Understanding Sarcopenia

The secret to being older, wiser and stronger:

The idea of getting older is disliked by all of us. So much so that the ‘anti-ageing’ industry is experiencing growth right throughout the world. You’ve probably heard about ‘anti-ageing’ for your skin, but what about for your muscles? If you want to stand tall and stay active as you age, read on.

As we age, we begin to lose muscle mass. In fact, after the age of 30, we begin to lose as much as 3-8% per decade and this rate of decline is even higher after the age of 60 (1).

This involuntary loss of muscle mass is a main contributor of disability in older adults. As we lose muscle mass, we become more susceptible to falls and injury which contributes to a loss of independence and a poorer quality of life. Skeletal muscle is also the largest insulin-sensitive tissue in the body, meaning that those who have low muscle mass have a higher risk of developing Type 2 diabetes (2). Furthermore, as we lose muscle mass, our bone density decreases, joint stiffness increases, and there is a small reduction in stature (1). All these changes have implications for conditions such as obesity, heart disease and osteoporosis (1).

Whilst the above paragraph includes many references to chronic disease, I’d like to highlight its reference to ‘quality of life’. At the end of the day we are all trying to improve our “Healthspan” (years we are active and healthy) more than our “Lifespan” (chronological age that doesn’t given any indication of quality of life) so the impact of losing muscle mass on quality of life should not be underestimated.

Importantly, there is a difference between losing a little bit of muscle mass and losing a lot of muscle mass.

What is Sarcopenia?

Sarcopenia is defined as the gradual reduction in skeletal muscle over a period of time. It is caused by an imbalance in two groups of cells: those responsible for muscle growth and those responsible for muscle breakdown. More commonly found in individuals over the age of 50, it shares similar characteristics to that of osteoporosis without the effect on the bone. It has been estimated that sarcopenia affects 10-30% of older adults living in the community (3). Despite its prevalence there is no official criteria to diagnose sarcopenia worldwide. In Australia, the operational definition is based on the clinical definition from the European Working Group on Sarcopenia in Older People (EWGSOP) (4). The EWGSOP defines sarocpenia as the presence of both low muscle mass and low muscle function (strength or performance).

The main symptom of the development of sarcopenia is weakness. This may lead to a loss of stamina, difficulty balancing, worsening ability to complete activities of daily living, decreased sport performance and consequently, an overall loss of confidence.

Factors that accelerate muscle loss

While ageging is the main cause of sarcopenia, there are a number of factors that may accelerate muscle loss:

  • Physical inactivity (sedentary lifestyle) - Physical inactivity is one of the strongest triggers of sarcopenia, leading to faster muscle loss and increasing weakness (5). Periods of decreased activity can become a vicious cycle. Muscle strength decreases, resulting in greater fatigue and making it more difficult to return to normal activity.
  • Hormones - A variety of hormonal changes are seen during aging that may contribute to muscle loss. In about 60% of men over the age of 65, testosterone levels decrease to below the normal youthful values (6). Since testosterone increases muscle mass and strength, it has been proposed that the decrease in testosterone may result in a loss of muscle mass for men as they age. In addition, the loss of growth hormones as we age have been linked to a reduction in muscle mass. 
  • Diet - A diet providing insufficient calories and protein results in weight loss and diminished muscle mass. Unfortunately, low-calorie and low-protein diets become more common with aging, due to changes in sense of taste, problems with the teeth or increased difficulty shopping and cooking.
  • Chronic Disease - Chronic or long-term diseases can result in muscle loss. Sarcopenia has shown to be highly prevalent in individuals with cardiovascular disease, dementia, Type 2 Diabetes and respiratory disease (7).

Exercise can reverse sarcopenia

The best way to fight the effects of sarcopenia is to keep your muscles active - if you don't use it you lose it! Combinations of aerobic exercise, resistance training and balance training can prevent and even reverse muscle loss (8). 

Resistance exercise places tension on your muscle fibres resulting in growth signals that leads to increased strength. These signals cause the muscle to break down and repair itself ongoing - serving as the best form of activity to build muscle mass and reduce its loss. Progressive resistance exercise training has also been shown to induce muscle hypertrophy and increase strength in the elderly and physically frail adults (1).

Improvements in strength, muscle mass and function can be achieved at any age, even right into our 90s. In a well-known study published in the 90’s, researchers took 10 frail nonagenarians and completed 8 weeks of strength training with them. After 8 weeks they had a 48% increase in tandem gait speed, a 174% increase in strength and a 9% increase in muscle area in their thighs (10). Results like this for nonagenarians should give great confidence to those of us in our 50s, 60s and 70s that reversing some, not all, affects of ageing is possible and certainly worth attempting.

Despite the clear efficacy in increasing muscle mass, 87% of older adults describe perceiving at least one barrier to their participation in physical activity (9). These barriers often surround concerns over these adults’ own physical competence and safety in completing exercises. The majority lack confidence in their physical ability, and feel self-conscious in traditional gym environments.

Kieser and sarcopenia

Kieser is a unique Physiotherapy and strength training facility. We aim to shift the paradigm of traditional fitness training by taking away the barriers for clients of all ages, providing older clients with a safe and supportive environment in which to improve their strength and physical function.

FAQ’s

I’ve got a chronic disease, can I still strength train?
For those of you who have an injury, chronic condition, or feel to frail to exercise: our team of Physiotherapists and Exercise Physiologists are highly qualified and experienced in designing programs that are both safe, and effective.

But I’ve never done ‘weights’ before.
For those of you who have never completed strength training, the Kieser equipment is designed to be simple and effective to use. There’s no need to load weight plates on bars, or remember complex exercises: whilst our machines are technologically advanced, they’re also straight forward and logical

I think I’m too old for strength training.
Kieser Australia has over 10,000 members and with an average client age of 55, our clients are able to build strength in a safe and supportive environment, surrounded by their peers. We have clients who train with us into their 90s, so you are never to old to be strong.

 

References:

1. Volpi, Elena et al. “Muscle tissue changes with aging.” Current opinion in clinical nutrition and metabolic care vol. 7,4 (2004): 405-10. doi:10.1097/01.mco.0000134362.76653.

2. DeFronzo, Ralph A, and Devjit Tripathy. “Skeletal muscle insulin resistance is the primary defect in type 2 diabetes.” Diabetes care vol. 32 Suppl 2,Suppl 2 (2009): S157-63. doi:10.2337/dc09-S302

3. Mayhew, A J et al. “The prevalence of sarcopenia in community-dwelling older adults, an exploration of differences between studies and within definitions: a systematic review and meta-analyses.” Age and ageingvol. 48,1 (2019): 48-56. doi:10.1093/ageing/afy106

4. Zanker, J et al. “Establishing an Operational Definition of Sarcopenia in Australia and New Zealand: Delphi Method Based Consensus Statement.” The journal of nutrition, health & aging vol. 23,1 (2019): 105-110. doi:10.1007/s12603-018-1113-6

5. Santilli, Valter et al. “Clinical definition of sarcopenia.” Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases vol. 11,3 (2014): 177-80.

6. Stanworth, Roger D, and T Hugh Jones. “Testosterone for the aging male; current evidence and recommended practice.” Clinical interventions in aging vol. 3,1 (2008): 25-44. doi:10.2147/cia.s190

7. Jacob Pacifico, Milou A.J. Geerlings, Esmee M. Reijnierse, Christina Phassouliotis, Wen Kwang Lim, Andrea B. Maier. "Prevalence of sarcopenia as a comorbid disease: A systematic review and meta-analysis." Experimental Gerontology, Volume 131, 2020, 110801, https://doi.org/10.1016/j.exger.2019.110801.

8 Kemmler, Wolfgang, and Simon von Stengel. “Exercise frequency, health risk factors, and diseases of the elderly.” Archives of physical medicine and rehabilitation vol. 94,11 (2013): 2046-53. doi:10.1016/j.apmr.2013.05.013

9. Justine, Maria et al. “Barriers to participation in physical activity and exercise among middle-aged and elderly individuals.” Singapore medical journal vol. 54,10 (2013): 581-6. doi:10.11622/smedj.2013203

10. Fiatarone, M, Marks, E, Ryan , Meredith C, Lipsitz L, Evans W (1990) High-intensity strength training in nonagenarians. Effects on Skeletal muscle. Journal of American Medical Association. Jun 13;263(22):3029-34

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