This document provides an overview of strength training for older adults. It discusses the aging population and benefits of strength training for health, physical function, and quality of life. Strength declines significantly with age starting at 45 years old. Inactivity leads to further losses. The document recommends progressive strength training targeting all major muscle groups using varied exercises and resistance. It emphasizes the need for clinical guidelines on strength training for older adults to improve health outcomes and reduce healthcare costs.

1. Strength Training For
Older Adults
@strengthforlifecampaign
@strength4_life #StrengthSavesLives
www.strengthforlifeltd.co.uk

2. • Our backgrounds and approach.
• Background on the ageing population.
• Health benefits of strength training.
• Psychosocial effects of reduced strength and
frailty.
• Programme requirements for healthy ageing.
Overview

3. Chris Hattersley
• BSc Sport & Exercise Science
• MSc Strength & Conditioning
• UKSCA Accredited S & C Coach
• NSCA Accredited S & C Coach
• MSc Physiotherapy
Kaseem Khan
• BSc Occupational Therapy
• MSc Physiotherapy
• NSCA Accreditation
Our backgrounds
Dave Hembrough
• BSc Sport Science
• MSc Sport Therapy
• PGDIp Advanced Business
Engagement
• UKSCA Accredited S & C Coach
• NSCA Accredited S & C Coach
Dr Tom Maden-Wilkinson
• BSc Physiology with Sports
Biomedicine
• PhD with the EU Myoage project.
• Senior Lecturer in Neuromuscular
Function and Ageing

4. Our Approach
S & C
- Programme design
- Exercise selection
- Varied training
techniques.
Exercise Science
-Data collection & analysis.
- Adaptive physiology /
nutrition.
- Constant innovation
through scientific approach
Physiotherapy
- Anatomy &
pathophysiology
- Co-morbidities /
Diagnostic Skills
- Knowledge of health care
system
Occupational Therapy
- Person centred
- Equipment / environmental
adaptation
- Treatment of complex
patients in a holistic manner.
To get the best from each profession we need continuous
education, collaboration and positive conflict.
Research
Based
Multidisciplinary
Practical
Application

5. Background Information
• Currently 10 million people over age 65
in the UK, this will double to ~20 million
by 2033 (Cracknell, 2010).
• The cost of health and social care for the
over 65 population is estimated to be
around 40% of total NHS expenditure.
• Lack of strength is highly correlated with
functional limitations in daily living,
morbidity and early mortality (Sharples
et al, 2015).
• Despite strength being a critical aspect of
good health, there are no guidelines
from UKSCA, NICE guidelines & minimal
from CSP.
Cracknell (2010)

6. The Cost of Muscle Weakness
Health care costs;
• An average cost increase of £2707 for a
sarcopenic patient
• Estimated annual total cost = £2.5 billion
Cost to the individual;
• Associated with increased risk of functional
impairment, poor health-related quality of
life, physical frailty, premature death.

7. Strength Levels through the lifespan
• Decline starts at 45 with major drops at
65 and 80, accelerates more rapidly with
disuse and increases chance of disability
(Bell et al, 2016).
• ‘50% of the physical decline associated
with ageing is actually disuse atrophy
resulting from inactivity’ (Jette et al,
1999).
• 100,000’s of hospital admissions per
year for sarcopenia, osteopenia,
osteoporosis for the elderly (Cruz-Jentoft
et al, 2010).
• Covert and happens over many years -
‘saving for retirement starts in early life’.
45y point of
‘accelerated aging’.

8. Musculoskeletal Aging
• Initial decline in strength caused by
denervation of high threshold motor
units and reduced rate of force
development.
• Anabolic hormone levels also
decrease, leading to preferential
atrophy of fast twitch fibres.
• Less tension developed by the
muscle = less force transmitted to
the bone reducing bone density and
compromising collagen alignment.
Strength training is the only intervention which can simultaneously combat all these factors!

9. Cognitive Ageing
• Cognitive function begins to
deteriorate at 45y.
• Increased chance of
cerebrovascular disease.
• The brain is still capable of
neuroplasticity throughout life
and remains adaptable to stimuli
and activities.
• Strength programme should
include new movements and
cognitive stimulation in order to
stimulate and retain cognitive
function.

10. Lose Strength, Lose Independence

11. Psychosocial Effects
• Amount of movement / ability to move is highly correlated to
life expectancy.
• Lack of strength impairs movement patterns and behaviours.
• Lack of movement causes psychological and social problems.
• Environmental adaptation must promote movement not remove
it.

12. Quality of life
A compromised movement systems leads to:-
• Cardiorespiratory decline
• Increase risk of chronic illness (diabetes, cancer, cardiovascular
disease)
• Reduction in balance, proprioception = falls risk
• Skin integrity
• Disuse physiology
• Incontinence
• ‘Treat people like they are frail,
and avoid activity, and they become
more frail at an even faster rate’

13. Clinical Use of Strength Training

14. Health Benefits of Strength Training
• Strength training has numerous
unique benefits in healthy and
clinical groups.
• Increased strength and muscle
mass levels improves systemic
health not just muscles.
• Strength training increases
length and quality of life!
• Current healthcare model is
not set up to deliver this.

15. SARCOPENIA
Muscle
mass
MuscleStrength
Physical
Performance
Risk of fracture, deterioration of physical
performance and QUALITY OF LIFE!
MusclePower
Sarcopenia

16. How do we find those most at risk ?
Strength
Assessment
Muscle Mass
Assessment
Functional
Assessment
Grip
Strength
5 Sit to
Stands DXA BIA Gait
Speed
Timed Up
And Go
Stair
Ascent/
Descent
SPPB
400m
Walk
M < 27kg
F < 16kg
> 15
seconds
M < 20kg
Muscle Mass
F < 15kg
Muscle mass
<0.8
m/s
Score
< 8
>20s
> 6
mins
Cruz- Jentoft et al., Age and Ageing, 2018.
https://vimeo.com/74649739
https://vimeo.com/74649738
https://vimeo.com/74649737

17. Strength as a Red Flag?
Strength
Assessment
Grip Strength 5 Sit to Stands
M < 27kg
F < 16kg
> 15 seconds
Patients under these thresholds
should be seen as a serious
cause for concern;
Increased risk of mortality
Functional limitations,
reduced independence &
quality of life.
Increased need of healthcare
support for ADL’s &
increased costs.

18. Current Guidelines
‘Physical activities that strengthen
muscles involve using body weight
or working against a resistance.
This should involve using all the
major muscle groups. Examples
include:
• Carrying or moving heavy loads
such as groceries
• Activities that involve stepping
and jumping such as dancing
• Chair aerobics’
• Huge discrepancy between the
size of the problem and current
guidelines.
• UKSCA have numerous articles
regarding youth training but
have never published an article
for older populations.
• CSP has information leaflets
but no actual guidelines
detailing the physiology of
ageing, programme design or
use of strength diagnostics.

19. Programming Requirements
• Progressive
loading
• Compound
movements
• Cognitive
loading
• Multi-
Movement
• Educational / psychosocial approach.
Something new every session & psychosocial
techniques to stimulate neuromodulators /
neuroplasticity.
• Multi-planar / level – dynamic control of
COM through challenging movements to
prevent falls.
• Neurological adaptations – to retain motor
unit recruitment and rate of force
development.
• Structural adaptations – to retain muscle
mass and bone density

20. Existing Research
There is currently research on all the following areas with elderly
participants:
Hypertrophy
High - Velocity
Maximum
Strength
BFR
Eccentric Training Balance/
Proprioception
Plyometrics
Iso-inertial Resistance

21. Key Studies

22. Conclusions
• A significant improvement in current guidelines and increased
awareness are needed from governing bodies to improve practice.
• Educate clinical and non clinical practitioners, S & C, physio, nursing,
GP’s, care home staff, personal trainers etc.
• Routine monitoring of strength diagnostics throughout the health
care system primary care, wards etc.
• Needs to target early prevention aiming for a high peak strength level
by age 45 and then a slow decline afterwards.
• More interventions to promote strength training in diverse groups.

23. Please follow our social media channels to
see how we put all these methods into
practice!
@strengthforlifecampaign
@strength4_life
That's all Folks...
@strengthforlifecampaign
info@strengthforlifeltd.com

24. References
• Cracknell, R., 2010. The ageing population. Key issues for the new parliament, p.44.
• Cruz-Jentoft, A.J., Landi, F., Topinková, E. and Michel, J.P., 2010. Understanding sarcopenia as a geriatric syndrome.
Current Opinion in Clinical Nutrition & Metabolic Care, 13(1), pp.1-7.
• Jette, A.M., Lachman, M., Giorgetti, M.M., Assmann, S.F., Harris, B.A., Levenson, C., Wernick, M. and Krebs, D.,
1999. Exercise--it's never too late: the strong-for-life program. American journal of public health, 89(1), pp.66-72.
• Izquierdo, M., Häkkinen, K., Ibañez, J., Garrues, M., Antón, A., Zúñiga, A., Larrión, J.L. & Gorostiaga, E.M. 2001,
"Effects of strength training on muscle power and serum hormones in middle-aged and older men", Journal of
Applied Physiology, vol. 90, no. 4, pp. 1497-1507.
• Macaluso, A. & De Vito, G. 2004, "Muscle strength, power and adaptations to resistance training in older people",
European Journal of Applied Physiology, vol. 91, no. 4, pp. 450-472.
• Nejc, S., Loefler, S., Cvecka, J., Sedliak, M. & Kern, H. 2013, "Strength training in elderly people improves static
balance: a randomized controlled trial", European Journal of Translational Myology, vol. 23, no. 3, pp. 85-89.
• Sharples, A.P., Hughes, D.C., Deane, C.S., Saini, A., Selman, C. & Stewart, C.E. 2015, "Longevity and skeletal muscle
mass: the role of IGF signalling, the sirtuins, dietary restriction and protein intake", Aging Cell, vol. 14, no. 4, pp.
511-523.
• Sipilä, S. & Poutamo, J. 2003, "Muscle performance, sex hormones and training in peri‐menopausal and
post‐menopausal women", Scandinavian Journal of Medicine & Science in Sports, vol. 13, no. 1, pp. 19-25.
• Stamatakis, E., Lee, I.M., Bennie, J., Freeston, J., Hamer, M., O'Donovan, G., Ding, D., Bauman, A. and Mavros, Y.,
2017. Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population
cohorts with all-cause, cancer, and cardiovascular mortality endpoints. American journal of epidemiology.