An ounce of prevention: intensive resistance training to optimize health in pre-frail older adults

This new strength training program can help prevent future frailty. Furthermore, the results from this study will also help develop future research to examine if higher-intensity strength programs can be used with older Canadians living with frailty to improve their health and function, reduce the need for institutionalized care and lower healthcare costs.

About the Project

Our population is aging, and while many older Canadians live healthy and active lifestyles, many others grow weaker, move slower and become less and less active over time. These are signs of frailty, which can lead to difficulty with everyday tasks, higher risk for falls and fractures, or need for institutionalized care or hospitalizations. One way to prevent frailty in older adults is to participate in regular exercise. In particular, strengthening exercises can improve muscle strength and bone strength, walking ability and balance, which contribute to better health and function.

We aimed to test the safety and feasibility of a new, higher-intensity strength training program in pre-frail older adults. Higher-intensity training has led to greater improvements in strength in athletes and younger adults, but has not yet been studied in older adults. We also compared the impact of this higher-intensity program on walking ability, muscle and bone health, quality of life and health care usage to a more traditional lower-intensity program that is typically used with older adults.

Click here to read more about the project’s impact.

Project Team

Principal Investigators:

Ada Tang, PT, PhD, MSc — McMaster University

Christopher Gordon, PhD — McMaster University

Feng Xie, PhD, MSc — McMaster University


Jonathan Adachi, MD, FRCPC — McMaster University

Norma MacIntyre, PT, PhD — McMaster University

Stuart Phillips, PhD — McMaster University

Julie Richardson, PT, PhD — McMaster University

Knowledge Users and Partners:

Bonnie Campbell, Trainer — Crossfit Indestri

Alex Cibiri, Trainer — Element Crossfit

Stephanie McKean, Trainer — Crossfit Indestri

Project Contact: Ada Tang —

Rationale, Hypothesis, Objectives & Research Plan

Rationale: Higher-intensity strength training can lead to greater improvements in younger adults. We don’t know if it’s safe in older adults who are starting to show early signs of frailty, or effective in preventing future frailty.

Hypothesis: We believe that higher-intensity strength training will be safe for older adults with early signs of frailty, and effective in improving walking, balance, muscle and bone health, quality of life, and healthcare usage.

Objectives: This study will test the safety and effectiveness of a new, higher-intensity strength training program compared to more traditional lower-intensity training in pre-frail older adults.

Research plan: 38 volunteers, over age 65 and starting to show early signs of frailty, will be randomly assigned to participate in 12 weeks of higher-intensity or lower-intensity strength training. We will track class attendance and safety, and compare improvements in mobility, health, quality of life and healthcare usage.

Communication to Patients & Family

Lay Title: An Ounce of Prevention: Learning which Exercise is best for People who are at Risk for becoming Frail

Key Findings:

  • A 12-week strengthening program can improve walking and mobility to help you do tasks you need to do and activities you enjoy
  • The exercise program can be higher weights, fewer repetitions (higher-intensity) or lower weight, more repetitions (lower-intensity) but the exercise program needs to be progressed.
  • Beginning an exercise program before a person becomes frail can help to prevent frailty, and improve the health

Why was this study was needed?

Many exercise studies involve individuals once they are already frail. It is important to also examine how exercise may help people who are pre-frail, or at-risk for developing frailty, to determine what the ideal exercise program.  Our study compared two strengthening programs in pre-frail older adults with the aim of improving health, function, and to preventing transitions into frailty.

Suggestions on how these findings could impact frail older adults and/or their family caregivers and how this might be measured:

  • This study showed that strength training, at both moderate or high intensity, improved walking and other functional tasks around the house like going up stairs. Therefore, we may be able to offer exercise at different intensities and see similar improvements.
  • For people at risk for developing frailty, starting an exercise program as early as possible may help improve strength needed to keep them safe at home and prevent future frailty.

Brief comment on type of study in lay terms:

  • Participants had equal opportunity of being in either exercise program to compare a higher-intensity and a lower-intensity exercise program for people who were at risk for developing frailty
  • Exercise programs were offered twice per week for 12 weeks at a local community gym and were led by a kinesiologist.
  • Older adults in both groups improved in walking, muscle strength and balance. There were no changes in fear of falling, bone mineral density or muscle size in either group.
  • Older adults in the high-intensity group reported less difficulty with community tasks such as walking a flight of stairs after the exercise program.
Communication to Policy

Lay Title: An Ounce of Prevention: Learning which Exercise is best for People who are at Risk for becoming Frail

Key Findings:

  • This study established the safety and feasibility of higher-intensity and lower-intensity progressive resistance training for persons who were pre-frail.
  • Individuals in both groups showed significant improvements in walking ability, functional strength and balance.
  • These positive benefits seen through preventative exercise programs may be a method of preventing future frailty and reduce the burden on the healthcare system.

Why was this study was needed?

It is important to determine ways to prevent transitions into frailty, optimize physical function and ability in older age, and keep Canadians in their homes for longer. This study explored how resistance training can improve physical outcomes for Canadians with pre-frailty to prevent transitions into frailty and decrease burden on the healthcare system.

Suggestions on how administrators or policy maker could use the findings:

  • Exploring the implementation of policies in preventative healthcare strategies is a necessary step to circumvent the increases in healthcare expenditure that may occur as a result of the aging Canadian population.
  • Strength training has the capacity to prevent functional strength losses in older Canadians that may translate into increased independence and keeping Canadians in their homes for longer.
  • Exercise programs, if able to prevent transitions to frailty that cost the healthcare system, are easily implemented and have the potential to reduce healthcare expenditure in the long-term for older Canadians.

 Brief comment on type of study in lay terms:

  • The objectives of this study were to: 1) establish the safety and feasibility of a higher-intensity resistance training program in community-dwelling older adults with pre-frailty, and 2) compare its effects on walking ability, muscular strength, balance, timed-up-and-go and sarcopenia-related outcomes with conventional lower-intensity exercise.
  • Pre-frailty was defined as the presence of one or two of the following: muscular weakness, physical inactivity, self-reported exhaustion or lethargy, unexpected weight loss, and slow gait speed.
  • The 12-week exercise program took place in local community gyms in Mississauga, Ontario and Collingwood, Ontario. Both groups performed upper and lower body exercises. The higher-intensity group performed three sets of 3-5 repetitions of complex multi-joint exercises, such as squats and step ups. The lower-intensity group performed three sets of 10-15 repetitions of single joint isolation exercises, such as bicep curls and knee extensions.
  • This study demonstrates that older adults at-risk for the development of frailty can safely and effectively participate in a higher-intensity resistance training exercise program and improve their physical function.

Figure 1. The methods at which strength training can improve or potentially prevent the physical characteristics of frailty.