What is sarcopenia?
As we get older, carrying shopping bags becomes more difficult, climbing stairs becomes more tiring, and even getting up from a chair takes more effort. Many people regard this as a normal, inevitable part of growing older.
The age-related loss of muscle mass and muscle strength is known as sarcopenia. The term comes from Greek and literally means ‘lack of flesh’. The condition usually develops gradually and goes unnoticed for a long time. The risk of sarcopenia increases significantly with age: Whilst younger adults are rarely affected, the prevalence rises steadily from the age of 60 and reaches significantly higher levels among the very elderly.
The consequences go far beyond a loss of strength. Sarcopenia increases the risk of falls and fractures, makes it harder to recover from illness, and can significantly limit a person’s ability to live independently in everyday life.
The good news is that muscle loss is not an inevitable fate. With regular strength training, a protein-rich diet and an adequate intake of key micronutrients, it is possible to maintain and even rebuild muscle mass well into old age.
Why muscle mass is lost as we age
Our muscles are constantly being built up and broken down. However, as we get older, muscle growth slows down, whilst muscle breakdown increases. This process is exacerbated by a lack of exercise, an insufficient protein intake, hormonal changes (particularly during the menopause), chronic inflammation or a vitamin D deficiency.
Muscle loss begins gradually from the age of 30 and accelerates significantly between the ages of 50 and 60. Each year, around 1 to 2 per cent of muscle mass and up to 3 per cent of muscle strength may be lost.
This often leads to a vicious circle: reduced muscle strength leads to less physical activity – and as a result, the body loses even more muscle mass. This makes it all the more important to take action at an early stage.
Muscles – far more than just organs of movement
Healthy muscles play a crucial role in our health: they provide far more than just strength, flexibility and stability. With every movement, muscles release numerous signalling substances known as myokines. These are hormone-like signalling substances that act on the whole body via the bloodstream.
The function and effects of myokines
- Anti-inflammatory effects: They inhibit silent inflammation in the body and reduce harmful immune responses.
- Metabolism: They improve insulin sensitivity, aid fat loss and help protect against type 2 diabetes.
- Brain and mind: They promote the formation of neural connections in the brain, boost cognitive function and help to reduce stress and depression.
- Inter-organ communication: It transmits signals to the liver, adipose tissue, bones and heart, and helps to regulate important adaptive and regenerative processes in the body.
Recognising sarcopenia – take the early warning signs seriously
Muscle loss is often only noticed when everyday activities become increasingly difficult or physical performance begins to decline.
Possible signs include:
- Difficulty climbing stairs
- Difficulty getting up from a chair without using one’s hands
- diminishing grip strength, e.g. when opening screw-top jars
- lack of strength to carry loads such as shopping bags
- more frequent stumbling or unsteadiness when walking, as well as walking slowly
- lower load-bearing capacity, rapid wear and tear in everyday use
- visible muscle loss, e.g. in the calves
A medical diagnosis of sarcopenia is made using various tests and measurements.
The three key strategies for combating sarcopenia
The good news is that muscle loss can be slowed down at any age – and can often even be partially reversed. Three factors, which complement one another, are key.
1 Strength training – the most important stimulus for the muscles
Strength training is considered the most effective way to combat sarcopenia. It stimulates muscle growth, improves strength, increases stability and reduces the risk of falls. Studies show that even older people can significantly increase their muscle strength through regular exercise.
Just two to three training sessions a week are enough to achieve positive results. It is important to challenge your muscles regularly and to increase the intensity gradually.
Suitable exercises to do at home include, for example:
- Standing up from and sitting down on a chair (without using your hands)
- Squats
- Calf raises
- Wall push-ups
- Pelvic lifts
The principle of progressive overload applies here: if an exercise becomes too easy, the number of repetitions, the weight or the volume of training should be increased gradually. This provides the muscle with the necessary stimulus to adapt and become stronger.
Recovery is part of building muscle
Muscles grow not during training, but during recovery periods. Getting enough sleep and taking regular breaks are therefore just as important as the training itself.
2. Sufficient protein – the building block for muscles
Exercise alone is not enough. In order to build new muscle mass, the body needs sufficient protein. Whilst an intake of around 0.8 g of protein per kilogram of body weight is recommended for younger adults, the requirement for older people is at least 1.0 to 1.5 g per kilogram of body weight per day. The more active you are, the more protein you need. People with acute or chronic illnesses also need more protein – with the exception of those with severe kidney disease.
Ideally, this amount should be spread across three meals and sourced from different foods – for example, 20–30 g of protein per meal for a person weighing 60 kg.
How much protein is there in it?
To help you visualise what 20 to 30 g per meal looks like, here are some common foods with their approximate content:
| Food | Protein (approx.) |
| Raw meat, 100 g | 25 g |
| Raw fish, 100 g | 22 g |
| Tofu, 120 g | 18 g |
| Low-fat quark, 200 g | 20 g |
| Skyr, 150 g | 20 g |
| Cottage cheese, 100 g | 12 g |
| Dried pulses, 60 g | 15 g |
| Pumpkin seeds, 25 g | 8 g |
| Oatflakes, 60 g | 8 g |
| 1 egg | 7 g |
| Hard cheese, 30 g | 8g |
Dairy products are a good source of protein. As intolerances and digestive problems associated with dairy products are common, fermented products such as yoghurt or kefir are often better tolerated. Products made from goat’s or sheep’s milk can also be a well-tolerated alternative for some people.
3 Supportive dietary supplements
Anyone who is unable to meet their protein requirements through their diet should consider taking high-quality protein powders or amino acid supplements. One thing is clear, however: protein only delivers its full benefits when combined with regular strength training.
As well as exercise and protein, certain micronutrients can further support muscle health:
- Vitamin D: contributes to normal muscle function. As a deficiency is common in older people, it may be advisable to have your vitamin D levels checked.
- Creatine: is one of the most thoroughly researched substances in the field of muscle strength. When combined with strength training, it can help people – particularly older adults – to maintain their strength and muscle mass more effectively. It is also highly recommended during the menopause.
- Omega-3 fatty acids: are the subject of intensive research. Evidence suggests that they may support muscle protein synthesis and adaptation to physical training. They also support the immune system and have anti-inflammatory effects.
It’s never too early – and never too late
Although sarcopenia is part of the natural ageing process, it is by no means inevitable. Our muscles remain adaptable well into old age and respond to the right stimuli.
Regular exercise and strength training, an adequate intake of protein and essential micronutrients, and recovery form the basis for strong muscles and greater independence in old age. Starting early builds up a valuable reserve – but it’s still worth starting later in life. After all, every muscle that is maintained or rebuilt helps to preserve mobility, quality of life and health in the long term.
Studies
Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group: https://pubmed.ncbi.nlm.nih.gov/23867520
Progressive resistance strength training for improving physical function in older adults: https://pmc.ncbi.nlm.nih.gov/articles/PMC4324332
The role of myokines in exercise and metabolism: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00080.2007
