Starting Strength Weekly Report

October 26, 2020

Hallomas Edition

On Starting Strength
  • On the Verge of Unsubscribing! – Another world famous Q&A episode with Mark Rippetoe. Rip answers questions from Starting Strength Radio fans.
  • Bigger and Stronger at Starting Strength Houston – Starting Strength Houston member Kyle went from a 55 lb squat to a 280 lb squat and a bodyweight of 150 to 170. Head coach Josh wells discusses his progress and increase in physical capacity over the last year.
  • Benton's Aged Hickory Smoked Country Ham – Starting Strength Coach Grant Broggi introduces you to Benton's Country Ham, a versatile, delicious, and American piece of aged meat and official snack of the Starting Strength Seminars.
  • 5s, Not 10s by Carl Raghavan – You don’t know it yet, but I do. You need to do your 5s 3 days per week, then eat and sleep enough to recover. And that’s all you need from the weight room...
  • Dylan by Jim Steel – A few years back, when I was still the head strength coach at the University of Pennsylvania, I walked into the equipment room in the basketball arena to visit my friend Johnny...
  • Weekend Archives: How to Spot the Squat –Starting Strength Coach Nick Delgadillo and the WFAC demo team show you how to properly spot a squat.
  • Weekend Archives: Why Being Sore Doesn't Mean You're Getting Stronger by Mark Rippetoe – Training with weights produces muscle soreness. Many people don't like to be sore, and that's why they won't train for strength.
  • Translation: Latihan Barbel adalah Obat yang Ampuh – Untuk beberapa waktu, dalam tugas saya sebagai dokter emergensi, saya memiliki pikiran aneh saat memeriksa beberapa pasien saya... [Indonesian translation of Barbell Training is Big Medicine by Joannes Marvin]

From the Coaches
  • A safety squat bar (or "safety bar") can be a useful training tool, but sometimes, the person who needs such a bar also requires a lighter version of the bar than what is commercially available. In this video, Phil Meggers discusses how to simply and economically make a DIY safety bar that weighs about 10 lbs.
  • Training - or getting stronger - is analogous to driving down a highway that you are simultaneously constructing. Phil Meggers explains this analogy and its relationship to the novice, intermediate, and advanced phases of training.
Get Involved

In the Trenches

maggie between sets at wichita falls athletic club
Maggie getting some love and cuddles between sets at WFAC. [photo courtesy of Bre Hillen]

Best of the Week

Vasovagal Syncope and avoiding a pacemaker

Ever trained anyone who faints when the room temp changes?

My housemate (female 23yo 5'2" 48kg) has been struggling with vasovagal syncope for the best part of 8 years now. It would not be uncommon for her to faint once or more times a week. Temperature changes, high stress events, stimulants and rapid change in exertion all result in nap time.

It goes without saying doctors have advised avoiding strenuous exercise at all costs. She runs, squats and deadlifts nonetheless, not dead yet. They have also proposed a pacemaker may be her only out.

It seems logical to me that a stronger heart could only do good things. Thought it worth seeking a professional opinion, maybe someone on here could help her find a path to a more functional life.

Mark Rippetoe

A pacemaker? For vasovagal syncope????


You can have a cardio depressive version of vasovagal syncope, where the heart rate drops out....but it’s pretty darn uncommon. Unless they’ve documented it on a tilt table test (or cardiac monitoring of SOME sort), she doesn’t have that and doesn’t need one.


I guess if she has had an event recorder demonstrate genuine bradycardias associated with the loss of consciousness and it is happening as frequently as you mention then there may be no other choice. However, why this means no strenuous exercise is beyond me.

Jonathon Sullivan

“A pacemaker? For vasovagal syncope????”

Yeah. That's exactly my response. Something else is going on.

Yeah, we're talking in a vacuum here. "Vasovagal" is a wastebasket term. It basically means the syncope is most syncopes. But sometimes it's because of a malignant arrhythmia. As Simon intimates, she needs a tilt-table test and probably a holter and an echo. IOW, she needs to see cardiology. If she came to me, I wouldn't train her until I had that workup in hand.

I knew this girl once, a lab tech, with a similar presentation, which did not get worked up beyond the "oh it's just vasovagal syncope now go away" phase. Turns out she had a Brugada variant. Sudden cardiac death in the lab one day while working at the bench. Fortunately across the street from our ED. Resuscitated in less than 15 minutes with a fair neuro outcome, and got an ICD. Happy ending. Could have been...worse.

Remember: syncope is a condition in which your brain temporarily stops working for some reason. Respect that, and get to the bottom of the "some reason" part. That's the role of a doctor who gives a shit and doesn't just slap a "vasovagal" diagnosis on a young person with recurrent syncope.


I really need to stop being imprecise in my replies.

Syncope is loss of blood pressure to the head, for whatever reason, that lasts long enough for you not to be able to stay conscious (or at least upright). If. I remember right, it will happen to about 10% of us during the course of our lifetimes. Most of the time, we never figure out what it was, and it goes away.

There are red flags to watch out for, but one noteworthy thing about your friend is that she hasn’t died from any of these multiple episodes. That all but rules out most of the more terrifying causes. I’d be interested to know what they know about her syncope, before they start putting hardware into her.

If nobody has documented a pause in her heart rate of more than 3 seconds, or SOME sort of bradycardia at the time she passes out, then they shouldn’t even bring up the word pacemaker.


She has been diagnosed with cardiodepressive vasovagal syncope. She was diagnosed via the tilt table test. She does see a cardiologist. No arrhythmia.

During an episode her heartrate ramps up to +140ish before dropping to 40bpm and thus inducing the faint. At least that is what was recorded on the table. Her resting bpm is usually around 70.


In that scenario I suspect she does need a pacemaker. I’m no expert in cardiology but I can’t think of another way to prevent the profound bradycardias she is getting and frequent fainting would be quite an unpleasant symptom to suffer I hope she gets somewhere.


Ah, then that’s simple. Pacemaker. It will greatly improve her quality of life.

I mean, there’s other stuff (making sure she’s hydrated, etc), but if she’s failed that, then this is a no-brainer.

The vast majority of the time, the pacemaker will just sit there and watch the world go by. It will only leap into action if she goes low.


Yes, this should definitely be worked up and characterized before putting in a device, but I would just add that dying from the syncope itself is not the only concern. Regardless of the cause, sudden loss of consciousness can be a big problem if you are driving, swimming, holding a baby, rock climbing, etc. Not to mention it's a bummer to have an ambulance called on you unnecessarily every time you drop in the grocery store or mall. Fainting 2/week puts a huge crimp in your lifestyle. So even if it's "benign," it needs treatment. Whether a pacer is needed is another story. Pacers are pretty darn expensive, so I would assume that at the very least the insurance company is insisting on proper eval and perhaps trial of other treatment first, even if the doctor is a pacer-happy cowboy who drives a Bentley with a "MEDTRONIC" vanity plate. But maybe I shouldn't assume these things...

Best of the Forum

Do softer bumpers result in meaningfully less noise?

We've been training in our newly outfitted garage at home for about a month and got our first noise complaint from a neighbor this weekend. I was doing cleans and dropping them with my newly acquired bumpers on my newly constructed platform. We like our neighbors and have good relationships with them, including the guy who complained and so don't want to be belligerent about it. The bumpers we have were bought second hand and are way to the hard side of the continuum. If buying more expensive, softer bumpers would help dampen the noise then we'd bite the bullet and do that, but I don't want to spend several hundred dollars more on additional new equipment if it isn't going to meaningfully change the situation.

Mark Rippetoe

The "softness" of bumper plates does not vary to any significant degree, since it would affect their bounce, which must be controlled. The noise is the result of the weight hitting the platform. I guess your HOA needs to pass an amendment to their CC&Rs prohibiting the Olympic lifts in the neighborhood.

Erik Y

Where’s your platform? Can you soundproof the room?

Mark Rippetoe

Those of us who do not like neighbors having input into our affairs have chosen not to have neighbors.


That is the dream, but it is increasingly difficult when your country's population has almost doubled in 50 years, placing you in the third most populous country in the world. Or when you live in China. Or India. Or Britain, which keeps trying to grow its population through immigration despite constant environmental claims that the island has already far exceeded its population capacity.


Wow! That escalated fast. From bumper plates to world population growth. Congrats to you Mark for presiding over one "big picture" forum!

Mark Rippetoe

Acoustic insulation is the only thing that might work. But dropped plates make noise.

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