The Strength Insurgence

dl-oldDr. Scotty Butcher

 “No citizen has a right to be an amateur in the matter of physical training…what a disgrace it is for man to grow old without ever seeing the beauty and strength of which his body is capable.” – Socrates (~400BC)

There is a problem with our system of ‘health and fitness’.  Since the age of modern technology, the vast majority of the world’s societies have become sedentary; progressively less fit; and consequently, riddled with chronic, preventable disease (1).    Despite the best efforts of over 40 years of academic study about the efficacy of becoming active and attaining ‘fitness’ for achieving optimal health, today’s society continues to be collectively weak, unfit, and unhealthy – to epidemic proportions.  What’s worse is that the world’s greatest classical scholars wrote about this well over two millennia ago and we apparently have not listened.  What a disgrace, indeed.

There is no doubt that becoming physically active can ameliorate many of these lifestyle-related diseases.  The problem lies in not the knowledge, but in the methods.  At the dawn of the modern fitness age in the early 70’s, a dichotomy was emerging between the newly forming ‘aerobics’ movement and the surge in popularity of bodybuilding with Ahnold.  I don’t really know for sure why aerobics won out as the ‘health and fitness’ method of choice; perhaps it was that its founder, Dr. Kenneth Cooper, was (is) a respected physician and researcher, whereas Mr. Olympia was (is) seen to be a dumb-sounding musclehead.  Or perhaps, it is simply sufficient to say that aerobic exercise (low intensity aerobic exercise such as walking) is vastly easier than strength training.  Easier usually means more accessible.  Nevertheless, our current system of health and fitness is engrained in the idea that aerobic exercise is ‘best’.  In fact, aerobic exercise has become synonymous with ‘cardio’ as the best method of achieving cardiovascular health and fitness.  In some cases, noted exercise physiologists, physicians, physical therapists will tell you that it is the only method of exercise you need to stay healthy throughout your life.

Herein lies the problem.  First, no one method is ‘best’.  ‘Best’ is only relevant along with a discussion of who, what, when, where, and why.  Second, there is only so much that low to moderate intensity continuous aerobic exercise can do.  Sure, when the intensity is low, and the duration is not too long, it is easy exercise.  Compared with sitting on the couch, there is much benefit to be derived from a brisk 20-30 minute walk or play, 5-6 days per week.  This recommendation for individuals attain this baseline level of physical activity as a co-requisite to any further training is crucial.  This level of activity is sufficient to improve aerobic fitness to the levels needed for optimal prevention of all-cause mortality (2).  In fact, from a mortality prevention perspective, further increases in aerobic fitness do not convey further prevention (2).

There won’t be too many arguments against being more physically active for health benefits.  Where this issue gets contentious, however; is how an individual then progresses.  Within reason, there are more fitness benefits to be achieved by higher intensities of exercise.  The research is relatively clear that there is a dose-response relationship between the intensity of exercise and the derived health, mortality, and fitness benefits (2).  So, if one follows the established guidelines for exercise for health, this progression means you should now run or jog; and as you get fitter, you should run faster.  Right?  If your goal is to run a 10K, half marathon, etc., then right.  For general health and fitness, for enhancing athletic ability, for weight loss, or for prevention of age related disability, then most likely wrong.  The evidence is becoming increasingly clear that this method of progressing aerobic exercise by itself is both ineffective and potentially detrimental to function over time (3,4).  That’s right: our current system of prescribing exercise for health and fitness DOES NOT WORK beyond an initial increase in health and fitness.  From the evidence presented in the first paragraph, we already know this.  Even in those who choose to be active, there is a huge piece of the health and fitness puzzle missing – strength.  Strength training is harder, but that’s also the point.  It is harder and that’s why it works.

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So, why strength training?  Physical strength is arguably (although we won’t argue against this) the most important physical quality for everyone, of all ages, and regardless of the goal or physical pursuit.  That’s not to say that some of the ‘side benefits’ of strength training are not important, or that one should only do strength training, but that a sufficient level of strength is required for optimal human function.  What this ‘sufficient level’ of strength is depends on the person and the circumstances, but in general, the more, the better.  Whether it be sprinting to catch a bus, lifting furniture to help a friend move, performing a high-repetition or high load CrossFit WOD, carrying bags of groceries, improving performance and preventing injuries in sports including endurance sports, walking fast enough to cross the street before the light changes, catching oneself to prevent a fall after a trip, or simply getting up off of the toilet; the more strength available, the better those circumstances can be dealt with.

In rapid, point form, here is a snippet of the research on the benefits of strength training (ST) and increasing muscle strength (MS):

  1. ST increases muscle and movement strength in most populations: including healthy, chronic disease, young children, older adults, and the frail elderly.  Aerobic exercise does not increase strength and does not prevent the loss of muscle mass and strength with increasing age; whereas ST can prevent and reverse sarcopenia (3,5-10).
  2. ST prevents age-related functional decline in healthy and clinical populations (11-17).
  3. With advancing age, MS and anaerobic power decline faster (18-20), contribute more to functional decline (13,14,21), and are usually more trainable than aerobic power (9,19,20,22).
  4. MS is a stronger predictor of mortality and morbidity in aging individuals and those with chronic disease than aerobic fitness (23-25).  Mark Rippetoe has a well-known quote based on this research that says, “Strong people are harder to kill than weak people, and more useful in general.”  There is much truth to that.
  5. If you have poor aerobic fitness to start, ST increases aerobic fitness similarly to aerobic exercise (true of young and old).  So, improving MS is more important than aerobic fitness in many cases, but ST improves aerobic fitness anyway (26,27).  Which training method sounds like a bigger ‘bang-for-your-buck” to you?
  6. Even if you have good aerobic fitness to start, whole body, maximal ST can improve cardiovascular fitness and endurance performance (29-31).
  7. ST improves metabolism, results in fat mass loss, prevents and treats diabetes by reducing insulin resistance, improves cardiovascular health, reduces blood pressure, improves blood lipids, improves surgical outcomes, reduces pain perceptions, increases bone mineral density, prevents falls, enhances mental health, and can even reverse some factors associated with aging.  Most importantly, these effects are at least as effective with ST as with aerobic training; and in many cases, ST is more effective (32-45).

It is increasingly evident that quality, whole body strength training is safe (46) and vastly more effective than aerobic exercise for multiple functional, performance, health, fitness, and rehabilitation benefits.  So, why do most exercise guidelines still promote aerobic exercise as the ‘best’ method?  So, why are our rehabilitation programs still structured around walking only? So, why are we still telling clients that the best way to lose weight is with ‘cardio’?  So, if we know that strength training is better in most of these circumstances, why are we not doing anything about it?

This is your Call to Arms.  Strength Rebels is organizing an insurgence.  Rise up and challenge the aerobic-only convention.  As health, rehabilitation, and fitness professionals, you can rebel against this established system and promote a better way.  A way that is not one-dimensional.  A way that produces multiple physiological and functional gains.  A way that will help clients become masters of their own physical training and truly see the strength of which their bodies are capable.  This insurgence is vital to our population health to reverse the epidemic of weakness.

Physical weakness is an epidemic; join the strength insurgence by subscribing to our channel.

References:

  1. Blair S. Physical inactivity: the biggest public health problem of the 21st century.  Br J Sports Med. 2009:43;1-2.
  2. Franklin BA. Cardiovascular events associated with exercise. The risk-protection paradox. J Cardiopulm Rehabil. 2005:Jul-Aug;25(4):189-95.
  3. Marcell TJ, Hawkins SA, Wiswell RA.  Leg Strength Declines with Advancing Age Despite Habitual Endurance Exercise in Active Older Adults. J Strength Cond Res. 2013 Nov 20. [Epub ahead of print].
  4. O’Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA.  Potential adverse cardiovascular effects from excessive endurance exercise.  Mayo Clin Proc. 2012:87;587-595.
  5. Aagaard, P, Suetta, C, Caserotti, P, Magnusson, SP, & Kjær, M. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Sports. 2010; 20: 49-64.
  6. Barry, BK, & Carson, RG. The consequences of resistance training for movement control in older adults. Journal of Gerontology. 2004; 59A(7): 730-754.
  7. Correa, CS, LaRoche, DP, Cadore, EL, Reischak-Oliviera, A, Bottaro, M, Kruel, LFM, Tartaruga, MP, Radaelli, R, Wilhelm, EN, Lacerda, FC, Gaya, AR, & Pinto, RS. 3 different types of strength training in older women. Int J Sports Med. 2012; 33: 962-969.
  8. Fiatarone, MA, Marks, EC, Ryan, ND, Meredith, CN, Lipsitz, LA, & Evans, WJ. High-intensity strength training in nonagenarians: Effects on skeletal muscle. JAMA. 1990; 263(22): 3029-3034.
  9. Hurley, BF, Hanson, ED, & Sheaff,  AK. Strength training as a countermeasure to aging muscle and chronic disease. Sports Med. 2011; 41(4): 289-306.
  10. Peterson, MD, Rhea, MR, Sen, A, & Gordon, PM. Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Res Rev. 2010; 9(3): 226-237.
  11. Bean, JF, Kiely, DK, Herman, S, Leveille, SG, Mizer, K, Frontera, WR, & Fielding, RA. The relationship between leg power and physical performance in mobility-limited older people. J Am Geriatr Soc. 2002; 50(3): 461-467.
  12. Bean, JF, Herman, S, Kiely, DK, Frey, IC, Leveille, SG, Fielding, RA, & Frontera, WR. Increased velocity exercise specific to task (InVEST) training: A pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. J Am Geriatr Soc. 2004; 52(5): 799-804.
  13. Buchman, AS, Wilson, RS, Boyle, PA, Tang, Y, Fleischman, DA, & Bennett, DA. Physical activity and leg strength predict decline in mobility performance in older persons. J Am Geriatr Soc. 2007; 55(10): 1618-1623.
  14. Butcher SJ, Pikaluk BJ, Chura RL, Walkner MJ, Farthing JP, Marciniuk DD. Associations between Isokinetic Muscle Strength, High-Level Functional Performance, and Physiological Parameters in Patients with Chronic Obstructive Pulmonary Disease. International Journal of COPD. 2012; 7:537-542.
  15. Chin A Paw, MJM, van Uffelen, JGZ, Riphagen, I, & van Mechelen, W. The functional effects of physical exercise training in frail older people. Sports Med. 2008; 38(9): 781-793.
  16. Hazell, T, Kenno, K, & Jakobi, J. Functional benefit of power training for older adults. Journal of Aging and Physical Activity. 2007; 15: 349-359.
  17. Puthoff, ML, & Neilsen, DH. Relationships among impairments in lower-extremity strength and power, functional limitations, and disability in older adults. Phys Ther. 2007; 87(10): 1334-1347.
  18. Gent, DN, & Norton, K. Aging has a greater impact on anaerobic versus aerobic power in trained masters athletes. Journal of Sports Sciences. 2013; 31(1): 97-103.
  19. Kostka, T, Drygas, W, Jegier, A, & Zaniewicz, D. Aerobic and and anaerobic power in relation to age and physical activity in 354 men aged 20-88 years. Int J Sports Med. 2008; Online 19 August. doi:10.1055/s-0028-1104591.
  20. Neder JA, Nery LE, Silva AC, Andreoni S, Whipp BJ. Maximal aerobic power and leg muscle mass and strength related to age in non-athletic males and females.  Eur J Appl Physiol.  1999:79;522-530.
  21. Cuoco, A, Callahan, DM, Sayers, S, Frontera, WR, Bean, J, & Fielding, RA. Impact of muscle power and force on gait speed in disabled older men and women. Journal of Gerontology. 2004; 59A: 1200-1206
  22. Fatouros, IG, Kambas, A, Katrabasas, I, Nikolaidis, K, Chatzinikolaou, A, Leontsini, D, & Taxildaris, K. Strength training and detraining effects on muscular strength, anaerobic power, and mobility of inactive older men are intensity dependent. Br J Sports Med. 2005; 39: 776-780.
  23. Artero, EG, Lee, D, Ruiz, JR, Sui, X, Ortega, FB, Church, TS, Lavie, CJ, Castillo, MJ, & Blair, SN. A prospective study on muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 2011; 57(18): 1831-1837. doi:10.1016/j.jacc.2010.12.025
  24. Swallow EB, Reyes D, Hopkinson NS, Man WDC, Porcher R, Cetti EJ, Moore AJ, Moxham J, Polkey MI. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease.  Thorax. 2007:62:115-120.
  25. Ruiz, JR, Sui, X, Lobelo, F, Morrow, JR, Jackson, AW, Sjöström, M, & Blair, SN. Association between muscular strength and mortality in men: Prospective cohort study. BMJ. 2008; 337: a439.
  26. Gerage, AM, Forjaz, CLM, Nascimento, MA, Januário, RSB, Polito, MD, & Cyrino, ES. Cardiovascular adaptations to resistance training in elderly postmenopausal women. Int J Sports Med. 2012; Online 23 October. doi:10.1055/s-0032-1331185.
  27. Ozaki, H, Loenneke, JP, Thiebaud, RS, & Abe, T. Resistance training induced increase in VO2max in young and older subjects. Eur Rev Aging Phys Act. 2013; Online 15 January. doi:10.1007/s11556-013-0120-1
  28. Betik, AC, & Hepple, RT. Determinants of VO2max decline with aging: An integrated perspective. Appl Physiol Nutr Metab. 2008; 33: 130-140.
  29. Hoff J, Gran A, Helgerud J. Maximal strength training improves aerobic endurance performance. Scand J Med Sci Sports. 2002:12;288-295.
  30. Jung AP. The impact of resistance training on distance running performance.  Sports Med. 2003:33;539-552.
  31. Lovell, D, Cuneo, R, Delphinus, E, & Gass, G. Leg strength and the VO2max of older men. Int J Sports Med. 2010; Online 8 November. doi:10.1055/s-0030-1269844
  32. Akasaki, Y, Ouchi, N, Izumiya, Y, Bernardo, BL, Labrasseur, NK, & Walsh, K. Glycolytic fast-twitch muscle fibre restoration counters adverse age-related changes in body composition and metabolism. Aging Cell. 2013; Online 8 August. doi:10.1111/acel.12153
  33. Bento, PCB, Pereira, G, Ugrinowitsch, C, & Rodacki, ALF. Peak torque and rate of torque development in elderly with and without fall history. Clinical Biomechanics. 2010; 25: 450-454. doi:10.1016/j.clinbiomech.2010.02.002
  34. Candow, DG, Chilibeck, PD, Abeysekara, S, & Zello, GA. Short-term heavy resistance training eliminates age-related deficits in muscle mass and strength in healthy older males. J Strength Cond Res. 2011; 25(2): 326-333.
  35. Clemson, L, Fiatarone, Singh, MA, Bundy, A, Cumming, RG, Manollaras, K, O’Loughlin, P, & Black, D. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomized parallel trial. BMJ. 2012;345: e4547. doi:10.1136/bmj.e4547.
  36. DiPietro, L, Yeckel, CW, & Dziura, J. Progressive improvement in glucose tolerance following lower-intensity resistance versus moderate-intensity aerobic training in older women. Journal of Physical Activity and Health. 2008; 5: 854-869.
  37. Hess, JA, & Woollacott, M. Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults. J Manipulative and Physiol Ther. 2005; 28(8): 582-590. doi:10.1016/j.jmpt.2005.08.013
  38. Knutzen, KM, Pendergrast, BA, Lindsey, B, & Brilla, LR. The effect of high resistance weight training on reported pain in older adults. Journal of Sports Science and Medicine. 2007; 6: 455-460.
  39. Martins, RA, Verissimo, MT, Coelho e Silva, MJ, Cumming, SP, & Teixeira, AM. Effects of aerobic and strength-based training on metabolic health indicators in older adults. Lipids in Health and Disease. 2010; 9: 76.
  40. Melov, S, Tarnopolsky, MA, Beckman, K, Felkey, K, & Hubbard, A. Resistance exercise reverses aging in human skeletal muscle. PLoS ONE. 2007; 2(5): e465. doi:10.1371/journal.pone.0000465
  41. Orr, R, Raymond, J, & Fiatarone Singh, M. Efficacy of progressive resistance training on balance performance in older adults: A systematic review of randomized controlled trials. Sports Med. 2008; 38(4): 317-343.
  42. Rantanen, T, & Avela, J. Leg extension power and walking speed in very old people living independently. Journal of Gerontology. 1997; 52A(4): M225-M231.
  43. Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. J Obesity. 2011:Article ID 482564;9pgs.
  44. Sundell J. Resistance training is an effective tool against metabolic and frailty syndromes.  Adv Prev Med. 2011:Article ID 984683;7pgs.
  45. Westcott WL. Resistance training is medicine: Effects of strength training on health.  Curr Sports Med Rep. 2012:11;209-216.
  46. Sagiv, M. Safety of resistance training in the elderly. Eur Rev Aging Phys Act. 2009; 6: 1-2.
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