​Growing Old is Not Growing Feeble

To overcome sarcopenia or muscle loss, one has to fight the misconception that age and weakness always come as a pair. Strengthen those muscles before it is too late!

Many people believe getting old means getting weak, but that is not always true. While most think muscle loss, also called sarcopenia, only affects the elderly, it actually starts far earlier than most realise – typically from the age of 30. 

“This misconception often leads individuals to accept sarcopenia without taking proactive steps to address it, potentially leading to long-term health consequences,” explains Clinical Associate Professor Frederick Koh, Consultant, Colorectal Surgery Service, Sengkang General Hospital.

What is Sarcopenia

Sarcopenia is the progressive state of loss of muscle mass and function. It is a term coined in 1989 by Irving Rosenberg, an American professor of nutrition and medicine. 

The biggest cause of sarcopenia is an inactive (sedentary) lifestyle, which worsens with age. However, many health issues that we develop along the way can accelerate its progression. These include diabetes, drug consumption (including steroids and alcohol), vitamin D deficiency, inadequate nutrition (which could be exacerbated by swallowing difficulties or poor oral health), as well as other diseases such as chronic kidney disease, cancer, and osteoporosis.

Muscle Loss Can Cause Serious Health Issues

The progressive loss of muscle in both mass and function not only affects strength but also affects metabolic health and reduces bone strength, 

“Everyone’s at risk,” stresses Clin Assoc Prof Koh. “Muscles are vital for movement and maintaining posture. Sarcopenia affects these functions, leading to loss of independence in movement and increased reliance on walking aids. This raises the risk of falls and fractures, resulting in frailty and hospitalisation, which impacts one’s quality of life,” he shares. 

A lesser-known aspect of sarcopenia is that it lowers immunity. Clin Assoc Prof Koh explains: “Muscles serve as a main reserve of energy and protein that supports our immunity. Sarcopenia weakens immunity, increasing susceptibility to illnesses and hospitalisations. In cancer patients, sarcopenia is associated with earlier cancer recurrences and a shorter lifespan.” 

He adds that sarcopenia can delay recovery from major stressors such as infections, fractures, chemotherapy, severe illness, and surgery.

For those undergoing surgery, sarcopenia can lead to less favourable outcomes. Extensive research has shown that sarcopenia results in increased complications and mortality rates after surgery. It is also associated with prolonged hospital stays and much slower recovery from surgery, with some patients failing to return to their original health status.

Prehabilitation to Combat Sarcopenia

Clin Assoc Prof Koh shares that a way SKH mitigates sarcopenia is through prehabilitation for patients undergoing any major surgery. “Prehabilitation is the process of focusing on increased energy and protein intake along with resistance-based training for muscles,” he explains. This strengthens muscles and boosts physical resilience before surgery.

“Studies have shown that two to six weeks of prehabilitation before major surgery can help improve the patient’s original health condition to a higher level after surgery. This prepares patients better to withstand the stress of surgery, and provides sufficient resources for healing afterward, reducing the rates of complications, deterioration and mortality after major surgeries.”

Part of SKH’s SUPREME (SUrgical PREhabilitation for coMprehensive Enhanced recovery) programme, this prehabilitation service has shown promising outcomes. “We’ve helped patients increase their chances of returning home independently after surgery – without requiring rehabilitation in a step-down facility – by more than 10%,” says Clin Assoc Prof Koh who leads the SUPREME programme. 

SKH’s SUPREME programme involves a multi-disciplinary team of surgeons, doctors, physiotherapists, and dietitians working to create personalised plans, including exercises and nutritional advice, for patients undergoing surgery.  

At one month and three months post-surgery, patients who participated in the SUPREME programme showed much improved functional status and quality of life compared to non-participants. “Our patients’ experience also improved as they felt better taken care of holistically for their surgery,” he adds. 

Ways to Improve Muscle Health

However, one should not wait until surgery is imminent before embarking on a programme to improve muscle health. 

Clin Assoc Prof Koh says, “In its early stages, sarcopenia can be slowed down or even reversed. But when sarcopenia progresses to severe stages or frailty, the chance of reversal is much reduced.” As early in life as possible, you should start doing simple activities daily to improve muscle health. Remember these five main components:

• Nutrition: Ensure adequate calories with more protein intake. 
• Exercise: Engage in weight training or anti-gravity movements (e.g. climbing up the stairs or slope, light weight bicep or tricep curls, leg raises, etc) at least three times a week for 30 minutes per session. 
• Change mindset: Eradicate the notion of inevitable weakness with age (“I will become weak when I get older” or “I am weak because I am older”)
• Support system: Encourage and remind loved ones about the importance of nutrition, exercise, and a positive mindset. 
• Vitamin D: Studies have shown that vitamin D can mitigate sarcopenia, so be exposed to sunlight before 9am and after 5pm for at least 10 minutes daily, though if you cannot get sunlight, consult with your doctor how much to supplement in your diet.