Maintaining muscle mass and balance becomes critical in preventing falls and ensuring a high quality of life as we age. In 2021, there were 38,742 fall-related deaths among adults 65 and older, which translates to about 106 deaths per day from falls in this age group (1). Falls are creeping up to challenge the traditional central 4 causes of death; Cardiovascular, Cancer, Metabolic and Neurodegenerative as the cause of death in the US.
Aging is accompanied by many challenges, such as sarcopenia—a progressive loss of muscle mass and strength—and declining balance, both of which increase the risk of falls and adverse health outcomes. In this blog, we explore the role of resistance training, nutrition, and balance assessment in combating these challenges and minimizing this stealthy mortality threat.
The Balance Factor: Using the 10-Second One-Legged Stance (10-s OLS)
Balance often diminishes after age 50, significantly increasing fall risks. The 10-s one-legged stand (OLS) is a simple, practical test for assessing individuals' balance and overall health. Interestingly, participants who fail to complete this test have significantly higher mortality rates over seven years compared to those who succeed (2).
Findings from the British Journal of Sports Medicine revealed that out of 1,702 individuals between the ages of 51-75, 20.4% of participants failed the test (classified as "NO"), and mortality rates were 17.5% for "NO" individuals versus only 4.6% for "YES" participants. This test showed significant effectiveness in mortality risk prediction and insights into overall health.
What does this have to do with what we're talking about today? Well, unlike other health and mortality predictors, we can naturally improve on balance with practice. And what is a significant component of our balance? Skeletal Muscle!
Understanding Sarcopenia
Sarcopenia is characterized by generalized and progressive loss of skeletal muscle mass and function and affects up to 9% of older adults in community healthcare settings (3). Diagnosis typically combines measures of low muscle mass with diminished strength or physical performance (3). Experts report we don't lose muscle mass linearly but rather in a step-down fashion when we are temporarily inactive from injury or sickness.
Luckily, there are multiple strategies to address this that one can take into their own hands. Non-pharmacological approaches like resistance training (RT) are the gold standard for treatment, with significant evidence supporting their effectiveness. On top of that, adequate nutrition, especially sufficient protein, vitamin D, and antioxidant intake are equally important (3). For extreme cases, there are some potential pharmacological options; although no FDA-approved drugs for sarcopenia exist, potential therapeutic agents are under study, including anabolic steroids and myostatin inhibitors (3).
The Power of Resistance Training
Resistance training is a cornerstone for combating muscle loss, enhancing balance, and improving physical function. Research shows inactive adults lose 3–8% of muscle mass per decade, leading to metabolic declines and increased fat accumulation (4).
RT counteracts these effects by boosting lean weight, metabolic rate, and functional independence (4). Consistent RT has been shown to improve muscle and bone health—in just 10 weeks, RT can increase lean muscle mass by 1.4 kg and improve bone density by 1–3% (4). It also enhances metabolic and cardiovascular health, reducing visceral fat, HbA1c, and insulin resistance while improving cholesterol profiles and lowering blood pressure (4).
But it doesn't stop there; RT also boosts mental health, relieves pain, enhances cognitive function, reduces back pain, and alleviates arthritis symptoms (4). All of these provide a strong argument for including RT in your daily routine, but how should we be training, and where should you start?
Resistance Training Guidelines for Aging Adults
First, some essential variables are highlighted in RT research for optimizing your outcome: frequency, intensity, and volume (5). Starting with frequency, even minimal time commitment can be practical in RT. Brief RT sessions, such as 13 minutes three times per week, can yield strength and endurance gains similar to a more substantial time commitment (6). This shows that it's not the length of your session that matters; it's the consistency and frequency that yield great results.
The second two variables go hand-in-hand with intensity, AKA load, being how heavy the weight you're moving, and volume being how many sets you're doing of each exercise (5). What sets these two apart is that while frequency is non-negotiable, intensity and volume are very much customizable based on one's ability, experience, and personal goals.
Some examples of the "personal goals" in question are hypertrophy vs strength training. Hypertrophy is the goal of increasing muscle size or building muscle and can be fulfilled with lower weight and higher rep range (7). Strength training is just what it says: increasing strength and maximizing performance. It requires a heavier weight with a lower rep range (7).
It is important to not jump into either of these without adequate guidance, the worst thing you can do is do too much too fast and injure yourself. Discussing with a doctor or qualified trainer is a great place to start; they can provide a tailored program specifically for you and help you learn the proper exercise techniques.
Overall, the best tips to remember are to only use the heaviest weight that allows you to remain in good form, enable enough recovery time between sets, and focus on training that matches your goals (7).
In a mini-review, "Strength training in the elderly: A Useful tool against sarcopenia," some exercises were highlighted for different goals that could provide insight into where to start your exercise journey (8).
Balance Training: Activities such as tai chi or yoga help improve proprioception and coordination.
Core Strengthening: Focus on exercises like planks and bridges to enhance stability and posture.
Lower Body Strengthening: To build muscle in the legs and hips, incorporate squats, step-ups, toe stands, and leg presses.
Flexibility and Stretching: Ensure muscles remain pliable to allow for a better range of motion and quicker recovery from stumbles.
Unfortunately, even the most rigorous resistance training cannot compensate for an improper and unbalanced diet. Protein intake is the key to quick and lasting exercise results.
Nutrition: The Perfect Companion to RT
Nutrition plays an essential role in maintaining muscle health. Sadly, many older adults fail to meet the recommended protein intake of 0.36 grams per pound of body weight, limiting their ability to build and maintain muscle (9).
Pairing RT with protein-rich diets improves muscle mass and strength (9). Supplements such as essential amino acids (essential amino acids, or EAA, the AA that the body needs to get from food), creatine, fish oil, and vitamin D should be considered to further support muscle health (10). In fact, protein is the foundation of muscle health, providing the vital components for muscle tissue and driving muscle protein synthesis, which repairs and strengthens muscles after exercise (10).
Experts recommend 0.8 grams of protein per kilogram of body weight for basic nutritional needs, but for building muscle, 1.6 to 2.2 grams of protein per kilogram is necessary (11). Animal proteins like chicken breast, beef, eggs, and fish like salmon are particularly effective due to their rich amino acid profiles (11). For those who prefer plant-based diets, options like lentils, tofu, and quinoa can suffice, though combining sources may be necessary for optimal results (11).
For some added benefits, supplements such as essential amino acids (EAA), creatine, fish oil, and vitamin D should be considered to further support muscle health (10). For supplement recommendations, you can check out the products under the website's “Favorites” tab.
Long-Term Benefits: Fall Prevention and Longevity
Regular physical activity, especially RT, contributes significantly to healthy aging. Midlife predictors such as high grip strength, walking speed, chair stand counts, one-foot balance, and daily physical activity all correlate with increased longevity, with adults with greater grip strength and physically active lifestyles being more likely to reach 100 years old (12). Including balanced diets rich in protein and essential nutrients further bolsters the capacity for long-term health and vitality (11).
Take Action: Stay Active, Eat Well, and Balance
Maintaining muscle mass and balance through resistance training, proper nutrition, and routine assessments can transform aging. To get started, incorporate strength and balance exercises into your routine. Monitor your protein intake to ensure it meets your body's needs. Use tools like the 10-s OLS to track your physical health and risks. Enhance your diet by including high-quality protein sources and supplementing where necessary for added muscle health. With these strategies, you can reduce fall risks, improve health, and enjoy a fulfilling, active life.
Stay strong and curious, and be your own best doctor,
Chuck Meakin MD
Resources to get started:
Dr. Meakin’s health videos: https://meakinmetaboliccare.com/metabolic-health-videos/
Simple stretchy band exercises: https://youtu.be/UMBFSVMMRx0
Fullscript Weight Gain Supplements: https://us.fullscript.com/welcome/meakinmetaboliccare
Digest Gold
Collagen Peptides Unflavored
Klean Creatine
Perfect Amino Tablet
Beef Liver Capsules
Meakin Metabolic Care: https://meakinmetaboliccare.com/
Heal Navigator: https://healnavigator.com/
Disclaimer: This information is not meant as direct medical advice. Readers should always review options with their local medical team. This is the sole opinion of Dr. Meakin based on a literature review at the time of the blog and may change as new evidence evolves.
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Citations
Gorina Y, Hoyert D, Lentzner H, Goulding M. Trends in causes of death among older persons in the United States. Aging Trends, No 6. Hyattsville, Maryland: National Center for Health Statistics. 2006.
Araujo CG, de Souza e Silva CG, Laukkanen JA, et alSuccessful 10-second one-legged stance performance predicts survival in middle-aged and older individualsBritish Journal of Sports Medicine 2022;56:975-980.
Cho, M. R., Lee, S., & Song, S. K. (2022). A Review of Sarcopenia Pathophysiology, Diagnosis, Treatment and Future Direction. Journal of Korean Medical Science, 37(18), e146. https://doi.org/10.3346/jkms.2022.37.e146
Westcott W. L. (2012). Resistance training is medicine: effects of strength training on health. Current sports medicine reports, 11(4), 209–216. https://doi.org/10.1249/JSR.0b013e31825dabb8
Krzysztofik, M., Wilk, M., Wojdała, G., & Gołaś, A. (2019). Maximizing Muscle Hypertrophy: A Systematic Review of Advanced Resistance Training Techniques and Methods. International journal of environmental research and public health, 16(24), 4897
Schoenfeld, B. J., Contreras, B., Krieger, J., Grgic, J., Delcastillo, K., Belliard, R., & Alto, A. (2019). Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine and science in sports and exercise, 51(1), 94–103. https://doi.org/10.1249/MSS.0000000000001764
Frothingham, S., & Meacham, J. (2024, June 11). Hypertrophy training vs. strength training: Pros and cons of each. Healthline. https://www.healthline.com/health/exercise-fitness/hypertrophy-vs-strength
Cannataro, R., Cione, E., Bonilla, D. A., Cerullo, G., Angelini, F., & D’Antona, G. (2022, June 27). Strength training in elderly: An useful tool against sarcopenia. Frontiers. https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2022.950949/full
Restivo, J. (2024, August 14). Muscle loss and protein needs in older adults. Harvard Health. https://www.health.harvard.edu/staying-healthy/muscle-loss-and-protein-needs-in-older-adults
Malec, A. (2024, September 3). Best supplements to prevent age-related muscle loss: Combat Sarcopenia. ConsumerLab.com. https://www.consumerlab.com/answers/best-protein-to-gain-and-maintain-muscle/best-protein-for-muscle/
Tsai, S. (2024, September 11). 6 proven nutritional strategies for building muscle. The Epoch Times. https://www.theepochtimes.com/health/power-up-your-plate-6-proven-nutritional-strategies-for-building-muscle-5714934?welcomeuser=1
Rantanen, T., Masaki, K., He, Q., Ross, G. W., Willcox, B. J., & White, L. (2012). Midlife muscle strength and human longevity up to age 100 years: a 44-year prospective study among a decedent cohort. Age (Dordrecht, Netherlands), 34(3), 563–570. https://doi.org/10.1007/s11357-011-9256-y
Thanks again for making the effort to provide this information. This is another good one that applies to so many people!