Medicine’s iron age unofficially began in 1945.

That’s when US Army physician Thomas DeLorme, MD, showed that soldiers with orthopedic injuries responded so well to strength training that they could complete their rehab in a fraction of the time.

DeLorme’s system, which he eventually referred to as “progressive resistance exercise,” went against the conventional emphasis on restoring muscular endurance following a major injury. His priority was rebuilding strength and muscle mass, which he believed were far more important to a full recovery.

Ironically, the structure of his program — three sets of 10 — lives on, while DeLorme’s urgent message about the importance of muscular development hasn’t quite gotten through. That’s despite the addition of “muscle strengthening activities” to the CDC’s exercise guidelines in 2008.

“Seventy percent of Americans do not do resistance training twice weekly,” which is the current recommendation, said Brad Currier, PhD, clinical trial manager at Timeline, a biotech company in Lausanne, Switzerland. “And 60% do none at all.”

Currier is the lead author of the American College of Sports Medicine’s new position stand on prescribing strength exercise.

The authors’ primary goal, Currier said, was to “synthesize all available clinical evidence” and “understand how resistance training can be prescribed most effectively, so physicians and other practitioners can give their patients the best chance of benefiting.”

Which brings us to another challenge: Getting doctors to prescribe resistance exercise in effective ways.

Here’s a good way to start.

The All-Important First Steps

Andrew Mock, MD, has two advantages over most family-practice physicians when it comes to exercise prescription.

First, his practice at Hoag Medical Group in Southern California emphasizes lifestyle medicine. So patients who select his clinic expect him to talk about physical activity. 

Second, he’s a big, strong dude, which makes it easier to talk about resistance exercise specifically.

“It’s a blessing to have that credibility, just from an appearance standpoint,” he said. “We know that physicians who exercise are more likely to talk to their patients about it, and patients are more likely to listen.”

Even so, he still asks for permission to talk about exercise before beginning the conversation.

If the patient is open to the idea of strength training but has no idea how to begin, their first priority is to determine if it’s safe for them to begin a program, based on their health history, activity level, and whether they have any current symptoms.

“The truth is, for most people, it’s actually more dangerous for them to not exercise,” he said.

The next step is to get a sense of their starting point — what they can do on day one.

Do they have a safe environment to exercise? Do they have social support? What resources do they have? If they have access to a private or commercial fitness facility, will they also have access to a qualified exercise professional? 

Once he has that information, Mock begins his evaluation of their current physical abilities. But he doesn’t tell them they’re being evaluated.

Instead, he asks the patient to stand up, walk across the room, and sit on the exam table. 

Did they stand straight up, or did they use their hands to push off from the chair? Or, worse, did they rock back to generate momentum before pushing off with their hands?

If they need hand support and/or momentum to rise from the chair, they’ll probably begin their exercise program with body-weight squats, one of the six basic movement patterns we’ll explain in the next section. 

“But if they stand up hands-free, they need external resistance to get their legs stronger,” he said.

He’ll also introduce the patient to the hip hinge, another key movement pattern.

The deadlift is the most common version of the hip hinge, but few entry-level exercisers are ready to bend forward and lift something heavy off the ground.

He has them stand with their hands on the front of their thighs. They then slide their hands down, keeping their legs relatively straight, while pushing their hips back. He compares it to reaching down to tie a shoe.

“I’ll have them go as low as they comfortably can,” he said, with the movement slow and controlled. Then they return to the starting position at normal speed. 

A Minimalist Program With Maximum Flexibility

Patients without recent strength-training experience begin with a simple program:

Two days a week, they do a full-body workout at moderate or greater intensity (more on that in a moment), with at least 48 hours between training sessions.

Each session includes six basic movement patterns, which work all the major muscle groups (and most of the minor ones):

Squat. This is the foundational movement for human function. It works more muscle mass than any other, and the muscles it strengthens are used for everything from walking and climbing stairs to getting up and down from a chair.

Hip hinge. Being able to lift something from the floor, whether it’s a bag of groceries or a sleeping child, is important to lifelong independence. Hip hinge exercises work the posterior muscles, primarily the glutes and hamstrings.

Upper-body horizontal push. This movement works the chest, shoulders, and arms and is one of the easiest to modify for a patient’s ability and equipment. Options range from pushups against a wall for the most deconditioned patients to chest presses with free weights or machines.

Upper-body horizontal pull. Rowing exercises work muscles in the back, shoulders, and arms. Unfortunately, they’re difficult to do at home without specialized equipment. Free weights need to be relatively heavy to challenge the targeted muscles, and resistance bands need to be anchored to something sturdy. But even the most bare-bones gym will have multiple rowing options.

Upper-body vertical push. Conversely, a patient doesn’t need a lot of resistance to get the benefits of lifting something overhead. And with older patients, you don’t want them doing heavy shoulder presses. Light dumbbells or resistance bands should give their shoulder and arm muscles an adequate stimulus.

Upper-body vertical pull. This is probably the most challenging movement to perform outside a gym. Even a patient who’s strong enough to do chin-ups or pull-ups will need a bar capable of supporting their body weight.

Mock writes up each patient’s program in the form of a prescription. They typically do one set of each exercise the first week, two sets the second week, and three sets the third week.

He also gives them five exercise variations for each movement pattern: 

• Modified body weight
• Body weight
• Machine
• Resistance band
• Free weights

Finally, he gives them a straightforward way to assess their own effort. “The number one thing you can teach patients is how hard it’s supposed to feel,” he said.

He instructs them to pay attention to the speed of their repetitions. If the final reps of the set are significantly slower than the initial ones, that suggests moderate intensity, which is the goal.

If the reps don’t slow down, “that’s your cue to add some weight,” he said — or, in the case of body-weight exercises, to move on to a more challenging variation.

Adherence Is Everything

The best program for a strength-training novice is the one they’ll actually do. That’s why you want to make it as simple and enjoyable as possible for those patients.

“The most important thing people can do is show up and adhere to the program,” said Currier. “It takes very little participation to have tremendous benefit.”

Over time, Currier noted, three principles will determine the patient’s success:

Progressive overload. That means doing a little more each week or month — a little more weight, a few more reps, and/or additional sets, more challenging exercise variations.

Individualization. You want to accommodate each patient’s preferences and limitations. “Time is a big one,” Mock said, especially if they think of strength training as something that requires driving to a gym for hour-long workouts. Mock gives them simple alternatives they can do at home with minimal equipment.

One example: a single set of body-weight squats performed multiple times a day. Mock cited a 2024 study in which overweight and obese participants who did 10 squats every 45 minutes had improved glycemic control compared to a sedentary control group.

Consistency. Almost all the benefits of resistance training come from long-term adherence. “Muscle is so important for overall health,” Currier said, noting that it’s the primary disposal site for blood glucose. But it takes time to develop those carb-hungry muscles. So do what you can to help your patients stay engaged and motivated.

The Value of ‘Something’ vs ‘Nothing’

Let’s circle back to where we began, with DeLorme at an army hospital in 1945. 

Before he could demonstrate the value of resistance training for injured soldiers, he had to get buy-in from someone willing to try the experimental program. That first patient, like DeLorme, was an experienced lifter who understood both the risk and potential reward.

The opposite is true for many of your patients. 

“Resistance training can be intimidating to people, especially older adults,” Currier said. Maybe they’re worried about getting hurt, reluctant to change their routine, or overwhelmed by all the details they think they have to focus on.

For those patients, Mock asks for the minimal effective dose. “Literally anything is better than zero,” he tells them. “Can we make sure today is not a zero day?”