Your Doctor Should Tell You To Lift.

One of the most important things that you can do for your health is to start a resistance training program. Whether you are male, female, young, old, skinny, fat, healthy, unhealthy, athletic or completely non-athletic, adding more muscle and strength will result in major health benefits that should be touted more in the medical community. Not only should resistance training be universally recommended, it should be prioritized over the usual exercise advice provided (steady state cardiovascular exercise).

You don’t consider you self the “weight lifting type?” You’re not that interested in chasing 6 pack abs? Or trying to “get swole?”

Good.

You are just the person that needs this message. Yes…resistance training does have the greatest capacity to give you a leaner and more muscular body. BUT…it is the resulting health and functional benefits that will enhance your quality of life the most, and you deserve to know how.

In this blog post I will discuss…

– How sarcopenia (muscle/strength loss) is a lead domino in today’s chronic disease epidemic
– How resistance training combats sarcopenia, improves insulin sensitivity, catalyzes fat loss, speeds metabolism, and decreases inflammation and chronic disease
– How resistance training will improve bone health, fall risk and therefore fracture risk in the older population
– How resistance training activates our “genes of youth”
– And ultimately…why your doctor should be telling you to lift.


Image above: The Wife!

Before we continue, I want to address some pre-conceived notions that may serve as barriers. For the average Joe, we are talking about 2-3 workouts a week for 15-40 minutes. There are many ways to go about it, but if you are prioritizing health, especially if you are new to resistance training, keeping things time efficient and simple will go a very long way. Gym rats (myself included) are not the ones that need to hear this message. It’s the majority of patients I see in my orthopedic / sports medicine clinic every day…

– It’s those with obesity, insulin resistance/diabetes, and hypertension
– It’s the older crowd with arthritic joints.
– It’s the people who are sedentary, sitting in the office all day, then the car, then at home, then repeat.
– It’s the male in his 50’s concerned about decreasing testosterone levels
– It’s the teenage female whose body is establishing most of the bone that will be with her the rest of her life
– It’s the people who are desperately trying to lose pounds, unsuccessfully, by running miles upon miles and spending more and more of their precious time to no avail.
– It’s the long distance runners looking for new ways to improve their performance
– It’s those that convince themselves that their identity doesn’t jive with the typical weight room culture.

No matter who you are, deciding to start a high quality resistance training program maybe one of the most important decisions that you will make for yourself.

CHRONIC DISEASES AND THE CURRENT HEALTH CRISIS


Image Credit: http://healthlive.co.in/2017/02/07/obese-partners-take-longer-time-to-conceive/

In the US we are amidst a healthcare crisis the likes of which have never been seen before. The cost of medical care is way beyond sustainable and the outcomes are poor relative to other countries. The primary driver underlying this crisis is the growing abundance of chronic diseases. These include diabetes, obesity, hypertension, hyperlipidemia, osteoporosis, Alzheimer’s dementia, arthritis, tendinopathy, COPD, autoimmune diseases, many cancers, cardiovascular disease, heart failure among others.

Currently 50% of Americans have at least 1 chronic disease, and 25% have multiple. 7/10 deaths in this country are related to chronic disease and it accounts for 86% of US healthcare expenditures (1, 2). Nearly 100 million Americans (or nearly 1/3rd) have pre-diabetes or diabetes (3). Even more depressing, this crisis is negatively impacting our youth as 27% of children now suffer from chronic disease, up from just 13 percent (doubled) in 1994 (4) and the rate of Type 2 DM in children and teenagers seems to be increasing by 5% every year (5). Perhaps the scariest piece of all, a 2005 study showed that modern children are on average likely to be the first generation to live shorter lifespans than their parents (6). This would be the first time that this trend has turned south since the industrialized age began!

 

SARCOPENIA
(If you don’t use it, you lose it…but you can still get it back!)

 (7)
Image: MRI Images of people’s thighs.

In the westernized world there is an epidemic loss of muscle and strength in the aging population. This process is secondary primarily to disuse and is called sarcopenia. In the US, the average person experiences significantly decreased muscle mass, changes in fat distribution, and loss of strength as they age. Though this drastic loss in strength and muscle maybe the “average”, this should not be accepted as “normal”. The aging body still has the capacity to remain lean, muscular, and strong well into old age. It is a mistake to assume that sarcopenia is part of the normal aging process. At least to the extent that is common. All that is missing in these folks is the right signal, which can be easily delivered through resistance training.

Skeletal muscle is composed of 4 main types of fibers. Each type has a specialized function.

Muscle fibers that get used more often will receive more resources from the rest of your body and therefore will stay healthy and robust. Type I fibers specialize in lower intensity longer duration efforts, and take the longest to tire out , or are fatigue resistant. These are the fibers used for your everyday activities (like going to the store) as well as longer duration / lower intensity cardiovascular exercise (like jogging 3 miles). Since Type I fibers are the easiest to activate and therefore the most frequently used over time, they receive a significant proportion of your body’s resources.

Type II fibers specialize in moving heavy objects, or your body, more powerfully. They are stronger and more powerful. They also fatigue much quicker than Type I fibers. Your body will not use type II fibers for tasks that do not require strength (like going to the store). As we age, the body allocates less and less resources to the Type 2 fibers because they don’t get used much in our modern society. The result is atrophy (or degeneration) of type 2 fibers and/or they will transform into type I fibers. This causes strength and muscle tissue loss, with a more dramatic loss in strength relative to size (8-16).

Remember! This is not an inevitable process. At least not to the extent that it is occurring in our modern society. All that your body needs is the appropriate signal telling it to allocate more resources to your Type II fibers! This signal is easily delivered with resistance training of sufficient intensity. This is why recommending exercise that is unable to fatigue your Type II muscle fibers (such as “take lots of walks”) is grossly inadequate in regards to combating sarcopenia and related chronic diseases (see below).

For more detail on Sarcopenia and how lifting weights is the antidote, check out this awesome blog post (http://www.barbellmedicine.com/gainzzz-in-clinical-practice-part-i/) from Barbell Medicine, this lecture (https://vimeo.com/112867678) by Dr. Jonathan Sullivan, and this book (https://www.amazon.com/Body-Science-Research-Strength-Training/dp/0071597174) “Body by Science” by Dr. Doug McGuff.

How is having more strength and muscle (esp. Type II fibers) beneficial for our overall health?

Body Composition. Way Beyond Sexiness…

Glucose, Insulin, Inflammation, and Chronic Disease

The greatest way to reduce your body’s level of harmful inflammation is by reducing its glucose exposure and therefore decreasing insulin levels. Your muscles (in addition to your diet) play a pivotal role in this process. Glucose is stored in your muscles in the form of glycogen, especially type II fibers. Glycogen is stored for later use in an emergency fight or flight situation, or to provide your muscles with the ability to do hard physical work. If you have to fight off a bear, you will have immediate energy from glycogen available to your muscles to quickly get the hell out of there! Obviously, this type of situation rarely occurs in modern society.

The glucose/glycogen storage system plays an enormous role in how sensitive your body is to insulin. When your Type II fibers are sufficiently worked (as they are with adequate intensity resistance exercise) the glycogen stored in your muscles gets used up. Your muscles then need to be replenished. This replenishment results in a net decrease in glucose (and therefore insulin) exposed to the rest of your body. Chronically elevated levels of glucose and insulin leads to insulin resistance and eventually diabetes (resulting in even MORE glucose exposure over time). Poor glucose control leads to chronically elevated harmful inflammation which plays a central role in the pathophysiology of many (most?) chronic diseases. I believe that it plays a major role in tendon problems, which is outlined in my post, Your Tendons On Cake.

So…by increasing your body’s muscle tissue (especially Type II fibers), you will significantly increase your body’s ability to handle glucose (via a larger storage tank) and insulin which results in dramatically reduced levels of harmful inflammation and chronic diseases. These include cardiovascular disease, cancer, diabetes, autoimmune conditions, arthritis, Alzheimer’s disease, etc. (17, 18, 19, 20, 21, 22).

Remember that while all exercise can be beneficial, no other category (running, walking, cycling, etc.) has the ability to fatigue your Type II fibers quite like resistance training.

Metabolism, Fat loss, Inflammation and Chronic Disease

Resistance training provides a strong signal to your body to stimulate lipolysis (burning fat). When insulin is chronically elevated, as is the case with insulin resistance, the body is in storage mode. This results in the storing of fatty acids into your body’s adipose tissue (body fat). This is why insulin resistance is so closely linked with obesity. As discussed above, periodically fatiguing Type II muscle fibers can drive your blood glucose and insulin levels down over time. This is one way that resistance training takes your body out of storage mode resulting in a greater ability to metabolize or “burn” fat.

Also…Muscle tissue contains the highest concentration of mitochondria (your body’s power plants) in the body, therefore requiring a greater proportion of your body’s total energy. Adipose tissue (fat) on the other hand is relatively inert and does not require much energy to sustain itself. Increasing muscle tissue creates a competition with fat over your body’s resources. This leads to fat being burned to help maintain or grow muscle. In other words, increasing the amount of muscle (especially type II fibers) results in a faster metabolism which equals significantly more calories burned throughout the day and not just during your work out! (17, 18, 19, 20, 21, 22).

Resistance training is one of the only ways that you can actually speed up your body’s metabolism. In fact, with a good resistance training regimen, your overall activity levels maybe less, elevating your metabolism more (compared to doing a high volume of cardiovascular exercise). In fact, chronically high volumes of cardiovascular training may eventually drive your metabolism down, causing the body to go into storage mode, which is why you often see these folks struggling to lose excess pounds.

Decreasing fat isn’t all about looks! Having excess fat tissue (especially central obesity) is highly inflammatory, much like elevated glucose/insulin. In fact, the way that your body handles glucose/insulin and fat storage are completely related while independently harmful via elevated inflammation. In this way, metabolic syndrome is exponentially harmful. The glass-is-half-full side of the story is that addressing these issues, via resistance training and diet, can exponentially benefit your health.

Take home message…Modest increases in type 2 fiber mass can have a profound systemic effect on whole-body metabolism, glucose processing and adipose mass, all ultimately resulting in drastically decreased harmful inflammation over longer periods of time and dramatically reducing the risk for chronic disease.

BRITTLE BONES + LOW STRENGTH = A RECIPE FOR DISASTER

Histology Image – http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302010000200002

Osteoporosis is another common chronic disease plaguing the industrialized world. Osteoporosis is the gradual degeneration and “thinning” of bones. Osteoporotic bones are more fragile and susceptible to fractures. In the older population, hip fractures are one of the leading causes of morbidity and mortality (23). Just go to an inpatient rehabilitation unit or a skilled nursing facility and you will see that a large percentage of patients are there due to a fall and associated hip fracture.

Fortunately, Muscle and fat are not the only tissues that greatly benefit from resistance training. We now know that one of the most potent ways to increase bone mineral density (bone strength) is by improving your strength. This is important for everyone, but particularly females given their greater risk for osteoporosis. Also, improving strength is key for decreasing the likelihood of falling in the first place! Remember that your body loses Type II fibers more readily over time if not used. This is why you often see the combination of sarcopenia, loss of strength, osteoporosis, and increased fall risk occurring simultaneously. A resistance training program that targets Type II fibers can dramatically improve all of the above! (24-30).

LIFTING WEIGHTS AND YOUR DNA…

I would like to briefly mention a study by Dr. Simon Milov looking at how resistance training influences our genes. He identified over 300 genes that were more highly expressed in young people compared to old folks. He then had the older participants engage in 26 weeks of strength training which resulted in strength increases of 50% (which is actually pretty modest in untrained individuals). Results? 179 of the identified genes reverted back to being expressed at the same level as their youthful counterparts!

MYOKINES: Why the whole is greater than the sum of its parts…

Myokines are a hot topic in the muscle physiology world. These are signals given off by working muscles that communicate with the rest of the body. They help ensure that maintaining muscle mass is a priority. There are myokine receptors on muscle, fat, liver, pancreas, bone, heart, immune cells, and brain cells. This is how exercise results in so many downstream benefits beyond just bigger stronger muscles, AND why disuse/sarcopenia has such a profound negative impact on the rest of the body seemingly unrelated to the musculoskeletal system. They are the signals behind the scenes. Absence of exercise results in absence of myokines and therefore increased risk for chronic diseases (and vice versa) (32).

Image above: My Grams was a huge source of inspiration for me to prioritize fitness…and not to be trifled with 😉.


Take home points…

– We are in the middle of a chronic disease crisis
– Sarcopenia (esp. loss of Type II fibers) plays a central role to this epidemic
– Resistance training can enhance your body’s density of muscle (esp. type II fibers) in EVERYONE
– This has profound health benefits (via myokines) way beyond your physical appearance, including improved glucose/insulin processing, enhanced metabolism, fat loss, and decreased harmful inflammation
– Resistance training also improves bone health and fall/fracture risk
– Myokines play a significant role in facilitating these benefits

There are MANY more benefits not discussed here. If interested in going farther down the rabbit hole, please check out the following links…

LECTURES…
https://m.youtube.com/watch?v=jeFdYy815pQ
https://vimeo.com/112867678

PODCASTS:
https://www.ihmc.us/stemtalk/episode-24/
https://chriskresser.com/importance-of-strength-training-with-sal-di-stefano/

BLOG:
http://www.barbellmedicine.com/


What about the “How”?

There are many ways to go about the “how” part of the equation and it would be beyond the purpose of this blog post to delve deeply into specific workout strategies. The best way to approach it, especially if you are a beginner would be to utilize a skilled personal trainer who understands your goals, can design a quality program, and make sure that you are able to perform the lifts safely with good form. There is much debate on this part of the equation and I think that it is safe to say that we do not yet really know what the perfect workout entails. The most important thing is to do something!

I will, however, share some basic principles that I personally take into account when thinking through my own workouts. Important to note…Though I am fairly knowledgeable about weight lifting through my own personal journey, I am not a personal trainer and haven’t trained others besides some family members. If you are not interest in getting a trainer, I do like the following do-it-yourself sources…

The link below is a great online program from the guys at Mind Pump that my wife has been doing, and seems to have well thought out programming with high quality instruction and videos…

https://www.mindpumpmedia.com/p/rdm17-what-is-maps

My basic principles to resistance training…

– You want enough intensity to fatigue type II fibers. This means that your last 1-3 reps should be difficult

– Not too much intensity to where you are negatively impacting your ability to recover

– Enough frequency to stimulate glycolysis and continue to provide an appropriate signal for muscle to build

– Not too much frequency so that you are not adequately recovered before your next workout (2-3 times a week on average, but there is an argument to be made for 1 per week if intensity is really high (see Body by Science book link above)

– Keeping it simple can go a long way, especially for a beginner or when the primary goal is better health

– Use multi-joint lifts broken down into a push, a pull, a squat/lunge, and carries

– “Resistance” can be applied via a variety of tools. Barbells, Dumbbells, kettlebells, Machines, Resistance Bands, and your own body weight. It’s probably a good idea to mix things up as you go.

– Progress your workouts a little more slowly than you think you are capable of

– It is likely a good idea to have a well rounded approach and mix in a couple sessions of low intensity cardiovascular exercise and perhaps 1-2 sessions of HIIT  a week

– BUT…if all you can do is 2 strength training session a week, mixed with walking a couple of miles a day…you be doing pretty darn well!

Thanks for reading and I hope that this was helpful in some way!

James Crownover, MD, CAQSM

 

REFERENCES:

1. (NCCDPHP) National Center for Chronic Disease Prevention and Health Promotion. 2016. “At a Glance 2016.” CDC.gov. https://www.cdc.gov/chronicdisease/overview/index.htm
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3. (CDC) Centers for Disease Control and Prevention. 2017. New CDC report: More than 100 Million Americans have Diabetes or Prediabetes. July 18, 2017. www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
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