Aging and Strength Training
Betty is a 73-year-old woman who has experienced a challenging couple of years. She was a caretaker for her aging mother and then began to experience some persistent health problems that resulted in multiple doctors’ visits and a few hospitalizations. Over time, Betty has found that she is extremely tired from activities that she used to do with ease like standing for 30 minutes to wash the dishes and lifting and carrying her groceries from her car to her house. Unfortunately, Betty has also started to notice an involuntary loss of urine when she gets up from a chair and with coughing and sneezing. She has become increasingly worried that she will become weaker over time until she isn’t able to do normal daily activities and will have to change her clothes multiple times per day to avoid smelling of urine.
Betty’s story is all too common for many aging adults. We humans are living longer than our ancestors. In fact, the world’s population over 60 years old will double from 11% to 22% by 2050.1 Unfortunately, many will experience a loss of functional ability leading to increased impairment and disability. As we age, there are changes within our body, such as an increase in body fat and a reduction in muscle mass and bone density. In fact, there is a 30-40% decrease in muscle mass between our 20s and 80s.1 Muscle mass loss can be further exacerbated by physical inactivity and poor nutrition.2 In fact, 10 days of bed rest can reduce lower leg strength, reduce aerobic ability by 12% and reduce physical activity by 7% in older adults.2
The good news is that it is possible to improve mobility after a period of inactivity! One of the strongest predictors of mobility, or movement, is muscle strength.1 Muscle strength can increase with resistance training over a long period of time in addition to appropriate protein intake.3 In fact, most studies support that an increase in muscle size (hypertrophy) can occur specifically in older individuals who participate in resistance training.3 The key to achieving the benefits of strengthening exercises is if “sufficient stimulus is maintained”. Meaning that exercise must be performed consistently and over time for us to increase our movement abilities. Additionally, an added benefit of resistance training is improved balance, which is often a concern as we age.2
A question I often receive from my patients is whether their pelvic floor muscles can increase strength and function even if they are “old”. The answer is yes! As with other muscle groups, aging (and menopause) has been associated with atrophy (decrease in muscle size) and loss of pelvic floor muscle force production (strength).4 A study specifically looked at urinary incontinence in older women aged 60 years and older and the effect of pelvic floor muscle training on urinary incontinence. Women were treated for 12 weeks at one-hour weekly sessions with additional 5 days per week of strengthening at home. After the 12-week training program, women were asked to continue with pelvic floor strengthening 3 days per week for 9 months. At 1 year follow-up, pelvic floor muscle training was found to reduce the levator hiatus resulting in increased force production (strength). This study supported the idea that age and level of incontinence do not prevent our muscles from improving with specific strength training, such as pelvic floor muscle training.4
Luckily for Betty, a physical therapist (PT), specifically one trained in pelvic floor rehabilitation, would be able to develop a strengthening program specific to her needs and goals. Betty’s PT should incorporate exercises that are challenging but doable and prescribe the exercises in an amount that are appropriate for her current physical abilities. Depending on the type of exercise and its purpose, it will often need to be performed anywhere from 2-7 times per week or a few times per day over a period of at least two to three months for the body to adapt in a meaningful and long-lasting way. I often tell my patients that small wins lead to big changes over time.
If you are noticing that your current abilities are decreasing or want to make ensure that your current physical activity if sufficient to keep you moving as you age, reach out to a physical therapist so a program can be developed that is specific to you and your needs! And please remember, aging does not mean that you can’t continue to enjoy your activities, and you most certainly do not need to leak urine or feces while doing so.
Written by Jordan Schmidt, PT, DPT
References
- Miljkovic, N., Lim, J. Y., Miljkovic, I., & Frontera, W. R. (2015). Aging of skeletal muscle fibers. Annals of rehabilitation medicine, 39(2), 155–162. https://doi.org/10.5535/arm.2015.39.2.155
- McLeod, M., Breen, L., Hamilton, D. L., & Philp, A. (2016). Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology, 17(3), 497–510. https://doi.org/10.1007/s10522-015-9631-7
- Hughes, D. C., Wallace, M. A., & Baar, K. (2015). Effects of aging, exercise, and disease on force transfer in skeletal muscle. American journal of physiology. Endocrinology and metabolism, 309(1), E1–E10. https://doi.org/10.1152/ajpendo.00095.2015
- Cacciari, L. P., Morin, M., Mayrand, M. H., & Dumoulin, C. (2022). Never Too Late to Train: The Effects of Pelvic Floor Muscle Training on the Shape of the Levator Hiatus in Incontinent Older Women. International journal of environmental research and public health, 19(17), 11078. https://doi.org/10.3390/ijerph191711078
