At this point, I assume it’s a common conversation with your doctor if you are 60+ (at least I hope it is): “You should exercise more,” and if the doc really knows their stuff, “You should strength train.” This is how I hope every meeting with your doctor ends. Strength training, real strength training, produces results that nothing in medicine can.

If your doctor has told you to start strength training, or even mentioned it as an option, that’s a solid start. The issue is that not all strength training is created equal. In fact, most exercises that look like strength training probably aren’t. More on that later.

Let’s first take a look at why doctors will sometimes recommend strength training. The simplest version is that they believe it will positively impact the lives of their patients. But more importantly, the research has caught up, and we have mounds of evidence that people as old as 100 will build muscle, gain strength, and reduce their fall risk, ultimately improving their independence, quality of life, and mental health. This is all good stuff, but it’s not that simple. Do a quick Google search for “strength training over 60” and you will yield all sorts of low-intensity “safe” exercises with chairs, bands, bouncy balls, and foam pool noodles.

What you are experiencing when you do a Google search, or go to your local health club, is what the market offers, not what the evidence supports.

Arnold Schwarzenegger (best we can tell) trained with loads between 60–100% of his one-rep max (1RM). 1RM is the maximum weight that you can lift for one repetition cycle, AKA maximum effort. Serious stuff. From there, we can take percentages of your 1RM for training purposes, 3 sets of 8 repetitions at 70%, for example. For virtually everyone on earth, this would be a tough workout. Joints might ache, muscles will shake, and you might even break a sweat, or worse, grunt… Fundamentally, this is the only way to gain strength, build muscle, improve gait speed, balance, etc. Virtually all of the research that looks at improving function at any decade in life uses similar parameters. Fiatarone et al., 1994, looked at leg strength, muscle size, stair climbing power, and gait speed in 100 nursing home residents age 72–98 after an 8-week strength training program. They performed each exercise at 80% 1RM for 3 sets of 8 repetitions. (In most of these studies, researchers are actually finding the maximum force output for these seniors. Amazing, I know.) The results give me goosebumps. 113% increase in muscle strength, 15% increase in gait velocity, 30% increase in stair climbing power, and a 4% increase in thigh cross-sectional area (this is real muscle building in your 90s).

Without even knowing it, doctors are recommending real strength training. They are recommending it based on the best available evidence. This is the evidence. This is what actually works, but the market pushes safety, fragility, pain avoidance.

Intensity must be high enough to drive physiological change. There is no way around it. I wish there was. If you do 3 sets of 10 repetitions and call it a day because it felt like work, but your objective capacity was 30 reps per set, it won’t result in the improvements that you’re looking for. We see it every day, and the research overwhelmingly supports it.