For those who don’t know me or haven’t known me long, it may be surprising that I am not just an exercise advocate, but a recovering meat head. Specifically, whilst I spend a lot of my time in the endurance sport world now, there was a period of time where the extent of my pure endurance training was a some high intensity interval work and a 5km once a week. The rest of my training week was lots of heavy metal (in all meanings of the phrase). This is all as a declaration of biases in favour of resistance training - I couldn’t be more positive about it.
It is with this in mind that a paper I saw recently really took me by surprise!
The paper looked to answer the question of whether resistance training helps people suffering myositis (more on what this is below). It is one of the very few areas that I have seen any evidence that resistance training helps and been surprised by the findings. The fact that I am rarely surprised stems partially from my biases and partially due to the seemingly universally beneficial nature of resistance training.
A Quick Explainer on Myositis
The name, myositis, is Latin: “Myo-” being of the muscle and “-itis” being inflammatory in nature. Medicine is full of Latin based diagnoses which in effect are just labels for what the diseases comprises of (super helpful for medical students, especially the 5 who speak Latin). In the case of myositis, it is characterised by a muscle biopsy showing inflammation of the muscle cells. The term myositis actually refers to a heterogenous group of rare autoimmune diseases (but I promised to be quick so I will leave it there).
The classic symptoms of myositis include weakness and reduced endurance and current treatments are usually systemic steroids. Often even after these patients have received their treatment they have some lingering weakness and reduced quality of life (hence the reason this study was done).
What Did the Researchers Find?
In short, after 16 weeks of the twice weekly training, there were significant improvements in quality of life when comparing the intervention group (doing resistance training) to the control group. Similarly the resistance training also improved functional capacity, endurance and strength. Most importantly, the training did not cause disease flare-ups.
Why Were the Findings a Surprise?
The very short answer to this is; myositis is an inflammatory condition (of autoimmune origin) and exercise itself is inflammatory. That’s right, in the short term, exercise increases inflammation, because ultimately it is about catabolism (breaking down) of tissue to then have anabolism (building back) of the tissue to result in being stronger in the long term. This process involves an inflammatory milieu as part of the signalling cascade for recovery (also why ice baths and anti-inflammatories should probably be avoided in the immediate post workout window if you’re looking for long term adaptation) and I erroneously assumed this could exacerbate myositis. Upon reflection I am a little annoyed at myself for this as resistance training has been repeatedly shown to be beneficial in these sorts of situations (more on this later) in other conditions but for some reason when it involved the muscles I’d thought this may not apply.
Why Are These Sorts of Trials Necessary?
The surprise I, as the most ardent resistance training advocate, showed speaks to the fact that there was potential for resistance training to be less than positive in this group of patients. Thus it is infinitely necessary for a trial such as this one to be performed.
Failing the chance of significant negatives (which in this case could be envisioned) there’s no reason to not recommend strength training, but there could be an argument that without data we may not know that it was beneficial. For the record, I will acknowledge this viewpoint for academic honesty but truly believe it to be fairly weak - we cannot do research on everything and in issues without great financial incentive it is hard to believe we will see all the research we need. Science is a process and way of thinking, in which we can make inferences. For example, the fact that resistance training is almost universally helpful suggests it will probably help and there without contraindications we should be prescribing it. The viewpoint that we cannot without research is less truly scientific and more religious (with the religion being science).
Ultimately in this specific case, the trial was very necessary to show resistance training was both safe and beneficial. In similar cases, however, the research is more of a ‘nice to have’ in my opinion as the likelihood of resistance training being positive is so high. That said, the trials may aid us in convincing patients to engage with resistance training (though the knowledge action gap is huge; see diet, smoking etc and more research doesn’t generally help bridge the gap) or more importantly, practitioners to prescribe and encourage it.
What Stops These Sorts of Trials?
In general trials such as this struggle to get funded as they aren’t cheap and there’s not a great deal of funding available. Without significant financial incentive research can be quite difficult to find funding for (the opposite being a new drug which stands to earn the pharmaceutical company millions or billions). Especially in the context when there may be bias against exercise (and there almost certainly is in worlds where it is less common - just like my bias is towards exercise).
In this specific situation, it is difficult to find subjects who are willing to participate. In rare diseases folks are often contacted very frequently for a myriad of reasons (medical students, exams etc) and have enough fatigue as a result of their disease burden that another thing to do is the lowest on their list of things they’d like to do.
Other Somewhat Surprising Issues That Resistance Training Helps
I’d hope readers would be well aware of most of the benefits of resistance training (if not please comment below on the Substack app or reply to your email). The big stuff is assumed, but some lesser known insights may be helpful (and it’s what you’re hear for, or I think it is anyway) and these insights are below:
Cancer Related Fatigue - It’s always paradoxical to folks that fatigue can be improved by exercise, but here we are. Resistance training as part of an exercise program has great evidence for use in cancer related fatigue. In somewhat of a parallel to the paper that spawned this article, the dose is key - too much can be a problem for fatigue levels.
Blood Pressure - This often surprises people, though in much the same way as inflammation is initially increased but long term decreases, the rise in blood pressure during resistance training (and it can get high!) means a reduction in chronic blood pressure.
Pre Surgery - This one is a little more specific in the literature, in that the research usually focussed on orthopaedic surgery and sees improved outcomes with ‘prehabilitation’ in many conditions requiring orthopaedic surgery. That said, I have no doubt that the benefits of strength training probably help all surgeries, and if not, the added strength and muscle bulk will be helpful because bed rest is horrible for these things - they disappear fast! (I have an upcoming article on this so subscribe if you haven’t yet, the button is above)
Endurance Performance - There is good evidence for use in shorter distance endurance activities for resistance training. Similarly, whilst we don’t necessarily have the research on strength training for longer endurance training, the rate limiters of some of this and behaviours of top performers (success leaves clues) suggest it may be helpful in longer endurance too.
Multiple Sclerosis - Whilst this is itself a bit of a heterogeneous diagnosis, there is evidence suggesting resistance training can help strength and quality of life as well as contributing to improve gait (walking) when combined with motor control exercises.
Back Pain - In those suffering back pain there is research supporting the use of resistance training to effectively reduce pain, improve quality of life and reduce disability. It certainly seems paradoxical but movement truly is medicine in this case.
Arthridities - This term refers to the group of joint related issues (“Arth-” being joint in Latin) such as osteoarthritis and rheumatoid arthritis. Again, this may strike people as strange given these joints are painful and doing resistance training means we are loading them up, but with a well formulated program the mixture of (chronic) anti-inflammatory and analgesic effects of strength training generally improve symptoms.
Hopefully nobody needed convincing upon arrival at this article, but if so, this is your sign to start some resistance training. There are few thing I recommend as passionately and unreservedly as resistance training. Whilst not 100% true, there is a statement in strength & conditioning which applies in this case (for most people, most of the time) “you can’t go wrong getting strong”.
References
Jensen, K.Y., Aagaard, P., Suetta, C. et al. High-intensity resistance training improves quality of life, muscle endurance and strength in patients with myositis: a randomised controlled trial. Rheumatol Int (2024). https://doi.org/10.1007/s00296-024-05698-y
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Cano-Sánchez, J.; Aibar-Almazán, A.; Hita-Contreras, F.; Afanador-Restrepo, D.F.; Martínez-Amat, A.; Achalandabaso-Ochoa, A.; Carcelén-Fraile, M.d.C. Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 1378. https://doi.org/10.3390/jcm13051378
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