Review of The McGill 2 course: "Reducing pain and enhancing performance: The three hour back assessment."

I attended this course on 4th February at the Anglo-European College of Chiropractic in Bournemouth. I previously attended McGill 1 ('Building the ultimate back: from rehabilitation to performance') in Dublin in 2015.

To see the general description of Professor Stuart McGills courses and his books and publications go here. I assume by reading this blog you already know who he is.

Now, I'm not going to give the detail of the course, if you want that you can pay for the course yourself! But I will compare McGill 1 and 2, give a few insights and suggest whether it is worth you doing the course yourself if you are interested. Also, McGill doesn't let you take pictures of video either, so none of that here.

Anything in quotation marks is a quote from Stuart McGill unless otherwise stated.

McGill 2.

The course is one day, and split in two halves. The morning is lectures covering the theory, movement screening, imaging and examples from various research studies.

The afternoon is the practical going through various tests, movement screens, and practical recommendations in a clinical environment. In this case using Chiropractor plinths - which I must say are bizarre and not very good if you are not doing Chiropractic manipulations! Apparently McGill has presented at AECC on several occasions, so they should have known that the treatment tables they had were not going to be any good for the practical things we were doing.

Movement Screens.

McGill is quick to point out that he is not going to give you a simple system like an FMS to use. There is no simple screen or test with complicated back pain cases.

He covers his research into the FMS - which he also does on McGill 1. He probably spent more time on this in McGill 1.

There is an assumption that people on this course had done McGill 1, but it seemed most people hadn't. Most people on McGill 2 were Chiropractors (surprising eh, being at a Chiro school) whereas I would say at McGill 1 there were more athletic trainers.

In short, even though he has a lot of good things to say about Gray Cook and suggests any new trainer learns the FMS, this is not going to be enough for anyone trying to be a top notch clinician. In essence the FMS is a three chord punk song whereas the McGill assessment is "jazz".

For example, the overhead squat test in the FMS, which requires very good shoulder mobility to score a 3,  but "shoulder mobility is a gift from God!', not necessarily something you can change.

His approach is about "converging on a precise diagnosis".

This is where his scientific background comes in. You formulate your hypothesis, and then test it. For example, pain is coming from disc at L.4. Test it, if your wrong, go again.

You can read his books, get his DVDs and listen to podcasts with him in to garner most of what he covers in his seminars. However, there is that extra quality to seeing him in a real life situation. He has charisma, a wealth of knowledge and despite protestations that he is no clinician - obviously is gifted in this area as well as his ability to relate to people.

He has worked with so many different types of people from professional hockey, NFL, MMA, rugby, powerlifting, as well as every day people with everyday jobs with back pain that has been dismissed or misdiagnosed (or not diagnosed at all). He is normally the last resort, if you are seeing him, you are desperate and have seen 10 other experts; his approach has to work.

He brings all this into the lecture theatre, at his best when going off on tangents, citing a research study, talking about specific patients, answering questions - but genuinely listening and not afraid to give strong opinions and say "I don't know" when he doesn't.

For example, I asked him why people sit into their pain, it seems counter-intuitive that someone who is forward flexion intolerant would adopt that posture. He said he didn't know why people did it, but they do and we don't know why.

Or, a friend of mine who is in his 2nd year at Chiropractor school asked if McGill ever saw acute cases. He doesn't, by the time they reach him they are chronic. He said the acute cases are for the clinicians and manual therapists.

Context.

His approach is all about context. He gives the example of posture, no variability and too much variability in posture will result in injury, there is a "sweet spot" in the middle. However, in the weights room there should be zero variability (not in that everyone should squat or deadlift the same) but when you have found the best technique for you or a client, you should be fastidious with every rep.

He also gives examples of very good winning athletes with so called 'poor movement', are you going to change their posture when they are winning and not in pain? Of course not.

He also covered several studies in the morning session. Including one on firefighters and movement screening, and how some moved better with load and some moved worse with load. And studies on changing hip mobility, stretching,  and trying to change peoples lordotic spine curves.

Stop trying to fit a pentagon shaped peg into a square hole. Everyone is different.

Non specific back pain and imaging.

If  you really want to wind up Prof. McGill mention non specific back pain and general exercise recommendations.

He is dismissive of the medical profession that gives this diagnosis (no one ever had non specific head pain and then was told to have surgery anyway to remove part of the head!) and also some radiologists and their inability to interpret an MRI.

In the morning session of McGill 2 he briefly covers medical imaging and differential diagnosis.

For example, MRI might show a disc bulge at L.2, but if all the symptoms show a problem with L.4, then surgery in L.2 is not going to do anything, even if the MRI shows 'abnormality' there.

In fact, he is very much certain that in 95% of cases that have been told they need surgery you can help them avoid it.

I think one of the other attendees used the phrase "Victim Of Medical Imaging Technology" - VOMIT. Haha. Yes imaging is a fantastic tool but know its limitations.

People giving general exercise recommendations like 'do yoga or pilates' is also lazy. Know the limitations of research where people are diagnosed with 'general back pain' and given 'general exercise'.

In terms of differential diagnosis, McGill interestingly says he has only come across two cases of piriformis syndrome - it is very rare. But, as anyone working in this field knows, people get told all the time they have piriformis syndrome and advised to drive a lacrosse ball into it.

Two interesting things McGill mentioned were spinal shock and neural resonance.

These were interesting, and I will have to think about them more from a neuroscience point of view. The neural resonance effect is when someone has a shuddering in a 8-10 Hz range before being able to do a movement like stand up. This appears to be coming from the Motor Cortex itself. This is easier to demonstrate than explain.

At this point he mentioned visualization and trying to lay down myelination and form new engrams (the software in the brain needs updating, the hardware is fine) of movement. This very much chimes with what I've  been reading recently in neuroscience, neuroplasticity and long term synaptic potentiation.

The assessment.

I think what he is trying to get across is how complete the assessment of the person in front of you has to be. From observing how they get out of their car, walk up the stairs, open the door, the look on their face, their complete history, how they sleep, how long they sleep, are they a type A or B personality and on and on.

He doesn't have a set assessment form. Every person is different.

You need to see how they move when fresh, when under stress, when under fatigue - 'break them down' and see what their movement does.

"What matters most to that person" is what you need to focus on.

Is it getting down on the floor and playing with their kids or returning to the NFL or running 10k? There is not one route.

When you have tested the hypothesis, and have a plan you then need to "coach movement not corrective exercise"

You should then "know the goal of the training programme and every single exercise."

The practical.

In the afternoon McGill then goes through the various practical assessments such as heel drop test, seated compression and things like neural flossing. All looking to identify if there is a stability problem, what are the triggers etc. Too many to mention here, with too many pearls of clinical wisdom.

But, I think if you hadn't read his books or watched his DVDs this section could be overwhelming. I would recommend familiarizing yourself with these before attending the course.

Yeah I'm the fan boy who bought the books when they originally came out over 10 years ago. I would read these or watch his assessment DVDs before attending the course. These are my books from 2002 and 2004, the latest editions contain  more recent research.

His assistant Joel (website for his facility here) covered the hip assessment, I believe he is an S&C coach.

By 6pm everyone was flagging and there was information overload. And left me with a couple of final thoughts on how to integrate all this information.

Three hour assessment.

In reality I don't think anyone in that room apart from McGill is going to go away and start doing three hour back assessments. However, I think everyone can take something away and make their approach more rigorous. We all get stuck in patterns, become a  bit lazy and default to certain ways of thinking , or diagnosis (if that's what you do).

Courses like this re-energise you.

McGill 1 or 2?

McGill 1 covered the research for the exercises more in depth and had a big practical element going through cat camels, bird dogs, side bridges, curl ups, glute exercises and more. Afterall McGill 1 is 2 days long.

If you are an athletic trainer, McGill 1 is the course to do. If don't have access to a therapy couch or your job doesn't allow hands on testing and assessment then there is not much you can practically take away from McGill 2.

From a clinician/ therapist point of view, McGill 2 is going to give you more assessment tools and some treatment options that can be done in a clinical setting and help the client can move better. But if you don't know the big 3 exercises, what a hip hinge is, and more, then it doesn't give you much to give your client to take away and do. For example, McGill mentioned the side bridge on the course and some peoples obsession with making it harder, but said that lifting a leg in a side bridge can double the spine load. If you don't know how to do the side bridge in the first place, this information may not be of use.

McGill 1 cover more things you can do with athletes as well. He covers deadlifting technique, squat technique, neural drive and more. In McGill 2 he only briefly mentions the spate of end plate fractures from people deadlifting and broken pelvic rings from people going too heavy on unilateral leg work.

In someways, it might be better to have the courses the other way round.

We had more time on McGill 1, McGill 2 seemed like we were rushing through the tests and assessments in the afternoon. And these are subtle things, with nuance that take time to learn. In some ways trying to cram too much in can cause confusion and lack of clarity.

On McGill 1 we were given a pdf of all the lectures. On this course there was no pdf or printed copy of the slides provided. This would have been useful to have.

Questions.

Some of these questions have only occurred to me after the course, some I had on the day.

McGill 2 doesn't give you an exercise pathway as such. For example, someone has a underhook at L.3, does this change the way you do the cat camel or bird dog? Aren't you going to do the big three exercises regardless of outcome?

Why do some people sit into their pain?

Why do some people have "reversed perception" and constantly self manipulate, how can you stop them?

Does any professional team or facility have a robust screening/assessment process that has been shown to reduce injury and improve performance by individualizing programmes?

Would it be possible to see neural resonance traces on an EEG or fMRI?

As always courses like this always throw up more questions and more to learn.

As McGill says "It depends" and "We are playing Jazz here". Treat or train the person in front of you, adapt and freestyle as needed, but use science and logic as your guide.

Closing thoughts.

You could learn nearly all that is covered on the course from McGills books, DVDs and research publications.

But by going on the course, you learn something more. It gives you an insight into how to interact with clients and patients. You see the man in action and his thought process.

He has just retired and is winding down, so if this is your thing now is probably the time.

I believe AECC billed this as a more intimate course than McGill 1 but it seems there were as many people as McGill 1, with 50+ other people in the room.

But even if you only take away 1 or 2 new bits of information or a way of phrasing something or carrying yourself in front of client then it was worth it.

I preferred McGill 1 as a course, and from McGill 2 I enjoyed the morning lectures session the most. It has given me a list of research to follow up. But maybe that's just my bias of wanting to know more about the research and not being so clinic based.

Take home message - be better, know more.

Now should I do McGill 3?

Forming new habits. How long will you wait for results? Part 3.

How long before people abandon their new nutrition plan or exercise habit?

For parts one and two, go here and here.

Research shows that by now most people have given up on their new year exercise plan or nutrition plan. Dry January or Veganuary have quickly turned into beer and a burger for quite a few people.

But why? And why are some people still going and sticking to their plan?

Temporal Discounting.

In behavioural economics and neuroscience there is something called Temporal Discounting. Basically, how long are you willing to wait for a reward. And in general humans (and animals) prefer immediate reward to delayed reward.

For example, its not unusual for people to say after a week of exercise 'I haven't lost any weight yet' or a week of more healthy eating 'I don't feel any different, when will I lose weight?'.

The brain wants immediate results and rewards.

"Large probable, immediate rewards are preferred to smaller, less likely and distant ones." (Gazzaniga et al, 2008:p528)

This could explain two phenomena we all see on a daily basis. One, people weighing themselves after every workout, in the hope there has been an immediate loss of fat or gain in muscle mass. Two, people rewarding themselves with a chai latte and cake after a workout and immediately consuming more calories than they burned off.

Most of the studies focus on monetary rewards in humans (sometimes while they are are in an MRI scanner) or giving juice to monkeys, or sometimes a poor rat with an electrode implanted in the 'reward' centre of the brain.

A common question in these studies is, would you like �10 now or �11 tomorrow,? Most people choose �10 today. But if you say would you like �10 in a year, or �11 in a year + 1 day? It is so far in the future people will choose the �11. (McClure, 2004).

It is not uncommon for lottery winners to be offered a lump sum now, but half the actual amount they won, or the total sum in portions over several years. People opt for the lump sum, even though it is less money.

Exercise and new nutrition habits are by their very nature delayed rewards for people new to it. They are not necessarily exercising because they love it, they are doing it because of a future delayed reward such as fitting into a dress, looking good on the beach. And for many people this reward seems 'distant' and unlikely (due to past failures).

The brains reward system likes immediate rewards. The release of dopamine creates pleasure. It activates neurons in the Nucleus Accumbens/ Ventral Striatum (the 'reward' centre deep in the brain).This dopamine release can be caused by drugs, but also by other things such as a tasty cake. Therefore, your reward system can say 'eat the cake, weightloss is too far away to think about, we need a reward now, we've had a tough day at work.'

Back to rat in the lab, when it has an electrode in its brain that fires off some dopamine reward cells every time it hits a lever, guess what it does? It hits that lever obsessively, in fact ignoring food and water until it collapses from exhaustion because it values the activation of the reward centre in the brain over everything else.

If you keep checking social media every 5 mins, or have ever played a computer game all night, you are basically that rat hitting the lever, looking for a hit of dopamine.

BUT, humans are not rats. We have some (newer from an evolutionary point of view) parts of the brain that deal in self control and planning. The Pre Frontal Cortex (PFC), at the front of your brain.

You can make your brain choose healthy foods.

For example, in one study on dieters (Hare et al, 2009). There were two groups, a group exercising self control, a group not exercising self control.  They rated 50 different foods for taste ( very bad to  very good) and healthiness (unhealthy to very healthy). These foods included 'junk' food like crisps and candy, and healthy foods like fruit and vegetables.

Then while in a MRI scanner they had to reject foods on offer and choose other ones. They had actually not eaten for three hours, and the food they choose they got to eat at the end. The self controllers rejected the unhealthy foods they liked and choose healthy ones they disliked more often. It is not that they didn't find junk food tasty or really likes healthy foods, they just had better self control. In fact, a part of their brain called the dlPFC was more activated in the self controllers. This is the part of the brain that is making more deliberate decisions. This part of the brain was operating far sighted behaviour.

And your brain does this all the time. For example, people book holidays in the future, they save money for pensions and they go to University, when the reward of a degree is years away.

Our brain would like things as soon as possible (Kable and Glimcher, 2010), but it knows that this might involve a delay. For example, you order something on the internet, it wont arrive for 3 or 4 days, but you are prepared to wait. If you went into a shop and they said you had to wait 3 or 4 days before you could buy an item, you would go somewhere else. Your brain understands context.

The reward has to be big enough and important enough. �10 now or �10,000 in a year, err I'll wait a year thanks. The problem is most people aren't thinking about the rewards of exercise and nutrition like this. In their mind the reward isn't big enough to wait.

They are thinking about it much more like a monkey being given juice. A trigger goes off, a few seconds later the monkey is given some juice, there is a dopamine spike in the brain and the reward centre is activated. After a while, there is a dopamine spike when the trigger happens, before the monkey has had the juice. The expectation of reward is triggering a response in the brain. But, if there is a trigger and no reward, eventually the monkey gets wise and realises there will be no reward, the expectation has gone, that 'reward' part of the brain no longer activates.

This is like someone who starts exercising, the anticipation of weight loss and feeling better drives them, but after a while they get no results, they get despondant and give up, the reward system is not firing anymore. A cake will fire it off immediately.

Whereas, the crash diet industry knows how to hit the reward system. Have a novel food you have to eat, restrict calories, lose a lot of weight in a short period of time, weigh yourself five days later and the reward system in the brain goes into overdrive. But the pain is too much, eventualy they give up.

Your emotions are affecting your decisions.

Attractive women, bad decisions and blue oceans.

In one study called Do Pretty Women Inspire Men to Discount the Future ( Wilson and Daly, 2003), the researchers offered men a small monetary reward tomorrow or a larger sum in the future (7 to 236 days). One group were shown pictures of 'hot women' (yes, the researchers actually got the pictures from hot or not.com). The men who viewed the hot pictures were more likely to accept the smaller offer tomorrow than a larger amount in the future. They forgot about the future, the planning part of their brain wasn't thinking that far ahead.

Or to put it another way, a young guy is doing some shoulder rehab work and mobility exercises in a gym, an attractive female in yoga pants walks past, next thing you know he is doing max bench press and bicep curls and ignoring his shoulder health.

The researchers found no such effect with women looking at hot men, they were better at keeping a sense of perspective!

Imagine a calming blue ocean...

In another study (Delgado et al 2008), a group of people were asked to visualise a small money monetary reward, $4, or imagine something in nature that is calming and blue, while in an MRI scanner.

The people imagining the calming blue ocean had less activation in the reward centre of the brain and more activation in the control, future planning centre of the brain. They weren't thinking about the money they were going to get.

Now, this doesn't mean emotions are bad. In fact, people who have damage to the emotional parts of the brain make notoriously bad decisions or no decision at all.

The point of this is not that you should avoid hot women or imagine blue calming things, but how even the most basic visualisation and exposure to pictures can affect your brains activation centres and decisions.

What if you actually applied these principles in a much more in depth, sophisticated way?

Where the rubber meets the road.

This is what neuroscientist Sam McClure calls where the rubber meets the road. The practical advice arising from all these studies.

He also points out the hippocampus (where memories are made) is now known to be involved in prospecting about the future.

He recommends:

1) Envisioning future rewards. Make them easy to envision. Envision what the reward will do for your life.

So, really imagine how exercise and nutrition will make you feel and look.

2) Change how you frame things.

Frame rewards in different ways. See the exercise session as a reward in itself. Or in relation to food, demotivate appreciation of unhealthy foods, try seeing cookies like inanimate objects like a rock and think of green tea as a reward or treat.

3) Become more myopic in the way rewards are represented.

Attach more positive emotions to healthy foods. The self controlling dieters knew the junk food was tasty, they were just more focused on their goal and choose a 'less tasty' healthy option. Or even better make it so you see the healthy food as tasty and a rewarding. There are plenty of visualisation techniques to do this. Its just most people don't do them, and have no systematic approach.

And don't forget

'neurons that fire together wire together'

The more you use a pathway in the brain, the more you practice, the stronger the connection gets.

And one last thing, aerobic exercise is shown to activate that deliberate dlPFC part of your brain more. It becomes a self fullfilling prophecy, the more you exercise, the better your brain will get at decision making and planning!


Nuts and bolts are easy.

The fitness and nutrition industries have focused on the nuts and bolts, the programme, the recipe. But this is the easy bit, the nuts and bolts.

The hard part is making people stick with it. The future will be the coach who can change mindset.

Some visualisation techniques have been dismissed in the past as pseudoscience. However, neuroscience is now showing us how important envisioning and mindset are in framing your goals, seeing where you want to be and succeeding.

Lastly, associating the process itself as the reward. Taking pleasure in the exercise, looking forward to cooking that healthy meal. The people who stick with exercise are the ones who look forward to going to the gym or for a run. It becomes their passion, their reward.

Or as Adrienne of Yoga with Adriene said this week:

"The journey is the reward, the process is the candy."

Or for another excellent article I read this week about focusing on the process and forgetting goals by James Clear please click here 

In part 4 we will cover memory.

References:

Gazziniga et al (2008) Cognitive Neuroscience

McClure et al (2004) Separte Neural Systems Value Immediate and Delayed Monetary Rewards.

Hare et al (2009) Self control in dieters study.

Wilson and Daly (2003) Hot women cause men to discount the future study.

Kable and Glimcher (2010) We want things 'as soon as possible'

Interview with Sam McClure, Introduction to Neuroeconomics MOOC.

Forming new habits. Why is it so hard to give things up? Part 2.

Why losing things is twice as painful as gaining things.

In this series I am going to cover some of the behavioural science and neuroscience of forming habits, giving up bad habits, goals and rewards. I am going to come at it from a different tack possibly to the usual writings on fitness and nutrition, and at points I am going to extrapolate, stretch the science if you will, or apply some principles to exercise and diet that you may not have seen framed in this way before.

Human decisions are complex, the brain is complex(go figure), so there will be some simplification as necessary.

Over the next few posts I will cover the parts of the brain that deal with addiction and reward, loss and memory, making comparisons, motivation and decision making.

But lets break it down.

First up

Prospect Theory.

I've covered forming new habits before, see here for part one.

Essentially, I don't think the process of forming the new habit is hard. What is hard is the things you have to give up for the new habit to work.

It might be time you have to give up to go to the gym, this could be time when you normally watch TV or cruise the internet.

It could be some foods you have to reduce or give up and then replace with better alternatives. Despite what you may have read, you can't just eat what you want and lose weight, you may have to actually modify what you eat.

I am an example myself. Yes, I add in healthy foods, vegetables, green tea and all that but I still eat way too much cheese. Yes, there may be some addiction here (which I will cover in future posts) but basically I don't want to give it up.

If humans were following purely rational utility, then we would not eat the donut if there was an option of an apple as well. But as we all know, this is not always the case.

Most of these traditional theories of economics and utility ignore emotions but obviously your emotions have a profound impact on what you choose.

Human beings are risk averse and loss averse.

In some classic studies by Daniel Kahneman and Amos Tversky, they showed people when given a choice generally accept the less risky option. Even if they could possibly win more money, people generally go with the sure thing.

Two of their classic problems:
Which do you choose:
Get $900 for sure OR 90% chance to get $1000?

Which do you choose?
Lose $900 for sure OR 90% chance to lose $1000


Most people choose option 1 in the first problem and option 2 in the second problem, essentially for the same reason. People don't like losing things, they like the sure thing, but will take a risk if the sure thing could involve a loss.

In fact, most people find losing something twice as 'painful' as gaining something.

See the graph below.

Prospect Theory graph: Note how losing something causes twice as much psychological pain, as the joy of gaining something.

(The caveat being if you trade on the stock market and take class A drugs there is a chance you are not risk averse and are prepared to lose big time).

These studies are normally done in purely economic terms, you could win money, but what if we applied these ideas to fitness and nutrition?

If you are trying to develop a new lifestyle there is uncertainty and this cause emotional arousal.

Yes, logically you know eating healthier and  exercising is good for you But these are things that are going to happen in the 'future'. All the time you brain is making a cost benefit analysis.

To frame prospect theory in fitness and nutrition terms, as some people see it:

Which do you choose:
Give up an extra hour in bed, eating crisps and chocolate, sitting on the sofa when you get home OR the chance you may lose weight, feel better and possibly prevent a future disease.

Or when taking out a gym membership think of it this way:

Lose �40 a month for sure (gym membership fees) and you may get fitter and lose weight and prevent disease

OR

Keep �40 a month for sure (don't join a gym) and you might get fitter a lose weight by going for a walk everyday or may not develop those diseases anyway by doing nothing.


Some speculation on my part...

There is the potential loss of your old self or things you enjoy. This can fire off a part of the brain called the Insular Cortex. This part of the brain is also monitoring body states such as disgust, if you are eating something you find horrible then could this part of the brain fire. If you find exercise painful and not enjoyable then this part of the brain could again be active. Meanwhile the part of the brain that responds to reward and potential gains (the fabled dopamine response) could not be so active.

Going into a gym, getting out of your comfort zone, trying something new are all 'risky' things. And to begin with you may not perceive them as pleasurable, in fact they may be decidedly uncomfortable to begin with.

Where you Insular is, in case you were wondering.

Then we have the amygdala, the so called fight or flight part of the brain. But, it is a bit more complicated than this. The amygdala is also working out cost benefit (should I do this new thing, what is the cost, what is the benefit), fear conditioning and more.

Of course, if you start to really enjoy exercising, or enjoy the health new foods, and enjoy the feeling of being healthier and maybe carrying a little less fat, then the potential gain has outweighed the potential loss of Dominos pizza and 10 hours on the internet. But, the gain would have to be perceived as twice as much as the loss.

This also relates to what Kahneman calls system 1 and 2 of thinking.

In general system 1 is quick, emotional, intuitive and can actually make better decisions than your logical mind when there are a lot of factors to consider.

System 2 is slow and rational.

When you eat that donut, you are probably already licking your lips before system 2 has had a rational chance to start working.

People are not risky in all aspects of their life, for example, people can make sound financial decisions, wear a seat belt while driving and still smoke.

People normally view monetary risk in terms of the status quo, you don't want to lose what you've already got.

In terms of health and well being you have to re-frame it in your mind. Make the potential gains and benefits overwhelming.

So to re-frame one of the statements above:

Invest �50 a month in your health, add a new enjoyable activity into your life for 4 hours a week, try some new nutritious food and it is a sure thing your health and fitness will improve and you will probably live longer and have less chance of developing certain diseases (and look better naked!).

People make subjective probability choices rather than objective ones. For example, If people were being objective they would never buy a lottery ticket, and they would realize that something like a terrorist attack in the western world has a very low probability (which they will tend to overreact to, thanks media) whereas heart disease, cancer and type 2 diabetes have a large probability and people tend to under react to them.

Except, if they get a health scare, then some people modify behaviour but some people don't.

One thing Prospect Theory cannot contend with is regret and disappointment. The choice you should have made, that could have been an easy financial win but you were greedy. OR in terms of health, the small lifestyle changes you could have made that would have had a profound impact on your well being but you chose the status quo instead.

Why is that? Why would your brain let you continue on a path of behaviour that may result in its early demise?

Find out in part 3.

References:
Kahneman D (2011) Thinking, Fast and Slow.
Introduction to Neuroeconomics, How the Brain Makes Decisions, MOOC, Higher School of Economics(Moscow).

January ain't what it used to be.

Why the January gym rush wont happen this year.

There was a time in the fitness industry when everyone waited for January.

Sales targets were cranked up and everyone braced themselves. Most of the years finances were dependent on the first 2 months of the year.

People keep asking me if it is busy yet, are all the new people taking over all the equipment. The answer as always at the start of January is no.

The first 2 weeks of January in my experience are never that busy anyway. People stay away because they think it will be busy or they are still at home finishing off the last of the Baileys and Stilton before they can start their exercise plan.

The people you see in the gyms in January are normally returning members, people upping their number of visits, not substantially new people. Most of the people you seen in the gym in January are the people you saw all year round, they are just visiting more.

Everyone is posting up memes on social media of the January gym rush. Everyone expects it to happen, but it hasn't really happened like that in a few years. Everyone hypes it up, and this may put people off coming because they think it's going to be crowded.

This probably wont happen. Source: every fitness person on the internet

I don't think the rush is going to happen. The last couple of years I've noticed the rush in January isn't as big, and there is a much more even pattern of people joining throughout the year.

The busiest I've seen the gym I work in is actually in August, with all the students returning and working out.

I was training in a budget gym this morning, which has over 4000 members, it was quieter than normal. The same gym in December on a Wednesday afternoon, you couldn't move in the weights area for bro's.

Possibly, the public have got wise. The industry is now relatively old. Twenty years ago, no joining fees and joining a gym were a novelty. Now, the discounts are old hat, and most of the public are not so wedded to the idea of joining a gym in January. They have either 1) already joined one and stayed 2) Or have joined and dropped out so many time they realize this is not going to work for them.

I could be overestimating the mood of the general populous. As I would have thought everyone would have got wise to Boxing Day, Black Friday, January sales but they patently have not.

The market is also increasingly fragmented, 15 years ago, you either joined one of the big health club chains (Esporta, LA Fitness, Canons, Holmes Place - remember them?) or your local leisure centre or sat at home with your Davina workout DVD.

Now you can join a budget gym, sign up to 30 days of yoga for free on youtube, join a crossfit gym, go to a yoga studio, do clubbercise in your local hall, join a local micro gym, go to a PT studio, find a local PT online (with a professional looking website), buy a programme online, do a bootcamp in the park, have a gym in your garage, download an app, go for a run, buy a bicycle and joining a club or go for a walk.

A personal trainer friend of mine recently said January is good for gyms but not so good for PTs, people join gyms thinking they can do it themselves, realize they can't and then find a PT in March. He could be right.

I think January may not be so good for gyms anymore.

This is a good thing, as an industry and model we have matured, we have a more even stream of income throughout the year. We are not cashing in so much on broken dreams and promises.

I've noticed more and more gyms, local and multi site now offering 3 day and 5 day passes to entice people in, it seems to have overtaken the no joining fee sale. Probably because no joining fee is now available all year round, and no one sees it as a special offer anymore.

But the people who use your free pass in January are essentially the same people who use it the rest of the year (unless you are in a large town with a large turn over of population and a transient workforce).

In most gyms now, the cardio equipment is hardly ever all in use. The weights areas are full. You don't see anyone putting their towel on the screen to cover up the time, next to the sticker that says 20 mins only on a treadmill. The queue is for the power rack now*

This implies to me that most gym users are 'experienced' in some fashion, most newbies steer clear of freeweights areas and stick to cardio.

The people who go to the gym, go more and get more value for money, and the people who don't go, don't go at all.

The exception to this may be the budget gyms, that rely on 5,000 people not all turning up at the same time.

Something is shifting, the paradigm is changing, and something is going to happen but I'm not sure what yet.

Fitness companies and trade magazines will naturally remain buoyant in their appraisal of January and February and the market penetration and number of people joining. But that doesn't help move things on.

I hope when sales targets are missed and income levels drop, companies don't try and do more of the same, make more calls, give out more free passes. The game has changed. The strategy needs to change too.

Of course, I could be wrong. You could go to the gym next week and it is full of newbies and all the equipment is in use. In which case, welcome them, we were all beginners once.



*Freeweight areas are much busier and cardio areas much quieter in gyms: I've noticed this in the gym I work at, a local independent gym but more importantly at a large budget gym I go to. This budget gym has a whole floor of cardio equipment, 20 plus treadmills etc, and it is hardly ever more than half full, and mostly empty. Whereas, the floor with all the resistance machines and freeweights can be very busy and full. Walking in this gym, it is like going back 20 years, the cardio area is mainly women and older people, the weights area is 99% young guys with the occasional women venturing in; hats off to them for not being intimidated by the bro 'love in' and skinny jogging bottoms. I'm pleased to say where I work the freeweights area has just as many women in it and sometimes more women than men, all credit to the coaching team for achieving this. It's easy to forget that some parts of the industry haven't moved on and certain things are still not the norm.

The Shadow of the Future*

Near Year. Always new beginnings.

Everyday a new beginning.

You will start something with good intentions, and give up and fail. It doesn't matter. Begin again.

You will write down goals that you will miss. Begin again.

You will start something and succeed.

You will achieve something.

Lose weight, get fit, enter a 5k, 10k, 50k, climb a mountain, read a book, learn an instrument, start a course, learn to cook. You can choose to start whatever you want to. You can begin something new now.

The edited highlights of someone elses life on social media will make you feel like you are missing out. You are not.

The perfect filtered picture on instagram will make you feel that you are not good enough. You are good enough.

You will promise yourself you will eat healthier and exercise. You will fall off the wagon. Begin again.

You will be scared and anxious and wonder if the rain will ever stop. But you will get up and begin another day.

Other people will be scared and anxious and frightened. They will not tell you this.

There will be lost loves and lost opportunities.

There are other opportunities. Do not squander them.

You will lose someone you love. There will be someone who loves you.

You will try your best. But at times it will seem half arsed. It doesn't matter. Begin again.

You will have an argument with someone you care about.

You will say something stupid and dumb. You wont know why.  Don't worry, this is not who you are. You will try and be better and more understanding. Be better. Begin again.

You will be misunderstood and you will misunderstand other people.

You will cut someone up in traffic. You will be cut up in traffic. There will be cancelled trains, and delayed planes and crowded stations. They are only moments. They will pass. You will begin again.

You will do a good job. You will do a bad job. No matter, either way begin again.

These moments will not define your life.

Someone will make you laugh out loud. You may cry.

You will forget something important. You will remember a pointless fact about a TV show or song.

A celebrity will die. A celebrity you've never heard of will get married or divorced.

There will be a war in a place you've never heard of, and people will die.

And millions of people will be kind and generous. And it wont be reported.

Someone will sit on their ass and not do a damn thing. This does not affect you.

Your goals are your own. Do not do them for other people.

Your failures are you are your own. Do not blame others.

You will make mistakes. Accept, apologise if necessary. Begin again.

Governments will change and fall and you will get up and go for a run as usual, roll out your mat or lift that weight.

There will be someone you will never speak to or see again.

You will meet new people. They will meet you. You can't trust your internal voice and they can't trust theirs either.

Someone will say something that pisses you off, or will be a dumbass. It doesn't mean that is who they are. Let them begin again.

Give people the benefit of the doubt. But don't accept dogmatism and hatred.

Choose weightlifting, or running, or yoga, or powerlifting, or walking, or cycling. You can choose your path. It is okay to change your path.

Don't hate yourself because you ate a dessert or missed a training session or got drunk.

You are not a bad person because you ate a chocolate bar.

Be kind to yourself and begin again.

Everything you will ever know or experience will be from a first person perspective.

You can let the past cast a shadow or you can let it go.

The shadow of the future has no shape yet.

You don't have to be the same person you were yesterday. You can wake up  and start again. Brand new.

You will forget all this in the heat of the moment.

All you can do is try your best.

Only one outcome is certain.

Every moment, every breath is an opportunity to begin again.

Start now.

Get some perspective.

*The shadow of the future is a term from Game Theory. In Game Theory you generally have the chance to co-operate with an opponent or be selfish and make a pre-emptive strike, but they could also do the same. However, if you are likely to meet the person in the future it is always best to co-operate. In general a strategy of 1)Be nice 2)Reciprocate 3) Don't be envious 4) Don't be too clever, always outperforms all other strategies in Game Theory. Life lesson - always start by being nice to people, and co-operate where possible. Plus 'The shadow of the future' is a cool title.

My Best Books of 2016

This is my list of the best books of 2016. Most were released in 2016 but a few were not, but this happened to be the year I read them.

I have broken the list into non-fiction, fiction and biography. Hopefully it will give you some ideas if you are looking for something to read.

Some books I read.

Non-Fiction.

My non fiction reading this year was dominated by the 'smart thinking' genre, how to improve your ability to learn new skills and be more productive,  as well as a smattering of neuroscience.

So without further ado.

Peak: Secrets from the new science of expertise by Anders Ericsson and Robert Pool.

Eric Anderson is the guy who did the research that led to the popular idea (myth) of 10,000 hours of practice to be an expert in something.

In the book he goes into much more detail than the authors who have quoted him. He gives you all the research and practical advice on how to engage in purposeful practice and deliberate practice.

This is a must for coaches. Reading through the quotes I highlighted I realised I need to read this again.

There are so many gems in this book, but here are two.

Quotes:

"...whenever possible, the best approach is almost always to work with a good coach or teacher. An effective instructor will understand what must go into a successful training regimen and will be able to modify it as necessary to suit individual students."

"The hallmark of purposeful or deliberate practice is that you try to do something you cannot do - that takes you out of your comfort zone - and that you practice it over and over again, focusing on exactly how you are doing it, where you are falling short, and how you can get better."

Deep Work by Cal Newport.

I have written about this book before here.

In the age of distraction to focus and do quality work you need to remove yourself from environments that don't work for you.

Newport suggests quitting social media, which I have done a few times (easier said than done) limiting emails, and avoiding the open plan office working space ( I can attest to the fact it is the least productive environment in the world).

Hats off to Newport for coining the term 'pseudo-work' which is what most people are doing most of the day; reacting to email, looking busy but not actually doing anything.

I need to employ Newport's strategies in 2017.

Grit: The power of passion and perserverance by Angela Duckworth.

In short, successful people stick with things and don't give up easily.

I found Duckworth's book more anecdotal than Ericsson's, and at one point she interviews Ericsson and asks him how to improve her running, he recommends she gets a coach!

Quotes:

"The bottom line on culture and grit is: If you want to be grittier, find a gritty culture and join it. If you're a leader, and you want the people in your organisation to be grittier, create a gritty culture."

"As any coach or athlete will tell you, consistency of effort over the long run is everything."

The Art of Learning: An inner journey to optimal performance by Josh Waitzkin.

This got mentioned in the Learning How to Learn MOOC weekly email.

Written by a guy who became a chess champion at a very young age and then became a Tai Chi champion.

He tells you what strategies he employed to get there. I actually enjoyed the chess sections the most.

Quote:

"The secret is that everything is always on the line. The more present we are at practice, the more present we will be in competition, in the boardroom, at the exam, the operating table, the big stage. If we have any hope of attaining excellence, let alone of showing what we've got under pressure, we have to be prepared by a lifestyle of reinforcement. Presence must be like breathing."

The Idiot Brain: A neuroscientist explains what your head is really up to by Dean Burnett.

Covering such things as why you get motion sickness, why clever people lose arguments, why you get addicted to things and why your memory is unreliable.

Written for the lay person, the author explains neuroscience concepts really well, and I also like the British sense of humour that the author has.

Pivot: The only move that matters is your next one by Jenny Blake.

I like the central premise of the book. You don't have to completely give up what you are doing now, you can pivot out of your current situation (if you so wish) with a more low risk strategy of side projects and a plan.

We don't all work at Google or in offices but the strategy is overall a good one.

Do Fly: Find your way. Make a living. Be your best self by Gavin Strange.

I really like to 'Do' series of books, they are easy to read, you can read them in less than a day. They are deceptively simple but full of good advice.

The are also really well designed in terms of layout and graphics.

Excerpt from Do Fly.

Fiction.

I don't read much fiction, one of my goals for 2017 is to read more fiction. But here are the stand out fiction books for me.

The Circle by David Eggers.

Imagine a world in the not too distance future (as in now) where a corporation that is a combination of Facebook and Google controls everything.

If you like Charlie Brookers Black Mirror you will like this book.

It has been made into a film due for release next year. So read it now before the film comes out and you can be one of the cool kids.



Led me to also read his first book A Heart Breaking Work of Staggering Genius, an autobiographical novel where both of Egger's parents die and he has to bring up his younger brother.

Quote:

"Your comment on things, and that substitutes for doing them."

Stoner: A novel by John Williams.

Published 50 years ago. Tag line: the greatest book novel you've never read.

The prose in this book is stunning, one mans entire life. Not a heros life, but an ordinary, average, heart breaking life which most of us lead.

Biography.

Born to Run by Bruce Springsteen.

Because its Springsteen autobiography, enough said.

But it turns out his early life is a mixture of On The Road and Bukowski characters with prose to match.

If you want to see an example of Ericssons purposeful practice in real life then read Springsteens book. That's how you become good at something.

If I had read this when I was 18 I would have probably headed west and slept on the beach with my guitar.

Quote:

"Back east we usually experience the freedom that comes with a good snowstorm. No work, no school, the world shutting its big mouth for a while, the dirty streets covered over in virgin white, like all the missteps you've taken have been erased by nature. You can't run; you can only sit. You open your door on a trackless world, your old path, your history, momentarily covered over by a landscape of forgiveness, a place where something new might happen."

Which is kind of how I've always felt about snow but never managed to articulate like Bruce does.

That's the list for 2016.

And in 2017.

I still have a few books I need to finish reading. Neurophilosophy and the Health Mind by Georg Northoff and Decisions, Uncertainty, and the Brain: The Science of Neuroeconomics by Paul Glimcher. These are part of my project to see if you can teach yourself the equivalent of a masters degree in Neuroscience. (Which I will write about another time).

I also have a plan to read more fiction. I have a list of classics to read, you know the ones that always appear on the greatest books of all time lists.

So far I'm thinking:

Tolstoy - Anna Karenina or War and Peace
Dickens -  David Copperfield or Great Expectations
Proust -  In Search of Lost Time (started but never finished)
Steinbeck -  Grapes of Wrath
Hemingway - For Whom the Bell Tolls
Hunger by Knut Hamsun
Anathem by Neal Stephenson, which I saw mentioned somewhere.

And today I bought Fiesta: The Sun Also Rises by Hemingway, so that will be the one I start with.

Non fiction:
The Man Who Mistook His Wife for a Hat by Oliver Sacks
Why Zebras Don't Get Ulcers by Robert M Sapolsky.

I better start employing Cal Newports ideas if I'm going to fit all these in!


What do you plan on reading, what are your top book recommendations for next year? What fiction books should I add to my list? What inspired you in 2016?

Top 6 Cardio Exercises of all Time!

Everything comes full circle. 30 years ago it was all about aerobic exercise. Then in the last 10 years there was a backlash - anything above 5 reps was cardio, and there was no need to do steady state cardio. Then all you needed was HIIT and Tabatas. And now LISS is back being mentioned by strength coaches.

As always, the truth lies in the middle way. There are numerous benefits to cardio exercises and doing some is a good thing. In fact the number one thing you can do for your brain health and memory is aerobic exercise, it's way better than any smart drug.

So without further ado here is my top 6 cardio exercise choices. I have tried to have a selection that incorporates things that require no equipment, and things you can do in the gym (depending on how well equipped your gym is). These happen to be the things I like.

Number 1: Walking.

Walking is the best exercise you can do for your health. It is good for heart and lung function, improves blood sugar levels and even more impressively

Walking also

• Improves memory
• Can make you more creative
• Can help ease depression
• Can prevent and help you recover from back pain
• Being outside may even help improve your eyesight and prevent myopia!
• Plus walking outside means you will be synthesizing vitamin D, which has a whole host of health benefits.

You can walk 20-30mins a days, it requires no special equipment.

If you are a beginner or looking for something with all round benefits and low injury risk then walking should be your number one choice.

Top Tips: 

Walking in nature has been shown to improve cognitive function (memory) and has a calming and peaceful effect. It improves memory over and above walking in an urban environment.

Also walking on uneven ground will help strengthen ankles, proprioception and is therapeutic for the lower back, and is a more interesting than pounding the pavement.

Stuart McGill (2002; 83) has shown that walking with a backpack weighing 10kg on uneven ground has actually been shown to REDUCE compression on the spine and relieve symptoms of certain types of back pain.

Make sure you swing the arm from the shoulders and no window shopping walking!

Number 2: Stairmill.

Aka stairmaster.

I made sure we got a couple of these for our gym 4 or 5 years ago. Now I see they are becoming more popular for good reason.

This is my number one choice for gym based cardio exercise. There is nowhere to hide on the stairmill, you can't drift off or coast. You are relentlessly walking up stairs. Your heart rate goes up with very little impact on knees and hips.

When training for long ultraruns the stairmill was part of my cross training.  As anyone who has run an ultra in a mountain environment knows at some point you are going to hit a hill that you are going to have to walk up. I would say it prepared me for long power hikes up hills and mountains better than almost anything else.

Top Tips:

Try not to hold on. This may be difficult at first as you have to concentrate on not missing a step. Or try not holding on for a minute at a time at lower levels.

To increase difficulty and to prepare for mountain races where you are carrying your gear try it with a weighted vest; 30 mins with a 10kg vest on will make you a believer!

Number 3: Hill sprints.

I think I first got these from running coach Brad Hudson, where he uses them at a start of a running phase to build strength.

Go for very short sprints, 8-10 secs.  Start with 5 sets, build up to 10. After a warm up jog to the hill, start with some build up sprints. Recovery is a slow walk back to the start. All you need to do is find a steep hill.

The mechanics of sprinting are much improved for most people uphill compared to the flat. The chance of muscle pull or injury sprinting up hill are much lower. Lets face it, most of us (including me) haven't been coached to sprint, and running uphill helps you to engage posterior chain muscles and drive hard.

Top Tips: 

Find a hill outside. You can do these on a treadmill, but the time it takes you to increase and decrease speed on a treadmill is not conducive to short sprints. If you are using a treadmill go for 5-10% gradient.

If outside, find a hill, if you can find a long hill, 1 mile or longer, you can gradually make your way up the hill.

Number 4: Ski Erg.

From the people who brought you the most reliable piece of cardio equipment ever, the Concept 2 Rower, comes the Ski Erg.

Cross country skiing is a phenomenal cardio exercise, and in fact the only winter sport I can do without falling over every 10 seconds, and the only one I've ever received any coaching for. But unless you live in Norway actual cross country skiing is not a cardio option.

Not many gyms have Ski Ergs yet, and I've only just used one, but it is well worth it. One of the few cardio exercises that truly is hitting the upper body, I actually got a tricep pump!

It's a good finisher after a workout, seems to help to get the blood flowing in the upper body.

Or do some intervals, 10-15 secs with 45-50 sec recovery. 5-10mins on this machine is enough, unlike walking or the stairmill I wouldn't be doing this for 30-60 minutes.

Top tips:

If you don't know how to cross country ski, watch some technique videos online of the Ski Erg or even some pro skiers using the double pole technique. You can vary the technique on the machine, one leg at a time like skater technique of cross country, alternate arms like classic cross country or double pole for maximum power.

Get a full body extension and hinge at the hips.

Number 5: Versaclimber.

A total body exercise. They haven't changed the design of this machine since the original Robocop was released, and it is over priced if you are going to buy one, but nothing takes your heart rate up like this.

A cross crawl movement pattern, engaging upper and lower body. This is hard, use as a finisher or in a conditioning workout or at the start of a stubborn fat loss protocol workout, anymore than 5-7 mins and you are doing well.

Top tips:

The handles adjust. Try different lengths of pull and stride to see what works best for you.

Number 6: What you enjoy.

Of course, the best cardio exercise is the one you enjoy and have access to. If you like mountain biking or rowing do those. Or it could be badminton or a studio class like spinning.

The best exercise is the one you do.

Nearly made the top 6:

Other things to consider.

Skipping:

Didn't make the top 6, as some people don't seem to be able to skip, therefore they don't really get any cardio benefit from it. I guess that's why Gray Cook called it a 'self limiting exercise'. If you can skip and have access to an area with a good surface to skip on, it's a great exercise.

Prowlers and sleds: 

If you have access to these with an indoor track I would definitely use them. If you don't, hill sprints are the way forward. These days it is more likely that your gym has a prowler or sled than it does a Versaclimber or Ski Erg.

Also I would consider prowlers and sleds hybrid exercises. Go light and explosive or go heavy and use them as a strength exercise or hypetrophy training.

Get moving.

Your body doesn't know how you got your heart rate up. As long as you are using a mixture of some low intensity longer and higher intensity shorter work you'll be covered.

What's your favourite cardio exercise, is it something I haven't thought of? Let me know.


References:

http://sites.lsa.umich.edu/jonides-lab/wp-content/uploads/sites/439/2016/10/2008_2.pdf

http://news.stanford.edu/2014/04/24/walking-vs-sitting-042414/

https://www.scientificamerican.com/article/regular-walking-can-help-ease-depression/

http://www.health.harvard.edu/blog/regular-exercise-changes-brain-improve-memory-thinking-skills-201404097110

http://www.marksdailyapple.com/sunlight-myopia/

http://www.nhs.uk/news/2012/04april/Pages/walking-treatment-depression-symptoms.aspx

http://www.nature.com/news/the-myopia-boom-1.17120

McGill S (2002) Low Back Disorders. Evidence Based Prevention and Rehabilitation.