Book review: The Barbell Prescription

Did you know that adults who do not engage in regular strength training lose up to 1 pound (0.45 kg) of muscle per year after 40? This is just one of numerous items of information in a comprehensive new book, The Barbell Prescription: Strength Training for Life After 40, by Jonathon Sullivan and Andy Baker. Jonathon Sullivan is doctor who has been working in Emergency Medicine in Detroit for 20 years. He is also a Starting Strength Coach who owns and runs a gym devoted to barbell-based strength training for people in their 40s and beyond, Greysteel Strength and Conditioning. Andy Baker is also a Starting Strength Coach and owner of a barbell training facility. The foreword is by Nassim Nicholas Taleb (of Black Swan fame).

Why should the over 40s consider strength training? As a physician, Dr Sullivan has spent many years on the front line dealing with the devastating results of poorly-managed aging which he calls the sick aging phenotype. Phenotype is a biological term denoting the overall appearance and condition of an organism, as opposed to genotype which denotes its genetic inheritance. It is possible to have two organisms with identical genotypes, such as identical twins, but with very different phenotypes because of their different behaviours and lifestyles. There is no escape from the ageing phenotype, but its condition is largely down to the choices we make.

At its most extreme, the sick aging phenotype is a deadly cocktail of metabolic syndrome (a set of symptoms and disorders that include obesity, hyperglycaemia, hypertension, dyslipidaemia and inflammation), sarcopenia and osteopenia (muscle and bone loss), frailty and polypharmacy (the many pharmaceuticals that are routinely prescribed for older people for such conditions as diabetes, hypertension, depression, cardiovascular disease, and high cholesterol). This is very bad news, that will not only lead to a shorter lifespan but also a lower quality of life for many years prior to death.

Sullivan and Baker’s proposition is that exercise is the most powerful medicine available to prevent the development of the sick ageing phenotype by addressing its root causes, rather than just ameliorating its symptoms. The book goes into considerable detail about the multiple ways in which exercise medicine can improve musculoskeletal, cardiovascular, metabolic, cellular, neurological and psychological health. The power of exercise is to prevent disease occurring; once a diseased state has been established it is difficult to reverse.

Exercise is a general term that really means anything from going for a stroll to attending a gym class and working up a sweat. All types of exercise are good for humans and will likely lead to far better health outcomes than a sedentary lifestyle. It is an inconvenient fact that the modern way of life encourages sedentary behaviour; without deliberate choice, it is so easy to spend nearly all one’s waking hours sitting, on a chair, in a car or train, or at a desk. Compared to just a few generations ago, most of us sit for most of our day. No wonder that it has been said that sitting is the new smoking.

Sullivan and Baker take this a step (no pun intended) further by highlighting the distinction between exercise and training. Training is a specific form of exercise that aims to improve one or more general fitness attributes such as strength, power, endurance, balance, mobility or body composition. An athlete will often focus on one of these attributes to the exclusion of others. For example, a long-distance runner will train for endurance. The Barbell Prescription proposes a change of mindset for the over 40s, in that we are athletes training to do better at the extreme sport of aging. Effective training may not extend longevity, but it should extend healthy lifespan, that is, shrink the sick and dysfunctional stage to the smallest possible slice of life.

As is clear from the title of their book, Sullivan and Baker believe that the optimal form of exercise for tackling the extreme sport of aging, and mitigating the risk of becoming another sick aging phenotype, is strength training; and that barbell training is the most effective way to train for strength, whatever one’s age. In this book, they present multiple a range of evidence to demonstrate that using barbells develops the broadest range of fitness attributes, with the least number of exercises, and the minimum of complexity and training time.

I urge you to read this book to fully explore the many arguments laid out with great clarity in support of the barbell prescription for the older ‘athlete’. For example, barbell exercises like the Squat, Press, Bench Press and Deadlift use whole systems of the human body in ways that are close to the natural movements that humans have been doing for hundreds of thousands of years. In this they differ from the popular ‘resistance machines’ that purport to train individual muscles, such as the quadriceps or calves. There are no natural human movements that only use individual muscles in this way. Unfortunately for the older athlete who is seduced by the technological wizardry at their local gym, these machines are far less effective than barbells.

Although The Barbell Prescription is not yet available in the UK, it can be ordered from

What about you? Are you strong enough? Would you consider using barbells for strength training? Let us know in the comments below.



3 thoughts on “Book review: The Barbell Prescription”

  1. I have been training with Dr. Sullivan for just over four years. I began right after by 66th birthday. At first I wasn’t sure I could actually stand to do the exercises but with careful coaching I have become stronger by objective measurements during each year of training. Dr. Sullivan loves his work and it is clear that he loves his clients. My waste went from 44 inches to 38 inches while my weight has remained between 215 and 220 lbs. the entire four years. During that time my chest has expanded from 46 inches to 50 inches. After only a few weeks of training my wife looked at me and declared “Here Comes Hercules”. My wife joined me for training shortly after that. She was diagnosed with Osteoporosis when she started. She no longer has that diagnosis.

    This book is a wonderful introduction to what can happen if you don’t do strength training but it is also a wonderful clear prescription for what can happen if you do. We all will make a choice. The longer we live two things are for sure. We get older and we get beat up. Those aren’t choices. The only choice we have is will we get old beat up and weak and less able to live a full life. Or will we get older and strong and much more able to live a full life until we die. Put another way, will we die for most of our life with agony upon agony or will we live a strong life and die only for the few moments or even seconds at the end.

    Carson Daniel Lauffer

  2. I started weight training in 1969 (at 18), started my first gym (Club Rockys) in 1992 and competitive bodybuilding in 1997 through to 2008. For most of that time did compound and isolation exercises as per the accepted method of getting Bigger. Since reading Primal Blueprint, 12 months ago, I have focused on the Big exercises- squats, bench, deadlifts, chins and planks, and only twice per week (as against 4-5 times per week for 2 hours). Now at 65 I am in better shape than ever before. Most of my training involves barbells, 4 exercises, 2-3 sets, over in 45 minutes, and little if any DOMS. I have been amazed at how little it takes to make a big difference.

  3. Outstanding to hear Dan Lauffer!

    I attended a Starting Strength squat workshop at Dr. Sullivan’s facility 2 months ago. Dr. Sullivan and Chris Kurisko were the coaches. Great experience! The Starting Strength methodology is super solid and it works. It has inspired me to change the way that I work with all of my clients. The results of what Sully and the rest of the SS folks espouse speaks for itself. This outfit is trustworthy!

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