Should You Add Resistance Training to Your Exercise Regimen?

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey, everyone. Today I spoke with Sal Di Stefano from Mind Pump regarding his new book – ‘The Resistance Training Revolution’ and he makes a cogent case for the importance of resistance training. Some of the benefits here are obvious, which would be longevity, functionality and bone/mineral density. One other thing I just want to flag before the episode in full – Sal put together three different resistance training programs in the book that can all be done at home with minimal or no equipment. This is especially for someone who is newer to this conversation and thinking about, “Okay, I’m doing some walking and maybe some cardio. I’d like to get some resistance training in. Where do I start?” This can give you a good on-ramp before that. We will now go to the interview with Sal Di Stefano from Mind Pump.

DrMR:

Hey, everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio with my good friend Sal Di Stefano, and he has written a book. So not only is he handsome, but he’s also intelligent. I have to say – You’re one of the most in shape people that I know. Every time I come here, you guys look good… you look better. I think that is important for our audience to understand because some people only masquerade as being healthy, but you’re definitely living the principles. So, I just want to acknowledge that. Tell people a little about the book that you wrote and what the motivations were behind it. What’s the high level? We can then drill down into the details. By the way, I think you have the most popular fitness podcast?

SalDiStefano:

We’ve been pinned at the top now for a little while.

DrMR:

So, some clout there, for sure.

SDS:

It’s been a lot of fun. First off, I appreciate your intro. That’s very nice. I got into fitness for a lot of the same reasons I think a lot of people do. It tends to be based on some insecurity, right? You want to change your body… you don’t like the way you look… Personally, I’ve been doing it for almost 30 years. I started out really young and I’ve been doing it professionally – where I’m actually training people or managing other trainers or gyms. I’ve been doing that for over 20 years. When you pursue it long enough, it’s really about personal growth in many different ways. Either you stop and you don’t do it anymore… or it starts to become healthier and healthier for you.

SDS:

I feel like I’m now at that stage. Of course, we have this podcast, we talk about it all the time and that also helps you self-reflect on yourself. The book is called ‘The Resistance Training Revolution.’ This has been something that I’ve wanted to write about for the last few years. We got approached by a publisher who noticed our podcast and said, “Hey, do you guys have any ideas for any books?” I said, “Well, absolutely. This is something I’ve been wanting to write for a long time. I think it’s really important.” There was a book that inspired me years ago called ‘The Complete Book of Running.’ It’s been around for a long time and it started the running revolution in the 70’s and 80’s.

DrMR:

Pretty iconic.

SDS:

Anybody who worked out over the last four decades probably had that book in their bookshelf and it did start the running revolution. A lot of people don’t realize this, but decades ago, people didn’t just go outside to run to work out. All of a sudden it became this thing. I thought to myself, “We need to have a resistance training revolution.”

SDS:

Luckily today, we’re seeing a lot more data. Mainstream medicine is starting to really acknowledge the benefits and effects of resistance training on health. Now, as a coach and trainer, I got really good at getting people to be consistent with exercise forever, which took me a long time to figure out. This is a very hard problem. It’s really easy to say that everybody should work out all the time, but the reality is our lives are not structured around activity. We have to schedule it and plan it. We probably didn’t do it for much of our life and making big, fundamental changes in your life and making them so that they stick forever, that’s a really tough thing to do.

SDS:

You know this better than anybody.

DrMR:

Absolutely.

SDS:

You work with people all the time on this kind of stuff. In my experience, the most that we could ever hope for the average person – I’m not talking about the fitness fanatic or somebody who is really into health or a professional like yourself, but just my aunt or your neighbor or the person down the street – is consistently about 2 or 3 days a week.

DrMR:

That seems reasonable.

SDS:

Again, that’s the most we can hope for. We could also maybe get them to do one form of exercise consistently. I know a lot of times people in our space will say, “To optimize your health, you’ve got to do all these 50 million different things and a perfect workout. You’re going to do some component of resistance training, cardio, some kind of mobility, flexibility and meditation…” The reality is most people will pick just one thing.

SDS:

It’s important to pick the one thing that is most impactful – the thing that’s going to give people the most bang for their buck.

DrMR:

Absolutely. Love it.

The Case Against Cardio

SDS:

If we look at modern Western societies, the big problem – the big health issue, the umbrella, the one thing that kind of connects to everything else – is obesity. We have this obesity epidemic that we’ve been aware of now for the past few decades. It contributes to everything from cancer to heart disease to dementia and Alzheimer’s. It contributes to those things and chronic health issues in general. We just have lots of chronic health issues and the form of exercise that we tend to get recommended by mainstream health and medical advice is actually the worst form of exercise to solve those things. The form of exercise they tend to recommend – as they have for decades – is cardio.

SDS:

What do they tell people? “Do 30 to 60 minutes of vigorous cardiovascular activity. This is the form of exercise that you should do to solve these chronic health issues.” Unfortunately, it’s a very ineffective form of exercise to solve those things. I’m not saying there isn’t any benefit and I do want to be clear that any form of activity applied appropriately is better than nothing. Yes, you’ll get some benefit. However, in comparison to resistance training – other words for it will be strength training, lifting weights, using machines, resistance bands, body weight – it pales. Resistance training is just far superior, pretty much on every metric you can measure in terms of health. We didn’t have a lot of data supporting this for a long time because they just didn’t study it. There were really no studies on resistance training and heart disease.

DrMR:

It kind of parallels the low-fat movement where a lot of the research initially was on low-fat dieting. So, it was assumed low-fat dieting was the best. It’s just what had the luxury of being the most studied.

Functional Flexibility

SDS:

Totally. There were no studies, except for exercise performance or strength – that kind of stuff. You just didn’t see any studies. Now we have studies coming out showing just how effective it is. It’s superior to other forms of exercise, especially in that context that I painted earlier. So, if you don’t mind, I’d like to dig a little deeper.

DrMR:

Yes. Just one or two things I’ll throw out there as fodder. One of the things I’m concerned about in aging populations is function and bone density. Those are obvious. You’re not going to see nearly the benefit – really, if any – if you’re not actually loading for bone density and for function. Also, one of the things that I really learned in having Mike Nelson do my programming, is that a good balanced resistance training program negated my need to stretch. It kept me really well-balanced. What I thought was tight hip flexors, tight groin and tight hamstrings was a weak posterior chain. Once they balanced that out, it was like, “Hmm, there goes my 15 minute stretching routine.” So, I do agree with you that this seems to be the most bang for the buck.

SDS:

Since you brought them up, let’s touch on those first. I’ll then get into the false paradigm that we’ve been sold and the solution. So let’s talk about what you’re talking about – flexibility. When we’re talking about flexibility, the best form of flexibility that you want is what’s known as functional flexibility. So, you can have range of motion. I have a 10 month old son at home. He’s got incredible range of motion. I can take his legs and put them by his head and bend them all over the place, but he’s got terrible stability and control. If I put 5 pounds. on him, he would fall and hurt himself, right? So, range of motion is not what you’re looking for. Now, it contributes and it’s a piece of functional flexibility, but what we want is range of motion that we own and control.

SDS:

In fact, lots of range of motion minus strength is terrible instability. It’s actually one of the worst. It’s actually worse than being tight. When you’re super lax and loose without strength, injuries are actually quite common. Now, it’s more rare than tightness, which is why we tend to go after tightness, but it is a problem. What we want is a larger range of motion that we own. You should do appropriate resistance training – meaning appropriate for your body/your movement. I’m doing squats, overhead presses, rows; rotating and doing split stance exercises. What I’m doing is I’m working on this range of motion that I’m going to use in everyday life, but I’m also strengthening that range of motion.

DrMR:

A beautiful, functional carry over there.

SDS:

Totally. So, it’s the difference between being able to get in a squat – which I can totally get my 10 month old son to do – and being able to get into squat with load… or get out of that position… or twist in that position… or move out of that position very quickly. There are actually studies that support this now. We never saw this before, but now studies are showing that resistance training is as good or superior to stretching for a range of motion, functional flexibility and reduction of pain. All of the above. I knew this as a trainer. When I trained clients, I could stretch clients out and I would sometimes get temporary relief. However, when I got them to do strength training and I got the ranges of motion to improve with the strength training, their pain was gone and they just felt much better.

DrMR:

One quick data point – I did come across a study. This was probably about a year ago, but it was that exact set up – a custom, tailored, therapeutic plan vs. a core resistance training program showed equivalent, or maybe even better results, for the resistance training. By this I mean, having someone give you this foam roll/stretch/etc. as compared to a good core program showed equivalent or better results.

SDS:

Absolutely. Let’s say right now you’re listening to this and you want to test this out. Get yourself in a hamstring stretch where you hold the stretch for 30 seconds to a minute. You’ll notice immediate increase in your range of motion. At first, maybe you can’t touch your toes, but if you hold the stretch, now you can go 3 inches further and boom – automatic increased range of motion. You didn’t make the muscle any longer. What you did is you told the central nervous system that it’s okay for it to relax a little bit and give you this increased range of motion. Let’s compare that to a hamstring exercise that loads the stretch. Let’s say I’m doing a single leg toe touch or a Romanian deadlift, which is a little bit more advanced. I’m still stretching in that position. I’m still getting my central nervous system to increase the range of motion. You’ll notice this when you do a Romanian deadlift. You’ll notice with each rep, you can go a little deeper with the same form, but what’s happening is I’m strengthening that range of motion, as well. So, I’m not just giving myself more range of motion, I’m making it stronger.

Bone Density

SDS:

All right, let’s go back to bone density that you were talking about. Your bones are – in this particular sense – very similar to muscle. I’ll give you an example. Most studies show that a relatively high protein diet will build more muscle than one that’s low protein. Of course, there are individual variances, but generally speaking, higher protein builds more muscle. Does that mean I could take somebody who’s completely sedentary and just have them increase their protein intake and that they’re going to build muscle? No. They’re not going to build muscle. It’s the same thing as taking someone whose bone density is dropping and giving them more calcium – which they used to do. “Here’s more calcium here. Your bones are going to build.” No, they’re not.

SDS:

In fact, that’s what they used to recommend. What they found was it actually started increasing calcium deposits in the arteries. Why is it that giving someone more protein – who is not doing anything – doesn’t build muscle? Why doesn’t just giving someone more calcium not increase their bone density? It’s because your body is not getting any signal to do so. Your body is not going to add new tissue that it needs to support unless it thinks it needs to. So, step one to improving bone density is to give your body a reason to think it needs to have stronger bones. Resistance training – hands down – nothing builds bone density like it.

SDS:

Even when they show running or walking to improve bone density, you see minor improvements only in the lower extremities. Sometimes you actually see a decrease in the upper extremities. With resistance training – across the board – you see these improvements in bone density. Lifting weights, using bands, etc. tells your muscles to get stronger. The muscles anchor at bone and send signals to the bone to get stronger. During the back half of my career as a trainer, I worked with lots of people of advanced age. I used to have a studio next to a hospital and I started training some doctors. Then, they would send me their patients and they would monitor their bone density. They would always come back and literally say, “I’ve never seen people improve their bone density as quickly as these people who are working with you.” I’d say, “Well, all they’re doing is lifting weights and it’s telling their body to build.” I wanted to cover those because you brought those up.

The False Paradigm

SDS:

All right – let’s go back to this false paradigm that we’ve been sold for so long and why it’s so terrible. Here’s the old paradigm that we’ve been communicated to in terms of obesity and all those umbrella connected chronic health issues – Okay, we’re obese. How do we fix this? Well, what we need to do is we need to take in less calories than we burn… or to put differently, burn more calories than we take in. This this is true. Of course, it’s more complex than this and how you do it makes a big difference. At the end of the day, if you’re not taking in less calories than you’re burning, you’re not going to burn.

DrMR:

It’s a high level heuristic that gets you to the ballpark, but it doesn’t necessarily navigate you to the seed that you’re trying to get to.

SDS:

Right. However, at the end of the day, if the calories are higher than you’re burning, you’re going to gain weight. They have to be lower than you’re burning. So, this is part is true, but here’s the problem with that. Let’s forget the food part. We could get real crazy with that. I’m sure you already have on your podcast a million times. Let’s focus on the exercise part. They said, “Okay, burn more calories.” Now what they’ve done is they’ve looked at all the forms of exercise and they’ve placed value on one thing. In fact, they’ve placed the most value on one thing- “How many calories is this burn per hour being done?” Here’s the crazy thing about this. That is actually the least important factor of exercise. That’s the thing you should pay attention to the least.

SDS:

It means almost nothing. Here’s why – because exercise doesn’t just burn calories. Exercise tells your body to adapt in a particular way. It is those adaptations that we need to pay attention to. Those are the things that make the biggest impact.

SDS:

I’ll highlight a study here to illustrate what I’m talking about. They’ve done subsequent studies on other populations, but this one really blew the lid off the whole thing. They studied a modern hunter-gatherer tribe known as the Hadza tribe in Northern Tanzania. It’s a very famous study where scientists went down and through some sophisticated testing, looked at how many calories they burned every single day. These are hunter-gatherers. For all intents and purposes, they’re way more active than the average Western couch potato. They don’t have electronics… they’re not at desks… they’re moving all the time. The way they get food is they either gather and look for roots, seeds, nuts and fruit or they hunt. The way they hunt is probably the way that humans hunted thousands of years ago. You take a spear, you throw it at an animal, you wound it and then you run after it until it gets exhausted and dies. So, it’s lots of activity. These scientists speculated that these tribal people had to be burning a tremendous amount of calories. They’re just active all the time. Here’s what they found. These Hadza tribal people burnt roughly the same amount of calories as the average Western couch potato. At first you think, “How is that possible? They’re moving so much.” Let’s think about evolution for a second. It makes zero sense that a hunter-gatherer would burn 7,000 calories a day when 7,000 calories is almost impossible to come by on a regular basis. Their bodies adapted to the form of activity that they did most, which is very closely related to cardio. Their bodies adapted that and learned how to slow down and become more efficient with calories. Their metabolism essentially slowed down so they could burn less calories.

SDS:

So, now let’s go back to that paradigm. They said, “Oh, let’s look at exercise. Let’s value the one that burns the most calories since we need to increase that calorie outside of the formula.” Cardio – everybody should do cardio. Now, it is true that one hour of cardio will burn more calories than one hour of resistance training, yoga, Pilates or pretty much any other form of exercise. The problem is that cardio literally teaches your body to become more efficient with calories – steady state cardio, in particular (i.e. long distance running, cycling, swimming, etc.)

SDS:

When you’re doing that, what you’re telling your body is, “Okay, we need energy to perform this particular activity. We don’t need much strength.” In fact, long distance running needs very little strength. For example, if you’ve ever seen a long distance runner, they have very little muscle on their body. So, we don’t need much strength. So, what does your body do to make itself better at this form of exercise? Remember, when you’re doing any form of exercise consistently, the reason why you get better at it is your body adapts to that form of exercise. What your body is effectively doing is it’s slowing down its metabolism. One of the primary ways it does this is that it reduces muscle mass. It’s not the only way, by the way. The metabolism is actually quite complex and there’s this range of calories your body will burn with the same amount of lean body mass you have. This is why the “one pound of muscle = this much calories” math never really works out. There’s this range and your body can become more or less efficient within that range. Cardio training really sends a very strong “get more efficient with calories” signal. So, what happens? The studies actually show this quite clearly. You lose weight – roughly 1/2 of it tends to be muscle. So, you lose 10 pounds, but 5 pounds of it was muscle. Now you’re a smaller – roughly same body fat percentage – version of yourself. You’re smaller… same flabbiness… slower metabolism. So, here’s what happens. Somebody follows this advice. Doctor said, “Cut my calories and do cardio. I’m going to do that. Ooh, I lost 10 pounds in a month. I think this is working.” Boom – hard plateau. Why did they plateau? Their metabolism slowed down to match the amount of calories they were bringing in, even though they’re doing more activity.

SDS:

So now what do they do? They increase their activity even more… cut their calories even more… lost another 5 pounds. Boom – plateaued again. It’s not hard to see how unsustainable this is. At the end of that road, you might have lost 20 pounds, but you’re eating way less than you did before. You’re doing way more activity than you did before. Again, we need to consider the context of modern life. We are surrounded by hyper-palatable, easily accessible food. In fact, today it is beneficial to have a metabolism that burns lots of calories, whereas 10,000 years ago, it was probably the opposite. One of the best buffers you can have to a modern lifestyle is a metabolism that burns lots of calories. That’s the opposite of what you’re doing with the old recommendation.

SDS:

Now, replace that with resistance training. It is true that resistance training doesn’t burn as many calories per time being spent, but the primary adaptation that you’re triggering in your body is strength and muscle. Over time, this speeds up your metabolism. You burn more calories. In fact, two to three days a week of resistance training – you can go a long way with that with somebody in terms of strength, muscle and metabolism boosting. As a trainer, it was not uncommon for me to see people lose 20 pounds of body fat over the course of 6 months to a year by incorporating resistance training and end up with higher calories at the end of that process. They lost 20 pounds, but now I’m eating more than I started with. This is a great place to be.

SDS:

I would love to ask your opinion on this. From the studies that I’ve seen with nutrition, we know there are certain sugars, oils or fats that might not necessarily be as healthy, but in the context of a low-calorie diet, a lot of the damage from those things gets erased. Not all of it, but you see quite a bit of it. For example, there have been studies where people have eaten generally crappy diets, but because the calories are low and they lost weight, you see improvements with blood lipids and stuff like that. Right?

DrMR:

Yep.

SDS:

So, this makes a huge difference. The book is centered around resistance training, why it’s been stigmatized, why it’s so effective and why (especially when you consider the context of modern life) this is the form of exercise that everybody should be going after or being pushed into. It’s by far the most effective.

DrMR:

One thing that comes up for women when they hear resistance training – and I think this is a bit of a canard, definitely – is that they’re going to bulk up. I think most people have probably heard a counter argument against that, but for the women who might be listening and thinking “Well, I don’t want to gain all this muscle.” Speak to that point.

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Women & Resistance Training

SDS:

Absolutely. So, if you’re a female and you’re listening to this right now, and I could magically get your body to lose 10 pounds of body fat, but also gain 10 pounds of muscle, your scale would read the same. You would be much smaller. So, that’s number one. Muscle is very dense in comparison to body fat. I think it takes up 2/3 of the space that that fat will. If you lost body fat and gained muscle, even if the scale stayed the same, or even if it went up a little bit, you tend to be smaller. So that’s number one. Number two – building muscle is not easy, or at least building the kind of muscle that makes you look bulky, is not easy at all, especially for a woman. Now, the problem is that when we look at social media and we look at female bodybuilders and power lifters, we’re looking at the extreme genetic anomalies of people that can build tremendous amounts of muscle. Oftentimes, they’re taking anabolic steroids to look the way they do.

DrMR:

They’re trying to gain as much muscle as possible.

SDS:

Right. I’ll give this example to illustrate it. Let’s look at another scale of genetics. Let’s look at height. I’ll ask you, Mike. Aside from going to an NBA game or watching the NBA on TV… In real life, how many times have you seen someone who is over 7 feet tall.

DrMR:

Very rarely.

SDS:

I bet you remember the one or two times because it’s so rare, right? The genetics to build incredible, ridiculous amounts of muscle mass – to where you look at a woman and you say, “Oh my gosh, she looks like a man.” That’s actually more rare than the genetics you need to have to be 7 feet tall. You could lift weights like a bodybuilder your entire life and what you’ll probably accomplish is a very tight, sculpted physique.

The Weakness Epidemic

DrMR:

I’m glad you say tight because this is something that I was just remarking on to a friend of mine the other day. Sorry to the younger generations on this, but I feel like I’m seeing more skinny-fat people than I ever have before my life. You’re not not large, but your arms are kind of flabby and your stomach has this pudge. I think a part of that reason is not only diet, but also that there’s just so little muscle.

SDS:

We’re in a weakness epidemic. There was a recent study they did where they tested grip strength with college males. The grip strength that they registered was equivalent to a 60 year old’s grip strength in the 1980’s.

DrMR:

No kidding. Wow.

SDS:

Just to show you the decrease, right? So, there are lots of tests you can do to test somebody’s health. It’s really hard to get off of one test. Believe it or not, one of the single best predictors/tests of all-cause mortality is a simple strength test – a grip strength test. Another one would be – “Can you get up off the floor without having to hold on to anything?”

DrMR:

These indicators of muscle mass and strength absolutely correlate with all-cause mortality. You could also make a counter argument – chicken or the egg – healthier people have more muscle mass. It seems to me that it’s reasonable to try to skew this by living and eating in such a way that maintains the muscle mass and maintains the strength.

SDS:

The interesting thing about muscle is it’s a tissue that your body will only be as strong as it thinks it needs to be – mainly because muscle is expensive. It’s an expensive tissue. Your body has no reason to give you more muscle and strength and waste precious resources supporting it if you sit at a desk all day, the heaviest thing you lift is your 3 year old and you’re not really doing much. Your body is going to reduce muscle mass. We are definitely in an epidemic of reduced muscle mass. That last study I told you about is one example, and they see this across the board.

DrMR:

It’s crazy example, too.

SDS:

There was another study and this one’s really cool. I believe it came out of Sydney, Australia. They were looking at resistance training and Alzheimer’s. They were looking at some of the things they can connect to progressing Alzheimer’s – like beta amyloid plaques and so forth. So far, resistance training was the only natural intervention they found that stops the progression of Alzheimer’s.

DrMR:

I was unaware of this.

SDS:

It’s the only so far and maybe later on they’ll find other things. They’ve looked at cardiovascular exercise, but nothing has really stopped the progression. Resistance training did this. Now, there are some theories around that. One of them is there’s almost nothing you can do that will impact your insulin sensitivity as effectively as adding a little bit of muscle. In fact, there are studies that show obese people not lose any weight at all, but just gain a little bit of muscle, and we see an improvement in insulin sensitivity. Muscle is very insulin-sensitive. Although a majority of the glycogen that you store is in your liver, muscles also store some glycogen. So, now you’ve improved your body’s ability to assimilate and store carbohydrates.

SDS:

Some researchers will refer to Alzheimer’s and dementia as Type 3 diabetes. Improving insulin sensitivity is probably one of the reasons why they saw such an improvement with resistance training. It’s an incredible way of improving that sensitivity.

Hormones & Resistance Training

SDS:

Speaking of hormones, this one’s really interesting. This is really a good selling point for why people should pick resistance training as a form of exercise. There is no form of exercise that has shown consistently a positive effect on hormones like resistance training. Now, generally speaking, improving your health will improve your hormone profile. So, with appropriate exercise and diet, you tend to see that. However, no form of exercise has consistently shown an improvement like resistance training. For example, in men, it quite reliably raises testosterone. It also increases androgen receptor density. These are the receptors that testosterone attaches to. This is actually even more important than testosterone levels. They just did a study where they were comparing men to see how much of an impact high testosterone has on the ability to build muscle and increased strength. They didn’t use people out of the ranges – it wasn’t like they took people with testosterone that needed to be medically treated. They took guys who were 400 and compared them to guys who were 1100 – the two ends of the spectrum. What they found was there was a little bit of a connection, but really the biggest connection was androgen receptor density. So, a man with a testosterone level at 500, but with lots of androgen receptor density (really dense receptors), built more muscle and strength than a guy at 1000 who had worse androgen receptor density. Resistance training up-regulates those receptors quite reliably.

SDS:

Resistance training improves growth hormone levels. If done properly, you’ll also see better cortisol levels. In women, you tend to see a balancing of estrogen and progesterone. My theory behind why we see such great hormone results from appropriately applied resistance training is because resistance training is pro-tissue. Other forms of exercise, not so much. If we go back to cardio, for example, it is not a pro-tissue form of exercise. If anything, it’s more anti-tissue. It’s telling your body to burn body fat, but also pare down muscle – in particular, that muscle part is something we should focus on. Resistance training tells your body to add muscle. That’s the primary adaptation. Think of the hormones related to those two actions, right? If I’m telling my body to build more muscle, it’s more likely to organize my hormones in a way that it’s going to make that happen.

DrMR:

All the things that you want… all the things that people go to see anti-aging doctors for… to have injections into them or put on as creams, right? Your androgens… your growth hormone – You’re going to get more of those as opposed to cortisol being a more catabolic and tissue destructive hormone.

SDS:

100%. If I’m telling my body to gain muscle and it’s a good signal and everything else looks good, my body is going to say, “Okay, in order to make this happen, we need to increase testosterone. We need to upregulate androgen receptor density.” In women, we need to balance estrogen and progesterone. By the way, testosterone plays a role with women, as well. If I’m telling my body to pare muscle down in order to make me more efficient at cardio, for example – What hormones are associated with reducing muscle mass? We have studies that show that cardiovascular activity in men oftentimes lowers testosterone. It doesn’t bring it down to dangerous levels, but oftentimes we’ll see a reduction because it’s hard to lose muscle when your testosterone is really high. Cortisol is an energy producing hormone, but it’s also a tissue destroying hormone. If you’re trying to pare down muscle, we’re probably going to elevate cortisol a little bit. When it comes to promoting a hormone profile that’s more – for lack of a better term – youthful, it’s by far the most superior form of exercise.

SDS:

In the book, I make this case. If you talk to the fitness savvy individual, they’re all on board, they understand – men and women. “Oh yeah. I need to do some resistance training. It’s very important.” However, if the average guy goes to the doctor and the doctor says, “Hey, John – You’re overweight. Your blood lipids are off. You need to lose some weight.” They don’t think, “I’m going to go lift weights.” They think, “Well, I’ve got to get on the stationary bike or lace up my running shoes.” In fact, I’ve talked to people like this. They come hire me and I’ll say, “Well, we need to do resistance training.” They’ll say, “Oh no, I don’t want to get big. I just want to get healthy.” The data now is completely supporting what we’ve observed as coaches and trainers for so long. The impact it has on your body is tremendous. Oftentimes, the stuff that we were told to do before – not only is it not nearly as effective – but, often puts us in a situation where it’s unsustainable. Actually, you start going on this backward pattern. When you lose muscle and stop doing whatever you were doing before to lose the weight, you gain weight back and the muscle doesn’t come back. So, now you’re in a position where you’re even worse off than before.

DrMR:

That’s a natural trajectory we follow as we age, which is your muscle mass tends to decrease as you age. This is something I always found really compelling. If the negative facet of aging is losing tissue, especially muscle tissue, why would you do a form of exercise that seems to predominantly exacerbate that decline? Why not do something – as you’re saying – that’s more anti-aging, muscle preserving and muscle building? You can maintain a healthier metabolism and healthier function.

SDS:

If I could snap my fingers and change one thing about everybody’s body that would give them the greatest impact on combating these modern chronic health issues, it would be to increase everybody’s metabolism by 50%. If you’re burning 3000 calories and you only need to work out a couple of days a week to get that to happen. You can burn calories manually, but that’s a losing battle. Or you could teach your body to burn more calories automatically. If you have a body that burns 3000 calories, that means you could eat up to 3000 calories every day and really not suffer all the effects of doing so. If you’re burning 2000 calories, now you’ve got to move that number down. As a trainer, I’ve seen people come to me – and this is more common than you think – where they were struggling with obesity for a long time and then they lost weight and gained it back. The way they lost it was calorie restriction – lots of cardio – calorie restriction – lots of cardio. Then they come see me. When I was a new trainer, I didn’t believe them. “How much are you eating? Let’s have you track your food.” Right? “Oh, I’m only eating 1700 calories.” I would look at them crooked, like, “Yeah, right. You’re 60 pounds overweight.” More times than I’d like to admit, clients were honest -their bodies had adapted to that. Now you’re eating 1700 calories and you’re 60 pounds overweight. That’s really tough – where do we go from there? I gotta cut your calories down 1000?

SDS:

So, with those clients, what I would do is exactly what I’m talking about. Over time, we would see these tremendous improvements. I had one lady that I trained and I’ve talked about her on the show as a great example. She was a bit of an extreme example because she was a bikini competitor. When bikini competitors get on stage, they extreme diet and get really lean. The way she did it was just tons and tons of activity and calorie restriction. So, she came to me. She was running every single day for an hour, she would lift weights two days a week and do Pilates. She was eating about 1,700 calories a day. She was relatively lean, but she wanted to get even leaner and she was frustrated. She was like, “What do I do? I just cut my calories down to 1,200. I can’t possibly work out anymore.” Through a process of slowly reducing her activity, focusing more on resistance training, increasing her calories over time, her body adapted in that direction. We got to the point where she was lifting weights four days a week and she was doing cardio one day a week. We got her calories up to 2,800 calories a day – over 1,000 calories more a day. When she got ready for a show, it was super easy because she’d cut from 2,800 calories vs. 1,700.

SDS:

Speaking of women – that’s probably the hardest demographic to communicate this to because of the belief that they’re going to look a particular way. When I used to manage gyms, I used to have this really effective sales technique that I would use – that would always get whatever woman I was talking to, to sign up, get training and work out at my gym. This is what would happen. I would get someone to come in – a middle-aged woman – and we’d do a tour of the gym and I would show her the cardio machines. “Oh, I like this. I like all your treadmills. These are great.”

SDS:

I’d show her the aerobics room. “Oh, I like classes. That looks like a lot of fun.” We’d then go to the machines and the free weights. “Oh, no, no, no. I’m not going to use these at all.” I would tell them the benefits but they’d say “No, no. I don’t want to. I just want to burn calories. I just want to sweat. I get really bulky. I don’t want to get any bigger.” Then, we’d come back to my office and I would say, “I’m going to call one of my female trainers in here. If you can guess her weight within 15 pounds, I’ll give you a free membership for two months. Do you want to take this challenge?” Of course they’d be like, “Absolutely. I’ll take that challenge.”

SDS:

I’d get on the intercom and I’d say. “Attention staff – so-and-so come to my office.” There was this female trainer I used to do this with all the time and in would walk my very sculpted 5’2″ trainer with great hamstrings and nice posture. She didn’t look like a bodybuilder, but she looked very sculpted and fit the way that a lot of women would say that looks really good. So she would walk in – tiny little thing – and I’d say, “Okay, how much do you think she weighs?” I had a scale in my office and they’d say, “Oh, she’s like 100 pounds or 90 pounds or 110 pounds. Then, I’d have her step on the scale. She was 135 pounds on the scale. They would always be blown away. I’d say she has little body fat, but she has a lot of muscle. Muscle takes up very little space. When you have it, it gives you curve, tightness and tone.

SDS:

The scale registers heavier because muscle is very dense. I’d say to my trainer, “Can you tell her what you ate yesterday?” “Oh yeah, absolutely. For breakfast, I had a four egg scramble with cheese, two slices of toast and a piece of avocado… for lunch, I had a burrito from wherever… for dinner…” They would be blown away by the amount of calories this little trainer would eat. I’d say, “You know, her metabolism is burning it all because she has that muscle. Wouldn’t you like to be in that position?” Every time they would be like, “Sold!” right there on the spot. I think we need more examples of that for women. Right now, the examples for resistance training are these extreme examples that aren’t going to happen to you if you start doing resistance training.

DrMR:

In the book, are you giving specific guidelines? How do people plug in? I know you have a lot of programming online, but what do the next couple of steps look like for – let’s say a woman – whose curiosity is piqued? How do I go forward from here?

The Resistance Training Revolution

SDS:

Yes. A big segment of the book is making the case – I’m showing studies supporting what I’m talking about. I’m telling lots of anecdotes and stories about my clients. The back half of the book, I do give exercises and routines. The routines in the book are geared towards people who are starting resistance training or who haven’t done it for a long time. If you’re advanced with resistance training, you’re probably buying this book for someone else. You’re probably getting this book for your mom or your dad or your cousin who doesn’t want to lift weights or do resistance training for whatever reason. If you’re buying this book for yourself, you’re probably someone who doesn’t have a lot of experience with resistance training and those are the routines I put in the book.

SDS:

I put three routines in there. I put a routine that requires just your body weight and bands – so you need no equipment at all or very minimal equipment. I put a routine that requires only dumbbells -so if all you have are a pair of dumbbells and a bench, then you’re set. The third routine I put in there is a full home gym, which includes the rack, barbell and dumbbell.

DrMR:

Very easy entry point.

DrMR:

I wanted to make it that way. One of the other myths about resistance training is that you need lots of expensive equipment to perform it…

DrMR:

… and a trainer… a bunch of sessions…

SDS:

One of the things I love about resistance training – among other forms of exercise – is the emphasis on a form and technique. Here’s why that’s important. Years ago, I had this epiphany as an early trainer. I was up in the hills in San Jose by where I live and I was going on a hike. By this point, I was a trainer for two or three years. As I’m walking, every once in a while a runner would pass me up. As a new trainer, it was hard for me not to notice biomechanics. This is what I was into. So, as people were running, I’d look at their movement patterns.

DrMR:

Yeah. I love watching someone’s gait. It’s great.

SDS:

Exactly – same thing. “Oh my gosh – look at those feet pronating… and oh, bad anterior pelvic tilt…” I would just notice all these people running by me are going to end up injured.

SDS:

Then, this guy runs by and it was like a gazelle. He ran by and it was beautiful and perfect. It dawned on me – evolutionarily speaking, humans do very few things very well in comparison to other animals. One of them is run. We can out trek pretty much most animals on earth. Now, this doesn’t mean you could just go start running. It’s a skill. We’ve lost that skill. Why do all these people run so terribly? It’s because they don’t practice running. They work out. So somebody who is 34 years old says “I’m going to start working out. Let me go run.” They don’t think to themselves, “I haven’t run since I was 10. I’m going to go practice running and perfect it.”

SDS:

They think, “I’m going to run until I get tired.” First off – your form and technique is bad. You don’t run well because you forgot the skill. Number two – when you’re fatigued, forget technique. Then it really goes out the window. When you’re fatigued, you’re going to go back to old established movement patterns, which were not very good to begin with. This is why running is one of the most injury-prone sports that you’ll see. With resistance training, there is more of an emphasis on technique and form, but I make this important point in the book – treat your exercise like practice. So you’re far better off going to the gym and thinking to yourself, “I’m going to get better at squatting. I’m going to get better at overhead pressing. I’m going to get better at rowing.” than you are going to the gym saying, “I’m going to make my legs tired and sore. I’m going to get my chest tired and sore. I’m going to get my back tired and sore.” These are two different mental approaches. One is practicing the skill over and over, getting good at it. The other one is “I just have to get real tired while I’m doing this” and form and technique go out the window, especially when you’re fatigued.

SDS:

I do talk about that a lot in the book. Approach your exercise like a skill, especially resistance training, and it’ll pay you far more dividends to do so – and not just in reduced risk of injury. A squat, for example, is a very basic, but extremely beneficial exercise. The benefits you can derive from a squat are tremendous if you do them well.

DrMR:

I just want to plant the seed for people. Maybe this sounds like one more thing to have to learn. “Can’t I just go run?” Yes, but there’s something to be said for learning new skills. That cognitive challenge opens up so much gain for you. Whereas, if you just keep running, you don’t get better at squatting, preventing back injuries and having better function. For example – my parents… I recently wanted to take them on a hike, but I was like, “I don’t think they can make it.” My dad is crushing it on the treadmill, but he’s not doing these other movements that make him more able to walk up a hill on unstable terrain. Love you dad.

SDS:

One of the beauties of resistance training is it is one of the most individualized forms of exercise that you’ll find. If you go to physical therapy because you’re injured – you got in a car accident, something terrible happened to you – the primary form of exercise you use is resistance training. Of course, it’s very regressed using bands, body weight or connecting to muscle patterns, but it is resistance training. I can train anybody with resistance. I don’t care what your issue is or movement pattern, we can do resistance. You can’t say this for other forms of exercise. So, that’s number one. I could adjust the resistance… I could bring it all the way down to no resistance… I can work within your range of motion. No matter how limited it is, we can do some form of strength building within that. That’s one of the most important aspects.

SDS:

Here’s the other one. The proprioceptive ability that you develop from proper resistance training trumps anything else. Proprioception is your awareness of your body in space. There are probably 10,000 resistance training exercises and probably 10 different ways to do each one. You’re going to move in every different plane of movement – the frontal, the sagittal, the transverse. Other forms of exercises tend to be very distinct in their movement patterns and they tend to be very repetitive. Riding a bike is riding a bike. Running is running. Walking is walking. Swimming has more movement patterns you can take from, but they still tend to be very similar. With resistance training, I can twist. I can press. I can row. I can squat. I can split my stance. I can go laterally. It’s almost infinite.

The Role of the Central Nervous System

SDS:

Here’s the important thing people need to realize. A lot of the benefit you get from exercise in general, isn’t just the physical muscle benefits. A lot of the adaptations that you get are for the central nervous system (CNS). The central nervous system is the control that tells the muscles how to move, where to move, how hard to contract and when to relax.

DrMR:

Key point.

SDS:

You’re training it as much or more than you’re training the muscles. Your central nervous system – just like your muscles – will only be as good as it needs to be. So, if you stop doing a particular movement or a movement pattern, you slowly begin to lose it. If you’re bedridden and in a coma for five years, and then you wake up, you don’t have to learn how to walk again just because you’re weak. You have to learn how to walk again because your central nervous system forgot.

DrMR:

What’s that stat? Isn’t it something like 30% of gains initially are nervous system adaptations?

SDS:

Absolutely. Think of it this way. Your central nervous system is like an amplifier and your muscles are like speakers. You can have big, expensive speakers, but if you have a crappy amplifier, there’s going to be no sound coming out of those speakers. So, you need to have a very effective amplifier. This is may not be applicable to the average person, but I still find it fascinating – Olympic lifters are some of the most well-trained strength athletes you will find in the world. The most study with resistance training in regards to performance has gone there. It had been in the Olympics for years during The Cold War. The Soviet Union and America used to compete so they spent lots of money on optimizing all that stuff.

SDS:

A lot of these Olympic lifters can be very muscular, but not compared to a bodybuilder or other strength athletes (which are far bigger) yet, they can generate tremendous amounts of force. What they find is they’re able to reach the max capacity of their CNS. They’ve trained their body to do so. You hear those stories like where a car is on fire and the mom has to get their kid out – all of a sudden, she summons the strength to move the car, injures herself in the process, but is able to save her child. It’s because of the CNS under those extreme states of duress.

SDS:

Your CNS is constantly limiting you. It tries not to let you do things that it thinks are going to injure you. So, what does it do? It makes things tight, weak and limits the amount of output. Training and strengthening your body trains your central nervous system to function more optimally. If you can move with weights or with resistance laterally, to the front, to the back, rotate and you can add resistance/strength, everyday life is going to feel effortless. You won’t be in pain. You’ll sit in your chair and feel okay. You’ll have amazing posture without thinking about it. A lot of people think bad posture is because people are not thinking to stand properly. No. Posture is natural, like breathing. I don’t have to think to breathe all the time. It should be something that happens naturally. Well, if I don’t train it well, it’s going to happen in a way that’s suboptimal. Posture is just like that.

Making the Case for Starting Resistance Training

SDS:

I keep making the case for this form of exercise, but if you want to get lean, healthy, move better and have better hormone profiles, nothing compares to resistance training. Consistency-wise, if you can only work out 2-3 days/week and you only want to pick from one form of exercise – hands down – nothing compares to it.

DrMR:

Well, this is something I’ve lived my entire life. So, I fully get it. I want other people to embody this more. To our audience – If you haven’t yet really made a commitment to resistance training, I would highly encourage you to do so. When I’m in the best resistance training shape is when I feel the most proper postured – the most confident – and it’s a great feeling. When I’m the most de-conditioned, I feel the worst. Now, for me, I’m oscillating in a pretty high level, but even within that level, I notice I feel better and I look better. I also think I probably even think better when I’m really getting some good high-intensity training. The high-intensity resistance training may not be a thing for most people, but at least get into this realm if you haven’t yet tried it.

DrMR:

Also, women need to embody this, as well as aging men. I think some aging men are afraid they’re going to get injured if they lift weights. It’s the absolute wrong way of thinking about it. Your likelihood of injuring yourself doing something in everyday living is going up every day if you’re not learning how to gradually onboard to resistance training.

Dr Ruscio Resources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to DrRuscio.com/resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of the fact that we deliver cost-effective, simple, but highly efficacious functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who have been unable to improve their health – even after seeing numerous doctors – to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line and other gut supportive and health supportive supplements. Health coaching. We now offer health coaching – so if you’ve read the book, listened to a podcast like this one or are reading about a product and you need some help with how to use it or integrate it with diet, we now offer health coaching to help you along your way. Finally, if you’re a clinician, there is our clinician’s newsletter – The Future of Functional Medicine Review. I’m very proud to say that we’ve now had doctors who’ve read that newsletter find challenging cases in their practices, apply what we teach in the newsletter and be able to help those patients who were otherwise considered challenging cases. Everything for these resources can be accessed through DrRuscio.com/resources. Alrighty – back to the show.

SDS:

Yeah. Remember the individualized aspect of it. It’s gotta be appropriate for your body. So, if you look at like Dr. Ruscio’s workout routine – he’s been working out for a long time. His training reflects that for him. To get his body to progress any further, he has to apply a greater level of intensity, volume and frequency in order to do that. If you’re listening right now, and you haven’t worked out for a long time, anything that’s a little over that is going to get your body to react and adapt. One of my favorite myths to tackle is exactly what you’re talking about. “Oh my God, I’m going to injure myself.” No, no. It’s going to be appropriate. When I would take somebody in advanced age, here’s one example of an exercise – and this would be after doing an assessment – I would have a chair and I would even add pads to the chair. I’d have them sit down and stand up. And that was their squat. You’d sit down slowly and stand up. Of course, gradually we would then progress that where I’d remove the pads so it’s a little lower. Then, I’d take the chair away. Now you’re not sitting on anything. You’re just doing a squat. Eventually, we would add some resistance. That’s why I talked about the practice aspect. If you want to get started with resistance training, don’t think about soreness. That’s a big one, right? That does not dictate whether or not you had a good workout. Don’t aim for soreness. In fact, soreness oftentimes will tell you that you did too much.

SDS:

Neither is sweating and muscle burn and that kind of stuff. In fact, at the end of your workout, you should have more energy and feel better than you did at the beginning. You should not feel like you’re crawling out of the gym or, “Oh my God, I gotta go sit down on the couch.”

DrMR:

Great point.

SDS:

You should literally finish and feel energized. The exercises I have in the book – practice them. That’s all you gotta do. 2 or 3 days/week – practice them and just try to get better at them. Gradually over time, what that’ll mean is you’re adding resistance. You’re adding range of motion. You’re maybe doing things a little more challenging and your body is progressing the entire time. By the way, strength adaptations are pretty fun. They’re fun because if you did 5 push-ups last week, you’ll probably be able to do 6 or 7 this week.

SDS:

It’s a very objective way of measuring your results. Oh, here’s one more thing. I have to touch on this. I love this one – another great selling point. There’s no such thing as permanent results, but the closest thing you can get to that (or the results you get) are from strength training. One of the questions that used to annoy me with new clients or people that would come into my gyms was, “Oh, what happens when I stop working out?” Well, obviously you get back out of shape, right? Nothing is permanent. However, here’s why resistance training is better than the other forms of exercise. When it comes to “long lasting” or permanent results, muscle memory is a very real thing. Here’s how muscle memory works. Let’s say, as a man, I’m working out. I’ve never done resistance training before, and I’m trying to build muscle. Let’s say, over the course of a year, I build 10 pounds of lean body mass, which by the way, is a lot of lean muscle to gain in a year. Let’s say I accomplish that in one year. I gained 10 pounds of lean body mass through hard work, good diet and consistency. Then, for whatever reason, I stopped working out for three months. I become very sedentary and I lose all 10 pounds of that lean body mass. Then, I get back into it. I’ll gain it back in something like 1/10th of the time it took me the first time. If I gained 10 the first time, the second time gaining it back happens much, much faster. An example of that would be if you’ve ever had a cast on an arm or a leg – you see it completely atrophy and then it comes back to looking normal in a relatively short period of time. This is a very real phenomenon.

SDS:

You don’t see this with other forms of exercise. So if you build muscle, you’re actually setting yourself up with insurance for your entire life. The longer you keep that muscle on your body, the more that happens. In fact, there was a recent study that showed that the amount of volume that is required to maintain muscle is about 1/9th of the volume that was required to build it. So, if it took me five days a week of consistency to build X amount of muscle and strength – and I’ve been doing this for 10 -15 years – I could get away with two days a week to keep it. I notice this now as a 42 year old man. I’ve been working out for a long time. I can maintain muscle now with volume that before would have done nothing for me. I’m sure you’ve noticed the same thing.

DrMR:

Also, I don’t know what the literature says here, but I’m assuming the coordination benefit has a very good carry over. I’ll look at people who had a solid athletic background or resistance training background at one point. They still seem to have a better coordination than people who never had any of that, even if they’re not currently training.

SDS:

Yes. Again, that’s connected to muscle memory, which has a central nervous system component left. It’s like you build your body and even if you atrophy and go backwards, your body has this memory of where it was before. This is great. If the main benefit of your exercise is calorie burning, the second you stop that benefit is gone. So you’re like, “I’m doing this cardio workout… I cut my calories… I’m getting ready for Hawaii with my husband.” Then, you go to Hawaii for two weeks, you stop doing it and you’re like, “Oh my God, I gained 7 pounds in two weeks.” Well, if it was resistance training based with a faster metabolism, you’re not missing much. In fact, I’ve had clients come back from vacation and be the same – or maybe even a little stronger – because they needed the break.

DrMR:

They recovered better. I’ve noticed that same thing, actually. I’ve taken short stints off and I come back and I crush whatever workout I’m doing. I was like “That was a nice surprise.” That’s where it makes sense if you need that recovery time.

SDS:

Yeah. We had a cardiologist on the podcast recently – Dr. Alo was his name. The reason why we had him on the show was because he’s a cardiologist that goes and does talks with other cardiologists. One of the main points he talks about is get all your patients to do resistance training. He’s like, “I’m a cardiologist and I’m telling people go and do resistance training.” This is because they notice the best outcomes now when they do that.

Episode Wrap-Up

DrMR:

That’s great. I’ll have to check out that episode because I think we need more people, especially in cardiology, who are challenging the low-fat/resistance training dogma. Now, there’s definitely more evidence showing a broader landscape of dietary choices, and exercise stimuli that can be helpful for the heart. It’s sad when there’s this carry over from this initial pocket of research and there hasn’t been any nuanced updating of the recommendations because big heart associations got behind X message and they’ve been slow to adjust. The only person who loses there is the individual.

SDS:

Yup. However, it’s coming. The data now and the studies now are starting to pile up.

DrMR:

For sure. The tide is shifting. Definitely.

SDS:

I think it’s a matter of time. I’m glad I timed it the way I did to write this book, but I think the resistance training revolution is going to happen anyway. In 10 years, I think it’ll be the primary form of exercise that they’ll start recommending because now the studies are supporting it.

DrMR:

Right. So, tell them where they can grab the book or anywhere else you want to point them.

SDS:

You can go to resistancetrainingrevolution.com, or you can find it pretty much anywhere they sell books – Amazon, Barnes & Noble, Target. They’ll all have it. Of course, if you want more of this kind of information and other information related to fitness, health and nutrition, there is my podcast – Mind Pump.

DrMR:

Awesome. Sal – thanks for what you’re doing, my man. You have such a great podcast. I always love being on your show. You guys are a ton of fun. Again, for our audience, these guys are really walking the walk. You’re 42 and you look a lot better than some guys I know who are in their mid-twenties. So, I just want to give you that hat tip. Yeah, guys – check out the book. If you’re not resistance training, I would highly recommend it. If you’re doing nothing, something is better than nothing, but if you’re doing something and you’re going to try to get to that next level, start getting that resistance working. It’s just so valuable and Sal’s book is a great place to start.

SDS:

Thank you.

Outro:

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