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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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.
“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]
High-intensity progressive resistance training has been recognized as a safe and effective means to combat frailty for over three decades.
“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]
Older adults with advanced frailty and multiple comorbidities remain very capable of undertaking high intensity progressive resistance training, even in the tenth decade of life.
“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]
High-intensity progressive resistance training (PRT) is feasible and effective for older adults who are severely frail.
“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]
A properly designed PRT program can counteract age-related changes in contractile function, atrophy, and morphology of the aging human skeletal muscles.
“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]
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.
“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]
Resistance training programs or multicomponent exercise interventions with robust PRT have enhanced muscle strength in older adults with frailty and sarcopenia.
“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]
The major barrier to implementing robust exercise in nursing home settings is the lack of financial reimbursement, trained professionals, and necessary equipment to conduct programs with fidelity.
“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]
High-intensity progressive resistance training (PRT) has been recognized for over three decades as a safe and effective means to combat frailty.
“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]
Such individuals remain very capable of undertaking high intensity PRT, even in the tenth decade of life.
“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]
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 activities.
“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]
High-intensity PRT is both feasible and effective for older adults who are severely frail.
“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]
A properly designed PRT program can counteract age-related changes in contractile function, atrophy, and morphology of aging human skeletal muscles.
“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]
The major barrier to implementing robust exercise programs in nursing homes is the lack of financial reimbursement, trained professionals, and necessary equipment.
“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]
Fiatarone et al found that strength increased >100% after several weeks in institutionalized seniors in their 80s and 90s, with many able to reduce dependence on wheelchairs and walkers.
“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.”
Resistance exercise is an effective means of combating the loss of muscle mass and function in a variety of populations.
“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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Weight stability masks sarcopenia in elderly men and women
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Sarcopenia, Cachexia and Aging: Diagnosis, Mechanisms and Therapeutic Options - A Mini-Review
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Stair Negotiation in Older People: A Review
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Aerobic and Strength Training in Patients with Chronic Obstructive Pulmonary Disease
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“In young and older normal subjects, muscle hypertrophy and improved neural recruitment patterns account for the increase in muscle strength following muscle training (7, 25, 26 ).”
BackgroundExercise Attenuates the Major Hallmarks of Aging
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BackgroundTemporal and Biomechanical Characteristics of Oropharyngeal Swallow in Younger and Older Men
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“Resistance-type exercise training represents an effective interventional strategy to increase muscle mass and function in the elderly (Fiatarone et al. 1990; Frontera et al. 1988).”
BackgroundEccentric Muscle Contractions: Their Contribution to Injury, Prevention, Rehabilitation, and Sport
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BackgroundMethodInfluentialThe benefits of strength training for older adults
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The Effect of Tai Chi Quan and Computerized Balance Training on Postural Stability in Older Subjects
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“Also in frail institutionalised elderly resistance training is feasible [5,6], and can lead to clinically relevant strength gain and improved mobility [7,8].”
Gait Disorders in Older Adults
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Exercise in the Prevention of Falls in Older People
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Water-based exercise improves health-related aspects of fitness in older women
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“Many studies using weight training ranging from moderate to high intensity have reported increases of muscle strength and hypertrophy in elderly men and women (13,15,17).”
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Strength Training in the Elderly
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- 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 › 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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