
Association between muscular strength and mortality in men (2008) [pdf] - davidtanner
http://www.bmj.com/highwire/filestream/397551/field_highwire_article_pdf/0/bmj.a439
======
unoti
I've been doing strength training (the program is called Stronglifts 5x5[1])
with freeweights for about 9 months now. I just turned 44, and I've never felt
better, and I'm stronger now than I have ever been. The program I use
describes 3 simple exercises to do 3 times a week, and each workout takes me
30-45 minutes. Very little equipment is needed. It's hard to find good
information about this on the net that covers both what exercises to do, how
to do them, and how to eat. This program covers all of that, taking you from
lifting an empty bar right on up. It's totally free, with an option to pay if
you want personal consultation.

I used to have knee pain, and I don't anymore. I used to get a sore back from
coding all the time, and I don't any more. I seriously recommend trying
strength training.

[1] [http://stronglifts.com/stronglifts-5x5-beginner-strength-
tra...](http://stronglifts.com/stronglifts-5x5-beginner-strength-training-
program/)

~~~
drexel
The book "Starting Strength" by Mark Rippetoe (book and author pretty much
universally lauded by the strength training community) is also a great
starting point.

Beginners can often become overwhelmed by all the differing viewpoints and
training methods presented to them when researching strength training but
(besides avoiding injury by maintaining proper form and generally listening to
your body to allow sufficient recovery time) the most important thing by far
in anyone's fitness lifestyle is simply consistency in actually working out.

~~~
archon
> Beginners can often become overwhelmed by all the differing viewpoints

Yeah, I'm in this position. I've been using the machines at my gym (more for
variety than any other reason) and when I started looking into strength
training, I was swamped with competing methods, many of which instantly sent
up red flags in my brain reading "SCAM".

It's difficult for someone from outside the fitness world (me) to judge
whether a method is legitimate or if it's simply the fitness equivalent of a
get rich quick scheme.

~~~
stouset
The basic approach to getting strong hasn't changed over the past several
hundred years, despite Nautilus' and personal trainers' best attempts.

Lift heavy shit over your head. Put it down. Repeat.

To this end, barbell training is pretty much the gold standard in gaining
strength. Machines are suboptimal in that they stress muscles in isolation
from one-another, and remove the need for compound, coordinated muscle
contractions that occur in literally every situation where you would want
actual strength. Proper barbell training with compound lifts (squats,
deadlifts, overhead press) trains whole groups of muscles at once, including
the crucially-important stabilizers which are often neglected in machine-based
training.

Starting Strength and Stronglifts are two extremely similar barbell training
programs with a very large number of success stories. I've been doing the
Stronglifts routine for three months, and am transitioning into Starting
Strength as I make my way through the extremely thorough book (which goes into
extremely helpful detail about performing the lifts with correct technique).
In three months, my squat is now 195lb, deadlifts are 235lb, overhead press at
90lb, bench at 125lb, and barbell rows (which I'm phasing out in favor of
power cleans) at 125lb. And I continue to add weight almost every single time
I go out.

The numbers aren't super impressive by themselves, but for only three months
from having starting at the weight of the empty bar (45lb), I'm seriously
thrilled.

~~~
davidtanner
Awesome dude!

I recommend you read this archive of Bill Starr articles:
<http://billstarrr.blogspot.com/>

He taught Rippetoe much of what he knows back in the day. I think Starr
articles are way more readable and useful than most of Rippetoe's stuff to be
honest.

------
micro_cam
It is important to note that this is a study of people who happened to be
stronger, not people who were randomly caused to be stronger (ie by randomly
assigning workout routines). Larry Wassermann has a great write up on the
distinction with regards to inferring causation vs association here:

<http://normaldeviate.wordpress.com/2012/06/18/48/>

It is good that they attempted to control for things like cardiovascular
fitness but on there are also confounding factors like genetics and selection
bias that are harder to look at (ie maybe the genetic variants that make it
easier to build fast twitch muscles are what has the protective effect and
increased strength training won't help someone without those genes).

That being said I highly endorse bouldering and rock climbing in general as a
way to build strength and move towards a healthy life style for people who
don't enjoy typical gym workouts.

------
mindcrime
I used to dabble with some amateur powerlifting (I could deadlift 420 and
squat about 340 at my peak), and I have to say, there's something really
addictive about lifting weights and getting stronger. Knowing that it can
decrease your chance of death makes it even more compelling.

Sadly, I, like so many other people, "fell off the wagon" and more or less
quit lifting, gained a bunch of weight, and now, a few years later, I find out
I'm diabetic and I wind up in the hospital with a life-threatening condition
known as DKA.

Moral of this story: Get your ass in a gym and lift some weights! And step
away from the buffet table. Don't be stupid like me. Especially for the
younger folks here, and the people who are already in good shape, if you ever
take one bit of advice from an "old guy" take this one: Take care of your
body. When you're 20, even 30, it's real easy to assume that you don't have to
worry about your diet, about exercise, etc... it all seems to come so easily,
and it's SO easy to rationalize not going to the gym, eating that extra
Snickers bar, drinking those couple of extra cans of Coke, etc. Don't do it.
It _will_ freaking catch up with you, sooner or later. Don't wait until you're
40 and lying in a hospital bed to think "Oh, maybe I should clean my diet up
and get some exercise".

~~~
sudont
Forgive the fact it comes from a shameless marketer. I've always thought
"panic early" was good advice, though:

<http://www.sethgodin.com/bigmoo/free/panic.pdf>

~~~
mindcrime
_Forgive the fact it comes from a shameless marketer._

Why would that be something that should be forgiven? Marketing is awesome, and
I - for one - am a huge Seth Godin fan.

Great article, too. That's a great point about "panic when there's still time
to do something about it". You should probably submit that to HN as a
standalone submission, actually.

------
tokenadult
The most statistically astute comment posted here so far is the top-level
comment by micro_cam

<https://news.ycombinator.com/item?id=5493772>

pointing out that the study design here doesn't involve random assignment to
strength training of any kind, but rather just observation of the study
population over time. Sure, it's a good idea to be stronger rather than
weaker. Moreover, it is plausible that exercises that tend to develop strength
(as measured in the study) have health benefits above and beyond merely
developing strength. There is certainly no reason not to exercise based on
this finding. But there is also not a strong reason to predict a longer rather
than shorter life from your personal strength measurement, even though the
study did the usual kind of regression analysis to control for other
independent variables. Simply put, this was not a treatment-control study
design,

<http://norvig.com/experiment-design.html>

<http://escholarship.org/uc/item/6hb3k0nz>

so no inference of causation is supported here. The authors were careful to
write the word "association" (which is honest), and the authors were careful
to investigate all-cause mortality in this study population (which is
thoughtful), but we don't know yet how much you or I can improve individual
lifespan by doing strength-building exercises.

AFTER EDIT: The comment by micro_cam, which deserves your upvote for getting
me started on my comment, is especially astute because it mentions that this
was not a genetically sensitive study design. To answer the question posed in
one of the replies this comment received, that will eventually be an issue
worth looking at, which sorts of "endophenotypes" gain the most benefit from
what sort of exercise. But we are nowhere near that level of precision of
investigation yet. The statement about limitations of the study at the end of
the submitted article mentions more issues.

Picking up on something I learned from the late Richard Feynman's comments on
the Challenger explosion investigation, I would like to see a scatterplot of
these data displayed over the calculated regression line, to see how much
uncertainty still surrounds their model. As it is, the confidence intervals
around the death rates for different categories of strength overlap
considerably, so there are some strong people with the same mortality risk as
some of the weaker people.

~~~
ignostic
Criticism regarding association, while valid, is largely irrelevant.

You need to understand that a clinical trial on this matter is nearly
impossible.

1) Imagine the cost of holding a clinical trial over 20 years.

2) Imagine the difficulty of trying to get people to adhere to a workout
routine for 20 years!

3) Given what we already know, it's probably unethical to tell a control group
not to exercise or build significant muscle strength.

4) Finally, even if you work out all the issues above, imagine trying to get
funding for a hugely expensive study trying to answer the question of whether
strength training lowers these risks when it's already widely regarded as
healthy.

The researchers are very aware of the limitations, so they went to great
lengths to exclude the most likely confounding variables.

> _there are also confounding factors like genetics and selection bias_

To be more accurate, these are _potential_ confounding variables. It's very
possible that the association would hold up if we could adjust for these
variables, too.

Causation here is not proven, that's true, but taken together with everything
else we know, it does strengthen the case. E.g. we can independently explain
the mechanism whereby the heart is strengthened by resistance training. I'm
not an expert in either cancer or heart disease, but I would love to hear
whether we can explain the mechanism of action already.

~~~
micro_cam
First, I believe that strength training is good for you and do a ton of it in
the form of rock climbing.

As a scientist I dislike the trend of observational studies getting massive
press (see associations between Wine, Coffee, Chocolate etc and
health/lifespan) because, as you say, we are doing (and should be funding
more) studies on some of the underlying mechanisms but it is difficult to
summarize them in a punchy headline.

There are have also been some really elegantly designes observational studies
that use comparisons between family members, twins or features of the
population to reduce bias in an ethical way.

~~~
ignostic
You'll see no argument from me there. Understanding underlying mechanisms
requires a degree of systemic knowledge far beyond that needed for an
observational study, which is one reason we see far fewer of them. The other
reason is funding. We are just beginning to understand how the brain works,
and for one of the most promising and important areas of research it's
remarkably poorly funded.

------
reasonattlm
Hand grip strength. Pretty much all other measures of frailty - such as muscle
mass. Time spent jogging. Time spent not sitting. Time spent being active.

All of these correlate well with mortality. Causation is harder to prove on
these longer timescales. e.g. more likely to be strong and exercising because
you are more robust, or more likely to be more robust because you are strong
and exercising. Or if both, as is likely, to what degree and circumstance.

Is it being strong, or is it side effects of processes that are involved in
building and maintaining muscle mass the old fashioned way - e.g. hormetic
effects of regular exercise, that cause mild cellular stress and thus boost
housekeeping processes to better maintain tissue?

Studies in shorter lived animals support causative roles for exercise and
maintained muscle mass in long term health. For other data points, one could
look at, for example, the fact that calorie restriction (not normally noted in
conjunction with building strength) considerably reduces age-related loss of
muscle mass and strength through a range of not fully understood mechanisms.

~~~
kyllo
I think the calorie restriction studies deserve scrutiny. Do people who
practice calorie restriction live longer compared to otherwise fit, healthy
people who do not practice it? Or do they just live longer compared to the
average (which includes a significant component of obese and/or diabetic over-
eaters)?

~~~
saalweachter
[http://www.nature.com/news/calorie-restriction-falters-in-
th...](http://www.nature.com/news/calorie-restriction-falters-in-the-long-
run-1.11297)

This article actually answers both your questions:

""" One reason for that difference could be that the WNPRC monkeys were fed an
unhealthy diet, which made the calorie-restricted monkeys seem healthier by
comparison simply because they ate less of it. The WNPRC monkeys’ diets
contained 28.5% sucrose, compared with 3.9% sucrose at the NIA. Meanwhile, the
NIA meals included fish oil and antioxidants, whereas the WNPRC meals did not.
Rick Weindruch, a gerontologist at the WNPRC who led the study, admits:
“Overall, our diet was probably not as healthy.” """

So, monkeys on a calorie restricted diet are not healthier than monkeys on a
healthy, unrestricted diet, but are healthier than monkeys on a diet of monkey
junk food.

------
jstanley
In plain English: stronger people live longer.

~~~
jpdoctor
> _In plain English: stronger people live longer._

You'll never get follow-up funding with a title like that.

~~~
jkuria
Why not? Do you need to say something confusing stated in esoteric medical
terms?

~~~
hyperpape
Have you ever read an explanation of a compiler or concurrency using only the
1000 most common English words? It can be done (and I wish I could find the
link), but there's a reason we don't talk like that, and neither should
scientists.

~~~
ISL
Sometimes scientists can, and we should.

Simple precision is good.

~~~
hyperpape
I think it's a great exercise--you will learn something if you try it. But you
lose so much precision, and you wouldn't want to make that your normal way of
speaking.

------
guylhem
Why are so many people discussing the evidence here?

If one seriously believes the BMJ would let a questionable study be published,
think again. I'm not saying everything that is published in high quality peer
reviewed journals is absolutely true, but it is subject to so much scrutiny
that is unlikely to have an evident flaw in the reasoning, or at least some
that is not properly mentioned in the article or letters to the editor.

Which leads us back to why are so many here angry at the conclusion - because
many answer seem emotionally charged.

Among the tools offered to you to try to increase your lifespan, and
especially the "high quality" years, is physical effort.

There is even a very positive message there - you don't have to be in a
perfect physical form, or do sports, to get the gains- muscle mass alone is
enough.

If you have had health problem, say broken bones, reduce mobility, pain,
whatever, you can still get some of the positive advantages of muscle mass
with weight training - which can be done at home, in a gym, anywhere.

You may not get as much benefits as somebody fully healthy (ex: if you hip is
not working, it will be a problem to train both legs, etc.) but it is still
better than nothing!!!

Exercice, as in improving the muscle mass, is well known to have positive
health effects. If one does not exercise, the blame is not to be put on the
lack of time, but rather on the lack of proper prioritization.

------
dalys
I'd like to point out that when looking only at persons aged <60 OR persons
with a BMI >25, the strongest (upper) third group did NOT have the lowest
death rate in this study. Instead it was the "middle" group in both cases.
Admittedly with not much of a difference from the upper group. And again, this
study did not claim _causation_ between strength and mortality, but
_association_.

Although if we just play with the thought and assume a causation between
strength and mortality and if you are under 60 years of age or have a BMI over
25 and you want to minimize your mortality rate, your one-repetition maximum
(1RM) strength goals in a lifting weight / body weight ratio would be x:

    
    
      Bench press: 0.7 < x < 1.1
      Leg press: 1.4 < x < 1.9

------
richardlblair
I've never been one for strength training. I just like to run really hard for
a short period of time... Guess I will need to change that.

~~~
chollida1
Well it depends on how hard and how long you run. Sprinting is one of the best
muscle building activities you can do.

I thought it was crazy to try, but I swear it's added 50lbs to my deadlift
with one sprint work out a week for 3 months.

Going from 475 to 525 is a pretty incredible increase in my deadlift
considering I was adding about 5lbs a month before.

~~~
bytefactory
I'd just like to add that while running is great, one of the most effective
forms of running is HIITs (High Intensity Interval Training). Basically, you
run at maximum speed (80-100% of your capacity) for short bursts (10-15
seconds when you're starting out), and at about 50-60% for the warm-up and
cool-down periods before and after (around 2 minutes) [1]. You do a total of
about 20 minutes of this (and believe me, this will destroy you the first few
times).

The results are drastic, and unlike with marathon running, you don't lose
muscle, instead you gain it.

You lose fat FAST and gain strength in the process [2]. Can't recommend it
enough!

Note: I thought that EPOC (Excess Post-Exercise Oxygen Consumption) meant you
burnt calories for the next 24 hours, but that's possibly not as significant
as it appears :( [3]

[1]:
[http://www.sparkpeople.com/resource/fitness_articles.asp?id=...](http://www.sparkpeople.com/resource/fitness_articles.asp?id=621)
[2]: [http://greatist.com/fitness/complete-guide-interval-
training...](http://greatist.com/fitness/complete-guide-interval-training-
infographic) [3]: [http://ca.askmen.com/sports/bodybuilding_900/962_popular-
met...](http://ca.askmen.com/sports/bodybuilding_900/962_popular-metabolism-
myths-part-2.html)

~~~
ChrisInEdmonton
I'm quite capable of running a half-marathon and decided to try the HIITs.
They were terrible for me. My knees couldn't handle the added stress, and I
had to give up HIIT and go back to 'regular' training. I'll certainly grant
that it was an interesting training technique, though, and I can well see that
it would be good for most people.

~~~
pm90
_My knees couldn't handle the added stress_

This. I didn't know what HIIT was, but I figured out something like it for my
daily exercise. Result was repeated shin-splits and painful knee injuries

~~~
PeterisP
You may want to try and find specific excercises to improve your joint-
stabilizing muscles - even something very simple like
[http://archive.mensjournal.com/wp-
content/uploads/picture-81...](http://archive.mensjournal.com/wp-
content/uploads/picture-81.jpg) should allow your body to do higher
intensities safely.

------
enraged_camel
I'm not a scientist, and this is wild conjecture, but one possible reason why
people who workout live longer is that working out boosts happiness (releases
endorphins) and reduces stress, and both of those have been shown to
contribute to a long life.

------
nnq
Related brain-snack concerning muscle tissue and cancer:
[http://www.ted.com/talks/eva_vertes_looks_to_the_future_of_m...](http://www.ted.com/talks/eva_vertes_looks_to_the_future_of_medicine.html)

From it: "skeletal muscle tissue is resistant to cancer, and furthermore, not
only to cancer, but of metastases going to skeletal muscle" (not entirely
true, you have rhabdomiosarcomas, though they are rare and may originate in
connective tissues, but she's definetely on to something).

~~~
hackinthebochs
I would guess its almost all because of the hormone myostatin. It's a negative
growth regulator in muscle (perhaps other tissues as well). Myostatin is
precisely why our muscles don't grow wildly out of control, and why it is so
hard to grow a significant amount of muscle. Cell growth is tightly controlled
by the level of myostatin and the levels of positive growth regulators. I
wonder if myostatin or an analogue could have an affect as an anti-cancer
compound.

------
chaosphere2112
To quote my wife (Biostatistics grad student), "The confidence intervals for
cancer deaths are wussy."

------
ErikAugust
Was thinking of putting together a HN/Digg style site for fitness links
(example here: <http://erikaugust.com/sportslinks/>)... Good idea? Or am I
missing a site out there already (outside of the sub-Reddits)?

~~~
jewbacca
Why "outside of the sub-Reddits"? Are they missing something you can offer?

I'm only peripherally aware of the scene, but I know there's at least 3
massive, established online social fitness communities, for links and
otherwise:

<http://reddit.com/r/fitness/>

<http://4chan.org/fit/>

<http://forum.bodybuilding.com/>

------
scottrogowski
One important thing to keep in mind is that the upper third average bench
press measured was 83.8kg (~185lbs). That is still a light bench press by the
standards of those in the fitness and bodybuilding industries. I would imagine
that there is a limit to the longevity gains that could be made from muscle
strength and that these gains might start to reverse for bodybuilders and
other strength athletes due to the increased strain it is putting on your
heart and other organs.

~~~
Voluntaryist
That is PURE speculation on your part.

Why would the added "stress" on heart and other organs all of a sudden become
harmful?

You aren't supporting that whatsoever.

------
antirez
Just in case after reading this you want to start exercising, I strongly
suggest the following two resources:

* <http://www.reddit.com/r/Fitness/wiki/faq>

* <http://simplesciencefitness.com/>

I have been doing strength training for a couple of years now and I can ensure
you that it changed my life: better health, better quality of life, better
code (I'm more focused).

------
candybar
I'd be much more interested in the same study without adjusting for BMI,
because adding muscular strength would increase one's weight when not
accomplished by reduction in body fat. As it stands, it's not controversial or
surprising, because body fat loss would make you stronger relative to your
BMI, without any increase in strength.

------
boldpanda
The writing in these research briefs is horrible. It's nearly impossible to
even deduce what point they're trying to make.

------
wahsd
Seems like "Association between muscular atrophy and mortality in men" would
be more accurate and clear.

------
albertsun
Published 2008? Hacker News seems to be developing a strong interest in
fitness and weight lifting.

~~~
davidtanner
Fitness and strength training are extremely important for everyone.

------
reedlaw
What about the risk of osteoarthritis? See this discussion:
[http://www.reddit.com/r/Fitness/comments/s2kzg/my_doctor_tol...](http://www.reddit.com/r/Fitness/comments/s2kzg/my_doctor_told_me_squats_are_the_single_worst/)

~~~
jacques_chester
I have an osteoarthritic left knee. In my case the underlying cause was a
misfiring vastus medialis, possibly due to an acquired trigger point.

It would have happened simply by walking around as a fat guy.

I get synvisc injections every 6 months and I've returned to training. Trigger
point therapy seems to do the rest.

------
jcfrei
Starting Strength is one of the best books on building strength, written by
Mark Rippetoe and Jason Kelly. they propagate (among others exercises):
squats, which is a single exercise that trains about 60% of your body.

------
EA
"We love CrossFit. It is great job security." - my physical therapist

edit: my point being that from the PT's POV, the more intense the strength
training, the more likely a serious injury will occur during training.

~~~
marknutter
It's well known in weight-lifting circles that CrossFit is rife with problems.
Intense strength training does not correlate with increased injury; bad form
and instruction correlates with increased injury.

------
dbruce
It's likely that healthier people are stronger on average....hence getting
stronger by doing strength training will not change things.

~~~
nosequel
So you are saying you didn't read the paper or abstract. They sort of covered
that entire topic. This is about strength not "health", they took that into
account in the study.

~~~
alexvr
By taking it into account, they probably excluded people with medical issues
that would skew the results. The study isn't perfect, so this guy has a point:
People with genes that make them naturally strong may have related genes that
contribute to their overall health. And the converse may be true for weak
people.

~~~
scottrogowski
There is no such thing as naturally strong... there might be some genetics in
how quickly you can gain muscle strength but no one is born strong. To think
of it conversely, if a limb becomes paralyzed, that limb will undergo extreme
muscle atrophy no matter who it is. Also, they listed as a mean 83kg for bench
press for the "upper third". This is not a very large amount of weight and is
easily within the genetic limits of the grand majority of men.

------
3327
here is my 2 cents. Im a coder, developer but I am ripped (sorry for the self
love) I work out like crazy and actively surf / kitesurf, rockclimb. So my gym
sessions have always had a purpose - to make myself stronger per the
requirements of those sports. So my 2 cents - get of the whey protein. don't
take it do not touch it. I have no scientific evidence but way too many people
are on that and no long term studies. Only evidence is this: A good friend
fellow athlete (sailor olympic level windsurfer) healthy as none other, got a
heart attack at the age of 33. He looked into my eyes and said he never took
anything (when i asked if he doped of any sort) and he only took whey. Made me
get off it. Difference in phenomenal. You get "cut" lean, stronger muscles,
just eat well. Not to mention your body gets conditioned to the "easy"
absorption of nutrients that come from whey and gets lazy. There thats my 2
cents.

TLDR - get of whey protein, you'll get stronger live longer.

~~~
nosequel
Nice job, no scientific evidence, but your "friend" had a heart attack. Just
pure amazing post my friend.

Oh, so I don't fall into the same trap, here are scientific studies in favor
of Whey protein:

[http://examine.com/supplements/Whey+Protein/#main_clinical_r...](http://examine.com/supplements/Whey+Protein/#main_clinical_results)

TLDR - <http://s3.roosterteeth.com/images/Ataxx50e4c5160c877.jpg>

~~~
3327
Sorry, but this study is a joke. If you think this is a study that validates
your belief go ahead. But I will take any seasoned athlete's take on something
than a half assed study funded by who knows who. These things take years to
prove and large studies over long periods of time. IF you want to justify your
own whey protein habits with this thats just you.

> my 2 cents

means my two cents, you take it as you will. Hearing negative stuff is always
hard but its the truth. So go looking around the internet for studies that are
pro whey, and believe them and justify your habits and don't worry about my
friend.

~~~
nosequel
What do you mean by "this" study? I linked to page that linked to tons of
studies, all with ratings on how well they did each study.

I think you need to figure out how to internet man, oh and s/of/off/ it is
driving me nuts how ridiculous "get of whey" sounds.

~~~
3327
did you actually take a look at any of the studies? Not a single study where n
> 100, in fact average is around 30. This is not youtube, its HN so please
save the dudebro commentary and insult tone to your normal domain.

