Strength Training for Health: A Physiotherapist’s Perspective

Our Ancestors Stayed Stronger for Longer

There is a group of hunter gatherers indigenous to Paraguay named the Aché. Like most of us, the Aché can expect to reach their peak level of strength in their twenties. Like most of us, they can expect to gradually lose strength as they age. But unlike most of us, the Aché do not lose their strength at quite as high a rate.

When they reach the age of 70, Aché men and women are still as strong as British men and women in their 50s (1). The main reason for this? Their lifestyle. They don’t sit back and put their feet up because they think they are “too old for that”. They continue to be involved in the day to day running of their group – gathering and processing food, making shelters, minding infants, etc.

Let’s explore strength, why it is important, and how we might take a lesson from the Aché so we can maintain strength right into our twilight years.

Use it or Lose it – Train it to Gain it

In Western societies, for every decade past the age of 50, people’s strength declines by an average of 12-14% and their muscle mass drops by an average of 6% (2). However, this does not have to be the case for you. This loss of strength and muscle mass can be stopped in its tracks, and even reversed. A well-run strengthening programme in older individuals can increase strength by 30% and muscle mass by 12% – counteracting 2 decades of strength loss(!) (2).

As we age it becomes more difficult to put on muscle. However, people still have a great capacity to improve their strength into older age. This brings many magnificent benefits – such as improved walking speed, reduced falls risk, reduced dependence on others and improved ability to take part in meaningful activities. Higher levels of strength are associated with a longer, more independent and healthier life (3).

MRI scans of the thighs of 3 different people - showing "Use it or Lose it" and "Train it to Gain it" in action.

What’s good for your muscles is good for your health

Strength training offers countless benefits that go far beyond the muscles. The effects on bone health are amazing (see this previous blog post for more on this). Strength training benefits heart health and helps to control blood pressure and cholesterol levels. Our metabolic health benefits too, reducing the risk of diabetes and helping the body to control blood sugar levels. It can help to boost the immune system’s function, reduce the risk of some cancers, and reduce systemic inflammation (3). For any nerds out there interested in learning more – check out reference number 3 in the list below.

Ok, so strength training sounds like a good idea. So, what can you do about it? Let’s explore a few things to give you an idea of where you might start.

What Constitutes Strength Training – Find Your Level

Strength training will look different depending on a person’s ability. For a fit athlete, it might involve heavy weightlifting in the gym. For an untrained person, basic bodyweight exercises (e.g. squats, kneeling push-ups) might be a good starting point. For someone who has become deconditioned, simply standing from a chair several times can be a real challenge to their muscles.

Many activities that we perform can be fantastic for maintaining muscle mass and strength. Examples might include heavy yard or garden work, moving furniture or lifting heavy shopping bags. The problem most people have with this, however, is that they don’t perform these tasks regularly or intensely enough. Some exercise classes such as yoga and pilates put strain through some of the major muscle groups – offering a degree of strengthening for many people.

Moving weights in a gym is often the most effective way to gain strength. This is a great way to challenge the body, causing it to compensate by getting stronger. By regularly subjecting the body to moving gradually heavier loads, it will adapt and become stronger as a result.

Finding the level that challenges your muscles is key. Working with a fitness or healthcare professional like a physiotherapist can be a great starting point.

What Is Recommended for Me?

Exactly what the best programme is will vary in many ways for different people. There are, however, a few key principles to follow to get the most bang for your buck and reap the rewards of growing stronger.

1. Be Consistent – The Body Adapts

This is absolutely key. The body adapts to what we do frequently (use it or lose it; train it to gain it). The best results come from programmes performed 2-3 days per week. However, even just 1 day per week of good strengthening will offer huge benefits.

2. Challenge Yourself – Nothing Good Comes Easy

Every strengthening session should be a challenge. You should aim for a degree of fatigue in the various key muscle groups of the body (e.g. legs, hips, back, shoulders, arms). These sessions should last at least 30 minutes – but some beginners may benefit from just 15 minutes, gradually increasing as the weeks go by.

3. Train the Large Muscle Groups – Simple and Effective

Unless you are a bodybuilder, or you are rehabilitating a specific injury, then there is no need to get too specific with your programme. The best way to build strength is to perform exercises moving several joints at once, targeting large groups of muscles. For example, a squat or lunge will move the ankles, knees and hips, strengthening many muscles around those joints. A push up will challenge the muscles of the chest, shoulders and the arms. These so called ‘compound’ movements are the backbone of any strengthening programme, and most people won’t need to perform anything more specific.

4. Reps, Sets and making sense of them

An exercise is performed in reps (repetitions – i.e. how many times you perform a movement in one go) and sets (i.e. how many times you repeat a group of reps). For example, performing 1 push-up is 1 rep. 10 without a break is 10 reps. If you were to perform 10 push-ups, then take a break for a minute or two, then performing 10 more; you would have performed 2 SETS of 10 REPS each.

When it comes to strengthening, there is no hard and fast rule about exactly how many sets or reps you should do. The key is to find the level that challenges your muscles. Whether that is lifting a heavy weight for 5 or 6 reps, or lifting your bodyweight for 20-30 reps, it doesn’t really matter so long as you challenge the muscles and feel a fatiguing effect.

A good place to start is to train each muscle group for 2 sets of somewhere in the region of 10-30 reps (whatever works for you with the exercise you do). You can then build up to performing 3-5 sets of exercises per muscle group.

The benefit of heavier weight means that you can get good stimulation of the muscles in a shorter space of time – however, it often takes experience to become comfortable in moving heavy loads. Lifting very heavy weights is unnecessary unless you have specific goals to lift extremely heavy weights or perform a sport that demands it.

Invest in Your Health – Take the Next Step

Get down to your local gym and ask for help with getting started with a beginner strengthening programme. Check out what classes are available in your locality. There are some great resources available online and on YouTube – but approach them with an open mind and it’s best to take some of the advice and instructions with hefty pinch of salt (anyone who claims to have THE BEST exercise for X issue is at best ill-informed, and at worst a lying opportunist).

If you have any concerns regarding your health or an injury, make an appointment with a physiotherapist who is experienced in exercise prescription to see what might work for you.

This is an investment in your health. Even one strengthening session per week can have massive benefits. Find a way that works for you to fit it into your week – your future self will thank you later.


Interested in learning more? Here are some of my favorite resources on this topic:



Exercised: The science of physical activity, rest and health. Penguin UK. Daniel Lieberman. 2020.



  1. Lieberman, D., 2020. Exercised: The science of physical activity, rest and health. Penguin UK.
  2. Hurley, B.F. and Roth, S.M., 2000. Strength training in the elderly: effects on risk factors for age-related diseases. Sports medicine, 30, pp.249-268.
  3. Mcleod, J.C., Stokes, T. and Phillips, S.M., 2019. Resistance exercise training as a primary countermeasure to age-related chronic disease. Frontiers in Physiology, 10, p.645.


Title Image by Ryan McGuire from Pixabay

“Use it or Lose it” MRI image from the study – Wroblewski, A.P., Amati, F., Smiley, M.A., Goodpaster, B. and Wright, V., 2011. Chronic exercise preserves lean muscle mass in masters athletes. The Physician and sportsmedicine, 39(3), pp.172-178.

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