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Yes, we love to pit runners against gym bros in a one size fits all health economy where each will claim superiority over the other.

The main point that Dr. Stu Philips continually pounded out during his lecture to our clients this spring was that the best form of exercise is the one that you enjoy the most!

So when yet another giant study comparing aerobic exercise with resistance training just got published to much fanfare, I can admit I started to leaf through it with a bit of a narrow view, expecting to learn nothing.

I was pleasantly surprised at the change in tone of the recommendations made by the researchers.

This was a massive study looking at the effectiveness of both aerobic health and resistance training on many health factors with one catch.

This large meta-analysis only included people with diabesity.

That immediately begs the question…….what the heck is diabesity???

Well the article notes that in 2021 alone, cardiovascular disease and type 2 diabetes combined for over 20 million deaths. This can no longer be called an issue, it is now considered a full blown obesity related epidemic.

Cardiovascular disease and type 2 diabetes share a lot of common features: high blood pressure, dyslipidemia (issues with your fat levels), impaired fasting glucose, insulin resistance and many more.

Researchers are now starting to take a step back and look at what are called ‘network models’ of disease where they acknowledge the complexity of these conditions and grouping them together allows for us to make scalable lifestyle interventions to impact more conditions.

This was the birth of the term ‘diabesity’ which links insulin resistance, impaired glycemic control, fat deposition throughout the body, fatty tissue chronic inflammation and chronic low grade systemic inflammation.

Recommendations for one disease are likely to be very impactful on the other. This makes a ton of sense.

The issue is that all clinicians know that diabesity carries huge risks but they are not sure which to emphasize between aerobic exercise and resistance training.

If someone comes in severely overweights, many doctors will suggest biking a number of times a week, however this may ignore the benefits of resistance training for folks with type 2 diabetes like maintaining skeletal muscle mass which is a key factor in insulin sensitivity.

The other issue is that most prior meta-analysis where they group trials together to draw out conclusions, tend to compare aerobic exercise with non-exercise or ‘usual care’. Same with resistance training. They rarely compare one against the other.

After a ton of exclusion criteria this trial ended up including 1,184 trial participants across 23 studies. The mean BMI in the group was 32.1.

This graphic summarizes the study findings (we will break them down below):

A simple summary:
– Aerobic training was better for fasting blood glucose and cardiorespiratory fitness
– Resistance training for body fat and free fat mass
– There was no difference between the two for an astounding number of factors including body weight, body mass index, HbA1c, lipid markets and many others.

Overall this is yet another study showing that both aerobic training and resistance training should likely be combined. However, researchers are starting to recognize that there should be no one size fits all program for folks struggling with weight.

Let’s say someone was trying to lose weight and had just started a GLP-1. Perhaps the dominant treatment target is to stop muscle loss (sarcopenia) while they lose weight. Then an emphasis on resistance training should likely be at the forefront.

Let’s say that a person’s blood work showed that glucose metabolism issues are the primary goal. Well aerobics may be a better emphasis here.

Overall the concluding sentence does a good job of summarizing the findings:

“When interpreted within lifestyle medicine paradigm, these complementary findings support a goal directed and individualized approach to exercise prescription rather than a one modality fits all model.”

Like Dr. Phillips said……you’re best exercise is the one that you enjoy the most!

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Both the cancer itself and cancer treatment often leaves patients dealing with fatigue, muscle loss, reduced cardiovascular fitness, pain, and decreased independence. These challenges can persist long after chemotherapy or radiation has ended.

A 2025 umbrella review published in the British Journal of Sports Medicine showed that exercise consistently reduces cancer-related fatigue, anxiety, depression, physical deconditioning, treatment complication while improving quality of life, physical function and overall fitness.

And these improved quality of life measures are not limited to early stage and lower grade diagnoses.

The 2024 PREFERABLE-EFFECT trial, published in Nature Medicine, focused on people living with metastatic breast cancer, a group historically underrepresented in exercise research. Participants completed a supervised program combining aerobic exercise, resistance training, balance work, and behavioural coaching over nine months.

The results demonstrated meaningful improvements in cancer-related fatigue, physical fitness, quality of life, pain and overall physical functioning.

Perhaps most importantly, the study showed that appropriately prescribed exercise is both safe and beneficial, even for individuals living with advanced cancer.

Exercise can and should be recommended as supportive care for almost anyone with cancer, however the science has taken a remarkable step forward in the last couple years.

We now know exercise isn’t simply about recovering from cancer treatment, it may actually improve cancer outcomes itself.

A Landmark Study Changes the Conversation

In 2025, researchers published the results of the CHALLENGE trial in the New England Journal of Medicine, the first large randomized controlled trial to demonstrate that a structured exercise program can reduce cancer recurrence and improve survival after treatment for colon cancer.

The study followed 889 patients with Stage II and III colon cancer who had completed surgery and chemotherapy. Participants were randomized to either receive standard health education or a three-year, behaviourally supported exercise program led by exercise professionals.

The results were striking.

Patients who participated in the exercise program experienced:

• 28% lower risk of cancer recurrence, developing a new primary cancer, or death
• 37% lower risk of death
• Higher disease-free survival and overall survival after nearly eight years of follow-up

This is a pivotal finding because randomized controlled trials are considered the highest level of clinical evidence. Previous research had shown that people who exercised tended to live longer after cancer, but it was difficult to know whether exercise itself was responsible (causation versus correlation).

The CHALLENGE trial provides compelling evidence that structured exercise can directly improve long-term outcomes in at least one common cancer.

The exact mechanisms for exercise causing better survival rates will be an area of study for decades to come.

However one recent hypothesis is that exercise may be able to literally starve a tumour.

A fascinating new study published in PNAS found that just 4 weeks of regular exercise dramatically slowed tumour growth in multiple mouse models.  Researchers found that increases in muscle glucose metabolism and reductions in tumour glucose metabolism correlated with slower tumour progression.

Essentially exercising muscle becomes a powerful glucose competitor pulling glucose into skeletal muscle and the heart, leaving less fuel available for tumours to grow.

The authors also found that exercise can reduce mTOR signalling, a major pathway that drives cell growth and is frequently overactive in cancer.

Yes, this is just an animal (mouse) study, so it alone does not prove anything.  However, it’s provides an interesting mechanistic framework supporting this growing body of evidence that exercise interventions may enhance future cancer prevention and treatment strategies.

What Does the Research Suggest Patients Should Do?

So what should you do, if you or a loved one is diagnosed with cancer?  While every individual requires a personalized plan, the strongest evidence supports programs that include:

• 150–300 minutes of moderate aerobic activity per week, such as brisk walking or cycling
• Resistance training two to three times per week to preserve and rebuild muscle
• Progressive increases based on tolerance
• Long-term consistency rather than short bursts of activity

For many people recovering from cancer treatment, simply beginning with regular walking and a supervised strengthening program can provide substantial benefits.  And as a mentor of mine once said, there are many roads to Rome.  How you incorporate exercise into your cancer care strategy will depend on many different factors.

Train for strength.  Train for cardiovascular fitness (both low intensity, longer duration sessions or higher intensity intervals can work).  Mix in some training for power, mobility and recovery if you have time as well.  You have lots of options.  And if you have questions on how to get started safely and effectively, we can help.

The Bottom Line

The message from the latest research is clear: exercise is no longer simply a way to help people recover from cancer treatment, it is becoming an important part of cancer care itself.

If you or someone you know has been diagnosed with cancer, talk to your healthcare team about incorporating exercise into your treatment and recovery plan.  Don’t wait for your oncologist to advise on your exercise strategy.  Your oncologist may not recommend exercise as part of your active treatment plan for various reasons; knowledge translation from academic research to clinical practice takes decades.

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Dr. Christopher Neason, a young Australian, is the athletic research example of this.

He just completed his PhD program and published not one, not two, not three but FOUR ground breaking original research studies (plus some additional bolt on studies) on the same topic to help educate the population and lower fear about what can now be considered a VERY useful intervention in the management of chronic low back pain.

RUNNING.

That’s right running.

If you asked me 5 years ago (heck, even 3 years ago) if high intensity running intervals were good for those with chronic low back pain I would suggest trying just brisk walking instead.

But Dr. Neason’s research has officially made me a believer in running.

Let’s briefly explore the 4 studies he published (including a pair of new ones).

Study 1:  

This was a secondary analysis on a prior 6 month long study that looked at strength and conditioning and low back pain.  Specifically he was looking at variables like training volume, intensity and frequency and how it affected those with low back pain.  This key study showed that shorter session duration and higher perceived exertion was associated with reductions in pain intensity in those with chronic low back pain.  From this, he thought to try this with running……specifically a run-walk interval programme as this allows for shorter duration spurts of higher intensity followed by rest periods.

Study 2:

This was the real ground shaking study.  It was called the ASTEROID study and was such a shock to our respective biases that we wrote a big blog article about it when it came out in 2024.  Essentially this was a 12 week trial comparing a run/walk interval intervention against a control group for those with chronic low back pain using just 3 thirty minute sessions per week.  This study showed that those in the run group had a statistically lower pain intensity and disability when compared to controls.  This was THE FIRST solid piece of literature to definitively show that running at intensity can actually be GOOD for chronic low back pain.

Study 3:

This is the first of his more recent studies that looked at how patients with low back pain actually FEEL about running.  In it, he studied the beliefs about the safety of running in adults with chronic low back pain both prior to his ASTEROID trial and then after.  Folks completed a questionnaire specific to beliefs questions both before and after the running intervention.  Overall 25% of participants in the trial reported that running was unsafe at baseline.  After the running intervention there was a trend towards more positive beliefs about running in those with chronic low back pain however the number of people was not large enough to make it generalizable to the population et large.

Study 4: 

His most recent study from January of this year showed definitively that adults with chronic low back pain had negative beliefs about running.  To do this he compared a group of people with low back pain to a group without.  This showed that adults with chronic low back pain have negative beliefs 69% of the time where they generally felt that running was unsafe.  On top of that, 93% of those with chronic low back pain limited the amount of running they did due to these negative beliefs.

So one obstacle as a therapist (and the purpose of this blog) is to convince folks with chronic low back pain that running is both SAFE and EFFECTIVE.  It will only be by changing these beliefs that people suffering with low back pain will be willing to try intense running as a potential intervention.

Call me a convert.

Running can not only be safe, but also efficacious in the treatment of low back pain.  Counterintuitively, short but intense running can actually amplify these benefits!

Here are two charts that nicely sum up his research finds on running with low back pain and why it is a GREAT, not good intervention.

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Sounds too good to be true.

But there is a training intention gaining attention in the research and rehab world.

The concept is simple:

Train muscles to build capacity at long lengths.

In other words, train muscles to produce force while in a stretched position.

Simple idea. Powerful results.

At our clinic, we commonly see hamstring, groin, calf, pec, rotator cuff, and forearm strains. A common thread? Many of these injuries occur when muscles are loaded while lengthened.

So the question becomes:

Are we adequately preparing muscles for the positions where they are most vulnerable?

I did a Therapy Thursday a couple weeks back emphasizing the same concept but wanted to reinforce the message.

Stretching Versus Stretching Under Load

Most active people already stretch.

Yet despite regular stretching, hamstrings stay tight, hips remain restricted, and muscle strains still happen.

Why?

Conventional stretching involves placing a muscle in a lengthened position and holding it there. This can improve flexibility and reduce stiffness, but research suggests much of that improvement comes from better stretch tolerance rather than major structural changes within the muscle.

Stretching still matters, but it may not be the whole story.

Why Load Changes the Equation

Recent research examining sarcomerogenesis, the addition of sarcomeres within muscle fibres, suggests that mechanical tension at longer muscle lengths may be a key driver of muscle adaptation.

A recent review by Blazevich and colleagues challenges the idea that passive stretching alone creates these changes. Instead, the more meaningful stimulus may be loading muscles while they are lengthened.

That is an important shift in thinking.

Many studies have concluded that eccentric exercise is the key to sarcomerogenesis, however Blazevich has proposed that it may be that muscles adapt best when they are asked to produce force in stretched positions.  Eccentrics are not the magic rehab potion, training at long muscle lengths might be.

What does loaded stretching or training at long-lengths look like?

Long-length training is not new.

Many effective rehab and strength programs already use it such as the use of Romanian deadlifts/lengthened Nordic variations in hamstring rehab or the use of deficit calf raises in calf and achilles rehab or cossacks/copenhagen variations for groin and hip rehab.

These exercises combine mobility and strength rather than treating them separately.

Instead of merely visiting end range, they help you own it.

The bodybuilding world has also embraced the research on hypertrophy from long-length training.  Resistance training performed at longer muscle length has been found to be more effective for promoting overall hypertrophy compared to training at a shorter length.

Bodybuilding programs often includes “lengthened partials”, where you only perform the stretched half of an exercise (partial range of motion), keeping the muscle under maximum tension when it is lengthened.

But a word of caution before you start doing some intense lengthened partials or advanced bodyweight stretch holds.  If you are new to resistance training, start with full-range strength training and progress gradually. Mobility, stability, and movement quality still matter and the challenges for long length muscle training may be too much for a beginner resistance trainer.

The takeaway message is simple:

Think of how you can emphasize muscle length in some of your common resistance training exercises.  Can you emphasize the reach and hold extended portion of a row or can you work your split squat for better control at a lower depth.

Or think outside of the traditional exercise box and create effort in some of your stretched positions.

There appears to be a unique adaptation when muscles are challenged in a fully lengthened state.

Research in this area has certainly changed the way I think about improving mobility, enhancing rehabilitation and preventing injuries for both myself and my patient care and hopefully it will change how you think about your own resistance training plan!

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Dr. Topol just highlighted an article that was just published today (May 6, 2026) that really caught my attention.

The Nature Journal is considered the holy grail scientific journal that all researchers try to get published in.  When Nature deems an article to be of particular importance, they will make it open access, removing the paywall for the greater good.

This was one of those articles.

To absolutely nobodies surprise, lots of prior studies have shown that both diet and physical activity levels can have a major impact on your ‘affective well-being’, essentially meaning how you are feeling emotionally.

These prior studies tend to have lots of flaws.  They are almost always ‘retrospective’ meaning they use surveys to ask people how they felt or how much they exercised over a given period.  These surveys tend to be terribly inaccurate and skew results.  On top of that, to ‘standardize’ studies, the physical activity sessions are usually in a lab setting which hardly mirrors a nice walk in nature.

With technological advances, associations like physical activity and your emotional well being are now much easier to accurately quantify.  Have someone be prompted to complete a quick smartphone survey at regular intervals and have them wear an accelerometer to track how much physical activity they are actually completing and voila!  You’ve greatly improved your dataset to draw conclusions.

That is essentially what this article sought to answer:  How does physical activity relate to your affective well being in everyday life.

The researchers took other studies and pooled 67 datasets from 321,345 participants that all used smartphone based affective wellness ratings and contributed to roughly 1 MILLION hours of accelerometer data.

This allowed them to establish a number of previously unknown answers:

• How does your mood change BEFORE exercise versus after?
• Is it different between genders?
• What about age?
• Does what level of shape you are in to begin with matter?
• What aspects of affective wellness are changed – is it increased energy? Is it emotional well being?  What about calmness?

Here is a little graph from the article to look at prior to summarizing the results.  The middle section with the lines with dots that look like drone planes from star wars tell whether physical activity was associated with particular variables.  If the drone plane is to the right of the vertical line then physical activity helped.  If it was to the left then it actually made it worse.

To summarize the study findings:

• The researchers were able to show that in everyday life, physical activity is associated with the following within a person:
  • Valence (a feeling of goodness)
  • Energetic arousal
  • Positive affective states
• These occurred if the person took the phone survey either before OR after exercising.
• These changes were there even if a person just went for a walk instead of continuing to sit!
• They were also able to show that in everyday life, if someone had a higher affective wellness score, then they did more physical activity and vice versa. This means that the emotional side of things and exercise play off one another.  Those with higher affective wellness scores did more physical activity.
• Some factors did impact these scores:
  • The findings were less pronounced in older folks when compared to younger people.
  • Women felt more energetically aroused after being physically active then men.
  • Those with a higher body mass index had a lower affective wellness score after and before exercise. The researchers think this is potentially attributed to feelings of discomfort, pain, heat etc.
  • The finding was stronger on weekends versus weekdays……work sucks!

Why is this important?

This paper started with an absolute banger of a statistic.  If people met the current WHO physical activity requirements, GDP would increase by USD $314 to $446 billion a year.  The reason is twofold.  First, it would counteract many physical ailments that cause people to miss work, and equally as important, it is now shown to have the ability to decrease days missed due to mental illness.

If you want more evidence as to the importance of exercise and mental health, Dr. Topol also linked to this 2024 mega article that showed that all forms of physical activity were superior to SSRI drugs for depression.

The post Does physical activity actually change your mood? first appeared on The Proactive Athelete.

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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