Everything You Need To Know About How To Use Heat Exposure To Enhance Performance, Burn Fat, Gain Muscle And Think Better.

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I go to the sauna once a week, and often twice a week in the winter.

I get a huge pile of the magazines or journals I subscribe to, like ESPN, Fast Company, or Mother Earth News (and sometimes even grab a book I don't mind destroying) then settle in for a good 30-45 minute sweat session.

After about 25 minutes, it get pretty tough as my heart rate and core temperature rapidly rise, and I eventually get so hot that I have to quit reading – and then I simply switch to staring at the wall and doing deep, meditative breathing to sit things out for as long as I can. I pretend I'm some kind of ancient warrior sitting in an Indian sweat lodge, or a prisoner of war tossed into one of those heat torture chambers.

Then I take a cold shower and I feel amazing.

I've used this strategy to train for everything from racing Ironman in the lava fields of Hawaii to preparing for a tennis tournament in a stifling indoor tennis courts stadium.

But why does heat work so well to enhance performance?

Can you use heat to build muscle or burn fat?

What's the best kind of heat? Saunas? Steam rooms? Those dorky sauna suits?

You're about to find out the answers to these burning questions (ha!), and so much more.

rhonda patrickMy guest in today's podcast, Dr. Rhonda Patrick (pictured right) has a Ph.D. in biomedical science, a Bachelor’s of Science degree in biochemistry/chemistry, has done extensive research on aging, cancer, and nutrition, she did her graduate research on the link between mitochondrial metabolism, apoptosis, and cancer…

…and she knows a thing or two about heat exposure too, as you can see from her video here on heat stress

Dr. Patrick is currently a postdoctoral fellow at Children’s Hospital Oakland Research Institute, where she conducts clinical trials looking at the effects of micronutrients (e.g. vitamins and minerals) on metabolism, inflammation, DNA damage, and aging. In addition, she is investigating the role of vitamin D in brain function and other physiological functions. She has also done research on anti-aging techniques at the Salk Institute for Biological Sciences.

During our podcast, you'll learn everything you need to know about how to use heat exposure to enhance performance, burn fat, and gain muscle.

-3 ways getting into a sauna could actually grow new neurons and make you smarter…

-The best to use heat to build endurance, build muscle and heal injuries…

-How much heat exposure is enough, and how much is too much…

-Whether it's really true that you can increase growth hormone inside a sauna…

-How heat can help you produce the “runner's high”…

-The amazing anti-aging effect of saunas and how it works…

-What the best type of heat is, and whether there is a difference between wet heat vs. dry heat vs. sauna suits vs. infrared saunas and mats…

-How to ideally combine heat exposure with cold thermogenesis…

Resources discussed in this podcast:


Biomat infrared mat

CoolFatBurner vest

Do you have questions about how to use heat to enhance performance, or any other thoughts about this episode with Rhonda Patrick? Leave your comments below!

Ask Ben a Podcast Question

80 thoughts on “Everything You Need To Know About How To Use Heat Exposure To Enhance Performance, Burn Fat, Gain Muscle And Think Better.

  1. Tim Chaten says:

    Ben – great podcast. For those without access to a sauna would hot baths accomplish the same thing or would the water not be able to be warm enough to help here?

  2. Shane Elgort says:

    Great article Ben! Dr. Patrick is a mammoth in the field. I’m really happy to see genetic-based diet plans gaining momentum. I found myself to have had a tremendous improvement in my lifestyle after tailoring my diet and fitness regimen to parallel my genetics. To be on the safe side, I got these tests from different companies and compare the reports and so far I’ve been pretty satisfied. Foundmyfitness was great and is usually the first company that consumers seek for fitness based genetic information. Another company I would suggest is Xcode Life, I came across them very recently and found their reports to be easy to understand and informative. Cheers! Keep on posting. https://www.xcode.life/

  3. Alan Raitman says:

    Ben, Doesnt cold after heat negates the benefits of sauna?

  4. Tyler DiPentima says:

    Hey Ben! I know I’m late to the party here but I just found this. I’m 23 and getting serious about my fitness and about trying different methods to be a healthier person for the long haul along with gaining muscle while burning off my remaining fat. I’ve read up on the great benefits of both hot and cold therapy however I’m not seeing much on how to use them cohesively. I know that heat is best used directly after a workout whereas it is best to wait a few hours after a workout to emerge in an ice bath. when using a sauna directly after a workout, what are the benefits or dangers in following up hyperthermic conditioning directly with an ice bath or cold shower? If it is not best to follow one directly up with the other than what is the optimal time to wait between them? I’d really appreciate any feedback you have or being pointed in the direction of a podcast or article delving deeper in to the cohesive use of hot and cold. Thanks!

  5. Matthew Tortoriello says:

    Infrared vs dry/wet sauna? Is one better to performance and healing?

      1. Don says:

        This article is full of false information . It’s a deceptive strategy to get people to by FIR Infared Saunas . Here is a copy of what Dr Rhonda Patrick said about dry Saunas vs Infared Saunas.
        ” I’ve been searching everywhere for information on (FIR) Infrared Saunas – I can’t tell if its fad or effective/comparable results to steam saunas. Most of the research showing benefits of sauna use on the heart and brain are using traditional hot saunas that can reach a temp of 180F. The FIR saunas do not get this hot. the key is heat stress and perhaps staying in the FIR sauna longer may get you more heat stress. Personally, I prefer traditional saunas over FIR saunas.”

  6. Deneen says:

    I would like to know if anyone has found a fitness tracker that can monitor HR IN THE SAUNA. I’ve been searching for a year! With saunas coming back into popularity, I’d think one of these companies would have stepped up!

    1. Frank morel says:

      Orua ring. Made in Finland. Made for Saunas are a given

  7. Ebrunner says:

    A little off topic but this sort of came up: any sense of how one’s current state of fitness/health affects the genes passed on through reproduction (I.e, is there a benefit to conceiving at peak fitness for a sport you want your future child to excel at)?

    1. Great question to call into the podcast and we'll cover it on there. Go to <a href="http://www.speakpipe.com/bengreenfield” target=”_blank”>www.speakpipe.com/bengreenfield and keep it under one minute!

  8. danellajade says:

    Hi Ben,
    just interested if regular sauna use is safe while breastfeeding. My thought pattern is heading along the lines of toxins stored in fat cells releasing into the blood stream. Any thoughts? Im exclusively breastfeeding my 5 month old.

    1. Not a ton of research out there, but far-infrared sauna use is safe and effective for increasing lactation in breastfeeding mothers. Check this out: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27185…

  9. justinstenstrom says:

    Great episode! Such a fascinating concept hyperthermic conditioning is. I do think more research should be done in this field as I think it's such a promising therapy for a lot of issues. Good stuff!

  10. johnr801 says:

    Any studies, and/or thoughts as to if/how heat and/or cold exposure can help lower high blood pressure? Thanks John R.

    1. Yes, absolutely. If will produce an upregulation of nitric oxide synthase and that can help with blood pressure. Easy fix! I talk about many of the reasons why here: http://www.t-nation.com/training/cold-temps-for-a…

      1. johnr801 says:

        Thank you Ben for the quick and thoughtful reply, including the T-Nation link. From that article it seems that "quick cold showers"…. would cause "… "a release of nitric oxide and increased blood flow"; and if one pushes CT further, adiponectin would be generated that could "… relax blood vessls, and direclty reduce cardiovascular inflammation." Thanks again! John R.

  11. Ramrise says:

    Ben, I've been meaning to comment on this podcast for a long time. Dr. Patrick did a great job discussing the neurological and physiological adaptations and very briefly touched on the immune response. I wanted to expand on this just a bit for your clients who do not have the bio/chem background. Your body has approximately 6 quarts of blood (assuming 160 pounds) and you have a dedicated pump (heart). The body also has approximately 2.5 gallons of water and this does not include intracellular water. We do not have a dedicated pump for this water so our bodies depend on muscle constriction to circulate this fluid. The lymphatic system is highly dependent on this constriction to circulate the toxins out of the body and, more importantly, toxins out of the core body organs. As you know, all our organs are housed within a pleural sack and all these sacks are housed in a pleural cavity that is itself bathed in water. This water is circulated through the lymphatic system primarily by core squeezing during physical activity (Can you say Yoga). It's important for good health that we:
    1. Drink lots of water.
    2. Circulated this water through physical activity and more importantly vigorous muscle contraction.
    3. Purge this water through sweat expulsion which is also beneficial to the skin
    Imagine if you will a wet sponge sitting on your kitchen counter. If you leave it there for any length of time, it will sour with bacterial and fungal growth. By flushing this sponge with fresh water and squeezing the crap out of the pores you prevent the sponge from souring. The same process happens with a pond that doesn't have an outflow channel. It sits there and becomes rancid with bacterial overgrowth and the fish will eventually die. It's my belief that this is a major factor in the epidemic of cancers that plague our society. The normal immune response is burdened by a sedentary lifestyle and the organs are "cooked" in rancid sour body fluids. This is compounded by a tendency to live our lives in a dehydrated state.

    The best way to take advantage of the heat in a sauna is as follows. A dry sauna is better than a wet sauna but a wet sauna will still accomplish your goals. Take a bottle of cold water into the sauna and drink this water as you arrive at your tolerance level in the sauna. Plan to stay in the sauna until you finish the bottle of water. If you must, exit the sauna only to shower with cold water and then reenter as soon as possible. The goal here is drink the entire bottle of water in order to keep the core organs cool. I take a 1.5 liter bottle of very cold water and stay in the sauna up to an hour. It all depends on the temperature of the sauna and my tolerance level that day. You will develop a headache later on that day when you first begin this therapy. This is caused by a high volume of water in your circulatory system. This will pass and your body will adapt quickly as the toxins are flushed from your body. Your skin will also thank you in a few days. For best results, attend a Yoga class on a regular basis to squeeze that core. Good luck my friends.

    Tom Schwarzkopf

  12. dustinzahursky says:

    Sauna Suits will mimic the results of a sauna and amplify it because you are also exercising while wearing a sauna suit rather then just sitting in a sauna. Check out our sauna suit clothing made by Kutting Weight

  13. gamm0 says:

    Ben, any idea what causes the "tingling hands" sensation after being in the sauna a while? It kicks in with me after around 20mins@185F. I googled it and one of the links was this one in which you talk of the same sensation:

    1. Increased blood flow. Same reason stuff like arginine and nitric oxide can cause tingling….

  14. tomselliott says:

    I love the sauna and like to end every workout w/ the hot sauna/cold shower routine. Any reason to not hit up the sauna 5x/week? That was the one question I kept hoping you guys would address.

    Excellent show.

    1. As long as you stay rehydrated and step up mineral intake or electrolyte intake, it shouldn’t be a big deal at all. Just don’t overdo it without taking care of your hydration needs!

      1. tomselliott says:

        Awesome, thanks!

  15. Jason says:

    Would sitting in your vehicle with the windows up on a hot day be a safe alternative to a dry sauna?

    1. I guess… but it would have to be one HECK of a hot day. I hope you don't live in Finland ;)

  16. dputts says:

    GREAT PODCAST! (as usual). Could some of the same benefits be realized through use of a hot tub? I am thinking a temperature of 105ish Farenheight. I know it's not as high temp as a sauna or steamroom, but was thinking since water helps conduct more effectively, it might work? Now that I am thinking about it, maybe even use a snorkel so head can also be submerged rather than head being at normal temp of the room. Just brainstorming here. Thanks!

    1. Yes, BUT dry heat is always going to be more metabolically demanding than wet heat. Also, be VERY careful with chlorine…

  17. HIT_Trainer says:


    Thanks for the great episode as always. I sort of got the vibe that you and Dr. Patrick were not sold on the "dorky" home sauna units, mostly because they seem to not create the same stress response as a standard dry sauna. After listening to this episode, I was thinking about buying one of those cheapy, home FIR tents. I'm looking at this unit: http://amzn.com/B002POAYDW. Is it worth it? Or should I just suck it up and try to track down a dry sauna in my community?

    1. I have yet to find an FIR that truly gets "hot" to the point where you feel metabolic stress. I'm pretty sure what you are showing on Amazon does not BUT you could always add in a heater…somehow place it inside there…

  18. ejb7 says:

    Ben – if i don't have access to a sauna, what are your on sitting in my car that is in the sun post-workout for 20 minutes or so?

    1. Not such a great idea. We talk about that in the recent podcast, but you'd get a huge dose of UVA radiation.

      1. ejb7 says:

        Yuck. Thanks

  19. darcieg76 says:

    I tried this today at about 170-180. I lasted for 31 minutes, but most of that was uncomfortable. Felt a bit dizzy afterwards. Hit the cold shower, and now I feel fine, but not amazing. Alas, no printed material is allowed in our sauna. :-)

    1. gamm0 says:

      I too felt dizzy and had a very mild headache and 2hrs later I still feel a bit lightheaded. Err on the side of caution I think with this.

  20. gamm0 says:

    also, how many sauna visits are needed to get an ergogeic boost for endurance sports (doesnt it take time for new red blood cells to grow in the extra plasma)?

    if you stop going to the sauna, how long to return blood to "normal"

    1. Studies have shown a minimum of 2 weeks for sports effect. I have a USAT webinar on this: http://www.usatriathlon.org/events/usat/2013/01/b…

      1. gamm0 says:

        when one stops going to the sauna how quickly do the blood benefits take to disappear? plasma changes quite quickly but red blood cells surely have longer gestation and longevity?

        would you typically stop going a couple of days before a race (presumably so as to help ensure hydration and electrolyte levels)?

        1. In most cases passive heat acclimation takes 4-6 weeks and I've noticed from personal experience disappear after 7-10 days. And yes, I taper off heat 1-2 days prior to an event. I talk about that strategy in this webinar: http://www.usatriathlon.org/events/usat/2013/01/b…

          1. gamm0 says:

            Going to give this a go. First session today at 85C/185F. After 10mins I thought this is boring but by 20mins something happened and I wanted to get out. I thought I could do 30mins, then 27mins but finally gave in at 25mins. At this point my RHR was only just over 100 so I don't know how on earth you got yours so high unless you were exercising. I also noticed my hands tingling. Presumably the cold shower thing doesn't negate the blood boosting effects as the "changes" have already been triggered?

          2. gamm0 says:

            2nd go today. 28mins. Oberservations: helps alot if you drink a bit more beforehand(duh!), have someone to talk to in there, and somehow felt easier this time.

      2. gamm0 says:

        1. is this something that would be best cycled throughout the season for maximum efficacy, or if one actually enjoys the experience do the benefits remain if one goes habitually?

        2. drinking water in the sauna – reduced benefits? I notice mentally it seems easier to stay in that bit longer.

        Cheers Ben….

        1. I stop in the summer because I get heat acclimation from so many other sources. But I do it all fall/spring/winter 1-3x/week. And yes, drinking water cools you in the sauna, so i avoid it for the most part. Just little sips here and there.

          1. gamm0 says:

            Have you been able to substantiate the RBC boost claim yourself through blood tests or Powermeter spikes in peformance? I am going to continue going to the sauna until early September when my racing finishes and then get a blood test (which I would've anyway as I'm Celiac).

            Also, any idea WHY the body increases plasma volume?

          2. Not yet, but I definitely "notice" a difference. Sorry I can't be more quantitative (yet) with this one…the body increases plasma volume because blood can be shunted to skin surface to cool.

          3. gamm0 says:

            Maybe scope for a follow-up podcast Ben, or at least one with feedback from listeners? I started the experiment on 30 June and have been 9 times so far for between 25-33mins@185F each time. Not noticed any extra power on the bike but one observation is extra fluid intake in the hours after the sauna seems to not produce as much urine as might be expected – short term plasma variations?

          4. Or maybe you dehydrated yourself and the water is filling back up your plasma volume…

          5. gamm0 says:

            12th session today since starting 5 weeks ago. One observation – in the last week or so, it has gotten easier, now even 35mins@185F is not that hard. Do you think this is because of plasma expansion? Or a range of acclimation changes in the body? I raced a week ago and posted some strong numbers. Coincidence?

          6. Increase in plasma volume and cooling capabilities and probably an upregulation of heat shock proteins too!

          7. gamm0 says:

            Hi Ben, I just wanted to say I tried passive heat acclimation for 12 weeks progressing to 40mins@180F. In that time I noticed after about 4 weeks there was a point where I "got used" to the discomfort. I had blood test results today. There was no spike in red or white blood cell values (other than for Eosinophils) compared with before sauna use. So….it may be that exercise+sauna straight after (as per the study with treadmill runners) is the preferred option. I also didn't really notice any power meter increases although 3 out of 4 races I did were towards the upper end of what I'd expect. I suspect this is coincidental given the blood test.

  21. gamm0 says:

    Ben, great podcast.

    1. is it better to train with heat or passively use it?
    2. better to use the sauna on rest days, or on say a morning on the same day later on when you have a high intensity workout planned?


    1. Training with heat is more stressful, but you get faster results. I use sauna on rest days because of TIME and because stress is, well, stress…it all adds up.

  22. PaulG says:

    Ben, great podcast.

    1. is it necessary or more beneficial to do some cardio just prior to a sauna session, to get the performance benefits?

    2. would a morning sauna work well on days where a late afternoon high intensity session is planned? or better for rest days?


  23. Paul says:

    Found your podcast a few months ago. Love them. Thank you so much for the great information.

    Right now my training consists of running outside 2x a week. (~3 miles – just trying to bring down the time) and doing stairs 3x a week (8 flights, enclosed parking garage stairwell – 6 times up and down alternating skipping one or two steps while running and then jumping with both feet. I’m also using Mir Weight vest wtih 12 lbs – slowly increasing the added weight). I live in charlotte, NC and right now its 83 degree F and 53% humidity and its only going to get hotter. I don’t have access to any kind of sauna right now. Do you think running outside and doing stairs in the enclosed stairwell would provide enough heat exposure to generate the benefits you discussed in the podcast or would i need to wear an extra layer of clothes or maybe an Underarmour “cold gear” base layer to raise my internal temperature even higher? I’ve also been trying the cold thermogenesis a couple times a week but haven’t been albe to get the water below 55 degrees and that’s after 30 lbs of ice. How cold does the water need to be for maximum benefit? Sorry for all the questions. Thanks again.

    Personal Details just in case they’re relevant.

    41 years old

    6’2″ – 220 lbs – fairly lean – not sure of body fat %. Want to do one of the dexa? scans you talked about.

    Paleo for 2.5 years now trying to get keto/fat adapted. 1 week in.

    1. That’ll definitely help. I’ve gone as far as to set up my bike trainer in the laundry room and ride with a parka on and the dryer running. You do what you gotta do! Check this out for the Cold part – https://bengreenfieldfitness.com/2013/09/tim-f…

      1. phoward777 says:

        Right! thank you. I'll try the cold gear wear in the stairwell first. See how that goes. I like getting the sun on the longer runs so I'll keep running half buck naked for now.

        1. Paul says:

          Quick follow up question. I just listened to episode #255 where you were talking about exercising in a fasted state and how it’s it’s too strenuous it can be be counterproductive and damaging. Would doing the exercises mentioned above be enough to put me into catabolic state you referenced? I do intermittent fasting from 8 pm to 12:30 pm.

          1. If you are huffing and puffing and feel your muscles burning at all, then yes.

          2. Jony says:

            What if you took ECAA’s before the workout? Also, would it be more beneficial to do the heat exposure training in a heated pool or hot tub? Does the heat from the water transfer to the body better just like cold water does?

          3. Heat exposure is better in air. You'll lose too many minerals if you do it in water. And EAA's help ANY workout, including this one.

  24. JoeRN936 says:

    Ben, thanks for the great podcast. After swimming this morning, I sat in the dry sauna for 25 minutes @ 170 degrees, in search for the "runner's high" mentioned in the podcast. My LG G2 phone only lasted 23minutes and 30 seconds before it shut it's self off from being over heated, I was listening to music to help tolerate the discomfort. Fortunately, after the phone cooled off, it did come back on. Caution to all the listeners: electronic devices may not tolerate the heat as well as Ben Greenfield does.

    1. Ha ha! Good advice.

  25. cherylcact says:

    I live in Houston. I exercise outside. I just can't bring myself to add heat to a workout. Guess I'll always be mediocre!

  26. biggiesmalls1 says:

    I have a dry sauna in my apartment (half the reason I moved in!) after coming upon your first post about hyperthermic conditioning 2 weeks ago I've been giving it a considerable effort. Initially my goal was boosting recovery for a herniated disk from powerlifting but have noticed a drop in bodyfat. Ordered my ice vest today to continue with biohacking.

    Thank you for providing high quality human performance articles!!!

  27. keplernicus says:

    Hi Ben, thanks for a great podcast. I have actually been reading up on saunas for a few weeks now so this came at a very opportune time. Found a great review article here for those who have access:

    Unfortunately, the only saunas I can find in my area go to up to a pathetic temperature of 110-115 F. Perhaps this has some mild benefit, but I doubt it is nearly enough cause the sorts of adaptations discussed in this interview.
    Can I get some feed back from people? Where are you finding saunas that go to 160 F and above? It seems like gyms/health clubs in my area (San Diego) are WAY cooler than that.


    1. Bring in the studies and encourage them to boost the temp! Or workout while you are in the sauna to boost your own temperature higher. Active heat training is awesome.

    2. keplernicus says:

      Just to follow up on this it seems that all LA Fitness gyms do have saunas that are kept at 180 F. This did not seem to be the case with other commercial gyms. So for those having a hard time finding a real sauna, check out LA Fitness.

  28. kzem12345 says:

    Regarding the question: does heat training make you FASTER? My N=1 experiment showed absolutely. As an ultramarathoner type, I run a lot, and use a HR monitor every session. I also do a lot of flat runs, and am pretty dialed in to my pace at my maffetone-aerobic threshold HR. Been doing this for years. I KNOW how fast I can run on the flats, and the variations in that, at my particular HR.

    Last year I got into and trained for Badwater, so I did a 6 week dry sauna protocol as outlined in some of the info available on the Badwater 135 website. Started at 15 min/160F and worked my way up to 180-190F for about 35 min (all I could take). Interestingly, after about two weeks during my regular runs, my pace at my easy HR started dropping. Now, this isn't all that surprising, since my blood plasma levels were (allegedly) rising, and if that came with more red blood cells as is hypothesized in this podcast, then I didn't have to work as hard to go the same pace… but I also found that at that maffetone-easy pace HR, my speed increased. A lot. Pretty much 15 sec/mile, which for a well trained athlete is massive.

    I do not know if it increased my top (sprint) speed, but for a guy running long distances, going faster at easy effort = faster finish time. Placebo effect? Doubtful. Not for a consistent 15 sec/mile increase, and I'm talking over a 1, 2 hour run, not 20 min.

    Anyway, lots of good training notes on sauna training over at the Badwater site. And yes, sauna training absolutely helped me run just fine last year, when temps hit 125. In the shade. But there was no shade…

  29. steve says:

    I have a infrared sauna at home that I purchased on craigslist. It was well worth the money I feel great after a 20_30 min session. I own a healthmate and was reading some info on emf and how this can be bad for you ,any thoughts on the best sauna to have /own ? Is emf exposure in an infrared sauna harmful??

    1. I personally use an infrared that has an EMF blocker on it, like this: http://goo.gl/ct6pX0

    2. bdm4 says:

      I've been using one of these over the last few months since it's convenient and relatively inexpensive: http://amzn.com/B000ZGQUJO . Obviously it's not the most optimal choice, but it definitely gets me drenched in sweat. Do you think there are any issues with this type of sauna (perhaps when it comes to emf exposure)?

      1. bdm4 says:

        Ben, what are your thoughts?

        1. Well, the biomat does the same thing but you can sleep on it. I'm all about killing two birds with one stone. ;) Anyways though, neither the biomat nor that other one get super hot…compared to dry sauna or wet sauna, so I think you need both elements.

  30. oysteila says:

    So did you mention temperatures in this podcast? I didn't register if it was mentioned. I usually want the temperature to be at least 70C/160F, but I much prefer 80C/175F if I can help it, or even 90C, usually for fifteen minutes which is more than enough to get me gasping and my heart pumping hard. I usually prefer a little bit of steam to get stuff running – what the Finns call a good "löyly".

    A note on cold showers (apart from the fact that they'll make you feel like a winter's day is summery and cozy): concentrating on breathing steadily with your stomach while icy water washes over your face is an excellent tool for open water swimmers to adjust to swimming freestyle in colder waters, since most OW swimmers starting out feel breathing is difficult because of the cold water coming into their mouths and nostrils (maybe related to the gasp reflex during waterboarding torture..?) Make sure to get some into your nose – good times. Tell God I said hello.

    I swim 2000m all weekdays at the moment as part of a weight loss effort and I use the sauna afterwards about three times a week to relieve stress from intermittent fasting and life in general. I'll certainly maintain the habit now. Five sauna sessions a week was absolutely a strain – I quickly got a sense of permanent fatigue that made swimming and other training difficult.

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