Should older people head for the gym? Some evidence on the benefits of resistance training.

This Saturday the World Health Organisation celebrates World Health Day with a call to reinvent ageing, as this year the theme is how good health can add life to years, enabling older men and women to not only live longer, but also to extend their active involvement in all levels of society. How we can maximise health and wellbeing as we age concerns us all and is rightly the focus of much research activity.

Lots of older people use gyms and feel better for it. The Elf Mother herself, at almost 640 elf years old (that’s 80 human years), swears by her twice weekly sessions at her local gym, having discovered it in retirement, and she isn’t thinking of stopping any time soon. So what does the research say about some of the benefits? It’s a big subject, so I’m going to focus here on one category of exercise,  progressive resistance training (PRT).

Muscle strength declines with age, but there is evidence that strength can be improved with PRT, in which people exercise their muscles against some type of resistance that is increased as strength increases. Reviewers from the Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group undertook a systematic review to bring together the evidence on the impact of PRT compared with another type of exercise or no exercise on older people’s physical (dis)ability. Data were pooled where appropriate.

A comprehensive and systematic search identified 121 randomised controlled trials (RCTs) with 6700 participants, which were suitable for inclusion in the review.The majority of RCTs were set in the US, with others in Australasia, Canada and a number of European countries. In 59 studies the participants were healthy adults aged 60 and over and in 62 they had health problems. Most PRT programmes took place in gyms or clinics and were supervised. Most involved high-intensity training and were carried out two to three times a week.

Here’s what they found:

  • PRT had a small but significant effect on improving physical ability (complex activities) (33 trials, 2172 participants; Standardised Mean Difference 0.14, 95% Confidence Interval 0.05 to 0.22)
  • PRT had a large effect on increasing strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00)
  • PRT had a small to moderate effect on decreasing some impairments (anatomical or physiological problems) and functional limitations (performing simple activities such as getting up from a chair, walking, reaching)
  • Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13).
  • PRT versus other training showed no significant differences

BUT:

  • The studies were generally of poor methodological quality
  • The long-term outcome of PRT is unclear because the majority of studies stopped following up participants once the intervention had ended
  • Adverse events were poorly monitored and reported

The authors concluded:

“This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.”

There’s a message here for those designing trials, as is often the case, that poor trial design means weak evidence and the best of systematic reviews will not be able to provide clear answers to the questions it addresses based on poor quality trials. If you’re going to the gym today, enjoy!

 Links:

Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD002759. DOI: 10.1002/14651858.CD002759.pub2.

Cochrane summary and podcast of this review.

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Sarah Chapman

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My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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