Saturday , July 13 2024

TREATING SARCOPENIA: How To Deal With The Single Most Frequent Cause Of Late Life Disability

TREATING SARCOPENIASarcopenia is a potentially serious health-related condition that affects the majority of older adults, progressively reducing their muscle strength, muscle mass and physical function. This paper briefly summarizes the current research on sarcopenia – its scope and risk, as well as its ongoing effects on the aging body. It will also show that strength training can prevent a diagnosis of, or delay the onset of sarcopenia, better enabling older adults to remain healthy, active and independent.
Sarcopenia is the clinical name for the loss of muscle mass, strength and function that occurs with advancing age. Such losses are particularly noticeable in the performance of activities of daily living (ADL): everyday activities that were once taken for granted (climbing stairs, getting out of chairs, walking briskly, carrying shopping, etc.) become more and more of an effort and, for some,
even impossible. While such losses are, ultimately, inevitable with more advanced aging, their scope, progression and impact are within the capabilities of almost everyone to minimize, reduce or delay.
Up to 13% of adults in their 60s, and 50% of adults in their 80s have been clinically diagnosed with sarcopenia, meaning their muscle mass losses have reached severe levels. This amounts to approximately 18 million older adults in the United States. However, the definition and scope of sarcopenia has recently been expanded to encompass more than just muscle mass loss. A recent international sarcopenia consensus conference stated that there are grades of sarcopenia that range from sub-clinical to frailty. Sarcopenia thus affects all adults to some extent as they transition into their later years. That is, subclinical loss of muscle mass, strength and function are evident, and inevitable, in virtually all older adults compared to young, healthy, physically active young adults.
Sarcopenia is to muscle what osteoporosis is to bone.
By age 30, many individuals have begun to lose muscle mass. This can amount to as much as 10% per decade between 30 and 70 yrs of age, and 15% per decade thereafter.
Strength losses are even greater: as much as 15% per decade between 30 and 70 yrs of age, and up to 40% per decade thereafter. Physical function losses parallel these findings: in recent surveys of adults 65+ yrs of age,  0-70% report difficulty in performing a wide range of ADL. Sarcopenia also compromises muscle function
(‘muscle quality’) by allowing fatty tissue to infiltrate the muscle resulting in significant reductions in strength and force generation.
Such losses, if unchecked, can also lead to a clinical diagnosis of frailty. This is a disabling condition characterized not only by an inability to perform daily activities and to an increased risk of falls, but also by general malaise, fatigue, susceptibility to infection and a precipitous drop in body weight.
As a result of this, now generally accepted catalogue of lifestyle-impacting deficits, sarcopenia is regarded as the single most frequent cause of late-life disability.
The European Working Group on Sarcopenia in Older People recommends that sarcopenia risk be assessed on the basis of three criteria: low muscle mass, low muscle strength and low physical function. However, because strength and physical function represent major determinants of sarcopenia, a low score on these two factors alone is considered sufficient to indicate a high risk of
its incidence. This would then merit a referral for specific strengthening interventions. Accordingly, at ActiveRx we utilize an evidence-based screening test designed to assess aspects of strength and functional status that identify the level of risk of sarcopenia, or its diagnosis. Depending on the results of these tests, we then design an appropriate intervention/treatment, in collaboration with the individual’s physician.
Strength training (‘resistance training’) has been shown to increase strength at any age, and it is now acknowledged as the most effective method for the treatment of sarcopenia. A recent international conference on sarcopenia reported that “Resistance exercise, at present, is the treatment modality of choice.” This statement represents the culmination of a remarkable change in attitude. Until recently, society in general – and even medical professionals – considered strength training to be unsuitable
or unsafe for older adults. However, over the course of the past two decades, a growing body of research has conclusively demonstrated the safety and fundamental value of strength training for this population – even at high-intensities.
The benefits of strength training are noticed relatively quickly. Research has shown that 15-20 minutes of moderate to high intensity strength training 2-3 times per week for as little as 8-12 weeks can increase muscle mass by 12% or more, and strength by as much as 100%. A recent review has also reported that muscle mass can be increased 12-62% over 9-52 weeks of training, 2 to 3 days per week. In lifestyle terms, more than a decade of ageinduced loss of muscle, strength and function can be regained over a period of 9-12 weeks, with a regular and appropriately-designed program of strength training.
The consequence of this, now well established, information is that older adults can (i) delay, slow or even reverse for a time, the pre-clinical effects of sarcopenia and, (ii) significantly increase their potential for avoiding an actual diagnosis of sarcopenia and frailty. Importantly, all this is possible without the use of drugs or pharmaceuticals. At ActiveRx, we have a long pedigree of work in this area. In 1996, Dr. Wayne Phillips, our Research Director, was the first scientist in the UK to publish evidence of the safety and effectiveness of high intensity strength training to increase both strength and muscle mass in older adults. Since this time, we have published
many other studies in support of our philosophy. The scientific literature regarding the benefits of strength training for older adults also continues to expand and confirm our early application of, and advocacy for,
this approach.
At our neighborhood Strengtherapy Centers, we take every opportunity to collaborate with physicians and other medical professionals in working with patients who may be at risk for sarcopenia. An essential aspect of this approach is providing a friendly, welcoming and positive environment. In the Centers, our members can be heard to share lifestyle-related stories of their strength and functional regeneration, as well as their newly reacquired experience of independence and quality of life.
Getting older does not have to stand in the way of greater strength, independence and quality of life. Instead of defining aging by loss, it is time to discover just how much is yet to be gained!
Our unique national network of Strengtherapy Centers is currently established in 10 states, with more to follow by the end of 2015.
In summary, we provide an evidence-based sarcopenia screening battery with follow-up services that include:
• Our proprietary Strengtherapy® System that directly addresses the primary determinants of sarcopenia
• A proven evidence-based approach that increases strength, muscle mass and muscle quality, while improving a range of sarcopenia-limited functional tasks, and
• Muscle mass assessment via BIA (at selected locations)
NOTE: Sarcopenia screenings can be conducted
as part of a Medicare Preventive visit and/or yearly
wellness exam.
Access the following links for more information on ActiveRx and the work that we do with older adults:
• ActiveRx website:
• ActiveRx Aging Insights newsletter:
• ActiveRx Choose How You Age blog: Access the following studies for more in-depth research on sarcopenia:
• Brotto, M. & Abreu, EL. Sarcopenia: Pharmacology of Today and Tomorrow. Journal of Pharmacology and Experimental Therapeutics, 343: 540–546, 2012.
• Tracy, BL, et al. Muscle quality. II. Effects of strength training in 65- to 75-yr-old men and women. Journal of Applied Physiology, 86: 195–201, 1999.
• Cruz-Jentoft, AJ, et al., Sarcopenia: European consensus on definition and diagnosis. Age and Aging, 39: 412–423, 2010.
*Dr. Phillips is an internationally known consultant, researcher, author and speaker in the field of gerontology, whose work focuses on the role of strength and behavior in active, healthy aging.

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