May 11, 2020

Nick Bray, MSc, CSEP-CEP

Department of Kinesiology, Western University, London, Ontario, Canada

This month’s knowledge translation article was written by Nick Bray, a PhD Candidate at Western University and CSEP Clinical Exercise Physiologist. The work presented in this article is the product of Nick’s MSc research while under the supervision of Drs. Jennifer Jakobi and Gareth Jones at the University of British Columbia, Okanagan campus. Nick is currently supervised by Dr. Manuel Montero-Odasso. His Ontario Graduate Scholarship (OGS) funded PhD research investigates the impact of a multi-modal intervention (exercise, cognitive training, and vitamin D supplementation) on brain function. Nick is using functional magnetic resonance imaging (fMRI) to understand these elements in frail older adults with mild cognitive impairment.

This article relates to Dalton’s honours thesis, where he studied the effects of a cluster set configuration on measures of power in sprint athletes under the supervision of Dr. Phil Chilibeck. Dalton will continue his education in the Fall of 2020 at the School of Rehabilitation Science at the University of Saskatchewan, beginning his Masters of Physical Therapy.

Take home message

  • This article offers insight into the safety and potential benefits of a multi-component (aerobic, resistance, balance, and flexibility) exercise program and may be helpful to practitioners working with pre-frail older females.
  • Pre-frail females who exercise could consider using a multi-component exercise program including high-intensity free-weight strength training with exercises such as the squat, deadlift, and bench press. The study findings suggest such exercise may be safe for pre-frail females in a supervised setting.


  • Frailty is a condition of reduced function and health in older adults, often characterized by slow walking speed, excess fatigue, weight loss, muscle weakness, and low physical activity. Pre-frail individuals have some symptoms of frailty and are more likely to progress to becoming frail than those that are non-frail. Among those living with frailty symptoms, females that are pre-frail represent the largest demographic.
  • Exercise is an effective therapy to prevent progression to frailty, yet exercise interventions in frailty have included only low-intensity, single-joint resistance training – perhaps as a result of a commonly held belief that intense, free-weight exercise is unsafe.
  • The study aimed to determine if supervised, high-intensity, free-weight resistance training was safe, enjoyable, and effective in pre-frail females.

How the study was done

  • The 12-week intervention included nine pre-frail females older than 65 (72.9 ± 4.8) years. Eleven age- and frailty-matched females (72.4 ± 5.4) maintained their normal routine for the same duration.
  • The exercise was a supervised, multi-component intervention performed for ~60 min/day, 3 days/week. The program included progressive resistance training involving the squat, deadlift, and bench press exercises. Each session also included an aerobic warm-up, balance exercises, and flexibility cool-down.
  • Participant adherence, dropout, and adverse events were monitored throughout. Both groups were assessed for frailty status, functional task performance (walking speed, hand-grip strength, and sit-to-stand time), muscle strength, and muscle speed at week 0 (pre-intervention) and 13 (post-intervention). Measures of functional tasks, muscle strength, and muscle speed were repeated at weeks five and nine for only the exercise group.

What the researchers found

  • No participants dropped out or experienced an adverse event, and adherence was ~90%.
  • The exercise group became less frail, whereas the control group became more frail.
  • The exercise group improved all measures of functional task performance, including walking speed, hand-grip strength, and sit-to-stand time. These improvements were observed as early as week nine of the intervention. The control group improved only in sit-to-stand time, and the improvement was smaller than that observed in the exercise group.
  • The exercise group improved knee extension strength and speed, and elbow flexion speed, whereas the control group declined. Improvements in elbow flexion occurred despite the elbow flexors not being directly trained during the intervention.


  • Supervised high-intensity, free-weight resistance training appears to be a feasible and safe option for pre-frail females.
  •  A 12-week intervention can improve frailty status, functional task performance, muscle strength, and muscle speed in this demographic.

Reference: Bray, N.W., Jones, G.J., Rush, K.L., Jones, C.A., Jakobi, J.M. Multi-Component Exercise with High-Intensity, Free-Weight, Functional Resistance Training in Pre-Frail Females: A Quasi-Experimental, Pilot Study. J Frailty Aging (2020).