24.6 — Strength, Cardio and Mobility

You lose 3 to 8 percent of your muscle mass per decade after 30, and the rate accelerates after 60.

And strength falls faster than mass — power, which is force times speed, falls fastest of all.

Which explains something important: the reason an older person cannot get out of a chair is usually not that they lack the strength to push. It is that they lack the power to push fast enough to get moving.

Resistance training reverses a substantial part of this at any age. Studies in people in their eighties and nineties, including nursing home residents, have shown meaningful gains in strength, walking speed and stair-climbing ability within weeks.

Which makes strength training the single highest-value thing most people over 50 are not doing.

The four components

Cardiovascular fitness — the heart, lungs and circulation.

Strength — muscle force.

Mobility and flexibility — range of motion.

Balance — increasingly important with age.

A complete programme touches all four. Most people do one and neglect the rest, and the one they do is usually cardio.

Cardiovascular training

Zone 2 — the base

Moderate intensity, sustainable, conversational.

Around 60 to 70 percent of maximum heart rate. The talk test works better than the number: you can hold a conversation but would rather not sing.

This is where most of your cardio should be — the majority of training volume in endurance athletes is at this intensity, sometimes called the 80/20 rule.

What it develops: mitochondrial density, capillary networks, fat oxidation, and the aerobic base everything else sits on (Chapter 24.5).

Examples: brisk walking, easy jogging, cycling, swimming, rowing, hiking.

Duration: 30 to 60 minutes.

Intervals — the top end

Short bursts of high effort with recovery between.

They improve VO2 max more efficiently per minute than steady work, and they improve the ability to tolerate hard effort.

A well-studied format: 4 minutes hard, 3 minutes easy, repeated 4 times, after a warm-up.

Shorter formats: 30 seconds hard with 90 seconds easy, repeated 6 to 10 times.

One to two sessions a week is plenty. Intervals are demanding and need recovery, and doing all your training hard is the classic way to stall progress and get injured.

Not the place to start if you are new to exercise. Build a base first.

How to choose

Walking is genuinely underrated. It is the most sustainable exercise there is, it requires nothing, and brisk walking is associated with substantial mortality reduction.

Running — efficient, high impact, good for bone.

Cycling and swimming — joint-friendly, and they do little for bone density, so pair them with resistance work.

Rowing — full body, low impact.

And the best one is the one you will keep doing. That criterion beats every other consideration.

Strength training

The principles

Progressive overload. Muscle adapts to what it is asked to do, so the demand has to increase over time — more weight, more repetitions, more sets, or less rest.

Without progression, you maintain. Which is fine as a goal and is not the same as improving.

Specificity. You get better at what you practise.

Recovery. 48 hours between sessions for the same muscle group.

What actually matters

And the research here is more forgiving than gym culture suggests.

Volume drives hypertrophy — roughly 10 or more hard sets per muscle group per week, with more producing more up to a point.

Load range is wide. Muscle growth is similar across a broad range of loads — anywhere from about 30 percent to 85 percent of your maximum — provided sets are taken close to failure.

Which means light weights for many repetitions and heavy weights for few both build muscle. Heavy loads build maximal strength better; lighter loads work fine for size and are easier on the joints.

Proximity to failure matters more than the exact weight. Stopping with 1 to 3 repetitions left in reserve is close to optimal, and training to absolute failure every set adds fatigue without much extra benefit.

Frequency: two or more sessions per muscle group per week is better than one, for the same total volume.

Rest between sets: 2 to 3 minutes for strength, 1 to 2 for hypertrophy. Short rests are not better — they reduce the quality of subsequent sets.

The movements worth knowing

Six patterns cover the body:

Squat — bodyweight squat, goblet squat, barbell squat, leg press.

Hinge — deadlift, Romanian deadlift, hip thrust, kettlebell swing.

Push — press-up, bench press, overhead press.

Pull — row, lat pulldown, pull-up.

Carry — farmer's carry, suitcase carry. Underrated, and directly transferable to real life.

Core — plank, dead bug, pallof press. And a note: the core's main job is resisting movement — preventing the spine from bending, extending and rotating — which is why anti-movement exercises like planks train it better than endless sit-ups.

A simple twice-weekly programme: squat, hinge, push, pull, carry, core. Two to four sets each. Add weight or repetitions when you can complete all sets comfortably.

That is a complete strength programme, and it fits in 40 minutes.

Equipment

None is needed to start. Bodyweight training builds real strength, particularly for beginners — press-ups, squats, lunges, planks, glute bridges.

Resistance bands — cheap, portable, effective.

Dumbbells or kettlebells — versatile.

Barbells — the most efficient for heavy progressive loading.

Machines — safe, easy to learn, and good for isolation.

All of them work. The evidence does not support any one modality as clearly superior for general health.

Form and safety

Learn the movement before adding load.

Full range of motion where your joints allow.

Control the lowering phase, which is where much of the muscle-building stimulus comes from.

Breathe — exhale on effort. And avoid prolonged breath-holding under heavy load, which spikes blood pressure sharply.

Warm up with lighter sets of the movement itself.

And distinguish good pain from bad. Muscle burn and fatigue are fine. Sharp, joint or radiating pain is not.

A qualified coach for a few sessions is genuinely worth the money if you are learning barbell movements.

Mobility and flexibility

And the evidence here is less impressive than the industry around it.

Static stretching before exercise temporarily reduces strength and power output, and it does not reduce injury risk. Which is why it has been replaced in warm-ups.

A dynamic warm-up works better: 5 to 10 minutes of light aerobic activity, then movements through the range you are about to use — leg swings, arm circles, bodyweight squats, lunges.

Static stretching is fine afterwards or as a separate session, and it does improve range of motion over time — mostly by increasing tolerance to stretch rather than by lengthening tissue.

What actually improves mobility:

Full range of motion strength training. Training a muscle through its full range improves flexibility comparably to stretching, and it builds strength at the same time — which is why the two goals are less separate than they appear.

Loaded stretching — such as Romanian deadlifts for hamstrings, deep squats for hips and ankles.

Yoga and Pilates, which combine mobility, strength and balance and have reasonable evidence for back pain and general function.

And a genuine caution: hypermobility is not a goal. Excessive range without strength to control it increases injury risk. The target is usable range, not maximum range.

Foam rolling — produces short-term improvements in range and reduces perceived soreness. It does not release fascia or break down adhesions, whatever the marketing says. The effect is probably neurological. It is pleasant and it helps a bit.

Balance

And this is the one most people ignore until they fall.

Falls are the leading cause of injury death in older adults (Chapter 21.6), and balance training is one of the few interventions that reliably prevents them.

Simple progressions, each held for 30 seconds:

Feet together. Then heel-to-toe. Then single leg. Then single leg with eyes closed. Then single leg on an unstable surface.

Add movement: heel-to-toe walking, sideways walking, standing up from a chair without using hands, stepping over objects.

Tai chi has particularly strong trial evidence for fall prevention, and it is enjoyable enough that people keep doing it, which matters more than any single component.

The practical test: being able to stand on one leg for 10 seconds is associated with lower mortality in middle-aged and older adults — not because standing on one leg is protective, but because it is a marker of overall neuromuscular condition.

Balance can be trained anywhere. Stand on one leg while brushing your teeth. That is a real intervention and it costs no time at all.

Building a week

A realistic template for general health:

2 strength sessions — full body, 30 to 45 minutes.

2 to 3 cardio sessions — mostly moderate, one harder if you want it.

Daily walking — aim for around 7,000 steps.

Balance work — woven into daily life.

Mobility — a few minutes after sessions, or one longer session.

That is around 4 to 5 hours a week, and it covers everything.

If you have less time, the priority order is: strength training first, because nothing else replaces it; then daily walking; then everything else.

Special situations

Pregnancy — exercise is recommended and beneficial. Continue what you were doing, avoid contact sports and falls risk, avoid lying flat on the back after the first trimester, and be aware that ligament laxity increases. Pelvic floor training has good evidence (Chapter 15.7).

Older adults — strength and balance become more important, not less. Higher protein intake supports it (Chapter 24.1). Start light and progress; frailty is not a reason to avoid resistance training, it is the reason to do it.

Existing conditions — exercise is beneficial in almost all chronic disease, including heart failure, COPD, arthritis, diabetes, cancer and depression. Cardiac rehabilitation and pulmonary rehabilitation are specific programmes with strong evidence (Chapter 21.1). Get advice on how, rather than whether.

Children and adolescents — 60 minutes of moderate to vigorous activity daily, including bone-loading and muscle-strengthening activity three times a week. Resistance training is safe for young people with proper supervision and does not stunt growth, which is a persistent myth.

Returning after injury or illness — start below where you left off and progress gradually. Something is always better than nothing.

The behavioural part, which decides everything

And this matters more than any programme detail, because the best programme you abandon in March is worth less than the mediocre one you keep.

Make it specific. "Exercise more" fails. "Monday and Thursday at 7pm, strength, at home" works.

Attach it to something you already do — after dropping the children off, before the shower, straight after work.

Start smaller than you think you should. The commonest reason people quit is starting too hard and being too sore, too tired or too discouraged in week two.

Track something — sessions completed, weight lifted, distance walked. Visible progress sustains motivation better than intention does.

Make it social where you can. Training with someone else, or in a class, substantially improves adherence.

Choose something you do not hate. This sounds obvious and it is the most ignored piece of advice in fitness.

Plan for disruption. You will miss weeks — illness, travel, work, family. The people who succeed are not the ones who never miss; they are the ones who restart without treating a missed fortnight as a failed year.

And two things worth losing entirely: the idea that it has to be an hour, and the idea that a missed session ruins anything. Ten minutes counts. A single session after three weeks off is a restart, not a rounding error.

What the next page fixes

Chapter 24.7 covers sleep — the third pillar alongside food and movement, and the one most reliably sacrificed.