David

Talking with my 72-year-old patient about training reps, I explained strength vs. muscle health. He said, “I’m not trying to be the strongest man in the gym. I’m just trying to live longer!” I think he’s got it figured out. — shared with permission

This study provides a powerful roadmap for healthier aging. It's not just about the number on the scale; it's about building the strength to live well.

Full study: Mesinovic J, et al. JCSM, 2025.

#HealthyAging #Geriatrics #StrengthTraining #Sarcopenia #FallPrevention

The bottom line: Don't just encourage older adults to lose weight. Encourage them to build strength while they do it.

And for those wondering, the study showed that this high-intensity program was safe, with very few injuries (one back strain I think).

Here's the kicker: BOTH groups lost the same amount of weight (~11 lbs).

But only the HiRIT group got measurably stronger and more mobile. They lost weight AND gained function. The other group just lost weight.

Why is walking speed so important? It's often called the "sixth vital sign" in geriatrics.

Even a small increase is directly linked to a lower risk of falls, fewer hospitalizations, and a longer, healthier life. It’s a direct measure of resilience.

The results were clear. While both groups lost weight, only the HEAVY LIFTING group saw a clinically meaningful improvement in their walking speed.

The HiRIT group got faster. The walking group didn't. 🚀

The setup: A 12-week study with older adults with obesity on a weight-loss diet.
GROUP 🚶: Unsupervised, home-based walking.
GROUP 🏋️: Supervised, high-intensity resistance & impact training (HiRIT).

When older adults lose weight, are they actually getting healthier? Or just weaker? 🤔

A recent study pitted two exercises against each other to find the best way to lose weight WITHOUT losing strength and function. The results might surprise you.

Thread 👇

Yo quiero #creatine!

Weighing the risk of GLP-1 treatment in older adults: Should we be concerned about sarcopenic obesity? Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been pivotal for obesity treatment, achieving 15–25 % weight loss over 12–24 months, but qu…

Full study here:

📖 Full breakdown here:
open.substack.com/pu...

RT if you agree “muscle retention” must be part of every weight loss protocol.

The solution is simple:
✅ Resistance training 2–3x/week
✅ 1.2–1.6 g/kg protein
✅ Sarcopenia screening


The wider availability of GLP-1s is a huge win.
But prescribers must protect muscle, not just chase weight loss.

This is sarcopenic obesity:
🔻 Low muscle
🔺 High fat
⚠️ Higher risk of falls, fractures, diabetes, mortality


Already 10–20% of older adults live with it.
GLP-1 cycling could push that higher.

When treatment stops?
Weight comes back.
But mostly as fat, not muscle.


Example: after liraglutide cessation
+6.3 kg fat
+2.5 kg lean
➡️ Net: weaker, not stronger.


Another study:
+2.52 kg fat
−0.12 kg lean
➡️ Sarcopenia risk climbs.

Weight loss isn’t just fat loss.
It always includes muscle.
And with GLP-1 drugs, that matters more than ever

GLP-1s deliver 15–25% weight loss.
An incredible breakthrough.

But ~20% of that loss is lean mass — muscle and bone.

All changes were statistically significant (p < 0.01, except SMI p < 0.05)

Then they stopped training for 12 weeks

What happened?
• Most gains declined slightly
• But SARC-F remained 40% lower than baseline

Outcomes:

• Grip ↑ 17%
• Sit-to-Stand reps ↑ 39%
• Gait speed ↑ 19%
• SARC-F score ↓ 43%
• Muscle mass ↑ 3.2%

Study: 41 women, mean age ~79, diagnosed with sarcopenia


🏋️‍♀️ Intervention: 12 weeks of progressive resistance training, 2x/week

The GP's Secret Weapon Against Aging: A 5-Step Guide to Muscle Health Why your GP should be obsessed with your muscle, and the simple framework they can use to turn back the clock on aging.

One framework. Big impact.

Full guide here ➡️open.substack.com/pu... — RT to spread to clinicians.

Flag early with 🇦🇺 cutoffs: Grip <37kg, 5xSTS ≥11s

Confirm with 🇪🇺 criteria: Grip <27kg, 5xSTS >15s

Prescribe: 1.0–1.5 g/kg/day protein + 2x/week resistance training.

One visit.

A new 5-step system solves this: Screen all 50+ adults using SARC-F ≥2.

Then assess grip strength and chair-rise time (5xSTS).

Use the PowerFrail app to turn that test into a predictive biomarker: muscle power.

Google Play Apple App Store

Only 1 in 4 GPs screens for muscle loss.

Yet sarcopenia is predictive of falls, fractures, hospital stay, and death.

23 years ago my darling said “I do.”

I am very thankful that she did!

I love you Abby.

Some get hyped. Some get quiet.

“Noise fractures focus; stillness forges strength.”

How do you prepare for your next lift? Team Hype or Team Still? ⬇️

Wegovy is now FDA-approved for MASH (fatty liver with fibrosis).
First GLP-1 therapy to carry this indication.

Full breakdown, insurance insights, and a free toolkit for patients and providers:

open.substack.com/pu...

GLP-1 Medicines, Brain Health, and Stroke Prevention: What the Latest Research Tells Us By David Propst, DMSc, PA-C

Full breakdown here:

propstmetabolichealt...

New JAMA Network Open study: GLP-1 meds (semaglutide, tirzepatide) linked to:

37% ↓ dementia risk

19% ↓ ischemic stroke risk

30% ↓ mortality
Most benefit: age 60+, women, BMI 30–40. Observational, not causal, but promising for brain & heart health.

Forget 10 000 steps. Hitting 7 000 daily steps cuts all-cause mortality by 47 %, lowers CVD mortality by 47 %, reduces cancer mortality by 37 % and even slashes dementia risk by 38 %. Small, consistent walks add up to big health gains. Not 7000? 3000 better than 2000!

Should Your Kids Lift Weights? What the Science Actually Says About a Common Fear.

Check out my Substack post for more: open.substack.com/pu...?