How to Pick Resistance Exercises for Older Adults

With an increasingly large population of older adults, the World Health Organization (WHO) have created exercise guidelines for older adults to improve their health and well-being (1). Exercise, specifically resistance training, helps adults maintain high levels of function and slow the decrease in muscle mass, strength, and power that comes with age (2).

Current WHO guidelines recommend performing muscle strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week. However, little guidance exists on what resistance exercises older adults should perform. Here we’ll answer that question. If you want more detail, then check out Dr. Mariana Wingood’s Masterclass on Exercise Prescription for Older Adults.

When selecting resistance exercises for the older adult, our aim is to:

1. Match the exercises to the client’s goals, balance/coordination capabilities, mobility levels, medical history, injury/pain history, and equipment access.
2. Maximize functional improvements (such as improving transfers, including floor transfers), along with muscle mass and strength.
3. Select a number of exercises that match the client’s current fitness level and recovery capacity.

Fundamental Exercises

These exercises include basic movements that efficiently target major muscle groups and carryover to functional activities. Since there are only four exercises here, these exercises can be a great starting point for clients with lower fitness levels. We’ll go through exercises for the lower and upper body.

Lower Body

Age-related decreases in muscle strength and mass are more pronounced in the lower limbs and can significantly impact functional independence and fall risk (3). Therefore, strengthening the lower body is vital for the older adult.

Two fundamental exercises for the lower body are the squat and the lunge. These exercises not only effectively target the major muscles of the lower body, but also carryover to tasks such as transfers and negotiating stairs.

The highest level squat is the traditional barbell back squat. However, this exercise may not be ideal for those with upper body mobility limitations, poor tolerance to axial loading of the spine, compromised balance, or difficulty coordinating the exercise. To decrease balance and coordination demands, the Smith Machine back squat and hack squat are viable alternatives. The hack squat also requires less upper body mobility than the back squat, so may be better for certain clients.

For those who do not tolerate higher axial spinal loading, clients can perform goblet squats or unloaded bodyweight squats. However, these standing squat variations require some balance and coordination so may not be an ideal starting point for all clients. This brings us finally to the leg press. This variation places minimal axial load on the spine, requires minimal balance and coordination, and can be a starting point for those who cannot yet perform a bodyweight squat. So a sample squat progression for a client could be:

• Leg press → to bodyweight squat → to goblet squat

The lunge is an excellent complement to the squat that can be easily scaled. At the highest level, we have the barbell lunge (analogous to the barbell squat). However, for the same reasons listed above some clients may need other exercise options. To accommodate for decreased upper body mobility, lunges can be performed with dumbbells held at the sides or in the goblet position. Also, for those clients who have difficulty coordinating the lunge or lack the requisite strength to perform a bodyweight lunge, a countertop can be used for upper body assistance. A sample lunge progression could be:

• Lunge with countertop assistance → to bodyweight lunge → to lunge with dumbbells held at sides

Upper Body

Upper body strength is vital for performing daily activities such as carrying groceries, housework, and yard work. To that end, we’ll prioritize compound, multi joint movements that can be adequately loaded and scaled. Ideal upper body exercises include the chest press, row, shoulder press, and lat pulldown.

The chest press can be performed with a machine, dumbbells, barbell or bodyweight (i.e. a pushup). Similarly, rows are versatile and can be performed with a machine, dumbbells, or bodyweight (such as TRX rows). Shoulder presses also can be performed with dumbbells, barbells, or a machine, but if a client has upper body mobility limitations, the incline press can be a substitute exercise. Likewise, the lat pulldown exercise can be difficult for some clients due to upper body mobility restrictions, so variations such as a high row may be better for those clients.

Note that barbell bench or incline presses require a spotter or safety arms to be performed safely. Also, when adequately loaded, dumbbell shoulder and chest presses should be performed with a spotter for safety. Therefore, selecting these exercises depends on the level of supervision the client will have.

In general, the machine chest press or pushup and machine row can be performed by most clients, so serve as an excellent starting point for upper body strengthening.

Accessory Exercises

For many clients, just focusing on the fundamental exercises above will be a challenging initial training program. As a client gets fitter, accessory exercises can be added to further increase strength, muscle mass, and functional capacity. These accessory movements address some muscles that are not well stimulated by the above exercises, provide increased exercise volume, and decrease the monotony of training by providing exercise variety.

Lower Body

In the squat and lunge all the vastus muscles are adequately activated. However, the rectus femoris is not well developed due to its biarticular nature, performing both hip flexion and knee extension. The rectus femoris is a crucial muscle for ambulation and postural balance and is best developed by including knee extension exercises or straight leg raises (3). Similarly, the hamstring muscle group is not sufficiently loaded in the squat, so we should add in hamstring focused movements such as knee flexion exercises (3).

The gluteus medius plays a critical role in hip stabilization during gait and in single leg stance, but is not loaded sufficiently with movements such as the squat. Exercises such as side lying or standing hip abduction help fully develop hip stability.

Lastly, the triceps surae group helps maintain balance and is important during ambulation (2). For optimal development of this muscle group, we can add in heel raises, which also can be scaled from seated to performing standing with a single leg.

Upper Body/Trunk

The chest press and row stimulate the major muscles of the upper body. However, additional loading of the elbow flexors and extensors can further increase upper body muscle mass and strength. Biceps curls and triceps push downs are just two examples of exercises to further load the arms.

Also, while free weight exercises stimulate the abdominal muscles (4), focused abdominal exercises provide a more robust stimulus. Some example exercises include the seated Pallof press and isometric front plank, which are simple to perform and are tolerated well by most clients.

Summary of Exercises to Select

Here we’ve covered the exercises that best address the needs of older adults and tend to work best in practice. Note that there are nearly an infinite number of exercises and variations that we cannot possibly cover in a single post.

To wrap up, a fundamental resistance training program should include a variation of the:

• Squat
• Lunge
• Chest press
• Row

The shoulder press and lat pull down (or their variations) may be included as well if the client is able to perform these exercises.

For optimal muscle mass, strength and functional gains, we can add accessory exercises including:

• Knee extension and flexion
• Hip abduction
• Heel raises
• Elbow flexion and extension
• Abdominal exercises such as Pallof presses and the front plank

Wrapping Up

In general, the fundamental resistance exercises are a good starting point and over time the accessory exercises can be added in. For more specifics on creating an exercise program for older adults check out Dr. Mariana Wingood’s Masterclass on Exercise Prescription for Older Adults!