Ozan Atalağ, Cem Kurt, Lincoln A. Gotshalk, Richard E. J. Shanklin, Jenna H. Aina, Ian McQuate


This narrative review evaluates strength or resistance training on cardiorespiratory endurance, blood pressure, contractile function, contractile protein synthesis rate, bone turnover, gait and balance, and neuromuscular adaptations in elderly populations. Seventy-eight studies spanning from 1999 through 2020 were reviewed. Database sources including PubMed, Science Direct, Web of Knowledge and Google Scholar were searched in accordance with the purpose of the study. A majority of the studies reported that resistance training reduces blood pressure and increases contractile functions, contractile protein synthesis rate, bone turnover, gait and balance, cardiorespiratory endurance, and neuromuscular adaptations in the elderly. Furthermore, combined training (CT), also known as concurrent training (strength plus endurance training) may also be as effective as traditional endurance training or traditional strength/resistance training alone for improving cardiorespiratory endurance and functional performance. According to the evaluation of studies included in this review, we concluded that training modalities that involve low-load, high velocity strength training combined with endurance training might be the best training strategy in improving cardiovascular fitness, functional capacity and musculoskeletal health in the elderly populations. Elderly people should be encouraged to participate in a concurrent training or a combination of strength and endurance training to delay, or even reverse the negative effects of aging.

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Agergaard, J., Bülow, J., Jensen, J. K., Reitelseder, S., Drummond, M. J., Schjerling, P., & Holm, L. (2017). Light-load resistance exercise increases muscle protein synthesis and hypertrophy signaling in elderly men. American Journal of Physiology-Endocrinology and Metabolism, 312(4), E326-E338.

Allen, J. D., Robbins, J. L., VanBruggen, M. D., Credeur, D. P., Johannsen, N. M., Earnest, C. P., & Kraus, W. E. (2013). Unlocking the barriers to improved functional capacity in the elderly: Rationale and design for the “Fit for Life trial.”. Contemporary Clinical Trials, 36(1), 266-275.

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75(1), 51-61.

Beck, B. R., Daly, R. M., Singh, M. A. F., & Taaffe, D. R. (2017). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438-445.

Bell, G., Syrotuik, D., Socha, T., Maclean, I., & Quinney, H. A. (1997). Effect of strength training and concurrent strength and endurance training on strength, testosterone, and cortisol. The Journal of Strength & and Conditioning Research, 11(1), 57-64.

Blumenthal, J. A., Smith, P. J., & Hoffman, B. M. (2012). Is exercise a viable treatment for depression? ACSM's Health & Fitness Journal, 16(4), 14.

Bottaro, M., Machado, S. N., Nogueira, W., Scales, R., & Veloso, J. (2007). Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men. European Journal of Applied Physiology, 99(3), 257-264.

Bowden Davies, K. A., Pickles, S., Sprung, V. S., Kemp, G. J., Alam, U., Moore, D. R., & Cuthbertson, D. J. (2019). Reduced physical activity in young and older adults: Metabolic and musculoskeletal implications. Therapeutic Advances in Endocrinology and Metabolism, 10. doi:10.1177/2042018819888824

Braith, R. W., & Stewart, K. J. (2006). Resistance exercise training: Its role in the prevention of cardiovascular disease. Circulation, 113(22), 2642-2650.

Cadore, E. L., Pinto, R. S., Teodoro, J. D., Da Silva, L. X. N., Menger, E., Alberton, C. L., & Izquierdo, M. (2018). Cardiorespiratory adaptations in elderly men following different concurrent training regimes. The Journal of Nutrition, Health & Aging, 22(4), 483-490.

Cadore, E. L., Pinto, R. S., Lhullier, F. L. R., Correa, C. S., Alberton, C. L., Pinto, S. S., & Kruel, L. F. M. (2010). Physiological effects of concurrent training in elderly men. International Journal of Sports Medicine, 31(10), 689-697.

Callahan, D., Phillips, E., Carabello, R., Frontera, W. R., & Fielding, R. A. (2007). Assessment of lower extremity muscle power in functionally-limited elders. Aging Clinical and Experimental Research, 19(3), 194-199.

Centers for Disease Control and Prevention (CDC). (2004). Strength training among adults aged>/= 65 years--United States, 2001. MMWR. Morbidity and Mortality Weekly Report, 53(2), 25.

Cheng, J. C., Chiu, C. Y., & Su, T. J. (2019). Training and evaluation of human cardiorespiratory endurance based on a fuzzy algorithm. International Journal of Environmental Research and Public Health, 16, 2390.

Cornelissen, V. A., Fagard, R. H., Coeckelberghs, E., & Vanhees, L. (2011). Impact of resistance training on blood pressure and other cardiovascular risk factors: A meta-analysis of randomized, controlled trials. Hypertension, 58(5), 950-958.

Cuoco, A., Callahan, D. M., Sayers, S., Frontera, W. R., Bean, J., & Fielding, R. A. (2004). Impact of muscle power and force on gait speed in disabled older men and women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(11), 1200-1206.

da Cunha Nascimento, D., Tibana, R. A., Benik, F. M., Fontana, K. E., Neto, F. R., de Santana, F. S., & Balsamo, S. (2014). Sustained effect of resistance training on blood pressure and hand grip strength following a detraining period in elderly hypertensive women: A pilot study. Clinical Interventions in Aging, 9, 219.

da Rosa Orssatto, L. B., de la Rocha Freitas, C., Shield, A. J., Pinto, R. S., & Trajano, G. S. (2019). Effects of resistance training concentric velocity on older adults' functional capacity: A systematic review and meta-analysis of randomised trials. Experimental Gerontology, 127, 110731.

Dantas, F. F. O., Brasileiro-Santos, M. D. S., Batista, R. M. F., do Nascimento, L. S., Castellano, L. R. C., Ritti-Dias, R. M., & Santos, A. D. C. (2016). Effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and blood pressure of hypertensive elderly women: A randomized clinical trial. PloS one, 11(8), e0161178.

Demontiero, O., Vidal, C., & Duque, G. (2012). Aging and bone loss: New insights for the clinician. Therapeutic Advances in Musculoskeletal Disease, 4(2), 61-76.

Distefano, G., & Goodpaster, B. H. (2018). Effects of exercise and aging on skeletal muscle. Cold Spring Harbor Perspectives in Medicine, 8(3), a029785.

Fagard, R. H. (2011). Exercise therapy in hypertensive cardiovascular disease. Progress in Cardiovascular Diseases, 53(6), 404-411.

Fielding, R. A., LeBrasseur, N. K., Cuoco, A., Bean, J., Mizer, K., & Singh, M. A. F. (2002). High‐velocity resistance training increases skeletal muscle peak power in older women. Journal of the American Geriatrics Society, 50(4), 655-662.

Finger, D., Goltz, F. R., Umpierre, D., Meyer, E., Rosa, L. H. T., & Schneider, C. D. (2015). Effects of protein supplementation in older adults undergoing resistance training: A systematic review and meta-analysis. Sports Medicine, 45(2), 245-255.

Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance training for older adults: Position statement from the national strength and conditioning association. The Journal of Strength & Conditioning Research, 33, (8).2019-2052.

Ferrucci, L., Baroni, M., Ranchelli, A., Lauretani, F., Maggio, M., Mecocci, P., & Ruggiero, C. (2014). Interaction between bone and muscle in older persons with mobility limitations. Current Pharmaceutical Design, 20(19), 3178-3197.

Frontera, W. R., Meredith, C. N., O'Reilly, K. P., & Evans, W. J. (1990). Strength training and determinants of VO2max in older men. Journal of Applied Physiology, 68(1), 329-333.

Frost, D. M., Cronin, J., & Newton, R. U. (2010). A biomechanical evaluation of resistance: fundamental concepts for training and sports performance. Sports Medicine, 40(4), 303-326.

Gray, M., Powers, M., Boyd, L., & Garver, K. (2018). Longitudinal comparison of low-and high-velocity resistance training in relation to body composition and functional fitness of older adults. Aging Clinical and Experimental Research, 30(12), 1465-1473.

Greenway, K. G., Walkley, J. W., & Rich, P. A. (2012). Does long-term swimming participation have a deleterious effect on the adult female skeleton? European Journal of Applied Physiology, 112(9), 3217-3225.

Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 13(1), 105.

Guizelini, P. C., de Aguiar, R. A., Denadai, B. S., Caputo, F., & Greco, C. C. (2018). Effect of resistance training on muscle strength and rate of force development in healthy older adults: A systematic review and meta-analysis. Experimental Gerontology, 102, 51-58.

Hamczyk, M. R., Nevado, R. M., Barettino, A., Fuster, V., & Andrés, V. (2020). Biological versus chronological aging: JACC focus seminar. Journal of the American College of Cardiology, 75(8), 919-930.

Hasten, D. L., Pak-Loduca, J., Obert, K. A., & Yarasheski, K. E. (2000). Resistance exercise acutely increases MHC and mixed muscle protein synthesis rates in 78–84 and 23–32 yr olds. American Journal of Physiology-Endocrinology and Metabolism, 278(4), E620-E626.

Hazell, T., Kenno, K., & Jakobi, J. (2007). Functional benefit of power training for older adults. Journal of Aging and Physical Activity, 15(3), 349-359.

Holviala, J., Häkkinen, A., Karavirta, L., Nyman, K., Izquierdo, M., Gorostiaga, E. M., & Häkkinen, K. (2010). Effects of combined strength and endurance training on treadmill load carrying walking performance in aging men. The Journal of Strength & Conditioning Research, 24(6), 1584-1595.

Hortobagyi, T., Tunnel, D., Moody, J., Beam, S., & DeVita, P. (2001). Low-or high-intensity strength training partially restores impaired quadriceps force accuracy and steadiness in aged adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(1), B38-B47.

Huovinen, V., Ivaska, K. K., Kiviranta, R., Bucci, M., Lipponen, H., Sandboge, S., & Nuutila, P. (2016). Bone mineral density is increased after a 16-week resistance training intervention in elderly women with decreased muscle strength. European Journal of Endocrinology, 175(6), 571-582.

Hurst, C., Weston, K. L., McLaren, S. J., & Weston, M. (2019). The effects of same-session combined exercise training on cardiorespiratory and functional fitness in older adults: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 31 (12), 1701-1717.

Inder, J. D., Carlson, D. J., Dieberg, G., McFarlane, J. R., Hess, N. C., & Smart, N. A. (2016). Isometric exercise training for blood pressure management: A systematic review and meta-analysis to optimize benefit. Hypertension Research, 39(2), 88-94.

Izquierdo, M., Ibanez, J. K. H. A., Hakkinen, K., Kraemer, W. J., Larrión, J. L., & Gorostiaga, E. M. (2004). Once weekly combined resistance and cardiovascular training in healthy older men. Medicine and Science in Sports and Exercise, 36(3), 435-443.

Jaul, E., & Barron, J. (2017). Age-related diseases and clinical and public health implications for the 85 years old and over population. Frontiers in Public Health, 5, 335.

Kraschnewski, J. L., Sciamanna, C. N., Poger, J. M., Rovniak, L. S., Lehman, E. B., Cooper, A. B., & Ciccolo, J. T. (2016). Is strength training associated with mortality benefits? A 15-year cohort study of US older adults. Preventive Medicine, 87, 121-127.

Karavirta, L., Häkkinen, A., Sillanpää, E., García‐López, D., Kauhanen, A., Haapasaari, A., & Gorostiaga, E. (2011). Effects of combined endurance and strength training on muscle strength, power and hypertrophy in 40–67‐year‐old men. Scandinavian Journal of Medicine & Science in Sports, 21(3), 402-411.

Kim, H. S., & Kim, D. G. (2013). Effect of long-term resistance exercise on body composition, blood lipid factors, and vascular compliance in the hypertensive elderly men. Journal of Exercise Rehabilitation, 9(2), 271.

Komi, P. V. (1984). Physiological and biomechanical correlates of muscle function: Effects of muscle structure and stretch—shortening cycle on force and speed. Exercise and Sport Sciences Reviews, 12(1), 81-122.

Kraemer, W. J., & Ratamess, N. A. (2004). Fundamentals of resistance training: Progression and exercise prescription. Medicine & Science in Sports & Exercise, 36(4), 674-688.

Kumar, V., Selby, A., Rankin, D., Patel, R., Atherton, P., Hildebrandt, W., & Rennie, M. J. (2009). Age‐related differences in the dose–response relationship of muscle protein synthesis to resistance exercise in young and old men. The Journal of Physiology, 587(1), 211-217.

Lacroix, A., Kressig, R. W., Muehlbauer, T., Gschwind, Y. J., Pfenninger, B., Bruegger, O., & Granacher, U. (2016). Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: A randomized controlled trial. Gerontology, 62(3), 275-288.

Landi, F., Calvani, R., Tosato, M., Martone, A. M., Fusco, D., Sisto, A., & Marzetti, E. (2017). Age-related variations of muscle mass, strength, and physical performance in community-dwellers: Results from the Milan EXPO survey. Journal of the American Medical Directors Association, 18(1), 88-e17.

Lyttle, A. D., Wilson, G. J., & Ostrowski, K. J. (1996). Enhancing performance: Maximal power versus combined weights and plyometrics training. Journal of Strength and Conditioning Research, 10, 173-179.

Ma, D., Wu, L., & He, Z. (2013). Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: A systematic review and meta-analysis. Menopause, 20(11), 1216-1226.

Maiorana, A., O'Driscoll, G., Cheetham, C., Collis, J., Goodman, C., Rankin, S., & Green, D. (2001). Combined aerobic and resistance exercise training improves functional capacity and strength in CHF. Journal of Cardiopulmonary Rehabilitation and Prevention, 21(1), 51-52.

Mancia, G., Fagard, R., Narkiewicz, K., Redán, J., Zanchetti, A., Böhm, M., & Galderisi, M. (2013). Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. Journal of Hypertension, 31(10), 1925-1938.

Martel, G. F., Hurlbut, D. E., Lott, M. E., Lemmer, J. T., Ivey, F. M., Roth, S. M., & Hurley, B. F. (1999). Strength training normalizes resting blood pressure in 65‐to 73‐year‐old men and women with high normal blood pressure. Journal of the American Geriatrics Society, 47(10), 1215-1221.

Marques, E. A., Mota, J., Viana, J. L., Tuna, D., Figueiredo, P., Guimarães, J. T., & Carvalho, J. (2013). Response of bone mineral density, inflammatory cytokines, and biochemical bone markers to a 32-week combined loading exercise programme in older men and women. Archives of Gerontology and Geriatrics, 57(2), 226-233.

Mayer, F., Scharhag-Rosenberger, F., Carlsohn, A., Cassel, M., Müller, S., & Scharhag, J. (2011). The intensity and effects of strength training in the elderly. Deutsches Ärzteblatt International, 108(21), 359.

Navaratnarajah, A., & Jackson, S. H. (2017). The physiology of ageing. Medicine, 45(1), 6-10.

Olher, R. D. R. V., Bocalini, D. S., Bacurau, R. F., Rodriguez, D., Figueira Jr, A., Pontes Jr, F. L., & Moraes, M. R. (2013). Isometric handgrip does not elicit cardiovascular overload or post-exercise hypotension in hypertensive older women. Clinical Interventions in Aging, 8, 649.

Orr, R., De Vos, N. J., Singh, N. A., Ross, D. A., Stavrinos, T. M., & Fiatarone-Singh, M. A. (2006). Power training improves balance in healthy older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(1), 78-85.

Paddon-Jones, D., Campbell, W. W., Jacques, P. F., Kritchevsky, S. B., Moore, L. L., Rodriguez, N. R., & Van Loon, L. J. (2015). Protein and healthy aging. The American Journal of Clinical Nutrition, 101(6), 1339S-1345S.

Pal, S., & Tyler, J. K. (2016). Epigenetics and aging. Science Advances, 2(7), e1600584.

Paterson, D. H., & Warburton, D. E. (2010). Physical activity and functional limitations in older adults: A systematic review related to Canada's Physical Activity Guidelines. International Journal of Behavioral Nutrition and Physical Activity, 7(1), 1-22.

Pescatello, L. S., MacDonald, H. V., Lamberti, L., & Johnson, B. T. (2015). Exercise for hypertension: A prescription update integrating existing recommendations with emerging research. Current Hypertension Reports, 17(11), 87.

Pirauá, A. L. T., Cavalcante, B. R., de Oliveira, V. M. A., Beltrão, N. B., de Amorim Batista, G., Pitangui, A. C. R., & de Araújo, R. C. (2019). Effect of 24‐week strength training on unstable surfaces on mobility, balance, and concern about falling in older adults. Scandinavian Journal of Medicine & Science in Sports, 29(11), 1805-1812.

Pollock, M. L., Gaesser, G. A., Butcher, J. D., Després, J. P., Dishman, R. K., Franklin, B. A., & Garber, C. E. (1998). ACSM position stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine & Science in Sports & Exercise, 30(6), 975-991.

Raisz, L. G., & Rodan, G. A. (2003). Pathogenesis of osteoporosis. Endocrinology and Metabolism Clinics of North America, 32(1), 15-24. Raymond, M. J., Bramley-Tzerefos, R. E., Jeffs, K. J., Winter, A., & Holland, A. E. (2013). Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Archives of Physical Medicine and Rehabilitation, 94(8), 1458-1472.

Rebelo-Marques, A., De Sousa Lages, A., Andrade, R., Ribeiro, C. F., Mota-Pinto, A., Carrilho, F., & Espregueira-Mendes, J. (2018). Aging hallmarks: The benefits of physical exercise. Frontiers in Endocrinology, 9, 258.

Reid, K. F., & Fielding, R. A. (2012). Skeletal muscle power: A critical determinant of physical functioning in older adults. Exercise and Sport Sciences Reviews, 40(1), 4.

Ren, J., & Zhang, Y. (2018). Targeting autophagy in aging and aging-related cardiovascular diseases. Trends in Pharmacological Sciences, 39(12), 1064-1076.

Ros, M., & Carrascosa, J. M. (2020). Current nutritional and pharmacological anti-aging interventions. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1866(3), 165612.

Stec, M. J., Thalacker-Mercer, A., Mayhew, D. L., Kelly, N. A., Tuggle, S. C., Merritt, E. K., & Roberts, B. M. (2017). Randomized, four-arm, dose-response clinical trial to optimize resistance exercise training for older adults with age-related muscle atrophy. Experimental Gerontology, 99, 98-109.

Vincent, K. R., & Braith, R. W. (2002). Improved Cardiorespiratory Endurance Following 6 Months of Resistance Exercise in Elderly Men and Women. Arch Intern Med, 162(6):673-678

Villareal, D. T., Smith, G. I., Sinacore, D. R., Shah, K., & Mittendorfer, B. (2011). Regular multicomponent exercise increases physical fitness and muscle protein anabolism in frail, obese, older adults. Obesity, 19(2), 312-318.

Walker, S., Hulmi, J. J., Wernbom, M., Nyman, K., Kraemer, W. J., Ahtiainen, J. P., & Häkkinen, K. (2013). Variable resistance training promotes greater fatigue resistance but not hypertrophy versus constant resistance training. European Journal of Applied Physiology, 113(9), 2233-2244.

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., & Kahan, T. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal, 39(33), 3021-3104.

Wollesen, B., Mattes, K., Schulz, S., Bischoff, L. L., Seydell, L., Bell, J. W., & von Duvillard, S. P. (2017). Effects of dual-task management and resistance training on gait performance in older individuals: A randomized controlled trial. Frontiers in Aging Neuroscience, 9, 415.

Wood, R. H., Reyes, R., Welsch, M. A., Favaloro-Sabatier, J., Sabatier, M., Lee, C. M., & Hooper, P. F. (2001). Concurrent cardiovascular and resistance training in healthy older adults. Medicine and Science in Sports and Exercise, 33(10), 1751-1758.



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