New ACSM resistance training guidelines: What they mean for your practice

The American College of Sports Medicine has published its first major update to resistance training guidelines in 17 years, synthesising findings from 137 systematic reviews and more than 30,000 participants. The key message for physiotherapists is clear: consistent resistance training in almost any form drives meaningful clinical outcomes, and removing barriers to participation matters more than optimising programme complexity.

The updated position stand from the ACSM, published in the April 2026 issue of Medicine & Science in Sports & Exercise, draws on 137 systematic reviews involving more than 30,000 participants — making it the most comprehensive evidence synthesis on resistance training to date. The core message is both clinically useful and practically empowering: consistent resistance training, in almost any form, produces meaningful improvements in strength, muscle size, power and physical function.

The position stand covers a broad population, from complete novices with no resistance training experience through to experienced trainees. This is important context for physiotherapists, the findings are not derived from elite or highly trained athletes, but from a wide cross-section of healthy adults, which makes them more relevant to typical clinical caseloads.

One of the most significant shifts in this update is the move away from rigid prescription criteria. Previous guidelines specified relatively narrow parameters around load, sets, repetitions and equipment. The 2026 position stand takes a different approach, concluding that individualising programmes to increase participation is more important than adhering to specific prescription variables. In practice, this means that training to failure, choice of equipment and complex periodisation did not consistently impact outcomes for the average healthy adult. Drop sets versus straight sets, free weights versus machines, gym-based versus home-based training: the evidence does not show a meaningful difference between these approaches for most people.

For physiotherapists working in community, outpatient or home-based settings, this is significant. Elastic bands, bodyweight exercises and home routines all produced meaningful gains in strength, hypertrophy and physical function. Removing the gym as a prerequisite for effective resistance training has direct implications for patient adherence and accessibility.

The most actionable finding is that moving from no resistance training to any resistance training represents the greatest single gain a patient can make. This reframes the clinical goal: rather than optimising a complex programme, the priority is reducing barriers and supporting consistent participation. Patients with limited capacity, time or motivation do not need elaborate programmes to see functional benefit; simpler is not inferior, and may be more sustainable.

The evidence also confirms that hypertrophy and strength gains occur across a wide loading spectrum when effort is sufficient. This is particularly relevant when prescribing for patients who cannot tolerate heavier loads due to pain, post-surgical restrictions or deconditioning. The position stand also highlights physical function outcomes including gait speed, balance, and stair climbing: outcomes that map directly onto the goals of many physiotherapy patients, particularly older adults. Incorporating exercises that involve speed of movement, even at moderate loads, is well supported by the evidence.

On safety, an analysis of more than 38,000 participants, including over 11,000 older adults, found that resistance training did not increase the risk of serious adverse events; a useful point to share with patients who are hesitant about resistance exercise due to perceived injury risk.

It is worth noting that the position stand is intended for healthy adults, and direct application to clinical populations requires professional judgement. Patients with chronic conditions, frailty, neurological presentations or post-surgical status fall outside the primary scope of this guidance. The “any training is better than none” message is well supported for the general population, but load, intensity and modality still need to be individualised in a rehabilitation context.

Clinical takeaways for physiotherapists

• Any resistance training is better than none: the biggest gain comes from moving a patient from zero to something, however simple
• Home-based tools (resistance bands, bodyweight, light dumbbells) are as effective as gym equipment for strength, hypertrophy and physical function
• Complex programme variables (training to failure, periodisation, equipment type) do not consistently change outcomes for most adults: reduce complexity to improve adherence
• Strength and hypertrophy gains occur across a wide loading range when effort is sufficient; useful for patients who cannot tolerate heavy loads
• Train all major muscle groups 2x per week and build gradually over time
• Physical function outcomes (gait speed, balance, stair climbing) are supported by the evidence, making this directly relevant to older adult and rehabiliation caseloads
• Resistance training is safe for older adults: evidence from 38,000+ participants found no increased risk of serious adverse events
• These guidelines apply to healthy adults; clinical judgement is still required for patients with chronic conditions, frailty, or post-surgical presentations

New evidence like this is exactly why keeping open-access rehabilitation resources current matters. Your expertise shapes what clinicians and students worldwide can access. If you’ve come across new resources related to resistance training, or spotted a Physiopedia page that needs updating in light of this evidence, we’d love to hear from you; your input directly improves the resource for the whole community.

The full position stand is open access and available in Medicine & Science in Sports & Exercise (April 2026). An infographic and slide deck are also available via the ACSM website.

The 2026 ACSM position stand represents the strongest evidence base yet for flexible, participation-focused resistance training prescription, and its implications reach well beyond the gym into everyday physiotherapy practice. As the evidence evolves, so does your practice, and the global rehabilitation community plays a vital role in making sure those updates reach clinicians everywhere through Physiopedia.