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Getting Older Doesn’t Have to Mean Getting Weaker

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If you’re age 50 or older, you’ve probably noticed that your suitcases and grocery bags have gotten mysteriously heavier. It’s hard to admit it, but your muscle power is not what it used to be.

Unfortunately, far too many people assume that this age-related condition known as sarcopenia, which literally means “loss of muscle or flesh,” is an inevitable part of aging. But that’s simply not true. New and better ways to prevent and diagnose this condition now are available—and there’s more reason than ever to not ignore it.

The dangers of sarcopenia are more serious than experts once thought—and may involve other crucial elements of your health such as your risk for diabetes, dementia and other chronic conditions.

MORE THAN MUSCLE LOSS

With advancing age, our muscles shrink because the body loses some of its ability to convert protein into muscle tissue. By age 50, the average adult loses about 1% to 2% of muscle mass every year.

That’s bad enough, but the real problem is what results from this muscle loss. Over time, it becomes more difficult to stand up from a chair…climb a flight of stairs…or even open a jar. People with sarcopenia are far more likely than stronger adults to suffer falls and/or bone fractures. They’re also more likely to be hospitalized or admitted to a nursing home—and even die during a given period of time.

An increasing body of evidence shows that people with weak muscle strength have a higher risk of developing type 2 diabetes—a disease that can also double your risk for heart attack and stroke.

Recently discovered danger: People with sarcopenia are at increased risk for cognitive decline, including brain atrophy and dementia, according to research published in Clinical Interventions in Aging. In this study, people with sarcopenia were six times more likely to suffer from physical/cognitive impairments than those without this condition.

What this means to you: Collectively, the risks associated with sarcopenia are so great that clinicians from a variety of disciplines assess signs such as weight loss (from shrinking muscles)…fatigue…and a loss of strength to determine which patients are at highest risk for frailty and to work toward intervention.

The 4-STEP PLAN

As scientists learn more about sarcopenia, the better your odds are of fighting it—if you take the appropriate steps. What works best if you have sarcopenia…

STEP 1: Load up on protein. Everyone needs protein to increase muscle size/strength. People with sarcopenia need a lot of protein. The recommended daily allowance (RDA) for protein is 0.8 g per kilogram of body weight. (That’s about 54 g for a 150-pound woman.) If you’ve been diagnosed with sarcopenia, you need much more (about 1.2 g per kilogram of body weight).

My advice: Whenever possible, get most or all of your protein from natural foods rather than from protein-fortified foods—the nutrients in natural foods work synergistically to provide greater benefits than supplements. (For example, a small, 3.5-ounce serving of lean pork has about 26 g of protein…one-half cup of pinto beans, 7 g…and a large egg, about 6 g.)

Note: If you have kidney disease, you may have been told to limit your protein intake. Ask your nephrologist for advice on optimal protein levels for you.

Helpful: If you find it difficult to get enough protein from food alone, try whey protein supplements. You can buy these milk-based supplements in powder and liquid forms. Products such as Ensure typically provide 12 g to 20 g of protein per serving, while some protein powders deliver up to 60 g in two scoops mixed in a smoothie, for example. An advantage of whey protein supplements is that they contain leucine, an amino acid involved in muscle synthesis. If you can’t have dairy, ask your doctor about taking an essential amino acid supplement enriched with leucine.

STEP 2: Get enough vitamin D. You need vitamin D for both muscle and bone strength. Depending upon the time of year and where you live, you can get all you need from 10 or so minutes of daily unprotected sun exposure. But many older adults don’t spend that much time in the sun…and those who do are probably covering up or using sunscreen to protect against skin cancer.

My advice: Consume at least 1,000 international units (IU) of vitamin D daily. You can get some of this from D-fortified cereal, milk or juice. If you don’t eat a lot of these foods, you may find it easier to take a 1,000-IU vitamin D supplement.

STEP 3: Eat fish. There’s good evidence that two-to-four weekly meals of fatty fish (such as salmon, mackerel or sardines) will improve blood flow to all of the body’s muscles, including the heart. In theory, this should help people with sarcopenia maintain or gain muscle mass, but the evidence that it helps isn’t conclusive. Even so, I still recommend fish because it’s a good protein source and has many other health benefits.

STEP 4: Exercise the right way. Exercise is the only way to build muscle, even if you consume plenty of protein. Aerobic exercise (such as brisk walking) is good—everyone should get some because it improves both muscle and cardiovascular health. But strength training is the real ticket for building muscle. As an added bonus, it also appears to promote brain health.

Important new finding: When Australian researchers had 100 people age 55 or older with mild cognitive impairment (a condition that often precedes Alzheimer’s) do weight-lifting exercises twice a week for six months, the stronger the study participants’ muscles got, the greater their cognitive improvement, according to a study published in 2016 in Journal of the American Geriatrics Society.

Even if you are not able to use weight-lifting machines at a gym, there are plenty of ways to do strength training. The American College of Sports Medicine recommends lifting weights (hand weights are fine) or using elastic resistance bands two to three days a week. Unfortunately, that’s too ambitious for many people.

My advice: Just do some exercise, whether it’s 10 minutes every day or an hour once a week. If you feel too weak to start with “real” exercise, you can keep things simple. Example: A chair-stand exercise, in which you sit in an armless chair…extend your arms in front of you…slowly stand up…then slowly lower yourself back down. Do this five to 10 times, twice daily.

For arm strength: Hold the ends of a large elastic resistance band in each hand, and stand with both feet on the middle of the band. Keeping your body straight and your elbows by your side, slowly curl your hands up toward your shoulders. You can raise both hands together or one at a time. Try to repeat the movement eight to 12 times, twice daily.

For leg strength: Sit on a chair. Keeping your back straight, slowly extend your right leg straight out in front of you and hold for several seconds before lowering it slowly back down. Repeat with the left leg. Do 10 repetitions on each leg. When this becomes easy, strap on an ankle weight that’s heavy enough so that you cannot do more than 15 repetitions per leg.

If you tend to get bored with exercise, here’s a great solution…

Research shows that people who work with an exercise coach or personal trainer—at home or at a health club—are more likely to stick with regular exercise. In a program that my colleagues and I supervise, patients with sarcopenia first attend physical therapy to help restore flexibility, balance and endurance, then attend weekly sessions led by exercise coaches who are enthusiastic and keep people motivated.

My advice: Consider using an exercise coach. It may be one of the best things you do for your overall health! To find an exercise coach near you, consult the American Council on Exercise, ACEfitness.org.

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Source: John E. Morley, MD, director of the division of geriatric medicine and the Dammert Professor of Gerontology at Saint Louis University School of Medicine. He is coeditor of the textbook Sarcopenia and editor of the professional publication Journal of the American Medical Directors Association. Dr. Morley is also a recipient of the American Geriatrics Society’s Lascher/Manning Award for Lifetime Achievement in Geriatrics. Date: January 1, 2018
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