Sarcopenia: what it is, what to eat and which exercises to do

What is sarcopenia?

Sarcopenia combines a loss of muscle function and of muscle mass. The international sarcopenia guideline covers its assessment and its interventions in older people [2]. The diagnosis is the responsibility of your healthcare team.

Strength shows in everyday tasks, such as carrying the shopping or climbing stairs. The guideline includes strength and physical performance measures for the assessment [2]. Your weight on the scales does not describe those abilities on its own.

Independence also depends on being able to move. The World Health Organization includes mobility among the abilities that make healthy ageing possible [3]. The full picture is in the nutrition guide for longevity.

How do I know if I have sarcopenia?

A new difficulty deserves an assessment, but it does not confirm a disease. The healthcare team may use questionnaires and measures of strength or of walking speed [2]. These are tools that they interpret together with your clinical situation.

The international guideline distinguishes screening, which looks for possible difficulties, from diagnosis [2]. Measuring yourself with a stopwatch at home does not replace that assessment. Nor does it let you decide on your own which supplement you need.

Note which tasks have changed and since when. You can take this information to your medical appointment.

What should I eat to avoid losing muscle?

Enough protein every day and enough food overall. The European clinical nutrition in geriatrics guideline sets at least one gram of protein per kilo of body weight a day [1].

ESPEN does not set a single higher amount for everyone. It asks for protein to be adjusted to nutritional status, activity, illness and tolerance; some situations may need more, but the amount is individualised [1]. You can read “Exercise and protein after 60“.

Total food intake also matters. Insufficient energy intake increases protein needs [1]. The guidance is around 30 kilocalories per kilo of body weight a day, adjustable for each person [1].

If you eat less because of low appetite or difficulty preparing food, it is worth reviewing those barriers [1].

Spreading protein-rich foods across your meals can help you reach the daily amount. This practical approach does not replace an individual calculation, nor does it show by itself an extra effect on muscle.

If you have kidney disease, do not increase your protein following a general guide. Your team should assess the amount and whether other components of your diet need adjusting for your situation.

Do leucine or vitamin D help?

The international guideline does not recommend vitamin D supplementation as a stand-alone intervention in sarcopenia. The certainty of the evidence it assessed was very low [2]. Correcting a deficiency and promising a gain in strength are different decisions.

In studies with preparations that combine vitamin D and leucine, any possible benefit cannot be attributed to vitamin D alone [2]. Leucine is a component of proteins. The evidence for recommending it on its own in older people with sarcopenia is also limited [2].

If you already have a prescription, do not stop it because of this conclusion. The professional may have prescribed it for another reason, such as a deficiency [2]. Bring your blood test results and the packaging so the prescription can be reviewed.

What exercise to do and how many days

Strength exercise has a firm recommendation for sarcopenia. It is the intervention with the firmest recommendation in that guideline [2]. With supplements and hormones, by contrast, the evidence falls short [2].

Any activity that makes the muscle work against something counts as strength: dumbbells, weights, elastic bands or your own body weight [2]. Resistance and difficulty are adapted to your ability. Walking and strength training serve different functions [4].

WHO sets the days. It asks all adults for strength work at least two days a week [4]. From age 65, add activity that combines balance and strength three or more days a week, to maintain functional capacity and prevent falls [4].

And at any age, between 150 and 300 minutes a week of moderate activity, such as brisk walking [4].

If you are starting from zero, begin with little and build up. If you have an injury, a prosthesis or a heart problem, let a physiotherapist or your doctor guide you. And let food support it, because the nutritional intervention is recommended combined with exercise [2].

How is muscle gained and kept after 60?

With strength exercise that becomes a little more demanding over time. A position statement on strength training in older people describes it as a powerful intervention against loss of strength and muscle mass, with benefits for mobility and independence [5].

An international consensus on exercise in older people adds that, in sarcopenia, where there is no effective drug, exercise may be the main resource [6].

Maintaining and gaining are worked on with the same exercise. What changes is how much load you carry and how much food accompanies it. What follows is a general outline and not an individual plan. With your history, a physiotherapist or an exercise professional adjusts it.

• Work the large muscles first. Sitting down and standing up from a chair, rowing with a band, pushing against a wall or rising onto your toes all count.
• Start with your own body weight or a soft band, and increase the difficulty gradually. When a set feels easy, add repetitions or a little more resistance. Well-designed programmes adjust that load progressively [5].
• The international consensus on exercise in older people proposes strength training two or three days a week [6].
• Leave at least one day between sessions that work the same muscles [6]. You may feel the effort, but it should not hurt.
• If you have chest pain, severe dizziness or shortness of breath that is not your usual, stop and see your doctor.

The days per week are already set by WHO, in the previous section.

What to eat in practice to gain muscle?

A recognisable source of protein at every meal, and enough food overall. The daily reference is above [1]. No minimum per meal is set here. The practical point is that none of the three meals should lack a clear source.

• Breakfast with plain yoghurt, or milk with bread and fresh cheese, or an egg.
• Lunch with pulses and rice, or with fish and potato, and vegetables on the side.
• Dinner with an omelette and bread with tomato, or a creamy vegetable soup with fresh cheese or a hard-boiled egg.

These are examples and not a menu. If it is hard for you to eat enough, ideas for enriching dishes without increasing their volume are in the guide to protein in older people. If you have an illness, do not change the amount on your own. Your team adjusts protein to your clinical situation and your tolerance [1].

Vitamin D does not have a recommendation as a stand-alone intervention in sarcopenia [2]. If your doctor finds a low level in a blood test, it is he or she who will prescribe it and review it. How it is obtained and when it is measured is explained in the vitamin D guide.

Creatine is a supplement that has been studied in older people who do strength training. A pooled analysis of trials found that, with strength training, those who took it gained more lean mass and more strength than with placebo [7]. If you have kidney disease or take several medicines, check with your doctor first.

All the details are in the guide to creatine in older people.

What does not work to gain muscle?

Products that promise muscle without training. Muscle needs the stimulus of exercise [6], and food and supplements only support it [2]. At the consultation we can review those products before you start using them.

• Leucine and HMB, one of its derivatives, have very little evidence in older people with sarcopenia [2].
• Vitamin D taken on your own, without a blood test and without training, does not have enough support either [2].
• Hormones taken on your own, because the evidence is insufficient and their use is a medical decision [2].
• A shake or a bar as a substitute for a meal. They may make sense in specific situations, and it is better for a professional to assess them. You will find the details in the guide to protein powder.

Training without eating enough does not help either. If energy intake is insufficient, protein needs may increase [1].

Can sarcopenia improve?

Strength and function can improve with an adapted plan. Strength exercise has the firmest recommendation; a protein-rich diet is recommended conditionally and should be individualised [2] [1]. Progress depends on each person’s situation.

If you have lost weight without meaning to, we work on this in weight gain. First, read the section on when to see a doctor, because losing weight without intending to is looked at first in the medical consultation.

Bone health also needs attention. If that is your case, also read the nutrition for osteoporosis guide.

If you have been advised to lose weight after 65

A plan to lose weight in your seventies also requires assessing muscle health. Rapid weight loss takes away fat and muscle at the same time, whether it comes from a strict diet, an illness or a treatment to lose weight.

ESPEN only proposes a weight-loss diet for older people with obesity and health problems related to weight. The plan must be individualised and combined with exercise [1].

To find where to start, see the weight-loss guide. If medication is involved, your doctor is in charge of that.

When to consult if you lose strength or fall?

When you notice you are losing strength, falling, or finding it hard to do what you used to do without thinking. You do not need to wait until you start training to ask. If you have already fallen, ask for an assessment before increasing the pace.

Exercise is part of the answer. A Cochrane review of trials in people aged 60 or over living at home found that exercise reduces falls. With balance and functional exercises, the reduction is around a quarter [8].

The specific signs are further down, in the block “When to see a doctor”.

Frequently asked questions about gaining muscle after 60

Can you gain muscle at 70 or 80?

Yes. The statement on training in older people describes possible benefits for strength and muscle mass [5]. With frailty or chronic illnesses, a professional adapts the plan [5].

How long does it take to notice?

The creatine trials with strength training lasted from seven to 52 weeks [7]. That range describes the studies, not a timescale of improvement for you. Pay more attention to what you do than to the scales, for example how hard it is to get up from a chair.

Is walking enough?

Walking helps the heart and balance, but it does not replace strength work. WHO asks for both from age 65 [4].

Do I need a gym?

No. Elastic bands, light dumbbells or your own body weight count as strength [2]. A gym can suit you if you like the atmosphere. A professional can help you adapt the exercises at home [5].

Can I do strength training if I have osteoporosis or osteoarthritis?

Often yes, with adaptations, and the position statement on strength training in older people has a section on chronic illnesses [5]. Your doctor or physiotherapist assesses the adaptations. If bone is your concern, see the nutrition for osteoporosis guide.

What mistakes do we see in consultation?

• Spending on supplements before starting strength training. Exercise and enough food come first.
• Thinking it is just due to age and not raising it with your doctor. Loss of strength is investigated and treated.
• Looking only at the scales. A weight that does not change can hide less muscle and more fat.
• Waiting until you feel more energetic before starting to move. Strength can improve with an adapted programme, starting with little.
• Stopping strength work as soon as the first week’s muscle soreness appears. Mention the pain to whoever supervises your exercise so they can assess the load.
• Drinking only when you feel thirsty. Follow the fluid plan indicated for your clinical situation [1].
• Caring for a partner or a relative and forgetting your own food. At the consultation we can assess whether you need help organising meals.

What is the relationship between vitamin D and strength?

The question of vitamin D and strength is not resolved by choosing a product. In older people with sarcopenia, the international guideline distinguishes the lack of evidence for a stand-alone intervention from the medical assessment of a low level [2].

A blood test reports a marker in the blood. It does not measure strength and does not replace the tests the healthcare team uses to assess muscle [2]. If you have been prescribed vitamin D, ask which reason is being addressed and how follow-up will be done.

Adequate food and adapted exercise remain part of the approach. Daily protein is individualised according to nutritional status, activity and illnesses [1]. The guideline offers a firm recommendation for strength exercise and a conditional one for a protein-rich diet [2].

To review how meals are spread, see the guide to protein in older people. The guide to exercise and protein after 60 explains how to accompany training.

If your question is about another product, the guide to creatine in older people has a different scope. The evidence for one supplement does not transfer to another. There is no universal dose of vitamin D for gaining strength [2].