The Old Do Not Need Gentle Movement

Picture from NRI Nation

I was very surprised to read that older adults need more than gentle movement. They need strength. Yes, a lot of stength if you read the following review by Toien et al (2025). This is in contrast to current guidelines which recommend low to moderate intensity (60-70 percent of 1 RM) and slow to moderate concentric velocity.

The review showed convincing benefits of maximal strength training (MST) in healthy and 'diseased' older adults including frail and post stroke patients. Training performed with heavy (80-84 percent) of 1 RM and very heavy loads (>85% of 1 RM).

Key benefits were increased strength gains (2.5 percent per session). 4.5 percent increases in muscle power per session. Increase in Type II muscle fiber size, decrease in oxygen cost of walking and stair climbing. It also helps with balance.

MST uses loads of about 90% of 1 RM, which can only be performed a maximum of 3-5 reps, 3-5 sets and maximum intentional concentric velocity.

Here are the guidelines. Do 4 sets of 4 reps at about 90% of 1 RM or 4 RM. Do this 2 to 3 times a week. Single set options are also effective twice  a week. Prioritize lower body compound lifts e.g. leg press, squats, step ups since strength reduction is more effective in lower compared to upper limbs with increasing age. Moreover the lower limbs are crucial for walking during everyday activities. 

Picture from article

For this, a horizontal leg press (pictured above) may be ideal over a free weight squat since technique and safety will minimally limit the intensity of the load. The health care provider needs to consider the main challenges of the specific disease or individual. Those with osteopenia or osteoporosis will benefit from axial loading through the spine to stimulate bone density enhancement. The hack squat or horizontal leg press where the back can be reclined to ensure loading through the spine is recommended to attain this axial loading of the spine while also protecting the impact of the heavy load. 

Some diseases or injuries may require other exercises to target an affected or impaired muscle or muscle group. Examples may include the bench press for wheelchair users, dorsiflexion for foot drop patients or hip abduction following hip surgery. Also note that very heavy unilateral (or single leg) strength training induces adaptations in the untrained, opposite injured limb. This is useful during acute or chronic periods of immobilization to limit the loss of function in the immobilized limb.

Supervised training are encouraged since it improves safety and confidence.

It is a very interesting read since it is good to have evidence that it is safe to use the heavier strength training lifts compared to the current guidelines. I am wondering if the 4 sets of 4 repetitions at 90 percent of 1 RM for older patients is a recipe for injury. Is the volume and frequency of the MST sustainable for the long term?

Reference

Toein T, Berg OK, Modena R et al (2025). Heavy Strength Training In Older Adults: Implications For Health, Disease And Physical Performance. J Cachexia Sar Muscle. 16(2): e13804. DOI: 10.002/jcsm.13804