Prevent and Reverse Sarcopenia (Muscle Loss) with Exercise, Protein and Vitamin D

The word ‘sarcopenia’ originates from Greek roots, which combines ‘sarx’ (meaning ‘flesh’) and ‘penia’ (meaning ‘loss’). It was introduced by Dr Irwin Rosenberg in 1989.

“Sarcopenia is the gradual age-related decline in muscle strength, mass and physical function. Although the condition is preventable, most people come to accept these changes as “normal” due to ageing. Eventually affecting their quality of life and independence,” Clin Assoc Prof Koh said.

Sarcopenia leads to:

• Loss of muscle mass and size
• Reduced muscle quality due to fatty tissue infiltrating muscle fibres (called intramuscular fat infiltration) and
• Muscle scarring due to the accumulation fat between the muscles fibres

“Older adults with sarcopenia experience more difficulty performing basic daily tasks or Activities of Daily Living (ADL) such as bathing and dressing or even being able to get up from a chair unassisted, climbing stairs, carrying groceries etc,” Clin Assoc Prof Koh explained.

“But muscle does far more than just help you to move. It is also the body's largest protein and energy storage system – essential for fighting illness and recovering from injury. People with poor muscle health tend to get more frequent infections and take longer to recover from injury or infection. Giving rise to frailty and increasing risk of other medical conditions," he added.

According to the Prevalence and Associated Factors of Sarcopenia in Singaporean Adults – The Yishun Study:

• 1 in 3 older adults (aged 60 and above) have sarcopenia
• 1 in 14 younger adults (aged 60 and below) have sarcopenia

“Many think that sarcopenia only affects older adults, but it can start setting in as early as when a person is in his or her 30s or 40s,” added Clin Assoc Prof Koh.

“Some degree of muscle loss over time is of course inevitable, but the goal is to slow this trajectory so as to ensure decent muscular function and adequate physiological reserves to resist stresses that the body need to experience (such as infections, elective surgeries, injuries etc),” Clin Assoc Prof Koh answered.  

“We often lose muscle at a rate of 3% every decade of life, but many often lose muscle mass at a rate much higher than this (and yet accept it as part of ageing).” He added.

The AWGS diagnostic assessment 

The AWGS (Asian Working Group for Sarcopenia) uses the following assessment to measure risk of sarcopenia, based on a person’s handgrip strength and appendicular skeletal muscle mass (total amount of skeletal muscle in a person’s arms and legs).

For the ease of screening for sarcopenia in the community, the AWGS recommended the inclusion of a simple measurement of calf circumference.

Click here to try the AWGS Sarcopenia Screening Calculator!

The SARC-CALF screening tool 

This tool combines a questionnaire (SARC-F) with the measurement of a person’s calf circumference (SARC-Calf) for a quick, low-cost way to screen for sarcopenia.

Alternatively, an instrument-free method you can try to use to check for sarcopenia risk is the “Yubi-wakka” (finger ring) test. For this test, the smaller the size of the person’s calf, the greater the risk of sarcopenia.

1. Drugs

Common

• Statins
• Fibrates
• Steroids
• Alcohol

Less common

• Cholroquine
• Colchicine
• Antiretroviral drugs such as lamivudine, zinovudine
• Chemotherapy medications

2. Type 2 Diabetes (Diabetes Mellitus)

3. Other diseases

• Chronic lung, kidney, liver or heart disease
• Osteoporosis
• Knee osteoarthritis
• Neurological diseases such as stroke, Parkinson’s disease
• Cancer

4. Deficiency

• Poor oral health
• Swallowing difficulties
• Vitamin D deficiency
• Conditions/medications causing anorexia or malabsorption
• Other factors affecting access to food

1. Movement is medicine

Exercising regularly is key to maintaining good muscle health. But it isn’t enough to just hit the basic 150mins-a-week of moderate-intensity physical activity.

“A combination of cardiovascular, resistance based, and balance optimising exercises is needed to maintain good overall health. Resistance training in particular, helps you to maintain and improve muscle health,” Clin Assoc Prof Koh advised.

For older adults, HPB’s “Singapore Physical Activity Guidelines for Older Adults (65 years & above)” recommends:

• Doing muscle strengthening activities on 2 or more days a week, at moderate or greater intensity, 
  • plus Include multi-component physical activity that emphasises strength and functional balance for at least 3 days of the week at a moderate-intensity or greater
• Engaging in at least 150 to 300mins of moderate-intensity aerobic activity per week

2. Ensure sufficient protein intake

A common misconception among older adults is that they require less protein than younger adults – this is FALSE!

According to HPB, the recommended amount of protein intake for adults are:

For seniors that cut back on meat due to dental issues and difficulty swallowing, they can try soft protein sources including:

• Soft-cooked fish (e.g., steaming)
• Tofu and bean curd
• Eggs (e.g., scrambled, steamed)
• Beans and lentils
• Properly prepared lean meats, cut into smaller pieces

Protein tip*: “When increasing protein consumption, don’t add it all in just a single meal (as shown in graph B), instead, spread over three meals (as shown in graph A) to maximise its effects for muscle-building,” Clin Assoc Prof Koh shared.

* For persons with kidney or liver conditions or have gout, do seek proper nutritional advice from a nutritionist or dietitian for a tailored amount of daily protein intake.

To know the protein content for local food items and for easy ways to add more protein to your diet, see this article.

3. Vitamin sufficient protein intake

Did you know that up to 8 in 10 Singaporeans suffer from a lack of vitamin D?

Getting sufficient Vitamin D is important for maintaining the regenerative ability of our muscles.

In fact, according to a 2018 study, sarcopenic older adults with >20ng/ml of 25(OH)D in their blood, enjoyed up to 3 times more muscle gain than those with <20ng/ml.

“Going out into the sun and exposing our full length of arms and legs for more than 15 mins daily is enough to maintain a good level of Vitamin D. For people with Vitamin D deficiency, it is important that they take supplements to return their Vitamin D levels to normal levels,” advised Clin Assoc Prof Koh.

Vitamin D has two main forms, the ‘sunshine vitamin’ and the other from food sources. To know what these foods are, see this article.

In summary,

The first step towards preventing sarcopenia begins with changing the mindset that losing function and getting weaker is a normal part of ageing (it is NOT).

Only with mindset change, then taking the necessary steps such as exercise and diet can take place. After all, building and maintaining muscle is easier than trying to get it back once it is lost.

Ref: F26

Related articles:
How to Beat Sarcopenia (Loss of Muscle Mass and Strength)

How to Avoid Frailty: Doctor's Advice for Merdeka and Pioneer Generation Seniors