Peter A. McCullough, MD: Exercise is very important. The average patient thinks about exercise in terms of aerobic exercise, getting out and moving, walking, jogging, bicycling, and going to a fitness center. But when we talk about lean muscle mass, we’re really talking about strength activities. Strength activities involve lifting weights, or using resistant bands, or doing exercises against one’s own body weight. And here, we’re interested in building the large muscle groups. The large muscle groups are the arms and the shoulders, as well as the gluteus and quadriceps muscles. But we’re also interested in building the muscle mass of the core, or truncal musculature.
If the body has a strong muscle mass, it affords many benefits to patients, including a nutritional reservoir for amino acids that are used in immunity and in organ function—particularly the liver is heavily benefited—and this overall depot that we have in the skeletal muscles. But there are some practical things for some patients to enjoy, including better locomotion, better quality of life, and resistance to fracture when there’s a fall. So, there’s many benefits of having a larger muscle mass. And although it’s not thought about in most elderly patients, it’s important to actually lift weights and be a strength trainer as we get older.
I think the special considerations for patients who have sarcopenia and who are going to embark on a nutritional and exercise program to improve it include, really, what’s the base illness. If the base illness is, for instance, forms of cancer or forms of other illnesses that lead to comorbidities like anemia, we have to make sure the anemia is addressed. And if iron supplementation is needed, that’s given. We have to understand whether or not heart failure is present because heart failure is oftentimes a great limiter in terms of the ability to do aerobic and strength activity. And then we have to consider practical things, like the presence of osteoporosis or fractures, the presence of neurodegenerative disease, and gait and balance. All of these things have to be considered. So, our allied health professionals in the areas of physical therapy, occupational therapy, rehabilitation medicine, physiatry, these are all very important specialties to really help us perform a detailed evaluation of a patient and to give a solid plan in terms of exercise, as well as a solid plan lead by a dietician in terms of nutrition.
Nicolaas Deutz, MD, PhD: Of course, if somebody is starting to lose muscle mass, that is usually related to either that they reduced their protein intake and/or that they are doing less exercise. So, in the daily practice, if people are not doing a lot of exercise, they will start feeling weaker and weaker. That will limit the exercise even more and that makes them weaker. Muscle mass loss has a major implication of the daily quality of living of older adults. And I think we all should really try to keep older adults active and moving around, and have a higher protein intake that they are normally doing.