Strength training and why it matters after forty

Cardiovascular exercise receives most of the public health attention, and the evidence for resistance training in the second half of life is at least as compelling.

What declines and when

Muscle mass and strength decline from around the third or fourth decade, accelerating with age, in a process termed sarcopenia when it becomes clinically significant.

Strength declines faster than mass, and power — force produced quickly — declines faster still, which is what matters for catching yourself when you stumble.

Bone mineral density declines with age and falls sharply in women after menopause.

The consequences are functional: difficulty rising from a chair, reduced walking speed, falls, fractures and eventual loss of independence.

Hip fracture in older adults carries substantial mortality and a high rate of permanent loss of independence, which makes prevention a matter of considerable consequence.

What resistance training does

The evidence is unusually strong for an exercise intervention.

It increases muscle mass and strength at every age tested, including in people in their eighties and nineties in supervised trials.

It improves bone mineral density when the loading is sufficient, with high-intensity resistance and impact training showing the clearest effects.

It improves balance, walking speed and functional capacity.

It improves insulin sensitivity and glycaemic control.

It has evidence for depressive symptoms and for cognition.

And falls prevention programmes combining strength and balance training have among the best evidence of any intervention in older adults.

What it actually involves

Less than people assume.

Two to three sessions a week, covering the major muscle groups.

Six to eight exercises, one to three sets each, in a repetition range that is genuinely challenging by the end of the set.

Progression over time, which is the essential element — doing the same thing indefinitely maintains rather than improves.

Sessions of thirty to forty-five minutes are sufficient.

The movements that matter most are the ones that mirror daily function: squatting, hinging at the hips, pushing, pulling, carrying and stepping.

Intensity, and the misconception

Where older adults are frequently under-trained.

Light weights and high repetitions are commonly prescribed to older people out of caution, and trials consistently show that higher-intensity training produces substantially better strength and bone outcomes, with good safety records under supervision.

Loading needs to be meaningful to stimulate bone.

Which is an argument for progressing rather than for staying at a comfortable weight indefinitely, and for supervision when learning technique.

Protein

The dietary component with the most relevance here.

Protein requirements are higher in older adults than in younger ones, and intakes below the requirement are common.

Distribution across meals appears to matter, since the muscle protein synthesis response requires a sufficient amount at each meal rather than one large intake.

Practical sources are ordinary and cheap: eggs, dairy, pulses, tinned fish, chicken, and lower-cost cuts of meat.

Protein supplements are convenient and are not necessary for people eating adequately, and are among the more heavily marketed products in this space.

Doing it cheaply

Since cost is a common barrier.

Bodyweight training progresses a long way before external load is needed, particularly for the lower body.

Resistance bands are inexpensive, portable and effective.

Adjustable dumbbells or a couple of kettlebells cover most needs at home.

Second-hand equipment is abundant and cheap, since a great deal of it is bought and abandoned.

Community and council leisure centres are frequently far cheaper than commercial gyms and have concessionary rates.

And exercise referral schemes provide supervised programmes for eligible people at low or no cost.

Safety

Practical points.

Learn technique before adding load, ideally with qualified instruction for the first sessions.

Start conservatively and progress gradually, since the most common injury cause is doing too much too soon.

Breathe rather than holding the breath, which raises blood pressure sharply.

Get advice before starting if you have cardiovascular disease, uncontrolled hypertension, osteoporosis with previous fracture, joint replacements or retinal problems, since some movements may need modifying.

Muscle soreness for a day or two is normal; joint pain is not.

And stop and seek assessment for chest pain, severe breathlessness, dizziness or unusual palpitations.

The long view

The economic case is the same as the health case.

Maintaining strength and balance is the main modifiable factor in whether someone remains independent, and the cost of losing independence — care, adaptations, lost earnings for family — dwarfs any conceivable spending on prevention.

Which makes two sessions a week, started in midlife, one of the highest-return uses of time available.

General information only, not medical advice. Consult a qualified clinician before starting resistance training if you have a medical condition, and seek instruction in technique.