Loving Our Muscles for Life — Part 2

From the age of 50, we lose muscle mass every year. The loss of muscle mass is aligned to loss of muscle strength, and muscle power. Protein supplementation in addition to muscle strengthening exercises is required for optimum effect. Our bodies are those of hunter-gatherers, designed for physical activity. One estimate says a modern equivalent to the typical exertions of a hunter-gatherer is walking or running 20 kilometres per day, with frequent squatting, not sitting. The hunter-gatherer had to search for food and to use his mind all the time. So, in addition to exercise, current recommendations are to stand where possible and to stand up at 45-minute intervals during prolonged sitting. This is good for ‘waking up’ our physiological systems and improving brain blood flow. In summary, a combination of aerobic and muscle strengthening exercises coupled with regular standing-up when sitting for prolonged periods are preferred and most closely aligned to how we have evolved.

The concept of sarcopenia is relatively new in medicine but is fast gaining momentum. It is certainly something that I see many times each day when dealing with older patients and particularly people who have been unwell for a long period of time or who have had a fall. Sarcopenia is closely aligned with physical activity and exercise. Its name comes from the Greek words sarx and penia, signifying ‘loss of flesh’, which is indicative of the core features of sarcopenia – skeletal muscle loss. It is a progressive and generalised ageing muscle disease characterised by loss in muscle mass, weaker muscle strength and infiltration of muscles with fat.

Chapter 11: Loving Our Muscles for Life

The main factors that cause sarcopenia are ageing, chronic diseases, low physical activity and poor nutrition. We lose 15 per cent of muscle strength due to decline in muscle mass every ten years after age 50. This loss in strength accelerates after the age of 70. This is why it becomes even more important to increase exercise, not decrease it with age and to ensure that we do both aerobic and resistant exercises. We have to work much harder after age 50 and harder again after 70 to prevent age-related sarcopenia. Studies vary regarding how common sarcopenia is but some estimates are that up to two thirds of people over 70 have it. Of course, once sarcopenia sets in, it becomes more difficult to reverse and physical activity declines further such that it becomes a vicious cycle, making it more challenging to counteract age-related weakness in skeletal muscle and offset or reverse sarcopenia. So, if you have a bad cold and are confined to bed for a few days, be aware to put effort into keeping muscles moving when in bed and building up exercise programmes once recovery starts.

Chapter 11: Loving Our Muscles for Life

What can be done to prevent or reverse sarcopenia? The solution is exercise and diet. The type of exercise is important. Whereas aerobic exercise is a must, it is not sufficient without additional resistance exercises from midlife onwards. Because loss of muscle mass is generally gradual, beginning as early as age 30 and accelerating after age 60, those who have been involved in physical activity from an early age do have an advantage. The better our starting muscle mass before decay starts, the higher the reserve capacity and the less the impact of future loss of muscle. But again, I repeat, it is never too late and we do derive benefit from resistance programmes at all ages.

Resistance exercise mitigates the effects of ageing on the nerves that feed skeletal muscles as well as on skeletal muscles themselves. A properly designed training programme will enhance muscular strength and power. At a cellular level, oxidative stress is improved and the ‘energy powerhouse’ of the muscle cells – the mitochondria – function more efficiently with resistance training. A programme should include an individualised, periodised approach, working towards two to three sets of one or two multi-joint exercises per major muscle group, two or three times per week. Programmes should be progressive. The earlier that one is commenced, the better, but whatever age one starts, you will feel the benefits. If training pauses or stops, there will be a regression in muscle strength and fat tissues will infiltrate the muscles. So try to keep it up and if you pause – which almost all of us do – start up again as soon as you can.

Chapter 11: Loving Our Muscles for Life

Despite the known benefits of resistance training, only 8 per cent of adults over 75 years of age in the United States participate in muscle-strengthening and resistant exercises as part of their leisure time. Reported barriers to participation include fear, health concerns, pain, fatigue, lack of social support and, of course, lack of awareness of the benefits. I do regular supervised sessions with a physical trainer. In this way, I am best motivated and he ensures progression of the resistance programmes. Wouldn’t it be great if more recognition and support was given to supervised training and adults could avail more readily of affordable programmes? The longer-term benefits would outweigh subsidy costs, provided that those taking part remained true to the levels of participation required.

If you do not at present do resistance exercises to complement aerobic exercise then I recommend that you start to prevent or reduce sarcopenia. This is what Charles Eugster recognised and promoted – the value of hitting the iron, even aged 87. Studies confirm Eugster’s convictions and show that even in people aged 90 and over, resistance exercises are feasible and make a difference to strength and overall well-being.

Chapter 11: Loving Our Muscles for Life

Supplements to enhance muscle power are not the exclusive dominion of the young body builder. Given that the production of protein is impaired in ageing, that proteins are key to the strength of muscles and that muscle wasting accelerates with age, including sarcopenia, protein supplements should be used to complement resistant exercise programmes. The most appropriate are supplements that target protein synthesis and thereby muscle metabolism and muscle strength, such as whey protein. One recent trial of 380 adults with sarcopenia manifesting with low muscle power and low muscle mass showed that the group who were treated with daily whey protein, which was leucine (an amino acid), and vitamin D for a three-month period had a significant improvement both in muscle mass and in strength with no side effects from the supplements. This was in the context of already having muscle wasting so the results are very promising. I take a protein whey drink after each resistance training session.

Vitamin E molecules with their antioxidant and anti-inflammatory capabilities also enhance muscle regeneration and reduce sarcopenia. Animal and human experimental studies show that vitamin E benefits new muscle formation and better muscle strength. So, for the purposes of better muscle function, vitamin D, vitamin E, omega fatty acids, amino acids – particularly leucine provide the answer and appear to work when coupled with aerobic and resistance exercise.

Chapter 11: Loving Our Muscles for Life

Exercise and diet are some of the most important modifiable factors for biological ageing and, as you now appreciate, there are a host of different exercise and healthy food options. As we get older, the inclination is to slow down with each year. I propose instead that we have a target whereby we strive to do a little more exercise with each passing year. I hope that you have enjoyed reading the book as much as I have enjoyed sharing my experience of over 35 years in clinical and research practice in this fascinating topic, and, in particular, sharing the findings from the study I established and lead, TILDA, together with other global longitudinal studies. I expect that some of you are keen to see how you operate on different performance tasks compared with chronological peers and to this end I have included some tests that cover the principal areas we have discussed. At the end of each test you will find a graph illustrating the normal distributions from the TILDA study so that you can benchmark your performance with people of similar age and sex. Happy testing!