Why Protein Alone Won't Save Your Muscles with Robin Daly

James Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

James Hill:

Here we go.

Holly Wyatt:

Today we're diving into something that might change how you think about your workout routine. I know, Jim, you love for people to work out, but what if I told you that the order that you're doing the exercises could actually impact whether you build muscle or maybe you just get tired?

Robin Daly:

Well, I'd say that sounds suspiciously specific, Holly. Are you about to tell me I've been doing everything wrong at the gym?

Holly Wyatt:

Well, maybe not everything wrong, but there's definitely more strategy involved than most people realize, and we have the perfect person to help us figure this all out.

James Hill:

That's right. In this show, we go all over the world to find the very best people. So today joining us is Professor Robin Daly, who holds the chair in Exercise and Aging at Deakin University. Holly, you know where Deakin University is?

Holly Wyatt:

I'm not sure, Jim. I know it's somewhere far away. Why don't you tell us?

James Hill:

It's in Melbourne, Australia, a wonderful city. So Robin has made it his mission to prove that the right kind of exercise isn't just good for your muscles. It's essential for your bones, your brain, and pretty much everything else.

Holly Wyatt:

And what I love about Robin's work is that he's not just telling people, go exercise. He's figured out exactly what types of exercise work, and more importantly, what people will actually stick with, because that's a big, important part of it. Just to say, do it, and they won't do it, that doesn't get you anywhere. His research has been cited over 12,000 times. But he's also getting his hands dirty creating real-world programs that people and communities can actually implement.

James Hill:

Aha. Well, Robin, welcome to the show. We're happy to have you.

Robin Daly:

Oh, thanks for having me, Jim and Holly, and it's good to be here.

James Hill:

Before we dive into the science, I have to ask, when people find out you study exercise for a living, do they automatically assume you're judging their workouts?

Robin Daly:

Not necessarily. Often the first question I get from them is what they're actually doing, is it the right thing? Should I be doing something different? Often I get questions around pilates, yoga, aquatic exercise or walking which is what most older people tend to do and they want to know is that the best thing they can do.

Holly Wyatt:

Yeah. I do a lot with nutrition and so if i see someone in the grocery store they're always kind of like you know thinking I'm judging what's in their cart, but it sounds like people are more interested in asking your opinion about what they're doing when it comes to activity.

Robin Daly:

Absolutely because if we look at the physical activity guidelines, and some people are aware of them that, you know, you're trying to meet 150 minutes per week or trying to undertake resistance training, and some people can't achieve all that. So, they really want to know what they're currently doing. If it's a smaller dose or divided doses, is that equally effective?

James Hill:

Yeah, you hear the question of what's the minimal amount, Robin, I have to do to be healthy?

Robin Daly:

Yeah, look, absolutely. And people want that. They just want to know, what's the minimum I can get away with?

James Hill:

That's right.

Robin Daly:

And I guess it's human nature, but people want to do that.

James Hill:

That's the way we're geared. We often tell people, first thing is to do something. Then we can talk about the what to do. But it's more important that you move your body, because when you stop moving your body, all kinds of bad things happen.

Robin Daly:

Yeah, absolutely. And that's one of my key messages. From nothing to something generally results in some drastic health benefits.

Holly Wyatt:

Yeah. What would you say, what should an exercise prescription or a plan include? And what would be the optimal not the minimum, what do you think?

Robin Daly:

Yeah, well, I guess the first thing is something that people are actually going to do first and foremost. If we're thinking about the optimal, if we adhere to the current physical activity guidelines, that's something around 150 minutes of moderate to vigorous physical activity per week. But it also includes now at least two muscle strengthening, or for older people, multi-component exercise type programs. And interestingly, all the physical activity guidelines now also include limit sedentary time or prolonged periods of sitting. And so it's that combination, which probably is really going to give us the optimal health benefits.

James Hill:

Robin, one of the ways Holly and I often say this, we actually break it down into kind of three components. First is don't be sedentary. Second is get in some planned activity. And the third one is figure out a way to move more just in your daily life, to get more walking in and be more efficient in your life.

Robin Daly:

Yeah. And I think that's a perfect message and a message that many consumers or patients can actually understand and try to achieve. And we know you will get health benefits from integrating those types of messages for people beyond just having to meet 150 minutes every week.

James Hill:

So, Robin, you've done a lot with resistance exercise. Tell us why you believe that resistance exercise plays an important part in an optimum exercise regime.

Robin Daly:

Yeah, for me, I guess resistance training is critical largely because its effects on muscle and that's its effects on muscle mass, strength, and to a certain extent, physical function dependent upon if it's an optimal exercise prescription or the type that's prescribed. But I think the role of muscle is really underappreciated, just how important it is to our health and well-being. And we basically now have evidence that muscle is linked to pretty much all common chronic conditions or health outcomes.

And yet remarkably, just with eight to 12 weeks of resistance training, we can essentially combat decades of muscle loss. It is really that effective in resistance training and you can get adaptations really quickly. And I guess the other important point is there's a lot of interest in longevity and health span at the moment. And there's all these 12 hallmarks of aging, which really talk about the cellular and the molecular mechanisms. But for me, what people perhaps don't fully understand is the physiological and the functional hallmarks of aging. And they encompass neuromuscular function, muscle strength, fitness, body composition, bone middle density, and brain health. And if you look at the link for all of those, the central factor is our muscle health. Our muscle health is critical to all of them. There are no pharmacological agents to optimize muscle health at present. There's some on in line coming but resistance training in particular that's how effective it is because it can influence all those muscle factors.

Holly Wyatt:

You said something about eight to twelve weeks you're not talking about necessarily putting on muscle in eight to twelve weeks. What happens that you can make such a big difference in an eight to twelve week period of time?

Robin Daly:

Well, in fact, you can gain muscle in 8 to 12 weeks. So a lot of our short-term studies that we do between 12 and 16 weeks where we look at exercise approaches with or without additional nutritional approaches, we do. In older people, we do see gains in muscle mass and size, whether we measure it by DEXA or CT. Usually, we're not talking massive gains. It might be half a kilogram up to a kilogram in total lean mass, but you can get massive improvements in our muscle strength. Likethey can be 100% or more with a well-structured exercise program and that encompasses neuromuscular adaptations as well as the physiological adaptations in terms of our muscles.

Holly Wyatt:

So one to two pounds of muscle gain but you're you're seeing a lot more impact by that strength and I think that's important because people can't necessarily see it. I think they feel it a little bit but to understand what's really going on and that that's improving and that may not be something they can measure as easily as the actual gains in muscle.

Robin Daly:

Absolutely. It is difficult to know whether we've actually gained the size of our muscles. And yes, gaining size of muscles is important, but for a lot of older people in particular, they're less interested in the size of their muscles. They're more interested in its functional capacity. And so it's strength and function. And if you ask them what matters most to them, it's not about the size of their muscles. It's the ability to maintain their independence, which strength and function is absolutely a critical core component of that.

James Hill:

Holly, he was looking at me when he talked about old people and muscle. You noticed that, right?

Holly Wyatt:

Well, Jim, if it fits you, then I can't help that.

James Hill:

Robin, I don't know how it is in Australia, but in the U.S. right now, people are gaga over protein. Everybody is just looking to get as much protein. There are all these new protein products, and people are trying all this new stuff. How does protein intake relate to muscle function and size in relation to exercise? Because I know this is an area you've really worked a lot in.

Robin Daly:

Yeah, and I've really changed my view on the role of protein and even nutrition to a certain extent in its role for health outcomes, particularly related to body composition.

Robin Daly:

So I would argue that protein, there's too much hype around the role of protein. And I think in people who are malnourished or have insufficient protein intakes, ensuring they've got adequate protein intakes or increasing intakes, can have some beneficial effects on muscle health. But by and large, in Australia in particular, we find our average protein intake for older adults is somewhere between 1 to 1.2 grams per kilogram body weight per day. And giving people a little bit of extra protein pretty much has very little effect on their muscle health. When we combine it with resistance training, so we've done multiple studies now in different clinical populations ranging from menopausal women to people with type 2 diabetes to older adults. And in fact, recently, we just pulled all the studies together where we looked at resistance training with additional protein, and that could be through sources such as lean red meat to supplements. What we found was that resistance training clearly had a beneficial effects on muscle mass or size, and giving people a little bit of extra protein, so getting their intake to at least 1.2 grams per kilogram per body weight, resulted in an additional benefit somewhere between 0.2 to 0.5 maybe kilograms body weight. So exercise is the king. Clearly, it's so effective. And adding a little bit of extra protein can result in some small added benefits. But just trying to optimize your muscle health with protein alone, I would argue, is not the best approach.

James Hill:

See, I love that, Holly, because I think there are people out there that believe just eating more protein, even though they're sedentary, is really helping their muscles. And it's not just having the protein. It's having some stimulus, some stimulation that actually helps you use the protein. Otherwise, our bodies just get rid of the protein we don't need.

Robin Daly:

Absolutely.

Holly Wyatt:

I also think it's important to think about in weight loss. It's a little bit different situation.

James Hill:

We're going to get into that.

Holly Wyatt:

But I think people may get confused. They may be thinking in their head, wait a minute, people have really been talking about protein when I'm losing weight. What you were talking about was protein and exercise just not during necessarily the weight loss when you're just trying to increase your muscle mass or function, so to speak.

Robin Daly:

Exactly right. And I'm not saying we shouldn't use protein. They do go hand in hand. So if you're going to undertake resistance training, I definitely recommend ensuring you have adequate protein intake or adequate energy and protein intake. And we certainly know if you're malnourished and you undertake resistance training, for example, the effects of exercise are actually blunted in terms of the muscle hypotropic response. And so I'm not saying one or the other, and they do complement each other. And Jim's right, muscle, doing resistance training sort of enhance the sensitivity of muscle to protein and the window for feeding our muscles after a workout can be anywhere between 24 to 48 hours. We can still get benefits if you enhance your protein intake.

James Hill:

Okay, I want to turn to weight loss, but before we do, I want to ask one question about muscle. We've focused a lot on the mass of muscle. so measuring muscle by DEXA or something like that, what's the difference between the amount of muscle you have and how well it works, its function? Should we be looking at both? Does just the amount of muscle tell us all we need or do we need to look at some functionality?

Robin Daly:

Absolutely. Our work is very much interested in the functional outcomes from exercise and or nutrition. Clearly, the size of our muscle plays a role, but it doesn't directly correlate with the strength of our muscles or the functional outcomes as well. And we know, for example, with aging, we get changes in our neuromuscular system or our nervous system, which can lead to changes in our muscle function. And just to put this into perspective, for example, we know our muscle mass decreases about 20 to 30% throughout our life. Our muscle strength decreases somewhere between 40 to 50% throughout our life. So it's a much greater increase. So that implies it's just not the loss of muscle itself. And then our muscle function is 50 or 60% as well. But one aspect that people tend to ignore is our muscle power. And our muscle power is the ability to produce force quickly. And so we need that for balance and coordination. And if we're on a train and it takes off quickly, we need to step quickly. That requires muscle power. And so that clearly highlights us not just about the size of our muscles. It's about our capacity to move our muscles.

Holly Wyatt:

Yeah. So that really kind of brings me to kind of, well, how do we make sure we're exercising to get that, to get that power, to do all that stuff? So what's kind of the, how much do you need? How long do you need to do it? Give us some details so we can develop that power that you're talking about.

Robin Daly:

Yes, absolutely. So look, the minimum guidelines for exercise, for resistance training are roughly at least two times per week. And the recommendations in terms of the dose, and this is somewhat controversial because it seems to be changing, is roughly six to maybe 10 exercises.

You can do them at moderate to high intensity. And if you really want to improve muscle strength, you increase the load or how intense it is. If you really want to improve the size of your muscles, you do a few more sets. So you increase the volume of the load. So that would be sort of a starting approach, which is what the currently guidelines recommend. But we now have a lot of evidence showing that you can still get benefits with different doses. And people are interested in the minimal dose, perhaps, as we mentioned earlier. And there's some recent research looking at the weekend warrior, the person that just does one workout and they're actually showing that they can get some benefits in muscle strength. And then we've got the other group that won't do multiple sets. They just do one exercise, one set, maybe two to three times a week and they still can get benefits in terms of their muscle strength.

So, there really is different ways you can improve different elements of your muscle mass strength and function. And I think, for me, one of the key elements which I've really learned in more recent years, particularly working with older adults which is absolutely critical, is the concept of specificity. In other words, designing resistance exercises which meet the specific needs of people. So, it's not a matter of just going to the gym, sitting on the machines, doing a leg press and thinking that's going to make you walk faster or improving functional aspects. You need to design exercises which are specific to the needs of an older person. So, that might be lifting weights so people can put stuff into the cupboard above of the head, whether they can reach down and pick things off the floor. So design activities, which are very specific to their needs.

James Hill:

Let me put in a plug here that there are a lot of exercise specialists, trainers, and so forth that help you do that. And Holly, I've done that. I work with trainers on the resistance stuff. I can do the aerobic stuff myself, but having someone who understands that and can guide you in doing those different kinds of resistance training so you target specific areas and not just one. So there are a whole bunch of people out there, any gym, YMCAs, etc. You can usually find someone to help guide you in the kinds of resistance training you should use.

Holly Wyatt:

Yeah. So, are machines not good? Should we not be using machines because they don't really kind of mimic what you're talking about.

Robin Daly:

I'm not saying that. They're a good foundational exercise to build strength, but we need to move beyond the machines. We do a lot of resistance training programs outside the traditional gym these days. So we've done them in aged care communities. We now even deliver resistance training programs remotely to people using technology. We have to be adaptive in how we can deliver these programs to still make them challenging. And there was a recent meta-analysis which looked at the effects of different types of resistance training, whether it was with the machines, bands, the combination, body weight exercises, and clearly the machines resulted in the greatest improvements in strength, but you could still get benefits with bands, dumbbells, and those different combinations. So if you're really after maximal strength, machines are great, but from a functional point of view, they won't always result in the best benefits.

James Hill:

So you don't have to go to the gym necessarily to get resistance training in. There are lots of things around your house you can use to do that.

Robin Daly:

Absolutely. And that's where we need to be creative because a lot of our work would show that many older people, for instance, don't want to go to the gym. They want something they can do that fit within their lifestyle and a home-based program might be optimal for them. And there are creative ways that we can deliver home-based programs that provide enough stimuli so they get benefits. And like I said, a lot of our work for them, it's not about improving the size of their muscles, it's about improving the functional capacity and we can deliver programs pretty much anyway for them.

James Hill:

Okay. I want to turn to weight loss a little bit. And with the advent of these new GLP-1-based medications, people are losing a lot of weight. And that has raised a lot of questions about people losing too much muscle mass when they lose weight. Talk a little bit about how you've looked at that issue of what you're trying to do is avoid loss of muscle rather than necessarily gain muscle.

Robin Daly:

Yeah, look, it's a very topical issue at present in terms of the loss with the GLP-1s, loss in muscle with the GLP-1s. So typically what we've seen from the published studies that have measured muscle mass, and typically they're largely through DEXA. Remember, DEXA actually doesn't measure muscle mass per se. It measures lean soft tissue mass, which is not all muscle. Generally, the loss ranges from anywhere between 15% to 40%.

Robin Daly:

Typically, as a rule of thumb, there's been the traditional thought that when you lose weight, you will lose muscle and it's typically around 25% of the total loss. Whether that, what level of muscle loss is harmful or has negative consequences, I don't think we really know that at present, but clearly those with 40% muscle loss is, we would say it's a concern. The challenge we've got is often when they lose so much weight, their physical function improves because they've lost so much weight. And so one could argue, well, it doesn't matter if they're losing muscle because their function has improved as well. And the other element which we still don't really have a handle on is this muscle that they lose, what impact does it have on their bone health and their risk for osteoporosis? Muscle and bone are physically connected. They talk to each other and we know that a loss of muscle is related to loss of bone. Again, we don't have a lot of data at the present, so that will come out in coming years. My concern, I think, moving forward on this is those that undergo weight cycling. So they go on the drugs, off the drugs, on the drugs, which seems to be somewhere between 30 to 50 percent or more of people, and we know that they'll lose muscle, they won't regain it, they'll lose it again, and I think in the long term they're going to be the ones we have to be worried about.

James Hill:

Now, I agree with you totally. In the look-ahead study, which we were part of, what we found is in the elderly folks, when they lost weight and regained it, they ended up worse than where they started. They didn't gain back the muscle they lost. They lost more fat. And I worry about that too, particularly with older folks.

Robin Daly:

Absolutely. And I don't think we have enough data on that. I'd like to look ahead and various other trials have looked at various effects on functional outcomes. and it doesn't seem to be as negative as we thought. But again, I don't think we have the long-term data to really understand the consequences, particularly with these GLP-1s, at least anyway.

Holly Wyatt:

Which shows it's probably even more important, maybe with the GLP-1s and bigger amounts of weight loss, not to cycle, to be able to have a plan to keep it off. Even if you are going off the medication, I think you can be successful. But if you cycle over and over, over again, that's a risk that you're going to ratchet down your muscle level, basically.

Robin Daly:

Yeah, look, and absolutely now I think with these GLP-1s, what we really need, we need really strong behavioral support for people to be able to make real changes to their lifestyle long-term. And that's hard. We all know that's hard. It's always been difficult. And a lot of these trials, they do give lifestyle advice. They encourage people to be physically active and change their diet. But I think it's lip service. In reality, it's probably not evidence-based prescription, which is optimal. I don't think any of them included resistance training in terms of targeting muscles. So I agree with you there. We really need a more strategic approach when we're dealing with these people on these drugs.

James Hill:

He's talking our language, Holly.

Holly Wyatt:

Yeah.

James Hill:

Holly and I, we've really focused a lot of our career, not so much on weight loss, but weight loss maintenance, keeping the weight off. And as you probably know, with the GLP-1 meds, even though they're sort of set up that you do these for life, people aren't buying it yet. They go on these meds and at least half the people that go on them don't stay on them for a year. So just in total transparency here, Holly and I have just written a book on how to keep off the weight if you go off the GLP-1s. And basically, we use three cornerstones. We use nutrition, we use exercise, including resistance exercise, and then we use what we call mind state, the mental aspects of this. But the idea is if you go off them, unless you have a plan, you aren't going to keep the weight off. You're going to regain it and you need a plan. And everything we've done with weight loss maintenance shows that you might as well not even try it unless you're going to substantially increase your physical activity.

Robin Daly:

Yeah, that's a fantastic approach. And I totally agree with that. And in fact, we're starting to explore something similar. Again, we're using a digital health approach so we can get a widespread approach where we can actually give or provide people with support or access to support from exercise physiologists and dieticians while they're undertaking their treatment. We're currently doing some co-design work, so we haven't started yet, but that's our plan.

James Hill:

See, I think that's critical because we can tell people what to do. Well, we know from years of experience that eventhe best intentioned people, it gets hard to do it. So what can we do to remove their barriers? And we think about like on the food side, well, you could deliver meals or you could deliver groceries. And I love what you were doing with the virtual exercise or gym memberships. And I think that's the way we have to proceed. This is hard. It is hard to make lifestyle change and we can give people advice, but we have to do everything we can to break down the barriers to allow them to stick with that.

Holly Wyatt:

Okay, Jim, you know what you just did?

James Hill:

What'd I do?

Holly Wyatt:

You broke the rule.

James Hill:

What's the rule?

Holly Wyatt:

It's hard. It's hard. It's hard.

James Hill:

Oh, that's right. Holly, she doesn't let me say it's hard because you can explain.

Holly Wyatt:

It doesn't have. It's a mind state. If you believe it's going to be hard, if I have to struggle, you know, victim, sucks to be me, basically. It's a mind state. And I think there's people out there who can do this and you can create a lifestyle that's actually not hard.

James Hill:

Yeah.

Holly Wyatt:

I'm not saying it doesn't require effort and new habits and a new way of living, but to make this, oh my gosh, I've got to pay the piper and sacrifice and suffer.

James Hill:

Mea culpa, whatever.

Holly Wyatt:

You know I couldn't resist, Jim. I couldn't resist.

James Hill:

No, no, no. But it's true, Robin. In the National Weight Control Registry that we've done for years and years and years, people always tell us essentially that life is better with their new lifestyle that keeps the weight off. Now, it may take a while, but Holly's point is, I think we need to get people to realize is a lifestyle that maintains a healthy weight, physical activity and nutrition can be a very rewarding lifestyle. It doesn't have to be a deprivation lifestyle, which is why physical activity is so important. If you try to do it with diet alone, it's deprivation. You cannot get enough calories and maintain your weight. You have to add the exercise.

Robin Daly:

Yeah, and all the evidence would support that. The combination of exercise with diet or caloric restriction in terms of the health outcomes, the body composition changes, it's the combination that's best. And obviously for a muscle has to include resistance-based exercise if you're doing weight loss, as you've mentioned.

Holly Wyatt:

So I'm going to ask a question I'm dying to ask you.

James Hill:

Uh-oh, watch out.

Holly Wyatt:

Yeah, I know. It just popped into my head. These new drugs that are coming out that they're studying now in combination with the GLP-1s that are thought to preserve muscle mass or decrease the amount you lose, not necessarily build it, but preserve it when you lose weight. Thoughts on those? Any early thoughts?

Robin Daly:

Yeah, look, I'm quite fascinated by that because very early work years ago, they started looking at some of these drugs to, you know, as for older people to try to maintain muscle. And it staggered me that their main focus was just on muscle mass and trying to preserve the size of our muscles.

Yet, what effect does it really have on muscle function and muscle strength? Just increasing the size of your muscle doesn't necessarily is going to translate into these more relevant outcomes on strength and function. So, it does worry me that in a lot of these trials, they never included exercise. In all the original drug trials on muscle health, they literally just wanted to give these people the drug to try to improve muscle mass and hoped that it would then relate into functional outcomes. And it didn't work. And there was the classical study in mouse, on the myostatin deficient mouse model. So when you're myostatin deficient, you grow these huge muscles. And in one of those original studies, they did that and they looked at the bone outcomes. And what they found was that despite having huge muscles, there was no effect on their bone density or their bone structure. Yet as soon as they exercised them with the huge muscles, they got improvements in their bone density. So, I still think that there should be some element of movement or stimuli with these drugs to get the optimal benefits.

Holly Wyatt:

Well, I think that earlier trials weren't very successful and they stopped them for different reasons. But my understanding is some of these newer ones, I think there's going to be a little bit better outcomes. But I think that the message you're saying is make sure you've got the stimulus of exercise on board too.

Robin Daly:

Absolutely. And I've seen some of the original, of the new data that's come out, it's been in abstract form only. And it does appear that it helps preserve or even results in small improvements in muscle. I do wonder like really what are the functional consequences? Because when you're a really big person and you lose a lot of weight, how much muscle can you keep carrying around that is functionally useful? I do wonder about that question because when you're 130 kilograms and you lose 40 kilograms, but you've maintained your muscle, are you still functionally capable? So we don't really have the answer to that question. I think that's still a lot to learn in this area.

James Hill:

Holly and I, we're fans of the new medications for weight loss. Don't get me wrong. But I think we're never going to do it with medication alone. And even if we were able to do it, is that success? Because one of the things that we talk about in our book, Robin, is maybe with the success created by these medications, it allows us to rethink what success really is. Is success a number on that scale or is it more? Is it more happiness than weight? Health and happiness. And that's why exercise does so much more than just burn calories. Mental health, cognitive function, et cetera. I think when we try to totally replace that, we're missing something.

Robin Daly:

Absolutely. And there's the push now for this concept of exercise is medicine. And that's around how we actually prescribe it. It's no longer just telling people you've got to go for a walk and it's a generic prescription for everyone. We know there's different prescriptions for people with different chronic conditions as well. But I think you're right. the benefits of exercise are never going to be in a pill. There is no way that you're going to get all the benefits that we know from being physically active in terms of the mental, the psychosocial elements, the physiological elements. I mean, when you take a medication, it's usually targeted at one specific element. You take a drug for osteoporosis, it targets your bone health. It doesn't target your muscle health. It doesn't reduce your risk of falling, which is the major factor contributing to fractures.

Robin Daly:

And so I think exercise really needs to come to the fore. It still staggers me that we have all this evidence around exercise, yet it is still not mainstream in primary care.

James Hill:

Oh my gosh, Holly, he's going to get me started.

Holly Wyatt:

I know, I know. Well, we used to say if exercise could be put in a pill, it would be the number one best-selling pill ever, but it can't. All the things that exercise does, we're not able to stick it in a pill. And that's what I think people have to realize.

James Hill:

It's true of nutrition too, Robin. It's interesting because there's an initiative called food is medicine. And people vary a lot. Some people say, oh yeah, yeah, it's great. It can replace medicine. And other people say, I don't want to think of my food as medicine. Food is much more. Food is pleasurable. I have to take my medicine, but I don't have to take my food. So I think how we approach this is going to be pretty interesting to see what resonates best.

Robin Daly:

Exactly. I don't know the answer really to that, but I think, like you said, people from a food point of view, people like enjoy eating, socializing with each other. That's what food, eating is a lot of that as well. And even exercise to some extent, like people love the social interaction and engagement from exercise. And you can get huge benefits from that, that social interaction and obviously the physiological outcomes. I guess the approach we've taken now in particular is we try to think of what is going to work best for that particular individual. We have all the evidence about what works, but if it doesn't suit the needs, the preferences, the budget of certain individual, then it's not going to work. And so we have to adapt what we can offer them or what they're willing to do for them to get the biggest benefits from it.

James Hill:

And that really is personalized approaches to lifestyle. Even if resistance training did exactly the same thing, not everybody's going to stick with it and not everybody's going to enjoy it. And unless you enjoy it at some level, you're probably not going to stick with it.

Robin Daly:

Absolutely. And that's why in all our programs, when we start off with these interventions that we run on these community-based trials, we always ask the people, you know, what are their goals? What are they hoping to achieve? What are their barriers? What's really work for them? Everyone's at different levels of sort of stages of contemplation or pre-contemplation, like where they're ready, are they ready to actually undertake exercise? And we really have to tailor it according to those needs. It is pointless just having someone saying, okay, we've got to meet 150 minutes per week if they do nothing, for example. So this personalized exercise prescription, even the food-based approach is really where we're heading. I think the challenge we've got is how we fund or how people get the support for that, the level of attention that they might need from a government point of view. In Australia, we have exercise physiologists and they are subsidized through the government for people under the chronic disease care plan. But they only get five Medicare rebateable sessions per year. And that's with other allied health professionals. So it is a challenge. I don't think governments invest enough in prevention.

James Hill:

We talk a lot about it. Is that not enough?

Holly Wyatt:

So I want to go back to one thing though. I'm asking this question for Jim because he really needs this. Let's go back to the optimal prescription, and we can talk about how Jim does it if we want to.

Holly Wyatt:

Does the order matter? You know, we kind of teased with that at the beginning. Could you be doing it wrong? And I get it. Doing something is better than doing nothing. But should you do weights first, cardio first? Can you do them on the same day? Should you separate them? Do we know anything about the order of the exercises?

Robin Daly:

Yes, there's been a number of studies which have looked at the order, and it is somewhat conflicting. So the concurrent training, which basically means we're doing, you know, aerobic training and resistance training in the same session, essentially, rather than doing aerobic training on one day and resistance training on another day. That's a different story in itself. But when we talk about concurrent training, there was a recent large review which looked at the effects on muscle strength and muscle hypertrophy outcomes. And what they were able to show was really no difference when you did them together, although it did seem to blunt explosive strength, which is like the power elements, like the neuromuscular elements. Now, in that particular study, they couldn't work out or they didn't really decipher whether aerobic first or resistance training first had the effect. But some earlier studies before that definitely were able to show that it did make a difference. And what they were able to show really was that if you did the aerobic training first, it tended to blunt the effect of some of the hypertrophy gains from resistance training. We still have a little bit to know, to learn on that training.

Holly Wyatt:

So would you say we should do the resistance first and the aerobic second?

Robin Daly:

Yes, to some extent. It sort of depends on whether you're looking for an athlete point of view or whether you're looking at the general population. Andit seems to depend on whether you're an untrained or a trained person. So there's a few ifs and buts here, essentially. But yes, I would probably say that you would generally probably do your resistance training first or aerobic. Some people, if you are concerned about it, you could mix it up within the session. So you could do a resistance training, then an aerobic, a resistance, like shorter bouts, It's a bit like high-intensity training, essentially. I don't think we should get too caught up, especially if we're talking about older people, in the order of it, particularly. But if we're being specific, yeah, maybe do your resistance training first and then incorporate your aerobic training. And it's a bit like when we do multi-component exercise programs as well for older people, for example. So a lot of our programs are multi-component resistance-based programs where we include strength training, weight-bearing impact exercise, and functional challenging balance exercises. So we wouldn't put all the functional and challenging balance exercise at the end of the workout because they'd be fatigued and more likely to be at risk for falling over or something like that. So yes, it does. In that case, order might be important.

James Hill:

All right, Holly, you know what it's time for?

Holly Wyatt:

What is it time for, Jim?

James Hill:

Listener questions.

Holly Wyatt:

Listener questions. All right, you've got the list. Go ahead and give us one.

James Hill:

Okay, here's the first one. I just started strength training and I can barely lift the bar. Is that normal?

Robin Daly:

For some people, yes, it can be. But the good news is they will see adaptations very quickly if they stick at it.

Holly Wyatt:

I know when I started for some things, just lifting the bar, that's all I could do. Some of those bars weigh like 30 or 40 pounds. That's a significant amount to lift for some exercisers. So, all right, let me do another question. My weight loss is slowing down. We get this question a lot. I'm starting to plateau. Do I need to change my workout? Could exercise help me maybe break through a plateau or speed it up again?

Robin Daly:

Well, I think if we look at the evidence for exercise from a weight loss point of view alone, without any calorie restriction or energy restriction, you need a high volume of exercise. And the current evidence would suggest somewhere around like 200 or 300 minutes per week, which is quite a high dose. So in that point of view, we also need to consider what type of training you're doing. So if you're undertaking resistance training, it's likely that you're gaining muscle. And so on the scales, the scales are potentially lying to you because muscle is heavier than fat, obviously. You might be having changes in your body composition which are not reflected on the actual scales itself.

Holly Wyatt:

All right.

James Hill:

All right, here's another one. Can resistance training help if I've been diagnosed with early osteoporosis?

Robin Daly:

Absolutely, and it's part of the core recommendations around for osteoporosis prevention. But for the optimal benefits, I would argue that resistance training alone is not as effective compared to if it's combined with weight-bearing impact activities. And resistance training for bone health needs to be very specific and targeted at the muscles around the hip and the spine, which are the most common fracture sites and what is generally measured for osteoporosis risk, to get the greatest benefits. But we and others have certainly shown if you introduce short bouts of weight bearing exercises, and you don't need a lot, you might only need 50 to 100 impact loads and that might be like 10 repetitions of five sets with a minute or two break, you can get improvements in your bone health when you combine those two together. Basically bones love stress and they get bored with the same type of loading and so if you're able to introduce loads which are varying direction, that are novel, sort of monitor high impact, you know, they get really excited and they'll, you know, get an adaptive response. So, it is the combination of resistance training with weight-bearing exercise to get the best benefits.

Holly Wyatt:

Yeah, sounds like changing it up, which is kind of a theme we're starting to hear more and more. The metabolism doesn't like to do the same thing. We now talk about fasting and feeding. And Jim, it's kind of fitting right in there. You got to stress it.

James Hill:

So far, he said all the right things, Holly.

Holly Wyatt:

All right. I like it.

James Hill:

Can I ask one more?

Holly Wyatt:

Sure.

James Hill:

Okay. Here's one more question. I'm 80 years old. Is it too late for me to get benefits from resistance training?

Robin Daly:

No, it's the perfect age to start. And in fact, you know, one of the original studies, which was done, I think in 1994, which looked at the effects of moderate to high-intensity resistance training in people aged, I think the average age was 89 years. And they did it with extra protein supplements. And it was a 10-week trial. It was published in the New England Journal of Medicine. And they were able to show over 140% improvements in their muscle strength in these older people. And they got improvements in the size of their muscles as well. So it is never too late to start resistance training.

James Hill:

Never too late. That's the message, Holly.

Holly Wyatt:

I got it, Jim. So it's not too late for you, Jim. I'm glad.

James Hill:

This was not me. I'm not 80 yet, but I'm not too far away. All right. You know what's next?

Holly Wyatt:

Yes.

James Hill:

We have to hit our guest with vulnerability questions.

Holly Wyatt:

Yeah, my favorite.

James Hill:

I think we need to give him some hard ones.

Holly Wyatt:

Oh, I like the ones that really get them thinking. So I don't if they're hard but get them thinking. I'm going to go first. Was there ever a finding that maybe it was something that you studied or maybe it was something that was published that challenged something you believed and you were actually wrong and you kind of said, "Oh, my gosh, I'm wrong. And now I believe something different because of that."

Robin Daly:

Look, it probably comes down to the interaction between nutrition and exercise and the added health benefits you get from it. So we have spent a lifetime, essentially, it feels like it, running multiple trials looking at different combinations of various nutritional factors and how they can enhance the effects of exercise. And unfortunately, continually, we are underwhelmed by the additional benefits you get from providing, whether it's protein, omega-3s, the combination.

James Hill:

Interesting.

Robin Daly:

The benefits are modest. I'm not saying they're not there. And part of our problem is most of our people are not malnourished. They don't have insufficient vitamin D. They don't have low calcium or really low protein intakes. But I think more and more people are now starting to find this, that exercise is clearly the most effective factor for improving multiple health outcomes. And you get some additional small benefits with nutrition. But if you've got inadequate nutrition, then you're at higher risk. So that's probably the major takeaway more recently from what we've found.

James Hill:

Wow. That's cool. Robin, how has your research affected your own behavior?

Robin Daly:

Yeah, it's a good question. I think historically, like many people, I was probably one of these people that thought you do your two or three or key exercise bouts per week and that's sufficient that's enough whereas I've really changed my thought a bit like we discussed before. I try to look for throughout the day, throughout the week, every opportunity for some type of activity. And so I'll do my aerobic sessions. I'll go for a cycle or I might do some weights, but even for me now, this is my weekly schedule would be, I have weights in my office and I snack on exercise sessions. So I do 10 minutes, I do five exercises for one minute, basically almost to failure, so to speak. I have a minute's rest and it takes me 10 minutes to do it. And sometimes I can do it twice a day and I just do it in my office while I'm sitting between the computer. I have a standing desk, so I try to not sit for a prolonged period of time. I have like 10 flight of stairs just outside my office, and I try to walk up and down those. So, yes, I do. I try to stick to my normal workouts, but I really now try to integrate as much movement or activity as I can, which is sort of like incidental to a certain extent, or the snacking is a little bit more structured.

Holly Wyatt:

I like that term, exercise snacking.

James Hill:

I love that. I'm going to start doing that. I'm going to get some weights in my office and do some weightlifting snacks.

Holly Wyatt:

Yeah. You know, you have three minutes. You can do something in three minutes if you have.

James Hill:

While we're doing a podcast, I could be doing weights.

Holly Wyatt:

No, Jim, you need to pay attention to the podcast.

James Hill:

Robin, this has been terrific, man. We so thank you for your time. One last thing for you to our listeners who are sitting there saying, yeah, I know it. I should do some resistance training. I don't know. What's one thing they could do that might help them get started?

Robin Daly:

Look, I think for me, it would just be start snacking on activity. Like thinking about you're watching TV during the commercial break, start thinking about, can I snack on some activity and build it from there? I think if you're doing nothing, start to think about how you can integrate movements in there. And I think snacking is a great way to do that because you can do aerobic snacking, you can do strength snacking. And if you want to, you can reward yourself with a high protein snack at the end of it with a milk drink or some nuts or something like that to try to maximize the benefit.

Robin Daly:

So for the person that does nothing, that's what I would recommend.

Holly Wyatt:

I like it.

James Hill:

So Holly, what we've learned with this podcast is the importance of exercise and particularly the value of adding some resistance exercising. And that's true whether you're normal weight and you just want to maximize your muscle because maximizing your muscles probably going to help you live longer. But it's also true if you're trying to lose weight that it's one of the best things you can do to make sure you preserve probably both muscle mass and muscle function as you're losing weight. Nutrition helps, so a little bit more protein, some of the good nutrition tips. But without the exercise, it's very, very hard to maintain optimal muscle mass.

Holly Wyatt:

I agree. And I think the snacking tip, this is what I'm going to take. I'm going to take away because that's something we can do today.

James Hill:

Absolutely.

Holly Wyatt:

So let's put a challenge out there, Jim. Let's see if all of our listeners can start snacking on activity.

James Hill:

Send us your snacks. Tell us about your exercise snacks and we'll talk about them on the podcast.

Holly Wyatt:

That sounds like a good idea.

James Hill:

Robin, thanks a million. This has been really helpful, really informative. And we'll see everybody next time on Weight Loss And.

Holly Wyatt:

Bye, everybody.

James Hill:

And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:

We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:

And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.