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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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MethodExercise, Aging and Frailty: Guidelines for Increasing Function
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Training Balance and Strength in the Elderly to Improve Function
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Skeletal muscle protein balance and metabolism in the elderly
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“Notably, one of the first studies in this arena was that by Fiatarone et al. (1990), which showed an almost twofold improvement of nonagenarian muscle strength and balance by a weight-lifting protocol.”
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“in older people (Frontera et al., 1988; Fiatarone et al., 1990; Harridge et al., 1999), strenuous exercise with large mechani-”
BackgroundImpaired standing balance: The clinical need for closing the loop
Pasma, J. H., Engelhart, D., Schouten, A. C., van der Kooij, H., Maier, A. B., & Meskers, C. G. M. (2014) · Neuroscience · doi:10.1016/j.neuroscience.2014.02.030 · Cited by 110
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Physical activity and predisposition for hip fractures: A review
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Lack of skeletal muscle hypertrophy in very aged male Fischer 344 × Brown Norway rats
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“…resistance training can induce 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 highintensity resistance training leads to prevention and/or improvement of sarcopenia…”
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Understanding the Science of Resistance Training: An Evolutionary Perspective
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High-resistance versus variable-resistance training in older adults
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“Most of these studies report relatively high training intensities of approximately 80% of the maximum weight that can be lifted one time (1RM) (5,7,8,22).”
BackgroundResultArmenian, S. H., Chemaitilly, W., Chen, M. Y., Chow, E. J., Duncan, C., Jones, L. W., Pulsipher, M. A., Remaley, A. T., Rovó, A., Salooja, N., et al. (2016) · Transplantation and Cellular Therapy · doi:10.1016/j.bbmt.2016.08.019 · Cited by 109
Physical determinants of independence in mature women
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Myotendinous plasticity to ageing and resistance exercise in humans
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“In recent years, resistance exercise training has been shown to be an effective method for increasing strength in older adults (Frontera et al. 1988; Fiatarone et al. 1990; Roman et al. 1993; Welle et al. 1996; Hakkinen et al. 1998a,b, 2001; Harridge et al. 1999; Jozsi et al. 1999; Tracy et al.…”
MethodHigh Intensity Interval Training Improves Physical Performance and Frailty in Aged Mice
Seldeen, K. L., Lasky, G., Leiker, M. M., Pang, M., Personius, K. E., & Troen, B. R. (2018) · The Journals of Gerontology Series A · doi:10.1093/gerona/glx120 · Cited by 104
“These findings are consistent with the evidence that HIIT is safe for both healthy and frail older adults (8,9,27) and also supports individually tailoring exercise programs (58).”
BackgroundResultGryson, C., Ratel, S., Rance, M., Penando, S., Bonhomme, C., Ruyet, P. L., Duclos, M., Boirie, Y., & Walrand, S. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.09.011 · Cited by 112
Age-Related Rates of Decline in Performance among Elite Senior Athletes
Wright, V. J., & Perricelli, B. C. (2007) · The American Journal of Sports Medicine · doi:10.1177/0363546507309673 · Cited by 106
“Even in people older than 90 years, the supposed age-dependent loss of muscle size and strength can be reversed by weight lifting.(9) The strength gains, however, were modest compared with those in young individuals.”
ResultRoth, S. M., Martel, G. F., Ivey, F. M., Lemmer, J. T., Tracy, B. L., HURLBUT, D. E., Metter, E. J., Hurley, B. F., & Rogers, M. A. (1999) · Journal of Applied Physiology · doi:10.1152/jappl.1999.86.6.1833 · Cited by 105
Effects of Vibration Exercise on Muscle Performance and Mobility in an Older Population
Rees, S., Murphy, A. J., & Watsford, M. L. (2007) · Journal of Aging and Physical Activity · doi:10.1123/japa.15.4.367 · Cited by 104
“To date, numerous studies have demonstrated that resistance training can increase muscle mass, strength, and power along with physical function (Fiatarone et al., 1990; Lamoureux, Sparrow, Murphy, & Newton, 2003).”
BackgroundInvestigation of skeletal muscle quantity and quality in end‐stage renal disease
Cheema, B. S., Abas, H., Smith, B., O’Sullivan, A., Chan, M., Patwardhan, A., Kelly, J. J., Gillin, A. G., Pang, G., Lloyd, B. D., et al. (2009) · Nephrology · doi:10.1111/j.1440-1797.2009.01261.x · Cited by 103
“However, randomized controlled trials have shown that the biological aging of the muscle can be reduced through exercise intervention including PRT.(35) For example, Fiatarone et al.”
BackgroundInfluentialEffects of resistance training on selected indexes of immune function in elderly women
Flynn, M. G., FAHLMAN, M. M., Braun, W. A., Lambert, C. P., Bouillon, L. E., Brolinson, P. G., & Armstrong, C. W. (1999) · Journal of Applied Physiology · doi:10.1152/jappl.1999.86.6.1905 · Cited by 103
“(11) reported a 174% increase in strength, concomitant with a 9% increase in muscle size, in female nonagenarians after only 8 wk of resistance training.”
BackgroundBrooks, N., Cloutier, G. J., Cadena, S. M., Layne, J. E., Nelsen, C. A., Freed, A. M., Roubenoff, R., & Castaneda-Sceppa, C. (2008) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01346.2007 · Cited by 102
Metabolic age modelling: the lesson from centenarians
Paolisso, G., Barbieri, M., Bonafè, M., & Franceschi, C. (2000) · European Journal of Clinical Investigation · doi:10.1046/j.1365-2362.2000.00729.x · Cited by 102
Exercise to prevent and treat functional disability
Singh, M. A. F. (2002) · Clinics in Geriatric Medicine · doi:10.1016/s0749-0690(02)00016-2 · Cited by 102
The advantages and limitations of cross-sectional body composition analysis
MacDonald, A. J., Greig, C. A., & Baracos, V. (2011) · Current Opinion in Supportive & Palliative Care · doi:10.1097/spc.0b013e32834c49eb · Cited by 101
Nilsson, M. I., Mikhail, A. I., Lan, L., Carlo, A. D., Hamilton, B., Barnard, K., Hettinga, B. P., Hatcher, E., Tarnopolsky, M. G., Nederveen, J. P., et al. (2020) · Nutrients · doi:10.3390/nu12082391 · Cited by 113
Sarcopenia definition: Does it really matter? Implications for resistance training
Smith, C., Woessner, M. N., Sim, M., & Levinger, I. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2022.101617 · Cited by 115
Cochrane, D. J., Sartor, F., Winwood, K. L., Stannard, S. R., Narici, M. V., & Rittweger, J. (2008) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2007.09.055 · Cited by 99
Movement Velocity in Resistance Training
Pereira, M. I. R., & Gomes, P. S. C. (2003) · Sports Medicine · doi:10.2165/00007256-200333060-00004 · Cited by 101
Effects of eccentric and concentric resistance training on arterial stiffness
Okamoto, T., Masuhara, M., & Ikuta, K. (2006) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001979 · Cited by 101
Nelson, M. E., Fiatarone, M., Layne, J., Trice, I., Economos, C. D., Fielding, R., Ma, R., Pierson, R., & Evans, W. J. (1996) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/63.5.678 · Cited by 100
Self-citationLoaded wheel running and muscle adaptation in the mouse
Konhilas, J. P., Widegren, U., Allen, D. L., Paul, A. C., Cleary, A. S., & Leinwand, L. A. (2005) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00085.2005 · Cited by 101
Dickinson, J. M., Gundermann, D. M., Walker, D. K., Reidy, P. T., Borack, M. S., Drummond, M. J., Arora, M., Volpi, E., & Rasmussen, B. B. (2014) · Journal of Nutrition · doi:10.3945/jn.114.198671 · Cited by 107
Knee strength and lower- and higher-intensity functional performance in older adults
Salem, G. J., Wang, M., YOUNG, J. T., Marion, M., & Greendale, G. A. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200010000-00003 · Cited by 100
FIATARONE, M. A., O’Neill, E. F., Doyle, N., Clements, K. M., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., & Evans, W. J. (1993) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1993.tb06714.x · Cited by 101
Self-citationVanSwearingen, J. M., Perera, S., Brach, J. S., Wert, D. M., & Studenski, S. A. (2011) · Physical Therapy · doi:10.2522/ptj.20100391 · Cited by 104
Hortobágyi, T., & DeVita, P. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.8.b401 · Cited by 100
“Because aged skeletal muscles retain their responsiveness to mechanical stimuli in terms of strength gains, muscle activation, and muscle hypertrophy (4, 5 ,6), it is important to identify the most effective exercise modalities to remedy, offset, or perhaps reverse age-associated strength loss.”
BackgroundInfluentialBiochemical changes in response to intensive resistance exercise training in the elderly
Bautmans, I., Njemini, R., Vasseur, S., Chabert, H., Moens, L., Demanet, C., & Mets, T. (2005) · Gerontology · doi:10.1159/000085122 · Cited by 98
“Important strength gains (up to >100% in 6–9 weeks) can be obtained following strength training in the elderly, even in subjects aged 90 years and older (Fiatarone et al., 1990).”
BackgroundSarcopenia: A Major Challenge in Elderly Patients with End-Stage Renal Disease
Domański, M., & Ciechanowski, K. (2012) · Journal of Aging Research · doi:10.1155/2012/754739 · Cited by 101
“Very often it can be reduced through appropriate physical training [3].”
BackgroundUnderutilization of Cardiac Rehabilitation in Women
Khadanga, S., Gaalema, D. E., Savage, P. D., & Ades, P. A. (2021) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000629 · Cited by 105
The Effects of Resistance Training and Walking on Functional Fitness in Advanced Old Age
Simons, R., & Andel, R. (2006) · Journal of Aging and Health · doi:10.1177/0898264305281102 · Cited by 100
“measurable gains in muscle mass and strength following resistancetraining programs (Akima et al., 2001; Cavani, Mier, Musto, & Tummers, 2002; Fiatarone et al., 1990).”
BackgroundHagstrom, A. D., Marshall, P. W., Lonsdale, C., Cheema, B. S., Singh, M. A. F., & Green, S. (2015) · European Journal of Cancer Care · doi:10.1111/ecc.12422 · Cited by 105
Jones, M. D., Wewege, M. A., Hackett, D. A., Keogh, J. W. L., & Hagstrom, A. D. (2021) · Sports Medicine · doi:10.1007/s40279-020-01388-4 · Cited by 96
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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