Active Voice: Get Stronger to Stay Independent Longer

Active Voice is a column by ACSM experts in science, medicine, and allied health. The viewpoints expressed do not necessarily reflect positions or policies of ACSM.

Teresa Merrick, Ph.D., is an ACSM Certified Health Fitness Specialist as well as a Masters Powerlifter and highland games competitor in the Omaha, Nebraska area. Her research focus includes promoting strength exercise, both in healthy adults and in those with special medical conditions, through education of both physicians and the adults themselves.

When Dr. Walter Bortz II, eminent geriatric expert and author of “Dare to Be 100”, first appeared at ACSM’s Health and Fitness Summit in 2002, he said something that galvanized my thinking: The biggest predictor of whether you’ll end up in a nursing home is not the strength of your heart; it’s the strength of your legs.

The reason should be obvious to exercise professionals: your legs can make your heart stronger, but your heart can never make your legs stronger.

Strength training is truly the “fountain of youth” for adults over 40. Stronger muscles from strength exercise make movement of all kinds more inviting by raising the bar of capability. Instead of daily activities such as carrying groceries, walking from parking lots and up stairs, or getting out of chairs and cars being near-maximal efforts, they become less fatiguing and more do-able.

Sarcopenia (loss of muscle tissue) as people get older is increasingly recognized more as the result of “use it or lose it” rather than an inevitable consequence of aging alone. Strength exercise is the key to maintaining and even increasing muscle tissue and strength. It stimulates muscle tissue that typical steady-state aerobic exercise doesn’t begin to tap into, especially the Type II fiber that uses glucose almost exclusively for energy. Does anyone recognize the mechanism for the better long-term glucose control seen with strength exercise in persons with type 2 diabetes? Strength exercise lessens the oxygen demand of the heart at submaximal workloads, promotes bone health, increases flexibility and joint mobility, and helps prevent falls. For me, seeing people of all ages get stronger, even those with several comorbidities, is evidence that age and chronic illnesses aren’t barriers to strength training. As a fitness professional who has worked with more than 900 clients in the community over the last 12 years, I haven’t identified a single chronic medical condition that can’t benefit—directly or indirectly—from properly applied strength exercise.

So far, however, emphasis continues on aerobic exercise despite strength training having been specifically part of ACSM’s guidelines since 1990. The present Physical Activity Guidelines for Americans mirror the current ACSM recommendations of performing strength exercise for the entire body at least twice weekly. Although we’re trying to increase doctors’ discussions of exercise with patients (still woefully infrequent), most quick screenings and assessment tools focus only on aerobic exercise and don’t ask about strength training. Since physicians aren’t trained as exercise professionals, it’s certainly easier for them to tell patients to start walking or do some other moderate aerobic activity.

Also, doctors sometimes perpetuate myths about strength training. One female client was told by both an orthopedic specialist and her primary care provider that she might want to avoid lifting heavy weights so she wouldn’t get bulky muscles. Others have said their doctors told them not to perform squats, which begged me to question whether the physician had told them to never sit in a chair again.

Physicians, both primary care and specialty, need to know the strength exercise guidelines. With Exercise is MedicineTM, they need to assess patients’ participation in strength training as a “vital sign”; if they aren’t meeting the guidelines, advise them accordingly to perform strength exercise. To get them started on a safe and successful strength exercise program, the doctors should then refer patients to an exercise professional. And lastly, doctors should follow up on strength training at any visit as ongoing monitoring of this vital sign.

Adults over 40, regardless of their existing medical conditions, stand to benefit from strength training across a wide range of loads, repetitions, and carrying patterns. When delivered by exercise professionals, such training is much more relevant to real-life strength demands for lifting and carrying. Strength exercise is as powerful as aerobic exercise in promoting health and functional fitness in all adults.