Table 5.

Top ten training guidance towards increasing muscle mass. The most important objective in resistance training is primum non nocere (“first do not harm”). Patients who engage in resistance training should first undergo proper health evaluation, especially of their cardiovascular, pulmonary, musculoskeletal, and neurologic body systems. Afterwards, patients should learn the proper use of free weights and machines. Short-term sore muscles may be expected. Sore joints suggest poor technique. The emphasis should be to safely increase total muscle mass, which may be achieved in a more time-efficient manner by training large muscle groups (e.g., leg pressing exercises such as squats, upper-body pulling exercises such as pull-ups and upper-body pushing exercises such as bench press) [95]. Increasing total muscle mass will increase the percentage of lean body mass. Developing “core” muscles (midsection of the body, such as abdomen, back, and hips) may help healthy posture, balance stabilization, back muscle strength, and endurance [96]. For most individuals, if performed to momentary muscle failure, then low load (i.e., lower weights per set with more repetitions) and high load (i.e., heavier weights with fewer repetitions) resistance training will both help promote muscle fiber hypertrophy [97]. What matters most is the long-term adherence to a physical exercise routine, involving the strengthening of major muscle groups two or more times per week [86]. Utilizing a variety of free weights, machines, and resistance bands may reduce boredom and provide greater flexibility regarding scheduling and location. While dietary protein supplements are sometimes used by elite level athletes [98], for most individuals, adequate protein is best obtained from natural food sources [99] and overall healthful nutrition. While resistance training is important, so is dynamic physical exercise [86], which is complementary to resistance training. As with numerous other health benefits, including effects on body composition [13], healthful sleep can favorably affect the results of resistance training [100]. Conversely, in addition to improving anxiety and depression, resistance physical exercise may in turn, improve sleep quality [101]. Monitoring the progress of resistance training might best include muscle mass metrics (e.g., muscle tape measurements, body composition analyses) versus body weight or the amount of weight lifted. It is relatively common that after initiating a new resistance training program, body weight will increase due to increased muscle water retention (i.e., muscle inflammation and increased glycogen-associated water stores). The good news is that during negative caloric balance, resistance training can help mitigate muscle loss and limit the reduction in resting metabolic rate [9]. Finally, given all the available information (both accurate and inaccurate), it is best to keep in mind simple principles such as those listed above, and avoid trying to “overthink” how best to increase muscle mass, or how to employ a “quick fix” via unproven and potentially unsafe interventions such as supplements [102].

1. Learn proper and safe resistance training techniques
2. Target large muscle groups
3. Target core muscle groups
4. Overload muscles
5. Adhere to a routine
6. Healthful nutrition (with adequate protein) and proper hydration
7. Don’t forget dynamic training
8. Prioritize healthful sleep
9. Utilize proper metrics to assess progress
10. Keep it simple and safe