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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 a decrease was detected in subcutaneous fat area of the thigh in both training groups, this decrement is not a significant finding, which is in agreement with the study of Fiatarone et al. (1990).”
BackgroundResultInfluentialATP Citrate Lyase Improves Mitochondrial Function in Skeletal Muscle
Das, S., Morvan, F., Jourde, B., Meier, V., Kahle, P., Brebbia, P., Toussaint, G., Glass, D. J., & Fornaro, M. (2015) · Cell Metabolism · doi:10.1016/j.cmet.2015.05.006 · Cited by 91
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BackgroundEfficacy of a home-based training program for older adults using elastic tubing
Mikesky, A. E., Topp, R., Wigglesworth, J. K., Harsha, D. M., & Edwards, J. E. (1994) · European Journal of Applied Physiology and Occupational Physiology · doi:10.1007/bf00392037 · Cited by 139
“Our findings demonstrate the trainability of these older adults and corroborate the findings of earlier studies involving older adults participating in resistance training programs utilizing exercise machines (Brown et al. 1990; Charette et al. 1991; Fiatarone et al. 1990; Frontera et al. 1988), wrist and ankle weight…”
BackgroundResultInfluentialPhysical Activity and Mortality in Frail, Community-Living Elderly Patients
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MethodResultSkeletal Muscle as a Paradigm for Regenerative Biology and Medicine
Gayraud-Morel, B., Chrétien, F., & Tajbakhsh, S. (2009) · Regenerative Medicine · doi:10.2217/17460751.4.2.293 · Cited by 103
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“Although it is known that heavy strength training elicits substantial gains in muscular strength, even in the oldest individuals (Fiatarone et al., 1990), circuit training using lower loads has previously been shown not to promote comparable strength increases as traditional weights training…”
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Strength Training Effects on Subjective Well-Being and Physical Function in the Elderly
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Falls in the Nursing Home: Are They Preventable?
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“Furthermore, it may be possible that during 21 weeks of strength training muscle hypertrophy may become an important factor in contributing to the increase in maximal strength even in aging men (Fiatarone et al. 1990; Frontera et al.1988; Häkkinen et al. 1998).”
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Humoral Mediation of Changing Body Composition During Aging and Chronic Inflammation
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The Tromsø Study: Physical Activity and the Incidence of Fractures in a Middle-Aged Population
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da Rosa Orssatto, L. B., de la Rocha Freitas, C., Shield, A. J., Silveira Pinto, R., & Trajano, G. S. (2019) · Experimental Gerontology · doi:10.1016/j.exger.2019.110731 · Cited by 86
“Resistance training is an effective intervention to improve functional capacity in the elderly (Borde et al., 2015; Byrne et al., 2016; Csapo and Alegre, 2015; Fiatarone et al., 1990; Orssatto et al., 2019; Skelton et al., 1995; Steib et al., 2010; Tschopp et al., 2011).”
BackgroundThe influence of lower extremity joint torque on gait characteristics in elderly men
Burnfield, J. M., Josephson, K. R., Powers, C. M., & Rubenstein, L. Z. (2000) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2000.7174 · Cited by 88
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“…downstream effectors to pro-growth interventions including growth factors and resistance exercise and, in turn, an attenuation of fiber hypertrophy (Fiatarone et al., 1990, 1994; McCartney et al., 1995; Welle et al., 1996; Hakkinen et al., 1998; Tamaki et al., 2000; Morris et al., 2004; Parkington…”
Isometric intermittent endurance of four muscle groups in men aged 20-74 yr
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Selected Methods of Resistance Training for Prevention and Treatment of Sarcopenia
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Effects of Exercise on Senescent Muscle
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Myotendinous alterations and effects of resistive loading in old age
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“Enlargement of muscle size measured using techniques such as computed tomography, ultrasound and more recently magnetic resonance imaging, has been observed following resistive training programs (e.g., Fiatarone et al., 1990; Ferri et al., 2003; Suetta et al., 2004).”
MethodEffects of Resistance Training on Lower-Extremity Impairments in Older People With Hip Fracture
Portegijs, E., Kallinen, M., Rantanen, T., Heinonen, A. O., Sihvonen, S. E., Alén, M., Kiviranta, I., & Sipilä, S. (2008) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2008.01.026 · Cited by 85
Effects of a 6-Week Resistance-Training Program on Functional Fitness of Older Adults
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“Specifically, age-related loss in muscle strength is related to impaired functional mobility (i.e., rising from a chair, gait velocity) in older adults (Bassey et al., 1992; Brown, Sinacore, & Host, 1995; Fiatarone et al., 1990; Hughes, Myers, & Schenkman, 1996; Scarborough, Krebs, & Harris, 1999).”
BackgroundThere are no no-responders to low or high resistance training volumes among older women
Barbalho, M., Gentil, P., Izquierdo, M., Fisher, J. P., Steele, J., & Raiol, R. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.09.003 · Cited by 88
“…evidence that it can also improve other important health outcomes in the elderly, such as body composition (Avila et al., 2010), waist circumference (Cottell et al., 2011), cardiorespiratory fitness (Frank et al., 2016) and functional capacity (Fiatarone et al., 1994; Fiatarone et al., 1990).”
BackgroundResultInfluentialEffect of resistance training on self-reported physical functioning in HIV infection
Roubenoff, R., & Wilson, I. B. (2001) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200111000-00003 · Cited by 84
“In fact, this concept is not proven, and experience with strength training as a means to increase LBM has shown that strength gains are far greater than increases in lean tissue (7,8,23).”
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Respiratory Muscle Strength in the Physically Active Elderly
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“These adaptations by the respiratory muscles are similar to the increases in quadriceps strength and mass noted in elderly individuals following resistive strength training [23, 24] and suggest that the age-related decline in muscle strength may be attenuated by routine vigorous physical activity.”
BackgroundPower training for older adults
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BackgroundComparison of high and moderate intensity of strength training on mood and anxiety in older adults
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“per week (10,11,32,34), some studies (12,15,38) suggested that”
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Progressive strength training in sedentary, older African American women
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Frailty amplifies the effects of aging on protein metabolism: role of protein intake
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The effects of improved strength on obstacle negotiation in community-living older adults
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A 1-Year Exercise Program for Older Women: Effects on Falls, Injuries, and Physical Performance
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Maximal motor unit discharge rates in the quadriceps muscles of older weight lifters
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Physical activity, muscle function, falls and fractures
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“reported the muscle strength to decrease by 32% after only four weeks of reduced physical training (17).”
BackgroundFatigue during High-Intensity Intermittent Exercise
Lambert, C. P., & Flynn, M. G. (2002) · Sports Medicine · doi:10.2165/00007256-200232080-00003 · Cited by 79
“It has been well established that in older adults resistance exercise can improve muscle mass, strength and physical function.[1,2] Other beneficial effects of resistance training are increased caloric expenditure as a result of the accretion of metabolically active muscle tissue[3,4] and increased bone density.”
BackgroundSedentary Habits, Health, and Function in Older Women and Men
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Changes in Function and Disability After Resistance Training: Does Velocity Matter?: A Pilot Study
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Hemodynamic Responses During Aerobic and Resistance Exercise
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Physical activity, exercise, and sarcopenia – future challenges
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“In addition different exercise regimens – resistance, power, or functional training – showed different results thus making it mandatory to investigate which exercise regimen has the best effects on the sarcopenia process [41, 53, 54, 56, 59].”
BackgroundRogus‐Pulia, N. M., Rusche, N., Hind, J. A., Zielinski, J., Gangnon, R. E., Safdar, N., & Robbins, J. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13933 · Cited by 79
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Bruseghini, P., Calabria, E., Tam, E., Milanese, C., Oliboni, E. S., Pezzato, A., Pogliaghi, S., Salvagno, G. L., Schena, F. F., Mucelli, R. P., et al. (2015) · Oncotarget · doi:10.18632/oncotarget.4031 · Cited by 83
“The functional consequences of sarcopenia are obvious and several studies have highlighted the negative impact of muscle loss on strength [16, 17] that is evident even when corrected for muscle loss.”
BackgroundEffects of Eccentrically Biased versus Conventional Weight Training in Older Adults
Raj, I. S., Bird, S. R., Westfold, B. A., & SHIELD, A. J. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182442ecd · Cited by 79
“The 6MFWT, performed between two sets of light gates, involved the timing of participants as they walked as quickly as possible (11,15).”
MethodResistance Training and Cardiac Hypertrophy
Haykowsky, M. J., Dressendorfer, R. H., Taylor, D. A., Mandic, S., & Humen, D. P. (2002) · Sports Medicine · doi:10.2165/00007256-200232130-00003 · Cited by 78
“[2] However, despite these established benefits, disagreement exists concerning the effect of RT on left ventricular (LV) morphology.”
BackgroundCardiopulmonary responses to eccentric and concentric resistance exercise in older adults
Vallejo, A. F., Schroeder, E. T., Zheng, L., Jensky, N. E., & Sattler, F. R. (2006) · Age and Ageing · doi:10.1093/ageing/afj082 · Cited by 79
Improvements in Quadriceps Strength With Regular Seated Exercise in the Institutionalized Elderly
McMurdo, M. E. T., & Rennie, L. M. (1994) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(21)01627-0 · Cited by 78
Effects of Detraining on Knee Extensor Strength and Functional Mobility in a Group of Elderly Women
Connelly, D. M., & Vandervoort, A. A. (1997) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.1997.26.6.340 · Cited by 78
Armamento‐Villareal, R., Aguirre, L. E., Napoli, N., Shah, K. N., Hilton, T. N., Sinacore, D. R., Qualls, C., & Villareal, D. T. (2013) · Osteoporosis International · doi:10.1007/s00198-013-2450-2 · Cited by 80
“The positive impact of regular exercise on muscle strength, gait, and balance in elderly has been demonstrated in several studies [15, 16].”
Motor plasticity in a juggling task in older adults—a developmental study
Voelcker‐Rehage, C., & Willimczik, K. (2006) · Age and Ageing · doi:10.1093/ageing/afl025 · Cited by 78
Dietary protein adequacy and lower body versus whole body resistive training in older humans
Campbell, W. W., Trappe, T. A., Jozsi, A. C., Kruskall, L. J., Wolfe, R. R., & Evans, W. J. (2002) · The Journal of Physiology · doi:10.1113/jphysiol.2002.020685 · Cited by 77
“…in the more recent studies (Campbell et al. 1994b, 1995; Fiatarone et al. 1994) performed whole body (upper and lower body) resistive training programmes, in contrast to the lower body only resistive training programmes used in the earlier studies (Frontera et al. 1988; Fiatarone et al. 1990).”
BackgroundResultInfluentialBody composition, body fat distribution, and resting metabolic rate in healthy centenarians
Paolisso, G., Gambardella, A., Balbi, V., Ammendola, S., D’Amore, A., & Varricchio, M. (1995) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/62.4.746 · Cited by 77
C57BL/6 life span study: age-related declines in muscle power production and contractile velocity
Graber, T. G., Kim, J., Grange, R. W., McLoon, L. K., & Thompson, L. V. (2015) · AGE · doi:10.1007/s11357-015-9773-1 · Cited by 78
Anabolic Interventions for Aging-Associated Sarcopenia
Bross, R., Javanbakht, M., & Bhasin, S. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.10.6055 · Cited by 75
Timonen, L., Rantanen, T., Timonen, T. E., & Sulkava, R. O. (2002) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.757 · Cited by 78
“Strength training can, at least to some extent, counteract these losses and improve daily functioning (Fiatarone et al., 1990; Sauvage et al., 1992; Fiatarone et al., 1994; Lord et al., 1995).”
BackgroundVoluntary Aerobic Exercise Reverses Frailty in Old Mice
Graber, T. G., Ferguson-Stegall, L. M., Liu, H. M., & Thompson, L. V. (2014) · The Journals of Gerontology Series A · doi:10.1093/gerona/glu163 · Cited by 76
Timonen, L., Rantanen, T., Ryynänen, O., TAIMELA, S. P., Timonen, T. E., & Sulkava, R. O. (2002) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1034/j.1600-0838.2002.120310.x · Cited by 79
“In a study by Fiatarone et al. (1990) with institutionalized nonagenarians, 32% of the strength increase measured as a one-repetition maximum was lost 4 weeks after training.”
BackgroundClinical implications of osteoarthritis and ageing.
Hamerman, D. (1995) · Annals of the Rheumatic Diseases · doi:10.1136/ard.54.2.82 · Cited by 74
Exercise in chronic pulmonary disease: resistance exercise prescription
STORER, T. W. (2001) · Medicine and Science in Sports and Exercise · doi:10.1097/00005768-200107001-00006 · Cited by 75
“Loads as high as 80% of the pretraining 1-RM have been successfully applied in healthy, frail elderly (13,15) and in patients with chronic pulmonary disease (5,27) with no ill effects.”
BackgroundResponse of joint structures to inactivity and to reloading after immobilization
Brandt, K. D. (2003) · Arthritis Care & Research · doi:10.1002/art.11009 · Cited by 75
Caggiano, E., Emrey, T., Shirley, S., & Craik, R. L. (1994) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.1994.20.1.22 · Cited by 75
Effect of Tongue Exercise on Protrusive Force and Muscle Fiber Area in Aging Rats
Connor, N. P., Russell, J. A., Wang, H., Jackson, M., Mann, L. B., & Kluender, K. R. (2008) · Journal of Speech Language and Hearing Research · doi:10.1044/1092-4388(2008/08-0105 · Cited by 75
Roie, E. V., Delecluse, C., Opdenacker, J., Bock, K. D., Kennis, E., & Boen, F. (2010) · Journal of Aging and Physical Activity · doi:10.1123/japa.18.3.335 · Cited by 77
“It has also been shown that strength-training interventions help improve physical performance and reduce falls (Campbell et al., 1997; Fiatarone et al., 1990).”
BackgroundSarcopenia: Pharmacology of Today and Tomorrow
Brotto, M., & de Abreu, E. L. (2012) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.112.191759 · Cited by 76
“Frontera et al. (1990) conducted a 12-week progressive resistance training program with 60- to 72-year-old men, whereas Fiatarone et al. (1990) conducted a similar program but with 87- to 96-year-old men and women that lasted only 8 weeks.”
MethodRole of resistance training in heart disease
McCartney, N. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199810001-00008 · Cited by 75
Joseph, L. J. O., Davey, S. L., Evans, W. J., & Campbell, W. W. (1999) · Metabolism · doi:10.1016/s0026-0495(99)90162-2 · Cited by 74
Singh, A. S., Paw, M. J. C. A., Bosscher, R. J., & van Mechelen, W. (2006) · BMC Geriatrics · doi:10.1186/1471-2318-6-4 · Cited by 75
“Several studies have demonstrated a positive association between muscle strength of the lower extremities and mobility tasks such as rising from a chair [8-10] and walking speed [8,11-13].”
Frailty Syndrome in Geriatric Medicine
Ruiz, M. A., Cefalu, C. A., & Reske, T. (2012) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e318256c6aa · Cited by 76
“5% to 9% increase in frail or institutionalized older adults.(35,36) Frailty Syndrome”
BackgroundNutrition and sarcopenia: evidence for an interaction
Millward, D. J. (2012) · Proceedings of The Nutrition Society · doi:10.1017/s0029665112000201 · Cited by 77
Boshuizen, H. C., Stemmerik, L., Westhoff, M. H., & Hopman-Rock, M. (2005) · Journal of Aging and Physical Activity · doi:10.1123/japa.13.1.5 · Cited by 74
“One study (Fiatarone et al., 1990) showed that even frail, institutionalized elderly people could gain an increase in knee-extensor strength of 174% in 8 weeks of training.”
BackgroundCheol-Jin, K., Kim, Y. L., & Lee, S. M. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.3189 · Cited by 74
Sex differences in the response to resistance exercise training in older people
Da Boit, M., Sibson, R., Meakin, J. R., Aspden, R. M., Thies, F., Mangoni, A. A., & Gray, S. R. (2016) · Physiological Reports · doi:10.14814/phy2.12834 · Cited by 73
“In conclusion, this study has demonstrated a difference in the magnitude of adaptation, of some of the outcome measures employed, in response to 18 weeks of resistance exercise training between men and women.”
Sarcopenic Obesity: An Emerging Cause of Frailty in Older Adults
Jarosz, P. A., & Bellar, A. (2008) · Geriatric Nursing · doi:10.1016/j.gerinurse.2008.02.010 · Cited by 74
Hvid, L. G., Strotmeyer, E. S., Skjødt, M., Magnussen, L. V., Andersen, M., & Caserotti, P. (2016) · Experimental Gerontology · doi:10.1016/j.exger.2016.03.018 · Cited by 73
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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