Strength training for seniors: what the NHS advises, where to start and when to ask first

What do the NHS and the UK Chief Medical Officers advise for older adults?

For people aged 65 and over, both the NHS and the UK Chief Medical Officers give the same minimum: activities that improve muscle strength, balance and flexibility on at least 2 days a week.¹⁶ The Chief Medical Officers add that these can be combined with aerobic sessions or done on their own.⁶

The NHS says strength work should target the major muscle groups: legs, hips, back, abdomen, chest, shoulders and arms.² It does not set a session length. It says only to start gradually and build up over a period of weeks.² Strength exercises do not count towards the 150 minutes a week of aerobic activity, so they come on top of it.¹

Why bother? The Chief Medical Officers describe a decline in muscle mass and bone density from around the age of 50, and call the loss of muscle strength with age the primary limiting factor for functional independence.⁶ The NHS says strength work helps keep the ability to do everyday tasks and slows the rate of bone and muscle loss linked to ageing.²

This page is about the senior reader: precautions, a gentle start and a way to check your progress. It does not repeat the full guidelines, which are set out in the strength training guidelines. For the wider picture of muscle loss, see muscle loss after 50.

Is it safe to start strength training at 65 or 75?

The Chief Medical Officers write that for older adults the benefits of activity outweigh the risks.⁶ Age UK says functional strength work is safe for older people if you start slowly, and that anyone with a health problem or an injury should talk to a health professional first.⁷

The NHS is plain on the first step: speak to a GP first if you have not exercised for some time or have a medical problem. It also says the activity and its intensity should match your fitness.¹ The NHS Strength and Flex videos add that a recent health event such as a heart attack or an operation is a reason to ask a professional before you try them.⁵

For some people, the Chief Medical Officers say a trained professional may be a better starting point. Their examples are frailty, moderate to severe dementia, previous spinal fractures and regular falls, where the first sessions can be supervised by a trained professional to make sure the technique is safe.⁶

Intensity is personal. The Chief Medical Officers say it is relative to an individual’s fitness, so an activity that is light for a fit person can be moderate or vigorous for an older or inactive adult.⁶ The NHS talk test applies: if you can still talk but not sing, the effort is moderate.¹

Conditions and precautions: who to talk to

The table sets out what the pages read for this guide say for common conditions. It is a summary of published advice, not advice for you. If you have any of these, a GP or other health professional is the person to ask before you begin.

The BHF also says to take a break if you cannot talk normally during the exercises, and to use slow, controlled movements, taking 2 seconds for the effort and 2 seconds to return.¹⁷

Which exercises? Four simple moves from the NHS and Age UK

You do not need a gym. The NHS lists resistance bands, body-weight exercises and weights as ways to build strength, at home or in a gym.¹ Age UK says these moves need no special equipment and can use your own furniture at no cost.⁷ The moves below come from the NHS and Age UK pages, and the numbers differ between them, so each is labelled with its source.

Chair exercises need a solid, stable chair with no wheels and, according to the NHS, one that does not slip.³ Do balance moves near a wall or a stable chair in case you lose your balance.⁴

The NHS Strength and Flex video series covers more, including the squat, standing press-up, sit to stand with a calf raise, wide squat and bench dip.⁵ The page gives the how-to videos only. No week-by-week Strength and Flex plan was found, so this guide does not describe one.

If you are choosing between a body-weight start and weights, begin with your own body weight and bring in bands or weights later, as the Royal Osteoporosis Society suggests.¹² For a general beginner’s route, see how to start strength training and strength training at home.

A five-chair-stand test, and why it is not a British norm

A common way to track leg strength is to time how long five chair stands take. The NHS, Age UK and the Chief Medical Officers do not time this exercise.³⁷⁶ The reference times below come from one source only: a 2006 meta-analysis by Bohannon of 13 articles on the five-repetition sit-to-stand test, read here as a PubMed abstract.²⁵ It is not a British source, and the abstract does not say where the people tested lived.

1. Set up the chair. Use a chair without arm rests, set against a wall so it cannot slide. Age UK describes a chair test with the arms across the chest and no help from the hands.¹⁰
2. Time five stands. Ask someone to time you, or use a clock with a second hand, from the first stand to the fifth. Go at a steady pace and keep the movement safe.
3. Write it down. Note the time and the date. Repeat after a few weeks, in the same chair and at the same time of day, to compare your own results.
4. Stop if unwell. Stop if you feel pain, dizziness or anything unusual, and see the last section.

The best use of the test is against your own earlier time, not against a table. A change of a second or so on one day proves little. If you have balance problems or a history of falls, do the test only with someone beside you, or leave it out and speak to your GP.

A first month to try: a suggestion, not a prescription

No source read gives a session-by-session plan for older adults, and the NHS writes that there is no precise recommendation for how long strength sessions should last.² The plan below is a suggestion of this page, built only from the sourced ingredients: at least 2 days a week, 8 to 12 repetitions as 1 set, and a gradual build-up over weeks.¹² It is not a clinical programme.

Work to the point where you need a short rest before repeating the activity, as the NHS puts it.¹ If you cannot manage 8 repetitions with good technique, the Royal Osteoporosis Society says to try a lighter weight; if 12 are easy, a heavier one.¹²

What the numbers add up to

Two sessions a week for four weeks is 2 × 4 = 8 sessions. At 20 minutes each, that is 20 × 8 = 160 minutes over the month. The Royal Osteoporosis Society suggests 20 to 30 minutes a session, which would be up to 240 minutes.¹² The 20 minutes is this page’s figure.

The NHS wall press-up, at 3 sets of 5 to 10, is 15 to 30 repetitions.³

A second view on frequency: the Royal Osteoporosis Society advises strength exercise on 2 to 3 days a week with at least a day of rest between sessions.¹² The NHS minimum is 2 days. They are separate sources, so use whichever suits you and your GP.¹¹²

For how sets, reps and progress fit together, see sets and reps and progressive overload.

At home, in a class or at a gym

The Chief Medical Officers say evidence-based strength and balance programmes can be group or home-based, and can be built into daily life.⁶ Which you choose depends on confidence, space and health.

• At home. The moves above need only a chair, a wall and a step, and Age UK notes no special equipment is needed.⁷
• In a class. Many local Age UKs run regular exercise classes for people of all abilities at very discounted rates, and Age UK has a postcode search to find them.⁸
• Chair-based classes. Many local Age UKs also run chair-based classes led by a trained instructor, which suit people who find getting active difficult.¹⁰
• Through your GP. The NHS says a GP can refer you to a falls service with strength and balance training, a home safety check and a medicines review.²¹

NICE guideline NG249 says falls prevention exercise should be delivered by appropriately trained professionals, progressive and tailored to the person, and it can be given individually or in a group.²² Not every class counts as a falls programme, so ask a GP if you have fallen or fear falling.

Some readers ask whether women need different advice. No source read gives separate guidance for women: the advice is the same for all adults. The Chief Medical Officers date the decline in muscle and bone from around the age of 50.⁶

If you are thinking about equipment for the home, see home gym equipment. Most people can start without any.

Bones, balance and falls: what strength work can and cannot do

A Cochrane review of 108 trials, with 23,407 participants whose average age was 76, found exercise reduces the rate of falls by 23% in older people living in the community, with high certainty evidence.²⁴ The 23% comes from a rate ratio of 0.77: 1 − 0.77 = 0.23.²⁴ The same review found exercise reduces by 15% the number of people who fall at least once.²⁴

On fractures, the review found exercise may reduce fall-related fractures (risk ratio 0.73), but with low certainty.²⁴ It says “may”, and so does this page.

For muscle, a meta-analysis of 49 studies including 1,328 people aged 50 and over found resistance training raised lean body mass by 1.1 kg on average, with gains somewhat smaller in the oldest.²³ That is an average across varied studies, not a promise for any one person, and the abstract reports very varied results.

For bones, the Chief Medical Officers say weight-bearing activities that create an impact through the body help maintain bone health.⁶ The Royal Osteoporosis Society explains that as muscles work they pull on bones, which helps keep or improve bone strength.¹²

Strength work is one part of falls prevention. For the full set of measures, see falls prevention for older adults, and for how a falls risk assessment works, falls risk assessment.

Frequently asked questions