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Why Are Physicians Afraid of Iron?

Op-Med is a collection of original articles contributed by Doximity members.

No, not the element Fe, but the iron that makes up dumbbells, plates, barbells, and other equipment found in gyms. More than likely, 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 WHO are as follows:

“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 eight out of 10 adults within the USA aged 18–80 do not meet the physical activity guidelines set forth by WHO. Even worse is the proportion of those completing the muscle strengthening portion, with an estimate of roughly between 10% and 30% of adults meeting this guideline. 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, with no differentiation as to the starting age. Surely we as physicians should 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 one year of surgery, in someone who has never squatted versus someone who has squatted consistently for many years. 

My experience in medicine thus far has led me to understand that physicians 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 of 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 PCP 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. Thus, the average man is likely to sustain one injury over 3,000 hours of training, and the average woman will likely sustain one injury in 20,000 hours of training. Assuming two hours per week of muscle-strengthening exercises, per the guidelines, that’s one injury every 28 and 192 years for men and women, respectively. Compare that to running, which has an injury risk of 2.5 to 33 per 1,000 hours in long distance and novice runners, respectively. 

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 at 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!

What exercises have you recommended to patients? Share in the comments.

Dr. Sharma is a physical medicine and rehabilitation resident who is focused on improving patient quality of life through lifestyle — especially exercise. He is a record-holding powerlifter, marathon finisher, personal trainer, and can be followed on all social media platforms @_RagavSharma_.

Image by Angelina Bambina / Getty Images

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