Strength Training Recommendations for Older Individuals

 

Strength training has many benefits for older aged individuals and it is often recommended by experts in the field, including the American College of Sports Medicine.(1,2) Weight training can help the elderly to improve their health, delay the aging process, and increase their functional capacity. We will discuss in detail the benefits, the precautions that one should take, and make recommendations for designing such a workout program. We caution you to check with your doctor (or your client’s doctor) before engaging in any exercise program as injuries do occur from weight training, including the occasional death.

The most important reason for geriatrics to consider weight training is to reverse the age related loss of both muscle mass and strength that tends to occur, esp. after the age of 40.  The technical term for loss of muscle mass is sarcopenia.  Without regular exercise, you will lose 30-40% of your muscle
mass by age 70.(3,4,5)  Many wrongly think that this sarcopenia is an inevitable fact of aging, but research has shown that resistance training can halt and reverse this.  Older people can increase their strength two to three times in a relatively short period of time.(1,6,7)  Even 80 and 90 year olds have been shown to be able to gain strength and muscle mass on a high intensity resistance training program.(7)  Such strength gains can facilitate engaging in other forms of exercise, such as aerobic exercise and sporting activities (such as tennis and golf).

It was a common belief in the past that weight training was too dangerous for most older folks, as there would be too much risk of breaking one of their frail bones.  However, we have found out just the opposite.  Resistance training is one of the best ways to stimulate increased bone density throughout the body, thus helping to prevent a fracture.(8,9,10)  As long as the weights are gradually increased over a period of time and proper form is utilized, weight training should be safe for most geriatrics.

Walking is often recommended to help with bone density.  However, while walking can help stimulate the bone in the hips, it will not produce increased bone mineralization in the spine and the other regions of the body.  This effect is specific.  A certain amount of controlled stress must be placed on different body regions to cause the body to strengthen the bones in each of those areas.  For this, a full body weight training program is ideal since you can load each bone in the body with progressive resistance.

This full body weight lifting program should utilize some free weight exercises as these not only stimulate more bone mass, but help to improve neuromuscular coordination and balance.(5) Research has shown that balance, often referred to as “postural stability”, declines with age, along with strength.(1)  By improving such stability, this will decrease the likelihood of falling, often associated with hip fractures.

By strengthening the muscles that support the joints, such as the knees, weight training can help reduce the load on these joints.  Stronger muscles serve as shock absorbers.  This can be of great benefit for folks suffering with osteoarthritis.  Exercise won’t reverse the arthritis, but it makes it easier to deal with it.

While we are focusing on resistance training, we should mention that flexibility also tends to decrease with aging.  Flexibility decreases 20 to 30% between the ages of 20 and 70.(5,12)  Flexibility is an important component of fitness, esp. for those suffering with arthritis.  Both regular stretching(13) and strength training(5,12,14) have been shown to increase flexibility.  Such strength training must involve exercising the joints through a full range of motion.

 


Since a large number of geriatrics suffer with various medical conditions, we should briefly touch on some of the training program modifications that are recommended for some of these.  However, you should check with your doctor (or your client’s doctor) prior to starting such an exercise program, as this individual may have unique needs or concerns:

ARTHRITIS: The following recommendations are for the client who suffers with osteoarthritis, the most common form of arthritis. If rheumatoid or other forms of arthritis are present, you should speak to your (or your client’s) doctor for specific recommendations. There are certain forms of
arthritis where exercise is harmful.

Make sure to perform a thorough warm up for each area to be exercised.  Consider 5 minutes on the bike prior to doing any leg exercises.  Use lighter weights with higher reps.  Avoid pain in the joints. This is not good pain, unlike the good pain of working the muscles.  This may require performing some exercises with a limited range of motion.  Always stay within the pain free range.  This may differ from session to session.

Keep all joints within the neutral position, esp., the spine and the wrists.  Avoid over arching the neck or the back.  Keep the neck supported whenever possible.  This may mean avoiding abdominal crunches on the floor and substituting a crunch machine.  Avoid compressive loading of the back by avoiding exercises such as squats, standing calf raises, and military presses.

OSTEOPOROSIS: Avoid movements that compress the ribcage, such as incline leg presses where the legs are brought back too far.  Use a limited range of motion on such exercises.  The ribs are one of the most common sources of fracture, along with the hips and the spine. Exercises that involve twisting should be avoided or used with extreme caution, as these will also stress the rib cage.

Avoid loading the spine with heavy weights.  Avoid hip abduction and adduction exercises on machines as this may place too much torque on the hips, though performing them on the floor or standing with light ankle weights or cable is probably safer.

Make sure that you (or your client) is taking the proper nutritional supplements and following the proper nutritional program to optimize bone density. This should include adequate calcium intake, adequate (but not excessive) protein intake, and avoiding coffee, alcohol, salt, soft drinks, and smoking, as these could result in a loss of calcium.  Supplements of highly absorbed forms of calcium, magnesium, vitamin D, vitamin K, vitamin C and boron should be considered.

HIGH BLOOD PRESSURE: Avoid heavy weights. Use lighter weights with higher reps. Avoid holding the breath during exercises as this increases pressure. You need to breath normal while exercising. Make sure to check with your (or your client’s) doctor to find out if the blood pressure medication will affect their exercise tolerance.  Make sure to drink plenty of water before, during, and after exercise.

DIABETES: Avoid heavy weights. Especially avoid heavy leg presses and calf raises, as these place stress on the feet and diabetics often have foot problems due to circulation problems. Diabetics may have lost feeling in their feet and may not even be aware that they are damaging their feet until it is too late.

Find out where the diabetic has injected his insulin and avoid exercising this area too strenuously as this will disturb the gradual release of the insulin.

Be aware of the symptoms of hypoglycemia and carry some simple carbohydrate/sugar foods that can be used in an emergency, such as juice, soda, or raisins.

 

REFERENCES:

1. Mazzeo RS, Cavanagh P, Evans WJ, et al. Exercise and physical activity for older adults. Position stand for the American College of Sports Medicine. Medicine and Exercise in Sports and Exercise. 30(6):992-1008.
2. Pollock ML, Gaesser GA, Butcher JD, et al. The recommended quantity and quality of exercise for developing and maintaining
cardiorespiratory and muscular fitness and flexibility in healthy adults. Medicine and Exercise in Sports and Exercise. 30(6):975-991.

3. Grimby G, Saltin B. The aging muscle. Clin Physiol. 1983; 3:209-218.
4. Israel S. Age-related changes in strength and special groups. In: Strength and Power in Sport. PV Komi, ed. (Boston, MA: Blackwell Scientific, 1991).
5. Adams K, O’Shea P, O’Shea KL. Aging: Its effects on strength, power, flexibility, and bone density. Nat Strength and Cond Assoc. 1999; 21(2): 65-77.
6. Frontera WR, Meredith CN, O’Reilly KP, Evans WJ. Strength  training and determinants of VO2 max in older men. J Appl. Physiol. 1992; 64:329-333.
7. Frontera WR, Meredith CN, O’Reilly KP, Knutgen HG, Evans WJ.  Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J. Appl. Physiol. 1988; 64: 1038-1044.
8. Fiatarone MA, Marks CE, Ryan ND, et al. High intensity strength training in nonagenarians:  Effects on skeletal muscle. JAMA. 1990; 263(22): 3029-3034.
9. Nelson ME, et al. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. JAMA. 1994; 272: 1909-14.
10. Rizzo TH, Knopf K. Resistance training for older adults. Idea Source. 1999; 17(6): 32-43.
11. Snow-Harter C, Bouxsein M, Lewis BT, et al. Effects of resistance training and endurance exercise on bone mineral status of young women: A randomized exercise intervention trial. J Bone Mineral Res. 1992; 7: 761-769.
12. Chapman EA, deVries HA, Swezey R. Joint stiffness: Effects of exercise on young and old men. J Gerontol. 1972; 27(2): 218-221.
13. Bell RD, Hoshizaki TB. Relationship of age and sex with range of motion of seventeen joint actions in humans. Canadien J of Applied Sports Science. 1981; 6(4):202-206.
14. Leighton JR. A study of progressive weight training on flexibility. J Assoc Phys Ment Rehabil. 1964; 18:101.