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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“persons with known heart or lung disease, hypertension, or other chronic conditions may not produce the same results, although maximal strength testing appears to be safe and effective even in nonagenarians (15).”
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Mallery, L. H., MacDonald, E. A., Hubley‐Kozey, C. L., Earl, M., Rockwood, K. J., & MacKnight, C. (2003) · BMC Geriatrics · doi:10.1186/1471-2318-3-3 · Cited by 70
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Patient‐Related Predictors of Rehabilitation Use for Community‐Dwelling Older Americans
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Idoate, F., Cadore, E. L., Casas-Herrero, A., Zambom-Ferraresi, F., Marcellán, T., de Gordoa, A. R., Rodriguez-Mañas, L., Bastarrika, G., Marques, M. C., Martínez-Velilla, N., et al. (2015) · European Radiology · doi:10.1007/s00330-014-3555-5 · Cited by 56
Frailty in Advanced Heart Failure: A Consequence of Aging or a Separate Entity?
Goldwater, D. S., & Pinney, S. (2015) · Clinical Medicine Insights Cardiology · doi:10.4137/cmc.s19698 · Cited by 59
Villanueva, M., He, J., & Schroeder, E. T. (2014) · European Journal of Applied Physiology · doi:10.1007/s00421-014-2821-1 · Cited by 60
Fragnoli-Munn, K., Savage, P. D., & Ades, P. A. (1998) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-199811000-00003 · Cited by 57
Anaerobic Power and Physical Function in Strength-Trained and Non-Strength-Trained Older Adults
Slade, J. M., Miszko, T. A., Laity, J., Agrawal, S. K., & Cress, M. E. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.3.m168 · Cited by 57
“Our results confirm several previous studies that show that functional performance is improved by strength training (20,34,35).”
ResultNew Physical Activity Guidelines
Thompson, P. D., & Eijsvogels, T. M. H. (2018) · JAMA · doi:10.1001/jama.2018.16070 · Cited by 57
Dirks, M. L., Tieland, M., Verdijk, L. B., Losen, M., Nilwik, R., Mensink, M., de Groot, L. C. P. G. M., & van Loon, L. J. C. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.02.006 · Cited by 56
Dietary Protein Sources and Muscle Mass over the Life Course: The Lifelines Cohort Study
Alexandrov, N. V., Eelderink, C., Singh-Povel, C. M., Navis, G. J., Bakker, S. J. L., & Corpeleijn, E. (2018) · Nutrients · doi:10.3390/nu10101471 · Cited by 56
The Effects of Resistance Training Performed in Water on Muscle Strength in the Elderly
Graef, F. I., Pinto, R. S., Alberton, C. L., de Lima, W. C., & Kruel, L. F. M. (2010) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e3181e2720d · Cited by 56
“the elderly, reverting losses or maintaining strength levels and functional capacity (7,9,11,12).”
BackgroundMorris, M. S., & Jacques, P. F. (2012) · British Journal Of Nutrition · doi:10.1017/s0007114512003133 · Cited by 56
The Interaction between Mobility Status and Exercise Specificity in Older Adults
Brahms, C. M., Hortobágyi, T., Kressig, R. W., & Granacher, U. (2020) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000237 · Cited by 58
Alkhedhairi, S. A., Aba Alkhayl, F. F., Ismail, A. D., Rozendaal, A., German, M., MacLean, B., Johnston, L., Miller, A. A., Hunter, A. M., Macgregor, L. J., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.04.007 · Cited by 56
“Even though resistance exercise improves muscle mass and function, even in nonagenarian women [6], it is less effective than in young people, the so-called “ anabolic resistance ” [7], and participation rates are low [8].”
BackgroundBiomarkers of aging: from molecules and surrogates to physiology and function
Furrer, R., & Handschin, C. (2025) · Physiological Reviews · doi:10.1152/physrev.00045.2024 · Cited by 68
Bone Mineral Density Responses to High-Intensity Strength Training in Active Older Women
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“Resistance training, however, can maintain or increase muscle mass and strength of elders (Nichols, Omizo, Peterson, & Nelson, 1993), even in nonagenarians (Fiatarone et al., 1990).”
BackgroundSeguin‐Fowler, R. A., Economos, C. D., Palombo, R., Hyatt, R. R., Kuder, J., & Nelson, M. E. (2010) · Journal of Aging and Physical Activity · doi:10.1123/japa.18.2.201 · Cited by 56
“P A A uthor M anuscript Fiatarone et al., 1990; Lemmer et al., 2001; Menkes et al., 1993; Nelson et al., 1994; Sims, Hill, Davidson, Gunn, & Huang, 2006; Tracy et al., 1999).”
BackgroundCunha, P. M., Tomeleri, C. M., do Nascimento, M. A., Nunes, J. P., Antunes, M., Nabuco, H. C. G., Quadros, Y., Cavalcante, E. F., Mayhew, J. L., Sardinha, L. B., et al. (2018) · Journal of Sports Sciences · doi:10.1080/02640414.2018.1479103 · Cited by 55
“Resistance training (RT) has been shown to promote improvements in the health of older populations (ACSM, 2009, 2011; Westcott, 2012), with well-established positive effects on muscle strength and muscle growth (Fiatarone et al., 1990; Ribeiro et al., 2015; Souza et al., 2017).”
BackgroundThe association between physical fitness and mental health in Norwegian adolescents
Åvitsland, A., Leibinger, É., Haugen, T., Lerum, Ø., Solberg, R. B., Kolle, E., & Dyrstad, S. M. (2020) · BMC Public Health · doi:10.1186/s12889-020-08936-7 · Cited by 65
Exercise-Induced Activation of STAT3 Signaling Is Increased with Age
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Preventing Disability Through Community‐Based Health Coaching
Holland, S. K., Greenberg, J. N., Tidwell, L., & Newcomer, R. J. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51068.x · Cited by 55
Physical Activity, Sport, and Health: Toward the Next Century
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“The presently applied resistance exercise regimen was deliberately focused on leg extension, as both the knee and hip extensors are the muscle groups widely acknowledged to be of critical importance in executing such basic postural shifts as sit-to-stand (and vice versa) and walking, with a long-term aim of appreciabl…”
BackgroundKrist, L., Keil, & Dimeo (2013) · Clinical Interventions in Aging · doi:10.2147/cia.s42136 · Cited by 64
Resistance Exercise, Skeletal Muscle FOXO3A, and 85-Year-Old Women
Williamson, D. L., Raue, U., Slivka, D. R., & Trappe, S. W. (2010) · The Journals of Gerontology Series A · doi:10.1093/gerona/glq005 · Cited by 53
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Has exercise an antifracture efficacy in women?
Karlsson, M. K. (2003) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/j.1600-0838.2003.00322.x · Cited by 53
“This increase is far greater than the corresponding increase in muscle volume, usually described as 2–20%, and greater than the increase in BMD, usually described as 1–2%, with a similar training regime (Fiatarone et al., 1990; Pyka et al., 1994; Province et al., 1995).”
BackgroundRibeiro, A. S., Schoenfeld, B. J., de Souza, M. F., Tomeleri, C. M., Venturini, D., Barbosa, D. S., & Cyrino, E. S. (2016) · Experimental Gerontology · doi:10.1016/j.exger.2016.03.007 · Cited by 53
“Previous research has shown decreased body fat in elderly women after a period of RT (Fiatarone et al., 1990; Ribeiro et al., 2015).”
BackgroundThe role of physiotherapy in the prevention and treatment of osteoporosis
Bennell, K. L., Khan, K. M., & McKay, H. A. (2000) · Manual Therapy · doi:10.1054/math.2000.0369 · Cited by 53
Ravaglia, G., Forti, P., Maioli, F., Boschi, F., Cicognani, A., Bernardi, M., Pratelli, L., Pizzoferrato, A., Porcu, S., & Gasbarrini, A. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb03769.x · Cited by 53
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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