The benefits of lifting weights for the elderly: it is no longer enough to go for a walk

Like many people her age, Sylvia McGregor, a 97-year-old Australian from Sydney, has to deal with various ailments — in her case, arthritis, osteoporosis, hearing loss, macular degeneration, lung disease, hypothyroidism, chronic kidney disease, heart disease. and two total knee replacements.

But unlike most nonagenarians, she does intense resistance training twice a week.

She credits the exercises, which she has been doing for 12 years, with the fact that she can now live independently.

“I still live alone and take care of myself,” says McGregor.

“It wasn't until last year, when I was in the hospital, that they told me I had to use a walker to go home by myself.

And I have no problem with it."

Sylvia belongs to one of the fastest growing age groups, who have already crossed the 80-year-old barrier.

It is expected that by 2050 this group of "older people" will triple and reach 447 million people worldwide.

Their longevity reflects better management of chronic diseases, which allows older adults to live longer, even if they have serious health problems.

But physical function deteriorates as people age, and many become unable to care for themselves, eroding the quality of those extra years and decades.

“Maintaining independence is very important,” says public health scientist Rebecca A. Seguin-Fowler, director of the Healthy Living program at the Texas A&M AgriLife Institute for Advancing Health through Agriculture, and StrongPeople, which runs community nutrition and physical activity programs.

“Even though they live in a retirement community and then eventually maybe in assisted living, they still want to be able to do things on their own as much as possible.”

According to researchers, exercise is the best recipe for maintaining independence.

But what is the proper dosage in terms of frequency, intensity, and duration?

What kind of exercise is best?

At what age should you start and when is it too late?

There are too few studies on exercise among the elderly to offer definitive guidelines for that age group, says Erin Howden, a researcher and exercise physiologist at the Baker Heart and Diabetes Institute and co-author of a review on exercise in octogenarians in the

2022

But the evidence based on older people in younger age groups—ages 60 to 75—is enough to offer sound advice to anyone who wants to continue gardening at age 97.

Walking improves cardiovascular health in the elderly, but it may not be enough exercise to maintain functional independence.Samuel Sánchez

The four keys to independence

Independent living requires the ability to carry out basic activities of daily living, such as showering, dressing, getting in and out of bed or a chair, walking, going to the bathroom, and eating.

Doing these things requires four physical attributes: cardiorespiratory fitness (the ability of the cardiovascular system and respiratory system to deliver oxygen during physical exertion);

muscle strength and power;

flexibility and dynamic balance, that is, the ability to remain stable while moving.

Biological aging takes its toll on each of them.

Cardiovascular fitness—the ability of the heart and blood vessels to distribute and utilize oxygen during exertion—declines throughout adulthood as circulatory capacity declines.

This decline accelerates considerably in the final stretch of life.

Above the age of 70, cardiovascular capacity declines by more than 21% per decade (and that in healthy people).

Prolonged inactivity and common chronic diseases such as heart failure, diabetes, and obesity worsen the situation.

Cardiovascular function in octogenarians is often so low that it prevents them from doing basic activities, such as vacuuming or cooking.

Dynamic balance, essential for walking, climbing stairs, and avoiding falls, is also diminished as a result of impaired musculoskeletal system and neurological function.

And muscle mass is reduced between 3 and 8% per decade from the age of 30, accelerating the decline from the age of 60.

This usually decreases both the strength -to lift objects- and the muscular power, which is the speed that allows the impulse necessary, for example, to climb stairs.

The more immobile you are, the faster wear can progress.

This muscle loss, known as sarcopenia, is why walking, one of the most popular forms of exercise, may not be enough to keep the body functioning independently.

“People think: 'Oh, but if I walk', but walking does not help build muscle”,

People who exercise throughout their lives are more likely to maintain functional independence into old age.

Over the years, they have developed greater physical abilities—strength, range of motion, stamina, and balance—and improved organ function.

But that's not the case for most Americans.

In fact, in 2018 only a quarter of Americans 18 and older met the government's adult exercise guidelines, according to the Centers for Disease Control and Prevention.

The guidelines recommend a minimum of at least 150 minutes a week of moderate-intensity aerobic activity (or 75 minutes of vigorous activity), along with muscle-strengthening exercises such as lifting weights or working with resistance bands (with at least eight repetitions for each exercise, two days a week).

To this, adults over the age of 65 should add balance and flexibility exercises—such as Tai Chi, Pilates, or yoga—about three days a week.

The ideal age to take physical exercise seriously

If the recipe sounds daunting, Howden offers another perspective: Any physical activity is better than none, and it's never too late to start.

Older people should always strive to do more.

"Whether you're walking, cycling or doing any other activity, extend the time you spend doing it and, one or two days a week, try to do something a little more intense," says the researcher.

There are many ways to get the recommended aerobic exercise.

An analysis of 41 clinical trials involving adults over the age of 67 on average revealed that activities such as walking, running, dancing, etc., work at different levels of intensity and duration.

In general, the more frequently a person exercises, the greater the benefits.

To get an idea: if a healthy 67-year-old sedentary person started doing half an hour of moderate aerobic exercise three times a week, they could improve their aerobic capacity by around 16% in just under five months.

Aerobic training in midlife is best for preventing—and earlier, even reversing—the normal age-related hardening of the arteries, which is a risk factor for high blood pressure and stroke.

For example, a study of 10 healthy but sedentary people, aged 65 or over, who managed to do 200 minutes of intense aerobic exercise per week over the course of a year, showed that they improved their cardiovascular capacity, but the training did not. had no effect on arterial stiffness.

In contrast, a small study of adults ages 49 to 55 found that cardiovascular fitness was improved and heart stiffness was decreased by a combination of high-, moderate-, and low-intensity aerobic exercise for 150 to 180 minutes per week over two weeks. years.

Howden, who led the second study, sees a clear conclusion: "It is during midlife and late middle age that we need to be more serious about incorporating a structured exercise program into our daily lives."

weights for frail elderly

And the muscles?

Two decades of research have shown that resistance training can prevent and even reverse the loss of muscle mass, power and strength that people often experience as they age.

Here's what works, according to an analysis of 25 studies involving people aged 60 and older, with a mean age of 70: Exercisers should do two weight machine training sessions a week, with a training intensity of 70 to 79% of their “one repetition max”, i.e. the maximum load they could fully lift if they only lifted once.

Each session includes two to three sets of each exercise and seven to nine repetitions per set.

Regarding the physical condition of the elderly, the first study of this group was a clinical trial with 100 frail elderly people who lived in nursing homes in Boston.

The median age was just over 87, and more than a third of the participants were 90 or older.

The vast majority (83%) used a cane, walker or wheelchair;

half had arthritis;

many suffered from lung disease, bone fractures, hypertension, cognitive impairment, or depression.

Physical exercise is essential so that the elderly can continue to fend for themselves, even if they live in a residence with assistance. BSIP (Universal Images Group via Getty)

People assigned to the exercise group completed a high-intensity resistance training regimen of the hip and knee muscles three days a week for 10 weeks.

For each of the muscle groups, the resistance machines were set to 80% of one repetition maximum force.

Training was progressive, meaning that the load was increased at each training session if the individual could tolerate it.

The sessions lasted 45 minutes and, in each session, the individual performed three sets of eight lifts for each muscle group.

At the end of the trial, the participants had significantly increased muscle strength and hip and knee mobility compared to a non-exercising group.

Four participants stopped using walkers after the training and got by with just a cane.

More than walking, "the first thing is to have strength and balance"

The principal investigator for that study was Maria A. Fiatarone Singh, now a geriatrician at the University of Sydney.

For older people, she says, resistance training, which helps maintain balance, is the priority exercise, because it makes other forms of activity possible.

“Most people, including healthcare professionals, still think that the most important thing is to help people walk, but that's only important if they can actually walk,” she says.

"First you have to have strength and balance."

Fiatarone Singh launched the resistance training program in which McGregor and his older companions lift weights twice a week, and no one gets away easily.

"In fact, we increase the weight every time someone starts," says Singh.

"At some point, your gains are less pronounced, but you're still gaining muscle mass if you keep increasing the weight."

Looking at McGregor's graph of muscle mass over time—“Hers is rock solid”—Fiatarone Singh sees inspiration.

"When a ninety-year-old sees himself getting stronger," he says, "he'll tell you how good he feels."

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