The DOI matches its Crossref record, with a small difference in title or year; 1 of the 1 references it cites were found in a registry or an index.
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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Cited by
Sorted by citations
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BackgroundAdaptability of elderly human muscles and tendons to increased loading
Narici, M. V., & Maganaris, C. N. (2006) · Journal of Anatomy · doi:10.1111/j.1469-7580.2006.00548.x · Cited by 196
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MethodCancer cachexia prevention via physical exercise: molecular mechanisms
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“Furthermore, the 50% increase in muscle strength and 6% increase in muscle size are in agreement with other investigations on older adults using a similar resistance training protocol (1, 5, 6, 9, 12).”
ResultValenzuela, T. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2011.11.001 · Cited by 184
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Self-citationA Meta-Analysis of Periodized versus Nonperiodized Strength and Power Training Programs
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“…resistance exercise has proven effective to elicit increases in muscle strength and muscle size in old (Roman et al., 1993; Reeves et al., 2004), very old and frail (Fiatarone et al., 1990; Harridge et al., 1999) and several types of frail patients (Suetta et al., 2004; Braith & Beck, 2008).”
BackgroundTraining for Muscle Power in Older Adults: Effects on Functional Abilities
Hruda, K. V., Hicks, A. L., & Mccartney, N. (2003) · Canadian Journal of Applied Physiology · doi:10.1139/h03-014 · Cited by 185
“The training-induced gains in strength and power observed in the present study were comparable to those seen in similar studies using more costly and sophisticated training equipment (Fiatarone et al., 1990; Jozsi et al., 1999; Skelton et al., 1995).”
ResultDa Boit, M., Sibson, R., Sivasubramaniam, S., Meakin, J. R., Greig, C. A., Aspden, R. M., Thies, F., Jeromson, S., Hamilton, D. L., Speakman, J. R., et al. (2017) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.140780 · Cited by 185
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“In fact, most authors have studied changes in muscle strength (Fiatarone et al. 1990, 1994; Fischer et al. 1991), and only a few investigators have examined changes in muscle power in the elderly (Skelton et al. 1995; Jozsi et al. 1999).”
Strength training alters the viscoelastic properties of tendons in elderly humans
Reeves, N. D., Narici, M. V., & Maganaris, C. N. (2003) · Muscle & Nerve · doi:10.1002/mus.10392 · Cited by 181
Changes in power with resistance training in older and younger men and women
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“Most previous studies on resistance training in elderly subjects report a lack of correlation (Fiatarone et al., 1990; Grimby et al., 1992; Sipilä et al., 1996).”
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“…for future participation in resistance training, which is in turn associated with improved strength (e.g., Cavani, Mier, Musto, & Tummers, 2002; Fiatarone et al., 1990; Jette et al., 1999; Tsutsumi et al., 1997), reduced risk of falling, (Connell, 1996) and improved cognition (Lachman et al.,…”
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Exercise and injury prevention in older people
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High-volume, heavy-resistance strength training and muscle damage in young and older women
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The Consequences of Resistance Training for Movement Control in Older Adults
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Risk of Increased Physical Inactivity During COVID ‐19 Outbreak in Older People: A Call for Actions
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“The magnitude of increases in muscle size and strength in the present study are lower than those reported in some HI-RT studies (27,28) and in a BFR resistance training study (9).”
BackgroundResultChronic Pain Management in the Elderly
Schwan, J., Sclafani, J. A., & Tawfik, V. L. (2019) · Anesthesiology Clinics · doi:10.1016/j.anclin.2019.04.012 · Cited by 174
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“partially reverse age-related atrophy, resulting in whole muscle size and strength increases ( 12 , 14, 26, 36, 40, 46, 47, 51-53).”
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“While the gains in muscle strength were lower than that observed in several previous trials utilising traditional PRT methods ((33-35)), they were consistent with those observed in several other studies incorporating HV-PRT.”
ResultAbility to sit and rise from the floor as a predictor of all-cause mortality
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BackgroundOutcomes of Total Hip Arthroplasty: A Study of Patients One Year Postsurgery
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“Resistance training has been reliably shown to be a safe and effective strategy to improve muscle mass and function in older adults [45], including the very old [46].”
BackgroundSinclair, A. J., Abdelhafiz, A. H., Dunning, T. L., Izquierdo, M., Rodríguez‐Mañas, L., Bourdel‐Marchasson, I., Morley, J. E., Munshi, M. N., Woo, J., & Vellas, B. J. (2018) · The Journal of Frailty & Aging · doi:10.14283/jfa.2017.39 · Cited by 158
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Trappe, S. W., Williamson, D., & Godard, M. P. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.4.b138 · Cited by 152
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Sarcopenic obesity: molecular clues to a better understanding of its pathogenesis?
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“Resistance training reduces body weight and enhances muscle strength and mass effectively in aging individuals (Frontera et al. 1988; Fiatarone et al. 1990).”
BackgroundReduction in hybrid single muscle fiber proportions with resistance training in humans
Williamson, D. L., Gallagher, P. M., Carroll, C. C., Raue, U., & Trappe, S. W. (2001) · Journal of Applied Physiology · doi:10.1152/jappl.2001.91.5.1955 · Cited by 150
“ing studies, as well as in our own laboratory (11, 12, 21, 22, 25), and applied to young adults (18–30 yr).”
BackgroundMethodResultInfluentialda Nóbrega, A. C. L., de Freitas, E. V., de Oliveira, M. A. B., Leitão, M. B., Lazzoli, J. K., Nahas, R. M., Baptista, C. A. S., Drummond, F. A., Rezende, L., Pereira, J., et al. (1999) · Revista Brasileira de Medicina do Esporte · doi:10.1590/s1517-86921999000600002 · Cited by 150
Functional Mobility Discriminates Nonfallers From One-Time and Frequent Fallers
Gunter, K. B., White, K. N., Hayes, W. C., & Snow, C. M. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.11.m672 · Cited by 150
“The Tandem Gait, Sit-to-Stand, and Get Up and Go tests are described elsewhere (13,14,15).”
Timmerman, K. L., Lee, J. L., Fujita, S., Dhanani, S., Dreyer, H. C., Fry, C. S., Drummond, M. J., Sheffield-Moore, M., Rasmussen, B. B., & Volpi, E. (2010) · Diabetes · doi:10.2337/db10-0415 · Cited by 149
Poulsen, J. B., Møller, K., Jensen, C. V., Weisdorf, S., Kehlet, H., & Perner, A. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e318205c7bc · Cited by 149
Hunter, S. K., Thompson, M. W., & Adams, R. D. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.6.b264 · Cited by 155
Nichols, J. F., Omizo, D. K., Peterson, K. K., & Nelson, K. P. (1993) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1993.tb06692.x · Cited by 148
A Home‐based Exercise Program for Nondisabled Older Adults
Jette, A. M., Harris, B. A., Sleeper, L. A., Lachman, M. E., Heislein, D. M., Giorgetti, M., & Levenson, C. (1996) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1996.tb01825.x · Cited by 150
Muscle ultrasonography and computed tomography in elderly trained and untrained women
Sipilä, S., & Suominen, H. (1993) · Muscle & Nerve · doi:10.1002/mus.880160309 · Cited by 148
Hollings, M., Mavros, Y., Freeston, J., & Fiatarone Singh, M. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317713329 · Cited by 148
Physiological Basis of Fatigue
Evans, W. J., & Lambert, C. P. (2007) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e31802ba53c · Cited by 152
Yasuda, T., Fukumura, K., Uchida, Y., Koshi, H., Iida, H., Masamune, K., Yamasoba, T., Sato, Y., & Nakajima, T. (2014) · The Journals of Gerontology Series A · doi:10.1093/gerona/glu084 · Cited by 146
Nursing rehabilitation and exercise strategies in the nursing home
Morris, J. N., Fiatarone, M., Kiely, D. K., Belleville-Taylor, P., Murphy, K., Littlehale, S., Ooi, W. L., O'Neill, E., & Doyle, N. (1999) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/54.10.m494 · Cited by 145
“Despite the Nursing Home Reform Law of 1987, and demonstrated efficacy of exercise intervention in this setting (15,27), many nursing homes have yet to develop institutional philosophies and programs that promote individualized resident rehabilitation for most residents.”
Self-citationHaub, M. D., Wells, A. M., Tarnopolsky, M. A., & Campbell, W. W. (2002) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/76.3.511 · Cited by 146
Evidence-Based Exercise Prescription for Balance and Falls Prevention
Shubert, T. E. (2011) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0b013e31822938ac · Cited by 154
Gender differences in disability: Evidence and underlying reasons
Leveille, S. G., Resnick, H. E., & Balfour, J. L. (2000) · Aging Clinical and Experimental Research · doi:10.1007/bf03339897 · Cited by 142
Perucchini, D., DeLancey, J. O. L., Ashton‐Miller, J. A., Peschers, U., & Kataria, T. C. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.121089 · Cited by 145
Yasuda, T., Fukumura, K., Fukuda, T., UCHIDA, Y. M. D., Iida, H., Meguro, M., Sato, Y., Yamasoba, T., & Nakajima, T. (2013) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12087 · Cited by 144
“Highintensity resistance training (HI-RT) can induce muscle hypertrophy and improve insulin resistance and type-2 diabetes in the elderly (Frontera et al., 1988; Fiatarone et al., 1990), suggesting that HI-RT leads to the prevention and/or improvement of sarcopenia in the elderly (Aagaard et al.”
BackgroundAlexander, N. B., Galecki, A. T., Grenier, M. L., NYQUIST, L. V., Hofmeyer, M. R., Grunawalt, J. C., Medell, J. L., & Fry-Welch, D. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.4911232.x · Cited by 142
Kemmler, W., Kohl, M., Fröhlich, M., Jakob, F., Engelke, K., von Stengel, S., & Schoene, D. (2020) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.4027 · Cited by 139
“However, even during a 1RM test situation (ie, work to momentary failure), increased risk of injuries((74,75)) or cardiovascular complications((76)) were not reported for older people, at least when properly introduced and supervised.”
BackgroundNutrition, exercise, and healthy aging
EVANS, W. J., & CYR-CAMPBELL, D. (1997) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(97)00160-0 · Cited by 138
The meaning and measurement of lean body mass
Roubenoff, R., & Kehayias, J. J. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.1991.tb03013.x · Cited by 218
Preventing falls on an elderly care rehabilitation ward
Donald, I. P., Pitt, K. J., Armstrong, E., & Shuttleworth, H. (2000) · Clinical Rehabilitation · doi:10.1191/026921500677888641 · Cited by 139
Skeletal Muscle and Cardiovascular Adaptations to Exercise Conditioning in Older Coronary Patients
Ades, P. A., Waldmann, M. L., Meyer, W. L., Brown, K. A., Poehlman, É. T., Pendlebury, W. W., Leslie, K. O., Gray, P. R., Lew, R. R., & LeWinter, M. M. (1996) · Circulation · doi:10.1161/01.cir.94.3.323 · Cited by 138
Stewart, V. H., Saunders, D. H., & Greig, C. A. (2013) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12123 · Cited by 144
“Four of four studies reported change (three positive and one negative) in CSA of either the total thigh or quadriceps (knee extensor) muscles (Fiatarone et al., 1994; Sipilä & Suominen, 1995; Goodpaster et al., 2008; Machado et al., 2010) and three of four of these studies also measured changes in muscle strength (Fia…”
BackgroundAtrophy and hypertrophy of skeletal muscles: structural and functional aspects
Boonyarom, O., & Inui, K. (2006) · Acta Physiologica · doi:10.1111/j.1748-1716.2006.01613.x · Cited by 144
“A1: Berg et al. (1991), Mitch & Goldberg (1996), McCarthy et al. (1997), Chakravarthy et al. (2000), Fluckey et al. (2002), Grounds (2002), Machida & Booth (2004b) A2: Thomason & Booth (1990), Hather et al. (1992), LeBlanc et al. (1992), Widrick & Fitts (1997), Andersen et al. (1999), Mujika & Padilla (2001), Reardon…”
InfluentialBeyond the Zone: Protein Needs of Active Individuals
Lemon, P. W. R. (2000) · Journal of the American College of Nutrition · doi:10.1080/07315724.2000.10718974 · Cited by 137
“Further, muscle performance/function improves with strength exercise even into the tenth decade of life [50], and this is not due to improved neurological function alone, as three months of regular strength exercise can increase mixed muscle protein synthesis even in the frail elderly (76 to 92 year-old men and women)…”
BackgroundMood, Anxiety, and Serum IGF-1 in Elderly Men Given 24 Weeks of High Resistance Exercise
Cassilhas, R. C., Antunes, H. K. M., Tufik, S., & de Mello, M. T. (2010) · Perceptual and Motor Skills · doi:10.2466/pms.110.1.265-276 · Cited by 146
The Effects of Strength Conditioning on Older Women's Ability to Perform Daily Tasks
Hunter, G. R., Treuth, M. S., Weinsier, R. L., Kekes-Szabo, T., Kell, S. H., Roth, D. L., & Nicholson, C. (1995) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1995.tb07045.x · Cited by 138
Holloszy, J. O. (2000) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(19)30634-2 · Cited by 136
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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