Features May 2019 Issue

Combatting Muscle Loss

A decline in skeletal muscle with age is common. You can do something about it.

If you are over 50 and don't feel as strong as you used to or don't have as much stamina as you once did, it's not surprising. Just like bone density decreases with age, we also lose muscle mass. The decline in skeletal muscle, a condition called sarcopenia, is a natural process that occurs in everyone over time. It can lead to frailty and increased risk for falls and loss of independence.

"Fortunately, we can do something about it," says physical therapist Gary Calabrese, DPT, Senior Director of Sports Health and Orthopaedic Rehabilitation at Cleveland Clinic.

An Imbalance


Illustration by Marty Bee

A: Normal muscle

Muscle loss occurs because of an imbalance between two neurological signals involved in muscle growth. A catabolic response sends a signal to reduce the size of muscle, while an anabolic response sends a signal to build up muscle. A stronger catabolic response means less muscle is built.

Most experts agree that the imbalance that leads to muscle loss begins around age 50, although some studies suggest it might start earlier. "This will affect everybody by the age of 75," says Calabrese. An inactive lifestyle accelerates theprocess.

"Younger adulthood and middle age is when you want to get a jump on this to preserve muscle strength over time," says Calabrese. Even if you didn't start early, it's not too late. No matter how old you are, you can combat sarcopenia. Exercise builds strength, but nutrition is just as important.

Role of Nutrition


Illustration by Marty Bee

B: muscle loss (sarcopenia) Exercise and good nutrition can build muscle strength.

"You can't just exercise and not eat properly, and you can't just eatproperly and not exercise," says Calabrese. Eating protein‑rich foods to help build muscle is thekey.

"To build muscle, you need 0.45 gram of protein per pound of body weight," says Calabrese. For example, a person weighing 140 pounds should eat 63 grams of protein a day (140 x 0.45). Good sources are milk, cheese, eggs, poultry, fish, peanuts and beans.

Protein is critical, but you also need carbohydrates, which is the energy source your body uses to be able to exercise. Middle- and older-age adults should not be on a low-carbohydrate diet. But be sure to choose healthy carbohydrates. Vegetables, fruits and whole grains are preferable to highly processed foods. Whole, fresh foods also have vitamins and other nutrients your body needs.



samael334 | Getty Images

"The best way to limit the extent of loss of muscle strength is by staying physically active all through life," says Calabrese. "But if you've been sedentary and have lost strength, the answer is still exercise."

A combination of aerobic and strength-training exercises will improve muscle health, as well as overall health. If you haven't been very active and are just beginning to exercise, go slow. "Don't do too much too soon," says Calabrese.

Start by consulting an expert, such as a physical therapist or exercise physiologist. This professional will not only teach you the correct exercises but will put together a program with the right sequence and progression of exercises to get the best results.

You need a well-rounded program that will strengthen all of your muscles, starting with the large muscle groups. We will discuss some principles of an exercise program in more detail in the June issue of Arthritis Advisor. Calabrese emphasizes that it's important to be patient. It can take six to eight weeks to see results.

Sources of Protein


Protein (grams)

Tuna, salmon, trout (3 oz)


Turkey, chicken (3 oz)


Plain Greek yogurt (6 oz)


Cooked beans (1/2 cup)


Milk (1 cup)


Nuts (1/4 cup)




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