To celebrate World Sarcopenia Day, Professor Janet Lord, until recently director of the MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research , describes what sarcopenia is, what causes it and ways to prevent it in order to ensure that old age is Enjoyed and not Endured!
What is sarcopenia?
Sarcopenia is the loss of skeletal muscle mass, strength and function that primarily occurs as we age. As we are now living longer the incidence of this condition will only increase in coming years unless we can prevent it in the first place. We start to lose muscle mass from middle age and this is accompanied by reduced muscle strength which older adults may first detect as making it harder to get out of a chair without a groan, or to open lids on jars! However, sarcopenia is also common in several chronic inflammatory diseases, such as Rheumatoid Arthritis, Chronic Liver Disease and Inflammatory Bowel Disease.
Sarcopenia reduces the ability to do normal everyday tasks and as such can lead to loss of independence and physical disability. Poor musculoskeletal health in the UK is one of the leading causes preventing people aged 60-64 years from working and it has been estimated that over 10 million working days are lost through musculoskeletal conditions each year in the UK. Not surprisingly sarcopenia is an expensive condition, increasing costs to the NHS and increasing pressure on family carers and social care systems. The excess healthcare costs alone for the UK have been estimated as £2.5 billion each year.
What are the main causes of sarcopenia?
Like most health conditions sarcopenia has many causes but the two main risk factors are age and obesity. With ageing there are changes to the body that make it harder to maintain our muscle mass, these include loss of sex hormones in both men and women and a reduced ability to build muscle when we take in protein and exercise. Our lifestyle is also a big factor because as we get older people tend to be less physically active. The Chief Medical officer recommends 150 minutes of aerobic exercise a week and at least 2 sessions of strength exercises such as using resistance bands or even carrying heavy shopping bags. However, less than 10% of over 65 year olds actually meet these activity targets meaning that muscle does not get the prompts it needs to stay strong.
With obesity there is the link with reduced physical activity but in addition fat tissue can have direct negative effects on muscle. In particular fat releases factors that increase inflammation and this causes muscle to break down. In addition, we now know that the amount of time we spend sitting is another factor driving muscle loss, this is why when you are in hospital and in bed all day you can lose muscle mass. So it is important to not sit for too long, get up and walk around as often as possible.
How can we prevent sarcopenia?
The best way to both prevent and treat sarcopenia is physical activity, specifically strength / resistance exercise. You do not need to go to a gym to do this, simple exercises such as chair rises – sitting in a hard backed chair, crossing your arms on your chest and then standing up and sitting down again. If you cant do it with arms crossed first of all just try to stand up with perhaps another chair in front to give you support, or use the arms of the chair. If you can start with 5 and build up to 10 this is a great exercise for leg strength. For arms you can just try putting a weight in your hand (tin of beans for example) and the doing a bicep curl (put your arm out in front and then bring you hand to your shoulder). Try 5 times with each arm. Professor Lord has made a Youtube video showing simple exercises to maintain your muscle health (#Covid19 How to keep your immune system working efficiently whilst self-isolating – YouTube).
Are there any drugs that can help? The short answer is not yet. Some new drugs have bene tried which do show they can increase muscle mass but they dont improve strength and in the end its muscle strength and function that matter for quality of life. Research in the MRC-versus Arthritis Centre for Musculoskeletal Ageing Research is trying to understand exactly how muscle function is lost so that we can try and develop new drugs to work with exercise to prevent sarcopenia.
Our research MRC-versus Arthritis Centre for Musculoskeletal Ageing Research
The MRC-versus Arthritis Centre for Musculoskeletal Ageing Research is a collaboration between researchers at the Universities of Birmingham and Nottingham. We are looking in to the causes of muscle mass and function loss with age and also with chronic diseases such as rheumatoid arthritis. We are also investigating sarcopenia that occurs after a major injury and bed rest in hospital.
In all of these conditions we are looking at how quickly muscle is built up and lost and more recently we are using the powerful imaging technique of MRI to look at signals in the brain that might affect how muscle strength and function is lost. We are also investigating how the bacteria in our gut change with age and how this might be one of the causes of increased inflammation and loss of muscle mass. If this gives us some clues as to which bacteria are helpful this could lead to us trying different probiotic drinks a s away to keep muscle healthy in old age.
All of this work aims to both understand the causes of sarcopenia and to find treatments to prevent this condition. This will have many positive effects, such as reducing falls and improving quality of life by ensuring people to maintain functional ability for as long as possible. It will also help to meet the government target of adding 5 more years of healthy, independent living for adults in the UK by 2035.