Strength at Every Age: How to Protect and Enhance Muscle Performance

 Anna Staehli Wiser, DPT, FAAOMPT

‍Aging does not have to mean slowing down. Although hormonal shifts, gradual muscle loss, and changes in collagen production occur over time, the musculoskeletal system remains remarkably adaptable. With the right combination of progressive strength training, thoughtful nutrition, and evidence-based medical care, people can maintain strong muscles and resilient tendons well into midlife and beyond.

Below is a summary of treatments and strategies that research suggests may help support muscle and tendon strength, organized by the level  of available scientific evidence.

Hormones and Tissue Health (High Level of Evidence)

Estrogen in Women

After menopause, estrogen levels decline significantly. Estrogen influences collagen metabolism and connective tissue structure, and receptors are present in tendons, ligaments, muscle, and bone.¹,² Research suggests estrogen deficiency alters tendon collagen turnover and may contribute to age-related tissue changes.²

Menopausal hormone therapy reduces bone loss and fracture risk and may support overall musculoskeletal health in appropriately selected women when prescribed by a qualified healthcare provider.³ Hormone therapy carries potential risks and should be individualized in consultation with a healthcare professional.⁴,⁵

Testosterone in Men

Testosterone supports muscle mass and bone density. Testosterone replacement therapy can increase lean muscle mass and improve bone mineral density in men with clinically low testosterone levels when prescribed and monitored by a qualified healthcare provider.⁶,⁷

 As with estrogen therapy, testosterone therapy carries potential risks and should only be used in appropriately evaluated individuals under medical supervision.⁸

Nutrition and Supplements 

Vitamin D (High Level of Evidence)

Vitamin D is essential for bone mineralization and muscle function. Deficiency is common, particularly in northern climates. Studies show that correcting vitamin D deficiency can reduce fracture risk and improve muscle performance.⁹

Protein (High Level of Evidence)

Age-related “anabolic resistance” means older adults require adequate dietary protein to maintain muscle mass. Sufficient protein intake remains one of the most evidence-supported strategies for preserving strength with aging.¹⁰

Creatine Monohydrate (Moderate Level of Evidence)

Creatine is one of the most studied and well-tolerated performance supplements. When combined with resistance training, creatine supplementation has been shown to improve strength and increase lean muscle mass in older adults.¹¹

Omega-3 Fatty Acids (Moderate Level of Evidence)

Omega-3 fatty acids may support muscle protein synthesis and help reduce inflammation. Research suggests omega-3 supplementation may enhance the muscle-building response to exercise and potentially support recovery.¹²

Collagen and Gelatin (Moderate Level of Evidence)

Collagen is the primary structural protein in tendons and ligaments. Vitamin C–enriched gelatin consumed before exercise has been shown to increase markers of collagen synthesis.¹³ Another study found that collagen supplementation during resistance training improved lower-limb rate of force development compared with placebo.¹⁴

A systematic review suggests collagen supplementation may modestly reduce joint pain and improve function in individuals with osteoarthritis.¹⁵

Curcumin and Ginger (Modest or Mixed Evidence)

Curcumin, the active compound in turmeric, has demonstrated modest reductions in knee osteoarthritis pain in randomized trials.¹⁶ Ginger also shows mild anti-inflammatory effects and modest reductions in osteoarthritis pain compared with placebo.¹⁷

Glucosamine and Chondroitin (Modest or Mixed Evidence)

 Research findings for glucosamine and chondroitin are mixed. Some individuals experience symptom relief for osteoarthritis, but more recent systematic reviews and meta-analyses have found overall benefits to be small, inconsistent, or not clinically meaningful.¹⁸,¹⁹

Resistance Training: The Most Powerful Strategy (High Level of Evidence)

 Progressive resistance training is the single most effective intervention for maintaining musculoskeletal health with aging. Mechanical loading stimulates collagen remodeling in tendons, increases bone mineral density, and promotes muscle hypertrophy and strength. Regular strength training has also been shown to improve balance, reduce fall risk, and preserve functional independence in older adults. For these reasons, resistance exercise remains the cornerstone of injury prevention and healthy aging.¹⁰

The Big Picture

No supplement or medication replaces the foundational role of movement. Strength training, adequate nutrition, and maintaining overall health remain the most reliable strategies for protecting musculoskeletal function as we age.

 When combined thoughtfully, evidence-based medical therapies and nutritional strategies may provide additional support for maintaining strong muscles, resilient tendons, and healthy joints throughout life. Individuals experiencing persistent joint pain, tendon injuries, or declining strength should consider consulting a qualified healthcare professional to determine the most appropriate treatment plan.

References 

1. Hansen M, et al. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. J Appl Physiol. 2009;106(4):1385-1393.
   
   

2. Ganderton C, et al. The effect of female sex hormone supplementation on tendon structure and function: a systematic review. Sports Med. 2016;46(9):1251-1271.
   
   

3. The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
   
   

4. Manson JE, et al. Menopausal hormone therapy and health outcomes during the Women’s Health Initiative trials. JAMA. 2013;310(13):1353-1368.
   
   

5. Henderson VW, Lobo RA. Hormone therapy and the risk of stroke. Climacteric. 2012;15(3):229-234.
   
   

6. Snyder PJ, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624.
   
   

7. Snyder PJ, et al. Effect of testosterone treatment on volumetric bone density. J Clin Endocrinol Metab. 2017;102(2):583-593.
   
   

8. Bhasin S, et al. Testosterone therapy in men with hypogonadism. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
   
   

9. Bischoff-Ferrari HA, et al. Vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367:40-49.
   
   

10. Morton RW, et al. Protein supplementation and resistance training gains. Br J Sports Med. 2018;52:376-384.
    
    

11. Chilibeck PD, et al. Creatine supplementation and strength in older adults. Med Sci Sports Exerc. 2017;49:1789-1799.
    
    

12. Smith GI, et al. Omega-3 fatty acids increase muscle protein synthesis. Am J Clin Nutr. 2011;93:402-412.
    
    

13. Shaw G, et al. Vitamin C–enriched gelatin supplementation augments collagen synthesis. Am J Clin Nutr. 2017;105:136-143.
    
    

14. Lis DM, et al. Collagen and vitamin C improve rate of force development. Int J Sport Nutr Exerc Metab. 2022;32:65-73.
    
    

15. Zhu R, et al. Collagen supplementation in osteoarthritis: systematic review. Nutrients. 2021;13:2259.
    
    

16. Bannuru RR, et al. Pharmacologic interventions for knee osteoarthritis. Ann Intern Med. 2021;174:339-347.
    
    

17. Bartels EM, et al. Ginger for osteoarthritis: meta-analysis. Osteoarthritis Cartilage. 2015;23:13-21.
    
    

18. Shtroblia V, et al. Recent advances in knee osteoarthritis management. Front Med. 2025.

19. Meng Z, Liu J, Zhou N. Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2023;143(1):409–421.