Weekly Blog

July 10

Back in 2019, we read a showstopper study that quickly became one of my favorites. It was by no means perfect. For example, using only men in the sample group made it far from generalizable, but the findings were so significant, simple, and clear that they begged people to explore further. The punchline, which we've discussed numerous times here, was that in a group of more than 1500 firefighters who were, on average, about 40 years old, the ability to perform 40 continuous push-ups translated to a status of near heart-attack proof (96% reduced risk) over the next decade. This, of course, led to conversations and plenty of impromptu testing sessions where someone would wonder enough to get on the floor and try...and usually realize, 40 is a LOT for an average person. Anyone who can get even close is both strong and fit, which we know are critical predictors of future health.

Since that time, other studies relaying the predictive power of the push-up have been published. For example, in female soldiers, after statistical scrubbing, the number of push-ups completed was one of the six risk factors identified (and one of two measures of physical capacity) that had a significant relationship with injury risk, as discussed here. A similar association was found in professional firefighters in South Africa: more push-ups related to lower risk of injury. However, in an interesting and counterintuitive twist, higher physical capacity—including that measured by the push-up test—correlated with increased general discomfort and soreness. This finding underscored the need for a well-designed recovery plan for those who tend to push themselves toward their physical limits, as this tendency drives higher capacity. However, in a world where seeing is believing, new research may have unlocked a better understanding of why.

Published on June 30th, a study using an artificial intelligence model to assess CT scans of 1,722 people found that muscle density—specifically whether the muscles in the chest and upper back had fatty streaks (like a marbled steak)—was a stronger predictor of heart attack incidence and severity risk than similar scans of the liver or even the torso. For every 10-point increase in image brightness, which suggests greater muscle density, a 31% risk reduction was noted. Individuals with below-average muscular density—lower than the group's median—had a 58% greater likelihood of having a heart attack and an 85% greater likelihood of dying from one over the next ten years. Practically speaking, this means the quality of our chest and upper back muscles—a result of regular strenuous pushing and pulling—may be more important than other metrics we commonly use to estimate health, such as weight or body fat. However, there are caveats.

Push-ups (and pull-ups if aiming for balanced training) are complex full-body movements that require not only strength but also the ability to load the shoulders and wrists and stabilize the trunk. Unfortunately, this blocks a fair number of people from getting the full benefit of using these movements as either tests or training. This study from 2025 showed that as many as 1 in every 20 participants could not complete a single push-up, most often due to discomfort or some other orthopedic limitation. The important thing to remember here is that there are MANY ways to modify them, whether finding a way to keep the wrists in neutral, dropping to a knee to reduce strain, or even using a wall to start less intensely...so please don't let that stop you.

So what's a good goal?

The short answer here is: progress; anything more than yesterday is a step in the right direction. However, realizing that such an answer is probably unfulfilling, aiming for at least 10 high-quality push-ups daily is a great first goal for most people, while working toward 20 or more for strivers is backed by both experts and evidence. The Mayo Clinic for example provides a recommended standard by age about half way down the page here and although 40 was the gold standard in the firefighter study above, what tends to get less attention is that the risk reduction in that study was generally stepwise: those who could do more than 10 push-ups had a 64% reduction in risk, while those who could grind out 20 or more dropped their risk by another 20%. Doing so at least a few times per week increases the likelihood that the muscle quality will improve over time. Of course, incorporating some pulling, hinging, squatting, and carrying to ensure all fundamental movements stay strong is even better.

Reach out if you're ready for a routine that'll help you stand strong against the number 1 killer of Americans for the last 100 years by this Fall.

Have a great weekend,

Mike E.