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Progressive resistance strength training for physical disability in older people

  1. Nancy K Latham1,*,
  2. Craig S Anderson2,
  3. Derrick A Bennett3,
  4. Caroline Stretton4

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 15 APR 2009

Assessed as up-to-date: 2 DEC 2002

DOI: 10.1002/14651858.CD002759

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Latham NK, Anderson CS, Bennett DA, Stretton C. Progressive resistance strength training for physical disability in older people. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD002759. DOI: 10.1002/14651858.CD002759.

Author Information

  1. 1

    Boston University, Health and Disabilty Research Institute, School of Public Health, Boston, MA, USA

  2. 2

    The George Institute for International Health, Department of Neurological and Mental Health, Sydney, Australia

  3. 3

    Oxford University, Clinical Trials Service Unit and Epidemiological Studies Unit, Oxford, UK

  4. 4

    Auckland University of Technology, School of Physiotherapy, Auckland, New Zealand

*Nancy K Latham, Health and Disabilty Research Institute, School of Public Health, Boston University, 580 Harrison Avenue, 4th Floor, Boston, MA, 02118-2639, USA. nlatham@bu.edu.

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  1. Publication Status: Unchanged
  2. Published Online: 15 APR 2009

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Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

The loss of muscle strength in old age is a prevalent and disabling condition. Muscle strength declines with age such that, on average, the strength of people in their 80's is about 40 per cent less than that of people in their 20's (Doherty 1993). Muscle weakness, particularly of the lower limbs, is associated with reduced walking speed (Buchner 1996), increased risk of disability (Guralnik 1995) and falls in older people (Tinetti 1986).

Contrary to long held beliefs, the muscles of older people (i.e. people aged 60 years and older) continue to be adaptable, even into the extremes of old age (Frontera 1988). Trials have revealed that older people can experience large improvements in their muscle strength, particularly if their muscles are significantly overloaded during training (Brown 1990; Charette 1991; Fiatarone 1994). This training approach is referred to as progressive resistance training (PRT), since the participants exercise their muscles against some type of resistance which is progressively increased as strength improves.

Despite evidence of benefit from PRT in terms of improving muscle strength, there is still uncertainty about how these effects translate into changes in substantive outcomes such a reduction in physical disability (Chandler 1998). Most studies have been under-powered to determine the effects of PRT on these outcomes or have included PRT as part of a complex intervention. In addition, there is uncertainty about the effects of PRT when more pragmatic, home or hospital-based programs are used, and the safety and effectiveness of this intervention in older adults who have health problems and/or functional limitations. Finally, there is uncertainty about the relative benefits of PRT compared to other exercise programs, or the effectiveness of varying doses of PRT (i.e. programs of varying intensity and duration).

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

The main objective of this review was to determine whether PRT, as a single exercise intervention, reduces physical disability in older people. The specific null hypothesis tested was: in randomised controlled trials, there is no evidence that participation in PRT produces improvement in physical disability in older people. In this review, measures of physical disability included measures of daily activities and measures of physical domains of health-related quality of life.

Secondary outcomes explored included the effects of PRT on:

  • functional limitations (i.e. gait speed, time up and go test, chair rise)
  • impairment (i.e. strength, balance, aerobic capacity)
  • pain and vitality
  • falls
  • adverse events
  • hospitalization, health service use and death.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Any randomised or quasi-randomised (i.e. allocation of participants to treatment groups which are not strictly random, such as date of birth, alternation etc.) clinical trials meeting the specifications below were included. All non-randomised controlled trials (e.g. controlled before and after studies) were excluded.

 

Types of participants

Older people, resident in institutions or at home in the community. Trials were included if the mean age of participants was 60 or over, but excluded if participants aged less than 50 were enrolled. The participants could include frail or disabled older people, people with identified diseases or health problems, or fit and healthy people.

 

Types of interventions

Any trial that had one group of participants who received PRT as a primary intervention was considered for inclusion. Progressive resistance strength training was defined as a strength training programme in which the participants exercised their muscles against an external force that was set at specific intensity for each participant, and this resistance was adjusted throughout the training programme. The type of resistance used included elastic bands or tubing (i.e. therabands), cuff weights, free weights, isokinetic machines or other weight machines. This type of training could take place in individual or group exercise programmes, and in a home-based or gymnasium/clinic setting. Studies that utilised only isometric exercises were excluded. Studies that included balance, aerobic or other training as part of the exercise intervention (and not simply part of the warm-up or cool-down) were also excluded.

We found the following comparisons between groups in the trials:

  • PRT versus no exercise (greatest difference between groups was expected)
  • PRT versus regular care (including regular therapy or exercise)
  • PRT versus another type of exercise (smaller difference between groups expected)
  • low intensity or frequency of PRT versus high intensity or frequency of PRT (greatest effect expected in the higher intensity groups)

 

Types of outcome measures

The primary outcome of this review was physical disability. This was assessed as a continuous variable. The outcomes were categorized based on the Nagi model of health states (Nagi 1991). In this model, disability is considered to be a limitation in performance of socially defined roles and tasks that can relate to self-care, work, family etc. In this review, the primary assessment of physical disability included the evaluation of self-reported measures of activities of daily living (ADL, i.e. the Barthel Index) and the physical domains of health-related quality of life (HRQOL, i.e. the physical function domain of the SF-36). Data from these measures were pooled for the main analysis of physical disability. However, because these two types of measures (ADL and physical domains of HRQOL) evaluate different health concepts, they were also evaluated in separate analyses. The Nagi model also includes firstly, the domain of 'functional limitations' which are limitations in performance at the level of the whole person and includes activities such as walking, climbing or reaching, and secondly, 'impairments' that are defined as anatomical or physiological abnormalities.

Since the protocol of this review was written the International Classification of Functioning, Disability and Handicap (ICF) has been released (WHO 2001). Under this system, disability is an umbrella term for impairments, activity limitations and participation restrictions. Using the ICF, the outcome measures evaluated in this review fall under the domains of impairments, limitations in simple activities (similar to 'functional limitations' in Nagi's system) and limitations in complex activities (similar to some aspects of disability in Nagi's model).

The following secondary outcomes were assessed as continuous variables:

Measures of impairment (outcome comparisons 1 and 2)

  • muscle strength (e.g. 1 repetition maximum test, isokinetic and isometric dynamometry)
  • aerobic capacity (e.g. 6 minute walk test, VO2 max)

Measures of functional limitation (simple physical activities)

  • balance (e.g. Berg Balance Scale, Functional Reach Test)
  • gait speed, timed walk
  • timed 'up-and-go' test
  • chair rise (sit to stand)

The dichotomous secondary outcomes assessed were adverse events, admission to hospital and death. The effect of PRT on falls was also evaluated, although these outcomes are considered in a separate Cochrane review. Pain and vitality measures were evaluated as continuous outcomes, and were used to provide additional information about the potential adverse effects or benefits of PRT.

In the original protocol for this review, measures of fear of falling and participation in social activities were also included as outcomes. However, when the size and complexity of this review became apparent, the authors decided to limit this review to assessments of physical disability as this was the prespecified primary aim of the review. Therefore, these outcomes are not included in the current review. In addition, the protocol also stated that assessments of disability using the Barthel Index and Functional Independence Measure (FIM) would be dichotomised. However, as no trials included the FIM as an outcome and only three trials used the Barthel, the decision was made to report these data as continuous outcomes only.

 

Search methods for identification of studies

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialized register (to August 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2002), MEDLINE (1966 to February 1, 2002), EMBASE (1980 to February 1, 2002), CINAHL (1982 to February 1, 2002), Sports Discus (1948 to February 2002), PEDro - The Physiotherapy Evidence Database (http://ptwww.cchs.usyd.edu.au/pedro/; accessed February 1,2002) and Digital Dissertations (accessed February 1,2002). We contacted authors and searched reference lists of identified studies, and reviews ( Anonymous 2001; Buchner 1993; Chandler 1996; Fiatarone 1993; Keysor 2001; King 1998; King 2001; Mazzeo 1998; Singh 2002), and also handsearched the following conference proceedings:

  • 16th International Association of Gerontology World Congress; 1997; Adelaide (Australia).·
  • 17th International Association of Gerontology World Congress; 2001; Vancouver (Canada).
  • Proceedings of the 13th World Congress of Physical Therapy; 1995; Washington (DC).·
  • Proceedings of the 14th World Congress of Physical Therapy; 1999; Japan·
  • New Zealand Association of Gerontology Conferences - 1996 Dunedin, 1999 Wellington and 2002 Auckland (New Zealand).

In MEDLINE (OVID Web) the subject specific search strategy (see Appendix 1) was combined with the optimal search strategy (Clarke 2001) and modified for use in other databases.

 

Data collection and analysis

 

Selection of studies

One of the reviewers (NL) performed the search strategy on the databases and downloaded the information to a file. Two reviewers (NL, CS) reviewed the titles, descriptors or abstracts identified from all literature searches to identify potentially relevant trials for full review. A copy of the full text of all trials that appeared to be potentially suitable for the review was obtained. The two principal reviewers independently used previously defined inclusion criteria to select the trials. The reviewers attempted to reach a consensus if they disagreed about the inclusion of a trial. A third reviewer (CA) was asked to participate in the final decision if disagreement persisted.

 

Data extraction and management

Two reviewers independently extracted the data and recorded information on a standardised paper form. They considered all primary and secondary outcomes. If the data were not reported in a form that enabled quantitative pooling, the authors were contacted for additional information. If the authors could not be contacted or if the information was no longer available, the trial was not included in the pooling for that specific outcome.

 

Assessment of risk of bias in included studies

In this review, risk of bias is implicitly assessed in terms of methodological quality.

The methodological quality of each trial was independently assessed by two reviewers (NL, CS) using a scoring system that was based on the Cochrane Bone, Joint and Muscle Trauma Group evaluation tool. The reviewers were blinded to the authors, institution, journal that the trial was published in and the results of the trial. A third reviewer (CA) was consulted if a consensus about the trial quality could not be reached between the two reviewers. The following assessments of internal and external validity were assessed:

A. Was the assigned treatment adequately concealed prior to allocation?
2 = method did not allow disclosure of assignment.
1 = small but possible chance of disclosure of assignment or unclear.
0 = quasi-randomised or open list/tables.

B. Were the outcomes of patients/participants who withdrew described and included in the analysis (intention to treat)?
2 = withdrawals well described and accounted for in analysis.
1 = withdrawals described and analysis not possible.
0 = no mention, inadequate mention, or obvious differences and no adjustment.

C. Were the outcome assessors blind to treatment status?
2 = effective action taken to blind assessors.
1 = small or moderate chance of un blinding of assessors.
0 = not mentioned, or not possible.

D. Were the treatment and control group comparable at entry? Specifically, were the groups comparable with respect to age, medical co-morbidities (one or more of history of coronary artery disease, stroke, hypertension, diabetes, chronic lung disease), pre-entry physical dependency (independent vs dependent in self-care ADL) and mental status (clinical evidence of cognitive impairment, yes or no)?
2 = good comparability of groups, or confounding adjusted for in analysis.
1 = confounding small; mentioned but not adjusted for.
0 = large potential for confounding, or not discussed.

E. Were care programmes, other than the trial options, identical?
2 = care programmes clearly identical.
1 = clear but trivial differences.
0 = not mentioned or clear and important differences in care programmes.

F. Were the inclusion and exclusion criteria clearly defined?
2 = clearly defined.
1 = inadequately defined.
0 = not defined.

G. Were the interventions clearly defined?
2 = clearly defined interventions are applied with a standardised protocol.
1 = clearly defined interventions are applied but the application protocol is not standardised.
0 = intervention and/or application protocol are poorly or not defined.

H. Were the outcome measures used clearly defined?
For our primary outcome, physical disability in terms of self-report measures of physical function, we considered the outcome clearly defined if a validated and standardised scale was used and the method of data collection was clearly described.

Our secondary outcome measures included gait speed, muscle strength (e.g. one repetition maximum test, isokinetic and isometric dynamometry), balance (e.g. Berg Balance Scale, Functional Reach Test), aerobic capacity, and chair rise. These secondary outcomes were considered well defined if validated and standardised measures were used, and the method of data collection and scoring of any scales was clearly described.

2 = clearly defined measures and the method of data collection and scoring are clearly described
1 = inadequately defined measures
0 = not defined.

I. Was the surveillance active and of clinically appropriate duration (i.e. at least 3 months)?
2 = active and appropriate duration (three months follow-up or greater).
1 = active but inadequate duration (less than three months follow-up).
0 = not active or surveillance period not defined.

 

Data synthesis

Where it was thought appropriate, the results from the studies were combined. Data synthesis was carried out using MetaView in Review Manager version 4.0.4. For continuous outcomes, weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated when similar measurement units were used. To pool outcomes using different units, standardised units (i.e. standardised mean differences, SMD) were created as appropriate. We employed Hedges adjusted g for the standardised mean difference. This is very similar to Cohen's d, but includes an adjustment for small sample bias. We planned to calculate relative risks and 95% CI for dichotomous outcomes, where possible.

For each outcome, a test of statistical heterogeneity was carried out. If minimal statistical heterogeneity (P<0.1) existed, fixed effects meta-analysis was performed. If substantial statistical heterogeneity did exist, the reviewers looked for possible explanations. Specifically, we considered differences in age and baseline disability of the study participants, the methodological quality of the trials and the intensity and duration of the interventions. If the statistical heterogeneity could be explained, the reviewers considered the possibility of presenting the results as sub-group analyses. If the statistical heterogeneity could not be explained, the reviewers considered not combining the studies at all, using a random effects model with cautious interpretation or using both fixed and random effects models to assist in explaining the uncertainty around an analysis with heterogeneous studies. When adequate data was available, funnel plots were created to assess whether small study bias influenced the results.

Sensitivity analyses were conducted to assess the effect of differences in methodological quality (including blinding of outcome assessors and intention to treat analysis), intensity of the intervention, duration of training, patient characteristics and the intervention the control group received.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

Please see the Characteristics of Included Studies table.

Sixty-six trials with 3783 participants at entry were included in this review. Four studies were published only as abstracts and/or theses (Collier 1997; Fiatarone 1997; Moreland 2001; Newnham 1995). There was variation across the trials in the characteristics of the participants, the design of the PRT programs, the interventions provided for the comparison group and the outcomes assessed. More detailed information is provided in the Characteristics of Included Studies table, however a brief summary is provided here.

 

Participants

The participants in 38 trials were healthy older people. In the remaining 28 studies, the participants had a health problem, functional limitation and/or were residing in a hospital or residential care. Fifteen of these 28 trials included older people with a specific medical condition, including osteoarthritis (Baker 2001; Ettinger 1997; Maurer 1999; Schilke 1996), peripheral arterial disease (Hiatt 1994; McGuigan 2001), recent stroke (Moreland 2001), congestive heart failure (Pu 2001; Tyni-Lenne 2001), chronic airflow limitation (Simpson 1992), clinical depression (Singh 1997), low bone-mineral density (Parkhouse 2000), obesity (Ballor 1996), chronic renal insufficiency (Castaneda 2001) and coronary artery bypass graft surgery three or more months before exercise training (Maiorana 1997). In 11 other studies, the trials recruited participants who did not have a specific health problem, but were considered frail and/or to have a functional limitation (Chandler 1998; Fiatarone 1994; Fiatarone 1997; Hennessey 2001; Jette 1999; Latham 2002; McMurdo 1995; Mihalko 1996; Newnham 1995; Skelton 1996; Westhoff 2000), including four of these studies in which the participants resided in a rest-home or nursing home (Fiatarone 1994; McMurdo 1995; Mihalko 1996; Newnham 1995). In additional two studies included participants who were in hospital at the time the exercise program was carried out (Donald 2000; Latham 2001). In the other trials, most or all of the participants lived in the community.

Most studies included both men and women, although six trials included only men (Hagerman 2000; Haykowsky 2000; Hepple 1997; Maiorana 1997; Newnham 1995; Sartorio 2001) and 13 trials included only women (Charette 1991; Damush 1999; Flynn 1999; Jones 1994; Kerr 2001; Nelson 1994; Nichols 1993; Parkhouse 2000; Pu 2001; Rhodes 2000; Sipila 1996; Skelton 1995; Taaffe 1996). In 32 studies the mean or median age of the participants was 60-69, in 23 studies the mean/median age was 70-79 and in 10 studies it was 80 years or greater.

 

PRT programmes

Most training programs took place in gym or clinic settings with all sessions fully supervised. Seven studies were entirely home-based (Baker 2001; Chandler 1998; Fiatarone 1997; Jette 1996; Jette 1999; Latham 2002; McMurdo 1995), while seven additional studies carried out some of the training at home and some in gym/clinic settings (Ettinger 1997; Jones 1994; Skelton 1995; Skelton 1996; Topp 1993; Topp 1996; Westhoff 2000).

The resistance training programs in most trials (i.e. 47 trials) involved high intensity training. Most of these trials used specialized exercise machines for training. Twelve trials used low- to moderate-intensity training, with most using elastic tubing or bands. All of the high-intensity training was carried out at least in part in gym or clinic based settings, with the exception of two published trials (Baker 2001; Latham 2002) and a trial published as an abstract (Fiatarone 1997).

The frequency of training was consistent across studies, with the exercise program carried out two to three times a week in almost all trials. Two exceptions to this were the two trials conducted in hospital which carried out the exercises on a daily basis (Latham 2001; Donald 2000). In contrast, there was large variation in the duration of the exercise programs and the number of exercises performed in each program. Although most of the programs (i.e. 38 trials) were eight to 12 weeks long, the duration ranged from two to 78 weeks. In 27 trials the exercise program was longer than 12 weeks. The number of exercises performed also varied, from one to more than 14.

Data about adherence to the PRT program is reported in the Included Studies table. These data are difficult to interpret because different definitions for adherence or compliance were used across the trials. In most trials, adherence referred to the percentage of exercise sessions attended compared to the total number of prescribed sessions. Many studies only included participants that completed the entire trial (i.e. excluded drop-outs), while some trials reported these data with drop-outs included.

 

Comparison interventions

Sixty-two trials compared PRT to a control group. In eleven trials PRT was compared to an aerobic training program (Ballor 1996; Buchner 1997; Earles 2001; Ettinger 1997; Hepple 1997; Hiatt 1994; Jubrias 2001; Kerr 2001; Pollock 1991; Sipila 1996; Wood 2001). Eight of these studies also included a control (non-exercise) group. One study compared PRT to balance training, combined PRT and balance training or a control group (Judge 1994). Another study compared PRT to functional training and to a control group (McMurdo 1995). Five studies compared PRT programs of different intensities (Hortobagyi 2001, Hunter 2001; Taaffe 1996; Tsutsumi 1997; Vincent 2002). One trial compared PRT performed at different frequencies (i.e. once, twice or three times per week; Taaffe 1999).

 

Outcomes

A variety of outcomes were assessed in these studies. Six studies did not report final means and standard deviations for some or all of their outcome measures but instead reported mean baseline scores and mean change in score from baseline, and additional data could not be obtained from the investigators (Buchner 1997; Chandler 1998; Fiatarone 1994; Hiatt 1994; Jette 1996; Topp 1996). The final mean score was calculated for these studies by adding the change in score to the baseline score, and the standard deviation of the baseline score was used for the final score.

 

Excluded studies

The excluded studies and their reasons for exclusion are listed in the Characteristics of Excluded Studies table. The main reasons for exclusion were that the studies used a combination of exercise interventions (i.e. not resistance training alone), the strength training program did not use a progressive resistance approach, the participants were not elderly (i.e. did not have a mean age of at least 60 years and/or included some participants below 50 years of age), the study design caused serious threats to its internal validity or the study was not a randomised controlled trial.

 

Risk of bias in included studies

Methodological quality scores of each item for all included studies are given in  Table 1. A summary of the findings of key indicators of internal validity are listed below.

 

Blinded outcome assessment

Thirteen studies stated that they used a blinded assessor for all outcome measures (Buchner 1997; Chandler 1998; Ettinger 1997; Jette 1996; Jette 1999; Jones 1994; Judge 1994; Latham 2002; Maurer 1999; McMurdo 1995; Moreland 2001; Newnham 1995; Westhoff 2000). Five additional studies used a blinded outcome assessor for some, but not all outcome assessments (Baker 2001; Castaneda 2001; Fiatarone 1994; Pu 2001; Singh 1997).

 

Blinding of participants

Blinding of participants is difficult in studies of exercise interventions. However, the use of attention control groups (i.e. control group receives matching attention) can help to minimise bias. Eighteen studies used some type of attention program for the control group (Baker 2001; Castaneda 2001; Damush 1999; Ettinger 1997; Fiatarone 1994; Fiatarone 1997; Judge 1994; Latham 2002; Maurer 1999; McCartney 1995; McMurdo 1995; Mihalko 1996; Moreland 2001; Newnham 1995; Pu 2001; Singh 1997; Topp 1993; Topp 1996). In three of these studies the control group received 'sham' exercise programs (Baker 2001; Castaneda 2001; Pu 2001).

 

Intention-to-treat analysis

Nine studies stated that they used intention to treat analysis (Baker 2001; Buchner 1997; Ettinger 1997; Fiatarone 1994; Judge 1994; Latham 2002; Moreland 2001; Nelson 1994; Pu 2001).

 

Concealed randomisation

Twenty-one studies provided some information about the method of randomisation that was used which suggested that randomisation was probably concealed and/or randomisation lists were appropriately generated (Baker 2001; Buchner 1997; Chandler 1998; Donald 2000; Earles 2001; Fiatarone 1994; Haykowsky 2000; Judge 1994; Kerr 2001; Latham 2001; Latham 2002; Maurer 1999; McMurdo 1995; Moreland 2001; Nichols 1993; Pollock 1991; Sartorio 2001; Simpson 1992; Singh 1997; Skelton 1995; Vincent 2002).

 

Study size

Most of the studies were small, with less than 40 participants in total, but seven studies had 100 or more patients in total in the PRT and control groups (Chandler 1998; Ettinger 1997; Jette 1996; Jette 1999; Latham 2002; McCartney 1995).

 

Loss to follow-up

Some trials had high drop-out rates, with several studies reporting more than 20 per cent of their participants lost to follow-up (Donald 2000; Topp 1996). In some studies there was clear evidence of bias associated with the excluded patients, with people who failed to adhere to the exercise program (Topp 1996) or those who had adverse responses deliberately excluded (Hagerman 2000). When the number of drop-outs from the PRT and control groups were compared, there were 61 per cent more drop-outs in the PRT group (219 drop-outs) compared to the control group (148 drop-outs).

 

Effects of interventions

See Graphs

 

PRT versus control

 

Measures of impairment

 
Strength

Many different muscle groups were tested and a number of methods were used to evaluate muscle strength in these trials. To minimise clinical heterogeneity, data were pooled from one muscle group. The leg extensor group of muscles was selected since this group was the most frequently evaluated. The effect size was calculated using standardised mean difference (SMD) to allow the pooling of data that used different units of measurement. Forty-one studies involving 1955 participants reported the effect of resistance training on a lower-limb extensor muscle group and provided data that would allow pooling. A moderate-to-large beneficial effect was found with the SMD 0.68 (95% CI 0.52 to 0.84) using a random effects model (fixed effects estimate 0.48; 95% CI 0.39 to 0.57).

Significant statistical heterogeneity was apparent in these data (P<0.0001). Since a large number of studies assessed this outcome, it was possible to explore this heterogeneity by stratifying the data. Differences in treatment effects due to the quality of the trials were investigated. We also explored subgroups of trials that were based on the design of the treatment programs and the characteristics of the participants.

To explore the effect of data quality on treatment effects, data were stratified by four design features that are associated with improved internal validity. These are the use of blinded assessors; attention control groups; concealed allocation and intention to treat analysis (ITT). Random effects models were used for all analyses. The effect estimates were lower in studies that used blinded assessors (10 trials, 1010 participants, SMD 0.29, 95% CI 0.12 to 0.47) compared to studies that did not use blinded assessors (31 trials, 945 participants, SMD 0.83, 95% CI 0.64 to 1.01). This was also true for studies that reported the use of concealed allocation: nine studies, 570 participants, SMD 0.38, 95% CI 0.38 to 0.70; non-concealed allocation: 32 studies, 1385 participants, SMD 0.78, 95% CI 0.60 to 0.96 ) and intention to treat analysis (ITT: 7 trials, 656 participants, SMD 0.33, 95% CI 0.05 to 0.61; no ITT: 34 trials, 1299 participants, SMD 0.76, 95% CI 0.59 to 0.93). The use of attention control groups did not appear to reduce the effect estimates (attention control: 12 studies, 830 participants, SMD 0.63, 95% CI 0.31 to 0.94; no attention control: 29 studies, 1125 participants, SMD 0.70, 95% CI 0.52 to 0.87).

Subgroup analyses were conducted to explore the effect of PRT when the design of the exercise program and the characteristics of the participants differed. The effect of differences in the exercise program were explored by examining effect estimates in studies that used different intensity and duration. High intensity strength training was compared with low to moderate intensity training. This analysis suggests that while both training approaches are probably effective in improving strength, higher intensity training has a larger effect on strength than low to moderate intensity training (high intensity: 32 trials, SMD 0.81, 95% CI 0.60 to 1.01; low-moderate intensity: nine trials, SMD 0.34, 95% CI 0.18 to 0.51). Longer duration programs (i.e. greater than 12 weeks) were also compared with shorter duration programs (less than 12 weeks). The duration of the trial appeared to have minimal effect on the strength outcome (<12 weeks training: 25 trials, SMD 0.62, 95% CI 0.42 to 0.82; >12 weeks of training: 16 trials, SMD 0.77, 95% CI 0.50 to 1.05). Considerable statistical heterogeneity still exists across these data, which suggests that the design of exercise program does not explain all of the variation in effect estimates across trials.

Treatment effects in older people with and without a chronic disease (or functional limitation) were also assessed. Again, resistance training appeared to be effective in improving strength in both groups of older people, but there was statistical heterogeneity in the effects. Studies that included participants who had specific health problems and/or functional limitations were compared with studies that included only healthy older people. There was no apparent difference in the effect of treatment in older people who were healthy compared with trials that recruited people with specific health problems (healthy older people: 26 studies, n = 939, SMD 0.69, 95% CI 0.51 to 0.86 versus people with specific health problems: 15 studies, 1016 participants, SMD 0.66, 95% CI 0.38 to 0.93). On the other hand, studies that included people who had a physical disability or functional limitation appeared to be less effective than those that included people who did not have functional limitations (people with no functional limitations: 32 studies, 1084 participants, SMD 0.76, 95% CI 0.59 to 0.94 versus people with functional limitations: nine studies, 871 participants, SMD 0.36, 95% CI 0.11 to 0.60). However, this result could be confounded by the intensity of the PRT programs, as almost all programs that included people with functional limitations were carried out at a low to moderate intensity.

 
Aerobic capacity

The main measure of aerobic capacity was pooled from 16 studies (n = 777) using a fixed effect model (Ades 1996; Buchner 1997; Chandler 1998; Ettinger 1997; Hagerman 2000; Hiatt 1994; Maiorana 1997; McGuigan 2001; Moreland 2001; Pollock 1991; Pu 2001; Rall 1996; Simpson 1992; Singh 1997; Tsutsumi 1997; Tyni-Lenne 2001). These data suggest that PRT has a non-significant effect on aerobic capacity (SMD 0.13, 95% CI -0.02 to 0.27). Different measures of aerobic capacity were used, so further analyses were performed using WMD to pool data from two specific measures of aerobic capacity: VO2 max, measured in ml/kg/min and the Six-Minute Walk Test, measured in metres. A consistent non-significant effect was found when data from measures of VO2 max alone (Ades 1996; Buchner 1997; Ettinger 1997; Hagerman 2000; Hiatt 1994; Maiorana 1997; Pollock 1991; Pu 2001; Rall 1996; Tsutsumi 1997; Tyni-Lenne 2001) were combined (11 trials, n = 496, WMD 0.47 ml/kg/min, 95% CI -0.03 to 0.97). However, when data from the Six-minute Walk Test were combined, (six trials, n = 212; Chandler 1998; McGuigan 2001; Pu 2001; Simpson 1992; Singh 1997; Tyni-Lenne 2001) a significant positive effect was found (WMD 53.69 metres, 95% CI 27.03 to 80.36).

 

Measures of functional limitations (simple physical activities)

 
Balance/ postural control

Results from all balance performance measures were pooled using SMD and a fixed effect model. A SMD of 0.11 (-0.03 to 0.25) was found in 12 studies with 789 participants (Buchner 1997; Chandler 1998; Jette 1999; Judge 1994; Latham 2001; Latham 2002; Newnham 1995, Schlicht 1999; Skelton 1995; Skelton 1996; Topp 1993; Westhoff 2000) suggesting a small, nonsignificant benefit (higher score indicates better balance). Because a variety of balance outcome measures were used in these trials, we explored further the effect of PRT when two different types of balance measures were pooled separately. The first type were simple measures of the time that a person is able to maintain postural control under different conditions (e.g. single leg stance, tandem standing) and the second type were measures of postural control during more complex activities (e.g. the Functional Reach Test and the Berg Balance test). The simple timed measures (five studies, 187 participants; Buchner 1997; Judge 1994; Schlicht 1999; Topp 1993; Westhoff 2000 ) found a SMD 0.16 95% CI -0.13 to 0.45, while the measures of more complex balance activities (seven studies, 602 participants; Chandler 1998; Jette 1999; Latham 2001; Latham 2002; Newnham 1995; Skelton 1995; Skelton 1996 ) found an overall SMD of 0.10, 95% CI -0.06 to 0.26. Both of these are consistent with the overall finding of a non-significant effect on balance.

 
Gait speed

Two different measures of walking speed were used: gait speed (measured in metres per second) and timed walk (i.e. time to walk a set distance, measured in seconds). A higher gait speed score indicates faster mobility, while a higher timed walk score indicates slower mobility. Because of this difference, these data were analysed separately using fixed effect models and WMD. Gait speed was measured in 14 studies (Brandon 2000; Buchner 1997; Chandler 1998; Fiatarone 1994; Judge 1994; Latham 2002; Newnham 1995; Schlicht 1999; Singh 1997; Sipila 1996; Skelton 1995; Topp 1993; Topp 1996; Tyni-Lenne 2001) that included 798 participants and produced a WMD of 0.07m/s (95% CI 0.04 to 0.09), indicating that PRT has a modest but significant beneficial effect on gait speed. The limited number of trials and participants using the timed walk (seconds) as an outcome measure (Donald 2000; Latham 2001; Skelton 1996; Westhoff 2000) limited the analyses for this method of describing gait speed, and no evidence of an effect was found (81 participants, WMD 0.77 seconds, 95% CI -0.65 to 2.20).

 
Timed up-and-go

Timed up-and-go (i.e. time to stand, walk three metres, turn, and return to sitting, measured in seconds) was analysed using a fixed effect model and WMD. The timed up-and-go was analysed in six trials and a total of 494 participants (Jette 1999; Latham 2001; Latham 2002; Newnham 1995; Skelton 1996; Westhoff 2000). The WMD was -1.23 seconds (95% CI -2.80 to 0.35, lower score indicates improvement), which is consistent with no benefit from PRT on this mobility task.

 
Timed chair rise

The time to stand up from a sitting position was measured in four studies (n = 185; Brandon 2000; Judge 1994; Singh 1997; Skelton 1996). Because different numbers of sit-to-stands were counted, SMD were used to pool these results. A SMD of -0.67 (95% CI -1.31 to -0.02) was found, indicating a significant, moderate to large effect on this task (i.e. less time was required to stand up).

 
Measures of physical disability / HRQOL (complex physical activities)

The main disability measures from trials that had appropriate data were pooled using SMD. It was necessary to conduct two separate analyses of the main disability measures because 10 studies (n = 722; Baker 2001; Buchner 1997; Chandler 1998; Damush 1999; Donald 2000; Hiatt 1994; Latham 2002; Moreland 2001; Singh 1997; Tsutsumi 1997) used measures in which a higher score indicates less disability/better function, while six studies (n = 559; Baker 2001; Ettinger 1997; Jette 1999; Schilke 1996; Singh 1997; Westhoff 2000) used scores in which a higher score indicates more disability / poorer function. SMD and fixed effect models were used for both comparisons. In both analyses, there was no evidence that PRT has an effect on physical disability (higher measure indicates less disability: SMD 0.01, 95% CI -0.14 to 0.16; higher measure indicates more disability: SMD -0.17 95% CI -0.53 to 0.19). When HRQOL and ADL measures were examined separately, there was also no evidence of benefit. For example, when the physical function domain of SF-36 was pooled from seven studies (n = 493; Baker 2001; Chandler 1998; Damush 1999; Hiatt 1994; Latham 2002; Singh 1997; Tsutsumi 1997) using a fixed effect model, a small difference of less than one point on this 100-point scale was found (WMD 0.96, 95% CI -3.35 to 5.26). A number of studies had disability measures (i.e. measures of activity, function or HRQOL) that could not be pooled. The available data from these measures is reported in Additional  Table 2 .

 

Falls

Five studies collected data about the effect of resistance training on falls, but the outcomes reported did not allow pooling of the data. The available data is reported in Additional  Table 3. Three of these studies (Buchner 1997; Fiatarone 1994; Judge 1994) were part of the FICSIT trial, a prospective preplanned meta-analysis to determine the effectiveness of exercise to prevent falls in older people (Province 1995). The data were extracted from the main FICSIT paper, because papers published about the individual exercise programs did not provide useful data about the effect of resistance training alone on falls. One additional trial investigated the effect of resistance training on falls in older people while they were in hospital (Donald 2000). A recent trial also assessed the effect of PRT on frail older people following discharge from hospital (Latham 2002).

With the exception of Latham 2002, all of these trials were small (i.e. less than 80 participants in the resistance training and control groups). Only the study by Donald 2000 found a significant reduction in falls, but there were few fall events in this trial.

 

Adverse Events

 
Adverse events reported

Thirty-five studies provided no comment at all about adverse events associated with the training program. Out of the 31 studies that did provide some comment about adverse events, 14 reported no adverse events and 17 reported some adverse reaction to the exercise program. An additional nine studies did not report adverse events as such, but it is possible that an event occurred since these studies reported drop-outs from the exercise group secondary to increasing pain or specific injuries (Chandler 1998; Charette 1991; Fiatarone 1997; Hagerman 2000; Hortobagyi 2001; Jette 1996; Kerr 2001; Maurer 1999; Topp 1993). Given that there were considerably more drop-outs from the PRT group than from the control group (see methodological quality section above), it is possible that the number of cases of adverse events reported here are an underestimate.

Only seven of 66 studies provided an a priori definition of an adverse event in the study methods or objectives (Earles 2001; Ettinger 1997; Judge 1994; Latham 2002; Moreland 2001; Pollock 1991; Singh 1997). Six of these seven studies detected adverse events (Earles 2001; Ettinger 1997; Judge 1994; Latham 2002; Moreland 2001; Pollock 1991). However, there was little consistency in the definition that was used, with some studies only reporting serious events that the investigators thought to be possibly related to the exercise program (i.e. Ettinger 1997) while other studies reported all adverse events that occurred in each group. Most adverse events were musculoskeletal problems; there was no report of cardiac events or death associated with PRT. Further details about all adverse events reported in these trials are in Additional  Table 4.

 
Pain

The bodily pain (BP) domain of the SF-36 health status measure was assessed in six studies involving 440 participants (Baker 2001; Buchner 1997; Damush 1999; Latham 2002; Singh 1997; Tsutsumi 1997). For this measure, a higher score indicates better health (i.e. less pain). When the BP domain was pooled, there was no evidence that PRT had an effect on bodily pain (WMD -0.14, 95% CI -4.45 to 4.18). In contrast, three studies with 311 participants (Baker 2001; Ettinger 1997; Schilke 1996) included pain measures where a higher score indicates more pain, and found evidence to support a modest reduction in pain following PRT (SMD -0.33, 95% CI -0.55 to -0.11). These three studies all included participants with osteoarthritis and used pain measures designed specifically for this population, which could have increased their sensitivity to change.

 
Vitality

The vitality (VT) domain of the SF-36 health status measure was assessed in five studies involving 389 participants (Baker 2001; Damush 1999; Latham 2002; Singh 1997; Tsutsumi 1997). For this measure, a higher score indicates better health (i.e. more vitality). When the VT domain was pooled there was no evidence of an effect of PRT (WMD 1.42 95% CI -2.22 to 5.07).

 
Health service use, hospitalization and death

Three studies provided data about hospitalization rates, length of stay and/or outpatient visits. Donald 2000 reported that people who received PRT in addition to regular in-hospital physiotherapy had a length of stay of 27 days compared to 32 days for the control group. Latham 2002 found that 42/120 people in the PRT group were admitted to hospital over six months compared to 35/123 in the control group. The third trial by Singh 1997 reported that, over a 10 week period, people in the PRT group had mean 2.1 (SD 0.4) visits to a health professional and mean 0.24 (SD 0.2) hospital days compared to controls mean 2.0 (SD 0.5) visits and mean 0.53 (0.4) hospital days. An additional study, Buchner 1997, provided data about health service use, but only reported data that was pooled to include participants in aerobic training, combined aerobic training and PRT and PRT alone. This study found no change in hospital admissions between those in the exercise and control groups, but an increased number of outpatient visits by those in the control group. Finally, two studies stated that there was no difference in health care visits (Fiatarone 1997) or hospitalization (Pu 2001) but no specific data were provided.

Six studies provided data about participant deaths that allowed pooling (Donald 2000; Ettinger 1997; Fiatarone 1994; Latham 2002; Moreland 2001; Newnham 1995). There was no evidence of difference in the number of deaths in treatment and control groups (treatment group: 10 deaths versus control group: 17 deaths; RR = 0.60, 95% CI 0.29 to 1.23).

 

Comparison of PRT doseage

 

Strength

Six trials investigated the effects of different doses of PRT. Four studies (n = 85) examined the effect of low versus high intensity PRT on lower limb strength (Hortobagyi 2001; Hunter 2001; Taaffe 1996; Tsutsumi 1997). These data suggest that high intensity training results in greater lower limb strength, as a moderate effect was seen (SMD = 0.51, 95% CI 0.07 to 0.94; higher score favours high-intensity group). One trial (n = 24) compared high intensity PRT with variable intensity PRT with inconclusive results (SMD = 0.61, 95% CI -0.21 to 1.44; Hunter 2001). Finally, one trial (n = 46) compared PRT performed at difference frequencies - once, twice or three times per week (Taaffe 1999). When the effect on strength of PRT once per week was compared to three times per week, no significant difference was found (SMD 0.40, 95% CI -0.44 to 1.25).

 

Aerobic capacity

One study compared the effect of high versus low intensity PRT on aerobic capacity (Tsutsumi 1997). This study (n = 27) found greater benefit from high intensity compared to low intensity training (WMD 5.20 ml/kg/min, 95% CI 1.30 to 9.10; higher score favours high-intensity group). Another trial compared high intensity training with variable intensity training, and found that the point estimate favoured variable intensity training (WMD = 1.30, 95% CI -0.12 to 2.72). However, there were few participants in these trials.

 

Physical disability, pain and vitality

One study (Tsutsumi 1997; n = 27) compared high versus low intensity PRT, and evaluated pain, vitality and physical function using the domains of the SF-36. No significant difference was found for any of these outcomes, however there were few participants included.

 

PRT versus aerobic training

 

Strength

Seven studies (n = 420) evaluated the effect of PRT compared to aerobic training on lower extremity strength (Ballor 1996; Buchner 1997; Earles 2001; Ettinger 1997; Pollock 1991; Sipila 1996; Wood 2001). A fixed effect model and SMD were used for this analysis. This found that PRT had a non-significant benefit compared to aerobic training on strength with SMD 0.11(95% CI -0.08 to 0.30; higher score favours PRT group).

 

Aerobic capacity

The effect of aerobic training compared to PRT on aerobic capacity was evaluated in six studies involving 374 participants (Ballor 1996; Buchner 1997; Ettinger 1997; Hepple 1997; Hiatt 1994; Pollock 1991). This was measured using VO2 max in ml/kg/min. Aerobic training had a non-significant benefit compared to PRT for this outcome (WMD -0.47 ml/kg/min, 95% CI -1.00 to 0.05; lower score favours aerobic group).

 

Physical disability

Four studies evaluated the effect of PRT compared to aerobic training on physical disability. Three studies (Buchner 1997; Earles 2001; Hiatt 1994) used outcomes in which a higher score indicates less disability (n = 102), and found no significant difference, with a SMD of -0.26 (95% CI -0.65 to 0.14; lower score favours the aerobic training group). One large study (Ettinger 1997) also found no significant difference between the groups. This trial used a measure in which a higher score indicates less disability (n = 237), and found SMD 0.05 (95% CI -0.21 to 0.30; higher score favours aerobic group).

 

Pain

Ettinger 1997 evaluated pain in people who undertook PRT compared to aerobic training (n = 237) using a scale in which a lower score indicates less pain. The trial found no significant difference between groups (SMD 0.12; 95% CI -0.14 to 0.37; higher score favours aerobic group).

 

PRT versus balance or functional training

One study (Judge 1994) included an evaluation of PRT alone compared to balance retraining alone (n = 55). Both exercise programs were performed in a research center three times per week for three months. Balance training included training on a computerized balance platform and non-platform training (i.e. balancing on different surfaces, with varying bases of support, with different perturbations).This study found that strength improved in the PRT group, but not in the balance training group. Chair rise time and gait speed did not improve in any group, with gait speed actually declining in the balance training group. However, balance improved in the balance trained group compared with the PRT group.

A second study (McMurdo 1995) included an evaluation of PRT alone compared to 'mobility training' (n = 41). Participants in both groups carried out home exercise programmes, and were visited every three to four weeks by a physiotherapist for six months. There was no difference between the two groups for any measures, including measures of strength, physical performance, function or quality of life.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms
 

Overview of main results

This review identified, graded and synthesised the available literature regarding the effect of a specific exercise intervention, PRT, on a particular population, older people. To increase the generalisability of these data, the trials included participants with a range of health problems, and the dose and delivery of the PRT programs varied. This made it possible to assess overall effects of the intervention on older people, while still providing adequate data to explore the effects on subgroups (i.e. in different groups of older people or with different doses of PRT). Overall, this review suggests that PRT has a large positive effect on strength, the most proximal impairment measure, and a small to modest positive effect on some other measures of impairment and functional limitations. However, the current data suggest that PRT does not have an effect on physical disability (complex activities). There is some evidence, however, that suggests that PRT might reduce pain in older people with osteoarthritis. Adverse events were poorly reported in most studies, which limits the ability of this review to assess the risks associated with this intervention. In addition, the sparse data did not allow an adequate assessment of the effect of PRT on fall risk.

 

Methodological quality

The 66 studies in this review were generally of poor methodological quality, as most of the studies did not use design features that are known to increase internal validity, such as intention to treat analysis, blinded outcome assessors, attention control groups, or concealed randomization. For example, only 13 of the 66 studies used blinded outcome assessors for all outcomes, and nine studies appeared to use intention to treat analysis. Therefore, caution is required when drawing conclusions from these data. When data were stratified by indicators of study quality, results from the high quality trials continued to support the positive effect of resistance training on strength. However, these data also indicate that low quality trials that comprise the majority of the studies in the review probably overestimate the effect of resistance training.

 

PRT versus control

PRT appears to have a large positive effect on strength in older people. However, there was a large amount of statistical heterogeneity associated with this estimate. This variation was reduced, but not eliminated, by investigating differences in outcome in different groups of participants, types of intervention and in trials that used different quality indicators. In exploratory subgroup analyses, it appeared that training intensity has the greatest effect on strength (i.e. high intensity training has a greater effect on strength than lower intensity training), while the duration of the training appears to have a reduced effect. The health status of the participants does not have a clear effect on their response to the intervention, as there was no difference in the effect on strength between people with specific health problems and those who were generally healthy. It did appear that people with pre-existing functional limitations had smaller gains in strength. However, these subgroup analyses must be interpreted with caution as the number of participants is reduced which decreases the precision of these estimates. In addition, it is possible that study quality is a confounder for some of these observed differences, as several of the largest and highest quality trials included people with function limitations and/or lower intensity training programs, and study quality appears to reduce the effect estimates.

PRT also appears to have a positive effect on aerobic capacity and most measures of functional limitations, including gait speed and the time to stand up from a chair. Some of these effects, such as the improvements in gait speed and the distance walked in the Six-Minute Walk Test, could be considered clinically as well as statistically significant. Despite these improvements in functional limitations, no effect of PRT was found on measures of disability. There were fewer data in these comparisons than for impairment measures, which would decrease the precision of these estimates. However, there was no evidence of a trend towards improved physical ability in the overall pooled estimates or when the activity and health-related quality of life measures were analysed separately.

It was not possible to pool fall data because falls were reported differently in the five studies that measured this outcome. These data might suggest a trend towards PRT reducing falls, since four of the five studies found that participants in the PRT group had fewer falls than those in the control group. However, the effect of PRT alone on falls is still not clear.

Adverse events were poorly monitored and reported in most of these trials. This makes it difficult to assess the risk of injury or other adverse events associated with resistance training. The finding that several studies reported drop-outs from the exercise program due to pain or injury, yet failed to report any adverse events, suggests that adverse events might have been under-reported in some trials. This hypothesis is further supported by the finding that the studies with a clear definition of adverse events in their study methods were more likely to detect these events than those with no definition. The large number of drop-outs from the PRT group compared to controls also raises the possibility that people are experiencing adverse effects from PRT that are not identified in these trials. However, it is reassuring that participant's pain and vitality were not affected by PRT, and in fact PRT appeared to decrease pain in people with osteoarthritis. Furthermore, there was no evidence of increased risk of hospitalization, and several studies reported decreased use of health care services in the PRT group. Finally, there were no reports of serious adverse events (i.e. myocardial infarction or death) associated with PRT.

 

Comparison of PRT dosage

There are currently few randomised data available to guide the dose and prescription of PRT. Six studies investigated different aspects of this issue, but all were small studies and most were of poor quality. The available data suggests that high intensity training has a greater effect on strength than lower intensity training. However, some caution is needed before applying this finding to all older people. All of the participants in these trials were healthy older people who participated in highly supervised, gym-based programs. Therefore, it is not clear if high intensity PRT is more beneficial than low intensity training in less fit or healthy older people and/or in home or hospital based programs.

 

PRT vs other training

Overall, no significant differences were found between the different types of training. When aerobic training is compared to PRT, is appears that aerobic training tended to produce larger gains in measures of aerobic capacity while PRT tended to produced larger gains in strength. This finding is to be expected, given that these outcomes are more specific to the particular type of training. There are fewer data available to determine the comparative effect of these types of training on physical disability, but the available data suggest that the two training programs have a similar effect on this outcome. There are too few data to draw conclusions about other forms of training such as balance or mobility training compared to PRT.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

 

Implications for practice

PRT increases muscle strength and has a positive effect on some functional limitations in older people. Therefore, it would appear to be an appropriate intervention for many older people to improve performance of some simple physical tasks. In particular, this intervention might be appropriate for older people with osteoarthritis as their pain appeared to decrease in response to PRT. However, based on current data, there is no evidence that PRT alone has an effect on physical disability. Other interventions, either other forms of exercise training to improve overall physical capacity and/or other strategies to increase self-efficacy, motivation or reduce barriers to participation might be required to impact at this level.

Some caution is warranted with this intervention since adverse effects have been poorly monitored, but appear to occur when they are looked for in a trial. When used in clinical practice, clinicians should monitor for adverse effects, particularly when older people who might be at higher risk of injury (i.e. frail or recently ill older people) are undertaking PRT.

 
Implications for research

We recommend that future trials investigating the effect of PRT in older people should:

  • minimise bias by using concealed randomisation, blinded outcome assessors, intention to treat analysis and attention control groups
  • recruit an adequate number of subjects so that a precise estimate of the effect of the intervention can be determined (should have a priori power calculations)
  • include a careful assessment of adverse events in both treatment groups, so that both the benefits and the risks PRT are fully evaluated.

Future trials should include participants and interventions that are similar to those in health care settings (i.e. frail or recently ill older people), so that, if proven to be effective, resistance training can be incorporated into routine health care services. Well-designed trials are also required to determine the most appropriate dose of PRT to use with different participants and in different settings. This review will be updated every two years to incorporate new trials and new data from existing studies.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

The reviewers would like to thank the Cochrane Bone, Joint and Muscle Trauma Group, particularly Lesley Gillespie and Leeann Morton, for their assistance throughout the review process. In particular, thanks to Lesley for searching the Cochrane registers and assistance with developing the search strategies. Thank you to Leeann for her advice and guidance about the procedures and content of this review. We would also like to thank the review group's editors and the external reviewers, Prof John Campbell and Dr Keith Hill, for their helpful comments on earlier drafts of this review.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms
Download statistical data

 
Comparison 1. Strength
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Main Lower Limb Strength (LL) Measure - PRT versus control411948Std. Mean Difference (IV, Random, 95% CI)0.68 [0.52, 0.84]
 2 Main LL strength measure - high versus low intensity485Std. Mean Difference (IV, Fixed, 95% CI)0.51 [0.07, 0.94]
 3 Main LL strength measure - high intensity versus variable intensity124Std. Mean Difference (IV, Random, 95% CI)0.61 [-0.21, 1.44]
 4 Main LL strength measure - once per week versus 3x per week122Std. Mean Difference (IV, Random, 95% CI)0.40 [-0.44, 1.25]
 5 Main LL strength measure - PRT versus aerobic7420Std. Mean Difference (IV, Fixed, 95% CI)0.11 [-0.08, 0.30]

 
Comparison 2. Aerobic capacity
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Main measure of aerobic function - PRT versus control16777Std. Mean Difference (IV, Fixed, 95% CI)0.13 [-0.02, 0.27]
 2 VO2 max (ml/kg.min) - PRT versus control11496Mean Difference (IV, Fixed, 95% CI)0.47 [-0.03, 0.97]
 3 Six-Minute Walk Test (metres) - PRT versus Control6202Mean Difference (IV, Fixed, 95% CI)53.69 [27.03, 80.36]
 4 High versus low intensity PRT - VO2 Max (ml/kg/min)127Mean Difference (IV, Fixed, 95% CI)5.20 [1.30, 9.10]
 5 High intensity PRT versus variable intensity PRT - VO2 Max128Mean Difference (IV, Fixed, 95% CI)1.30 [-0.12, 2.72]
 6 Aerobic Training versus PRT - Six minute walk test140Mean Difference (IV, Fixed, 95% CI)8.0 [-42.58, 58.58]
 7 Aerobic Training versus PRT - VO2 max (ml/kg.min)6374Mean Difference (IV, Fixed, 95% CI)-0.47 [1.00, 0.05]

 
Comparison 3. Balance
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Balance measures (higher = better balance) - PRT versus control12789Std. Mean Difference (IV, Fixed, 95% CI)0.11 [-0.03, 0.25]
 2 Balance measures - PRT versus balance training139Std. Mean Difference (IV, Fixed, 95% CI)-0.60 [-1.24, 0.04]

 
Comparison 4. Gait speed
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Gait speed (m/s) - PRT versus control14798Mean Difference (IV, Fixed, 95% CI)0.07 [0.04, 0.09]
 2 Timed walk (seconds) - PRT versus control481Mean Difference (IV, Fixed, 95% CI)0.77 [-0.65, 2.20]
 3 Timed "Up-and-Go" (seconds) - PRT versus control6494Mean Difference (IV, Fixed, 95% CI)-1.23 [-2.80, 0.35]

 
Comparison 5. Chair Stand
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Time to stand from a chair - PRT versus control4185Std. Mean Difference (IV, Random, 95% CI)-0.67 [-1.31, -0.02]

 
Comparison 6. Disability
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Main Disability Measure (higher score =better function) - PRT versus control10722Std. Mean Difference (IV, Fixed, 95% CI)0.01 [-0.14, 0.16]
 2 Main Disability Measure (lower score=better function) - PRT versus Control6559Std. Mean Difference (IV, Random, 95% CI)-0.17 [-0.53, 0.19]
 3 PF of SF-36 (Higher score=better function) - PRT versus Control7493Mean Difference (IV, Fixed, 95% CI)0.96 [-3.35, 5.26]
 4 ADL Measure (higher score = better function) - PRT vs control2258Std. Mean Difference (IV, Fixed, 95% CI)0.09 [-0.15, 0.34]
 5 Activity level measure, kJ/week - PRT versus control258Std. Mean Difference (IV, Fixed, 95% CI)1.36 [0.68, 2.04]
 6 High versus Low Intensity Training - main disability measure (higher score=better function)127Std. Mean Difference (IV, Fixed, 95% CI)-0.29 [-1.05, 0.46]
 7 Aerobic Training versus PRT - main disability measure (higher score = better function)3102Std. Mean Difference (IV, Fixed, 95% CI)-0.26 [-0.65, 0.14]
 8 Aerobic training versus PRT - main disability measure (lower score =better function)1237Std. Mean Difference (IV, Fixed, 95% CI)0.05 [-0.21, 0.30]

 
Comparison 7. Pain
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Pain (higher =less pain, BP on SF-36) - PRT versus Control6440Mean Difference (IV, Fixed, 95% CI)-0.14 [-4.45, 4.18]
 2 Pain (lower score=less pain) - PRT versus control3311Std. Mean Difference (IV, Fixed, 95% CI)-0.33 [-0.55, -0.11]
 3 PRT versus Aerobic training - Pain (lower score=less pain)1237Std. Mean Difference (IV, Fixed, 95% CI)0.12 [-0.14, 0.37]
 4 High versus low intensity PRT- Pain (higher score=less pain)127Std. Mean Difference (IV, Fixed, 95% CI)-0.21 [-0.97, 0.55]

 
Comparison 8. Vitality
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Vitality (SF-36, higher = more vitality) - PRT versus Control5389Mean Difference (IV, Fixed, 95% CI)1.42 [-2.22, 5.07]
 2 High versus low intensity PRT - Vitality (SF-36, higher score=more vitality)127Mean Difference (IV, Fixed, 95% CI)5.40 [-0.85, 11.65]

 
Comparison 9. Death
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Death - PRT versus control6806Risk Ratio (M-H, Fixed, 95% CI)0.60 [0.29, 1.23]

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms
 

Appendix 1. Search strategy for MEDLINE (OVID Web)

1 strength training.tw.
2 resist$ training.tw.
3 or/1-2
4 Exercise/
5 Exercise Therapy/
6 exercise$.tw.
7 or/4-6
8 resist$.tw.
9 and/7-8
10 or/3,9
11 limit 10 to "all aged <65 and over>"
12 (elderly or senior$).tw.
13 and/10,12
14 or/11,13

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

Last assessed as up-to-date: 2 December 2002.

DateEventDescription
21 October 2008AmendedConverted to new review format.


 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

Protocol first published: Issue 4, 2000
Review first published: Issue 2, 2003

 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

All reviewers contributed to the development of the protocol, the analysis and interpretation of the data and the write-up of the review. Nancy Latham took the lead in conducting the analyses and writing the protocol and review. In addition, Nancy and Caroline Stretton conducted the searches, identified the trials, conducted the quality assessments and extracted the data. Derrick Bennet provided methodological and statistical guidance for the review. Craig Anderson served as the adjudicator when a consensus about data issues could not be reached between the two reviewers, and provided guidance about the methods and interpretation of the review.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Index terms

None known.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
Ades 1996 {published data only}
  • Ades PA, Ballor DL, Ashikaga T, Utton JL, Nair KS. Weight training improves walking endurance in healthy elderly persons. Annals of Internal Medicine 1996;124(6):568-72. [MEDLINE: 96175655]
Baker 2001 {published data only}
  • Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: A randomized controlled trial. The Journal of Rheumatology 2001;28:1655-65.
Balagopal 2001 {published data only}
  • Balagopal P, Schimke JC, Ades P, Adey D, Nair KS. Age effect on transcript levels and synthesis rate of muscle MHC and response to resistance exercise. American Journal of Physiology. Endocrinology and Metabolism 2001;280(2):E203-8.
Ballor 1996 {published data only}
  • Ballor DL, Harvey-Berino JR, Ades PA, Cryan J, Calles-Escandon J. Contrasting effects of resistance and aerobic training on body composition and metabolism after diet-induced weight loss. Metabolism: Clinical & Experimental 1996;45(2):179-83.
Bermon 1999 {published data only}
  • Bermon S, Philip P, Ferrari P, Candito M, Dolisi C. Effects of a short-term strength training programme on lymphocyte subsets at rest in elderly humans. European Journal of Applied Physiology and Occupational Physiology 1999;79(4):336-40.
Brandon 2000 {published data only}
  • Brandon LJ, Boyetter LW, Gaasch DA, Lloyd DG. Effects of lower extremity strength training on functional mobility in older adults. Journal of Aging and Physical Activity 2000;8(3):214-27.
Buchner 1997 {published data only}
  • Buchner DM, Cress ME, de Lateur BJ. The effect of strength and endurance training on gait, balance, fall risk and health services use in community-living older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1997;52(4):M218-24.
  • Buchner DM, Cress ME, de Lateur BJ, Wagner EH. Variability in the effect of strength training on skeletal muscle in older adults. Facts and Research in Gerontology 1993;7:143-53.
  • Coleman EA, Buchner DM, Cress ME, Chan BKS, de Lateur BJ. The relationship of joint symptoms with exercise performance in older adults. Journal of the American Geriatrics Society 1996;44(1):14-21.
Castaneda 2001 {published data only}
  • Castaneda C, Gordon PL, Uhlin KL, Levery AS, Kehayias JJ, Dwyer JT, et al. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. Annals of Internal Medicine 2001;135(11):965-76.
Chandler 1998 {published and unpublished data}
  • Chandler JM, Duncan PW, Kochersberger G, Studenski S. Is lower extremity strength gain associated with improvement in physical performance and disability in community-dwelling elders. Archives of Physical Medicine and Rehabilitation 1998;79(1):24-30.
Charette 1991 {published data only}
  • Charette S, McEvoy L, Pyka G. Muscle hypertrophy response to resistance training in older women. Journal of Applied Physiology 1991;70(5):1912-6.
Collier 1997 {unpublished data only}
  • Collier CD. Isotonic resistance training related functional fitness, physical self-efficacy and depression in adults ages 65-85 (thesis). Stillwater (OK): Oklahoma State University, 1997.
Damush 1999 {published data only}
  • Damush TM, Damush JG Jr. The effects of strength training on strength and health-related quality of life in older adult women. Gerontologist 1999;39(6):705-10.
Donald 2000 {published and unpublished data}
  • Donald IP, Pitt K, Armstrong E, Shuttleworth H. Preventing falls on an elderly care rehabilitation ward. Clinical Rehabilitation 2000;14(2):178-85.
Earles 2001 {published data only}
  • Earles DR, Judge JO, Gunnarsson OT. Velocity training induces power-specific adaptations in highly functioning older adults. Archives of Physical Medicine and Rehabilitation 2001;82(7):872-8.
Ettinger 1997 {published data only}
  • Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomised trail comparing aerobic exercise and resistance exercise with a health education program in older adults. The Fitness Arthritis and Seniors Trial (FAST). JAMA: Journal of the American Medical Assocation 1997;277(1):25-31.
  • Messier SP, Royer TD, Craven TE, O'Toole ML, Burns R, Ettinger WH Jr. Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis and Seniors (FAST) Trial. Journal of the American Geriatrics Society 2000;48(2):131-8.
  • Rejeski WJ, Ettinger WH Jr, Martin K, Morgan T. Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Arthritis Care and Research 1998;11(2):94-101.
  • Sevick MA, Bradham DD, Muender M, Chen GJ, Enarson C, Dailey M, et al. Cost-effectiveness of aerobic and resistance exercise in seniors with knee osteoarthritis. Medicine and Science in Sports and Exercise 2000;32(9):1534-40.
Fiatarone 1994 {published data only}
  • Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 1994;330(25):1769-75.
  • Singh MA, Ding W, Manfredi TJ, Solares GS, O'Neill EF, Clements KM. Insulin-like growth factor I in skeletal muscle after weight-lifting exercise in frail elders. American Journal of Physiology. Endocrinology and Metabolism 1999;277(40):E135-43.
Fiatarone 1997 {published data only}
  • Fiatarone MA, O'Neill EF, Doyle RN, Clements K. Efficacy of home-based resistance training in frail elders. Abstracts of the 16th Congress of the International Association of Gerontology. Bedford Park, South Australia: 1997 World Congress of Gerontology Inc, 1997:323 Abstract 985.
Flynn 1999 {published data only}
  • Flynn MG, Fahlman M, Braun WA, Lambert CP, Bouillon LE, Brolinson PG, et al. Effects of resistance training on selected indexes of immune function in elderly women. Journal of Applied Physiology 1999;86(6):1905-13.
Hagerman 2000 {published data only}
  • Hagerman FC, Walsh SJ, Staron RS, Hikida RS, Gilders RM, Murray TF, Toma K, Ragg KE. Effects of high-intensity resistance strength training on untrained older men 1. Strength, cardiovascular and metabolic responses. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 2000;55A(7):B336-46.
Haykowsky 2000 {published data only}
  • Haykowsky M, Humen D, Teo K, Quinney A, Souster M, Bell G, et al. Effects of 16 weeks of resistance training on left ventricular morphology and systolic function in healthy men >60 years of age. American Journal of Cardiology 2000;85(8):1002-6.
Hennessey 2001 {published data only}
  • Hennessey JV, Chromiak JA, DellaVentura S, Reinert SE, Puhl J, Kiel DP, et al. Growth hormone administration and exercise effects on muscle fibre type and diameter in moderately frail older people. Journal of the American Geriatrics Society 2001;49(7):852-8.
Hepple 1997 {published data only}
  • Hepple RT, Mackinnon SL, Goodman MJ, Thomas SG, Plyley MJ. Resistance and aerobic training in older men: effects on VO2 peak and the capillary supply to skeletal muscle. Journal of Applied Physiology 1997;82(4):1305-10.
Hiatt 1994 {published data only}
  • Hiatt WR, Wolfel EE, Meier RH, Regensteiner JG. Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Circulation 1994;90(4):1866-74.
  • Regensteiner JG, Steiner JF, Hiatt WR. Exercise training improves functional status in patients with peripheral arterial disease. Journal of Vascular Surgery 1996;23(1):104-15.
Hortobagyi 2001 {published data only}
  • Hortobagyi T, Tunnel D, Moody J, Beam S, DeVita P. Low- or high-intensity strength training partially restores impaired quadriceps force accuracy and steadiness in aged adults. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2001;56(1):B38-47.
Hunter 2001 {published data only}
  • Hunter GR, Wetzstein CA, McLafferty CL Jr, Zuckerman PA, Landers KA, Bamman MM. High-resistance versus variable-resistance training in older adults. Medicine and Science in Sports and Exercise 2001;33(10):1759-64.
Jette 1996 {published data only}
  • Jette AM, Harris BA, Sleeper L, Lachman ME, Heislein D, Giorgetti M, et al. A home-based exercise program for nondisabled older adults. Journal of the American Geriatrics Society 1996;44(6):644-9.
Jette 1999 {published and unpublished data}
  • Jette AM, Lachman M, Giorgetti MM, Assman SF, Harris BA, Levenson C, et al. Exercise - it's never too late: The strong-for-life program. American Journal of Public Health 1999;89(1):66-72.
  • Krebs DE, Jette AM, Assmann SF. Moderate exercise improves gait stability in disabled elders. Archives of Physical Medicine & Rehabilitation 1998;79(12):1489-95.
Jones 1994 {published data only}
  • Jones CJ, Rikli RE, Benedict J, Williamson P. Effects of a resistance training program on leg strength and muscular endurance in older women. Scandinavian Journal of Medicine and Science in Sports 1995;5(6):329-41.
Jubrias 2001 {published data only}
  • Jubrias SA, Esselman PC, Price LB, Cress ME, Conley KE. Large energetic adaptations of elderly muscle to resistance and endurance training. Journal of Applied Physiology 2001;90(5):1663-70.
Judge 1994 {published data only}
  • Judge JO, Whipple RH, Wolfson LI. Effects of resistance and balance exercises on isokinetic strength in older persons. Journal of the American Geriatrics Society 1994;42(9):937-46.
  • Wolfson L, Whipple R, Derby C, Judge J, King M, Amerman P, et al. Balance and strength training in older adults: intervention gains and tai chi maintenance. Journal of the American Geriatrics Society 1996;44(5):498-506.
Kerr 2001 {published data only}
  • Kerr D, Ackland T, Maslen B, Morton A, Prince R. Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. Journal of Bone and Mineral Research 2001;16(1):175-81.
Latham 2001 {published and unpublished data}
  • Latham NK, Stretton CS, Ronald M. Progressive resistance strength training in hospitalised older people: a preliminary investigation. New Zealand Journal of Physiotherapy 2001;29(2):41-8.
Latham 2002 {published and unpublished data}
  • Latham NK, Anderson CS, Lee A, Bennett D, Moseley AM, Cameron ID. A randomized controlled trial of resistance exercises and vitamin D in hospitalised frail elderly: The Frailty Interventions Trial in Elderly Subjects (FITNESS). Journal of the American Geriatrics Society in press.
Maiorana 1997 {published data only}
  • Maiorana AJ, Briffa TG, Goodman C, Hung J. A controlled trial of circuit weight training on aerobic capacity and myocardial oxygen demand in men after coronay artery bypass surgery. Journal of Cardiopulmonary Rehabilitation 1997;17(4):239-47.
Maurer 1999 {published data only}
  • Maurer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR. Osteoarthritis of the knee: isokinetic quadriceps exercise versus and educational intervention. Archives of Physical Medicine and Rehabilitation 1999;80(10):1293-9.
McCartney 1995 {published data only}
  • McCartney N, Hicks A, Martin J, Webber C. A longitudinal trial of weight training in the elderly: continued improvements in year 2. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 1996;51(6):B425-33.
  • McCartney N, Hicks AL, Martin J, Webber CE. Long-term resistance training in elderly: Effects on dynamic strength, exercise capacity, muscle and bone. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 1995;50(2):B97-104.
McGuigan 2001 {published data only}
  • McGuigan MR, Bronks R, Newton RU, Sharman MJ, Graham JC, Cody DV, et al. Resistance training in patients with peripheral arterial disease: effects on myosin isoforms, fiber type distribution and capillary supply to skeletal muscle. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 2001;56(7):B302-10.
McMurdo 1995 {published data only}
  • McMurdo ME, Johnstone R. A randomized controlled trial of a home exercise programme for elderly people with poor mobility. Age and Ageing 1995;24(5):425-8.
Mihalko 1996 {published data only}
  • Mihalko SL, McAuley E. Strength training effects on subjective well-being and physical function in the elderly. Journal of Aging and Physical Activity 1996;4(1):56-68.
Moreland 2001 {unpublished data only}
  • Moreland J. personal communication 2001.
Nelson 1994 {published data only}
  • Morganti CM, Nelson ME, Fiatarone MA, Dallal GE, Economos CD, Crawford BM, et al. Strength improvements with 1 yr of progressive resistance training in older women. Medicine and Science in Sports and Exercise 1995;27(6):906-12.
  • Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. JAMA : The Journal of the American Medical Association. 1994;272(24):1909-14.
Newnham 1995 {unpublished data only}
  • Newnham J. The effects of a strengthening program on muscle function and mobility skills in an elderly instituionalised population [thesis]. Montreal (Quebec): McGill University, 1995.
Nichols 1993 {published data only}
  • Nichols JF, Omizo DK, Peterson KK, Nelson KP. Efficacy of heavy-resistance training for active women over sixty: Muscular strength, body composition and program adherence. Journal of the American Geriatrics Society 1993;41(3):205-10.
Parkhouse 2000 {published data only}
  • Parkhouse WS, Coupland DC, Li C, Vanderhoek KJ. IGF-1 bioavailabililty is increased by resistance training in older women with low bone mineral density. Mechanisms of Ageing and Development 2000;113(2):75-83.
Perrig-Chiello 1998 {published data only}
  • Perrig-Chiello P, Perrig WJ, Ehrsam R, Staehelin HB, Krings F. The effects of resistance training on well-being and memory in elderly volunteers. Age and Ageing 1998;27(4):469-76.
Pollock 1991 {published data only}
  • Hagberg JM, Graves JE, Limacher M, Woods DR, Leggett SH, Cononie C, et al. Cardiovascular responses of 70- to 79-year-old mean and women to exercise training. Journal of Applied Physiology 1989;66(6):2589-94.
  • Panton LB, Graves JE, Pollock ML, Hagberg JM, Chen W. Effect of aerobic and resistance training on fractionated reaction time and speed of movement. Journal of Gerontology 1990;45(1):M26-31.
  • Pollock ML, Carroll JF, Graves JE, Leggett SH, Braith RW, Limacher M, et al. Injuries and adherence to walk/jog and resistance training programs in the elderly. Medicine and Science in Sports and Exercise 1991;23(10):1194-1200.
Pu 2001 {published data only}
  • Pu CT, Johnson MT, Forman DE, Hausdorff JM, Roubenoff R, Foldvari M, et al. Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. Journal of Applied Physiology 2001;90(6):2341-50.
Rall 1996 {published data only}
  • Rall LC, Meydani SN, Kehayias JJ, Dawson Hughes B, Roubenoff R. The effect of progressive resistance training in rheumatoid arthritis. Increased strength without changes in energy balance or body composition. Arthritis and Rheumatism 1996;39(3):415-26.
  • Rall LC, Rosen CJ, Dolnikowski G, Hartman WJ, Lundgren N, Abad LW, et al. Protein metabolism in rheumatoid arthritis and aging. Effects of muscle strength training and tumor necrosis factor alpha. Arthritis and Rheumatism 1996;39(7):1115-24.
  • Rall LC, Roubenoff R, Cannon JG, Abad LW, Dinarello CA, Meydani SN. Effects of progressive resistance training on immune response in aging and chronic inflammation. Medicine and Science in Sports and Exercise 1996;28(11):1356-65.
Rhodes 2000 {published data only}
  • Rhodes EC, Martin AD, Taunton JE, Donnely M, Warren J, Elliot J. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. British Journal of Sports Medicine 2000;34(1):18-22.
Sartorio 2001 {published data only}
  • Sartorio A, Lafortuna C, Capodaglio P, Vangeli V, Narici MV, Faglia G. Effects of a 16-week progressive high-intensity strength training (HIST) on indexes of bone turnover in men over 65 years: A randomized controlled study. Journal of Endocrinological Investigation 2001;24(11):882-6.
Schilke 1996 {published data only}
  • Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nursing Research 1996;45(2):68-72.
Schlicht 1999 {published and unpublished data}
  • Schlicht, J. Effect of intense strength training on walking speed, standing balance and sit-to-stand performance in older adults [thesis]. Storrs (CT): Univ. of Connecticut, 1999.
  • Schlicht J, Camaione DN, Owen SV. Effect of intense strength training on standing balance, walking speed and sit-to-stand performance in older adults. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 2001;56(5):M281-6.
Simpson 1992 {published data only}
  • Simpson K, Killian K, McCartney N, Lloyd DG, Jones NL. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax 1992;47(2):70-5.
Singh 1997 {published data only}
  • Singh NA, Clements KM, Fiatarone MA. A randomised trial of progressive resistance training in depressed elders. Journals of Gerontology.Series A, Biological Sciences & Medical Sciences 1997;52(1):M27-35.
  • Singh NA, Clements KM, Fiatarone Singh MA. The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2001;56(8):497-504.
Sipila 1996 {published data only}
  • Siplia S, Multanen J, Kallinen M, Era P, Suominen H. Effects of strength and endurance training on isometric muscle strength and walking speed in elderly women. Acta Physiologica Scandinavica 1996;156(4):457-64.
Skelton 1995 {published and unpublished data}
  • Skelton DA, Young A, Greig CA, Malbut KE. Effects of resistance training on strength, power, and functional abilities of women aged 75 and older. Journal of the American Geriatrics Society 1995;43(10):1081-7.
Skelton 1996 {published and unpublished data}
  • Skelton DA, McLaughlin AW. Training functional ability in old age. Physiotherapy 1996;82(3):159-67.
Taaffe 1996 {published data only}
  • Pruitt LA, Taaffe DR, Marcus R. Effects of a one-year high-intensity versus low-intensity resistance training program on bone mineral density in older women. Journal of Bone and Mineral Research 1995;10(11):1788-95.
  • Taaffe DR, Pruitt L, Pyka G, Guido D, Marcus R. Comparative effects of high- and low- intensity resistance training on thigh muscle strength, fiber area, and tissue composition in elderly women. Clinical Physiology 1996;16(4):381-92.
  • Taaffe DR, Pruitt L, Reim J, Butterfield G, Marcus R. Effect of sustained resistance training on basal metabolic rate in older women. Journal of the American Geriatrics Society 1995;43(5):465-71.
Taaffe 1999 {published data only}
  • Taaffe DR, Duret C, Wheeler S, Marcus R. Once-weekly resistance exercise improves strength and neuromuscular performance in older adults. Journal of the American Geriatrics Society 1999;47(10):1208-14.
Topp 1993 {published data only}
  • Mikesky AE, Topp R, Wigglesworth JK, Harsha DM, Edwards JE. Efficacy of a home-based training program for older adults using elastic tubing. European Journal of Applied Physiology and Occupational Physiology 1994;69(4):316-20.
  • Topp R, Mikesky A, Wigglesworth J, Holt W, Edwards JE. The effect of a 12-week dynamic resistance strength training on gait velocity and balance in older adults. The Gerontologist 1993;33(4):501-6.
Topp 1996 {published data only}
  • Topp R, Mikesky A, Dayhoff NE, Holt W. Effect of resistance training on strength, postural control and gait velocity in older adults. Clinical Nursing Research 1996;5(4):407-21.
Tsutsumi 1997 {published and unpublished data}
  • Tsutsumi, T. The effects of strength training on mood, self-efficacy, cardiovascular reactivity and quality of life in older adults [thesis]. Boston (MA): Boston University, 1997.
  • Tsutsumi T, Don BM, Zaichkowsky LD, Delizonna LL. Physical fitness and psychological benefits of strength training in community dwelling older adults. Applied Human Science 1997;16(6):257-66.
  • Tsutsumi T, Don BM, Zaichkowsky LD, Takenaka K, Oka K, Ohno T. Comparison of high and moderate intensity of strength training on mood and anxiety in older adults. Perceptual and Motor Skills 1998;87(3 Pt 1):1003-11.
Tyni-Lenne 2001 {published data only}
  • Tyni-Lenne R, Dencker K, Gordon A, Jansson E, Sylven C. Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. European Journal of Heart Failure 2001;3(1):47-52.
Vincent 2002 {published data only}
  • Vincent KR, Braith BW. Resistance exercise and bone turnover in elderly men and women. Medicine and Science in Sports and Exercise 2002;34(1):17-23.
Westhoff 2000 {published data only}
  • Westhoff MH, Stemmerik L, Boshuizen HC. Effects of a low-intensity strength-training program on knee-extensor strength and functional ability of frail older people. Journal of Aging and Physical Activity 2000;8(4):325-42.
Wood 2001 {published data only}
  • Wood RH, Reyes R, Welsch MA, Favaloro-Sabatier J, Sabatier M, Lee CM, et al. Concurrent cardiovascular and resistance training in healthy older adults. Medicine and Science in Sports and Exercise 2001;33(10):1751-8.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
Adami 1999 {published data only}
  • Adami S, Gattie D, Braga V, Bianchini D, Rossini M. Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. Journal of Bone and Mineral Research 1999;14(1):120-4.
Adams 2001 {published data only}
  • Adams KJ, Swank AM, Berning JM, Sevene-Adams PG, Barnard KL, Shimp-Bowerman J. Progressive strength training in sedentary older African American women. Medicine and Science in Sports and Exercise 2001;33(9):1567-76.
Agre 1988 {published data only}
  • Agre JC, Pierce LE, Raab DM, McAdams M, Smith EL. Light resistance and stretching exercise in elderly women: effect upon strength. Archives of Physical Medicine and Rehabilitation 1988;69(4):273-6.
  • Raab DM, Agre JC, McAdam M, Smith EL. Light resistance and stretching exercise in elderly women: effect upon flexibility. Archives of Physical Medicine and Rehabilitation 1988;69(4):268-72.
Allen 1999 {published data only}
  • Allen A, Simpson J. A primary care based fall prevention programme. Physiotherapy Theory and Practice 1999;15:121-33.
Aniansson 1984 {published data only}
  • Aniansson A, Ljungberg P, Rundgren A, Wetterqvist H. Effect of a training programme for pensioners on condition and muscular strength. Archives of Gerontology & Geriatrics 1984;3(3):229-41.
Aniansson 1980 {published data only}
  • Aniansson A, Grimby G, Rundgren A, Svanborg A, Orlander J. Physical training in old men. Age and Ageing 1980;9(3):186-7.
Aniansson 1981 {published data only}
  • Aniansson A, Gustafsson E. Physical training in elderly men with special reference to quadriceps muscle strength and morphology. Clinical Physiology 1981;1(1):87-98.
Ardman 1998 {published data only}
  • Ardman O. The effects of strength training on strength, mobility and balance in two groups of institutionalised elderly subjects [thesis]. Montreal (Quebec): McGill University, 1998.
Beniamini 1997 {published data only}
  • Beniamini Y, Rubenstein JJ, Zaichkowsky LD, Leonard D, Crim MC. Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients. American Journal of Cardiology 1997;80(7):841-6.
Beniamini 1999 {published data only}
  • Beniamini Y, Rubenstein JJ, Faigehbaum AD, Lichenstein AH, Crim MC. High-intensity strength training of patients enrolled in an outpatient cardiac rehabilitation program. Journal of Cardiopulmonary Rehabilitation 1999;19(1):8-17.
Berg 1998 {published data only}
  • Berg WP, Lapp BA. The effect of a practicial resistance training intervention on mobility in independent, community-dwelling older adults. Journal of Aging and Physical Activity 1998;6(1):18-35.
Bernard 1999 {published data only}
  • Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory Care and Critical Care Medicine 1999;159(3):896-901.
Bilodeau 2000 {published data only}
  • Bilodeau M, Keen DA, Sweeney PJ, Shields RW, Enoka RM. Strength training can improve steadiness in persons with essential tremor. Muscle and Nerve 2000;23:771-8.
Brill 1998 {published data only}
  • Brill PA, Matthews M, Mason J, Davis D, Mustafa T, Macera C. Improving functional performance through a group-based free weight strength training program in residents of two assisted living communities. Physical & Occupational Therapy in Geriatrics 1998;15(3):57-69.
  • Brill PA, Probst JC, Greenhouse DL, Schell B, Macera CA. Clinical feasibility of a free-weight strength-training program for older adults. Journal of the American Board of Family Practice 1998;11(6):445-51.
Brown 1990 {published data only}
  • Brown AB, McCartney N, Sale DG. Positive adaptations to weight-lifting in the elderly. Journal of Applied Physiology 1990;69(5):1725-33.
Brown 1991 {published data only}
  • Brown M, Holloszy JO. Effects of a low intensity exercise program on selected physical performance characteristitics of 60- to 70- year olds. Aging (Milan, Italy) 1991;3(2):129-39.
Brown 2000 {published data only}
  • Brown M, Sinacore DR, Ehsani AA, Binder EF, Holloszy JO, Kohrt WM. Low-intensity exercise as a modifier of physical frailty in older adults. Archives of Physical Medicine and Rehabilitation 2000;81(7):960-5.
Bunout 2001 {published data only}
  • Bunout D, Barrera G, de la Maza P, Avendano M, Gattas V, Petermann M, et al. The impact of nutritional supplementation and resistance training on the health and function of free-living Chilean elders: results of 18 months of follow-up. Journal of Nutrition 2001;131(9):2441S-6S.
Campbell 1997 {published data only}
  • Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Journal of Medicine 1997;315:1065-9.
Chaloupka 2000 {published data only}
  • Chaloupka V, Elbl L, Nehyba S. Strength training in patients after myocardial infarct [Silovy trenink u nemocnych po infarktu myokardu]. Vnitrni Lekarstvi 2000;46(12):829-34.
Chapman 1972 {published data only}
  • Chapman E, DeVries HA, Swezey R. Joint stiffness: effects of exercise on young and old men. Journal of Gerontology 1972;27:218-21.
Connelly 1995 {published data only}
  • Connelly DM, Vandervoort AA. Effects of detraining on knee extensor strength and functional mobility in a group of elderly women. Journal of Orthopaedic & Sports Physical Therapy 1997;26(6):340-6.
  • Connelly DM, Vandervoort AA. Improvement in knee extensor strength of institutionalized elderly women after exercise with ankle weights. Physiotherapy Canada 1995;41(1):15-23.
Connelly 2000 {published data only}
  • Connelly DM, Vandervoort AA. Effects of isokinetic strength training on concentric and eccentric torque development in the ankle dorsiflexors of older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000;55:B465-72.
Cress 1991 {published data only}
  • Cress ME, Thomas DP, Johnson J, Kasch FW, Cassens RG, Smith EL, et al. Effect of training on VO2 max, thigh strength and muscle morphology in septuagenarian women. Medicine and Science in Sports and Exercise 1991;23:752-8.
Cress 1999 {published data only}
  • Cress ME, Buchner DM, Questad KA, Esselman PC, de Lateur BJ, Schwartz RS. Exercise: effects on physical functional performance in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1999;54(5):M242-8.
Crilly 1989 {published data only}
  • Crilly RG, Willems DA, Trenholm KJ, Hayes KC, Delaquerriere-Richardson LF. Effect of exercise on postural sway in the elderly. Gerontology 1989;35(2-3):137-43.
De Vito 1999 {published data only}
  • De Vito G, Bernardi M, Forte R, Pulejo C, Figura F. Effects of a low-intensity programme on VO2 max and maximal instantaneous peak power in elderly women. European Journal of Applied Physiology and Occupational Physiology 1999;80(3):227-32.
Dupler 1993 {published data only}
  • Dupler TL, Cortes C. Effects of a whole-body resistive training regimen in the elderly. Gerontology 1993;39(6):314-9.
Fernandez Ramirez 99 {published data only}
  • Fernandez Ramirez AI, Fernandez Ramirez AS. Effect of an exercise program on physical fitness of institutionalized elderly men. Archivos de Medicina del Deporte 1999;16(72):325-32.
Fiatarone 1990 {published data only}
  • Fiatarone MA, Marks ED, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA: the Journal of the American Medical Association 1990;263(22):3029-34.
Fisher 1991 {published data only}
  • Fisher NM, Pendergast DR, Calkins E. Muscle rehabilitation in impaired elderly nursing home residents. Archives of Physical Medicine and Rehabilitation 1991;72:181-5.
  • Fisher NM, Pendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Archives of Physical Medicine and Rehabilitation 1991;72(6):367-74.
Fisher 1993 {published data only}
  • Fisher NM, Gresham G, Pendergast DR. Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic kne. Archives of Physical Medicine and Rehabilitation 1993;74(12):1319-26.
  • Fisher NM, Kame VD, Rouse L, Pendergast DR. Quantitative evaluation of a home exercise program on muscle and functional capacity in patients with osteoarthritis. American Journal of Physical Medicine and Rehabilitation 1994;73(6):413-20.
Fisher 1993a {published data only}
  • Fisher NM, Gresham GE, Abrams M, Hicks J, Horrigan D, Pendergast DR. Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees. Archives of Physical Medicine and Rehabilitation 1993;74(8):840-7.
Fisher 1994 {published data only}
  • Fisher NM, Kame VD, Rouse L, Pendergast DR. Quantitative evaluation of a home exercise program on muscle and functional capacity of patients with osteoarthritis. American Journal of Physical Medicine and Rehabilitation 1994;73(6):413-20.
  • Fisher NM, Pendergast DR. Effects of a muscle exercise program on exercise capacity in subjects with osteoarthritis. Archives of Physical Medicine and Rehabilitation 1994;75(7):792-7.
Fisher 1997 {published data only}
  • Fisher NM, White SC, Yack HJ, Smolinski RJ, Pendergast DR. Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation. Disability and Rehabilitation 1997;19(2):47-55.
Frontera 1988 {published data only}
  • Frontera WR, Meredith C, O'Reilly KP, Knuttgen HG, Evans W. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. Journal of Applied Physiology 1988;64(3):1038-44.
Frontera 1990 {published data only}
  • Frontera WR, Meredith CN, O'Reilly KP, Evans WJ. Strength training and determinents of VO2 Max in older men. Journal of Applied Physiology 1990;68(1):329-33.
Grimby 1992 {published data only}
  • Grimby G, Aniansson A, Hedberg M, Henning GB, Grangard U, Kvist H. Training can improve muscle strength and endurance in 78- to 84-year-old men. Journal of Applied Physiology 1992;73(6):2517-23.
Hakkinen 1995 {published data only}
  • Hakkinen K, Hakkinen A. Neuromuscular adaptations during intensive strength training in middle-aged and elderly males and females. Electromyography and Clinical Neurophysiology 1995;35:137-47.
Hakkinen 1996 {published data only}
  • Hakkinen K, Kallinen M, Linnamo V, Pastinen U-M, Newton R, Kraemer W. Neuromuscular adaptations during bilateral versus unilateral strength training in middle-aged and elderly men and women. Acta Physiologica Scandinavica 1996;158:77-88.
Hakkinen 1999 {published data only}
  • Hakkinen A, Sokka T, Kotaniemi A, Kautiainen H, Jappinen I, Laitinen L, et al. Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density. Journal of Rheumatology 1999;26(6):1257-63.
Hartard 1996 {published data only}
  • Hartard M, Haber P, Ilieva D, Preisinger E, Seidl G, Huber J. Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia. American Journal of Physical Medicine & Rehabilitation 1996;75(1):21-8.
Humphries 2000 {published data only}
  • Humphries B, Newton RU, Bronks R, Marshall S, McBride J, Triplett-McBride T, et al. Effect of exercise intensity on bone density, strength, and calcium turnover in older women. Medicine & Science in Sports & Exercise 2000;32(6):1043-50.
Hunter 1995 {published data only}
  • Hunter GR, Treuth MS, Weinsier RL, Kekes-Szabo T, Kell SH, Roth DL, et al. The effects of strength conditioning on older women's ability to perform daily tasks. Journal of the American Geriatrics Society 1995;43(7):756-60.
Hurley 1998 {published data only}
  • Hurley M, Scott D. Improvements in quadriceps sensorimotor function and disability in patients with knee osteoarthritis following a clinically practicable exercise regime. British Journal of Rheumatology 1998;37:1181-7.
Ivey 2000 {published data only}
  • Ivey FM, Tracy BL, Lemmer JT, NessAiver M, Metter EJ, Fozard JL, et al. Effects of strength training and detraining on muscle quality: age and gender comparisons. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000;55(3):B152-7.
Jones 1987 {published data only}
  • Jones D, Rutherford O. Human muscle strength training: The effects of three different regimes and the nature of the resultant changes. Journal of Physiology 1987;391:1-11.
Judge 1993 {published data only}
  • Judge J, Underwood M, Gennosa T. Exercise to improve gait velocity in older persons. Archives of Physical Medicine and Rehabilitation 1993;74:400-6.
Judge 1993B {published data only}
  • Judge J, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: Effects of exercise training. Physical Therapy 1993;73:254-5.
Kauffman 1985 {published data only}
  • Kauffman TL. Strength training effect in young and aged women. Archives of Physical Medicine & Rehabilitation 1985;66(4):223-6.
Kauranen 1998 {published data only}
  • Kauranen K, Siira P, Vanharanta H. A 10-week strength training program: effect on the motor performance of an unimpaired upper extremity. Archives of Physical Medicine and Rehabilitation 1998;79:925-30.
Kerr 1996 {published data only}
  • Kerr D, Morton A, Dick I, Prince R. Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. Journal of Bone & Mineral Research 1996;11(2):218-25.
King 1991 {published data only}
  • King A, Haskell W, Taylor B. Group vs home-based exercise training in healthy older men and women: a community-based clinical trial. JAMA: the Journal of the American Medical Association 1991;266(11):1535-42.
King 2000 {published data only}
  • King AC, Pruitt LA, Phillips W, Oka R, Rodenburg A, Haskell WL. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Journals of Gerontology. Series A, Biological Sciences & Medical Sciences 2000;55(2):M74-83.
Komatireddy 1997 {published data only}
  • Komatireddy GR, Leitch RW, Cella K, Browning G, Minor M. Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. Journal of Rheumatology 1997;24(8):1531-9.
Larsson 1982 {published data only}
  • Larsson L. Physical training effects on muscle morphology in sedentary males at different ages. Medicine and Science in Sports and Exercise 1982;14(3):203-6.
Lazowski 1999 {published data only}
  • Lazowski DA, Ecclestone NA, Myers AM, Paterson DH, Tudor-Locke C, Fitzgerald C, et al. A randomized outcome evaluation of group exercise programs in long-term care institutions. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1999;54(12):M621-8.
Lexell 1992 {published data only}
  • Lexell J, Robertsson E, Stenstrom E. Effects of strength training in elderly women [letter]. Journal of the American Geriatrics Society 1992;40(2):190-1.
Lexell 1995 {published data only}
  • Lexell J, Downham DY, Larsson Y, Bruhn E, Morsing B. Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles. Scandinavian Journal of Medicine & Science in Sports 1995;5(6):329-41.
Lichenstein 1989 {published data only}
  • Lichtenstein MJ, Shields SL, Shiavi RG, Burger MC. Exercise and balance in aged women: a pilot controlled clinical trial. Archives of Physical Medicine & Rehabilitation 1989;70(2):138-43.
Liemohn 1975 {published data only}
  • Liemohn WP. Strength and aging: an exploratory study. International Journal of Aging and Human Development 1975;6(4):347-57.
Lohman 1995 {published data only}
  • Lohman T, Going S, Pamenter R, Hall M, Boyden T, Houtkooper L, et al. Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. Journal of Bone & Mineral Research 1995;10(7):1015-24.
Lord 1994 {published data only}
  • Lord S, Castell S. Effect of exercise on balance, strength and reaction time in older people. Australian Journal of Physiotherapy 1994;40(2):83-8.
Lord 1995 {published data only}
  • Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength and falls in older women: a randomized controlled trial. Journal of the American Geriatrics Society 1995;43(11):1198-206.
Lord 1996 {published data only}
  • Lord SR, Lloyd DG, Niruni M, Raymond J, Williams P, Stewart RA. The effect of exercise on gait patterns in older women: a randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1996;51(2):M64-70.
MacRae 1994 {published data only}
  • MacRae PG, Feltner ME, Reinsch S. A 1-year exercise program for older women: effects on falls, injuries, and physical performance. Journal of Aging and Physical Activity 1994;2(2):127-42.
Maddalozzo 2000 {published data only}
  • Maddalozzo GF, Snow CM. High intensity resistance training: effects on bone in older men and women. Calcified Tissue International 2000;66(6):394-404.
Magnusson 1996 {published data only}
  • Magnusson G, Gordon A, Kaijser L, Sylven C, Isberg B, Karpakka J, et al. High intensity knee extensor training in patients with chronic heart failure. European Heart Journal 1996;17(7):1048-55.
Martel 1999 {published data only}
  • Martel GF, Hurlbut DE, Lott ME, Lemmer JT, Ivey FM, Roth SM, et al. 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 1999;47(10):1215-21.
McAuley 2000 {published data only}
  • McAuley E, Blissmer B, Katula J, Duncan TE, Mihalko SL. Physical activity, self-esteem, and self-efficacy relationships in older adults: a randomized controlled trial. Annals of Behavioral Medicine 2000;22(2):131-9.
McCool 1991 {published data only}
  • McCool J, Schneider J. Home-based leg strengthening for older adults initiated through private practice. Preventative Medicine 1991;28:105-10.
McMurdo 1993 {published data only}
  • McMurdo ME, Rennie L. A controlled trial of exercise by residents of old people's homes. Age & Ageing 1993;22(1):11-15.
McMurdo 1994 {published data only}
  • McMurdo M, Rennie L. Improvements in quadriceps strength with regular seated exercise in the institutionalised elderly. Archives of Physical Medicine and Rehabilitation 1994;75:600-3.
Meredith 1992 {published data only}
  • Meredith CN, Frontera WR, O'Reilly KP, Evans WJ. Body composition in elderly men: effect of dietary modification during strength training. Journal of the American Geriatrics Society 1992;40(2):155-62.
Messier 2000 {published data only}
  • Messier SP, Loeser RF, Mitchell MN, Valle G, Morgan TP, Rejeski W J, et al. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Journal of the American Geriatrics Society 2000;48(9):1062-72.
Meuleman 2000 {published data only}
  • Meuleman JR, Brechue WF, Kubilis PS, Lowenthal DT. Exercise training in the debilitated aged: strength and functional outcomes. Archives of Physical Medicine and Rehabilitation 2000;81:312-8.
Morey 1989 {published data only}
  • Morey MC, Cowper PA, Feussner JR, DiPasquale RC, Crowley GM, Kitzman DW, et al. Evaluation of a supervised exercise program in a geriatric population. Journal of the American Geriatrics Society 1989;37:348-54.
Morey 1991 {published data only}
  • Morey MC, Cowper PA, Feussner JR, DiPasquale RC, Crowley GM, Sullivan RJ Jr. Two-year trends in physical performance following supervised exercise among community-dwelling older veterans. Journal of the American Geriatrics Society 1991;39(6):549-54.
Moritani 1980 {published data only}
  • Moritani T, DeVries HA. Potential for gross muscle hypertrophy in older men. Journals of Gerontology 1980;35(5):672-82.
Morris 1999 {published data only}
  • Morris JN, Fiatarone M, Kiely DK, Belleville-Taylor P, Murphy K, Littlehale S, et al. Nursing rehabilitation and exercise strategies in the nursing home. Journals of Gerontology. Series A, Biological Sciences & Medical Sciences 1999;54(10):M494-500.
Mulrow 1994 {published data only}
  • Mulrow CD, Gerety MB, Kanten D, Cornell JE, DeNiro LA, Chiodo L, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA: Journal of the American Medical Association 1994;271(7):519-24.
Narici 1989 {published data only}
  • Narici MV, Roi GS, Landoni L, Minetti AE, Cerretelli P. Changes in force, cross-sectional area and neural activation during strength training and detraining of the human quadriceps. European Journal of Applied Physiology and Occupational Physiology 1989;59(4):310-9.
Nelson 1997 {published data only}
  • Hausdorff JM, Nelson ME, Kaliton D, Layne JE, Bernstein MJ, Nuernberger A, et al. Etiology and modification of gait instability in older adults: A randomized controlled trial of exercise. Journal of Applied Physiology 2001;90:2117-29.
  • Nelson ME, Layne JE, Nuernberger A, Allen MJ, Judge J, Kailiton D, et al. Home-based exercise training in the frail elderly: Effects on physical performance. Medicine and Science in Sports and Exercise 1997;29(Suppl 5):S110.
Nowalk 2001 {published data only}
  • Nowalk MP, Prendergast JM, Bayles CM, D'Amico FJ, Colvin GC. A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program. Journal of the American Geriatrics Society 2001;49(7):859-65.
O'Reilly 1999 {published data only}
  • O'Reilly S, Muir K, Doherty M. Effectiveness of home exercise on pain an disability from osteoarthritis of the knee: a randomised controlled trial. Annals of Rheumatic Diseases 1999;58:15-19.
Oka 2000 {published data only}
  • Oka RK, De Marco T, Haskell WL, Botvinick E, Dae MW, Bolen K, et al. Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. American Journal of Cardiology 2000;85(3):365-9.
Okumiya 1996 {published data only}
  • Okumiya K, Matsubayashi K, Wada T, Kimura S, Doi Y, Ozawa T. Effects of exercise on neurobehavioral function in community-dwelling older people more than 75 years of age. Journal of the American Geriatrics Society 1996;44(5):569-72.
Oster 1997 {published data only}
  • Oster P, Hauer K, Specht N, Rost B, Baertsch P, Schlierf G. Muscle strength and coordination training for prevention of falls in elderly patients [Kraft- und Koordinationstraining zur Sturzpravention im Alter. Kraft- und Koordinationstraining zur Sturzpravention im Alter]. Zeitschrift fur Gerontologie und Geriatrie 1997;30(4):289-92.
Parsons 1992 {published data only}
  • Parsons D, Foster V, Harman F, Dickinson A, Olivia P, Westerlind K. Balance and strength changes in elderly subjects after heavy resistance strength training [abstract]. Medicine and Science in Sports and Exercise 1992;24(Suppl 5):S21.
Perhonen 1992 {published data only}
  • Perhonen M, Komi P, Hakkinen K, Von Bonsdorff H, Partio E. Strength training and neuromuscular function in elderly people with total knee endoprosthesis. Scandinavian Journal of Medicine & Science in Sports 1992;2:234-43.
Perkins 1961 {published data only}
  • Perkins L, Kaiser H. Results of short-term isotonic and isometric exercise programs in persons over sixty. Physical Therapy Review 1961;41:633-5.
Petrella 2000 {published data only}
  • Petrella R, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2000;27(9):2215-21.
Pyka 1994 {published data only}
  • Pyka G, Lindenberger E, Charette S, Marcux R. Muscle strength and fiber adaptations to a year-long resistance training program. Journal of Gerontology 1994;49(1):M22-7.
Richards 1996 {published data only}
  • Richards D. Efficacy of upper extremity strength training on upper extremity functional performance among elderly long-term care residents [thesis]. Pittsburgh (PA): Univ. of Pittsburgh, 1996.
Rikli 1991 {published data only}
  • Rikli RE, Edwards DJ. Effects of a three-year exercise program on motor function and cognitive processing speed in older women. Research Quarterly for Exercise and Sport 1991;62(1):61-7.
Roman 1993 {published data only}
  • Roman WJ, Fleckenstein J, Stray-Gundersen J, Alway SE, Peshock R, Gonyea WJ. Adaptations in the elbow flexors of elderly males after heavy-resistance training. Journal of Applied Physiology 1993;74(2):750-4.
Rooks 1997 {published data only}
  • Rooks D, Kiel D, Parsons C, Hayes W. Self-paced resistance training and walking exercise in community-dwelling older adults: effects on neuromotor performance. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1997;52(3):M161-8.
Rubenstein 2000 {published data only}
  • Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, et al. Effects of a group exercise program on strength, mobility and falls among fall-prone elderly men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000;55(6):M317-21.
Ryan 1998 {published data only}
  • Ryan AS, Treuth MS, Hunter GR, Elahi D. Resistive training maintains bone mineral density in postmenopausal women. Calcified Tissue International 1998;62(4):295-9.
Sagiv 1989 {published data only}
  • Sagiv M, Fisher N, Yaniv A, Rudoy J. Effect of running versus isometric training programs on healthy elderly at rest. Gerontology 1989;35(2-3):72-7.
Sanders 1998 {published data only}
  • Sanders S. The effects of two modes of strength training on elderly men [thesis]. Minneapolis (MN): Walden University, 1998.
Sashika 1996 {published data only}
  • Sashika H, Yoshiko M, Watanabe Y. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Archives of Physical Medicine and Rehabilitation 1996;77:273-7.
Sauvage 1992 {published data only}
  • Sauvage LJ, Myklebust B, Crow-Pan J, Novak S, Millington P, Hoffman MD, et al. A clinical trial of strengthening and aerobic exercise to improve gait and balance in elderly male nursing home residents. American Journal of Physical Medicine and Rehabilitation 1992;71:333-42.
Sforzo 1995 {published data only}
  • Sforzo GA, McManis BG, Black D, Luniewski D, Scriber KC. Resilience to exercise detraining in healthy older adults. Journal of the American Geriatrics Society 1995;43:209-15.
Sharp 1997 {published data only}
  • Sharp S, Brouwer B. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Archives of Physical Medicine and Rehabilitation 1997;78:1231-6.
Shaw 1998 {published data only}
  • Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1998;53(1):M53-8.
Sherrington 1997 {published data only}
  • Sherrington C, Lord SR. Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 1997;78:208-12.
Shumway-Cook 1997 {published data only}
  • Shumway-Cook A, Gruber W, Baldwin M, Liao ST. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Physical Therapy 1997;77(1):46-57.
Sinaki 1996 {published data only}
  • Sinaki M, Wahner H, Bergstralh E, Hodgson SF, Offord KP, Squires RW, et al. Three-year controlled, randomized trial of the effect of dose-specified loading and strengthening exercises on bone mineral density of spine and femur in nonalthletic, physically active women. Bone 1996;19(3):233-44.
Sipila 1994 {published data only}
  • Sipila S, Suominen H. Knee extension strength and walking speed in relation to quadriceps muscle composition and training in elderly women. Clinical Physiology 1994;14(4):433-42.
Sullivan 2001 {published data only}
  • Sullivan DH, Wall PT, Bariola JR, Bopp MM, Frost YM. Progressive resistance muscle strength training of hospitalized frail elderly. American Journal of Physical Medicine & Rehabilitation 2001;80:503-9.
Taaffe 1997 {published data only}
  • Taaffe DR, Marcus R. Dynamic muscle strength alterations to detraining and retraining in eldelry men. Clinical Physiology 1997;17(3):311-24.
Thompson 1988 {published data only}
  • Thompson RF, Crist DM, Marsh M, Rosenthal M. Effects of physical exercise for elderly patients with physical impairments. Journal of the American Geriatrics Society 1988;36(2):130-5.
Tinetti 1994 {published data only}
  • Tinetti M, Baker D, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. The New England Journal of Medicine 1994;331(13):821-7.
Treuth 1994 {published data only}
  • Treuth MS, Ryan AS, Pratley RE, Rubin MA, Miller JP, Nicklas BJ, et al. Effects of strength training on total and regional body composition in older men. Journal of Applied Physiology 1994;77(2):614-20.
Tsuji 2000 {published data only}
  • Tsuji I, Tamagawa A, Nagatomi R, Irie N, Ohkubo T, Saito M, et al. Randomised controlled trial of exercise training for older people: study design and primary outcome. Journal of Epidemiology 2000;10(1):55-64.
van den Ende 2000 {published data only}
  • van den Ende CH, Breedveld FC, le Cessie S, Dijkmans BA, de Mug AW, Hazes JM. Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Annals of the Rheumatic Diseases 2000;59(8):615-21.
Verfaillie 1997 {published data only}
  • Verfaillie D, Nichols J, Turkel E, Hovell M. Effects of resistance, balance and gait training on reduction of risk factors leading to falls in elders. Journal of Aging and Physical Activity 1997;5:213-28.
Welsh 1996 {published data only}
  • Welsh L, Rutherford OM. Effects of isometric strength training on quadriceps muscle properties in over 55 year olds. European Journal of Applied Physiology & Occupational Physiology 1996;72(3):219-23.
Williams 1997 {published data only}
  • Williams P, Lord S. Effects if group exercise on cognitive functioning and mood in older women. Australian and New Zealand Journal of Public Health 1997;21(1):45-52.

References to studies awaiting assessment

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
Brochu 2002 {published data only}
  • Brochu M, Savage P, Lee M, Dee J, Cress ME, Poehlman ET, et al. Effects of resistance training on physical function in older disabled women with coronary heart disease. Journal of Applied Physiology 2002;92(2):672-8.
Fahlman 2002 {published data only}
  • Fahlman MM, Boardley D, Lambert CP, Flynn MG. Effects of endurance training and resistance training on plasma lipoprotein profiles in elderly women. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2002;57(2):B54-60.
Fielding 2002 {published data only}
  • Fielding RA, LeBrasseur NK, Cuoco A, Bean J, Mizer K, Fiatarone Singh MA. High-velocity resistance training increases skeletal muscle peak power in older women. Journal of the American Geriatrics Society 2002;50(4):655-62.
Vincent 2002a {published data only}
  • Vincent KR, Braith RW, Feldman RA, Magyari PM, Cutler RB, Persin SA, et al. Resistance exercise and physical performance in adults aged 60 to 83. Journal of the American Geriatrics Society 2002;50(6):1100-7.

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Characteristics of studies
  17. References to studies included in this review
  18. References to studies excluded from this review
  19. References to studies awaiting assessment
  20. Additional references
Anonymous 2001
  • Anonymous. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Journal of the American Geriatrics Society 2001;49(5):664-72.
Buchner 1993
  • Buchner DM. Understanding variability in studies of strength training in older adults: a meta-analytic perspective. Topics in Geriatric Rehabilitation 1993;8(3):1-21.
Buchner 1996
  • Buchner D, Larson E, Wagner E, Koepsell T, De Lateur B. Evidence for a non-linear relationship between leg strength and gait speed. Age and Ageing 1996;25:386-391.
Chandler 1996
  • Chandler JM, Hadley EC. Exercise to improve physiologic and functional performance in old age. Clinics in Geriatric Medicine 1996;12(4):761-784.
Clarke 2001
  • Clarke M, Oxman AD. Locating and selecting studies. Cochrane Reviewers Handbook 4.1.5 [updated April 2002]; Section 5. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated quarterly.
Doherty 1993
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