Strength Training Benefits Older Participants
Wayne Westcott and Bob Simons
While strength training is advantageous for people of all ages, it can be especially beneficial for older individuals. Consider that regular resistance exercise has been shown to reduce resting blood pressure,4 improve blood lipid profiles,1 enhance blood glucose usage,8 speed-up gastrointestinal transit,5 increase bone mineral density,9 alleviate low-back pain,11 ease arthritic discomfort,7 improve post-coronary performance,3 relieve depression12 and reduce body fat.2 Perhaps more important, strength training is the most effective means for building larger and stronger muscles that can significantly improve functional abilities in older adults.10
In sedentary societies, the aging process takes a serious toll on the musculoskeletal system. On average, adults lose about 6 pounds of muscle mass and up to 3 percent of their bone mineral density on a decadeby- decade basis unless they perform some type of strength exercise. This results in a metabolic slow-down exceeding 3 percent per decade, and is analogous to going from an eight-cylinder engine to a six-cylinder engine to a four-cylinder engine.
Although building bone is a relatively slow process,6 the rate at which older individuals can add muscle, increase strength and recharge their metabolism is quite amazing.2,10 Consider the results of a strength-training study with older adults (ages 56 to 81) conducted at Tufts University in Boston, Mass.2 After 12 weeks of basic strength exercise, the research subjects added 3 pounds of lean (muscle) weight, lost 4 pounds of fat weight, increased their resting metabolism by 7 percent and increased their daily energy utilization by 15 percent. These are impressive improvements that essentially reverse many degenerative effects associated with the aging process.
With people living longer than previous generations, we wanted to examine the effects of simple strength-training programs on individuals in their ninth and 10th decades of life. The first study was conducted at John Knox Village Campus in Orange City, Fla., and the second study was conducted at The Fountains at Boca Ciega Bay in St Petersburg, Fla.
John Knox studyAt John Knox Village,we conducted a basic strength-training program for 19 older adults (14 women, five men) with an average age of 88.5 years.13 Before and after the 14-week training period,we assessed all of the subjects for body composition, leg strength, upper-body strength, hip flexibility, shoulder flexibility and functional ability. The subjects trained twice a week over 14 weeks for a total of 28 exercise sessions. Each workout consisted of six exercises performed on five Nautilus weightstack machines.
Because many of the program participants were wheelchair users and required assistance transferring on and off the machines, the training sessions averaged about 20 minutes in duration. However, the actual time spent performing resistance exercise was approximately six minutes per session. The subjects trained at a relatively slow movement speed (six seconds per rep, with two seconds for lifting actions and four seconds for lowering actions). All exercise repetitions were executed through the full range of joint movement in accordance with the subject’s functional ability and freedom from discomfort. Each exercise session was individually supervised by a trained instructor from the John Knox Village physical therapy staff.
The results of this basic strength-training program were highly reinforcing. The nearly 90-year-old participants added about 4 pounds of lean (muscle) weight, lost about 3 pounds of fat weight, increased leg strength by more than 80 percent, increased upper-body strength by almost 40 percent, enhanced shoulder flexibility by about 10 percent, enhanced hip flexibility by more than 50 percent, improved functional abilities (FIM Score) by 14 percent, increased mobility distance by more than 70 percent and reduced fall rate by almost 40 percent. All but one of the wheelchair users (a double amputee) reduced their wheelchair dependence, and one assisted living patient improved so much that she left the nursing facility and returned home.
The Boca Ciega Bay studyA second study was conducted at the Fountains of Boca Ciega Bay, St Petersburg, Fla., in 2002. This study included 64 residents (45 women, 19 men) from the independent living portion of the retirement facility (where assistance with the performance of activities of daily living is not required). The study sought to determine changes in functional ability, muscle strength, joint flexibility and health knowledge after 16 weeks of exercise interventions. The 64 physician-cleared, sedentary, older adult volunteers (average age 84.5) were randomly assigned to either a non-exercising control group or one of two exercise groups, strength training (ST) or cardiovascular training (CT), for a total of 32 exercise sessions. The ST group trained two times a week at 75 percent of their one-repetition maximum (1RM), performing one set of eight to 12 repetitions on six different Keiser strength-training machines. When 12 repetitions were completed with proper form for three to five consecutive sessions, the weight load was increased by 5 percent. The CT group walked an average of two exercise sessions per week at an intensity set by each individual’s 880 yard walk “pre-test” score. All participants were strongly encouraged to attend health lectures, given approximately every three weeks. Subjects in all three groups were assessed for functional ability before and after a 16-week intervention, using the American Alliance for Health, Physical Education, Recreation and Dance Functional Fitness Assessment for Adults Over the Age of 60 Years.Additional assessments included 1RM strength using Keiser equipment, joint flexibility using a mechanical goniometer, and health knowledge using the Fast- Simons Senior Adult Health Knowledge Test.
The results of this 16-week study were also highly reinforcing. The ST group improved the most, with an average of 33 percent in strength, 18 percent in coordination, 14 percent in agility, 7 percent in endurance, 10 percent in flexibility and 13 percent in health knowledge. The CT group also improved an average of 12 percent in strength, 13 percent in coordination, 9 percent in agility, 6 percent in endurance, 11 percent in flexibility and 15 percent in health knowledge. The control group surprisingly improved an average of 12 percent in strength, 13 percent in coordination, 2 percent in flexibility and 16 percent in health knowledge, but, most notably, exhibited a 21-percent decline in agility and a 6 percent decline in endurance. The exercise group subjects also reported improvements in quality of life indicators (social interactiveness, energy levels and mood).
This study shows that a 16-week exercise intervention of strength training or walking results in significant improvement in physical function in older men and women (ages 66 to 96 years) when compared with a non-exercising control group. The findings indicate that strength training is more effective at improving strength, coordination and agility than walking. Strength training increased lowerbody strength by 38 percent overall, and upper-body strength by 21.3 percent overall. Improvements in strength, endurance, coordination, agility and flexibility translated into functional independence improvements of 14 percent for the strength-training group, and 9 percent for the walking group. Notably, the participants had a 61- percent decrease in the incidence of falls. Other significant quality-of-life benefits appear to result from older residents engaging in a regular exercise program. This study population differed from the John Knox study population in that, although sedentary, participants were still considered to be living in an independent status. This study has important implications for understanding the cost/benefits of strength-training programs in senior housing. It is estimated that every point increase in a resident’s functional independence score (FIM) reduces cost of care by 50 cents a day.13 A 14-percent gain in functional ability, therefore, could represent a cost of care reduction of $7 per day. Multiplying this by the 21 subjects in the strength-training group equals a daily cost-of-care reduction of $147. On a yearly basis this equals $53,655 — far more than the cost of strength-training programs. Cost savings associated with reduced falls can also be significant. Exercise programs geared toward improving the physical function of older adults should include strength training, and further studies need to be performed to solidify the link between changes in functional independence scores and cost savings.
Somewhat unique to this study was exercise and study constraint adherence. Although not showcased in this study protocol, the professional integration of motivation, team building, informed knowledge acquisition, social interaction and competition — tempered and molded by the six dimensions of wellness — were believed to be significant. Team building and social interaction complemented exercise adherence and made exercising fun for these older participants.
In conclusion, the findings of this study indicate that previously sedentary adults in advanced old age can improve their functional fitness by engaging in a supervised exercise program. Both resistance- training and walking programs yielded improvements on multiple measures of functional fitness, suggesting that the benefits of exercise in advanced old age may be universal rather than specific to the type of exercise. However, if the Boca Ciega study had, as in the John Knox study, measured body composition, it is postulated that the strength training group would have significantly exceeded the lean muscle and metabolic gains of both the control and walking groups. Based on this observation, strength training for seniors should be strongly encouraged. Eliminating the inhibitions and fear of injury of previously sedentary older adults with a fun program involving group participation in strength development is the key to success and to functional and quality-of-life gains.
DiscussionThe findings from both of these studies demonstrate that frail older adults can successfully perform basic strength exercises at the same relative training intensity as younger adults, and can experience the same training benefits with respect to adding muscle, losing fat, gaining strength, enhancing flexibility and increasing functional abilities. Although our studies were conducted in senior living facilities, there are large numbers of older adults in every community who could, should and probably would enroll in fitness center exercise programs if such opportunities were available. It is time for us to provide carefully supervised classes of basic and brief strength exercise for the rapidly growing population of mature men and women. Based on our experiences, they will be some of your most committed, cooperative and appreciative members. If your staff does not currently feel competent and confident working with older individuals, there are organizations, such as the American Academy of Health and Fitness, that teach fitness professionals how to effectively instruct older adults and how to interest them in fitness program participation.
1. Boyden, T.W., R.W. Pamenter, S.B. Going, T.G. Lohman, M.C. Hall, L.B. Houtkooper, J.C. Bunt, C. Ritenbaugh and M. Aickin. Resistance exercise training is associated with decreases in serum low-density lipoprotein cholesterol levels in premenopausal women. Archives of Internal Medicine 153(1):97-100, January 1993.
2. Campbell, W.W., M.C. Crim, V.R. Young and W.J. Evans. Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition 60(2): 167-175, August 1994.
3. Ghiladucci, L.E., R.G. Holly, E.A. Amsterdam. Effects of high resistance training in coronary artery disease. American Journal of Cardiology 64(14):866- 870, October 1989.
4. Harris, K.A., and R.G. Holly. Physiological response to circuit weight training in borderline hypertensive subjects. Medicine and Science in Sports and Exercise 19(3): 246-252, June 1987.
5. Koffler, K.H., A. Menkes, R.A. Redmond, W.E.Whitehead, R.E. Pratley and B.F. Hurley. Strength training accelerates gastrointestinal transit in middle-aged and older men.Medicine and Science in Sports and Exercise 24(4): 415-419, April 1992.
6. Layne, J.E., and M.E. Nelson. The effects of progressive resistance training on bone density: A review. Medicine and Science in Sports and Exercise 31(1): 25- 30, January 1999.
7.Marks, R. The effect of isometric quadriceps strength training in mid-range for osteoarthritis of the knee. Arthritis Care and Research 6(1):52-56,March 1993. 8.Miller, J.P., R.E. Pratley, A.P. Goldberg, P. Gordon, M. Rubin, M.S. Treuth, A.S.
Ryan and B.F.Hurley. Strength training increases insulin action in healthy 50- to 65-year-old men. Journal of Applied Physiology 77(3): 1,122-1,127, September 1994.
9. Nelson, M.E., M.A. Fiatarone, C.M. Morganti, I. Trice, R.A. Greenberg and W.J. Evans. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. Journal of the American Medical Association 272(24): 1,909-1,914, December 1994.
10. Pratley, R., B. Nicklas, M. Rubin, J.Miller, A. Smith, M. Smith, B. Hurley and A. Goldberg. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-year-old men. Journal of Applied Physiology 76(1): 133-137, January 1994.
11. Risch, S.V., N.K. Nowell, M.L. Pollock, E.D. Risch, H. Langer, M. Fulton, J.E. Graves, S.H. Leggett. Lumbar strengthening in chronic low-back pain patients. Spine 18(2): 232-238, February 1993.
12. Singh, N.A., K.M. Clements and M.A. Fiatarone. A randomized controlled trial of progressive resistance training in depressed elders. Journals of Gerontology: Series A 52(1): M27-M35, January 1997.
13.Westcott, W.,M. Richards, G. Reinl and D. Califana. Strength training elderly nursing home patients. Journal of the American Senior Fitness Association 1-8, www.seniorfitness.net, 2000.
Facility of the Week
Ithaca College Athletics and Events Center