Resistance Training Works for Your Condition. Here’s What the Research Actually Says.

By Dr. Heather Toma, PT, DPT, OCS, FAAOMPT - Move to Mend Physical Therapy

If you have a chronic condition, you might think progressive resistance training isn’t for you. Maybe you’ve been told to take it easy. Maybe you’re worried about making things worse. Maybe it just feels like something that belongs to a younger, healthier version of yourself.

The research says otherwise. And after years of treating patients, so does my clinical experience. Progressive resistance training may take more nuance to structure and work with a physical therapist when chronic conditions are present. However, it is a very valuable tool for improving quality of life, muscle/bone/ligament/tendon quality, and physical and psychological resilience.

Progressive resistance training is the practice of gradually and systematically increasing the challenge placed on your muscles over time.  The great news is when you challenge your muscles, you also positively challenge your joints, bones, neural systems, and mind. If done correctly, it is an amazing evidence-based, accessible and powerful tool available for managing chronic conditions. It’s not about lifting heavy. It’s not about grinding through pain. It’s about consistently challenging your system a little more than you did before, in a way that’s appropriate for your body and your condition.

Here’s what the research actually supports, condition by condition.

What Progressive Resistance Training Actually Means

Before diving into the conditions, it’s worth being clear about what we’re talking about. Progressive resistance training means gradually increasing the challenge placed on your muscles/system over time: more weight, more repetitions, or more complex movement patterns. It is not always about lifting heavy. It’s about consistently challenging your system more than you did before.  Starting from your current safe threshold of an exercise/movement and incrementally increasing the load.  This requires the body to adapt and tolerate more. As our systems adapt, the functional activities we wish to do often become more accessible

This is what makes it different from general exercise advice. The progression is the point. And the progression needs to be guided by an understanding of your condition, your history and your body.

Chronic Low Back Pain

In the acute phase of back pain, movement may need to be gentler and more supported. But once the initial flare settles, avoiding movement altogether often makes chronic low back pain significantly worse.^1,2

The reason has to do with how your nervous system works. When you consistently avoid movements that feel threatening, your brain learns to treat those movements as dangerous, even after tissue has healed. This is the fear-avoidance cycle, and it is one of the most important concepts in understanding chronic pain.³

Progressive resistance training, done appropriately, retrains your nervous system to feel safe moving again. Research confirms that exercise training is significantly more effective than non-exercise approaches at reducing fear-avoidance beliefs in people with low back pain, and that resistance training specifically produces meaningful improvements in pain intensity, disability and quality of life.^1,4

Post-Surgical Rehab

Surgery is always followed by a period of muscle atrophy around the surgical site. This is not a minor inconvenience. It affects how you move, how stable you feel and how completely you recover.

When your surgeon and physical therapist give the green light, progressive resistance training is one of the most important tools for rebuilding that strength and restoring the movement patterns you need to return to the life you want. The timing matters. The progression matters. And having someone who understands your specific procedure and presentation makes a meaningful difference in outcomes. 

Osteoarthritis

Cartilage gets its nutrients through movement and load, not through rest. It’s one of the most counterintuitive things I tell patients, but it matters: rest is often the wrong prescription for osteoarthritis.

The act of strength training improves joint awareness, movement mechanics and how load is distributed across the joint. Multiple systematic reviews and meta-analyses confirm that resistance training significantly reduces pain and improves physical function in people with knee and hip osteoarthritis.^5,6,7

The caveat worth knowing: with osteoarthritis, starting slowly and building systematically is essential. This is not a condition where you jump in at full intensity. How you progress matters as much as which exercises you choose.

Osteoporosis

Bones respond to load by getting stronger. That’s the core principle behind resistance training for osteoporosis, and it is well supported by research. A 2022 meta-analysis confirmed that resistance training promotes meaningful changes in bone mineral density in older adults. A 2023 systematic review of postmenopausal women found that moderate-intensity resistance training was superior to no exercise for improving bone mineral density at both the lumbar spine and femoral neck.^8,9

For women with osteoporosis, the most effective exercise approach brings together progressive resistance training, impact exercises and balance training. Together they address the two biggest levers for fracture prevention: bone density and fall risk.

Exercise is one part of a comprehensive osteoporosis management plan. If you’re working with a physician and a physical therapist together, you’ll get the most complete picture of what your body needs.

Pregnancy and Postpartum

Pregnancy and postpartum are not a reason to stop strength training. With appropriate modifications, progressive resistance training supports posture, reduces pain, prepares your body for the physical demands of labor and early parenthood, and supports a faster postpartum recovery. The American Heart Association’s 2023 scientific statement on resistance training notes that resistance training is generally safe during both pregnancy and the postpartum period.¹⁰

Appropriate modifications is the key phrase. What’s right for you depends on where you are in your pregnancy, your baseline fitness and any specific complications or considerations. This is an area where working with a provider who understands perinatal exercise is genuinely important.

GLP-1 Medications

GLP-1 medications like semaglutide and tirzepatide are powerful tools for weight loss. But rapid weight loss without resistance training can lead to significant muscle and bone loss. Studies are showing that lean mass loss comprises a meaningful percentage of total weight loss with GLP-1 receptor agonists, and that higher-dose medications are among the least effective in preserving lean mass.¹¹

Progressive resistance training combined with adequate protein intake is an effective strategy to preserve and even build muscle while your body transforms. Multiple systematic reviews confirm that resistance exercise effectively reduces lean mass loss and the associated risk of sarcopenia during periods of significant weight loss.^12,13

Cardiovascular Disease

For people living with cardiovascular disease, resistance training is endorsed by the American Heart Association as safe and effective. The AHA’s 2023 updated scientific statement confirms that resistance training has favorable physiological and clinical effects on cardiovascular disease and its risk factors, including blood pressure, cholesterol and overall heart function. Combined with aerobic exercise, the benefits are even greater.¹⁰

If you have a cardiovascular condition and have been avoiding resistance training out of caution, this is worth a conversation with your care team. The evidence is stronger than most people realize.

Diabetes: Type 1 and Type 2

For type 2 diabetes, resistance training improves insulin sensitivity, supports glycemic control and helps preserve muscle mass. All of those things matter for long-term metabolic health. Resistance training has been found to significantly improve insulin resistance markers, fasting glucose and HbA1c in middle-aged and older adults with type 2 diabetes.¹⁴

For type 1 diabetes, the picture is different but equally important. Resistance exercise can produce more stable blood glucose during exercise and results in less exercise-associated hypoglycemia compared to aerobic exercise alone.^15,16

In both cases, supervised training tends to produce better outcomes. The details of how you structure the program matter, and they’re worth getting right.

Mental Health

Resistance training isn’t just good for your body. Research shows it significantly reduces symptoms of depression and anxiety across all age groups. ^17,18

Movement is medicine for the mind too. Resistance training doesn’t replace mental health care. It supports it. If you’re working with a mental health provider, keeping them in the loop about your exercise program is always a good idea.

The Through Line

Every condition above responds to the same fundamental principle: your body adapts to the demands you place on it. Progressive resistance training works because it places those demands in a structured, intentional and evidence-based way.

You don’t need a gym. You don’t need expensive equipment. You don’t need to be young, healthy or pain-free. You need consistency, appropriate progression and an

understanding of your specific condition.

That last part is where the nuance lives, and it’s what we’ll be exploring in the weeks and months ahead. Each of these conditions deserves its own conversation. Follow along for deeper dives into each one.

Important: This article is for educational purposes only and is not a substitute for personalized medical or physical therapy advice. Always consult a qualified healthcare provider before starting a new exercise program.

Dr. Heather Toma is a Doctor of Physical Therapy and founder of Move to Mend, a concierge physical therapy practice serving Silicon Valley. She offers in-home and online PT for people who want evidence-based, personalized care. Learn more at movetomendpt.com.

References

1. Pinheiro MB et al. Does resistance training improve pain intensity, quality of life, and disability in people with chronic nonspecific low back pain? A systematic review and meta-analysis. PubMed 41065407. 2025.

2. Wewege MA et al. Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis. Archives of Physiotherapy. 2025.

3. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–332.

4. Stanton TR et al. Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis. PubMed 32946074. 2020.

5. Koh EJ et al. The Effects of Resistance Training on Pain, Strength, and Function in Osteoarthritis: Systematic Review and Meta-Analysis. J Pers Med. 2024;14(12):1130.

6. Liao CD et al. The effect of resistance training on patients with knee osteoarthritis: a systematic review and meta-analysis. PubMed 38980284. 2024.

7. Fan TL et al. Effects of three types of resistance training on knee osteoarthritis: A systematic review and network meta-analysis. PLOS One. 2024.

8. Massini DA et al. The Effect of Resistance Training on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022;10(6):1129.

9. Wang Z et al. Comparative efficacy of different resistance training protocols on bone mineral density in postmenopausal women: A systematic review and network meta-analysis. Front Physiol. 2023;14:1105303.

10. Paluch AE et al., on behalf of the American Heart Association. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation. 2024;149(3):e217–e231.

11. Karakasis P et al. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis. Metabolism. 2025;164:156113.

12. Locatelli JC et al. Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? Diabetes Care. 2024;47(10):1718–1730.

13. Lopez P et al. Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta-analysis. Obes Rev. 2022;23(5):e13428.

14. Wang J et al. Resistance training enhances metabolic and muscular health and reduces systemic inflammation in middle-aged and older adults with type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. 2025.

15. Yardley JE et al. Resistance Versus Aerobic Exercise: Acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537–542.

16. Yardley JE et al. Effects of Performing Resistance Exercise Before Versus After Aerobic Exercise on Glycemia in Type 1 Diabetes. Diabetes Care. 2012;35(4):669–675.

17. Marinelli R et al. Resistance training and combined resistance and aerobic training as a treatment of depression and anxiety symptoms in young people: A systematic review and meta-analysis. Early Interv Psychiatry. 2024;18(8):585–598.

18. Cunha PM et al. Can resistance training improve mental health outcomes in older adults? A systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2024;349:176–186.