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All Aboard the Gains Train: Why We Need to Stop Underprescribing Exercise in an Older Population



Image from Functional Training for Older Clients. By Zac Martin, https://www.theptdc.com/functional-training-older-clients.

In the physical therapy field, we’re no strangers to the benefits of regular physical activity and exercise to improve health outcomes, increase functional capacity, and create an overall better quality of life. This holds true for the older adult population, a growing demographic as we see Baby Boomers entering this next phase of life. Older adults represent a rapidly growing demographic of the population. The 2019 census indicated more than 54 million U.S. residents compared to 40.3 million reported in the 2010 census1. Participation in regular physical activity and exercise is proven to have substantial health benefits, delay physiological dysfunction associated with aging, and help prevent chronic disease2. Yet research suggests that only 22% of adults over the age of 65 years old meet the appropriate physical activity recommendations³. Furthermore, despite the known benefits of exercise, many clinicians remain hesitant to prescribe exercise to an older population4. This piece outlines the appropriate exercise parameters for this population, as well as how we can implement these recommendations to our patients in this demographic.



Healthy aging and maintenance of functional capacity require consistent physical activity with prescription of higher intensity, longer duration and greater frequency being particularly beneficial for older adults. Some short-term benefits of exercise include reducing blood pressure and risk of anxiety, depression and sleep disturbances. In the long-term exercise promotes brain, heart and bone health while reducing risk of cancer, obesity and falls⁵. Physical activity is associated with greater executive function, memory and processing speed as well as lower risk of dementia and other cognitive impairments. It also reduces the risk of multiple types of cancers including bladder, breast, gastrointestinal and lung, and regular exercise improves quality of life with lower mortality risk in cancer survivors. Risk of cardiovascular disease and stroke are reduced by following the aerobic activity guidelines mentioned below. Multimodal physical activity leads to a reduction in risk of falls, and resistance training via the lifting recommendations mentioned below can slow the loss of bone density associated with aging making fractures less likely if an older person is to have a fall or experience other impact. Overall risk of mortality is lower in physically active individuals; arguably more importantly, improvements in physical function and injury reduction are observed when meeting the recommended aerobic, and muscle strengthening exercise recommendations⁶.


Cardiovascular exercise has been shown to have multiple beneficial effects in the senior population. Some of those effects include a reduced maximal heart rate in response to exercise, increased cardiac output due to increased stroke volume, and improved peak VO2 levels due to increased perfusion and arterial compliance. All of these beneficial effects lead to improved cardiovascular performance despite physiological aging⁷. The American College of Sports Medicine’s exercise guidelines for seniors recommends 30-60 minutes of moderate intensity physical activity per day for a total of 150-300 minutes per week. Moderate physical activity indicates approximately 40-60% of an individual’s heart rate reserve, or approximately 5-6/10 of perceived physical exertion. This can be performed in shorter bouts of 10 minutes at a time. Alternatively, at least 20-30 minutes of more vigorous activity may be performed each day for a total of 75-100 minutes/week at 60-90% of HRR. This may also consist of an equivalent combination of moderate to vigorous activity¹.

This may be performed in a variety of ways, and to see the most success, should pertain to the individual’s interests. For example, walking, biking, and aquatic exercises offer great opportunities to meet these guidelines and yield cardiovascular benefits without imposing excessive orthopedic stress.


While cardiovascular fitness is crucial, resistance training should not be overlooked and can counteract physiological changes related to aging, including help preserve muscle mass, strength, and bone density. Resistance training can also increase mobility, function and independence, which is extremely important to our older individuals. Increased strength and mobility will also help prevent falls which in turn can prevent serious medical complications such as fractures and increase quality of life⁸. Resistance training is beneficial for psychological wellbeing and can be tailored to the patient's skill level, meaning that each and every older adult is able to perform resistance training in some capacity and will likely benefit from it. The ACSM recommends older adults who have previously been sedentary begin at 50% of a 1 rep max and gradually increase load overtime¹. This can be applied to a variety of resistance training exercises, including squats, deadlifts, overhead presses, and other movements specific that promote functional independence.



As physical therapists and physical therapy students, we have a role in effectively prescribing safe levels of exercise to enhance quality of life and promote optimal health amongst all populations. The ACSM outlines useful criteria and parameters of rexercise. Prior to beginning a new exercise regimen, we play a crucial role in screening for risk factors. This includes taking patient vitals regularly, implementing an orthopedic screen, movement assessment, and monitoring use of medication.


Furthermore, providing patient education on both the importance and benefits of regular exercise should be provided in order to help promote adherence and address potential barriers. We may also encourage and provide resources for group exercise classes, which may provide increased social support and encouragement to support long term success.




  1. United States Census Bureau. Stats for Stories: National Senior Citizens Day: August

21, 2020. https://www.census.gov/newsroom/stories/senior-citizens-day.html. Accessed June 1, 2021.

  1. American College of Sports Medicine. Chodzko-Zajko WJ, Proctor DN et al. American

College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009 Jul;41(7):1510–30.

  1. Zaleski AL, Taylor BA, Panza GA, et al. Coming of Age: Considerations in the

Prescription of Exercise for Older Adults. Methodist Debakey Cardiovasc J. 2016;12(2):98-104. doi:10.14797/mdcj-12-2-98.

  1. Barnes PM, Schoenborn CA. Trends in adults receiving a recommendation for

exercise or other physical activity from a physician or other health professional. NCHS Data Brief. 2012;(86):1–8.

  1. Centers for Disease Control and Prevention (CDC). Benefits of Physical Activity

https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Page last reviewed April 5, 2021. Accessed June 1, 2021.

  1. U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines

for Americans, 2nd edition. Retrieved from https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf

  1. Vigorito C, Giallauria F. Effects of exercise on cardiovascular performance in the

elderly. Front Physiol. 2014;5:51

  1. 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(8):2019-2052.


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