Ragav Sharma, DO
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.
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Show Notes
What Is Resistance Training?
Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:
Free weights (dumbbells, barbells, kettlebells)
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.
The Evidence-Based Benefits of Resistance Training
1. Improved Body Composition
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.
2. Stronger Bones and Lower Fracture Risk
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:
Slowing osteopenia and osteoporosis
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.
3. Cardiovascular Benefits
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.
4. Improved Metabolic Health
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.
5. Mental Health Benefits
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.
6. Reduction in Chronic Pain
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.
7. Frailty Prevention and Improved Longevity
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
Lowers frailty and functional decline
Any strength training → 15% lower all-cause mortality
~60 minutes per week → 27% reduction (maximum benefit)
This is one of the strongest arguments for making resistance training a standard part of preventive medicine.
Why Most People Still Aren’t Strength Training
Despite overwhelming evidence, only about 10% of adults meet strength training guidelines. Common barriers include:
Misconceptions about “proper form”
Limited access to equipment or facilities
But most barriers are built on incorrect assumptions — and many can be addressed effectively.
Resistance Training Myths — Debunked
Myth #1: “I’ll get injured.”
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:
Strength training is far safer than most sports.
Myth #2: “Squats and deadlifts will ruin my back.”
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.
Myth #3: “I have bad knees. I can’t squat.”
People with knee osteoarthritis benefit from resistance training:
Even common “faults” like knee valgus are not inherently dangerous.
Myth #4: “I’m too old to lift heavy.”
Strength training is safe and effective at any age — including people with:
The Lift More Trial proved heavy lifts can be safe even in 60+ adults with fragile bones.
Myth #5: “It takes too much time.”
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.
Myth #6: “I need perfect form.”
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.
How to Start Resistance Training (Safely and Effectively)
Here is a simple evidence-based template:
Pick one movement for each pattern:
Push (push-ups, machine press, overhead press)
Squat (goblet squat, leg press)
Hinge (deadlift variation, hip thrust)
Carry (farmer carry, loaded hold)
Do:
That’s it. This template is enough to significantly improve strength, function, and metabolic health.
For Clinicians: How to Talk to Patients About Strength Training
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.
Final Takeaway: Strength Training Is Preventive Medicine
Resistance training isn’t just a fitness trend — it’s one of the most powerful interventions for:
Chronic disease prevention
Mobility and independence
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.
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