The Expert in High Intensity Training and Fitness Medicine

Hit Market Penetration: Supply Creates Demand

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At latest count, the directory at has 177 listings.  This is an impressive number of facilities providing state of the art training.  This likely under-represents what is available because several of the listings have multiple locations, and there are probably almost as many HIT shops that are not listed on the directory.

One of the most rewarding aspects of my consultation business is the opportunity to provide start-up advice for those wanting to open a HIT personal training studio.  Many of my consultation clients are now owners of multiple successful facilities and are making a fantastic living doing what they love.  It is a fantastic business model with low start up costs, minimal ongoing expenses and the only complexities come from the government.  It is literally a six-figure lemonade stand.  Enough people have gone this route that we are now at a tipping point.

This stuff works, and it works astoundingly well.  Very few people know about it, so there is little demand…yet.  What anyone considering this business as an option needs to know is they don’t need to worry about demand.  As the old movie yarn goes, “build it and they will come”.  It is a law of economics that supply creates demand.  Allow me to demonstrate.

I distinctly remember the news feeds of Steve Jobs unveiling the iPhone.  I watched these news clips of Jobs in his blue Jeans and black turtle-neck holding up a slender rectangle as throngs of worshipers in the audience stared in awe, mouths open and hands involuntarily clapping.  I rolled my eyes so hard that it hurt.  I remember thinking “I wonder which classic rock song of my youth will be pillaged to advertise for this latest trinket from geek-land”.  I just could not see any utility to many of its options.  Why would I want my music collection on my phone?  Why would I take pictures with a phone?  My current phone had that capability, but the pictures were of terrible quality.  And what use did I have for all of the “apps” that I could buy at the iTunes store?

I also remember some of the early adopters.  One of them was a physician colleague.  He was (and still is) one of our hardest working primary care doctors, who probably gets less sleep than anyone I have ever known.  Why would this man camp out overnight at the Apple Store to get the first release of the iPhone?  I remember when he came through the ER with his new prize.  I again rolled my eyes as he demonstrated his custom ring-tone, and an app which was called “the world’s smallest violin” which you could cue up and play anytime someone was whining or telling a tale of woe (very common in the life of a primary care doctor).  I remember asking him if these features were worth camping out on the sidewalk for.  He smiled and said “probably not, but its just so cool!”.  I thought Jobs might be going off his rocker as evidence by his willingness to invest so much in a product without the appropriate research into the market and what the demands of consumers might be.

I fancy myself as somewhat of an amateur economist.  I have read the works of most of the free-market Austrian economists such as Ludwig Von Mises, George Reisman, Henry Hazlitt, Milton Friedman and others.  Despite my background and alleged understanding of Capitalist economic theory, I failed to understand something that Steve Jobs knew (either by instinct or informed study).  What Jobs understood is that consumers do not necessarily know what they want or need.  Demand doesn’t create supply.  Supply creates demand.  No consumer at that time had any idea that he wanted or needed an iPhone.  Steve Jobs had to create the product and supply for demand to develop.  The most successful products are those that address needs and desires that the consuming public does not realize it has….yet.

Flash forward a couple of months.  I am working in the ER on an unstable patient in septic shock.  The patient belongs to my iPhone wielding colleague.  He arrives at the ER as I am preparing the patient for the ICU.  I am flipping through a tattered, small notebook that I have carried since residency.  It holds the dosing formulas for critical resuscitation drugs and treatment algorhythms that I need to have at quick disposal in dire emergencies.  I am frantically trying to calculate a dobutamine drip in micrograms/kilograms/minute on a drug that is concentrated in milligrams/milliliter and is run through a pump that runs at milliliters per hour.

As I am straining to double check my decimal point placement and make certain that I divide by 60 (or is it multiply?), he pulls out his iPhone and pulls up a critical care “app” and quickly generates the appropriate drip rate.  The drip gets started and the patient gets wheeled to the ICU.  Before he runs upstairs, he runs through a string of 50 or more high quality photos that he took while on a family vacation.  Oh, he is also getting all of his CME done through podcasts that he downloads and listens to while driving, hiking or just between patients.  I started to realize that the only benefit I would experience of being a late adopter is the lower price afforded to me by my more forward-thinking colleague.

Lesson for HIT: Supply Creates Demand

HIT is just now reaching a tipping point.  The major reason is that the pioneers in the field never stopped creating a supply.  Over time there have been enough articles written, case reports done, blogs, books to keep some purchase in the market.  Now that we are at the tipping point, we need to push it over the top in the same way that Jobs has done with the iPhone.

We must continue to realize that we don’t need market research.  Our customers do not yet know what they want or need.  It is up to us to create a supply of something that they later will realize they can’t live without.  We must supply the equipment, the philosophy, protocols, the science, the popular writing, the results, and most of all the enthusiasm that creates a community experience.  When you have done all of these things, that is when you have a Starbucks, Apple, or Whole Foods on your hands.  This is what we are doing and what we must continue to do with HIT.

The Philosophy

We must articulate a philosophy that makes the customer realize that our product is essential to life, health and attractiveness.  We need to emphasize that it is so important that it would justify almost any amount of time invested, while simultaneously showing that brief and infrequent training exposures are not just possible…they are what is required.  We must show that best results require a time efficient protocol.

The Protocols

Through the work of HIT pioneers such as Arthur Jones and Mike Mentzer, we have been given grist for the mill.  Over the years this has been refined by numerous HIT practitioners such that we now have the ability to prescribe an effective starting point for anyone wanting to get started in HIT.  One of my main goals in writing Body by Science was to create a template that could be used to get anyone started in HIT.  Once someone begins, they will then seek out further refinements, but a starting protocol is key.

The Equipment

One of the biggest strides HIT made was due to its attachment with Arthur Jones and his Nautilus equipment.  Equipment is a product that generates excitement.  It offers the ability to generate results quickly and safely, but most of all it looks cool.  The design element of equipment must never be underestimated.  It must not only be functional, it must look elegant.  It also must be dedicated to an ideal.

Currently, there are fewer and fewer manufacturers that produce functional equipment, with amazing design appeal, that (most importantly) are rooted in HIT philosophy. As few as 5 years ago, there were more viable hit manufacturers.  A brief list of the top of my head includes: MedX (hard to acquire in the U.S. but more available in Europe under the Delphex name), Nautilus (the more recent models being less ideal), Hammer Strength (now sold to Life Fitness), Rogers Athletic, David (available in Europe), Renaissance Exercise (currently dormant), and ARX (currently active).

The existence of this equipment gives a face to HIT and a sense of what is possible while simultaneously demonstrating that HIT can generate results with conventional equipment or even no equipment at all.  The interesting thing is that without HIT-based equipment, almost no-one ever considered that it could be accomplished with barbells, dumbbells or with free-hand exercise.

The Popular Writing

We commonly think that the science precedes invention and commercial application or popular writing.  The truth is, the opposite is true.  First the tinkering and experimentation comes.  Fellow geeks communicate to each other through articles and books directed at each other.  As tinkering leads to protocols, equipment and results, then (and only then) do the academics become aware and start to formally state and test the hypothesis of the tinkerers.

Suddenly, there appears “breaking news from the world of science” that then reflects back to popular writing, but this time in the public media.  This is a dangerous process as the original thinkers and experimenters may feel cheated as any Johnny-come-lately with a University affiliation can jump on the bandwagon.  This is a mistake.  As academics test and prove the efficacy of the protocols of the tinkerers, this is the opportunity to take the confirmation and regenerate and refresh the original writing and protocols.

Right now, academia is experiencing the failures of endorsing aerobics philosophy over the past 3-4 decades and the new blood in academia is piling on to the HIT/time efficient exercise band-wagon.  The early-adopters must not resent having paid the early costs, so that others can get on board easily.  THIS is what we worked for, and we must continue to push it further.

The Science

We have established that the popular writing and tinkering precedes the science.  Science is catching on and providing resounding evidence that HIT works.  We must continue to feed them grist for that mill.  There is a virtual treasure-trove of material to study with regards to HIT. There is not a single body system, biochemical pathway or disease state that cannot be benefitted by HIT.  We need to keep writing popular articles that help to direct these areas of investigation.  We must cite and publicize the work done by scientists in the HIT field.  The more popular press these breakthroughs receive, the more funding will flow into further investigating the myriad benefits of HIT.

The Results

HIT produces results in a reliable and predictable fashion.  This is one thing we have been reluctant to push largely because of the heavy emphasis on before-and-after transformations in the exercise industry.  These “transformations” have largely been cherry-picked from extreme responders in order to sell the product.  After 3 decades of this sort of marketing, the public is becoming weary of being duped.

Actually demonstrating the more realistic, but completely reliable and reproducible, results that HIT generates is an important component to expanding the HIT market.  To some extent this can be done through our own websites, blogs and publications.  However, the best results will be obtained by the word-of-mouth that occurs as our clients go out in the world and answer the question “what have you been doing?”.

The Community Experience

The most critical element as we proceed is to develop a sense of community in the HIT world.  A sense of community is what is felt every time you walk into a starbucks.  A sense of community is what you feel when you and another iPhone user smile and nod. HIT offers an opportunity for shared experience.

When you do HIT, you become one of the smart people who realize that you can get in great shape with minimal time investment.  You know that the time-efficiency is not laziness or a short-cut, it is a requirement to produce the results you enjoy.  You also know that time efficiency is purchased with extreme effort and intensity.  You are a member of a rarified group that is able to generate that kind of effort and intensity…you are special; you feel it on the inside and it is visible as well.

With regard to the HIT community, we on the provider side need to realize that we are in this together.  There are many differing factions and sub-philosophies.  There are numerous equipment manufacturers vying for what is currently a small market.  What we all need to remember is supply creates demand.

There is a reason that Burger King is always located at the same intersection as McDonald’s…and McDonald’s is happy when Burger King shows up.  They understand that supply creates demand. This is why food courts exist.  Put your product, philosophy or protocol out there and compete like hell.  But be happy as more and more enter our field.  Supply creates demand. Lets get busy providing that supply.

Supply. Creates. Demand.

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:

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