4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging

It’s one of those cliches that is true: exercise really is very good for your health.

In fact, one expert in applied longevity wrote that:

“Exercise is by far the most potent longevity ‘drug’. No other intervention does nearly as much to prolong our life span and preserve our cognitive and physical function.” — Peter Attia, MD, in his book “Outlive.” (Note: the emphasis there is mine.)

If you’re an older adult: are you exercising regularly? And if so, are you doing enough of the “right” kinds of exercises?

People are often quite interested in “balance exercises for seniors,” especially if they’ve become concerned about preventing falls. Those are great, but there’s really much more to know and do, when it comes to exercise and aging.

Since exercise is such an essential activity that most older adults are under-using, in this article, I’ll explain what’s most important to know about exercising in later life, including what types of exercise to do.

Specifically, I’ll cover:

The benefits of exercising in aging
What to know about walking for exercise
Four types of exercise to make sure you do
Why balance exercises and strength are key to mobility and preventing falls
Protein intake and strength-building
The risks of exercise in aging and what to ask your doctors
How to avoid getting injured

The benefits of exercising in aging

Whereas “physical activity” means anything that moves the body, the term “exercise” generally means some form of structured physical activity that is done with the intention of exerting oneself or physically challenging oneself, for health reasons (or to enjoy oneself).

Obviously, there are lots and lots of activities that can qualify as exercise. In general, they should be at least a bit more challenging than one’s usual practical activities. (So for instance, if you usually walk around your neighborhood, that might not really count as exercise for you…unless you intentionally walk fast, or walk up hills.)

Countless research studies have confirmed that exercise provides health benefits, including:

Lower risk of cardiovascular disease
Lower risk of diabetes, high cholesterol, and other forms of metabolic dysfunction
Improved cognition and decreased risk of Alzheimer’s disease
Reduction in symptoms of anxiety and depression
Improved sleep
Improved bone health
Lower risk of falls
Improved physical function

In short, exercise often helps people feel better in the shorter term, and also is good at reducing the risk of the most common health problems that affect older adults.

Most longevity experts believe that although both exercise and nutrition are important, the effect of exercise can be much stronger than the effect of diet and/or supplements.

(That said: you can’t out-exercise a truly lousy diet, such as one based on junk food.)

As a geriatrician, I find that exercise can be especially helpful when it comes to older adults maintaining mobility and preventing falls. These are crucial for maintaining independence as we age, and are often key to being able to age in place.

The right kind of exercise can also stave off muscle loss and frailty (more on that below).

What to know about walking for exercise

When I ask older adults if they exercise, they often tell me that they walk a lot. (And for many of them, that seems to be just about it, for exercise.)

Now, walking is a wonderful wonderful activity to engage in. It gets one out and about in the world, it certainly counts as physical activity, and it helps one maintain the ability to walk.

That said, in most cases, unless you are really exerting yourself while walking, it does not count as exercise.

By this, I mean that it doesn’t build up your strength (and trust me, if you aren’t proactive about strength in aging, you will be losing it every year), nor does it build up cardiovascular capacity, or really improve your balance.

So when it comes to exercise: walking is not enough.

Instead, look to do additional activities that will challenge your body through the four types of exercise all older adults should engage in.

Four types of exercise every older adult should be doing

Any exercise is better than no exercise. But to really benefit from exercise, all older adults should make sure to regularly engage in the following four types of exercise.

1.Strength training exercises (also known as resistance exercises)

These are exercises that challenge muscle strength, to help a person maintain and increase muscle power. These exercises often including lifting weights, although that’s not always necessary.

To strengthen muscles, the exercises need to get more challenging over time. The ideal weight (or body weight exercise) can be done 8-10 times before needing to take a break; if a person can do up to 15 repetitions of the movement, then it’s time to increase the weight.

Strength training should take place at least twice a week.

Older adults should try to work their upper body, their core, and their lower body; you need all of these parts to be strong enough, to continue to do basic tasks such as carrying groceries and navigating stairs as you age.

2. Aerobic exercises (also known as endurance exercises or “cardio”)

Aerobic exercises are the ones that make you distinctly short of breath while you do them. This gives your heart and lungs a workout, and improves the body’s ability to use oxygen.

Common examples include swimming, water aerobics, and bicycling. Brisk walking or walking up hills also counts. Gyms usually include machines for aerobic exercise, such as treadmills and stationary bicycles.

Guidelines from the American Heart Association recommend a minimum of 150 minutes per week of moderate intensity aerobic activity, or 60 minutes per week of vigorous activity.

However: research suggests that even “less-than-recommended” amounts of exercise are associated with reduced mortality. So, less exercise is better than no exercise!

Also, if you are older and just starting out, it’s good to start with a very modest amount of exercise, and then slowly work your way up to recommended amounts over time.

(To determine whether an effort is moderate intensity or vigorous: moderate is usually considered a 5-6 out of ten, on a scale of perceived effort, whereas vigorous should feel like an 8 out of ten. Another rule of thumb is that you should be able to carry on a conversation during moderate activity but not really during vigorous activity.)

3. Balance exercises

Balance exercises are the ones that challenge your balance more than daily life activities do.

Maintaining balance usually requires the strength of stabilizing muscles in your body’s core, plus the participation of your brain and nerves to coordinate your senses and your movements.

These skills in the muscles and brain improve when you regularly challenge your balance.

There are a variety of exercises that specifically challenge balance and can help you develop better balance, such as walking heel-to-toe.

There are also athletic and recreational activities that tend to challenge balance, such as tai chi, yoga, and social dancing.

4. Flexibility exercises

Flexibility exercises help your muscles and joints move through a fuller range of motion, to help maintain (or improve) their available range. They usually look like some form of stretching.

Without flexibility exercises (or activities that put joints through their full range of motion), range of motion tends to constrict over time.

To safely stretch, first warm up the body through aerobic exercise or strengthening exercises. Then you can slowly stretch into a position and try to hold the stretch for 30 seconds. Be sure to breathe normally and avoid bouncing into the stretch. You should feel a little bit of a pull, but not actual pain.

(Note: it’s not clear that a lot of static stretching before vigorous activity is a good idea; studies suggest that stretching after the activity is less likely to lead to injury. To warm up for vigorous activity, it’s probably better to jog or otherwise do some mild-moderate activity that gets the blood moving and the muscles warmed up.)

Some forms of exercise, such as yoga and certain types of dance, naturally incorporate a fair amount of stretching. Aim to stretch or do some form of flexibility exercise at least twice a week. Your goal should be to stretch all your major muscle and tendon groups, including the neck, the shoulders, the trunk and lower back, the hips, and the legs.

Flexibility exercises are often overlooked, as people may not think flexibility is important. However, maintaining adequate flexibility is key for common life tasks such as putting on your shoes or picking something up off the floor.

Combining these four types of exercise in an exercise plan

An exercise plan usually lays out a weekly plan for exercise. The best ones provide specifics on which exercise will be done and how (e.g. for how long, where).

It’s also good to have a plan for slowly increasing the amount of exercise over time, especially when it comes to sedentary older adults who often have to “start low and go slow.”

It can be very helpful to work with a professional to create an exercise plan. If you have chronic health conditions, ask your health professionals to advise you on creating an initial exercise plan.

Why balance exercises and strength are key to mobility and preventing falls

All four types of exercise are valuable for older adults. But when it comes to maintaining independence and preventing falls, there are two types that are especially important: balance and strength.

Just think about it: older adults often start to seem visibly frail when their physical movements become more tentative, or when they seem to easily lose their balance.

The truth is that most of us take for granted the balance and strength abilities we have in midlife. It’s also hard to imagine not having these abilities as we age.

However, the nature of aging is that if you aren’t proactive about maintaining muscle strength and balance, these abilities will slowly dwindle over the years.

I really cannot overstate this. It’s not enough to adopt “use it or lose it”, because normal daily life use of our muscles is not enough to counter the way our muscles naturally tend to weaken with age. Instead, to maintain the abilities you had in your fifties and sixties, you will need to be intentional about maintaining strength and balance.

Furthermore, older adults often experience a big drop in strength if they are hospitalized after a fall or a health crisis; starting off with more strength makes it easier to recover back to levels needed to confidently walk and participate in daily activities.

Protein intake and strength-building

Here’s another thing to know if you want to build and maintain strength in aging: be sure to eat enough protein.

This is important because your body needs protein in order to actually make your muscles bigger and stronger.

Research suggests that the combination of increased protein intake plus strength-building exercises can help older adults avoid sarcopenia and frailty.

(Note: It’s not clear that simply increasing protein intake is helpful; you almost certainly need to combine it with resistance exercises.)

Now, how much protein is enough, or is optimal? Most experts in aging agree that older adults should consume more than the current recommended daily allowance (0.8 grams of protein/kg body weight/day, which means 0.36 grams per pound), with many suggesting 1-1.5 grams/kg/day.

I think it’s reasonable to aim for 1.3 grams/kg/day, which means 0.6 grams/pound/day.  (So if you weigh 150 pounds, aim for 88.5 grams per day.) You should aim to eat this protein throughout the day (e.g. 25-30 grams at every meal), because the body cannot absorb very large quantities of protein in a single meal.

Now, to reach this level of protein intake, most older adults will need to be intentional, and make sure they are taking in a good amount of protein at every meal. It can help to supplement with whey protein (often used in research studies). Animal protein is usually more easily absorbed than plant protein.

Note: People with  kidney disease may need to be careful about protein intake; check with your doctor before significantly increasing your protein intake.

The risks of exercise in aging and what to ask your doctors

For most older adults, the risks of exercising fall into these categories:

Risk of injury due to muscle or joint overuse. Examples include injuring a joint (such as a shoulder or a knee) or a muscle, through doing a certain type of physical activity.
Risk of injury related to falling. Most falls result in scrapes and bruised egos, but some falls can cause musculoskeletal injuries, bone fractures or even head injuries. Women with osteoporosis are at particular risk of fractures after a fall.
Risk of cardiovascular strain. By definition, aerobic exercise requires your heart and lungs to work harder than usual. Especially in people with pre-existing cardiovascular disease, this can sometimes cause angina or other symptoms of cardiovascular strain. Examples include developing chest pain or light-headedness with exertion.

These risks are all real. However, they shouldn’t keep you from exercising, because in most cases, these risks can be kept manageable and it should be possible to come up with an exercise plan that is reasonably safe.

To manage these risks, before starting or significantly changing your exercise routine, be sure to talk to your doctors to find out what kinds of exercise might be suitable for you, and what kinds of precautions to take.

Older adults with a history of heart or lung problems might benefit from cardiac rehabilitation or pulmonary rehabilitation.

Your doctors can also help you determine whether to see physical therapy before pursuing a more substantial exercise program.

How to avoid getting injured

By far the most common risk of exercising is getting injured, especially when first starting out.

Here are five ways to reduce the risk of getting injured.

1. Start with a small and consistent effort, then increase the intensity slowly.

Especially if you are new to exercising, or if you are starting a new type of exercise: keep the physical challenge small at first. Your motto should be: start low, and go slow.

For strength training, this might mean very little weight at first, and perhaps even starting with fewer repetitions.

For aerobic exercise, this might mean starting with a shorter amount of time exercising, and keeping the intensity moderate (rather than vigorous).

Starting small makes it more likely that your body will be able to adjust to the challenge of exercise, without actually getting injured.

2. Give yourself rest days.

This is especially helpful for strength training, but can help with other forms of exercise.

Especially when you are starting out, avoid doing a certain type of exercise every day, and instead do it every other day (or even twice a week). This will give your body a chance to rest and recover.

3. Listen to your body and stop if something is hurting.

It’s normal for exercise to make you uncomfortable, or to feel like an effort. But if you are feeling pain as you exercise, don’t “push through.”

Instead, stop the exercise and let your body rest. If you feel the pain again when you exercise, seek help from a professional, to check for injury and to advise on how to modify your exercise routine.

4. Work with a personal fitness trainer if you can afford it.

If it’s financially feasible, consider working with a personal fitness trainer who has experience with older adults. This can be especially helpful when you are just starting out.

A good trainer will be able to coach you through how to safely and correctly do your exercises. They will also be able to create an exercise program that is suitable for your level of fitness, and that can work around any previous injuries or limitations.

A trainer (or even group class leader) who is approximately your age is much more likely to have a good understanding of what kinds of precautions and modifications can help you avoid injury as you ramp up your exercise abilities. Younger trainers can be good as well, but make sure they have a lot of experience working with people like you.

5. Avoid untreated osteoporosis.

Many older adults (especially women) have untreated osteoporosis. This means that if they fall, it can be relatively easy to break a bone.

You can reduce your risk of a fracture injury by making sure you get screened for osteoporosis if you are a woman. Expert guidelines recommend treating osteoporosis with a combination of lifestyle changes and pharmacological therapy. Bisphosphonate drugs are usually considered as first-line therapy. These drugs have been associated with rare serious side-effects, which has left some people with osteoporosis reluctant to take them. However, research indicates that for most people with osteoporosis, the likely benefit of pharmacologically treating osteoporosis outweighs the risk of harm.

If you do get injured

If you do get injured while exercising, be sure to seek help from your healthcare providers. Physical therapy can often help with recovering from an injury.

Special situations in geriatrics

Ok, I have shared what I believe is most important for all older adults to know and do regarding exercise.

Here are a few additional situations that come up in geriatrics:

1.Advanced age and/or frailty

On average, there is a big difference physiologically between people who are 70 and people who are 90.

As people get much older, they do still benefit from exercise, especially as a way to help them maintain mobility and independence. However, with advanced age, it becomes even more important to be careful and not overly tax the body. For this reason, it can be a good idea to start exercise under supervision of physical therapy.

I am also a fan of attempting to get the person to do “just a little more exercise” rather than trying to sign them up for a comprehensive program that might overwhelm them or feel like a burden to their quality of life.

And it’s always a good idea to focus on forms of exercise that the person is likely to enjoy.

2. Cognitive impairment, Alzheimer’s, and other forms of dementia

There certainly is a lot of research suggesting that regular exercise can help stabilize cognitive impairment. Exercise often helps people with Alzheimer’s and other forms of dementia feel and function better, so I consider it an important part of a dementia care routine.

The problem is that families often find that it can be quite challenging to get a person with dementia to exercise. This can happen because the person with dementia has lost motivation, or keeps forgetting to exercise. In other cases, the person with dementia is resisting doing the exercise.

If you are facing this situation, here are a few suggestions:

Start by exploring what are the current obstacles to exercise.

If those include active resistance, be sure to explore the perspective and priorities of the person with dementia.

Then, brainstorm options to work around the obstacles. These might include:

Providing a family member or companion to initiate and do the exercise with the person.
Focusing on exercises that are more feasible or enjoyable.

In general, people with dementia often need a companion to cue them and also provide a lot of positive encouragement during exercise.

It helps for the exercise to be part of a predictable routine. Many people also enjoy exercise activities that are part of a group. However, they may still need the attention of a companion while they are in the group.

You can look for exercise classes that are designed for people with cognitive impairment. Check with your local Alzheimer’s Association or dementia caregiving group for ideas.

3. Trying to get your spouse or aging parent to exercise.

I get asked about this a LOT, often by concerned family members who are trying to keep an older loved one from losing mobility and independence.

Or, they may be urging their loved one to exercise to keep chronic health conditions under control, or in hopes of stabilizing cognitive decline. Obviously, there is a long list of reasons that we might very legitimately feel our older loved one would benefit from exercising.

If this is you, here’s what to know:

It’s fine to encourage exercise. But it’s usually counter-productive to insist, or provide a lot of pressure.

What’s better: be curious and explore your loved one’s perspective, when it comes to exercise. Help them feel heard and understood.

Older adults who have decisional capacity get to decide how to manage their life and health.

It is frustrating to see someone not choosing to do something that is good for them, but sometimes we have to accept this.

Exercise is great, but especially as people get much older, pushing someone to exercise is not a viable way to head off most of the hard situations that families are worrying about.

It will not keep a person with Alzheimer’s from continuing to slowly decline.
It’s not likely to enable an older person to live independently in their own home with no assistance until they die.

In short, I think it’s fine to encourage exercise, but pushing really hard for this is usually not the best use of a family member’s time and energy. There are usually much better ways to direct your time and energy if you are a family caregiver, or in a position of being concerned for an older loved one.

Key points on exercise and aging

In short: exercise doesn’t solve all aging problems. But it IS really important, when it comes to maintaining independence as we age, so I hope this article will inspire you to make sure you are getting enough exercise.

Remember: The nature of aging is that we lose strength and muscle mass as we age, unless we are proactive about maintaining that strength. So don’t wait until you feel older and frailer; exercise works better when you start it earlier in life. But it’s also never too late to start: better late than never.

Walking is great but it is NOT enough to maintain strength as we age.

And you actually need to maintain your strength, in order to do things like continue to navigate stairs and carry groceries with ease.

To maintain your abilities as you age, try to do these four types of exercise:

Strength training

Aim for at least 2x/week

Aerobic exercise that works your heart and lungs more than usual

Aim for 150 minutes/week of moderate aerobic exercise or 60 minutes/week of vigorous aerobic exercise

Balance exercises

These challenge your core muscles to keep you stable and your brain to coordinate your balance

Flexibility exercises

These move your muscles and joints through a fuller range of motion

When possible, look for exercise activities that are fun and provide multiple benefits. Yoga and tai chi challenge balance and also are good for mindfulness, whereas social dancing will work your balance while providing social engagement.

To prevent falls and maintain mobility, strength training and balance exercises are especially important. 

You can also maintain muscle strength as you age by combining adequate protein intake with your strength training. Unless you have significant kidney disease, it’s good to aim for 1.3 grams/kg/day (0.6 grams/pound/day), spread out over 3-4 meals.

Avoid injuries by starting small and being consistent when you first start to exercise. Especially if you have any chronic health conditions, it’s safest to check with your health provider before starting an exercise program.

If you are signing up for a class or program, look for one that is designed for people your age. (I find it’s very helpful when the instructor is at about the same age as you are; they will be familiar with common risks and injuries for your age group.)

It’s normal for exercise to be uncomfortable but it shouldn’t hurt; if you are experiencing pain, definitely check with your doctor.

Last but not least: it’s never too late to start or increase one’s exercise! For sedentary older adults, even small increases in daily steps walked can help.

Good luck with your exercising!

Do you have questions, feedback, or suggestions? We’d love to hear from you!

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