lack of access to facilities and good trainers. 

Dr. Joe Camoratto (12:21): 

Now I think that we can go in the direction of why are those not great ideas to have? Why is fear of risk of injury, not a great thing to think about for resistance training. Why is fear of a heart attack or a stroke also not a great thing to think about or might be actually the opposite direction of thought that we should be going. And when thinking about exercise and resistance training. 

Dr. Cody Misuraca (12:46): 

Yeah. So specifically for musculoskeletal injury risk this is something that has been studied. We have studies now in the sport of powerlifting sport of weightlifting. There’s a fair amount of research now in injury injury rates in CrossFit. There’s a big meta analysis on that out there. Oh, sorry. It wasn’t a meta analysis, just a systematic review, but they’ve collected a lot of information on that. So like generally speaking, strength, sports, barbell, sports, this has been measured. And in most cases they’re looking at competitors in these sports. So if we were to expect to find the highest rate of injuries in some realm of exercise, we would probably expect to see that those higher injury rates and competitors, just because they’re, they’re doing it at the highest intensity they possibly can. And so like generally speaking, when you kind of kind of group these all together, whether it’s weightlifting, powerlifting, CrossFit the, the injury rates seem to be somewhere in the realm of like one to five injuries per thousand hours of participation. 

Dr. Cody Misuraca (13:52): 

And so that’s like pretty on par with other non-contact sports that you could play. I feel like I don’t remember the exact number, but I feel like like walking for exercise has like a similar, similar rate of injuries per thousand hours of participation. So resistance training is definitely low risk in people that are competing in it for a musculoskeletal injury, or so then you consider that, you know, the, the person who’s just trying to be healthy, they don’t, they don’t necessarily have to have that drive to go a 

hundred percent all the time or to like, you know go at a hundred percent of their maximal ability. So that injury risk is probably a little bit lower. 

Dr. Joe Camoratto (14:31): 

Yeah. And if the way that I always try and think about like, why injury risk is so low or instances, incidence is so low in resistance training is like, what are the few things that we know that reduce risk of injury? It’s like doing some form of resistance training over time and load management for the most part. I mean, I know there’s been some stuff coming out about workload ratios. We don’t have to get into that. So like you’re doing the thing as a sport that does the two things that, you know, decrease risk of injury, which is getting stronger in some fashion, increasing tissue tolerances, and then slowly progressing your ability to, to adapt over time. It just always, it clicked so hard for me when I thought of it that way. I was like, Oh yeah, that makes a hundred percent sense. 

Dr. Cody Misuraca (15:19): 

You’re, you’re doing the thing that reduces injuries and other kinds of athletes, you know, you’re like a soccer player, football player, something like that. Or like a coach for one of those teams and you want to reduce the likelihood of people getting injured, you have them do resistance training. And so if like you’re choosing to do resistance training as your thing, like there it is, it’s it’s baked in. 

Dr. Joe Camoratto (15:40):
 Yes, absolutely. So I think that we should go over the activity guidelines. Like what, what mark are 

people trying to hit at a minimum for resistance training and exercise in general? 

Dr. Cody Misuraca (15:55): 

Yeah. So ACSM is a couple of different, different bodies that have put out these guidelines. I don’t think we need to get too into the weeds on that, but generally speaking, they’re recommending something in the realm of 150 minutes, a week of moderate to vigorous activity. And then two days a week specifically of resistance training or strength training or something along those lines. And I believe that, you know, there’s like a recommendation for if you’re just doing vigorous exercise. Those like total minutes per week could be a little bit lower as well. 

Dr. Joe Camoratto (16:28):
 It’s 75 to 150 minutes. If you’re doing vigorous intensity aerobic training, 

Dr. Cody Misuraca (16:35): 

I would imagine most people that are listening to this are probably doing CrossFit or something similar to that. Some sort of functional training. Yeah. So, you know, you’re probably hitting those if you’re going into a box or doing workouts on your own several days a week. 

Dr. Joe Camoratto (16:49): 

Yeah. And if we’re thinking of like, how do you define moderate for aerobic? At least I was actually looking into this this morning because I had sent my father the like 13.5% prevalence with people who actually hit the guidelines over the age of 55. And he was like, that seems really low. And I was like, well, we need to take into consideration that you’re probably not even hitting that either. Even though you come and lift like at a high intensity three times a week, you know, if we’re looking at the aerobic part, 

you know, you walk your dog every day, but how do we define what moderate is? And that’s actually in the guideline that brisk walking is a metabolic equivalent of, I think four, which for moderate, between three and six is, you know, moderate. But if it’s like leisurely walking, it’s a two or something like that. So there, there are at least definitions, but I think to pull from that, knowing that at least sticking with a peppy walk would be hitting those, you know, that, that threshold for moderate. And if he can do that for a couple hours a week, you’re probably in the, in the clear there. 

Dr. Cody Misuraca (17:56): 

Yeah. Yeah. And I think it’s also important to recognize that, like, those are the guidelines. But if you’re not hitting that, it’s, it’s okay. It’s still better than nothing. And I feel like sometimes like maybe like as a, as a group or as a population, we tend to kind of think of things in like black and white or like, yes, no, like if it’s not a hundred percent effective, then it’s not worth our time. And you know, that’s, that’s false. Like if, even if you’re not hitting 150 minutes a week of moderate to vigorous exercise, if you’re doing something that’s better than nothing, and it’s a starting point and you don’t have to like, you know kill yourself or stress yourself out to, to get up to those 150 minutes right now you can build to it over time. And that’s totally fine. 

Dr. Joe Camoratto (18:43): 

Yeah. That’s a huge thing as far as dose goes, because there are, there are like these thresholds that people think that that they have to meet, not even for like, just getting into exercise, but for things like learning how to squat or learning how to run, they’re like I have to, and this is kind of where like, like corrective exercise almost comes into play, which we’re not going to get into, but people don’t think that they can, you know, add resistance to standing up from a chair or like hang onto something while they’re going up and down the stairs. And that counts, you know, there, there’s almost like this arbitrary threshold that they have to hit before being able to reap those, those benefits 

Dr. Cody Misuraca (19:19): Parallel or it doesnt help right. 

Dr. Joe Camoratto (19:21): 

It’s actually something that I used to kind of subscribe to when I was a starting strength zealot. It was like, how much what’s the minimum effective dose of exercise? Like how much is enough to make a physiologic change? I don’t, I don’t know if I know the answer to that anymore, but I don’t think that there’s. Yeah. Right. 

Dr. Cody Misuraca (19:40):
 Three sets of five. Five pounds heavier than last week. 

Dr. Joe Camoratto (19:44): 

Yeah. Right. And it is, it’s funny because now that I realize how many barriers we put in front of people and us as like #woke PTs trying to like tear down those barriers down. It, it’s very frustrating to see that there’s like, Oh, you’re not doing enough to make a change. It’s like, we probably are. 

Dr. Cody Misuraca (20:03): 

Yeah. Or like, maybe not, but if it’s, if it’s something that you can do regularly and consistently, and then over time build off of, then that’s fine. Yeah. You don’t have to be there right now. If you can’t comfortably squat to parallel right now. That’s okay. You can still resistance train. There’s there’s other ways to do it. 

Dr. Joe Camoratto (20:20): 

Yeah. Realizing that the criteria that like parallel or that like movement standards are imposed by like competitive people, not people, but like competitive associations or, or federations is, is again another breakthrough where you’re like, Oh, I can just do box squats for the rest of my life because nobody is judging me. 

Dr. Cody Misuraca (20:41):
 Yeah. Those those standards are there to like, you know, standardize scoring and competition and you 

know, if you’re not competing, that’s not your concern. So yeah. 

Dr. Joe Camoratto (20:51):
 What are some of the, I guess, health or physiologic changes that we can expect from people just doing 

anything as far as resistance training or hitting these activity guidelines that you talked about before? 

Dr. Cody Misuraca (21:03): 

Yeah. So a lot of this is intensity dependent. But you know, generally speaking, you can expect over the long-term improvements in like muscle mass bone, mineral density. You know, theres some evidence suggesting that over the long terms, you can see improvements in like tendon stiffness and other sort of markers of connective tissue durability, I guess, for lack of a better term. So those are some like the, probably the most well-known and well-recognized benefits of resistance training and some of that’s intensity dependent. Right? So if you’re trying to improve bone mineral density with resistance training specifically, you’re gonna need something that’s, that’s relatively heavy for that person. And if I recall Saba had something in the realm of like 80% of a one RM or greater but you can build muscle mass off of pretty much any intensity, as long as the volume is sufficient. 

Dr. Cody Misuraca (22:01): 

And then we also tend to see there’s there’s studies showing that doing resistance training alone will improve like blood pressure systolic, blood pressure. So like that kind of ties into some of the concerns about heart attack and stroke. Like, yes, there are certainly some people that are at an increased risk of those things. If they do high intensity exercise, those people are fairly few and far in between. And generally speaking, when it’s been studied, we see that over the long-term while yes, blood pressure goes up while you’re lifting weights over time that can actually reduce blood pressure. There’s studies suggesting improvements in like psychological state and mental health with resistance training. Pretty much every, as far as I’m aware, pretty much every organ system in the body that’s been studied tends to see benefits from resistance training. 

Dr. Joe Camoratto (22:54): 

Yeah, it’s, it’s good for it’s like, I know that in our realm it’s like if something works for everything and it probably works for nothing sort of thing, you know, you think of like all of these silly BS things that, that we kind of send memes about to each other on, in the DMS, but it, it really is like this almost silver bullet 

that can just affect so many things because there’s that just like adaptation that occurs in every aspect of your body when you’re doing these, these higher intensity type activities 

Dr. Cody Misuraca (23:30): 

I’d like to be clear, it doesn’t like cure cancer or something. Yeah. But we, you know, we do tend to see benefits pretty much everywhere in the body from resistance training. You know, it’s not going to be the, like the one thing that solves all your problems for sure. But yeah, I think probably the thing that we can most expect to see with resistance training is going to be improvements in functional capacity, muscle mass strength you know, over the long-term with the right intensity improvements in bone mineral density. And then yeah, people tend to tend to feel more confident you know, tend to generally feel, feel better because being stronger makes life easier. 

Dr. Joe Camoratto (24:12): 

Yeah. yeah. And that’s, that’s actually one of the motivators and drivers of that same paper that you sent me was the ability to do things in your everyday life that you weren’t able to before the ability to be independent when you really start getting up there in, in decades and the ability to create this like social belongingness, I think that they mentioned as well, which is kind of big when you get into like class aspects of training or training with a partner or a coach is, you know, you’re, you’re doing this interaction with somebody that’s not only helping you as far as like health goes that, and, you know, it’s helping you, but also you have somebody that you’re doing something fun because you chose exercises that are enjoyable for that person. And, and this whole thing kind of works out in this big happy circle. 

Dr. Joe Camoratto (24:59): 

Yeah. I wanted to go back onto the the stroke and the blood pressure thing, and it’s definitely something that I hear a lot of when we’re talking about like holding our breath for doing big lifts. I think a lot of people don’t realize how often the valsalva maneuver or kind of bearing down and bracing happens throughout the day. Not only when you’re under a bar when you’re lifting something heavy, but a lot of other things like going to the bathroom, you know I know that a lot of pelvic health PTs might tell people, you know, you’re not supposed to push it out, but they do and it happens and the blood pressure goes up when you cough, when you sneeze, when you’re doing things like going up and down the stairs, lifting, groceries up, all these things, 

Dr. Cody Misuraca (25:48):
 Even when you exert yourself and you actively exhale and avoid holding your breath and your blood 

pressure still goes up. 

Dr. Joe Camoratto (25:55): 

Yeah. And so if I think if people were, who are afraid of strokes or of things like that, or to think of it as more of like practice in a, a preventatory, preventatory preventative technique. Yeah. That it might be a little bit less stressful to think about that way, you know? 

Dr. Cody Misuraca (26:19): 

Yeah. And I think there, again, there definitely are people and this isn’t a large percentage of people, but there are people that are, that are like, it’s contra-indicated to do a heavy and high intensity resistance training, but that’s not a lot of people that said, talk to your doctor, consult with your, you know, consult with your physician to make sure that you’re cleared to do these things. I don’t want this to be 

misconstrued as, you know, saying everyone go out and lift weights and don’t worry about it. But for the large majority of people, like there just aren’t many, there aren’t many recorded instances of this happening. It’s just not something that’s, that’s you know, recognized as a major issue. And, and as you were saying, like your body’s adaptive to some degree, like there’s always ceilings and limits on adaptation, but your body is adaptive. And so acutely increasing your blood pressure can give your body a stimulus to adapt, to, to get better at managing and managing increases in blood pressure. 

Dr. Joe Camoratto (27:17): 

Sure. and I mean, you probably see that in the hospital when people are in bed for a long time or they stand up and they get what’s called orthostatic hypotensive response, which is, they have a decrease in blood pressure due to the change in elevation of their body. And how do you, you know, how do you help that, right. 

Dr. Cody Misuraca (27:34):
 Yeah. You’ve got to get up and move. Yeah. If I bit appropriately dosed 

Dr. Joe Camoratto (27:39): 

Let’s, let’s kind of stay on the topic of being in the hospital because you brought up at least in the outline that you sent protein. And I know that there is a, a big issue with hospital stays inactivity, and then loss of percentage of muscle mass per, you know, I think the measures are what seven days. I don’t, I’m not looking for like a specific yeah. 

Dr. Cody Misuraca (28:02):
 Yeah. I think we tend to see people measures of deconditioning occurring within 24 hours. 

Dr. Joe Camoratto (28:08): 

Yeah. and so how, how can people kind of take this idea of inactivity, loss of muscle mass and like protein as far as their nutrition goes and kind of also smush it together? Like, what would you recommend as far as nutritional, like cliff notes? 

Dr. Cody Misuraca (28:25): 

Yeah. So I’m not a registered dietician. I’m not a medical doctor. I can’t make specific dietary recommendations. However there are organizations out there that, that lay out kind of guidelines for these sorts of things. So I think this was fairly recently there’s a, there’s a study group from like the European union of geriatric medicine. And they laid out guidelines for protein intake for people over the age of 65. And their recommendations were for people to be consuming at least one gram per kilogram of body, weight of protein per day. So their, their range is like one to 1.2. So that could be like a pretty useful general, general guideline people that are into resistance training tend to tend to eat more protein anyways. So most people are probably pretty close to that. 

Dr. Cody Misuraca (29:20): 

But that’s like the general guideline for older adults as far as protein consumption goes and that’s in the absence of resistance training something to recognize is they’re, they’re like different ways that you can stimulate muscle protein synthesis within the body. And one of them is resistance training and then consumption of protein or amino acids is the other and combining the two of them is going to give you 

like an optimal effect, but, you know, again, just because something isn’t like a hundred percent perfect, it doesn’t mean you wouldn’t do it right. Even if you couldn’t optimize your protein intake, you’d still exercise. And even if you couldn’t exercise, you still want to optimize your protein intake. 

Dr. Joe Camoratto (29:57): 

Yeah. I think a lot of the questions that I get from the aging population especially the women in the aging population are, it seems like I’m not responding the same way that I was before. And so it can kind of get a little bit, I mean, not a little bit, it does get very confusing regarding volume, intensity frequency nutrition recommendations, as we see this stuff that kind of would fall into the category of like anabolic resistance, where there isn’t the same response that happens. And I think what you’re saying is that supplementing resistance training and, you know, a little bit more of focus on protein intake for a diet can help to combat that stuff, even if it is extremely complicated and over the both of our heads. 

Dr. Cody Misuraca (30:43): 

Yeah. Yeah. I mean, there, again, this is something that’s been studied that it’s been found that when you, when you do one or the other, we tend to see lower muscle protein synthesis responses compared to younger people in older populations. But when you optimize the two, they tend to be similar in terms of like their relative effect and long-term studies on resistance training in older people compared to younger people and comparing men to women find similar relative improvements in strength and muscle mass. So, and the thing to note in these studies, when they’ve tracked protein intake, they tend to all be at least consuming one gram per kilogram of body weight per day. But it’s, it’s helpful to recognize that when you look at these things in a relative sense, there, there isn’t, there isn’t a noticeable difference when it’s been studied. Whether you’re younger, older male or female, the response to resistance training is relatively different. So I think that can be helpful. 

Dr. Joe Camoratto (31:55): 

Yeah, absolutely. Any, Oh man, what was I going to say? Oh yeah. So another question that I get a lot is regarding changes in ability to recover or handle stress as age increases. And I don’t, I don’t exactly have a, I guess, a line in the sand to draw as far as like, because you’re this age, you can’t adapt to the stimulus. And I think that it, there, there’s definitely a theory about, I mean, I know I’ve heard a hundred times from people that I’m like casually talking to you about training. They’re like, Oh, I used to do that. But then I tried it again, like 10 years without 10 years of training. And, you know, I, I blew my stuff out and it’s like, all right, well, I D I don’t know if it’s that you can’t handle adaptation as you get older. I don’t know if there’s like a change in that ability. Maybe you can tell me, but from my point of view, it seems like if you had filled that time gap of not training with training or some sort of exercise, you might not have been as likely to blow it out. 

Dr. Cody Misuraca (33:04): 

Yeah. I mean, again, the human body’s adaptive and deconditioning is like an adaptive response. If you don’t do the thing, your body’s not going to spend the energy on maintaining the adaptations to it there, I mean, time, time never stops moving, right. Aging never, never stops occurring. And so that’s like a confounding factor with these things. And so if you don’t do something for a long period of time, deconditioning does occur. And there’s this confounding, this confounding factor of you’re also getting older as that happens. And so you could, you could like look at that and say, Oh, the reason why those adaptations went away is because I got older. But if you ignore the fact that the person is just like not 

doing the thing or not doing as much of the thing over time I think it can be, it can be easy to confuse the two 

Dr. Joe Camoratto (33:51):
 Bit of a post hoc reasoning fallacy. 

Dr. Cody Misuraca (33:54): 

Exactly. But I mean, again, when this has been studied older and younger people have the same relative response to resistance training now sure. If you’re starting from a lower point than the absolute difference is going to be less, but if it’s relatively the same, so relatively meaning like as a percentage of your, your baseline. So if you’re starting from a lower point, then like the, the overall change is going to look different or less, but in terms of the relative change, it appears to be the same. So I, you know, I think that’s just something that’s important to recognize and inevitably, no matter what we do over time, as we get older, we do see declines in strength and muscle mass and these sorts of things. And there’s just, unfortunately at this point, no way to stop that from happening, that’s just life. But that doesn’t mean that as you get older, you can’t adapt to resistance training because it appears that we do. 

Dr. Joe Camoratto (34:48): 

Yeah, for sure. I mean, it would, it would be like outside of the normalcy of the human organism to stop adapting to things. I know that a lot of people were curious about like, is there a way that I can recover better? I know my answer to that. And I’m curious to know yours before I say mine. Like what, what’s your recommendation for “recovery” quote unquote. 

Dr. Cody Misuraca (35:17): 

Yes. I think the first question is what do we mean when we say recovery and, you know, I’m not trying to like, just get into semantics for the sake of it. But when this has been studied a lot one thing that they’ll often look at is self-reported muscular soreness after about of exercise. And that’s one way to look at recovery and the other way to look at recovery, that many people that are listening to this are probably more interested in is improvements in performance, or like return of performance to baseline after about an exercise. And those are two very different things. You know, everyone’s gone into the gym on day when they just feel like trash and they’re, you know, stiff and sore and whatever, and have had a great performance or set a PR I’ve, you know, I’ve had that happen countless times over the years. 

Dr. Cody Misuraca (36:01): 

And then everyone’s had the experience of going into the gym and feeling super fresh and energized and like ready to go. And then their performance just falls flat on its face. So those two things aren’t the same. And so I think it’s, it’s important to first just define what do we mean by recovery? And if you’re wondering, what can I do to feel less sore? There are probably lots of things that, that will work or appear to work, right. But that doesn’t necessarily mean that it’s going to improve your performance. And so in terms of improving performance recovery it’s, it’s kind of the, the basic stuff that everyone kinda knows they should do, which is, you know, try to get eight hours of sleep each night, or at least just increase the amount of sleep that you’re getting each night right now. You know, making sure you’re staying hydrated, optimizing protein intake you know, consuming fruits, vegetables, stuff like that. Those are the, probably the things where you’re giving your body, the resources, it needs to recover. They’re going to maximally improve performance or recovery specifically. Whereas improving like muscle soreness recovery is just a totally different story. 

Dr. Joe Camoratto (37:08): 

Yeah. And I think if people are focused on like delayed onset muscle soreness or exercise induced muscle damage, then load management is going to be a pretty big factor in that as far as like not introducing yourself to novel stimuli in a short period of time, because it really, it’s, it’s kind of a tough thing as I get more and more into the world of CrossFit. It’s a little bit difficult to really control that because the whole point is you want to be ready for everything. And so I think all those things that you said are important, but also trying to pay attention to how you react to these kinds of new stimuli, whether that’d be more volume or more frequency or, or new movements or, or new intensities and kind of being cognizant of that when looking at an exercise session. 

Dr. Cody Misuraca (37:58): 

Yeah. And also recognizing that when you’re new to something, it doesn’t take a lot of stimulus to adapt. Your body will have a larger adaptive response to stimuli that are novel or new kind of, regardless of what you do. So we see this born out in resistance training research all the time. They’ll do a study where they take X resistance training program and they have untrained subjects do it, and they get stronger and then a different different study with a different routine and they also get stronger and then this other group gets stronger. And so when you’re doing something that’s fairly novel, your body seems to have a large adaptive response anyways, kind of, regardless of what you do. And so that suggests that you don’t need to, you don’t need to jump in at a hundred percent. You don’t need to jump in and, you know, do rounds and reps until you, until you die. Like you can, you can start in at lower intensities, initially lower volumes, you will get an adaptive response and then build from there. 

Dr. Joe Camoratto (38:53): 

Yeah. Perfect. So we’ve talked about, you know activity guidelines, nutrition, kind of, we’ve talked about injury recovery, all these things. I have one more question before we end here and that’s what’s your plan for doomsday, because I know that I am getting ready to start housing chickens and, you know, getting solar panels and all that kind of thing. Do you have any plan as 

Dr. Cody Misuraca (39:21):
 Oh are you going to survive doomsday 

Dr. Joe Camoratto (39:24): 

Yeah well I mean, it depends on how I define doomsday. If it’s like collapse society, if it’s a like electromagnetic pulse that comes from a solar flare, I’m curious, like what’s the San Diego like environment, like as far as the ability to bug out, 

Dr. Cody Misuraca (39:38): 

Well, we’re going to be underwater. So I think it’s always funny when people think about doomsday, they assume that they’re going to be the one who survives. Right. Like presumably doomsday means everyone. There are a large number of people have not survived and everyone assumes that they survived. 

Dr. Joe Camoratto (39:51):
 Yeah. Maybe not doomsday, but like, you know, the fall of man 

Dr. Cody Misuraca (39:56): 

So, you know, San Diego fairly, fairly low elevation, right. Where we’re right on the water, there are mountains there at least two hours away, the big ones. So that we’re going to be under water if anything bad happens. Probably. yeah. I don’t know. I’m just going to keep stockpiling coffee and, you know, as long as I have a way to heat, water and coffee on hand, I can, I can, die happy. 

Dr. Joe Camoratto (40:21): 

I mean, when the dollar fails, right, you’re going to be trading coffee as far as a good cause they throw it back, you’d get coffee, get some bags of sugar you’re going to be good to go. Absolutely. well, cool man where can uh the people find you. 

Dr. Cody Misuraca (40:35): 

So I’m on Instagram @codymisuraca.dpt, Umy Instagram page links to the website for waypoint strength and performance. Uthose are kind of the two places. I’m the most active. I have a Facebook page for waypoint. I’m a little bit less active on there. Ubut those are the main places you can find me. Uyou know, I was saying this in jest earlier, but if you’re actually interested in coffee related content,uyou’ve got that new, new Instagram account for that. That’s @coffee_bycody. Ubut u@codymisuraca.dpt is my main Instagram page. 

Dr. Joe Camoratto (41:08):
 Cool, man. Well, thanks for coming on. We really appreciate it. 

Dr. Cody Misuraca (41:11):
 Yeah. Thanks for having me. It was a good time. 

Dr. Joe Camoratto (41:12): All right. See you later. 

Dr. Cody Misuraca (41:14): Have a good one. 

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