Fitness · Health

Reversing Muscle Mass Decline

Everyone fears loss of independence. Having the ability to go where we want to and get what we need gives us this freedom. Mobility is provided by the musculoskeletal system—which is, we spine and sports physiatrists jokingly contend, the most important system in the body. (During medical-school lectures, while neurologists declared that the brain is the master organ, followed by cardiologists claiming first place for the heart, I was in the back of the room thinking, “The brain or heart can’t even take a single step without a muscle or bone.”)

Most patients come to see me for issues with immobility and/or pain. Many times, muscle weakness or poor muscular function is the cause. Take, for example. the sedentary banker with low back pain caused by core muscle weaksness and resulting poor posture. Most of us realize that muscle mass or size increases with exercise and decreases with inactivity. Muscle mass and size also decrease with aging. Sarcopenia is the medical term utilized to describe this process.

If you break down the Greek roots that make up this word, “sarx” refers to flesh or muscle and “penia” to poverty or loss. Almost everyone in the U.S. is familiar with other “penias” such as osteopenia. Osteopenia refers to loss of bone mass, or decreased density of the bone. Osteoporosis is a more severe type of bone loss and results in an increased risk for fractures of the bone. Osteopenia and osteoporosis tend to receive all the media attention and are often portrayed as the primary reason for fractures. Even health care professionals focus on screening, identifying, and then treating osteoporosis in women over 50 as the primary way to prevent fractures and functional decline.

Falls are the major cause of fractures in older adults, and fall rates increase as mobility declines. The purpose of this post is not to take any attention away from osteopenia and osteoporosis, since they are serious health concerns, but to increase awareness of sarcopenia and the negative impact it can have on health and function.

The onset of sarcopenia, like the onset of hypertension, can be silent. This makes early recognition difficult, but not impossible. We actually know from different studies on muscle physiology that sarcopenia is inevitable, and the initial decline in muscle mass actually begins in your 30s. According to WebMD, “At some point in your 30s, you begin to lose muscle mass and function, a condition known as age-related sarcopenia. Some evidence supports the fact that people who are physically inactive can lose as much as 3% to 5% percent of their muscle mass per decade after age 30.”

Sarcopenia has been linked to many factors or causes. As previously discussed, there is age-related sarcopenia. Inactivity or disuse also results in loss of muscle mass. Hormonal changes have been linked to sarcopenia, and so has malnutrition, especially decreased protein intake. Malnutrition and inactivity, especially the lack of resistance exercise, are considered to be extremely important factors; fortunately, they are modifiable risk factors for sarcopenia.

The most important thing to realize is that sarcopenia is manageable, reversible, and maybe even preventable. As stated above, inactivity can increase the percentage of lean muscle loss per decade, whereas routine physical activity can reverse the process. Strength training or progressive resistive exercises can result in increases in lean muscle mass even in the oldest individuals. The American College of Sports Medicine currently recommends strength training of major muscle groups 1 to 3 times a week (acsm.org), and this may be the most important tool in the prevention of sarcopenia.

Nutritional issues or deficiencies can contribute to sarcopenia as well. The major concern is decreased protein availability, since protein is the building block for muscle. This may occur if there is decreased intake of lean protein in your diet or decreased absorption of protein, which can occur with certain gastrointestinal disorders (e.g., celiac disease).

If you are reading this post and concerned about sarcopenia’s negatively impacting your mobility and overall health, then it is time to come up with a plan.

First, look at your exercise routine and keep an exercise diary over one week, or even one month. Then discuss your current routine with a physician, physical therapist, and possibly fitness professional. Physiatrists and sports medicine specialists are two groups of physicians with expertise on exercise counseling who can help you come up with a good plan to prevent the functional decline that can be associated with sarcopenia.

Second, exercise is, in my opinion, the best medicine to address this issue and many other medical problems, and nutrition is the perfect complement to exercise. I would recommend a similar dietary plan. Keep a daily and weekly food diary. Then review this with your physician, and possibly a nutritionist or dietician, to make sure your current diet supports your exercise plan, your individual health needs, and your overall plan for maintaining function and independence.

Good luck at preventing muscle loss and maintaining your mobility and independence.

 

 

References:

“Sarcopenia,” Wickipedia, https://en.wikipedia.org/wiki/Sarcopenia

“50 Plus: Live Better, Longer,” WebMD, http://www.webmd.com/healthy-aging/sarcopenia-with-aging

“Growing Stronger: Weight Training in Older Adults,” Centers for Disease Control, http://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf

Evans, WJ. Reversing sarcopenia: how weight training can build strength and vitality. Geriatrics 1996, http://www.ncbi.nlm.nih.gov/pubmed/8621102

 

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