Sarcopenia: Muscle Loss, Protein and Strength

What sarcopenia is

Sarcopenia is a progressive loss of skeletal muscle mass and strength. Current European guidance defines it mainly by low muscle strength (for example, weak hand grip or slow rising from a chair), confirmed by low muscle quantity or quality, and graded as severe when physical performance is also poor (such as slow walking). It is distinct from simple weight loss or frailty, though they overlap; see frailty in older adults: what it means and what helps.

Why it happens - Ageing changes: fewer muscle fibres and nerve connections, hormonal changes and a muscle that responds less to protein and exercise ("anabolic resistance"). - Inactivity: bed rest, sitting for long hours, fear of falling, pain or illness. - Inadequate food: low protein and energy intake, poor appetite, dental problems; see malnutrition in older adults: signs and prevention. - Chronic disease: heart failure, COPD, kidney disease, diabetes, cancer, arthritis and inflammation. - Low vitamin D and other nutrient deficiencies; see vitamin D deficiency in India. - Medicines, such as long-term steroids. - Smoking and alcohol. - Hospital stays, which can cost days or weeks of muscle in a few days of bed rest.

Signs at home

• Difficulty standing up from a chair without using the arms, or from the toilet or floor.
• Slower walking, taking short steps, needing to hold on to furniture.
• Weak grip: trouble opening jars, turning taps or carrying a water pot.
• Tiredness and breathlessness with ordinary activity.
• Loose clothes and thin arms and legs, though body weight may be normal or high (sarcopenic obesity).
• Falls or near-falls.
• Reduced activity and avoiding stairs.
• Weight loss without trying; see weighing scales and unplanned weight loss in older adults.

Simple home checks (not diagnoses): - Chair stand test: how long does it take to stand from a firm chair five times without using the arms? Taking more than about 15 seconds suggests weakness; use safely, with a helper. - Walking speed: a walk of four metres taking more than about five seconds (slower than about 0.8 metres per second) suggests reduced function. - Calf measurement, grip strength and a short questionnaire (SARC-F, which asks about strength, walking, rising, climbing stairs and falls) can be used by clinicians.

Ask the doctor or physiotherapist for a proper assessment, which may include grip strength with a dynamometer, a walking test and a body composition scan.

Food: the main ingredients

### Protein

Protein is the key nutrient for muscle. Older adults generally need about 1.0 to 1.2 grams per kilogram of body weight per day, more during illness, unless a doctor advises otherwise because of kidney disease. See how much protein do older adults need. Spread it across meals, with 20 to 30 grams at each. Indian sources: dals, sprouts, eggs, curd, milk, paneer, soya, nuts, fish and chicken; see high-protein Indian meals for seniors. Leucine-rich foods such as milk, eggs, whey, meat, fish and soya are particularly good for stimulating muscle building.

### Energy

Muscle cannot be built or preserved on too few calories. A person who eats very little loses muscle even if protein is adequate. Include healthy fats such as groundnut, mustard or rice bran oil in cooking, ghee in modest measured amounts, nuts and seeds, and energy-dense foods when appetite is poor; see loss of appetite in older adults: causes and practical fixes.

### Vitamin D, calcium and other nutrients

• Vitamin D supports muscle function and bones, and deficiency is very common in India; see vitamin D deficiency in India and calcium and vitamin D after 60. Test levels and supplement only as the doctor advises.
• Vitamin B12 matters for nerves and blood, particularly for vegetarians; see vitamin B12 in older vegetarians.
• Magnesium, potassium and antioxidants from vegetables, fruit, nuts, whole grains and pulses.
• Omega-3 fats from fish, flaxseed and walnuts may have a modest role; see omega-3 supplements for seniors: evidence and cautions.
• Fluids: dehydration reduces strength and balance; see hydration for older adults.

### Supplements

• Protein powder or sip feeds can help when food intake is low; see protein powder for older adults and nutrition supplements and sip feeds: when food is not enough.
• Vitamin D and calcium only as advised.
• Avoid unproven "muscle builders," hormones and herbal tonics. Check with a doctor or pharmacist about interactions; see supplements and medicine interactions: a safety guide.

Exercise: the other half

Food alone will not rebuild muscle. Resistance exercise, which makes muscles work against a load, is the most effective treatment for sarcopenia, and works at any age, even in the nineties.

What to do - Two to three times a week, with a day of rest between. - Exercises: chair stands (sit-to-stand), wall push-ups, leg raises, heel raises, bicep curls and shoulder raises with light weights, water bottles or resistance bands, step-ups on a low, stable step with a rail, and gentle squats holding a counter. - 8 to 12 repetitions, one to three sets, with rests, at an effort that feels moderately hard but allows good technique. - Progress gradually, adding repetitions, then resistance. - Add balance and walking: daily walking, balance work, and activities such as gardening, climbing stairs with a rail and carrying light loads. - Move more through the day, avoiding long sitting.

See resistance band routine for seniors, strength after 60: how much is enough, chair exercises for seniors, balance exercises for seniors and walking programme for older adults.

Safety: ask a doctor before starting if there is heart disease, uncontrolled blood pressure, severe arthritis, osteoporosis, recent surgery or other conditions; see exercise with heart disease, exercise for osteoporosis and exercise with arthritis. Stop for chest pain, dizziness, severe breathlessness or sharp joint pain. A physiotherapist can supervise.

A sample day of Indian meals for muscle

• Early morning: a glass of warm milk or buttermilk.
• Breakfast: moong dal or besan chilla with curd, or two eggs with a roti, or idli with sambar and a glass of milk, with a fruit.
• Mid-morning: a handful of roasted chana or nuts, or a banana with a spoon of peanut butter.
• Lunch: roti or rice, a bowl of dal, a vegetable, curd, and fish, chicken, paneer or soya.
• Evening: sundal, sprouts chaat or a boiled egg; tea with a protein snack.
• Dinner: khichdi with vegetables and curd, or roti with dal and paneer or egg curry.
• Bedtime: a small glass of milk if it suits.

Adjust for allergies, medical conditions and preferences; a dietician can personalise.

Special situations

• After hospital or bed rest: start moving early, as doctors advise, and ensure protein and calories; see monitoring a parent after hospital discharge.
• Overweight with sarcopenia: avoid crash diets that cause muscle loss; a dietician can plan modest weight loss with enough protein and exercise.
• Kidney disease: protein adjustments needed; see eating with chronic kidney disease: a family guide.
• Diabetes: balance carbohydrates and protein; see eating for diabetes after 60.
• Dementia: appetite and participation issues; see dementia, eating and weight loss.
• Swallowing or dental problems: soft, protein-rich foods; see soft and pureed diets.
• Bedridden people: gentle limb movements, positioning and physiotherapy; see positioning a bedridden parent.

Monitoring and safety

Track weight, grip, chair stands and walking speed every month or two. Watch for falls, and make the home safer; see falls risk assessment at home. Seek advice if there is sudden weakness (possible stroke or other illness): call 112 for weakness on one side, facial droop or speech difficulty.

When to ask a professional

Ask a doctor to assess muscle strength and look for causes such as thyroid problems, vitamin deficiencies, anaemia, medicines and chronic illnesses. Ask a dietician for a protein and energy plan, and a physiotherapist for a resistance programme. Ask a pharmacist before using supplements. Seek prompt help for rapid weight loss, new weakness, repeated falls, difficulty swallowing or inability to rise from a chair.