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Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association

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Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association Original Research Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association Maren S. Fragala,1 Eduardo L. Cadore,2 Sandor Dorgo,3 Mikel Izquierdo,4 William J. Kraemer,5 Mark D. Peterson,6 and Eric D. Ryan7 1Quest Diagnostics, Secaucus, New Jersey; 2School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; 3Department of Kinesiology, University of Texas at El Paso, El Paso, Texas; 07/25/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3OleNjk5BaNwPefXLhnAlTZrujou63UXsScGTFDP3Ayw= by https://journals.lww.com/nsca-jscr from Downloaded Downloaded 4Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES), Navarrabiomed, Pamplona, Navarre, Spain; 5Department of Human Sciences, The Ohio State University, Columbus, Ohio; 6Department of Physical from Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, Michigan; and 7Department of Exercise and Sport Science, https://journals.lww.com/nsca-jscr University of North Carolina-Chapel Hill, Chapel Hill, North Carolina Abstract Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: by position statement from the national strength and conditioning association. J Strength Cond Res XX(X): 000–000, 2019—Aging, BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3OleNjk5BaNwPefXLhnAlTZrujou63UXsScGTFDP3Ayw= even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults. Key Words: strength training, elderly, frail, seniors, exercise, resistance exercise Summary Statements Part 1: Resistance Training Program Variables The purpose of this Position Statement is to provide an overview of the 1. A properly designed resistance training program with current and relevant literature, evaluate exercise program variables, appropriate instructions for exercise technique and proper and provide evidence-based recommendations for resistance training spotting is safe for healthy, older adults. for older adults. Current research has demonstrated that countering 2. A properly designed resistance training program for older on 07/25/2019 muscle disuse through resistance training is a powerful intervention to adults should include an individualized, periodized approach combat muscle strength loss, muscle mass loss (sarcopenia), physio- working toward 2–3setsof1–2 multijoint exercises per logical vulnerability (frailty), and their debilitating consequences on major muscle group, achieving intensities of 70–85% of 1 physical functioning, mobility, independence, chronic disease man- repetition maximum (1RM), 2–3 times per week, including agement, psychological well-being, and quality of life. power exercises performed at higher velocities in concentric A list of 11 summary statements for effective resistance training movements with moderate intensities (i.e., 40–60% of 1RM) in older adults is presented in 4 parts below. The goals of these 3. Resistance training programs for older adults should follow the recommendations are to (a) help foster a more unified and holistic principles of individualization, periodization, and progression. approach to resistance training for older adults, (b) promote the health and functional benefits of resistance training for older adults, and (c) prevent or minimize fears and other barriers to Part 2: Positive Physiological Adaptations to Resistance implementation of resistance training programs for older adults. Exercise Training in Older Adults Address correspondence to Maren S. Fragala, Maren.S.Fragala@ QuestDiagnostics.com. 4. A properly designed resistance training program can Journal of Strength and Conditioning Research 33(8)/2019–2052 counteract the age-related changes in contractile function, ª 2019 National Strength and Conditioning Association atrophy, and morphology of aging human skeletal muscle. 2019 Copyright © 2019 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited. Resistance Training for Older Adults (2019) 33:8 5. A properly designed training program can enhance the beginning after age 30 and accelerating after age 60 (413). Pre- muscular strength, power, and neuromuscular functioning vious longitudinal studies (199,225) have suggested that muscle of older adults. mass decreases by 1.0–1.4% per year in the lower limbs, which is 6. Adaptations to resistance training in older adults are more than the rate of loss reported in upper-limb muscles mediated by neuromuscular, neuroendocrine, and hor- (207,298). Sarcopenia is considered part of the causal pathway monal adaptations to training. for strength loss (200,494), disability, and morbidity in older adult populations (518). Yet, muscle weakness is highly associ- ated with both mortality and physical disability, even when Part 3: Functional Benefits of Resistance Exercise Training adjusting for sarcopenia, indicating that muscle mass loss may be for Older Adults secondary to the effects of strength loss (124). 7. A properly designed resistance training program can The contribution of age-related losses in muscle mass to improve mobility, physical functioning, performance in functional decline is mediated largely by reductions in muscle activities of daily living (ADL), and preserve the indepen- strength (409,456,632). The rate of decline in muscle strength dence of older adults. with age is 2–5 times greater than declines in muscle size (155). As 8. A properly designed resistance training program can such, thresholds of clinically relevant muscle weakness (grip improve an older adult’s resistance to injuries and strength of ,26 kg in men and ,16 kg in women) have been catastrophic events such as falls. established (14) as a biomarker of age-related disability and early 9. A properly designed resistance training program can help mortality. These thresholds have been shown to be strongly re- improve the psychosocial well-being of older adults. lated to incident mobility limitations and mortality (409). In ad- dition, the European Working Group on Sarcopenia in Older People recently updated their recommendations to focus on low Part 4: Considerations for Frailty, Sarcopenia, or other muscle strength as the key characteristic of sarcopenia and use Chronic Conditions detection of low muscle quantity and quality to confirm the sar- 10. Resistance training programs can be adapted for older copenia diagnosis (138). Given these links, grip strength (a robust adults with frailty, mobility limitations, cognitive impair- proxy indicator of overall strength) (192) has been labeled “ ” ment, or other chronic conditions. a biomarker of aging (526). Losses in strength may translate to 11. Resistance training programs can be adapted (with functional challenges because decreases in specific force and portable equipment and seated exercise alternatives) to power are observed (155,225,292,412). Declines in muscle accommodate older adults residing in assisted living and power have been shown to be more important than muscle skilled nursing facilities. strength in the ability to perform daily activities (37,292). Moreover, a large body of evidence links muscular weakness to a host of negative age-related health outcomes including diabetes Introduction (469), disability (407,409), cognitive decline (13,74,85,590), osteoporosis (406), and early all-cause mortality Effect of Age on Skeletal Muscle Mass and Strength (367,409,470,653). Aging, even in the absence of chronic disease, is associated with Age-related changes in skeletal muscle mass, strength, and a variety of biological changes that can contribute to decreases in function may be attributable to a variety of mechanisms, in- skeletal muscle mass, strength, and function, leading to a general cluding disuse, impaired protein synthesis, and chronic in- decrease in physiological
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