Ragav Sharma, DO is a Physical Medicine and Rehabilitation (PM&R) physician with training in interventional spine and musculoskeletal medicine. He formerly set powerlifting records and has also completed several races including ultramarathons. He is an avid proponent of resistance training and has coached others, obtaining a Certified Strength and Conditioning Specialist (CSCS) certification, for both general health and powerlifting goals. 

In this episode, Dr. Ragav Sharma breaks down the science and strategy behind resistance training — one of the most powerful tools for improving long-term health, performance, and longevity. We explore what the evidence says about strength training for muscle growth, fat loss, metabolic health, injury prevention, and healthy aging. If you’ve ever wondered how often to lift, what exercises actually matter, or whether resistance training is “safe,” this episode gives you the no-nonsense, research-driven answers.

Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:

Bodyweight exercises

Free weights (dumbbells, barbells, kettlebells)

Resistance bands

Machines

Household objects (backpacks, water jugs, cinder blocks)

Strength training is not just for athletes or bodybuilders. It is one of the most potent therapeutic tools we have for improving overall function, mobility, and longevity — and it should be accessible to everyone.

Resistance training:

Increases fat-free mass (muscle)

Reduces overall and visceral fat

Helps preserve muscle during weight loss or GLP-1/GIP therapy

Predicts lower mortality independent of BMI

Muscle is metabolically protective. Higher muscle mass is associated with a lower risk of chronic disease and death, even in those with a high BMI.

Bone density peaks around age 25–30 and declines after 40, especially in women. Walking alone does little for bone mineral density.

Mechanical loading — squats, deadlifts, step-ups, weighted carries — is essential for:

Increasing bone density

Slowing osteopenia and osteoporosis

Reducing fracture risk

Maintaining physical function later in life

One of the strongest demonstrations is the Lift More Trial, where women 60+ with diagnosed osteoporosis safely performed heavy squats and deadlifts twice per week. They improved bone density significantly, with only one mild strain in over 2,600 sessions.

Many people assume aerobics is the only way to protect the heart. The data tells a different story:

Any resistance training → 19% lower cardiovascular mortality

Improves LDL, HDL, triglycerides, blood pressure

Enhances functional capacity in heart failure patients

The best results come from combining aerobic exercise with strength training — but strength training alone has a meaningful impact.

Strength training increases insulin sensitivity through GLUT4 upregulation and:

Lowers HbA1c in both type 1 and type 2 diabetes

Reduces visceral fat, a major driver of insulin resistance

Improves metabolic flexibility

For people unable to tolerate high-impact cardio, resistance training becomes even more important.

The psychological benefits are just as powerful:

Significantly reduces anxiety symptoms

Lowers depressive symptoms in adolescents and adults

Benefits occur regardless of strength gains

Simply engaging in resistance training reliably improves mood and mental well-being.

Movement is medicine — and resistance training consistently reduces pain:

Decreases chronic low back pain

Improves pain and function in knee osteoarthritis

Helps patients with fibromyalgia reduce fatigue and tender points

For general musculoskeletal pain (3–7/10), strength training should not be avoided — it is often one of the most effective treatments.

Inactive adults lose 3–8% of muscle per decade, accelerating after age 50. Resistance training:

Rebuilds strength and muscle

Improves gait speed, grip strength, and mobility

Reduces fall risk

Lowers frailty and functional decline

Most importantly:

This is one of the strongest arguments for making resistance training a standard part of preventive medicine.

Despite overwhelming evidence, only about 10% of adults meet strength training guidelines. Common barriers include:

Fear of injury

Lack of knowledge

Lack of time

Misconceptions about “proper form”

Intimidation around gyms

Poor clinician guidance

Social stigma

Limited access to equipment or facilities

But most barriers are built on incorrect assumptions — and many can be addressed effectively.

Weight training has one of the lowest injury rates of any physical activity:

0.05–0.31 injuries per 1,000 hours
Compare that to:

Running: 2.5–33

Basketball: ~8

Tennis: 27–62

Golf: 3–8

Strength training is far safer than most sports.

Data shows:

Powerlifters report no major back injuries in squat/deadlift reviews

Only 6.5% of disc herniations are related to heavy lifting

Most herniations occur during daily tasks like mopping or twisting

A well-dosed program protects your back — it doesn’t harm it.

People with knee osteoarthritis benefit from resistance training:

Reduced pain

Improved strength

Better function

Lower disability

Even common “faults” like knee valgus are not inherently dangerous.

Strength training is safe and effective at any age — including people with:

Osteoporosis

Arthritis

Chronic pain

Frailty

The Lift More Trial proved heavy lifts can be safe even in 60+ adults with fragile bones.

The research shows:

60 minutes per week → maximum longevity benefit

15–20 minutes per week → effective for muscle and strength

“Exercise snacking” (5 minutes) → still beneficial

Time is not the barrier — expectations are.

Form matters, but not the way most people think.

CrossFit (irregular form) has injury rates similar to powerlifting

Machines and free weights produce similar strength gains

“Good form” is often just what feels natural and safe for the individual

The real risk factor isn’t form — it’s doing too much, too soon.

Here is a simple evidence-based template:

Push (push-ups, machine press, overhead press)

Pull (rows, pulldowns)

Squat (goblet squat, leg press)

Hinge (deadlift variation, hip thrust)

Carry (farmer carry, loaded hold)

3 sets

8 repetitions

Twice per week

That’s it. This template is enough to significantly improve strength, function, and metabolic health.

Avoid nocebo language (“deadlifts will hurt your back”).

Focus on function, not weight loss.

Give general guidance — not detailed workout plans.

Celebrate adherence to ACSM guidelines.

Identify the patient’s stage of readiness to change.

Provide reassurance, clarify myths, and help them feel capable.

A simple conversation can dramatically shift a patient’s willingness to exercise.

Resistance training isn’t just a fitness trend — it’s one of the most powerful interventions for:

Chronic disease prevention

Pain reduction

Bone health

Metabolic health

Mental well-being

Mobility and independence

Longevity

And best of all, the maximum health benefit requires only one total hour per week.

If we could package resistance training into a prescription pill, it would be the most effective blockbuster drug in modern medicine.