Just the words “high intensity interval training” are probably enough to make some of you sweat, am I right? It sounds hard, and maybe even unnecessary. Additionally, if you’re already doing strength training, focusing on weightbearing exercises, why should you consider high intensity exercise? If it ain’t broke, don’t fix it, right?
Well, it may be that the current resistance training you are doing isn’t quite enough.
It’s generally accepted that weightbearing exercises should be done in order to increase strength and bone mineral density (for more information on bone loss with age, see this article.)
Weightbearing exercise important for all populations, but particularly important for older adults, as muscle mass and strength, and bone density all decrease as a natural part of aging.
However, current research indicates that the effectiveness of this type of exercise results in only “modest” results.
Is this type of exercise really needed then, if the results are only found to be “modest”? Furthermore, how are “modest” results helping those with osteopenia and osteoporosis?
Current recommendations for resistance training for older adults with osteoporosis is as follows: Moderate-intensity exercise (70-80% of 1 repetition maximum) for individual muscle groups.
While it is good to at least meet this recommendation, current research is finding that more needs to be done in order to stimulate bone growth.1
This article will discuss the potential benefits and risks of high intensity exercise. Specifically, interval training for older adults, using findings from a study performed on older adult females with osteopenia or osteoporosis.
I highly recommend reading this article and implementing the strategies within it (under the direction of your care provider, of course) whether you have low bone density or not. While the study focused on those with bone density conditions, most older adults have decreased bone density and would benefit from ensuring their workout routine focuses on building muscle and bone strength through high intensity exercise.
How Can You Improve Your Current Strength Training Routine?
“Large, multi-joint, coumpoud exercises, such as the squat and deadlift.”1
According to the study done by Watson and colleagues in 2018, including movements like the squat and deadlift increase recruitment of a multitude of muscles, and help with loading the bones and the hip and spine, which are common sites for fracture in older adults with low bone density.1
While these exercises may sound scary (particularly the “dead” lift) they are actually essential parts of functional movements we do every day- getting on and off the toilet, picking up the laundry basket, getting in and out of a chiar, lifting a grandchild from the floor, etc.
Arguably, these types of movements are essential to practice, train, and improve upon in order to boost functional strength and bone density.
What Does the Research Say?
Watson and colleagues completed a study in 2017 that is called the LIFTMOR study. LIFTMOR stands for Lifting Intervention for Training Muscle and Osteoporosis Rehab.
The study aimed to finid out if “brief, bone-targeted high-intensity, progressive resistance, and impact weight bearing training (HiRIT) would imporve bone mineral density in the lumbar spine (low back) and hip.”1
What that means in layman’s terms is the researchers wanted to know if older adults with osteoporosis and osteopenia could safely progress through a high intensity exercise program, and if that higher level of workload would lead to significant improvements in bone strength.
Here’s How the Study was Performed:
Participants included post-menopausal women, age 58 and older with low bone mass. Of the 101 particiipants, 44 were considered to have osteoporosis and 57 were classified as having osteopenia. Twenty-seven of them had expereinced an osteoporotis fracture within the last 10 years, 11 of which were due to a fall.
The participants were randomly assigned to one of two groups:
(1) The Lift Group: completed 30 minutes of supervised HiRIT, two times per week for 8 months
Lift Group workouts included 5 sets of 5 reps at >80 to 85% of 1 repetition maximum (1RM) of the following:
- Warm-up: 2 sets of deadlifts at 50%-70% 1RM
- Deadlifts
- Overhead press
- Back squat
- Impact loading- jumping chin ups
What’s important to note is that researchers had participants work their way up to these exercises! It was progressed for each individual, as appropriate, in terms of exercise type and how much weight was used.
(2) The Control Group: completed 30 minutes of low-intensity exercises at home, unsupervised, two times per week, for 8 months
Control group workouts included the following, low-load exercises:
- Warm-up: walking for 10 minutes
- Lunges
- Calf raises
- Standing forward raise
- Shrugs
- Stretches (neck, calf, shoulder, low back)
Participants in the Control Group progressed from body weight to a maximum of 3kg hand weights (about 6.6lbs)
What Did the Researchers Find?
Following the 8-month study, participants in the Lift Group were found to have superior improvements in bone mass and physical function, compared to the Control Group.
In the Lift Group, only 12% had a decrease in bone mineral density (BMD) in the low back, whereas 72% of those in the Control Group had a decline in low back BMD. For hip density, 22.9% of those in the Lift Group versus 63% of those in the Control Group experienced decreased density.
In addition to greater bone density, those in the Lift Group also showed significant improvements in leg extensor strength, back extensor strength, walking speed, vertical jump height, functional reach, and the sit-to-stand tests. These results indicate that the participants were not only stronger after high intensity interval training, but possibly had decreased fall risk as well.
Furthermore, those in the Lift Group was found to have significant improvements in height compared to those in the Control Group. Although this may seem like an odd result, the research team believes this is due to the increased in back extensor strength of those in the Lift Group. This increased strength likely helped improve overall posture.1
But Is High Intensity Exercise Really Safe for Seniors?
Yes, if done correctly!
A major takeaway from this study is that it was done with supervision, which is recommended when transitioning to a higher level of activity. As previously mentioned, movements like the squat and deadlift are done in our daily activities so you’re likely doing some form of them right now without supervision. When you’re training, however, you really want to focus on form to ensure safety, as well as progressing when appropriate, and a PT or trainer can help with that.
In the study discussed above, only one, minor adverse event occurred in the Lift Group over the course of 260,000 sessions.One participant incurred a mild, low back strain at week 28. This participant had to miss two training sessions, but then was able to return and complete the study.
In total, there were 7 falls throughout the course of the study- 5 in the Lift Group and 2 in the Control Group, none of which resulted in an injury.
No fractures or serious adverse events occurred in either group.
Common Concerns About Strength Training
(1) “I don’t want to do too much strength training, because I will bulk up.”
This is something I tend to hear from my female clients, however I can almost guarantee this will not happen. Even younger female clients aren’t likely to “bulk up” due to hormonal makeup. Even more so, as we age, we have decreased amounts of growth hormone, testosterone, and estrogen, all which help with muscle building and recovery.
Although the goal is to increase muscle mass, it won’t result in you looking “bulked up”.
(2) “I don’t want to increase my fall risk.”
Good. Me neither!
While fear of falling is a very understandable concern, the truth is, the less activity/exercise we do, the more likely we are to experience a fall. We need to build the strength and balance to prevent a fall, and strength training (including high intensity training) will enable us to achieve greater functional capacity and stability.
(3) “I’ll Get Sore.”
Yes, this one is likely true. However, this isn’t necessarily a bad thing!
It’s normal to experience some soreness following exercise. In fact, it means that your muscles are building!
What we want to avoid is so much soreness that you can’t function. That would indicate that the exercise does need to be adjusted, but that can be done, so don’t give up if you experience soreness!
Also, the best way to decrease soreness is actually to exercise! Getting blood flowing back into your muscles will help dissipate that soreness even quicker!
(4) “My back/knees/hands/anything & everything hurts, so I should wait to start weight training.”
This is most likely a false belief. Of course, clear activity with your doctor and PT, but it’s very likely that your current aches and pains can be helped or resolved with exercise.
Weight training in particular can allow for muscles to work more effectively and efficiently, which will provide your joints with better support, decreasing pain.
What Should You Do With This Information?
Start with assessing your current strength training program. I’m guessing it looks more like the Control Group protocol than the Lift Group. That’s not to say that type of exercise is bad, but I encourage you to seek out exercise that will give you more bang for your buck.
To do that, seek out a physical therapist (PT)! All states have what is called Direct Access for PTs. This means you can get an evaluation done without a referral. **Please note some clinics prefer you have a referral. Call and ask the PT clinic prior to scheduling an evaluation appointment**. The PT will help determine if you will benefit from PT services, or if it’s better to go see a trainer.
Either way, you must voice your desire to do high intensity exercise to promote strength, bone growth, and decreased fall risk! Show them this article, or the study listed below in the sources if they are unsure.
Sadly, many healthcare providers aren’t providing their senior clients with the higher level of activities. This is likely due to the providers’ fear of injury or falls. What you and providers should be more concerned about is not challenging your body enough! As shown in this article, it’s necessary to place higher demand on the body to get the desired results!
Check out this video of Dr. Katie demonstrating functional ways to perform the squat and deadlift. Remember to focus on form and check with a provider before starting any type of physical activity to ensure safety.
Have the Strength to Live Life to the Fullest!
Sources:
- Watson, S., Weeks, B., Weis, L., Harding, A., Horan, S. and Beck, B., 2017. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research, 33(2), pp.211-220.
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