Sarcopenia: Understanding muscle loss, its impact, and how exercise can help

Sarcopenia is a progressive, age-related condition characterised by the loss of muscle mass and strength. In the UK, where the population is steadily ageing, sarcopenia has become an important issue to address. The condition affects individuals in several ways by reducing mobility and independence, whilst also increasing the risk of falls, fractures and hospital admissions. It is therefore vital that both healthcare professionals and the public understand the development and consequences of sarcopenia. This article provides an overview of the condition, examines the underlying mechanisms, describes early signs and symptoms and discusses the significant benefits that exercise can offer as an intervention.

Sarcopenia is defined as the progressive loss of skeletal muscle mass and strength that occurs naturally with ageing. Although a decline in muscle mass is inevitable as people grow older, the progression of sarcopenia may be accelerated by several factors. A sedentary lifestyle and poor nutritional choices can worsen muscle wasting, and underlying medical conditions such as diabetes and cardiovascular diseases further increase the risk. A thorough understanding of sarcopenia is essential because the condition directly affects an older adult’s ability to remain active, maintain independence and enjoy a good quality of life.

It is estimated that a significant proportion of the elderly population may be living with sarcopenia, with some studies suggesting that up to 30 per cent of individuals over the age of 65 might be affected. The clinical significance of this condition extends beyond individual health; sarcopenia leads to an increased risk of falls and fractures and contributes to higher rates of hospitalisation and long-term care. This situation imposes a substantial burden on the NHS and underscores the need for early detection as well as effective management strategies to minimise its impact on both individuals and the wider healthcare system.

The processes underlying sarcopenia are complex and involve both structural and functional changes in the muscle tissue. As people age, there is a reduction in both the number and size of muscle fibres, particularly those fibres that are responsible for generating power. Alongside this loss of muscle fibres, there is also a decline in the number of motor neurons, which disrupts the communication between nerves and muscles and negatively affects overall muscle function. At the cellular level, several processes contribute to the degradation of muscle tissue. Chronic low-grade inflammation, which is common among older adults, accelerates the breakdown of muscle proteins, while natural decreases in hormones such as testosterone and growth hormone reduce the ability to synthesise new muscle. In addition, age-related declines in mitochondrial efficiency hinder muscle repair and energy production. These interconnected processes highlight the need for interventions that consider both lifestyle choices and the biological mechanisms that drive sarcopenia.


Cross section of a muscle in 25 year old (left) and 65 year old (right)

The signs and symptoms of sarcopenia are often apparent in the form of muscle weakness and a reduction in muscle mass. Many individuals begin to find that daily tasks, which were once easy to complete, become increasingly challenging as their muscle strength diminishes. A reduction in muscle bulk can be detected through clinical examinations and imaging, and a decrease in balance and coordination is frequently observed, which further increases the risk of falls and injuries. Early warning signs include difficulty with routine activities such as climbing stairs or carrying shopping, along with a general decline in physical endurance.

A further complexity arises when sarcopenia occurs alongside obesity, a condition known as sarcopenic obesity. This dual condition involves reduced muscle mass in combination with an excess of body fat, creating compounded health risks. The presence of excess adipose tissue along with muscle deterioration is associated with worsened insulin resistance and a heightened inflammatory state, and it frequently leads to an even greater decline in mobility.

Exercise is increasingly recognised as a fundamental strategy in the fight against sarcopenia. Research has consistently demonstrated that regular physical activity not only slows the progression of muscle loss but also improves overall physical function. For example, resistance training, which includes activities such as weight lifting and the use of resistance bands, is particularly effective at stimulating muscle growth and building strength. Regular exercise also enhances neuromuscular function by improving the coordination between nerves and muscles. Furthermore, exercise has broader benefits as it reduces chronic inflammation and improves metabolic health by enhancing insulin sensitivity and energy metabolism. Adequate nutrition, particularly ensuring sufficient protein and vitamin D intake, is also essential for promoting muscle repair and maintaining strength.

Sarcopenia, then, represents a significant challenge as the population ages, with its effects extending to both individual quality of life and the demands placed on national healthcare resources. By better understanding the mechanisms that lead to muscle loss, recognising the early warning signs and symptoms and addressing the combined effects of sarcopenic obesity, society can be better prepared to confront this condition. Exercise has proven to be a powerful tool in this endeavour, as it helps to prevent further muscle loss while also improving overall physical function and independence.

A few links:

Yuan, S. et al. (2021)   ‘Epidemiology of sarcopenia: Prevalence, risk factors, and consequences’, Metabolism   – Clinical and Experimental, 144, p. 155533. https://www.metabolismjournal.com/action/showCitFormats?doi=10.1016%2Fj.metabol.2023.155533&pii=S0026-0495%2823%2900136-1

Papadopoulou, S.K.   (2020) ‘Sarcopenia: A Contemporary Health Problem among Older Adult Populations’, Nutrients, 12(5), p. 1293. https://pmc.ncbi.nlm.nih.gov/articles/PMC7282252/

Dodds, R.M., Granic, A.,   Robinson, S.M. and Sayer, A.A. (2020) ‘Sarcopenia, long-term conditions, and multimorbidity: findings from UK Biobank participants’, Journal of   Cachexia, Sarcopenia and Muscle, 11(1), pp. 62-68. https://pmc.ncbi.nlm.nih.gov/articles/PMC7015236/

https://research.uhs.nhs.uk/news/experts-warn-of-expected-rise-in-age-related-muscle-loss

https://www.birminghambrc.nihr.ac.uk/our-research/sarcopenia-and-multimorbidity.html

https://www.bda.uk.com/resource/addressing-sarcopenia.html

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Dave Lee

Dave Lee

Dave Lee has over 30 years experience in the health and fitness sector and has developed the AllActive course range to help make physical activity more accessible to everyone.

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