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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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Cardio-sarcopenia: A syndrome of concern in aging
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Effect of Strength Training on Orthostatic Hypotension in Older Adults
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Is exercise of value in the prevention of fragility fractures in men?
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Training increases the in vivo strength of the lower leg: An experimental study in the rat
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Evaluation of older Adults with obesity for bariatric surgery: Geriatricians' perspective
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Skelettmuskuläre Faktoren, Sarkopenie und Stürze im Alter
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“For example, Atkinson et al. (2010) reported testosterone administration preserved muscle mass in elderly individuals, which is the same effect appropriately prescribed exercise exerts (Frontera et al., 1988; Fiatarone et al., 1990; Herbert et al., 2017b).”
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“Improvements in muscle strength have been shown with resistance exercises in the elderly population and may prove beneficial in slowing the progression of age-associated muscle mass loss [150,151].”
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“…exercises (i.e., movements performed against a specific external force that is regularly increased during training) are especially useful for improving muscle mass or strength in the elderly (Liu and Latham, 2009), including in the oldest-old (people aged 90 years or over) (Fiatarone et al., 1990).”
BackgroundHeavy Strength Training in Older Adults: Implications for Health, Disease and Physical Performance
Tøien, T. H., Berg, O. K., Modena, R., Brobakken, M. F., & Wang, E. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13804 · Cited by 30
“In the hallmark studies by [37, 39], frail nursing home residents of almost 90 years old (mean age 87 years, range 72–98 years) performed strength training with heavy loads of 80% of 1RM, with considerable improvements in strength and functional status.”
InfluentialGeroprotector drugs and exercise: friends or foes on healthy longevity?
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“In addition, even in adults 85 years of age and older, resistance exercise is capable of increasing muscle mass, strength, and power [47, 48].”
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“RT offers many health benefits, including greater muscular strength and functional mobility (Fiatarone et al. 1990), as well as assisting in the attenuation of age-related osteoporosis (Suominen 2006) and sacropenia (Burton and Sumukadas 2010).”
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“The most effective interventions to prevent or recover from sarcopenia include resistance training and proper nutrition [18], even among nonagenarians [19].”
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“Repetitionmaximum testing, including one-repetition-maximum (1RM) testing, has also been used to assess muscle strength in elders (Atha, 1981; Fiatarone et al., 1990; Frontera, Meredith, O’Reilly, Knuttgen, & Evans, 1988; Judge, Underwood, & Gennosa, 1993; Nichols, Omizo, Peterson, & Nelson, 1993).”
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“Data on the benefit of exercise or resistance training in advanced age to enhance muscle mass and strength are largely unambiguous.(14-18) If a training stimulus is set sufficiently high and often, neuronal-, metabolic-, structural-morphological and anatomical changes in skeletal muscle can be observed.”
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“Research on strength training has revealed improved balance and strengthwith both free-form training (9,13,14,23) and fixed form resistance training devices (2,12), yet research has not clearly established whether one type of training modality has any advantages over the other.”
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ResultNeural strategies in the control of muscle force
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Mitigating Sarcopenia with Diet and Exercise
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Thomas, S., Halbert, J. A., Mackintosh, S. F., Quinn, S. J., & Crotty, M. (2011) · Journal of Aging and Health · doi:10.1177/0898264311422254 · Cited by 22
“…training are both particularly important forms of exercise in older age (Gillespie et al., 2009; Sherrrington et al., 2008), even among frail nonagenarians, it is possible to increase muscle strength through progressive resistance training (Binder et al., 2002; Fiatarone et al., 1990, 1994).”
BackgroundVan Roie, E., Bautmans, I., Boonen, S., Coudyzer, W., Kennis, E., & Delecluse, C. (2013) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e3182606e35 · Cited by 22
“In the literature, high-resistance training has already been proven to be effective in increasing muscle strength and muscle volume (4,11,16,19,21,33,35).”
BackgroundExplosive and maximal strength before and 6 months after total hip arthroplasty
Friesenbichler, B., Casartelli, N. C., Wellauer, V., Item‐Glatthorn, J. F., Ferguson, S. J., Leunig, M., & Maffiuletti, N. A. (2017) · Journal of Orthopaedic Research® · doi:10.1002/jor.23626 · Cited by 22
Lee, H., Kim, I., Sung, C., Jeon, T., Cho, K., Ha, Y., Park, K., Yoo, J., Kang, G. H., Kim, S. J., et al. (2019) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13597 · Cited by 22
Novel individualized power training protocol preserves physical function in adult and older mice
Graber, T. G., Fandrey, K. R., & Thompson, L. V. (2019) · GeroScience · doi:10.1007/s11357-019-00069-z · Cited by 21
Hamerman, D. (1998) · Clinics in Geriatric Medicine · doi:10.1016/s0749-0690(18)30099-5 · Cited by 21
Knee Extensor Isometric Unsteadiness Does Not Predict Functional Limitation in Older Adults
Manini, T. M., Cook, S. B., Ordway, N. R., Ploutz-Snyder, R. J., & Ploutz‐Snyder, L. L. (2005) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/01.phm.0000151940.47912.df · Cited by 22
“Depending on the functional ability of the group studied, resistance training in older adults has shown positive improvements in function.(27,28)”
BackgroundSkelton, D. A., & Mavroeidi, A. (2018) · Journal of Frailty Sarcopenia and Falls · doi:10.22540/jfsf-03-085 · Cited by 24
Hamdorf, P. A., Withers, R. T., Penhall, R. K., & Plummer, J. L. (1993) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(93)90108-m · Cited by 22
Physical Activity in the Elderly
Harridge, S. D. R., & Suominen, H. (2003) · doi:10.1002/9780470757277.ch16 · Cited by 22
Diagnostisches und therapeutisches Vorgehen bei Sarkopenie
Schaupp, A., Martini, S., Schmidmaier, R., & Drey, M. (2021) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-021-01968-7 · Cited by 25
The non-modifiable factors age, gender, and genetics influence resistance exercise
Viecelli, C., & Ewald, C. Y. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.1005848 · Cited by 26
Peyrusqué, É., Buckinx, F., Kergoat, M., & Aubertin‐Leheudre, M. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2023.01.015 · Cited by 21
Physical Activity as a Strategy to Reduce the Risk of Osteoporosis and Fragility Fractures
Karlsson, M. K., & Rosengren, B. E. (2012) · Intern J Endocrinol Metab · doi:10.5812/ijem.3309 · Cited by 21
“The lower fracture incidence in physically active elderly people is therefore, probably the result of non-skeletal effects such as; increased muscle strength and/or improved neuromuscular function, traits which are possible to influence by training even in the tenth decade of life (38).”
Quittan, M. (2016) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-015-0418-x · Cited by 21
PADRÃO DE MARCHA, PREVALÊNCIA DE QUEDAS E MEDO DE CAIR EM IDOSAS ATIVAS E SEDENTÁRIAS
Abdala, R. P., Barbieri, W., Júnior, C. R. B., & Gomes, M. M. (2017) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-869220172301155494 · Cited by 21
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“Three training sessions per week were provided for each periodization protocol (Buford et al., 2007; Fiatarone et al., 1990; Frontera et al., 1988; Roberson et al., 2018).”
To sit or not to sit? A systematic review and meta‐analysis of seated exercise for older adults
Sexton, B. P., & Taylor, N. F. (2018) · Australian Journal on Ageing · doi:10.1111/ajag.12603 · Cited by 24
Validation and reliability of the Modified Elderly Mobility Scale
Kuys, S. S., & Brauer, S. (2006) · Australian Journal on Ageing · doi:10.1111/j.1741-6612.2006.00169.x · Cited by 21
The Clinical Importance of the Anaerobic Energy System and Its Assessment in Human Performance
Cahill, B. R., MISNER, J. E., & Boileau, R. A. (1997) · The American Journal of Sports Medicine · doi:10.1177/036354659702500623 · Cited by 21
Health enhancing strength training in nonagenarians (STRONG): rationale, design and methods
Rexach, J. A. S., Ruiz, J. R., Bustamante-Ara, N. E., Villarán, M. H., Gil, P. G., Ibáñez, M. J. S., Sanz, N. B., Santamaría, V. O., Sanz, N. G., Prada, A. B. M., et al. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-152 · Cited by 22
Health-related implications and management of sarcopenia
Zacker, R. J. (2006) · JAAPA · doi:10.1097/01720610-200610000-00008 · Cited by 23
Home-Based Leg Strengthening for Older Adults Initiated through Private Practice
McCool, J. F., & Schneider, J. K. (1999) · Preventive Medicine · doi:10.1006/pmed.1998.0406 · Cited by 21
Aging, Body Composition, and Physical Activity: A Review
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Exercise Considerations in Older Adults
Buchner, D. M., & Coleman, E. A. (1994) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/s1047-9651(18)30530-8 · Cited by 19
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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