Muscle loss after 70 isn't just ageing

It has a name — sarcopenia— and that matters, because naming it makes it a condition rather than a fact of life. Muscle mass and strength decline with age, faster after 70, and faster again after any period of illness or bed rest.

The useful part: it responds to training at any age. Not to rest, and not to waiting.

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

That last one is the trap. 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. If the demand never increases, neither does the strength.

That is the difference between a program that is running and a program that is merely continuing.

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

Read that again with a calendar in mind. Strength twice a week, balance three times a week. No weekly physiotherapy visit can deliver that on its own. One visit is one day; the guideline asks for four or five.

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. The rest of the week is where the strength is actually built.

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.
• Do not start with balance alone. Balance work on weak legs is a fall waiting to happen. Strength first, then balance, then both.
• Expect it to get harder. If it does not, it has stopped working.

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.