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Power Training Prescription in Older Individuals: Is It Safe and Effective to

Promote Neuromuscular Functional Improvements?

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DOI: 10.1007/s40279-022-01758-0

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CURRENT OPINION

Power Training Prescription in Older Individuals: Is It Safe and Effective

to Promote Neuromuscular Functional Improvements?
Régis Radaelli2 · Gabriel S. Trajano3 · Sandro R. Freitas1 · Mikel Izquierdo4,5 · Eduardo L. Cadore6 · Ronei S. Pinto6

Accepted: 13 August 2022

© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022

Abstract
Muscle power has been reported to be critical in counteracting age-related declines in functional performance. Muscle power
output in functional performance exercises can be greatly improved in a short period of time (i.e., ≤ 12 weeks) using specific
exercise interventions such as power training (i.e., exercises attempting to move loads ranging from 20 to 70% of 1-repetition
maximum as fast as possible during the concentric muscle action, followed by a controlled, slower eccentric muscle action).
Despite the widespread evidence on the effectiveness of power training in older adults (~ 300 scientific articles published on
this topic in the past 10 years), some scientists do not recommend the use of explosive-type muscular contractions during
resistance training (i.e., power training) for the older population; indeed, some international guidelines do not mention this
type of exercise for older people. The reasons underlying this absence of mention and recommendation for the use of power
training as a fundamental exercise strategy for older people are still not well known. Therefore, we attempted to point out
the main issues about safety, feasibility, and effectiveness of muscle power training to promote neuromuscular functional
improvements in older people.

Key Points 

Some health international organizations and health pro-

fessionals do not mention power training as a fundamen-
tal type of neuromuscular muscle training to improve
functional capacity in older people.
Power training for older people is safe, and this may be
guaranteed when appropriate methodological premises
* Régis Radaelli are applied and coupled with direct training supervision.
regis.radaelli@hotmail.com
Power training is more effective in improving functional
1
Faculty of Human Kinetics, University of Lisboa, Cruz abilities than low-velocity resistance training in older
Quebrada, Dafundo, Portugal people.
2
Faculty of Human Kinetics, CIPER, University of Lisboa,
Cruz Quebrada, Dafundo, Portugal
3
School of Exercise and Nutrition Science, Faculty of Health,
Queensland University of Technology (QUT), Brisbane,
QLD, Australia
4
Hospital Universitario de Navarra (HUN), Universidad 1 Introduction
Pública de Navarra (UPNA), Navarrabiomed, IdiSNA,
Pamplona, Spain
Functional performance is the cornerstone of healthy aging
5
CIBER of Frailty and Healthy Ageing (CIBERFES), Instituto [1], and its enhancement involves several essential struc-
de Salud Carlos III Madrid, Madrid, Spain
tural (e.g., skeletal muscle mass) as well as biomechanical
6
School of Physical Education, Physiotherapy and Dance, (e.g., muscular strength) factors [2]. Muscle power output
Universidade Federal do Rio Grande do Sul, Porto Alegre,
RS, Brazil (i.e., defined as the product of the force of contraction and

Vol.:(0123456789)

velocity of movement) in functional performance exercises
has been reported to be more critical in counteracting age-
related declines in functional performance than strength in
older people [3–6]. Previously, it has been demonstrated
among 80 community-dwelling women with self-reported
disability, that leg peak muscle power (r = 0.47; p < 0.0001)
was superior to muscle strength (r = 0.43; p < 0.0001) and
aerobic capacity (r = 0.40; p < 0.0003) in determining func-
tional status, and that it independently predicted functional
dependency even after accounting for additional neuropsy-
chological and health status indicators [7]. Also, Marsh et al.
[8] reported that the lower extremity strength and power
of 655 older men and women were significant predictors
of mobility performance. However, muscle power output
explained the variance in the functional capacity to a greater
extent than strength, in both linear (31.1% vs 24.7%) and
cubic (35% vs 28.7%) regression models. In addition, it has
been identified that muscle power output is a risk factor for
mortality, independent of muscle strength, physical activ-
ity, and muscle mass (relative risk = 0.93–0.96; p < 0.05;
n = 993) [9]. Thus, when viewed alongside evidence demon-
strating the longitudinal decline in muscle power occurring
at a faster rate (− 3% per year) than muscle mass (− 1% per
year) and strength (− 2% per year) during the natural aging
process [10–12], it is reasonable to argue in favor of muscle
power as the primary therapeutic target for exercise interven-
tions. Currently, there is clear evidence that this parameter
can be greatly improved (i.e., effect size = 0.70–0.88) in a
short period of time (i.e., ≤ 12 weeks) using specific exercise
interventions [13]. Indeed, exercise programs focusing on
increasing power output in functional performance exercises
such as power training (i.e., exercises attempting to move
loads ranging from 20 to 70% of 1-repetition maximum
[1-RM] as fast as possible during the concentric muscle
action, followed by a controlled, slower eccentric muscle
action [14, 15]) are fundamental to optimizing functional
outcomes in older adults with or without clinical conditions
(i.e., hospitalized older patients, frail nonagenarians, and
frail patients with dementia) [16, 17]. Despite the wide-
spread recommendations and evidence on the effective-
ness of power training [16, 18] (i.e., ~ 300 scientific articles
published in different databases on this topic in the past
10 years), some health professionals may remain reluctant
to implement this mode of exercise for older people. Some
authors, indeed, have recommended that older people only
perform resistance training at slow and controlled speeds
[19]. In addition, some current exercise guidelines, particu-
larly for muscle-strengthening in older adults, do not include
information about the velocity of execution or a recommen-
dation on how to make use of power training [20, 21].
The reasons underlying why some researchers and inter-
national guidelines do not mention power training as a fun-
damental exercise strategy for older people [19, 20, 22, 23]
R. Radaelli et al.
are not well known. This positioning may discourage health
professionals to prescribe power training for older popula-
tions in their practice. Furthermore, because muscle power
is an important predictor of functional capacity, strategies
to develop skeletal muscle power in this population must be
included in programs aiming to prevent or postpone func-
tional limitations and subsequent disability [18]. Therefore,
we attempted to point out the main issues about safety, feasi-
bility, and effectiveness of muscle power training to promote
neuromuscular and functional improvements in older people.
2 Power Training for Older People: Is It Safe?
As power output depends on the force and velocity exerted
by the body’s limbs, power training is characterized by
performing skeletal muscle contractions against resist-
ance as fast as possible, which may be called (by analogy)
explosive-type muscle actions (i.e., fast and forceful mus-
cle contractions) [18, 24]. This mode of muscular contrac-
tion reflects the ability to increase and implement maximal
or near-maximal velocity at a given load, optimizing the
power output [25, 26]. The explosive-type muscle action is
believed to be influenced by several mechanical and neural
parameters including maximal strength, fascicle length and
angle, muscle–tendon unit stiffness, and the recruitment of
fast-twitch motor units responsible for producing a higher
rate of development [27–30]. Since safety is a major factor in
the design of exercise programs [31], both practitioners and
professionals might assume that performing skeletal muscle
contractions as fast as possible may compromise exercise
safety in older people, particularly in those with clinical
conditions associated and with advanced age. However,
although some adverse events (e.g., minor strains and ten-
donitis) have been reported in older people following power
training [32, 33], the injury incidence is apparently very low
and not different compared to other training modalities [25,
34, 35]. Compared to other resistance training modalities,
power training has been associated with similar rates of (1)
discomfort, i.e., one case with traditional slow-speed resist-
ance training (n = 72) versus one case with power training
(n = 66) [36]; (2) dropouts due to exacerbation of clinical
symptoms (osteoarthritis, joint pain, or fasciitis), i.e., three
cases with power training (n = 15) versus two cases with
traditional slow-speed resistance training (n = 15) [25]; and
(3) adverse events per 1000 person-sessions, i.e., 3.27 (95%
confidence interval [CI] 1.76–6.09) for power training versus
2.08 (95% CI 0.99–4.36) for traditional slow-speed resist-
ance training [35]. Note that in situations where power train-
ing is supervised, the injuries and/or adverse events appear
to not exist even with a considerable number of practition-
ers in relation to the supervisor (i.e., 1:10) [37], though the
authors did not specifically assess the adverse effects of
Power Training in Older Individuals: Is It Safe and Effective?
power training as the primary outcome. It should be noted
that injury derived from power training in older people nor-
mally occurs when individuals exert themselves at near the
maximal muscular force [38], or perform a combination of
heavy and repetitive workload executed until exhaustion
[39]. However, power training for older individuals typically
uses moderate to high external loads (30–70% of 1-RM), and
is performed without muscle failure (i.e., muscle fatigue is
not reached) [40], which minimizes the risk of injury. How-
ever, in certain clinical situations the increase in execution
speed may exacerbate the symptoms of the clinical condi-
tions if undiagnosed degenerative changes are present (e.g.,
risk of meniscus or tendon injuries) [2, 41, 42]. So, in these
situations, power training is not recommended. In conclu-
sion, we contend that power training for older people is safe
when appropriate methodological premises are applied and
minimal training supervision is provided.
3 Power Training: Is It Efficient for Older
People?
There is consistent scientific evidence suggesting that
short-term interventions of power training (i.e., ≤ 12 weeks)
improve muscle power output (4.4–36.9%), rate of force
development (22.9–64.8%), maximal strength (9.6–75.8%),
and muscle size (4.6–8.3%) and quality (2.8–7.8%) with a
positive impact on the power output in functional perfor-
mance exercises (2.1–37.3%) in both healthy older individu-
als and older individuals with sarcopenia, frailty, and other
comorbidities [13, 43–50]. In addition, when comparing the
effects of short-term power training and traditional slow-
speed resistance training in older individuals, similar muscle
hypertrophy has been found when a similar volume load
between groups is employed [51, 52]. Also, power train-
ing and traditional resistance training are similarly effective
for increasing maximal isometric and dynamic strength in
older people [51, 53–55]. More importantly, previous studies
(including meta-analyses) have shown that power training
is more effective in improving functional abilities (i.e., sit-
to-stand, walking ability, stair climbing) than low-velocity
resistance training (~ 14–21% vs ~ 9–19%, respectively) [17,
34, 50, 53, 56]. Thus, we can state that power training can
achieve very satisfactory results in terms of neuromuscular
improvements as well as functional performance in older
people.
Current scientific evidence also indicates that an effec-
tive power training program can be implemented without
requiring a large investment of time (~ 30–50 min per ses-
sion) [44], and it can be integrated into different exercise
modalities. For instance, power training interventions may
include the use of exercise machines [13, 37, 44, 48, 52,
57] or be combined with calisthenics exercises [46, 52],
aerobic exercise [43, 45], or multicomponent interventions
(i.e., combined with balance and gait retraining exercises)
[58]. Thus, power-training interventions can be integrated
with different training modes, which increases the number
of possibilities in designing an effective exercise program.
Power output improvements in older people have also been
observed to occur using low volumes of workload in each
training session (i.e., one set per exercise) [13, 44]. In
addition, enhancement of power output (as well as maxi-
mal strength, muscle size, and functional performance) is
achieved using submaximal intensities (i.e., 30–60% of
1-RM) [44, 49, 52]. As results can be obtained within a short
period of time (≤ 12 weeks) using low doses of training,
we can state that power training in older people is efficient.
4 Power Training for Older People: Why Is It
Not Implemented?
Despite the proven benefits of power training for older peo-
ple, some researchers still do not recognize this modality
as a fundamental strategy to help attenuate the age-related
declines in neuromuscular function [16]. This may dis-
courage health care professionals from prescribing power
training in older adults. In addition, some methodological
doubts may persist among professionals, and this may con-
stitute barriers to implement power training in older people.
It has been demonstrated that the lack of knowledge about
a method and how to implement it are critical barriers to
health professionals prescribing an exercise program [59].
In the following paragraphs, we will describe some strate-
gies and alternatives to implement this modality in older
people (Fig. 1).
Optimal training regimens for maximizing muscle power
should be performed using the concentric muscle action
phase (shortening) as fast as possible, followed by a con-
trolled, slower eccentric muscle action phase (lengthening)
[24, 60], always avoiding concentric failure (i.e., muscle
fatigue) [61]. One important aspect of power training in
older people is that the maximal velocity of muscle concen-
tric action may be self-determined by an individual’s capac-
ity. In cases when the older individual is not able to perform
fast contractions from the beginning, the individual may start
with a slower execution and another person’s assistance and
then progress gradually until the individual can perform the
exercise alone and as fast as possible [24]. Concerning the
training intensity, it is recommended to use a range between
20 and 70% of 1-RM in order to maximize muscle power in
lower limbs [10]. Nevertheless, it has been shown that low to
moderate intensities (i.e., 20 to 60% of 1-RM, respectively)
are similarly effective in improving the maximal strength
and power output to improve functional capacity and muscle
mass in healthy and frail older adults, as well as in those

Fig. 1  A proposed power training prescription for older adults with a
broad range of health states. The proposal is based on the findings of
19 studies including a total of 512 older participants [13, 25, 33, 34,
37, 43–46, 49, 50, 52, 54, 56, 58, 62, 65, 71, 72]; All studies utilized
isoinertial exercises, free weights, pneumatic machines, jumps and\or
throws. Two studies [13, 44] compared the effect of power training
volume in a total of 52 older individuals. Three studies [32, 62, 65]
with limited mobility (i.e., score of 8.1–8.8 in short physi-
cal performance battery) [13, 32, 58, 62, 63]. When it is not
possible to monitor the intensity by using the percentage of
maximal strength (1-RM), the movement velocity (which is
inversely associated with the relative intensity) [64] or scales
of perceived exertion (i.e., 13–18 points on the original Borg
scale) [65] can be used as strategies of training control.
The performance of power training using plate loaded
machines and free weights is effective for power improve-
ments, but not essential. For instance, significant power
improvements can be achieved with a combination of cal-
isthenic exercises and plyometric training (i.e., jumping up
onto platforms/boxes) [46, 52, 66], when individuals have
a very low risk of falls and have a clinical condition that
allows them to perform these exercises (e.g., absence of pre-
vious injuries). Previous evidence has suggested that one or
three sets per exercise of power training are similarly effec-
tive in promoting favorable neuromuscular adaptations [13,
44]. However, it is important to select an appropriate number
of sets to avoid muscle fatigue during their performance.
Muscle fatigue may pose safety risks and is not necessary for
power development [67]. Thus, although a volume progres-
sion should be performed, selecting the number of sets that
can be performed without a great loss of velocity of execu-
tion from the first to last set may be an effective strategy
R. Radaelli et al.
compared the intensity effect in a total of 179 older individuals. There
is a lack of data comparing different progressions, different training
frequencies, and rest periods. 1-RM 1-Repetition Maximum (the max-
imal amount of weight that can be lifted for one complete repetition),
RPE rating of perceived exertion, RFD rate of force development (see
[16, 18] for guidance)
for minimizing muscle fatigue and defining an appropriate
volume for power training.
The combination of power training with other exercise
modalities, such as endurance training or multicomponent
programs, has also been demonstrated as safe and effective
for improving muscle function. In this regard, Muller et al.
[43, 45] found improvements in lower limb muscle power
output assessed by countermovement jump in healthy older
men who underwent combined high-intensity interval train-
ing (at 75–80% of the heart rate at VO2peak) and power train-
ing for 16 weeks (twice weekly). Therefore, when the prin-
ciples of training are applied to avoid acute residual fatigue
(from the previous exercise session) and/or chronic fatigue
(due to undertaking a greater total workload to match the
adaptive responses of single-mode training), power train-
ing may be combined with high-intensity aerobic exercise.
These previous investigations demonstrated that power train-
ing can be applied together with other exercise modalities
to mitigate age-related effects without causing any harm.
Another interesting advance in recent years has been the
inclusion of power training for unhealthy older individuals
[48, 49, 58, 68, 69]. It has been reported that 12 weeks of a
multicomponent exercise training program including power
training (i.e., exercises performed with a high velocity at
40–60% of 1-RM) improved muscle power output, maximal
Power Training in Older Individuals: Is It Safe and Effective?
strength, muscle cross-sectional area, and muscle fat infiltra-
tion, as well as functional outcomes and dual task perfor-
mance in frail institutionalized nonagenarians [58]. When
working with patients with cognitive impairments and physi-
cal vulnerability, attention needs to be paid to emotional
aspects, such as providing reassurance and showing respect
and empathy for the participants, as described in patient-
centered techniques that were developed for communica-
tion with these individuals [70]. Also, creating a respectful,
mindful, and empathetic training atmosphere for individuals
with cognitive impairment may promote their participation
in and adherence to a power training intervention [49]. Fur-
thermore, it is necessary to ensure that power exercises need
to be performed properly (i.e., attempting movements using
maximal intentional velocity), regardless of age and partici-
pants' characteristics. With regard to hospitalized older indi-
viduals, an individualized multicomponent exercise training
program, with special emphasis on muscle power training
(i.e., exercises performed with a high velocity at 30–60% of
1-RM), proved to be an effective therapy for improving mus-
cle strength and muscle power in very old patients during
acute hospitalization [68]. These findings support the key
role of power training during hospitalization in older adults
to minimize the hazards of prolonged bed rest. Also, power
training has been found to improve the skeletal muscle mass
index, and muscle strength in postmenopausal older women
with sarcopenia following 6 weeks of intervention [71]. Fur-
thermore, power training seems to be an alternative for older
individuals with diagnosed systemic arterial hypertension; it
has induced a reduced systolic blood pressure increase and
lower magnitude of diastolic blood pressure changes com-
pared with traditional slow-speed resistance training [69].
Therefore, power training seems to be a safe and effective
exercise modality also for unhealthy older populations. In
addition, the major part of the principles of prescription of
the power training utilized in healthy older individuals (i.e.,
velocity of execution and intensities) may be applied for
unhealthy older individuals. However, the efficacy and fea-
sibility of power training and the rate of improvements in
older individuals with other chronic conditions (e.g., cancer,
cachexia, and diabetes) require further investigation.
Nevertheless, the use of some specific power training
exercises should be avoided in patients with specific con-
ditions. For instance, open kinetic chain exercises such as
knee extension and chest press should not be prescribed for
older adults with specific clinical conditions such as knee
osteoarthritis and rotator cuff diseases, respectively [16]. In
addition, explosive-type actions in leg press exercise should
be avoided by individuals with lumbar spine disc degen-
eration and osteoarthritis conditions, including those with
hip osteoarthritis [16]. This challenge does not preclude the
performance of more traditional, slow-velocity resistance
training or even isometric resistance training against an
immovable object. As symptoms improve, isometric con-
tractions can progress to dynamic lifting through the pain-
free range of motion until a full range of motion is achieved.
During exacerbations of arthritis, this regression to isomet-
ric training followed by gradual resumption of dynamic and
then power exercises can be utilized to prevent injury and
optimize adaptations [18].
5 Conclusion
Power training is regarded as one of the main counterattack
strategies to prevent the deterioration of functional ability
observed with aging. Discrepancies in routine power train-
ing protocols might limit the consensus regarding optimal
training programs to improve muscle power. However, the
current evidence demonstrates that for older people with
a broad range of health and functional states, it is safe to
engage in a power training program with different exercise
modalities. Furthermore, when progression is supervised
and proper techniques are applied, there should be no major
concern regarding safety. However, there is a lack of data on
continuing and improving the design of power training. For
instance, there is a lack of data comparing different progres-
sions and different training frequencies. It is also unclear
how the decrease in contraction velocity during the sets may
influence the adaptations in older people, and more needs to
be learned about what the minimum acceptable velocity is
for power training in older people. Also, although the effec-
tiveness of power training in healthy older individuals has
been widely demonstrated, there is still limited availability
of studies investigating older individuals with chronic dis-
eases. Thus, it is not currently possible to provide an entirely
evidence-based prescription of power training for some
populations. Further randomized clinical trials are neces-
sary in order to advance the potential of power training as a
treatment for older adults diagnosed with chronic diseases.
Finally, we need to determine what the real barriers among
health professionals are when it comes to prescribing power
training for older people, as well as what the adherence rates
of older people are with this type of training.
Declarations 
Author contributions  RR and SRF wrote the first draft of the manu-
script. GST, ELC, RSP, and MI revised the original manuscript. All
authors read and approved the final version of the manuscript.
Funding  No external sources of funding were used in the preparation
of this article.
Conflict of interest  Régis Radaelli, Sandro Freitas, Gabriel Trajano,
Mikel Izquierdo, Eduardo Cadore, and Ronei Pinto declare that they

have no conflicts of interest that are relevant to the content of this ar-
ticle.
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