Resistance Training for Older Adults

Resistance training is arguably the most important component of exercise programming for older adults. It directly addresses sarcopenia, improves functional capacity, enhances bone health, and supports metabolic function. This lesson provides evidence-based guidelines for designing safe and effective resistance training programs for the senior population.

The Case for Resistance Training

Why Resistance Training is Essential

Research consistently demonstrates that resistance training for older adults:

• Increases muscle mass and strength even in the oldest old (90+)
• Improves bone mineral density at loaded sites
• Enhances functional performance (walking speed, stair climbing, chair rises)
• Reduces fall risk through improved strength and power
• Improves metabolic health (insulin sensitivity, glucose control)
• Supports weight management by maintaining metabolic rate
• Reduces symptoms of chronic conditions (arthritis, diabetes, depression)
• Enhances quality of life and independence

Overcoming Resistance to Resistance Training

Many older adults are hesitant to begin resistance training. Common concerns include:

"I'm too old to lift weights." Response: Research shows benefits at any age. People in their 90s have doubled strength with training.

"I'll hurt myself." Response: Properly supervised resistance training is very safe. It actually reduces injury risk by building strength.

"It's not for women." Response: Women benefit greatly and won't "bulk up" due to hormonal differences.

"I have arthritis/bad knees/back problems." Response: Resistance training often helps these conditions. We'll modify exercises appropriately.

Training Principles for Older Adults

Progressive Overload

The principle of progressive overload applies to older adults just as it does to younger populations:

• The body adapts to training stress
• To continue improving, demands must gradually increase
• Progression may be slower than in younger adults
• Various methods of progression can be used

Specificity

Training adaptations are specific to:

• Muscle groups trained
• Movement patterns practiced
• Velocities of movement
• Energy systems utilized

Design programs that train movements relevant to daily activities.

Individualization

Each older adult is unique in their:

• Baseline fitness level
• Health conditions and limitations
• Goals and preferences
• Response to training
• Recovery capacity

Programs must be tailored accordingly.

Reversibility

Training benefits are lost when training stops:

• Strength declines faster in older adults during detraining
• Some benefits maintained longer than others
• Emphasizes importance of consistent, long-term training
• "Use it or lose it" is particularly relevant for seniors

ACSM Guidelines for Older Adult Resistance Training

Frequency

• 2-3 days per week
• At least 48 hours between sessions for same muscle groups
• Can use full-body sessions or split routines

Intensity

For healthy older adults:

• 60-80% of 1-repetition maximum (1RM)
• Or approximately 8-12 repetitions to moderate fatigue

For frail or very deconditioned:

• 40-50% of 1RM initially
• Progress gradually toward higher intensities

Intensity monitoring:

• Use RPE (Rate of Perceived Exertion) scale
• Target RPE 5-7 out of 10 for most sets
• Avoid training to failure initially

Volume

Novice:

• 1-2 sets per exercise
• 8-10 exercises targeting major muscle groups
• 10-15 repetitions per set

Intermediate/Advanced:

• 2-3 sets per exercise
• 8-12 repetitions per set
• Increased exercise variety

Exercise Selection

Priority muscle groups:

1. Lower body (quadriceps, hamstrings, glutes, calves)
2. Core (deep abdominals, back extensors)
3. Upper body (chest, back, shoulders, arms)

Movement patterns to include:

• Squat/sit-to-stand variations
• Hip hinge movements
• Pushing (horizontal and vertical)
• Pulling (horizontal and vertical)
• Carrying/loaded walking
• Core stability

Exercise Progressions

Lower Body Progressions

Sit-to-Stand (Squat) Progression:

1. High seat height, using armrests
2. Standard chair height, using armrests
3. Standard chair height, no armrests
4. Slow eccentric with controlled descent
5. Goblet squat (holding weight)
6. Split squat
7. Step-ups

Hip Hinge Progression:

1. Wall hip hinge
2. Hip hinge with dowel on spine
3. Romanian deadlift with light weight
4. Deadlift from elevated position
5. Conventional deadlift

Calf Progression:

1. Seated calf raises
2. Standing calf raises with support
3. Standing calf raises without support
4. Single-leg calf raises (with support)

Upper Body Progressions

Horizontal Push (Chest) Progression:

1. Wall push-ups
2. Incline push-ups (hands elevated)
3. Knee push-ups
4. Full push-ups
5. Chest press variations with weights

Horizontal Pull (Back) Progression:

1. Seated row with band
2. Standing row with band
3. Bent-over row with light weight
4. One-arm dumbbell row

Vertical Push (Shoulder) Progression:

1. Seated shoulder press with band
2. Standing shoulder press with dumbbells
3. Landmine press
4. Overhead press

Vertical Pull Progression:

1. Lat pulldown (machine or band)
2. Assisted pull-ups
3. Negative pull-ups

Core Progressions

Anti-Extension Progression:

1. Dead bug (basic)
2. Dead bug with arm/leg movement
3. Plank (knees)
4. Plank (full)
5. Plank with limb movements

Anti-Rotation Progression:

1. Pallof press (isometric)
2. Pallof press with movement
3. Single-arm exercises (demand core stability)

Anti-Flexion Progression:

1. Bird dog
2. Loaded carries (farmer's walks)
3. Hip hinge patterns with load

Sample Programs

Beginner Full-Body Program (2x/week)

Warm-up (5-10 minutes):

• Light walking or cycling
• Joint mobility exercises
• Movement rehearsal

Main workout:

Cool-down (5-10 minutes):

• Light stretching
• Breathing exercises

Intermediate Program (3x/week, A/B split)

Day A - Lower Body Emphasis:

Day B - Upper Body Emphasis:

Day C - Full Body:

Special Considerations

For Osteoporosis

• Include weight-bearing exercises
• Avoid loaded spinal flexion
• Focus on hip and spine loading (squat, hinge patterns)
• Use appropriate intensity to stimulate bone
• Emphasize balance to prevent falls

For Arthritis

• Exercise during times of lowest joint stiffness
• Extended warm-up period
• Modify range of motion as needed
• Avoid positions that cause pain
• Strengthen muscles around affected joints

For Frailty

• Start with very low intensity
• Emphasize movement quality over load
• Shorter sessions initially
• Close supervision
• Chair-based exercises may be appropriate
• Gradual progression is key

For Diabetes

• Time exercise to optimize blood glucose management
• Monitor for hypoglycemia signs
• Have fast-acting carbohydrate available
• Resistance training improves insulin sensitivity

Recovery Considerations

Rest Between Sets

• 60-90 seconds for general fitness
• 2-3 minutes for heavier strength work
• Longer rest may be needed for deconditioned individuals

Rest Between Sessions

• Minimum 48 hours for same muscle groups
• May need longer recovery than younger adults
• Watch for signs of overtraining (excessive fatigue, declining performance)

Sleep and Recovery

• Adequate sleep is essential for adaptation
• 7-8 hours recommended
• Discuss sleep hygiene if sleep is an issue

Nutrition

• Adequate protein supports muscle adaptation
• Time protein around exercise when possible
• Ensure adequate hydration

Monitoring Progress

Strength Measures

• Track weights used for exercises
• Monitor rep improvements
• Periodic reassessment with standardized tests

Functional Measures

• Chair stand test
• Grip strength
• Walking speed
• Balance tests

Subjective Measures

• Perceived exertion during activities
• Daily function questionnaires
• Quality of life indicators

Key Takeaways

1. Resistance training is essential for older adults to combat sarcopenia and maintain function
2. Progressive overload applies but progression may be slower
3. Prioritize functional movements that translate to daily activities
4. Individualize programs based on health status, goals, and preferences
5. Start conservatively and progress gradually for deconditioned individuals
6. Include all major muscle groups with emphasis on lower body and core
7. Monitor recovery and adjust volume/intensity as needed
8. Combine with adequate protein intake for optimal results