Cardio, strength training benefit metabolism

DEAR DR. ROACH: Can you comment on the benefits of weightlifting over aerobic exercise? I know that any exercise is beneficial compared with nothing, but which is better for losing weight long term? Running or jogging can burn calories, but I have read that muscle requires more energy metabolically and therefore the more muscle you build, the more fat you will burn.

— K.K. ANSWER: Researchers have debated the relative benefits of aerobic exercise against weightlifting exercise for many years, and there remains debate. However, I can give you the general consensus.

First, the distinction is often not absolute. Weightlifting burns calories aerobically; however, many serious weightlifters take pains to make sure that their aerobic capacity does not limit their ability to lift by resting in between repetitions. Similarly, many “aerobic” exercises use elements of resistance, so there is considerable overlap.

There are benefits to resistance exercise that even high amounts of pure aerobic exercise cannot achieve. Resistance training has a much larger effect on bone health. Empirically, those who do resistance training have lower rates of both falls and fractures. This is most important in older people, especially older women.

From the standpoint of weight loss, having a larger muscle mass means a greater ability to burn calories. On the other hand, having high cardiovascular fitness from consistent aerobic activity means a greater ability to use oxygen (called VO2), which corresponds to metabolism of carbohydrates and fats. Longer exercise sessions of at least moderate intensity burn more fat than shorter or less-intense sessions. It is very difficult to burn large amounts of calories with pure weightlifting exercise, so weight loss is typically more effective with aerobic exercise. However, it is possible to do resistance training so that you get aerobic benefit as well, by rapidly progressing from one muscle group to another.

Nearly all elite athletes incorporate resistance training, as it improves performance in addition to its benefits on bones.

DEAR DR. ROACH: My cousin, a woman in her mid-50s, was recently diagnosed with polymyalgia rheumatica. She was diagnosed early and has been on the standard prednisone treatment for seven days. She’s been athletic most of her adult life and became concerned when the pain she was suffering was different from normal athletic pains. Her mom (my aunt) also had PMR, but not until her late 70s.

I’d like to know more about PMR, its treatment and the likelihood of it being hereditary. Would exercises, supplements or an anti-inflammatory diet help?

— N.P. ANSWER: Polymyalgia rheumatica is a common but underdiagnosed inflammatory rheumatic condition found almost exclusively in older adults. It most often causes pain in the muscles of the arms, shoulders, neck and torso, and is typically much worse in the morning. It is more frequent in women.

Both sides of the body are equally affected. The diagnosis is made based on symptoms, but a blood test helps support the diagnosis.

Virtually all people with PMR respond rapidly and dramatically to low-dose (1020 mg) of prednisone. Only half of people are able to stop the prednisone within a year or two.

There is a familial association with PMR; however, it’s a common disease. One woman in 40 will get it in her lifetime (for men, it’s less common, 1 in 70). A family history is certainly not necessary to get the condition.

Supplements and an anti-inflammatory diet may relieve symptoms in some people. Whether or not this is a placebo effect is difficult to say. The prednisone is a much more powerful anti-inflammatory than any diet or over-the-counter supplement. Exercise has benefit in preventing deconditioning but not managing the actual condition.