Preserving Strength. Starting Now.
One of the most common complaints I see in the emergency department is falls. Falls happen in life both literally and figuratively, but the literal falls increase with age. And the injuries sustained from those falls worsen with age. The primary reason is because our bodies naturally lose muscle mass and bone density with age. We become less stable and more frail. What most people don’t know is that we can do things at any age to decrease the percentage of muscle and bone loss. And the earlier we start, the better.
What is Sarcopenia?
Sarcopenia is age-related, progressive skeletal muscle loss leading to decreased function. It can negatively impact physical performance and quality of life. This degenerative condition increases vulnerability to falls, fractures, disability, and death, and is now recognized as a major health concern worldwide.1,2
Multiple interacting factors contribute to sarcopenia including aging, sedentary lifestyle, inadequate nutrition, and chronic inflammation. These can stem from changes in hormone levels, altered protein metabolism, and insulin resistance.3 It is estimated that adults lose 5-10% of muscle mass per decade after they reach 50 years of age.4
Lifestyle Factors in Preventing Sarcopenia
While sarcopenia has negative impacts, it isn’t inevitable. Adopting specific lifestyle practices can significantly mitigate muscle loss and support overall health.
Nutritional Approaches
Protein Intake
Protein is pivotal in muscle health as it makes up the building blocks of muscle synthesis. Evidence suggests older adults require more dietary protein than younger individuals due to anabolic resistance, a phenomenon that occurs with aging. Recommended protein intake for older adults is 1.2–1.5 g/kg body weight/day, significantly higher than the recommended dietary allowance of 0.8 g/kg/day typically prescribed for younger individuals.3 A 60 kg older adult, for instance, may benefit from 72–90 grams of protein daily as opposed to 48 grams when using the traditional 0.8g/kg/day recommendation.
Not only is the amount of protein intake important to maximize muscle synthesis, but it is also important to consume protein evenly across every meal. This constant, steady state promotes muscle formation and decreases breakdown.3 Protein is often associated with meat. The downside to animal-based proteins is that they often contain saturated fats as well. Prioritize lean meats such as fish and eggs in addition to plant-based proteins such as beans, tofu, and quinoa. My family gets most of our protein from eggs, chicken breast, and quinoa. For individuals who have overall low caloric intake, protein powder supplements can also be considered.
Vitamin D and Calcium
Vitamin D supports muscle function and strength. Low vitamin D levels are linked to reduced muscle function and increased sarcopenia risk. Ensuring adequate intake (≥800 IU daily) through sunlight, fortified foods, or supplementation can help prevent deficiency.5
Omega-3 Fatty Acids
Emerging research highlights omega-3 fatty acids for their anti-inflammatory properties and role in enhancing muscle protein synthesis. Sources include salmon, sardines, walnuts, chia seeds, and flaxseeds.6
Exercise Strategies
Physical activity, particularly resistance training, is essential for combating sarcopenia.
Resistance Training
Resistance or strength training has consistently demonstrated effectiveness in improving muscle mass, strength, and functional status in older adults. Incorporating exercises targeting major muscle groups at least 2-3 times weekly, including weightlifting, resistance bands, and bodyweight exercises like squats and push-ups, is strongly recommended.7
Aerobic and Balance Exercises
While resistance training directly impacts muscle strength, aerobic exercise (walking, cycling, swimming) supports cardiovascular health and endurance, complementing strength training.8 Balance exercises, such as tai chi or yoga, enhance stability, reducing fall risk associated with sarcopenia.9
Additional Lifestyle Considerations
Sleep and Stress Management
Quality sleep supports muscle recovery and hormonal balance, both crucial for maintaining muscle mass.10,11 Chronic stress elevates cortisol levels, contributing to muscle breakdown, which emphasizes stress management through mindfulness practices or adequate restful sleep as complementary strategies.12
Avoidance of Substances
Several studies have evaluated the effects of alcohol and smoking on muscle development. While studies have not found a direct link between alcohol and tobacco use and muscle loss, they have found indirect associations. Excessive alcohol use is often associated with decreased nutritional intake. This is what leads to sarcopenia in the setting of alcohol use.13 Similarly, smoking does not directly cause decreased muscle development, but it often limits aerobic exercise capacity and indirectly can lead to sarcopenia.14
Additional Steps to Take
It’s important to stay ahead of sarcopenia. Changing your diet and exercise habits at any time is the first step and the sooner, the better. The next step is to see your doctor to determine your current baseline. Your doctor can check your vitamin levels and evaluate the presence of other conditions. Most Americans have vitamin D levels that fall below the recommended range.15 Blood work can assess not only your vitamin levels but may unmask other chronic diseases such as high cholesterol or diabetes.
Your doctor can also obtain a DEXA scan that provides accurate data on your current muscle mass, bone density, and fat percentage. A DEXA scan can serve as a helpful baseline to understand where you are now. You may also consider investing in a body composition scale. While they are less accurate than DEXA scans, these scales are more affordable and allow you to monitor trends in your muscle mass over time as you make additional lifestyle changes.
Sarcopenia, while common, is not an unavoidable fate of aging. By proactively integrating balanced nutrition, routine resistance training, regular physical activity, and maintaining a healthy lifestyle, individuals can significantly diminish the risk and impact of sarcopenia.
References
- Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019;48(1):16-31.
- Dent E, Morley J, Cruz-Jentoft A, et al. International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management. The Journal of nutrition, health and aging. 2018;22(10):1148-1161.
- Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the american Medical Directors association. 2013;14(8):542-559.
- Rodrigues F, Domingos C, Monteiro D, Morouço P. A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. International journal of environmental research and public health. 2022;19(2):874.
- Uchitomi R, Oyabu M, Kamei Y. Vitamin D and sarcopenia: potential of vitamin D supplementation in sarcopenia prevention and treatment. Nutrients. 2020;12(10):3189.
- Smith GI, Julliand S, Reeds DN, Sinacore DR, Klein S, Mittendorfer B. Fish oil–derived n− 3 PUFA therapy increases muscle mass and function in healthy older adults. The American journal of clinical nutrition. 2015;102(1):115-122.
- Fragala MS, Cadore EL, Dorgo S, et al. Resistance training for older adults: position statement from the national strength and conditioning association. The Journal of Strength & Conditioning Research. 2019;33(8)
- Coelho-Júnior HJ, Calvani R, Picca A, Tosato M, Landi F, Marzetti E. Engagement in aerobic exercise is associated with a reduced prevalence of sarcopenia and severe sarcopenia in Italian older adults. Journal of personalized medicine. 2023;13(4):655.
- Bao L, Liu Z-H, Zhu H-E, Mo J-c, Cheng D-H. Effects of tai chi on lower-limb myodynamia in the elderly people: a meta-analysis. Journal of Traditional Chinese Medicine. 2011;31(2):141-146.
- Rubio-Arias JÁ, Rodríguez-Fernández R, Andreu L, Martínez-Aranda LM, Martínez-Rodriguez A, Ramos-Campo DJ. Effect of sleep quality on the prevalence of sarcopenia in older adults: a systematic review with meta-analysis. Journal of Clinical Medicine. 2019;8(12):2156.
- Pourmotabbed A, Ghaedi E, Babaei A, et al. Sleep duration and sarcopenia risk: a systematic review and dose-response meta-analysis. Sleep and Breathing. 2020;24:1267-1278.
- Yanagita I, Fujihara Y, Kitajima Y, et al. A high serum cortisol/DHEA-S ratio is a risk factor for sarcopenia in elderly diabetic patients. Journal of the Endocrine Society. 2019;3(4):801-813.
- Hong S-H, Bae Y-J. Association between alcohol consumption and the risk of sarcopenia: a systematic review and meta-analysis. Nutrients. 2022;14(16):3266.
- Prokopidis K, Witard OC. Understanding the role of smoking and chronic excess alcohol consumption on reduced caloric intake and the development of sarcopenia. Nutrition Research Reviews. 2022;35(2):197-206.
- Kelly J, Clayton JS. Foundations of lifestyle medicine board review manual. American College of Lifestyle Medicine; 2021.
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