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Medicine & Science in Sports & Exercise:
Clinical Sciences: Symposium: Resistance Training For Health And Disease

Exercise training guidelines for the elderly


Section Editor(s): Pollock, Michael L.

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Nutrition, Metabolism and Exercise Program, Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72114

Submitted for publication June 1997.

Accepted for publication February 1998.

Support for this project was received from National Institutes of Health Grant RO1-AG-11811.

Address for correspondence: William J. Evans, Ph.D., Director, Nutrition, Metabolism and Exercise Program, Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, VA Medical Center, 2200 Fort Roots Drive Slot NMEL/NLR, North Little Rock, AR 72114. E-mail:

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Exercise training guidelines for the elderly. Med. Sci. Sports Exerc., Vol. 31, No. 1, pp. 12-17, 1999. The capacity of older men and women to adapt to increased levels of physical activity is preserved, even in the most elderly. Aerobic exercise results in improvements in functional capacity and reduced risk of developing Type II diabetes in the elderly. High-intensity resistance training (above 60% of the one repetition maximum) has been demonstrated to cause large increases in strength in the elderly. In addition, resistance training result in significant increases in muscle size in elderly men and women. Resistance training has also been shown to significantly increase energy requirements and insulin action of the elderly.

Purpose: We have recently demonstrated that resistance training has a positive effect on multiple risk factors for osteoporotic fracture in previously sedentary postmenopausal women.

Methods: Because the sedentary lifestyle of a long-term care facility may exacerbate losses of muscle function, we have applied this same training program to frail, institutionalized elderly men and women.

Results: In a population of 100 nursing home residents, a randomly assigned high-intensity strength-training program resulted in significant gains in strength and functional status. In addition, spontaneous activity, measured by activity monitors, increased significantly in those participating in the exercise program whereas there was no change in the sedentary control group. Before the strength training intervention, the relationship of whole body potassium and leg strength was seen to be relatively weak (r2 = 0.29, P < 0.001), indicating that in the very old, muscle mass is an important but not the only determining factor of functional status.

Conclusions: Thus, exercise may minimize or reverse the syndrome of physical frailty, which is so prevalent among the most elderly. Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise than the elderly.

Advancing age is associated with a remarkable number of changes in body composition. Reductions in lean body mass have been well characterized. This decreased lean body mass occurs primarily as a result of losses in skeletal muscle mass (9,26). This age-related loss in muscle mass has been termed sarcopenia (4). Loss in muscle mass accounts for the age-associated decreases in basal metabolic rate (BMR), muscle strength, and activity levels, which, in turn are the cause of the decreased energy requirements of the elderly. In sedentary individuals, the main determinant of energy expenditure (EE) is fat-free mass, which declines by about 15% between the 3rd and 8th decade of life. It also appears that declining caloric needs are not matched by a appropriate decline in caloric intake, with the ultimate result an increased body fat content with advancing age. Increased body fatness along with increased abdominal obesity are thought to be directly linked to the greatly increased incidence of Type II diabetes among the elderly.

Age-related reductions in muscle is a direct cause of the age-related decrease in muscle strength. Our laboratory (9) recently examined muscle strength and mass in 200 healthy 45- to 78-yr-old men and women and concluded that muscle mass (not function) is the major determinant of the age and sex-related differences in strength. This relationship is independent of muscle location (upper vs lower extremities) and function (extension vs flexion). Reduced muscle strength in the elderly is a major cause for their increased prevalence of disability. With advancing age and very low activity levels seen in the very old, muscle strength and power are critical components of walking ability (1). The high prevalence of falls among the institutionalized elderly may be a consequence of their lower muscle strength.

The question that we have been attempting to address is: To what extent are these changes inevitable consequences of aging? Our data suggest that changes in body composition and aerobic capacity that are associated with increasing age may not be age-related at all. By examining endurance-trained men, we saw that body fat stores and maximal aerobic capacity were not related to age but rather to the total number of hours these men were exercising per week (19). Even among sedentary individuals, energy spent in daily activities explains more than 75% of the variability in body fatness among young and older men (22). These data and the results of other investigators indicate that levels of physical activity are important in determining EE and ultimately body fat accumulation.

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Aerobic exercise has long been an important recommendation for those with many of the chronic diseases typically associated with old age. These include non-insulin dependent diabetes mellitus or NIDDM (and those with impaired glucose tolerance), hypertension, heart disease, and osteoporosis. Regularly performed aerobic exercise increases V˙O2max and insulin action. The responses of initially sedentary young (age 20-30 yr) and older (age 60-70 yr) men and women to 3 months of aerobic conditioning (70% of maximal heart rate (HR), 45 min·d−1, 3 d per week) were examined by Meredith et al. (18). They found that the absolute gains in aerobic capacity were similar between the two age groups. However, the mechanism for adaptation to regular submaximal exercise appears to be different between old and young people. Muscle biopsies taken before and after training showed a more than twofold increase in oxidative capacity of the muscles of the older subjects, whereas that of the young subjects showed smaller improvements. In addition, skeletal muscle glycogen stores in the older subjects, significantly lower than those of the young men and women initially, increased significantly. The degree to which the elderly demonstrate increases in maximal cardiac output in response to endurance training is still largely unanswered. Seals and coworkers (24) found no increases after 1 yr of endurance training whereas, more recently, Spina et al. (25) observed that older men increased maximal cardiac output whereas healthy older women demonstrated no change in response to endurance exercise. If these gender-related differences in cardiovascular response are real, it may explain the lack of response in maximal cardiac output when older men and women are included in the same study population.

The fact that aerobic exercise has significant effects on skeletal muscle may help explain its importance in the treatment of glucose intolerance and NIDDM. Hughes and coworkers (14) demonstrated that regularly performed aerobic exercise without weight loss resulted in improved glucose tolerance, rate of insulin stimulated glucose disposal, and increased skeletal muscle GLUT 4 levels in older glucose intolerance subjects. In this investigation, a moderate intensity aerobic exercise program was compared with a higher intensity program (50 vs 75% of maximal HR reserve, 55 min·d−1, 4 d·wk−1, for 12 wk). No differences were seen between the moderate and higher intensity aerobic exercise on glucose tolerance, insulin sensitivity, or muscle GLUT-4 levels, indicating perhaps that a prescription of moderate aerobic exercise should be recommended for older men or women with NIDDM or a high risk for NIDDM to help to ensure compliance to the program. Although Seals and coworkers (23) found that a high-intensity training program showed greater improvements in the insulin response to an oral glucose load compared with lower intensity aerobic exercise, their subjects began the study with normal glucose tolerance. Kirwan and coworkers (15) found that 9 months of endurance training at 80% of the maximal HR (4 d·wk−1) resulted in reduced glucose stimulated insulin levels; however, no comparison was made to a lower-intensity exercise group.

Endurance training and dietary modifications are generally recommended as the primary treatment in the non-insulin-dependent diabetic. Cross-sectional analysis of dietary intake supports the hypothesis that a low carbohydrate/high fat diet is associated with the onset of NIDDM (17). This evidence, however, is not supported by prospective studies in which dietary habits have not been related to the development of NIDDM (6,16). The effects of a high carbohydrate diet on glucose tolerance have been equivocal (2,11). Hughes et al. (13) compared the effects of a high carbohydrate (60% CHO and 20% fat)/high fiber (25 g dietary fiber/1000 kcal) diet with and without 3 months of high-intensity (75% max HR reserve, 50 min·d−1, 4 d·wk−1) endurance exercise in older, glucose intolerant men and women. Subjects were fed all of their food on a metabolic ward during the 3 months of the study and were not allowed to lose weight. They observed that neither the diet or the diet plus exercise group improved their glucose tolerance or insulin-stimulated glucose uptake. Thus, when combined with exercise, a high carbohydrate diet had a counterregulatory effect.

There appears to be no attenuation of the response of elderly men and women to regularly performed aerobic exercise when compared with those seen in young subjects. Increased fitness levels are associated with reduced mortality and increased life expectancy. It has also been shown (12) to prevent the occurrence of NIDDM in those that are at the greatest risk for developing this disease. Thus, regularly performed aerobic exercise is an important way for older people to improve their glucose tolerance.

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Increasing Levels of Physical Activity in the Elderly

Community-based exercise programs for men and women over the age of 50 yr are growing in popularity. For individuals participating in such programs, physician screening for every participant may be either impractical or a barrier to participation.

1. The American College of Sports Medicine recommends a physician-supervised stress test for anyone over the age of 50 yr who wants to begin a vigorous training program. However, if the general recommendation is for an older person to simply walk or participate in a resistance training program, this test is probably not necessary. However, you should use the following questions to determine whether this individual should be carefully examined by a physician. This questionnaire was developed by Maria Fiatarone, M.D., for use in a state-wide, community-based exercise program for men and women over the age of 50 yr. Individuals who answered yes to any of the following questions were strongly encouraged to speak to a physician before participation.

Do I get chest pains while at rest and/or during exertion?

If the answer to question A is "yes," is it true that I have not had a physician diagnose these pains yet?

Have I ever had a heart attack?

If the answer to question C is "yes," was my heart attack within the last year?

Do I have high blood pressure?

If you do not know the answer to question E, answer this: Was my last blood pressure reading more than 150/100?

Am I short of breath after extremely mild exertion and sometimes even at rest or at night in bed?

Do I have any ulcerated wounds or cuts on my feet that do not seem to heal?

Have I lost 10 pounds or more in the past 6 months without trying and to my surprise?

Do I get pain in by buttocks or the back of my legs-my thighs and calves-when I walk?

While at rest, do I frequently experience fast irregular heartbeats or, at the other extreme, very slow beats? (Although a low HR can be a sign of an efficient and well-conditioned heat, a very low rate can also indicate a nearly complete heart block.)

Am I currently being treated for any heart or circulatory condition, such as vascular disease, stroke, angina, hypertension, congestive heart failure, poor circulation in the legs, valvular heart disease, blood clots, or pulmonary disease?

As an adult, have I ever had a fracture of the hip, spine, or wrist?

Did I fall more than twice in the past year (no matter what the reason)?

Do I have diabetes?

In our experience, this sort of questionnaire is effective in identifying individuals who may be at a higher risk than the general population of men and women over the age of 50 yr. Our Massachusetts-wide program (titled "Keep Moving-Fitness after 50") was a community based walking program for men and women over the age of 50 yr. At its peak, between 7500 and 8000 men and women (average age of 67 ± 5 yr old) had registered and participated. Walking "clubs" were located throughout the state in nursing homes, retirement communities, hospitals, and councils on aging (buildings that housed many of the activities provided by the Massachusetts Executive Office of Elder Affairs). The questionnaire was approved by a medical advisory board for this program. During the 8-yr existence of the program, there were no reports of a myocardial infarction, cardiac arrest, or any cardiovascular "event" during the exercise training session.

2. Advancing age results in increased muscle stiffness and reduced elasticity of connective tissue. For this reason, proper warm-up and stretching can have a greater effect in reducing the risk of an orthopedic injury in the elderly than in young men and women. A 5-min warm-up (exercise at a reduced intensity) followed by 5-10 min of slow stretching is highly recommended.

3. Cool down after exercise is important in older individuals. You should never finish a workout by immediately jumping into a hot shower. End your exercise session with a slow walk and more stretching. Your postexercise stretching will be more effective than the stretching you did before the exercise. This is because your muscles have warmed up and, along with tendons and ligaments, are much more elastic.

4. Find a friend to exercise with. The more people you exercise with, the more likely you are to stay with the exercise. This is a perfect opportunity for sons and daughters to spend time with their older parents, to the benefit of both generations.

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Strength Training

Although endurance exercise has been the more traditional means of increasing cardiovascular fitness, strength or resistance training is currently recommended by the American College of Sports Medicine as an important component of an overall fitness program. This is particularly important in the elderly, in whom loss of muscle mass and weakness are prominent deficits.

Strength conditioning or progressive resistance training is generally defined as training in which the resistance against which a muscle generates force is progressively increased over time. Progressive resistance training involves few contractions against a heavy load. The metabolic and morphological adaptations resistance and endurance exercise are quite different. Muscle strength has been shown to increase in response to training between 60 and 100% of the one repetition maximum (1 RM); 1 RM is the maximum amount of weight that can be lifted with one contraction. Strength conditioning will result in an increase in muscle size and this increase in size is largely the result of increased contractile proteins. The mechanisms by which the mechanical events stimulate an increase in RNA synthesis and subsequent protein synthesis are not well understood. Lifting weight requires that a muscle shorten as it produces force. This is called a concentric contraction. Lowering the weight, on the other hand, forces the muscle to lengthen as it produces force. This is an eccentric muscle contraction. These lengthening muscle contractions have been shown to produce ultrastructural damage that may stimulate increased muscle protein turnover (5).

Our laboratory examined the effects of high-intensity resistance training of the knee extensors and flexors (80% of 1RM, 3 d·wk−1) in older men (age 60-72 yr). The average increase in knee flexor and extensor strength were 227% and 107%, respectively. CT scans and muscle biopsies were used to determine muscle size. Total muscle area by CT analysis increased by 11.4%, whereas the muscle biopsies showed an increase of 33.5% in Type I fiber area and 27.5% increase in Type II fiber area. In addition, lower body V˙O2max increased significantly whereas upper body V˙O2max did not, indicating that increased muscle mass can increase maximal aerobic power. It appears that the age-related loss in muscle mass may be an important determinant in the reduced maximal aerobic capacity seen in elderly men and women (8). Improving muscle strength can enhance the capacity of many older men and women to perform many activities such as climbing stairs, carrying packages, and even walking.

We have applied this same training program to a group of frail, institutionalized elderly men and women (mean age 90 ± 3 yr, range 87-96). After 8 wk of training, the 10 subjects in this study increased muscle strength by almost 180% and muscle size by 11%. More recently (7), a similar intervention on frail nursing home residents demonstrated not only increases in muscle strength and size, but increased gait speed, stair climbing power, and balance. In addition, spontaneous activity levels increased significantly whereas the activity of a nonexercised control group was unchanged. It should be pointed out that this was a very old, very frail population with diagnoses of multiple chronic diseases. The increase in overall levels of physical activity have been a common observation in our studies (7,10,21). Because muscle weakness is a primary deficit in many older individuals, increased strength may stimulate more aerobic activities like walking and cycling.

In addition to its effect on increasing muscle mass and function, resistance training can also have an important effect on energy balance of elderly men and women (3). Men and women participating in a resistance training program of the upper and lower body muscles required approximately 15% more calories to maintain body weight after 12 wk of training when compared with their pretraining energy requirements. This increase in energy need came about as a result of an increased resting metabolic rate (RMR), the small energy cost of the exercise, and what was presumed to be an increase in the energy cost of increase protein metabolism. Because resistance training can preserve or even increase muscle mass during weight loss, this type of exercise for those older men and women who must loose weight may be of genuine benefit. Although endurance training has been demonstrated to be an important adjunct to weight loss programs in young men an women by increasing their daily energy expenditure, its utility in treating obesity in the elderly may not be great. This is because many sedentary older men and women do not spend many calories when they perform endurance exercise, because of their low fitness levels. Thirty to forty minutes of exercise may increase energy expenditure by only 100-200 kcal with very little residual effect on calorie expenditure. Aerobic exercise training will not preserve lean body mass to any great extent during weight loss. Recently, strength training was demonstrated to cause improved glucose tolerance in elderly subjects (20). By improving bone density, muscle mass, strength, balance, and overall levels of physical activity, resistance training has been recently (21) demonstrated to be an important way to decrease the risk for an osteoporotic bone fracture in postmenopausal women.

Muscle strength training in the elderly. Muscle strength training can be accomplished by virtually anyone. Many health care professionals have directed their patients away from strength training in the mistaken belief that it can cause undesirable elevations in blood pressure. With proper technique, the systolic pressure elevation during aerobic exercise is far greater than that seen during resistance training. Muscle strengthening exercises are rapidly becoming a critical component to cardiac rehabilitation programs as clinicians realize the need for strength as well as endurance for many activities of daily living.

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Adults of all ages:

* Elderly, hypertensive patients should be carefully evaluated before beginning a strength training program.

* Instead of a treadmill stress test, we use a weight-lifting stress test. Have the patient perform three sets of eight repetitions at approximately 80% of the one repetition maximum. Monitor ECG and blood pressure responses during the exercise.

* Patients with rheumatoid or osteoarthritis may also participate. Patients with a limited range of motion should train within the range of motion that is relatively pain free. Most patients will see a dramatic improvement in the pain-free range of motion as a result of resistance training.

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* Resistance training should be directed at the large muscle groups that are important in everyday activities, including the shoulders, arms, spine, hips, and legs.

* Each repetition is performed slowly through a full range of motion, allowing 2-3 s to lift the weight (concentric contraction) and 4-6 s to lower the weight. (eccentric contraction).

* Performing the exercise more quickly will not enhance strength gains and may increase the risk of an injury.

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Training Intensity and Duration

* A high-intensity resistance training program has been shown to have the most dramatic effects at all ages. This is a training intensity that will approach or result in muscular fatigue after it has been lifted and lowered with proper form 8-12 times. A weight that you can lift 20 or more times will increase your muscular endurance, but not result in much of a gain in strength or muscle mass.

* The amount of weight that is lifted should increase as strength builds. This should take place about every 2 to 3 wk. In our research studies, we have seen a 10-15% increase in strength per week during the first 8 wk of training.

* We have seen significant gains in muscle strength and mass as well as an improvement in bone density with only 2 d·wk−1 of training.

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Breathing Technique

* Inhale before a lift, exhale during the lift, and inhale as the weight is lowered to the beginning position.

* You should avoid performing the Valsalva maneuver (holding your breath during force production).

* With proper breathing technique, the cardiovascular stress of resistance exercise is minimal.

* HR and blood pressure should rise only slightly above resting values in the elderly who follow these guidelines.

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* Any device that provides sufficient resistance to stress muscles beyond levels usually encountered may be used.

* Weight stack or compressed-air resistance machines may be found at many community fitness facilities or purchased for home use.

* Simple weight-lifting devices might include Velcro-strapped wrist and ankle bags filled with sand or lead shot, or heavy household objects, such as plastic milk jugs filled with water or gravel, or food cans of various sizes.

With interest in the establishment of community-based exercise programs for the elderly increasing, the following are recommendations that may be of help:

1. Work with local or state agencies. Often, state agencies for aging have some small amount of resources set aside for health-related activities. The individual working in these agencies have access to the elderly population in your area.

2. Use an already-developed infrastructure. Councils on aging may have a facility specifically for programs to serve the elderly. Contact your local hospital, YMCA, or university.

3. Promote and advertise your program as a "social" exercise program. Often, older women and men will join programs because of increase opportunity for socialization, not necessarily for fitness benefits.

4. More women than men will join. Use strategies to increase your recruitment of men.

5. Plan for a wide variability in functional status. Highly fit and very frail individuals are likely to join. If you establish a walking program, plan for at least two groups, slow and fast.

6. Form a medical advisory group from local physicians.

7. Attempt to incorporate some resistance exercise in any newly established program.

In conclusion, there is no other group in our society that can benefit more from regularly performed exercise, than the elderly. Although both aerobic and strength conditioning are highly recommended, only strength training can stop or reverse sarcopenia. Increased muscle strength and mass in the elderly can be the first step toward a lifetime of increased physical activity and a realistic strategy for maintaining functional status and independence.

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21. Nelson, M. E., M. A. Fiatarone, C. M. Morganti, I. Trice, R. A. Greenberg, and W. J. Evans. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. JAMA 272:1909-1914, 1994.

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Swislocki, A; Green, JA; Heinrich, G; Barnett, CA; Meadows, ID; Harmon, EB; Rank, MF; Noth, RH
American Journal of Managed Care, 16(6): 427-433.

Gaceta Medica De Mexico
Frailty, an enigmatic and controversial concept in geriatrics. The biological perspective
Avila-Funes, JA; Aguilar-Navarro, S; Melano-Carranza, E
Gaceta Medica De Mexico, 144(3): 255-262.

Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Physical Activity as a Preventative Factor for Frailty: The Health, Aging, and Body Composition Study
Peterson, MJ; Giuliani, C; Morey, MC; Pieper, CF; Evenson, KR; Mercer, V; Cohen, HJ; Visser, M; Brach, JS; Kritchevsky, SB; Goodpaster, BH; Rubin, S; Satterfield, S; Newman, AB; Simonsick, EM
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 64(1): 61-68.
Medizinische Klinik
Physical Activity for Prevention and Therapy of Internal Diseases in the Elderly
Weisser, B; Preuss, M; Predel, HG
Medizinische Klinik, 104(4): 296-302.
International Journal of Sports Medicine
Test-retest reproducibility and inter-rater reliability of a motor skill test battery for adults
Rinne, MB; Pasanen, ME; Miilunpalo, SI; Oja, P
International Journal of Sports Medicine, 22(3): 192-200.

Physical Therapy
Maximum voluntary activation in nonfatigued and fatigued muscle of young and elderly individuals
Stackhouse, SKS; Stevens, JE; Lee, SCK; Pearce, KM; Snyder-Mackler, L; Binder-Macleod, SA
Physical Therapy, 81(5): 1102-1109.

Journal of Nutrition
Nutrition and healthy functioning in the developing world
Zohoori, N
Journal of Nutrition, 131(9): 2429S-2432S.

Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Low- or high-intensity strength training partially restores impaired quadriceps force accuracy and steadiness in aged adults
Hortobagyi, T; Tunnel, D; Moody, J; Beam, S; DeVita, P
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 56(1): B38-B47.

Aging Clinical and Experimental Research
Effectiveness of a home-based strengthening program for elderly males in Italy. A preliminary study
Capodaglio, P; Facioli, M; Burroni, E; Giordano, A; Ferri, A; Scaglioni, G
Aging Clinical and Experimental Research, 14(1): 28-34.

Primary Care
Preventive health care for older patients
Parks, SM; Hsieh, C
Primary Care, 29(3): 599-+.
PII S0095-4543(02)00005-2
Aging Clinical and Experimental Research
Anabolic and catabolic hormonal responses to experimental two-set low-volume resistance exercise in sedentary and active elderly people
Kostka, T; Patricot, MC; Mathian, B; Lacour, JR; Bonnefoy, M
Aging Clinical and Experimental Research, 15(2): 123-130.

Psychology and Aging
Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies
Netz, Y; Wu, MJ; Becker, BJ; Tenenbaum, G
Psychology and Aging, 20(2): 272-284.
European Journal of Applied Physiology
Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men
Bottaro, M; Machado, SN; Nogueira, W; Scales, R; Veloso, J
European Journal of Applied Physiology, 99(3): 257-264.
Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Can neuromuscular strength and function in people with dementia be rehabilitated using resistance-exercise training? Results from a preliminary intervention study
Thomas, VS; Hageman, PA
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 58(8): 746-751.

Clinical Physiology and Functional Imaging
Suppression of heart rate variability after supramaximal exertion
Niewiadomski, W; Gasiorowska, A; Krauss, B; Mroz, A; Cybulski, G
Clinical Physiology and Functional Imaging, 27(5): 309-319.
British Journal of Sports Medicine
Differential effects of strength versus power training on bone mineral density in postmenopausal women: a 2-year longitudinal study
von Stengel, S; Kemmler, W; Lauber, D; Kalender, WA; Engelke, K
British Journal of Sports Medicine, 41(): 649-655.
Osteoporosis International
Heritability of impaired balance: a nationwide cohort study in twins
Wagner, H; Melhus, H; Pedersen, NL; Michaelsson, K
Osteoporosis International, 20(4): 577-583.
Journal of Women & Aging
The Influence of the Built Environment and Other Factors on the Physical Activity of Older Women from Different Ethnic Communities
Bird, S; Kurowski, W; Feldman, S; Browning, C; Lau, R; Radermacher, H; Thomas, S; Sims, J
Journal of Women & Aging, 21(1): 33-47.
Sports Medicine
Physical activity, cardiometabolic health and older adults - Recent findings
Pescatello, LS
Sports Medicine, 28(5): 315-323.

Clinical and Investigative Medicine
Exercise training and heart rate variability in older adult female subjects
Madden, KM; Levy, WC; Stratton, JR
Clinical and Investigative Medicine, 29(1): 20-28.

Geriatrics & Gerontology International
Functional benefits of combined resistance training with nutritional interventions in older adults: A review
Breen, L; Stewart, CE; Onambele, GL
Geriatrics & Gerontology International, 7(4): 326-340.
Physical Therapy
The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty
Lewek, M; Stevens, J; Snyder-Mackler, L
Physical Therapy, 81(9): 1565-1571.

International Journal of Sports Medicine
Resistance Training and Neuromuscular Performance in Seniors
Granacher, U; Gruber, M; Gollhofer, A
International Journal of Sports Medicine, 30(9): 652-657.
Ageing & Society
The effects of a physical activity programme on the psychological wellbeing of older people in a residential care facility: an experimental study
Ciairano, S; Liubicich, ME; Rabaglietti, E
Ageing & Society, 30(): 609-626.
Journal of Clinical Endocrinology & Metabolism
Anabolic interventions for aging-associated sarcopenia
Bross, R; Javanbakht, M; Bhasin, S
Journal of Clinical Endocrinology & Metabolism, 84(): 3420-3430.

Sports Medicine
Exercise prescription for the elderly - Current recommendations
Mazzeo, RS; Tanaka, H
Sports Medicine, 31(): 809-818.

Journal of Aging and Physical Activity
Effects of an 8-week multimodal exercise program on strength, flexibility, and golf performance in 55-to 79-year-old men
Thompson, CJ; Osness, WH
Journal of Aging and Physical Activity, 12(2): 144-156.

Australian Journal of Physiotherapy
Effects of a water-based program on women 65 years and over: A randomised controlled trial
Devereux, K; Robertson, D; Briffa, NK
Australian Journal of Physiotherapy, 51(2): 102-108.

Journal of Science and Medicine in Sport
A comparison of periodised and fixed repetition training protocol on strength in older adults
DeBeliso, M; Harris, C; Spitzer-Gibson, T; Adams, KJ
Journal of Science and Medicine in Sport, 8(2): 190-199.

American Journal of Human Biology
Effects of progressive strength training on the performance of the Functional Reach Test and the Timed Get-Up-and-Go Test in an elderly population from the rural north of Portugal
Sousa, N; Sampaio, J
American Journal of Human Biology, 17(6): 746-751.
Archives of Physical Medicine and Rehabilitation
Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial
Faber, MJ; Bosscher, RJ; Paw, MJCA; van Wieringen, PC
Archives of Physical Medicine and Rehabilitation, 87(7): 885-896.
European Respiratory Journal
Cardiopulmonary stress during exercise training in patients with COPD
Probst, VS; Troosters, T; Pitta, F; Decramer, M; Gosselink, R
European Respiratory Journal, 27(6): 1110-1118.
International Journal of Sports Medicine
Physical activity and oxidative stress during aging
Polidori, MC; Mecocci, P; Cherubini, A; Senin, U
International Journal of Sports Medicine, 21(3): 154-157.

American Family Physician
Promoting and prescribing exercise for the elderly
Nied, RJ; Franklin, B
American Family Physician, 65(3): 419-426.

European Journal of Applied Physiology
The effects of resistance training on functional outcomes in patients with chronic obstructive pulmonary disease
Panton, LB; Golden, J; Broeder, CE; Browder, KD; Cestaro-Seifer, DJ; Seifer, FD
European Journal of Applied Physiology, 91(4): 443-449.
Journal of Orthopaedic & Sports Physical Therapy
Total knee arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches
Meier, W; Mizner, R; Marcus, R; Dibble, L; Peters, C; Lastayo, PC
Journal of Orthopaedic & Sports Physical Therapy, 38(5): 246-256.
International Journal of Behavioral Medicine
The relations between musculoskeletal diseases and mobility among old people: Are they influenced by socio-economic, psychosocial, and behavioral factors?
Avlund, K; Osler, M; Damsgaard, MT; Christensen, U; Schroll, M
International Journal of Behavioral Medicine, 7(4): 322-339.

Experimental Gerontology
Glucose regulation and oxidative stress in healthy centenarians
Barbieri, M; Rizzo, MR; Manzella, D; Grella, R; Ragno, E; Carbonella, M; Abbatecola, AM; Paolisso, G
Experimental Gerontology, 38(): 137-143.
PII S0531-5565(02)00153-5
Journal of Electromyography and Kinesiology
Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly
Pijnappels, M; Reeves, ND; Maganaris, CN; Van Dieen, JH
Journal of Electromyography and Kinesiology, 18(2): 188-196.
Nursing Clinics of North America
The role of exercise in the prevention and treatment of osteoporosis and osteoarthritis
Sharkey, NA; Williams, NI; Guerin, JB
Nursing Clinics of North America, 35(1): 209-+.

Therapeutische Umschau
Physical therapy for the elderly
Ongaro, G; Zwisler, C; Grob, D
Therapeutische Umschau, 58(8): 497-502.

Clinical Orthopaedics and Related Research
Breakout session 3: Issues related to muscle growth, atrophy, and tissue engineering
Caiozzo, VJ; Green, S
Clinical Orthopaedics and Related Research, (): S252-S261.
Annals of Internal Medicine
Mens sana in corpore sano
Podewils, LJ; Guallar, E
Annals of Internal Medicine, 144(2): 135-136.

Clinical Rehabilitation
Effect of additional functional exercises on balance in elderly people
de Bruin, ED; Murer, K
Clinical Rehabilitation, 21(2): 112-121.
Journal of Human Kinetics
Hemodynamic effects of strength exercises
Niewiadomski, W; Pilis, A; Kwiatkowska, D; Gqsiorowska, A; Cybulski, G; Strasz, A; Chrzanowski, J; Langfort, J
Journal of Human Kinetics, 18(): 45-62.

Physician and Sportsmedicine
Rejuvenating patients - One step at a time
Schwenk, TL
Physician and Sportsmedicine, 27(): 3-+.

Journal of Applied Physiology
Power training is more effective than strength training for maintaining bone mineral density in postmenopausal women
Stengel, SV; Kemmler, W; Pintag, R; Beeskow, C; Weineck, J; Lauber, D; Kalender, WA; Engelke, K
Journal of Applied Physiology, 99(1): 181-188.
Aging Clinical and Experimental Research
Physical activity and performance in older persons with musculoskeletal impairment: results of a pilot study with 9-month follow-up
Cecchi, F; Pasquini, G; Chiti, M; Lova, RM; Enock, E; Nofri, G; Paperini, A; Conti, AA; Mannoni, A; Macchi, C
Aging Clinical and Experimental Research, 21(2): 122-128.

Journal of the American Geriatrics Society
In the steps of giants: The early geriatrics texts
Chase, P; Mitchell, K; Morley, JE
Journal of the American Geriatrics Society, 48(1): 89-94.

Archives of Medical Research
Bone mineral density and its related factors in elderly male Chinese patients with type 2 diabetes
Xu, L; Cheng, M; Liu, XQ; Shan, PY; Gao, HQ
Archives of Medical Research, 38(2): 259-264.
Aging Clinical and Experimental Research
Effects of a one-year exercise training program in adults over 70 years old: a study with a control group
Deley, G; Kervio, G; Van Hoecke, J; Verges, B; Grassi, B; Casillas, JM
Aging Clinical and Experimental Research, 19(4): 310-315.

Physical Therapy
Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: A randomized control-led trial
Jan, MH; Lin, JJ; Liau, JJ; Lin, YF; Lin, DH
Physical Therapy, 88(4): 427-436.
Archives of Gerontology and Geriatrics
The relationship between physical condition and change in balance functions on exercise intervention and 12-month follow-up in Japanese community-dwelling older people
Arai, T; Obuchi, S; Inaba, Y; Shiba, Y; Satake, K
Archives of Gerontology and Geriatrics, 48(1): 61-66.
International Journal of Sports Medicine
Effects of Power Training on Muscle Thickness of Older Men
Nogueira, W; Gentil, P; Mello, SNM; Oliveira, RJ; Bezerra, AJC; Bottaro, M
International Journal of Sports Medicine, 30(3): 200-204.
Strength and Conditioning Journal
Exercise considerations for patients with osteoarthritis
Barnes, JT; Pujol, TJ
Strength and Conditioning Journal, 23(3): 74-76.

Journal of Physiological Anthropology
The Influence of Short-term Strength Training on Health-related Quality of Life and Executive Cognitive Function
Kimura, K; Obuchi, S; Arai, T; Nagasawa, H; Shiba, Y; Watanabe, S; Kojima, M
Journal of Physiological Anthropology, 29(3): 95-101.
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee
Musculoskeletal fitness and health
Warburton, DER; Gledhill, N; Quinney, A
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee, 26(2): 217-237.

Strength and Conditioning Journal
Exercise testing of patients with osteoarthritis
Pujol, TJ; Barnes, JT; Chartrau, D
Strength and Conditioning Journal, 23(4): 14-16.

British Medical Journal
Recent advances - Sports medicine
Bahr, R
British Medical Journal, 323(): 328-331.

Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Nutrition, physical activity, and quality of life in older adults: Summary
Drewnowski, A; Evans, WJ
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 56(): 89-94.

International Journal of Aging & Human Development
Physical exercise and experienced bodily changes: The emergence of benefits and limits on benefits
O'Connor, BP; Rousseau, FL; Maki, SA
International Journal of Aging & Human Development, 59(3): 177-203.

Movement and mobility influence on successful aging: Addressing the issue of low physical activity
Rikli, RE
Quest, 57(1): 46-66.

Preventive Medicine
Recommendations for and warnings against physical activity given to older people by health care professionals
Hirvensalo, M; Heikkinen, E; Lintunen, T; Rantanen, T
Preventive Medicine, 41(1): 342-347.
Strength and Conditioning Journal
Resistance training for the older adult: Manipulating training variables to enhance muscle strength
Galvao, DA; Taaffe, DR
Strength and Conditioning Journal, 27(3): 48-54.

Applied Physiology Nutrition and Metabolism-Physiologie Appliquee Nutrition Et Metabolisme
Resistance exercise: good for more than just Grandma and Grandpa's muscles
Phillips, SM
Applied Physiology Nutrition and Metabolism-Physiologie Appliquee Nutrition Et Metabolisme, 32(6): 1198-1205.
Journal of the American College of Nutrition
Association of Nutritional Risk and Depressive Symptoms with Physical Performance in the Elderly: The Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge)
Avila-Funes, JA; Gray-Donald, K; Payette, H
Journal of the American College of Nutrition, 27(4): 492-498.

Ageing & Society
Factors influencing the physical activity levels of older people from culturally-diverse communities: an Australian experience
Bird, S; Radermacher, H; Feldman, S; Sims, J; Kurowski, W; Browning, C; Thomas, S
Ageing & Society, 29(): 1275-1294.
Archives of Gerontology and Geriatrics
The history and economic impact on the functional fitness of elderly in the South-Eastern region of Poland: A comparison with US citizens
Wiacek, M; Hagner, W
Archives of Gerontology and Geriatrics, 46(2): 221-226.
Turkiye Klinikleri Tip Bilimleri Dergisi
Exercise-Fitness Program Development in Older Adults
Toraman, NF
Turkiye Klinikleri Tip Bilimleri Dergisi, 28(6): S137-S140.

Oncology Nursing Forum
Exercise Effects on Bone Mineral Density in Women With Breast Cancer Receiving Adjuvant Chemotherapy
Schwartz, AL; Winters-Stone, K; Gallucci, B
Oncology Nursing Forum, 34(3): 627-633.
Journal of the American Geriatrics Society
Exercise and older patients: Guidelines for the clinician
Christmas, C; Andersen, RA
Journal of the American Geriatrics Society, 48(3): 318-324.

Journal of Aging and Physical Activity
Flexibility and physical functions of older adults: A review
Holland, GJ; Tanaka, K; Shigematsu, R; Nakagaichi, M
Journal of Aging and Physical Activity, 10(2): 169-206.

Journal of Clinical Epidemiology
Tiredness in daily activities among nondisabled old people as determinant of onset of disability
Avlund, K; Damsgaard, MT; Sakari-Rantala, R; Laukkanen, P; Schroll, M
Journal of Clinical Epidemiology, 55(): 965-973.
PII S0895-4356(02)00463-8
Archives of Physical Medicine and Rehabilitation
Long-term home exercise program: Effect in women at high risk of fracture
Kerschan-Schindl, K; Uher, E; Kainberger, F; Kaider, A; Ghanem, AH; Preisinger, E
Archives of Physical Medicine and Rehabilitation, 81(3): 319-323.

Physician and Sportsmedicine
Weight training injury trends - A 20-year survey
Jones, CS; Christensen, C; Young, M
Physician and Sportsmedicine, 28(7): 61-+.

Nursing Clinics of North America
Exercise in the prevention and treatment of osteoporosis - The role of physical therapy and nursing
Hertel, KL; Trahiotis, MG
Nursing Clinics of North America, 36(3): 441-+.

Changes of parameters of the functional state of the organism and oxidative stress in patients after surgical revascularization at early stage of restorative treatment
Arak-Lukmann, AK; Maaroos, YA; Landyr, AP; Vider, EV; Tsilmer, MK; Tsilmer, KY; Vikhalemm, TE; Kullisaar, TE; Sulling, TAA; Ekha, YE
Kardiologiya, 42(2): 14-19.

Sports Medicine
Skeletal muscle damage with exercise and aging
Close, GL; Kayani, A; Vasilaki, A; McArdle, A
Sports Medicine, 35(5): 413-427.

Journal of Science and Medicine in Sport
Resistance training effects on muscular strength of elderly are related to intensity and gender
Beneka, A; Malliou, P; Fatouros, I; Jamurtas, A; Gioftsidou, A; Godolias, G; Taxildaris, K
Journal of Science and Medicine in Sport, 8(3): 274-283.

Isokinetics and Exercise Science
Different training programs for improving muscular performance in healthy inactive elderly
Malliou, P; Fatouros, I; Beneka, A; Gioftsidou, A; Zissi, V; Godolias, G; Fotinakis, P
Isokinetics and Exercise Science, 11(4): 189-195.

Experimental Physiology
Myotendinous plasticity to ageing and resistance exercise in humans
Reeves, ND; Narici, MV; Maganaris, CN
Experimental Physiology, 91(3): 483-498.
Journal of Science and Medicine in Sport
Retention, adherence and compliance: Important considerations for home- and group-based resistance training programs for older adults
Cyarto, EV; Brown, WJ; Marshall, AL
Journal of Science and Medicine in Sport, 9(5): 402-412.
Pediatric Pulmonology
Cardiopulmonary responses of asthmatic children to exercise: Analysis of systolic and diastolic cardiac function
Alioglu, B; Ertugrul, T; Unal, M
Pediatric Pulmonology, 42(3): 283-289.
Archives of Physical Medicine and Rehabilitation
The feasibility of measuring joint angular velocity with a gyro-sensor
Arai, T; Obuchi, S; Shiba, Y; Omuro, K; Nakano, C; Higashi, T
Archives of Physical Medicine and Rehabilitation, 89(1): 95-99.
Archives of Physical Medicine and Rehabilitation
A comparison of the Physiologic effects of acute whole-body vibration exercise in young and older people
Cochrane, DI; Sartor, F; Winwood, K; Stannard, SR; Narici, MV; Rittweger, J
Archives of Physical Medicine and Rehabilitation, 89(5): 815-821.
Mechanisms of Ageing and Development
Can physical training have an effect on well-being in adults with mild intellectual disability?
Carmeli, E; Zinger-Vaknin, T; Morad, M; Merrick, J
Mechanisms of Ageing and Development, 126(2): 299-304.
International Journal of Sports Medicine
The effects of systematic resistance training in the elderly
Wieser, M; Haber, P
International Journal of Sports Medicine, 28(1): 59-65.
Cyberpsychology & Behavior
Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training
Bisson, E; Contant, B; Sveistrup, H; Lajoie, Y
Cyberpsychology & Behavior, 10(1): 16-23.
Nutrition Research
Muscle mass gain observed in patients with short bowel syndrome subjected to resistance training
Araujo, ECF; Suen, VMM; Marchini, JS; Vannucchi, H
Nutrition Research, 28(2): 78-82.
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee
The effects of strength training on sarcopenia
Porter, MM
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee, 26(1): 123-141.

Sports Medicine
Prescription of resistance training for healthy populations
Hass, CJ; Feigenbaum, MS; Franklin, BA
Sports Medicine, 31(): 953-964.

Medicine & Science in Sports & Exercise
Prescription of resistance training for health and disease
Medicine & Science in Sports & Exercise, 31(1): 38-45.

Medicine & Science in Sports & Exercise
Progression Models in Resistance Training for Healthy Adults
This pronouncement was written for the American College of Sports Medicine by: William J. Kraemer, Ph.D., FACSM (Chairperson); Kent Adams, Ph.D.; Enzo,
Medicine & Science in Sports & Exercise, 34(2): 364-380.

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Muscle tissue changes with aging
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Oxidative stress before and after exercise conditioning in patients following surgical revascularization of the myocardium
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Echocardiographic Evaluation of Stress Test for Determining Safety of Participation in Strength Training
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