Dr. Jahan: Engineer, Doctor of Physical Therapy

The older athlete can and should strength train, as we’ve discussed here, which begs the question, how to do it?

Fortunately, there are evidence based guidelines that form a blue print for strength training in the aging athlete. For older adults, the National Strength and Conditioning Association (NSCA) recommends:

-2-3 sessions per week

-2-3 sets of 1-2 multijoint exercises per major muscle group (with 1.5 – 3 minutes of rest between sets)

-An intensity of 70-85% of 1 repetition maximum (% 1RM)

Of course, this is a rough frame work. A new strength trainee will likely see strength gains with a lower volume and intensity initially (i.e. fewer sets and/or session and a lower % 1RM). However, to continue to see strength gains we’ll have to increase the volume and intensity, since strength follows a “dose-response” relationship. This means that as you increase the intensity and volume of strength training, the strength gains will be larger. Of course, this only happens up to a point – we cannot infinitely add volume and intensity. An excess of volume and intensity could actually lead to decreased strength gains due to poor recovery from the training program. That sweet spot of volume and intensity is highly individualized and can really only be determined by strength training and assessing the athlete’s response.

Given the above parameters, let’s start with the exercises to build the program around. The fundamental strength exercises fall into six buckets of movement patterns:

• Squat – bending at the knees and hips, such as the barbell squat, leg press, and lunge.
• Deadlift – bending primarily at the hips, such as the deadlift and hip thrust.
• Horizontal press – pressing straight out in front of the torso, such as the bench press and pushup.
• Vertical press – pressing up overhead, such as the barbell and dumbbell “military” press.
• Horizontal Pull – pulling from straight out in front of the torso, such as the barbell row and seated row machine.
• Vertical pull – pulling from overhead, such as the pullup or the lat pull down.

To prescribe the intensity of these exercises we’ll gauge that by the number of repetitions in reserve, also known as “RIR”. The RIR of an exercise is the number of repetitions we have left in reserve or “left in the tank”. For example, if you can do a squat at given weight for a maximum of 12 reps, but only perform 10 reps, the intensity would be a 2 RIR, because you have 2 reps in reserve. If you did that squat for 12 reps, the intensity would be 0 RIR, because you have 0 reps in reserve.

RIR is useful because it helps us pick a weight for the day based on our actual strength levels that day. Strength varies day to day based on many factors such as sleep, nutrition, stress, etc. For example, do you think you would lift the same weight at 11 am after a good night of sleep and a solid breakfast versus at 11 pm after a long day of work when you skipped lunch and dinner? If we just try to force the same weight, we will likely over fatigue our body since we are not matching the exercise to our current strength level. Conversely, using RIR helps us take advantage of “good days” in the gym, by letting us lift more weight when we are especially recovered and energized.

There have been conversion charts developed which give a rough guideline to equate %1RM to RIR. My adaptation for the aging athlete is the general recommendation to:

-Perform 5-10 reps, with 4-2 RIR

For example, if you can do a deadlift 9 times at a certain weight and you want to stay at 4 RIR (4 reps left in the tank), you would perform 5 reps. At the other end if you can perform a bench press 12 times and you want to stay at 2 RIR (2 reps in reserve), you would perform 10 reps.

Of course this is not an exact science. We won’t always assess RIR with perfect accuracy and that is OK. Research suggests that over time a trainee gets better at estimating their RIR for an exercise.

To wrap up, here is a summary of the blue print of strength training for the aging athlete. Like with an athlete of ANY age, medical screening and adapting the training program based on their individual physiology and response to the program is vital.

Pick:

1. Frequency: 2-3 sessions per week
2. Volume: 2-3 sets per exercise
3. Movement Pattern (1-2 exercises for each pattern, each session):
   • Squat
   • Deadlift
   • Horizontal Press
   • Horizontal Pull
   • Vertical Press
   • Vertical Pull
4. Intensity: pick a weight that allows for 5-10 reps per set, leaving 2-4 reps in reserve on each set (choose a lower RIR for heavier weights, choose a higher RIR for lighter weights)

To create your strength training plan, reach out to me and we’ll create an adaptive strength plan customized to you, no matter your age.

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

2. Helms ER, Cronin J, Storey A, Zourdos MC. Application of the Repetitions in Reserve-Based Rating of Perceived Exertion Scale for Resistance Training. Strength Cond J. 2016;38(4):42-49. doi:10.1519/SSC.0000000000000218

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/

One of the most common challenges in physical therapy practice is getting patients to actually do their exercises at home. As I’ve written about previously, we see about a 50% adherence rate to home exercises, despite the low cost and time commitments of most programs. 

It is easy for us to dismiss patients as being lazy or illogical for not being able to perform a few minutes of exercise. However, I see this often with people who are otherwise hard working and highly motivated in other areas of life. I have worked with lawyers who work 10+ hour days, yet struggle to perform 10 minutes of home exercises. 

One of the lowest hanging fruits to help patients perform exercises is our choice of equipment. The amount and type of equipment impacts how likely patients are to adhere to the program.

Here are a few common barriers and how to address them with your choice of equipment:

• The need to setup or find equipment decreases adherence. For some patients, the act of having to find or setup equipment makes them less likely to actually perform exercises. This might seem ridiculous, but when adding a new behavior to someone’s life, small hurdles such as having to wrap a band around a doorknob, can prevent adherence. With these patients, we need to ask questions about when in the day they might have time to do exercises, where, etc. Then pick exercises that have minimal equipment setup needs. Rather than a band resisted row at a doorway, the patient could perform bent over reverse flies without weight. 

• When the “busyness” of the day makes them forget about performing exercises. Some patients actually perform exercises once they remember, but they just get caught up in the demands of daily life. Here, equipment such as a band or dowel actually serves as a visual reminder.  For example, an office worker might have a red band by their keyboard which cues them to perform a few band pull aparts when they take breaks during the day.

• When the patient wants exercises that look specific and technical. Patients come to physical therapists for our professional expertise. For certain personalities, if an exercise seems too simple it actually cheapens its value. For example, performing forward shoulder flexion (lifting your arms straight out front) can feel just like it sounds, just lifting your arms out in front of you. However, if we assign a patient a D2 band resisted diagonal (lifting out front at a slight angle with a resistance band) this feels more technical and specific. The context of exercise matters. 

The choice of equipment depends on the specific barrier and personality of the patient in front of you. Our expertise as doctors of physical therapy goes behind our clinical skills. Seemingly minor decisions, such as exercise equipment choice, play a key role in our patients feeling better and returning to the activities they love.

A client of mine recently said “Once the weather warms up, then I’ll start walking more.”

They had struggled to reach their walking goal for the week. The cloudy, chilly days made walks unappealing. And, like many people, their mood and energy dipped in the winter.

I said to this client “You know winter is coming again.” The point being, that conditions are never optimal.

If it’s not winter, it’s some other circumstance. Moving to a new city. A busy period at work. An injury.

Waiting for perfect conditions feeds the formula of “Once my life is in X condition, then everything will be better”. It hinders us from making progress, even if it is slower than we would like. It hinders us from taking any action at all.

We cannot wait for conditions to improve, we just need to do the best we can given the situation.

We cannot wait for conditions to improve, we just need to do the best we can given the situation.

I’ve seen this mindset in my own life. When I was first getting into barbell training, I told myself “Once I have squat shoes, Olympic micro plates, and a lifting belt, then I’ll be ready to train.” Unfortunately, this led to months of not lifting, since I wanted to lift in supposedly ideal circumstances. Waiting for those “optimal” conditions led to me doing nothing at all.

Fitting in exercise (or any other behavior), even in sub-optimal conditions, is critical because:

• You create blocks in your schedule for exercise. For example, if you walk 10 minutes, 3 days a week, you now have three blocks of time for walking. The hard part, creating the blocks of time, is already done. Those blocks form a strong foundation that can be built on later. Once you have the habit of walking for 10 minutes, adding 5 more minutes is quite easy.
  
• You can progress, maintain, or at least minimize losses. At the start of the COVID-19 pandemic, I had limited access to barbells. So I did weighted push ups in place of the bench press. Push ups maintained some degree of strength and muscle, until I could get back to a barbell. Had I simply stopped exercising altogether, I would have lost significant muscle and strength. And the return to the bench press would have been that much harder.
  
• You maintain a sense of control over your training. It is fragile if your whole exercise routine depends on the perfect set of external conditions. Changes in equipment availability, time, etc. can easily derail you. By continuing exercise, you maintain control over your training, even when circumstances force a change in plans.

So instead of waiting for winter to end, get started, even in small ways. Then the arrival of spring is just a bonus, rather than a prerequisite to exercise.

He was frustrated and confused. Jason (I’m using a fictional name for this individual) came in with low back pain after exercising.

Jason was in his 50’s and decided he finally wanted to get fit. He excitedly hired a trainer and began a weight training program. But then he started having low back pain. It seemed to always come after doing bent over barbell rows. The trainer insisted that bent over barbell rows were an important exercise, so Jason kept at it. The pain continued session after session. And it got worse. Finally, Jason decided to see a doctor. The doctor gave him pain-relieving medications, recommended physical therapy, and told him that weight training is dangerous.

So, Jason comes to the PT clinic with conflicting advice. The trainer insists that the exercise (the bent over barbell row) is fantastic and crucial to getting fit. The doctor says that weight training is dangerous.

Sound familiar?

Unfortunately, this happens all too often. Trainers fetishize certain exercises. They insist on the superiority of a particular exercise to get fit. Then on the other hand, some doctors and physical therapists say that certain exercises are inherently dangerous.

So what does someone new to exercise do?

In the example with Jason, we first ruled out a more insidious, “red flag” cause of the low back pain. Note that in the vast majority of people with low back pain, there is not an insidious, “red flag” cause of pain (such as tumor or fracture) (Hartvigsen 2018), (Seizer 2007).

Next we zoomed out to ask, “Why do bent over barbell rows?”

We do them to strengthen the upper body pulling muscles like the biceps, latissimus dorsi, rear deltoids, and trapezii.

The next question, “How else can we strengthen those upper body pulling muscles?”

There are many options; seated cable rows, arm supported dumbbell rows, and more.

We found exercises to work those upper body pulling muscles, while not aggravating his low back. This might seem like an obvious solution. But many coaches fixate on certain exercises as being of vital importance. They fit the person to the exercise, rather than fit the exercise to the person.

Why do coaches prize certain exercises?

Well-intentioned coaches may focus on certain exercises because of their training. Some training organizations and influential fitness gurus prefer certain exercises. Aspiring coaches learn from them and then carry on the tradition.

For example, some coaches dogmatically state that low bar back squats are superior. However, research suggests that many squat styles, both back and front squats, produce similar muscle activation (Yavuz, 2015). Anecdotally, you observe people building plenty of muscle and strength using different squat styles.

Further, the squat is not even necessary for everyone. Research shows that for those new to lifting, the leg press exercise can build just as much strength and muscle as a squat (Rossi, 2018).

A caveat. If you want to compete in a sport like powerlifting or must perform a specific exercise for athletic testing, that is a different story. In that case, you have to specifically train that exercise at some point.

Are bent over barbell rows “bad”? Is weight training dangerous?

There is nothing inherently dangerous or “bad” about the bent over barbell row. I use them for myself and clients. They can be a fantastic exercise. But certain people, at certain phases in their life, may not tolerate them well.

For Jason at that point in his life, the bent over barbell row was not a good exercise. But later, when his back was feeling less aggravated, we could reintroduce it. Just because an exercise is not well tolerated now, does not mean we cannot return to it later.

Broadly speaking, there is nothing inherently dangerous about weight training. Research suggests that the injury rate of weight training is low (similar to that of walking for exercise – quite low) (Powell, 1998). This is not to say that walking is dangerous. Rather, that weight training is a safe, healthy activity just like walking. Further, the Center for Disease Control (CDC) actually recommends “muscle-strengthening activities” at least 2 days per week for adults.

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So, to wrap up, there are no “perfect” exercises that you need to get fit. And most exercises aren’t inherently dangerous or “bad”. In weight training, we have a menu of options for different people in different phases of life. 

*Medical Disclaimer: Please be advised, the information provided in this article is educational in nature and not meant to diagnose or treat any disease, illness, or condition. For individualized recommendations it is best to follow up with a licensed provider, like myself or another physical therapist.