Strength Training: Overlooked Medicine for Chronic Disease Prevention - Episode Hero Image

Strength Training: Overlooked Medicine for Chronic Disease Prevention

Dhru Purohit Show · · Listen to Original Episode →
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TL;DR

  • Strength training is a critical intervention for preventing and managing chronic diseases like heart disease, cancer, type 2 diabetes, and Alzheimer's, with research showing significant reductions in mortality and disease progression.
  • The medical system's historical separation of strength training from healthcare creates a prejudice that overlooks its profound impact, necessitating a paradigm shift to recognize exercise as a vital, prescriptive treatment.
  • High-intensity progressive resistance training demonstrably improves cognitive function, particularly in areas like empathy and memory, by increasing the size of key brain regions like the posterior cingulate cortex.
  • Muscle mass serves as the body's primary glucose-disposal engine, making strength training a more effective intervention for glycemic control and insulin sensitivity in type 2 diabetes than weight loss alone.
  • Strength training cultivates self-efficacy, enhancing confidence and the perceived ability to handle challenges, which is crucial for navigating life and fostering social connection across all ages.
  • Even frail, elderly individuals can achieve significant proportional strength and muscle mass gains with appropriately challenging resistance training, demonstrating that it is never too late to improve physical capacity.
  • Ancient Greek philosophy viewed strength as a collaborative phenomenon of interdependence, highlighting that human achievement, including physical capability, is always a product of both individual effort and external support.

Deep Dive

Muscle mass is a critical, yet largely overlooked, determinant of health, directly impacting the risk and progression of major chronic diseases including heart disease, cancer, type 2 diabetes, and Alzheimer's. This oversight stems from an ancient prejudice that separates mind and body, leading the medical establishment to silo disease management and neglect exercise as a foundational treatment. Recognizing and prioritizing strength training offers profound benefits, not only for physical health and longevity but also for shaping identity and self-efficacy.

The link between muscle mass and chronic disease is stark. Research indicates that muscle decline contributes significantly to the reduction in aerobic fitness with age and that strength training alone can reduce cancer mortality by 16%, a benefit amplified when combined with aerobic exercise. For type 2 diabetes, muscle acts as the body's primary glucose disposal engine; high-intensity resistance training, specifically, has been shown to significantly improve glycemic control and insulin sensitivity, more so than low-intensity training, even if both result in weight loss. The impact extends to cognitive health, with progressive resistance training demonstrating the ability to increase the size of brain regions associated with empathy and memory, the same areas that atrophy in Alzheimer's patients. Studies, like the SMART trial, suggest that strength training is a powerful intervention for cognitive function, with lower body strength showing a particular correlation with improvement. Furthermore, a multi-component lifestyle intervention including strength training has been shown to triple the reduction in the progression of mild cognitive impairment compared to a control group, suggesting the potential for population-level dementia prevention.

Despite this compelling evidence, the medical system's siloed approach persists. This is partly due to an "ancient prejudice" dating back to ancient Rome, where physicians disparaged physical training, fostering a cultural divide between intellectual and physical pursuits. This has led to a lack of focus on exercise in medical education, policy, and reimbursement structures, unlike the robust pharmaceutical industry. The consequences are significant: a widening health gap between those with resources and education who are healthier, and those without who are increasingly sicker. Addressing this requires a systemic shift, including integrating exercise science into medical curricula, incentivizing strength training knowledge through board exams, and establishing Medicare reimbursements for exercise physiologists to provide home-based treatment, particularly for vulnerable populations like those on dialysis who suffer from muscle wasting.

The profound impact of strength training on identity and self-efficacy is exemplified by figures like Jan Todd, a pioneer in women's strength training. Her journey highlights how gaining physical strength can fundamentally alter one's perception of capability, translating into greater confidence and agency in all aspects of life. This concept of self-efficacy, the belief in one's ability to succeed in specific situations, is crucial for navigating life's challenges. Similarly, the story of Helene Friedlich, a Holocaust survivor who regained mobility through strength training in her 90s, underscores that it is "never too late" to improve one's physical capacity and quality of life. This is further supported by studies on 90-year-olds demonstrating significant gains in strength, walking speed, and spontaneous activity, revealing that growth and improvement are possible even in advanced age.

The future of medicine, as envisioned by centers like the Center for Strong Medicine in Australia, integrates exercise as a core treatment for chronic diseases. These clinics combine comprehensive strength evaluations with personalized, progressive weight training programs, normalizing exercise for older adults and demonstrating its efficacy as medicine. This model, which prioritizes accessibility, safety, and support, offers a powerful blueprint for how healthcare can evolve. Ultimately, strength training builds more than physical strength; it enhances aerobic fitness and balance, providing a foundational approach to aging well and mitigating the risks of chronic diseases. By embracing strength training, individuals can actively participate in their health journey, fostering a sense of empowerment and unlocking greater potential throughout their lives.

Action Items

  • Audit medical system's approach: Identify 3-5 systemic barriers preventing exercise prescription as primary treatment for chronic diseases (ref: Hippocratic imperative).
  • Create patient education module: Develop 3-5 key talking points on strength training's impact on cancer, diabetes, and Alzheimer's risk (ref: Maria Fetteroni Singh's research).
  • Design pilot program: Implement strength training for 10-15 seniors in a local community center, measuring improvements in functional capacity (ref: Hebrew Rehab study).
  • Draft policy proposal: Outline 3-5 recommendations for Medicare reimbursement of in-home exercise physiologists for chronic disease patients (ref: Public policy discussion).
  • Evaluate personal health plan: Integrate progressive resistance training into weekly routine, focusing on long-term functional capacity and injury prevention (ref: Charles Stoking's multi-temporal training).

Related Episodes

Key Quotes

"Heart disease, type two diabetes, cancer, Alzheimer's disease--these are all urgently tied to muscle mass and strength."

Michael Gross argues that the leading causes of death and disability are directly linked to a lack of muscle mass. This highlights the critical, often overlooked, role of muscle in preventing and managing chronic illnesses. Gross emphasizes that muscle is not just for physical appearance but is fundamental to overall health and longevity.

"Maria Fetteroni Singh actually argues that it is a Hippocratic imperative for doctors to give patients access to resistance training as a treatment for their disease."

Gross explains Maria Fetteroni Singh's assertion that doctors have a moral obligation, akin to the Hippocratic Oath, to prescribe resistance training. This suggests a fundamental shift is needed in medical practice, where exercise is recognized and utilized as a primary treatment modality, not just a supplementary recommendation. Singh believes withholding this could be considered doing harm.

"Muscle mass is the biggest sink for the disposal of glucose in the human body. That's why people talk about muscle as a metabolic organ."

Michael Gross explains that muscle plays a crucial role in regulating blood sugar levels. He highlights that muscle's function as a "sink" for glucose disposal makes it a vital metabolic organ, underscoring its importance in managing conditions like type two diabetes. This points to the direct impact of muscle mass on metabolic health.

"High intensity weight training, progressive resistance training actually causes an increase in the size of the brain's posterior cingulate cortex, which is the part of the brain that's the seat of empathy and emotional memory. It's the first part of the brain to atrophy in Alzheimer's patients."

Gross presents research indicating a direct link between strength training and brain health, specifically mentioning the posterior cingulate cortex. This area, crucial for empathy and memory, is shown to grow with intense training, while it is one of the first to decline in Alzheimer's patients. This suggests resistance training may offer a powerful intervention for cognitive decline.

"Strength being our ability to act upon the world. It's probably the oldest definition of strength that I found in all my years of research on this book. That really is how ancient Greeks understood human identity."

Michael Gross shares that the ancient Greek understanding of strength was not merely physical power, but the capacity to act effectively in the world. He connects this to identity, suggesting that this definition of strength, focused on agency and capability, was central to how ancient Greeks perceived themselves. This perspective reframes strength training as foundational to self-perception and life engagement.

"The ancient prejudice expresses itself in very pointed ways in education in policy and economics. You know, there's no real entity to make money off exercise as a treatment for chronic disease the same way we have the pharmaceutical industry to make money from making pills."

Gross identifies systemic barriers to integrating exercise as medicine, particularly the lack of a profitable industry around exercise prescriptions. He contrasts this with the pharmaceutical industry, suggesting that economic incentives play a significant role in why exercise is not as widely adopted as a treatment. This points to a need for new economic models to support exercise-based healthcare.

"Strength builds more than strength. Strength training is the only form of exercise that increases all the capacities that we need as we get older: strength, aerobic fitness, and balance."

Michael Gross argues that strength training offers a unique, comprehensive benefit for aging. He asserts it is the only exercise form that simultaneously enhances strength, aerobic fitness, and balance, all critical for maintaining function and independence in older age. This positions strength training as a foundational element for healthy aging, surpassing other forms of exercise in its holistic benefits.

"Maria Fetteroni Singh screened them and found a group of nine who were game to try this crazy idea that older people might be able to lift weights that were heavy for them to lift... these people showed up for three sessions a week... they gained strength an average of about 160%."

Gross recounts a groundbreaking study where elderly individuals, previously believed incapable of significant strength gains, participated in high-intensity weight training. He details their remarkable average strength increase of 160%, challenging the long-held medical belief that older adults could not build muscle or strength. This demonstrates the profound potential for improvement even in the most frail populations.

Resources

External Resources

Books

  • "Starstruck: When A Fan Gets Close to Fame" by Michael Gross - Mentioned as a previous work by the author.
  • "Stronger: The Untold Story of Muscle in Our Lives" by Michael Gross - Mentioned as the author's primary work discussed in the episode, exploring the role of muscle in health and history.

Articles & Papers

  • "The Hidden Common Link Between Heart Disease, Diabetes, Cancer and Alzheimer’s with Michael Gross" (Dhru Purohit Show) - The title of the podcast episode featuring Michael Gross.
  • "Smart trial" (Maria Fetteroni Singh) - Mentioned in relation to research showing progressive resistance training's impact on cognitive function.
  • "nature medicine" (Publication) - Mentioned as the source for a publication detailing an internet-based lifestyle intervention program that reduced mild cognitive impairment progression.

People

  • Michael Gross - Author of "Stronger: The Untold Story of Muscle in Our Lives," guest on the podcast discussing muscle and strength training.
  • Dhru Purohit - Host of the Dhru Purohit Show, interviewing Michael Gross.
  • Maria Fetteroni Singh - Professor at the University of Sydney Medical School, researcher on strength training and chronic disease.
  • Jan Todd - Pioneer of women's strength training and historian of strength, faculty at the University of Texas at Austin.
  • Charles Stocking - Classical scholar and professor of kinesiology, specializing in ancient Greek literature and athletics.
  • Jenny McGonigal - Past podcast guest, author, and advocate for strength training, who reversed osteopenia.
  • Herschel - Older sister of Dhru Purohit, who supported their mother's strength training journey.
  • Neil - Husband of Herschel, who supported Dhru Purohit's mother's strength training journey.
  • Helene Friedlich - Wheelchair-bound Holocaust survivor who participated in strength training studies.

Organizations & Institutions

  • Dhru Purohit Show - Podcast where the interview with Michael Gross took place.
  • Vanity Fair - Magazine where Michael Gross worked as a contributing editor.
  • University of Sydney - Institution where Maria Fetteroni Singh is a professor.
  • University of Texas at Austin - Institution where Jan Todd and Charles Stocking are faculty.
  • International Olympic Committee - Organization that runs the International Olympic Academy.
  • International Olympic Academy - Facility near ancient Olympia where Charles Stocking organizes a symposium.
  • Charline Neurology - Clinic where a neurologist integrates strength training into neurological treatment.
  • Hebrew Rehabilitation Center for Aged (Hebrew Rehab) - Boston area nursing home where early strength training studies for the elderly were conducted.
  • Tufts Medical School - Institution where Maria Fetteroni Singh held a dual appointment.
  • Harvard Medical School - Institution where Maria Fetteroni Singh held a dual appointment.

Websites & Online Resources

  • Instagram (Michael Gross) - Social media platform to follow Michael Gross.
  • Website (Michael Gross) - Online resource for more information about Michael Gross.
  • drinkLMNT.com/dhru - Website for LMNT electrolyte mix, offering a free sample pack.
  • cozyearth.com/dhru - Website for Cozy Earth products, offering a discount with code DHRUP.
  • fatty15.com/dhru - Website for Fatty15, offering a discount on their Starter Kit with code DHRU.
  • mauinuivenison.com/DHRU - Website for Maui Nui Venison, offering holiday gift sets.
  • Amazon - Retail platform where Michael Gross's book is available.
  • dhruporohit.com - Website for Dhru Purohit, including a link to his newsletter.

Other Resources

  • Muscle mass - Discussed as a critical factor in preventing chronic diseases and improving overall health.
  • Strength training - Presented as a vital component of healthcare, impacting chronic disease risk, cognitive health, and identity.
  • Glucose disposal - Explained as a primary function of muscle mass, making it a metabolic organ.
  • Cancer cachexia - Mentioned as the loss of muscle mass accompanying cancer, increasing risk of infection and weakness.
  • Self-efficacy - Discussed as the confidence in one's ability to perform tasks, which is enhanced by strength training.
  • Osteopenia - Condition of early bone loss, which can be reversed or managed with strength training.
  • Osteoporosis - Condition of severe bone loss, which can be prevented by building bone density through strength training in youth.
  • Ancient Greek definitions of strength - Explored as a paradox of both divine gifts and human effort, emphasizing interdependence.
  • Co-care - A model where patients actively participate in their treatment structure and provide feedback.
  • Progressive resistance training - A method of strength training that gradually increases weight or intensity.
  • Mediterranean diet - Part of a lifestyle intervention program that showed benefits for mild cognitive impairment.
  • Internet-based multi-component lifestyle intervention program - A program involving diet and exercise that reduced the progression of mild cognitive impairment.
  • Medicare reimbursements - Discussed as a potential policy change to cover exercise physiologists for home treatment.
  • GLP-1s - Medications mentioned as potentially supporting health journeys when used correctly.
  • EMDR - Eye Movement Desensitization and Reprocessing, a therapy that involves bilateral movements, similar to some aspects of walking.
  • Vo2 max - A measure of the maximum amount of oxygen an individual can utilize during intense exercise, which can be improved by strength training.
  • One repetition maximum (1 RM) - The maximum amount of weight that can be lifted one time with perfect form.
  • Ensure - A nutritional supplement used in studies with older adults to improve strength gains.
  • Isometrics - Exercises where muscles contract but do not move, used as a starting point for individuals with limited mobility.
  • Stadion - The single event that started the ancient Olympic Games, a 200-meter race.
  • Living in the past, present, and future - A concept of training that considers historical achievements, current capabilities, and future goals.

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