Strength and resistance training matter more as we get older. Here’s why.

While going for a brisk walk or jog is great for overall health as we age, it’s important not to overlook the benefits of strength and resistance training.

Done proactively – meaning before bone and joint problems arise – this approach to exercise can build strength while also improving balance and the risk of falls and fractures.

Strength training uses weights (think squats and bench presses) to improve metabolism and deter wear and tear on bones and joints. Resistance training helps with flexibility, balance and core strength by using dumbbells and bands to target and strengthen muscle groups.

“As you get older, two things happen: your bones get weaker, and you begin to lose muscle mass,” said orthopedic surgeon Dr. Mike Kissenberth, lead physician at Novant Health Orthopedics & Sports Medicine in Greenville, South Carolina.

“Strength training addresses both, while helping you stay independent. The biggest goal is to keep your skeleton strong and healthy, because strength and resistance training are more effective than just walking,” Kissenberth said. As baby boomers age, many worry about being able to stay in their own homes. Building your strength and balance are key moves to make when it comes to continuing to live on your own.

Working out for at least a half-hour a day can improve balance and prevent the risk of falls, which often require joint replacement surgery.

Here, Kissenberth discusses the benefits of strength and resistance training as we age. If it’s been awhile since you’ve picked up a set of weights, remember that it’s important to start gradually and work with an exercise group or personal trainer for best results.

What type of patients are you seeing most often?

More than half of my patients are older than 50. We see plenty of young athletes and weekend warriors, but most of our clientele are often in the older age group that benefits from strength training.

For example, with pickleball, we see all kinds of overuse injuries with older players. As we get older, females in particular experience a reduction in bone density (that sometimes leads to osteoporosis), which can be helped with resistance training, calcium and vitamin D. Not only does this build up and maintain bone mineral density, it can also reduce the risk of falls and fractures. As we age, we can fight the decline of bone strength with supplementation. But we have to work on it before there’s a problem.

Do you often see patients who have suffered falls?

Yes, every day. And the numbers are astonishing. Falls most often cause broken hips and shoulders, and it’s because balance and flexibility only get worse with age. People fall because they often don't have the coordination to prevent it. If we become more sedentary, that means we’re losing more muscle mass. Your body weakens if you’re sitting all the time, and all it takes is a misstep.

Weight training can improve coordination and reaction time. But depending on your age and experience, you might start with the supervision of a personal trainer. That way you can avoid an injury.

How do we motivate someone who won’t get off the couch?

Gravity isn’t easy on us as we get older, but we have to maintain our activity level. Part of my job as a surgeon is trying to not have to operate, and instead motivate the patient to start moving.

When I address a badly arthritic knee, for example, the only way to get the patient active again is to replace the knee. I often see patients who have underlying orthopedic conditions that make it too painful to be active, which is why it’s important to start simple with strength training. A group activity through your gym is great for this. Once you get started, there’s plenty of motivation to keep going. I encourage everybody to join a gym or YMCA. They offer all kinds of programs, including personal trainers and classes for older people that start simple.

(We’ve got you covered with this beginner’s workout, which details exercises like leg presses, chest presses and bicep curls.)

How do I know if I'm strong enough to use free weights versus weight machines?

For older adults, there’s no need to act like you’re 30 anymore. Just get back into a routine, and get going gradually. Let’s say a 60-year-old who has worked out in the past is getting started again. For that person I would recommend circuits on weight machines first, because these offer more control than free weights. But for people in middle age resuming workouts with free weights, I recommend three sets of 15 repetitions to start.

Older people should have a physical therapist assess their risk of falling before they pick up any gym equipment. Physical therapy works on balance while slowly building strength, and the next step would be to work with a personal trainer.

Many gyms are replacing cardio machines with more weight-training machines. Is that the right move?

The shift over the last few years, even for collegiate athletes, has been toward more functional training. That’s good because it works our whole bodies. Standard bench presses, squats and deadlifts are fine, but resistance training is much healthier in the long run. I love Pilates and yoga, because flexibility as we get older is huge. But it’s important to combine flexibility with more functional movement-type exercise.

When is surgery the answer?

This always depends on the patient, the situation and the diagnosis. If it’s safe, we will maximize conservative treatments as a first line of treatment. This may include over-the-counter medications, steroid injections, biologic injections with platelet-rich plasma, and physical therapy and exercise. Usually the patient knows when they’re ready for a joint replacement.

Joint replacement has made significant improvements over the last few years with specialized preoperative planning, improved materials and robotics. Joint replacement can be a significant game-changer for relieving pain and enabling a more active lifestyle.

What questions should patients be asking?

I wish patients would ask more about preventive measures. Many often want a quick fix or an injection, but it’s more reassuring when the patient says, “I know I have this problem, but what things can I do to prevent it from getting worse, or from happening somewhere else in my body?”