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High-Intensity Strength Training in Nonagenarians: Effects on Skeletal Muscle
Abstract
Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very old and its reversibility through strength training. Ten frail, institutionalized volunteers aged 90 +/- 1 years undertook 8 weeks of high-intensity resistance training. Initially, quadriceps strength was correlated negatively with walking time (r = -.745). Fat-free mass (r = .732) and regional muscle mass (r = .752) were correlated positively with muscle strength. Strength gains averaged 174% +/- 31% (mean +/- SEM) in the 9 subjects who completed training. Midthigh muscle area increased 9.0% +/- 4.5%. Mean tandem gait speed improved 48% after training. We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age.
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In the citing paper
“With exercise, frail older people can gain muscle strength and function into their 9th and 10th decades of life, as shown in resistance-training studies.133e135”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [133]
In the citing paper
“for over three decades [17,35,36], high-intensity progressive resistance training (PRT) has been recognized as a safe and effective means to combat frailty”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“such individuals remain very capable of undertaking high intensity PRT, even in the tenth decade of life [35,84]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“Evidence dating back to 1990 has shown that high-intensity PRT is both feasible and effective for older adults who are severely frail [35].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“A properly designed PRT program can counteract age-related changes in contractile function, atrophy, and morphology of the aging human skeletal muscles [17,35,36].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“In 1990, Fiatarone et al. [35] showed that an 8-week high-intensity PRT program in frail institutionalized nonagenarians led to a 9% increase in mid-thigh muscle area determined by computer tomography.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“Resistance training programs or multicomponent exercise interventions with robust PRT have enhanced muscle strength in older adults with frailty and sarcopenia [35,84,241,[456], [457], [458], [459]].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“The major barrier to the implementation of robust exercise in this setting, as shown since 1990 [35], is the lack of financial reimbursement, trained professionals and the necessary equipment to conduct these programs with fidelity.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“For example, for over three decades [17,35,36], high-intensity progressive resistance training (PRT) has been recognized as a safe and effective means to combat frailty.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“However, such individuals remain very capable of undertaking high intensity PRT, even in the tenth decade of life [35,84].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“Current recommendations and guidelines for PA in older adults generally advocate a multifaceted exercise regimen that includes aerobic, PRT, balance, and mobility training through structured and casual (integrated lifestyle) activities [17,35,36,114,137].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“Evidence dating back to 1990 has shown that high-intensity PRT is both feasible and effective for older adults who are severely frail [35].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“A properly designed PRT program can counteract age-related changes in contractile function, atrophy, and morphology of the aging human skeletal muscles [17,35,36].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“The major barrier to the implementation of robust exercise in this setting, as shown since 1990 [35], is the lack of financial reimbursement, trained professionals and the necessary equipment to conduct these programs with fidelity.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [35]
In the citing paper
“Fiatarone et al70 analyzed the benefits of strength training in institutionalized seniors in their 80s and 90s and found that strength increased >100% after several weeks, with many able to reduce their dependence on wheelchairs and walkers.”
In the citing paper
“Although not specifically evaluated in older adults during bed rest, there is clear evidence that resistance exercise is an effective means of combating the loss of muscle mass and function in a variety of populations [25-34].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [28]
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“Although skeletal muscle strength has been shown to improve functional performance (5,24,25), the findings in the current study and others from our laboratory underscore the potentially greater influence of skeletal muscle power on functional performance than strength (22,23).”
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One-repetition maximum strength test represents a valid means to assess leg strengthin vivoin humans
Verdijk, L. B., van Loon, L. J. C., Meijer, K., & Savelberg, H. H. C. M. (2008) · Journal of Sports Sciences · doi:10.1080/02640410802428089 · Cited by 245
“Hence, although leg strength is probably the most important factor affecting mobility in the elderly (Bernardi et al., 2004; Fiatarone et al., 1990; Jette & Jette, 1997) and numerous studies have included leg extension and leg press exercises for training of the upper legs (Hagerman et al., 2000;…”
BackgroundValidation and Reliability of the Elderly Mobility Scale
Smith, R. (1994) · Physiotherapy · doi:10.1016/s0031-9406(10)60612-8 · Cited by 220
Functional and Metabolic Consequences of Sarcopenia
Evans, W. J. (1997) · Journal of Nutrition · doi:10.1093/jn/127.5.998s · Cited by 218
Nutritional factors in physical and cognitive functions of elderly people
Rosenberg, I. H., & Miller, J. (1992) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/55.6.1237s · Cited by 219
Nutritional Management in Long-Term Care: Development of a Clinical Guideline
Thomas, D. R., Ashmen, W., Morley, J. E., & Evans, W. J. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.12.m725 · Cited by 217
Rhodes, E. C., Martin, A. D., Taunton, J. E., Donnelly, M., Warren, J., & Elliot, J. R. (2000) · British Journal of Sports Medicine · doi:10.1136/bjsm.34.1.18 · Cited by 216
Chakravarthy, M. V., Joyner, M. J., & Booth, F. W. (2002) · Mayo Clinic Proceedings · doi:10.4065/77.2.165 · Cited by 217
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A Randomized Outcome Evaluation of Group Exercise Programs in Long-Term Care Institutions
Lazowski, D.-A., Ecclestone, N. A., Myers, A. M., Paterson, D. H., Tudor‐Locke, C., Fitzgerald, C., Jones, G., Shima, N., & Cunningham, D. A. (1999) · The Journals of Gerontology Series A · doi:10.1093/gerona/54.12.m621 · Cited by 214
“Many studies did not have a control group (4,5,9,10,12,15,16) or the control group consisted of regular routine (11,13,17,18) social visits (7,8) or reminiscence therapy (14).”
BackgroundExercise as an Intervention for Frailty
Liu, C., & Fielding, R. A. (2010) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2010.08.001 · Cited by 224
Greater Age-Related Reductions in Central Arterial Compliance in Resistance-Trained Men
Miyachi, M., Donato, A. J., Yamamoto, K., Takahashi, K., Gates, P. E., Moreau, K. L., & Tanaka, H. (2003) · Hypertension · doi:10.1161/01.hyp.0000047649.62181.88 · Cited by 213
Grgic, J., Garofolini, A., Orazem, J., Sabol, F., Schoenfeld, B. J., & Pedisic, Z. (2020) · Sports Medicine · doi:10.1007/s40279-020-01331-7 · Cited by 208
Yasuda, T., Fujita, S., Ogasawara, R., Sato, Y., & Abe, T. (2010) · Clinical Physiology and Functional Imaging · doi:10.1111/j.1475-097x.2010.00949.x · Cited by 223
“…can induce appendicular and trunk muscle hypertrophy and improve insulin resistance and type-2 diabetes in the elderly (Frontera et al., 1988; Fiatarone et al., 1990; Dunstan et al., 2002), suggesting that high-intensity resistance training leads to preventing and ⁄ or improving the…”
BackgroundLacroix, A., Kressig, R. W., Muehlbauer, T., Gschwind, Y. J., Pfenninger, B., Brügger, O., & Granacher, U. (2015) · Gerontology · doi:10.1159/000442087 · Cited by 217
Sadjapong, U., Yodkeeree, S., Sungkarat, S., & Siviroj, P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17113760 · Cited by 238
Lai, J., Cella, D. F., Chang, C., Bode, R. K., & Heinemann, A. W. (2003) · Quality of Life Research · doi:10.1023/a:1025014509626 · Cited by 210
“Physiological approaches typically test one’s capacities, such as muscle strength, or involve observation of performance, such as exercise tolerance, or maximal oxygen capacity after exercise [9, 10].”
BackgroundIn vivo human muscle structure and function: adaptations to resistance training in old age
Reeves, N. D., Narici, M. V., & Maganaris, C. N. (2004) · Experimental Physiology · doi:10.1113/expphysiol.2004.027797 · Cited by 205
“In the present study, as in many others (e.g. Fiatarone et al. 1990; Harridge et al. 1999), the effects of training were not assessed separately on males and females.”
Fatouros, I. G., Kambas, A., Katrabasas, I., Nikolaidis, K., Chatzinikolaou, A., Leontsini, D., & Taxildaris, K. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.019117 · Cited by 217
Raue, U., Slivka, D. R., Jemioło, B., Hollon, C. J., & Trappe, S. W. (2006) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01616.2005 · Cited by 209
Protein Nutrition, Exercise and Aging
Evans, W. J. (2004) · Journal of the American College of Nutrition · doi:10.1080/07315724.2004.10719430 · Cited by 204
Exercise dosing to retain resistance training adaptations in young and older adults
BICKEL, C. S., CROSS, J. M., & BAMMAN, M. M. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318207c15d · Cited by 203
“Of the countermeasures tested to date including pharmacologic therapies and various modes of exercise training, intense resistance exercise training has consistently shown the highest degree of potency in this context—inducing muscle hypertrophy and markedly increasing strength, power, and mobility (5,8,9,14,17).”
BackgroundRaymond, M. J., Bramley-Tzerefos, R. E., Jeffs, K. J., Winter, A., & Holland, A. E. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.02.022 · Cited by 202
Galvão, D. A., Taaffe, D. R., Spry, N., Joseph, D., Turner, D., & Newton, R. U. (2009) · Prostate Cancer and Prostatic Diseases · doi:10.1038/pcan.2008.51 · Cited by 198
Phillips, S. M., Tang, J. E., & Moore, D. R. (2009) · Journal of the American College of Nutrition · doi:10.1080/07315724.2009.10718096 · Cited by 243
“While much of our knowledge on these topics comes from studies of younger persons, it is still worth recognizing that even older persons in their 10th decade can gain muscle mass with appropriately formulated resistance exercise programs [16,17] and nutritional support [17,18].”
BackgroundMultisystem physiological perspective of human frailty and its modulation by physical activity
Taylor, J. A., Greenhaff, P. L., Bartlett, D. B., Jackson, T., Duggal, N. A., & Lord, J. M. (2022) · Physiological Reviews · doi:10.1152/physrev.00037.2021 · Cited by 218
Metadata
- Authors
- Fiatarone, M. A.
- Corresponding author
- Fiatarone, Maria A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1990-06-13
- Volume
- 263
- Issue
- 22
- Pages
- 3029
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W3143060430
- Cited by
- 1,593
- References
- 1
- Citations by year
- 2026: 24 · 2025: 30 · 2024: 27 · 2023: 36 · 2022: 33 · 2021: 52 · 2020: 99 · 2019: 50 · 2018: 43 · 2017: 54 · 2016: 50 · 2015: 46 · 2014: 47 · 2013: 46 · 2012: 45
- FWCI
- 22.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Funders
- National Institute on Aging (AG06443, AG 04390)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- high-intensity resistance training, resistance training, nonagenarians, frail elderly, muscle weakness, muscle strength gain, fat-free mass, muscle mass, functional mobility, walking speed, nursing home residents, muscle dysfunction
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