Story
Elderly resistance training
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In one pass Can nursing-home residents in their eighties and nineties, who struggle even to walk, still train their muscles back? Not this — The elderly can't build strength anymore — In a study of 87-year-olds, 8 weeks of progressive strength training raised strength by 174% (Fiatarone 1994, NEJM). It has been replicated for more than 30 years.
Educational content, not medical advice — consult a clinician.
Story path
Chapter 1
Frail elders can regain strength
Can nursing-home residents in their eighties and nineties, who struggle even to walk, still train their muscles back? Yes. That is the conclusion of a classic randomized trial.
Fiatarone 1994, published in the New England Journal of Medicine (NEJM), enrolled 100 frail nursing-home residents with an average age of 87, most living with several chronic diseases. They were randomly assigned to four groups: high-intensity progressive resistance training, a nutritional supplement, both, or neither. The training groups worked their legs at 80% of (80% of the heaviest weight they could lift in one full repetition), 3 times a week for 10 weeks.
The results: muscle strength in the training groups rose by an average of 113%, while those who did not train barely changed (3%). Stair-climbing power rose by about 28% and walking speed by about 12%. Taking the supplement without training improved none of the main outcomes.
What the trial pinned down is one sentence: frailty is not fate. With enough stimulus and someone supervising, muscles close to 90 years old still respond to training, and a Cochrane systematic review by Liu 2009, which pooled more than a hundred randomized trials, points the same way. That does not mean anyone can go straight to heavy weights: if chest pain, fainting, unusual breathlessness, or swelling and pain in one calf appear during training, stop at once and seek medical care.
Fiatarone 1994, published in the New England Journal of Medicine (NEJM), enrolled 100 frail nursing-home residents with an average age of 87, most living with several chronic diseases. They were randomly assigned to four groups: high-intensity progressive resistance training, a nutritional supplement, both, or neither. The training groups worked their legs at 80% of (80% of the heaviest weight they could lift in one full repetition), 3 times a week for 10 weeks.
The results: muscle strength in the training groups rose by an average of 113%, while those who did not train barely changed (3%). Stair-climbing power rose by about 28% and walking speed by about 12%. Taking the supplement without training improved none of the main outcomes.
What the trial pinned down is one sentence: frailty is not fate. With enough stimulus and someone supervising, muscles close to 90 years old still respond to training, and a Cochrane systematic review by Liu 2009, which pooled more than a hundred randomized trials, points the same way. That does not mean anyone can go straight to heavy weights: if chest pain, fainting, unusual breathlessness, or swelling and pain in one calf appear during training, stop at once and seek medical care.
Evidence · Why nutrition alone was not enough
The same trial also had a group that took only the nutritional supplement. Supplement alone improved none of the main outcomes, and the group that trained and took the supplement did not clearly outperform the group that only trained. This result is often misread as "nutrition doesn't matter." The real meaning is finer: without mechanical loading, protein, vitamins, and minerals alone can hardly pull strength up, and once baseline nutrition is adequate, what usually limits adaptation is the training stimulus.So this story is best read alongside the ones on protein, vitamin D, and bone. Older adults need enough good-quality protein and adequate vitamin D, but those work more like giving training materials to build with than as a substitute for training itself.
Mechanism · Why older muscle responds less to a meal
The supplement-only group barely improved, and that is worth digging into one layer further. Dig all the way down and you reach why older adults have to do strength training, not merely the fact that training helps.First, what happens in the body after a meal that contains protein. Protein is broken into amino acids in the small intestine, enters the blood, and is carried to muscles throughout the body. When muscle cells sense that the amino-acid level in the blood has risen, they switch on a building switch inside the cell () and, over the next few hours, assemble those amino acids into new contractile protein. That stretch of time is called the synthesis window. How much muscle you carry is, at bottom, the net income from these windows minus the breakdown that runs in the background all the time.
With age, this switch goes dull: the same amount of protein produces a smaller synthesis response. The technical name is anabolic resistance. Researchers think it sticks in at least two places:
The amino acids do not get there: after a meal, the capillaries in a young person's muscle open up and send amino-acid-carrying blood in among the muscle fibers. In older adults this response is weaker, so the blood level looks the same, but fewer amino acids actually reach the fibersThe signal is not heard clearly: even when the amino acids arrive, older fibers need a stronger signal before they start work. Muscle relies mainly on one amino acid, leucine, to tell that a meal has arrived. In young muscle a small amount is enough to set it off; in older muscle the same amount is not. The threshold has been raised
The result is that one meal produces a tall, long synthesis window in a young person and only a short, low one in an older person. A few times a day, more than a thousand times a year, the shortfall adds up bit by bit to a net loss of muscle. Following this mechanism, this is how sarcopenia actually happens in daily life: it does not begin on any particular day; every meal simply earns a little less.
And mechanical load acts exactly on this threshold. In short-term experiments, after one resistance-training session heavy enough, the muscle that was trained becomes more sensitive to amino acids again for a good while afterward, so the same meal now sets it off. That gives the trial result a plausible explanation: in the nutrition-only group, materials kept arriving, but nobody opened the door. What training did was open the door.
Follow it this far and the conclusion is clear. For older adults, eating and training are not two parallel jobs; they are two halves of the same job. Protein is the bricks, and training is the permit that lets the building site start. Deliver only bricks and they pile up at the gate.
Mechanism · Strength grows in the nerves first
Most of the strength gained over those ten weeks was not newly grown muscle. To see why, you first need to know how you produce force.The nervous system divides every muscle into work crews. One motor nerve plus the batch of muscle fibers it controls is called a motor unit. How hard you want to push decides how many crews the brain calls on: the more force you need, the more crews it calls and the faster it fires them. So when the same muscle lifts a cup of water and then a bucket of water, it is not the same crew doing the work.
In someone who sits a lot and does not train, a sizable share of crews have not been called in years. They are not dead, just out of contact. In the first weeks of strength training, most of the progress comes from the brain relearning how to call them: waking more crews at once, getting them to fire more in sync, and getting the opposing muscle, which would otherwise hold you back, to let go in time. None of these three requires the muscle to get thicker, yet together they clearly raise the force you can actually produce.
So a strength gain that looks extravagant after only a few weeks, while the thigh has barely changed in size, is no contradiction at all. That is what happened in Fiatarone 1994: thigh muscle cross-sectional area in the training group grew only slightly, and the difference from those who did not train was not statistically significant. The earlier Fiatarone 1990 study was much smaller and had no control group: 10 nursing-home residents averaging 90 years old trained for 8 weeks, and in the 9 who finished, strength rose by an average of 174%, mid-thigh muscle area measured on scans grew by 9%, and tandem walking speed (walking a straight line heel to toe) improved by 48%. Taken together, strength rises fast and muscle grows slowly, but that slower layer does get going.
This timeline matters especially for older people, because it means the earliest gains do not have to wait for muscle to grow. Getting up from a chair, or climbing stairs without holding the rail, may improve before you can see any change in your legs. Put the other way, quitting after two or three weeks because the mirror shows nothing means stepping off at exactly the moment the gains are starting to pay out.
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Chapter 2
Risk screen before loading
The first step in strength training for older adults is not reaching for a barbell; it is sorting people by risk. In a review in The Lancet, Cruz-Jentoft and Sayer 2019 describe the updated standard from the European working group on sarcopenia (EWGSOP2), which moves the focus of diagnosis from muscle that looks scarce to falling strength. Low grip strength, or taking more than 15 seconds to stand up from a chair 5 times in a row, points to weakness; a walking speed below 0.8 m/s points to a more severe stage. All of these are signals to act early.
Why look at strength instead? Because in older adults, the size of a muscle and the force it can produce have long since parted ways. Force fails first, and neither a scale nor a body-composition device can see that layer.
The screening has a very practical use. Someone who can stand up unaided, has had no recent cardiovascular event, and can follow instructions for a movement can usually start with machines, resistance bands, or body-weight exercises and add load gradually. Someone with a recent fall, dizziness, chest pain, severe osteoporosis, or difficulty following instructions because of memory or thinking problems should have a medical assessment first and then train under supervision. Strength training is not better the harder it is; the point is to give the right dose to the right person.
Why look at strength instead? Because in older adults, the size of a muscle and the force it can produce have long since parted ways. Force fails first, and neither a scale nor a body-composition device can see that layer.
The screening has a very practical use. Someone who can stand up unaided, has had no recent cardiovascular event, and can follow instructions for a movement can usually start with machines, resistance bands, or body-weight exercises and add load gradually. Someone with a recent fall, dizziness, chest pain, severe osteoporosis, or difficulty following instructions because of memory or thinking problems should have a medical assessment first and then train under supervision. Strength training is not better the harder it is; the point is to give the right dose to the right person.
Clinical · Three markers you can check at home
At home and in primary care, three markers are the most useful:Sit-to-stand: stand up from a chair 5 times in a row. If it is clearly slow, needs the armrests, or takes more than 15 seconds, both leg strength and nerve control are sounding an alarmWalking speed: people whose everyday walking speed is below 0.8 m/s have a higher risk of falls, hospital stays, and disability (this is an observed association)Recent falls: a fall in the past year, or frequent near-falls, means the training plan must include balance work and a safety check of the home, not just leg exercises
These markers are not a diagnosis, but they are enough to help you decide where training starts: light loads at home, machines at a gym, or training under the supervision of a rehabilitation specialist or doctor.
Mechanism · Aging takes speed before muscle
Why should diagnosis shift from how much muscle there is to how much strength there is? Because in older adults these two parted ways long ago, and strength is the one that fails first.Muscle fibers come in roughly two kinds. One is the endurance type: slow, not very forceful, and extremely tireless. When you stand, walk, or hold a posture, these are the fibers on shift. The other is the explosive type: fast and forceful but quick to tire, called in only when a sudden effort is needed.
Aging mainly dismantles the second kind, and it starts from the nerve end. The motor neurons that control explosive fibers retire in batches, and the fibers they ran lose their command, like a workshop whose supervisor has been laid off. Neighboring slow neurons grow new branches and take over these orphaned fibers. The fibers are saved and the muscle mass on the scale does not drop much, but from then on they can only work at the slow tempo. The fast workers are still there; they have just been reassigned to slow work.
The result: the body-composition reading still looks acceptable, but the maximum force you can produce, and how fast you can produce it, have clearly dropped. So measuring only muscle mass misses some of the people who really need help, and measuring strength misses far fewer. That is the main reason diagnosis moved its focus.
Push one step further and you can see why this so often ends in a fall. After you trip, you have only a very brief instant to swing the other leg out in front of your center of mass and catch yourself. That step needs speed, not endurance. When the system that drives the fast fibers has declined, the foot arrives half a beat late, and the same trip that was a near-fall when you were young now becomes a real fall.
The good news lies in the same chain: the fibers were taken over, but they are still there. A load heavy enough, or a set taken close to failure, is exactly the signal that can call this high-threshold crew back to work.
Clinical · Why the tests are standing and walking
Those three markers look ordinary, but each one is a strength test disguised as an everyday movement.Standing up from a chair makes the body do three things in quick succession. First it leans the upper body forward, moving the center of mass from under the hips to over the feet. Then the knees and hips push together to lift the whole upper body. Finally the ankles and trunk brake, so you neither sit back down nor pitch forward. The middle step asks the legs to produce a large burst of force in a short time, and all at once: pushing slowly will not get you up, because the center of mass drops back halfway. So being unable to do it, needing the armrests, or rocking back and forth first for momentum is not laziness. It means the legs' strength reserve is already living right at the minimum that daily life demands.
Walking speed tests the same set of abilities. Walking fast depends on the push off the ground at each step: the hip and ankle must produce force quickly the instant the foot lands, then release quickly. Walking slowly is often not a lack of wanting to go faster; that push simply no longer works. So a fall in walking speed usually signals a problem earlier than a fall in body weight does.
Grip strength looks unrelated to the legs. Its value is that it is a cheap sample: strength in the hands declines broadly in step with strength in the whole body, and grip is the easiest to measure, needing no special place and little cooperation. It is not asking whether you can open a jar; it uses a cheap probe to estimate overall strength.
Put the three side by side and the picture is clear. All of them measure whether you can produce enough force in a very short time, which is to say how much is left of the fast crews that aging takes first. These tests are not a formality; they aim directly at the problem.
Chapter 3
Prescription — enough load, slow progression
The most common mistake in training older adults is taking safe to mean always light. The lesson of the Fiatarone trial is not to push dangerously hard; it is that an effective dose usually needs moderate to fairly high intensity: about 60-80% of , or a weight you can lift 8-12 times in a set with 1-3 repetitions still in reserve. A load that is too light and stops far from failure moves the body, but it can hardly reverse the loss of strength.
A conservative starting point: 2-3 sessions a week, 5-6 exercises each time, covering a squat or leg press, hip extension, a row, a press, calf raises, and core work that resists rotation. Spend the first 2-4 weeks learning the movements and finding where pain starts. After that, add 2-5% to the load every 1-2 weeks, or first add 1-2 repetitions and then add weight. People with painful joints can start with machines, resistance bands, and a smaller range of motion, and widen the range slowly once control is steady.
A conservative starting point: 2-3 sessions a week, 5-6 exercises each time, covering a squat or leg press, hip extension, a row, a press, calf raises, and core work that resists rotation. Spend the first 2-4 weeks learning the movements and finding where pain starts. After that, add 2-5% to the load every 1-2 weeks, or first add 1-2 repetitions and then add weight. People with painful joints can start with machines, resistance bands, and a smaller range of motion, and widen the range slowly once control is steady.
In practice · A 12-week ramp
Weeks 1-2 can serve as an assessment period: light loads, slow movements, and a note of pain and fatigue. Weeks 3-6 settle into steady training: 2 sets per exercise, 8-12 repetitions per set, at a controlled speed. In weeks 7-12, move the main exercises up to 2-3 sets and let the last 2-3 repetitions feel clearly hard.If joint pain after training lasts more than 24-48 hours, or if chest pain, fainting, unusual breathlessness, or swelling and pain in one calf appear, do not push through. The last four are not signs of overtraining: stop training at once and see a doctor as soon as possible, and if chest pain does not ease or someone faints, call emergency services. Expertise in training older adults shows precisely in knowing when to add and when to back off.
Mechanism · Why too light a load misses the target
The brain calls up its crews in a fixed order: first the small endurance crews, and only when their force is not enough, the large explosive crews. From small to large, from cheap to costly, this order almost never changes.That order has a direct consequence: when the load is light and the set stops far from failure, the large crews never get their turn. Lift something very light and the small crews are enough, so the large crews are never called from start to finish and never receive any notice that they need to get stronger. They are not refusing to improve; they simply do not know it is needed.
And aging dismantles the large crews first. So always using very light weights for safety, with every set feeling easy, precisely bypasses the part that most needs training. It is genuinely safe, and genuinely not much use. That is the mechanism behind the idea that a load that is too light moves the body but can hardly reverse the loss of strength.
So how do you call up the large crews without taking a reckless risk? There are two routes, and the numbers in the prescription describe them.
One is raising the weight close to your current limit. With a heavy enough weight, the small crews cannot cope even on the first repetition, and the large crews have to step in at once. That is what the intensity range is about.
The other is working close to failure. Keep going with a moderate weight and the small crews gradually tire and stop delivering force, so the body has to call in more help and the large crews get called up this way too. That line in the prescription about how many repetitions you have left is about exactly this. It is not counting repetitions; it makes sure the last few in each set are genuinely hard. Those hard repetitions are when the large crews come on, and the easy ones before them mostly clear the way.
The two routes load the joints differently, so people with uncomfortable joints can lean toward the second. But one thing cannot bend: whichever route you take, the signal has to be strong enough that the body feels it has no choice but to change. The body builds itself only for what it is currently asked to do, and if that demand is missing, it has no reason to change.
Mechanism · What muscle does after a set
Nothing grows during the session itself. The real construction happens after you walk away from the machine.A heavy enough contraction pulls on and stretches the muscle fibers and the connective tissue wrapped around them. In the cell membrane and the cell's internal scaffolding sits a set of structures that specialize in sensing deformation. They translate this mechanical deformation into a chemical signal and switch on the cell's building switch, and once it is on, the ribosomes, the cell's assembly line, start making more contractile protein from the blueprint. At the same time, dormant satellite cells (the muscle's own stem cells) sitting on the outside of the fiber are woken up, divide, and merge into the fiber, giving it new nuclei. On the usual explanation, each nucleus can look after only so much protein, so this step of adding nuclei decides how thick a fiber can grow in the long run.
This response has three features, and each leads to a practical conclusion.
First, it is local. Only the muscle that was trained switches on. Training the legs does not strengthen the shoulders on the side, so the prescription has to cover every direction daily life uses: standing up, pushing, pulling, rising onto the toes, and resisting being twisted. A muscle that was not trained gets no free ride.
Second, it lasts for a while. For a period after training, that muscle is especially sensitive to amino acids; as described earlier, training lowers the threshold that anabolic resistance raised. Here eating and training merge into one job.
Third, tissues rebuild at very different speeds. Nerves adapt fastest, with clear improvement within a few weeks. Muscle protein is rebuilt on a rolling timescale of days. Tendons, ligaments, and other connective tissues have little blood flow and a slow metabolism, so they remodel slowest of all. That easily opens a dangerous window: you can already lift more, because the nerves got there first, but the tendon pulling on that muscle is still at its old strength.
This gap is generally thought to be larger in older adults. So progress slowly is not a cautious courtesy; it is waiting for the slowest tissue to catch up.
Myth · Walking is good but cannot replace strength
Walking is the everyday activity most worth recommending, but it puts almost no demand on strength, and the reason is again that calling order.The load in walking is your body weight spread across one step after another: low in intensity and extremely even. Following the small-to-large calling order, that intensity needs only the small endurance crews, and even over an hour of walking they carry it from start to finish. The large crews are never called, and they are exactly the ones aging dismantles.
So walking trains the heart and lungs, blood-sugar handling, joint mobility, and overall activity, and each of those matters. But it sends almost no signal about whether your legs can push your whole body up in one go. A person can walk many steps every day and still be unable to get up from a chair; the two facts do not contradict each other.
A handy test: if you can keep doing a movement without it feeling like effort, it is not a strength stimulus. Conversely, the movements that demand all your attention within a few repetitions are the ones calling out to the large crews.
The conclusion follows. Walking and strength training are not a choice between two; they divide the work. Walking keeps you willing to move and able to keep moving; strength training keeps force available in the instant you need it. Older adults need both, because a fall happens in that instant, not on the walking path.
Chapter 4
Falls, bone and nutrition
The goal of strength training for older adults is not visible muscle definition; it is to cut the chain that leads to disability. Strength lets you get up from a chair, balance makes a fall less likely, and weight-bearing keeps the hips and spine receiving mechanical signals. is only one layer of this; what really decides quality of life is muscle, bone, nerves, and balance working together.
Nutrition connects here too. Older adults often have anabolic resistance: the same meal of protein stimulates muscle protein synthesis less than it does in younger people, so daily protein needs to be enough, and no single meal should be too low. People who lack vitamin D should have it corrected, because deficiency affects muscle function and is linked with fall risk; but taking vitamin D on its own cannot replace training. The safer way to put it: strength training, enough protein, enough vitamin D, and fall prevention, done together, give the full benefit.
Nutrition connects here too. Older adults often have anabolic resistance: the same meal of protein stimulates muscle protein synthesis less than it does in younger people, so daily protein needs to be enough, and no single meal should be too low. People who lack vitamin D should have it corrected, because deficiency affects muscle function and is linked with fall risk; but taking vitamin D on its own cannot replace training. The safer way to put it: strength training, enough protein, enough vitamin D, and fall prevention, done together, give the full benefit.
In practice · If you remember only one version
If you can remember only one version: 2-3 strength-training sessions a week, plus enough protein every day. Treat vitamin D deficiency if you have it, make the home slip-resistant, and have your eyesight and any sedating medicines checked. Walking is good, but it mainly trains the heart and lungs and everyday activity; it cannot replace the strength stimulus for the legs.How much protein to eat, how to check vitamin D, and how to read are each covered in detail in the stories on protein, vitamin D, and osteoporosis. The exact daily protein figures for older adults are in the story on sarcopenia.
Mechanism · How long you have to catch a trip
A fall is not a single instant. It is a string of movements that could have been interrupted in time.Your foot catches on a door sill, your upper body keeps going forward at the same speed, and your center of mass runs out ahead of your feet. You then have a very brief instant to swing the other leg out, land it in front of your center of mass, and catch your body again. Make that step and it was a near-fall; miss it and you fall. The whole difference between those two endings is packed into that instant.
Everything that instant demands is speed. The hip flexors must swing the leg out at once, the front of the thigh and the buttocks of the landing leg must catch the whole falling body the moment the foot touches down, and the trunk must brace at the same time so the upper body does not keep folding over. All of it is work for the explosive crews, and all of it is what aging takes first.
So fall prevention cannot be only about walking slower and holding on. Slowing down and holding on reduce how often you trip; strength and the speed of producing force decide whether you can recover after you trip. The first is dodging; the second is catching. People who only dodge will sooner or later meet the trip they cannot dodge.
One layer further down, this links to the bone half of the story. When you really do not recover, the impact of landing is often taken by the hip and the wrist, and whether the hip withstands it then depends on its ; bone density in turn depends partly on whether the muscles have been pulling on that bone over the years. The same reason, no longer using force, makes you both more likely to fall and more likely to break something when you do. The chain toward disability has to be cut from the strength end, because strength sits on two links of that chain at once.
Mechanism · Muscle places the orders for bone
Bone is not a dead stone. It is being torn down and rebuilt all the time: one type of cell eats away old bone, another follows behind and fills the pits with new bone, and the whole skeleton is renewed every several years. Where to fill in more and where to fill in less is decided mainly by mechanical signals.How are those signals sensed? Buried in bone is a layer of sensing cells that live in tiny chambers and are linked into a network by extremely fine fluid-filled channels. When bone is loaded it deforms very slightly; that deformation squeezes the channels and sets the fluid inside moving. The flowing fluid washes over the sensing cells, which then send the instruction to reinforce this spot, and a little more work is assigned to the bone-building side. Conversely, sites that have not deformed for a long time receive the opposite instruction.
The key is the next sentence, which reflects the mechanical regulation view widely used in bone biology: the largest pull a bone receives comes mainly not from body weight but from the pull of muscle. Muscles attach to bone at both ends and, when they contract, drag the bone toward themselves, and the deformation near those attachments is far larger than the small compression that comes from simply standing. The stronger the muscle and the harder it contracts, the clearer the order the bone receives.
So when muscle wastes, it takes along with it. No one is placing orders, so the building side naturally slows down while the demolition side keeps working its usual shift. This chain explains something often discussed as two separate matters: sarcopenia and osteoporosis often appear together. Less mechanical loading is one shared cause upstream of both; hormones, nutrition, and aging itself each play a part too.
It also explains why walking helps bone only a little, and only in some places. Walking gives the hips some vertical impact, pulls relatively little on the spine, and does almost nothing for the arms. Strength training is one of the few ways to send clear orders to the hips, spine, and arms at the same time, which is exactly why the prescription includes presses, rows, and calf raises, movements that seem to have nothing to do with walking.
Evidence · Should protein be spread across meals?
That earlier line, eat enough protein across the day, and do not let any meal be too low, has a concrete reason behind it and a limit that needs stating.In experiments that follow people for only a few hours, muscle protein synthesis responds to a meal more like a series of ignitions than like a slowly filling tank. If a meal raises the amino-acid level in the blood high enough, synthesis clearly rises and the next few hours are a synthesis window. If it does not rise enough, the response is small, and the extra amino acids are mostly used for other jobs or burned for energy.
Older adults have a higher threshold than younger people, so eating enough over the day does not necessarily mean the muscle received enough signal. If breakfast is only rice porridge and a steamed bun with almost no protein, lunch is a quick bite, and all the protein is piled into dinner, then by this model only one of the day's several chances actually ignites.
The advice that follows is to spread the same amount of protein across every meal. The limit to state is this: it is a hypothesis drawn from experiments lasting a few hours. In trials lasting weeks and months, spreading protein evenly across meals has not consistently added benefit for muscle mass or strength, and the daily total still comes first. So it is an easy, no-cost adjustment worth making, not a hard rule.
Meanwhile, training is doing something else: pushing the threshold down. Only when both sides move together do the effects add up. Training makes each ignition more likely to succeed, and enough protein gives each ignition something to work with. Doing only one wastes some of the effort put into the other.
References · 4
- Fiatarone, M. A., O'Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., et al. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330(25), 1769-1775. 100 frail nursing-home residents (63 women, 37 men; mean age 87, range 72-98), 10 weeks, 94% completed. Strength rose 113% with resistance training vs 3% without; gait velocity +11.8% vs -1.0%; stair-climbing power +28.4% vs +3.6%; thigh-muscle area +2.7% vs -1.8% (P = 0.11, not significant). The multi-nutrient supplement had no effect on any primary outcome (abstract, PMID 8190152). 10.1056/NEJM199406233302501
- Liu, C., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, 2009(3), CD002759. 121 RCTs in older adults: progressive RT improves strength (SMD 0.84), gait speed, sit-to-stand, and stair climbing — across frail and healthy elderly. 10.1002/14651858.CD002759.pub2
- Cruz-Jentoft, A. J., & Sayer, A. A. (2019). Sarcopenia. The Lancet, 393(10191), 2636-2646. 10.1016/S0140-6736(19)31138-9
- American College of Sports Medicine. (2018). ACSM's Guidelines for Exercise Testing and Prescription (10th ed.). Wolters Kluwer. www.acsm.org/education-resources/books/guidelines-exercise-testing-prescription