Introduction
This blog will discuss the nature and advantages of maximal strength training in its role of significantly improving physical function and fall prevention. Thus, knowledge and engagement in maximal strength training is of considerable health value.
As of 2022, only 16.8% of adults, 65-74 years of age, in the USA followed the federal guidelines for aerobic and resistance exercises recommended for health maintenance (1). Percentage participation declined further with advancing age (12.3% of 75-84 years of age and 6.2% of 85 years and older) (1). This is indeed a disappointing record considering the plethora of benefits produced by engagement in aerobic and resistance exercises e.g. secure balance, physical endurance, assured mobility and overall continued independence (see earlier blogs; Insight 2, Insight 3, Blog 4. Blog 5).
Federal guideline recommend “a minimum of 150 minutes of moderate intensity or 75 minutes of vigorous aerobic activity a week and at least 2 days of activities that strengthen muscles (https://www.cdc.gov/physical-activity-basics/guidelines/older-adults.html). Although these guidelines guarantee mobility and independence, recently reviewed data indicate that there is a difference in the results obtained with conventional strength training and maximal strength training.
Specifically, maximal strength training provides the type of strength improvements especially needed by the older adult to prevent falls, rise with ease from a chair and climb stairs (2).
Prevention/maintenance
Fall prevention is imperative for the older individual because the consequences of a fall lead to a vicious downward spiral that may culminate in death. A fall may cause muscle tears and bone fractures that require extensive rehabilitation. In the case of hip fractures and subsequent replacement, extended hospitalization often leads to exposure to deadly pathogens (3). Furthermore, anxiety called “fear of falling” occurs after a fall (4). Fear of falling prompts the faller to approach mobility with caution. This results in a change in posture and stride that rather than preventing a fall, provides the conditions for another fall (5). Therefore, all means to prevent a fall should be of the greatest interest to the older adult. Similarly, maintenance of mobility (chair rise, stair climb) is similarly important as reduced mobility leads to reduced independence.
Strength Training – Maximal verses Conventional
Maximal strength training requires that the weight of one maximal repetition (1RM) be initially determined. 1RM is the maximal weight that can be lifted once by an individual. This varies from individual to individual. It would be low for someone with frailty and considerably higher for a physically active adult. However, once 1RM is determined, exercises commence at least 85-90% of the 1RM (considered heavy-very heavy training) with several sets of 4 repetitions and 3-4 minutes rest between sets (2). As muscle strength increases, the percent of 1RM increases until the initial 1RM eventually increases.
Additionally, in maximal strength training, the concentric contraction phase (muscle shortens as the muscle contracts) of the exercise is performed as rapidly as possible. The eccentric contraction (muscle lengthens as it contracts) is performed at a slower rate. Both upper and lower body muscles benefit from this routine. However, the human studies discussed here primarily used leg press, squats, or knee extension.
In contrast, conventional strength training commences at 70-75% of 1RM, generally starting at an even much lower level. However, the number of repetitions is high, mainly 12 per sets of 2-3. Exercises are performed with slow movement for both concentric and eccentric contractions (6).
Age Changes in Skeletal Muscles
As one ages, skeletal muscles if not subjected to routine resistance exercises lose both mass, strength, and power. Sadly, loss of strength and power exceed by many fold, loss of muscle mass (7). The composition of muscles also changes with age. Specifically, muscles are comprised of several subtypes of fast twitch fibers (Type II) and one type of slow twitch fibers (Type I) (8). As indicated in the name, fast twitch Type II respond rapidly for short periods of time. Slow twitch Type I respond more slowly but for longer periods of time.
Among the fiber types there is considerable heterogeneity and diversity allowing for the variety of human activities (8). However, although little is known about the maintenance of diversity in muscles of the older adult, it is known that both fiber number and size decrease with age. This is attributed largely to disappearance of the motor neurons that recruits fibers for unified contraction (9). Additionally, Type II fibers are affected to the greatest extent (10). Resistance exercises counter loss of fibers and hence restore both mass and strength depending on the type of exercise stimulus.
Advantages of Maximal Strength Training
The advantages of maximal strength training are 3-fold. As shown in many studies, there are the expected
(1) increase in strength (approximately 68%)
(2) a near 50% increase in the rate of force development and
(3) an increase in work efficiency (less energy used to do work) (2, 11).
An 8 week program of maximal strength training in the older adult (~70 yrs) confirmed these benefits. Results additionally showed a select increase in the number and size of fast twitch Type II fibers (assessed with biopsies before and after exercise). These changes were comparable to that of young physically active (not strength training) individuals (6). Slow twitch Type I fibers decreased after maximal strength training. Interestingly, conventional strength training in older adults for 8 weeks produced similar fiber changes but also increased the size of Type I fibers. This potentially negated an increase in work efficiency obtained with maximal strength training (6). Furthermore, conventional strength training did not increase the rate force development.
Impact of maximal strength training
Both the increase in rate of force development and the increase in work efficiency, specific to maximal strength training, are key to maintenance of posture and prevention of falls. To counteract a fall, rapid muscle response by fast twitch Type II fibers is essential. In an experiment comparing rate of muscle force activity in a trip fall (most common type of fall), older adults compared to young adults exhibit a reduced rate of muscle force development (12). Maximal strength training unlike conventional strength training drives neuronal recruitment to engage more muscle fibers per contraction, thus greater strength (2). This additionally contributes to an increased rate of force development and improved work efficiency that permits a faster action with less resource. Similarly, effects of maximal strength training are important in “force-demanding tasks such as chair rising and stair climbing” (2).
Participants
Maximal strength training is not limited to the healthy older adult. It has been successful in improving strength and mobility in the frail older individual (13, 14) and those with stable cardiovascular disease (15). As reviewed in Toien et al., (2025) (2), other patient categories that include women with osteoporosis or osteopenia, survivors of a stroke, those recovering from hip fracture surgery and cancer patients receiving adjuvant therapy had engaged successfully in lower limb maximal strength training. Compared to conventional strength training, maximal strength training increased leg strength, rate of force development, walking distance and general functional performance.
Contributions of conventional strength training.
Conventional strength training is still important for health maintenance. However, using resistance less than 50% of 1RM produces no improvement in muscle function (16). To achieve increased strength, resistance greater than 50% 1RM is required and muscles must be worked to exhaustion(2).
Conclusions
Strength training whether conventional or maximal faciiitates life-long independence. Maximal strength training offers additional advantages of rapid muscle response with less energy input. Such benefits are of special assistance in fall prevention, stair climbing and getting up from a chair. Maximal strength training is worth the effort.
1. Elgaddal N, Kramarow EA. Characteristics of Older Adults Who Met Federal Physical Activity Guidelines for Americans: United States, 2022 Natl Health Stat Report . 2024 Nov 26:(215):CS355007. doi: 10.15620/cdc/166708.
2. Toien T, Ber OK, Modena R, Brobakken MF, Wang E. Heavy Strength Training in Older Adults: Implications for Health, Disease and Physical Performance J Cachexia Sarcopenia Muscle . 2025 Apr 16;16(2):e13804. doi: 10.1002/jcsm.13804
3. Barcelo M, Torres OH, Mascaro J, Casademont J, “Hip Fracture and Mortality: Study of Specific Causes of Death and Risk Factors,” Archives of Osteoporosis 16 (2021): 15.
4. Jung D. Fear of falling in older adults: comprehensive review. Asian Nursing Research. 2008;2:214–222. doi: 10.1016/S1976-1317(09)60003-7
5. Jefferis BJ, Iliffe S, Kendrick D, Kerse N, Trost S, Lennon LT. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC Geriatr . 2014 Oct 27:14:114. doi: 10.1186/1471-2318-14-114.
6. Wang E , Nyberg SK, Hoff J, et al., “Impact of Maximal Strength Training on Work Efficiency and Muscle Fiber Type in the Elderly: Implications for Physical Function and Fall Prevention,” Experimental Gerontology 91 (2017): 64–71
References
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8 Schiaffino S, Reggiani C. Fiber types in mammalian skeletal muscles..Physiol Rev. 2011 Oct;91(4):1447-531. doi: 10.1152/physrev.00031.2010.
9. Larsson L, Ansved T. Effects of ageing on the motor unit. Prog Neurobiol 45: 397–458, 1995. doi: 10.1016/0301-0082(95)98601-Z.
10. Larsson L, Degens H, Li M, Salviati L, Lee YI, Thompson W, Kirkland JL, Sandri M.Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev. 2019 Jan 1;99(1):427-511. doi: 10.1152/physrev.00061.2017.
11. Heggelund, J., Fimland, M.S., Helgerud, J., Hoff, J., 2013. Maximal strength training improves work economy, rate of force development and maximal strength more than conventional strength training. Eur. J. Appl. Physiol. 113 (6), 1565–1573.
12, M. Pijnappels, M. F. Bobbert, and J. H. van Dieen, “Control of Support Limb Muscles in Recovery After Tripping in Young and Older Subjects,” Experimental Brain Research 160 (2005): 326–333.
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14 . Singh MA, Ding W, Manfredi TJ, et al., “Insulin-Like Growth Factor I in Skeletal Muscle After Weight-Lifting Exercise in Frail Elders,” American Journal of Physiology 277 (1999): E135–E143
15. De Oliveira JL, LimaLC, Barreto RV, et al., “Cardiovascular Responses to Unilateral, Bilateral, Upper, and Lower Limbs Resistance Exercise,” International Journal of Exercise Science 16 (2023): 1154–1164.
16. Kamiya M., Ihira H., Taniguchi Y., et al., “Low‐Intensity Resistance Training to Improve Knee Extension Strength in Community‐Dwelling Older Adults: Systematic Review and Meta‐Analysis of Randomized Controlled Studies,” Experimental Gerontology 172 (2023): 112041