Should you strength train in older age?

The simple answer is YES. That said, it is more nuanced than a simple yes.

Now, let me explain a bit first.

With ageing comes a natural loss in muscle strength and power. This loss can lead to a decrease in function and increase in the risk of falling. Through research, it is estimated that after your 6th decade of life, there is a 3.6% loss in muscle strength each year. Realistically and functionally this does mean that older adults need to exert considerably more effort to perform daily tasks (Stairs, In & Out of Cars etc).

Examples of this would be; A young adult uses about 42% relative effort to rise from a chair, whereas an older adult uses about 80% relative effort. Thankfully with strength training, and other forms of training, we can increase that capacity helping the older adult maintain function longer – and ultimately living better, longer!!

graph showing older age muscle loss

Source: https://sci-fit.net/anabolic-resistance-sarcopenia/

The above image shows the difference between a trained 66 year old versus a non trained 66 year old & compared to a 24 year old.

As you may or may not be aware, the population of Ireland is ageing. We are seeing an extended life expectancy far greater than those our grandparents would have thought. So with an ageing population, we as physiotherapists, athletic therapists, and even GP’s are seeing more older adults come through our doors.

The increasing rise of the older population has led to a whirlwind of discussions and conferences on the right level of training for those considered “older” (Separate debates for what defines the term old). These discussions have led to a general consensus that in previous decades we have been generally under recommending strength exercises and loading for the ageing population.

Why did strength training used to be under recommended for the older adult?

  • Well honestly, on the whole we didn’t want to cause further injury or damage.
    • Not that we saw the older adult clients as weaker or soft or delicate. But they generally come with “Baggage” of other health issues, which can raise the risk of injury. Complex medical issues, musculoskeletal pathologies; Osteoporosis or arthritis, a decreased tissue elasticity and also slower recovery capacity. So there was a good intention in holding back….

But now, through research and studies it has been seen that the older adult can safely perform & benefit from strength training. One particular study, who’s average participants’ age was 90 reported that there was a 174% increase in baseline strength score. These participants were lifting 80% of what they could lift maximally.

  • We did not want to risk causing adverse Cardiac Events.
    • Any good therapist taking a client’s history will note that the older adult tends to have more complex medical issues than younger adults.

However, even in most medical issues, research shows exercise can be done at a relatively high intensity. This is why there are therapist run classes. Monitoring vital signs, symptoms and looking for a “Rate of Perceived Exertion” are VITAL.

  • We believed that the older adult didn’t need high intensity exercise.
    • Wrongly thinking that it’s a young person’s game, the elderly should be given handy comfy exercises. While yes, that old lady or gentleman may feel lovely doing their lighter work, it isn’t going to necessarily help them with their activities of daily living, or keeping up their hobbies (think of your mothers aunt who lives alone on her farm, or the grandads brother who just loves the golf)

As discussed before, the tasks like getting up & down of the chair do become more challenging as we age. So as an older adult, they do need sufficient loading in strength work, so that they stay less challenging longer. Thus leading to a better quality of life.

 So, now we are coming around to the idea that training the older adult is not only safe, but very beneficial. How do we go about it?

1. Set The Appropriate Intensity For Strength Training.

To gain & train actual strength generally we need to be training at above ~60% and below ~85% of what your 100% maximum lift once would be. So if you could lift a 40kg bag of coal just the once and you’re goosed – that is your 100% or 1 Rep Max (1RM). To develop strength you would need to be regularly lifting ~24-34kg. Between 70%-85% has been seen to be the optimal range though.

That said, are we going to make you lift the 40kg bag of coal to test out your 1RM? Nah, we use a scale called the Rate of Perceived Exertion (RPE). A rough guide for us to know where you are at.

scale of strength training levels

You may lift something heavier 4 times and still rate it the same as something lighter being lifted 7 or 8 times.

This is down to the weight being nearer or further from muscle failure. This is normal, so we need to make sure you’re not over doing it on the lighter weights as such.

Which is where this graph comes in handy!

Source: https://www.researchgate.net/figure/OMNI-Resistance-Exercise-Scale-OMNI-RES-of-perceived-exertion_fig1_10916385

2. We Need To Assess Your Strength Adaptions Over Time

There is no point in us giving you a strength programme and not monitoring it over time. Because while working on Strength over a few weeks, you will have gotten stronger. Example, lifting that 34kg bag of coal 6 times was a 7/10 on the effort scale – NOW, 6 weeks in it is a 6/10 to you. STRONGER!! Your maximum weight now becomes a moving target – to a point.

There are however cases where over the weeks, you may feel the exact same, or maybe even feeling it has become more of a challenge. This is when we may need to re-evaluate the programme to cater for your needs.

This does come down to judgement from the therapist point of view, but also from honesty of the client too. It needs to be a two way street.

In a Nutshell:

Strength Training is VITAL for the Older Adult!!

Strength Training is SAFE for the Older Adult!!

Ideal Intensity is ~70-85% of 1RM for ~6-15 Reps of the Exercise

 

 

 

References:

  1. Five Things Physical Therapists and Patients Should Question. (2018). Choosing Wisely. https://www.choosingwisely.org/societies/american-physical-therapy-association/
  2. Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of strength and conditioning research, 33(8), 2019–2052. https://doi.org/10.1519/JSC.0000000000003230
  3. Hortobágyi, T., Mizelle, C., Beam, S., & DeVita, P. (2003). Old adults perform activities of daily living near their maximal capabilities. The journals of gerontology. Series A, Biological sciences and medical sciences, 58(5), M453–M460. https://doi.org/10.1093/gerona/58.5.m453
  4. Fiatarone, M. A., Marks, E. C., Ryan, N. D., Meredith, C. N., Lipsitz, L. A., & Evans, W. J. (1990). High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA, 263(22), 3029–3034.
  5. Gearhart, R. F., Jr, Lagally, K. M., Riechman, S. E., Andrews, R. D., & Robertson, R. J. (2009). Strength tracking using the OMNI resistance exercise scale in older men and women. Journal of strength and conditioning research, 23(3), 1011–1015. https://doi.org/10.1519/JSC.0b013e3181a2ec41
  6. Naclerio, F., Rodríguez-Romo, G., Barriopedro-Moro, M. I., Jiménez, A., Alvar, B. A., & Triplett, N. T. (2011). Control of resistance training intensity by the OMNI perceived exertion scale. Journal of strength and conditioning research, 25(7), 1879–1888. https://doi.org/10.1519/JSC.0b013e3181e501e9