October 3, 2022

Strength Matters: Recommendations for Physical Activity in Older Adults

Written by: Marina Peric, M.D.

An interesting study was recently published by Todd and associates. They interviewed a small group of healthy, active, independently-living seniors to find out more about their physical activity habits, and compare them to the United Kingdom’s Chief Medical Officers’ Physical Activity Guidelines. It turned out that, although all of the participants claimed to be engaged in aerobic activities such as walking or pilates for more than 150 minutes per week (thus being considered highly active), none of them were performing any activities that would improve their strength. Moreover, even those who had heard something about the physical activity guidelines for older adults were unaware of the strength training recommendations and their importance.

The idea of resistance training was unappealing for most of the participants, and several problems were listed as the reasons for such attitude: lack of enjoyment in strength-building exercises, boredom and lack of motivation for practicing exercises at home, lack of knowledge and equipment for proper exercising, discomfort related to visiting the gym, or distance from the nearest gym.


What are the recommendations for physical activity in older adults?

The recommendations by World Health Organization (WHO), the Centre for Disease Control (CDC), and the aforementioned UK guideline all state the same: people aged over 65 years should have:

  1. At least 150 minutes of moderate-intensity*, or at least 75 minutes of vigorous-intensity* aerobic activity per week (or a combination of the two)
  2. Strength-promoting exercises that activate all major muscles groups at least 2 days a week
  3. Balance-improving exercises on at least 3 days a week.

It is recommended that moderate-intensity flexibility exercises are performed after aerobic or strength-promoting activities at least twice a week.

Sedentary time should be minimized and replaced with physical activity of any intensity whenever possible.

The activity should be aligned with one’s general state and functional abilities. It is recommended that the intensity and duration of exercising slowly grow over time, as the level of fitness becomes higher. In very frail individuals, strength and balance training should precede aerobic training.

As indicated in the WHO Guidelines on Physical Activity and Sedentary Behavior, the benefits of physical activity in elderly people include improved all-cause and cardiovascular mortality, improved mental and cognitive health and sleep, improved outcomes of hypertension, cancer, and diabetes, as well as better functionality and prevention of falls.

*Moderate-intensity aerobic activity is such that makes one breathe faster, while still being able to talk. Vigorous-intensity aerobic activity means fast breathing without being able to talk normally.


Why is strength training so important?

Numerous studies have been conducted on the effects of muscle training and its different varieties on the elderly population. The obtained results vary, but some conclusions are common to most research:

  • It improves muscle mass, strength, and power, as well as overall functionality.

Loss of muscle mass, or sarcopenia, is a characteristic normal part of aging. However, other factors contribute to muscle strength and power. Twenty years ago Harley and associates proved that strength training in older adults significantly impacts those other factors, and can improve muscle strength, and even volume, regardless of sarcopenia.

  • It improves gait speed.

More than one research found that resistance training exercises can over time increase gait speed by about 0,08m/s. Standing up from a chair and stair climbing are also reported to be faster.

  • It works preventively on falls.

Elderly people who exercise regularly are less prone to falls than their sedentary peers, so claims a 2013 study by Silva and associates. This preventive effect is better if exercising lasts for at least 1-3 months, if it is performed 2-3 times a week, and if different exercises are being mixed. Certain other studies support the thesis that strength exercises can help increase or maintain bone mineral density, but the preventive effect of strength training on fractures is uncertain.

  • It reduces pain in people with osteoarthritis.

In a few research, participants with osteoarthritis reported a reduction in pain from the disease. Some other studies, however, did not confirm any effect of strength training on bodily pain.

  • It is beneficial for mental health.

There is evidence that regular physical activity improves mood, lessens anxiety, and reduces the risk of depression – mental health concerns that are typical for the elderly population.


Which activities improve strength?

Activities that make your muscles work harder than usual, either by working against resistance or using body weight, are good for strength improvement. These can include lifting weights, training with resistance bands, or doing push-ups, sit-ups, squats, and similar exercises in which body weight is used to create resistance.

A set of exercises should consist of 8-12 repetitions, and training should consist of a minimum of 2-3 sets of exercises that involve different large muscle groups (for example, arm, leg, and abdominal muscles).

Such training can be done at a gym, however, it can also be performed at home with little or no big financial investment. What is important is that the exercises are done properly and that their intensity and duration are well adjusted to the physical and functional abilities of the exerciser. To achieve this, it is best to consult an expert and start training under supervision, especially if one has had little or no exercise in a long time. Creating a specialized and individualized program will help prevent sports injuries and acquire optimal results.

Certain household activities such as heavy gardening (shoveling, digging) are also strength-improving, and, although usually considered to be more of an aerobic activity, so are some forms of yoga.


Take-away messages

  • Start low, go slow: intensity and duration of physical activity should start at a low level, and gradually increase over time. It must be aligned with the exerciser’s abilities and preferences at all times. When possible, recommended minimums of activities can and should be exceeded to further improve fitness.
  • A combination of aerobic, strength-building, balance-improving, and flexibility exercises is optimal to achieve long-term health benefits.
  • Sedentary time has to be limited.
  • Any activity is better than none!



  1. Gluchowski A, Bilsborough H, et al. 'A Lot of People Just Go for Walks, and Don't Do Anything Else': Older Adults in the UK Are Not Aware of the Strength Component Embedded in the Chief Medical Officers' Physical Activity Guidelines-A Qualitative Study. Int J Environ Res Public Health. 2022;19(16):10002.


  1. Clemson L, Fiatarone Singh MA, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012;345:e4547.


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  1. Aartolahti E, Lönnroos E, et al. Long-term strength and balance training in prevention of decline in muscle strength and mobility in older adults. Aging ClinExp Res. 2020;32(1):59-66.


  1. Silva RB, Eslick GD, Duque G. Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis. J Am Med Dir Assoc. 2013;14(9):685-9.e2.


  1. Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age (Dordr). 2012;34(6):1493-515.


  1. Cassilhas RC, Antunes HK, Tufik S, de Mello MT. Mood, anxiety, and serum IGF-1 in elderly men given 24 weeks of high resistance exercise. Percept Mot Skills. 2010;110(1):265-76.
Article written by Marina Peric, M.D.
Marina is a medical doctor from Belgrade, Serbia. She graduated with high honors in 2020 and is aspiring to become a pathologist. During her studies, she took part in several scientific researches, mostly in the pharmacology niche. She was also an assisting teacher at the Department of Histology and Embryology for 5 years (2015-2020). Marina has years of experience as a writer on health-related topics. Apart from English, she fluently speaks several languages, including Spanish, Russian, and Czech.

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