Wednesday, August 7, 2013

Loss of Muscle Mass with Aging! What should I do?

Skeletal muscles grow bigger and stronger from the time we were born until the age of 30. After the age of 30, we begin to loose muscle mass, strength and function -- a condition known as age-related sarcopenia or sarcopenia with aging. People who are physically inactive can lose as much as 3 to 5 percent of their muscle mass per decade after age 30. Even those who are physically active will still experience some muscle loss. 

Loss of muscle mass and strength can affect balance, gait and the overall ability to perform functional living tasks especially among the elderly. It also increases 
frailty and the risk of falling and subsequent fractures in those who suffer from concomitant osteoporosis. 

Normal muscle mass on right; muscle wasting on left

Who is at risk for sarcopenia?

Although more commonly seen among inactive people, the risk of getting sacropenia increases as we age due to depleting hormone levels (particularly testosterone, growth hormone and insulin-like growth factor), decreasing protein production, motor unit re-modelling, and a more sedentary lifestyle. Inadequate intake of calories and/or protein for those who practise very strict diet control can also result in sarcopenia as the protein (mainly from muscles) is used as fuel source in starvation. Studies also reveal that diets that are rich in acid-producing food (meat and cereal grains), and low in non-acid producing food (fruits and vegetables), have been shown to have negative effects on muscle mass.

How can I prevent and treat sarcopenia?

Preventing and treating sarcopenia require an integrated approach that involves exercise, adequate nutrition, hormone replacement and nutritional supplementation.


Resistance training (or weight training) is extremely effective for preventing sarcopenia. It increases motor neuron activities, protein production and hormones level - all of which are needed in building muscle mass, even among the elderly. This indicates that it is possible to rebuild muscle strength even at an advanced age. 

Aerobic exercise also appears to aid in the fight against sarcopenia. This form of exercise has shown to increase protein production apart from improving cardiorespiratory fitness and reducing body fat. 

Here are the basic recommendations on exercise from the American College of Sports Medicine (ACSM) 2013 Guidelines. A good exercise program should incorporate 4 different types of exercise, namely aerobic, resistance, flexibility and neuromuscular exercise.

1. Aerobic (cardiovascular endurance) exercise

  • At least 5 days per week of moderate exercise (30 - 60 min in a day), or at least 3 days per week of vigorous exercise (20 – 60 min in a day)
  • Regular and purposeful type of exercise that involves major muscle groups and is continuous and rhythmic in nature
  • Exercise may be performed in one continuous session (at least 20 – 30 min) or in multiple shorter sessions (at least 10 min each) in a day to accumulate the desired duration amount of daily exercise
  • A gradual progression of exercise volume by adjusting exercise duration, frequency and intensity is recommended to enhance adherence and reduce risks of injury and adverse heart events

2. Resistance exercise

  • Each major muscle group (eg. chest, shoulder, upper back, lower back, quadriceps, hamstring, abdomen) should be trained on 2 – 3 days per week
  • Very light-to-light intensity for older persons or sedentary individuals beginning exercise and vigorous intensity for experienced trainers
  • A variety of exercise equipment and/ or body weight can be used
  • For each exercise, 8 -12 repetitions to improve strength and power in most adult and 15 -20 repetitions to improve muscular endurance
  • 2 – 4 sets of each exercise to improve strength and power in adult; 2 sets or less to improve muscular endurance
  • Rest intervals of 2 – 3 min between each set
  • A rest of at least 48 hours between sessions for any single muscle group 

3. Flexibility (Stretching) exercise

  • At least 2 – 3 days each week to improve range of motion of joint
  • Hold a static stretch for each major muscle group to the point of  tightness or slight discomfort for 10 – 30s 
  • Repeat each stretch 2 – 4 times to accumulate total stretching time of 60s for each muscle group
  • Stretching exercise is most effective when the muscle is warmed. Try light-to-moderate aerobic exercise or a moist heat packs or hot baths before stretching

      4. Neuromuscular exercise

  • Exercise involving motor skills (eg. balance, agility, coordination, gait), proprioceptive exercise training, and multifaceted activities (eg. tai ji, yoga) are  recommended for older individuals to improve physical function and reduce risk of  fall
  • At least 2 – 3 times in a week with 20 – 30 minutes each time


Adequate nutrition intake plays a major role in preventing sarcopenia. Research has shown that older adults may need more protein (1.0 – 1.2 g/ kg of body weight) than their younger counterparts to maintain proper levels that reinforce muscle mass. Older adults tend to take in fewer calories in general, which may lead to pronounced protein deficiency as well as deficiency of other important nutrients.

   Diets rich in acid-producing foods (meat and cereal grains) and low in non-acid producing foods (fruits and vegetables) have been shown to have negative effects on muscle mass. Thus, a balance diet that consists of high-quality protein, and more fruits and vegetables but reduced amount of meat and cereal gains should be taken to prevent sarcopenia.

Hormonal Replacement Therapy
All adults over 40 should undergo annual blood testing to track their hormone levels. If necessary, deficiencies of essential hormones such as growth hormone, DHEA, and testosterone can be addressed using bioidentical hormone replacement therapy.

    Nutritional Supplementation
Several nutrients including creatine, vitamin D, and whey protein have shown great promise in combating sarcopenia.

   - Creatine. Various studies have found that when creatine is given to older adults, it helps increase muscle strength and lean body mass

- Vitamin D.
 Scientists recently noted that vitamin D helps support both muscle and bone tissue, and that low vitamin D levels seen in older adults may be associated with poor bone formation and muscle function. Thus, ensuring adequate vitamin D intake may help reduce the incidence of both osteoporosis and sarcopenia in aging people

- Whey protein.
 Whey protein, a high-quality protein which is derived from dairy products, may help aging adults to optimize their protein intake and protect against muscle loss. Whey has an exceptionally high biological value
- it contains amino acids in proportions that are similar to those required by humans. 

   Other nutrients such as omega-3 fatty acids, L-carnitine, and the amino acid glutamine are believed to have biological activities and mechanisms of action that suggest a potentially beneficial role in promoting healthy muscle mass

   For any inquiries and to know more about various hormone level tests and hormone replacement therapy, please do not hesitate to contact us at +603-79601211 or write to us at  

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