Exercise Prescription for the Elderly

Current Recommendations


The benefits for elderly individuals of regular participation in both cardiovascular and resistance-training programmes are great. Health benefits include a significant reduction in risk of coronary heart disease, diabetes mellitus and insulin resistance, hypertension and obesity as well as improvements in bone density, muscle mass, arterial compliance and energy metabolism. Additionally, increases in cardiovascular fitness (maximal oxygen consumption and endurance), muscle strength and overall functional capacity are forthcoming allowing elderly individuals to maintain their independence, increase levels of spontaneous physical activity and freely participate in activities associated with daily living. Taken together, these benefits associated with involvement in regular exercise can significantly improve the quality of life in elderly populations. It is noteworthy that the quality and quantity of exercise necessary to elicit important health benefits will differ from that needed to produce significant gains in fitness.

This review describes the current recommendations for exercise prescriptions for the elderly for both cardiovascular and strength/resistance-training programmes. However, it must be noted that the benefits described are of little value if elderly individuals do not become involved in regular exercise regimens. Consequently, the major challenges facing healthcare professionals today concern: (i) the implementation of educational programmes designed to inform elderly individuals of the health and functional benefits associated with regular physical activity as well as how safe and effective such programmes can be; and (ii) design interventions that will both increase involvement in regular exercise as well as improve adherence and compliance to such programmes.

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  1. 1.

    Tran ZV, Weltman A. Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight. JAMA 1985; 254: 919–24

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    DeSouza CA, Shapiro LF, Clevenger CM, et al. Regular aerobic exercise prevents and restores age-related declines in endothelium- dependent vasodilation in healthy men. Circulation 2000; 102: 1351–7

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Tanaka H, Dinenno FA, Monahan KD, et al. Aging, habitual exercise, and dynamic arterial compliance. Circulation 2000; 102: 1270–5

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Holloszy JO, Kohrt WM. Exercise. In: Masoro EJ. Handbook of physiology: aging. New York (NY): Oxford University Press, 1995: 633–66

    Google Scholar 

  5. 5.

    Despres JP, Lamarche B. Low-intensity endurance exercise training, plasma lipoproteins and the risk of coronary heart disease. J Int Med 1994; 236: 7–22

    Article  CAS  Google Scholar 

  6. 6.

    ACSM Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 1998; 30 (6): 992–1008

    Article  Google Scholar 

  7. 7.

    Lee IM, Rexrode KM, Cook NR, et al. Physical activity and coronary heart disease in women. JAMA 2001; 285: 1447–54

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Lee IM, Hsieh CC, Paffenbarger RS. Exercise intensity and longevity inn men: the Harvard Alumni Health study. JAMA 1995; 273: 1179–84

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Stevens J, Cai J, Pamuk ER, et al. The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Kohrt WM, Malley MT, Dalsky GP, et al. Body composition of healthy sedentary and trained, young and older men and women. Med Sci Sports Exerc 1992; 24 (7): 832–7

    PubMed  CAS  Google Scholar 

  11. 11.

    Schwartz RS, Shuman WP, Larson V, et al. The effect of intensive endurance exercise training on body fat distribution in young and old men. Metabolism 1991; 40 (5): 545–51

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Kohrt WM, Obert KA, Holloszy JO. Exercise training improves fat distribution patterns in 60- and 70-year-old men and women. J Gerontol 1992; 47 (4): M99-M105

    Article  Google Scholar 

  13. 13.

    National Cholesterol Education Program. Detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel II). Circulation 1994; 89 (3): 1329–445

    Google Scholar 

  14. 14.

    Stevenson ET, Davy KP, Seals DR. Hemostatic, metabolic, and androgenic risk factors for coronary heart disease in physically active and less active postmenopausal women. Arterioscler Thromb 1995; 15: 669–77

    Article  CAS  Google Scholar 

  15. 15.

    Haskell WL. The influence of exercise training on plasma lipids and lipoproteins in health and disease. Acta Med Scand Suppl 1986; 711: 25–37

    PubMed  CAS  Google Scholar 

  16. 16.

    Cefalu WT, Werbel S, Bell-Farrow AD, et al. Insulin resistance and fat patterning with aging: relationship to metabolic risk factors for cardiovascular disease. Metabolism 1998; 47 (4): 401–8

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Mykkanen L, Laakso M, Pyorala K. High plasma insulin level associated with coronary heart disease in the elderly. Am J Epidemiol 1993; 137 (11): 1190–202

    PubMed  CAS  Google Scholar 

  18. 18.

    Joint National Committee on Prevention Detection, Evaluation, and Treatment of High Blood Pressure. The Sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157 (24): 2413–46

    Google Scholar 

  19. 19.

    Tanaka H, DeSouza CA, Seals DR. Exercise and hypertension in older adults. In: Tanaka H, Shindo M, editors. Exercise for preventing common diseases. Tokyo: Springer-Verlag, 1999: 45–50

    Google Scholar 

  20. 20.

    Seals DR, Silverman HG, Reiling MJ, et al. Effect of regular aerobic exercise on elevated blood pressure in postmenopausal women. Am J Cardiol 1997; 80 (1): 49–55

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Hagberg JM, Montain SJ, Martin WH, et al. Effect of exercise training in 60- to 69-year-old persons with essential hypertension. Am J Cardiol 1989; 64: 348–53

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Ishikawa K, Ohta T, Zhang J, et al. Influence of age and gender on exercise training-induced blood pressure reduction in systemic hypertension. Am J Cardiol 1999; 84 (2): 192–6

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Buskirk ER, Hodgson JL. Age and aerobic power: the rate of change in men and women. Fed Proc 1987; 46: 1824–9

    PubMed  CAS  Google Scholar 

  24. 24.

    Tanaka H, Seals DR. Age and gender interactions in physiological functional capacity: insight from swimming performance. J Appl Physiol 1997; 82 (3): 846–51

    PubMed  CAS  Google Scholar 

  25. 25.

    Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all-cause mortality: a prospective study of men and women. JAMA 1989; 262: 2395–401

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Blair SN, Kohl HW, Barlow CE, et al. Changes in physical fitness and all-cause mortality. JAMA 1995; 273: 1093–8

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Hagberg JM. Effect of training on the decline of V̇2max with aging. Fed Proc 1987; 46: 1830–3

    PubMed  CAS  Google Scholar 

  28. 28.

    Seals DR, Hagberg JM, Hurley BF, et al. Endurance training in older men and women I. cardiovascular responses to exercise. J Appl Physiol 1984; 57 (4): 1024–9

    PubMed  CAS  Google Scholar 

  29. 29.

    Dempsey JA, Seals DR. Aging, exercise, and cardiopulmonary function. In: Lamb DR, Gisolfi CV, Nadel E, editors. Perspectives in exercise science and sports medicine. Vol. 8. Exercise in older adults. Carmel (IN): Cooper Publishing Group, 1995: 237–304

    Google Scholar 

  30. 30.

    Kohrt WM, Malley MT, Coggan AR, et al. Effects of gender, age, and fitness level on response of V̇2max to training in 60–71 yr olds. J Appl Physiol 1991; 71 (5): 2004–11

    PubMed  CAS  Google Scholar 

  31. 31.

    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273 (5): 402–7

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    King AC, Haskell WL, Taylor CB, et al. Group- vs home-based exercise training in healthy older men and women: a community- based clinical trial. JAMA 1991; 266: 1535–42

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol 2001; 37 (1): 153–6

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Hakim AA, Curb JD, Petrovitch H, et al. Effects of walking on coronary heart disease in elderly men: the Honolulu Heart Program. Circulation 1999; 100 (1): 9–13

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl JMed 1999; 341 (9): 650–8

    Article  CAS  Google Scholar 

  36. 36.

    Booth ML, Bauman A, Owen N, et al. Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Prev Med 1997; 26: 131–7

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Dutta C, Hadley EC. The significance of sarcopenia in old age. J Gerontol 1995; 50A: 1–4

    Google Scholar 

  38. 38.

    Larsson L. Morphological and functional characteristics of the ageing skeletal muscle in man: a cross sectional study. Acta Physiol Scand Suppl. 1978; 457: 1–36

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol 1995; 50A Spec.: 11–6

    Google Scholar 

  40. 40.

    Overend TJ, Cunningham DA, Paterson DH, et al. Thigh composition in young and elderly men determined by computed tomography. Clin Physiol 1992; 12: 629–40

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Young A, Stokes M, Crowe M. Size and strength of the quadriceps muscles of old and young women. Eur J Clin Invest 1984; 14: 282–7

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Young A, Stokes M, Crowe M. Size and strength of the quadriceps muscles of old and young men. Clin Physiol 1985; 5: 145–54

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Evans WJ. Exercise training guidelines for the elderly. Med Sci Sports Exerc 1999; 31 (1): 12–7

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Miller JP, Pratley RE, Goldberg AP, et al. Strength training increases insulin action in healthy 50- to 65-yr-old men. J Appl Physiol 1994; 77: 1122–7

    PubMed  CAS  Google Scholar 

  45. 45.

    Pratley R, Nicklas B, Rubin M, et al. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-yr-old men. J Appl Physiol 1994; 76 (1): 133–7

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Treuth MS, Hunter GR, Kekes-Szabo T. Reduction in intra-abdominal adipose tissue after strength training in older women. J Appl Physiol 1995; 78 (4): 1425–31

    PubMed  CAS  Google Scholar 

  47. 47.

    Lexell J, Taylor T. Variability in muscle fiber areas in whole human quadriceps muscle: effect of increasing age. J Anat 1991; 174: 239–49

    PubMed  CAS  Google Scholar 

  48. 48.

    Aniansson A, Hedberg M, Henning G, et al. Muscle morphology, enzymatic activity, and muscle strength in elderly men: a follow up study. Muscle Nerve 1986; 9: 585–91

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Essen-Gustavsson B, Borges O. Histochemical and metabolic characteristics of human skeletal muscle in relation to age. Acta Physiol Scand 1986; 126: 107–14

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Feigenbaum MS, Pollock ML. Prescription of resistance training for health and disease. Med Sci Sports Exerc 1999; 31 (1): 38–45

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Fleck SJ, Kraemer WJ. Designing resistance training programs. 2nd ed. Champaign (IL): Human Kinetics Books, 1997: 1–115

    Google Scholar 

  52. 52.

    McDonagh MN, Davies CM. Adaptive response of mammalian skeletal muscle to exercise with high loads. Eur J Appl Physiol 1984; 52: 139–55

    Article  CAS  Google Scholar 

  53. 53.

    ACSM Position Stand. The Recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998; 30 (6): 975–91

    Article  Google Scholar 

  54. 54.

    Graves JE, Holmes BL, Leggett SH, et al. Single versus multiple set dynamic and isometric lumbar extension strength training. In: Proceedings of the World Confederation for Physical Therapy, 11th International Congress. III. London: Charted Society of Physiotherapy, 1991: 1340–2

    Google Scholar 

  55. 55.

    Messier SP, Dill ME. Alterations in strength and maximal oxygen uptake consequent to Nautilus circuit weight training. Res Q Exerc Sport 1985; 56: 345–51

    Google Scholar 

  56. 56.

    Feigenbaum MS, Pollock ML. Strength training: rationale for current guidelines for adult fitness programs. Physician Sportsmed 1997; 25 (2): 44–64

    CAS  Google Scholar 

  57. 57.

    Westcott WL, Greenberger K, Milinus D. Strength-training research: sets and repetitions. Scholastic Coach 1989; 58: 98–100

    Google Scholar 

  58. 58.

    Berger RA. Application of research findings in progressive resistance exercise to physical therapy. J Assoc Phys Mental Rehabil 1965: 19: 200–3

    CAS  Google Scholar 

  59. 59.

    Hunter GR. Changes in body composition, body build, and performance associated with different weight training frequencies in males and females. Natl Strength Cond Assoc J 1985; 7: 26–8

    Article  Google Scholar 

  60. 60.

    Graves JE, Pollock ML, Foster DN, et al. Effect of training frequency and specificity on isometric lumbar extension strength. Spine 1990; 15: 504–9

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Demichele PD, Pollock ML, Graves JE, et al. Effect of training frequency on the development of isometric torso rotation strength. Arch Phys Med Rehabil 1997; 27: 64–9

    Article  Google Scholar 

  62. 62.

    Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997; 30 (1): 260–315

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    Fletcher GF, Froelicher VF, Hartley LH, et al. Exercise standards: a statement for health professionals from the American Heart Association. Circulation 1990; 82 (6): 2286–322

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 6th ed. Baltimore (MD): Lippincott Williams & Wilkins, 2000

    Google Scholar 

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Dr Hirofumi Tanaka was supported in part by a National Institute of Health award AG00847.

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Correspondence to Robert S. Mazzeo.

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Mazzeo, R.S., Tanaka, H. Exercise Prescription for the Elderly. Sports Med 31, 809–818 (2001). https://doi.org/10.2165/00007256-200131110-00003

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  • Resistance Training
  • Exercise Intensity
  • Regular Exercise
  • Maximal Heart Rate
  • Exercise Prescription