Skip to content
Spiral Staircase
Buy the book
Menu

Chapter 4 of the book

Load, Strength and Bone

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.3 things to start with2 popular claims graded51 works cited

How the chapter opens

The women in the trial had the kind of bones that make doctors careful. All of them, about a hundred in total, were past menopause, and all had low bone mass: some thin enough to count as osteopenia, some as osteoporosis. Their average age was the mid-sixties. The obvious fear with a skeleton like that is that a heavy weight will break the bone it is meant to build.

The trial, called LIFTMOR, tested that fear directly. Half the women were randomly assigned to a program that sounds reckless on paper: twice a week for eight months, in half-hour sessions with a trainer watching, they did impact training and lifted at more than 85% of the heaviest weight each could lift once. That is heavy lifting. The other half followed a gentle, low-intensity program at home.

What the chapter covers

The argument, the studies and the stories are in the book. Get the book.

  • ·What Your Body Expects
  • ·What It Gets Instead
  • ·Muscle That Leaves Quietly
  • ·Bone After Menopause
  • ·Feeding the Muscle

Mismatch card

The system

Skeletal muscle and bone, which calibrate their strength to the loads they carry.

What it expects

Daily walking, carrying and lifting, often heavy, across a whole life.

What it gets

Chairs, wheels and machines; little that is heavy; and, for women, a menopausal transition that speeds bone loss with no extra load to answer it.

What happens in the gap

Strength falls faster than size, bone thins where load is missing, and the losses show up decades later as weakness, falls and fractures.

The handrail

Two short strength sessions a week, enough protein for your age, and heavier loading for bone after 50 (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).

Strength of evidence

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials. Resistance training reliably builds strength in trials, but the links to longer life come from cohorts, and the bone evidence rests on one heavy-lifting trial measured by density.

What you've heard

Popular claims this chapter tests, each with the book's verdict and grade.

The protocol

Each action carries the book's evidence grade. How the grades work.

The actions below are ranked by how much good they are likely to do for a typical reader, and graded by how firm the evidence is. Start with the first three. Everything after them is optional.

Start here

  1. Two strength sessions a week, 20 to 30 minutes each

    StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.

    How: work every major muscle group, meaning legs, hips, back, chest and arms, on two separate days; the no-gym week below is one way. Why: in trials, training builds strength at every age studied; in cohorts, this amount is also linked to longer life (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).13

  2. Reach the daily protein range for your age

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.

    How: for a 155-pound person, the official minimum is roughly 55 grams a day and the current US goal 85 to 110 grams. Over 65, do not drop below about 70 to 85 grams, the expert-group floor; the upper part of the US range suits active older adults. In lifting trials, more than about 110 grams stopped adding muscle. (Per pound of body weight: the minimum is a little over a third of a gram, the US goal half to three-quarters of a gram, the over-65 floor about half a gram.) A protein food at each meal, such as eggs, yogurt, fish, beans, tofu or meat, is the easy way to get there (Chapter 5 covers the rest of the plate). Why: enough protein helps training build a little more muscle, and expert panels judge that older muscle needs more.

  3. Over 50, or told you have low bone mass: add heavier and impact loading, learned in person

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.

    How: once the basic session feels easy, work with a physical therapist or qualified trainer toward heavier lifts and impact training (moves that jolt the skeleton, such as landing from a jump), as LIFTMOR's women did; the loads are heavy and form matters. If a trainer is out of budget, ask your doctor whether a physical therapy referral is covered. Why: this kind of training raised spine density in a trial of women with thin bones, while walking alone barely registers.

A no-gym week

Bands, bodyweight and household loads count (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.). Do the same session on two days a week, for example midweek and at the weekend:

  • Sit-to-stand from a firm chair, or squats down until you touch the seat. Stand up fully each time.

  • Push-ups against a wall or a kitchen counter, or from the knees on the floor. The lower the surface, the harder it gets.

  • A hip bridge: lie on your back with knees bent and lift your hips until your body makes a straight line from shoulders to knees.

  • Rows with an elastic band looped round a door handle, or bending forward and pulling a loaded backpack toward your ribs.

  • Step-ups onto a low, sturdy step, or lunges, holding a rail or counter for balance.

  • A carry: walk the length of the house or yard with a full shopping bag in each hand, standing tall.

Do one to three sets of each, ending each set when only a couple more good repetitions are left in you. When a set gets easy, add repetitions first, then load: a heavier backpack or bag, a firmer band. The whole session takes under half an hour once you know it.

A simple first month: in the first week, one set of each move, just learning the shape of it. In weeks two to four, two sets. After that, three sets, adding load whenever the top of your repetition range comes easily.

How hard is hard enough? The last two or three repetitions of each set should feel slow and effortful, while your form still holds: back straight, knees tracking over your toes, the movement under control on the way down as well as up. If you could keep going for another ten, the load is too light. If your form falls apart before the set ends, it is too heavy.

Then, pick from this menu

  • **Train balance, especially after sixty (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.).** Single-leg stands beside a counter, stepping practice or tai chi, on several days a week. In a large review of trials, exercise cut the rate of falls in older people by about a quarter, and programs combining balance and strength probably by about a third; those that challenged balance for more than three hours a week worked best (Chapter 3).22

  • **Check yourself once or twice a year (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials. as a marker).** Try the sitting-rising test with something sturdy within reach, count how many chair stands you can do in half a minute, or squeeze a grip gauge if you or your clinic has one. With a painful knee or hip, or after a hip replacement unless your surgeon allows deep bending, use the chair-stand count instead of the floor test. Write the number down and compare it with your own last score next time. Treat a low score as a prompt to train, not a prognosis.

  • **Creatine monohydrate, 3 to 5 grams a day, only if you are lifting (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).** Expect about three pounds of extra lean tissue over months, and no transformation. A loading phase is not needed for the lean-mass gains.

  • **Carry things you would otherwise wheel (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Groceries, laundry, a small child. Weighted-vest trials hint at bone benefits, but everyday carrying has never been tested on its own.23

  • **Keep cold plunges away from lifting days (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.),** if you use them at all.

  • **Tie the sessions to something you already do (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Lift after the same fixed thing each time, such as the morning coffee or the end of the workday. In one small trial, people told to floss after brushing built a stronger habit than those told to floss before. Expect about two months, with a huge range, before it feels automatic; missing a single day did not undo the progress.24

If this is you

Over 50, or stiff joints

raise the chair seat with a cushion until sit-to-stands are possible, use the wall for push-ups, and hold a rail for step-ups. With knee osteoarthritis, avoid long spells in a deep squat, and expect some extra ache in the first weeks. After a hip replacement, follow your surgeon's rules on deep bending.

Perimenopause and after

this is the decade to start. Lift twice a week and move toward heavier and impact loading as you progress. Once you are past menopause, ask whether your risk factors call for earlier screening, and discuss bone as part of any hormone therapy decision (Chapter 15).

Short on time

in small trials of trained men, even a single hard set of each exercise, done one to three times a week, raised strength, though the authors call those gains "suboptimal, yet significant." Those sets used heavy loads taken to failure; for a beginner at home, one set of each move is a start, and short of the full dose.26 One set of each of the six moves above takes roughly ten minutes.

Caregiving, or no free half-hour

split the session, three moves in the morning and three in the evening.

Tight budget

the no-gym week needs a chair, a wall, a backpack and a floor. Plastic jugs filled with water make adjustable weights. An elastic band is the only purchase worth making.

Safety

If you have osteoporosis or have broken a bone in a minor fall, start heavier or impact training only under supervision. If you have heart disease, a recent injury or fracture, or chest pain or breathlessness with effort, see a clinician before beginning. With kidney disease, or on medicines that affect the kidneys, ask before raising protein or taking creatine. Sharp or worsening joint pain means stop and get it checked.

The skeptic's box

What could overturn this chapter, from the chapter itself.

Much of this chapter rests on markers and cohorts. Grip and the sitting-rising test predict death, but no study has shown that raising your grip lengthens your life; strong people differ from weak ones in many ways, and illness can cause weakness as well as follow it. The strength-and-mortality curve is cohort data too, and the Dallas figures come from well-off men only. LIFTMOR was a single trial of about a hundred women over eight months, and it measured bone density and function, a stand-in for fractures rather than fractures themselves. The protein targets for older people come from expert panels, not long trials, and the creatine evidence, while consistent, comes from many small studies in a field with industry ties; several authors of the safety review have them. What stands on firmer ground is narrower and still worth a great deal: training builds strength at every age studied, and balance and strength work cuts falls in trials.

Go deeper in the reference library

The research this chapter was built from, as longer reference entries: each with its own mismatch card, graded recommendations and the case against it.

See also in the book

Sources behind this page

  1. 20.Roberts, L.A., Raastad, T., Markworth, J.F., Figueiredo, V.C., et al. (2015). "Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training." Journal of Physiology, 593(18), 4285-4301. https://doi.org/10.1113/JP270570; Malta, E.S., Dutra, Y.M., Broatch, J.R., Bishop, D.J., and Zagatto, A.M. (2021). "The effects of regular cold-water immersion use on training-induced changes in strength and endurance performance: a systematic review with meta-analysis." Sports Medicine, 51(1), 161-174. https://doi.org/10.1007/s40279-020-01362-0; Grgic, J. (2023). "Effects of post-exercise cold-water immersion on resistance training-induced gains in muscular strength: a meta-analysis." European Journal of Sport Science, 23(3), 372-380. https://doi.org/10.1080/17461391.2022.2033851; Piñero, A., Burke, R., Augustin, F., Mohan, A., et al. (2024). "Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy." European Journal of Sport Science, 24(2), 177-189. https://doi.org/10.1002/ejsc.12074 (Roberts: 21 men, 12 weeks; fast-twitch fibers grew only in the active-recovery group.)
  2. 21.Morton, R.W., Murphy, K.T., McKellar, S.R., Schoenfeld, B.J., et al. (2018). "A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults." British Journal of Sports Medicine, 52(6), 376-384. https://doi.org/10.1136/bjsports-2017-097608; Tagawa, R., Watanabe, D., Ito, K., Otsuyama, T., et al. (2022). "Synergistic effect of increased total protein intake and strength training on muscle strength: a dose-response meta-analysis of randomized controlled trials." Sports Medicine - Open, 8(1), 110. https://doi.org/10.1186/s40798-022-00508-w; Devries, M.C., Sithamparapillai, A., Brimble, K.S., Banfield, L., et al. (2018). "Changes in kidney function do not differ between healthy adults consuming higher- compared with lower- or normal-protein diets: a systematic review and meta-analysis." Journal of Nutrition, 148(11), 1760-1775. https://doi.org/10.1093/jn/nxy197; Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., et al. (2025). "Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society." American Journal of Clinical Nutrition, 122(1), 344-367. https://doi.org/10.1016/j.ajcnut.2025.04.023 (Morton: 49 trials; the break point is 1.62 g/kg a day, 95% CI 1.03-2.20. Devries: 28 trials on kidney function.)
  3. 13.Momma, H., Kawakami, R., Honda, T., and Sawada, S.S. (2022). "Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies." British Journal of Sports Medicine, 56(13), 755-763. https://doi.org/10.1136/bjsports-2021-105061; Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., et al. (2020). "World Health Organization 2020 guidelines on physical activity and sedentary behaviour." British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955 (Momma: 16 cohort studies; the authors call the effect of larger volumes unclear.)
  4. 26.Androulakis-Korakakis, P., Fisher, J.P., and Steele, J. (2020). "The minimum effective training dose required to increase 1RM strength in resistance-trained men: a systematic review and meta-analysis." Sports Medicine, 50(4), 751-765. https://doi.org/10.1007/s40279-019-01236-0 (Six studies, with loads of about 70-85% of maximum taken to failure.)
  5. 22.Sherrington, C., Fairhall, N.J., Wallbank, G.K., Tiedemann, A., et al. (2019). "Exercise for preventing falls in older people living in the community." Cochrane Database of Systematic Reviews, 1, CD012424. https://doi.org/10.1002/14651858.CD012424.pub2; Sherrington, C., Michaleff, Z.A., Fairhall, N., Paul, S.S., et al. (2017). "Exercise to prevent falls in older adults: an updated systematic review and meta-analysis." British Journal of Sports Medicine, 51(24), 1750-1758. https://doi.org/10.1136/bjsports-2016-096547 (Cochrane review; the 23% cut in the rate of falls was rated high certainty, the combined-program cut moderate.)
  6. 23.Wang, X., Zhou, L., Shi, T., et al. (2026). "Effects of weighted vest on bone health and body fat in middle-aged and older adults: a systematic review and meta-analysis." Osteoporosis International, published online. https://doi.org/10.1007/s00198-026-08196-y (The one study that isolated the vest found it added nothing for bone.)
  7. 24.Judah, G., Gardner, B., and Aunger, R. (2013). "Forming a flossing habit: an exploratory study of the psychological determinants of habit formation." British Journal of Health Psychology, 18(2), 338-353. https://doi.org/10.1111/j.2044-8287.2012.02086.x; Singh, B., Murphy, A., Maher, C., and Smith, A.E. (2024). "Time to form a habit: a systematic review and meta-analysis of health behaviour habit formation and its determinants." Healthcare, 12(23), 2488. https://doi.org/10.3390/healthcare12232488; Lally, P., van Jaarsveld, C.H.M., Potts, H.W.W., and Wardle, J. (2010). "How are habits formed: Modelling habit formation in the real world." European Journal of Social Psychology, 40(6), 998-1009. https://doi.org/10.1002/ejsp.674 (Median 59-66 days, individual range 4 to 335 days.)

Every work this chapter cites

The chapter's 26 notes cite 51 works, listed by note number. Each is also in the full source register.

  1. 1.Watson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., et al (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research. 10.1002/jbmr.3284
  2. 2.Greendale, G.A., Sowers, M., Han, W., Huang, M-H., et al (2012). Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). Journal of Bone and Mineral Research. 10.1002/jbmr.534
  3. 3.Frost, H.M (2003). Bone's mechanostat: a 2003 update. Anatomical Record Part A. 10.1002/ar.a.10119Bonewald, L.F (2011). The amazing osteocyte. Journal of Bone and Mineral Research. 10.1002/jbmr.320
  4. 4.Jones, H.H., Priest, J.D., Hayes, W.C., Tichenor, C.C., et al (1977). Humeral hypertrophy in response to exercise. Journal of Bone and Joint Surgery (American). 10.2106/00004623-197759020-00012
  5. 5.Ryan, T.M. and Shaw, C.N (2015). Gracility of the modern Homo sapiens skeleton is the result of decreased biomechanical loading. PNAS. 10.1073/pnas.1418646112
  6. 6.Macintosh, A.A., Pinhasi, R., and Stock, J.T (2017). Prehistoric women's manual labor exceeded that of athletes through the first 5500 years of farming in Central Europe. Science Advances. 10.1126/sciadv.aao3893
  7. 7.Cipriani, A., Furukawa, T.A., Salanti, G., Chaimani, A., et al (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 10.1016/S0140-6736(17
  8. 8.Lang, T., LeBlanc, A., Evans, H., Lu, Y., et al (2004). Cortical and trabecular bone mineral loss from the spine and hip in long-duration spaceflight. Journal of Bone and Mineral Research. 10.1359/JBMR.040307Gabel, L., Liphardt, A-M., Hulme, P.A., Heer, M., et al (2022). Incomplete recovery of bone strength and trabecular microarchitecture at the distal tibia 1 year after return from long duration spaceflight. Scientific Reports. 10.1038/s41598-022-13461-1
  9. 9.Cruz-Jentoft, A.J., Bahat, G., Bauer, J., Boirie, Y., et al (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 10.1093/ageing/afy169Mitchell, W.K., Williams, J., Atherton, P., Larvin, M., et al (2012). Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Frontiers in Physiology. 10.3389/fphys.2012.00260
  10. 10.Blair, S.N., Davey Smith, G., Lee, I-M., et al (2010). A tribute to Professor Jeremiah Morris: the man who invented the field of physical activity epidemiology. Annals of Epidemiology. 10.1016/j.annepidem.2010.06.001
  11. 11.Leong, D.P., Teo, K.K., Rangarajan, S., Lopez-Jaramillo, P., et al (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 10.1016/S0140-6736(14Ruiz, J.R., Sui, X., Lobelo, F., Morrow, J.R. Jr., et al (2008). Association between muscular strength and mortality in men: prospective cohort study. BMJ. 10.1136/bmj.a439
  12. 12.Brito, L.B., Ricardo, D.R., Araújo, D.S., Ramos, P.S., et al (2014). Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology. 10.1177/2047487312471759
  13. 13.Momma, H., Kawakami, R., Honda, T., and Sawada, S.S (2022). Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 10.1136/bjsports-2021-105061Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., et al (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 10.1136/bjsports-2020-102955
  14. 14.Roberts, B.M., Nuckols, G., and Krieger, J.W (2020). Sex differences in resistance training: a systematic review and meta-analysis. Journal of Strength and Conditioning Research. 10.1519/JSC.0000000000003521Jones, M.D., Wewege, M.A., Hackett, D.A., Keogh, J.W.L., et al (2021). Sex differences in adaptations in muscle strength and size following resistance training in older adults: a systematic review and meta-analysis. Sports Medicine. 10.1007/s40279-020-01388-4
  15. 15.Currier, B.S., D'Souza, A.C., Singh, M.A.F., Lowisz, C.V., et al (2026). American College of Sports Medicine Position Stand. Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Medicine & Science in Sports & Exercise. 10.1249/MSS.0000000000003897Schoenfeld, B.J., Grgic, J., Ogborn, D., and Krieger, J.W (2017). Strength and hypertrophy adaptations between low- vs. high-load resistance training: a systematic review and meta-analysis. Journal of Strength and Conditioning Research. 10.1519/JSC.0000000000002200
  16. 16.Ma, D., Wu, L., and He, Z (2013). Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause. 10.1097/GME.0000000000000100
  17. 17.Sarafrazi, N., Wambogo, E.A., and Shepherd, J.A (2021). Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief. 10.15620/cdc:103477Nicholson, W.K., Silverstein, M., Wong, J.B., Chelmow, D., et al (2025). Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 10.1001/jama.2024.27154
  18. 18.Phillips, S.M., Fulgoni, V.L., Heaney, R.P., Nicklas, T.A., et al (2015). Commonly consumed protein foods contribute to nutrient intake, diet quality, and nutrient adequacy. American Journal of Clinical Nutrition. 10.3945/ajcn.114.084079Bauer, J., Biolo, G., Cederholm, T., Cesari, M., et al (2013). Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association. 10.1016/j.jamda.2013.05.021Deutz, N.E., Bauer, J.M., Barazzoni, R., Biolo, G., et al (2014). Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical Nutrition. 10.1016/j.clnu.2014.04.007US Department of Health and Human Services and US Department of Agriculture (2026). Dietary Guidelines for Americans, 2025-2030. cdn.realfood.govKim, I.Y., Schutzler, S., Schrader, A.M., Spencer, H.J., et al (2018). Protein intake distribution pattern does not affect anabolic response, lean body mass, muscle strength or function over 8 weeks in older adults: a randomized-controlled trial. Clinical Nutrition. 10.1016/j.clnu.2017.02.020
  19. 19.Chilibeck, P.D., Kaviani, M., Candow, D.G., and Zello, G.A (2017). Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access Journal of Sports Medicine. 10.2147/OAJSM.S123529Devries, M.C., and Phillips, S.M (2014). Creatine supplementation during resistance training in older adults: a meta-analysis. Medicine and Science in Sports and Exercise. 10.1249/MSS.0000000000000220Kreider, R.B., Kalman, D.S., Antonio, J., Ziegenfuss, T.N., et al (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 10.1186/s12970-017-0173-zForbes, S.C., Candow, D.G., Ostojic, S.M., Roberts, M.D., and Chilibeck, P.D (2021). Meta-analysis examining the importance of creatine ingestion strategies on lean tissue mass and strength in older adults. Nutrients. 10.3390/nu13061912
  20. 20.Roberts, L.A., Raastad, T., Markworth, J.F., Figueiredo, V.C., et al (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. Journal of Physiology. 10.1113/JP270570Malta, E.S., Dutra, Y.M., Broatch, J.R., Bishop, D.J., and Zagatto, A.M (2021). The effects of regular cold-water immersion use on training-induced changes in strength and endurance performance: a systematic review with meta-analysis. Sports Medicine. 10.1007/s40279-020-01362-0Grgic, J (2023). Effects of post-exercise cold-water immersion on resistance training-induced gains in muscular strength: a meta-analysis. European Journal of Sport Science. 10.1080/17461391.2022.2033851Piñero, A., Burke, R., Augustin, F., Mohan, A., et al (2024). Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy. European Journal of Sport Science. 10.1002/ejsc.12074
  21. 21.Morton, R.W., Murphy, K.T., McKellar, S.R., Schoenfeld, B.J., et al (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine. 10.1136/bjsports-2017-097608Tagawa, R., Watanabe, D., Ito, K., Otsuyama, T., et al (2022). Synergistic effect of increased total protein intake and strength training on muscle strength: a dose-response meta-analysis of randomized controlled trials. Sports Medicine - Open. 10.1186/s40798-022-00508-wDevries, M.C., Sithamparapillai, A., Brimble, K.S., Banfield, L., et al (2018). Changes in kidney function do not differ between healthy adults consuming higher- compared with lower- or normal-protein diets: a systematic review and meta-analysis. Journal of Nutrition. 10.1093/jn/nxy197Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., et al (2025). Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Obesity. 10.1002/oby.24336
  22. 22.Sherrington, C., Fairhall, N.J., Wallbank, G.K., Tiedemann, A., et al (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 10.1002/14651858.CD012424.pub2Sherrington, C., Michaleff, Z.A., Fairhall, N., Paul, S.S., et al (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine. 10.1136/bjsports-2016-096547
  23. 23.Wang, X., Zhou, L., Shi, T., et al (2026). Effects of weighted vest on bone health and body fat in middle-aged and older adults: a systematic review and meta-analysis. Osteoporosis International. 10.1007/s00198-026-08196-y
  24. 24.Judah, G., Gardner, B., and Aunger, R (2013). Forming a flossing habit: an exploratory study of the psychological determinants of habit formation. British Journal of Health Psychology. 10.1111/j.2044-8287.2012.02086.xSingh, B., Murphy, A., Maher, C., and Smith, A.E (2024). Time to form a habit: a systematic review and meta-analysis of health behaviour habit formation and its determinants. Healthcare. 10.3390/healthcare12232488Lally, P., van Jaarsveld, C.H.M., Potts, H.W.W., and Wardle, J (2010). How are habits formed: modelling habit formation in the real world. European Journal of Social Psychology. 10.1002/ejsp.674
  25. 25.National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management. nice.org.ukBannuru, R.R., Osani, M.C., Vaysbrot, E.E., Arden, N.K., et al (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 10.1016/j.joca.2019.06.011
  26. 26.Androulakis-Korakakis, P., Fisher, J.P., and Steele, J (2020). The minimum effective training dose required to increase 1RM strength in resistance-trained men: a systematic review and meta-analysis. Sports Medicine. 10.1007/s40279-019-01236-0

The full source register

This page carries the chapter's apparatus. The chapter itself, and the fifteen others, are in the book.

Get the bookThe 30-day protocolAll sixteen chapters