April 2026

New Old Concepts in Resistance Training

Resistance training (RT) has, for years, taken a back seat to cardio, or aerobic, training. The early work by Dr. Ken Cooper at the Cooper Aerobics Center in Dallas that identified cardiovascular capacity, or maximal oxygen uptake (maxVO2), as the key to health set the stage and the standard for the jogging and aerobic dancing era of the 1970s-1990s. RT was relegated to sweaty old gyms for bodybuilders and football players.

But RT started making a name for itself in the 1980s and that name has only escalated over the years. Just recently, the Washington Post ran an article (Mar. 17, 2026) based on a new position stand from the American College of Sports Medicine (MSSE, Mar. 5, 2026) that summarized the galaxy of benefits from a RT program. First and foremost is the overload principle that states one must lift or push a load that challenges the muscles sufficiently to induce growth, or hypertrophy. (Other principles are critical, too, but we don’t have space to cover them.)

A Brazilian study just confirmed that overload must be progressive in order to maximize hypertrophy. That is, one must lift gradually higher loads or more repetitions over time in order to improve. Lifting the same weights the same number of times won’t cut it. (Int J of Sports Medicine, June 2024)

Another systematic review (J Physiol Dec. 2025) just gave new fuel to the fodder: the weights do not have to be progressively heavier (unless you have more athletic goals) so long as the level of fatigue at the end of the set is similar. That is, do high, high reps and if you have at most 2 more reps to go before failure, you can get bigger and stronger muscles, even with high numbers of repetitions. In other words, lift, more and more reps, for health and longevity.

To Get a Knee, Take the D

Knee and hip replacements are, despite their ubiquity and superb safety records, major surgeries. After all, the surgeon is sawing off the ends of bones and reaming out sockets in order to position metal components to replace damaged joint surfaces. Usually these surgeries occur in patients who are older, have been more sedentary due to pain and dysfunction, and, in many cases, have nutritional deficiencies due to lifestyle choices and/or less-than-optimal diets.

Vitamin D deficiency affects ~35% of Americans, with the elderly at greater risk due to excess body fat and less exposure to sunshine. (Cleveland Clinic, “Vitamin D Deficiency”, Aug. 2022) Some pertinent symptoms of this are lower bone and muscle quality, not good precursors to joint replacement surgery.

A meta-analysis of studies that met inclusion criteria found that 4 of them showed that D deficiency “resulted in poorer functional outcome scores [on standardized knee tests] as well as increased risk of revision surgery, incidence of joint infection, and postoperative stiffness”. Too, these patients tended to have longer hospital stays.

By comparison, other studies have shown that D supplementation resulted in “improved functional outcomes” and reduced hospital stays (where longer stays are associated with increased risks for deep vein thrombosis, joint stiffness, and noncompliance with therapies.) Since bone quality is often diminished in older people, the integrity of the implant was also a concern.

Bottom line: start taking vitamin D supplements, according to your physician’s guidance, several months prior to joint replacement surgery to give you a better chance of a safer, easier, and more functional outcome.   

JBJS Reviews, Sept. 2025

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