Protocol · graded by use, three uses
Resistance training 2–3×/week
Muscle size and strength, progressive overload.
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How this letter has changedLatest: October 2026 · Corrected.
The A rested on one pooled analysis in adults 75 and over; the Cochrane review of progressive resistance training (Liu and Latham, 2009; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 19588334), 73 trials on measured strength, now stands beside it and the population is no longer narrowed to 75 and over. The glycemic use said it rested on a single pooled analysis; Wan et al. (2024; PMID 38623887), 46 trials, is added. The blood pressure use now cites the earlier, smaller Cornelissen pool (2013; PMID 23525435). Wording that implied every measure improved is corrected: handgrip strength and fiber size did not change significantly in Grgic 2020 (PMID 32740889). The Greek replication trial (Kalapotharakos et al., Aging Clin Exp Res, 2010; PMID 20440099) states no funder, so its entry reads unclear. Letters unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 19588334 PMID 20440099 PMID 23525435 PMID 32740889 PMID 38623887
Resistance training was carried as THREE separate top-level records: blood pressure and lipids at Grade B, glycemic control at Grade B, and progressive overload for strength at Grade A. One intervention, three endpoints The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score., three letters, and the glycemic record's entire evidence base was a single paper the blood-pressure record already cited. With the records split that way, nothing checked the letters against each other: gate_g13 compares a headline against the uses beneath it, and three separate top-level records slipped past that check entirely. They are now one record graded by use, the shape already used for creatine, omega-3 and CoQ10. The surviving record's headline is A, matching the site convention that a headline is no better than its best use, and the A is scoped on the record to muscle size and strength. Blood pressure with lipids, and glycemic control, remain at B as separate uses because every endpoint behind them is a surrogate. No letter changed its meaning in this consolidation: the A, and both Bs, rest on exactly the citations they rested on before.PMID 32740889 PMID 37491419 PMID 35273011 PMID 39331324 PMID 35228201
Every change to a letter on this site is dated and published. The full evidence log →
Resistance training means working muscles against a load two to three times a week, with the load rising over time. In older adults, including people over 75, pooled studies found large gains in measured strength and some gain in muscle size. Grip strength did not clearly change. Pooled studies also found lower resting blood pressure, and lower average blood sugar in type 2 diabetes. On its own, it did not lower cholesterol. Claims that it helps people live longer come from weaker studies.
The A belongs to one of the three uses graded on this record. The other two carry their own letters.
This record carries a separate letter for each thing it has been measured on. The headline grade is the best of them, and it does not transfer to the others.
Meta-analysis of randomized trials in adults 75 and over reporting large objectively measured gains in lower and upper body strength and a smaller gain in whole-muscle size, with handgrip strength and muscle fiber size not significantly changed (Grgic et al., Sports Medicine, 2020; PMID 32740889). The Cochrane review of progressive resistance training in older adults found a large effect on measured strength across 73 trials and 3,059 participants (Liu and Latham, 2009; PMID 19588334). One-repetition maximum is an instrument reading, which is the route to A without a hard clinical outcome.
Network meta-analysis of 270 randomized trials: dynamic resistance training lowered resting blood pressure by 4.55/3.04 mm Hg against non-exercising controls (Edwards et al., Br J Sports Med, 2023; PMID 37491419). Resting blood pressure is a surrogate endpoint A lab value or measurement used in place of the outcome that matters, such as LDL cholesterol standing in for heart attacks. Moving a surrogate does not always move the outcome. measured over weeks, which caps this use at B. An earlier meta-analysis found a smaller fall after dynamic resistance training, 1.8 mm Hg systolic with an upper confidence limit near zero and 3.2 mm Hg diastolic (Cornelissen and Smart, J Am Heart Assoc, 2013; PMID 23525435), so the size of the effect is uncertain across populations.
Two independent meta-analyses of randomized trials report lower HbA1c in adults with type 2 diabetes: Jansson et al. (BMJ Open Diabetes Res Care, 2022; PMID 35273011), 20 trials, about 0.39 points, with high heterogeneity How much the results of the pooled trials differ from each other. High heterogeneity makes a combined estimate less reliable.; Wan et al. (Biol Res Nurs, 2024; PMID 38623887), 46 trials and 2,130 participants, 0.50 points, with fasting glucose also lower. HbA1c is a surrogate endpoint, which caps this use at B.
Randomized trials show objectively measured gains in lower and upper body strength and in whole-muscle size, including in adults 75 years and older (Grgic 2020; PMID 32740889) and in older adults generally (Cochrane review, 73 trials; PMID 19588334); handgrip strength and muscle fiber size did not change significantly in the 75-and-over pool. Meta-analyses of randomized trials also report lower resting blood pressure (Edwards 2023; PMID 37491419) and improved HbA1c in type 2 diabetes (Jansson 2022; PMID 35273011; Wan 2024; PMID 38623887), each a surrogate endpoint with its own letter on this record. Blood lipids carry no letter here: in a meta-analysis of 148 randomized trials, resistance training on its own did not lower total cholesterol, LDL Low-density lipoprotein cholesterol, the cholesterol fraction most closely tied to plaque in the arteries., triglycerides or VLDL, and raised only HDL (Smart 2025; PMID 39331324). Observational Research that watches what people already do rather than assigning a treatment. It can show that two things travel together, not that one causes the other. cohorts associate muscle-strengthening activity with lower all-cause mortality (Momma 2022; PMID 35228201); that is not randomized and carries no letter here.
Why this gradeThe reasoning, and what the grade does not cover.
Grade A by the instrument-measured function route: meta-analyses of randomized trials reporting objective gains in strength and whole-muscle size, in adults 75 and over (Grgic 2020, PMID 32740889) and in older adults generally (Cochrane, 73 trials, PMID 19588334); handgrip strength and muscle fiber size did not change significantly in the 75-and-over pool, so the A rests on lifted strength and whole-muscle size, not every measure. One-repetition maximum is a reading off a bar, not a questionnaire.
WHY THE OTHER TWO USES SIT AT Bresting blood pressure and HbA1c are surrogate endpoints measured over weeks, and a surrogate caps at B however good the pooling is.
WHY BLOOD LIPIDS CARRY NO LETTERthe pooled randomized trials found resistance training alone did not lower total cholesterol, LDL, triglycerides or VLDL (Smart 2025, PMID 39331324); the lipid changes in that analysis came from aerobic and combined training, which this record does not grade.
WHAT THIS GRADE DOES NOT COVERthe A is earned on strength and size, and it does not travel to the other two uses on this record, which carry their own letters. It is not a grade for resistance training against mortality, the claim most often attached to it: that evidence is observational (Momma 2022, PMID 35228201) and is excluded here under the same rule applied to the Finnish sauna cohorts. And it does not grade any particular program, split or weekly volume beyond the two to three sessions with progressive overload that the pooled trials tested.
Shared endpoint: Measured muscle strength, supervised progressive resistance training versus no training, adults over 75
- Hebrew Rehabilitation Center for Aged, Boston, USA (Fiatarone): Strength up 113 percent versus 3 percent in controls, nursing-home residents of mean age 87, 10 weeks. PMID 8190152 · Funding: academic
- Democritus University of Thrace, Komotini, Greece (Kalapotharakos): 3-RM strength up 25 to 55 percent and functional performance up 15 to 25 percent, no change in controls, men aged 80 to 88, 8 weeks. PMID 20440099 · Funding: not stated in the indexed record
What the replication does not cover: The Greek trial is small (22 men) and its funder is not stated. Replication across many more groups is pooled in Grgic 2020 (PMID 32740889) for adults 75 and over and in the Cochrane review (PMID 19588334) for older adults generally; participants cannot be blinded to exercise.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
No prominent contraindication A condition or medication that makes a treatment unsafe or unsuitable for a particular person. at the loads and frequencies studied. The trials behind this grade were conducted with supervision and progression.
The evidence, in fullEight papers, each linked to its PubMed record.
Graded by use, because the three things resistance training is measured on do not share an endpoint class. Grgic et al. (Sports Medicine, 2020; PMID 32740889): meta-analysis of randomized trials, objective gains in muscle size and strength; this is what the Grade A rests on. Edwards et al. (Br J Sports Med, 2023; PMID 37491419): network meta-analysis, exercise including resistance training lowers resting blood pressure. Smart et al. (Sports Med, 2025; PMID 39331324): meta-analysis of 148 randomized trials of exercise training; resistance training alone did not lower total cholesterol, LDL, triglycerides or VLDL and raised only HDL, a rise that held only in the lower-quality trials, so blood lipids carry no letter here. Jansson et al. (BMJ Open Diabetes Res Care, 2022; PMID 35273011): meta-analysis, resistance training lowered HbA1c in adults with type 2 diabetes. Momma et al. (Br J Sports Med, 2022; PMID 35228201): muscle-strengthening activity associated with lower mortality, observational and excluded from every letter here. Added October 2026: Liu and Latham (Cochrane Database Syst Rev, 2009; PMID 19588334), progressive resistance training in older adults, 121 trials, a large effect on measured strength across 73 trials and 3,059 participants; Wan et al. (Biol Res Nurs, 2024; PMID 38623887), 46 randomized trials in type 2 diabetes, HbA1c 0.50 points lower; Cornelissen and Smart (J Am Heart Assoc, 2013; PMID 23525435), dynamic resistance training lowering systolic pressure 1.8 and diastolic 3.2 mm Hg across 29 groups.
One-rep max or submaximal strength (e.g., 5RM) on two to three compound movements at baseline and every 8 weeks: these are the instrument readings the pooled trials measured (Grgic 2020, PMID 32740889). Whole-muscle size, by DEXA lean mass or imaging, is the second endpoint that moved in those trials. Grip strength did not change significantly with resistance training in the same meta-analysis, so a flat grip reading is not evidence that the training failed.
Evidence notes: meta-analysis, observational, randomized trial
Endpoint graded: Objectively measured muscle size and strength (functional)
Last reviewed: October 2026
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
As studiedDose, form, population and duration for every use.
Sold as nothing: this is a behavior, not a product. The gap here is the reverse of the usual one. What the trials delivered was supervised or programmed training with the load actually going up, and unsupervised training at a fixed weight is not the thing that was studied.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
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