Can muscle lost with age be rebuilt?

What is sarcopenia?

Sarcopenia is a progressive loss of muscle strength and muscle mass that occurs with ageing and is linked with falls, fractures, disability and loss of independence. The revised European consensus defines sarcopenia primarily by low muscle strength, confirmed by low muscle quantity or quality, with low physical performance indicating severe sarcopenia 1.

Muscle strength is commonly measured with a grip strength test or the time taken to rise from a chair five times. Physical performance can be assessed by walking speed.

Why do we lose muscle as we age?

Muscle loss with age results from a combination of changes in nerves and muscle fibres, hormones, inflammation and, importantly, reduced physical activity and inadequate protein intake. Illness, periods of bed rest and hospital stays can speed up muscle loss.

Because inactivity plays a large part, much of this loss can be slowed or partly reversed.

What does the evidence show about strength training?

In a randomised trial of 100 frail nursing home residents aged 72 to 98, with a mean age of 87.1 years, 10 weeks of high-intensity progressive resistance training increased muscle strength by 113 per cent compared with 3 per cent in those who did not exercise 2. Walking speed increased by 11.8 per cent in exercisers and declined by 1.0 per cent in non-exercisers 2.

Stair-climbing power also improved more in the exercise group. The nutritional supplement used in the trial had no effect on the main outcomes without exercise 2. This shows that even very old and frail people can build strength.

How much strength training is recommended?

The World Health Organization recommends that older adults do muscle-strengthening activities at moderate or greater intensity involving all major muscle groups on two or more days a week, and varied multicomponent activity that emphasises balance and strength training on three or more days a week 3.

Exercises can include sit-to-stand from a chair, step-ups, wall push-ups, resistance bands and weight machines. Loads should be challenging enough that the last few repetitions feel hard, and increased gradually as strength improves.

Does nutrition matter?

Adequate protein and overall energy intake support muscle building, especially when combined with exercise. Many older adults eat less protein than they need, particularly when appetite is poor or during illness.

Including a source of protein at each meal, such as eggs, dairy, fish, meat, beans or lentils, and discussing vitamin D levels and any unintended weight loss with a doctor can help. People with kidney disease should seek advice before increasing protein intake.

How can I start safely?

Start with light resistance and focus on correct technique. Supervised sessions with a physiotherapist or trained instructor are helpful for people who are frail, have had falls or have other health conditions.

Combining strength work with balance training and walking gives broader benefits for independence and falls prevention.

What are simple strength exercises to try at home?

Sit-to-stand from a sturdy chair, wall push-ups, heel raises holding a kitchen counter, step-ups on the bottom stair with a rail, and seated knee extensions with an ankle weight are simple options. Performing each exercise slowly and with control, for several repetitions, is a common starting point.

Increasing the number of repetitions, slowing the movement further, or adding light weights or resistance bands makes exercises harder as strength improves. Anyone with dizziness, chest pain or recent falls should seek advice before starting.

When should muscle weakness be checked by a doctor?

Seek assessment for weakness that develops quickly, affects one side of the body, is accompanied by muscle pain, weight loss, difficulty swallowing or breathing, or follows starting a new medicine.

Frequent falls, difficulty rising from a chair or a noticeable decline in walking speed are good reasons to ask for a strength and falls assessment.

Frequently asked questions