Why Are Physicians Afraid of Iron?

No, not the element Fe, but the iron that makes up dumbbells, plates, barbells, and other various equipment found in gyms. More than likely at some point you’ve heard or experienced a physician somewhere say, “be careful lifting weights, don’t hurt yourself.” Unfortunately, resistance training maintains a stigma due to a perceived injury risk that is shared by both the public and physicians alike. Given the inadequacy of most in reaching physical activity guidelines, we as physicians cannot be the nail in the coffin in stopping our patients from lifting weights.

The current physical activity guidelines set forth by the American College of Sports Medicine (ACSM) and echoed by the World Health Organization (WHO) are as follows [1]:

“Moderate intensity aerobic physical activity for a minimum of 30 minutes on five days per week, or vigorous intensity aerobic activity for a minimum of 20 minutes on three days per week AND activities that maintain or increase muscular strength and endurance for a minimum of two days per week.”

Currently, about 8 out of 10 adults within the USA aged 18-80 do not meet the physical activity guidelines set forth by the World Health Organization (WHO) [2]. Even worse is proportion of those completing the muscle strengthening portion with an estimate of roughly between 10-30% of adults meeting this guideline [3]. This means that 70 to 90% of the population is missing out on the unique benefits provided by lifting weights.

What benefits? Improved insulin sensitivity, better weight management, increased bone density, and overall reducing the morbidity and mortality in many other ways. There’s a lot to gain with benefits for every age group and with no differentiation as to the starting age. Surely, we as physicians should be help our patients receive these benefits. However, how many times do you think a physician has recommended (appropriately loaded) deadlifts to a 70-year-old patient? I would wager not many.

As a physical medicine and rehabilitation resident, I see patients with a broad array of musculoskeletal, neuromuscular, and cardiovascular diagnoses and have seen how these diagnoses can drastically affect a patient’s quality of life. In my experience, those with exposure to training tend to have less severe injuries with a lower impact on quality of life. Conversely, those with minimal to no exposure are more likely to sustain severe injuries with a massive impact on quality of life. For example, I’m much more likely to see a hip fracture, which carries a 16.6% mortality rate within 1 year of surgery, in someone who has never squatted versus someone who has squatted consistently for many years [4].

My experience in medicine thus far has led me to understand physicians to have an irrational fear of lifting weights due to some perceived injury risk. Whether due to previous biases and stories we’ve heard growing up, a simple lack of knowledge, or plain inexperience, we are always scared in telling our patients to lift weights. Instead, we hide behind the guide of “recommending exercise.” When pressed further by patients that recommended exercise more than likely ends up being walking, jogging, playing a sport, etc. which are all thought of as “safe” exercises.

I heard many of these same statements from my primary care physician and endocrinologist as I became engrossed in weight training to overcome childhood obesity due to hypothyroidism. My journey started near the end of high school and as my body weight dropped, not only did the total weight lifted go up but so did the comments about safety and injury. Now, as a drug-tested state record holder, I have deadlifted over 700 pounds and sustained no-more injuries than anyone else would have at my age. I continue to hear words of caution but can now break the chain in passing down this fear to my patients.

In reality, the incidence of injury risk is 0.31 and 0.05 per 1,000 hours of weight training for men and women respectively [5]. Thus, the average male is likely to sustain 1 injury over 3000 hours of training and average female 1 injury in 20,000 hours of training. Assuming 2 hours per week of muscle strengthening exercises per the guidelines, that’s 1 injury every 28 and 192 years for males and females respectively. Compare that to running which has an injury risk of 2.5 to 33 per 1000h in long distance and novice runners respectively [6].

As physicians, we must recognize the unique benefits of resistance training and recommend it to our patients whether young, old, relatively healthy, or with multiple comorbidities. This doesn’t mean suggesting Mr. Olympia worthy routines or deadlifting 700 pounds, but starting an appropriate level just like for anything else. Let’s stop the fear inducing statements and avoidance of weight training and help deliver the multitude of associated benefits to our patients!

This article was originally published on Doximity as an Op-Med in July 2023.

Citations:

1.     https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

2.    Bennie JA, De Cocker K, Teychenne MJ, Brown WJ, Biddle SJH. The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults. Int J Behav Nutr Phys Act. 2019 Apr 18;16(1):34. doi: 10.1186/s12966-019-0797-2. PMID: 30999896; PMCID: PMC6472085.

3.    Bennie JA, Shakespear-Druery J, De Cocker K. Muscle-strengthening Exercise Epidemiology: a New Frontier in Chronic Disease Prevention. Sports Med Open. 2020 Aug 26;6(1):40. doi: 10.1186/s40798-020-00271-w. PMID: 32844333; PMCID: PMC7447706.

4.     Morri M, Ambrosi E, Chiari P, Orlandi Magli A, Gazineo D, D' Alessandro F, Forni C. One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study. Sci Rep. 2019 Dec 10;9(1):18718. doi: 10.1038/s41598-019-55196-6. PMID: 31822743; PMCID: PMC6904473.

5.     Grier T, Brooks RD, Solomon Z, Jones BH. Injury Risk Factors Associated With Weight Training. J Strength Cond Res. 2022 Feb 1;36(2):e24-e30. doi: 10.1519/JSC.0000000000003791. PMID: 32796416.

6.  Videbæk S, Bueno AM, Nielsen RO, Rasmussen S. Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Med. 2015 Jul;45(7):1017-26. doi: 10.1007/s40279-015-0333-8. PMID: 25951917; PMCID: PMC4473093.