Ragav Sharma, DO

Ragav Sharma, DO is a Physical Medicine and Rehabilitation (PM&R) physician with training in interventional spine and musculoskeletal medicine. He formerly set powerlifting records and has also completed several races including ultramarathons. He is an avid proponent of resistance training and has coached others, obtaining a Certified Strength and Conditioning Specialist (CSCS) certification, for both general health and powerlifting goals. 

In this episode, Dr. Ragav Sharma breaks down the science and strategy behind resistance training — one of the most powerful tools for improving long-term health, performance, and longevity. We explore what the evidence says about strength training for muscle growth, fat loss, metabolic health, injury prevention, and healthy aging. If you’ve ever wondered how often to lift, what exercises actually matter, or whether resistance training is “safe,” this episode gives you the no-nonsense, research-driven answers.

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Show Notes

What Is Resistance Training?

Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:

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  Bodyweight exercises

  
  


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  Free weights (dumbbells, barbells, kettlebells)

  
  


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  Resistance bands

  
  


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  Machines

  
  


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  Household objects (backpacks, water jugs, cinder blocks)

  
  

Strength training is not just for athletes or bodybuilders. It is one of the most potent therapeutic tools we have for improving overall function, mobility, and longevity — and it should be accessible to everyone.

The Evidence-Based Benefits of Resistance Training

1. Improved Body Composition

Resistance training:

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  Increases fat-free mass (muscle)

  
  


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  Reduces overall and visceral fat

  
  


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  Helps preserve muscle during weight loss or GLP-1/GIP therapy

  
  


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  Predicts lower mortality independent of BMI

  
  

Muscle is metabolically protective. Higher muscle mass is associated with a lower risk of chronic disease and death, even in those with a high BMI.

2. Stronger Bones and Lower Fracture Risk

Bone density peaks around age 25–30 and declines after 40, especially in women. Walking alone does little for bone mineral density.

Mechanical loading — squats, deadlifts, step-ups, weighted carries — is essential for:

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  Increasing bone density

  
  


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  Slowing osteopenia and osteoporosis

  
  


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  Reducing fracture risk

  
  


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  Maintaining physical function later in life

  
  

One of the strongest demonstrations is the Lift More Trial, where women 60+ with diagnosed osteoporosis safely performed heavy squats and deadlifts twice per week. They improved bone density significantly, with only one mild strain in over 2,600 sessions.

3. Cardiovascular Benefits

Many people assume aerobics is the only way to protect the heart. The data tells a different story:

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  Any resistance training → 19% lower cardiovascular mortality

  
  


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  Improves LDL, HDL, triglycerides, blood pressure

  
  


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  Enhances functional capacity in heart failure patients

  
  

The best results come from combining aerobic exercise with strength training — but strength training alone has a meaningful impact.

4. Improved Metabolic Health

Strength training increases insulin sensitivity through GLUT4 upregulation and:

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  Lowers HbA1c in both type 1 and type 2 diabetes

  
  


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  Reduces visceral fat, a major driver of insulin resistance

  
  


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  Improves metabolic flexibility

  
  

For people unable to tolerate high-impact cardio, resistance training becomes even more important.

5. Mental Health Benefits

The psychological benefits are just as powerful:

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  Significantly reduces anxiety symptoms

  
  


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  Lowers depressive symptoms in adolescents and adults

  
  


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  Benefits occur regardless of strength gains

  
  

Simply engaging in resistance training reliably improves mood and mental well-being.

6. Reduction in Chronic Pain

Movement is medicine — and resistance training consistently reduces pain:

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  Decreases chronic low back pain

  
  


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  Improves pain and function in knee osteoarthritis

  
  


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  Helps patients with fibromyalgia reduce fatigue and tender points

  
  

For general musculoskeletal pain (3–7/10), strength training should not be avoided — it is often one of the most effective treatments.

7. Frailty Prevention and Improved Longevity

Inactive adults lose 3–8% of muscle per decade, accelerating after age 50. Resistance training:

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  Rebuilds strength and muscle

  
  


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  Improves gait speed, grip strength, and mobility

  
  


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  Reduces fall risk

  
  


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  Lowers frailty and functional decline

  
  

Most importantly:

Any strength training → 15% lower all-cause mortality

~60 minutes per week → 27% reduction (maximum benefit)

This is one of the strongest arguments for making resistance training a standard part of preventive medicine.

Why Most People Still Aren’t Strength Training

Despite overwhelming evidence, only about 10% of adults meet strength training guidelines. Common barriers include:

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  Fear of injury

  
  


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  Lack of knowledge

  
  


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  Lack of time

  
  


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  Misconceptions about “proper form”

  
  


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  Intimidation around gyms

  
  


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  Poor clinician guidance

  
  


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  Social stigma

  
  


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  Limited access to equipment or facilities

  
  

But most barriers are built on incorrect assumptions — and many can be addressed effectively.

Resistance Training Myths — Debunked

Myth #1: “I’ll get injured.”

Weight training has one of the lowest injury rates of any physical activity:

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  0.05–0.31 injuries per 1,000 hours
  Compare that to:

  
  


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  Running: 2.5–33

  
  


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  Basketball: ~8

  
  


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  Tennis: 27–62

  
  


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  Golf: 3–8

  
  

Strength training is far safer than most sports.

Myth #2: “Squats and deadlifts will ruin my back.”

Data shows:

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  Powerlifters report no major back injuries in squat/deadlift reviews

  
  


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  Only 6.5% of disc herniations are related to heavy lifting

  
  


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  Most herniations occur during daily tasks like mopping or twisting

  
  

A well-dosed program protects your back — it doesn’t harm it.

Myth #3: “I have bad knees. I can’t squat.”

People with knee osteoarthritis benefit from resistance training:

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  Reduced pain

  
  


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  Improved strength

  
  


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  Better function

  
  


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  Lower disability

  
  

Even common “faults” like knee valgus are not inherently dangerous.

Myth #4: “I’m too old to lift heavy.”

Strength training is safe and effective at any age — including people with:

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  Osteoporosis

  
  


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  Arthritis

  
  


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  Chronic pain

  
  


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  Frailty

  
  

The Lift More Trial proved heavy lifts can be safe even in 60+ adults with fragile bones.

Myth #5: “It takes too much time.”

The research shows:

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  60 minutes per week → maximum longevity benefit

  
  


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  15–20 minutes per week → effective for muscle and strength

  
  


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  “Exercise snacking” (5 minutes) → still beneficial

  
  

Time is not the barrier — expectations are.

Myth #6: “I need perfect form.”

Form matters, but not the way most people think.

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  CrossFit (irregular form) has injury rates similar to powerlifting

  
  


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  Machines and free weights produce similar strength gains

  
  


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  “Good form” is often just what feels natural and safe for the individual

  
  

The real risk factor isn’t form — it’s doing too much, too soon.

How to Start Resistance Training (Safely and Effectively)

Here is a simple evidence-based template:

Pick one movement for each pattern:

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  Push (push-ups, machine press, overhead press)

  
  


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  Pull (rows, pulldowns)

  
  


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  Squat (goblet squat, leg press)

  
  


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  Hinge (deadlift variation, hip th