And then as it gets to Christmas day, he picks up his granddaughter and holds her out so she can put the star on top of the tree. And it’s absolutely heartwarming.

One of the most common goals that we hear at our studios, they want to be able to get up off the floor from playing with their grandkids. Welcome to the Strength Changes Everything podcast, where we introduce you to the information, latest research, and tools that will enable you to live a strong, healthy life. On this podcast, we will also answer your questions about strength, health, and wellbeing. I’m Amy Hudson.

I own and operate three exercise coach studios. My co-hosts are Brian Sagan, co-founder and CEO of The Exercise Coach, and Dr. James Fisher, leading researcher in evidence-based strength training. And now for today’s episode.

Welcome back to the podcast. I’m Amy Hudson here with Dr. Fisher today and we are going to introduce you to a research paper that Dr. Fisher has led the charge in and we’re going to describe what the question being answered in this research systematic review and meta-analysis was and why this is important. So hi Dr. Fisher, how are you?

I’m great Amy, how are you doing?

I am well. So what is the title of the research paper that we are going to be talking about

today?

So, the title of the paper is Machine-Based Resistance Training Improves Functional Capacity in Older Adults, a Systematic Review and Meta-Analysis. So, this is a review really of the topic of whether simply using machine-based resistance training can improve functional capacity in older adults. Okay, so let’s first start by describing what is, what do we mean by functional capacity and what are some examples? Yeah, that’s a great question. So the key thing that we should think about as we age is along with our loss of strength and our loss of muscle mass and any other markers is what’s

called a functional decline. And a functional decline is indicative of maybe a loss of walking speed, gait speed, a loss of balance, which might then lead to falls, and even a loss of ability to function as far as self-care activities, the ability to get up and use the restroom or the bathroom. So we lose that capacity to do these things. And of course, as we lose that physical ability, we also lose our confidence.

So there’s a loss of social interaction and there’s a loss of self-esteem and engagement in other activities. So kind of the less we do, the more decline we see and the more decline we see, the less we do. So we fall into this kind of vicious cycle.

Mm.

Yeah.

I think everybody can picture what those are, right? The loss of functionality. I’m picturing going up the stairs, sitting on the floor and then standing back up.

Right.

These are examples that are everyday quality of life examples. So then, you know, this study is asking the question, machine-based resistance training, will it improve that functional capacity in older adults? And so, you know, why is that question important to answer? Whether or not machine-based resistance training alone can improve this?

Yeah, absolutely. Well, the historic thinking in strength training has been that to improve sort of what we call functional performance, you need to perform functional tasks. So it might be specific movements or specific weights, so using kettlebells or using balance platforms,

things that specifically challenge our balance or specifically apply a resistance in a certain way. Maybe it’s performing certain exercises like lunges or bodyweight squats or exercises with battle ropes or things like that. So the key is if we tend to think that you need to do those things to improve in those things, well that’s fine, but some people can’t even engage in those things to begin with. So the the benefit of resistance machines is that you’re always in a seated position. So you’re always, you can always sit down on a chest press

or a seated row or a leg press exercise. It’s not dependent upon a high degree of balance

to begin with to perform those exercises. Which makes it accessible to almost anybody, right? Even those with balance issues, a seated machine is a lot less intimidating than swinging ropes or swinging a kettlebell around your head, especially if you have

vulnerabilities in your joints to begin with, for example. Yeah, absolutely, and

this is the key part of this study, that we were looking at older adults, those that might be infirm, might have already suffered from a functional decline, might be lacking inm, might have already suffered from a functional decline, might be lacking in confidence in engaging in certain resistance training activities. So we’ve taken the most basic,

but potentially the most efficacious type of exercise, simply using a resistance machine, and we’re seeing if just engaging in that can improve functional capacity.

Okay, perfect. So before you dive into the setup and how the research was done and the findings, just share with us, I mean, this is called a systematic review and meta-analysis. So can you describe what those two terms mean?

Yeah, absolutely. So this is a review paper. It’s a combination of 17 different research papers that we’ve included within this review. Uh, and what we did is we identified key inclusion criteria. So participants had to be over 60 years of age.

Uh, they had to be healthy and no, no current medical conditions. And they needed to be a pre and a post test measurement for functional capacity, which we’ll talk about in just a second. And the intervention had to be a minimum of six weeks in duration. And then what we did is we take the data

from each of the studies that we found that met those criteria, and we start to combine all the data together. So individually, there are 17 studies and they might have between 20 or 50 or 60 participants. So they’re fantastic studies, but they’re not hugely meaningful at a population level. Whereas when we start to combine all the data together, we actually ended up with nearly

900 participants and the average study duration was 12 weeks. And so we then have data for kind of how 900 people are expected to, or reacted, sorry, to this type of training intervention over a 12-week duration. And that’s far more indicative of what we would expect to see at a population level. And that’s exactly what a meta analysis is. It’s combining all the data together to try to get a single, a single effect. Now a systematic review part is similar, but that’s really just

kind of the details of the studies. That’s the clarity of over maybe what exercises they did, maybe the study duration, maybe the mean age, maybe the number of sets or repetitions that they performed and so forth.

Okay, perfect. Well, thank you for getting that set up of the study and how it was done out of the way. So now I’m going to just hand it over to you to dive in to describe this from start to finish and share with us what was revealed

from this. That’s great. So first of all we do a big literature search and we have specific criteria that we put into scientific search databases and revealed about 3,200 research papers that might meet the criteria and then we have to sift through those papers to see if they do meet the eligibility criteria. Now we talked about the idea of asymptomatic participants without a medical condition, and it’s important that we identify those if we include people with osteoporosis, or

maybe with cancer, or other medical conditions. It’s not to say that they might not receive receive or might not respond, sorry, in the same way to this type of intervention, but there might be a reason why they either respond better or maybe they respond worse than the general population. So specifically we chose the group of people that we did. After sifting through these 3,200 papers, we got down to 17 specific papers that met the criteria. And we were very stringent over this as is every review of this type.

Um, and we specifically wanted papers that only included resistance machines. So there were some studies that included maybe six or seven resistance machines. And then they had somebody do a standing barbell curl. Uh, well that paper had to go because. The fact that they’re doing a standing barbell curl. Uh, well that paper had to go because the fact that they’re doing a standing barbell curl could be seen to influence their balance and could be seen to

train their balance specifically. So we wanted to exclude those studies. So we, we got down to these 17 papers and then two of the criteria that we were looking at with the measures of functional capacity themselves. So we had what’s called a timed up and go and a timed up and go is a simple task. You, you sit in a chair and upon the start of the timer, you rise from the

chair unaided, you walk a given distance around a cone or a marker of some kind. You return to the chair and you sit back down again. And it’s a really nice, simple test that can be done, but it’s really used to assess walking speed, ability, agility to some extent, dynamic balance, confidence, falls risk, and so forth. And then the second measure of functional capacity was what’s called the sit to stand test. And again, this is a common test used by clinicians.

Uh, you, you start seated in a chair and you cross your arms over your chest or your shoulders, so you don’t use your hands to help you out of the chair. And you simply rise and sit back down into the chair as many times as you can within a 30 second period. And again, this is well correlated to stair climbing speed, to walking speed, uh, dynamic balance and, uh, and

risk of falls and so forth. So these are two really key measures of functional capacity.

Yeah.

So I was going to ask you how prevalent these two measures are.

Yeah, they’re very common in the literature and there are other measures that other people may have seen and may be familiar with, but these two measures are two of the most prevalent in my opinion. And they’re also two that are becoming more and more common in day-to-day facilities because there are more and more apps that are able to measure the performance. So they’ll be more and more frequently used in the academic literature, and they correlate very, very well to other activities of daily living and other functional tasks.

CMH Okay, perfect.

MH Okay, so we got to our 17 studies, and as I said before, this list left us with nearly 900 participants, and the average age at this stage was actually 70 years old. So 70 year old participants, 630 of them were female, so a very high proportion of female participants, which by the way, is a great representation in strength training studies. Normally, strength training studies seem to be done on young males, so it’s really nice to see a large number of females. When we look across the 17 studies, the mean, the average, was six exercises. That was three upper body and three lower

body exercises. Now some studies did just upper body training and some studies did just lower body training and some studies did just lower body training and some studies did both upper and lower body. And then the mean study duration was 12 weeks with a frequency of two and a half times per week. So some studies trained once per week, some studies trained three times per week, many trained twice per week. Some studies were only eight or ten weeks in duration, one study was nearly a year in

duration. So the median duration was 12 weeks. And then the average was 2.5 sets of each exercise for around about 11 repetitions. And most studies found some way to measure the perceived exertion or the effort level, and the average across all 17 studies worked out about 8.4 out of 10. So 10 out of 10 is maximal effort, so 8.4 is probably pretty hard work. Now you know people working pretty hard. And you’ll probably

repeat this in a minute but just to clarify with the upper body and the lower body exercises, what machines were used for those?

Yeah, sure.

So they used the three upper body on average, the three upper body were chest press, lap pull down and seated row. So all multi-joint upper body exercises, a press, a vertical pull and a horizontal pull. And then the three lower body were a leg press, a knee extension and a leg curl.

And again, they’re three of the most common exercises that you see. A multi-joint lower body pressing movement in the leg press, and then a quadricep exercise, so an exercise for the front of the thighs, for the front of the upper legs, and then a leg curl. So for the back of the upper legs as well.

Got it. thank you.

And then on average, they worked out, or we worked out that the studies used an average of about 63% of the one rep max. So the one rep max is the load that a person can lift for a single repetition. It’s a measure of how strong somebody is. So they didn’t use a very, very heavy weight. I think that’s really important to recognize. They weren’t close to their one rep max. They used around 60%, which as we’ve said before, was equivalent to around about 10

or 11 repetitions. Okay, so then we can get into our findings, if that’s okay, Amy? Yes, let’s do that. Okay, so the first outcome is strength and I know this sounds like it’s the most obvious thing to think that people engaging in strength training got stronger, but I think it’s worth remembering that when we’re talking about 70-year-olds engaging in a 12-week strength training intervention twice per week, it’s very important to recognize how much stronger

they got. Now I’ve shown a graph on the screen here and we can see that the blue markers are the untraining control group, they’re the non-training control group, they didn’t engage in any strength training. We can see that they are pretty close to the dotted line, the zero dotted line, which means they didn’t make any improvements in strength. Now that’s exactly what you would expect. The orange markers are representative of the groups from the different studies and how

much stronger they got. So we can see that in some of the studies they didn’t get a lot stronger and in other studies they got so much stronger. And that might be indicative of perhaps the population group themselves, it might also be indicative of the training study duration, the number of exercises, frequency of training and so forth. But really what we’re interested in is this second figure.

And again, we can see the blue graph at the top, we see an effect or a standard mean change of 0.1. And we can see that it crosses that zero bar. That really says that at a population level, we don’t expect people that don’t engage in resistance training to get any stronger. And that’s obviously what you would expect. But then if we look to the orange part at the bottom of the figure, we can see a standardized

mean change of 0.71. Uh, and that’s indicative of quite a significant change in strength, quite a significant improvement in strength for these people. Now, again, remembering these as a 70 years, uh, old on average. So this is really important to recognize that if nothing else, engaging in strength training, improve strength. We, engaging in strength training improves strength.

We know engagement in strength training and strength as a single marker is resistant to all cause mortality. So being stronger first and foremost makes you harder to kill is a nice way to think about it. So I think this is really important to recognize.

So just if you’re listening at home and this is the audio version only, what these graphs are showing is all of the data. If you were to plot the data on, on a graph of basically non-training individuals, they all populate around a baseline area that doesn’t really show any changes to their strength. It remains about the same. And then moving over on the axis to the right, when you plot all of the data showing people who did engage in some of the

strength training that Dr. Fisher is describing, they’re all shifted over to the right to show the distribution of their strength gains. And so it’s pretty across the board that what you would expect is that they all saw those improvements in strength. Is that a fair description?

It’s a great summary, Amy. Exactly.

Yeah.

Fantastic. Okay. So our second measure was functional functional capacity. And again, the figure on the screen is exactly as Amy’s just described. The blue markers are close to the zero. They’re close to the baseline.

Seldom do people that don’t engage in exercise improve their functional capacity. Whereas the orange markers are quite significantly shifting towards the right-hand side. We see some quite large effect sizes and that’s showing that people engaging

in strength training are making an improvement in their functional capacity. And if I cut to the second image and again this shows our blue marker and effect size or a standardized mean change of 0.09 and this shows that again our control groups within each of the studies they didn’t make an improvement in functional capacity over the 12-week duration. Whereas in contrast, our strength training group, and remembering, they only did resistance

machines, they didn’t do any balance training or any specific training to improve their balance. They made quite significant improvements in their functional capacity in the two tests that we talked about, the sit- stand and the timed up and go. So, we’re seeing that strength training using resistance machines, you know, an uncomplicated method of strength training can make quite significant improvements in functional capacity.

CMH I’m looking at the graph here and if you’re, again, listening at home, you can see this all on YouTube as well. Just a question for you. So with the um with the functional capacity was it about the same amount of uh differential in toward the baseline um as the strength gains itself? So what I’m asking is is the functional improvement on average about the same level of improvement as strength? Is it more, is it less?

It was actually very, very close to strength. So that’s a great question. And one of the things that we often caveat with the paper like this is we say, we didn’t ever try and correlate, did the people that got stronger, did they make the greatest improvement

in functional capacity? And did the people that didn’t get very strong or didn’t get much stronger today not make much adaptation functional capacity. We didn’t look at that we simply look that if people engage in strict training. How does it improve their functional capacity well as it happens yes. The margin of strength by which the training group improved by is very very similar to the margin by which they also improve functional. So it does lend itself to suggest that it was the strength change itself that improved

the functional capacity.

CM1 Sure, makes sense.

MG Okay, but there’s a couple of other things that we should kind of caveat to this. Certainly, the strength increases likely resulted in an improvement in physical function. But there are also a lot of benefits from strength training that might also be impacted the physical function of the participants beyond just the actual strength improvement. So first of all, there’s a lot of research to say that engagement in resistance training, irrespective of strength increases, improve self-efficacy.

Self-efficacy is our self-confidence, it’s how we feel about ourselves, it’s maybe a marker of self-esteem, which might dictate how confident we can perform activities of daily living or perform tasks that we’re being tested on. So I’m sure you can imagine if somebody has now undergone 12 weeks of resistance training and then they’re asked to come back into the labs and repeat a sit-to-stand test or a timed up and go test, then they’re now much more confident in what they’re doing

simply as a product of engaging in resistance training. So that’s certainly a possible mechanism by which they might have improved their functional capacity test scores. We also know that participation in muscle strengthening exercise reduces fear of falls, improves confidence when undertaking physical activity. So specifically, engagement in physical activity, such as resistance training, might have led to greater engagement in other day-to-day activities. So you can imagine if somebody isn’t very confident getting out of the chair to use the bathroom or to go up and down the stairs,

then they might not do it very often. But as they’re engaging in resistance training and their self-confidence improves, they might feel more inclined to use the stairs, or they might feel more inclined to go for a walk or so forth. And that in itself would certainly serve to improve their functional performance in assessment. And then of course muscle strengthening exercise improves cognitive function. And we’ve talked about this on a previous podcast, Amy. So there might be a cognitive improvement where they are now more aware of the test

parameters, they’re now more kind of cognizant of what’s actually being asked of them, and their engagement in physical activity day to day improves as well.

You know, what I’m thinking about as you’re talking is when we meet clients for the first time, and I’m picturing a 70 year old who isn’t exercising and they really have some goals in the areas you just described. Do you know, do you want to know one of the most common goals that we hear at our studios?

Is for people.

Yeah.

They want to be able to get up off the floor from playing with their grandkids. And so, you know, I’m picture, you know, that is a meaningful, important thing is being able to stand up from a seated position on the floor, right? And so when we say strength changes everything, you just described several different areas that that changes and confidence, you know, just the strength to get up, all of those things are impacted. And that really is why machine-based resistance training will get you those goals and those outcomes.

So it’s just a, wanted to, wanted to pop that in there as a little anecdote.

Absolutely. And I’ve worked with clients in the past and I know the exercise coach, coaches that I spoke with, have worked with clients and they say things like, oh, they feel much more confident. Uh, or they’re now much more capable of picking out a bag of dog food out of the trunk of their car and things like that. And ultimately it’s not necessarily about making strength increases in the gym.

I mean, that’s great to see, but it’s about how those strength increases transfer to a, to day- day to day activity. Uh, there was a commercial that ran over here in the UK, a couple of Christmases back for a big, uh, a big check, a big, uh, shop called John Lewis. And it was, uh, an older adult that went into his garden shed, uh, in the wintertime and started picking up a kettlebell and holding it out in front of him and all the neighbors are watching and gossiping and the family are watching.

And then as it gets to Christmas day, he picks up his granddaughter and holds her out so she can put the star on top of the tree. And it’s absolutely heartwarming. It’s, you know, it’s really pretty jerking, but that’s exactly what we want to see. It’s not the capacity to pick up a kettlebell. It’s the capacity to play with grand, grand kids or pets and family members and engage in

those meaningful day-to-day activities. Absolutely. That’s why we do it at the end of the day, isn’t it? Yeah, for sure. So basically having done this, this research, you know, what, what would you

say are the most important key learnings from this that you would want those listening to this podcast really remember? PW Yeah, well I think the first thing is that strength training doesn’t have to be complicated. So I’m a big proponent of what I call uncomplicated resistance training. I know that many people avoid resistance training because they might have a fear of some of the things that they’re being asked to do or because they lack confidence in some of the tasks.

And, you know, social media and even some of the organizations have portrayed strength training as being a series of complex exercises that you have to do if you want to make improvements. And I think, first of all, that’s not necessary. If you want to make improvements in your simple, functional day-to-day activities, then engagement in seated resistance machines can absolutely do that. And then I think, second of all, continuity and training. I mean, these studies, the average was 12 weeks in duration and they made a really huge increase in strength and a really positive

improvement in functional capacity. But then what I would love to see is the data over the subsequent year or 18 months or two years that shows that continued functionality and shows that continued improvement in quality of life.

Yeah I mean when was the last time if you think about engaging in anything for 12 weeks, let’s say you start a walking habit and you walk, you know, three times a week for a mile for 12 weeks, is that going to translate into such meaningful functional and strength adaptations, as we’re describing in this study. You know, the amount of change, both functionally and with somebody’s strength,

and like you just described, their confidence in other areas, that you can see in 12 weeks through just engaging in brief strength training are incredible incredible right and more significant and more profound than lots and lots of other things you might

choose to do but like you said it doesn’t have to be complicated it doesn’t have to take a long time and it doesn’t have to involve very minute movements that are difficult for the average person to do, which is really pretty exciting. And that is the type of research that supports why it’s great to focus on strength training to me, almost any goal you have.

Absolutely. Absolutely. And of course I’m a big proponent of people getting outdoors, breathing fresh air and, and getting, getting their steps in during the day, but there’s no doubt that the health benefits of, of engaging in walking are nowhere near the health benefits of engaging in strict training.

I don’t think that’s a, that’s not a question at all.

Yeah. Well, those are really exciting findings. And so if you, you know, listen to this podcast, we will link in the show notes to this paper. Really exciting stuff, Dr. Fisher, and please do go back and watch this on YouTube if you would like to see some of the graphics associated with this paper. And so, any final thoughts you have?

No, not at all. Just get out there and get engaging in the strength training. It’s never too late. And then go and reap the benefits in your day-to-day activities.

All right.

Let’s do that.

All right.

Well, we will see you next time.

Remember, strength changes everything. Thanks for listening to today’s episode. If you enjoyed this episode, please share it with a friend. Make sure you follow the show on Apple Podcasts, YouTube, or wherever you get your podcasts so that you never miss another episode. You can find out more information about this episode or connect with the show at strengthchangeseverything.com. Join us next week for another episode.

Join us next week for another episode. Here’s to you and your best health.