*This post about why at 64 I prioritize strength training over aerobic training is a bit long, but, because of the nature of the subject, it needed to be comprehensive.
Maybe you’ve visited your MD recently for your annual physical. She points out to you that the “couch potato” lifestyle you adhere to is not the best medicine for aging well. So she suggests that maybe you should consider doing some exercise.
Or maybe you’re reaching middle age and realize you’re not in the best of shape. Climbing those stairs are definitely not as easy as they were 10 years ago. You know you have to do something to improve your health.
So, you consider putting on the trainers and going for a jog around the neighborhood.
After all, isn’t that what you do to get fit? Aerobic training is the way to go, right?
But how much aerobic training should you do? Is a 20 – 30 minute walk five days a week sufficient or should you do some higher intensity training like cycling?
Let’s back up. Let me ask you this question. If you’re getting to middle age, is aerobic training even the best exercise for you?
Notice I didn’t say aerobic training wasn’t good for you. I said, if you’re approaching middle age (or beyond), is aerobic training the best choice for you?
Let’s say you’re in your late 40s, 50s, or even 60s, and you’re now determined to start an exercise program to maintain better health.
Exactly what kind of exercise should you do? What exercise modality will give you the best bang for your buck?
In other words, should you concentrate on aerobic training (AT), like putting on the trainers and jogging around the block? Or should you concentrate on resistance training (RT), stressing your muscles with machines or weights? Or should you spend time equally on both?
I’m not raising this question as a hypothetical. As an older adult, the exercise modality you chose to concentrate on may matter when it comes to optimizing your health benefits.
In this post, I’ll explore why I believe resistance training may be a better exercise protocol to emphasize if you’re an older adult.
Over seven years ago, I started to concentrate on resistance training (RT). While I still do a brisk walk almost everyday, RT is what I prioritize. Since I started RT, I’m stronger, healthier, and more agile than I’ve been in 30 years. If you’re interested in my current strength totals see here.
Let’s take a look at why RT may be the important exercise protocol for the older individual.
Before we do that, though, let’s first look at how much exercise the experts tell us we must engage in to obtain optimal health benefits.
How much exercise do we need?
To maintain optimal health the Mayo Clinic advises that average healthy adults get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly, or a combination of moderate and vigorous activity. They also recommend strength training at least two times a week, exercising all major muscle groups.
Okay, that’s the recommendation for the average adult. But what about older adults?
To help older people reduce the risk of chronic diseases associated with aging (cardiovascular disease, type 2 diabetes, and cancer), the American College of Sports Medicine (ACSM) recommends the same aerobic training (AT) guidelines as the Mayo Clinic.
They also recommend that older persons perform RT at least 2 days a week. This includes progressive weight training or weight bearing calisthenics (8-10 exercises involving the major muscle groups of 8-12 repetitions each).
Notice that there is no either or with these guidelines. The Mayo Clinic and the ACSM both recommend doing AT and RT on a regular basis.
So, if you’re an older adult, you should be getting at least 30 minutes a day of AT and at least 2 days of significant RT.
Now, most health professionals seem to stress AT as the best exercise modality for preventing the chronic diseases of aging.
But what if you as an older individual are for some reason unable to engage in 30 minutes of AT training every day?
For example, let’s say you’re 65 years old with arthritic knees. A 30 minute brisk walk every day might be too much for you.
Or maybe you’re 60 years old and live in North Dakota. Walking around the neighborhood in the middle of the winter might not be such a good idea.
Also, if you’re 55 years old, overweight, have type 2 diabetes, and haven’t exercised in years, a 30 minute daily stint on a treadmill might do you more harm than good.
Or what if you just hate AT because it bores you to death and you refuse to do it!
Does that mean that you as an older individual are consigned to a future of rapidly deteriorating health because you don’t engage in AT?
Not necessarily. I’ll answer that question shortly. Remember, we still have RT recommended by health professionals as a prescription for good health.
First, though, I want to introduce an important factor older individuals must consider when choosing exercise modalities.
Older people: don’t forget your muscles!
If you’re in your 50s or 60s, your muscular physiology is probably very different than it was when you were in your 20s or 30s. That’s obvious right!
However, here’s an important fact of aging.
After about the age of 35, everyone begins to lose muscle mass. This is called age-related sarcopenia. It’s one of the consequences of human aging that we can’t avoid. Like wrinkled skin and gray hair. I didn’t have to remind you of that, did I? Sorry.
However, and this is important, the loss of muscle due to aging is even more acute in someone who has been sedentary for years. That person can lose up to 5% of muscle mass per decade. Most men in fact will lose about 30% of muscle in their lifetime.
If you think that’s no big deal, consider why older people use walkers, higher toilets and prefer ranch homes.
The loss of muscle happens slowly and imperceptibly at first. But the day will come when you notice that your arms and legs are not as strong as they once were. They may not look like they’ve gotten weaker. That’s because our insatiable desire for donuts has caused some muscle to be replaced with fat.
But you know what? Your muscle mass is deteriorating, and unless you do something about it, your arms and legs are going to get a lot weaker.
Okay, that’s the bad news. Now the good news. We can slow down the process of muscle deterioration and even increase muscle mass and strength into old age.
Dr. Thomas W. Storer, director of the exercise physiology and physical function lab at Harvard-affiliated Brigham and Women’s Hospital, tells us,
Older men can indeed increase muscle mass lost as a consequence of aging. It takes work, dedication, and a plan, but it is never too late to rebuild muscle and maintain it.
As we’ll see later, Storer’s “plan” is the implementation of a good RT program.
Of course, Storer’s insight applies to women as well.
Now, here’s something to carefully consider. The loss of muscle mass will make you weaker. And it will also make you less healthy.
The lack of muscle mass and chronic disease
It appears that muscle loss is a recipe for a poor aging process. If you lose muscle you’ll get weaker, and if you’re weaker you’ll be more prone to falls. If you suffer a fall in old age, all kinds of bad things can happen. Some of us with older parents know that well.However, many of the diseases of aging are made even worse because people have lost too much muscle mass. Researchers now know that the loss of muscle mass can exacerbate insulin resistance. Insulin resistance is highly associated with type 2 diabetes. And type 2 diabetes is associated with several other metabolic diseases like cardiovascular disease and cancer.
We don’t know all the exact association between muscle loss and poor healing in the aged. But we know for sure that people with poor muscle quality don’t age as well as those who have better muscle mass.
So, we see here that RT is something older people must do. There’s no way around it. Without engaging in some kind of RT, a poor aging process is guaranteed.
A major limitation of AT for the older adult
As I said previously, health professionals usually prioritize AT as a prescription for warding off chronic diseases. If they can get their patients off the couch and moving around, it’s a major victory for them.
However, AT will do little to improve muscle quality and mass. Jogging around the block may strengthen your quads a little, but it will not build the muscle your body needs for a good health outcome.
I’m not saying this disqualifies AT as an important exercise strategy for the aging adult. But AT alone is not sufficient exercise for the aging adult.
However, what if we were to prioritize RT over AT as our exercise modality of choice? Would we seriously hurt our chances of aging well?
In other words, if RT gave us little benefit in our ability to fight off type 2 diabetes (T2D), cardiovascular disease, and cancer, would it really be an optimal exercise program? Probably not.
But what if RT helps us to significantly reduce our risk of developing the chronic diseases of aging while at the same time improves our muscle mass?
Then, if you’re an older person, it may be worth considering prioritizing RT over AT as an exercise modality.
Let’s take a look at what science actually says about how well RT does at improving our ability to fight the chronic diseases of aging.
Resistance training and increased mobility
Check out some of these statistics on falls among our aging population:
- One in four Americans aged 65+ falls each year.
- Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
- Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
There is little doubt that as we age the loss of mobility and strength are important factors contributing to falls.
Fortunately, there is now significant evidence (see here, here and here) that acombination of AT and RT have a profound effect in reducing age-related declines in physical mobility.
However, and here is the important question, is there an improvement in physical function in older individuals when RT alone is employed?
In fact, there is!
This umbrella review that included 6,927 pre-frail and frail older individuals showed that “resistance training alone also appeared to be beneficial, in particular for improving muscular strength, gait speed and physical performance.”
Another review of 33 randomized controlled trials of 2172 participants found that “PRT (progressive resistance training) is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities.”
After evaluating the data from 18 RCTs involving 2,580 participants, researchers found that in community-dwelling, mobility-impaired older adults, physical performance was better when strength training was incorporated into the exercise therapy program.
At this time, researchers are not sure which exercise modality, AT or RT, is the best for improving physical performance in the older person. However, there is little doubt that RT significantly improves performance and probably as much as AT.
How does RT improve physical function?
While RT will increase neurological function and bone density, the primary way RT increases physical function is through the increase of muscle mass.
As I mentioned before, a loss of muscle mass is associated with poor physical performance. RT is a potent stimulant for increasing muscular hypertrophy and mass. See here and here. Increased muscle mass means increased strength, and if you are stronger, then your physical performance will also increase.
Remember that AT alone cannot produce the same increase in skeletal muscle mass and strength as RT.
Okay, so far we have learned that AT and RT combined will probably give us the best opportunity for increasing physical performance. But RT alone is also a potent prescription for guarding against age-related declines in physical functioning.
How much RT is necessary to ward off frailty?
This meta-analysis found that high-intensity RT (≥70% of 1RM) tended to be more effective than low-to-moderate intensity RT (30–69% of 1RM) in combating loss of mobility.
In order to reach these kinds of 1RMs, it would appear that heavy-weight might have to be used. However this study found that body-weight exercises (e.g. body weight squats) alone could achieve similar results as those achieved by an external load such as free weights.
I should note here that all of the above studies are extremely difficult to perform. Different parameters such as exercise modalities, frequency of exercise, and measuring methods can differ from study to study.
However, I think it’s safe to say that RT alone is extremely effective in improving physical performance in older individuals.
Does resistance training help in the fight against type 2 diabetes?
As we age, our body’s sensitivity to insulin and subsequent glycemic control decreases. Again, it’s another one of those consequences of making it to your golden years.
Unfortunately, this predisposes older people to type 2 diabetes (T2D). In fact, about 26.8% of Americans over the age of 65 have T2D.
Now, there’s an important connection between muscle mass and T2D. After you eat,about 80% of the glucose from that meal is deposited into your skeletal muscle. If you don’t have a lot of skeletal muscle, then your body’s ability to effectively clear the glucose will be diminished.
Conversely, the more muscle you have, the better insulin sensitivity you’ll experience. The lack of insulin sensitivity (insulin resistance) is highly associated with T2D.
Scientific data has also shown that there’s an inverse relationship between lean body mass and insulin resistance. In older people, scientists have shown that this relationship is independent of obesity but does seem to be made worse by it.
Also, as most individuals grow older, their muscles weaken, and they move less. This small study showed that in elderly, obese, pre-diabetic individuals, after two weeks of inactivity (e.g. hospitalization or recovering from and illness), experienced worsening of glycemic control that did not correct after two weeks of normal activity.
Interestingly, in 2002, a Diabetes Prevention Program (DPP) study of individuals who were at a high risk for T2D, showed greater reduction (58 vs. 31%) in the incidence of T2D when diet and exercise were prescribed as opposed to therapy with the drug metformin. Metformin is one of the frontline pharmaceutical treatments for T2D.
Unfortunately, the main exercise protocol the DPP focused on was AT. There was little consideration of the beneficial effects of RT on glycemic control.
However, we do have some excellent data on the benefits of RT on glucose metabolism.
The benefits of RT on glucose metabolism
The scientific data appears to support resistance exercise training as an excellent prescription for attenuating the effects of impaired glucose metabolism.
In 2017, a study of 170, sedentary, obese, pre-diabetic adults, aged 50–69 was conducted. These individuals were placed on a 3 month, 2 times a week, progressive, supervised, whole-body (1 set at 70–80% of a one maximum repetition) resistance training program. The study revealed that after only three month, about 34% of the individuals were no longer pre-diabetic.
A large analysis conducted in 2012, on data taken from Health Professionals’ Study of approximately 32,000 men between the ages of 40–75 years, showed that men engaging in at least 150 min/week of RET had a 34% lower risk of developing diabetes over an 18-year period.
More recently, a 2017 meta-analysis of 360 older patients with T2D, who did RT for at least 8 weeks showed clinically relevant improvements in glycated-hemoglobin (HbA1c) and muscle strength.
One caveat to remember here is that these are association studies. Diet plays an important role in the formation and progression of insulin resistance. We don’t know in the above studies how much of a part diet played.
That, notwithstanding, it appears that there’s excellent data to support the conclusion that RT has an important role to play in prevention and treatment of insulin resistance in older adults.
How much resistance training is enough to help mitigate insulin resistance?
At this time, we don’t know exactly what optimal amount of RT provides the best help for glycemic control.
However, we do have some evidence. Gordon et al., preformed a systematic review in 2009 that suggested that exercise intensity is the key variable and that performing high-intensity RT (≥70% 1RM) results in the greatest improvement in glycemic control.
However, this 2017 study, of 62 T2D patients showed that when matched for volume, there was no significant difference in glycemic control with high- or low-intensity RET (75 vs. 50% of 1RM, respectively).
So the takeaway here is that RT is an excellent prescription for helping to improve glycemic control.
Does resistance exercise training help in the prevention of cardiovascular disease?
The CDC tells us that one person dies every 36 seconds in the United States from cardiovascular disease and about 655,000 Americans die from heart disease each year.
That’s about 25% of all deaths in a year in the U.S.!
There is little disagreement among health professionals that regular exercise, especially AT, will improve cardiovascular health.
So, it’s not difficult to see why physicians put a greater emphasis on AT rather than RT.
However, does RT also provide a significant benefit to cardiovascular health?
Consider some of these recent findings.
Health professionals’ follow-up study
In 2002, researchers examined data from the Health Professionals’ Follow-up Study with the intent to assess potential coronary heart disease (CHD) risk factors, identify newly diagnosed cases of CHD, and assess levels of leisure-time physical activity.
From the data of 44,452 men, researchers were able to conclude that RT for at least 30 min per week resulted in a similar risk reduction compared to 2.5 h of brisk walking in fatal and nonfatal myocardial infarction
Women’s health study
In 2017, researchers looked at data from 35,754 healthy women (mean age, 62.6 years, range 47.0 – 97.8) from the Women’s Health Study concerning the effect of RT on cardiovascular disease (CVD).
Researchers found that women engaging in 60–120 min of RT per week had a similar 22% reduced risk of incident CVD as women engaging in 60–120 min of AT per week.
Small comparison study
A small 1992 study of 37 previously untrained males (aged 50 ± 9 years) was performed to gauge the effect of RT and AT on CHD risk factor intervention.
Fourteen participants engaged in RT (whole-body, progressive 2 sets at 60–70% 1RM)), 13 in AT (treadmill walking/jogging (75–85% heart rate reserve)) and 10 did no exercise.
Researchers discovered at the end of 20 weeks that RT and AT have comparable effects on risk factors for CHD.
Okay, so here we have three independent studies that confirm that RT and AT produce similar results when it comes to reducing your chances of developing CVD.
I’ll throw in two more studies for good measure.
A 2017 study of 403,199 participants revealed that “men and women with greater GS (grip strength) had lower risks of all-cause and CVD mortality, independent of adiposity.”
Apparently, the stronger your muscles are, the lower your risk of dying from CVD.
Getting even more specific, this study showed that RT will improve several risk factors associated with CVD to the same degree as AT. These include blood pressure, blood lipids, insulin sensitivity, and vascular function.
Now check out the benefits RT will offer concerning one specific cardiac risk factor.
Resistance training and its positive effect on lowering blood pressure
Hypertension is a well known risk factor in the development of CDV. Physicians often recommend several life-style strategies to help treat hypertension. These include things like weight loss, lowering stress, and exercise.
But what about RT as a specific modality for lowering our blood pressure (BP)?
Two meta-analyses have shown that in healthy adults, RT can indeed reduce systolic and diastolic blood pressure to the same or greater degree than AT. See here, and here.
Notably the second meta-analyses also showed that individuals with hypertension also benefited from RT and even showed larger reductions in blood pressure than healthy individuals.
So, RT could be an important prescription for lowering the blood pressure for the over 100 million people suffering from hypertension.
Is RT training dangerous for your heart?
If RT is effective for lowering the risk of CVD, then why don’t more physicians prescribe it?
Doctors probably assume the risk of injury from RT is a lot higher than AT.
One specific worry is that high pressure loads from RT can cause cardiac hypertrophy or an enlarged heart. It is believed that this can lead to a higher death rate.
However, the evidence doesn’t seem to confirm this conclusion. Consider the following.
This study found that excessive blood pressure elevation is seen only with high-intensity RET (≥70% of 1RM) while lighter-to-moderate intensity RET (30–69% of 1RM) didn’t appear to be a concern.
The authors of the study state, “Weight lifting is a relatively safe sport with few instances where the excessive elevations in blood pressure, demonstrated in this paper, are known to result in injury.”
Note, however, this study was done on young healthy men.
Another study that pooled together data from five studies evaluating adverse events during low-to-moderate intensity RT (30–69% of 1RM) in older adults with CVD found that RT was actually associated with a lower rate of adverse cardiovascular complications than AT.
Finally, a recent meta-analysis of 653 older adults who have or at risk for developing CVD demonstrated that arterial stiffness (a risk factor for predicting CVD mortality) does not increase or worsen following RT.
So, there doesn’t seem to be sufficient evidence that RT is dangerous to your heart.
Here’s an important point about lower intensity training. If you do RT at a lower intensity, you won’t lose any of the benefits of improved blood pressure.
Okay, have I convinced you yet that RT might be the exercise you concentrate on to improve your aging process?
If you’re wavering, this might tip the scale. Let’s see if RT helps in reducing your cancer risk.
Does RT help to reduce the risk of getting cancer?
The American Cancer Society estimates that “in 2020, there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States.”
Researchers now know that there seems to be some common risk factors associated with many cancer diagnoses. In particular, T2D, CVD, obesity, and a sedentary lifestyle.
Since we know that exercise will improve the above factors, it makes sense that increasing your level of physical activity will reduce the risk of getting cancer, dying from cancer, and improving recovery from cancer treatment. See here.
But does RT specifically help in our fight against cancer?
This recent meta-analyses of over 80,000 adults over the age of 30 showed that performing RT (at least two times per week) was associated with a 34% reduced risk for cancer death.
However, adhering to the AT guidelines provided no statistical benefit.
A 2014 study of 2863 male and female cancer survivors, aged 18 to 81years old, showed that RT at least once a week reduced all-cause mortality by 33%.
This large cohort study from 2017 showed that following a diagnosis of cancer individuals who engaged in regular AT and RT “were observed to have a lower relative risk of cancer mortality and recurrence and experienced fewer/less severe adverse effects.”
These findings all make sense in light of the fact that increased muscularity is associated with an overall decrease in cancer mortality.
There have been several reasons offered for the positive effects RT has on reducing the risk of cancer. They include the following:
- Improved insulin sensitivity and body composition
- Improved immune function
- Decreased inflammatory response
- Increased secretion of myokines
So, as we can see, there is excellent evidence that RT is a potent prescription for reducing our risk of cancer.
What’s the best type of RT for warding off the chronic diseases of aging?
It’s difficult to definitively answer this question. It depends on your age, current health, goals, and lifestyle.
Initially, I started with dumbbells and a month later graduated to a barbell. I set up a power rack in my basement and started using the Starting Strength program.
There are, though, some parameters everyone can follow:
- Always check with your doctor first before you start any exercise program. Make sure he clears you for the program you want to do.
- The best program is the one you are committed to do.
- You don’t have to use a barbell or dumbbells. Bodyweight exercise (squats, push-ups, pull-ups) to failure (you can’t do any more) can be very effective for improving health. Resistance bands can also be used.
- Light-to-moderate relative loads (30–69% of 1RM) can be just as effective as lifting heavy relative loads (≥70% of 1RM) for exerting health benefits. See here.
Now if you think you’re too old to start strength training watch this.
So my last word is this. If Gussie can do it, you can do it. Just get up and do it!
Thanks for reading. God bless!
Intro photo : Image by Henryk Niestrój from Pixabay
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