Perspective: Pragmatic Exercise Recommendations for Older Adults: The Case for Emphasizing Resistance Training

Abstract

Optimal health benefits from exercise are achieved by meeting both aerobic and muscle strengthening guidelines, however, most older adults (OAs) do not exercise and the majority of those who do only perform one type of exercise. A pragmatic solution to this problem may be emphasizing a single exercise strategy that maximizes health benefits. The loss of muscle mass and strength at an accelerated rate are hallmarks of aging that, without intervention, eventually lead to physical disability and loss of independence. Additionally, OAs are at risk of developing several chronic diseases. As such, participating in activities that can maintain or increase muscle mass and strength, as well as decrease chronic disease risk, is essential for healthy aging. Unfortunately, there is a widely held belief that adaptations to aerobic and resistance exercise are independent of each other, requiring the participation of both types of exercise to achieve optimal health. However, we argue that this assertion is incorrect, and we discuss crossover adaptations of both aerobic and resistance exercise. Aerobic exercise can increase muscle mass and strength, though not consistently and may be limited to exercise that overloads a particular muscle group, such as stationary bicycling. In contrast, resistance exercise is effective at maintaining muscle health with increasing age, and also has significant effects on cardiovascular disease (CVD) risk factors, type 2 diabetes (T2D), cancer, and mortality. We posit that resistance exercise is the most effective standalone exercise strategy for improving overall health in OAs and should be emphasized in future guidelines.

Strategies to Prevent Serious Fall Injuries: A Commentary on Bhasin et al. A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries. N Engl J Med. 2020;383(2):129-140

“…Moreover, when one considers that incorrect weight shifting and trips/stumbles account for more than 60% of falls in long-term care facilities [19], it strongly suggests Association [20], many seniors are often prescribed "low-dose" exercises that are physiologically inadequate to robustly increase physical function, lean mass, and strength. Unfortunately, our anecdotal observation is that there is a large degree of variability in the implementation of physical activity programs in the community-based setting, and that many of these programs lack the intensity and duration/volume to induce robust physiological and functional gains (for further discussion please see [14,16] In summary, we commend Bhasin and colleagues for conducting an incredibly strong pragmatic trial of a multifactorial strategy to prevent serious fall injuries. In our opinion the modest effect size that was observed should not be discounted just because it did not reach statistical significance.…”

“…For instance, there is overwhelming evidence that lifelong exercise can delay the onset of at least 40 chronic conditions/diseases [ 11 ]. Unfortunately, only 13% of older adults meet the minimum nationally endorsed physical activity levels for aerobic exercise (at least 150 min/week) and muscle strengthening activities (at least twice/week) [ 12 , 13 ], and even this low number may be an overestimate (see [ 14 ] for further discussion). This has been suggested to be less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms [ 15 ].…”

“…Additionally, it should also be clearly recognized that not all exercise and/or exercise programs are created equal. For instance, it is well-known that exercise intensity, volume, and progression are keys to optimizing the exercise prescription (for further discussion see [ 14 , 16 ]). For instance, the effectiveness of resistance exercise training interventions for strength and muscle mass improvement is variable across studies, and a meta-analyses by Peterson et al attempted to identify critical aspects of resistance exercise training programs that promote strength and skeletal muscle adaptation (e.g., the frequency of exercise training, the duration of exercise training, the intensity of exercise training, the volume of exercise training, etc.)…”

“…With respect to more general exercise training many older people are unable or unwilling to embark on strenuous exercise training programs, and, despite a call from the American Physical Therapy Association [ 20 ], many seniors are often prescribed “low-dose” exercises that are physiologically inadequate to robustly increase physical function, lean mass, and strength. Unfortunately, our anecdotal observation is that there is a large degree of variability in the implementation of physical activity programs in the community-based setting, and that many of these programs lack the intensity and duration/volume to induce robust physiological and functional gains (for further discussion please see [ 14 , 16 ]). Thus, as Bhasin et al point out, it is possible that the implemented community-based exercise programs may not have been evidence-based.…”

Effects of Three Different Exercise Strategies for Optimizing Aerobic Capacity and Skeletal Muscle Performance in Older Adults: A Pilot Study

“…In fact, fewer than 13% of older adults meet the aerobic (150 minutes moderate intensity/week; e.g., walking, stationary bicycling) and muscle strengthening (2 days/week; e.g., weight lifting) guidelines concurrently, while only 31% meet one of the two ( 3 ). A more pragmatic approach that emphasizes a single exercise strategy with the greatest effect on overall health may be a reasonable solution to optimize outcomes and improve adherence ( 4 ).…”