A Call For Resistance Training in Mainstream Medicine
Author: Andrew Chang, Hillsdale High School
Resistance training may be defined as exercise involving the deliberate production of force against an external resistance. Typically, it refers to weight training, but it also includes bodyweight, banded, and machine-based exercises. The 2014 National Health Interview Survey found that less than 25% of adults in the United States met the 2008 physical activity guidelines for resistance training — twice-weekly “muscle-strengthening activities” at a moderate to high intensity . Additionally, a 2010 survey of 1,230 Australian adults found that only approximately 14% of the population engaged in some form of resistance training, with participation predictably declining from the 23% in 18-34 year-olds to a pitiful 7% in the 55+ group . This is concerning, considering that resistance training exerts a plethora of beneficial physiological and psychological effects. Resistance training elicits adaptations at the vascular, muscular, neural, and skeletal level, resulting in increased tendon stiffness, bone density, and muscle body activation, as well as improved vascular function, glucose and cholesterol levels, and body composition . It also produces improvements in various markers of mental health, including anxiety, cognition, chronic fatigue, self-esteem, sleep habits, and depression . Simply stated, resistance training is an underutilized therapy that should become a standard part of medical practice.
The benefits of resistance training may seem unclear in the short-term, especially for otherwise healthy young individuals. However, inactive adults experience a 3% to 8% reduction in muscle mass per decade, therefore resistance training can quite literally become life-changing. A 2008 cohort study of 8,762 men aged 20-80 years old concluded that “muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders” . In other words, stronger individuals, even after calculating for the effect of confounding variables, have lower chances of mortality in any given time period. Confounders are other characteristics outside of muscular strength that would predispose a certain individual to have different health outcomes. In this case, even after adjusting for cardiorespiratory fitness — the ability of the body to supply oxygen during physical activity — there was still an inverse relationship between muscular strength and all-cause mortality .
Despite the aforementioned data, many are hesitant to begin resistant training. Some may fear that it is too “late” to start, but this concern is unfounded: middle-aged and elderly men can experience significant increases in muscle strength and size, even after a short 16-week-total body strength training program . Some may be under the impression that low-intensity cardiovascular exercise is sufficient for optimizing general health outcomes and preventing major diseases. However, cardiovascular exercise alone is suboptimal for preventing sarcopenia — decreases in skeletal muscular strength and function due to the aging process — and its comorbidities . Granted, cardiovascular exercise does produce significant increases in muscle mass in untrained, inactive individuals in the short-term, but alone, it is insufficient to counteract lean body mass losses in extreme hypocaloric conditions . In other words, although cardio may aid in the loss of fat mass or attenuation through increased energy expenditure, it has limits in preventing sarcopenia, especially when compared with the ability of resistance training to elicit gains in muscle mass or at the minimum attenuate muscle loss . Thus, there really is no viable replacement for some form of resistance training in any exercise prescription.
For the vast majority of the population, there is little reason for medical professionals to forgo prescribing resistance training as an adjunct and preventative therapy. The prevalent misconception that weight training is somehow “dangerous,” or that it is reserved for “young people” or “athletes,” must immediately be discarded. Adolescent powerlifters — those lifting substantial, near-maximal loads on large, gross motor movements like the squat, bench press, and deadlift — show injury rates of 0.29 injuries per 100 participation hours, as compared to the 0.80 per 100 hours in contact sports like rugby . Meanwhile, a 2015 systematic review found that “running-related injuries per 1000 h of running ranged from a minimum of 2.5 [injuries] in a study of long-distance track and field athletes to a maximum of 33.0 in novice runners” . The argument that resistance training is dangerous is unreasonable, as it is no more dangerous than any other form of exercise. More importantly, just as the risk of preventable diseases should be more concerning than the risk of vaccines, the risk of sarcopenia should be far more concerning than the risk of training. Progressive strength training — strength training that incorporates progressive overload, or regular increments in the magnitude of training stimulus — improves strength and function ratings and reduces pain ratings in older adults with osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage . The prevalence of sarcopenia ranges from 13% to 24% in people 65 to 70 years old and to over 50% in those who are more than 80 years old, making it clear that strength training is necessary to prevent the diminished quality of life from the approximately 4-fold sarcopenia-related risk of disability . The aged-related loss of muscle and strength is not a matter of cosmetics or vanity: sarcopenia creates a self-reinforcing cycle of neuromuscular impairment, falls, fractures, and immobilization .
Resistance training programs can be designed in an efficient, effective, and user-friendly manner. A 2015 meta-analysis of resistance training in older adults reported, that a training frequency of two sessions per week with a training volume of three sets per exercise including seven to nine repetitions per set and a rest of 4.0 s between repetitions were most effective in improving measures of muscle strength . SMDbs is referring to the standardized mean differences between subjects; put another way, it serves as a statistical measure of the difference between the outcome measures for the treatment and the control groups . In the context of this meta-analysis, the listed training variables were most effective in generating improvements in muscular strength in older adults. Nonetheless, it’s important to recognize that these recommendations are based on population averages in training responses. Thus, individuals should not worry about finding the “optimal” strength training program, but rather, should focus on finding a sustainable, enjoyable training program that produces the desired outcome: increased muscular strength and size, with an accompanying improvement in daily function. For untrained individuals, any form of resistance training is an improvement, even if that means a few sets on the chest press and lat pulldown machine a couple times per week. Finally, it is important to recognize that no one particular exercise is required for general health. Thus, whether an individual wishes to participate in powerlifting, join a weekend Crossfit class, or practice gymnastic exercises, he or she will reap some of the positive effects of resistance training.
With well-documented benefits in a wide spectrum of health outcomes, resistance training should be included in virtually every health management program. Undoubtedly, the most significant impact of resistance training revolves around its effects on general quality of life and function in the aging population. In essence, resistance training acts as a preventative measure and treatment for the negative repercussions of the sedentary westernized lifestyle. Cliché as it may sound, given the potential of resistance training to positively impact practically every facet of any biopsychosocial model of health and wellbeing, it truly underscores the power of exercise as medicine.
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