Increasingly, public health guidelines are including resistance (strength) training as a recommended form of exercise for older adults. This is because of a number of health benefits, including to prevent and reduce the age-related loss of muscle mass and strength.
However, to gain muscle strength effectively and efficiently, older adults need specific training programmes with carefully selected exercises, which specify frequency and intensity. The programme must be appropriate and challenging.
Unfortunately, the public health guidelines are currently quite vague. They recommend performing resistance training exercises for the major muscle groups in the upper and lower body, on at least 2 days a week. But what specifically does this mean? I know a lot of older adults who have no previous experience with resistance training, who would have no idea where to start with this recommendation.
Which resistance training exercises should older adults be doing?
A great review was recently published on this topic in Sports Medicine. We have summarised this review below in 10 easy to follow steps, and included the best resistance training exercises for each muscle group.
1) Put slightly more focus on the lower body
Age-related strength loss tends to be markedly increased in the lower limbs compared to the upper limbs. Weakness in the lower limbs tends to affect more functional daily activities and can lead to an increased risk of falls as we get older.
The squat is a highly recommended lower limb exercise for everybody, working multiple muscles over multiple joints in a very functional way: namely the quads, glutes, hamstrings, adductors (inner thigh), calves, abdominals and a number of important back muscles. By working all of these muscles in one, it is also an extremely efficient exercise!
There are a number of different variations of the squat depending on your current level. It can be started as a sit to stand from a chair or bench, a wall squat or a bodyweight squat. These can then be progressed with added load, such as holding a weighted household object, an added band, or a weight in the gym, such as dumbbells or kettlebells.
There are a number of machines which work the quads and glute max (your big buttock muscle) in a closed chain fashion – such as the smith machine, hack squat machine and the leg press. For the more advanced fitness levels, using an added load of the free bar in the gym is an excellent way to progress the load and provides more challenge to your balance and coordination.
2) Single-joint leg exercises are also important
Single-joint means you are isolating one joint, and usually one muscle group in an exercise. The knee extension exercise has been shown to activate one of the quad muscles (the rectus femoris) to a greater extent than in the traditional closed chain exercises such as the squat.
This muscle is very important for walking and balance. The leg curl is a single-joint exercise which targets the hamstrings. Most gyms have knee extension and leg curl machines, or alternatively resistance can be added with the use of ankle weights or elastic bands.
3) Your gluteus maximus is the biggest muscle in your body and must be worked
The gluteus maximus (glut max) is the largest and most powerful muscle in the body. Its primary function is hip extension and lateral rotation. It has an essential role in many functional activities: walking, running, stair climbing, and lifting.
Due to its attachments, it is important for maintaining posture and balance, because it contributes to pelvic and trunk stability, and knee stability. Low glut max strength has been linked to chronic pain and injuries in the general population, and to increased risk of falls in the elderly population.
The best exercises to target the glut max involve hip extension. The other important muscle group which contributes to this movement are the hamstrings (posterior thigh muscles which not only flex the knee but also cross the hip joint to help with hip extension).
One of the best hip extension exercises is the deadlift. There are numerous variations of this exercise which can be adapted for different abilities and to target different muscle groups more effectively. The basic idea is that you are picking a weighted object up from the floor, keeping a relatively neutral spine, with the predominant motion of the movement coming from hip (this will be covered in more detail in a later post).
An alternate exercise would be the glut bridge and the hip thrust- which have numerous variations to increase difficulty.
4) Don’t forget your other gluts
You actually have 3 glut muscles (‘the glutes’) – the gluteus maximus, the gluteus medius (glut med) and the gluteus minimus (glut min).
The glut med is a very important muscle for hip stability when walking and for balance. Its primary action is hip abduction (leg out to the side).
Hip abduction exercises can be done in standing, sitting or lying, with the added resistance of bands, cables or ankle weights.
Your hip adductors are on the inside of your thigh, they work to pull your leg inwards. They can be worked in much the same way, with an added band, cable or ankle weights. They are also targeted in the traditional closed chain exercises such as the squat and leg press- a wider stance targets these greater.
5) Your calf muscles are essential for walking and balance
Calf raises (heel raises) are the simplest and most effective way to strengthen your calf muscles. But you actually have two calf muscles: the gastrocnemius and the soleus. The gastrocnemius is better activated during the standing calf raise, and the soleus is better activated during the seated calf raise, due to their attachments.
Easy progressions with these exercises are made by simply adding weight.
6) Upper limb strength is very important for functional activities too
While we have stressed the importance of lower limb strength above, upper limb strength is vital too. It is required for daily activities such as dressing, washing, cooking, cleaning, eating & more.
Studies have linked upper limb strength to a number of functional limitations. For example lower hand grip strength is associated with an increased risk of having problems with eating, washing, dressing and toileting; each of these functional limitations is separately associated with a high mortality risk!
Upper limb strength has also been linked to cardiovascular events.
7) Multi-joint exercises to target the 3 major muscles around your shoulder
The pectoralis major is the large muscle in your upper chest. The chest press or bench press is an excellent exercise to target this muscle, as well as the large shoulder muscle (the deltoid) and the triceps. This can be done with light weights, dumbbells, a machine or a free bar.
The latissimus dorsi is the largest muscle in the upper body, a triangular shaped muscle covering your lower back and attaching onto your arm. It has a number of functions, but primarily it extends and adducts your arm, pulling it down and back from a raised position.
A great exercise to target this muscle is a row (seated, standing, using a machine, free weights or a bar). This also activates the upper and middle scapular muscles – the trapezius and the rhomboids. Another option is the cleverly named lat pull down machine, which also works the teres minor, lower trapezius and the biceps.
The deltoid is the large muscle sitting at the top of your arm and shoulder. It has 3 components: anterior, middle and posterior. Together they work to abduct the arm, lifting it out to the side- a very useful and functional movement in day to day activities. The anterior portion also assists in arm elevation and the posterior portion also assists in arm extension (pulling the arm back down from elevation).
One of the best exercises to target the deltoid is the shoulder press – which can be done with bands, machines, dumbbells or free bars.
Other important muscles around the shoulders are the rotator cuff muscles which not only have roles in movement of the arm, but also in stabilisation of the shoulder joint. These are commonly weakened muscles in a number of shoulder pain conditions. Effective exercises for the rotator cuff muscles include internal and external rotation with bands, light weights or cable machines, as well as exercises involving weight bearing through the arms.
8) Don’t forget the biceps and triceps
Although the biceps and triceps, muscle groups at the front and back of your arm respectively, are activated during the larger multi-joint exercises mentioned above (such as the bench press, rows and the lat pull down), it can be useful to target these individually too.
You can do this in single joint exercises involving bending and straightening your elbows, holding bands, cable machines or light weights.
9) Trunk stability is very important
Loss of trunk strength can increase age-related changes in spinal alignment, such as increased thoracic curvature (the stereotypical flexed and stooped forwards elderly posture).
Studies have shown a strong association between poor trunk muscle functioning in older women and an increased risk of spinal vertebral fractures, which can have devastating consequences.
The trunk muscles are also important stabilisers for your body during day to day activities, they work to keep your body stable during movements of your upper and lower limbs.
Crunches are often seen as the ‘core’ exercise, but in fact trunk stabilisation or isometric exercises have actually been shown to more effectively target the trunk and core musculature.
An excellent example of this type of exercise involves your trunk and core muscles activating to stabilise your body – such as the plank. This may sound daunting for some, but it can be started against a wall, progressing to a bench or table, to the knees and eventually to the floor.
10) Ultimately in order to keep fit, functional & healthy as we get older we need to be performing whole body resistance exercises.
The most effective way to do this is to focus on the larger multi-joint exercises, with the addition of complimentary or accessory single-joint exercises specific to certain muscles.
The most effective multi-joint resistance training exercises for older adults are the following:
- Hip extension
- Hip abduction
- Calf raises
- Chest press
- Pull down
- Shoulder press
- Trunk stabilisation
These exercises are essential because they target more than one muscle group in one go. They all have a high functional carry-over to day to day activities and can help to avoid injury. Ultimately, these should make up the basics of any good resistance training programme for an older adult, with the addition of a variety of more specific single-joint exercises throughout.