Kettlebells are Still Overhyped

or

Why Fitness Fads Annoy Me

I recently came across this article on “9 Kettlebell Exercises for Everyone” and it is typical kettlebell ad copy (propaganda?).

It starts with:

Everyone can benefit from kettlebell exercises. Kettlebells have a unique shape which lets you blast your body in ways dumbbells can’t. You can pull, push, twist and swing kettlebells to get leaner, stronger and more powerful. Plus, kettlebells are easier on your wrists than dumbbells. Also, because of their offset weight, the gravitational pull of a kettlebell goes straight down, instead of from side-to-side with a dumbbell (which is shaped like a teeter-totter).

Let’s break this apart.

  • Everyone can benefit from resistance exercises. Kettlebells are not a special kind of mass. Ask a physicist. Or an exercise physiologist.
  • “Blast your body in ways that dumbbells can’t” is such advertising nonsense that I’m surprised that there is not a link to a product the author makes money off of.
  • Any kind of resistance can “pull, push, twist or swing”. Kettlebells are still not special.
  • Every kind of resistance training can help you get “leaner, stronger and more powerful”. If programmed correctly. Kettlebells actually aren’t good at power!
  • How are kettlebells easier on the wrists? No explanation is given.
    • Kettlebells are harder on your hands though, because the handle will twist against your skin causing more abrasion and callouses.
  • Uh, the gravitational pull of a dumbbell is also straight down. That’s how gravity works. Not side-to-side. This is a made-up problem about dumbbells.

Not an auspicious start.

So, what are the exercises?

Exercises with Kettlebells

There is only one Kettlebell Exercise™©®, Bottoms-Up presses. It’s the only exercise where the unique characteristics of a kettlebell are both necessary and useful. An argument can be made also for the swing. But I don’t buy that argument.

Everything else is just exercises that can be done with kettlebells. All of these existed before kettlebells were getting hyped. All of them can be done well with dumbbells or barbells. These exercises, done with barbells and dumbbells, are used for athletic performance development and have demonstrated track records (literally) of being the best approach for athletic development.

So what exercises made the list?

In the linked article we see the following:

  1. Deadlift – like seriously, that’s where you start your article? The deadlift is an exercise clearly best done with a barbell, as that let’s move the most weight. Do you want to do a deadlift with form that mimics the kettlebell? Great, do sumo deadlifts. Problem solved.
  2. Swing – the other exercise that is arguably better with a kettlebell besides the bottom’s up. But this exercise was done with dumbbells before kettlebells. And using a KB causes rotational stresses on your hand that rip up your skin. Some folks find this manageable but other don’t.
  3. Squat – you are limited by your ability to get the weight into place, an upper body limitation more than a lower body limitation. Barbells do this better. And the version depicted – goblet-style – can be done just fine with dumbbells.
  4. Snatch – NO. Just no. Unless you actually compete in kettlebell snatches there is no good reason to do them. They risk breaking your arm for no benefit. Even if you don’t break it, you’re going to get bruises and welts from the weight landing on your forearm. Do them with dumbbells for the exact same fitness benefit without the risk. Or do them with barbells to really train power. The weight limit imposed by doing them with KBs means they can’t do a good job of training power.*
  5. Clean – can be done with dumbbells. Are better done with barbells. Rotating sleeves. Higher weights. Better outcomes.
  6. Turkish** Get-up – can be done with dumbbells. There is no benefit to doing them with kettles.
  7. Push-press – do I have to repeat myself at this point?
  8. (kneeling) Halos – Can be done with anything. I’m not sure why these are being shown kneeling. No explanation is given. Also, do I really want to “blast my core”? What does that even mean?
  9. Counting error in original article. Seriously.

Cults

Seriously. The kettlebell gets pretty cult like. They have certifications and instructors and competitions and great ad copy. They charge a lot of money for a cheap lump of iron.

Nothing does everything well

I love barbells. I own four, and lots of weight to go on them. I do a lot of barbell exercises. And I acknowledge their limitations. Anyone that says something is good for everything is wrong. And they are probably selling something.

Fitness Objectives

On this blog I’ll talk about strength training or cardiovascular training and similar terms. Where we focus on the fitness objective in defining the exercise, instead of focusing on the tool. And that’s one of the big differences between a sensible training program and exercise fads.

 

Also, I’ve talked about kettlebells before on my old blog: Fight with All Your Strength.

 

* Also, the idea that a one paragraph description of how to do a KB snatch is sufficient is just irresponsible and dangerous. The author wrote more on the push press than the snatch.

** I’ve been worried for a while now that this term is racist, just because of human history. But I can’t find anything on that. And what I can find about just it’s origin is inconclusive.

Bad News Everybody!

or

On How I Continued Strength Training with a Broken Finger

About a month ago I broke a finger. My right index finger, proximal phalanx. Yes, I’m  right-handed.

I broke it sword-fighting. (For those who don’t know I do Historical Fencing at Athena School of Arms.) My opponent’s sword hit a gap in my protective gear. The hit split my skin all the way down to the tendon. There was a visible, longitudinal defect in the tendon – that I got to see in the ER. And there is a diagonal fracture along the length the bone. Minor as far as fractures go – not displaced or open.

And so I was put into a heavy duty splint. It immobilized me from the tip of the index finger down to the carpal bones. With the middle finger included in the finger splint, almost like buddy taping the fingers. And it wrapped around the base of my thumb. I could barely get my thumb and pinky finger to grip.

But I Did Strength Training Anyways

I’m not convinced the OT who created my splint would have really approved of my exercise routine, but . . .

There was no chance I was going to stop unless it was impossible.

Lower Body Strength Training

Squats, and variants thereof, were alright, it was just harder to grip the bar solidly to stabilize it. I’ve just been concerned with the fail state – if I had to ditch the weight I can’t move my hand out of the way as easily as usual.

Deadlifts are right out because I can’t generate the grip strength necessary. So I replaced them with barbell hip thrusts. It’s possible to move a surprising amount of weight with this. I’m up to almost 300 pounds with this. Single-leg deadlifts were still doable because the weight was light enough to grip.

Upper Body Strength Training

This is where it got interesting. I couldn’t do any pushing exercises because the splint came down across the heel of my palm by the thumb. And of course I had trouble gripping for pulling exercises!

I solved this with a lifting hook. This is like the more common lifting straps, but I went for something more intense, these: Lifting Lab Weightlifting Hooks. These put almost all the pull into the strap around my wrist letting me do pulling exercises pretty close to normal. I even reached a point where I could do pullups!

The other workaround I used was to put an ankle strap around  my wrist and use a cable column machine for flyes, reverse flyes and front raises. This allowed me to target both the pecs with the flyes and the deltoids with the raises. Thereby covering the same muscles I would work with typical pushing exercises. This preserves the muscle performance.

When I got back to bench press last week my plan had worked and I had maintained nearly 100% of what I was at when I broke my finger (5 pounds away from finally benching 2 plates!)

And the reverse flyes hit the mid-back muscles until I was able to return to doing rows instead.

Olympic Lifts

. . . were right out. Boo. But I continued with box jumps to keep up my lower body explosive power.

Progress

At my follow-up appointment last week the splint got reduced to just a finger splint, freeing up most of my hand and allowing me to go back to doing regular pushing exercises. Hooray!

Finger splint

After a few weeks like that and now I can even take the splint off and type normally.

The Physical Therapy Attitude

I didn’t let my injury stop me anymore than absolutely necessary. I kept up with every exercise I could and adapted those that were not doable in the usual manner. A big part of what I see physical therapy as being good for is this concept of maintaining function and adapting instead of stopping activity. We keep people moving. No matter what (almost).

Good News Everybody!

After half a year of job hunting I’m finally employed as a full-time physical therapist. I am working at ProSports Therapy in Waltham. It is an outpatient clinic with a primarily orthopedic patient population. I appreciate working alongside a Boston Sports Club because it gives me access to the sort of equipment necessary for working at higher levels, especially with athletic patients.

It may seem odd but I’ll probably post more now that I’m working full-time. The job hunt was incredibly stressful and depressing for me. And left me feeling unmotivated.

Now that I’ve got patients to discuss I’m happy to be looking up research and thinking about physical therapy.

Woo hoo!

Medical Marijuana and “What’s the Harm

Recently I posted this article on my Facebook: Marijuana Beliefs Outstrip Evidence. I summarized a key point thus, “The only use for which marijuana has reasonably good evidence of effectiveness is for nausea.”

Note, I am all for removing marijuana from schedule 1 of FDA regulation and allowing for comprehensive research of the ways in which marijuana derived substances can be used medically. However I am firmly of the belief that they should go through the exact same FDA process as all other drugs.

The responses I got were predictable. One of the key points made by many was that if it helps people then what’s harm? I am going to set aside the point that it’s not helping most users and focus on the old “what’s the harm?” gambit. It is a standard part of the responses to criticism of alternative medicine.

So, What is the Harm?

If a treatment is just a placebo, and does not provide actual benefits then these are the harms that may result:

  1. Money. These are hardly ever free. And especially in a country where medical expenses are the most common cause of personal bankruptcy the cost of a treatment that doesn’t work is harm.
  2. Time. The time spent going and getting a treatment done, transportation etc. are all costs for the patients and these are things that have a tangible monetary value and therefore refer back to the above point. Is the patient giving up time at work spending, money on transportation and so on? If so that is a very real harm.
  3. Delayed treatment. If a person delays getting effective treatment because they mistakenly believe that this placebo is actually treating their condition then that is an unambiguous harm which has demonstrable negative effects in a wide variety of diseases.
  4. Side effects. Marijuana very clearly has side effects if we are viewing it as a medicinal substance. It is used specifically for its mind-altering effects. Remember the point of this drug originally was that it got you high, that you are stoned while you’re taking it. This is incompatible with most jobs. And even when it’s not it’s still constitutes a set of risks. FDA-approved drugs go through a risk assessment process comparing the benefits to the risks. And as detailed in the linked article above there are very clearly side effects from marijuana use.
  5. Purity and content testing. FDA approved drugs are rigorously tested for their purity, that is their absence of toxic substances and adulteration. As well as that the medication actually contains what it says on the package. Marijuana for medical purposes lacks all of these protections.
  6. Addiction potential. While marijuana does not have the same addictive properties that opioids do it still possesses a risk of becoming habit forming, as can any behavior, especially when it is a mind-altering one such as marijuana use.

This list is not intended to be comprehensive. But does at least hit the highlights of the potential harms of medical marijuana.

An additional range of harms from the current approach to medical marijuana also includes the fact that it increases the danger to children for accidental ingestion and poisoning, especially with the prevalence of edibles and related products that are in similar packaging and have similar names to candy, as detailed here: More Marijuana More Problems for Young Children.

Conclusion

Ultimately, my position on this topic is that all medical treatments should be subject to a uniform study and approval process. The FDA is not perfect but they have a very good track record. The objective should be to lobby for marijuana to be removed from Schedule I, not to create a carve out from regulation where marijuana gets a free pass written by legislators.

Links: Processed Food and Disease

One of the other blogs I follow is the Angry Chef. I aspire to be as entertaining as that blog. But also to be seen as serious – which I think are mutually exclusive goals.

Recently posted was a two-parter about “Ultra-Processed Foods” and the dietary guidelines of Brazil and the World Health Organization.

Rise of the Ultra Foods, part 1 and part 2.

I encourage you to read them. But the short version is that the new nutrition guidelines of Brazil have a lot of positive characteristics about them. They encourage enjoying food, acknowledge the cultural and familial components of eating and meal times. These are good things. But they also go off on the concept of ultra-processed foods. Which is never defined. And the available evidence just doesn’t support the idea that UPF are inherently problematic

There exists this anti-chemical strain of though that modern processing of food is intrinsically bad. Because chemicals or something. That somehow the rise of lifestyle diseases like cardiovascular disease and diabetes are because of the chemicals and not calories and poverty.

There is already an enormous body of evidence that calories consumed are the primary driver of increased lifestyle diseases. And that the biggest confounder in this type of research is the known effect of poverty on health outcomes as well as on food choices/availability.

All of the various safety studies of chemicals used in processing food fail to show any evidence of harm.

Why then should we consider the idea that the “real” problem is processed foods? Well, as The Angry Chef points out, at least one researcher is actually performing a study to address this question. As opposed to just blaming the chemicals. It’s a randomized controlled study comparing matched diets of processed and not processed foods. Here’s the study at ClinicalTrials.gov.

I await the results of this study. And will update my understanding of the topic based on the results if they show that I’ve been wrong so far.

No. I Prefer Food. Not Protein Powder.

I asked a colleague if she had any suggestions for topics. She suggested protein powders.

I said, “ugh, no. I prefer food.”

So she suggested I explain why. And fine, I will.

Protein Powder for Strength Gains

The basic concept behind protein powder and supplements is that they “help” or are even necessary for strength training. Because you need sooo much protein (I resisted the urge to insert an eyeroll emoji). I saw some pretty big numbers for protein requirements for strength training, as big as 400g per day! And if you really believed those numbers then sure, protein powder would help you hit that number.

To the research!

How much protein do people need? The USDA gives a value of 0.8 g/kg/day. This number is set to be sufficient for 97.5% of the population. Let’s assume that people who are serious about strength training make-up the 2.5% who need more (not actually a reasonable assumption, but let’s pretend). But remember that plenty of folks actually need less than the RDA.

The American College of Sports Medicine (ASCM) recommends (PDF) 1.2-1.7 g/kg/day for strength training. With a floor of 1.5 for novice lifters recommended by the National Strength & Conditioning Association (NSCA).

Published research from the National Health and Nutrition Examination Survey (NHANES) shows that most people are getting enough protein. The average American is actually already getting enough protein to be engaged in serious strength training without having to change their diet or add protein powder/supplements.

The exceptions found in the NHANES study were that a small but significant number of adolescent and elderly women who were not getting enough protein. That’s it.

If most people are getting enough without doing anything extra then why is there such a business in protein powder sales?

Protein Powder is Easy

If you’re worried that you’re not getting the gains you want then protein powder provides an easy route to thinking you’ve solved the problem. Just buy something and you’re all set! You don’t have to actually analyze your diet, activity, form or program. Just buy something.

But protein consumption doesn’t trigger muscle building. If I deliver a bunch of construction materials to a local builder they aren’t going to just build a building because I provided the supplies. And you won’t build muscle just from eating protein. You need to do the strength training. You need to have a sensible program, with proper rest periods and enough work etc.

From looking around the gym it seems like a lot of the folks who are consuming the protein powder are already doing a reasonable program and are probably doing just fine with building muscle. In which case the powder is just a placebo. It does nothing but helps them feel like their approach is great. That feeling that they are doing all the right things probably helps with motivation and effort – which improves the outcomes. But the powder still isn’t actually helping.

But why not use it, just in case?

Because it’s false.

Because it’s a waste of time.

Because it’s a waste of money.

Because it causes some people digestive problems. And telling those people they “need” to do it is a problem.

Because facts matter.

But maybe I’m not getting enough protein.

Then use MyFitnessPal and check. The app is free, unlike the powder. Or any other fitness and nutrition app – I can personally vouch for liking this app and finding it useful and having heard almost universally positive reviews.

Odds are you are getting enough protein, though.

Don’t use the target number the app generates. Use the math above.

Vegetarians and Vegans

Folks with these types of diets are more likely to be not getting enough protein. For meat eaters it’s pretty easy to get enough protein. For non-meat eaters is frequently takes a bit more effort and planning. But it’s still perfectly possible to do so just using food. And they need to make sure they’re protein sources are complete, which most vegetarians and vegans seem to already be aware of. Vegetables and fruits do have protein and a quick Google search brings up plenty of lists of high protein plant foods.

Conclusion

Protein powder is unnecessary and if you really are having trouble getting enough with the foods you are eating then I encourage you to first try upping your intake of protein rich foods to hit the goal. In particular vegetables and fruits. The real reason for preferring food though is the benefits of the micronutrients and fiber contained in the food. Both of which are good for health.

Bibliography

Fulgoni, V. L. (2008). Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003–2004. The American Journal of Clinical Nutrition, 87(5), 1554S-1557S. https://doi.org/10.1093/ajcn/87.5.1554S
protein-intake-for-optimal-muscle-maintenance.pdf. (n.d.). Retrieved from https://www.acsm.org/docs/default-source/brochures/protein-intake-for-optimal-muscle-maintenance.pdf
Szedlak, C., & Robins, A. (2012). Protein Requirements for Strength Training. Strength & Conditioning Journal, 34(5), 85. https://doi.org/10.1519/SSC.0b013e31826dc3c4

Appendix: Looking at Online Searches

I expected to find that most of the links I clicked would overestimate protein needs. And perhaps my results are associated with my search history and particular search terms, but I was pleasantly surprised to not find that. In fact WebMD even low-balled the protein estimate (and didn’t even say I had cancer!). Many of the sources I found just quoted the USDA and/or ACSM recommended numbers, which is encouraging.

But the hits weren’t all good. Strength training oriented sites (like BodyBuilding.com) tended to recommend higher amounts than actually needed. With the International Sport Sciences Association (ISSA) recommending 2-3 g/kg per day. Which is almost double the actual need. The reason I highlight this is the fact that ISSA does personal trainer certifications. Which shows that the cert isn’t necessarily a reliable indicator of knowledge. (I’ll also point out that they provide references for the rest of the info on that ‘myths’ page but have no reference for this recommendation.)

In general the hits I got were for sites emphasizing the need to get enough protein and generally taking the attitude that you need more or need to make sure you’re getting enough. But the reality is that most people already are. So the emphasis is all out of whack.

Benefits of Strength Training

I’ve written before about the benefits of strength training, on my previous blog. Now recent research backs up one of the reasons I’ve long suspected.

As I’ve brought up before, it’s important not to over-interpret preliminary evidence or attempt to extrapolate from basic science to clinical reality. So while I’ve long suspected that strength training would have a benefit when it comes to diabetes development, I’ve avoided actually saying that.

And so it’s always nice when the clinical studies back up what I suspected. Hooray!

One of the things I learned from my exercise physiology education was that strength training upregulates GLUT4 on muscle cells. GLUT4 is an insulin triggered transporter for glucose. This means that strength training increases the ability and sensitivity of the of the muscle cell to take glucose out of the bloodstream and put it in the muscle cell.

Theoretically, this should reduce the likelihood of diabetes. But does it?

To the research!

I recently came across this study from JAMA: A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men. The large Health Professionals Follow-up Study was used to track physical activity in 32,002 men for 18 years. Any physical activity reduced the risk of developing or dying from diabetes. Strength training was more effective than cardiovascular training. Both was better than just one.

Things to note about why this research is notable for this conversation:

  1. The size of the study. Tens of thousands of subjects followed for nearly 2 decades is a lot.
  2. The effect sizes are large. For relative risk, reducing the number of cases by up to 1/3, of one of the most common and expensive lifestyle modifiable diseases, is a big deal.
  3. P value was tiny. P < .001. This wasn’t one of those, “if I hack it I can get P to equal .05” types of studies.
  4. Dose response. There is a clear, fairly linear, dose response of more weight training leads to lower risk.
  5. Normal living humans. Study was conducted on humans. The people were not having their lives dictated to them by researchers.

The best results were seen at 150+ minutes per week of weight training, cardiovascular exercise and for both. This may seem like a lot, but it’s hitting the gym 3 times a week and going for a 30 minute brisk walk most days.

There are limitations to the study, of course. It’s not randomized, but the best studies of this type of question can’t be because it’s hard to control behavior for that long in free-living humans. It’s only in men. Weight training is not necessarily defined the same as strength training.

Conclusion

As I’ll keep saying, the best outcomes result from a complete approach to physical activity which includes strength training, cardiovascular exercise, flexibility/range-of-motion and neuromotor (balance/agility) training.

Reference

Grøntved, A., Rimm, E. B., Willett, W. C., Andersen, L. B., & Hu, F. B. (2012). A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men. Archives of Internal Medicine, 172(17), 1306–1312. https://doi.org/10.1001/archinternmed.2012.3138