Maintaining Muscle Mass - Why It Matters

[Music] You're listening to Stronger Through The Ages, a podcast about being well, aging better, no matter your age, level of disease or disability. Aging slows you down unless you fight back. With just two evidence-based resistance training sessions a week, you can build muscle, strength and balance, reduce your symptoms of disease, prolong your independence, and increase your mobility. To keep you ready and engaged in life, resistance training remains underutilised and under-prescribed. We're here to unravel why and explore the evidence, with the aim of getting more people involved, because the secret to staying sharp, steady, and strong isn't gentle exercise, it's pushing your limits. [Music] In today's episode, we're going to explore why muscle matters as we age. Muscle is the key to staying strong, independent and resilient as you age. It supports balance, mobility, and everyday function, reduces the risk of falls and frailty, and even impacts disease. In late- to-life building muscle and maintaining muscle isn't just about fitness, it's about everything. So, Justin, let's get started. Your physiology is far better than mine. What happens as we age that we lose muscle? There's a host of changes that occur. Probably the simplest, Tim, is that we just lose the amount of muscle that we have as a younger adult. In addition, the quality of the muscle, that is how well that muscle, per unit of area, can produce force, reduces, and we also have to think of the nervous system as well, because ultimately the nervous system controls the muscles. There's a host of changes within the brain, the spinal cord, and a range of other areas that also, in essence, just mean that the muscle that we have is less effective at producing force and allowing us to do activities of daily living, be exporting activities, plan for grandkids, or look after your house. So, it's not just as simple as use it or lose it. There is a lot of complicated things going. I know from my time in my PhD, all those years and moons ago, the discussion about the type 1 and the type 2 fibres, the genetic susceptibility to more type 1s and type 2s, blah, blah, blah. But the actual ability to rejuvenate those is particularly a type 2s, was really hard for older adults, particularly in my PhD study. That's correct. I didn't talk about the type 1, type 2 muscle fibres, but those stronger, type 2 muscle fibres, those are the ones that typically have the greatest loss as we age. And we think that's potentially related to the higher intensity activities that we often do as children and young adults, lifting heavy things, jumping, sprinting, throwing, are those activities that are most reduced as we age. And those high intensity, strong type 2 fibres, they lose that activity. And hence, the body just goes, "Well, you're not using me. I'm just going to disappear. I'm not needed here." So, in essence, the aging process does that to some extent, but it's also, in addition to how we become so less active in those higher intensity activities as we age. Yeah, like the power stuff, I think, is very poorly acknowledged. And obviously, in my PhD looked at responsive muscle strength training to muscle power training and how that changed with six months' worth of twice-weekly training. And explaining muscle power to people was actually quite complex. The most basic analogy I could come up with was it's that shortening and lengthening of muscles that get you to standing, get you to walking. And particularly when we start to talk about balance, get you to balance successfully. The loss of those type 2 fibres really impacts that muscle power side of things, which makes that lengthening and shortening, which makes all those sort of ballistic dynamic movements really hard for people to do. Exactly. So muscle power is, in essence, the ability to produce strength with speed. So, as we age, we're going to lose both strength and speed. So, if we've lost 50% of our maximum strength, if we've lost 50% of our maximum speed, multiply those two things together, we now have 25% of our initial muscle power. And that really large loss of muscle power is potentially even more relevance of function than losses of strength or muscle mass per se. So, we've talked about strength and we've talked about power. Let's start to dig into how it impacts the rest of our body. Like I've got this great slide that often present to people, which goes strength power, aerobic capacity, metabolic capacity, all these different things that we take for granted that muscle actually takes. And I reckon we leave bone to last, because the lack of understanding of the correlation between bone and muscle size and muscle use is absolutely phenomenal. So, again, using your powers of physiology, let's start to have a look at the aerobic system and the metabolic system. So, the aerobic system, like other systems, will typically decline of age, that may be related again to some of the losses of activity. And particularly for the older person who might have reduced leg strength. If you consider getting out of the chair difficult, walking upstairs or a hill is difficult, you're out of breath, the biggest limitation can potentially be that lack of leg strength that you don't have the capacity to walk, cycle, run, all those common aerobic activities we do when we're younger, your leg strength is just insufficient to do that for any period of time. So, as a consequence of not doing prolonged physical activity, the aerobic system then declines markedly as well. So, that muscle strength and muscle mass, particularly through the lower body muscles, is that safety net for maintaining sufficient aerobic function that you can go walking anywhere in the community. Yeah, and I always used to tell people as well, like, you know, your heart's a big muscle, the muscles that control your lungs are also working hard, you die frame and you're what are they called, intercostals. And declining muscle mass, we often pocket it into relation for strength and power, as we just talked about, but it's also affecting those muscles, isn't it? So, when your heart needs to pump harder because you are walking up that hill and your lungs need to work harder as well to get oxygen to those working muscles, when the muscles, all those muscles that are controlling your aerobic capacity and getting that oxygenated blood to the working muscles, when they're compromised, your aerobic system is compromised. Exactly. And even though lots of research and focuses on the lower body muscles, that's exactly right. You're not going to be losing 50% of your quadricep muscle mass and strength and still have fully functional heart, lungs and upper body muscles. All those things are going to be related in their level of decline. And then you met a bollic control as well, because muscle is turning over energy all the time. So, I always used to tell people, smaller muscles, you consume less energy, bigger muscles, you can consume more energy. So, it's not really going to correlate to whether you've got your summer beach body, but it also does very much relate to weight control and weight gain in late alive. Exactly. And again, if you know big muscular athletes, they can eat a prodigious amount of food just because they're burning so much energy every day based on their muscle mass and their training. So, that metabolic benefit of exercise is huge. We know that type 2 diabetes is progressively becoming more and more common in middle and older age. And exercise, including resistance training, has a profound effect on things such as reducing that sort of rate of type 2 diabetes, improves initial and control, improves triglycerides or the fats in the blood and your cholesterol markers as well. So, those levels of exercise benefits can then have profound effect on a range of cardiovascular sort of health conditions as well. And so, let's talk about bone because obviously osteoporosis got a ton of funding before frailty in sarcopenia got a ton of funding. But the direct correlation between how well and how often you use your muscles and how big your bone is just seems to go unnoticed and unscribable. It is an interesting, I suppose, lack of understanding of that muscle and bone connection. So, when our muscles contract, be it in walking, lifting weights, throwing etc, the muscles via the tendon pull on the bone. So, that stress on the bone is related to the amounts and the intensity of those muscle contractions. And we then are in things like weight bearing. So, walking to a point, lifting weights, landing from sort of jumps, all those things positively impact our bone health as well. So, if we've got a reduced level of muscle mass, it's very likely, we're also going to reduce level of bone. And again, at a certain level, we call that osteoporosis. Yeah, we're my PhD again. We looked at bone mass through dexascans. And in six and 12 months, we didn't see any further declines, but we didn't see any amazing increases either for people who were osteoporosis and osteopenic. That's the one that's in between, isn't it? Yeah. And that's bone remodeling. That's the speed. It's really slow. We It is. So probably the biggest things people see when they do resistance training will be improved strength muscle muscle then be noticeable a little bit later. So maybe a couple of months and bone maybe six months or so But again the bone changes are less profound for some reason some research now indicates that the inclusion of some jumping and landing And these landings don't have to be necessarily from very high just five or 10 centimeter drops potentially to begin with That impact loading with resistance training is the best physical stimulus to improve bone health markers Why do you reckon that is? Physiology of bone seems to be that that rate of loading so that sort of if we think of That very quick response to the bone that stimuli Seems to be perhaps better than just resistance training like large loads on its own. So that combination some of the Work from Belinda Beck in her a narrow program. That's a Valwin Australia and other countries around the world now Which incorporates heavy lifting and some impact loading from those jumps Seems to be the best exercise combination of the research done to date to improve bone markers in older people of osteoporosis Could it also be the co-contraction? Like you know, you think about it when you're doing that drop jump Yeah, you're turning your quads and your hamstrings on one's more dominant to stop your crashing into the ground And with that co-contraction instead of having that that force that's just pushing in one direction on the bone like you would with resistance training You're actually getting that dual force through the bone. Yeah, I think that could be a part that those forces as you mentioned are going to be multi-directional And perhaps that multi-directional loading is even a great stimulus The actual physiology of why will still be I suppose debated for many years to come But ultimately those types of exercise Combinations have been shown to be just as or even more effective than our common pharmacological treatments for osteoporosis Hmm, I remember a few years ago they have one of those Vibration platforms, you know, not the one that you see down at the Westfield But this thing was huge. They had to keep it in the basement because it vibrated the whole building so much when it was in action And if I remember correctly the guy who was doing research with that thing he did show more Bone stimulated changes than he showed muscle stimulated changes using it as a resistance training platform That's a great point. I was actually just thinking that towards the end of our last conversation there as well Tim So I'm not as up to date with that literature But there was some good benefits to that and I think similar to the Impact loading from a jump That vibration stimulus, which is sort of oscillatory It's not sort of as Maintained for a period of time like resistance training That is perhaps a part of that stimuli that's useful to bone as well So but you're exactly correct. It's just not a vibration platform. You might find it a beauty salon So before we move to far away from the physiology and start to talk about what we're going to talk about the answer getting people in the gym What can people do across their life spans to actually slow down that loss of muscle and loss of strength? It's probably two messages there and this is somewhat similar to the osteoporosis health messages as well At a younger age like even in childhood adolescence do physical activities that are intense that require muscles and bones to contract so If you built up that muscle and bone mass in year teens 20s 30s and 40s Whatever that natural decline that will still exist is going to be less pronounced as you hit your 70s and 80s Obviously not everyone has done that So if you're a 50 or six-year-old person seeing they go hmm, I've missed that boat You can still definitely start and while you won't have that level at this point that some of your More exercising friends and family members may have done you can still massively increase your strength Improve your muscle and bone mass at least in comparison to those who aren't exercising and reap a range of Profile benefits of that exercise Stronger through the ages is proudly sponsored by age-fit solutions Helping organizations transform the lives of those they care for whether you're running an allied health them on the service or looking to start one age-fit solutions provides expert driven programs and practical solutions to build a sustainable Evidence-based offering the delivers real benefits for both your organization and your clients And I want to dig into it too much because you know, I'm not a dietician. Shouldn't be giving diatetics advice but Protein I think that's a big unsung hero for a lot of older adults as well that you don't eat enough And it's actually quite high and I think it's getting higher isn't it like what are we looking at at the moment 1.2 grams per kilogram of body weight per day and even more If you're exercising or you've got some level of metabolic syndrome or sickness or something like that So it's actually a lot of protein for potentially someone who's not eating even big meals anymore But yeah, look I've always been a big fan of protein and you know if I had to choose between staked and salad I know where my heart lies But what do you know about the protein side of things as are a preventative to that muscle loss? So again, I'll preface this I'm not a dietician but from reading the literature regarding muscle strength and function in aging Exactly right at least 1.2 grams per kilogram of body weight per day needs to be consumed in protein. So if you are Let's say 60 kilograms 1.2 grams per kilogram is 72 grams of protein per day if you're 100 kilos, it's 120 grams We then need to consider How many grams that is per meal? So if we can eat three main meals and maybe a snack or something So myself I'm close to 90 kilos I'm looking at probably somewhere in the range of 105 grams minimum per day If I was to eat four meals a day which I typically do I'm looking to try to find at least 25 grams of protein in each of those meals And then from there what constitutes my regular eating am I getting close to 25 grams in in those meals? So again breakfast might be two eggs 300 400 mills of milk Which is probably putting me into the low 20 grams already So that's close to that sort of threshold Well, they might add in a bit of protein powder for smoothie or something like that as well Dinner as long as you're eating 100 grams or so of any sort of meat if you do eat meats You're typically going to get at least 15 to 20 grams of protein there as well So little things like just understanding the protein content of certain foods And if you're vegetarian or vegan perhaps consulting a dietitian to get some really good I suppose tips on Maximizing the protein intake as well as some other nutrients that can be a little bit lacking in a vegan diet such as iron or some other things like sink Ensuring that it also fits into the the energy sort of Requiem it so you have as well. Yeah, of course there's tons of supplements available these days for older right? I don't some of them Potentially aren't as protein rich as they promise to be but they're they're better than nothing I remember do we remember we went to that conference and you took home all that protein Guess they didn't want to take it with them Hey, yeah, yeah, you must have looked like the greatest man on an in Australia on the train You would have been given that stuff out. Oh, I do remember that and again if we didn't have our Immussel strength and function wind of animal carry all those tops of protein powder My mom at the time got a few so yeah, it was a well shared around Like some of those supplements can be very complex in what they're actually giving to people Whereas like, you know, you know, I don't know what you take it in when you go to the gym But I just take away protein the isolate and just Straight after my workout and that's is well proven to help maintain and build muscle mass is As some of those other supplements and balance meals out. Yeah, that's two big things for me Wayprotein isolate as you mentioned and creatine monohydrate Which again is now being shown to have um At least some level of evidence if not strong level evidence of improving a host of areas of health and wellbeing Particularly as we get older. So let's come at it from another direction We've talked about what loss looks like and the impact So let's start to talk about building it back up I you know, you were both being part of a ton of resistance studies and I've been part of like translational activities through my recent role with Southern crosscare that Demonstrated that people could rebuild muscle and whether they're rebuilding muscle or not There's definitely with types of exercise that translation to improve strength Improve power that then translates to increases in functional capacity Resistance of falls all that sort of stuff So, you know, are we talking physiologically about just the exact opposite where muscle starts to break down because you're not using it getting smaller and and stuff like that now Under strain it builds up because it needs to reproduce those forces Well ultimately yeah, that's pretty much it like even Arnold Schwarzenegger back in some of the interviews and some of those movies he was involved in the 70s pumping iron Just stated it so well that the training sessions where you stimulate like the muscle, you give it some sort of stimulus that it goes, "Wow, this is more than capable of at the moment." You take the body to a point where it perhaps hasn't been recently. And then with rest and good nutrition, the body builds back up. So every training session acts as that sort of stimulus to the body that goes, "Well, I need to get bigger and stronger." It can be as little as two sessions per week. If you work quite hard in those two sessions per week, particularly after maybe a two to four week period, where you're just starting to get familiar with the program. But after that period of time, start training relatively, relatively hard where additional repetitions are hard to perform. You will then see in that space of perhaps another four weeks, quite profound increases in what you're doing in the gym. And soon after you'll see things in your everyday life that have been challenging for you to do, that you're now able to do again. Yeah, and I think it is quite amazing because the story you've just told is, I think we need to focus as well, that there is an end point for people. I've met a dozen people in my life. A dozen, two dozen, three dozen, hundred, good nose, and how many? Who think that with six months of training, they're going to walk out looking like Arnold Schwarzenegger. And that's one of the negatives that they find with resistance training. But of course, there's no truth to it. You know, you and me are great examples. We train very hard, very regularly, and that sort of stuff. And we can still buy shirts off the rack. So I like that I do carry more muscle than the average Joe. Very, very, very, but for the average Joe, you're not just going to get massive, but you are going to get that effective muscle that you talked about that's going to help carry your weight around, help you stand, help you climb, help you walk, help you mobilize, help you stay on your feet, and then start to resist a raft of other things. We mentioned it before. We mentioned bone, how we can start to rebuild bone with resistance training. But what about the impact to disease and things like that? - It's interesting. Any person studying medicine or general health sciences will look at some of the most common diseases and the most common risk factors for those diseases. And typically for almost all the chronic diseases, our society faces, things like a lack of physical activity, poor diets, and perhaps other things we put into our bodies such as alcohol, cigarettes, and other drugs, are at the forefront of risk factors for most conditions. So ultimately that sort of tells us that the body requires movements, and if we don't give it that regular movement, and again, a variety of different movement patterns, some high intensity activities, and some just low activities, which is just like walking around, which again is great for the soul and the mind as well, just getting out there in nature and letting all the stresses of modern society disappear for a little while. That is, in essence, what if we look at some of these communities that live regularly to 100, while they're not necessarily going into a gym, you look at the activities they do in their regular lives, they're carrying weighted objects up and down hills, they're digging, they're gardening with tools that we would never use because it's too hard work. All those sort of things, they're preparing their food, that level of physical activity, the fact that their food is basically produced locally, they know what is going into their mouth, they're out in nature, they're not stressed about some of the things that we think are important. Again, that's a supposed to me, what life is about, and because our society is quite different from that sort of more natural, suppose where we've lived, things like gyms allow us to maintain that sort of intensity of exercise, and you're right, we don't need to look like Arnold Schwarzeninger, most of us will never get there regardless of what we do, but doing some regular resistance training can have those really profound changes in our strength and function, that ultimately allows us to do the things that make us get up in the morning and want to live another day. Yeah, unfortunately, like even we've been part of a ton of research that's demonstrated the value, and we know that there's thousands and thousands of resistance training research papers out there that sing the praise of getting people involved in relation to independence, disease prevention, false prevention, and stuff like that, but society's just not set up for it. Like, you know, I do have a few theories, we've got a combination of health literacy, we've got a group of older adults currently who were inactive generations, so now that they are starting to experience arthritic pain or chronic disease markers or caring for a loved one, because, you know, their partner's starting to decline themselves, they are becoming more sedentary. And it's that period of sedentary behavior that sort of starts in their late 60s and then escalates into their 70s, that's having some of the greatest impacts to loss of muscle mass and all these other outcomes that we've talked about. I don't think there is great avenues out there, like I was obviously part of a movement with Southern Cross Care to establish gyms, and there's another group of other aged care providers who have set up sort of, well, they might be 50 plus or 60 plus gyms, but they're very much targeted at people 75 and older who are already in the aged care space. But for the size of that population and for the needs of that population, there's just not enough training availability out there. And on top of that, you've got to think about the actual people who are doing the training. You know, I've been to allied health clinics in aged care providers and they're doing seated, gentle, exercise and people still get sick. They still decline, they still have falls. You know, you said it yourself before, like the more you push yourself, the better you're gonna be. But I think we look at these people and we go, oh dear, I might break you, I might hurt you, but by actually doing that sort of thing, you're actually going to hurt them even more if you don't get them involved. - That's so true, Tim. I suppose the perceptions of what older people can do has always probably been a bit conservative. We've gone through that process and again in research and probably the two most, I suppose, best examples of that, are a host of studies that are now involving people in their 90s, even some in their hundreds in aged care facilities, some of which that we've been involved with Smith the Fiends PhD, where again, these people have profound increases in function. So one of Smith the Fiend studies, with 12 weeks of training, just two days a week and the program was very simple in terms of its equipment, nothing more complicated and expensive than dumbbells from up to two kilograms and a few other small accessories. These individuals went from being unable to get out of their chair doing a sit to stand with their hands on their chest to being able to do about seven of them after 12 weeks of training. So in essence, that sit to stand pattern is exactly like a barbell squat. It's the same movement that athletes do to get stronger faster jump higher. And again, and older person will get those same functional benefits. They can walk faster, they can get out of a chair, they can potentially jump again, which again are just indicators of overall health and function. - Good friend of mine, Joe Boyle, and would be jumping up and down about how this is ageism. Like, you know, if you went to a gym and they treated you like that, would you go to a gym? No, you wouldn't, but there is so much of this going on. I don't know if it's the university system, I don't know if it's the consumer, I don't know if it's health literacy, I think probably all those things are broken in relation to understanding how we can push people to get the best out of them. So it is about breaking down a stereotype. It is about trying to convince the people who are supplying those services that they can make people work harder. Yes, you might need to supervise. Yes, you might need to do exercise tolerance test. Yes, you might need to get a GP's clearance to make sure that person's not gonna have a heart attack on you. But you also need to be pushing them if they're gonna get better. I remember going into a gym a years and years ago and using really expensive equipment and they had the resistance set on zero. Everybody had their resistance set on zero and they were just going through the motion doing 12 repetitions. One of the first things I did when I started with Southern Cross Carers, I went around and I got all the 0.5 Kilo dumbbells and threw them out. Because if you can't lift 0.5 Kilo, you can't lift a liter of milk. You can barely lift your cup of coffee. Yeah, yes, so we need to embrace the evidence we need to get people training at higher levels. Yes, right levels of supervision. I think we need to move away from the set and forget. Give them an exercise program, pat them on the backside, send them on their merry way, you'll be fine. We talked about it before. Like the gains and the changes you're gonna have in the first six weeks need to be supported and need to be fed for you to reach that plateau that you might reach at six months. So we need to move people's mindsets away from there. Oh, they could get hurt. So if we don't do something like more intensive exercise for them, where we're hurting them anyway. Exactly, and that's that concept of progression or progressive overload. So if we think of any other aspect of our life, where we've wanted to get better at something, if you're a school student trying to get better at maths or science, what do you do? You study longer, you put the time and effort into it. If you're trying to get better at playing the guitar or the drums. Again you start some simple sort of chords. they become progressively more challenging. Elite athletes is always trying to do something bigger and better than they've done in previous years. So the body, regardless of what we're trying to learn, requires that repeated effort and some level of progression to take us from our current state to a higher state. And again, for an older person, if they've trained relatively hard for six months, 12 months, 18, 24 months, they might get to a level where they're completely satisfied with, yep, I'm able to do everything I want to do. And then they can continue to train, they can take the foot off the pedal a little bit and maintain that function pretty well. But again, it's going to take some concerted efforts to get to that point potentially. But yeah, that issue of just giving someone a program and they repeat that a couple times a week and are expecting to get better if not changing anything. That doesn't make sense based on everything else that you've tried to improve in your life. It's a day, yep, all very valid points. So one thing I think we should really talk about before we wrap up for today is the role of these people's GPs. If we have a quick opinion, Aitagen, without offending too many general practitioners, then we can maybe think about, but not going this on the head for the day. So my perspective is the GPs does play an essential role. I think we mentioned sort of the university system. I think the GP curriculum doesn't set them up for exercise prescription. So I think, you know, I know a lot of GPs who are very, very adamant about suggesting their older clients should get involved in exercise. But I do think there is scope for actually pointing people in the right direction. And we're not going to talk about the funding pathways, but getting GPs to gain relationship to our health professionals to get people involved in good exercise is a pathway I think needs to happen. And, you know, we know there's a lot of big movement in the frailty space and sarcopenea, which we haven't really dug into. But, and these are all muscle loss, obviously, muscle loss-based diseases or syndromes. So the GP can play both a really early preventative role to point people in the right direction, as well as getting people to the right person, even if they're sick, even if they're old, even if they're aged and have high levels of disease, to get people pointed in the right direction to get started. Completely agree, Tim. And while it's probably beyond today's discussion, GPs can have such a profound role in many older people's health. They're the first part of call that most people go to. You're right, their accreditation requirements are very broad already. There's a host of things every university has to have in terms of accreditation. And at the moment, things like exercise aren't included to much of an extent. But for an interest to GP, just staying on top of some of the evidence where possible, which again, is that resistance training, is that cornerstone for exercise for older people. And being connected in some way with those sort of groups in your community that provide those services that are evidence-based, safe, and sort of socially acceptable to older people. So partly that's a GP's role, but that's also those allied health practitioners in that community to get in contact with their GPs and try to develop those referral pathways. I agree. Now, I've got to try to wrap up these episodes with stats, pointy stats for people. So to wrap up today's episode about muscle. So across our lifespan, we know we're going to lose about 10% of our muscle mass into the last decade. We don't have a parallel loss in muscle strength. We actually have a significantly larger, a 50% loss in muscle strength between when people are 30 and 80 years of age, that also then impacts a loss in muscle power of up to 75%. But if people start training today, if they're a previously untrained individual independent of their age, they can expect an increase in muscle strength by as much as 40% in the first six months. And in muscle mass, by up to 5% greater, would them what they've got now. And if you've been listening today, you'll understand the value of muscle mass. So get involved. Thanks for joining us on Stronger Through the Ages, a podcast that advocates for better strength, balance, and health, no matter how old you are. For more about what we do, have a look at the show notes. You'll find our LinkedIn profiles and some other resources for you. Until next time, thanks for listening.