Sarcopenia
“No decline in structure and function is more dramatic than the decline in muscle mass that develops as we age.”
What is sarcopenia and why are we seeing earlier onset Sarcopenia?
Sarcopenia is a musculoskeletal disease in which muscle mass, strength, and performance are significantly compromised with age. Sarcopenia most commonly affects elderly and sedentary populations and patients who have comorbidities that affect the musculoskeletal system or impair physical activity.
Sacropenia has been shown to start as early as the third decade of life (around your 30s), with a noticeable decline becoming more apparent in the fifth decade (around your 50s) according to most research; meaning muscle mass gradually decreases throughout life, but becomes more significant with advancing age.
Simply put, if you haven’t started doing resistance exercise by age 30, (particularly Hypertrophy Strength Training), you are losing your lean tissue and this is happening at a rate of no less than 1% per year–previously believed to start at age 50, but studies have shown that the decline in lean tissue without resistance training begins far sooner–at age 30 on average!
WHY ARE WE SEEING EARLIER ONSET SARCOPENIA
Sedentary lifestyles, poor nutrition, lack of resistance exercise, and a culture that doesn’t promote or support wellness or resistance training or proper physical education. For example: we are raising the youth without providing them the education on how to properly develop their 639 muscles in their bodies or how important protein intake is!
HOW DOES SARCOPENIA AFFECT THE BODY?
Generally, a significant decline of type II, but not type I muscle fibers are observed in sarcopenic patients.[28] Several mechanisms of the underlying pathophysiology of sarcopenia have been described:
- Age-related declines in anabolic hormone serum concentrations: Normal physiological serum levels of anabolic hormones such as testosterone, human growth hormone (HGH), and insulin-like growth factor-1 (IGF-1) have been demonstrated to function in the development, maintenance, or rejuvenation of muscle tissue.[29][30][31][32] Age-related declines of such hormones are observed in patients with sarcopenia and thus, support this underlying pathophysiology of the disease.[33]
- Insulin resistance with “sarcopenic obesity”: Aging patients often experience changes in body composition represented by increased adipose tissue alongside decreased muscle mass, coined as “sarcopenic obesity.”[34] These changes are associated with metabolic dysfunction, including insulin resistance (IR), leading to the accumulation of visceral fat mass.[35] Additionally, IR is inversely associated with skeletal muscle mass.[36]Such pathophysiology is likely mediated via dysfunction of insulin’s exerted effects on skeletal muscle – insulin resistance impairs the anti-proteolytic and MPS enhancing properties of the hormone on skeletal muscle tissue.[37] Similarly, diminished lean body mass reduces uptake of glucose into skeletal muscle, further propagating IR.[38][39]
- Age-related neurodegeneration: Progressive neurodegeneration is a commonly observed phenomenon in aging populations.[40] Aging is accompanied by a decline of alpha motor neurons in the spinal cord, loss of peripheral nerve fibers, and reduced number of neuromuscular junctions.[33][41] Considering the role of the neurological system in muscle fiber recruitment, current evidence supports neurodegeneration as underlying pathophysiology for reduced muscle strength and size in sarcopenia.[41]
- Age-related increase in inflammatory markers: Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF), interleukin (IL)-6, and IL-1 are observed in elderly populations.[42] The catabolic effects that may be exerted by these cytokines on skeletal muscle are well documented and may present a mechanism in which sarcopenia develops with age.[43][44][45]
Basic testing methods for Sarcopenia:
Screening Tools to Identify Probable Sarcopenia
- Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire: The SARC-F questionnaire is a screening tool that can be rapidly implemented by clinicians to identify probable sarcopenic patients. The questionnaire screens patients for self-reported signs suggestive of sarcopenia, which include deficiencies in strength, walking, rising from a chair, climbing stairs, and experiencing falls.[46] Each of the self-reported parameters receives a minimum and maximum score of 0 and 2, respectively, with the greatest maximum SARC-F score being 10.[47] Data suggests that a SARC-F score of ≥4 best predicts the need for further, more comprehensive evaluation.[1][46]
Assessing sarcopenia: muscle strength
- Handgrip test: Generally, handgrip strength is one of the two methods utilized to quantify muscle strength in patients with suspected sarcopenia. Handgrip strength correlates with strength in other muscles and is therefore used as a surrogate to detect deficits in overall strength.[48] Additionally, decreased handgrip strength predicts poor patient outcomes, including increased lengths of stay (LOS), functional deficits, and death.[48][49] Accurate grip strength measurement and interpretation of results rely on a calibrated dynamometer and relevant reference populations.[50] The Jamar dynamometer is a validated tool in measuring grip strength and may be used for this assessment.[51] The suggested cutoff point for handgrip is <27 kg and <16 kg, for males and females, respectively.[52]
- Chair stand test: The chair stand test may be used as a proxy to gauge lower extremity strength, particularly the quadriceps muscles. The chair stand test measures the number of times a patient can stand and sit from a chair, without the use of their arms, over 30 seconds.[53] This test has been established as a valid indicator of lower extremity strength in community-dwelling populations.[54] The suggested cutoff point for the chair stand test is >15 seconds for five rises.[53]
Can you pass the tests?
The fact is that the majority of the population have increasingly sedentary jobs, fail to get two or more resistance training sessions per week, do not consume enough protein on a consistent basis, and then many add sleep deprivation, stress, and alcohol/or other drug uses to the mix. You are your habits and a product of your environment. You need to change what is making you sick. With any habit, it must be replaced, not merely extinguished. A habit left unattended will habituate itself back in. One must adopt the identity of the new habit they want. Commit. One day at a time to the new, healthier habits. When it comes to the muscle addition and retention habit, you have the ultimate healthy habit.
Keys to muscle addition/retention:
-Nutrition (Protein, carbohydrates, and Fats, plus your micronutrients and hydration)
-Hypertrophic Resistance Training (style of training that best promotes muscle growth and stimulation of type 2 muscle fibers): 2 x Week minimum! …There are 639 muscles in the human body—good luck counting them all. Although there are three different types of muscles, the type that many of us are most familiar with is the skeletal muscle. Skeletal muscles attach to our bones, pushing and pulling our body in different directions so we can move.
-Proper recovery (rest, sleep, mobility, clearing up tissue, addressing over/under training)
Once you get your hypertrophy strength training in 2 x week or more, are consistent with your nutrition, and regularly get adequate sleep–you get to keep the muscles you build!
Treatment: “Physical activity, particularly resistance training, effectively attenuates muscle loss and improves strength in sarcopenia, providing a means of both preventing and managing the condition.[74][75] Additionally, increasing total protein intake through supplementation or food sources can help prevent and manage sarcopenia. Specifically, consuming 20-35 grams of protein per meal is advised, as such amounts provide sufficient amino acid content to maximize MPS, thus minimizing age-related muscle loss.[76] Additionally, patients with sarcopenia are recommended to consume 1.0 – 1.2 g/kg (body weight)/day.[77] Furthermore, the greatest effects are observed when resistance training and high protein diets are combined and appear to act synergistically.”
Prevention appears to be the most effective way to deal with the potential issues that sarcopenia presents in the elderly. Nonetheless, prevention, management, and treatment of sarcopenia are most effectively achieved by maintaining physical activity and increased protein intake. Specifically, patients should be educated on the daily and per meal basis protein recommendations. Furthermore, patients should be educated on the benefits of resistance training, in combination with the aforementioned recommendations, to avoid developing or treat or manage sarcopenia.
“Currently, the most effective modalities available to fight sarcopenia are physical activity and nutrition optimization.”
The National Library of Medicine in this article fails to cite the best practices for adding lean tissue (hypertrophy strength training) or delve deeply into the most important muscle groups to focus on. This is where your experienced trainer/coach comes in! All the principles and best practices are available for those that want Sarcopenia prevention and to age gracefully and not wastefully!
Do not wait to begin a Hypertrophy Strength Training program! It is never too late or too soon! We all benefit from resistance training–regardless of age! Everyone can benefit from meeting with a trainer that is experienced in Hypertrophy Strength Training! Whether you are a beginner or an advanced trainee or somewhere in the middle, getting an evaluation and then an optimized training program based upon where you are at, can help provide the proper framework to progress your muscles and movement, while providing you with the guidance and support to maximize your results from your efforts.
Our BEEfit gym and trainers are ready to help you make the most out of your body and fitness habit!
Cited sources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3060646/
Posted on: November 21, 2024Ryan