Preprint has been submitted for publication in journal
Preprint / Version 2

Machine-based resistance training improves functional capacity in older adults

A systematic review and meta-analysis.


  • Archie Kirk Solent University
  • James Steele Solent University
  • James Fisher Solent University



Generality of strength, specificity, transfer, activities of daily living


Resistance training is evidenced to positively impact functional performance of older adults which serves to maintain independence and quality of life, preventing or delaying institutionalisation or hospitalisation. It has been proposed that training interventions should implement resistance and balance exercises associated with movements needed in everyday life, following a principle of “train the movement, not the muscle”. However, this strength training philosophy presents challenges, and the use of resistance machines might present an efficacious alternative. The aim of this systematic review and meta-analysis was to explore the impact of machine-based resistance training upon strength and functional capacity in older adults. A PubMed/MEDLINE search was conducted, and following screening 17, articles met inclusion criteria for the systematic review, 15 of which were included in the meta-analysis for functional outcomes, and 11 of which were included in the meta-analysis for strength outcomes, respectively. Analyses revealed significant standardised mean change in favour of machine-based resistance training for functional outcomes (0.72, 95% CIs 0.39 to 1.07) and strength outcomes (0.71, 95% CIs 0.34 to 1.08) compared to control conditions (functional = 0.09, 95% CIs -0.1 to 0.28, strength = 0.1, 95% CIs -0.05 to 0.24). Substantial heterogeneity was noted in the manipulation of resistance training variables (load, effort, volume, etc.) and in the magnitude of effects between studies. In conclusion, the current data supports that significant strength and functional performance outcomes are attainable using uncomplicated, machine-based resistance training.


Metrics Loading ...


Clark BC, Manini TM. Sarcopenia ≠ Dynapenia, J Gerontol A Biol Sci Med Sci. 2008;63(8):829–834

Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4(2):61-76.

Boros K, Freemont T. Physiology of ageing of the musculoskeletal system. Best Pract Res Clin Rheumatol. 2017;31(2):203-217.

Ruiz JR, Sui X, Lobelo F, Morrow JR, Jackson AW, Sjostrom M, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:439.

Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547–553.

Correia RR, Veras ASC, Tebar WR, Rufino JC, Batista VRG, Teixeira GR. Strength training for arterial hypertension treatment: a systematic review and meta-analysis of randomized clinical trials. Sci Rep. 2023;13(1):201.

O’Bryan SJ, Giuliano C, Woessner MN, Vogrin S, Smith C, Duque G, Levinger I. Progressive resistance training for concomitant increases in muscle strength and bone mineral density in older adults: a systematic review and meta-analysis. Sports Med. 2022;52(8):1939-1960.

Ihalainen JK, Inglis A, Mäkinen T, Newton RU, Kainulainen H, Kyröläinen H, Walker S. Strength training improves metabolic health markers in older individual regardless of training frequency. Front Physiol. 2019;10:32.

Chmelo EA, Crotts CI, Newman JC, Brinkley TE, Lyles MF, Leng X, Marsh AP, Nicklas BJ. Heterogeneity of physical function responses to exercise training in older adults. J Am Geriatr Soc. 2015;63(3):462-9.

Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462.

Morat T, Mechling H. Training in the functional movement circle to promote strength and mobility-related activities in older adults: a randomized controlled trial. Eur J Ageing. 2014 18;12(2):105-118.

Liu CJ, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 2014;11:95-106.

Spitz RW, Kataoka R, Dankel SJ, Bell ZW, Song JS, Wong V, Yamada Y, Loenneke JP. Quantifying the Generality of Strength Adaptation: A Meta-Analysis. Sports Med. 2023;53(3):637-648.

Buckner SL, Kuehne TE, Yitzchaki N, Zhu WG, Humphries MN, Loenneke JP. The generality of strength adaptation. J Trainol. 2019;8(1):5-8.

Mende E, Moeinnia N, Schaller N, Weiß M, Haller B, Halle M, Siegrist M. Progressive machine-based resistance training for prevention and treatment of sarcopenia in the oldest old: a systematic review and meta-analysis. Exp Gerontol. 202;163:111767.

Safons MP, de Lima MS, Gonçalves KF, de Souza Junior GA, Barreto TL, Oliveira AJS, Ribiero ALA, Dos Santos Couta Paz CC, Gentil P, Bottaro M, Martins WR. Effects of Resistance Training With Machines and Elastic Tubes on Functional Capacity and Muscle Strength in Community-Living Older Women: A Randomized Clinical Trial. J Aging Phys Act. 2021;29(6):959-967.

Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med. 2010;38(4):765-71.

Fisher J, Steele J, Bruce-Low S, Smith D. Evidence based resistance training recommendations. Med Sport. 2011;15(3):147-162.

Fisher J, Steele J, Smith D. (2013). Evidence-based resistance training recommendations for muscular hypertrophy. Med Sport. 2013;17(4):217-235.

Fisher JP, Steele J, Gentil P, Giessing J, Westcott WL. A minimal dose approach to resistance training for the older adult; the prophylactic for aging. Exp Gerontol. 2017;99: 80-86.

Winett RA, Williams DM, Davy BM. Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach. Br J Sports Med. 2009;43(2):114-9.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29:372.

Unhjem R, van den Hoven LT, Nygård M, Hoff J, Wang E. Functional Performance With Age: The Role of Long-Term Strength Training. J Geriatr Phys Ther. 2019;42(3):115-122

Sprint G, Cook DJ, Weeks DL. Toward Automating Clinical Assessments: A Survey of the Timed Up and Go. IEEE Rev Biomed Eng. 2015;8:64-77.

Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8

Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.

Balachandran AT, Gandia K, Jacobs KA, Streiner DL, Eltoukhy M, Signorile JF. Power training using pneumatic machines vs. plate-loaded machines to improve muscle power in older adults. Exp Gerontol. 2017;98:134-142.

Muñoz-Bermejo L, Adsuar JC, Mendoza-Muñoz M, Barrios-Fernández S, Garcia-Gordillo MA, Pérez-Gómez J, Carlos-Vivas J. Test-Retest Reliability of Five Times Sit to Stand Test (FTSST) in Adults: A Systematic Review and Meta-Analysis. Biology. 2021;10(6):510.

Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113-9.

Bohannon RW, Bubela DJ, Magasi SR, Wang YC, Gershon RC. Sit-to-stand test: Performance and determinants across the age-span. Isokinet Exerc Sci. 2010;18(4):235-240.

Lajeunesse MJ. Juicr: Automated and Manual Extraction of Numerical Data from Scientific Images. 2021.

Schoenfeld BJ, Androulakis-Korakakis P, Pinero A, Coleman M, Burke R. (2023). Standards Method for Assessment of Resistance Training in Longitudinal Designs (SMART-LD): Explanations of Items. 2023. Pre-print: Accessed April 2024.

Cumming G. The new statistics: why and how. Psychol Sci. 2014;25(1):7-29.

Kruschke JK, Liddell TM. The Bayesian New Statistics: Hypothesis testing, estimation, meta-analysis, and power analysis from a Bayesian perspective. Psychon Bull Rev. 2018;25(1):178-206.

Ushey K, cre, Wickham H, Software P, PBC. Renv: Project Environments. 2023.

Landau, WM, Warkentin MT, Edmondson M, Oliver S, Mahr T, Company E L and. 2023. Targets: Dynamic Function-Oriented ’Make’-Like Declarative Pipelines.

Viechtbauer W. Metafor: Meta-Analysis Package for R. 2023.

Bürkner PC, Gabry J, WeberS, Johnson A, Modrak M, Badr HS, Weber F, Ben-Shachar MS, Rabel H, Mills SC, Wild S. Brms: Bayesian Regression Models using ’Stan’. 2023.

Kay M, Mastny T. Tidybayes: Tidy Data and ’Geoms’ for Bayesian Models. 2023.

Arel-Bundock V, cre, cph, Diniz MA, Greifer N, Bacher E. Marginaleffects: Predictions, Comparisons, Slopes, Marginal Means, and Hypothesis Tests. 2023

Wickham H, Chang W, Henry L, Pedersen TL, Takahashi K, Wilke C, Woo K, Yutani H, Dunnington D, Posit PBC. Ggplot2: Create Elegant Data Visualisations Using the Grammar of Graphics. 2023.

Pedersen TL. Patchwork: The Composer of Plots. 2023

Hong H, Chu H, Zhang J, Carlin BP. A Bayesian missing data framework for generalized multiple outcome mixed treatment comparisons. Res Synth Methods. 2016;7(1):6-22.

Becker BJ. Synthesizing standardized mean-change measures. Br J Math Stat Psychol. 1988;41(2):257–278.

Borges-Silva F, Martínez-Pascual M, Colomer-Poveda D, Márquez G, Romero-Arenas S. Does Heavy-Resistance Training Improve Mobility and Perception of Quality of Life in Older Women? Biology. 2022;11(5):626.

Buskard ANL, Jacobs KA, Eltoukhy MM, Strand KL, Villanueva L, Desai PP, Signorile JF. Optimal Approach to Load Progressions during Strength Training in Older Adults. Med Sci Sports Exerc. 2019;51(11):2224-2233.

Filho MM, Venturini GRDO, Moreira OC, Leitão L, Mira PAC, de Castro JBP, Aidar FJ, Novaes JDS, Vianna JM, Caputo Ferreira ME. Effects of Different Types of Resistance Training and Detraining on Functional Capacity, Muscle Strength, and Power in Older Women: A Randomized Controlled Study. J Strength Cond Res. 2022;36(4):984-990.

Hanson ED, Srivatsan SR, Agrawal S, Menon KS, Delmonico MJ, Wang MQ, Hurley BF. Effects of strength training on physical function: influence of power, strength, and body composition. J Strength Cond Res. 2009;23(9):2627-37.

Johnen B, Schott N. Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: a pilot study. Aging Clin Exp Res. 2018;30(7):819-828.

Lee SY, Goh A, Tan K, Choo PL, Ong PH, Wong WP, Wee SL. Effectiveness of a community-delivered pneumatic machine resistance training programme (Gym Tonic) for older adults at neighbourhood senior centres - a randomized controlled trial. Eur Rev Aging Phys Act. 2021;18(1):21.

Leenders M, Verdijk LB, van der Hoeven L, van Kranenburg J, Nilwik R, van Loon LJ. Elderly men and women benefit equally from prolonged resistance-type exercise training. J Gerontol A Biol Sci Med Sci. 2013;68(7):769-79.

Moura BM, Sakugawa RL, Orssatto LBDR, de Lima LAP, Pinto RS, Walker S, Diefenthaeler F. Functional capacity improves in-line with neuromuscular performance after 12 weeks of non-linear periodization strength training in the elderly. Aging Clin Exp Res. 2018;30(8):959-968.

Pinto RS, Correa CS, Radaelli R, Cadore EL, Brown LE, Bottaro M. Short-term strength training improves muscle quality and functional capacity of elderly women. Age. 2014;36(1):365-72.

Raj IS, Bird SR, Westfold BA, Shield AJ. Effects of eccentrically biased versus conventional weight training in older adults. Med Sci Sports Exerc. 2012;44(6):1167-76..

Roma MF, Busse AL, Betoni RA, Melo AC, Kong J, Santarem JM, Jacob Filho W. Effects of resistance training and aerobic exercise in elderly people concerning physical fitness and ability: a prospective clinical trial. Einstein (Sao Paulo). 2013;11(2):153-7.

Sayers SP, Gibson K, Bryan Mann J. Improvement in functional performance with high-speed power training in older adults is optimized in those with the highest training velocity. Eur J Appl Physiol. 2016;116(11-12):2327-2336.

Schaun GZ, Bamman MM, Andrade LS, David GB, Krüger VL, Marins EF, Nunes GN, Häfele MS, Mendes GF, Gomes MLB, Campelo PC, Pinto SS, Alberton CL. High-velocity resistance training mitigates physiological and functional impairments in middle-aged and older adults with and without mobility-limitation. Geroscience. 2022;44(3):1175-1197.

Schlicht J, Camaione DN, Owen SV. Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. J Gerontol A Biol Sci Med Sci. 2001;56(5):M281-6.

Walker S, Haff GG, Häkkinen K, Newton RU. Moderate-Load Muscular Endurance Strength Training Did Not Improve Peak Power or Functional Capacity in Older Men and Women. Front Physiol. 2017;8:743.

Haff GG, Triplett NT. Essentials of strength training and conditioning 4th edition. Human kinetics; 2015.

Steele J, Fisher JP, Smith D, Schoenfeld BJ, Yang Y, Nakagawa S. Meta-analysis of variation in sport and exercise science: Examples of application within resistance training research. J Sports Sci. 2023;41(17):1617-1634.

Steele J, Fisher JP, Giessing J, Androulakis-Korakakis P, Wolf M, Kroeske B, Reuters R. Long-Term Time-Course of Strength Adaptation to Minimal Dose Resistance Training Through Retrospective Longitudinal Growth Modeling. Res Q Exerc Sport. 2023;94(4):913-930.

Haynes EMK, Neubauer NA, Cornett KMD, O'Connor BP, Jones GR, Jakobi JM. Age and sex-related decline of muscle strength across the adult lifespan: a scoping review of aggregated data. Appl Physiol Nutr Metab. 2020;45(11):1185-1196.

Saeidifard F, Medina-Inojosa JR, West CP, Olson TP, Somers VK, Bonikowske AR, Prokop LJ, Vinciguerra M, Lopez-Jimenez F. The association of resistance training with mortality: A systematic review and meta-analysis. Eur J Prev Cardiol. 2019;26(15):1647-1665.

Shailendra P, Baldock KL, Li LSK, Bennie JA, Boyle T. Resistance Training and Mortality Risk: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022;63(2):277-285.

Pagan JI, Bradshaw BA, Bejte B, Hart JN, Perez V, Knowles KS, Beausejour JP, Luzadder M, Menger R, Osorio C, Harmon KK, Hanney WJ, Wilson AT, Stout JR, Stock MS. Task-specific resistance training adaptations in older adults: comparing traditional and functional exercise interventions. Front Aging. 2024 30;5:1335534.


2024-07-02 — Updated on 2024-07-10