Empower Older Adults: Exploring the Effectiveness and Implementation of Power Training to Improve Independence and Performance of Activities of Daily Life in Older Adults

The global population is undergoing a major demographic transition, characterized by a rapid increase in both the number of older adults and the proportion of the “oldest-old.” This shift presents substantial societal, economic, and healthcare challenges, particularly in relation to maintaining physical functioning, independence, and autonomy in later life. Age-related declines in physical function are a primary contributor to reduced participation in daily activities and increased dependency. Among the components of physical functioning, muscle power is especially critical, as it declines earlier and more rapidly than muscle mass and strength. Muscle power decreases by approximately 10–30% per decade after the age of 40, with losses of up to 70% by the age of 80. This decline is strongly associated with impaired performance in activities of daily living and an increased risk of falls. Although older adults were previously considered to have limited capacity to improve muscle power, growing evidence demonstrates that meaningful improvements in muscle power, strength, and functional performance are achievable through targeted exercise interventions. Power training, defined as high-velocity resistance training emphasizing rapid and explosive force production, has emerged as a promising modality. It targets fast-twitch (Type II) muscle fibers, which are disproportionately affected by aging, and induces neuromuscular adaptations that enhance movement efficiency and coordination. Despite these benefits, power training remains underutilized in rehabilitation and exercise programs for older adults due to inconsistent definitions, heterogeneous intervention designs, concerns regarding feasibility and safety, and variability in outcome measurement. To address these challenges, this dissertation positions power training within the International Classification of Functioning, Disability and Health (ICF) framework, emphasizing performance-related physical fitness outcomes that are directly relevant to daily functioning. The overarching aim of this dissertation is to bridge the gap between scientific evidence and real-world application of power training in older adults. Specifically, the objectives are to: (1) establish standardized outcome measures within the ICF framework; (2) evaluate the effectiveness of power training in improving physical functioning; and (3) examine the feasibility and clinical applicability of power training in practice. The dissertation is structured into two parts. Part 1 focuses on methodological rigor and outcome measurement. A systematic review demonstrates that many power training interventions lack sufficient reporting detail and do not meet key criteria for therapeutic validity, limiting reproducibility and translation to practice. A second review evaluates the psychometric properties of commonly used outcome measures and identifies limited evidence for responsiveness. To address these limitations, a Delphi study establishes a core outcome set encompassing muscle power, physical performance, and functional independence, providing a standardized framework for future research and clinical evaluation. Part 2 evaluates effectiveness and implementation. A systematic review and meta-analysis shows that power training is superior to traditional strength training for improving muscle power and dynamic functional outcomes such as gait speed and stair climbing. A pilot and feasibility study demonstrates that power training can be safely and effectively implemented in older adults, with high adherence and no major adverse events. A descriptive case series further illustrates meaningful improvements in muscle power, physical performance, and daily functioning following power training interventions. In conclusion, this dissertation provides robust evidence that power training is an effective and feasible intervention to mitigate age-related functional decline in older adults. By addressing key issues related to definition, measurement, effectiveness, and implementation, this work supports the broader integration of power training into exercise and rehabilitation programs to enhance functional independence, autonomy, and quality of life in ageing populations.