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VERIFIED CONTENTAuthor: Agnieszka Siwik, dietitian

Sarcopenia - The involuntary loss of muscle mass, endurance and strength in the elderly is an important clinical problem that affects millions of elderly people worldwide. Can sarcopenia be prevented? What are its symptoms? What is the treatment of sarcopenia?

Sarcopeniais a term derived from Greek and means "body deficiency", "soft tissue deficiency" (sarx - meat, body + penia - deficiency, poverty). It was first used in 1989 by Irwin Rosenberg, a scientist in the study of aging and nutrition, to describe age-related progressive loss of muscle mass.

Until recently, sarcopenia did not have a universally accepted clinical definition, clear diagnostic criteria, and uniform treatment guidelines.

In 2010, the European Working Group on Sarcopenia in Elderly (EWGOSP) published the European Consensus on the definition and diagnosis of sarcopenia.

It defines sarcopenia as a condition characterized by loss of muscle mass and muscle strength, where the reduction in muscle mass is directly responsible for the impairment of motor function and loss of strength.

Sarcopenia: Symptoms

Typical symptoms of sarcopenia are:

  • loss of muscle mass
  • weakening of physical strength
  • quick fatigue (e.g. during everyday activities)
  • low endurance during exercise (e.g. climbing stairs)
  • imbalance, frequent falls
  • impaired motor coordination
  • rapid weight loss (except for sarcopenic obesity)
  • weakening of the strength and functioning of the abdominal muscles (impaired passing stool), respiratory (breathing disorders) and others
  • reduction of energy reserves (disturbances in thermoregulation and lack of fever during infection)
  • immunity reduction

As sarcopenia progresses, daily functioning, mobility, and balance are impaired, which can result in falls, fractures, thrombophlebitis, pulmonary embolism, isolation, depression, and even death.

It is estimated that 14% of people aged 65 to 75 years oldrequires help with daily activities, and this number rises to 45% for people aged 85 and over.

Sarcopenia: related problems

In connection with reduced muscle mass and weakening of their strength, apart from sarcopenia, there are several related terms:

  • elderly malnutrition

Malnutrition in the elderly is a state of deficiency, excess or imbalance of nutrients, especially energy and protein, which affects vital functions, the patient's clinical condition and the general condition of the body.

Malnutrition is diagnosed when an elderly person has one or more factors: unintentional weight loss (more than 5% in a month or 10% in six months), BMI (body mass index) less than 21 kg / m² or decrease in albumin concentration below 35 g / l.

  • cachexia (Cachexia)

Cachexia (Cachexia) is defined as a complex metabolic syndrome associated with other diseases (e.g. cancer, kidney failure). It is characterized by increased breakdown of muscle proteins, loss of muscle mass and fat tissue.

Factors contributing to the development of cachexia include anorexia (anorexia), chronic and severe inflammation, insulin resistance, and impaired protein and lipid metabolism.

Cachexia is a wasting of the body leading to difficulties in treatment and increased mortality of patients.

  • Frailty Syndrome

Frailty Syndrome is also referred to as Brittleness Syndrome or Depletion Syndrome. Weakness is defined as a biological state of the organism in which the functionality of many organs decreases at the same time, physiological reserves are exhausted, resistance to stress factors decreases.

The balance of the body is disturbed, the morbidity and mortality of the elderly increase.

Symptoms of Weakness Syndrome include age-related declines in lean body mass, loss of muscle strength, endurance, fatigue, imbalance, slower walking, low or inactivity.

Weakness syndrome is also characterized by slow or disturbed psychological, cognitive and / or social functioning.

  • Sarcopenic obesity

Sarcopenic obesity is a condition in which the loss of muscle mass is accompanied by an excessive increase in adipose tissue.

Sarcopenic obesity is a significant risk factor for double-burden disabilitymetabolic processes resulting from low muscle mass (sarcopenia) and excessive obesity.

Research suggests that inflammatory cytokines produced by adipose tissue, especially visceral (intrinsic) fat, accelerate muscle breakdown causing a "closed circle" - further muscle wasting in favor of fat cells.

Obesity and sarcopenia may worsen each other, increasing their impact on morbidity, disability and mortality in the elderly.

Sarcopenia: causes

The mechanisms of the formation of sarcopenia are not fully known. Risk factors include age, gender and level of physical activity. This disease mainly affects the elderly, more often men than women.

Poor physical condition in the elderly is also associated with low birth weight, and this applies to both men and women, regardless of height and weight in adulthood. This suggests that development in the early months and years of life (e.g., malnutrition) may have an impact on the risk of sarcopenia in old age.

Genetic factors also largely affect the variability of muscle strength, which affects their quality and function.

The development of sarcopenia is also associated with a lack of exercise, prolonged immobilization, and comorbidities such as obesity, osteoporosis, insulin resistance, and type 2 diabetes.

Some people have a single, clear cause of sarcopenia, and in other cases no clear cause of sarcopenia can be identified. Depending on the causes, sarcopenia is defined as:

  • primary sarcopenia , related to age, when no other cause other than the aging itself is found
  • secondary sarcopenia , where there is muscle loss associated with disease, malnutrition or lack of physical activity

In most cases, the loss of muscle mass and strength cannot be explained solely by the aging of the body.

Sarcopenia is a typical multi-cause disease, the most important of which are:

  • loss and changes in muscle fibers, especially type II, which are able to generate four times the strength of type I fibers, which explains the decline in muscle strength in older people
  • loss of selected neuromuscular functions, especially loss of contact between the nerve and the muscle fiber
  • decrease in the number and conduction velocity of motor neurons, especially type II motor units with the largest diameter
  • hormonal changes related to the aging of the body - production slowerhormones (e.g. growth hormone, estrogen, testosterone), changes in insulin secretion, impaired response to hormonal stimuli
  • deterioration of muscle blood supply related to cardiovascular diseases, e.g. atherosclerosis
  • the occurrence of chronic inflammation - the influence of pro-inflammatory cytokines on the breakdown of muscle tissues
  • oxidative stress
  • increase in the proportion of adipose tissue in the body composition, obesity
  • insulin resistance, diabetes
  • changes in tissue responses to nutrients
  • changes in the digestive system related to aging, impaired absorption of some nutrients
  • nutritional deficiencies and the resulting malnutrition (caloric, protein, vitamins)
  • low or inactivity, including prolonged immobilization due to illness or injury
  • wasting the organism
  • taking certain medications

Sarcopenia usually results from a combination of several of the above factors, albeit in different proportions depending on the person.

It remains an indisputable fact, however, that the atrophy of skeletal muscles, regardless of the underlying mechanisms, results from an imbalance between the synthesis of muscle proteins and their breakdown.

Most important factors in sarcopenia

  • Muscle changes in the elderly

Progressive loss of muscle mass occurs from around the age of 40. A clear reduction in muscle mass is observed in the following years of life and it is a progressive and inevitable process, even in physically active people.

This loss is estimated at around 8% per decade up to age 70, and increases to 15% for each decade thereafter.

Leg strength decline is estimated at 10-15% per decade up to age 70, followed by a faster loss of strength - from 25% to 40% per decade.

The causes of these changes include changes in the innervation of the motor units and the conversion of fast Type II muscle fibers into slower Type I fibers.

The muscles are also "overgrown" with fat cells, which results in the loss of muscle strength necessary for daily activities.

The physiological features of muscles characteristic for sarcopenia in old age are:

  • reduced muscle mass
  • reduced cross-sectional area of ​​muscles
  • "overgrowth" of muscles by adipose tissue and connective tissue
  • reduction in size and amount of type I and IIa muscle fibers
  • reduced number of motor units in muscles and others
  • Neurological aging asarcopenia

Aging of the nervous system is an irreversible process that progresses with age and can have a significant effect on muscles.

Elderly people experience changes in the peripheral fibers of the nerves and degenerative processes in their myelin sheaths.

There are also age-related disorders in the neuromuscular junction, which together with changes in muscle structure is one of the reasons for the reduction in the number of muscle fibers and muscle mass.

  • Changes in hormone levels and sensitivity

Maintaining proper muscle mass requires a balance in the building processes and the speed of muscle fiber degradation. Aging of the body is associated with a slowdown in production and a decrease in the sensitivity of tissues to hormones.

In the context of sarcopenia, this particularly applies to insulin-like growth factor I (IGF-1), androgens, estrogens, corticosteroids and insulin.

These hormones can affect both the building and breakdown processes, and the maintenance of proper metabolism of muscle proteins. Reduction in IGF-1 levels is often seen in the elderly, with increased visceral fat, decreased lean body mass, and decreased bone mineral density.

Aging is also associated with low testosterone levels, which can lead to reduced muscle mass and bone strength, and therefore more fractures and complications. Testosterone has been proven to increase muscle mass and muscle function.

In turn, cortisol in the elderly reduces protein synthesis and its high level in the elderly intensifies sarcopenia through a strongly accelerated breakdown of muscle proteins.

Cellular resistance to insulin (insulin resistance) may also be associated with loss of muscle mass, in which case skeletal muscle protein synthesis is resistant to the anabolic effects of insulin.

Conversely, the loss of skeletal muscle, which is the largest insulin-sensitive target tissue, may cause insulin resistance. This, in turn, promotes metabolic disorders and the formation of diabetes.

Research confirms that type 2 diabetes is associated with accelerated loss of muscle mass and strength and with sarcopenia.

  • Age-related Inflammatory Factors

Chronic inflammation in the body is considered to be one of the mechanisms involved in aging. According to research, the so-called chronic subliminal inflammation, understood as a several-fold increase in the level of pro-inflammatory cytokines circulating in the blood, e.g.Tumor Necrosis Factor-alpha, Interleukin Protein, and C-Reactive Protein (CRP).

These compounds accelerate the breakdown of muscle tissue, damage it and reduce the rate of muscle protein synthesis (muscle rebuilding).

Inflammation is associated with many diseases: diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, atherosclerosis and dementia.

Adipose tissue is also an active endocrine organ that secretes hormones and cytokines that contribute to systemic inflammation.

Research results confirm that chronic inflammation plays a significant role in the formation and development of sarcopenic obesity.

  • Oxidative stress and muscle aging

Oxidative stress is a phenomenon that arises as a result of the excessive activity of reactive oxygen species, which results from an imbalance between the release of oxygen free radicals and their removal from the cell by antioxidant systems.

As the body ages, the amount of reactive oxygen species increases in tissues, especially in well-oxygenated tissues, e.g. skeletal muscles.

The aging process is accompanied by an increased concentration of free radicals in muscle cells. At the same time, in the elderly, the functioning of antioxidant mechanisms is impaired, which leads to the formation of oxidative stress. Since the harmful effect of free oxygen radicals is manifested, inter alia, in their ability to oxidize proteins and destroy other components of the body's cells, damage to muscle tissues occurs.

This process may be important in initiating the processes of reducing muscle mass and strength in an aging body.

  • Intestinal flora

Modern research shows that one of the very important factors influencing human he alth is a properly functioning digestive system, including the correct proportions of the microflora inhabiting the intestines.

Disturbances in the functioning of the body in the elderly, changes in diet, lifestyle, diseases and medications deeply affect the structure and functions of intestinal bacteria.

There is an imbalance in the composition of microorganisms (dysbiosis), which, among other things, contributes to the formation of chronic inflammations, greater susceptibility to systemic infections or malnutrition.

Dysbiosis may also result in accelerated progression of chronic diseases, weakness and sarcopenia.

Gut bacteria are, among others involved in regulating inflammation and alleviating oxidative stress, regulate insulin sensitivity and fat storage.

MoreoverThe gut microflora can influence the bioavailability and biological activity of most nutrients that have been suggested as countermeasures against malnutrition.

In the context of sarcopenia, a better understanding of the relationship between the aging body and the gut microflora is of great importance in developing a therapeutic management in the elderly.

  • Lack of physical activity

Physical activity is defined as any movement produced by skeletal muscle contraction that increases energy expenditure. Physical activity includes daily activities such as getting up from a chair or climbing stairs, as well as deliberate activities for a he alth benefit, such as running, walking, swimming, and cycling.

A sedentary lifestyle is behavior where no additional measures are taken to increase energy expenditure above the resting level (e.g. sleeping, sitting, lying down, watching TV).

Elderly people who only perform basic physical activities such as standing, walking slowly and lifting light things are considered inactive.

Studies on the effects of immobilization on skeletal muscles show disturbances in the balance between protein synthesis and protein breakdown, a reduction in muscle mass, volume and strength, especially in the muscles of the lower extremities.

A sedentary lifestyle is a major risk factor for chronic diseases, weakness syndrome and sarcopenia.

So not only elderly people, but also little or physically inactive younger adults are at greater risk of developing sarcopenia in the future.

  • Smoking

Cigarette smoke contains many compounds that are harmful to he alth. The components of the smoke can reach skeletal muscles, causing increased oxidative stress and protein degradation.

Epidemiological studies show that elderly smokers have lower muscle mass, smoking is associated with sarcopenia, and that not smoking early in life can prevent sarcopenia in old age.

  • The role of nutritional factors in the formation of sarcopenia

Changes accompanying the physiological aging process of the organism, including changes in the functioning of the digestive system, contribute to the deficiency of nutrients and weaken the sense of taste and smell. Decreasing the rate of basic metabolism and total energy expenditure also leads to disturbances in the perception of hunger and satiety.

Appearing lack of independence, loneliness, depression andlow income can lead to neglect or even failure to prepare meals during the day.

The above-described phenomena and diseases that often accompany old age lead to serious nutritional deficiencies, especially protein-caloric and vitamin deficiencies, favoring the development of sarcopenia.

The factor that is most important in the development of sarcopenia is malnutrition, especially protein and caloric malnutrition.

This is a problem belonging to the so-called large geriatric syndromes, i.e. chronic, multi-causal disorders leading to limited fitness or functional disability of seniors.

Food ingredients most important in Sarcopenia

  • Protein

Insufficient protein intake is one of the major mechanisms underlying sarcopenia. Skeletal muscles are mainly made of proteins and their formation is stimulated, among others, by by amino acids provided in meals.

In seniors, the degree of muscle protein synthesis decreases by about 30% compared to young people, which is due, among other things, to slower anabolic reactions to the consumed protein.

This means that older adults require more dietary protein than younger adults to stay he althy, function well, or recover from an illness.

  • Leucine

Leucine is a component of proteins, currently considered the most important amino acid with building properties for muscle tissue. It protects muscle tissue against breakdown processes, it is a factor that activates protein synthesis, which supports regeneration and enables the growth of muscle mass.

Elderly people who suffer from protein malnutrition are therefore at risk of leucine deficiency, and thus a reduction in muscle mass and strength.

  • Carnitine

Carnitine is a compound that plays a key role in the metabolism of fatty acids and energy - it is necessary for the proper production of energy in skeletal muscles.

Carnitine also affects the functioning of the immune system and has antioxidant (antioxidant) properties, which is important in preventing or alleviating inflammation.

With age, the concentration of carnitine decreases, leading, among others, to to weaken muscle strength.

A good source of carnitine is meat, offal and dairy products - as in the case of leucine, a significant deficiency of carnitine affects people who do not eat enough protein products.

  • Vitamin D

Inadequate vitamin D levels are quite common in the elderly. The skin's ability to produce vitamin D decreases with age and the kidneys become less able to convert vitamin D into the active ingredient vitamin D3. In addition, insufficient sunlight and improper diet, frequent in the elderly, lead to vitamin D deficiency in the body.

Vitamin D has a protective effect and plays an important role in the proper functioning of the immune and skeletal systems, and the proper functioning of the β-cells of the pancreas, brain and muscles.

Plays an important role in building muscle tissue and helps maintain the function of type II muscle fibers, thereby maintaining strength. Low vitamin D levels, kidney failure, and low dietary calcium intake can also cause mild secondary hyperparathyroidism, which can lead to impaired muscle function.

  • Excessive alcohol consumption

People who abuse alcohol often suffer from low muscle mass and strength experience muscle pain, cramps, and difficulty walking. Consuming alcoholic beverages is not a direct cause of sarcopenia, but research suggests that their regular consumption may accelerate the loss of muscle mass and strength in old age.

Sarcopenia and overweight and underweight

Another important issue in the context of sarcopenia is correct body weight. Currently, much attention is paid to preventing obesity and maintaining a proper body mass index (BMI).

Older people with a body weight within the normal range for young people may be at risk of consuming less calories and nutrients later in old age, underweight and risk of sarcopenia.

Also, trying to lose weight in the elderly can lead to caloric and protein deficiencies, which accelerate the progression of weight loss.

Weight loss should be avoided after the age of 70, especially if it causes the BMI to fall below the normal index.

On the other hand, you should consider excessive caloric intake, which leads to obesity and can also accelerate sarcopenia.

Muscle quality in obese people is poor due to increased intramuscular fat. This situation leads to muscle weakness and, consequently, to disability.

Weight loss in obese people is necessary, but should be achieved in such a way that the muscle tissue is preserved. This goal can be achieved by following a proper diet and exercise program.

Research and evaluationsarcopenia

The EWGSOP guidelines define specific parameters that gradate the sarcopenia and allow it to be identified. Identifying the stages of sarcopenia can help in choosing treatment options and setting the appropriate goals for the management.

Presconopeniais characterized by low muscle mass without affecting muscle strength or physical function. This stage can only be identified by techniques that accurately measure muscle mass as a score is compared to the population standard group.

Sarcopeniais characterized by low muscle mass, low muscle strength or low physical fitness.

Severe Sarcopeniais found when low muscle mass and low muscle strength result in poor physical performance. This type of sarcopenia can be identified by examining muscle strength, grip strength, and walking speed.

The European Working Group on Sarcopenia in the Elderly has developed and suggested an algorithm based on gait velocity measurement as the simplest and most reliable method for the initial diagnosis of sarcopenia.

If the walking speed of test subjects over 65 years of age is less than 0.8 m / s over a distance of 4 m, the muscle mass should be measured.

Low muscle mass is found when the result divided by the square of the height is less than two standard deviations for a normal young person. Muscle mass is measured using instrumental methods.

If the test walking speed is greater than 0.8 m / s, grip strength should be tested - if this value is less than 20 kg for women and 30 kg for men, muscle mass should also be tested.

How is muscle strength tested?

The simplest method of testing muscle strength is the Grip Strength Test - it is a widely used test that gives good results.

Measure of the strength of muscles of different parts of the body are related to each other - the grip strength of the hand, measured under standard conditions with a hand dynamometer, is a reliable test of the strength of the arms and legs. The isometric grip strength of the hand is strongly related to the muscular power of the lower extremities, the torque of the knees and the cross section of the calf muscles.

Low hand grip strength is a clinical indicator of poor body mobility and a better indicator than low muscle mass. In practice, there is also a confirmed relationship between grip strength in the elderly and their low dexterity in everyday life.

Other tools to assess the strength and functionality of the elderly are functional fitness tests: The most commonly used are:

  • "Get up and walk" test

The test subject is asked to get up from the chair, walk 3 meters, turn around and return to the chair and sitting position.

The limit value is 10 seconds - if the patient performs all activities below this value, he has no problems with moving and is fit.

Test results greater than 10 seconds indicate limitations in fitness, walking speed, balance.

A result of 10-14 seconds and over 14 seconds indicates significant limitations and an increasing risk of falls.

The Get and Walk test result is usually commensurate with the results of other functional fitness tests. It is very practical, simple to carry out and easy to explain to an elderly person. It can also be used to assess changes in the fitness of older people over time.

  • Short Physical Performance Battery -SPPB

The test is used to assess fitness in three areas and requires the performance of several tasks. The subject of assessment is:

  • strength of the lower limbs - the test person's task is to get up from the chair without the help of hands; with a successful one attempt to get up from the chair and sit down again, this activity is repeated five times
  • static balance - the subject should remain in balance in three different positions for at least 10 seconds: with the feet placed side by side, with one leg in a lunge and the foot behind the foot.
  • gait speed - assessed using the method described above. The evaluation is repeated twice and a better time is recorded.

Other fitness assessment tests:

  • 6-minute walk test
  • Berg's balance scale
  • functional reaching test
  • test of moving in different directions while passing an obstacle
  • chair rising functional test

Sarcopenia: how muscle mass is assessed

In recent years, the methods most widely used in assessing muscle mass include the Dual Energy X-ray Absorptiometry Method - DEXA, which involves scanning the whole body with two low doses of X-rays.

High-precision testing allows you to assess the density of tissues in the body, including muscle and bone tissues. The DEXA test is particularly recommended in the diagnosis of sarcopenic obesity and osteoporosis.

The BIA (Bioelectrical Impedance Analysis) electrical bioimpedance method is now recommended as a routine test for determining body composition.

The primary purpose of the BIA test is to determine the amount of adipose tissue andlean body mass in the body. This test can be performed using portable devices, is relatively cheap and simple, and does not require specialized personnel.

In addition, various body imaging techniques are used to determine muscle mass and quality: computed tomography and magnetic resonance imaging, which allow you to calculate segmental and total muscle mass and assess muscle quality based on fat overgrowth in the muscles.

These tests, despite their many advantages, are expensive, inaccessible and not used routinely for the diagnosis of sarcopenia.

It is worth emphasizing at this point that, according to the recommendations of research groups, in order to find sarcopenia, it is enough to prove low muscle mass and reduce walking speed (below 0.8 m / s in the 4 m walk test).

According to the position of the International Working Group on Sarcopenia (IWGS), screening for sarcopenia should be carried out in people who:

  • feel slower when walking and have difficulty moving
  • prone to falls
  • quickly lose more than 5% of their normal weight
  • have recently been hospitalized
  • affected by chronic diseases: cancer, type 2 diabetes, chronic heart failure, obstructive pulmonary disease, kidney disease, rheumatoid arthritis

The research should also cover people who, regardless of their age, are immobilized for a long time.

Prevention and therapeutic management of sarcopenia

Sarcopenia is associated with age, inadequate nutrition, inactivity and chronic disease, factors that often coexist in the elderly. Therefore, a proper diagnosis is necessary before starting therapeutic measures.

Since there is a significant relationship between the lack of physical activity and loss of muscle mass and strength, physical activity should be a protective factor in the prevention and management of sarcopenia.

In addition, one of the first steps to be taken to prevent and support sarcopenia sufferers is to ensure proper and adequate nutrition.

The aim of prophylactic treatment is to prevent and delay as much as possible the onset of muscle changes related to sarcopenia.

A comprehensive approach to treating primary and secondary sarcopenia should include:

  • individual nutritional therapy,
  • supplementation with selected ingredients
  • personalized resistance training
  • not smoking
  • pharmacological treatments related to sarcopenia and comorbidities

Sarcopenia interventions should be designed with the greatest care, bearing in mind the elderly person's individual he alth, abilities and environment.

Sarcopenia: nutritional therapy and exercise

Therapies that combine proper nutrition and exercise adapted to the capabilities of the elderly are the basic steps in the prevention and treatment of sarcopenia. In addition, supplementation (e.g. with amino acids, vitamins) effectively contributes to accelerating the effects of treatment.

  • Diet

When planning a diet for an elderly person with sarcopenia, it is very important to maintain good nutritional status or improve and prevent malnutrition.

For nutritional intervention in sarcopenia to be effective, it should:

  • provide the right amount of calories for each person, taking into account body weight and nutrition
  • provide adequate amounts of nutrients, taking into account age, gender, metabolic profile, he alth status, level of physical activity and concomitant therapies
  • eliminate intolerant and potentially harmful ingredients
  • last long enough to improve muscle he alth

Diet in sarcopenia should be based on the principles of nutrition for the elderly - an easily digestible, high-protein diet.

The recommended intake of high-quality protein for people over 50 is 1.0-1.2 g per kg of body weight per day in the amount of 20-25 g in each meal.

Meals should be calorically balanced, with adequate amounts of carbohydrates and good quality fats.

Fruits and vegetables are essential, which are an excellent source of vitamins, fiber and antioxidants to counteract oxidative stress.

Use the least processed products, avoid fresh, smoked, cured products stored in brine and vinegar, too sweet.

Meals should be traditionally or steamed, baked in parchment or foil, and stewed.

Sometimes it is advisable to crush the products, which allows better absorption of nutrients.

The consistency of the food should be adjusted to your biting, chewing and swallowing skills.

Adequate hydration of the body is very important, at the level of about 2 liters a day.

You should also support the diet with highly nutritious preparations and supplements - vitamin D3, omega 3 acids, vitamin C and others, andselected protein supplements and probiotics,

  • Physical exercise

The role of exercise in preventing sarcopenia depends on the type of exercise.

Aerobic exercise such as brisk walking, jogging, cycling, or high-intensity swimming stimulates the muscles, improves neuromuscular function, and improves muscle quality (strength). They also reduce body fat, including intramuscular fat, which is important for improving the functional role of muscles in relation to body weight.

Contrary to aerobic exercise, resistance training improves muscle mass and strength. The age-changing neuromuscular system responds very well to resistance training.

The training effect can be achieved with the use of specialized equipment for strength training, rehabilitation rubbers, household items or your own body weight.

Moderately intensive training performed once or twice a week, aimed at the main muscle groups, is sufficient to improve muscle protein synthesis, muscle mass and strength, even in weak and frail elderly people.

Research confirms that routine, daily activity is not enough to prevent a decline in muscle mass in old age, while aerobic and resistance training improve balance, motor coordination, cardiovascular function and appetite.

Although resistance training is the best way to prevent and treat sarcopenia, both types of training and an active lifestyle contribute to the maintenance and improvement of muscle mass and strength in the elderly.

While there are promising pharmaceutical therapies for combating sarcopenia, resistance training, combined with diet and supplements, is most effective in preventing and treating sarcopenia.

Pharmaceutical therapies for sarcopenia are still under investigation as many drugs that affect muscle strength and mass are either not having the desired effect or are subject to controversy. The best researched and proven effects show:

  • testosterone, which is a steroid hormone, stimulates the development of secondary sexual characteristics in men, including increasing muscle mass. Research results confirm that high doses of testosterone in the elderly increase the force of contraction, but are associated with complications (e.g. edema)
  • growth hormone - growth hormone (GH) supplementation improves body composition by increasing muscle mass and reducing fat, slows bone demineralization, but shows no improvement in muscle contraction strength and functionality
  • dehydroepiandrosterone(DHEA) administered to the elderly increases bone density, but does not change muscle size, contraction force and function
  • vitamin D - vitamin D supplementation is associated with improved functionality, increased endurance in the elderly, and reduced risk of falls and mortality
  • omega-3 acids (EPA and DHA) - thanks to the strong anti-inflammatory function confirmed by research, it is believed that appropriate supplementation can improve the conditions for metabolism of aging muscle tissue

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