[00:00:00.050] - Andy Baxter
If you get into a fixed work-rest ratio recovery and you start to get overwhelmed, either because the weight's too heavy or you've done too many reps, or it's just cumulative overload, then the quality of the work will suffer and you're not getting the stimulus and response relationship that you're actually going for. So everything suffers because of it.

 [00:00:22.000] - Dr. Lemanne
You have found your way to the Lemanne Gorton Podcast, where docs talk shop. Happy eavesdropping! I'm Dr. Dawn Lemanne. I treat cancer patients.

 [00:00:40.850] - Dr. Gordon
I'm Dr. Deborah Gordon. I work with aging patients.

 [00:00:44.560] - Dr. Lemanne
We've been in practice a long time.

 [00:00:46.950] - Dr. Gordon
A very long time.

 [00:00:48.570] - Dr. Lemanne
We learn so much talking to each other.

 [00:00:50.580] - Dr. Gordon
We do. What if we let people listen in? 

 In today's episode, we welcome back a familiar and popular guest, Andy Baxter, who has an impressive resume as rower, rowing coach, and particularly insightful rehabilitation specialist. He has two fitness centers locally with several unique features, which we'll hear a little bit more about today. But what Dr. Lemanne and I have particularly appreciated about his work is his focus on not just rehabbing an injury, but going beyond rehab. Safely building both strength and resilience, good for avoiding both dementia and cancer. Let's hear about his exciting new techniques at achieving those goals. I recorded with Dr. Bredesen yesterday, and one of the things we moved in and out of was talking about the role of exercise in preventing and reversing dementia. So it's great, of course, that we have our exercise special guest on the podcast today. Andy, welcome.

 [00:02:05.190] - Andy Baxter
Thank you. Good to be here.

 [00:02:07.040] - Dr. Lemanne
And I want to welcome you too. This is Dr. Lemanne. I know that my audience very much— our audience understands that exercise is one of the most important things you can do to prevent cancer, one of the most important things you can do if you have cancer to get well. So yes, so happy to have you.

 [00:02:26.610] - Dr. Gordon
So for, you know, assuming that our audience grows by leaps and bounds every episode, some people I think people may not have heard your bio before, which is pretty impressive, and we could spend the whole hour on that, but could you just give us a Cliff Notes version, as they used to say in the old days?

 [00:02:44.880] - Dr. Lemanne
And it's because we're really proud of your bio.

 [00:02:48.990] - Dr. Gordon
Yeah.

 [00:02:49.700] - Dr. Lemanne
We have an Olympic athlete here with us.

 [00:02:53.070] - Andy Baxter
Right, kind of, kind of.

 [00:02:55.420] - Dr. Gordon
Definitely.

 [00:02:57.180] - Andy Baxter
Yeah, so I guess my, My title would be medical exercise specialist. That's sort of my day-to-day, the day-to-day trappings of what I do. So I work predominantly with the senior population. Started originally in joint replacement specialties and then got into more of the neural protocols where exercise is medicine is what we preach. But I'm also a coach and a former athlete. And so I'm kind of interested in all things fitness. But more specifically, the Fitness is Medicine model and fitness for longevity's sake and the science behind that.

 [00:03:39.130] - Dr. Gordon
I was looking at some pertinent exercise for older people, and do you know they start considering people's— making age-related— having age-related losses and needing to make age-related interventions starting in their 40s.

 [00:03:56.080] - Dr. Lemanne
Yeah.

 [00:03:56.650] - Andy Baxter
Yeah, that's right.

 [00:03:57.780] - Dr. Lemanne
Oh, so you've just expanded our audience that way.

 [00:04:00.240] - Andy Baxter
Right, exactly. That's the way you've done it.

 [00:04:02.260] - Dr. Lemanne
So all of you who are 40, you're now old.

 [00:04:05.650] - Andy Baxter
Yeah, that's really true. I mean, that's expanded my audience to 45. That's kind of where we're starting now, where we used to start at 55.

 [00:04:13.850] - Dr. Gordon
Yeah, yeah.

 [00:04:14.530] - Andy Baxter
So yeah, that's quite relevant.

 [00:04:17.170] - Dr. Gordon
Uh-huh. So, you know, I think any of the audience that's paid attention to the brain stuff knows that, you know, yes, you encourage aerobic, just like the New York Times encourages aerobic, activity and, you know, some intervals, but the resistance part of it is what's new for a lot of older people. And I think you have some interesting new insights about that.

[00:04:39.350] - Andy Baxter
Yeah, absolutely. So, and this is quite the deep dive here. So we'll just jump in and see where it takes us. But I wanted to start with a conversation that we had had, Debra, about hypertrophy and hypertrophy or muscle growth as combatant to sarcopenia, the loss of muscle mass as we age. And so we had talked a bit about strength versus hypertrophy in and of itself. And what I mean by that is that there is a type of hypertrophy sort of affiliated with bodybuilding style muscle building processes that cause muscles to grow but don't necessarily cause muscles to become stronger. Hmm. That's called sarcoplasmic hypertrophy.

 [00:05:33.360] - Dr. Gordon
That's kind of a waste.

 [00:05:34.620] - Andy Baxter
It is kind of a waste, unless you're a bodybuilder, and then it's great because that's what you're going for. But as an athletic coach, and certainly as a functional trainer for seniors, we want to build stronger, more powerful people, not dependent on muscle size necessarily, but muscle density and function. And that also has a place for hypertrophy, and that's called myofibrillar. Hypertrophy, where the actual fibers are increasing in density and size relative to strength, or strength relative to size, not just size for size's sake.

 [00:06:14.390] - Dr. Lemanne
So we have myofibrillar, and the first one is—

 [00:06:17.190] - Andy Baxter
Sarcoplasmic.

 [00:06:18.090] - Dr. Lemanne
Sarcoplasmic.

 [00:06:19.420] - Andy Baxter
Yeah.

 [00:06:20.010] - Dr. Lemanne
Sarcoplasmic—

 [00:06:20.960] - Andy Baxter
Hypertrophy.

 [00:06:22.000] - Dr. Lemanne
Hypertrophy.

 [00:06:22.640] - Andy Baxter
Yeah, and that's basically fluid, right?

 [00:06:24.870] - Dr. Lemanne
Oh, okay.

 [00:06:27.130] - Andy Baxter
It's sort of a cellular inflammatory response.

 [00:06:30.200] - Dr. Lemanne
Is that what you get when you take creatine?

 [00:06:33.410] - Andy Baxter
No.

 [00:06:33.940] - Dr. Lemanne

Okay.

 [00:06:34.760] - Andy Baxter
No, this is— yeah. And so this gets into concentric versus eccentric contractions, right? So a concentric muscle contraction is where we're shortening the muscle under a load, and the eccentric contraction is where we're lengthening the muscle under a load. And this is where, you know, the meat of this conversation kind of Kitsch.

 [00:06:52.990] - Dr. Lemanne
Kitsch. Pun intended.

 [00:06:54.600] - Andy Baxter
Yeah, right, exactly. Because bodybuilding style workouts, higher rep workouts where there is a focus on the eccentric phase to induce hypertrophy creates inflammatory responses. There's microtrauma in the fibers. And in some cases, that's a good thing because we have to adapt to that and the muscles grow. As they're repairing the damage.

 [00:07:21.080] - Dr. Gordon
I was going to quote back to you this advice I got from a trainer I was working with a couple years ago in winter rowing workouts. You might know him, his name is Andy Baxter, who was telling us all that, you know, if doing a bench press with 50 pounds, we just couldn't take it up past that, as long as we went down, let the weight down really slowly, we were gonna get extra bang for our buck.

 [00:07:45.400] - Dr. Lemanne
Now for our audience, this is a different Andy Baxter, right?

 [00:07:48.030] - Dr. Gordon
We had—

 [00:07:48.570] - Andy Baxter
That was my stunt double.

 [00:07:49.610] - Dr. Lemanne
On our last podcast, we had two Deborah Gordons. This time we have two Andy Baxters, at least that we're talking about.

 [00:07:55.140] - Andy Baxter
Well, so let me clear that up. That's a really good point. And in fact, there's a whole medical protocol for that style of work that I actually was involved in the ground floor of that years ago. And that is controlling the tempo of the work to create a higher quality of work with less weight. So in rehab environments, that's a much safer way to do it. And so an example of that would be like a 4-second concentric with a 7-second eccentric. So you're spending more time on the eccentric centric phase, and that allows you to work with smaller weights at a higher quality or intensity. So that does have its place for sure. But what we're getting into is how do we get the— basically a clean anabolic signal from the muscle to the brain without any inflammatory reaction? And how also do we get this increased myofibrillar hypertrophy, which is the best kind, without inflammatory response? And the answer is we need to isolate the concentric phase of those movements. And so the two best ways to do that are through A, high-intensity interval training, and B, very heavy weightlifting. Um, and when we say very heavy, we mean, you know, in the 1 to 5 rep range, uh, potentially when we get into power and power endurance, we get up into the 5 to 8 rep range, but certainly nothing higher than that.

 [00:09:22.980] - Andy Baxter
Okay. So now here's the problem. The problem with both of those modalities is that there is the potential for A, volatility, and B, a steep learning curve that most folks simply aren't going to want to get involved with.

 [00:09:37.870] - Dr. Gordon
And they seem completely different, so I think you have to give us a little bit of info on each one, the high-intensity intervals and the—

 [00:09:45.820] - Andy Baxter
Yeah, so high-intensity interval training can be anything where you're doing, just a simple example would be a 3-to-1 rest-to-work ratio. So let's say you're going to go as hard as you can for 15 seconds, and then you're going to go easy for 45 seconds. Okay? And that's typically in the aerobic realm. Now, it can be strength endurance as well. So you can do weight training versions of that also. But the problem is, is that usually that becomes sort of volatile. There can be a concussive component if you're jumping around. There could be stress on the joints if you're moving free weights. And then even some aerobic, you know, even sprints involve some orthopedic potential red flags for the aging population.

[00:10:33.060] - Dr. Lemanne
Before we go too far into that, can you give us an example of what a weightlifting or resistance training, HIIT, session might look like? Hard 15 seconds, 45 seconds off. I think you mentioned doing what? What are you doing in that 15 seconds?

 [00:10:51.400] - Andy Baxter
Well, that's—

 [00:10:52.040] - Dr. Lemanne
Walk us through that.

 [00:10:52.670] - Andy Baxter
How do you do that? That's the problem. The problem is to do that effectively and safely, there's very few solutions out there. Now, there is power. So when we get into power, we're dealing with strength times speed, right? So load times speed. We take a load, we accelerate that load, which is actually functionally more relevant to an aging population than just strength for strength's sake. Strength in a vacuum isn't all that practical, but if we can take a load and accelerate it and make it dynamic, that's much more functional.

 [00:11:19.970] - Dr. Lemanne
Well, let's take me for a second. So I'm 71. And I have a set of dumbbells at home, and kind of my favorite denomination is, at the moment, is either 10 pounds or 15 pounds. And I can do some things with my arms, overhead presses, bench presses, various things without hurting myself, I think, with those. How would I be able to do, am I in good enough shape to do an HIIT, hard 15 seconds? On 45 seconds off, and what would that look like?

 [00:11:52.520] - Andy Baxter
What would I be actually physically doing in front of you if I did that? Let's take a power, an Olympic-style movement. Let's say a clean, where you're gonna take a weight, and you can mimic this with a dumbbell. So let's say you take your 15-pound dumbbells and you get into a deadlift position where the dumbbells are maybe 3/4 of the way down your shin, right? 'Cause that's gonna mimic a bumper plate in an Olympic bar. Then you're gonna accelerate upward and lift that weight until you catch it at shoulder height.

 [00:12:21.180] - Dr. Lemanne
Sure.

 [00:12:21.470] - Andy Baxter
OK, so that's a power movement. You're taking a load and accelerating that load. OK?

 [00:12:26.240] - Dr. Lemanne
Got it.

 [00:12:26.640] - Andy Baxter
And that's the drive phase. So that's the concentric phase. So you're shortening muscles as you do that. So if you were to take that load and move it as fast as possible for 15 seconds, then you're probably going to net somewhere around 7 to 8 repetitions.

 [00:12:44.200] - Dr. Lemanne
Got it.

 [00:12:44.440] - Andy Baxter
OK. In a 15-second period. Now here's the problem. The problem is that every time you do one of those repetitions, you've got to lower that weight.

 [00:12:51.630] - Dr. Gordon
I know, as Dawn pointed out, she could You could just drop it.

 [00:12:53.810] - Andy Baxter
You could. And that's typically what you would do to safely do a concentric power workout. And that's what Olympic lifters do. They lift the weight and then they drop the weight because they don't want to deal with the eccentric load for a number of reasons. One is it saps your energy and takes away from the quality of the work. And the work is the concentric drive. But the other is, is that that eccentric, trying to control an eccentric movement is going to induce a chemically, inflammatory response. And that's going to prolong your recovery time. It's going to produce inflammation systemically throughout the body, including the brain. And it's generally not a great thing. Okay. Because again, we want to find a weight that you're going to accelerate basically in a way that you would be exhausted by that 15 seconds, if not before, maybe 12 seconds, you might be completely done.

 [00:13:47.200] - Dr. Lemanne
And just using the concentric—

 [00:13:49.050] - Andy Baxter
Correct.

 [00:13:49.920] - Dr. Lemanne
—traction part of things. Okay. Yeah. All right. And then I take 45—

 [00:13:53.710] - Andy Baxter
I've done my 15 seconds, gotten 7 or 8 reps in. And then you would rest for 45 seconds. Correct. And then how many times would I repeat that? Well, so if you're doing it purely concentrically, you would do that 4 times. And then you would— we use a protocol, which is a motor unit recruitment for the first 2 sets and then what's called rate coding. And what that means very simply is that the first 2 sets, are going to be to maximize motor unit recruitment and neural adaptation. So we want it nice and heavy. And then the second 2 sets, we're going to halve that weight and then halve that weight again so that it's getting lighter. Why would we do that? Because we want to accelerate faster. And when we do that, we increase what's called rate coding, which is how quickly a muscle fiber activates. OK. And if we can do this concentrically, what we're doing is creating a— clean anabolic signal from the muscles to the brain. And this is the really cool part. This is where we get into what are called myokines. And myokines are basically messengers within the endocrine system and the paracrine system.

 [00:15:02.790] - Andy Baxter
So long distance travel throughout the body or short localized distance from wherever the, you know, the muscle that's activating. And all of these myokines are elicited specifically from muscle contractions and most specifically from concentric muscle contractions. And so this is really important because myokines have the unique ability to pass through the blood-brain barrier. And they do this in a clean signal environment so that they actually reduce neuroinflammation. Uh-huh. So when we can get a clean path to generate this conversation using myokines as our messengers within the endocrine system, it actually has really wonderful effects on the brain and at the same time It doesn't have negative effects on the brain, which other cytokines do.

 [00:15:51.500] - Dr. Gordon
So it has a more powerful, you know, I think people who care about brain health know about the BDNF messenger.

 [00:16:03.370] - Andy Baxter
Yes. And that is a myokine.

 [00:16:06.800] - Dr. Gordon
Okay, brain-derived neurotrophic factor, which, you know, little side point, one of the things that I like that induces brain-derived neurotrophic factor is chewing a good steak, steak better than most things, don't you think, Dr. Lemanne?

 [00:16:21.490] - Dr. Lemanne
I do, and it's not the chewing though, is it?

 [00:16:24.000] - Dr. Gordon
No, it is the chewing. The chewing?

 [00:16:26.380] - Dr. Lemanne
No, the chewing. You could chew on a piece of wood then.

 [00:16:28.560] - Dr. Gordon
You could chew on a piece of wood, and it is one of the, you know, I mean, it's interesting about chewing because there you are exerting pressure and you don't have to, it's no work to, you don't have to drop the weight, you just open your mouth. It's concentric only. And it is a muscular activity that a lot of people lose with age for a variety a variety of reasons. Nobody's cooking them a steak anymore. They've lost some teeth in the back. They have gum disease.

 [00:16:53.490] - Dr. Lemanne
Well, you know, there's, there's research showing that if you chew gum while you're studying— I found this out when I was a college student— chewing gum while you're studying actually improves your recall. And I don't think we knew why back then.

 [00:17:06.410] - Dr. Gordon
Before we go on, may I ask you a quick favor? Hit the subscribe button. Your hitting that subscribe button really, really matters. You're making sure cutting-edge ideas that matter to you move to the center of medical discourse where they belong. Thank you. But maybe it's brain-derived neurotropic factor. Interesting. Okay, well, that was a little—

 [00:17:28.890] - Dr. Lemanne
That was an aside, wasn't it?

 [00:17:30.160] - Dr. Gordon
That was a whole big detour, but myokines, so they're essentially hormones. They're proteins that are made in one place that act in another place in the body. They're made in the muscle and they are really, they're only made from concentric exercise or they're more made? More made in concentric than eccentric.

 [00:17:50.570] - Andy Baxter
But the key differentiator there again is that they're made without any inflammatory dirt in the signal.

 [00:17:57.490] - Dr. Gordon
Uh-huh, uh-huh. That's enticing, yeah, you know? And do people know if they're getting inflammatory dirt like dirt in their signal?

 [00:18:13.440] - Andy Baxter
I think that some of the psychology papers that I've read talk about neuroinflammation in terms of cognition, thought processing, memory. So yeah, in the day-to-day, you could actually notice either the degrading effects or the positive effects when it's not present in terms of clarity and memory retention and problem-solving abilities.

 [00:18:38.470] - Dr. Gordon
And maybe even mood, yeah. Oh, definitely mood.

 [00:18:41.270] - Dr. Lemanne
Included. So, Andy, you mentioned that you can isolate two aspects, and one of them was the high intensity.

 [00:18:47.030] - Andy Baxter
What was the other one? Yeah, so high intensity interval training, concentric only, which examples of that might be cycling, for instance. That's a concentric only movement when you pedal a bicycle. Swimming, that's concentric only. Rowing, of course.

 [00:19:04.200] - Dr. Gordon
Isn't rowing the best exercise for all these things you're talking about?

 [00:19:08.200] - Andy Baxter
It is, but the barriers to entry there is that, you know, you got to get on the water, you got to join join a rowing club. You know, not everybody can do that. So that becomes part of this issue, part of my life mission here is to find a solution that could be accessible to everybody.

 [00:19:24.710] - Dr. Lemanne
Well, now wait a minute. There's concept too for those of us who don't go on the water.

 [00:19:30.740] - Dr. Gordon
Yeah. Or in the water.

 [00:19:32.500] - Dr. Lemanne
In, is that how we say it? See, I don't, yeah. No, no, I'm just.

 [00:19:36.190] - Dr. Gordon
I do believe at one point you went in the water. I did several times.

 [00:19:39.870] - Dr. Lemanne
Once in my rowing career, went straight in the water, had to be pulled out. Yeah.

 [00:19:43.910] - Andy Baxter
Was that after you trained on a Concept2? There might be a connection. Could be, huh? Yeah, so Concept2 ergometers, that's a machine just like a bike machine where the ergometry or the measurement of power and output is in the rowing form, which is concentric only. True. Some of the problems with the Concept2 because it has a flywheel and the flywheel has weight and once it starts moving, it creates its own kinetic energy, is that you're not getting a consistent load throughout the movement. And so the second problem there is that there's slip at the catch, which induces over time chronic overuse injuries like epicondylitis and shoulder issues and back issues.

 [00:20:25.910] - Dr. Lemanne
So slip at the catch for our audience is what? When you're lifting the paddles or oars, I don't even know which way, paddles or oars out of the water?

 [00:20:36.410] - Andy Baxter
Yeah, so when you're on a Concept2 or Concept2+ ergometer, a rowing machine, and you initiate the drive phase, you start applying pressure on that handle, there's some slip in the clutch mechanism, right? And if you've never rowed outside of just using a Concept2, then you probably don't know that because your brain's adapted to it. But the way that the brain adapts to it typically breaks some of the kinetic chain, usually at the elbow or the shoulder or the spine. So you can get injuries from that. Okay.

 [00:21:06.690] - Dr. Gordon
So, but can I ask you, speaking as a rower, So we approach that putting the blade into the water by slowing things down, and I do that on the erg too. I come away fast and move up, and then I kind of wait to engage my force until I can feel there's no slippage. Am I overcoming that by what I've learned from being on the water?

 [00:21:34.410] - Andy Baxter
Actually, the answer is no, because in the water, if you have a good catch, then you're directly locked on. Uh-huh, right. When you start the drive on the erg, you're going to get that slip once you apply the pressure, not before.

 [00:21:47.330] - Dr. Gordon
Okay.

 [00:21:47.820] - Dr. Lemanne
Well, now I want to bring us back to the two methods. So I'm not sure I'm— make sure I'm understanding this, Andy. So there's the HIIT, and the other one is?

 [00:21:58.400] - Andy Baxter
Is heavy weightlifting. Heavy weightlifting. And preferably explosive weightlifting. So with a speed component, and with the speed component, then we're talking about power. Now, there is another misnomer that we should get out of the way right there because powerlifting, the term powerlifting, is actually completely inaccurate. Powerlifters are actually strength athletes and weightlifters are Olympic athletes. And so weightlifting technically are the Olympic movements like clean and press, the snatch, the clean and jerk, where you're taking very heavy loads and you're accelerating those loads. Powerlifters actually do very short movements that don't have a speed component, and that would be bench press, deadlift, and squat. Squat. Yeah, so it's a bit of a misnomer there, but—

 [00:22:47.900] - Dr. Lemanne
So just for our audience, there are two different weightlifting sports that Andy's talking about here, and Andy, correct me if I'm wrong, but powerlifting is a combination of three different lifts: bench press, squat, and what was the third one? Deadlift. Deadlift, thank you. Whereas Olympic weightlifting is a very different animal. It is. Why don't you, Andy, describe a few of the lifts for Olympic weightlifting so that our audience knows that there's a big difference here.

 [00:23:15.450] - Andy Baxter
Yeah, so Olympic weightlifting is very technical. It's very complicated because it's multi-joint movement and it's a sequence of movements that have to be performed perfectly. And of course, you have to do this under very heavy loads. But the concept of power being a load-speed equation is you're lifting a weight that without acceleration, you simply wouldn't be able to lift. So you have to have that acceleration component in order to complete that movement.

 [00:23:44.280] - Dr. Lemanne
So Olympic weightlifters are using their legs to get barbells into various high positions at their collarbone, over their head, et cetera.

 [00:23:52.510] - Andy Baxter
They're using their entire bodies to accelerate a weight.

 [00:23:55.890] - Dr. Lemanne
Yeah.

 [00:23:56.300] - Andy Baxter
Whereas a powerlifter is just using They're just using pure strength at a very low rate over a very short distance.

[00:24:04.630] - Dr. Gordon
And if they tried— so you just, of course, you named all the weightlifting I do in my garage, my bench press, my deadlift. I mean, could somebody incorporate acceleration even to a shorter movement? Yes, they absolutely can.

 [00:24:19.550] - Andy Baxter
And that would be a good idea. It would be a good idea. In fact, there's some simple ways to change up your weightlifting routine, pausing at the bottom of the movement, for instance, and then accelerating accelerating up. That's a common rowing modality. So like if you were doing a bench press, coming down fairly slow and controlled to the point of contact at the chest, and then just pausing briefly and then accelerating out of that movement.

 [00:24:43.270] - Dr. Gordon
Uh-huh, in kind of a thunderbolt kind of way. Sure. Yes. Okay, I got to go home and try that. Excuse me, I'll be right back.

 [00:24:52.570] - Andy Baxter
Now what you don't want to do is you don't want to do the opposite where you're coming down really fast and bouncing out of that movement. Oh, God. To connective tissues and joints and all that good stuff. But, um, but so, so again, that type of training, um, especially as we age, is probably going to run higher risks of injury, right? So if we're jumping around and throwing weights around, um, then injury rates tend to go up. And again, because there is an eccentric phase, there's going to be the potential for more inflammation. So So I kind of made this my mission about 10 years ago to create equipment that would be concentric only, where you couldn't out-accelerate the weight, meaning there was no momentum involved because momentum is also volatile, right? And if we have momentum, then we're kind of cheating the weight. And if you're an Olympic weightlifter, that's fine. That's kind of what you do. But since we're not all Olympic weightlifters and that functionally doesn't always translate to our daily lives, The concept of having a consistent resistance through an entire range of motion without a mechanical sticking point or failure point is where we get into isokinetics.

 [00:26:03.630] - Andy Baxter
And so that's, that's the solution. The solution for both of those modalities, high-intensity interval training and explosive powerlifting, comes through isokinetic movement. And then there's a subdivision of that as well.

 [00:26:17.940] - Dr. Gordon
So isokinetic isokinetics doesn't sound like something— so explain that because that doesn't sound like an acceleration to me.

 [00:26:25.860] - Andy Baxter
Yeah, so isokinetics basically means same speed. So I'll give you an example, a medical example. So a lot of our equipment has an isokinetic mode where, say, in a therapy environment, you want to control the speed of the movement. So you can set a given RPM or or RPM for this example, let's say a bicycle. And so you're on a bicycle and your therapist wants you to be at 40 RPM, 40 revolutions per minute. If you try to go 41 revolutions per minute, the machine will clamp down and hold you to that 40. So everything you do that tries to surpass 40 RPM gets pushed back at you in terms of resistance. And so you end up producing more power. So it's somewhat custom to the user, but it's based on a preset ceiling. Wow. And that has its place. Again, very valid in the therapy world. The problem is, is that if you try to put that into, say, a class format or something moving in real time where different people are different or an individual has different strengths and weaknesses throughout a given range of motion, then we're gonna have to adjust that ceiling on the fly manually in order to accommodate that.

 [00:27:45.610] - Andy Baxter
So that doesn't quite work. So now enter adaptive isokinetics. And this is what we've harnessed in, in our system, which is using water for resistance. We can now be at any speed we want and have it be constant for the user. So that way, Deborah, you and I, and an 80-year-old guy and a 20-year-old guy, all 4 of us could be side by side side, ostensibly doing exactly the same thing, but we're all going to be at our own individual peak power. And that's a rarity.

 [00:28:17.770] - Dr. Lemanne
So the idea then is that the user goes to their peak and tries to surpass that 40 RPMs, but the harder they push—

 [00:28:29.610] - Andy Baxter
The harder it pushes back.

[00:28:30.980] - Dr. Lemanne
The harder it pushes back, so they will get stronger and stronger at any one particular RPM? That's correct.

 [00:28:36.170] - Andy Baxter
That's correct. And the beauty of that is that the machine adapts to the user and not the other way around. And there's very few machines that actually do that.

 [00:28:46.430] - Dr. Gordon
Mm-hmm. And so tell us a little bit about your machine, because I have a question as to how it's different from some others.

 [00:28:54.150] - Dr. Lemanne
What exercises can you do on your machines?

 [00:28:56.160] - Andy Baxter
So we do— we have 6 pieces in our FitSpan protocol. FitSpan is the name of our new entity, which we're launching nationally, FitSpanstudios.com. There's my plug. Yeah, so we have 6 machines. We have a rowing machine, of course, the best rowing machine in the world. And then we have a climbing machine. We have— Climbing?

 [00:29:20.870] - Dr. Lemanne
So you're upright with your hands and legs and arms engaged? Correct, hands and legs working together. Diagonally, probably.

 [00:29:27.290] - Andy Baxter
That is correct. Okay. Yeah. Okay. Contralateral, yeah. So we have a climbing machine. We have an upper body ergometer, which is like a big arm crank, like a bicycle for your upper body.

 [00:29:37.240] - Dr. Gordon
And Concept2 has which we've referred to, has something like that now too, right?

[00:29:42.210] - Andy Baxter
Concept2 has a strength apparatus that has 3 movements in 1. It's a leg press, a press, and an upright seated row.

 [00:29:50.390] - Dr. Gordon
Oh, okay, I thought it was a, yeah, okay, upright seated row. But I thought they have a pull-down ski. Oh, they have SkiErg as well.

 [00:29:58.000] - Andy Baxter
Yeah. Yeah, and we have one of those also.

 [00:29:59.430] - Dr. Gordon
Yeah, anyway, so anyway.

 [00:30:00.810] - Andy Baxter
Yeah, so we have our rower, we have a climber, we have an upper body ergometer, we have a SkiErg, We have a squat press machine, which is absolutely unique. And as the name implies, it's a squat and an overhead press, but done safely. And then we have our Cube, which is a lifting device which mimics the deadlift high pull Olympic-style movements. And that actually was the genesis of this entire thing, was I created that in response to a strength training clinic that I taught for All-American Rugby rowing, about 10 years ago, where the coaches, the college coaches, were saying that a lot of their athletes were getting injured in the gym doing Olympic-style movements in preparation for rowing, and that didn't make any sense because you're getting hurt training for another sport. So I made it my mission to create a way to do deadlifts and high pulls without injuring the athlete. And that's how this whole thing started.

 [00:30:59.210] - Dr. Gordon
And the way your machines wises up to somebody's own different varying inputs is because it uses— Water. Water. Yeah. So didn't the original— this is, you know, didn't the original rowing machines before the Concept2 use water? They didn't.

 [00:31:20.130] - Andy Baxter
They actually used— they were called gamuts, and they were— they actually used a giant heavy concrete flywheel that spun, and then it had a shoe brake on it, and then there was a little plate that hung from a cable, and you would put weights in the plate. Plate, and then that would create the brake force on the turning concrete flywheel. And there's a famous story about my buddy Steve breaking one of those, so he figured out how to cheat the machine, because if you hit the front end hard enough, it would unweight the plates, and then it would release the brake. But anyway, yeah. Now, there are other water devices, water rowing machines. The difference between theirs and ours is that those are a fixed blade design and with a fixed amount of water in the tank.

 [00:32:06.440] - Dr. Lemanne
Uh-huh, that's what I was thinking.

 [00:32:07.740] - Andy Baxter
We have two tanks internally that we can adjust to create different loads based on the amount of water that transfers from the inner tank to the outer tank and vice versa. Well, you know, tell us about—

[00:32:18.620] - Dr. Lemanne
I want to hear about all these machines, but tell us about the squat press machine. I'm really interested in that.

 [00:32:24.860] - Dr. Gordon
Yeah, that sounds like the hardest one.

 [00:32:26.330] - Dr. Lemanne
So I need to practice my squats and I'm not at a very high weight. Let's say I could do 35 pounds a few times with a front squat. Squat, how could I use that machine and improve?

 [00:32:37.810] - Andy Baxter
So it's a really— I'm glad you asked that because typically when we're looking at big movements like that, especially overhead pressing movements, we're going to be dealing with issues of shoulder mobility and thoracic mobility. And so people's range of motion when it comes to shoulder mobility and the ability to extend our thoracic spine has to do with how we align that weight relative to the rest of our body. So if my arms are fully extended overhead, head, I should be basically intersecting my ears. And most people can't do that. Most people don't have that kind of flexibility, say, past their now 45s. What does it look like instead if they're not intersecting their ears? They're forward. They're in front of their ears.

 [00:33:22.190] - Dr. Gordon
Oh, OK.

 [00:33:22.690] - Andy Baxter
Exactly like that. So they're not getting the full extension. That comes from either the shoulder range of motion, or as we age, more often than not, it comes from kyphosis. Kyphosis, right? So if we have a kyphotic forward contracture of the thoracic spine, it's very hard to get into that complete vertical position.

 [00:33:41.590] - Dr. Gordon
Right. Just speaking about kyphosis, I was noticing recently that I, you know, I have uneven ground at my house. This is totally a diversion. And I spend a lot of time walking around looking down, and I've decided I'd rather— that that's not a good thing. I mean, I don't want to get kyphosis. And what, you know, that's a the dowager's hump kind of thing that our readers may be familiar with, the older people and their heads sort of slowly bend forward. But I think just the— I can feel an improvement in my sense of posture if I walk around looking up, which is also a nicer view, frankly, than looking for cat shit as I'm walking around the property. And, you know, I have to put a little more caution into my awareness of my balance, which is another good thing. It's better not to look down while you're walking. That's my belief for the day.

 [00:34:33.560] - Andy Baxter
You know, that reminds me of— do you remember Bill Bradley, the former— is it Bill Bradley? The former basketball player turned congressman, and he got Parkinson's, I think. I think we talked about this before, but they use this now in low-light therapeutic environments for Parkinson's, is that, you know, looking up, looking out, having a sight line that's 10 to 12 feet out in front of you is much better for fall prevention because if you get myopic and you're looking straight down at the ground, you're probably going to fall more often.

 [00:35:04.340] - Dr. Gordon
Yeah, so it wasn't a total diversion. Anyway, but I understand that what you're saying about the overhead press, which is—

 [00:35:14.680] - Andy Baxter
Yeah, so with our machine then, we can accommodate those limited ranges of motion depending on how you're interfacing with the machine. If you're facing the machine, it actually allows you to extend without getting into painful ranges of motion. Motion, and then as you improve, you can turn around and do the same movement, but it will push you into extension because of the position of the arc relative to where your body is. So it works for everybody. It can push you and increase your range of motion, or it can accommodate limited ranges of motion as you seek to improve.

[00:35:48.080] - Dr. Gordon
I think an important part of healthy aging is maintaining shoulder range of motion. Definitely. Is I see so many people who have a rotator cuff injury and you need to 100% recover from that one way or another. Yeah.

 [00:36:04.890] - Dr. Lemanne
Well, in oncology, one of the things that I'm concerned about is insulin resistance. And one of the things that happens with insulin resistance right away is loss of quadriceps strength. And I'm not sure we understand exactly why that is, but I certainly would like to— to push back against that with squat training. And so tell us a little bit about how your machine— it's the same machine for the overhead press and squat? And squat, correct. Tell us how that works and how someone can use your machine to improve their squat and overall lower compartment strength.

 [00:36:40.150] - Andy Baxter
Yeah, well, I think that a lot of those machines do very similar things. I mean, the rowing movement is basically a big deadlift high pull just in a horizontal plane versus a vertical plane. And then the climber is very quad dominant. And then the squat press, of course, very quad dominant or co-contraction. You're getting glutes and hamstrings as well. So yeah, there's a bunch of machines that will get the quads involved, but I think sort of holistically, overall metabolic health from connected muscular functional movements. So where you're not necessarily isolating a muscle group like the quads, but you're incorporating them into more compound movements actually has more metabolic bang for your buck, which I think would have more positive effects for insulin sensitivity.

 [00:37:27.280] - Dr. Lemanne
Well, sure, but tell us how the squat works on your machine.

 [00:37:31.050] - Andy Baxter
Well, so you have a yoke and it sits across your shoulders, much like a yoke in weightlifting. And then you descend into a squat position. Now, as you're descending into that position, there's no load at all. And this is what makes this so much safer. So there's no eccentric load. And in this case, what's called an axial eccentric load pushing you down.

 [00:37:49.990] - Dr. Lemanne
I'm already feeling happy about this. Yeah, right? Just thinking about it.

 [00:37:53.760] - Andy Baxter
Yeah, because if you're lowering down with a load under you, the potential for injury goes way up because you're having to control that load and then stop that load and then turn that load around. So in this case, you have no eccentric load. So you get into your start position and you only have resistance once you start the drive phase. And so then you press out of your squat and then continue that motion by pressing up over overhead, and you're taking that yoke that has handles on it, and you're pushing that yoke up over, overhead, so you're continuing that resistance movement.

 [00:38:24.160] - Dr. Lemanne
Okay, so you're kind of doing a thruster.

[00:38:26.510] - Andy Baxter
Exactly, I was gonna say that. So a thruster is an old-school machine, doesn't exist anymore, but it was really common in football, and this is very similar to a thruster. But again, the weight doesn't come back at you like a thruster would.

 [00:38:39.510] - Dr. Lemanne
And if you find that you're failing in the middle of your press, up, you just stop and the weight doesn't fall.

 [00:38:44.890] - Andy Baxter
That's correct. Okay. Yeah, you can get to the very top. My partner, my business partner David, is fond of saying that when you do this movement and you get to the very top, you could hold that with one finger at the overhead position and have no problem with it at all. Nice, nice. Yeah.

 [00:39:02.770] - Dr. Gordon
Wow, this is fascinating, and I'm trying to think of ways to incorporate that principle if I am far from a FitSpan studio, which I probably am not that far from one.

 [00:39:16.100] - Andy Baxter
Do you have one locally? Well, we are opening— thank you— we're opening our flagship location in Medford in the fall.

 [00:39:22.100] - Dr. Gordon
Okay, but until that time, or if I don't want to drive to Medford, you know, I'm thinking like when people do resistance bands, doesn't that— I mean, it doesn't at all do the proper guided muscle training that this machine does, but it's a brilliant concept to try and think of incorporating into as much as possible what we do otherwise.

 [00:39:49.380] - Andy Baxter
So some examples of how to do really good accelerative concentric work would be things like ropes, you know, doing the rope, the rope drill. Another really good one is using slam balls. So take a medicine ball that doesn't bounce, right? So a slam ball. And so if I took a medicine ball, for instance, and I held it in front of my chest and I squatted down and then I drove up as fast as I could and I threw that ball as far as I could, that would be the same thing as our squat press. Oh, how fun. The main difference being you don't want to be on the receiving end of that wherever it lands.

 [00:40:25.580] - Dr. Gordon
No, you just have to walk to where it landed, turn around, and toss it back to where you were before.

 [00:40:30.860] - Andy Baxter
Yeah, so that would be a good example of that.

 [00:40:33.620] - Dr. Gordon
Oh, that's a— now I have to go get one of those balls. 

[00:40:36.160] - Andy Baxter
Yeah, and if you picked up a slam ball from the ground and sort of a sumo deadlift position and then lifted it overhead and then slammed it back down on the ground, that would be another example.

 [00:40:44.990] - Dr. Gordon
Okay. A good example, yeah. And it seems like then a properly done on-the-water rowing stroke is a good way to do that too.

 [00:41:00.480] - Andy Baxter
Yeah, and that, you know, getting into the power component. So rowing being a power endurance sport, we get the best of both worlds. We get all, we get all of the high-intensity interval training and the powerlifting style or the Olympic lifting style movements in the rowing motion. So the different energy systems, this gets back to our 15-second on, 45-second off. The different energy systems utilized are such that at peak power in any movement, but we'll use rowing as an example, you're only good for about 12 seconds or so. And so roughly speaking, whether it's an on-off phase or a cycling phase that's continuous, you're going to be good from anywhere from 7 to 14 seconds. And so that just happens to coincide with a racing start in rowing, right? And in strength training, again, it tends to coincide with about 7 repetitions. You're going to peak right around the 5th repetition, and then it's going to start to fall off. 99% of people are going to be thoroughly taxed by that 7th rep.

 [00:42:01.730] - Dr. Gordon
Can I ask you another little detail about HIIT training? I was encouraged at some point when I'm coaching people from afar and telling them to go work with somebody like you or a coach to really do it, that for older people, that the 15-45 or in the old days Tabatas, which I think was 20-10, something like that. The older you get, the longer recovery you need, and I was encouraging people, if it takes you a full minute and a half to recover, for instance, I'd rather have you do 2 good sets of those 15 seconds than do a lesser one the second time because you haven't fully recovered. But you tell me a different perspective on that, perhaps.

 [00:42:45.640] - Andy Baxter
Yeah, so that's a great question. Typically, you know, the science behind the work-to-rest ratios are completely dependent on the volume and the intensity of the work. So typically, the higher the intensity of the work, the greater the ratio of rest. So for instance, if you're doing— let's say you're doing a 10-second all-out and then you had a 50-second rest. Well, that's a 5:1 ratio, right? If you did a 15-second and then a 45 seconds, then that's a 3:1 ratio. So changing the ratio of work to rest can accommodate that. But if you have an adaptive isokinetic, then that kind of goes out the window. It's not as important because you're only pushing as hard as you can. You're not dealing with a fixed weight that could overwhelm you. Yeah. So it really solves some of those problems. And because it's all concentric, you're not dealing with the inflammatory response as well. And that's a big part of recovery. Is that you're dealing with the inflammatory responses, which chemically can last 48 to 72 hours. Okay. And if—

 [00:43:54.540] - Dr. Gordon
so if somebody is dealing with a less enlightened resistance system, like, you know, if I'm doing this on the erg now, it still makes some sense to recover enough so that my next high intensity is a good high intensity.

 [00:44:08.450] - Andy Baxter
It is. Absolutely. So the quality of the work is paramount and everything else should revolve around that. —on that. If you get— and I'm glad you brought that up because I preach the same principles— is that if you get into a fixed work/rest ratio recovery and you start to get overwhelmed, either because the weight's too heavy or you've done too many reps or it's just cumulative overload, then the quality of the work will suffer and you're not getting the stimulus and response relationship that you're actually going for. So everything suffers. Because of it.

 [00:44:40.060] - Dr. Gordon
And you're probably more apt to injure yourself just by inattention.

 [00:44:43.490] - Andy Baxter
That's correct, yeah. So it's a lose-lose.

 [00:44:47.130] - Dr. Gordon
So your system obviates that need to, it allows people to do a fixed interval and do it in a group of people even because their machine's gonna accommodate to them. That's correct, yeah. Wow, so this is the flagship opening in Medford, and then you're gonna have it in every gym across the country, right?

 [00:45:11.470] - Andy Baxter
Yeah, absolutely. So we're currently, we've got Medford, we're working on a building down in Emeryville, down in the Bay Area, and then another one in Connecticut. So those will be, I think, our first 3.

 [00:45:22.200] - Dr. Lemanne
Oh, Ashland isn't on your list?

 [00:45:24.450] - Andy Baxter
Well, we've already got the Ashland gym. So we have all these toys in my place already.

 [00:45:28.150] - Dr. Gordon
Oh, you have them in Ashland?

 [00:45:29.510] - Dr. Lemanne
Oh yeah. Oh, okay. All right.

 [00:45:30.700] - Andy Baxter
And the Medford shop has 'em too, but the FitSpan studio It will be a formatted group class gym. So it'll be everything, this equipment specifically, and then these protocols specifically.

 [00:45:42.660] - Dr. Gordon
But you do have the equipment in your current two gyms, one in Medford and one in Ashland. Yeah. Okay, oh, that's interesting.

 [00:45:49.210] - Dr. Lemanne
Oh, that's good news. I was disappointed. I heard Medford. I can go to Medford, but now I don't have to.

 [00:45:54.420] - Dr. Gordon
I go to Ashland. You don't have to yet. Because I have seen water resistance in some of your machines for quite a time in Ashland. Yeah, exactly.

 [00:46:02.720] - Andy Baxter
I developed this about 10 years ago.

 [00:46:05.460] - Dr. Gordon
Aha, work in progress, and now it's at its— Yeah. Oh, that's great. Congratulations. Thank you very much.

 [00:46:11.350] - Dr. Lemanne
So when people come to the FitSpan Studio, will they be in a class? Yes. Will they be one-on-one coaching? How does this look like when I show up for my workout?

 [00:46:22.760] - Andy Baxter
Yeah, it's really cool. It's 24 pieces, so you get 24 people in a class, but you're rotating through on 10-minute centers, 8 people at a time. Now, there's only 6 different machines. Correct.

 [00:46:34.190] - Dr. Lemanne
So there's 4 of each of them?

 [00:46:36.500] - Andy Baxter
There are 4 of each of them, yeah. Okay. And so you'll have teams of 4. So you get to meet new people and integrate with them. And then there's the social component, the community component. There's a memory component. We throw in some memory tricks. 

 [00:46:52.390] - Dr. Lemanne
Wait a minute. Memory? Talk about that.

 [00:46:54.410] - Andy Baxter
So in our protocol, we do some simple things. We have a sequence of numbers and letters. Letters that's different every day that you have to remember and then repeat at the end of the workout. And then we also have some balance activities during the transitions between the work. That's great. So yeah, it's hitting all the things we want to hit. That's fantastic.

 [00:47:16.850] - Dr. Lemanne
And you have all of these things now already in your Ashland and Medford without the class component?

 [00:47:23.330] - Andy Baxter
Without the class component. But we utilize a few different protocols so people can try out different things, but the FitSpan protocol is been really exciting to use with our existing members, and they're enjoying it.

 [00:47:35.450] - Dr. Gordon
Uh-huh, because it's a journey through all those machines, not just the ones that you're most comfortable or familiar with.

 [00:47:42.580] - Andy Baxter
Yeah, and the format is basically 4 minutes on, and within those 4 minutes, you have 4 sessions of 45 seconds and 15 seconds.

 [00:47:50.890] - Dr. Gordon
Uh-huh, and you can do that because the machine adapts. If I'm tuckering out, it'll make it—

 [00:47:55.710] - Andy Baxter
Exactly, if you're having a bad day, you just go at whatever pace you want to go, and if you're having a great day, pack it.

 [00:48:01.710] - Dr. Gordon
Uh-huh, and it'll—

 [00:48:03.480] - Andy Baxter
It'll accommodate, exactly.

 [00:48:05.020] - Dr. Lemanne
You stay on one machine for all 4? Yes.

 [00:48:07.410] - Andy Baxter
Or do you rotate? No, no, you stay on the machine for the full 4 minutes and then you rotate, and within the minute transition phase, you do some group activities, balance and memory-based motor skills.

 [00:48:18.360] - Dr. Lemanne
So how long does a workout take?

 [00:48:20.430] - Andy Baxter
30 minutes. That's it? Exactly, so you're in and out and then it runs on 10-minute centers, so you can schedule appointments every 10 minutes, rather than if it's running on a half hour or an hour and you miss the class, you've got to wait.

 [00:48:34.290] - Dr. Gordon
Oh, so you have a class starting and then 10 minutes later you have another class starting. Yeah, you're transitioning in 8 people at a time. This is a good business model as well as a good athletic model. Yeah.

 [00:48:46.100] - Dr. Lemanne
Are you going to be franchising it?

 [00:48:48.280] - Andy Baxter
We are. Excellent. Excellent. You can check it out. It's, And again, it's FitSpanstudios.com, so you can check it out online.

 [00:48:57.930] - Dr. Gordon
And do you, so one of the other things that's great about the rowing itself is you get to be outside, you can do the aerobic component. So this is really a highly specific and safe and theoretically sound way to do the resistance part of a workout.

 [00:49:18.780] - Andy Baxter
And the aerobic. And, well, not the long steady state stuff, No, this is gonna be your high-intensity interval training.

 [00:49:25.530] - Dr. Gordon
High-intensity aerobic, right, which I sort of think of as anaerobic-aerobic combo. It is. Yeah, but you know, there's a benefit to going for a walk in the hills for 20 minutes or rowing out on the lake. Absolutely. Which is a whole different, yeah.

[00:49:40.660] - Andy Baxter
Yeah, and plus you're outdoors and sunshine and involvement with your environment.

 [00:49:46.430] - Dr. Gordon
Yeah, I would imagine just because of the scientist that you are that you have done some measurements of before and after, you know, a 1-month series of classes that people do. And in general, you're recommending people do them— like, I always think of resistance exercise, I do 2, maybe 3 days a week, not more.

 [00:50:07.240] - Andy Baxter
So that's, yeah, of course, that's a dogma as well. And that just depends on how much time is needed for recovery. But a lot of that recovery time is dependent on the eccentric phase of the movement. Movement because that's really what you're recovering from. So I'll give you an example. So I can't name the team, but there's a pro basketball team that uses my system. And the argument that they made to their general manager when they purchased the system for their athletes is that if they've got a game on a Wednesday night, they can use this system on a Thursday night, and then they can play another game on Friday night with no repercussions. So your delayed onset muscle soreness is nonexistent. Your recovery time is much faster. Faster, and you can maintain a higher quality of work and a higher volume of work with less, if not any, inflammatory response.

 [00:50:57.470] - Dr. Gordon
Have you done any specific studies measuring people's progress in the weights they can lift? Like, does the machine tell me how many pounds I just lifted?

 [00:51:07.500] - Andy Baxter
Yeah, so all power is measured in watts. That's the universal measurement of power. So we do have monitors, but I can tell you that we don't use them in the FitSpan protocol. And the reason we don't do that is we don't really want to get into the competitive mentality where people are looking over their shoulder at what somebody else is doing. There is that sort of internal competitive part, but the downside to that is that if you're having a weak day, you don't want to be— A wimp. You don't want to be seeing it, or you don't want to be overworking because you're trying to match some predetermined number. So we're actually just going on feel. But in terms of—

 [00:51:48.260] - Dr. Gordon
so they did— the basketball team had a really good argument to their managers, but for, you know, I think scientific purposes, I'm just wondering too, like, have you measured strength improvements or aerobic capacity and those kind of things?

 [00:52:04.820] - Andy Baxter
Yeah, so I can tell you one specific example. We did this with offensive linemen, NFL linemen, and we put them on that— don the same machine that you were asking about, the Power press, we put them on a power press so that we could measure peak power and wattage. Those numbers were terrifying, by the way. But yeah, so when we get into motor unit recruitment and rate coding, there is this adaptation, of course, which is your body figures out how to maximize your power output, which is how to efficiently balance the strength and the acceleration. Components, which creates a more powerful athlete.

 [00:52:45.490] - Dr. Lemanne
So for a person just coming into your studio out of the community, how many times a week do they come?

 [00:52:52.540] - Andy Baxter
We have some folks that come every day. We have a lot of our medical people that are, depending on what they're recovering from, whether it's like a TBI or even MS, something with a super high inflammatory response, they might do very short bouts, and some folks will even come in twice 6 a day because they're doing very low volume, very low intensity. So more sessions in the beginning is better for them. As people get stronger, they may split their routines so they could still come in 4 or 5 times a week, but they're not going to do the same thing every time. So there's a bunch of different ways to set that up.

 [00:53:29.290] - Dr. Gordon
Yeah, this is— tell me again the name of this heavy ball that I've got to go buy to throw across.

 [00:53:35.900] - Andy Baxter
Oh, it's a slam ball.

 [00:53:36.850] - Dr. Gordon
A slam ball. That's different from a medicine ball?

 [00:53:40.450] - Andy Baxter
It can be. So a lot of medicine balls bounce and you don't want a ball coming back at you. So the slam balls just go thud when they hit the ground. So that's the key differentiator. They're more like sandbags.

 [00:53:52.190] - Dr. Lemanne
Yeah, exactly.

 [00:53:53.330] - Dr. Gordon
They're just balls with sand in it. It's good to think of there's some things somebody can do to try and introduce themselves, or I'm speaking personally, introduce myself to this concept concept and see what the effect would be of doing something like this for a while. Because obviously tossing the slam ball across the garage is only really doing one part of one of your machines, right? And, and then your system is 6 machines?

 [00:54:22.830] - Andy Baxter
6 machines, yeah. And I'll add to that, Deborah, what you said about the testing. We have a FitSpan score that every member does every quarter, so we can measure range of motion. We talked about that thoracic extension and shoulder mobility. So important. We measure strength and strength endurance. Yeah, so you're going to have some markers and we'll record all of that, and then we retest every 3 months.

 [00:54:46.310] - Dr. Lemanne
Tell us, I want to know who should come to see you, and you're going to say everyone, but are there people who might be thinking, this isn't, you know, this is too much for me, I can't, I couldn't possibly do this, that might be surprised? Surprised if you call them out and say, you know, you actually, you could. So, you know, maybe thinking of some people who have come with, without identifying anyone, of course, but who have some unusual or difficult health situations that might benefit.

 [00:55:17.810] - Andy Baxter
Well, I think that as we discussed, it's, whereas it used to be the entry point was 55, now it's really 45. And so we're targeting folks that are 45 and over, folks that have not exercised before or folks that have exercised all their lives and maybe are tired of getting injured or they're just not recovering as fast from their workouts based on whatever the workout style is. So it's just a more accommodating type of activity. It's a smarter way to train. It's a healthier way to train. It allows people to be at their peak power whatever that is, and there's no judgment there, and that's kind of the beauty of it, and then get stronger.

 [00:56:03.990] - Dr. Lemanne
And I recall that your gym has some unusual hours.

 [00:56:10.520] - Andy Baxter
My gym? Well, the Ashland gym is 24 hours a day. That's unusual. Yeah, so, but I see folks in the morning, but we're actually full up. We're not, yeah. We're not really seeing new people these days, but— That's great. Yeah, and I think the Medford gym has regular gym hours.

 [00:56:32.680] - Dr. Gordon
So it seems to me that one of the beneficial opportunities with a system like this would be to work with somebody— maybe what you were getting at, Dawn— who is seriously recovering from some kind of physical injury or Or thinking of some of my patients who really need, both of these examples of people maybe really need specialized individual attention.

 [00:56:56.110] - Dr. Lemanne
I'm thinking of cancer patients who need to have metabolic rehabilitation. Yeah. They are not processing glucose, lipids, inflammatory flares properly and need to change that, and exercise is great.

 [00:57:13.010] - Andy Baxter
So, Da, that's awesome. One of your patients is one of our biggest FitSpan advocates. Advocates. Well, I send a lot of patients to you, so I don't know who that is. He's our poster boy. He's amazing, and he does FitSpan every day. Wow. So I don't want to say his name on the show because I don't want to embarrass him or get sued or something. I don't know. But yeah, no, I agree. It's a safe modality. But I'm thinking of people who really need one-on-one guidance.

 [00:57:43.880] - Dr. Gordon
Can somebody get a solo session? Like a patient with dementia who would maybe just walk away from a class, something like that. Is there an opportunity for individual?

 [00:57:55.930] - Andy Baxter
Not in the FitSpan environment. That's a group class thing. And it's pretty, you know, it's running on 10-minute centers. That's great. But certainly, you know, in our facilities, Baxter Fitness Medford, Baxter Fitness Ashland, I mean, that's what we do day in, day out.

 [00:58:12.700] - Dr. Gordon
Yeah. Hold somebody's hand if they need.

 [00:58:14.860] - Dr. Lemanne
Absolutely.

 [00:58:15.420] - Andy Baxter
Okay, great. Yeah, hands-on. Yeah. Yeah.

 [00:58:18.080] - Dr. Gordon
Terrific. Wow.

 [00:58:20.230] - Andy Baxter
Yeah, that was a lot. Yeah, this is exciting.

 [00:58:24.560] - Dr. Gordon
I mean, it's a great concept, and, you know, I think ideally somebody could actually try one of your studios, but secondarily, we can all think about if we're going to be careful with ourselves exercising, I mean, I— and avoid injury so that we can keep exercising. It's not the weight we're lifting, it's how we put that weight down where we are setting ourselves up for injury if we're not paying attention to our posture, stress level, all kinds of things like that. Yeah, well put. So I think there's a message to take away for everybody, and I can't wait to try your studio.

 [00:59:03.030] - Andy Baxter
Cool. Thank you very much.

 [00:59:04.480] - Dr. Lemanne
Thank you very much. So Andy, as we close, I want to invite you to tell people where they can get in touch with you, where they can find out more, and if they're interested, what their next step should be with you.

 [00:59:15.850] - Andy Baxter
So we'll be opening our flagship location in Medford on McAndrews, actually right next to the See's Candy Store. How good is that? And we're planning to open in the fall. And so you can go to FitSpanstudios.com that's just the general website, but we'll have the local website up running soon. Sounds great. Yeah, thank you.

 [00:59:38.070] - Dr. Gordon
Thank you. And Dawn, I'll see you next week, and Andy, maybe we'll see you in— I'm sure I'll see you before then, but maybe see you in the fall at FitSpan. That would be wonderful.

 [00:59:48.720] - Andy Baxter
I appreciate it.

 [00:59:49.530] - Dr. Lemanne
Okay, have a good week. Thanks. Bye-bye. Bye. If you haven't already, please please, please take a moment to subscribe. Your simple click is not abstract, it's not anonymous. To us, it's very, very real. It helps us reach more patients and physicians to challenge the old ways of thinking about health and to keep these evidence-based conversations going. Hitting that subscribe button actually makes a huge, huge difference, and thank you.

 [01:00:24.370] - Dr. Gordon
You have been listening to the Lemanne Gordon Podcast. The podcast where docs talk shop.

 [01:00:30.000] - Dr. Lemanne
For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.com. Happy eavesdropping. Everything presented in this podcast is for educational and informational purposes only. Personally and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

 [01:01:06.300] - Dr. Gordon
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 [01:01:18.420] - Dr. Lemanne
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 [01:01:32.860] - Dr. Gordon
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 [01:01:39.690] - Dr. Lemanne
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 [01:01:57.060] - Dr. Gordon
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