3 sets of 8–12 reps.
Rest 60–90 seconds.
Lift heavy. Train to failure.
Periodize or mix up your program regularly for progress.

Much of those specific guidelines came from the 2009 position stand from the American College of Sports Medicine (ACSM)  which is a document that shaped how many clinicians, trainers, and athletes approached resistance training for over a decade.  It was largely a programming manual, prescribing how to strength train.  It catered to our human desire of “just tell us exactly how to do it.”

The 2009 position stand made strength training look like a strict recipe that needed to be followed.

But just recently (March of 2026) the ACSM released a major update and the message is surprisingly simple: we may have been overcomplicating resistance training for the general population.

More recent research has demonstrated that strength training can be far more flexible than we thought and your body can respond to many different ways of training.

Variables like tempo, set structure, machines vs free weights and fancy programming methodology show little consistent effect on results.

The new position stand suggests there are many effective ways to do your resistance training.  The foundation of a resistance training plan that can deliver results requires 2 key elements: sufficient intensity of effort repeated consistently over a long period of time.  Essentially the best plan is one you work hard enough at on a regular basis.

Some things from the original 2009 position stand still matter such as you should train at least 2x/week and progressive overload is essential for progress.  So as you get stronger (the workout feels easier) then add more: weight, resistance, volume (more sets) or another training day.

Full range of motion is recommended to maintain joint health and mobility.  These are still the foundation for an effective resistance training program.

But emphasis on training to failure, periodized programs, specific rest intervals, exercise order, equipment choice (machines vs free weights), blood flow restriction and optimizing time under tension have become less of a priority.  Doesn’t mean some of those variables don’t work, but they are not a requirement for building muscle.

Of course your goals still matter.  And if you have very specific strength or performance goals then your resistance training absolutely needs to align with your goals and the skill and practice required to get proficient at those goals needs to be trained.

If strength is your goal, you have to lift relatively heavy (apprx 80%+ 1RM effort).  Lift through a full range of motion, 2-3 sets works well and place key lifts at the beginning of the session.

If hypertrophy (muscle growth) is your goal accumulate enough weekly volume (apprx 10+ sets/muscle/week).  Periodic eccentric overload also appears to enhance growth.

If power is your goal move lighter loads (20-70% 1RM) quickly.  Emphasize velocity of the concentric portion of the movement (control through the eccentric) but train with low-to-moderate volume to avoid fatigue.
And if you are concerned about the loss of physical function with aging, the updated position stand recommends adding or emphasizing power training in your resistance training plan.  The loss of power with age (powerpenia) is a significant threat to your health span (the quality of your life) and adding purposeful quicker movements within your capacity can slow the rate of muscle power loss.

For the general population who is either looking to get started or inconsistent with their fitness routine, you have many options for your strength training.  Light weights or heavy weights.  Bands, body weight, circuit style training, machines or free weights.  Many sets over a prolonged period of training time or a single set to failure.

Doing some (any form) of resistance training is better than none at all.  The biggest opportunity for improvement in muscle health is simply getting started and working at it consistently.

This is a major shift for clinicians and patients alike and suggests that individual preferences should absolutely be harnessed for long term adherence to a resistance training program.

Why does this shift matter?  Quite simply not enough people are meeting muscle-strengthening guidelines.

Stu Phillips, McMaster researcher and co-author of the updated position stand has often been quoted as saying fewer than 1 in 5 people meet resistance training guidelines.  And in some populations, for example older women, that number is much lower.

The goal of the shift is to empower patients to carve their own personalized resistance training path.  The best program is the one you will sustain.  So pick an environment you like to spend time in and equipment you enjoy using and build up to working harder and harder over time.  Results compound from consistent stimulus over a long period of time.

The key takeaway point with the updated position stand is that consistency and effort trump complexity when it comes to resistance training.  Let’s encourage as many people as we can to start lifting as it may just be the most important public health message we can all help spread.

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As a society, we are starting to become ‘over imaged’ in terms of finding musculoskeletal problems. 

Ahhhh….that felt good to put it in writing.

Why do I feel this way?

Study after study show that imaging findings alone, whether x-ray, ultrasound, or MRI, seem to have little to no correlation to how someone is actually feeling, and seems to matter less and less in terms of guiding treatment.

This isn’t a new concept.

One of most read blogs of all time was from back in 2015 (man we are getting old) titled ‘So….do I need an MRI?  Why advanced imaging at times does more harm then good’

Every so often, a great study on this topic will come along and be deemed so controversial that even popular media outlets will pick it up.

Does this change the way people think?

Absolutely not!

(Sigh).

But maybe just maybe, with enough repetition of a similar topic, we will hit the proverbial tipping point and attitudes of both clinicians and patients will change.

Well, one such very important (and controversial) study was very recently published in the Journal of the American Medical Association (JAMA Internal Medicine).

So what makes this study different?

Lots!

This was a giant population based cross sectional cohort study in a completely random but representative sample of adults in Finland aged 41-76.

Essentially they took 602 random adults, gave them a history and physical evaluation of their shoulders and then did high quality 3T MRI’s on both shoulders.  They had 3 radiologists independently read the MRI’s of both shoulders of each person.  These doctors were completely blinded to both clinical symptoms the people may be experiencing as well as what the other radiologists found.

They then classified the rotator cuff tendons of each shoulder in 1 of 4 categories:

• Normal
• Tendinopathic changes (think tendonitis)
• Partial thickness tears
• Full thickness tears

Before we get into the results let’s ask why they even did this study and why it’s so darn important.

We know shoulder pain is extremely common.  It affects 18-31% of the general population each month and is the 3^rd most common reason people go and see their doctors for musculoskeletal injuries.

Issues with the rotator cuff are determined to be responsible by clinicians an astounding 85% of the time.  Equally astounding is that doctors order special imaging of the shoulders 50% of initial visits, even before trying any rehab.  In fact, a shocking 82% of General Practitioners view shoulder imaging as essential. 

Side note – I would guess 100% of patients also view it as essential!

But is it?

Maybe this increased imaging just leads to more interventions.

Imaging guided injections have increased 46 fold since the year 2000 and rotator cuff repairs have increased between 2 and 7 fold in high income countries over the same period.

So then, the question begs…..are the imaging findings causing this rapid increase in interventions?

In this study sample, 18% of folks had current shoulder symptoms and 60% of people reported shoulder pain in the past (these findings agree with the general population at large).

Here are the findings from the study and why it caused such a kurfluffle (I’ve been trying to crowbar that word into a blog for years).

Of the 602 people that had MRI’s

• 585 had MRI abnormalities of their rotator cuffs
  • 25% were tendinopathy
  • 62% had partial tears and
  • 11% had complete tears of their cuffs.
• Of the 70 people with full tears, 37% had full tears in BOTH SHOULDERS
• There was a clear age-related progression where those in their 40’s largely had tendinopathic changes, while those a little older had partial and complete tears starting around age 55.
• In fact, no one under 45 had a complete tear but 28% of those over 70 had complete tears.
• So if there were 602 people, that means 1204 shoulders
  • Rotator cuff abnormalities were seen in 96% of those without symptoms and 98% in those with symptoms.
  • Just as confusing was that the prevalence of tendinopathy and partial tears had zero difference between those with and without pain.
  • Even in the 96 full tendon tears, 78% were in shoulders of people with NO SYMPTOMS.

Ok let’s take a breath and think about what the implications of this study are.

Of the total study, 99% of people aged 41 and older had at least 1 rotator cuff abnormality on MRI. 

Yes…..99%.

Even partial tendon tears were present in 43% of people 45 years old or younger.

MOST rotator cuff issues were seen in people with NO PAIN, highlighting the lack of concordance between a person’s symptoms and what is found on MRI.

This completely challenges the routine attribution of shoulder symptoms to a person’s imaging.

Why?

BECAUSE EVERYONE (literally 99% of people over 41) HAVE IMAGING ISSUES OF THEIR SHOULDERS!

So as clinicians we need to shift our thinking from ‘does an abnormality exist?’ – because it almost certainly does – to ‘does the imaging abnormality plausibly explain the persons clinical findings.

This INCLUDES full tendon tears as with increasing age this is very common, and this study showed that the large majority had no pain whatsoever!

Another thing to think about as a derivative of this paper is that whole body MRI’s have zero value as far as shoulders go and will likely do much more harm then good as again, 99% of people will have a finding in their shoulder and most will have no pain!

So essentially all of you reading this would have shoulder findings if you had an MRI, whether you have pain or not.  What really matters is seeing a qualified professional that is able to link any symptoms you are experiencing with MRI findings……otherwise the imaging alone really serves no purpose.

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Or maybe it’s worse than that, maybe you’re one of the unfortunate souls (like my wife recently) who tore their ACL skiing or like a patient of our clinic last week who tore his achilles playing pickleball.

You get to a certain point and you wonder if all these recreational activities are really worth the risk.
A recent study, helps put those concerns into perspective, showing that recreational exercise variety may be one of the most underrated longevity tools.

Researchers followed 110,000+ adults for more than 30 years, tracking the types of physical activity people did and how consistently they did them. They then compared this with death rates from all causes, including heart disease, cancer, and respiratory disease.

Most common activities such as, walking, jogging, running, cycling, resistance training, stair climbing, and racquet sports, were linked to lower mortality. Benefits increased with activity but plateaued at higher volumes (more isn’t always better).

Most importantly this long term observational study found that people who regularly did a greater variety of activities had a ~19% lower risk of death, even when total exercise volume was the same.

In other words someone who walks, lifts, runs and plays sports does better long-term than someone who only walks or only lifts or only runs, even if weekly minutes are identical.

So it’s not just how much you move, it’s how varied your movement challenges are. This makes complete sense. Some activities will challenge our cardiovascular system, some will challenge strength and help build muscle mass, some will build power or challenge mobility, balance or co-ordination. Having a more rounded approach to your exercise selection increases the odds that you are addressing most of the key areas of your physical health.

But it’s not just the physical movement diversity component at play here. The varied cognitive challenges associated with pursuing and learning different activities may help mitigate some of the key factors associated with aging and some forms of chronic disease. You may even become a super ager.

And the varied environments with different social networks can’t be ignored either. Our social circle starts to naturally shrink as we get older. A variety of recreational endevours are a fantastic way to both build and maintain a stronger social network. Your social community and supports are key pillar of your overall health.

We all know that being active lowers your risk of disease and early death. But don’t just move more, challenge yourself to pick more ways to move. Your body thrives with variety.

So next time you’re wrestling with that “is it all worth it” question, remember your healthspan (quality of life) and lifespan, quite literally depends on it.

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Back pain can be classified many ways, but researchers now like to use umbrella terms to encompass the large majority of low back pain that is not scary in nature, meaning not from pressure on a nerve sending pain down your leg, a fracture, or other problematic condition.

Nowadays, the ‘preferred’ term is chronic non-specific low back pain and at any given instance it is estimated there are 540 MILLION people worldwide affected by it.

We put rehab exercises at the base of the pyramid for best evidenced care regardless of what condition you are dealing with.

Tennis elbow?  Exercises

Achilles tendon?  Exercises

Chronic back pain?  Exercises

Kids bugging you from an unexpected snow day (like today)?  Exer…..can’t really help you there.

People that have a history of gym based workouts are often surprised when we start the large majority of low back pain patients with exercises that have no external load (meaning no external weights added to their exercises).

We often do progress to exercises with weights in the gym……but not in every case.

Confused?

Well at our clinic one of our main values is individualized, tailored care.  We despise clinics with cookie cutter handouts for any type of condition as they do not address the stage of healing you may be in, let alone your experience with exercises, your attitudes and beliefs about rehab, or any other contextual implications to your recovery.

We have some general ideas that we follow in terms of progressing people, largely guided by people’s pain levels and expected tissue adaptations.

But to be clear: If you are doing the same exercises you were 6 or 12 weeks ago, we have failed.

This means that sometimes rehab is a bit more of an art then a science.

Sometimes we use weights and sometimes we don’t.

This begs the obvious question, are weights better than body weight for chronic non-specific low back pain (which makes up over 80% of ‘everday’ low back pain)?

Well a systematic review and meta-analysis recently looked at all past studies that address this question, pooled the results for us and gave us some interesting guidelines and answers.

Generally, we tend to side with external loads for many conditions.  We know it results in better strength gains increasing tissue capacity.  It increases cartilage turnover and there’s even research showing exercising with weights improves your responses to pain by increasing your pain threshold.

We also like that you can do graded exposure by slowly increasing the amount of weight you add at any given time.

Simply put the only way we can ask a tissue to adapt is by challenging it with added work. 

The back is different.

It is a symphony of insanely complex tissues with a multitude of pain generators.  You also can’t exactly ‘rest’ your back as it’s loaded with everything you ever do including sitting and standing!

Often, just your body weight (or at times even less than that) is all that is needed to ask back tissue to adapt and hopefully decrease your pain.

This meta analysis grouped 778 patients with non specific low back pain where roughly half did a resistance training program using external loads, and the other half used just movements and body weight.

The typical program was 8 weeks long, and 3 times weekly for the program.

Here is what the researchers found:

Overall, external loads may promote measurable neuromuscular adaptations but these benefits DO NOT consistently translate into better outcomes in either pain or disability nor have any advantages on psychological variables like fear avoidance and catastrophizing. 

What does this mean?

Generally it means that external loads can be a USEFUL tool but in no way a universally necessary one.

It turns out that clinical outcomes for those with chronic low back pain depend more on how your exercise program is structured, delivered and interpreted than on the intensity of the exercise and how much weight you are using in your rehab.

The DELIVERY of exercise is likely more impactful than it’s intensity or volume.

HINT – THIS MEANS THE QUALITY OF THERAPIST IS KEY!

When you look at the data from this study, the researchers suggest instead of high intensity, they believe that exposure consistency and volume are more important.  This means low intensity and high frequency strategies are the best.

See our past blogs on both walking, and exercise snacks as examples.

So next time your back is sore, added weight may not be important…..or it may be!  What’s really important is finding a good therapist to help guide you on your path to recovery.

To sum up this entire article:

Exercise works, but how it is delivered matters more than how heavy it is!

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In the past two years, we have seen a quiet boom in private “longevity diagnostics.” Clinics around the GTA now offer whole-body MRI scans for thousands of dollars, while executive medical centres promise a head-to-toe investigation of your heart, metabolism, mental health, and cancer risk.

The pitch is seductive: Detect disease and diagnose early. Get ahead of the treatment curve. Live longer.

But here’s the uncomfortable truth: neither whole-body MRI nor executive medical screens have strong evidence that they extend lifespan.

And the difference between the two services reveals something even more important, the real determinants of longevity are not what most people think.

Whole-Body MRI: The High-Tech Longevity Mirage

A whole-body MRI sounds like the ultimate safety net — one scan, no needles, no radiation, and a chance to catch “silent killers.” But large studies tell a very different story.

Whole-body MRI detects cancer in less than 1–2% of healthy people… but finds incidental abnormalities in 20–40%. Most of these “findings” are harmless cysts, nodules, shadows, or anatomical variations. But once they’re on a radiology report, the cascade begins: more scans, biopsies, specialist visits, anxiety, and sometimes unnecessary procedures. See here, here, and here.

Even more striking? There’s no evidence that whole-body MRI screening lowers mortality in average-risk adults. National radiology groups in Canada, the U.S., and Australia all advise against it for asymptomatic people. (here, here, and here).

In short: whole-body MRI is outstanding at finding things and terrible at telling us whether those things matter.

Executive Medical Screens: Closer to the Mark, but Still a longevity let down

Executive health assessments (think MedCan, Cleveland Clinic Executive Health, TELUS Health) take the opposite approach; they look for the common diseases that shorten life like cardiovascular disease, diabetes, and metabolic dysfunction.

The upside? These programs actually measure markers that matter like blood pressure, glucose control, Cholesterol and ApoB, inflammation, aerobic and muscular fitness, mental health and evidence-based cancer screening.

This approach is far more aligned with what kills people before their time.

But the best available evidence assessing the benefit and potential harm of these types of medical screenings indicates that they are unlikely to be beneficial. A recent update of a Cochrane review included 17 trials with data from more than 250,000 people. The trials assessed various combinations of blood, urine and lung function tests, electrocardiograms, cancer screening, vision and hearing assessments. It found strong evidence that general health screens at the population level have little or no effect on overall mortality.

But you may argue that your health doesn’t care about population level statistics and that more information for your own health is good, right? Potentially. However, overdiagnosis, complications related to follow-up tests, unnecessary treatments and false positives can also have detrimental psychological and physiological effects.

And we all know that one person who was given a “clean bill of health” from their executive medical screen despite being on the surface anyways far from the picture of health. The screen in these patients may have negative effects on prevention behaviour due to an overconfidence of “good health”.

Anaecdotally, these programs have helped many of our patients identify potential issues to follow up on and have motivated positive health behaviour changes, so I don’t want to come across as entirely negative on these programs.

However, ultimately, these programs have failed to demonstrate at the population level that they extend lifespan beyond what good primary care and evidence-based screening already accomplish.

So What Does Improve Longevity? And where should you spend that $ instead.

Here’s the part most people don’t want to hear: longevity isn’t purchased, scanned, or blood-drawn. It’s trained.

Study after study shows that the strongest predictors of long, healthy life are physical factors such as:

Leg strength

VO₂ max

Gait speed

Balance

Muscle mass

Physical activity volume

(See here, here, here, and here).

These are better predictors of mortality than cholesterol, blood pressure, or even smoking status in many models.

And while your executive medical test may include elements of these powerful predictors, is it the focus of their program?

Here in Burlington we do have a program that does measure these primary trainable attributes that matter. It’s called Benchmark Proactive Health which is led by Dr. Kaitlyn Link and includes body composition, leg strength testing, VO2 max testing and balance (among other things).

And the Benchmark program is a fraction of a whole body MRI or comprehensive executive medical screen.

And if you want to further put that $3000 to good use for longevity: invest in strength training, aerobic conditioning, mobility and balance training and injury prevention guided by experts who actually understand how to improve those areas.

In other words, stop searching for longevity in diagnostic technology and instead focus on training and building your own, as Dr. Peter Attia calls it, centenarian decathlon.

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