What is Sarcopenia?

Sarcopenia is age related adverse changes in muscle quantity and quality (1,2). These adverse changes in muscle mass can lead to decreased functional ability in older adults (2). Although, it is primarily linked with aging it is also related to and worsened by physical inactivity, chronic diseases, poor nutrition, and hormonal changes (1,4).

Characteristics of sarcopenia include a decrease in muscular strength, muscular quality and muscle fibres (1,2). It is significantly linked with decreased mobility, metabolic health, lower muscular performance, increased fatigue and an increase in falls (1,2,3).

The risk factors for sarcopenia are both intrinsic and extrinsic. Therefore, its onset is not inevitable. It can be prevented, halted or even reversed with early intervention.    

 

Interventions

Resistance training has been shown to be one of the most effective ways to prevent muscle loss, strength, and function (1,5).  It is currently recommended as the first line of defence/treatment for sarcopenia (5). There is plenty of evidence that illustrates the benefits of resistance training as a treatment strategy across several populations (6,7,8).

Typically exercise programmes designed to combat sarcopenia include 2-3 resistance training sessions per week (5). Whole body resistance training should be performed targeting the major muscle groups (5,6). While exercises targeting specific muscle groups are beneficial, practitioners should also include functional strength movements (e,g, sit to stands) as these may benefit the person’s functional ability (5,9).  Recommendations for sets and reps vary from 2-3 sets of 6-12 reps with 2-3 minutes of rest between sets (5.10).

As with all resistance training there is a need for an optimal protein intake to help maximise the benefits. Older adults are especially susceptible to inadequate protein in-take (12) with it being reported that anywhere between 22-41% of over 50s don’t consume the basic recommendation for protein of 0.8g/kg/day (12). Adequate protein intake is required for the maintenance of muscle health (12). It is recommended that older adults taking part in resistance training consume between 1 to 1.5 g/kg/day of protein (12).

 

Screening

It is important to identify older adults who may be at risk. One if the best ways to do this is to assess muscle strength (e.g. grip strength). Risk factors such as age, history of falls and low activity levels should be flagged (1,2,4,5). The SARC-F questionnaire is a simple tool practitioners can use to screen for risks associated with sarcopenia (5, 11).

 

References

1)     Rosenberg I. H. Sarcopenia: origins and clinical relevance. Journal of Nutrition. 1997;127(5):990S–991S. doi: 10.1093/jn/127.5.990

2)     Hunter GR, Singh H, Carter SJ, Bryan DR, Fisher G, (2019), β€˜Sarcopenia and Its Implications for Metabolic Health’, Journal of Obesity. 6; 8031705. doi: 10.1155/2019/8031705. PMID: 30956817; PMCID: PMC6431367.

3)     Dufour A. B., Hannan M. T., Murabito J. M., Kiel D. P., McLean R. R., (2013) β€˜Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study’, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(2):168–174. doi: 10.1093/gerona/gls109

4)     Bauer J, Morley JE, Schols A, et al., Sarcopenia: A Time for Action. An SCWD Position Paper, Journal of Cachexia, Sarcopenia and Muscle, 10: 956–961. 10.1002/jcsm.1248

5)     Hurst C, Robinson SM, Witham MD, Dodds RM, Granic A, Buckland C, De Biase S, Finnegan S, Rochester L, Skelton DA, Sayer AA. (2022), β€˜Resistance exercise as a treatment for sarcopenia: prescription and delivery’, Age Ageing, 2;51(2):afac003. doi: 10.1093/ageing/afac003. PMID: 35150587; PMCID: PMC8840798.

6)      Straight CR, Lindheimer  JB, Brady  AO, Dishman  RK, Evans  EM. Effects of resistance training on lower-extremity muscle power in middle-aged and older adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med  2016; 46: 353–64

7)      Strasser B, Steindorf K, Wiskemann J, Ulrich CM. Impact of resistance training in cancer survivors: a meta-analysis. Med Sci Sports Exerc  2013; 45: 2080–90

8)      Cheema BS, Chan D, Fahey P, Atlantis E. Effect of progressive resistance training on measures of skeletal muscle hypertrophy, muscular strength and health-related quality of life in patients with chronic kidney disease: a systematic review and meta-analysis. Sports Med  2014; 44: 1125–38.

9)      Skelton, D.A., Young, A., Greig, C.A., Malbut, KE., (1995), β€˜Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older’, Journal of the American Geriatric Society, 43: pp. 1081–7

10)    Borde, R., HortobΓ‘gyi, T., Granacher, U., (2015), β€˜Dose–response relationships of resistance training in healthy old adults: a systematic review and meta-analysis’, Sports Med, pp. 45, pp. 1693–720

11)    Malmstrom, T.K., Morley, J.E., (2013), β€˜SARC-F: a simple questionnaire to rapidly diagnose sarcopenia’, Journal of the American Medical Directors Association,14(8), pp.531-2. doi: 10.1016/j.jamda.2013.05.018. Epub 2013 Jun 25. PMID: 23810110.

12)    Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehner W, Fearon KC, Ferrucci L, Hellerstein MK, Kalantar-Zadeh K, Lochs H, MacDonald N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Rossi Fanelli F, Schambelan M, Schols AM, Schuster MW, Anker SD; Society for Sarcopenia, Cachexia, and Wasting Disease., (2010), β€˜Nutritional recommendations for the management of sarcopenia’, Journal of the American Medical Directors Association, 11(6), pp. 391-6. doi: 10.1016/j.jamda.2010.04.014. PMID: 20627179; PMCID: PMC4623318.

Recommendations

There are varying reports on how much fluids someone should consume per day. Water consumption has been recommended to be between 1.6L up to nearly 3L for men and 1.2L – 2.2L for women (1)(2). This is because there is no one size fits all solution. In Ireland it is reported that we are pretty good at water consumption with one study reporting that on average Irish men and women consumed 2.5L and 2.1L of water per day respectively (3).  

There are plenty of factors that affect the recommended fluid intake. These include; the temperature, your diet, your health and your activity levels (1). We will focus on activity levels.

With activity there is a need for greater fluid intake as we lose fluids through sweat. Here are some general recommendations for fluid consumption.

1)     Try to drink water/fluids throughout the day not just close to activity as this results in better hydration levels (4).

2)     Start to drink additional fluids around 2 hours before activity (5).

3)     During Activity continue to drink fluids.

4)     Drink fluids post activity to avoid dehydration and aid in recovery. It has been recommended to consume roughly 1.5L of fluids for every 1kg of body mass lost during exercise (4)(5).

 

 

Measuring Hydration levels.

The easiest way to measure your hydration status is the urine assessment chart. The chart has been shown in studies to be a valid method (6).

Consequences of poor hydration can be seen below;

  1. Dehydration can adversely affect your training. It has been shown to negatively affect strength, endurance, coordination, and thermoregulation (body temperature) (7).

  2. It has also been shown to affect cognitive performance. This includes decreased attention levels, immediate memory and alertness (8) while also increasing drowsiness.

  3. Dehydration can significantly increase the chance of falls in the elderly with some studies recording that 1/3 of fall patients were dehydrated at the time of their fall (9).

Being properly hydrated can prevent help prevent these negatives and help to improve performance levels.

References
1) Mayo Clinic, β€˜Water How much should you drink every day?’ Oct 12 2022, Water: How much should you drink every day? - Mayo Clinic.

2) Norton, C., (2023), β€˜How much water should I drink daily? (rte.ie)’ RTE,9) Hamrick, I., Norton, D., Birstler, J., Chen, G., Cruz, L., Hanrahan, L., β€˜Association Between Dehydration and Falls’, Mayo Clin Proc Innov Qual Outcomes, ;4(3), pp. 259-265.

3) O'Connor L, Walton J, Flynn A., (2013), β€˜Water intakes and dietary sources of a nationally representative sample of Irish adults’, J Hum Nutr Diet, 27(6), PP.550-6

4) Evans GH, James LJ, Shirreffs SM, Maughan RJ., (2017), β€˜Optimizing the restoration and maintenance of fluid balance after exercise-induced dehydration’, Journal of Applied Physiology (1985), 122(4), pp. 945-951.

5) Dobrowolski H, Karczemna A, WΕ‚odarek D., (2020), β€˜Nutrition for Female Soccer Players-Recommendations’, Medicina (Kaunas), 56(1):28.

6) Kostelnik, S.B., Davy, K.P., Hedrick, V.E., Thomas, D.T., & Davy, B.M., (2021), β€˜The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review,’ Journal of the American College of Nutrition, 40:2, pp.172-179,

7) Kalman, D.S., Lepeley, A. (2010) β€˜A Review of Hydration’, Strength Cond. J, 32, pp. 56–63

8) Adan, A., (2012), β€˜Cognitive performance and dehydration’, J Am Coll Nutr, 31(2), pp. 71-78,

9) Hamrick, I., Norton, D., Birstler, J., Chen, G., Cruz, L., Hanrahan, L., β€˜Association Between Dehydration and Falls’, Mayo Clin Proc Innov Qual Outcomes, ;4(3), pp. 259-265.

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Approximately 65-80% people will experience low back pain (LBP) during their lifetime with 10-30% of the adult population currently experiencing LBP. Chronic LBP can be scary, painful, limiting and frustrating but is rarely dangerous. The majority of the time a specific source of a person’s pain cannot be identified. There are multiple factors that can lead to and influence LBP, these include mechanical sources (Nerves, Joint, muscles etc.), sleep, physical activity levels, stress levels.

There is strong evidence that a multidisciplinary approach including exercise, manual therapy, education and relaxation strategies work in easing pain levels and helping people with back pain.

If you are suffering from Low back pain and need some help, please get in touch and/or book an appointment.


Low Back Pain

The Gastrocnemius

πŸ”΅ The Gastrocnemius is one of the main calf muscles.

πŸƒβ€β™‚οΈ It is important for lower limb movement such as walking, running and jumping.

πŸ“š Here are 4 exercises to help strengthen this muscle.

1. Double leg calf raise.

2. Single leg calf raise.

3. Deficit Double leg calf raise.

4. Deficit Single leg calf raise.

The Soleus

πŸ”΅The soleus muscle is the 2nd major calf muscle.

πŸƒβ€β™‚οΈ Along with the Gastrocnemius it is important in movements such as running and jumping.

πŸ“š Here are 2 exercises to strengthen the Soleus.

1. Bent knee calf raise

2. Deficit bent knee calf raise.

If you would like to know more or get any niggles or injuries sorted contact me via this page or the email in my bio