Poverty of Flesh: Age-Related Decline in Strength

As we age, things become more difficult. We have more responsibilities, greater stresses, and time seems to fly by. Add to all this that our immune systems are weaker and our metabolisms are slower, and life starts to be a really challenging ride. One of the greatest challenges an adult faces late in life is “sarcopenia,” a fairly recent neologism, meaning “poverty of flesh,” that describes an unhappy natural process. Starting in our late 20s, we lose an average of a little under 1 percent of our muscle mass per year.

This loss in muscle mass is characterized by overall atrophy of muscle cells, particularly the cells responsible for strength and power. Although this loss is probably related to decreased presence of anabolic (muscle-building) hormones such as testosterone and estradiol, even adults receiving hormone replacement therapy show some loss in mass. The designation sarcopenia has come to be recognized as any vulnerability to weakness, functional deficit, or loss of reactive strength. Since it’s not really a disease state, but rather a discrete condition, sarcopenia is rarely recognized until significant problems begin to arise.

Although this decline is a natural process, seen in all mammals as they age, it is becoming a big health problem in our country because of our general population’s decreased activity levels and increased longevity. Combined with osteoporosis (which results in decreased bone mass), sarcopenia can be a significant health risk for otherwise healthy older adults. Over age 80, death related to falls goes up dramatically. Although it’s usually a broken bone that sends one to the hospital, the cause of the fall is often the frailty associated with loss of muscle.

By 2030, about 20 percent of our population– more than 70 million people– will be over the age of 65. Research tells us that at present, 10 to 20 percent of Americans aged 60 to 70 are affected by sarcopenia, while more than half of adults in their 80s are affected. Women with sarcopenia are more likely to get the double-whammy: they are also more likely to show signs of osteoporosis. In both men and women, the associated decline in strength is typically 20 to 40 percent.

As with osteoporosis, cardiovascular disease, obesity, arthritis, and diabetes, certain behavioral risk factors seem to be closely associated with sarcopenia. These risk factors include smoking, poor diet, and physical inactivity. Of these, physical inactivity may be the easiest to change.

Exercise seems to be the most effective deterrent of sarcopenia. In fact, the exercise prescription for sarcopenia is the same as for osteoporosis: participate both in strength and cardiovascular exercises, increasing intensity and duration as the body allows. More specifically, the literature recommends higher-intensity exercise– such as resistance training– over lower-intensity modes such as walking. Resistance training has been shown not only to be safe for older adults, but also to maintain lean muscle mass and to maintain or increase bone density.

An effective resistance training plan to combat sarcopenia would include two or three sessions a week of familar exercises repeated over several weeks to assist in adaptation. At first, these workouts should focus on range-of-motion and bodyweight movements, and would lead to weight training as strength increases.

Loss of muscle mass is natural and inevitable, but the rate of loss can be controlled. The more fit an adult is as he enters old age, the better chance he has to avoid sarcopenia-related issues. The take-home message from researchers is this: if you wait until you sees the effects of sarcopenia, it’s going to be a massive task to get muscle back. Better to prevent the problem by getting stronger today.