The Art and Science of Fitness | Strength training too is needed for cardiovascular health

These seemingly controversial words were spoken in the early 1980s by Arthur Jones, the father of high-intensity training and a pioneer in introducing resistance training for medical purposes. Is this statement of his true, or was it just an attention-seeking stunt?

I was first introduced to Jones’ work two decades ago when I was heading Kieser Training, a Swiss-German medical strength training rehabilitation centre in London, between 2004 and 2006. We were using medical and preventive strengthening machines made by MedX, Inc., a company founded and owned by Jones. He had sold off Nautilus, Inc., where he made cutting-edge strength training machines. Besides the hardware, his training protocols were far ahead of their times.

Understanding loss of muscle strength

An article titled ‘Sarcopenia and Cardiovascular Diseases’, published in the May 2023 edition of Circulation journal looked at the role of muscles in patients. Sarcopenia, usually associated with old age, is the progressive loss of muscle strength, mass and function, leading to a decline in physical functioning and loss of independence, increasing the risk of disability, falling, hospitalisation and death. It also has a vicious circle associated with cardiovascular diseases.

Sarcopenia can lead to excessive fatty tissue in the body, insulin resistance (diabetes) and chronic inflammation, predisposing the individual to have a higher chance of getting cardiovascular diseases. Other conditions like chronic inflammation, malnutrition, as well as decreased physical activity in cardiac patients also lead to sarcopenia.

Dr Abdulla A. Damluji and his colleagues, the authors of the 2023 study suggested that besides loss of type-II muscle fibres, satellite cells — which are the skeletal muscle somatic stem cells responsible for muscle repair and regeneration — deteriorate in sarcopenia. On top of that, there is fat infiltration of skeletal muscles, which can be an independent process from loss of muscle mass and function. Then there is sarcopenic obesity, in which individuals are obese while having weak muscles, reduced muscle mass and declined muscle function. These individuals have the highest occurrence of cardiac issues.

Not enough movement leads to weak muscles, which in turn, weakens the whole system, and those weak muscles, lead to the person not having the capability to move enough. This can lead to a diagnosis of sarcopenia, but muscle weakness can occur even without sarcopenia.

On top of that, midlife obesity puts even more pressure on the system and sarcopenia soon follows. And then medical professionals tell obese cardiac patients to walk or run. If the muscles and bones aren’t strong enough and have excess baggage to carry, we actually make the condition worse by straining the heart and the rest of the system. What is needed is to get started with strength training, gradually increasing the load, one pound at a time. Once those muscles are stronger, which will be gradual, there is going to be less load on the heart.

Always remember that muscles are an asset as they help you move, unlike fat, which is a liability as you need to carry all that weight.

This is not to say that aerobic exercises like swimming, walking, cycling, trekking and even running don’t have a role to play in preventing sarcopenia whether for cardiac benefits or other chronic conditions like back and knee pain, kidney disease, diabetes, high cholesterol, and cancer, among others.

Christine’s success story

A decade ago, 60-year-old Christine Pemberton had come to me for her knee pains. On May 3, she summited Lobuche, a 6,119-metre mountain in Nepal.

Pemberton shares, “The tears I shed on the summit were of gratitude for being privileged to witness such sublime beauty. Gratitude for being strong enough to climb. Gratitude for recovering from cancer, and a million other things. I got into the fitness, exercise and running game rather late in life — exactly 10 years ago — my 60s have been a decade of huge learning, of huge joy, of successes that excited me beyond reason, as well as some silly injuries and niggles. The overwhelming feeling has been one of pleasure and, yes, pride in getting fit and staying fit. As I headed towards my 60s, my knees weren’t in great shape — two double arthroscopies and still I was in pain. Luck, and a good friend who was sick of my moaning about my aching knees, led me to the door of Dr Rajat Chauhan. The good doctor promptly told me there was nothing majorly wrong with my knees, that I simply needed to strengthen muscles, and focus on specific exercises and then, as a gateway drug, the doc got me into a running programme, a Couch to 6k in 12 weeks.”

Pemberton added, “If I could change one thing about the last 10 years it would be to have heeded Doc’s advice to strength train more. As it was, I was so thrilled at being able to run marathons, and take part in huge races, that I got a bit swept away, and blithely ignored Doc’s strength training advice. That has all changed now since I have a personal trainer who comes home and I am currently obsessed with weight lifting, but I regret the 6 to 7 years when I simply ran, without also working on strength. Strength training has been just as much of a game-changer as learning how to run. My lower back pain niggles — gone, gone, gone. The ability to bend and pick up heavy weights has given me a feeling of confidence that I can tackle my 70s in good shape. I know that part of the reason I enjoyed my summiting of Lobuche last week was that my arm and leg strength were both better than ever, thanks to strength training.”

Perils of an unfit lifestyle

It was at Kieser Training that I was made aware of the importance of muscle mass, muscle strength and physical performance in back and knee pains, besides other medical conditions, something we otherwise underestimate as doctors. Back then most of the people who consulted me were retired. Within a couple of years, the average age of the people approaching me for help with their back and knee aches was the 40s. I associated the sudden drop in the age to the change in our working style: using computers for long hours. By the time the first iPhone was released in 2007, the average age of people I was seeing reduced by another decade. And in the last decade, to my horror, the usual person I see with back and knee pains is in their 20s, even some teens.

When I get three generations of the same family together in my consultation room, it never ceases to amaze me that almost always, the youngest of the lot are usually the most unfit. They barely get to the chair-level while squatting, and when it comes to trying to touch their toes, they just about make it past their knees. When they sit, their posture is worse than their parents and grandparents. It makes me wonder if we should change the phrase ‘don’t sit or stand like an old person’ to ‘don’t sit or stand like a youngster’.

Then come their parents, some of whom would cross the chair level while squatting and manage to get to their shins while trying to touch their own toes. When it’s the turn of the grandparents, they, almost always, happily squat down all the way and touch their toes with their palms, leave alone fingers. And they have the best posture of the lot.

Key tips to get started

I got excited when 73-year-old Mr J S Chadha, the founder of the restaurant Pind Baluchi, dropped into the clinic the other day and asked, “Earlier I could easily pull 18-hour working days. Now, I feel tired all the time. I want to get back to life. Will I be able to get stronger at this age?”

I smiled and told him something that’s relevant to all of you reading this. “We all have a basic characteristic of getting stronger when we do resistance exercises, no matter what the age. It’s just as we age, our response to strength training might be a little slower. We need more recovery time. Just start slowly, progressively increasing the weights and time doing the exercise, and time on your feet while walking or jogging. Please don’t pick up strength training and aerobic exercises as rehabilitation only for 2-3 months, but for life. Post 80, instead of doing three strength training sessions in a week, maybe do only two. That is for high-intensity exercise. But it is important to stay active and do exercises every day.”

Here are some pointers for you to get on with strength training, whether on strength training machines, weights or free bodyweight exercises.

• Use weights or choose an exercise that seems easy to begin with

• Focus on the form and not just on getting done with the exercise

• If you feel the strain somewhere other than the body part the exercise is meant for, you are doing it incorrectly

• Keep the movement slow. Don’t be in a rush. Follow a 4-2-4 seconds protocol. Do each repetition over 10 seconds

• Do not have your breathing in sync with movement. Let it be independent. Do not close your mouth and do not hold your breath. Remind yourself to relax your shoulders at all times

• It’s a good idea to get a metronome app on your phone to sync to your movement. One easy way to pace the repetitions well is to count seconds as ‘1 one thousand, 2 one thousand’

• Do only 6-9 repetitions per exercise. Effectively that becomes 60-90 seconds per exercise

• Take a 1-2 min gap between different exercises. If you need more rest, that’s fine too. As you get used to the exercises, you’ll not need long gaps between exercises

• One single set per exercise is ample. The first 2-3 repetitions become warm-up for the exercise. The real adaptation happens in the last few repetitions

• Do exercises for the whole body, rather than thinking about different body parts on different days

• Total time for the workout will end up being less than 30 minutes

• This protocol is only followed on alternate days, i.e. 3 days a week. Rest of the days, do easy workouts

• Recovery days become very important to allow the loaded muscles to optimally adapt and become stronger

The one big mistake you’ll make is that you’ll try to rush it or start where you left off. At heart, you are definitely only 16, but your body has matured a bit. Take it slow, one baby step at a time. And as I mentioned above, keep the movements slow, not jerky and explosive, while you breathe easy. More muscle fibres are engaged when you move slowly. Magic is bound to happen, one movement at a time.

Dr Rajat Chauhan (drrajatchauhan.com) is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

The views expressed are personal