David
@primarycarepac.bsky.social
@PrimaryCarePAC from X
Husband, dad, exercise evangelist.
Power lifting
#Creatine
Husband, dad, exercise evangelist.
Power lifting
#Creatine
Not every fitness plan deserves your effort.
Look for coaches who respect safety, explain the “why,” and adjust to your real life, not just your before-and-after photo.
Look for coaches who respect safety, explain the “why,” and adjust to your real life, not just your before-and-after photo.
November 20, 2025 at 3:27 PM
Not every fitness plan deserves your effort.
Look for coaches who respect safety, explain the “why,” and adjust to your real life, not just your before-and-after photo.
Look for coaches who respect safety, explain the “why,” and adjust to your real life, not just your before-and-after photo.
New research: diet + resistance training vs. diet alone = same scale weight, completely different body composition. You can lose fat while preserving muscle. The scale doesn't tell the whole story.
open.substack.com/pu...
November 19, 2025 at 5:02 PM
New research: diet + resistance training vs. diet alone = same scale weight, completely different body composition. You can lose fat while preserving muscle. The scale doesn't tell the whole story.
open.substack.com/pu...
Your workout improves instantly when you remove distractions.
Phones lower reps, slow reaction time, and reduce focus.
Give today’s session your full attention.
Phones lower reps, slow reaction time, and reduce focus.
Give today’s session your full attention.
November 19, 2025 at 2:13 PM
Your workout improves instantly when you remove distractions.
Phones lower reps, slow reaction time, and reduce focus.
Give today’s session your full attention.
Phones lower reps, slow reaction time, and reduce focus.
Give today’s session your full attention.
You can get stronger at any age. 💪
Even people in their 80s and 90s gain strength with training. Muscle grows slowly, but it grows.
Body weight, bands, machines or dumbbells all work if you use them consistently. Start small, keep going.
jamanetwork.com/jour...
Even people in their 80s and 90s gain strength with training. Muscle grows slowly, but it grows.
Body weight, bands, machines or dumbbells all work if you use them consistently. Start small, keep going.
jamanetwork.com/jour...
November 18, 2025 at 5:29 PM
You can get stronger at any age. 💪
Even people in their 80s and 90s gain strength with training. Muscle grows slowly, but it grows.
Body weight, bands, machines or dumbbells all work if you use them consistently. Start small, keep going.
jamanetwork.com/jour...
Even people in their 80s and 90s gain strength with training. Muscle grows slowly, but it grows.
Body weight, bands, machines or dumbbells all work if you use them consistently. Start small, keep going.
jamanetwork.com/jour...
Muscle health is medicine. I write about resistance training, protein, creatine, and the science of healthy aging.
Join me on Substack:
👉 substack.com/@propst...
Join me on Substack:
👉 substack.com/@propst...
November 3, 2025 at 4:27 PM
Muscle health is medicine. I write about resistance training, protein, creatine, and the science of healthy aging.
Join me on Substack:
👉 substack.com/@propst...
Join me on Substack:
👉 substack.com/@propst...
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
September 25, 2025 at 8:30 PM
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
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).
And for those wondering, the study showed that this high-intensity program was safe, with very few injuries (one back strain I think).
September 14, 2025 at 2:01 PM
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).
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.
But only the HiRIT group got measurably stronger and more mobile. They lost weight AND gained function. The other group just lost weight.
September 14, 2025 at 2:01 PM
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.
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.
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.
September 14, 2025 at 2:01 PM
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.
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 HiRIT group got faster. The walking group didn't. 🚀
September 14, 2025 at 2:01 PM
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 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).
GROUP 🚶: Unsupervised, home-based walking.
GROUP 🏋️: Supervised, high-intensity resistance & impact training (HiRIT).
September 14, 2025 at 2:01 PM
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).
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 👇
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 👇
September 14, 2025 at 2:01 PM
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 👇
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 👇
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.
✅ 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.
September 6, 2025 at 2:18 PM
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.
✅ 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.
🔻 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.
September 6, 2025 at 2:18 PM
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.
🔻 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.
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.
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.
September 6, 2025 at 2:17 PM
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.
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.
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
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
August 27, 2025 at 4:25 PM
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
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.
Yet sarcopenia is predictive of falls, fractures, hospital stay, and death.
August 27, 2025 at 4:25 PM
Only 1 in 4 GPs screens for muscle loss.
Yet sarcopenia is predictive of falls, fractures, hospital stay, and death.
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.
I am very thankful that she did!
I love you Abby.
August 25, 2025 at 1:09 PM
23 years ago my darling said “I do.”
I am very thankful that she did!
I love you Abby.
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? ⬇️
“Noise fractures focus; stillness forges strength.”
How do you prepare for your next lift? Team Hype or Team Still? ⬇️
August 21, 2025 at 6:59 PM
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? ⬇️
“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...
First GLP-1 therapy to carry this indication.
Full breakdown, insurance insights, and a free toolkit for patients and providers:
open.substack.com/pu...
August 19, 2025 at 2:00 PM
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...
First GLP-1 therapy to carry this indication.
Full breakdown, insurance insights, and a free toolkit for patients and providers:
open.substack.com/pu...
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.
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.
August 13, 2025 at 1:01 PM
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.
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!
July 30, 2025 at 2:54 PM
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!
Is it safe for kids to lift weights? 🤔
A powerful paper in @BJSM_BMJ is calling out the myths that are making our kids weaker.
Spoiler: The biggest danger isn't lifting; it's avoiding it. Here’s what the evidence says. 🧵
A powerful paper in @BJSM_BMJ is calling out the myths that are making our kids weaker.
Spoiler: The biggest danger isn't lifting; it's avoiding it. Here’s what the evidence says. 🧵
July 29, 2025 at 4:01 PM
Is it safe for kids to lift weights? 🤔
A powerful paper in @BJSM_BMJ is calling out the myths that are making our kids weaker.
Spoiler: The biggest danger isn't lifting; it's avoiding it. Here’s what the evidence says. 🧵
A powerful paper in @BJSM_BMJ is calling out the myths that are making our kids weaker.
Spoiler: The biggest danger isn't lifting; it's avoiding it. Here’s what the evidence says. 🧵
Kids shouldn’t perform resistance exercise?
What does Dr Avery Faigenbaum (et al) have to say about this?
Find out Tuesday.
Follow here and subscribe to my Substack (open.substack.com/pu...)
to get every post in your email.
What does Dr Avery Faigenbaum (et al) have to say about this?
Find out Tuesday.
Follow here and subscribe to my Substack (open.substack.com/pu...)
to get every post in your email.
July 26, 2025 at 2:44 PM
Kids shouldn’t perform resistance exercise?
What does Dr Avery Faigenbaum (et al) have to say about this?
Find out Tuesday.
Follow here and subscribe to my Substack (open.substack.com/pu...)
to get every post in your email.
What does Dr Avery Faigenbaum (et al) have to say about this?
Find out Tuesday.
Follow here and subscribe to my Substack (open.substack.com/pu...)
to get every post in your email.