Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials



Effects of resistance training on muscle strength and hypertrophy are well established in adults and younger elderly. However, less is currently known about these effects in the very elderly (i.e., 75 years of age and older).


To examine the effects of resistance training on muscle size and strength in very elderly individuals.


Randomized controlled studies that explored the effects of resistance training in very elderly on muscle strength, handgrip strength, whole-muscle hypertrophy, and/or muscle fiber hypertrophy were included in the review. Meta-analyses of effect sizes (ESs) were used to analyze the data.


Twenty-two studies were included in the review. The meta-analysis found a significant effect of resistance training on muscle strength in the very elderly [difference in ES = 0.97; 95% confidence interval (CI) 0.50, 1.44; p = 0.001]. In a subgroup analysis that included only the oldest-old participants (80 + years of age), there was a significant effect of resistance training on muscle strength (difference in ES = 1.28; 95% CI 0.28, 2.29; p = 0.020). For handgrip strength, we found no significant difference between resistance training and control groups (difference in ES = 0.26; 95% CI − 0.02, 0.54; p = 0.064). For whole-muscle hypertrophy, there was a significant effect of resistance training in the very elderly (difference in ES = 0 30; 95% CI 0.10, 0.50; p = 0.013). We found no significant difference in muscle fiber hypertrophy between resistance training and control groups (difference in ES = 0.33; 95% CI − 0.67, 1.33; p = 0.266). There were minimal reports of adverse events associated with the training programs in the included studies.


We found that very elderly can increase muscle strength and muscle size by participating in resistance training programs. Resistance training was found to be an effective way to improve muscle strength even among the oldest-old.

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  1. 1.

    Clark BC, Manini TM. What is dynapenia? Nutrition. 2012;28:495–503.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Visser M, Deeg DJ, Lips P, et al. Skeletal muscle mass and muscle strength in relation to lower-extremity performance in older men and women. J Am Geriatr Soc. 2000;48:381–6.

    CAS  PubMed  Google Scholar 

  3. 3.

    Newman AB, Kupelian V, Visser M, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006;61:72–7.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Clark BC, Manini TM. Functional consequences of sarcopenia and dynapenia in the elderly. Curr Opin Clin Nutr Metab Care. 2010;13:271–6.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–311.

    PubMed  Google Scholar 

  6. 6.

    Faigenbaum AD, Kraemer WJ, Blimkie CJ, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23:S60–79.

    PubMed  Google Scholar 

  7. 7.

    Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009;3:002759.

    Google Scholar 

  8. 8.

    American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687–708.

    Google Scholar 

  9. 9.

    Fragala MS, Cadore EL, Dorgo S, et al. Resistance training for older adults: position statement from the National Strength and Conditioning Association. J Strength Cond Res. 2019;33:2019–52.

    PubMed  Google Scholar 

  10. 10.

    Ouchi Y, Rakugi H, Arai H, et al. Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int. 2017;17:1045–7.

    PubMed  Google Scholar 

  11. 11.

    Stewart VH, Saunders DH, Greig CA. Responsiveness of muscle size and strength to physical training in very elderly people: a systematic review. Scand J Med Sci Sports. 2014;24:e1–.

    CAS  PubMed  Google Scholar 

  12. 12.

    Phillips SM. A brief review of critical processes in exercise-induced muscular hypertrophy. Sports Med. 2014;44:71–7.

    PubMed Central  Google Scholar 

  13. 13.

    Burd NA, Gorissen SH, van Loon LJ. Anabolic resistance of muscle protein synthesis with aging. Exerc Sport Sci Rev. 2013;41:169–73.

    PubMed  Google Scholar 

  14. 14.

    Petrella JK, Kim JS, Mayhew DL, et al. Potent myofiber hypertrophy during resistance training in humans is associated with satellite cell-mediated myonuclear addition: a cluster analysis. J Appl Physiol. 2008;104:1736–42.

    PubMed  Google Scholar 

  15. 15.

    Petrella JK, Kim JS, Cross JM, et al. Efficacy of myonuclear addition may explain differential myofiber growth among resistance-trained young and older men and women. Am J Physiol Endocrinol Metab. 2006;291:E937–E946946.

    CAS  PubMed  Google Scholar 

  16. 16.

    Karlsen A, Bechshøft RL, Malmgaard-Clausen NM, et al. Lack of muscle fibre hypertrophy, myonuclear addition, and satellite cell pool expansion with resistance training in 83–94-year-old men and women. Acta Physiol (Oxf). 2019;227:e13271.

    Google Scholar 

  17. 17.

    Lundberg TR, Gustafsson T. Fibre hypertrophy, satellite cell and myonuclear adaptations to resistance training: have very old individuals reached the ceiling for muscle fibre plasticity? Acta Physiol. 2019;227:e13287.

    Google Scholar 

  18. 18.

    Doherty TJ, Vandervoort AA, Brown WF. Effects of ageing on the motor unit: a brief review. Can J Appl Physiol. 1993;18:331–58.

    CAS  PubMed  Google Scholar 

  19. 19.

    Doherty TJ, Vandervoort AA, Taylor AW, et al. Effects of motor unit losses on strength in older men and women. J Appl Physiol. 1993;74:868–74.

    CAS  PubMed  Google Scholar 

  20. 20.

    Fiatarone MA, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263:3029–34.

    CAS  PubMed  Google Scholar 

  21. 21.

    Bruunsgaard H, Bjerregaard E, Schroll M, et al. Muscle strength after resistance training is inversely correlated with baseline levels of soluble tumor necrosis factor receptors in the oldest old. J Am Geriatr Soc. 2004;52:237–41.

    PubMed  Google Scholar 

  22. 22.

    Caserotti P, Aagaard P, Larsen JB, et al. Explosive heavy-resistance training in old and very old adults: changes in rapid muscle force, strength and power. Scand J Med Sci Sports. 2008;18:773–82.

    CAS  PubMed  Google Scholar 

  23. 23.

    Giné-Garriga M, Guerra M, Pagès E, et al. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. J Aging Phys Act. 2010;18:401–24.

    PubMed  Google Scholar 

  24. 24.

    Hruda KV, Hicks AL, McCartney N. Training for muscle power in older adults: effects on functional abilities. Can J Appl Physiol. 2003;28:178–89.

    PubMed  Google Scholar 

  25. 25.

    Judge JO, Whipple RH, Wolfson LI. Effects of resistive and balance exercises on isokinetic strength in older persons. J Am Geriatr Soc. 1994;42:937–46.

    CAS  PubMed  Google Scholar 

  26. 26.

    Kalapotharakos VI, Diamantopoulos K, Tokmakidis SP. Effects of resistance training and detraining on muscle strength and functional performance of older adults aged 80 to 88 years. Aging Clin Exp Res. 2010;22:134–40.

    PubMed  Google Scholar 

  27. 27.

    Kim HK, Suzuki T, Saito K, et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc. 2012;60:16–23.

    PubMed  Google Scholar 

  28. 28.

    Serra-Rexach JA, Bustamante-Ara N, Hierro Villarán M, et al. Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. J Am Geriatr Soc. 2011;59:594–602.

    PubMed  Google Scholar 

  29. 29.

    Skelton DA, Young A, Greig CA, et al. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. J Am Geriatr Soc. 1995;43:1081–7.

    CAS  PubMed  Google Scholar 

  30. 30.

    Bechshøft RL, Malmgaard-Clausen NM, Gliese B, et al. Improved skeletal muscle mass and strength after heavy strength training in very old individuals. Exp Gerontol. 2017;92:96–105.

    PubMed  Google Scholar 

  31. 31.

    Benavent-Caballer V, Rosado-Calatayud P, Segura-Ortí E, et al. Effects of three different low-intensity exercise interventions on physical performance, muscle CSA and activities of daily living: a randomized controlled trial. Exp Gerontol. 2014;58:159–65.

    CAS  PubMed  Google Scholar 

  32. 32.

    Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr). 2014;36:773–85.

    Google Scholar 

  33. 33.

    Kim H, Suzuki T, Kim M, et al. Effects of exercise and milk fat globule membrane (MFGM) supplementation on body composition, physical function, and hematological parameters in community-dwelling frail Japanese women: a randomized double blind, placebo-controlled, follow-up trial. PLoS ONE. 2015;10:e0116256.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Sahin UK, Kirdi N, Bozoglu E, et al. Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly. Int J Rehabil Res. 2018;41:211–7.

    PubMed  Google Scholar 

  35. 35.

    Christensen K, Doblhammer G, Rau R, et al. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–208.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    National Center for Health Statistics. Survey description, national health interview survey, 2015. Hyattsville: National Center for Health Statistics; 2016.

    Google Scholar 

  37. 37.

    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Fielding RA. The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly. J Am Coll Nutr. 1995;14:587–94.

    CAS  PubMed  Google Scholar 

  39. 39.

    Guizelini PC, de Aguiar RA, Denadai BS, et al. Effect of resistance training on muscle strength and rate of force development in healthy older adults: a systematic review and meta-analysis. Exp Gerontol. 2018;102:51–8.

    PubMed  Google Scholar 

  40. 40.

    Liberman K, Forti LN, Beyer I, et al. The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Curr Opin Clin Nutr Metab Care. 2017;20:30–533.

    PubMed  Google Scholar 

  41. 41.

    Porter MM. High-intensity strength training for the older adult—a review. Top Geriatr Rehabil. 1995;10:61–74.

    Google Scholar 

  42. 42.

    Steib S, Schoene D, Pfeifer K. Dose-response relationship of resistance training in older adults: a meta-analysis. Med Sci Sports Exerc. 2010;42:902–14.

    PubMed  Google Scholar 

  43. 43.

    Straight CR, Lindheimer JB, Brady AO, et al. Effects of resistance training on lower-extremity muscle power in middle-aged and older adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2016;46:353–64.

    PubMed  Google Scholar 

  44. 44.

    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Grgic J, Schoenfeld BJ, Davies TB, et al. Effect of resistance training frequency on gains in muscular strength: a systematic review and meta-analysis. Sports Med. 2018;48:1207–20.

    PubMed  Google Scholar 

  46. 46.

    Grgic J, Schoenfeld BJ, Skrepnik M, et al. Effects of rest interval duration in resistance training on measures of muscular strength: a systematic review. Sports Med. 2018;48:137–51.

    PubMed  Google Scholar 

  47. 47.

    Morris B. Estimating effect sizes from pretest–posttest-control group designs. Organ Res Methods. 2008;11:364–86.

    Google Scholar 

  48. 48.

    Tanner-Smith EE, Tipton E, Polanin JR. Handling complex meta-analytic data structures using robust variance estimates: a tutorial in R. J Dev Life Course Criminol. 2016;2:85–112.

    Google Scholar 

  49. 49.

    Sasaki H, Kasagi F, Yamada M, et al. Grip strength predicts cause-specific mortality in middle-aged and elderly persons. Am J Med. 2007;120:337–42.

    PubMed  Google Scholar 

  50. 50.

    Fisher Z, Tipton E, Zhipeng H. robumeta: robust variance meta-regression. R package version 2.0. 2017. https://www.CRAN.R-project.org/package=robumeta. Accessed 1 Feb 2020.

  51. 51.

    Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.

    Google Scholar 

  52. 52.

    Fiatarone MA, O'Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769–75.

    CAS  PubMed  Google Scholar 

  53. 53.

    Fiatarone Singh MA, Ding W, Manfredi TJ, et al. Insulin-like growth factor I in skeletal muscle after weight-lifting exercise in frail elders. Am J Physiol. 1999;277:E135–E143143.

    Google Scholar 

  54. 54.

    Sipilä S, Suominen H. Effects of strength and endurance training on thigh and leg muscle mass and composition in elderly women. J Appl Physiol. 1995;78:334–40.

    PubMed  Google Scholar 

  55. 55.

    Sipilä S, Multanen J, Kallinen M, et al. Effects of strength and endurance training on isometric muscle strength and walking speed in elderly women. Acta Physiol Scand. 1996;156:457–64.

    PubMed  Google Scholar 

  56. 56.

    Sipilä S, Elorinne M, Alen M, et al. Effects of strength and endurance training on muscle fibre characteristics in elderly women. Clin Physiol. 1997;17:459–74.

    PubMed  Google Scholar 

  57. 57.

    Hvid LG, Strotmeyer ES, Skjødt M, et al. Voluntary muscle activation improves with power training and is associated with changes in gait speed in mobility-limited older adults—a randomized controlled trial. Exp Gerontol. 2016;80:51–6.

    PubMed  Google Scholar 

  58. 58.

    Kim H, Suzuki T, Saito K, et al. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Geriatr Gerontol Int. 2013;13:458–65.

    PubMed  Google Scholar 

  59. 59.

    Xue QL, Beamer BA, Chaves PH, et al. Heterogeneity in rate of decline in grip, hip, and knee strength and the risk of all-cause mortality: the women’s health and aging study II. J Am Geriatr Soc. 2010;58:2076–84.

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    Mitchell WK, Williams J, Atherton P, et al. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol. 2012;3:260.

    PubMed  PubMed Central  Google Scholar 

  61. 61.

    Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61:1059–64.

    PubMed  Google Scholar 

  62. 62.

    Delmonico MJ, Harris TB, Visser M, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90:1579–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. 63.

    Moreland JD, Richardson JA, Goldsmith CH, et al. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2004;52:1121–9.

    PubMed  Google Scholar 

  64. 64.

    Cronin J, Lawton T, Harris N, et al. A brief review of handgrip strength and sport performance. J Strength Cond Res. 2017;31:3187–217.

    PubMed  Google Scholar 

  65. 65.

    Saric J, Lisica D, Orlic I, et al. Resistance training frequencies of 3 and 6 times per week produce similar muscular adaptations in resistance-trained men. J Strength Cond Res. 2019;33:S122–S129129.

    PubMed  Google Scholar 

  66. 66.

    Sale D, MacDougall D. Specificity in strength training: a review for the coach and athlete. Can J Appl Sport Sci. 1981;6:87–92.

    CAS  PubMed  Google Scholar 

  67. 67.

    Tieland M, Verdijk LB, de Groot LC, et al. Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail older people. Int J Sport Nutr Exerc Metab. 2015;25:27–36.

    CAS  PubMed  Google Scholar 

  68. 68.

    Buckner SL, Dankel SJ, Bell ZW, Abe T, Loenneke JP. The association of handgrip strength and mortality: what does it tell us and what can we do with it? Rejuvenation Res. 2019;22:230–4.

    PubMed  Google Scholar 

  69. 69.

    Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.

    CAS  PubMed  Google Scholar 

  70. 70.

    Wilson W, Breen L, Lord JM, et al. The challenges of muscle biopsy in a community based geriatric population. BMC Res Notes. 2018;11:830.

    PubMed  PubMed Central  Google Scholar 

  71. 71.

    Burton E, Farrier K, Lewin G, et al. Motivators and barriers for older people participating in resistance training: a systematic review. J Aging Phys Act. 2017;25:311–24.

    PubMed  Google Scholar 

  72. 72.

    Gentil P, Bottaro M. Effects of training attendance on muscle strength of young men after 11 weeks of resistance training. Asian J Sports Med. 2013;4:101–6.

    PubMed  PubMed Central  Google Scholar 

  73. 73.

    Buckner SL, Jessee MB, Mattocks KT, et al. Determining strength: a case for multiple methods of measurement. Sports Med. 2017;47:193–5.

    PubMed  Google Scholar 

  74. 74.

    Schoenfeld BJ, Grgic J, Ogborn D, et al. Strength and hypertrophy adaptations between low- vs. high-load resistance training: a systematic review and meta-analysis. J Strength Cond Res. 2017;31:3508–23.

    PubMed  Google Scholar 

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Correspondence to Jozo Grgic.

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Jozo Grgic, Alessandro Garofolini, John Orazem, Filip Sabol, Brad J. Schoenfeld and Zeljko Pedisic have no conflicts of interest that are directly relevant to the content of this article.

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The datasets generated and analyzed during the current systematic review and meta-analysis are available from the corresponding author on reasonable request.

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Author Contributions

JG conceived the idea for the review. JG and AG conducted the study selection quality assessment. JG and FS conducted the data extraction. JO performed the statistical analysis. JG drafted the initial manuscript. All authors contributed to data interpretation, writing of the manuscript, and its revisions.

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Grgic, J., Garofolini, A., Orazem, J. et al. Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 50, 1983–1999 (2020). https://doi.org/10.1007/s40279-020-01331-7

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