What is Sarcopenia?
Sarcopenia is the loss of muscle mass, muscle power, and strength that occurs as we age.
Sarcopenia unfortunately can lead to frailty, (which is not just a noun but a medical syndrome) and total disability, even death.
“Sacropenia can be considered for muscle what osteoporosis is to bone,” writes Dr. John E. Morley, geriatrician at Saint Louis University School of Medicine. He goes on to say that sarcopenia is prevalent in about five to 13 percent of people in their 60s and as high as one in two over the age of 80.
Based on our picture of the elderly, we may be more familiar with the term “frailty” or even the “frailty syndrome” than sarcopenia. But sarcopenia is a major component of the 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. And they are inexorably linked. 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 and can even lead to death.
The good news is that sarcopenia is reversible. We just need to identify the symptoms in order to be able to prevent, delay and reduce their consequences and the tolls sarcopenia and frailty can take on our lives.
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, decreases as we get older. A sedentary lifestyle is unfortunately is becoming more and more common. So 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 include weakness and a loss of stamina. This of course can interfere with physical activity of any kind, which sets up the cycle of less physical activity leading to more loss of muscle mass as a result of inactivity.
In a recent 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.
Strength training is well established as one of the most effective strategies to prevent the loss of muscle mass during aging. Even a 6-week strength-training program can increase muscle quality and the ability to function.
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 product 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.
There is also some evidence that shows working out in a group is more effective than alone.
Antioxidants are necessary to prevent oxidative stress on our cells, so vitamin supplementation is important to maintain a healthy balance of antioxidants and free radicals. Low levels of vitamin D in older people are associated with sarcopenia, falls, hip fractures, and death. Another reason to supplement with Vitamin D.
There’s no real test to diagnose sarcopenia but ultrasound is an effective way of determining our muscle mass. The real 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 that are about 1.) strength (can you life and carry 10 pounds?) 2.) difficulty walking 3.) difficulty rising from a chair or bed 4.) difficulty climbing a flight of stairs and 5.) how many times you have fallen in the past year. If the answer if “None” give yourself a 0, if It’s “Some” it’s 1 point, and 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.
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. 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. Supplements with leucine are often used in combination with strength training.
Other sarcopenia treatments may include drugs or medications, though this is not the preferred sarcopenia treatment. Some drugs like Urocortin II can help prevent muscle atrophy in certain situations like when you are in a cast, but 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 just 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.