Researchers seek to prevent frailty with strength training

It’s commonly accepted in our society that people become progressively weaker with age. On top of this, many people believe that attempting to become stronger by lifting or carrying increasingly heavy loads is particularly risky for older people and could lead to serious injury.

Two physiotherapists in Ontario have teamed up and secured funding from the Canadian Frailty Network (CFN) to challenge this perception. They aim to show not only that older people are perfectly capable of building strength safely, but that they can also prevent themselves from becoming frail—or more frail—in the process.

“We need to be proactive with people at risk of slipping into frailty,” says Dr. Ada Tang, a physiotherapist and associate professor in the School of Rehabilitation Sciences at McMaster University in Hamilton, Ontario. “If we intervene with well-designed strength training programs, we can help people who might otherwise become frail to maintain their mobility and independence. It’s much harder to bring someone back once they are already frail.”

I had never worked out before in my life… I felt overweight, low energy and uncomfortable in my body when I saw the ad for the strength training study…

The idea of preventing frailty by putting older people on strength training programs came to Dr. Tang from Christina Prevett, a community-based physiotherapist now located in Kingston, Ontario. Prevett had noticed, while working in a gym in Mississauga, that older people recovering from orthopedic surgery made great improvements in their mobility and pain if they stuck with their workouts and continually challenged themselves with ever-more intense workouts.

“There’s a great hesitation among physiotherapists and personal trainers to get older people lifting relatively heavy weights,” Prevett remarks. “But the body continually adapts and requires progressively more intense demands to become stronger at any age.”

Prevett approached Tang with the idea of launching a study of strength training in older people, to be the basis of her PhD thesis. Tang agreed to be her faculty supervisor and the two applied for funding from the CFN. They received a CFN Catalyst Grant in 2015 to design and conduct a feasibility study in the form of a randomized, controlled clinical trial of two distinct strength training programs in older adults. Half of the 34 participants were randomized to a conservative program using low weights and many repetitions of singe-joint exercises, such as biceps curls, and half were randomized to a more intense program using heavier weights in fewer repetitions of full-body exercises, such as push-ups and squats. Both programs ran for 12 weeks, with weight-training sessions three times a week at gyms in Mississauga and Collingwood.

“We saw a lot of improvement in both groups,” says Dr. Tang. “Everyone scored better in a wide range of strength, balance and mobility tests after taking part in the 12-week programs.”

These tests included standing with the eyes closed, picking up an object from the floor without losing balance, and shifting from sitting to standing.

None of the 34 participants sustained any injury due to the exercise program and, most surprisingly, not one of them dropped out.

Weight lifting story pic

“I had never worked out before in my life… I felt overweight, low energy and uncomfortable in my body when I saw the ad for the strength training study,” recalls McDonald, 68, who was assigned to the study’s conservative training program. “It was intimidating showing up at a gym, but the exercise program was so well calibrated to each individual, with a slow-enough progression that it was challenging but never too much. It really got me motivated and I’ve been going to the gym twice a week ever since, to do the new strength training programs they’ve started for older people.”

“Typically, 20 per cent of participants in clinical trials will drop out,” says Dr. Tang. “But people enjoyed the programs so much and felt so much better for taking part, they didn’t want to stop.”

In fact, participants were so keen, many carried on with strength training. Collingwood study participant Lorraine McDonald still goes to the gym there, where community-based study collaborator Bonnie Campbell—a personal trainer, former phys-ed teacher and physiotherapy assistant—has continued working with study participants and other older adults looking to improve their overall fitness and quality of life.

I want to reach physicians and physiotherapists with information about how important strength training is in preventing frailty, and provide physiotherapists and kinesiologists with a toolkit of resources they can use to work with older adults at risk of tipping into frailty.

Thanks to regular strength training, McDonald feels much more confident to ride a bicycle, ski, and go boating, much to the delight of her 81-year-old husband, Jim Dobson, a long-time gym goer, avid skier, golfer and all-round physical activity enthusiast.

“As a prime example, I fell off my bike recently and popped right back up, no problem,” she says. “I’m not concerned about aging anymore, I feel strong and full of energy.”

Study participants’ results—including a 90-year-old man who progressed from a 15-pound bar to lifting 50 pounds off the floor—inspired Prevett to launch a new company, Stave Off, dedicated to helping older people stave off frailty with progressively more challenging weight-bearing workouts. In addition to building her new company, she and Tang intend to continue their research.

“We will need to launch a larger study to involve more people and give more statistical strength to our results,” Prevett notes. “One of the things we really want to tease out is the differences between the more conservative and more intense styles of strength training.”

In the initial study, participants in the more intense program reported fewer mobility restrictions than participants in the more conservative program using lower weights, even though their scores on other tests were about the same.

“The main takeaway is that everyone benefitted from weight-bearing exercise, regardless of the style of program, and no one was injured,” notes Dr. Tang. “Now that we know this kind of study and program is feasible, we are applying for more funding from CFN and other agencies to dig more deeply into the effects of different styles of strength-training programs on older adults at risk of frailty.”

The researchers are not content to wait until they’ve completed their next study to begin talking to colleagues about their results.

“We want to move this knowledge into practice,” says Tang. “Beyond changing what I teach, I want to reach physicians and physiotherapists with information about how important strength training is in preventing frailty, and provide physiotherapists and kinesiologists with a toolkit of resources they can use to work with older adults at risk of tipping into frailty. We need to challenge how they approach care with their older clients… they can absolutely give clients the option to go with heavier loads.”

Prevett wants to throw a monkey wrench into an expected continuum of decline that typically goes from robust to pre-frail to frail with advancing age.

“Can we actually move people back on that continuum, from pre-frail to robust?” she asks. “Or at least keep them pre-frail longer, so they have more years of better health, mobility and independence? That’s the new territory we want to explore.”