The Athlete, The Patient, The Training Log, And a Modest Proposal by Jonathon Sullivan MD, PhD, SSC | June 23, 2016 I was looking at my training log the other day. It’s a little composition book, the kind you get at Walgreens for about a buck, and I started it in early 2011. By the end of this year (2016), I’ll have to get a new one. It’s almost filled up with training data, coffee stains, and protein-bar crumbs. It’s also full of triumphs, failures, embarrassments, false starts, stupid programming errors, productive program modifications, and a fair number of expletive asides. It documents one of my life’s greatest adventures, and progress I’d never dreamed possible when I made my first entry. I plan for it to be just the first installment in a long line of such books, like one of those interminable Tolkien-wannabe fantasy novel series everybody reads in college. When I’m ninety, I hope to have a shelf full of them, with another in progress. I know we’re living in a digital age, but I’m going to stick with paper. The humble English composition book fits in my gym bag. It’s simple, quick, and easy to use, it doesn’t need a power cord, and nobody in their right mind is going to steal it. Spreadsheets and online training logs are cool, and can be extremely useful. But paper logs don’t have server crashes. These considerations are completely alien to most of the population, even those who try to “stay active.” People who just exercise don’t keep a training log…because they don’t have to. Exercise is always better than a sedentary alternative, but it doesn’t require record-keeping or careful programming. All that’s needed for exercise is a willingness to sweat, along with a P90X CD or “boot camp” membership, a cool-looking headband, and some acetaminophen. Exercise is something you do today. Of course, if you’re particularly motivated, disciplined, and completely outside the norm for the average American adult, you may also do it tomorrow, and the day after that. Which, again, is far better than sitting on your Big Old Butt in front of the TV – unless the exercise itself is stupid and reckless and gets you hurt. In the age of broad domains and fashionable group thrashabouts, this unfortunately happens with a certain regularity. Caveat emptor. Training is an entirely different matter. Training is the manipulation of training variables in a long-term program aimed at the progressive optimization of fitness attributes. The goals of any rational training program are explicit and quantifiable: Strength. Body composition. Power. Endurance. Accordingly, most of the training variables we manipulate to achieve these goals are also quantifiable or explicit: Intensity. Volume. Rest intervals. Training days per week. Macronutrient intake. Exercise selection. And so on. Training is applied physiology. It’s an ongoing experiment conducted on the most complex object in the known universe: you. This elaborate system of cells, tissues, organs, joints, hormones, synapses, and weird primate behaviors will respond to the Stress-Recovery-Adaptation cycle in a fairly predictable way at first. The novice phase works more-or-less the same for everybody, because in this phase we’re really only manipulating one variable: the weight on the bar. Even so, novices start at different baselines and progress at different rates, reaching the end of their linear progression at different levels of strength. The novice phase is a bit less predictable as the age of the trainee increases. A hundred bros who train and eat properly will have a far more homogeneous response to novice training than a hundred geezers. By the sixth or seventh decade, any Sentient Ape has accumulated his own peculiar set of stories, scars, injuries, illnesses, commitments, skin folds, prostheses, and neuroses. Even so, he can add weight to the bar from one workout to the next, and he gets stronger on a linear progression with the exercises he can do at a rate he can tolerate. As training progresses, things become more complicated, even for the undifferentiated bro-mass. When the trainee enters intermediate status, he must manipulate more than one training variable. Volume, which was held constant during the novice phase, is now modulated throughout the Stress-Recovery-Adaptation cycle. The cycle itself spans several workouts over a longer training period. Exercise selection may be changed. Rest intervals get longer. And recovery variables become even more critical (though, sadly, just as frequently neglected by unwise athletes and their coaches). The training log was certainly important during the novice phase, both to document progress and to provide a reference for troubleshooting any difficulties with the program. But now, as the program becomes more complex, the training period more protracted, and the gains smaller and more difficult, the importance of the log grows exponentially. When a program runs into trouble, the differential diagnosis is long. Is the athlete starting on empty or running out of gas? Does he do too many warmups at small jumps, or too few warmups with jumps too big? Does he need to reduce the number of sets on volume day? Does he need to start running it out and decrease the number of target reps on intensity day, or start an intensity-day rep rotation? Is he getting enough to eat? What’s his protein intake? Is he getting enough sleep? Did the silly kid just get greedy? Without the log, we can’t hope to make an intelligent diagnosis of what’s holding up the athlete’s progress. And without a diagnosis, we can’t prescribe a correction. Exercisers don’t need this information, because they’re just getting in today’s workout. Two days from now, they’ll just do it again, or they’ll do some other, equally silly, unstructured thrashabout. But athletes are people who train. For the athlete, today’s workout is part of a larger plan and more explicit, ambitious goals. Training without assiduous attention to the log is like performing a long-term applied physiology experiment without recording your data. Actually, no. It isn’t like that. That’s exactly what it is. The athlete and his coach are applied physiologists. Now, there’s another type of applied physiologist who also has to keep careful records, whether he wants to or not. He’s called a physician, and like a good coach he’s responsible for carefully modulating and monitoring the physiological parameters of those in his care. Many of the parameters tracked by modern physicians are esoteric, misunderstood, or even useless. We’re just not as sure as we used to be that PSA and fecal occult blood screening are really as useful as originally touted. Body mass index (BMI) has become its own punch line. The healthiest, strongest people I know have BMIs that put them squarely in the “very obese” range, and we all know “lean” people who are easy to break. Blood pressure, HbA1c, glucose tolerance, and serum lipid monitoring are important to different extents, and all have their place, but unfortunately the knee-jerk medical response to abnormalities in these values is to prescribe some new pills and see what happens. Usually the parameters respond to the pills in a way that makes the doctor smile, even as the patient’s health continues to deteriorate. Because his real problems aren’t the parameters – his real problems are the underlying pathologies and behaviors that threw those parameters out of whack in the first place. The patient smokes. He’s fat. He’s sedentary. He never lifts anything heavier than a mega-burrito. He only bends over when he drops his Vicodin on the floor. Eventually, he will pester his doctor into writing for one of those neat little electric scooters so he can toodle on down to the Krispy Kreme in style. But, goddamit, he takes his statin. So his cholesterol levels will be golden, baby. Mission Accomplished. None of this is likely to change anytime soon, but I would like to go out on a limb and suggest that a 185-lb squat for a 62 year-old lady is also a clinically relevant health parameter. So is her 200-lb deadlift, her 90-lb press, and her heart rate response during Prowler pushes. So are her caloric and macronutrient intakes. Her training frequency and density. The adjustments in her rest intervals, volume, and intensity during recovery week. I’ve said before many times, and will say again, that training is medicine, and the foregoing is exactly why. In training, as in medicine, we aim to manipulate physiological variables with a view toward optimizing targeted heath and performance outcomes. Any athlete’s log, properly kept, will be a window into the physiology of a human being who takes both his physical performance and his health as seriously as any physician. And that log will document parameters that tell us far more about the individual’s long-term health and well-being than most of the surrogate markers you’ll find in his medical chart. And so, I have a modest proposal for all of you applied physiologists out there. If you all do it, perhaps we can begin, slowly but inexorably, to bring about a much-needed change in the modern medical mind. The next time you go to see your primary care physician, bring a copy of your training log. If he’s never seen you or your log before, copy off the whole damn thing and take it to your appointment. When you follow up in six months or a year, take a copy of what you’ve done since your last visit. Hand this painstakingly collected physiological data to your confused, bemused, astonished doctor, and say: “Here’s my training log. It documents continuous improvement in various physical, performance, and lifestyle parameters that correlate strongly with my health and well-being. It shows the frequency, formulation, route of administration, and dosage of my exercise medicine, and how I’ve responded to it. It should be part of my medical record.” Because, whether he puts it in your file or (bad doctor!) throws it away, it is part of your medical record. Maintain it accordingly, with diligence and discipline and care, like a good patient. Like a physiologist. Like an athlete.