This article explains how ageing is related to sarcopenia and frailty, and what we can do to prevent or manage it and age well.
Most people who are inactive and above the age of 70 may start to feel slowed up, low energy or weak. In Singapore, studies show about 1 in 2 seniors (above 65 years old) are in a state of frailty or pre-frailty.
What is Frailty and Sarcopenia?
Frailty is a state of vulnerability to minor stressors due to a lack of reserve or resilience. Think of it like a car that’s been used for many years: it might still work, but it needs more care and attention because the parts are worn out, and it doesn’t run as smoothly as it used to. Those with frailty may need extra help or support to stay healthy and safe.
A urine infection or flu for a healthy robust individual may mean feeling slightly weaker and low in energy but still being able to care for oneself. For someone with frailty, usual walking may already be slow, sometimes requiring the use of a walking aid. A minor illness may cause the body to feel even weaker, resulting in increased difficulty standing up and requiring physical help to move around. If the individual is not careful or does not have help, he may fall and break a bone, this may cause a long hospitalisation stay and possibly a downward spiral towards disability and death. Frailty also makes it harder for someone to recover, often taking a longer period and sometimes never making it back to baseline function.
What causes frailty?
Local studies show that malnutrition, lack of exercise and chronic disease are the main reasons why people develop frailty.
Sarcopenia, or the loss of muscle mass, strength and function is a central factor in the development of frailty. Sarcopenia undermines the body’s physical reserves, which are essential for maintaining independence and resilience against health challenges.
To a certain extent, sarcopenia is natural process which occurs with ageing. Typically, our body has the most muscle mass during our 20’s, after which muscle mass gradually declines by about 3-5% each decade. The rate of muscle loss accelerates at about 70 years of age, around the time where most people exhibit signs of frailty.
The pictures below show thigh muscle cross-section views of two individuals, the left belonging to a young healthy person, the right, belonging to an older person who is sarcopenic and has very little muscle.
How do I know if I have Sarcopenia?
There are several simple tests which may point to a likelihood of sarcopenia.
One example which looks at muscle physical performance would be the 5 times sit to stand test.
Place a steady chair against the wall. Have a family member or friend measure the time taken for you to complete 5 sit to stand’s as quickly as you can. A duration of more than 12 seconds points towards poor physical performance and possible sarcopenia.
If you have access to a handgrip dynamometer or if your health provider has done that with you, a maximum grip strength of <28kg for males and <18kg for females points towards poor strength.
Poor muscle strength or poor physical performance indicates possible sarcopenia where lifestyle interventions should commence.
Further testing and diagnosis are usually not necessary and are usually only used for research purposes.
How can I prevent or manage Sarcopenia and Frailty?
Studies show that maintaining a healthy balanced diet with adequate protein intake and engaging in regular resistance exercises gives us the best chance at preventing and reversing sarcopenia and frailty.
What is a healthy balanced diet with adequate protein intake?
The Healthy Plate visual, developed by the Health Promotion Board, is one way to check if we are eating a balanced meal.
- Fill one Quarter plate with wholegrain carbohydrates such as brown rice or wholemeal bread
- Fill one Quarter plate with good sources of protein such as lean meat, fish, eggs or tofu
- Fill Half plate with fruit and vegetables.
Protein is crucial for preventing sarcopenia (muscle loss) and frailty because it helps build and repair muscles, which naturally decline with age. Protein also helps slow muscle breakdown and supports metabolism, keeping the body active and healthy. Adequate protein helps maintain muscle mass, strength, and overall well-being as we age.
The below infographic shows some examples of a protein serving. Seniors should aim for at least three servings of proteins each day.
Exactly how much protein should I consume a day?
It is generally recommended for a senior to consume protein equivalent to their body weight in grammes each day.
For example, if Mr Tan is 60kg, he should consume at least 60g of protein each day. A sample meal plan for Mr Tan could be as below.
| Meal | Protein source | Protein (g) |
| Breakfast | 1 glass low fat high calcium milk (250ml) | 8 |
| 2 whole eggs | 14 | |
| Lunch | 1 palm sized piece of fish, chicken or lean meat (90g) | 18-24 |
| Tea break | 1 glass low fat high calcium milk (250ml) | 8 |
| Dinner | 2 small block bean curd (170g) | 18 |
| Total | 66-72 | |
Disclaimer- Restricted protein intake may be recommended for some health conditions such as chronic kidney disease. Seek advice from your doctor or dietitian for personalised recommendations.
What are Resistance Exercises and how often to perform?
Resistance exercise is a type of exercise which focuses on improving strength. This involves pushing, pulling high loads for short periods. Resistance loads may be dumb bells, resistance bands, gym machines or even your own body weight.
We should aim to do 8-10 exercises targeting our major muscle groups around our arms, chest, stomach, legs and back. The same action should be repeated 8-15 times with good posture. The last repetition should be difficult to complete due to fatigue. Complete 2-3 sets within each session.
If you are just starting to exercise, you should start with an effort of about 5-6 upon 10, with 0 being no effort and 10 being the hardest effort possible. The load should be increased over time such that it feels like an 8 out of 10.
Strengthening exercises should be performed at least 2x/week. Some muscle soreness is expected the day after if the muscles are adequately challenged. Leave at least one rest day between each exercise session.
Exercises should be pain free and should not exacerbate any joint issues. If they do, please consult our physiotherapist for more personalised recommendations.
What are some examples of Resistance Exercises?
If you are already having difficulty standing up from chairs or from the floor, sit to stand may be a simple exercise to do at home.
Place a steady chair against a wall for safety. The chair height should be low enough for you to feel some effort when getting up but not too low that you need to push off excessively with your hands.
Sit with your buttocks halfway out and your ankles slightly behind your knees, feet hip width apart. Lean forward and push through your hips to stand up straight. To sit, lean forward slightly, pushing your hips slightly back, aiming for the middle of the chair, lower your buttock down with control. Perform as many times as you can.
If you were able to complete more than 20 reps, progress to a lower chair for a better challenge.
If you were able to complete 8-15 reps with the last repetition being difficult, this exercise is perfect for you!
How soon should I feel stronger?
Muscle adaptations should occur within 1-2 weeks of practice. Actual strength gains may take about 4-6 weeks. Exercises should be progressed every 2 weeks or so. Progression may be by
- Increasing reps
- Increasing difficulty of exercise eg. Using a lower chair or performing the same sit to stand with one leg supporting instead of two legs
- Adding weights eg. Carrying dumbbells close to your chest
- Performing more sets or having more regular training sessions each week
What should I do if I want more personalised advice?
Where possible, it is best to target sarcopenia or muscle weakness early before it progresses to frailty.
Support from a physiotherapist may be necessary to maximise your strength gains and regain your mobility and independence after an acute medical event.
Contact us to arrange a home visit and our physiotherapist will be happy to help!
THE GERI PHYSIO 