In this blog, we are going back to the basics and looking at how to programme strength training sessions and classes for older adults and what adaptations may be needed.

Why all older adults should do strength training

When the updated Chief Medical Officer (CMO) guidelines came out in 2019, the importance of strength training for adults was recognised and given prominence in the infographic, although the guidelines were the same as previous versions. The guidelines also gave people ideas of activities they could use to build strength, as well as traditional weight training.
The guidelines state:
‘Adults are advised to undertake strength-based exercise at least 2 days a week. This can help delay the natural decline in muscle mass and bone density that starts from around age 50. It is believed that this is a major reason why older people lose their ability to carry out daily tasks.
Evidence suggests strength training has many benefits including the obvious improvements in muscle strength, bone density and joint mobility, offering protective benefits against musculoskeletal conditions such as arthritis and osteoporosis. Additionally, strength training can improve metabolism and sleep, both of which can help maintain a healthy weight and reduce the risk of type 2 diabetes and cardiovascular disease.

What type of activities and exercises can be included to strengthen muscles?

It is important to encourage older adults to improve their strength in different ways and include activities that appeal to them. Not all older adults will enjoy using the gym or attending a circuit class, but they may enjoy gardening, Yoga, or Pilates for example.

  • The NHS gives these examples of muscle strengthening activities:
  • carrying heavy shopping bags.
  • yoga.
  • Pilates.
  • tai chi.
  • lifting weights.
  • working with resistance bands.
  • doing exercises that use your own body weight, such as push-ups and sit-ups.
  • heavy gardening, such as digging and shovelling.

Sourced from: https://www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-older-adults/

What is the recommended amount of resistance training for older adults?

The current fitness industry guidelines for resistance training in older adults state that this should be done twice a week at a light intensity (40 – 50% 1RM) building up to moderate intensity (60 – 70 % 1RM). One or more sets of 8 – 10 exercises using all major muscle groups. However, any strength work is better than none and as stated already it may be that a client improves strength by doing other activities.

If possible, exercises should include the lower body to help maintain independence and prevent falls. If only a small number of exercises are going to be included, they should be compound (involve more than one joint action) and functional (mimic everyday activities).
An example of a short programme could be:
Squat or leg press
Chest press
Seated row
Shoulder press

Programme structure

Ensuring a full warm up, which includes joint mobility, pulse raiser and pre-stretch, is performed before the resistance session is a fundamental step (see blog on programming for mobility and flexibility). All muscle groups worked in the session should also be stretched at the end.
Ensure exercises are in the correct order with compound exercises first and isolation exercises (if appropriate) at the end.
Consider the order of the exercises to avoid overloading muscle groups, joints, and synergist muscles.
It may be beneficial to split up leg exercises if you are including more than one and make sure the legs are not fatigued by being performed immediately before or after cardiovascular training.

Exercise considerations

When programming for older adults, as with all clients, it is important that sessions are planned to meet each client’s individual needs and goals. However, with this population group, the instructor should be ready to adapt to the following potential situations.

Older adults may need exercises that avoid getting down on the floor such as kneeling or lying positions; therefore, trainers will need to be able to adapt to seated or standing versions. For example, a wall press-up rather than a floor-based version.

Older adults may have weak wrists and impaired grip or may struggle to perform exercises which include weight bearing on their wrists. In this case, you could try resistance machines making sure the wrists are in alignment or using bands with handles (detachable handles are available for resistance bands). Alternatively, try using hand weights with backs so they do not have to grip much at all. Pilates balls can be squeezed between the elbows to work the chest and anterior deltoid for example.

Reduced range of movement is common in the older demographic so understanding appropriate adaptations is important to keep the client safe. Examples include using range of movement adjustments that are available on resistance machines and slowly progressing body weight exercises based on what the joints allow, especially focusing on the shoulders, knees, and hips. To prevent an unsafe range of motion, teach controlled movements with good technique and reinforce the starting and finishing points.

Core and trunk exercises may need to be adapted to seated or standing using exercises such as side bends or seated abdominal movements.

Extra equipment may be needed to help achieve a comfortable position such as pads or thick mats for kneeling or lying.

Balance may affect some exercises and you may need to use a chair back or similar to give support. Balance can also be challenged with exercises such as calf raises to increase neuromuscular response.

In conclusion, strength and resistance training has many benefits for older adults and it is essential that bone-loading exercise is included in a balanced programme. To ensure adherence, make sure the exercises are client centred, appropriate, and enjoyable.

To learn more about this topic, we recommend you read the following:

‘A Lot of People Just Go for Walks, and Don’t Do Anything Else’: Older Adults in the UK Are Not Aware of the Strength Component Embedded in the Chief Medical Officers’ Physical Activity Guidelines-A Qualitative Study

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

If you wish to work specifically with the older demographic, then the L3 Award in Designing Exercise Programmes for Older Adults can support you.

References

Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int. 2011 May;108(21):359-64. doi: 10.3238/arztebl.2011.0359. Epub 2011 May 27. PMID: 21691559; PMCID: PMC3117172.

Fragala, Maren S.1; Cadore, Eduardo L.2; Dorgo, Sandor3; Izquierdo, Mikel4; Kraemer, William J.5; Peterson, Mark D.6; Ryan, Eric D.7. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of Strength and Conditioning Research 33(8):p 2019-2052, August 2019. | DOI: 10.1519/JSC.0000000000003230