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Aging & Muscle Mass Loss

Friday, September 14, 2018


“Use it or lose it.” How many times have we heard this advice?


One of my favorite New York Times health writers, Jane Brody, devoted her column last week to the importance of staying in shape as we age to prevent falls and fractures associated with increased risk of early death.

 

Like so many others way past the age of 50, I have personally noticed a decline in skeletal muscle loss, in spite of my addiction to reaching my daily Fitbit steps goal.


Science now clearly suggests that without proper intervention, muscle loss becomes increasingly worse, with as much as half of muscle mass lost by the age of 70 in those who do not incorporate resistance training into their daily exercise program. There is a name for this condition, which I will not use, since the FDA objects to web sites that sell nutritional supplements mentioning any disease process, so I will stick to structure / function issues associated with muscle mass loss.


​It has been reported in medical journals that up to 13 percent of people in their 60s and half of those in their 80s suffer muscle loss associated with falls and fractures, with the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control estimating the public health care cost of falls and fractures in the older population to exceed $40 billion annually by 2020.


Screen for loss of muscle mass


​This simple questionnaire to rapidly diagnose muscle mass loss was printed in JAMA a few years ago:


Component question scoring


Strength 

 

How much difficulty do you have in lifting and carrying 10 pounds?

None = 0

Some = 1

A lot or unable = 2


Walking

 

How much difficulty do you have walking across a room?

None = 0

Some = 1

A lot, use aids, or

unable = 2


Rising from a chair


How much difficulty do you have rising from a chair without

​using arm strength, or transferring from a chair to a bed?

None = 0

Some = 1

A lot or unable without

help = 2


Climbing stairs 

 

How much difficulty do you have climbing a flight

of 10 stairs?

None = 0

Some = 1

A lot or unable = 2


Falls 

 

How many times have you

fallen in the past year?

None = 0

1 to 3 falls = 1

4 or more falls = 2


The scores range from 0 to 10. Preliminary studies suggest that a score equal to or greater than 4 is predictive of serious loss of muscle mass and poor outcome.​ 


The Biosyntrx team suggests that a score of one or two should tell everyone to start resistance training immediately.                   


The New York Times article pointed out that few physicians bother to alert their older patients to this condition and tell them how to slow or reverse what is otherwise an inevitable decline that can seriously impair their physical and emotional well-being and ability to carry out the tasks of daily life.

 

The really good news


No matter how old or out of shape we are, we can restore much of the strength we have already lost. Research documenting the ability to reverse the loss of muscle—even among nursing home residents in their 90s—has been in the medical literature for 30 years, and the time is long overdue to act on it. 


Maintaining muscle mass also requires adequate nutrients, especially  protein, the main constituent of healthy muscle tissue.


Older adults need about one-half gram of protein in their daily diet for every pound they weigh. Protein acts synergistically with exercise to increase  muscle mass. One-half gram per pound of weight is more protein than the  majority of older adults consume these days.


Studies published in JAMA report, eight weeks of high-intensity resistance training significantly enhanced the physical abilities of nursing home residents age 90 and older. Strength gains in nine subjects over the age of 90 averaged 174 percent, with mid-thigh muscle mass increasing 9 percent, and walking speed improving 48 percent.  


A study published ​in September 2018 in the Journal of Diabetes Investigation, found that low-intensity resistance training improves glycemic control in older patients with type 2 diabetes. 


A study published in August 2018 in Nutrients found that higher protein diets improved markers of health and functional capacity, in older women participating in a resistance-based exercise programs. 


A new study coming out in the October 2018 edition of Experimental Gerontology found a reduction in inflammatory markers when muscle mass was increased with a high-volume of resistance training protocols.


So what are we all waiting for? If you’re sedentary or have a serious chronic illness, check first with your physician. But as soon as you get the go-ahead, start a strength-training program using free weights, resistance bands or machines, preferably after taking a few lessons from a physical therapist or certified trainer.


Since ocular health is also our focus, we would be remiss if we did not let our readers know that annual eye exams are also necessary to identify vision problems associated with falls and fractures. Many eye problems related to age can be addressed through new prescription glasses or contacts, necessary surgery, and community-based services, as well as low-vision therapies designed to help prevent falls, fractures, emotionally devastating loss of independence, and, too frequently, loss of life.

  

Ellen Troyer, with Spencer Thornton, MD, David Amess and the Biosyntrx staff



PEARL

PEARL: In keeping with the Biosyntrx commitment to identifying cause and ways to lower the societal burden of increasing health care costs, as well as pain and suffering, we will continue to frequently address the issue of balance, falls, and fractures, because low vision, lack of physical conditioning, and nutritional deficiencies all play a major role.


For those who may not know, SilverSneakers is a program encouraging older adults to participate in physical activities that will help them maintain greater control of their health. Medicare Advantage plans (part C) may provide this benefit. To see if your plan provides this coverage in your state, check here.