What is Sarcopenia?

Sarcopenia is the loss of muscle mass, muscle power, and strength that occurs as we age.

Sarcopenia, unfortunately, can lead to the frailty (a medical syndrome), and total disability. It can even lead to death.

Sarcopenia can affect everything we do as we age, from how we function to how we move; it can affect our ability to live independently. One of the main reasons people end up in a nursing home is their inability to get on and off of the toilet due to lack of muscle and strength.

The term “frailty” or “frailty syndrome” might be more familiar to you than sarcopenia. But sarcopenia is a major component of frailty syndrome, which is a strong predictor of disability and death in older people. Frailty is characterized by weight loss, exhaustion, low physical activity, slowness, and weakness. Sarcopenia is muscle loss. It is all inexorably linked.

The good news is that sarcopenia is reversible. We can take action to potentially prevent, delay, and reduce the consequences and the tolls sarcopenia and frailty can take on our lives. Medical science shows that intense strength training is important to fight and prevent sarcopenia, the loss of muscle mass as you age. In fact, strength training is the number one way to beat the insidious disease. It also reduces your risk of heart disease, diabetes, and certain types of cancer. Researchers around the world tout the benefits of strength training to combat sarcopenia, especially as we age.

Taking on Sarcopenia, the Muscle-Wasting Disease

Fred Bartlit is living proof that sarcopenia can be avoided. He’s been lifting weights for more than 35 years. Now, in his late 80s, Fred maintains that he feels stronger than he did when he was in his 20s and an Army Ranger.

Once Fred started working out hard, lifting weights with increasing intensity he began to notice that his friends were slowing down. He wasn’t sure why, so he started researching the impact strength training had on aging. In his research, he came across the term sarcopenia. It wasn’t being talked about too much at the time. Curious, he dug in more, reading, researching and learning all that he could about the muscle-wasting disease. As he asked around, he noticed many doctors hadn’t heard the term sarcopenia. Few people he knew had either. At the time, it hadn’t even been designated as an official medical condition. In 2016, it was finally given a diagnosis code, and slowly, the medical community started to become aware of sarcopenia, as did the need to work to avoid getting it by doing strength training.

Fred started trying to explain to people that life after age 70 or 80 could be amazing if they would just get to the gym and lift weights. He came up against a lot of resistance among his peers and, surprisingly, even some doctors. He stumbled across an article written by a leading medical professional suggesting we’d all be better off if life ended at age 75, that anything beyond that just wasn’t worth living for.

Fred refused to listen. He knew too much about this then mysterious muscle-wasting disease called sarcopenia. And he knew the importance of strength training to combat sarcopenia.

“People think it’s okay to just go for a walk for exercise. But your body has two kinds of muscles in it and walking only gets to 40 percent of them. If you’re not pumping iron, you’re not getting to the 60 percent—fast-twitch muscles—that are good for skiing, hitting a golf ball, and not falling down when you’re in your 70s,” he said.

“I don’t just lift weights. I do cardio. You’ve got to do both,” said Fred. “But to really live the kind of life you want to live you really have to use heavy weights to failure.”

Fred decided to sound the alarm bells about sarcopenia. He co-wrote a bestselling book, Choosing the StrongPath, filled with research on the disease, and then launched StrongPath.com. Why? Simple: He believes strength training is the best medicine. He believes the StrongPath is the road map. Mostly, he hopes everyone can stay healthy and enjoy life to the fullest, just like he does.

Choose the StrongPath

What is the StrongPath?

StrongPath is a movement. It’s an inspirational and informational website filled with stories and up-to-date research on Sarcopenia. StrongPath is a network of fitness coaches who will help train you to build muscle and stave off sarcopenia, the muscle-wasting disease. StrongPath recently partnered with HealthSnap. HealthSnap is a digital platform designed to gather lifestyle data to help manage and prevent-lifestyle-related chronic conditions. Together, HealthSnap and StrongPath have teamed up and work in conjunction with your doctors and other fitness professionals, all working together toward the same healthy goal of combatting sarcopenia.

By empowering you, StrongPath is redefining healthcare by providing lifestyle strategies that will help you take control of your health, your resilience, and your overall enjoyment of life.

That’s always been Fred’s goal—to spread the word and make sure you fully enjoy life in your 40s, 50s, 60s, 70s, and beyond. He’s not alone in his thinking that strength training is the answer to combatting sarcopenia.

“The Academy of Medical Royal Colleges has concluded that intense physical activity is a miracle cure, not just for frailty and aging, but for a whole wide range of diseases,” said Fred. “Harvard Medical School has concluded that exercise has a bigger impact on disease risk than any other remedy and, if it could be followed, it would be the most prescribed medicine. The Centers for Disease Control calls exercise a ‘wonder drug’. These guys don’t throw these words around lightly.”

Fred’s not the only one spreading the word. He is, however, living proof that it’s possible to stay strong as we age.

Sarcopenia Causes

Sarcopenia is seen mostly in people who are inactive. The function of our nervous system becomes impaired as we age and so we naturally reduce our general physical activity. Plus working out, or the amount we exercise, tends to decrease as we get older. A sedentary lifestyle is unfortunately becoming more and more common. That’s why it’s important to keep the healthy cycle of activity going to help maintain and increase muscle mass.

Other sarcopenia causes include lower concentrations of some hormones that decrease as we age, such as growth hormone, testosterone, and insulin-like growth factor. There are other sarcopenia causes, including insulin resistance, inflammation, oxidative stress, and lack of proper nutrition, especially adequate protein, which helps maintain and feed muscle mass. Older people often don’t get enough protein in their diets and can suffer from malnutrition without realizing it. Plus, as we age, sometimes there is a decrease in the ability to turn protein into energy that can contribute to the development of sarcopenia.

Sarcopenia Symptoms

Sarcopenia symptoms include weakness and a loss of stamina. Loss of balance and a shift in gait could indicate a problem as well. Regular daily activities might be more difficult, such as taking the stairs, walking, or carrying heavier things. A loss of endurance is an indicator as well. Once these symptoms materialize, a downward spiral begins. People are weaker, and that can interfere with physical activity of any kind, which leads to less physical activity leading to more loss of muscle mass as a result of inactivity.

That leads to emotional issues. In a New York Times article about sarcopenia, the author Jane Brody brings up the emotional impact of sarcopenia as well as physical. Without muscle strength, the simple daily activities of life —walking, shopping, driving, cleaning, opening a jar — are compromised. This can lead to an even more sedentary lifestyle and the lack of desire to really do anything because it becomes too overwhelming. It’s common for older people to be isolated and homebound as going out becomes just too difficult. Depression can follow and the cycle continues.

Sarcopenia Prevention

Strength training is well established as one of the most effective strategies to prevent the loss of muscle mass during aging. Even a six-week strength-training program can increase muscle quality and the ability to function and execute basic tasks.

It’s never too late to become physically active. Even individuals who were previously sedentary and start working out at age 85 experience a three year longer life expectancy compared to sedentary people.

It’s also been shown that resistance training in elderly people must be conducted at relatively high intensities and volumes to see improvements. (Low intensity resistance exercise programs produce little or no strength gains.) In the Journal of the American Medical Association (JAMA) there was a report that eight weeks of high-intensity resistance training had significantly enhanced the physical abilities of frail nursing home residents aged 90 and older. Strength gains averaged 174 percent.

Exercise can improve functional capacity, decrease the risk of falls and improve your walking ability, balance, cardio capacity, and muscle strength development.

There is also some evidence that shows working out in a group is more effective than working out alone.

Sarcopenia Diagnosis

There’s no real test to diagnose sarcopenia but ultrasound is an effective way of determining our muscle mass.

The one way to determine if you have sarcopenia is a simple functional test. A SARC-F questionnaire was developed by Theodore K. Malmstrom PhD and John E. Morley MB, BCh as a way to determine whether or not you have sarcopenia. There are five questions related to testing and measuring strength:

1.) Can you lift and carry 10 pounds?

2.) Do you have difficulty walking?

3.) Do you have difficulty rising up from a chair or bed?

4.) Do you have difficulty climbing a flight of stairs?

5.) How many times you have fallen in the past year?

If the answer if None to each question, give yourself a 0.

If it’s Some it’s 1 point.

If it’s A lot or unable or 4 or more falls, it’s 2 points.

Their studies predict that if the score equal to or great than 4, there’s a good chance you have sarcopenia.

There are some getting started videos on our website, StrongPath.com, and more information on functional movement screening in our resources section.

Sarcopenia Treatment

Exercise, especially strength training, is hands down the most effective way to treat sarcopenia, and many believe is the absolute best way to prevent it from happening in the first place, or at least lessening the degree to which it occurs. Strength training increases muscle strength and can help the neuromuscular system as well as the production of hormones. It can also improve the ability to convert protein to energy in as little as two weeks.

Maintaining muscle function is even more important than maintaining muscle mass, so a strategy that includes a strength-training program with nutrition that helps sustain muscles may be the most effective routine managing sarcopenia.

Making sure you eat enough, and especially enough protein, is important to prevent and treat sarcopenia.

Getting Started? Combat Sarcopenia by Improving Strength, Balance, and Flexibility

Balance Exercises for Beginners

Putting the focus on the lower limbs in your workouts can leads to better balance, a key concern for many seniors keen to head off falls.

Kick off your balance training with three small, focused exercises recommended by the UK’s National Health Service. They’re doable in pretty much any location, from your living room to the grocery aisle as you pick up ingredients for dinner.

The first movement is a sideways walk. Stand with your feet together, knees slightly bent. Step to the side, slow and controlled, moving one foot then the other to join it. Avoid dropping your hips as you step. Try 10 steps in each direction and increase when ready.

The next exercise is a simple grapevine, which is a sideways walk but with the added action of crossing one foot over the other. Pro tip: The smaller the step, the more you work on your balance.

The last is a heel-to-toe walk. Standing upright, place your right heel on the floor directly in front of your left toe. Then repeat with your left heel. Look forward (not down) and try to perform at least five steps. If you need extra stability for any of these, work near a wall with your fingers lightly supporting your balance and move away as you progress over time.

Another excellent lower body strengthener is step-ups, a power move recommended by the Centers for Disease Control that hits the legs, hips and butt. Stand in front of a set of stairs with feet flat and toes facing forward. Place your entire left foot on the first step (use the handrail for balance if necessary). Count to two, then place your weight on your left leg and straighten it while slowly lifting your right leg until it reaches the first step. Keep the left knee straight and don’t let it shift forward past your ankle as you’re lifting yourself up. Tap your right foot on the first step, then lower it back to the floor as you count to 4. Repeat 10 times with the left leg and 10 times with the right leg for one set. Rest for about one minute. Then do a second set of 10 repetitions with each leg.

Chair Exercises for Beginners

Intimidated by gym equipment? Anxious about your balance? It’s totally understandable. “There is no question, you have to move, and you just have to find a safe way to do it,” said Dr. Ailshire. Happily, one of the most useful pieces of exercise gear can be found in almost every home, and chances are you’re sitting on it right now: a chair.

Dr. Ailshire notes that it’s often easiest to start with exercises that aren’t too far from actions we do during the course of most days. You might hear “squats” and think, Oh no, I can’t do those. But in this case, it’s just a series of repetitions in which you sit down and stand up again, an everyday movement that nevertheless strengthens your abdomen and thighs.

To begin these squats, stand in front of a sturdy chair, feet slightly more than shoulder width apart. Extend your arms so that they are parallel to the ground. Place your body weight more on your heels than on the balls of your feet. Bend your knees as you lower your rear toward the chair in a slow, controlled motion while you count to four. Pause there, then slowly rise back up to a standing position for a count of two. Position your knees over your ankles and keep your back straight. Repeat the squat ten times. Rest for about one minute, then complete a second set of ten.

For added stability and peace of mind, position the chair next to a table. “You can even hold onto it while doing the exercise,” said Dr. Ailshire. “It will make you feel safer and it might actually make you safer.”

Stretching Exercises for Beginners

For seniors who haven’t quite gotten up the resolve to start strength training, research shows that even gentle stretching has fantastic benefits. “Muscle stretching performed regularly can have a real impact by increasing blood flow to muscles in the lower leg,” said Dr Judy Muller-Delp, Professor of Biomedical Sciences at the Florida State University College of Medicine. “This highlights that even individuals who struggle to walk due to pain or lack of mobility can undertake activity to possibly improve their health.” Customize your own stretching routine with help from The University of California at Berkeley, which has compiled an excellent comprehensive guide to seated, standing and floor stretches.

Address Sarcopenia with Protein and Nutrition

Douglas Paddon-Jones, Ph.D., professor of nutrition and metabolism at The University of Texas Medical Branch, Galveston, said a decent amount of protein is equal amounts at all three meals—20 to 35 grams or so being a reasonable, moderate serving.

“If you’re a tiny person, you aim for the low-side. If you’re an athlete you need more of everything.” And if your appetite shrinks as you age, he said, skip the roll and the starch and make sure the protein still lands on the plate.

He also warned people to be careful about eating too much protein, that doubling protein intake can translate into extra calories.  “One-hundred and fifty to two hundred grams a day isn’t going to do you any harm, but that’s a lot of protein. That’s a lot of food. There’s no need to eat that much.”

Plus, he said starting good habits when you’re young might help you maintain them over a lifetime. Changing life-long behavior is tricky, and instead, according to Dr. Paddon-Jones, we should start consuming the appropriate amount of protein at an early age. And just stick with it.

A study published in the American Journal of Clinical Nutrition is in line with Dr. Paddon-Jones’s suggestions. It suggests that you should spread your protein out throughout the day. Researchers looked at a group of healthy, older adults for more than three years, assessing their strength and mobility. For many, muscle strength declined. However, those who spread their protein out throughout the day had greater muscle strength at both the beginning and the end of the study. Researchers recommend getting protein at each meal—breakfast, lunch, and dinner—and even at snack time.

Studies show that leucine-enriched mix of essential amino acids increase protein synthesis more than other forms of protein. Foods containing leucine include milk, cheese, beef, tuna, chicken, peanuts, soybeans and eggs.

Other sarcopenia treatments may include drugs or medications, though this is not the preferred sarcopenia treatment. Some drugs are being researched, mostly to help older people who have already lost mobility and need help preventing muscle atrophy in certain situations like when they are in a cast or immobile. This has not been studied adequately and is not recommended as a sarcopenia treatment. Hormone Replacement Therapy (HRT) for women after menopause can increase lean body mass and help prevent bone loss. Testosterone and growth hormone supplements are being studied as well.

However, strength training is the most effective way to treat sarcopenia successfully. Check with your doctor or health care professional, but it’s smart to start a strength-training program, no matter your age or muscle mass currently. Strength training is also a good way to increase bone density, too.

Strength training is different than cardio (aerobic) exercise and playing sports. Though playing tennis or bike riding is of course good for you, it’s not enough to effectively stop the loss of muscle mass and function that comes with aging. Only strength training and resistance training can.

Sarcopenia and Chronic Disease

Need a few more reasons to get physical? How about: Cancer. Alzheimer’s Disease. Heart disease.

Research from Rush University in Chicago shows people who followed four of five specific healthy behaviors had a greater chance of lowering their risk of Alzheimer’s dementia by 60 percent compared to those who didn’t. One behavior: moderate to vigorous exercise 150 minutes per week. That, combined with a few other good habits like a healthy diet, and easing up on the alcohol, will help keep this age-related disease from affecting older adults according to one report. To read the full report click here.

When you think heart disease you might think only older adults are impacted. But a confluence of health issues, what doctors are calling “clustering of risk factors,” like obesity, high blood pressure, and other factors, is putting more and more young people—as young as 34, at risk. And the number of cases is rising—one report shows 6.2 million adults in the United States suffered heart failure in recent years, up from 5.7 million five years earlier. A story in Heathline reports that lifestyle changes, including diet and exercise are key to lowering the risk of heart disease, and that prevention is imperative. To read the full report click here.

Recommendations on just how much exercise you have to do varies but getting at least 150 minutes of moderate cardio or 75 minutes of high intensity and a couple of strength training sessions per week is recommended by the Department of Health and Human Services.

How Does Exercise Help Fight Cancer?

Studies show that people who exercise and are physically active significantly reduce their risk of getting certain types of cancer and for some cancer patients, a regular exercise routine can improve chances of survival.

According to research, exercise has positive effects on our biology, which may explain the links to certain cancers like breast and colon cancer. Our bodies experience positive changes that include:

  1. Hormone levels like insulin and estrogen are lowered
  2. Immune systems are boosted
  3. Inflammation is reduced
  4. Healthy weight maintained
  5. Digestion and metabolism are improved

What You Should Know About Certain Cancer Risks and Exercise

  • Physically active people may reduce their risk of colon cancer by 24 percent compared to men and women who are not physically active.
  • Breast cancer incidence and progression are powerfully affected by lifestyle factors and health choices, including healthy or unhealthy diets and exercise or a sedentary lifestyle. Studies show that women who are physically active have a 12 percent lower chance of getting breast cancer, especially after menopause. Women with breast cancer who exercised at least one hour a week were 35 percent to 40 percent less likely to die from the disease than women who didn’t exercise at all.
  • Endometrial cancer is reduced by 20 percent in people who had high levels of physical activity than those who did not.
  • Vigorously exercising three times a week can reduce the risk of death by prostate cancer by 61 percent in men with non-metastatic prostate cancer.

Bottom line is that leading a sedentary lifestyle not only affects your waistline but can lead to a greater risk of developing chronic illnesses.

StrongPath Coaches are Here to Help You Fight Sarcopenia

Our coaches are trained to help you get strong, and also to address the specific needs of people with sarcopenia. Not in a generic way, either. While sarcopenia is widespread, there are various types of sarcopenia that impact different people. That’s why we customize treatment for following:

1) Some people’s Sarcopenia is due to having metabolic disease related to lack of muscle. Muscle is the primary site for glucose and lipid metabolism. Muscle weakness and dysfunction lead to less movement and greater risk of cardiovascular and metabolic disease, which prevents individuals from being able to build muscle.

2) Sarcopenic obesity is something often seen in athletes who don’t refuel properly during recovery. Over-trained athletes or people on high protein/low carbohydrate diets lose muscle, not fat when they work out. This could reveal itself in someone who loses weight, but gains fat because they have lost muscle mass

3) Traditionally defined sarcopenia.

Our coaches will work with you and your doctors to customize a nutrition and workout program that meets your specific health needs.

While everyone is different, and we suggest you meet with a trainer to help you get on track, there are some general StrongPath guidelines for fighting classic sarcopenia. If you have had a challenge building mass, low Body Mass Index, you sleep poorly, and you suffer from joint pain, stiffness, and lack of mobility, you’ll want to get to the gym to increase strength, function, and joint and skeletal health by getting on the StrongPath. Consider the following to increase strength and function:

Resistance Training:

  • Four to six days per week at the gym.
  • Isolate movements based on large muscle groups.
  • Do 30 to 40 sets of eight to 12 reps each session.
  • Include 45 to 90 seconds of recovery.
  • Age and your coach will help you determine if you should do low or high intensity exercises.

Lifestyle:

  • Get eight hours of sleep each night.
  • Limit your alcohol intake.
  • Hydrate.

Nutrition:

  • Eat quality protein timed around workouts
  • Eat functional foods such as walnuts, pumpkin nuts, broccoli, beets, sweet potato, fatty fish, lentils, mushrooms, avocado, flax seeds, and pasture-raised eggs.

Remember, Sarcopenia Impacts Us All

Here are the five most important things you need to know about Sarcopenia:

  1.  Sarcopenia is the loss of skeletal muscle mass due to aging
    The functions of skeletal muscle include control of movement and posture; regulation of metabolism; storage of energy; acting as a primary source of amino acids for the brain and immune system; and acting as a substrate for malnutrition/starvation, injury/wound healing and disease. Maintaining skeletal mass is critical not only for remaining physically independent but also for survival.
  2. Sarcopenia effects half of all older adults
    More than 18 million Americans suffer from sarcopenia. One in three adults over 60 have the disease, and that number increases to more than 50 percent by the time we reach age 80.
  3. Muscle loss from Sarcopenia begins in our 30s
    Beginning in our 30s, every single human being on earth develops sarcopenia. Every year we get weaker and weaker unless we proactively work against the muscle loss. The erosion of strength accelerates in our 50s and continue to increase as we move into our 60s. By our mid-70s, there is an exponential increase in the loss of lean tissue.
  4. Sarcopenia can cause muscle weakness, frailty, and loss of independence
    The loss of strength that accompanies sarcopenia will dramatically impact your physical health. This loss of strength makes it hard to recover is we lose our balance. As we become weaker, we become more cautious and less physically active. When we are less active, we are weaker. The downward spiral continues.
  5. Strength training is the only treatment for Sarcopenia
    You can counteract this loss of muscle tissue with strength training, which will also have a positive effect on many other chronic diseases. We’re living longer. Strength is critically important to enjoying the extra four or five decades that we each have been given through medical science advances over the last century. Strength training at least three times a week as you age is the recognized treatment for combating the devastating effects of sarcopenia.

Of all of these important facts, the last one is the most important. Medical scientists at Harvard Medical School, Tufts University, the Academy of Royal Colleges, and dozens of respected medical research institutions have all concluded that intense strength training is the only way to combat the downward spiral of physical health and loss of strength that Sarcopenia causes.

Fight sarcopenia by getting started on a strength training program in your 30s and 40s. If you haven’t exercised regularly, getting started can be intimidating. We’re here to help. StrongPath.com brings you all the latest research on sarcopenia and has videos and articles on beginning a workout program. Of course, it’s important to speak to your doctor before you start any program and follow her or his recommendations on how to exercise safely.