Strength Training Changes Lives of 90-Year Old Nursing Home Patients


The assisted living patients selected to participate in our strength training study were typical of many nursing home residents. They were old, weak and relatively immobile. As a general description, our new research participants were characterized by a dropped head, rounded shoulders and a curved back. Most had low back pain, and spent the majority of their time in a bed, chair or wheelchair.

Nonetheless, after talking with senior exercise advocate Gary Reinl, the administrators and medical team at the John Knox Village Senior Living Center in Orange City, Florida were convinced that these deliberated individuals had the potential to change their lives for the better through a simple and sensible program of strength exercise.

Strength Training Program

In fact, they challenged us to implement a safe, efficient and effective strength training program that would enable these older adults to feel better, function better, and ambulate better. Basically, they were hoping that after 14 weeks of strength training these special seniors would have less low back pain and spend fewer hours in their wheelchairs.

We accepted the challenge, and introduced a five-machine Nautilus program to the physical therapists and elderly patients who would participate in this innovative research experiment.  All of the subjects were assessed for body composition, muscle strength, joint flexibility and functional ability before and after the 14-week training period.

The participants completed two brief strength training sessions per week, working one-on-one with a physical therapist. Each exercise was performed for one set of 8 to 12 repetitions to the point of moderate muscle fatigue. When 12 repetitions were completed in good form (slow movement speed and full movement range), the weightload was increased by about five percent. 

Although each strength exercise required less than 90 seconds of physical exertion, the training sessions typically took between 15 to 20 minutes depending upon the participant’s physical ability to transfer on and off the equipment. Table 1 presents the Nautilus exercises, target muscles and desired outcomes of the strength training program.


The results of the assisted living patients strength training study surpassed everyone’s expectations. As presented in Table 2, the elderly exercisers achieved significant improvements in body composition, muscle strength, joint flexibility and functional ability over the 14-week training period. 

Specifically, they replaced about four pounds of lean (muscle) weight, reduced about three pounds of fat weight, increased their leg strength by more than 80 percent, increased their upper body strength by almost 40 percent, enhanced their joint flexibility by 30 percent, and improved the functional independence measure (FIM Score) by almost 15 percent.

Even more impressive than the objective outcomes of the strength training program were the personal observations by the medical professionals and administrative directors. Dr. Pradeep Mathur, John Knox Village Medical Director, reported that the exercise participants exhibited better physical and mental fitness, more endurance, and less low back pain.

Gary Brcka, Assisted Living Administrator, cited examples of how the strength training program helped patients.  In one case, an 87-year-old woman with compression fractures in her lower spine wore a back brace to reduce pressure and pain.  After completing the exercise program, she discontinued wearing the back brace claiming that she no longer needed it.

Carol Sullivan, John Knox Village Director of Nursing, noted that with more muscle strength some patients spent less time in wheelchairs, and one patient no longer needed to use a wheelchair.

Donna Califano, PTA and On-Site Program Director, reported that the patients enjoyed doing the strength exercises because they felt they were really working and seeing progress as their weightloads increased.

Perhaps the most remarkable lifestyle change was experienced by Esther Duvall, an 84 year old assisted living patient who claimed to hurt all the time.  After completing the strength training program, her functional capacity and walking ability improved so much that she actually left the nursing home and rejoined her husband in the independent living campus.

Fitness, Function and Finance

As the exercise participants increased their physical fitness, they concurrently improved their functional abilities. That is, they were able to perform various activities associated with daily living that they were unable to do before the strength training program. These restored abilities included walking, washing, dressing, brushing, combing and other activities characteristic of personal independence.

Of course, this is beneficial to both the participants and the providers. It is estimated that every point increase in a patient’s FIM Score reduces the cost of care by 50 cents a day. An 11-point FIM Score gain therefore represents a cost of care reduction of $5.50 per day. 

Multiplying this by the 19 subjects in our study, we have a daily cost of care reduction of about $105. On a yearly basis, this represents almost $40,000, which is about 2.5 times the cost of the Nautilus machines.


Based on the results of our 14-week strength training study with frail nursing home residents, we conclude that performing one set of 8 to 12 repetitions on five selected Nautilus machines is a safe, efficient and effective means for enabling elderly exercisers to attain:

  • Improved body composition
  • Increased muscle strength
  • Enhanced joint flexibility
  • Increased functional ability

Our findings further indicate that senior living facilities that provide well-designed and properly supervised strength training programs may expect:

  • Increased patient independence
  • Improved cooperation between patients and care givers
  • Reduced health care costs
  • Enhanced potential for attracting new residents and professional staff

Table 1. Nautilus machines, target muscles and desired outcomes of the strength training program.

Nautilus Exercise Target Muscles Desired Outcome of the Training Program
Neck Machine Neck Extensors, Neck Flexors Able to hold head erect for enhanced breathing, swallowing, speaking, seeing, and comfort
Low Back Machine Spinal Erectors Able to hold torso erect for better posture, physiological function, ambulation, and comfort.
Compound Row Machine Latissimus Dorsi, Teres Major, Trapezius, Rhomboids, Biceps Able to hold shoulders square for better posture, physiological function and comfort.
Triceps Press Machine Triceps, Pectoralis Major, Deltoids Able to push against chair arms to assist legs in rising from and lowering to wheelchairs or chairs.
Leg Press Machine Quadriceps ,Hamstrings, Gluteus Maximus Able to lift body up from and down to wheelchairs or chairs. Able to walk without losing balance or falling.

Table 2. Changes in body composition, muscle strength, joint flexibility and functional ability for elderly exercisers following 14 weeks of strength training (N=19).

Parameter Pre-Training Post-Training Percent Change Difference
Bodyweight 130.2 lbs 131.2 lbs + 1.0 lbs 0.8 %
Percent Fat 22.7 % 20.5 % – 2.2 %* 9.7 %
Fat Weight 29.7 lbs 26.8 lbs – 2.9 lbs* 9.8 %
Lean Weight 100.5 lbs 104.3 lbs + 3.8 lbs* 3.8 %
Leg Press 58.1 lbs 105.3 lbs + 47.2 lbs* 81.2 %
Triceps Press 37.9 lbs 52.6 lbs + 14.7 lbs* 38.8 %
Shoulder Flexibility 100.0 deg 109.4 deg + 9.4 deg* 9.4 %
Hip Flexibility 29.0 deg 44.3 deg + 15.3 deg* 52.8 %
FIM Score 77.5 pts 88.5 pts + 11.0 pts* 14.2 %

* Statistically significant difference (p<0.05)

About the author:
Wayne L. Westcott, Ph.D., C.S.C.S, is Fitness Research Director at the South Shore YMCA in Quincy, MA. He is strength training consultant for numerous national organizations, such as the American Council on Exercise, the American Senior Fitness Association, and the National Youth Sports Safety Foundation, and editorial advisor for many publications, including Prevention, Shape, and Club Industry magazines.


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