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.
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