Muscle loss after 70 isn't just ageing

Muscle mass and strength decline with age, faster after 70, and faster again after any illness or period of bed rest. It has a name, sarcopenia, which makes it a condition rather than a fact of life. The Australian movement guidelines for people 65 and over are built around holding it off.

It responds to training at any age. Rest and waiting do not help it.

How would you know it’s happening?

It shows up in function long before it shows up on a scale. In an elderly parent, the early signs are ordinary things getting harder:

• Pushing up with both arms to stand from a chair
• Taking the stairs one at a time, leading with the same leg
• Struggling with a full kettle, or a shopping bag she used to manage
• Walking more slowly, or stopping partway along a familiar route
• Feeling unsteady on uneven ground, and so avoiding it

Doing less protects her from a fall today and costs her the strength that would have prevented one next year.

Can it be reversed?

A good deal of it, yes. Muscle remains responsive to progressive resistance training into the eighties and nineties. What it will not respond to is repetition without progression — the same light exercises, at the same effort, for months. Muscle adapts to a demand it has not already met.

What do the guidelines actually ask for?

The Australian Government’s physical activity guidelines for people 65 and over are specific:

• Moderate to vigorous activity for 30 minutes or more on most days
• Muscle-strengthening activities on 2 or more days per week
• Functional activities targeting mobility, balance and coordination on 3 or more days per week
• Several hours of light activity daily, and less sitting

Put that against a calendar. Strength twice a week and balance three times is four or five days of activity, and a weekly physiotherapy visit is one of them.

So what is the visit for?

To make the other days count. A physiotherapy visit sets the load, checks the technique, progresses what has become easy, and leaves something specific to do before the next one. The visit is where the program changes, and the rest of the week is where the strength is built.

Progressing what has become easy means knowing what was hard last month, which means the same physiotherapist each visit. Someone new starts her at the weight she started at in March.

Which is why a home program nobody follows up on is a budget spent on nothing, and why the exercises she was given two years ago are probably no longer doing anything.

Where to start

• Count the chair. How many times can she stand from a dining chair in thirty seconds without using her arms? It is a rough measure, and it is the one that tracks.
• Protein matters too. Older adults need more of it than they often eat, and training without it works less well. Worth raising with the GP.
• Don’t do balance work unsupervised on very weak legs. The best-evidenced falls programs train strength and balance together from the start, but they do it with someone there.
• Expect the exercises to get harder over time. If they have not changed in months, they have stopped adding anything.

Four or five days a week is not something most people reach on their own. That is what the home program is for, and it is the part most services hand over once and never mention again.

If she has been getting unsteady, the two-minute falls-risk check covers the screening questions, and why an elderly parent keeps falling goes through the other causes.