Sarcopenia is the loss of muscle mass in conjunction with reduced strength and/or physical performance. In July 2019, sarcopenia was recognised as a disease with its own International Classification of Disease, ICD-10 code (M62.84). It can also occur secondarily to chronic disease (e.g. cardiovascular disease and diabetes).
At least five definitions for its clinical identification exist, most include three themes – low muscle mass, strength and physical performance.
Currently, no pharmacological treatment exists for sarcopenia. The most effective intervention to improve muscle mass, strength and performance is lifestyle strategies such as progressive resistance training combined with a healthy diet that includes adequate dietary protein and energy intake.
The resistance exercise prescription can probably be summarised as completing at least 2-3 days a week of weight training that includes whole body movements (upper and lower body exercises), performed over 2-4 sets and using a repetition range that can be completed using a moderate to heavy intensity load until fatigue.
For adults over 65, the general recommendation for daily protein intake is 1.1 to 1.2g/kg/day, even for those undertaking resistance exercise, and for those with sarcopenia the requirement may increase to 1.5 g/kg/day.
Diets rich in vegetables providing a plethora of nutrients including vitamin K, nitrate and organosulphur compounds are also likely to support musculoskeletal health. A daily 75g serve of green leafy and/or cruciferous vegetables (e.g. broccoli, cauliflower, cabbage) would represent rich sources for these nutrients.
Most importantly, including clinical nutrition expertise in the management of chronic disease including sarcopenia should be actively promoted to patients as part of their treatment plan.
A surprisingly low number of older adults currently meet exercise guidelines, with only one in four over 65 considered sufficiently active. Low physical activity and sedentarism are significant risk factors for sarcopenia and other chronic diseases.
Based on official guidelines, adults aged over 65 years should be completing at least 30 minutes a day of physical activity on most days of the week, incorporating activities such as fitness, strength, and balance exercise. This includes any physical activity that increases heart rate and ideally these activities include weight bearing.
The biggest barrier to exercise participation in older adults has been shown to be related to poor health or injury, yet inadequate lifestyle choices (i.e. inactivity, insufficient diet) contribute greatly to compromised health. Overcoming this barrier to physical inactivity begins with good education, setting achievable and realistic goals and working with an individual to find easy-to-implement strategies to improve their physical activity levels.
In our clinical experience many older adults, including those with or without chronic disease, are under prescribed exercise by their doctors or have been advised that exercise participation may be unsafe due to age or chronic conditions.
It is important to differentiate between physical activity and exercise. Physical activity refers to activities that are a part of one’s usual daily activity (e.g. household chores or walking to the letterbox). There are many opportunities to be physically active every day, and this should be encouraged for all older adults.
Some easy to implement examples:
- Walk or ride to work
- Parking the car at the back of the carpark when you go to do your grocery shop
- Walking every aisle at the supermarket
- Choosing the stairs instead of the lift.
If completing 30 minutes of physical activity in one session is not achievable, benefits can still be achieved in smaller increments (e.g. three sessions of 10 mins).
Exercise is a more structured and focused approach usually performed for a particular duration or intensity. Exercise is safe if individualised and prescribed within the recommended guidelines. For patients who have complex medical histories, when assessed and prescribed by an accredited exercise physiologist, appropriate modifications and individualisation can still occur enabling safe exercise participation.
For those with sarcopenia traits, it is always recommended that before beginning a new exercise routine a GP is consulted for a general health screen and they should be able to refer to an accredited exercise physiologist who can prescribe an individualised plan taking into consideration the patients’ medical history, medications, risk factors and goals.
Key messages
- Sarcopenia is common in older adults and associated with falls, fractures and cardiovascular disease
- 75% of older adults are not meeting recommended physical activity guidelines
- The only intervention consistently shown to improve muscle mass, strength, and physical function in older adults is resistance exercise, combined with a balanced diet.
ED: Dr Smith is a postdoctoral research fellow and accredited exercise physiologist, and Dr Marc Sim is a Senior Research Fellow (Nutrition) both at ECU.
Author competing interests – nil