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Exercise in the Elderly


Brian D. Johnston

, Exercise Specialist, International Association of Resistance Training

Last full review/revision Sep 2018| Content last modified Sep 2018
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At least 75% of people over age 65 do not exercise at recommended levels despite the known health benefits of exercise

  • Longer survival

  • Improved quality of life (for example, endurance, strength, mood, flexibility, sleep quality, mental function)

Furthermore, many older people are not aware of how hard to exercise and do not know how much exercise they are capable of.

Exercise is one of the safest ways to improve health. Because of the decline in physical capability due to aging and disorders that are more common among older people, older people may benefit from exercise more than younger people. Exercise has proven benefits even when begun in later years. Basic, modest strength training helps older people carry out activities of daily living.

The largest health benefits occur, particularly with aerobic exercise, when people who are not physically active begin exercising.

Strength decreases with age, and decreased strength can compromise function. Strength training can increase muscle mass, meaningfully improving function. With a larger muscle mass, the same degree of muscle work demands less cardiovascular exertion. Increasing leg muscle strength improves walking speed and stair climbing. Older people who exercise are likely to have a better prognosis during a critical illness.

Not all older people can exercise safely. Some heart disorders and uncontrolled high blood pressure or diabetes mellitus may make exercise dangerous for some people. Other disorders, such as arthritis, may make exercise difficult. However, most older people, even those with heart disorders, are able to exercise. They may need to follow a specially designed exercise program or exercise under the supervision of a physician, physical therapist, or certified trainer. People should stop exercising and seek medical help if they develop chest pains, light-headedness, or awareness of irregular or rapid heartbeats (palpitations) during exercise.

Before beginning an exercise program, older people should be evaluated by their doctors to detect heart disorders and physical limitations to exercise. Electrocardiography (ECG) is not usually needed unless the person's medical history or findings during the physical examination suggest a problem. Exercise stress testing is usually unnecessary for older people who plan to begin exercising slowly and increase intensity only gradually. Doctors may do stress testing for people who are not physically active who plan to begin intense exercise, especially if doctors suspect they have diabetes, a lung disorder, or a heart disorder.

Exercise program

As for younger people, a comprehensive exercise program for older people should include

  • Aerobic activity

  • Strength training

  • Flexibility and balance training

Often doctors or exercise professionals can design a single program to help the person achieve all exercise goals. Strength training improves muscle mass, endurance, and strength. If strength training is done through a full range of motion, many exercises improve flexibility, and the enhanced muscle strength improves joint stability and, consequently, balance. Moreover, if rests between sets are minimal, exercise can be aerobic and thus cardiovascular function can also improve.

Duration of aerobic activity for older people is similar to that for younger adults, but exercise should be less intense. Usually during exercise, the person should be able to comfortably converse. Older people who have no disorders that limit exercise can gradually increase their target heart rate to the one calculated by use of age-based formulas (see Table: Usual Maximum and Target Heart Rates).

Some older people who are not physically active need to improve their functional abilities by strength training before they will be able to do aerobic exercise.

Strength training is done according to the same principles and techniques as in younger adults. Lighter forces (loads/resistance) should be used initially (for example, using exercise bands or light weights [2 pounds, or 1 kilogram] or arising from a chair) and increased as tolerated.

To help increase flexibility, major muscle groups should be stretched once daily, ideally after exercise when muscles are least resistant to being stretched.

Balance training aims to challenge the center of gravity by exercising in unstable environments, such as standing on one leg or using balance boards. Balance training is often used in an attempt to prevent falls in older people, particularly if their position sensation is impaired. However, it may be ineffective because any balance activity is skill specific (that is, good balance while standing on a balance board does not improve balance in dissimilar activities). Also, such balance training itself can cause falls. For most older people, flexibility and strength training exercises prevent falls more effectively. Such a program develops strength around the joints, increasing stability, and helps people hold body positions more effectively while standing and walking.

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Starting a new exercise program or sport can put some people at risk of musculoskeletal injury. Which of the following groups is at greatest risk for such an injury if engaging in a high-impact exercise such as jogging? 
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