What is sarcopenia? And why haven't I heard of it before?
Simply put, sarcopenia is the natural, progressive, generalized muscle loss and failure that occurs with aging. One's muscle bulk is progressively replaced by fat and fibrous tissue.
Sarcopenia is considered the muscular equivalent of osteoporosis, but general awareness of sarcopenia as a disease - even among clinical professionals - remains very low.
Conditions such as dementia and osteoporosis have become relatively prioritized by major health entities, research groups and the mainstream media.
In comparison, sarcopenia, has lagged far behind - lacking similar popularization and recognition. And, despite being a major cause of morbidity, cost and mortality, it has failed to come to the fore in the eyes of the general public.
For these reasons, sarcopenia remains largely unrecognized and underdiagnosed.
When should I be worried about sarcopenia?
Recent studies have shown that sarcopenia starts as early as your mid-30’s.
The condition progresses faster when one enters their 50’s, eventually resulting in up to 50% of muscle mass being lost in those entering their 70's.
How do I know if I have sarcopenia?
Progressive fatigue and reduced stamina are felt as a result of decreased muscle strength and function. This results in declining function as one enters one's senior years.
This debility results in a downward spiral of decreasing physical activity and diminishing muscle mass, resulting in falls, fractures and even death.
Increased fat content in muscle is also associated with insulin resistance - whose symptoms mimic those of diabetes mellitus.
How is the diagnosis of sarcopenia made?
The SARC-F questionnaire (linked) is a useful and validated five-question screening tool that can be used by individuals or clinicians to help establish the risk of sarcopenia.
SARC-F is comprised of five questions that assess strength and mobility, with each question allocated between zero to two points. The questionnaire has an overall maximum score of 10, but a score greater than or equal to four is predictive of sarcopenia and poor outcomes.
Other clinical tools available include grip strength (using a dynamometer) and 'chair-stand' assessments.
A dual energy x-ray absorptiometry (DEXA) scan is the current recommended tool for radiographic measurement of low muscle quality and quantity. Although other tools can be used they are sometimes less readily accessible, less reliable and are not as cost effective.
The severity of sarcopenia is assessed through timed performance measures, such as 'gait speed' and the TUG (Timed-up and Go) tests among others. These assessments are often carried out by physiotherapists and biokineticists.
How can I prevent (or reverse) the effects of sarcopenia?
The severity of sarcopenia in one's senior years is determined quite early on. In fact, it is established right from birth: there has been found a positive association between higher birth weight and a higher lifetime muscle strength.
Nonetheless, there remain recommended objectives for muscular fitness in the different phases of life, with the overarching goal of limiting the severity of sarcopenia in one's latter years.
In the youth and young adults, maximizing muscle strength is a priority.
In one's middle age, you should work to maintain this strength, while senior age groups must ensure minimal muscle loss or ought to work to reverse weakness as it sets in.
It is important to be aware that, despite your usual level of physical activity, sarcopaenia is progressive. It is an inevitable part of getting older.
The reason your basic physical routine alone is insufficient to maintain muscle strength as you age, is likely due to altered hormone balances, altered dietary habits, decreased gut protein absorption, among other changes that can occur with age - over and above contributory effects related to chronic medical conditions.
The good news is that, despite the inevitability of sarcopenia, it can be slowed down or reversed, and this is primarily through focused resistance and strength training exercises – over and above routine day-to-day physical activity.
Is there medication I can take to manage sarcopenia?
Medication is not the first line therapy in sarcopenia. While there are several pharmacological options currently being studied, medicines are certainly not considered useful in isolation.
Physical exercise is still the mainstay of treatment for sarcopenia even when pharmacological supplements are prescribed by your doctor.
What should I consider when I start my physical training programme?
It will take a multidisciplinary team to help you work towards - and maintain - your health, fitness and mobility goals safely.
Before commencing strength and resistance training it is important to establish that your proposed exercise program is compatible with your pre-existing medical conditions and physical limitations.
A visit to your GP or Specialist Physician will help establish what is safe for you from a cardiovascular perspective.
Dr. Maina will be able to advise on potential physical limitations you may have that might affect your spine, joints, ligaments and/or tendons. Dr. Maina will also be able to make recommendations to both you and your physical therapist on how to manage pain and instability that could negatively impact your training and recovery programme.
With increased exercise, one’s protein intake will need to proportionately increase. This quantity is calculated based on one’s ideal (not actual) body weight, and is essential to adjust because of the decreasing efficiency of protein absorption with age.
A visit to the dietitian will help with establishing nutritional quantities, drawing up a meal routine and meal plan that is compatible with your medical conditions, your weight goals, personal preferences and/or allergies. The dietitian will also review and recommend improvements to any problematic dietary habits you may have developed over time.
Proteins she/he may recommend may include nut butters, legumes, eggs, dairy products, chicken, fish and other meats. The dietitian may also have access to a Bioelectrical Impedance Analysis (BIA) scale to calculate your muscle mass and document your progress in gains over time.
Physiotherapists, biokineticists and/or personal trainers (PT) are vital health and fitness professionals who will safely help you establish and modify a training programme you should follow in order to acheive well-rounded and balanced muscle growth and fitness.
They also assess and adjust the appropriate intensity of exercise (resistance should always be “somewhat hard”) to achieve your muscle growth goals, and, importantly, ensure that the exercises you do are being performed using a technically correct and safe manner to avoid injury.
Physios and bios also have the tools to objectively measure and document muscle strength during the course of rehabilitation through tools such as isokinetic tests, dynamometers among other relevant apparatus.
When it comes to physical activity, sooner is better when it comes to getting moving. None of us are getting any younger.
In the words of Arthur Ashe:
"Start where you are.
Use what you have.
Do what you can."
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits) CIME
References:
1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019 Jan 1;48(1):16-31.
2. Brody J.E. Preventing Muscle Loss as We Age. New York. The New York Times. 2018 Sept 3. Available from: https://www.nytimes.com/2018/09/03/well/live/preventing-muscle-loss-among-the-elderly.html
3. Gilliot S, Bastijns S, Perkisas S, De Cock AM. Investigating sarcopenia awareness using Google Trends. Journal of Frailty, Sarcopenia and Falls. 2021 Mar;6(1):32.
4. Malmstrom TK, Morley JE. SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia. Journal of the American Medical Directors Association. 2013 Aug 1;14(8):531-2.
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