Regular Progressive Resistance Training is the answer

So what can the older adult do to assure continued independence, normal weight and avoid a fall and Type 2 Diabetes?  Results of over hundreds of clinical trials conclude that regular progressive resistance training (PRT) is the answer.  This is the way the to retard skeletal muscle aging. Although this strategy has been in the scientific literature for near 30 years, surprisingly and sadly, very few adults follow an exercise program that includes resistance exercises (in the US population, an estimated 5% participate in resistance exercise versus more than 50% that engage in an aerobic regimen e.g. walking, swimming, jogging).  An additional piece of advice, stemming directly from clinical trial results, recommends the ingestion of 20-35 grams of quality protein post PRT workout to maximize the benefit gained from the resistance training alone. 

Progressive resistance training to retard skeletal muscle aging?

So what exactly is progressive resistance training (PRT)?  Simply, it is strength and speed training against a resistance which is either free weights e.g. dumbbells or barbells, weight machines (gravity resistance), calisthenics e.g. squats (body and gravity resistance) and/or use of resistance elastic bands or tubes.   In starting a program of PRT, consideration is given not only to the  type of resistance as just indicated but also, target muscles, frequency of exercise, intensity, and repetitions. 

Liu and Latham (2015)* reviewed 121 clinical trials with over 6,000 participants and concluded  that ” Doing PRT two to three times a week can improve physical function in older adults, including reducing physical disability, some functional limitations (i.e. balance, gait speed, timed walk, timed ‘up-and-go’, chair rise; and climbing stairs) and muscle weakness in older people.”  The average age in these studies ranged from 61 to 88 years.   Approximately half of the studies enrolled healthy sedentary older adults; the remainder were comprised of older adults with physical disabilities or limitations.   PRT lasted anywhere from 10 weeks to 2 years, targeting different muscle groups with increasing intensity.   It is noteworthy that older adults of any age, with or without physical limitations, will benefit from PRT.

A reasonable progressive resistance training program

What is an example of a successful PRT program?  A reasonable PRT program, based on results of interventional studies discussed above, has been developed for beginners, intermediate and advanced participants (Law et al., 2016)*.  The program is given below (PDF 1).  Target muscles are those of the chest, back, arms, shoulder, upper legs and lower legs.  For beginners, the program is 8 weeks in duration, twice weekly. Phase 1 (2 weeks) requires exercises at an intensity of 50-60% of one maximal repetition (RM) with performance of one exercise set with 12-15 repetitions.  For weeks 3-8,  the intensity increases to 60-69% of 1RM, the repetitions increase to 18, and a new exercise set is added. 

Ideally start with weight machines and trainer

Law et al., (2016) favors starting with weight machines and ideally a trainer to assure that the correct form is achieved for each exercise.  It is also advisable to discuss a new exercise program with your physician before setting forth.  The sample program for intermediate and advanced PRT modifies the beginner program and adds new exercises with increases in both intensity, sets and repetitions.  In lieu of weight machines, there are reliable established  free videos on strength training with dumbbells (PDF 2), and alternative exercises e.g. calisthenics and elastic bands (PDF 3)).  Remember the program must be progressive to be of benefit and hence must increase in intensity over time.

Progressive resistance training and protein supplementation are proven means to minimized age-associated sarcopenia and dynapenia.

To maximize the benefits of PRT, findings from numerous studies, albeit with a small number of volunteers, show that consumption of high quality protein e.g. soy or whey (20-35 gm) or essential amino acids leucine and isoleucine (3.5 gm) stimulates skeletal muscle formation and leads to better outcomes (mass, strength, performance) than PRT without protein supplementation.  Leucine and isoleucine cannot be synthesized by the body so both must be ingested. Leucine and isoleucine are the amino acids most adept at encouraging exercised muscles to up their production of major muscle proteins e.g. myosin.  Protein supplementation is based on studies with volunteers, 55-85 years of age, of various weights (normal to obese) who performed resistance exercises  (hand held weights and machines) for 10-26 weeks, 2-3 x per week, multiple target muscles with 3 sets of 8-12 repetitions at 70-85% maximal repetition.  

Do not forget protein supplementation

PRT plus protein supplementation is the anti-aging strategy that is definitely in sync with living a longer healthier life.  Consider the wealth of benefits from this strategy:  strength to perform all desired daily activities, avoidance of physical disabilities, maintenance of ideal weight or weight reduction, adequate handling of sugars/carbohydrates, avoidance of falls and an acceptable response to the cold.  These are advantages that guarantee continued independence and optimal quality of life.  These are benefits that should motivate every adult over 50 to participate in this strategy. 

Progressive resistance training is part of 4-prong exercise program for the older adult

PRT is one part of a 4-prong exercise program validated to minimize age changes.  PRT is of high priority considering the plethora of positive outcomes for the older adult.  However, the three other components (aerobics, balance and stretch ) of the 4-prong exercise program provide different but equally important advantages and will be discussed in my next blog.

Resistance exercise with machines

PDF 1 (Resistance exercises with machines) describes evidenced-based PRT proposed by Law et al., (2016)**   It consists primarily of exercises using machines one would find in a fitness gym or YMCA.  There are three progressive levels, beginner, intermediate and advanced that progress the individual from 1 set of 12 repetitions to 3 sets of 10 repetition over a period of 32 weeks.  Machine-dependent exercises is probably the easiest way to initiate PRT but this approach does require a gym membership.  The main advantage is that experienced personnel are available to assist with the use of each machine.  To provide a level of familiarization, PDF 1 also contains videos that demonstrate the proper execution of each exercise with the particular machine. 

Resistance exercises with dumbbells

PDF  2 (Resistance exercises with dumbbells) follows the progression of strength training defined by Law et al., in PDF 1 but substitutes dumbbells (hand held weights).   The advantage of these exercises is that they can be done at home.  However, one must purchase a set of dumbbells.  I have added videos for all of these exercises since it is essential that they be performed exactly as described to gain the most benefit and avoid injury.

Alternative workouts

PDF 3 (Alternative workouts) list 7 different workouts ranging in time and difficulty, available on line that one may also follow and that can be performed at home.  Although none per se have been subjected to a clinical trial they contain exercises providing benefits comparable to those defined in PDF 1 and 2.  The key point to remember is that resistance exercise needs to be progressive.  Thus either increase in weight or resistance and/or number of repetitions is required to yield strength benefit.

*  Liu C-J, Latham NK.  Progressive resistance strength training for improving physical function in older adults.  Cochran Database Syst Rev: July 8 (3): CD002759, 2009.

** Law TD, Clark LA, Clark BC.  Resistance exercise to prevent and manage sarcopenia and dynapenia. Annu Rev Gerntol Geriatr 36: 205-228, 2016.