Why Senior Strength Training Matters: Sarcopenia, Falls, and the 1994 Fiatarone Nursing-Home Study

Senior strength training matters because aging muscles shrink faster than aging bones, aging hearts, or aging brains. The medical name for age-related muscle loss is sarcopenia. The term comes from the Greek words for flesh and loss. And it was coined by the physician Irwin Rosenberg in 1989. The National Institutes of Health at nih.gov estimate that adults lose 3 to 8 percent of their total muscle mass per decade after age 30, and the rate roughly doubles after age 60. By age 80, the average sedentary adult has lost about 30 to 40 percent of the muscle mass they had at age 30. The muscle is replaced by fat and connective tissue, which is why the same outward body weight at 80 hides a very different body composition than at 30.

The practical consequences of sarcopenia drive most of what people call frailty. The Centers for Disease Control at cdc.gov publishes the STEADI fall prevention data, which shows that one in four adults aged 65 and older falls each year in the United States. Falls are the leading cause of fatal and nonfatal injury in this age group. A hip fracture from a fall carries a one-year mortality rate of 21 to 30 percent according to the American Academy of Orthopaedic Surgeons at aaos.org. The downstream costs are enormous. Medicare spent more than 50 billion dollars on fall-related medical care in the most recent fully reported year. Sarcopenia is the single largest modifiable risk factor for falls, ahead of vision changes, medication interactions, and home hazards.

The 1994 study by Maria Fiatarone Singh and colleagues changed how the medical world thought about strength training in older adults. The paper, titled Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People, was published in the New England Journal of Medicine in volume 330, pages 1769 to 1775. The full citation is available on pubmed.ncbi.nlm.nih.gov by searching the title. The study enrolled 100 frail nursing home residents with an average age of 87. The participants were randomized to four groups: progressive resistance training, nutritional supplement, both, or neither. The strength training group lifted weights on machines three days per week at high intensity for ten weeks. The results were striking. Muscle strength in the exercise groups roughly doubled. Stair-climbing power increased by 28 percent. Gait speed increased by 12 percent. Spontaneous physical activity rose. Several participants who had used walkers before the study no longer needed them.

The Fiatarone study established that strength training works at any age, even in the oldest old, even in people already in nursing homes. The findings have been replicated dozens of times in the three decades since. The Cochrane review on progressive resistance training in older adults, available at cochranelibrary.com, summarizes 121 randomized trials and concludes that resistance training improves muscle strength, walking ability, and self-reported physical function in adults aged 65 and older. The American College of Sports Medicine at acsm.org and the National Institute on Aging at nia.nih.gov both now recommend muscle-strengthening activities involving all major muscle groups on at least two days per week for adults aged 65 and older. The recommendation appears in the Physical Activity Guidelines for Americans, second edition, published by the United States Department of Health and Human Services at health.gov. Sources include nih.gov, cdc.gov/steadi, aaos.org, pubmed.ncbi.nlm.nih.gov, cochranelibrary.com, acsm.org, nia.nih.gov, and health.gov.