How to Prevent and Reverse Sarcopenia (Muscle Loss) - Doctor Q&A

Start young: Sarcopenia (muscle loss) starts earlier than you think

Sarcopenia is the progressive loss of muscle mass, strength and function that occurs with ageing. The terms derived from Greek - sarx (flesh) and penia (loss). In Singapore, sarcopenia is estimated to affect approximately 1 in 3 adults aged 60 years and above*. 

While muscle loss is a natural part of aging, sarcopenia develops when this loss becomes significant enough to affect mobility, independence and quality of life. The gradual decline in muscle health can begin as early as the 30s and accelerates after the age of 60. 

Who is at risk of sarcopenia (muscle loss)?

While anyone can develop sarcopenia with age, certain factors increase the risk. These include:

• Sedentary lifestyle or low levels of physical activity
• Poor nutritional intake, particularly inadequate protein
• Chronic medical conditions such as diabetes, heart disease or kidney disease
• Prolonged bed rest or repeated hospitalisation
• Excessive alcohol consumption

Individuals with one or more of these risk factors should pay closer attention to maintaining muscle health. 

Recognising the early signs of sarcopenia (muscle loss)

Early signs of sarcopenia are often subtle and may be mistaken for “normal aging”.

However, it is not normal to become weaker as we age! Recognising these warning signs early allows intervention before significant muscle loss occurs:

• Feeling weaker or more easily tired than before
• Difficulty climbing stairs, carrying groceries or rising from a chair
• Walking more slowly than usual
• Reduced balance or more frequent falls

As sarcopenia progresses to its later stages, visible muscle wasting may occur, particularly in the arms, legs and shoulders. 

How is sarcopenia (muscle loss) diagnosed?

Based on the Asian Working Group for Sarcopenia (AWGS) 2025 recommendations, healthcare professionals assess sarcopenia by evaluating:

1) Handgrip strength test to measure muscle strength.

2) Body composition assessment such as Bioelectrical Impedance Analysis (BIA) to estimate muscle mass

Additional assessment including physical performance tests such as 6-minute walk test may also be performed to determine the severity of the condition and guide treatment.

Protecting your muscle health

The good news is that sarcopenia can be prevented, delayed or even reversed, especially if detected early. The earlier healthy habits are adopted, the better the long-term outcomes. 

Key strategies include:

• Perform regular resistance and strength-training exercise
• Consume adequate protein throughout the day to support muscle maintenance
• Maintain a healthy, balance diet
• Stay physically active and avoid prolonged inactivity.

Vitamin D also plays an important role in muscle health. Low vitamin D levels have been associated with muscle weakness. It can be obtained through sunlight exposure and foods such as salmon, sardines, eggs and vitamin D-fortified milk. 

If you have questions about sarcopenia or muscle health, submit them through the forum. A/Prof Frederick Koh is here to help you better understand the condition and what you can do about it. 

*Source: Prevalence and Associated Factors of Sarcopenia in Singaporean Adults – The Yishun Study 2021 

1. Tan LF, Koh FH, Lim WS, Wang Y, Woo J, Arai H, Merchant RA. Sarcopenia: Current evidence, advances in assessment, clinical implementation and future directions. Ann Acad Med Singap. 2026 Jan 15;55(1):26-37. doi: 10.47102/annals-acadmedsg.2025287. PMID: 41601290.

2. Wang JJ, Quak GS, Lee HB, Foo LX, Tay P, Mah SM, Tong C, Koh FH. The Role of Vitamin D Supplementation in Enhancing Muscle Strength Post-Surgery: A Systemic Review. Nutrients. 2025 Apr 29;17(9):1512. doi: 10.3390/nu17091512. PMID: 40362819; PMCID: PMC12073290.

3. Maier AB, Chew STH, Goh J, Koh FHX, Tan NC. Strengthening Muscle Health of Community-Dwelling Older Adults in Singapore: Evidence Towards Clinical Implementation. J Frailty Aging. 2023;12(4):258-266. doi: 10.14283/jfa.2023.31. PMID: 38008975.)[YL1]  [YL1]Can we add a hyperlink for readers who want to learn more?

Clin Assoc Prof Frederick Koh is a Consultant in the Department of Colorectal Surgery, Division of Surgery, at Sengkang General Hospital (SKH). He is also an NMRC-funded Surgeon-Scientist and Principal Investigator at the SKH Musculoskeletal Regenerative Laboratories and leads the SingHealth Duke-NUS Muscle Health Programme. In addition, he serves as Deputy Vice Chair (Research) for the Surgery Academic Clinical Programme (ACP) and Deputy Director, Research at SKH.

Clin Assoc Prof Koh is a strong advocate for academic surgery and is widely published in peer-reviewed journals. His clinical and research interests span general and colorectal surgery, sarcopenia, and the use of artificial intelligence in endoscopy. He holds a PhD focusing on the impact of sarcopenia in surgical patients and continues to lead research in this area, including serving as Clinical Lead for the Mechanistic Investigation and Clinical Innovation for Sarcopenia Diagnosis and Therapy (MAGNET) programme, funded by NMRC OF-LCG in 2025.

His contributions to research and clinical innovation have led to recognition as a key opinion leader with global industry partners such as Abbott, Hyphens Pharma, Pharmacosmo, and Medtronic. In recognition of his academic contributions, he was awarded the 28th Yahya Cohen Memorial Lectureship in 2025 by the College of Surgeons, Academy of Medicine, Singapore.

1. Question by JJ

Dear Doctor,

Will be most grateful if you can assist with the below questions on sarcopenia.

Questions:

a) How frequent does Vitamin D levels need to be monitored for a patient with low levels on replacement?

b) Where in Singapore can I bring my elders for physical assessment? Any ActiveSG labs that provide formal assessments?

c) Any tips on how to convince the old folks to exercise?

Thanks very much!

Answer by Dr Frederick Koh

Hi JJ, Great questions! Please find my responses below.

a) For a patient with vitamin D deficiency, Vitamin D levels are typically rechecked every 3 to 6 months, or as advised by your doctor.

b) A few options worth exploring:

• Sengkang General Hospital (SKH) Muscle Health Programme offers muscle health assessments, and if any deficiencies are found, we have direct referral access to Physiotherapy and Dietetics teams who are familiar with muscle health and its interventions. This is the most precise option for muscle health assessment. Feel free to reach out to SKH at skh.muscle.health.programme@skh.com.sg to find out more.
• Polyclinics provide functional assessments for seniors as part of their primary care services.
• Active Ageing Centres (AACs) offer health and functional screenings in a community setting.
• ActiveSG Sport Centres have fitness programming tailored for seniors.

c) Group activities such as Qigong, line dancing, or morning walks with friends tend to work well, as many seniors are more motivated to exercise in the company of others. Joining programmes at an Active Ageing Centre is a great way to combine staying active with building new friendships in the community.

2. Question by Prasad

Dear Dr,

Where can I get tested and diagnosed for sarcopenia? (muscle loss).

Do I need to get a referral letter from a Polyclinic GP? Many thanks.

Answer by Dr Frederick Koh

Sengkang General Hospital (SKH) Muscle Health Programme offers muscle health assessments (referral needed?)and if you are already a SKH patient, you can seek your doctor to refer you to our inhouse programme. Feel free to reach out to SKH at skh.muscle.health.programme@skh.com.sg to find out more.

ActiveSG Sport Centres also offer the Combat Age-Related Loss of Muscle (CALM) 1.0 programme under their Active Health initiative, which helps individuals understand their muscle health through assessments.

3. Question by Tan CH

Dear Prof Frederick Koh,

I am 81 years old and have diabetes for about 40 years and well control with an average of HbA1C of 7.5.

My balance in the last 2 months is getting worse. I saw a Senior Consultant Neurologist and the result after the Neurophysiologist report states that sensor motor axonal polyneuropathy.

I went to seek a second opinion with Brain and Spine Specialist after an MRI Cervical on my spine. Conclusion is Loss of normal Lordosis, T2 signal, high T2 in the posterior C3/4 disc and Facet arthopathy in C3/4 to C7/T1.

He now wants me to do Discoplasty to regain my balance. What should I do? Thank you for your advice.

Answer by Dr Frederick Koh

Dear Tan CH,

Thank you for your question. This is a very personal and specific medical situation, and I'm glad you are already seeing specialists for it. You should continue discussing with your doctors regarding the need for surgery, the potential benefits, and any concerns you may have.

Should you decide to proceed with an operation, it would be important to prepare adequately beforehand. Given your age and other medical conditions, ensuring your muscles are in the best possible condition prior to surgery can give you a better chance of a smooth recovery. Do speak with your doctors about prehabilitation and rehabilitation options.

4. Question by Audrey

Hi Dr,

I am a small sized female in my mid 50’s and have lost muscle over the years. I’ve tried various ways to improve muscle mass but have not been successful.

I would like to enquire if there are any opportunities to participate in any studies or programs related to sarcopenia and building muscle mass?

Thank you.

Answer by Dr Frederick Koh

Hi Audrey,

Thank you for sharing. Muscle mass can be improved through progressive resistance training, ensuring adequate protein intake at each meal, and maintaining sufficient Vitamin D levels. These work together to support muscle strength and mobility.

At Sengkang General Hospital, we have an initiative focused on the research, diagnosis, and treatment of sarcopenia. If you are already a SKH patient, do approach your doctor for a referral to our programme. Otherwise, feel free to reach out to us at skh.muscle.health.programme@skh.com.sg to find out more.

5. Question by Max

Dear Dr Koh,

I have the following questions about muscle loss:

a) Is sarcopenia the same as muscle atrophy? How are they different?

b) Does sarcopenia affect more men or women or equally?

c) Apart from frailty and increased risk of falling, does sarcopenia increase the risk of other conditions? If yes, what are they?

d) When should I consult a doctor for sarcopenia?

Answer by Dr Frederick Koh

Dear Max,

Thank you for the questions! Please find my responses below.

a) Muscle atrophy refers to muscle loss. There are two forms: progressive loss (sarcopenia) and accelerated loss (cachexia), which are driven by different factors and require different types of intervention and monitoring. Do approach your doctor to find out more.

b) Sarcopenia affects both men and women. Before menopause, men are more susceptible to developing sarcopenia. However, the drop in oestrogen following menopause reduces the protective effect in women, making them more vulnerable to sarcopenia thereafter.

c) Yes, beyond frailty and falls, sarcopenia can also affect immunological and physiological reserves. It increases the risk of infections and reduces the body's ability to recover from illness or injury. This means individuals with sarcopenia face a higher risk of hospitalisation and longer hospital stays, reduced quality of life, and in serious cases, increased risk of death.

d) You should consult a doctor if you notice any of these warning signs:

• Feeling weaker or more easily tired than before,
• Difficulty climbing stairs, or
• Difficulty carrying groceries, or
• Difficulty rising from a chair, or
• Walking more slowly than usual, or
• Reduced balance and more frequent falls

You can certainly learn more about sarcopenia from your doctors or email skh.muscle.health.programme@skh.com.sg to enquire more.

Ref: F26