The Low Hanging Fruit or Don't Complicate Things

 Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away. Antoine de Saint-Exupery.

Perhaps it is human nature, the allure of complexity, or even our innate tendency to conflate credentials and confidence with competence, but as a species we seem to consistently fall prey to adding increasing complexity to problems with simple solutions. Not necessarily easy solutions, but simple solutions.

Take frailty in the elderly, a project my niece is working on with a handful of “experts.” Frailty, sadly, is no longer limited to the elderly in modern populations but is increasingly being seen in younger and younger individuals and is inevitably a product of life in the modern age. I could quote endless studies on the prevalence of sarcopenia and its corollary sarcopenic obesity but none of that is actually necessary if you have eyes in your head. Simply look around you in any public place and observe the flaccid bodies across a spectrum of age groups and you will observe high levels of sarcopenia and sarcopenic obesity. We don't need fancy dexa scans or full body imaging to note that the last few decades have wrought frightening changes on the human physique. Even the youth in the modern world have no visible muscle mass, a situation which is simply not normal; average maybe, but normal no.

The solution to frailty in the elderly is elegantly simple:

• Eat more high quality animal protein (we know that older individuals have poorer absorption of protein rendering current RDA's too low):

• Perform some kind of progressive resistance training focusing on the five fundamental human movements: (squat, push, pull, hinge, carry);

• Move as often as possible, preferably walking (the other fundamental human movement).

And there, in three bullet points is the solution to frailty in the elderly; elegantly simple in theory, exceptionally difficult in practice. Therein lies the problem of increasing complexity. A task force cannot be convened and kept functioning for months on end with a solution that is so simple and basic. Instead, we must add unnecessary and ultimately unhelpful complexity.

Enter 1 RM testing and training at 80% of 1 RM. In theory, 1 RM is relatively easily tested but in practice every strength coach and gym rat knows that not only is 1 RM testing difficult in untrained populations, but also that there is nothing magical about training at 80% of 1 RM. If you want to get stronger (strength is defined as “the application of force against an external resistance") all that is necessary is an increase in load over time. Which is why the other name for strength training is “progressive resistance training”.

But strength in humans is not only a product of hypertrophy, strength is also influenced by neurological factors, primarily the wiring together of neurones that coordinate working muscle. This is the reason why, on a boulder problem that requires strength and power to climb, I can work the problem a few times in one session and ultimately send the boulder in that session. There has been no hypertrophy or strength gains over that time, in fact, my muscles have fatigued, but I have learnt how to move my current musculature in a way that enables me to improve my performance. And all of life is about performance; even frailty in the elderly is best visualised as a performance outcome: don't fall down and break a hip.

It follows therefore, that if you test one RM in untrained populations, such as the frail elderly (any older person that knows their one RM is highly unlikely to be frail) today, that one RM will be markedly different when tested in a few days time after the individual has practised the exercise. Ergo, any program based on training at 80% of one RM has perhaps a week time frame before it is outdated. This is complexity added for the sake of complexity. If you want to train the frail elderly for strength start somewhere, anywhere, and increase resistance in a progressive fashion. Anything works for a while, and in untrained populations, that while can be a long time.

Those who want empirical data to support this theory are going to be sadly disappointed. Perhaps it is my contrarian nature, or perhaps I am simply more realistic than many, but I think there are very, very few things that we can be certain about in the modern world and while we might pretend we have both accurate and precise information about all manner of things, “50% of what we know is false and we don't know which 50%.” John Ionnidis goes so far as to say that “most published research findings are false,” a position which people who unthinkingly accept the word of experts should definitely read and heed.