Strength training after sixty
The intervention with the best evidence for keeping people out of care homes, and the one most often replaced with walking.
settledLarge, consistent evidence base. Unlikely to reverse.Revised 11 Sept 2026
Load has to increase over time. A fixed pair of light dumbbells stops working within weeks.Photograph: Esther Ann / Unsplash
Definition
Progressive resistance training: repeated muscular contractions against a load that is increased over time. The defining word is progressive. A fixed routine with the same pink dumbbells is exercise, and it stops being training within a few weeks.
What the guidelines ask for
The WHO’s 2020 guidelines recommend, for older adults, the same aerobic targets as for younger adults — 150–300 minutes moderate or 75–150 minutes vigorous per week — plus muscle-strengthening activity on two or more days a week, and additionally multicomponent activity emphasising balance and functional training on three or more days, to prevent falls.
That last clause is specific to older adults and it is the part usually dropped.
Why it outperforms walking
Walking is excellent and it is not a substitute. Aerobic activity does little for muscle mass, bone density or the ability to produce force quickly — and force production, not endurance, is what determines whether a stumble becomes a fall and whether a fall becomes a fracture.
Resistance training in older adults reliably produces:
- Increases in strength, including in people in their eighties and nineties.
- Gains in muscle mass, smaller than in young adults but real.
- Improvements in gait speed, chair-rise time and balance.
- Increases in bone mineral density where the loading is sufficient.
What it looks like in practice
Two sessions a week, six to eight movements covering a squat pattern, a hinge, a push, a pull, a carry and something for the calves and ankles. Two to three sets each, in a range of roughly 6–12 repetitions, taken close enough to difficult that the last repetitions are genuinely hard.
Machines are fine. Bands are fine to start and become inadequate quickly, because they cannot be loaded progressively in small steps. Free weights are best if supervision is available at the beginning.
The two real barriers
Fear of injury, which is misplaced — supervised resistance training in older adults has a very low injury rate, and the alternative is guaranteed loss.
Under-loading, which is nearly universal. The commonest failure is a programme that is safe, pleasant and too easy to cause adaptation. If the last repetition of a set feels the same as the first, the load is not doing anything.
Cautions
Uncontrolled hypertension, unstable cardiac disease and recent surgery are reasons to get clearance first. They are reasons to start supervised, not reasons not to start.