Gain insight into how hot and cold are used in the military's very particular and high-performance world—and how to best tailor your hot and cold exposure to reach your goals—through a conversation with Framework’s founder Allen Penn and Framework Medical Advisor Dr. Patrick Owsiak.

Dr. Patrick Owsiak is an ER physician and a US military member. Currently, he’s the Special Operations Central Command surgeon—and before that, he met Framework founder Allen Penn while stationed as a doctor with a special forces group at Fort Campbell. As an integral voice in the human performance and wellness program there, Dr. Patrick’s expertise and effort were focused on addressing the question, ‘How can we maintain, sustain, and grow the performance of our trainees?’ Hot and cold modalities proved to be a consistent part of that algorithm—as they were practices based on science and, put simply, working.

Dr. Patrick has been working with Allen on Framework in a medical advisory role for more than a year—digging into the science (both what’s been robustly explored and what’s rather understudied) to determine which well-supported claims Nashville’s first social sauna and cold plunge could bring to the community. Just before the fourth of July, we spoke with Dr. Patrick about his experiences with hot and cold exposure in day-to-day training—and how to better discern what exposure practices are worth exploring in your regimen.

Allen Penn: How did you personally start pulling on the thread of hot and cold as health practices or recovery practices? How does that interweave with your work here in Tennessee (or wherever) that originated with the military sector?

Dr. Patrick Owsiak: They both developed simultaneously. It was a perfect mix of space and time. Like many folks, I'm not getting younger—I'm getting older. I'm constantly searching for sound science and an edge to extend my mind. I'm still 20 years old in my head, but in my body, I'm sometimes reflecting on my current age. So, I'm looking for opportunities to recover better and be the best physical self I can be. I'm going to take advantage of any advantage I can get or any recovery technique that I can do that's healthy and science-driven. That perspective emerged as I was in that role at Fifth group [Fort Campbell], and we had access to some of the modalities like the cold tubs, so it made it super easy and removed all the barriers for me to go all in and try. Part of my regimen was to get in the sauna post-workouts and work on my flexibility when those muscles were already warmed up. I just elongated them and did some rolling, and I found that that really helped me get ready for that workout and the next day's workout. That was fantastic for me, as far as addressing some of the issues that I was having.

Allen: Did you find that you wanted to test it out yourself first or make it a part of your practices before you recommended it to others?

Dr. Patrick: Mostly, I try to be the person who's done what I say or what I say other people should do.

Allen: It makes sense that the military would be interested in health practices with recovery factors adding performance. Some studies originated with extreme temperatures ‘on the field.’ Not to mention a general interest in developing sustainable bodies and minds.

Patrick: Sauna and cold plunge are great modalities because of how we approach human performance. Physical is one of them; indeed, it fits into the physical category but bleeds over into the psychological category. The spiritual category is activated for some people, too, given the time to reflect in the sauna.

Allen: What did that broad training regimen look like when you found hot and cold practices to be something you’re recommending to folks? What role did you find hot and cold most valuable, and who was it recommended for?

Patrick: Thinking back even just 10 years to my time in the conventional army…we were getting into providing equipment to do functional fitness. As I progressed into the Special Operations community, they were already well ahead of that—they already had purposefully built performance facilities staffed by professional strength and conditioning coaches, nutritionists, and sports psychologists. The prescribed training regimens differed because we had purpose-built teams to perform certain functions. The Dive Team is a good example—some teams are qualified combat divers with a particular task list and physical characteristics to maintain. The team to train them is based on that, but the individual training is based on the physical rigors of performing that job. Layer on top of that ‘army school stuff.’ A trainee knows, ‘In 12 months, I'm going to whatever school, and there's a specific train-up for that as well.’ In training, consistency really is the key—that's the goal. Regarding the hot and cold facilities available, the advice on regimens usually comes from strength and conditioning coaches. As you know from some of the studies we looked at, the timing of applying some of those practices is pretty crucial if there’s a specific result we're hoping to get out of it. Muscle hypertrophy is a good example. We looked at the studies, and there are some questions about whether or not you activate muscle hypertrophy if you use the cold too close to something like a heavy training session. If you ask the strength and conditioning coaches, it certainly does. They're unequivocally like, ‘Don't do it.’ However, we benefit significantly from delayed onset muscle soreness prevention if we apply it 12 to 18 hours after a different training session. My general theory is, ‘Hey, if it works for you, that's fantastic.’ We gotta encourage you to use this stuff and to be the best you can be, regardless of how I feel. If you think it's an advantage, then it's an advantage.

Allen: Some folks gravitate naturally to hot and cold, and others are probably less so. To what degree in the populations that you worked with was exposure therapy something that was a no-brainer versus something that you had to advocate for?

Patrick: Trainees are generally curious and super willing to try new stuff. My issue was providing the resources for them to make it easy and remove the barriers to access. We had four cold tubs that had to be maintained by the staff, and they had to be safe for repetitive use. We had to go through and eliminate the barriers to why they couldn't be up and running and ready, and that was my task as an administrator. Framework does that for you if you're trying to use the facilities—that's the fantastic thing about your model, right?

Allen: One of the most significant barriers [to hot and cold usage] is access, and it shows up in the day-to-day [of the general population]. But it sounds like they're limited relative to the population size, for example, within the military.

Patrick: Yeah. You can be in an environment where a physical therapist doesn't believe in something, and then suddenly, the door’s always locked to that room with the tub in it. Having a more open access facility is essential; most people don't have a sauna in their house here in America.

Allen: What does sauna and cold plunge equipment distribution look like if you reflect on the bases you've been to?

Patrick: It was eye-opening moving here [to Central Command, in Tampa] because there’s a collection of people from multiple organizations. Seeing what they're accustomed to and what they have at their previous home stations was pretty crucial. Here, there’s a lot currently under construction. There’s a beautiful indoor physical training facility next door to that and a beautiful indoor rehab facility that houses the physical therapists and athletic trainers. There's no sauna in our footprint for the unit, but there’s one on the base you still have 24/7 access. We're past the point where we're trying to convince people that these are suitable modalities. Now, we're solving the resourcing problem of making them available to the masses. What that looks like in a footprint here is a six-to-eight-person sauna that's pretty much operational 24/7. Then, three cold tubs, which service about 300 people.

Allen: What would you estimate the prevalence of usage to be like? If you talk about that population of 300, do you have 10% of people that, in a given week, would utilize some of this? More or less?

Patrick: I don't have exact numbers, but I will tell you that one of the things that surprised me was the [large] number of people that use the cold tub. I hadn't experienced that. Here, it seems like everybody does some cold submersion at some point during the week and in different variables. I do it twice a week after Tuesdays and Fridays. Everybody's got a recipe, and everybody's doing it. There is an understood rotation of cold-plunging people when I go in there after PT or physical training in the morning. They all know who goes ahead of them, and they come in a particular order into the locker room and have it down to a regimen. It's been impressive just hearing people say, ‘Yeah, I go down after lunch on Wednesdays, and I cold plunge for eight minutes, shower, and go back to work.’ And you’d never know—like, during their lunch break.

Allen: I mean, it's so ideal, right? We should all be lucky to have a cold tub down the hall from our...

Patrick: —building. Literally, we're at work!

Allen: That's awesome. As someone who believes a lot in these practices, I was excited to see what usage looks like when you remove that barrier to access. I was reading about this being a big trend in high-end apartment buildings—they're starting to add hot and cold exposure access as an amenity. It's no longer just a pool and a gym. It’s a cold tub, too. With that prevalence of usage, when someone talks about why they do it, how have people described the benefits that they feel?

Patrick: If I had to quantify or share the most common thing I hear, it’s just recovery. When I dig into that more, I understand that to mean the reduction in the delayed onset muscle soreness (DOMS) and the ability to sort of repeat physical effort at a 24-hour interval. For most of the guys here, a PT would be four days a week—Monday, Tuesday, Thursday, Friday, and whatever they decide to do in their own time, on Saturday, Sunday, and Wednesday.

Allen: Would you rate those recurring PT sessions as fairly intensive workouts?

Patrick: If they're participating and doing the prescribed regimens, yeah. It's lower body days to upper body days with cardio built on the back end of the workouts. For the most part, those are pretty intense workouts—a lot of weight moved, a lot of physical effort. The heart rate has to be moderate. We have yoga on Wednesdays and Fridays for recovery and flexibility, and that's kind of their 'down day.' So, a little bit of rest but quite a bit of participation.

Allen: I don't know if the stereotype is that the US Army takes yoga classes, right? Haha. But with many of these practices—everybody believes they are a part of building and sustaining your body.

Patrick: We've seen that ‘the border athletes,’ or just middle-aged guys like me, like injury prevention, considerable variations in the actual training regimen, and then utilizing science to incorporate things you wouldn't think—like the yoga example. While I wait to jump into the evidence, I'll tell you my most useful Sauna hack regarding physical training.

Allen: I don't want people to get the wrong impression when you say, ‘middle-aged guys like you.’ Didn’t you tell me you did a 5k, a 10k, and a half in a marathon back-to-back-to-back days?

Patrick: Yeah, it was just under 50 miles. It was fun. It was for charity. The cold tank was a good part of that training regimen.

Allen: I would think so.

Patrick: It helped me get through the soreness of it and just work everything out. It was perfect.

Allen: Is there anything else that you’ve talked about—muscle soreness and recovery being some top talking points—or that people are pointing to?

Patrick: Another thing I hear all the time is that users are cognitively ‘switched on.’ I was studying these individuals doing full submersion—the whole head and face immersion—and they swear by it. They put their feet over the tub's edge and do a sit-up when they want to come out, going entirely in and underwater for whatever that is—30 seconds or so. And they'll do that a few times. Then they'll hop out and hit the showers, and they say, ‘Hey, that's my morning, that gets me going.’

Allen: Let's get your scientific and medical overlay to that point. This is something that I've observed, and I’ve talked to a lot of people at Framework about it. They liked coming in the morning before work and getting a cold tub. Customers say they’re much better at their jobs after using cold or feel like more attentive partners at home. I’ve always ended with a cold plunge because I think a lot more energized and focused. What's scientifically eliciting that more anecdotal, subjective description?

Patrick: It's not much different than people who find other activities in the morning to be particularly activating. The runner who loves to run in the morning but feels less great of a runner in the afternoon or less energetic. In the morning, we haven't done anything. We've just been sleeping. Our bodies are ready to be turned ‘on.’ The morning is an excellent opportunity to kick everything off well. The body's receptive, and when we have that stimulus, it makes an individual more resilient to those exposures. In that moment, we're getting a release of our body sensing that stimulus—a release of neurotransmitters. All those things are exciting for people. It's akin to smoking your first cigarette in the morning—your body's receptive, you haven't had anything for a while, it hits different. If you are an active and a cold tub user, it’s gratifying. Cognitively, and then that carries through. That's beautiful—you don't need to ‘smoke again’ at noon. That's the layperson science behind it—it's just a fascinating, really stimulating event as it is primed to happen and then leaves people with green, positive results for the rest of the day.

Allen: What a tool. To be able to do something that is measured in a few minutes and that can work on your physical body, recovery, and mind and make you feel good and ready to enter the day? That's a powerful thing to do with lightweight equipment at the end of the day. You can go jump in the lake. You can turn the shower cold, you know?

Patrick: When we went to Ireland for a trip, my wife and I did cold water swimming. We ran to the beach, and then we did the cold-water plunge. Then we ran back to the hotel, and what a fun experience. We weren't the only ones out there—there were a bunch of local folks out there doing it, and we didn't feel strange at all.

Allen: The tubs that Framework or the tubs of the military have—fancy equipment to make sure that you can do that indoors—but people have been seeking this out for thousands of years without totally understanding the science.

Patrick: We stumbled into this a little bit in the military. When we bought them initially, we thought that the tub would probably be used more for heat—like a whirlpool—than cold. We're on our own exploration journey as well.

Allen: We went pretty deep into the cold water side, no pun intended. Let's talk a bit about sauna—what are the situations where you encourage people to use the sauna? What do you find usage to be, and what benefits do people report after they try it?

Patrick: Many folks use it at the end of a workout to boost the heart rate—an excellent cardiovascular kick—but the evidence suggests that it promotes the growth hormone. Lifting weights is a no-brainer if you’re trying to get the most out of the work you just did. If I can have that at the end of my workout and potentially get an extra kick, that will last a few days, like awesome. Then, while you're in there, you might as well do some rolling and stretching—let's face it, we're terrible at getting that in any way. Then, as we age, that doesn't go away if we ignore it. That's a big part of injury prevention and recovery as well. We love it for putting our individuals in ‘zone two’—or exercise mode. If I tell you, ‘Allen, I need you to do 150 minutes of zone two this week.’ Your heart doesn't know the difference between what you're doing. Your legs can get tired. You can be sick of rowing, biking, or doing whatever you're trying to do, but that's the beautiful thing about the sauna—the heart doesn't know. So if I throw you in the sauna, we can get you into zone two and keep you there? Those are free minutes from a work standpoint. It's not comfortable if you do sauna correctly. For folks recovering from injury and/or if we're trying to optimize BMI or anything like that, we can get a little extra squeeze out of there with a low risk of injury.

Allen: The ability to stack some of these benefits and do some of these things internally at the same time…no matter who you are, everybody's time-crunched. It’s really compelling when you can do an exposure workout regularly and repeatedly, and you start to step into some chronic health prevention. Flexibility, even. One of the things I've started trying to do is sit cross-legged—which I am really bad at. My hips and ankles are so tight, but I've started to try to do that while I'm in the sauna. Again, your body is in this receptive state. I've made a lot of progress, actually.

Patrick: The last part is just that, and it's gonna sound hokey, but I've met some great people in the sauna at the gym and people that I probably wouldn't have had conversations with if we weren't sitting six feet apart and looking at each other for 20 minutes while we were sweating.

Allen: It's pretty funny how that happens. There's a personal thing going on in saunas, where you will generally be far more likely to chat with the stranger for the better.

Patrick: I'm far more likely to stay in for the full-time, even if I'm hurting. If I'm talking to a stranger, just having a good conversation.

Allen: What do you recommend—and how does it vary by purpose—regarding the duration of those sauna sessions?

Patrick: Everybody's coming from a different place. Technology has made everything so readily available that I have polar heart rate monitors that we throw on them, and we can put them on a giant board that the coaches can see. You can track it all during the workout or if they're doing a sauna session. We don't have to guess anymore; we can hit ‘zone two,’ work it, and write you the regimen for what that will look like for them going forward. If there’s deviation or improvement and adjustments are needed, that's easy. The other side is if something's not quite right—like you're just not Allen today or you had a rough weekend at the beach with friends—that's reflected, and we can back off on some of the things that we're doing to let your body recover before we put it through those stresses. It's helpful in all aspects of the training.

Allen: What do you pay attention to concerning those heart rate levels?

Patrick: There is a company out there that does ear pricks and checks your lactate levels in association with your heart rate and your power output, and then they'll give you a range specifically tailored to you. When you link your polar heart rate monitor to their app, they bump you around and remind you if you're ‘out of the zone’ or ‘in the zone.’ It's been used by many professional athletes to enhance their training because we found that humans are terrible at regulating their own efforts. We're either on the weak side when we just aren't giving enough effort, or oftentimes, we're actually over the effort for the goal that we're trying to obtain. ‘Zone two’ is the hardest because you naturally don't feel like you had a good run if you're running a 12-minute mile.

Allen: I find that ‘zone two’ is the most annoying place to be—it's one of the reasons I like trying it in the sauna.

Patrick: It’s so individual. Yours is probably quite a bit different than some of our other individuals, some borderline, the Olympic athletes—we really have to get them into a distinct area to be ‘zone two,’ even if it's ridiculous.

Allen: We were wading through scientific literature when you and I started working together. You and I went through 60 to 80 papers; three-fourths of those were in the sauna domain compared to cold. There's a lot out there, but you and I also disqualified many of the papers you read. We're all becoming more aware of the health benefits, but there are many claims out there. If there's one thing we know about the news and media landscape, we need to educate ourselves more than just the headlines. What advice would you give people if they wanted to start looking at the underlying research behind a claim and trying to vet it?

Patrick: Numbers matter. Be wary of studies that have just a couple of participants. That's how we get started and realize that an extensive study is what we need. Those are valuable for finding our way before spending millions of dollars on studies, but numbers rule. Some population studies had tens of thousands of people in them—the masses are not wrong. If we see benefits like that, there's some truth to what the masses are doing. That's the starting thing—and the second thing is, who's paying for the study? Be wary of studies paid for by people who have financial interests in the study. It's excellent when government agencies sponsor the studies, and your tax dollars go to things like the CDC, which grants university people money to study a question. The last part is that the devil really is in the details. If you do a sauna study but your temperature is 110 degrees in the sauna, that's quite a bit different than what the rest of the world is doing. Their result might be valid, but it might not be relevant to the question you're trying to answer. Those little nuances do matter. When we went through studies, we didn't get rid of any of the research—we just decided that it wasn't probably valid to answer the questions that we needed to provide Framework guests to reasonably say with some degree of surety that it was compelling evidence. There are a lot of great, reputable resources out there. Dr. Rhonda Patrick, Peter Attia, and [Andrew] Huberman want to get it right.

Allen: They have the expertise to evaluate studies. Peter Attia, in particular, has a whole content series that points out flawed studies that have made it into mainstream media, which I appreciate when you see through that lens. [You can] use some of these proxies as a starting point. Thanks for going through that together—I learned a lot, and hopefully, others will. And with that, I'd say, let's wrap it up here. This has been awesome and a lot of fun.

Patrick: It was a lot of fun working on this. Working on these projects is a passion—we are immensely proud of Framework. What drew me in was your desire to understand the science and to give people a service, but to do it in a way that accurately reflected the health benefit. Thank you for that.

Turning cold dips into a daily habit can fortify the foundations of your health.

If you're new to this, it's key to start slow. Kick your practice off with shorter dips and then work your way up to longer ones as you get used to the chill. But know—with sauna and cold plunge as everyday practices, that ‘feel good’ feeling will be a new life-long constant.

Will we see you at the studio? Book a class today.

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