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Barbell Training is Big Medicine
Jonathon Sullivan MD, PhD
...Aging is characterized by a loss of strength, flexibility, and adaptive physiologic reserve; by senescence of growth and repair systems, blunting of hormonal responses, and atrophy of muscle, nerve, tendon, ligament and bone. This physical atrophy is accompanied by an even more deadly psychological decline. Too often, the aging individual sees that he is getting weaker, and so lowers his expectations and his effortsand thereby grows weaker still. This is analogous to the cell cutting up its own DNA. Once the psyche has surrendered to decline and death, its all over but the suffering.
Like cellular self-destruction, I think human apoptosis also comes in both intrinsic and extrinsic flavors. Fortunately, we have seen a decrease in extrinsic death signaling to older people, with the growing acknowledgment that it is possible to remain fit and active well into our extended life spans. Still, aging individuals are told by cultural stereotypes, TV, family, doctors and other experts that they need to slow down, eat less meat, and for Gods sake act their age. The intrinsic signals are even worse: Im fat. Im weak. Im worthless. My joints ache. And Im too old to do anything about it. Where are the Cheetos?
This is an increasingly prevalent phenotype of aging in America and other industrialized nations  a living hell of progressive weakness, obesity, inactivity, shrinking horizons, sexual impotence, decreased expectations, mounting despair, a growing list of expensive drugs, learned helplessness, sickness, and pain. Its being All Done At Sixtyor Fifty. Its a life of waiting to die from a skin infection or a broken hip or a blot clot, of needing a stupid little fucking go-cart to get from here to there, of not being able to reach your own ass to wipe it, of narcotizing yourself with alcohol, cigarettes, American Idol and Doritos so you dont have to face your own grim existence as a slowly rotting Jabba The Hut. I see it every day. We call it old-itis. A joke, I guess, but an obscene one. This gruesome avatar of aging offends the eye, the mind, and the spirit, and it cries out for both compassion and correction.
Strength training is a macroscopic growth factor, countersignalling all of this evil shit. This is not my wishful extrapolation of cellular phenomena to the human sphere. Its a medical observation, supported by study after study. Research with elderly subjects indicates that resistance training improves overall function and strength , enhances bone density and balance adaptations , and improves the metabolic profiles and glycemic control of patients with type 2 diabetes  . A landmark 2008 study of nearly 9000 men followed for an average of nearly nearly 20 years showed that muscular strength is inversely associated with death from all causes, even when adjusting for fitness and cardiovascular health .
Thats strength training. What about barbell training? Like every other area of exercise science, research into strength training in the elderly under-represents barbell training. But I would posit that all of the well-known advantages of barbell training will be magnified in elderly populations. The basic barbell exercises train the largest amount of tissue, and will thereby evoke the largest systemic and local responses, including elaboration of trophic factors. Squats, deadlifts, and presses strengthen functional movementsgetting up, walking, standing, bending over, reachingthat we all rely on every day and that can be challenging for deconditioned elderly people. And because, unlike machines, barbell exercises do not isolate joints and their corresponding tendons and ligaments in unnatural loaded movement patterns, we can expect them to be far less likely than machines to damage older, more beat-up joints.
Finally, barbell training, like any other medicine we would give an elderly person, is titratable. In fact, it is far more exquisitely titratable than most medicines. It can be dosed exactly, according to the needs of the patient. But there is one crucial difference here that I must bring to your attention. Unlike other medicines, where an increase in dose corresponds to the patient getting sicker, the 70 year-old patient whose squat prescription goes from 195 to 200 lbs is getting healthier, and stronger.
Thats the kind of prescription Id like to write.
To the Last Rep
In a system (the aging person) whose default mode is to die, whose human apoptotic signaling is in place and activated, barbell training signals for survival and for growth. It forces muscles to grow stronger and more flexible, tendons and ligaments to become thicker, bones to start sopping up calcium and lay down new matrix, kinesthetic perception to get with the program, and endocrine systems to get off their ass. It negates the extrinsic form of human apoptotic signaling: every additional geezer who trains with a barbell is a living refutation of the stereotype of the frail senior, an example of what aging can and should be. More importantly, training blocks the intrinsic form of human apoptotic signaling, by sending a message to the gray goo in our head that yes, we can get stronger...
And before you ask: at present there is absolutely no solid evidence that strength trainingor any other exercise or dietary programwill substantially prolong our life spans. But the preponderance of the scientific evidence, flawed as it is, strongly indicates that we can change the trajectory of decline.
We can recover functional years that would otherwise have been lost. There is much talk in the aging studies community about compression of morbidity, a shortening of the dysfunctional phase of the death process. Instead of slowly getting weaker and sicker and circling the drain in a protracted, painful descent that can take hellish years or even decades, we can squeeze our dying into a tiny sliver of our life cycle. Instead of slowly dwindling into an atrophic puddle of sick fat, our death can be like a failed last rep at the end of a final set of heavy squats. We can remain strong and vital well into our last years, before succumbing rapidly to whatever kills us. Strong to the end.
That, my friends, is Big Medicine...
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