Barbell Training is Big Medicine

[stef]

by Jonathon Sullivan

”[A]t present there is absolutely no solid evidence that strength training—or any other exercise or dietary program—will substantially prolong our life spans. But the preponderance of the scientific evidence, flawed as it is, strongly indicates that we can change the trajectory of decline. We can recover functional years that would otherwise have been lost.”

Article (http://startingstrength.com/index.php/site/barbell_training_is_big_medicine)

Resources Page (http://startingstrength.com/index.php/site/resources)

[PressesPeople]

Aww he didn't use my quote in the article :(

[OCG]

Interesting. I now know more about the squirting of Sully's glands then I ever wanted to.

[Valhall]

I loved this article, and especially the ending:

Instead of slowly dwindling into an atrophic puddle of sick fat, our death can be like
a failed last rep at the end of a final set of heavy squats. We can remain strong and vital well into our
last years, before succumbing rapidly to whatever kills us. Strong to the end.

The article also makes me think about my father who has had several heart attacks and probably might go any day. But in his younger days he was a powerlifter. 15 years ago he had his first surgery and at that point he went back to barbell and dumbell training and took me with him to teach. We trained together for 2-3 years until I had to move due to college. About a year after this we both kinda stopped training, unfortuantly.

The years went and we both got fatter and out of shape. For him the consequence was another heart attack (and more). Today he's functioning on medicine and nitroglycerin but fat and hopelessly out of shape, while I have started getting back into shape. Unfortuantly I dont think he is in any state to pick up a barbell today, but I think that if he didnt stop training after the first surgery he would have stopped any future heart attacks and been in good shape today.

Atleast I know that I will not end up like him, or his father who died of a heart attack getting the mail. Barbell training truly is big medicine as Sully says.

[MPE]

Dr. Sullivan-
That, sir, was fantastic!

[bob g]

Thanks, Sully. Outstanding.

[drskillet]

"Instead of slowly dwindling into an atrophic puddle of sick fat, our death can be like
a failed last rep at the end of a final set of heavy squats."
Nice!

[Mark E. Hurling]

Great article Sully. I confess my chemistry and other science isn't sufficiently up to scratch to follow some the finer points you made sufficiently but the main message for me was this:


Too often, the aging individual sees that he is getting weaker, and so lowers his expectations and his efforts—and thereby grows weaker still. This is analogous to the cell cutting up its own DNA. Once the psyche has surrendered to decline and death, it’s all over but the suffering.

and this:


It’s being “All Done At Sixty”…or Fifty. It’s a life of waiting to die from a skin infection or a broken hip or a blot clot, of needing a stupid little fucking go-cart to get from here to there, of not being able to reach your own ass to wipe it, of narcotizing yourself with alcohol, cigarettes, American Idol and Doritos so you don’t have to face your own grim existence as a slowly rotting Jabba The Hut. I see it every day. We call it “old-itis.” A joke, I guess, but an obscene one. This gruesome avatar of aging offends the eye, the mind, and the spirit, and it cries out for both compassion and correction.

Well I am 60 and fuck that. What's scary is that I was ready about this time last year to settle into "maintenance." But this place and it's denizens inspired me to take up squats, deadlifts, and bench presses again. Well done and thanks from another geezer.

[Sam Crish]

Nice!
I work on an age-related neurodegenerative disease (glaucoma) and it is amazing how few people, even colleagues that should know better, just don't get these points. We need more articles like this.

[ChuckBell]

Great article Sully. Thanks for the inspiration to get up and lift again today. This Geezer appreciates it!

[MDR2]

Instead of slowly dwindling into an atrophic puddle of sick fat, our death can be like
a failed last rep at the end of a final set of heavy squats.


That was a great article and full of interesting information.

[Dirichlet]

Excellent, like always. My girlfriend (she is a medical student) loved it.

[JWarkala]

Excellent article. Just reaffirms my wish in life to eventually, hopefully quite a few years from now, die under the bar.

[Grant Mccaulley]

Here is a reference on barbell training in the elderly, awesome outcomes! I have trained people into there 70's, real simple take 3 days per week to 2 days per week, fancy modification that works!


Can J Appl Physiol. 2002 Jun;27(3):213-31.
Effects of heavy resistance/power training on maximal strength, muscle morphology, and hormonal response patterns in 60-75-year-old men and women.
Häkkinen K, Kraemer WJ, Pakarinen A, Triplett-McBride T, McBride JM, Häkkinen A, Alen M, McGuigan MR, Bronks R, Newton RU.
Source
Department of Biology of Physical Activity and Neuromuscular Research Center, University of Jyväskylä, Finalnd.
Abstract
Eleven women (TRW; 64 +/- 4 yrs) and ten men (TRM; 65 +/- 5 yrs) participated in the strength/power training twice a week for 24 weeks. Basal concentrations of serum total and free testosterone, growth hormone (GH), dehydroepiandrosterone sulfate (DHEAS), cortisol and sex hormone binding globulin (SHBG) as well as acute responses of serum total and free testosterone, growth hormone (GH) were measured. Maximal 1RM strength in the squat, chair rise time and muscle fibre distribution and areas of type I and IIa and IIb of the vastus lateralis were also examined. 1RM squat increased in TRW by 26 (SD10)% (p < .001), and in TRM by 35 (7)% (p < .001) and chair rise time improved in both groups (p < .001). Fibre areas increased in type I, (p < .01), IIa (p < .01) and IIb (p < .01) in TRM and type I (p < .05) and IIa (p < .05) in TRW. The proportion of type IIa increased from 31% to 43% (p < .05) in TRW and that of type IIb decreased from 27% to 17% (p < .05) in TRW and from 25% to 17% (p < .05) in TRM. Individual concentrations of testosterone/cortisol ratios correlated (r = 0.63; p < .05) with the individual increases in 1RM strength in TRW. The exercise sessions resulted in acute increases in serum GH in both groups (p < .05) with a further increase (p < .01) up to 10 minutes post-loading in TRM at post-training.

[Mark Rippetoe]

Aww he didn't use my quote in the article :(

It was written before you posted it. But we all thought it was quite good.


Nice!
I work on an age-related neurodegenerative disease (glaucoma) and it is amazing how few people, even colleagues that should know better, just don't get these points. We need more articles like this.

Be sure to link it to your buddies, so that it can get more widely read. Of all the articles we've run, this is the one that people outside our little community need to read.

[Karl Schudt]

Thank you, thank you, thank you. Will be sharing with the multitudes.

[jlmoss]

I really liked reading this. Very motivational. Makes me think of my father and father in law. I'm thinking of printing this out and laying it around for them to read. I'm not sure many of the exercise articles I have read in the past 2 - 3 months have affected me in this way.

Thank You...

[Tom Campitelli]

Phenomenal article, Dr. Sulivan. I will be sharing this with others.

[Sam Crish]

Be sure to link it to your buddies, so that it can get more widely read. Of all the articles we've run, this is the one that people outside our little community need to read.

Oh, I sent it off immediately to several people. Most of my colleagues in aging and degeneration that do recognize the importance of exercise do LSD running. I am very vocal with my opinions on that and am constantly trying to convince them to take up strength training with little success.

[Jonathon Sullivan]

Thanks, all.


Here is a reference on barbell training in the elderly

Added to my database. Thanks for sharing it.

[Tamara Reynolds]

I've already shared this article more than I've shared any other SS article. Thanks, Sully.

[Bean1871]

Great work, Dr. Sullivan. Your contributions are very important, and appreciated, especially by your fellow geezers here. -Bill

[Jungledoc]

This article expresses what I believe far better than I could have expressed, and with more and better scientific background. I'm a family physician who practiced in the US for many years (I now live and work in a third-world country) and I wish that I had known then what I understand now.

Great job! Have you written other articles on related topics?

[Dutch]

Awesome article.

'Death is winning, do something' (Paul Carter)

[Immortal_k]

Wonderful article, thanks Dr. Sullivan.

[Bahadur]

I know many people on this board don't hold faith in fate or fortune, and I'm not sure I do all the time but the timeliness of this article does give me pause.

The past couple of days have seen me questioning why I do this (barbell strength training) at all. The internet is a curse and a blessing, and seeing the logs of people who started much younger than I am (37 this past March) discourages me at times.

Am I told old to continue this? How close am I to my genetic/age strength limits and is it fruitless to continue, when I will never have the lofty squat numbers of a 20 something starting the program? Can a 37yo even develop a respectable amount of muscle who doesn't have the benefit of muscle memory?

Actually laid awake at night the past several nights mulling over whether I'm a fool for doing this when all the folks I know my age chide me over not doing any LDS work instead of 'acting like a teenager'. Many friends/family believe my lifting weights is a form of a mid-life crisis and sometimes mock me. In fact, this very morning I had a heart to heart talk with my wife about quitting lifting, esp. when the likes of Sanjay Gupta and Dean Ornish are so heavily promoting veganism and long slow cardio (to my wife's credit, she said she doesn't want "no skinny ass husband" and told me not to quit).

This couldn't have possibly come at a better time.

[Rusty9]

Excellent article. I think Im going to send this over to my grandfather he plays alot of racquetball and golf but I cant get him to do anything with a barbell. I think the added hip strength would help him increase his golf swing too but maybe this will sway him.

Bahadur: Who cares if you can't hit the numbers you may have been able to do if you would have started at twenty. If you enjoy training and what you are getting out of it, why worry?

[DenghisCon]

Bahadur, You would be stronger if you were not such a mind wimp.

[Mark E. Hurling]

I know many people on this board don't hold faith in fate or fortune, and I'm not sure I do all the time but the timeliness of this article does give me pause.

The past couple of days have seen me questioning why I do this (barbell strength training) at all. The internet is a curse and a blessing, and seeing the logs of people who started much younger than I am (37 this past March) discourages me at times.

Am I told old to continue this? How close am I to my genetic/age strength limits and is it fruitless to continue, when I will never have the lofty squat numbers of a 20 something starting the program? Can a 37yo even develop a respectable amount of muscle who doesn't have the benefit of muscle memory?

Actually laid awake at night the past several nights mulling over whether I'm a fool for doing this when all the folks I know my age chide me over not doing any LDS work instead of 'acting like a teenager'. Many friends/family believe my lifting weights is a form of a mid-life crisis and sometimes mock me. In fact, this very morning I had a heart to heart talk with my wife about quitting lifting, esp. when the likes of Sanjay Gupta and Dean Ornish are so heavily promoting veganism and long slow cardio (to my wife's credit, she said she doesn't want "no skinny ass husband" and told me not to quit).

This couldn't have possibly come at a better time.

Hell no you are not too old at 37(!?) to do just fine. The people who chide or mock you merely demonstrate their own lack of commitment and dedication. Don't bring the subject up around them and put the kibosh on any direction they take to introduce the matter. If they persist agressively find new friends or avoid them. The real foundational aspect of your success is the support you got from your wife. Dearly Beloved thinks I'm a little eccentric on my lifting, but supports it for much the same reasons yours does. As for the likes of Ornish and Gupta, how much can they deadlift? That's at least some indication of their credibility.

[Patrick L.]

I hate to echo previous gushings, but I will anyway.

Simply an excellent article. Your balance of being a man of science and your hard core, no bullshit, "get it done" attitude was perfect. Thanks.

[Michele Knaub]

Bahadur, keep lifting.

Dr. Sullivan - shared the article with my brother, an orthopedic surgeon (spine.)

[MylesKantor]

The Jabba the Hut reference was one of the many excellent aspects of this article.

[El Viejo]

Many friends/family believe my lifting weights is a form of a mid-life crisis and sometimes mock me. Mark Hurling already gave an excellent response to this, but I'd like to reenforce it. Don't bring up the subject of weight training around these people and absolutely avoid preaching the benefits to them. It's simply not worth it.

They don't want to hear about it. They don't want to put forth the effort. They don't want to get big and bulky. (That's only partially a joke. I've actually heard people say that). And, most importantly, they do not want to see you succeed. That's right, they don't want you to be better than they are.

There are 4 of us where I work aged 55, 59 (me), 62, and 63. My 3 co-workers are all on medication and well on their way to Type II diabetes. The youngest one has more health problems than any 10 older guys on this forum put together. I once counted the pills in his little plastic container when he wasn't around. He takes 12 different pills every single day. They all get winded at the slightest bit of exertion and won't lift anything over 20 pounds without help.

They know I go to the gym during my lunch hour, but have never asked me what I do there (they probably assume I run on the treadmill). That tells me they are not interested and therefore I don't talk about it. That's unfortunate because they could really benefit from weight training and improve the quality of their lives. But the fact of the matter is I'd just be wasting my breath and would have to hear their silly excuses as to why they can't (or won't) do it.

Keep doing what you are doing. Do it for yourself and fuck what the people around you think. Your wife is on your side and she's the only one that counts.

[Mark E. Hurling]

And, most importantly, they do not want to see you succeed. That's right, they don't want you to be better than they are.

Yep, this. It's called the crab bucket phenomenon in the minority community but it works the same way with us white folks too in other contexts.

[Carlos Daniel]

I know many people on this board don't hold faith in fate or fortune, and I'm not sure I do all the time but the timeliness of this article does give me pause.

The past couple of days have seen me questioning why I do this (barbell strength training) at all. The internet is a curse and a blessing, and seeing the logs of people who started much younger than I am (37 this past March) discourages me at times.

Am I told old to continue this? How close am I to my genetic/age strength limits and is it fruitless to continue, when I will never have the lofty squat numbers of a 20 something starting the program? Can a 37yo even develop a respectable amount of muscle who doesn't have the benefit of muscle memory?

Actually laid awake at night the past several nights mulling over whether I'm a fool for doing this when all the folks I know my age chide me over not doing any LDS work instead of 'acting like a teenager'. Many friends/family believe my lifting weights is a form of a mid-life crisis and sometimes mock me. In fact, this very morning I had a heart to heart talk with my wife about quitting lifting, esp. when the likes of Sanjay Gupta and Dean Ornish are so heavily promoting veganism and long slow cardio (to my wife's credit, she said she doesn't want "no skinny ass husband" and told me not to quit).

This couldn't have possibly come at a better time.

Look badahur. I just squatted 500 (yes, I'm tooting my own horn, you'd be too if you squatted 500.) I'm psyched, I feel like I should be called the Brazilian car-jack or some silly nick name but the truth is 500 is not good. There's probably at least 10000 fucking chinese guys who can do high-bar, unbelted and without wraps those same 500. I don't even wanna find out what Ed Coan did when he lifted in my weight class.

So, the lesson is: unless you are incredibly awesome, there will always be someone stronger than you. If you let this get in the way, you won't go very far.

[Jungledoc]

Hell no you are not too old at 37(!?) to do just fine. The people who chide or mock you merely demonstrate their own lack of commitment and dedication. Don't bring the subject up around them and put the kibosh on any direction they take to introduce the matter. If they persist agressively find new friends or avoid them. The real foundational aspect of your success is the support you got from your wife. Dearly Beloved thinks I'm a little eccentric on my lifting, but supports it for much the same reasons yours does. As for the likes of Ornish and Gupta, how much can they deadlift? That's at least some indication of their credibility.
I wish I had started at 37, instead at 53 when I did, but I'm even more glad that I started when I did. I'm not lifting what most people would consider big weight, but I'm gaining all the time! I also have a supportive spouse, which makes a huge difference. If she were criticizing me, or expressing resentment over the time I spend at the gym, it would be way harder to stick with it.

[5inthehall]

Sullydog, this article is simply wonderful. Thank you for taking the time to write it and share it with us. Watching my 65-year-old father slowly circle the drain, as you call it, is sad and depressing, and it makes me more determined than ever to fight that kind of fate (I'm only 42 -- still climbing the hill!). Anyway, thanks again.

[Tamara Reynolds]

I just squatted 500 (yes, I'm tooting my own horn, you'd be too if you squatted 500.) I'm psyched, I feel like I should be called the Brazilian car-jack or some silly nick name but the truth is 500 is not good. There's probably at least 10000 fucking chinese guys who can do high-bar, unbelted and without wraps those same 500. I don't even wanna find out what Ed Coan did when he lifted in my weight class.

So, the lesson is: unless you are incredibly awesome, there will always be someone stronger than you. If you let this get in the way, you won't go very far.

This is one of my favorite posts ever.

[Jonathon Sullivan]

This is one of my favorite posts ever.

Yeah, it's a good 'un. For multiple reasons.

[stronger]

I liked the article, and appreciated the good explanation of what actually happens on a cellular level - thanks Dr!

one question and a suggestion: Why didn't you recommend barbell lifts for this patient seen in the first few paragraphs? Seems like a good opportunity, but I can see how it might be fruitless.

And for the suggestion: I think if these articles ever want to be taken seriously by anyone outside this little community (i.e. people who might be curious), there needs to be less cursing. It is fine and quite colorful in lay speech, but in an article which is as academic as this one, it comes across as out of place and unnecessary. Just a few thoughts.

[RRod]

Awesome article! I'd love to post it on the fridge at work, but the one expletive keeps me from doing it...

[Jonathon Sullivan]

one question and a suggestion: Why didn't you recommend barbell lifts for this patient seen in the first few paragraphs? Seems like a good opportunity, but I can see how it might be fruitless.

Well, I think the whole point of the article is that it would not be fruitless. To answer your question, though: I have eight other patients waiting to be seen. A good emergency physician (and I am a good emergency physician) never forgets that the sickest patient under his care is the one he hasn't seen yet. Moreover, referring this special population, with special needs, to "barbell clinic" is not yet an easily-executed option. Nor would it be considered "standard medical practice" by my colleagues, many of whom already think I'm Out There.

OTOH, I've been giving a lot of thought to my Second Act in Life, and the ideas I've sketched out in this article are...well, we'll see. I don't yet have the expertise in barbell training, nor do I yet have the professional freedom, to actualize some of the Weird Thoughts I've been having. But I have to say, as I proofread this post, that the phrase "barbell clinic" has a certain resonance to it that I find appealing.

As to the expletives: what can I say? One day, perhaps, if fortune and honor smile upon me, Rip and Stef and I will write a paper for the Lancetor JAMA. If and when that day comes, we will couch our (no doubt contentious) ideas in appropriately dry language, I promise.

[Jonathon Sullivan]

Awesome article!

Thanks!


I'd love to post it on the fridge at work, but the one expletive keeps me from doing it...


They don't have Sharpies where you work?

[stronger]

Well, I think the whole point of the article is that it would not be fruitless. To answer your question, though: I have eight other patients waiting to be seen. A good emergency physician (and I am a good emergency physician) never forgets that the sickest patient under his care is the one he hasn't seen yet. Moreover, referring this special population, with special needs, to "barbell clinic" is not yet an easily-executed option. Nor would it be considered "standard medical practice" by my colleagues, many of whom already think I'm Out There.

OTOH, I've been giving a lot of thought to my Second Act in Life, and the ideas I've sketched out in this article are...well, we'll see. I don't yet have the expertise in barbell training, nor do I yet have the professional freedom, to actualize some of the Weird Thoughts I've been having. But I have to say, as I proofread this post, that the phrase "barbell clinic" has a certain resonance to it that I find appealing.

As to the expletives: what can I say? One day, perhaps, if fortune and honor smile upon me, Rip and I will write a paper for the Lancetor JAMA. If and when that day comes, we will couch our (no doubt contentious) ideas in appropriately dry language, I promise.

Awesome - thanks for the quick reply! And hopefully the paradigm shifts so that while you're treating emergency cases, other doctors who have less urgency can recommend this type of training to their patients.

[RRod]

They don't have Sharpies where you work?

There's a whole gym downstairs that needs to read an article like this, so yes perhaps I will white it out and give it to the staff to copy. But I try not to underestimate the power that the prudes get from protocol (and alliteration). I've been bitten enough times by this to not be naive. I was just saying that perhaps leaving little things like that out lets you easily reach the widest possible audience... fuck.

[Jonathon Sullivan]

I was just saying that perhaps leaving little things like that out lets you easily reach the widest possible audience... fuck.

Point taken.

[tertius]

I liked the article, and appreciated the good explanation of what actually happens on a cellular level - thanks Dr!

one question and a suggestion: Why didn't you recommend barbell lifts for this patient seen in the first few paragraphs? Seems like a good opportunity, but I can see how it might be fruitless.

And for the suggestion: I think if these articles ever want to be taken seriously by anyone outside this little community (i.e. people who might be curious), there needs to be less cursing. It is fine and quite colorful in lay speech, but in an article which is as academic as this one, it comes across as out of place and unnecessary. Just a few thoughts.

I have to say I disagree. I personally wouldn't care a whit if there were more swearing in journal articles (it does happen from time to time, especially in the liberal arts, and articles in extremely contentious fields like anthropology might not contain actual swearing, but are often sarcastic to a very amusing degree). There's this idea that people who swear aren't serious, somehow. Which is ridiculous. It's like when we catch politicians swearing on open mics. Everyone pretends to be appalled, but we all know they say far worse when behind closed doors. Go listen to tapes of LBJ, if you want to hear some creative use of language. Academics are the same, and pepper their speech with expletives in meetings, and so forth.

The fact is that cursing has always had a place in speech, and used properly can drive home a point better than any amount of dry academic language. Especially to a lay audience, which is the intended target of this article. Also, seriously, fuck'em if they can't deal with a little bit of swearing.

[Mark E. Hurling]

There's a whole gym downstairs that needs to read an article like this, so yes perhaps I will white it out and give it to the staff to copy. But I try not to underestimate the power that the prudes get from protocol (and alliteration). I've been bitten enough times by this to not be naive. I was just saying that perhaps leaving little things like that out lets you easily reach the widest possible audience... fuck.

Let me add to that. The aerospace HR police are always on the prowl for someone with a grievance about something. I subscribe to the don't feed them policy, although what with one thing another I let slip I seem to be helping their population base to flourish.

[Jonathon Sullivan]

ER dox are a foul-mouthed bunch in general.

[stronger]

I have to say I disagree. I personally wouldn't care a whit if there were more swearing in journal articles (it does happen from time to time, especially in the liberal arts, and articles in extremely contentious fields like anthropology might not contain actual swearing, but are often sarcastic to a very amusing degree). There's this idea that people who swear aren't serious, somehow. Which is ridiculous. It's like when we catch politicians swearing on open mics. Everyone pretends to be appalled, but we all know they say far worse when behind closed doors. Go listen to tapes of LBJ, if you want to hear some creative use of language. Academics are the same, and pepper their speech with expletives in meetings, and so forth.

The fact is that cursing has always had a place in speech, and used properly can drive home a point better than any amount of dry academic language. Especially to a lay audience, which is the intended target of this article. Also, seriously, fuck'em if they can't deal with a little bit of swearing.

You can be right all you want, but if people are appalled, by pretend or otherwise, it doesn't matter

[TomF]

First, thank you. Great article, Sully - for all that it mostly confirms my own biases. Nice to find that some of those biases have a basis in reality.

Second, my day job is as a health policy wonk. For some years now, my job has been to try to discover ways to make populations healthier, and write policy which promotes those changes. Working in health policy, and reading the research, is perhaps the most persuasive thing that got me off the couch and doing physical activity myself, about 8 years ago; the stats were simply too compelling to ignore. And I've successfully done what my parents didn't manage - my kids also see regular rigorous activity, including strength work, as a requirement in their lives. Not a lot different from brushing their hair or teeth.

So here's the thing: we're abnormal. I'm not the only guy who reads the research, not even the only guy in my Health policy wonk office who does. But I'm in a serious minority of people who act on it, personally. Knowing this stuff isn't enough to get people to do it, though we all wish it were. I am more than likely going to have many more productive years of life than most of the people up and down my office hall, and have a better physical quality of life now. That isn't enough to motivate change.

I'm increasingly convinced that a huge proportion of physical illness ... is symptomatic of mental illness. Most people would rather live in a body that could squat 300 and take them for a walk 'round the lake every day to living in a body that gets emphysemic at the thought. But sitting on the couch eating Doritos and smoking gives them something. It's a coping strategy .. which delivers immediate "hits" of pleasure that get them through their dismal lives. That coping strategy works, or Dorito and cigarette manufacturers would be bankrupt, or selling Barbells instead.

And Rip's sure as hell not getting rich selling the prescription which actually works.

Your article is eloquent about the prescription - and it's one I take. But what I don't know is what carrots and sticks will be effective in getting others to take the same prescription. Lifting heavy objects right now to stave off a statistical likelihood of death and disability somewhere in the future doesn't compete with American Idol and ice cream right now, to stave off loneliness, self-disgust, or low self-esteem etc.

That's quite literally crazy, but that's my point. All the crap we do which leads to type 2 diabetes, COPD, the various preventable cancers, etc. etc. are coping strategies, intended to help us deal with something. If they weren't somewhat effective at it, we wouldn't do them - we'd do some other coping strategy instead. Like lifting weights, maybe. Or not primarily eating shit.

My problem - and the problem which if solved will absolutely revolutionize health care in the developed world - is how to discover effective motivations for positive behaviour which will compete successfully with all the motivations to do negative behaviour. I think we've got to find and address the causes, the things we apparently feel the overwhelming need to cope with, before we've got a hope in hell of having a back squat or press compete with a Big Mac.

[Mark E. Hurling]

You can be right all you want, but if people are appalled, by pretend or otherwise, it doesn't matter

A-bloody-well-men to that. Gloria Allred and her ilk wouldn't have billable hours at all without the Great American Grievance Industry, whether the "grievance" is real or feigned. Too much money and publicity and votes are at stake. Gotta be creative when expanding the constituency of the aggrieved and oppressed.

[Gabe Grinstead]

I know many people on this board don't hold faith in fate or fortune, and I'm not sure I do all the time but the timeliness of this article does give me pause.

The past couple of days have seen me questioning why I do this (barbell strength training) at all. The internet is a curse and a blessing, and seeing the logs of people who started much younger than I am (37 this past March) discourages me at times.

Am I told old to continue this? How close am I to my genetic/age strength limits and is it fruitless to continue, when I will never have the lofty squat numbers of a 20 something starting the program? Can a 37yo even develop a respectable amount of muscle who doesn't have the benefit of muscle memory?

Actually laid awake at night the past several nights mulling over whether I'm a fool for doing this when all the folks I know my age chide me over not doing any LDS work instead of 'acting like a teenager'. Many friends/family believe my lifting weights is a form of a mid-life crisis and sometimes mock me. In fact, this very morning I had a heart to heart talk with my wife about quitting lifting, esp. when the likes of Sanjay Gupta and Dean Ornish are so heavily promoting veganism and long slow cardio (to my wife's credit, she said she doesn't want "no skinny ass husband" and told me not to quit).

This couldn't have possibly come at a better time.

Thanks for sharing this. We all get discouraged at times. This article came at the right time. My dad recently had a widowmaker (left main corony artery 95% blocked) heart attack. A few minutes into the attack they have given him some drug to open up everything. He lived, they ran some tests on him, found the blockage and ran an angioplasty+stent on him. This was about 1.5 months ago. After that event he has taken fitness seriously. Our first barbell session is Thursday night. I know one thing, I am NOT going to push him. He is in decent shape, heart itself is in good shape (asside from the blockage his heart was very strong, no scarring - was lucky). So I plan on taking him through SS, but at a very, very, very slow pace.

This article was great for this reason. :D

[PRCalDude]

Look badahur. I just squatted 500 (yes, I'm tooting my own horn, you'd be too if you squatted 500.) I'm psyched, I feel like I should be called the Brazilian car-jack or some silly nick name but the truth is 500 is not good.

Yeah, but it's better than 99.999999999999% than what the general population can do and 99.99999% of the gym-going public.

Badahur, you can't have a mid-life crisis at 37. Ignore the other crabs. Who cares what everyone else thinks - you're biggest opponent is Gravity.

[Gillian Mounsey]

Thanks Sully. Great article. I teach a strength training/health education program to seniors that I call Forever Young. I am bringing your article in today for our required reading and discussion segment. In the past year I have witnessed the strength work dramatically improve the quality of life for this group - most are women over 65. One woman suffers from Parkinson's and appears to be walking better and standing more erect, she also loses her balance less frequently.

[Jonathon Sullivan]

Thanks Sully. Great article. I teach a strength training/health education program to seniors that I call Forever Young. I am bringing your article in today for our required reading and discussion segment. In the past year I have witnessed the strength work dramatically improve the quality of life for this group - most are women over 65. One woman suffers from Parkinson's and appears to be walking better and standing more erect, she also loses her balance less frequently.

This...is outstanding. This--what you are doing--this is medicine. This is the very best validation of the article I could hope for. Thank you.

(Tell them this old Marine is sorry about the expletives.)

[Jonathon Sullivan]

Oops. I think I locked this thread by accident. Sorry.

[Gillian Mounsey]

Sully, thought you would be interested in hearing the follow up. The women loved the article. Right now they are in an uproar because the budget only allows for me to teach the class 2 days per week. We have been campaigning for a third day to be added. The gym decided to put a yoga class in instead on Friday hoping that it would attract a bigger and more diverse demographic. Lucky for me some of women are community leaders and will fight to get what they want. Pretty sure Friday's will become our class and yoga will get dropped. Becoming strong and physically capable has empowered them in many ways.

[thefinalsql]

Sully, excellent article!

I already had the heart attack. Started lifting weights a year later. I too have exclaimed that lifting weights is the fountain of youth.

[Simma Park]

Sully, thought you would be interested in hearing the follow up. The women loved the article. Right now they are in an uproar because the budget only allows for me to teach the class 2 days per week. We have been campaigning for a third day to be added. The gym decided to put a yoga class in instead on Friday hoping that it would attract a bigger and more diverse demographic. Lucky for me some of women are community leaders and will fight to get what they want. Pretty sure Friday's will become our class and yoga will get dropped. Becoming strong and physically capable has empowered them in many ways.

I think this is one of the most awesome things I've read in a long time. Keep fighting the good fight, Gillian!

[Jonathon Sullivan]

I think this is one of the most awesome things I've read in a long time. Keep fighting the good fight, Gillian!

Amen.

[Cod]

Thanks Doc, I loved this article.

I was recently the obese, lethargic, near-alcoholic Jabba in question. I've only been doing SS for a few weeks, but I feel better than ever and my chronic back pain has pretty much disappeared. I am now sore, but it's a good soreness that comes from a hard workout.

[bowdirk]

Thanks for the wonderful article Doc, I will be emailing to many.

Have you heard of the Buck Institute for Research on Aging? http://www.buckinstitute.org/

It would be great if there is some way you could get them to sponsor your research. As a 52 year old who lives 5 miles from the place, I would gladly be a lab rat for the study.

Bowdirk

[tennisgod]

So here's the thing: we're abnormal

Absolutely right, TomF. 99% of people are weak-willed. They continue in jobs they hate, continue to smoke when the evidence of harm is irrefuteable, and continue to lose health bit-by-bit, and continue to put imaginery limitations in-front of them. These people tell their children that 'you can be anything you want', but the kids think: if I can be anything, what happened to you, Dad?

But I see it everyday in the corporate world, most corporations are run by only a few super-stars with the rest of the employees just clock-watchers. But this is what GB Shaw meant when he said: All progress depends on unreasonable men. I would suspect that alot of barbell lifters are unreasonable.

[Twodogs]

I'm increasingly convinced that a huge proportion of physical illness ... is symptomatic of mental illness. Most people would rather live in a body that could squat 300 and take them for a walk 'round the lake every day to living in a body that gets emphysemic at the thought. But sitting on the couch eating Doritos and smoking gives them something. It's a coping strategy .. which delivers immediate "hits" of pleasure that get them through their dismal lives. That coping strategy works, or Dorito and cigarette manufacturers would be bankrupt, or selling Barbells instead.



Thanks TomF. This article is popular here because people here "get it." Folks here are not normal, they are motivated, hopeful, smart, well informed, and the strongest ones brutally realistic. These are all above average traits.

I could forward this article all day long to friends, my father (63, obese, CHF, type 2, gout, ....) and other fools who would prefer to enlighten themselves with your article while sitting on a couch sucking down whatever coping mechanism does the trick. This article inspires me, but I get it. What about fat fuck using a walker and crowding up your ER?

[Simma Park]

I'm increasingly convinced that a huge proportion of physical illness ... is symptomatic of mental illness.

I think it's more of a cycle than anything else, a chicken and egg kind of situation. Physical degeneration from bad diet and inactivity can produce mental disturbance, just as mental disturbance can manifest in habits that cause physical degeneration.

But one of the easier ways to break in and disrupt this feedback loop should be to get people to discover the joys of strength training, IMO. It's more immediately rewarding than diet change, and the effect can be nearly instantaneous sometimes when it comes to affecting mood and attitude.


So here's the thing: we're abnormal.

The way I see it, the problem is not that we're special but that what we know is hard to come by and hard for most people to trust. We have been fortunate to be exposed to the information we have now.

To me, a big cause of this is the penance model of health, which is incredibly damaging. Doctors and the media are constantly harping on cardio and "heart healthy" diets, but cardio is a miserable activity for someone who is overweight and out of shape, and "heart healthy" diets are similarly unhappiness-inducing (not to mention unproven in their heart healthiness anyway). People don't actually believe that they can do something enjoyable and eat delicious, nutrient-rich food and improve their health, because the paradigm right now is so fucking Puritan.

I'm not saying that training hard and eating unprocessed, real food are easy to do. But I think that, because they're not joyless, people have a hard time believing that they will produce health and happiness. It's bizarre, but most of us are conditioned to believe that a prescription for life that is based on obligation and deprivation is going to succeed in producing health, even though we've demonstrated over and over again that it doesn't work.

Not everyone who lifts needs to fulfill their genetic potential. I do agree that people who pursue strength with that kind of dogged determination are unusual. But I have met enough people who found enough enjoyment in barbell training to derive significant health benefits, once they were taught the lifts, that I'm starting to believe that the main problem may not be that the general public is incapable of the effort or consistency required to train, but that too many people don't actually believe deep down that strength training is unpleasant enough to make and keep them healthy.

[Jonathon Sullivan]

As usual, Spar demonstrates some heavy thinking.

I don't have all the answers. Barbell training may be big medicine--and, obviously, I believe it is. Getting people to take advantage of medicine? Well, that's been a physician's bane since before Hippocrates.

I just got off work. My patients are good people (most of them) and I have devoted my professional life to helping them. But here is the bitter, bitter truth that I bring home with me after every shift, and it breaks my heart: most of them suffer at their own hand. It's hard to relieve suffering unless the patient is willing to stop hurting themselves.

We can show the way to a stronger, healthier body. But each of us must take his own medicine, and do his own squats.

[Simma Park]

We can show the way to a stronger, healthier body. But each of us must take his own medicine, and do his own squats.

Indeed. But I think it does a world of good to have doctors like you serving as examples. Perhaps you'll even inspire some of your colleagues. Wouldn't that be something?

[Mark E. Hurling]

To me, a big cause of this is the penance model of health, which is incredibly damaging. Doctors and the media are constantly harping on cardio and "heart healthy" diets, but cardio is a miserable activity for someone who is overweight and out of shape, and "heart healthy" diets are similarly unhappiness-inducing (not to mention unproven in their heart healthiness anyway). People don't actually believe that they can do something enjoyable and eat delicious, nutrient-rich food and improve their health, because the paradigm right now is so fucking Puritan

Now that is a very interesting and spot on "religulous" take on so much of what gets peddled our way in terms of health. If it's unpleasant, it must be good for you. Not so long ago in the 80's the weight trainers commonplace was "no pain, no gain." Thank you so much Joe Weider and Ahhhhnollld who were the chief purveyors of that saw. Sham artists the both of them. You don't have to be Henry II, getting flogged in penance by the good monks for having had Bishop Becket killed when in a drunken rage. Or in the case of most of the rest of us to restore or perhaps develop real strength for the first time after having neglected it long into your life. You likewise need not be Cotton Mather, subsisting on a diet of barley gruel so as not to be called a voluptuary and make certain all that fiber is helping you between your heart and your lower digestive tract. Live life and enjoy it, challenge yourself along the way and enjoy that and your life still more.

[Cod]

AThey continue in jobs they hate, continue to smoke when the evidence of harm is irrefuteable, and continue to lose health bit-by-bit, and continue to put imaginery limitations in-front of them. These people tell their children that 'you can be anything you want', but the kids think: if I can be anything, what happened to you, Dad?

That's me, Tennisgod, and that's why I started SS. I watched my son watch me and realized that he saw a fat, weak slob giving him a whole lot of blah blah blah. Time to man up and live up to the talk.

[Xray]

It used to be survival of the fittest. Now medicine tries to enable the survival of the fattest.

I watched a fellow physician in the hospital dining room give a colleague advice on hypertension meds while shoveling plates of food down his 300lb carcass. How can I expect the medical community to serve up rational health advice & treatment when the vast majority of physicians can't do 1 measly pull up. I have only convinced one of my colleagues to start ss with me, but it is a start.

Thanks for the great article.

[Simma Park]

It used to be survival of the fittest. Now medicine tries to enable the survival of the fattest.

What does this mean? A huge part of medicine is to act as a bulwalk against the attrition of the sick, weak, and disabled. A “survival of the fittest” mentality should be seen as antithetical to the profession.

I do agree, however, that medicine should try to help these people by seeking ways to make them stronger and healthier whenever possible, and that being content to enable the sick to just keep on keeping on could be seen as a suboptimal manifestation of medicine’s ultimate purpose--or even a perversion of them, when it’s done out of something like greed or lack of will to question established assumptions, etc. Maybe that’s what you meant.

[bob g]

...
To me, a big cause of this is the penance model of health, which is incredibly damaging. Doctors and the media are constantly harping on cardio and "heart healthy" diets, but cardio is a miserable activity for someone who is overweight and out of shape, and "heart healthy" diets are similarly unhappiness-inducing (not to mention unproven in their heart healthiness anyway). People don't actually believe that they can do something enjoyable and eat delicious, nutrient-rich food and improve their health, because the paradigm right now is so fucking Puritan.
...


The echoes of the Puritan's early influence on our society just won't die. The ascetic, Calvanist model where gluttony and sloth are sold as the causes of ill health is broadcast by "expert" sources far and wide. The message is pernicious. It is wrong. It is at the root of a nationwide health disaster. It requires the sinner to be consumed by guilt before he can repent and become healthy. And if you do not achieve the results you were promised then you must still be a sinner and require further penance of more cardio and more heart healthy consumption.

I am thrilled by Sully's article and by the responses from the medical professionals who are crying "bullshit" to this madness.

[Jonathon Sullivan]

What does this mean? A huge part of medicine is to act as a bulwalk against the attrition of the sick, weak, and disabled. A “survival of the fittest” mentality should be seen as antithetical to the profession.

I do agree, however, that medicine should try to help these people by seeking ways to make them stronger and healthier whenever possible, and that being content to enable the sick to just keep on keeping on could be seen as a suboptimal manifestation of medicine’s ultimate purpose--or even a perversion of them, when it’s done out of something like greed or lack of will to question established assumptions, etc. Maybe that’s what you meant.

Spar nails it again.

[Simma Park]

Spar nails it again.

Except I mistyped “bulwark”. Dammit.

[jillingworth]

If it's of interest to anyone, I've found that the heavy lifts have done a lot to help control my hypertension. Over the course of a year, my medication intake has cut to 1/4 of what it was originally. If I'm really careful about what I eat, I've found I can actually go a few days without the meds - but stress and slipping on my diet can seriously derail this. I remember when I was first "diagnosed" with hypertension a few years ago the doctor told me that if anything, I'd probably end up having to take more meds over time. While I'm not sure I can "cure" myself the rest of the way, I've been pretty psyched about the degree of "remission" I've gotten so far.

[Matt275]

What does this mean? A huge part of medicine is to act as a bulwalk against the attrition of the sick, weak, and disabled. A “survival of the fittest” mentality should be seen as antithetical to the profession.

I do agree, however, that medicine should try to help these people by seeking ways to make them stronger and healthier whenever possible, and that being content to enable the sick to just keep on keeping on could be seen as a suboptimal manifestation of medicine’s ultimate purpose--or even a perversion of them, when it’s done out of something like greed or lack of will to question established assumptions, etc. Maybe that’s what you meant.

If they don't want to help themselves there's nothing a doctor can do to help them long term. I think the best they could do is educate them as to why they should and then point them in the right direction to go about doing it but they cannot move the weight for them. My personal opinion is that those that won't help themselves should have higher premiums the same way a person who refuses to obey traffic laws pays more for car insurance.

[Xray]

... that being content to enable the sick to just keep on keeping on could be seen as a suboptimal manifestation of medicine’s ultimate purpose--or even a perversion of them, when it’s done out of something like greed or lack of will to question established assumptions, etc. Maybe that’s what you meant.

I agree totally. You have a very polished writing style. I am envious.

I feel that too many people give up too early on their health and find it easier to swallow pills, undergo surgeries such as gastric bypass, or continue the downward spiral of prolongued inactivity rather than exercise/train for the long haul. I am in my early 40's and feel like I am in the prime of my life, because of exercise and information available on sites like this.

[Gabe Grinstead]

My personal opinion is that those that won't help themselves should have higher premiums the same way a person who refuses to obey traffic laws pays more for car insurance.
I share that same opinion. But before I'd support it, they would have to get rid of the crappy BMI method first in regards to weight. It is sad when a skinny fat person who is weak and fat can be considered to be at a more healthy weight than a 5'10" 200 lifter.

[Simma Park]

I share that same opinion. But before I'd support it, they would have to get rid of the crappy BMI method first in regards to weight. It is sad when a skinny fat person who is weak and fat can be considered to be at a more healthy weight than a 5'10" 200 lifter.

I might share this opinion in an ideal world, but in this one, whom do you suggest be responsible for monitoring compliance? You’d need diet and exercise police, stress police...

What about people who take health risks for the sake of others, like people who have the temperament to step in to dangerous situations to help someone out? And what about people who are genetically blessed with great health and can get away with crappy behaviors? They should pay a fine? Also, what about people who just get the shit end the genetic/environmental stick and, despite doing everything “right” end up with a chronic or potentially terminal illness? How should we calculate what they should pay for health care?

Not to mention: Who is going to determine what the “right” behaviors are so that we could establish such a system? The people who are telling us to eat low-fat diets and do LSD cardio? The people who tell us that squatting is bad for the knees and back?

[Mark E. Hurling]

I might share this opinion in an ideal world, but in this one, whom do you suggest be responsible for monitoring compliance? You’d need diet and exercise police, stress police...

What about people who take health risks for the sake of others, like people who have the temperament to step in to dangerous situations to help someone out? And what about people who are genetically blessed with great health and can get away with crappy behaviors? They should pay a fine? Also, what about people who just get the shit end the genetic/environmental stick and, despite doing everything “right” end up with a chronic or potentially terminal illness? How should we calculate what they should pay for health care?

Not to mention: Who is going to determine what the “right” behaviors are so that we could establish such a system? The people who are telling us to eat low-fat diets and do LSD cardio? The people who tell us that squatting is bad for the knees and back?

Sounds pretty much like the direction we're headed with ObamaCare in any event. My employer began using a $50 gift card carrot a few years ago to entice us to fill out a health questionnaire. It was pretty obvious they were conducting a risk survey from the questions. Last week they elected to use a stick to get us to fill it out, to the tun of an additional $40 a month pay-in by the employee along with the existing contribution, the co-pay, and the deductible. Just the nose of the camel coming in under tent. I can already imagine they will be on my ass non-stop over my BMI, and how much I lift, my jujitsu, and my other activities be damned. I suspect the jujitsu and my aspirations to compete in senior's powerlifting will tick me up to a higher risk category with them. This is all in addition to the increase we got hit with last year after the jamdown of ObamaCare. None of this will stop me from doing what I do, although it may cost me more for my healthcare.

[TomF]

I might share this opinion in an ideal world, but in this one, whom do you suggest be responsible for monitoring compliance? You’d need diet and exercise police, stress police......It could be pretty simple. Decide on the indicators you want to follow, based on their actual, evidence-based relationship with population health. I share your issues with BMI, but there should be some measure which addresses obesity. Probably also resting heart rate, blood pressure. Wouldn't it be great to also have some way of measuring strength as an element?

Anyway, have these measures be collected during your annual physical with your physician, and if your results are within spec for your particular slice of the demographic ... you'd get a non-refundable tax credit. If not, not. Tweak the process to account for genetic anomalies, and to recognize change over time to improve your standing ... to give some recognition and incentive for the enormous work of becoming active after years of becoming Jabba the Hut.

In Canada, and other places where health care is paid through taxes, the non-refundable tax credit should be just less than the actuarial predictions of the savings to the health system of being active rather than being a slug. In the US, or other places where private insurance is the rule, I agree that the incentive should be reduced premiums.

[Akoni]

Thank you for the read. I'll try to have everyone I work with read it.

[Simma Park]

Sounds pretty much like the direction we're headed with ObamaCare in any event.

Actually, my experience has been that, in countries that have insurance that is much more commie than the comparatively modest reforms we made, citizens have greater rights to privacy when it comes to matters medical.

[Jonathon Sullivan]

Actually, my experience has been that, in countries that have insurance that is much more commie than the comparatively modest reforms we made, citizens have greater rights to privacy when it comes to matters medical.

A system--such as ours--that regards an insured patient as the "property" of one health care network or another cannot have any credible commitment to patient well-being. A system--such as ours--that uses the Emergency Department as the default backup and the default entry point into the hospital, or into the healthcare system itself, cannot have any credible commitment to patient privacy.

Off topic here, but there is something people don't understand. The specialty of Emergency Medicine--my specialty--is taking an increasingly central role in American health care--clinically, academically, politically. We are the young Turks in the house of medicine.

This is not a good thing. This is a marker for a highly dysfunctional and dangerous health care system.

[Simma Park]

Absolutely agreed, Sully. I think you and I have discussed this before, but I've experienced socialized medicine firsthand, and it made me embarrassed for the American health care system.

[Mark E. Hurling]

Actually, my experience has been that, in countries that have insurance that is much more commie than the comparatively modest reforms we made, citizens have greater rights to privacy when it comes to matters medical.

With any luck, we'll never know after 2012. When the First Lady carps away about requiring adult consent for kids to have french frys and lots of references to BMI in the bill we'd have to pass first to find out what is in it, I suspect that the health care you find so inferior to the enlightened Europeans who are going broke from their own extravagance is about to get a good deal more inferior.

[Matt275]

Wouldn't getting away from employer sponsored health care and opening it up to individual policies which can be shopped just like car insurance be better? Seems to me that insurance companies competing for our business would force them to be better. Do we really want our govt in control of any more of our benefits? Correct me if I'm wrong Sully but isn't the ER the entry point due to the non insured not being able to be turned away so they treat it like their primary care? Couldn't this be cured by turning away those who are uninsured or can't show ability to pay? I'm sure the left leaning will be appalled at that last statement.

[Jonathon Sullivan]

WCorrect me if I'm wrong Sully but isn't the ER the entry point due to the non insured not being able to be turned away so they treat it like their primary care?

Okay. You're wrong. Most people in the ER have insurance. And the reason they treat it like primary care is that (a) there aren't enough primary care physicians, (b) the primary care physicians that are out there are overwhelmed, (c) emergency departments and hospitals actually want people to come to overcrowded, understaffed EDs ($$$$, a beautiful example of quarterly consciousness and self-destructive behavior), and (e) emergency physicians are picking up more and more primary care responsibilities thanks to our "system," which means that both emergency care and primary care are being undermined. I could write volumes on this stuff. People think the system is dysfunctional and unjust. They have no fucking idea.


Couldn't this be cured by turning away those who are uninsured or can't show ability to pay?

Of course. Much as cancer can be cured by decapitation. Recently, some on the right have actually given voice to this sentiment, highlighting the brutal truth that magical thinking, short-sightedness and craven stupidity are not exclusive to the left.

Of course, it could also be cured by changing the system so that vast amounts of health care money don't get siphoned off by people who don't actually deliver any health care. But that's another topic.


I'm sure the left leaning will be appalled at that last statement.

I'd like to think that everyone would be appalled. But of course, I'd be wrong. Forgive me, I'm a physician. I have this bleeding-heart tendency to regard access to health care, regardless of ability to pay, as a basic human right. It's an occupational hazard.,

[Matt275]

I'd like to think that everyone would be appalled. But of course, I'd be wrong. Forgive me, I'm a physician. I have this bleeding-heart tendency to regard access to health care, regardless of ability to pay, as a basic human right. It's an occupational hazard.,

I am not championing the idea, but it in my opinion it is the other end of the spectrum from socialized health care. I think we are some where in the middle right now and it definitely needs tweaked but not all out govt controlled.

Personally I don't go to the doctors unless something is wrong. I should probably start getting regular physicals but I just can't stand that my Dr. doesn't seem to get that I am his customer. My time is just as valuable as his. Waiting for my appt. over an hour after it was scheduled is fucking annoying. I deal with it because he is a good Dr. and my entire family sees him. I figure he's so busy and over booked for 1 of 2 reasons.

1. He's greedy and wants to see as many patients as possible to pay the mortgage and then some.
2. The hospital he is associated with makes him see so many people a day due to their greed.

I lean towards 2 but either way it's greed that drives my frustration with having to wait and waste my time. Again if I'm off base here I'm open to your expert opinion. As for people who don't actually deliver health care, I'm guessing you mean the tons of medicare fraud that is going on out there. Again, do we really want the govt running our health care when it allows these things to happen. If your referring to physicians running unneeded tests to pad the bill, I think insurance is part of the problem. How many people would take a hard look at the tests they need if they were paying out of pocket?

I am in no way an expert on the subject and these are just my opinions on a system that I admittedly have had very little interaction with so far in my life.

[Jonathon Sullivan]

I am not championing the idea, but it in my opinion it is the other end of the spectrum from socialized health care. I think we are some where in the middle right now and it definitely needs tweaked but not all out govt controlled.

I have been a patient, many times. And I am involved in the administration of our group and I am familiar with where the money comes from. And I can tell you as both a patient and as a provider that I'd much rather deal with Medicare or Medicaid than a private insurance firm or HMO. By orders of magnitude. This is based on experience, not ideology. In my experience, corporate bureaucracy is usally at least as Byzantine, and generally twice as craven, as govt bureaucracy. And that's saying something. (I've recently embarked on reading Weber; it's an eye-opener.)

Someday, I'll have to tell the story of The Night My Balls Got Twisted.


Personally I don't go to the doctors unless something is wrong. I should probably start getting regular physicals but I just can't stand that my Dr. doesn't seem to get that I am his customer.

He's right. You're not his customer. You're his patient. Being a patient and a customer are two different things. That's why we have two different words for them. When you doctor and your hospital start to treat you like a customer (as many have started to do) it's time to get terrified. But I'm a fuddy-duddy. I hold my relationship to my patients as special. Sacred, actually. Customers? That's what McDonald's has. Or, say, those cocksmokers at Netflix.


My time is just as valuable as his. Waiting for my appt. over an hour after it was scheduled is fucking annoying.

I agree that it's annoying; the time/value thing is subject to reasonable debate but beside the point. Did he tell you that he spent that hour dealing with a patient who showed up for a routine physical and actually had an acute non-ST-segment myocardial infarction? Or evidence of malignant hypertension? Or melted down in the exam room after being told the path came back positive for malignancy? No, he didn't tell you. Because those people were his patients, and he doesn't discuss patients with other patients. I hate to state the obvious, but medicine--even "routine" clinic medicine--is unpredictable. And difficult.


I deal with it because he is a good Dr. and my entire family sees him. I figure he's so busy and over booked for 1 of 2 reasons.

1. He's greedy and wants to see as many patients as possible to pay the mortgage and then some.
2. The hospital he is associated with makes him see so many people a day due to their greed.

Both, either or neither may be true, I don't know. But it most certainly is true that physicians, especially primary care, acute care and emergency physicians, are under enormous financial, administrative, medicolegal and -- oh yes! -- clinical pressures these days. And those pressures sure as hell ain't all (or even mostly) coming from the Evil Government.


As for people who don't actually deliver health care, I'm guessing you mean the tons of medicare fraud that is going on out there.

No. THat's not what I mean.


Again, do we really want the govt running our health care when it allows these things to happen.

I'm not in favor of government "running" health care, anymore than I'm in favor of allowing HMO suits to run it. Actually--here is the Sullydog Heresy--I think doctors and patients should "run" health care. And government doesn't "allow" these things to happen--in fact, it's gone overboard in enforcement.


If your referring to physicians running unneeded tests to pad the bill, I think insurance is part of the problem.

Nope, I'm not talking about that either, although unnecessary testing is certainly a source of waste. It's almost never done to pad the bill, however. It's done because (a) private insurers mandate it (eg, blood cultures for hospital admissions for pneumonia--utterly ridiiculous yet required) or (b) an out of control tort system requires it. For the record, if you come in to see me for a minor head bonk, I get paid almost exactly the same whether I scan your head or send you home after a simple neuro exam. The only question is whether I've got the balls to send you home without an unnecessary test against the possibility that you'll sue me three years from now for post-concussive syndrome, chronic pain, and unemployability. (I do, but I'm an outlier.)


How many people would take a hard look at the tests they need if they were paying out of pocket?

Oh, you'd be surprised.

[tertius]

I wondered when we'd get to hear about your opinions on the matter, Sully. I've been looking forward to it, I assure you.

On topic, I do wonder about the 'Prescribed Barbell'. Doctors do recommend dietary and other lifestyle changes all the time, from what I hear. And that advice mostly goes untaken, apparently.

And yet, many things have emerged from medical culture to impact the mainstream. Things that weren't based on terribly strong evidence, even, and which had big lobbies opposed to them. Like, say, that red meat is bad for you. Or animal fat is evil. These ideas are pretty ingrained in American culture these days. In part because some people made a lot of money selling them, but also because generations of doctors have been telling people these things over and over.

So on the culture side, can useful, healthy barbell training break out? It is, in its way, brutally difficult, but not in that Puritanical sense that makes Crossfit so popular. Or at least not until you are already pretty strong, if you're doing it right. So it is both too hard and too easy for many.

So what gets the bar rolling? In part, Rip does and Crossfit does. Maybe Sully impresses these ideas into the minds of the young ER docs who move in and out of his tutelage. Maybe Dr. Sullivan's Iron Fountain of Youth (with Mark Rippetoe) becomes a best selling self-help book, and touches off a revolution. I dunno.

But it would be nice to give a script for squats and actually expect it to be taken seriously.

[Matt275]

I should have said this earlier, I loved the article and have shared it with a few family members and friends.


Actually--here is the Sullydog Heresy--I think doctors and patients should "run" health care. And government doesn't "allow" these things to happen--in fact, it's gone overboard in enforcement.

I think we have some what of the same goal in mind just different ideas of how to get there. Customer was a bad choice of word. I get that docs are dealing with unexpected events on a near constant basis and that those events are going to affect me in a miniscule way compared to the other patient. I wouldn't want him telling me about his other patients. Just a simple "Sorry you had to wait, what can I do for you" would go a long way. Or even when I get there to sign in the receptionist could let me know he's behind. In the end it doesn't really matter because I go to him anyway.

For the first four years out of high school I "learned" that 800 mg of ibuprofen and a canteen full of water will cure 99% of what ails you. Sick call was for utter pussies. While that's certainly not true it has kept from cluttering up ER's and waiting rooms with things that a band aid or some robitussin would fix. I have to imagine you would like to look at less scraped knees in an ER.

Your patient that you spoke of with the rash? on her head who thought it might be cancer (at the campfire) did melt some of the iciness of my cold right wing heart. I can sympathize with her fear. I don't think that it will ever get warm enough in there to produce blood flow let alone bleed though. Maybe to my detriment, maybe not.

[Jonathon Sullivan]

I wondered when we'd get to hear about your opinions on the matter, Sully. I've been looking forward to it, I assure you.

Well...I'm not in the majority. Any majority. Let's just say that. And my perspective is unique, even for a physician, so I'm biased. I'm the first to admit it. Also the first to admit that I don't know how to make a modern health care system completely rational, efficient, or just. Because, quite frankly, I don't think it's possible to do so. But we could at least try.


Maybe Dr. Sullivan's Iron Fountain of Youth (with Mark Rippetoe) becomes a best selling self-help book, and touches off a revolution. I dunno.

Nice idea, but premature, at least, and presumptuous. Yes, I would like to be part of "barbell medicine," and I hope to be able to talk to Rip and Stef about these things in the future. But, to quote the great American philosopher Harry Callahan, a man's got to know his limitations. I'm a relative newcomer to serious, programmatic barbell training. I don't have experience as a coach, and my clinical experience and expertise have been focused on resuscitation, stroke and acute/critical care, not physical training, geriatrics or rehabilition. I've just begun exploring a world that Rip has lived and worked in for 30 years. Hell, I'm still trying to get my power clean unfucked.


But it would be nice to give a script for squats and actually expect it to be taken seriously.

I agree, obviously. Using barbells to get people--especially older and obese people--healthier and stronger is an area of intense interest to me; Rip has opened my eyes to a lot of possibilities. I would like to do my part to bring it to people who will benefit from it, but I'm still just a newcomer myself. We'll see. I will say this: I'll be posting my .02 on the forum until somebody kicks me out.

[Simma Park]

I'm not in favor of government "running" health care, anymore than I'm in favor of allowing HMO suits to run it. Actually--here is the Sullydog Heresy--I think doctors and patients should "run" health care. And government doesn't "allow" these things to happen--in fact, it's gone overboard in enforcement.

Bingo. Also, slogans like "government-run" health care are designed to obfuscate and are inaccurate, unless you're actually talking about totalitarian states. Not that I necessarily advocate a single-payer system. Lots of countries manage to universally cover citizens using other models. But the sad fact is that single-payer systems actually do a better job of giving people care at a lower per capita cost than the current U.S. system.


Couldn't this be cured by turning away those who are uninsured or can't show ability to pay? I'm sure the left leaning will be appalled at that last statement.

Don't use euphemisms like "turning away". Just say it: you are advocating letting people die if they cannot pay.

And, on a purely logical plane that cares nothing for human life, you're right--any other system is socialism, either officially or in name. Under our current system, the costs for the uninsured and the poor DO get spread around to everyone else, probably on the order of thousands of dollars a year for every person who IS insured. It's just that it's the private insurance companies who rake in the cash under this system. Some people may think that's fine, though, and better than the government getting that money.

[tertius]

Well, I'm nothing if not premature and presumptuous. :-)

Where angels fear to tread, and so on.

[Jonathon Sullivan]

Well, I'm nothing if not premature and presumptuous. :-)

That's what she said.

Seriously, it's why we like you.


Where angels fear to tread, and so on.

I hear you, my friend, and I'm flattered. I'm also cautious, practical, and acutely aware of my own ignorance. It was not always so, but I've accumulated scars on my journey...

[dcottrill43223]

Someday, I'll have to tell the story of The Night My Balls Got Twisted.


Yes please. You HAVE to share that one!!!

[Jonathon Sullivan]

I should have said this earlier, I loved the article and have shared it with a few family members and friends.

Thank you.


Just a simple "Sorry you had to wait, what can I do for you" would go a long way.

Agreed. And docs could certainly do better at this. Some people call this "customer service." I like to call it "common fucking courtesy."



Your patient that you spoke of with the rash? on her head who thought it might be cancer (at the campfire) did melt some of the iciness of my cold right wing heart. I can sympathize with her fear.

I'm sincerely pleased to hear that.

We should talk again the first time you go to the ER with horrible chest pain and come home with a (hopefully correct) diagnosis of "gas." Being a patient in the CCU or operating room can make certain realities very vivid, including the reality that We're All In This Together (WAITT). That sounds all fuzzy and cuddly and Up With People! and liberal and bleeding heart, I know. But it's really not. WAITT is actually a very hard, ragged, existential, brutal, impersonal, almost malevolent Truth. We ignore it at our peril.

[TomF]

Once again, Sully, I find we agree on a lot. Like not siphoning off zillions of health care dollars to pay for things which aren't health care.

For what it's worth, one of the things I inevitably hear from physicians who've worked both in Canada and in the US ... is how much less hassle and time is wasted working with a single payer system. Pretty much anyone who works in any system has numerous beefs with it, but the enduring refrain is that a single payer means you have vastly reduced the administrative and accounts payable headaches of negotiating with multiple private insurers. A physician friend in Boston has 3 full time staff in his group practice wrangling accounts payable - while an analagous group practice up here does all the same function with part of the FTE for their receptionist.

Consider the enormous amount of money available to be re-directed to actual patient care, rather than to competing insurance company bureaucracies, and additional administrative FTEs in every physicians' office.

[Jordan Feigenbaum]

Sully,

This is exactly what I want to do after I complete medical school/residency/fellowship. I've been coaching for awhile and plan on continuing to do so, need to further refine my "coaching" eye. But this is something I will do. I'll look you up in about.....6 years or so. Lol.

[Mark E. Hurling]

This will be a multi-part post that I undertake with some trepidation. The first part is easy though. My friend from jujitsu and I had a chance to talk over your article Sully. As I thought it would, it had a powerful effect on him. The same thing that resonated so significantly for me struck him as well. The unchallenged cell's "decision to die." Maybe it's the age thing on our parts I don't know, but it hit him right between the eyes. He started asking me about the relative effectiveness of pushups to bench presses or some other loaded movement. I told him increasing weight and load was the key and repetitions less so. So maybe he'll get some more iron in his blood. We'll see.


I'm not in favor of government "running" health care, anymore than I'm in favor of allowing HMO suits to run it. Actually--here is the Sullydog Heresy--I think doctors and patients should "run" health care. And government doesn't "allow" these things to happen--in fact, it's gone overboard in enforcement.

This is the part I have trouble with. Not government getting out part or staying out, but the true understanding of what happens behind the curtain of the transactions between the doctor or hospital or the billing department and the entity that pays for the treatment or medication. I don't profess to understand that part of it. Dearly Beloved gets it better than me and those of you who are not married will inevitably discover that when you do, your significant other will have an excellent grasp of the ins and outs of this from her own experience and check ups and will get your own part of this equation in good marching order with little or no effort on your part. When kids come into the bargain, all this goes double.

I don't want government involved. When government becomes even more intrusive then it was even two years ago, they will inevitably begin to look for ways to cut costs. The private sector too? No doubt they will too, but they do not have the same extensive power. One aspect of ObamaCare that bothers me the most is the premise that digitizing the records of patients will achieve huge cost savings and efficiencies. I am no IT expert but I call BS. The downside of the huge government database of health care records in the Tron world is immense. Compromise, hacking, and data mining is inevitable. I know enough about the frailities of human nature and greed with respect to selling our nation's secrets to have few doubts about the sanctity of this data. Here in LA LA land hospital and medical info is sold to the National Enquirer or TMZ routinely. Any talented or rich individual or entity who wants some or a lot of information from this repository will get it easily.

Hell, every week the Feds and others lose laptops with all manner of information on them. In my own company HR lost one, and the credit union each lost one within months of each other. Even the FBI carelessly disposed of some PC's containing witness protection information a few years ago. Is the current system with my HMO or PPO the answer? It's working for me and my family so far, thanks of some creative billing practices and careful consultation with Dearly Beloved. But the best? I'm certain not. Just keep the government out of my business. I'm in deep enough already of my own volition because of what I do.

[Matt275]

Don't use euphemisms like "turning away". Just say it: you are advocating letting people die if they cannot pay.

I said in my next post that I'm not championing the idea just wanted to show an example of what to me is the other end of the spectrum of govt run health care. However, I would have absolutely no problem with telling people with scraped knees or the sniffles who can't pay to go home, use a band aid or cough medicine or whatever over the counter measure would fix what ails them. I'm no doctor, nurse, emt, but I have taken a combat life savers course (thankfully never had to use it other than hung over monday's with a self administered IV). A lot of what I have seen in the ER would be given a bandage, some ibuprofen, water and told to get the sand out of their female nether regions.

[Jonathon Sullivan]

Too late. Government has been involved, continues to be involved, and will be involved, barring some sort of geopolitical-socioeconomic-environmental Singularity that would make all of this quite irrelevant. And electronic medical records are here to stay, too. Regardless of how you or I feel about these things (and frankly, my good friend, our views are probably pretty divergent on this topic), the toothpaste is out of the tube.

We all want our nation to be strong and healthy and prosperous and boast the best care in the world and cutting edge research and teaching and total privacy and cost-effectiveness and complete freedom and .....well. I just don't think we can have it all. We have to make hard choices. If we ever do it right, nobody will be happy with what emerges.

But we won't do it right. There's too much dirty fucking money in this game, and it ain't all (or even mostly) going to E-vil government, greedy doctors or freeloading patients. Trust me on this. And the political price for proposing substantive rational solutions of either the left or the right variety is too high right now. Nobody has the nuts to carry water for a completely free market system or a single-payer system. So we'll continue to limp along with the deeply fucked Frankenstein we have, sewing parts onto or hacking parts off of the devitalized corpse of the beast, and calling it "reform," for the foreseeable future. Plus ca change, plus c'est le meme chose.

[jdjohnson50]

I am no IT expert but I call BS.

I am an IT expert. I'm not trying to blow my horn here, but Information Security (InfoSec) is my livelihood. I've worked both in the private sector and in government. I've audited defense contractors, who supposedly have the best security controls in the world. I've worked for government agencies who say the same. I've also worked for fortune 100 companies. By far the best InfoSec controls are in place for the organizations that actually perceive the treat and have the means to pay for the controls. The government doesn't yet perceive the threat, they think they are invulnerable, and so are exploitable. Big business is starting to understand the ramifications of a breach but isn't completely convinced. Defense contractors are rock hard, as evidenced by the targeted attack against RSA and the follow up attacks on major defense contractors that were completely unsuccessful.

If I had to entrust my electronic medical records to any organization it would be the insurance companies. They are the defense contractors of the medical world. They understand the risk and have the means to provide adequate controls.

[Mark E. Hurling]

Defense contractors are rock hard, as evidenced by the targeted attack against RSA and the follow up attacks on major defense contractors that were completely unsuccessful.

If I had to entrust my electronic medical records to any organization it would be the insurance companies. They are the defense contractors of the medical world. They understand the risk and have the means to provide adequate controls.

Interesting to get your assessment given your broad range of experience. Defense contractors have indeed got robust protections because they actually implement the requirements the folks in the government and military mandate but fall short of doing themselves. Especially stateside in places like the Pentagon, who did get successfully attacked and not in a trivial manner. Of course once you get by that, the defense contractors' other operating elements are laughable in their protections, and that includes the parts that deal with medical records. I'm a physical/technical security type, AKA G3D (Gates, Guards, Guns and Dogs) with a nod toward the acoustic and RF spectrums.

[Jonathon Sullivan]

It's important to remember that, outside of the VA and the military, the government does not maintain medical records. Nor do they wish to. And no health policy proposal on either the right or left proposes that they should. Medical records, even those for Medicare and Medicaid patients, have been and will be maintained by providers, not the government, even if we were to go to a nationalized system. Nor do insurance companies maintain medical records, even in a completely market-driven system. At present, whether the patient is covered by private insurance, govt insurance or no insurance at all, records are maintained by providers--doctors and hospitals. This gets fuzzy when the hospital is owned by the insurance company, but I think you take my point. The idea that a nationalized system is going to result in your records floating around the internet due to govt malfeasance is a red herring.

In fact, it is govt legislation and govt monitoring (some of it pretty fucking draconian) that has led to increased privacy protections and fines for breaches. Getting into our Electronic Medical Records system at the DMC is something akin to James Bond getting access to MI6 headquarters. Even when I'm inside, it's for real: If I, a doctor, access the records of a patient, any patient, I'd better have a damn good reason for doing so, because that access is monitored. We fire people for accessing the records of patients without authorization or reason. We don't fuck around.

Any potential for loss or breach of electronic records is way offset by their utility, flexibility, and potential for improving patient safety and care (although I believe that potential is presently unrealized and overblown; EMR is in its infancy). And let's just suppose that a breach did occur, and health care information ended up in the open. WHo would abuse it? For the most part, it would be private insurers who would abuse it, not the government.

Sorry, but I really don't think this is the big problem with our system. We have much, much bigger fish to fry.

[Jonathon Sullivan]

Yes please. You HAVE to share that one!!!

http://startingstrength.com/resources/forum/showthread.php?t=23854&p=323714#post323714

[vivek]

Sully,
As a fellow physician (anesthesiologist) I commend you on your article. It really needed to be said. There is not a day that goes by where I don't anesthetize a patient who has a disease process that likely could have been stalled, reversed, or prevented altogether by Big Medicine.
I have forwarded this to several colleagues of mine.....
Regards,
V

[Jonathon Sullivan]

Sully,
As a fellow physician (anesthesiologist) I commend you on your article. It really needed to be said. There is not a day that goes by where I don't anesthetize a patient who has a disease process that likely could have been stalled, reversed, or prevented altogether by Big Medicine.
I have forwarded this to several colleagues of mine.....
Regards,
V

Thanks, Vivek, and all those who are helping to spread the word.

[bob g]

A question for the medical types who forwarded Sully's article to colleagues, what kind of feedback have you received? I know you all are crazy busy and really don't need another thing to read in your off time but I'm curious how this is being received outside of this forum. Thanks.

[twindeltatandem]

Sully,

Dead thread?

Life-changing article. Really great! Just a few thoughts...

- There's an elitism associated with barbell training that both contributes to its effectiveness, I would guess, and presents a barrier to entry. This barrier is surely higher for those who need barbell training the most. Just saying.

- Your article suggests that placing the body's muscular system under progressive stress provides systemic benefits as long as the stress is progressive. Therefore, am I correct that any stress is good stress as long as its progressive? My real question--could a very weak and untrained senior benefit from, say, 3 pound dumbbell presses and assisted body weight squats as long as next month he worked up to 4 pound dumbbell presses and body weight squats with less assistance? Would artificial joints or histories of knee/shoulder issues with ongoing pain or mobility limitations necessarily bar the elderly from weight training those particular joints? (I wouldn't think so--I mean, what's the point?) Rather, is there benefit in pressing through the pain, so to speak, with initially very low weights and seeking incremental progression? I'm thinking that as long as activity is smartly and properly done and is progressive enough to produce DOMS it's probably enough to elicit the desired hypertrophic responses. Is that what you're saying?

- Love the language. Some of these people are just being pussies.

- And for what it's worth, my primary concern over "Obamacare" is that it will create another enormously expensive government program that, along with social securty, medicare and medicaid, will send us all down the memory hole. I'd feel much better about the whole thing if there were any indication at all that our federal leaders had the balls and sense to solve these other problems before creating another potentially huger and certainly just as irrevocable mess. I also wonder whether innovation can survive within such a system--just try building a unique house from the ground up sometime. The building department simply won't allow it.

John

[Jonathon Sullivan]

Sully,

Dead thread?

Guess not.


Life-changing article. Really great! '

Thank you. It does seem to have been well-received, in spite of its innate geekiness.


- There's an elitism associated with barbell training that both contributes to its effectiveness, I would guess, and presents a barrier to entry. This barrier is surely higher for those who need barbell training the most. Just saying.

I think you may be right. Higher, but not insurmountable. And to the extent the barrier is there, it is a perceptual one, a cultural artifact. Barbellls are associated with meatheads and bodybuilders, with prison gangs and steroid freaks. The solution is simple: change the associations. I think I mention somewhere in the article the power of having geezers out there training. It will break down those prevailing (and largely incorrect) associations.


- Your article suggests that placing the body's muscular system under progressive stress provides systemic benefits as long as the stress is progressive. Therefore, am I correct that any stress is good stress as long as its progressive? My real question--could a very weak and untrained senior benefit from, say, 3 pound dumbbell presses and assisted body weight squats as long as next month he worked up to 4 pound dumbbell presses and body weight squats with less assistance?

What you're talking about is programming, and programming for severely deconditioned seniors would be different from programming for other novices only in the particulars. It would still involve progressive increases in load, because without such increases, there will be no increases in strength. Of course, the particulars are important, and would often have to be tailored to the individual. Rip has a great video on one starting point: see The Leg Press (http://startingstrength.com/index.php/site/platform_the_leg_press).


Would artificial joints or histories of knee/shoulder issues with ongoing pain or mobility limitations necessarily bar the elderly from weight training those particular joints?

Artificial joints? Certainly not. As to the other limitations you mention, it would depend. If the limitation is due to advanced, bone-on-bone arthritis, the first step in getting stronger is to replace the joint.


I'm thinking that as long as activity is smartly and properly done and is progressive enough to produce DOMS it's probably enough to elicit the desired hypertrophic responses. Is that what you're saying?

Not exactly. It's not about DOMS, or even about hypertrophy, although they certainly come along for the ride to one degree or another. It's about strength. If the weight on the bar is going up, you're getting stronger.


- Love the language. Some of these people are just being pussies.

Well...yes, I'm afraid that's true.


- And for what it's worth, my primary concern over "Obamacare" is that it will create another enormously expensive government program that, along with social securty, medicare and medicaid, will send us all down the memory hole. I'd feel much better about the whole thing if there were any indication at all that our federal leaders had the balls and sense to solve these other problems before creating another potentially huger and certainly just as irrevocable mess. I also wonder whether innovation can survive within such a system--just try building a unique house from the ground up sometime. The building department simply won't allow it.

This is a great board, full of smart people...like you. I love to come here and talk about strength, barbells, aging, medicine, music, martial arts, philosophy...you name it.

But I do my best to avoid talking politics on this board. There's a very animated and intelligent discussion on this topic right now on Rip's forum, which you might like to look at:

http://startingstrength.com/resources/forum/showthread.php?t=27413

You will observe that I did not participate.

[Carlos Daniel]

This is a great board, full of smart people...like you. I love to come here and talk about strength, barbells, aging, medicine, music, martial arts, philosophy...you name it.

But I do my best to avoid talking politics on this board. There's a very animated and intelligent discussion on this topic right now on Rip's forum, which you might like to look at:

http://startingstrength.com/resources/forum/showthread.php?t=27413

You will observe that I did not participate.

A wise man, you are. I did notice your absence in controversial medical topics.

[tertius]

You will observe that I did not participate.

Meanie.

[Jonathon Sullivan]

This just in. Directly on point.


Abstract: Sharafi, H, and Rahimi, R.

The effect of resistance exercise on p53, caspase-9, and caspase-3 in trained and untrained men.

J Strength Cond Res 26(4): 1142–1148, 2012

—Apoptosis is a programmed cell death that has been demonstrated in human and animal studies and plays an essential role to remove injured cells after acute strenuous exercise. Protein p53 plays important roles in regulating apoptosis via mitochondrial pathway. Therefore, the aims of this study were to determine the effects of acute resistance exercise (RE) on serum p53, caspase-9, and caspase-3, markers of apoptosis, and whether resistance training status influences the magnitude of the RE-induced apoptosis. Nine resistance-trained (RT) (age, 22.37 ± 1.99 years; height, 174 ± 5.04 cm; body weight, 71.32 ± 5.57 kg; and body mass index 23.58 ± 2.05 kg·m−2) and 9 untrained (UT) college-age men (age, 22.25 ± 2.13 years; height, 171 ± 3.4 cm; body weight, 68.45 ± 3.23 kg; and BMI, 23.41 ± 1.08 kg·m−2) volunteered to participate in this study. Resistance-trained and UT men completed an RE bout consisting of 4 sets of 6 exercise at 80% of 1 repetition maximum until failure. Serum levels of p53, caspase-9, and caspase-3 were examined at preexercise (pre), immediately post (IP), 3 hours post (3 hours post), and 24 hours post RE (24 hours post). In UT, serum levels of p53, caspase-9, and caspase-3 were significantly increased at IP compared with RT. [B]However, plasma insulin-like growth factor 1 level was higher for RT compared with UT at IP.

Collectively, our data suggest the role of p53 in regulating apoptosis through mitochondrial pathway as measured by caspase-9 and caspase-3 after acute RE in UT. Our results also revealed that regular RT alters apoptosis biomarkers, especially the intrinsic pathway of apoptosis.

[Jsutt]

You're not involved with that research?

[Karl Schudt]

Sully, could you translate that? Maybe a one-sentence summary?

[tertius]

If I follow that correctly, it would seem to suggest that resistance training causes up-regulation of apoptosis in the untrained (it would be very useful here to know whether or not the the training sessions for the two groups were scaled appropriately, i.e. sufficient to induce adaptation in both groups), and that trained individuals have a higher IGF-1 response to training.

I can think of a few ways to interpret these results, but they are pretty interesting. I also note some strong language in the abstract there, so I would imagine the effect size must be fairly large, given the small sample used. I'd look up the paper, but ain't got time for that now.

[DPMuller]

Sully... for the medically-challenged amongst us, do you have an english version that summarizes the above post in 15 words or less?


I've experienced socialized medicine firsthand, and it made me embarrassed for the American health care system.

I've experienced socialized medicine firsthand, and it made me embarrassed for healthcare.

Our mileage seems to vary. Might help to define what "socialized medicine" means.

[jheald1]

Interesting: they were able to publish a paper with a conclusion that was new a few decades ago (I.e. the role of p53 in apoptosis), but they "confirmed" it is the exact same in people who work out...

[tnumrych]

If I follow that correctly, it would seem to suggest that resistance training causes up-regulation of apoptosis in the untrained (it would be very useful here to know whether or not the the training sessions for the two groups were scaled appropriately, i.e. sufficient to induce adaptation in both groups), and that trained individuals have a higher IGF-1 response to training.

I can think of a few ways to interpret these results, but they are pretty interesting. I also note some strong language in the abstract there, so I would imagine the effect size must be fairly large, given the small sample used. I'd look up the paper, but ain't got time for that now.

Just requested the paper through my school's library. I'm willing to share with those who PM me to request it.

[dawson]

Thanks for posting such a fine article, for dealing with the complexities of the subject matter and for framing the subject in profound simple terms. We all see the cost our society is paying each and every day, in many ways. When will people wake up and say enough is enough? Probably only when folks like you can grab people by the throat in the office and scare the living crap out of them is my guess.

[vanslix]

This just in. Directly on point.


Abstract: Sharafi, H, and Rahimi, R.

The effect of resistance exercise on p53, caspase-9, and caspase-3 in trained and untrained men.

J Strength Cond Res 26(4): 1142–1148, 2012

—Apoptosis is a programmed cell death that has been demonstrated in human and animal studies and plays an essential role to remove injured cells after acute strenuous exercise. Protein p53 plays important roles in regulating apoptosis via mitochondrial pathway. Therefore, the aims of this study were to determine the effects of acute resistance exercise (RE) on serum p53, caspase-9, and caspase-3, markers of apoptosis, and whether resistance training status influences the magnitude of the RE-induced apoptosis. Nine resistance-trained (RT) (age, 22.37 ± 1.99 years; height, 174 ± 5.04 cm; body weight, 71.32 ± 5.57 kg; and body mass index 23.58 ± 2.05 kg·m−2) and 9 untrained (UT) college-age men (age, 22.25 ± 2.13 years; height, 171 ± 3.4 cm; body weight, 68.45 ± 3.23 kg; and BMI, 23.41 ± 1.08 kg·m−2) volunteered to participate in this study. Resistance-trained and UT men completed an RE bout consisting of 4 sets of 6 exercise at 80% of 1 repetition maximum until failure. Serum levels of p53, caspase-9, and caspase-3 were examined at preexercise (pre), immediately post (IP), 3 hours post (3 hours post), and 24 hours post RE (24 hours post). In UT, serum levels of p53, caspase-9, and caspase-3 were significantly increased at IP compared with RT. [B]However, plasma insulin-like growth factor 1 level was higher for RT compared with UT at IP.

Collectively, our data suggest the role of p53 in regulating apoptosis through mitochondrial pathway as measured by caspase-9 and caspase-3 after acute RE in UT. Our results also revealed that regular RT alters apoptosis biomarkers, especially the intrinsic pathway of apoptosis.

So from whence comes the caspases? What cell types are undergoing intrinsic apoptosis? And why? And how would this compare with other exercise types?

[Jonathon Sullivan]

So from whence comes the caspases? What cell types are undergoing intrinsic apoptosis?


Caspase assays were taken from serum samples, so your guess is as good as mine. And we don't actually know that it was intrinsic apoptosis that was being activated because the authors apparently did not look at APAF-1 or cytochrome c.


And why?

Good question.


And how would this compare with other exercise types?


An interesting question, isn't it? If you find any papers that answer it, please send them my way.

For me, what's interesting about this paper is that the finding is consistent with a model in which resistance training promotes an (apparently systemic) anti-apoptotic GF response. As noted above, I'll have more to say about this paper in this year's science review.

[sbhikes]

I just read your article and watched your video. I sent the video to my significant other who is 62 years old. The both of us have long believed (and practiced) that hiking is the best medicine. We have both known people who were able to hike well into their 80s and maintain mobility, youth and adventurousness. I had no idea what strength training could do on a molecular level. I am even more excited to have started it recently. No wonder I always feel so energized and fired up afterwards. It's all that growth stuff coursing through my veins. I hope that my boyfriend also takes it up. It's too bad that barbell training has the aura of being all about body building. The main reason I took it up was my attempt to get stronger doing boot-camp-type stuff wasn't working anymore and I hoped that maybe finally I could get a decently-functioning metabolism that would let me eat to my appetite without being so fat. I'm not sure the last one is ever going to happen, but at least I am getting stronger, and that feels great when I'm rest-stepping up some big giant mountain.

[Jonathon Sullivan]

It's too bad that barbell training has the aura of being all about body building.

This misperception, and the curious reticence of physicians, are two of the principle obstacles we face. But I'd rather light a candle than curse the darkness.

[TomF]

But I'd rather light a candle than curse the darkness.Fuck yeah.

[sbhikes]

Dr. Sullivan, you might also add to your presentation that people might be able to avoid their ED and Low-T medication with an Rx for barbells.

[Simma Park]

Dr. Sullivan, you might also add to your presentation that people might be able to avoid their ED and Low-T medication with an Rx for barbells.

I'm not sure this would be something that one could claim is backed up by research. Sully?

[Jonathon Sullivan]

Nope, not backed up by research. It's not a panacea, guys. It won't pay your bills, scoop the litterbox, or grow your hair back.

Isn't getting stronger, feeling better, and adding useful tissue miracle enough?

[dpinsen]

Excellent article. Just reaffirms my wish in life to eventually, hopefully quite a few years from now, die under the bar.

Consider benching with a thumbless grip.

[dpinsen]

To me, a big cause of this is the penance model of health, which is incredibly damaging. Doctors and the media are constantly harping on cardio and "heart healthy" diets, but cardio is a miserable activity for someone who is overweight and out of shape

This is so true. I did an hour of it 3x per week for about 5 months this year before I started SS, and I dreaded going to gym.

[luke.conrad]

Just wanted to thank Sully for this article! I gave it to my dad recently and his squat rack just arrived in the mail today. Excited to get him started this week.

[Jonathon Sullivan]

Just wanted to thank Sully for this article! I gave it to my dad recently and his squat rack just arrived in the mail today. Excited to get him started this week.

This pleases me.

[SquatQueen]

I've already shared this article more than I've shared any other SS article. Thanks, Sully.

Get your ass in gear and get Sully here to speak to the medical community. This is a public service announcement. Thank you.

[Tamara Reynolds]

Get your ass in gear and get Sully here to speak to the medical community. This is a public service announcement. Thank you.

Yeah, yeah, yeah. I'm on it, woman!

[Jonathon Sullivan]

Yeah, yeah, yeah. I'm on it, woman!

Reply forthcoming. We're gonna do this; only question is when.

[Luchesar]

Hi. My name is Luchezar, and I am from Bulgaria. I want to share with you that in our National Sports Academy we have professor Pavel Dobrev who is using barbell training to help people of old age, up to ninety years old for their quality of life with big results. He has free trainings in the mornings in 7:30-8:30 am for all who desire to participate.

[billb7581]

Very inspirational article Dr. Sullivan. I am glad I found it.

Back in September I was 290 lbs (6'4") and a fat mess. I was diagnosed with Type 2 diabetes with a fasting bg of 268 and an a1C of nearly 11%. I was sent home with a prescription for Metformin, a blood glucose monitor, and little else in the way of direction. They sent me to diabetes class, which was pretty much useless, and didn't really advocate exercise outside of walking and doing stuff that was "easy"..

I started eating to my meter, which meant low carb most of the time, with carbs consumed around workouts.... I had some improvement with strictly areobic workouts, but read this article and it made a lot of sense to me.

I started Benching, Squatting, Pressing, Rowing, and doing Chins and Dips on an assistance machine. After about 3 months of heavy compound exercises, at my last Dr appointment, I was 255 lbs, had a fasting BG of 105 and an a1C of 6.3%...he was so impressed he said I dont have to come back until August, and at that point we will take a look at discontinuing the Metformin.

It's really sad the state of diabetes education in the US. Resistance training wasn't even discussed, when it is the best thing you can do.

[Jonathon Sullivan]

Hi. My name is Luchezar, and I am from Bulgaria. I want to share with you that in our National Sports Academy we have professor Pavel Dobrev who is using barbell training to help people of old age, up to ninety years old for their quality of life with big results. He has free trainings in the mornings in 7:30-8:30 am for all who desire to participate.

Outstanding. Thank you for this.


Very inspirational article Dr. Sullivan.
(snip)

I started Benching, Squatting, Pressing, Rowing, and doing Chins and Dips on an assistance machine. After about 3 months of heavy compound exercises, at my last Dr appointment, I was 255 lbs, had a fasting BG of 105 and an a1C of 6.3%...he was so impressed he said I dont have to come back until August, and at that point we will take a look at discontinuing the Metformin.

You're the one who's inspirational, Bill. Thank you for sharing this. Don't stop now.


It's really sad the state of diabetes education in the US. Resistance training wasn't even discussed, when it is the best thing you can do.

We're working on it.

[billb7581]

Dont worry, I am not going anywhere. My goals are to get everything to non diabetic levels and be off of medication...although Metformin seems relatively safe from everything I have read.

[Jonathon Sullivan]

Chronic resistance training activates autophagy and reduces apoptosis of muscle cells by modulating IGF-1 and its receptors, Akt/mTOR and Akt/FOXO3a signaling in aged rats
Li Luoa, b, A-Ming Lua, Yan Wangb, An Honga, Yulan Chena, Juan Hua, Xiaoning Lic, Zheng-Hong Qinb

Experimental Gerontology 2013; 48(4)427–436

Abstract

Resistance exercise training (RET) remains the most effective treatment for the loss of muscle mass and strength in elderly people. However, the underlying cellular and molecular mechanisms are not well understood. Recent evidence suggests that autophagic signaling is altered in aged skeletal muscles. This study aimed to investigate if RET affects IGF-1 and its receptors, the Akt/mTOR, and Akt/FOXO3a signaling pathways and regulates autophagy and apoptosis in the gastrocnemius muscles of 18–20 month old rats. The results showed that 9 weeks of RET prevented the loss of muscle mass and improved muscle strength, accompanied by reduced LC3-II/LC3-I ratio, reduced p62 protein levels, and increased levels of autophagy regulatory proteins, including Beclin 1, Atg5/12, Atg7, and the lysosomal enzyme cathepsin L. RET also reduced cytochrome c level in the cytosol but increased its level in mitochondrial fraction, and inhibited cleaved caspase 3 production and apoptosis. Furthermore, RET upregulated the expression of IGF-1 and its receptors but downregulated the phosphorylation of Akt and mTOR. In addition, RET upregulated the expression of total AMPK, phosphorylated AMPK, and FOXO3a. Taken together, these results suggest that the benefits of RET are associated with increased autophagy activity and reduced apoptosis of muscle cells by modulating IGF-1 and its receptors, the Akt/mTOR and Akt/FOXO3a signaling pathways in aged skeletal muscles.