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These reductions are often augmented by concomitant acute and chronic diseases, resulting in attenuated physical performance and higher propensity of falls and injuries. With the proportion of older adults in the population increasing, there is an alarming need for cost\u2010effective strategies to improve physical performance and combat a multitude of age\u2010related diseases. Surprisingly, despite convincing evidence emerging over three decades that strength training can substantially improve maximal strength (1RM), rate of force development (RFD) and power, contributing to improved health, physical performance and fall prevention, it appears that it has not fully arrived at the older adults' doorsteps. The aim of the current narrative review is to accentuate the convincing benefits of strength training in healthy and diseased older adults. As intensity appears to play a key role for improvements in 1RM, RFD and power, this review will emphasize training performed with heavy (80%\u201384% of 1RM) and very heavy loads (\u2265\u200985% of 1RM), where the latter is often referred to as maximal strength training (MST). MST uses loads of ~90% of 1RM, which can only be performed a maximum of 3\u20135 times, 3\u20135 sets and maximal intentional concentric velocity. Strength training performed with loads in the heavy to very heavy domain of the spectrum may, because of the large increases in muscle strength, focuses on neural adaptations and relatively low risk, provides additional benefits for older adults and contrasts current guidelines which recommend low\u2010to\u2010moderate intensity (60%\u201370% of 1RM) and slow\u2010moderate concentric velocity. This review also provides information on practical application of MST aimed at practitioners who are involved with preventive and\/or rehabilitative health care for older adults.<\/jats:p>","DOI":"10.1002\/jcsm.13804","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T02:51:46Z","timestamp":1744858306000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Heavy Strength Training in Older Adults: Implications for Health, Disease and Physical Performance"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9632-3848","authenticated-orcid":false,"given":"Tiril","family":"T\u00f8ien","sequence":"first","affiliation":[{"name":"Department of Health and Social Sciences Molde University College  Molde 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