Older persons (60 years of age and older) constitute the fastest growing segment of our population with an expected increase from 43.1 million in 2012 to a projected 83.7 million in 2050 (72). The loss of muscle and neuromuscular performance with age eventually leads to reduced physical independence, increased fall risk, and declining quality of life in older persons (49,62). Maintaining function and independence arguably is more important than increasing life expectancy (50). Given the increase in the elderly population, the social and economic burdens of declined physical function are a major public health concern. In recognition of this dilemma, an overriding goal of the U.S. Department of Health and Human Services’ Healthy People 2020 initiative is to reduce the proportion of older adults with moderate-to-severe functional limitations (47). Interventions that can successfully address these concerns are imperative to the well-being of older persons and society as a whole (46). Resistance training has proven to be an effective modality for addressing the needs of older individuals; however, the specific loading techniques, movement patterns, and protocols available to the clinician vary considerably. Careful manipulation of these training variables allows targeted prescriptive exercise designs that can address the particular needs of the individual and effectively reflect the American College of Sports Medicine’s (ACSM’s) Exercise is Medicine® initiative. This article will present protocols designed to address individual needs and explain the theories behind their design and implementation. Sidebar 1 presents definitions that may prove helpful as you read this article. In addition, although diagnostic testing is beyond the scope of this article, Sidebar 2 presents references for tests that you may use to track clients’ progress and recognize how to use the techniques included in this article to maximize clients’ progress.


Sarcopenia (sarco = muscle; penia = deficiency or lack) was traditionally defined as a decline in muscle mass. The classic definition was a sex-specific decline in muscle mass below two standard deviations of normal young men and women (Figure 1) (28). This definition encouraged concentration on increases in muscle mass rather than on muscle function (strength, power, endurance). Given this goal, and likely the dominant influence of bodybuilding on the design of resistance training workouts, most of the early work with older persons concentrated on hypertrophy-based protocols (22,41). The evolution of the definition, which incorporates functions such as walking speed and grip strength, and the prevalent use of the term dynapenia (dyna = power; penia = deficiency or lack), has redirected attention as it relates to this topic toward muscle function rather than size (24,28). Simply defined, dynapenia is a loss of strength, power, or endurance that can be expected to lead to an increased risk for functional loss and mortality in older persons (24,28). The distinction between sarcopenia and dynapenia is especially relevant to training prescription because muscle size has a progressively weaker relationship to neuromuscular function as we age.