On 28th September 2017, a mini review into resistance training for older adults was published in Experimental Gerontology titled “A minimal dose approach to resistance training for the older adult; the prophylactic for aging”.
This is a very exciting piece of research, thrilling for the simplicity and practicality of its conclusions and recommendations. It is the kind of paper that I want to beam into the hands of every individual over the age of 60 and every health influencer of that age group too. Scratch that, if all other resistance training research on earth was somehow decimated and just this document was left to become the blueprint from which all adults of any age begin their resistance training journey, the world of exercise would be a better place. No hype, no marketing b.s., no unnecessary complexity- just simple, safe and beneficial greatness.
There are some familiar names behind the research; James Fisher, James Steele, Paulo Gentil, Jürgen Giessing and Wayne Westcott: may as well call them the A-team for consistently publishing fascinating and most of all practical research.
Cheerleading done let’s look at why I am so excited about this research and why I think you should be too. This is mandatory reading for HITuni trainers, students, those over the age of 60 and anyone with an interest in getting the most out of resistance training.
Benefits of resistance training for older adults
The authors present a useful collection of both the physiological and psychological benefits of resistance training (RT). For individuals looking for motivation to resistance train, especially those who are older adults, or moving in that direction here are the reasons you want to (these are great lists for personal trainers and fitness professionals too):
Physiological benefits of resistance training
Wow, hold on there if I held the patent to a drug that could offer the benefits of the lists above, my hand, heck entire arm would be bitten off. And you would be queuing up at your health care provider to get your prescription. Well I can’t offer you that drug, but I can present the findings of this research paper which will require just 20 minutes of your mental and physical focus per week to get those same benefits. That is a fantastic deal, and the cumulative upshot of all those benefits is you will feel better both mentally and physically, and have a better quality of life. If you are 70 and begin doing this you may well feel the best you have since your mid- twenties, genetically you may start performing like a twenty-something again!
Not enough older people are exercising
Despite all the benefits of performing regular resistance training, incl. impact on senescence and reversing aging that I wrote about previously, not enough older people are engaging in the process, the authors state that “participation and adherence remains low.”
What is it that is holding the aging population back from reaping these benefits? The two most commonly cited barriers are “time constraints and perceived difficulty.” It is these barriers that the authors specifically set out to minimize, in this paper. Workout doses (or routines) presented here last minimally 7 minutes and maximally 30 minutes, much shorter than most people think they “should” be in the gym.
Perceived difficulty is addressed by utilising “uncomplicated equipment/methods” such as weight-stack machines which dramatically reduce the learning curve required to exercise well, increase safety, and are less intimidating/perceived as less difficult in comparison with for example, free weights.
Seeking out the minimal dose
Whilst scanning the previously published research for clues as to the minimally required dose of exercise to provide the benefits listed at the start of this article, the authors looked at variables such as load used, volume of sets per exercise and frequency of training per week. Results suggest that any load that can be used to achieve momentary muscular failure (MMF) in 60-90 seconds is appropriate and any number of sets per exercise can be appropriate. When it came to frequency of resistance training, it appeared that some benefits were attained by once a week training, but not all the benefits in some cases. Specifically, the authors refer to one piece of research that suggests despite strength and muscle activation continuing to increase after dropping from a 2x per week to a 1x per week frequency, muscle mass cross sectional area did not. This study showed that a reduction in cross sectional area may occur at a lower frequency, leading Fisher et al. to surmise that “It might be that muscle function can be sustained with low frequency training whereas muscle mass requires RT of 2 days/week to be maintained.”
Intensity of effort is important
If an individual is going to get benefits from a relatively low frequency approach to resistance training, then the research suggests that it is important to exercise to a high intensity of effort. Fisher et al. suggest two viable routes to this end, the first is simply exercising to momentary muscular failure (the point at which concentric movement is no longer possible), and the second is to perform multiple sets of an exercise to build a cumulative fatigue that results in a high degree of intensity of effort.
My preference is to go the MMF route and get the job done efficiently and effectively in a single set. However, if your preference is to accumulate fatigue over multiple sets and you have the time to do so, this may work just as well for you. HITuni personal trainers do need to aim to get their clients to MMF in a single set, however at the very outset of training and for coaching purposes you may want to have a client re-set and perform multiple sets initially as the client learns the exercises and masters to-failure training.
Supervision is very important, perhaps essential
This paper highlights two main reasons why supervision is important for older adults during exercise, firstly it appears to improve adherence to a resistance training regime. Secondly and perhaps shockingly, as revealed in research from Steele et al. (2017), is that older adults who had performed supervised RT for 6 months, were not able to continue to gain or even maintain strength during a follow-on 6 months of unsupervised RT. Their strength levels and functional task ability reduced to the same degree as adults who had simply ceased RT after the initial 6 months of the study. This suggests that in general older adults who are motivated enough to continue RT by themselves after being well-supervised and presumably well taught/instructed in how to produce sufficient intensity are still not capable of producing appropriate levels of intensity when training alone.
This hammers home the importance of the role of the personal trainer who is well versed in High Intensity Resistance Training and the impact you can have on the results of exercise for older adults. All but the most motivated, dedicated and experienced exercisers of any age will likely get much better results training with a personal trainer as often as possible and even the most motivated and capable exercisers will probably get more out of exercise from at least the occasional professionally supervised session.
There is a need for a greater number of fitness professionals and personal trainers globally who fully understand the value of resistance training, especially for older adults. These will be individuals who can, not only instruct proper exercise technique and biomechanics, but also understand the value of intensity of effort and its safe application. These, the best in their field will also be adept in the skills of communication and motivation.
The ideal modality of exercise
Resistance training exercise can be performed on machines, with free weights and even with no external load at all in the case of bodyweight training. What do the researchers suggest as the optimal tool for older adults?
They suggest older adults use weight-stack resistance machines when possible, for several reasons:
- Load adjustment is quick and convenient
- Simplicity of setting exercises up and performance
- Increases appeal of gym exercise to those less confident or inexperienced in that environment
- Machines are likely safer than free-weight exercises
As an alternative option for those without access to weight-stack machines the authors suggest bodyweight exercise may also be suitable. They do point out that bodyweight exercise requires greater technique acquisition and recommend that older adults who go down the route of bodyweight exercise do so with professional supervision.
The dangers of overreaching
Fisher et al. point out that there is such a thing as excessive resistance training, although it can be hard to define specifically the point at which negative effects begin from training too often. Overreaching is the first dysfunctional state that may occur from too much resistance training.
Symptoms and signs of overreaching
- Decreased immune system function
- Increased susceptibility to upper respiratory tract infections
- Decrease in testosterone : cortisol ratio
- Possible imbalance between anabolic and catabolic states
- Psychological disturbances
- Negative affective states
- Reduction in strength
Overreaching is a state that professional athletes are often very familiar with, as throughout the training year it is likely that they will tread the boundary between normal functioning and overtraining at least several times. If the athlete backs off appropriately during the overreaching phase recovery to normal can happen quickly (within about two weeks). If the initial signs and symptoms of overreaching are missed and the athlete continues to forge ahead with normal training, then they may well enter the overtrained state which can take much longer to recover fully from.
Despite what professional and serious amateur athletes put themselves through in the name of attempting to perform the very best they possibly can in their sport, the authors point out that this is not beneficial for “the lay population or older adults.” Indeed, exercise with the primary purpose of supporting health and increasing general fitness for living needs to be about improving function, not reducing it.
The routine templates
Fisher et al. present two exercise routine templates (and supporting evidence for the exercises chosen) for older adults. The first is a minimal dose routine, this is the bare bones approach, consisting of the least possible amount of exercise for the greatest return on time and effort invested. It is also a routine that can be used as an introduction to RT, one that can be expanded upon with additional exercises as appropriate over time.
The Minimal Dose routine
The routine below will take less than 10 minutes to perform if rest periods between exercises are kept relatively short (<60 seconds)!
- Chest Press
- Leg Press
- Seated Row
Expanding the routine
As mentioned above, in time the individual may need or want to expand on the minimal dose routine. The authors suggest considering adding the seven exercises below to the minimal dose routine, if appropriate for the individual:
- Overhead press (ensure there are no contraindications for the individual e.g. high blood pressure, shoulder mobility/ impingement issues)
- Pull-down (ensure there are no contraindications for the individual e.g. high blood pressure, shoulder mobility/ impingement issues)
- Leg extension (use leg extension/ leg curl instead of Leg press if that exercise is contraindicated, or in addition to the leg press if specific targeting of knee extensors/flexors is desired)
- Leg curl (use leg extension/ leg curl instead of Leg press if that exercise is contraindicated, or in addition to the leg press if specific targeting of knee extensors/flexors is desired)
- Low back extension (include intermittently to reduce risk or severity of back pain, improve posture and to protect the spine and vital organs)
- Abdominal Flexion (include occasionally to reduce risk or severity of back pain, to improve posture and to protect the spine/ vital organs)
- Neck extension (to enhance the strength of cervical extensors, which can be particularly weak, and to reduce injury risk)
Even if all seven exercises above are added to a single routine the workout will still come in at less than 30 minutes in total!
Resistance training can stimulate many desirable outcomes for older adults, Fisher et al. state the aim of their paper is to use pre-existing research in the field to establish the “minimal dose” (volume and frequency) of RT required to attain these benefits.
Their research suggests the minimal dose can consist of 3-10 carefully selected weight-stack machine exercises (or bodyweight alternatives if appropriate for the individual). A single set of each exercise can be performed lasting 60-90 seconds and culminating in momentary muscular failure. Depending on the number of exercises used a single workout will last anywhere from just under 10 minutes to a maximum of 30 minutes. Resistance training workouts can be performed twice a week, which means total weekly time invested in RT dose is going to be somewhere between 20 and 60 minutes.
This minimal dose and simple approach does much to address the two main barriers to resistance training engagement and adherence namely, time commitment and perceived complexity. There is no need to make resistance training any more complicated. This is an amount and frequency of exercise, that most older adults (and adults in general) will be capable of and able to fit in to their life.
I wholeheartedly endorse the information presented in this research and join the authors in calling for medical professionals to use the information contained within this research paper to prescribe resistance training exercise to their patients. In addition, I highly recommend that HITuni personal trainers, those currently studying or planning to be a HITuni personal trainer and fitness professionals in general read, familiarise themselves with and prescribe, teach and communicate the information contained within Fisher et al.s article.