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3 Myths About Aging Athletes

The terms “aging” and “athlete” almost seem like opposites. Sports and athletics are typically considered to be a young person’s game. Many of the recommendations around exercise for older adults focus on improving basic daily activities and reducing fall risk. This is clearly important for many older adults, however many aging adults still want to participate in sports and identify as athletes.  

Here we’ll look at a few common myths that hold back the aging athlete (also known as masters athletes).

  1. Aging athletes can’t improve their body composition (i.e. build muscle and lose fat)

A major concern in older adults is the development of sarcopenia, a loss in muscle mass. It is related to strength loss, disability, and morbidity in older adults (1). Starting around age 60, muscle mass decreases by up to 1.4 % per year. However, resistance training can slow this trend and for those who haven’t resistance trained before, they can actually build muscle mass (1). It must be stated, that an older athlete, likely will not build as much muscle mass as their younger self and it will happen more slowly. For example, a 40 year old male golfer will likely build more muscle mass, more quickly than the same golfer at age 80.

With regards to fat loss, research also demonstrates that the elderly can effectively decrease body fat levels (2). That being said, this should be monitored to ensure that as weight is lost, there is not a significant loss in muscle mass, since there is already a tendency towards muscle loss.

2.Aging athletes can’t build muscle strength

In sports, strength training is crucial for performance and reduction of injury risk (3). Similar to muscle mass, strength and power tend to decrease with age. It is estimated that strength decreases by up to 3.6 % per year, starting around age 60. Fortunately, research shows that masters athletes can still improve muscle strength and power. Even adults over 80 years old have shown the ability to get stronger (1). Still overall, the elderly athlete likely develops muscle strength and power at a slower rate and to a lesser extent than their younger counterparts. For example, a 30 year old female sprinter will likely develop more strength, at a faster rate than the same woman at age 70.

3. Aging athletes should only lift light weights

Due to fear of injury, many believe that older adults should only lift light weights, because lifting heavy weights is inherently dangerous. However, there is actually little evidence to support this claim. In a study examining powerlifters (who tend to use lift relatively heavy loads), there was no connection found between lifting loads greater than 85% of 1 repetition maximum (1 RM) and increased injury risk (4).

In fact, the National Strength and Conditioning Association actually recommends that older adults lift weights at a level of 70-85% of their 1 RM, because heavy loads tend to improve activation of type II muscle fibers, which help express maximal strength and power. Interestingly, lighter and moderate weights seem just as effective for building and preserving muscle mass.

Overall, older athletes can improve body composition, build muscle strength and power, and safely lift heavy weights. Of course, like with an athlete of ANY age, a training program should be tailored to their specific goals, values, training history, and medical history. Aging and athletics can go hand in hand – in the future we’ll look at more specific training considerations for masters athletes.  

References:

  1. Fragala MS, Cadore EL, Dorgo S, et al. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J Strength Cond Res. 2019;33(8):2019-2052. doi:10.1519/JSC.0000000000003230 https://pubmed.ncbi.nlm.nih.gov/31343601/
  2. Tayrose GA, Beutel BG, Cardone DA, Sherman OH. The Masters Athlete: A Review of Current Exercise and Treatment Recommendations. Sports Health. 2015;7(3):270-276. doi:10.1177/1941738114548999 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482301/
  3. Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med. 2018;52(24):1557-1563. doi:10.1136/bjsports-2018-099078 https://bjsm.bmj.com/content/52/24/1557
  4. https://www.strongerbyscience.com/powerlifting-injuries/

How To Do Your First Pull-Up

The pullup is a simple exercise, yet seems impossible to achieve for so many. When I was dealing with chronic shoulder pain (for almost a decade) I dreamed of what it would be like to do a pullup. And it felt incredible to nail my first pullup. Then came the fun of doing more reps and performing weighted pullups.

In this article, we’ll go through how to master your first pullup.

While many programs exist online, this one is different in that we’ll be keeping in mind:

  1. Reducing the risk of injury due to loading joints too quickly
  2. Setting you up to progress to multiple pullups

This program will take roughly 3 months and you’ll need: an assisted pullup machine, lat pulldown (or machine row), and dumbbells.

There will be 2 workouts per week, A and B, each with 2 exercises. The workouts should be performed with 2 days of rest in between each session. So an example schedule could be to perform workout “A” on Monday and workout “B” on Thursday.

AB
Assisted pullupLat pulldown (or machine row)
Bicep curlFlexed arm hang/eccentric pullup

Purpose of Each Exercise and How to Perform:

Here we’ll cover why we perform each exercise and links on how to perform each one correctly:

Assisted pullup: this most closely mimic the movement pattern of the pullup and allows us to safely practice the full motion as you progress towards a full unassisted pullup.

Bicep curl: this accessory exercise builds the necessary pulling strength and tissue capacity to perform pullups.

Lat pull down (or row): this is a compound pull that builds the requisite strength and tissue capacity needed for pullups.

Flexed arm hang: your pulling muscles have more strength and endurance in the top position holding your head above the bar, as compared to pulling up from the bottom dead hang position of the pullup. So before you can actually pull yourself up to the bar, we can use the flexed arm hang to practice handling your full body weight. Note that if you can’t perform the flexed arm hang for at least 10 seconds then just perform the other 3 exercises (assisted pullup, bicep curl, and lat pulldown) until you can perform the flexed arm hang for at least 10 seconds.

Eccentric pullup: similar to the flexed arm hang, your pulling muscles have more strength in the lowering down portion of the pullup than the upward pulling motion. So after you’ve mastered the flexed arm hang for 3 sets of 60 seconds, we’ll progress to eccentric pullups, where you’ll start at the top position of the pullup and slowly lower your body down to the floor over 4 seconds.

How to Progress Each Exercise:

Over the course of 3 months, we’ll progress each exercise in slightly different ways. The assisted pullup and hang/eccentric pullup will be progressed to more closely match the high strength needs of performing your first pullup. On the other hand, the bicep curl and lat pulldown will stay at higher reps with more moderate loads to develop the strength endurance necessary for performing multiple pullups later on.

WeekAssisted PullupBicep CurlsLat PulldownHang/Eccentric Pullup
1-43×10, decrease assistance while leaving 2 RIR2×10, add weight while leaving 2 RIR3×10, add weight while leaving 2 RIRHang: 3×10 sec, leaving at least 5 seconds in reserve
5-83×8, decrease assistance while leaving 2 RIR2×10, add weight while leaving 2 RIR3×10, add weight while leaving 2 RIRHang: Work up to 3×60 seconds, leaving at least 5 seconds in reserve
9-123×5, decrease assistance while leaving 2 RIR2×10, add weight while leaving 2 RIR3×10, add weight while leaving 2 RIR3×5, eccentric pullup (4 second lower), leave 1 RIR

With the 3 month plan outlined, here are a few key definitions and notes:

-Sets and reps: For each exercise, the sets and reps are written as “sets x reps”, so “3×10” means 3 sets of 10.

-RIR: This means “reps in reserve”. When performing exercises to improve strength we don’t want to work until full muscle failure regularly. Instead we will work to a point where we still have 1-2 reps left in reserve at the end of each set. For example, if you perform 10 unassisted pullups with 40 lbs of assistance, but you probably could have done 12 reps that means that you still have 2 reps in reserve (2 RIR). Of course, this is a rough estimate and sometimes you might over or undershoot and that is ok. You’ll get better with time at estimating how many reps you have left at the end of each set. On a similar note, we’ll use 5 seconds as our reserve for the flexed arm hang. So if you perform the flexed arm hang for 15 seconds, but you could have held on for 20 seconds, that is a good intensity level for you.

-How to progress exercises: As your strength improves, we’ll have to progress each exercise. For the bicep curl and lat pulldown, we will gradually add weight, while still keeping 2 RIR. I would recommend doing the smallest weight increases possible each time. For the assisted pullup, we will gradually decrease the amount of assistance for the movement. Lastly, for the flexed arm hang, aim to increase by 5-10 seconds for each set.

Note that we want to progress while still staying within the RIR recommendations for each exercise. For example, imagine that you perform a 10 lb bicep curl for 10 reps with 2 RIR. Then at the next session, you perform a 12.5 lb bicep curl for 10 reps with 0 RIR (going all the way to muscle failure). You haven’t really gotten stronger, you’ve just forced yourself to use a heavier weight. Being stronger would mean performing a 12.5 lb bicep curl for 10 reps with 2 RIR.

For all of the exercises, you’ll likely be able to progress every week for the first 4-6 weeks. After that point, you may have to progress every other week.

-How to include these exercises in a workout: Perform these exercise at the beginning of a workout. If you perform these after other exercises, you will be fatigued and performance will be less than optimal.

-Rest between sets: Rest for 2-3 minutes between each SET of an exercise. While it can be tempting to rush through, you’ll be able to get more reps and use increasingly heavier loads if you rest sufficiently between each set.

Wrapping Up

By the end of the 12 weeks, if you can perform 3×5 assisted pullups with the minimum resistance (usually 10 lbs) and can perform 3×5 eccentric pullups, you should be ready to perform a full pullup.

Of course, how close you get to a pullup in 3 months depends on many factors such as body size (pullups tend to be easier for lighter, shorter people), how much training you have done before, your recovery (fatigue from other physical activity, sleep quality, stress levels, etc.), and your nutrition status (ensuring you’re consuming sufficient calories and protein).

The pullup will take time to master, but with this program you’ll be able to safely progress to your first pullup and be setup to do many more after that.

Tendon Neuroplastic Training 101 – A Novel Approach to Tendon Rehab

Patients and physiotherapists alike struggle to manage tendinopathy and its nasty habit of recurrence. Fortunately, the field keeps evolving and here we’ll discuss a novel approach to tendon rehab called “Tendon Neuroplastic Training”, which targets an often overlooked issue in tendinopathy-motor control.

But First, What is Tendinopathy?

Tendinopathy is a broad term that covers the pain and impaired performance related to overuse of a particular tendon. Most people have heard of “tendinitis” which implies an inflammatory response. However, tendinopathy is a more useful term since there are many ways a tendon can be irritated, which can include degenerative and inflammatory pathways (see Dr. Peter Malliaras’ post for more on this). A whole article could be written on staging tendon dysfunction, so for simplicity we’ll stick with the catch-all term “tendinopathy”.

Photo by Andrea Piacquadio on Pexels.com

How Do We Currently Treat Tendinopathy?

Current rehab protocols focus on changing tendon mechanical properties, improving muscle performance, managing load, pain management (i.e. modalities and manual therapy), interventions that affect local tissue (e.g. corticosteroid injection), and changing kinetic chain biomechanics. However, many treatments fail to adequately address the motor control of the muscle linked to the irritated tendon.

Why Focus on Motor Control?

In many tendinopathies there are changes in motor control of the muscle linked to the tendon in question, which can persist, even when pain is decreased and strength is improved (1). One of the main changes is in corticospinal excitability and inhibition, that is, the signals from the motor cortex that excite or inhibit a muscle.

File:UMN vs LMN.png

Adapted from: https://commons.wikimedia.org/wiki/File:UMN_vs_LMN.png

For example, a study showed that patients with patellar tendinopathy exhibited abnormal excitability of the quadriceps (1). Normal excitability looks like smoothly ramping up the signal from the motor cortex down to the muscle. However, abnormal excitability looks like little to no signal and then suddenly a sharp spike in the signal to activate a muscle. Think of a driver who shifts from 2nd to 4th gear abruptly, causing the car to jerk forward, versus an experienced driver who smoothly shifts through gears to build up speed.

Curiously, these patients also exhibited increased inhibition of the quadriceps. This means that their brain is limiting the signals from the motor cortex down to the muscle. The net effect has been described by Dr. Ebonie Rio as a driver who has their foot on the gas and brake at the same time (1). This dysfunctional signaling makes it difficult for the muscle to properly respond to the loads placed on it.  

So in rehab, we need to normalize this corticospinal excitability and inhibition to restore patients to full function and reduce the risk of recurrence.  

How Do We Change Motor Control?

To target the motor control deficits seen in tendinopathy, we can use externally paced strength training. Self-paced exercises have less of an effect on cortical motor control, so just doing more reps with heavier loads will not create the desired changes in motor control. External pacing, on the other hand, has a powerful effect on changing motor control (2).

Enter Tendon Neuroplastic Training (TNT), where we use an external cue, like a metronome, to control the pace of an exercise. For example, rather than performing a heel raise where the patient counts “3 seconds up, 4 seconds down”, in TNT, the patient coordinates their heel raise to a metronome set at 60 beats per minute (bpm), to ensure they are truly working at the desired speed. Once patients try it, many are surprised by how inconsistent their self-paced speed is compared to when they follow the metronome beat.

In addition to improving motor control, TNT keeps patients much more engaged with exercises. How often does a patient perform an exercise and then start gazing around the clinic? Or even forget what rep they are on? The external auditory cue of the metronome creates more engagement in the exercise and keeps patients on task.

How to Implement TNT in the Clinic?

The original protocol described in research by Dr. Ebonie Rio was used for patellar tendinopathy and included an isometric and isotonic knee extension as shown in the table below (1):

IsometricIsotonic
5 sets of 45 seconds4 sets of 8 reps
Patient counts duration of hold with 60 bpm metronomePatients performs 3 second concentric and 4 second eccentric to a 60 bpm metronome

Of course, this protocol should be modified based on the person in front of you and their stage of rehab.

For example, for posterior tibialis tendinopathy, we could use a heel raise while squeezing a tennis ball, performing a 3 second concentric and 4 second eccentric phase. In the clinic, I set the metronome to 60 bpm and count the first few reps with the patient, saying “1-2-top” (meaning that they should be at the highest position of the heel raise on the 3rd beat) and then “1-2-3-bottom” (meaning that they should be at the lowest position of the heel raise on the 4th beat). Once the patient understands the pacing, they would complete the prescribed number of reps. Below is an example of how this would look in practice:

As the patient progresses we can use the metronome to quantify and progress the speed of exercise, since rate of loading is a crucial factor in tendon rehab. For example, performing slow, heavy heel raises is great. However, during the gait cycle, the average stance time is just 0.6 seconds, meaning that lower limb tendons must handle fast rates of loading (3). Instead of just saying “do the heel raise faster” we can gradually increase the rate of the metronome beat to approximate the goal activity. Then if appropriate, we can progress to plyometric exercise.

Summary

Tendon Neuroplastic Training (TNT) addresses the motor control deficits that come with tendinopathy in a novel way. All you need to get started is a metronome so that patients have an external cue to pace the speed of an exercise. I personally have integrated TNT seamlessly into clinical practice and look forward to seeing more research into its application in a variety of tendinopathies. Its main benefits are that it:

-Improves motor control from the brain down to the muscle

-Can easily be implemented into exercises we already perform in rehab

-Keeps patients highly engaged during exercises

-Lets us quantify and progress the rate of loading of a tendon

References:

  1. Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British journal of sports medicine50(4), 209–215. https://doi.org/10.1136/bjsports-2015-095215
  2. Leung, M., Rantalainen, T., Teo, W. P., & Kidgell, D. (2017). The corticospinal responses of metronome-paced, but not self-paced strength training are similar to motor skill training. European Journal of Applied Physiology117(12), 2479-2492. https://doi.org/10.1007/s00421-017-3736-4
  3. Murray, M. P., Drought, A. B., & Kory, R. C. (1964). Walking Patterns of Normal Men. The Journal of bone and joint surgery. American volume46, 335–360.

Improve Recovery and Performance through “Via Negativa”

Weight loss supplements. Muscle building supplements. Home massage tools. There is a tendency in fitness and rehab to want to keep adding more and more interventions to improve recovery and performance. Unfortunately, many of these things, have marginal to zero real benefit (beyond possibly feeling good in the moment). And we often fail to consider how powerful subtraction can be. This removal of barriers is summed up in the term “via negativa”, popularized by Nassim Taleb in his book Antifragile. The idea is that removal can be a powerful strategy that often is cheaper and simpler than adding more. For example, if a pebble in your shoe is causing you a tad of pain, what’s the best solution? You could buy specialized padded socks. Or insert a fancy pebble-shielding shoe insert. Or purchase special shoes that offload the spot where the pebble is. Or you could just remove the pebble.

In the fitness and rehab world, examples abound of adding interventions of marginal benefit, rather than removing barriers to performance and recovery. Consider foam rolling, often recommend as a recovery strategy. While it feels great, foam rolling only has a minor effect on decreasing muscle soreness. On the other hand, improving sleep quality (and quantity when possible) is foundational to recovery.

Some people claim that things like foam rolling are cheap and have no real cost. I would say practices like foam rolling DO have a cost. The reality is that time, energy, and attention are limited. Your time and energy spent foam rolling could be better spent on other more important activities. Further, doing marginally beneficial things, like foam rolling, can distract us from more important practices. For example, if someone foam rolls for 10 minutes but regularly stares into a bright, blue light emitting screen before bed, how great will their recovery be? What if those 10 minutes were instead invested in powering down the phone and starting a relaxing bedtime ritual like having a cup of chamomile tea?

Now to clarify I am not against practices like foam rolling, per se. The issue arises when people start adding in these practices over more fundamental tactics, like managing sleep quality.

So to sum up, before ADDING more, consider asking what can I SUBTRACT to improve recovery and performance?

*There are some supplements (like creatine for strength and building muscle) which are effective. However, the list of truly effective supplements is quite small and they should be just that-supplements. They are not foundational for recovery and performance.

Why Older Adults Need to Build Power

Slowing down. Losing one’s spring in their step. These are common refrains that we associate with getting older. And there is a kernel of truth here. While aging is associated with a decrease in muscular strength of 1-2% yearly, the decline in muscular power is about 3.5% per year [1]. This loss in muscle power is largely due to the decrease in size and number of Type-II muscle fibers (commonly referred to as “fast twitch”). This decrease in Type-II muscle fibers (and subsequent decline of muscular power) is associated with a host of negative outcomes such as decreased quality of life and loss of independence in daily activities [2]. Fortunately, research shows that training specifically for power can help older athletes improve muscle power [2].

Research shows that training specifically for power can help older athletes improve muscle power

What exactly is muscular power?

Muscular strength and power are related physical qualities that we can improve through training. Strength refers to the ability to maximally produce force, regardless of the velocity of the contraction. For example, performing a deadlift from the floor with maximum load but at a slow speed is an expression of maximum strength. Power, on the other hand, is the ability to express force but at high velocities (for the nerds like myself, Power=Force x Velocity). For example, jumping as high as possible is an expression of maximum power since the force produced is lower, but it is performed at a higher speed.

Strength and power are related since developing strength helps to produce the high levels of force needed to express power. However, for maximum power we also need to be able to express that force at high velocities.

So how do we maximize muscle power?

First, we want to develop a base of muscular strength, since improving the ability to produce force is the foundation for developing power. Once a baseline of strength has been developed, we can add in power training. This involves the use of light to moderate loads, where we move the load as fast as possible during the concentric phase*. For example, in a squat this would mean performing the rising up portion of the movement as quickly as possible.

While many protocols exist for power training, the recommended protocol for older adults is to perform 1-3 sets of 6-8 repetitions performed at 40-60 %1-Repetition Maximum (%1RM) [2,3].  With power training we want to maintain high velocities, so we perform a lower number of reps and stay well away from muscular failure. Another way to select loads, is to use the Rating of Perceived Exertion scale (RPE). This scale ranges from 1-10, with 1-2 meaning “Little to no effort” and 10 meaning “Maximum effort”. For the purpose of power exercises, we want to select the heaviest load possible, while staying at a 3-4 RPE (“Light effort”) [4]. Now, this does not mean that power training should be easy. There should still be a high degree of focus on moving the weight explosively. Picking weights that correspond to a “Light effort” ensures that we can maintain high velocities during training.

With power training we want to maintain high velocities, so we perform a lower number of reps and stay well away from muscular failure

For the tempo of power exercises, I prescribe these for each phase of the movement (eccentric, pause at end range, concentric)*. For power movements, we will use a tempo of 3-1-X. These means a 3 second lower, followed by a 1 second pause, and a concentric phase performed as fast as possible (“X”). So for a squat, we would lower down for 3 seconds, pause for 1 second, and then rise up as quickly as possible.

In general, power exercises are best performed with multijoint movements, since we typically express power with full body movements, rather than isolated, single joint motions.

Wrapping Up

Muscular power is a vital quality that needs to be trained specifically in the aging athlete. Power training is effective in improving muscular power and should be performed after a baseline of strength has been developed. Below is a table summarizing the protocol for power training for the older adult:

Frequency1-2 days/week
Load/Intensity40-60 %1RM or heaviest possible load @ 3-4 RPE (“Light effort”)
Sets1-3
Reps6-8
Tempo3-1-X (3 sec lower, 1 sec pause, lift quickly)
Example ExercisesSquats, lunges, pushups, rows


Note: There are MANY other exercises that can be performed for power training, these are just a few example options. Also, sport specific power training varies so the parameters for that will look different depending on the goal of the client.

*The concentric portion of the movement is when when we move the weight/our body. The eccentric portion is where we are lowering/slowing down the weight/our body. For example, in a squat, controlling the lower down portion is the eccentric phase, whereas, rising up to standing is the concentric phase. Similarly, in a row, the controlled lowering of the weight is the eccentric phase, while the pulling of the weight up to the chest is the concentric phase.


References

  1. Signorile, Joseph. “Power Training for Older Adults.” IDEA Health & Fitness Association, IDEA Health & Fitness Association, 30 Nov. -1, https://www.ideafit.com/personal-training/power-training-older-adults/.
  2. Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of strength and conditioning research, 33(8), 2019–2052. https://doi.org/10.1519/JSC.0000000000003230
  3. Miszko, T. A., Cress, M. E., Slade, J. M., Covey, C. J., Agrawal, S. K., & Doerr, C. E. (2003). Effect of strength and power training on physical function in community-dwelling older adults. The journals of gerontology. Series A, Biological sciences and medical sciences, 58(2), 171–175. https://doi.org/10.1093/gerona/58.2.m171
  4. Helms, E. R., Cronin, J., Storey, A., & Zourdos, M. C. (2016). Application of the Repetitions in Reserve-Based Rating of Perceived Exertion Scale for Resistance Training. Strength and conditioning journal, 38(4), 42–49. https://doi.org/10.1519/SSC.0000000000000218

How to Pick Resistance Exercises for Older Adults

How to pick the best resistance exercises for older adults to maximize functional improvements, muscle mass, and strength

With an increasingly large population of older adults, leading health organizations, such as the World Health Organization (WHO), have created exercise guidelines for older adults to improve their health and well-being. Exercise, specifically resistance training, helps adults maintain high levels of function and slow down the decrease in muscle mass, strength, and power that comes with age (1). Current WHO guidelines recommend performing muscle strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week. However, little guidance exists on what resistance exercises older adults should perform. Here we’ll answer that question.

When selecting resistance exercises for the older adult, our aim is to:

1. Match the exercises to the client’s goals, balance/coordination capabilities, mobility levels, medical history, injury/pain history, and equipment access

2. Maximize functional improvements (such as improving transfers-including floor transfers), along with muscle mass and strength

3. Select a number of exercises that match the client’s current fitness level and recovery capacity

Fundamental Exercises

These exercises include basic movements that efficiently target major muscle groups and carryover to functional activities. Since there are only four exercises here, these exercises can be a great starting point for clients with lower fitness levels. We’ll go through exercises for the lower and upper body.

Lower Body

Age-related decreases in muscle strength and mass are more pronounced in the lower limbs and can significantly impact functional independence and fall risk (2). Therefore, strengthening the lower body is vital for the older adult.

Two fundamental exercises for the lower body are the squat and the lunge. These exercises not only effectively target the major muscles of the lower body, but also carryover to tasks such as transfers and negotiating stairs.

The highest level squat is the traditional barbell back squat. However, this exercise may not be ideal for those with upper body mobility limitations, poor tolerance to axial loading of the spine, compromised balance, or difficulty coordinating the exercise. To decrease balance and coordination demands, the Smith Machine back squat and hack squat are viable alternatives. The hack squat also requires less upper body mobility than the back squat, so may be better for certain clients.

For those who do not tolerate higher axial spinal loading (such as the exercises listed above), clients can perform goblet squats or unloaded bodyweight squats. However, these standing squat variations require some balance and coordination so may not an ideal starting point for all clients. This brings us finally to the leg press. This variation places minimal axial load on the spine, requires minimal balance and coordination, and can be a starting point for those who cannot yet perform a bodyweight squat. So a sample squat progression for a client could be:

Leg press > bodyweight squat > goblet squat

The lunge is an excellent complement to the squat that can be easily scaled. At the highest level, we have the barbell lunge (analogous to the barbell squat). However, for the same reasons listed above some clients may need other exercise options. To accommodate for decreased upper body mobility, lunges can be performed with dumbbells held at the sides or in the goblet position. Also, for those clients who have difficulty coordinating the lunge or lack the requisite strength to perform a bodyweight lunge, a countertop can be used for upper body assistance. A sample lunge progression could be:

Lunge with countertop assistance à bodyweight lunge à lunge with dumbbells held at sides

Upper Body

Upper body strength is vital for performing daily activities such as carrying groceries, housework, and yardwork. To that end, we’ll prioritize compound, multijoint movements that can be adequately loaded and scaled. Ideal upper body exercises include the chest press, row, shoulder press, and lat pulldown.

The chest press can be performed with a machine, dumbbells, barbell or bodyweight (i.e. a pushup). I personally like pushups because they can be easily scaled to a client’s ability, ranging from being performed against a wall to on the floor. Similarly, rows are versatile and can be performed with a machine, dumbbells, or bodyweight (such as TRX rows). Shoulder presses also can be performed with dumbbells, barbells, or a machine, but if a client has upper body mobility limitations, the incline press can be a substitute exercise. Likewise, the lat pull down exercise can be difficult for some clients due to upper body mobility restrictions or height limitations (i.e. to grab the handle of the machine), so variations such as a high row may be better for those clients.

Note that barbell bench or incline presses require a spotter or safety arms to be performed safely. Also, when adequately loaded, dumbbell shoulder and chest presses should be performed with a spotter for safety. Therefore, selecting these exercises depends on the level of supervision the client will have.  

In general, the machine chest press or pushup and machine row can be performed by most clients, so serve as an excellent starting point for upper body strengthening.

Accessory Exercises

For many clients, just focusing on the fundamental exercises above will be a challenging initial training program. As a client gets fitter, accessory exercises can be added to further increase strength, muscle mass, and functional capacity. These accessory movements address some muscles that are not well stimulated by the above exercises, provide increased exercise volume, and decrease the monotony of training by providing exercise variety.

Lower Body

In the squat and lunge all the vastus muscles are adequately activated. However, the rectus femoris is not well developed due to its biarticular nature, performing both hip flexion and knee extension. The rectus femoris is a crucial muscle for ambulation and postural balance and is best developed by including knee extension exercises or straight leg raises (2). Similarly, the hamstring muscle group is not sufficiently loaded in the squat, so we should add in hamstring focused movements such as knee flexion exercises (2).

The gluteus medius plays a critical role in hip stabilization during gait and in single leg stance, but is not loaded sufficiently with movements such as the squat. Exercises such as side lying or standing hip abduction help fully develop hip stability.

Lastly, the triceps surae group helps maintain balance and is important during ambulation (2). For optimal development of this muscle group, we can add in heel raises, which also can be scaled from seated to performing standing with a single leg.

Upper Body/Trunk

The chest press and row stimulate the major muscles of the upper body, however additional loading of the elbow flexors and extensors can further increase upper body muscle mass and strength. Biceps curls and triceps push downs are just two examples of exercises to further load the arms.

Also, while free weight exercises stimulate the abdominal muscles (3), focused abdominal exercises provide a more robust stimulus. Some example exercises include the seated Pallof press and isometric front plank, which are simple to perform and are tolerated well by most clients.

Summary of Exercises to Select

Here we’ve covered the exercises that best address the needs of older adults and tend to work best in practice. Note that there are nearly an infinite number of exercises and variations that we cannot possibly cover in a single post.

To wrap up, a fundamental resistance training program should include a variation of the:

  • Squat
  • Lunge
  • Chest press
  • Row

The shoulder press and lat pull down (or their variations) may be included as well if the client is able to perform these exercises.  

For optimal muscle mass, strength and functional gains, we can add accessory exercises including:

  • Knee extension and flexion
  • Hip abduction
  • Heel raises
  • Elbow flexion and extension
  • Abdominal exercises such as Pallof presses and the front plank

In general, the fundamental resistance exercises are a good starting point and over time the accessory exercises can be added in. For more specifics on creating an exercise program for older adults check out Dr. Mariana Wingood’s Masterclass!

References:

  1. Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of strength and conditioning research33(8), 2019–2052. https://doi.org/10.1519/JSC.0000000000003230
  2. Ribeiro, A. S., Nunes, J. P., & Schoenfeld, B. J. (2020). Selection of Resistance Exercises for Older Individuals: The Forgotten Variable. Sports medicine (Auckland, N.Z.)50(6), 1051–1057. https://doi.org/10.1007/s40279-020-01260-5
  3. Oliva-Lozano, J. M., & Muyor, J. M. (2020). Core Muscle Activity During Physical Fitness Exercises: A Systematic Review. International journal of environmental research and public health, 17(12), 4306. https://doi.org/10.3390/ijerph17124306 Core activation