Managing age-related muscle loss

Sarcopenia is a gradual loss of muscle mass and strength as we age. This can then affect your balance, gait and overall ability to perform tasks of daily living like walking, climbing stairs and lifting objects. Muscle loss is a condition that affects 10% of adults over the age of 50.

As muscle loss progresses older people may begin to reduce their physical activities, leading to further loss of muscle tone and endurance and increasing the risk of fall and fractures.

Studies have shown that we start to lose muscle mass from as early as 40-years-old. We then lose 8% of our muscle mass every decade from the age of 40, with the rate almost doubling to 15% every decade after the age of 70.

Due to the aging population in Singapore, sarcopenia and its impact on quality of life is an increasingly important health issue.

Yes, muscle loss is part of the aging process. However, there are other factors that can exacerbate it including:

• A sedentary lifestyle or being physically inactive – This is one of the strongest triggers of sarcopenia
• Immobility due to prolonged illness – If a muscle is not used, the body will eventually break it down to conserve energy. Periods of decreased activity can become a vicious cycle as when muscle strength decreases, this results in greater fatigue which makes it more difficult to return to normal activity.
• Lack of protein in the diet – A diet with insufficient calories and protein will result in weight loss and decreased muscle mass. Unfortunately, low calorie and low protein diets become more common with aging due to changes in your sense of taste and poor oral health (e.g. less teeth or poorly fitted dentures or problem with swallowing). Protein is a very important component of muscle and is needed to maintain healthy muscles. Forms of protein that should be incorporated into your diet include eggs, fish (such as cod, mackerel and salmon), meat, shellfish, cheese, yoghurt, nuts, beans, and legumes. You may also like to consider adding collagen powder into your drinks.
• Lowered sex hormones (e.g. decreased oestrogen after menopause and low testosterone after andropause) – The fall in oestrogen level during menopause leads to loss in muscle mass. Since muscle burns more calories than fat, less muscle means fewer calories are burned which leads to weight gain. Fat also tends to accumulate around the abdomen leading to increased risk of diabetes and heart disease. Andropause, triggered by low testosterone, can also lead to loss of muscle mass and strength.

Muscle loss occurs naturally with aging but can be more severe in people who do not exercise or eat a balanced diet, which is needed to repair and build muscles. As these signs normally creep up gradually, we have to look out for symptoms especially in our aging society.

These include:

• Less energy and fatigue
• Slower walking speed
• Decreased strength
• General weakness
• Unintentional weight loss
• Frequent falls
• Weaker handgrip which may be a warning sign of progressive loss of muscle strength

While it is inevitable that everyone loses muscle mass with age, it is possible to slow down or even reverse muscle loss with proper exercise and diet.

The main methods are:

Strength and resistance training exercise

• Strength training, at least twice a week, is the most important intervention against muscle loss.
• This may use body weight as resistance, machines to add load to muscles or resistance bands and tubes.
• Strength and resistance training includes weightlifting, pulling against resistance bands or moving parts of the body against gravity (e.g. climbing stairs, leg presses and extending knees against resistance on a weight machine).

Aerobic (cardiovascular) exercise

• This involves sustained exercises that raise your heartbeat, including aerobic exercises and endurance training which improve heart health and blood circulation.
• Walking is an activity that most people can do for free. Other activities you may like to consider include cycling and jogging.
• The Health Promotion Board promotes at least 150 minutes of aerobic activity (moderate to vigorous) per week and this can be accumulated over the week (e.g. 30 minutes a day for five days). A moderate activity is one where you are able to talk but not sing. A vigorous activity is one where you can only speak a few words.

Good diet

It’s important to eat a balanced diet sufficient in protein and Vitamin D. Protein provides the building blocks for muscle and stimulates its growth. Low Vitamin D has also been associated with higher risk of sarcopenia.

Physical exercise, both strength training and cardiovascular, is important to maintain muscle health and strength. Remember, we can stay active and exercise at home even during this circuit breaker.