As we age, our bodies undergo changes that lead to a decrease in muscle size, strength and function. This may affect our ability move around safely or to participate in some of the activities we enjoy.1,2 As the number of Albertans over 65 increases, the question of how to prevent or minimize the effects of aging on our muscles becomes an important one to answer. Along with recommendations to live an active lifestyle, the addition of strength training is something that research has shown to help prevent or decrease muscle weakness in older adults and should be added to our weekly exercise routines. However, current statistics identify that only 8.7% of older adults (greater than 75 years of age) in the US participate in muscle strengthening activities1 (no Canadian equivalent statistics available) and that only 15% of Canadians aged 65+ meet recommended activity guidelines for older adults.2,3
Why is muscle strength important?
Muscle weakness has been linked to increased falls, decreased ability to perform daily tasks, and difficulty walking and safely moving around the community.1,4 The increased weakness is primarily caused by inactivity and disuse.1 Over time this can lead to a loss of independence and overall quality of life.1 Although it may be difficult to determine which happens first, a decrease in muscle strength is also associated with increased risks for developing chronic diseases such as diabetes, osteoporosis, cardiorespiratory conditions, and early death.1
Improved muscle strength helps prevent these problems by:1,2,3,4,5,
Building up muscle strength and endurance
Keeping bones strong and healthy
Improving balance, coordination, and ability to walk
Not only will improved muscle strength reduce the risk of falling, it may also reduce the severity of injuries or fractures suffered from a fall making recovery easier and faster.
Equally important, lower strength and physical activity levels appear to be associated with difficulties with cognitive function (ability to think) and may place individuals at greater risk for developing Alzheimer’s Disease and other cognitive impairments.1,6 Research indicates that high-intensity strength training not only improves muscle strength but also results in significant improvement in the physical and cognitive function of those diagnosed with mild cognitive impairment (MCI).1,6
Overall, being physically stronger is associated with improved quality of life and may extend the ability of older adults to live independently while enjoying the lifestyle they choose.1,2,6,7,8
What is strength training?
Strength training is any exercise program that increases muscle strength by adding some form of resistance to movement. Resistance can be provided in many ways including using a hand-held weight, an elastic exercise band, an exercise machine, or your own body weight.
The Canadian Physical Activity Guidelines recommend older adults (65+) participate in at least 150 minutes of moderate to vigorous activity per week, in bouts of 10 minutes or more.3 These guidelines also suggest including strengthening activities 2-3 times a week.3
Any exercise program must be developed to meet the needs of the individual at their current level of fitness, strength and general activity. A well-rounded strengthening program should include 2-3 sets of 6-12 repetitions per major muscle group. It is important to target all major muscle groups in the shoulders, back, core, hips and knees to ensure a complete program.1 Strengthening exercises that offer too little resistance or repetitions produce minimal changes in muscle strength or power, while using excessive weight may increase the risk of injury.1,4 Working at roughly 70 – 85% maximum resistance is recommmended.1 People who haven’t participated in strengthening exercises before, are unsure where to start or don’t know what 70% of maximum resistance should seek advice before they start.
Beginners and individuals who are frail need to start slowly and gradually progress as they are able. Using a seated machine-based program, resistance bands or isometric exercises may be better for frail older adults, beginners or those with functional limitations.1 A more fit and/or active older adult may be able to safely begin using free-weights, doing more repetitions, more times a week.1 Combining a strength program with some form of cardio activity such as going for a brisk walk, cycling or swimming on alternate days provides optimum benefits.1,3
Exercises that target a single muscle are a great place to start; however, gradually adding exercises that work more than one joint or muscle at a time, in a more functional way, is a vital part of a good program.1 An example would be to perform several sit to stands from progressively lower surfaces like a bar stool, chair or toilet. This exercise uses your body weight as the resistance and mimics tasks you need to do every day. Step ups, balancing or reaching and lifting exercises for the arms are also examples of functional exercises that will help you maintain your independence and prevent falls or injury.
I am over 60 and have never lifted weights – is it safe for me to start?
YES! Muscle disuse or weakness is preventable and reversible at any age.1,2,4
Evidence supports the recommendation that a properly designed, guided strength training program is safe for healthy older adults, frail seniors, and those living with health issues or chronic disease.1,2
Are there risks?
Studies have identified some risk of injury with strength training; however, it appears injuries often relate to inexperience, heavy and repetitive exercise, poor positioning or technique, or inappropriate exercise selection.1,2
Some health conditions or chronic diseases may present other risks to exercise that must be identified and managed to ensure you are safe performing more aggressive strength training. For example if you are an older adult living with uncontrolled high blood pressure or diabetes, your activity plan must take this into account and be modified appropriately.1 Unstable heart or serious lung disease may require that you avoid high-intensity exercises.1 Seniors with joint pain or instability will also need guidance on finding exercises to strengthen the muscles around the joint without causing further pain or injury.
A physiotherapist can complete an initial screening assessment and may use a questionnaire called a PAR-Q.9 This tool is appropriate for anyone aged 15-69 and can identify when you should check with your doctor before starting a new exercise program. If you are over 69 medical screening is recommended if you are not used to being active.1,9
Ask for help
Each individual is unique and has different health challenges and activity goals. Once you have decided to start an exercise routine, it is important that you seek professional advice to ensure your program is safe and designed specifically to meet your needs. Seeking help from a physiotherapist is a great place to start. Physiotherapists have the education to assess your current status, identify any risk factors that need to be managed and develop a program based on your activity and fitness levels, and lifestyle goals. Working with your physiotherapist will ensure you are taught appropriate exercises and correct techniques, your response to each type of exercise is observed, and changes are made to meet your needs as you progress. Your physiotherapist will also be able to monitor how you are doing and help you increase your exercise program as you get stronger and more active.
To find a physiotherapist who will help you safely start a strengthening program, click here.
Fragala, M, Cadore, E, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, Mark D, et al. Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association, Journal of Strength and Conditioning Research: August 2019 - Volume 33 - Issue 8 - p 2019-2052. doi: 10.1519/JSC.0000000000003230.
Mavros Y, Gates N, Wilson GC, Jain N, Meiklejohn J, Brodaty H, et al. Mediation of Cognitive Function Improvements by Strength Gains After Resistance Training in Older Adults with Mild Cognitive Impairment: Outcomes of the Study of Mental and Resistance Training. J Am Geriatr Soc 65: 550– 559, 2017. https://doi.org/10.1111/jgs.14542
El-Khoury F, Cassou B, Charles M, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials BMJ 2013; 347 :f6234 doi: https://doi.org/10.1136/bmj.f6234