The Expert in High Intensity Training and Fitness Medicine

Benefits of High Intensity Exercise: Cognitive Dissonance Has a Physical Sensation

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My recent fascination with myokines has made me much more aware that skeletal muscles performing hard work signals for beneficial adaptations in all of the tissues of the body.  The brain and nervous system are no exception.  In the recent past, I have become much more aware of this fact.

In my professional life as an emergency physician, the recent years have heralded an almost exponential increase in the stressors faced by emergency physicians.  At baseline, it is amongst the most cognitively demanding landscapes imaginable.  High stakes situations present without warning and many times at a pace that is not manageable (picture the I Love Lucy episode where Lucy and Ethel get a job in the chocolate factory).  Major decisions must be made rapidly with little to no information and in an environment that tolerates no mistakes.  Now, due to signal disruptions from political and economic forces, even more is being diverted to the ER as it is the sole entry point into the healthcare system for almost any situation.

Over the course of the past few years, I have shifted my focus from trying to change the system or rebelling against the situation to one of adaptation.  I came to realize that my stressors in life, and in the ER, will never decrease.  If I want things to be better, I could not rely on changing my external environment.  Instead, I would have to focus on improving my internal environment.  I needed to handle stress better.  I simply had to get tougher.

In the context of cognitive processing, working in a fast-paced environment involves fast decision-making based on intuition and past experience.  For the well-trained and/or experienced emergency physician it works well to use what Daniel Kahneman (author of  Thinking Fast and Slow ( System 1 thinking.  However, there are times where our System 1 thinking will betray us and lead us to a wrong conclusion.  All sorts of cognitive biases can lead us astray (premature closure, anchoring, recency bias, diagnostic momentum or just plain exhaustion).  When this situation occurs, we need to switch to a System 2 thinking strategy…one that relies on asking disconcerting questions, rooting out the cognitive biases that may be at play and methodically thinking “what else could be at play here”.

This all sounds well and good, but one must ask:  if System 1 depends upon intuition and subconscious processes, how do we recognize when it is about to fail us.  Enter Cognitive Dissonance.  Cognitive Dissonance is commonly defined as the mental discomfort or psychological stress that one feels when someone holds two contradictory beliefs, ideas or values.  However, my personal experience also shows that it occurs when you reach a System 1 conclusion that is contradicted by System 2 data points that are present but not consciously acknowledged.  The mental discomfort, however is much less intense than what is experienced under the formal definition.  As such, it is much easier to have “slips”, especially when the pace of the work does not allow the empty space to be in touch with more subtle emotions.

Here is where I venture into the “land of Woo” a little bit, but bear with me.  I found that I was unearthing these System 1 errors at two very specific times, usually hours or days after the actual decision event.  The first was during deep stages of sleep when I would awake with the answer and experience a slight sense of “flight or fight” that may or may not be linked to a dream or a nightmare.  The second incidence would occur during my workout, usually fairly deep into a set, somewhere between the bogging down of speed and failure.  Also, it would occur deeper in the workout and during significant metabolic stress.  Several of these instances have resulted in my calling a patient hours or days later to come back for a recheck and further workup that revealed the true problem.

As I paid particular attention to these events, I began to notice a particular pattern in the experiencing this sort of cognitive dissonance.  The pattern that emerged was that what heralded my recognition of the System 1 error and the cognitive dissonance was a physical sensation.  I cannot really describe the sensation, and probably shouldn’t attempt to do so, because it is probably different for each individual.  It was the same sensation if the realization came during the workout, or if it occurred during sleep or elsewhere.  Most importantly, it is a sensation that I have come to experience every time I do a high intensity workout.

The physical sensation seemed to correlate with the same sensation that I have previously referred to as the pop-up timer.  I used this term to describe the sensation I would have when I new I was reaching the appropriate level of fatigue or inroad.  This heralded a level of effort and concentration that was sufficient to trigger an adaptive response.  Also, it served as a warning of when I was about to venture into territory that would would result in overtraining or a degree of stimulus that was so severe as to be disproportionately difficult to recover from.   Over time, I developed a sense of this transition zone between optimal stimulus and a damaging one and came to recognize it easily.

Much has been made recently of the value of a meditative practice, and I find myself very much in agreement with this notion.  I believe this is largely a function of our evolutionary brain structure.  We are both the victim and beneficiary of a very rapid evolutionary increase in our brain size and capacity.  The result is a giant neocortex layered over a primitive brainstem.  Much of our behavior is dictated by the relatively automatic functioning of our more primitive brainstem.  For more complex and deliberate behaviors, we rely on our neocortex, especially our prefrontal cortex.  Most of the time, we carry out our lives with these two systems operating in tandem, but relatively separate from each other.  We are content to allow them to operate in a silo system.  However, if we want to function on the highest cognitive plane possible, we must integrate these two systems.  We must try to have conscious control over autonomic functions.  This is where meditation comes in.  It is incredibly simple…as simple consciously focusing on our breath.  This is commonly termed “mindfulness”.  As one becomes adept at this simple act (which is no easy task), they can then expand their mindfulness to other bodily sensations.  One can take note of the pressure of a chair on their body as they sit, or the sounds in their environment, but then return to the breath.  Once one becomes adept at this practice, they find that their mental performance improves in all kinds of tasks, simple and complex.  This is because they are becoming more adept at activating higher brain centers to focus on the task at hand and controlling autonomic responses that might affect performance.  Philosopher Ayn Rand once noted that the human animal is the only animal whose consciousness is not automatic.  Instead, it takes an act of volition to turn on consciousness and this act is perceived as effort.  In essence, all humans have ADHD…we naturally don’t pay attention, and we have to work to do it.

Meditation is an act of learning.  Initially, one pays attention to autonomic functions in order to later assume control of them.  At the beginning, you do something as simple as becoming aware of your breath.  Later, having developed this awareness you can try and control your breath.  As you progress, you will become adept at controlling other aspects of your physiology, and as you do so, you learning and awareness improve.  The real power of a meditative practice as it relates to learning and awareness really begins to express itself when the autonomic processes are more intense.

One person who has really married the concept of combining a meditative practice and intense physical experience is Wim Hof (  Hof combines breathing exercises and cold exposure to elevate the power of the meditative practice by combining it with intense physical experiences.  He uses cold exposure as a means of making the conscious control of autonomic functions both more challenging and to make the learning process more powerful.  While reading his articles and listening to him being interviewed– I was struck by how similar this sounded to Ken Hutchins description of the internalization process he recommends when training and how one should focus on the pain of exercise…to rush up on it and deliberately try to make it worse.  In so doing, he described it as being like a mirage, in that as you run up to it, it disappears.  The control over breathing, the relaxation of the face and the stoic focus on the task at hand had eerie parallels.

The ability to focus on bodily sensations and control autonomic functions while in quiet meditation is a challenging achievement.  Accomplishing this in conjunction with an intense experience is not just merely a higher achievement, it is an opportunity for a quantum leap in learning and awareness.   Learning during an intense experience can accelerate the learning process and greatly improve long term retention.

Dave Grossman, Author of the book “On Combat” ( has described this augmented learning as “limbic learning”.  The emotion of intense physical or emotional experience burns memories into our minds.  Learning to control intense autonomic events is not just a learning experience in itself, it is a way to learn new skills more effectively.  Being exposed to new material under stressful situations increases retention, especially when the stress is mitigated by a learner that has been taught how to have conscious control over autonomic functions.  One becomes familiar with their bodily sensations as they relate to the acquisition and retention of knowledge.  As more knowledge is accumulated, one becomes attuned to the bodily sensations that occur when acquired knowledge and new data are in conflict.  One begins to recognize the physical sensation of when something is not right.

So this brings me back to my original thought.  I think one of the benefits to intense exercise is the effect it has on cognition.  Done properly, it is an intense meditative practice that is elevated by the severe autonomic processes that are triggered and have to be overcome.  It is a practice that takes incredible concentration and focus.  The benefits are likely amplified by some kind of myokine signaling.  It has been my experience that these skills translate into other areas of your life where you expend intense cognitive effort and focus.  It is for this reason that I believe I am able to detect a cognitive bias while working in the ER by the very same physical sensation.

Ultimately, I know I have done a fairly poor job of articulating this experience, likely because I don’t yet fully understand it myself.  If you want to seek out this sort of experience yourself, I suggest the following steps.

  1. Adopt a meditative practice.  Using an app for guided meditation is a good starting point.  One of the most popular is the headspace app (
  2. Meditate immediately before your workout, and bring this meditative focus to your workout itself.  Rely on it to maintain an internal focus on what you are doing and to quell the autonomic storm that tries distract you from the task at hand.
  3. Rely on this state of mind in the other areas of your life that you are deeply engaged in.  Practice at work, with family and with sports.
  4. Be on the lookout for bodily sensations that alert you to important moments, danger or cognitive dissonance.

High intensity exercise offers so much more than just improved physical performance.  We are just beginning to scratch the surface of what is possible.

HIT “Indy” – “I’m Not Dead Yet”

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Remember Monty Python’s Holy Grail? The scene from the movie during the great plague where the guy is pushing a cart yelling “bring out your dead”? The throw a guy on the cart who protests… “I’m not dead yet!”. The guy pushing the cart retorts… “oh shut up, you’ll be dead soon”. “But I’m not dead yet!!”.

Lately, I feel like the guy that is thrown into that cart. The luminaries of the strength and conditioning world are all celebrating that HIT is dead. Fed up with “HIT Jedi” and SuperSlow/Ren-Ex agitators, they are happy to get on with “Strength-Speed, Speed-Strength, Acceleration, Explosiveness, Power, Strength-Endurance, Endurance-Strength, and just plain Strength” amongst other training variations applied through complex programming schedules that only the true athlete can understand or appreciate.

Mike Bradley (Strength Coach for the Florida State University Basketball team) recently dropped by for a visit when they came into town to play (and defeat) Clemson. Mike knows what I’m talking about. He is like that Japanese soldier from WW II that is still hunkered down in the Philippines. He lives (and enjoys) the life of a S&C hermit. There are still a handful of guys like him in the collegiate and professional S&C arena, but they are few and far between.

Mike loves his job like you wouldn’t believe. He gets to apply the most efficient and effective training programs to the most responsive athletes imaginable. He says… “Doug…it’s like Jurassic Park”. And, his head coach loves him. mHis players are strong, dominant and injury resistant. One of the most important aspects of sport at the collegiate level is recruiting. Mike feels that his S&C program gives them a recruiting advantage because the kids, and their parents see something that is very different from the same old thing that they see at every other program. The players, and their parents are impressed with the approach and with the emphasis on injury prevention, both on the court and in the training room.

Mike’s visit was a breath of fresh air. We had a great time in the gym and had a wonderful dinner and wine afterwards. My son was along and was absolutely mesmerized by Mike’s stories. My son and wife also got to enjoy a great game the next day (I, unfortunately, was in the ER). After the BBS site crashing and HIT fading into the sunset, it was great to see a HIT/BBS approach proving itself at the highest level of competition.

Another breath of fresh air has been Lawrence Neal’s podcasts at His interviews with HIT thought leaders, along with experts in diet, business and productivity have made my drive time to and from the kids’ schools an absolute pleasure. In a recent podcast Lawrence details how he has taken everything he has learned from his interviewees and applied it to his own life. It is really a great listen, and shows how the best of many different approaches can be combined to fit into a busy lifestyle. Give it a listen here:

Finally, I have another video up on my Youtube channel discussing my feelings on the how BBS fits into the world of training in 2017. Check it out here:

For Any Need… Strength Training

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Welcome to the re-opening of the Body by Science blog, now located at The prior site ( eventually succumbed to Chinese hackers and malware and the host ultimately shut down the site. This was initially very upsetting as 8 years of content is still unaccounted for. Hopefully, I can retrieve this at some point and turn it into an ebook that will document the amazing journey that was BBS.

The silver lining on this otherwise dark cloud is the opportunity to reboot and take a slightly different approach. What I would like to focus on going forward is my ever-growing certainty that no matter the issue, no matter the benefit sought, no matter the disease state to be addressed, or the problem to be surmounted, strength training seems to be the answer.

Want to look better in your clothes (or out of them)? Strength training is the answer. Want to address almost any disease state (diabetes, hypertension, heart disease, cognitive decline, obesity, metabolic syndrome)? Strength training is the answer.

Are you about to enter into chemotherapy? Strength Training will help prevent cachexia and even help defeat your foe. Are you suffering from depression? You guessed it… Strength training. In almost all of these situations, strength training is not just adjunctive; it is the most effective measure you can take, with other measures adding adjunctive to marginal value. It seems that we have evolved from struggle in the constant presence of gravity and our adaptation to this fact have given us a tool to solve almost any problem.

When it comes to strength training, I have some definite opinions on the best and most efficient way to perform it, but those opinions are not as strong as my belief that you should perform strength training in almost any form. Muscle has evolved over billions of years and is the most adaptive and plastic tissue there is. As such, strength training can be incredibly simple, precisely because muscle is so complex.

There are many different ways to train and skeletal muscle will adapt to them all. My only major objection as to the form of training will be towards those techniques which pose an undue risk of injury. As Arthur Jones once said “It won’t matter if you have 20 inch arms if you injure your back”. Or, as I say in my elevator pitch when people ask me about Ultimate Exercise (my personal training facility), “It’s like Crossfit… without the torn rotator cuff”.

In the past 10 years the scientific literature has exploded with studies that uncover benefits to strength training that we never imagined. Much of this linked to myokines, the hormone-like substances released by exercising muscle that signal benefits all the other tissues of the body.

Like my new focus, most of this literature focuses on the why of strength training; but as the why becomes obvious, the focus will begin to shift on the how. Once this shift happens, we may begin to find some answers to some of the most heated debates that have occurred at (as well as other sites).

Initially this blog will focus on the why as well. This is simply because I feel that strength training is the single most effective public health initiative that we could undertake.

2016 was the first year since we began tracking life expectancy where the numbers started going down. If the message spreads broadly enough, we can at worst reverse this trend, and at best, serve as a bridge to true life extension technology. But as the studies on how accumulate, we can also debate the best way to get there. I look forward to exploring these frontiers with all of you.

Doug McGuff, MD

Copyright © 2017 by Dr. Doug McGuff. All rights reserved.