As We Age We MUST Continue to Lift Heavy Weights - The WHY.

I work with a lot of 50+ year old clients/athletes.  Some, by definition, would call this the 'aged population'.  The hardest part for me writing that is that I turned 50 this year. And I don't feel 'aged'. In fact my passion for healthy movement and longevity has only but increased.

However, as a clinician that treats clients all the way up to 80+, there is a distinct pattern that presents itself when asking the client to move/lift weight.  Especially 'heavy' weight ('heavy' being a personal definition for the client). Fear. Lack of confidence. Trepidation even.

So when researching a piece I had to do for Newstalk ZB a few weeks ago, I went down a rabbit hole of what the evidence says about the 'aged population*' lifting weights.  And the results were remarkable for a number of reasons.

*this also applies the 'younger' lifter.  The focus on this Blog is to breakdown barriers to heavy lifting particularly in the older person.

Some Definitions:

You may have a 5kg hand weight, and struggle to do an overhead shoulder press.  Sure, this feels heavy to you, but under the definition of the term 'heavy lifting' it probably isn't.  And as you'll see below, the evidence strongly suggests you need to know what your heavy is.

1RM: 1 repetition maximum.  The absolute limit if what you can lift in a specific sense: back squat, deadlift etc.  ONCE. (eg: 50kg back squat)

Heavy Lifting: once it is determined what your 1RM is, then lifting around 80%+ of that is determined as being Heavy Lifting. (80% of 50kg is 40kg. Anything above 40kg would be regarded as a 'heavy squat')

Rating of Perceived Exertion (RPE):  is a tool used to monitor the perceptual response to training, which has been well established as a method of determining exertion during exercise (typically on a scale of 1-10 (1: little to no effort, 10: maximum effort))

Repetitions in Reserve (RIR): if you were asked to do a set of 8 deadlifts, your RIR would be the number more you could do get to failure (the maximum number of completed repetitions).  So if you did a back squat set of 8 with 2RIR, then 10 should be your max.

You could say that RPE and RIR are almost the same thing.  And yes, that's correct.  However Hackett et al (1) identified that RPE is more accurate at predicting perceived effort when the rating is 1-4, and RIR more accurate 5-10. Sounds a little confusing? Since we're looking at getting clients to lift heavy, and we need to mitigate risk in determining what the correct loading is, it is more accurate for the client to use the RIR scale (ie: "I' have 2 squats left in me" vs saying "I have an RPE of 8").

The Research:

So what are we trying to achieve here? Some LOVE lifting heavy. Some really don't. But if we're looking for a specific reason why we MUST get the aging population to lift, here are some VERY compelling reasons:

Sarcopenia:

Def'n: the loss of skeletal muscle mass and strength as a result of ageing. Also as a result of immobility.

In all the studies listed, there was one thing they all did: they had trainers/clinicians on hand to educate the clients on good lifting mechanics and to determine what their lifting limits were. 

That being said, as shown below, in order to build strength, there is a specific rep count, and RPE we need to be within.  The secondary gain when improving strength (vs hypertrophy (muscle growth, which is also desirable)) is improved neural efficiency.  This will reduced the likelihood of falls and associated disability.

So what are the key principles in building strength for the sarcopenia patient:

• Progressive Overload: the training stimulus must disrupt homeostasis to cause an adaptation. So over time you must continue to increase your loads
• Specificity and individualization: all exercisers are different based on training experience and genetics (even in the same age range).
• Periodization: training load (e.g., intensity, volume) must vary over the time to avoid accommodation. (3.)

So with confidence, we want the client to train with a low rep count and high RPE/low RIR. Initially I would start the client off in a higher rep count, and low RPE/high RIR situation to bed in confidence and technique.  As mentioned below, if you're diarising the sessions this can be managed quite easily. 

Potential issues here: supervised training, the learning path to movement and managing DOMS (delayed onset muscle soreness due to heavy lifting (this is not a bad thing, but it can take the untrained lifter by surprise)) can be something to be prepared for. 

 SOURCE: Application of the Repetitions in Reserve-Based Rating of Perceived Exertion Scale for Resistance Training (Helms et al, 2016)

Maybe though, before you get to the point of age-related muscle loss, start lifting younger.  Make it part of your weekly plan.  Understand the tenets of goal setting and break some down so as to make this a lifelong passions, vs a catch up plan. 

Osteoperosis:

Heavy resistance training significantly improves bone health in the elderly, providing a potent, non-pharmacological way to mitigate osteoporosis and the associated risk for fractures. Lifting weights stimulates osteoblasts, the cells responsible for bone formation, which adapt by reinforcing the bone's structure to handle increased stress. Heterogeneous loading (different types of resistance activities) and high-impact weight-bearing exercises are particularly useful in increasing bone mineral density, even in later stages of life. 

In 2019 Watson et al (4.) performed a randomised trial of over 100 post-menopausal women suffering from osteoporosis, and put them through the LIFTMOR programme.

"Participants allocated to the intervention group participated in an 8-month, twice-weekly, 30-minute, supervised program. To ensure safe transition to high-intensity exercise, the first month of the intervention comprised body weight and low-load exercise variants, with a focus on progressively learning the movement patterns of the HiRIT exercises. All participants were able to perform the 4 fundamental exercises of the intervention within 2 months Resistance exercises (deadlift, overhead press, and back squat) were performed for the remainder of the intervention period in 5 sets of 5 repetitions, maintaining an intensity of >80% to 85% 1 RM."  

The control group "undertook an 8-month, twice-weekly, 30-minute, home-based, low-intensity (10 to 15 repetitions at <60% 1 RM) exercise program designed to improve balance and mobility but provide minimal stimulus to bone."

RESULTS: on average, bone density increased in the lumbar spine and neck of femur of the intervention group.  They also gained some vertical height.  These changes were not seen in the control group, in fact their bone density continued to decrease.

Plus:

.....studies have shown very positive effects on depression levels, gait speed, grip strength, glycemic regulation and anti-inflammatory actions. If performed in a gym environment, there is also the very powerful community effect.

In my reading, unless there are underlying contraindications to resistance training in the aged population, there appear to be zero negative associations.  

The How:

So this is where it starts to get a little tricky.  We're coming full circle to provide a solution to reduce 'fear' etc and to create a safe strategy that can be employed to reduce the likelihood of injury when determining what sort of weight you should be lifting to stay within that +/-80% mark.

Firstly, if you're thinking about getting into a heavy lifting programme, then consult your Dr/lead health practitioner to ensure it is appropriate for you/no underlying issues to have to contend with.

Once that box is ticked, I strongly recommend getting professional guidance on technique and to ensure you're lifting the correct weight.  What's important, particularly if you're new to lifting, is that you take your time here.  If you're coming from a background of lifting, then this process won't take as long.  

So:

DON'T: just rip into a heavy lifting programme.  As in the studies above, the participants spent +/- 2 months learning correct technique and building capacity.

DO: document your progress.  Make notes on the loading and rep count.  Be consistent and be kind to yourself. 

When you're ready to start pushing the loading (as above, after a couple of months of prep work) build in the 1-2RIR system.  Just back squatted and had an RIR of 3?  You weight is too low.  Got to failure?  Loading is too high. 

My Recommendation:

Get the basics right, and don't over complicate things.  But mostly: make it FUN.  

Get your deadlift, back squat, overhead press and jump chin-up dialled in.  There are always ways to regress if you're struggling, but progress where possible.  If you're wanting to lose some weight with this programme, then integrate some whole body/multi-joint movements and have the rep count higher: 8-12.

And don't forget to recover: this is when your tissues will adapt and you'll get strong.  More is not more.  Less can be more!

Don't undervalue the benefits of walking, swimming etc.  

Be Active. For Life.

REFERENCES: 

1: Hackett DA, Johnson NA, Halaki M, Chow CM. A novel scale to assess resistance-exercise effort. J Sports Sci 30: 1405–1413, 2012

2: Helms ER, Cronin J, Storey A, Zourdos M. Application of the Repetitions in Reserve-Based Rating of Perceived Exertion Scale for Resistance Training. J Strength Cond 38(4) 42-49, 2016

3: Cannataro R, Cione E, Bonilla DA, Cerullo G, Angelini F, D'Antona G. Strength training in elderly: An useful tool against sarcopenia. Front Sports Act Living. 2022 Jul 18;4:950949. doi: 10.3389/fspor.2022.950949. PMID: 35924210; PMCID: PMC9339797.

4: Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. 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. J Bone Miner Res. 2018 Feb;33(2):211-220. doi: 10.1002/jbmr.3284. Epub 2017 Oct 4. Erratum in: J Bone Miner Res. 2019 Mar;34(3):572. PMID: 28975661.