Strength Training

Consensus guidance on exercise in older adults holds that structured prescriptions, including progressive Resistance Training, should be customized and monitored like any other medical treatment, considering dose-response relationships and the adaptations needed for intended outcomes. ^[1] The WHO 2020 guidelines on physical activity recommend regular muscle-strengthening activity for all age groups, alongside aerobic activity and reduced sedentary behaviour. ^[2] Programs are shaped by the training goal: the ACSM position stand gives distinct loading recommendations for strength, hypertrophy, power and local muscular endurance training. ^[3] Power training, an explosive form of progressive resistance training using rapid and forceful concentric contractions, gains importance with advancing age because muscle power declines through fast-twitch (Type II) fiber atrophy and changes in neural recruitment. ^[1] Strength programs for older adults can be delivered with resistance machines, bodyweight or low-cost equipment, with an individualized approach based on the equipment available. ^[4] In multicomponent physical activity, muscle strengthening is combined with aerobic and balance training in a single session, for example walking, lifting weights and balance exercises. ^[2]

For novice training, the ACSM position stand recommends loads corresponding to an 8-12 repetition maximum (RM), with a training frequency of 2-3 days per week for novice, 3-4 for intermediate and 4-5 for advanced training. ^[3] Strength-specific programs combine concentric, eccentric and isometric muscle actions and sequence large before small muscle group exercises and multiple-joint before single-joint exercises to preserve exercise intensity. ^[3] Progression is built in: a 2-10% increase in load is recommended once the individual can perform the current workload for more repetitions than the desired number. ^[3] Power training uses light loads (0-60% of 1 RM for lower body exercises and 30-60% of 1 RM for upper body exercises) performed at a fast contraction velocity. ^[3] For older adults, the ICFSR consensus recommends resistance training 2-3 days per week, with 1-3 sets of 8-12 repetitions covering 8-10 major muscle groups, and loads that start at 50% of 1RM and progress to 70-80% of 1RM over the first weeks of training. ^[1] The same consensus notes that progressive resistance training

WHO strongly recommends that adults do muscle-strengthening activities at moderate or greater intensity involving all major muscle groups on 2 or more days a week, and found no evidence of a dose-response association with higher volumes of muscle-strengthening activity. ^[2] For older adults, WHO recommends varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity on 3 or more days a week, to enhance functional capacity and prevent falls. ^[2] In a meta-analysis that included a total of 10 studies in nonclinical adult populations, any amount of resistance training compared with none was associated with a 15% lower risk of all-cause mortality (RR 0.85), a 19% lower risk of cardiovascular disease mortality and a 14% lower risk of cancer mortality. ^[6] Its dose-response analysis suggested a nonlinear relationship, with a maximum all-cause mortality risk reduction of 27% at around 60 minutes per week of resistance training and diminishing reductions at higher volumes. ^[6] In a network meta-analysis that included a total of 69 RCTs in participants aged 60 years or older,

For Osteoporosis and fragility fractures, guidelines recommend progressive resistance training combined with weight-bearing impact activities and balance and mobility training, while walking as a singular intervention has limited benefits. ^[10] In a meta-analysis of 17 randomised controlled trials in postmenopausal women, resistance training improved bone mineral density at the lumbar spine, femoral neck and total hip, with high-intensity training (≥ 70% 1RM) and longer training duration appearing optimal. ^[11] A Cochrane review found progressive resistance strength training for the lower limbs to be the most effective exercise for femoral neck bone mineral density (MD 1.03), but exercise showed no effect on the number of fractures (OR 0.61). ^[12] In a pairwise and network meta-analysis of 270 randomised controlled trials, dynamic resistance training reduced resting Blood Pressure by 4.55/3.04 mm Hg, although isometric exercise