David Taylor (Host): Hello. This is David Taylor with Riverwood Healthcare Center and the On Call podcast. Today, my guest is Jonas Kyllonen. He's one of our physical therapists here at Riverwood. Hey, Jonas, how are you doing?

Dr. Jonas Kyllonen: Good. Thank you.

Host: Yeah. Thanks for joining us today. What we'd like to talk about is some strength or resistance training, and I think primarily I'd like to see if we could talk about topics for mostly healthy community members or healthy listeners. And by healthy, I mean people who aren't recovering from surgery. I feel like specific protocols and specific treatments for postsurgical patients could be its own podcast and maybe doesn't pertain to our entire listenership.

Dr. Jonas Kyllonen: Yeah, that sounds good.

Host: So, let's start out with just some of your background, some of your credentials, how you got into physical therapy, what some of your areas of interest are, and then we'll go from there.

Dr. Jonas Kyllonen: So, I've been a physical therapist for about 19 years. My undergraduate work was in Kinesiology, which is basically the study of how the body moves with my intentions of hoping to get into a physical therapy program. With that Kinesiology degree, there was a heavy emphasis in exercise physiology. I was able to get into the physical therapy program at the University of Minnesota, where I ended up with a doctorate degree in Physical Therapy. But in that coursework, you know, there's, again, heavy emphasis on exercise physiology, therapeutic exercise for kind of the patients that we'd be seeing with some impairments.

Throughout the years to maintain my licensure, of course, we need to go through some continuing education courses. And some of those courses just learn what was the latest as far as the science with resistance training, how you would implement that with not only healthy individuals, but also those with some impairments.

When I joined Riverwood about eight years ago, I decided to kind of focus my practice and I ended up taking some very specific continuing education courses. I studied and I sat for an exam and I became an orthopedic clinical specialist in Physical Therapy. In more recent years here at Riverwood, we've actually had the equipment and we implement a very specific intervention called blood flow restriction training, which really targets muscle strength, hypertrophy, and lends very well with the type of patients that we have.

Host: Oh, sure. Yeah, great. Well, maybe with that background, why don't we start with just some basics of resistance training? Like, if you wouldn't mind, explain to people what are the advantages. I mean, I realize this might be obvious, but let's just start on a very basic level, and then work our way up. What is resistance training? What's strength training mean to you? How would you define that for people?

Dr. Jonas Kyllonen: Well, with strength training, it's really putting our muscles to work, okay? So really, with resistance, it could be, you know, a number of ways of performing this. Some of the obvious would be either going to a fitness center, using certain types of equipment, you know, even using your own body weight to actually ask your muscles to move certain forces. I mean, we could break it down into if our goals is to actually get our muscles stronger or to get our muscles to be able to perform better over a longer period of time, such as endurance or challenging our muscles for more powerful movements or actually muscle size. So again, you really break it down into some of those very specifics as how you go about with your strength training program.

Host: So, hypertrophy versus strength versus muscular endurance. Is that a good way to break down those three categories?

Dr. Jonas Kyllonen: We certainly can. So if we were looking at just trying to improve muscle strength, what some of the guidelines tell us is that we have to be able to challenge the muscle with enough force, enough of a stimulus. So, what the guidelines tell us that we have to be able to move a weight that is at least 60-70 % of our one rep max. And what I mean by a one repetition max is being able to lift a heavy enough load where we can only do one repetition before our muscles fatigue. So, an example of what that would be is if I were to try a bench press and I'm trying to target chest and arm muscles, you know, if I went to the bench and I put a hundred pounds on that bar, and I was only able to lift it for one repetition, and I wasn't able to lift it again, that would be my one repetition max. So if I was trying to target muscle strength, I would have to put on that bar at least 60 to 70 pounds, okay? That much of a load and with enough repetitions and enough sets to really benefit from the muscle strengthening.

Host: Sure. Okay. How about hypertrophy? What would be different if you're focusing on a hypertrophy, or is it going to be similar?

Dr. Jonas Kyllonen: It's going to be similar. So, hypertrophy is kind of trying to increase the size or mass of the muscle. So, we're looking at a little bit higher repetitions. It's still going to be that higher load, you know, that over 60% of that one rep max. Now, I'm trying to bring those muscles to more of a fatigue feeling. If anybody has lifted weights and challenged the muscles, they're going to start feeling that muscle burn. So, you're going to look at higher repetitions, higher volumes, higher overall sets, in a given week to try to target size.

Now, with that, if you're targeting size, you're also going to build strength. I mean, if you would look at programs of, let's say a powerlifter versus a bodybuilder, you look at these individuals that have larger muscles. But their programming is a little bit different their goals. Powerlifters, they are more competition-based, whereas bodybuilders, you know, they're going and competing and showing off these muscles.

Host: Yeah. Okay. And then, how would a program that is more for muscular endurance, how would that differ from the first two?

Dr. Jonas Kyllonen: So if you think about muscle endurance, we're asking muscles to perform over a period of time. There's a number of different things that we can think of as far as asking our muscles to be performing over a period of time. When it comes to our muscles, you know, they're made up of different types of fibers. There's fibers that are made to allow us to go for longer periods of time, such as going for a walk or a brisk walk or jogging for a period of time versus another type of muscle fiber that are more of our power fibers where you think about our sprinters or powerlifters. You know, you're really asking these muscle fibers to perform over a shorter period of time with sometimes quicker movements.

Host: Yeah, this might be what people commonly refer to as fast twitch and slow twitch muscle fibers. I'm guessing a lot of our listeners have heard of that term.

Dr. Jonas Kyllonen: Exactly.

Host: All right. So, there's a whole bunch of questions actually that this brings up for me. But before we get into more detailed diving into it, let's step back a second and let's say if we're a listener who does not have a lot of weightlifting experience, hasn't spent a lot of time in the gym, is not a bodybuilder or a powerlifter, or isn't doing a lot of weightlifting to complement their cardiovascular activities, what steps would you recommend for somebody starting to get into weightlifting, first, maybe why that's important, and then, like, how you would start a program. Is there a set of exercises you'd recommend, some just basic framework that people should look at doing if they were going to try to do this on their own?

Dr. Jonas Kyllonen: Sure. I guess a very key question for an individual is why do they feel this is important to them, which through a full lifespan, you know, you take ages from seven to the elderly, there's robust research showing that actually resistance training is very beneficial and for many different reasons. And so, kind of asking this individual, why does this seem to be important for you, wherever they're at. Let's just say if they're beginning a program and really kind of trying to taylor a program that is going to be working towards their goals, I guess if it's something where we're trying to initiate some type of a program, what we'd want to do is keep the movements and the resistance pretty basic, pretty low resistance because we want quality as far as engaging some of these muscles. It would be appropriate if somebody is truly looking at a full body workout, either to have some guidance, especially if they've never done it before. So, guidance could be whether it be seeing a personal trainer, somebody who has knowledge and understanding of muscles and how we should appropriately train them.

Luckily, this day and age, you know, you don't have to go to a fitness center. You don't have to hire a personal trainer. I mean, there's certainly ways where you can go online and whether it's on certain type of fitness apps that kind of provide some guidance and you can do it in your own home. So really, some of the keys is starting off with lower weights, making sure that the quality of the movements are pretty basic, but the quality is there before you start getting into higher weights or even more complex movements.

Host: I like that. Let's say I'm a middle-aged guy, which I am, that has never lifted weights, which is not the case for me, but I want to get into it, would you recommend an all-around kind of program? Should I focus on upper and lower body? Is there a framework you would recommend like upper body one day, lower body another day? Or I've heard some people break it down by push and pull exercises. Do you have something that you like to recommend to somebody who has really no experience lifting weights?

Dr. Jonas Kyllonen: I guess what I would recommend is if somebody is just looking to get stronger, and they're trying to introduce a new program, what I try to tell that individual, let's just say, if it is a kind of middle-aged male who's looking to hopefully get stronger is it should be a full body, where you're targeting full body muscle strengthening. When it comes to thinking about function, yes, we look at how do we live our life? So, you know, there's times where we had to push, we had to pull, we had to lift and kind of targeting those very specific muscle groups for function. It's very important that when we implement a strength training program that not only, I said earlier, that we provide a strong enough stimulus with a heavy enough load, but one thing that's very important is actually it shouldn't be done every day, targeting a certain muscle group every day of strengthening. These muscles do need rest days. So, kind of what are the recommendations are is being able to target certain muscles a few days a week with rest days. That's very important.

So, if somebody wanted some programming, it could be, "Okay. One day I do my legs or my lower half. The next day, I do my upper body." And sometimes, certain days could be more of a pushing action. Next day is a pulling action. So, you're really targeting different muscle groups, giving certain muscle groups days off because that's part of the kind of the recovery and the positive adaptations that we need to build strength and hypertrophy.

Host: Yeah. So, let's stay with this middle-aged man who's a rookie at lifting weights, and they kind of listen to that. One of the questions I might ask is, "Well, how many days a week should I lift then?" So, it sounds like not every day, or at least not every muscle group every day. What would be a weekly framework? Should I be doing upper body twice a week? Should I be doing upper body more than that? As an example, what would you recommend? And how much time would you recommend, or if I'm asking you, how much time should I be devoting in my day to this? What's a good number that I could use as I build my program?

Dr. Jonas Kyllonen: Right. So if the goal is strengthening muscles, some general guidelines or what the guidelines tells us is, you know, we should be, again, back to the heavier weights that really challenge these muscles. That's 60-70% of our one rep max, a rep range of anywhere from three to five repetitions, if our goal is just to build strength. If we're looking at more of not only strength, but also some size, you know, we were looking at a higher rep range of eight to 12 repetitions targeting that muscle group.

As far as sets, so let's just say we're targeting chest or arms and we do an exercise, we try to hit that anywhere from eight to 12 repetitions. We take a rest, you know, that's one set, take a rest, which can be anywhere from one to three minutes, again depending on what our specific goals are. And then, we do another set of that eight to 12 repetitions, up to a total of three sets, okay? So, we can challenge the muscles a little bit more if needed, depending on how much we're exerting these muscles. I know, you know, talking to Dr. Arnold in previous episodes, you talked about how important exercise is these muscles is super crucial. And then, as far as, well, how many days a week, you know, it could be three to four days week. Again, giving those very specific muscles these days off.

Host: Yeah, okay. That's kind of where I've been going with this line of questioning. I feel like if we have listeners who are already accomplished weightlifters or they may already have an advanced level of knowledge in terms of how to achieve hypertrophy, if bodybuilding is part of their goal versus if they've done some either lifting for a sport that requires power, say football in the past or wrestling versus like a cross-country runner, I feel like those individuals are well beyond the basics, but I want to make sure that people who haven't considered weightlifting or haven't gotten into it in the past, understood a framework that they could start with, but also if they haven't listened to the previous podcast, you know, that importance of weightlifting, all the benefits it gives you with stimulating your bones, helping protect you from falls, obviously balance is part of that too, but just some of those; protects you from injury with the things you talked about earlier. If you're doing things in your daily life that require pushing or pulling, if you're doing training for that, you're going to be more able to do that with less risk of injury. And I think that is a large part of our community where they may not be enthusiasts or avid weightlifters, but they would benefit from just starting a weightlifting program or a resistance program.

Dr. Jonas Kyllonen: Kind of back to your question about, you know, if it was a middle-aged male wanting to start a resistance program, something that's very important, I guess, for the audience to have an understanding is what happens to the muscle through the lifespan. And we know what the research tells us is already starting in our 30s, we have weakness and loss of mass occurring. We call that sarcopenia. And on average, we lose about 1% of our strength starting in our 30s annually. You think what happens over then the decades following, and we see some of the sharpest drop in strength and size of muscle in our 60s and 70s.

So, thinking about this, when we're young, these teenagers and 20-year-olds, you know, they have a lot going for them, some of the important hormones for building size and strength of muscle. But as we go through the aging process, how important this resistance training is to try to maintain and sometimes even improve through the decades is something that's very important. You think about how important it is if we're looking to retire someday and have enough money to live on, you know, we should be investing in that future. Also with our muscles, we should start young and try to be as best as possible with our resistance training to really think about the future.

Host: For sure. For sure. And obviously, a high-level athlete who is weight training and at their peak in their 20s, well, in their 40s, 50s, 60s, they're not going to be able to reach the peak that they reached in their 20s. But somebody who maybe never lifted in their 20s, 30s, or 40s, is it fair to say that they can still see gains well beyond what their level of strength was if they weren't weight training back in those earlier years when they had the benefit of the biochemistry, even though they're at a disadvantage in their 50s, but they can still see those gains? Is that a fair statement?

Dr. Jonas Kyllonen: That is very fair statement. To start something, you know, it's really never too late. An example of this is I had a patient in this last year, an outpatient who is 102 years old, and he came in because he was noticing a decline in his walking ability and his balance and he felt like he was getting weak. He had a stroke a couple of years ago. And I asked him, what are you hoping to get out of physical therapy? And he says, I want to get stronger.

Host: Yeah. That's a great story. Yeah.

Dr. Jonas Kyllonen: Decades ago, it would have been thought like, "Well, that's not possible." And so, I asked him, "Well, why do you want to get stronger?" And he goes, "I want to be able to go outside and walk in my yard and cut my grass." A 102 years old, you know, and so we started talking about what does it take to get stronger? And he was already, every day, very dedicated to an exercise program. And we started talking about, well, he's kind of maintaining to see some improvements while we have to do some modifications to what he's working on, to challenge those muscles a little bit more. Fast forward a month later, you know, when he has been dedicated to exercise, including some resistance training, he came in. He told me that he got down on the ground and he changed out his mower blades on his riding lawnmower, which was incredible, which requires strength, power, you know...

Host: Flexibility, yeah.

Dr. Jonas Kyllonen: Flexibility to get up and down from the ground. It was amazing.

Host: Jonas, I hope to be alive at 102, but I absolutely hope to be able to change the blades on my lawnmower. I mean, like, what a powerful statement. That's a great story.

Dr. Jonas Kyllonen: And there's countless stories over the 19 years I was a physical therapist, just seeing age, it's a number. You know, it's still possible to continue to strive to be as mobile as possible, as independent as possible, and to continue trying to live an active lifestyle.

Host: Yeah, this goes back to what you brought up when I was earlier bringing up the different types of hypertrophy versus strength versus endurance. And some of the frameworks is it all comes back to what are you trying to get out of it. And I think, really for anyone, you could say a reason to do this is not necessarily to get bigger, it's not necessarily to get stronger, other than you'll get stronger as a byproduct of it, but to be able to live more functionally and independently throughout your years while you have your health. And to help promote your health, I think, is one of the most basic reasons everyone should be considering adding in strength training if they aren't already.

Dr. Jonas Kyllonen: Absolutely.

Host: So, let me ask you a couple more specific questions. So, we kind of used the scenario of a male, well, let's use the scenario of a female. I've heard this before, I haven't heard it for a while because in my work now, I don't talk with people a lot about their individual goals with strength training like I did back when I was in more of a family practice clinic or in my Sports Medicine fellowship. But I would hear, this is on the female side typically, "I would start strength training, but I don't want big muscles. This isn't for me." I don't know if you've encountered that attitude or that feeling, or if somebody has that fear. Can you help talk about how you would guide somebody about how you could still be doing strength training, but not necessarily worry about changing your body in a way you don't want it to?

Dr. Jonas Kyllonen: Certainly, I've heard that too, as far as the fear of bulking up, that's not their goal. Again, for a female, males and females, I mean, there's a lot of things that go on as we kind of hit the middle age with our hormones and that kind of stuff. But one of the things that's super important for you females is resistance training. You want to optimize muscle strength. So, it is possible to work muscles through resistance training without bulking up. I talked about those lower rep ranges, but making sure that it's a heavy enough load. So, it's certainly possible where you kind of just tone up versus bulk up. And it is something that we should really consider as we're hitting those middle ages and, into our geriatric ages that we do want to maintain as much muscle mass as possible as long as possible, because inevitably we are going to lose some of that. And back to those muscle fibers, there's those ones that are more for endurance. So, some of them that are more important for power, those power fibers are what start to go as we go through the aging process, which makes it more difficult for, let's say, the geriatric age to get down on the ground or get back up, or let's say if you are walking the lawn and you catch your toe, that ability to recapture your balance in a quick manner. You know, we lose that speed component. So, it's very important, you know, male, female, resistance training, to really target these muscles in those ways.

Host: Yeah. No, that's a great point. So, we'll tell you what, we're starting to run a little short on time and I have a lot more questions, but they tend to be more detailed. I want to give you a chance to make sure that you are getting out to our listeners some important thoughts you have or any pearls that you want to give or any other just topics or comments we'll make sure we hit before we run out of time.

Dr. Jonas Kyllonen: Well, I think this is just kind of piggybacking off of Dr. Arnold's first episode of exercise. If there's the closest thing to a magical pill, it's exercise. It shows such profound health benefits in many different areas. Again, with resistance training being a piece of exercise from the full lifespan, we used to think that kids should not be doing any kind of resistance training because of growth plates or they're growing bones or muscles, tendon issues. That's no longer the case. I mean, they've done studies on this and if a kid is active with athletics, that puts a lot of strain and stresses through the tissues. You know, if they're going through the athletics, resistance training should be a piece of it. Why? To optimize the function of the muscle also prevent injuries. And then, we already highlighted some of the changes that happen, middle age and on up and how it doesn't matter how old we are. We can make those improvements still, you know, the example of the 102-year-old.

Host: Yeah. Yeah. That's a great point, for the most part, never too early to start. Intentionally, smartly, not just throwing yourself into it, but also never too late to start either. All right. Anything else you want to hit before we go? And Jonas, what I feel like is we could get really detailed about a lot of this. You know, we could talk about the concentric phase versus the eccentric phase and how you should actually dial in your individual exercises. But I think we'll save that for a future podcast since we're just getting this whole series rolling. I'm trying to do more overview, and you could probably tell that with the podcast with Dr. Arnold. So, anything else you want to hit before we let this one go and then get more detailed at a future podcast?

Dr. Jonas Kyllonen: One more thing I would mention is, and this was highlighted with Dr. Arnold in his nutrition episode, when it comes to muscle strength, hypertrophy, another key component is protein intake. Protein synthesis is how we optimize muscle strength and size. You know, not only working a muscle through resistance, but we also have to, as that muscle gets broken down from resistance training, we have to supplement it with enough protein. So, Dr. Arnold did talk about the recommended daily allowances, and that those are actually little on the light side. And that if we are truly working a muscle, we need to make sure that we're get appropriate amounts of protein to really aid that muscle in the strengthening and hypertrophy process.

Host: Yeah, that's a great point to highlight because that's going to go hand in hand with your ability to gain strength or gain hypertrophy or both. I think if I remember right, and this is not my area of expertise, but the recommended daily allowance is like 0.8 grams per kilogram, but it really should be more like 1.2 to 1.6. Are those numbers sounding right to you?

Dr. Jonas Kyllonen: Yep, that's correct.

Host: Yeah. Okay. So, that's our takeaway for the listeners is increase it, 1.2 to 1.6 grams per kilogram per day of protein. And it's hard to eat that amount of protein if you're not used to it.

Dr. Jonas Kyllonen: And I guess one more takeaway too, when it comes to strength and working muscles to improve your strength and maybe size, it takes time, okay?

Host: Good point.

Dr. Jonas Kyllonen: We didn't talk about how long it takes. If we started initiating a new exercise and start challenging the muscles within the first couple of weeks, we might see some gains as far as our ability to perform more repetitions, but the muscles actually not getting stronger at that point, they're not gaining size. It's really how the nerve and muscle communicate. It becomes more efficient, allowing the muscle to perform more efficiently. It's not until further down the road of consistent work where we actually see some of those strength gains, you know, the two to three months. And then, as far as seeing actual size changes, we're talking three to four plus months, okay? So, I mean, it takes time and consistency. And I tell my patients, if their goal is, "I want to get stronger," well, I tell them, "It's going to take time, it's going to take consistency and it's going to take effort."

Host: Yeah, that's a great point. Put the work in, but don't get discouraged because you need to let the time play out with that consistent work.

Dr. Jonas Kyllonen: Correct.

Host: All right. Well, this has been great. I really appreciate you coming on the podcast. I'd like to have you back in the future and, again, dive into some of those more technical details for listeners that are interested in that. Thank you very much.

Dr. Jonas Kyllonen: Yeah. I appreciate it. Thanks for having me on.

Host: Okay. Thanks, Jonas. Bye-bye.

Dr. Jonas Kyllonen: Bye. Have a good day.