Older adults and resistance training

As the number of individuals over 65 years old continues to grow, there are increasing opportunities for older adults to participate in strength training, cardiovascular exercise, and sports.

While some older athletes maintain high levels of fitness, there is a natural decline in performance after age 30, with more significant decreases occurring around age 70. These declines can lead to frailty, loss of mobility, and increased risk of injury if physical activity is not maintained. Power, in particular, declines more rapidly than strength with age. To address this, older adults should include dedicated power training using light to moderate loads that are moved quickly, once proper technique and a foundation of base strength are established.

Age-related changes in musculoskeletal health

Aging impacts muscle, bone, and overall physical function, often leading to:

• Loss of muscle mass and strength (sarcopenia)
• Decreased bone density (osteoporosis)
• Increased risk of fractures (particularly in the hip, spine, and wrist)

Osteoporosis:

• Defined as bone mineral density (BMD) more than 2.5 standard deviations below the young adult mean.
• Leads to weaker bones, making fractures more likely with falls.

Muscle mass and strength loss:

• Muscle atrophy is largely due to physical inactivity.
• Power declines faster than strength, affecting activities like stair climbing and walking.
• Denervation of muscle fibers and decreased nervous system efficiency contribute to age-related losses.

The image below illustrates differences between healthy bone and osteoporotic bone, showing the increased porosity that results from aging-related bone loss.

The table below summarizes the effects of aging on physical function and how resistance training can counteract these changes.

Physical variable	Effect of aging	Effect of resistance Training
Muscular strength	Decreases	Increases
Muscular power	Decreases	Increases
Muscular endurance	Decreases	Increases
Muscle mass	Decreases	Increases
Muscle fiber size	Decreases	Increases
Metabolic capacity	Decreases	Increases
Resting metabolic rate	Decreases	Increases
Body fat	Increases	Decreases
Bone mineral density	Decreases	Increases
Physical function	Decreases	Increases

Neuromotor function and fall prevention in older adults

A major concern for older adults is the increased risk of falls, which can result in:

• Pain syndromes
• Joint dislocations
• Fractures
• Reduced mobility and confidence
• Institutionalization and loss of independence

Factors contributing to falls:

• Muscle weakness
• Delayed reaction time
• Impaired balance and postural stability
• Decreased ability to absorb force during movement

Preventative strategies:

• Proprioception training: Improves joint awareness and movement control.
• Balance exercises: Enhances stability to reduce fall risk.
• Strength training: Builds lower-body strength to improve gait and mobility.

Research indicates that progressive resistance training can improve neuromotor function, reducing fall risk and increasing independence in older adults.

Responsiveness to resistance training in older adults

Studies show that even sedentary older adults can experience significant strength gains with resistance training. Research findings include:

• Doubled knee extensor strength and tripled knee flexor strength after 12 weeks of training.
• Gait speed, balance, and coordination improvements in senior populations.
• Greater improvements in power output with high-velocity training compared to slow movements.

Resistance training enhances muscle protein metabolism, nitrogen retention, and energy balance, helping prevent muscle atrophy and frailty in older adults.

Program design considerations for older adults

While aerobic exercise has traditionally been emphasized for older adults, resistance training is now recognized as a key component of healthy aging.

Key principles:

• Maintain or improve musculoskeletal health: Programs should target strength, power, and mobility.
• Address individual needs: Consider medical conditions, previous injuries, and training history.
• Safe progression: Gradually increase intensity to reduce the risk of injury.

Before beginning a resistance training program, older adults should undergo medical screening, particularly if they have:

• Heart disease, diabetes, arthritis, osteoporosis, or other chronic conditions.
• Previous injuries or mobility limitations.

A balanced training plan should include:

1. Strength training: Exercises focusing on major muscle groups (2–3 sessions per week).
2. Balance and proprioception training: Enhances coordination and stability.
3. Flexibility exercises: Maintains joint mobility and range of motion.

Safety considerations for older adults in resistance training

While resistance training is highly beneficial for older adults, strength and conditioning professionals must be aware of certain risk factors and precautions.

The Valsalva maneuver and blood pressure risks:

• The Valsalva maneuver helps stabilize the trunk during heavy lifting but can cause sudden increases in systolic and diastolic blood pressure.
• This technique is discouraged for older adults, particularly those with:
  • Heart conditions (e.g., arrhythmias, angina)
  • Cerebrovascular conditions (e.g., history of stroke, dizziness)

Guidelines for safe training progression:

• Older adults should gradually progress from:

  • Low-intensity training (40% to 50% 1RM) with higher repetitions (10–12 reps)
  • To moderate-intensity training (60% to 80% 1RM) based on individual needs and experience.

• Advanced exercises (e.g., high-velocity movements, balance drills) can be introduced once participants master basic resistance movements.

• Recovery considerations:

  • Training volume and intensity should vary throughout the year to reduce overtraining risk.
  • Rest between sessions: At least 48–72 hours of recovery between sessions for optimal adaptations.

Safety recommendations for resistance training in older adults

A summary of best practices for reducing injury risk and optimizing results:

• Medical screening: Older adults should be evaluated for age-related medical conditions before beginning resistance training.
• Appropriate warm-ups: 5 to 10 minutes of low-to-moderate activity before training.
• Static stretching: Can be performed before and/or after training to maintain flexibility.
• Exercise selection: Use resistance levels that do not overstrain the musculoskeletal system.
• Avoid the Valsalva maneuver: Prevents dangerous spikes in blood pressure.
• Rest and recovery: Older adults should have 48–72 hours of recovery between exercise sessions.
• Pain-free movements: All exercises should be performed within a comfortable range of motion.
• Qualified supervision: Training should be guided by experienced professionals.

Psychological and nutritional considerations for older adults

Older adults may hesitate to engage in resistance training due to:

• Fear of injury
• Lack of knowledge about its benefits
• Concerns about pre-existing conditions

Building confidence in resistance training:

• Social support: Encouragement from trainers, peers, and family improves adherence.
• Gradual progression: Starting with light loads and fundamental movements fosters confidence.
• Education on benefits: Understanding how strength training enhances mobility, independence, and quality of life increases motivation.

Nutritional needs for strength training in seniors:

• Protein intake is critical for preventing muscle loss (sarcopenia) in older adults.
• Adequate consumption of macronutrients (carbohydrates, fats, and protein) and micronutrients (vitamins and minerals) supports recovery.
• Hydration and electrolyte balance play a role in maintaining performance and reducing fatigue.