Health

Strength training after 40: how much is enough

The guideline dose does not change at 40, but few people meet it: the World Health Organization's 2020 guidelines ask adults aged 18 to 64 for muscle-strengthening activity that works all major muscle groups at moderate or greater intensity on 2 or more days a week, rising to 3 or more days with balance work from 65. Muscle mass falls by roughly 3 to 8 percent per decade after 30 and the loss speeds up after 60. In a 2022 meta-analysis of 16 cohort studies, people who did any muscle-strengthening activity had a 15 percent lower risk of death from any cause, with the lowest risks at 30 to 60 minutes a week.

What happens to muscle after 40

Skeletal muscle is the largest tissue you own, and it starts to shrink long before anything feels wrong. The review by Volpi, Nazemi and Fujita in Current Opinion in Clinical Nutrition and Metabolic Care puts the loss at roughly 3 to 8 percent of muscle mass per decade after the age of 30, with a faster rate again after 60. The same paper notes a fall of around 30 percent in the ability to use oxygen during exercise (VO2 max) across the adult years, so aerobic capacity and strength drift down together.

The fast, forceful muscle fibres shrink first and the nerve connections that drive them thin out, so force per kilogram of muscle falls as well. That is why grip strength and walking speed are used as markers of ageing; the guides on grip strength and walking speed cover the numbers.

None of this is fixed. The same review reports that progressive resistance exercise produces muscle growth and strength gains even in elderly and physically frail adults, and it puts the protein need of older people at around 1 gram per kilogram of body weight a day, above the 0.8 grams per kilogram in the standard recommendation. Protein alone, without training, did little for muscle mass in the studies reviewed.

How much the guidelines ask for

The World Health Organization's 2020 guidelines on physical activity give adults aged 18 to 64 two targets. The first is 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous activity, or a mix. The second is muscle-strengthening activity at moderate or greater intensity that involves all the major muscle groups on 2 or more days a week. Both are strong recommendations graded on moderate-certainty evidence, and the second is the one most people miss.

From 65 the emphasis shifts. The same guidelines say older adults should do varied multicomponent activity that emphasises functional balance and strength training at moderate or greater intensity on 3 or more days a week, to keep functional capacity and to prevent falls. The NHS asks adults aged 65 and over for activities that improve strength, balance and flexibility on at least 2 days a week, alongside the same 150 minutes of moderate activity.

Moderate or greater intensity has a plain definition in the NHS strength guidance: a set is 8 to 12 repetitions, you do at least 2 sets and ideally 3, and each set should end at the point where another repetition would be difficult without help. The muscle groups to cover are legs, hips, back, abdomen, chest, shoulders and arms; weights, resistance bands, push-ups, squats and heavy gardening such as digging all qualify.

What 30 to 60 minutes a week is associated with

The largest pooled analysis is a 2022 meta-analysis by Momma and colleagues in the British Journal of Sports Medicine, which combined 16 prospective cohort studies, with study sizes from 3,809 to 479,856 people and follow-up of 2 to just over 25 years, mostly from the United States. Compared with people who did no muscle-strengthening activity, those who did some had a 15 percent lower risk of death from any cause, a 17 percent lower risk of cardiovascular disease, a 12 percent lower risk of cancer, a 10 percent lower risk of lung cancer and a 17 percent lower risk of developing diabetes, independently of aerobic activity.

For all-cause mortality the curve was J-shaped: the lowest risk, 17 percent below non-participants, sat at about 40 minutes a week, and the advantage shrank to nothing at roughly 140 minutes a week. For cardiovascular disease the lowest point was at 60 minutes a week and the benefit faded by about 130 minutes. For total cancer the lowest risk, 9 percent below non-participants, was at 30 minutes a week. Diabetes followed an L-shaped curve: risk fell sharply up to 60 minutes a week and then kept falling gradually. People who reported both strength and aerobic activity did best of all, with 40 percent lower all-cause mortality, 46 percent lower cardiovascular mortality and 28 percent lower cancer mortality than people who did neither.

All 16 studies measured strength training by questionnaire or interview, so the minutes are what people remembered, not what they lifted. These are also observational associations; people who lift may differ in ways no adjustment fully removes. Few studies covered the upper end of the curves, so the fading benefit above about 130 minutes means no evidence of extra benefit, not evidence of harm.

How much stronger you can expect to get

The trial evidence shows what changes when people over 50 actually train. Peterson and colleagues pooled 47 studies with 1,079 participants aged 50 to 92 (mean 67.4 years) in a 2010 meta-analysis. The programmes lasted 6 to 52 weeks, on average 17.6 weeks, at an average of 2.7 sessions a week, 8.3 exercises, 2.5 sets per exercise and loads averaging 70 percent of the one-repetition maximum. Strength rose by 29 percent on the leg press, 33 percent on the knee extension, 24 percent on the chest press and 25 percent on the lat pull, or 9.8 to 31.6 kilograms in absolute terms. Higher training intensity predicted larger gains.

The 2009 Cochrane review by Liu and Latham is broader: 121 randomised trials with 6,700 older participants, most training 2 to 3 times a week at high intensity, with 71 of the programmes lasting 8 to 12 weeks. The effect on muscle strength was large, a standardised mean difference of 0.84 across 73 trials. Walking speed improved by 0.08 metres a second across 24 trials with 1,179 participants, getting out of a chair improved with a moderate to large effect across 11 trials, and people with osteoarthritis reported less pain across 6 trials with 503 participants. Serious adverse events were rare and none was attributed to the training, although joint pain and muscle soreness were common in the trials that looked for them.

Participants were mostly in their sixties and seventies, and 20 of the Cochrane trials had an average age of 80 or over, so starting at 40 or 50 is early, and the gains arrived within 8 to 18 weeks, not years.

A starting plan and when to check with a doctor

A first programme that meets the WHO dose is modest: 2 sessions a week on non-consecutive days, 6 to 8 exercises covering legs, hips, trunk, back, chest, shoulders and arms, and 2 sets of 8 to 12 repetitions of each, rising to 3 sets after a few weeks. Choose a load at which the last 2 repetitions are hard but your form stays clean. When 12 repetitions feel easy in 2 consecutive sessions, add the next small weight increment and drop back to 8. Breathe out on the effort and never hold your breath, which pushes blood pressure up sharply. Each session takes about 20 to 30 minutes, which lands you in the 40 to 60 minutes a week where the cohort data showed the largest reductions in risk. The protein by age guide and the Protein and Fibre Target tool turn the 1 gram per kilogram figure into a daily number.

Some situations call for a doctor's advice first. If you have heart disease, uncontrolled high blood pressure or take blood pressure medication, ask about safe loads and about breath-holding. If you use insulin or other glucose-lowering drugs, strength training can lower blood glucose for hours afterwards, so discuss monitoring and dose timing. Osteoporosis, a recent joint replacement, a hernia or diabetic eye disease each change what is safe to lift, and in pregnancy heavy loads and exercises lying flat on the back in the later months are usually advised against; ask your midwife or doctor. Stop and seek help for chest pain, dizziness, sudden breathlessness or a sharp joint pain that does not settle. Muscle soreness in the 2 days after a session is normal and fades as you adapt.

A first month of strength training

Frequently asked

Is it too late to start strength training at 50 or 60?

No. In a meta-analysis of 47 trials, participants with a mean age of 67.4 years gained 24 to 33 percent in strength over an average of 17.6 weeks, and 20 of the 121 trials in the Cochrane review had an average age of 80 or over.

Do I need a gym?

Not necessarily. The NHS counts push-ups, squats, resistance bands and heavy gardening such as digging as muscle-strengthening activity, provided each set ends at the point where another repetition would be difficult. Most of the trials used machines or free weights because the load is easy to increase, and progression is what keeps the gains coming.

How many minutes a week do I need?

The WHO guideline is 2 or more days a week covering all major muscle groups, without a minute count. In the 2022 meta-analysis of 16 cohort studies the lowest risks sat at 30 to 60 minutes a week, which 2 sessions of 20 to 30 minutes will cover.

Is more strength training always better?

Not in the cohort data. The association with lower all-cause mortality peaked at about 40 minutes a week and was no longer detectable above roughly 140 minutes, though the authors caution that few studies covered the high end. There is no evidence of harm from training more, only no evidence of extra protection.

Is it safe with high blood pressure or heart disease?

Usually yes, with advice first. Ask your doctor about safe loads, avoid holding your breath during a lift, and stop for chest pain, dizziness or sudden breathlessness. Across 121 randomised trials in older adults, serious adverse events were rare and none was attributed to the training.

Does walking count as strength training?

No. Walking counts towards the 150 to 300 aerobic minutes in the WHO guidelines, but strength work needs a load that makes 8 to 12 repetitions hard. People who reported both kinds of activity had a 40 percent lower all-cause mortality than those who did neither, so the two are complementary, not interchangeable.

Sources

• Bull et al. 2020, British Journal of Sports Medicine: World Health Organization 2020 guidelines on physical activity and sedentary behaviour · Adults 18 to 64: strength work on 2 or more days a week; 65 and over: balance and strength on 3 or more days; full text on PubMed Central
• Momma et al. 2022, British Journal of Sports Medicine: Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases, a systematic review and meta-analysis of cohort studies · 16 prospective cohort studies; dose-response curves; activity self-reported; full text on PubMed Central
• Volpi, Nazemi and Fujita 2004, Current Opinion in Clinical Nutrition and Metabolic Care: Muscle tissue changes with aging · 3 to 8 percent of muscle mass per decade after 30; protein around 1 gram per kilogram a day for older adults; author manuscript on PubMed Central
• Liu and Latham 2009, Cochrane Database of Systematic Reviews: Progressive resistance strength training for improving physical function in older adults · 121 randomised trials, 6,700 participants; author manuscript on PubMed Central
• Peterson et al. 2010, Ageing Research Reviews: Resistance exercise for muscular strength in older adults, a meta-analysis · 47 studies, 1,079 participants aged 50 to 92; author manuscript on PubMed Central

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This guide is for general information. It does not replace medical advice or an examination.