Having strong bones and muscles is probably the best way to prevent fall. It is never too late or too soon to start regular aerobic and strengthening exercises. Apart from improving bone and muscle strength, physical exercise is also important for ensuring good balance and brain health.
Yes, if you would exercise regularly and take good nutritional diet.
We know the importance of active lifestyle and exercise. And many of us already have the good habit of swimming, walking or jogging for a few times per week. However, these aerobic exercises are great for oxygenation and blood circulation but less so for muscle building and strengthening.
To improve muscle strength and function, we must add resistance training to our exercise routines. And take a bit of time to plan a healthy diet.
What is resistance training?
Resistance or strength training put your muscles to work by using hand-held weights, weight machines, resistance bands, resistance balls and even your own body. Pilates and yoga classes are two examples of strength-training workouts that use your own body weight to strengthen bones and muscles.
The Center for Disease Control and Prevention (CDC) recommends older adults to take part in muscle-strengthening activities for at least twice a week. You should exercise all the major muscle groups — the legs, arms, chest, shoulders, back, and abdomen. Ideally, you should work with a trainer who can guide you through a strength training program which is effective and safe.
If you like gardening, digging and shoveling are great for muscle strength too. Even mundane chores such as carrying shopping, vacuuming, and mopping floors, can be creatively included in your keep fit programme.
The 2014 International Sarcopenia Initiative2 carried out a review of published studies from January 2000 to May 2013. The aim was to find out the effects of exercise on muscle mass, strength and performance for people aged 60 and above. The conclusion was very positive that resistance training can improve muscle strength and function. However, its effect on building muscle mass was less consistent.
Resistance training can help both young and old people to increase muscle strength. Studies had been done to compare the muscle strengthening effects of two age groups which were given the same training programme. It was found that the strength gained by people between 70 and 80 years old was the same as that gained by those 20 to 30 years old. So, you are never too old to start working on your muscle.
Some health providers suggest exercise programme which combines aerobic, resistance, flexibility and/or balance training for overall health benefits and preventing fall.
What happens to a muscle undergoing resistance training?
When you start resistance training, the neural activity which stimulates muscle contraction increases. As you continue to practice, very soon you will notice an increase in muscle strength.
But muscle growth is due to a different mechanism. If you lift a heavier weight than what the muscle is normally used to, it will disrupt the cell structures of the muscle fibres. The body responds by sending out signals which activate a series of biological events to repair the damage. Protein synthesis in the muscle cell will produce more contractile proteins which cause the myofibrils to increase in size or numbers. The final result is thicker individual muscle fibre, and stronger muscle contraction.
Protein synthesis in the muscle is regulated by several substances including testosterone, growth hormones, and insulin-like growth factors. This helps explain why older people and women are unlikely to grow big muscles despite training. But their muscle strength will improve.
The response of muscle to the overload stress of resistance exercise begins immediately after each session. However, it may take several weeks or months before we see the result.
Why a balanced diet with high protein is important?
Resistance training alone is not enough to improve muscle strength. We need a good diet with adequate calories and rest. A well balanced diet should contain proteins, fats, carbohydrates, minerals and vitamins.
Muscle fibres are made of proteins. In health, proteins structures undergo a constant process of breaking down and rebuilding. Much like constructing different objects with Lego bricks, our body can build complex protein structures from 21 kinds of building bricks – the amino acids.
Our body is able to make most of these amino acids if conditions are satisfied. But there are 9 essential amino acids* which can only be obtained from food. That’s why we have to eat proper diet to make sure that the pool of amino acids, especially the essential amino acids, is regularly replenished.
Leucine is an essential amino acid which plays an important role in muscle protein synthesis. And HMB**, the metabolite of leucine, has been shown effective at preserving lean mass from breakdown. However, results of comparative studies are often conflicting. So, although Leucine and HMB supplements seem to have effects on muscle mass and function, further clinical trials are needed to confirm their efficacy for older people2.
How much proteins do we need?
Healthy adults are advised to take about 0.8 gram of protein per kilogram of their body weight each day. So, for a person weighs 70 kg, he or she should consume around 56 grams of proteins per day. Bear in mind though this is the minimal amount to prevent protein deficiency. For people such as athletes who train regularly and hard, their protein needs will be much higher.
But older people need higher levels of dietary proteins according to research published in the Journal of the American College of Nutrition3. It is because as we get older, we are less efficient at processing proteins and need to consume more to build the same amount of muscle.
Therefore, you should aim to get 1.0 to 1.2 g per kilogram of your body weight of proteins per day. And more if you are showing signs of muscle loss. Your doctor, or a dietician or nutritionist will give you good advice if you are not sure.
Proteins are available in both plants and animals: meat, poultry, fish, eggs, dairy, beans, legumes and nuts. So, you have plenty of choices to mix and match them in your meal plans. But make sure you take enough carbohydrate calories to provide your body with energy. Otherwise the proteins you eat will be used for energy instead of building muscle.
The subsequent increase in healthcare costs will be a great burden on individual family and society as the proportion of elderly increases in the population. This awful scenario could be prevented if we just take a bit of time to plan our diet and exercise.
It may be cliché, but prevention is really much better than cure.
Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age and Ageing 2004; 33: 548–555.
Cruz-Jentoft, AJ, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age and Ageing 2014; 43: 748–759. https://doi.org/10.1093/ageing/afu115
Chernoff, R. Protein and Older Adults. J Am Coll Nutr. 2004 Dec;23(6 Suppl):627S-630S.
Having problem walking long distance, up a slope, or climbing stairs?
The tired old legs are usually the first to warn that we are young no more……
If you don’t have other health problems, that feeling of low energy and decreasing physical strength is very likely due to sarcopenia.
What is sarcopenia?
Sarcopenia is a progressive loss of skeletal muscle mass and strength or function. It is associated with ageing, but can also be due to long term illness, bed rest and malnutrition.1
Our muscles begin to atrophy or shrink around age 40. It is estimated that muscle mass loss after 50 is 0.5-1% per year. That rate can accelerate to 15% every 10 years from about age 70.
The muscles shrink because there is a reduction in the number of muscle fibres and a decrease in their size. This in turn leads to poorer physical strength and functional ability.
Even top athletes, such as marathon runners and weight lifters, experience decline in performance after about 40 because of lower muscle strength.
So, what is the cause of sarcopenia?
The pathophysiology of sarcopenia is quite complex and is still not fully understood. However, the following contributing factors have been suggested.
Age-related hormonal changes. The decreasing levels of testosterone and insulin-like growth factor (IGF-1) affect muscle growth and muscle mass.
Older people’s ability to produce the proteins which make up muscle fibres has decreased.
Poor nutrition. Older people’s diet may not contain enough proteins, essential amino acids and important nutrients such as Vitamin D. Also, there might be problem of malabsorption due to chronic diseases.
Many older people lead a sedentary lifestyle and not taking enough exercise. Some of them need bed rest or hospitalization because of one or more health problems. Even healthy people suffer significant muscle wasting following a period of bed rest.
We can see that some of these causative factors are modifiable. We may be able to prevent sarcopenia or improve on its outcome by changing our lifestyle, take more exercise, improve our diet, and so on.
The diagnosis of sarcopenia
According to The European Working Group on Sarcopenia in Older People, a
diagnosis of sarcopenia is confirmed if a person has low muscle mass, plus either low muscle strength or low physical function.1
The following measurement methods and techniques have been used in both research and clinical practices to diagnose sarcopenia. Some equipment is expensive and may not be available to every situation.
Measurement of muscle mass
Body imaging techniques have been used for estimating muscle mass or lean body mass. They are: computed tomography (CT), magnetic resonance imaging (MRI) and Dual energy x-ray absorptiometry (DXA). CT and MRI are gold standards for estimating muscle mass in research. However, DXA is the preferred alternative method because it exposes the patient to minimal radiation.
Bioimpedance analysis (BIA) estimates the volume of fat and lean body mass. It is an easy and inexpensive method and is suitable for both ambulatory and bedridden patients. BIA results under standard conditions have been found to correlate well with MRI predictions.
Measurement of muscle strength
Handgrip strength measured with a handheld dynamometer is a simple and widely used measure of muscle strength. When employed with population references, it correlates well with leg strength.
Measurement of physical performance
A number of physical performance tests are available for evaluating balance, gait, strength and endurance. For example: short physical performance battery (SPPB), timed get-up-and-go (TGUG), and the stair climb power test.
How does sarcopenia affect our life?
Age-related sarcopenia is recognized as a geriatric syndrome and is linked to a number of adverse health outcomes.
When muscle are weak, simple tasks such as getting dressed, lifting up objects, using the bathroom and walking can become difficult.
The older person will lose his or her ability to live independently and needs institutional care.
Sarcopenia is also associated with a variety of other chronic diseases and earlier death.
Studies on the prevalence of sarcopenia had inconsistent results because of different choices of definition and measuring methods. Nevertheless, the numbers are significant and alarming.
A review of past research showed that prevalence in the 60–70 years olds ranged from 5–13%. For elderly aged above 80 years, 11 to 50% of them were found to be sarcopenic1. It is a world-wide problem affecting both men and women.
But it is not all groom and doom though. You can take steps to maintain muscle mass and strength. We shall look into that in the next post.
It is never too young or too old to look after your muscle health.
Cruz-Jentoft J, Baeyens J, Bauer J, Boirie Y, Cederholm T et al (2010). “Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People”. Age and Ageing, Volume 39, Issue 4, 1 July 2010, Pages 412–423 https://doi.org/10.1093/ageing/afq034
“What Is Sarcopenia?” International Osteoporosis Foundation. https://www.iofbonehealth.org/what-sarcopenia
“Sarcopenia with Aging”. https://www.webmd.com/healthy-aging/guide/sarcopenia-with-aging
“The Facts about Sarcopenia”. Aging in Motion. http://www.aginginmotion.org/wp-content/uploads/2011/04/sarcopenia_fact_sheet.pdf
We lose some muscle mass naturally as we grow older, that explains the declining muscle power and strength in the elderly. This problem gets worse if we lead a sedentary lifestyle or become bedridden due to illness.
But being old does not equate with weakness and frailty. Numerous studies have shown that regular physical exercise and strength training can help to build bone and muscle mass and improve our overall health and quality of life.
The muscles are strengthened when you lift or push against weight. This can be achieved by exercising with weights, or daily activities such as lifting and
carrying groceries, mowing lawn, digging the garden or vacuuming.
Strong muscles improve balance and make it easier to perform everyday activities – climbing stairs, getting out of car, carry groceries, walking dog etc. – with less risk of falling.
However, millions of people are letting their muscles wasting away. Based on a recent survey of over-65s in UK, the Chartered Society of Physiotherapy (CSP) said that nearly a quarter of elderly do not do muscle strengthening activities at all.
The internet age lifestyle is a big threat to our health. People are glued to their smartphones and reluctant to move. And they don’t have to leave home to get food or carry groceries!
This trend is worrying as we record more falls each day. Fall results in pain and injuries, and possibly death. A majority of hip fractures were suffered by elderly who fell, and it is costing the National Health Service around £1bn each year.
To prevent fall and stay healthy, NHS Choices1 recommends seniors who are generally fit and with no limiting health conditions to do:
at least 150 minutes of moderate aerobic activity such as cycling or walking every week
strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
The strength exercises that you can do at home or in the gym include:
exercise with weights
exercise with resistance bands
exercises that uses your own body weight, such as push-ups and sit-ups
vacuuming, digging and shovelling in the garden
carrying heavy load such as shopping
Seniors who have not done any exercise before must get advice from their doctors first. You should also get help from a physiotherapist who will guide you through exercises that fit your physical conditions.