Written by Mitchell Robinson

The elderly are, despite the common misconception of youth, not another species. Resistance training guidelines for young people are very much applicable to the elderly. Many healthy and relatively fit elderly people will not require programs that differ significantly from those for 20-40 year olds. For the frail elderly (those with signs of sarcopenia), however, a more specific program that prioritises activities of daily living seems appropriate. The use of a step-up, for example, would have a more direct transfer to stair walking than would the leg press or even a squat. Of course this doesn’t mean that you shouldn't squat (or leg press), in fact a combination of the two might maximise both hypertrophy and functional benefits. To enhance gait you should also consider that the knee extensors (quadriceps) and plantar flexors (calves) deteriorate faster with age than the hip extensors, so squats and leg presses should be performed in manner that maximises quadriceps activity (e.g. high bar for squats; feet low on the foot plate with the back rest declined for leg press). Moreover, a calf exercise seems appropriate and is probably of more value than a leg curl or back extension.

Importantly, your blood pressure (BP) may need to be considered. Minimising high BP may be necessary as a relatively high percentage of people in the 60+ age bracket have elevated resting BP and some arterial stiffness. You can minimise high BP by:

• incorporating unilateral rather than bilateral exercises (particularly for the legs),
• pausing briefly between repetitions,
• performing sets with fewer repetitions,
  • as BP seems to accumulate with each rep, 1) BP would be higher after a high rep set and 2) BP would be elevated for a longer time as it takes longer to complete the high-rep set,
    • fascinatingly, this may mean a heavier weight should be used for fewer reps,
• stopping sets 1-3 reps prior to failure (particularly when training for power),
• and performing eccentrically biased exercises that involve lifting a load with 2 limbs and lowering it with one.

Exercise selection

For the lower limb, the emphasis should be on anti-gravity muscles - think, quadriceps and calves. Moreover, a lot of these exercises will require some measure of balance. Some of you will be apprehensive about performing jumping activities (and it should be acknowledged that the very frail will not be able to leave earth). If this is you, simply performing the concentric part of the exercise as fast as you can will suffice. But if you can still jump safely (even if it just a few centimeters), you should! Use it or lose it.

The DB squat involves holding a single DB (by the plates at one end) between the legs. This is a good functional alternative to traditional barbell back squats as it avoids the discomfort associated with placing a heavy load across the shoulders while providing a model of how to safely lift items around the house. This and the traditional squat can be modified to include plantar-flexion at the end of the movement. Push-ups can be performed with the hands on a table or kitchen bench so they need not be too difficult even for the frail. The idea behind the use of body mass exercises is that they are more specific to activities of daily living – the push-up may be a component of getting up off the ground after a fall. Abdominal exercises should include those that tax the flexors and lateral flexors with the view to maintaining the ability to roll and sit up (an important pre-requisite to getting up off the ground or out of bed – in this sense the act of getting up from the ground will act as a positive training stimulus for some frailer folk).

Many of these exercises place significant compressive loads on bones that are prone to osteoporotic fractures such as the vertebral column, neck of the femur, the carpals, radius and humerus. You should recognise, however, that those who already have severe osteoporosis may come to harm if these sites are loaded excessively. Arthritic changes, common in the joints of the elderly, may limit exercise choice or the range of motion (ROM) that older lifters can move through. Modifying the ROM should be seen as preferable to abandoning the exercise completely.

Importance of diet 

• Meal timing 
  • Some evidence exists for timing protein with RT to increase the degree of hypertrophy (the evidence is not conclusive here however, and perhaps it's best to simply recommend training in a "well-fed" state and ensure appropriate hydration). 
• General concerns
  • There are contradictory opinions regarding protein requirements in the elderly
    • Some suggest that the elderly may have increased protein requirements, although this is not universally agreed upon. One potential detrimental effect of aging on muscle growth is the decline in appetite (the anorexia of aging) that occurs.
  • Appetite declines with age 
  • The elderly often have other comorbidities that may necessitate alterations in diet (e.g., reduced kidney function)
    
    

The best time to consume protein is immediately before and immediately after resistance training. There are some studies that show even greater benefits for the elderly. Esmark and colleagues reported that taking a protein-carbohydrate supplement immediately after training resulted in significantly greater increases in muscle fibre cross-section than taking the same supplement 2 hours after training. This suggests that there may be a narrow "window of opportunity" for the elderly who should be encouraged to eat appropriately soon after, or even before ‘working out’ (though new evidence has challenged this, suggesting it's more of a "barn door" than a "narrow window"). 

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