I am 45 and had both hips replaced last year (June and October 2019). My father had his first hip replaced at 47, so the doctor believes my issue is genetic. I started LP in January before COVID halted my progress. I started over with LP once gyms reopened. I have worked up to a 200# squat (from 95#), 275# DL (from 135#), 175# press, and 235# bench. The Ortho said that I should do sets of 10 and squat (maybe even DL) no more than 250#. I am well aware of your thoughts and feelings on most doctors. I agree with you and see the flaws in his reasoning, but I would like some guidance as to how to proceed with my training. I have read other threads regarding training and hip replacements but see no specifics on a long-term plan of progress. I would like to make training progress for the rest of my life after having done all of the wrong things (strength coaches playing football until college and after, playing catcher in baseball, Crossfit, my own stupidity, etc.) until now. I found The Barbell Prescription helpful, but would like to get more details on a plan for those with hip replacements.
Post the specifics of the procedure, so we can see what actually was done to your hips.
I had the anterior approach done on both hips. Both were outpatient procedures, and I was walking down the street that afternoon/evening. I ditched the walker after one day and used a cane for 2 additional days. I have a plastic socket liner and a ceramic head to the hip prosthesis.
There is no long-term plan. There is only the linear progression approach to your own situation, that evolves into more complex weekly training when it becomes necessary. The plastic socket liner will be the problem eventually.
What type of problems have you seen? Is this a matter of normal wear and tear or does training cause these issues? Can I still progress to have weights on the lifts? Are there any considerations I need to make in programming long term? I assume you would recommend a coach to help me.
I am a PT and as Rip alluded to, there isn't a specific long-term plan that someone can lay out for you about training after hip replacement as there isn't any research on the topic that I am aware of. As far as your doctor's advice goes, as is typical, they are just giving you conservative advice to protect themselves if you hurt yourself training. How hard you push yourself in your training is up to you. The implants used today are very durable, but you are a young guy and will most likely need revision surgery down the road regardless of whether you train hard or spend your time lounging on the couch. As long as your programming is sensible in terms of volume, frequency, load progression, etc. then you will be fine. Also, make sure you follow your surgeon's advice about your follow-up schedule with him as those scans will pick up any problems with the implants that will eventually occur with time.
I am sorry that I am not being more specific than that. If you want to speak more about your training privately, feel free to DM me.
Good luck with your recovery.
Do you think that appetite is something that is regulated by your body for health? i.e. your body telling you it does not need more food because that would cause problems for you?
You notice some people have no problem "filling out" while growing up, they get a natural spike in appetite and gain weight rapidly. Others seem to struggle – they end up skinny.
Could this be a result of eating habits that have formed for the two individuals? or is it the body telling itself that its not comfortable carrying the extra weight?
I think weight gain happens naturally as a result of barbell training, but it happens very slowly. This makes sense, since muscles need to be repaired and reinforced so that next time what caused the micro tears in the muscle bellies does not do so as easily now.
But if we're interested in speeding up the process, we need to intervene and "artificially" spike appetite. Why do we need to do this? Why can't the body understand that if more food means better, faster recovery, why doesn't it significantly increase its appetite naturally?
Lastly, when appetite is left unsupervised, I've noticed that it always tends to drift back to where it was previously (i.e. fat people on a diet get back to being fat, skinny guys who've gained weight lose weight)
Back to the question: Appetite: Health measures taken by the body or eating habits formed?
Great question! There are certainly mechanisms in place that regulate appetite and what is more interesting is that research has found that individuals who "weight cycle" (meaning gain and lose weight) disrupt some of them. Specifically hunger hormones tend to get upregulated after periods of dieting, resting metabolic rate decreases via adaptive thermogenesis etc. Even more interesting is in the case of the person who is naturally thin and struggles to gain weight. Some individuals have more brown adipose tissue, which contains higher levels of uncoupling proteins, which cause more energy to be lost as heat. These people tend to be naturally thin no matter how much they eat and also tend to "run hot," meaning that they feel hot very easily. That's the biology half of it. We all have homeostatic set points for most things and that set point is going to vary from individual to individual. Some of this can be altered to an extent through training, diet etc but generally we are always going to naturally gravitate back to our physiological "norm."
How come everybody’s set points went upwards a few dozen pounds post-1970? My own family got fat like a light switch turning on.
We don't really have an exact answer to this but I venture to speculate that if we had measures of actual dietary intake we'd have a better sense of why this is.
Questions regarding set points: Are they tied specifically to body weight or body fat percentage? Do we know?
Do we have a collective data point on what type of fluctuation from a percentage is tolerable for the body before other metabolic regulators kick in?
I'd say it's tied to fat mass since that is a direct metric of our stored energy depots. At a certain point our body recognizes that additional fat loss threatens survival. I'm not sure that we have a collective data point but there are plenty of papers out there on weight cycling and fat loss plateaus that show a return to baseline and sometimes above baseline. There was a paper in the 1970s that looked at fat cell size and fat cell number in overweight and obese women losing weight. Not the tightest controlled trial but they found that the fat cells seemed to hit a wall at around ~0.40 mcg per cell, which was the proposed minimum fat cell size. Again, the diet was not controlled and they were simply instructed to "lose weight until they couldn't anymore" then return to the lab. Interesting nonetheless.
My guess would be body fat.
I suppose if it isn't body-fat then it's muscle mass, and why would the body have a reason to get rid of muscle mass – something that's useful for survival?
I would think that bulking/cutting works because of this fact, the body gets rid of fat quickly (returning to a physiological "norm") – especially if you had to "forcefully" eat to get that way, but maintains the muscle because that's important.
As for the tolerable fluctuation for an increase in weight (body-fat), I'm not sure.
I have a vague memory of a BBC(?) documentary talking about experiments carried out on prison inmates, forcing them to eat up to 10000 calories a day in exchange for shorter sentences. Apparently some of them couldn't get past a certain weight no matter how much they ate. Metabolic regulators?
sI'm unsure about the rigour of the study but perhaps Robert might know more about this.
Ah yes you are referring to the Vermont Studies done by Ethan Allen Sims in the late 60s. They were investigating the effects of experimentally induced obesity on a group of prisoners in the Vermont State Prison. Essentially they took a group of prisoners, fed them in the ballpark of ~4000 calories and saw that some gained weight initially and then weight stabilized. So they had to increase the calories up to 10,000 calories to induce obesity. All meals were measured, monitored, and recorded. Several papers were published on this and I'm still trying to locate the first one so I can get a hold of the macronutrient breakdown but they said that they used "standard dietary tables," which tells me that this diet was likely moderate-to-low fat, which could explain why it required so many calories to induce weight gain. They also collected adipose tissue biopsies and this is one of the first papers to report that the fat gain was due to an increase in fat cell size and not an increase in fat cell number. Now keep in mind this is a short term study so it didn't tell us much about the long-term effects of this but it was the first to give us some insight on the biological variability in the response to overfeeding. This was later extended by Bouchard and colleagues in 1990, where they studied the effects of overfeeding on monozygotic twin pairs and reported that genetics were 9x more likely to predict the response to overfeeding than energy intake. All very cool and fascinating stuff! The short of it is if you wanna walk around super lean, then select your parents wisely!
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