When Your Muscles Quietly Disappear

When Your Muscles Quietly Disappear

Muscle loss strikes silently, often driven by lifestyle rather than age alone. Learn the real causes, the hidden signs, and how to protect your muscle health.

Mrs T watched her 72-year-old mother struggle to open a jar of sambal. Nothing unusual there — until she noticed her mother frequently needed both hands to push herself up from the sofa. Then her mother skipped a family outing at the community centre because "the stairs felt too steep".

These weren't just signs of getting older. Her mother was experiencing sarcopenia, progressive muscle loss that affects one in three Singaporeans aged 60 and above.

Meet the Expert

"Many families accept these changes as normal ageing, but they are actually warning signs that shouldn't be ignored," explains Clinical Associate Professor Frederick Koh, Consultant, Department of Colorectal Surgery, Sengkang General Hospital (SKH), as well as Clinical Lead and Principal Investigator of the SingHealth Duke-NUS Muscle Health Programme.

Clin Assoc Prof Koh has seen firsthand how muscle loss quietly affects health. "One in three older adults have sarcopenia, and malnutrition is a big risk factor. In fact, even among those younger than 60, one in 14 suffer from it as well."

What surprised many families: muscle loss begins much earlier than most people think — as early as 30 years old. By 40, we start losing muscle at a rate of 8 per cent every decade, accelerating to 15 per cent after age 70.

When does "just getting old" become a medical issue? Clin Assoc Prof Koh explains exactly what families should look out for in this clip.

Find out more: Understanding Sarcopenia: Muscle Loss, Ageing, and Prevention.

A Hidden Crisis 

Over 20% of older folks in Singapore are at risk of malnutrition. Not from lack of food, but from not getting proper nutrition. 

Clin Assoc Prof Koh noticed a pattern that we see at the dinner table. As seniors get older, they tend to eat "bird stomach" portions, filling up on comforting rice and noodles while cutting back on meat. 

The irony? Older adults actually need more protein than younger, active people. Yet, data shows many seniors are missing out on calcium and fibre while consuming excess sugar and fats. 

This creates a vicious cycle, especially since many of them do not exercise regularly. Less movement means less appetite. Without enough protein, muscles disappear faster and cannot repair themselves. Once the muscle is gone, moving around becomes even harder, keeping one stuck in a cycle.

Why Muscle Loss Is More Serious Than You Think

Muscle does far more than help you move. It is your body's largest protein and energy storage system – essential for fighting illness and recovering from injury.

"People with poor muscle health get more frequent infections and take longer to recover from injury or infection," Clin Assoc Prof Koh explains. "Cancer survivors with sarcopenia experience more frequent recurrences. This all points to the link between the immune system and muscle."

The Hidden Link to Your Immunity

Research is still uncovering exactly how muscles and the immune system communicate, but the associations are strong. Muscles produce and release compounds that help activate and distribute immune cells throughout the body. When muscle mass drops, the body loses this protective reserve.

Cognitive (brain) function takes a hit too. Whilst scientists are still piecing together the exact mechanisms, studies consistently show connections between muscle health and brain function.

Warning Signs Your Family Should Watch For

When does struggling with everyday tasks signal something more serious than typical ageing?

Clin Assoc Prof Koh explains when muscle weakness is actually a warning signal for your loved ones.

Watch the full breakdown: Understanding Sarcopenia: Muscle Loss, Ageing, and Prevention

• He points to several key indicators that should not be ignored:
• Needing to use arms or hands to push yourself up from a chair
• Feeling weaker when climbing stairs you used to manage easily
• Struggling to carry shopping bags or lift everyday objects
• Poor stamina or getting tired more quickly
• Unintentional weight loss

Simple Tests You Can Do At Home

For families wanting to check at home, here are some simple tests to try:

• Measure hand grip strength
• Time how fast someone walks a short distance
• Have them stand up from a chair five times and see if they can do it in under 12 seconds

You do not need high-tech tests to spot red flags, although there are tests like DEXA (Dual-Energy X-ray Absorptiometry) scans in hospitals to measure actual muscle mass. These simple home checks usually can tell you if something is wrong.

To make it easier, here's a quick cheat sheet on what to look out for:

Why Some People Age Faster Than Others

You might think some people just have "bad genes". That is usually not the case. If it were genetic, weakness would appear way earlier in life. It comes down to mindset and daily choices. We often prioritise everything else over exercise. We make convenient but poor food choices and accept getting weak as normal ageing.

The Nutrition Fix: What Actually Works

If eating becomes a chore, whether it is due to chewing difficulties or having no appetite, Clin Assoc Prof Koh recommends a two-step plan:

• Chat with a doctor or speech therapist to adjust food intake and food texture.
• Work with a dietitian to figure out the right food mix for your specific lifestyle.

Senior Dietitian, Lee Hui Bing, points out that while the under-60 crowd needs about 0.8g of protein per kg of body weight, those over 60 actually require 1.0-1.2g.

Spread this 1-1.2g across meals and pair it with resistance exercise. Since many seniors cut back on meat because of dental issues, finding the right soft protein sources is important.

For seniors:

• Soft-cooked fish (e.g., steaming)
• Tofu and bean curd
• Eggs (e.g., scrambled, steamed)
• Beans and lentils
• Properly prepared meats, cut into smaller pieces

These options accommodate chewing difficulties whilst delivering the protein older bodies need.

However, Hui Bing cautions: "Those with medical conditions such as chronic kidney disease may require protein restriction, and they should follow tailored dietary advice from healthcare professionals."

Movement is Medicine

"Seniors experiencing muscle loss can improve strength, muscle mass and physical function with regular, well-designed physical activity and exercise," Mah Shi Min, Senior Principal Physiotherapist, confirms.

"Guidelines recommend strength or resistance exercises 2-3 times per week targeting major muscle groups, 150 minutes of moderate-intensity aerobic exercise, and balance and flexibility exercises to reduce fall risk."

You do not need fancy equipment or gym memberships. These daily habits will help you build strength:

• Climb stairs but take the lift down
• Walk up slopes whenever possible
• If joints become an issue, try walking in a swimming pool or swimming itself – you get resistance without impact

For those aged over 60 facing sarcopenia, Clin Assoc Prof Koh puts it simply: The ‘magic formula’ is eating more protein, walking, and doing resistance exercises. Also, a crucial tip: never try to lose weight just by dieting. If you do that without exercise, you usually end up losing precious muscle instead of fat.

Take Action Before It’s Too Late

Building muscle is easier than trying to get it back once it is gone. We should not accept sarcopenia as part of normal ageing.

SKH has also developed comprehensive programmes to tackle muscle health for patients at different stages:

These programmes work by combining early diagnosis with proper nutrition and exercise to maintain independent.

Take Mrs T's mother. After working with a dietitian and physiotherapist, she’s back to attending family gatherings. She may not be able to open that tight sambal jar on her own, but she can climb the stairs at the community centre by herself again.