Ageing is a complex process that results in the reduced functioning of most of the body’s organ systems, with the musculoskeletal system (muscle, bone, tendon and cartilage) significantly affected.

The musculoskeletal system is compromised not only by loss of muscle, bone and cartilage with age, but also by the decline in function of the nervous system, which results in reduced control of movement and balance leading to frailty. Ageing is also often accompanied by weight gain, which puts further strain on joints and contributes to erosion of cartilage and bone, increasing the chances of developing osteoarthritis. Importantly, both ageing and obesity are associated with decreased physical activity levels, an increased level of systemic inflammation, an altered anabolic hormone milieu, muscle anabolic resistance to nutrition and exercise and insulin resistance, all of which affect the ability of the body to maintain a healthy musculoskeletal system and accelerate chronic disease progression. Therefore, increased physical activity and interventions that are able to reduce inflammation, correct age- and obesity-related hormone and body composition changes, and sustain tissue metabolic health offer a way forward for delaying age-related changes in the musculoskeletal system and disease progression. Indeed, strong relationships exist between physical inactivity and chronic disease and all-cause and disease-specific mortality rates. The problem is we do not yet know the rate of change or mechanistic basis of these relationships.