So, for decades, exercise advice in primary care has really been lacking. You know, we have a hard time, we don't get it a lot in our training, and we're confused on what to do, right? We have patients who have comorbid conditions or arthritis, we don't know what to do. And we have some vague suggestions like walk more, which failed to build mechanical resistance required for independent aging. So, overall, we've done a terrible job in primary care prescribing exercise. Today, we're going to talk about the 2026 ACSM position statement that replaces hopefully a lot of these myths with data-driven frameworks. So, we're moving from Expert consensus to a massive data synthesis that prioritizes patient outcomes and clinical safety over all the confusion. So we're going to dive in right now. Let's get started. So, I know what your Tuesday afternoon looks like, right? You have an inbox of a thousand things. You have an endless stream of patient-reported messages, and people are double-booked. And so, the last thing you care about is diving into evidence-based methodological overhaul of exercise physiology, right? You're like, Jordan, that is not what I'm here. But guess what? That's why I'm here for. That's my why I love doing this. This is what I do. But for decades, our patients have been Given really bad advice, these gym protocols, rigid things, you know, and fitness extremes, right? You go online and it is a cesspool of terrible information. We all know that. And so today, once again, we are unpacking this position stand on resistance training. So, the ACSM American College of Sports Medicine came out with a position stand, which I kind of like stand instead of statement. It just kind of sounds like more sportsmany. I love it. But they're talking all about resistance training, what we know, and For the mass public, right? So we're moving away from specifically kind of niche things. Their last position statement back in the day was really a good document, but it went into like the weeds a lot about specific programming, all that stuff. They're taking a step back here and saying, hey, how can we apply this to? The biggest population possible? How can we get a clinically applicable framework out there for people to use? And so, overall, this is a big shift from where we were. Not just a little minor addendum. I really like the new approach that they're going with. Let's talk more about it. So back in 2009, they had the last recommendations, right? And it was solid. It was a great idea, but it was lacking in some ways, right? So for example, in 2009, the ACSM gave a grade A recommendation for Some hypertrophy recommendations. And when we see grade A, we assume that's a mountain of data, right? Like, oh, grade A, that's the best. But when you look at the numbers under the hood, there was a lack of rigorous evidence that was there, right? So because they didn't have the data that we do have today. These guidelines were heavily dependent on expert consensus rather than hard numbers. So, as I mentioned before, for the hypertrophy recommendations, for example, that grade A was based on exactly three studies with a total of 59 participants. That's incredibly shaky, right? Nowhere in medicine would we say, yeah, that's robust grade A evidence that nowhere close to that. And so, and so I do want to, you know, use the steel man always, right? Like, we want to assume they had positive intent, they did the best they had. They were pioneers doing the best with what they could have and the limited data that they did have. So I'm not knocking that, but we've come a long way. But we have to acknowledge that they were kind of operating with. Outdated grading criteria and numbers overall, and much less data. And to be fair, they said in the paper that since the last update, there have been more than 30,000 new papers on resistance training. 30,000. And so Historical guidelines, they relied on expert consensus to bridge massive empirical gaps, and hopefully, moving in the right direction now with these new guidelines. And so, this new update is what we call an umbrella review, meaning it's an overview of reviews that successfully saw 137 systematic reviews synthesized. So, 137 systematic reviews. That's great. So instead of relying on 59 people like the old data, we now have data from 137 reviews. And so, for the academic skeptics in the room who might worry this is just an echo chamber recycling the same studies, right? Because that has happened. That we a very important study is cited here and here and here and here, and then those data are double counted. That's their word about. Fear not, they ran something called a corrected covered area or CCA index. And in plain English, A CCA index is a mathematical tool that checks if we're just reading the exact same primary studies over and over and over again under different titles, right? So it ensures we aren't artificially inflating. Our confidence by double counting the exact same pairs. And what do they find when they ran this check? Well, only six to 10% of statistical data overlap across all these views is what they found. So that's pretty low. And it gives us more confidence in the findings. And so the data is a lot more robust than it was previously and more diverse, which is wonderful. And so these guidelines represent a more comprehensive scrub data pool. than anything we've ever had in the history of resistance training literature for the primary care or just general population. And now let's talk about the big three. They talked about some big things strength, hypertrophy, and power. We'll start with strength. So, when we talk about absolute strength, the primary target is the central nervous system, not necessarily the muscle tissue itself. That seems counterintuitive. Most people think Hey, get really big muscles that'll make you stronger. And yes, on average, if you have more muscle, you will be able to lift more. That's not bad advice. That's practical. But it's not that simple. So it's more about the brain firing action potentials in exactly the right sequence to maximize neural drive and motor synchronization. So, you're effectively teaching your nervous system to fire all your muscles at the exact same time. So, to trigger this adaptation, the prescription is using an 80% or greater one rep max load. So, if you think about one rep max, that means the absolute max amount you can do. 80% is when that threshold, when we really start to see great strength improvements. So you have to lift heavy to improve strength at high end. That being said, if you've never lifted anything and you just lift something and it's not even close to 80% of your one-round max, you will get stronger for sure. But. To a point you'll eventually say, okay, you've plateaued out. And then to really drive strength predominantly, a little higher is better. And when we talk about higher is better, we mean about the load. So, like 80% or above, we will talk, you don't have to go to 100%, but Overall, you don't have to do a ton, right? Just two or three sets per session. So the volume is relatively low. We found that if you go above that, your nervous system gets fried. If you're doing really, really heavy things. A lot, it's a fast way to get burned out and just to kind of have overdrive your CNS. So, if a patient does 45 minutes of cardio first, that's another thing. We want to make sure we understand where we're doing this and the sequence and priority of this matter. So, we want to prioritize. Resistance training early in the training session. So, as I mentioned before, if you do four to five minutes of cardio and then you lift, well, you've kind of worn things out and you're fatigued, and so you don't have the correct stimulus that you're ready for, pure strength gain. So, Taking a step back. Strength is very important, right? It's very important as we age, it's very important to helpless function, all those things. But strength is much more than just muscle size. It is a brain event requiring high load, low volume, and pretty much should be doing it when we're fresh. But that's the big thing is for training for strength using relatively higher loads, and it's safe to do that. Spoiler, it's safe to do that. That's their general recommendations. Next, I want to talk about an interesting topic. I thought it was kind of cool. I'm just mentioning it here. It's not life-changing, but it's something really cool to talk about, and I want to mention it. When we talk about training an untrained lib, that sounds like magic. Like, what are we doing? Like, untrained limb, what do you mean by that? So, essentially, what we're saying is: if you just train one side, what happens to the other? And it's actually pretty cool. So, if you lift heavy, With your healthy arm, your motor cortex fires signals. And because of that, these neural pathways cross in the brainstem, and there's a neurologic spillover effect on the non-working side. So essentially, by non-working, I just mean you're not exercising and doing that. So think about this direct application for. Someone who's immobilized in their fracture, they're in cast or whatnot. If a patient has a fractured wrist or we'll say radius and they're mobilized for six weeks, you don't just let them sit and rest on the couch. You can actually Have them lift heavy strength on the other arm, healthy arm, and that spill of our effect may help preserve their strength despite their immobilization. Like, Is it going to be perfect? No, obviously not. But it does provide some sort of neurologic stimulus to help maintain strength, which is wonderful, without ever removing or risking the healing appendage that's there. Which I thought was pretty cool. And I think this is something I recommend all the time. When I have patients who are injured, whether it's on their foot, they're in a boot or whatnot, I say, Hey, That's great. Your three other limbs are still working. So we can always prescribe exercise for the other things. And now there actually is data showing that, hey, doing that may help the immobilized area as well, which I thought that was kind of cool. Not life-changing, but I just thought this was a cool like clinical pearl. Now, let's talk about hypertrophy. Hypertrophy is huge these days. Everyone's talking about building muscle. So, hypertrophy just means building muscle size. And unlike strength, the primary target here is cellular metabolic stress. So, for strength, a lot of times it was neurologic, we're going higher weights. This is a little different. So, the goal here is to feel that deep burn and fatigue. The nervous system cares way more about the total work completed than the weight on the bar. So, what matters is most is total weekly value, aiming for 10 or more sets per muscle group. And once again, I'm talking about this is like, hey, when we really are starting to get higher Benefits, that's there. But if you do zero, you can start seeing some benefits if you do one set per week, two step per week. So, working up there, this is kind of where we see up to 10, and then above there, it's kind of diminishing return. So, that's what they're saying. Overall, this is a good idea. And the clinical win for busy patients is that the data shows frequency is irrelevant if volume is equated. What I mean by that is that if you're doing 10 sets of quadricep work on Monday, it builds the exact same muscle as doing two sets. Of five, you know, five days a week. So essentially, if you're in 10 total sets, it doesn't matter if you do it two sets, five days a week, or 10 at once, it seems to be the same. And it's freeing for people who can only carve out, you know, one or two days a week for exercise. But yeah, that's function. On top of that, they also recommend for maximum hypertrophy to focus on eccentric or the lowering phase of the movement. That creates a huge mechanical tension for growth. When I talk about eccentric biceps, it is the best way to explain it. When you contract up and you slowly lower down, this is the eccentric. Eccentric is contraction with lengthening of the muscles. So that Seems to have a particular effect on hypertrophy. And finally, the research proves hypertrophy is really agnostic to load, meaning the weight on the bar doesn't really matter nearly as much as the effort. So you can get nearly the exact same muscle growth lifting a weight. That is 30% of your one rep max to fatigue as you would grinding out a heavy 100% one rep max. And so, this is like the big take-home. We'll talk more about that. 30, anywhere from 30 up, you can get the stimulus as long as you're going towards the end, kind of towards failure. We'll talk more about this in the future here. But an idea is called auto-regulation. You can kind of listen to your body, you can do something called the reps in reserve or RPE rating of perceived exertion. When we're exercising, we want to get above that kind of seven area. Seven RP means like, hey, like seven out of 10 scale, that's as hard as it was, or reps in reserve is three or less. When I mean reps in reserve, what I mean is You could only do three more. So, if I have three reps in reserve, I'm saying I could only get three more if I tried my absolute hardest. If it was two reps in reserve, I could only do two more. That's like the general area we're looking for. So, you could use a really lightweight, do a lot of reps, but still get to that area where you could only do one or two more, and that's going to be a solid stimulus for muscle growth. I want to throw a clinical scenario right here. So, let's say maybe this hopefully drives something home. So, traditionally, we've been hesitant to prescribe resistance training for people with, maybe, let's say, knee arthritis, right? Because we're feared that heavy loads might damage the cartilage. And exacerbate the pain. So, beyond the problems with that simplistic view, which I've talked about before, the biomedical model is like no longer exists. But besides that simplistic view, let's pretend that a patient still holds on that view. So, they're saying, I am worried about the doc. With these recommendations here, we can say, okay, cool. Let's apply lower loads to the joint while still getting the muscle to grow. So we can do this. So we can prescribe a very lightweight. Specifically 30% of their one rep max, which is estimated, and just do high reps in them. And when they lift the weight over and over until they feel deep fatigue, Something amazing happens biologically. Even though the weight is light as the small muscle fibers tire out, the nervous system relies on the size principle, meaning that As fatigue sets in, the brain is forced to recruit larger fibers, the big fast-switch muscles, just to keep the limb moving. And so, the result, you get the exact same muscle growth as a bodybuilder. Who's lifting a lot more potentially? So, obviously, that's a little bit hyperbole. You won't get the same thing as a bodybuilder, but that is a very valid use that people in bodybuilding actually do use. So, they can use lower load and high reps. And so. Overall, low load, high effort training builds muscle safely in lots of populations. So that's an example that we talked about. Now, let's move from strength and hypertrophy to our third target power. So in primary care, We hear a lot about sarcopenia, right? Which is the loss of muscle mass, but there's also an interesting thing that I read about called dynapenia, the loss of muscle strength and power. And so, from a basic physics perspective, power equals force multiplied by velocity, right? So, force times velocity. And as we age, our bodies undergo a very specific, selective, fast twitch fiber loss. We lose our velocity. Long before we lose our raw baseline strength. It's the difference between having the raw force to slowly stand up from the chair and having the power to throw your leg out fast enough. To catch yourself when you trip on a ruck. That's kind of what the difference between power and strength is. And because of that, power is the absolute critical factor for fall prevention, right? Having that power. And to train this, well, we kind of shift gears a little bit. The prescription is a 30 to 70% one rep max load. So, once again, kind of a wide range, but lower here. And so it's very moderate manageable weight. But the key to making this work is keeping the volume extremely low, less than 24 total reps perception. And why is that? Well, because if you do too many reps, metabolic fatigue sets in and the movement slows down. And you're no longer training power, you're training endurance. And we talk about power training as well. One thing is having intent. So, power training is usually trying to be explosive and it's working as fast as we can. So, trying to push things up safely, obviously, but quickly as possible, and force really matters. We'll talk more about that. But for power training, this is very, very critical for fall prevention and even more so than necessarily simple strength. They obviously go hand in hand. Like, if you do lots of heavy lifting, you're going to have probably more power because of that. But you can train specifically for power with these rep ranges and these load ranges. And so when I say train for power, people immediately picture a young athlete throwing heavy barbells over their head. And yeah, sure, that can do that. But Here's the nuance we need to explain to our patients. During a lift, the bar doesn't actually have to move fast. What matters more is the explosive concentric face, so the intent and the lifting or pushing part of the movement. That's really, really important. And so, when I, once again, let's do concentric here for biceps to easy. Concentric is coming, it's contracting with the muscle shortening. And so, that intent. Hard going, challenging, and bringing it up in the concentric phase, that is the most important. That's kind of the biological trigger for kind of saying, hey, the muscles, we're going to try to accelerate this. And so the attempt to move it fast and as fast as possible is really what counts. The brain then sends a signal to explode the muscles, recruit more motor units, and neurologically get everything going and required for this. Power of a movement, and so we get these fast switch muscles, and that's what we're going for. And when we're recruiting these fast switch muscles, that's how we preserve them, right? By using them over and over. So, that's really what we're looking for because of this. Physiology, you can actually have a slow bar speed, but massive neural drive as well. However, they do recommend making it a moderate load, as I mentioned before. Not going crazy high, but the intent is really important. Like, as I mentioned, you will gain power if you lift really, really heavy, but you can also develop the skill at a much lower, and for some people, More manageable weight, that's really really important. So, if they push a moderate weight fast and hard, the brain is adapting for power, even if the movement looks like it's happening, um, you know, at various speeds. So, whether it's slow or fast, and there's lots of things you can nerd out about this, like velocity-based trading. You can like put it on the barbell and see how fast you're going. That doesn't matter. The intent is really what matters. And so, yes, can you do Olympic snatches or cleaning jerks? Yeah, you can absolutely do that, but it's not required. You can use traditional exercises. And with intent, and it will be helpful, and we can get this power training there. So, very, very important power training, often underutilized and not talked about, but the position stand did a great job talking about that. And so now I want to talk about a couple myths that we kind of hear a lot in Primary Care about lifting. So, first is talking about training of failure. Weightlifting culture and gym culture in general, it's no pain, no gain, right? And I'm not saying we shouldn't work hard, that's not the case. But when we look at this data, we see that failure is not biologically superior for building strength or muscle in the general population. So, pushing a set to absolute grinding failure adds negligible physical benefit, but comes at a pretty steak physiologic and neurologic cost, right? So, it causes a massive spike. In central nervous system fatigue, right? So essentially frying the nervous system and making recovery much harder for that patient. So you're going to have to, you know, spread it out, take a much longer rest if you're grinding things out. And also, you might have to take multiple days of rest. So it kind of causes. A lot of stress in the body, which we don't necessarily need. There's the theory behind that that also, if we're grinding the failure, it may cause acute vascular or sympathetic stress, which Isn't necessarily known to be dangerous, but is a consideration for people who aren't used to that sensation or are worried about it. And so, as I mentioned before, the prescription is two to three reps in reserve. So, tell your patients to work hard, but to deliberately stop the set when they feel they could still complete two or three more repetitions with good form. And so, this approach provides Incredibly safe margins for their heart, for their nervous system, for everything, while giving similar results to those who push themselves to the point of physical collapse. And so, am I talking about the elite bodybuilder who wants to eke out every single You know, gain possible in their muscles. No, that's not what I'm talking about. If you're looking at this thing, Jordan, you're an idiot. I'm not talking to you. You know, you probably know much more than I do about this. But overall, we don't have to go crazy high to failure to get really, really big improvements. And that's like the myth number one. Next, let's talk about some stability. One favorite thing of mine is stability or functional training. So, we're going to talk about unstable service training. We constantly have patients asking that they need to be on, you know, like, or they, you know, I've had patients come to me and say, hey, Is this better if I stand on a bo-su ball or a bounce bar or something like that, as opposed to doing just regular traditional exercises? And the science here is wonderfully freeing and decisively negative, meaning. When you put a patient on an unstable surface, you cause a protective biological reaction where the unstable surfaces actually down-regulates force, meaning like I can't handle as much, so we cannot. Take this big load. So, the brain gets so focused on not falling over that it actively prevents the muscles from pushing hard. It literally puts the brakes on them, saying, Hey, like, we can't handle that. So, as clinicians, We have to clearly delineate between balance training versus strength training. Both can be important. I'm not saying there's no place for this. I'm just saying that if we're going to do. One, we should pick which one we're going for. Because if you do both, you're probably doing neither of them very well. And so if you try to do both at the same time, you fail to maximize easier. So for strength, you absolutely should put your patients on solid ground. I think that's probably the best. And here's the best news for our older patients. Who are intimidated by free mates as well, the data conclusively shows that machines equal free weights for adaptations, meaning like you get the same adaptations whether using machines or Or free weights. And so muscles don't know if they're pushing a heavily, you know, an engineered leg press or a barbell. It doesn't really matter. And so when it comes to modalities, use what your patients prefer. If they feel safer and more confident locked into a machine, then let them use it. That's fine. Remove the complexity. In fact, it was shown in this review that simple strength training improves balance. So you could honestly just do that and you'd still be receiving balance benefits. So. I'm not here to say that we can't do balance training. I'm just saying strength training, if I had to pick one, is going to be a much higher priority because doing strength and power and stuff like that will automatically improve balance as well. And then if you're saying, hey, I want to do some more fun things for balance. We can absolutely do that. But overall, I think training for strength, like doing that, will be much more high yield than rather than just doing like bosu ball stuff. Once again, not knocking boast ball off at your thing, that's okay. There are some applications for it, but in general, most people would benefit from just doing more strength training, I think. And so now let's tackle the third myth. It's a big one, which is the idea that you need a highly regimented, complex plan to see results. So if your patients look up how to start lifting online, they might see Terms like microcycle or macrocycle or undulating periodization. And it looks like an advanced math assignment, but as clinicians, we need to reassure them that spreadsheets Are not requirements, not by any means. Periodization is just a complex counter. So when I think of periodization, we talk about high-level athletes. Like, let's think about Olympics. Like, hey, in four years, I need to peak. That's what it is. So we think about year one, two, three, four. When are we going to competitions? When it's a big term in the sports, medicine, and strength and conditioning world. We don't have to worry about that. Pretty much, we don't have to do that. The actual engine that's like making changes here is simple progressive loading. And so, this is a side ramp for me. I will, you know, if you want to skip forward 30 seconds or however long it takes. But I want a clarify idea of progressive loading versus progressive overload. And so they're constantly used interchangeably online, but I'm going to explain why they're not quite the same. And as you see, I prefer one versus the other. And so. Generally, there are two ways people look at this. The first view is that the traditional view of progressive overload, that seems that slapping on more weight onto the bar is the actual biologic trigger that forces your body to adapt. Basically, the belief that lifting heavier makes you stronger. The second view flips that kind of completely around. And it's the idea that progressive loading, talking about as you naturally adapt, as your body adapts to the current weight and gets stronger, you have to increase the load just to keep up with your own progress. So, it's not that lifting heavier weights makes you stronger, it's that getting stronger allows you to lift heavier. And is it critical to know this difference? Probably not. In the literature, it mostly uses the term progressive overload, but I wanted to mention it because it's kind of a pet peeve of mine. If you want more concept about this, I'm more than happy to talk in detail about this. But this is just something that's important to me is because eventually you hit a point where you can't go further, right? And all of a sudden, it's like, oh. Progressive overload stops. Like, well, it's not the case. Like, we just need to change some variables. But this is a Jordan Renicky rant. I'm sorry, but we'll get back to the idea of this. So, back to the idea of programming. The 2026 data shows us clearly that complex puritization is not necessary for general health. Yes, having a plan is a good idea and you're likely to see better results. But the essentials are telling people they can just go do something and they're still going to get benefits. And yes, a peer-to-peer program. Will work better for a high-level athlete, as I mentioned. But for our patients, the counter doesn't really matter. The only thing that matters is progressive stimulus applied over time. So that's pretty much the entire secret. We have to guide them to focus on consistency over complexity. Don't let, you know, spreadsheets or crazy programs worry about them. Yes, I do recommend everyone having a plan. Because if you've walked into the gym, And you have no plan, you're not going to get stuff done. But you do not need to sweat about this. To make improvements enough to get all the benefits of general health, you don't need a complex program, just a simple idea, and resistance training is going to be all you need. And so now let's talk about how we deliver this into our patients' lives. So, specifically using something so simple, but non-traditional like body weight or resistance bands is cool. So, the 2026 guidelines Explicitly highlight elastic bands and the physiology behind why they work so well. So they provide what's called a variable resistance that matches our natural strength curve. What that means is as you stretch the band, it physically gets harder to pull. So, this perfectly matches human biomechanics. The movement provides the most resistance. Right when your joint is at its strongest mechanical advantage. So it kind of meets you where you're at. But it's not about just isolating one muscle, right? The data shows that bands are highly effective for multi-component function. They mean that they don't just train a single muscle in a vacuum, they train the whole body. In multiple different muscles. And this also directly improves gait speed and balance they saw. And these are things that can allow a patient to live at home independently or end up in a nursing facility, right? So if you all have solid gait speed and balance, you're more likely to live on your own. And so By approving these essential functions, this simple intervention has a direct impact on all cause mortality as well. We are literally extending the functional lifespan of someone. And the best part? It's incredibly accessible, right? They mentioned resistance span, but it can be body weight. There's really no thing you have to do. It's accessible, low-cost, and requires no gym. A patient can do this in the living room if they wanted to while watching TV. And skeletal muscle doesn't know if it's pulling against a $5,000 selectorized cable machine, like a perfect one that's calibrated, or some bands that are anchored to a bedroom door. Yes, at the end of the day, will this get you maximum gains? No, absolutely not. But once again, there's no excuse now. We have data showing that pretty much doing anything is better than nothing. So there's no excuse at this point not to be doing something. And I do want to talk a little bit about one finding here that was kind of interesting in the study. And so it's a little bit of pushback you might get if you read that. Jordan, what's going on? They looked at something called the short physical performance battery or the SPPB. And for those who aren't familiar with that, the SPB is a common clinical tool used in geriatric literature to assess lower extremity function. And it's a composite score, meaning it's added up of multiple things. And in the reviews, they saw null composite score findings. And yes, this was the finding, but the authors mentioned this null finding was most likely a result of severe data sparseness. Because if we break it down, It's interesting. In the umbrella review, they found that only two reviews actually looked at these SPPB scores. So we just didn't have the statistical power to show a big difference in there. However, When you break the SPP down into its parts, the individual components, specifically gate speed, balance, and chair stands, they all showed improvements. With resistance training on their own. And so, yes, the p-value for here did not necessarily show significance on the aggregate here, but like context is everything, right? If a patient is walking faster, balancing better, and getting out of their chair easier, they are functionally doing much better despite what that's PPB shows. And so that's just one thing I wanted to mention from a Kind of an evidence-based medicine perspective, like, yeah, it's helpful to see those things, but understanding a statistical quirk can be helpful to understand, like, hey, let's look at this with our brains and actually look at it and understand what they're saying. And so, another thing I want to talk about, and I'm sorry, I'm keep going here, but it's a big, big document. And I really want to talk about this idea. So, for decades in primary care, we've operated on the assumption that, you know, for exercise safety, we confidently tell our patients: hey. Go on a walk on a treadmill or do some cardio because it's safer. And we cringe at the thought of them lifting weights because we worry about them straining and having a heart attack, right? That's what everyone's worried about. Well, the 2026 data Pretty much inverted and flipped all that on its head. So, let's look at the data they looked at here. They looked at a study of 1,174 patients with coronary artery disease. And so, once again, not healthy college kids. These are people who have a real established. Pathology, coronary artery disease. And during their exercise protocols, there were 63 events during aerobic training, meaning 63 cardiovascular complications occurred while they were doing the safe cardio. And how many events occurred when they were lifting weights? Zero. There were zero events during resistance training. Now, this isn't a massive data set, I understand that, but it gives us the evidence-based permission we need to stop tiptoeing around strength training. It's exceptionally safe, even with established pathology. We have historically avoided this. Because we were worried about this, and they're saying, hey, we're worried about the heart attacks, but statistically might be even safer than cardio. And so, resistance training has a potential superior safety profile compared to aerobic training in cardiac populations. And so, we really should not be afraid of this. And why is this the case? You may say, well, I'm not quite sure, Jordan. That doesn't make sense. Here's an idea I've kind of seen in some literature. It wasn't necessarily talked about a lot in the paper. But the main hypothesis comes down to the intermittent nature of resistance training, right? So it can be thought that weight training is like a short stress with a built-in recovery, whereas aerobic exercise is continual stress. So when a patient performs a lift, It might take 15, 20, 30 seconds. Yes, their blood pressure goes up very high temporarily, but immediately after they stop and rest. And these built-in rest periods allow myocardio recovery, right? This is a classic issue of sustained. Versus intermitt oxygen demand. Aerobic exercise like jogging on a treadmill for 30 or 45 minutes requires a massive unyielding Sustained demand for oxygen from the heart muscle, right? So, but with resistance training, as soon as the set ends and demand drops, it leads back to normalization of coronary perfusion. So, meaning blood gets back freely to the heart, no issue, and it doesn't have a high demand, whereas Over time, we have a high sustained demand when doing sustained cardio. And so that sustained 45-minute aerobic exercise demand is probably what causes the ischemic mismatch and leads to these events potentially. Once again, this is. A little more, not necessarily definitively known, but that's the idea of why we're thinking. So we know the heart needs oxygen, but the pipe is too narrow to deliver it potentially in these patients continuously. So giving a break might be helpful. And so. That's the proposed mechanism that intermittent rest periods may make resistance training hemodynamically safer than sustained cardio. But I'm not going to say you should not do cardio. That's not the case at all. You should be doing it. Cardiac patients should be doing it, they can do it safely. They should probably need a graded exercise program, and so that's a whole other thing behind the scope of this, but just wanted to mention that. And so now, as we're winding down here, let's talk about the 30-second counsel, the exact script you can use tomorrow morning when a patient asks what they should do. You can tell them the frequency is a minimum of twice weekly, right? So, the minimum effective dose to build a foundation we're recommending is two times a week. You don't need to give them a complex body part split, meaning like I need to do you know buys and tries and legs and glutes. Like ultimately, you could pick like three movements: like a push movement, which is like a push-up, a pull, which could be a ring row, or a pull-up, or banded rows. And then a leg exercise, whether that's a squat or a lunge or whatever, that covers the vast majority of the functional muscle mass. Like, that would be a great start. If no one's doing something, just do that. That's perfect. It covers most of what we need. And when they ask you what you should use, you can say, hey, use whatever. You can use elastic bands, body weight, household objects like heavy jugs of water. You know, you can go to a park, you can do so many things. We want to remove every possible barrier to entry. And then, on top of that, what we want to do is clarify the intensity, right? So, hey, tell them we want you to work hard, but not to failure. Stop when the movement slows down, and you know you only have two or three good reps left in the tank. That's it. This is the 2026 prescription. By stripping away all the fitness industry noise, we provide accessible resilience for all ages. Whether they're 25 or 85, this simple framework works. And so effective resistance training can be distilled into Just a couple simple movements twice a week using whatever tools are available. Like, that's a great place to start. And then, yes, hopefully, they get bit by the lifting bug and get stronger and want to do this more. And that's the whole goal. More exercise is going to be better, but the bar for getting better is very low, and just doing something seems to be helpful. And so, ultimately, I have a vision that we don't just hand out paper to patients: say, here's this. We hopefully dispense standardized, you know, green bands or red bands or tubing or whatever at the pharmacy right next to medications we're giving them. And primary care, I want them to be comfortable enough to prescribe exercise. Understanding, like having time to do that. I get that. Like, I get that for sure. You're like, Jordan, I don't have time. Totally get that. That'd be my pipe dream, though. Right. So, but I've said it before: if exercise were a pill, it would be the most prescribed medication of all time because of all the amazing effects. And so. I think we should be talking about exercise with the same seriousness and vigor we do as any medication that we prescribe. And so, exercise should be a conversation you're having with patients all the time. And so we have this playbook. We have a much larger data set that gives us a lot more data. And we know that resistance training is exceptionally safe. And if we have learned anything from this entire document, it's that something is better than nothing. And consistency will be complexity any day of the week. And that's going to be it. If you did find this helpful, it means the world to me if you share this with a friend or colleague. But now get off your phone and get outside and have a rest of your day. We'll see you next time.
