Resistance activities, which include weight machines, free weights and resistance tubing or bands, and body-weight activities, provide a stimulus to the neuromuscular system promoting health and functional adaptations. As the aging population continues to grow, the ability to maintain or slow the decline in neuromuscular health is essential for the prevention of disability, disease, and premature death. Age-induced neuromuscular alterations begin to occur early in life and become accelerated around the sixth and seventh decades. The nervous system undergoes reductions in motor unit number due to apoptosis and an increase in motor unit size due to the reinnervation of denervated muscle fibers. These changes lead to decreases in voluntary activation, conduction velocity, motor unit discharge rate, and motor unit recruitment range. In addition, decreases in the number of skeletal muscle fibers (predominantly type II fibers), satellite cells, and muscle fiber size also occur as part of the aging process. These alterations contribute to reductions in contractile velocity, peak force, and power output. Participation in resistance activities has a positive effect on enhancing neuromuscular strength, power, and physical function in older adults. Principles of specificity, overload, variation, reversibility, and individuality can be used to inform the design of resistance exercise programs to promote neuromuscular and functional outcomes of interest. Despite the many benefits of resistance activities, potential risks should be considered when determining the appropriateness of engaging in such activities, especially when working with vulnerable populations. Monitoring strategies enhance both adherence and efficacy of resistance activities and provide valuable information to be used by the healthcare team to make timely and informed decisions regarding modifications to the prescribed resistance exercise program.