Lift Heavy Stuff, So That When You Lift Heavy Stuff, Heavy Stuff Is Not So Heavy

Yesterday I had a conversation with a long-term client of mine. This patient is a 74-year-old woman who has been working with me for almost eight years. My primary work with her has been creating and managing her resistance training program. She originally came to me as a referral from her former personal trainer, as she was having knee pain with loaded exercise. She felt that because her knee hurt, her trainer was afraid to program any lower body exercises — and that was holding her back from making progress.

Fast forward to the present. This patient recently went in for a check-up at her doctor’s office. During the visit, she was having a conversation with her physician about her current exercise program, and the physician told her: “You should not lift heavy things, because that is the fastest way to hurt yourself.” They also suggested that if she was going to exercise, bodyweight-only exercises were the safest approach, as they had the lowest potential for injury.

Because this is such an important topic — and one that is very important to me — I think we should spend some time talking about it.

In the context of this conversation, I think we need to start by defining what we mean by lifting. The physician was referencing resistance training. If we stick with a strict definition, lifting is “the act of raising a physical load, or the process of raising or moving something from a lower position to a higher position.” In that sense, we are lifting numerous times throughout our daily activity. Lifting is so embedded in what we do as humans that it is inseparable from what it means to function. At the end of the day, lifting is what we do.

If we view this from the rehabilitation side of the equation, we would place lifting — or resistance training — in the functional integration stage of care. This comes after the patient has already moved through the acute management, foundational kinematics, and motor control stages. In this stage, we are adding load to the fundamental patterns of movement: upper extremity pushing and pulling, squatting, hinging, twisting, and locomotion. When rehabilitating an injury, we load these patterns by choosing exercises that apply load to a specific joint or tissue, manipulating the many variables available to us to achieve specific tissue loading outcomes.

For performance training, we start in the same place — the functional integration stage. Whereas in rehabilitation this stage is reached by progressing through three prior stages of care, in performance training it is the starting point. In either case, load applied through resistance training is used to develop the motor patterns. That training needs to encompass patterns for the upper extremity, trunk and spine, and lower extremity. Regardless of how you arrive there, resistance training is — and always will be — one of the most important components of any rehabilitation or performance program.

In the conversation in question, the physician suggested that patients should not “lift heavy.” The word heavy is relative to the individual and their current physical capacities. What exactly did this physician mean by heavy, and how did they arrive at the determination that it was inappropriate?

By definition, heavy means weighing a lot, serious or intense, in large amounts. I have to consider that by heavy they may have meant maximal load. In that context, I equate heavy to the concept of effort — since heavy means different things to different people. There are four types of effort when performing resistance training: maximal effort, dynamic effort, sub-maximal effort, and repetitious effort.

If we place these on a loading continuum from 100% down to 1% of an individual’s one-rep maximum, we get a much more accurate picture of what any of this actually means.

Repetitious effort falls up to approximately 65% of the individual’s one-rep max and can be performed for 15 or more repetitions. It is best used for muscular endurance. Sub-maximal effort falls between 65 and 85% of the one-rep max and can be performed for 8 to 12 repetitions at higher volume — best used for muscular hypertrophy, though hypertrophy can occur across rep ranges under the right circumstances. Dynamic effort falls between 70 and 85% of the one-rep max, typically performed for 4 to 6 repetitions, and is best used for rate of force production and power development. Maximal effort occurs between 90 and 100% of the one-rep max, performed for 1 to 4 repetitions, and is best used for the development of absolute strength.

When discussing lifting heavy, it is important to remember that there are many factors to consider. There is no meaningful debate about whether adults should be performing resistance training — the research demonstrating its health benefits and its role in expanding longevity is too compelling. We should all agree that everyone should be lifting. How we do that, and at what volume and intensity, is where the conversation begins.

The first consideration is the individual’s goals. In the case of my patient, her goals are to improve her healthspan, pick up and play with her grandchildren, perform daily activities without pain or impedance, and travel without discomfort. Her goal is to live life without complications, and my job is to help her make that happen. In this context, maximal effort does not align with her goals. What she needs is body-relative strength — not maximal strength. Applying loads of 90 to 100% of her maximum would introduce unnecessary risk without corresponding benefit.

The second consideration is the individual’s current capacity and tolerance to load. If a patient has never lifted weights, she has no established tolerance to maximal loads. Asking her to perform maximal effort lifts would be asking her body to absorb a load that exceeds her current capacity — and injury occurs when load exceeds capacity. The best course of action is to find the individual’s current capacity and do just a little more. Find the hardest thing they can do well, and add 10% more challenge.

A third consideration is how long the individual has had to accommodate to load — or more accurately, how long they have been training to develop the physical qualities necessary to tolerate it. Timing matters. If someone is new to resistance training, maximal efforts are not appropriate even if they happen to align with their goals. If the individual has been training for one to two years, maximal efforts may be worth considering — but only if they align with their goals and history. In the case of my client, even though she has been resistance training for many years, I would still consider traditional maximal effort work inappropriate for her.

The final consideration is risk versus reward. I often ask myself: is there any risk for this individual to perform this exercise or at this intensity? If the answer is yes, you choose a different exercise or intensity. To determine risk, I ask: Does this person have any pathology that may be aggravated by this exercise? Does this individual have any constraints or dysfunction that may complicate its execution? Has this individual performed this exercise before, or performed it at the proposed intensity, and for how long? If the answers point toward risk, we find a different option.

Going back to the original question: should we lift heavy stuff? Yes — everyone should be lifting, and heavy needs to be relative to their individual goals, current capacity and load tolerance, and training history. But the underlying question remains: do people need to lift heavy things? My answer is still yes.

In order to receive the health and longevity benefits of resistance training, we need to lift with relative intensity. For most people this means lifting sub-maximal loads consistently and repeatedly — in the range of 65 to 80% of the individual’s one-rep maximum. For most people, that is heavy enough to build muscle and increase relative strength. And it does not mean those individuals should stop increasing their loads as they continue to train. Quite the opposite.

In the case of my patient, for the last seven years we have been lifting sub-maximal loads for repetitions in the 8 to 12 range. We shoot for 10 repetitions and gauge our loads based on that number. If she performs 12 repetitions or more, we determine the load is too light and add slightly more. If she can only perform 8 or fewer, we determine the load is too heavy and slightly regress. I call this the “Goldilocks zone of loading” — an easy way to gauge the relative heaviness of a load.

Alongside this, we follow the concept of microprogression — consistently making the smallest meaningful change. After reaching a weight she can perform for 10 repetitions, we slowly work over a couple of weeks to increase that to over 12 — and then we add more weight. A slow stair-stepping of load over time. This is what allows us to continue making progress without increasing the overall risk of injury. This is what has allowed her to continue getting stronger even as she ages.

An important consideration when working with individuals over the age of 60 is normal age-related strength loss. Research has shown that after age 60, muscle mass and strength decline at approximately 3 to 8% per year. Strength loss outpaces muscle mass loss because the amount of muscle and its quality decline together. After age 70, that loss accelerates to 15 to 25% per decade.

This is directly relevant to older clients and patients. In my patient’s sixties, she was consistently getting stronger as we progressively increased loads over time. Once she hit her seventies, strength gains began to slow. Not stop — but slow. At one point she became concerned that she wasn’t improving as much as in prior years. I had to point out an important consideration: if we know that it is normal after age 60 to lose 3 to 8% of strength per year, and she was consistently maintaining her current strength levels, that meant she was actually continuing to increase her strength — which is quite a feat for a 70-year-old woman.

Yes — everyone should lift, and they should lift with relative heaviness. This means building body-relative strength to improve activities of daily living. I understand why physicians might suggest that lifting heavy is dangerous — many people do get injured by doing too much, too soon, and too often. But physicians should not be discouraging people from receiving the well-documented benefits of resistance training.

The musculoskeletal benefits include increased muscle mass and strength, improved bone mineral density, stronger tendons and ligaments, and better joint stability. Metabolic benefits include improved insulin sensitivity, better blood sugar control, increased resting metabolic rate, and favorable changes to body composition even without significant weight change. Cardiovascular benefits include improvements in blood pressure, better cholesterol profiles, and reduced cardiovascular disease risk markers. Cognitive and mental health benefits include improved memory and cognitive function, reduced risk of cognitive decline, reductions in depression and anxiety, better sleep quality, and improved body image.

There are numerous benefits to resistance training — and lifting with sub-maximal loads, performed consistently over time with incremental microprogression, can be genuinely life-changing.

When my patient had her examination this year, her results were remarkable. In the year since her last check-up she had gained 0.7% in muscle mass and lost 1% of fat mass. Her bone density stayed exactly the same, as did her visceral fat index. In essence: no loss of strength, a slight improvement in muscle mass, a small reduction in fat — all while maintaining bone density. None of that would have been possible with bodyweight-only exercise.

And this doesn’t even account for her improvements in activities of daily living. She currently spends hours chasing her grandchildren, picking them up, taking them on adventures, and enjoying being a grandparent. As her grandchildren grow bigger, she is still doing all of it with relative ease. If that is not the result of getting stronger from lifting heavy, I don’t know what is.

The bigger conversation, though, is about educating physicians on what appropriate resistance training actually looks like. My client was afraid to lift weights for years because her doctor told her she would tear up her knee. I can tell you with certainty that nothing is further from the truth. At 74, she rarely has knee pain. We do appropriate variations of squats, lunges, single-leg squats, step-ups, and deadlifts every week — and have for years. She went from not lifting at all out of fear, to training twice a week for the last eight years. None of it would have been possible if she had listened to that advice. Physicians need better education on resistance training and exercise — but that is a conversation for another day.

At the end of the day, the most important thing to remember is to lift heavy stuff — so that when you lift heavy stuff, heavy stuff is not so heavy.

This is the way.

What do you do when a patient comes in having been told by their physician not to lift — and how do you navigate that conversation?

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If you want to understand how resistance training fits into a complete framework — from the foundational kinematics stage all the way through functional integration and beyond — the Language of Human Performance guide lays out the full model.