Heavy Strength Training in Older Adults: Implications for Health, Disease and Physical Performance

Abstract

Older adults typically exhibit reductions in skeletal muscle maximal strength and the ability to produce force rapidly. These reductions are often augmented by concomitant acute and chronic diseases, resulting in attenuated physical performance and higher propensity of falls and injuries. With the proportion of older adults in the population increasing, there is an alarming need for cost-effective strategies to improve physical performance and combat a multitude of age-related diseases. Surprisingly, despite convincing evidence emerging over three decades that strength training can substantially improve maximal strength (1RM), rate of force development (RFD) and power, contributing to improved health, physical performance and fall prevention, it appears that it has not fully arrived at the older adults' doorsteps. The aim of the current narrative review is to accentuate the convincing benefits of strength training in healthy and diseased older adults. As intensity appears to play a key role for improvements in 1RM, RFD and power, this review will emphasize training performed with heavy (80%-84% of 1RM) and very heavy loads (≥ 85% of 1RM), where the latter is often referred to as maximal strength training (MST). MST uses loads of ~90% of 1RM, which can only be performed a maximum of 3-5 times, 3-5 sets and maximal intentional concentric velocity. Strength training performed with loads in the heavy to very heavy domain of the spectrum may, because of the large increases in muscle strength, focuses on neural adaptations and relatively low risk, provides additional benefits for older adults and contrasts current guidelines which recommend low-to-moderate intensity (60%-70% of 1RM) and slow-moderate concentric velocity. This review also provides information on practical application of MST aimed at practitioners who are involved with preventive and/or rehabilitative health care for older adults.

Keywords: heavy resistance training; high load; intended velocity; maximal strength training; rehabilitation.

FIGURE 1

Lower extremity maximal strength gain per session (%) in older adults (> 60 years) following heavy‐very heavy strength training (80–84 and ≥ 85% of one repetition maximum, respectively).

FIGURE 2

Lower extremity rate of force development gain per session (%) in older adults (> 60 years) following heavy‐very heavy strength training (80–84 and ≥ 85% of one repetition maximum, respectively).

FIGURE 3

A description of the execution of very heavy strength training (maximal strength training [MST]) in a horizontal leg press apparatus. (A) Set the weight/resistance to ~90% of 1RM, which can only be lifted four times (i.e., 4RM). Assist the participant from the bottom position to knees near extended. Note the start position should be slightly below 90° angle in the knee joint so that the weights do not rest on the weight stack in the bottom position where the knee angle should be 90° (see Panel C). (B) Instruct the subject to conduct a slow controlled eccentric movement, lasting ~2–3 s. (C) Give a clear stop command when angle between tibia and femur is 90°, where a short stop in the movement should be emphasized before the next part of the movement. (D) Give a clear and encouraging command to lift the weight by extending the legs. The movement should be done with maximal intended velocity. Given the high load the actual movement velocity will be slow. Repeat steps B–D three more times for a total of four repetitions. Give the participant 3–4 min rest before the next set. This should be repeated for a total of four sets.

FIGURE 4

A typical training session of very heavy strength training (maximal strength training, MST). The sessions start with two warm‐up sets at a low‐moderate intensity, where 8–10 repetitions are performed in the first set and 6–8 repetitions in the final warm‐up set, before commencing with four training sets of four repetitions maximum (4RM). The training sets should be separated by 3–4 min of rest.