Healthy aging is “the process of developing and maintaining the functional ability that enables well-being in older age.” World Health Organization
The United Nations has proclaimed 2021-2030 the Decade of Healthy Aging and I love the definition of healthy aging from the initiative. Why? Because it is focused on developing and maintaining function that allows us to do the things we love to do. For some of us it is a simple as being able to garden, walk the dog, or clean the house. For others, it might be participating in the senior Olympics or playing competitive pickleball or tennis. Whatever it is, how can we keep and maintain good function? What can we do right now to achieve healthy aging?
I turned to Sharon Collison, MS, RDN, Clinical Instructor of Nutrition in the Department of Behavioral Health and Nutrition at the University of Delaware to help us understand what we can do stay functionally fit to help maintain independence as we age. I listened to Sharon give a virtual presentation titled Sarcopenia: Strategies for Prevention and Treatment, and I was anxious to talk to her and learn more about the prevention side of the equation to share with you.
Let’s start with an activity to assess your leg strength. Find a straight-backed chair, perhaps a kitchen or dining table chair with no arms and grab a stopwatch (most smart phones have a stopwatch feature under the “clock” icon). (Note: if you’ve been inactive or recovering from illness or injury, ask a family member to spot you for safety).
1. Sit in the middle of the chair.
2. Place your hands on the opposite shoulder crossed, at the wrists.
3. Keep your feet flat on the floor.
4. Keep your back straight and keep your arms against your chest.
5. Start the stopwatch and rise to a full standing position, then sit back down again.
6. Repeat this for 30 seconds.
Count the number of times you can rise to a full standing position and sit back down. Click here for the full test instructions and scoring by gender and age. Using myself as an example, if I could perform the test 10 times in 30 seconds, my leg strength and endurance puts me at a lower risk for falls. (I passed the “test!”) (For another test of mobility, try the TUG or Timed Up and Go test described here.)
Sitting and standing seem like ordinary activities and indeed, they are. But as we age, we can lose both muscle mass and strength which can lead to loss of function and independence. We all lose some muscle mass and strength as we age but “the rate of decline is within our control,” says Collison. Loss of muscle mass and strength is called sarcopenia (sarco means flesh and penia means loss or decline).
Collison explains that “loss of muscle mass/function is a natural course of aging although loss to the point of a diagnosis of sarcopenia may not be. Sarcopenia is also tied to our lifestyle. Clinicians further classify sarcopenia as primary (or age-related) and secondary to disease states or disuse with injury or illness. When injury or illness is coupled with aging, it can lead to a rapid loss of muscle mass and strength.”
Check out this cross-sectional illustration of aging muscle. It represents a cross slice of thigh muscle in a healthy 30-year-old compared to an inactive 50- and 80-year-old. The dark brown color represents muscle, the light brown represents fat and the circle in the middle is bone. Not only is muscle mass lost in sedentary folks but there is also an increase in fat mass around and within the muscle. This helps explain some of the body composition changes that happen when we get older: less muscle and more fat mass.
When do these changes begin? Dr. Stu Phillips, Research Chair in Skeletal Muscle Health in Aging at McMaster University, writes that “aging is associated with a slow loss of muscle mass and function. Sarcopenic muscle loss proceeds at a rate of ~0.8%/year, and strength is lost at a rate of ~1–3%/year. It is difficult to say exactly when sarcopenia begins, but it likely that in the fifth decade of life that muscle mass and function begin to measurably decline dependent to large extent on a persons’ level of physical activity and general health.” (Click here for the citation.)
Collison add that, “between ages 40-70, healthy adults lose an average of 24% of muscle, which increases to 15% per decade after 70.” She stresses that muscle mass and muscle strength are different, yet both are important.
Dr. Bob Murray, co-author of Food & Fitness After 50, put it this way, “We lose muscle mass as we age but we also lose strength, 70-year-olds are about 30% weaker than they were at age 50…a large drop in strength over just 20 years.”
What can we do? Collison says, “a sedentary lifestyle is a major contributing factor to sarcopenia and functional disability. Significant evidence shows clear benefits of exercise interventions to prevent and treat loss of muscle mass and strength in older people. Physical activity represents the most effective strategy currently available in the management of sarcopenia.”
How should we get started? Find something that is a good fit for you. Going to the gym and using weight machines or working with a personal trainer (for the benefits of working with a personal trainer, click here) works for some, but for others it can be as simple as working out with hand weights, resistance bands, or even items found around the house, like a gallon jug filled with water. My husband discovered TRX and works out twice a week to stay strong. Remember to start slowly if you haven’t been active (and always check with your health care provider before starting an exercise routine) and gradually increase the amount of weight lifted. Just like brain needs a challenge to stay sharp, so do muscles. Challenge muscles through progressive resistance exercise, a fancy name for lifting a weight until your muscle says, “no more!” As you get stronger, challenge your muscle by lifting a heavier weight…that is the progressive part of progressive resistance exercise or strength training.
While strength training is important, Collison reminds us that “multimodal exercise that includes a combination of resistance training, walking, aerobic training, and balance training are recommended to improve muscle mass, muscle strength, and physical performance in older people. Research supports 30 minutes each day of physical activity to prevent sarcopenia.”
And, emerging research shows that physical strength can also improve mental strength. “We are beginning to understand muscle and brain cross talk,” says Dr. Nick Burd, Associate Professor of Kinesiology and Community Health at the University of Illinois at Champaign-Urbana. “In our studies, we are finding that older adults who are physically strong have better reaction times and better performance on memory tests.”
Don’t forget to feed muscle with the good stuff. Whether a Mediterranean style eating plan or the DASH eating plan, a healthy dietary pattern is needed to get and keep us strong. When it comes to muscle and mental strength, dietary protein is the star nutrient. Food sources of protein are preferred to protein powders or shakes because foods are healthy packages of important vitamins and mineral and key amino acids (the building blocks of body proteins) that are absent in a simple powder. Research suggests that older adults should aim for 30 grams of protein at each meal. For more on the benefits of protein, click here.
Collison says the evidence is clear that we can prevent severe loss of muscle mass and strength with changes to lifestyle. While many questions remain about the treatment of sarcopenia, one thing is clear. As Collison said at the beginning of this blog, “the rate of decline is under our control.”
OK, my fitness watch just told me it is time to get moving!
Chris Rosenbloom is a registered dietitian nutritionist and professor emerita at Georgia State University. She is the co-author of Food & Fitness After 50. Follow her blog, Fit to Eat, by clicking here.