Getting Stronger for Living Longer Better
UNDERSTANDING MUSCLE AGEING AND FITNESS
The term sarcopenia was created at a conference in New Mexico in 1989, being defined as involuntary loss of skeletal muscle mass and consequently of strength.” (1) It became more widely used and was eventually adopted into the International Classification of Diseases as a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality (2). There was however ongoing debate about its usefulness with one paper , in the BMJ Too Much Medicine series, on the over diagnosis of the condition (3).
Perhaps the greatest concern is that the use of a term such as sarcopenia implies that it is a distinct condition, like rheumatoid arthritis. It is probably more accurate to think of it as being analogous to the term high blood pressure, which also implies it is a distinct condition but is in fact defined by the opinion of epidemiologists deciding a point in the normal distribution of blood pressures at which the individual should be offered the opportunity of a drug to reduce their risk. Sarcopenia too can be considered to be a condition defined by a person's point on a distribution curve. Unfortunately there is no simple clinical intervention like an anti hypertensive medication. For this reason it is vitally important to remember the principle first articulated by the epidemiologist Geoffrey Rose that it is more important to shift the whole population curve than to focus only those at highest risk as illustrated in his classic diagram.
The term sarcopenia was created at a conference in New Mexico in 1989, being defined as involuntary loss of skeletal muscle mass and consequently of strength.” (1) It became more widely used and was eventually adopted into the International Classification of Diseases as a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality (2). There was however ongoing debate about its usefulness with one paper , in the BMJ Too Much Medicine series, on the over diagnosis of the condition (3).
Perhaps the greatest concern is that the use of a term such as sarcopenia implies that it is a distinct condition, like rheumatoid arthritis. It is probably more accurate to think of it as being analogous to the term high blood pressure, which also implies it is a distinct condition but is in fact defined by the opinion of epidemiologists deciding a point in the normal distribution of blood pressures at which the individual should be offered the opportunity of a drug to reduce their risk. Sarcopenia too can be considered to be a condition defined by a person's point on a distribution curve. Unfortunately there is no simple clinical intervention like an anti hypertensive medication. For this reason it is vitally important to remember the principle first articulated by the epidemiologist Geoffrey Rose that it is more important to shift the whole population curve than to focus only those at highest risk as illustrated in his classic diagram.
This means that a whole population approach is needed as well as providing support to those with least muscle who are at highest risk. Each neighbourhood needs a plan to reach every group of older people, faith organisations, WIs, bridge clubs and bowls clubs.
REACHING MEN AND WOMEN IN THEIR 60s,70s, 80s & 90S
It is essential to ensure that women as well as men are informed about the benefits of strengthening muscle and the evidence it can be achieved at any age. They have less muscle than men but are at higher risk of falls and fractures and of course building muscle strength also strengthens bones.Clear advice is given on the NHS Strength and Flex website and of course from a trainer; information will be prepared for the W:ISH system to distribute
Every Neighbourhood needs to develop a strength programme for living longer better working with their Active Partnership and local gyms and fitness centres.
W:ISH
W:ISH creates a personalised physical activity 'prescription' linking the persons diagnosis or symptoms to local opportunities for fitness training for example Nuffield Charity sponsored sessions. There are also links to resources describing the importance of the four aspects of fitness with a link to the DHSC Strength and Flex website.
1 Rosenberg I H (2011)
Sarcopenia; Clinical Relevance and Origins
Clin Geriatr Med 27 ;33-339
2 Cruz-Jentoft A J, and Sayer A A (2019)
Sarcopenia
Lancet 393: 2636–46
3 Haase C B et al (2022)
Sarcopenia: early prevention or overdiagnosis?
BMJ 2022;
376:e052592