Who can build muscle?
There is a common assumption that older adults don’t need to build muscle and that it’s not possible to make significant improvements. However there is ample evidence that challenges these beliefs. Research suggests that just about everyone can build muscle and strength with medium to large gains in strength and muscle mass even for individuals over the age of 75. There are also many other studies that have found the opposite however - that exercise had no impact on muscle strength. Oftentimes this is because studies use exercise protocols that are not properly made for building up muscle mass. There are specific exercise protocol requirements that must be met for creating the optimal conditions for promoting muscle growth and increasing strength.
EXCEPTION: For Those with Kidney Disease or Cancer Strength training is a common topic discussed with our patients with kidney disease or cancer, because both of these conditions commonly lead to something called cachexia. Cachexia is characterized by a dramatic sudden loss of muscle mass and often accompanied by substantial weight loss. During high stress, the body breaks down muscle tissue as a source of energy, leading to frailty and weakness. According to the National Cancer Institute, nearly one-third of cancer deaths can be attributed to cachexia. While historically we have had no evidence to draw upon, we have now had several studies released recently that have found that resistance exercise can help prevent or reverse cachexia. A 2020 study from the University of Cairo in Egypt found that muscle mass and strength improved in patients with pancreatic cancer undergoing resistance exercise, while these attributes decreased in those who did not. Another study, completed in Germany in 2018 found 20-30% increases in strength with resistance exercise and concluded the exercises were both safe and feasible. There appears to be benefits in the context of kidney disease as well, as outlined in this 2021 Japanese study. One of the largest studies is yet to be released in 2022 and should give more conclusive results.
Why build muscle?
Strength building exercises are beneficial for just about everyone. Research shows that elderly individuals with higher muscle mass compared to those with lower mass, had one third the risk of having a fall. A 2018 study from Norway on men and women found that increased muscular strength and muscle mass significantly reduced the risk of people having injuries.
Strength building is important in helping to support joint health, benefit balance and improve longevity and lifespan. A 2018 study on 80,000 adults found that those who participated in both aerobic and strength training exercise had a greater improvement in longevity and cancer risk than those who were doing aerobic exercise alone. Research has found the same trend in older individuals as well. It is important to note that without strength training, any gain to muscle is unlikely. This 2012 study found that individuals who only completed aerobic exercises had a trend towards decreased muscle mass by the end of the study. On the other hand, the participants who completed a combination of aerobic and strength training together gained muscle mass.
Aside from the above benefits, strength training exercise has also shown to help:
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Improve body composition
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Increase lean body mass (bone density and muscle)
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Decrease fat, including visceral fat, an important risk factor for the development of metabolic syndrome, diabetes, and chronic systemic inflammation (2013 study)
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Improve cardiovascular health to a greater extent than aerobic exercise alone (2012 study)
What are sets and reps?
A repetition, or “rep,” is one complete exercise movement while a “set” is a group of consecutive reps. So, two sets of ten reps looks like 10 shoulder presses, rest, 10 shoulder presses, rest.
A Comprehensive Approach Works Best
Muscle mass can only be increased with a strong plan that carefully and progressively adjusts training variables over time. Furthermore, a holistic strategy integrates elements of both training variables and lifestyle variables, to promote not only productive strength gains but also general health. These recovery variables include:
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Proper nutrition
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Adequate sleep
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Active rest (light, physical activity on non-training days)
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Stress management
Regarding nutrition, we can also look at blood testing for factors that might be affecting your progress. For example, if iron levels are too low, then the body cannot create enough hemoglobin, which is used for transporting oxygen to muscles and can directly impact exercise capacity. Other factors we can test that might impact performance include:
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Hormone health
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Heart health
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Lung health
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Kidney health
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Inflammatory markers
Reducing Risk of Injuries
When done correctly, strength training helps to protect joints and muscles as well as reduce risk of strains and sprains throughout daily life. If done without proper planning, strength training itself can cause sprains, strains, tendonitis and damage to joints.
There are many factors we can address to help prevent injury, such as:
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Type of equipment (free weights or machines)
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Recovery time (a person generally requires 2-3 days to recover after exercising a muscle group)
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Amount of weight (it is easy to injure oneself if the starting weight is too high, and equally easy to end up with no gain in muscle mass if the weight is not high enough)
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Gradual increases in activity and weight level (muscle gains plateau quickly if weight is not adjusted progressively)
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Warm up protocol (usually simply doing the same exercise prescription at a lower weight for just the first set is sufficient)
Type of Equipment
Contrary to popular belief, exercise machines do not appear to provide any superior benefits when compared to using free weights (dumbbells, barbells) - as outlined by this 2022 study. Exercise machines were not found to lead to any greater impact on strength, power, or overall muscle mass. A study from the University of Saskatchewan actually found that free weights caused greater muscle activation than an exercise machine, when measured by electromyography. Free weights also appear to stimulate natural hormone production to a greater degree. This 2014 study showed greater increases in testosterone, growth hormone, and cortisol within the blood after a workout with free-weight squats, rather than when an exercise machine was used.
Exercise machines do not put as much pressure on the axial skeleton - the spine and chest. While reducing stress to the bones might seem like a good thing, it is actually the increased pressure and stress on the bone tissue that stimulates bone growth and helps prevent osteoporosis. Here’s a study from 2020 that found free weights lead to greater improvements in bone mass than exercise machines. Lastly, the most natural ergonomic exercise movement is dependent on each individual - one person’s joint movement pattern might be different than another. Exercise machines generally have one fixed movement that might not be as suitable for everyone. With free weights joints are able to move freely and unrestricted, in their most natural and ergonomic pattern. Ultimately, the best equipment depends on what works best for you and your goals.
Another option is body weight exercises. These exercises use a person's own bodyweight to create resistance and improve strength. While strength levels may increase initially, it is difficult to progressively increase weight in a controllable manner. Once a person gets to the point where they can complete a large number of repetitions (such as 12-30) then the stimulus on the muscle encourages the development of endurance rather than strength. While there are health benefits to improving endurance, it is unlikely any muscle growth will occur (given that research suggests minimal change to muscle with endurance and aerobic exercise).
Free weights are the last main option we can consider. This includes dumbbells and barbells. The dumbbell can be used individually or in pairs, with one in each hand. A barbell consists of a long bar with weights attached at each. Dumbbells are a reasonable choice and can be a good introductory option. However, the barbell may be preferred because it allows for careful adjustment of weight levels and the exercises that can be done usually activate the largest volume of muscular tissue at once.
So What Is The Best Exercise Protocol ?
If a protocol does not meet the right requirements, the stimulus on the muscle will often mimic that of an endurance or aerobic exercise. As mentioned previously, this does not appear to lead to any benefit to muscle mass. At our clinic we build an exercise protocol that takes into account your goals and physical health. It is important to focus on what you can do and work up from there. Oftentimes to build significant muscle mass, only 5-7 different exercises completed two to three times per week is required. The time commitment does not need to be massive, but rather it is the careful control of workout variables alongside optimal nutrition that leads to improvements in muscular strength and overall well being.
Common Mistakes to Avoid
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Using a “1 repetition maximum” to determine how much weight to use for an exercise. Essentially it is the absolute maximum amount of weight the person can use for the exercise. After determining the maximum, a percentage of that weight is used for the workout. While this is a popular method, there is a high risk of injuring oneself because suddenly lifting your maximum weight puts significant stress on the muscles and joints that you are likely not accustomed to. The 1 rep max routinely causes significant breakdown in the exercise technique/form, which compromises safety.
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Performing exercises to muscle failure. You should not be pushing yourself to the point where your muscles are completely exhausted and you cannot do anymore repetitions. There is no evidence that this provides any benefit and this practice can cause harm to the joints and muscles.
Is Strength Building Safe with Arthritis ?
As of 2020 there were 12 studies that had assessed safety and effectiveness of strength training in those with osteoarthritis. Of these 12, 11 of them found that strength training improved pain and/or physical function. Specific muscles should be strengthened according to the location of pain. In the knee for example, it is weakening of the quadriceps muscle that has been associated with signs of osteoarthritis progression in research. Evidence shows benefits in rheumatoid arthritis as well, with improvements in inflammation, pain, and function.
Final Notes
The ideal exercise strategy depends on you and your goals. At our clinic we take a comprehensive approach and look at your nutrition levels, your current health and any injuries, and lifestyle factors that can be addressed to optimize your progress.