The Checkup: Flunking The Insanity Workout But Coming Away Wiser

It's getting embarrassing. Week after week, month after month, this post — Flunking The Insanity Workout But Coming Away Wiser — tends to top the WBUR Web traffic stats.

It's no mystery why: The inescapable Insanity infomercials continue to populate the late-night TV airwaves, and viewers tantalized by their amazing before-and-after photos, and the charismatic energy of trainer Shaun T., proceed to google "Insanity workout" to try to discern whether the set of DVDs is really worth more than $140. And there, on the first Google search page, is our CommonHealth post, and the lively, long, occasionally rough exchange of pro-and-con comments that follow.

This week, The Checkup, our podcast on Slate, revisits the Insanity workout, with a brief recap of Carey's sad tale of flunking it and additional wisdom from experts. In particular, we spoke with Dr. John Richmond, chair of orthopedics at New England Baptist Hospital, which specializes in orthopedics. The original post mentions fear of injury, but Dr. Richmond delves into the nitty-gritty of which particular moves are most dangerous, particularly for older exercisers.

And for an added dose of sanity, the podcast also features Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine, and his data-driven depiction of the overwhelming health benefits of exercise — even in far lower doses than you might expect.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

Below, a full transcript of Dr. Richmond, lightly edited:

CG: So I hear that orthopedic specialists are often very grateful to workouts like Insanity because they send you a lot of customers. Is that true?

JR: It definitely drives business. There’s no question that there are a number of people that end up in offices and actually, ultimately in operating rooms because they’ve torn things or worn things out by doing over-aggressive exercise.

So what would be your top tips of what to avoid?

There’s a couple. One that we see a lot of is lunges, or deep-knee bends, deep squats . . .

What do they do to you?

They beat up your knees, big time. And they can damage the joint’s surface cartilage, they can overload that cartilage and cause it to wear, and it’s particularly problematic in the scenario you described as not being a youngster anymore, being a little more in the middle-age realm, when people oftentimes have already accumulated some wear-and-tear damage in their joints. And then to really overload it with lots of squats and lunges tends to exacerbate problems and cause further damage.

So do you stop doing deep-squats or lunges altogether? Just don’t do them very deeply? Or really avoid the whole move?

If you have any pre-existing knee problems, avoid the whole move. Just stay away from them. It’s kind of a good test to do a squat down, come up and feel them, and if they have any grinding — crepitus is the medical term — but any grinding sensation, that’s probably a joint that shouldn’t be put through repetitive lunges or squats.

Okay, what’s your other top one?

The other top one is shoulder problems with over-use. With doing above-shoulder activities, with lifting, pushups, chin-ups, all of those things that are oftentimes tossed into these mega-workout programs.

So pushups, even?

Even pushups. Again, pushups are great if you’re 18, 24, 26 and healthy and have no issues, but to all of a sudden jump into a strenuous program as somebody who’s in the over 40 crowd, you may in fact find that that puts enough stress on your shoulders to lead to tendonitis of the rotator cuff, and, rarely, tearing of the rotator cuff.

And again, is this a move that you can modify? Or should you just stay away from it, those of us in the over-40 crowd?

I’d stay away from the pushups; I think you can do the equivalent by doing bench-press activities, but you can adjust the weight. The problem with a pushup is you’re stuck with half your body weight on your arms, the other half being on your toes, so that you can’t adjust the weight. But you can do bench-presses with much lighter weight and therefore be able to get the same physical benefit from it, but at a lower pressure on your joints.

Right, the only thing is, you can’t do that in a DVD-workout that requires no equipment.

That’s correct! That needs a weight bench, and some weights.

Another thing that seems to be very typical of Insanity and workouts like it is that they’re going for this super intensity. So they tell you, 'Okay, here’s the move, it’s a pretty basic move, NOW DO IT REALLY FAST! Now do it as fast as you can!' And so you’ll be inevitably losing form, right? You’ll be doing things with worse form than slowly?

Yes. You’re going to do them in worse form, and you’re going to do more reps than you may be prepared to do. One of the principles of training up to a high-performance exercise program is to start gradually and go up slowly. You start at an intensity that’s very tolerable, and I tell folks, never increase what you’re doing by more than 10% per week. So, if you’re doing 10 of one thing one week, the next week you only go to 11, you don’t go to 20.

Also, workouts like "Insanity" do vary the exercises somewhat, but you’re doing a lot of very similar and particularly high-impact moves, like jumping up and down, day after day after day, without resting those specific muscles. Is that known to be problematic as well, or more likely to lead to injury?

It is. And you need some time to recover. How much time you need to recover depends on your exercise history: Are you well-trained beforehand, and somewhat on your age, but you don’t do something like that necessarily five days a week. You maybe do it three days a week. You try not to push it too, too hard. You can maybe ultimately work to five days a week if you’re young, and you build up gradually to it, but there aren’t very many, say in the over-50 crowd, that ought to be doing something like that on a daily basis.

Have you ever seen the amazing before-and-after photos on the Insanity ads? What do you think?

Well, you certainly can train yourself to lose a lot of weight — or they’re not actually losing that much weight, they’re gaining so much muscle tone and conditioning that they’re replacing fat with muscles, they look great. You can do that, but that’s probably more the exception than the rule if you follow their training programs. I think they’re just too quick.