Strength Training in Senior Living Facilities

Dr. Westcott
Between early October 1998 and mid-January 1999, a rather unusual
strength training study was conducted at the John Knox Village Nursing
Home in Orange City, Florida. In conjunction with my professional
colleagues, Gary Reinl and Donna Califano, I served as the research
director for this special project. Gary Reinl designed the
six-exercise Nautilus strength training program called Vigor¨, which
has been implemented in 120 senior living centers nationwide. John
Knox Village Nursing Home is one of these facilities, and Donna
Califano, a physical therapy assistant, served as the on-site director
for the strength training research program.

Donna and her staff personally trained 19 physician-referred nursing
home patients (14 women and 5 men) for a period of 14 weeks. The
patients were elderly (average age 88.5 years), and most were confined
to wheelchairs at the start of the study.

The program participants performed one set of each exercise, using a
weightload that they could lift between 8 and 12 repetitions. Whenever
they completed 12 repetitions, the resistance was increased by five
percent for the following workout. Every repetition was executed
through a full range of joint movement in approximately six seconds
(two seconds for the lifting phase and four seconds for the lowering
phase). The subjects averaged two training sessions per week.

Although each training session took 15 to 20 minutes, much of that time was spent assisting patients on and off the Nautilus machines. The actual exercise time was about six minutes per session, as each strength training set required about one minute for completion.

The six training exercises were designed specifically for older
individuals who have difficulty standing up and walking, and also
suffer from poor posture. Consider how the following Nautilus
exercises can effectively address these problems:

Leg Press

The leg press exercise strengthens the lower body muscles used to rise from a chair or wheelchair, namely the front thigh (quadriceps), rear thigh (hamstrings), and buttocks (gluteus maximus). It does so with full support of the back and no loading forces on the spine, which are important safety considerations for senior men and women.

Triceps Press

The triceps press exercise strengthens the upper body muscles used to rise from a chair or wheelchair, namely the rear arms (triceps), front shoulders (anterior deltoids), and chest (pectoralis major). These pushing muscles produce force against the arm rests to assist the legs when moving from a sitting to standing position.

Compound Row

Because it is essential to develop muscle strength in a balanced manner, the compound row exercise complements the triceps press. This exercise strengthens the upper body pulling muscles, namely the front arms (biceps), rear shoulders (posterior deltoids), and upper back (latissimus dorsi, middle trapezius, rhomboids). These muscles counteract the roundshoulderness characteristic of many older adults.

Lower Back

The low back exercise is perhaps the most important component in the training program. Strong low back muscles maintain erect posture and reduce the risk of problems/pain in this vulnerable area of the body. In fact, a 12-year research study at the University of Florida Medical School has reported an 80 percent success rate in relieving low back discomfort by strengthening the low back muscles.

Four-Way Neck

Weak neck extensor muscles result in a forward and downward head position that makes it more difficult to eat, drink, talk, and see. Strengthening the neck extensor muscles on the Nauitlus Four-Way Neck machine enables participants to hold their heads erect, which typically eliminates these problems.

To ensure front-to-back muscle balance, the neck flexor muscles are also trained on the Nautilus Four-Way Neck machine. Strong neck flexor muscles make it easier to turn the head from side to side.


Before and after the 14-week training period I traveled to Orange City, Florida to assess the research program participants. The physical changes that they achieved from 12 minutes of strength exercise a week were nothing short of amazing. As you will note in the accompanying table, these elderly nursing home patients added about 4 pounds of muscle and lost about 3 pounds of fat, for a 7-pound improvement in their body composition. They increased their lower body strength by over 80 percent and their upper body strength by almost 40 percent. In addition, they improved their hip flexibility by 50 percent and their shoulder flexibility by 10 percent.

Perhaps more important, these impressive physiological improvements resulted in greater functional capacity for the activities of daily living, thereby enhancing the patients quality of life. For example, their Functional Independence Measurement (FIM) score increased by 11 points, their mobility distance increased by 87 feet, and their falling rate decreased by 36 percent.

These functional improvements made life better for the patients, reduced cost of care, and positively impacted the professional staff. Consider that the 11-point increase in FIM score should result in a $38,000 cost of care reduction for these 19 patients over the course of a year. Consider also the following comments by the John Knox Village medical practitioners and administrators regarding the strength training program.

Dr. Pradeep Mathur, Medical Director

“The program participants exhibited better physical and mental
fitness, more endurance and less low back pain.”

Mr. Gary Brcka, Assisted Living Administrator

“Residents have shown notable improvements in gait, stability and stamina.”

Ms. Carol Sullivan, Director of Nursing

“With more muscle strength, some patients could spend less time in
wheelchairs, and one resident no longer needed a wheelchair after
completing the strength training program.”

Ms. Carol Ann McGovern, Director of Health Care Services

“The strength training program received positive feedback from the patients, therapists, and nurses who participated in the study.”

Ms. Donna Califano, Physical Therapy Assistant

“The patients enjoyed doing the strength exercise because they felt
they were really working and seeing progress as their weightloads


Based on the results of this study, the excellent research conducted at Tufts University, and many years of working with senior exercisers at the YMCA, it is clear to me that older adults of all ages and ability levels can benefit from a simple program of strength exercise. I also believe the senior living facilities should provide supervised strength training programs to increase residents’ physical fitness and functional capacity, and to decrease patient cost of care.

Table 1. Results of 14-week strength training program with
elderly nursing home residents (N = 19).

130 lbs.
131 lbs.
+1 lb.
Fat Weight
30 lbs.
27 lbs.
-3 lbs.
Lean (Muscle) Weight
100 lbs.
104 lbs.
+4 lbs.
Lower Body Strength
58 lbs.
105 lbs.
+47 lbs.
Upper Body Strength
38 lbs.
53 lbs.
+15 lbs.
Hip Flexibility
29 deg.
44 deg.
+15 deg.
Shoulder Flexibility
100 deg.
110 deg.
+9 deg.
FIM Score
78 pts.
89 pts.
+11 pts.
Mobility Distance
123 ft.
210 ft.
+87 ft.
Fall Rate

Special thanks to Scott Glover and Susan Ramsden for their assistance
in analyzing the research data for this study.

Wayne L. Westcott, Ph.D., is fitness research director at the South
Shore YMCA in Quincy, MA., and author of several fitness books
including the new releases, Building Strength and Stamina and Strength
Training Past 50.

© 2000 Wayne L. Westcott, Ph.D. all rights reserved

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Written by Wayne L. Westcott PhD

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