Keep It Moving: Strength and Balance Training for the Older Adult

The population of adults over the age of 65 is rapidly rising, leading to more people hoping to age well. However, aging is associated with a natural decrease in physical and physiological health which can lead to increased disability, dependence, and risk of comorbidities due to declining muscle strength and mass. Additionally, about 27 percent of U.S. adults ages 60 and over live alone, posing an even greater risk.

How can strength and balance training help keep older adults independent and living well?

The Impact of Muscle Strength Loss

While skeletal muscle mass decreases by 20-30 percent throughout adulthood, or roughly 3-8 percent per decade after the age of 30, loss of muscle strength is more greatly associated with a decrease in function.1,3 Muscle strength loss leads to decreased power that is required for activities of daily living (ADLs). This can be partially due to disuse, poor protein synthesis, and chronic inflammation caused by hormonal and metabolic changes.1

Loss of strength and muscle mass can lead to bigger problems that most patients are more concerned about, the primary trouble being falls. While only one in five falls requires medical attention, those that do can lead to a dramatic loss in overall function and most older adults do not return to their previous function. A hip fracture can lead to a 22-29 percent increase in the risk of mortality in one year.3

How to Combat the Effects of Aging

Regular resistance training, even starting late in life, has been proven to not only reverse muscle loss due to aging but also improve muscle strength and mass while rebuilding muscles to be more oxidative and powerful.5

Regular strength training can lead to increased metabolism, quality of life, strength, and endurance while decreasing cardiovascular and metabolic diseases.5 The Centers for Disease Control and Prevention (CDC) recommends that adults incorporate regular resistance exercises two times per week focused on the major muscle groups, and that older adults add an additional one day per week of multidirectional movement such as dance, tai chi, or pickleball.

Resistance and Balance Programs Specific to Older Populations

With the population of older adults increasing and strong evidence for strength and resistance training, rehabilitation professionals are in a unique position to make a major difference. Most studies show that regular group exercise that is challenging, variable, and progressive is the best way for older adults to gain strength and build resiliency. Given that this exact kind of program may be difficult for your client to access, the following guidance will help curate the best resistance and balance program for the older adult in your care:

1. Dynamic Resistance Exercises

As with building up general strength and conditioning programs for athletes and other patients, the goal of a strength program for an older adult is simple: Choose eight to twelve exercises to be performed two to three times per week. The challenge for an older adult comes with designing functional exercises that usually involve multiple muscle groups and require little equipment.

Utilizing bodyweight exercises, along with easily found or inexpensive weights, is key for this population. Don’t be fooled by a person’s outward appearance. Many older adults can still perform challenging exercises. They just need to be encouraged to do so to increase muscle strength and mass. Along with creating challenging exercises, make sure that exercises are varied with speed and direction to improve power and control.4

2. Multidirectional and Complex Movements

When designing a training program for older adults, it’s essential to use multidirectional and multi-joint movements. This helps train the body systems to work together, along with making the exercise more functional and pertinent to everyday tasks. Using big muscle groups and movements helps to keep the exercises simple and easy to do while challenging the body to do lots of different tasks at once.

Focusing on simple exercises that challenge the system in a complex manner helps create a meaningful exercise. Including a balance component is additionally beneficial. Some great examples of these exercises include marching with trunk rotation, wall push-up with rotation to side plank, calf raises with a hold at the top and eccentric lowering, and biceps curls with a narrow base of support.1

3. Balance Exercises in All Conditions

Falls are a large concern for the aging population. Be sure to complete regular fall risk assessment and screenings so that you’ll be able to detect a decline in balance before a fall occurs. When training for balance there are a few key principles to keep in mind.

Balance can be divided into two main categories: proactive and reactive. Proactive balance is the process of anticipating a predicted disturbance. Reactive balance is the process of compensating for the disturbance. Interestingly, there is little carry-over in function when training for balance, so it is best to work on training balance under all conditions to achieve the best results.1,3

Balance exercises must be challenging enough to cause mild unsteadiness or loss of balance, however not so challenging that the patient falls or cannot maintain the position for more than a few seconds. Using varied surfaces and distraction techniques, as well as incorporating dual and multi-tasking during balance exercises will help your client create a more robust balance system.

4. Focus on Function

Functionality is a key component of creating exercises for older adults, especially incorporating ADLs. Creating and emphasizing exercises that focus on functional limitations and daily activities will help to improve overall health and wellness. Individualize exercises to the needs and difficulties of the older adult with whom you are working and pay attention to potential limitations.

5. Make It Fun and Meaningful

Ensure that an older adult’s exercise program is compatible with their life and helps them focus on their goals. The best-designed program only helps if the client is going to do it. Listening to your client’s goals and wishes and consistently relating exercises to what they want to achieve will not only help with buy-in but also with regular adherence.

A Key Aspect of Health

Regular resistance training is a key aspect of health for people of all ages, but it is especially important for older adults. There are significant physical, physiological, and mental benefits for older adults, including critical injury prevention factors that will help decrease falls and mitigate cardiovascular and metabolic disease risks.

To learn more about strength training in aging adults, MedBridge instructor J.J. Mowder-Tinney offers this four-course series that focuses on assessing aging adults for exercise, matching the intensity and duration of exercise to an individual’s goals and abilities, and creating realistic and prioritized interventions that can be built upon and progressed.

  1. Benefits of strength training for older adults. Exeter Fitness. (n.d.). Retrieved January 27, 2022, from
  2. Centers for Disease Control and Prevention. (2020, October 7). How much physical activity do adults need? Centers for Disease Control and Prevention. Retrieved January 27, 2022, from
  3. Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of strength and conditioning research33(8), 2019–2052.
  4. Frankel, Christopher, and Len Kravitz. “Periodization: Latest Studies and Practical Applications.” Periodization, 2000,
  5. Gschwind, Y.J., Kressig, R.W., Lacroix, A. et al. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr 13, 105 (2013).