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From the Townsend Letter
July 2011
Exercise is Medicine
Metabolic Conditioning
by Jade Teta, ND, CSCS, and Keoni Teta, ND, LAc, CSCS
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Metabolic Conditioning
Any good health-care practitioner knows that exercise is of paramount importance in health, fitness, and weight loss. It is always important to stay abreast of the latest trends and practices in medicine, and new methods of exercise are no different. This month we tackle the new genre of fitness called metabolic conditioning.

What Is It?
We define metabolic conditioning (MC) as a system of exercise that uses the latest understanding of endocrinology, exercise science, and strength and conditioning research to fully tax the body's major energy systems with the chief goal of maximizing the amount of fat that can be burned both during and after the exercise session. Unlike other exercise protocols that focus exclusively on developing power, muscular endurance, aerobic capacity, or bigger muscles, metabolic conditioning is focused on attempting to derive multiple fitness benefits while addressing body composition primarily.

Inspired by Athletes
MC takes its inspiration from the world of sports. Most sport involves multiple fitness parameters, and simultaneously challenges all three energy systems. If you watch sports such as soccer, tennis, or boxing, you will see fluid and steady movement that can quickly change into powerful bursts of strength and speed before changing back again. Sport is both aerobic and anaerobic. Metabolic exercise seeks to reproduce the nature of sport by combining resistance training, cardio interval exercise, and other fitness elements into one workout. The workouts are faster paced and involve short rest periods along with muscle-fatiguing protocols.

Metabolic Conditioning Research
MC often uses compound and hybrid exercises that work multiple muscle groups across several joints. These include exercises like squats, dead lifts, and squat presses. It also moves from exercise to exercise quickly, leaving little downtime in the workout. It frequently combines aerobic-dominated lower-body activity with anaerobic-dominated upper-body movements.

Two studies published in the European Journal of Applied Physiology in 2005 and 2006 found substantial benefits for exercise protocols that combine endurance and resistance training.1,2 Both studies had elements common in metabolic conditioning workouts. In the first of these studies, body fat percent was reduced by 1.3%, while abdominal adiposity declined by 12% over just a few months. These results surpassed the strictly aerobic control group.

Another analysis of MC style training was published in the September 2008 Journal of Strength and Conditioning Research.3 In this study, what the researchers called "cardio-acceleration," which amounted to a treadmill sprint, was wedged between weight-lifting exercises. This protocol showed a 10 times greater reduction in fat mass compared with the same workout where the aerobic component and weight lifting elements were separated.

Finally, a 2010 study from the Journal of Sports Medicine and Physical Fitness compared an endurance-only group against circuit weight training that added cardiovascular bursts.5 This research showed that circuit training with cardiovascular sprints provided a 15-pound weight loss and a 5% reduction in body fat over 12 weeks. This reached statistical significance over the endurance group, almost doubling the effect. The endurance group lost just under 7 pounds and 3% body fat in comparison.

How It Is Done
To accomplish the goals of a MC workout, we have found four areas to coach patients on. We call them the Bs and Hs. They stand for breathless, burning, heavy, and heat. In order to make sure you are generating the desired effect unique to metabolic conditioning, these elements are helpful. Each workout should get patients breathless as if they have just climbed a large flight of steps. This can be accomplished with a short treadmill sprint wedged between weight training sets or by doing any full-body exercise, such as lunges while carrying weights.

The workout should also create a feeling of burning in the muscles. Using light weights, doing more reps, and training the muscle to exhaustion can do this. At the same time, the workout should fully engage the type II muscle fibers. This means heavier, "strain-inducing" weights should also be used at times. This may involve going immediately from a steep incline walk to 10 heavy reps on a leg press machine. Finally, help your patient generate some heat. That means sweat. Sweating is a sure sign they are generating the desired effect, and combined workouts are very good at this.

You may be thinking that these workouts are too intense for the average patient. However, this style of training can be tolerated by the less fit and even frail. As long as the cardinal rule of metabolic training is not broken, anyone can do this workout. That rule is resting when needed. Resting in a metabolic conditioning workout is essential. Without the use of rest, pacing is inevitable. Pacing simply defeats the purpose of metabolic conditioning and turns the workout into a strictly aerobic effort.

Resting, whether it involves lots of short rests or a few longer ones, is essential and will drive the results of the workout. The more rest taken, the harder patients can work. And the harder they work, the more rest they will need. We use a method we call "rest-based training," or RBT, which we have written on before in Townsend Letter.6 RBT exploits rest in a way to generate big results. In this system, rest is taken anywhere in the workout, then exercise is resumed right where the patient left off.

Final Thoughts
Metabolic conditioning is a new fitness genre that is a different way to think about and practice exercise. While it is relatively new, this form is beginning to show up in many of the exercise programs that patients may be exposed to. As a health-care provider, you need tools that go beyond single-dimension exercise protocols. MC gives you a prime tool to improve health, fitness, and weight loss.

Jade Teta, ND, CSCS, and Keoni Teta, ND, LAc, CSCS |

1.  Braun et al. Acute EPOC response in women to circuit training and treadmill exercise of matched oxygen consumption. Eur J Appl Physiol. August 2005;94(5–6):500–504.
2.  Verney et al. Combined lower body endurance and upper body resistance training improves performance and health parameters in healthy active elderly. Eur J Appl Physiol. June 2006;97(3):288–297.
3.  Davis et al. Concurrent training enhances athletes cardiovascular and cardiorespiratory measures. J Strength Cond Res. 2008;22(5):1503–1514.
4.  Davis et al. Concurrent training enhances athletes' strength, muscle endurance and other measures. J Strength Cond Res. 2008;22(5):1487–1502.
5.  Paoli et al. Effects of three distinct protocols of fitness training on body composition, strength and blood lactate. J Sports Med Phys Fitness. March 2010;50(1):43–51.
6.  Teta J, Teta K. Rest-based training: a new system and psychology for exercise. Townsend Lett. October 2010.



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