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Low-Impact Exercise, Yoga, Reduces Urinary Incontinence in Older Women

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Low-Impact Exercise, Yoga, Reduces Urinary Incontinence in Older Women
A 12-week study shows that low-impact yoga and exercise can significantly reduce urinary incontinence episodes in older women, offering a safe, accessible alternative to medications

It’s more likely than not that personal trainers will work with female clients who deal with incontinence issues, which could be an obstacle on their path to the fitness and wellness goals. Recent research supports the belief that solutions are available, and exercise may be one of them.

A recent study led by Stanford Medicine and the University of California, San Francisco, has found that low-impact exercise programs, such as yoga and general stretching, significantly reduce urinary incontinence episodes in older women. The research, published in Annals of Internal Medicine on August 27, provides promising alternatives for women seeking non-pharmacological treatments.

A Underreported & Common Issue

Urinary incontinence affects more than half of middle-aged women and up to 80% of women over 80 and can interfere with daily activities and significantly impact quality of life. The study examined the effects of a 12-week low-impact yoga program and found a 65% reduction in incontinence episodes among participants.

“We were testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” said Dr. Leslee Subak, chair of obstetrics and gynecology at Stanford Medicine and the study’s senior author. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor and is accessible wherever you live.”

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The research set out to find cost-effective and accessible solutions for a problem that is often stigmatized and underreported. According to Subak, incontinence is mistakenly viewed as an inevitable part of aging, though treatments are available.

“Incontinence is not only common, but it also interferes with people’s lives,” Subak noted. “It takes away independence. Many women avoid staying with their children or grandchildren due to the fear and embarrassment of an accident.”

credit: MixMedia

Study Parameters

The study involved 240 women between the ages of 45 and 90, all experiencing daily incontinence. Participants were divided into two groups: one practicing 16 hatha yoga poses aimed at strengthening the pelvic floor, and the other group performing general stretching and strengthening exercises.

Both groups attended two 90-minute exercise sessions weekly and were asked to practice independently for at least an hour per week.

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Both the yoga and the control groups experienced significant improvements. Participants in the yoga group reported an average of 2.3 fewer daily incontinence episodes, while those in the general exercise group saw a reduction of 1.9 episodes per day. These results are comparable to the 30% to 70% improvement rates seen with medications for incontinence, according to the researchers.

Subak emphasized the importance of regular activity, which is good news for fitness professionals who work with this population.

“One of the take-home messages from this study is ‘Be active!’ I’m impressed that exercise did so well and that yoga did so well,” Subak added.

The benefits of physical activity, including yoga, extend beyond managing incontinence. As the study’s lead author, Dr. Alison Huang, professor at UCSF, pointed out, being physically active helps reduce the risk of other health issues, such as falls and bone fractures, which can be exacerbated by conditions like incontinence.

The study was funded by the National Institutes of Health, with contributions from researchers at Yale University and San Francisco State University.

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Psychology says people who stay fit after 60 without formal exercise aren’t lucky – they practice 10 daily habits that turn their entire life into low-grade movement their body interprets as purpose, not obligation

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Psychology says people who stay fit after 60 without formal exercise aren’t lucky – they practice 10 daily habits that turn their entire life into low-grade movement their body interprets as purpose, not obligation

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You know the type. They are in their sixties or seventies, visibly fit, moving easily, and when you ask them what their exercise routine is, they look at you blankly. They do not have one. They do not go to the gym. They do not run. They do not follow a program. And yet they are in better physical shape than most people half their age who have gym memberships they use three times a week.

They are not lucky. They are not genetically gifted. They have built a life that moves.

The research has a name for this. It is called non-exercise activity thermogenesis, or NEAT, and it may be the most important concept in fitness that almost nobody talks about.

What NEAT actually is

Research by James Levine at the Mayo Clinic defined NEAT as the energy expended for everything that is not sleeping, eating, or sports-like exercise. It includes walking to work, typing, performing yard work, undertaking agricultural tasks, and fidgeting. Even trivial physical activities increase metabolic rate substantially, and it is the cumulative impact of a multitude of small exothermic actions that culminate in a person’s daily NEAT. For the vast majority of people, even avid exercisers, NEAT is the predominant component of activity-related energy expenditure.

The variation between individuals is staggering. Research published in Arteriosclerosis, Thrombosis, and Vascular Biology found that NEAT can vary by up to 2,000 calories per day between people of the same weight, primarily due to differences in lifestyle and occupation. The majority of the world’s population does not participate in formal exercise. For them, it is not variable exercise levels but rather the variance in NEAT that accounts for most of the variability in total activity-related energy expenditure.

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The people who stay fit after 60 without a gym membership have simply built lives where NEAT is high. Here are the ten habits that do it.

1. They cook their own meals

Cooking is a full-body, low-grade physical activity that most people do not think of as movement. Standing, reaching, chopping, stirring, bending to get things out of the oven, moving between counter and stove. A person who cooks two meals a day from scratch is on their feet and moving for an hour or more without ever thinking of it as exercise. The person who orders delivery is sitting the entire time.

2. They maintain their own home

Vacuuming, mopping, cleaning bathrooms, doing laundry, making beds, tidying. A review of NEAT as a component of total daily energy expenditure noted that if obese individuals adopted the NEAT-enhanced behaviors of their lean counterparts, they could expend an additional 350 calories per day from these numerous small activities. Household maintenance is one of the largest reservoirs of daily movement available, and the people who outsource all of it are removing one of the most reliable sources of physical activity from their lives.

3. They garden

Gardening involves squatting, kneeling, digging, lifting, carrying, bending, and walking, often for hours at a stretch. It is weight-bearing, it requires balance and flexibility, and it happens outdoors. For many fit older adults, the garden is not a hobby. It is an unintentional full-body workout that they do because they enjoy it, which is why they have been doing it consistently for 30 years. Consistency is the variable that matters most in fitness, and enjoyment is the variable that predicts consistency.

4. They walk as transportation, not exercise

They walk to the shops. They walk to visit friends. They walk to the post office. The walk is not a workout. It is how they get places. This distinction matters because it removes the psychological barrier of motivation. You do not have to talk yourself into walking to the grocery store the way you have to talk yourself into going for a 30-minute walk for health reasons. The movement is embedded in the task, not attached to it.

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5. They take stairs as a default

Not as a fitness decision. As a habit. They simply use stairs when stairs are available, the same way they use doors when doors are available. It is not a choice they make each time. It is a default that was set years ago and never reconsidered. That automaticity is what makes it sustainable. The moment you have to decide whether to take the stairs, willpower is involved. When it is a default, no willpower is required.

6. They carry things

Groceries, laundry baskets, grandchildren, bags of soil, firewood. They have not outsourced the physical labor of daily life to delivery services and convenience tools. They still lift, carry, and transport objects as part of their routine. This provides natural, functional resistance training that maintains grip strength, bone density, and the kind of practical strength that prevents falls and injuries as you age.

7. They stand more than they sit

Research published in Mayo Clinic Proceedings found that NEAT movements could result in up to an extra 2,000 calories of expenditure per day beyond the basal metabolic rate, and that the benefits of NEAT include not only extra calories expended but also reduced occurrence of metabolic syndrome, cardiovascular events, and all-cause mortality. Simply standing rather than sitting is one of the most impactful NEAT behaviors. The fit older adults tend to be people who stand while talking on the phone, stand while reading, stand while cooking, and default to standing whenever sitting is not required.

8. They have active social lives

They meet friends for walks rather than coffee. They play with grandchildren on the floor. They attend community events that require getting up, going out, and moving around. Social activity that takes place in physical space, rather than on screens, is inherently movement-rich. The fit older adult’s social calendar is also, without them thinking of it this way, a movement calendar.

9. They do their own errands

They go to the bank, the pharmacy, the hardware store. They do not batch all errands into a single car trip for efficiency. They make multiple small trips throughout the week, each of which involves getting up, getting dressed, walking to and from the car or walking to the destination, moving through a store, and carrying items back. Efficiency is the enemy of NEAT. The person who optimizes their errands into one weekly outing has also optimized the movement out of five days.

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10. They have a purpose that requires their body

This is the one that ties all the others together. The people who stay fit after 60 without formal exercise are not just moving more. They are moving for reasons that matter to them. The garden matters. The home matters. The meals they cook for their family matter. The grandchildren they pick up and carry matter. The community they walk through matters. Their movement is not separated from their life and packaged as a workout. It is woven into the fabric of a life that has purpose, and their body interprets that purpose as a reason to stay capable.

Levine’s original research on NEAT noted that epidemiological studies highlight the importance of culture in promoting and quashing NEAT. Agricultural and manual workers have high NEAT, whereas wealth and industrialization appear to decrease it. The modern world has systematically removed movement from daily life and then told us to add it back in the form of structured exercise. The people who stay fit after 60 simply never made that trade. They kept the movement where it always was: inside the life itself.

That is not luck. That is architecture. And it is available to anyone willing to build a life that moves instead of a schedule that exercises.

 

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Should you try the 75 Hard challenge? Experts warn the risks may outweigh the benefits | CNN

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Should you try the 75 Hard challenge? Experts warn the risks may outweigh the benefits | CNN

Five requirements. Seventy-five days. No breaks and no room for mistakes.

That’s the premise of 75 Hard, a challenge created by entrepreneur and author Andy Frisella and marketed as a “transformative mental toughness program” and “an ironman for your brain,” according to his website.

Chicago runner Sarah Lyons learned quickly how demanding the rules could be.

On paper, the daily checklist seems straightforward: Follow a structured diet with no alcohol, drink a gallon of water, read 10 pages of nonfiction, take a progress photo, and complete two 45-minute workouts, one outdoors, every day for 75 consecutive days.

In practice, the routine can take over your schedule and your life.

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The challenge includes several healthy habits such as daily movement, reading and hydration, but experts say its rigid, all-or-nothing approach may undermine the long-term behavioral changes it promises.

For people drawn to 75 Hard, the goal shouldn’t be perfection but building habits you can keep when life inevitably gets messy, according to experts. Here’s what they say should be taken away from this challenge — and what could be left behind.

One of the program’s defining features is its strictness: Miss one task and you restart the entire challenge, whether you’re on day 2 or day 74.

The website discourages modifications, saying that “compromise nerfs off the sharp edges of what could be an exceptional life.”

Before she started her first 75 Hard challenge, Lyons “felt stuck in a rut both physically and mentally.” Initially drawn to the structure of the challenge, she was looking for something to help rebuild discipline and momentum.

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But that structure can backfire.

“Sustainable fitness isn’t about punishment or proving discipline through extremes — it’s about building habits that integrate into your lifestyle in a way that feels supportive and repeatable,” said CNN fitness contributor Dana Santas, a certified strength and conditioning specialist and mind-body coach in professional sports.

Forcing a restart after one deviation, Santas said, can reinforce a cycle of perceived failure rather than building durable behavior changes — especially when real life inevitably intervenes through travel, illness, family obligations, weather or simply an off day.

That mindset may also affect eating behaviors. It can contribute to binge eating, disordered eating patterns, negative body image and negative self-talk, warned Bethany Doerfler, senior clinical research dietitian at Northwestern Medicine Digestive Health Institute in Chicago.

People may also define “slip-ups” differently, she added, creating a potential gateway to unhealthy behaviors.

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Lyons said the rigidity sometimes created stress in her own life, too. During her first attempt, she said there were many days when she delayed tasks until late in the evening, which added pressure rather than making her feel healthier.

With that strict framework in mind, experts say it’s worth separating the challenge’s healthier building blocks from the parts that may be risky or unsustainable.

One important note: Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

One element of the 75 Hard that does allow flexibility is the way people eat. Participants choose their own diet. That could mean Mediterranean, Paleo, cutting ultraprocessed foods or another structured approach.

But experts stress that any diet change works best when it’s designed for real life.

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If you’re considering a structured eating plan, Doerfler points to the Mediterranean diet. It emphasizes fruits, vegetables, whole grains, legumes and nuts, uses plant-based fats, and limits ultraprocessed foods and desserts, she noted.

Lasting dietary change usually requires a lifestyle shift — and consistency matters more than intensity. “Patients often benefit from a routine strategy which reduces friction for lifestyle change,” she said.

Doerfler recommends setting aside one or two days each week to wash and cut produce for meal prep and snacks. She suggests having a plan for social settings so eating out feels manageable rather than stressful.

Lyons, the runner, said her diet evolved between her two attempts at the challenge. During her first round, she followed a strict whole-food, plant-based diet. During her second attempt, she focused on eliminating processed sugars, fast food and baked goods while still including meat and fish.

But she also noticed the rules changed how she navigated food socially. Lyons said she became cautious about eating out and often avoided restaurants because she felt anxious about potentially breaking the challenge.

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Alcohol and water: One clear benefit and one major red flag

Food rules may be flexible in 75 Hard — but the drinking rules are not.

Participants must abstain from alcohol and drink 1 gallon of water each day.

Cutting back on alcohol can improve how you feel and lower your risk of cancer, heart disease, liver disease and memory problems to list a few, according to the US Centers for Disease Control and Prevention.

The water requirement, however, raises concerns among experts.

“I do not recommend drinking this much water,” Doerfler said. She noted 1 gallon is 16 cups of water. Experts recommend 9 cups of fluids for females and 12 ½ cups for males. Combined with a strict diet and increased exercise, there is a great risk of developing an electrolyte imbalance, particularly sodium, she said.

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Symptoms of hyponatremia, or having abnormally low sodium levels in the blood, can include seizures, muscle cramping, nausea and vomiting according to the Cleveland Clinic.

Hydration needs vary widely depending on body size, activity level and climate, Santas said. While drinking enough water is important, rigid daily targets without guidance can disrupt sleep or contribute to electrolyte imbalances if large amounts of fluid are consumed quickly.

Lyons said the gallon rule often felt excessive. The frequent bathroom breaks often disrupted her routine and didn’t always feel necessary from a hydration standpoint.

Because the program requires two workouts a day, hydration and recovery can become even more important.

Participants must complete two 45-minute workouts every day for 75 straight days — and one must be outdoors. This is where experts see some of the biggest physical and behavioral risks.

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During her first attempt, Lyons quickly realized that using the outdoor workout primarily as a walk would be more feasible.

“Two high-intensity 45-minute workouts each day would not have been realistic for me long term ,” she said.

Santas pointed to the US Department of Health and Human Services Physical Activity Guidelines for Americans, which recommend 150 to 300 minutes per week of moderate-intensity activity (or 75 to 150 minutes of vigorous activity), with an emphasis on customization, progressive overload, recovery and sustainability.

“The 75 Hard structure far exceeds the recommendations and doesn’t provide any individualized guidance or programmed recovery,” Santas added.

The program’s claim that it works for everyone “regardless of physical fitness” may not hold up in practice, Santas said. Professional athletes or people with highly flexible schedules might manage it, but for many people balancing work and family, the structure can be unrealistic.

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Even for those who complete it, Santas warned of overuse injuries, excessive fatigue and burnout due to unclear intensity guidance and zero recovery days.

Lyons experienced that challenge firsthand during her second attempt, which overlapped with training for the Boston Marathon. Long marathon runs can last 2 to 3 ½ hours and because the challenge prohibits combining workouts, she often had to complete a long training run plus an additional 45-minute workout.

On some days, this resulted in four or more hours of exercise.

It was “physically and mentally exhausting and ultimately unsustainable,” she said. In hindsight, she would not recommend pairing 75 Hard with marathon training. She found herself avoiding the gym because she needed physical and mental recovery, she added.

Lyons also questioned the rigidity of the outdoor-workout requirement. During her 2025 attempt, she was living in Chicago during winter, when temperatures occasionally dropped below zero. Exercising outdoors in extreme conditions felt unsafe and impractical, she said, and while she still completed two workouts daily, she chose to prioritize safety and consistency over strict adherence to that specific rule.

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If the extreme discipline of Hard 75 isn’t the best way to build lasting habits, what does science-based research show?

“Habits are behaviors that we enact without deliberation,” said Dr.
Katy Milkman, James G. Dinan Endowed Professor at Wharton School of the University of Pennsylvania.

Imagine everyday routines like shampooing your hair or making coffee in the morning she said.

Habits are formed through repetition. The more often we repeat a behavior, the more likely it is to become habitual and go on autopilot, added Milkman, the author of “How To Change : The Science of Getting From Where You Are to Where You Want to Be.”

“They’re formed through positive associations and rewards,” she said. Picture your caffeine buzz after drinking a coffee or getting paid after you complete your work, these habits are often triggered by a common cue like a location, time or even smell.

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It takes a set number of days to form a habit, Milkman said, but she noted that more complex habits typically take longer to become automatic.

“The more friction you put between someone and execution of a habit the worse it is in terms of habit formation,” she said. “If you want to break a habit, you make it really hard to do.”

If someone is already regularly exercising, reading daily and staying well-hydrated, Milkman said, 75 Hard may be more doable. But for someone starting from scratch, she said the time and logistical burden of completing every requirement every day may be the biggest obstacle.

Lyons said one part of the challenge that did help her build a lasting routine was the daily reading component.

She said she genuinely enjoyed that requirement because she has many books she wants to read but often struggles to consistently set aside time for it. Across both attempts at the challenge, she finished four books each time, she said, and the structure helped rebuild her habit.

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If you’ve heard of 75 Hard, you may also know about 75 Medium or 75 Soft, which include flexibility and customization for things like rest days or hydration goals and can be adjusted to meet people where they are.

That adaptability is often key to long-term behavioral change, experts say. There is no one-size-fits-all approach.

Lyons said she doesn’t believe 75 Hard is inherently negative, and she thinks it can work for people who are highly motivated by strict structure and intensity. But she believes it may be overwhelming for beginners or anyone starting from a low baseline of fitness — and she doesn’t support its extreme approach.

In her experience, sustainable consistency is built through adaptability and learning to recover from setbacks rather than viewing them as failures.

“There are positive elements embedded in the challenge — encouraging movement, outdoor time, reading and hydration — but I would advocate for a more structured, individualized and recovery-aware approach that aligns with established exercise science,” Santas said.

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I couldn’t hold a plank at 59 – now I can do pull-ups at 76

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I couldn’t hold a plank at 59 – now I can do pull-ups at 76

Lillian Haynes reaches overhead and wraps her knuckles around a chalky metal pull-up bar. She takes a deep breath, sets herself, then contracts her back muscles, pulling her body skywards with surprising ease. She is 76 years old.

Later, she cranks out 15 perfect press-ups with technique that would put most twentysomething gym-goers to shame. Yet, at 59, she lacked the strength to hold a bodyweight plank.

Lillian, mother of experienced strength coach and Coastal Fitness founder Ed Haynes, is a prime example of the fact that it is never too late to start training, having started working out with her son shortly before turning 60.

“When I started training my mum, all she had done was jogging,” Haynes says. “I’ve been coaching her for 16 years now, and now she does strength training four days a week, plays golf three times a week and is more knowledgeable than most coaches when it comes to nutrition. At 76, she’s more active than most people half her age.”

Prioritise quick wins

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“If you walk 10km into the woods, you have to walk 10km to get out of it,” says Haynes. In other words: the impact of 20 years of unhealthy habits is going to take time and effort to undo.

“For most people, the rate of adaptation from exercise is quite slow, especially if they are a little bit older,” he adds. This is why he prioritises quick wins with his clients – lifestyle changes that have a near-immediate positive impact.

“I think a lot about the pain points that people are dealing with,” he continues. “One is physical pain – sore joints, or difficulty walking down the stairs. So what are the quick wins we can use that are going to reduce pain tomorrow?

For most people, it’s all about nutrition and lifestyle. “For example, most people don’t drink enough. But we know that if we can drink adequate amounts of water relative to our body weight and activity levels, inflammation reduces. And when inflammation reduces, pain reduces.”

Read more: I specialise in coaching people aged 40-plus – do these six things for immediate results

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Small lifestyle changes can have a near-instant positive impact on how your body feels (Kawee – stock.adobe.com)

Make gradual changes

Breaking old habits and creating new ones is hard. For this reason, Haynes recommends making gradual changes and building on them over time. For example, if you currently sleep for five hours each night, start aiming for five-and-a-half hours. When that feels manageable, look to hit six.

The same applies with exercise. Don’t jump from zero workouts to five gym sessions per week – rather, start with one short weekly workout, then when this feels like second nature, you can add more.

Read more: Do these five things daily for 90 days to see a ‘profound difference’ in your health, fitness and energy levels

Making and breaking habits is not easy – particularly if you have held them for a long time. Use gradual changes to ease yourself into healthier practices.
Making and breaking habits is not easy – particularly if you have held them for a long time. Use gradual changes to ease yourself into healthier practices. (Getty/iStock)

“Changes are happening in our bodies all the time, and each time they do, it can be like dealing with a whole person.”

For this reason, you can’t bullishly push forward with your pre-existing plans and habits. Instead, as Haynes puts it, “the protocols need to evolve”. Find ways to build healthy, sustainable habits that work alongside your lifestyle, and change them as needed to suit your ever-updating circumstances.

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Read more: Why the perfect workout doesn’t exist – and why that’s good news

Choose full-body workouts

“Generally speaking, full-body resistance training works really well for this demographic,” Haynes says. “Most people don’t really need to be doing strength training more than three days a week, but if you’re at zero weekly workouts right now, you should start with one. If you’re at one and comfortable with that, we will look to get you to two.”

If you can commit to this, you will see increased muscle mass, which Haynes likens to “armour” – capable of preventing injury and protecting you from falls. It also improves physical capacity and aids blood sugar regulation, combatting diabetes.

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“It’s also the best way to increase bone density,” Haynes adds. “Running, yoga and pilates are not going to do it because there’s not enough tension on the muscle tissue and bone structures to make them adapt and fight things like osteopenia and osteoarthritis.”

Read more: The uncomfortable truth about building muscle and eight golden rules for strength training in midlife

Full-body strength training workouts allow you to recruit every major muscle group in a single session, making for a time-efficient and effective approach to training
Full-body strength training workouts allow you to recruit every major muscle group in a single session, making for a time-efficient and effective approach to training (Alamy/PA)

Choose your exercise wisely

Strength training sessions for people aged 50 and above can generally look quite similar to those used by people of any age. But there are some extra elements to consider.

“My stance on exercise is that nothing is off the table – why put limits on yourself because you’re 70?” says Haynes. “Most exercises are useful, but every exercise can be bad if performed incorrectly.

“There are plenty of beautiful things that might come from learning more complex exercises if you can nail it, but there’s also a potential risk of injury. It’s about working out if you are OK with that, or if you would rather stick with safer dumbbell or machine exercises.”

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For example, if you want to strengthen your legs, you can choose between a barbell squat and a leg press, among other movements.

“Both exercises are training the knees and hips in a flexed position – they’re flexing, then extending,” says Haynes. “But with a barbell squat, we have a high stability component, and you have to keep your joints in alignment and learn to brace effectively.”

The leg press, on the other hand, has a shallower learning curve and can be safer as a result.

“Because time is precious and the risk of injury is higher when you are older, we’re often going to choose lower-risk movements,” Haynes concludes.

Read more: The science-backed exercise method that can help fight the effects of ageing

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The key is finding the right exercise for your fitness goals, considering their safety, complexity, stimulus and how much you enjoy them
The key is finding the right exercise for your fitness goals, considering their safety, complexity, stimulus and how much you enjoy them (Getty/iStock)

Choose your rep scheme carefully

If you are new to an exercise, start by using lighter weights and performing more repetitions – Haynes suggests 15 to 20 reps per set. This, he says, is generally safer than performing a five-rep set with a heavier weight, while still allowing you to challenge your muscles.

“You’re going to start light and do lots of reps,” says Haynes. “As time passes and your body learns to handle this, you can gradually reduce the target number of repetitions and increase the load.

“Maybe, in a few years’ time, you will be able to work to a five-rep max [the most weight you can lift for five repetitions] of an exercise.”

Read more: Doctor of strength training shares a 40-minute weekly dumbbell workout plan for building strength and mobility

Physical ability peaks at 35 but if you can create a healthier lifestyle than you followed in your younger years, there’s no reason why you can’t see impressive fitness progress at any age
Physical ability peaks at 35 but if you can create a healthier lifestyle than you followed in your younger years, there’s no reason why you can’t see impressive fitness progress at any age (Getty/iStock)

Avoid comparison syndrome

“I have a lot of conversations with people comparing themselves to their younger self, which can be a massive roadblock for some people,” says Haynes. “Another thing that comes up a lot is biological age – people think they’ve missed the bandwagon and there’s no point in training.”

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But if you only start strength training in your thirties or forties, or you change your routine to live a healthier life than your younger self, chances are you can trump your former abilities, Haynes says.

“You can still have your highest level of muscle mass in your sixties and be hitting strength PRs in your seventies because you’re so new in your training journey,” he explains. “The best time to start is now.”

Read more: Expert warns why this daily habit is shortening your life – even if you exercise

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