The human body goes through many changes throughout life — sarcopenia is one of them. It’s defined as the loss of muscle mass and strength, often as part of the aging process.
The human body goes through many changes throughout life — sarcopenia is one of them. It’s defined as the loss of muscle mass and strength, often as part of the aging process.
Although everybody experiences sarcopenia if they live long enough, some people develop it more severely or at a younger age. A few factors influence its development:
Genetics
Levels of exercise and strength training
Underlying medical conditions
Diet, especially protein intake
Body composition
Sarcopenia poses a significant risk to older adults because it can increase the risk of injury and affect their quality of life and ability to perform daily activities.
This guide examines everything you need to know about sarcopenia, including symptoms, treatment options, and risk factors.
Sarcopenia is muscle degeneration that limits muscle strength and mass. It’s thought to occur in five to 13 percent of people over age 60 and 11 to 50 percent of those 80 and older. Its exact prevalence is hard to estimate since no internationally accepted definition exists.
In 2018, the European Working Group on Sarcopenia updated its diagnostic criteria and definition to:
Low muscle strength
Low muscle quantity or quality
Low physical performance
Probable sarcopenia is when someone has the first criteria (low muscle strength), but low muscle mass hasn’t been confirmed yet. Sarcopenia is considered severe if you meet all three criteria.
Older adults with sarcopenia have an elevated risk of injury, as the condition is strongly related to frequent falls and bone fractures.
Muscle atrophy is when muscles shrink in size. It often happens after periods of extended inactivity or bed rest, like recovering from a major surgery or being sick for a long period. It can also occur as part of the natural aging process.
Frailty and sarcopenia are similar concepts. Sarcopenia specifically describes changes to muscles with age, whereas frailty is a more general concept of weakness. Cachexia is loss of muscle mass associated with unintentional weight loss.
Loss of muscle mass and strength characterize sarcopenia.
The defining characteristics of sarcopenia include:
Muscle weakness
Loss of muscle mass (muscle atrophy)
Reduced muscle function
Low physical performance
These signs and symptoms are somewhat subjective since they don’t have precise definitions. Those with sarcopenia might also experience:
More frequent falls or injuries
Decreased handgrip strength
Impaired ability to do daily activities
Loss of independence
These symptoms might cause disruptions to daily life, making it difficult to do things like climb stairs, stand up from a seated position, open containers, or walk around. This can make it hard for someone to live on their own, as they may need help with daily tasks.
You can lose muscle quickly if you’re immobile for a prolonged period, for example, during extended bed rest. You might have noticeable reductions in muscle mass after several weeks.
Sarcopenia is often caused by the natural aging process, which leads to loss of muscle and strength. But other factors can increase the risk of developing it at a younger age.
The primary cause of sarcopenia is aging, as people experience a natural decline in muscle fibers and muscle tissue. Muscle loss starts in middle age but accelerates after age 60. Strength is lost more rapidly than muscle mass.
Researchers don’t know exactly what the primary driver of sarcopenia is. But multiple factors are thought to play a role, such as:
A decrease in type II muscle fiber size and number (muscle fibers that produce large amounts of force but fatigue quickly)
Physical inactivity
Reduced insulin-like growth factor (IGF-1) and growth hormone
Reduced androgen hormones, such as testosterone
Reduced growth factor concentrations
Inadequate protein intake
Inflammation
The development of sarcopenia is also linked to other underlying medical conditions. This includes kidney disease, chronic obstructive pulmonary disease (COPD), chronic heart failure, diabetes, HIV, and cancer.
Some folks have a higher risk of developing more severe sarcopenia or experiencing it at a younger age.
Risk factors for sarcopenia include:
Age. Sarcopenia becomes more common with increasing age. Older adults, particularly those over 60, have the highest risk.
Chronic illnesses. Some younger adults with chronic illnesses may also be more likely to develop sarcopenia. Those with cancer, HIV, or other conditions affecting musculoskeletal health are at an increased risk.
Physical inactivity. People who live sedentary lifestyles (with very little daily physical movement) have an elevated risk of sarcopenia.
Low protein intake. Protein is required for the body to build new muscle tissue. Diets lacking adequate protein can contribute to reduced muscle synthesis.
Body composition. Increased fat mass and reduced lean body mass contribute to sarcopenic obesity, where excess body fat coexists with low muscle mass. Those with a high BMI (body mass index) might be more prone to sarcopenia.
Long-term immobility conditions. Conditions that cause long-term hospitalization or immobility can increase muscle wasting and may lead to sarcopenia.
Smoking. Smoking may damage your lungs and make you less likely to do regular physical activity. Some research suggests smoking is a risk factor for sarcopenia.
Other conditions. Other medical conditions have been linked to a higher risk of sarcopenia, including heart disease, lung disease, depression, cognitive impairment, Parkinson’s disease, and rapid or drastic weight loss.
Medical providers may run many tests to assess your strength and muscle mass when determining whether you have sarcopenia.
A sarcopenia diagnosis can usually be made by your primary healthcare provider. During your initial assessment, your provider will:
Review your personal and family medical history
Ask about your symptoms
Perform a physical exam, where they’ll take your height and weight to calculate your BMI.
The diagnostic criteria for sarcopenia have evolved over the years with technological improvements. Many additional tests are now available to help assess body composition.
We’ll go over some of the more common ones here.
A handgrip strength test is a common way healthcare providers measure muscular strength in patients with suspected sarcopenia. Low scores for this test often correlate with decreased strength in other parts of the body. Decreased handgrip strength is also linked to poorer sarcopenia outlooks.
Grip strength is measured with a tool called a dynamometer. The score is compared to numbers representing your age and sex.
The suggested cutoff point for handgrip strength is less than 27 kilograms (59.5 pounds) for males and less than 16 kilograms (35.3 pounds) for females.
The chair stand test is often used to gauge lower body strength, particularly in the muscles in the front of the thighs called the quadriceps. Healthcare providers are looking to see how many times you can stand and sit from a chair in 30 seconds without using your arms.
Taking more than 15 seconds to do at least five rises might indicate sarcopenia.
A number of advanced tests can measure the quality and quantity of muscle:
Magnetic resonance imaging (MRI). MRI is the gold standard for confirming sarcopenia, as it can provide highly accurate measurements of muscle mass.
Computed tomography (CT) scans. CT scans are another reliable way to measure lean muscle mass, but they’re rarely used in primary care settings.
Dual-energy X-ray absorptiometry (DEXA). DEXA isn’t as accurate as CT scans or MRIs, but since it’s more widely available, it’s used more often.
Bioelectrical impedance analysis (BIA). This non-invasive test checks body composition and protein-energy use by measuring the voltage of a small electrical current released into the body.
Walking speed tests can predict adverse outcomes in patients with sarcopenia. A common test is called the four-meter usual walking speed test.
Healthcare professionals measure the time it takes to walk four meters at your usual pace. A speed less than 0.8 meters per second (2.6 feet per second) may point to severe sarcopenia.
The SPPB includes three timed tests used together to assess physical performance: getting up from sitting in a chair, balancing in a standing position, and walking speed.
The TUG test measures how long it takes to rise from a chair, walk three meters away from the chair, and then walk meters back. Longer than 20 seconds could suggest a medical condition like sarcopenia.
The 400-meter walk test measures how long it takes to walk 20 laps, each 20 meters, as quickly as possible with no more than two minutes rest between laps. Being unable to complete the test or needing more than six minutes might be a predictor of severe sarcopenia.
Questionnaires can also be used to evaluate your symptoms. One questionnaire you might do is the SARC-F, which stands for “strength, assistance with walking, rising from a chair, climbing stairs, and falls.” You’ll rate the severity of your signs of sarcopenia on a scale from zero to 10.
Treatment of sarcopenia typically involves a combination of lifestyle changes, nutritional support, targeted physical activities, and medication.
Resistance training has shown to improve muscle strength and prevent further muscle shrinking. It’s the main non-medication treatment for the management of sarcopenia, but it can take three months or longer to see noticeable improvements.
Strength training exercises, such as weight lifting and bodyweight movements, help stimulate muscle hypertrophy and enhance muscle fibers. Workout programs should be progressively adjusted to maintain improvements in muscle strength and body composition.
Nutritional changes that may help treat sarcopenia include:
Increased protein intake. Ensuring you’re getting enough high-quality protein and amino acids is essential. Older adults should aim for at least 0.45 to 0.55 grams of protein per pound of body weight every day or 20 to 35 grams of protein per meal. We recommend 100 grams of protein per day.
Supplements. Vitamin D and other supplements like protein powders can support muscle health, particularly for those with nutritional deficiencies.
Healthy diet. A balanced intake of high-caloric food rich in nutrients and low in unhealthy fats can improve overall muscle function and body composition.
No medications have been specifically FDA-approved for treating sarcopenia, but many drugs may help manage it.
Medications for sarcopenia might include:
Growth hormone
Anabolic steroids
Selective androgenic receptor modulators (SARMs)
Protein anabolic agents
Appetite stimulants
Myostatin inhibitors
Angiotensin-converting enzyme (ACE) inhibitors
Troponin activators
Can muscle atrophy be reversed? Muscle atrophy may be somewhat reversible with a regular exercise routine, a high-protein diet, and improvements in overall health.
Sarcopenia is a natural part of the aging process, but making changes to your lifestyle can help reduce its severity or delay its development.
Prevention of sarcopenia calls for a proactive approach, starting in middle age, to maintain muscle mass and strength. Strategies include:
Regular physical activity. Engaging in resistance training and aerobic exercises helps sustain muscle tissue and prevent atrophy. Resistance exercise like weight training is particularly effective in preserving muscle fibers and strength.
Adequate nutrition. Ensuring sufficient protein intake — along with vitamin D, calcium, and other micronutrients — supports muscle synthesis and strength. A diet full of lean meats, fish, dairy, and plant-based proteins is recommended.
Prevention programs. Community and healthcare-based programs can help older adults understand the importance of muscle maintenance and guide them through structured exercise plans.
Resistance training helps maintain and build muscle tissue. When you think of resistance training, you may immediately imagine lifting weights, but this form of exercise can take many other forms, such as:
Banded exercises
Calisthenics (bodyweight exercises)
Yoga or pilates
When lifting weights, it’s best to focus on exercises that use your body’s large muscles (squats, for instance) to stimulate muscle growth.
In a 2022 review, researchers proposed a sarcopenia program involving two exercise sessions a week, with a combination of upper- and lower-body exercises and a high degree of effort.
Many different strength-training programs can be effective for building muscle strength and mass. If you aren’t sure how to build a training program, you may benefit from working with a personal trainer or physiotherapist.
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