Daisyworld Media Network – Bengaluru
Bengaluru, February 19: Most people are worried about weight gain as they age. Very few people think about muscle loss. Yet sarcopenia – the gradual, involuntary loss of muscle and strength with age – is both common and often overlooked.
According to Dr Pradeep Kochippan, consultant orthopedics at Apollo Hospital, Bannerghatta Road, Bengaluru, Indians – especially South Indians – are genetically predisposed to have lower baseline muscle mass than many Western populations. With a sedentary lifestyle, desk-bound jobs and minimal physical stress, this increases the risk of age-related muscle decline.
Modern lifestyle requires very little physical effort. Groceries are delivered, doors open automatically, and most of the work happens on screens. Over time, a decrease in resistance-based activity – especially involving the upper limbs – is what doctors call disuse atrophy.
Biologically, sarcopenia primarily affects type 2 (fast-twitch) muscle fibers, which are responsible for strength and quick movement. These fibers help you support yourself during falls or while lifting heavy objects. Type 1 (slow-twitch) fibers, which support endurance, are relatively less affected. This explains why many elderly people can manage slow, sustained activities but struggle with sudden increases in strength.
Dr. Kochippan explains that fitness training should be tailored to individual goals:
• Strength training: focuses on increasing maximum force, usually using heavy weights with low repetitions (e.g., squats, deadlifts, bench presses).
• Endurance training: Sustained activity for long periods using light resistance (for example, rowing, cycling).
• Strength training: Combines force and speed (e.g., plyometrics, medicine ball throws).
• Hypertrophy training: Increasing muscle size by lifting weights that fatigue the muscles.
• Functional training: mimics everyday activities, improving coordination and balance.
To prevent age-related muscle loss, he emphasizes that there can be no compromise on strength training.
Muscle loss accelerates after 40, especially affecting type 2 fibers. Without intervention, decline becomes almost inevitable.
Adults over 40 should ideally include at least 20 minutes of strength and power exercises several times a week. However, the number of senior adults in gyms remains low, partly due to a lack of instructors experienced in safely guiding older individuals.
A structured approach is important. Doctors often assess 1RM (one-repetition maximum), the maximum weight a person can lift once. Strength training typically involves working at 80% or more of 1RM with low repetitions. Power training uses light weights – about 30-50% of 1RM – performed at high speed.
Strength improves muscle mass; Power improves speed. With endurance and functional training, they create a balanced routine.
Muscle health is closely related to bone health. Bones respond to the stress placed on them by muscles. Without strengthening muscles, bone density can decrease.
“If a DEXA scan shows low bone density, exercise becomes even more important. But sometimes, exercise alone is not enough,” Dr. Kochippan said.
In advanced cases, medications may be required. These may include anabolic agents that stimulate muscle response when combined with exercise. It is also important to optimize vitamin D and B12 levels. Doctors can evaluate parathyroid hormone levels and prescribe treatment to improve bone density.
Newer drugs such as romosozumab (marketed as Evenity) target specific pathways involved in bone loss and are given monthly under supervision. Other treatments include injectable therapies such as ibandronic acid and denosumab, which help maintain or improve bone mass.
Traditionally, bone loss was thought to be largely irreversible. Today, with a combination of targeted exercise and medical therapy, progression can often be slowed—and in some cases, bone density improved.
Muscle and bone health is not a cosmetic concern. They determine independence, balance, mobility, and the ability to recover from illness or injury.
Strong muscles support strong bones. Strong bones enable one to lead an active life. While aging is inevitable, muscle loss doesn’t have to be – especially with timely strength training, proper nutrition and medical guidance when needed.
